[Downloaded free from http://www.ijccm.org on Wednesday, May 2, 2018, IP: 60.48.58.48] Letters to the Editor technique versus the cannula‑over‑needle technique. Crit Care Med 2015;43:2112‑6.
Komal Anil Gandhi, Tanvir Samra Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India Address for correspondence: Dr. Tanvir Samra, Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India. E‑mail:
[email protected]
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References
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1. Monaca E, Trojan S, Lynch J, Doehn M, Wappler F. Broken guide wire – A fault of design? Can J Anaesth 2005;52:801‑4. 2. Hegde HV, Sachidananda R, Rao RP, Deshapande SS. Communication between two channels of central venous catheter: A rare manufacturing defect. Anesth Analg 2009;109:2032‑3. 3. Mansfield PF, Hohn DC, Fornage BD, Gregurich MA, Ota DM. Complications and failures of subclavian‑vein catheterization. N Engl J Med 1994;331:1735‑8. 4. Lee YH, Kim TK, Jung YS, Cho YJ, Yoon S, Seo JH, et al. Comparison of needle insertion and guidewire placement techniques during internal jugular vein catheterization: The thin‑wall introducer needle
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DOI: 10.4103/ijccm.IJCCM_360_17
How to cite this article: Gandhi KA, Samra T. Preprocedural check of central venous catheter set. Indian J Crit Care Med 2018;22:197-8. © 2018 Indian Journal of Critical Care Medicine | Published by Wolters Kluwer ‑ Medknow
Risk Factors and Outcome of Acute Kidney Injury after Congenital Heart Surgery Sir, I read the article “Risk factors and outcome of acute kidney injury after congenital heart surgery: A prospective observational study” by Amini et al. with interest.[1] While this article highlights the importance of recognition and assessment of acute kidney injury (AKI) in children following congenital heart surgery, there are many things that the authors failed to notice in their study. As shown in your table 3, in the manuscript, the authors mentioned that a total of 96 children underwent surgery in the group AKI, while 227 underwent surgery under cardiopulmonary bypass (CPB) and are within the group with “no AKI.” However, what the authors failed to demonstrate is the proportion of children who did not receive CPB, but still ended up having AKI (which seemed to be a total of 54 out of 150).
other than a mention of “dialysis.” We also know that while some of these children with severe form of AKI can go on to receive hemodialysis for a period of time, there are also a significant number of children who are helped electively, and prophylactically by peritoneal dialysis, and in some units, with continuous venovenous filtration.[2] These would help in understanding the spectrum of AKI as well as the efficiency of management, thereby highlighting the clinical relevance of some of the postoperative variables including morbidity they have assessed in this study.
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Conflicts of interest
There are no conflicts of interest.
Furthermore, the role of vasoconstrictors in selectively compromising mesenteric and renal circulation is well known. While the inotropic score was briefly mentioned in methodology, this particularly important factor was not assessed anywhere else in the article, nor mentioned for its relevance to the study. It is also interesting to note that while the authors have used an appropriate definition for AKI in the methodology section, they failed to define the various management schemes for different categories of AKI. Furthermore, the renal replacement therapy (seen in three children) was not expanded fully, 198
Nagarajan Muthialu Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, UK Address for correspondence: Mr. Nagarajan Muthialu, Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK. E‑mail:
[email protected]
References 1. Amini S, Abbaspour H, Morovatdar N, Robabi HN, Soltani G, Tashnizi MA, et al. Risk factors and outcome of acute kidney injury after congenital heart surgery: A Prospective observational study. Indian
Indian Journal of Critical Care Medicine ¦ Volume 22 ¦ Issue 3 ¦ March 2018 Page no. 74
[Downloaded free from http://www.ijccm.org on Wednesday, May 2, 2018, IP: 60.48.58.48] Letters to the Editor J Crit Care Med 2017;21:847‑51. 2. Tóth R, Breuer T, Cserép Z, Lex D, Fazekas L, Sápi E, et al. Acute kidney injury is associated with higher morbidity and resource utilization in pediatric patients undergoing heart surgery. Ann Thorac Surg 2012;93:1984‑90.
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DOI: 10.4103/ijccm.IJCCM_508_17
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
How to cite this article: Muthialu N. Risk factors and outcome of acute kidney injury after congenital heart surgery. Indian J Crit Care Med 2018;22:198-9. © 2018 Indian Journal of Critical Care Medicine | Published by Wolters Kluwer ‑ Medknow
Rabies Treatment: Are We Anywhere Close to Cure? Sir, In the case report on rabies, Bawaskar et al.[1] had attempted novel therapeutic agents to find a protocol for curative treatment but it was a disappointment. However, they highlighted various molecular mechanisms to explain the symptoms and signs. In the Western world, the management of dog bite is centered on prevention of infection from organisms present in the oral cavity of the animal. However, in India and South‑east Asia, the crucial concern is combating the possibility of rabies, since once the disease sets in, it is predictably fatal. A cure for rabies would be a great boon for the developing world. Milwaukee protocol gave initial hope that some component of the therapy might actually have therapeutic efficacy in human rabies. However, multiple efforts to replicate this expensive and intense protocol have not been successful. Numerous therapies for established rabies based on the molecular mechanisms have been implemented but, one could not succeed as on date and unmet medical needs. Hueffer et al. noticed that the glycoprotein of rabies virus has homology with snake toxin (venom), which alters the behavior of animals through inhibition of nicotinic acetylcholine receptors present in central nervous system. Thus, it is clear that the virus‑receptor interaction and host manipulation by pathogens might have contributed to behavioral changes in rabies. [2]
Earlier work in rabies has shown that a number of isomers of host protein kinase C are responsible for phosphorylation of protein P, specifically α, β, γ, and δ, with γ appearing to be the most effective of these isoenzymes. These kinases may be differentially inhibited either by staurosporine or heparin. Apart from the above, we would like to mention that Gupta et al.,[3] also identified a γ‑protein C kinase that appeared
unique to rabies‑infected cells, designated rabies virus protein kinase, and which was inhibited by heparin: It appears that rabies virus protein kinase is present in purified virions, likely indicating a critical role in the viral life cycle. Since, tamoxifen, midostaurin, and heparin inhibit protein kinase one has to find out the applicability of these molecules or modified ones in the treatment of rabies.[4] These newer explanations have given confidence that in future natural molecules derived from snake venom/toxin or modified molecules might revert the effects of rabies or prevent the progression of disease. Overall, it is clear that more we understand the molecular mechanisms of a disease; we are likely to introduce newer therapeutic agents more. At the same time, there is need for continued vigilance and public awareness, education of health‑care workers, and prevention with early post‑exposure prophylaxis when indicated, all of which are proven to prevent clinical rabies.[5]
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Conflicts of interest
There are no conflicts of interest. Subramanian Senthilkumaran, Namasivayam Balamurugan1, Nanjundan Karthikeyan2, Ponniah Thirumalaikolundusubramanian3 Department of Emergency and Critical Care, Be Well Hospitals, Erode, Department of Neurosciences, SIMS Chellum Hospital, Salem, 3Department of Internal Medicine, Chennai Medical College Hospital and Research Center, Trichy, Tamil Nadu, India, 2Department of Emergency Medicine, Hamad General Hospital, Doha, Qatar 1
Address for correspondence: Dr. Subramanian Senthilkumaran, Department of Emergency and Critical Care Medicine, Be Well Hospitals, Erode, Tamil Nadu, India. E‑mail:
[email protected]
Indian Journal of Critical Care Medicine ¦ Volume 22 ¦ Issue 3 ¦ March 2018 Page no. 75
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