As there is no current evidence from any randomized control trails (RCTs) to recommend any specific treatment for suspected or confirmed patients with COVID-19 with acute necrotizing encephalitis.
Our case highlights the importance of identifying encephalitis as a presenting sign of COVID-19 based on NCCT findings with normal cerebrospinal fluid (CSF) and normal chest X-ray (CXR) findings.
Kumar N, Kumar S, Kumar A, Pati BK, Kumar A, Singh C,
Acute Necrotizing Encephalitis as a Probable Association of COVID-19. Indian J Crit Care Med 2020;24(10)991-994.
Kumar N, Kumar S, Kumar A, Pati BK, Kumar A, Singh C, et al. Acute Necrotizing Encephalitis as a Probable Association of COVID-19. Indian J Crit Care Med 2020;24(10)991-994.
Snakebites are one of the commonest occupational hazards in tropical countries and viperine bites are potential to cause systemic toxicity. Coagulopathies and acute kidney injury (AKI) have been documented and easily dealt with in past, but pulmonary hemorrhage has been rarely seen and plasmapheresis has shown promising result for the same. This case reports highlight the effective use of plasmapheresis for pulmonary hemorrhage post-snakebite.
Viperine snakebite has been associated with high morbidity and mortality due to its toxic systemic envenomization. The important systemic manifestations are coagulopathy, neuromuscular paralysis, AKI, myotoxicity, and cardiovascular collapse. Antivenomization, renal replacement therapy, steroids, and other supportive care are considered to be the mainstay of treatment till date. Pulmonary hemorrhage has been an unusual manifestation of viper bite and rarely reported and steroids have been used in such scenario but with mixed results. Role of plasmapheresis has been re Med 2020;24(10)986-990.Doctrine of novus actus interveniens (NAI) sometimes plays an important role as a tool of defense in medical negligence suits. It is a Latin phrase which means breakage of the causal chain at some point, relieving the initial wrongdoer. In medical negligence suits, the appearance of an external factor or event in the causal chain and the outcome is not directly related to the negligence of the doctor, but for the novel agent; the doctrine of NAI can be applied and the initial wrongdoer, i.e., the treating physician can be exempted. Autopsy of a similar type of case was performed in a tertiary care hospital in the State of Chhattisgarh. The autopsy findings identified a new factor in the form of dereliction in duty by another physician causing breakage of the chain in the current case described. How to cite this article Dheeraj AB, Giri SK, Sarma B. Doctrine of Novus Actus Interveniens Not Always a Defense Analysis of a Case. Indian J Crit Care Med 2020;24(10)983-985.The importance of this intubation box has come to light recently in view of the coronavirus disease-2019 (COVID-19) pandemic and the fact that intubation is an aerosol-generating procedure (AGP). Risks of the healthcare worker attending to the airway of COVID-19 patients is high and the intubation box aims to minimize that and reduce contamination of the environment. To address this objective of decreasing transmission during AGP, we created a negative airflow aerosol box with a leak-proof airway handling system using readily available and affordable materials. The dimension of this box was 24 × 17.5 × 17.5 cm and it was made of high-quality 4 mm transparent acrylic sheet with two arm holes of 10 cm diameter. The caudal end of the negative airflow aerosol prevention box is wrapped with disposable plastic sheet and the both hand slots are sealed using camera cover and latex hand gloves and it decreases the risk of contamination. How to cite this article Kumar N, Kumar A, Kumar A, Sinha C. Modified Negative Airflow Aerosol Prevention Box for COVID-19 Patients. Indian J Crit Care Med 2020;24(10)981-982.With increasing knowledge of the coronavirus disease-2019 (COVID-19), we now understand that COVID-19 presents with various extrapulmonary manifestations with multi-organ involvement. Involvement of the central nervous system (CNS) occurs probably via transsynaptic spread or transfer across the blood-brain barrier. Hypoxia, immune-mediated injury, and vascular damage are the potential mechanisms for the CNS manifestations. Headache, dizziness, chemosensory disturbances, such as loss of smell, taste, encephalopathy, stroke, etc., are among the commonly encountered neurological presentations. Headache is identified as one of the red flag symptoms for COVID-19. buy PF-05221304 Sudden onset of loss of smell and/or taste in the absence of nasal congestion can help in COVID-19 case identification and testing prioritization. Both hemorrhagic and ischemic brain injury is common in patients developing stroke. Besides these, COVID-19-associated CNS involvement demands more careful attention toward patients with existing neurological disorders especially that are managed with immunosuppressant agents. In all, neurological involvement in COVID-19 is not uncommon and may precede, occur concomitantly or after the respiratory involvement. It may also be the sole presentation in some of the patients necessitating high vigilance for COVID-19. In this review, we briefly discussed the pathogenesis of CNS involvement and some important neurological manifestations in COVID-19. How to cite this article Zirpe KG, Dixit S, Kulkarni AP, Sapra H, Kakkar G, Gupta R, et al. Pathophysiological Mechanisms and Neurological Manifestations in COVID-19. Indian J Crit Care Med 2020;24(10)975-980.Coronavirus disease-2019 (COVID-19) has heralded a wide set of challenges involving not only the medical management of the patients but also the legal dilemma with regards to provision of healthcare services. The medical professionals have experienced difficulty in balancing their obligations and duties toward the patients, and their own right to safeguard self, family, and their clinical establishments. The professional regulatory bodies and government have formulated new policies and amended laws to control the current situation. It is the need of the hour to be mindful of the existing laws and our rights and duties in the era of current pandemic. Collaborative efforts are needed to provide best possible care in the current unpredictable environment. The commonly encountered problems and their possible solutions are discussed in the context of medicolegal framework applicable to Indian medical practitioner. How to cite this article Kumar A, Kapila M, Pankaj R. Medicine and Law in the Times of COVID-19 Pandemic Understanding the Interphase.buy PF-05221304
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