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Ștef A, Bodolea C, Bocșan IC, Vesa ȘC, Pop RM, Cainap SS, Achim A, Antal O, Tintiuc N, Buzoianu AD. Investigating Potential Correlations between Calcium Metabolism Biomarkers and Periprocedural Clinical Events in Major Cardiovascular Surgeries: An Exploratory Study. J Clin Med 2024; 13:2242. [PMID: 38673516 PMCID: PMC11051212 DOI: 10.3390/jcm13082242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background: There is emerging but conflicting evidence regarding the association between calcium biomarkers, more specifically ionized calcium and the prognosis of intensive care unit (ICU) postoperative cardiac patients. Methods: Our study investigated the relationship between ionized calcium, vitamin D, and periprocedural clinical events such as cardiac, neurologic and renal complications, major bleeding, vasoactive-inotropic score (VIS), and length of ICU and hospitalization. Results: Our study included 83 consecutive subjects undergoing elective major cardiac surgery requiring cardiopulmonary bypass. The mean age of the participants was 64.9 ± 8.5 years. The majority of procedures comprised isolated CABG (N = 26, 31.3%), aortic valve procedures (N = 26, 31.3%), and mitral valve procedures (N = 12, 14.5%). A difference in calcium levels across all time points (p < 0.001) was observed, with preoperative calcium being directly associated with intraoperative VIS (r = 0.26, p = 0.016). On day 1, calcium levels were inversely associated with the duration of mechanical ventilation (r = -0.30, p = 0.007) and the length of hospital stay (r = -0.22, p = 0.049). At discharge, calcium was inversely associated with length of hospital stay (r = -0.22, p = 0.044). All calcium levels tended to be lower in those who died during the 1-year follow-up (p = 0.054). Preoperative vitamin D levels were significantly higher in those who experienced AKI during hospitalization (median 17.5, IQR 14.5-17.7, versus median 15.3, IQR 15.6-20.5, p = 0.048) Conclusion: Fluctuations in calcium levels and vitamin D may be associated with the clinical course of patients undergoing cardiac surgery. In our study, hypocalcemic patients exhibited a greater severity of illness, as evidenced by elevated VIS scores, and experienced prolonged mechanical ventilation time and hospital stays. Additional larger-scale studies are required to gain a deeper understanding of their impact on cardiac performance and the process of weaning from cardiopulmonary bypass, as well as to distinguish between causal and associative relationships.
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Affiliation(s)
- Adrian Ștef
- Clinical Department of Anesthesia and Intensive Care, Heart Institute “Niculae Stancioiu”, “Iuliu Hatieganu” University of Medicine and Pharmacy, Motilor 19-21, 400001 Cluj-Napoca, Romania
- Anesthesia and Intensive Care 2 Discipline, “Iuliu Hatieganu” University of Medicine and Pharmacy, Victor Babes Nr 8 Street, 400012 Cluj-Napoca, Romania
- Cardiology Department, Heart Institute “Niculae Stancioiu”, “Iuliu Hatieganu” University of Medicine and Pharmacy, Motilor 19-21, 400001 Cluj-Napoca, Romania
| | - Constantin Bodolea
- Anesthesia and Intensive Care 2 Discipline, “Iuliu Hatieganu” University of Medicine and Pharmacy, Victor Babes Nr 8 Street, 400012 Cluj-Napoca, Romania
| | - Ioana Corina Bocșan
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Victor Babes Nr 8 Street, 400012 Cluj-Napoca, Romania; (I.C.B.); (R.M.P.)
| | - Ștefan Cristian Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Victor Babes Nr 8 Street, 400012 Cluj-Napoca, Romania; (I.C.B.); (R.M.P.)
| | - Raluca Maria Pop
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Victor Babes Nr 8 Street, 400012 Cluj-Napoca, Romania; (I.C.B.); (R.M.P.)
| | - Simona Sorana Cainap
- Department of Mother and Child, 2nd Pediatric Discipline, “Iuliu Hatieganu” University of Medicine and Pharmacy, Victor Babes Nr 8 Street, 400012 Cluj-Napoca, Romania
| | - Alexandru Achim
- Cardiology Department, Heart Institute “Niculae Stancioiu”, “Iuliu Hatieganu” University of Medicine and Pharmacy, Motilor 19-21, 400001 Cluj-Napoca, Romania
| | - Oana Antal
- Anesthesia and Intensive Care 2 Discipline, “Iuliu Hatieganu” University of Medicine and Pharmacy, Victor Babes Nr 8 Street, 400012 Cluj-Napoca, Romania
| | - Nadina Tintiuc
- Clinical Department of Anesthesia and Intensive Care, Heart Institute “Niculae Stancioiu”, “Iuliu Hatieganu” University of Medicine and Pharmacy, Motilor 19-21, 400001 Cluj-Napoca, Romania
| | - Anca Dana Buzoianu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Victor Babes Nr 8 Street, 400012 Cluj-Napoca, Romania; (I.C.B.); (R.M.P.)
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Hiriscau EI, Cauli O, Donca V, Marinescu LA, Macarie AE, Avram L, Cancel OG, Donca S, Buzdugan EC, Crisan DA, Bodolea C. The Association between Functional Health Patterns and Frailty in Hospitalized Geriatric Patients. Geriatrics (Basel) 2024; 9:41. [PMID: 38667508 PMCID: PMC11050315 DOI: 10.3390/geriatrics9020041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/06/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
This study investigates the association between the Functional Health Pattern Assessment Screening Tool (FHPAST) and frailty in hospitalized geriatric patients. One hundred and forty patients (mean age 78.2 years, age range 65-90) were screened for frailty using the Frail Scale during hospitalization in the geriatric unit. Among them, 57 patients were identified as prefrail (40.7%), and 83 were identified as frail (59.3%). A comparative analysis between groups in terms of the FHPAST components covering health risk, general well-being, and health promotion was performed. Correlations between FHAPST components, socio-demographic data, frailty criteria, as well as logistic regression to identify variables that better predict frailty were also sought. Frailty was mainly associated with difficulty urinating, limitations in performing activities of daily living and walking, physical discomfort, less positive feelings in controlling one's own life, lower compliance with recommendations from the healthcare provider, and engagement in seeking healthcare services. Patients with difficulty urinating and walking had a probability of 4.38 times (OR = 4.38, CI 95% [1.20-15.94]), p = 0.025) and 65.7 times (OR = 65.7, CI 95% [19.37-223.17], p < 0.001) higher of being frail rather than prefrail. The relationship between frailty and prefrailty in hospitalized geriatric patients and components of nursing Functional Health Patterns (FHP) has yet to be explored. This study provides evidence of the most prevalent needs of frail geriatric patients in hospital settings.
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Affiliation(s)
- Elisabeta Ioana Hiriscau
- Nursing Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400083 Cluj-Napoca, Romania;
- Intensive Care Unit Department, University Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania;
| | - Omar Cauli
- Nursing Department, University of Valencia, 46010 Valencia, Spain
| | - Valer Donca
- Geriatric Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400139 Cluj-Napoca, Romania; (V.D.); (L.-A.M.); (A.-E.M.); (L.A.)
- Geriatric Department, University Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania; (O.-G.C.); (S.D.)
| | - Luminita-Aurelia Marinescu
- Geriatric Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400139 Cluj-Napoca, Romania; (V.D.); (L.-A.M.); (A.-E.M.); (L.A.)
- Geriatric Department, University Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania; (O.-G.C.); (S.D.)
| | - Antonia-Eugenia Macarie
- Geriatric Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400139 Cluj-Napoca, Romania; (V.D.); (L.-A.M.); (A.-E.M.); (L.A.)
- Geriatric Department, University Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania; (O.-G.C.); (S.D.)
| | - Lucretia Avram
- Geriatric Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400139 Cluj-Napoca, Romania; (V.D.); (L.-A.M.); (A.-E.M.); (L.A.)
- Geriatric Department, University Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania; (O.-G.C.); (S.D.)
| | - Oana-Gabriela Cancel
- Geriatric Department, University Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania; (O.-G.C.); (S.D.)
| | - Steliana Donca
- Geriatric Department, University Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania; (O.-G.C.); (S.D.)
| | - Elena-Cristina Buzdugan
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400139 Cluj-Napoca, Romania; (E.-C.B.); (D.-A.C.)
- Internal Medicine Department, University Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
| | - Dana-Alina Crisan
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400139 Cluj-Napoca, Romania; (E.-C.B.); (D.-A.C.)
- Internal Medicine Department, University Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
| | - Constantin Bodolea
- Intensive Care Unit Department, University Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania;
- Intensive Care Unit Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400139 Cluj-Napoca, Romania
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Grăjdieru O, Petrișor C, Bodolea C, Tomuleasa C, Constantinescu C. Anaesthesia Management for Giant Intraabdominal Tumours: A Case Series Study. J Clin Med 2024; 13:1321. [PMID: 38592177 PMCID: PMC10931942 DOI: 10.3390/jcm13051321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Due to a lack of randomised controlled trials and guidelines, and only case reports being available in the literature, there is no consensus on how to approach anaesthetic management in patients with giant intraabdominal tumours. METHODS This study aimed to evaluate the literature and explore the current status of evidence, by undertaking an observational research design with a descriptive account of characteristics observed in a case series referring to patients with giant intraabdominal tumours who underwent anaesthesia. RESULTS Twenty patients diagnosed with giant intraabdominal tumours were included in the study, most of them women, with the overall pathology being ovarian-related and sarcomas. Most of the patients were unable to lie supine and assumed a lateral decubitus position. Pulmonary function tests, chest X-rays, and thoracoabdominal CT were the most often performed preoperative evaluation methods, with the overall findings that there was no atelectasis or pleural effusion present, but there was bilateral diaphragm elevation. The removal of the intraabdominal tumour was performed under general anaesthesia in all cases. Awake fiberoptic intubation or awake videolaryngoscopy was performed in five cases, while the rest were performed with general anaesthesia with rapid sequence induction. Only one patient was ventilated with pressure support ventilation while maintaining spontaneous ventilation, while the rest were ventilated with controlled ventilation. Hypoxemia was the most reported respiratory complication during surgery. In more than 50% of cases, there was hypotension present during surgery, especially after the induction of anaesthesia and after tumour removal, which required vasopressor support. Most cases involved blood loss with subsequent transfusion requirements. The removal of the tumor requires prolonged surgical and anaesthesia times. Fluid drainage from cystic tumour ranged from 15.7 L to 107 L, with a fluid extraction rate of 0.5-2.5 L/min, and there was no re-expansion pulmonary oedema reported. Following surgery, all the patients required intensive care unit admission. One patient died during hospitalization. CONCLUSIONS This study contributes to the creation of a certain standard of care when dealing with patients presenting with giant intraabdominal tumour. More research is needed to define the proper way to administer anaesthesia and create practice guidelines.
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Affiliation(s)
- Olga Grăjdieru
- Department of Anaesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (O.G.); (C.P.); (C.B.)
| | - Cristina Petrișor
- Department of Anaesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (O.G.); (C.P.); (C.B.)
| | - Constantin Bodolea
- Department of Anaesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (O.G.); (C.P.); (C.B.)
| | - Ciprian Tomuleasa
- Department of Hematology, Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania;
| | - Cătălin Constantinescu
- Department of Anaesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (O.G.); (C.P.); (C.B.)
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Simon R, Petrisor C, Bodolea C, Golea A, Gomes SH, Antal O, Vasian HN, Moldovan O, Puia CI. Efficiency of Simulation-Based Learning Using an ABC POCUS Protocol on a High-Fidelity Simulator. Diagnostics (Basel) 2024; 14:173. [PMID: 38248050 PMCID: PMC10814096 DOI: 10.3390/diagnostics14020173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/30/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
Critically ill patients with rapidly deteriorating clinical status secondary to respiratory and cardio-vascular compromise are at risk for immediate collapse if the underlying pathology is not recognized and treated. Rapid diagnosis is of utmost importance regardless of the setting. Although there are data to support the use of point-of-care ultrasound in critical patients, there is no consensus about the best educational strategy to implement. We designed a curriculum based on the ABC (Airway, Breathing, Circulation) protocol that covers essential airway, lung, and cardiac ultrasound skills needed for fast diagnosis in critical patients and applied it in high-fidelity simulation-based medical education sessions for anesthesia and intensive care residents year one and two. After theoretical and practical assessments, our results show statistical differences in the theoretical knowledge and above-average results in practical assessment. Our proposed curriculum based on a simple ABC POCUS protocol, with an Airway, Breathing, and Circulation approach, is useful in teaching ultrasound basics regarding airway, lung, and cardiac examination using high-fidelity simulation training to anesthesia and intensive care residents, but further research is needed to establish the utility of Simulation-Based Medical Education in Point of Care Ultrasound in the critical patient.
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Affiliation(s)
- Robert Simon
- Doctoral School, Faculty of Medicine, University of Oradea, 410087 Oradea, Romania;
- Anesthesia and Intensive Care Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (C.P.); (H.N.V.)
- Clinical Institute of Urology and Renal Transplant, 400000 Cluj-Napoca, Romania
| | - Cristina Petrisor
- Anesthesia and Intensive Care Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (C.P.); (H.N.V.)
- Clinical County Emergency Hospital, 400347 Cluj-Napoca, Romania;
| | - Constantin Bodolea
- Anesthesia and Intensive Care Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (C.P.); (H.N.V.)
- Municipal Clinical Hospital, 400139 Cluj-Napoca, Romania
| | - Adela Golea
- Clinical County Emergency Hospital, 400347 Cluj-Napoca, Romania;
- Emergency Medicine Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Sara Hora Gomes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal
- ICVS/3B’s-PT Government Associate Laboratory, 4710-057 Braga, Portugal
| | - Oana Antal
- Anesthesia and Intensive Care Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (C.P.); (H.N.V.)
- Clinical Institute of Urology and Renal Transplant, 400000 Cluj-Napoca, Romania
| | - Horațiu Nicolae Vasian
- Anesthesia and Intensive Care Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (C.P.); (H.N.V.)
- Regional Institute of Gastroenterology and Hepatology, 400394 Cluj-Napoca, Romania
| | - Orlanda Moldovan
- Clinical Emergency Hospital for Children, 400177 Cluj-Napoca, Romania
| | - Cosmin Ion Puia
- Doctoral School, Faculty of Medicine, University of Oradea, 410087 Oradea, Romania;
- Regional Institute of Gastroenterology and Hepatology, 400394 Cluj-Napoca, Romania
- Surgery Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
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Bălan AM, Bodolea C, Nemes A, Crăciun R, Hagău N. Rapid Point-of-Care PCR Testing of Drug-Resistant Strains on Endotracheal Aspirate Samples: A Repurposed Effective Tool in the Stepwise Approach of Healthcare-Acquired Pneumonia-A Pilot Study. Int J Mol Sci 2023; 24:13393. [PMID: 37686203 PMCID: PMC10487584 DOI: 10.3390/ijms241713393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/17/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Healthcare-associated pneumonia (HCAP) is a common nosocomial infection with high morbidity and mortality. Culture-based detection of the etiologic agent and drug susceptibility is time-consuming, potentially leading to the inadequate use of broad-spectrum empirical antibiotic regimens. The aim was to evaluate the diagnostic capabilities of rapid point-of-care multiplex polymerase chain reaction (PCR) assays from the endotracheal aspirate of critically ill patients with HCAP. A consecutive series of 29 intensive care unit (ICU) patients with HCAP and a control group of 28 patients undergoing elective surgical procedures were enrolled in the study. The results of the PCR assays were compared to the culture-based gold standard. The overall accuracy of the PCR assays was 95.12%, with a sensitivity of 92.31% and a specificity of 97.67%. The median time was 90 min for the rapid PCR tests (p < 0.001), while for the first preliminary results of the cultures, it was 48 h (46-72). The overall accuracy for rapid PCR testing in suggesting an adequate antibiotic adjustment was 82.98% (95% CI 69.19-92.35%), with a specificity of 90% (95% CI 55.50-99.75%), a positive predictive value of 96.77% (95% CI 83.30-99.92%), and a negative predictive value of 56.25 (95% CII 29.88-80.25%). This method of rapid point-of-care PCR could effectively guide antimicrobial stewardship in patients with healthcare-acquired pneumonia.
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Affiliation(s)
- Andrei-Mihai Bălan
- Department of Anaesthesia and Intensive Care 2, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania; (A.-M.B.); (C.B.); (N.H.)
- Department of Anaesthesia and Intensive Care, Municipal Clinical Hospital, 400139 Cluj-Napoca, Romania
| | - Constantin Bodolea
- Department of Anaesthesia and Intensive Care 2, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania; (A.-M.B.); (C.B.); (N.H.)
- Department of Anaesthesia and Intensive Care, Municipal Clinical Hospital, 400139 Cluj-Napoca, Romania
| | - Andrada Nemes
- Department of Anaesthesia and Intensive Care 2, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania; (A.-M.B.); (C.B.); (N.H.)
- Department of Anaesthesia and Intensive Care, Municipal Clinical Hospital, 400139 Cluj-Napoca, Romania
| | - Rareș Crăciun
- Department of Internal Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania;
- Gastroenterology Clinic, ”Prof. Dr. O. Fodor” Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Natalia Hagău
- Department of Anaesthesia and Intensive Care 2, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania; (A.-M.B.); (C.B.); (N.H.)
- Department of Anaesthesia and Intensive Care, ”Regina Maria” Hospital, 400221 Cluj-Napoca, Romania
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Bălan AM, Bodolea C, Trancă SD, Hagău N. Trends in Molecular Diagnosis of Nosocomial Pneumonia Classic PCR vs. Point-of-Care PCR: A Narrative Review. Healthcare (Basel) 2023; 11:healthcare11091345. [PMID: 37174887 PMCID: PMC10177880 DOI: 10.3390/healthcare11091345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/23/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
Nosocomial pneumonia is one of the most frequent hospital-acquired infections. One of the types of nosocomial pneumonia is ventilator-associated pneumonia, which occurs in endotracheally intubated patients in intensive care units (ICU). Ventilator-associated pneumonia may be caused by multidrug-resistant pathogens, which increase the risk of complications due to the difficulty in treating them. Pneumonia is a respiratory disease that requires targeted antimicrobial treatment initiated as early as possible to have a good outcome. For the therapy to be as specific and started sooner, diagnostic methods have evolved rapidly, becoming quicker and simpler to perform. Polymerase chain reaction (PCR) is a rapid diagnostic technique with numerous advantages compared to classic plate culture-based techniques. Researchers continue to improve diagnostic methods; thus, the newest types of PCR can be performed at the bedside, in the ICU, so-called point of care testing-PCR (POC-PCR). The purpose of this review is to highlight the benefits and drawbacks of PCR-based techniques in managing nosocomial pneumonia.
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Affiliation(s)
- Andrei-Mihai Bălan
- Department of Anaesthesia and Intensive Care 2, "Iuliu Hatieganu", University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
- Department of Anaesthesia and Intensive Care, Municipal Clinical Hospital, 400139 Cluj-Napoca, Romania
| | - Constantin Bodolea
- Department of Anaesthesia and Intensive Care 2, "Iuliu Hatieganu", University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
- Department of Anaesthesia and Intensive Care, Municipal Clinical Hospital, 400139 Cluj-Napoca, Romania
| | - Sebastian Daniel Trancă
- Department of Anaesthesia and Intensive Care 2, "Iuliu Hatieganu", University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
- Emergency Department, The Emergency County Hospital Cluj, 400347 Cluj-Napoca, Romania
| | - Natalia Hagău
- Department of Anaesthesia and Intensive Care 2, "Iuliu Hatieganu", University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
- Department of Anaesthesia and Intensive Care, "Regina Maria" Hospital, 400221 Cluj-Napoca, Romania
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Botoș ID, Pantiș C, Bodolea C, Nemes A, Crișan D, Avram L, Negrău MO, Hirișcău IE, Crăciun R, Puia CI. The Dynamics of the Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict Progression to Septic Shock and Death in Patients with Prolonged Intensive Care Unit Stay. Medicina (B Aires) 2022; 59:medicina59010032. [PMID: 36676656 PMCID: PMC9861709 DOI: 10.3390/medicina59010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/12/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Background and objectives: The prognoses of patients experiencing a prolonged stay in the intensive care unit (ICU) are often significantly altered by hospital-acquired infections (HAIs), the early detection of which might be cumbersome. The aim of this study was to investigate the roles of the neutrophil-to-lymphocyte (NLR), derived-NRL (d-NLR), platelet-to-lymphocyte (PLR), and lymphocyte-to-C-reactive protein (LCR) ratios in predicting the progression to septic shock and death. Materials and Methods: A retrospective analysis of a consecutive series of ninety COVID-19 patients with prolonged hospitalization (exceeding 15 days) admitted to the ICU was conducted. The prevalence of culture-proven HAIs throughout their hospital stays was documented. NLR, dNLR, PLR, and LCR were recorded on admission, day 7, and day 14 to assess their discriminative prowess for detecting further progression to septic shock or death. Results: The prevalence of HAIs was 76.6%, 50% of patients met the criteria for septic shock, and 50% died. The median time to the first positive culture was 13.5 days and 20.5 days for developing septic shock. Mechanical ventilation was a key contributing factor to HAI, septic shock, and mortality. On admission and day 7 NLR, dNLR, PLR, and LCR values had no prognostic relevance for events occurring late during hospitalization. However, day-14 NLR, dNLR, and PLR were independent predictors for progression to septic shock and mortality and have shown good discriminative capabilities. The AUCs for septic shock were 0.762, 0.764, and 0.716, while the values for predicting in-hospital death were 0.782, 0.778, and 0.758, respectively. Conclusions: NLR, dNLR, and PLR are quick, easy-to-use, cheap, effective biomarkers for the detection of a more severe disease course, of the late development of HAIs, and of the risk of death in critically ill patients requiring a prolonged ICU stay.
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Affiliation(s)
- Ioana Denisa Botoș
- Faculty of Medicine and Pharmacy, University of Oradea, 410068 Oradea, Romania
| | - Carmen Pantiș
- Faculty of Medicine and Pharmacy, University of Oradea, 410068 Oradea, Romania
| | - Constantin Bodolea
- Intensive Care Unit, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Correspondence:
| | - Andrada Nemes
- Intensive Care Unit, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Dana Crișan
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Internal Medicine, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
| | - Lucreția Avram
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Internal Medicine, Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
| | | | - Ioana Elisabeta Hirișcău
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Rareș Crăciun
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Gastroenterology Clinic, “Prof. Dr. O. Fodor” Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Cosmin Ioan Puia
- Faculty of Medicine and Pharmacy, University of Oradea, 410068 Oradea, Romania
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Surgery, “Prof. Dr. O. Fodor” Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
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8
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Szabo R, Petrisor C, Bodolea C, Simon R, Maries I, Tranca S, Mocan T. Hyperferritinemia, Low Circulating Iron and Elevated Hepcidin May Negatively Impact Outcome in COVID-19 Patients: A Pilot Study. Antioxidants (Basel) 2022; 11:antiox11071364. [PMID: 35883855 PMCID: PMC9311882 DOI: 10.3390/antiox11071364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 01/27/2023] Open
Abstract
Inflammation in COVID-19 produces intracellular iron overload with low circulating iron available for metabolic processes. The accumulated intracellular iron generates reactive species of oxygen and results in ferroptosis, a non-programmed cell death. Since no organ is spared, iron dysmetabolism increases the mortality and morbidity. Hepcidin and the mediator interleukin 6 are believed to play a role in the process. Our aim is to evaluate the predictive values of serologic iron and inflammatory parameters in COVID-19 critically ill patients. Hence, 24 patients were included. Hepcidin and interleukin 6, along with routine blood parameters, were determined and outcomes, such as death, multiple organ damage (MOD), anemia, and need for transfusions, were assessed. The results of this pilot study indicate that iron metabolism parameters individually, as well as models consisting of multiple laboratory and clinical variables, may predict the outcomes. Further larger studies are needed to validate the results of this pilot stud. However, this paper identifies a new direction for research.
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Affiliation(s)
- Robert Szabo
- Physiology Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (R.S.); (T.M.)
- Anaesthesia II Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (C.P.); (R.S.); (I.M.); (S.T.)
- Clinical County Emergency Hospital, 400000 Cluj-Napoca, Romania
| | - Cristina Petrisor
- Anaesthesia II Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (C.P.); (R.S.); (I.M.); (S.T.)
- Clinical County Emergency Hospital, 400000 Cluj-Napoca, Romania
| | - Constantin Bodolea
- Anaesthesia II Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (C.P.); (R.S.); (I.M.); (S.T.)
- Municipal Clinical Hospital, 400139 Cluj-Napoca, Romania
- Correspondence:
| | - Robert Simon
- Anaesthesia II Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (C.P.); (R.S.); (I.M.); (S.T.)
| | - Ioana Maries
- Anaesthesia II Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (C.P.); (R.S.); (I.M.); (S.T.)
| | - Sebastian Tranca
- Anaesthesia II Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (C.P.); (R.S.); (I.M.); (S.T.)
- Clinical County Emergency Hospital, 400000 Cluj-Napoca, Romania
| | - Teodora Mocan
- Physiology Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (R.S.); (T.M.)
- Nanomedicine Department, Regional Institute of Gastroenterology and Hepatology, 400000 Cluj-Napoca, Romania
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9
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Bodolea C, Hiriscau EI, Buzdugan EC, Grosu AI, Stoicescu L, Vesa Ș, Cauli O. The Association between Peripheral Blood Cells and the Frailty Syndrome in Patients with Cardiovascular Diseases. Endocr Metab Immune Disord Drug Targets 2021; 20:1419-1433. [PMID: 32787768 PMCID: PMC8226153 DOI: 10.2174/1871530320666200813135905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/02/2020] [Accepted: 06/11/2020] [Indexed: 12/24/2022]
Abstract
Background Frailty syndrome is characterized by multisystem dysregulation frequently found in older individuals or even in younger patients with chronic disabling diseases such as cardiovascular diseases. Objective To determine whether peripheral blood cell count, and its subpopulations, red blood cell and platelets, morphology and different ratios (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and red blood distribution width-to-platelet ratio) are associated with cardiac frail patients, and through this to improve the prediction of frailty status in patients with cardiovascular diseases. Methods An observational, retrospective, cohort study enrolling 179 patients with cardiovascular disease divided into two groups: non-frail group (100 pts) and frail group (79 pts), a cohort detached from the Frail.RO study. The frailty was evaluated based on the Fried criteria; haematological markers, sociodemographic data, and variables related to cardiovascular diseases and comorbidities were also recorded. Results Lower lymphocytes, platelet count, and neutrophil-to-lymphocyte ratio were significantly associated with a more severe frailty syndrome. Regarding red blood cells, haemoglobin concentration and red cell distribution width significantly correlated with the severity of the frailty syndrome. Receiver operating characteristic curve analysis for these markers associated with the frailty syndrome revealed an acceptable sensitivity of 66% and specificity of 65% to identify frail individuals. Malnutrition and hypercholesterolemia are relevant predictors for identifying frailty in hospitalized cardiovascular patients. Conclusion The evaluation of peripheral blood cell composition routinely measured in clinical practice can represent a valuable, but limited indicator, to diagnose frailty syndrome and eventually, the effects of interventions in frail patients with cardiovascular diseases.
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Affiliation(s)
- Constantin Bodolea
- ICU Department, ”Iuliu Hațieganu”, University of Medicine and Pharmacy, Cluj-Napoca, Romania,ICU Department, ”Iuliu Hațieganu” University Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - Elisabeta I Hiriscau
- ICU Department, ”Iuliu Hațieganu” University Clinical Municipal Hospital, Cluj-Napoca, Romania,Nursing Department, ”Iuliu Hațieganu”, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Elena-Cristina Buzdugan
- Internal Medicine Department, ”Iuliu Hațieganu”University of Medicine and Pharmacy, Cluj-Napoca, Romania,Cardiology Unit, University Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - Alin I Grosu
- Internal Medicine Department, ”Iuliu Hațieganu”University of Medicine and Pharmacy, Cluj-Napoca, Romania,Cardiology Unit, University Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - Laurențiu Stoicescu
- Internal Medicine Department, ”Iuliu Hațieganu”University of Medicine and Pharmacy, Cluj-Napoca, Romania,Cardiology Unit, University Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - Ștefan Vesa
- Department of Clinical Pharmacology,”Iuliu Hațieganu”University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Omar Cauli
- Department of Nursing, University of Valencia, Valencia, Spain
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10
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Simon R, Petrișor C, Bodolea C, Csipak G, Oancea C, Golea A. A.B.C. approach proposal for POCUS in COVID-19 critically ill patients. Med Ultrason 2021; 23:94-102. [PMID: 33245734 DOI: 10.11152/mu-2733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The rapid spread of SARS-CoV-2 (COVID-19) since December 2019 forced Intensive Care Units to face high numbers of patients admitted simultaneously with limited resources. COVID-19 critically ill patients, especially those on mechanical ventilators, demand special attention as they can develop potential complications with critical hemodynamic and respiratory consequences. Point of Care Ultrasound (POCUS) might have important roles in assessing the critically ill SARS-CoV-2 patient. Mostly, lung ultrasound has been presented as having a role in diagnosis and monitoring, but airway examination and hemodynamic evaluation are of interest also. We propose an A.B.C. POCUS approach focusing on A-airway (orotracheal intubation), B-breathing (interstitial syn-dromes, pneumothorax, atelectasis, pneumonia), and C-circulation (cardiac function, pulmonary embolism, volume status, deep veins thrombosis). This A.B.C. approach has emerged during ICU care for 22 adult COVID-19 critically ill patients, along with the analysis of recent papers describing ultrasound in COVID-19 patients including the use of ultrasound that is currently applied in the management of the general critically ill population. This A.B.C- POCUS algorithm parallels the well-established clinical A.B.C. algorithms. There are few extensive ultrasonographic studies in COVID-19 critically ill patients up to now, but techniques extrapolated from non-COVID studies seem reasonable even though comparative studies are not available yet.
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Affiliation(s)
- Robert Simon
- 1 Clinical Emergency County Hospital Cluj-Napoca 2 "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca.
| | - Cristina Petrișor
- 1 Anestehsia and Intensive Care 1 Department, Clinical Emergency County Hospital Cluj-Napoca, Romania 2 Anesthsia and Intensive care II Department, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania.
| | - Constantin Bodolea
- 2 "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca 3 Municipal Hospital Cluj-Napoca.
| | | | - Cristian Oancea
- 1 Clinical Emergency County Hospital Cluj-Napoca 2 "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca.
| | - Adela Golea
- 1 Clinical Emergency County Hospital Cluj-Napoca 2 "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca.
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11
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Constantinescu C, Bodolea C, Pasca S, Teodorescu P, Dima D, Rus I, Tat T, Achimas-Cadariu P, Tanase A, Tomuleasa C, Einsele H. Clinical Approach to the Patient in Critical State Following Immunotherapy and/or Stem Cell Transplantation: Guideline for the On-Call Physician. J Clin Med 2019; 8:jcm8060884. [PMID: 31226876 PMCID: PMC6616972 DOI: 10.3390/jcm8060884] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 12/11/2022] Open
Abstract
The initial management of the hematology patient in a critical state is crucial and poses a great challenge both for the hematologist and the intensive care unit (ICU) physician. After years of clinical practice, there is still a delay in the proper recognition and treatment of critical situations, which leads to late admission to the ICU. There is a much-needed systematic ABC (Airway, Breathing, Circulation) approach for the patients being treated on the wards as well as in the high dependency units because the underlying hematological disorder, as well as disease-related complications, have an increasing frequency. Focusing on score-based decision-making on the wards (Modified Early Warning Score (MEWS), together with Quick Sofa score), active sepsis screening with inflammation markers (C-reactive protein, procalcitonin, and presepsin), and assessment of microcirculation, organ perfusion, and oxygen supply by using paraclinical parameters from the ICU setting (lactate, central venous oxygen saturation (ScVO2), and venous-to-arterial carbon dioxide difference), hematologists can manage the immediate critical patient and improve the overall outcome.
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Affiliation(s)
- Catalin Constantinescu
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400124 Cluj Napoca, Romania.
- Intensive Care Unit, Ion Chiricuta Clinical Cancer Center, 400005 Cluj Napoca, Romania.
| | - Constantin Bodolea
- Department of Anesthesia, Iuliu Hatieganu University of Medicine and Pharmacy, 400124 Cluj Napoca, Romania.
| | - Sergiu Pasca
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400124 Cluj Napoca, Romania.
| | - Patric Teodorescu
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400124 Cluj Napoca, Romania.
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, 400005 Cluj Napoca, Romania.
| | - Delia Dima
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, 400005 Cluj Napoca, Romania.
| | - Ioana Rus
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, 400005 Cluj Napoca, Romania.
| | - Tiberiu Tat
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, 400005 Cluj Napoca, Romania.
| | - Patriciu Achimas-Cadariu
- Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400124 Cluj Napoca, Romania.
| | - Alina Tanase
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania.
| | - Ciprian Tomuleasa
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400124 Cluj Napoca, Romania.
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, 400005 Cluj Napoca, Romania.
- Research Center for Functional Genomics and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Victor Babes Street, 400124 Cluj Napoca, Romania.
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Wuerzburg, 97070 Wuerzburg, Germany.
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12
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Petrisor C, Dîrzu D, Trancă S, Hagău N, Bodolea C. Preoperative difficult airway prediction using suprahyoid and infrahyoid ultrasonography derived measurements in anesthesiology. Med Ultrason 2019; 21:83-88. [PMID: 30779836 DOI: 10.11152/mu-1764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Airway management is one of the most important skills in everyday practice of anesthesia. Improper airway management might contribute to significant morbidity and mortality. In some patients, clinical parameters do not anticipate all difficulties related to airway management. Ultrasonography (US) might confer a potential screening tool for difficult airway. Suprahyoid and infrahyoid US measurements have been investigated for difficult airway prediction in anesthesiology. The most extensively investigated parameter was the anterior neck soft tissue thickness measured at different levels: anterior to the hyoid bone, epiglottis and vocal cords commissure. Hyomental distances measured with the head placed in neutral, sniffing or maximal hyperextended position and the derived hyomental distance ratios have also been evaluated for difficult airway prediction. For the evaluation of the tongue, measurements such as thickness, cross-sectional area, width, volume and tongue-to-oral cavityratio can be used. Thus, anesthesiologists have many available potential US measurements, which could provide information regarding airway anatomy during the preoperative airway assessment and could serve as potential screening parameters for difficult airway. Still, we do not yet know which of these provides optimal predictive accuracy and larger sample size studiesare required to validate their use in the preoperative evaluation of the airway.
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Affiliation(s)
- Cristina Petrisor
- Anestehsia and Intensive Care 1 Department, Clinical Emergency County Hospital Cluj-Napoca, Romania Anesthsia and Intensive care II Department, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania.
| | - Dan Dîrzu
- Clinical Emergency County Hospital Cluj-Napoca.
| | - Sebastian Trancă
- 1 Clinical Emergency County Hospital Cluj-Napoca 2 "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca.
| | - Natalia Hagău
- "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca.
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13
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Bodolea C. Epidural Anaesthesia: How Easy Is It to Walk on Quicksand? J Crit Care Med (Targu Mures) 2016; 2:153-155. [DOI: 10.1515/jccm-2016-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Constantin Bodolea
- University of Medicine and Pharmacy “Iuliu Hatieganu“ Cluj Napoca, Romania
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14
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Abstract
Experimental studies performed on immature animal brains had demonstrated a neurotoxic effect following sedation and general anaesthetics administration. The same magnitude of neurotoxicity has been suggested but not been proven to neonates, infants and small children who have undergone anaesthesia. There is a justified and increasing inquiry regarding the administration of general anaesthesia to paediatric patients.
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Affiliation(s)
- Constantin Bodolea
- Department of Anaesthesia and Intensive Care, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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15
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Larsson A, Carlsson L, Lind AL, Gordh T, Bodolea C, Kamali-Moghaddam M, Thulin M. The body mass index (BMI) is significantly correlated with levels of cytokines and chemokines in cerebrospinal fluid. Cytokine 2015; 76:514-518. [PMID: 26188367 DOI: 10.1016/j.cyto.2015.07.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 07/08/2015] [Accepted: 07/08/2015] [Indexed: 12/18/2022]
Abstract
Cytokines and chemokines regulate many functions in the body including the brain. The interactions between adipose tissue and the central nervous system (CNS) are important for the regulation of energy balance. CNS function is also influenced by age. The aim of the present study was to investigate the effects of body mass index (BMI) and age on cytokine and chemokine levels in cerebrospinal fluid. Cerebrospinal fluid samples (n=89) were collected from patients undergoing routine surgical procedures. The samples were analyzed using the multiplex proximity extension assay (PEA) in which 92 different cytokines are measured simultaneously using minute sample volume. We found no significant correlations between age and cytokine levels for any of the studied markers. In contrast, at a false discovery rate of 10%, 19 markers were significantly associated with BMI (in decreasing significance: FGF-5, ADA, Beta-NGF, CD40, IL-10RB, CCL19, TGF-alpha, SIRT2, TWEAK, SCF, CSF-1, 4E-BP1, DNER, LIF-R, STAMPB, CXCL10, CXCL6, VEGF-A and CX3CL1). This study reveals a clear effect of BMI on cytokine and chemokine levels in cerebrospinal fluid.
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Affiliation(s)
- Anders Larsson
- Department of Medical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden.
| | - Lena Carlsson
- Department of Medical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Anne-Li Lind
- Department of Surgical Sciences, Anesthesiology and Intensive Care and Uppsala Berzelii Technology Center for Neurodiagnostics, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Torsten Gordh
- Department of Surgical Sciences, Anesthesiology and Intensive Care and Uppsala Berzelii Technology Center for Neurodiagnostics, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Constantin Bodolea
- Department of Anaesthesia and Intensive Care, University of Cluj Napoca, Romania
| | - Masood Kamali-Moghaddam
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, SE-751 08 Uppsala, Sweden
| | - Måns Thulin
- Department of Statistics, Uppsala University, SE-751 05 Uppsala, Sweden
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16
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Orsolya M, Attila-Zoltan M, Gherman V, Zaharie F, Bolboaca S, Chira C, Bodolea C, Tomuleasa C, Irimie A, Coman I, Ionescu D. The effect of anaesthetic management on neutrophil gelatinase associated lipocalin (NGAL) levels after robotic surgical oncology. J BUON 2015; 20:317-324. [PMID: 25778333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE The main objective of this study was to compare the effect of two anaesthetic techniques (general vs combined) on plasma levels of NGAL (Neutrophil Gelatinase Associated Lipocalin) after robotic urogenital oncosurgery. The secondary objective was to correlate NGAL levels with the incidence of acute kidney injury (AKI). METHODS This was a longitudinal prospective study. Forty patients were included and randomized in 2 groups: group C (N=16 cases; combined general-epidural anesthesia) and group G (N=24 cases; control group with general anesthesia). Demographic data, Charlson Comorbidity Index, Apache II, SOFA and ASA scores were similar in both groups. Serum creatinine was determined preoperatively and every 24 hrs for 4 postoperative days to identify AKI according to RIFLE and AKIN criteria. Serum NGAL was determined at 6 and 12 hrs after induction of anesthesia. RESULTS Serum creatinine increased at 24 hrs postoperatively in both groups as compared to baseline, but significant changes were registered only in the G group (p(control) = 0.004). Serum NGAL increased significantly in both groups as compared with baseline levels (pcase=0.0034 vs p(control)=0.0001). The incidence of AKI was 12.50% (95% CI 0.4-34) in the C group and 37.50% (95% CI 17-58) in the G group (p=0.0909), respectively. CONCLUSION Impaired renal function and AKI occurred in robot-assisted laparoscopic urogenital oncosurgery under both general and combined anaesthesia. The incidence of AKI was lower in patients undergoing combined anesthesia compared to general anaesthesia after robotic urogenital oncosurgery but the difference did not reach statistical significance. However, plasma levels of NGAL were significantly increased at 6 and 12 hrs in the general anaesthesia group as compared with combined anaesthesia. NGAL may be a better marker in detecting postoperative acute kidney injury. Further studies are needed.
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Affiliation(s)
- Mihaly Orsolya
- Department of Anesthesiology and Intensive Care Unit, Clinical Emergency County Hospital, Cluj-Napoca, Romania
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17
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Gordh T, Lind AL, Bodolea C, Hewitt E, Larsson A. Cathepsin S is increased in cerebrospinal fluid from patients with neuropathic pain—A support of the microglia hypothesis in humans. Scand J Pain 2014. [DOI: 10.1016/j.sjpain.2014.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Aims
Cathepsin S has been reported to be a biomarker of spinal microglial activation, a process suggested to be involved in the pathophysiology of chronic neuropathic pain. So far this has been shown only in animal experiments. The aim of this study was to investigate the concentrations of cathepsin S in human cerebrospinal fluid (CSF) samples from a well-defined patient cohort suffering from neuropathic pain as compared to controls.
Methods
CSF samples from patients suffering from chronic neuropathic pain (n = 14) were analyzed for cathepsin S levels using commercial sandwich ELISAs (DY1183, R&D Systems, Minneapolis, MN, USA). Control CSF was sampled from patients undergoing minor urological surgical procedures under spinal anaesthesia (n = 70), having no obvious pain suffering.
Results
The neuropathic pain group had significantly higher levels of CSF cathepsin S (median 15189 pg/mL, range 3213–40,040), than the control group (median 5911 pg/mL, range 1909–17,188) (p < 0.005, Mann–Whitney U-test).
Conclusion
The results support the existence of microglial activation in chronic neuropathic pain patients. CSF Cathepsin S may serve as a potential biomarker for this specific mechanism linked to neuropathic pain. In the future, Cathepsin S inhibiting drugs might become a new treatment alternative for neurophatic pain.
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Affiliation(s)
- Torsten Gordh
- Department of Surgical Sciences , Uppsala University , Uppsala , Sweden
| | - Anne-Li Lind
- Department of Surgical Sciences , Uppsala University , Uppsala , Sweden
| | - Constantin Bodolea
- Department of Anaesthesia and Intensive Care , University of Cluj Napoca , Napoca , Romania
| | | | - Anders Larsson
- Department of Medical Sciences, Clinical Chemistry , Uppsala University , Uppsala , Sweden
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18
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Damian L, Felea I, Simon SP, Lupse M, Bodolea C, Ghib L, Mocanu R, Rednic S. THU0394 Macrophage activation syndrome in adult onset still’s disease: A single center experience. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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Peştean C, Taulescu M, Ober C, Cătoi C, Miclăuş V, Oana L, Bodolea C. The effect of chronic toxicity of pethidine on the spinal cord: an experimental model in rabbits. Rom J Morphol Embryol 2013; 54:617-622. [PMID: 24068413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The aim of this study was to evaluate the toxicity of chronic spinal analgesia with pethidine in a rabbit model. We introduced epidural catheters in twenty New Zealand white rabbits, divided into two groups, and we administered 0.5 mg/kg pethidine or the same volume of normal saline through the catheters, for three consecutive days. Throughout the experiment, the animals were evaluated in terms of neurological status using the Tarlov score. After the rabbit's euthanasia, 4 μm sections of spinal cord stained with Hematoxylin-Eosin were analyzed by a pathologist blinded to the study for neurohistopathological changes. The results were statistically analyzed with Prism 5 software for Windows. No significant differences were noticed between the two groups in as far as body temperature (p=0.295) and weight (p=0.139) were concerned. In the group of animals, which received epidural pethidine, nine rabbits showed histological changes suggestive for neurotoxicity at the lumbar level of the spinal cord. These findings were significantly different compared with the control group which received only saline (no microscopic lesions revealed; p=0.0006). When combining the data from both groups or using the pethidine group alone, there was a significant correlation between the presence of neurological injury (Tarlov score) and the presence of the histopathological lesions in the spinal cord (r=-0.709, p=0.0002 and r=-0.635, p=0.013, respectively). Based on our findings, the chronic epidural administration of pethidine in rabbits induces moderate to severe histological changes on the spinal cord, but further investigations are needed to make a definitive statement about the histological effect of pethidine on the neurological tissue.
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Affiliation(s)
- C Peştean
- Department of Pathology, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, Cluj-Napoca, Romania;
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Ndjole AM, Bodolea C, Nilsen T, Gordh T, Flodin M, Larsson A. Determination of cerebrospinal fluid cystatin C on Architect ci8200. J Immunol Methods 2010; 360:84-8. [DOI: 10.1016/j.jim.2010.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 06/09/2010] [Accepted: 06/15/2010] [Indexed: 11/27/2022]
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Constantea N, Axente D, Miclaus D, Dudric V, Jianu F, Bodolea C. Minimally invasive surgical treatment of morbid obesity in patients with specific comorbidities. A case report. J Gastrointestin Liver Dis 2007; 16:449-451. [PMID: 18193132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The mortality of patients with morbid obesity is 2 to 12 times higher according to age, comorbidities and the degree of obesity. Surgical treatment has proved to be the only type of treatment that has led to favorable long-term results. We present the therapeutic strategy used in a 39 year old obese patient with BMI=39.8 kg/sqm type 2 diabetes mellitus, arterial hypertension, severe hypercholesterolemia, nonalcoholic steatohepatitis and metabolic syndrome. The patient underwent laparoscopic gastric banding with adjustable silicon band.
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Affiliation(s)
- Nicolae Constantea
- 5th Surgical Clinic, Municipal University Hospital, Tabacarilor Str., no.11, Cluj-Napoca, Romania
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Abstract
We determined the effects of intrathecally administered epinephrine and clonidine on the duration and quality of a meperidine spinal block. Forty-five patients scheduled for orthopedic surgery, divided into three groups, received spinal anesthesia with 1 mg/kg 5% meperidine, alone or with 200 microg epinephrine or 2 microg/kg clonidine. Using a double-blind method, the onset, extension, and duration of sensory block (to pinprick) and the duration and degree of motor block (Bromage scale) were assessed. Hemodynamic responses, duration of postoperative analgesia, degree of sedation, and occurrence of side effects were also recorded. The addition of epinephrine to the meperidine solution prolonged the sensory block (P<0.01) but did not affect its onset or extent. A similar potentiating effect was demonstrated for clonidine (P<0.001). The duration and degree of motor block were increased by addition of both epinephrine and clonidine. A tendency toward bradycardia and a decrease of mean arterial pressure was potentiated by clonidine but not by the epinephrine. Only the addition of clonidine prolonged the postoperative analgesia (P<0.001), but was associated with an increased sedation score. The incidence of other side effects did not differ between the groups. We conclude that coadministration of epinephrine or clonidine with meperidine enhances the duration and degree of spinal anesthesia and that adding clonidine prolongs the duration of postoperative analgesia.
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Affiliation(s)
- I Acalovschi
- Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy, Clinical Hospital, Cluj-Napoca, Romania
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