Radu Țincu

Objectives: To assess the prognostic value of the mean Lethality Risk Score (LRS), reflecting the toxicity of substances involved in an exposure, and to develop prediction models for complicated outcomes in ICU patients with acute intoxication. Design: Multicenter prospective cohort study. Setting: Seventy-eight ICUs in Europe, Australia, and the Eastern Mediterranean (2020–2023). Patients: A total of 2265 adult patients were admitted to the ICU with acute intoxication as the main reason for admission for at least 4 hours. Intervention: None. Measurements and Main Results: The primary outcome was defined as ICU complications or death (22.5%). Clinical data were collected in an electronic capture system. We developed two prediction models: one incorporating laboratory variables (“Laboratory Model”), and one including the mean LRS (“Expo Model”). The mean LRS was calculated as the average of the individual LRS values assigned to the toxicants involved in the exposure. Key predictors were age, severity at presentation, systolic blood pressure, Glasgow Coma Scale score, and hospital type. The mean LRS remained significant only when laboratory variables were not considered. Model performance was assessed using the area under the receiver operating characteristic (AUROC), calibration plots, likelihood ratio tests, and decision curve analysis. Internal validation demonstrated good performance for both models (AUROCs of 0.79 and 0.77; calibration slopes of 0.94 and 0.95; intercepts of −0.06 and –0.06), with minimal overfitting. Decision curve analysis revealed clinically relevant threshold probability ranges of 0–50% for the Laboratory Model and 0–40% for the Expo Model. Conclusions: The mean LRS had prognostic value only in the absence of laboratory test results. Both models may aid decision-making regarding the management of acutely intoxicated patients in the ICU.

Background/Objectives: Emergency surgical patients are at increased risk of acute postoperative delirium. Processed EEG monitoring, such as entropy indices and burst suppression ratio (BSR), may optimize anesthetic dosing, yet their role in non-elective surgery remains underexplored. This retrospective cohort study aimed to examine whether entropy monitoring and intraoperative burst suppression are associated with the incidence of early postoperative delirium during the first 72 h after emergency surgery. Methods: Adult patients undergoing emergency surgery between March 2022 and March 2024 were classified into two groups based on anesthesia records: the entropy-monitored group (EG) and the standard care group without processed EEG (SG). Demographic, intraoperative, and cognitive data (NEECHAM scores during the first 72 h) were extracted from institutional perioperative records. The primary outcome was postoperative delirium (NEECHAM ≤ 24), with secondary analyses examining anesthetic exposure, burst suppression, and intraoperative hemodynamics. Results: Entropy-monitored patients received lower sevoflurane and fentanyl doses and exhibited improved hemodynamic stability, including fewer hypotensive episodes and lower norepinephrine requirements. Early postoperative cognitive dysfunction (NEECHAM ≤ 24) was more frequent among patients with intraoperative burst suppression, with BSR > 15% or suppression duration > 6 min strongly associated with cognitive decline within the first 72 h. Conclusions: In this retrospective cohort, entropy-guided anesthesia was associated with more precise anesthetic titration and more stable hemodynamic parameters. Burst suppression characteristics may serve as indicators of neurocognitive vulnerability rather than solely reflecting direct effects of anesthetic dosing. These results support the use of processed EEG monitoring in emergency surgery, though prospective studies are needed to confirm these findings.

Trace elements are essential for several physiological processes. To date, various data have suggested that inadequate levels of trace elements may be involved in the pathogenesis of different chronic diseases, including immune-mediated ones, or may develop during their course. Systemic sclerosis (SSc) is a complex autoimmune multisystemic disease, primarily characterized by microvascular dysregulation, the widespread activation of the immune system and tissue fibrosis. According to the latest reports regarding the pathogenesis of SSc, the main pathophysiological processes—inflammation, vasculopathy and fibrosis—may include various trace element derangements. The present literature review aims to update the available data regarding iron, zinc, copper and selenium status in SSc as well as to underline the possible implications of these trace elements in the complexity of the pathogenic process of the disease. We observe that the status of trace elements in SSc plays a crucial role in numerous pathogenic processes, emphasizing the necessity for proper monitoring and supplementation. The reported data are heterogenous and scarce, and future studies are needed in order to draw clearer conclusions about their complete spectrum.

The administration of intravenous lipid emulsion (ILE) is a proven antidote used to reverse local anesthetic-related systemic toxicity. Although the capacity of ILE to generate blood tissue partitioning of lipophilic drugs has been previously demonstrated, a clear recommendation for its use as an antidote for other lipophilic drugs is still under debate. Venlafaxine (an antidepressant acting as a serotonin–norepinephrine reuptake inhibitor (SNRI)) and quetiapine (a second-generation atypical antipsychotic) are widely used in the treatment of psychotic disorders. Both are lipophilic drugs known to induce cardiotoxicity and central nervous depression. We report the case of a 33-year-old man with a medical history of schizoaffective disorder who was admitted to the emergency department (ED) after having been found unconscious due to a voluntary ingestion of 12 g of quetiapine and 4.5 g of venlafaxine. Initial assessment revealed a cardiorespiratory stable patient but unresponsive with a GCS of 4 (M2 E1 V1). In the ED, he was intubated, and gastric lavage was performed. Immediately after the admission to the intensive care unit (ICU), his condition quickly deteriorated, developing cardiovascular collapse refractory to crystalloids and vasopressor infusion. Junctional bradycardia occurred, followed by spontaneous conversion to sinus rhythm. Subsequently, frequent ventricular extrasystoles, as well as patterns of bigeminy, trigeminy, and even episodes of non-sustained ventricular tachycardia, occurred. Additionally, generalized tonic–clonic seizures were observed. Alongside supportive therapy, antiarrhythmic and anticonvulsant therapy, intravenous lipid emulsion bolus, and continuous infusion were administered. His condition progressively improved over the following hours, and 24 h later, he was tapered off the vasopressor. On day 2, the patient repeated the cardiovascular collapse and a second dose of ILE was administered. Over the next few days, the patient’s clinical condition improved, and he was successfully weaned off ventilator and vasopressor support. ILE has the potential to become a form of rescue therapy in cases of severe lipophilic drug poisoning and should be considered a viable treatment for severe cardiovascular instability that is refractory to supportive therapy.

Considering the prioritization of life-threatening injuries in trauma care, secondary dysfunctions such as ventilator-induced diaphragmatic dysfunction (VIDD) are often overlooked. VIDD is an entity induced by muscle inactivity during invasive mechanical ventilation, associated with a profound loss of diaphragm muscle mass. In order to assess the incidence of VIDD in polytrauma patients, we performed an observational, retrospective, longitudinal study that included 24 polytraumatized patients. All included patients were mechanically ventilated for at least 48 h and underwent two chest CT scans during their ICU stay. Diaphragmatic thickness was measured by two independent radiologists on coronal and axial images at the level of celiac plexus. The thickness of the diaphragm was significantly decreased on both the left and right sides (left side: −0.82 mm axial p = 0.034; −0.79 mm coronal p = 0.05; right side: −0.94 mm axial p = 0.016; −0.91 coronal p = 0.013). In addition, we obtained a positive correlation between the number of days of mechanical ventilation and the difference between the two measurements of the diaphragm thickness on both sides (r =0.5; p = 0.02). There was no statistically significant correlation between the body mass indexes on admission, the use of vitamin C or N-acetyl cysteine, and the differences in diaphragmatic thickness.

Cardiac tamponade is a rare presentation in patients with COVID-19, which may be induced by the associated exacerbated inflammatory response. The onset of cardiac tamponade may be concomitant with the acute phase of the disease or may develop subsequently as a new health condition secondary to the disease. We report four cases of cardiac tamponade that occurred late after the acute phase of the disease. One of them may be considered a post-acute complication of the disease, and three of them may be classified as a new health condition induced by COVID-19. Only two cases had a history of severe respiratory distress due to COVID-19. In all four cases, pericardiocentesis was imposed, and surprisingly, in every case, hemorrhagic fluid was evacuated. In this case, series, immune-mediated etiology is supported by histopathological results, where the main identified feature was fibrous pericarditis with inflammatory infiltrate. Only one patient included in this report died, and three of them were discharged after anti-inflammatory treatment was initiated.

Background and Objectives: Conditions such as trauma, burns, sepsis, or acute intoxications have considerable consequences on the endocrine status, causing “sick euthyroid syndrome”. Organophosphate exposure may induce an increase in acetylcholine levels, thus altering the thyroid’s hormonal status. The present study aims to identify the effects of acetylcholinesterase inhibition on thyroid hormones. Material and methods: A prospective experimental study was conducted on twenty Wistar rats. Blood samples were drawn to set baseline values for thyroid-stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4). Chlorpyrifos 0.1 mg/kg was administered by oral gavage to induce acetyl-cholinesterase inhibition. After exhibiting cholinergic symptoms, blood samples were collected to assess levels of cholinesterase and thyroid hormones using ELISA. Results: Butyrylcholinesterase levels confirmed major inhibition immediately after intoxication compared to the baseline, certifying the intoxication. A significant increase in T4 levels was noted (p = 0.01) both at 2 h and 48 h after administration of organophosphate in sample rats. Similarly, T3 almost doubled its value 2 h after poisoning (4.2 ng/mL versus 2.5 ng/mL at baseline). Surprisingly, TSH displayed acute elevation with an afterward slow descending trend at 48 h (p = 0.1), reaching baseline value. Conclusions: This study demonstrated that cholinesterase inhibition caused major alterations in thyroid hormone levels, which may be characterized by a transient hypothyroidism status with an impact on survival prognosis.

The emergence of knowledge economy has created the necessary conditions for an interdisciplinary approach of medical practices. This paper explores, in an interdisciplinary manner, the case of lead exposure in the Romanian context. We consider it crucial to be aware of the socio-economic impact of lead exposure in Romania and prevent unhealthy consumption habits that generate economic and social costs. The purpose of the research is to evaluate the social, economic, and medical effects of lead poisoning, and, on this basis, to identify prevention recommendations. The research was conducted while using a descriptive survey based on qualitative and quantitative methods, by analyzing a group of 115 participants that were admitted in the Toxicology Department of the Clinical Emergency Hospital Bucharest with the diagnosis of lead exposure/intoxication. The study followed an Observational Retrospective Protocol that was based on the investigations of the participants registered in the Toxicology Department with signs and symptoms suggestive of lead exposure/intoxication. The data was statistically processed by while using Microsoft Excel 2013 and SPSS Statistics 22. Based on our research results, we facilitated the knowledge sharing process of medical practices and formulated a series of recommendations in an interdisciplinary manner, in order to diminish the negative socio-economic effects of unhealthy consumption habits.

Snakebite is a health issue specific to some parts of the world, especially in the tropical areas, where it produces many victims. The main clinical damage caused by snakebite involves haemotoxic, neurotoxic and myotoxic reactions. We report the case of a young woman suffering from snakebite who developed deep vein thrombosis and compartment syndrome. We present the case of a 32-year-old Romanian woman who was injured by her own Crotalinae snake (also known as pit viper or rattlesnake) on her left forearm. When admitted to our Emergency Department, she was conscious with a Glasgow coma scale of 12/15, somnolent, febrile, suffering of headache, tachypnoea; the marks of the snakebite were located in the distal part of the anterior left forearm; she had pain and bleeding at the bite site and swelling of the left upper limb with lymphangitis up to the axilla. She experienced fasciotomy-requiring compartment syndrome of the upper limb and required unfractionated heparin and close monitoring using activated partial thromboplastin time evolution due to micro-thrombosis in the brachial vein. Local improvement was achieved in the next 4 days with progressive diminishment of local tenderness and swelling. Limb deep vein thrombosis might be induced by snakebite, despite the pro-haemorrhagic general condition induced by the envenomation. A high index of clinical suspicion is needed for early diagnosis and timely management, which can improve survival of these patients.