In late December 2019, a cluster of atypical pneumonia cases was noticed in Wuhan, China, which was later identified as an outbreak of coronavirus disease 2019 (COVID'Äê19). Since then, it has spread globally, causing public health emergency and urgency, and declared as a pandemic by the World Health Organization (WHO). As of 1 April 2020, the data shows more than 200 countries and territories have been affected, with more than 824,000 con-firmed cases and 41,000 deaths. Across the globe, many cancer patients visit the hospital and clinics for treatment and investigations. A large number of this population are immunocom-promised, either due to their underlying disease or cancer treatments which put them at higher risk for infection and complications. In addition, several risk factors have been identified that increase the risk and severity of infection with COVID-19, and cancer patients commonly have many of them. Recently, a large retrospective study among cancer patients infected with COVID-19 in Wuhan, China, found a higher incidence of severe events in cancer patients compared to patients without cancer. As doctors working amid this pandemic, we all have responsibilities and duties to act upon local guidelines to ensure the continuation of essential cancer services without overwhelming the health care system. In this review, we addressed the potential challenges and possible actions for clinicians to manage cancer patients during this unusual time.
Sepsis syndrome is an emerging healthcare problem, especially in critically ill patients, regardless whether it's community- or hospital-acquired sepsis. This study evaluates the characteristics of these patients, in addition to the type, source, and outcome of sepsis and septic shock, in a university tertiary hospital in Palestine. It also studies the most common organisms encountered in these patients.This is retrospective observational chart review study of all adult admissions to the intensive care unit over a period of 2 years. The presence of sepsis and septic shock was assessed and documented based on the Third International Consensus Definitions (Sepsis-3). Data regarding demographics, severity, comorbidities, source of infection, microbiology, length of stay, and outcomes (dead/alive at discharge from ICU) were recorded.A total number of 174 patients were included. The mean age was 57.4 years, with cardiovascular diseases and diabetes being the leading comorbidities encountered in them. Respiratory infections were the most common site of sepsis, found in around 71% of patients, followed by urinary tract infections. More than 70% of cases were due to hospital-acquired infections (HAIs). Acinetobacter species were the most common gram-negative organisms encountered, while Enterococcus was the most common gram-positive organisms. Around 54% of patients had multidrug-resistant organisms. The average length of stay in the ICU was 8 days. The average mortality rate was 39.7%, which is higher among septic shock patients.Both sepsis and septic shock carry high morbidity and mortality rates, and they are very frequent among critically ill patients. Special care and developing management bundles are crucial in controlling and preventing this threat.Rabee HA, Tanbour R, Nazzal Z, Hamshari Y, Habash Y, Anaya A, et al. Epidemiology of Sepsis Syndrome among Intensive Care Unit Patients at a Tertiary University Hospital in Palestine in 2019. Indian J Crit Care Med 2020;24(7):551-556.
Sheehan's syndrome is a postpartum hypopituitarism state caused by necrosis of the pituitary gland. It is usually the result of severe hypotension or shock caused by massive hemorrhage during or after delivery. Sheehan's syndrome symptoms are often subtle and hence it is diagnosed late. Herein, we report a case of a 41-year-old woman who developed severe postpartum hemorrhage after childbirth that required a total abdominal hysterectomy to control bleeding at the age of 36 years. Since then, she has progressively developed symptoms of headache, general fatigue, and malaise, and finally presented with pancytopenia for investigations. Anemia is a well-known hematological association with Sheehan's syndrome while pancytopenia is rarely reported. However, complete recovery of pancytopenia was observed after the treatment. Pancytopenia (due to bone marrow failure to produce cells) is a serious finding in clinical practice that causes significant stress as it may point to a diagnosis of malignancy (mainly leukemia) and other serious disorders. Despite being a rare cause, a high index of suspicion is required from the physicians in women with pancytopenia, in order to look for a possible treatable cause of pancytopenia (like Sheehan's syndrome), if the common causes were excluded.
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