Prevalence of suspected obesity hypoventilation syndrome in Hungarian Intensive Care Units during the COVID-19 pandemic.

INTRODUCTION: The symptoms of obesity hypoventilation syndrome (OHS) may be present for years with concomitant progressive comorbidities, and the condition is frequently diagnosed late as a result of acute-on-chronic hypercapnic respiratory failure. Although some data exist on intensive care unit (ICU) prevalence, mortality and morbidity of OHS, little is known about the ICU mortality of these chronic respiratory failure patients during the COVID-19 pandemic. METHODS: We performed a cross-sectional observational study in five Hungarian Intensive Care Units for 4 months during the COVID-19 pandemic. All ICU patients were screened for OHS risk factors by treating physicians. Risk factors were defined as obesity (body mass index [BMI] ≥ 30 kg/m2 ) and at least one of the following: Epworth Sleepiness Score ≥ 6; symptoms of right heart failure; daytime or night-time hypoxemia; presence of loud snoring; witnessed apnoea. We calculated prevalence, mortality and factors associated with unfavourable outcome. RESULTS: A total of 904 ICU patients were screened for OHS risk factors. Overall 79 (8.74 ± 5.53%) patients were reported to have met the criteria for suspected OHS with a mortality rate of 40.5%; 69% (54 patients) of the cohort displayed at least 3 symptoms related to OHS before their acute illness. COVID-19 infection was associated with higher mortality in OHS-suspected patients, independently of actual BMI. CONCLUSION: Despite the increased risk of obese patients, suspected OHS did not show higher prevalence than expected during the COVID-19 pandemic in critically ill patients. COVID-19 infection however was a risk for mortality in these patients, independent of actual BMI.

[The complex intensive care and rehabilitation of a quadriplegic patient using a diaphragm pacemaker]. / Magas nyaki gerincvelôsérült beteg komplex intenzív ellátása, rehabilitációja rekeszi pacemaker alkalmazásával.

A 21 year female polytraumatized patient was admitted to our unit after a serious motorbike accident. We carried out CT imaging, which confirmed the fracture of the C-II vertebra and compression of spinal cord. Futhermore, the diagnostic investigations detected the compound and comminuted fracture of the left humerus and femur; the sacrum and the pubic bones were broken as well. After the stabilization of the cervical vertebra, a tracheotomy and the fixation of her limbs were performed. She spent 1.5 years in our unit. Meanwhile we tried to fix all the medical problems related to tetraplegia and respiratory insufficiency. As part of this process she underwent an electrophysiological examination in Uppsala (Sweden) and a diaphragm pacemaker was implanted. Our main goal was to reach the fully available quality of life. It is worth making this case familiar in a wider range of public as it could be an excellent example for the close collaboration of medical and non-medical fields.

A proposed novel method for CHD screening by fetal heart murmur detection using phonocardiography.

The paper presents a novel screening method to indicate congenital heart diseases (CHD) which otherwise would remain undetected because of their low level. Therefore, not belonging to the high-risk population, they are omitted from the regular fetal monitoring with ultrasound echocardiography. Based on the fact that CHDs are morphological defects of the heart causing turbulent blood flow, this turbulence appears as a murmur, which can be detected by phonocardiography (PCG). The proposed method applies measurements on the maternal abdomen and from the recorded sound signal a sophisticated processing determines the fetal heart murmur. The paper describes the problems and the additional advantages of the PCG method including the possibility of measurements at home and its combination with the prescribed regular cardiotocographic (CTG) monitoring. The proposed screening process implemented on a telemedicine system provides an enhanced safety against hidden cardiac diseases.

Comparison of separation performances of novel ß-cyclodextrin-based chiral stationary phases in high-performance liquid chromatographic enantioseparation.

Three ß-cyclodextrin-based chiral stationary phases were developed applying novel bonding chemistry. The separation performances of ß-cyclodextrin, (R,S)-2-hydroxypropyl-ß-cyclodextrin, and permethyl-ß-cyclodextrin-based CSPs were compared in the resolution of structurally divergent analytes, such as coumarins, dansyl amino acids, and propionic acid derivatives. Separations were carried out in reversed phase mode applying 0.1% triethylammonium phosphate (pH 3.5)/MeOH mobile phase systems in different compositions. Of the three novel CSPs the permethyl-ß-cyclodextrin bonded phase proved to be the most effective one for the enantioseparation of investigated analytes.

Screening for congenital heart diseases by murmurs using telemedical phonocardiography.

A large proportion of congenital heart diseases (CHD) remain undetected during pregnancy or even after birth. Many of them generate turbulent blood flow, resulting heart murmur. Doppler ultrasound cardiotocography (CTG) is suitable for the assessment of the fetal heart rate and some derived parameters, but it is inadequate for detecting heart murmurs. Although comprehensive examination can be carried out with echocardiography, it is expensive and requires expertise; therefore, it is not applicable for widespread screening. This paper presents a new possibility for screening for some CHDs using phonocardiography, which can be combined with Doppler ultrasound CTG as an extension of it. Furthermore it can be carried out at home allowing repeated measurements, which increases also the reliability of filtering out innocent murmurs. The diagnostic capability of this screening method is supported by a large number of evaluated fetal heart sound records. Moreover, according to experiences pregnant women prefer this reliable, easy to use method, which facilitates their examination.

Enantioseparation of beta-substituted tryptophan analogues with modified cyclodextrins by capillary zone electrophoresis.

Direct capillary zone electrophoretic methods were developed for the separation of the enantiomers of unnatural beta-substituted tryptophan analogues such as erythro- and threo-beta-methyl-, beta-2-propyl-, beta-3-pentyl-, beta-phenyl- and beta-2,5-dimethoxyphenyltryptophan. Cyclodextrins (CDs) were chosen as chiral selectors because of their favorable properties (stability, commercial availability, low cost, UV transparency, inertness, etc.). Capillary zone electrophoresis was carried out using sulfopropylated-alpha-CD (SP2-alpha-CD), sulfopropylated-beta-CD (SP2-beta-CD) both with a degree of substitution of 2moles/mole cyclodextrin, and sulfopropylated-beta-CD (SP4-beta-CD) with a degree of substitution of 4moles/mole beta-cyclodextrin. With this technique all compounds investigated are baseline resolved using different background electrolytes and chiral additives. The elution sequence was determined in all cases.

Enantioseparation of beta-methyl-substituted amino acids with cyclodextrins by capillary zone electrophoresis.

Direct capillary zone electrophoretic methods were developed for the separation of the enantiomers of unnatural beta-methyl-amino acids such as erythro- and threo-beta-methylphenylalanine, beta-methyltyrosine, beta-methyltryptophan and beta-methyl-1,2,3,4-tetrahydroisoquinoline-3-carboxylic acid. Capillary zone electrophoresis was carried out using sulfopropylated-alpha-CD (SP2-alpha-CD), sulfopropylated-beta-CD (SP2-beta-CD) both with a degree of substitution of 2 moles/mole cyclodextrin, and sulfopropylated-beta-CD (SP4-beta-CD) with a degree of substitution of 4moles/mole beta-cyclodextrin. The effects of selector and buffer concentrations, electrolyte pH and applied voltage were studied on the separation efficiency. Varying the electrophoretic conditions with application of 20 kV, hydrodynamic injection, unmodified silica capillary, three different buffers (borate, phosphate and acetate) and modified cyclodextrins as chiral selectors all compounds investigated are nearly baseline resolved. The elution sequence was determined in most cases.