Background and Objectives: Patients with traumatic injuries have often been excluded from studies that have attempted to pinpoint modifiable factors to predict the transient disturbance of the cognitive function in the postoperative settings. Anesthetists must be aware of the high risk of developing postoperative delirium and cognitive dysfunction (POCD) in patients undergoing emergency surgery. Monitoring the depth of anesthesia in order to tailor anesthetic delivery may reduce this risk. The primary aim of this study was to improve the prevention strategies for the immediate POCD by assessing anesthetic depth and nociception during emergency surgery. Material and Methods: Of 107 trauma ASA physical status II–IV patients aged over 18 years undergoing emergency noncardiac surgery, 95 patients were included in a prospective randomized study. Exclusion criteria were neurotrauma, chronic use of psychoactive substances or alcohol, impaired preoperative cognitive function, pre-existing psychopathological symptoms, or expected surgery time less than 2 h. Entropy and Surgical Pleth Index (SPI) values were constantly recorded for one group during anesthesia. POCD was assessed 24 h, 48 h, and 72 h after surgery using the Neelon and Champagne (NEECHAM) Confusion Scale. Results: Although in the intervention group, fewer patients experienced POCD episodes in comparison to the control group, the results were not statistically significant (p < 0.08). The study showed a statistically significant inverse correlation between fentanyl and the NEECHAM Confusion Scale at 24 h (r = −0.32, p = 0.0005) and 48 h (r = −0.46, p = 0.0002), sevoflurane and the NEECHAM Confusion Scale at 24 h (r = −0.38, p = 0.0014) and 48 h (r = −0.52, p = 0.0002), and noradrenaline and POCD events in the first 48 h (r = −0.46, p = 0.0013 for the first 24 h, respectively, and r = −0.46, p = 0.0002 for the next 24 h). Conclusions: Entropy and SPI monitoring during anesthesia may play an important role in diminishing the risk of developing immediate POCD after emergency surgery.

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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.

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The coronavirus disease outbreak in 2019 (COVID-19) reached devastating pandemic proportions, still representing a challenge for all healthcare workers. Furthermore, the social environment underwent significant changes and healthcare facilities were overwhelmed by COVID-19 patients. The purpose of our study was to compare the prevalence, characteristics and outcomes of 234 patients presenting with pulmonary embolism diagnosed by computed tomography pulmonary angiography (CTPA) during the COVID-19 pandemic, to patients presenting with PE one year before, aiming to assess differences and similarities between these patients. Or main findings were: patients with PE had worse survival during the pandemic, there was an increased incidence of PE among hospitalizations in our cardiology unit during the COVID-19 pandemic, and patients hospitalized with PE during the pandemic were more likely to be obese, allowing us to infer that weight control can have a positive impact on preventing PE. Future research should establish optimal therapeutic, epidemiological and economical strategies for non-COVID patients, as the pandemic continues to put significant burden on the healthcare systems worldwide.

Chemotherapy-induced peripheral neuropathy (CIPN) is the type of toxicity that affects treatment decisions often. Oncology specialists usually grade it using Common Terminology Criteria for Adverse Effects version (CTCAE), with some limitations. Dyck scale is a more objective method that is usually used for diabetic neuropathy grading.The present study included retrospectively registered patients (n=80) treated with platinum salts, taxanes, fluoropyrimidines or vinorelbine that subsequently developed CIPN. In some, the decision to lower the chemotherapy dose or withhold the treatment altogether was taken. CIPN was graded using both CTCAE 4.0 and Dyck scale for each patient. The aim of the study was to determine how the grades of each scale influenced the decision on the oncological treatment and whether objective, measurable changes are directly proportional to the impact CIPN has on the patients life. The present study reports high sensibility for both CTCAE and Dyck scale in deciding to modify the dose or interrupt chemotherapy. CTCAE should have more importance for the clinician in the early stages of CIPN. If CIPN presents as advanced, a less subjective alternative like the Dyck scale is a more suitable alternative. Dyck scale should be the most important argument in the decision regarding oncological treatment if the patients� scores more than 2a on this grading system.The decision to lower the dosage or stop oncological treatment due to CIPN is a complex one and both grading systems are useful. However, when dealing with a more severe case of CIPN, the more objective Dyck scale should be the more important argument.

Background and Objecitves: Appendicitis is one of the most frequent surgical emergencies in pediatric surgery. Complicated appendicitis can evolve with appendicular peritonitis characterized by the diffusion of the pathological process to the peritoneal cavity, thus producing generalized or localized inflammation of the peritoneum. The capacity to anticipate the possibility of perforation in acute appendicitis can direct prompt management and lower morbidity. There is no specific symptom that could be used to anticipate complicated appendicitis, and diagnostic clues include a longer period of symptoms, diffuse peritoneal signs, high fever, elevated leukocytosis and CRP, hyponatremia, and high ESR. Imagistic methods, particularly US and CT, are useful but not sufficient. There are no traditional inflammation biomarkers able to predict the evolution of uncomplicated to complicated appendicitis alone, but the predictive capacity of novel biomarkers is being investigated. Materials and Methods: The present study represents a retrospective evaluation of children hospitalized between January 2021 and July 2022 in the Grigore Alexandrescu Clinical Emergency Hospital for Children with a diagnosis of acute appendicitis settled based on clinical characteristics, traditional and novel biomarkers, and ultrasonographic features. The children were subsequently grouped into two groups based on the existence of appendicular peritonitis on intraoperative inspection of the abdominal cavity. The aim of this report is to establish the predictors that may aid physicians in timely identifying pediatric patients diagnosed with acute appendicitis at risk for developing complicated appendicitis with evolution to appendicular peritonitis. Results: The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte radio (PLR) are representative severity markers in infections. This report analyzes the benefit of these markers for distinguishing uncomplicated appendicitis from complicated appendicitis in pediatric patients. Conclusions: Our study suggests that a value of neutrophil-to-lymphocyte ratio greater than 8.39 is a reliable parameter to predict the evolution to appendicular peritonitis.

Background: The fish-based diet is known for its potential health benefits, but it is less known for its association with mercury (Hg) exposure, which, in turn, can lead to neurological and cardiovascular diseases through the exacerbation of oxidative stress. The aim of this study was to evaluate the correlations between Hg blood concentration and specific biomarkers for oxidative stress. Methods: We present a cross-sectional, analytical, observational study, including primary quantitative data obtained from 67 patients who presented with unspecific complaints and had high levels of blood Hg. Oxidative stress markers, such as superoxide dismutase (SOD), glutathione peroxidase (GPX), malondialdehyde (MLD), lymphocyte glutathione (GSH-Ly), selenium (Se), and vitamin D were determined. Results: We found positive, strong correlations between Hg levels and SOD (r = 0.88, p < 0.0001), GPx (r = 0.92, p < 0.0001), and MLD (r = 0.94, p < 0.0001). We also found inverted correlations between GSH-Ly and vitamin D and Hg blood levels (r = −0.86, r = −0.91, respectively, both with p < 0.0001). Se had a weak correlation with Hg plasma levels, but this did not reach statistical significance (r = −0.2, p > 0.05). Conclusions: Thus, we can conclude that low-level Hg exposure can be an inductor of oxidative stress.