Gastrointestinal Emergencies in the ICU.

Gastrointestinal (GI) emergencies and disorders are among the most common reasons to be admitted to an intensive care unit (ICU). In addition, critically ill patients admitted to the ICU for non-GI-related diseases are frequently at risk of developing GI complications during their hospitalization. This article details the epidemiology/etiology, clinical presentation, diagnostic assessment, and management of the following GI emergencies: upper and lower GI bleed, acute pancreatitis, and ascending cholangitis.

Asthma in Pregnancy.

Asthma is a common chronic respiratory condition that affects approximately 10% of adult women in the United States. Pregnancy can present unique challenges for women with asthma, as changes in the body can alter the severity and management of asthma-related respiratory symptoms. In this article, we review the current understanding of asthma during pregnancy, including the direct effects of the disease state on the pregnant woman and fetus, risk factors for poor control of disease, as well as current treatment recommendations.

Hematologic and Oncologic Emergencies.

This article reviews both hematologic and oncologic emergencies that may be seen in the intensive care setting. Hematologic emergencies, including autoimmune hemolytic anemia, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, and disseminated intravascular coagulation, as well as oncologic emergencies including tumor lysis syndrome, superior vena cava syndrome, and cardiac tamponade secondary to metastatic disease, are discussed in detail. This review focuses on the pathophysiology, clinical features, diagnosis, and treatment of each entity.

Health Care Workers' Challenges in the Care of a COVID-19 Patient.

The COVID-19 pandemic has introduced us to new challenges with personal protective equipment, long shifts, and changes in regular routines. This has placed a tremendous stress on health care workers. This article defines the various health care worker challenges, both at the bedside and on a personal front. Therapeutic strategies are discussed.

Mechanical Ventilation in ARDS.

Mechanical ventilation is the primary supportive, invasive measure utilized in patients with acute respiratory distress syndrome. Throughout the years, many large multicenter randomized controlled trials and observational studies were analyzed to determine what ventilator parameters to use that would produce a mortality benefit after initial diagnosis. This article discusses the concepts of ventilator-induced lung injury, permissive hypercapnia, high-versus-low peep strategies, oxygenation goals, and recruitment strategies from a physiologic perspective and the major studies that produced recommendations for each. Newer concepts, such as driving pressure, are also discussed.

Opioids and opioid receptors orchestrate wound repair.

We have previously shown that topical opioids including morphine and its congeners promote healing of full thickness ischemic wounds in rats. We examined the contribution of mu opioid receptor (MOPr)-mediated healing of full thickness ischemic wounds using MOPr and delta or kappa opioid receptor knockout (KO) mice. Wound closure in the early (day 5) as well as later phases was delayed in topical morphine or PBS-treated MOPr-KO mice compared with reciprocal treatments of wounds in wild-type (WT) mice. MOPr expression was significantly upregulated at 30 min in the wound margins and colocalized with wound margins and vasculature in the epidermal and dermal layers of the skin. We next examined whether neuropeptide expression was involved in the mechanism of MOPr-mediated wound closure. Substance P (SP) and calcitonin gene-related peptide immunoreactivity (ir) was significantly increased in the skin of MOPr-KO mice as compared with WT mice. Neuropeptide-ir was increased significantly in PBS-treated wounds of MOPr and WT mice, but morphine treatment reduced neuropeptide immunoreactivity in both as compared with PBS. Wounding of keratinocytes led to the release of opioid peptide beta-endorphin (ß-END) in conditioned medium, which stimulated the proliferation of endothelial cells. MOPr-selective (D-Phe-Cys-Tyr-D-Trp-Orn-Thr-Pen-Thr-NH2, CTOP) and nonselective OPr antagonist naloxone-inhibited endothelial proliferation induced by wounded keratinocyte-conditioned medium. In addition, accelerated wound area closure in vitro by morphine was suppressed by methylnaltrexone, a nonselective OPr antagonist with high affinity for MOPr. Morphine and its congeners stimulated the proliferation of endothelial cells from WT mice but not those from MOPr-KO mice. Furthermore, morphine-induced mitogen-activated protein kinase/extracellular signal-regulated kinase phosphorylation in endothelial cells was significantly decreased in MOPr-KO mice as compared with WT mice. Collectively, these data suggest that MOPr plays a critical role in the proliferation phase with the formation of granulation tissue during wound healing.

Depression, anxiety and stress levels in industrial workers: A pilot study in Bangalore, India.

BACKGROUND: Mental health disorders affect around 500 million people worldwide. In India, around 10-12% of people are affected by a mental disorder either due to stress, depression, anxiety, or any other cause. Mental health of workers affects the productivity of the workplace, with estimates putting these losses to be over 100 million dollars annually. AIMS: The study aims to measure depression, anxiety, and stress levels of workers in an industry and to investigate if it has any effect on productivity of the firm. MATERIALS AND METHODS: The study utilized a cross-sectional design and was conducted among workmen of the firm. A sociodemographic based questionnaire and a mental health screening tool -Depression Anxiety Stress Scale (DASS)-21 were used for the same. A total of 90 completed questionnaires were analyzed for the study. The data was analyzed for central tendencies as well as for any associations and correlations. RESULTS: The study showed that none of the workers had a positive score for depression. It also showed that around 36% of the workers had a positive score for anxiety and 18% of the workers had a positive score for stress on DASS-21 scale. The odds ratio between stress and number of leaves taken by a worker in the last 3 months suggested a dose-response relationship, but was statistically insignificant. CONCLUSION: The study found a prevalence rate of around 18-36% for anxiety and stress amongst the workers at the factory. Large-scale studies will help understand the effect mental health status has on the Indian workplace.