Objective To evaluate the hypothesis that the Modified Early Warning Score (MEWS) at the time of intensive care unit discharge is associated with readmission and to identify the MEWS that most reliably predicts intensive care unit readmission within 48 hours of discharge. Methods This was a retrospective observational study of the MEWSs of discharged patients from the intensive care unit. We compared the demographics, severity scores, critical illness characteristics, and MEWSs of readmitted and non-readmitted patients, identified factors associated with readmission in a logistic regression model, constructed a Receiver Operating Characteristic (ROC) curve of the MEWS in predicting the probability of readmission, and presented the optimum criterion with the highest sensitivity and specificity. Results The readmission rate was 2.6%, and the MEWS was a significant predictor of readmission, along with intensive care unit length of stay > 10 days and tracheostomy. The ROC curve of the MEWS in predicting the readmission probability had an AUC of 0.82, and a MEWS > 6 carried a sensitivity of 0.78 (95%CI 0.66 - 0.9) and specificity of 0.9 (95%CI 0.87 - 0.93). Conclusion The MEWS is associated with intensive care unit readmission, and a score > 6 has excellent accuracy as a prognostic predictor.

Timolol Maleate (also called Timolol) is a nonselective beta-adrenergic blocker and a class II antiarrhythmic drug, which is used to treat intraocular hypertension. It has been reported to cause systemic side effects especially in elderly patients with other comorbidities. These side effects are due to systemic absorption of the drug and it is known that Timolol is measurable in the serum following ophthalmic use. Chances of life threatening side effects increase if these are coprescribed with other cardiodepressant drugs like calcium channel or systemic beta blockers. We report a case where an elderly patient was admitted with three side effects of Timolol and his condition required ICU admission with mechanical ventilation and temporary transvenous pacing. The case emphasizes the need of raising awareness among physicians of such medications about the potential side effects and drug interactions. A close liaison among patient's physicians is suggested.

Transorbital penetrating injuries are unusual but may cause severe brain damage if cranium is entered. These kinds of injuries are dangerous as the walls of orbit are very thin, hence easily broken by the otherwise innocent objects. Because of the very critical anatomical area involved, these injuries pose a serious challenge to the physicians who first receive them as well as the treating team. These may present as trivial trauma or may be occult and are often associated with serious complications and delayed sequel. Prompt evaluation by utilizing best diagnostic modality available and timely interference to remove them are the key aspects to avoid damage to vital organs surrounding the injury and to minimize the late complications. We report a case of transorbital assault with a 13 centimeter long knife which got broken from the handle and the blade was retained. The interesting aspect is that there was no neurological deficit on presentation or after removal.

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Critically ill patients are frequently immobilized which exposes them to multiple hazards particularly muscle weakness. Early mobilization of those patients was proposed few years ago and may be associated with improvement of patient's outcomes, especially reduction of ICU length of stay.Aim: To report the results of a quality improvement project of early mobilization in a tertiary center ICU.Method: A full detailed protocol was developed for the intervention and applied in the ICU as of January 2017. Outcomes of enrolled patients were compared to that of un-enrolled patients. The impact of the program on ICU LOS was evaluated by propensity score matching, using un-enrolled patients as controls.Results: Propensity score matching yielded a significant impact on LOS in the form of average reduction of 8.6 days (95% CI: 3.4-13.8, p=0.001), the average ICU LOS of enrolled patients was significantly lower than that of un-enrolled (15.8±8.2 vs. 21±9, p=0.04), as well as the duration of weaning trials duration (4.1±2.6 vs. 7.6±5.2, p=0.03), there was no difference in ICU mortality (p=0.07). Conclusion:Early mobilization of critically ill patients may be associated with reduced ICU LOS and weaning trial period.