Plasma Renin Concentration in Critically Ill COVID-19 Patients

Investigations of plasma renin concentration as a marker of organ perfusion in several intensive care settings have shown a significant correlation between its increase and a lack of perfusion in critical tissues, especially in septic patients. Castillo et al. proposed that activation of the non-canonical pathway of the renin–angiotensin–aldosterone system could improve cardiovascular homeostasis under COVID-19. During the first wave of COVID-19, we preliminarily enrolled a small cohort of subjects admitted to the Intensive Care Unit with a diagnosis of COVID-19 and acute respiratory distress syndrome. Their plasma renin value was measured in the first 24 h (T0), in the following 72 h (T1), and after one week (T2). In eight patients, we observed a higher plasma renin concentration—patients with difficulty weaning and in non-survivors. This is a preliminary observation. The variation of plasma renin levels in a septic condition is known, but settings such as COVID-19 infection have recently been investigated, showing a correlation with angiotensin-converting enzyme 2 receptor expression and functionality; in the near future, it will be interesting to have more data about its variation and value in COVID-19 patients.

Supralevator Abscess Complicated by Necrotic Fasciitis of Peritoneum, Genitalia, Anterior Abdominal Wall and Retroperitoneum.

A supralevator anorectal abscess may lead to a rare clinical complication, such as perineal necrotizing fasciitis. A 57-year-old man was admitted on an emergency basis with evidence of a deep anorectal abscess of 5-day duration. The clinical presentation involved an unbounded purulent destructive inflammation spreading onto the adjacent areas, with the development of a septic condition. Following a short preparation, a radical surgical debridement of a subfascial purulent necrotic phlegmon of the pelvic space was performed. Since the lower part of the abdomen, retroperitoneum and scrotum were involved, 4 additional subsequent necrectomies were performed at 48-hour intervals. The aggressive radical operative treatment and the combined intensive therapy were the main contributors to the favorable outcome of the disease.

Clinical case of multiple intestinal perforations caused by magnets

Gastrointestinal foreign bodies in children are a common reason for emergency surgical care. Among the foreign bodies of the digestive tract, special attention should be paid to neodymium magnets, known for their strong magnetic abilities and high resistance to demagnetization. The usual age of hospitalized children with intestinal magnetic bodies is 2–4 years. Swallowing neodymium balls can be accompanied with perforation, fistula, intestinal obstruction, peritonitis, shot bowel syndrome; septic condition with fatalities. The article presents a clinical case of swallowing 17 magnets by two-years-old boy for a long time. The child was hospitalized without anamnestic date of foreign bodies to the digestive tract. Intestinal magnets were diagnosed radiological. Early surgery with gentle tactics was used. The child recovered. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: foreign bodies of digestive tract, perforation, magnets.

Lactate Level as a Prediction Factor of Reperforation after Repairing Gastric Perforation

Reperforation after gastric perforation repair is a complication which increases the rate of morbidity and mortality in gastric perforation. The lack of ability of the tissue to use oxygen in septic condition causes anaerobic cellular metabolism and furthermore it will cause failure in closing the perforation. The production of anaerobic metabolism is lactic acid which can be measured from the blood. The aim of this study is to determine the cut-off point of blood lactate level as a predictor of reperforation after repairing gastric perforation. Forty-six patients diagnosed as gastric perforation, who were repaired in Dr Soetomo Hospital from October 2014 to October 2015 were recruited as samples. Serum lactate was taken one hour before repairing the perforation. After being repaired, the patients were observed until the 14th day to evaluate whether any reperforation would occur or not . The design of this research was cross-sectional, analytic observational. The data was analyzed using independent t-test and ROC for obtaining the cut-off point as a predictor of the reperforation after the gastric perforation was repaired. There was a significant difference in the mean of lactate level in the group with reperforation compared with that of the non-reperforation group, that is as big as 3.74±0.59 mmol/L and 2.60±0.76 mmol/L. Using ROC curve analysis, there was the cut-off point of lactate level for reperforation 3.35 mmol/L, with sensitivity 92.9%, specificity 84.4%, positive predictive value 72% and negative predictive Value 96.4%, accuracy 87.0% and in the AUC value 0.902.

Perioperative considerations for COVID-19 patients: lessons learned from the pandemic -a case series-

Background: As the coronavirus disease 2019 (COVID-19) pandemic spreads globally, hospitals are rushing to adapt their facilities, which were not designed to deal with infections adequately. Here, we present the management of a suspected COVID-19 patient. Case: A 66-year-old man with a recent travel history, infective symptoms, and chest X-ray was presented to our hospital. Considering his septic condition, we decided to perform an emergency surgery. The patient was given supplemental oxygen through a face mask and transported to an operating theatre on a plastic-covered trolley. An experienced anesthetist performed rapid sequence intubation using a video laryngoscope. Due to the initial presentation of respiratory distress, the patient remained intubated after surgery to avoid re-intubation. Precautions against droplet, contact, and airborne infection were instituted. Conclusions: Our objective was to facilitate surgical management of patients with known or suspected COVID-19 while minimizing the risk of nosocomial transmission to healthcare workers and other patients.

Review Article: Presepsin: New Biomaker to Evaluate Empirical Antibiotic Therapy Outcome in Septic Condition

This review presents key publications from the research field of new biomarker of sepsis and other relevant journals during 2009-2015. The results of these experimental studies and clinical trials are discussed in the context of biomarker for sepsis and the accuracy of presepsin for optimising antibiotic therapy. The discussion highlights and summarises articles on three main topics: diagnostic and prognostic biomarkers, presepsin as new biomarkers, and outcome studies. According to the review, presepsin is specific biomarker for bacterial infections compare with CRP and PCT. It may be useful to evaluate the empirical antibiotic outcome in sepsis condition.

SEPTIC CONDITION OF ARRIGATED MEADOW SIEROZEM SOILBY PESTICID RESIDUES

In the Republic of Uzbekistan widespread agrotechnical and melioration measures are carried out, aimed to melt the population demands on the ecologically clean agricultural products. The output quality can be improved through quantity reduction of residue toxic pesticides accumulating in soil. Study of soil quality, development of agro-engineering measures on pollution decrease are an important problem today. The research was conducted in the fields of meadow sierozem soil with a total area of 5 hectare of selected agricultural holding. In 5 key fields soil samples were taken for chemical analysis. As an experimental zone the 1st cut was chosen, placed with a height of 420 meters above sea-level. In the first ten days of April 26 soil samples were selected from soils 0-30, 30-50, 50-80, 80-100, 120-150 centimeters with 3 cuts and 2 borer points (hand drill). The research was conducted in field and laboratory conditions. Solution of obtained soil samples was tested on Mass- chromatograph machine. In determining of initial ecological state of soil, the main focus was given to organochlorine pesticides with toxic effect. Admissible quantity (MAC) in soil for pesticides HCCH and its metabolites is 0,1 mg / kg. Laboratory research showed that in analytics in all cuts the number of pesticides is high, that is 1-35, 3 times higher than MAC, determined for soil.

A gastrointestinalis traktusból migrált, lenyelt idegen testek esetei

Migration of swallowed foreign bodies from the gastrointestinal tract is a rare phenomenon compared with the total number of ingestions. In the reported two cases, the serious septic condition indicated urgent surgical intervention. We found a piece of wire swallowed a few months earlier in the right lobe of the liver and the retroperitoneum in case one, and a piece of wire in the pericardium, which migrated from the stomach through the left lobe of the liver, in case two. Abscesses and phlegmonae were found in the retroperitoneum and then in the femoral region requiring a reoperation in case one, and in the liver and pericardium in case two. After the evacuation of abscesses, both patients made full recovery. Diagnostic difficulties and therapeutic challenges served the reasons to present these cases. Orv Hetil. 2019; 160(42): 1677–1681.

Lactate Level as a Prediction Factor of Reperforation after Repairing Gastric Perforation

Reperforation after gastric perforation repair is a complication which increases the rate of morbidity and mortality in gastric perforation. The lack of ability of the tissue to use oxygen in septic condition causes anaerobic cellular metabolism and furthermore it will cause failure in closing the perforation. The production of anaerobic metabolism is lactic acid which can be measured from the blood. The aim of this study is to determine the cut-off point of blood lactate level as a predictor of reperforation after repairing gastric perforation. Forty-six patients diagnosed as gastric perforation, who were repaired in Dr Soetomo Hospital from October 2014 to October 2015 were recruited as samples. Serum lactate was taken one hour before repairing the perforation. After being repaired, the patients were observed until the 14th day to evaluate whether any reperforation would occur or not . The design of this research was cross-sectional, analytic observational. The data was analyzed using independent t-test and ROC for obtaining the cut-off point as a predictor of the reperforation after the gastric perforation was repaired. There was a significant difference in the mean of lactate level in the group with reperforation compared with that of the non-reperforation group, that is as big as 3.74±0.59 mmol/L and 2.60±0.76 mmol/L. Using ROC curve analysis, there was the cut-off point of lactate level for reperforation 3.35 mmol/L, with sensitivity 92.9%, specificity 84.4%, positive predictive value 72% and negative predictive Value 96.4%, accuracy 87.0% and in the AUC value 0.902.