Severe Respiratory Complications Research Articles

Association between COVID-19 severity and tobacco smoking status: a retrospective cohort study using propensity score matching weights analysis

IntroductionThe COVID-19 pandemic continues to be a global threat to public health, with over 766 million confirmed cases and more than 6 million reported deaths. Patients with a smoking history...

Exploring the Antiviral Potential of Esters of Cinnamic Acids with Quercetin

Severe acute respiratory syndrome-related Coronavirus 2 (SARS-CoV-2) has infected more than 762 million people to date and has caused approximately 7 million deaths all around the world, involving more than 187 countries. Although currently available vaccines show high efficacy in preventing severe respiratory complications in infected patients, the high number of mutations in the S proteins of the current variants is responsible for the high level of immune evasion and transmissibility of the virus and the reduced effectiveness of acquired immunity. In this scenario, the development of safe and effective drugs of synthetic or natural origin to suppress viral replication and treat acute forms of COVID-19 remains a valid therapeutic challenge. Given the successful history of flavonoids-based drug discovery, we developed esters of substituted cinnamic acids with quercetin to evaluate their in vitro activity against a broad spectrum of Coronaviruses. Interestingly, two derivatives, the 3,4-methylenedioxy 6 and the ester of acid 7, have proved to be effective in reducing OC43-induced cytopathogenicity, showing interesting EC50s profiles. The ester of synaptic acid 7 in particular, which is not endowed with relevant cytotoxicity under any of the tested conditions, turned out to be active against OC43 and SARS-CoV-2, showing a promising EC50. Therefore, said compound was selected as the lead object of further analysis. When tested in a yield reduction, assay 7 produced a significant dose-dependent reduction in viral titer. However, the compound was not virucidal, as exposure to high concentrations of it did not affect viral infectivity, nor did it affect hCoV-OC43 penetration into pre-treated host cells. Additional studies on the action mechanism have suggested that our derivative may inhibit viral endocytosis by reducing viral attachment to host cells.

Exploratory mass cytometry analysis reveals immunophenotypes of cancer treatment-related pneumonitis.

Anticancer treatments can result in various adverse effects, including infections due to immune suppression/dysregulation and drug-induced toxicity in the lung. One of the major opportunistic infections is Pneumocystis jirovecii pneumonia (PCP), which can cause severe respiratory complications and high mortality rates. Cytotoxic drugs and immune-checkpoint inhibitors (ICIs) can induce interstitial lung diseases (ILDs). Nonetheless, the differentiation of these diseases can be difficult, and the pathogenic mechanisms of such diseases are not yet fully understood. To better comprehend the immunophenotypes, we conducted an exploratory mass cytometry analysis of immune cell subsets in bronchoalveolar lavage fluid from patients with PCP, cytotoxic drug-induced ILD (DI-ILD), and ICI-associated ILD (ICI-ILD) using two panels containing 64 markers. In PCP, we observed an expansion of the CD16+ T cell population, with the highest CD16+ T proportion in a fatal case. In ICI-ILD, we found an increase in CD57+ CD8+ T cells expressing immune checkpoints (TIGIT+ LAG3+ TIM-3+ PD-1+), FCRL5+ B cells, and CCR2+ CCR5+ CD14+ monocytes. These findings uncover the diverse immunophenotypes and possible pathomechanisms of cancer treatment-related pneumonitis.

Exploratory mass cytometry analysis reveals immunophenotypes of cancer treatment-related pneumonitis

Anticancer treatments can result in various adverse effects, including infections due to immune suppression/dysregulation and drug-induced toxicity in the lung. One of the major opportunistic infections is Pneumocystis jirovecii pneumonia (PCP), which can cause severe respiratory complications and high mortality rates. Cytotoxic drugs and immune-checkpoint inhibitors (ICIs) can induce interstitial lung diseases (ILDs). Nonetheless, the differentiation of these diseases can be difficult, and the pathogenic mechanisms of such diseases are not yet fully understood. To better comprehend the immunophenotypes, we conducted an exploratory mass cytometry analysis of immune cell subsets in bronchoalveolar lavage fluid from patients with PCP, cytotoxic drug-induced ILD (DI-ILD), and ICI-associated ILD (ICI-ILD) using two panels containing 64 markers. In PCP, we observed an expansion of the CD16+ T cell population, with the highest CD16+ T proportion in a fatal case. In ICI-ILD, we found an increase in CD57+ CD8+ T cells expressing immune checkpoints (TIGIT+ LAG3+ TIM-3+ PD-1+), FCRL5+ B cells, and CCR2+ CCR5+ CD14+ monocytes. These findings uncover the diverse immunophenotypes and possible pathomechanisms of cancer treatment-related pneumonitis.

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.

PREDICTIVE MODELS FOR ASSESSING RISKS OF POSTOPERATIVE CARDIAC AND RESPIRATORY COMPLICATIONS IN PATIENTS WITH LUNG CANCER

The aim of the study is to identify risk factors for the development of postoperative cardiac and respiratory complications in patients after lobectomy and to develop nomograms to predict such complications.
 Materials and Methods. From January 2020 to August 2023, 411 lobectomies were performed in patients with non-small cell lung cancer in the surgical department of thoracic oncology, Regional Clinical Oncology Dispensary (Ulyanovsk). The present study included 162 patients according to the designed enrolment criteria. The authors identified statistically significant risk factors for the development of severe cardiac and respiratory complications after lobectomy with systematic lymph node dissection.
 Results. Due to insufficient data cardinality, artificial data with a similar distribution were synthesized using the MICE method (multivariate imputation by chained equations). The sample is divided into training (n=1258) and validation (n=342) datasets at a ratio 80 to 20. Final testing of the initial data was carried out (n=162).
 Logistic regression for respiratory complications: respiratory complications = 23.4232 – 0.7427 × stair climbing test – 0.0259 × shuttle walking test. Based on these data, a nomogram was constructed to predict the development of respiratory complications. Error matrix characteristics: accuracy – 0.95; sensitivity – 0.86; specificity – 0.97; positive predictive value – 0.86; negative predictive value – 0.97.
 Logistic regression for cardiac complications: cardiac complications = 11.1147 – 0.1247 × stair climbing test – 0.1651 × ejection fraction + 0.1568 × BMI + 1.133 × hypertension. Based on these data, a nomogram was constructed to predict cardiac complications. Error matrix characteristics: accuracy – 0.91; sensitive-
 ty – 0.63; specificity – 0.98; positive predictive value – 0.9; negative predictive value – 0.92. 
 Conclusions. The developed prognostic models allow us to determine the risk group among patients who are planning a lobectomy for lung cancer at the preoperative stage. It also allows us to ensure high-quality prevention for these complications in patients at high risk.

Effect of Surfactant Therapy on Clinical Outcomes of COVID-19 Patients With ARDS: A Systematic Review and Meta-Analysis.

The COVID-19 pandemic has brought unprecedented challenges, not only in terms of public health but also in the realm of innovative therapeutic approaches to combat the severe respiratory complications associated with the virus. The effect of surfactant therapy on reducing mortality in COVID-19 patients with acute respiratory distress syndrome (ARDS) hasn't been explored before. We conducted a search on PubMed, Scopus, Science Direct, and Clinicaltrials.gov to identify relevant studies, incorporating subject headings and keywords related to "Surfactant Therapy," "COVID-19," and "ARDS." Binary random effects were used to estimate the odds ratio (OR) for 28-day mortality, and continuous random effects were used to estimate the mean difference (MD) for length of hospitalization with their respective 95% confidence interval (CI). Analysis was performed with RevMan Version 5.4.1 (The Cochrane Collaboration, London, GBR). We included four studies with 126 patients. Patients who received surfactant had lower odds of mortality (OR 0.53, 95% CI (0.23, 1.20), p=0.13) and a shorter duration of hospital stay (MD -5.69, 95% CI [-7.06, -4.30], p <0.00001) compared to patients who did not receive surfactant therapy. However, the findings regarding mortality were not statistically significant. The COVID-19 patients with ARDS who received surfactant therapy had lower hospitalization stays and mortality rates, indicating that surfactant therapy may improve clinical outcomes in COVID-19 patients with ARDS. However, the results were not significant, and further research with more prospective studies and randomized clinical trials (RCTs) with larger sample sizes is needed to confirm these findings and assess their practical significance and generalizability.

Caspase-8 activation regulates enterovirus D68 infection-induced inflammatory response and cell death

Enterovirus D68 (EV-D68) infection causes severe acute respiratory infection and severe neurological complications, such as acute flaccid myelitis (AFM), in children. However, although EV-D68 has pandemic potential, no effective drugs or vaccines are currently clinically available. Furthermore, EV-D68 infection-induced inflammatory response and cell death are not fully understood. In this study, we demonstrated that several inflammatory cytokines were upregulated in a multiplicity of infection (MOI) dependent manner in EV-D68-infected human rhabdomyosarcoma (RD) cells. Quantitative reverse transcriptase PCR (qRT-PCR) confirmed that tumor necrosis factor-α (TNF-α), interleukin 6 (IL-6), C-C motif chemokine ligand-5 (CCL-5), and CXC motif chemokine ligand-5 (CXCL-5) mRNA levels were highly upregulated after EV-D68 infection. IL-1β processing and maturation mediated by caspase-8 was inhibited by the caspase-8 inhibitor Z-IETD-FMK. EV-D68 infection activates caspase-8 to mediate IL-1β maturation and secretion. Additionally, EV-D68 activated cell death-related proteins such as caspase-3, poly (ADP-ribose) polymerase 1 (PARP-1), phosphorylation of Mixed Lineage Kinase domain-like protein (pMLKL), and gasdermin E (GSDME). Thus, EV-D68 infection activates caspase-8, which triggers the necroptosis and apoptosis pathways. Overall, our data suggest that caspase-8 activation is associated with the inflammatory response and cell death in EV-D68-infected RD cells. This mechanism represents a novel target for the treatment of EV-D68 infection by inhibiting caspase-8 activation.

Developing lateral-flow devices for the fast and cheap detection of SARS-cov-2 in wastewater: a potential tool to monitoring local virus outbreaks by wastewater based epidemiology

The SARS-CoV-2 virus generates severe respiratory tract complications such as pneumonia and bronchitis and mild symptoms such as common colds or asymptomatic conditions. The SARS-CoV-2 presence in human feces and in treated/untreated wastewater suggests a transmission way that could generate local outbreaks, in addition to other type of diseases or disorders. Based on the above, in this work it was proposed the assembly of a lateral flow device (LFD) to determine the SARS-CoV-2 presence in wastewater samples. In the LFD a wastewater sample capillary flowed through four membranes: sample zone, conjugate delivery zone, reaction zone and the reactive adsorption zone. The virus amplification was achieved by the novel reverse transcription loop-mediated isothermal amplification (RT-LAMP) at the sampling point. The membranes preconditioning processes and the use of membranes with 5-20 nm porous size increased the capillary flow rate and it was promoted the interaction of the gen of SARS-CoV-2 with the capture agents in the reactive adsorption zone. Additionally, the sensibility of the detection was improved using several methods for the immobilization of the capture agents on the reaction zone membrane. The RT-LAMP method combined with the assembled LFD allowed an efficient SARS-CoV-2 detection at the sampling point in a simple way, cheap and fast compared to conventional and expensive RT-PCR.

Patient-Reported Outcomes and Healthcare Practices: A Retrospective Analysis of Cystic Fibrosis Management During the COVID-19 Pandemic

Background: Cystic fibrosis (CF) is one of the most prevalent inherited diseases in children. Coronavirus can lead to more severe respiratory complications in patients with comorbidities, such as CF. Additionally, the coronavirus disease 2019 (COVID-19) pandemic has imposed a substantial burden on both national and international healthcare systems. Coronavirus disease could influence CF patients’ morbidities and mortalities. Methods: A descriptive retrospective study was performed at Mofid Children's Hospital to determine the effect of the COVID-19 pandemic on CF patients. A physician completed 128 valid and reliable questionnaires. Moreover, hospital medical records were also used to revalidate the data and complete the remaining part of the questionnaire. The information collected for this study included demographic data, patients' height, patients' weight, body mass index (BMI), past and current positive history of COVID-19-like symptoms, socially determined condition, and influence of COVID-19 on routine therapeutic measurements in CF. The data were analyzed using SPSS software (version 21). Results: The majority of cases continued to perform chest physiotherapy at home, maintained routine follow-ups with pulmonologists, and adhered to their previous medication regimens (59.4%, 42.2%, and 82%, respectively). Moreover, 65.5% of participants reported leaving home less frequently than before, and approximately 73% of patients’ parents also reduced their outings, with no statistically significant differences (P &gt; 0.05). Conclusions: The daily habits of CF patients did not undergo significant changes during the COVID-19 pandemic, particularly during the Omicron wave, despite the dramatic increase in infection rates.

MIRO study: Do the results of a randomized controlled trial apply in a real population?

BackgroundThe aim of our study was to evaluate the external validity of the MIRO randomized controlled trial findings in a similar nationwide setting “real life” population, especially the benefit of a hybrid approach in esophageal resection for pulmonary complication. The external validity of randomized controlled trial findings to the general population with the same condition remains problematic because of the inherent selection bias and rigid inclusion criteria. MethodsThis study was a cohort study from a National Health Database (Programme de Medicalisation des Systemes d’Informations) between 2010 and 2022. All adult patients operated on using Ivor Lewis resection for esophageal cancer were included. We first validated the detection algorithm of postoperative complications in the health database. Then, we assessed the primary outcome, which was the comparison of postoperative severe pulmonary complications, leak rate, and 30-day mortality between the 2 surgical approaches (hybrid versus open) over a decade. ResultsBetween 2010 and 2012, 162 of 205 patients in the MIRO trial were anonymously identified in the health care database. No difference between randomized controlled trials and healthcare database measurements was found within severe respiratory complications (24% vs 22%, respectively) nor within leak rate (10% vs 9%, respectively). After application of selection criteria according to the MIRO trial, 3,852 patients were included between 2013 and 2022. The hybrid approach was a protective factor against respiratory complications after adjustment for confounding variables (odds ratio = 0.83; 95% confidence interval = 0.71–0.98, P = .025). No significant difference in the 30-day mortality rate or 30-day leakage rate between the types of approach was reported. ConclusionThis national cohort study demonstrates the external validity of the MIRO randomized controlled trial findings in a real-life population within France.

SARS-CoV-2 Omicron Variants Show Attenuated Neurovirulence Compared with the Wild-Type Strain in Elderly Human Brain Spheroids.

Infection with severe acute respiratory syndrome coronavirus 2 Omicron variants still causes neurological complications in elderly individuals. However, whether and how aging brains are affected by Omicron variants in terms of neuroinvasiveness and neurovirulence are unknown. Here, we utilize resected paracarcinoma brain tissue from elderly individuals to generate primary brain spheroids (BSs) for investigating the replication capability of live wild-type (WT) strain and Omicron (BA.1/BA.2), as well as the mechanisms underlying their neurobiological effects. We find that both WT and Omicron BA.1/BA.2 are able to enter BSs but weakly replicate. There is no difference between Omicron BA.1/BA.2 and WT strains in neurotropism in aging BSs. However, Omicron BA.1/BA.2 exhibits ameliorating neurological damage. Transcriptional profiling indicates that Omicron BA.1/BA.2 induces a lower neuroinflammatory response than WT strain in elderly BSs, suggesting a mechanistic explanation for their attenuated neuropathogenicity. Moreover, we find that both Omicron BA.1/BA.2 and WT strain infections disrupt neural network activity associated with neurodegenerative disorders by causing neuron degeneration and amyloid-β deposition in elderly BSs. These results uncover Omicron-specific mechanisms and cellular immune responses associated with severe acute respiratory syndrome coronavirus 2-induced neurological complications.

IBC-Oxford University2023_BJSPoster_12Outcomes of Intra-Gastric Balloon as a first step before bariatric surgery for the treatment of patients with super obesity (BMI&amp;gt;50)

Abstract Introduction The treatment of super obesity, defined as a body mass index (BMI) ≥ 50 Kg/m2, presents several challenges. The best therapeutic strategy is debatable and dependent on each case. The intragastric balloon (IGB) can be used as a "neoadjuvant" therapy before metabolic/bariatric surgery (MBS). The purpose of this study is to evaluate the outcomes and safety profile of the IGB as a first step before MBS for the treatment of super obese patients. Methods Retrospective study of all patients with BMI ≥ 50 Kg/m2 submitted to intragastric balloon placement before MBS between 2009 and 2023. Several variables were analysed including weight loss outcomes, adverse events, and complications of IGB. Therapeutic failure of IGB was defined as %TWL&amp;lt; 5 or early removal of IGB due to adverse events. Results We identified 74 patients with BMI≥ 50 Kg/m2 that were proposed for intragastric balloon placement prior to bariatric surgery, of which 56 (76%) were women, with a mean age of 43,0 ± 11,8 years. The mean initial BMI was 59,4 ± 5.3 Kg/m2. The intragastric balloon remained in the patient for 7,0 ± 1,4 months. The weight loss up to the moment of subsequent bariatric surgery was 22,5 ± 13,2 Kg and the percentage of total weight loss (%TWL) was 14.4 ± 8.4%. The overall rate of complications was 23% (17), the most frequent being nausea and vomiting, of which 50% (8) led to an emergency service visit and 50% (8) to rehospitalization. Regarding serious complications, 3 were identified: 1 gastric perforation and 2 severe respiratory complications, one of which resulted in mortality. Out of the 74 patients, 9 (12%) did not achieve the pre-established %TWL &amp;lt; 5 and 4 (5%) had to remove the intragastric balloon beforehand. Conclusion This study demonstrates that the intragastric balloon is a possible "neoadjuvant" therapeutic strategy in this particularly difficult group of patients, resulting in satisfactory weight loss. However, it has a non-negligible complication rate that should be considered when planning each patient's therapeutic strategy.

Caffeine administration to treat oversedation after general anesthesia: A retrospective analysis

Study objectiveOur institution has adopted an informal practice of administering postoperative caffeine to expedite anesthesia recovery for patients with excessive sedation. This study aimed to determine whether caffeine administration was associated with improved sedation recovery and reduced risk of respiratory complications. DesignSingle-center, retrospective, observational study. SettingQuaternary medical center. PatientsWe included adult patients who were admitted to a postanesthesia recovery care unit (PACU) after general anesthesia and had evidence of postoperative sedation (Richmond Agitation Sedation Score [RASS] < 0). Patients were seen from May 5, 2018, through December 31, 2020. InterventionsPatients were categorized according to caffeine administration (0 vs 250 mg). MeasurementsSedation was measured with RASS. To account for potential confounding, binary and ordinal logistic regression with inverse probability of treatment weighting (IPTW) were used to compare RASS and episodes of severe respiratory complications within 48 h after PACU discharge. Main resultsWe identified 47,222 adult surgical patients with evidence of sedation in the PACU, and of these, 1892 (4.0%) were intravenously administered caffeine. Patients who received caffeine had more sedation in the PACU. In the IPTW-adjusted analysis, caffeine administration was associated with improved sedation scores after PACU discharge (ordinal logistic regression odds ratio [OR], 1.13 [95% CI, 1.00–1.28]; P = .04 for the first RASS score after PACU discharge) but increased risk of respiratory complications (OR, 2.99 [95% CI, 1.44–6.24]; P = .003) and emergency response team activation (OR, 7.18 [95% CI, 2.85–18.10]; P < .001). ConclusionsIn this observational study, caffeine administration during anesthesia recovery was associated with improved sedation scores. However, it was also associated with an increased risk of respiratory complications, possibly reflecting selection bias (ie, administering caffeine to higher-risk patients). Patients with signs of excessive sedation during anesthesia recovery may benefit from enhanced postoperative respiratory monitoring.

The Picornaviridae Family: Knowledge Gaps, Animal Models, Countermeasures, and Prototype Pathogens.

Picornaviruses are nonenveloped particles with a single-stranded RNA genome of positive polarity. This virus family includes poliovirus, hepatitis A virus, rhinoviruses, and Coxsackieviruses. Picornaviruses are common human pathogens, and infection can result in a spectrum of serious illnesses, including acute flaccid myelitis, severe respiratory complications, and hand-foot-mouth disease. Despite research on poliovirus establishing many fundamental principles of RNA virus biology and the first transgenic animal model of disease for infection by a human virus, picornaviruses are understudied. Existing knowledge gaps include, identification of molecules required for virus entry, understanding cellular and humoral immune responses elicited during virus infection, and establishment of immune-competent animal models of virus pathogenesis. Such knowledge is necessary for development of pan-picornavirus countermeasures. Defining enterovirus A71 and D68, human rhinovirus C, and echoviruses 29 as prototype pathogens of this virus family may provide insight into picornavirus biology needed to establish public health strategies necessary for pandemic preparedness.

The nature of kidney damage causing the development of acute renal failure in patients with COVID-19 (according to morphological studies)

The literature review presents data on the study of the nature of kidney damage in patients with COVID-19 with acute renal insufficiency according to histo-morphological lifetime and postmortem studies of the kidneys during the peak of the epidemic of infection in 2020-2022. In the analysis, the role of direct viral damage to tissues and organ cells is questioned. The frequency of diagnosis of glomerular, tubular, interstitial and vascular lesions is specified, the significance of the presence of variants of the apolipoprotein-1 (APOL1) gene in patients with severe respiratory complications of acute viral infection is assessed.

SARS-CoV-2 Detection and COVID-19 Diagnosis: A Bird's Eye View.

The battle against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) associated coronavirus disease 2019 (COVID-19) is continued worldwide by administering firsttime emergency authorized novel mRNA-based and conventional vector-antigen-based antiCOVID-19 vaccines to prevent further transmission of the virus as well as to reduce the severe respiratory complications of the infection in infected individuals. However; the emergence of numerous SARS-CoV-2 variants is of concern, and the identification of certain breakthrough and reinfection cases in vaccinated individuals as well as new cases soaring in some low-to-middle income countries (LMICs) and even in some resource-replete nations have raised concerns that only vaccine jabs would not be sufficient to control and vanquishing the pandemic. Lack of screening for asymptomatic COVID-19-infected subjects and inefficient management of diagnosed COVID-19 infections also pose some concerns and the need to fill the gaps among policies and strategies to reduce the pandemic in hospitals, healthcare services, and the general community. For this purpose, the development and deployment of rapid screening and diagnostic procedures are prerequisites in premises with high infection rates as well as to screen mass unaffected COVID-19 populations. Novel methods of variant identification and genome surveillance studies would be an asset to minimize virus transmission and infection severity. The proposition of this pragmatic review explores current paradigms for the screening of SARS-CoV-2 variants, identification, and diagnosis of COVID-19 infection, and insights into the late-stage development of new methods to better understand virus super spread variants and genome surveillance studies to predict pandemic trajectories.

Open Conversion Abdominal Aortic Endograft in Thoracic Epidural Anesthesia alone in Patient with Severe COPD: A Case Report of Surgery in awake Patient and Review of the Literature

A 79-year-old male was referred, with open abdomen surgical indication, for an asymptomatic iuxtarenal abdominal aortic aneurysm and type I endoleak with distal migration of an endovascular aortic – bisiliac prosthesis, after an endovascular correction done eight years before. This patient has several comorbidities such severe COPD (Stage IV and oxygen dependent), chronic kidney disease (G4 KDIGO CKD classification), systemic arterial hypertension and severe peripheral vasculopathy. Spirometry gives a picture of severe obstruction: FVC 2,44 L (68%), FEV1 0,68 L (25%), TLC 7.72 L (118%), RV 4,88 L (181%). 3 L/min oxygen arterial blood gas was: pH 7,34, PaO2 74,9 mmHg, PaCO2 51,2 mmHg, HCO3- 24,3 mEq/L, BE – 0,2, SpO2 94,2%. Cardiological consultation did not found any problem (normal ejection fraction, no valvular pathologies, and no pulmonary hypertension). Vascular echography highlighted an aortic aneurysm, confirmed by computed tomography angiography: iuxtarenal abdominal aortic aneurysm of 68 mm × 72 mm extended for 70 mm (Figure 1). According to the European Society of Anesthesiologists guidelines [1,2], general anesthesia is not safe, because of the elevated perioperative risks of severe respiratory complications. After a collegial respiratory risk evaluation, we have decided for an awake surgery with an epidural anesthesia. Operative risks were assessed with the patient who accepted intervention.

Rate of occurrence of respiratory complications in patients who undergo shoulder arthroplasty with a continuous interscalene brachial plexus block and associated risk factors

IntroductionContinuous interscalene nerve block techniques are an effective form of targeted non-opioid postoperative analgesia for shoulder arthroplasty patients. One of the limiting risks, however, is potential phrenic nerve blockade with...

Modern methods of diagnosis and treatment of patients with COVID and post-COVID anosmia

Since 2019, the interest in coronavirus infection has increased worldwide due to the emergence of several pandemic outbreaks associated with this group of pathogens. In total, 3 outbreaks of pandemics were registered in the 21st century, caused by new strains of coronaviruses: MERS-CoV, SARS-CoV and SARS-CoV-2. Among them the leader in prevalence, occurrence of severe respiratory complications and mortality is SARS-CoV-2. SARS-CoV-2 is the causative agent of the coronavirus disease of 2019. COVID-19 is a disease characterized by acute respiratory viral syndrome, transmitted by airborne droplets. The clinical course of COVID-19 varies significantly from patient to patient and can range from asymptomatic to severe forms. One of the common symptoms of the manifestation of COVID-19 is a smell disorder. The pathogenesis and clinical course of coronavirus infection caused by SARS-CoV-2 were examined to identify the causes leading to olfactory disorders in the manuscript. The analysis of existing methods for the diagnosis of olfactory disorders and their treatment was also carried out. The content of the article includes current hypotheses of the pathogenesis of viral anosmia in COVID-19 and a new look at the relevance of this problem among the population around the world. The article analyzes scientific data on the problem of anosmia in coronavirus infection caused by SARS-CoV-2, investigates modern diagnostic methods, highlights the principles of treatment of patients with post-COVID anosmia and presents prospects for further research on this problem.