OTROVANJE GLJIVOM AMANITA PHALLOIDES – RANO LIJEČENJE AKTIVNIM UGLJENOM I N-ACETIL CISTEINOM: PRIKAZ BOLESNIKA I KRATAK PREGLED LITERATURE

Consumption of wild poison mushrooms is one of the serious poisonings which may end in death. The present case report and recent literature review describe Amanita phalloides mushroom poisoning and possible treatment for this emergency state. A 59-year-old male presented in the Emergency Unit of the Foggia University Hospital, Italy, with clinical signs of extreme dizziness, nausea, vomiting, and diarrhea, 12 h after consuming one ovule of a wild mushroom that was mistaken for an edible ovule of the Boletus edulis mushroom. The suspected poison mushrooms were collected in the forest near the city of Foggia, Italy. Urgent examination of urine showed the presence of _-amanitin. After 6 days of intensive and supportive treatment with activated charcoal and N-acetyl cysteine, the patient was transferred to the internal medicine department and discharged without organ complications 10 days after mushroom ingestion. Early recognition of mushroom poisoning and immediate intensive treatment with supportive care give the patients a better chance for survival after this fatal poisoning.Jedenje divljih otrovnih gljiva može dovesti do ozbiljnog otrovanja i smrti. Prikaz bolesnika i pregled najnovije literature opisuje otrovanje gljivama Amanita phalloides te moguće načine liječenja ovoga hitnog stanja. Poslije 12 sati nakon što je pojeo jajašce otrovne gljive, koje je zabunom zamijenio za jajašce jestive gljive vrganj (Boletus edulis), 54-godišnji muškarac je došao na hitni prijam Kliničke bolnice u Foggiai, Italija, s kliničkom slikom velike slabosti, mučninom, povraćanjem i proljevom. Prikupljene gljive bile su ubrane u šumi blizu grada Foggia. Hitan pregled mokraće je pokazao prisutnost otrova alfa-amanitina. Nakon šest dana liječenja na intenzivnoj njezi aktivnim ugljenom i N-acetil cisteinom pacijent je bio prebačen na odjel interne medicine bez komplikacija na organima te je nakon 10 dana bio otpušten iz bolnice. Rano prepoznavanje otrovanja gljivama i rano intenzivno liječenje s potporom životnih funkcija daje dobre izglede za preživljavanje ovoga opasnog otrovanja

OTROVANJE GLJIVOM AMANITA PHALLOIDES – RANO LIJEČENJE AKTIVNIM UGLJENOM I N-ACETIL CISTEINOM: PRIKAZ BOLESNIKA I KRATAK PREGLED LITERATURE

Consumption of wild poison mushrooms is one of the serious poisonings which may end in death. The present case report and recent literature review describe Amanita phalloides mushroom poisoning and possible treatment for this emergency state. A 59-year-old male presented in the Emergency Unit of the Foggia University Hospital, Italy, with clinical signs of extreme dizziness, nausea, vomiting, and diarrhea, 12 h after consuming one ovule of a wild mushroom that was mistaken for an edible ovule of the Boletus edulis mushroom. The suspected poison mushrooms were collected in the forest near the city of Foggia, Italy. Urgent examination of urine showed the presence of _-amanitin. After 6 days of intensive and supportive treatment with activated charcoal and N-acetyl cysteine, the patient was transferred to the internal medicine department and discharged without organ complications 10 days after mushroom ingestion. Early recognition of mushroom poisoning and immediate intensive treatment with supportive care give the patients a better chance for survival after this fatal poisoning.Jedenje divljih otrovnih gljiva može dovesti do ozbiljnog otrovanja i smrti. Prikaz bolesnika i pregled najnovije literature opisuje otrovanje gljivama Amanita phalloides te moguće načine liječenja ovoga hitnog stanja. Poslije 12 sati nakon što je pojeo jajašce otrovne gljive, koje je zabunom zamijenio za jajašce jestive gljive vrganj (Boletus edulis), 54-godišnji muškarac je došao na hitni prijam Kliničke bolnice u Foggiai, Italija, s kliničkom slikom velike slabosti, mučninom, povraćanjem i proljevom. Prikupljene gljive bile su ubrane u šumi blizu grada Foggia. Hitan pregled mokraće je pokazao prisutnost otrova alfa-amanitina. Nakon šest dana liječenja na intenzivnoj njezi aktivnim ugljenom i N-acetil cisteinom pacijent je bio prebačen na odjel interne medicine bez komplikacija na organima te je nakon 10 dana bio otpušten iz bolnice. Rano prepoznavanje otrovanja gljivama i rano intenzivno liječenje s potporom životnih funkcija daje dobre izglede za preživljavanje ovoga opasnog otrovanja

Acute abdomen as a consequence of an unusual suicide attempt: intra-abdominal injection of sulfuric acid

Caustic ingestion is a common cause of life-threatening upper gastrointestinal tract injuries. It mostly happens in children as accidental exposure, but may occur in adults as a result of suicide attempt. We present a case of an acute abdomen that occurred after a peculiar way of self-administration of sulfuric acid as a suicide attempt in an adult psychiatric male patient, already known for self-harm with caustic agents in the previous years. In a few hours, the patient developed diffuse peritonitis, pneumoperitoneum, and a rapid hemodynamic deterioration, as a consequence of ileum and sigmoid necrosis, requiring an emergency surgery with the application of a damage control strategy. The patient was then transferred to intensive care unit for hemodynamic stabilization, and definitive surgical correction of the abdominal lesions was performed after 3 days with Hartmann procedure. Thirty-nine days after hospital admission, the patient was discharged. In conclusion, to our knowledge, never has been reported in the literature a case of intra-abdominal self-administration of caustic substance causing a rapid evolution of clinical conditions and requiring the application of damage control strategy

Effects of Tibetan Music on Neuroendocrine and Autonomic Functions in Patients Waiting for Surgery: A Randomized, Controlled Study

Background. The aim of this study was to investigate the effects of listening to Tibetan music on anxiety and endocrine, autonomic, cognitive responses in patients waiting for urologic surgery. Methods. Sixty patients waiting for surgery were enrolled to the study. They were randomized in music (M) and control (C) groups. The M group listened to a low-frequency Tibetan music for 30 min (T0–T30) through headphones, and the C group wore headphones with no sound. The State Trait Anxiety Inventory Questionnaire (STAI) Y-1 was administered at T0 and T30. Normalized low (LFnu) and high frequencies (HFnu) of heart rate variability, LF/HF ratio, and galvanic skin response (GRS) data were analyzed at T0, T10, T20, T30, and T35. The salivary α-amylase (sAA) samples were collected at T0, T35, and T45. Results. In the M group, the STAI Y-1 score decreased at T30 versus baseline p<0.001, sAA levels decreased at T35 versus T0p=0.004, and GSR remained unchanged. In the C group, the STAI Y-1 score remained unchanged, sAA level increased at T35 versus T0p<0.001, and GSR slightly increased at T35 versus baseline p=0.359. LFnu was lower, and HFnu was significantly higher (T10–T30) in M versus C group. Mean LF/HF ratio slightly reduced in the M group. Conclusions. Our results suggest that preoperative listening to relaxing Tibetan music might be a useful strategy to manage preoperative anxiety

P-hydroxyphenylpyruvate, an intermediate of the Phe/Tyr catabolism, improves mitochondrial oxidative metabolism under stressing conditions and prolongs survival in rats subjected to profound hemorrhagic shock

The aim of this study was to test the effect of a small volume administration of p-hydroxyphenylpyruvate (pHPP) in a rat model of profound hemorrhagic shock and to assess a possible metabolic mechanism of action of the compound. The results obtained show that hemorrhaged rats treated with 2-4% of the estimated blood volume of pHPP survived significantly longer (p<0.001) than rats treated with vehicle. In vitro analysis on cultured EA.hy 926 cells demonstrated that pHPP improved cell growth rate and promoted cell survival under stressing conditions. Moreover, pHPP stimulated mitochondria-related respiration under ATP-synthesizing conditions and exhibited antioxidant activity toward mitochondria-generated reactive oxygen species. The compound effects reported in the in vitro and in vivo analyses were obtained in the same millimolar concentration range. These data disclose pHPP as an efficient energetic substrates-supplier to the mitochondrial respiratory chain as well as an antioxidant supporting the view that the compound warrants further evaluation as a therapeutic agent. © 2014 Cotoia et al

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Pathogenesis-Targeted Preventive Strategies for Multidrug Resistant Ventilator-Associated Pneumonia: A Narrative Review

Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in the intensive care unit (ICU), accounting for relevant morbidity and mortality among critically ill patients, especially when caused by multidrug resistant (MDR) organisms. The rising problem of MDR etiologies, which has led to a reduction in treatment options, have increased clinician&rsquo;s attention to the employment of effective prevention strategies. In this narrative review we summarized the evidence resulting from 27 original articles that were identified through a systematic database search of the last 15 years, focusing on several pathogenesis-targeted strategies which could help preventing MDR-VAP. Oral hygiene with Chlorhexidine (CHX), CHX body washing, selective oral decontamination (SOD) and/or digestive decontamination (SDD), multiple decontamination regimens, probiotics, subglottic secretions drainage (SSD), special cuff material and shape, silver-coated endotracheal tubes (ETTs), universal use of gloves and contact isolation, alcohol-based hand gel, vaporized hydrogen peroxide, and bundles of care have been addressed. The most convincing evidence came from interventions directly addressed against the key factors of MDR-VAP pathogenesis, especially when they are jointly implemented into bundles. Further research, however, is warranted to identify the most effective combination