Diagnostic Re-Evaluation and Potential Predictor Factors of Transient and Permanent Congenital Hypothyroidism in Eutopic Thyroid Gland

Background: The incidence of congenital hypothyroidism (CH) has increased over the years, and many predictors for detecting newborns with transient forms (TCH) as early as possible have been considered. Methods: All newborns diagnosed with primary CH and eutopic gland in the Piedmont region of Italy in the period of January 2014–June 2019 were enrolled and re-evaluated at the age of 2 years. Results: 105 newborns were diagnosed with CH during the study period. Dyshormonogenesis was observed in 55/105. At re-evaluation, we found that 52.7% had permanent CH (PCH), while 47.3% had TCH. Male/female rate, TSH levels at diagnosis, levothyroxine requirement at withdrawal and extra-thyroid congenital malformations rate were higher in the PCH group (p = 0.02, p = 0.009, p = 0.02 and p = 0.01), while fT4 levels at diagnosis were lower (p = 0.03). Sensitivity of 72.4% and specificity of 80.7% for serum TSH above 60 mcUI/mL, sensitivity of 73% and specificity of 72.4% for serum fT4 level below 7.2 pg/mL and sensitivity of 66% and specificity of 68% for drug requirement above 2.25 mcg/kg/day were observed in PCH. Conclusions: Demographic, clinical and hormonal data at diagnosis and levothyroxine requirement during the first two years should be adequately monitored to identify infants who are most likely to discontinue therapy after the age of 24 months.

Predictors of Perioperative Vasoactive Drug Requirement During Retroperitoneal Adrenalectomy for Pheochromocytoma: A Retrospective Exploratory Study

The aim of the present study was to test a hypothesis that baseline systemic vascular resistance index (SVRI) assessed by method of transpulmonary thermodilution predicts perioperative requirement for vasoactive drugs. The primary outcomes were: (1) peak vasoactive-inotropic score (VIS) and (2) peak dose of hypotensive drugs at any stage of surgery. The main exposure variable was baseline SVRI. Hemodynamics were retrospectively assessed by transpulmonary thermodilution in 50 adults who had undergone posterior retroperitoneal surgery for pheochromocytoma. Univariate linear regression analysis showed predictive value of SVRI on VIS [regression coefficient, 95% CI; 0.024 (0.005, 0.4), p=0.015]. Other significant factors were the history of peak diastolic pressure, baseline MAP, baseline betablocker therapy, and history of coronary artery disease (CAD). After adjustment of SVRI for the history of CAD, its prognostic value became non-significant [0.018 (0.008, 0.03), p=0.063 and 29.6 (19, 40.2), p=0.007 for SVRI and history of CAD, respectively]. Requirements of vasodilators were predicted by baseline adrenergic activity [0.37 (0.005, 0.74), p=0.047]. In conclusion, baseline SVRI is associated with perioperative requirement of vasopressor drugs, but history of CAD is a stronger prognostic factor for vasopressor support. Perioperative requirement in vasodilators is associated with baseline adrenergic activity.

EFEKTIVITAS PERENCANAAN KEBUTUHAN OBAT DENGAN METODE MORBIDITAS TERHADAP KETERSEDIAAN OBAT KEMOTERAPI

One cycle of chemotherapy does not eliminate all cancer cells, therefore it takes a repeated cycle (Williams, et al, 2016), so the guarantee the availability of chemotherapy drugs is needed. An effective drug requirement planning is required to ensure the availability of chemotherapy drug. This study was intended to determine the effectiveness of planning the need for chemotherapy drugs using the morbidity method on the availability of chemotherapy drugs in Dr. Ramelan Navy Hospital. This study was an observational study with a cross sectional study design. The instrument used in this study was the data collection sheet with data sources prescription sheets and sheets of chemotherapy drug reconstitution during 2015-2017. Descriptive data analysis and to determine effective planning methods using indicators of drug availability. The results showed that the planning of drug needs with the morbidity method can better guarantee the availability of chemotherapy drugs and can minimize drug shortages compared to the consumption method that has been done so far in Dr. Ramelan Navy Hosptal. So it can be concluded that in this study, the morbidity method is effective in meeting the needs of chemotherapy drugs.

Negative central venous to arterial lactate gradient in patients receiving vasopressors is associated with higher ICU 30-day mortality: a retrospective cohort study

Background Serum lactate has long been used to evaluate hypoxia and predict prognosis in critically ill patients, however, discrepancy in lactate measurements between different sites have not been recognized as a useful tool for monitoring hypoxia and evaluating outcome. Methods Data were obtained from the clinical information system of the intensive care unit (ICU) in a tertiary academic hospital for 1582 ICU patients with vasoactive drug requirement and valid paired blood gas. The mortality rates were compared between patients with sustained negative venous to arterial lactate gradient (VALac) and the others using the Cox proportional hazard model. Predictive factors associated with negative VALac were searched. Results A sustained negative VALac was significantly associated with higher 30 day ICU mortality [Adjusted hazard ratio (HR) = 2.31, 95% confidence interval (CI), 1.07–4.99; p = 0.032. Propensity score- weighted HR: 2.57; 95% CI, 1.17–5.64; p = 0.010]. Arterial lactate in the first blood gas pair, 24-h arterial lactate clearance, use of epinephrine, mean positive end-expiratory pressure level, and extracorporeal membrane oxygenation initiation showed statistically significant association with sustained negative VALac during the first 24 h. Conclusion The sustained negative VALac in the early stage of treatment may suggest additional information about tissue hypoxia than arterial lactate alone. Critical care physicians should pay more attention to the lactate discrepancy between different sites in their clinical practice.

Regional Anaesthesia for the Neonate

Numerous regional and local anaesthesia techniques are available for safe use in neonates and can be administered either in combination with general anesthesia or in the awake neonate. Regional anaesthesia provides effective analgesia with reduced drug requirement which is especially beneficial in view of the immature physiology and metabolism in the neonate. The reduced requirement of anaesthetic drugs facilitates stable hemodynamics, faster recovery and a decreased length of stay in the neonatal intensive care unit.

Abstract 136: Improvement of BP Control (and Simultaneous Reduction of Drug Consumption) in Treated Hypertensive Patients Compliant to a Minimal Dietary Sodium Restriction

The official guidelines for hypertension recommend a low sodium diet as a basic approach. Sodium should be restricted to 100 mEq a day. Such tight diets are seldom paralleled by an adequate compliance. Methods: we studied the effects of a reasonable and realistic low sodium diet on the BP values in 196 pts. (157 pts. completed the study). The patients had to avoid ice creams, cheese and salt-preserved (cured) meat. They were switched from regular to salt-free bread. Otherwise they were free to follow their usual mediterranean diet. Urinary output of Na and K, weight, number of antihypertensive drugs taken, and office BP/HR were measured before diet started (Value 1 in the table) and after 9±1 weeks on diet (Value 2 in the table) (all values are mean ± SD). The BP was recorded with the patient alone, in a seated position, with automatic repeated measures, by means of Omron 907 HEM monitors. At the end of the study 88 patients showed a reduction in the urinary sodium (compliant pts.), whereas 69 did not (noncompliant pts.). In those compliant to the low salt approach (88 out of 157 pts. i.e. 56%), a substantial improvement was attained in terms of BP control and body weight with a simultaneous significant reduction in the daily drug requirement. The responders increased from 47 to 69 (i.e. from 53% to 78%). In the noncompliant group the BP values, the responder rate (35 to 32, i.e. 50% to 46%), the weight, and the drug consumption were stable. Conclusion: even a limited dietary salt reduction may be beneficial in terms of BP control, with a decrease of the BP levels and an increase in the responder rate, paralleled by a reduction of the drug requirement. Take home message: even a bit of diet is better than no diet.

Effects of scalp block with bupivacaine versus levobupivacaine on haemodynamic response to head pinning and comparative efficacies in postoperative analgesia: A randomized controlled trial

Objective This study was performed to determine the effects of scalp blocks with bupivacaine versus levobupivacaine on the haemodynamic response during craniotomy and the efficacies and analgesic requirements of these drugs postoperatively. Methods This randomized, prospective, placebo-controlled, double-blind study included 90 patients (age, 18–85 years; American Society of Anesthesiologists physical status, I or II). The patients were randomly divided into three groups: those who received 20 mL of 0.5% bupivacaine (Group B, n = 30), 20 mL of 0.5% levobupivacaine (Group L, n = 30), or saline as a placebo (Group C, n = 30). Scalp blocks were performed 5 min before head pinning. The primary outcome was the mean arterial pressure (MAP), and the secondary outcomes were the heart rate (HR), visual analogue scale (VAS) scores, and additional intraoperative and postoperative drug use. Postoperative pain was evaluated using a 10-cm VAS. Results During head pinning and incision, the MAP and HR were significantly higher in Group C. The additional drug requirement for intraoperative hypertension and tachycardia was significantly higher in Group C. There were no significant differences in MAP, HR, or VAS scores between Groups B and L. Conclusion Both bupivacaine and levobupivacaine can be effectively and safely used for scalp blocks to control haemodynamic responses and postoperative pain.