Levamisole tainted cocaine induced vasculitis

Abstract

Levamisole has been implicated in the vasculitis and aganulocytosis. It has been pulled from the United States market for human use. Due to its euphoric and bulking properties, it has been used as a bulking agent in cocaine.
We hereby present a case of a 56-year-old Hispanic male, who developed vasculitis due to cocaine use adulterated with levamisole.


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Peripherally-inserted central catheters: Watch for retained wires!

An increasing number of patients are being admitted to critical care units with multiple chronic medical conditions. In some of these patients, intravenous access is a challenge. With a concern for indwelling catheter infections, peripherally inserted central catheters (PICC). These lines have been advocated due to their lower rate of complications and comfort to the patients. PICC are routinely inserted by physicians and trained nurses. Complications such as pneumothorax and infections are lower than in central venous lines and the incidence of retained guide wire is minimal and in some cases unrecognized.
We recently had one such case. An elderly man with sepsis required a PICC placement. A trained nurse attempted to place it when she recognized that the guidewire was missing, as the vessel dilator was being used. A chest radiograph confirmed that the guidewire remained in the patient’s chest cavity. Interventional radiology successfully retrieved the missing wire. Vigilance and frequent refresher courses are required to evaluate the competency among health care workers placing these catheters to help avoid complications.


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Prognostic value of serum cholinesterase activity in the septic shock due to bacterial infections

Abstract
Context: Kinetics of SChE activity analyses, in our knowledge, was not previously studied in the prediction of prognosis of patients with septic shock.
Objective: We aimed to analyse kinetics of SChE activity in 4 patients with septic shock.
Materials and methods: Prospective study.
Results: The kinetics analyses of SChE activity showed that SChE activity was correlated with the prognosis (decrease in deads and increase in survivors).
Discussion and conclusion: The kinetics of SChE activity can be used as a biomarker to
predict the prognosis of patients with septic shock.


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The association between delta shock index and mortality in children with shock

Abstract
Background: Shock remains one leading cause of morbidity and mortality in hospitalized children. Delta shock index is a simple tool to assess and evaluate shock.
Objective: To investigate whether delta shock index might be related to mortality in children with shock.
Methods: Prospective cohort study.
Setting: Emergency Room (ER) and Pediatric Intensive Care Unit (PICU) of Sanglah University Hospital, Bali from March 2015 to March 2016.
Patients and participants: Children aged 1- month to 12-year-old that were diagnosed with shock during admission or during hospitalization. Subjects were divided into delta shock index (DSI)≤0 group and DSI>0.
Results: From March 2015 to March 2016 a total of 80 subjects were recruited. There were 40 cases with DSI≤0 and 40 cases with DSI>0. Mortality was found in 28 (70%) patients with DSI≤0 group. Chi-square analysis showed significant association between DSI and mortality (RR 1.9, 95%CI:1.2-2.9; p=0.004). Survival analysis showed median time survival was 5 days for the group with DSI≤0 and 7 days for the group with DSI>0 (log-rank 0.03). Cox regression analysis showed that DSI≤0 (RR 1.895, 95%CI:0.989-3.623; p=0.037) and age (RR 0.988, 95%CI:0.979-0.997; p=0.015) were risk factors for mortality in children with shock.
Conclusion: DSI≤0 was associated with mortality in children with shock.


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Is my patient really brain dead?

Abstract
The diagnosis of brain death can be fraught with multiple challenges ranging from the presence of complex motor movements to inappropriate patient screening, e.g. patient’s not meeting preconditions.
We describe two cases where complex motor movements persisted following clinical death by standard brain death criteria and caused uncertainty with regards to diagnosis of brain death.
We wish to highlight that complex motor movements are common and do not always preclude the diagnosis of brain death.


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