The Pathophysiology and Management of Diabetic Ketoacidosis in COVID-19 Patients: A Literature Review

Diabetic individuals are considered a vulnerable population during the COVID-19 Pandemic, and several studies noted worse outcomes, including death, among those who get infected. Diabetic emergencies, such as ketoacidosis (DKA), are common and potentially life-threatening conditions in uncontrolled patients. While the pathophysiological background of the relationship between COVID-19 and DKA is not fully understood, early reports available so far indicate that patients with pre-existing diabetes who get infected with the SARS-CoV 2 virus are at higher risk of DKA. It was also suggested that DKA is a poor prognostic sign for infected patients, these being at higher risk of developing worse forms of COVID-19 disease and having high mortality. Therefore, healthcare personnel dealing with such patients face a considerable challenge, as the correct and safe emergency management of such cases is far from established. This article aimed to conduct a study that reviews the current published data available about patients with DKA and COVID-19.

MAIN ASPECTS AND RESULT’S TREATMENT OF PRIMARY MEDIASTINAL B-CELL LARGE LYMPHOMA

Efficiency of first-line immunopolychemotherapy schemes was comparable. Long-term results were better with immunochaemoradiotherapy; the presence of PET-negative data after the first line of immunopolychemotherapy is a favourable prognostic sign. Radiation therapy executed in proper time helps to reduce the systemic cytostatic stress.

О локальных полях напряжений в гетерогенных средах, определяемых по параметрам акустической эмиссии

Local internal stress fields were computed from the time series of acoustic emission intervals between the successive signals for the case of structurally different heterogeneous materials. It is shown that a change in the nature of these stresses accumulation can serve as a prognostic sign of impending failure.

Characterization of post-anoxic tonic eyelid-opening (PATEO): A poorly-recognized prognostic sign

ABSTRACTBackgroundPost-anoxic myoclonus is a known poor prognostic sign and other post-anoxic spontaneous movements have been reported but poorly described. We aim to describe the electro-clinical phenomenon of post-anoxic eyelid openings in context of its possible prognostic value.MethodsWe collected clinical data on post-cardiac arrest patients with suspicious eyelid movements noted on continuous EEG monitoring. The eyelid movements captured on the video were correlated to the EEG findings and final clinical outcome. Neuroimaging data was reviewed when available. We also conducted a thorough literature review on this topic.ResultsA total of 10 patients (5 females) with average age of 56.1 (±14.4) years were included. The mean cardiopulmonary resuscitation duration was 18.9 (±11.3) minutes. Post-anoxic eyelid-opening movements occurred at variable intervals (0.5 to 570 seconds) in each individual. Close examination of eyelid opening (available in 6 patients) revealed them to be tonic movements, lasting an average of 3 (±0.8) seconds and always succeeded the onset of burst of EEG activity in a burst-suppression background. This is a transient phenomenon, lasting a median duration of 30 (IQR 7.75-36) hours. MRI findings in 3 patients demonstrated diffuse cortical ischemic injury with relative sparing of the brainstem. All patients passed away within 2-7 days following cardiac arrest.ConclusionContrary to previous descriptions, the post-anoxic tonic eyelid-openings (PATEO) are repetitive but non-periodic, non-myoclonic movements. Their close and specific temporal correlation to the burst of EEG activity suggests that this could be considered an ictal phenomenon requiring an intact midbrain based on MRI findings.

COVID-19 and Acute Kidney Injury requiring Kidney Replacement Therapy: A Bad Prognostic Sign.

The development of acute kidney injury in patients with COVID-19 is estimated to about 0.5% from earlier studies from China. The incidence of AKI in patients with COIVID-19 in the largest inpatient series in the United States is 22.2%3. Development of AKI requiring kidney replacement therapy in hospitalized patients is a bad prognostic sign. Out of Fifty patients admitted to our hospital with COVID-19 13/50(26%) developed AKI. All patients required hospitalization in intensive care unit care and 12/13 required initiation of kidney replacement therapy. The median age was 41 years (31-85 years) and 50% were men. Common comorbidities were obesity (83%), diabetes (42%), and hypertension (25%). 10/12 (83%) patients were hypoxemic and required oxygen therapy. 11/12 (92%) patients required invasive ventilation. Majority of patients had elevated neutrophils counts (81.8%) and low lymphocyte counts (81.8%). All patients had chest x-ray findings suggestive of pneumonia. 11/12(91.6%) developed septic shock requiring vasopressors. Review of UA showed all patient (9/9) had active urine sediments with blood but 7/9 of them have sterile pyuria. At the end of study period, 1 patient remained hospitalized. 10/11(90%) patients died and one patient was discharged home with resolution of AKI. Median length of stay was 13 days. The exact mechanism of AKI is not well understood in COVID-19 but can be due to acute tubular necrosis due to septic shock because of cytokine storm in severe COVID-19 or direct invasion by SARS-CoV-2 on podocytes and proximal renal tubular cells. Our findings suggest poor prognosis despite continuous kidney replacement therapies in patients who develop AKI with COVID-19.