scholarly journals Assessment of systemic inflammatory reactions and coagulopathy against the background of hormonal therapy in covid-associated lung damage

2021 ◽  
pp. 230-237
Author(s):  
V. V. Salukhov ◽  
N. I. Gulyaev ◽  
E. V. Dorokhina
Keyword(s):  
Pulse Therapy ◽  
Cardiovascular Complications ◽  
Lung Damage ◽  
Coagulation System ◽  
Inflammatory Reactions ◽  
High Incidence ◽  
Life Threatening ◽  
High Doses ◽  
Anticoagulant Prophylaxis ◽  
Inflammatory Effect

The mechanisms of COVID-19-associated coagulopathy (CAC) are complex and differ in many ways from the standard mechanisms of thrombosis in critically ill patients. This review presents the pathogenesis, diagnosis, and comparison of various types of coagulopathy with SAS. During COVID-19 infection, the number of sudden deaths outside the hospital increased. One possible reason is the high incidence of serious thrombotic events in patients with COVID-19. However, the pathogenesis of these life-threatening events is multifactorial and requires independent discussion.Deviations in laboratory studies of the hemostatic system in patients infected with SARS-CoV-2 with a severe course indicate the activation of the blood coagulation system corresponding to sepsis-induced coagulopathy (SIC) or DIC. However, hemostasis disorders in COVID-19 have characteristics that distinguish them from DIC in sepsis.The clinical and laboratory features of CAC overlap with hemophagocytic syndrome, antiphospholipid syndrome, and thrombotic microangiopathy. The review presents data on their similarities and differences.Inadequate diagnosis or inadequate treatment of hypercoagulability may explain the high incidence of unexplained deaths from COVID-19. They can be associated with potentially preventable microvascular and macrovascular thrombosis and subsequent cardiovascular complications, including myocardial injury and infarction, as well as insufficient information content of biomarkers for their assessment.Research to identify the most informative biomarkers for decision-making to intensify anticoagulant prophylaxis in patients with severe COVID-19 is progressing rapidly, with increasing focus on TEG and ROTEM.The review presents changes in CAC during hormone therapy for COVID-19-associated lung damage. Pulse therapy with high doses of GCS has a rapid anti-inflammatory effect, but at the same time increases the level of D-dimer, which increases the risk of venous thrombosis and thromboembolism. 

scholarly journals ANTISYNTHETASE SYNDROME AND THE POSITION OF CLINICAL IMMUNOLOGIST

2020 ◽  
pp. 66-71
Author(s):  
Валентина Чоп’як ◽  
Христина Ліщук-Якимович ◽  
Роман Пукаляк ◽  
Омелян Синенький
Keyword(s):  
Clinical Case ◽  
Inflammatory Myopathy ◽  
Idiopathic Inflammatory Myopathy ◽  
Pulse Therapy ◽  
Lung Damage ◽  
Aged Patient ◽  
Antisynthetase Syndrome ◽  
Erythematous Rash ◽  
Fibrosing Alveolitis ◽  
High Doses

Antisynthetase syndrome is a clinical and laboratory syndrome that develops in patients with idiopathic inflammatory myopathy and is characterized by the development of interstitial lung disease, namely fibrosing alveolitis syndrome, resistance to traditional corticoid therapy and the presence of myositis-specific antibodies.We present a clinical case of an antisynthetase syndrome in a middle-aged patient who has presented severe myalgic syndrome, photodermatosis, Raynaud’s phenomenon. The disease debuted with cutaneous (heliotropic erythema, erythematous rash on the skin of the upper torso) and myalgic symptoms, fever with next adding of the joint syndrome, as well as lung damage (pulmonitis and infiltrates). Immunological testing revealed anti-Jo-1, anti-PL-12-, anti-PL-7 antibodies («Polycheck», BIOCHECK, Germany). Since years, the patient has got the diagnosis of antisynthetase syndrome. The use of combined pulse therapy with cyclophosphamide and methylprednisolone, as well as the addition of high doses of vitamin D3 has contributed to the regression oflung damage and reduction of dermatomyositis activity.

scholarly journals Rescuable effect of R-salbutamol in LPS-induced immune dysfunction of sepsis

2021 ◽  
Author(s):  
Huimin Beng ◽  
Shanping Wang ◽  
Junhua Hu ◽  
Xinglong Liang ◽  
Haolong Qin ◽  
...  
Keyword(s):  
Therapeutic Effect ◽  
Inflammatory Cell ◽  
Minute Volume ◽  
Lung Damage ◽  
Racemic Mixture ◽  
Lps Challenge ◽  
Threatening Condition ◽  
Life Threatening ◽  
Alveolar Septa ◽  
Inflammatory Effect

Sepsis is a severe life-threatening condition caused by a dysregulated host response to infection. So far, there are no pharmacotherapies to stop sepsis. Salbutamol, an commonly used β2-adrenoreceptor agonist, has found to be potential in regulating immune response dysfunction and exert anti-inflammatory effect. However, salbutamol exists two isomers. R-isomer exhibits the therapeutic effect and clinical benefit, while S-isomer proves to be detrimental rather than benign. So, in this study, we investigated the preventive and therapeutic effect of R-salbutamol (R-sal), S-salbutamol (S-sal) or racemic mixture in a mouse model of lipopolysaccharide (LPS)-induced sepsis. Dexamethasone (Dex) was set as comparison. The results showed that R-sal markedly improved seven-day survival rate of septic mice both administered before or after LPS. Whereas Dex showed toxic and accelerated the death of septic mice when given before LPS injection. Lung histological examination and lung function assay revealed that LPS challenge resulted in acute lung damage, including inflammatory cell infiltration, thickened alveolar septa and congestion, and decreased minute volume in septic mice. R-sal pretreatment efficiently inhibited these changes, accompanying by markedly reduced lung MPO level, serum cytokines levels and lactate release and significantly restored the lymphocytes and suppressed the percentage of monocytes. Racemic mixture exhibited diminished effects while S-sal showed enhanced cytokines release. In addition, R-sal pretreatment showed a better improvement in prognostic pulmonary function at day4 in survived mice than that of Rac-sal. Collectively, our results indicate the potential benefit of R-sal for sepsis and sepsis-induced lung injury.

scholarly journals Therapeutic Role of Tocilizumab in SARS-CoV-2-Induced Cytokine Storm: Rationale and Current Evidence

2021 ◽  
Vol 22 (6) ◽  
pp. 3059
Author(s):  
Corrado Pelaia ◽  
Cecilia Calabrese ◽  
Eugenio Garofalo ◽  
Andrea Bruni ◽  
Alessandro Vatrella ◽  
...  
Keyword(s):  
Review Article ◽  
Lung Damage ◽  
Current Evidence ◽  
Therapeutic Effects ◽  
Cytokine Storm ◽  
Future Perspectives ◽  
Pathogenic Role ◽  
Refractory Rheumatoid Arthritis ◽  
Life Threatening

Among patients suffering from coronavirus disease 2019 (COVID-19) syndrome, one of the worst possible scenarios is represented by the critical lung damage caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-induced cytokine storm, responsible for a potentially very dangerous hyperinflammatory condition. Within such a context, interleukin-6 (IL-6) plays a key pathogenic role, thus being a suitable therapeutic target. Indeed, the IL-6-receptor antagonist tocilizumab, already approved for treatment of refractory rheumatoid arthritis, is often used to treat patients with severe COVID-19 symptoms and lung involvement. Therefore, the aim of this review article is to focus on the rationale of tocilizumab utilization in the SARS-CoV-2-triggered cytokine storm, as well as to discuss current evidence and future perspectives, especially with regard to ongoing trials referring to the evaluation of tocilizumab’s therapeutic effects in patients with life-threatening SARS-CoV-2 infection.

scholarly journals A fatal toxic shock-like syndrome post COVID-19 infection in a child

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Houda Ajmi ◽  
Wissem Besghaier ◽  
Wafa Kallala ◽  
Abdelhalim Trabelsi ◽  
Saoussan Abroug
Keyword(s):  
Ejection Fraction ◽  
Pediatric Intensive Care ◽  
Fresh Frozen Plasma ◽  
Multiple Organ ◽  
Clinical Feature ◽  
Fresh Frozen ◽  
Life Threatening ◽  
High Doses ◽  
Definition Of ◽  
High Level

Abstract Background Children affected by Coronavirus disease 2019 (COVID-19) showed various manifestations. Some of them were severe cases presenting with multi-system inflammatory syndrome (MIS-C) causing multiple organ dysfunction. Case presentation We report the case of a 12-year-old girl with recent COVID-19 infection who presented with persistent fever, abdominal pain and other symptoms that meet the definition of MIS-C. She had lymphopenia and a high level of inflammatory markers. She was admitted to pediatric intensive care unit since she rapidly developed refractory catecholamine-resistant shock with multiple organ failure. Echocardiography showed a small pericardial effusion with a normal ejection fraction (Ejection Fraction = 60%) and no valvular or coronary lesions. The child showed no signs of improvement even after receiving intravenous immunoglobulin, fresh frozen plasma, high doses of Vasopressors and corticosteroid. His outcome was fatal. Conclusion Pediatric patients affected by the new COVID-19 related syndrome may show severe life-threatening conditions similar to Kawasaki disease shock syndrome. Hypotension in these patients results from heart failure and the decreased cardiac output. We report a new severe clinical feature of SARS-CoV-2 infection in children in whom hypotension was the result of refractory vasoplegia.

Cardiovascular complications of Streptococcus pneumoniae bacteraemia

2021 ◽  
Vol 14 (4) ◽  
pp. e240341
Author(s):  
Michelle M de Leau ◽  
Remko S Kuipers
Keyword(s):  
Antibiotic Resistance ◽  
Streptococcus Pneumoniae ◽  
Cardiovascular Complications ◽  
Diagnosis And Treatment ◽  
Immunocompromised Patients ◽  
Correct Treatment ◽  
Life Threatening ◽  
Pneumococcal Bacteraemia

The incidence of Streptococcus pneumoniae bacteraemia has risen due to a worldwide increase in immunocompromised patients and antibiotic resistance. We describe three patients who experienced severe, including cardiovascular, complications of pneumococcal bacteraemia. Cardiovascular complications related to pneumococci may run a fulminant course. However, some of these life-threatening complications (eg, endocarditis and aortitis) may long remain unnoticed or be misdiagnosed and therefore delay correct treatment. We review the literature with regards to the incidence, diagnosis and treatment of these rare but possibly lethal and hence important cardiovascular complications.

Mechanism of Anaphylactoid Reactions: Improper Preparation of High-Dose Intravenous Cyclosporine Leads to Bolus Infusion of Cremophor El and Cyclosporine

1997 ◽  
Vol 31 (11) ◽  
pp. 1287-1291 ◽  
Author(s):  
Merry Liau-Chu ◽  
Jochen GW Theis ◽  
Gideon Koren
Keyword(s):  
High Dose ◽  
Cremophor El ◽  
Bolus Infusion ◽  
Cyclosporine Therapy ◽  
High Incidence ◽  
Life Threatening ◽  
Anaphylactoid Reactions ◽  
Mixing Techniques ◽  
Initial Bolus ◽  
Therapy Protocol

BACKGROUND: During a Phase I/II trial of high-dose intravenous cyclosporine, a high incidence of anaphylactoid reactions was observed. Epidemiologic investigations revealed that the occurrence of anaphylactoid reactions was significantly associated with improper mixing during preparation of the infusions. It was hypothesized that improper mixing during the preparation of the infusion may have caused initial bolus infusions of the vehicle, Cremophor EL. These inadvertent bolus infusions may have caused the anaphylactoid reactions. OBJECTIVE: To investigate the effect of different mixing techniques on the distribution of the components of cyclosporine concentrate for infusion: cyclosporine, Cremophor EL, and ethanol in the infusions administered to the patients. METHODS: Infusions were prepared in a similar fashion as those administered to study patients enrolled in a high-dose cyclosporine therapy protocol. Samples were collected at defined time points of the infusions. Concentrations of cyclosporine and Cremophor EL were spectrophotometrically determined; ethanol concentrations were measured enzymatically. RESULTS: Cyclosporine and Cremophor EL concentrations were up to ninefold higher than intended during the first 10 minutes of the infusions that were not appropriately mixed. In contrast, the concentrations of cyclosporine and Cremophor EL were similar to the intended concentrations in all of the well-mixed infusions. CONCLUSIONS: Inappropriate mixing of high-dose cyclosporine infusions can lead to initial bolus infusion of cyclosporine and Cremophor EL. Bolus infusions of Cremophor EL have been associated with anaphylactoid reactions. Thus, thorough mixing of high-dose cyclosporine infusions may be important to reduce the possibility of life-threatening anaphylactoid reactions.

Treatment of autoimmune ophthalmopathy syndrome

1993 ◽  
Vol 74 (4) ◽  
pp. 293-294
Author(s):  
V. V. Talantov ◽  
E. N. Khasanov ◽  
R. L. Shamsutdinova ◽  
I. F. Gilmullin
Keyword(s):  
Clinical Practice ◽  
Pulse Therapy ◽  
High Doses

The treatment of autoimmune ophthalmow pathy by the high doses (pulse-therapy) or glucocorticoids in terms of interrupted courses (3 days cycles in every 710 days and in 1 1,5 months later on) may be successfully used in clinical practice. Pulse-therapy in the treatment of autoimmune ophthalmopathy syndrome is primarily recommended in the heavy course of the disease. Roentgenotherapy on the orbit region is prescribed in case of the insufficient effect.

scholarly journals Travel-Related Typhoid Fever: Narrative Review of the Scientific Literature

2020 ◽  
Vol 17 (2) ◽  
pp. 615 ◽  
Author(s):  
Narcisa Muresu ◽  
Giovanni Sotgiu ◽  
Bianca Maria Are ◽  
Andrea Cossu ◽  
Clementina Cocuzza ◽  
...  
Keyword(s):  
Low Income ◽  
Delayed Diagnosis ◽  
Low Income Countries ◽  
Travel Health ◽  
High Incidence ◽  
Health Advice ◽  
Life Threatening ◽  
Risk Of Disease ◽  
Resistant Strains ◽  
Drug Resistant Strains

Enteric fever is a foodborne infectious disease caused by Salmonella enterica serotypes Typhi and Paratyphi A, B and C. The high incidence in low income countries can increase the risk of disease in travelers coming from high income countries. Pre-travel health advice on hygiene and sanitation practices and vaccines can significantly reduce the risk of acquiring infections. Although the majority of the cases are self-limiting, life-threatening complications can occur. Delayed diagnosis and cases of infections caused by multi-drug resistant strains can complicate the clinical management and affect the prognosis. More international efforts are needed to reduce the burden of disease in low income countries, indirectly reducing the risk of travelers in endemic settings. Surveillance activities can help monitor the epidemiology of cases caused by drug-susceptible and resistant strains.

A case of life-threatening valvulitis mimicking infective endocarditis in systemic juvenile idiopathic arthritis

2020 ◽  
Vol 30 (5) ◽  
pp. 728-731
Author(s):  
Kyung Jin Oh ◽  
Hye Won Kwon ◽  
Sungkyu Cho ◽  
Jeong Wook Seo
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Infective Endocarditis ◽  
Mitral Valve ◽  
Macrophage Activation ◽  
Systemic Juvenile Idiopathic Arthritis ◽  
Pulse Therapy ◽  
Steroid Pulse ◽  
Intracardiac Mass ◽  
Acute Infectious Disease ◽  
Life Threatening

AbstractDifferential diagnosis of an intracardiac mass is difficult when detected only by echocardiography before a biopsy is completed. However, treatment cannot be postponed until the biopsy results are obtained. We report the case of a 12-year-old girl who presented with an intracardiac mass in the mitral valve mimicking infective endocarditis and severe mitral regurgitation. The mass was finally diagnosed as valvulitis associated with systemic juvenile idiopathic arthritis, which was complicated with macrophage activation syndrome. After careful exclusion of acute infectious disease, we started steroid pulse therapy and administered tocilizumab to treat the cytokine storm before performing the surgery. Finally, we performed mass excision and mitral valve replacement after immunosuppressant therapy.

scholarly journals Anakinra in the treatment of protracted paradoxical inflammatory reactions in HIV-associated tuberculosis in the United Kingdom: a report of two cases

2020 ◽  
Vol 31 (8) ◽  
pp. 808-812 ◽  
Author(s):  
Alexander J Keeley ◽  
Vivak Parkash ◽  
Anne Tunbridge ◽  
Julia Greig ◽  
Paul Collini ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Therapeutic Option ◽  
Interleukin 1 ◽  
High Dose ◽  
Inflammatory Reactions ◽  
Amyloid A ◽  
The United Kingdom ◽  
First Case ◽  
Life Threatening ◽  
Dose Corticosteroid

Paradoxical reactions, including immune reconstitution inflammatory syndrome (IRIS), are common in patients co-infected with human immunodeficiency virus (HIV) and tuberculosis (TB). Paradoxical reactions may confer substantial morbidity and mortality, especially in cases of central nervous system (CNS) TB, or through protracted usage of corticosteroids. No high-quality evidence is available to guide management in this scenario. Interleukin-1-mediated inflammation has been implicated in the pathophysiology of TB–IRIS. We describe two cases where anakinra (human recombinant interleukin-1 receptor antagonist) was used as steroid-sparing therapy for life-threatening protracted paradoxical inflammation in HIV-associated TB. In the first case of disseminated TB with lymphadenitis, protracted TB–IRIS led to amyloid A amyloidosis and nephrotic syndrome. In the second case of disseminated TB with cerebral tuberculomata, paradoxical inflammation caused unstable tuberculomata leading to profound neuro-disability. In both cases, paradoxical inflammation persisted for over a year. Protracted high-dose corticosteroid use led to adverse events yet failed to control inflammatory pathology. In both patients, anakinra successfully controlled paradoxical inflammation and facilitated withdrawal of corticosteroid therapy. Following anakinra therapy, nephrotic syndrome and neuro-disability resolved, respectively. Anakinra therapy for protracted paradoxical inflammation in HIV-associated TB may be a viable therapeutic option and warrants further research.

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