Influence of the COVID-19 pandemic on causes for the development of carbon monoxide intoxications.

Introduction: Several causes can lead to carbon monoxide (CO) intoxication. A first-line treatment option for such intoxications is hyperbaric oxygenation (HBO2) therapy. The COVID-19 pandemic has been changing everyday life in Germany since March 2020, mainly caused by statutory provisions. Our aim was to review whether these changes have an influence on the causes and frequency for the development of CO intoxication. Methods: We retrospectively analyzed the data of patients who were treated for CO intoxication in our institution between April 2019 and March 2021. Besides demographic data, we compared the overall number and documented causes for each CO intoxication in the period of April 2020 to March 2021 with the period between April 2019 and March 2020. Results: After applying inclusion and exclusion criteria, 139 patients were included. We found a significant decrease in the overall number of patients who needed treatment since the beginning of the COVID-19 pandemic. However, the share of CO intoxication caused by the indoor use of coal stoves, coal barbecue, or suicide attempts increased. In contrast, the share of cases caused by apartment or house fire, smoking waterpipe, or gas stoves decreased. Conclusion: The COVID-19 pandemic and the associated restrictions lead to a significant reduction in the number of patients in need for HBO2 therapy due to CO-Intoxication. The causes leading to CO intoxication also changed since the beginning of the COVID-19 pandemic. We observed a shift toward causes related to the indoor use of coal-fired stoves and barbecues as well as suicide attempts.

Abstract of 17th Congress of Pediatric Emergencies and Common Diseases

The proceedings contain 81 papers. The topics discussed include: management of caustic ingestion in pediatrics;updates in pediatric gastroenterology hepatology;successful changing of the pediatric hematology and oncology curriculum in Iran;primary immunodeficiency disorders among PICU patients;post cardiac arrest care supports in pediatrics;general aspects of primary immunodeficiency;the setting of pediatric palliative care in Iran;causes and clinical manifestation of hypoxemia;hypoxemia in children: diagnosis;carbon monoxide poisoning;do's and don'ts;covid vaccination in children;inappropriate lifestyle as an effective factor on inflammation in cystic fibrosis;and management of elevated intracranial pressure (ICP) in pediatric intensive care unit.

DELAYED DECLINE: A CASE OF DELAYED POST-HYPOXIC LEUKOENCEPHALOPATHY

CASE: A 44 year old female with history of depression and recent suicide attempt presents with one week of cognitive and functional decline. One month prior to presentation, patient attempted suicide with opioids requiring intubation for respiratory depression and stroke sequelae. She was discharged from this stay after 12 days having returned to mental and functional baseline. Two weeks later, she demonstrated decreased focus and concentration, progressing to decreased mobility and akinesis, eventually presenting to our hospital. Admission metabolic and toxic workup was negative. CT head redemonstrated findings of previously known stroke. MRI demonstrated new increased T2 Flair of the parietal lobes and the cerebral white matter. LP was without evidence of infection or inflammation. Encephalitis panel and autoimmune workup were negative. Neurology consult suggested delayed post-hypoxic leukoencephalopathy as a possible diagnosis, given clinical course of improvement and subsequent decline, along with akinetic mutism and deep cortical white matter flair abnormalities. After failed trial of lorazepam, she was started on amantadine and her cognitive and functional status improved slowly. IMPACT/DISCUSSION: Delayed post-hypoxic leukoencephalopathy (DPHL) is a rare syndrome characterized by biphasic time course with initial recovery and subsequent cognitive and functional decline. DPHL can follow any event of prolonged cerebral hypoxia most frequently CO poisoning. It can occur with more common causes of hypoxia including overdose, cardiac arrest, and seizures;recent case reports have reported DPHL following severe covid infection. The clinical course involves a hypoxic event followed by a return to functional baseline typically lasting 7-21 days, after which progressive physical and mental decline occur. Signs include neuropsychiatric symptoms like amnesia and disorientation, as well as parkinsonism or akinetic mutism (1). The mechanism of DPHL is unclear. One possible mechanisms involves diffuse demyelination. The half life of myelin basic proteins is approximately 20 days, the length of the lucid interval. Hypoxia may abruptly halt the myelination process but symptoms may not emerge until a critical threshold of loss was achieved. Evaluation of DPHL involves considering other causes of encephalopathy, such as infection, substance use, stroke, catatonia, and toxins. In the absence of other causes, diagnosis of DPHL is based on characteristic time course following hypoxic event, symptoms, and MRI findings of diffuse T2 hyperintensity of cerebral white matter are pathognomonic (1). Treatment of DPHL is generally supportive. Limited evidence suggests amantadine may be of benefit. CONCLUSION: Physicians should consider DPHL in patients who have experienced cerebral hypoxia and present with the characteristic time course and imaging findings.

From vaping and smoking: Risk assessment of new tobacco and nicotine releasing systems

90% of all e-cigarette users use tobacco cigarettes instead of quitting smoking and, due to sweet-flavored liquids and advertising as a lifestyle product, young never-smokers are increasingly using these new products. Even though e-cigarettes may also contain lower levels of harmful substances, no e-cigarette was free from potentially toxic and carcinogenic substances, and there is also evidence that e-cigarettes contain new toxic substances;in 2019, they led to EVALI in the USA with 68 deaths. In the steam from tobacco heaters, 295% increased amounts of carcinogenic acenaphthene compared to tobacco cigarettes were found. The use of nicotine-containing e-cigarettes and tobacco heaters did not reduce tobacco-related diseases. Shisha lead to a similar nicotine addiction potential, a considerably higher pollution, and carbon monoxide exposure. Shiazzo steam stones have a significantly lower health risk than shishas with the same risk of carbon monoxide poisoning. The consumption of e-cigarettes by adolescents and young adults led to a 5-fold increased risk of contracting COVID-19, in combination with tobacco cigarettes even to a 7-fold increased risk. The new tobacco or nicotine-releasing substances are neither harmless to health nor suitable for smoking cessation.

Hyperbaric oxygen therapy and its suitability as an adjuvant for treatment of covid-19 patients: A review

The outbreak of the SARS CoV2 ’Coronavirus pandemic’ is believed to have originated in Wuhan in 2019 as a zoonotic spread from bats to humans. It is a highly communicable infection-causing rapid human to human transmission of the virus by virtue of its infectious and pleomorphic nature. The virus has affected millions of people worldwide, with numbers still rising with each passing day. Depleting oxygen saturation levels is amongst the prime concerns in the majority of infected patients. Nasal prongs, face masks, mechanical ventilation and extracorporeal membrane (ECMO) are the commonly used modes of oxygen delivery in such patients. These methods though mostly successful, at times fail to restore the depleting oxygen levels to normal. Hyperbaric oxygen therapy (HBOT) involves the administration of 100% O2 in a special chamber whose pressure is maintained at a level greater than 1 ATP. The main purpose for raising the pressure within the chamber is that as the atmospheric pressure increases, the saturation levels of oxygen in the blood also increase, which eventually result in increased overall tissue oxygenation. This article provides a systematic and wholesome review on the basic principle of hyperbaric oxygen therapy, its effects on the body at a microscopic and macroscopic level, its various uses and its suitability as an adjuvant for the treatment of select COVID-19 infected patients.