Blood Pressure Fluctuations Research Articles

Morvan syndrome: Unravelling the engimatic neurological disorder and its immunomodulatory management

Syndrome is by with autonomic and involvement. Syndrome is to be an autoimmune disorder including an association with to voltage-gated potassium channel (Anti-Vgkc -Ab). Associated protein like 2, and leucine rich inactivated protein. These antibodies cause peripheral producing painful cramps, and central producing confusion, Hallucinations, and memory problem and autonomic producing, Fluctuation in blood pressure. There are several suggesting that morvan syndrome may be closely associated with drug intake leading to heavy metal toxicity. Here, we present a case with clinical symptoms suggestive of morvan syndrome following intake traditional medicine.

Closed-Loop Pharmacologic Control of Blood Pressure: A Review of Existing Systems.

Blood pressure management is a critical aspect of patient care, particularly in surgical and critical care settings. Closed-loop systems, which utilize real-time data and feedback to adjust treatment interventions, have gained attention for their potential to enhance blood pressure control. This review explores the application of closed-loop systems in blood pressure management. We discuss various closed-loop approaches, including their mechanisms, benefits, and limitations. By harnessing real-time patient data and feedback, closed-loop systems can tailor interventions dynamically, thus enhancing blood pressure regulation. Additionally, we examine the integration of advanced monitoring technologies and artificial intelligence algorithms in closed-loop systems. The review highlights recent studies and their findings, emphasizing the evolving landscape of closed-loop blood pressure management across different clinical scenarios. From the perioperative period to critical care settings, closed-loop systems hold the potential to optimize patient outcomes by precisely adjusting vasopressor administration in response to continuous blood pressure fluctuations. By providing insights into the current state of closed-loop systems for blood pressure control, this review offers a comprehensive overview of their potential contributions to improved patient outcomes and future directions for research and implementation.

The Promise and Illusion of Continuous, Cuffless Blood Pressure Monitoring.

Blood pressure (BP) fluctuations outside of clinic are increasingly recognized for their role in the development of cardiovascular disease, syncope, and premature death and as a promising target for tailored hypertension treatment. However, current cuff-based BP devices, including home and ambulatory devices, are unable to capture the breadth of BP variability across human activities, experiences, and contexts. Cuffless, wearable BP devices offer the promise of beat-to-beat, continuous, noninvasive measurement of BP during both awake and sleep periods with minimal patient inconvenience. Importantly, cuffless BP devices can characterize BP variability, allowing for the identification of patient-specific triggers of BP surges in the home environment. Unfortunately, the pace of evidence, regulation, and validation testing has lagged behind the pace of innovation and direct consumer marketing. We provide an overview of the available technologies and devices for cuffless BP monitoring, considerations for the calibration and validation of these devices, and the promise and pitfalls of the cuffless BP paradigm.

Abstract 083: Neurovascular And Cognitive Dysfunction In Middle-Aged Mice With High Blood Pressure Variability

Blood pressure variability (BPV) is a novel risk factor for cognitive decline. This study tested the hypothesis that BPV disrupts cellular function and communication at the neurovascular complex (vascular, glia, and neuron) contributing to BPV-induced neurovascular dysfunction. A main goal of the study was to establish a murine BPV model and examine how this risk factor impacts key functional outputs of the neurovascular complex. Middle-aged C57BL6 mice were implanted a cranial window and injected GCaMP viral vectors to monitor Ca 2+ activity in cortical neurons or astrocytes. DSI telemetry was used to monitor cardiovascular variables simultaneously ( in vivo ) with arteriole diameter and astrocyte/neuronal Ca 2+ responses via two-photon imaging. In addition, mice were implanted a programmable pump and infused 6-8 pulses/day of saline (Control) or angiotensin II (Ang II, 18 μg/day) for 20-25 days. Ang II infusions evoked transient BP increases (Δ 23±2 mmHg, mean arterial pressure (MAP, P=0.0001, n=14)), and increased BPV (P=0.04, n=12) measured by the average real variability. The 24-hour MAP was not different compared to Controls, allowing for the investigation of BPV-evoked changes in neurovascular function in the absence of hypertension. BPV mice displayed cognitive decline (NOR, P=0.006, n=10). Myogenic responses were lost in parenchymal arterioles of BPV mice but preserved in Controls (P<0.01 n=6). In addition to impaired vascular function, during Ang II-induced BP increases, astrocytes of BPV mice exhibited greater Ca 2+ event frequency (P<0.0001, n=4-6), but of lesser amplitude and reduced area (P=0.02, n=4-6). Furthermore, the neurovascular coupling response, evoked via whisker stimulation, was blunted in mice with high BPV (P<0.0001, n=6-10). Relevant to inflammation, microglial cells from BPV mice had elevated Iba1 (P=0.03, n=4-5) and CD68+ (P=0.003), an inflammatory marker. These findings show that BPV, in the absence of hypertension, result in a loss of cerebral autoregulation, a shift in spontaneous astrocyte Ca 2+ dynamics during blood pressure fluctuations, and increased microglia reactivity. Future mechanistic studies are needed to determine how BPV contributes to cognitive decline.

Abstract P330: Two Rodent Models Of Augmented 24-hour Blood Pressure Variability Showing Similar Pathophysiological Features: Rats Infused With Norepinephrine Or Angiotensin II

Background: Augmented fluctuation of blood pressure (BP), so-called BP variability (BPV), was shown to be associated with cardiovascular diseases independently of BP levels. Recently we reported that 24-h BP variability is augmented in rats continuously infused with norepinephrine (NE) or angiotensin II (Ang II), assuming these animals as models of augmented BPV seen in ambulatory BP monitoring (ABPM) of humans. This study was aimed to clarify the underlying mechanisms for augmented BPV and the effects of azelnidipine, a calcium channel blocker, in rats infused with Ang II or NE. Methods and Materials: Nine-week-old male Wistar rats were continuously infused with subcutaneous 30 μg/h NE or 5.2 μg/h Ang II with or without oral administration with 30 mg/kg/day azelnidipine (Azl) for 14 days (n=8 to 9 per group). BPV was evaluated before and after 14 days of the infusions, using standard deviations (SDs) of systolic and diastolic BP (SBP and DBP) recorded every 15 min under an unrestrained condition by a radiotelemetry system. Baroreceptor reflex sensitivity (BRS) was quantified with a sequence analysis, while sections of the aortic arch, where baroreceptors are thought to be located, were microscopically evaluated by computerized measurement. Results: Both SBP and DBP rose following infusion of NE or Ang II, while these increases were attenuated by Azl (P<0.01). SDs of SBP at the light (L) and dark (D) cycles were increased by NE (L, +94%; D, +117%, P<0.01) and Ang II (L, +94%; D +95%, P<0.01), with similar changes in SDs of DBP. These increases in SDs were attenuated following treatment with Azl almost to the control level (P<0.01). Augmented BPVs in both the NE and Ang II groups were accompanied by reductions in BRS (P<0.05) and by thickened medial area of the aortic arch (P<.0.01), while Azl alleviated impairment of BRS and aortic medial thickening (P<0.05). When analyzed for all groups by a simple regression, augmented BPV correlated with impairment of BRS (r=-0.54, P<0.01), which was associated with aortic medial area (r=-0.56, P<0.01). Conclusion: Rats infused chronically with NE or Ang II are models of increased 24-h BPV, both of which similarly showed impaired BRS and thickening medial layer of the aortic arch in association with augmented BPV.

Effects of Perioperative Music Therapy on Patients with Postoperative Pain and Anxiety: A Systematic Review and Meta-Analysis.

Background: As a mind-body therapy, music may have a positive effect on patients with postoperative pain and anxiety. Objective: The aim of this systematic review and meta-analysis was to explore the effects of perioperative music therapy on postoperative pain and anxiety based on existing clinical trials. Methods: The Cochrane Library, PubMed, and Embase were searched from their inception to August 2022, selected the literature according to the inclusion and exclusion criteria, and completed the meta-analysis using RevMan 5.3. Results: A total of 19 eligible randomized controlled trials were enrolled, including 1803 patients. The results of the meta-analysis showed that the scores of pain (standardized mean difference [SMD], -0.90; 95% confidence interval [CI], -1.26 to -0.53; p < 0.00001) and anxiety (SMD, -0.75; 95% CI, -1.19 to -0.31; p = 0.0008) decreased in the music group on postoperative day 1. The blood pressure (mean difference [MD], -5.29; 95% CI, -9.53 to -1.06; p = 0.01) and heart rate (MD, -6.13; 95% CI, -11.69 to -0.58; p = 0.03) also decreased on the same day. Further, the score of change in pain (SMD, 0.35; 95% CI, 0.01 to 0.68; p = 0.04) and anxiety (SMD, 1.35; 95% CI, 0.01 to 2.69; p = 0.05) increased between preoperative and postoperative days in the music group. However, the scores of hospital satisfaction (MD, -0.07; 95% CI, -1.40 to 1.27; p = 0.92) and incidences of postoperative nausea and vomiting (risk ratio, 0.41; 95% CI, 0.13 to 1.34; p = 0.14) did not decrease in the music group. Conclusion: Perioperative music therapy can significantly reduce postoperative pain and anxiety and avoid fluctuations in blood pressure and heart rate but does not improve patient hospital satisfaction or incidences of postoperative nausea and vomiting.

Entropy Generation Analysis on MHD Ag+Cu/Blood Tangent Hyperbolic Hybrid Nanofluid Flow Over a Porous Plate

This study is motivated by the vital role of dissipating thermal energy in the physiological system where energy depletion can lead to severe health complications. These complications encompass a range of issues, including sudden death, anemia, hypothermia, blood pressure fluctuations and the necessity for cardiac surgery. Biomedical engineers and clinicians have recognized the significance of analyzing entropy generation to quantify energy loss in biological systems. Furthermore, this study acknowledges the importance of understanding the thermodynamic state of entropy generation, particularly in evaluating cancer cells during chemotherapy treatment and enhancing heat transfer in tissues. The primary objective of this study is to evaluate the heat transfer characteristics of a magnetohydrodynamic (MHD) tangent hyperbolic hybrid nanofluid near a heat source and thermal radiation as it flows over a porous plate. The research methodology utilizes the MATLAB program bvp4c for solving the momentum and temperature equations. These equations are subsequently transformed into ordinary differential equations using the appropriate self-similarity variables. An elevation in the heat source parameter leads to heightened internal energy of liquid particles, resulting in an increase in temperature. Additionally, the magnetic field parameter is directly proportional to the entropy generation; as it increases, so does the entropy generation. Moreover, nanoparticles, owing to their high surface area-to-volume ratio, have the capacity to hinder heat transport within the fluid. The specific application of this study lies in the field of biomedical engineering and clinical practices. The findings can contribute to developing advanced heat-transfer techniques for medical applications, such as improving chemotherapy treatments for cancer cells and enhancing tissue heat-transfer efficiency. Moreover, using silver and copper nanoparticles as heat-transfer agents could hold promise in treating blood-related health conditions and facilitating the healing of injured tissue.

Posterior reversible encephalopathy syndrome as the first presentation of a connective tissue disorder: A case report

Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical-radiological diagnosis. Although hypertension is the main cause of this condition several secondary causes have been identified. Here we discuss a 53-year-old woman with a history of hypertension who presented with sudden onset of headache, seizures, and bilateral cortical blindness. MRI was suggestive of PRES. She had minimal blood pressure fluctuations. Antinuclear antibodies were significantly positive and a history of symmetrical polyarthritis was revealed. As the criteria for a particular connective tissue disorder were not fulfilled, the diagnosis of an undifferentiated connective tissue disease was made. In the presence of classical symptoms and imaging, PRES should be suspected even amongst patients without blood pressure fluctuations. Secondary causes should be identified and corrected in such patients.

Intraventricular Hemorrhage in Premature Infants: A Review of Risk Factors, Pathology, Treatment, and Prognosis

Abstract Intraventricular hemorrhage (IVH) in newborns is defined as bleeding within the ventricles, surrounded by the brain. This condition is most commonly observed in premature newborns and is directly proportional to gestational age; the smaller the gestational age, the higher the risk of IVH. It typically occurs in the subependymal germinal matrix, a highly vascularized area undergoing significant development in newborns and regression in full-term infants. The etiology is multifactorial and primarily attributed to the intrinsic fragility of the vascularization of the germinal matrix. Risk factors for IVH in premature infants include the immaturity of the cerebral vascular system, fluctuations in blood pressure, hypoxia, and oxidative stress. Furthermore, clinical factors such as respiratory distress syndrome, mechanical ventilation, and coagulation disorders contribute to the vulnerability of preterm infants to this complication. Regarding treatment, interventions can range from careful monitoring and medical support to surgical procedures such as cerebrospinal fluid drainage or ventriculoperitoneal shunting in severe cases. Pharmacological therapy, including the use of anti-inflammatory drugs, may be implemented to minimize brain injuries. Complications of IVH include obstructive hydrocephalus, non-obstructive hydrocephalus, post-hemorrhagic hydrocephalus, developmental disorders, cerebral palsy, and seizures. In conclusion, IVH in premature infants remains a complex and delicate issue in neonatology. An integrated approach covering both prevention and treatment is essential to minimize the negative impact of this complication on the neurological development of premature infants. Continuous research is necessary to develop innovative and effective strategies for managing this critical problem in neonatal medicine. Transfontanelar ultrasound remains the election method for diagnosis. Mild and moderate forms have shown favorable progression, while severe IVH has led to the development of post-hemorrhagic obstructive hydrocephalus.

New approaches for rapid setpoint determination and uninterrupted tracking in non-invasive continuous blood pressure monitoring based on volume-clamp method

The volume-clamp method (VCM) is a widely used non-invasive continuous blood pressure (BP) monitoring technique, but determining the volume setpoint (V0) in the open-loop phase can be time-consuming and may cause finger tissue displacement. Additionally, frequent interruptions in BP measurement are required during the closed-loop phase to reset V0. We proposed two new approaches: the proportional value method (PVM) for rapid V0 determination in the open-loop phase and the uninterrupted V0 tracking method (UVTM) in the closed-loop phase. PVM adaptively searches for V0 by analyzing the shape index (Prop) of the plethysmographic (PG) signal under constant cuff pressure, while UVTM introduces a new vascular compliance calculation method in closed-loop phase to track changes in V0 without interrupting BP measurement. We describe the non-invasive continuous BP monitor (NC-BPM) based on these methods. Experimental results show that PVM can accurately determine V0, with a mean arterial pressure error of −1.72 ± 2.80 mmHg when compared to oscillometric method (OSCM). UVTM in NC-BPM produced a mean absolute error (MAE) of 2.44 ± 2.91 mmHg for mean arterial pressure (MAP) in induced BP fluctuation test compared to the Nexfin monitor. In the clinical study with invasive reference, the MAE in measuring MAP by NC-BPM was 4.69 ± 5.39 mmHg. Our results show that PVM and UVTM are highly accurate and reliable, with the potential to integrate effectively into VCM-based BP monitoring devices that could benefit patients, healthcare providers, and researchers.

Effects of Nondipping Blood Pressure Changes: A Nephrologist Prospect.

Blood pressure (BP) variations depend on various internal, environmental, and behavioral factors. BP fluctuations occur both in normotensive and hypertensive people. Although it fluctuates over the 24-hr day and night, the morning BP increases after waking up and declines throughout sleep.It is typical for BP to decrease by 10% to 20%, while sleeping, known as dipping BP. However, if there is no decrease in nighttime mean systolic BP or a drop of less than 10 mmHg, it is called nondipping BP. Conversely, reverse dipping BP means an increase in mean systolic BP instead of a drop during the night. Reverse dipping is observed in hypertension (HTN), diabetes mellitus (DM), chronic kidney disease (CKD), and obstructive sleep apnea (OSA) syndrome. The introduction of ambulatory BP monitoring (ABPM) led to the emergence of identifying normal and elevated BP patterns. Non-dipping BP increases the risk of cardiovascular system (CVS) complications such as left ventricular hypertrophy, proteinuria, glomerular filtration rate (GFR) reduction, and CKD progression.A loss or blunting of the normal BP profile is recognized as a deleterious variant, and restoring abnormal BP patterns has been reported to significantly impact end-organ damage, morbidity, and mortality. In this non-systematic clinically-oriented, comprehensive review, we aim to update the BP variables and the pathophysiology of nondipping BP and point out the areas which need more investigation from a nephrology perspective because the nondipping BP increases the risk of proteinuria, GFR reduction, and CKD progression. A literature search of PubMed, Google, EMBASE, and Google Scholar was conducted. Checks of selected papers and relevant reviews complemented the electronic search. With improved BP measurement methods, the physiology of BP profile variations is readily detectable during the day and night. A nondipping BP profile is a distinct BP pattern that may have significant end-organ damage effects and therapeutic importance for nephrologists. The pathophysiology of the nondipping BP variant must be clarified to prevent complications, and further investigations are required. Furthermore, there is debate about the best BP index to utilize: systolic BP, diastolic BP, mean arterial pressure, or a mixture of all. All these areas are important and need new research projects.

Non-invasive estimation of arterial blood pressure fluctuations using a peripheral photoplethysmograph inside the MRI scanner.

The blood-oxygen-level-dependent (BOLD) signal measured by functional magnetic resonance imaging (fMRI) is modulated by neural activity through the neurovascular coupling effect, as well as non-neural factors of physiological origin such as heart rate, respiration, and arterial blood pressure (ABP). While the former two effects have been previously characterized, the modulation of the BOLD signal by ABP fluctuations is still poorly understood. This is largely due to the difficulty of obtaining reliable ABP measurements in the MRI environment. Here, we propose a combined experimental and mathematical modeling framework to estimate ABP fluctuations inside the MRI scanner using photoplethysmography (PPG). Specifically, we used concurrent PPG and ABP measurements obtained outside the scanner to train the mathematical model and applied it to PPG measurements obtained inside the MRI scanner. Our results suggest good agreement between the model-predicted and experimentally measured ABP fluctuations and region specific correlations with the BOLD fluctuations.

Acute bilateral multiple subcortical infarcts as manifestation in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is characterised by recurrent subcortical ischemic events, migraine with aura, dementia and mood disturbance. Strokes are typically lacunar infarcts; however, bilateral multiple subcortical lacunar infarcts have been described only sporadically. We described four CADASIL patients who presented with acute bilateral multiple subcortical infarcts as the first manifestation. We also briefly summarised the case reports detailing the bilateral multiple infarcts in CADASIL. Patient 1 and patient 2 were family members, and they presented with cognitive impairment. Patient 3 and patient 4 presented with slurred speech and hemiparesis. Patients 1, 3 and 4 developed hemodynamic fluctuations before the occurrence of ischemic stroke. Laboratory tests revealed elevated fibrinogen levels in patients 3 and 4. The brain magnetic resonance imaging showed acute bilateral multiple subcortical infarcts on the periventricular white matter in all the patients. CADASIL, with a poor brain hemodynamic reserve, is vulnerable to hemodynamic alterations (e.g. blood pressure fluctuation, dehydration, blood loss and anaemia) and intolerable to ischemia and hypoxia of the brain. Furthermore, blood hypercoagulation may contribute to acute multiple bilateral infarctions in CADASIL. Therefore, it is necessary to avert these predispositions in CADASIL patients in their daily life.

Spatial Feature Extraction for Acute Blood Pressure Fluctuations in Facial Visible Images Using Sparse Coding

Remote blood pressure measurement using visible images facilitates routine blood pressure monitoring and leads to early detection of hypertension, a risk factor for lifestyle diseases. The previous study that attempted to estimate blood pressure by applying CNN to facial thermal images found that facial images contain two types of features, physiological responses and expression changes, which need to be separated. In contrast, we found that these features could be separated by using sparse coding on facial thermal images. This study used sparse coding to extract physiological response areas during acute blood pressure fluctuations from facial visible images by examining preprocessing. The results indicated that sparse coding and the proposed preprocessing methods for images were effective. © 2023 Institute of Electrical Engineer of Japan and Wiley Periodicals LLC.

Efficacy and safety analysis of midazolam combined with dezocine sedation and analgesia colonoscopy in patients with inflammatory bowel disease: a prospective single-center open study.

Objective: Colonoscopy plays an important role in the diagnosis, prognosis prediction, assessment of disease activity and severity, and treatment of inflammatory bowel disease (IBD)-related complications. However, some patients refuse to undergo colonoscopy due to perceived pain and other discomfort, their diagnosis and treatment are affected. Therefore, we conducted a prospective study to explore the efficacy and safety of midazolam combined with dezocine for sedation in IBD patients undergoing colonoscopy. Methods: 224 patients were divided into sedative-colonoscopy-group (SCG, n = 93), anesthesia-colonoscopy-group (ACG, n = 90) and ordinary-colonoscopy-group (OCG, n = 41). The vital signs (blood pressure, pulse, respiration and blood oxygen saturation), pain degree during colonoscopy, satisfaction and complication rates of the three groups were compared. Results: Before colonoscopy, there was no significant difference among the vital signs of the three groups. The vital signs of the ACG were significantly lower than those of the SEG and the OCG (p < 0.05), and the difference was not significant between the SCG and OCG during colonoscopy. The colonoscopy pain score in the SCG was lower than that in the OCG (0.79 ± 1.09 vs. 2.98 ± 1.27, p < 0.001). The satisfaction score of the SCG (9.26 ± 1.16) was not significantly different from that of the ACG (9.42 ± 1.41) but was higher than that of the OCG (6.63 ± 1.13) (p < 0.001). The total complication rate of the ACG was 45.56% (41/90), which was significantly higher than that of the SCG [20.43% (19/93)] and the OCG [19.51% (8/41)]. Colon perforation, abnormal blood pressure fluctuation and hypoxemia were significantly more common in the ACG than in the SCG and the OCG (p < 0.05). However, there was no significant difference in the incidence of complications between the SCG and OCG. Conclusion: Compared with ordinary-colonoscopy, colonoscopy performed under midazolam and dezocine sedation is more comfortable for patients, thereby increasing satisfaction and compliance. Colonoscopy that is performed under midazolam and dezocine is similar to colonoscopy that is anesthesia with propofol in terms of comfort, satisfaction and compliance and similar to ordinary-colonoscopy in terms of safety. Considering the shortage of anesthesiologists, the application of midazolam combined with dezocine for digestive endoscopy is worthy of clinical promotion.

Amyotrophic lateral sclerosis with respiratory failure and dysautonomia: a case report.

A 58-year-old male presented with left lower limb limping, difficulty climbing stairs, and left foot weakness, followed by right upper limb weakness and was diagnosed with ALS and received edaravone and riluzole treatment. He presented again with right lower limb weakness, shortness of breath, and wide fluctuations in blood pressure, leading to ICU admission with new diagnosis of ALS with dysautonomia with respiratory failure and was managed with non-invasive ventilation, physiotherapy, and gait training exercises. ALS is a progressive neurodegenerative disease affecting motor neurons but non-motor symptoms can also occur, including dysautonomia, which can result in blood pressure fluctuations. Dysautonomia in ALS is caused by several mechanisms such as severe muscle atrophy, prolonged ventilatory support, and upper and lower motor neuron lesions. Management of ALS involves giving a definitive diagnosis, providing nutritional support, using disease-modifying drugs such as riluzole and non-invasive ventilation to improve survival and quality of life. Early diagnosis is essential for effective management of the disease. Early diagnosis, use of disease-modifying drugs, non-invasive ventilation, and maintaining the patient's nutritional status are crucial for managing ALS which can have non-motor symptoms as well.

Using telemedicine to manage a patient with a hypertensive emergency due to pheochromocytoma.

The COVID-19 pandemic has led to the emergence of telemedicine on a global scale. In endocrinology, telemedicine has mainly been used in relation to chronic diseases, including diabetes. Herein, we report the case of an 18-year-old woman with a hypertensive emergency due to a pheochromocytoma who was quickly diagnosed and treated using telemedicine. The patient was referred to a cardiovascular hospital because of fatigue and sweating that did not improve with carvedilol. She had fluctuating blood pressure and tachycardia. Subsequently, since her thyroid function was normal, endocrine hypertension not due to thyroid dysfunction was suspected; a case consultation was made by phone to our clinic. Plain computed tomography (CT) was recommended owing to the high possibility of a pheochromocytoma; the CT scan showed an adrenal tumor with a 30 mm diameter. To assess her condition, endocrinologists, together with the attending doctor, interviewed her and her family directly using an online tool to obtain detailed information. We thus determined that she was at risk of a pheochromocytoma crisis. She was transferred to our hospital immediately for treatment, was diagnosed with pheochromocytoma, and underwent surgery. Telemedicine, especially involving doctor-to-patient with doctor consultations, can be effective in treating rare and emergent medical conditions such as pheochromocytoma crisis. Telemedicine can be used for chronic diseases and emergency conditions. Online doctor-to-patient with doctor (D-to-P with D) consultations are useful when the expert opinion of a highly specialized physician present in a different geographical location is required. Telemedicine, especially D-to-P with D online consultations, can be effectively used for the diagnosis of rare and emergent medical conditions, such as pheochromocytoma crisis.

Factors influencing blood pressure fluctuation in pediatric patients with sickle cell disease in Saudi Arabia: A retrospective single-center cohort study.

To investigate changes in blood pressure (BP) among pediatric patients with sickle cell disease (SCD) and determine the variables that might influence these changes. A total of 100 pediatric patients with SCD who followed up in the pediatric outpatient clinic were recruited for this retrospective cohort study. Clinical data included anthropometric measures, average systolic and diastolic BP recorded during multiple follow-up visits, hemoglobin (Hb) level, serum creatinine, and hemoglobin S percentage. Blood pressure measurements were categorized according to the guidelines of the American Academy of Pediatrics (AAP, 2017). In this cohort, 68% of the patients had normal systolic BP, 13% had elevated systolic BP, 17% had stage 1 hypertension (HTN), while only 2% reported stage 2 HTN. Patients who were overweight had relatively high systolic BP compared to patients who were underweight (p=0.034) or had normal weight (p=0.023). The average systolic BP significantly correlates with body mass index (r= 0.377, p<0.001) and serum creatinine (r=0.369, p<0.001). Pediatric overweight SCD patients exhibited higher average systolic BP than those underweight or normal weight. Body mass index and serum creatinine significantly influenced the average systolic BP more than the Hb level or Hb S percentage.

Revealing the coupling directionality and synchronization between time series from physiological data by analysis of joint recurrences

We applied methods for determining the recurrence based phase synchronization index and the coupling directionality based on conditional probabilities of recurrence to analyze the direction of coupling and synchronization of time series obtained from experimental data. The activity of brain neurons, fluctuations in arterial blood pressure, and the respiratory rhythm of anesthetized rats were used as experimental data. For the first time, variants of changing the direction of the coupling between the analyzed time series before and during pain exposure were revealed. The relationship of pain exposure with the adjustment of the frequency of the variability of neuron activity of the brain to the frequency of the variability of arterial blood pressure or with the adjustment of the frequency of the variability of blood pressure to the respiratory rhythm with the subsequent occurrence of phase synchronization has been established.

Comparison of TAP block and epidural analgesia for postoperative analgesia after robotic-assisted radical prostatectomy

Pain remains an important problem after radical prostatectomy, leading to discomfort and sometimes prolonged hospital stays. Despite the fact that laparoscopic procedures are less invasive surgical interventions, they can still be challenging in terms of postoperative pain, as both somatic and visceral pain pathways are involved. To alleviate pain and optimize improved recovery after laparoscopic prostatectomy, regional anesthesia techniques have been used to avoid or reduce the need for opioids. The aim of our study was to investigate the postoperative recovery of patients after laparoscopic robotic-assisted radical prostatectomy, depending on the method of postoperative analgesia and in the context of the peculiarities of anesthesia in robotic surgery. To achieve this goal, the “Medical Plaza” Medical Center examined 49 patients who underwent radical prostatectomy using a robotic system. Patients were divided into 2 groups. Group 1 (n=25) – combined intraoperative anesthesia with epidural analgesia with 0.125% bupivacaine. Patients in group 2 (n=24) underwent TAP-block with 15 ml of 0.25% bupivacaine immediately after the last suture was placed on the skin both sides of the abdomen. Patients in the groups did not differ in age, height, body weight and physiological status (р&gt;0.05) according to the American Society of Anesthesiologists (ASA) scale. When analyzing the statistical data it was found that the volume of the prostate did not differ in the study groups, as well as the duration of the operation and the amount of blood loss (р&gt;0.05). Blood pressure and heart rate fluctuations were similar between the groups. The amount of muscle relaxants used had no statistical difference in the study groups (р&gt;0.05). The amount of opiates used during anesthesia did not differ (р&gt;0.05). Mobilization of patients in both groups occurred in 8 hours without statistical difference (p=0.094). A direct medium strength significant correlation was found between the method of analgesia and weakness in one of the lower limbs at the time of mobilization (r=0.69; p=0.039), a direct medium strength significant correlation was found between the size of the prostate and the time to tracheal extubation (r=0.39; p=0.041). So, the level of intraoperative blood loss did not depend on the variants of perioperative analgesia. Haemodynamics and heart rate did not decrease with the addition of intraoperative epidural analgesia. Intraoperative initiation of epidural analgesia with a low concentration of local anesthetic does not affect the rate of postoperative mobilization. Pain after robotic radical prostatectomy is moderate, but requires multimodal treatment for faster mobilization of the patient, adaptation to the existing urinary catheter. Both epidural analgesia and TAP block have shown sufficient safety profile and efficacy in postoperative pain management. After radical prostatectomy, the TAP-block is an effective method of analgesia, while not interfering with the timely full mobilization of the patient. Epidural analgesia has a high analgesic profile, but is associated with certain risks of catheter migration and interference with full mobilization of the patient.