Case Of Respiratory Distress Syndrome Research Articles

The association of LPCAT1-rs9728 polymorphism with cord blood IL-10, MIF, and VEGF levels in neonatal respiratory distress syndrome: a case–control study

BackgroundLysophospholipid acyltransferase (LPCAT) is crucial for surfactant biosynthesis. It is encoded by LPCAT genes. We investigated the LPCAT1-rs9728 genotypes in neonatal respiratory distress syndrome (NRDS) cases and their possible association with the cord arterial serum interleukin-10 (IL-10), macrophage migration inhibitory factor (MIF), and vascular endothelial growth factor (VEGF) levels.MethodsThe study included 160 neonates grouped into G1: 60 healthy neonates and G2: 100 NRDS cases. IL-10, MIF, and VEGF levels were measured by their corresponding kits. The Gene JETTM Whole Blood Genomic DNA Purification Mini Kit was used to extract the DNA from the newborn venous blood. The quantitative real-time polymerase chain reaction was carried out for LPCAT1-rs9728 genotyping.ResultsThe IL-10 and MIF levels were significantly higher, while VEGF levels were significantly lower in G2 than in G1. The percentages of LPCAT1-rs9728 AA and LPCAT1-rs9728 AG genotypes were significantly higher in G2 than in G1. The IL-10 and MIF levels were significantly higher, while the VEGF levels, birth weight, and APGAR score at 1 and 5 min were significantly lower in neonates with LPCAT1-rs9728 AA genotype than in neonates with LPCAT1-rs9728 AG and LPCAT1-rs9728 GG genotypes and in neonates with LPCAT1-rs9728 AG genotype than in neonates with LPCAT1-rs9728 GG genotype.ConclusionThere is an association between the LPCAT1-rs9728 AA genotype and its A allele and the NRDS development and severity. Further research may provide a better understanding of this association to help future management.

A Case of Metapneumovirus Pneumonia-Related Acute Respiratory Distress Syndrome in a Young Adult Patient

Human metapneumovirus (hMPV) infections commonly present as mild upper respiratory tract infections in healthy adults, although severe respiratory complications have been observed, particularly in elderly and immunocompromised patients. We report a case in whom pneumonia caused by hMPV progressed to acute respiratory distress syndrome (ARDS) in a healthy adult without underlying diseases. A 31-year-old female presented with fever and dyspnea, prompting transfer to our hospital for mechanical ventilation 3 days after symptom onset. Auscultation revealed coarse breath sounds and crackles in both lung fields, and chest X-ray showed non-specific infiltrative nodules with poorly defined borders throughout both lungs. ARDS caused by community-acquired pneumonia was diagnosed. hMPV was identified via rapid testing of respiratory samples for genes that encode pneumonia pathogens and drug resistance markers; we employed reverse transcription polymerase chain reactions to these ends. Six days later, the patient was weaned off the mechanical ventilator, and discharged from the hospital in good clinical condition.

Risk factors for the incident of respiratory distress syndrome in neonates at the Regional General Hospital of Buleleng District, 2020

<p><strong><em>Background</em></strong><em> : The main causes of death in neonates are complications of pregnancy and childbirth, such as asphyxia, sepsis and low birth weight complications. Respiratory Distress Syndrome (RDS) is a condition related to the respiratory system of neonates. The large number of RDS cases is one of the highest causes of death in neonates.</em></p><p><strong><em>Objectives</em></strong><em>: The aim of this study is to determine the risk factors for the incidence of RDS at Buleleng District Hospital, especially in premature neonates in 2020.</em></p><p><strong><em>Methods</em></strong><em>: This research method uses a retrospective cohort study. Where the data was taken using secondary data in the NICCU room at Buleleng Regional Hospital. The independent variables included are the characteristics of the neonate including gestational age, history of hypertension experienced by the mother during pregnancy, birth weight, history of premature rupture of membranes, history of asphyxia experienced during the birth process. The dependent variable in this study was the incidence of RDS in neonates. The sample included in this research was 64 mothers who gave birth at the Buleleng District Hospital in 2020. This research used univariate analysis to assess the frequency distribution of each variable, then continued using bivariate analysis to determine the variables that were included in the multivariate analysis. Multivariate analysis was carried out computerized using logistic regression</em></p><p><strong><em>Results</em></strong><em>: The results of this study found that there were 2 risk factors that directly increased the incidence of RDS in neonates including premature gestational age with a value of p 0.01 (19.8, 95% CI 1.8-133.7, low birth weight ( 2.9, 95% CI 1.9-8.4). </em></p><p><strong><em>Conclusions</em></strong><em>: The conclusion is that there are 2 risk factors that are associated and increase the incidence of RDS in neonates, namely premature gestational age and low birth weight.</em></p>

Justification of Intensive care management of children with severe COVID19 (а case study)

the unprecedented COVID-19 pandemic that spread across the world and lasted for more than 3 years had significant medical and social consequences. Despite the fact that in the children's population the coronavirus infection has a milder course and a much lower risk of mortality, there are individual cases with pre-existing comorbidities that cause severe acute respiratory distress syndrome. Thus, in most cases, severe COVID-19 developed in children with pre-existing conditions, including: immunodeficiency, diabetes mellitus, bronchial asthma, etc. Therefore, comorbidities disposed children to progress to severe Covid-19 which requires treatments with more aggressive therapeutic tactics and personalised management. The article presents a clinical case of severe acute respiratory distress syndrome caused by the SARS-CoV-2 virus in an early age child. The patient was observed in the Anesthesiology and Intensive Therapy Department of the Chernivtsi Regional Children's Clinical Hospital. Due to acute respiratory infection, the child has been developing signs of respiratory failure. The available instrumental findings confirmed right lung pneumonia, complicated by pneumothorax. Laboratory tests confirmed leukocytosis, thrombocytopenia, hypertransfusion, increased procalcitonin, increased level of C-reactive protein, D-dimer and interleukin-6 as well as circulating immune complexes. The treatment regimen included respiratory protection (oxygen therapy), support of hemodynamics (infusion of glucose-saline solutions), administration of intravenous normal human immunoglobulin, a short course of parenteral glucocorticosteroids, the use of step-by-step combined antibacterial therapy and a direct-acting antiviral drug (remdesivir), and thromboembolism prophylaxis (low-molecular-weight heparin). Following intensive treatment, the child's condition was characterised by a slow positive dynamics, leading to full recovery. This case demonstrates the need for timely detection of life-threatening conditions caused by COVID-19 and requires an aggressive management of child's condition using a complex intensive therapy.

A Rare Case of Chlorine Inhalation-induced Severe Acute Respiratory Distress Syndrome: A Case Report and Review of Literature

A Rare Case of Chlorine Inhalation-induced Severe Acute Respiratory Distress Syndrome: A Case Report and Review of Literature

Diagnostic value of bedside lung ultrasound and 12-zone score in the 65 cases of neonatal respiratory distress syndrome and its severity

ObjectiveTo explore the predictive value of bedside lung ultrasound score in the severity of neonatal respiratory distress syndrome (NRDS) and mechanical ventilation and extubation.MethodsThe clinical data of 65 neonates with NRDS and invasive mechanical ventilation diagnosed in the neonatal intensive care unit of our hospital from July 2021 to July 2022 were retrospectively analyzed. 65 neonates were included in the NRDS group, and 40 neonates with other common lung diseases were selected as the other lung disease groups. All neonates underwent lung ultrasound and X-ray examination. The correlation between lung ultrasound scores and arterial blood gas indexes was analyzed by Pearson. The efficacy of successful evacuation of mechanical ventilation was evaluated by lung ultrasound analysis by ROC curve analysis.ResultsThe positive rates of lung consolidation and white lung in NRDS group were higher than the other lung disease groups (P < 0.05). The positive rates of bronchial inflation sign and double lung points were lower than these in the other lung disease groups (P < 0.05). The ultrasound scores of both lungs, left lung, right lung, bilateral lung and double basal lung in the NRDS group were significantly higher than those in the other lung disease groups (P < 0.05). There was a significant positive correlation between lung ultrasound score and X-ray grade (r = 0.841, P < 0.001). The area under the curve (AUC) of lung ultrasound score for the differential diagnosis of NRDS and common lung diseases was 0.907. The AUC of lung ultrasound score in the differential diagnosis of mild and moderate, and moderate and severe NRDS were 0.914 and 0.933, respectively, which had high clinical value. The lung ultrasound score was positively correlated with the level of PaCO2 (r = 0.254, P = 0.041), and negatively correlated with the levels of SpO2 and PaO2 (r = − 0.459, − 0.362, P = 0.001, 0.003). The AUC of successful mechanical ventilation withdrawal predicted by the pulmonary ultrasound score before extubation was 0.954 (95% CI 0.907–1.000). The predictive value of successful extubation was 10 points of the pulmonary ultrasound score, with a sensitivity of 93.33% and a specificity of 88.00%.ConclusionThe bedside lung ultrasound score can intuitively reflect the respiratory status of neonates, which provides clinicians with an important basis for disease evaluation.

Serum Levels of IL-21, IL-23 and 8-hydroxy-2′-deoxyguanosine in Pediatric Severe Pneumonia Cases

Background: Pneumonia causes the majority of acute respiratory distress syndrome (ARDS) cases. The microbes that cause pneumonia are very diverse. In addition to DNA, RNA viruses, Gram-negative and Gram-positive bacteria cause two types of cytokine imbalances, anti-inflammatory and pro-inflammatory. It can also influence the progno-sis of sepsis and other infectious diseases. This study aims to search for 8-hydroxy-2'-deoxyguanosine (8-OHdG), IL-21, IL-23, and c-reactive protein (CRP) and compare cytokine levels. It is also to determine if Pediatric pneumonia patients CRP and cytokine levels correlate with results. Materials and Methods: In the study, blood was drawn from approximately 43 pediatric pneumonia patients and 43 healthy controls who came to the pediatric clinic to investigate serum IL-21, IL-23, 8-OHdG, and CRP levels. The levels of biomarkers were determined by ELISA method. Serum CRP levels were measured using the ATELLICA IM Analyzer. Results: Serum CRP, 8-OHdG, IL-21 and IL-23 levels were significantly higher in the pediatric pneumonia patient group than in the control group. Conclusions: Increased serum IL-21, IL-23, 8-OHdG and CRP expression in pediatric pneumonia patients is a poten-tial determinant suggesting that IL-21, IL-23-related cytokines may play a role in endothelial cell activation reported in patients. Increased 8-OHdG oxidative stress is more pronounced in patients without pediatric pneumonia while pro inflammatory cytokines are higher in pediatric pneumonia patients. However, it is used as a possible therapeu-tic target to reduce inflammation. Further study on the impact of these findings on comorbidities with larger num-ber test size is needed

Hantavirus Pulmonary Syndrome Caused by Puumala Orthohantavirus-A Case Report and Literature Review.

In this article, we report on a rare case of acute respiratory distress syndrome (ARDS) caused by the Puumala orthohantavirus (PUUV), which is typically associated with hemorrhagic fever with renal syndrome (HFRS). This is the first documented case of PUUV-associated ARDS in Southeast Europe. The diagnosis was confirmed by serum RT-PCR and serology and corroborated by phylogenetic analysis and chemokine profiling. The patient was a 23-year-old male from Zagreb, Croatia, who had recently traveled throughout Europe. He presented with fever, headache, abdominal pain, and sudden onset of ARDS. Treatment involved high-flow nasal cannula oxygen therapy and glucocorticoids, which resulted in a full recovery. A systematic literature review identified 10 cases of hantavirus pulmonary syndrome (HPS) caused by PUUV in various European countries and Turkey between 2002 and 2023. The median age of patients was 53 years (range 24-73), and six of the patients were male. Most patients were treated in intensive care units, but none received antiviral therapy targeting PUUV. Eight patients survived hospitalization. The presented case highlights the importance of considering HPS in the differential diagnosis of ARDS, even in areas where HFRS is the dominant form of hantavirus infection.

Optimal timing of delivery for growth restricted fetuses with gastroschisis: A decision analysis.

Our objective was to determine the optimal timing of delivery of growth restricted fetuses with gastroschisis in the setting of normal umbilical artery (UA) Dopplers. We designed a decision analytic model using TreeAge software for a hypothetical cohort of 2000 fetuses with isolated gastroschisis, fetal growth restriction (FGR), and normal UA Dopplers across 34-39weeks of gestation. This model accounted for costs and quality adjusted life years (QALYs) for the pregnant individual and the neonate. Model outcomes included stillbirth, respiratory distress syndrome (RDS), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), short gut syndrome (SGS), neonatal sepsis, neonatal death, and neurodevelopmental disability (NDD). We found 38weeks to be the optimal timing of delivery for minimizing overall perinatal mortality and leading to the highest total QALYs. Compared to 37weeks, delivery at 38weeks resulted in 367.98 more QALYs, 2.22 more cases of stillbirth, 2.41 fewer cases of RDS, 0.02 fewer cases of NEC, 1.65 fewer cases of IVH, 0.5 fewer cases of SGS, 2.04 fewer cases of sepsis, 11.8 fewer neonatal deaths and 3.37 fewer cases of NDD. However, 39weeks were the most cost-effective strategy with a savings of $1,053,471 compared to 38weeks. Monte Carlo analysis demonstrated that 38weeks was the optimal gestational age for delivery 51.70% of the time, 39weeks were optimal 47.40% of the time, and 37weeks was optimal 0.90% of the time. Taking into consideration a range of adverse perinatal outcomes and cost effectiveness, 38-39weeks gestation is ideal for the delivery of fetuses with gastroschisis, FGR, and normal UA Dopplers. However, there are unique details to consider for each case, and the timing of delivery should be individualized using shared multidisciplinary decision making.

Ferroptosis plays a crucial role in lung cell damage caused by ventilation stretch

Mechanical ventilation is an essential respiratory support in acute respiratory distress syndrome and intensive care cases. However, it is possible to cause ventilator-induced lung damage (VILI). In this work, we used a microfluidic device to provide a mechanical ventilation with cyclic stretch (30% total area change rate and 15 cycles per min) and oxygen (air) flux applied by a controlled pressured airflow. Compared to static control, the ventilation stretch resulted in significant death of A549 cells accompanied by increased lipid peroxidation, mitochondrial reactive oxygen species (ROS) production, and ferrous ion accumulation, while by decreased protein expression of solute carrier family 7 member 11 (SLC7A11) and glutathione peroxidase 4 (GPX4) proteins, as well as ratio of reduced-to-oxidized glutathione. The resulted A549 cell death could be alleviated by two ferroptosis inhibitors, deferoxamine and ferrostatin-1. These similar phenomena also occurred in other three types of human lung cells, such as primary alveolar type II epithelial cells, primary alveolar microvascular endothelial cells, and bronchial epithelial cell line. From the A549 RNA sequence analysis, the gene ontology (GO) based on 85 ferroptosis-related genes (FRGs) indicated that several iron homeostasis-related biological processes and molecular functions were involved in the ventilation-stretch-induced cell death, while the gene set enrichment analysis (GSEA) based on 2901 differentially expressed genes (DEGs) showed that glutathione metabolism was significantly suppressed. Finally, solute carrier family 39 member 14 (SLC39A14), a transporter of uptake extracellular divalent metal ion, was selected to be knocked down to verify its role in the ventilation-stretch-induced death of A549. Our results suggest that ferroptosis may be an alternative pathway for VILI, but it needs to be confirmed by further animal experiments and clinical data.

Machine learning-based prediction model of acute kidney injury in patients with acute respiratory distress syndrome

BackgroundAcute kidney injury (AKI) can make cases of acute respiratory distress syndrome (ARDS) more complex, and the combination of the two can significantly worsen the prognosis. Our objective is to utilize machine learning (ML) techniques to construct models that can promptly identify the risk of AKI in ARDS patients.MethodWe obtained data regarding ARDS patients from the Medical Information Mart for Intensive Care III (MIMIC-III) and MIMIC-IV databases. Within the MIMIC-III dataset, we developed 11 ML prediction models. By evaluating various metrics, we visualized the importance of its features using Shapley additive explanations (SHAP). We then created a more concise model using fewer variables, and optimized it using hyperparameter optimization (HPO). The model was validated using the MIMIC-IV dataset.ResultA total of 928 ARDS patients without AKI were included in the analysis from the MIMIC-III dataset, and among them, 179 (19.3%) developed AKI after admission to the intensive care unit (ICU). In the MIMIC-IV dataset, there were 653 ARDS patients included in the analysis, and among them, 237 (36.3%) developed AKI. A total of 43 features were used to build the model. Among all models, eXtreme gradient boosting (XGBoost) performed the best. We used the top 10 features to build a compact model with an area under the curve (AUC) of 0.850, which improved to an AUC of 0.865 after the HPO. In extra validation set, XGBoost_HPO achieved an AUC of 0.854. The accuracy, sensitivity, specificity, positive prediction value (PPV), negative prediction value (NPV), and F1 score of the XGBoost_HPO model on the test set are 0.865, 0.813, 0.877, 0.578, 0.957 and 0.675, respectively. On extra validation set, they are 0.724, 0.789, 0.688, 0.590, 0.851, and 0.675, respectively.ConclusionML algorithms, especially XGBoost, are reliable for predicting AKI in ARDS patients. The compact model maintains excellent predictive ability, and the web-based calculator improves clinical convenience. This provides valuable guidance in identifying AKI in ARDS, leading to improved patient outcomes.

A retrospective study on the role of surfactants in respiratory distress syndrome among neonates admitted in the neonatal intensive care unit at a tertiary care hospital in Western India

ABSTRACT Background and Aims: Respiratory Distress Syndrome (RDS) is one of the leading causative factors of morbidity and mortality in neonates of developing countries. The aim of this study was to evaluate role of Surfactants in RDS with due regard to administration timing, outcome and comparison between two natural surfactants- Survanta (bovine lung extract), and Curosurf (Poractant alfa). Methods: A Retrospective Study was conducted on neonates admitted between 16th May, 2021 to 15th Nov, 2022 (for 18 months duration) at NICU of GMERS Medical College, Gandhinagar. A dataset was created consisting of neonates with final diagnosis of RDS who received Surfactant and outcome was analyzed based on various parameters. Results: Out of 2001 NICU Admissions, 176 (8.79 %) were RDS cases. Out of 176 RDS cases, 131 (74.43 %) were inborn and 45 (25.57 %) were outborn, 96 (54.54 %) were male and 80 (45.46 %) were female cases. Among 176 RDS cases, 92 (54.27 %) cases were treated with Curosurf, and 84 (47.73 %) were treated with Survanta. Out of 128 cases where surfactant administered within first 6 hrs of birth had 106 cases (82.81 %) successfully discharged and 22 (17.19 %) died and out of 48 cases where surfactant is given beyond 48 hrs, 21 (43.75 %) cases were successfully discharged and 27 (56.25 %) cases were expired. Conclusion: Study reveals that RDS cases are invariably related to preterms (161 / 91.5 %) and Low Birth Weight 63 (35.79%) neonates. It has been observed after comparing 112 (63.63 %) successfully discharged and 49 (27.84 %) expired cases that early administration of Surfactant is having a good outcome. Study reveals that there were no significant difference in mortality between Curosurf and Surventa. However, need for repeated doses in Curosurf group is less than Surventa.

Incidence of nosocomial infection and causative microorganism during extracorporeal membrane oxygenation in adult patients, a single center study.

Extracorporeal membrane oxygenation (ECMO) is an organ support whose use is increasing in acute respiratory distress syndrome (ARDS) cases where adequate gas exchange cannot be achieved despite mechanical ventilation. Patients who were followed up on ECMO are at risk for developing nosocomial infections. In this study, we aimed to investigate the incidence of nosocomial infection and define isolated pathogens from microbiological samples in a single center in Turkey. Patients who were followed up on ECMO due to ARDS between January 1, 2018, and December 31, 2021, were included in the study. Nosocomial infections that were diagnosed after the first 48h of ECMO cannulation and after 48h of ECMO decannulation were accepted as ECMO-related infections. A total of 50 patients with ARDS were followed up with ECMO. Mean age of patients was 46,8 ± 15,4 and 38 (78%) patients were male. A total of 30 patients (60%) had at least one nosocomial infection, for a rate of 37.6 per 1000 ECMO days. COVID-19, steroid treatment, and ECMO duration were found to be associated with nosocomial infections in patients who underwent ECMO support. In multivariate analysis, antibiotic use was found to be protective against nosocomial infection (OR:0.14, 95% CI: 0.03 - 0.70, p = .017). In addition, prolonged ECMO duration was associated with an increased risk of nosocomial infection in multivariate analysis (OR:1.13, 95% CI: 1.03 - 1.23, p = .010). Gram-negative pathogens were isolated dominantly in blood cultures and tracheal secretion samples, followed by fungi and Gram-positive bacteria. Patients are prone to nosocomial infections during ECMO. Microorganisms causing nosocomial infections in ECMO patients seem similar to the flora of each center, and this should be taken into account in the choice of empirical antibiotics.

A comparison of 2 doses of antenatal dexamethasone for the prevention of respiratory distress syndrome: an open-label, noninferiority, pragmatic randomized trial

Antenatal corticosteroids have been used for the prevention of respiratory complications, intraventricular hemorrhage, necrotizing enterocolitis, and other adverse neonatal outcomes for over 50 years, with limited evidence about their optimal doses. Higher steroid doses or frequencies of antenatal corticosteroids in preterm newborns pose adverse effects such as prolonged adrenal suppression, negative effects on fetal programming and metabolism, and increased risks of neurodevelopmental and neuropsychological impairments. Conversely, lower doses of antenatal corticosteroids may be an effective alternative to induce fetal lung maturation with less risk to the fetus. Late preterm births represent the largest population of all preterm neonates, with a respiratory distress syndrome risk of 8.83%. Therefore, determining the optimal antenatal corticosteroid dosage is of particular importance for this population. This study aimed to compare the efficacy of 5-mg and 6-mg dexamethasone in preventing neonatal respiratory distress syndrome in women with preterm births at 320 to 366 weeks of gestation. This was an open-label, randomized, controlled, noninferiority trial. Singleton pregnant women (n=370) at 320 to 366 weeks of gestation with spontaneous preterm labor or preterm premature rupture of membranes were enrolled. They were randomly assigned (1:1) to a 5-mg or 6-mg dexamethasone group. Dexamethasone was administered intramuscularly every 12 hours for 4 doses or until delivery. The primary outcome was the reduction in neonatal respiratory distress syndrome cases, whereas the secondary outcomes were any adverse maternal or neonatal events. Between December 2020 and April 2022, 370 eligible women, anticipating deliveries within the gestational range of 32 0/7 to 36 6/7 weeks, willingly participated in the study. They were evenly split, with 185 women assigned to the 5-mg group and 185 to the 6-mg group. The study revealed that the demographic profiles of the participants in the 2 groups were remarkably similar, with no statistically significant disparities (P>.05). It is noteworthy that most of these women gave birth after 34 weeks of gestation. Despite a substantial proportion not completing the full course of steroid treatment, the 5-mg dose exhibited noninferiority compared with the 6-mg dose of dexamethasone, as indicated by a modest proportional difference of 0.5% (95% confidence interval,-2.8 to 43.9). Neonatal respiratory distress syndrome occurred in a relatively low percentage of newborns in both groups, affecting 2.2% in the 5-mg group and 1.6% in the 6-mg group. Notably, the risk difference of 0.6% fell comfortably within the predefined noninferiority threshold of 10%. Our study suggests that a 5-mg dexamethasone dose is noninferior to a standard 6-mg dose in preventing neonatal respiratory distress syndrome in preterm births.

Ultrasound-Guided Popliteal Artery Cannulation: An Alternative for Emergency Arterial Cannulation During Prone Position

ABSTRACT Arterial cannulation is an essential procedure for invasive blood pressure measurement as well as repeated arterial blood gas sampling in intensive care unit setting. Common sites for placing an arterial cannula are the radial artery, femoral artery, brachial artery, and dorsalispedis artery. In certain situations such as in the case of prone ventilation, arterial cannula from common peripheral sites may get accidentally disconnected and it becomes very difficult for even a senior anesthesiologist to place an arterial cannula in the prone position. In those circumstances, an alternate site such as the popliteal artery may serve as a site for arterial cannulation. Therefore, here we present three cases of severe acute respiratory distress syndrome, whose arterial cannula was accidentally dislodged during prone ventilation maneuver and were successfully managed by ultrasound-guided popliteal artery cannulation.

Cholecalciferol as a means of nonspecific immunoprophylaxis against COVID-19

The current direction of scientific research in recent years has been the study of the immunobiological properties of vitamin D. The purpose of this work was to analyze the results of oral administration of cholecalciferol in order to prevent infection with the SARS-CoV-2 virus in the first wave of the COVID-19 pandemic. The study was performed in the period from October 07 to December 29, 2020, when there were no immunobiological drugs for specific prevention of COVID-19. The total number of respondents was 73 people; all had been ill with coronavirus only once. The etiological diagnosis of the disease included molecular genetic testing of samples of two localizations obtained by the conventional method (nasopharynx, oropharynx). The concentration of antibodies to the virus was determined on average 2 months after the disease using a set of reagents SARS-CoV-2-IgG quantitative-ELISA-Best (JSC Vector-Best, Russia). An approximate assessment of IgM concentration was carried out using a set of SARS-CoV-2-IgM-ELISA-Best from the same manufacturer. Among the study participants were those who used immunobiological drugs for the prevention of infection (riamilovir, umifenovir hydrochloride monohydrate, human recombinant interferon alpha-2b, zinc acetate, vitamin C). In particular, 28 people (38.4%) took cholecalciferol (group No. 1) and 45 people (61.6%) did not use this (group No. 2). Statistical processing of the obtained data was performed using the statistical package STATISTICA v.12.5.192.5 (StatSoft, Inc., USA). We applied the analysis of basic statistics, Linear Discriminant Analysis, Kolmogorov–Smirnov test, Chi-Square test, Wald–Wolfowitz Runs Test, Kruskal– Wallis test. Differences in the incidence of respiratory distress syndrome of the two studied groups were revealed: in patients taking cholecalciferol, the syndrome did not develop at all; in group No. 2, it was registered in 20.0% of cases (Chi-Square = 5.242, p = 0.02). In addition, in patients of group No. 1, the concentration of IgG 2 months after the disease was 3.8 times higher than the values in group No. 2 (Chi-Square = 9.268, p = 0.003). Similar differences were found for the IgM level (Wilks' Lambda: 0.659 approx. F (7.32) = 2.367 p &lt; 0.045). It was known that in both groups there were respondents who used other immuno-active substances for preventive purposes. In the first group there were 18 people (24.7% of all); in the second, there were 13 people (17.8% of all). It was found that those who used other immuno-active substances and did not take vitamin D suffered the disease more easily than everyone else. The respondents who did not use any immunoprophylactic agents were the next in terms of the severity of the infection. The respondents who took cholecalciferol mainly assessed the severity of the infection as average. The study participants who took both vitamin D and used other means of prevention suffered the most from COVID-19. Respondents who took cholecalciferol more often than others reported long-term fatigue, exacerbation of chronic and the appearance of new diseases (hypertension, cardialgia, bronchial asthma, allergies, decreased visual acuity), muscle, joint and vertebral pains that appeared for the first time. The phenomenon of arthralgia and other lesions of large joints in COVID-19 was described by us earlier. Studies by other authors also report frequent complaints of increased fatigue and joint pain. At the same time, the role of vitamin D is considered exclusively from the standpoint of vitamin deficiency in a new coronavirus infection and its potential role in inhibiting hyperinflammatory reactions, as well as accelerating the healing process of affected areas, especially in lung tissue. It was found that vitamin D intake did not affect the incidence of fever, the incidence of pneumonia, the volume of lung tissue damage (based on computed tomography data), the duration of hospitalization and the disease as a whole, and also did not prevent the development of anosmia and dysgeusia. The use of vitamin D as a protective agent to prevent infection with the SARS-CoV-2 virus has had an impact on reducing the frequency/ prevention of cases of respiratory distress syndrome during the disease. Also, those who took vitamin D recorded an increase in the formation of IgG to the SARS-CoV-2 virus 2 months after infection 3.8 times higher than the values recorded in respondents who did not take cholecalciferol. The participants who took cholecalciferol suffered the infection more severely, especially if they used any other protective substances. Also, with the preventive intake of vitamin D after COVID-19, increased fatigue persisted longer, the appearance of new and activation of chronic diseases and muscle, joint and vertebral pains that appeared for the first time were reported more often, which correlates with the data we received earlier.

Anti-inflammatory effect of breast milk miR-148a on the state of mucous membranes in premature newborns

Background. Breast milk (BM) is an optimal nutritional product for newborns and a source of exogenous microRNAs (miR). MiR-148a is one of the most highly expressed miR of BM. Currently, there is a lack of data on the miR-148a effect on the development of necrotizing enterocolitis (NEC) in premature newborns. The purpose of the study was to determine the influence of miR-148a of the mother’s BM on the risk of NEC development in preterm newborns. Materials and methods. We examined 74 newborns, who were treated in neonatal departments. We determined the level of miR-148a in the BM of 44 mothers of exclusively breastfed children. In parallel, we evaluated gene expression of the transcription factor T-bet in scrapings of the buccal mucosa of all the newborns. Three groups for comparison were selected: group 1 consisted of 32 newborns up to 37 weeks of gestation on breastfeeding (BF); group 2 — of 30 preterm newborns on artificial feeding; the control group — 12 full-term newborns on BF. Results. The gestational age median of group 1 children was 33 (31; 34) weeks; group 2 — 32.5 (32; 35) weeks; and it was comparatively higher in the control group (p &lt; 0.001) — 40 (39; 41) weeks. Neonatal encephalopathy as the main diagnosis occurred more often among full-term newborns (p &lt; 0.001). Children of groups 1 and 2 did not differ significantly in the frequency of cases of respiratory distress syndrome and neonatal encephalopathy (p &gt; 0.05). In group 2 compared to the first one, manifestations of NEC occurred significantly more often (p &lt; 0.05): 9/30.0 ± 8.4 % vs 3/9.4 ± 5.2 %. We determined that the level of miR-148a expression in the BM of the mothers of premature children on BF was significantly lower (p &lt; 0.001) than in the group of full-term children: 0.089 (0.048; 0.142) c.u. vs 1.0 (1.0; 1.0) c.u. Furthermore, the level of the transcription factor T-bet expression in the cells of the buccal mucosa scrapings was higher in premature children with clinical NEC (p = 0.022): 2.36 (1.94; 3.17) c.u. vs 1.49 (1.0; 3.27) c.u. in children without signs of NEC. We proved the presence of direct positive correlation between the T-bet level and NEC manifestations (r = 0.271; p = 0.021) and determined the inverse correlation between the level of miR-148a expression in the mother’s BM and the level of T-bet expression (r = –0.371; p = 0.043). Conclusions. The miR-148a expression level is relatively lower in the BM of the mothers whose children were born prematurely and have problems with adaptation than in the mothers who gave birth at term. However, in case of NEC development, there is an increase of miR-148a level in the mother’s BM, which contributes to a decrease in the T-bet expression in the mucous membranes of the child and has a protective impact on intestinal walls.

Severe CMV pneumonitis and the resulting ARDS in a 28-year-old pregnant woman: a case report

BackgroundCytomegalovirus (CMV) is a common virus. In pregnant women, CMV infection is usually mildly symptomatic or asymptomatic but can lead to fetal infection. Here we present a rare case of severe CMV pneumonitis and acute respiratory distress syndrome in a healthy immunocompetent pregnant woman.Case presentationA previous healthy 28-year-old woman with spontaneous conception, was admitted to the General University Hospital of Patras at 29 weeks of gestation with a day history of fever, fatigue, pharyngitis, and cough. She was diagnosed with acute CMV infection and CMV pneumonitis. During her hospitalization she developed acute distress syndrome (ARDS). The patient was intubated and underwent emergency caesarean delivery. She was admitted to the intensive care unit and received intravenous ganciclovir. She was discharged at 20th day postpartum in a good clinical condition.ConclusionsThis case highlights the infrequent yet potential complexity of CMV infection in immunocompetent patients and in pregnancy.

Which is more accurate measuring pulmonary artery resistance index or 4D lung volume for prediction of neonatal respiratory distress in preterm pregnancies?

BackgroundNeonatal respiratory distress syndrome (RDS) is a leading cause of neonatal respiratory failure and neonatal mortality. It is frequent in preterm infants, because deficient surfactant needed to keep the airways (alveoli) open to assist infants breathe after birth. Nonetheless, it was also seen in full-term pregnancies. Noninvasive approaches for predicting the development of neonatal respiratory distress (RD) in preterm newborns include comparing the prenatal clinical outcome with the pulmonary artery resistance index (PA-RI) and fetal lung capacity as assessed by the virtual organ computer-aided analysis (VOCAL). Our study aimed to estimate optimal cutoff values and compare measurements of fetal pulmonary artery resistance index (PA-RI) and fetal lung volume (LV) assessed by VOCAL as noninvasive measures to predict neonatal RD development in preterm pregnancies to show which is more accurate.ResultsOut of the examined 147 women who delivered 147 living newborns, 59 of newborn (40.1%) developed neonatal RD. PA-RI has a higher value in 45 (76.27%), while fetal lung volume (FLV) was significantly lower in 43 (72.88%) of neonates who developed RD. Combining both measurements of PA-RI and FLV could predict all cases of RDS 59 (100%). Thirty of RDS neonates had mechanical ventilation and died (50.85%). Cutoff values of PA-RI ≥ 0.75 with 76.27% sensitivity, 82.95% specificity and 81.5% accuracy, whereas a cutoff of FLV ≤ 28 cm3 with sensitivity of 72.88%, specificity of 65.91% and accuracy of 74.8%, for prediction of RDS. Combining both cutoffs generated a more accurate detection 100%, specificity of 65.91% and 66.3% positive predictive value (PPV) and 100% negative predictive value (NPV) and 83% accuracy.ConclusionsBoth PA-RI and FLV are promising noninvasive tools which help in predicting RD fetuses with high sensitivity and specificity. PA-RI is more accurate than FLV cm3 in prediction of neonatal RDS. Combining these parameters increases the predictive value.

A new challenge for the liver in the 21st century

Recently accumulating evidence suggests that if patients have existing diffuse liver disease, the risk of developing serious complications both for the liver itself and for the course of COVID-19 increases significantly. The presented article provides information on the impact of the COVID-19 pandemic on the social aspects of human life, changes in the daily routine, which has a particularly unfavorable course on non-alcoholic fatty liver disease. In turn, a relationship has been found between progressive liver fibrosis in NAFLD patients and the severe course of COVID-19. It is noted that in patients with alcoholic liver disease the incidence of which increases with self-isolation, cases of severe bilateral pneumonia and acute respiratory distress syndrome with unfavorable outcomes, including cardiopulmonary and multiple organ failure, have been described. It is shown that patients with cirrhosis of the liver, especially those with decompensated form, are the most vulnerable group of patients, since immune dysfunction makes them prone to any type of infection, including COVID-19, with potentially serious consequences. It was noted that the risk of detecting liver cancer at later stages increased in about 25% of patients with a biologically aggressive type of disease against the background of the COVID-19 pandemic.