High-flow oxygen therapy — its application in COVID-19-related respiratory failure and beyond

Oxygen therapy is the primary method of treating acute respiratory failure during Sars-CoV-2 infection. Depending on the patient’s condition, treatment may be carried out using traditional nasal cannulas, oxygen masks, non-invasive ventilation or mechanical ventilation. A relatively modern method that has been used worldwide for about 10 years is High Flow Nasal Oxygen Therapy (HFNOT). Equipment for HFNOT allows you to obtain high (up to 60 L/min) flows in nasal cannulas and precisely set a high concentration of oxygen in the mixture of inhaled gases. Such high flow is also associated with the generation of constant positive pressure in the airways, which further supports the treatment of respiratory failure by maintaining airway patency, recruitment of alveoli and reducing the breathing workload. HFNOT also leads to a reduction in anatomical dead space and facilitates carbon dioxide washout from the upper respiratory tract which also reduces the work of breathing and increases the efficiency of ventilation. Moreover, this ventilation method is tolerated well by patients and does not require specialized and longterm personnel training. Therefore, the method was widely applied in hospital wards treating patients with severe respiratory failure during Coronavirus Disease 2019 (COVID-19). Additional applications for this relatively novel method of oxygen support in different fields of medicine were analysed

Idiopathic anaphylaxis

Anafilaksja idiopatyczna jest ciężką, zagrażającą życiu systemową lub uogólnioną natychmiastową reakcją nadwrażliwości o objawach podobnych/zbliżonych do innych postaci anafilaksji. Dotyczy ok. 30-60% przypadków u dorosłych i ok. 20% przypadków u dzieci. W patogenezie anafilaksji idiopatycznej istotną rolę mogą odgrywać zespół alfa-gal, mastocytoza, schorzenia przebiegające z aktywacją komórki tucznej oraz ukryte alergeny i kofaktory – wysiłek fizyczny, alkohol, leki. Objawy kliniczne anafilaksji idiopatycznej oraz postępowanie terapeutyczne są identyczne jak w anafilaksji o znanym czynniku sprawczym. W pracy omówiono epidemiologię anafilaksji, patomechanizm, diagnostykę oraz postępowanie terapeutyczne według wytycznych międzynarodowychIdiopathic anaphylaxis is a severe, life-threatening systemic or generalized immediate hypersensitivity reaction with symptoms similar to resembling other forms of anaphylaxis. It concers approximately 30-60% of cases in adults and 20% of cases in children. In the pathogenesis of idiopathic anaphylaxis, alpha-gal syndrome, mastocytosis, diseases associated with mast cell activation, and hidden allergens and cofactors -physical exertion, alcohol, drugs can play a significant role. The clinical manifestations of idiopathic anaphylaxis and therapeutic management are identical to those of anaphylaxis with a known causative agent. The paper discusses epidemiology of anaphylaxis, pathomechanism, diagnostics and therapeutic management according to international guidelines

Iron Status and Inflammation in Early Stages of Chronic Kidney Disease

Background/Aims: One of the most common causes of anemia of chronic disease (ACD) is chronic kidney disease. The main pathomechanism responsible for ACD is subclinical inflammation. The key element involved in iron metabolism is hepcidin, however, studies on new indices of iron status are in progress.The aim of the study was to assess the iron status in patients in early stages of chronic kidney disease, iron correlation with inflammation parameters and novel biomarkers of iron metabolism. Methods: The study included 69 patients. Standard laboratory measurements were used to measure the iron status, complete blood count, fibrinogen, prothrombin index, C-reactive protein concentration (CRP), creatinine, urea, uric acid. Commercially available kits were used to measure high-sensitivity CRP, interleukin 6 (IL-6), hepcidin-25, hemojuvelin, soluble transferrin receptor (sTfR), growth differentiation factor-15 (GDF-15) and zonulin. Results: Absolute iron deficiency was present in 17% of the patients, functional iron deficiency was present in 12% of the patients. Functional iron deficiency was associated with significantly higher serum levels of fibrinogen, ferritin, transferrin saturation, total iron binding capacity, hepcidin and older age relative to patients with absolute iron deficiency. In comparison with patients without iron deficiency, patients with functional iron deficiency were older, with lower prothrombin index, higher fibrinogen, CRP, hsCRP, sTfR, GDF-15, urea and lower eGFR. Hepcidin was predicted by markers of inflammation:ferritin, fibrinogen and IL-6. Conclusion: Inflammation is correlated with iron status. Novel biomarkers of iron metabolism might be useful to distinguish iron deficiency anemia connected with inflammation and absolute iron deficiency