ABO blood types and major outcomes in patients with acute hypoxaemic respiratory failure: A multicenter retrospective cohort study

Introduction ABO blood type A was reported to correlate with an increased risk of acute respiratory distress syndrome (ARDS) in white patients with severe sepsis and major trauma compared with patients with other blood types. Information regarding ABO phenotypes and major outcomes in patients with ARDS is unavailable. The primary aim was to determine the relationship between ABO blood type A and intensive care unit (ICU) mortality in patients with acute hypoxemic respiratory failure (AHRF). The secondary aim was to describe the association between ABO blood type A and ICU length of stay (LOS) in this study population. Methods In a multicenter, retrospective cohort study, we collected the clinical records of patients admitted from January 2012 to December 2014 in five ICUs of Northern Italy. We included adult white patients admitted to the ICU who were diagnosed with AHRF requiring mechanical ventilation. Results The electronic records of 1732 patients with AHRF were reviewed. The proportion of patients with ABO blood type A versus other blood types was 39.9% versus 60.1%. ICU mortality (25%) and ICU LOS (median [interquartile range], 5 [2\u201312] days) were not different when stratified by ABO blood type (ICU mortality, overall p value = 0.905; ICU LOS, overall p value = 0.609). SAPSII was a positive predictor of ICU mortality (odds ration [OR], 32.80; 95% confidence interval [CI], 18.80\u201357.24; p < 0.001) and ICU LOS (\u3b2 coefficient, 0.55; 95% CI, 0.35\u20130.75; p < 0.001) at multivariate analyses, whereas ABO blood type did not predict ICU outcome when forced into the model. Conclusion ABO blood type did not correlate with ICU mortality and ICU LOS in adult patients with AHRF who were mechanically ventilated

Metformin overdose causes platelet mitochondrial dysfunction in humans

Introduction. We have recently demonstrated that metformin intoxication causes mitochondrial dysfunction in several porcine tissues, including platelets. The aim of the present work was to clarify whether it also causes mitochondrial dysfunction (and secondary lactate overproduction) in human platelets, in-vitro and ex-vivo. Methods. Human platelets were incubated for 72 h with saline or increasing dose of metformin (in-vitro experiments). Lactate production, respiratory chain complex activities (spectrophotometry), mitochondrial membrane potential (flow-cytometry after staining with JC-1) and oxygen consumption (Clark-type electrode) were then measured. Platelets were also obtained from ten patients with lactic acidosis (arterial pH 6.97\ub10.18 and lactate 16\ub17 mmol/l) due to accidental metformin intoxication (serum drug level 32\ub114 mg/l) and ten healthy volunteers of similar sex and age. Respiratory chain complex activities were measured as above (ex-vivo experiments). Results. In-vitro, metformin dose-dependently increased lactate production (p<0.001), decreased respiratory chain complex I activity (p=0.009), mitochondrial membrane potential (p=0.003) and oxygen consumption (p<0.001) of human platelets. Ex-vivo, platelets taken from intoxicated patients had significantly lower complex I (p=0.045) and complex IV (p<0.001) activity compared to controls. Conclusions. Depending on dose, metformin can cause mitochondrial dysfunction and lactate overproduction in human platelets in-vitro and, possibly, in-vivo. Trial registration. NCT 0094212

Cumulative Prognostic Score Predicting Mortality in Patients Older Than 80 Years Admitted to the ICU.

OBJECTIVES: To develop a scoring system model that predicts mortality within 30 days of admission of patients older than 80 years admitted to intensive care units (ICUs). DESIGN: Prospective cohort study. SETTING: A total of 306 ICUs from 24 European countries. PARTICIPANTS: Older adults admitted to European ICUs (N = 3730; median age = 84 years [interquartile range = 81-87 y]; 51.8% male). MEASUREMENTS: Overall, 24 variables available during ICU admission were included as potential predictive variables. Multivariable logistic regression was used to identify independent predictors of 30-day mortality. Model sensitivity, specificity, and accuracy were evaluated with receiver operating characteristic curves. RESULTS: The 30-day-mortality was 1562 (41.9%). In multivariable analysis, these variables were selected as independent predictors of mortality: age, sex, ICU admission diagnosis, Clinical Frailty Scale, Sequential Organ Failure Score, invasive mechanical ventilation, and renal replacement therapy. The discrimination, accuracy, and calibration of the model were good: the area under the curve for a score of 10 or higher was .80, and the Brier score was .18. At a cut point of 10 or higher (75% of all patients), the model predicts 30-day mortality in 91.1% of all patients who die. CONCLUSION: A predictive model of cumulative events predicts 30-day mortality in patients older than 80 years admitted to ICUs. Future studies should include other potential predictor variables including functional status, presence of advance care plans, and assessment of each patient's decision-making capacity

Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study.

BACKGROUND: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. RESULTS: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86-1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87-1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7-60.7) vs. 57.1% (95% CI 53.7-60.1), p = 0.85]. CONCLUSIONS: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival

Vitrectomo

Vitrectomo (1) atto ad asportare corpo vitreo (1a) e comprendente un condotto cavo (2) atto ad andare a contatto diretto con il corpo vitreo (1a), definente un asse prevalente di sviluppo (2a) e comprendente un canale interno (21), e un’apertura (23) atta a permettere al corpo vitreo (1a) di entrare in detto canale interno (21) e comprendente almeno un tagliente (23a, 23b); un apparato di aspirazione atto a mettere in depressione il canale interno (21) aspirando il corpo vitreo (1a); un organo di movimentazione atto a movimentare detto condotto cavo (2) definendo un moto oscillatorio (A) del condotto cavo (2) che produce così onde di pressione riducenti la viscosità del corpo vitreo (1a) e un moto alternato (B), di frequenza inferiore al moto oscillatorio (A), atto a permettere al tagliente (23a, 23b) di eseguire il taglio del corpo vitreo (1a)

VITRECTOMY PROBE

Vitrectomy probe (1) for the removal of the vitreous humour (1a) and comprising a tube (2) adapted to be put into direct contact with said vitreous (1a), defining a main axis (2a) and including an internal passage (21) and a opening (23) enabling said vitreous (1a) to enter said internal passage (21) and comprising at least one cutting edge (23a, 23b); a suction system suitable for the creation of vacuum within the internal passage (21) sucking the vitreous (1a) into the opening (23); a drive unit adapted to move said tube (2) defining a vibrational motion (A) of the tube (2) which therefore produces pressure waves reducing the viscosity of the vitreous (1a), and a reciprocating motion (B), having a frequency lower than the frequency of the vibrational motion (A), adapted to enable the cutting edges (23a, 23b) to cut the vitreous (1

Femtosecond laser-assisted cataract in vitreoretinal surgery

Purpose: To assess the safety and surgical results of femtosecond laser-assisted phacovitrectomy. Methods: Fifteen patients over 50 years of age with coexisting vitreoretinal pathologies and cataract underwent combined femtosecond laser-assisted cataract extraction and sutureless 25-G and 27-G vitreoretinal surgery. Results: The indication for surgery was macular hole in 6 patients, epiretinal membrane in 6, vitreous hemorrhage in 2, and retinal detachment in 1. The mean preoperative best-corrected visual acuity (BCVA) was 0.64 ± 0.23 logMAR and the mean postoperative BCVA was 0.19 ± 0.11 logMAR. In 4 patients with epiretinal membrane with corneal astigmatism of 3.35 ± 0.32 D as mean value, a toric intraocular lens (IOL) was implanted: mean residual refractive cylinder was 0.47 ± 0.23 D. Three months postoperatively, mean IOL rotation was 1.64 ± 0.28°. All patients improved their visual acuity. The intraoperative complications of femtosecond laser were 1 subconjunctival hemorrhage, 1 case of miosis, and 1 suction loss. The surgeon was able to maintain a clear view of the retina at all times. After surgery, a better fundus examination was possible with no capsular opacification. Mean follow-up was 6 months. Conclusions: Femtosecond laser cataract in vitreoretinal surgery appears a safe and effective technique with potential benefits: the precision and centration of the capsulorhexis may potentially reduce the risk of IOL prolapse into the anterior chamber in gas-filled eyes. Implantation of the toric IOL was effective in reducing preexisting corneal astigmatism and provided good rotational stability and refractive outcome

Netilmicin/dexamethasone fixed combination in the treatment of conjunctival inflammation

Francesco Faraldi,1 Vincenzo Papa,2 Daria Ras&agrave;,2 Debora Santoro,2 Simona Russo21Struttura Complessa Oculistica III, Presidio Ospedaliero Oftalmico, Torino, Italy; 2Medical Affairs, SIFI SpA, Aci S Antonio, Catania, ItalyPurpose: To compare the efficacy and safety of 0.1% dexamethasone/0.3% netilmicin (Netildex), with that of 0.1% dexamethasone/0.3% tobramycin (Tobradex) in the treatment of external ocular inflammation requiring antibiotic therapy.Methods: In this randomized, double-blind study, 139 subjects with conjunctival inflammation associated with signs of ocular infection were treated with Netildex (n = 71) or Tobradex (n = 68) four times daily for 6 days. The primary efficacy analysis was based on the percentage of patients with at least a 50% decrease in conjunctival hyperemia at the endpoint visit (Day 6 [&plusmn; 1]) with respect to baseline (responder rate). An equivalence margin of 20% was set for this study. A follow-up visit was performed at Day 14 (&plusmn; 1). Other efficacy parameters were: conjunctival edema, conjunctival discharge, lid hyperemia, lid edema, presence of ocular infection, and symptoms of ocular discomfort. Safety evaluations included intraocular pressure, visual acuity, and adverse events.Results: At Day 6, a decrease of conjunctival hyperemia was observed in 87.3% and 90.9% of the patients treated with Netildex and Tobradex, respectively. The 95% confidence interval for the difference between groups (&ndash;15.3 &divide; 8.0) satisfied the equivalence hypothesis. Subjects treated with Netildex had a better control of lid hyperemia (P = 0.016), tearing (P = 0.001), burning (P = 0.007), and stinging (P = 0.004). No adverse reactions were observed during the study except one case of keratitis in the Tobradex group.Conclusion: Netildex was as effective and safe as Tobradex in reducing signs and symptoms in patients with conjunctival inflammation when ocular infection was suspected.Keywords: conjunctivitis, dexamethasone, netilmicin, red ey