Chemical Composition of Corallina mediterranea Areschoug and Corallina granifera Ell. et Soland

Abstract The composition of sterols, volatiles and some polar compounds from three Corallina samples (C. granifera and C. mediterranea from the Black Sea and C. mediterranea from the Mediterranean Sea) was established. The sterol composition of the Black Sea samples was similar but it differs from that of the Mediterranean sample. The composition of the volatiles was very complex. The main groups of constituent were hydrocarbons, alcohols, carbonyl compounds, acids and their esters, terpenes. The composition of the polar components, soluble in n-butanol, was also established. There were some differences in the chemical composition of the two Black Sea species, which may be due to the biodiversity between them, while the differences in the composition of the two C. mediterranea samples could be due to the differences in the environment (salinity, temperature, pollution, etc.)

Comparative characteristics of some methods for estimating energy expenditure in critically ill mechanically ventilated patients

Aim: To compare the energy expenditure (EE) assessed by ventilator-derived carbon dioxide production (EE–VCO2-ventilator) and the energy expenditure calculated from six predictive equations with the gold standard energy expenditure measured with indirect calorimetry (IC) in mechanically ventilated patients. Materials and methods: This is a prospective, non-randomized, one-month study which included six mechanically ventilated patients with FiO2 <60% and PEEP <10 mbar. Thirty-minute measurements were taken using a Cosmed Q-NRG+ metabolic monitor. The average ventilator-derived VCO2 from the Drager Evita Infinity V500 respirator (VʹCO2, ml/min) was calculated for the same period. The IC-measured EE (MEE-IC) was compared with EE–VCO2-ventilator by a formula proposed in ESPEN (8.19×VCO2) and with six predictive equations. Results: Mean MEE-IC was 1650±365 kcal. Mean measured EE–VCO2-ventilator was 1669±340 kcal. A statistically nonsignificant difference was found between the two measurements (p=0.84, correlation coefficient 0.98). Of the predictive equations we compared, the best correlation to the reference method was the Penn State 3 with mean EE of 1679±356 (p=0.81, correlation coefficient of 0.78). Conclusions: In critically ill mechanically ventilated patients, the assessment of EE based on a ventilator-derived VCO2 is an alternative to IC and is more accurate than most predictive equations

Ehlers-Danlos Syndrome Type IV - Anaesthetic Considerations

Ehlers-Danlos syndrome (EDS) is a rare disorder that occurs due to genetic defect in the collagen synthesis. The vascular subtype of EDS (type IV) is defined by characteristic facial features, translucent skin, easy bruising, and spontaneous arterial rupture and visceral perforation of such organs as the uterus and intestines, with possible life-threatening consequences. We report a case of a 15-year-old male patient with no past medical history undergoing emergency laparotomy after a spontaneous sigmoid colon perforation. Post-operatively and during the ICU stay complications developed and several revision operations and invasive procedures were necessary. A chest CT angiography revealed a right subclavian artery aneurysm, which was treated by an endovascular stent grafting. Taking into consideration the family history and clinical presentation EDS type IV was discussed as a possible cause of the patient’s condition. DNA analysis confirmed the diagnosis. Due to the lack of evidence-based recommendations the anaesthetic management of these patients is still challenging

Surgical treatment of pneumothorax in patients with COVID-19 – results and management

Introduction: The new coronavirus, SARS-CoV-2, provokes infection with different clinical presentation. It involves an asymptomatic condition, mild variants with fever and dry cough to severe pneumonia, adynamia and respiratory failure with lethal outcome. The fibrotic lung tissue after the inflammatory process is a background for development of a secondary pneumothorax. Although it rarely causes lethal outcomes in COVID-19 patients, pneumothorax requires early diagnosis and adequate treatment to prevent any complications and decrease mortality rate.Aim: The aim of this study was to analyse the results of surgical treatment of hospitalized COVID-19 patients with pneumothorax in terms of demographic data, concomitant diseases, complications, and outcome.Materials and methods: Longitudinal prospective study was carried out with 26 patients with pneumothorax as a result of SARS-CoV-2 infection. They were treated at the Intensive Care Unit of the Infectious Disease Clinic and at the Second Clinic of Surgery, St George University Hospital in Plovdiv over a 6-month period from September 2020 to February 2021.Results: Seventeen of the patients were men and nine – women. Twenty-four of all patients underwent thoracentesis and two of them had a video-assisted thoracoscopy. The mean age of the studied patients with pneumothorax and COVID-19 was 66.77±12.61 years, which shows that it is the patients of advanced age with concomitant diseases that are at a higher risk of serious complications and adverse outcome. Of the hospitalized 1245 patients with COVID-19, 385 (30.92%) passed away. Of all hospitalized patients with SARS-CoV-2, 26 (2.08%) developed pneumothorax. Sixteen of them (62%) passed away. The possibility of a lethal outcome for intubated patients increased more than twice.Conclusions: The pneumothorax as a complication of COVID-19 carries high mortality and severely worsens the prognosis for these patients

Bioimpedance analysis for fluid status assessment in critically ill septic patients

Aim: The aim of this study was to assess the usefulness of bioimpedance analysis in fluid status evaluation in patients with sepsis and septic shock admitted to the adult ICU. Materials and methods: This is a prospective, observational, clinician-blind study. The inclusion criteria were a diagnosis of sepsis at admission to ICU, a stay in ICU of at least 72 hours, and the first BIA measurement to be conducted within the first three hours of ICU admission. We took whole-body BIA measurements upon admission and every 24 hours thereafter for at least four consecutive measurements. All enteral and parenteral fluids administered to the patients were recorded, as well as the loses through drains, tubes, aspiration, and urine. The cumulative fluid balance (CFB) was calculated every 24 hours. Results: A total of 51 patients with a mean age of 62 years were included in the final analysis. CFB gradually increased during the first 72 hours of ICU stay from 2003±1331 mL at 24 hours to 3680±2368 mL at 48 hours and 5217±2642 mL at 72 hours. There was a statistically significant positive correlation between the increase in CFB and the increase in total body water, extracellular water, and overhydration. The daily changes of vector length and impedance ratio, as well as the overall 72-hour changes showed statistically significant correlation with the CFB. Conclusion: Bioimpedance analysis is a non-invasive, easy-to-use, inexpensive, portable, and fast tool for fluid status assessment. In critically ill septic patients it can be a useful tool in fluid therapy management

Descending Necrotizing Mediastinitis in Healthy Young Adults: The Fatal Consequence of the Delayed Help

Introduction: Descending necrotizing mediastinitis is one of the most lethal forms of acute mediastinitis. It originates from an odontogenic or deep neck infection, which descends to the mediastinum through the fascial planes. It is a rare condition, but mortality rates remain high, especially in the presence of comorbidities or predisposing factors. Delay in diagnosis has been shown to be one of the most important factors for the disease outcome. Therefore, early diagnosis and treatment by a multidisciplinary team are of utmost importance. Case series: Four healthy young males with descending necrotizing mediastinitis were treated at our institution. None of them had any comorbidities, but all of them waited between 3 and 4 days before seeking medical help. Upon their arrival at the hospital, in addition to the presence of a severe neck infection, the presence of mediastinitis was also found. Despite the timely surgical treatment of both the source of the infection and the mediastinitis, three of the four cases had a fatal outcome. Conclusion: We believe that the time factor is of greater importance for the outcome of acute descending mediastinitis than the factors of age and presence of accompanying diseases. Proper and rapid treatment by a multidisciplinary team is essential, even for young and healthy people

Effect of a Recombinant Human Soluble Thrombomodulin on Mortality in Patients With Sepsis-Associated Coagulopathy The SCARLET Randomized Clinical Trial

Importance: Previous research suggested that soluble human recombinant thrombomodulin may reduce mortality among patients with sepsis-associated coagulopathy. Objective: To determine the effect of human recombinant thrombomodulin vs placebo on 28-day all-cause mortality among patients with sepsis-associated coagulopathy. Design, Setting, and Participants: The SCARLET trial was a randomized, double-blind, placebo-controlled, multinational, multicenter phase 3 study conducted in intensive care units at 159 sites in 26 countries. All adult patients admitted to one of the participating intensive care units between October 2012 and March 2018 with sepsis-associated coagulopathy and concomitant cardiovascular and/or respiratory failure, defined as an international normalized ratio greater than 1.40 without other known etiology and a platelet count in the range of 30 to 150 × 10 9/L or a greater than 30% decrease in platelet count within 24 hours, were considered for inclusion. The final date of follow-up was February 28, 2019. Interventions: Patients with sepsis-associated coagulopathy were randomized and treated with an intravenous bolus or a 15-minute infusion of thrombomodulin (0.06 mg/kg/d [maximum, 6 mg/d]; n = 395) or matching placebo (n = 405) once daily for 6 days. Main Outcome and Measures: The primary end point was 28-day all-cause mortality. Results: Among 816 randomized patients, 800 (mean age, 60.7 years; 437 [54.6%] men) completed the study and were included in the full analysis set. In these patients, the 28-day all-cause mortality rate was not statistically significantly different between the thrombomodulin group and the placebo group (106 of 395 patients [26.8%] vs 119 of 405 patients [29.4%], respectively; P =.32). The absolute risk difference was 2.55% (95% CI, -3.68% to 8.77%). The incidence of serious major bleeding adverse events (defined as any intracranial hemorrhage; life-threatening bleeding; or bleeding event classified as serious by the investigator, with administration of at least 1440 mL [typically 6 units] of packed red blood cells over 2 consecutive days) was 23 of 396 patients (5.8%) in the thrombomodulin group and 16 of 404 (4.0%) in the placebo group. Conclusions and Relevance: Among patients with sepsis-associated coagulopathy, administration of a human recombinant thrombomodulin, compared with placebo, did not significantly reduce 28-day all-cause mortality. Trial Registration: ClinicalTrials.gov Identifier: NCT01598831

Effect of a Recombinant Human Soluble Thrombomodulin on Mortality in Patients With Sepsis-Associated Coagulopathy The SCARLET Randomized Clinical Trial

Importance: Previous research suggested that soluble human recombinant thrombomodulin may reduce mortality among patients with sepsis-associated coagulopathy. Objective: To determine the effect of human recombinant thrombomodulin vs placebo on 28-day all-cause mortality among patients with sepsis-associated coagulopathy. Design, Setting, and Participants: The SCARLET trial was a randomized, double-blind, placebo-controlled, multinational, multicenter phase 3 study conducted in intensive care units at 159 sites in 26 countries. All adult patients admitted to one of the participating intensive care units between October 2012 and March 2018 with sepsis-associated coagulopathy and concomitant cardiovascular and/or respiratory failure, defined as an international normalized ratio greater than 1.40 without other known etiology and a platelet count in the range of 30 to 150 × 10 9/L or a greater than 30% decrease in platelet count within 24 hours, were considered for inclusion. The final date of follow-up was February 28, 2019. Interventions: Patients with sepsis-associated coagulopathy were randomized and treated with an intravenous bolus or a 15-minute infusion of thrombomodulin (0.06 mg/kg/d [maximum, 6 mg/d]; n = 395) or matching placebo (n = 405) once daily for 6 days. Main Outcome and Measures: The primary end point was 28-day all-cause mortality. Results: Among 816 randomized patients, 800 (mean age, 60.7 years; 437 [54.6%] men) completed the study and were included in the full analysis set. In these patients, the 28-day all-cause mortality rate was not statistically significantly different between the thrombomodulin group and the placebo group (106 of 395 patients [26.8%] vs 119 of 405 patients [29.4%], respectively; P =.32). The absolute risk difference was 2.55% (95% CI, -3.68% to 8.77%). The incidence of serious major bleeding adverse events (defined as any intracranial hemorrhage; life-threatening bleeding; or bleeding event classified as serious by the investigator, with administration of at least 1440 mL [typically 6 units] of packed red blood cells over 2 consecutive days) was 23 of 396 patients (5.8%) in the thrombomodulin group and 16 of 404 (4.0%) in the placebo group. Conclusions and Relevance: Among patients with sepsis-associated coagulopathy, administration of a human recombinant thrombomodulin, compared with placebo, did not significantly reduce 28-day all-cause mortality. Trial Registration: ClinicalTrials.gov Identifier: NCT01598831