Sari A, et al. J Korean Med Sci. 2023 Jul;38(29):e232. https://doi.org/10.3346/jkms.2023.38.e232

Background and Objectives: Erdosteine (Erd) is an antioxidant and anti-inflammatory drug. Vitamin B has been reported to exert anti-inflammatory and antioxidant effects. In this study, we investigated the effect of erdosteine and vitamin B complex on a liver ischemia/reperfusion (I/R) model. Materials and Methods: Thirty-two Wistar Albino male rats weighing 350–400 g were used. The animals were randomly selected and divided into four groups. The groups are as follows: first group (Sham), second group (I/R), third group (I/R + vit B), and fourth group (I/R + vit B + Erd). Rats were subjected to 45 min of hepatic ischemia, followed by a 45 min reperfusion period in the I/R and Vitamin B + Erd groups. An amount of 150 mg/kg/day of erdosteine was given orally for 2 days, and 0.05 mL/kg of i.p. vitamin B complex was given 30 min before the reperfusion. Serum biochemical parameters were measured. Serum Total Antioxidant Status (TAS) and Total Oxidant Status (TOS) were measured, and the Oxidative Stress Index (OSI) was calculated. Hepatic tissue samples were taken for the evaluation of histopathological features. Results: In terms of all histopathological parameters, there were significant differences in the I/R + vit B group and I/R + vit B + Erd group compared with the I/R group (p < 0.01). In terms of aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), TNF-alpha, and IL-6 levels, there were significant differences between the I/R group and treatment groups (p < 0.01). The lowest TOS and OSI levels were obtained in the treatment groups, and these groups had statistically significantly higher TAS levels compared with the sham and I/R groups (p < 0.01). Conclusions: As a preliminary experimental study, our study suggests that these agents may have potential diagnostic and therapeutic implications for both ischemic conditions and liver-related diseases. These results suggest that the combination of vit B + Erd may be used to protect against the devastating effects of I/R injury. Our study needs to be confirmed by clinical studies with large participation.

Objective: To compare the efficacy of pulsed-dose corticosteroids (≥250 mg methylprednisolone, 3 days) and tocilizumab in treating COVID-19-related hyperinflammation. Methods: This prospective observational study included RT-PCR positive COVID-19 patients with acute respiratory distress syndrome, who were admitted to the COVID-19 Adult Intensive Care Unit of Prof Dr. Murat Dilmener Emergency Hospital (Istanbul, Turkey) between December 1, 2020 and February 28, 2021. Clinical, laboratory and radiological examinations were used to diagnose COVID-19 associated hyperinflammation. Three cohort groups were formed: the pulsed-dose corticosteroids group (250 mg methylprednisolone for 3 days), the tocilizumab group (8 mg/day single dose or 400 mg/day for 2 days), and the combined group (pulsed-dose corticosteroid+tocilizumab). The difference in mortality rates among the groups was compared primarily. The most common cause(s) of death was determined. Furthermore, adverse events (secondary infection, acute kidney injury, arrhythmia, gastrointestinal system bleeding) for 28 days were recorded. Results: A total of 60 patients were included in this study, with 20 patients in each group. There was no statistically significant difference between the 3 groups in mortality rates (55% in the pulsed corticosteroid group, 60% in the tocilizumab group, 50% in the combined group, χ²=0.404, P=0.817). Infectious causes were found to be the most common cause of mortality in all the three groups, and no difference was found between them (χ²=0.404, P=0.817). There was also no difference in the development of adverse events such as secondary infection, acute kidney injury, arrhythmia, and gastrointestinal bleeding among the groups (P>0.05). Conclusions: Corticosteroids can be used instead of tocilizumab to treat hyperinflammation in COVID-19 patients with acute respiratory distress syndrome.

Amaç DKA (Diyabetik ketoasidozis) hastalarında salin (%0.9 NACI) ve dengeli kristaloid (İsolen veya Laktatlı ringer) solüsyonlarının avantaj ve dezavantajlarının karşılaştırılması amaçlandı. Gereç ve Yöntem Çalışma 2013 ve 2023 yılları arasında erişkin yoğun bakıma ünitesi (ICU)’ne kabul edilen 129 DKA’lı hasta içerisinden orta-şiddetli DKA mevcut olan 80 hasta (salin=31, dengeli=49) üzerinde retrospektif olarak gerçekleştirildi. Bulgular DKA resolusyon süresi salin ve dengeli grubunda benzerdi [12(6-16), 9(7-12), p=0.539]. İstatistiksel olarak salin grubunda dengeli grubuna göre DKA rezolüsyonu sonrası bakılan kan klor düzeyi daha yüksek (115±5.5, 110.8±4.4, p<0.001) ve anion gap değeri ise daha düşüktü [5.9(3.9- 10.6), 9.7(7.0-12.0), p=0.005]. Salin grubunda DKA resolusyonu sonrası kan potasyum düzeyleri normalden düşüktü [3.4(3.1-3.6), 3.6(3.2-4.0), p=0.088]. Salin ve dengeli grubu arasında 1 aylık mortalite oranları [0(0), 2(4.1), p=0.524], renal replasman tedavi ihtiyacı [1(3.2), 2(4.1), p=1.000] ve ICU kalış saati [46 (32-70), 44 (36-68), p=0.961] açısından istatistiksel olarak anlamlı bir fark yoktu. Sonuç İlk resusitasyon sıvısı olarak salin veya dengeli kristaloid solüsyonun seçiminin DKA resolusyon süresi, mortalite oranı ve ICU kalış süresi üzerine bir etkisi yoktur. Bununla birlikte dengeli elektrolit solusyonları daha az yan etki profiline sahiptir.

Ekstrakorporeal membran oksijenasyonu (ECMO) desteğinin etkin ve güvenli bir şekilde uygulanabilmesi için vasküler kanülasyon adımı büyük önem taşımaktadır. Çalışmamızda koronavirüs hastalığı-2019 akut solunum sıkıntısı sendromu gelişen ve V-V ECMO desteği alan 3 hastada ECMO damar kanülasyonu ile ilgili yaşadığımız çeşitli sorunlar (malpozisyon, tromboz, rekanülasyon, kollaps) ve bunların yönetimindeki deneyimlerimizi paylaşmayı amaçladık. Uygun vasküler kanül boyutu, vasküler kanül yapısı, vasküler kanülasyon bölgesinin seçimi ve hassas vasküler kanülasyon, ECMO desteğini daha etkili ve güvenilir hale getirebilir.