Journal of Critical Care & Emergency Medicine
Journal of Critical Care & Emergency Medicine is an open access peer-reviewed journal from the publishers of Scientific Research and Community (SRC) which publishes articles in the form of written, video and power-point presentations from the arena of Critical Care & Emergency Medicine. The journal focuses to build up accessing the complete content of articles freely from online for reader’s perusal. Article acceptance will be in the form of Research, Review, Case Reports, Analysis, Magazines, Editorials, Opinion, Communications, Mini-Review, Short Communications, Picturized, Book Review, Video Type and Power Point Presentations (PPTs). You can submit your articles through online https://www.onlinescientificresearch.com/submit-online (or) can send through an e-mail with attachment for: emergencymedicine@onlinescientificresearch.info
When Time is of the Essence: Comparing Infusion Rates by Gravity, “Push-Pull” Technique and Pressure Bag Delivery
Background: Rapid infusion is a fundamental component of resuscitation in trauma, conditions such as shock, perioperative bleeding and sepsis. The ability to deliver fluids and blood products swiftly and safely often determines the outcome of critical cases. Rapid fluid administration will help to restore volume, augment cardiac output and reverse shock. It represents one of the early interventions that can help reduce mortality and morbidity. In most emergency situations, peripheral intravenous (IV) access provides the fastest and most practical route for initial resuscitation when central access or automated rapid infusers are not yet available. However, infusion rate through a peripheral line is affected by multiple mechanical and physical factors, such as bag height, tubing length, cannula gauge, external pressure, and fluid viscosity. Objective: To compare the flow rates via three peripheral infusion techniques gravity flow, pressure-bag assistance, and push–pull syringe method, using both normal saline and simulated blood at two pole heights (1.85 m and 1.50 m). Methods: Thirty-six bench-simulation trials were conducted in a controlled laboratory using an 18-gauge cannula, standard transfusion tubing, and a mannequin arm. Each combination of method, pole height, and fluid type was tested in triplicate (250 mL per run). Mean infusion times (seconds) and flow rates (mL/min) were recorded. Results: Pressure-bag infusion produced the highest flow rate (118 ± 27 mL/min), significantly outperforming gravity (36 ± 7 mL/min) and push–pull syringe techniques (31 ± 2 mL/min) (p < 0.001). Raising the pole from 1.50 m to 1.85 m increased flow by 14–25%, depending on method. Saline infused faster than simulated blood (mean +23 mL/min, p < 0.05). The fastest combination was Pressure Bag + High Pole + Saline (139.7 mL/min), and the slowest was Gravity + Low Pole + Blood (26.7 mL/min). Conclusion: External pressure and greater hydrostatic height substantially enhance infusion speed. Pressure-bag assistance offers a simple, effective solution when rapid infusion is required, particularly in emergency or low-resource settings.
Copyright (c) 2025 Journal of Critical Care & Emergency Medicine
Evaluation of Brain-Derived Neurotrophic Factor Nano Therapies to Treat Alzheimer’s Diseases
Alzheimer’s disease is a neurodegenerative disorder affecting millions across the world. It is caused by the progressive build-up of Amyloid-β plaques and tau tangles resulting in inflammation in neurons, followed by apoptosis. This paper aims to synthesize the findings of various researchers on Alzheimer’s Diseases to shed light on a treatment using molecules that promote the survival and proliferation of neurons - neurotrophic factors. Each family of neurotrophic factors has different functions and after evaluating each one, brain-derived neurotrophic factor (BDNF) was shown to have the most potential in treating Alzheimer’s disease. Nano therapy was considered as a carrier for BDNF to cross the blood-brain barrier. PolyPGLA was found to be the most effective nanocarrier for BDNF
Copyright (c) 2023 Journal of Critical Care & Emergency Medicine
Rare Diseases and the Unseen Burden: A Patient-Centered Perspective
Background: Rare diseases affect millions worldwide and pose substantial challenges to patients, healthcare providers, and researchers. Definitions of rarity vary geographically, complicating coordinated global responses. Patients often face prolonged diagnostic delays, limited treatment options, and significant social barriers. Main Body: This perspective explores the multi-dimensional burden faced by rare disease patients, highlighting key issues such as diagnostic odysseys marked by misdiagnoses and emotional distress. Treatment availability is constrained by high costs and lack of approved therapies, especially in low- and middle-income countries. Clinical trials, central to advancing therapies, remain difficult to access for many due to geographic and logistical barriers. Decentralized Clinical Trials (DCTs) emerge as a promising innovation, leveraging telemedicine and remote monitoring to increase inclusivity and trial participation. Beyond medical challenges, patients and caregivers experience social isolation, stigma, and significant psychosocial strain. Addressing these gaps requires coordinated efforts to raise awareness, improve healthcare infrastructure, foster patient-centric and decentralized research models, and implement supportive policies promoting equitable access to care. Conclusion: The rare disease community urgently needs integrated action combining early diagnosis, expanded therapeutic research, inclusive clinical trial designs, and social support mechanisms. Amplifying patient voices and fostering partnerships in research and policy are critical to developing effective, meaningful solutions. This comprehensive approach promises to transform the rare disease landscape, ensuring no patient remains unseen or underserved.
Behavior of Perfusion Variables in Adult Patients Undergoing Cardiac Surgery in the Hospital Cardiovascular Del Niño De Cundinamarca Descriptive Cohort
Introduction: Blood lactate levels during extracorporeal circulation (ECC) have been the method used to monitor the state of microcirculation. New studies recommend the central venous oxygen saturation (SvcO2) and the central venous - arterial difference of CO2 (Cv-aCO2 ) as innovative tools to evaluate such state in this group of patients. Aim: To describe the levels of tissue perfusion biomarkers (SvcO2, Cv-aCO2 and lactate) of adult patients undergoing ECC cardiac surgery, at the Hospital Cardiovascular del Niño, from April 1 to July 31, 2019. Methodology: Historical descriptive cohort study. A review of the medical records of adult patients undergoing cardiac surgery of any etiology under ECC was carried out, evaluating the variables to be studied intraoperatively and postoperatively at 6, 12 and 24 hours in the Intensive Care Unit. Descriptive statistics were used. Results: 54 patients undergoing different types of cardiac surgery with ECC were included. The most frequent one was myocardial revascularization in 24 patients (44,4%). The duration of ECC in 30 cases (55,5%) ranged between 60-120 minutes. During the intraoperative period, a progressive rise in the medians of the Lactate variables was observed, being greater towards the end of the ECC and being reestablished outside the ECC and in the first 24 hours of ICU stay. Conclusions: This study allowed the integration of 3 tissue perfusion variables and findings that are relevant from the clinical perspective for the perioperative management of patients undergoing cardiac surgery in ECC.
Venous-toArterial Carbon Dioxide Difference
Prevalence, Severity, and Persistence of Chemotherapy-Induced Peripheral Neuropathy in Early-Stage Breast Cancer Patients Treated with Paclitaxel: an Observational Study in a Referral Hospital in Latin America
Chemotherapy-induced peripheral neuropathy (CIPN) is one of the main adverse effects of antitumor treatment. The aim of our study was to examine the prevalence and severity of CIPN in breast cancer patients treated with paclitaxel. The association with specific patient-, tumour- and treatment-related variables was also explored. Thus, 45 patients with early-stage breast cancer were evaluated at a referral hospital in Argentina. Patient-reported CIPN-related symptoms were assessed using an abbreviated version of EORTC QLQ-CIPN20 questionnaire. Additional variables analyzed included age, weight, body mass index, tumor phenotype, and chemotherapy regimen. The study population included women aged 25-71 years. Most tumors were ER/PR-positive, and the most frequently used chemotherapy regimen was adjuvant anthracycline-based therapy. The prevalence of clinical CIPN, defined by the presence of at least one symptom experienced ‘quite a bit’ or ‘very much’, was 62%. In contrast, clinical records showed a prevalence of 24%. No significant associations were observed between patient-, tumor- or treatment-related variables and CIPN development. Among patients with neuropathy, mean CIPN score was 26,25. Of these patients, 50% presented both sensory and motor symptoms, 29% only motor and 18% only sensory symptoms. Two years after finishing chemotherapy, 46% of CIPN-patients still experienced at least one symptom. All patients with persistent symptoms had experienced motor disturbances during chemotherapy, with significantly higher motor scores. Our results indicate a high prevalence of CIPN-related symptoms during and after paclitaxel administration in our population. The presence and/or the severity of motor symptoms during chemotherapy could be postulated as possible predictors of CIPN persistence. Clinical underreporting and symptom persistence emphasize the need to incorporate patient-reported measures into clinical practice to better detect symptoms and guide interventions to improve patient’s quality of life.
Chemotherapy-Induced Peripheral Neuropathy
Sympathetic Crashing Acute Pulmonary Edema (SCAPE): A Race Against Time in the Emergency Department
Sympathetic Crashing Acute Pulmonary Edema (SCAPE) represents the extreme end of the heart failure spectrum, characterised by hemodynamic instability and severe respiratory distress. Prompt recognition and intervention are crucial to reducing morbidity and mortality in patients with SCAPE. High-Dose Nitroglycerin (HDN) and Non-Invasive Ventilation (NIV) are pivotal in managing these cases. We present a case of a 56-year-old man who presented to our Emergency Department (ED) with SCAPE. He was successfully managed with HDN at a dosage of 100 µg/min and positive pressure ventilation. This case underscores the importance of early recognition and aggressive intervention in SCAPE, highlighting the effectiveness of HDN and NIV in stabilising hemodynamics and improving outcomes.
Sympathetic Crashing Acute Pulmonary Edema (SCAPE)
Blunt Abdominal Trauma with an open Book Pelvic Fracture and a retrohepatic caval injury in a patient with cirrhosis
A 42-year-old male was involved in a high-speed motor vehicle collision. He was intubated at the scene and transported to a Level 2 trauma center.
Utilization of Immediate Energy Resources in Critical Care, Emphasis on Phosphocreatine
Modern societies heavily rely on sophisticated energy resources, likewise human baseline daily and stress related activity commencing on the molecular and cellular level is essentially dependent on properly functioning energy producing, rebooting and storage conditions. Adenosine triphosphate (ATP) assumes the role of universal energy currency stored in high energy phosphate bounds, with immediate availability for biochemical processes requiring fuel resources. The intrinsic resources for ATP are mitochondria providing synthesis from ADP mediated by ATPase, and ATP is recycled in significant amounts from high ATP containing organs, like muscles. ICU patients are characterized by low ATP reserves. The reasons are conceivably multifactorial, including increased requirements, mitochondrial damage, catabolism and muscle breakdown, leading to impaired availability and increased demand. Phosphocreatine (PCr) provides the high energy substrate to promote regeneration of ATP rendering an immediate energy resource bypassing the largely oxygen dependent oxidative phosphorylation. Currently, phosphocreatine substitution is available therapeutically, offering a transient supportive tool to the organism during conditions when demand is enhanced, production may suffer and endogenous resources of creatine or phosphocreatine are relatively low. Exogenous phosphocreatine supplementation may be beneficial during critical care illness, when energy resource processing and utilization may be dampened by ischemic and inflammatory pathological processes. The significance of supplementary immediate energy substitution is demonstrated on case reports during inflammatory conditions.
Treatment by Ozone and a Parasympathomimetic Drug in Liposome Cream on Knee after Surgery or Trauma
Verify the pain relief by applying a parasympathomimetic drug in liposomes cream distributed supra cute males, in-group of patients suffering from painful knee, after surgery or trauma. This study was carried out in double blind. Material and Methods: From 2022 to 2023, the authors, on double blind method, of which 34 females and 84 males, average age, studied 118 patients 49 years old, suffering from painful knee, after surgery or trauma. by application of a parasympathomimetic drug diluted in liposomes cream, at a dose of 20 mg in 150 ml of cream, for 20 session, after ozone by 10 ml for each treatment. For each patient, the intensity of pain was assessed by the visual analogue scale (VAS) and the assessment of functional impotence with the 5 levels of the semantic scale: A = Absent AA = Almost Absent M =Mild R = Remarkable T = Total Detection occurred at T0’, T10’, T20’, T60’ after each medicated session. Results: Of118 patients, 34 females and 84 males, therefore 85,00% of the total obtained a good pain control with restoration of functional activity (See poster’s graphic).
Dual Burden: Radiologically Confirmed Neurocysticercosis Complicated by Infective Endocarditis in a Young Patient: Case Report
We report the case of a 17-year-old male who presented with progressive headache, fever, vomiting, and neck stiffness. On admission, he was febrile, tachycardic, tachypneic, hypoxic, and severely anemic, with conjunctival hemorrhages and new cardiac murmurs. Neurologically, he had reduced consciousness, left-sided weakness, hypertonia, and meningeal signs. Echocardiography revealed large vegetations on the aortic and mitral valves with moderate regurgitations and pulmonary hypertension, confirming native-valve infective endocarditis. Neuroimaging demonstrated a left parietal mass extending from the choroid plexus with multiple subarachnoid and scalp cystic lesions, consistent with racemose neurocysticercosis, complicated by severe vasogenic edema, obstructive hydrocephalus, subfalcine herniation, and intraparenchymal hemorrhages. The patient underwent burr-hole decompression (yielding mainly blood) and was treated with albendazole, praziquantel, corticosteroids, and antiepileptics for neurocysticercosis, alongside intravenous vancomycin and ceftriaxone for six weeks for infective endocarditis. This case highlights the rare coexistence of infective endocarditis and racemose neurocysticercosis with intracerebral hemorrhage, underscoring the importance of multidisciplinary care in managing overlapping infectious and neurological pathologies.
Comparison of Hematological Indices in Patients before and After Coronary Artery Bypass Grafting (CABG)
Subject: Clinically, a reduction in hematocrit (Hct) or hemoglobin (Hb) levels is a notable condition commonly observed in patients undergoing coronary artery bypass grafting (CABG). Postoperative anemia is a risk factor for mortality in patients undergoing CABG, affecting both the early and late stages of recovery. However, the underlying mechanisms remain incompletely elucidated. We aimed to investigate the relation between the hematologic indices with two surgery methods (on-pump & off-pump). Methods: Fifty consecutive CABG cases were randomly assigned to group I (On-pump, n= 24) and group II (Off-pump, n = 26). General clinical and surgery parameters, hematologic incidence were measured in two blood samples, the first sample was taken from each patient on the morning of the day of surgery after 12-hr fasting, and the second sample on the first postoperative day at 24-hr after surgery. Statistically assessing serum levels pre- and post-CABG and comparing between the two groups was analyzed and the correlation between parameters was evaluated. Result: In the baseline, there were significant differences between the on-pump and off-pump groups regarding heart rate (HR) (p = 0.002). Investigation after surgery showed that the difference in HR and urea levels in pre- and post-CABG was significant when compared between the two groups. A significant difference was observed in the white blood cell, it became less after the operation. The decrease in platelet and PT level in patients who underwent the on-pump and off-pump surgery (diff = -23.5 and diff = -0.62, respectively) was shown and this difference remained significant between the two groups. Conclusion: We achieve the on-pump method places greater stress on blood cells, resulting in reduced levels of white blood cell in patient outcomes. It can be suggested that it should be adjusted for patients undergoing both on-pump and off-pump surgeries.
Using the ERAS Concept as an Evolution of the Fast Track Surgery Program for Safe Elective Surgical Treatment of Primary Progressive Chronic Vein Disease During Pregnancy
Objective: To date, therapeutic tactics for primary symptomatic chronic disease of sphere and/or non-sphere veins during pregnancy remain the subject of discussion. There are no generally accepted approaches to the choice of therapy methods, especially indications for planned surgical treatment. Material and Methods: Surgical treatment of 457 pregnant women in the second and third trimesters with primary symptomatic chronic disease of saphenous (large and / or small saphenous veins) of clinical class C2-4s, Er, As, p, Rg (according to the classification of the basis of CEAP, 2002) and / or non-saphene veins (varicose veins of the inguinal canal, and/or vulva, and perineum) was carried out in a planned manner according to the ERAS program. The most important thing in this program is a multidisciplinary approach to the observation of pregnant women, hospitalization of them in a specialized obstetric hospital on the day of surgery, the use of perinatal psychotherapy to prepare the pregnant woman and fetus for surgery, performed by a vascular surgeon - the so-called “obstetric vascular surgeon”. Results: As a result of the study, all operated patients noted that the use of the ideology of the ERAS program for planned surgical treatment of pregnant women with primary symptomatic chronic disease of saphene and/or non-saphene veins required the implementation of general and adaptation of some of its components to this contingent of patients, scrupulous adherence to them at all stages (before, during and after) of surgery. These factors contributed to the achievement of clinical effectiveness planned surgical treatment 97% in the absolute absence of complications from the fetus and mother in all operated patients, protected against premature birth, caused a decrease in the number and severity of postoperative complications from postoperative wounds, which did not require additional treatment, did not affect the development of the fetus, the course of pregnancy. Conclusion: This ensured the safety of childbirth and the postpartum period, formed comfortable conditions for the course of pregnancy in the postoperative period with a reduction in the period of stay in the hospital and the patient’s return to a normal lifestyle as soon as possible. All operated patients did not need medical support in the postoperative and postpartum periods, except for the use of elastic knitwear of compression class 2 (stockings or knee-highs) during physical exertion.
NonObstetric Elective Surgical Interventions
The Health and Nutritional Benefits of Fruits and Vegetables to Reduce the Risk of Obesity and High Blood Lipids
Background: Vegetables and fruits are an important part of a healthy diet and help with growth and support body functions and physical, mental, and social well-being at all ages. They can also help prevent all forms of malnutrition, such as undernutrition, micronutrient deficiencies, obesity, and overweight, and reduce the risk of non-communicable diseases. World Health Organization consumption of at least 400 grams of fruits and vegetables per day, or five servings of 80 grams each, and the reasons for the sad fact that most people do not eat enough of them to maintain a healthy life for the sake of obesity treatment and weight reduction. Objectives: The aim of the study was to investigate the effects of increasing fruit and vegetable intake rich in antioxidants and vitamins on people at risk of obesity and high levels of blood fat and to provide education about its benefits and the amount of daily rations. Methods: This a descriptive cross-sectional study, 160 obese women underwent to Aspetar ospital in Misurata city during The period (October–December 2022) and they were divided into two groups of 80 women per group. The first group was presented with a weight-loss diet devoid of vegetables and fruits. The second group was given a weight-loss diet rich in vegetables, including cucumber, lettuce, tomato, and fruits (kiwi, apple, and orange). For three consecutive months. Results: The findings were a decrease in weight with an average of 8 kg per woman for the first group and 15 kg per woman for the second group, and the average cholesterol and triglycerides were 280 mg/100 dL of blood and 230 mg/100 dL of blood, respectively, for the women of the first group. While it was 150 mg/100 dL blood and 90 mg/100 dL blood for the women of the second group, with some daily light exercise for all women in the two groups. Conclusion: This study indicates that consumption of three to five portions/day of fruit and vegetables is highly associated with prevention and a low risk of obesity, high blood fat, cholesterol, and cardiovascular disease. Therefore, we recommend relying on eating vegetables and fruits daily to reduce weight and blood fats, improve health, and nourish the body.
Approach to Thrombocytopenia in Critical Care
Thrombocytopenia is one of the most frequently encountered haematological abnormalities in critically ill patients, with reported incidence ranging from 13–65% [1]. It is defined as a platelet count <150,000/µL or a decline of >50% from baseline. The condition may develop due to multiple, often overlapping mechanisms, and its presence in ICU patients correlates with increased morbidity, mortality, and prolonged ICU stay.
Using Ultrasound Cyclo-Plasty as A Preventive Glaucoma Treatment for Eyes Undergoing Boston Keratoprosthesis Type I Implantation
Purpose: To study the benefit of performing Ultrasound Cyclo-Plasty (UCP) using High-Intensity Focused Ultrasound (HIFU) as a glaucoma treatment in eyes undergoing Boston kerato-prosthesis type I and to evaluate the control of intraocular pressure and glaucoma progression postoperatively. Methods: This is a retrospective study review of cases that underwent Boston Kerato-prosthesis type 1 implantation with UCP treatment at the same time in Ocular Hypertension (OHT), glaucoma suspects or glaucoma patients. Results: Fourteen patients (14) underwent a BKpro implant combined with UCP procedure. Mean age 53,2 ± 20 years (range 26 to 81 years). 10 males and 4 females, 5 right eyes and 9 left eyes. The average duration of follow-up was 36 months (range 6 to 70 months). Mean IOP was reduced from 21.7 ± 6.6 mm Hg to 15.86 ±4.02 which was sustained in longer follow up periods 15.1 ± 4.3. at the last visit, corresponding to a mean IOP reduction of 23%. Only two patients required further glaucoma surgical intervention. Vision improved to better than 20/80 in five patients, better than 20/200 in two and four remained unchanged in the 20/200-20/400 vision group and two patients had worsening of vision. Conclusions: For a mean follow-up of 3 years and ranging up to more than 5 years, the glaucoma progression or the conversion from Glaucoma Suspect (OHT) into a Glaucoma according to our criteria and definition, was only seen in 1 case (7,14%). The complications cannot be associated with the UCP treatment and might be related to the BKpro + UCP surgery itself. UCP, in combination of BKpro, seems to be a safe procedure to slow down the progression of glaucoma in cases undergoing BKpro.
High-Intensity Focused Ultrasound Ablation
Asthma is a chronic condition that affects the airways. It causes wheezing and breathing difficulties. There are different types, such as childhood, adult-onset, seasonal, and workplace-related asthma.
Case Report: Understanding Malignant Coronary Artery Anomalies
Background: The right coronary artery (RCA) plays a crucial role in providing innervation to the right ventricle and right atrium, including key nodes involved in heart rhythm regulation. Anomalous origin of the RCA, particularly from the left coronary sinus, termed malignant RCA, is a rare congenital condition. Similarly, abnormalities involving the left circumflex artery (LCX), which supplies blood to the lateral and posterior walls of the left ventricle, can also pose significant clinical risks, particularly in cases where the LCX is anomalously connected or obstructed. Given the rarity of these conditions, we report three cases of hospitalized adults with malignant courses of their coronary arteries (two RCAs and one LCX). Case report Case 1: A 53-year-old male with diabetes presented with severe chest pain persisting for 3 days. Diagnostic tests revealed ST segment elevation in inferior leads on electrocardiogram (ECG) and elevated troponin T levels. Coronary angiography revealed an anomalous RCA origin, along with significant occlusion and stenosis in other coronary arteries, indicating a malignant course. The patient underwent coronary revascularization and was scheduled for coronary artery bypass grafting (CABG). Case 2: A 69-year-old female with multiple comorbidities, including diabetes and hypertension, presented with continuous chest pain. ECG indicated left bundle branch block (LBBB), and troponin T levels were elevated. Imaging confirmed a malignant course of the RCA with calcification atheromatous plaque. Despite diagnosis, the patient declined intervention. Case 3: A 76-year-old male presented with chest pain following a road traffic accident where he sustained impact to his chest. Initial tests showed an abnormal ECG and elevated troponin, prompting further investigation. Imaging revealed a sternal fracture and pericardial fluid but no major cardiac events. A coronary CT scan uncovered several significant coronary artery abnormalities, including a calcified obtuse marginal artery, a hypoplastic aberrant left anterior descending artery, and an abnormal left circumflex artery. Conclusion: These cases highlight the clinical challenges posed by anomalous coronary arteries and underscore the importance of timely diagnosis and management. Treatment strategies should be tailored considering individual patient factors and preferences, with a focus on optimizing outcomes and improving quality of life.
Rectal Artery Embolization for Acute Uncontrollable Rectal Bleeding: Case Series and Systematic Literature Review
Purpose: The article aims to evaluate the possibilities of transcatheter arterial embolization (TAE) as a method of hemostasis in inoperable, life-threatening rectal cancer bleeding by embolizing rectal arteries related to the tumor. Materials and Methods: Using PubMed, Embase, Web of Science, and Cochrane Library, a systematic literature review following the PRISMA 2020 guidelines was performed on October 26, 2023. The search focused exclusively on patients with bleeding rectal cancer controlled by TAE. In addition, in alignment with the PROCESS 2016 guidelines, we describe three patients who underwent transcatheter embolization of the rectal arteries for rectal cancer bleeding from Surgery Department No.2, admitted to the Municipal Saint Trinity Hospital, in Moldova, Chisinau, over the period 2020-2023. Results: Out of 4,958 articles identified, 89 were included for analysis, and only nine were relevant to the topic addressed. In total, 33 cases of rectal cancer bleeding controlled by the rectal artery embolization (RAE) approach were found. Technical success was achieved in 32 out of 33 patients. Technical failure was encountered in one patient due to a practical shortfall in advancing the microcatheter to the source of bleeding. The most frequently embolized artery was the superior rectal artery (in 22 patients). Bleeding control was achieved in 24 patients from the first attempt. Recurrent bleeding was observed in nine patients who successfully responded to repeated RAE. There was no evidence of bowel infarction, and the procedure was well tolerated, in general. Conclusions: The present review and case presentation of patients who underwent endovascular approaches to treat rectal cancer bleeding showed that rectal artery embolization is a safe and feasible procedure, with a high technical success rate.
Ethical and Clinical Challenges in Managing Brain Death During Pregnancy
Introduction: Diagnosis of brain death in a pregnant patient is highly challenging both ethically and clinically when the usual medical criteria for brain death cannot be utilized completely because of pregnancy-related restrictions. The situation is compounded by the requirement to weigh the medical limitations posed by the patient’s critical status. Pregnancy itself can interfere with some diagnostic tests, making it difficult to conclude brain death, this case is reported which aims to discuss the ethical challenges and clinical intricacies in diagnosing brain death when critical diagnostic tests are restrained or limited. Case Report: A 31-year-old pregnant patient at her12 weeks gestation was admitted. We reported her history of headache, vomiting and acute loss of consciousness. Presenting with GCS 3/15 on arrival, unequal, non-reactive pupils on physical examination, she was intubated. Imaging scans revealed a thalamic hematoma on the left side as well as extensive brain edema and signs of herniation of the brain. decompressive craniectomy was carried out to lower intracranial pressure. Due to the patient’s pregnancy, an apnea test was not feaasible, The patient also had a craniectomy which made it impossible to use an EEG to determine brain function. Conclusion: Presented case illustrates ethical and clinical dilemma of establishing a diagnosis of brain death in a pregnant woman when pregnancy-related constraints hamper use of routine tests. Inability to perform critical tests like the apnea test and EEG show complexity of making an irreversibility diagnosis while weighing the risk of harm to both maternal and fetal health.
Approach to Hyperglycemia and Its Crises
Hyperglycemia may be simple due to uncontrolled or newly discovered DM, but may also be due an underlying serious condition like infection, stroke or even MI. Also hyperglycemia may be complemented with hyperglycemic crises, namely Diabetic Keto-Acidosis (DKA) and Hyperglycemic Hyperosmolar State (HHS).
Outcomes of Transcatheter Balloon Valvuloplasty for Mitral Valve
Objective: To evaluate the effectiveness of transcatheter balloon valvuloplasty (TBV) in patients with mitral valve stenosis by assessing post-procedural expansion of the mitral valve area. Materials and Methods: From March 2023 to March 2024, 16 patients diagnosed with mitral valve stenosis were evaluated at the International Cardiology Center. Among them, 15 patients underwent TBV. The study included patients aged 37 to 69 years with no prior history of TBV. The cohort comprised 11 females (68.75%) and 5 males (31.25%). Diabetes mellitus was present in 3 patients (18.75%). Results: TBV was successfully performed in all 15 patients, achieving a 100% procedural success rate. The mitral valve area increased from 1.20 ± 0.4 cm² to 2.90 ± 0.9 cm² post-procedure. Sinus rhythm was restored in 6 of 7 patients undergoing cardioversion. No in-hospital mortality or major complications occurred within the 30-day follow-up period. Conclusion: TBV is an effective minimally invasive alternative to surgical valve replacement, providing significant improvements in hemodynamic parameters and clinical outcomes.
How Effective is ChatGPT as a Guide for Critical Care and Resuscitation During Basic and Advanced Life Support Scenarios?
Cardiac arrest and stroke are critical health emergencies with high mortality rates, making them leading causes of death worldwide. These conditions strike suddenly and require immediate intervention to improve survival outcomes and minimize longterm disabilities [1]. Despite established algorithms from reputable organizations such as the American Heart Association (AHA), the persistently high mortality associated with cardiac arrest and stroke often stems from a lack of prompt action in crucial moments. [2]. AI-based large language models, such as ChatGPT, can be applied effectively in the context of cardiac arrest and stroke emergencies by providing immediate and contextually relevant guidance [3]. Leveraging natural language processing capabilities, this technology can offer dynamic decision support by generating human-like responses based on established algorithms and medical protocols. The study aims to evaluate how ChatGPT can fill this gap and enhance the decision-making process in critical care and resuscitation scenarios.
Percutaneous Closure of Giant PDA with Ducts Occluders in a 4-Years-Old Child with Low Body Weight
Our review of the literature using PubMed identified limited cases of percutaneous closure for PDAs of this size, highlighting the unique nature of this case.
Through the Skies of Hope inside the Extraordinary World of an Indian Aeromedical Intensivist
Even as a young boy in primary school, I was drawn to the sky. Aircraft, flight paths, anything that flew-I was enchanted. For years, I dreamed of becoming a pilot.
Case Report: Intracranial Hemorrhage as Initial Manifestation of Metastatic Trophoblastic Disease
Background: Gestational trophoblastic disease is a heterogeneous group of epithelial tumors that arise in placental trophoblastic tissue following abnormal fertilization and are related to a pregnancy event (miscarriage, extrauterine or term/preterm pregnancy). Choriocarcinoma is the most aggressive histologic type, as it shows early vascular invasion and blood metastases. It can manifest itself through hemorrhages originating in the most frequent metastatic foci of choriocarcinoma, which are usually the lung (80%), vagina (30%), brain and liver (10%). Clinical Case: 22-year-old female patient, who presented to the emergency department secondary to neurological deterioration with initial evaluation Glasgow 3 points, with presentation of Fisher IV subarachnoid hemorrhage, which merited neurosurgical treatment (decompressive craniectomy), with diagnosis of choriocarcinoma, with result of chorionic gonadotropin beta fraction 91114 mIU/ml, uterine choriocarcinoma in posterior wall of uterus, metastasis to lung and splenic and right renal infarction. Conclusion: Choriocarcinoma is a highly aggressive trophoblast pathology, due to its great capacity for angioinvasion, which facilitates its dissemination and favours the development of pulmonary, cerebral, hepatic and other organ metastases. This increases mortality, since diagnosis and treatment is usually not carried out early, or is incomplete.
Coronavirus Disease 2019: Investigating Baseline Characteristics and Clinical Symptoms in COVID 19 Patients
Background: Coronavirus Disease 2019 started in Wuhan, China in December 2019. Since then several studies examined the clinical characteristics of coronavirus disease 2019 (COVID-19) in China.1 But these studies were focused on Chinese people, not those infected in the Kingdom of Saudi Arabia. To our knowledge, there is only one related study conducted in the Middle East, which was conducted in Saudi Arabia by Alsofayan et al [1]. Objectives: The objective of our retrospective study is to analyze the baseline characteristics and clinical symptoms of individuals with COVID 19 and compare differences between those receiving care and those managing symptoms at home of confirmed positive Covid-19 patients presenting to KFSHRC in Riyadh from March to September 2020. Design: Retrospective observational study carried out in the tertiary care institution in Riyadh, Saudi Arabia. Methods: We included the for all the patients who presented to our hospital and were screened positive for Covid-19, on their first hospital encounter, for the study period from March 2020 to September 2020. Electronic medical records were accessed for data collection. Outcome: Discharge status per age group Sample Size: 1176 patients. Results: One thousand one hundred seventy-six (1176) patients were screened positive for Covid-19 for the study period from March 2020 to September 2020. 616 were male (52.4%). 94% were adult (1109). 70 patients (6%) were pediatric (age group 1- 14 yrs.). 912 Saudi nationality (77.6%). One thousand and four (1004) patients had DEM Walk-in screening, 158 outpatient screening, 14 inpatient screening Table 1. The age group > 60 yrs. were the most prevalent group (68%) of the positive Covid 19 who were admitted to the hospital, followed by 46-60 yrs. (45%), 1-14 yrs. (40%), 15-30 yrs. and 31-45 years (25%). Fever and cough were the most dominant signs in both adult and pediatric. 1136 (96.6) Conclusions: Our study provides a comprehensive characterization of clinical features among COVID-19 patients. Fever and cough were the most common clinical signs and symptoms, while muscle pain, short of breathing, and GI symptoms are uncommon. Our study did not find significant differences between Adults and pediatrics in terms of most common laboratory abnormalities (low lymphocytes and high neutrophils). The age group > 60 yrs. were the most prevalent admission group and had the highest mortality rate. Limitations: Our study was done in a tertiary care institution, which is a large transplant and oncology center, therefore cannot be generalized to other non- tertiary centers. Conflict of Interest: None.
Left Ventricular Outflow Tract Obstruction (LVOTO) Causing Syncope in Hypertrophic Cardiomyopathy (HCM): A Case Report
Background: Hypertrophic cardiomyopathy (HCM) is one of the most common inherited cardiovascular diseases. HCM can sometimes result in dynamic obstruction of the left ventricular outflow (LVOT) tract that can subsequently compromise adequate cardiac output. The symptoms of left ventricular outflow tract obstruction (LVOTO) can range from mild symptoms of impaired cardiac output to sudden cardiac death (SCD) in extreme cases. Case Description: A 68-year-old female with comorbidities including obesity, obstructive sleep apnea (OSA), and hyperlipidemia but no prior diagnosis of HCM or known family history of HCM, presented after a witnessed syncope and subsequent head injury, who had an extensive evaluation of the etiology of her syncope. Transthoracic echocardiogram (TTE) revealed presence of HCM with evidence of dynamic LVOTO. The patient underwent a transesophageal echocardiogram (TEE) which showed hypertrophy of LVOT in the septal area causing moderate increase in LVOT mean gradient. The patient was started on medical management with diltiazem that was not tolerated because of bradycardia. The patient had a stable clinical course without any hemodynamic events and was discharged home with outpatient Cardiology follow-up. The patient was also advised to get a referral for a cardiac magnetic resonance (CMR) for further evaluation of HCM and the potential for dynamic LVOTO. Conclusions: HCM can cause dynamic LVOTO that can lead to symptoms including fatigue, chest pain, presyncope, and syncope. Extreme cases of LVOTO can lead to SCD. Medical management is imperative in HCM with symptoms of LVOTO. In extreme cases risk stratification for implantable cardioverter defibrillator (ICD) implantation is indicated to prevent SCD.
Left Ventricular Outflow Tract Obstruction (LVOTO)
Sepsis includes a life-threatening organ dysfunction as a result of a dysregulated host response to an infection [1]. Sepsis can sometimes result in septic cardiomyopathy, a sequela that is associated with increased mortality in sepsis [2,3]. Septic cardiomyopathy implies a temporary and non-ischemic cardiac dysfunction that can happen in septic states. Septic cardiomyopathy is defined as a newly discovered reduction in left ventricular ejection fraction (LVEF) of </= 50% or a 10% reduction in LVEF with known heart failure with reduced ejection fraction (HFrEF) [2]. Septic cardiomyopathy is characterized by rapid onset and it is usually reversible (usually in 7 to 10 days) with no identifiable coronary lesions [4].
What to do from the Emergency Room in Case of Suspected Chemical Submission
A 44-year-old woman comes to the Health Center Disoriented in the Temporal Sphere, stating that “she does not remember what happened.” Her brother, the companion who brings her to the health center, says that he has found her in a place he does not usually frequent. The patient misses a bag she was carrying and cannot locate her mobile phone. The patient and companion suspect that she may have been “drugged” in order to rob them. Given the suspicion that the patient may have been a victim of chemical submission, the Emergency Service is called to inform that the victim is going to be referred.
Diabetic Ketoacidosis and Diabetes Mellitus Caused by Trazodone: A Rare Case Report
We describe a 28-year-old male with a history of schizophrenia who developed diabetic ketoacidosis and diabetes mellitus within 3 months after starting on trazodone to replace aripiprazole, and then the hyperglycemia and hemoglobin A1c level regained normal levels within 3 months after trazodone was stopped. To our knowledge, this is the first ever report on trazodone causing hyperglycemia. We therefore suggest checking blood glucose level before and after prescribing trazodone. Trazodone should be discontinued when hyperglycemia is detected, and alternative medication than trazodone should be considered for patients with diabetic history