The Unknown Miracle of the Forgotten Element: “Magnesium and Immunity”

Bu derleme magnezyumun pek çok kullanım alanına ek olarak kritik hastada enflamasyon sürecine etkisi, immün sisteme olan katkısını göstermeyi amaçlamıştır. Magnezyum insan vücudunda ekstrasellüler alanda dördüncü sırada, intrasellüler olarak da ikinci olarak en sık bulunan katyonu olup; nükleik asit ve protein sentezi gibi birçok temel reaksiyonda enzim kofaktörü olarak rol alması, hücre membran stabilizasyonunu sağlaması gibi görevleri göz önüne alındığında son derece önemli bir elementtir. Diğer pek çok elektrolite kıyasla en önemli özelliği immün sisteme ve canlı immünitesine olan etkisidir. Yoğun bakımda yatan immünosüpresif ya da immünokompetan olan her grup hastada magnezyum eksikliği desteklenmeli ve pek çok yararına ek olarak magnezyumun immmün sisteme katkısı akılda tutulmalıdır

Evaluation of Intrapulmonary Shunt Alterations at Different Oxygen Concentrations and Oxygenation Parameters

Aim: The aim of the current study was to evaluate the relationship of intrapulmonary shunt with FiO2 alterations in patients treated with mechanical ventilation in intensive care unit for extrapulmonary disorders. Also, we aimed to assess the role of correlation between shunt ratio and PaO2/FiO2, PaO2/PAO2, P(A-a) O2 values in determining the treatment strategies. Methods: Twenty patients between ages of 19 and 75 years, requiring mechanical ventilation were enrolled into the study. We excluded two patients due to congestive heart failure and two patients due to acute respiratory distress syndrome (ARDS). Shunt fraction, P(A-a)O2, PaO2/FiO2, PaO2/PAO2 values were calculated at each FiO2 level for each patient. Results: The lowest median shunt value was measured at FiO2: 0.3 There was a significant correlation between shunt values at FiO2 0.5 and 0.7 (r=0.850). The highest mean value of P(A-a)O2 was measured at FiO2: 1 (382.91±106.46), and the lowest value of P(A-a)O2 was measured at FiO2: 0.21 (38.64±16.97). PaO2/FiO2 and PaO2/PAO2 ratios measured at FiO2: 0.3 and 0.5 were found to be statistically significant. Conclusion: In this study, we have shown increased shunt fraction at FiO2: 1 level. Different oxygenation indices and shunt measurements give us important and useful knowledge about the patients’ current condition. (The Medical Bulletin of Haseki 2015; 53:124-9

A Case of Biotinidase Deficiency in an Adult with Respiratory Failure in the Intensive Care Unit

Background: Biotinidase deficiency (BD) is a rare, inherited autosomal recessive disorder that is treatable within childhood. We present a patient with pneumonia and respiratory acidosis who was not diagnosed with any systemic disorders; the patient was finally diagnosed as BD. Case Report: A thirty-year-old woman was admitted to the emergency department with respiratory failure that had persisted for a few days and progressively weakening over the previous six months. Then, the patient was admitted to the intensive care unit with marked respiratory acidosis, respiratory failure and alterations in consciousness. At the follow-up, the patient was not diagnosed with a systematic disorder. Rather, the patient’s historical clinical findings suggested a metabolic disorder. Finally, the patient was diagnosed with biotinidase deficiency. Conclusion: Even though biotinidase deficiency is not frequently seen in the intensive care unit, metabolic syndromes such as biotinidase deficiency should be considered. Patients should be evaluated holistically with attention to medical history, family history and clinical findings