Role of diagnostic and prognostic value of hemocytometry markers in Covid-19 patients

Currently, there are several international guidelines that clearly describe that infection with the SARS-CoV-2 virus presents abnormalities of the hemocytometric indices, especially in severe forms. The prognostic values of these biomarkers reflect the intensity of the hyperinflammatory response, mediated by cytokines, and are strongly associated with a poor outcome of SARS-CoV-2 infection. In severe forms of COVID-19, leukocytes show lymphocytopenia, decrease in the number of monocytes and eosinophils, significant increase in neutrophils and neutrophil/lymphocyte ratio. These simple and feasible parameters can be used to predict and early identify patients with severe and critical forms of COVID-19. Leukocytosis, neutrophilia, lymphocytopenia, thrombocytopenia and the neutrophil/lymphocyte ratio were identified as independent factors for the poor clinical outcome in this category of patients and can be called, with certainty, true prognostic markers of severity, mortality, with the need to admit patients to the intensive care unit. The estimation of hematological laboratory parameters at hospitalization, capable of differentiating severe cases from non-severe cases, cases with high or low risk of mortality, allows awareness, supervision and timely treatment of patients with early improvement of the clinical outcomes. However, the interpretation of these indicators in the surveillance of patients with COVID-19 must take into account the administration of drug remedies (corticosteroids) and the occurrence of bacterial co-infection that could interfere with the result. The assessment of the accuracy of hemocytometric biomarkers needs to be determined in further research worldwide – more relevant studies with more accurate design, more rigorous execution and larger sample size

Terapia imunomodulatoare în sepsis

Immunomodulatory therapy in sepsis presents a new area, one that requires measures to improve the severe disturbances, seen and demonstrated in severe infl ammator pathology. The attempts of tampering with drugs the processes of septic syndromes gave positive results only in laboratory conditions, the trials have failed

Acute disseminated encephalomyelitis with bilateral optic nerve involvement

Background: Acute disseminated encephalomyelitis (ADEM), possibly demyelinating is an acute, rapidly progressive autoimmune process characterized by CNS demyelination (frequently associated with involvement of optic nerves) due to immune-mediated inflammation, which requires rapid diagnosis and selection of appropriate early treatment. The aim of the studywas to present an unusual case of ADEM with bilateral involvement of optic nerves. Material and methods: A case study presentation. Results: Case report study of a 47-year-old man presented with progressive loss of vision in both eyes, numbness in the upper and lower limbs, static and gait disorders, urinary retention. The clinical onset was preceded by a Covid-19 infection 3 weeks before presentation. ENG demonstrated sensitive axonal polyneuropathy, brain MRI – demyelination in left frontal lobe area; cervical and thoracic contrast MRI – without pathological changes, visual evoked potentials results suggestive of prechiasmic demyelinating involvement on the right side, lumbar puncture – impossible to perform, ophthalmological examination – neuroophthalmopathy of unknown etiology, anti-MOG, anti-AQP4 antibodies – negative. Progressive evolution of the disease, following the first-line treatment (Prednizolon 500 mg, N8) and plasmapheresis. Home discharge with second-line treatment with Azathioprine 50 mg without positive dynamics. Conclusions: The presented case of ADEM proved no therapeutic effects to plasmapheresis and immunosuppressive treatment in spite of its autoimmune pathogenesis. Other therapy options to be considered: mofetil mycophenolate, IV IG, calcineurin inhibitors or other immunomodulatory agents

Midazolam versus thiopental for induction of general anesthesia. A comparative analysis of hemodynamic changes and their relation with preanesthetic heart vegetative tonus: prospective, randomized clinical study

Rezumat. Introducere. Administrarea tiopentalului sau midazolamului pentru inducţia anesteziei generale se asociază cu modificări ale presiunii arteriale și a ritmului cardiac. Până la moment nu există studii clinice care ar fi dovedit riscul pentru dezvoltarea acestor evenimente hemodinamice în funcţie de predominarea tonusului cardiac vegetativ simpatic sau parasimpatic la pacient. Material și metode. Studiu de tip prospectiv, randomizat. Aviz pozitiv al CEC. Au fost înrolaţi după un acord informat semnat, 94 de pacienţi, care au fost repartizaţi aleator în unul din cele 2 eșantioane: eșantionul M care a beneficiat de inducţia anesteziei generale cu midazolam (0,2-0,3 mg/kg + fentanil 1,0 mkg/kg) și eșantionul T care a beneficiat de inducţia anesteziei generale cu tiopental 5,0-6,0 mg/kg + fentanil 1,0 mkg/ kg). Tonusul cardiac vegetativ preanestezic a fost determinat prin analiza ECG Holter a raportului LFun/HFun. Monitorizarea hemodinamică a inclus măsurarea neinvazivă a TAs, TAd, TAM și FCC. Rezultatele sunt prezentate drept medie și 95%CI (pentru variabilele cu distribuţie simetrică) sau mediană și interval intercuartilic (pentru variabilele cu distribuţie asimetrică). Rezultate. În lotul M, TAs s-a redus cu 20,6% (129 mmHg (95%CI 124 – 133 ) vs 102 mmHg (95%CI 98 – 107) (p=0,001), TAd s-a redus cu 27,8% (78 mmHg (95%CI 74 – 81) vs 56 mmHg (95%CI 53 – 60) (p<0,001) iar TAM s-a redus cu 24,3% (97 mmHg (95%CI 94 – 101) vs 74 mmHg (95%CI 70 – 78) (p=0,001). La fel s-a redus și FCC cu 18,0% (74 (95%CI 70 – 77) vs 61 (95%CI 56 – 67) (p=0,03). După administrarea soluţiei de tiopental pentru inducţia anesteziei generale TAs s-a redus cu 19,7% (129 mmHg (95%CI 125 – 132) vs. 103 mmHg (95%CI 99 – 108) (p<0,0001), iar TAd s-a redus cu 26,1% (77 mmHg (95%CI 75 – 80) vs 57 mmHg (95%CI 49 – 64) (p<0,0001), TAM s-a redus cu 23,0% (97mmHg (95%CI 94 – 100) vs 75 mmHg (95%CI 71 – 79) (p<0,0001) iar FCC a crescut cu 8,0% (75,9 (95%CI 72 – 79) vs 82,5 (95%CI 79 – 86) (p=0,02). Parasimpaticotonia cardiacă preanestezică crește riscul de dezvoltarea a bradicardiei sinusale: RR – 4,5 (95%CI 1,7 – 11,4; p=0,0002), Se – 0,79 (95%CI 0,54 – 0,94), Sp – 0,77 (95%CI 0,58 – 0,91) și a hipotensiunii arteriale: RR – 4,8 (95%CI 1,6 – 14,5; p=0,0003), Se – 0,84 (95%CI 0,60 – 0,97), Sp – 0,70 (95%CI 0,59 – 0,86). Concluzii. Parasimpaticotonia cardică preexistentă la pacient reprezintă un factor de risc pentru apariţia hipotensiunii arteriale (riscul relativ – 4,8) și bradicardiei sinusale (riscul relativ – 4,5) după inducţia anesteziei generale cu midazolam.Abstract. Introduction. Administration of thiopental or midazolam for induction of general anesthesia is associated with changes of arterial pressure and heart rhythm. There are no studies which proved the risk for development of these hemodynamic events in function of predominance of sympathetic or parasympathetic heart tonus. Material and methods. Prospective, randomized study. Approved by Ethic Committee. A number of 94 patients was randomly distributed in 2 groups: group M, in which induction of general anesthesia was performed with midazolam (0,2-0,3 mg/kg + fentanyl 1,0 mkg/kg) and group T in which induction was performed with thiopental (5,0-6,0 mg/kg + fentanyl 1,0 mkg/kg). Preanestesic vegetative heart tonus was assessed by ECG Holter and interpretation of LFun/HFun ratio. Hemodynamic monitoring involved non-invasive registration of SBP, DBP, MAP and HR. Results are presented as mean with 95%CI and median with IQR (for values with asymmetric distribution). Results. În group M, SBP dropped by 20,6% (129 mmHg (95%CI 124 to 133) vs 102 mmHg (95%CI 98 to 107) (p=0,001), DBP dropped by 27,8% (78 mmHg (95%CI 74 to 81) vs 56 mmHg (95%CI 53 to 60) (p<0,001) and MAP dropped by 24,3% (97 mmHg (95%CI 94 to 101) vs 74 mmHg (95%CI 70 to 78) (p=0,001). The same was attested a reduction by 18,0% of HR (74 (95%CI 70 to 77) vs 60 (95%CI 56 to 67) (p=0,03). After induction of general anesthesia with midazolam the most patients presented normal HR (53,2%) and arterial hypotension (51,0%). After induction of general anesthesia with thiopental, SBP dropped by 19,7% (129 mmHg (95%CI 125 to 132) vs. 103 mmHg (95%CI 99 to 108) (p<0,0001), DBP dropped by 26,1% (77 mmHg (95%CI 75 to 80) vs 57 mmHg (95%CI 49 to 63) (p<0,0001), MAP reduced by 23,0% (97 mmHg (95%CI 94 to 100) vs 75 mmHg (95%CI 71 to 79) (p<0,0001) and HR enhanced by 8,0% (76 (95%CI 72 to 79) vs 82 (95%CI 79 to 86) (p=0,02). Preanesthetic enhanced parasympathetic heart tonus represents a risk factor for development of sinus bradycardia: RR – 4,5 (95%CI 1,7 to 11,4; p=0,0002), Se – 0,79 (95%CI 0,54 to 0,94), Sp – 0,77 (95%CI 0,58 to 0,91) and arterial hypotension: RR – 4,8 (95%CI 1,6 to 14,5; p=0,0003), Se – 0,84 (95%CI 0,60 to 0,97), Sp – 0,70 (95%CI 0,59 to 0,86). Conclusions. Enhanced preanesthetic parasympathetic heart tonus is a risk factor for development of arterial hypotension (RR – 4,8) and sinus bradycardia (RR – 4,5) after induction of general anesthesia with midazolam

Factors to consider when assessing the severity of COVID-19

Background: Analysis and evaluation of the multitude of parameters that impact and mirror clinical evolution of COVID-19 infection. Narrative literature review type of study. Bibliographic search of the PubMed database, applying the keywords: ”SARS-CoV-2”, ”COVID-19”, ”risk score”, ”laboratory parameters”, ”pathophysiology”, ”cytokine storm”, ”imaging evaluation”, “outcomes”, “clinical evolution”, which were combined with each other. There were selected English-language publications, in extenso, published in recognized journals from March 2020. Priority in the analysis was given to articles of critical synthesis of literature, randomized studies, those with large samples of patients. One of the clinically important symptoms that reflects severe or critical clinical evolution is persistent fever during the time. The presence of comorbidities, especially associated with obesity, represents a high risk of severe evolution. Proinflammatory, prothrombotic and systemic endothelial damage processes are represented by changes in platelet count, lymphocytes, neutrophil / lymphocyte ratio, C-reactive protein, D-dimers, fibrinogen, procalcitonin, urea, creatinine, ALS, AST, interleukin-6 and serum ferritin. Bacterial and fungal infections negatively influence clinical evolution. Common prediction scores have low value in COVID-19 patients and need adaptation. Imaging evaluation identifies the type of lung injury and correlates with the severity degree and outcome. Conclusions: COVID-19 disease caused by SARS-CoV-2 virus includes a multitude of pathophysiological changes that through its mechanism represent a systemic nosology. The complete analysis of all the factors and parameters that can influence its clinical evolution is a basic component of the decisionmaking steps and treatment approach

Current affairs in the use of medical ozone. Biological effects. Mechanisms of action

Abstract. Introduction. Oxygen-ozone therapy stands as a medically endorsed practice confirmed by numerous international clinical studies. Various authors have illustrated the beneficial clinical outcomes of ozone therapy in terms of its capacity to regulate redox balance, cellular inflammatory responses, and adaptation to ischemia/reperfusion processes. Ozone therapy extends to encompass a range of viral infections, inflammatory disorders, and degenerative ailments, used as both monotherapy and as an adjunct to unified conventional therapies. Material and methods. Narrative literature review study. Bibliographic search was conducted using the PubMed, Hinari, and SpringerLink databases, as well as the National Center of Biotechnology Information and Medline. Articles published between 1990 and 2022 were selected using various combinations of keywords, including “ozone”, “ozone therapy”, “mechanisms of ozone action”, “biological effects of ozone”, “antioxidant effect”, “anti-inflammatory effect” and “immunomodulatory effect.” Information regarding ozone’s mechanisms of action was identified and processed. Following the database information processing and search criteria, a total of 475 full-text articles were found. The final bibliography consists of 52 relevant sources that were deemed representative of the materials published on the topic of this synthesis article. Results. The effects of ozone on oxygen metabolism are explained by changes in the rheological properties of blood, including inhibition of erythrocyte aggregation and stimulation of 2,3-diphosphoglycerate in erythrocytes, favoring the transport and delivery of oxygen to tissues while facilitating the substantial elimination of nitric oxide and increasing blood flow. Intracellular triatomic oxygen enhances the oxidative carboxylation of pyruvate, stimulating ATP production, which also contributes to reducing peripheral vascular resistance. Conclusions. Ozone generates a moderate oxidative stress. Yet, it can set off several beneficial biochemical mechanisms that reactivate both the intra- and extracellular antioxidant systems and reverse chronic oxidative stress in various inflammatory and degenerative processes. Ozone induces a mild activation of the immune system by triggering neutrophil activation and stimulating the synthesis of certain cytokines (IL-2, TNF-α, IL-6, and IFN-γ), thereby initiating a complete cascade of immune responses. Ozone therapy yields the following biological reactions: optimization of blood circulation and oxygen delivery to ischemic tissue, regulation of cellular antioxidant enzymes, initiation of a slight immune system activation, and enhancing the release of growth factors

Prognostic value of D-dimers in patients with COVID-19: narrative synthesis

Introduction. Contemporary researchers have suggested and demonstrated the hypothesis that the elevated level of D-dimers, which is a valuable marker of coagulation and fibrinolysis activation, can predict the severity of COVID-19, pulmonary complications, and thromboembolic events before they occur. Material and methods. The bibliographic resources were analyzed and selected from databases such as PubMed, Hinari, SpringerLink, and Google Search using keywords such as “COVID-19,” “SARS-CoV-2,” “coronavirus,” “D-dimers,” “biomarkers,” and “severity prediction,” which were used in various combinations to maximize search efficiency. Therefore, the manuscript contains 51 representative articles for this synthesis article. Results. The D-dimer levels are significantly higher in patients with severe forms of COVID-19 compared to those with non-severe forms, in patients with acute respiratory distress syndrome compared to those without acute respiratory distress syndrome, and in deceased patients compared to those who have survived. D-dimers positively correlate with the degree of severity and the increased risk of progression to severe disease, inversely proportional to the survival rate. They can predict prognosis, determine therapeutic strategies, prevent complications, positively influence the disease’s course, and monitor the prognosis. Conclusions. D-dimers should be used as a pre-radiographic screening tool as early as possible after admission and as an indicator for risk stratification of venous thromboembolism in hospitalized patients with COVID-19. Based on the increase in D-dimer levels, adjusting therapeutic doses of anticoagulants is more beneficial for patients compared to administering prophylactic doses

Isolation of branched chain aminoacids (Valine, Leucine and Arginine) using maghemite particles

In this paper, we report the optimal conditions for the isolation and preconcentration of branched chain amino acids (BCAAs) - leucine, valine and arginine from different types of matrix, such as tissue, plasma, blood, bacteria or cells. Herein, we focused on the synthesis of paramagnetic particles able to isolate and immobilize amino acids and thus preconcentrate it for subsequent analysis on ion-exchange liquid chromatography with VIS detector. We modified nanomaghemite (-Fe2O3) by multi walled carbon nanotubes (MWCNT) and hyaluronic acid as the functional carriers providing excellent affinity properties. Our paramagnetic particles have potential for better isolation of BCAAs mainly from plasma or bacteria and in the future they can also be applied as a platform of delivery system