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For patients monitored in intensive care units in the aftermath of a cardiac arrest, one of the well-established difficulties of care after resuscitation is the ability to perform the necessary prognostic assessments as accurately and early as possible. Although current guidelines include algorithms to determine prognosis, there are still missing links and uncertainties. Biomarkers obtained from peripheral blood are generally non-invasive and easy to obtain. Although the potential to use microRNA as a prognostic biomarker after cardiac arrest has received less interest recently, its popularity has increased in the last few years. By identifying prognostic biomarkers within 24 h of cardiac arrest, clinicians in intensive care could gain valuable insights to guide patient outcomes and predict both mortality and survival rates. [ABSTRACT FROM AUTHOR]

Introduction: Magnesium is an intracellular ion that has analgesic properties through calcium regulation and N-methyl- D-aspartate receptors. However, the safety of neuroaxial magnesium is not proved. The aim of this experimental study is to investigate the possible neurotoxicologic effects of epidural magnesium sulfate (MgSO4) on medulla spinalis in rabbits. Methods: After ethic committee's approval, 18 male Albino New Zealand rabbits were enrolled into the study. Epidural catheter was inserted into the sacral canal under ketamine. The development of motor and sensorial block 5 min after the administration of 1 mL of 1% lidocaine verified the placement of the catheter. Group Control (n=6): 0.20 mL isotonic saline was administered through epidural catheter. Group M150 (n=6): One mL of 150 mg.mL-1 MgSO4 (~ 0.6 mmol elemental magnesium) (pH=6.20) was administered through epidural catheter, then catheter was flushed with 0.20 mL isotonic saline. Group M450 (n=6): One mL of 450 mg.mL-1 MgSO4 (~ 1.8 mmol elemental magnesium) (pH=6.10) was administered through epidural catheter then catheter was flushed with 0.20 mL isotonic saline. Catheter's placement was localized by laminectomy. Spinal sections were taken between 5 cm rostral and caudal segments from the tip of the catheter. The sections were stained both hematoxylin-eosin and Cresyl violet. The slides were examined using a light microscope. Results: Nissl body loss, vacuolization, myelin irregularity, gliosis, and fibrosis in gray and white matter samples were assessed. There were no signs of histological tissue damage. There was no statistically significant histopathological difference between groups. Discussion and Conclusion: This is the first study that investigates spinal cord injury after epidural magnesium administration to our knowledge. These results are important since epidural route is the second most common route for MgSO4. In this study, we report that, even relatively higher doses of epidural MgSO4 did not cause any spinal cord injury. Further studies need to be performed to adapt these findings to clinical practice. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Intensive Care is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Dokuz Eylul University Journal of Graduate School of Social Sciences is the property of Dokuz Eylul University Graduate School of Social Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Intensive Care is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Intensive Care is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

As in the whole world, when the first case detection in the pandemic emerged in our country on March 11, 2020, as anesthesiologists and Dokuz Eylul University Faculty of Medicine Anesthesiology and Reanimation Department Faculty Members, we took the necessary precautions in the operation of the operating theatre and intensive care units. Subsequently, it was aimed to prepare a guideline on how to behave in patients whose operation is mandatory in the light of the available data, which can be applied during the pandemic, aiming to protect both patient safety and working healthcare professionals. [ABSTRACT FROM AUTHOR]

Background: The prediction of high-flow nasal oxygen (HFNO) failure in patients with coronavirus disease-2019 (COVID-19) having acute respiratory failure (ARF) may prevent delayed intubation and decrease mortality. Aims: To define the related risk factors to HFNO failure and hospital mortality Study Design: Retrospective cohort study. Methods: To this study, 85 critically ill patients (≥18 years) with COVID-19 related acute kidney injury who were treated with HFNO were enrolled. Treatment success was defined as the de-escalation of the oxygenation support to the conventional oxygen therapies. HFNO therapy failure was determined as the need for invasive mechanical ventilation or death. The patients were divided into HFNO-failure (HFNO-F) and HFNO-success (HFNO-S) groups. Electronic medical records and laboratory data were screened for all patients. Respiratory rate oxygenation (ROX) index on the first hour and chest computed tomography (CT) severity score were calculated. Factors related to HFNO therapy failure and mortality were defined. Results: This study assessed 85 patients (median age 67 years, 69.4% male) who were divided into two groups as HFNO success (n = 33) and HFNO failure (n = 52). The respiratory rate oxygenation (ROX) was measured at 1 hour and the computed tomography (CT) score indicated HFNO failure and intubation, with an area under the receiver operating characteristic of 0.695 for the ROX index and 0.628 for the CT score. A ROX index of <3.81 and a CT score of >15 in the first hour of therapy were the predictors of HFNO failure and intubation. Age, Acute Physiology and Chronic Health Evaluation II score, arterial blood gas findings "(i.e., partial pressure of oxygen [PaO2], PaO2 [fraction of inspired oxygen]/SO2 [oxygen saturation] ratio)", and D-dimer levels were also associated with HFNO failure; however, based on logistic regression analysis, a calculated ROX on the first hour of therapy of <3.81 (odds ratio [OR] = 4.78, 95% confidence interval [CI] = 1.75-13.02, P = 0.001) and a chest CT score of >15 (OR = 2.83, 95% CI = 1.01-7.88, P = <0.001) were the only independent risk factors. In logistic regression analysis, a ROX calculated on the first hour of therapy of <3.81 (OR = 4.78, [95% CI = 1.75-13.02], P = 0.001) and a chest CT score of >15 (OR 2.83, 95% CI = 1.01-7.88, P = <0.001) were the independent risk factors for the HFNO failure. The intensive care unit and hospital mortality rates were 80.2% and 82.7%, respectively, in the HFNO failure group. Conclusion: The early prediction of HFNO therapy failure is essential considering the high mortality rate in patients with HFNO therapy failure. Using the ROX index and the chest CT severity score combined with the other clinical parameters may reduce mortality. Additionally, multi-centre observational studies are needed to define the predictive value of ROX and chest CT score not only for COVID-19 but also other causes of ARF. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 is a novel viral infection that has caused a pandemic globally. Many kinds of vaccine development studies were conducted to prevent the spread and deaths. The CoronaVac is the most commonly used vaccine in Turkey. Phase 3 trials from various countries revealed that CoronaVac efficacy ranged from 50.7% to 91.25% but increased in moderate or severe cases to 100%. Additionally, it was remarkable owing to high seroconversion rates achieving up to 100%. After the vaccine campaign began in Turkey, critically ill patients continued to admit to our center's intensive care unit though they had been vaccinated with 2 doses of CoronaVac. The clinical course of these patients revealed that they are still at high risk of severe disease and death. Therefore, we aimed to share these patients' clinical characteristics and disease course, laboratory, and radiologic data. [ABSTRACT FROM AUTHOR]

Background: Treatment of acidosis is serious health problem within emergency departments and intensive care units etc. Ingestion of household cleaning solutions (due to both suicidal and accidental reasons) is still also a serious public health problem in Turkey and the most fatal complication thereof is, severe metabolic acidosis. An effective treatment should be provided for the cases presenting to emergency departments with life-threatening metabolic acidosis. Aim: We aimed to compare the survival rate of rats with experimental metabolic acidosis created by intragastric administration of hydrochloric acid and treated with "tris--hydroxymethyl aminomethane" or normal saline solution alone. Study Design: This was an experimental animal study. Methods: Following ketamine-xylazine anesthesia, internal carotid artery of fourteen female Wistar albino rat was cannulated, basal blood samples were drawn and esophagus of each was cannulated with intracath. Hydrochloric acid was subsequently poured through the cannula towards stomach. After 30 minutes, blood gas status was checked in order to see if acidosis occurred or not. The rats which developed acidosis were randomly divided into "tris-hydroxymethyl aminomethane" and "normal saline solution" groups. Later the treatment with IV tris-hydroxymethyl aminomethane or normal saline was initiated. At 30th and 60th minutes of the treatment, pH, PaO2, HCO3, PaCO2 and base deficit parameters were checked through arterial blood gas samples to monitor the efficacy of the treatment. At the end of the second hour of the study, the experiment was finalized and the survival of rats was documented. Results: Following the development of experimental metabolic acidosis in rats by ingestion of intragastric hydrochloric acid, four rats in tris--hydroxymethyl aminomethane and six rats in normal saline group died prior to the end of the follow-up period. This finding was statistically significant. There was no statistically significant difference between tris--hydroxymethyl aminomethane and normal saline groups with regard to body temperature, blood pressure, heart rate, PaCO2 and PaO2. However, the comparison of two groups with respect to survival indicated a significant difference (p<0.05). pH at 60th minute in tris--hydroxymethyl aminomethane group was significantly lower compared to that in normal saline group (p<0.05), and base deficit values at 30th and 60th minutes in tris--hydroxymethyl aminomethane group were significantly higher compared to that in normal saline group (p<0.05). Conclusion: In this experimental rat model, we observed that treatment with IV tris--hydroxymethyl aminomethane prolonged the survival of rats with experimental metabolic acidosis created by ingestion of hydrochloric acid compared to the treatment with normal saline solution. [ABSTRACT FROM AUTHOR]

Intensive care treatment needs and costs are expected to increase with the ageing population in our country and the world. Tele-intensive care unit (Tele-ICU) applications can provide an alternative solution to treat and follow up critical patients remotely. It can help use existing resources efficiently. With the Tele-ICU program, intensive care specialists will reach all intensive care beds in the country without restrictions. They will evaluate the patients’ situations with all data from electronic recording systems. However, problems with some legal regulations or terms of job descriptions, deterioration of patient-doctor, doctor-patient’s relative relationships, or some infrastructure deficiencies when using the Tele-ICU system could override the potential benefit of the new solution strategy. This review was written to inform about Tele-ICU, draw attention to opportunities, shortcomings, and limitations if Tele-ICU is applied in our country, and ensure that the necessary steps are taken to resolve these deficiencies. [ABSTRACT FROM AUTHOR]

In December 2019, in Wuhan, China, scientists observed a sudden and sharp increase in the number of cases of pneumonia and acute respiratory distress syndrome of an unknown origin. By the end of January 2020, the outbreak had spread to Asia, Europe, America, and Australia. In this article, we have outlined the pandemic action plan of our university hospital. [ABSTRACT FROM AUTHOR]

Introduction: Acute mercury intoxication (AMI) rarely reported and is mostly caused by accidental inhalation. However, several cases of subcutaneous injection were reported. AMI may cause hemorrhagic gastroenteritis, cardiovascular collapse, shock, acute kidney injury, and death. Here, we shared a case of acute elemental mercury intoxication. Case: A 31-year-old man admitted to emergency department with complaints of fever and erythema on his left-hand after an insect bite (his own statement). X-ray revealed a radiopaque foreign body on his left-hand dorsum (Figure 1). Then the patient expressed the self-administration of mercury which was bought online. Laboratory analysis determined 647 µgr/L mercury in blood test and 5514 µgr/day in urine. To define possible mercury inhalation chest computed tomography was planned and multilobar ground glass opacities were shown (Figure 2). The patient underwent operation for removal of subcutaneous mercury and was transferred to intensive care unit (ICU) postoperatively. On admission, the patient did not have any respiratory and cardiovascular symptoms. Urine output was >0.5 mL/kg/h with the normal values of renal function tests. X-ray image revealed that almost all the mercury was eliminated (Figure 3). Dimercaprol therapy was started as an antidote of mercury, but after first dose, the therapy was converted to succimer due to the adverse effects of dimercaprol, including hypertension, tachycardia, and chest pain. Succimer was administered with a dose of 3x800 mg/day, then reduced to 2x800 mg/day. The patient’s blood mercury level reduced to 194 µgr/L after therapy. Lung infiltrates resolved. On the 10th day of the ICU admission the patient was transferred to ward with no complication. Written informed consent was obtained from the patient to present this case report. Discussion: The misuse of mercury may cause death and might be diagnosed with suspicion in some cases. In addition, mercury trade should be regulated and limited by the local authorities. [ABSTRACT FROM AUTHOR]