Diarrhea during critical illness: a multicenter cohort study.

PURPOSE: To study the incidence, predictors, and outcomes of diarrhea during the stay in the intensive care unit (ICU). METHODS: Prospective cohort of consecutive adults in the ICU for > 24 h during a 10-week period across 12 intensive care units (ICUs) internationally. The explored outcomes were: (1) incidence of diarrhea, (2) Clostridioides difficile-associated diarrhea (CDAD); (3) ICU and hospital length of stay (LOS) and mortality in patients with diarrhea. We fit generalized linear models to evaluate the predictors, management, morbidity and mortality associated with diarrhea. RESULTS: Among 1109 patients aged 61.4 (17.5) [mean (standard deviation)] years, 981(88.5%) were medical and 645 (58.2%) were mechanically ventilated. The incidence was 73.8% (818 patients, 73.8%, 95% confidence interval [CI] 71.1-76.6) using the definition of the World Health Organisation (WHO). Incidence varied across definitions (Bristol 53.5%, 95% CI 50.4-56.7; Bliss 37.7%, 95% CI 34.9-40.4). Of 99 patients with diarrhea undergoing CDAD testing, 23 tested positive (2.2% incidence, 95% CI 1.5-3.4). Independent predictors included enteral nutrition (RR 1.23, 95% CI 1.16-1.31, p < 0.001), antibiotic days (RR 1.02, 95% CI 1.02-1.03, p < 0.001), and suppositories (RR 1.14 95% CI 1.06-1.22, p < 0.001). Opiates decreased diarrhea risk (RR 0.76, 95% CI 0.68-0.86, p < 0.001). Diarrhea prompted management modifications (altered enteral nutrition or medications: RR 10.25, 95% CI 5.14-20.45, p < 0.001) or other consequences (fecal management device or CDAD testing: RR 6.16, 95% CI 3.4-11.17, p < 0.001). Diarrhea was associated with a longer time to discharge for ICU or hospital stay, but was not associated with hospital mortality. CONCLUSION: Diarrhea is common, has several predictors, and prompts changes in patient care, is associated with longer time to discharge but not mortality.

Validation of APACHE II and SAPS II scales at the intensive care unit along with assessment of SOFA scale at the admission as an isolated risk of death predictor.

BACKGROUND: Disease's severity classification systems are applied to measure the risk of death and to choose the best therapy for patients admitted to intensive care unit (ICU). The aim of the study was to verify risk of death calculated with APACHE II (Acute Physiology and Chronic Health Evaluation II), SAPS II (Simplified Acute Physiology Score II), SOFA (Sequential Organ Failure Assessment) and evaluate correlation between these scores. The usefulness of SOFA score as a sole scale also was assessed. METHODS: This was a retrospective study conducted in 30-beds ICU in Kraków, Poland. Every male and female patient over 18 years old who was admitted to the ICU between 18.04.2016 and 12.08.2016 was included in the analysis. Patients who were transferred from another ICU were excluded from the research. APACHE II, SAPS II, SOFA were calculated after admission using laboratory results and clinical examination. Discrimination and calibration were used to validate these scoring system. RESULTS: Analysis included 86 patients. The outcomes were compared within survivors and non-survivors groups. The prediction of death was statistically significant only for APACHE II and SAPS II. The best AUROC was for APACHE II 0.737 and SAPS II 0.737; discrimination for SOFA was not statistically significant. There was high correlation only between SAPS II and APACHE II results (r ≥ 0.7, P < 0.01). The calibration was excellent for SAPS II, P = 0.991, and slightly worse for APACHE II, P = 0.685, and SOFA, P = 0.540. Patients who survived spent more days on ICU (P < 0.01), mean Length of Stay (LOS) in this group was 38.25 ± 16.80 days. CONCLUSIONS: APACHE II and SAPS II scales have better discrimination, calibration and power to predict deaths on ICU than SOFA. Among these scales SOFA did not achieve expected results.

[Adenoma polymorphum localised out of salivary glands in material of ENT Department MSS Hospital between 2007-2009 - two cases]. / Pozasliniankowa lokalizacja gruczolaka wielopostaciowego w materiale Oddzialu Otolaryngologii MSS w latach 2007-2009--opis dwóch przypadków.

The adenoma polymorphum is benign salivary glands tumor. The most common location of occurrence is the parotid followed by the minor salivary glands in which the palate, upper lip and buccal mucosa are most commonly affected. It is a demarcated from the surronding, painless, capsulated and slow growing mass. Microscopically these tumors are composed of varying proportions of epithelial and mesenchymal tissue. Treatment of adenoma polymorphum is complete surgical excision with a surronding margin of normal tissue. This procedure avoids local recurrence. In two years (2007-2009) In Otolaryngology Ward In Miedzyleski Szpiatl Specjalistyczny treated four patients with adenoma polymorphum localised out of salivary glands. The authors described two cases of tumor mixtus localised on soft palate and in external ear canal. The first is a 57-year old male presented a painless swelling over the palate of four months duration. Admitted to ENT Unit on april 2009. He denier dysphagia and dyspnoea. On examination there was a firm, circumscribed tumor of the palate in the right side. CT scans show a right soft palate well-defined mass. He underwent transoral surgical excision. Postoperative period was uneventful. Another case is 18-year old girl with progressive worsening of hearing .On examination external ear canal was blocked due to firm and round tumor on his upper wall. The tumor was excised In local anesthesia. During two years observation there was no evidence of local reccurence.

[Unusual pathology of submandibular gland--Küttner tumor]. / Rzadka patologia slinianki podzuchwowej--guz Küttnera.

Küttner tumor (chronic sclerosing sialadenitis) is a chronic, benign lesion of salivary gland. Its clinical course resamble malignant process. Authors report two typical cases of CSS affecting submandibular gland. We inform, that we start follow up of those cases consist of--us imaging /twice a year/, indication of LE and IgG level, protein electrophoresis.

[A sudden sensorineural hearing loss caused by a thunderbolt]. / Nagla gluchota spowodowana uderzeniem pioruna.

The authors present a case of 12-years old girl with sudden sensorineural hearing loss caused by computer adapter explosion during the storm. She denied any tinnitus and vertigo. She was admitted immediately to ENT Ward. Audiometric examination showed rigt ear deaffness. She administered vasodilatators, oxygen, Vitamin B complex, 1% xylocain, dextran, betahistin and steroids i.v. After few days she started to hear her rigt ear. Conrtol audiometric examination showed hearing in normal range. In a case of sudden deaffness is important to strart treatment as qiuck as is possible. And we should remember that new technics with nature could be dangerous to our health.