In vitro mitochondrial respiration was significantly depressed by septic serum. The addition of N(G)-methyl-L-arginine, a nitric oxide synthase inhibitor, and 3-aminobenzamide, a blocker of the poly(ADP-ribose) synthase pathway, significantly attenuated this suppression. These data suggest that nitric oxide and poly(ADP-ribose) synthase activation may play an important role in the inhibition of mitochondrial respiration in septic shock.

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٥٠ % . . ٢٥ ‫ﻤﻠﻠﻰ‬ ‫ﻤﻊ‬ ٠,٢ ‫ﻤﻠﻠﻰ‬ . ‫ﺴﻴﺎﺒﻴـﺔ‬ . ‫ﻓﻰ‬ ‫ﻜﺎﻤﻼ‬ ‫ﺼﺎﺼﻪ‬ . : .. . Ranitidine HCl is a histamine H 2 -receptor antagonist reducing gastric acid secretion under daytime and nocturnal basal conditions. Ranitidine HCl is 50% absorbed after oral administration. This research was undertaken in order to examine the effect of short-chain fatty acids (SCFAs), acetate, propionate, and butyrate on the absorptive clearance of ranitidine HCl as a function of intestinal site (jejunoileum vs ascending-colon). A "through-and-through" in situ intestinal perfusion technique was adopted using the rabbit as an animal model. Coperfusion of either sodium acetate, sodium propionate, or sodium butyrate, 25 mM each, along with ranitidine HCl, 0.2 mM, allowed for an examination of increased solvent drag on intestinal permeability of this compound in both anatomical sites. The results show that ranitidine HCl is absorbed from rabbit jejunoileum as well as the ascending-colon, however the value of the absorptive clearance of this compound normalized to the intestinal length PeA/L in the ascending-colon was almost double that in the jejunoileum. A strong correlation was found between the absorptive clearance and the net water flux in both segments suggesting that the mechanism of ranitidine HCl absorption apparently consists of passive diffusion via the paracellular pathway. The negative value of anatomical reserve length ARL in both segments reflects the incomplete absorption of this compound. SCFAs had a significant effect on increasing the absorptive clearance of ranitidine HCl in both segments studied. This effect was in the order butyrate > propionate > acetate. However there was no statistical difference between the effect of butyrate and propionate. The permeability enhancing effect of SCFAs was much higher in the ascending-colon, this could be attributed to the higher Na + , Cl  , and water Mohammed A. Osman 204 influx in this segment. In conclusion, marked segmental differences in the absorption of ranitidine HCl are apparent in the rabbit small and large intestine which could be significantly enhanced by the use of SCFAs.

Background: Hypertrophic obstructive cardiomyopathy (HOCM) is known to be associated with supraventricular and ventricular arrhythmias. The burden of such arrhythmias and its effect on in-hospital outcomes in patients hospitalized with HOCM is not clear. Objectives: Our aim was to identify the burden of arrhythmia and its effect on in-hospital mortality in patients hospitalized with HOCM in recent years (2008 -2014) using National Inpatient Sample (NIS). Methods: We identified patients who were hospitalized with primary diagnosis of HOCM using International Classification of Diseases codes -9th edition (ICD-9) code 425.11. We identified presence of arrhythmias in this group using appropriate ICD-9 codes. We used multivariate binary logistic regression and multivariate linear regression to identify predictors associated with in-hospital mortality, length of stay (LOS), and total hospital charges respectively. Results: We identified 8534 patients discharged with diagnosis of HOCM. A total of 2880 (33.7%) patients had concomitant diagnosis of any arrhythmia. Among patients with HOCM, 235 (2.8%) patients had ventricular fibrillation (VF), 2025 (23.7%) had atrial fibrillation (AF), 324 (3.8%) had atrial flutter (AFL), 347 (4.1%) had atrioventricular nodal blocks, and 268 (3.1%) had premature beats. The in-hospital mortality in arrhythmia group was 2.6% compared to 1.5% in non-arrhythmia group. We found that only VF had significant effect on in-hospital mortality with these patients having adjusted odds ratio (AOR) of 19.41 (95% CI = 10.39 -36.25, P < .001) when compared to patients without VF. Median length of stay in arrhythmia group was 5 days compared to 3 days in non-arrhythmia group. Arrhythmias predicting increased LOS included VF (average of 3.63 days longer), AF (average of 0.61 days longer), and AFL (average of 6.95 days longer). Mean total charges of arrhythmia group were $122,503 compared to $76,435 in non-arrhythmia group. Arrhythmias predicting increased total hospitalization charges included VF (increased by an average of $70,572), and AFL (increased by an average of $131,193). Conclusion: About 1/3rd of patients admitted with HOCM had a concomitant diagnosis of arrhythmia. Atrial fibrillation was the most common arrhythmia. Presence of VF was a significant predictor of in-hospital mortality. Presence of VF, AF, AFL increased the LOS, while VF and AFL were associated with increased total hospital charges in patients hospitalized with HOCM.

We describe the insertion of the Impella 5.0, a peripherally placed mechanical cardiovascular microaxial pump, in a patient with ischemic left ventricular dysfunction. The Impella is a 7 Fr device capable of achieving a flow of 4.0–5.0 L/min; its use necessitates an open arterial cut-down. A subclavicular incision is used to access the right or left axillary artery. A 10-mm tube graft is anastomosed to the artery through which the Impella 5.0 is inserted. The device traverses the tube graft and is advanced via the aorta, across the aortic valve, to its final position (inflow toward the ventricular apex and outflow above the aorta). The device may remain in situ for 10 days until recovery or until further supports are instituted. Our goal is to demonstrate the insertion of the Impella 5.0 device in a patient with cardiogenic shock whose situation was further complicated by coronavirus disease 2019.

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