Acute Kidney Injury and Chronic Kidney Disease and Their Impacts on Prognosis among Patients with Severe COVID-19 Pneumonia: An Expert Center Case-Cohort Study.

Background: Acute kidney injury (AKI) is associated with substantial mortality. In this case-control study, we analyzed the impacts of AKI and chronic kidney disease (CKD) on outcomes in a group of 323 patients with severe COVID-19. The correlation of clinical and laboratory data with AKI and CKD was also analyzed. Methods: A retrospective case-control study was conducted among AKI, CKD, and normal kidney function (NKF) groups hospitalized in a COVID-19 center in 2021. Results: AKI patients had higher in-hospital mortality (55.2 vs. 18.8%, p < 0.001), more frequent transfers from the HDU to ICU (57.5 vs. 12.9%, p < 0.001), and prolonged hospital stays (15.4 ± 10.7 vs. 10.7 ± 6.7 days, p < 0.001) compared to the NKF group. AKI was a predictor of death (OR 4.794, 95%CI: 2.906-7.906, p < 0.001). AKI patients also had broader lung parenchymal involvement and higher inflammatory markers compared to the NKF group. Patients with prior CKD had higher in-hospital mortality compared to the NKF group (64.0 vs. 18.8%, p < 0.001, OR 4.044, 95%CI: 1.723-9.490, p = 0.013); however, transfers from the HDU to ICU were not more frequent (16.0 vs. 12.9%, p = 0.753). Conclusions: AKI among COVID-19 patients was correlated with more ICU transfers, higher morbidity, and greater markers of severe disease. Patients with CKD had a higher mortality; however, the rate of ICU transfer was not substantially higher due to their poor prognosis.

Effect of Respiratory Failure on Peripheral and Organ Perfusion Markers in Severe COVID-19: A Prospective Cohort Study.

Microvascular dysfunction and inflammation caused by COVID-19 disrupt organ function. The study aimed to investigate the association between the severity of SARS-CoV-2 pneumonia and peripheral and organ perfusion as a consequence of altered microcirculation. A total of 116 patients hospitalized due to severe COVID-19 were enrolled in the study. On admission, the patients underwent a Capillary Refill Time (CRT) examination, finger oxygen saturation measurement, thermal imaging of the hand (FIT), and a kidney Doppler ultrasound. Medical data were collected from the medical history. From the evaluated perfusion parameters, only renal cortex perfusion (RCP) was substantially correlated with the CT score (p < 0.010). The peripheral perfusion parameters of Sat., FIT, CRT, and RCP correlated with the ARDS stages (p = 0.0021; p = 0.038; p < 0.0006; p < 0.0002, respectively). The Oxygenation Ratio value (p < 0.001) was significantly associated with all the perfusion parameters (saturation, CRT, FIT, and RCP) in the multivariable regression analysis model. According to the stepwise retrograde regression analysis, RCP was an independent parameter linked with the Oxygenation Ratio (p < 0.001). Severe COVID-19 can result in microvascular dysfunction influencing peripheral and organ perfusion, which can be measured with various methods. The staging of COVID-19 assessed by CT and the Oxygenation Ratio correlates with RCP, CRT, FIT, and oxygen saturation.

Factors related to opioid misuse among patients undergoing elective surgery in Poland.

In many countries, the consumption of illicit opioids is rising, becoming a major public health issue called the "opioid crisis". Many reasons contribute to this phenomenon. One of them is opioid misuse, defined as the use of legally prescribed opioids for a purpose different than pain treatment. This matter has not been well studied in Poland, where the opioid crisis has not been identified so far. This study was conducted among patients admitted for elective surgery with opioid-based postoperative pain treatment. The frequency of opioid misuse was found to be 10.8% in a sample comprising 92 patients. The group of individuals with potential opioid use disorder had a more frequent history of inadequately controlled postoperative pain compared to the group of non-misusers (p = 0.023). Furthermore, this group asked to receive additional pain treatment almost six times more often than the control group (p < 0.000). Also, patients declaring opioid misuse reported substantial differences concerning their knowledge and opinions about pain treatment and opioid analgesics: supporting the administration of opioids for pain when needed, finding opioids less harmful, and supporting messages that opioids are safe, effective, well-tolerated, easy to cutoff more often than control. There is an urgent need for the education of patients to avoid the spreading of the opioid crisis.

ICU Delirium Is Associated with Cardiovascular Burden and Higher Mortality in Patients with Severe COVID-19 Pneumonia.

BACKGROUND: COVID-19 can lead to functional disorders and complications, e.g., pulmonary, thromboembolic, and neurological. The neuro-invasive potential of SARS-CoV-2 may result in acute brain malfunction, which manifests as delirium as a symptom. Delirium is a risk factor for death among patients hospitalized due to critical illness. Taking the above into consideration, the authors investigated risk factors for delirium in COVID-19 patients and its influence on outcomes. METHODS: A total of 335 patients hospitalized due to severe forms of COVID-19 were enrolled in the study. Data were collected from medical charts. RESULTS: Delirium occurred among 21.5% of patients. In the delirium group, mortality was significantly higher compared to non-delirium patients (59.7% vs. 28.5%; p < 0.001). Delirium increased the risk of death, with an OR of 3.71 (95% CI 2.16-6.89; p < 0.001). Age, chronic atrial fibrillation, elevated INR, urea, and procalcitonin, as well as decreased phosphates, appeared to be the independent risk factors for delirium occurrence. CONCLUSIONS: Delirium occurrence in patients with severe COVID-19 significantly increases the risk of death and is associated with a cardiovascular burden. Hypophosphatemia is a promising reversible factor to reduce mortality in this group of patients. However, larger studies are essential in this area.

Ultrasound Doppler Flow Parameters Are Independently Associated with Renal Cortex Contrast-Enhanced Multidetector Computed Tomography Perfusion and Kidney Function.

BACKGROUND: The assessment of kidney perfusion has an emerging significance in many diagnostic applications. However, whether and which of the ultrasound Doppler parameters better express renal cortical perfusion (RCP) was not shown. The study aimed to prove the usefulness of Doppler ultrasound parameters in the assessment of RCP regarding low-dose contrast-enhanced multidetector computer tomography (CE-MDCT) blood flow. METHODS: Thirty non-stenotic kidneys in twenty-five hypertensive patients (age 58.9 ± 19.0) with mild-to-severe renal dysfunction were included in the study. Resistive index (RI) and end-diastolic velocity (EDV) in segmental arteries, color Doppler dynamic RCP intensity (dRCP), RI (dRI), pulsatility index (dPI), and CE-MDCT blood flow (CBF) in the renal cortex were estimated. RESULTS: CBF correlated significantly with age, estimated glomerular filtration rate (eGFR), RI, EDV, dRI, dPI, and dRCP. In separate multivariable backward regression analyses, RI (R2 = 0.290, p = 0.003) and dRCP (R2 = 0.320, p = 0.001) were independently associated with CBF. However, in the common ultrasound model, only dRCP was independently related to CBF (R2 = 0.317, p = 0.001). Only CBF and EDV were independently associated with eGFR (R2 = 0.510, p < 0.001). CONCLUSIONS: Renal cortical perfusion intensity is the best ultrasound marker expressing renal cortical perfusion. In patients with hypertension and kidney dysfunction, renal resistive index and end-diastolic velocity express renal cortical perfusion and kidney function, respectively.

Femoral and Lateral Femoral Cutaneous Nerve Block as Anesthesia for High-Risk Intertrochanteric Fracture Repair Patients.

Introduction. Intertrochanteric fracture (IF) is a common injury among the elderly. Due to significant comorbidities, anesthesia for IF repair may be challenging. The authors propose femoral nerve block together with a lateral femoral cutaneous nerve block and sedation as an anesthetic technique for most severe cases of IF with contraindications to spinal anesthesia. Methods. In total, 61 patients were enrolled prospectively in a study, 19 received general anesthesia (GA group), 22 spinal anesthesia (SA group), and 20 nerve blocks with sedation (PNB group). Results. Groups were comparable in terms of age, gender, independence, and several comorbidities: diabetes, obesity, underweight, cardiovascular, and cerebrovascular incidents in the past, dementia, chronic obstructive pulmonary disease, and frailty. Heart failure (p = 0.033), hemoglobin < 10 g/dL (p = 0.001) and eGFR < 30 mL/min (p = 0.039) were more frequent in PNB group. PNB group had higher American Society of Anesthesiologists (ASA) (p < 0.001), Nottingham Hip Fracture Score (NHFS) (p < 0.001), and Charlson Comorbidity Index (CCI) (p = 0.002) scales scores, and lower probability of 10-year survival according to CCI (p = 0.012). GA group had more frequent active malignancy (p = 0.041). GA and PNB groups had a higher frequency of hemostasis disorder (p < 0.001). Surgery was completed under the scheduled anesthesia technique. Survival, frequency of cardio and cerebrovascular incidents after surgery, loss of independence, and postoperative delirium were comparable between groups, as well as the length of postoperative stay. Conclusions. Surgical repair of intertrochanteric fracture with intramedullary nailing system among elderly, frail, and sick patients can be conducted under peripheral nerve block. FNB and LFCNB in the combination is a viable option for IT fracture repair.

Analysis of the Relationship among Cognitive Impairment, Nutritional Indexes and the Clinical Course among COVID-19 Patients Discharged from Hospital-Preliminary Report.

Numerous data indicate the presence of cognitive impairment in people who have undergone COVID-19, often called COVID Fog (CF). This phenomenon persists even 6 months after infection, and its etiology and pathogenesis are not fully known. The aim of this article was to analyze the relationship among cognitive functioning, clinical data and nutrition indexes in patients discharged from the COVID-19 hospital of the Military Institute of Medicine, Warsaw, Poland. The sample comprised 17 individuals-10 women and 7 men, with ages of 65 ± 14 years. Cognitive impairment was measured with the use of the Montreal Cognitive Assessment (MoCA). The nutrition parameters included: hemoglobin, red blood cells, total cholesterol and its fractions, triglycerides, total protein, albumin, urea, creatinine, phosphates, calcium and sodium. The analysis showed that albumin concentration significantly correlated with the total MoCA score and especially with the short-term memory test score. Conversely, total cholesterol, and especially LDL concentrations, were highly and negatively associated with the MoCA score. In conclusion: markers of nutritional status are correlated with the severity of CF. Individuals with malnutrition or risk of malnutrition should be screened for CF. Further studies need to be performed in this area.

COVID-19 Pandemic-Related Depression and Insomnia among Psychiatric Patients and the General Population.

BACKGROUND: The COVID-19 pandemic and limited access to healthcare professionals pose a serious risk of worsening mental conditions. This study was designed to examine the changes in symptoms of insomnia and depression during the pandemic as compared to before the pandemic, as well as the factors correlated with abovementioned mental state deterioration. METHODS: The study was conducted from 1 April to 15 May 2020, on 212 psychiatric outpatients and 207 healthy controls. Participants completed a survey focused on symptoms during and prior to COVID-19 (the Beck Depression Inventory, the Athens Insomnia Scale). The following correlations were analyzed: demographics, social support, work status, income, and possible participants' and their relatives' COVID-19 diagnoses. RESULTS: Insomnia and depression severity intensified during the pandemic in both groups and were associated with age, gender, education, employment, and financial status. No correlations between social support nor becoming sick with COVID-19 and insomnia or depression were observed. Maintaining work and enough money for one's own needs were found to be significant protective factors of depression (OR 0.37 and 0.29, respectively). CONCLUSIONS: Exacerbation of insomnia and depression during the pandemic needs to be addressed. Economic crisis seems to influence mental state even more than COVID diagnosis among study subjects/relatives.

COVID-19 Pandemic Influence on Healthcare Professionals.

During the pandemic, many healthcare professionals (HCPs) are overburdened by work and stress. The aim of the study was to examine alcohol intake, sleep disorders, and depressive symptoms of HCPs during the pandemic in comparison with the pre-pandemic period. Another goal was to indicate risk factors for mental state deterioration and an increase in alcohol use. A cross-sectional survey study was conducted from 1 April to 15 May 2020. HCPs (n = 158) completed questionnaires that probed for symptoms during and prior to the pandemic, including the Beck depression inventory (BDI), Social Support Scale (MOS-SSS), Athens insomnia scale (AIS), and Alcohol Timeline Followback (TLFB) calendar of alcohol consumption. Gender, age, education, marital status, work situation, income, participants' and relatives' COVID-19 diagnosis as correlates were analyzed. Depressive symptoms and insomnia became more severe during the pandemic among HCPs, while social support increased. The increase in depressive symptoms was even higher among women (OR 2.78, 95% CI 1.05-7.36; p = 0.04) and was also positively correlated with work reduction (p = 0.02); the presence of sleep disorders was correlated with female gender. Alcohol consumption increased during the pandemic, and was correlated with both more time spent at work and income increase. HCPs involved in the treatment of COVID-19 need support and attention due to the excessive stress load during pandemics, resulting in depression, insomnia, and increased alcohol intake.

COMT and BDNF Gene Variants Help to Predict Alcohol Consumption in Alcohol-dependent Patients.

BACKGROUND: The neurobiology of alcohol dependence (AD) involves alterations in neurotransmitters and the stress response. We hypothesized that an interaction between functional variants of dopaminergic and neurotrophic genes may influence drinking in AD. METHODS: The relationship between alcohol consumption and single-nucleotide polymorphisms, Val66Met in the brain-derived neurotrophic factor (BDNF), and Val158Met in the catechol-O-methyltransferase (COMT), was analyzed among 281 alcohol-dependent individuals. RESULTS: Individuals carrying both the COMT Met158Met genotype and the BDNF Val66Val genotype drank more than those with other variants of these genes (P = 0.039). Those who had a family history of AD also drank more than those without a family history (P = 0.048). Patients with both Met/Met genotype in the COMT Val158Met polymorphism and Val/Val genotype in the BDNF Val66Met polymorphism suffered from more health problems than those carrying other variants (P = 0.030) and had lower motivation to change drinking patterns (P = 0.031). CONCLUSIONS: Patients carrying both the BDNF Val66Val and COMT Met158Met variants had higher alcohol consumption. These effects may be influenced by the effects of BDNF and COMT on dopamine responses to alcohol. Motivation-enhancing strategies might benefit the group of patients identified by genotyping in this study, and also treatment aimed at reducing alcohol consumption.

[Comorbidity of alcohol dependence with other psychiatric disorders. Part I. Epidemiology of dual diagnosis]. / Wspólwystepowanie uzaleznienia od alkoholu z innymi zaburzeniami psychicznymi. Czesc I. Epidemiologia podwójnego rozpoznania.

The paper is a review of the literature on the comorbidity of alcohol dependence with other psychiatric disorders. A condition when alcohol dependence is accompanied by another mental disorder is much more common than it is commonly believed. It is estimated that more than one third of people diagnosed with mental disorders, abuses or is dependent on psychoactive substances, especially alcohol; among alcohol-dependent patients 37% suffer from other mental disorders. Alcohol dependence is associated with increased risk of mood disorders - more than three times higher, depression - almost four times higher, bipolar disorder - more than six times higher, anxiety disorders in general - more than twice, generalized anxiety disorder - more than four times higher, panic disorders - almost double, posttraumatic stress disorder - more than twice. Underestimating of comorbidity is an important problem during treatment of such population of patients. Social skills training can improve a stress management and decrease alcohol and drug use among dual diagnosed patients.

[Comorbidity of alcohol dependence with other psychiatric disorders. Part II. Pathogenesis and treatment]. / Wspólwystepowanie uzaleznienia od alkoholu z innymi zaburzeniami psychicznymi. Czesc II. Patogeneza i leczenie.

Co-occurrence of alcohol dependence with other mental disorders is very common, being important cause of diagnostic and therapeutic difficulties. There is a lack of systemic solutions in mental health care dedicated to the patients with dual diagnosis. The literature on the topic of treatment of patients with dual diagnosis is limited. While comorbidity of alcohol dependence with mental disorders is prevalent, there is rising interest among researchers on that issue. In this paper we present current hypotheses on pathogenesis of dual diagnosis as well as recommendations for its treatment. The role of disturbances in functioning of hypothalamic-pituitary-adrenal axis in pathogenesis of co-occurrence of alcohol dependence with anxiety and affective disorders is presented. Researchers studying dual diagnosis underline the fact that simultaneous treatment of alcohol dependence and co-occurring psychiatric disorders increases the chance to improve patients` functioning. Inappropriate treatment without complete management of all existing problems may make full recovery impossible.

Violent behavior and driving under the influence of alcohol: prevalence and association with impulsivity among individuals in treatment for alcohol dependence in Poland.

BACKGROUND: Driving while intoxicated or under the influence (DUI; for the purposes of this paper, we use the following terms synonymously: driving under the influence, driving while intoxicated, and drunk driving) and engaging in interpersonal violence are two injury-related problems of high public health importance that have both been linked to alcohol consumption. This study sought to estimate the prevalence of DUI and violence in a sample of individuals in treatment for alcohol dependence in Poland. Patient characteristics associated with DUI and violence involvement, with a particular focus on impulsivity, were examined. METHODS: Three hundred and sixty-four patients consecutively admitted to four alcohol treatment programs in Warsaw, Poland participated in this study. Questions concerning history of interpersonal violence as well as those about DUI were derived from the Michigan Alcoholism Screening Test. Impulsivity level was measured using the Barratt Impulsiveness Scale 11, the Revised NEO Personality Inventory, and the stop-signal task. RESULTS: Among all participants in the study, 148 (40.1%) had been arrested in the past for DUI, and 196 (55%) reported involvement in a fight under the influence of alcohol (FUI). The DUI group had a significantly earlier onset of alcohol problems, a longer period of heavy alcohol use, and fewer women in comparison to participants without a DUI history. FUI patients were significantly younger, with a younger average age of onset of drinking problems, longer period of heavy drinking, and lower percentage of women than the non-FUI group. CONCLUSION: Both of the self-reported measures of impulsivity indicated a higher level of impulsivity among participants from the FUI group than those from the non-FUI group.

Mast cells and histamine: do they influence placental vascular network and development in preeclampsia?

UNLABELLED: The physiological course of pregnancy is closely related to adequate development of the placenta. Shallow invasion of trophoblast as well as decreased development of the placental vascular network are both common features of preeclampsia. To better understand the proangiogenic features of mast cells, in this study we aim to identify the potential relationship between the distribution of mast cells within the placenta and vascular network development. MATERIAL AND METHODS: Placentas from preeclampsia-complicated pregnancies (n = 11) and from physiological pregnancies (n = 11) were acquired after cesarean section. The concentration of histamine was measured, and immunohistochemical staining for mast cell tryptase was performed. Morphometric analysis was then performed. RESULTS: We noticed significant differences between the examined groups. Notably, in the preeclampsia group compared to the control group, we observed a higher mean histamine concentration, higher mast cell density (MCD), lower mean mast cell (MMCA) and lower vascular/extravascular (V/EVT) index. In physiological pregnancies, a positive correlation was observed between the histamine concentration and V/VEVT index as well as MCD and the V/VEVT index. In contrast, a negative correlation was observed between MMCA and the V/EVT index in physiological pregnancies. CONCLUSIONS: Based on the data from our study, we suggest that a differential distribution of mast cells and corresponding changes in the concentration of histamine are involved in the defective placental vascularization seen in preeclamptic placentas.

Angiotensin II (Ang II) evoked secretion of the human placental lactogen (HPL) in intrauterine growth retardation: examination of the relationship with Ang II receptor type 1 (AT1) expression.

Angiotensin II (Ang II) and its hemodynamic effects on placental vasculature mediated via Ang II receptor type 1 (AT1) may play significant role in intrauterine growth retardation (IUGR). Placental lactogen (HPL) production directly reflects placental function. We compared influence of Ang II on HPL production in normal and IUGR-complicated pregnancies and correlated this phenomenon with AT1 expression. Basal and Ang II-evoked HPL secretion was examined in perfused placental lobules using ELISA. After immunostaining of placental sections, AT1 expression was estimated using quantitative morphometry. Ang II increased HPL secretion. Ang II-evoked increase in HPL concentration in the perfusion fluid was 27.36+/-6.4 (%, +/-SEM) lower in IUGR (p<0.05) compared to normal-course pregnancies. AT1 expression was significantly decreased in IUGR and was 78.12+/-8.2 (%, +/-SEM) of the mean value of controls. Demonstrating that Ang II-evoked secretion of HPL in preeclampsia-free IUGR is decreased and correlates with down-regulated expression of AT1, we present a new approach to the pathophysiology of IUGR.

[Continuous renal replacement therapy in children with acute renal failure--5 years of experience]. / Zastosowanie ciaglych metod leczenia nerkozastepczego u dzieci z ostra niewydolnoscia nerek--5 lat doswiadczen.

Continuous renal replacement therapy (CRRT) has became a modality of choice in chidren with acute renal failure (ARF), especially in cases of multiorgan failure (MOF) and in hemodynamically unstable patients in whom regular hemodialysis is difficult to reform. Newborns and infants with contraindications to peritoneal dialysis are another group of patients treated with CRRT. Retrospective analysis of CRRT therapy in 112 patients treated with (CVVHD, CVVH, CVVHDF, SCUF-continuous veno-venous hemodialysis/hemofiltration/ hemodiafiltration/ultrafiltration) between 2000-2005 is presented. Indication to CRRT was MOF (n=23, 20%), complications post-liver transplant (n=33, 29%), congenital metabolic defects (n=5, 4.5%), complications of cancer or chemotherapy (n=11, 9.8%) and other causes of ARF (n=40, 36.7%). Overall mortality was 36.6%. The highest rate was seen in children between 0-2 years of age (52,3%) and in patients with congenital metabolic diseases (80%). When adjusted to specific modality--the highest mortality was seen in patients treated with CVVHF (55.4%), while lower was in cases treated with CVVHD (37.8%) and CVVHDF (35.4%). Among older children higher mortality was seen in patients with mean arterial pressure (MAP) <70 mmHg (68.4%), compared to patients with MAP >70 mmHg (23.1%).

[Mast cells, histamine and development of the placental vascular network in pregnancies complicated by preeclampsia and intrauterine growth retardation]. / Komórki tuczne. i histamina a rozwój sieci naczyniowej lozyska w ciazach powiklanych stanem przedrzucawkowym i wewnatrzmacicznym zahamowaniem wzrostu plodu.

UNLABELLED: Importance of angiogenesis in proper development of placenta is unquestioned. Abnormalities in vascular development are typical for complications of pregnancy: intrauterine growth retardation (IUGR) and preeclampsia (PE). As mast cells are involved in new vessels sprouting and development we tried to disclose if they can be involved in etiology or pathogenesis of IUGR and/or PE. MATERIAL AND METHODS: Placentas from PE-complicated pregnancies (n=11), IUGR-complicated pregnancies (n=10), and from healthy women--controls (n=13) were obtained after cesarean sections. Histamine concentration was measured and immunohistochemical staining for mast cell tryptase was performed. Microscopic slides of placental tissue were analyzed with morphometric software. RESULTS: We disclosed increased histamine concentration in PE group--227.3 +/- 17.7 (in ng of histamine per 1 g of tissue) and decreased concentration in IUGR group 114.3 +/- 13.5 vs control--178.1+/- 18.9. Histamine concentration corresponded with density of mast cells in examined groups: PE group--8.32 cells/mm2 +/- 1.3, IUGR--3.07 +/- 1.05 and control--5.14 +/- 1.2. The mean area of mast cells identified in PE as well as in IUGR group was smaller than the mean area of mast cells in controls. V/EVT index was decreased in PE and IUGR group in comparison to controls, respectively: 0.15 +/- 0.018; 0.12 +/- 0.014; 0.23 +/- 0.029. CONCLUSIONS: We suggest that differences in mast cells density and corresponding differences in histamine concentration are associated with pathogenesis of PE and IUGR or are consequence of primary cause.