The association between procalcitonin, venous blood gas parameters, and clinical prognosis in patients with Crimean--Congo Hemorrhagic Fever

Objective: Crimean–Congo hemorrhagic fever (CCHF) is a zoonotic infection characterized by fever and hemorrhage that is endemic to northeastern Turkey. This study aimed to examine the association between procalcitonin and venous blood gas parameters and clinical course and prognosis in patients with CCHF. Methods: A total of 96 CCHF patients who were followed up in the infectious diseases department between March and September 2020 were included in the study. The patients’ routine laboratory tests, serum procalcitonin, and results of venous blood gas analysis were analyzed retrospectively. Results: There were statistically significantly differences in serum platelet, aspartate transaminase, alanine transaminase, creatinine kinase, lactate dehydrogenase, potassium, C-reactive protein, sedimentation, D-dimer, activated partial thromboplastin time, ferritin, procalcitonin and lactate levels, and platelet/lymphocyte ratio among the patients with mild, moderate and severe disease (p=0.017 for potassium and p=0.001 for rest of others). In receiver operating characteristic (ROC) curve analysis of serum lactate for the differentiation of patients with severe disease and those with mild/moderate disease, the area under the curve was 0.802 and a cut-off value of 1.9 mmol/L had 77.8% sensitivity and 76.9% specificity. For serum procalcitonin, the area under the ROC curve was 0.892 and a cut-off value of 0.61 ng/ml had 83.3% sensitivity and 89.7% specificity. Conclusion: Serum procalcitonin and lactate levels may be useful and easily obtained parameters to guide the evaluation of clinical severity and follow-up in patients with CCHF.

Comparison of the effects of volume-controlled ventilation and pressure-controlled ventilation modes on hemodynamics, respiratory mechanics and blood gas parameters in patients undergoing laparoscopic cholecystectomy

Background: This study aimed to compare the changes induced by VCV and PCV modes in hemodynamics, respiration (airway pressures, gas exchange parameters) and metabolism (acid-base balance) in patients undergoing laparoscopic cholecystectomy.Methods: Patients were divided into two randomised groups as volume-controlled ventilation (VCV) group (VC) and pressure-controlled ventilation (PCV) group (PC). The following parameters were recorded at 3 different time points: T1: in supine position 10 minutes after induction of anaesthesia, T2: 15 minutes after CO2 insufflation in inverted Trendelenburg position (head 30 degrees up), T3: 10 minutes after CO2 desufflation. HR, SpO2, SAP (systolic arterial pressure), DAP (diastolic arterial pressure), MAP (mean arterial pressure), PetCO2 (end-tidal carbon dioxide pressure), Ppeak, Pplateau, Pmean, Vt (tidal volume) and compliance with the available data, the cases in both groups Vd, Vd/Vt ratios and P(A-a)O2 were calculated. Arterial blood gas parameters (pH, PaO2, PaCO2, SaO2, P(a-et)CO2) values were recorded.Results: It was found that Ppeak and Pplateau values were significantly higher in the VC group (p<0.05). It was found that compliance was significantly higher in the PC group (p<0.05) (p<0.01). In the postoperative period, it was found that PaO2 values were significantly higher in the PC group compared to the VC group (p<0.05). It was found that the P(A-a)O2 values of the PC group were significantly higher than those of the VC group during the desufflation phase (p<0.05).Conclusions: We think that PCV mode can be a good alternative for the prevention and correction of physiopathological changes due to laparoscopic surgery.

COMPARISON OF THE EFFECT OF PHENYLEPHRINE AND EPHEDRINE ON UMBILICALARTERIAL BLOOD GAS PARAMETERS IN ELECTIVE CAESAREAN SECTION UNDER LUMBAR SUBARACHNOID BLOCK

Introduction: Potential side effects such as supraventricular tachycardia, tachyphylaxis, and most importantly, fetal acidosis render the use of ephedrine as a rst line agent to treat hypotension in obstetric patient debatable. Phenylephrine, an alternative drug, has a reduced incidence of nausea and vomiting as well as decreased fetal acidosis, which gives it an advantage over the use of ephedrine. Materials and methods: We conducted an observational study in 68 ASA II patients scheduled for lower segment caesarean section. Parturients who satised the inclusion criteria were randomly assigned into one of the two groups of 34 each- group P with parturients who were to receive phenylephrine boluses in 100 mcg increments and group E with parturients who were to receive ephedrine boluses in 6mg increments when they developed hypotension. Fetal umbilical arterial blood gas was analyzed and parameters were compared. Results: On analyzing umbilical arterial blood values, a lower mean pH was found in group E (7.27± 0.09) when compared to group P (7.3± 0.04). Also a higher PCO value (49± 7.4) was found in group E when compared to group P (43.9 ± 6.4). Other umbilical arterial blood gas values were 2 comparable between both groups

Features of gas composition and acid-base state of blood in newborns with intrauterine infections

Aim. To study the features of the gas composition and acid-base state in newborns with specific intrauterine infections.Material and methods. The examination was conducted based on the neonatal pathology unit of the SI NMCShifobakhsh.The degree of oxygenation of blood and skin was determined using daily pulse-oximetry. The partial pressure of gases and the study of the acid-base state (CBS) of blood was carried out using Convergys/liquid device.Result and discussion. The results of our study of blood gases and the acid-base indicator of blood in newborns with severe IUI showed noticeable hypoxemia, moderate hypercapnia, and a deficiency of buffer States, which indicate a violation of gas exchange function in the lungs with the development of compensatory respiratory-metabolic acidosis in children of this group. In patients with a very severe course of IUI, as the syndrome of respiratory disorders and the severity of hyperventilation syndrome increased, deeper changes in blood gas parameters and the acid-base state of the blood were noted. It indicates significant damage to the ventilation function of the lungs, diffuse perfusion processes, gas, and acid-base homeostasis.Conclusions. Impairment of the function of organs and systems that developed against the background of a severe or very severe course of IUI, depending on the degree of severity of deviations in blood gas parameters and acid-base balance, shows the need for adequate corrective therapy.

The effect of ultrasonographic measurement of vena cava inferior diameter on the prediction of post-spinal hypotension in geriatric patients undergoing spinal anesthesia

Aims: In our study,we aimed to investigate whether end-expiratory vena cava inferior (expVCI) diameter and vena cava inferior collapsibility index predicted post-spinal hypotension in geriatric patients undergoing spinal anesthesia, the correlation between them and other parameters. Material and methods: Our prospective study included ASA I-4,73 patients over 65 years of age, who were scheduled for operation using spinal anesthesia. According to the expVCI diameter displayed with USG before spinal anesthesia, patients; those with an expVCI diameter less than 1.8 cm previously determined as the threshold value are grouped as 1.(Small-VCI) Group,those greater than 1.8cm as 2.(Large-VCI) Group. Demographic characteristics of the patients, comorbidities, duration and type of operation, basal (preoperative) heart rate, systolic, diastolic, mean blood pressure, peripheral oxygen saturation values before spinal anesthesia and after spinal anesthesia in supine position (0 min) and 5th, 10th, 15th, 20th, 25th, 30th min and preoperative arterial blood gas parameters, amount of peroperative urine and bleeding, inotropic and fluid requirement, complications were recorded. Results: Hypotension developed in 28(38.4%) patients and bradycardia in 14 (19.2%) of patients. The patients who developed hypotension had more ASA 2 and ASA 3 (p=0.01), shorter height (p=0.02), and smaller expVCI diameter (p=0.004).It was observed that they had higher lactate (p=0.03), lower pH (p=0.006) values, and more inotropic agents were administered (p<0.001). While the rate of developing hypotension was 51.1% (n=23) in the patients in the Small-VCI group, this rate was 17.9% (n=5) in the patients in the Large-VCI group (p=0.004). Conclusion: It was concluded that the expVCI diameter value measured by USG before spinal anesthesia in elderly patients is effective in predicting post-spinal hypotension with lactate and pH values, which are among the blood gas parameters, and expVCI can be preferred to invasive methods due to its noninvasive, easy and fast application.

Impact of Face Masks on Exercise Capacity and Lactate Thresholds in Healthy Young Adults

Background: Although many countries have introduced strict guidelines regarding mouth and nose coverage in public to contain infection rates during the SARS-CoV-2 pandemic, more information is needed regarding the impact of wearing face masks on lactate thresholds (LT) and performance parameters during exercise. Methods: Ten healthy male and 10 healthy female subjects (age = 33.4 [10.26] y, body mass index = 23.52 [2.36] kg/m2) performed 3 incremental performance tests, wearing no mask (NM), surgical mask (SM), and filtering face piece mask class 2 (FFP2), with a cycle ergometer. The authors analyzed changes in the LT, in blood gas parameters, and in the rating of perceived exertion (RPE). Results: Performance at LT remained unchanged in subjects wearing SM or FFP2 in comparison with NM (162.5 [50.6] vs 167.2 [58.9] vs 162.2 [58.4] W with NM, SM, and FFP2, respectively, P = .24). However, the peak performance was significantly reduced wearing FFP2 compared with NM (213.8 [71.3] vs 230.5 [77.27] W, FFP2 vs NM, respectively, P < .001). Capillary pCO2 was increased while wearing SM as well as FFP2 compared with NM (29 [3.1] vs 33.3 [4] vs 35.8 [4.9] mmHg with NM, SM, and FFP2, respectively; P < .001), and pO2 decreased under maximum performance (84 [6.7] vs 79.1 [7.5] vs 77.3 [8.2] mmHg with NM, SM, and FFP2, P < .01). Importantly, rating of perceived exertion was significantly increased by wearing FFP2 compared with NM at LT according to Mader (16.7 [2.7] vs 15.3 [1.8] FFP2 vs NM, respectively, P < .01). Conclusion: Wearing face masks during exercise showed no effect on LT, limited maximum performance, and induced discrete changes in capillary pCO2 and pO2 within the physiologic range while increasing RPE at LT.

Malignant priapism secondary to metastatic colon adenocarcinoma: a case report

Background and objective: Priapism is an uncommon urological emergency, and is even less commonly caused by colon adenocarcinoma metastasis. The aim of this article is to report a case of malignant priapism caused by metastatic colon adenocarcinoma. Methods and materials: Case sharing and clinical experience summary of a 61-year-old man with priapism and hematuria persisting for more than 30 days presented to our hospital in September 2019. Results: The patient did not have a history of perineal trauma, nervous system disease, or hematological system disease. Penile Doppler ultrasound showed no obvious blood flow signal, and penile arterial blood gas parameters were pH of 7.01, partial pressure of oxygen of 26 mmHg, and partial pressure of carbon dioxide of 71 mmHg, suggesting the occurrence of ischemic priapism. Abdominopelvic computed tomography enhancement images showed a localized irregular shape and high-density imaging of the root of the corpus cavernosum. Histopathology after cystoscopy confirmed the metastasis of colon adenocarcinoma. Superselective embolization of the internal pudendal artery was performed, which partially relieve the abnormal penile erection, but drug treatment did not significantly alleviate the patient's priapism. Conclusion: Priapism secondary to metastatic colon adenocarcinoma suggests systemic dissem-ination, indicative of a poor prognosis. In such cases, unnecessary surgery should be avoided. Superselective embolization could be an optional treatment for priapism secondary to cancer.