Safety and efficacy of fluvoxamine in COVID-19 ICU patients: An open label, prospective cohort trial with matched controls.

AIMS: Fluvoxamine, a selective serotonin reuptake inhibitor (SSRI) and sigma-1 receptor agonist, has so far shown promise in the prevention of COVID-19 progression as an early treatment option in three trials. The aim of this study was to evaluate the safety and efficacy of fluvoxamine in COVID-19 patients if administered later in the course of the disease. METHODS: The study was designed as an open-label, prospective cohort trial with matched controls. In April and May 2021, 51 ICU COVID-19 patients hospitalised in the University Hospital Dubrava and University Hospital Centre Zagreb, Croatia, were treated with fluvoxamine 100 mg three times daily for 15 days in addition to standard therapy and they were prospectively matched for age, gender, vaccination against COVID-19, disease severity and comorbidities with 51 ICU controls. RESULTS: No statistically significant differences between groups were observed regarding the number of days on ventilator support, duration of ICU or total hospital stay. However, overall mortality was lower in the fluvoxamine group, 58.8% (n = 30/51), than in the control group, 76.5% (n = 39/51), HR 0.58, 95% CI (0.36-0.94, P = .027). CONCLUSION: Fluvoxamine treatment in addition to the standard therapy in hospitalised ICU COVID-19 patients could have a positive impact on patient survival. Further studies on the effects of fluvoxamine in COVID-19 patients are urgently required.

REGIONAL ANESTHESIA FOR NEUROSURGERY.

During neurosurgery procedures it is vital to assure optimal cerebral perfusion and oxygenation. Despite physiological autoregulation of brain perfusion, maintaining hemodynamic stability and good oxygenation during anesthesia is vital for success. General anesthesia with mechanical ventilation and current drugs provide excellent hemodynamic condition and it is the first choice for most neurosurgery procedures. However, sometimes it is very hard to avoid brief increase or decrease in blood pressure especially during period of intense pain, or without pain stimulation. This could be detrimental for patients presented with high intracranial pressure and brain edema. Modifying anesthesia depth or treatment with vasoactive drugs usually is needed to overcome such circumstances. On the other hand it is important to wake the patients quickly after anesthesia for neurological exam. That is why regional anesthesia of scalp and spine could show beneficial effects by decreasing pain stimuli and hemodynamic variability with sparing effect of anesthetics drugs. Also regional techniques provide excellent postoperative pain relief, especially after spinal surgery.

Serum glutathione S-transferase Pi as predictor of the outcome and acute kidney injury in premature newborns.

BACKGROUND: The incidence of acute kidney injury (AKI) among the neonates treated at the Neonatal Intensive Care Unit is high with high mortality rates. Glutathione S-transferase (GST) class Pi plays an important role in the protection of cells from cytotoxic and oncogenic agents. The aim of the study was to examine whether the levels of serum glutathione S-transferase Pi (GST Pi) determined after birth have any predictive value for the outcome and development of AKI in premature neonates. METHODS: The prospective study included 36 premature neonates. The data about morbidity was gathered for all the neonates included in the study. The blood samples were taken in the first 6 h of life and GST Pi levels were measured. RESULTS: The mean values and standard deviations of GST Pi among the neonates who died and who survived were 1.904 ± 0.4535 vs 1.434 ± 0.444 ng/ml (p = 0.0128). Logistic regression revealed a statistically significant, positive correlation between GST Pi levels and death (p = 0.0180, OR7.5954; CI 1.4148-40.7748).The mean value of GST Pi levels in the neonates with AKI was higher than in neonates without AKI (p = 0.011). CONCLUSIONS: The conclusion of our study is that high levels of serum GST Pi in the first 6 h after birth are associated with an increased mortality and development of AKI in prematurely born neonates.

Corrosion of NiTiDiscs in Different Seawater Environments.

This paper gives an approach to the corrosion resistance analysis and changes in the chemical composition of anNiTi alloy in the shape of a disc, depending on different real seawater environments. The NiTi discs were analysed after 6 months of exposure in real seawater environments: the atmosphere, a tidal zone, and seawater. The corrosion tests showed that the highest corrosion rate for the discs is in seawater because this had the highest value of current density, and the initial disc had the most negative potential. Measuring the chemical composition of the discs using inductively coupled plasma and X-ray fluorescence before the experiment and semiquantitative analysis after the experiment showed the chemical composition after 6 months of exposure. Furthermore, the applied principal component analysis and cluster analysis revealed the influence of the different environments on the changes in the chemical composition of the discs. Cluster analysis detected small differences between the similar corrosive influences of the analysed types of environments during the period of exposure. The obtained results confirm that PCA can detect subtle quantitative differences among the corrosive influences of the types of marine environments, although the examined corrosive influences are quite similar. The applied chemometric methods (CA and PCA) are, therefore, sensitive enough to register the existence of slight differences among corrosive environmental influences on the analysed NiTi SMA.

A Nonlinear Probabilistic Pitting Corrosion Model of Ni-Ti Alloy Immersed in Shallow Seawater.

The degradation of metal materials in a marine environment represents the consequence of the electrochemical corrosion of metals under the influence of the environment. The application of new materials in the maritime industry requires experimental, real-world research on the form of corrosive damage and the intensity of the corrosion. This paper analyses the pitting corrosion of a rod-shaped nickel-titanium (Ni-Ti) alloy that was produced by means of the continuous casting method. In total, three samples were posted in a real seawater environment and analysed after 6, 12, and 18 months. Pits were detected on the Ni-Ti alloy after 18 months of exposure to the marine environment. The database on pitting corrosion was created by measuring depth in mm, which was performed by means of a nonlinear method, and by the generation of an artificial database of a total of 120, gauged in critical pit areas. The data were obtained by the application of a nonlinear model, and under the assumption that corrosion starts after 12 months of exposure in the corrosive marine environment. The EDX analysis of the Ni-Ti alloy composition inside the pits and on the edges of the pits indicated that the corrosion process in the hole of the pit occurs due to the degradation of the Ni.

Ultrasonographic finding of lung sliding in patients on mechanical ventilation with alveolar-interstitial syndrome.

BACKGROUND AND OBJECTIVES: To determine the visibility of pleural lung sliding in alveolar-interstitial syndrome (AIS) in patients on mechanical ventilation at two different time points, as a confirmatory ultrasonographic method for excluding pneumothorax. METHODS: Fifty-two mechanically ventilated patients in the semirecumbent position in a surgical/neurosurgical intensive care unit with ultrasonographic lung 'comet tails' in three upper anterolateral intercostal spaces, indicating the presence of AIS, were scanned for lung sliding in the same three intercostal spaces with a linear 5-10 MHz transducer after starting mechanical ventilation and on weaning trials. Pneumothorax and atelectasis were excluded by chest radiograph. RESULTS: Absent lung sliding was found in 22.7% of intercostal spaces scanned after starting mechanical ventilation and in 21.2% of scans taken on weaning trials. The lowest invisible rate was in patients with acute heart failure and the highest in patients with acute respiratory distress syndrome. CONCLUSION: Lung sliding specificity in AIS during mechanical ventilation was 78%. Our opinion is that different levels of airway pressure between starting mechanical ventilation and weaning trials have no influence on lung sliding visibility.

Liver function assessment by indocyanine green plasma disappearance rate in patients with intra-abdominal hypertension after "non-hepatic" abdominal surgery.

BACKGROUND AND OBJECTIVE: Liver function assessment in patients with intra-abdominal hypertension (IAH) after major abdominal surgery is complex and often confounding. Elevated intra-abdominal pressure (IAP) often occurs after major abdominal surgery, and is associated with decreased abdominal blood flow and organ dysfunction, and it could cause abdominal compartment syndrome (ACS), which is a life-threatening condition. Plasma disappearance rate (PDR) of indocyanine green (ICG) and ICG retention rate after 15 min (R15) were used to evaluate liver function and as a prognostic parameter after major abdominal surgery. METHODS: In this prospective/observational study, 51 patients were followed in the surgical intensive care unit after major abdominal surgery (operation of the small and large intestine, stomach, pancreas, spleen, or resection of the abdominal aorta), 29 had IAH. The PDR-ICG and R15 were analyzed 24 h after surgery concurrently with IAP, APP, bilirubin, AST, ALT, prothrombin time, albumin, cardiac index, arterial lactate, oxygen delivery, MAP (mean arterial pressure), APACHE II (acute physiology and chronic health evaluation), SOFA (sequential organ failure assessment), and SAPS II (simplified acute physiology score). IAH has been defined as a peak intra-abdominal pressure (IAP) value of ≥12 mmHg, at a minimum, as two standardized measurements obtained 1-6 h apart. RESULTS: The PDR-ICG measured 24 h after surgery was not different among groups (20.95% [SD = 10.34] vs 25.40% [SD = 7.42]), p = .094. ICG R15 was significantly higher in patients with IAH, 11.10% [SD = 13.82] vs 8.30 [SD = 11.46], p < .05, respectively. The PDR/ICG value was significantly lower in non-survivors than survivors (16.82 [SD = 10.87] vs 24.35 [SD = 8.48], p < .05). CONCLUSIONS: The results suggest that PDR/ICG and ICG R15 are useful dynamic tests for evaluation of complex liver function and survival prediction after major abdominal surgery in patients with IAH.

Human soluble TREM-1: lung and serum levels in patients with bacterial ventilator associated pneumonia.

Human soluble triggering receptor expressed on myeloid cells (sTREM-1) is a glycoprotein of the immunoglobulin superfamily. In normal lung tissue, sTREM-1 is selectively expressed in lung alveolar macrophages specialized for pathogen clearance and is up-regulated in the presence of bacteria and fungi. The aim of this study was to assess sTREM-1 levels in serum and lungs of patients with ventilator associated pneumonia (VAP) and to evaluate its potential diagnostic role. The study cohort included 31 patients meeting the criteria for VAP, including clinical, microbiological, radiological and laboratory findings in patients on mechanical ventilation for more than 48 hours and with Clinical Pulmonary Infection Score (CPIS) > 6. Serum and lung levels of sTREM-1 were obtained and tested for differences. The samples were analyzed using ELISA technique and the values were expressed in pg/mL. The samples for lung sTREM-1 were obtained from direct bronchial lavage fluid and serum samples from peripheral blood. Differences were tested by Mann Whitney U test with P < 0.05 considered significant. In patients with bacterial VAP, a statistically significant difference was found between serum and lung sTREM-1 levels (P < 0.05), with very high levels of sTREM-1 recorded in lung samples (mean value 1565 pg/mL). There was no statistically significant difference in pulmonary sTREM-1 level between the polymicrobial and monomicrobial VAP groups. In conclusion, sTREM-1 is present in a high concentration in the lungs of patients with bacterial VAP. sTREM-1 levels can help in making the diagnosis of bacterial pneumonia as a standalone marker.

Constant cardiac output monitoring using the PiCCO and LiDCO methods versus PAK in septic patients: when to do calibration?

The accuracy of cardiac output measurement by two most widely used methods of less invasive hemodynamic monitoring and by the standard technique of thermodilution with pulmonary catheter was assessed. The measurements were carried out in septic surgical patients immediately after and between system calibrations. Study results showed satisfactory compatibility of measurements performed by the two methods and by pulmonary catheter in both phases, thus system calibration being recommendable in hemodynamically unstable septic patients.