Effect of Nebulized Heparin on Weaning off Intubated Patients with Acute Respiratory Distress Syndrome (ARDS) Admitted to Intensive Care Unit (ICU): A Randomized Clinical Trial

Background: Acute respiratory distress syndrome (ARDS) treatment is based on supportive care such as mechanical ventilation, prophylaxis of stress ulcer, prophylaxis of deep vein thrombosis (DVT), nutritional support, and treatment of underlying disease. Objectives: We aimed to investigate the effects of nebulized heparin on weaning off intubated ARDS patients admitted to the intensive care unit (ICU). Methods: In this double-blind clinical trial study, 60 patients with ARDS receiving routine care according to the ARDS protocol were randomly assigned into two groups: intervention group (receiving nebulized heparin 5000 u/BD for one week) and control group (receiving nebulized sterile water 2 cc/BD for one week). The respiratory index (PaO2/FiO2), pulmonary shunt percentage (measured by ABG), tidal volume, minute ventilation, admission duration in the ICU, and days of mechanical ventilation required were recorded for each patient for one week. Results: There was no significant difference in demographic data between the two groups. Inhaled heparin in patients with ARDS could significantly increase the respiratory index (PaO2/FiO2) and decrease pulmonary shunt percentage, minute ventilation, and tidal volume. It also significantly reduced the number of admission days in the ICU and the need for mechanical ventilation. Conclusions: The result of the present study showed that inhaled heparin in intubated ARDS patients admitted to the ICU improved respiratory and pulmonary status and reduced the need for mechanical ventilation and admission days in the ICU. Nebulizing heparin, as an anti-inflammatory and anti-coagulant agent, is an effective and safe medication for ARDS patients on mechanical ventilation.

SAFETY AND EFFICACY OF STEM CELL THERAPY FOR TREATMENT SEVERE TRAUMATIC BRAIN INJURY

Traumatic brain injury (TBI) is a complicated topic.TBI has expensive treatment, sequelae, high mortality and efficient therapeutic strategies for TBI are urgently needed. Patients with severe TBI account for 10% of all traumatic brain injury patients, but more than 80% of patients who die from traumatic brain injury are in this group of patients. That proves the danger of severe TBI. Mesenchymal stem cells (MSCs) are multipotent cells with high proliferative and self-renewal capacities, as well as immunomodulatory and neuroregenerative effects. MSCshave been shown to treat TBI and significantly reduce inflammation of injured tissue. In the present study, we evaluated the quality and effectiveness of mesenchymal stem cell transplantation with the graft dose of 9x106cells/kg. Clinical indexes (Pulse, temperature, SBP, HATTr, HATTB, GCS) and subclinical (Hepatic index, kidney, cortisol, lactate, glucose, hematological index, respiratory index) were monitored on 60 patients within 6 months. The results showed that the recovery journey is different for every person with the graft dose of 6-9x106 cells/kg, but there were no adverse complications for the patients, the clinical and paraclinical indicators were stable. No significant side effects were observed during the trial as well as after 6 months of treatment. The MSC transfusions significantly increased the life quality patients; reduced brain damage and increased HSC counts. Inflammatory cytokines (IL-6) levels decreased and GCS increased in the MSC transfusion group, indicating that the patient's health improved.

Clinical pneumonia in the hospitalised child in Malawi in the post-pneumococcal conjugate vaccine era: a prospective hospital-based observational study

Objective Assess characteristics of clinical pneumonia after introduction of pneumococcal conjugate vaccine (PCV), by HIV exposure status, in children hospitalized in a governmental hospital in Malawi. Methods and findings We evaluated 1,139 children ≤5 years old hospitalised with clinical pneumonia: 101 HIV-exposed uninfected (HEU) and 1038 HIV-unexposed, uninfected (HUU). Median age was 11 months (IQR 6-20), 59% were male, median mid-upper arm circumference (MUAC) was 14 cm (IQR 13-15) and mean weight-for-height z score was -0.7 (+/-2.5). The highest Respiratory Index of Severity in Children (RISC) scores were allocated to 10.4% of the overall cohort, respectively. Only 45.7% had fever, and 37.2% had at least one danger sign at presentation. The most common clinical features were crackles (54.7%), nasal flaring (53.5%), and lower chest wall indrawing (53.2%). Compared to HUU, HEU children were significantly younger (9 months v. 11 months), with lower mean birth weight (2.8 kg v. 3.0 kg) and MUAC (13.6 cm v. 14.0 cm), had higher prevalence of vomiting (32.7% v. 22.0%), tachypnoea (68.4% v. 49.8%), and highest RISC scores (20.0% v. 9.4%). Five children died (0.4%). However, clinical outcomes were similar for both groups. Conclusions In this post-PCV setting where prevalence of HIV and malnutrition is high, children hospitalised fulfilling the WHO Integrated Management of Childhood Illness criteria for clinical pneumonia present with heterogeneous features. These vary by HIV exposure status but this does not influence either the frequency of danger signs or mortality. The poor performance of available severity scores in this population and the absence of more specific diagnostics hinder appropriate antimicrobial stewardship and the rational application of other interventions.

INFLUENCE OF MAGNETIC BLOOD TREATMENT ON THE DETOXIFICATION POTENTIAL OF HEMOPERFUSION THROUGH THE DOMESTIC HEMOSORBENT "HEMO-PROTEASOSORB" IN PATIENTS WITH SEVERE COVID-19

Background: The COVID-19 infection is a disease, in severe cases of which the mortality rate in the intensive care unit is 42-62%. Its main cause is the development of a "cytokine storm" and hypoxia in pulmonary injury. It has been proven that hemoperfusion through selective hemosorbents is effective for suppressing cytokine aggression. Considering the effectiveness of hemosorption in combination with magnetic blood treatment (MBT) in patients with sepsis, which is also characterized by endotoxemia and the development of a "cytokine storm", it is important to study the effectiveness of autohemomagnetotherapy in patients with severe COVID-19. Purpose: To evaluate the effectiveness of MBT in combination with hemoperfusion through the hemosorbent "Hemo-proteazosorb" in the severe course of COVID-19 infection. Material and methods: We studied the clinical and laboratory parameters of 36 patients with a severe course of COVID-19 infection, whose treatment included extracorporeal detoxification methods. All the patients were divided into 2 groups: "Hemo-proteazosorb" (19 patients) and "Hemo-proteazosorb + MBT" (17 patients). Results: Against the background of hemoperfusion through the domestic hemosorbent "Hemo-proteazosorb" in combination with MBT, a statistically significant increase in the levels of erythrocytes, hemoglobin, lymphocytes and the respiratory index was established. In the group "Hemo-proteazosorb + MBT" there was a statistically more pronounced elimination of IL-6 in comparison with the group where only hemoperfusion was performed. Conclusion: The inclusion of MBT in the standard protocol of hemoperfusion through “Hemo-proteazosorb” sorbent increases the effectiveness of the treatment of patients with severe COVID-19 by increasing its detoxification potential, improving the oxygen transport function of the blood, stimulating lymphopoiesis and improving the rheological properties of blood.

THE USE OF ANTI-CYTOKINE PROPERTIES OF THE DOMESTIC HEMOSORBENT HEMO-PROTEASOSORB IN CYTOKINE STORM IN PATIENTS WITH SEVERE COVID-19

Background: The urgency of the problem of treating a severe form of COVID-19 is due to the high mortality rate among patients in intensive care units (more than 25.8%). One of the main contributors to the severe course of the disease is the cytokine storm caused by the release of a large concentration of pro-inflammatory cytokines into the bloodstream. In addition to the drug-induced blockade of this condition, extracorporeal elimination can also be considered as an effective method for suppressing the clinical manifestations of cytokine aggression. Purpose: To assess the possibility of extracorporeal removal of cytokines by hemosorption through the Hemoproteasosorb sorbent in patients with severe COVID-19 accompanied by cytokine storm. Material and methods: A clinical and laboratory assessment of the course of the disease was made in 12 patients with a severe form of COVID-19 who developed the cytokine storm associated with hemosorption. Results: After hemosorption, a statistically significant decrease in the level of IL-6, neutrophils, procalcitonin and D-dimers was established. There was also observed an improvement in the oxygen transport function of the blood represented by an increase in the respiratory index. Conclusion: Hemisorption through the Hemo-proteasosorb sorbent can be effectively used to suppress the cytokine storm in patients with severe COVID-19.

8806 Russian patients demonstrate T cell count as better marker of COVID-19 clinical course severity than SARS-CoV-2 viral load

The article presents a comparative analysis of SARS-CoV-2 viral load (VL), T lymphocyte count and respiratory index PaO2:FiO2 ratio as prospective markers of COVID-19 course severity and prognosis. 8806 patients and asymptomatic carriers were investigated in time interval 15 March–19 December 2020. T cell count demonstrated better applicability as a marker of aggravating COVID-19 clinical course and unfavourable disease prognosis than SARS-CoV-2 VL or PaO2:FiO2 ratio taken alone. Using T cell count in clinical practice may provide an opportunity of early prediction of deteriorating a patient’s state.