The effects of selenium supplementation on clinical outcomes in mechanically ventilated, non-surgical/traumatic critically ill patients

Background: Selenium presents anti-inflammatory and antioxidant properties which plays a critical role in nutrition of patients following devastating conditions. Furthermore, several lines of evidence reported that most of patients who admitted to intensive care unit (ICU) have lower plasma levels of selenium. Therefore, this study was designed to define the impact of selenium supplementation on clinical outcomes of mechanically ventilated non-surgical/traumatic critically ill patients.Materials and Methods: This study was conducted on 105 subjects hospitalized in ICU of Shohadaye Haft-e Tir Hospital, Tehran, Iran. Here the acute physiologic assessment and chronic health evaluation (APACHE) II score of patients was documented on the day of their ICU admission. The patients were divided to two groups based on block randomization technique and were assigned to receive selenium or placebo. Then the effect of selenium supplementation was evaluated based on the APACHE II score, the occurrence of ventilator associated pneumonia (VAP), length of ICU stay and the rate of mortality.Results: The acquired data revealed no significant difference between two experimental groups based on the demographical information. Also it was demonstrated that selenium supplementation of critically ill patients was associated with better APACHE II score, fewer length of ICU stay and fewer mortality rate. Incidence of VAP indicated no significant difference between groups.Conclusion: The obtained data of this single center clinical trial showed that selenium supplementation could improve clinical outcomes of critically ill patients.Keywords: Selenium supplementation; APACHE II score; ventilator associated pneumonia; mortality rate; length of ICU sta

Biochemical Markers in Neurocritical Care

During the past two decades, a variety of serum or cerebrospinal fluid (CSF) biochemical markers in daily clinical practice have been recommended to diagnose and monitor diverse diseases or pathologic situations. It will be essential to develop a panel of biomarkers, to be suitable for evaluation of treatment efficacy, representing distinct phases of injury and recovery and consider the temporal profile of those. Among the possible and different biochemical markers, S100b appeared to fulfill many of optimized criteria of an ideal marker. S100b, a cytosolic low molecular weight dimeric calciumbinding protein from chromosome 21, synthesized in glial cells throughout the CNS, an homodimeric diffusible, belongs to a family of closely related protein, predominantly expressed by astrocytes and Schwann cells and a classic immunohistochemical marker for these cells, is implicated in brain development and neurophysiology. Of the 3 isoforms of S-100, the BB subunit (S100B) is present in high concentrations in central and peripheral glial and Schwann cells, Langerhans and anterior pituitary cells, fat, muscle, and bone marrow tissues. The biomarker has shown to be a sensitive marker of clinical and subclinical cerebral damage, such as stroke, traumatic brain injury, and spinal cord injury. Increasing evidence suggests that the biomarker plays a double function as an intracellular regulator and an extracellular signal of the CNS. S100b is found in the cytoplasm in a soluble form and also is associated with intracellular membranes, centrosomes, microtubules, and type III intermediate filaments. Their genomic organization now is known, and many of their target proteins have been identified, although the mechanisms of regulating S100b secretion are not completely understood and appear to be related to many factors, such as the proinflammatory cytokines, tumor necrosis factor alpha (TNF-a), interleukin (IL)-1b, and metabolic stress.

The Relationship between Platelet Volume Indices (PVIs) and Epileptic Seizure

Background: Platelet volume indices (PVIs) are low on price and easily accessible criteria in today’s medicine. However, the impact of PVIs on seizure characteristics in epileptic patients is not clear.Aim: To assess the level of PVIs in seizure affected patients and to see if there is a relationship between these results and the clinical status of patients.Methods: The current study enrolled patients with the epileptic seizure (ES) to evaluate the PVIs for investigating whether a relationship exists between PVIs levels with duration, frequency and type of seizure. In this survey, the platelet indices including mean platelet volume (MPV), platelet distribution width (PDW), and platelet count (PLT) were calculated for the patient.Results: A total of 199 patients were included in the study period, for which 59 attacks were focal seizures and 149 attacks were generalized convulsive seizures. The platelet counts and PCT were significantly higher in focal seizure than in generalized convulsion seizure. In generalized onset, MPV was significantly higher as compared to the focal onset.Conclusion: The acquired data indicated that the high level of MPV and low level of PLT and PCT in generalized seizures might substantially contribute to the clinical signs of epileptic patients

Dexmedetomidine in Neurocritical Care

Early and appropriate management of brain insults has significantly reduced patient morbidity and mortality. Neuromonitoring, neuroprotection and secondary brain injury prevention are the essential principals of brain injury management. In this literature review we have elaborated the neuroprotective role of dexmedetomidine (DEX), predominantly in different animal models of brain insults and reports in patients cared in a neurocritical care setting.  We undertook an electronic literature search of articles published in English prior to July 2019. This search resulted in inclusion of 59 studies from medical databanks such as PubMed, Scopus, EMBSCO, CINAHL, ISC and the Cochrane Library. The keywords used were brain, α2 agonist, neurocritical care and dexmedetomidine. DEX may have a neuroprotective effect in a broad spectrum of brain pathologies such as traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), ischemic stroke, intracerebral hemorrhage (ICH), and cerebral hypoxia. However, its neuroprotective role in status epilepticus (SE) is less clear. Further animal and human studies are needed before we could consider DEX as a neuroprotective agent in this patient population. Due to its favorable properties outlined in this review, DEX could be considered a favorable sedative agent in the neurocritical care settings

Demographic and Clinical Characteristics of Patients Who Died of Methanol Toxicity During COVID 19 Period in Loghman-e Hakim Hospital in Tehran

Background: Outbreaks of methanol poisoning were observed during the COVID-19 pandemic. Acute methanol poisoning is a global crisis. Methanol can cause acute and fatal toxicity through metabolic acidosis. In the present study, we evaluated demographic, clinical, and paraclinical characteristics of patients who died in the recent outbreak of methanol poisoning in Tehran from March to April 2020. Methods: This cross-sectional study was accomplished at the Loghman-Hakim Hospital in Tehran on 80 patients who died of methanol toxicity. Demographic, clinical, and laboratory data were collected retrospectively from the patient’s files and analyzed with appropriate statistical tests.Results: Men were significantly more involved than women (%85 vs. %15). There were no significant differences between other characteristics of male and female patients, including the time between consumption to arrive hospital, dialysis sessions, pulse rate, respiratory rate, loss of consciousness, seizure, acute kidney injury, brain CT, and Intracerebral Hemorrhage ( ICH). Blood sugar, serum potassium, and liver function tests were higher than average in most of the patients.Conclusion: Our study showed that this outbreak of methanol poisoning was due to the use of alcoholic drinks that contain methanol. Men were primarily affected that could be because of the cultural and social status of our country. The greater seizure probability in females could be because of enhancing the NMDA receptor by estrogen. Abnormalities in Alanine aminotransferase (ALT), Aspartate Aminotransferase (AST), and Prothrombin Time (PT) were seen in most patients, indicating liver damage. Misbeliefs about the protective effects of alcohol consumption against COVID-19 may lead many to consume poorly made alcohols that contain methanol and outbreaks of methanol intoxication

Neuro-critical Care Unit Bed Allocation Optimization based on Hybrid Approach: Designing of Experiments and Simulation

سابقه و هدف: واحد مراقبت‌های ویژه مغز و اعصاب به مراقبت از بیماران دچار شرایط بحرانی و تهدید کننده حیات در زمینه بیماری های مغز و اعصاب اختصاص دارد و از آنجایی‌که با محدودیت منابع جهت افزایش تخت های مراقبت های ویژه و همچنین افزایش زمان انتظار بیماران در این بخش رو به رو می باشیم نیازمند دستیابی به بهینه ترین ترکیب ممکن برای تخصیص تخت ها به هر نوع از بیماران و تعداد تخت در بخش مراقبت های ویژه می باشیم. لذا در این مطالعه برای استفاده بهینه از تخت ها و نیز به منظور کاهش متوسط زمان انتظار بیماران در بخش مراقبت‌های ویژه مغز و اعصاب مرکز پزشکی، آموزشی درمانی لقمان حکیم وابسته به دانشگاه علوم پزشکی شهید بهشتی به شبیه سازی بخش مورد نظر پرداخته تا ترکیب بهینه تخت های موجود در این بخش حاصل شود. روش بررسی: در این مطالعه ابتدا ترکیب تخصیص تخت های بخش مراقبت های ویژه مغز و اعصاب بیمارستان لقمان حکیم به هر دسته از بیماری ها مشخص شد و با استفاده از نرم افزار طراحی آزمایشات بهینه ترین ترکیب های ممکن بدست آمد. سپس ترکیب های بدست آمده شبیه سازی شده و دو معیار میانگین زمان انتظار در صف برای بیماران و میزان بهره وری (اشغال تخت) برای هر یک از ترکیب ها محاسبه شد. پس از آن مدل ریاضی شامل اهداف کمینه سازی متوسط ​​زمان انتظار بیماران در صف و همچنین میانگین بهره وری تخت ها با استفاده از روش پاسخ خطی ارائه شد. نتایج: بر اساس نتایج، تعداد بهینه انواع تخت های مورد استفاده در این بخش به ترتیب برابر با شش، دو، سه، سه و دو تخت برآورد شدند که منجر به متوسط زمان انتظار 1.4 ساعتی بیماران و نیز متوسط بهره وری 34.5 درصدی مجموع تخت ها شد. نتیجه‌گیری: نتایج مطالعه حاضر بیانگر این واقعیت است که بهینه سازی تخصیص تخت در بخش مراقبت‌های ویژه مغز و اعصاب با بکارگیری رویکرد ترکیبی شبیه سازی و طراحی آزمایشات ، باعث کاهش متوسط زمان انتظار بیماران و به تبع آن افزایش بهره وری (درصد اشتغال به کار) تخت ها می شود. How to cite this article: Goharani R, Shafagh-sorkh O, Nateghinia S, Hajiesmaeili M, Alibabaei A, Shafigh N. Neuro-critical Care Unit Bed Allocation Optimization based on Hybrid Approach: Designing of Experiments and Simulation. J Saf Promot Inj Prev. 2021; 9(1):9-17.Background & Objectives: Neurological Critical Care Unit is allocated for patients with critical conditions in the field of neurological diseases. ICU beds and their equipment are very expensive and there are some economic constraints for increasing the ICU beds. At the same time, the admission waiting time for patients in this unit is not favorable. Therefore, an initiative for better management of this ward was needed.  The objective of this study was to examine an optimal program for allocating beds to patients, based on their required length of stay in the unit. Methods and Materials: In this study, different categories of patients and their quantity was investigated in the Loghman Hakim hospital. Then, by using the design of experiments technique, optimal combinations were obtained. The obtained combinations were simulated for each of two criteria was calculated; patients' average waiting time and bed occupancy rate. Subsequently, a mathematical model with the objective function of minimizing the average waiting time for patients, as well as the average bed occupancy rate was presented using the linear response method. Results: According to the results of this study, an optimal combination of beds allocation to different categories of patients for the Neurological Critical Care Unit were respectively 6, 2, 3, 3, and 2 beds, and average waiting time was 1.4 hours and an average bed occupancy rate was 34.5%. Conclusion: The present study demonstrated that optimization of bed allocation in ICU by using a combined approach of simulation and design of experiments, resulted in a decrease in average waiting time and increase in bed occupancy rate (bed productivity). How to cite this article: Goharani R, Shafagh-sorkh O, Nateghinia S, Hajiesmaeili M, Alibabaei A, Shafigh N. Neuro-critical Care Unit Bed Allocation Optimization based on Hybrid Approach: Designing of Experiments and Simulation. J Saf Promot Inj Prev. 2021; 9(1):9-17. &nbsp

Effect Of The Cardio First Angel™ Device On CPR Indices: A Randomized Controlled Clinical Trial

Background: A number of cardiopulmonary resuscitation (CPR) adjunct devices have been developed to improve the consistency and quality of manual chest compressions. We investigated whether a CPR feedback device would improve CPR quality and consistency, as well as patient survival. Methods: We conducted a randomized controlled study of patients undergoing CPR for cardiac arrest in the mixed medical-surgical intensive care units of four academic teaching hospitals. Patients were randomized to receive either standard manual CPR or CPR using the Cardio First Angel™ CPR feedback device. Recorded variables included guideline adherence, CPR quality, return of spontaneous circulation (ROSC) rates, and CPR-associated morbidity. Results: A total of 229 subjects were randomized; 149 were excluded; and 80 were included. Patient demographics were similar. Adherence to published CPR guidelines and CPR quality was significantly improved in the intervention group (p \u3c 0.0001), as were ROSC rates (72 % vs. 35 %; p = 0.001). A significant decrease was observed in rib fractures (57 % vs. 85 %; p = 0.02), but not sternum fractures (5 % vs. 17 %; p = 0.15). Conclusions: Use of the Cardio First Angel™ CPR feedback device improved adherence to published CPR guidelines and CPR quality, and it was associated with increased rates of ROSC. A decrease in rib but not sternum fractures was observed with device use. Further independent prospective validation is warranted to determine if these results are reproducible in other acute care settings

Therapeutic Potential of Microvesicles in Cell Therapy and Regenerative Medicine of Ocular Diseases With an Especial Focus on Mesenchymal Stem Cells-Derived Microvesicles

These days, mesenchymal stem cells (MSCs), because of immunomodulatory and pro-angiogenic abilities, are known as inevitable factors in regenerative medicine and cell therapy in different diseases such as ocular disorder. Moreover, researchers have indicated that exosome possess an essential potential in the therapeutic application of ocular disease. MSC-derived exosome (MSC-DE) have been identified as efficient as MSCs for treatment of eye injuries due to their small size and rapid diffusion all over the eye. MSC-DEs easily transfer their ingredients such as miRNAs, proteins, and cytokines to the inner layer in the eye and increase the reconstruction of the injured area. Furthermore, MSC-DEs deliver their immunomodulatory cargos in inflamed sites and inhibit immune cell migration, resulting in improvement of autoimmune uveitis. Interestingly, therapeutic effects were shown only in animal models that received MSC-DE. In this review, we summarized the therapeutic potential of MSCs and MSC-DE in cell therapy and regenerative medicine of ocular diseases