Intensive Care Medicine

Viruses, and in particular, RNA viruses, dominate the WHO's current list of ten global health threats. Of these, we review the widespread and most common HIV, influenza virus, and SARS-CoV-2 infections, as well as their possible prevention by vaccination and treatments by pharmacotherapeutic approaches. Beyond the vaccination, we discuss the virus-targeting and host-targeting drugs approved in the last five years, in the case of SARS-CoV-2 in the last one year, as well as new drug candidates and lead molecules that have been published in the same periods. We share our views on vaccination and pharmacotherapy, their mutually reinforcing strategic significance in combating pandemics, and the pros and cons of host and virus-targeted drug therapy. The COVID-19 pandemic has provided evidence of our limited armamentarium to fight emerging viral diseases. Novel broad-spectrum vaccines as well as drugs that could even be applied as prophylactic treatments or in early phases of the viremia, possibly through oral administration, are needed in all three areas. To meet these needs, the use of multi-data-based precision medicine in the practice and innovation of vaccination and drug therapy is inevitable.

Shayyamutra (Primary Nocturnal Enuresis) is a common problem for small age groups and also of older age group too. When young children are in trouble it become a nuisance for them as well as parents. Moreover, it hampers the emotional and social growth of the child. In the management of conditions like enuresis the other system of medicines have their own limitations. Though claims for cure rate are very great by contemporary science but associated hazards also have been noticed. Hazards due to drugs compel the medical fraternity to search a cure that would be better and convenient for enuretic child in all aspects. Ayurveda is the only medical system in the world that clearly emphasizes the treatment of ailments and further maintenance of health by reversing the pathology. Thus, this problem was selected for the present review study. A genuine effort will be made to understand the psychological state of the patients and guide them appropriately.

To efficiently treat type 1 diabetes, exogenous insulin injections currently represent the main approach to counter chronic hyperglycaemia. Unfortunately, such a therapeutic approach does not allow for perfectly maintained glucose homeostasis and, in time, cardiovascular complications may arise. Therefore, seeking alternative/improved treatments has become a major health concern as an increasing proportion of type 2 diabetes patients also require insulin supplementation. Towards this goal, numerous laboratories have focused their research on β-cell replacement therapies. Herein, we will review the current state of this research area and describe the cell sources that could potentially be used to replenish the depleted β-cell mass in diabetic patients.

Viruses account for the majority of the acute respiratory tract infections (ARIs) globally with a mortality exceeding 4 million deaths per year. The most commonly encountered viruses, in order of frequency, include influenza, respiratory syncytial virus, parainfluenza and adenovirus. Current evidence suggests that the major mode of transmission of ARIs is through large droplets, but transmission through contact (including hand contamination with subsequent selfinoculation) and infectious respiratory aerosols of various sizes and at short range (coined as "opportunistic" airborne transmission) may also occur for some pathogens. Opportunistic airborne transmission may occur when conducting highrisk aerosol generating procedures and airborne precautions will be required in this setting. General infection control measures effective for all respiratory viral infections are reviewed and followed by discussion on some of the common viruses, including severe acute respiratory syndrome (SARS) coronavirus and the recently discovered novel coronavirus.

Mitochondria are sub-cellular organelles that produce adenosine triphosphate (ATP) through oxidative phosphorylation (OXPHOS). As suggested over 70 years ago by Otto Warburg and recently confirmed with molecular techniques, alterations in respiratory activity and in mitochondrial DNA (mtDNA) appear to be common features of malignant cells. Somatic mtDNA mutations have been reported in many types of cancer cells, and some reports document the prevalence of inherited mitochondrial DNA polymorphisms in cancer patients. Nevertheless, a careful reanalysis of methodological criteria and methodology applied in those reports has shown that numerous papers can't be used as relevant sources of data for systematic review, meta-analysis, or finally for establishment of clinically applicable markers. In this review technical and conceptual errors commonly occurring in the literature are summarized. In the first place we discuss, why many of the published papers cannot be used as a valid and ...

Premature mortality (PM) has emerged as a global health challenge. This is of eminent importance in low- and middle-income countries, where nearly three fourths of the deaths occur. The concerning issue is the early occurrence of fatal events in productive age. Fatal events before the age of 70 are called PM, which mainly result from cardiovascular diseases (CVDs). Iran as a middle– income country greatly suffers from the cardiovascular burden, which accounts for almost 50% of all PM. Despite substantial success in reducing mortality due to communicable diseases across different age ranges, urbanization and pervasiveness of cardiovascular risk factors have increased the death rate in adults in recent years. Undoubtedly, such lifestyles have imposed heavy costs on the healthcare system; it is possible that PM reduction, as one of the fundamental elements of sustainable development goals defined by the World Health Organization (WHO), would not be reached by the due date. Recently, re...

The acute respiratory illnesses caused by severe acquired respiratory syndrome corona Virus-2 (SARS-CoV-2) is a global health emergency, involving more than 8.6 million people worldwide with more than 450,000 deaths. Among the clinical manifestations of COVID-19, the disease that results from SARS-CoV-2 infection in humans, a prominent feature is a pro-thrombotic derangement of the hemostatic system, possibly representing a peculiar clinicopathologic manifestation of viral sepsis. The severity of the derangement of coagulation parameters in COVID-19 patients has been associated with a poor prognosis, and the use of low molecular weight heparin (LMWH) at doses registered for prevention of venous thromboembolism (VTE) has been endorsed by the World Health Organization and by Several Scientific societies. However, some relevant issues on the relationships between COVID-19, coagulopathy and VTE have yet to be fully elucidated. This review is particularly focused on four clinical questions: What is the incidence of VTE in COVID-19 patients? How do we frame the COVID-19 associated coagulopathy? Which role, if any, do antiphospolipid antibodies have? How do we tackle COVID-19 coagulopathy? In the complex scenario of an overwhelming pandemic, most everyday clinical decisions have to be taken without delay, although not yet supported by a sound scientific evidence. This review discusses the most recent findings of basic and clinical research about the COVID-associated coagulopathy, to foster a more thorough knowledge of the mechanisms underlying this compelling disease.

Background: Sepsis is a serious threat, causing a staggering number of hospitalizations; additionally, the difficulties in identifying early symptoms and starting the right treatment is a major contributing factor to the high mortality rates linked to sepsis. Severe sepsis is a serious complication of sepsis where the body's response to an infection damages its organs. This study investigated nurses' knowledge about implementing the one-hour sepsis bundle in Najaf, Iraq. Methodology: A descriptive cross-sectional design was employed. Data was collected from 52 nurses working in the respiratory, intensive, and burn care units at two government hospitals in Najaf City between 19th and April 25th, 2024. The study was conducted in Al-Najaf City's governmental hospitals: (The study was conducted at one governmental hospital (Al-Sadr Medical City and Burn Hospital in Al-Najaf City). A specially prepared questionnaire was used to collect the required data, and a selfadministered questionnaire, developed based on relevant guidelines and validated by experts, was used for data collection. Purposive sampling was employed to recruit participants. Descriptive statistics and qi-square were used to analyze the data. Results: The study revealed a concerning lack of understanding among nurses regarding the key steps outlined in the one-hour sepsis bundle. Furthermore, there was no association between the overall assessment of nurses' knowledge about the one-hour sepsis bundle and their demographic data (P>0.05). Conclusion: Based on the results and discussion, the study concluded that the majority of nurses had a fair knowledge of the one-hour sepsis bundle, which is considered satisfactory. Nurses in Najaf hospitals require improved knowledge about the one-hour sepsis bundle for effective participation in early sepsis management. Implement regular in-service education programs on the surviving sepsis campaign guidelines and the onehour sepsis bundle. Closely monitor adherence to the sepsis bundle and provide feedback to nurses. Ensure comprehensive training on the one-hour sepsis bundle for all newly hired nurses.

Total parenteral nutrition is a feeding strategy widely used in children and, particularly, in preterm infants, due to a variety of pathological conditions that hinder enteral feeding. Parenteral feeding has been associated with the development of metabolic bone diseases. These can manifest as rickets and/or pediatric osteoporosis, with a prevalence reaching 40%, while the nutritional limitations of parenteral feeding, along with the increased metabolic needs of the bones at this growth stage, further deteriorate the problem. There are plenty of theories regarding the underlying mechanisms. Deficiency or toxicity of nutrients, such as calcium, phosphorus and vitamin D, and cholestasis have been identified as risk factors. Another contributing factor is the contamination with aluminum, with its numerous deleterious effects, along with the composition of the fatty acid emulsions administered. Appropriate enrichment of parenteral nutrition solutions with specific nutrients plays a key ...

Pseudothrombocytopenia (PTCP), a relative common finding in clinical laboratories, can lead to diagnostic errors, overtreatment, and further (even invasive) unnecessary testing. Clinical consequences with potential life-threatening events (e.g., unnecessary platelet transfusion, inappropriate treatment including splenectomy or corticosteroids) are still observed when PTCP is not readily detected. The phenomenon is even more complex when occurring with different anticoagulants. In this review we present a case of multi-anticoagulant PTCP, where we studied different parameters including temperature, amikacin supplementation, measurement methods, and type of anticoagulant. Prevalence, clinical risk factors, pre-analytical and analytical factors, along with clinical implications, will be discussed. The detection of an anticoagulant-dependent PTCP does not necessarily imply the presence of specific disorders. Conversely, the incidence of PTCP seems higher in patients receiving low molecular weight heparin, during hospitalization, or in men aged 50 years or older. New analytical technologies, such as fluorescence or optical platelet counting, will be soon overturning traditional algorithms and represent valuable diagnostic aids. A practical laboratory approach, based on current knowledge of PTCP, is finally proposed for overcoming spuriously low platelet counts.

The timing of surgical intervention and prosthesis selection in mildly
symptomatic aortic and mitral valve disease remain an area of clinical
uncertainty. Symptom-based referral often occurs after the onset of
adverse ventricular remodeling, whereas earlier surgery may improve
long-term outcomes but introduces procedural risk. This article
synthesized contemporary evidence to delineate optimal strategies in
this intermediate-risk population. In aortic stenosis, randomized trials
including RECOVERY and AVATAR demonstrate that early surgical
aortic valve replacement reduces heart failure events and may improve
survival. In aortic and mitral regurgitation, observational data associate
early intervention, triggered by mild symptoms or subclinical ventricular
dysfunction, with improved survival and preservation of cardiac function.
Emerging modalities such as global longitudinal strain and natriuretic
peptide biomarkers enhance risk stratification in asymptomatic individuals.
Prosthesis selection is primarily informed by patient age, comorbidity
burden, and anticoagulation tolerance. Mechanical valves confer superior
durability and lower reoperation risk in younger patients. Bioprosthetic
valves are increasingly favored in older adults due to compatibility with
transcatheter valve-in-valve reintervention and avoidance of lifelong
anticoagulation.

Chronic obstructive pulmonary disease (COPD) and lung cancer (LC) occupy first place among diseases with high incidence and mortality and become a genuine health problem through costs for the medical system. COPD is considered an independent risk factor for LC, in addition to smoking and occupational exposure. Prevention policies and early diagnosis and treatment may contribute to the decrease in the incidence of both diseases. This article reviews the epidemiological overlaps between the two diseases and the particular features of the diagnosis and treatment of LC in COPD patients.

Pharmacotherapy is an essential component of dental practice to manage pain, prevent infections, and maintain oral health. Analgesics such as non steroidal anti-inflammatory drugs (NSAIDs) and opioids are commonly used to manage pain during and after dental procedures. Antibiotics are prescribed to treat and prevent infections, but their use should be limited to reduce the risk of antibiotic resistance. Local anesthetics provide safe and effective pain relief during dental procedures. Fluorides are used to prevent tooth decay and strengthen tooth enamel. Dental healthcare providers should evaluate each patient's individual needs and medical history to determine the most appropriate pharmacotherapy. Patient education on the proper use of medications and potential side effects is also important. By incorporating pharmacotherapy as part of a comprehensive dental care plan, patients can experience a more comfortable and successful dental experience.

Introduction: Liver and biliary tract disorders in the neonate are relatively rare and often complex. Aims: To evaluate the incidence of neonatal liver and biliary tract disorders, main causes, clinical presentation, treatment and outcome. Material and Methods: Clinical, imagiological, laboratory, pathological and autopsy data concerning all newborns with liver and biliary tract disorder admitted to the neonatal intensive care unit of five tertiary medical centers from the north of Portugal, between 1997 and 2006, were retrospectively analysed. Results: 77 neonates (incidence 0.5% -77/14505 admissions); 44M/33F; gestational age 34 weeks (25-41); preterm 50 (65%); birthweight 1980g (570-4130), < 1500 g 29 (38%). Several causes were identified and classified as infectious, metabolic, anatomic/structural, neoplastic, vascular, traumatic, immune, genetic and idiopathic. Clinical signs appeared between days 1 and 61 of life. Jaundice was the most frequent clinical sign (92%). Cholestasis occurred in 67 (87%) patients. Duration of hospital stay was 35 days (5-146); 18 patients (23%) were deceased. Autopsy study was diagnostic in 8 cases (10%). Conclusions: Nosocomial and intrauterine infection were the most common causes of liver and biliary tract disease. Several other rare causes represented an important challenge in diagnosis and treatment, and some were fatal. Awareness of the spectrum of liver and bile duct disorders in the neonate and recognition of the key clinical features are essential to optimize outcome. Introdução: No recém-nascido, as doenças com atingimento hepático e do tracto biliar são relativamente raras e frequentemente complexas. Objectivos: Avaliar a incidência de doenças com atingimento hepático e biliar no recémnascido, principais causas, apresentação clínica, tratamento e evolução clínica. Material e Métodos: Análise retrospectiva de dados clínicos, imagiológicos, laboratoriais, anatomopatológicos e autópsias de recém-nascidos com doenças de atingimento hepático e do tracto biliar, admitidos nas unidades de cuidados intensivos neonatais de cinco centros hospitalares do norte de Portugal, entre 1997 e 2006. Resultados: 77 recém-nascidos (incidência 0,5% -11/14505 admissões); 44M/33F; mediana da idade gestacional 34 semanas (25 -41); recém-nascidos pré-termo 50 (65%); mediana do peso ao nascimento 1980 g (570 -4130), 29 (38%) com peso ao nascimento < 1500 g. Foram identificadas várias causas e classificadas como infecciosa, metabólica, anatómica/estrutural, neoplásica, vascular, traumática, imunológica, genética e idiopática. A apresentação clínica variou entre os dias 1 e 61 de vida. A icterícia foi o sinal clínico mais frequente (92%). Sessenta e sete doentes (87%) apresentaram colestase. A mediana da

Purpose: In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results: 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions: HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes.

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases. (

The 2019 Corona virus Outbreak (COVID-19) is a scientific, medical and social challenge. The complexity of Severe Acute Respiratory Syndrome Corona virus 2 (SARSCoV2) focuses on the clinical course of unpredictable illnesses that can develop rapidly and cause serious complications leading to death. Systemic inflammation and lung problems can ensue, causing considerable morbidity and mortality. Acute coronary syndrome (ACS), arrhythmias, myocarditis, acute myocardial damage, heart failure, and other problems affect the cardiovascular system. Existing data about cardiovascular complications had been collected from the case study performed in China, Wuhan and New York COVID-19 patients. In the case report of China, 16.7% out of 138 patients showed arrhythmias where heart failure was identified as a problem in 23% of patients in a retrospective study from Wuhan and 52% of non-survivors in China. On the other hand case studies on 18 COVID-19 patients with ST-elevation myocardial infarction (STEMI) on electrocardiogram (ECG) from New York were investigated; 6 patients(33%) reported chest pain, 14 patients (78%) reported ST-segment elevation, 6 patients (35%) reported regional wall motion abnormality on TTE, and 8 patients (44%) reported a clinical diagnosis of myocardial infarction and a total of 9 patients individuals (50%) had coronary angiography, with 6 patients (67%) of them showing obstructive disease. The cardiovascular consequences of COVID-19 infection are examined in this brief paper. The virus attaches to ACE2 (Angiotensin converting enzyme 2), allowing it to enter. COVID-19 therapy is currently being studied in conjunction with cardiovascular drugs. Therefore, emergency physicians should keep these cardiovascular complexities in mind while assessing and treating patients with COVID-19.

Obesity is epidemiologically and likely, causally related to various hematological cancers, while both conditions may predispose to severe SARS-CoV-2 infection. The COVID-19 pandemic brought about a variety of obstacles with respect to numerous aspects in the management of hematological malignancies. In the present overview, the evidence linking obesity with the development of hematological cancers and their role as risk factors for severe COVID-19 is critically appraised. Furthermore, the various challenges which emerged during the the pandemic are reviewed, regarding not only the treatment of the underlying hematological malignancies themselves, but also the prevention and therapeutic management of SARS-CoV-2 infection in this patient group. Lastly, we discuss further unresolved issues which need to be addressed in order to optimize the management of patients with hematologic cancers in the course of ongoing COVID-19 pandemic.

We report a case of an intravenous drug user (IVDU) patient who had 4 episodes of endocarditis within a 2-year time period in rural Georgia. The institutional cost was approximately $380,000. The lack of an established transitional care plan for IVDUs to outpatient care is a common phenomenon at institutions. Guidelines are essential to optimize the quality of care rendered to IVDUs with such infections, to assist providers in utilizing limited resources, and to limit the cost to the institutions.

en nombre del grupo de estudio COVID CODE SPAIN Objectives. To analyze the prescription of antiviral therapy for mild to moderate COVID-19 in Spanish emergency departments, the incidence of missed opportunities to prescribe, and associated factors. Methods. Retrospective cross-sectional study in 16 hospital emergency departments. We collected data for adults with mild to moderate COVID-19 confirmed within 7 days of first symptoms. The patients studied were at risk for progression and were treated as outpatients during the first 8 months of 2022. We estimated the incidence of missed opportunities and evaluated associated factors with a Bayesian statistical approach assuming noninformative prior distributions. Results. The overall incidence of missed opportunities to prescribe was 33.5% (95% probability interval [PI], 31.7%-35.3%). Incidences in the 16 hospitals ranged from 17.8% to 50.6%. Adjusted odds ratios (aORs) showed that factors associated with more missed opportunities were age (aOR, 1.021; 95% PI, 1.013-1.029); widening of recommended indications relative to the first period (aOR third period, 2.641 [95% PI, 1.844-3.783]; aOR fourth period, 7.440 [95% PI, 5.352-10.343]; and aOR fifth period, 17.743 [95% PI, 10.821-29.105]); immunosuppression (aOR, 2.698; 95% PI, 2.115-3.443); and fewer vaccine doses relative to no vaccination (aOR 3 doses, 0.287 [95% PI, 0.197-0-417] and aOR 4 doses, 0.115 [95% PI, 0.074-0.179]). Factors associated with increased antiviral prescription were obesity (aOR, 0.735, 95% PI, 0.567-0.952) and the existence of automated clinical pathway alerts (aOR, 0.287; 95% PI, 0.114-0.721). Conclusions. The incidence of missed opportunities to prescribe antiviral therapy is high. Incidences vary across hospitals and more often involve the most vulnerable patients.

Objectives To develop and validate a delirium prediction model for adult intensive care patients and determine its additional value compared with prediction by caregivers. Design Observational multicentre study. Setting Five intensive care units in the Netherlands (two university hospitals and three university affiliated teaching hospitals). Participants 3056 intensive care patients aged 18 years or over. Main outcome measure Development of delirium (defined as at least one positive delirium screening) during patients' stay in intensive care. The model was developed using 1613 consecutive intensive care patients in one hospital and temporally validated using 549 patients from the same hospital. For external validation, data were collected from 894 patients in four other hospitals. The prediction (PRE-DELIRIC) model contains 10 risk factors-age, APACHE-II score, admission group, coma, infection, metabolic acidosis, use of sedatives and morphine, urea concentration, and urgent admission. The model had an area under the receiver operating characteristics curve of 0.87 (95% confidence interval 0.85 to 0.89) and 0.86 after bootstrapping. Temporal validation and external validation resulted in areas under the curve of 0.89 (0.86 to 0.92) and 0.84 (0.82 to 0.87). The pooled area under the receiver operating characteristics curve (n=3056) was 0.85 (0.84 to 0.87). The area under the curve for nurses' and physicians' predictions (n=124) was significantly lower at 0.59 (0.49 to 0.70) for both. The PRE-DELIRIC model for intensive care patients consists of 10 risk factors that are readily available within 24 hours after intensive care admission and has a high predictive value. Clinical prediction by nurses and physicians performed significantly worse. The model allows for early prediction of delirium and initiation of preventive measures. Trial registration Clinical trials NCT00604773 (development study) and NCT00961389 (validation study).

The concurrent timing of the COVID-19 pandemic and the seasonal occurrence of influenza, makes it especially important to analyze the possible effect of the influenza vaccine on the risk of contracting COVID-19, or in reducing the complications caused by both diseases, especially in vulnerable populations. There is very little scientific information on the possible protective role of the influenza vaccine against the risk of contracting COVID-19, particularly in groups at high-risk of influenza complications. Reducing the risk of contracting COVID-19 in high-risk patients (those with a higher risk of infection, complications, and death) is essential to improve public well-being and to reduce hospital pressure and the collapse of primary health centers. Apart from overlapping in time, COVID-19 and flu share common aspects of transmission, so that measures to protect against flu might be effective in reducing the risk of contracting COVID-19. In this study, we conclude that the risk o...

ÖZ Koronavirüsler; solunum yolu ve gastrointestinal sistem enfeksiyonlarına, daha nadir olarak da hepatik, nörolojik ve nefrotik tutulum gösteren hastalık tablolarına neden olan zarflı, pozitif polariteli, tek sarmallı RNA virüsleridir. 2019 sonunda, Çin'in Wuhan şehrinde ortaya çıkan ve şiddetli akut solunum yolu sendromu-koronavirüs-2 (SARS-CoV-2) olarak adlandırılan yeni bir koronavirüs, olağan dışı viral pnömoni salgınına neden olmuştur. Bu çalışmada, koronavirüs hastalığı-2019 (COVID-19) hastalarında sistemik immün-enflamasyon (SII) indeksi, C-reaktif protein (CRP) ve interlökin-6 (IL-6) ile viral dinamik arasındaki ilişkiyi ortaya koymak amaçlanmıştır. Çalışma tek merkezli ve retrospektif olarak yapılmıştır. 1 Nisan-31 Mayıs 2020 tarihleri arasında Ankara Şehir Hastanesi'ne başvuran ve nazofarengeal/orofarengeal sürüntü örneklerinde SARS-CoV-2 polimeraz zincir reaksiyon (PCR) testleri pozitif bulunan, 338 yatan hasta çalışmaya dahil edilmiştir. Hastalar servis/yoğun bakım, entübasyon ve mortalite durumlarına göre üç gruba ayrılmış ve klinik verileri değerlendirilmiştir. Viral dinamikler ile SII, nötrofil lenfosit oranı (NLR), lenfosit CRP oranı (LCR), lenfosit monosit oranı (LMR) ve platelet lenfosit oranı (PLR), CRP, IL-6, ferritin, albümin düzeyleri ve lenfosit sayısı arasındaki ilişkiyi saptamak için korelasyon analizi yapılmıştır. İleri yaş, düşük Ct değeri, IL-6 artışı, SII'da artış, albüminde azalma, ferritin artışı, lenfosit sayısında azalma, NLR'de artış,

Venous thrombosis happens when a blood clot becomes stuck in a vein. It can affect either superficial veins or deep veins. The presence of thrombosis is typically associated with phlebitis, which is the swelling of the vein. The condition can arise from clotting disorders or might signal an undisclosed cancer. Various elements that could lead to thrombosis include: trauma to the blood vessel lining caused by a catheter, blood flow stagnation after surgeries, use of birth control pills, and extended periods of sitting with legs down, posing risks even to those who are otherwise healthy.

ObjectiveWe aimed to provide an evidence-supported update of the ECCO-ESPGHAN guideline on the medical management of paediatric Crohn’s disease [CD].MethodsWe formed 10 working groups and formulated 17 PICO-structured clinical questions [Patients, Intervention, Comparator, and Outcome]. A systematic literature search from January 1, 1991 to March 19, 2019 was conducted by a medical librarian using MEDLINE, EMBASE, and Cochrane Central databases. A shortlist of 30 provisional statements were further refined during a consensus meeting in Barcelona in October 2019 and subjected to a vote. In total 22 statements reached ≥ 80% agreement and were retained.ResultsWe established that it was key to identify patients at high risk of a complicated disease course at the earliest opportunity, to reduce bowel damage. Patients with perianal disease, stricturing or penetrating behaviour, or severe growth retardation should be considered for up-front anti-tumour necrosis factor [TNF] agents in combi...

Children and adolescents with Crohn&#39;s disease (CD) present often with a more complicated disease course compared to adult patients. In addition, the potential impact of CD on growth, pubertal and emotional development of patients underlines the need for a specific management strategy of pediatric-onset CD. To develop the first evidenced based and consensus driven guidelines for pediatric-onset CD an expert panel of 33 IBD specialists was formed after an open call within the European Crohn&#39;s and Colitis Organisation and the European Society of Pediatric Gastroenterolog, Hepatology and Nutrition. The aim was to base on a thorough review of existing evidence a state of the art guidance on the medical treatment and long term management of children and adolescents with CD, with individualized treatment algorithms based on a benefit-risk analysis according to different clinical scenarios. In children and adolescents who did not have finished their growth, exclusive enteral nutriti...

Background: Neonates, inherently vulnerable due to low birth weight, physiological immaturity, and extensive medication exposure, are at an increased risk of iatrogenic skin harm. Aim of the study: The study aimed to evaluate effectiveness of an educational program on iatrogenic skin afflictions, focusing on pediatric nurses' performance and neonates' clinical outcomes. Methods: Conducted at the Neonatal Intensive Care Unit (NICU) of Aswan University hospital, the quasiexperimental study involved a convenient sample of 55 nurses and 39 neonates admitted within one month. Data collection utilized three tools: a structured interview questionnaire encompassing biosocial data and nurses' knowledge, an observation checklist to assess nurse practices regarding iatrogenic skin affliction, and an assessment of neonate clinical outcomes. Results: Posteducational program, the study revealed significant improvements in both nurses' knowledge and practices. Statistically significant differences were observed in nurses' knowledge and practices before, immediately after, and one month after the educational program. Conclusion: Implementation of an educational program addressing skin injuries resulted in improved nurses' performance in Neonatal Intensive Care Units. Integrating preventive care measures for acquired skin injuries into routine neonatal care is highly recommended. Practical Implications: Highlighting neonatal vulnerability to iatrogenic skin issues, the NICU education program proved crucial for nurses. Post-program, enhanced knowledge and practices were noted, emphasizing the practical significance of targeted education to mitigate iatrogenic risks in neonatal care settings. for targeted neonatal education to mitigate iatrogenic risks.

Acute renal failure is one of the most common complications of rhabdomyolysis. Rhabdomyolysis is a serious syndrome and should be suspected in patients presenting after direct or indirect muscle injury, seizures, strenuous exercise, crush injuries and ingestion of drug or toxins. Rhabdomyolysis secondary to status epilepticus is a serious complication, leading to life threatening acute renal failure. Therefore, early recognition of risk of rhamdomylosis in status epilepticus and initiation of treatment is important.

patients who died of COVID-19 in China demonstrated that there is evidence of the invasion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into kidney tissue, along with significant acute tubular injury and endothelial damage, as well as glomerular and vascular changes indicative of underlying diabetic or hypertensive disease. 2 Moreover, Chung et al., 2021 found that the incidence of COVID-19 may be higher in people

Stroke is a leading cause of morbidity and mortality in the United States. Whether hemorrhagic or ischemic, stroke leads to severe long-term disability. Prior to the mid-1990s, the treatment offered to a patient who presented with an acute stroke was mainly limited to antiplatelets. The lack of adequate treatment, in particular, one without reperfusion contributed to the disability that ensued. There have been many advances in stroke care within the past two decades, especially with the acute management of ischemic stroke. Even with these advances, it is quite alarming that only a fraction of patients receive acute stroke treatment. Numerous trials were conducted to broaden treatment eligibility in hopes that more patients can be treated acutely and safely. These trials have tested both the time window for IV tPA and endovascular therapy (EVT). Acute stroke management is moving from a universal time window approach to a concept of tissue preservation. Specifically, preserving cerebral blood flow, the penumbra, and reducing the risk of a second event. This movement is being executed through the use of multimodal CT and MRI, as well as individualizing treatment to our patients. Minimizing the initial effect of stroke changes the outcome and leads to an increased likelihood of functional independence. In this review, we discuss the recent updates of acute ischemic stroke management in regards to mechanical thrombectomy as well as thrombolytics including tenecteplase.

Stroke is a leading cause of morbidity and mortality in the United States. Whether hemorrhagic or ischemic, stroke leads to severe long-term disability. Prior to the mid-1990s, the treatment offered to a patient who presented with an acute stroke was mainly limited to antiplatelets. The lack of adequate treatment, in particular, one without reperfusion contributed to the disability that ensued. There have been many advances in stroke care within the past two decades, especially with the acute management of ischemic stroke. Even with these advances, it is quite alarming that only a fraction of patients receive acute stroke treatment. Numerous trials were conducted to broaden treatment eligibility in hopes that more patients can be treated acutely and safely. These trials have tested both the time window for IV tPA and endovascular therapy (EVT). Acute stroke management is moving from a universal time window approach to a concept of tissue preservation. Specifically, preserving cerebral blood flow, the penumbra, and reducing the risk of a second event. This movement is being executed through the use of multimodal CT and MRI, as well as individualizing treatment to our patients. Minimizing the initial effect of stroke changes the outcome and leads to an increased likelihood of functional independence. In this review, we discuss the recent updates of acute ischemic stroke management in regards to mechanical thrombectomy as well as thrombolytics including tenecteplase.

E xperimental studies have provided evidence indi- cating that mesenchymal stem cells (MSC) may be useful for the treatment of a variety of clinical disorders, including sepsis, acute renal failure, acute myocardial infarction, and more recently, acute lung injury (ALI). Based on these preclinical studies, MSC reduce the severity of organ injury as well as enhance recovery. The objectives of this article are the following: (1) to discuss briefl y the general properties of MSC, (2) to review key experimental studies that support the potential value of MSC for treatment of clinical ALI, (3) to consider which patients with ALI might be the best candidates for cell-based therapy, and (4) to outline the steps that will be required to test allogeneic human MSC for patients with ALI. MSC are multipotent adult stem cells that were fi rst isolated from the bone marrow and have the capacity to differentiate into bone, cartilage, muscle, fat, and fi broblasts. MSC do not possess the plasticity of embryonic stem cells, but they offer practical advantages because of their ease of isolation and propagation and also because their use does not generate the ethical issues that are often raised by the use of embryonic stem cells. 1 MSC were originally characterized in 1968 by Friedenstein and colleagues, 2 who reported that bone marrow stromal cells were adherent, fi broblastic in appearance, and clonogenic. Subsequent work indicated that adult MSC can be isolated from several human tissues, including bone

Leishmaniasis is one of the six major tropical diseases targeted by the World Health Organization. It is a life-threatening disease of medical, social and economic importance in endemic areas. No vaccine is yet available for human use, and chemotherapy presents several problems. Pentavalent antimonials have been the drugs of choice to treat the disease for more than six decades; however, they exhibit high toxicity and are not indicated for children, for pregnant or breastfeeding women or for chronically ill patients. Amphotericin B (AmpB) is a second-line drug, and although it has been increasingly used to treat visceral leishmaniasis (VL), its clinical use has been hampered due to its high toxicity. This review focuses on the development and in vivo usage of new delivery systems for AmpB that aim to decrease its toxicity without altering its therapeutic effi cacy. These new formulations, when adjusted with regard to their production costs, may be considered new drug delivery systems that promise to improve the treatment of leishmaniasis, by reducing the side effects and the number of doses while permitting a satisfactory cost-benefi t ratio.

Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disease associated with increasing morbidity and mortality worldwide. Whilst tobacco smoking is the important cause, other cuases are regognised. This article discusses the contribution that harmful inhaled occupational exposures make to the overall burden of COPD, and goes on to discuss other aspects of the COPD workplace interface. Prevention is key. All healthcare professionals have a resposibility to consider workplace issues when dealing with their COPD patients.

Background: Continuous renal replacement therapy (CRRT) is the recommended modality of dialysis for critically ill patients with hemodynamic instability. Yet there remains significant variability in how CRRT is prescribed and delivered, and limited evidence-basis to guide practice. Methods: This is a prospective, multi-center observational study of patients undergoing CRRT. Initial enrollment phase will occur at 4 academic medical centers in North America over 5 years, with a target enrollment of 2000 patients. All adult patients (18-89 years of age) receiving CRRT will be eligible for inclusion; patients who undergo CRRT for less than 24 h will be excluded from analysis. Data collection will include patient characteristics at baseline and at time of CRRT initiation; details of CRRT prescription and delivery, including machine-generated treatment data; and patient outcomes. Discussion: The goal of this study is to establish a large comprehensive registry of critically ill adults receiving CRRT. Specific aims include describing variations in CRRT prescription and delivery across quality domains; validating quality measures for CRRT care by correlating processes and outcomes; and establishing a large registry for use in quality improvement and benchmarking efforts. For initial analyses, some particular areas of interest are anticoagulation protocols; approach to fluid overload; CRRT-related workload; and patient safety. Trial registration: Registered on ClinicalTrials.gov 1/10/2014: NCT02034448.

There exists general agreement within neonatology that antibioti cs should be administered promptly to neonates with possible bacterial sepsis and meningitis. We initiated a series of quality improvement cycles designed to reduce delays in the initiation of antibiotic therapy to less than 2 hours when hospital-acquired infection (HAI) was suspected. All infants in this study were in neonatal intensive care (level II or III) who were started on antibiotics for a suspected HAI (defined as an infection that occurred 72 hours after admission to the NICU) were audited. Through a series of quality improvement cycles, we analyzed sources of delays in the initiation of antibiotic therapy from the time the order was written through administration. In subsequent cycles, we intervened to reduce delays through education, standardize the evaluation process, and develop an online ordering system that streamlined the workflow patterns in the nurseries and pharmacy. Using a prospective cohort design, we compared antibiotic delivery times after each process improvement cycle. Antibiotic delivery time was reduced from a median of 137.5 minutes to 75 minutes and variation of practice was reduced in terms of standard deviation and range (P Ͻ .001). The use of computerized physician order entry significantly improved the writing of STAT orders (P Ͻ .0001). A systematic analysis of workflow patterns and efficiencies, coupled with improvement cycles targeting delays and development of a computerized physician order entry system, allowed us to improve antibiotic delivery time in neonates with suspected HAI in an intensive care nursery system.

Acute respiratory infections (ARIs) are the leading cause of death among children less than 5 years in India. Emergence of newer pathogenic organisms, reemergence of disease previously controlled, wide spread antibiotic resistance, and suboptimal immunization coverage even after many innovative efforts are major factors responsible for high incidence of ARI. Drastic reduction in the burden of ARI by low-cost interventions such as hand washing, breast feeding, availability of rapid and feasible array of diagnostics, and introduction of pentavalent vaccine under National Immunization Schedule which are ongoing are necessary for reduction of ARI.

Akutt hoste i forbindelse med øvre luftveisinfeksjon forekommer hyppig, men det er sparsom dokumentasjon av effekten av medikamentell behandling. Enkelte pasientgrupper vil ha nytte av opioider som kodein og etylmorfin, men sett i sammenheng med misbrukspotensialet bør forskrivningen vaere restriktiv.

Chronic pain continues to pose substantial and growing challenges for patients, caregivers, health care professionals, and health care systems. By the time a patient with severe refractory pain sees a pain specialist for evaluation and management, that patient has likely tried and failed several nonpharmacologic and pharmacologic approaches to pain treatment. Although relegated to one of the interventions of "last resort", intrathecal drug delivery can be useful for improving pain control, optimizing patient functionality, and minimizing the use of systemic pain medications in appropriately selected patients. Due to its clinical and logistical requirements, however, intrathecal drug delivery may fit poorly into the classic pain clinic/interventional model and may be perceived as a "critical mass" intervention that is feasible only for large practices that have specialized staff and appropriate office resources. Potentially, intrathecal drug delivery may be more readily adopted into larger practices that can commit the necessary staff and resources to support patients' needs through the trialing, initiation, monitoring, maintenance, and troubleshooting phases of this therapy. Currently, two agents -morphine and ziconotide -are approved by the United States Food and Drug Administration for long-term intrathecal delivery. The efficacy and safety profiles of morphine have been assessed in long-term, open-label, and retrospective studies of 400 patients with chronic cancer and noncancer pain types. The efficacy and safety profiles of ziconotide have been assessed in three double-blind, placebo-controlled trials of 457 patients, and safety has been assessed in 1,254 patients overall, with severe chronic cancer, noncancer, and acquired immunodeficiency syndrome pain types. Both agents are highlighted as first-line intrathecal therapy for the management of neuropathic or nociceptive pain. The purpose of this review is to discuss practical considerations for intrathecal drug delivery, delineate criteria for the identification and selection of candidates for intrathecal drug delivery, and consider which agent may be more appropriate for individual patients.

Continuous intrathecal infusion of drugs to treat chronic pain and spasticity has become a standard part of the algorithm of care. The use of opioids has been associated with noninfectious inflammatory masses at the tip of the intrathecal catheter, which can result in neurologic complications. The Polyanalgesic Consensus Conference is a meeting of a group of well-published and experienced practitioners; the purpose of the meeting is to update the standard of care for intrathecal therapies to reflect current knowledge gleaned from literature and clinical experience. An exhaustive literature search was performed, and information from this search was provided to panel members. Analysis of the published literature was coupled with the clinical experience of panel participants to form recommendations regarding intrathecal inflammatory masses or granulomas. The panel has made recommendations for the prevention, diagnosis, and management of intrathecal granulomas. The use of chronic infusi...