RESUMO
Severity of a new coronavirus infection (COVID-19) caused by the SARS-COV-2 virus is largely due to abnormal immune condi-tion in these patients. Lymphopenia is observed in 85% of patients with severe COVID-19 that may be associated with enhanced apoptosis of lymphocytes. Objective. To analyze apoptotic death of lymphocytes and changes in proteins regulating apoptosis in patients with severe COVID-19. Material and methods. We analyzed 93 ICU patients. All patients were divided into three groups depending on severity and outcomes of disease: group 1 consisted of 53 patients with favorable course and outcomes of disease, group 2 included 26 patients with unfavorable course and favorable outcomes of disease, group 3 included 14 patients with unfavorable course and outcomes of disease. Blood sampling for analysis of apoptosis markers was carried out in 5-12 and 14-18 days after clinical manifestation of disease. Quantitative parameters of lymphocyte apoptosis were evaluated using flow cytometry. Regulatory proteins of apop-tosis (phosphorylated AKT, JNK, BAD, BCL-2, p-53, active caspase 8 and 9) were determined on the Luminex platform. We also assessed concentration of leukocytes, relative and absolute lymphocyte count, concentration of C-reactive protein (CRP), procal-citonin and lactate dehydrogenase. Results. Study groups significantly differed in NEWS score (p=0.001), SOFA score (p=0.001), CRP level (p=0.001), severity of lymph-openia (p=0.001) and level of CD14+HLA-DR+ monocytes (p=0.001). Quantitative parameters of lymphocyte apoptosis did not cor-relate with lymphopenia. The highest rates of lymphocyte apoptosis were observed in patients with favorable course and outcomes of disease. There was no correlation between concentration of lymphocytes in venous blood and level of proteins regulating apoptosis. Conclusion. Patients with severe COVID-19 are characterized by abnormal induction of lymphocyte apoptosis through external and internal activation pathways in response to viral aggression. In deceased patients, pro-apoptotic factors prevailed while activity of anti-apoptotic factors was decreased. © 2023, Media Sphera Publishing Group. All rights reserved.
RESUMO
Objective. To study the effect of vitamin D concentration on the course and outcomes of COVID-19 in intensive care patients. Material and methods. A prospective study included 43 ICU patients admitted to the Sklifosovsky Research Institute for Emergency Care with a confirmed diagnosis of a novel coronavirus infection. Single blood sampling was performed in 1—2 days after admission for analysis of 25-OH D3 concentration. Patients were divided into 2 groups with normal and reduced level of vitamin D. We analyzed chest CT data and laboratory parameters at admission and at the peak of cytokine storm. Administration of IL-6 antagonists and IL-6 receptor blockers was compared. We also compared the need for respiratory support, period between the onset of disease and respiratory therapy, its total duration and type of respiratory support, incidence of complications (sepsis, multiple organ failure, nosocomial pneumonia, acute kidney injury, thrombosis and hemorrhagic events). We analyzed the outcomes of disease, length of ICU-stay and hospital-stay. Results. Patients with normal vitamin D level at admission were characterized by lower serum C-reactive protein (15.41±7.96 vs. 63.271±11.988;p=0.029), while lymphocyte count (1.69±0.49 vs. 0.921±0.0719;p=0.029), leukocyte count (7.88±1.33 vs. 5.305±0.468;p=0.041) and serum lactate dehydrogenase (454.50±102.5 vs. 271.315±16.867;p=0.024) were higher. Minimum daily saturation at the peak of cytokine storm was higher in patients with normal vitamin D level (95.2±1.39 vs. 90.947±0.9585;p=0.044). Conclusion. Patients with vitamin D deficiency have a more pronounced inflammatory response in initial stages of disease and more severe lung damage at the stage of cytokine storm. However, this does not increase aggressiveness and duration of respiratory support, ICU-and hospital-stay. There was no worsening of the outcomes too. © S.S. PETRIKOV1, G.E. SAVKOV1, M.A. GODKOV1, N.V. BOROVKOVA1, A.M. KVASNIKOV1, D.A. LEBEDEV1, K.V. KISELEV2, K.A. POPUGAEV1.
RESUMO
We report a clinical case of treatment of a complicated postoperative course in a patient who underwent pancreatoduodenal resection associated with coronavirus infection. Prevention and treatment of such complications have been suggested. Pancreatoduodenal resection (PDR) is indicated for malignant tumors of the pancreatic head, duodenum or its large papilla, distal common bile duct, as well as in chronic pancreatitis with a predominant lesion of the pancreatic head with severe pain syndrome. The given clinical observation describes an example of treatment of a patient who developed a series of thromboembolic complications in the early stages after PDR performed for a neuroendocrine tumor of the pancreatic head. The oncology disease, extensive surgery such as PDR, and the postoperative period itself are risk factors for the development of various thromboembolic complications. According to the literature, the incidence of thromboembolic complications after PDR is 3–3.3%. The reason for the atypical course of the postoperative period when performing pancreatoduodenal resection in patients with tumor of the pancreas may be conditions that are not directly related to either the pathology of the pancreas or the features of the surgical intervention. When analyzing the patient’s condition, one should take into account the conditions of treatment. In such situations, proper detection of COVID-19 and adequate correction of therapy can fundamentally change the outcome of the disease. © 2021 Sklifosovsky Research Institute for Emergency Medicine. All rights reserved.