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A randomized comparison of low dose ropivacaine programmed intermittent epidural bolus with continuous epidural infusion for labour analgesia

Abstract

Background: Two methods of local anaesthetic administration into the epidural space in natural delivery pain management are compared in the article. Methods compared are programmed intermittent epidural bolus (PIEB) and continuous epidural infusion (CEI). Patient-controlled epidural analgesia was provided simultaneously in all cases.

Methods: 84 primipara with average age 30.7 (27.5-34) years, and gestational age 39.1 (38.5-40) weeks planned to natural delivery were examined. PIEB and patient controlled epidural analgesia was used in the first group. Patient controlled epidural analgesia and continuous epidural infusion (CEI) of local anaesthetic was used in the second group. Ropivacaine hydrochloride 0.08% without any adjuvants was utilized as local anaesthetic. Pain assessment was conducted using VAS while motor block was assessed using the Bromage scale.

Results: Labor progression dynamics and condition of newborns were equally independent to the method of analgesia. However, analgesic endpoint was better and more long-lasting while using PIEB with patient controlled epidural analgesia. Moreover, a lesser amount of local anaesthetic was consumed. In the group with programmed bolus, the total volume of local anaesthetic was 59.9 (45-66) ml in comparison with 69.5 (44-92) ml in the continuous infusion group (p = 0.033). The time to first bolus requested by the puerpera was significantly longer in the programmed bolus group – 89.2 (57-108) min compared to 43.2 (35-65) minutes in the continuous infusion group (p = 0.021).

Conclusion: Administration of low-concentrated ropivacaine solution 0.08% with no opioids using PIEB provides better and more prolonged analgesia with less local anaesthetic consumption and without any additional maternal and newborn side effects in comparison with continuous infusion.

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New Targets for End-Stage Chronic Kidney Disease Therapy

Dev. 2001;103:183-8. 7. Norris RA, Kern CB, Wessels A, et al. Identification and detection of the periostin gene in cardiac development. AnatRec A Discov Mol CellEvolBiol. 2004;281:1227-33. 8. Corren J, Lemanske RF, Hanania NA, et al. Lebrikizumab treatment in adults with asthma. N Engl J Med. 2011;365:1088-98. 9. Naik PK, Bozyk PD, Bentley JK, et al. Periostin promotes fibrosis and predicts progression in patients with idiopathic pulmonary fibrosis. Am J Physiol Lung Cell Mol Physiol. 2012;303:L1046-56. 10. Guerrot D, Dussaule JC, Mael

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Plasma Neutrophil Gelatinase Associated Lipocalin (NGAL) – Early Biomarker for Acute Kidney Injury in Critically Ill Patients

predict worsening renal function in high-risk patients presenting with oliguria. Intensive Care Med. 2015;41:68-76. 22. Bolignano D, Lacquaniti A, Coppolino G, et al. Neutrophil gelatinase-associated lipocalin (NGAL) and progression of chronic kidney disease. Clinical Journal of the American Society of Nephrology. 2009;4:337-44. 23. Haase M, Bellomo R, Fielitz AH. Neutrophil gelatinaseassociated lipocalin: a superior biomarker for detection of subclinical acute kidney injury and poor prognosis. Biomarkers Med. 2011

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The Relevance of Coding Gene Polymorphysms of Cytokines and Cellular Receptors in Sepsis

Abstract

Sepsis is an injurious systemic host response to infection, which can often lead to septic shock and death. Recently, the immune-pathogenesis and genomics of sepsis have become a research topic focusing on the establishment of diagnostic and prognostic biomarkers. As yet, none have been identified as having the necessary specificity to be used independently of other factors in this respect. However the accumulation of current evidence regarding genetic variations, especially the single nucleotide polymorphisms (SNPs) of cytokines and other innate immunity determinants, partially explains the susceptibility and individual differences of patients with regard to the evolution of sepsis. This article outlines the role of genetic variation of some serum proteins which have the potential to be used as biomarker values in evaluating sepsis susceptibility and the progression of the condition.

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Statins as Pleiotropic Modifiers of Vascular Oxidative Stress and Inflammation

Abstract

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the industrialized world and in the future is expected to be the number one killer worldwide. The main cause underlying CVD is atherosclerosis. A key event in atherosclerosis initiation and progression is oxidative stress through the production of reactive oxygen species as well as endothelial dysfunction. Several pro- inflammatory and anti-inflammatory cytokines and proteins are involved in this process, complemented by activation of adhesion molecules that promote leukocyte rolling, tethering and infiltration into the sub-endothelial space. Statins represent the agent of choice since numerous clinical trials have verified that their pharmacological action extends beyond lipid lowering. Statins demonstrate direct anti-oxidant effects by scavenging free radicals and stimulating anti-oxidant enzymes while acting as regulators for cytokine, protein and adhesion molecule expression, all of which are involved in the atherosclerotic process. Statin use is considered one of the most efficient currently used interventions in managing CVD with the likely hood of remaining so in the near future.

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An Evaluation of Serum Procalcitonin and C-Reactive Protein Levels as Diagnostic and Prognostic Biomarkers of Severe Sepsis

Abstract

Background: Recommendations have been made, following the multicenter Surviving Sepsis Campaign study, to standardize the definition of severe sepsis with reference to several parameters such as haemodynamic stability, acid-base balance, bilirubin, creatinine, International Normalized Ratio (INR), urine output and pulmonary functional value of the ratio between arterial oxigen partial pressure and inspiratory oxigen concentration. Procalcitonin (PCT) is considered to be a gold standard biomarker for the inflammatory response, and recent studies have shown that it may help to discover whether a seriously ill person is developing sepsis. C-reactive protein (CRP) is also used as a marker of inflammation in the body, as its blood levels increase if there is any inflammation in the body. The aim of this study was to evaluate serum procalcitonin and C-reactive protein levels as diagnostic and prognostic biomarkers of severe sepsis.

Material and method: Sixty patients, diagnosed as being “septic”, were admitted to the intensive care unit (ICU). Based on laboratory results and clinical findings a diagnosis of “severe sepsis“ was made, and correlated with PCT and CRP values. The APACHE II, SAPS II and SOFA severity scores were calculated, analyzed and correlated with PCT and CRP.

Results: Fifty two patients (86.67%) presented with criteria for severe sepsis. Multivariate correlation analysis indicated a significant positive association between procalcitonin and all severity scores (APACHEII p<0.0001, SOFA p<0.0001, SAPS II p<0.0001). CRP proved to be significantly correlated only with the SAPS II score (p=0.0145). Mortality rate was high, with 48 patients (80%) dying. There was no significant correlation between the levels of the PCT and CRP biomarkers and severe sepsis (p=0.2059 for PCT, p=0.6059 for CRP).

Conclusions: The procalcitonin levels are highly correlated with the severity scores (APACHE II, SAPS II, SOFA) regularly used in ICUs and therefore can be used for determining the severity of the septic process. Quantitive procalcitonin and C-reactive protein analysis was not shown to be useful in diagnosing severe sepsis. However, PCT and CRP can be used to predict the fatal progression of the septic patient.

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Neutrophil Gelatinase-Associated Lipocalin as a Marker for Renal Dysfunction Detection in Critically Ill Patients with Increased Intraabdominal Pressure

Care Surg. 2013;74:1060–1066 20. Hjortrup PB, Haase N, Wetterslev M et al. Clinical review: Predictive value of neutrophil gelatinase-associated lipocalin for acute kidney injury in intensive care patients. Crit Care. 2013;17(2):211.013 21. Patel ML, Sachan R, Verma A, Kamal R, Gupta KK. Neutrophil gelatinase-associated lipocalin as a biomarker of disease progression in patients with chronic kidney disease. Indian J Nephrol. 2016;26(2):125-30. 22. Munna LP, Rekha S, Misra M, Ritul K, Radhey S, Pushpalata S. Prognostic significance of urinary NGAL in

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Pulseless Electrical Activity Arrest as the First Symptom of Testicular Cancer with Subsequent Phlegmasia Cerulea Dolens

is usually the first imaging modality in the diagnosis of PCD, due to its accessibility, reliability, and non-invasive nature. CT and MR venography are useful adjuvant modalities to determine the extent of thrombus and potential underlying causes, including extrinsic venous compression [ 1 ]. The gold standard imaging modality is considered to be CT venography [ 6 ]. The management of PCD involves a combination of medical and surgical therapies depending on the effectiveness of treatment. The goal of any initial treatment is to halt the progression of thrombus

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Sepsis in Acute Mediastinitis – A Severe Complication after Oesophageal Perforations. A Review of the Literature

case of cervical perforation, surgical and endoscopic therapeutic options are extremely low, in thoracic and abdominal ones, primary suturing and endoscopic stenting of the perforation significantly improve survival rate [ 42 ]. Late perforations and oesophageal neoplasm require difficult surgical treatment with oesophageal stripping, oesophagostomy and gastrostomy, followed by oesophageal reconstruction after 6–12 months. The evolution of these cases is in most cases unfavourable, due to the progression of mediastinitis and the development of septic shock [ 27

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