Cachexia and muscle wasting is a frequent but partly reversible complication in patients with chronic obstructive pulmonary disease (COPD), and affects the disease progression and prognosis. Weight loss in COPD is a consequence of increased energy requirements unbalanced by dietary intake. Nutritional supplement therapy has been shown to be effective for maintaining and improving the muscle strength and exercise tolerance in poorly nourished COPD patients, thereby decreasing morbidity and mortality. This mini review discusses the role of nutritional supplement therapy in the treatment of COPD.
The world is facing a number of emerging infections. The latest outbreak of Zika virus infection has only added to the suffering. The WHO declared a state of emergency in the affected countries and has issued alarms worldwide. The paucity of literature leading to lack of clear guidelines is one of the most important factors resulting in a higher number of cases. The absence of clinical vaccine and an antiviral drug may prove to be a really grave situation. The present paper throws some light on this new emerging virus that has been known to man since 1947.
The waterpipe tobacco smoking is an ancient form of smoking that is present in the society since centuries. The majority of consumers of this exotic activity are still unaware of the serious consequences that this type of smoking has on the health of the smoker. The paucity of data related to the prevalence and extent of this habit in the society is still not available. In this present short review, the authors try to highlight this serious health issue and suggest preventive measures.
Acute respiratory distress syndrome (ARDS) is a life threatening condition characterized by severe hypoxemia due to pulmonary gas exchange failure and was first recognized in 1960s.Since its first description, it has undergone intensive research in the past few decades to understand its pathogenesis and therapies. Despite this, the recommended therapies to decrease mortality in ARDS remain limited and include low-tidal volume mechanical ventilation, prone ventilation and recently, the ECMO rescue therapy in extreme cases. This review article will summarize the key features of ARDS with a brief overview of the therapeutic options in the management of ARDS.
Survival of critically unwell patients has improved in the last decade due to advances in critical care medicine. Some of these survivors develop cognitive, psychiatric and /or physical disability after treatment in intensive care unit (ICU), which is now recognized as post intensive care syndrome (PICS). Given the limited awareness about PICS in the medical faculty this aspect is often overlooked which may lead to reduced quality of life and cause a lot of suffering of these patients and their families. Efforts should be directed towards preventing PICS by minimizing sedation and early mobilization during ICU.All critical care survivors should be evaluated for PICS and those having signs and symptoms of it should be managed by a multidisciplinary team which includes critical care physician, neuro-psychiatrist, physiotherapist and respiratory therapist, with the use of pharmacological and non-apharmacological interventions. This can be achieved through an organizational change and improvement, knowing the high rate of incidence of PICS and its adverse effects on the survivor’s life and daily activities and its effect on the survivor’s family.
A rare complication associated with the Hodgkin’s lymphoma is the occurrence of persistent or recurrent hypoglycemia. Although few cases have been reported in the literature, describing its pathophysiology to be multifactorial, it is difficult to determine the exact cause. We present the case of a 26 year old patient diagnosed with Hodgkin’s lymphoma who developed recurrent episodes of hypoglycemia and also discuss the various causes for its pathogenesis. In this case the serum insulin and C-peptide levels were found to be low, suggesting the presence of insulin like growth factors (IGF) secreted by the cancer cells. Also, we performed a18F-2-fluoro-2-deoxy-d-glucose positron emission tomography that showed a massive tumor load. The published reports in literature have similary suggested the presence of IGF or auto-antibodies secreted by the tumor cells and also the Warburg effect in patients with high tumor load. Further research is required to clearly diagnose and define the exact etiopathogenesis of the hypoglycemia occurring in a patient with Hodgkin’s lymphoma.
Anemia in patients admitted to an intensive care unit is common and affects almost all critically ill patients. The intensivist is faced with the challenge of treating multifactorial etiologies, mainly bleeding and blood loss due to phlebotomy and decreased erythropoiesis. Red cell transfusion, the most common treatment for anemia, comes with associated risks, which may further reduce the chance of survival of these patients. The best evidence suggests the practice of restrictive RBC transfusion (transfusion at Hb<7 g/dl).
In this article, the etiopathogenesis of the anemia in critically ill is reviewed, and current opinion on the pros and cons of various management strategies are discussed with emphasize on restrictive transfusion policy.
Extracorporeal Membrane Oxygenation (ECMO) is now a recognized revolutionary technology, which has emerged as a life-saving therapeutic option for patients with potentially reversible severe respiratory failure who fail to respond positively with the conventional ventilation therapy. Severe acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality, and ECMO has been proven to increase the survival rates in these patients by improving the gas exchange and thus preventing the further hypoxia and catecholamine induced multi-organ damage. The authors present a case of H1N1 influenza related severe ARDS who was successfully rescued by the early use of ECMO. The authors recommend the early use of ECMO to be incorporated in the management of severe refractory ARDS caused due to a potentially reversible cause.