https://www.theskygallerypattaya.com/jcicm A Heighpubs Open Access Journal en-us 06/04/2020 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1031.php <h2>Abstract</h2> <p>In this paper we summarise, in chronological order, all COVID-19 preventive measures undertaken by the Macau Special Administrative Region (SAR) government during the first quarter of 2020. The information and narrative contained herein may be of useful to other parts of the world in COVID-19 control and prevention, especially cities with ultra-high population densities. The four main lessons from Macau SAR are: (1) Proactive leadership and early prevention. (2) Strict adherence to community endemic control. (3) Clear prioritising of public health. (4) Planed relief for financial hardships amidst the post-pandemic recession.</p> 05/29/2020 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1030.php <p>Levosimendan is a calcium sensitizer and its inotropic effect is mainly attributed to the troponin C of the myocardial fine filaments with calcium. Levosimendan also inhibits phosphodiesterase III. In contrast to inotropic effects, this does not increase calcium entry into the cell, which explains that levosimendan does not worsen myocardial diastolic dysfunction and may even improve diastolic function. Levosimendan does not increase the use of myocardial oxygen and increases coronary vasodilation and myocardial oxygen delivery. Levosimendan opens potassium channels and causes hyperpolarization in smooth muscle cell membrane, thus causing vasodilatation [1]. Levosimendan has also been reported to have antiinflammatory [2,3] and antiapoptotic  effects [2].</p> 05/19/2020 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1029.php <p>The emergence of COVID-19 worldwide in an unprecedented pandemic. COVID-19 has a significant mortality, mostly from acute lung injury. We reviewed the available literature from China and Europe in regard to the behavior of SARS-Cov2 and ability to adhere to the cell wall [1,2]. The evidence based literature describes three component for the virus to grant entry to the target cells including Cathepsin B/L (the viral cap protein needed for initial connectivity to the cell wall), the angiotensin converting enzyme 2 and a low PH environment to allow the first connectivity of the virus to the cell wall [3]. The goal of our Case study was to prevent SARS- SARS-Cov2 from entering target cells by raising the airways PH using sodium bicarbonate inhalation. The sodium Bicarbonate inhalation (4.2% concentration) has been used safely in Cystic fibrosis (CF) patients with inspissated mucoid impaction [3,4] and in chloride inhalation toxicity by opposing the effect of the low PH induced by the insulting agent [4,5]. It has not been administered for COVID -19 patients particularly prior to this study.</p> 05/12/2020 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1028.php <h2>Abstract</h2> <p>The growth of the urban population exerts considerable pressure on municipalities’ public managers to focus their attention on providing emergency medical care that meets the growing demand for emergency pre-hospital medical care. It is estimated that, by 2050, urban areas should have a population of 6.29 billion people, equivalent to 69% of the world’s total population. Currently, there are a significant number of traffic accidents and other serious occurrences, such as heart attacks, drownings, fires and disasters (floods, landslides, earthquakes) that demand a prompt and seamless response from pre-hospital medical care. In Brazil in the year of 2014 there were 43,075 traffic-related deaths and in 2016 62,517 homicides occurred. As a result of such scenario, the present article endeavours to apply a dual-coverage mathematical model (DSM-Double Standard Model) to define the optimal location of the SAMU decentralized dispatch bases in Natal / RN and conduct a simulation study to evaluate the displacement of ambulances between such bases. The results obtained throughout the research demonstrated the feasibility of redefining the decentralized bases of SAMU/Natal ambulances as a strategy to reduce response time and guarantee compliance with performance parameters established by international organizations (the World Health Organization, for instance, establishes the time of 8 minutes for emergency medical service calls response). The simulation study showed a significant reduction in response time, by up to 60% in some cases.</p> 03/12/2020 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1027.php <h2>Abstract</h2> <p><strong>Background:</strong> Premarital sexual practice significantly attributes for increase adolescent’s risk of unintended pregnancy, early marriage, abortion and STIs. In Ethiopia adolescents were intended to engage at early initiation to sexual intercourse without having proper protection has been one of the concerns. Study aimed to assess the prevalence of premarital sexual practice and associated factors among high school students.</p> <p><strong>Method:</strong> A facilities based study design was employed. Data were collected from 291 randomly selected Negade and Finca Bamo high school students using structured questionnaire from June 1-30, 2018. Bi-variate logistic regression used to identify variables that crudely associated and variables with p - value < = 0.05 fitted to multiple logistic regression. Odds ratio with 95% confidence interval was estimated using multivariable logistic regression to identify independent predictors of premarital sex.</p> <p><strong>Result:</strong> Among high school students, 31.2% reported had experienced premarital sexual practices. This shows that premarital sexual practices among high school adolescent’s students were high. Drinking alcohol [AOR = 4.06, 95%CI, (2.06 - 7.99)]. Watching pornographic video [AOR: 2.78, 95%CI, (1.45 - 5.3)] and educational status of mothers [AOR: 0.33; 95% CI (0.13, -0.84)] were significantly associated factors.</p> <p><strong>Conclusion:</strong> Drinking alcohol, watching pornography and mother education were predominantly significantly associated. Therefore, an integrated effort needs to be highlighted to deter the health behavioral problems of school adolescents at the early stages.</p> 12/12/2019 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1026.php <h2>Abstract</h2> <p>Septic Iliac vein thrombophlebitis with associated psoas abscess is a rare and severe entity, which diagnosis is challenging when no risk factor is clearly present. We are presenting a case of severe septic cavitary pulmonary emboli complicated with Acute Respiratory Distress Syndrome (ARDS) that evolved rapidly to respiratory distress and multi organ failure.<br /> A 61-year-old Hispanic male, had multiple emergency department visits due to back pain, being most of them intramuscular pain medications and steroids. In the history, he had back pain that worsened accompanied by poor mobility, generalized malaise, fever and chills. Computed tomography (CT) scan showed a paravertebral psoas abscess with L5 - S1 diskitis/spondylitis inflammatory changes, which was then later evidenced by a gallium study. Further imaging studies were done, showed bilateral cavitary lung lesions, consistent with septic emboli. Subsequent blood cultures were positive for Methicillin Resistant Staphylococcus Aureus (MRSA), for which a successful combined therapeutic regimen was used. Transthoracic and transesophageal echocardiogram were not suggestive of endocarditis. Staphylococcus aureus (SA) bacteremia is one of the most common serious bacterial infections with a high risk of metastatic complications, which makes this pathogen a unique one. The combination of factors iliac vein thrombophlebitis, psoas muscle abscess, diskitis/spondylitis with ARDS makes cavitary pulmonary disease a challenging perspective. After a 6-week antimicrobial treatment, full anticoagulation, his clinical condition and image findings improved, and he was recently admitted for physical rehabilitation. Major vessels thrombophlebitis should always be considered, when primary source of septic pulmonary emboli is not clear. This case illustrates the complexity of illness and complications that may arise from a source of infection as the one in this patient. Further therapeutic strategies were tailored accordingly.</p> 12/09/2019 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1025.php <h2>Introduction</h2> <p>Brain stem death is when a person has permanently lost the potential for consciousness and the capacity to breathe. When this happens, a machine called a ventilator keeps oxygen circulating through the person’s bloodstream - a person confirmed as being dead when their brain stem function is permanently lost [1].</p> 08/22/2019 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1024.php <h2>Introduction</h2> <p>Stroke following coronary interventions is a devastating and most dreaded complication with signiβicant morbidity and mortality. Various factors have been ascribed for this complication including the technical errors [1]. A small percentage of strokes are iatrogenic, including those associated with invasive cardiac procedures. According to the literature, it is a rare complication of left heart catheterization [2]. Percutaneous coronary intervention is increasingly used to treat patients with diffuse atherosclerosis, acute coronary syndromes and even high-risk patients such as low ejection fraction [1]. The authors describe a patient who underwent percutaneous coronary intervention in the context of inferior infarction, which was complicated by ischemic stroke during cardic catheterization.</p> 07/22/2019 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1023.php <h2>Abstract</h2> <p>Alcohol abuse is a global health problem. Alcohol withdrawal syndrome (AWS) ranges from mild to severe symptoms that can lead to fatal delirium tremens requiring ICU admission and incurring high health care cost as high as $20,000 a month. The latest published reports suggest that phenobarbital is a promising therapeutic option for management of AWS as evidenced by less ICU admissions, length of stay in hospital, use of adjunctive agents, health care costs and attention from the nursing staff than that of patients treated with commonly used benzodiazepines such as lorazepam, diazepam, and chlordiazepoxide. Phenobarbital is beneficial for the treatment of AWS, both in the emergency and inpatient settings and both as monotherapy or in conjunction with benzodiazepines. It is safe for patients without severe hepatic impairment, has a better mechanism of action and longer half-life than benzodiazepines, and leads to less delirium and agitation. Powered randomized controlled trials with large populations are required, yet phenobarbital can be used to safely to treat AWS.</p> 04/19/2019 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1021.php <h2>Letter to the Editor</h2> <p>The question raised in the title of this letter is a natural consequence of the findings and conclusions that have been growing steadily in recent years regarding the results of treatment for acute pneumonia (АР). If you look at the publications of recent years in this field of medicine, it turns out that one of the main obstacles to progress in improving the results of treatment of this disease is the lack of appropriate methods for determining the pathogen. Thus, the lack of timely diagnostic information about the etiology of the disease excludes the possibility of targeted antibiotic therapy. In recent years, such regrets have become more and more relevant, playing the role of the main explanation for treatment failures .Continuing to narrow the unidirectional view of the problem and to pay attention only to the microbial factor as the main cause of the disease, such views are in fact another illusion, which, even in the case of its hypothetical implementation, will not make significant changes in the overall trend. This statement is easy to verify if you rely on well-known facts, and not use as arguments assumptions and guesses.</p> 02/07/2019 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1020.php <h2>Abstract</h2> <p>The article presents the results of x-ray anatomical studies of 56 whole lung preparations, which were carried out immediately after the autopsy of children who died from АP. In 47 cases it was carried out the contrast of the vessels and in 9 cases the bronchial tree. The results allowed to clarify some details of the pathogenesis of АP and were additional arguments in support of the new doctrine of the disease.</p> 02/04/2019 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1019.php <h2>Abstract</h2> <p>Modern AP concepts are focused exclusively on the infectious nature of the disease and the presence of certain pathogens. This belief determines the principles of treatment, the lack of effectiveness of which remains a concern of health professionals. The article presents a fragment of the study devoted to the etiology of АP. 994 children aged 4 months to 14 years with various forms of so-called community-acquired pneumonia were examined and treated. Bacteriological examination of the material from the inflammation zone was carried out in 542 patients. Experiments on modeling АP and its pleural complications were performed on 44 animals. The obtained results and critical analysis of the literature data and scientific facts allow us to consider bacteria only as one of the etiological elements of АP, which is not mandatory in all cases of the disease. Scientifically based revision of existing ideas about the causes and mechanisms of AP development leads to the need for a radical change in the principles of treatment and is a strategic direction in solving the problem.</p> 01/24/2019 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1018.php <h2>Abstract</h2> <p><strong>Background</strong>: Skin diseases is a common worldwide problem. It affected every aspect of patients’ quality of life (QOL) mainly physically, socially and psychologically.</p> <p><strong>Objectives</strong>: to assess the impact of skin disorders on patients’ quality of life and to identify factors associated with it.</p> <p><strong>Methodology</strong>: This cross-sectional study was conducted in outpatient dermatology clinic of a tertiary hospital in Malaysia. A random sample of 145 patients with acne, psoriasis and atopic dermatitis (AD) were interviewed using DLQI questionnaire during their scheduled follow-up appointments at dermatology clinic.</p> <p><strong>Main outcome measure</strong>: Self-reported patients’ QOL due to their skin diseases.</p> <p><strong>Results and discussion</strong>: Out of three skin diseases psoriasis patients had the highest prevalence (39.3%) followed by AD (34.5%) and acne (26.2%). Patients’ QOL was highly influenced by their skin conditions especially on working/schooling domain. Furthermore, several factors were identified, namely age, working environment, concurrent skin diseases, usage of supplement for skin diseases and type of food as aggravating factors—that may influence patients’ QOL. QOL among females and younger adults was found to be more significantly influenced as compared to males and elderly. With respect to working environment, those who had both indoor and outdoor working environment showed the highest impact of their skin conditions on their QOL. Single patients were more influenced by their skin conditions when compared to those who are married, however it was not significant.</p> <p><strong>Conclusion</strong>: Our findings revealed skin disease had negatively impacted individual QOL with different level of aspects. Among the three diseases, AD patients had the worst impact on QOL. Significant predictors of QOL did not relate solely to skin diseases but also other factors such as type of food and working environment.</p> 10/31/2018 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1017.php <h2>Abstract</h2> <p><strong>Introduction</strong>: Hypertensive crisis (HC) is recognized consequence of inadequate blood pressure (BP) control. A hypertensive crisis is further divided into hypertensive emergency (HT-E) and hypertensive urgency (HT-U).</p> <p><strong>Method</strong>: Using a cross-sectional hospital-based study design, patients who had been diagnosed as having HC between January and October 2017 were consecutively recruited in the study. The criteria proposed by the Seventh Joint National Committee were used for the definition of HC.</p> <p><strong>Result</strong>: A total of 81 (.81%) patients newly diagnosed as having HC were enrolled in the study. Of these patients, 50 (61.7 %) patients met criteria for HT-E, while 31 (38.3%) patients had HT-U. Renal impairment (16%), stroke (30.8%), acute coronary syndrome (13.6%) and heart failure (22.2%) were predominant complications associated with HT-E. Out of 81 study subjects, 13 (16%) patients died. Although there was no significant difference in residence, history of smoking, Diabetes mellitus and history of alcohol consumption between groups, old age (P=.o22), male gender(.046), history of hypertension(.007), history of non-governmental employee(.003), poor compliance (p=.002) and high case fatality rate (p=.041) were significantly associated with hypertensive emergency (HT-E).</p> <p><strong>Conclusion</strong>: This study showed that HT-E has high case fatality rate among patients admitted with hypertensive crisis at kassala teaching Hospital. Therefore early detection of hypertension and appropriate management are the main stay for reducing morbidity and mortality among patients with hypertensive crisis.</p> 10/27/2018 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1016.php <h2>Short Communication</h2> <p>The Ontario government has been battling with the issue of extensive wait times in hospitals for several years. Although there are many complex reasons that stem off of the issues of wait times, such as available in patient beds and bed blockers (patients who stay in the hospitals for long periods of time after sustaining a massive injury), the primary cause is concentrated as a system wide problem in access to care [1]. Through numerous reforming and restructuring plans, the Ontario government devised a Wait Time Strategy plan to monitor, manage and improve access to health care services including surgeries and time spent in the ER. The strategy was also devised to enhance the efficiency and effectiveness of healthcare provision. The information derived from the results of the Ontario Wait Time Strategy (OWTS) was to be made public to citizens and providers to ensure that everyone is well aware of the results. Yet, it is quite difficult to implement such a strategy if the leadership challenges within the hospital are not addressed [2].</p> 10/17/2018 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1015.php <h2>Abstract</h2> <p>A 64-year-old woman was referred to our hospital due to progressive dypnoea for the past week, combined with fever and type 1 respiratory failure. White blood cell count and procalcitonin level were normal. The Chest X-ray showed bilateral disseminated pulmonary infiltrates. Within the next 24 hours the patient developed a severe ARDS. A first diagnostic work-up for typical and atypical pathogens as well as serological tests for CMV, RSV, HIV and HSV were negative. Analysis of a second bronchoalveolar lavage fluid revealed Pneumocystis jiroveci DNA. The patient was successfully treated with trimethoprim-sulfamethoxazole and off label use with caspofungin. The cause of the infection was a six week treatment with dexamethasone. The patient developed a toxic epidermal necrolysis during further course, but completely recovered.<br /> <br /> Pneumonia with Pneumocystis jirovecii must also be taken into account in non-HIV patients, whenever there are any indications that cellular immunity may be depressed</p> 10/15/2018 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1014.php <h2>Abstract</h2> <p>There are variations in therapeutic regimens of different liver diseases. The accurate diagnosis ensNusinersen treatment is a novel therapy for spinal muscular atrophy (SMA) type 1; consequently, the adverse reactions of the therapy, have not been well known, yet. The present study is a case report that declares a hyponatremia development after the nursinersen therapy. Since the therapy is quite new one and has limited practice, we hope that this rare complication will contribute to the scientific literature.</p> 09/11/2018 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1013.php <h2>Abstract</h2> <p><strong>Objectives</strong>: There are variations in therapeutic regimens of different liver diseases. The accurate diagnosis ensures prompt recovery from these diseases. The present study aimed to evaluate the underlying causes of unexplained signs and symptoms associated with liver diseases through biopsies.</p> <p><strong>Methods</strong>: A retrospective study was conducted in a public child care specialty of Lahore, Pakistan. The data was collected from medical records of the patients who were index hospitalized with unexplained clinical presentation of liver disease between 1st July, 2017 and 31st December, 2017. Data were analyzed by using Statistical Packages for Social Sciences (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.), and Microsoft Excel (MS Office 2010).</p> <p><strong>Results</strong>: Overall, the records of 53 patients were selected for the study. Most of them were 11 to 15 years of age. The patients were presented with unexplained hepatomegaly (60.4%) and jaundice (40.7%) during index hospitalization which made them eligible for liver biopsy (LB). The findings of LB revealed that the underlying causes of liver diseases in most of the cases were metabolic (33.9%) and inflammatory disorders (22.6%). Majority of the patients were ≤4 years of age, however cryptogenic cirrhosis (39.1%) was commonly found in >10 years of age. Although most of the patients were suffering from metabolic disorders (p-value=0.07) and liver cirrhosis (p-value=0.08) but these were not statistically significant.</p> <p><strong>Conclusions</strong>: LB was beneficial in evaluating the etiologies of unexplained signs and symptoms of liver diseases. It was found that glycogen storage diseases and liver cirrhosis were the most common etiologies of liver diseases among pediatric patients. But etiologies like metabolic and inflammatory diseases were insignificantly associated with gender.</p> 03/16/2018 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1012.php <h2>Introduction</h2> <p>Treatment of various inflammatory processes, including acute pneumonia(АP), over the past decades is identical and does not reflect the specifics of a particular disease. The basis of such treatment is «antibiotics alone». The need for additional therapeutic efforts is realized by the use of General therapeutic techniques, regardless of the diagnosis. This does not take into account the important fact that the localization of inflammation not only determines its clinical picture,but,above all,the mechanisms of influence on other organs and systems of the body.</p> <p>Attempts to cure fundamentally different diseases with the help of one aid package cannot give the expected result even theoretically. The futility of this approach is illustrated by the current dynamics of the results.Reducing the effectiveness of antibiotics and the emergence of new resistant strains of microorganisms forces the constant development of new antimicrobials. However, the success of pharmacists can not stop the continued increase in the number of purulent complications of АP even in developed countries with maximum capacity to provide patients. There is a solution to the existing problem and it lies in another plane.</p> 01/23/2018 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1011.php <h2>Abstract</h2> <p><strong>Background</strong>: Pulmonary fibrosis is a clinical problem with an enigmatic etiology with no effective therapy. Current therapies for lung fibrosis are ineffective for progression of lung fibrosis and preventing respiratory failure.</p> <p><strong>Objectives</strong>: The aim of this study is to explore the expression of Desmin, α-smooth muscle actin (α-SMA) and the telomerase subunit: human telomerase reverse transcriptase (h-TERT) in a spectrum of lung tissue samples consist of lung fibrosis, lung cancer, and healthy controls.</p> <p><strong>Materials and Methods</strong>: The expression of Desmin, α-SMA and hTERT were studied in samples of 15 pulmonary fibrosis samples, 16 samples of lung cancer and 14 healthy controls investigated. We evaluated Desmin, α-SMA as well as the expression of components of telomerase (TERT), by methods: RNA Extraction and cDNA synthesis, Real-Time quantitative PCR, Immunohistochemistry, all prepared from lung tissue paraffin blocked.</p> <p><strong>Results</strong>: α-SMA marker detected 1(8.3%) of healthy control and 11(91.7%) of lung fibrosis samples. The difference between groups was significant (p<0.001). Also the difference between healthy control 1(6.7%) and lung cancer 14 (93.3%) for α-SMA marker was a significant (P<0.001). It was a significant difference between healthy control and lung cancer for TERT expression (P=.005). TERT was not positive in any sample of neither healthy control nor lung fibrosis. For TERT, it was a significant difference between lung fibrosis and lung cancer by Fisher’s Exact Test (P=.004). Expression of TERT and α-SMA between small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) was not statistically significant (P=.700, P=0758), respectively.</p> <p><strong>Conclusions</strong>: We recommend more investigation to regard α-SMA, Desmin in patients with lung fibrosis and follow them for possible cancer risk. Also, more study is needed to regard TERT as a marker in lung cancer. Assessment of these markers may have future implication to explain the same way of pathogenesis and carcinogenesis of fibrosis and cancer and for prevention or treatment</p> 11/02/2017 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1010.php <h2>Abstract</h2> <p>Observing relevant biomedical literature we have see that clinical pharmacist play a crucial role in ICU settings with reducing in mortality rate and improving some clinical outcomes.</p> 09/08/2017 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1009.php <h2>Case Summary</h2> <p>A previously healthy 26-year-old gentleman, referred from a state hospital with history of alleged fall from 10 feet height at a construction site on the same day. Glasgow coma scale (GCS) at that hospital was E2 V2 M5. He was brought in to our Emergency Unit, Hospital Kuala Lumpur with GCS of E1 V2 M4 (7/15). Pupils were 5mm+ /3mm+. He sustained left ear bleed. Otherwise vital signs were stable, with no other extracranial injury. Computed tomography (CT) scan brain (Figure 1) showed right frontotemporal acute subdural hematoma with left frontotemporoparietal acute subdural hematoma, with underlying subarachnoid hemorrhage, mass effect and midline shift to left side more than 0.5cm and obliteration of basal cistern.</p> 09/07/2017 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1008.php <h2>Abstract</h2> <p>We report a case of 79-year-old man who presented to our emergency department (ED) for lipothymia. The patient developed significant bradycardia with hypotension. His EKG objectified a slow atrial fibrillation .the patient rapidly installed a coma. A non-contrast CT brain scan showed a bilateral vertebrobasilar ischemic stroke.</p> 07/11/2017 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1007.php <h2>SUMMARY</h2> <p><strong>Objectives</strong>: The study aims to assess the knowledge, attitude and practices of physicians who deal with pediatric age group SSTIs in reference to the Infectious Diseases Society of America (IDSA) guidelines on this regard that was published in 2014.</p> <p><strong>Background</strong>: Skin and soft tissue infections rank among the most frequent infections worldwide.</p> <p>It is estimated that over 11 million ambulatory healthcare visits occur each year in US for skin and soft tissue infections due to Staphylococcus aureus (S. aureus) alone.</p> <p>SSTIs are clinical entities of variable presentation, etiology and severity that involve microbial invasion of the layers of the skin and underlying soft tissues. SSTIs range from mild infections, such as pyoderma, to serious life-threatening infections, such as necrotizing fasciitis. One of the main challenges in managing SSTIs is to be able to identify those who need immediate inpatient intervention versus the more stable ones that can be manages in outpatient basis. In June of 2014, The Infectious Diseases Society of America (IDSA) released evidence based guidelines that has nicely covered all aspects related to the management of SSTIs.</p> <p><strong>Method</strong>:An anonymous 20-item survey exploring knowledge, attitude and practices associated with diagnosis and management of skin and soft tissue infection was distributed to physicians of different levels of expertise (from residents to consultants) in the departments of Pediatrics, Emergency Medicine and Family Medicine in different governmental facilities in Al-Ain city which is one of the major cities in United Arab Emirates.</p> 06/26/2017 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1006.php <h2>ABSTRACT</h2> <p>This study describes chemotherapy exposure, healthcare utilization, overall survival (OS) and progression-free survival (PFS) among patients diagnosed with chronic lymphoid leukemia (CLL). Newly diagnosed CLL patients who received chemotherapy were selected from the Eindhoven Cancer Registry between 1998-2011, linked on a patient-level to the PHARMO Database Network including data on in- and out-patient drug dispensings, hospitalizations and clinical laboratory measurements. Chemotherapy was classified in regimens of use based on chemotherapy combinations. OS and PFS were determined after diagnosis and after chemotherapy. Healthcare utilization was assessed in the year before diagnosis and in the year after chemotherapy.</p> <p>In total, 125 CLL patients received chemotherapy: 52 patients (42%) started chemotherapy within 6 months and 73 patients (58%) started chemotherapy ≥6 months after diagnosis. Mean (±SD) age was 67(±10) years and 68% was male. About 50% had one treatment line and about 25% two lines of treatment. Chlorambucil was the most common type of first line chemotherapy. Prior diagnosis, 44% were hospitalized for any cause and 94% had at least one drug dispensing. After chemotherapy, this was 43% and 98%, respectively. One-year survival rate after diagnosis was 94%. Median PFS after first treatment line was 17 months for patients starting within 6 months and 27 months for patients starting ≥6 months after diagnosis. In conclusion, most CLL patients receiving chemotherapy were treated with chlorambucil. One-year after initial diagnosis, 94% were still alive. Median PFS after first line chemotherapy ranged from 17 to 27 months, depending on the timing of chemotherapy.</p> 04/19/2017 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1005.php <h2>INTRODUCTION</h2> <p>Chest compression is the fundamental technique in cardiopulmonary resuscitation (CPR) in patients with cardiac arrest [1]. The quality and the early implementation of CPR are essential to improve the prognosis and the chances of restoring spontaneous circulation. In the literature, there are some articles about the poor quality of chest compression [2-4]. Therefore chest compression is as crucial as alerting the emergency services or early defibrillation in the survival chain. In accordance with the guidelines, chest compressions have to be performed continuously to improve the outcome [5]. However, the efficacy of manual chest compression diminishes over time with the fatigue of the provider (which appears within minutes of starting the procedure), and is impaired during transportation manoeuvres, which expose patients to unforeseen interruptions and a deterioration in the quality du massage in terms of power and rhythm. The efficacy of manual chest compression has been reported to fall by 20% per minute [6,7]. Mechanical chest compression overcome this problem of operator fatigue by ensuring constant efficacy in terms of both quality and quantity. Even though current data show no difference between manual chest compression and automated systems in terms of survival, haemodynamic studies in animal models have shown that mechanical techniques are more effective [8].</p> <p>The principal aim of this study was to evaluate the hemodynamic impact (systolic, diastolic and mean arterial blood pressure) of the LUCAS™ active compression-decompression device (Medtronics® Jolife; Lund, Sweden) as the mechanical chest compression technique versus manual chest compression. The secondary aims were on the one hand to evaluate in a quantitative manner cardiac output and its evolution during mechanical and manual cardiopulmonary resuscitation and on the other hand to evaluate the correlation between cardiac output and other routinely-measured hemodynamic parameters, in particular the EtCO2.</p> 03/14/2017 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1004.php <h2>ABSTRACT</h2> <p>Seizure is clinical manifestation of sudden disruption of the normal electrical activity of cortical neurons. The brain electrical activity is periodically disturbed, alteration in neural cell integrity, increase in firing impulses and spread to adjacent normal neurons result in temporary brain dysfunction with alterations in consciousness, behavior or motor function. It may be triggered by illness, infection, stress, stroke, brain tumor, or the underlying cause may not completely understand. Status epilepticus (SE) is a medical emergency and requires prompt diagnosis and treatment. Treatment includes general support measures, drugs to suppress epileptic activity and relieving the underlying condition. Refractory SE requires admission to an intensive care unit (ICU) to allow adequate monitoring and support of respiratory, metabolic and hemodynamic functions and cerebral electrical activity. For SE treatment, benzodiazepines are the first line antiepileptic agents, and if benzodiazepines fail to control seizures, Phenytoin is usually indicated; Phenobarbital or Valproate may also be considered. For refractory SE, Propofol and Thiopental represent first line agents after careful assessment of potential risks. In refractory SE, general anesthesia may be required. There is currently no unique consensus for definite treatment option of RSE. In this review, the management protocol of seizure, assessment, monitoring, and different alternative therapy would be discussed.</p> 12/30/2016 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1003.php <h2>ABSTRACT</h2> <p>Hepatitis A virus (HAV) infection is the commonest form of acute viral hepatitis all over the world. Complicated HAV cases had been reported with evolving presentations. This is a report of three cases of non-fulminant HAV infections annotating rare non hepatic sequalae.</p> 12/22/2016 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1002.php <h2>ABSTRACT</h2> <p><strong>Background</strong>: Intensive care patients are often in need of sedation to endure being intubated. Light sedation is increasingly common since it has been proved to offer benefits such as faster recovery to patients.</p> <p><strong>Aim</strong>: The aim of this study was to describe critical care nurses’ experiences of nursing patients lightly sedated with dexmedetomidine.</p> <p><strong>Research Methodology</strong>: Qualitative personal interviews were conducted during 2015 with 10 critical care nurses in Sweden. Interview transcripts were analysed using inductive qualitative thematic analysis.</p> <p><strong>Results</strong>: Light sedation of the patient facilitated communication and interaction with him or her, and the relationship between the patient and his or her family members. Dexmedetomidine was described as a fairly new drug, and the critical care nurses stated that they needed more knowledge about it and about sedation scales in order to learn more about the drug’s mechanism of action and its potential side effects on patients.</p> <p><strong>Conclusion</strong>: It is important to critical care nurses to learn more about dexmedetomidine and about sedation scales to assess levels of sedation, as light sedation has been shown to benefit the patient as opposed to deep sedation that can increase recovery time.</p> 12/17/2016 https://www.theskygallerypattaya.com/jcicm/jcicm-aid1001.php <h2>INTRODUCTION</h2> <p>The widespread availability of non-traditional dietary supplements and pharmacologically active substances via the Internet continues to introduce mechanisms for inadvertent toxidromes not commonly seen. Consumers are virtually unrestricted in their ability to acquire products purporting augmentation of normal physiology for the purposes of enhancement, recreation, and/or potential abuse. The safety profiles at standard or toxic doses remain largely unknown for many agents that can be purchased electronically. We report a case of mixed toxicity related to phenibut and fosaracetam, both of which are readily available for consumer purchase from online retailers. Written and verbal consent was obtained for this case presentation.<br />  </p>