Background: It is well documented that caregivers of patients with chronic respiratory failure under noninvasive mechanical ventilation (NIMV) are at high risk to develop depression, burden, overload and declining health over time. Objectives: The purpose of the study was to investigate the subjective and objective burden imposed on families of patients under NIMV at home and explore the coping strategies they adopt. Methods: The study population consisted of 50 informal caregivers of patients with chronic respiratory failure under NIMV at home for at least 6 months. The burden of the families, as well as the adaptation strategies, were estimated by a modified version of the Family Burden Questionnaire validated in Greek. Results: Profound objective burden was reported in the field of social relations in 49%, in household management in 43.2%, in financial issues in 31.3% and in employment issues in 29.4% of the families. The subjective burden which the families experienced was usually lower and it was reported in household management in 33.4%, in employment issues in 29.4%, in social relations in 21.6% and in financial issues in 21.5% of the families. The strategies adopted by the families in order to cope with the imposed burden included reorientation of goals in 92.2%, resignation in 88.2%, passivity in 62.7%, hopefulness in 45.3%, ambivalence in 19.6% and guilt in 13.7% of the families. Conclusions: The families of patients under NIMV seem to face major problems (severe burden) in household management and their social relations. Families do not seem to subjectively experience the burden that is objectively recorded and, in the vast majority, they adopt healthy coping strategies.

IntroductionHydrocarbon pneumonitis is an acute, intense pneumonitis resulting from aspiration of volatile hydrocarbon compounds with low viscosity and surface tension, most of which are members of the paraffin, naphthene and aromatic classes.Case presentationSix hours after participating in a party for teenagers, a 16-year-old boy developed dyspnea, cough, a fever (39°C) and chest pain. A chest radiograph showed infiltration in the right middle lobe. The patient reported alcohol abuse during the party and an episode of vomiting a few hours thereafter. He also reported practicing a fire-eating performance at the party using liquid paraffin, but was unaware of inhaling any of it. The radiographic infiltration was diagnosed as an aspiration pneumonia and he was treated at the local health center with antibiotics. Five days later, because of clinical deterioration, he was referred to a pulmonary clinic. A chest computed tomography scan was performed which showed consolidation with an air bronchogram in the right middle lobe and areas of atelectasis and ground glass opacities in the middle and lower right lobes. Spirometry revealed severe restriction of lung function. A bronchoscopy revealed inflamed, hyperemic mucosa. Bronchoalveolar lavage fluid revealed lipid-laden alveolar macrophages, which were detected by lipid staining, and neutrophilia. The patient was finally diagnosed with hydrocarbon pneumonitis and he was treated with systemic steroids and antibiotics. After 6 days of treatment there was complete clinical and significant radiologic regression.ConclusionHydrocarbon pneumonitis should be included in the differential diagnosis of pneumonias. Recent exposure to volatile hydrocarbons provides a basis for clinical diagnosis, as symptoms and radiologic findings are not specific.

Infectious complications remain one of the most challenging concerns for the burn team. The goal of this study was to evaluate the diagnostic and therapeutic approaches and prognosis in burn patients with septic shock. This retrospective study included patients with severe burn injury who were admitted to a burn intensive care unit (ICU). Demographic and clinical data were recorded for each patient. The diagnostic and prognostic value of a number of clinical and laboratory parameters and various treatment options were evaluated. Sixty-four of the 378 patients (16.9%) were identified as having experienced a septic shock during ICU stay. The mortality rate of patients with septic shock was 46.9%. The main bacterial strains responsible for infection were Gram-negative bacteria (78.1%). Factors associated with outcome of septic shock on logistic regression analysis were presence of stage III of acute kidney injury (odds ratio [95% confidence interval] 2.03 [1.06-3.84]; P = 0.019), and lactate levels > 4 mmol/L during the first 48 hours of shock (odds ratio 1.92; 95% confidence interval: 1.02-3.62; P = 0.043). Prognosis of septic shock remains poor in burn patients with septic shock. The main causative pathogens of septic shock identified in our burn ICU were Gram-negative species. The main prognostic factors identified in this study were the presence of AKI, stage III, and high lactate levels early after the onset of septic shock.

Introduction: The etiology of seizure disorders in lung cancer patients is broad and includes some rather rare causes of seizures which can sometimes be overlooked by physicians. Paraneoplastic limbic encephalitis is a rather rare cause of seizures in lung cancer patients and should be considered in the differential diagnosis of seizure disorders in this population.

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