Nutritional Risk Assessment Scores Effectively Predict Mortality in Critically Ill Patients with Severe COVID-19.

BACKGROUND: Malnutrition predicts a worse outcome for critically ill patients. However, quick, easy-to-use nutritional risk assessment tools have not been adequately validated. AIMS AND METHODS: The study aimed to evaluate the role of four biological nutritional risk assessment instruments (the Prognostic Nutritional Index-PNI, the Controlling Nutritional Status Score-CONUT, the Nutrition Risk in Critically Ill-NUTRIC, and the modified NUTRIC-mNUTRIC), along with CT-derived fat tissue and muscle mass measurements in predicting in-hospital mortality in a consecutive series of 90 patients hospitalized in the intensive care unit for COVID-19-associated ARDS. RESULTS: In-hospital mortality was 46.7% (n = 42/90). Non-survivors had a significantly higher nutritional risk, as expressed by all four scores. All scores were independent predictors of mortality on the multivariate regression models. PNI had the best discriminative capabilities for mortality, with an area under the curve (AUC) of 0.77 for a cut-off value of 28.05. All scores had an AUC above 0.72. The volume of fat tissue and muscle mass were not associated with increased mortality risk. CONCLUSIONS: PNI, CONUT, NUTRIC, and mNUTRIC are valuable nutritional risk assessment tools that can accurately predict mortality in critically ill patients with COVID-19-associated ARDS.

Acute poisoning due to ingestion of Datura stramonium - a case report.

Datura stramonium (DS) is a widespread annual plant, containing atropine, hyoscyamine, and scopolamine, which can produce poisoning with a severe anticholinergic syndrome. Teenagers ingest the roots, seeds or the entire plant to obtain its hallucinogenic and euphoric effects. We presented the case of a 22 year old male who was admitted to the Emergency Room in a coma after consuming Datura stramonium, 2 hours earlier. The patient presented with fever, tachycardia with right bundle branch block, and urinary retention. Rapid sequence induction and intubation was performed immediately, with sedation and assisted-control mechanical ventilation, after being transferred to the Intensive Care Unit. The patient received activated charcoal, in repeated doses, external and internal cooling was applied, and an infusion of neostigmine was started. The biological assessment revealed rhabdomyolysis and prevention of renal failure was initiated. After a proper neurological evaluation, 36 hours after using Datura stramonium, the patient was extubated and transferred to the Psychiatric ward for further assessment and care.

Lethal case of Vipera bersus bite.

Adder bites are rare events, but they can be fatal. Three adder types live in Romania - Vipera ammodytes, Vipera ursini and Vipera berus. Most adder bites happen during the summer with a peak incidence between July and August. Here we present the case of a 56 years old male patient who was bitten by an adder. The clinical presentation was severe from the beginning with a GCS of 3 points, respiratory and cardiovascular failure; despite of adequate treatment the patient developed multiorgan dysfunction and died 36 hours after the ICU admission. The aim of this report is to raise awareness that snake bites can have a life-threatening course and need immediate attention and medical care.

Antibiotic-induced immediate type hypersensitivity is a risk factor for positive allergy skin tests for neuromuscular blocking agents.

BACKGROUND: Skin tests for neuromuscular blocking agents (NMBAs) are not currently recommended for the general population undergoing general anaesthesia. In a previous study we have reported a high incidence of positive allergy tests for NMBAs in patients with a positive history of non-anaesthetic drug allergy, a larger prospective study being needed to confirm those preliminary results. The objective of this study was to compare the skin tests results for patients with a positive history of antibiotic-induced immediate type hypersensitivity reactions to those of controls without drug allergies. METHODS: Ninety eight patients with previous antibiotic hypersensitivity and 72 controls were prospectively included. Skin tests were performed for atracurium, pancuronium, rocuronium, and suxamethonium. RESULTS: We found 65 positive skin tests from the 392 tests performed in patients with a positive history of antibiotic hypersensitivity (1 6.58%) and 23 positive skin tests from the 288 performed in controls (7.98%), the two incidences showing significant statistical difference (p = 0.0011). The relative risk for having a positive skin test for NMBAs for patients versus controls was 1.77 (1.15-2.76). For atracurium, skin tests were more often positive in patients with a positive history of antibiotic hypersensitivity versus controls (p = 0.02). For pancuronium, rocuronium and suxamethonium the statistical difference was not attained (p-values 0.08 for pancuronium, 0.23 for rocuronium, and 0.26 for suxamethonium). CONCLUSIONS: Patients with a positive history of antibiotic hypersensitivity seem to have a higher incidence of positive skin tests for NMBAs. They might represent a group at higher risk for developing intraoperative anaphylaxis compared to the general population.

Epidemiology of self-reported drug-induced immediate-type hypersensitivity reactions in the surgical population: a 5-year single-center survey in a romanian allergo-anaesthesia center.

AIM: Immediate-type hypersensitivity drug reactions are frequently under-reported, epidemiological data being imprecise. The aim of our study was to identify the drugs involved and to describe the clinical characteristics of previous immediate-type hypersensitivity reactions in a large series of Romanian surgical patients, and to establish the concordance between in vivo and in vitro tests. METHODS: Of the 807 surgical patients referred to our outpatient department of allergo-anaesthesia, we retrospectively enrolled 632 patients with previous drug-induced hypersensitivity reactions. The allergological work-up included a complete allergological history, allergological skin tests and in vitro tests. RESULTS: The drugs involved were: antibiotics in 68% of our patients (with 83.02% being ß-lactams), followed by NSAIDs in 43.28% (50.24% of them being metamizol), general anaesthetics in 9.33%, and local anaesthetics or other drugs, each in 6.32% of the 632 patients. The clinical features reported were urticaria in 63.13%, angioedema in 41.77%, bronchospasm in 15.82%, hypotension in 16.61% and cardiovascular collapse in 21.51% of our patients; 31.80% of the referred patients were confirmed as being positive by at least one diagnostic test. The agreement between in vivo tests and BAT was fair (k=0.35), while between in vivo tests and IgE, the concordance was poor (k=0.12). CONCLUSIONS: The data obtained from the patients referred to our clinic without any filters and restrictions indicates the pattern of drug-induced immediate-type hypersensitivity reactions and the most frequently involved drugs in Romania. At the end of the allergological work-up we confirmed 31.80% of our patients as having drug-induced hypesensitivity.