Neglected Bilateral Facet Dislocation of the Cervical Spine with Intact Neurology: Reduction Technique.

Bilateral cervical facet dislocation is a serious injury that in majority cause neurologic deficit requiring prompt medical attention. Rarely, they retain normal neurology due to spontaneous decompression even though patients can have objective myelopathic or root compression signs. Neglected cases with normal neurology are uncommon with only few of them reported in the literature but their management is still a matter of debate. Here, we report a case of a 26-year-old female who had neglected bilateral facet dislocation with neck stiffness that was operated with posteroanterior approach with near-complete reduction and intact neurology. We describe the technique employed and discuss the literature.

Carbapenem-resistant Acinetobacter ventilator-associated pneumonia: Clinical characteristics and outcome.

OBJECTIVE: To study the clinical characteristics and 28-days mortality in patients with ventilator-associated pneumonia (VAP) due to carbapenem-resistant Acinetobacter (CRA). DESIGN: Retrospective, observational, cohort study. SETTING: Intensive care unit (ICU) of a university hospital. MATERIALS AND METHODS: Microbiologically confirmed VAP due to CRA infection. INTERVENTION: None. RESULTS: Out of 87 patients with VAP due to CRA, 60 (69%) were male; whose median age was 51 years; 73 (84%) patients were medical; 26 (30%) had history of hospitalization in last 3 months; median acute physiology and chronic health evaluation (APACHE) II was 15 and median SOFA 9 at admission; primary reason for ICU admission was respiratory failure (34%); 46 (53%) patients had more than 2 organ failure at ICU admission; median length of ICU stay was 19 days; 66 (76%) patients need vasoactive agents during ICU stay, whereas 55 (63%) patients had renal failure; median duration of mechanical ventilation was 17 days; 22 (25%) patients had acute respiratory distress syndrome (ARDS) during ICU stay; 72 (83%) patients had exposure to carbapenem before inclusion in the study; 33 (38%) patients had same organism at other sites. In the follow-up, 47 (54%) patient survived at 28 days after having VAP; whereas only 40 (46%) patients were discharged from the hospital. CONCLUSIONS: CRA-VAP has high crude mortality. Advanced age; severity of illness and presence of pneumonia at ICU admission; and presence of shock, ARDS and renal failure have impact on outcome in these patients.

High anion gap refractory metabolic acidosis as a critical presentation of endosulfan poisoning.

Organochloride insecticides are chlorinated cyclic hydrocarbons. One of such insecticides is endosulfan (6,7,8,9,10-10 hexachloro 1,5,5a,6,9,9a-hexahydro-6-methano-2,4,3-hexadithioxanthiep in 3-oxide) and it has been widely used in agriculture since 1960. The uncontrolled use of these compounds in developing countries has resulted in the deaths of animals and humans. Characteristic clinical signs following acute exposure are indicative of CNS disturbances or overstimulation. Mortality and morbidity rates are high and there is no specific antidote. We present an uncommon presentation of endosulfan poisoning in a 32-year-old male with high anion gap severe refractory metabolic acidosis. The patient was treated with continuous renal replacement therapy and was salvaged. Till date, there is no case report from India for endosulfan poisoning with severe metabolic acidosis and hypotension. Through this case report, we emphasize the role of continuous renal replacement therapy as a rescue therapy for endosulfan poisoning with severe refractory metabolic acidosis and hypotension, even though it is a non dialyzable poison.