Evaluation of Hyperkalemia Associated with Trimethoprim-Sulfamethoxazole in the Intensive Care Unit

Aim: The objective of this study was to determine the incidence and risk factors of hyperkalemia associated with trimethoprim-sulfamethoxazole (TMP-SMX) in the intensive care unit (ICU)

A severe case of levothyroxine intoxication successfully treated in intensive care unit

Levothyroxine intoxication is a rare clinical entity which is usually asymptomatic. However, severe symptoms such as respiratory failure, malignant hyperthermia, seizures, arrhythmia, and coma have been reported. In this case report, a patient who ingested high dose (15 mg) levothyroxine for suicide and admitted to intensive care unit was presented. There was a decrease in Glasgow coma score in the follow-up. The patient was intubated due to acute respiratory failure. Gastric lavage, activated charcoal, methylprednisolone, cholestyramine and therapeuthic plasma exchange were administered. Despite ingestion of high dose of levothyroxine, thyrotoxicosis symptoms resolved with appropriate treatment and the patient was discharged from the intensive care unit

Our Experience with Mesenchymal Stem Cells in Patients with COVID-19

Severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2), which causes Coronavirus disease-2019 (COVID-19), has rapidly spread all over the world and has become a public health emergency. Coronavirus disease-2019 has a wide clinical spectrum, from asymptomatic infection to Acute respiratory distress syndrome, sepsis, metabolic acidosis, coagulation disorder, multi-organ failure and even death. The dysregulated and hyperimmune response to SARS-CoV-2 could possibly explain the highly variable disease manifestations and play an important role in the pathogenesis of COVID-19. Since there is no specific antiviral treatment in the treatment of COVID-19, treatments for inflammation against the virus and sharing experience are important. Mesenchymal stem cells (MSCs) have potent anti-inflammatory and immunomodulatory abilities that can migrate to damaged tissues, promote tissue regeneration, and inhibit tissue fibrosis. Today, MSCs are widely used in many clinical studies on immune-mediated inflammatory diseases such as Graft-versus-Host disease, systemic lupus erythematosus, and perianal Crohn's disease. MSC treatment in COVID-19 is a promising option. In this study, we would present four patients with COVID-19 who were treated with MSCs and who were found to be positive for real-time polymerase chain reaction tests on nasopharyngeal swab or tracheal aspirate. All patients were critically ill were followed up with mechanical ventilator due to severe hypoxemia. One patient was extubated and discharged. Other patients died. In this study, MSCs were used as salvage therapy in the late period, so benefit might not be seen. In previous studies, this treatment was used earlier and there were results showing the benefits of MSCs. Based on this study, MSCs can be a promising treatment option when used in the appropriate patient at the time

Prognosis in Neurological Intensive Care Units

Objective: Neurocritical care, or neurological intensive care, provides critical care for patients with neurological or neurosurgical diseases. These patients need to receive medical care for their primary critical illnesses, comorbidities, and complications. This study aims to compare the clinical outcomes of patients with neurological or neurosurgical diseases treated in general ICUs and those of patients treated in neurological intensive care units (neuro-ICU). Materials and Methods: Patients with neurological and neurosurgical diseases who were treated in the ICUs by a neurointensivist were included in the study. The patients were categorized into two groups according to their ICU types and the study periods: patients in the mixed general ICU (period-1) and patients in the neuro-ICU (period-2). The records in the hospital automation system and this study's database of patients were evaluated retrospectively. Results: Sixty-one patients in period-1 and 58 patients in period-2 were evaluated. The ICU mortality rate and the ICU and hospital stay duration were lower in the neuro-ICU patients, but this difference was not statistically significant (P > 0.05). ICU readmission and in-hospital mortality rates were significantly lower in the neuro-ICU patients (P < 0.05). Conclusion: This study analyzed the effect of specialized neurocritical care and neuro-ICU organization on patient clinical outcomes. To achieve better patient management in the neuro-ICU, it is necessary to provide quality improvements in the process's structure, performance, and standardization. In Turkiye, there is a need for studies regarding this subject to establish and agree on standards for neurocritical care

Why are Patients with Acute Middle Cerebral Artery Infarction Being Intubated?

Objective: To describe the causes of intubation in patients who have been diagnosed with middle cerebral artery (MCA) infarction requiring mechanical ventilation (MV) by evaluating the clinical and radiologic features in the neurological intensive care unit (NICU)

Cranial Computed Tomography Findings in Methanol Intoxication: Two Case Reports

Computed tomography (CT) may show toxic effects of methanol on central nervous system in acute methanol intoxication, which may be helpful in diagnosing and predicting prognosis. In this article we discussed two cases of acute methanol intoxication with neuroimaging findings

CAN NEUTROPHIL-LYMPHOCYTE RATIO PREDICT DISEASE SEVERITY AND MORTALITY IN SEPSIS AND SEPTIC SHOCK PATIENTS?

Introduction: Sepsis and septic shock are the most serious clinical conditions in intensive care units with increased mortality rates. Efforts on improving treatment modalities and survival is still the most hot topic worldwide. One of the key points is finding out a reliable and cost-effective marker that can predict prognosis. The neutrophil-lymphocyte ratio (NLR) has been shown to be associated with prognosis in various clinical situations. The aim of this study was to investigate the relationship of NLR at admission and disease severity and 28-day mortality in sepsis and septic shock patients

Pandemide beyin ölümü tanısı ve yönetimi: Türk nöroloji derneği nörolojik yoğun bakım bilimsel çalışma grubu uzman görüşü

In the pandemic year, the number of brain death declarations decreased by more than 50% compared with previous years. The timely diagnosis of brain death is critical in terms of rational use of intensive care facilities, as well as organ transplantation. Apnea testing should not be omitted in patients with COVID-19, and can be performed either with apneic oxygenation method or ventilator-based spontaneous modes when standard prerequisites are met. Complete compliance with personal protection measures and prevention of the environmental escape of the expiratory air via tube clamping or filtering is essential. Other declaration processes should be conducted in accordance with the 2014 guidelines of the Turkish Neurology Association

Guillain-Barre Syndrome and Swallowing Dysfunction

WOS: 000422943000003PubMed ID: 28873071Purpose: Patients with Guillain-Barre syndrome (GBS), especially severe cases that require treatment in intensive care units, often experience swallowing difficulties. However, the oropharyngeal function of patients with GBS not treated in intensive care units is not typically evaluated using neurophysiological techniques. Methods: Electrophysiological techniques were used to determine dysphagia limit and sequential water swallowing values in an electromyography laboratory. Results: This study assessed 18 patients with GBS who were not treated in the intensive care unit between 4 and 45 days after their hospital admission; 18 healthy volunteers were used as a control group. Of the 18 patients with GBS, 7 exhibited the clinical involvement of either a single cranial nerve or a combination of cranial nerves while 11 did not show any lower cranial nerve involvement. Clinical dysphagia was observed in seven patients and six of these cases involved a lower cranial nerve while five patients without cranial nerve involvement had silent dysphagia according to the dysphagia limit test. In addition, the duration of sequential swallowing was significantly prolonged in all patients with GBS compared with the control subjects. Conclusions: The present findings demonstrated that neurophysiological techniques are useful and easily applicable for patients with GBS and that there were no complications. Furthermore, cranial nerve involvement in patients with GBS likely increased the incidence of oropharyngeal dysphagia, and subclinical dysphagia may be present in this population as well. Therefore, neurophysiological techniques can be initially used and then repeated during follow-up visits for all types of patients with GBS