Rebranding Nutritional Care for Critically Ill Patients Elena Mirea, Liliana; Cobilinschi, Cristian; Grințescu, Ioana Marina
Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures),
02/2023, Letnik:
9, Številka:
1
Journal Article
Abstract Purpose Older adults admitted to the intensive care unit (ICU) usually have fair baseline functional capacity, yet their age and frailty may compromise their management. We compared the ...characteristics and management of older (≥ 75 years) versus younger adults hospitalized in ICU with hospital-acquired bloodstream infection (HA-BSI). Methods Nested cohort study within the EUROBACT-2 database, a multinational prospective cohort study including adults (≥ 18 years) hospitalized in the ICU during 2019–2021. We compared older versus younger adults in terms of infection characteristics (clinical signs and symptoms, source, and microbiological data), management (imaging, source control, antimicrobial therapy), and outcomes (28-day mortality and hospital discharge). Results Among 2111 individuals hospitalized in 219 ICUs with HA-BSI, 563 (27%) were ≥ 75 years old. Compared to younger patients, these individuals had higher comorbidity score and lower functional capacity; presented more often with a pulmonary, urinary, or unknown HA-BSI source; and had lower heart rate, blood pressure and temperature at presentation. Pathogens and resistance rates were similar in both groups. Differences in management included mainly lower rates of effective source control achievement among aged individuals. Older adults also had significantly higher day-28 mortality (50% versus 34%, p < 0.001), and lower rates of discharge from hospital (12% versus 20%, p < 0.001) by this time. Conclusions Older adults with HA-BSI hospitalized in ICU have different baseline characteristics and source of infection compared to younger patients. Management of older adults differs mainly by lower probability to achieve source control. This should be targeted to improve outcomes among older ICU patients.
Acute mercury poisoning from occult ritual use Ţincu, Radu Ciprian; Cobilinschi, Cristian; Ghiorghiu, Zoie ...
Romanian Journal of Anaesthesia and Intensive Care,
04/2016, Letnik:
23, Številka:
1
Journal Article
Recenzirano
Mercury exposure is a serious environmental issue that concerns people worldwide. Industrial emissions containing mercury, some pharmaceutical and cosmetic products represent exposure sources. In ...Romania, as in many other countries, a supplementary cause for mercury exposure is represented by various occult rituals where liquids containing mercury are supposed to be ingested. We present the case of a 28 year old female who was admitted to the hospital for oral paresthesia, nausea, vertigo and sialorrhoea, after ingesting 100 ml diluted liquid mercury during an occult ritual. After the gastrointestinal decontamination, including gastric lavage, activated charcoal and cathartics, the outcome was favourable and 48 hours after admission the patient was discharged. This case report emphasizes the importance of an early digestive decontamination in mercury poisoning and the danger of mercury ingestion during various occult rituals.
Background: The fish-based diet is known for its potential health benefits, but it is less known for its association with mercury (Hg) exposure, which, in turn, can lead to neurological and ...cardiovascular diseases through the exacerbation of oxidative stress. The aim of this study was to evaluate the correlations between Hg blood concentration and specific biomarkers for oxidative stress. Methods: We present a cross-sectional, analytical, observational study, including primary quantitative data obtained from 67 patients who presented with unspecific complaints and had high levels of blood Hg. Oxidative stress markers, such as superoxide dismutase (SOD), glutathione peroxidase (GPX), malondialdehyde (MLD), lymphocyte glutathione (GSH-Ly), selenium (Se), and vitamin D were determined. Results: We found positive, strong correlations between Hg levels and SOD (r = 0.88, p < 0.0001), GPx (r = 0.92, p < 0.0001), and MLD (r = 0.94, p < 0.0001). We also found inverted correlations between GSH-Ly and vitamin D and Hg blood levels (r = −0.86, r = −0.91, respectively, both with p < 0.0001). Se had a weak correlation with Hg plasma levels, but this did not reach statistical significance (r = −0.2, p > 0.05). Conclusions: Thus, we can conclude that low-level Hg exposure can be an inductor of oxidative stress.
Year 2020 has been a cornerstone in medical research due to the COVID-19 pandemic outbreak. The process of understanding the condition brought to light certain organ involvement like pulmonary or ...kidney damage or endocrine disbalances, while connection to other types of organ impairment remain unclear. SARS-CoV-2 has previously been incriminated in cardiac involvement, ranging from mild symptoms to more severe occurrences such as myocarditis, arrythmias or heart failure, thus complicating the acute-phase management and worsening patients' prognosis. Despite being reported as an acute manifestation in critical COVID-19, cardiac tamponade seems to also occur as a "long- COVID19" complication. The latter is a distinct yet unclear entity associated with remanent fatigue or cough, but more severe sequelae like vasculitis or polyneuropathy can occsur.
We report the case of a 42-year-old patient admitted in the intensive care unit for severe respiratory and renal dysfunction one month after an initial mild episode of COVID-19. RT-PCR for SARS-CoV-2 on admission was negative. Initial imaging through CT and heart ultrasound revealed the presence of pericardial effusion but no signs of tamponade were initially obvious. Twelve hours later, the patient's state deteriorated with cardiocirculatory failure and signs of obstructive shock. Agents responsible for severe acute respiratory infection (SARI) such as influenza A and B, adenovirus,
,
, coxsackie virus,
or parainfluenza viruses were ruled out. Surprisingly, RT-PCR testing for SARS-CoV-2 came back positive, although the initial test was negative. Repeated imaging confirmed massive circumferential pericardial effusion for which emergency pericardiocentesis was performed. Fluid was an exudate and histopathology reported chronic inflammation. RT-PCR testing for
in the pericardial tissue came back negative.
The case is to our knowledge among the first to report cardiac tamponade one month after mild COVID-19 infection. The aim of this case report is to raise awareness in the medical community on the possibility of severe complications targeting major organs in the long-COVID-19 phase.
The emergence of knowledge economy has created the necessary conditions for an interdisciplinary approach of medical practices. This paper explores, in an interdisciplinary manner, the case of lead ...exposure in the Romanian context. We consider it crucial to be aware of the socio-economic impact of lead exposure in Romania and prevent unhealthy consumption habits that generate economic and social costs. The purpose of the research is to evaluate the social, economic, and medical effects of lead poisoning, and, on this basis, to identify prevention recommendations. The research was conducted while using a descriptive survey based on qualitative and quantitative methods, by analyzing a group of 115 participants that were admitted in the Toxicology Department of the Clinical Emergency Hospital Bucharest with the diagnosis of lead exposure/intoxication. The study followed an Observational Retrospective Protocol that was based on the investigations of the participants registered in the Toxicology Department with signs and symptoms suggestive of lead exposure/intoxication. The data was statistically processed by while using Microsoft Excel 2013 and SPSS Statistics 22. Based on our research results, we facilitated the knowledge sharing process of medical practices and formulated a series of recommendations in an interdisciplinary manner, in order to diminish the negative socio-economic effects of unhealthy consumption habits.
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