ABSTRACT
PURPOSE: To study the changes in corneal microstructure and nerve fibers in patients with cornea verticillata in Fabry disease. MATERIAL AND METHODS: The study included patients with a confirmed diagnosis of Fabry disease. All patients underwent standard ophthalmological examination. Corneal confocal microscopy was performed when slit-lamp examination revealed cornea verticillata. RESULTS: Cornea verticillata was found in 64.5% of patients. Corneal microscopy revealed hyperreflective deposits in the basal cell layer of corneal epithelium in all patients with cornea verticillata. Characteristic features were desquamation of epithelial cells with islands of epithelial cells deficiency, as well as hyperreflective intracellular deposits in the basal layer. Changes in keratocytes in the form of perinuclear white microdots were found in the stroma of 25.8% of patients. Endothelial layer was not changed and had normal cell density, reflectivity and morphology in all patients with cornea verticillata. CONCLUSION: Corneal confocal microscopy is a valuable diagnostic tool in patients with Fabry disease and may be important in evaluation of disease progression and monitoring of treatment efficacy.
Subject(s)
Corneal Dystrophies, Hereditary , Epithelium, Corneal , Fabry Disease , Cornea/diagnostic imaging , Fabry Disease/diagnosis , Fabry Disease/diagnostic imaging , Humans , Microscopy, ConfocalABSTRACT
AIM: In a retrospective study, we evaluated factors associated with the early development of septic shock in patients with severe COVID-19. MATERIALS AND METHODS: We collected medical records of the intensive care unit patients submitted by the local COVID-19 hospitals across Russia to the Federal Center for the Critical Care at the Sechenov First Moscow State Medical University (Sechenov University). Septic shock in crticially ill patients requiring mechanical ventilation was defined as a need in vasopressors to maintain blood pressure. RESULTS: We studied 1078 patients with severe COVID-19 who were admitted to the intensive care units for respiratory support. There were 611 males and 467 females. The mean age was 61.013.7 years. Five hundred twenty five medical records (48.7%) were received from the Moscow hospitals, 159 (14.7%) from the Moscow region, and 394 (36.5%) from the hospitals located in 58 regions of the Russian Federation. In 613 (56.9%) patients, diagnosis of SARS-CoV-2 infection was confirmed by PCR, and in the other cases it was established on the basis of the clinical picture and the results of the chest CT scan. Septic shock developed in 214 (19.9%) of 1078 patients. In the logistic regression model, the risk of septic shock in patients older than 50 years was higher than in patients of a younger age (OR 2.34; 95% CI 1.533.67; p0.0001). In patients with more severe SARS-CoV-2 infection, there was an increase in the prevalence of cardiovascular diseases, including coronary heart disease and atrial fibrillation, type 2 diabetes and malignant tumors. The risk of septic shock in patients with three or more concomitant diseases was higher than in patients without any concomitant chronic diseases (OR 1.76; 95% CI 1.762.70). CONCLUSION: The risk of septic shock in patients with acute respiratory distress syndrome induced by SARS-CoV-2 is higher in patients older than 50 years with concomitant diseases, although a severe course of the disease is also possible in younger patients without any concomitant disorders.
