A retrospective review of intensive care management of organophosphate insecticide poisoning: Single center experience.

BACKGROUND: Organophosphate (OP) compounds are used as insecticides. Given the widespread availability and use of these chemicals, OP poisoning is quite common following either accidental or intentional exposures. Immediate intensive care management can save lives in these patients. We aimed to investigate intensive care management provided to OP poisoning patients in a tertiary care hospital in Turkey. SUBJECTS AND METHODS: This was a retrospective chart review of 62 patients, admitted to the Intensive Care Unit (ICU) with OP poisoning between 2000 and 2012. RESULTS: Of the 62 patients studied, 40 (65%) were male, 45 (73%) were suicide attempts, 59 (95%) ingested the OP compounds, and three patients (5%) (two patients with suicide and 1 with accidental exposure) died in the ICU. There were statistically significant differences between survivors and nonsurvivors for Glasgow Coma Scale (GCS) on admission (P = 0.034), Acute Physiology and Chronic Health Evaluation II (APACHE II) score (P = 0.003), Sequential Organ Failure Assessment (SOFA) score (P = 0.024), time to initiation of treatment (P = 0.034) and serum lactate dehydrogenase (LDH) levels (P = 0.007). CONCLUSIONS: Organophosphate poisoning is a life-threatening condition that requires immediate diagnosis and management. GCS, APACHE II score, SOFA score, and time to admission to the emergency department and LDH levels can provide prognostic information and predict outcomes.

Comparison of colistin and colistin/sulbactam for the treatment of multidrug resistant Acinetobacter baumannii ventilator-associated pneumonia.

PURPOSE: To compare clinical and microbiological efficacy of colistin and colistin/sulbactam for the treatment of multidrug-resistant (MDR) Acinetobacter baumannii VAP in intensive care units (ICUs). PATIENTS AND METHODS: In this retrospective analysis, patients (>16 years-old) who received IV colistin or colistin/sulbactam for the treatment of MDR A. baumannii VAP were evaluated. The clinical and microbiological responses to therapies were assessed on the fifth day and at the end of the therapy. RESULTS: During the study period, 89 patients were enrolled into the study. Fifty-two (58.4 %) patients received colistin and 37 (41.6 %) patients received colistin/sulbactam therapy. The median APACHE II score was higher and diabetes mellitus was more common in the colistin/sulbactam group (p < 0.05). However, other demographic characteristics were not statistically significant between groups. On the fifth day of colistin and colistin/sulbactam therapies, clinical response rates were 40.4 and 43.2 %, respectively. At the end of the therapies, clinical response rates were 29.8 and 40 %, respectively. The bacteriological response rates were 72.3 and 85.7 % in colistin and colistin/sulbactam groups, respectively. There were no statistically significant differences in clinical cure rates or bacteriological clearance rates between the two groups. CONCLUSIONS: The colistin/sulbactam combination therapy is promising in severe MDR A. baumannii VAP. Although, the difference was not statistically significant, clinical cure rates or bacteriological clearance rates were better in the combination group than colistin monotherapy.

The effect of adenosine triphosphate on sunitinib-induced cardiac injury in rats.

In this study, we aimed to show the effect of adenosine 5'-triphosphate (ATP) on sunitinib-induced cardiac injury in rats. The rats (n = 30) were divided equally into three groups as sunitinib group (SG), sunitinib plus ATP group (SAG), and healthy group (HG); 2 mg/kg ATP was injected intraperitoneally (ip) to the SAG group. Same volume normal saline as solvent was administered ip to the other two groups. After 1 h, 25 mg/kg sunitinib was applied orally via catheter to stomach in the SAG and SG groups. This procedure was repeated once daily for 5 weeks. At the end of this period, all animals were sacrificed and their cardiac tissue was removed. Malondialdehyde (MDA), total glutathione (tGSH), tumor necrosis factor α (TNF-α), and nuclear factor κB (NF-κB) levels in rats' cardiac tissues and troponin I (Tp-I) levels in rats' blood samples were evaluated. Histopathological analysis was also performed in cardiac tissues of the animals. MDA, TNF-α, NF-κB, and Tp-I levels were higher in the SG group compared to the SAG and HG groups (p < 0.001). tGSH levels of the SG group were lower than the SAG and HG groups (p < 0.001). The structure and morphology of cardiac muscle fibers and blood vessels were normal in the control group. In the SG group, obvious cardiac muscle tissue damage with dilated myofibers, locally atrophic myofibers, and congested blood vessels were observed. In the SAG group, marked amelioration in these findings was observed. We showed this for the first time that ATP administration exerts a protective effect against cardiac effects of sunitinib.

Relationships between left atrial pericardial fat and permanent atrial fibrillation: Results of a case-control study.

PURPOSE: The goal of this study was to retrospectively investigate the relationships between pericardial fat, left atrium volume (LAV) as measured on multidetector row computed tomography (MDCT) and persistent atrial fibrillation (AF) using a case-control study. MATERIALS AND METHODS: The study population consisted of 58 patients (19 men, 39 women; mean age, 67.8±10 [SD] years) with persistent AF and 74 control subjects (30 men, 44 women; mean age, 67.8±10.9 [SD] years). The associations between the presence of persistent AF and periatrial pericardial fat volume (PAFV), periatrial pericardial fat thickness (PAFT), and LAV as measured on MDCT were searched for using univariate and multiple linear regression analysis. RESULTS: On univariate analysis, significant differences were found between patients with AF and control subjects for mean PAFV (54.33cm(3)±23.43 [SD]; range: 12.2-111.1cm(3) vs 42.99cm(3)±20.76 [SD]; range: 7.4-103.9cm(3), respectively) (P=0.01), PAFT at the esophagus (1.87mm±1.65 [SD]; range: 0.1-9.5mm vs 1.12mm±0.77 [SD]; range: 0.1-3.6mm, respectively) (P<0.001) and normalized LAV (78.3cm(3)/m(2)±48.84 [SD]; range: 32.1-319.6cm(3)/m(2) vs 42.1cm(3)/m(2)±25.43 [SD]; range: 15.7-191.4cm(3)/m(2), respectively) (P<0.001). Multiple linear regression analysis revealed that only LAV was an independent predictor (P<0.001) of persistent AF. Also PAFV was significantly associated with LAV (P=0.01). CONCLUSION: LAV is greater in patients with AF than in control subjects and PAFV is strongly associated with LAV. PAFV and PAFT are not independently associated with AF.

Outcomes of percutaneous endoscopic gastrostomy in hospitalized patients at a tertiary care center in Turkey.

BACKGROUND/OBJECTIVES: The aim of this study was to perform a retrospective analysis characterizing patients receiving tube feeding following percutaneous endoscopic gastrostomy (PEG) tube placement between 2004 and 2012 at Erciyes University Hospital in Turkey. SUBJECTS/METHODS: Patients above the age of 18 years who required long-term enteral tube feeding were studied. All PEGs were performed using the pull-through technique by one experienced endoscopist. Demographic, clinical outcomes and PEG-related complication data were collected. RESULTS: Of the 128 subjects studied, 91 were men (71%) and 37 were women (29%). The mean age of this patient population was 54 ± 19 years. The most common reason for PEG tube insertion was the inability to consume oral diet due to complications of cerebrovascular disease (27%), while cerebral hypoxia, occurring after nonneurological medical disorders, was the second most common indication (23%). A total of 70 patients (55%) had chronic comorbidities, with hypertension being the most common (20%). The most common procedure-related complication was insertion-site bleeding, which occurred in 4% of patients. Long-term complications during 1 year were insertion-site cellulitis, gastric contents leakage and peristomal ulceration, which occurred in 14%, 5% and 0.5% of patients, respectively. There were no PEG insertion-related mortalities; 1-year mortality was unrelated to the indication for PEG tube insertion. CONCLUSIONS: PEG tube insertion was a safe method to provide enteral access for nutrition support in this hospitalized patient population.

Comparison effects and dielectric properties of different dose methylene-blue-doped hydrogels.

The dielectric properties of methylene blue (MB)-doped hydrogels were investigated by impedance spectroscopy. The real part (ε') and the imaginary part (ε") of the complex dielectric constant and the energy loss tangent/dissipation factor (tan δ) were measured in the frequency range of 10 Hz to 100 MHz at room temperature for pH 5.5 value. Frequency variations of the resistance, the reactance, and the impedance of the samples have also been investigated. The dielectric permittivity of the MB-doped hydrogels is sensitive to ionic conduction and electrode polarization in low frequency. Furthermore, the dielectric behavior in high-frequency parts was attributed to the Brownian motion of the hydrogen bonds. The ionic conduction for MB-doped samples was prevented for Cole-Cole plots, while the Cole-Cole plots for pure sample show equivalent electrical circuit. The alternative current (ac) conductivity increases with the increasing MB concentration and the frequency.

Economic burden of ventilator-associated pneumonia in a developing country.

Ventilator-associated pneumonia (VAP) developed in 96 (60%) of 159 patients with 37.2 cases per 1000 ventilation-days in a medical intensive care unit (MICU). Median time for VAP development was 5.5 days (range: 2-25). The most significant risk factors for VAP were stay in hospital before MICU and length of stay in MICU. The mean length of stay in MICU for VAP patients was 23.8 ± 19.8 days, which was four-fold higher than for non-VAP patients. The daily cost for VAP patients was half that for non-VAP patients. The total costs for VAP patients were about three-fold higher than for non-VAP patients.