Prashant Nasa - Academia.edu (original) (raw)

Papers by Prashant Nasa

Overdose with calcium channel blockers is uncommon, but is associated with high mortality. The ma... more Overdose with calcium channel blockers is uncommon, but is associated with high mortality. The management includes fluid resuscitation, calcium gluconate, glucagon, vasopressors, and high-dose insulin-euglycemia therapy. We describe a rare case of massive overdose of lercanidipine with shock, refractory to conventional therapies and multi-organ failure. Charcoal hemoperfusion with continuous venovenous hemodiafiltration was then used successfully and the patient showed remarkable recovery.

Critical Care and Resuscitation Journal of the Australasian Academy of Critical Care Medicine, Sep 1, 2011

Candida sake infections are rare, but have been shown to cause severe infections including fungal... more Candida sake infections are rare, but have been shown to cause severe infections including fungal endocarditis, peritonitis and bloodstream infection. As the reported incidence of C. sake candidaemia is very low, there is a dearth of data regarding the associated risk factors, antifungal agent-susceptibility patterns, optimal treatment policies, clinical course and outcomes of patients with such infections. We report a series of seven non-neutropenic intensive care unit patients with C. sake candidaemia. Most of the patients were men (6/7), were over 65 years of age (5/7) and had a history of recent hospitalisation (4/7) and comorbidities (4/7). However, all seven patients had a previous history of antibiotic uptake for more than 5 days and had a central venous catheter in situ at the time of taking specimens for culture. In four patients, infection was azole-resistant. Four patients required vasopressor support, three required mechanical ventilation and two required renal replacement therapy. Three of the seven patients died. This case series emphasises the importance of performing species identification and antifungal susceptibility testing in ICU patients with candidaemia, especially those with advanced age, underlying chronic diseases, indwelling vascular catheters, or a history of previous antibiotics or recent hospitalisations, as these patients may be at an increased risk of developing rare Candida infections like C. sake. Moreover, these rare Candida species may be more frequently resistant to azole antifungal agents, and may be associated with significant mortality.

Middle East Journal of Anaesthesiology, Jun 1, 2009

A chronic hypertensive patient with electrocardiogram (ECG) showing left bundle branch block (LBB... more A chronic hypertensive patient with electrocardiogram (ECG) showing left bundle branch block (LBBB) was given general anesthesia for right modified radical mastectomy. Her ECG reverted to normal sinus rhythm intermittently during peri-operative period. This intermittent rate-dependent LBBB is a rare entity. Though hypertension is one significant co-morbid condition, the risk evalution of LBBB during anesthesia only on an ECG finding, is not justifiable. Rather patient should be investigated further for any cardiac risk.

Minerva Anestesiologica, Nov 18, 2011

The aim of this study was to assess the performance of Acute Physiology and Chronic Health Evalua... more The aim of this study was to assess the performance of Acute Physiology and Chronic Health Evaluation (APACHE) IV, Simplified Acute Physiology Score (SAPS) III, and Mortality Probability Model (MPM) III0 and compare these systems to more widely validated prognosis prediction tools like APACHE II, III, SAPS II, MPM II0 and Sequential Organ Failure Assessment (SOFA) score. The study provided a retrospective analysis of data for all consecutive patients admitted to a medical ICU over a 15-month period. Data related to patient demographics, and that necessary to compute various scores were recorded. Calibration was assessed by calculating Lemeshow-Hosmer goodness-of-fit test. Discrimination was evaluated by calculating the area under curves (AUC). Primary outcome measure was Intensive Care Unit mortality. Mortality predicted by APACHE IV score was closest to that of actual mortality with a SMR of 0.868 followed by that of MPM III0 (0.794) and SAPS III (0.763) scores. APACHE III (χ2=3.674), with P=0.885 had the best calibration followed by APACHE II (χ2=7.959; P=0.438) and SOFA scores (χ2=8.369; P=0.301). All scores had good efficacy and even though there was no significant difference between AUCs of various scores, MPM III0 (0.947) performed the best followed by APACHE IV (0.928) and MPM II0 (0.928). Overall, the newer scoring systems performed better than their older counterparts and were more accurate. Nevertheless, the difference in efficacy was not statistically significant and the choice of scoring system may depend on the ease of use and local preferences.

Indian Journal of Critical Care Medicine, 2015

Hypertriglyceridemia can cause severe diseases such as acute pancreatitis (AP) and coronary arter... more Hypertriglyceridemia can cause severe diseases such as acute pancreatitis (AP) and coronary artery disease. The routine management of hypertriglyceridemia is dietary restriction of fat and lipid-lowering medications to manage the secondary or precipitating causes of hypertriglyceridemia. However, in cases of AP with severe hypertriglyceridemia (SHTG) (triglycerides [TG] >1000 mg/dl) rapid reduction of TG levels to well below 1000 mg/dl can improve outcome and prevent further episodes of pancreatitis. Plasmapheresis is a therapeutic option in such medical emergencies. We discussed 2 cases of severe AP with SHTG where we used early plsmapheresis along with other supportive management.

The Aim of our research was: •To study prevalence of fungal infection (colonization Vs invasive) ... more The Aim of our research was: •To study prevalence of fungal infection (colonization Vs invasive) in ICU population. •To study any relations with mortality days of hospital and ICU stay in patient with/without fungemia. •Efficacy of various anti-fungal and outcomes comparison. •Percentage distribution of infectious Vs non infectious ICU presentations. •Distribution of diseases diagnosis contributing to ICU admissions. •Prevalence of comorbid associations in ICU admissions. •Percentage of patients shifted from other facilities for higher care to Indar Prastha Apollo hospitals. •Percentage of ICU stayed patients transferring to ICU patients. •Percentage distribution of ventilation, renal failure and modality of renal failure. •Correlation of APACHE II score at admission, number of days of hospitalization, comorbid association’s incidence of renal failure and other organ failure. •Trend of APACHE II score on 1st and 7th day of admissions. •Correlation of outcomes with APCHE II. •1st set...

Minerva anestesiologica, 2012

The aim of this study was to assess the performance of Acute Physiology and Chronic Health Evalua... more The aim of this study was to assess the performance of Acute Physiology and Chronic Health Evaluation (APACHE) IV, Simplified Acute Physiology Score (SAPS) III, and Mortality Probability Model (MPM) III0 and compare these systems to more widely validated prognosis prediction tools like APACHE II, III, SAPS II, MPM II0 and Sequential Organ Failure Assessment (SOFA) score. The study provided a retrospective analysis of data for all consecutive patients admitted to a medical ICU over a 15-month period. Data related to patient demographics, and that necessary to compute various scores were recorded. Calibration was assessed by calculating Lemeshow-Hosmer goodness-of-fit test. Discrimination was evaluated by calculating the area under curves (AUC). Primary outcome measure was Intensive Care Unit mortality. Mortality predicted by APACHE IV score was closest to that of actual mortality with a SMR of 0.868 followed by that of MPM III0 (0.794) and SAPS III (0.763) scores. APACHE III (χ2=3.67...

Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine, 2011

Candida sake infections are rare, but have been shown to cause severe infections including fungal... more Candida sake infections are rare, but have been shown to cause severe infections including fungal endocarditis, peritonitis and bloodstream infection. As the reported incidence of C. sake candidaemia is very low, there is a dearth of data regarding the associated risk factors, antifungal agent-susceptibility patterns, optimal treatment policies, clinical course and outcomes of patients with such infections. We report a series of seven non-neutropenic intensive care unit patients with C. sake candidaemia. Most of the patients were men (6/7), were over 65 years of age (5/7) and had a history of recent hospitalisation (4/7) and comorbidities (4/7). However, all seven patients had a previous history of antibiotic uptake for more than 5 days and had a central venous catheter in situ at the time of taking specimens for culture. In four patients, infection was azole-resistant. Four patients required vasopressor support, three required mechanical ventilation and two required renal replaceme...

Middle East journal of anaesthesiology, 2009

A chronic hypertensive patient with electrocardiogram (ECG) showing left bundle branch block (LBB... more A chronic hypertensive patient with electrocardiogram (ECG) showing left bundle branch block (LBBB) was given general anesthesia for right modified radical mastectomy. Her ECG reverted to normal sinus rhythm intermittently during peri-operative period. This intermittent rate-dependent LBBB is a rare entity. Though hypertension is one significant co-morbid condition, the risk evalution of LBBB during anesthesia only on an ECG finding, is not justifiable. Rather patient should be investigated further for any cardiac risk.

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 2014

Overdose with calcium channel blockers is uncommon, but is associated with high mortality. The ma... more Overdose with calcium channel blockers is uncommon, but is associated with high mortality. The management includes fluid resuscitation, calcium gluconate, glucagon, vasopressors, and high-dose insulin-euglycemia therapy. We describe a rare case of massive overdose of lercanidipine with shock, refractory to conventional therapies and multi-organ failure. Charcoal hemoperfusion with continuous venovenous hemodiafiltration was then used successfully and the patient showed remarkable recovery.

Hong Kong Medical Journal, 2014

South Asian Journal of Cancer, 2012

Inability to intubate and/or ventilate either due to distorted neck anatomy or restricted mouth o... more Inability to intubate and/or ventilate either due to distorted neck anatomy or restricted mouth opening is uncommon but potentially hazardous clinical scenario in head and neck cancer patients. Emergency cricothyroidotomy in such patients may provide a means of oxygenating the patient, but in practice has limitations and does not establish a definitive airway. We report 2 cases who had distorted face and neck anatomy in which percutaneous tracheostomy was done as an emergency life-saving procedure when other measures to obtain a definitive airway failed.

World Journal of Critical Care Medicine, 2012

The incidence of severe sepsis and septic shock is increasing in the older population leading to ... more The incidence of severe sepsis and septic shock is increasing in the older population leading to increased admissions to the intensive care units (ICUs). The elderly are predisposed to sepsis due to co-existing co-morbidities, repeated and prolonged hospitalizations, reduced immunity, functional limitations and above all due to the effects of aging itself. A lower threshold and a higher index of suspicion is required to diagnose sepsis in this patient population because the initial clinical picture may be ambiguous, and aging increases the risk of a sudden deterioration in sepsis to severe sepsis and septic shock. Management is largely based on standard international guidelines with a few modifications. Age itself is an independent risk factor for death in patients with severe sepsis, however, many patients respond well to timely and appropriate interventions. The treatment should not be limited or deferred in elderly patients with severe sepsis only on the grounds of physician prejudice, but patient and family preferences should also be taken into account as the outcomes are not dismal. Future investigations in the management of sepsis should not only target good functional recovery but also ensure social independence and quality of life after ICU discharge.

World Journal of Critical Care Medicine, 2012

Intensive care is slowly being recognized as a separate medical specialization. Physicians, calle... more Intensive care is slowly being recognized as a separate medical specialization. Physicians, called intensivists, are being specially trained to manage intensive care units (ICUs) and provide focused, high quality care to critically ill patients. However, these ICUs were traditionally managed by primary physicians who used to admit patients in ICUs under their own care. The presence of specially trained intensivists in these ICUs has started a "turf" war. In spite of the availability of overwhelming evidence that intensivists-based ICUs can provide better patient care leading to improved outcome, there is hesitancy among hospital administrators and other policy makers towards adopting such a model. Major critical care societies and workgroups have recommended intensivists-based ICU models to care for critically ill patients, but even in developed countries, on-site intensivist coverage is lacking in a great majority of hospitals. Lack of funds and unavailability of skilled intensivists are commonly cited as the main reasons for not implementing intensivist-led ICU care in most of the ICUs. To provide optimal, comprehensive and skilled care to this severely ill patient population, it is imperative that a multi-disciplinary team approach must be adopted with intensivists as in-charge. Even though ICU organization and staffing may be determined by hospital policies and other local factors, all efforts must be made to attain the goal of having round-the-clock onsite intensivist coverage to ensure continuity of specialized care for all critically ill patients.

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 2015

A 65-year-old gentleman was referred to our hospital with encephalopathy and renal failure. His m... more A 65-year-old gentleman was referred to our hospital with encephalopathy and renal failure. His medications included lithium for the treatment of bipolar disorder. The clinical examination and the laboratory investigations that followed revealed findings classical of lithium overdose. The patient was successfully managed and discharged from the hospital on Day 9 of admission. Clinicians should be aware of this rather unusual and relatively rare differential cause of acute on chronic renal failure with encephalopathy.

Indian Journal of Critical Care Medicine, 2014

We report a case of a 65-year-old female diagnosed with sever dengue fever. She started showing r... more We report a case of a 65-year-old female diagnosed with sever dengue fever. She started showing recovery from dengue fever with medical management. On day 6 of admission, she had leukocytosis, altered mental sensorium, and hemoptysis. Chest tomography showed air space consolidation with multiple nodules in the left upper and middle lobe sputum and bronchoalveolar lavage cultures were positive for Aspergillus flavus. The patient showed improvement with voriconazole and therapy was continued for 6 weeks.

ICU Protocols, 2012

ABSTRACT

Overdose with calcium channel blockers is uncommon, but is associated with high mortality. The ma... more Overdose with calcium channel blockers is uncommon, but is associated with high mortality. The management includes fluid resuscitation, calcium gluconate, glucagon, vasopressors, and high-dose insulin-euglycemia therapy. We describe a rare case of massive overdose of lercanidipine with shock, refractory to conventional therapies and multi-organ failure. Charcoal hemoperfusion with continuous venovenous hemodiafiltration was then used successfully and the patient showed remarkable recovery.

Critical Care and Resuscitation Journal of the Australasian Academy of Critical Care Medicine, Sep 1, 2011

Candida sake infections are rare, but have been shown to cause severe infections including fungal... more Candida sake infections are rare, but have been shown to cause severe infections including fungal endocarditis, peritonitis and bloodstream infection. As the reported incidence of C. sake candidaemia is very low, there is a dearth of data regarding the associated risk factors, antifungal agent-susceptibility patterns, optimal treatment policies, clinical course and outcomes of patients with such infections. We report a series of seven non-neutropenic intensive care unit patients with C. sake candidaemia. Most of the patients were men (6/7), were over 65 years of age (5/7) and had a history of recent hospitalisation (4/7) and comorbidities (4/7). However, all seven patients had a previous history of antibiotic uptake for more than 5 days and had a central venous catheter in situ at the time of taking specimens for culture. In four patients, infection was azole-resistant. Four patients required vasopressor support, three required mechanical ventilation and two required renal replacement therapy. Three of the seven patients died. This case series emphasises the importance of performing species identification and antifungal susceptibility testing in ICU patients with candidaemia, especially those with advanced age, underlying chronic diseases, indwelling vascular catheters, or a history of previous antibiotics or recent hospitalisations, as these patients may be at an increased risk of developing rare Candida infections like C. sake. Moreover, these rare Candida species may be more frequently resistant to azole antifungal agents, and may be associated with significant mortality.

Middle East Journal of Anaesthesiology, Jun 1, 2009

A chronic hypertensive patient with electrocardiogram (ECG) showing left bundle branch block (LBB... more A chronic hypertensive patient with electrocardiogram (ECG) showing left bundle branch block (LBBB) was given general anesthesia for right modified radical mastectomy. Her ECG reverted to normal sinus rhythm intermittently during peri-operative period. This intermittent rate-dependent LBBB is a rare entity. Though hypertension is one significant co-morbid condition, the risk evalution of LBBB during anesthesia only on an ECG finding, is not justifiable. Rather patient should be investigated further for any cardiac risk.

Minerva Anestesiologica, Nov 18, 2011

The aim of this study was to assess the performance of Acute Physiology and Chronic Health Evalua... more The aim of this study was to assess the performance of Acute Physiology and Chronic Health Evaluation (APACHE) IV, Simplified Acute Physiology Score (SAPS) III, and Mortality Probability Model (MPM) III0 and compare these systems to more widely validated prognosis prediction tools like APACHE II, III, SAPS II, MPM II0 and Sequential Organ Failure Assessment (SOFA) score. The study provided a retrospective analysis of data for all consecutive patients admitted to a medical ICU over a 15-month period. Data related to patient demographics, and that necessary to compute various scores were recorded. Calibration was assessed by calculating Lemeshow-Hosmer goodness-of-fit test. Discrimination was evaluated by calculating the area under curves (AUC). Primary outcome measure was Intensive Care Unit mortality. Mortality predicted by APACHE IV score was closest to that of actual mortality with a SMR of 0.868 followed by that of MPM III0 (0.794) and SAPS III (0.763) scores. APACHE III (χ2=3.674), with P=0.885 had the best calibration followed by APACHE II (χ2=7.959; P=0.438) and SOFA scores (χ2=8.369; P=0.301). All scores had good efficacy and even though there was no significant difference between AUCs of various scores, MPM III0 (0.947) performed the best followed by APACHE IV (0.928) and MPM II0 (0.928). Overall, the newer scoring systems performed better than their older counterparts and were more accurate. Nevertheless, the difference in efficacy was not statistically significant and the choice of scoring system may depend on the ease of use and local preferences.

Indian Journal of Critical Care Medicine, 2015

Hypertriglyceridemia can cause severe diseases such as acute pancreatitis (AP) and coronary arter... more Hypertriglyceridemia can cause severe diseases such as acute pancreatitis (AP) and coronary artery disease. The routine management of hypertriglyceridemia is dietary restriction of fat and lipid-lowering medications to manage the secondary or precipitating causes of hypertriglyceridemia. However, in cases of AP with severe hypertriglyceridemia (SHTG) (triglycerides [TG] >1000 mg/dl) rapid reduction of TG levels to well below 1000 mg/dl can improve outcome and prevent further episodes of pancreatitis. Plasmapheresis is a therapeutic option in such medical emergencies. We discussed 2 cases of severe AP with SHTG where we used early plsmapheresis along with other supportive management.

The Aim of our research was: •To study prevalence of fungal infection (colonization Vs invasive) ... more The Aim of our research was: •To study prevalence of fungal infection (colonization Vs invasive) in ICU population. •To study any relations with mortality days of hospital and ICU stay in patient with/without fungemia. •Efficacy of various anti-fungal and outcomes comparison. •Percentage distribution of infectious Vs non infectious ICU presentations. •Distribution of diseases diagnosis contributing to ICU admissions. •Prevalence of comorbid associations in ICU admissions. •Percentage of patients shifted from other facilities for higher care to Indar Prastha Apollo hospitals. •Percentage of ICU stayed patients transferring to ICU patients. •Percentage distribution of ventilation, renal failure and modality of renal failure. •Correlation of APACHE II score at admission, number of days of hospitalization, comorbid association’s incidence of renal failure and other organ failure. •Trend of APACHE II score on 1st and 7th day of admissions. •Correlation of outcomes with APCHE II. •1st set...

Minerva anestesiologica, 2012

The aim of this study was to assess the performance of Acute Physiology and Chronic Health Evalua... more The aim of this study was to assess the performance of Acute Physiology and Chronic Health Evaluation (APACHE) IV, Simplified Acute Physiology Score (SAPS) III, and Mortality Probability Model (MPM) III0 and compare these systems to more widely validated prognosis prediction tools like APACHE II, III, SAPS II, MPM II0 and Sequential Organ Failure Assessment (SOFA) score. The study provided a retrospective analysis of data for all consecutive patients admitted to a medical ICU over a 15-month period. Data related to patient demographics, and that necessary to compute various scores were recorded. Calibration was assessed by calculating Lemeshow-Hosmer goodness-of-fit test. Discrimination was evaluated by calculating the area under curves (AUC). Primary outcome measure was Intensive Care Unit mortality. Mortality predicted by APACHE IV score was closest to that of actual mortality with a SMR of 0.868 followed by that of MPM III0 (0.794) and SAPS III (0.763) scores. APACHE III (χ2=3.67...

Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine, 2011

Candida sake infections are rare, but have been shown to cause severe infections including fungal... more Candida sake infections are rare, but have been shown to cause severe infections including fungal endocarditis, peritonitis and bloodstream infection. As the reported incidence of C. sake candidaemia is very low, there is a dearth of data regarding the associated risk factors, antifungal agent-susceptibility patterns, optimal treatment policies, clinical course and outcomes of patients with such infections. We report a series of seven non-neutropenic intensive care unit patients with C. sake candidaemia. Most of the patients were men (6/7), were over 65 years of age (5/7) and had a history of recent hospitalisation (4/7) and comorbidities (4/7). However, all seven patients had a previous history of antibiotic uptake for more than 5 days and had a central venous catheter in situ at the time of taking specimens for culture. In four patients, infection was azole-resistant. Four patients required vasopressor support, three required mechanical ventilation and two required renal replaceme...

Middle East journal of anaesthesiology, 2009

A chronic hypertensive patient with electrocardiogram (ECG) showing left bundle branch block (LBB... more A chronic hypertensive patient with electrocardiogram (ECG) showing left bundle branch block (LBBB) was given general anesthesia for right modified radical mastectomy. Her ECG reverted to normal sinus rhythm intermittently during peri-operative period. This intermittent rate-dependent LBBB is a rare entity. Though hypertension is one significant co-morbid condition, the risk evalution of LBBB during anesthesia only on an ECG finding, is not justifiable. Rather patient should be investigated further for any cardiac risk.

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 2014

Overdose with calcium channel blockers is uncommon, but is associated with high mortality. The ma... more Overdose with calcium channel blockers is uncommon, but is associated with high mortality. The management includes fluid resuscitation, calcium gluconate, glucagon, vasopressors, and high-dose insulin-euglycemia therapy. We describe a rare case of massive overdose of lercanidipine with shock, refractory to conventional therapies and multi-organ failure. Charcoal hemoperfusion with continuous venovenous hemodiafiltration was then used successfully and the patient showed remarkable recovery.

Hong Kong Medical Journal, 2014

South Asian Journal of Cancer, 2012

Inability to intubate and/or ventilate either due to distorted neck anatomy or restricted mouth o... more Inability to intubate and/or ventilate either due to distorted neck anatomy or restricted mouth opening is uncommon but potentially hazardous clinical scenario in head and neck cancer patients. Emergency cricothyroidotomy in such patients may provide a means of oxygenating the patient, but in practice has limitations and does not establish a definitive airway. We report 2 cases who had distorted face and neck anatomy in which percutaneous tracheostomy was done as an emergency life-saving procedure when other measures to obtain a definitive airway failed.

World Journal of Critical Care Medicine, 2012

The incidence of severe sepsis and septic shock is increasing in the older population leading to ... more The incidence of severe sepsis and septic shock is increasing in the older population leading to increased admissions to the intensive care units (ICUs). The elderly are predisposed to sepsis due to co-existing co-morbidities, repeated and prolonged hospitalizations, reduced immunity, functional limitations and above all due to the effects of aging itself. A lower threshold and a higher index of suspicion is required to diagnose sepsis in this patient population because the initial clinical picture may be ambiguous, and aging increases the risk of a sudden deterioration in sepsis to severe sepsis and septic shock. Management is largely based on standard international guidelines with a few modifications. Age itself is an independent risk factor for death in patients with severe sepsis, however, many patients respond well to timely and appropriate interventions. The treatment should not be limited or deferred in elderly patients with severe sepsis only on the grounds of physician prejudice, but patient and family preferences should also be taken into account as the outcomes are not dismal. Future investigations in the management of sepsis should not only target good functional recovery but also ensure social independence and quality of life after ICU discharge.

World Journal of Critical Care Medicine, 2012

Intensive care is slowly being recognized as a separate medical specialization. Physicians, calle... more Intensive care is slowly being recognized as a separate medical specialization. Physicians, called intensivists, are being specially trained to manage intensive care units (ICUs) and provide focused, high quality care to critically ill patients. However, these ICUs were traditionally managed by primary physicians who used to admit patients in ICUs under their own care. The presence of specially trained intensivists in these ICUs has started a "turf" war. In spite of the availability of overwhelming evidence that intensivists-based ICUs can provide better patient care leading to improved outcome, there is hesitancy among hospital administrators and other policy makers towards adopting such a model. Major critical care societies and workgroups have recommended intensivists-based ICU models to care for critically ill patients, but even in developed countries, on-site intensivist coverage is lacking in a great majority of hospitals. Lack of funds and unavailability of skilled intensivists are commonly cited as the main reasons for not implementing intensivist-led ICU care in most of the ICUs. To provide optimal, comprehensive and skilled care to this severely ill patient population, it is imperative that a multi-disciplinary team approach must be adopted with intensivists as in-charge. Even though ICU organization and staffing may be determined by hospital policies and other local factors, all efforts must be made to attain the goal of having round-the-clock onsite intensivist coverage to ensure continuity of specialized care for all critically ill patients.

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 2015

A 65-year-old gentleman was referred to our hospital with encephalopathy and renal failure. His m... more A 65-year-old gentleman was referred to our hospital with encephalopathy and renal failure. His medications included lithium for the treatment of bipolar disorder. The clinical examination and the laboratory investigations that followed revealed findings classical of lithium overdose. The patient was successfully managed and discharged from the hospital on Day 9 of admission. Clinicians should be aware of this rather unusual and relatively rare differential cause of acute on chronic renal failure with encephalopathy.

Indian Journal of Critical Care Medicine, 2014

We report a case of a 65-year-old female diagnosed with sever dengue fever. She started showing r... more We report a case of a 65-year-old female diagnosed with sever dengue fever. She started showing recovery from dengue fever with medical management. On day 6 of admission, she had leukocytosis, altered mental sensorium, and hemoptysis. Chest tomography showed air space consolidation with multiple nodules in the left upper and middle lobe sputum and bronchoalveolar lavage cultures were positive for Aspergillus flavus. The patient showed improvement with voriconazole and therapy was continued for 6 weeks.

ICU Protocols, 2012

ABSTRACT