Transfusion practices among the neurosurgical community of Puerto Rico

Anemia is a common problem in the intensive care unit (ICU); almost 95% of patients admitted to an ICU have a hemoglobin (Hb) level below normal by day 3. (1) Serious effects of anemia include increased risk of cardiac related morbidity and mortality, as well as generalized decrease in oxygen carrying capacity. More than 50% of the patients admitted to the ICUs will receive blood transfusions. (1) Although anemia can easily be corrected with packed red blood cells (PRBC), multicenter, randomized, controlled trials and large, prospective, observational studies have shown that liberal use of blood transfusions to be ineffective and potentially harmful. (1-3)


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Clinical presentation and outcome of patients diagnosed with active pulmonary tuberculosis in a large critical care unit

Tuberculosis can be regarded as a global pandemic with almost 9 million new cases and approximately 2 million deaths each year. (1) An estimated one-third of the population of the world is infected with Mycobacterium tuberculosis, and the resultant disease represents a major public health problem. (2) Endemic infection is a major contributor to the annual death rate across the globe. The high morbidity and mortality of tuberculosis is the source of major medical and social problems, especially in developing countries.
It is ranked as the seventh highest cause of morbidity worldwide, and ranks even higher in emerging nations. (3,4)


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Early goal-directed therapy in the management of severe sepsis/septic shock in an academic emergency department in Malaysia

Sepsis continues to be a major cause of mortality and morbidity throughout the world. The annual incidence of severe sepsis was approximately 3.0 cases per 1,000 of the population. (1) In the United States alone, the incidence of severe sepsis will see an annual increase of 1.5% which may be attributable to an increasing ageing population. (1) Early goal-directed therapy (EGDT) was proposed by Rivers et al in 2001. This protocol advocates aggressive treatment commencing in the emergency department to achieve certain haemodynamic goals. This achieved a 16% absolute risk reduction for in-hospital mortality. (2)


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Therapeutic hypothermia after cardiac arrest in a Philippine tertiary hospital: a retrospective cohort study

A cardiac arrest is one of the most devastating events that can occur to a patient. Many attempts at resuscitation fail, but even with successful resuscitation, many patients die early from cardiac dysfunction, or later from neurologic dysfunction. (1,2) Comprehensive post-resuscitation care therefore aims to address the complex post-cardiac arrest syndrome and allow neurologically intact survival.
Therapeutic hypothermia (TH) was found to decrease mortality and improve neurologic outcome in initially comatose patients who had been resuscitated from cardiac arrest. (3-6) It has been recommended since 2005 by international consensus resuscitation guidelines to prevent or minimize neurologic complications, and has allowed


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Increased serum cystatin C is a predictive factor for renal outcome in non-cardiac critically ill patients

Cystatin C is a 122-amino-acid, 13 kDa protein that is a member of the family of competitive inhibitors of lysosomal cysteine proteinases. (1) Serum cystatin C is a useful tool employed in cardiac disease patients to measure kidney function, (2,3) and it may be a risk factor for cardiac events, including heart failure, coronary artery disease, and diastolic dysfunction, with or without chronic heart disease. (4-11) The estimated glomerular filtration rate (eGFR) of serum creatinine is also an established tool employed in measuring kidney function in cardiac disease patients. (12)
More than 30% of critically ill patients exhibit acute kidney


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Haemodynamic Stability and Vasopressor Use During Low-dose Spinal Anaesthesia in the High Risk Elderly

Surgical repair of traumatic fractured neck of femur (DHS or hemiarthroplasty) in elderly patients is a frequent procedure performed in acute theatres in New Zealand. National data using public theatre coding statistics show that close to 2800 procedures for surgical repair of fractured neck of femur are performed per annum in New Zealand. This number has more than doubled over the past 5 years. International data on fractured neck of femur predict a 3-4 fold increase in the numbers presenting by 2050. (1) These rising trends are related to our aging population. Over the last century in developed countries ...


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Comparison of Apache II, SOFA, and Modified SOFA Scores in Predicting Mortality of Surgical Patients in Intensive Care Unit

Intensive Care Units (ICUs) are equiped with many complex life support devices, which are key to monitoring intensive procedures performed by highly trained medical personels 24 hours a day. It is obvious that ICUs consume considerable operational resources and require very high maintenance cost. However, mortality rates of critically ill surgical patients remain very high regardless of technologically advanced centers. Dr. Hasan Sadikin ICU is the provincial referral ICU for West Java province. Unfortunately, due to financial limitations, as physicians, we face daily with the responsibility to select the best candidate to receive treatments. The patients mortality remains high ...


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