Search

Objectives: In critically ill patients, acute kidney injury (AKI) and sepsis often coexist. This confounds the assessment of outcomes of both sepsis and AKI in these patients. Hence, in this study, we compare the outcomes of AKI with sepsis, AKI without sepsis, and sepsis without AKI against a control cohort comprising patients with neither AKI nor sepsis. Materials and methods: Prospective observational study conducted in our critical care unit (CCU) between January and July 2009. Data including demographic details, acute physiology and chronic health evaluation (APACHE) III score, presence of AKI, presence of sepsis, intensive care unit (ICU) length of stay (LOS), and outcomes were collected for all patients. Acute Kidney Injury Network (AKIN) criteria were used to define the presence of AKI and American College of Critical Care Medicine 2001 definition was used to define the presence of sepsis. Results: A total of 250 patients were included in the study and 8 patients were excluded from analysis as they were discharged from hospital against medical advice. The remaining 242 patients (mean age 52.8 ± 17 years; 61.6% male; APACHE III score: 48.2 ± 24.1) were analyzed, and AKI was seen in 111 patients (45.8%). Among the patients with AKI, 55.8% (62/111) had sepsis and 44.2% (49/111) had nonseptic AKI. There was a higher need for renal replacement therapy (RRT) among patients with septic AKI in comparison to those with nonseptic AKI (19.3% vs 6.1%; p = 0.04), but no mortality difference was seen between the two groups (25.8% vs 20.4%, p = 0.5). Patients with sepsis and AKI had a significantly higher mortality (25.8%) compared to the patients with sepsis alone (5.6%; p < 0.01). Conclusion: Patients with septic AKI had a higher RRT requirement compared to patients with nonseptic AKI, but no significant differences in mortality were seen between the groups. Occurrence of AKI in septic patients substantially increases their mortality. [ABSTRACT FROM AUTHOR]

Background: Increasing prevalence of diabetes (type 1 and type 2) and obesity along with declining age of onset of type 2 diabetes, often create a diagnostic error in subtyping patients with young onset diabetes. Correct diagnosis of type of diabetes in this age group has clinical implications for management and longterm prognosis. In this study, we aimed to profile all consecutive young onset diabetes patients with respect to their clinical, biochemical, and genetic characteristics. Material and Methods: In this prospective study, conducted at a tertiary facility, all patients with diabetes onset between 18-30 years and diabetes duration less than 5 years were included. Assessment included detailed clinical and biochemical evaluation, autoantibody testing, c-peptide and genetic screening. Results: Total 100 patients were studied, out of which 80% were males and 55% were obese. Mean age of onset and median duration of diabetes were 24.98 ± 3.27 years and 18.0 months respectively. Initial clinical presentation was weight loss and osmotic symptoms in 58%, diabetic ketoacidosis in 5% and 25% patients were incidentally diagnosed. 20.8% of clinically autoimmune diabetes patients had negative antibody testing, 35.5% of clinically nonautoimmune diabetes had positive antibody testing. Overall, evidence of autoimmunity and decreased insulin secretion were found in 45% and 45% patients respectively. Ultrasound abdomen revealed small/atrophic pancreas in 9% of patients out of which nearly half did not had history of pancreatitis. Three patients were detected as MODY (1 = HNF1A and 2 = PAX4 mutations). One patient had Wolfram like syndrome (WFS1 mutation), 30 patients had variants of unknown significance. Conclusion: Evidence of autoimmunity was seen in 45%, monogenic diabetes in 4%, obesity in 55% of the study population. Higher incidence and aggressive nature of diabetes in young individuals are probably due to contributing effect of autoimmunity accompanied by increasing prevalence of obesity. Disclosure: P.K. Reddy: None. G. Jevalikar: None. A.A. Singhal: None. P. Kaur: None. A. Gupta: None. S.K. Mishra: None. J.S. Wasir: None. M.S. Kuchay: Speaker's Bureau; Self; Abbott, Boehringer Ingelheim International GmbH, Novo Nordisk A/S. B. Bansal: None. K. Farooqui: None. H. Kaur: None. A. Mithal: Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Johnson & Johnson, Lilly Diabetes, Novo Nordisk A/S. [ABSTRACT FROM AUTHOR]

Computed tomography with fractional flow reserve (CT-FFR) is increasingly common in assessing coronary artery disease. We report five cases of discrepancies that led to changes in treatment. This report highlights discordant findings between modalities, which should be considered during the diagnostic assessment of chest pain. • CT-FFR is increasingly common in assessing coronary artery disease. • We report 5 cases of discrepancies that led to changes in treatment. • This report highlights discordant findings between physiology modalities. • These should be considered during the diagnostic assessment of chest pain. [ABSTRACT FROM AUTHOR]

The Evolut FX system is the most recent generation of self-expandable transcatheter heart valve (THV) technology. This study aims to report the early experience and outcomes associated with this system. Our analysis included 200 consecutive patients who underwent transcatheter aortic valve replacement at our center from 2022 to 2023. The first cohort comprised the last 100 patients who received the Evolut PRO+ THV, while the second cohort included the first 100 patients who received the Evolut FX THV. The primary endpoints of the study were defined according to the Valve Academic Research Consortium-3 (VARC-3) criteria, which included technical success (at exit from procedure), device success (at discharge or at 30 days), and early safety (at 30 days). The study groups demonstrated no significant differences in baseline characteristics, including co-morbidities, pre-procedural imaging, and echocardiography. VARC-3 technical success rate was 99 % for both valves. The VARC-3 device success rate for the Evolut FX was 92 % compared to 97 % for the Evolut PRO+ (p = 0.12), and VARC-3 early safety rate was 80.1 % for the Evolut PRO+ vs. 81.5 % for the Evolut FX (p = 0.82). The in-hospital permanent pacemaker implantation rate for the Evolut FX was 12 % compared to 9 % for the Evolut PRO+ (p = 0.21). There were no differences in clinical outcomes, such as mortality or stroke, between the two groups. The Evolut FX THV performed well when used for patients with severe aortic stenosis, demonstrating high success with low complication rates when compared to an earlier generation of self-expanding THV. • The Evolut FX system is among the newest generation of self-expandable THVs. • We compared clinical outcomes of patients receiving Evolut FX vs. Evolut PRO+. • Evolut FX showed excellent VARC-3 clinical outcomes vs. Evolut PRO+. • FX showed similarly low complication rates but longer procedure times vs. PRO+. [ABSTRACT FROM AUTHOR]

With more than 23 million infections and more than 814,000 deaths worldwide, the coronavirus disease-2019 (COVID-19) pandemic is still far from over. Several classes of drugs including antivirals, antiretrovirals, anti-inflammatory, immunomodulatory, and antibiotics have been tried with varying levels of success. Still, there is lack of any specific therapy to deal with this infection. Although less than 30% of these patients require intensive care unit admission, morbidity and mortality in this subgroup of patients remain high. Hence, it becomes imperative to have general principles to guide intensivists managing these patients. However, as the literature emerges, these recommendations may change and hence, frequent updates may be required. [ABSTRACT FROM AUTHOR]

In a resource-limited country like India, rationing of scarce critical care resources might be required to ensure appropriate delivery of care to the critically ill patients suffering from COVID-19 infection. Most of these patients require critical care support because of respiratory failure or presence of multiorgan dysfunction syndrome. As there is no pharmacological therapy available, respiratory support in the form of supplemental oxygen, noninvasive ventilation, and invasive mechanical ventilation remains mainstay of care in intensive care units. As there is still dearth of direct evidence, most of the data are extrapolated from the experience gained from the management of general critical care patients. [ABSTRACT FROM AUTHOR]