Pathophysiology of thromboembolism in patients with COVID-19

Introduction and aim. A small number of critically ill patients with coronavirus disease (COVID-19) develop thromboembolism (arterial or venous), both micro- and macrovascular complications such as deep vein thrombosis, pulmonary embolism, and pulmonary arterial thrombosis. The objective of the study is to describe the pathophysiology of venous thromboembolism in patients with COVID-19. Material and methods. In this article a narrative review regarding pathophysiology of thromboembolism in patients with COVID-19. Analysis of the literature. The development of coagulopathy is a consequence of the intense inflammatory response associated with hypercoagulability, platelet activation, and endothelial dysfunction. The pathophysiology that relates pulmonary thromboembolism (PTE) with COVID-19 is associated with a hypercoagulable state. PTE is suspected in hospitalized patients presenting dyspnea, decreased oxygen requirement, hemodynamic instability, and dissociation between hemodynamic and respiratory changes. In COVID-19-associated coagulopathy, initially, patients present with elevated levels of fibrinogen and D-dimer, with minimal changes in prothrombin time and platelet count. The main risk factor for the development of pulmonary embolism is the increase in D-dimer that is associated with the development of PTE. The administration of iodine-based contrast agent to patients with COVID-19 would affect P-creatinine and renal function, where Ultrasound is viewed as cost-effective and highly portable, can be performed at the bedside. Conclusion. Acute respiratory distress syndrome severity in patients with COVID-19 can explain PTE as a consequence of an exaggerated immune response. © 2022 Publishing Office of the University of Rzeszow. All Rights Reserved.

A rare case of central post-stroke pain in a patient with migraine and lacunar infarcts in the medulla oblongata

Studies about headaches associated with acute ischemic stroke in patients suffering from migraine were limited, and therefore we present a clinical case of central post-stroke pain (CPSP) in a 47-year-old woman with migraine and lacunar infarcts in the medulla oblongata and also possible mechanisms of CPSP in patients with migraine. Magnetic resonance imaging of the brain revealed lacunar infarction in the medulla oblongata on the right (vertebral artery basin) and a single focus of gliosis in the parietal lobe on the right. Magnetic resonance angiography of cerebral vessels showed the fetal type of structure of both posterior cerebral arteries. This clinical case is a complex clinical situation of a combination of secondary headaches (post-stroke) in a patient with a primary headache (migraine), which was successfully treated by the combined administration of first-line drugs for the treatment of neuropathic pain in a patient with lacunar infarcts in the medulla oblongata. The treatment of CPSP is a difficult task due to the insufficiently unexplored mechanisms of development, the most effective approaches are those aimed at reducing the increased excitability of neurons.Copyright © 2023, Indian Association of Biomedical Scientists. All rights reserved.

Neurological manifestations in pediatric patients with COVID-19: A case series

In this case series of two male and one female patient with an age range of 2-12 years, only one patient had a history of neurological disorder and underwent ventriculoperitoneal shunt for a medulloblastoma, which describes coronavirus disease-associated neurological manifestations in pediatric patients, among which seizures and sensory disturbances are noticeable. In order to describe the various clinical and neurological manifestations that appeared earlier or developed over the course of illness, a series of cases of pediatric patients with coronavirus disease was documented. Copyright © 2022, Indian Association of Biomedical Scientists. All rights reserved.

Doxycycline inhibits SARS-CoV-2 replication in vitro

Introduction and Aim: We examined the effect of pre-and/or post-infection doxycycline on human nasal epithelial cell viability and SARS-CoV-2 (clinical strain IHUMI-3) replication in vitro. Materials and Methods: Human nasal epithelial cells, an in vivo SARS-CoV-2 target, were derived from healthy donor nasal epithelial stem/progenitor cells via in vitro differentiation. The cells were exposed to doxycycline at 0, 0.1, 0.5, 1, 5, 10, 50, and 100 μM before and/or after IHUMI-3 inoculation to determine the optimal inhibitory concentration. Viral replication was evaluated using quantitative reverse-transcription PCR, and doxycycline 50% cytotoxic concentration (CC50) and half-maximal effective concentration (EC50) were calculated. The peak serum concentration (Cmax) resulting from typical oral (100 or 200 mg) or intravenous (100 mg) doxycycline doses was estimated, and the Cmax/EC50 ratio was calculated as an index of potential clinical utility. Results: Doxycycline exhibited low cytotoxicity (CC50 > 100 μM) in human nasal epithelial cells and inhibited SARS-CoV-2 replication (EC50: 5.2 ± 3.3 μM) in a dose-dependent manner when administered pre-and/or post-infection. Reasonable oral or intravenous doses will help achieve effective concentrations in vivo. Conclusion: Early administration of this well-characterized, safe, and accessible drug may limit person-to-person transmission and prevent progression to severe coronavirus disease.

Chemical burns of the esophagus in children of kyrgyzstan: 10-year analysis of prevalence and cause

Introduction and Aim: In Kyrgyzstan, there are still no studies on the prevalence of chemical burns of the esophagus in children, and there are also few studies aimed at studying the causative agents. The present study aimed to assess the prevalence of burns of the esophagus due to the accidental use of various chemicals by children and the chemical composition of cauterizing substances over a 10-year period of admission of children to the clinic. Materials and Methods: An analysis of 1081 cases of chemical burns of the esophagus in children who received inpatient treatment for the period 2011–2020 is presented. Results: In our study, caustic substances were used more often by boys (56.9%) than girls (43.1%), most of the children were under the age of 3 years. There is a tendency for an annual increase in chemical burns of the esophagus. Among the causal factors, there is an increase in the use of alkalis, which are part of the cleaning agents for dishes and plumbing pipes-Krot;recently, the cleaning agent for cauldrons-Aurora is gaining momentum. Conclusion: The emerging situation indicates not only the need for further medical research in this area, but also the tightening of requirements for the packaging and use of household chemicals, and the solution of this problem at the state level.

Clinical features of acute ischemic stroke in moderately and severely ill patients with coronavirus disease 2019 (Covid-19)

Introduction and Aim: Although coronavirus disease 2019 (COVID-19) causes respiratory illness, it can even develop hypercoagulation and thrombotic complications. The main objective is to study the clinical features of acute ischemic stroke (AIS) with COVID-19 in moderately and severely ill patients. Materials and Methods: A retrospective analysis of thirty-four (34) patients who were infected with COVID-19 and even diagnosed with AIS in September 2020 was assessed. The main clinical and neurological characteristics of stroke, the results of clinical, laboratory, biochemical, coagulation, lipid metabolism, and clinical examination studies of COVID-19 were assessed. Results: The stroke severity, severity of brain damage, and degree of disability were reported more in the severely ill patients than in the moderately ill patients (p < 0.001, p = 0.002, and p = 0.7). Data from clinical-laboratory and biochemical parameters in moderately and severely ill patients showed that a more significant parameters are C-reactive protein (0.93 ± 0.03) and (5.79 ± 0.1), D-dimer (0.39 ± 0.11) and (0.76 ± 0.14), leukocytes (4.2 ± 1.69) and (3.6 ± 1.32), respectively (p < 0.001) and slightly altered values for fasting blood glucose levels (8.61 ± 2.41) and (7.21 ± 3.15). After clinical and pathomorphological analysis, acute respiratory distress syndrome signs were observed only in severely ill patients in 14 (41.1%). Conclusion: Among all the parameters characterizing clinical-laboratory and biochemical differences, inflammatory and infectious markers, and fasting glucose were higher. In moderately and severely ill patients with AIS and COVID-19 has a significantly favorable outcome with a longer hospital stay.