Renal Resistive Index on Intensive Care Unit Admission Correlates With Tissue Hypoperfusion Indices and Predicts Clinical Outcome.

BACKGROUND: Renal resistive index (RRI) has been used to evaluate renal blood flow. Our aim was to investigate the relation between RRI and global tissue hypoperfusion indices and their association with clinical outcome, in intensive care unit (ICU) patients. METHODS: RRI was measured within 24 h of ICU admission. Gas exchange and routine hemodynamic variables at the time of RRI assessment were recorded. An elevated RRI was defined as >0.7. The ratio of central venous-to-arterial carbon dioxide partial pressure difference by arterial-to-central venous oxygen content difference (P(cv-a)CO2/C(a-cv)O2) and lactate were used as global tissue hypoperfusion indices. RESULTS: A total of 126 patients were included [median age 61 (IQR 28) years, 74% males]. P(cv-a)CO2/C(a-cv)O2 ratio and arterial lactate were significantly higher in patients with RRI >0.7 compared with those with RRI ≤0.7 [2.88 (3.39) vs. 0.62 (0.57) mmol/L and 2.4 (2.2) vs. 1.2 (0.6)] respectively, both P < 0.001)]. RRI was significantly correlated with P(cv-a)CO2/C(a-cv)O2 ratio and arterial lactate for the whole patient population (rho = 0.64, both P < 0.0001) and for the subset of patients with shock (rho = 0.47, P = 0.001; and r = 0.64, P < 0.0001 respectively). Logistic regression models showed a significant association between RRI and P(cv-a)CO2/C(a-cv)O2 ratio with clinical outcome. The combination of RRI with P(cv-a)CO2)/(C(a-cv)O2 ratio and lactate better predicted mortality than RRI alone [AUC 84.8% (95% CI 5.1% -94.4%)] vs. [AUC 74.9% (95% CI 61%-88.8%)] respectively, P < 0.001. CONCLUSIONS: Renal blood flow assessed by RRI, on ICU admission, correlates with global tissue hypoperfusion indices. In addition, RRI in combination with tissue perfusion estimation better predicts clinical outcome than RRI alone.

Evidence for the involvement of cannabinoid receptors' polymorphisms in the pathophysiology of human diseases.

INTRODUCTION: Considerable progress has been made, over the last years, in understanding the role of the endocannabinoid system (ES) in regard to its role in a variety of physiological processes including nociception (pain-sensation), appetite, lipid metabolism, gastrointestinal motility, cardiovascular modulation, motor activity, and memory. Furthermore, ES is strongly associated with human behavior and the skeletal ES is of major importance. ES is comprised of cannabinoid receptors (CB1 and CB2), their endogenous ligands (endocannabinoids) and proteins responsible for their metabolism. AREAS COVERED: To summarize and present all the existing literature that associate CB receptors' polymorphisms with behavior and disease in different populations, as well as its possible therapeutic perspectives. A literature review presenting the most recent data in terms of ES and the latest knowledge regarding the involvement of genetic polymorphisms of cannabinoid receptors in a variety of human diseases and psychiatric and neurological disorders. EXPERT OPINION: The ES is an emerging target for drug discovery, because it is involved in the regulation of many cellular and physiological functions. The modulation of the ES by selective agonists or antagonists may hold tremendous therapeutic potential in various conditions mentioned in this review. However, further information is still required before the ES is completely comprehended.

Management of the airway without the use of neuromuscular blocking agents: the use of remifentanil.

Remifentanil belongs to opioid drugs, and its pharmacokinetic characteristics make it unique in this class of drugs and appropriate for use during intubation without neuromuscular blockage. This up-to-date review aims to summarize the findings of recent studies regarding remifentanil and intubation. Remifentanil combined either with propofol or with inhaled anesthetic agents has been proved to provide acceptable intubating conditions. Regarding children patients, remifentanil can be used safely, and as far as intubating conditions are concerned, its effectiveness is as excellent as with neuromuscular blockage. Strong evidence exists that illuminates the usefulness of the drug in cases of difficult airway as well as in neuromuscular diseases. Beyond all these favorable characteristics, anesthesiologists must be conscious with the use of remifentanil.

Spinal versus General Anaesthesia in Postoperative Pain Management during Transurethral Procedures.

We compared the analgesic efficacy of spinal and general anaesthesia following transurethral procedures. 97 and 47 patients underwent transurethral bladder tumour resection (TUR-B) and transurethral prostatectomy (TUR-P), respectively. Postoperative pain was recorded using an 11-point visual analogue scale (VAS). VAS score was greatest at discharge from recovery room for general anaesthesia (P = 0.027). The pattern changed significantly at 8 h and 12 h for general anaesthesia's efficacy (P = 0.017 and P = 0.007, resp.). A higher VAS score was observed in pT2 patients. Patients with resected tumour volume >10 cm(3) exhibited a VAS score >3 at 8 h and 24 h (P = 0.050, P = 0.036, resp.). Multifocality of bladder tumours induced more pain overall. It seems that spinal anaesthesia is more effective during the first 2 postoperative hours, while general prevails at later stages and at larger traumatic surfaces. Finally, we incidentally found that tumour stage plays a significant role in postoperative pain, a point that requires further verification.

The role of genes in the development of Mullerian anomalies: where are we today?

UNLABELLED: Recent studies claim that researchers are challenged to find out the pathogenesis of the congenital anomalies of the female reproductive tract. Their frequency is estimated to be between 0.1% and 3% of live births in humans. During the experiments a number of genes were detected to contribute to the formation and development of the female reproductive tract. This review article aims to report these genes, as they probably play a significant role in the pathology of the reproductive tract in females. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this educational activity, the participant should be better able to explain the genetic basis of Mullerian abnormalities, give examples of the complexity of the genetic basis behind a variety of mechanisms of disease, and recall the embryology of the female reproductive tract.