Acute Peritoneal Dialysis During the COVID-19 Pandemic at Bellevue Hospital in New York City.

Background: The COVID-19 pandemic strained hospital resources in New York City, including those for providing dialysis. New York University Medical Center and affiliations, including New York City Health and Hospitals/Bellevue, developed a plan to offset the increased needs for KRT. We established acute peritoneal dialysis (PD) capability, as usual dialysis modalities were overwhelmed by COVID-19 AKI. Methods: Observational study of patients requiring KRT admitted to Bellevue Hospital during the COVID surge. Bellevue Hospital is one of the largest public hospitals in the United States, providing medical care to an underserved population. There were substantial staff, supplies, and equipment shortages. Adult patients admitted with AKI who required KRT were considered for PD. We rapidly established an acute PD program. A surgery team placed catheters at the bedside in the intensive care unit; a nephrology team delivered treatment. We provided an alternative to hemodialysis and continuous venovenous hemofiltration for treating patients in the intensive-care unit, demonstrating efficacy with outcomes comparable to standard care. Results: From April 8, 2020 to May 8, 2020, 39 catheters were placed into ten women and 29 men. By June 10, 39% of the patients started on PD recovered kidney function (average ages 56 years for men and 59.5 years for women); men and women who expired were an average 71.8 and 66.2 years old. No episodes of peritonitis were observed; there were nine incidents of minor leaking. Some patients were treated while ventilated in the prone position. Conclusions: Demand compelled us to utilize acute PD during the COVID-19 pandemic. Our experience is one of the largest recently reported in the United States of which we are aware. Acute PD provided lifesaving care to acutely ill patients when expanding current resources was impossible. Our experience may help other programs to avoid rationing dialysis treatments in health crises.

Immune and Metabolic Response to COVID-19 Infection: Review for Molecular Pathways

The purpose of this review is a systematic analysis of data from clinical observations, international experience and reviews related to the pathogenetic aspects of the impact of a new coronavirus infection on the immune system. Information was searched in MEDLINE, PubMed, and RSCI databases. Some data for SARS-CoV-2 virus as etiological agent that provokes the development of COVID-19 are presented. Special attention was paid to immunity shifts, which were produced in patients under COVID-19 infection. The prevailing role of the "cytokine storm" in the development of severe forms of the disease is revealed in detail. Demonstrated and integrated into a single scheme of adjustment, innate and adaptive immunity is occurring with the new coronavirus infection. This information is supplemented by the characteristics of the metabolic response accompanying this pathology and by changes in the erythrocyte state under COVID-19 infection. Based on these pathogenetic mechanisms, potential variants of targeted correction of the disease are proposed and justified.

Generation and evaluation of a vaccine candidate of attenuated and heat-resistant genotype VIII Newcastle disease virus Impending Shortages of Kidney Replacement Therapy for COVID-19 Patients

Newcastle disease, which is a highly contagious and fatal disease caused by the Newcastle disease virus (NDV), has harmed the poultry industry for decades. The administration of effective vaccines can control most outbreaks and epidemics of Newcastle disease in the world. However, vaccination failures of live attenuated vaccines becasue of storage and transportation problems have been reported. Hence, thermostable live vaccine strains, such as V4 and I-2 strains, are being used and welcomed in tropical regions such as Africa and Southeast Asia. In this study, a thermostable, attenuated vaccine candidate strain NDV/rHR09 was generated using the genotype VIII heat-resistant virulent NDV strain HR09 by the reverse genetics system. The results of the determination of the mean death time and intracerebral pathogenicity index indicated that NDV/rHR09 is lentogenic even after 15 serial passages in embryonated chicken eggs. The thermostability assessment showed that the NDV/rHR09 strain exhibited hemagglutination activity and infectivity when exposed to 56°C for 60 min. Compared with the commercially available La Sota and V4 vaccines, the NDV/rHR09 induced higher antibody titers in specific pathogen-free chickens. In addition, NDV/rHR09 conferred complete protection against virulent genotype VII NDV challenge and virus shedding from vaccinated chickens. These results suggest that NDV/rHR09 is a promising thermostable vaccine candidate strain.