Subpopulation composition of peripheral blood lymphocytes in COVID-19

The pathogenesis of severe coronavirus infection COVID-19 is associated with activation of immune system, cytokine storm, impaired blood clotting, microvascular thrombosis, organ ischemia and multiple organ dysfunction syndrome. The role of various lymphocyte subpopulations in COVID-19 is still debated. The aim of our study was to analyze the subpopulational profile of peripheral blood lymphocytes in COVID-19 patients as compared with healthy donors.The study included 20 COVID-19 patients (11 males and 9 females,) and 26 healthy donors. Average age of the patients was 52 and 56 years, respectively. Clinical examinations were performed by standard laboratory methods. Peripheral blood lymphocytes were isolated in the Ficoll gradient. The cells were stained with antibodies to specific antigens of main lymphocyte populations, endothelial cells, and apoptotic cell markers. The analysis was performed by flow cytometry. The results showed that all patients had elevated C-reactive protein (14- to 35-fold), ferritin (1.2- to 13-fold), D-dimers (1.2- to 90-fold). 55% of men had a decrease in the absolute number of lymphocytes, in women this index was at the low normal limit. Cytometric analysis showed that, among peripheral blood lymphocytes, the proportion of functional cells expressing the CD45 marker ranged from 2 to 12% in 70% of patients, as compared with 80-99% among the donors. The proportion of CD45+ lymphocytes significantly correlated with the level of hemoglobin, but not with the levels of inflammatory biochemical markers. Among the functional lymphocytes of patients, there was a decrease in the proportion of CD3+, CD4+, CD8+T cells, increased proportion of natural killer CD56+ and the apoptotic (AnnexinV+) cell contents, but the proportion of CD19 and HLA-DR+B cells was not changed. Analysis of the lymphocyte (LC) subpopulations that did not express CD45 marker showed that this fraction contained different lymphocyte subsets with reduced expression of CD4, CD8, CD19, CD56 etc. in the blood of patients and donors. Higher percentage of endothelial cells expressing CD62P marker made the difference between patients and donors.Laboratory determination of lymphocyte subsets in blood samples of COVID-19 patients does not reflect the real severity pattern of the disease, thus requiring studies of the CD45-expressing functional cell populations

Анестезиологическое обеспечение открытых операций на плоде

Fetal surgery is a rapidly growing feld of medicine. Anesthetic provision of fetal operations is developing together with progressing surgical techniques. The fundamentals of the physiology of a pregnant woman and a fetus are considered. The features of transplacental drug transfer are described. The mechanisms of uteroplacental and fetoplacental interactions have been analyzed. The contemporary data are presented that allow judging about the method of choice and approach to anesthesia in open fetal surgery. Reviewed scientifc information, including reviews of recent years and randomized trials The perspective of an anesthesiologist is shown, involved in open fetal surgery, including perioperative and intraoperative management of two high-risk patients, i.e. a pregnant woman and fetus undergoing surgical intervention at the same time. Postoperative management of patient data. The impossibility of carrying out such operations without the well-coordinated work of a large multidisciplinary team of specialists is noted.Фетальная хирургия является быстроразвивающейся областью медицины. Анестезиологическое обеспечение фетальных операций развивается совместно с прогрессом в хирургической технике. Рассмотрены основы физиологии беременной и плода. Описаны особенности трансплацентарного переноса лекарственных средств. Проанализированы механизмы маточно-плацентарного и фетоплацентарного взаимодействия. Приведены современные данные, позволяющие судить о методе выбора и подхода к анестезии при открытой хирургии плода.Рассмотрена научная информация, включая обзоры последних лет и рандомизированные исследования. Показан взгляд анестезиолога, участвующего в проведении открытых операций на плоде, включая периоперационное и интраоперационное ведение двух пациентов высокого риска – беременной женщины и плода, которым одномоментно выполняется оперативное вмешательство, а также ведение в послеоперационном периоде. Отмечена невозможность проведения подобных операций без слаженной работы большой мультидисциплинарной команды специалистов

ОСОБЕННОСТИ АНЕСТЕЗИИ ПРИ АБДОМИНАЛЬНОМ РОДОРАЗРЕШЕНИИ ЖЕНЩИН С ТРАНСПЛАНТИРОВАННОЙ ПОЧКОЙ

The article describes the medical cases of the successful abdominal birth of the women with a transplant kidney, linked with the available features in the intraoperative and postoperative periods. Such approaches as the combined walking epidural, the control of the transplant function and the assessment of the immunosuppressive therapy level were used with the anesthetic management of the intervention and the intensive therapy in the postoperative period. В статье приведено описание клинических случаев успешных абдоминальных родоразрешений женщин с трансплантированной почкой, связанных с наличием особенностей в интраоперационном и после­операционном периодах. При анестезиологическом обеспечении вмешательства и интенсивной терапии в послеоперационном периоде применяли такие подходы, как комбинированная спинально-эпидуральная анестезия, контроль за функцией трансплантата и оценка уровня иммуносупрессивной терапии

Острое нарушение мозгового кровообращения по ишемическому типу в послеродовом периоде

During pregnancy and delivery, the risk of cerebrovascular disorders increases due to several physiological changes. The elevated level of estrogen stimulates the production of clotting factors, which deteriorates the risk of thromboembolism. Increased plasma volume and total blood volume lead to the risk of hypertension, and the high level of progesterone in the third trimester of pregnancy promotes the permeability of small blood vessels. The risk of developing cerebrovascular complications remains high in the postpartum period. The article describes two clinical cases of postpartum ischemic stroke as a complication after surgical delivery in young women with an aggravated somatic medical history. The treatment and follow-up of these patients during their stay in the intensive care unit included changes in management tactics, use of antiplatelet, anticoagulant, and metabolic therapy, and subsequent rehabilitation. This article describes the case-management interventions and changes in neurological symptoms of these patients, also it discusses the most likely etiological factors of cerebrovascular disorders in these casesБеременность и роды характеризуются более высоким риском цереброваскулярных нарушений, что обусловлено определенными физиологическими изменениями. Повышенный уровень эстрогена стимулирует выработку факторов свертывания крови, что увеличивает риск тромбоэмболии. Увеличение объема плазмы и общего объема крови повышает риск развития гипертензии, а повышенный уровень прогестерона в третьем триместре беременности способствует увеличению проницаемости мелких кровеносных сосудов. Риск развития цереброваскулярных осложнений остается высоким и в послеродовой период. В статье представлены два клинических наблюдения развития острого нарушения мозгового кровообращения по ишемическому типу после оперативного родоразрешения у молодых женщин с отягощенным соматическим анамнезом. Лечение и наблюдение этих пациенток во время пребывания в отделении реанимации и интенсивной терапии подразумевало изменение тактики ведения, включение антиагрегантной, антикоагулянтной, метаболической терапии и последующей реабилитации. Статья содержит описание комплексов лечебных мероприятий и динамики неврологической симптоматики этих пациенток, а также обсуждение наиболее вероятных этиологических факторов цереброваскулярных нарушений в данных случая

The low molecular weight heparins in treatment and prevention of complications puerperium after abdominal delivery

То determine the role of LMWH in the prevention of obstetric complications were examined 51 parturients with the use of prophylactic low molecular weight heparin (LMWH), the main group and 60 postpartum women (control group) without the use of LMWH. All patients surveyed general clinical and hemostatic parameters, determination of serum concentrations of pro- and anti-inflammatory cytokines, endotoxin, and held Doppler study of postpartum uterine vessels. The study found that low molecular weight heparin prophylaxis after abdominal delivery in women at moderate risk of thrombotic complications helps normalize hemostatic and inflammatory potential of the blood and, as a consequence, more prosperous course of puerperium.Для определения роли НМГ в профилактике послеродовых осложнений было обследовано 51 родильниц с профилактическим использованием низкомолекулярных гепаринов (НМГ), составивших основную группу и 60 родильниц (группа сравнения) без использования НМГ. Всем пациенткам проводилось исследование общеклинических и гемостазиологических показателями, определение в сыворотке крови концентраций про- и противовоспалительных цитокинов, эндотоксина, а также проводилось допплерометрическое исследование сосудов послеродовой матки. В результате было установлено, что профилактическое применение низкомолекулярных гепаринов после абдоминального родоразрешения у женщин группы умеренного риска развития тромботических осложнений способствует нормализации гемостатического и воспалительного потенциала крови и, как следствие, более благополучному течению пузрперия

АТИПИЧНЫЙ ГЕМОЛИТИКО-УРЕМИЧЕСКИЙ СИНДРОМ У ПАЦИЕНТКИ С МЕНОМЕТРОРРАГИЕЙ (клиническое наблюдение)

The article describes the follow-up over the development of atypical hemolytic-uremic syndrome in the female patient suffering menometrorrhagia which manifested with concurrent metrorrhagia and was accompanied with acute renal failure. В статье приведено описание клинического наблюдения развития атипичного гемолитико-уремического синдрома у пациентки с менометроррагией, манифестировавшего на фоне маточного кровотечения и сопровождавшегося развитием острой почечной недостаточности.

Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study

Purpose: To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. Methods: Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. Results: 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%–50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. Conclusions: ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality

Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set

Background: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients.Methods: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson's Chi-squared and continuous variables by Mann-Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the "full" matching method.Results: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO.Conclusions: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)