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We report a patient with a mass in the right atrium which led to pulmonary embolism. Postoperatively the mass was identified as a tuberculoma and it was culture-positive for Mycobacterium tuberculosis. Patient responded to modified antitubercular treatment and discharged from hospital in satisfactory condition. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about the clinical case of a 60-year-old woman who underwent off-pump cardiac surgery following leech therapy.

Sternal osteomyelitis with bacteremia due to Mycobacterium abscessus is rarely seen in immunocompetent hosts. Routine pyogenic cultures in these cases are often negative causing a delay in diagnosis and treatment. Clinicians and microbiologists should rule out the possibility of infection due to nontuberculous mycobacteria while managing cases of nonhealing culture-negative wounds with conventional antibiotic therapy. We report a case of bacteremia secondary to a nonhealing sternal wound due to M. abscessus. A combination of radical debridement and prolonged antimicrobial therapy helped in the complete eradication of the infection. [ABSTRACT FROM AUTHOR]

Importance: Infection is frequent among patients in the intensive care unit (ICU). Contemporary information about the types of infections, causative pathogens, and outcomes can aid the development of policies for prevention, diagnosis, treatment, and resource allocation and may assist in the design of interventional studies.Objective: To provide information about the prevalence and outcomes of infection and the available resources in ICUs worldwide.Design, Setting, and Participants: Observational 24-hour point prevalence study with longitudinal follow-up at 1150 centers in 88 countries. All adult patients (aged ≥18 years) treated at a participating ICU during a 24-hour period commencing at 08:00 on September 13, 2017, were included. The final follow-up date was November 13, 2017.Exposures: Infection diagnosis and receipt of antibiotics.Main Outcomes and Measures: Prevalence of infection and antibiotic exposure (cross-sectional design) and all-cause in-hospital mortality (longitudinal design).Results: Among 15 202 included patients (mean age, 61.1 years [SD, 17.3 years]; 9181 were men [60.4%]), infection data were available for 15 165 (99.8%); 8135 (54%) had suspected or proven infection, including 1760 (22%) with ICU-acquired infection. A total of 10 640 patients (70%) received at least 1 antibiotic. The proportion of patients with suspected or proven infection ranged from 43% (141/328) in Australasia to 60% (1892/3150) in Asia and the Middle East. Among the 8135 patients with suspected or proven infection, 5259 (65%) had at least 1 positive microbiological culture; gram-negative microorganisms were identified in 67% of these patients (n = 3540), gram-positive microorganisms in 37% (n = 1946), and fungal microorganisms in 16% (n = 864). The in-hospital mortality rate was 30% (2404/7936) in patients with suspected or proven infection. In a multilevel analysis, ICU-acquired infection was independently associated with higher risk of mortality compared with community-acquired infection (odds ratio [OR], 1.32 [95% CI, 1.10-1.60]; P = .003). Among antibiotic-resistant microorganisms, infection with vancomycin-resistant Enterococcus (OR, 2.41 [95% CI, 1.43-4.06]; P = .001), Klebsiella resistant to β-lactam antibiotics, including third-generation cephalosporins and carbapenems (OR, 1.29 [95% CI, 1.02-1.63]; P = .03), or carbapenem-resistant Acinetobacter species (OR, 1.40 [95% CI, 1.08-1.81]; P = .01) was independently associated with a higher risk of death vs infection with another microorganism.Conclusions and Relevance: In a worldwide sample of patients admitted to ICUs in September 2017, the prevalence of suspected or proven infection was high, with a substantial risk of in-hospital mortality. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the case study of a 52-year-old male patient who undergo airway management due to his severe respiratory distress.

The article presents a case study 33-year-old woman, who was scheduled for diagnostic hystero-laparoscopy under general anaesthesia (GA). The patient had low arterial oxygen saturation and admitted to the intensive care unit (ICU) for observation. The patient was shifted to the operating room and had inserted with laryngeal mask airway was with desflurane and oxygen/air mixture.

A 25-year-old man presented with a history of breathlessness for the past 2 years. He had a history of operation for Tetralogy of Fallot at the age of 5 years and history suggestive of Rheumatic fever at the age of 7 years. On echocardiographic examination, all his heart valves were severely regurgitating. Morphologically, all the valves were irreparable. The ejection fraction was 35%. He underwent quadruple valve replacement. The aortic and mitral valves were replaced by metallic valve and the tricuspid and pulmonary by tissue valve. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 59-year-old male patient who was presented in the ward due to severe respiratory distress and inability to lie down supine wherein he was diagnosed with fluid overload and chest infection. The patient was administered with antibiotics, fluid restriction, hemodialysis and mechanical ventilation. The patient was intubated with endotracheal tube due to difficulty in breathing.

Background: The Pneumatic CompREssion for Preventing VENous Thromboembolism (PREVENT) trial evaluates the effect of adjunctive intermittent pneumatic compression (IPC) with pharmacologic thromboprophylaxis compared to pharmacologic thromboprophylaxis alone on venous thromboembolism (VTE) in critically ill adults.Methods/design: In this multicenter randomized trial, critically ill patients receiving pharmacologic thromboprophylaxis will be randomized to an IPC or a no IPC (control) group. The primary outcome is "incident" proximal lower-extremity deep vein thrombosis (DVT) within 28 days after randomization. Radiologists interpreting the lower-extremity ultrasonography will be blinded to intervention allocation, whereas the patients and treating team will be unblinded. The trial has 80% power to detect a 3% absolute risk reduction in the rate of proximal DVT from 7% to 4%.Discussion: Consistent with international guidelines, we have developed a detailed plan to guide the analysis of the PREVENT trial. This plan specifies the statistical methods for the evaluation of primary and secondary outcomes, and defines covariates for adjusted analyses a priori. Application of this statistical analysis plan to the PREVENT trial will facilitate unbiased analyses of clinical data.Trial Registration: ClinicalTrials.gov , ID: NCT02040103 . Registered on 3 November 2013; Current controlled trials, ID: ISRCTN44653506 . Registered on 30 October 2013. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Blood transfusion practices in liver transplantation" by Chidananda Swamy, in the September-October 2014 issue.

A letter to the editor is presented regarding a 65-year-old male patient with lower back pain radiating to both lower limbs, in which magnetic resonance imaging (MRI) revealed cord compression on the lower lumbar vertebrae.

A letter to the editor about a case of burn injury caused by monopolar electrical cautery is presented.

A letter to the editor is presented about the monitoring of neuromuscular blockade by pulse oximetry.