Peripheral Capillary Blood Research Articles

PRE-DISCHARGE SYSTOLIC BLOOD PRESSURE IN HOSPITALIZED COVID-19 PATIENTS IS AN INDEPENDENT PREDICTOR OF IMROVEMENT IN 6-MINUTE WALK TEST DURING 1-MONTH FOLLOW-UP

Objective: To study the relation of hypertensive status and systolic blood pressure (SBP) pre-discharge values to the dynamics of functional re-conditioning as assessed by 6-minute walk distance during the 1-month follow-up after hospitalization for COVID-19. Design and method: 6-minute walk distance (6MWD) was assessed pre-discharge in 176 patients hospitalized for COVID-19 (40% hypertensive, 47% male, mean age 53,2 ± 13,5 years) using the 20 m walkway and an extended protocol that included monitoring of peripheral pulse and capillary blood oxygen saturation (SpO2) every 30 seconds via bluetooth-connected pulse oximeter. The repeated evaluation was performed after 1 month of follow-up. Results: Hypertensive participants were characterised by older age (57,8±11,8 vs 50,7±13,9, p < 0,001), higher weight and body mass index (31,7±5,3 vs 27,4±4,4 kg/m2, p < 0,001). As a result, 6MWD in them was shorter (378±57 vs 418±75 m, p = 0,001) but no difference in reached percent of predicted distance (6MWD%) was detected (63,0±8,5 vs 63,2±11,1 %, p = 0,939). The described relation persisted at 1 month, with no difference in absolute (72±43 vs 68±43 m, p = 0,324) and percentage gain of 6MWD (12,8±6,6 vs 11,2±7,5 %, p = 0,266) between groups. Multiple regression analysis has allowed to build the model that accounted for 94% of variability in the 6MWD% gain between visits (85% for dedicated hypertensive cohort model). After adjustment for age, sex, height, weight, Remdesivir treatment, minimal SpO2 levels during acute COVID-19, changes of SpO2 and pulse rate throughout the 6MWT, SBP remained a potent independent predictor of 6MWD% gain, with 10 mmHg higher values at baseline evaluation being associated with 21,5% lesser 6MWD% gain in hypertensive subjects and 8,2% lesser – in normotensives. Conclusions: Hypertensive status did not have an impact on 6MWD% in pre-discharge COVID-19 patients. Moderate-to-high quality multiple regression models have demonstrated an independent role of SBP, demographic and anthropometric data, changes of SpO2 and pulse rate throughout the 6MWT in prediction of 6MWD% gain during 1 month after discharge, both in hypertensive and normotensive patients.

Glycemic dispersion: a new index for screening high glycemic variability

ObjectiveFor patients with diabetes, high-frequency and -amplitude glycemic variability may be more harmful than continuous hyperglycemia; however, there is still a lack of screening indicators that can quickly and easily assess the level of glycemic variability. The aim of this study was to investigate whether the glycemic dispersion index is effective for screening high glycemic variability.MethodsA total of 170 diabetes patients hospitalized in the Sixth Affiliated Hospital of Kunming Medical University were included in this study. After admission, the fasting plasma glucose, 2-hour postprandial plasma glucose, and glycosylated hemoglobin A1c were measured. The peripheral capillary blood glucose was measured seven times in 24 h, before and after each of three meals and before bedtime. The standard deviation of the seven peripheral blood glucose values was calculated, and a standard deviation of > 2.0 was used as the threshold of high glycemic variability. The glycemic dispersion index was calculated and its diagnostic efficacy for high glycemic variability was determined by the Mann–Whitney U test, receiver operating characteristic (ROC) curve and, Pearson correlation analysis.ResultsThe glycemic dispersion index of patients with high glycemic variability was significantly higher than that of those with low glycemic variability (p < 0.01). The best cutoff value of the glycemic dispersion index for screening high glycemic variability was 4.21. The area under the curve (AUC) was 0.901 (95% CI: 0.856–0.945) and had a sensitivity of 0.781 and specificity of 0.905. It was correlated with the standard deviation of blood glucose values (r = 0.813, p < 0.01).ConclusionsThe glycemic dispersion index had good sensitivity and specificity for screening high glycemic variability. It was significantly associated with the standard deviation of blood glucose concentration and is simple and easy to calculate. It was an effective screening indicator of high glycemic variability.

Does the COVID-19 personal protective equipment impair the surgeon’s performance?

IntroductionDespite increasing vaccination rates, new viral variants of SARS-CoV-2 (severe acute respiratory syndrome coronavirus type 2) are advancing the COVID 19 (coronavirus disease 2019) pandemic and continue to challenge the entire world. Surgical care of SARS-CoV-2 positive patients requires special protective measures. We hypothesized that "COVID-19" personal protective equipment (PPE) during surgery of SARS-CoV-2 positive or potentially positive patients would negatively affect the surgeon and thus the surgical outcome.Materials and methodsTen experienced trauma surgeons participated in the study. Each surgeon performed two simulated surgeries of a distal tibial fracture on a Sawbone® under standardized conditions either wearing regular PPE or special COVID-19 PPE. Baseline values at rest were acquired for heart rate, blood pressure, saturation of peripheral oxygen (SpO2), respiratory rate and capillary blood gas (CBG) analysis including capillary partial pressure of oxygen (pO2) and carbon dioxide (pCO2), followed by four different standardized tests of attentional performance (TAP). Subsequently, the surgeon performed the first surgery according to a randomly determined order, with regular or COVID-19 PPE conditions in an operation theatre. After each surgery vital signs were acquired and CBG and TAP were performed again.ResultsIn our simulated surgical procedure heart rate, respiratory rate, systolic and diastolic blood pressure did not show relevant differences. Percutaneously measured SpO2 decreased with additional layers of PPE, while CBG parameters were not affected. TAP tests showed a significant impairment of attention if PPEs were compared to the baseline, but both PPEs had similar results and no meaningful differences could be measured.ConclusionsAccording to our results, for surgical procedures additional PPE required during COVID-19 pandemic does not relevant affect the surgeon’s mental and physical performance. Surgeries under COVID-19 PPE conditions appear safe and do not increase patient risk.Level of evidenceLevel I.

Аналіз результатів дослідження центральної гемодинаміки та периферичного капілярного кровообігу при різних режимах інтраопераційного рідинного забезпечення

Метою дослідження було порівняльне вивчення впливу двох режимів інтраопераційного рідинного забезпечення на стан центральної гемодинаміки (ЦГД) та величину периферичного капілярного кровотоку у хворих із злоякісною патологією кісток нижніх кінцівок, які піддаються травматичним хірургічним втручанням в ортопедичній онкології. У дослідження ввійшло 70 хворих віком 18–77 років, яким проведено планові хірургічні втручання під комбінованою анестезією, що включала спинномозкову анестезію бупівакаїном і внутрішньовенний пропофоловий наркоз. Сформовано дві групи дослідження. Пацієнтам першої групи (n = 35) забезпечувався рестриктивний режим інтраопераційного введення рідини. Пацієнтам другої групи (n = 35) проводили цілеспрямовану рідинну терапію (ЦРТ) із ретельним моніторингом серцевого викиду та цільовою підтримкою ударного індексу на рівні, що сягає 35 мл/м2, і середнього артеріального тиску на рівні, що не менше 80 мм рт.ст. для осіб молодого та середнього віку, та не менше 90 мм рт.ст. для осіб похилого та старечого віку. Якщо у хворих першої групи серцеве переднавантаження часто моделювалося за допомогою інфузії норадреналіну, то у хворих другої групи його підтримували короткочасними інфузіями розчину гідроксіетилкрохмалю. Кожну з груп було поділено на дві підгрупи: 1) пацієнти віком до 60 років (при обох режимах рідинного забезпечення таких хворих було по 10); 2) пацієнти віком 60 років і старше (при обох режимах рідинного забезпечення таких хворих було по 25). ЦГД вивчали за допомогою методики грудного біореактансу. Спроможність периферичного капілярного кровотоку оцінювали шляхом фотоплетизмометричного визначення величини перфузійного індексу. Результати дослідження показали, що в умовах обмеження рідинної підтримки спостерігається суттєве зменшення показників серцевого викиду, судинного тонусу та величини периферичного капілярного кровотоку. І у хворих віком до 60 років, і у хворих віком 60 років і старше методика ЦРТ забезпечувала вірогідно більші показники артеріального тиску, серцевого викиду та величини перфузійного індексу на травматичному етапі операції та наприкінці дослідження. Всі пацієнти з рестриктивним режимом рідинного забезпечення віком 60 років та старше (100 %) потребували інфузії норадреналіну з метою корекції судинного тонусу та серцевого переднавантаження. Пацієнтам із ЦРТ інфузії норадреналіну не знадобилися.

Bronchus-blocked ultrasound-guided percutaneous transthoracic needle biopsy (BUS-PTNB) for intubated patients with severe lung diseases

BackgroundExaminations based on lung tissue specimen can play a significant role in the diagnosis for critically ill and intubated patients with lung infiltration. However, severe complications including tension pneumothorax and intrabronchial hemorrhage limit the application of needle biopsy.MethodsA refined needle biopsy technique, named bronchus-blocked ultrasound-guided percutaneous transthoracic needle biopsy (BUS-PTNB), was performed on four intubated patients between August 2020 and April 2021. BUS-PTNB was done at bedside, following an EPUBNOW (evaluation, preparation, ultrasound location, bronchus blocking, needle biopsy, observation, and withdrawal of blocker) workflow. Parameters including procedure feasibility, sample acquisition, perioperative conditions, and complications were observed. Tissue specimens were sent to pathological examinations and microbial tests.ResultsAdequate specimens were successfully obtained from four patients. Diagnosis and treatment were correspondingly refined based on pathological and microbial tests. Intrabronchial hemorrhage occurred in patient 1 but was stopped by endobronchial blocker. Mild pneumothorax happened in patient 4 due to little air leakage, and closed thoracic drainage was placed. During the procedure, peripheral capillary hemoglobin oxygen saturation (SPO2), blood pressure, and heart rate of patient 4 fluctuated but recovered quickly. Vital signs were stable for patient 1–3.ConclusionsBUS-PTNB provides a promising, practical and feasible method in acquiring tissue specimen for critically ill patients under intratracheal intubation. It may facilitate the pathological diagnosis or other tissue-based tests for intubated patients and improve clinical outcomes.

Unsuccessful cardiopulmonary resuscitation in a 46-year old woman with malignant disease and severe refractory hypoglycaemia

Introduction: Severe hypoglycaemia carries high short-term mortality. When associated with malignancy, it is interestingly highly dependent on increased glucose consumption due to glycolytic metabolism preference. There is no general consensus on the therapy in end-stage malignant disease. Case report: A 46-year old female with a recently diagnosed Hodgkin lymphoma presented in September 2019 to the emergency department with weakness, chills and fever. Apart from the diffuse lung interstitial syndrome, sinus tachycardia and respiratory collapsing inferior vena cava, her vital signs and physical examination revealed no significant abnormalities. Hypoglycaemia was determined/detected in the laboratory findings. During the secondary assessment, she arrested and cardiopulmonary resuscitation was initiated. Peripheral glucose measurements showed that refractory hypoglycaemia was unresponsive to any glucose infusions. After the return of spontaneous circulation, laboratory findings revealed severe hyperglycaemia. Soon after, the patient arrested again and a decision was made to apply Intralipid emulsion. CPR ended unsuccessfully. Conclusion: Septic shock with clinical markers of peripheral malperfusion can cause falsely low or immeasurable glucose levels in peripheral capillary blood.

A study on inter-finger variation and hand dominance in peripheral capillary oxygen saturation values recorded from the different fingers of the hands by pulse oximetry

Background: To measure percentage of oxygen saturation of hemoglobin in the capillary blood (SpO2), pulse oximeter is used as an imperative noninvasive device. There is lack of reported study evaluating the hand dominance and inter-finger variation of SpO2 readings. Aim and Objectives: Our study aims at providing comparison of peripheral capillary blood oxygen saturation of hemoglobin (SpO2 values) among every finger of the two hands in healthy subjects with different hand dominance. Materials and Methods: In this study, 100 healthy subjects of age group between 18 and 30 years were enrolled, in which 76 subjects were right handed, 24 subjects were left handed. No subject was identified as ambidextrous. After 5 min of rest, they were monitored. After collecting different relevant demographic parameters such as age, sex, height, weight, noninvasive blood pressure, heart rate, body temperature and fasting period, SpO2 values were recorded from every finger of two hands with the same pulse oximeter. All the SpO2 values were measured providing at least 1 min of interval after each recording. Total 1000 SpO2 recordings were obtained from 100 subjects. Results: Our result shows that highest average SpO2 values were obtained from middle finger in both the left and right handed subjects. There was no statistically significant difference in the SpO2 values between the middle finger of dominant and non-dominant hand in both the right handed and left handed subjects. Again, thumb showed the second highest average SpO2 value. There was no statistically significant difference in the SpO2 values between the thumbs in right handed and left handed subjects. Lowest SpO2 values were obtained in little fingers of both the hands without showing significant difference of hand dominance. Conclusion: While recording the SpO2 by pulse oximeter, the middle fingers show the highest values followed by the thumbs. Lowest values are recorded from the little fingers. Again, result depicts that there is no statistically significant difference in SpO2 values between corresponding fingers of dominant and non-dominant hand.

Cannabidiol Determination on Peripheral Capillary Blood Using a Microsampling Method and Ultra-High-Performance Liquid Chromatography Tandem Mass Spectrometry with On-Line Sample Preparation.

The aim of this work is to evaluate volumetric absorptive microsampling (VAMS) from capillary blood as an alternative strategy for therapeutic drug monitoring (TDM) in patients treated with the newly available GW-purified form of cannabidiol (Epidiolex®). A fast ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) coupled to an online sample preparation system analysis was carried out on a Thermo Scientific Ultimate 3000 LC system coupled to a TSQ Quantiva triple quadrupole for the quantification of cannabidiol (CBD) and, in addition, delta-9-tetrahydrocannabinol (Δ9-THC). After validation using European Medicine Agency (EMA) guidelines the method was applied to samples obtained by finger prick of five pediatric patients treated with Epidiolex® and the results were compared to those obtained from venous blood and plasma. The method is linear in the range of 1–800 µg/L for both CBD and THC with intra- and inter-day precisions ranging from 5% to 14% and accuracies from −13% to +14% starting from 30 µL of sample. Stability in VAMS is ensured for up to 4 weeks at 25 °C thus allowing simple delivery. There was no difference (p = 0.69) between concentrations of CBD measured from VAMS sampled from capillary or venous blood (range: 52.19–330.14 or 72.15–383.45 µg/L) and those obtained from plasma (range: 64.3–374.09 µg/L) The VAMS-LC-MS/MS method represents a valid alternative strategy for therapeutic drug monitoring of patients treated with Epidiolex®.

Nailfold Capillaroscopy of Resting Peripheral Blood Flow in Exfoliation Glaucoma and Primary Open-Angle Glaucoma

Systemic blood flow alterations have been described using video nailfold capillaroscopy (NFC) in high-tension glaucoma (HTG) and normal-tension glaucoma (NTG) variants of primary open-angle glaucoma (POAG). To date, no previous studies have explored alterations in nailfold capillary blood flow in exfoliation glaucoma (XFG). To investigate the measure of peripheral blood flow as a surrogate marker of systemic vascular involvement in patients with XFG, HTG, and NTG, as well as in individuals serving as controls, using NFC. A cross-sectional clinic-based study at the New York Eye and Ear Infirmary of Mount Sinai was conducted from July 6, 2017, to May 18, 2018. A total of 111 participants (30 XFG, 30 NTG, 30 HTG, and 21 controls) received a comprehensive ophthalmic examination to confirm eligibility. Exclusion criteria were the presence of connective tissue disease, uncontrolled diabetes, history of bleeding disorders, and/or history of trauma or surgery to the nondominant hand. Resting capillary blood flow at the nailfold of the fourth digit of the nondominant hand in patients with NTG, HTG, XFG, and controls, using NFC. Two participants were excluded owing to poor nailfold image quality, resulting in 109 participants. Sixty-two participants (57%) were women and 79 (72%) were white. Mean (SD) age of the participants was 67.9 (11.7) years. Mean (SD) resting peripheral capillary blood flow at the nailfold for controls was 70.9 (52.4) picoliters/s (pL/s); HTG, 47.5 (41.9) pL/s; NTG, 40.1 (16.6) pL/s; and XFG, 30.6 (20.0) pL/s. Multivariable analysis of the differences of flow in HTG vs control participants showed values of -18.97 (95% CI, -39.22 to 1.27; P = .07) pL/s, NTG vs controls of -25.17 (95% CI, -45.92 to -4.41; P = .02) pL/s, and XFG vs controls of -28.99 (95% CI, -51.35 to -6.63; P = .01) pL/s. Decreased resting peripheral capillary blood flow may occur in patients with XFG and NTG compared with individuals without glaucoma. These findings may contribute to understanding the possible systemic nature of glaucoma.

Аssociation of parameters of energy metabolism and levels of stress hormone cortisol with cognitive characteristics of patients with vascular encephalopathy

Introduction. In patients with vascular encephalopathy (VE), the performance of cognitive tasks may be accompanied by stress and an increase in the level of cortisol affecting the regulation of insulin and glucose metabolism. It is known that an elevated level of cortisol may cause neurodegenerative changes in the hippocampus, and it also can lead to insulin resistance and hyperglycemia, which negatively affects cognitive function. Objective: to evaluate the association of parameters of cortisol, insulin and glucose levels and their reactivity with the cognitive results in patients with VE. Methods. Eighty four patients with VE (60 women and 24 men) aged 43–87 years were examined. Patients with type 2 diabetes and metabolic syndrome were excluded from the cohort. All patients performed 3 cognitive tasks (corrective, verbal fluency and verbal memory assessment, the Luria test). Cortisol and insulin in saliva, and glucose in peripheral capillary blood before and after testing of cognitive functions were examined. Results. In women, the level of salivary cortisol and insulin after the cognitive tasks increased significantly, and the blood glucose level decreased. In men, similar reactive changes of these hormones and glucose were observed, but the changes did not reach statistical significance. In men and women the higher reactivity of cortisol was accompanied by lower, and insulin and glucose by higher results of cognitive performance. Conclusion. In patients with VE, the cognitive performance is accompanied by reactive changes in cortisol, insulin and glucose levels associated with higher results in cognitive tests.

Use of magnesium sulfate to accelerate the withdrawal of patients suffering from hypovolemic traumatic shock in a resuscitation room and operating room

Summary. The study presents the justification for the use of magnesium sulfate when providing emergency medical care to patients in a state of hypovolemic traumatic shock. In order to increase the efficiency of fluid resuscitation and to prevent membrane cell damage caused by ischemia / reperfusion, a solution of magnesium sulfate in a normal saline is used. The concentration of magnesium ions in the solution proposed is entirely consistent with the physiological content of magnesium ions in the blood plasma.The study included 48 patients who arrived at the intensive care unit, and subsequently into the surgical unit, in a state of traumatic shock. For patients in the control group (n = 24), fluid resuscitation was performed according to the protocol “Hypovolemic shock” of the Ministry of Health of Ukraine (2014). Patients in the main group (n=24) also received infusion of magnesium sulfate at a concentration of 0.95 mMol / L. The indicators of central, peripheral hemodynamics (perfusion index), oxygen capillary blood saturation and carboxylated hemoglobin content in blood were stated.Patients in the main group had significantly better indicators of central hemodynamics, volume peripheral capillary perfusion and capillary blood oxygen saturation in 4 stages of the study, compared with patients treated strictly by protocol. The use of magnesium sulfate was associated with a significantly lower endogenous production in the body of patients with carbon monoxide. This effect may be due to prevention of cell membrane damage during reperfusion by blocking ionic calcium channels and limiting the activity of free radical reactions.

Comparison of the value of cardiac output with different methods of hemodynamic monitoring

The article deals with the physical basis for determining the parameters of central, peripheral hemodynamics and oxygen saturation with the help of photoplethysmography.A comparative study of the parameters of cardiac output and volume capillary peripheral blood flow in 34 patients with polytrauma was conducted. The purpose of the study was to consider the possibilities of modern photoplethysymometric technologies for assessing the state of peripheral and central hemodynamics, by comparing their results with the results of echosonographic study of central hemodynamics.Indicators of central hemodynamics in the examined patients were determined using the photoplethysmographic technology of Nihon Kohden, as well as with transthoracic echosonography. The evaluation of the state of the peripheral capillary blood flow was determinate with using Masimo Rainbow’s photoplace micrometric technology.The decrease of cardiac output and peripheral capillary blood flow with the increase of the severity of shock was revealed. Successful anti-shock measures that ensure the growth of cardiac output and arterial vascular tone, were associated with an increase in volume capillary flow. When comparing the results of photoplethysmographic and ultrasound technologies of hemodynamic evaluation, results are obtained that match the value of the values of cardiac output with a linear correlation coefficient of Pearson 0.983. Photoplethysmographic monitoring accurately reflects the clinical picture of shock and the effectiveness of intensive care.

Simple and sensitive high performance liquid chromatographic method for the simultaneous quantitation of the phenylalanine in human plasma

Phenylalanine (Phe) is the most reliable indicator for the diagnosis of phenylketonuria (PKU). The purpose of this study is to establish a reliable and quick method for the assignment of Phe in peripheral capillary blood from newborns and children by high performance liquid chromatography with ultraviolet detection (HPLC-UV). Phenylketonuria (PKU) is an inborn error of metabolism characterized by the inability of the body to use phenylalanine (Phe). A rapid and sensitive high performance liquid chromatographic (HPLC) method has been developed for determination of phenylalanine in plasma. The method uses a protein precipitation step with sulfosalicilic acid for sample preparation by separation on a Nova-pack C18 column using sodium acetate buffer and acetonitrile (94: 6 v/v) adjusted to pH 6.5 with glacial acetic acid. The eluted peaks detected by a UV detector was set at wavelength of 215 nm. The method was validated in the range of phenylalanine concentrations from 0.1 to 20µg/ml. The limits of detection (LOD) and quantitation (LOQ) of the method were 0.05 and 0.1µg/ml, respectively. The average drug recovery from plasma was 88.60 percent throughout the linear concentration range., with the average within-run and between-run accuracy values of 103.3 and 115.350, respectively. The method is quick, easy, very steady and precise for the screen, assignment, and evaluation of Phe in human plasma by HPLC, which is particularly a useful way for screening and diagnosis of PKU and monitoring of a diet therapy.

Simultaneous determination of phenylalanine and tyrosine in peripheral capillary blood by HPLC with ultraviolet detection

ObjectivesPhenylalanine (Phe) and tyrosine (Tyr) are the most reliable indicators for the diagnosis of phenylketonuria (PKU). The purpose of this study is to establish a simple and rapid method for the determination of Phe and Tyr in peripheral capillary blood from newborns and children by high performance liquid chromatography with ultraviolet detection (HPLC-UV). MethodsPeripheral blood specimens were taken from newborns or children by heel stick or skin puncture on the fingers. Blood samples were deproteinized by equal volume of 5% perchloric acid. Amino acid separation was carried out on a Hypersil C8 column. The mobile phase containing 5% acetonitrile (v/v) was run at a flow rate of 1.5mL/min. Phe and Tyr were determined in the ultraviolet detector at 210nm. ResultsThe determination was within 10.0min. The linear range was from 6.0 to 1512.0μmol/L for Phe and 5.5 to 1250.0μmol/L for Tyr. Although Phe and Tyr levels from peripheral blood samples were relatively lower than those from serum or plasma, the data showed a good agreement between them. ConclusionThe method we developed is simple, rapid and convenient. It is useful for screening and diagnosis of PKU in newborns and children.

Anti-HCV prevalence in the general population of Lithuania

SummaryBackgroundThe aim of this study was to assess risk factors for HCV acquisition and prevalence of anti-HCV in the general population of Lithuania.Material/MethodsThe study enrolled 1528 randomly selected adults from the 5 biggest cities of Lithuania and its rural regions. Screening for anti-HCV was performed by analysis of peripheral capillary blood with lateral flow immunochromatography and confirmation of positive cases by peripheral venous blood testing with 2-step chemiluminescent microparticle immunoassay.ResultsAnti-HCV prevalence in Lithuania is 2.78% and according to the standard European population the adjusted anti-HCV rate is 2.85%. It is more prevalent among men (crude rates: 4.02% males vs. 1.49% females, p=.0030) and this does not depend on age. Vilnius and Kaunas regions have higher infection rates than smaller rural regions (2.92% and 3.01% vs. 2.24%, 0.74% and 1.35%). Nowadays among our population HCV infection spreads mainly via intravenous drug use (OR=42.5, p<.0001). HCV transmission occurs through blood transfusions (OR=6.4, p=.0002), tooth removal (OR=4.1, p=.0048), childbirth (OR=5.0, p=.0224), multiple and a long-term hospitalization (OR=3.0, p=.0064), tattooing (OR=4.4, p=.0013), open traumas (OR=3.7, p=.0009) and intrafamilially (OR=11.3, p=.0002).Conclusions2.78% of the population is anti-HCV-positive. The anti-HCV rate is higher in Vilnius and Kaunas in comparison with other regions. HCV spreads mainly through intravenous drug use, but intrafamilial and some nosocomial routes are also important. The anti-HCV prevalence did not depend on age. Despite active prevention of nosocomial HCV transmission, the incidence of HCV infection does not decrease due to virus spread mostly in “trusted networks” of intravenous drug users.

All Glucose Measurements Are Not Equal

Dr. Rice et al. have raised a very interesting question about our article published in the March 2009 issue of Anesthesiology,1that concerns the accuracy of the glycemic measurements on capillary blood samples. We agree that the most reliable measurement for blood glucose concentration is on blood samples obtained by arterial line. Generally, the measurement of blood glucose concentration through the HemoCue B-Glucose analyzer (HemoCue, Angelhom, Sweden) with peripheral capillary blood is considered to be reliable in noncritical patients.2,3Thus, previous studies even in critical care patients have used this approach, including the one by Van den Berghe et al. that specified: “The dose of insulin was adjusted according to whole-blood glucose levels, measured at 1- to 4-h intervals in arterial blood or, when an arterial catheter was not available, in capillary blood, with the use of a point-of-care glucometer (HemoCue B-glucose analyzer, HemoCue).”4Our protocol is similar to that of Van den Berghe et al. , but we hypothesized that in our patients population, which is relatively younger than in previous studies, the risk of hypotension, hypoxia, and acidosis is lower.Nevertheless, as we have mentioned in our article, to overcome the risks of this bias we have performed the measurements of blood glucose concentration exclusively on capillary blood samples only in few cases (i.e. , patient in which was difficult to get arterial blood sample: &lt;5% of the measurements). Thus, “in all patients, glucose concentrations were measured in whole blood or on undiluted arterial blood rather than capillary blood samples.” Furthermore, as we reported in the paper, we have made systematic cross controls between blood glucose concentration obtained by arterial and capillary samples and found in our study group nonsignificant differences between the values obtained with the two approaches.*University of Rome, Rome, Italy. bilotta@tiscali.it

Retrobulbar and peripheral capillary blood flow in hypercholesterolemic subjects

PURPOSE: To assess retrobulbar blood flow velocities and finger nailfold capillary blood flow velocities (two readily accessible vascular beds) in subjects with primary hypercholesterolemia before and during lipid-lowering therapy. METHODS: Retrobulbar blood flow velocities and finger nailfold capillary blood flow velocities were assessed in 15 hypercholesterolemic subjects and in 15 age-matched and sex-matched healthy control subjects. In addition, the change in blood flow velocities after a 3-month period of lipid-lowering therapy was evaluated. RESULTS: No alterations in retrobulbar blood flow velocities after lipid-lowering therapy could be observed in hypercholesterolemic patients. Nailfold capillary blood flow velocity was slower in hypercholesterolemic subjects than control subjects immediately after local cooling ( P = .0052), but this vascular dysregulation did not improve after lipid-lowering therapy ( P = .58). CONCLUSIONS: Blood flow alterations, potentially caused by perturbed vascular endothelial function, may occur in nailfold capillaries of hypercholesterolemic subjects. Such alterations were not seen in retrobulbar vessels, and blood flow measures did not change during lipid-lowering therapy.

THE EFFECT OF TIDAL VOLUME (Vt) DRIVEN WEANING PROTOCOLS (WP) IN INTUBATED NEONATES WITH ACUTE RESPIRATORY DISTRESS SYNDROME (RDS) 1173

Historically, pressure limited, time cycled ventilation has been the cornerstone of neonatal ventilation. The advent of sensitive flow sensors now allows rapid, continuous measurement of Vt in small neonates. We hypothesized that an algorithm combining Vt measurements with maximal use of noninvasive monitoring would allow safe, uniform weaning of infants with RDS from mechanical ventilation with a minimum of blood draws. The primary premise of the algorithm: using Vt to modify peak inspiratory pressure (PIP) to keep Vt 5-7 ml/kg; modify rate to keep pH 7.27-7.33; modify FiO2 to maintain SaO2 89-94%. Tidal volumes were measured with the Bicore CP-100 Neonatal monitor. This uses a self calibrated transducer to measure air flow. Flow is then integrated to give the infant's tidal volume. CO2 was monitored with transcutaneous CO2 (Novametrix), SaO2 with the Nellcor pulse oximeter. Arterial blood gases were drawn from the umbilical arterial line when available, or peripheral capillary blood gases were followed. Data from 33 infants (mean BW=1326g, GA=29.5 wks, 54% male, 50% Caucasian, initial mean airway pressure (MAP)=8.5 cmH2O, initial FIO2= 0.62) intubated secondary to RDS and managed as per the WP were evaluated. This was compared with data from 33 matched retrospective controls (mean BW=1274 g, GA=29.2 wks, 57% male, 66% Caucasian, initial MAP=8.7 cm H2O, FIO2=0.63). Primary outcome variables included: initial PIP (IPIP) and maximum PIP (MPIP), total blood gases (BG) for initial 72 hours of management and for first 7 days of hospitalization, and duration of mechanical ventilation. No patient managed per the weaning protocol had a pH value of <7.25. There was a significant difference between the two groups in terms of IPIP (WP=21cm H2O vs NO WP= 24 cm H2O, p<0.03), MPIP (WP = 21.8 cm H2O vs NO WP= 25.0 cmH2O, p<0.01). The infants managed with the WP had an average of 13.6 BGs drawn during the first 72 hours vs. 22.5 BGs for the NO WP (p<0.001). For the first week, the WP infants had 19.0 BG vs. 33.5 BG (p < 0.01). In terms of hospital charges for BG in the first week, the WP charges were $1452 vs $2560 for the NO WP. Actual hospital COST (therapist time and supplies per blood gas) resulted in saving $65 per patient for the first week ($85 vs. $150; p<0.01). Although the infants on the WP had a trend for decreased time on ventilation, there was no significant difference. Institution of the Vt driven WP enhanced our ability to wean comparable infants with RDS in a uniform manner with significantly decreased IPIP and MPIP, and decreased BGs at both 72 hours and 7 days. We hypothesize that Vt driven WP may decrease barotrauma, and with their concurrent savings, can safely provide consistent and cost effective weaning of infants with acute RDS.

Peripheral capillaroscopic findings and blood rheology during normal pregnancy

Peripheral capillary microscopy and blood rheology where used to investigate circulatory changes during normal pregnancy. The first part of the investigation was designed as a cross-sectional study in which capillary morphology and blood flow in the first (n = 24) and third trimester (n = 15) of pregnancy was compared with non-pregnant controls (n = 15). In the second part a longitudinal comparison of capillaroscopic and hemorheological findings throughout pregnancy was performed in 12 women with four measurements at 10-week intervals. In addition, in this group hemorheological measurements were carried out. Both the cross-sectional as well as the longitudinal group showed a significant increase in capillary blood flow velocity which was already present in the first trimester. Throughout pregnancy a gradual enlargement of the pericapillar papilla was seen, reflecting water retention in the interstitial tissue. At low shear rates a significant increase in viscosity was found at the end of pregnancy both in whole blood and at a standardized hematocrit of 45%. Capillaroscopy appears to be an appropriate method to study circulatory changes throughout pregnancy and its value as a diagnostic tool to detect early pathological developments is the objective of a future investigation.

Peripheral capillaroscopic findings and blood rheology during normal pregnancy.

Peripheral capillary microscopy and blood rheology where used to investigate circulatory changes during normal pregnancy. The first part of the investigation was designed as a cross-sectional study in which capillary morphology and blood flow in the first (n = 24) and third trimester (n = 15) of pregnancy was compared with non-pregnant controls (n = 15). In the second part a longitudinal comparison of capillaroscopic and hemorheological findings throughout pregnancy was performed in 12 women with four measurements at 10-week intervals. In addition, in this group hemorheological measurements were carried out. Both the cross-sectional as well as the longitudinal group showed a significant increase in capillary blood flow velocity which was already present in the first trimester. Throughout pregnancy a gradual enlargement of the pericapillar papilla was seen, reflecting water retention in the interstitial tissue. At low shear rates a significant increase in viscosity was found at the end of pregnancy both in whole blood and at a standardized hematocrit of 45%. Capillaroscopy appears to be an appropriate method to study circulatory changes throughout pregnancy and its value as a diagnostic tool to detect early pathological developments is the objective of a future investigation.