Background: Pulse wave velocity (PWV) is a known predictor of target organ damage, cardiovascular disease and overall mortality. The aim of this study was to compare the PWV values in subjects with prediabetes, a non-dipper profile and arterial hypertension with their values in healthy subjects. Methods: A total of 301 subjects, aged 40–70 years, without diabetes mellitus were included in this cross-sectional study (150 with prediabetes). They underwent a 24 h ambulatory blood pressure monitoring (ABPM). Subjects were divided into three hypertension groups (A = healthy, B = controlled hypertension, C = uncontrolled hypertension). Dipping status was determined according to ABPM results, and PWV was measured by an oscillometric device. Prediabetes was defined as having 2 separate fasting plasma glucose (FPG) measurements between 5.6 and 6.9 mmol/L. Results: The highest PWV values were found in group C (9.60 ± 1.34 vs. 8.46 ± 1.01 in group B vs. 7.79 ± 1.10 in group A; p < 0.001), in subjects with prediabetes (8.98 ± 1.31 m/s vs. 8.26 ± 1.22 m/s; p < 0.001) and in prediabetic non-dippers among age groups (p = 0.05). In the multivariate regression model age, blood pressure, nocturnal indices and FPG were shown as independent predictors of PWV values. Conclusion: Significantly higher PWV values were found in subjects with prediabetes and non-dipping profiles in all three examined hypertension groups.

Diagnostic value and utility of commonly used biomarkers of cardiac and renal function in cardiorenal syndromes: a narrative review

The aim of this paper is to gather and evaluate available literature about using videolaryngoscopy as a training tool for novice learners and compare it to direct laryngoscopy. Search of the available literature was performed using the MEDLINE data...

Background and purpose: Extubation in patients with cervical spine injury (CSI) is a high-stakes clinical intervention, requiring a nuanced understanding of spinal pathophysiology, respiratory mechanics, and risk mitigation strategies. This review synthesizes the current evidence on the demographics, injury mechanisms, and extubation risks associated with CSI, highlighting the complexities that arise from associated spinal cord injuries, diaphragmatic dysfunction, and airway instability. Results: Epidemiological data reveal a bimodal age distribution and an increasing incidence of CSI due to falls, especially among the elderly. The anatomical vulnerability of the cervical spine and the two-phase pathophysiology of spinal cord injury—primary mechanical insult and secondary inflammatory cascades—complicate respiratory management and timing of extubation. Patients with CSI often face unique extubation challenges, including impaired airway reflexes, agitation, and upper airway edema. Existing guidelines, such as those from the Difficult Airway Society, underscore the need for high-risk extubation protocols, emphasizing preparedness, appropriate sedation, and airway reflex control strategies like remifentanil infusion or delayed extubation in select cases. Several predictors of extubation failure in patients with CSI have been investigated, such as prolonged surgery, vertebral level involvement and blood loss. For ventilator-dependent tetraplegic patients, individualized weaning strategies based on neurological and diaphragmatic function are crucial. The use of adjuncts like cough-assist devices post-extubation is essential for airway secretion clearance. Conclusion: Safe extubation in CSI patients demands a multidisciplinary, protocol-driven approach tailored to individual pathophysiological and surgical risk profiles.

Aim: This case report aims to describe the management of migraine resistant to standard therapy in the emergency department (ED) using intravenous esketamine, a novel treatment modality and a potent analgesic agent. Case report: A 24-year-old female presented to the ED with a chief complaint of intense headache lasting for 3 hours. She had a history of migraine headaches that were successfully treated with non-steroidal anti-inflammatory drugs (NSAIDs). The neurologic status was without abnormalities. The patient reported a pain intensity of 9/10 on the visual analogue scale (VAS). A peripheral venous cannula was placed. She was administered 10 mg of metoclopramide over 10 minutes intravenously, without a significant improvement in the VAS. After half an hour, she was administered another 10mg of metoclopramide, followed by 100 mg of ketoprofen over 30 minutes intravenously. Her VAS remained at 9/10, therefore a computed tomography (CT) scan of the brain with intravenous contrast was ordered. The laboratory tests were all within reference intervals. The CT scan reported no intracranial pathology. Due to persistent pain with a VAS of 9/10, the patient was administered 0.05 mg/kg of esketamine as an infusion over 30 minutes, followed by an infusion of 12 mg of dexamethasone, after which she reported a decrease in VAS from 9/10 to 2/10. Following symptom resolution and observation without any adverse events noted, the patient was discharged home with detailed return precautions. Conclusion: Esketamine is a potent analgesic which can be used an effective third-line therapy for migraine headache refractory to conventional treatment.

Airway management is one of the most crucial aspects of managing a critically ill patient. Being acquianted with the basic airway opening maneuvers and airway securing techniques like the placement of a supraglottic airway or endotracheal intubation is an obligatory prerequisite for working in any field of medicine that deals with treating critically ill patients, be it emergency medicine (both prehospital and hospital), anesthesiology or critical care medicine. Although singular workshops do not provide nearly enough experience to make a participant truly proficient in airway management, they provide a solid framework for learning the fundamental mental processes and physical tasks related to successfully securing an airway and allow for learning in a safe, controlled and risk-free environment. This workshop aims to provide its participants with an opportunity to learn basic and advanced airway management techniques through medical simulation, hands-on practice and question and answer (Q&A) sessions with the workshop instructors. The workshop will cover basic airway opening maneuvers, placing an oropharyngeal or nasopharyngeal airway, placement of a supraglottic airway, laryngoscopy, endotracheal intubation and using a videolaryngoscope with a standard geometry blade.