Hypertensive Episodes Research Articles

Comparison of Adductor Canal Block Before Versus After Total Knee Arthroplasty in Terms of Pain, Stress, and Functional Outcomes: A Double-Blinded Randomized Controlled Trial.

Whether an adductor canal block (ACB) is more effective when administered before or after total knee arthroplasty (TKA) is unclear. This study compared pain, stress, and functional outcomes between patients who received the block before surgery and those who received the block after surgery. In this double-blinded trial, 100 patients at our hospital were randomized to receive an ACB at either 30 minutes before general anesthesia or postoperatively in the post-anesthesia care unit (PACU). All patients received periarticular local infiltration analgesia during surgery. The 2 groups were compared with respect to the primary outcome, the postoperative consumption of morphine as rescue analgesia, and in terms of the secondary outcomes, including the time from the end of surgery to the first rescue analgesia or discharge, intraoperative and postoperative stress, postoperative pain, functional recovery, the incidence of chronic pain, and complications. All included patients were Asian (Chinese) in race/ethnicity. The 2 groups had similar demographic information. Compared with the postoperative ACB, the preoperative ACB was associated with significantly lower morphine consumption within the first 24 hours postoperatively and lower total morphine consumption. It was also associated with a longer time until the first rescue analgesia, lower intraoperative consumption of opioids and inhaled anesthetic, fewer episodes of hypertension during surgery, a lower rate of rescue analgesia in the PACU, lower levels of cortisol and adrenocorticotropic hormone in serum on the morning of postoperative day 1, lower pain on a visual analog scale while at rest or during motion within 12 hours postoperatively, better range of knee motion on postoperative day 1, and a lower incidence of chronic pain at 3 months postoperatively. The 2 groups did not differ significantly with respect to postoperative ambulation distance, time until discharge, or complication rates. Administering an ACB before rather than after TKA may lead to lower opioid consumption during hospitalization, lower intraoperative and postoperative stress responses, better pain relief during hospitalization, and a lower incidence of chronic pain at 3 months postoperatively. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

P-126. Host Factors Associated with Failure of Fecal Microbiota Transplant for Recurrent Clostridioides difficile Infection: 10- Year Real World Experience in a Dedicated C. difficile Clinic

Abstract Background Clostridioides difficile infection (CDI) continues to be an antibiotic-associated infection of urgent concern. Fecal microbiota transplantation (FMT) is the most effective treatment of recurrent CDI (rCDI). Despite high success rates, FMT has proven to be ineffective in 5-20% of cases. Factors associated with failure have not been clearly defined. We seek to better understand factors predictive of failure in patients who have undergone FMT. Failure Rate by Comorbidity Methods A retrospective chart review was conducted on adult patients who were screened at the Complicated C. difficile Clinic at the University of Virginia Health System and received FMT for rCDI between 2013 and 2022. Electronic medical records were thoroughly reviewed to collect data on demographics, comorbidities, CDI history, laboratory values prior to FMT, and performance after FMT. Primary outcome was failure of FMT, defined as either rCDI or death within one year. Failure Rate by Lab Values Results 240 patients with rCDI were treated with FMT: 70.4% were female, median age was 68 (range: 20 to 96), and median episodes of CDI was 4 (range: 1 to 25). Within one year, 24.6% of patients experienced failure: 18.3% of patients experienced rCDI and 7.1% died. Univariate analysis showed that older age (≥70), male sex, ≥4 episodes of CDI, hypertension, diabetes mellitus, malignancy, elevated TSH, anemia, and low zinc were linked to failure. Older age, ≥4 episodes of CDI, hypertension, and elevated TSH were also associated with recurrence. Male sex, diabetes mellitus, elevated TSH, anemia, and low zinc were associated with death. Multivariate analysis showed that older age, ≥4 episodes of CDI, and diabetes mellitus were linked to failure while older age and ≥4 episodes of CDI were linked to recurrence. Failure Rate by Number of C. difficile Infections Conclusion FMT continues to hold up as an effective treatment for rCDI. At one year follow-up, about 1 in 4 patients who underwent FMT at our institution experienced failure. Older age, ≥4 episodes of CDI, elevated TSH, anemia, and low zinc appear to be associated with failure, but additional research is needed to clearly define causality. Our results underscore the importance of recognizing factors that can predict failure and be targeted to further improve outcomes of FMT. Failure Rate by Sex Disclosures Jae Hyun Shin, MD, Ferring: Grant/Research Support Cirle A. Warren, MD, Ferring Pharmaceuticals: Site PI for ROAR

The Combination Usage of Dexamethasone and Prednisolone Versus Prednisolone Monotherapy for Inflammation and Intraocular Pressure After Cataract Surgery.

Purpose The purpose of this study is to survey the anti-inflammatory effect of combined preoperative dexamethasone and postoperative prednisolone therapy and postoperative prednisolone therapy for cataract surgery. The intraocular pressure (IOP) change between groups was also examined. Methods A retrospective cohort study was practiced, and individuals who received cataract surgery were enrolled and categorized according to the anti-inflammation therapy. A total of 62 and 108 eyes were included in the combined and single groups, respectively. The primary outcomes were ocular hypertension and anterior chamber (AC) inflammation. The independent t-test and generalized linear model were used for the statistical analysis. Results There were 12 and 16 episodes of ocular hypertension in the combined and single groups, and the incidence of ocular hypertension was similar between groups (P = 0.203). In addition, there were four and seven AC inflammation events in the combined and single groups, and the incidences of AC inflammation were similar between groups (P = 0.335). Old age was correlated to a higher risk of developing ocular hypertension in the combined and single groups (both P < 0.05). Besides, higher myopia is related to higher ocular hypertension risk in the combined group (P = 0.038). Preoperative dry eye disease (DED) was associated with higher AC inflammation risk in the combined and single groups (both P < 0.05). Also, the high myopia was related to higher AC inflammation risk in the two groups (both P < 0.05). Conclusion The combination therapy of dexamethasone and prednisolone showed similar anti-inflammatory effects. The IOP changes between groups were similar.

Postpartum furosemide for accelerating recovery in patients with preeclampsia: A Randomized Placebo-Controlled Trial: Furosemide for postpartum hypertension.

Preeclampsia is a major hypertensive disorder of pregnancy, which may lead to severe complications, particularly in the first two weeks of the postpartum period. During the postpartum period, blood pressure levels remain high, often increasing to levels higher than those experienced during pregnancy. Furosemide, a fast-acting diuretic, reduces the intravascular volume overload and may represent an alternative to accelerate the normalization of blood pressure levels. To evaluate the effectiveness of furosemide compared to placebo for blood pressure control in the postpartum period in women with severe preeclampsia. In a triple-masked placebo-controlled randomized clinical trial, women in the postpartum period with de novo preeclampsia with severe features or eclampsia diagnosed during pregnancy and adequate diuresis, who had received magnesium sulfate, were randomized to receive furosemide (40 mg/day orally for five days) or placebo. The primary outcomes were mean blood pressure levels. Secondary outcomes were: frequency of severe hypertensive episodes, a continued need for antihypertensives, number of antihypertensives used to control blood pressure, length of hospital stay, adverse effects and maternal complications. A sample size of 120 patients was estimated, 60 in each arm of the study, based on the estimated difference between the mean systolic pressure of 142±12mmHg for the furosemide group and 153±19mmHg for the placebo group. Between June 20 and November 30, 2014, 271 women were screened and 120 were randomized to furosemide or placebo, with 118 being included in the final analysis (58 in the furosemide group and 60 in the placebo group). Most characteristics were similar in both groups. Mean daily systolic and diastolic pressure was lower in the furosemide group (P<0.001) and there were fewer episodes of severe hypertension on the second (P=0.04) and fifth (P=0.04) days. In addition, shorter time was required until blood pressure was controlled (P=0.01) in the furosemide group. Compared to placebo, 40 mg/day of oral furosemide in patients with preeclampsia in the postpartum period reduced mean daily systolic blood pressure in 1st and 5th days and mean daily diastolic blood pressure in 1st, 2nd and 5th days and the time required until blood pressure is controlled.

Cerebral compliance assessment from intracranial pressure waveform analysis: Is a positional shift-related increase in intracranial pressure predictable?

Real-time monitoring of intracranial pressure (ICP) is a routine part of neurocritical care in the management of brain injury. While mainly used to detect episodes of intracranial hypertension, the ICP signal is also indicative of the volume-pressure relationship within the cerebrospinal system, often referred to as intracranial compliance (ICC). Several ICP signal descriptors have been proposed in the literature as surrogates of ICC, but the possibilities of combining these are still unexplored. In the present study, a rapid ICC assessment consisting of a 30-degree postural shift was performed on a cohort of 54 brain-injured patients. 73 ICP signal features were calculated over the 20 minutes prior to the ICC test. After a selection step, different combinations of these features were provided as inputs to classification models. The goal was to predict the level of induced ICP elevation, which was categorized into three classes: less than 7 mmHg ("good ICC"), between 7 and 10 mmHg ("medium ICC"), and more than 10 mmHg ("poor ICC"). A logistic regression model fed with a combination of 5 ICP signal features discriminated the "poor ICC" class with an area under the receiving operator curve (AUROC) of 0.80 (95%-CI: [0.73-0.87]). The overall one-versus-one classification task was achieved with an averaged AUROC of 0.72 (95%-CI: [0.61-0.83]). Adding more features to the input set and/or using nonlinear machine learning algorithms did not significantly improve classification performance. This study highlights the potential value of analyzing the ICP signal independently to extract information about ICC status. At the patient's bedside, such univariate signal analysis could be implemented without dependence on a specific setup.

Efficacy and Safety of Mydriatic Microdrops for Retinopathy of Prematurity Screening

Commercial mydriatics administered in preterm infants during retinopathy of prematurity (ROP) screening have been associated with various cardiorespiratory and gastrointestinal adverse events. To examine whether microdrops of a combined mixture of 1.67% phenylephrine and 0.33% tropicamide are noninferior to standard drops regarding mydriatic efficacy at 45, 90, and 120 minutes. The occurrence of systemic adverse events and systemic absorption of phenylephrine eyedrops were additional secondary outcomes. This randomized clinical trial with a double-masked, noninferiority, crossover design included infants undergoing ROP screening at a tertiary center in Northern Greece from September 2021 to January 2023. Eligible participants were infants with gestational age below 32 weeks and/or birthweight under 1501 g, or infants beyond these thresholds referred by an attending neonatologist due to comorbidities. Either microdrops or standard drops of the diluted mixture were administered at a random allocation sequence with a 1-week washout period. The horizontal pupil diameter at 45, 90, and 120 minutes was measured using a customized ruler in 0.5-mm increments. Mixed-effects linear regression models were developed, and the confidence interval (CI) approach was used for assessing noninferiority. The predefined noninferiority margin was -0.4 mm. Heart rate; oxygen saturation; blood pressure measurements at 45, 90, and 120 minutes; 24-hour hypertensive episodes; and 48-hour systemic adverse events were assessed. Phenylephrine concentration in peripheral blood within 3 hours postinstillation was measured using hydrophilic liquid chromatography-tandem mass spectrometry. Pooled pharmacokinetic parameters were calculated based on a developed mathematical model. A total of 83 infants were randomized (mean [SD] gestational age, 29.7 [2.0] weeks; mean [SD] birth weight, 1277 [374] g). Microdrops proved to be superior regarding mydriatic efficacy at 45 minutes (mean difference, 0.12; Bonferroni-corrected 95% CI, 0.01 to 0.23; P = .008) and noninferior at 90 minutes (Bonferroni-corrected 95% CI, -0.10 to 0.17) and 120 minutes (Bonferroni-corrected 95% CI, -0.18 to 0.14). Lower levels of oxygen saturation at 45 minutes (mean difference, 0.66; 95% CI, 0.09 to 1.24; P = .03) and 90 minutes (mean difference, 0.58; 95% CI, 0.03 to 1.14; P = .04) and higher percentage of 24-hour hypertensive episodes (median [IQR] percentage of hypertensive episodes: microdrops, 0.10% [0.02%-0.19%] vs standard drops, 0.14% [0.06%-0.40%]; P = .01) were observed after standard drops. A 1-compartment model with first-order absorption best described the pharmacokinetic data. To our knowledge, this is the first study establishing noninferiority of microdrops compared with standard drops of a diluted mydriatic mixture, showing reduced systemic adverse events after microdrops and determining the pharmacokinetic profile of phenylephrine eyedrops in preterm infants. ClinicalTrials.gov Identifier: NCT05043077.

Una paralisi del nervo facciale che ricorre

The paper describes the case of a 16-month-old girl with suspected neurofibromatosis I who was evaluated for recurrent episodes of peripheral facial nerve palsy and severe hypertension (160/110 mmHg). Tests revealed bilateral renal artery stenosis, treated with stenting and antihypertensive therapy. The case highlights that recurrent facial nerve palsy warrants detailed investigations, including blood pressure monitoring, as hypertension can be an underlying cause.

RISK FACTORS FOR EXTENSIVE HEMATOMAS AFTER RHYTIDECTOMY

Summary. Objective. To assess the main risk factors for the development of extensive hematoma following rhytidectomy and to establish a risk group based on the obtained data. Materials. A retrospective analysis of 410 inpatient medical records was conducted for patients who underwent rhytidectomy for involutional changes in the face and neck. All patients were examined by a therapist or cardiologist before surgery. Deep-rhytidectomy was performed in 121 patients, SMAS-rhytidectomy in 157, and 132 rhytidectomy were supplemented with additional procedures. Results. Extensive facial hematomas following aesthetic procedures were observed in 37 patients (9.02%). The main risk factors included age over 46 years (OR 1.78 [1.06-2.98], p=0.037), high body mass index (OR 1.92 [1.16-3.19], p=0.015), elevated systolic blood pressure (OR 2.14 [1.26-3.63], p=0.006), and diabetes mellitus (OR 2.99 [1.56- 5.73], p=0.001). Younger age, gender, smoking, alcohol use, and lung pathology were not significant risk factors. Conclusion. During the planning phase for surgical correction of involutional facial changes, a risk group for the development of extensive postoperative hematomas should be identified. This group includes patients over 46 years old, with a high body mass index (over 25.0), arterial hypertension (episodes of elevated systolic blood pressure), other cardiovascular pathologies, or diabetes mellitus.

Caring for Patients With Pheochromocytomas in the Perioperative Setting: Earn 1.4 Contact Hours.

Pheochromocytomas are rare, complex catecholamine-secreting tumors of the adrenal medulla. Patients with pheochromocytomas may experience episodes of life-threatening hypertension, and untreated tumors can be fatal. The nonspecific signs and symptoms (eg, headaches, palpitations, sweating) make diagnosing these tumors difficult. A comprehensive patient history, clinical evaluation during episodic hypertension, and biochemical test results can facilitate a definitive diagnosis. The only curative treatment is minimally invasive tumor removal. Because the tumor may recur, patients require follow-up visits for approximately 10years after surgery. Preoperative evaluations can include cardiac and imaging studies and genetic testing. Preoperative preparation involves controlling hypertension and planning for hypotension after tumor removal. Perioperative nurses should be prepared to assist anesthesia professionals with placing invasive hemodynamic monitors and responding to blood pressure changes. An interdisciplinary team can create a guideline or protocol for nurses to follow to enhance outcomes when caring for patients with pheochromocytomas.

Hypotension with and Without Hypertensive Episodes During Endoscopic Adrenalectomy for Pheochromocytoma or Paraganglioma-Should Perioperative Treatment Be Individualized?

Background: Hemodynamic instability is common during adrenalectomy for pheochromocytoma and paraganglioma (PPGL). Most analyses focus on the risk factors for intraoperative hypertension, but hypotension is a frequent and undesirable phenomenon during PPGL surgery. This study aimed to analyze the risk factors for hypotensive episodes during the removal of PPGL, and whether these episodes are always associated with concomitant intraoperative hypertensive events. Methods: A consecutive series of 121 patients (91.7% receiving preoperative alpha-blockade) treated with transperitoneal endoscopic adrenalectomy at a university hospital were analyzed, and pre- and intraoperative risk factors for intraoperative hypotension with or without intraoperative hypertension were analyzed using univariable and multivariable logistic regression analyses. Results: In total, 58 (56.2%) patients presented with intraoperative hypotension. Of these, 25 (20.7%) patients showed only hypotensive episodes but no hypertensive episodes (group 1), and 43 (35.5%) patients had both intraoperative hypotension and hypertension (group 2). The remaining 53 patients did not present with hypotension at all (group 3). When comparing group 1 (hypotension only) to all other patients with incidental diagnosis, higher age and lower preoperative diastolic arterial blood pressure (ABP) were significant risk factors for intraoperative hypotension; only the latter two were still significant in multivariate analysis. The significant risk factors for hypotension independent of hypertension (group 1 + 2 vs. group 3) were age and incidental diagnosis, pre-existing diabetes mellitus, and intraoperative use of remifentanil. Incidental diagnosis and use of remifentanil reached the level of significance in multivariate analysis. Conclusions: Since older age, incidental diagnosis of PPGL, lower preoperative ABP, and diabetes mellitus are risk factors for intraoperative hypotension, preoperative alpha-blocker treatment should be individualized for those at risk for hypotension. In addition, remifentanil should be used cautiously in the risk group.

Effect of remimazolam besylate versus propofol on haemodynamic profiles in patients undergoing thyroid surgery with recurrent laryngeal nerve monitoring: a protocol for a randomised controlled trial

IntroductionThyroid surgery with intraoperative nerve monitoring under total intravenous anaesthesia often requires deeper sedation due to limitations or lack of neuromuscular blocking agents, usually resulting in haemodynamic instability. Remimazolam, a...

Effect of Prednisone Dosing on Mineralocorticoid-Related Side Effects With Abiraterone in Prostate Cancer.

Abiraterone use for prostate cancer can cause mineralocorticoid excess syndrome (MES; eg, hypertension and hypokalemia). Prednisone mitigates these effects; however, the optimal dose level is unclear. This study examines MES effects from abiraterone with 5 mg of prednisone once daily versus 5 mg twice daily. Data for 1,410 abiraterone-treated patients from 2011 to 2022 were identified from a large academic/community hospital system. Three hundred and fifty-three patients were excluded for missing medication data and use of an alternative steroid; 1,057 patients remained (5 mg once daily, n = 550, 5 mg twice daily, n = 507). Prednisone dose was treated as a time-varying covariate. Hypokalemia and hypertension incidence over 24 weeks after abiraterone initiation was analyzed via Cox proportional hazard models using Common Terminology Criteria for Adverse Events (v5.0) grading via direct clinical measurements and International Classification of Diseases (ICD)-10 code outcomes. Patients receiving 5 mg of prednisone twice daily had a statistically significant decrease in cumulative hazard for experiencing at least one MES event (hypertension and/or hypokalemia) via direct clinical measurement (hazard ratio [HR], 0.79 [CI, 0.68 to 0.91]; P = .002) and by ICD-10 code (HR, 0.65 [CI, 0.54 to 0.79]; P < .001) analysis. This finding was durable with individual end point analysis of hypertension and hypokalemia. There were no changes to BMI or hyperglycemia (>140 mg/dL) between the cohorts. This retrospective analysis shows a decrease in risk for the development of at least one episode of hypertension or hypokalemia with abiraterone using 5 mg twice-daily prednisone in the study population. Assessments of metabolic impacts (BMI, hyperglycemia) did not show differences with prednisone dosing. These findings may merit consideration when determining an optimal prednisone dosing regimen.

7206 Perioperative Management of Pheochromocytoma: The Mayo Clinic Florida Experience

Abstract Disclosure: A. Verma: None. F. Elli: None. S. Rao: None. M. Smith: None. A. Shapiro: None. C. Moshe: None. R. Chadha: None. Introduction: Pheochromocytomas are rare, neuroendocrine tumors derived from chromaffin cells of the neural crest, typically within the adrenal medulla. The pathophysiologic effect of primary concern is the uncontrolled release of catecholamines into the bloodstream, which carry risk for episodic hypertension, palpitations, and life-threatening crises. Preoperative preparation with drugs that block adrenergic receptors is utilized to improve hemodynamic oscillation force and surgical outcomes. Widely used premedication include alpha-blockers, beta-blockers, and calcium channel blockers. Despite adequate pretreatment, hemodynamic instability continues to evoke massive risk. The objective of this study was to assess the incidence of intraoperative hypertensive episodes in patients undergoing robotic assisted laparoscopic adrenalectomy. Methods: This study is an observational retrospective analysis of patients who underwent elective laparoscopic robotic-assisted adrenalectomies from February 2019 to April 2023. 17 patients total patients were included. Preoperative information included age, BMI, ASA physical classification, preoperative blockade regiment, and urine metanephrines. Intraoperative information included operation duration, tumor size, intraoperative anti-hypertensives, and hypertensive spikes defined as a SBP greater than 175 mmHg for 5 consecutive minutes. Data analysis was performed to obtain frequency counts (%), means (standard deviations), and median (range) as appropriate. Results: The mean age at the time of surgery was 57.12 ± 17.2 years. The majority of patients (76%) were ASA status class III. 7 of the 17 patients did not have active pheochromocytoma based on symptomatology, the incidental diagnoses being made by imaging and workup. The average tumor diameter was 3.90 ± 1.8, with a range of 2.0 - 8.0. Mean operative time was 153.76 ± 53.9 minutes. Preoperative urinary metanephrines were observed to have a mean of 1,248.44 ± 2,866.9 pg/mL. In terms of preoperative preparation, 65% of patients received Doxazosin, and 29% of patients received an alternative anti-hypertensive. Yet, 64.7% of patients were found to have at least 1 intraoperative hypertensive spike Conclusion: Despite premedication with anti-hypertensives, a significant percentage of patients experienced intraoperative hemodynamic instability. This emphasizes the importance of anesthesiologist preparation for intraoperative hypertension management to aggressively prevent hypertensive crises. In addition, it questions the routine use of alpha blockade for all cases preoperatively as has been suggested in certain studies, and whether or not it should be driven by other patient characteristics. Presentation: 6/1/2024

Erector Spinae Plane Block Combined with Continuous Dexmedetomidine and Lidocaine Infusions as an Opioid-Free Anesthesia in Posterior Spinal Fusion Surgery

Abstract Background Lumbar spine surgery is a common type of orthopedic surgery and mostly elective in nature. Conventional spine surgeries (non-minimally invasive) often involve extensive dissection of subcutaneous tissues, bones, and ligaments, laminectomies, discectomies, and instrumentations thus result in a considerable degree of postoperative pain, that can hinder the postoperative recovery, and it includes a high risk of persistent postsurgical pain, with a frequency ranging from 20 % to 40%. Aim of the Work We aim to assess intraoperative variation of heart rate (HR) and systolic blood pressure (SBP) as a monitor to guide the antinociceptive component of OFA and if it can provide adequate hemodynamic control and stability during the perioperative period with the impact on patient satisfaction. Patients and Methods This interventional, randomized and double–blinded controlled trial study was conducted in the institute Hospitals, Ain Shams University Hospitals from 1 February, 2023 to 31 July, 2023. The purpose of the study was clarified to all patients in full detail, along with details of the anaesthesia technique to be used by both the surgeon and anaesthetist. Moreover, informed consent was signed by all patients who were scheduled for lumbar spine procedures on any levels between L1 and L5. Subjects were eliminated from the study if they refused to participate, were unable to evaluate their level of pain or had an allergy to the study drugs. Results Our results indicate that there were no significant differences in SBP and episodes of hypertension between the two groups during various stages of the surgical procedure. However, HR values showed less fluctuations in OFA group starting from after skin incision and throughout different stages of the surgery. Our population who are at high risk of postoperative nausea and vomiting due to previous opioid use on chronic back pain. In our study, incidence of PONV in group OFA was lower than that of in group OA in a period of 24h after surgery (5.7%, 15.7%). Conclusion Compared to OA technique, OFA technique, which is represented by non-opioid drugs, lidocaine and dexmedetomidine, may be an alternative anesthesia in patients undergoing posterior lumbar spine fusion surgery. With its non-inferiority of analgesic effect, safe anesthesia, and lower incidence of intraoperative hemodynamics fluctuations and PONV.

Vinblastine-Induced Posterior Reversible Encephalopathy Syndrome in Pediatric Hodgkin Lymphoma

AbstractPosterior reversible encephalopathy syndrome (PRES) is a critical care scenario seen with several etiologies. We report a pediatric case of Hodgkin lymphoma presenting with paraneoplastic features of nephrotic syndrome (NS). Diagnosis was confirmed with positron emission tomography-computed tomography scan and immunohistochemistry of the tissue biopsy. Remission for NS was achieved within a week of starting chemotherapy (ABVD–adriamycin, bleomycin, vinblastine, and dacarbazine). After the second cycle, he developed headache, seizures, and hypertension, requiring intensive care management. Magnetic resonance imaging brain was suggestive of PRES. The condition was managed with antihypertensives, antiepileptics, and supportive care. Considering all the risk factors for PRES including the drug, vinblastine, further chemotherapy was administered with only ABD regimen. The child attained complete remission after six cycles of chemotherapy and did not have any further episodes of hypertension or seizures. This case highlights the rare complication of vinblastine in a complicated lymphoid malignancy.

The effect of the immune response to SARS-CoV-2 S protein on angiotensin II levels in rats

Autoantibodies against key molecules of the renin-angiotensin system (RAS) are found in some patients infected with SARS-CoV-2. These autoantibodies include antibodies against angiotensin II and angiotensin converting enzyme 2 (ACE2). The presence of antibodies to the RAS-related molecules is associated with episodes of hypotension or hypertension. The aim of this work was to study the effect of antibodies to SARS-CoV-2 S protein and autoantibodies to ACE2 on angiotensin II levels in a model of induced multiple organ damage caused in rats by immunization with SARS-CoV-2 S protein. The effect of pre-existing autoimmune encephalomyelitis on change in angiotensin II level caused by immunization with S protein is also was studied. Wistar rats were immunized with S protein of SARS-CoV-2 emulsified in incomplete Freund’s adjuvant (IFA). At the time of injection of S protein 6 of the rats were intact (S group), in 4 of the rat experimental autoimmune encephalomyelitis was previously induced by immunization with guinea pig myelin basic protein (EAE + S group). The control group of rats was injected with IFA. Antibodies to S protein, autoantibodies to ACE2, and angiotensin II level were determined in blood plasma by enzyme linked immunosorbent assay. It was found that immunization with S protein leads to a transient decrease in the blood level of angiotensin II. The blood angiotensin II level was lower than normal in 3 out of 6 rats (50%) in group S, and in 3 out of 4 (75%) in the EAE + S group at week 6 after immunization. The decrease in angiotensin II level was significant in the EAE + S group relative to the control group (ANOVA, p = 0.0423). A deeper decrease in the angiotensin II level in the blood of EAE + S group than in S group was associated with a higher level of antibodies to S protein: the level of antibodies to S protein was significantly higher in the EAE + S group for 1-6 weeks after immunization with S protein compared to the S group of rats. Immunization of rats with S protein did not cause the production of anti-ACE2 autoantibodies in the EAE + S group, and in the S group it was weak and was not accompanied by an increase in angiotensin II levels. Thus, in rats immunized with S protein, a transient decrease in the level of angiotensin II was detected at the peak of production of antibodies to S protein, which may indicate that antibodies to S protein may contribute to a decrease in angiotensin II level in SARS-CoV-2 infection. In addition, pre-existing autoimmune disease leads to a stronger response to S protein, accompanied by a stronger decrease in angiotensin II level.

P001 AN UNCOMMON CAUSE OF HIGH BLOOD PRESSURE IN YOUNG BASKETBALL PLAYER

Paragangliomas are rare neuroendocrine tumors that affect approximately 1.5–9 patients per million. They originate from chromaffin cells of the adrenal medulla or sympathetic and parasympathetic ganglia. Paragangliomas account for 10%–20% of retroperitoneal tumors and can manifest at any age. These tumors can secrete catecholamines, leading to symptoms such as hypertension, headaches, and diaphoresis.However, palpitations or tachycardia may also be present. Definitive treatment entails surgical resection, with acceptable rates of morbidity and mortality, necessitating careful patient preparation and intraoperative management. Case Presentation: We present the case of a 29-year-old man with a BMI 26,5 kg/m2, who is physically active and without other cardiovascular risk factors, episodic hypertension, headaches and blush. A contrast CT scan of the abdomen revealed a retroperitoneal intercavoaortic mass and 24-hour urine Normetanephrines were significantly elevated, indicating a functional paraganglioma. Laboratory tests revealed an elevated plasma normetanephrine level of 1838 pg/ml (reference values 0 - 180 pg/ml). The patient was prepared for surgery with alpha blockers, followed by beta blockers. Intraoperative blood pressure elevation was managed with intravenous beta blockers. Postoperatively, the patient did not require anti-hypertensives. The tumor, measuring 6x4x3.5 cm, histopathology and immunohistochemistry confirmed the diagnosis of a normetanephrine producing paraganglioma. The genetic study revealed a pathogenic variant in the SDHB gene, specifically the c.166_170delCCTCA (p.Pro56Tyrfs*5) in heterozygosity. This variant is associated with a 49% risk of Pheochromocytoma and Hereditary Paraganglioma, a 14% risk of Renal Carcinoma and susceptibility to Gastrointestinal Stromal Tumors. The c.166_170delCCTCA variant follows an autosomal dominant inheritance pattern, indicating a 50% risk of recurrence. Conclusions: The diagnosis of extra-adrenal retroperitoneal paragangliomas remains challenging due to the silent evolution of the condition. It is essential to consider screening patients who are young, and present with resistant arterial hypertension for secondary hypertension.

A Prospective Randomised Observational Study of Obstructed Total Anamalous Pulmonary Venous Connection (TAPVC) Repair Patients with Milrinone Versus Milrinone and Inhaled Nitric Oxide

Abstract Background: Obstructed total anomalous pulmonary venous connection (OTAPVC) typically presents with severe cardiovascular decompensation and requires urgent surgical management. Pulmonary arterial hypertension (PAH) is a major risk factor affecting mortality. Perioperative management focuses on providing inotropic support and managing potential pulmonary hypertensive episodes. The aim of this study was to determine the outcome of patients with high pulmonary arterial pressure (PAP) with milrinone alone and a combination of milrinone and inhaled nitric oxide (INO). Material and Methods: After the approval of the ethical committee, this single-centre prospective randomised and observational study was conducted over a period of two years among eighty-six patients with obstructed TAPVC repair with severe PAH. Group-I patients received milrinone, and Group-II patients received both milrinone (after aortic cross clamp removal) and INO during the post-operative period at the cardiac care unit (CCU). Clinical outcomes such as ventilation time, length of stay (LOS) in the CCU, LOS in the hospital, complications, and hospital mortality were compared between the two groups. Result: The average ventilation time, LOS in CCU, and LOS in hospital for group I were 96.82 ± 19.46 hours, 10.91 ± 7.53 days, and 14.46 ± 7.58 days, respectively, and for group II, it was 85.14 ± 15.79 hours, 7.28 ± 3.68 days, and 10.21 ± 3.14 days, respectively, which was statistically significantly lower for group II. Reintubation, RV dysfunction, and hospital mortality were 16.3%, 37.2%, and 6.9% in group I, and 4.8%, 14.6%, and 2.4% in group II, respectively. The P value for each variable was significant &lt; 0.05 (except mortality). Conclusion: Preoperative obstruction is a risk factor for postoperative obstruction, as 235 patients with obstructed TAPVC had severe PAH (39.98%) in this study. Management of severe PAH with a combination of milrinone and INO had a better outcome than milrinone alone.

MULTIMODAL NEUROMONITORING IN DIFFERENT NEUROCRITICAL CONDITIONS – FIRST EXPERIENCES IN SINGLE NEUROCRITICAL CARE CENTRE

The study explores the use of multimodal neuromonitoring in a neurocritical care center, focusing on patients with acute brain injuries. The monitoring involves various sensors to track intracranial pressure (ICP), partial brain tissue oxygenation (PbO2), cerebral perfusion pressure (CPP), and more. The research, conducted at the Lithuanian University of Health Sciences, covers a small sample size (13 patients), mainly dealing with subarachnoid hemorrhage and traumatic brain injury cases. Results indicate challenges, such as episodes of intracranial hypertension and cerebral hypoxia, despite adherence to treatment protocols. The study faces limitations due to manual data registration, leading to potential inaccuracies. The outcomes reveal a mortality rate of 23.1%, with the majority experiencing unfavorable results. In conclusion, the study underscores the significance of multimodal monitoring but highlights the need for larger sample sizes, improved data recording methods, and emphasizes the complexity and challenges in managing neurocritical conditions.

Facial nerve neuropathy during the COVID-19 pandemic: clinical features, acupuncture treatment approaches

BACKGROUND: Facial nerve neuropathy (FNN) is a common mononeuropathy in the general stage of development of the peripheral nervous system. During the novel coronavirus disease (COVID-19) pandemic, the incidence of facial neuropathy increased from 1.3% in 2019 to 3.5% in 2020. Acute isolated neuropathy of the facial nerve may be the first and only manifestation of various infectious diseases, including COVID-19. Several experts showed that the mechanisms of facial neuropathy development after a coronavirus infection is associated with neuroinflammation. Accepted therapeutic algorithms do not always lead to the expected results. Acupuncture potentially plays a key role in the treatment of this disease. In several cases, its superiority over drug treatment for FNN has been noted. No Russian studies on the treatment of post-COVID FNN were found. AIM: This study aimed to study the clinical features of the course of FNN after COVID-19, develop reflexology approaches to treatment, and compare the course of FNN between patients with a history of coronavirus infection and those without a history of COVID-19 infection. MATERIALS AND METHODS: The study group (after COVID-19) consisted of 16 patients with FNN (13 men, 3 women). The comparison group included 21 patients with FNN without a history of COVID-19 (15 men, 6 women). For a comprehensive patient assessment, clinical, neurological, and electroneuromyographic examination data were used. RESULTS: The treatment results of 16 patients with FNN that developed up to 12 weeks after suffering from COVID-19 were analyzed. The onset of the disease was accompanied by an arterial hypertension episode, which was observed for the first time in two patients. Nerve fiber damage was mixed and severe (52%). The dynamics of clinical and electrophysiological parameters in the study group (after COVID-19) were significantly slower compared to that of the group without a history of COVID. CONCLUSION: FNN that develops after COVID-19 is characterized by severe nerve fibers damage and a long course. Reflexology is an effective and safe method as part of complex therapy.