Intensive care management of organophosphate insecticide poisoning

INTRODUCTION: Organophosphate (OP) insecticides inhibit both cholinesterase and pseudo-cholinesterase activities. The inhibition of acetylcholinesterase causes accumulation of acetylcholine at synapses, and overstimulation of neurotransmission occurs as a result of this accumulation. The mortality rate of OP poisoning is high. Early diagnosis and appropriate treatment is often life saving. Treatment of OP poisoning consists of intravenous atropine and oximes. The clinical course of OP poisoning may be quite severe and may need intensive care management. We report our experience with the intensive care management of serious OP insecticide poisonings. METHODS: A retrospective study was performed on the patients with OP poisoning followed at our medical intensive care unit. Forty-seven patients were included. Diagnosis was performed from the history taken either from the patient or from the patient's relatives about the agent involved in the exposure. Diagnosis could not be confirmed with serum and red blood cell anticholinesterase levels because these are not performed at our institution. Intravenous atropine and pralidoxime was administered as soon as possible. Pralidoxime could not be given to 16 patients: 2 patients did not receive pralidoxime because they were late admissions and 14 did not receive pralidoxime because the Ministry of Health office was out of stock. Other measures for the treatment were gastric lavage and administration of activated charcoal via nasogastric tube, and cleansing the patient's body with soap and water. The patients were intubated and mechanically ventilated if the patients had respiratory failure, a depressed level of consciousness, which causes an inability to protect the airway, and hemodynamic instability. Mechanical ventilation was performed as synchronized intermittent mandatory ventilation + pressure support mode, either as volume or pressure control. Positive end expiratory pressure was titrated to keep SaO(2) above 94% with 40% FIO(2). Weaning was performed using either T-tube trials or pressure support weaning. The chi-square test was used for statistical analysis. Data are presented as mean ± standard deviation. RESULTS: There were 25 female and 22 male patients. Thirty-two (68%) were suicide attempts and 15 (32%) were accidental exposure. The gastrointestinal route was the main route in 44 (93.6%) patients. The mortality rates for the patients who did and did not receive pralidoxime were 32 and 18.7%, respectively, and were not statistically different. The most frequent signs were meiosis, change in mental status, hypersalivation and fasciculations. Ten patients (21.2%) required mechanical ventilation. The mortality rate for the patients who required mechanical ventilation was 50%, but the rate was 21.6% for the patients who were not mechanically ventilated. Intermediate syndrome was observed in 9 (19.1%) patients. Complications were observed in 35 (74.4%) patients. These complications were respiratory failure (14 patients), aspiration pneumonia (10 patients), urinary system infection (6 patients), convulsion (4 patients) and septic shock (1 patient). The duration of the intensive care stay was 5.2 ± 3.0 days. DISCUSSION: Ingestion of OP compounds for suicidal purposes is a major problem, especially in developing countries. Thirty-two (68%) of our patients used the OP insecticide for suicide. Two patients did not receive pralidoxime because of delayed admission and they were successfully treated with atropine alone. Three of the patients who did not receive pralidoxime because of unavailability died. The mortality rate was no different between the patients treated with pralidoxime or those without pralidoxime. De Silva and coworkers have also reported that the mortality rate was not different between each group. Three patients with intermediate syndrome died due to delay for endotracheal intubation. The average respiratory rate of these patients increased from 22 to 38 breaths/min, which is an important sign of respiratory distress. The nurse to patient ratio was increased after these events. Early recognition of respiratory failure resulting in intubation and mechanical ventilation is a life-saving intervention for patients with OP poisoning. Respiratory failure is the most troublesome complication, which was observed in 35 (74.4%) patients. Patients with OP poisoning may have respiratory failure for many reasons, including aspiration of the gastric content, excessive secretions, pneumonia and septicemia complicating acute respiratory distress syndrome. CONCLUSIONS: OP insecticide poisoning is a serious condition that needs rapid diagnosis and treatment. Since respiratory failure is the major reason for mortality, careful monitoring, appropriate management and early recognition of this complication may decrease the mortality rate among these patients

Türkiye’de İş Geliştirme Merkezlerinde (İŞGEM) Yer Alan Kiracı Firmaların Hayatta Kalma Performansı

The aim of this study is to examine the effects of business incubator programs and its services on tenant firm performance. In this context, the effect of business incubator services on firms’ survival was examined through the case of Turkey’s Business Development Centers (İŞGEMs). The scope of this research consist of 414 firms, 238 firms which exist in incubators located in Adana, Diyarbakır, Elazığ, Ereğli, Eskişehir, Mersin, Nevşehir, Samsun, Tarsus, Van, Yozgat and Zonguldak İŞGEMs and 176 firms which left these incubators before. Within the framework of research model, business incubator services were categorized as (1) office services, (2) shared/common services, (3) education/training services and (4) counseling services and include total of 22 sub-services. As a research methodology, Kaplan-Meier survival estimates were used. As a result of the research models, it was concluded that all service groups have significant and positive effects on firms’ survival probabilities

İşletme Kuluçkaları ve Bölgesel Kalkınma: Kavramsal Çerçeve ve Literatür Bulguları

There are many support mechanisms for supporting newly established firms. Business incubators, one of them, are generally focused on supporting and promoting entrepreneurship, increasing employment through creating new job opportunities, enhancing local, regional and national R&D and innovativeness. The term of “incubator” is used to define supporting institutions to growth and survival of new firms. Business incubators are becoming a basic component of regional and national economic development strategies in many countries. In this study, the importance of business incubators in terms of local and regional economic development is discussed. Firstly, the concept of “business incubator” will be examined in terms of theoretical and conceptual perspective. Secondly, the importance of business incubators for regional development will be mentioned. Then, some recommendations based on the findings of the literature will be presented for using business incubators as a tool for regional development

İşletme Kuluçkaları ve Bölgesel Kalkınma: Kavramsal Çerçeve ve Literatür Bulguları

There are many support mechanisms for supporting newly established firms. Business incubators, one of them, are generally focused on supporting and promoting entrepreneurship, increasing employment through creating new job opportunities, enhancing local, regional and national R&D and innovativeness. The term of “incubator” is used to define supporting institutions to growth and survival of new firms. Business incubators are becoming a basic component of regional and national economic development strategies in many countries. In this study, the importance of business incubators in terms of local and regional economic development is discussed. Firstly, the concept of “business incubator” will be examined in terms of theoretical and conceptual perspective. Secondly, the importance of business incubators for regional development will be mentioned. Then, some recommendations based on the findings of the literature will be presented for using business incubators as a tool for regional development

Sequential left internal mammary artery grafting in combination with the aortic no-touch technique

Aim: This study aimed to investigate the short-term outcomes achieved with off-pump bypass combined with the aortic no-touch technique where sequential anastomoses between the left internal mammary artery (LIMA), left anterior descending (LAD) and diagonal artery were employed. Material and methods: A total of 583 patients (mean age 63, 80% male) who underwent off-pump bypass (LIMA-diagonal-LAD sequential) were enrolled in this retrospective analysis. Data regarding the frequency of in-hospital postoperative complications, intra-aortic balloon pump (IABP) and inotropic agent requirement, re-exploration for bleeding, and length of hospital stay were collected. Anastomosis patency was evaluated in 49 patients who underwent angiography. Results: 2.6% of the participants received inotropic agents and 0.5% required IABP. Frequency of acute renal failure, sternal wound infection, cerebrovascular event, respiratory failure, and hemodialysis was less than 1% in total. Among the 49 patients undergoing angiography at an average 41 ±17 months after bypass, the LIMA-LAD was patent in 98% and the LIMA-diagonal was patent in 84% of the subjects. Preoperative left ventricle ejection fraction (LVEF) and recent myocardial infarction (MI) prior to bypass were significantly correlated with postoperative IABP and inotropic agent requirement (r = 0.165, p < 0.01 for LVEF, p = 0.021 for recent MI). Conclusions: Off-pump bypass in combination with the aortic no-touch technique is associated with favorable postoperative outcomes including reduced postoperative stroke, renal dysfunction, IABP, and inotropic agent requirement compared to the results of previous randomized prospective studies published in the literature. © 2022 Termedia Publishing House Ltd.. All rights reserved

TEKNOLOJİ GELİŞTİRME BÖLGESİ YÖNETİCİ ŞİRKETLERİNİN YÖNETİM ETKİNLİĞİNİN VERİ ZARFLAMA ANALİZİ İLE DEĞERLENDİRİLMESİ

Bu çalışmada 4691 sayılı Teknoloji Geliştirme Bölgeleri (TGB) Kanunu kapsamında bölgenin yönetimi ve işletmesinden sorumlu şirketin yönetim etkinliğinin değerlendirilmesi amaçlanmaktadır. Bu doğrultuda 2014 yılı verileri ile 39 teknopark yönetici şirketinin yönetim etkinliği temel Veri Zarflama Analizi (VZA) ile değerlendirilmiştir. Etkinlik ölçümünde üç girdi (Kapasite geliştirme faaliyet sayısı, Toplam işbirliği sayısı, Anahtar personel sayısı) ve dört çıktı (Akademik spin-off sayısı, Firma sayısı, Yabancı firma sayısı, Toplam istihdam) kullanılmıştır. Çalışmanın sonucunda CCR modeline göre 10 teknopark teknik etkin, 23 teknopark saf teknik etkin ve 12 teknopark ölçek etkin bulunmuştur. Anahtar Kelimeler: Teknoloji Geliştirme Bölgesi, Teknopark, Etkinlik, Veri Zarflama Analizi. JEL Sınıflandırma Kodları: O32, C61, D61

İşletme Kuluçkalarında Sunulan Destek Hizmetlerinin Yeni Kurulan Firmaların Hayatta Kalabilirliği Üzerine Etkisi: İş Geliştirme Merkezleri (İŞGEM) Örneği

Business incubators are mechanisms which aim to formation and development of new ventures and to survive of these ventures through various supportive services. The aim of this study is to examine the effects of business incubator programs and its services on tenant firm performance in the context of Business Development Centers (ISGEMs). The study consists of 414 firms and 12 business incubators in Turkey. Within the framework of research model, business incubator services were categorized in 4 groups as (1) office services, (2) shared/common services, (3) education/training services and (4) counseling services and results show that all service groups have significant and positive effects on firms’ survival probabilities

Networking Activities and Growth of Newly Founded Firms under Incubation

The network approach to entrepreneurship has become a notable theoretical perspective within the literature. Networking activities enable gaining resources for new ventures in growth process while allowing growing firms to maintain their flexibilities. In this study, we investigate the effects of intra-incubator networking activities on new firm growth performance in business incubators. Based on a survey of newly founded firms located in three major incubation centers located in Adana, Tarsus and Samsun cities in Turkey, we empirical test the network success hypothesis. Differences between growing and non-growing firms have been analyzed by using essential network characteristics. Empirical research investigating the effect of networking on incubated new firm performance is rare. Among them, to our knowledge, we, first time, employ essential network characteristics approach in performance analysis among incubated firms. The results have shown that incubated firms have similar intra-incubator networking intensity whether it is a growing or non-growing over time

Networking Activities and Growth of Newly Founded Firms under Incubation

The network approach to entrepreneurship has become a notable theoretical perspective within the literature. Networking activities enable gaining resources for new ventures in growth process while allowing growing firms to maintain their flexibilities. In this study, we investigate the effects of intra-incubator networking activities on new firm growth performance in business incubators. Based on a survey of newly founded firms located in three major incubation centers located in Adana, Tarsus and Samsun cities in Turkey, we empirical test the network success hypothesis. Differences between growing and non-growing firms have been analyzed by using essential network characteristics. Empirical research investigating the effect of networking on incubated new firm performance is rare. Among them, to our knowledge, we, first time, employ essential network characteristics approach in performance analysis among incubated firms. The results have shown that incubated firms have similar intra-incubator networking intensity whether it is a growing or non-growing over time

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P &lt; 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P &lt; 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223