The effiency and safety of physiotherapy in intensive care units

Tıpta Uzmanlık TeziYoğun bakım ünitelerinde göğüs fizyoterapisi; pulmoner sekresyonların atılımı, oksijenizasyonun iyileştirilmesi, ventilasyon ilişkili pnömoni insidensinde azalma, mekanik ventilatörde geçen sürede azalma, yoğun bakımda kalış sürelerinde kısalma ve hastaların fonksiyonel kapasitelerinde artış amacıyla kullanılmaktadır. Bu çalışmada fizyoterapinin mekanik ventilatörde geçen süre ve yoğun bakımda kalış süreleri üzerine etkisini araştırmayı amaçladık. Ayrıca mortalite oranlarını ve ventilasyon ilişkili pnömoni insidensini de inceledik. Çalışmamıza yoğun bakım ünitesine alınan 60 hasta dahil edildi. Hastalar randomize edilerek iki gruba ayrıldı. Kontrol grubuna standart bakım uygulandı. Fizyoterapi grubuna ise standart bakıma ek olarak günde iki kez, haftada beş gün, en az 15 dakikalık seanslardan oluşan; postural drenaj, pozisyonlama, vibrasyon, öksürme teknikleri, solunum egzersizleri, aspirasyon ve kas egzersizlerini içeren fizyoterapi programı uygulandı. Çalışma sonucunda fizyoterapi grubu ile kontrol grubu arasında mekanik ventilatörde geçen süre ve yoğun bakımda kalış süreleri açısından istatistiksel olarak anlamlı fark bulunmadı. İki grup arasında ventilasyon ilişkili pnömoni insidensi ve mortalite oranları açısından da fark görülmedi. Çalışmamızda yoğun bakım ünitesinde pulmoner rehabilitasyonun hastalar açısından önemli kazanımlar sağlamadığı görüldü ancak bu konuda uygun fiziki şartlar altında ve daha geniş hasta grubunda yapılacak yeni çalışmaların ve meta-analizlerin literatüre katkı sağlayabileceğini düşünmekteyiz.AbstractChest physical therapy is used in intensive care unit to minimize pulmonary secretion retantion, to improve oxygenation, to decrease the occurence of ventilatory associated pneumonia, to reduce the length of stay intensive care unit, to decrease duration of mechanical ventilation and increase overall patient?s functional capacity. The aim of the present study is to investigate the effect of physiotherapy on the duration of mechanical ventilation and the length of intensive care unit stay. We also evaluated the mortality rates and incidence of ventilatory associated pneumonia. 60 patients who admitted to the intensive care unit were included in the study. Patient were randomized to two groups. The control group received only standart care. Physiotherapy group received standart care and physiotherapy program which is applied twice daily, for at least 15 minutes, 5 days per week and consisted of postural drainage, positioning, vibration, coughing, breathing exercises, aspiration and muscle training. The results showed that the duration of mechanical ventilation and the length of intensive care unit stay were not statistically different between the physiotherapy and control groups. Also there was no difference between the two groups in the incidence of ventilatory associated pneumonia and mortality rates. İn this study we found that chest physical therapy in intensive care unit has not provided benefits for patients. But new studies and meta-analyzies in optimal physical conditions and larger groups of patients can provide more contributions

Pulmonary Nocardiosis Induced by Long-Term Use of Steroids on a Bronchiectasis Backgroung

A 45-year-old male was assessed with the complaints of cough, sputum, fever, shortness of breath, tingling and burning in both legs. In his history, he had frequent hospitalizations and steroid use. Respiratory system examination revealed inspiratory and expiratory crackles on bilateral lower-middle zones and expiration rhoncus. Laboratory examination revealed leukocytosis and elevated CRP levels; serology for HIV was reported negative. Computed tomography showed diffuse interstitial pneumonia. Electromyography (EMG) showed lower extremity muscle activation compatible with myopathy. Acid-fast bacilli was negative (three consecutive negative microscopy results) and no reproduction was detected in the culture. Nocardia spp. growth was detected in sputum culture. According to the antibiogram results, he was treated with doxycycline, trimethoprim and sulfamethoxazole for 6 months. At the end of treatment, the lesions were found to be regressed on computed tomography. In conclusion, considering the high frequency of bronchiectasis in our country, the fact that nocardia may develop due to inappropriate long-term steroid use during an attack should be kept in mind

Alkaline phosphatase, cytokeratin 7, cytokeratin 8 in the diagnosis of primary lung adenocarcinoma from 148 pleura fluids specimens

Adenocarcinomas are the most common cause of malignancy in pleura fluids. Usual primary sites include the lung, breast, gastrointestinal tract, and genitourinary tracts. Predicting the site of origin of an adenocarcinoma can be difficult due to overlapping morphologic characteristics. We investigated the use of alkaline phosphatase (AP), Cytokeratin7 (CK7) Cytokeratin8 (CK8) to distinguish adenocarcinomas of lung in 148 body cavity fluid samples. Overall results for primary lung adenocarcinomas, demonstrated CK8 reactivity in 106 (72%) of 148 cases. 95 primary lung carcinoma samples (65%) were positive for CK7. AP was expressed in 81% of primary lung adenocarcinomas. Positive immunoreactivity for AP was characterized by a red, diffusely apical cytoplasmic staining in tumor cells that ocurred singly or in groups. There was a significant difference between AP, CK 7 and CK 8 expressions in primary lung adenocarcinomas (P=0.02; Chi-squared test). The sensitivity of AP, CK8, CK7 as a marker for primary lung adenocarcinomas were 82%, 72%, 64%, respectively. Thus the AP positive staining largely confirmed the cytologic diagnosis of lung adenocarcinoma.WOS:000282021000014PubMed: 1941994

Alkaline phosphatase, cytokeratin 7, cytokeratin 8 in the diagnosis of primary lung adenocarcinoma from 148 pleura fluids specimens.

Adenocarcinomas are the most common cause of malignancy in pleura fluids. Usual primary sites include the lung, breast, gastrointestinal tract, and genitourinary tracts. Predicting the site of origin of an adenocarcinoma can be difficult due to overlapping morphologic characteristics. We investigated the use of alkaline phosphatase (AP), Cytokeratin7 (CK7) Cytokeratin8 (CK8) to distinguish adenocarcinomas of lung in 148 body cavity fluid samples. Overall results for primary lung adenocarcinomas, demonstrated CK8 reactivity in 106 (72%) of 148 cases. 95 primary lung carcinoma samples (65%) were positive for CK7. AP was expressed in 81% of primary lung adenocarcinomas. Positive immunoreactivity for AP was characterized by a red, diffusely apical cytoplasmic staining in tumor cells that ocurred singly or in groups. There was a significant difference between AP, CK 7 and CK 8 expressions in primary lung adenocarcinomas (P=0.02; Chi-squared test). The sensitivity of AP, CK8, CK7 as a marker for primary lung adenocarcinomas were 82%, 72%, 64%, respectively. Thus the AP positive staining largely confirmed the cytologic diagnosis of lung adenocarcinoma

Compressed fluids for food by-product biorefinery

Food industries produce annually billions of tons of wastes that have become a major concern worldwide. These residues can be valorized by different strategies leading to a sustainable utilization of feedstock. Thus, the biorefinery concept is a promising option to reduce environmental impact with an obvious economic advantage. Furthermore, the use of greener solvents in combination with compressed fluid technologies for biorefinery approaches has several favourable features involving less time, an enhancement of the extraction efficiencies and a reduction in the energy employed. The present chapter highlights the potential of biorefinery approaches based on compressed fluid technologies and gives an overview of their applications to obtain high added-value products from food residues. Combinations of compressed fluid technologies are reviewed always taking into account a green chemistry point of view.M.B. would like to acknowledge the Ministry of Economy and Competitiveness for the “Juan de la Cierva” postdoctoral grant FJCI-2016-30902 and project the support from the AGL2017-89417-R project.Peer reviewe