Category Archives: JCCM 2017

Diagnosing “Brain Death” in Intensive Care

DOI: 10.1515/jccm-2017-0016

Death represents a biological state which appears at the end of life and can be defined by the halting of all life-sustaining biological functions.
Medically speaking, death represents the irreversible loss of consciousness associated with the irreversible loss of breathing [1].
Throughout its history, humanity has been interested by the mystery surrounding the end of life, and especially of finding out precise means of diagnosis.
But how can we medically diagnose the phenomenon of death?
Currently there are three means of diagnosis [1]: [More]

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Lung Abscess Remains a Life-Threatening Condition in Pediatrics – A Case Report

DOI: 10.1515/jccm-2017-0023

Pulmonary abscess or lung abscess is a lung infection which destroys the lung parenchyma leading to cavitations and central necrosis in localised areas formed by thick-walled purulent material. It can be primary or secondary. Lung abscesses can occur at any age, but it seems that paediatric pulmonary abscess morbidity is lower than in adults. We present the case of a one year and 5-month-old male child admitted to our clinic for fever, loss of appetite and an overall altered general status. Laboratory tests revealed elevated inflammatory biomarkers, leukocytosis with neutrophilia, anaemia, thrombocytosis, low serum iron concentration and increased lactate dehydrogenase level. Despite wide-spectrum antibiotic therapy, the patient’s progress remained poor after seven days of treatment and a CT scan established the diagnosis of a large lung abscess. Despite changing the antibiotic therapy, surgical intervention was eventually needed. There was a slow but steady improvement and eventually, the patient was discharged after approximately five weeks.

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Highlights for Improvement of Scientific Writing for Publication in High Impact Journals

DOI: 10.1515/jccm-2017-0022

For research scientists around the world, a primary goal is to publish results from their projects in high impact international journals.  Such an achievement can be highly rewarding because it is a formal way to release discoveries to the world and to be recognised for the discoveries, it allows findings to be shared and used by colleagues, and it can bring in personal benefits in awards and promotions.  However, achieving the goal is not a simple task, and it can sometimes be frustrating.  Therefore, this editorial was written to provide some highlights on how to improve chances for high impact publications and recognitions. [More]

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Use of Transcranial Doppler in Intensive Care Unit

DOI: 10.1515/jccm-2017-0021

Use of transcranial Doppler has undergone much development since its introduction in 1982, making the technique suitable for general use in intensive care units. The main application in intensive care units is to assess intracranial pressure, confirm the lack of cerebral circulation in brain death, detect vasospasm in subarachnoid haemorrhage, and monitor the blood flow parameters during thrombolysis and carotid endarterectomy, as well as measuring stenosis of the main intracranial arteries in sickle cell disease in children.
This review summarises the use of transcranial Doppler in intensive care units.

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The Importance of Haemogram Parameters in the Diagnosis and Prognosis of Septic Patients

DOI: 10.1515/jccm-2017-0019

Sepsis represents a severe pathology that requires both rapid and precise positive and differential diagnosis to identify patients who need immediate antimicrobial therapy. Monitoring septic patients’ outcome leads to prolonged hospitalisation and antibacterial therapy, often accompanied by substantial side effects, complications and a high mortality risk.
Septic patients present with complex pathophysiological and immunological disorders and with a predominance of pro-inflammatory or anti-inflammatory mediators which are heterogeneous with respect to the infectious focus, the aetiology of sepsis or patients’ immune status or comorbidities. Previous studies performed have analysed inflammatory biomarkers, but a test or combinations of tests that can quickly and precisely establish a diagnosis or prognosis of septic patients has yet to be discovered. Recent research has focused on re-analysing older accessible parameters found in the complete blood count to determine the sensitivity, specificity, positive and negative predictive values for the diagnosis and prognosis of sepsis.
The neutrophil/lymphocyte count ratio (NLCR), mean platelet volume (MPV) and red blood cells distribution width (RDW) are haemogram indicators which have been evaluated and which are of proven use in septic patients’ management.

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Reoccurrence of Bleeding of a Chronic Subdural Haematoma Following a Fall

DOI: 10.1515/jccm-2017-0020

The case of a 60-year-old patient who presented with an acute-on-chronic subdural haematoma is reported. Chronic haematoma usually remains asymptomatic, and this is considered to be an unusual course of events. Trivial or minor injury may cause the cortical bridge veins and fragile vessels in the former haematoma to rupture with concomitant reoccurrence of bleeding. Old age, repeated traumatic brain injuries, brain atrophy, antiplatelet agents and oral anticoagulants such as warfarin are considered to be the underlying conditions to cause the reoccurrence of bleeding. However, our patient did not have any of those conditions.

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Raoultella ornithinolytica Diagnosed in a Neurointensive Patient. A Rare Case with Recovery without Antibiotics

DOI: 10.1515/jccm-2017-0017

Infection with Raoultella ornithinolytica is rare and normally the infection is present in patients with underlying malignancies or chronic diseases. It is normally treated with antibiotics. In this case report, a neuro-intensive patient without malignancies or other severe chronic diseases was colonized with Pseudomonas aeruginosa but infected with Raoultella ornithinolyca. The patient recovered without treatment with antibiotics.

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The Eleventh Hour: Neurosyphilis, Still Fashionable but a Controversial Diagnosis

DOI: 10.1515/jccm-2017-0015

Syphilis is a consequence of a symbiotic relationship between Treponema pallidum and humankind.
The spirochete is nowadays well characterized in shape and in length, and its entire genome is sequenced. Despite all these, confirmation of infection is based on serologic tests. The diagnosis of nervous system disease heavily depends on examination of the cerebrospinal fluid [1-4].
Neurologic involvement is generally dichotomized into early/secondary (acute meningitis, cranial nerves involvement) or late/tertiary (all the rest of the manifestations) [1].
In the current issue of Journal of Critical Care Medicine, Bologa et al. present the utility of having meningovascular syphilis in mind as a possible diagnosis, in an apparent average case of an 84-year-old patient diagnosed with stroke [5]. [More]

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