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ObjectiveTo evaluate the effectiveness of noradrenaline for the treatment of hepatorenal syndrome (HRS).BackgroundHRS represents the development of renal failure in cirrhotic patients. The standard treatment for HRS is terlipressin, which, as opposed to noradrenaline, is more expensive and less accessible in most tertiary care centers.Patients and methodsThirty consecutive patients with HRS type 1 received noradrenaline (1–4.0 mg/hour) and albumin for 14 days. The parameters recorded were: serum creatinine levels, creatinine clearance, mean arterial pressure (MAP), urine output, and serum sodium levels evaluated at baseline and on treatment days 1, 3, 7, and 14.ResultsMost patients achieved serum creatinine levels <1.5 mg/dL and were considered responders (22/30, 73%), whereas eight patients (27%) were nonresponders. At baseline, responders and nonresponders differed only regarding initial bilirubin levels and international normalized ratio values. Treatment duration was 7.5±3.2 days. Responders experienced a significant (p<0.05) decrease in serum creatinine levels (from 3.26±0.48 to 1.28±0.14 mg/dL), as well as a significant increase (p<0.05) in creatinine clearance (from 21±4.1 to 67.7±12.1 mL/min), urine output (from 583±41.1 to 1163±105 mL/day), MAP (from 79.2±2.94 to 93.9±2.34 mmHg), and serum sodium levels (from 125±2.01 to 132.3±1.39 mEq/L). In nonresponders, the MAP increased, but serum creatinine levels also increased, reflecting a decrease in creatinine clearance and urine output, with no significant change in serum sodium levels over the duration of the treatment.ConclusionIn most patients, noradrenaline treatment induced systemic vasoconstriction resulting in HRS reversal, with acceptable safety, in agreement with previously reported outcomes of terlipressin treatment.

Background: Stroke in a migraine with aura has been documented in several cases, even deserving the merit of a classification as complicated migraine. Herein, we present a rare case of migrainous infarct without aura. The diagnosis was challenging due to lack of risk factors. The patient was unique in not having any other comorbidities. Case Presentation: The case is of a 21-year-old female presenting with right-sided hemiplegia and facial drooping. She had had an index presentation of throbbing headaches for the past 2 years, typical of a migraine but not preceded by any aura symptoms. However, in the current episode, the pain became excessively severe and accompanied by right-sided hemiplegia and facial drooping. A full investigation workup using MRI revealed evidence of infarct in the left temporoparietal and basal ganglion region. Conclusion: Our case highlights the need to evaluate silent ischemic stroke in case of prolonged headache with a history of migraine as well as the need for precaution to avoid the use of triptans or opioids in such a case. It also highlights the conditions that need to be excluded before labeling it as a migrainous infarct.

Table of contentsP1 D-Dimer in adult patients with presumed sepsis and their clinical outcomesSurinder Kumar Sharma, Anurag Rohatgi, Mansi BajajP2 Diagnosis of infection utilizing Acellix CD64Charles L. Sprung, Ricardo Calderon Morales, Harvey Kasdan, Allon Reiter, Tobias Volker, Julien MeissonnierP3 High levels of phenylcarboxylic acids reflect the severity in ICU patients and affect phagocytic activity of neutrophilsNatalia Beloborodova, Viktor Moroz, Aleksandra Bedova, Yulia Sarshor, Artem Osipov, Katerina ChernevskayaP4 The role of bacterial phenolic metabolites in mitochondrial dysfunctionNadezhda Fedotcheva, Ekaterina Chernevskaya, Natalia BeloborodovaP5 The early diagnosis of severe sepsis and judgment of rapid transport to critical care center: better prognostic factorHisashi Imahase, Kosuke C Yamada, Yuichiro Sakamoto, Miho Ohta, Ryota Sakurai, Mayuko Yahata, Mitsuru Umeka, Toru Miike, Hiroyuki Koami, Futoshi Nagashima, Takashi Iwamura, Satoshi InoueP6 Translational neuromodulation of the immune systemZhifeng Li, Dennis Grech, Patrick Morcillo, Alex Bekker, Luis UlloaP7 Pathway-level meta-analysis reveals transcriptional signature of septic shockSamanwoy Mukhopadhyay, Abhay D Pandey, Samsiddhi Bhattacharjee, Saroj K MohapatraP8 Antibiotic dosing in septic patients on the critical care unit - a literature reviewJulie K WilsonP9 Pandemic of Escherichia coli clone O25: H4-ST131 producing CTX-M-15 extended spectrum- β- lactamase- as serious cause of multidrug resistance extraintestinal pathogenic E. coli infections in IndiaSavita Jadhav, Rabindra Nath Misra, Nageswari Gandham, Kalpana Angadi, Chanda Vywahare, Neetu Gupta, Deepali DesaiP10 Detection and characterization of meningitis using a DDA-based mass spectrometry approachAnahita Bakochi, Tirthankar Mohanty, Adam Linder, Johan MalmströmP11 Diagnostic usefulness of lipid profile and procalcitonin in sepsis and trauma patientsDimple Anand, Seema Bhargava, Lalit Mohan Srivastava, Sumit RayP12 Heparin – a novel therapeutic in sepsis?Jane Fisher, Peter Bentzer, Adam LinderP13 Hypothalamic impairment is associated with vasopressin deficiency during sepsisLuis Henrique Angenendt da Costa, Nilton Nascimentos dos Santos Júnior Carlos Henrique Rocha Catalão, Maria José Alves da RochaP14 Presepsin (soluble CD14 subtype) is a dependable prognostic marker in critical septic patientsAlfredo Focà, Cinzia Peronace, Giovanni Matera, Aida Giancotti, Giorgio Settimo Barreca, Angela Quirino, Maria Teresa Loria, Pio Settembre, Maria Carla Liberto, Bruno AmanteaP15 Safety and efficacy of gelatin-containing solutions versus crystalloids and albumin - a systematic review with quantitative and qualitative summariesChristiane Hartog, Christiane Hartog, Claudia Moeller, Carolin Fleischmann, Daniel Thomas-Rueddel, Vlasislav Vlasakov, Bram Rochwerg, Philip Theurer, Konrad ReinhartP16 Immunomodulatory properties of peripheral blood mesenchymal stem cells following endotoxin stimulation in an equine modelAnna E. Smith, Sandra D. TaylorP17 Frequency and outcome of early sepsis-associat...

Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML), a cancer of the white blood cells. Its common manifestations are fatigue, fever, coagulopathy, anorexia, and pancytopenia. Oral manifestations are identified in huge majority of patients with AML of which gingival hypertrophy is more specific to acute monocytic (M5) and acute myelomonocytic (M4) subtypes of AML. Very rarely, gingival hypertrophy may be encountered in patients with APL. Herein, we present a case of a young male who presented with gingival hypertrophy and was subsequently diagnosed with APL (M3).