Anesthesia for cesarean in pregnant with uncorrected failot tetralogy

Tetralogy of Fallot is the most common cyanotic congenital heart disease. Hemodynamic changes can cause serious and fatal multi-organ complications, the choice of anesthesia is very difficult.Combined spinal epidural techniques have become an alternative to traditional neuraxial interventions; the advantages of spinal or subarachnoid block are fused with the flexibility of the epidural technique; they offer a fast, effective and minimally toxic spinal block, improve inadequate block, and prolong the duration of anesthesia with epidural supplements.The purpose of this article is to report the case of a pregnant woman with a diagnosis of uncorrected Tetralogy of Fallot and the anesthetic technique of effective establishment without producing harmful hemodynamic changes for the mother-child binomial.

Anaesthetic implications for splenectomy in a child with Gaucher’s disease

Gaucher’s disease, a lysosomal storage disorder, is caused by an inherited deficiency of beta glucocerebrosidase enzyme leading to the accumulation of glucocerebroside in the reticuloendothelial system. Patients with this disease often manifest coagulation abnormalities and multi-organ complications. These factors present a challenge to the anaesthesiologist, in deciding the type as well as the conduct of anaesthesia. We aim to report the anaesthetic management in a 3-years old child with Gaucher’s disease posted for splenectomy.

PROVE—Pre-Eclampsia Obstetric Adverse Events: Establishment of a Biobank and Database for Pre-Eclampsia

Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality. The burden of disease lies mainly in low-middle income countries. The aim of this project is to establish a pre-eclampsia biobank in South Africa to facilitate research in the field of pre-eclampsia with a focus on phenotyping severe disease.The approach of our biobank is to collect biological specimens, detailed clinical data, tests, and biophysical examinations, including magnetic resonance imaging (MRI) of the brain, MRI of the heart, transcranial Doppler, echocardiography, and cognitive function tests.Women diagnosed with pre-eclampsia and normotensive controls are enrolled in the biobank at admission to Tygerberg University Hospital (Cape Town, South Africa). Biological samples and clinical data are collected at inclusion/delivery and during the hospital stay. Special investigations as per above are performed in a subset of women. After two months, women are followed up by telephonic interviews. This project aims to establish a biobank and database for severe organ complications of pre-eclampsia in a low-middle income country where the incidence of pre-eclampsia with organ complications is high. The study integrates different methods to investigate pre-eclampsia, focusing on improved understanding of pathophysiology, prediction of organ complications, and potentially future drug evaluation and discovery.

Comparison of Clinical Characteristics of Adolescent Women With Different Subtypes of Anorexia Nervosa With First Episode and Without Treatment

Background This study compared whether differences between different anorexia nervosa(AN)subtypes(R-AN,B-AN) in multiple organ complications. Methods Peripheral white blood cells (WBCs),thyroid function,etc, were measured in 53 patients (R-AN = 30,B-AN = 23)and compared 55 healthy controls (HCs) Results Compared with HCs, significant differences between R-AN in T, P, DBP, SBP WBC, PRL, TT4, TSH, FT3, FT4, TT3, TP, HGB, RBC,, EDI total score and DT, I, ID, IA ,BD, P and MF. Compared with HCs, significant differences between B-AN in DBP, WBC, PRL, TT4, FT3, FT4, TT3, TP, HGB, RBC,, EDI total score, DT, BD, I, ID, and IA and differences in PLT and P. significant differences between R-AN and B-AN in T, P, DBP, SBP, PRL, TSH, B, FT4, and HGB. In R-AN, BMI negatively correlated with amenorrhea, and PRL EDI total score, DT, BD, and P positively correlated with DBP, SBP, HGB and GLB. In B-AN, BMI negatively correlated with amenorrhea, PRL, EDI total score, and DT, and B, BD, positively correlated with T and DBP. Conclusion The effects of R-AN and B-AN on T, P, DBP, SBP, PRL TSH, B, FT4, and HGB were different, and BMI played a role in the changes.

Microvascular Angiopathic Consequences of COVID-19

The coronavirus disease-2019 (COVID-19) pandemic has rapidly spread across the world. The disease is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which first appeared in Wuhan, China in December, 2019. Ever increasing data is continuing to emerge about the impact of COVID-19 on cardiovascular tissue and other organ system. Clinical features associated with COVID-19 suggest that endothelial cell dysfunction and microvascular thrombosis are to a large extent contributing to resultant multi-organ complications. This review is aimed at highlighting the critical aspects associated with COVID-19 and its presumed microvascular angiopathic consequences on the cardiovascular system leading to multi-organ dysfunction.

Monitoring of the kidneys, liver, and other vital organs

The prognosis of critically ill cardiac patients in the critical care unit and intensive cardiac care unit depends not only on the underlying cardiac disease, but also on the development of secondary organ complications and failures. Therefore, close monitoring of vital organs is mandatory in all critically ill cardiac patients to detect the development of non-cardiac organ failure as early as possible.

Microvascular Angiopathic Consequences of COVID-19

The coronavirus disease-2019 (COVID-19) pandemic has rapidly spread across the world. The disease is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which first appeared in Wuhan, China in December, 2019. Ever increasing data is emerging about COVID-19 and its effects on the arterial and venous circulation. Clinical features associated with COVID-19 suggest that endothelial cell dysfunction and microvascular thrombosis are to a large part contributing to resultant multi-organ complications. This review is aimed at highlighting the critical aspects associated with COVID-19 and its presumed microvascular angiopathic complications leading to multi-organ dysfunction.

Alloimmunization Is Associated with Increased Indirect Markers of Hemolysis and Distinct End-Organ Specific Complications in Sickle Cell Disease

Introduction Red blood Cell (RBC) transfusion therapy is an important disease modifying treatment in sickle cell disease (SCD). RBC alloimmunization is one of the more serious complications associated with transfusion therapy and limits its wider clinical application. This complication can result in both acute and delayed hemolytic reaction in the recipients. It is unknown at this time if alloimmunization can lead to broader downstream end-organ complications in sickle cell disease. In this retrospective study, we analyzed the complications associated with RBC alloimmunization in the Central Missouri SCD cohort following development of allo- antibodies (Allo-Ab). Methods We performed a retrospective chart review of all SCD individuals treated at the University of Missouri Medical Center from December 2000 to 2017. Only SCD patients that received RBC transfusions at the Center were included in the study. A two-tailed student's t-test was used to analyze all continuous variables. Fischer's exact test was used to analyze all categorical variables. Apvalue of <0.05 was considered statistically significant. Results Of the 130 SCD patients, 80 patients were eligible to be included in the study based on available laboratory and clinical data. There were 51 HbSS, 25 HbSC, and 4 HbSβ0/+ patients, and overall, 28% of the patients had alloantibodies following transfusion therapy. The mean hemoglobin and hematocrit were lower in alloimmunized versus non-alloimmunized (8.65 gm/dl vs 9.48 gm/dl, p = 0.016) SCD individuals. Reticulocyte count, total bilirubin (2.9 mg/dl versus 1.8 mg/d, p = 0.02), and urine urobilinogen were elevated in allo-immunized individuals. Overall, alloimmunized patients received more packed red blood cell (PRBC) units/life year (9.18 versus 3.60 units, p = 0.021). Demographic factors like age of first transfusion, systolic, diastolic, and mean blood pressures were not significantly different between the groups. Inflammatory markers such as erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP) were not significantly different in alloimmunized and non-alloimmunized individuals. Absolute neutrophil count, platelet count, and lymphocyte counts were not significantly altered in patients with and without allo-AB. Hemoglobin F concentration or hydroxyurea usage were not significantly different between the groups. Distinct gender differences in hematological profile and end-organ complications were observed in allo-immunized individuals (Table 1). Indirect markers of hemolysis were persistently elevated in alloimmunized men (Table1) compared to women. Seizures were an associated complication in alloimmunized compared to non-alloimmunized (66.6% versus 33.3%, p = 0.0058) men. Decreased glomerular filtration rate (GFR) was observed in women with alloimmunization compared to men. Conclusions Alloimmunization in men is associated with distinct downstream complications compared to women. Persistence of elevated indirect markers of hemolysis were observed more in men with allo-Ab. Men with allo- Ab had more central nervous system complications compared to women. These findings have important clinical and therapeutic significance and needs to be tested in larger clinical trials. Figure 1 Disclosures Busken: ASH:Other: 2018 HONORS Award Recipient.