Predictors of Venous Thromboembolism in COVID-19 Patients: Results of the COVID-19 Brazilian Registry

Background Previous studies that assessed risk factors for venous thromboembolism (VTE) in COVID-19 patients have shown inconsistent results. Our aim was to investigate VTE predictors by both logistic regression (LR) and machine learning (ML) approaches, due to their potential complementarity. Methods This substudy of a large Brazilian COVID-19 Registry included COVID-19 adult patients from 16 hospitals. Symptomatic VTE was confirmed by objective imaging. LR analysis, tree-based boosting and bagging were used to investigate the association of variables upon hospital presentation with VTE. Results Among 4,120 patients (55·5% men, 39·3% critical patients), VTE was confirmed in 6·7%. In multivariate LR analysis, obesity (OR 1·50, 95%CI 1·11-2·02); being an ex-smoker (OR 1·44, 95%CI 1·03-2·01); surgery ≤ 90 days (OR 2·20, 95%CI 1·14-4·23); axillary temperature (OR 1·41, 95%CI 1·22-1·63); D-dimer ≥ 4 times above the upper limit of reference value (OR 2·16, 95%CI 1·26-3·67), lactate (OR 1·10, 95%CI 1·02-1·19), C-reactive protein levels (CRP, OR 1·09, 95% CI 1·01-1·18); and neutrophil count (OR 1·04, 95%CI 1·005-1·075) were independent predictors of VTE. Atrial fibrillation, peripheral oxygen saturation/inspired oxygen fraction (SF) ratio and prophylactic use of anticoagulants were protective. Temperature at admission, SF ratio, neutrophil count, D-dimer, CRP and lactate levels were also identified as predictors by ML methods. Conclusion By using ML and LR analyse, we showed that D-dimer, axillary temperature, neutrophil count, CRP and lactate levels are risk factors for VTE in COVID-19 patients.

Progesterone supplementation for prevention of preterm birth.

Objective: To study the efficacy of Progesterone supplementation for prevention of preterm birth. Study Design: Descriptive Interventional Study. Setting: Department of Obstetrics and Gynecology at Independent University Hospital, Faisalabad. Period: January 2018 to December 2020. Material & Methods: Data collected by using Non probability consecutive sampling techniques. Total 156 patients were included in study. Data was collected after informed consent, on pre designed proforma. Patient presented in 1st trimester and having previous history spontaneous preterm labour and recurrent miscarriages. We included patient presenting after 24 weeks of pregnancy and patient having threatened or actual preterm labour. Results: Among 156 patients, more than 82% of patient were delivered after 34 weeks of gestation and 18% were delivered before 34 weeks of gestation. Fetal outcome was very good in those patients who were delivered after 34 weeks of gestation with the use of Prophylactic progesterone therapy. Conclusion: Prophylactic use of progesterone helps in prolongation of pregnancy beyond 36 weeks and also help in decreasing the morbidity associated with premature delivery.

Analgesic Effects of Different κ-Receptor Agonists Used in Daytime Laparoscopic Cholecystectomy

Background. Comparing the effect of two different κ-receptor agonists, nalbuphine and oxycodone, and regular morphine in patients for prophylactic analgesia of acute pain after daytime laparoscopic cholecystectomy. Methods. One hundred and twenty-four patients undergoing laparoscopic cholecystectomy were randomly allocated to receive nalbuphine (group N), oxycodone (group O), and morphine (group M). The three groups were all given intravenous injection (iv.) of 0.15 mg/kg injection before incision and 0.05 mg/kg injection at the end of pneumoperitoneum. The Visual Analogue Scale (VAS) scores (incision, visceral, and shoulder) and Ramsay sedation scores at 1, 2, 4, 8, 12, 16, 20, and 24 hours after surgery, the time of extubation, the incidence of postoperative adverse events, the satisfaction of pain treatment, and the duration of stay after surgery were all recorded. Results. Compared with group M, the VAS scores of visceral pain at rest decreased in group N and group O at 1-8 h after surgery ( P < 0.05 ). The VAS scores of visceral pain at movement in group N decreased longer than those in group O ( P < 0.05 ). Compared with that of group M, the postoperative time in Ramsay sedation score of group O increased longer than that of group N ( P < 0.05 ). Compared with group N, patients had worse sleep quality in group O, longer length of stay in group M, and lower satisfaction in both groups. Conclusion. Compared with morphine, prophylactic use of the κ-receptor agonists, nalbuphine and oxycodone, during laparoscopic cholecystectomy can reduce postoperative visceral pain. Furthermore, the nalbuphine group had fewer adverse reactions, better analgesia, and better satisfaction.

Expression of the Sod1 gene under conditions of experimental ethanol intoxication and administration of hepatoprotective drugs

The aim of the study was to study the effect of hepatoprotective drugs on the expression of the Sod1 gene in rats with ethanol liver damage.Materials and methods. Male outbred white rats were used in the experiment. Five groups of animals were formed, 14 individuals each. Distilled water was administered to rats of the 1st group (control); Group 2 — ethanol at a dose of 5 g/kg of body weight; Group 3 — ethanol and heptor at a dose of 72 mg/kg; Group 4 — ethanol and mexidol at a dose of 50 mg/kg; Group 5 — ethanol and OMU at a dose of 50 mg/kg. The drugs were administered 1 hour before the introduction of ethanol. 24 and 72 hours after the introduction of ethanol (7 individuals), the animals were decapitated and the liver was removed. The expression level of the Sod1 gene was assessed using real-time reverse transcription PCR.Results. The fold change in Sod1 expression in rat liver after 24 h practically did not change in response to the introduction of ethanol to the animals. A tendency to a slight decrease was observed in relation to changes in the expression of Sod1 with the use of heptor and mexidol, while under the influence of OMU, the expression level increased moderately. After 72 h, the exposure to ethanol was accompanied by a slight decrease in the frequency of expression of the Sod1 gene. A similar trend was observed with respect to changes in Sod1 expression with the use of heptor, mexidol, and OMU.Conclusion. The results obtained indicate that the introduction of both ethanol and the prophylactic use of hepatoprotective drugs did not lead to significant changes in the level of Sod1 gene expression in rat liver. Additional studies are needed to identify the mechanisms of regulation of the antioxidant system, as well as the search for drugs that affect the transcriptional activity of genes.

Pre-Operative, Prophylactic Use of Oral Zinc Tablet in the Management of Post-Operative Sore Throat

Background: Postoperative sore throat (POST) is considered to be quite common complaint. Its symptoms tend to improve with time, but use of oral zinc lozenge has been shown to reduce the incidence and severity of POST. The aim of the present study was to find the efficacy of oral zinc sulfate, given 30 min preoperatively, in reducing POST, primarily caused by endotracheal intubation, till 24 hours after surgery. Method: A prospective, randomized, double-blinded, placebo-control-trial study was conducted on 80 patients, further divided into two groups of 40 patients each, between the age group of 18-60 years, of either gender, in Super Specialty Hospital, GMC Jammu, over a period of 6-months. The two groups received either dispersible zinc tablet or a placebo. The severity of POST was graded on a 4-point scale ranging from 0 to 3 and evaluation was repeated at 30 min, 2, 4, and 24 hour, postoperatively. Results: The difference in severity of sore throat was found to be statistically significant at all evaluation time intervals, except at 24 hours, which was quite lower in Zinc group. The overall incidence of POST in Zinc group was 26.3%, which was significantly higher at 50% in placebo group. Conclusion: A dose 40 mg zinc dispersible tablet, equivalent to 40 mg elemental zinc, given 30 min before surgery, effectively reduced the incidence and severity of POST. Keywords: Post Operative Sore Throat, Oral Zinc Lozenge, Endotracheal Intubation.

Methodological approach to risk prediction noncompliance in patients with myocardial infarction

Aim. To develop a methodological approach in order to predict the risk of noncompliance in patients with myocardial infarction.Methods. 416 patients were questioned in the single-centered, prospective, non-randomized study using the original author's method. The patients were treated in specialized cardiological departments of the city of Kemerovo with the diagnosed myocardial infarction. The methodological approach to predicting the risk of non-compliance in patients with myocardial infarction covered 29 factors in 6 main blocks: sociodemographic and socio-economic characteristics, health status, medical and pharmaceutical culture of the patient, awareness of medical and pharmaceutical services, patient adherence to medical recommendations.Results. Patients with myocardial infarction were characterized by insufficient adherence to the therapy, low awareness of the disease, which can negatively affect the longterm disease prognosis. The identification of a large number of subjective factors limiting adherence to the therapy is the reason for the widespread use of noncompliance risk measurement among patients with myocardial infarction, which will allow determining the range of the risk group for each individual patient.Conclusion. The adherence to the treatment of patients with myocardial infarction is revealed as 80% which is indicated as low and requires the prophylactic use of educational and psychological programs that increase medical and social awareness and readiness to comply with the doctor's recommendations, and also justifies the need for complex risk measurement of non-compliance patients for personalized identification and addressing risk factors for poor adherence to therapy.

Development and functional significance of the pulmonary surfactant system

Relevance. Prevention of the development of postoperative acute respiratory distress syndrome during operations on the descending thoracic aorta increases the effectiveness of therapy. The study of damage to the surfactant complex during ischemia and reperfusion of the lungs is relevant, since it involves the prophylactic use of the surfactant preparation during operations on the descending part of the thoracic aorta, which are characterized by a high risk of postoperative acute respiratory distress syndrome. Objective: to increase the effectiveness of pharmacological and respiratory therapy of acute respiratory distress syndrome, as well as to identify the role of the surfactant system of the lungs in the onset of inflammation against the background of tuberculosis and the development of regeneration mechanisms that affect the course and outcome of the disease. Materials and Methods. The study involved 24 people, including 14 volunteer patients with a diagnosed respiratory disease in an acute course (while the whole group received the drug from the study as an additional therapy). The sample of 14 people was formed solely due to the compliance of these patients with the criteria that were established before the start of the study of the drug, which had postoperative acute respiratory distress syndrome of various origins in their diagnosis. Results and Discussion. For a comprehensive laboratory determination, an algorithm was used that corresponded to the state standard to identify postoperative acute respiratory distress syndrome. For each participant in the experiments, it was proposed to develop a plan of treatment procedures, taking into account individualization and standardization. Conclusion. Some of the resulting data are collected with respect to the surfactant pulmonary system, which is presented in a compactor model format. A number of basic components are reflected here, which are classified according to cellular and non-cellular factors. At the same time, the surfactant substance helps to reduce the pronounced swelling, which can significantly reduce the process of sticking of the alveolar structures during inhalation. All this added up to the normal system of gas metabolism in the lung structures, including the control of the mucociliary system, which acts as a natural stimulator of the function of alveolar macrophages.