Arterial Monitoring System Leveling Method, Transducer Location, and Accuracy of Blood Pressure Measurements.

BACKGROUND: Many critically ill patients have invasive arterial catheters inserted for blood pressure monitoring. Whether catheter leveling method and alternative transducer location affect the accuracy of blood pressure measurements is unknown. OBJECTIVE: To determine whether the use of alternative transducer locations and visual alignment versus laser device leveling significantly affect the accuracy of blood pressure measurements. METHODS: A convenience sample of 36 participants were randomly assigned to 1 of 3 experimental groups with different transducer locations: taped to the upper arm, next to the upper arm taped to a rolled cloth, or at the wrist. Participants served as their own controls; the control condition was having the transducer on the intravenous pole. Four blood pressure measurements were recorded for each patient (2 from each of the experimental and control conditions) using visual alignment and then laser device leveling. RESULTS: Only diastolic blood pressure (DBP) differed significantly between leveling methods (P = .01); no pressures differed significantly by transducer location. Covariate analysis indicated expected relationships between (1) age and DBP (P = .001), (2) Simplified Acute Physiology Score II and both DBP (P = .003) and mean arterial pressure (P = .03), and (3) duration of mechanical ventilation and DBP (P = .05). CONCLUSION: The findings indicate that any of the transducer locations evaluated may be useful in clinical prac-tice. Also, visual alignment rather than laser device leveling may be acceptable, except for DBP in the control location. More research is needed to strengthen these findings.

Mutagenesis of the modified bases, m(5)U1939 and psi2504, in Escherichia coli 23S rRNA.

Ribosomal RNAs (rRNAs) from all kingdoms contain a variety of post-transcriptional modifications and these are typically clustered in the functional centers of the ribosome. The functions of two bases in the 23S rRNA of Escherichia coli that are post-transcriptionally modified, m(5)U1939 and psi2504, were examined by mutagenesis of the rRNA bases and by inactivation of the RumA methylase that methylates U1939. Base substitutions at U1939 had little effect on growth or the fidelity of translation, but altered the sensitivity of the ribosomes to the antibiotics fusidic acid and capreomycin. Strains lacking the RumA methylase were gradually out-competed by wild type strains in growth competition experiments, suggesting that the m(5)U methylation improves ribosome performance. Base changes at psi2504 had dramatic effects on growth and resistance to several peptidyltransferase inhibitor antibiotics and increased the levels of translational errors. The results link these sites of post-transcriptional modification with the ribosome's response to antibiotics and the control of translational fidelity.

Emergency Cesarean Section at 38 Weeks of Gestation with COVID-19 Pneumonia: A Case Report.

BACKGROUND Up to 47% of pregnant women with COVID-19 have preterm deliveries. A severe, symptomatic COVID-19 infection in close-to-term pregnancies can have a poor prognosis. Early identification of COVID-19 in pregnant women can prevent the progression of the disease. Currently, there is very little guidance on treating pregnant close-to-term women with COVID-19; this case report suggests changes to current management to maximize positive maternal and fetal outcomes. CASE REPORT A pregnant woman (37 weeks of gestation) presented to the Emergency Department with a chief complaint of fever with an associated cough for 2 days. She was diagnosed with COVID-19 in the Emergency Department, and discharged in a stable condition. She returned 5 days later in preterm labor with severe respiratory distress. After an emergency cesarean section, she remained intubated in the Surgical Intensive Care Unit; she was persistently hypotensive and hypoxic despite maximal ventilator and medical treatment. She died after a cardiac arrest and unsuccessful resuscitation, 15 days after the delivery. We discuss the possible benefit of a planned C-section for close-to-term pregnancies prior to the onset of COVID-19 symptoms. The patient's next of kin gave informed consent for this case report. Approval from the Institutional Review Board or Ethics Review Board was not required as this is a case report. CONCLUSIONS Currently, asymptomatic pregnant women are not tested for COVID-19 infection until hospitalization for delivery. It could be beneficial to have a protocol in place to screen asymptomatic pregnant women so they can be identified early and monitored, as COVID-19 symptoms can escalate quickly.