scholarly journals COVID-19 and Rheumatology: so far, so close

2020 ◽  
pp. 135-143
Author(s):  
B. S. Belov ◽  
N. M. Muravyeva ◽  
G. M. Tarasova
Keyword(s):  
Pneumococcal Infection ◽  
Infectious Complications ◽  
Inflammatory Rheumatic Diseases ◽  
Prophylactic Efficacy ◽  
Extreme Caution ◽  
Increased Risk ◽  
Life Threatening ◽  
Tract Involvement ◽  
Social Importance

The disease caused by the new coronavirus COVID-19 is considered by the world community as an emergency of internationalimportance. Along with the huge social importance, the COVID-19 pandemic has highlighted a number of principally new clinical and fundamental problems of immunopathology of human diseases. This problem is extremely urgent for patients suffering from immune-inflammatory rheumatic diseases (IIRD) due to their higher exposure to infectious complications. Achieving and maintaining control over the activity of IIRD plays an important role in reducing the incidence of comorbid infections in these patients. It has been shown that patients with IIRD undergoing active anti-rheumatic therapy are most likely not characterized by increased risk of respiratory or other life-threatening complications within COVID-19 compared to the general population. Given the need for continued monitoring of patients receiving these therapy, unjustified “prophylactic” cancellation should nevertheless be avoided, thereby increasing the risk of relapse of major IIRD. The article also discusses the issues related to the use of basic anti-rheumatic drugs in COVID-19. Currently there is no evidence to support the therapeutic and prophylactic efficacy of chloroquine or hydroxychloroquine in COVID-19. Tocilizumab can be considered as “lifesaving therapy” for patients with acute respiratory distress syndrome in COVID-19, if other treatments have failed or are unavailable. The use of baricitinib in hospitalized pneumonia patients as part of COVID-19 should be considered with extreme caution. The need for further research to assess the potential role of baricitinib for these patients is highlighted. In the absence of a COVID-19 vaccine in a continuing pandemic, vaccination against influenza and pneumococcal infection should be strongly recommended to the absolute majority of patients with IIRD. This is associated with a high risk of fatal respiratory infection in rheumatological patients, especially given the high respiratory tract involvement in COVID-19.

The role of nutrition in critical care

2020 ◽  
Vol 11 (4) ◽  
pp. 166-171
Author(s):  
Kathryn Latimer-Jones
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Physiological Stress ◽  
Active Role ◽  
Drug Induced ◽  
Increased Risk ◽  
Anorexic Patient ◽  
Life Threatening ◽  
Improve Patient

Critically ill patients have conditions that are considered life-threatening and require comprehensive care and constant monitoring; nutritional support plays a key role in the recovery of these patients and is an area of veterinary medicine that is very easy for the registered veterinary nurse (RVN) to have an active role in. Critically ill patients are at increased risk of malnutrition; acute and chronic illness, trauma and inflammation induced stress-related catabolism, and drug-induced adverse effects may reduce appetite or increase nausea and vomiting. Challenges exist in the provision of support, especially in the anorexic patient. This article focuses on how severe physiological stress affects animals that are critically ill and how this might lead to malnutrition, how to accurately calculate energy requirements, and discusses the importance of selecting the most appropriate diet to improve patient outcomes.

scholarly journals The Role of Patiromer in Delaying the Onset of Renal Replacement Therapy in Patients with Advanced Renal Failure

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Nand K. Wadhwa ◽  
Jason A. Kline ◽  
Sreedhar R. Adapa
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Failure ◽  
Case Series ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk ◽  
Stage 4 ◽  
Initiation Of Dialysis ◽  
Life Threatening ◽  
Potassium Binding

Patients with chronic kidney disease (CKD) are at an increased risk of developing hyperkalemia, which can be potentially life threatening. Hyperkalemia is frequently encountered with renin-angiotensin-aldosterone system inhibitor (RAASi) therapy use in patients with CKD and often results in the underdosing or discontinuation of these drugs. RAASi therapy has been proven to delay the progression of CKD, ameliorate proteinuria, and reduce the overall risk of cardiovascular morbidity and mortality. Patiromer is a sodium-free, potassium-binding polymer used for the treatment of hyperkalemia. We present a case series of four patients with Stage 4 or 5 CKD in whom the initiation of dialysis was delayed with the use of patiromer. For one patient, dialysis was delayed by 18 months, whereas the remaining three patients, in whom hyperkalemia was one of the main complications, remain dialysis independent to date.

Androgen deficiency in women with adrenal insufficiency. Dehydroepiandrosterone. Review

GYNECOLOGY ◽  
2018 ◽  
Vol 20 (4) ◽  
pp. 35-39
Author(s):  
N F Nuralieva ◽  
M Yu Yukina ◽  
E A Troshina ◽  
N M Platonova
Keyword(s):  
Adrenal Insufficiency ◽  
Adrenal Glands ◽  
Dehydroepiandrosterone Sulfate ◽  
Malignant Neoplasms ◽  
Androgen Deficiency ◽  
Risk Of Death ◽  
Pathological Conditions ◽  
Increased Risk ◽  
Life Threatening

It is known that adrenal insufficiency (AI) is a severe life-threatening disease due to the exceptional role of glucocorticoids and mineralocorticoids in the human body. At the same time, according to some reports, the deficit of androgens synthesized by the adrenal cortex (dehydroepiandrosterone - DHEA and dehydroepiandrosterone sulfate - DHEAS) is associated with an increased risk of death, including increased risk of adverse cardiovascular events, development of osteoporosis, diabetes mellitus and malignant neoplasms. The main source of DHEA and DHEAS in females are adrenal glands, so women with hypocorticism have significantly reduced (down to undetectable) levels of these hormones. However, due to lack of a reliable evidence and, accordingly, clinical recommendations, correction of androgen deficiency in patients with AI is usually not performed. The review discusses the accumulated data on the physiological significance of DHEA and DHEAS, their role in the development of various pathological conditions, as well as safety and efficacy of these drugs.

scholarly journals COVID-19: the new challenge for rheumatologists

2020 ◽  
Vol 14 (2) ◽  
pp. 110-116
Author(s):  
B. S. Belov ◽  
A. E. Karateev
Keyword(s):  
Viral Infections ◽  
Immunosuppressive Treatment ◽  
Pneumococcal Infection ◽  
Infectious Complications ◽  
Inflammatory Rheumatic Diseases ◽  
Antirheumatic Drugs ◽  
Risk Of Death ◽  
Immune Mediated ◽  
Serious Infections ◽  
Tract Infections

Currently, the infection caused by the new coronavirus COVID-19 is considered by the global community as an emergency of international concern. Rheumatologists are particularly concerned about this problem, since patients with immune-mediated inflammatory rheumatic diseases (IMIRDs) are at higher risk for infectious diseases and receive immunosuppressive treatment. The use of disease-modifying antirheumatic drugs and biological agents increases the incidence of serious infections, but insufficient/no monitoring of IMIRD activity is an even greater risk factor for infectious complications. In addition, the role of vaccination mainly against influenza and pneumococcal infection is substantially increasing in modern conditions, since the risk of death from respiratory tract infections is quite high in patients with IMIRDs, which is very important in the context of the current COVID-19 pandemic.The paper presents an update on the incidence of viral infections in patients with IMIRDs and also discusses whether antirheumatic drugs can be used to treat COVID-19.

scholarly journals Preoperative hyponatremia predicts complications in older patients undergoing digestive tract surgery: a propensity score matching analysis

2021 ◽  
Author(s):  
Chun-Qing Li ◽  
Chen Zhang ◽  
Fan Yu ◽  
Hao Kong ◽  
Chun-Mei Deng
Keyword(s):  
Postoperative Complications ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Digestive Tract ◽  
Older Patients ◽  
Infectious Complications ◽  
Increased Risk ◽  
Life Threatening ◽  
Digestive Tract Surgery ◽  
Complications And Mortality

Abstract Purpose Whether preoperative hyponatremia increases the risk of postoperative complications in older patients undergoing digestive tract surgery remains unclear. The purpose of the study was to investigate the association between preoperative hyponatremia and life-threatening postoperative complications (including death) among older patients undergoing digestive tract surgery. Methods This was a propensity score-matched, retrospective cohort study. We recruited older patients (≥ 65 years of age) who underwent digestive tract surgery in our institution. The propensity score matching (PSM; 1:2) was used to balance a range of covariates between patients with preoperative hyponatremia (serum sodium [Na+] levels < 135 mmol/L) and those with normal [Na+] levels (135–145 mmol/L). The primary outcome was the occurrence of life-threatening postoperative complications and mortality (i.e., Clavien–Dindo grade IV and V [CD IV and V] complications) during hospital stay. The relationship between preoperative hyponatremia and the development of CD IV and V complications was identified with logistic regression analysis. Results A total of 1076 patients were analyzed (mean age 73.9 years; 421 female [39.1%]). Preoperative hyponatremia was identified in 122 patients. After matching, 312 patients were included in the analyses (104 patients with preoperative hyponatremia and 208 patients with normal [Na+] levels; mean age, 76.3 years; 130 female [41.7%]). When compared with normal [Na+] levels, preoperative hyponatremia was associated with an increased risk of CD IV and V complications (odds ratio [OR] 2.082, 95% confidential interval [CI] 1.041–4.164, P = 0.038). Preoperative hyponatremia was also significantly associated with a higher risk of postoperative infectious complications (OR 2.158, 95% CI 1.138–4.091, P = 0.018). Conclusion Preoperative hyponatremia can predict an increased risk of life-threatening postoperative complications and mortality in older patients undergoing digestive tract surgery.

Penicillin Prophylaxis in Children with Sickle Cell Disease

2010 ◽  
Vol 15 (3) ◽  
pp. 152-159 ◽  
Author(s):  
Mary Petrea Cober ◽  
Stephanie J. Phelps
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Pneumococcal Infection ◽  
Cell Disease ◽  
Older Children ◽  
American Academy Of Pediatrics ◽  
Increased Risk ◽  
Potential Problems ◽  
Life Threatening ◽  
Penicillin Prophylaxis

Abstract Children who have sickle cell disease and are under the age of five years are at increased risk of life-threatening pneumococcal infection due to absent or non-functional spleens and a decreased immune response. To prevent pneumococcal infection, the American Academy of Pediatrics recommends the use of penicillin prophylaxis in children with sickle cell disease under the age of five and in older children who have had a previous severe pneumococcal infection or have functional/surgical asplenia. These recommendations are based on two landmark studies, the first evaluating the effectiveness of penicillin prophylaxis and the second evaluating the duration of prophylaxis. Although the mortality rate from infection has been reduced following penicillin prophylaxis, altered immunologic response and penicillin-resistant S. pneumoniae remain a concern. This paper will review the literature that supports the use of penicillin prophylaxis, potential problems associated with prolonged therapy and recommendations for prophylaxis.

Infections in Compromised Hosts An Overview

1983 ◽  
Vol 4 (6) ◽  
pp. 452-453
Author(s):  
William Schaffner
Keyword(s):  
Immune Deficiency ◽  
World War Ii ◽  
Pneumococcal Infection ◽  
Underlying Disease ◽  
Scientific Investigation ◽  
Therapeutic Interventions ◽  
World War ◽  
Medical Progress ◽  
Increased Risk ◽  
Life Threatening

Much has been written recently concerning the new and growing occurrence of infections in compromised hosts. During the almost four decades since the end of World War II scientific investigation has produced extraordinary advances in diagnosis and treatment. This has resulted in two changes which have implications for this discussion. First, the classical acute community-acquired infections now are recognized quickly and treated effectively with antibiotics. Indeed, many such infections are managed quite effectively by physicians in the office or clinic and no longer require admission to the hospital. (For example, it has been years since I have seen mastoiditis or streptococcal erysipelas in my hospital consulting practice.) We have abandoned our “pneumonia ward” which once housed patients in various stages of life-threatening pneumococcal infection. Similarly, intensive immunization of our population has virtually eliminated poliomyelitis, diphtheria, tetanus, and measles; once common, these classical infectious diseases now are absent from our hospital.The second effect of medical progress has been the opportunity to offer patients with certain diseases, previously untreatable, the hope of increased survival and even cure. The list here is long and includes premature infants, children with congenital immune deficiency disorders, individuals with leukemia, lymphoma, aplastic anemia, burns, renal and other organ failure, and many others. Thus, the numbers of such patients in our hospitals have increased. These patients are at an increased risk of acquiring a complicating infection because of their underlying disease or because of our diagnostic and therapeutic interventions.

scholarly journals Modern approaches to immunization of patients of rheumatologic profile

2021 ◽  
Vol 93 (5) ◽  
Author(s):  
Boris S. Belov ◽  
Galina M. Tarasova ◽  
Natalia V. Muravyeva
Keyword(s):  
Decision Making ◽  
European Union ◽  
Hepatitis B ◽  
Pneumococcal Infection ◽  
Low Frequency ◽  
Inflammatory Rheumatic Diseases ◽  
The European Union ◽  
Joint Decision ◽  
Prevention Of Infections

Recently, the importance of comorbid infections in rheumatology has increased significantly, which have a significant impact on morbidity and mortality, especially in immuno-inflammatory rheumatic diseases (IIRD). In this regard, vaccination is becoming increasingly important in the prevention of infections in these patients. This review presents an updated version of the recommendations for vaccination of adult patients with IIRD, prepared by experts of the European Union League against Rheumatism (EULAR). There is a low (suboptimal) vaccination coverage of these patients, partly due to the low frequency of referral by doctors. The role of the rheumatology team in solving the problems associated with immunization of patients with IIRD is emphasized, as well as the importance of joint decision-making taking into account the needs and preferences of patients. The issues concerning the use of vaccines against influenza, pneumococcal infection, hepatitis B,

scholarly journals Infectious Complications in Adult ABO-Incompatible Liver Transplantation: Our Preliminary Experience

2020 ◽  
Vol 104 (3-4) ◽  
pp. 176-181
Author(s):  
Hironori Hayashi ◽  
Hiroyuki Takamura ◽  
Hidehiro Tajima ◽  
Yoshinao Ohbatake ◽  
Shinichi Nakanuma ◽  
...  
Keyword(s):  
Treatment Protocol ◽  
Prophylactic Antibiotic ◽  
Severe Infection ◽  
Infectious Complications ◽  
Infusion Therapy ◽  
Donor Liver ◽  
Antibody Mediated Rejection ◽  
Increased Risk ◽  
Liver Transplantations ◽  
Life Threatening

The number of ABO-incompatible living donor liver transplantations (ABO-I LDLT) has increased owing to the use of preoperative rituximab for immunosuppression. However, controversy remains regarding adequate immunosuppression owing to rejection and infection. Here, we present 5 cases of our ABO-I LDLT experience, emphasizing rejection and infectious complications, retrospectively. The treatment protocol included prophylactic rituximab followed by plasma exchange prior to transplantation, splenectomy, and immunosuppressive and prophylactic antibiotic regimens after transplantation. Four of the 5 patients also received local infusion therapy via the portal vein. Neither hyperacute nor antibody-mediated rejection occurred. All grafts were functioning well at discharge. Rehospitalization was required for 2 patients due to severe infection within 6 months of transplantation. Invasive aspergillosis was successfully treated in 1 patient, but the other patient died from severe sepsis with overwhelming postsplenectomy infection syndrome. Our results confirm that, although improved immunosuppressive therapy markedly reduces rejection in ABO-I LDLT, it is also associated with an increased risk of various life-threatening infections.

Vitamin A: dietologist’s position

2020 ◽  
pp. 49-57
Author(s):  
S. V. Orlova ◽  
E. A. Nikitina ◽  
L. I. Karushina ◽  
Yu. A. Pigaryova ◽  
O. E. Pronina
Keyword(s):  
Immune Response ◽  
Urinary Tract ◽  
Gastrointestinal Tract ◽  
Vitamin A ◽  
Developed Countries ◽  
Therapeutic Practice ◽  
The Past ◽  
Increased Risk ◽  
Mucous Membranes

Vitamin A (retinol) is one of the key elements for regulating the immune response and controls the division and differentiation of epithelial cells of the mucous membranes of the bronchopulmonary system, gastrointestinal tract, urinary tract, eyes, etc. Its significance in the context of the COVID‑19 pandemic is difficult to overestimate. However, a number of studies conducted in the past have associated the additional intake of vitamin A with an increased risk of developing cancer, as a result of which vitamin A was practically excluded from therapeutic practice in developed countries. Our review highlights the role of vitamin A in maintaining human health and the latest data on its effect on the development mechanisms of somatic pathology.

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