Critical Care Commons^™

Clinical And Laboratory Predictors Of 30-Day Mortality In Hiv-Positive Adults With Pneumonia: A Prospective Observational Study From North India, Mandip Singh Bhatia, Ankita Kumari Bhargav, Saurabh Chandrabhan Sharda, Shankar Naidu, M. R Shivaprakash, Sunil Sethi, Vikas Gautam, Arnab Ghosh

Journal of Community Hospital Internal Medicine Perspectives

Background: Pneumonia remains a major cause of morbidity and mortality among people living with HIV (PLHIV), particularly in low- and middle-income countries. Despite the availability of antiretroviral therapy (ART), early mortality after hospitalization for pneumonia remains high. Indian data on short-term mortality predictors in HIV-associated pneumonia are limited.

Methods: We conducted a prospective observational study of HIV-positive adults admitted with pneumonia to a tertiary-care hospital in North India between April and December 2025. Clinical, laboratory, microbiological, and radiological parameters were recorded at admission. Patients were followed for 30 days. The primary outcome was all-cause 30-day mortality. Predictors of …

Adrenal Crisis Induced-Seizures: A Case Report And Literature Review, Israel Umoh, Elizabeth Mikhail, Narjis Batool, Nosheen Hajra, Ibrahim Al-Sanouri

Journal of Community Hospital Internal Medicine Perspectives

This case report underscores the critical interplay between adrenal crisis and seizure activity, emphasizing the importance of rapid recognition and management of this life-threatening condition. Adrenal crisis, characterized by severe hypotension and electrolyte disturbances, often manifests with nonspecific symptoms such as fatigue, nausea, and altered consciousness, which can obscure diagnosis, especially in pediatric and young adult populations. The report details a 21-year-old female with a complex endocrinologic background who developed seizures precipitated by an adrenal crisis triggered by gastroenteritis and compounded by medication noncompliance. Clinical findings included profound dehydration, electrolyte abnormalities, refractory hypotension, and low cortisol levels, which responded favorably …

Fluid Resuscitation Choice And Its Effect On Plasma Chloride And Acute Kidney Injury In Severe Acute Pancreatitis: A Randomized Study Of Normal Saline Vs. Balanced Crystalloids (Physiomax), Mandip Singh Bhatia, Ritu Attri, Ashok Kumar Pannu, Atul Saroch, Saurabh C Sharda, Neeraj Singla, Sakshi Mehta

Journal of Community Hospital Internal Medicine Perspectives

Background: Acute pancreatitis (AP) is a potentially fatal gastrointestinal condition, often associated with organ failure and acute kidney injury (AKI). Early fluid resuscitation with Normal saline (NS) may lead to hyperchloremia and AKI, which prompted interest in using balanced crystalloids. However, the optimal choice of crystalloid fluid remains uncertain. This study aimed to compare the effects of NS versus Physiomax on plasma chloride levels and AKI incidence during early resuscitation in patients with predicted severe AP (pSAP).

Methods: A single-center, prospective, randomized study was conducted between November 2022 and December 2023 at PGIMER, Chandigarh, India. 112 patients with pSAP were …

Navigating Thyroid Crises: A Nationwide Analysis Of The Weekend Effect And Mortality Trends In Myxedema Coma (2016-2020), Mariam Hashmi, Zubair Hassan Bodla, Fatima Niaz, Umer Farooq, Zahra Niaz, Christopher L. Bray, Peters Okonoboh

Journal of Community Hospital Internal Medicine Perspectives

Our objective was to utilize the National Inpatient Sample (NIS) database for analyzing the outcomes of myxedema coma based on the day of admission and explore five-year mortality trends. This retrospective cohort study examined in-patient mortality and secondary outcomes of patients with myxedema coma from 2016 to 2020 using the NIS database. Patients were selected using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and divided into weekday and weekend admission groups. From 174,776,205 discharges, 5,095 patients were included. Mean age of admitted patients was higher on weekdays (67.1 year) than weekends (66.5), with females constituting 69.4% and …

Port Catheter Fracture: A Silent Intrusion Into The Right Ventricle, Sanya Chandna, Saumya Nanda, Ankit Agrawal, Kavin Raj, Umesh Bhagat, Keerthana Jyotheeswara Pillai, Suryansh Bajaj

Journal of Community Hospital Internal Medicine Perspectives

Central venous port-a-catheters play a pivotal role in various medical procedures, yet they are associated with a spectrum of complications. Catheter fracture with cardiac migration is a rare complication, occurring in less than 1% of patients. Although not very common, it can cause severe issues, necessitating fragment removal. We present a case of spontaneous mediport fracture and migration in a patient with a history of Hodgkin's lymphoma and prior chemotherapy. He presented with nausea, vomiting, and tachycardia. Further evaluation revealed elevated total leukocyte count and labs consistent with diabetic ketoacidosis. He was diagnosed with new-onset diabetes mellitus. Imaging studies confirmed …

A Case Of Adult Multisystem Inflammatory Syndrome Following Covid-19 Vaccine, Meghan Brown, Nika Zorko Garbajs, Simon Zec, Hisham Mushtaq, Anwar Khedr, Abbas Bashir Jama, Ibtisam Rauf, Mikael Mir, Aishwarya Reddy Korsapati, Shikha Jain, Thoyaja Koritala, Ramesh Adhikari, Amos Lal, Ognjen Gajic, Juan Pablo Domecq, Sarah Goksoy, Brian Bartlett, Amit Sharma, Nitesh Kumar Jain, Syed Anjum Khan

Journal of Community Hospital Internal Medicine Perspectives

Multisystem inflammatory syndrome is a life-threatening condition associated with elevated inflammatory markers and multiple organ injury. A diagnosis of exclusion, it has been reported after severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2) in children and adults; recently it has been described in some post-COVID-19 vaccinated individuals. The prognosis with supportive care and immunomodulatory therapy is good, although some individuals may require treatment in the intensive care unit (ICU). Here we report a case of a 58-year-old man who developed multi-organ failure after receiving the second dose of the Moderna mRNA-1273 COVID-19 vaccine. He required critical organ support in the …