Physiological Changes Research Articles

Stomatal and Non-Stomatal Leaf Responses during Two Sequential Water Stress Cycles in Young Coffea canephora Plants

Understanding the dynamics of physiological changes involved in the acclimation responses of plants after their exposure to repeated cycles of water stress is crucial to selecting resilient genotypes for regions with recurrent drought episodes. Under such background, we tried to respond to questions as: (1) Are there differences in the stomatal-related and non-stomatal responses during water stress cycles in different clones of Coffea canephora Pierre ex A. Froehner? (2) Do these C. canephora clones show a different response in each of the two sequential water stress events? (3) Is one previous drought stress event sufficient to induce a kind of “memory” in C. canephora? Seven-month-old plants of two clones (’3V’ and ‘A1’, previously characterized as deeper and lesser deep root growth, respectively) were maintained well-watered (WW) or fully withholding the irrigation, inducing soil water stress (WS) until the soil matric water potential (Ψmsoil) reached ≅ −0.5 MPa (−500 kPa) at a soil depth of 500 mm. Two sequential drought events (drought-1 and drought-2) attained this Ψmsoil after 19 days and were followed by soil rewatering until a complete recovery of leaf net CO2 assimilation rate (Anet) during the recovery-1 and recovery-2 events. The leaf gas exchange, chlorophyll a fluorescence, and leaf reflectance parameters were measured in six-day frequency, while the leaf anatomy was examined only at the end of the second drought cycle. In both drought events, the WS plants showed reduction in stomatal conductance and leaf transpiration. The reduction in internal CO2 diffusion was observed in the second drought cycle, expressed by increased thickness of spongy parenchyma in both clones. Those stomatal and anatomical traits impacted decreasing the Anet in both drought events. The ‘3V’ was less influenced by water stress than the ‘A1’ genotype in Anet, effective quantum yield in PSII photochemistry, photochemical quenching, linear electron transport rate, and photochemical reflectance index during the drought-1, but during the drought-2 event such an advantage disappeared. Such physiological genotype differences were supported by the medium xylem vessel area diminished only in ‘3V’ under WS. In both drought cycles, the recovery of all observed stomatal and non-stomatal responses was usually complete after 12 days of rewatering. The absence of photochemical impacts, namely in the maximum quantum yield of primary photochemical reactions, photosynthetic performance index, and density of reaction centers capable of QA reduction during the drought-2 event, might result from an acclimation response of the clones to WS. In the second drought cycle, the plants showed some improved responses to stress, suggesting “memory” effects as drought acclimation at a recurrent drought.

Association of Whole Blood Amino Acid and Acylcarnitine Metabolome with Anthropometry and IGF-I Serum Levels in Healthy Children and Adolescents in Germany

Background: Physiological changes of blood amino acids and acylcarnitines during healthy child development are poorly studied. The LIFE (Leipziger Forschungszentrum für Zivilisationserkrankungen) Child study offers a platform with a large cohort of healthy children to investigate these dynamics. We aimed to assess the intra-person variability of 28 blood metabolites and their associations with anthropometric parameters related to growth and excess body fat. Methods: Concentrations of 22 amino acids (AA), 5 acylcarnitines (AC) and free carnitine of 2213 children aged between 3 months and 19 years were analyzed using liquid chromatography/tandem mass spectrometry. Values were transformed into standard deviation scores (SDS) to account for sex- and age-related variations. The stability of metabolites was assessed through the coefficient of determination. Associations with parameters for body composition and insulin-like growth factor-I (IGF-I) SDS were determined by the Pearson correlation and linear regression. Results: Our research revealed substantial within-person variation in metabolite concentrations during childhood and adolescence. Most metabolites showed a positive correlation with body composition parameters, with a notable influence of sex, pubertal status and weight group. Glycine exhibited negative associations with parameters of body fat distribution, especially in normal weight girls, overweight/obese boys and during puberty. Conclusion: Blood AA and AC measurements may contribute to elucidating pathogenesis pathways of adiposity-related comorbidities, but the specific timings and conditions of development during childhood and adolescence need to be taken into consideration.

SP2.4 - Appendicetomy in pregnancy: a retrospective analysis of 39 cases between 2012-2022

Abstract Background Acute appendicitis is the commonest surgical emergency in pregnant women. Physiological changes during pregnancy can obscure symptoms. Prompt diagnosis and surgical intervention is essential to minimise risks such as sepsis and preterm labour. Objective This study aims to evaluate how gestational age, type of imaging, surgeons' expertise, and antibiotics management affect the surgical outcomes in pregnant patients with acute appendicitis. Methods A retrospective analysis of 39 obstetric cases between 2012 and 2022 in the Royal infirmary of Edinburgh. Statistical methods for analysis including ANOVA were used to compare different surgical techniques, and correlation assessments to investigate links between gestational age and aspects of post-operative care. Results The study found that the surgical method significantly impacted post-operative recovery, with laparoscopic procedures leading to shorter hospital stays and decreased antibiotic use compared to open surgeries (p=0.001169 for hospitalisation length and p=0.01049 for antibiotic course, respectively). Surgeon grade did not significantly alter these outcomes. There was a moderate correlation between gestational age and both post-operative antibiotic duration (r = 0.3293) and length of hospital stay (r = 0.3640. The varied use of imaging techniques across different stages of pregnancy suggests there is no consensus of best practice. Conclusion The study identifies a need for consistent guidelines on treating pregnant women with appendicitis, particularly regarding antibiotic use. The results support the preferential use of minimally invasive surgery and value MRI as a non-invasive diagnostic tool, both contributing to a comprehensive, multidisciplinary approach required for these complex clinical scenarios.

Efflux pumps mediate changes to fundamental bacterial physiology via membrane potential.

Efflux pumps are well known to be an important mechanism for removing noxious substances such as antibiotics from bacteria. Given that many antibiotics function by accumulating inside bacteria, efflux pumps contribute to resistance. Efflux pump inactivation is a potential strategy to combat antimicrobial resistance, as bacteria would not be able to pump out antibiotics. We recently discovered that the impact of loss of efflux function is only apparent in actively growing cells. We demonstrated that the global transcriptome of Salmonella Typhimurium is drastically altered during slower growth leading to stationary-phase cells having a remodeled, less permeable envelope that prevents antibiotics entering the cell. Here, we investigated the effects of deleting the major efflux pump of Salmonella Typhimurium, AcrB, on global gene transcription across growth. We revealed that an acrB knockout entered stationary phase later than the wild-type strain SL1344 and displayed increased and prolonged expression of genes responsible for anaerobic energy metabolism. We devised a model linking efflux and membrane potential, whereby deactivation of AcrB prevents influx of protons across the inner membrane and thereby hyperpolarization. Knockout or deactivation of AcrB was demonstrated to increase membrane potential. We propose that the global transcription regulator ArcBA senses changes to the redox state of the quinol pool (linked to the membrane potential of the bacterium) and coordinates the shift from exponential to stationary phase via the key master regulators RpoS, Rsd, and Rmf. Inactivation of efflux pumps therefore influences the fundamental physiology of Salmonella, with likely impacts on multiple phenotypes.IMPORTANCEWe demonstrate for the first time that deactivation of efflux pumps brings about changes to gross bacterial physiology and metabolism. Rather than simply being a response to noxious substances, efflux pumps appear to play a key role in maintenance of membrane potential and thereby energy metabolism. This discovery suggests that efflux pump inhibition or inactivation might have unforeseen positive consequences on antibiotic activity. Given that stationary-phase bacteria are more resistant to antibiotic uptake, late entry into stationary phase would prolong antibiotic accumulation by bacteria. Furthermore, membrane hyperpolarization could result in increased generation of reactive species proposed to be important for the activity of some antibiotics. Finally, changes in gross physiology could also explain the decreased virulence of efflux mutants.

Cancer knocks you out by fasting: Cachexia as a consequence of metabolic alterations in cancer.

Neoplastic transformation reprograms tumor and surrounding host cell metabolism, increasing nutrient consumption and depletion in the tumor microenvironment. Tumors uptake nutrients from neighboring normal tissues or the bloodstream to meet energy and anabolic demands. Tumor-induced chronic inflammation, a high-energy process, also consumes nutrients to sustain its dysfunctional activities. These tumor-related metabolic and physiological changes, including chronic inflammation, negatively impact systemic metabolism and physiology. Furthermore, the adverse effects of antitumor therapy and tumor obstruction impair the endocrine, neural, and gastrointestinal systems, thereby confounding the systemic status of patients. These alterations result in decreased appetite, impaired nutrient absorption, inflammation, and shift from anabolic to catabolic metabolism. Consequently, cancer patients often suffer from malnutrition, which worsens prognosis and increases susceptibility to secondary adverse events. This review explores how neoplastic transformation affects tumor and microenvironment metabolism and inflammation, leading to poor prognosis, and discusses potential strategies and clinical interventions to improve patient outcomes.

Physiological and Biochemical Blood Indicators of Boer X Saanen Crossbred Goats Raised in Binh Duong Province, Vietnam

This paper presents the results of a study on the physiological and biochemical blood indices of F1 (Boer x Saanen) crossbred goats raised in Binh Duong province, Vietnam. Blood samples from 160 goats were taken by venipuncture from each animal in the morning, data were collected by sex and two age groups (3-12 months and 12-24 months). Blood physiological indices were measured using a Hemascreen 18 hematology analyzer. Blood biochemical indices were measured using an Abaxis Vetscan 2 chemistry analyzer. The results showed that the WBC, Mono and Neut indices varied according to age and sex (P0.05). RBC, HGB, MCV, MCH had no statistically significant differences between ages and sexes (P>0.05). The average protein concentration was 64.82-81.85 g/L, with significant differences between the study groups (P0.05). Statistically significant differences in mean values between age groups were investigated in the following parameters: Glucose, creatinine, AST, ALP, K, Ca, P, Cl. This study provides data on physiological and biochemical blood indices of Hybrids goats F1 (Boer x Saanen) as a basis for periodic health diagnosis of goat herds, promptly detecting health abnormalities. The data obtained can be used as reference limits related to physiological changes in livestock due to disease, nutritional deficiencies or other health-affecting factors. This is also the premise for studies on large goat herds to build a database of physiological and biochemical blood indices of goat breeds raised in Vietnam.

Sex differences in physiological correlates of affectively driven decision-making behavior in adult ADHD

BackgroundSex differences in the symptomatology of adults with attention-deficit/hyperactivity disorder (ADHD) have often been overlooked when studying behavioral abnormalities. However, it is known that women exhibit considerably more stronger symptoms related to emotional competence than men. Since affective functions significantly influence the processing of risky decision-making and risk-engagement, we assume that risky behavior in ADHD is affected by sex differences. Therefore, we specifically investigated sex-specific effects on the interaction between emotionally induced changes in physiology and behavioral performance on a decision-making task.MethodsSkin conductance responses of twenty-nine adults with ADHD (n = 16 male; n = 13 female) and thirty-three adults in the control group (n = 14 male; n = 19 female) were recorded during the performance in a modified version of the Balloon Analogue Risk Task (BART). Additional questionnaires were used to reveal insights in the self-assessment of emotional competence, risk perception, and feedback sensitivity. Emotional arousal and decision-making behavior were analyzed using linear mixed-effects models.ResultsResults showed different effects of sex on risk behaviors in controls and ADHD. In contrast to healthy controls, female adults with ADHD showed a significantly greater risk engagement in the BART compared to males with ADHD. This contrary sex relation was not observed in skin conductance responses and revealed a significantly different sex-dependent correlation of body response and behavioral task performance in ADHD. Comparisons with results from self-assessments furthermore indicate a reduced behavioral self-perception in women with ADHD, but not in men.ConclusionIn summary, we found an altered interaction between physiological activity and risky behavior in women with ADHD. Thus, the present study indicates a reduced sensitivity towards the own bodily responses in women with ADHD, which could consequently cause increased risky DM behavior in daily life. The current results suggest that more consideration needs to be given to sex-specific effects on physiological processes and behavior in adults with ADHD.

Effects of Yoga on Stress in Pregnant Women.

During pregnancy, a woman's body undergoes physiological and metabolic changes to nourish the developing fetus. Every woman experiences pregnancy-related stress differently, with symptoms and difficulties ranging from mild to severe. However, various therapies are available to help reduce stress levels. The purpose of this study is to assess the impact of integrated yoga, which includes asanas and pranayama, on stress levels and physiological markers in pregnant women. The study is a prospective, randomized, controlled, single-blind trial with 2 parallel groups. The intervention group was provided with integrated yoga therapy, while the control group was given routine standard care from 18 to 22weeks to 33-35weeks of gestation. To measure the stress level, a standardized perceived stress scale was used, which has 10 items with stress scores ranging from 0 to 4, with a maximum score of 40. The average stress score was significantly lower in the intervention group (P <.001) as well as normal physiological parameters when compared to the control group. Findings suggest that practicing yoga during pregnancy is safe and effective in reducing stress and preventing complications. Women who began yoga therapy during their second trimester reported a significant decrease in physiological parameters from baseline to post-intervention. However, further randomized controlled trials are necessary to determine the validity and usefulness of yoga therapy during pregnancy.

Liquiritin ameliorates painful diabetic neuropathy in SD rats by inhibiting NLRP3-MMP-9-mediated reversal of aquaporin-4 polarity in the glymphatic system.

Despite advancements in diabetes treatment, the management of Painful Diabetic Neuropathy (PDN) remains challenging. Our previous research indicated a significant correlation between the expression and distribution of Aquaporin-4 (AQP4) in the spinal glymphatic system and PDN. However, the potential role and mechanism of liquiritin in PDN treatment remain uncertain. This study established a rat model of PDN using a combination of low-dose Streptozotocin (STZ) and a high-fat, high-sugar diet. Rats were treated with liquiritin and MCC950 (an NLRP3 inhibitor). We monitored fasting blood glucose, body weight, and mechanical allodynia periodically. The glymphatic system's clearance function was evaluated using Magnetic Resonance Imaging (MRI), and changes in proteins including NLRP3, MMP-9, and AQP4 were detected through immunofluorescence and Western blot techniques. The rats with painful diabetic neuropathy (PDN) demonstrated several physiological changes, including heightened mechanical allodynia, compromised clearance function within the spinal glymphatic system, altered distribution of AQP4, increased count of activated astrocytes, elevated expression levels of NLRP3 and MMP-9, and decreased expression of AQP4. However, following treatment with liquiritin and MCC950, these rats exhibited notable improvements. Liquiritin may promote the restoration of AQP4 polarity by inhibiting NLRP3 and MMP-9, thereby enhancing the clearance functions of the spinal cord glymphatic system in PDN rats, alleviating the progression of PDN.

Nanostructure-assisted drought tolerance in olive trees (Olea europaea L.): the role of Fe2O3-graphitic carbon.

Olive trees are known as one of the most iconic crops in the world. Considering the increasing water deficit worldwide, implementing some profitable and empirical strategies can be inevitable upon exposure to drought stress. Therefore, the present study aimed at clarifying the beneficial role of exogenously foliar application of Fe2O3 modified carbon nitride nanostructures (control, FeSO4, C3N4 and Fe2O3/g-C3N4) to "Shengeh" olive cultivars grown at different watering levels (100, 75, and 50% ET) in two experimental years (2022 and 2023) and the pomological attributes, physiological and biochemical changes happening in the treated leaves and fruits were discussed. The results indicated that drought stress caused a significant decline in pomological attributes in this experiment, and treatments could remarkably make up for this damage. Overall, Fe2O3/g-C3N4 outperformed as compared FeSO4 and C3N4 alone, which were also efficacious in conferring tolerance to the water deficit stress. Conversely, severe drought stressed-olive fruits showed higher oil content percent in the fresh matter and water use efficiency (WUE) in oil by 30% and 52.5%, respectively, as an average of results of two years, and after Fe2O3/g-C3N4, these features in olive plants subjected to severe drought improved by an average of 35% over two years. Ca2+ and K+ in olive plants under severe drought stress declined by 50% and 83% in 2022 and 46% and 24% in 2023, while Na+ increased in the plants exposed to 50%ET stress by 48% and 57% in two successive experimental years respectively. The application of Fe2O3/g-C3N4 remarkably improved the contents of Ca2+ and K+ by 101.5% and 369%, respectively, as an average of two years. Conversely, this beneficial treatment led to a significant decline in Na+ levels by 30% in 2022 and 2% in 2023 under stressful conditions. Moreover, it decreased the 'osmolytes' content, caused a smaller decline in chlorophyll levels, and resulted in higher relative water content occurring in the treated olive leaves. The reduction of oxidative markers was a result of the increased enzymatic activity after the use of Fe2O3/g-C3N4. Therefore, this treatment is a promising strategy to achieve improved resistance in olive plants in the future.

Management of anesthesia in elderly patients, special considerations and challenges

Introduction: Anesthesia management in elderly patients presents distinct challenges due to physiological changes related to aging. Comorbidities, physical frailty and increased risk of postoperative complications are important aspects to be considered. Methods: Systematic reviews of the literature and analyzes of clinical and experimental studies that addressed the management of anesthesia in elderly patients were carried out. Articles published in English, Spanish and Portuguese were selected. The keywords used were "anesthesia in the elderly", "preoperative assessment", "anesthetic techniques", "intraoperative monitoring", "postoperative pain control" and "prevention of complications". Results: Comprehensive and individualized preoperative assessment was identified as crucial for identifying and treating comorbidities and physical frailty in elderly patients. The choice of the appropriate anesthetic technique depends on the type of surgery and the patient's clinical conditions. Careful monitoring during anesthesia, including blood pressure, heart rate, oxygenation and capnography, is essential to detect and intervene early on hemodynamic and respiratory changes. Postoperative pain control in the elderly requires an individualized approach, with appropriate use of analgesics and regional blocks. Complication prevention strategies, such as optimizing hydration, glycemic control, early mobilization and appropriate use of medications, are essential to reduce the risk of delirium, infection and cognitive dysfunction. Conclusion: Anesthesia management in elderly patients requires an individualized and comprehensive approach, taking into account physiological changes related to aging and associated comorbidities. Careful preoperative assessment, appropriate choice of anesthetic technique, strict intraoperative monitoring, postoperative pain control and prevention of complications are essential to ensure a safe perioperative period and successful recovery in the elderly. Keywords: anesthesia in the elderly, preoperative assessment, anesthetic techniques, intraoperative monitoring, postoperative pain control, prevention of complications.

Exploring Circadian Changes in Muscle Physiology: Methodological Considerations.

Exploring Circadian Changes in Muscle Physiology: Methodological Considerations.

Pharmacokinetics in older people: an overview of prescribing practice

As the population ages, understanding the unique pharmacokinetic profiles of older adults is crucial for effective and safe medication management. This article provides an overview of the pharmacokinetic changes that occur with ageing, including alterations in absorption, distribution, metabolism, and excretion. Emphasising the implications for prescribing practice, the article highlights common challenges and strategies for optimising pharmacotherapy in older patients. By recognising the physiological changes and potential drug interactions, healthcare providers can tailor their prescribing practices to improve therapeutic outcomes and minimise adverse effects in this vulnerable population.

A Study to Estimate the effect of Water Scarcity On the Morphological and Biochemical Parameter of the Plant

The importance of doing research on the effects of water scarcity on plant health and productivity cannot be overstated, particularly in light of the effects of climate change and the rising urgency of water scarcity. Calculating the ways in which water scarcity influences the morphological and biochemical features of plants is the objective of this research. Protein concentrations, antioxidant activity, and chlorophyll content are examples of biochemical parameters, while plant height, leaf area, and root length are examples of morphological criteria. Furthermore, the length of the roots is an example of a root. We were able to see significant changes in the morphological and biochemical properties of the plants by conducting experiments that were carefully controlled and administered with varying degrees of water availability. Water scarcity is a direct factor that affects plant growth, as seen by reduced plant height, reduced leaf area, and shorter root length. In terms of biochemistry, we saw a decrease in the contents of chlorophyll and protein, both of which are essential for the process of photosynthesis and for the overall health of plants. On the other side, antioxidant activity increased, which is indicative of a stress response mechanism that is being used to cope with the lack of water. The findings highlight the critical need of implementing sustainable water management methods in order to achieve the goal of preserving the resilience of plants and the productivity of agricultural production in the face of water scarcity. This research provides valuable insights into the physiological changes that plants go through when they are subjected to water stress. These findings have the potential to open up new routes for the creation of plant varieties that are resistant to drought.

Mortality Risk Factors at Time on ED Admission in Elderly Patients with Infectious Diseases

Background: As elderly individuals often exhibit heightened vulnerability to infections due to factors such as compromised immune systems, chronic illnesses, and age-related physiological changes, understanding the characteristics and risk factors associated with infectious diseases in this population is crucial. The aim of the present study was to evaluate the characteristics of elderly patients with infectious disease in ED admission and to identify risk factors that influence in-hospital mortality. Material and Method: In this study, we enrolled 448 adult patients diagnosed with infectious diseases such as pneumonia, urinary tract infection, gastroenteritis, meningitis, and cellulitis. The participants were directly admitted to our Emergency Department (ED) from their homes or their relatives' residences between November 1, 2014, and May 31, 2015. We investigated patient’s vital signs, disease signs, source of infection, length of staying at hospital, length of staying at emergency service, mortality related scores, laboratory data, treatment and prognosis. Results and Conclusion: The rate of emergency care admissions with an infectious etiology was found as 17%. Average age of patients was 76±8 with 180 (40%) of them being female and 268 (60%) of them being male. Mortality rate was found as 23%. Cox regression analysis concluded that for 65 years or older patients, risk factors that effected mortality were; septic shock, cardiac disease and presence of malignancy, absence of COPD/Asthma, higher pCO2 and lower HCO3 at the time of admission to the emergency service. Calculating MEDS score and APACHE 2 score at admission to the emergency department and intensive care unit can facilitate early intervention, improving recovery prospects. Further research and clinical strategies may benefit from these identified predictors to improve the management and outcomes of elderly patients with infectious diseases in the ED.

A Pharmacologic Evaluation of Buprenorphine in Pregnancy and the Postpartum Period.

The dosing regimen in the package insert for sublingual buprenorphine is similar for pregnant and nonpregnant people despite the physiologic changes seen during pregnancy. To compare plasma buprenorphine pharmacokinetics during and after pregnancy and relate buprenorphine concentration to the pharmacodynamic endpoints of pupil diameter, Clinical Opioid Withdrawal Scale (COWS), and craving scores. Prospective cohort of 22 pregnant people undergoing 33 pharmacologic studies (6-8 hours each) during pregnancy or postpartum. Participants were on a stable daily dose of 2-8 mg sublingual buprenorphine every 6 or 8 hours. The dosing frequency was selected by the participant. On study day, baseline measurements of plasma buprenorphine, pupil diameter, COWS, and craving scores were obtained, then the usual morning dose was taken, and measurements were repeated several times over 1 dosing interval. The dose-normalized area under the plasma buprenorphine concentration time curve was significantly (P = 0.036) lower during pregnancy (155 ± 52 ng × min/mL) than postpartum (218 ± 113 ng × min/mL). Buprenorphine trough concentrations were similar at the start (1.1 ± 0.7 ng/mL) and end of a dosing cycle (1.2 ± 0.8 ng/mL) regardless of dosing frequency. Pupillary diameter, COWS, and craving scores returned to baseline as buprenorphine concentrations approached ~1 ng/mL. Pregnant people require a higher dose of buprenorphine to achieve concentrations comparable to nonpregnant people. There is a temporal relationship between the plasma buprenorphine concentration and the pharmacodynamic markers of pupillary diameter, COWS, and craving scores. An average plasma concentration of ~1 ng/mL was associated with the lowest level of COWS and craving scores.

A Systematic Review of the Relationship Between Traumatic Brain Injury and Disruptions in Heart Rate Variability.

Autonomic nervous system dysfunction is increasingly recognized as a common sequela of traumatic brain injury (TBI). Heart rate variability (HRV) is a specific measure of autonomic nervous system functioning that can be used to measure beat-to-beat changes in heart rate following TBI. The objective of this systematic review was to determine the state of the literature on HRV dysfunction following TBI, assess the level of support for HRV dysfunction following TBI, and determine if HRV dysfunction predicts mortality and the severity and subsequent recovery of TBI symptoms. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two raters coded each article and provided quality ratings with discrepancies resolved by consensus. Eighty-nine papers met the inclusion criteria. Findings indicated that TBI of any severity is associated with decreased (i.e., worse) HRV; the severity of TBI appears to moderate the relationship between HRV and recovery; decreased HRV following TBI predicts mortality beyond age; HRV disturbances may persist beyond return-to-play and symptom resolution following mild TBI. Overall, current literature suggests HRV is decreased following TBI and may be a good indicator of physiological change and predictor of important outcomes including mortality and symptom improvement following TBI.

Physiologic Changes of Pregnancy and Considerations for Screening and Diagnosis of Sepsis

Obstetric sepsis is a significant cause of morbidity and mortality in pregnant people worldwide. Initial evaluation and timely intervention are crucial to improving outcomes for birthing persons and their newborns. While many of the therapies and interventions for peripartum sepsis are consistent with the general population, there are considerations unique to pregnancy. Stabilization of the septic pregnant or immediately postpartum patient requires an understanding of the physiologic changes of pregnancy, hemodynamic changes during labor, and infections specific to pregnancy. We will review the interaction between pregnant physiology and sepsis pathophysiology, and how this can guide screening and diagnosis.

Characteristics, Physiopathology and Management of Dyslipidemias in Pregnancy: A Narrative Review.

Dyslipidemia is a significant risk factor for atherosclerotic cardiovascular disease (ASCVD). During pregnancy, physiological changes elevate cholesterol and triglyceride levels to support fetal development, which can exacerbate pre-existing conditions and lead to complications such as pre-eclampsia, gestational diabetes, and increased ASCVD risk for both mother and child. Effective management strategies are necessary, especially for pregnant women with inherited forms of dyslipidemia (i.e., familial hypertriglyceridemia, hyperchylomicronemia), where personalized dietary adjustments are crucial for successful pregnancy outcomes. Pharmacological interventions and lipoprotein apheresis may be necessary for severe cases, though their use is often limited by factors such as cost, availability, and potential fetal risks. Despite the promise of advanced therapies, their widespread application remains constrained by limited studies and high costs. Thus, a personalized, multidisciplinary approach is essential for optimizing outcomes. This review provides a comprehensive overview of current strategies and evidence-based practices for managing dyslipidemia during pregnancy, emphasizing the balance of maternal and fetal health. Additionally, it discusses the physiological changes in lipid metabolism during pregnancy and their implications, particularly for women with inherited forms of dyslipidemia.

The role of supraglottic airway devices for caesarean section under general anaesthesia. A scoping literature review with a proposed algorithm for the appropriate use of supraglottic airway devices for caesarean sections.

This review aims to assess the published evidence on airway management with a supraglottic airway device (SGA) for general anaesthesia in patients requiring a caesarean section. Physiological changes during pregnancy can make airway management in parturients challenging. At the same time, pregnant patients are at risk of pulmonary aspiration due to hormonal and mechanical alterations. The standard airway management for parturients undergoing caesarean section is rapid sequence induction followed by tracheal intubation. Evidence exists that using second-generation SGA devices is well tolerated and effective in selected patients. In this review, we provide an overview of the existing evidence and provide an algorithm to make an evidence-based clinical decision on the use of SGA devices. An online literature search was performed in Medline, Embase, PubMed, Emcare, Cochrane Library and CINAHL. The search terms used were 'supraglottic airway', 'supraglottic airway device', 'supraglottic airway management', 'supraglottic tube', 'i-gel', laryngeal mask', 'laryngeal mask airway', 'LMA', 'SGA', 'Proseal', 'Supreme', 'obstetric surgery', 'obstetric operation', 'general anaesthesia', 'caesarean' or 'caesarean section', 'abdominal delivery'. Full-text articles in English, Dutch and French were included. Case reports and studies in which the surgery was not a caesarean section were excluded. The initial search yielded 815 results. Following screening, deduplication and removal of publications that were unrelated to the topic or did not fit the inclusion criteria, 13 manuscripts were included in our analysis. A total of 7722 patients were described in the articles included. In the majority of manuscripts, second-generation SGA devices were used. There were seven cases of failed insertion and a need for conversion to tracheal intubation; first-generation SGA devices were used in these cases. There were no cases of pulmonary aspiration, and only one case of gastric regurgitation was described. Growing evidence suggests that the use of second-generation SGA devices might be well tolerated as the primary method for securing the airway for caesarean sections requiring general anaesthesia, in selected patients with a low risk for aspiration and difficult intubation.