Papers by Lalita Gouri Mitra
Indian journal of critical care medicine/Indian Journal of Critical Care Medicine, Mar 30, 2024
International journal of clinical studies and medical case reports, Mar 14, 2024
Magnesium Research, May 31, 2023
Indian Journal of Palliative Care
Objectives: Unrelieved pain significantly affects the quality of life of cancer patients. In rura... more Objectives: Unrelieved pain significantly affects the quality of life of cancer patients. In rural settings, cancer patients do not have information or knowledge about how to control their pain because of a lack of resources or awareness. We conducted an interventional, questionnaire-based prospective study in a rural tertiary care oncological centre to look for the impact of establishing a pain clinic based on the knowledge and experience of cancer patients regarding their cancer pain. Material and Methods: The patient pain questionnaire was filled by 380 random non-surgical patients complaining of pain who visited our centre for the treatment of cancer. The information generated was used for setting up a pain clinic covering all aspects of cancer pain. After 3 months of starting the pain clinic services, all these patients who visited the pain clinic at least once were again surveyed similarly. Out of 380 patients, we could only follow up with 348 patients and other patients were ...
Journal of Hepatology, 2015
International Journal of Clinical Studies and Medical Case Reports
Indian Journal of Anaesthesia
Indian Journal of Anaesthesia
International Journal of Advanced Research
Severe Acute Respiratory Distress Syndrome Coronavirus 2 (SARS CoV-2) and its new variant Omicron... more Severe Acute Respiratory Distress Syndrome Coronavirus 2 (SARS CoV-2) and its new variant Omicron was propelling the surge in Coronavirus Disease (COVID-19) in India and the world over. COVID-19 is associated with various extrapulmonary manifestations leading to acute coronary syndrome (ACS) in many patients. In our case report, a 55-year-old male with carcinoma soft palate on neo-adjuvant chemotherapy and radiotherapy came to our hospital emergency in an unconscious state. Cardiopulmonary resuscitation was initiated in the emergency suite, he was revived and shifted to the critical care unit for post cardiac arrest management. Patient was hemodynamically unstable and started on vasopressor support, electrocardiogram showed ischemic changes in anterolateral leads with cardiac enzyme troponin-T was positive. A diagnosis of ACS was made and managed appropriately. The patient got stabilized over a few hours, reverse transcriptase-polymerase chain reaction (RT-PCR) test was positive for...
Indian Journal of Critical Care Medicine
Journal of Anaesthesiology Clinical Pharmacology, Apr 1, 2007
INDIAN JOURNAL OF APPLIED RESEARCH
Hypocalcaemic cardiomyopathy is a rare postoperative complication after hemi-parathyroidectomy wh... more Hypocalcaemic cardiomyopathy is a rare postoperative complication after hemi-parathyroidectomy which reverses completely on the restoration of normocalcaemia. Patients of Turner syndrome have subtle cardiovascular anomalies due to the underlying oestrogen deciency. A 16-year-old female patient with Turner syndrome underwent hemi-parathyroidectomy for parathyroid adenoma. The patient developed signs of heart failure on postoperative day two, which was precipitated by tachycardia due to fever. She developed tachycardia, tachypnoea, hypertension, and pulmonary oedema with an ejection fraction of 20-30% at the time without any underlying cardiac disease. The patient was managed with intravenous diuretics, beta-blockers, and non-invasive ventilation. Other probable causes such as sepsis, pheochromocytoma, thyrotoxicosis, and Takotsubo syndrome were ruled out. A differential diagnosis of hypocalcaemic cardiomyopathy was suspected, and the patient was given intravenous calcium and vitamin...
Journal of Hepatology
BACKGROUND AND AIM The choice of resuscitation fluid in cirrhosis patients with sepsis-induced hy... more BACKGROUND AND AIM The choice of resuscitation fluid in cirrhosis patients with sepsis-induced hypotension (SIH) is unclear. 5% albumin has been superior to normal saline in the FRISC study. We compared the efficacy and safety of 20% albumin, which has greater oncotic properties with plasmalyte in reversing SIH. METHODS Critically-ill cirrhosis(CIC) patients underwent open-label randomization to receive either 20% albumin [0.5-1.0gm/kg over 3 hours; n=50] or plasmalyte (30ml/kg over 3 hours, n=50). The primary end-point of the study was the attainment of mean arterial pressure (MAP) above 65 mmHg at three hours. RESULTS Baseline characteristics were comparable in albumin and plasmalyte groups; arterial lactate(mmol/L) [6.16±3.18 vs. 6.38±4.77; p=0.78), MAP (mmHg) [51.4±6.52 vs. 49.9±4.45; p=0.17] and SOFA score [10.8±2.96 vs. 11.1±4.2; p=0.68] respectively. Most patients were alcoholics (39%) and had pneumonia (40%). In the intention-to-treat (ITT) analysis, albumin was superior to plasmalyte in achieving the primary end-point (62% vs. 22%; p<0.001). A rapid decline in arterial lactate (P=0.03), a lesser proportion of dialysis [48% vs. 62%; p=0.16], and a higher time to initiation of dialysis (in hours) [68.13±47.79 vs. 99.7± 63.4; p=0.06] was seen with albumin. However, the 28-day mortality was not different (58% vs. 62%, p=0.57). Patients in the albumin group required discontinuation of therapy in 11 (22%) patients due to adverse effects compared to none in plasmalyte group. CONCLUSION In patients with cirrhosis and SIH, 20% albumin transiently improves the hemodynamics with early lactate clearance than plasmalyte but needs monitoring as it is more often attended with pulmonary complications. Both fluids provide comparable 28 days survival. NCT02721238 LAY SUMMARY: The current randomized controlled trial performed in critically ill patients with cirrhosis and sepsis-induced hypotension highlights that 20% albumin restores hemodynamics but causes more pulmonary complications than plasmalyte. The impact on renal functions was also modest. These effects did not result in improvement in deaths at 28-days. Plasmalyte is safer and well-tolerated and can be considered for volume resuscitation in patients with cirrhosis and sepsis-induced hypotension.
Journal of Clinical Virology Plus
Hepatology International, 2021
Sepsis and septic shock are common causes of hospitalization and mortality in patients with cirrh... more Sepsis and septic shock are common causes of hospitalization and mortality in patients with cirrhosis. There is no data on the choice of fluid and resuscitation protocols in sepsis-induced hypotension in cirrhosis. In this open-label trial conducted at a single center, we enrolled 308 cirrhotics with sepsis-induced hypotension and randomized them to receive either 5% albumin or normal saline. The primary endpoint was a reversal of hypotension [mean arterial pressure, MAP, ≥ 65 mmHg] at 3 h. Secondary endpoints included serial effects on heart rate, arterial lactate and urine output. 154 patients each received 5% albumin (males, 79.8%, mean MAP 52.9 ± 7.0 mm Hg) or 0.9% saline (85.1%, 53.4 ± 6.3 mm Hg) with comparable baseline parameters and liver disease severity. Reversal of hypotension was higher in patients receiving 5% albumin than saline at the end of one hour [25.3% and 11.7%, p = 0.03, Odds ratio (95% CI)—1.9 (1.08–3.42)] and at the end of three hours [11.7% and 3.2%, p = 0.008, 3.9 (1.42–10.9)]. Sustained reduction in heart rate and hyperlactatemia (p < 0.001) was better in the albumin group. At one week, the proportion of patients surviving was higher in the albumin group than those receiving saline (43.5% vs 38.3%, p = 0.03). Female gender and SOFA ≥ 11 were predictors of non-response to fluid. 5% human albumin is safe and beneficial in reversing sepsis-induced hypotension compared to normal saline in patients with cirrhosis improving clinically assessable parameters of systemic hemodynamics, tissue perfusion and in-hospital short-term survival of cirrhosis patients with sepsis.
Journal of Hepatology, 2020
Journal of Clinical and Translational Hepatology, 2020
Access Microbiology, 2020
Background: Although Cytomegalovirus (CMV) reactivation is not uncommon in critically ill patient... more Background: Although Cytomegalovirus (CMV) reactivation is not uncommon in critically ill patients, it has not been studied for cirrhotic patients in Liver-ICU. Methods: CMV reactivation (CMV-plasma-DNAemia; ≥ 500 IU/ml), risk factors and clinical outcomes were assessed among sero-positive non-immunosuppressed critically ill cirrhotic adults at day 0, 7, 14 and 21 in Liver-ICU. Results: Of 94 consecutive patients in Liver-ICU monitored, 55(48 men) patients were enrolled. Overall, 20 critically ill cirrhotic adults showed CMV reactivation with a median day for follow-up of 11 (IQR: 8 to 18). Majority (n=17/55, 30.9%; CI: 19.1-44.8) showed CMV reactivation at day 7. During 21-day follow-up, incidence rate/density of CMV reactivation was 2.75% per person-day (95% CI: 1.68 - 4.26% per person-day).Total leucocyte count (day 0) was an independent risk factor for CMV reactivation (adjusted OR: 1.15, 95% CI: 1. 00-1. 32, p=0.04) with cut-off point of 19.05 (AUROC: 0.696, 95% CI: 0.547-0.844, p=0.017). Increased nosocomial infection (p=0.009), SIRS (p=0.01) and ARDS (p=0.04) were observed at day 7, coinciding with CMV reactivation during Liver-ICU stay. ICU-Mortality (61.8%) did not significantly differ with and without CMV reactivation. (55 % vs. 65.7%, p= 0.43). Patients with CMV reactivation experienced early death and slightly longer stay in Liver-ICU. (Log rank p=0.06 and 0.17, respectively). Conclusions: CMV reactivation occurs frequently with leucocytosis being an independent risk factor among critically ill non-immunosuppressed cirrhotic adults. Although CMV reactivation was associated with more severe organ dysfunction during Liver-ICU stay, it did not significantly influence ICU-mortality and Length of Liver-ICU stay.
Journal of Laboratory Physicians, 2019
BACKGROUND: Clinical significance of respiratory viruses (RVs) as an etiology of pneumonia in liv... more BACKGROUND: Clinical significance of respiratory viruses (RVs) as an etiology of pneumonia in liver disease patients with cirrhosis is usually underestimated. Therefore, the aim of this study was to evaluate the spectrum of RVs in cirrhotic patients with pneumonia admitted in critical care units (CCUs) and its impact on the clinical outcome of cirrhotic patients. MATERIAL AND METHOD: A prospective study was conducted in a tertiary care CCU, and consecutive cirrhotic patients with pneumonia were included. Bronchoalveolar lavage or throat swab/nasal swab was collected in viral transport medium for analysis of RVs by multiplex real-time polymerase chain reaction. A total of 135 cirrhotic patients were included, viral and bacterial etiology of pneumonia was identified, and analysis was done with the clinical outcome. RESULTS: Overall, RVs were detected in 30 (22.2%) cirrhotic patients and viral–bacterial coinfection in 16 (11.8%) cirrhotic patients. The most common virus detected was rh...
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Papers by Lalita Gouri Mitra