Arterial Blood pH Research Articles

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BACKGROUND: Twenty percent mannitol is widely used to reduce brain bulk and facilitate the surgical approach in intracranial surgery. However, a dose-response relationship has not yet been established. In this study, we compared the effects of 0.5, 1.0 and 1.5 gkg_1 mannitol on brain relaxation during elective supratentorial brain tumor craniotomy MATERIALS AND METHODS: In this prospective, randomized, single-blind study, we enrolled 48 patients undergoing supratentorial craniotomy for tumor resection. Patients were assigned to receive 0.5 gkg_1 (Group A), 1.0 gkg_1 (Group B) or 1.5 gkg_1 (Group C) of 20% mannitol at surgical incision. Brain relaxation was assessed immediately after opening of the dura on a scale (rozet quentin scale) ranging from 1 to 4 (Scale 1: perfectly relaxed (shrunken dura with prominent veins) (Scale 2: satisfactorily relaxed (only prominent veins) Scale 3: firm brain, Scale 4: bulging brain). Secondary outcome measures like mean arterial blood pressure, arterial blood electrolytes, blood PH, urine output and temperature also measured. RESULTS: There was no significant difference between the three groups regarding age, sex, body mass index, and brain tumor localization or size. We then used a proportional odds model to adjust for this unbalanced distribution and to assess the group effect (low-dose verses high-dose mannitol) on brain relaxation scores. Serum electrolytes, blood gases, urine output and hemodynamic stability are better maintained in group C. CONCLUSION: In this study, from the data and statistical analysis, shows that 1.5 gkg_1 OF 20% mannitol results in better brain relaxation scores than 0.5 and 1.0 gkg_1 in patients undergoing craniotomy for supratentorial brain tumor. In this study, it is concluded that 1.5 gkg_1 OF 20% mannitol gives better brain relaxation scores with blood electrolytes, blood PH, urine output and hemodynamic stability are better maintained.

Clinical evaluation of active abdominal lifting and compression CPR in patients with cardiac arrest

BackgroundChest compression is a standard recommendation during cardiopulmonary resuscitation (CPR). However, chest compression cannot be effectively applied under certain situations, such as chest wall deformity, rib fracture, or hemopneumothorax. An alternative method, abdominal compression, was reported to achieve better resuscitation outcomes in these patients. Materials and methodsA prospective study was performed in adult patients with cardiac arrest and anticipated ineffective chest compression (thoracic trauma, chest deformity, rib fracture, and hemopneumothorax). Active abdominal lifting and compression cardiopulmonary resuscitation was used. Primary outcome was success rate of restoration of spontaneous circulation (ROSC). Secondary outcomes included heart rate (HR), mean arterial pressure (MAP), pulse oximetry saturation (SpO2), arterial blood pH value, arterial oxygen pressure (PaO2), and arterial carbon dioxide tension (PaCO2), which were measured during the periods of pre-CPR, CPR, and 30min post-ROSC. ResultsA total of 35 patients were enrolled into the study. Five of them had ROSC (14.3%), which was statistically significantly higher than that (0%) reported in the 2015 Advanced Cardiovascular Life Support manual. HR, MAP, and SpO2 during CPR were also statistically significantly higher during CPR when compared to the period of pre-CPR period (HR 58 versus 0 beats/min, P<0.01; MAP 25 versus 0mm Hg, P<0.01; SpO2 0.68 versus 0.48%, P<0.01). In post-ROSC period, HR was statistically significantly higher than that during pre-CPR period (121 versus 0 best/min, P<0.01). ConclusionsActive abdominal lifting and compression cardiopulmonary resuscitation could reach better resuscitation outcomes in certain cardiac arrest patients.

Arterial versus venous lactate: a measure of sepsis in children

This study assessed the agreement between arterial and venous blood lactate and pH levels in children with sepsis. This retrospective, three-year study involved 60 PICU patients, with data collected from electronic or paper patient records. The inclusion criteria comprised of children (≤17 years old) with sepsis and those who had a venous blood gas taken first with an arterial blood gas taken after within one hour. The lactate and pH values measured through each method were analysed. There is close agreement between venous and arterial lactate up to 2 mmol/L. As this value increases, this agreement becomes poor. The limits of agreement (LOA) are too large (±1.90 mmol/L) to allow venous and arterial lactate to be used interchangeably. The mean difference and LOA between both methods would be much smaller if derived using lactate values under 2.0 mmol/L. There is close agreement between arterial and venous pH (MD = −0.056, LOA ± 0.121). However, due to extreme variations in pH readings during sepsis, pH alone is an inadequate marker.Conclusion: A venous lactate ≤2 mmol/L can be used as a surrogate for arterial lactate during early management of sepsis in children. However, if the value exceeds 2 mmol/L, an arterial sample must confirm the venous result.What is known:• In children with septic shock, a blood gas is an important test to show the presence of acidosis and high lactic acid. Hyperlactataemia on admission is an early predictor of outcome and is associated with a greater mortality risk.• An arterial sample is the standard for lactate measurement, however getting a sample may be challenging in the emergency department or a general paediatric ward. Venous samples are quicker and easier to obtain. Adult studies generally advise caution in replacing venous lactate values for the arterial standard, whilst paediatric studies are limited in this area.What is new:• This is the first study assessing the agreement between arterial and peripheral venous lactate in children with sepsis, with a significant sample of patients.• This study shows that a venous sample with a lactate of ≤ 2 mmol/L can be used as a surrogate measurement for arterial lactate during early management of sepsis in children. However, if the venous lactate is above 2 mmol/L, an arterial sample must be taken to confirm the result.

The importance of declining insulin requirements during pregnancy in patients with pre-gestational gestational diabetes mellitus

ObjectiveIn patients with pre-gestational and gestational diabetes mellitus (GDM), insulin requirements often increase during the third trimester of pregnancy in order to maintain proper glycemic control. However, a fraction of patients demonstrate a significant decrease in insulin requirements in late gestation. We aimed to evaluate the clinical significance of decreasing insulin requirements in patients with pre-gestational diabetes and GDM with respect to fetal wellbeing and pregnancy outcome. Study designWe performed a retrospective cohort study in a single referral center for gestational diabetes between 1/2010 and 12/2014. Healthy pregnant women with pre-gestational diabetes and GDMA2 and a decrease of at least 30% in insulin requirements over a period of two weeks during the third trimester (group A) were compared to women with stable or increasing insulin requirements (group B). The primary outcome was a composite of situations associated with feto-placental dysfunction (fetal growth restriction, oligohydramnios and cesarean section due to category 2–3 monitor). Secondary outcomes were maternal oral glucose tolerance test (OGTT) results 6 weeks postpartum, neonatal intensive care unit (NICU) admission rates, Apgar scores ≤7 at 5min, arterial blood pH≤7.1, macrosomia, neonatal hypoglycemia and a composite adverse neonatal outcomes (defined as one or more of the following: respiratory morbidity, cerebral morbidity, phototherapy, need for blood transfusion, necrotizing enterocolitis or death). ResultsGroup A consisted of 101 women and group B − of 203 women. There were no differences between the groups in demographic characteristics or diagnostic characteristics of diabetes. The frequency of conditions related to feto-placental dysfunction did not differ between the groups (7.9% vs. 8.4%, p=0.61). Secondary outcome measures also did not differ between the groups, regardless of insulin requirements. ConclusionDecreasing insulin requirements during the third trimester are not associated with adverse perinatal outcome related to placental dysfunction.

EARLY EFFECTIVENESS OF NONINVASIVE POSITIVE PRESSURE VENTILATION ON RIGHT VENTRICULAR FUNCTION IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE SUBJECTS WITH ACUTE HYPERCAPNIC RESPIRATORY FAILURE

Introduction: Noninvasive positive pressure ventilation (NIPPV) has become an integral tool in the management of acute hypercapnic respiratory failure (AHRF) in chronic obstructive pulmonary disease (COPD). This study was performed to evaluate the early effects of NIPPV on pulmonary artery pressure (PAP), serum N-terminal pro BNP (NT-proBNP), and ventilatory parameters in the COPD patients with AHRF. Materials & Methods: This quasi-experimental study was conducted on 20 COPD patients with AHRF. The participants received the standard treatment in addition to NIPPV. There was no contraindication for NIPPV. Arterial blood gas analysis, Doppler echocardiography (for measuring PAP), and plasma NT-proBNP measurements were performed before and after NIPPV. Results: According to the results, the mean age of the participants was 54.57±15.43 years. Furthermore, the mean pressures of carbon dioxide (PCO2), NT-proBNP levels, and PAP were 72.33±13.96 mmHg, 4333.90±6542.20 pg/ml, and 47.5±6.38 mmHg, respectively. After one week of NIPPV, there were statistically significant differences among the mean pH, PaCO2, PAP, and NT-proBNP (P<0.001, P=0.003, P<0.001, and P<0.001, respectively). Conclusion: As the findings of the present study indicated, the application of NIPPV in the COPD patients with AHRF can not only improve arterial blood pH and carbon dioxide tension, but also instantly decrease NT-proBNP levels and PAP.

Lethal Avian Influenza A (H5N1) Virus Induces Ataxic Breathing with Reduced Neurokinin 1 Receptor Expression in the Pre‐Botzinger Complex in Mice

The most common symptoms prior to death in patients infected by lethal influenza A (H5N1) are shortness of breath (tachypnea) and respiratory failure. Although the death has been observed in mice at 7 day postinfection, dynamic process of the ventilatory disorders leading to respiratory failure over the infection period and the underlying mechanisms has not been investigated. To this end, the mice were intranasally inoculated with vehicle (Ctrl), 100 PFU HK483 (lethal strain) or HK486 virus (nonlethal strain). We first measured ventilation and arterial blood pH and gases at 0 (before), 2, 4, and 6 days postinfection (dpi). Ctrl and HK486 mice showed no change over the infection period, while HK483 mice presented: 1) gradual body weight loss and hypothermia; 2) a remarkable tachypnea at 2–4 dpi and an ataxic breathing with appearance of long‐lasting apneas at 6 dpi; and 3) hypoxemia and hypercapnemia after 4 dpi that were worse at 6 dpi. Because lethal H5N1 virus is neurotropic and ataxic breathing (hypoxemia) has been reported in rats with an insufficient expression of neural neurokinin 1 receptor (NK1R) in the Pre‐Botzinger complex (PBC), we second asked if HK483 virus replicated in the PBC to induce apoptosis and reduce the population of neurons expressing NK1R. After euthanasia and fixation at 6 dpi, the medullary sections were processed to detect the nucleoprotein of H5N1 virus (NP) alone or coupled with immunoreactivity (IR) of NK1R or CASP3 (a marker for apoptosis). The results showed that HK483 but not HK486 replicated in PBC neurons, particularly local NK1R neurons and reduced the population of PBC NK1R neurons by 75%. CASP3‐IR was detectable in the PBC and NK1R neurons solely in HK483 mice. Our results suggest that lethal H5N1 virus replicates in the PBC to induce apoptosis and thereby reduce population of NK1R neurons, contributing to ataxic breathing and respiratory failure.Support or Funding InformationSupported by HL‐107462 and HL‐119683

Therapeutic effects of oral liothyronine on aluminum phosphide poisoning as an adjuvant therapy: A clinical trial.

In aluminum phosphide (AlP) poisoning, death is mainly due to cardiovascular failure and refractory acute heart failure. There is a lot of evidence showing thyroid hormones have cardioprotective effects. The purpose of this study was to evaluate the effect of oral liothyronine in the treatment of AlP poisoning. Twenty-four patients from intensive care unit of Baharloo Hospital, Tehran, Iran, were included based on the inclusion and exclusion criteria. They were randomly divided into two parallel groups of 12 cases and 12 controls. Intervention in the case group was administration of 50 µg liothyronine via nasogastric tube after gastric lavage, in the first 6 h of poisoning. In both groups, the routine treatment of AlP poisoning was performed. Blood samples were prepared at the beginning of the study and after 12 h. Patients were followed up till discharge from the hospital or death. The findings demonstrated that oral liothyronine was able to significantly improve systolic blood pressure, arterial blood pH, and total thiol molecules and also could decrease lipid peroxidation, increase catalase activity, and prevent further decline in total antioxidant capacity. Liothyronine administration is effective in controlling AlP poisoning and can improve patients' outcome.

Immunoexpression of GADD45β in the myocardium of newborns experiencing perinatal hypoxia

AimAmong the several organs affected by perinatal hypoxia, the heart plays a central role, with cell death caused mainly by apoptosis. One of the biomarkers most often linked to hypoxia-derived apoptosis of cardiomyocytes in animals is Gadd45β. From the published literature, Gadd45β is proposed as a biomarker of hypoxia-induced lesion in cardiomyocytes, both in vitro, as well as in animal models. Our study suggests that this protein can be used as an early biomarker of cell damage in neonate’s cardiomyocytes (humans specimens), a process that can ultimately lead to apoptosis. The aim is to determine levels of tissue immunoexpression of the Gadd45β biomarker in myocardium samples of newborns affected by hypoxia, and to correlate these results with clinical and anatomopathologic data. MethodsMyocardium samples from the left ventricle of newborns were used. The samples were collected from 78 autopsies performed in neonates of both genders, with hypoxia (Apgar score at five minutes below 6 and/or pH below 7.2 and/or autopsy with anatomopathological signs of hypoxia), who had died within the first day of life. All samples were organized in Tissue Microarray. Immunohistochemistry analysis, using anti-Gadd45β as the primary antibody, was performed on 3 multi-sample histological slides. There was no correlation between Gadd45β tissue immunoexpression and neonatal weight (p=0.93), gestational age (p=0.16), Apgar score at first minute (p=0.914), Apgar score at five minutes (p=0.988) and arterial blood pH (p=0.542). There was a relation between Gadd45β tissue immunoexpression and survival (p=0.02). The maximum peak of Gadd45β tissue immunoexpression was 8.43% HPF (high power field) and was observed around of six hours of life. ConclusionGadd45β could be a suitable biomarker of cardiomyocytes apoptosis in newborns experiencing hypoxia in the first day of life, as its highest tissue immunoexpression around at the first six hours after birth.

Intravenous 15% isoflurane lipid nanoemulsion for general anesthesia in dogs

ObjectiveTo investigate the efficacy of a new intravenous (IV) nanoemulsified isoflurane formulation for maintenance of general anesthesia in dogs. Study designProspective, crossover, experimental study. AnimalsSeven healthy, mature, mixed-breed dogs, three male and four female, weighing 11.5 ± 1.5 kg. MethodsAnesthesia was induced with propofol for instrumentation. Measurements were obtained before administration of either inhaled isoflurane (Iso-I) or IV 15% isoflurane-loaded lipid nanoemulsion (Iso-nano). The minimum alveolar concentration (MAC) of isoflurane was determined using the ‘up-and-down’ technique. A tail clamp was applied every 15 minutes for a total time of 90 minutes and isoflurane administration was adjusted according to the response. Data were recorded at 30, 60 and 90 minutes for end-tidal isoflurane concentration (Fe´Iso), end-tidal carbon dioxide partial pressure (Pe′CO2), inspired isoflurane concentration (FIIso), arterial hemoglobin oxygen saturation (SaO2), peripheral hemoglobin oxygen saturation (SpO2), respiratory rate (fR), heart rate (HR), arterial blood pH, PaCO2, PaO2, base excess (BE), bicarbonate (HCO3−), systemic arterial pressure (sAP), and biochemical variables of blood urea nitrogen, alanine aminotransferase, creatine kinase and creatinine. ResultsNo significant differences between treatments were detected for HR, fR, SaO2 or any biochemical variables (p > 0.05). In the Iso-nano treatment, sAP was significantly decreased throughout the study. Significant decreases in pH, Pe′CO2, BE and HCO3− were measured in the Iso-nano treatment. Isoflurane MAC was significantly lower in the Iso-nano than the Iso-I treatment. The dose of isoflurane (g hour−1) required to maintain general anesthesia did not differ significantly between treatments. Conclusions and clinical relevanceAdministration of 15% isoflurane-loaded lipid nanoemulsion IV was effective in maintaining general anesthesia in dogs but did not reduce the amount of isoflurane necessary to maintain general anesthesia. Significant hypotension and nonrespiratory acidosis occurred with the injectable form.

Hemi-Chorea in a Patient with Ketotic hyperglycemia: An Unusual Presentation

Chorea has often been associated with lesions in the basal ganglia and in the sub thalamic nucleus. It is possible for a patient with chorea-ballismus to have hyperglycemia at the initial presentation. We hereby present a case of an 81-year-old female, who was on treatment for type 2 diabetes mellitus and presented to us with sub acute onset of abnormal movements of right side of the body. She had semi purposeful, rapid and jerky movements of right upper limb and lower limb along with abnormal tongue movements. Laboratory data showed very high blood glucose levels, urine ketones were positive and pH of arterial blood was normal. MRI brain showed hyperintensities in right basal ganglia. So, hyperglycemia induced hemichorea was considered as a possibility and she was treated with insulin. These abnormal movements decreased subsequently with treatment and patient is doing better in the follow-up visits. This presentation is extremely rare, as review of literature showed similar presentations in patients with non ketotic hyperglycemia but not reported so far in diabetic ketosis.

Study the association of chronic obstructive pulmonary disease with early endothelial dysfunction and its impact on cardiovascular system by estimating urinary albumin creatinine ratio.

Background:Chronic obstructive pulmonary disease (COPD) attribute to systemic inflammation which is responsible for microalbuminuria reflecting endothelial dysfunction, could be a significant surrogate marker of potential cardiovascular morbidity.Objective:The aim of our study was to find out the possible association of COPD with early cardiovascular changes in the form of renal endothelial dysfunction.Settings and Design:Case–control, multi-group, cross-sectional hospital-based study was designed and conducted in the Department of Respiratory Medicine of BPS Government Medical College for Women, Khanpur Kalan, Sonipat, Haryana.Subjects and Methods:The study included 150 subjects, comprising of three groups with each having 50 subjects: Group 1 – acute exacerbation of COPD, Group 2 – stable COPD patients, Group 3 – asymptomatic smokers. Pulmonary function test, urine albumin creatinine ratio (UACR) and brachio-ankle pulse wave velocity were measured in all the subjects.Statistical Analysis:Data were analyzed using SPSS ver 20 (IBM, USA) software. Continuous variables were compared by unpaired Student's t-test while correlation was measured by Pearson correlation test, P < 0.05 was considered statistically significant.Results:The mean urine albumin creatinine ratio UACR value in acute exacerbation of COPD (283.30 mg/g; standard deviation [SD] ±871.98) was found significantly higher compare to control subjects (24.17 mg/g; SD ± 32.105;) P = 0.038. Besides this COPD patients with Type 2 respiratory failure having robust positive correlation in between UACR and arterial blood pH (r = 0.559; P = 0.030) while it was inverse and moderate with partial pressure of arterial oxygen (r = −0.470; P = 0.077).Conclusions:Acute state of COPD with or without Type 2 respiratory failure is having a significant impact on cardiovascular system in the form of early microvascular changes.

Comparative aspects of respiratory support via laringeal air ducts and endotracheal tube for video-assisted onkothoracic operations

To improve patient 's recovery after video-assisted thoracoscopic lobectomies (VATSL) by laryngeal mask using. This is a comparative analysis of 74 patients underwent VATSL. In 37 patients anaesthesia consisted of sevoflurane and fentanyl, myorelaxant, respiratory support via independent ventilation of either lung. In another 37patient 's anaesthesia protocol included respiratory support performed via laryngeal mask, propofol infusion and epidural analgesia with ropivacaine 0,2% and fentanyl. During the operation in both groups we evaluated hemodynamic, arterial blood gases, leukocytes, glucose and cortisol blood level, time to consciousness restoration (Aldrete-score) and time to discharge from ICU and duration of hospital stay, frequency of complications. Patients with ventilation through laryngeal mask showed a statistically lower stress-reaction, avoided bronchoscopy with BAL and frequency of complications. Duration of inhospital stay in patients with laryngeal mask was 7±1,3 days; in intubated patients was 11±3,2 days. In case of ventilation through the laryngeal mask hyper dynamic state of circulation, glycemia, leukocytes, cortisol blood level and arterial blood pH were lower, whereas Pa CO₂ increase. The number of bronchoscopy with BAL and time to discharge from ICU and from hospital not having risk of postoperative complications --lower.

Urinary Uric Acid/Creatinine Ratio - A Marker For Perinatal Asphyxia.

Perinatal hypoxia is one of the leading causes of perinatal mortality in developing countries. Both apgar score and arterial blood pH predict the neonatal mortality in asphyxia. Apgar score alone does not predict neurologic outcome and as it is influenced by various factors. This study was conducted to evaluate the utility and sensitivity of urinary uric acid to creatinine ratio (UA/Cr ratio) in asphyxia diagnosis, compared to invasive Arterial Blood Gas (ABG) analysis. To assess the urinary uric acid/creatinine ratio as an additional marker for perinatal asphyxia compared with ABG analysis in apgar score monitoring. The present case control study was conducted at a teaching hospital in Central Gujarat. Data of 40 healthy newborns and 40 asphyxiated newborns were collected. In absence of regional estimates, a sample of size 39 was required to attain a power of 80% at 5% alpha (type I error) considering a moderate effect size of 0.65. (UA/Cr) ratio was measured from the spot urine sample collected during 24-72 hours of birth. Statistical analysis was performed by Independent t-test, Pearson's correlation coefficient (r) and Receiver Operating Characteristic (ROC) plots. The mean (UA/Cr ratio) (2.75±0.18 vs 1.78±0.23) is significantly higher in asphyxiated group than in the control group (p<0.0001). Urinary UA/Cr ratio had negative correlation with blood pH (r= -0.27, p=0.18), which was not significant (p>0.05). Urinary UA/Cr ratio with criterion of >2.3 had 100% sensitivity, 100% specificity with AUC of 1 (p<0.0001) had a better predictive value. Apgar score is usually reduced in neonates with congenital anomalies and premature neonates. Hence, it is preferable that the clinical diagnosis of asphyxia by apgar scores be supported by other investigations so that early decision can be taken about the level of care the baby needs. pH, lactates and base deficits change with establishment of respiration following resuscitation. However, pH, lactate, base deficit estimations are invasive and need rapid estimations. Non-invasive urinary UA/Cr ratio may be an answer to these issues as it easy, economical and equally efficient.

A Prophylactic Phenylephrine Infusion for Preventing Hypotension during Spinal Anaesthesia for Caesarean Section and to Study its Effects on APGAR Score and Umbilical Artery Blood pH

A Prophylactic Phenylephrine Infusion for Preventing Hypotension during Spinal Anaesthesia for Caesarean Section and to Study its Effects on APGAR Score and Umbilical Artery Blood pH

THE POTENTIAL ROLE OF SERUM S100B PROTEIN AS A PREDICTOR OF ACUTE TRAMADOL OVERDOSE INDUCED SEIZURE

Background: Tramadol poisoning is one of the major health problems worldwide especially in developing countries. Seizure is considered a serious and life-threatening manifestation of acute tramadol overdose. Recently, serum S100B protein has been shown to be a useful and specific neuro-biochemical marker of central nervous system damage. Aim of the study: To assess the role of serum S100B protein on admission as a predictor of seizure occurrence in patients with acute tramadol poisoning and to determine the factors affecting tramadol-induced seizure. Participants and methods: Thirty-three patients with acute tramadol poisoning, of both sexes, and 20 healthy sexand age-matched volunteers as a control group were included in this study. The studied tramadol poisoned patients were classified into two groups; group I: Seizure group and group II: Non-seizure group. For all patients, demographic and poisoning data were recorded then clinical evaluation and investigations were performed. Serum S100B level was estimated on admission. Results: : There was a statistically significant difference between patients with seizures and patients without seizures regarding age group, gender, ingested tramadol dose, Glasgow coma scale (GCS), poisoning severity score (PSS) and administered naloxone dose. On the other hand, there was no significant difference between both groups in manner of poisoning, delay time, vital data, oxygen saturation, arterial blood gases & pH and hospitalization period. The mean serum S100B was significantly higher in tramadol poisoned patients when compared to the control group; moreover, it was significantly elevated in patients with seizures than patients without seizures. Serum S100B as a predictor of seizures showed AUC =0.863 (p= 0.58 µg/L with 75 % sensitivity and 95.24 % specificity. Conclusion: Serum S100B could be used as a good predictor of tramadol-induced seizure and it could be useful to assess clinical severity in acute tramadol overdose. Moreover, young adult males, increased ingested tramadol dose, increased administered naloxone dose and decreased level of consciousness are considered risk factors of tramadol-induced seizures.

Mesenteric Lymph Duct Ligation Alleviating Lung Injury in Heatstroke.

To explore the roles of mesenteric lymph on lung injury in heatstroke (HS), HS rat model was prepared in a prewarmed incubator. Vascular endothelium injury biomarkers (circulating endothelial cell [CEC] as well as von Willebrand factor [vWF] and thrombomodulin [TM]), proinflammatory factors (tumor necrosis factor-α [TNF-α], interleukin-1β [IL-1β], IL-6, and high mobility group box 1), and coagulant markers (activated partial thromboplastin time, prothrombin time, D-Dimer, and platelet count) were tested in HS and HS with mesenteric lymph duct ligation (LDL) rats. In addition, lung histopathology; arterial blood gas; Evans Blue dye (EBD) and protein lung permeability; intralung inflammatory parameters including bronchoalveolar lavage fluid (BALF) TNF-α, IL-1β, and IL-6 levels; myeloperoxidase (MPO) activity; and vWF immune staining were analyzed. LDL prolonged HS onset time but not HS survival time. LDL significantly attenuated endothelial cell injury for decreased CEC counts as well as plasma vWF and TM concentrations; downregulated systemic inflammation for decreased plasma TNF-α, IL-1β, IL-6, and high mobility group box 1 levels; and ameliorated coagulant disorders for decreased activated partial thromboplastin time, prothrombin time, and D-Dimer levels as well as increased platelet counts. LDL also significantly reduced acute lung pathological injury; improved lung function indexes including arterial blood PaO2, pH, PaCO2, and lactic acid; decreased BALF TNF-α, IL-1β, and IL-6 levels and lung MPO activity; improved EBD and protein lung permeability; and inhibited lung vascular endothelium vWF expression. However, all of these parameters were not recovered to the normal states. In summary, LDL developed protection roles systemically and alleviated lung injury in HS rats which indicated that modulating mesenteric lymph flow may have some potential benefits in HS.

Efficiency of acidemia correction on intermittent versus continuous hemodialysis in acute methanol poisoning

Context: Acidemia is a marker of prognosis in methanol poisoning, as well as compounding formate-induced cytotoxicity. Prompt correction of acidemia is a key treatment of methanol toxicity and methods to optimize this are poorly defined.Objective: We studied the efficiency of acidemia correction by intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT) in a mass outbreak of methanol poisoning.Methods: The study was designed as observational cohort study. The mean time for an increase of 1 mmol/L HCO3–, 0.01 unit arterial blood pH, and the total time for correction of HCO3– were determined in IHD- and CRRT-treated patients.Results: Data were obtained from 18 patients treated with IHD and 13 patients treated with CRRT. At baseline, CRRT group was more acidemic than IHD group (mean arterial pH 6.79 ± 0.10 versus 7.05 ± 0.10; p = 0.001). No association was found between the rate of acidemia correction and age, weight, serum methanol, lactate, formate, and glucose on admission. The time to HCO3– correction correlated with arterial blood pH (r= −0.511; p = 0.003) and creatinine (r = 0.415; p = 0.020). There was association between the time to HCO3– correction and dialysate/effluent and blood flow rates (r= −0.738; p < 0.001 and r= −0.602; p < 0.001, correspondingly).The mean time for HCO3– to increase by 1 mmol/L was 12 ± 2 min for IHD versus 34 ± 8 min for CRRT (p < 0.001), and the mean time for arterial blood pH to increase 0.01 was 7 ± 1 mins for IHD versus 11 ± 4 min for CRRT (p = 0.024). The mean increase in HCO3– was 5.67 ± 0.90 mmol/L/h for IHD versus 2.17 ± 0.74 mmol/L/h for CRRT (p < 0.001).Conclusions: Our study supports the superiority of IHD over CRRT in terms of the rate of acidemia correction.

PROGNOSTIC VALUE OF NEURON SPECIFIC ENOLASE IN SERUM FOR OUTCOME OF INFANTS WITH BIRTH ASPHYXIA

Background: Birth asphyxia [BA] and the resultant hypoxic ischemic encephalopathy [HIE] is a common cause of neonatal morbidity and mortality and neurologic disabilities among survivors .It is important to find an early and reliable indicator of brain damage and of poor long-term prognosis to initiate or end neuroprotective treatment. Objective: Assess if neuron specific enolase [NSE] can be used as a serum biochemical marker of brain damage in neonates exposed to perinatal asphyxia [PA], and if it can be used in predicting long- term outcome in these infants. Study design: This prospective study was carried out on 50 neonates who were delivered in the Obstetric Department of Zagazig University Hospitals and admitted to the neonatal intensive care unit [NICU]. The patient group comprised 30 full term neonates who developed symptoms and signs of HIE. Twenty healthy full term neonates of matched age, sex and weight served as a control group. All neonates were subjected to; history-taking, clinical examination and laboratory investigations, including measurement of serum NSE by enzyme immuometric assay. In addition survivor neonates were subjected to follow-up at 6 month and 12 month. Results: Apgar scores and arterial cord blood pH were significantly lower in HIE neonates than that in control neonates. Meanwhile, serum NSE and arterial cord blood base deficit were significantly higher in HIE neonates than that in control neonates. Serum NSE was significantly higher in neonates suffering HIE grade II & grade III than that in HIE grade I& control neonates. Furthermore, serum NSE was very highly significantly increased in neonates who had neurological sequalae than that in control neonates. Conclusion and recommendation: Serum NSE correlated significantly with HIE grades II&III and neonates who suffered neurological sequalae. So it may be used as a marker of grades II& III and neurological sequalae in asphyxiated neonates. However, it can not be used to prevent BA.

Positive serum ethanol concentration on admission to hospital as the factor predictive of treatment outcome in acute methanol poisoning

Mass methanol poisonings present a serious problem for health systems worldwide, with poor outcome associated with delayed treatment. Positive pre-hospital serum ethanol concentration may have predictive value as the prognostic factor of the treatment outcome. We studied the effect of positive serum ethanol level on admission to hospital on survival in patients treated during the Czech methanol outbreak during 2012–2014. Cross-sectional cohort study was performed in 100 hospitalized patients with confirmed methanol poisoning. Pre-hospital ethanol was administered in 42 patients (by paramedic/medical staff to 30 patients and self-administered by 12 patients before admission); 58 patients did not receive pre-hospital ethanol. Forty-two patients had detectable serum ethanol concentration on admission to hospital [median 18.3 (IQR 6.6–32.2) mmol dm−3]. Pre-hospital ethanol administration by paramedic/medical staff had a significant effect on survival without visual and CNS sequelae when adjusted for arterial blood pH on admission (OR 8.73; 95 % CI 3.57–21.34; p < 0.001). No patients receiving pre-hospital ethanol died compared with 21 not receiving (p < 0.001). Positive serum ethanol concentration on admission to hospital was a predictor for survival without health sequelae when adjusted for arterial blood pH (OR 8.10; 95 % CI 2.85–23.02; p < 0.001). The probability of visual and CNS sequelae in survivors reduced with increasing serum ethanol concentration on admission.Graphical abstract

Hypertriglyceridemia Induced Acute Pancreatitis Associated with Diabetic Ketoacidosis and a Vaginal Estrogen Contraceptive Device (NuvaRing): Successfully Treated with Insulin Infusion, Plasmapheresis, and Ring Removal

We present a 27-year-old female with only past medical history of gestational diabetes, who presented to our hospital with abdominal pain. Physical exam was significant for mild tachypnea and tachycardia, dry mucous membranes, and moderate epigastric tenderness to light palpation. Blood work revealed an elevated glucose of 411 mg/dl, creatinine of 0.4 mg/dl, severe wide anion gap metabolic acidosis, lipase >6,000, triglycerides (TG) increased to 1,368 mg/dl. Computed tomography of abdomen and pelvis was consistent with acute pancreatitis. She was started on an insulin infusion and intravenous fluids. Her condition worsened rapidly with significant decline in mentation and severe tachypnea requiring intubation. Further blood work showed worsening creatinine at 1.5 with an arterial blood pH of 6.9. Insulin infusion continued and plasmapheresis was initiated given the worsening in her clinical status. Post plasmapheresis, her triglycerides decreased to 259 mg/dl, glucose trending in the 100 range, and anion gap closed. Her severely elevated triglyceride level was attributed to a combined effect of her new onset diabetes and vaginal estrogen ring, which was removed on presentation. Hypertriglyceridemia pancreatitis is a rare cause of pancreatitis. Usually a serum triglyceride (TG) level of more than 1,000 mg/dL is an inciting factor for the episode. In DKA, the deficiency of insulin activates lipolysis in adipose tissue releasing increased free fatty acids, which accelerates formation of VLDL in the liver. In addition, reduced activity of lipoprotein lipase in peripheral tissue decreases removal of VLDL from the plasma, resulting in hypertriglyceridemia. Furthermore, exogenous estrogen use can cause an increase in TG by induced stimulation of the secretion of hepatic triglyceride-rich lipoprotein. Plasmapheresis has been repeatedly shown in case reports and series to be effective in quickly removing TG from the serum of patients with hypertriglyceridemia pancreatitis. Although a clear benefit of plasmapheresis in reducing the severity and improving outcomes in such patients has not been conclusively shown, we report the possible benefit of such therapy as an add-on treatment modality in case the clinical situation deteriorates while they are on standard therapy.