Antidepressant Poisoning Trends in Pediatric Intensive Care: A Comparative Study of New- and Old-Generation Antidepressants.

PURPOSE/BACKGROUND: This study aimed to compare the frequency, clinical findings, treatment practices, and outcomes of toxicity to old-generation (OG) and new-generation (NG) antidepressants in our pediatric intensive care unit (PICU) by year-to-year. METHODS/PROCEDURES: The study included patients hospitalized for antidepressant poisoning during the 11-year period of January 2010 through December 2020. Antidepressants were classified as OG and NG. The groups were compared in terms of patient demographic characteristics, type of poisoning (accidental/suicidal), clinical findings, supportive and extracorporeal treatments received, and outcomes. FINDINGS/RESULTS: The study included 58 patients (NG, n = 30; OG, n = 28). The median age of the patients was 178 months (range, 13.6-215 months) and 47 patients (81%) were female. Patients admitted for only antidepressant poisoning constituted 13.3% of all poisoning cases (58/436). Of these, 22 cases (37.9%) were accidental and 36 (62.3%) were suicidal. The most common cause of poisoning was amitriptyline (24/28) in the OG group and sertraline (13/30) in the NG group. Neurological symptoms were significantly more common in the OG group (76.2% vs 23.8%), while gastrointestinal involvement was more common in the NG group (82% vs 18%; P = 0.001 and P = 0.026, respectively). Old-generation antidepressant poisoning was associated with more frequent intubation (4 vs 0 patients, P = 0.048) and longer length of PICU stay (median, 1 day [range, 1-8] vs 1 day [range, 1-4], P = 0.019). Rates of therapeutic plasma exchange and intravenous lipid emulsion therapy did not differ ( P = 0.483 and P = 0.229, respectively). IMPLICATIONS/CONCLUSIONS: In poisoned patients, proper evaluation and management of patients requiring PICU admission are vital for favorable patient outcomes.

Timing of Endoscopic Retrograde Cholangiopancreatography in Postcholecystectomy Patients and Its Effect on Post-ERCP Complications.

Background: Due to the increasing use of laparoscopy for symptomatic cholelithiasis and other gallbladder disorders, as well as the ongoing issue of associated biliary tree injuries, endoscopic retrograde cholangiopancreatography (ERCP) still holds a significant position in the diagnosis and treatment of postcholecystectomy disorders. In our study, we aimed to examine the relationship between the time elapsed between cholecystectomy and ERCP with the post-ERCP complications. Methods: Ninety-six patients with a history of cholecystectomy who underwent ERCP between January 2016 and January 2021 at the General Surgery Clinic of the University of Health Sciences Bakirköy Dr. Sadi Konuk Health Application and Research Center were retrospectively evaluated. Patient and procedure-related factors were analyzed statistically through univariate analyses. Results: In the matter of post-ERCP complication status, differences observed in terms of age, body mass index (BMI) values, gender, comorbidities, number of ERCP procedures, and the time elapsed between cholecystectomy and ERCP among cases were not statistically significant. Discussion: Our study demonstrates that age, BMI values, gender, comorbidities, ERCP count, and the time between procedures are not significant risk factors for post-ERCP complications. Regardless of the time between surgery and ERCP, the presence of post-ERCP complications is comparable.

The Effect of Combined Spinal Epidural Anesthesia on Shoulder Pain in Laparoscopic Extraperitoneal Hernia Surgery.

BACKGROUND: Shoulder pain is a condition that seriously discomforts patients and develops caused by a peritoneal tear in laparoscopic extraperitoneal hernia repair (TEP) surgeries. Although surgeons generally prefer general anesthesia for the TEP technique, many studies have been carried out on the use of regional anesthesia in recent years. In our study, we aimed to investigate the efficacy and safety of the combined spinal/epidural anesthesia (CSEA) method to prevent shoulder pain in the TEP technique. METHODS: The patients who operated with the TEP procedure were divided into 2 groups; SA (group 1) and CSEA (group 2). The 2 patient groups were compared in terms of sex, age, body mass index, duration of surgery, total operation time, patient satisfaction, pain scores, length of hospital stay, adverse effects, intraoperative, and postoperative complications. RESULTS: The number of patients in group 1 was 42 and group 2 was 40. The mean operation time was recorded as 55.9 and 80.2 minutes in groups 1 and 2, respectively, which was statistically significantly shorter in group 1 ( P <0.001). Postoperative pain was significantly less in group 2 for the 4th hour ( P <0.0001) and the 12th hour ( P =0.047). There was no difference between the 2 groups in terms of peritoneal tear ( P =0.860). Intraoperative and postoperative shoulder pain was significantly less in group 2 ( P =0.038, P =0015, respectively). CONCLUSION: CSEA is an effective and safe anesthesia method for preventing shoulder pain that develops after TEP surgeries.

Exploiting ROS and metabolic differences to kill cisplatin resistant lung cancer.

Cisplatin resistance remains a major problem in the treatment of lung cancer. We have discovered that cisplatin resistant (CR) lung cancer cells, regardless of the signaling pathway status, share the common parameter which is an increase in reactive oxygen species (ROS) and undergo metabolic reprogramming. CR cells were no longer addicted to the glycolytic pathway, but rather relied on oxidative metabolism. They took up twice as much glutamine and were highly sensitive to glutamine deprivation. Glutamine is hydrolyzed to glutamate for glutathione synthesis, an essential factor to abrogate high ROS via xCT antiporter. Thus, blocking glutamate flux using riluzole (an amyotropic lateral sclerosis approved drug) can selectively kill CR cells in vitro and in vivo. However, we discovered here that glutathione suppression is not the primary pathway in eradicating the CR cells. Riluzole can lead to further decrease in NAD+ (nicotinamide adenine dinucleotide) and lactate dehydrogenase-A (LDHA) expressions which in turn further heightened oxidative stress in CR cells. LDHA knocked-down cells became hypersensitive to riluzole treatments and possessed increased levels of ROS. Addition of NAD+ re-stabilized LDHA and reversed riluzole induced cell death. Thus far, no drugs are available which could overcome cisplatin resistance or kill cisplatin resistant cells. CR cells possess high levels of ROS and undergo metabolic reprogramming. These metabolic adaptations can be exploited and targeted by riluzole. Riluzole may serve as a dual-targeting agent by suppression LDHA and blocking xCT antiporter. Repurposing of riluzole should be considered for future treatment of cisplatin resistant lung cancer patients.