A cat has 9 lives: The dilemma of diagnosing non hodgkin's lymphoma in intensive care unit.

Non hodgkins lymphoma is a common haematological malignancy characterized by abnormal clonal proliferation of T-cells, B-cells or both. The incidence of non hodgkins lymphoma is rapidly rising. The diagnosis and management of NHL presents as a challenge in developing countries like India due to high prevalence of tuberculosis, cost and poor patient compliance. We describe an unusual case of a patient who presented as a diagnostic dilemma and took 8 diagnosis before finally being confirmed as a case of NHL. A suspicion for NHL should always be kept in mind in a patient presenting with pneumonia, bilateral pulmonary infiltrates and eosinophilia.

Targeted temperature management: Current evidence and practices in critical care.

Targeted temperature management (TTM) in today's modern era, especially in intensive care units represents a promising multifaceted therapy for a variety of conditions. Though hypothermia is being used since Hippocratic era, the renewed interest of late has been since early 21(st) century. There have been multiple advancements in this field and varieties of cooling devices are available at present. TTM requires careful titration of its depth, duration and rewarming as it is associated with side-effects. The purpose of this review is to find out the best evidence-based clinical practice criteria of therapeutic hypothermia in critical care settings. TTM is an unique therapeutic modality for salvaging neurological tissue viability in critically ill patients viz. Post-cardiac arrest, traumatic brain injury (TBI), meningitis, acute liver failure and stroke. TTM is standard of care in post-cardiac arrest situations; there has been a lot of controversy of late regarding temperature ranges to be used for the same. In patients with TBI, it reduces intracranial pressure, but has not shown any favorable neurologic outcome. Hypothermia is generally accepted treatment for hypoxic ischemic encephalopathy in newborns. The current available technology to induce and maintain hypothermia allows for precise temperature control. Future studies should focus on optimizing hypothermic treatment to full benefit of our patients and its application in other clinical scenarios.

"Amber in chamber" an enigmatous right atrial mass in a neonate.

The incidence of fungal infection is increasing worldwide. Although fungal infection is common in adults, few cases have been reported in the neonatal population. We report a case of the preterm neonate of 34 weeks who developed respiratory distress on 2(nd) day and was initiated on mechanical ventilation. Treatment was instituted for sepsis, but the patient continued to deteriorate. Two-dimensional echocardiography revealed a large right atrial mass, which eventually turned out to be fungal ball. Intense surgical and medical management led to a speedy recovery of the patient. We stress on the early use of echocardiography in atypical presentation of neonatal septicemia along with routine investigations to help in early recognition of source of infection. This can be of great value in initiating definitive management and improving survival rate in such patients.