Hypothermic neonates need to be promptly rewarmed but there is no strong evidence to support a rapid or a slow pace of rewarming. This study aimed to investigate the rewarming rate and its ...associations with clinical outcomes in hypothermic neonates born in a low-resource setting.
This retrospective study evaluated the rewarming rate of hypothermic inborn neonates admitted to the Special Care Unit of Tosamaganga Hospital (Tanzania) in 2019-2020. The rewarming rate was calculated as the difference between the first normothermic value (36.5-37.5°C) and the admission temperature, divided by the time elapsed. Neurodevelopmental status at 1 month of age was assessed using the Hammersmith Neonatal Neurological Examination.
Median rewarming rate was 0.22°C/h (IQR: 0.11-0.41) in 344/382 (90%) hypothermic inborn infants, and was inversely correlated to admission temperature (correlation coefficient -0.36,
< 0.001). Rewarming rate was not associated with hypoglycemia (
= 0.16), late onset sepsis (
= 0.10), jaundice (
= 0.85), respiratory distress (
= 0.83), seizures (
= 0.34), length of hospital stay (
= 0.22) or mortality (
= 0.17). In 102/307 survivors who returned at follow-up visit at 1 month of age, rewarming rate was not associated with a potential correlate of cerebral palsy risk.
Our findings did not show any significant association between rewarming rate and mortality, selected complications or abnormal neurologic exam suggestive of cerebral palsy. However, further prospective studies with strong methodological approach are required to provide conclusive evidence on this topic.
Inflammatory bowel diseases (ulcerative colitis and Crohn’s disease) tend to increase in frequency and prevalence worldwide and lead to a significant reduction in quality of life with a complicated ...course. Intravenous administration of corticosteroids in acute severe ulcerative colitis is effective in 60–70 % of cases. Rescue therapy for patients with steroid‐refractory and steroid-dependence attacks is effective for reducing colectomy or colproctectomy and improves long-term treatment outcomes. Despite the proven efficacy of infliximab, limitations to the use of monoclonal antibodies are adverse reactions to the administration of genetically engineered biologic therapy (GEBT), both well-known and studied, and rare.
The aim of the study.
To analyze a case of an extremely rare and paradoxical incurable hyperergic reaction that occurred after using genetically engineered biological therapy with tumor necrosis factor alpha blockers in a patient suffering from ulcerative colitis.
Materials and methods.
We carried out the search in the PubMed, Embase, Scopus and Medline databases until November 1, 2022 using the following keywords: inflammatory bowel disease, ulcerative colitis (UC), anti-tumor necrosis factor α (antiTNFα), infliximab, fever, adverse events. In the scientific electronic library eLIBRARY, a search was made for Russian-language publications using similar queries in Russian. We analyzed the patient’s medical records from 03.06.2013 up to the present day; the patient signed an informed consent for the publication and discussion of the presented data.
Conclusion.
The widespread use of GEBT in the treatment of autoimmune and autoinflammatory diseases leads to the accumulation of both positive and negative experience of clinicians in real clinical practice. The officially described adverse events in the appointment of any drug suggest options for their prevention and treatment. Atypical manifestations or casuistic cases must be systematized for further fundamental pathophysiological studies.
Use and therapeutic effects of hypothermia were known far in the time B.C. described by Hippocrates, later after more than 1600 years by Napoleon armies surgeon in chief who noted that wounded ...soldiers who were near the fireplace died earlier than those in cold places, until Dr Peter Safar included hypothermia in his 'Heart-Lung Resuscitation Guidelines' back in 1961 in Pittsburgh. Finally in 2005, Pre-Hospital Cooling was put into the AHA and ERC Guidelines for resuscitation with the remark: 'As soon as possible after ROSC'. Procedure and equipment used in Vienna Ambulance is described as well as results, showing that prehospital use results in significantly shorter time to achieve target temperature of 33 C, 91 minutes compared with after admission use reaching the same temperature after 269 minutes (4h 29min) after ROSC. The present studies are aimed to the future implementation in acute myocardial infarction as well as in patients suffering from ischaemic stroke,EuroHYP-19) which is a multi-centre study sponsored by the European Union.
The probability of survival in avalanche accidents is time-dependent. Critically buried victims who undergo a long burial duration (over 60 min) face a possible mortality rate of over 80%. ...Understanding the physiological response during critical avalanche burial is crucial for improving rescue strategies and outcomes. We present the case of a 55-year-old male skier buried under an avalanche for 4 h and 51 min in the Italian Alps. Continuous heart rate monitoring revealed distinct phases of cardiac activity during burial. Despite severe hypothermia, the victim survived without extracorporeal rewarming. This case highlights the importance of continuous monitoring and appropriate on-site management in avalanche accidents. Factors such as the presence of an air pocket may positively influence survival. This case underscores the importance of comprehensive resuscitative measures and guidelines for managing avalanche victims with prolonged burial durations. Keywords: Avalanche, Severe hypotermia, Hearth electrical activity
Hypothermia is used for its neuroprotective effect in perinatal asphyxia. Mechanical ventilation is often used as a supportive therapy for severe asphyxiated infants who can present various degrees ...of respiratory failure. Animal studies demonstrated a protective effect of cooling on the lungs due to reduced ventilatory requirements. Even if actual knowledge on the effects of hypothermia and rewarming on respiratory parameters during mechanical ventilation is limited, nevertheless human studies seem to demonstrate that hypothermia is safe and does not cause significant changes in the level of respiratory supports.
Perioperative hypotermia is a common, but preventable complication of anaesthesia and surgery. Mild perioperative hypothermia increases the incidence of morbid myocardial outcomes, reduces resistance ...to surgical wound infections, and prolongs both postanaesthetic recovery and hospitalization. Hypotermia causes a coagulopathy due to inhibition of platelet function. In this short review, we will discuss three studies done in the last 6 years, which explored the influence of perioperative hypotermia and blood loss. All evaluated blood loss during hip arthroplasty and had similar methodologies. Two studies demonstrate that blood loss is increased, especially during surgery, in hypotermic patients while a third study failed to identify any thermal influence on blood loss. The benefits of maintaining perioperative normothermia on blood loss thus remain unclear. We thus continue to recommend that surgical patients be kept normothermic.
Since the first successful replacement of the aortic arch with perfusion of the head, various methods have been employed to preserve cerebral function during aneurysm operations. Although deep ...hypothermia was used for surgery of the aortic arch, as early as 1963, the introduction of prolonged circulatory arrest has simplified replacements of the aortic arch. Between October 1990 and September 1993, 69 patients underwent aortic arch replacement for aneurysmal disease at the Dept. of Cardio-Thoracic Surg., University of Vienna. 52 patients had an acute dissection Type A, 17 patients were operated on electively. The patients age (48 male, 21 female) ranged between 16 and 81 years. Primary diagnosis was hypertension (n=44), marfan (n=14), unknown (n=10) and trauma (n=1). Total cardiopulmonary bypass was established via femoral artery cannulation. All patients received Cortison and Thiopental for added cerebral protection. Deep hypothermia (12 degrees C), confirmed by 0-EEG, and circulatory arrest were induced in all patients. The aneurysm was opened longitudinally and a full thickness single patch or "island" of aortic wall, containing the origins of the three arch vessels, was constructed and anastomosed in a continuous fashion to an albumin coated graft. 68 patients survived the operation (intraoperative mortality 1%). The 30-day mortality was 23% (n=16). Twelve patients died of multiorgan failure, two patients of a stroke and two due to myocardial infarction. The mean cerebral circulatory arrest time was 32 minutes (range 11-61 min.). Our experience with aortic arch replacements using profound hypothermia and circulatory arrest supports our contention, that it is the method of choice in this very difficult surgical field.
Equipment to prevent, diagnose, and treat hypothermia Karlsen, Anders M; Thomassen, Øyvind; Vikenes, Bjarne H ...
Scandinavian journal of trauma, resuscitation and emergency medicine,
2013, Volume:
21
Journal Article
