Survival of critically ill patients with COVID-19 pneumonia-a single-center experience.

INTRODUCTION: The aim of the study was to determine the survival probability of critically ill patients with COVID-19 infection who needed mechanical ventilation and to determine the efficacy of Tocilizumab use. METHODOLOGY: The study was designed as a retrospective analysis of consecutive patients older than 18 years, treated in an intensive care unit. The criteria for admission to the intensive care unit was severe respiratory failure requiring mechanical ventilation. All patients received corticosteroid therapy (methylprednisolone 1-2 mg/kg). Tocilizumab was used at a dose of 8 mg/kg in patients with a severe form of the disease (onset, or developed ARDS), followed by cytokine storm (IL-6 ≥ 40 ng/L and CRP ≥ 50 mg/L). RESULTS: 88 patients were included in the study. Intrahospital mortality was 48.86%. No statistically significant difference was observed between patients with and without tocilizumab therapy. In the group of patients in whom this therapy was applied, the values of intrahospital survival were 45.7%, while in the group without this therapy the probability of intrahospital survival was only 0.93%. The probability of survival in the group with noninvasive mechanical ventilation (NIV) was 94.7%, while in the group with invasive mechanical ventilation (IMV) 0.78%. The duration of symptoms before hospitalization (RR-1.088 CI 1.025-1.155, p < 0.05), as well as the duration of IMV (RR-0.906 CI 0.841-0.976, p < 0.05), were shown to be an independent predictor of poor outcome. CONCLUSIONS: The mortality of patients with the most severe form of respiratory failure caused by COVID-19 infection remains high. Independent predictors of poor outcomes were needed for invasive mechanical ventilation and the duration of symptoms before hospitalization or late initiation of appropriate therapy.

Septo-optic dysplasia plus: a case report.

BACKGROUND: Septo-optic dysplasia, also referred to as de Morsier syndrome, is a congenital condition characterized by classic triad features: midline brain abnormalities, optic nerve hypoplasia and pituitary endocrine dysfunction. Sometimes, other various malformations appear within syndrome. CASE PRESENTATION: An 11 and 1/2-year-old Caucasian Southeast European female patient with earlier established diagnoses of growth hormone deficiency, diabetes insipidus, seizures, mental retardation, optic nerve atrophy and right ptosis, was directed to us for consultative examination.The girl of short stature and low weight for her age had bilateral optic nerve hypoplasia, poor vision, nystagmus and right eye oculomotor palsy. Electroencephalogram revealed epileptic changes. Magnetic resonance imaging showed an empty sella syndrome, partial hypoplasia of corpus callosum, cavum of pellucid septum and diffuse polymicrogyria of the left temporal lobe. We found all elements of septo-optic dysplasia plus syndrome with right oculomotor nerve involvement. CONCLUSION: By earlier findings and evaluation, we established a diagnosis of septo-optic dysplasia plus. The case confirms the existence of various malformations within the syndrome and the need for the cooperation of several specialists in the diagnosis and treatment of children with the syndrome.

[Clinical-epidemiologic characteristics of large, invasive basal cell carcinomas of the scalp].

We studied a large, invasive basal cell carcinoma of the scalp in 42 operated patients (53 tumors) of which 26 patients with recurrent and 16 with no recurrence. This is a rare clinical form of this tumor that invades the skin in addition to some or all of the following structure: soft tissue scalp, skull, brain and brain membranes. The literature is known as the Giant basal cell carcinoma according to TNM classification of BCC in pT4 stage. Caused by aggressive subtypes of BCC. Treatment is surgical and involves only large, mutilate surgery and extensive reconstruction. Relapse often occurs. The aim was to analyze clinical and epidemiological characteristics of large, invasive basal cell carcinoma of the scalp, finding the causes of relapse and proposal timely diagnosis. We have concluded that the appearance of tumors in the frontal and pariental region of the scalp is related to the presence of known risk factors, that tumors often penetrate bones and brains resulting in more frequent recurrence in this localization. All tumors were caused by aggressive forms of BCC. Patients in the group with recurrent, previously responded to treatment and had more surgery than patients without recurrence. Treatment-related adverse events occurred in most patients (recurrence and/or death).

The effect of intraocular pressure on visual field after trabeculectomy in patients with primary open angle glaucoma.

PURPOSE: To compare the mean intraocular pressure (IOP), peak IOP and percentage reduction in IOP in the first five years following trabeculectomy between the patients with progressed visual field loss and the patients with stable visual fields. MATERIAL AND METHODS: Thirty-six eyes of 36 patients were followed for five years after their first trabeculectomy with tonometry and automated perimetry (Octopus 500EZ, program G1). The rate of change of the visual field was measured by linear regression analysis of the mean sensitivity value (dB) of each field test versus time (month). Based on the statistical significance of the slope of the regression line (Spearman p value of the correlation coefficient less than 0.05), patients were divided into two groups: with significant negative slope of the regression line (group with progressed visual field loss) and with non-significant slope of the regression line (group with stable visual field). The mean IOP values and percentage of IOP reduction at the end of each of the first five years after surgery were compared between the group with progressed field loss and group with stable fields by using Mann-Whitney U test. RESULTS: Patients with progressed visual field loss had higher mean IOP, higher peak IOP and less reduction in pressure after the operation than patients with stable visual field. The mean IOP at end of the two year postoperative period was significantly higher in patients with progressed visual field loss (21.98 +/- 3.38 mmHg) than in those with stable fields (17.48 +/- 4.80 mmHg). The mean percentage reduction in IOP at the end of two year postoperative period was significantly less in patients that showed progression of field loss (21.84%) than in those with stable fields (41.0%). CONCLUSION: Prognosis for further field loss seems to be better if postoperative pressure is at lower levels and greater percent reduction of IOP is obtained after surgery. The data that predict better prognosis is the mean postoperative IOP value of approximately 18 mmHg or less resulting from at least 35% of IOP reduction.

[Comparison of normal tension and high tension glaucoma patients (corrected) according to age and sex].

INTRODUCTION: According to the level of intraocular pressure (IOP), open angle glaucoma is divided into high tension glaucoma (HTG) and normal tension glaucoma (NTG). OBJECTIVE: To determine if there are differences in the distribution of patients by age and sex between NTG and HTG. METHODS: Our prospective study included 30 patients with NTG and 30 with HTG. A complete eye examination was performed. The examination included measuring of intraocular pressure by Goldmann applanation tonometry, examination of optic disc head by indirect ophthalmoscopy with Volk 90 D lens and visual field examination using the Octopus program. RESULTS: The average damage of visual field in the group of patients with NTG was 8.14 +/- 4.43 dB, while in the group with HTG it was 7.40 +/- 2.84 dB (p > 0.05). The average age of the group of patients with NTG was 66 +/- 11.58 years, while among those with HTG the average age was 59.7 +/- 11.63 years (p < 0.01). Among the patients with NTG there were three times more women than men (chi2 = 9.124; p < 0.01), while in the group of patients with HTG there were more men than women, but without statistically significant difference between the tested groups (chi2 = 1.851; p > 0.05). CONCLUSION: Open angle glaucoma is a disease of elderly population. According to our results, risk factors for this disease can be age and sex. NTG is more frequently present than HTG among elderly population and females.

[Differences of optic disc appearance between normal tension and high tension glaucoma patients].

INTRODUCTION: The term glaucoma is used to cover a wide range of diseases, whose main feature is optic neuropathy. According to the level of intraocular pressure (IOP), the open angle glaucoma is arbitrarily divided into high tension glaucoma (HTG) and normal tension glaucoma (NTG). OBJECTIVE: The aim of this study was to investigate the differences of optic disc cup appearance between patients with NTG and HTG. METHODS: Prospective study included 30 patients (60 eyes) with NTG and 30 patients (60 eyes) with HTG. IOP was measured by Goldmann applanation tonometry. Examination of optic disc head was performed by indirect ophthalmoscopy with Volk 90 D superfield lens through a dilated pupil to observe qualitative and quantitative parameters. Visual fields were examined in all patients with the Octopus program G1, full threshold strategy (Octopus 500 EZ, Interzeag, Switzerland). RESULTS: Vertical form of optic disc cup was present in 11 eyes with NTG (18.3%) and three eyes with HTG (5%) (p < 0.05). A disc with localized tissue loss (polar notching) on the inferior pole was observed in eight eyes with NTG (13.3%) and in one eye with HTG (1.7%) (p < 0.01). Uniformly enlarged, round cup was more frequent in patients with HTG than NTG: 93.3% and 68.3% respectively (p < 0.05). CONCLUSION: The perceived differences indicate a complex multifactorial nature of glaucoma disease and a possible existence of two pathophysiological ways of optic disc changes within the same basic disease.