scholarly journals Vascular injury in macroscopically normal skin of patients with severe COVID-19 infection: clinical-pathologic correlations

2021 ◽  
Vol 67 (3) ◽  
pp. 154-161
Author(s):  
Mircea-Catălin Coșarcă ◽  
Vasile Adrian Mureșan ◽  
Emoke Horvath ◽  
Eliza Russu ◽  
Janos Szederjesi ◽  
...  
Keyword(s):  
Inflammatory Infiltrate ◽  
Normal Skin ◽  
Severe Disease ◽  
Intensive Therapy ◽  
Clinical Status ◽  
Perivascular Infiltrate ◽  
Cutaneous Tissue ◽  
Immunohistochemical Assessment ◽  
Fibrin Thrombi ◽  
Critical Type

Abstract Objectives: Taking into account that the documentation of the histopathological features in severe disease caused by SARS-CoV-2 has been scarce due to the avoidance of performing autopsies, the aim of the study was to detect the microscopic changes associated with severe COVID-19 infection in normal-appearing skin, without prominent dermatologic signs of a generalized microvascular thrombotic disorder, in accordance with the clinical evolution of disease. Methods: In this morphological and immunohistochemical study we included cutaneous biopsy samples from 12 symptomatic patients with severe and critical type SARS-CoV-2 infection (with the admission date between February and June 2020), treated in the Intensive Therapy Unit Care of Emergency County Hospital Targu-Mures, Romania. Results: The average age of our patients was 65.18 ± 14.21 years (range 41 to 83), and 66.67% of the patients were male. The histological and immunohistochemical assessment of cutaneous biopsies: in 4 cases the histological examination revealed small fibrin thrombi in deep-seated venules and small veins of subcuticular adipose tissue, and also 4 cutaneous biopsies showed occlusive vascular thrombosis in association with massive perivascular inflammatory infiltrate destroying and compromising the integrity of the vessel wall. The immunohistochemical examination of the composition of perivascular inflammatory infiltrate showed a predominance of CD3 positive lymphocytes, admixed with CD68 positive Mo/ MF, some of them activated with FXIII expression. In the perivascular infiltrate, the presence of granulocytes and B lymphocytes was not characteristic. Conclusion: According to our observations, in severe COVID-19, the cutaneous tissue is involved even in the absence of clinically obvious changes. Due to the relatively easy accessibility of skin samples, these could be applied to determine the severity of the patient’s clinical status, and to predict the necessity for anti-complement or anticoagulant treatments in the early stages of a severe SARS-CoV-2 infection.

scholarly journals Livedoid vasculopathy: fast involution after anticoagulant and hyperbaric oxygen therapy

2011 ◽  
Vol 9 (2) ◽  
pp. 212-215 ◽  
Author(s):  
Patricia Weinschenker Bollmann ◽  
Andréa Kazumi Shimada ◽  
Nilceo Schwery Michalany ◽  
Ana Rita de Araújo Burgos Manhani ◽  
Auro del Giglio
Keyword(s):  
Hyperbaric Oxygen Therapy ◽  
Inflammatory Infiltrate ◽  
Oxygen Therapy ◽  
Hyperbaric Oxygenation ◽  
Systemic Disease ◽  
Rare Condition ◽  
Lower Limbs ◽  
Livedoid Vasculopathy ◽  
Hyperbaric Therapy ◽  
Fibrin Thrombi

The livedoid vasculopathy is a rare condition characterized by the presence of recurrent painful ulcers in distal extremities of lower limbs. Histologically there is thickness of dermal vessels, occlusion of its light by fibrin thrombi associated with minimal inflammatory infiltrate. It might occur as an isolated condition or be associated with an underlying systemic disease, including coagulation and collagen disorders, or neoplasms. Because it is a rare disease there is no consensus for its treatment. We report a case of a 41-year-old man with painful ulcers in the lower extremities. We did not find any associated diseases. The lesions improved dramatically after treatment with anticoagulant and hyperbaric therapy. We concluded that anticoagulation associated with hyperbaric oxygenation may be benefit for the treatment of patients with livedoid vasculopathy. However, further studies should be done with a larger population to confirm our results.

scholarly journals Unsupervised Phenotypic Clustering for Determining Clinical Status in Children with Cystic Fibrosis

2021 ◽  
pp. 2002881
Author(s):  
Nicole Filipow ◽  
Gwyneth Davies ◽  
Eleanor Main ◽  
Neil J. Sebire ◽  
Colin Wallis ◽  
...  
Keyword(s):  
Machine Learning ◽  
Cystic Fibrosis ◽  
Lung Function ◽  
Disease Severity ◽  
Learning Algorithm ◽  
Severe Disease ◽  
Clinical Status ◽  
Oral Antibiotics ◽  
Multisystem Disease ◽  
Street Hospital

BackgroundCystic Fibrosis (CF) is a multisystem disease in which assessing disease severity based on lung function alone may not be appropriate. The aim of the study was to develop a comprehensive machine-learning algorithm to assess clinical status independent of lung function in children.MethodsA comprehensive prospectively collected clinical database (Toronto, Canada) was used to apply unsupervised cluster analysis. The defined clusters were then compared by current and future lung function, risk of future hospitalisation, and risk of future pulmonary exacerbation (PEx) treated with oral antibiotics. A K-Nearest Neighbours (KNN) algorithm was used to prospectively assign clusters. The methods were validated in a paediatric clinical CF dataset from Great Ormond Street Hospital (GOSH).ResultsThe optimal cluster model identified four (A-D) phenotypic clusters based on 12 200 encounters from 530 individuals. Two clusters (A,B) consistent with mild disease were identified with high FEV1, and low risk of both hospitalisation and PEx treated with oral antibiotics. Two clusters (C,D) consistent with severe disease were also identified with low FEV1. Cluster D had the shortest time to both hospitalisation and PEx treated with oral antibiotics. The outcomes were consistent in 3124 encounters from 171 children at GOSH. The KNN cluster allocation error rate was low, at 2.5% (Toronto), and 3.5% (GOSH).ConclusionMachine learning derived phenotypic clusters can predict disease severity independent of lung function and could be used in conjunction with functional measures to predict future disease trajectories in CF patients.

scholarly journals Study of the skin anatomy with high-frequency (22 MHz) ultrasonography and histological correlation

2015 ◽  
Vol 48 (5) ◽  
pp. 324-329 ◽  
Author(s):  
Elisa de Oliveira Barcaui ◽  
Antonio Carlos Pires Carvalho ◽  
Juan Piñeiro-Maceira ◽  
Carlos Baptista Barcaui ◽  
Heleno Moraes
Keyword(s):  
High Frequency ◽  
Normal Skin ◽  
Skin Structure ◽  
Cutaneous Tissue ◽  
High Frequency Ultrasonography ◽  
Skin Conditions ◽  
The Relationship ◽  
Subsequent Staining ◽  
Excellent Tool ◽  
Hematoxylin Eosin

AbstractThe present essay is aimed at getting the radiologist familiar with the basic histological skin structure, allowing for a better correlation with sonographic findings. A high-frequency (22 MHz) ultrasonography apparatus was utilized in the present study. The histological analysis was performed after the skin specimens fixation with formalin, inclusion in paraffin blocks and subsequent staining with hematoxylin-eosin. The authors present a literature review showing the relationship between sonographic and histological findings in normal cutaneous tissue, and discuss the technique for a better performance of the sonographic scan. High-frequency ultrasonography is an excellent tool for the diagnosis of different skin conditions. However, as this method is operator-dependent, it is crucial to understand the normal skin structure as well as the correlation between histological and sonographic findings.

scholarly journals Possible Implication of Local Immune Response in Darier's Disease: An Immunohistochemical Characterization of Lesional Inflammatory Infiltrate

2010 ◽  
Vol 2010 ◽  
pp. 1-8 ◽  
Author(s):  
Clelia Miracco ◽  
Francesco Pietronudo ◽  
Vasileios Mourmouras ◽  
Michele Pellegrino ◽  
Monica Onorati ◽  
...  
Keyword(s):  
Immune Response ◽  
Dendritic Cells ◽  
Inflammatory Infiltrate ◽  
Normal Skin ◽  
Pemphigus Vulgaris ◽  
Skin Lesions ◽  
Cell Mediated Immunity ◽  
Local Immune Response ◽  
Darier’S Disease ◽  
Darier's Disease

Cell-mediated immunity is considered to be normal in Darier's Disease (DD), an inherited skin disorder complicated by skin infections. To date, there are no investigations on the local inflammatory infiltrate in DD skin lesions. In this immunohistochemical study we characterized and quantified it, making comparisons with two other inflammatory skin disorders, that is, pemphigus vulgaris (PV) and lichen ruber planus (LRP), and with the normal skin (NSk). We found a significant () decrease of CD1a+ Langerhans cells (LCs) in DD, compared to PV, LRP, and NSk, and of CD123+ plasmacytoid dendritic cells (pDCs), compared to PV and LRP. We hypothesize that the genetic damage of keratinocytes might result in a loss of some subsets of dendritic cells and, consequently, in an impaired local immune response, which might worsen the infections that inevitably occur in this disease.

Surgical Workload Generated by a Single-Visit Venous Clinic

2001 ◽  
Vol 16 (2) ◽  
pp. 80-84
Author(s):  
M. Geyer ◽  
P. M. Stott ◽  
Angela Harvey ◽  
C. R. R. Corbett
Keyword(s):  
Continuous Wave ◽  
Ultrasound Examination ◽  
Severe Disease ◽  
Clinical Status ◽  
Duplex Ultrasound ◽  
District General Hospital ◽  
Injection Sclerotherapy ◽  
Single Visit ◽  
Moderate Disease ◽  
Venous Surgery

Objective: To determine the management of patients attending a single-visit venous clinic. Design: Observational study. Setting: District general hospital. Patients: Two hundred and sixty-nine patients who attended over 1 year. Intervention: Clinical assessment was carried out with continuous wave Doppler ultrasound examination in all cases and duplex ultrasound examination in selected patients, followed by standard appropriate management. Main outcome measures: Patients were classified according to their clinical status under the CEAP classification (clinical, aetiological, anatomical, pathophysiological). This was related to the chosen form of management (advice only, compression hosiery, compression bandaging, injection sclerotherapy, superficial venous surgery). Results: A much higher proportion of patients with mild or moderate disease (CEAP 2 or 3) undergo operation (109/146, 75%) than those with severe disease (CEAP 4–6), in whom operation is less often appropriate (37/106, 35%). Conclusions: Most of the operative workload is generated by patients with mild or moderate disease; patients with severe disease are more often treated conservatively.

Experimental Use of the Selenase in Complex Treatment of Purulent and Inflammatory Diseases of the Small Pelvis Organs with Peritonitis

10.12737/2731 ◽  
2013 ◽  
Vol 20 (4) ◽  
pp. 65-68
Author(s):  
Нурмагомедова ◽  
P. Nurmagomedova ◽  
Магомедова ◽  
Z. Magomedova ◽  
Магомедов ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
Inflammatory Disease ◽  
Phagocytic Activity ◽  
Inflammatory Diseases ◽  
Intensive Therapy ◽  
Clinical Status ◽  
Complex Treatment ◽  
Results Of Treatment ◽  
Inflammatory Processes ◽  
Experimental Use

An analysis of the results of treatment of 48 patients with acute purulent and inflammatory disease of the small pelvis organs with endolymphatic introduction of the Selenase is presented. The age of the patients was from 20 to 45 years. Course of treatment was 5-10 days. The use of the Selenase in the scheme of intensive therapy facilitated substantial positive dynamics of clinical status. A distinct reduction of paresis of the gastrointestinal tract and decrease phenomena endotoxemia were observed clinically in most cases (94,2±2,1%). In laboratory indicators after 5-10 daily courses of intensive therapy with use of the Selenase, a tendency to normalization of the blood formula and reduce the number of leukocytes, the increase in 2 times the number of lymphocytes were noted. The use of CRT was neutralized antioxidant and immunological imbalance, increased phagocytic activity. Endolymphatic introduction of preparation contributed cleansing of wounds and cavities, regress of purulent and inflammatory processes. Application of the Selenase is significantly important factor in improving the prediction of treatment patients with purulent and inflammatory disease of the organs of small pelvis. Results of this research can be the basis for further research to develop new approaches in the field of endolymphatic therapy. Complications and cases of mortality from endolymphatic therapy by the Selenase didn´t revealed.

scholarly journals Insight into ECMO, mortality and ARDS: a nationwide analysis of 45,647 ECMO runs

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Benjamin Friedrichson ◽  
Haitham Mutlak ◽  
Kai Zacharowski ◽  
Florian Piekarski
Keyword(s):  
Hospital Mortality ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Severe Disease ◽  
Intensive Therapy ◽  
Age Distribution ◽  
Minor Importance ◽  
International Statistical Classification ◽  
Va Ecmo ◽  
Vv Ecmo

Abstract Background Extracorporeal life support (ECLS) has become an integral part of modern intensive therapy. The choice of support mode depends largely on the indication. Patients with respiratory failure are predominantly treated with a venovenous (VV) approach. We hypothesized that mortality in Germany in ECLS therapy did not differ from previously reported literature Methods Inpatient data from Germany from 2007 to 2018 provided by the Federal Statistical Office of Germany were analysed. The international statistical classification of diseases and related health problems codes (ICD) and process keys (OPS) for extracorporeal membrane oxygenation (ECMO) types, acute respiratory distress syndrome (ARDS) and hospital mortality were used. Results In total, 45,647 hospitalized patients treated with ECLS were analysed. In Germany, 231 hospitals provided ECLS therapy, with a median of 4 VV-ECMO and 9 VA-ECMO in 2018. Overall hospital mortality remained higher than predicted in comparison to the values reported in the literature. The number of VV-ECMO cases increased by 236% from 825 in 2007 to 2768 in 2018. ARDS was the main indication for VV-ECMO in only 33% of the patients in the past, but that proportion increased to 60% in 2018. VA-ECMO support is of minor importance in the treatment of ARDS in Germany. The age distribution of patients undergoing ECLS has shifted towards an older population. In 2018, the hospital mortality decreased in VV-ECMO patients and VV-ECMO patients with ARDS to 53.9% (n = 1493) and 54.4% (n = 926), respectively. Conclusions ARDS is a severe disease with a high mortality rate despite ECLS therapy. Although endpoints and timing of the evaluations differed from those of the CESAR and EOLIA studies and the Extracorporeal Life Support Organization (ELSO) Registry, the reported mortality in these studies was lower than in the present analysis. Further prospective analyses are necessary to evaluate outcomes in ECMO therapy at the centre volume level.

scholarly journals POS1233 USE OF BARICITINIB AND TOCILIZUMAB FOR THE TREATMENT OF MODERATE TO SEVERE COVID-19 IN HOSPITALIZED PATIENTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 899.3-900
Author(s):  
D. X. Xibille Friedmann ◽  
S. M. Carrillo Vazquez
Keyword(s):  
Hospital Stay ◽  
Demographic Data ◽  
Severe Disease ◽  
Clinical Status ◽  
Supplemental Oxygen ◽  
Janus Kinase ◽  
Oral Drug ◽  
Assisted Mechanical Ventilation ◽  
Non Invasive ◽  
High Flow Oxygen

Background:SARS-CoV2 infection and COVID-19 associated pneumonia are associated to a dysregulated inflammatory response known as cytokine storm and the use of cytokine inhibitors, especially those targeting IL-6, has been proposed as a therapeutic alternative in these patients. Janus Kinase (JAK) inhibitors in combination to the antiviral Remdesivir have shown evidence of reducing recovery time and accelerating improvement in clinical status among patients with COVID-19, notably among those receiving high-flow oxygen or noninvasive ventilation1.Objectives:To describe the outcomes associated with the use of Tocilizumab (TCZ) and Baricitinib (Bari) in patients hospitalized for COVID-19.Methods:Descriptive study nested in a cohort. Patients from the General Hospital of Cuernavaca who were hospitalized due to COVID-19 associated pneumonia and/or respiratory failure requiring supplemental oxygen or invasive/non-invasive assisted mechanical ventilation (AMV) were analyzed. All patients had a positive RT-PCR upon hospital admission, sampled under standardized conditions. The clinical and demographic data of the patients upon hospitalization were obtained from the instrument on a specific platform (SISVER) used on a national basis. Severe disease was considered as the need for any type of AMV. TCZ was used at 400-600 mg in two infusions (baseline and at 72 hours), Bari at 4 mg daily for 14 days. The outcomes were the need for AMV, death, or discharge. A p≤ 0.05 was considered statistically significant.Results:Data from 404 SARS-CoV2 positive patients were analyzed. 269 (65.9%) were men. The mean age of the patients was 57.5 years (18-94; SD 15.3). 59.6% of the patients had one or more comorbidities (Diabetes and Hypertension in most cases [31.8%]). 22.8% of the patients had a history of current or previous smoking. Mean hospital stay was 7.4 days (1-36; SD 5.9). 15.9% of the patients required invasive or non-invasive AMV. 11 patients were treated with TCZ and 30 patients received treatment with Baricitinib. 5 of the 11 patients with TCZ required AMV (all but one were intubated), but only 6 of the 30 (20%) with Bari required AMV (all except one received CPAP). The use of Baricitinib was correlated with a reduction in the use of AMV (p 0.01). 6 patients with TCZ were discharged due to improvement and 5 died. In the case of Bari, 19 improved and were discharged and 11 died, significantly correlating with lower mortality (p 0.05). The use TCZ was not associated with a reduced hospitalization (50% remained hospitalized for more than 10 days) but patients receiving Baricitinib had significantly shorter hospital stays (86.6% had a hospital stay of less than 10 days) than those receiving TCZ (p<0.0001).Conclusion:The patients that were treated with Baricitinib and required AMV most often improved with non-invasive CPAP while the majority of the patients under AMV receiving TCZ were treated with an invasive mode, although this was due in part to the fact that TCZ can be employed intravenously and is more practical for intubated patients in whom oral drug administration is limited. Baricitinib was significantly associated with a better outcome (hospital discharge due to improvement) and a significantly shorter hospital stay.References:[1]Kalil, A.C.; Patterson, T.F.; Mehta, A.K.; Tomashek, K.M.; Wolfe, C.R.; Ghazaryan, V.; Marconi, V.C.; Ruiz-Palacios, G.M.; Hsieh, L.; Kline, S.; et al. Baricitinib plus Remdesivir for Hospitalized Adults with Covid-19. N. Engl. J. Med. 2020.Acknowledgements:Thanks to B. Flores and M. Hernandez for their help with data collection.Disclosure of Interests:Daniel Xavier Xibille Friedmann Speakers bureau: Lilly, Abbvie, Paid instructor for: Lilly, Abbvie, Consultant of: Pfizer, Lilly, Sandra Miriam Carrillo Vazquez Speakers bureau: Roche, Novartis, Paid instructor for: Roche, Janssen, Consultant of: Roche, Janssen

scholarly journals Immunodetection of Leishmania Infantum in the Subungual Area of Dogs with Visceral Leishmaniasis

2019 ◽  
Vol 2 (1) ◽  
pp. 1-10
Author(s):  
Paulo Henrique Leal Bertolo ◽  
Maria Eduarda Bastos Andrade Moutinho da Conceição ◽  
Pamela Rodrigues Reina Moreira ◽  
Damazio Campos de Souza ◽  
Daniela Bernadete Rozza ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Leishmania Infantum ◽  
Inflammatory Infiltrate ◽  
Parasite Burden ◽  
Clinical Findings ◽  
Vacuolar Degeneration ◽  
The Third ◽  
Cutaneous Tissue ◽  
Immunohistochemical Studies ◽  
Dorsal Epidermis

Onychogryphosis is one of the main clinical findings in dogs with visceral leishmaniasis (VL); however, research focusing on the subungual area of infected dogs is scarce. This study aims to assess the subungual area of dogs with VL that presented or not onychogryphosis by means of histopathological analyses and immunohistochemical studies (parasite burden). The third digit of the thoracic and pelvic limbs of Leishmania infantum naturally infected dogs was collected regardless of sex, breed or age. The animals were split into two groups, dogs with onychogryphosis (G1; n=7) and without onychogryphosis (G2; n=9). The digits were evaluated in four areas (dorsal epidermis/dermis, ventral epidermis/dermis, dorsal matrix/dermis and ventral matrix/dermis). All lesions observed (mononuclear inflammatory infiltrate, vacuolar degeneration of basal keratinocytes, dermoepidermal clefting and pigmentary incontinence) were present in both groups, being more severe in the digits of G1 group. Immunostaining of the amastigote forms of Leishmania infantum were observed in the different areas of the digit, with statistical difference between the dorsal epidermis/dermis area and the dorsal matrix/dermis of G1 group. In conclusion, the main histopathological alteration of the digit of dogs with VL is mononuclear inflammatory infiltrate and parasite burden, especially in cutaneous tissue adjacent to the nail matrix. This aspect can influence the onychogryphosis development, due to the presence of the parasite and by inflammatory mediators released in the nail microenvironment.

scholarly journals Application of a new phytopreparation for gastrointestinal disorders in piglets

2020 ◽  
Vol 50 (5) ◽  
pp. 56-61
Author(s):  
L. N. Savelyeva ◽  
M. L. Bondarchuk ◽  
A. A. Kudelko
Keyword(s):  
Severe Disease ◽  
Clinical Status ◽  
Growth Dynamics ◽  
Live Weight ◽  
Daily Basis ◽  
Control Group ◽  
High Survival ◽  
Large White ◽  
Recommended Treatment ◽  
Experimental Group

The analysis of the therapeutic efficacy of a new medical and prophylactic drug on piglets of Large White breed crossed with Duroc was carried out. The experiment was conducted in the conditions of a pig-breeding farm in theTrans-BaikalTerritoryin 2019, 2020. Experimental animals were treated with a preparation based on dry extracts of magnolia vine, wild rose, bird cherry, chamomile, and eleutherococcus rhizomes. For the experiment, three groups of newborn pigs (n = 30) with signs of gastrointestinal tract disorders were formed. The drug was administered to piglets for 10 days according to two regimens: the 1st experimental group was given the drug orally at a dose of 6 ml/kg of live weight once a day; the 2nd experimental group – at a dose of 6 ml/kg of live weight 2 times a day with an interval of 12 hours. The control group was injected with a prebiotic at a dose of 10 ml/kg (1x106 CFU/10 mg) once a day. The animals were assessed on a daily basis for their clinical status (temperature, pulse, respiration, level of dehydration according to skin turgor, intensity of reflexes, state of feces). Recovery in the 1st group was observed on the 4th day, in the 2nd group on the 2nd day. The animals of the control group suff       a severe disease, the death rate was 60%, the surviving animals recovered on the 10th day. In animals of the 2nd group, there was an increase in lymphocyte cells by 34.5%, erythrocytes – by 18.1%, hemoglobin – by 8.1%, hematocrit – by 13.9%. The biochemical analysis of the blood serum of piglets showed a positive growth dynamics of total protein by 12.1%, albumin – by 17.1%, globulins – by 6.2%. The most effective regimen of treating pigs with the herbal preparation proved to be the one used in the 2nd experimental group. The use of the drug according to the recommended treatment regimen will allow pig farms to ensure high survival rate of young pigs, increase their weight gain and get environmentally friendly pig products.

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