Category Archives: Case Series

A Challenging Diagnosis of Sheehan’s Syndrome in Non-obstetric Critical Care and Emergency Settings: A Case Series of Five Patients with Varied Presentations

Suhail Sarwar Siddiqui1, Nibu Dominic2, Sukriti Kumar3, Kauser Usman4, Sai Saran1, Avinash Agrawal1, Mohan Gurjar5, Syed Nabeel Muzaffar1

1 Department of Critical Care Medicine, King George Medical University, Lucknow, Uttar Pradesh, India
2 Department of Endocrinology, Aster Medcity, Kochi, Kerala, India
3 Department of Radiodiagnosis, King George Medical University, Lucknow, Uttar Pradesh, India
4 Endocrinology Division, King George Medical University, Lucknow, Uttar Pradesh, India
5 Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

DOI: 10.2478/jccm-2022-0018

Sheehan’s syndrome is a life-threatening endocrine emergency seen in postpartum females secondary to ischemic pituitary necrosis. It is a frequent cause of hypopituitarism in developing countries that occurs secondary to postpartum haemorrhage (PPH). Patients with Sheehan’s syndrome often present with organ dysfunctions in critical care settings, secondary to stressors precipitating the underlying hormonal deficiencies. The initial clinical picture of Sheehan’s syndrome may mimic some other disease, leading to misdiagnosis and diagnostic delay. Strict vigilance, timely diagnosis, and appropriate management are essential to avoid diagnostic delay and to improve the patient outcome. In this case series, we describe 5 cases of previously undiagnosed Sheehan’s syndrome (including young, middle aged and postmenopausal females) that presented to critical care and emergency settings with organ failures.

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The Use of Hydroxyurea in the Treatment of COVID-19

Melissa Robin Bowman Foster1, Ali Atef Hijazi2, Rebecca Opoku2, Priya Varghese2,
Chun Li2

1 Winston-Salem State University, Winston-Salem, NC, USA
2 Independent

DOI: 10.2478/jccm-2021-0019

Introduction: The rapid worldwide spread of COVID-19 motivated medical professionals to pursue and authenticate appropriate remedies and treatment protocols. This article aims to analyze the potential benefits of one treatment protocol developed by a group of care providers caring for severe COVID-19 patients.
Methods: The clinical findings of COVID-19 patients who were transferred to a specialized care hospital after unsuccessful treatment in previous institutions, were analyzed. The specialized care hospital used a treatment protocol including hydroxyurea, a medication commonly used for sickle cell treatment, to improve respiratory distress in the COVID-19 patients. None of the COVID-19 patients included in the analyzed data were diagnosed with sickle cell, and none had previously taken hydroxyurea for any other conditions.
Results: In all presented cases, patients reverted to their baseline respiratory health after treatment with the hydroxyurea protocol. There was no significant difference in the correlation between COVID-19 and hydroxyurea. However, deaths were extremely low for those taking hydroxyurea.
Conclusions: Fatality numbers were extremely low for those taking hydroxyurea; death could be attributed to other underlying issues.

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The Placement of Post-pyloric Feeding Tubes Using DRX-Revolution Mobile X-Ray System in an ICU. A Case Series

Leonid Koyfman1, Andrei Schwartz1, Yair Benjamin1, Alexander Smolikov2, Moti Klein1, Evgeni Brotfain1*

1 Department of Anesthesiology and Critical Care, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
2 Department of Radiology, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel

DOI: 10.1515/jccm-2016-0022

Enteral nutrition is crucial for ensuring that critically ill patients have a proper intake of food, water, and medicine. Methods to ensure this requirement should be initiated as early as possible. The use of PPF has several advantages compared to the use of a nasogastric feeding tube. In the present paper, the cases of three critically ill patients with a nonfunctional gastrointestinal system on admission to ICU, are detailed. Enteral feeding through a nasogastric tube by prokinetic agent therapy had been unsuccessful. The bedside placement of a post-pyloric feeding tube by the DRX-Revolution X-ray system is described.

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