COVID-19 induced aorto duodenal fistula following evar in the so called “negative” patient

Objectives Since October 2019, SARS-CoV-2 pandemic represents a challenge for the international healthcare system and for the treatment and survival of patients. We normally focus on symptomatic patients, and symptoms can range from the respiratory to the gastrointestinal system. In addition, we consider patients without fever and respiratory symptoms, with both a negative RT nasopharyngeal swab and lung CT, as a “Covid-19 negative patient.” In this article, we present a so called Covid-19 “negative” patient, with an unsuspected vascular clinical onset of the viral infection. Methods An 80 y.o. man, who previously underwent endovascular aortic repair for an infrarenal abdominal aortic aneurysm, presented to our department with an atypical presentation of an aorto-enteric fistula during the pandemic. While in hospital, weekly nasopharyngeal swab tests were always negative for SARS-CoV-2. However, the absence of aortic endograft complications, the gross anatomy of duodenal ischemic injury, and the recent history of the patient who lived the last months in Bergamo, the Italian city with the highest number of COVID-19 deaths, lead the senior Author to suspect an occult SARS-CoV-2 infection. The patient underwent to resection of the fourth portion of the duodenum and the first jejunal loop, with subsequent duodenum–jejunal latero-lateral anastomosis and the direct suture of the aortic wall. The intestinal specimen was investigated as suspected SARS-CoV-2 bowel infection by the means of immune-histochemistry (IHC). An ileum sample obtained in the pre-COVID-19 era was used as a control tissue. Results The histological analysis of the bowel revealed sustained wall ischemia and liponecrosis of the duodenal wall, with intramural blood vessels thrombosis. Blood vessel endotheliitis and neo-angiogenesis were also observed. Finally, the IHC was strongly positive for SARS-CoV-2 RNA and for HLA-G presence, with a particular concentration both in blood vessels and in the intestinal villi. The control tissue sample was not positive for both SARS-CoV-2 and HLA-G. Conclusions Coronavirus pandemic continues to be an international challenge and more studies and trials must be done to learn its pathogenesis and its complications. As for thromboembolic events caused by SARS-COV-2, vascular surgeons are involved in treatment and prevention of the complications of this syndrome and must be ready with general surgeons to investigate atypical and particular cases such as the one discussed in this article.

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Enhanced Vascular Biocompatibility and Remodeling of Decellularized and Secured Xenogeneic/Allogeneic Matrices in a Porcine Model

European Surgical Research ◽

10.1159/000487591 ◽

2018 ◽

Vol 59 (1-2) ◽

pp. 58-71 ◽

Cited By ~ 7

Author(s):

Mathieu van Steenberghe ◽

Thomas Schubert ◽

Caroline Bouzin ◽

Carlo Caravaggio ◽

Yves Guiot ◽

...

Keyword(s):

Vascular Remodeling ◽

Porcine Model ◽

Tissue Sample ◽

Fascia Lata ◽

Growth Potential ◽

Preclinical Model ◽

Control Tissue ◽

Hematoxylin And Eosin ◽

And Control ◽

Mini Pigs

Background/Purpose: Calcifications and absence of growth potential are the major drawbacks of glutaraldehyde-treated prosthesis. Decellularized and secured xeno-/allogeneic matrices were assessed in a preclinical porcine model for biocompatibility and vascular remodeling in comparison to glutaraldehyde-fixed bovine pericardium (GBP; control). Methods: Native human (fascia lata, pericardium) and porcine tissues (peritoneum) were used and treated. In vitro, biopsies were performed before and after treatment to assess decellularization (hematoxylin and eosin/DAPI). In vivo, each decellularized and control tissue sample was implanted subcutaneously in 4 mini-pigs. In addition, 9 mini-pigs received a patch or a tubularized prosthesis interposition on the carotid artery or abdominal aorta of decellularized (D) human fascia lata (DHFL; n = 4), human pericardium (DHP; n = 9), porcine peritoneum (DPPt; n = 7), and control tissue (GBP: n = 3). Arteries were harvested after 1 month and subcutaneous samples after 15–30 days. Tissues were processed for hematoxylin and eosin/von Kossa staining and immunohistochemistry for CD31, alpha-smooth muscle actin, CD3, and CD68. Histomorphometry was achieved by point counting. Results: A 95% decellularization was confirmed for DHP and DPPt, and to a lower degree for DHFL. In the subcutaneous protocol, CD3 infiltration was significantly higher at day 30 in GBP and DHFL, and CD68 infiltration was significantly higher for GBP (p < 0.05). In intravascular study, no deaths, aneurysms, or pseudoaneurysms were observed. Inflammatory reaction was significantly higher for DHFL and GBP (p < 0.05), while it was lower and comparable for DHP/DPPt. DHP and DPPt showed deeper recellularization, and a new arterial wall was characterized. Conclusions: In a preclinical model, DPPt and DHP offered better results than conventional commercialized GBP for biocompatibility and vascular remodeling.

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Gross anatomy of the blood vessels and ducts within the human liver

American Journal of Anatomy ◽

10.1002/aja.1000900104 ◽

1952 ◽

Vol 90 (1) ◽

pp. 59-111 ◽

Cited By ~ 105

Author(s):

Hans Elias ◽

David Petty

Keyword(s):

Blood Vessels ◽

Human Liver ◽

Gross Anatomy

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Rentgenoehndovaskuljarnaja occlusion of blood vessels in the treatment and prevention of massive obstetric hemorrhage

Family Medicine ◽

10.30841/2307-5112.1(69).2017.103344 ◽

2017 ◽

Vol 0 (1(69)) ◽

pp. 148-153

Author(s):

П. М. Веропотвелян ◽

І. С. Цехмістренко ◽

І. В. Гужевська ◽

О. М. Панасенко

Keyword(s):

Blood Vessels ◽

Obstetric Hemorrhage ◽

Treatment And Prevention

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Evaluation of SARS-CoV-2 Antigen-Based Rapid Diagnostic Kits in Pakistan: Formulation of COVID-19 National Testing Strategy.

10.21203/rs.3.rs-113852/v1 ◽

2020 ◽

Author(s):

Umar Saeed ◽

Sara Rizwan Uppal ◽

Zahra Zahid Piracha ◽

Azhar Rasheed ◽

Zubair Aftab ◽

...

Keyword(s):

Gold Standard ◽

Injection Drug Users ◽

Drug Users ◽

Diagnostic Testing ◽

False Negative ◽

Nasopharyngeal Swab ◽

Rt Pcr ◽

Cross Sectional ◽

Negative Results ◽

Treatment And Prevention

Abstract Rapid diagnosis of SARS-CoV-2 during pandemic enables timely treatment and prevention of COVID-19. Evaluating the accuracy and reliability of rapid diagnostic testing kits is crucial for surveillance and diagnosis of SARS-CoV-2 infections in general population, injection drug users, multi-transfused populations, healthcare workers, prisoners, barbers and other high risk populations. The aim of this study was to evaluate performance and effectiveness of nasopharyngeal swab (NSP) and saliva based rapid antigen detection testing kits in comparison with USFDA approved triple target gold standard real-time polymerase chain reaction. A cross-sectional sectional study was conducted on 33,000 COVID-19 suspected patients. From RT-PCR positive patients, nasopharyngeal swab (NSP) and saliva samples were obtained for evaluation of rapid COVID-19 testing kits (RDT). 100/33000 (0.3%) of specimens were RT-PCR positive for SARS-CoV-2. Among RT-PCR positive, 62% were males, 34% were females, and 4% were children. The NSP-RDT (Lepu Medical China) analysis revealed 53% reactivity among males, 58% reactivity among females, and 25% reactivity among children. However saliva based RDT (Lepu Medical China) analysis showed 21% reactivity among males and 23% among females, and no reactivity in children. False negative results were significantly more pronounced in saliva based RDT as compared to NSP-RDT. The sensitivity of these NSP-RDT and saliva based RDT were 52% and 21% respectively. The RDTs evaluated in this study showed limited sensitivities in comparison to gold standard RT-PCR, indicating that there is a dire need in Pakistan for development of suitable testing to improve accurate COVID-19 diagnosis in line with national demands.

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Microscopic changes in the organs of broiler chickens with Ornithobacterium rhinotra-cheale infection

Regulatory Mechanisms in Biosystems ◽

10.15421/022105 ◽

2021 ◽

Vol 12 (1) ◽

pp. 27-32

Author(s):

B. V. Borysevych ◽

V. B. Dukhnytskyj ◽

A. M. Tyshkivska ◽

M. Y. Tyshkivsky ◽

N. V. Tyshkivska

Keyword(s):

Blood Vessels ◽

Blood Cells ◽

Broiler Chickens ◽

Muscle Fibers ◽

Antibiotic Sensitivity ◽

Economic Losses ◽

Hepatic Veins ◽

Tracheal Mucosa ◽

Treatment And Prevention ◽

Antibiotic Sensitivity Test

Nowadays ornithobacteriosis is widespread among industrial poultry in Ukraine and the world. The disease leads to significant economic losses. The large variation in the serotypes of the bacteria complicates the treatment of the disease. The study of microscopic changes that occur in organs during ornithobacteriosis will help to better understand the pathogenesis of the disease development. Ornithobacteriosis was diagnosed in clinically sick broiler chickens by bacteriological studies using Maldi Tof mass-spectrometry. As a result of the antibiotic sensitivity test, the pathogen was found to be sensitive to doxycycline, tilmicosin, rifampicin, cefazolin, amoxiclav and benzylpenicillin. Histological studies of internal organs – trachea, lungs, heart, kidneys, liver and spleen – were carried out. It was found that with spontaneous ornithobacteriosis of broiler chickens, the most expressive microscopic changes occur in the respiratory organs – the lungs and trachea and are characterized by a decrease in the lumen of the parabronchials due to edema of their walls and infiltration with lymphocytes, the absence of epithelium on the surface of the parabronchials, narrowing of the air capillaries of the parabronchial complexes, hemorrhages in the parenchyma of the parabronchial complexes, vasodilatation of the lung vessels and overflow of their blood vessels with blood cells, edema around the epithelium trachea, destruction of part of the tracheal mucosa epithelial cells, edema of its submucosa, expansion and overflow of blood vessels of the mucous membrane with blood cells. In the spleen there was a uniform diffuse edema of the parenchyma and a decrease in the number of lymphocytes in the lymphoid follicles; in the kidneys – expansion and overflow of the stroma blood vessels, uneven edema of the glomeruli of one part of the renal corpuscles and destruction of the glomeruli of another, granular degeneration of the convoluted and straight tubules of the kidneys; in the liver – edema, hemorrhage, violation of the hepatic lobules’ structure, expansion of the hepatic veins, granular degeneration of hepatocytes or their destruction; in the heart – edema of the myocardial interstitium, muscle fibers’ granular dystrophy, fragmentation of muscle fibers as a result of their rupture. Histological research of ORT infected chickens will lead to a better understanding the mechanism of pathological changes at the microscopic level, which will facilitate the development of more effective methods of treatment and prevention of the disease.

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Embolia de dióxido de carbono

Revista Chilena de Anestesia ◽

10.25237/revchilanestv49n04-03 ◽

2020 ◽

Vol 49 (4) ◽

pp. 473-480

Author(s):

Ruth Köhnenkampf

Keyword(s):

Carbon Dioxide ◽

Blood Flow ◽

Laparoscopic Surgery ◽

Stroke Volume ◽

Blood Vessels ◽

Sudden Increase ◽

Cardiovascular Collapse ◽

Cardiorespiratory Arrest ◽

Treatment And Prevention

Carbon dioxide (CO) embolism is a complication of laparoscopic surgery that, although often does not have adverse sequelae, can be fatal. This is due to the fact that when CO is injected into the blood vessels, the bubbles impede blood flow, which clinically expresses as: decreased stroke volume, hypoxemia, sudden fall or sudden increase in expired CO, bradycardia, hypotension, dyspnea, cyanosis, arrhythmias, bilateral mydriasis, murmur in a mill wheel at auscultation and cardiovascular collapse with cardiorespiratory arrest. In this article we will present physiology of venous embolism, diagnosis, syntoms, treatment and prevention.

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Positive rate of COVID 19 in the setting of GGH Ghulam Muhammadabad

10.53350/pjmhs211571706 ◽

2021 ◽

Vol 15 (7) ◽

pp. 1706-1708

Author(s):

Babar Rafiq Khan ◽

Mazhar Iqbal ◽

Muhammad Saleem ◽

Muhammad Hanif

Keyword(s):

General Hospital ◽

Standard Method ◽

Virus Disease ◽

Study Data ◽

Nasopharyngeal Swab ◽

Inclusion Criteria ◽

Treatment And Prevention ◽

Lack Of Information ◽

Positive Rate ◽

Set Up

Background: The corona virus disease also known as COVID-19 has opened gates to a lot of research about detection, treatment and prevention in the last past year due to lack of information regarding the SARS-CoV-2 virus. PCR corona via nasopharyngeal swab is the standard method of detection in our set-up. Materials and methods: Nasopharyngeal swabs were taken by ENT department using precautions and following proper SOPs. Swabs were sent for rRT-PCR tests. Data was collected and analyzed. All the subjects meeting the inclusion criteria were included in study. Data was analyzed using SPSS version 20. Frequency and percentage was calculated for gender. Positivity rate was calculated using CDC formula. Study design: - Descriptive studies Place and Duration of Study: - Government General Hospital, Ghulam Muhammadabad, Faisalabad. 889 samples were taken from 7.1.2020 to 6.12.2020. Results: Standard PCR for corona test by nasopharyngeal route was taken of suspected corona patients and of patients with contact with corona positive patients. 894 samples were taken from 7.1.2020 to 6.12.2020. 263 were positive for corona. The calculated positive rate is 29.41%. Conclusions: Calculation of positive rates is a very easy metric to give us a quick overview of the spread of the virus. Keywords: COVID-19, Positive rates, PCR-Corona

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Pharmacology of treatment of vascular diseases with the help of endothelioprotectors

Infusion & Chemotherapy ◽

10.32902/2663-0338-2020-3.2-199-201 ◽

2020 ◽

pp. 199-201

Author(s):

V.I. Mamchur

Keyword(s):

Endothelial Dysfunction ◽

Blood Vessels ◽

Medical Science ◽

Rabbit Model ◽

Vascular Diseases ◽

Cerebrovascular Diseases ◽

Food Sources ◽

Signaling Molecule ◽

Treatment And Prevention ◽

Structural And Functional Properties

Background. Endothelioprotectors (EP) are a group of drugs with different pathogenetic mechanisms of action that prevent disruption and/or restore the structural and functional properties of vascular endothelium. EP are mainly used in the treatment and prevention of cardiovascular and cerebrovascular diseases and their complications. Objective. To describe the role of EP in modern therapy of vascular diseases on the example of L-arginine (Tivortin, “Yuria-Pharm”). Materials and methods. Analysis of literature data on this topic. Results and discussion. The endothelium can be considered as a separate organ that regulates the work of blood vessels. Nitric oxide (NO) is the main signaling molecule of the endothelium. In humans, NO is produced from L-arginine. The latter is a conditionally essential amino acid, which means that it is synthesized in sufficient quantities only in perfectly healthy adults. Arginine is practically not synthesized in children under 5 years of age and in persons over 50 years of age. The main food sources of arginine are meat (pork, poultry), chocolate, soybeans, however, nutrition may not always provide the necessary need for L-arginine. The effects of NO include decreased intracellular calcium, smooth muscle cell relaxation, and vasodilation. As a result, the total peripheral vascular resistance and blood pressure decrease. One of the leading negative factors affecting the heart and blood vessels is hypercholesterolemia, which disrupts the production and release of NO. An improvement in endothelium-dependent vasodilation and a reduction in the size of atherosclerotic plaques with L-arginine have been demonstrated in a rabbit model with hypercholesterolemia. Endothelial dysfunction is an important concept in modern cardiology and medical science. Its main manifestation is a decrease in the NO bioavailability, so in order to eliminate endothelial dysfunction, EP are prescribed. The ideal EP should have such properties as a pronounced cardio- and cerebroprotective effect, rapid onset of action, no side effects, and low cost. L-arginine (Tivortin) is one of the best known EP. It can be used in the treatment of chronic heart failure to increase exercise tolerance. Tivortin supplies the depleted endothelium with a substrate for NO synthesis, facilitating cell function. Tivortin can be used not only in cardiological patients. The research of V.V. Bezugla et al. (2017) showed that Tivortin aspartate for oral administration improves the general and special performance of athletes in cyclic and strength sports, as well as reduces the severity of psychophysiological stress. In addition, the neuro-rehabilitation properties of Tivortin are demonstrated, which justifies its feasibility in the treatment and prevention of stroke. In the study of M.M. Sunychuk et al. (2014) the inclusion of Tivortin (100 ml infusion once a day from the 4th day after stroke for 10-14 days) in the complex therapy contributed to a more positive dynamics of assessments on the NIHSS, Bartel and Rankin scales than the use of standard therapy only. Improvement of the cerebral blood flow with the use of Tivortin is shown in other scientific papers (Mankovsky B.N. et al., 2014). The beneficial effect of L-arginine on the course of hypertension has also been proven (West S.G. et al., 2005). Studies conducted at the Department of Pharmacology and Clinical Pharmacology of the Dnipropetrovsk Medical Academy confirmed the cardiotropic and vasotropic properties of L-arginine. Conclusions. 1. NO – the main signaling molecule of the endothelium – is produced from L-arginine, the production of which almost stops after 50 y. o. 2. EP supply the endothelium with a substrate for NO synthesis, facilitating its function. 3. L-arginine (Tivortin, “Yuria-Pharm”) improves clinical, laboratory and functional parameters in patients with cardiovascular and cerebrovascular diseases.

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