Fifth Day Of Hospitalization Research Articles

A case of non-traumatic rectus sheath hematoma in a post-kidney transplant patient undergoing catheter embolization during anticoagulation treatment for atrial fibrillation.

A 65-year-old man, a post living donor kidney transplant patient, was admitted to the intensive care unit (ICU) with a severe bacterial infection. He also tested positive for coronavirus disease and had a cough. On admission, heparin was administered for atrial fibrillation. On the third day of hospitalization, his general condition had recovered, and he was discharged from the ICU to the general ward. On the fourth day of hospitalization, he experienced abdominal pain, and a hard mass was palpated in the left lower abdomen. On the fifth day of hospitalization, contrast-enhanced computed tomography showed an extensive rectus sheath hematoma (RSH) extending from the left lower abdominal wall to the left side of the bladder, with extravasation from a small branch of the left inferior epigastric artery. Heparin was discontinued, and transcatheter arterial embolization was performed to control the bleeding. RSH is a rare disease, and cases of extensive hematoma in post-kidney transplant patients occur even less frequently. Patients taking anticoagulants and those with chronic kidney disease are at high risk for RSH, so physicians should be cognizant of this disease when these patients develop abdominal pain.

Influence of zinc supply on the course of infectious diarrhea in children of early age

Aim. Give a comparative characteristic of the course of infectious diarrhea in young children, residents of the Zaporizhzhia region (Ukraine), depending on their provision of zinc (Zn). Materials and methods. The study included 99 children aged 1 to 36 months with manifestations of infectious diarrhea. On the day of hospitalization, immunochromatographic and bacteriological examination of feces was performed. Also, on the first, third and fifth days of hospitalization, a general blood test and the level of Zn in the blood were determined for each patient. Results. It was found that among the examined patients with infectious diarrhea at the onset of the disease, 22 children (22.2 %) had a reduced concentration of Zn in blood serum. In these children, the zinc level ranged from 7.63 to 9.17 μmol/l. It was also noted that the level of Zn in these patients on the 5th day of inpatient treatment rose to the norm of reference indicators. After studying the anamnesis, it was found that 40.9% of children with low Zn content had episodes of acute intestinal infection before this disease. During a comparative analysis of the clinical and laboratory data of patients, it was found that the tendency to more frequent vomiting occurred in patients with Zn deficiency (p = 0.05), that Zn availability had the most significant effect on the expressiveness of the diarrheal syndrome at the onset of the disease and more than a third (n = 8, 36.4 %) of children with Zn deficiency had more than 5 episodes of diarrhea per day, among which every second had more than 10. We did not determine significant differences between the frequency of viral and bacterial causes of diarrhea in the comparison groups. As for complete blood count, patients with Zn deficiency more often had a tendency to blood neutrophilia with a reliably frequent shift of the leukocyte formula to the left (p = 0.003). At the same time, children with a reduced content of Zn in blood serum significantly more often had lymphopenia at the onset of diarrheal disease (p = 0.006). When investigating the effect of Zn deficiency on the course of the disease, we found that in children with reduced Zn, the duration of diarrhea was almost twice as long (8 [6; 9] days vs. 5 [4; 6] in children with normal Zn indicators; p = 0.0001 according to the Mann–Whitney test) and in patients with infectious diarrhea who had Zn deficiency at the onset of the disease, on the seventh day of treatment diarrhea persisted significantly more often (p = 0.03). Such symptoms were accompanied by the persistence of signs of anemia (p = 0.06 on the 5th day) and a shift of the leukocyte formula to the left (p = 0.007) without leukocytosis. Conclusions. Almost 25 % of young children with infectious diarrhea in the Zaporizhzhia region had Zn deficiency. Most likely, Zn deficiency is caused by the peculiarities of its supply with food and its metabolism. In the debut of a diarrheal disease, insufficient supply of Zn is associated with lymphopenia and a shift of the leukocyte formula to the left. Zn deficiency in infectious diarrhea leads to a long (more than 5 days) course of the disease due to prolongation of the diarrheal syndrome.

Severe Tropical Malaria with Acute Kidney Injury: A Case in a Remote Area

Background: Malaria remains a major health problem in Indonesia; P. falciparum is responsible for the majority of severe cases and malaria-related deaths. This report presents a case of severe tropical malaria complicated with acute kidney injury treated in a remote area with limited resources. Case: A 25-year-old male with a 9-day history of fever presented to the emergency department with severe headache, nausea, jaundice, abdominal pain, and hemoglobinuria. Microscopic examination of the blood revealed P. falciparum parasites. Laboratory results also showed anemia and thrombocytopenia, bilirubinuria, proteinuria, elevated liver enzymes, and pre-renal azotemia. The patient received antimalarial treatment (dihidroartemisinin/piperaquine once daily for 3 days and a single dose of primaquine) and supportive therapy. He was discharged in a stable condition on the fifth day of hospitalization. Conclusion: Early detection and management is crucial for the patient’s prognosis.

Right Diaphragmatic Rupture Post Earthquake

Traumatic rupture of the right diaphragmatic dome with herniation of the liver into the thorax is a rare lesion. It is often integrated into the context of multiple trauma, of which it is a criterion of severity. It exposes you, early or late, to cardiopulmonary complications due to compression. The diagnosis of a right diaphragmatic rupture is difficult to establish. Indeed, its clinical signs are not very specific and the imaging can be faulty because it visualizes the ascended organs but more difficultly the rupture itself. The thoracic approach is often preferred due to the difficulties of exposing the diaphragm in the presence of the liver. We report a case of a right diaphragmatic rupture with isolated and total intra-thoracic passage of the liver diagnosed on the fifth day of hospitalization in a multiple trauma patient.

Ascites Caused by Intestinal Anisakiasis: A Case Report and Literature Review.

Anisakiasis is a parasitic infection affecting the human gastrointestinal tract. It is caused by the consumption of contaminated, raw or inadequately cooked fish or squid, which is typically used for making sushi and sashimi. Most cases involve gastric anisakiasis, whereas intestinal anisakiasis is rare. This report describes the case of a 63-year-old Japanese woman with a history of raw fish consumption who presented with acute-onset abdominal pain and vomiting. Abdominal computed tomography (CT) demonstrated thickened small bowel loops and ascites on the liver surface. The patient was admitted for supportive care. On the second day of hospitalization, contrast-enhanced abdominal CT revealed that the ascites had moved from the liver surface to the pouch of Douglas. On the fifth day of hospitalization, the patient was discharged with a substantial improvement in abdominal pain. Five days after the discharge, her eosinophil count was elevated, and parasitic disease was therefore suspected. Anti-Anisakis IgG/A and IgE (RAST) antibody levels were elevated, confirming the diagnosis of intestinal anisakiasis. A review of 51 reported cases of intestinal anisakiasis suggests that the presence of ascites and measurement of anti-Anisakis antibody titers are helpful for diagnosis in cases presenting with nonspecific abdominal symptoms after consumption of raw or undercooked fish.

Evaluation of the Serum Levels of Minerals (Zinc, Selenium, Iron) and Thyroid Hormones (TSH, T3, T4) and Nutritional Intakes and Length of Stay in the Intensive Care Unit Among Burn Patients

Background: According to recent statistics, the rate of burns in Iran is higher than the world’s average. Therefore, it is necessary to improve the treatment protocols as much as possible. Objectives: This study investigated the level of mineral intake (iron, zinc, selenium) and thyroid hormones (TSH, T3, T4) serum levels among burn patients. Methods: This cross-sectional study was conducted on 24 patients admitted to the intensive care unit (ICU) of Taleghani Hospital, Ahvaz, Iran. The Kolmogorov-Smirnov test was used to check the normality of the distribution of quantitative variables. Blood samples were taken on the first, third, and fifth days of hospitalization. Serum levels of zinc, selenium, iron, T3, T4, and TSH were measured. The correlation of qualitative variables was examined using the chi-square test, and the correlation of quantitative variables was examined using Spearman's correlation analysis. The t-test was used to compare the means in two different groups with the standard value. The generalized estimating equation (GEE) test was used to investigate the effect of time and compare the two groups. Statistical analysis of the data was performed in SPSS v. 22. Results: The levels of iron, zinc, selenium, and thyroid hormones changed during the examined days, but these changes were not statistically significant. The amount of the analyzed elements in some cases was lower than their standard serum average, but this difference was significant only for selenium. Besides, there was no significant relationship between iron, zinc, T3, TSH, and the length of stay at the ICU; this relationship was positive and significant only for T4. Conclusions: Burn patients in the ICU have insufficient intake of minerals. Changes occur in the serum levels of micronutrients in these patients, affecting their physiological conditions and reducing the speed of recovery.

Psychological Changes During Inpatient Conservative Treatment for Lymphedema.

Background: Learning self-care for lymphedema is essential for patients to maintain their quality of life; however, it is sometimes difficult and stressful. There are only few studies about the psychological changes in patients hospitalized for conservative therapy. The purpose of this study was to evaluate the psychological changes in patients admitted for conservative therapy and training in self-care for lymphedema. Methods and Results: Nine patients who were hospitalized for conservative treatment of lymphedema of the lower limbs were administered the Profile of Moods States questionnaire twice: day of admission or the following day and after 5 days of hospital stay. Eight female patients and one male patient were included in this retrospective study. The mean age was 67.2 years. We provided standard compression therapy, manual lymph drainage, and exercise therapy to the patients. The Profile of Moods States 2nd edition, Japanese version of the Profile of Moods States, was used as an evaluation method of the psychological state. The results of the psychological tests were evaluated by a certified public psychologist. The scores for negative mood (anger or hostility, confusion or bewilderment, depression or rejection, fatigue or inertia, and tension and anxiety) were all lower on the fifth day of hospitalization compared with those at admission. In particular, the tension or anxiety scores decreased significantly (p = 0.019). However, the vigor or activity scores tended to increase. Conclusions: It was found that inpatient conservative therapy for lymphedema had a positive effect on the psychological state of the patients. Despite stressors such as a change in environment and introduction of new treatments (compression therapy and exercise therapy), the improvement in edema helped elevate the mood of the patients by the fifth day of hospitalization.

Effectiveness of one-to-one feedback methods of teaching with proper metered-dose inhaler technique and correcting errors in chronic obstructive lung disease patients

Abstract Objective To determine the most common mistakes made during the use of a metered-dose inhaler (MDI), and the effect of the repeated trainings performed with demonstration method by providing one-to-one feedback on these mistakes. Methods This is a quasi-experimental study with a control group. A total of 100 chronic obstructive pulmonary disease (COPD) patients (50 in the control group and 50 in the experimental group) were included in the research. “Patient Information Form (PIF)” (to determine the descriptive characteristics of patients) through the face-to-face interview method, using “MDI Skill Assessment Form” (MDISAF) (it is composed of 10 skill steps about the use of MDI) through observation method was used. Patients in both the groups were asked to use MDI and their abilities regarding use of MDI were assessed. Then in the intervention group, usage of MDI was explained by a nurse via demonstration and placebo MDI. Trainings were repeated on days 1,3, and 5 as from hospitalization of the patient. In the intervention group, three methods were used in this study: “face-to-face training,” “one-to-one,” and “with feedbacks and repeated.” Routine training regarding use of MDI was given by the nurses in the clinic to patients in the control group. The use of an MDI was assessed using MDISAF before training and after the training on the first, third and fifth days of hospitalization. On the seventh day, the last measurement was performed. Percentage, chi square, and mean were used to assess the data. Results After repetitive training with one-to-one feedback, several differences between the groups in favor of the experimental group were found in 7 of the 10 skill levels of the MDI. There was a significant difference after “training” between the groups in the third, fourth, fifth, sixth, seventh, eighth and ninth MDI steps in posttest measurement (P < 0.05). Evaluating the skills of the groups to use MDI from pretest to posttest, it was determined that while the intervention group made less mistakes in steps in which mistakes were made mostly, the control group continued to make mistakes. Conclusions Inhaler technique intervention with repeated, face to face, and one-to-one feedback trainings can significantly enhance the MDI techniques in COPD patients. The patients in the intervention group made less mistakes during MDI application and their application skills improved. It may be asserted that the training provided to the intervention group was effective for using the device correctly, while the training provided in the clinic for the control group was inadequate.

Low Levels of Serum and Intracellular Vitamin C in Hospitalized COVID-19 Patients.

Vitamin C is a crucial micronutrient for human immune cell function and has potent antioxidant properties. It is hypothesized that vitamin C serum levels decline during infection. However, the precise mechanisms remain unknown. To gain deeper insights into the true role of vitamin C during infections, we aimed to evaluate the body's vitamin C storage during a SARS-CoV-2 infection. In this single-center study, we examined serum and intracellular vitamin C levels in peripheral blood mononuclear cells (PBMCs) of 70 hospitalized COVID-19 patients on the first and fifth days of hospitalization. Also, clinical COVID-19 severity was evaluated at these timepoints. Our findings revealed a high prevalence of hypovitaminosis C and vitamin C deficiency in hospitalized COVID-19 patients (36% and 15%). Moreover, patients with severe or critical disease exhibited a higher prevalence of low serum vitamin C levels than those with moderate illness. Serum vitamin C levels had a weak negative correlation with clinical COVID-19 severity classification on the day of hospitalization; however, there was no correlation with intracellular vitamin C. Intracellular vitamin C levels were decreased in this cohort as compared to a healthy cohort and showed further decline during hospitalization, while serum levels showed no relevant change. Based on this observation, it can be suggested that the reduction of intracellular vitamin C may be attributed to its antioxidative function, the need for replenishing serum levels, or enhanced turnover by immune cells. These data give an incentive to further investigate the role of intracellular vitamin C in a larger and more heterogeneous cohort as well as the underlying mechanisms.

Impact of Bacterial Infections on COVID-19 Patients: Is Timing Important?

Along with important factors that worsen the clinical outcome of COVID-19, it has been described that bacterial infections among patients positive for a SARS-CoV-2 infection can play a dramatic role in the disease process. Co-infections or community-acquired infections are recognized within the first 48 h after the admission of patients. Superinfections occur at least 48 h after admission and are considered to contribute to a worse prognosis. Microbiologic parameters differentiate infections that happen after the fifth day of hospitalization from those appearing earlier. Specifically, after the fifth day, the detection of resistant bacteria increases and difficult microorganisms emerge. The aim of the study was to evaluate the impact of bacterial infections in patients with COVID-19 on the length of the hospital stay and mortality. A total of 177 patients hospitalized due to COVID-19 pneumonia were consecutively sampled during the third and fourth wave of the pandemic at a University Hospital in Greece. A confirmed bacterial infection was defined as positive blood, urinary, bronchoalveolar lavage (BAL) or any other infected body fluid. Patients with confirmed infections were further divided into subgroups according to the time from admission to the positive culture result. When comparing the groups of patients, those with a confirmed infection had increased odds of death (odds ratio: 3.634; CI 95%: 1.795-7.358; p < 0.001) and a longer length of hospital stay (median 13 vs. 7 days). A late onset of infection was the most common finding in our cohort and was an independent risk factor for in-hospital death. Mortality and the length of hospital stay significantly differed between the subgroups. In this case series, microbial infections were an independent risk factor for a worse outcome among patients with COVID-19. Further, a correlation between the onset of infection and a negative outcome in terms of non-infected, community-acquired, early hospital-acquired and late hospital-acquired infections was identified. Late hospital-acquired infections increased the mortality of COVID-19 patients whilst superinfections were responsible for an extended length of hospital stay.

Nosocomial COVID-19: A Nationwide Spanish Study

Introduction: SARS-CoV-2 is a highly contagious virus, and despite professionals’ best efforts, nosocomial COVID-19 (NC) infections have been reported. This work aimed to describe differences in symptoms and outcomes between patients with NC and community-acquired COVID-19 (CAC) and to identify risk factors for severe outcomes among NC patients. Methods: This is a nationwide, retrospective, multicenter, observational study that analyzed patients hospitalized with confirmed COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry) from March 1, 2020, to April 30, 2021. NC was defined as patients admitted for non-COVID-19 diseases with a positive SARS-CoV-2 test on the fifth day of hospitalization or later. The primary outcome was 30-day in-hospital mortality (IHM). The secondary outcome was other COVID-19-related complications. A multivariable logistic regression analysis was performed. Results: Of the 23,219 patients hospitalized with COVID-19, 1,104 (4.8%) were NC. Compared to CAC patients, NC patients were older (median 76 vs. 69 years; p < 0.001), had more comorbidities (median Charlson Comorbidity Index 5 vs. 3; p < 0.001), were less symptomatic (p < 0.001), and had normal chest X-rays more frequently (30.8% vs. 12.5%, p < 0.001). After adjusting for sex, age, dependence, COVID-19 wave, and comorbidities, NC was associated with lower risk of moderate/severe acute respiratory distress syndrome (ARDS) (adjusted odds ratio [aOR]: 0.72; 95% confidence interval [CI]: 0.59–0.87; p < 0.001) and higher risk of acute heart failure (aOR: 1.40; 1.12–1.72; p = 0.003), sepsis (aOR: 1.73; 1.33–2.54; p < 0.001), and readmission (aOR: 1.35; 1.03–1.83; p = 0.028). NC was associated with a higher case fatality rate (39.1% vs. 19.2%) in all age groups. IHM was significantly higher among NC patients (aOR: 2.07; 1.81–2.68; p < 0.001). Risk factors for increased IHM in NC patients were age, moderate/severe dependence, malignancy, dyspnea, moderate/severe ARDS, multiple organ dysfunction syndrome, and shock; odynophagia was associated with lower IHM. Conclusions: NC is associated with greater mortality and complications compared to CAC. Hospital strategies to prevent NC must be strengthened.

Clinical profile and severity predictors of coronavirus disease 19 infection in a reference center from southern Brazil: a cross-sectional study.

The coronavirus disease pandemic has become a major global health crisis since 2019. Recent data show the association of diabetes, hypertension, and obesity with poor related outcomes in coronavirus disease infection. This descriptive study aimed to identify the clinical and laboratory parameters in patients with acute respiratory syndrome and confirmed severe acute respiratory syndrome coronavirus 2 infection. In this cross-sectional study, we analyzed data of 409 patients admitted to a referral hospital in Rio Grande do Sul, Brazil, with coronavirus disease infection confirmed by reverse transcription polymerase chain reaction. Clinical, laboratory, and imaging data were collected retrospectively from electronic medical records using a template with the variables of interest. The average age was 64 years (52-73), and the body mass index was 27 kg/m² (22.1-31.2). Hypertension, diabetes, and obesity were observed in 58, 33, and 32% of the patients, respectively. Patients admitted to an intensive care unit were older [66 years (53-74) vs. 59 years (42.2-71.7)], with significantly higher impairment on chest computed tomography [75% (50-75) vs. 50% (25-60)] and received higher doses of corticosteroid therapy [39.4 mg (14.3-70.3) vs. 6 mg (6-14.7)]. Hematological parameters were lower in critically ill patients, with greater differences observed on the fifth day of hospitalization [hemoglobin 11.5 g/dL (9.5-13.1) vs. 12.8 g/dL (11.5-14.2), platelets 235,000 μL (143,000-357,000) vs. 270,000 μL (192,000-377,000), and lymphocytes 900 μL (555-1,500) vs. 1,629 μL (1,141-2,329)]. C-reactive protein levels and kidney function were also worse in intensive care unit patients. The mortality rate was significantly higher in the intensive care unit compared to the basic care unit (62.8 vs. 12.2%). Our findings suggest that metabolic and cardiovascular comorbidities, as well as abnormal hematological parameters, are common findings among patients with severe respiratory syndrome related to coronavirus disease.

Evaluation of inflammatory and hematological parameters in patients diagnosed with COVID-19.

This study aims to research the effects of hematological and inflammatory parameters on the prognosis of COVID-19 disease and hospitalization duration. One hundred and eighty-six patients with COVID-19 and a control group consisting of 187 healthy individuals were included in the study. Hematological variables and inflammatory parameters of the patients were recorded on the first and the fifth days of hospitalization. White blood cell count, lymphocyte count, and platelet count were statistically lower, and mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) levels were higher in the patient group compared to the control group. It was observed that the neutrophil count and MPV level were lower, and the platelet count and ferritin level were statistically higher on the fifth day of follow-up compared to the admission day. In contrast, there was a significantly positive correlation between the duration of hospitalization and the fifth day D-dimer (r = 0.546, p &lt; 0.001) and ferritin (r = 0.568, p &lt; 0.001); in addition, there was a negative correlation between the duration of hospitalization and admission day lymphocyte count and the fifth-day lymphocyte count. Increased levels of ferritin and D-dimer, and decreased count of lymphocytes are among the important factors affecting the duration of hospitalization for COVID-19 patients. Furthermore, we think that neutrophil count and MPV levels are low, and platelet count and ferritin levels are high during the disease. Therefore, these parameters can be used as prognostic indicators of the disease.

Efficacy of olive leaves extract on the outcomes of hospitalized covid-19 patients: A randomized, triple-blinded clinical trial

IntroductionSince the emergence of the novel coronavirus, herbal medicine has been considered a treatment for COVID-19 patients. This study was done to determine the efficacy of olive leaf extract on the outcomes of COVID-19 patients. Materials and MethodsThis randomized, triple-blinded clinical trial was conducted on hospitalized COVID-19 patients. Using block randomization, eligible patients were allocated to the following groups: intervention A received olive leaf extract (250 mg every 12 hours for five days), intervention B received olive leaf extract (500 mg every 12 hours for five days), and the control group received placebo (every 12 hours for five days). The outcomes (vital signs, laboratory tests, and length of hospitalization) were compared by group. ResultsOf the 150 patients randomized into groups, 141 completed the follow-up and were analyzed. On the fifth day of hospitalization, body temperature (MD=0.34, P<0.001), pulse rate (MD=5.42, P=0.016), respiratory rate (MD=1.66, P=0.001), ESR (MD=13.55, P<0.001), and CRP (MD=15.68, P<0.001) of intervention A were significantly lower than the control group, while oxygen saturation (MD= -1.81, P=0.001) of intervention A was significantly higher than the control group. Furthermore, body temperature (MD=0.30, P=0.001), pulse rate (MD=5.29, P=0.022), respiratory rate (MD=1.41, P=0.006), ESR (MD=14.79, P<0.001), and CRP (MD=16.28, P<0.001) of intervention B were significantly lower than the control group, while oxygen saturation (MD= -2.38, P<0.001) of intervention B was significantly higher than the control group. ConclusionOlive leaf extract can improve the clinical status of the patients and decrease the length of hospitalization.

The Prognostic Value of Cardiac Biomarkers in Patients with Acute Myocardial Infarction during and after Hospitalization.

Myocardial infarction (MI) carries a strong risk of death and the development of major adverse cardiovascular events (MACE). A number of biomarkers have been proposed for risk stratification among patients with MI. The aim of this study was to determine whether elevated galectin-3 and midregional-pro atrial natriuretic peptide (MR-proANP) levels can be used as predictors of MACE in patients with acute myocardial infarction (AMI). Plasma levels of galectin-3 and MR-proANP were collected from 96 patients following their first AMI hospitalised in our clinic over the course of a year. Samples were taken on admission, and on the first and fifth day of hospitalization. During hospitalization, all patients were followed up for the occurrence of early major adverse cardiac events (MACE), defined as sudden cardiac arrest, new onset atrial fibrillation and need to use pressor amines. All patients were also followed up twelve months after AMI for the occurrence of late MACE defined as cardiac death, reinfarction and need for unscheduled PCI. Patients who experienced early MACE had significantly higher galectin-3 and MR-proANP levels assessed on admission (p = 0.007, p = 0.003). ROC curve analysis found also galectin-3 concentration assessed on admission to be a strong predictor of late MACE (AUC = 0.75, p = 0.0061). MRproANP does not appear to have any value in predicting late MACE. A high concentration of galectin-3 and MR-proANP observed on admission in patients with acute myocardial infarction has significant prognostic value: it may identify patients at high risk of early adverse cardiac events after AMI. In contrast to MR-proANP, a high concentration of galectin-3 observed on admission may also identify patients at high risk of late MACE.

What are the effects of taking 300 pills of sodium valproate? - case report

INTRODUCTION: Sodium valproate is one of the most important antiepileptic drugs. It can be effective as a preventive treatment for migraine, it has also found use in the maintenance treatment of bipolar disorder and acute mania,it is sometimes used in the treatment of chronic neuropathic pain and fibromyalgia, in the treatment of schizophrenia borderline personality disorder and acquired brain injury, this drug is used off-label. Its overdose can be fatal.&#x0D; MATERIALS AND METHOD: Patient information was collected from hospital records available in the clinical toxicology department. In addition, we conducted a literature review on sodium valproate treatment, its toxicity, side effects and pharmacokinetics using PubMed.&#x0D; CASE REPORT: A 57-year-old patient with a history of depressive disorders was admitted to the Clinical Department of Toxicology and Cardiology in Lublin for intentional intoxication with the drug Absenor (sodium valproate). The patient had taken 3 packages of Absenor 500 mg (300 tablets in total) for suicidal purposes. The determined concentration of valproic acid was 841 µg/ml, and the patient's condition was very severe. Despite the treatment administered-multiple attempts at gastric lavage, administration of activated charcoal, performance of hemodialysis procedures, administration of infusion of catecholamines, the patient died on the fifth day of hospitalization.&#x0D; CONCLUSION: An overdose of sodium valproate can be fatal. Keep this in mind when ordering this drug for patients with a positive history of suicide attempts.

Effect of Statin Treatment on COVID-19 Patients’ Outcomes: A Randomized Double-blind Controlled Clinical Trial

Background: Statins may be protective against viral infection and have been suggested for the treatment of coronavirus disease 2019 (COVID-19). Objective: In this study, we aimed to evaluate the effect of atorvastatin on COVID-19 patients. Methods: Our study is a randomized double-blind controlled clinical trial that constitutes a population of COVID-19 patients admitted to Bu-Ali Sina Hospital in Qazvin, Iran, from May to August 2021. For the intervention and control groups, in addition to the national standard treatment, atorvastatin 40 mg tablet and placebo were daily administered for 7 days, respectively. A questionnaire including demographic characteristics, history of underlying diseases, vital signs, laboratory and imaging results, and outcome (alive, died) was completed on the first, third, and fifth days of hospitalization. Finally, the obtained data were analyzed by SPSS software, version 25. Findings: One hundred five patients with COVID-19 (62 females and 43 males, mean age 69 years) were studied. On days 3 and 5 after the intervention, no significant difference was observed between the groups in terms of vital signs, laboratory findings, hospitalization time, and need for intensive care unit hospitalization. However, 5.7% of patients in the atorvastatin group and 0% of patients in the control group died (P=0.243). Among the studied variables, C-reactive protein (P=0.227 vs P=0.002), blood urea nitrogen (P=0.055 vs P&lt;0.001), and creatinine (P=0.598 vs P=0.013) decreased significantly in the statin group (no control group during days 0-5). Conclusion: There was no evidence about the harm and benefits of statin treatment during COVID-19 hospitalization.

P415 NEUROGENIC STRESS CARDIOMYOPATHY

Abstract Case Report Caucasian 84–years–old woman was found on the floor at her house and was brought to the ED of Policlinico Umberto I with the diagnosis of cranial trauma following a syncope. A head CT showed right paramedian fracture of the occipital bone, left frontal subarachnoid hemorrhage and left frontal subdural hemorrhage. The neurosurgeon gave no indication to urgent evacuation of the hemorrhage. Then elevation of cardiac enzymes and ST–segment elevation at the EKG were found but due to the state of the patient a coronary angiography was not performed and the patient was transferred to the CCU. The patient was hemodynamically stable with right hemiplegia. The EKG showed rapid ventricular rate atrial fibrillation with ST segment elevation in inferior and lateral leads with T wave inversion in the same leads and elevated serum troponin levels. ETT showed: EF 30% with a global reduction of left ventricular systolic function with diffuse akinesis. Intravenous therapy with mannitol and corticosteroids for perilesional oedema was started. Beta blockers and a class III antiarrhythmic drug were also started, but hemodynamic conditions declined and acute kidney failure occurred with progressive hypotension followed by cardiogenic shock. The patient had an episode of nonsustained ventricular tachycardia treated with antiarrhythmic drugs and magnesium sulfate. The EKG started to show a normalization of the repolarization phase with regression of ST segment elevation and persistent T wave inversion.The patient’s neurological conditions were complicated with epileptic seizures.On the fifth day of hospitalization the TTE revealed a slight improvement of global systolic function and the presence of an apical thrombotic apposition.The patient’s clinical conditions worsened and led to exitus. Discussion The interpretation of this patient’s history was made more difficult by the lack of witnesses of the trauma.The patient’s age, her history of hypertension and the presence of regional wall motion abnormalities at the TTE suggested the presence of CAD. On the other side the atrial fibrillation could hint a primitive cerebral event. This case report shows the potentially severe cardiac manifestations of cerebral hemorrhage and the necessity to consider cerebrovascular events as the cause of EKG changes mimicking a myocardial infarction, cardiac enzymes elevation and ventricular wall motion abnormalities, in order to avoid inappropriate or delated therapies.

Determination of Antibiotic Susceptibility of Bacteria Isolated From Endotracheal Tube in Pulmonary Intensive Care Unit of a Hospital in Bandar Abbas

Background: The present study attempted to determine the antibiotic susceptibility of bacteria isolated from endotracheal tube culture on patients admitted to the intensive care units (ICUs) of Shahid Mohammadi hospital in Bandar Abbas. Materials and Methods: This cross-sectional study was conducted on 114 patients hospitalized in the pulmonary ICU of Shahid Mohammadi hospital in Bandar Abbas from March 2018 to March 2019. The samples of the patients’ endotracheal tube secretions were collected for the culture purpose on the first and fifth days of hospitalization in the ICU where the disk diffusion method was used to determine antibiotic susceptibility. Results: The most common isolated microorganisms from the first day of culture were 26 Acinetobacter spp. isolates (22.8%), 10 Candida isolates (8.8%), and 9 Pseudomonas aeruginosa isolates (7.9%). The most common microorganisms which were isolated on the fifth day comprised Acinetobacter spp. with 57 isolates (51.8%), Candida with 6 isolates (5.5%), and P. aeruginosa with 6 isolates (5.5%). The highest resistant bacteria isolated from Acinetobacter spp. samples on the first-day were amikacin (92.3%) and meropenem (84.6%). The highest resistance of P. aeruginosa was against meropenem (77.8%), while the highest resistance of Acinetobacter spp. isolates was found to be amikacin (94.7%) and meropenem (86%) from the fifth-day samples. Further, P. aeruginosa isolates had the highest resistance in meropenem (83.3%), co-trimoxazole, and cefepime (66.7% for each of them). Conclusion: Ventilator-associated pneumonia (VAP) is considered a warning condition due to multidrug-resistant bacteria. According to the present study, the most common VAP-causing bacteria are gram-negative, especially Acinetobacter, with high antibiotic resistance.

A false alarm: Pacemaker pocket pseudo-infection.

A 87-year-old man had a dual-chamber pacemaker for almost 10 years implanted for symptomatic sinus node disease. Subsequently, he underwent device replacement in our department because of battery depletion. Nineteen months after the last procedure, he presented to a district hospital because he noticed a diffuse redness over the pacemaker area. Shortly after, he was transferred to our center with a presumed diagnosis of “pacemaker pocket infection.” On inspection, there was an obvious redness over the pacemaker pocket area extending to half of the left hemithorax (Figure 1 Panel A). The erythema was warm on palpation but there was no tenderness. Of note, the patient was afebrile in good clinical condition. His past medical history was significant for hypertension and hyperlipidemia treated with perindopril, amlodipine, and atorvastatin. The laboratory examinations were all within normal limits, apart from the C-reactive protein (CRP) levels (initial value: 90 mg/L; normal value <8 mg/L). No specific site of injury, irritation, insect bite, or sting was evident over the pacemaker area. Given that a pacemaker pocket infection was suspected, he was placed on intravenous antibiotic treatment with ampicillin/sulbactam and clindamycin while an extraction procedure was scheduled. A transesophageal echocardiogram the following day did not reveal any abnormality. The blood cultures taken before the antibiotics institution were negative. Remarkably, the patient responded dramatically to the treatment and on the fifth day of hospitalization, the erythema disappeared (Figure 1B) while the CRP levels almost normalized (10 mg/L). Although the initial working diagnosis was a pocket infection, the possibility of a superficial infection caused by an involuntary irritation or minor injury was also considered. The patient was discharged home on the 8th day after admission and continued the same antibiotic treatment orally for another 7 days. During follow-up at 1, 6, and 12 months, the patient remained well without any relapse. The final diagnosis made by our team was local cellulitis that responded to antibiotic treatment and was confirmed by an internist with a special interest in infectious diseases. Cardiac implantable electronic device (CIED) infection represents a devastating complication leading to significant morbidity and mortality.1, 2 Current recommendations advocate a therapeutic approach consisting of complete removal of the system and antimicrobial therapy.2 Although most CIED infections occur within 1 year from the index procedure, a significant proportion of patients develop infections later.1, 3 The early recognition and management of CIED infections is important in terms of morbidity and mortality. The clinical presentation of our patient along with the elevated CRP was suspected of pocket infection, although 19 months had been elapsed since the generator replacement. Notably, we have reported a case series of patients with skin lesions that mimic pocket infection.4 These conditions include local cellulitis after CIED implantation, spontaneous bruising, herpes zoster, contact dermatitis because of the prolonged postoperative application of povidone-iodine.4 However, most conditions that may be misinterpreted as CIED pocket infection are neoplastic (malignant tumors).4 Moreover, titanium, nickel, or other pacemaker compounds may very rarely provoke allergic reactions including contact dermatitis.4 Our patient suffered localized diffuse cellulitis without any obvious cause (local injury, sting, or bite). Clinicians should be aware of conditions mimicking CIED pocket infection. Many of these entities can be treated conservatively without any meaningful complications. Inadvertent CIED extraction may have a negative impact on patient's clinical outcomes. Although CIED pseudo-infection is rare, a rapid and dramatic improvement of the local inflammatory signs after antibiotic treatment during the first few days may portend a benign outcome. However, the diagnosis of pseudo-infection would be certain only if complete remission will remain and no signs of infection recur after cessation of antibiotic treatment. Authors declare no conflict of interets for this article. The patient has given signed consent for publication of his medical case anonymously and without showing his face.