The INTOXICATE study: methodology and preliminary results of a prospective observational study

Background There is currently no practice-based, multicenter database of poisoned patients admitted to intensive care units (ICUs). The INTOXICATE study, endorsed by the ESICM and EAPCCT, aimed to determine the rate of eventful admissions among acutely intoxicated adult ICU patients. Methods Ethical approval was obtained for this multicenter, prospective observational study, and data-sharing agreements were signed with each participating center. An electronic case report form was used to collect data on patient demographics, exposure, clinical characteristics, investigations, treatment, and in-hospital mortality data. The primary outcome, ‘eventful admission’, was a composite outcome defined as the rate of patients who received any of the following treatments in the first 24 h after the ICU admission: oxygen supplementation with a FiO2 > 40%, mechanical ventilation, vasopressors, renal replacement therapy (RRT), cardiopulmonary resuscitation, antidotes, active cooling, fluid resuscitation (> 1.5 L of intravenous fluid of any kind), sedation, or who died in the hospital. Results Seventy-eight ICUs, mainly from Europe, but also from Australia and the Eastern Mediterranean, participated. A total of 2,273 patients were enrolled between November 2020 and June 2023. The median age of the patients was 41 years, 72% were exposed to intoxicating drugs. The observed rate of patients with an eventful ICU admission was 68% (n = 1546/2273 patients). The hospital mortality was 4.5% (n = 103/2273). Conclusions The vast majority of patients survive, and approximately one third of patients do not receive any ICU-specific interventions after admission in an intensive care unit for acute intoxication. High-quality detailed clinical data have been collected from a large cohort of acutely intoxicated ICU patients, providing information on the pattern of severe acute poisoning requiring intensive care admission and the outcomes of these patients. Trial registration: OSF registration ID: osf.io/7e5uy

Directional invisibility by genetic optimization

In this Letter, the design of a directional optical cloaking by a genetic algorithm is proposed and realized experimentally. A three-dimensional finite-difference time-domain method is combined with the genetic optimization approach to generate the cloaking structure to directionally cloak a cylindrical object made of a perfect electrical conductor by suppressing the undesired scattered fields around the object. The optimization algorithm designs the permittivity distribution of the dielectric polylactide material to achieve an optical cloaking effect. Experimental verifications of the designed cloaking structure are performed at microwave frequencies, where the proposed structure is fabricated by 3D printing. The imperfect conformal mapping from a large-scale permittivity distribution and the compensation of the remaining scattering by a small-scale permittivity distribution are the basic physical mechanisms of the proposed optical cloaking

Evaluation of the quality of life perceived by hypertensive patients and of the factors affecting the quality of life [Hipertansiyon tanisi almiş hastalarin algiladiklari yaşam kalitesi düzeyinin ve etki eden faktörlerin degerlendirilmesi]

The aim of this study was to determine the quality of life perceived by patients diagnosed to have hypertension and the factors affecting the quality of life. This descriptive study was performed on patients followed-up with the diagnosis of hypertention as either outpatient (n = 232) or inpatient (n = 89) at the Department of Internal Medicine of Gulhane Military Medical Academy between May 2006 and April 2007. A questionnaire constituted by two parts was used to collect data. In the first part, some sociodemographic features of participants, clinical aspects of the disease and availability of comorbidity were questionned. In the second part the scale of short form-36 (SF-36) was used in order to assess the quality of life perceived by the participants. The mean score of the short form-36 scale of the participants was 53.0 ± 19.3. Health related quality of life perceived by hypertensive patients with various risk factors was lower than that of patients without such risk factors. Risk factors of hypertensive patients should be considered on planning the treatment of these patients. © Gülhane Askeri Tip Akademisi 2008

Environmental malignant pleural mesothelioma in Southeast Turkey

[Abstract Not Available

P4518Cerebral blood flow is lower in heart failure patients with reduced ejection fraction

Abstract Purpose Heart and brain interaction is a well-known entity in heart failure (HF) and left ventricular systolic dysfunction poses an increased risk for stroke and cognitive impairment. Transcranial Doppler (TCD) provides valuable information on cerebral blood flow and detects microembolic signals that can be used to determine the risk of cerebrovascular events. However, less is known about cerebral blood flow in HF patients with reduced EF. So, we aimed to evaluate cerebral blood flow rates by means of TCD in HF patients with reduced ejection fraction (EF). Methods This study included 46 HF patients with an EF less than 35% (mean age 65.2±11 years, mean EF 20.1±3.8%) who underwent to TCD examination. In addition, 26 healthy individuals with sinus rhythm and EF &gt;50% (mean age 64.4±9.0 years, mean EF 63.5±2.38%) were included in the study as a control group. Minimum, maximum and mean flow velocities of the both right middle cerebral artery (RMCA) and left middle cerebral artery (LMCA) determined by TCD were analyzed. Results The average of RMCA maximum and mean flow velocities were found to be significantly lower in HF patients than those in control group (76,06±23,7 cm/s and 48,49±16,4 cm/s in HF group vs 87,84±14,5 cm/s and 56,41±10,7 cm/s in control group, p=0,025 and p=0,016, respectively). The average of LMCA maximum and mean flow velocities were also significantly lower in HF patients than those in control group (75,1±22,3 cm/s and 47,57±14.8 cm/s in HF group vs 88,73±17,7 cm/s and 57,15±12,4 cm/s in control group, p=0,009 and p=0,007, respectively). However, there was no significant difference in minimum RMCA or LMCA flow velocities between HF group and control groups (33,5±10,6 cm/s and 32,86±9,58 cm/s in HF group vs 36,34±9,2 cm/s and 36,53±10,4 cm/s in control group, p=0,226 and p=0,157, respectively). No significant microembolic signals were detected in HF and control groups. Conclusions The results of this study showed that HF patients with reduced EF have lower cerebral blood flow velocities as compared to healthy controls, which might be one of the explanations of the adverse interaction between heart and brain in HF. </jats:sec

Incidence of malignant pleural mesothelioma due to environmental asbestos fiber exposure in the southeast of Turkey

Background: Inhabitants of the southeast of Turkey (ST) have been exposed since childhood to inhalation of asbestos, from a material containing tremolite, used for whitewashing. This has resulted in an increased incidence of malignant pleural mesothelioma (MPM). Objectives: To review the epidemiological features of MPM cases in ST; to calculate and compare the incidence with the previously reported ones. Subjects and Methods: The study included 176 MPM cases from different places in ST. The incidence of MPM was calculated for those places according to the distribution of the cases. Results: In the previously identified regions of asbestos (region 1) where the population had been informed of the danger with the soil some decades ago, the MPM incidence was decreased, as compared to the previous reports. The annual incidence of MPM in these places was found to be 42.9 per million in this study while it had been reported to be 105.5 per million in the previous studies. In contrast, the incidence that was reported previously to be 2.75 per million in the regions where asbestos exposure had not been identified before (region 2] was found to be 8.6 per million in this study. In region 2 the incidence of MPM increased even in the second ha If of the last decade (5.9 versus 11.9 per million). Conclusions: Use of asbestos-containing soil continues in different places in ST. Even if the use of this soil is abandoned today, MPM will be an important health problem in this region till the third or fourth decades of this century. Informing the villagers of the danger and preventing the use of this soil may result in a considerable decrease in the incidence of MPM. Copyright (C) 2000 s. Karger AG, Basel