Fetal Supraventricular Tachycardia: A Case of (Intermittent) Atrial Flutter

Fetal tachycardia of “supraventricular” origin is uncommon. The authors present a patient with fetal ascites and atrial flutter. A review of the pertinent literature is included.     

Atrial Parasystole Induced Recurrent Supraventricular Tachycardia: Report of a Case

A case of atrial parasystole is reported in a patient who also demonstrated evidence of atrioventricular pathways. The pathogenesis of this rare dysrhythmia is discussed.     

Portending Complications in Pediatric Diabetic Ketoacidosis

How to cite this article: Williams V, Mohandoss V. Portending Complications in Pediatric Diabetic Ketoacidosis. Indian J Crit Care Med 2021;25(12):1339–1340.     

Synchronizing Computer Simulations with Measurement Data for a Case of Atrial Flutter

Atrial flutter is a common supraventricular tachycardia that can be treated using radiofrequency catheter ablation, a procedure that is guided by electroanatomical mapping systems. In this paper, we propose an algorithm for incorporating mapping data into computer simulations of atrial electrical activity with the purpose of creating a more accurate map of electrical activation. The algorithm takes as input the extracellular potential values recorded at a number of sites throughout the atria and estimates the activation time for the entire atrial domain. We test the algorithm using synthetic mapping data and an anatomically detailed atrial geometry with an activation pattern typical of atrial flutter. The results show that the algorithm performs well with synthetic mapping data with information from relatively few mapping sites and in the presence of modeling and measurement error.     

Severe Hypertriglyceridemia in Diabetic Ketoacidosis Accompanied by Acute Pancreatitis: Case Report

We report a case of diabetic ketoacidosis (DKA) and hypertriglyceridemia (severely elevated to 15,240 mg/dL) complicated by acute pancreatitis, which was treated successfully with insulin therapy and conservative management. A 20-yr-old woman with a history of type 1 diabetes came to the emergency department 7 months after discontinuing insulin therapy. DKA, severe hypertriglyceridemia and acute pancreatitis were diagnosed, with DKA suspected of contributing to the development of the other conditions. In Korea, two cases of DKA-induced hypertriglyceridemia and 13 cases of hypertriglyceridemia-induced acute pancreatitis have been previously reported separately.     

射频消融治疗阵发性室上性心动过速35例分析

目的 总结射频消融（RFCA）治疗阵发性室上性心动过速（PSVT）35例的经验。方法 左房室旁路消融二尖瓣室侧，右侧房室旁路消融三尖瓣房侧；房室结双径路通过下位法能量递增消融法改良房室结。结果 19例房室折返型心动过速，左侧旁道13条，右侧旁道6条，16例房室结折返型心动过速（AVNRT）首次消融均成功。术后1周1例AVNRT复发，再次消融成功。1～20个月随访无复发及严重并发症。结论 RFCA治疗PSVT安全、有效。     

Identification of Prevotella in Pedal Osteomyelitis of a Diabetic Patient

Osteomyelitis in a diabetic patient with a nonhealing foot ulcer, multiple medical conditions, and recurrent hospitalization for antibiotic therapy was found to be associated with gram-negative bacteria Prevotella melanginoganica and Prevotella melaninoganica hemagglutinating variant. Those organisms were identified due to the morphologically distinct features in electron microscopy and sequencing of the genes after Polymerase chain reaction amplification from the pathological material. The bacteria invaded the bone and resided in osteocyte, osteoblast, and endothelial cells. The bacteria are usually associated with periodontal plaques, causing inflammation and destruction of gingival tissue and resorption of the alveolar bone. This is the first ultrastructural and molecular study of a diabetic bone lesion with anaerobic bacterial infection.     

Crusted Scabies in a Patient With Intellectual Disability

An immunocompetent 42-year-old man presented to our outpatient department for generalized hyperkeratotic crusted skin lesions with pruritus. He was intellectually disabled and could not remember when his symptom started. His medical history included hypertension, dyslipidemia and diabetes mellitus. Physical examination showed widespread scaly, hyperkeratotic, greyish to yellowish crusted erythematous papules and plaques on the trunk, axillae, interdigital webs, inguinal area, scrotum, and legs (Fig. 1). The microscopic examination of the skin scrapings revealed a number of mites, eggs, and fecal pellets suitable for the diagnosis of crusted scabies (Fig. 2).Open in a separate windowFig. 1A 42-year-old man with intellectual disability presented for generalized hyperkeratotic crusted skin lesions with pruritus. His medical history included hypertension, dyslipidemia and diabetes mellitus. (A-E) Physical examination showed widespread scaly, hyperkeratotic, greyish to yellowish crusted erythematous papules and plaques on the trunk, axillae, interdigital webs, inguinal area, scrotum, and legs. The patient was diagnosed with crusted scabies with microscopic examination of the skin scrapings. The images are published under agreement of the patient and his guardian.Open in a separate windowFig. 2The microscopic examination of the skin scrapings revealed (A) scabies mites and (B) eggs.Crusted scabies was first reported in Norway in 1848 among patients with leprosy.1 It is a highly contagious form of scabies which is a skin infestation caused by the mite Sarcoptes scabiei var hominis. It is more common in people who are immunosuppressed, intellectually disabled, and physically incapacitated.1 Since the altered host response causes high proliferation of mites, typical clinical features of crusted scabies such as crusting and hyperkeratosis of skin appear.2Unlike classic scabies, itching is mild or absent in crusted scabies. Clinically, it is characterized by fissured, thick, hyperkeratotic plaques with yellowish, greyish, or yellow-brownish crusts. It often involves bony prominences (i.e. finger articulations, elbows, knees, and iliac crest), nailbeds, soles, scalp, face, neck, genitalia, and, sometimes, the entire body.1,3 The clinical differential diagnosis of crusted scabies include hyperkeratotic eczema, seborrheic dermatitis, psoriasis, Darier’s disease, palmoplantar keratoderma, pityriasis rubra pilaris, atopic dermatitis, contact dermatitis, Erythrodermic mycosis fungoides, and Sézary syndrome.3,4In Korea, crusted scabies is rare in the domestic literature with a total of 16 cases reported to date, since the first case was reported in 1974.5,6,7,8,9,10,11,12,13,14,15,16,17,18,19 The majority of the patients were immunocompromised due to hematologic diseases6,7,12 (e.g. hemolytic anemia, aplastic anemia, acute myeloid leukemia), use of systemic steroid and topical steroid,9,10,13,14 or use of allopurinol.17 One of the cases was reported in a physically incapacitated 55-year-old male with left-sided hemiplegia.19 Two of the cases were similar to ours in terms of patient characteristics. They presented immunocompetent patients with intellectual disability or Down syndrome.7,11Crusts from patients contaminate the immediate environment such as clothing, bedding, towels, curtains, floor, and furniture. Mites in these crusts can survive and remain infective for 48 to 72 hours.1 Therefore, potentially contaminated items should be machine washed with hot water or dry-cleaned and materials that cannot be washed should be sealed and stored in plastic bags.2,20 All the patient’s close contacts should be treated prophylactically. In addition, healthcare professionals and family members should avoid contact with the patient and the contaminated environment as much as possible, and wear disposable gloves and gowns during inevitable contact.2,14,20 Especially, medical devices, which are one of the main transmission carriers, should not be shared with others.8,14For successful treatment of crusted scabies, topical anti-scabietic agents alone are not sufficient. This is due to the high mite burden and the limited penetration of topical agents into hyperkeratotic lesions. Thus, oral ivermectin 200 micrograms/kg on days 1, 2, and 8 is recommended for crusted scabies with daily application of topical agents for 7 days.20 5% permethrin cream is the preferred topical agents and it should be applied overnight to all skin surfaces including clipped nails. Keratolytic agents such as 5-10% salicylic acid in petrolatum, 40% urea, or by soaking in a hot bath can also be helpful by eliminating hyperkeratotic crusts.2 The microscopic examination of skin scrapings should be repeated 2 weeks after completion of treatment.20In conclusion, we report a typical case of crusted scabies in a patient with intellectual disability. Early diagnosis is required to prevent the outbreak of scabies. In addition, aggressive treatment is recommended to prevent complications such as secondary infection or sepsis, especially for immunocompromised patients who are vulnerable to crusted scabies.     

An Unusual Presentation of Diabetic Ketoacidosis in Familial Hajdu-Cheney Syndrome: A Case Report

A 21-year-old man with diabetic ketoacidosis (DKA) displayed short and clubbed fingers and marked eyebrow, which are typical of Hajdu-Cheney Syndrome (HCS). Laboratory findings confirmed type 1 diabetes mellitus (DM). After conservative care with hydration and insulin supply, metabolic impairment was improved. Examinations of bone and metabolism revealed osteoporosis and craniofacial abnormalities. The mutation (c.6443T>G) of the NOTCH2 gene was found. The patient was diagnosed with HCS and DM. There may be a relationship between HCS and DM, with development of pancreatic symptoms related to the NOTCH2 gene mutation.     

Care of the Patient With a Critical Illness

A method of care applicable to all forms of critical illness is presented. A patient is considered to be critically ill when he is threatened with hypoxia. According to this concept, procedures to understand and solve problems of critical care are coordinated and unified. The relevant physiology and monitoring of the components of the oxygenating system are described. The treatment of patients with impaired function of these components is described.