An increased interest regarding the impact of frailty on the prognosis of cardiovascular disease (CVD) has been observed in the last decade. Frailty is a syndrome characterized by a reduced biological reserve that increases the vulnerability of an individual in relation to stressors. Among the patients with CVD, a higher incidence of frailty has been reported in those with heart failure (HF). Regardless of its conceptualizations, frailty is generally associated with negative outcomes in HF and an increased risk of mortality. Psychological factors, such as depression and anxiety, increase the risk of negative outcomes on the cardiac function and mortality. Depression and anxiety are found to be common factors impacting the heart disease and quality of life (QoL) in patients with HF. Depression is considered an independent risk factor of cardiac-related incidents and death, and a strong predictor of rehospitalization. Anxiety seems to be an adequate predictor only in conjunction with depression. The relationship between psychological factors (depression and anxiety) and frailty in HF has hardly been documented. The aim of this paper is to review the reported data from relevant studies regarding the impact of depression and anxiety, and their effects on clinical outcomes and prognosis in frail patients with HF.

We determined the effects of intrathecally administered epinephrine and clonidine on the duration and quality of a meperidine spinal block. Forty-five patients scheduled for orthopedic surgery, divided into three groups, received spinal anesthesia with 1 mg/kg 5% meperidine, alone or with 200 microg epinephrine or 2 microg/kg clonidine. Using a double-blind method, the onset, extension, and duration of sensory block (to pinprick) and the duration and degree of motor block (Bromage scale) were assessed. Hemodynamic responses, duration of postoperative analgesia, degree of sedation, and occurrence of side effects were also recorded. The addition of epinephrine to the meperidine solution prolonged the sensory block (P<0.01) but did not affect its onset or extent. A similar potentiating effect was demonstrated for clonidine (P<0.001). The duration and degree of motor block were increased by addition of both epinephrine and clonidine. A tendency toward bradycardia and a decrease of mean arterial pressure was potentiated by clonidine but not by the epinephrine. Only the addition of clonidine prolonged the postoperative analgesia (P<0.001), but was associated with an increased sedation score. The incidence of other side effects did not differ between the groups. We conclude that coadministration of epinephrine or clonidine with meperidine enhances the duration and degree of spinal anesthesia and that adding clonidine prolongs the duration of postoperative analgesia.

Purpose: To describe the correlation between clinically measured hyomental distance ratio (HMDR clin ) and the ultrasound measurement (HMDR echo ) in patients with and without morbid obesity and to compare their diagnostic accuracy for difficult airway prediction. Methods: HMDR clin and HMDR echo were recorded the day before surgery in 160 consecutive consenting patients. Laryngoscopy was performed by a skilled anesthesiologist, with grades III and IV Cormack-Lehane being considered difficult views of the glottis. Linear regression was used to assess the correlation between HMDR clin and HDMR echo and receiver operating curve analysis was used to compare the performance of the two for predicting difficult airway. Results: The linear correlation between HMDR clin and HDMR echo in patients without morbid obesity had a Pearson coefficient of 0.494, while for patients with morbid obesity this was 0.14. A slightly higher area under the curve for HMDR echo was oberved: 0.64 (5%CI 0.56-0.71) versus 0.52 (95%CI, 0.44-0.60) (p = 0.34). Conclusion: The association between HMDR clin and HDMR echo is moderate in patients without morbid obesity, but negligible in morbidly obese patients. These might be explained by difficulties in palpating anatomical structures of the airway.

Background: Malnutrition predicts a worse outcome for critically ill patients. However, quick, easy-to-use nutritional risk assessment tools have not been adequately validated. Aims and Methods: The study aimed to evaluate the role of four biological nutritional risk assessment instruments (the Prognostic Nutritional Index—PNI, the Controlling Nutritional Status Score—CONUT, the Nutrition Risk in Critically Ill—NUTRIC, and the modified NUTRIC—mNUTRIC), along with CT-derived fat tissue and muscle mass measurements in predicting in-hospital mortality in a consecutive series of 90 patients hospitalized in the intensive care unit for COVID-19-associated ARDS. Results: In-hospital mortality was 46.7% (n = 42/90). Non-survivors had a significantly higher nutritional risk, as expressed by all four scores. All scores were independent predictors of mortality on the multivariate regression models. PNI had the best discriminative capabilities for mortality, with an area under the curve (AUC) of 0.77 for a cut-off value of 28.05. All scores had an AUC above 0.72. The volume of fat tissue and muscle mass were not associated with increased mortality risk. Conclusions: PNI, CONUT, NUTRIC, and mNUTRIC are valuable nutritional risk assessment tools that can accurately predict mortality in critically ill patients with COVID-19-associated ARDS.