Toll-Like Receptor 4 in Acute Respiratory Distress Syndrome: Good Time to Target?

Acute respiratory distress syndrome (ARDS) is considered a major cause of death in the world. ARDS is defined by life-threatening pulmonary edema and hypoxemia with a mortality rate of up to 40%. Recent advances in understating cellular aspects of the syndrome have shed light on possible new treatments and reduction of mortality. Toll-like receptors (TLRs) are pattern recognition receptors (PRRs) involved in adaptive and innate immunity. They are present in the alveoli and their activation can lead to inflammatory responses and finally acute lung injury. Among them, Toll-like receptor 4 (TLR4) is abundantly available on the epithelial cells of the alveoli and also on resident monocytes. TLR4 is one of the players that can promote alveolar damages during ARDS. Here, we focus on the TLR4 role in ARDS pathophysiology. We also present the potential therapies for the syndrome based on TLR4 inhibition

Midazolam Enhances Ureter Visualization in Children Undergoing Magnetic Resonance Urography

Introduction: Magnetic Resonance Urography (MRU) is a popular method for identifying uropathies in children. Some children are not cooperative for such examinations and are sedated. We decided to evaluate the effects of midazolam as a sedative drug on ureter visualization in patients undergoing MRU.Materials and Methods: The study was conducted in Paytkaht Medical Imaging Center, Tehran, Iran. Two hundred and three children with urologic diseases were divided into 2 groups. Patients in the non-cooperative group received midazolam prior to MRU.Results: Our findings showed that non-cooperative children had a better ureter visualization on MRU (P<0.01).Conclusions: Midazolam increased ureter visualization possibly by reduction in the ureter peristaltic motility. Therefore, its use could shorten the duration of MRU. It is beneficial to use midazolam in all children who undergo MRU.Keywords:  Diagnostic Imaging, MRI; Urography; Midzolam; Child; Ureter

Nasopharyngeal Colonization and levofloxacin Susceptibility of Streptococcus pneumoniae among Healthcare Workers in a Teaching Hospital in Tehran, Iran

Background: Streptococcus pneumoniae commonly asymptomatically colonizes the human upper respiratory tract and the carriage rate varies between geographical regions. The colonized individuals are not only at risk of infections but also can be a source of transmission of the pathogen. The risk of the droplet or airborne transmission of pneumococcal strains healthcare workers is considerable.  The current study aimed to determine the extent of nasopharyngeal colonization with S. pneumoniae and their levofloxacin susceptibility at a tertiary hospital in Tehran, Iran. Materials and Methods: During a six-month period, the nasopharyngeal swab samples collected from 300 volunteer healthcare workers of Imam Hossein Hospital. Samples screened for S. pneumoniae using standard conventional biochemical methods. The minimum inhibitory concentration (MIC) of levofloxacin was determined using a commercially available strip antibiotic test according to the clinical laboratory standards institute (CLSI) guidelines. Results: A total of 19 (6.3%) enrolled healthcare workers were colonized with S. pneumoniae. Amongst the enrolled volunteers, nurses had a higher rate of pneumococcal colonization (47.3%) followed by interns (21%) and laboratory workers (15.8%). Our analysis revealed that there was a significant correlation between smoking and pneumococcal colonization. The antimicrobial susceptibility testing showed that all of the isolates were susceptible to levofloxacin (MIC≤2 μg/ml). Conclusion: This low rate of pneumococcal colonization amongst healthcare professionals may be attributed to the low risk of horizontal transmission of severe pneumococcal infections in the hospital. Additionally, our findings indicated that levofloxacin was an effective antimicrobial agent for the treatment of pneumococcal infections

Dexmedetomidine Mechanism of Action: an update

Dexmedetomidine (PRECEDEX) is an imidazole derivative that is a highly selective a2 receptor agonist. Activation of the a2 adrenergic receptors by dexmedetomidine leads to both sedation and analgesia; with negligible respiratory and cardiovascular side effects. The drug is likely to be increasingly used for sedation and as an anesthetic adjunct

Association between Red Cell Distribution Width and Mortality in Pediatric Patients Admitted to Intensive Care Units

Background: Red cell distribution width (RDW) is a routine laboratory measure that could be used as a predictor of mortality in critically ill patients. Identification of patients at risk for mortality early in the course of PICU admission is an important step in improving the outcome. We aimed to assess the use of RDW as an early biomarker for outcome in pediatric critical illnesses. Methods: A retrospective study by extracting administrative and laboratory data from patients admitted to PICU of an academic pediatric teaching hospital was accomplished. After exclusion of 64 patients according to our exclusion criteria, 304 pediatric patients with PICU admissions over the 6 months of study period were included in the study. Results: The mean RDW for all patients was 14.9%±2.5%. PICU mortality was 13.3%. The rate of mortality in the quartile of RDW>15.7% was 20.1%. Elevated RDW was associated with longer duration of PICU admission (P<0.001). Tracheal intubation and ventilator support was needed in 34.2% of the patients. This was also correlated with elevated RDW (P=0.043). Conclusion: We observed that higher RDW was strongly linked to higher mortality risk in pediatric patients admitted in PICU. Higher RDW was associated with longer duration of PICU admission

Toll-Like Receptor 4 in Ventilator-Induced Lung Injuries

Toll like receptors (TLRs) recognize pathogens and generate an immediate defense response by inducing the production of pro-inflammatory cytokines, which rapidly destroy or limit the pathogens. In their bridging role, TLR downstream signals link innate and adaptive immunity, particularly by mediating DC maturation and activation of pathogen specific T lymphocytes. These pathways lead to the activation of professional APCs, which is followed by enhanced expression of surface molecules, MHC and co-stimulatory molecules [CD40, CD80, CD86 and CD70].TLRs are expressed in a variety of cell types, mostly within the immune system where they have been linked to different cellular activation states, immune defense, maintenance of homeostasis, and various diseases. TLRs and related immunological pathways are being extensively studied for research, diagnostic and therapeutic purposes. Most mammalian species have between ten and fifteen types of TLRs. Ten functional TLRs (TLR1-10) have been identified in human.

Inadvertent Transfusion of Two Incompatible Blood Units: A Case Report

Background: An incompatible blood transfusion may lead to hemolytic transfusion reactions and severe complications such as intravascular hemolysis, multiorgan failure, and even death. Prevention, early diagnosis, and treatments have the main roles to decrease transfusion complications. Cases Report: We present a case of a 43-year-old woman with a history of mandibular malignancy and facial reconstruction surgery who needed to blood transfusion due to a hemorrhage around her tracheostomy, and inadvertently 2 units of incompatible blood were transfused. The errors conduce to this issue and consideration to prevent and manage incompatible blood transfusions are discussed. Conclusion: This case showed that an effective technique for recognizing and avoiding transfusion mistakes is staff awareness of the potential errors at the bedside and in the laboratory. Furthermore, patients’ immunological status, early detection, and recognition of blood transfusion manifestation are critical factors for early diagnosis and treatment

Twin pregnant woman with COVID-19: a case report

A Case of pregnant woman (G2Ab1, twin pregnancy with microinjection, Gestational Age 23 weeks and 3 days) referred to our center with a complaints of fever and dry cough and dyspnea. She was admitted with a diagnosis of COVID-19. During the hospitalization, O2 saturation progressively decreased, which led to patient get intubate. Gradual recovery with treatment occurred and the patient was extubed. Unfortunately, she was intubated again due to decreased O2 saturation, 5 days later. Liver enzymes increased, then both fetuses died intrauterine, the cardiac output then declined to 10% and the mother died within hours

Comparison of Death Rate in Hospitalized and Non Hospitalized Intensive Care Patients of Masih Daneshvari Hospital

Objectives: The aim of this study was to compare death rate in accepted patients in Masih Daneshvari hospital intensive care from 30th of November 2011 to 30th of December 2011 in comparison with unaccepted patients to the intensive care department. Methods: The research was done at Masih Daneshvari hospital on patients that had referred to the emergency, and hospitalized patients at the intensive care department. Overall, 170 candidates, who were hospitalized at intensive care were entered in the study with the method of aimed-incidental samplings. The information-collecting tool was a three-part survey; the first part included demographic information, the second part investigated acceptance and release factors in intensive care, and the third was the acute physiology and chronic health evaluation (APACHE II) tool. The collected data were analysed using the SPSS software. Results: Amongst the 170 candidates hospitalised at the intensive care unit (ICU), 81 people could enter the ICU after waiting three days, and the 89 remaining couldn’t enter the ICU. The death rate in hospitalized candidates in ICU was 32.09 and for those who couldn’t make it (not having entered the ICU) was 32.58. The average APACHE mark in ICU hospitalized patients was 12.00±6.63 and for those who couldn’t be hospitalized was 11.12 ± 6.69. Conclusions: On the basis of this study results, the APACHE score average and the death rate of those not able to enter the ICU in comparison with the hospitalized cases didn’t have a significant difference (P ≥ 0.05). The common cause of patients death at intensive care was pneumonia, while deaths were more common amongst males and the elderl