Malaria remains a major health problem in much of Asia and Africa. A steady number of cases of imported malaria are also seen in many countries of the developed world. Plasmodium falciparum malaria and to some extent malaria caused by other species of Plasmodium can lead to many complications such as acute respiratory distress syndrome (ARDS), cerebral malaria, acute renal failure, severe anemia, thrombocytopenia, and bleeding complications. About 10% of patients with severe malaria die, usually as a result of multiorgan dysfunction. Critical care physicians should be aware of the complications and management of severe malaria. There has been significant progress in the understanding of pathogenesis of severe malaria over the last decade. Effective management of severe malaria includes early suspicion, prompt diagnosis, early institution of appropriate antimalarial chemotherapy, and supportive care, preferably in an intensive care unit. In this article, we review the different manifestations of severe malaria as relevant to critical care physicians and discuss the principles of laboratory diagnosis and management.

Background: During recent years, fungal infections have risen exponentially and are a cause of significant morbidity and mortality in hospitalized patients, especially in the critical care setting. There is paucity of data from India on fungal pathogens. Methods:We prospectively studied patients admitted to medical and surgical critical care section of a tertiary care institute in northern India. The clinical samples of patients were processed in Department of Microbiology for isolation and identification of fungi by using standard protocols over a period of one year. The patients were categorized into fungal infection and colonization groups. The demographic data and risk factors for fungal infection and colonization were evaluated.Results: Ninety one (82.7%) of the 110 patients enrolled in the study, had fungal infection, whereas 19 (17.3%) had fungal colonization. Candida were isolated from 85/91 (93.4%) and 19/19 (100%) patients with fungal infection and colonization respectively. There was predominance of non-albicans Candida spp both in fungal infection 61/85 (71.7%) patients as well as fungal colonization group 16/19 (84.2% ). In non-albicans Candida spp., Candida tropicalis was the most common isolate observed in both fungal infection (85.3%) and fungal colonization (63.1%) groups. Overall, in patients with fungal infection, candiduria was detected in 68/91 (74.7%) whereas candidaemia was observed in 19/ 91 (20.8%) patients. The risk factors for fungal infections included urinary catheterization (85.7%), central line insertion (81.3%), mechanical ventilation (52.7%), use of corticosteroids (23.1%), total parentral nutrition (6.6%) and peritoneal dialysis (3.3%). Conclusions:The emergence of non-albicans Candida similar to the trends in the western countries should be a cause of concern in our country. Proper surveillance of fungal pathogens is important to improve quality of care in critical care setting and measures should be focussed to control these infections, especially in patients with these risk factors.

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Background:Outcome and predictors of survival after cardiopulmonary resuscitation (CPR) in Intensive Care Units (ICUs) have been extensively studied in western world, but data from developing countries is sparse.Objectives:To study the outcome and predictors of survival after CPR in a Medical ICU (MICU) of a tertiary level teaching hospital in North India.Materials and Methods:A 1-year prospective cohort study.Results:Of 105 in-MICU CPRs, forty patients (38.1%) achieved return of spontaneous circulation (ROSC). Only one patient (0.9%) survived up to hospital discharge. The predictors of ROSC were ventricular tachycardia/ventricular fibrillation as first monitored rhythm, intubation during CPR and CPR duration ≤ 10 min. CPR duration > 10 min was a significant factor for resuscitation failure.Conclusions:The rate of survival to hospital discharge after in-MICU CPRs is extremely poor. Our data may aid treating physicians, resuscitation teams, and families in understanding the likely outcome of patients after in-MICU CPRs.