[Hemophagocytic syndrome in a patient followed for IgG4-related disease in intensive care unit]. / Yogun bakimda IgG4 iliskili hastalik nedeniyle takip edilen hastada gelisen hemafagositik sendrom.

IgG4-related disease (IgG4-RD) is a set of diseases that can affect multiple organs, produce an immune-mediated fibroinflammatory response, and lead to tissue destruction and organ failure. Hemophagocytic syndrome is a life-threatening hyperinflammatory fatal disease caused by defect and excessive macrophage activity in natural killer cells. The disease can often be confused with other immune-mediated diseases such as cancer, infection, interstitial lung disease, sjogren's syndrome, wegener's vasculitis, or temporal arteritis. Hemophagocytic syndrome is defined as hemophagocytic lymphohistiocytosis (HLH) which is a pathological and clinical condition caused by phagocytosis of erythrocyte, leukocyte, platelet and precursor cells which are the cellular elements of the macrophages which are activated due to various reasons. Although there are two types as primary (familial) and secondary (depending on infections), the clinical findings are the same. Presence of familial disease/known gene defect and/or at least 5 of 8 clinical and laboratory diagnostic criteria is required for diagnosis. The first target is the suppression of hyperinflammation urgently, the second is the elimination of the stimulus triggering the event. In secondary HLH, treatment should be planned according to the underlying cause. As a rare complication of a rare disease, a case with the diagnosis of IgG4-related disease complicated with hemophagocytic syndrome is presented with the literature.

Evaluation of Patients with COVID-19 Followed Up in Intensive Care Units in the Second Year of the Pandemic: A Multicenter Point Prevalence Study.

OBJECTIVE: A 1-day point prevalence study was planned to obtain country data by determining the clinical characteristics, follow-up and treatment methods of coronavirus disease 2019 (COVID-19) cases that required intensive care unit (ICU) treatment in the second year of the pandemic. MATERIAL AND METHODS: All patients who were hospitalized in the ICUs due to COVID-19 between March 11, 2022, 08.00 am, and March 12, 2022, 08.00 am, were included in the study. Demographic characteristics, intensive care and laboratory data, radiological characteristics, and follow-up results of the patients were recorded. RESULTS: A total of 811 patients from 59 centers were included in the study, 59% of the cases were male, and the mean age was 74 ± 14 years. At least one comorbid disease was present in 94% of the cases, and hypertension was the most common. When ICU weight scores were examined, Acute Physiology and Chronic Health Evaluation-II: 19 (15-27) and Sequential Organ Failure Assessment: 7 (4-10) were seen. Sepsis was present in 37% (n = 298) of cases. PaO2/FiO2 ratios of the patients were 190 the highest and 150 the lowest and 51% of the cases were followed via invasive mechanical ventilation. On the study day, 73% bilateral involvement was seen on chest x-ray, and ground-glass opacities (52%) were the most common on chest tomography. There was growth in culture in 40% (n = 318) of the cases, and the most common growth was in the tracheal aspirate (42%). CONCLUSION: The clinical course of COVID-19 is variable, and ICU follow-up was required due to advanced age, comorbidity, presence of respiratory symptoms, and widespread radiological involvement. The need for respiratory support and the presence of secondary infection are important issues to be considered in the follow-up. Despite the end of the second year of the pandemic and vaccination, the high severity of the disease as well as the need for follow-up in ICUs has shown that COVID-19 is an important health problem.

The effect of preemptive airway pressure release ventilation on patients with high risk for acute respiratory distress syndrome: a randomized controlled trial.

BACKGROUND AND OBJECTIVES: The objective of this study was to investigate the use of early APRV mode as a lung protective strategy compared to conventional methods with regard to ARDS development. METHODS: The study was designed as a randomized, non-blinded, single-center, superiority trial with two parallel groups and a primary endpoint of ARDS development. Patients under invasive mechanical ventilation who were not diagnosed with ARDS and had Lung Injury Prediction Score greater than 7 were included in the study. The patients were assigned to APRV and P-SIMV + PS mode groups. RESULTS: Patients were treated with P-SIMV+PS or APRV mode; 33 (50.8%) and 32 (49.2%), respectively. The P/F ratio values were higher in the APRV group on day 3 (p = 0.032). The fraction of inspired oxygen value was lower in the APRV group at day 7 (p = 0.011).While 5 of the 33 patients (15.2%) in the P-SIMV+PS group developed ARDS, one out of the 32 patients (3.1%) in the APRV group developed ARDS during follow-up (p = 0.197). The groups didn't differ in terms of vasopressor/inotrope requirement, successful extubation rates, and/or mortality rates (p = 1.000, p = 0.911, p = 0.705, respectively). Duration of intensive care unit stay was 8 (2-11) days in the APRV group and 13 (8-81) days in the P-SIMV+PS group (p = 0.019). CONCLUSIONS: The APRV mode can be used safely in selected groups of surgical and medical patients while preserving spontaneous respiration to a make benefit of its lung-protective effects. In comparison to the conventional mode, it is associated with improved oxygenation, higher mean airway pressures, and shorter intensive care unit stay. However, it does not reduce the sedation requirement, ARDS development, or mortality.

Do totally occlusive nasal packs after nasal surgery increase the risk of immediate respiratory distress during recovery from anesthesia?

OBJECTIVES: This study aims to compare the risk of immediate respiratory distress (IRD) during the recovery of anesthesia between the nasal surgery with totally occlusive nasal packing and non-respiratory tract-related surgeries. PATIENTS AND METHODS: A total of 300 patients (180 males, 120 females; mean age 30.1±8.2 years; range 18 to 52 years) were included in the study. The patients were assigned to one of two age- and sex-matched groups according to surgery type: 1) patients undergoing nasal surgery with totally occlusive nasal packs for nasal septum deviation or 2) patients undergoing non-respiratory tract surgeries for various diseases. Immediate respiratory distress was defined as any unanticipated hypoxemia, hypoventilation or upper-airway obstruction (stridor or laryngospasm) requiring an active and specific intervention. RESULTS: The patients who underwent nasal surgery with totally occlusive nasal packs had a 6.25 times higher risk of IRD than the patients who underwent non-respiratory tract surgery during recovery from general anesthesia. Smokers had a 4.8 times higher risk of having IRD than non-smokers during the post-extubation phase. There were no significant differences in the incidence of IRD between males and females. CONCLUSION: Based on our study results, totally occlusive nasal packs and smoking were associated with poor extubation status at the end of the surgical procedure.

Synthetic Cannabinoid 'Bonzai' Intoxication: Six Case Series.

In the language of the streets, 'bonzai', known as '1-naphthalenyl of methanol', also known as JWH-18 group, is a drug belonging to the group of synthetic cannabinoids. At the beginning of 2004, it started to be sold on the internet and it is seen that private markets. It has structurally similar chemical characteristics as delta 9-tetrahydrocannabinol (THC), the active substance in marijuana. In 2013, in a study conducted by the European Monitoring Centre of Drugs and Drug Addiction (EMCDDA), 102 varieties of synthetic cannabinoids were identified; however, more than 200 substances have been reported since 1997. In this study, we report the difficulties in the clinical course, treatment and management of six patients that had a use history of bonzai although it was not detected in blood in a short period of time in the intensive care unit.

Delayed Post-Traumatic Anisocoria.

Post-traumatic carotid artery dissection is one of the major causes of ischemic stroke in young patients; its diagnosis remains a challenge for clinicians because of its variable clinical presentation. An otherwise healthy 37-year-old man was referred to the intensive care unit of our faculty for the management of multiple trauma because of a car accident. At 11 days from admission, his doctor noticed the advent of anisocoria. A prompt treatment was instituted with anti-platelet and-coagulant agents. The patient had a complete resolution of symptoms. The prognosis was good, and the patient achieved a complete clinical recovery. He was discharged without any sequelae.