Increased Kynurenine Indicates a Fatal Course of COVID-19

(1) Background: An inefficient immune response accompanied by an overwhelming inflammatory reaction is involved in severe courses of COVID-19. Kynurenine (KYN) has important immune-modulatory functions and may contribute to a failure in controlling SARS-CoV-2. The present study aims to explore biomarkers that hint at a fatal outcome of COVID-19 early on. (2) Methods: We established a cohort of 148 hospitalized COVID-19 patients for this study. Thirty-one patients died due to a severe COVID-19 course, and 117 recovered within 90 days. We built a biobank by collecting left-over material from these patients whenever blood arrived at the central laboratory of our University hospital for analysis of routine markers. The scientific laboratory analysis comprised KYN, Tryptophan (TRP), KYN/TRP ratio, ferritin, interleukin-6 (IL-6), C-reactive protein (CRP), creatinine, N-terminal pro-natriuretic peptide (NTproBNP), troponin T (TnT), fibrinogen, D-Dimer, prothrombin time (PT), activated partial thromboplastin time (aPTT), antithrombin (AT), protein C, protein S, factor XIII, lupus aPTT, angiotensin-2, vitamin D metabolites, and telomeres in all COVID-19 patients. Basic clinical characteristics and anteceding diseases including cardiovascular, oncologic, renal, hypertension, pulmonary, metabolic (diabetes, obesity) were recorded in a database together with the laboratory data. (3) Results: At the time of diagnosis of SARS-CoV-2 infection those patients who deceased within 90 days afterwards due to COVID-19, had a significantly higher age, higher KYN, KYN/TRP ratio, ferritin, creatinine, and NTproBNP values than SARS-CoV-2 patients who survived COVID-19 along the same time span. In a Kaplan-Meier analysis the variables age, KYN, ferritin, D-Dimer, TnT, NTproBNP, and creatinine showed a significant influence on survival time. Gender, however, showed no influence. In a combined Cox regression analysis KYN had the highest hazard ratio (1.188, 95% CI: 1.071–1.319) followed by age (1.041, 95% CI: 1.011–1.073). In a ROC analysis, KYN values above the cut off limit of 4.82 nmol/l (as specified by Youden index) had a sensitivity of 82% (95% CI: 66–95%) and a specificity of 72% (95% CI: 65–82%) to predict COVID-19 related death within 90 days observation time. (4) Conclusions: Kynurenine is a promising blood biomarker to predict an increased risk of mortality in SARS-CoV-2 infected people already at the time of the first positive SARS-CoV-2 verification detected in these persons.

Thoracic aortic aneurysm in pregnancy: morphological analysis of 6 cases

Aortic dissection is rare but life-threatening complication in pregnancy, causing significant maternal and perinatal losses. Pregnancy may influence the integrity of the vessel wall and is a risk factor for dissection. There are very few data in the literature on structural changes in the aortic walls during pregnancy complicated by aortic dissection. Aim. Study of pathological features in the wall of ascending aorta (AA) during or immediately after pregnancy is presented in the article. Materials and methods. Material after surgical correction of AA in patients during pregnancy and in the early postpartum period was studied. Frozen sections were made from one part of the sample, followed by hematoxylin and eosin (H&E) staining, as well as Sudan III–IV staining to detect lipids. Paraffin sections were stained with H&E and picrofuchsin (van Gieson’s stain) for differentiation of collagen and muscle fibers, as well as fuchselin (Weigert’s elastic stain). Results. Six cases of aortic surgery during pregnancy (n = 1) and postpartum period (n = 5) were included: severe aortopathy caused by Marfan syndrome (MS) (n = 3), aortic coarctation with bicuspid aortic valve (n = 1), renal hypertension (n = 1), and pregnancy-induced hypertension (n = 1). Pathohistological studies showed that in all patients who underwent aortic surgery at the end of the third trimester in the early postpartum period changes in aortic wall collagen structure were observed. In contrast, in a pregnant woman with MS and severe aortopathy, who underwent preventive aortic surgery at 19 weeks of gestation, there were no such changes, the morphologic samples showed areas of scarring. In all 6 cases signs of lipoidosis in the AA wall were observed. All these data require further theoretical study, but clinicians are already faced with the question of the feasibility of preventive surgery in women with severe aortopathy on the preconception stage or during pregnancy. Conclusions. The specific effect of pregnancy on the AA wall leads to collagen disruption and the appearance of lipoidosis in late pregnancy, which is an important pathomorphological substrate for the occurrence of acute aortic pathology.

Profile of Urine Sediments in Elderly People with Hypertension

Elderly was a person who reaches the age more than 60 years that susceptible by the aging, such as hypertension. Hypertension was one of the factor for kidney disease. Hypertension is a disease that has systolic blood preasure up to 140 mmHg and diastolic up to 90 mmHg. Find out how the description of urine sediment in older people with hypertension. Type of descriptive type,include data collection, processing and presentation of data. Samples were taken as many 25 people with criteria for elderly people affected by hypertension. Urine examination is carried out by the Malbin-Streinheimer painting method. The result showed 19 people (76%) had hematuria or the possibility of infection and 6 people (24%) did not have hematuria.from the examination also obtained a cylinder of 6 people, namely 4 people (16%) 1/Lpb and 1/Lpb 2 people (8%). This cylinder provides an overview of kidney abnormalities. Urine sediment examination in elderly people with hypertension gives an overview of renal hypertension with discovery of a cylinder accompanied by microscopic hematuri.

Bloodstream infection caused by Bacteroides caccae in a patient with renal hypertension: a case report

Bacteroides caccae is an anaerobic bacterium with a reportedly high isolation rate; however, it rarely causes bloodstream infections. Patients with hypertension are at increased risk of developing anaerobic bacterial infection. In this study, we report a case of bacteremia caused by B. caccae in a patient with renal hypertension and gastrointestinal hemorrhage. This study describes the clinical manifestations of bloodstream infection involving B. caccae to provide guidance for laboratory technicians and clinicians. A 42-year-old Chinese man was admitted for gastrointestinal hemorrhage and subsequently diagnosed with anaerobic blood infection. The pathogenic bacteria isolated from anaerobic blood culture bottles were identified as B. caccae by using an automatic bacterial identification instrument and mass spectrometry (MS). B. caccae is an intestinal opportunistic pathogen that can invade the intestinal mucosa and cause anaerobic bloodstream infection. Two or more sets of blood cultures and MS identification can greatly improve the positive detection rate of blood cultures of anaerobic bacteria. Furthermore, the increased drug resistance of anaerobic bacteria necessitates drug sensitivity tests for anaerobic bacteria in many hospitals. Thus, the early prevention and control of primary diseases with appropriate diagnoses and timely anti-infection therapies are necessary to reduce B. caccae bloodstream infection.

Treatment of renal hypertension during varicocele

Aim. To evaluate the results of treatment of renal hypertension in varicocele after the formation of the proximal intervenous anastomosis.Material and methods. A survey was conducted among 167 patients with varicocele aged 16 to 39 years. The evaluation of the Varicocele degree was made by the classification of the Amerla Cubin, which is used in the WHO Classification (1997). All patients had clinical signs of varicocele. Ipsilateral testicle hypotrophy was detected in 21 (12.6%) and hydrocele 6 (3.6%) patients. All patients before and after the operation went through the analysis of ejaculate.Results and discussion. The renotesticular hemodynamic type of varicocele was found in 115 (68.9%) of 167 surveyed patients. Varicocele of 1 degree was detected in 17 (14.8%) cases, 2 degrees in 31 (26.9%) and 3 degrees in 67 (58.3%) patients. With doppler ultrasonography of the veins of the spermatic cord, the inner diameter varied from 3 to 6 mm. On average, this value was 4.3±1.1 mm. All these patients received subinguinal varicocelectomy by Marmar. Therefore, the vein drainage operations to reduce renal hypertension was carried out for 65 (56.5%) patients.Conclusion. The formation of intervenous anastomoses is a pathogenetically justified method of treating regional venous renal hypertension in varicocele.

Closed kidney injuries in children

MATERIALS AND METHODS: Within 20 yrs, 76 children aged 28 yrs with kidney trauma were under observation, and 35 of them had associated trauma. Clinical, instrumental, and radiological methods were used in the diagnosis. RESULTS: Of the 76 children with closed kidney trauma, 23 were diagnosed with kidney contusion, 14 with kidney injury with subcapsular hematoma, 16 with kidney injury with rupture of the capsule and perirenal urohematoma, 21 with kidney rupture and damage to the calyxpelvic system, and 2 with traumatic hydronephrotic kidney. Conservative treatment was carried out in 49 (64.4%) children and surgical treatment in 28 (25.6%). In the long term, 28 children with kidney injuries and treated conservatively were examined. Complications were found in nine children: pyeloectasia, deformation of the calyxpelvic system, pyelonephritis, and renal hypertension. Organ-preserving surgery was performed in 22 (28.9%) children and nephrectomy in 5 (6.6%) children. As long-term results: the function of the operated kidneys was satisfactory, some changes occurred in the calyxpelvic systems, and no data for pyelonephritis was found. CONCLUSION: Renal injuries with subcapsular rupture and perirenal urohematoma should be surgically treated to prevent severe long-term complications. In unclear cases, the choice can be a two-stage organ-preserving operation for the so-called crushing of the kidney.

Optimization of therapy in patients with renal hypertension by stabilizing hemovascular hemostasis

Objective. To study the aggregation activity of platelets in patients with renal hypertension. Materials and methods. The research work was carried out on the basis of the nephrological department of the State Institution NMC RT “Shifobakhsh”. The study included 46 patients aged 25 to 60 years with chronic pyelo- and glomerulonephritis. The patients were divided into two equal groups: first, the control group received standard therapy in accordance with the clinical protocol of the Tajik Association of Nephrologists; second, the main group, along with complex pathogenetic therapy in order to stabilize the hemostasis system and improve endothelial dysfunction, used the drugs Tivortin (intravenously drip and then long-term per os Tivortin aspartate) and Rheosorbilact intravenously drip. In addition to the generally accepted studies of patients with kidney pathology, emphasis was placed on the criteria for platelet quality (number, mean platelet volume, platelet distribution index, thrombocyte and large erythrocyte ratio) and studies of the hemostasis system (fibrinogen, prothrombin time, activated partial thromboplastin time, prothrombin relation). Results. There were found the hemostasis in microvessels, increases of the blood viscosity, the activation of systemic thrombus formation, and the progression of endothelial dysfunction in patients with renal hypertension. The results of observation of the dynamics of platelet aggregation activity under the influence of the combination of the studied drugs in this category of patients prove an effective decrease in its level. It is also necessary to emphasize the antiplatelet effect of this combination in relation to the prevention of microthrombosis and the pronounced endothelioprotective effect in patients with renal pathology. Conclusions. The complex therapy of patients with renal hypertension with Tivortin and Rheosorbilact is an effective way to stabilize hemovascular hemostasis. The effects of this therapy contributed to the improvement of the clinical condition of the patients, and during repeated examinations, there was a stable preservation of the decrease in the level of platelet aggregation activity.

The Role of Bidara Leaf Extract (Ziziphus Mauritiana) on the Prevention of Renal Hypertension in Wistar Strain Rats

Hypertension is ranked the fourth highest disease in the word. Glomerulosclerosis is the initial lesion from kidney failure in patient with hypertension. Bidara leaves have active flavonoid such as saponins and tannins are thought to prevent an increase in blood pressure and repair glomerulosclerosis. This study to prove the effect of bidara leaf extract to decrease hypertension and to prevent glomerulosclerosis. This study was true experimental with Pre and Post Test Control Group Design. This study used male white rats wistar strain. Sample divided into 5 groups (positive group, treatment group with 3 leveled dose, and medicine-control group) and were being observed in 28 days. Hypertension was measured using tail cuff blood pressure. Glomerulus observed randomly with light microscope in 5 different field of view with 400x magnification and scoring by Sclerosis Index (SI). In the linear regression test had R 2 = 0,332 for systolic blood pressure and R 2 = 0,609 for diastolic blood pressure. For glomerulosclerosis we found that the highest SI (369,69) was positive control group, while the lowest SI (84,09) was the group with a dose 400mg/kg/day. Bidara leaves extract have a significant effect on reduce hypertension and glomerulosclerosis.