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Nasogastric tube syndrome:A Meta-summary of case reports

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World Journal of Clinical Cases 2024年第1期12卷 119-129页

作者： Deven juneja Prashant Nasa Gunjan Chanchalani Ravi Jain Department of Critical Care Medicine Max Super Speciality HospitalNew Delhi 110017India Department of Critical Care Medicine NMC Specialty HospitalDubai 7832United Arab Emirates Department of Critical Care Medicine Karamshibhai Jethabhai Somaiya Hospital and Research CentreMumbai 400022India Department of Critical Care Medicine Mahatma Gandhi Medical College and HospitalJaipur 302022RajasthanIndia

BACKGROUND Since its description in 1790 by Hunter,the nasogastric tube(NGT)is commonly used in any healthcare setting for alleviating gastrointestinal symptoms or enteral ***,the risks associated with its placement are often *** airway obstruction with a NGT is an uncommon but potentially life-threatening *** syndrome is characterized by the presence of an NGT,throat pain and vocal cord(VC)paralysis,usually *** is poten-tially life–threatening,and early diagnosis is the key to the prevention of fatal upper airway ***,fewer cases may have been reported than might have occurred,primarily due to the clinicians'*** lack of specific signs and symptoms and the inability to prove temporal relation with NGT insertion has made diagnosing the syndrome quite *** To review and collate the data from the published case reports and case series to understand the possible risk factors,early warning signs and symptoms for timely detection to prevent the manifestation of the complete syndrome with life-threatening airway *** We conducted a systematic search for this meta-summary from the database of PubMed,EMBASE,Reference Citation Analysis(https://***/)and Google scholar,from all the past studies till August *** search terms included major MESH terms"Nasogastric tube","Intubation,Gastrointestinal","Vocal Cord Paralysis",and“Syndrome”.All the case reports and case series were evaluated,and the data were extracted for patient demographics,clinical symptomatology,diagnostic and therapeutic interventions,clinical course and outcomes.A datasheet for evaluation was further *** Twenty-seven cases,from five case series and 13 case reports,of NGT syndrome were retrieved from our *** was male predominance(17,62.96%),and age at presentation ranged from 28 to 86 *** patients had diabetes mellitus(37.04%),and nine were hyperte

关键词： Nasogastric tube Nasogastric tube syndrome Ryle’s tube Sofferman syndrome Vocal cord paralysis

Deciphering the iron enigma: Navigating the complexities of iron metabolism in critical illness

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World Journal of Clinical Cases 2024年第27期12卷 6027-6031页

作者： Anjali Mishra Deven juneja Department of Critical Care Medicine Holy Family HospitalDelhi 110025India Department of Critical Care Medicine Max Super Speciality HospitalNew Delhi 110017India

Iron is a double-edged sword!Despite being essential for numerous physiological processes of the body,a dysregulated iron metabolism can result in tissue da-mage,exaggerated inflammatory response,and increased susceptibility to infection with certain pathogens that thrive in iron-rich *** sepsis,there is an alteration of iron metabolism,leading to increased transport and uptake into *** increase in labile iron may cause oxidative damage and cellular injury(ferroptosis)which progresses as the disease *** ill patients are often complicated with systemic inflammation which may contribute to multiple organ dysfunction syndrome or sepsis,a common cause of mortality in intensive care ***,ferritin was known to play an important role in the hematopoietic system for its iron storage ***,its role has emerged as a predictor of poor prognosis in chronic inflammation and critical *** from predicting the disease outcome,serum ferritin can poten-tially reflect disease activity as well.

关键词： Critical illness Ferritin Inflammation Iron Mortality Sepsis

Dengue induced acute liver failure:A meta summary of case reports

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World Journal of Virology 2024年第1期13卷 133-142页

作者： Deven juneja Ravi Jain Prashant Nasa Department of Critical Care Medicine Max Super Speciality HospitalNew Delhi 110017India Department of Critical Care Medicine Mahatma Gandhi Medical College and HospitalJaipur 302022RajasthanIndia Department of Critical Care Medicine NMC Specialty HospitalDubai 7832United Arab Emirates

BACKGROUND Dengue fever is the most common cause of viral hemorrhagic fever,with more than 400 million cases being reported annually,*** though hepatic involvement is common,acute liver failure(ALF)is a rare complication of dengue *** To analyze the demographic profile,symptomology,hospital course and outcomes of patients presenting with ALF secondary to dengue infection by reviewing the published case *** A systematic search was performed from multiple databases including PubMed,Reference Citation Analysis,Science Direct,and Google *** search terms used were"dengue"OR"severe dengue"OR"dengue shock syndrome"OR"dengue haemorrhagic syndrome"OR"dengue fever"AND"acute liver failure"OR"hepatic failure"OR"liver injury".The inclusion criteria were:(1)Case reports or case series with individual patient details;(2)Reported acute liver failure secondary to dengue infection;and(3)Published in English language and on adult *** data were extracted for patient demographics,clinical sympto-matology,clinical interventions,hospital and intensive care unit course,need for organ support and clinical *** Data from 19 case reports fulfilling the predefined inclusion criteria were *** median age of patients was 38 years(inter quartile range:Q3-Q126.5 years)with a female preponderance(52.6%).The median days from diagnosis of dengue to development of ALF was 4.5 *** increase in aspartate aminotransferase was higher than that in alanine aminotransferase(median 4625 U/L vs 3100 U/L).All the patients had one or more organ failure,with neurological failure present in 73.7%cases.42.1%patients required vasopressor support and hepatic enceph-alopathy was the most reported complication in 13(68.4%)*** of the patients were managed conser-vatively and 2 patients were taken up for liver *** 1 death was reported(5.3%).CONCLUSION Dengue infection may rarely lead to *** patients may frequently require inten

关键词： Dengue fever Acute liver failure Dengue induced hepatitis Hepatic failure Fulminant hepatitis Severe dengue

Cytomegalovirus infection in non-immunocompromised critically ill patients:A management perspective

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World Journal of Virology 2024年第1期13卷 38-50页

作者： Madhura Bhide Omender Singh Prashant Nasa Deven juneja Institute of Critical Care Medicine Max Super Speciality HospitalSaketNew Delhi 110017India Department of Critical Care Medicine NMC Specialty HospitalDubai 7832United Arab Emirates

Critically ill patients are a vulnerable group at high risk of developing secondary *** disease severity,prolonged intensive care unit(ICU)stay,sepsis,and multiple drugs with immunosuppressive activity make these patients prone to immuneparesis and increase the risk of various opportunistic infections,including cytomegalovirus(CMV).CMV seroconversion has been reported in up to 33%of ICU patients,but its impact on patient outcomes remains a matter of *** though there are guidelines regarding the management of CMV infection in immunosuppressive patients with human immunodeficiency virus/acquired immuno deficiency syndrome,the need for treatment and therapeutic approaches in immunocompetent critically ill patients is still *** the diagnosis of CMV infection may be challenging in such patients due to non-specific symptoms and multiorgan ***,a better understanding of the symptomatology,diagnostics,and treatment options may aid intensive care physicians in ensuring accurate diagnoses and instituting therapeutic interventions.

关键词： Cytomegalovirus Critically ill Immunocompetent Intensive care unit Virus

Optic nerve sheath diameters in nontraumatic brain injury:A scoping review and role in the intensive care unit

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World Journal of Critical Care Medicine 2024年第3期13卷 75-90页

作者： Madhura Bhide Deven juneja Omender Singh Shakya Mohanty Institute of Critical Care Medicine Kalinga Institute of Medical SciencesBhubaneshwar 751024OdishaIndia Institute of Critical Care Medicine Max Super Speciality HospitalSaketNew Delhi 110017India

BACKGROUND Neuromonitoring in medical intensive care units is challenging as most patients are unfit for invasive intracranial pressure(ICP)modalities or unstable to transport for ***-based optic nerve sheath diameter(ONSD)is an attractive option as it is reliable,repeatable and easily performed at the *** has been sufficiently validated in traumatic brain injury(TBI)to be incorporated into the ***,currently the data for non-TBI patients is inconsistent for a scientific recommendation to be *** To compile the existing evidence for understanding the scope of ONSD in measuring ICP in adult non-traumatic neuro-critical *** PubMed,Google Scholar and research citation analysis databases were searched for studies in adult patients with non-traumatic causes of raised *** from 2010 to 2024 in English languages were *** We found 37 articles relevant to our *** cutoff for ONSD in predicting ICP varied from 4.1 to 6.3 *** of the articles used cerebrospinal fluid opening pressure followed by raised ICP on computed tomography/magnetic resonance imaging as the comparator *** was also found to be a reliable outcome measure in cases of acute ischaemic stroke,intracerebral bleeding and intracranial ***,ONSD is of doubtful utility in septic metabolic encephalopathy,dysnatremias and aneurysmal subarachnoid *** ONSD is a useful tool for the diagnosis of raised ICP in non-traumatic neuro-critically ill patients and may also have a role in the prognostication of a subset of patients.

关键词： Intracranial hypertension Intracranial pressure monitoring Medical intensive care unit Neuro-monitoring Nontraumatic brain injury Optic nerve sheath diameter Optic nerve ultrasound

Artificial intelligence:Applications in critical care gastroenterology

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Artificial Intelligence in Gastrointestinal Endoscopy 2024年第1期5卷 1-10页

作者： Deven juneja Department of Critical Care Medicine Max Super Speciality HospitalNew Delhi 110017India

Gastrointestinal(GI)complications frequently necessitate intensive care unit(ICU)***,critically ill patients also develop GI complications requiring further diagnostic and therapeutic ***,these patients form a vulnerable group,who are at risk for developing side effects and *** effort must be made to reduce invasiveness and ensure safety of interventions in ICU *** intelligence(AI)is a rapidly evolving technology with several potential applications in healthcare *** produce a large amount of data,which may be employed for creation of AI algorithms,and provide a lucrative opportunity for application of ***,the current role of AI in these patients remains limited due to lack of large-scale trials comparing the efficacy of AI with the accepted standards of care.

关键词： Artificial intelligence Critical care Gastroenterology Hepatology Intensive care unit Machine learning

Capillary leak syndrome:A rare cause of acute respiratory distress syndrome

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World Journal of Clinical Cases 2022年第13期10卷 4324-4326页

作者： Deven juneja Sahil Kataria Department ofCritical Care Medicine Max Super Speciality HospitalDelhi 110017India

Capillary leak syndrome(CLS)is a rare clinical syndrome associated with significant morbidity and *** care and supportive therapy constitute the mainstay of the treatment,along with judicious use of crystalloids and colloids such as dextran and starch during the leak *** advantages of proning,steroids,and intravenous immunoglobins are worth contemplating in patients with such a *** membrane oxygenation appears to be an excellent strategy to surmount the impediments of the leak and post leak phase of CLS,especially in patients with severe or refractory hypoxemia.

关键词： Extracorporeal membrane oxygenation Capillary leak syndrome Organophosphorus poisoning Hemodynamics

“How Do We Actually Do Convergence”for Disaster Resilience?Cases from Australia and the United States

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International Journal of Disaster Risk Science 2021年第3期12卷 299-311页

作者： Shefali juneja Lakhina Elaina J.Sutley Jay Wilson Wonder Labs San JoseCA 95128USA Civil Environmental and Architectural EngineeringUniversity of KansasLawrenceKS 66045USA Clackamas County Disaster Management Oregon CityOR 97045USA

In recent years there has been an increasing emphasis on achieving convergence in disaster research,policy,and programs to reduce disaster losses and enhance social ***,there remain considerable gaps in understanding"how do we actually do convergence?"In this article,we present three case studies from across geographies—New South Wales in Australia,and North Carolina and Oregon in the United States;and sectors of work—community,environmental,and urban resilience,to critically examine what convergence entails and how it can enable diverse disciplines,people,and institutions to reduce vulnerability to systemic risks in the twenty-first *** identify key successes,challenges,and barriers to *** build on current discussions around the need for convergence research to be problem-focused and solutions-based,by also considering the need to approach convergence as ethic,method,and *** reflect on how convergence can be approached as an ethic that motivates a higher order alignment on"why"we come together;as a method that foregrounds"how"we come together in inclusive ways;and as an outcome that highlights"what"must be done to successfully translate research findings into the policy and public domains.

关键词： Convergence research Disaster resilience Disaster risk reduction Research ethics

Approach to thromboelastography-based transfusion in cirrhosis:An alternative perspective on coagulation disorders

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World Journal of Gastroenterology 2023年第9期29卷 1460-1474页

作者： Sahil Kataria Deven juneja Omender Singh Institute of Critical Care Medicine Max Super Speciality HospitalNew Delhi 110017India

Viscoelastic tests,specifically thromboelastography and rotational thromboelastometry,are increasingly being used in the management of postoperative bleeding in surgical intensive care units(ICUs).However,life-threatening bleeds may complicate the clinical course of many patients admitted to medical ICUs,especially those with underlying liver *** with cirrhosis have multiple coagulation abnormalities that can lead to bleeding or thrombotic *** to conventional coagulation tests,a comprehensive depiction of the coagulation process and point-of-care availability are advantages favoring these devices,which may aid physicians in making a rapid diagnosis and instituting early *** tests may help predict bleeding and rationalize the use of blood products in these patients.

关键词： Bleeding Chronic liver disease Cirrhosis Thromboelastography Viscoelastic tests