Hasil untuk "Medical emergencies. Critical care. Intensive care. First aid"

Lois Nunn, James McEntee, Suveer Singh

Mohammad K. El Badrawy, Afaf Abd El-Hafez, Mostafa Elmansy et al.

Abstract Background Pulmonary embolism (PE) means occlusion of the pulmonary artery with thrombi, tumor tissue, air, or fat. Blood clots may be located in the main pulmonary artery or in its branches. Aim To assess the frequency of hemoptysis among cases with pulmonary embolism at Mansoura Emergency Hospital and its relation to other symptoms, laboratory data, radiological findings, and the outcome of the affected patients. Methodology This prospective cross-sectional observational investigation has been performed on 73 cases admitted at Mansoura University Emergency Department, Mansoura, Egypt, over 1 year between May 2022 and May 2023. Patients were diagnosed with PE according to the clinical presentation, laboratory findings, and computed tomography pulmonary angiography (CTPA). They were divided into 2 groups, either with or without hemoptysis. Results Mortality was higher in patients with hemoptysis (37.5% vs 7.7%, OR = 6.9, 95% CI 1.4–33.2, p = 0.011). The need for mechanical ventilation and prolonged hospital stay (> 7 days) was also higher in patients with hemoptysis. Median hospital stay is as follows: 15 (10–29) days vs 9 (6–20), p < 0.001. Conclusion Hemoptysis is an uncommon presentation in cases with pulmonary embolism, as it was present in 11% of cases. Hemoptysis is highly associated with pulmonary infarction and must direct the attention to the severity of pulmonary embolism as well as the worse outcome.

Qiang Zhang, BA, Brandon McKown, MBA, Winnie Lau, MD et al.

OBJECTIVES:. Due to hospital visitor restriction policies, the COVID-19 pandemic forced many conversations between ICU patients’ families and organ procurement organizations (OPOs) to be conducted by phone, as opposed to in-person. We aimed to determine if OPO phone approaches are a negative predictor of authorization for donation. DESIGN:. Retrospective observational study. SETTING:. Hospitals partnering with New England Donor Services (NEDS) as their OPO. PATIENTS/SUBJECTS:. Multicenter database study of all ICU patients from 2017 to 2021 whose families had been approached by NEDS. Of note, registered organ donors who were declared brain dead were excluded due to their prior first-person authorization. However, registered organ donors who were candidates for donation after circulatory death were included in the analysis because of the family’s role in controlling the timing of ventilator withdrawal and, thus, their critical role in determining donation success. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. In addition to whether OPO approaches occurred in person or by phone, we extracted covariate data on patient and surrogate demographics, OPO representative training, and extent of ICU-OPO collaboration. Univariate and multivariate analyses were conducted to determine predictors of successful authorization. Among 2240 approaches of potential organ donors, OPO donation discussions by phone constituted 221 of 1282 (17%) of authorizations, as opposed to 134 of 958 (14%) of failed attempts (p = 0.04). In a multivariate model, phone approach was no longer significantly negatively associated with authorization. However, patient race/ethnicity, registered status for donors after cardiac death, ICU-OPO collaboration, specialized OPO representative training, OPO representative being the sole participant in authorization discussions, and surrogate relationship were strong predictors. CONCLUSIONS:. OPO approach by phone is not a barrier to organ donation. Strategies for successful donation discussions should focus on collaborative processes between ICU teams and OPOs and involvement of OPO representatives with special training for discussing authorization.

A. Yu. Anisimov, F. B. Mavlonov, D. E. Erkinova et al.

RELEVANCE Despite the obvious successes of transjugular intrahepatic portosystemic shunt and orthotopic liver transplantation in some high-tech centers of the Russian Federation, the relevance of substantiating the use of selective splenorenal anastomoses in the treatment plan for portal hypertension, when hundreds of patients return to emergency surgery departments every year after conservative treatment with new episodes of bleeding, liver failure and high mortality rates, is beyond doubt.AIM OF THE STUDY To substantiate the viability of the selective splenorenal anastomosis operation by improving the technique of performing the intraoperative vascular maneuver exposure and venous reconstruction through the use of original modern innovative approaches.MATERIAL AND METHODS A retrospective controlled clinical study included 56 patients with intrahepatic portal hypertension with relatively preserved liver function, in whose complex treatment program for secondary prevention of bleeding, various options for selective splenorenal bypass surgery were used. In 21 patients of comparison group A, who were treated between 2006 and 2017, selective splenorenal anastomoses were performed using the traditional technique. In 35 patients of the main group B, who were treated between 2018 and 2021, the surgical technique was improved through the use of two innovative surgical techniques: intraoperative vascular maneuver exposure and venous reconstruction during the formation of a splenorenal shunt.RESULTS Original intraoperative vascular maneuver exposure at the first stage of surgery in patients with portal hypertension provides convenient volumetricspatial relationships in the surgical wound, creates comfortable conditions for performing the main surgical technique, vascular anastomosis. The duration of surgical interventions in patients of group A was 35% longer, and the average intraoperative blood loss was 58.6% higher than in patients of group B. The difference was statistically significant. The suggested intraoperative maneuver of vascular exposure has a minimal risk of developing specific complications associated with the approach to the vessels of the left retroperitoneal space.Seven days after the operation, patients in both groups showed a decrease in the size of the portal and splenic veins and the volume of the spleen. The blood flow velocity indices in the portal vein decreased, while those in the splenic vein increased. Turbulent blood flow was observed in the lumen of the shunts. No thrombosis of vascular conduits was detected in the early postoperative period according to Doppler ultrasound data. The observed differences were statistically insignificant.In group A, 7 patients (33.3%) died during the study period, and in group B, 3 patients (8.6%). The differences in mortality were statistically significant. The survival rate of patients in group A was significantly lower than that of patients in group B.CONCLUSION Changing the technique of execution through the use of modern innovative surgical techniques intraoperative vascular maneuver exposure and venous reconstruction during the formation of the splenorenal shunt allowed to improve the treatment results of patients with portal hypertension, reduce the duration of surgical interventions from 305.5±44.3 to 198.6±21.1 min (p=0.00155), average intraoperative blood loss from 930.0±198.6 to 385.1±84.7 ml (p=0.00004), reduce the incidence of complications in the early postoperative period, including postoperative pancreatitis from 19.0% to 0, anastomotic thrombosis from 28.6% to 5.7%, and mortality from 33.3% to 8.6% (p&lt;0.05), increase the 8-week survival rate, thereby confirming the viability of the selective shunt operation splenorenal anastomosis, conditioned by the reserve for evolution built into it by the authors .When performed in a center with technical expertise, the procedure provides long-term survival and reliable hemostasis, potentially obviating the need for liver transplantation in a significant number of appropriately selected patients with portal hypertension and relatively preserved liver function.

Ling-Xi Xiao, De Liang Zhu, Juan Chen et al.

Abstract Background Acute respiratory distress syndrome (ARDS) is a severe respiratory condition characterized by a high mortality rate, the management of which relies on supportive care and a profound understanding of its pathophysiology. Heparin, with its anticoagulant and potential anti-inflammatory properties, offers a new therapeutic opportunity for the treatment of ARDS. Methods In this retrospective cohort study, we examined the MIMIC-IV database for ARDS patients who received prophylactic heparin within the first 72 h of ICU admission. Employing propensity score matching and inverse probability weighting (IPW) analysis, we evaluated the impact of early heparin use on patient outcomes, focusing on mortality rates. Results Patients who received prophylactic heparin had a significantly lower in-hospital mortality rate compared to those who did not (13.55% vs 17.93%, HR = 0.71, 95% CI: 0.54–0.93, P = 0.012). This result remained significant after propensity score matching (12.75% vs 17.93%, HR = 0.65, 95% CI 0.47–0.90, P = 0.010). Analysis using five different statistical models indicated that early use of heparin significantly reduced the in-hospital mortality rate, with HR = 0.669 (95% CI 0.487–0.919, P = 0.013) in the doubly robust model without balanced covariates; HR = 0.705 (95% CI 0.515–0.965, P = 0.029) with all covariates considered; HR = 0.660 (95% CI 0.491–0.888, P = 0.006) in the propensity score (IPW) model; HR = 0.650 (95% CI 0.470–0.900, P = 0.010) in the propensity score matching model; and HR = 0.706 (95% CI 0.536–0.930, P = 0.013) in the multivariate Cox regression model. Secondary outcomes indicated that heparin use was also associated with reduced mortality rates at 60 days, and 90 days. Conclusion This research highlights that early prophylactic administration of heparin may substantially lower mortality in ARDS patients. These findings underscore the potential of heparin as a key component in the management of ARDS, offering a new perspective and novel strategies for clinical treatment.

Anna V. Jones, Alana Shunnarah, Andrew Gwaltney et al.

Abstract Background Achieving therapeutic doses of sedation and analgesia are necessary for the safety and comfort of mechanically ventilated patients. Patients with complicated psychiatric histories, are neurocritical, and have acute respiratory distress syndrome usually require maximum sedation, making sedation weaning an arduous task. Case Presentation A 42-year-old female presented with a chief complaint of headache, hypertensive crisis, confusion, and nausea. Her past medical history is notable for hypertension, attention deficit hyperactivity disorder, bipolar II disorder, manic depression, agoraphobia, anxiety, and prior suicide attempts. Noncompliance with anti-hypertensive and psychiatric medications and prior substance abuse history was reported. A head computerized tomography scan revealed multifocal intraparenchymal hemorrhages and multifocal subarachnoid hemorrhages throughout the cerebrum. Within two hours, the patient became obtunded and required intubation. The patient’s severe agitation, likely due to metabolic encephalopathy, was difficult to control. Despite being on maximum dexmedetomidine, fentanyl, and quetiapine doses, the patient’s agitation remained. Due to her substance abuse and psychiatric history, a methadone and clonidine taper was initiated to attempt sedation weaning. Conclusion Sedation and analgesia weaning protocols for patients with psychiatric or substance abuse histories may aid in decreasing time on mechanical ventilation and/or in the ICU. The successful clonidine and methadone taper utilized in this patient has potential to be utilized in patients with similar histories. Future trials and approved sedation and analgesia weaning protocols for patients with a profound psychiatric and substance abuse history are urgently needed.

Sedat Özbay, Hüseyin Aydın, İlhan Korkmaz et al.

Aim:Metabolic changes begin after the invasion of an infectious microorganism and continue to develop as a series of interrelated events. Arginine is important in infectious diseases due to lymphocyte proliferation, nitricoxide production by macrophages, and the use of polyamides in the immune response. In this study, we aimed to examine the possible causes and consequences of urea cycle amino acid metabolism changes by comparing plasma arginine and urea cycle amino acid levels in Coronavirus disease-2019 (COVID-19) patients.Materials and Methods:In this cross-sectional study, we evaluated the urea cycle and arginine metabolic changes and compared the plasma aminoacid levels of 35 COVID-19 patients and a healthy control group (n=35). The patient was diagnosed by reverse transcriptase-polymerase chain reaction of oropharyngeal-nasofaringeal swab specimens. For statistical analyzes, Mann-Whitney U and chi-square tests were used.Results:The aminoacid plasma levels of argininosuccinate (1.03 μmol/L, p=3.3x10-3), arginine (53.64 μmol/L, p=1.1x10-3), aspartic acid (3.83 μmol/L, p=5.5x10-9), citrulline (27.79 μmol/L, p=3.3x10-5), glutamine (489.6 μmol/L, p=9.0x10-17), lysine (206.4 μmol/L, p=5.8x10-8), ornithine (129.5 μmol/L, p=0.012), plasma levels and glutamine/glutamate (p=3.4x10-11), arg/ornithine (p=0.033), asp/argininosuccinate (p=0.011) ratios were decreased in the COVID-19 patient group compared to the healthy group.Conclusion:Arginine is significant in endothelial control, the urea cycle, and immune activation. Arginine deficiency in COVID-19 patients may cause disturbances in this biological process and its pathways. As indicated by many clinical trials, we believe that preventing a decrease in plasma arginine levels will prevent a poor prognosis of patients and metabolic pathway disturbances in the urea cycle.

Ahmed Essa, Graeme G. Flett

Chananta Phaken, Chatkhane Pearkao, Wiphawadee Potisopha et al.

Introduction: Multiple traumatic injuries cause death among traumatized patients. Nurses at the emergency department (ED) must assess, provide nursing care, and record their interventions. Recording all patient information and nursing care procedures, however, is more challenging due to time constraints in emergency care. Methods: The aim of this study was to evaluate the use of a web application for nursing records of multiple trauma patients in an ED and the user's satisfaction. A web application developed based on the guidelines of Advanced Trauma Life Support was implemented in a resuscitation room of a university hospital in Khon Kaen, Thailand, from January to March 2022. The quality of nursing records through the web application for 40 trauma patients was evaluated. Thirty-seven nurses were surveyed for their satisfaction. The data were analyzed using descriptive statistics. Results: Overall, the comprehensive nursing process record through web application had 80.3% completeness. Some items were not recorded or partially recorded, including vital sign monitoring and patients' vital signs and symptoms summary records before discharge. Nurses expressed their satisfaction with the web application at a high level, with an average score of 3.99 (standard deviation [SD]: 0.68). They were most satisfied with the components of the nursing process for multiple trauma patients (mean: 4.14 and SD: 0.71). Conclusions: The use of a web application ensures the completeness of nursing records. Nurses are satisfied with implementing the web application in their clinic. A study of its effectiveness in reducing documentation time and improving patient outcomes is needed in the future.

Hamid Ilyas, Muhammad Abd Ur Rehman, Hina Akram

Abstract Vascular injuries are one of the most feared complications of orthopedic emergencies such as fractures and dislocations. The proximity of neurovascular structures to most of the long bones and major joints makes them more vulnerable to injury. A proper and repeated clinical examination is always advised for early diagnosis and prompt management of these complications in the emergency department. We present a case of delayed extensive thrombosis of upper limb arteries, one of the rare complications of closed posterior elbow dislocation managed by surgical thrombectomy.

Shadi Bsat, Adham Halaoui, Firas Kobeissy et al.

Stroke is considered as the first cause of neurological dysfunction and second cause of death worldwide. Recombinant tissue plasminogen activator is the only chemical treatment for ischemic stroke approved by the US Food and Drug Administration. It was the only standard of care for a long time with a very narrow therapeutic window, which usually ranges from 3 to 4.5 h of stroke onset; until 2015, when multiple trials demonstrated the benefit of mechanical thrombectomy during the first 6 h. In addition, recent trials showed that mechanical thrombectomy can be beneficial up to 24 h if the patients meet certain criteria including the presence of magnetic resonance imaging/computed tomography perfusion mismatch, which allows better selectivity and higher recruitment of eligible stroke patients. However, magnetic resonance imaging/computed tomography perfusion is not available in all stroke centers. Hence, physicians need other easy and available diagnostic tools to select stroke patients eligible for mechanical thrombectomy. Moreover, stroke management is still challenging for physicians, particularly those dealing with patients with “wake‐up” stroke. The resulting brain tissue damage of ischemic stroke and the subsequent pathological processes are mediated by multiple molecular pathways that are modulated by inflammatory markers and post‐transcriptional activity. A considerable number of published works suggest the role of inflammatory and cardiac brain‐derived biomarkers (serum matrix metalloproteinase, thioredoxin, neuronal and glial markers, and troponin proteins) as well as different biomarkers including the emerging roles of microRNAs. In this review, we assess the accumulating evidence regarding the current status of acute ischemic stroke diagnostic biomarkers that could guide physicians for better management of stroke patients. Our review could give an insight into the roles of the different emerging markers and microRNAs that can be of high diagnostic value in patients with stroke. In fact, the field of stroke research, similar to the field of traumatic brain injury, is in immense need for novel biomarkers that can stratify diagnosis, prognosis, and therapy.

Avanti Adhia, Vivian H. Lyons, Hannah Cohen-Cline et al.

Abstract Background This study assessed whether several adult life experiences, including loss of support, loss of food security, loss of housing, and substance use cessation, are associated with change in domestic violence (DV) perpetration from early to later adulthood. Using 2015 to 2016 cross-sectional, self-report survey data from Medicaid enrollees in Oregon (N = 1620), we assessed change in DV perpetration from early adulthood (19–30 years) to later adulthood (≥ 31 years of age), cut points determined by existing survey questions. Multinomial logistic regression models were constructed to estimate the association between life experiences and physical DV perpetration using odds ratios (OR), adjusting for sociodemographic characteristics, DV victimization, and childhood abuse, bullying, and social support. Findings Of the 20% of participants who perpetrated DV, 36% perpetrated DV in both early and later adulthood (persisters), 42% discontinued (desisters) and 22% began (late-onsetters) perpetration in later adulthood. Loss of support and loss of food security were both associated with change in DV perpetration (i.e., desistance or late onset of perpetration or both). Loss of support was associated with 9.5 times higher odds of being a desister (OR = 9.5, 95% CI = 1.1, 84.1) and 54.2 times higher odds of being a late-onsetter (OR = 54.2, 95% CI = 6.5, 450.8) of DV perpetration compared to persisters. Loss of food security was associated with 10.3 times higher odds of being a late-onsetter (OR = 10.3, 95% CI = 1.9, 55.4) of DV perpetration compared to persisters. In addition, substance use cessation was associated with 10.3 times higher odds of being a desister (OR = 10.3, 95% CI = 1.9, 56.2) compared to persisters. Conclusions Findings suggest that specific life experiences in adulthood, including loss of support, loss of food security, and substance use cessation, are associated with changes in DV perpetration.

Roganović Nikolina S., Živanović Slavoljub R.

Introduction: Lumbar pain is experienced by 80% of people during their lifetime. The most common type of back pain is nonspecific lower back pain, which accounts for approximately 95% of primary health care cases. In approximately 95% of cases, the cause of the pain is unknown even after complete diagnostic tests have been performed. Recurrences are common but complete recovery is usually expected. Most patients with acute lumbar pain are treated by a primary care physician who should inform the patient about the benign nature of the disease and a good prognosis. Objectives: The scope of study was to show the extent to which, in the outpatient clinic of the Institute for Emergency Medical Services Belgrade, we adhere to our current domestic guidelines for good clinical practice and foreign recommendations in the treatment of patients diagnosed with lumbar syndrome. Methodology: The research is a retrospective analysis of electronic medical records from the Institute for EMS Belgrade in the period from January 1, 2017 to December 31, 2018 on 17607 patients. We analyzed the data from our electronic database developed in Microsoft ACCESS. Only patients with one of the diagnoses from the spectrum of lumbar pain syndrome were selected for the study. Results: Results: 246 or 1.4% of patients with a diagnosis of lumbar pain syndrome were found. They were predominantly male patients, ages 19-81. Out of 125 patients with on which Lasègue test performed, 73 were negative and 52 were positive. The given therapy was NSAIDs, most often Diclofenac 93.9%, corticosteroids 47.55% and Diazepam 28.45%, metamizole corticosteroids, given mostly parenterally. Conclusion: In our ambulatory clinic LBP is most often treated with NSAIDs and corticosteroids given parenterally. In most cases, the recommendations from current domestic guidelines for good clinical practice and foreign recommendations are not followed in the treatment of this type of patients.

Mónica González

F. Vincent, M. Soares, D. Mokart et al.

ObjectivesTo assess outcomes at hospital discharge and day-120 after intensive care unit (ICU) discharge among patients with solid cancer admitted to ICU and to identify characteristics associated with in-hospital and day-120 after ICU discharge mortalities.DesignInternational, multicenter, retrospective study.SettingFive ICUs in France and Brazil, two located in cancer centers, two in university affiliated and one in general hospitals.PatientsConsecutive patients aged > 18 years, with underlying solid cancers (known before admission to the ICU or diagnosed during the stay in the ICU), admitted to the participating ICUs and discharged alive from the ICU from January 2006 to December 2011 were included in this study. Patients admitted after scheduled surgery or to secure procedure were excluded. Variables of interest were in-hospital and day-120 post-ICU mortality among patients discharged alive from the ICU.InterventionsNone.Measurements and resultsA total of 1053 patients aged 63 years (54–71) (median [IQR]) were included. Most of the patients were of the male gender (66.8%). The in-ICU, in-hospital, and four-month post-ICU discharge mortalities were, respectively, 41.3, 60.7, and 65.8%. Among patients discharged alive from the ICU, in multivariate analysis, factors associated with four months post-ICU discharge mortality were type of cancer (OR from 0.25 to 0.52 when compared to lung cancers), systemic extension of the disease (OR 2.54; 95% CI 1.87–3.45), need for invasive mechanical ventilation (OR 2.54; 95% CI 1.80–3.59), for vasopressors (OR 2.35; 95% CI 1.66–3.29), or renal replacement therapy (OR 1.54; 95% CI 0.99–2.38). A predictive score, “Oncoscore,” was built performing fairly in predicting 4 months post-ICU discharge outcome (AUC 0.74; 95% CI 0.71–0.77).ConclusionDespite the high day-120 mortality following the ICU discharge, our study reports a meaningful medium-term survival rate after the ICU discharge of solid cancer patients. Of utmost importance, the “Oncoscore” must be validated in prospective studies and cannot be used, in its form without external validation, for individual decision making. Prospective studies to answer questions not provided by this study are needed, including only patients with solid cancers admitted in the ICU for medical reasons or after emergency surgery.

Gloria-Beatrice Wintermann, Katja Petrowski, Kerstin Weidner et al.

Abstract Background Survivors of an acute critical illness with continuing organ dysfunction and uncontrolled inflammatory responses are prone to become chronically critically ill. As mental sequelae, a post-traumatic stress disorder and an associated decrease in the health-related quality of life (QoL) may occur, not only in the patients but also in their partners. Currently, research on long-term mental distress in chronically critically ill patient-partner dyads, using appropriate dyadic analysis strategies (patients and partners being measured and linked on the same variables) and controlling for contextual factors, is lacking. Methods The present study investigates the interdependence of post-traumatic stress symptoms (PTSS) and the health-related QoL in n = 70 dyads of chronically critically ill patients and their partners, using the Actor-Partner-Interdependence Model (APIM) under consideration of contextual factors (age, gender, length of partnership). The Post-traumatic Stress Scale (PTSS-10) and Euro-Quality of Life (EQ-5D-3L) were applied in both the patients and their partners, within up to 6 months after the transfer from acute care ICU to post-acute ICU. Results Clinically relevant post-traumatic stress symptoms were reported by 17.1% of the patients and 18.6% of the partners. Both the chronically critically ill patients and their partners with more severe post-traumatic stress symptoms also showed a decreased health-related QoL. The latter was more pronounced in male partners compared to female partners or female patients. In younger partners (≤ 57 years), higher values of post-traumatic stress symptoms were associated with a decreased QoL in the patients. Conclusions Mental health screening and psychotherapeutic treatment options should be offered to both the chronically critically ill patients and their partners. Future research is required to address the special needs of younger patient-partner dyads, following protracted ICU treatment. Trial registration German Clinical Trials Register No. DRKS00003386. Registered 13 November 2011

G. A. Boyarinov, I. S. Simutis, V. O. Nikolsky et al.

Purpose. To evaluate the role of ozonized erythrocytic mass transfusion in the restoration of damages in the architectonics of myocardium microvasculature and cardiomyocytes in case of a severe blood loss.Materials and Methods. Two batches of experiments were conducted, 17 white outbred rats in each. The animals were anesthetized with thiopental sodium (25 mg/kg). Blood loss was caused by taking 3ml of blood from the tail artery of rats, which is 35% of the circulating blood volume. One hour after the blood loss, transfusion of autoerythrocytes with normal saline solution and Ringer’s solution infusion in 1:1 ratio was performed in the control batch. In the experimental batch, 3 ml of autoerythrocytes treated with ozonized saline solution with ozone concentration of 2 mg/l and 3 ml of Ringer’s solution (1:1 ratio) were administered to rats. Erythrocyte mass was prepared from 3 ml of the autoblood harvested from the animals 3 days before the experiment. On a post-transfusion day5, in both batches and in five intact animals, hearts were removed following the intraperitoneal thiopental sodium injection (100 mg/kg). The left ventricle wall specimen from each heart was removed for examination. Histologic sections were stained with hematoxylin and eosin. The preparations were visually examined and morphometric studies were performed using microvisor Vizo-103.Results. It has been established that administration of ozonized erythrocyte for severe blood loss correction limited the decrease in numbers of capillary profiles and their diameters, formation of mixed and hyaline thrombi fully or partially occluding microvascular lumens, major hemorrhages and reduction of variation of nuclear profiles, decreased perivascular, pericellular, perinuclear, and endonuclear edema of myocardial tissue, cardiomyocyte overcontruction zone, and their ruptures.Conclusion. The positive trends for microcirculation indices, vascularization density and myocardial edematization as prognostic markers in assessing potential posthypoxic rehabilitation of damaged tissues upon blood loss correction with ozonized erythrocyte mass might be explained by the antihypoxic, antioxidant, and detoxifying actions of ozone on erythrocytes and/or its metabolites (ozonides) in the body post-transfusion.