BackgroundThe predictive role of many cytokines has not been well defined in Acute Respiratory Distress Syndrome (ARDS).MethodsWe measured prospectively IL-4, IL-6, IL-6 receptor, IL-8, and IL-10, in the serum and bronchoalveolar lavage fluid (BALF) in 59 patients who were admitted to ICU in order to identify predictive factors for the course and outcome of ARDS. The patients were divided into three groups: those fulfilling the criteria for ARDS (n = 20, group A), those at risk for ARDS and developed ARDS within 48 hours (n = 12, group B), and those at risk for ARDS but never developed ARDS (n = 27, group C).ResultsAn excellent negative predictive value for ARDS development was found for IL-6 in BALF and serum (100% and 95%, respectively). IL-8 in BALF and IL-8 and IL-10 serum levels were higher in non-survivors in all studied groups, and were associated with a high negative predictive value. A significant correlation was found between IL-8 and APACHE score (r = 0.60, p < 0.0001). Similarly, IL-6 and IL-6r were highly correlated with PaO2/FiO2 (r = -0.27, p < 0.05 and r = -0.55, p < 0.0001, respectively).ConclusionsBALF and serum levels of the studied cytokines on admission may provide valuable information for ARDS development in patients at risk, and outcome in patients either in ARDS or in at risk for ARDS.

Background: The predictive role of many cytokines and adhesion molecules has not been studied systematically in acute respiratory distress syndrome (ARDS). Methods: We measured prospectively tumour necrosis factor alpha (TNF-α), interleukin (IL)-1, soluble vascular adhesion molecule-1 (VCAM-1) and soluble intercellular adhesion molecule-1 (ICAM-1) in serum and bronchoalveolar lavage fluid (BALF) within 2 hours following admission, in 65 patients. The patients were divided into: those fulfilling the criteria for ARDS (n = 23, group A), those who were pre-ARDS and who developed ARDS within 24 hours (n = 14, group B), and those on pre-ARDS but who never developed ARDS (n = 28, group C). Results: All the measured molecules were only found at higher levels in the serum of patients that died either with or without ARDS (P < 0.05 -P < 0.0001). Patients at risk exhibited a good negative predictive value (NPV) of the measured molecules for ARDS development both in their serum (89 to 95%) and BALF (86 to 92%) levels. In contrast to BALF, serum levels of IL-1 and adhesion molecules exhibited a good NPV (68 to 96%), sensitivity (60 to 88%) and survival specificity (74 to 96%) in all groups. All molecules in serum and BALF IL-1 were correlated with the APACHE II (P < 0.05 -P < 0.0001). Serum and BALF IL-1 as well as BALF TNF-α were negatively correlated to PaO 2 /FiO 2 (all P < 0.05). Conclusions:The studied molecules have good NPV for ARDS development both in serum and BALF. Serum rather than BALF levels seem to be related to outcome.

Determination of serum IL-2 and IL-15 levels may be a valuable and simple aid to improve identification of patients with ARDS or at risk for ARDS who are at high risk of subsequent mortality.

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Introduction and objectives Short-term extreme increases in desert-derived particulate-matter with aerodynamic diameter below 10 μm (PM 10 ) may affect emergency department (ED) visits due to COPD exacerbations. Research question Our aim was to identify the effect of extreme increases in desert-derived PM 10 on ED visits for dyspnea and COPD exacerbations and on the related hospital admissions. Methods We performed a retrospective analysis of dyspnea-related ED visits and hospital admissions in Heraklion, Crete, during four consecutive storms of desert-derived PM 10 that happened during March 2018. We collected data from over 17,000 ED visits and recorded patients with atopic symptoms, COPD exacerbations, and dyspnea, as well as admissions to the departments of pulmonary medicine, internal medicine, and cardiology. PM 10 data were collected from a monitoring station in the same geographic area. Results Four desert dust storms were recorded during the study period with 238, 203, 1138, and 310 μg/m 3 average-daily PM 10 and 652, 308, 4262, and 778 μg/m 3 hourly mean day-peak PM 10, respectively. There was no clinically important increase in total ED visits, total admissions or admissions to the departments of cardiology, pulmonary medicine, or internal medicine, during PM 10 peaks. However, during the desert dust storm with daily-average PM 10 above 500 μg/m 3 , there was a striking increase in dyspnea-related ED visits (including COPD exacerbations, 3.6-fold increase), while there was no clinically important increase in non-asthma allergy-related ED visits. Conclusion Extreme desert dust storm episodes may cause meaningful increases in ED visits for dyspnea and COPD exacerbations/admissions.

This study paper reports on two cases of poisoning with the organophosphorus insecticides, fenthion and omethoate. The two victims were admitted in the Intensive Care Unit (ICU) a few hours after ingestion of the two insecticides. They received appropriate treatment for organophosphorous poisoning (gastric lavage, activated charcoal, atropine and pralidoxime) and supportive care. Both patients survived. Organophosphate blood levels were determined on admission (fenthion 2.9 micrograms/ml, omethoate 1.6 micrograms/ml) and during the hospitalisation and proved to be considerably high. Slow elimination rate of the poison already distributed in the body was indicated for both pesticides. The patient with omethoate poisoning remained clinically well (Glasgow Coma Scale: 15) and was discharged three days later. The patient with fenthion poisoning, who had also ingested 30 mg of bromazepam and 720 mg of oxetoron, developed cholinergic crisis six hours after admission and was intubated for 24 days, with concomitant complications.

The case of a 60-year-old male patient, who survived severe organophosphorus poisoning, and subsequently developed platypnoea and orthodeoxia is described. The patient was mechanically ventilated for a long period of time in the intensive care unit. During the weaning trial, he developed platypnoea and orthodeoxia (PaO2 85 mmHg in recumbency, and 40 mmHg in upright position). Interestingly, the patient's orthodeoxia was alleviated on continuous positive airway pressure (CPAP) treatment. This is a newly described cause of the platypnoea-orthodeoxia syndrome. The possible pathophysiological mechanisms are discussed and a review of the reported abnormal states associated with this condition is presented.

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