Anesthesia management for emergency cesarean section in a patient with takotsubo cardiomyopathy

Takotsubo cardiomyopathy (TCM) is a clinical entity resembling acute myocardial infarction that develops due to catecholamine discharge and coronary artery spasm following acute stress in postmenopausal women. The most common symptoms are chest pain, syncope and dyspnea. Moreover ST interval and T wave abnormalities are frequently seen on electrocardiogram (ECG). 19-year-old pregnant with TCM undervent for emergency caesarean section (C/S). Ejection fraction was measured 60% in preoperative echocardiography. Anesthesia induction was achieved with 2 mg/kg propofol and 1 mg/kg fentanyl, after rapid serial endotracheal intubation was performed by using 1.2 mg/kg rocuronium bromide. Anesthesia was maintained with sevoflurane. Residual block was reversed by 4 mg/kg dose of sugammadex and there was no there was complication in the perioperative period. In anesthesia management of patients with TCM, minimization of situations that caused an increase in catecholamine, if possible follow-up with advanced cardiac monitoring and it should be postoperative intensive care unit (ICU) preparation. Keywords

Correlation of Serum Asprosin Levels With Normalized Protein Catabolic Rate in Patients Receiving Peritoneal Dialysis Treatment.

Background Peritoneal dialysis patients are malnourished due to loss of protein in the dialysate and inadequate dialysis, although they take additional calories every day during treatment. Many parameters are used to assess nutritional status, with normalized protein catabolic rate (nPCR) being one of the most common. Asprosin, a novel adipokine secreted by adipose tissue, peaks during fasting and induces hepatic glucose release through the activation of the G-protein- cAMP-PKA pathway, which has been indicated to have a curative effect on chronic inflammation. In this study, we aimed to investigate the relationship between asprosin levels and nutritional parameters in patients receiving peritoneal dialysis treatment as well as to investigate the applicability of more practical tests. Methodology A total of 70 peritoneal dialysis patients, 35 female (59%) and 24 male (41%), were included in the study. The mean age of the patients was 53 +/- 14 years (range = 18-80 years), and the median peritoneal dialysis duration was 31.5 months (range = 20-56.2 months). The most common etiologic cause was hypertension (37%). Patients over 18 years of age who had been receiving peritoneal dialysis treatment for at least 24 months were included in the study. The correlation between patients' nPCR levels and serum asprosin, body mass index, and lipids was evaluated. Results The correlation between the level of nPCR and the serum asprosin level, body mass index, and lipids was evaluated. Patients with nPCR <0.815 were considered malnourished, and factors affecting malnutrition were determined by univariate analysis. Among the factors affecting malnutrition according to univariate analysis, those with p-value <0.05 were analyzed by multivariate analysis. Low asprosin level was one of the independent factors affecting malnutrition in patients (Exp(B) = 0.944, 95% confidence interval (CI) = 0.896-0.994). Other independent factors affecting malnutrition were Kt/V (Exp(B) = 0.018, 95% CI = 0.001-0.550) and residual renal function (Exp(B) = -0.004, 95% CI = 0.993-0.999). Conclusions There is a need for more accessible tests and reliable parameters to evaluate dialysis and nutritional deficiency in peritoneal dialysis patients. One possible hormone that could serve as a guide is asprosin

Severe Complication of Iatrogenic Sodium Phosphate Enema Overdose: Acute Kidney Injury

Sodium phosphate-based enema preparations are low-volume, hyperosmotic agents commonly used in bowel preparation for sigmoidoscopy/colonoscopy and surgical operation. Although generally safe and well tolerated in adults, severe metabolic complications have been reported with use. The patient in this case report was admitted to the general surgery department with complaints of nausea, vomiting, and abdominal pain after oral sodium phosphate solution. After clinical evaluation, hemodialysis was started for acute kidney injury (AKI). Clinicians should be alert using sodium phosphate solution for bowel cleansing before sigmoidoscopy/colonoscopy and surgical operation, in terms of acute kidney damage and electrolyte imbalance

Analysis of the Factors Affecting the Reasons of Transition From Peritoneal Dialysis to Hemodialysis

Background: Peritoneal dialysis is a frequently used renal replacement treatment option in patients with end-stage renalfailure, and it is emphasized several times that it should be started as the first treatment in the literature. However, for manydifferent reasons, sometimes the treatment is stopped and switched to hemodialysis. In this study, we aimed to examinethe reasons and factors affecting the transition to hemodialysis in our unit.Methods: Fifty-five patients who were – transferred to hemodialysis – regularly attending the Peritoneal Dialysis Unit ofErciyes University Nephrology Department were included in our study. Biochemical analysis, peritoneal equalization test(PET), dialysis adequacy (kt/V), and creatinine clearance of these patients were recorded regularly. Regular cardiac exami-nations and ambulatory blood pressure measurements were also performed. The reasons for the transition from perito-neal dialysis to hemodialysis were also noted in detail.Results: The mean age of the patients was 54.02 ± 11.41 years, and 27 (62.8%) of the patients were male. While the shortestperiod spent on peritoneal dialysis was 13 months, the longest was 191 months. The most common type of permeabilityin PET analysis of the patients was observed as high-average. The most common reason for the transition to hemodialysiswas inadequate dialysis. Using univariate and multiple regression models, factors that predict the duration of stay in peri-toneal dialysis were examined. We found that the urine volume, total kt/V, and the number of peritonitis could be effectivein predicting this period.Conclusion: Peritoneal dialysis is a renal replacement option that has advantages such as patient comfort, preservation ofthe kidney’s remaining work, and social life. The reasons for the transition should be examined in detail, and the necessaryinterventions to prolong the time in peritoneal dialysis should be evaluated.</div

Varicella-like Lesions in a Patient with Aggressive Lupus Nephritis

Systemic lupus erythematosus is an autoimmune disease that is widespread throughout the world. Vasculitis can present in patients with lupus nephritis in very different clinics. However, if rapid diagnosis and treatment are not applied, this disease may be mortal. The patient with lupus nephritis, which was aggressive and accompanied by infection, and remission with strong immunosuppressive therapy and infection treatment. In this case, vasculitis with varicella-like lesions is presented

Relationship between renal tubulointerstitial fibrosis and serum prolidase enzyme activity

Objectives: The severity of interstitial fibrosis/tubular atrophy (IFTA) is the most important determinant of the irreversible progression of chronic kidney disease (CKD). Prolidase is the key enzyme in collagen turnover and is associated with an extracellular matrix increase. We aimed to evaluate the relationship between the presence and degree of IFTA and serum prolidase enzyme activity (SPEA) in patients undergoing a renal biopsy

Cladophilaphora bantiana Brain Abscess Treated with Voriconazole in an Immunocompetent Patient

Phaeohyphomycosis is a term used to define infections caused by darkly pigmented fungi with septate hyphae which contain melanin in their cell walls. Although fungi rarely cause central nervous system (CNS) infections, the incidence of CNS infections caused by melanin-containing fungi has been increasing in the recent years. Cladophialophora bantiana is the most frequently isolated species from cerebral phaeohyphomycosis. It mostly affects adult men in the second and third decade of life and about half of the cases occurs in immunocompetent patients. In this report, the isolation of C.bantiana from brain tissue of an immunocompetent patient who was operated with the initial diagnosis of a brain abscess, was presented. A 27 year-old male patient presenting without any chronic disease was admitted to the emergency department of our hospital with the complaints of persistent headache and diplopia. Magnetic resonance imaging (MRI) showed a space-occupying lesion in the right parietal lobe and left frontal lobe. Brain abscess was diagnosed in the patient who was referred to the neurosurgery department. Treatment was initiated with ceftriaxone and metronidazole. The abscess material sent for direct microscopic examination in the mycology laboratory was stained with Gram and Giemsa and cultured in the Sabouraud dextrose agar medium (SDA) with and without antibiotics (cycloheximide and chloramphenicol). Then, it was incubated at 37 degrees C and 25 degrees C. Direct examination and staining revealed a septate hyphae. The patient who received liposomal amphotericin B was referred to the infectious diseases department. Surface colors of all media including SDA with cycloheximide were olive-gray to black and contained velvety colonies. Lemon-like very long and integrated chains of conidium with poor branching in cornmeal Tween 80 agar, as well as growth at 42 degrees C in passages, positive urease test result and cycloheximide resistance suggested C.bantiana. The isolate was confirmed as C. bantiana based on its DNA sequence analysis. Minimum inhibitor concentration (MIC) values for amphotericin B, voriconazole, caspofungin, and posaconazole were 2 mu g/ml, 0.03 mu g/ml, 0.03 mu g/ml and 0.03 mu g/ml, respectively. Liposomal amphotericin B was replaced with voriconazole due to the antifungal susceptibility profile. The patient who was symptom-free was discharged at 24 days after hospitalization with oral voriconazole treatment. In conclusion, cerebral phaeohyphomycosis should be considered in immunocompetent individuals. Given the fact that early diagnosis saves lives, such specimens should promptly be sent for mycological analysis

Possible Link between IgA Nephropathy and B-cell Acute Lymphoblastic Leukemia

IgA nephropathy (IgA-N) is the most common glomerulonephritis type globally. IgA-N is usually accepted as a kidney disease; however, IgA-N has been reported with infections, autoimmune diseases, and malignancies in the literature. In this report, we present a case of a 33-year-old man diagnosed with IgA nephropathy first and then with B-cell acute lymphoblastic leukemia (B-ALL). He was admitted to our hospital with complaints of nausea, vomiting, fatigue, and headache. Laboratory investigations revealed increased levels of blood urea nitrogen and creatinine, hypercalcemia, anemia, and thrombocytopenia. Kidney biopsy was performed, and IgA nephropathy was detected. Atypical lymphocytes and erythroblasts were present in the peripheral blood smear. Bone marrow biopsy was performed and demonstrated B-ALL. Kidney function tests normalized after 1 month of chemotherapy, including steroid treatment with intravenous fluid administration. In conclusion, it has been speculated that IgA nephropathy is associated with B-ALL

A rare complication following internal jugular vein catheterization to malposition: acute Budd Chiari syndrome

Background Tunneled catheters can be used as an alternative vascular access in patients with limited health expectancy,vascular access problems and several comorbidities. We aimed to present a patient with venous stenosis related- reversible acute Budd-Chiari syndrome after catheter malposition. Case presentation After changing of tunneled catheter insertion, 36-year old man was admitted to our hospital with sudden onset of nausea, fever, chills and worsening general condition In computed tomography (CT) imaging, a hypodense thrombus was observed in which the distal end of the catheter is at the level of drainage of the hepatic veins in the inferior vena cava and that blocked hepatic vein drainage around the catheter. The catheter was removed and a new catheter was inserted in the same session. Because patient's general condition was good and without fever, he was discharged with advices on the 9th day of hospitalization. Conclusion Although catheter malposition and thrombosis are not a common complication, clinicians should be alert of these complications

An Unusual Complication of Internal Jugular Vein Catheterization: Chylothorax

Background: Infection and vascular occlusion are common catheter-related complications in patients with central venous catheters