Acute Vascular Complications of VA-ECMO in COVID-19 Patients. Does COVID-19 Affect the Outcome?

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) through the femoral artery and vein can lead to significant vascular complications. We retrospectively studied the acute vascular complications of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) in COVID-19 patients compared to non-COVID patients during the period from January 2020 to July 2023. RESULTS: Seventy-eight patients underwent VA-ECMO for various indications from January 2020 to July 2023. The studied patients had a mean age of 59.6 ± 6.9 years for non-COVID patients (38 patients), and 62.2 ± 7.6 years for COVID patients (40 patients), with a P = 0.268. In non-COVID patients, The baseline characteristics were similar in both groups. The primary indications for ECMO were cardiac diseases, followed by respiratory failure (78.9% vs 10.5%). Conversely, in COVID patients, respiratory failure due to COVID-19 infection was the main indication (45% vs 40%). The overall incidence of general complications, including cerebrovascular stroke, acute kidney injury, intracardiac thrombi, and wound infection, was comparable in both groups (31.6% vs 45%). The overall incidence of vascular complications in both groups was 33.3%. Ipsilateral acute lower limb ischemia occurred in 5.3% vs 10% of non-COVID and COVID patients, respectively. Thrombosis of the distal perfusion catheter (DPC) occurred in 10.5% vs 15%, respectively. CONCLUSION: During the COVID-19 pandemic, an increasing number of patients required VA-ECMO due to associated respiratory failure. Patients undergoing VA-ECMO are at high risk of developing various vascular complications. COVID-19 significantly increases the risk of acute limb ischemia and distal perfusion catheter thrombosis in both upper and lower limbs. However, other VA-ECMO-related vascular complications are comparable between COVID-19 and non-COVID patients.

The outcome of endovenous intervention for acute iliofemoral deep venous thrombosis with and without inferior vena cava filter.

BACKGROUND: Catheter-directed thrombolysis (CDT) for acute iliofemoral deep venous thrombosis (DVT) is an endovenous interventional therapy that can quickly remove the acute thrombus, thereby improving the clinical outcomes of proximal DVT. However, instrumentation of extensive fresh thrombus may be associated with iatrogenic pulmonary embolism (PE). Therefore, we aimed to compare CDT's safety, complications, and perioperative embolic (PE) insults for acute iliofemoral DVT, with and without an IVC filter. METHODS: One hundred twenty patients having acute proximal DVT for less than 14 days and undergoing endovenous therapy were included and presented to the vascular surgery department of Al-Azhar University Hospitals, Egypt. The patients were randomized into two equal groups, Groups A and B, each having 60 patients. Group A was treated with IVC filter insertion, while Group B was treated without a filter. The anticoagulation and CDT procedures were similar between the two groups. RESULTS: The sample included 96 females (80%) and 24 males (20%), with a mean age of 32.6 ± 7.2 years. Clinically no clinical PE occurred in both groups. However, radiologically, new lesions in multislice CT pulmonary angiogram and V/Q scan were noted in two of 60 patients (3.33%) of the IVC filter group, compared with three patients (5 %) in the non-filtered group. CONCLUSION: Endovenous intervention in the form of CDT for acute iliofemoral DVT without an IVC filter is safe and not associated with an increased risk of pulmonary embolization than filter usage. The routine use of IVC filters should not be used mandatorily during CDT.

Genotyping and pathogenicity of fowl adenovirus isolated from broiler chickens in Egypt.

BACKGROUND: Over the past 10 years, inclusion body hepatitis outbreaks, essentially from commercial broiler flocks, have been detected in different geographic regions highlighting the wide distribution of FAdVs around the world resulting in serious economic losses due to increased mortalities as well as poor performance within poultry farms in Assiut province, Egypt. Thus, this study was achieved to detect fowl adenovirus in broiler chicken flocks in Assiut province, Egypt and to recognize the pathogenicity of the isolated virus. RESULTS: The phylogeny of the L1 loop of the hexon gene exposed that the isolated virus clustered and belonged to the reference strains serotype D FAdV. The isolated virus is closely related to inclusion body hepatitis (IBH) strains causing extensive economic losses. The pathogenicity study of the virus showed typical macroscopic lesions with 6% mortality; furthermore, histopathological inspection exhibited severe hepatitis and degenerative changes after 5d from infection in the immune system.  CONCLUSION: Results in this research support the primary pathogenicity and mortality caused by FADV serotype 2 (IBH) alone without immunosuppressive agents thus robust control measures should be implanted against FAdV to evade the serious economic losses in poultry farms.

Physicochemical modification of chitosan with fly ash and tripolyphosphate for removal of reactive red 120 dye: Statistical optimization and mechanism study.

Chitosan (CS) was physically modified with fly ash (FA) powder and subjected to chemical cross-linking reaction with tripolyphosphate (TPP) to produce a cross-linked CS-TPP/FA composite as adsorbent for removal of reactive orange 120 (RR120) dye. Different ratios of FA such as 25% FA particles (CS-TPP/FA-25) and 50% FA particles (CS-TPP/FA-50) were loaded into the molecular structure of CS-TPP. Box-Behnken design (BBD) was applied to optimize the input variables that affected the synthesis of the adsorbent and the adsorption of RR120 dye. These variables included FA loading (A: 0-50%), adsorbent dose (B: 0.04-0.1 g), solution pH (C: 4-10), temperature (D: 30 °C-60 °C), and time (E: 30-90 min). Results revealed that the highest removal (88.8%) of RR120 dye was achieved by CS-TPP/FA-50 at adsorbent dosage of 0.07 g, solution of pH 4, temperature of 45 °C, and time of 60 min. The adsorption equilibrium was described by the Freundlich model, with 165.8 mg/g at 45 °C as the maximum adsorption capacity of CS-TPP/FA-50 for RR120 dye. This work introduces CS-TPP/FA-50 as an ideal composite adsorbent for removal of textile dyes from the aqueous environment.