Background: Malposition of central venous catheters is a potentially severe but often preventable complication. This study aimed to assess the radiological distribution of central venous catheter tip positions and to discuss malposition mechanisms based on anatomical and radiographic literature.Methods: A retrospective analysis of 374 patients who underwent intraoperative central venous catheter insertion between January 2022 and December 2023 was conducted. Radiographs were evaluated using a carina-based classification system: Zones A–C (normal) and Zone D (malposition). Data were analyzed retrospectively.Results: The right internal jugular vein was the most commonly preferred access site, used in 80.0% of cases. Zone A: 52.3%, Zone B: 18.5%, Zone C: 17.8%, Zone D (malposition): 11.4%. There was no statistically significant association between catheter size and malposition (p>0.05).Conclusion: Utilizing the carina as a reference point during post-procedural imaging is essential for accurate catheter tip localization. Adjunctive modalities—including intracavitary ECG, ultrasound, and radiography—contribute to complication reduction and procedural safety.

Introduction: Scorpion sting-induced Kounis syndrome (Ks) is a rare and underrecognized form of allergic acute coronary syndrome. Although scorpion envenomation is a significant cause of morbidity in endemic regions, its association with Ks has been infrequently reported. This study aimed to describe the clinical characteristics, management, and outcomes of venom-induced Ks. Methods: Following institutional ethical approval, medical records of 175 patients admitted with scorpion envenomation between January 2014 and March 2024 were retrospectively reviewed. Of these patients, 34 met predefined inclusion criteria. Demographic data, clinical features, cardiac investigations, treatments, intensive care unit course, and short-term outcomes were analyzed. Group comparisons and odds ratios with 95% confidence intervals were calculated using appropriate statistical methods. Results: The cohort comprised 21 children and 13 adults, with a median age of 9 y (interquartile range 4–52). Chest pain (88.2%) and generalized erythema or urticaria (94.1%) were the most frequent presenting features. Pediatric patients exhibited significantly higher rates of cardiac involvement, including left ventricular ejection fraction reduction, hyperlactatemia, clinical need for prazosin, and need for inotropic support. Severe cardiac involvement occurred more frequently in children than in adults (90 vs 23%; odds ratio 31.7, 95% CI 4.52–221.73, P <0.001). Coronary angiography, performed selectively, revealed no significant obstructive lesions in most patients. No 30-d mortality was observed. Conclusions: Pediatric patients demonstrated a more severe pattern of cardiac involvement than adults, suggesting an age-dependent clinical phenotype following scorpion envenomation. Given the limited sample size, these findings should be interpreted with caution and warrant validation in larger multicenter cohorts.

Background: Acute respiratory distress syndrome (ARDS), particularly in COVID-19–related severe respiratory failure, remains a major challenge in intensive care. Flow-controlled ventilation (FCV) may improve gas exchange by enabling precise airway pressure control; however, clinical data on its prolonged use in ARDS are limited. Methods: This single-center retrospective observational study included adult patients with moderate to severe ARDS who underwent FCV during invasive mechanical ventilation. FCV was delivered using the Evone^® ventilator with the Tritube^®. Demographic data, ventilatory settings, and arterial blood gas values were analyzed before and during 48 h of FCV and for 8 h after transition to conventional ventilation. Results: Seven patients with COVID-19–related ARDS were included. Following initiation of FCV, PaO₂ increased within the first 8 h (median increase: +24 mmHg), accompanied by a median 38% improvement in the PaO₂/FiO₂ ratio, which remained above baseline throughout follow-up. Arterial PCO₂ progressively declined, with the most pronounced reduction observed within the first 24 h (median decrease: −14 mmHg; approximately 22%). After transition back to conventional ventilation, mild deterioration in gas exchange parameters was observed; however, none returned to baseline values. All patients died during their ICU stay, mainly due to secondary infections and pulmonary embolism. Conclusions: In advanced COVID-19–related ARDS unresponsive to conventional ventilation, prolonged FCV application was technically feasible under controlled ICU conditions and associated with descriptively observed improvements in gas exchange parameters. However, late initiation of FCV did not translate into survival benefit. Prospective studies are required to define the optimal timing and patient selection for FCV. The present findings primarily support the technical feasibility and short-term physiological effects of FCV rather than clinical efficacy.

Early identification of patients at high risk of amputation remains a major challenge in frostbite management, particularly in resource-limited settings wh

Whether recorded deaths in intensive care units (ICUs) follow a uniform temporal distribution throughout the 24-hour cycle remains uncertain. Previous stud

Background and Objectives: Sustained weight loss remains one of the greatest challenges in obesity management, as many individuals experience weight regain after initial treatment success. Although early weight loss has consistently been associated with greater overall weight reduction, its relationship with subsequent weight regain in routine clinical practice remains insufficiently characterized. This study examined the association between early weight loss and clinically significant weight regain among adults participating in a lifestyle-based obesity management program. Materials and Methods: We conducted a retrospective cohort study of adults receiving structured lifestyle-based obesity treatment at a tertiary care obesity clinic. Early weight loss was defined as the percentage reduction in body weight from baseline to the routinely scheduled third-month follow-up measurement. Clinically significant weight regain at one year was defined as regaining at least 50% of the maximum weight lost from baseline to nadir weight, expressed as the weight regain ratio (WRR ≥ 0.50). Logistic regression was used to examine the association between early weight loss and subsequent weight regain after adjustment for age, baseline body mass index, and baseline body weight. Sensitivity analyses included a female-only model, an alternative weight regain definition (WRR ≥ 0.25), and Firth-penalized logistic regression. Results: Among 79 participants with complete follow-up data, 9 (11.4%) experienced clinically significant weight regain at one year. Conclusions: Greater early weight loss was independently associated with lower odds of clinically significant weight regain (adjusted odds ratio 0.784, 95% confidence interval 0.646–0.950; p = 0.013). The association remained consistent in the female-only analysis and in the Firth-penalized logistic regression. When clinically significant weight regain was alternatively defined as WRR ≥ 0.25, the association remained in the same direction but did not reach statistical significance. Age, baseline body mass index, and baseline body weight were not significantly associated with the outcome.