Cytokine Release Syndrome (CRS) in Severe COVID-19 Patients: Two Controversial and Interesting Case Reports and Literature Review.

Background: Cytokine release syndrome (CRS) represents a potentially life-threatening and systematic inflammatory response where it is noted an increase of secretion of proinflammatory cytokines from lymphocytes, myeloid cells like macrophages, dendritic cells, and monocytes. This syndrome is characteristic of some conditions such as viral infections, administration of antibody-based therapy, auto immune disease, and immunotherapy, especially in severe COVID-19 patients. Case reports: We presented two cases of COVID-19 patients in which the clinical picture significantly deteriorated during hospitalization, where the value of CRP, ferritin, LDH, and IL-6 dramatically increased, especially values of IL-6 were recorded over 2000. We treated them with third-generation cephalosporins, carbapenems, glycopeptides, metronidazole, anti-IL-6 inhibitor, low molecular weight heparin (LMWH), glucocorticoids, immunoglobulins (IVIG), and vitamins. Both patients were successfully treated and were discharged from the hospital with a recommendation for oral anticoagulant therapy. Conclusion: CRS is a complex syndrome. In the future, it is necessary to educate doctors about this syndrome, as well as to develop drugs whose goal would be to reduce the inflammatory response in already developed diseases.

Lung and diaphragm ultrasound in noninvasive respiratory support: A real tool or fashion?

Introduction: Over the past few years, there has been an increase in lung and diaphragm ultrasound applications as a tool to evaluate the outcomes and settings of noninvasive respiratory supports. However, actual clinical practices in this field are yet to be known. The aim of this study was to investigate the current clinical utilization of ultrasound for noninvasive respiratory supports on an international level. Materials and Methods: The study employed an online survey consisting of 32 items, which was sent via email to intensivists, pulmonologists, emergency medicine physicians, and other specialists with expertise in using ultrasound and/or noninvasive respiratory supports. Result: We collected 52 questionnaires. The ultrasound study of diaphragm dysfunction was well-known by the majority of respondents (57.7%). Diaphragm performance was used as a weaning failure predictor (48.5%), as a predictor of noninvasive ventilation failure (38.5%) and as a tool for the ventilator settings adjustment (30.8%). In patients with acute respiratory failure, 48.1% used ultrasound to assess the damaged lung area to set up ventilatory parameters, 34.6% to monitor it after noninvasive ventilation application, and 32.7% to match it with the ventilatory settings for adjustment purposes. When administering high flow nasal cannula - oxygen therapy, 42.3% of participants used ultrasound to evaluate lung involvement and assess flow parameters. Conclusions: Lung and diaphragm ultrasound is an established clinical practice to evaluate noninvasive respiratory supports outcomes and settings. Further studies are needed to evaluate the educational aspects to increase confidence and indications for its use.

Validation of online version of asthma control questionnaire in pediatric patients.

Introduction: The Asthma Control Questionnaire (ACQ) is a seven-item questionnaire assessing symptoms that asthma clinicians consider to be most important for evaluating the adequacy of asthma control. An online version of the ACQ may be able to indicate whether a visit to the physician is warranted to modify therapy to achieve better control of their asthma, ultimately reducing the number of unnecessary visits, particularly during the pandemic. The aim of our study is to compare the paper and online ACQ to validate the online version for use in real-life settings.Methods: Our study included 28 patients who completed both paper and the online ACQ on the same day when they came home. The online version of the questionnaire was prepared to look similar to the paper form, with the same sentences and answers.Results: The correlation between paper and online ACQ questionnaires was very high (r = 0.935; p < 0.001). When comparing each individual item, correlation coefficients ranged from 0.672 to 0.935. The lowest correlation is obtained in activity limitations, while the next one is 0.767, others higher than 0.8. The online form gave small and insignificantly higher scores compared to paper form with mean difference between -0.07 and 0.21. Mean difference of 0.01 (p = 0.986) between paper ACQ and online ACQ is obtained.Conclusion: The online version of the ACQ can be used for asthma control monitoring in pediatric patients in order to minimize unnecessary social contacts as well as hospital patient load, but retain adequate surveillance of disease symptoms by their physician.

In Silico and In Vitro Studies of Alchemilla viridiflora Rothm-Polyphenols' Potential for Inhibition of SARS-CoV-2 Internalization.

Since the outbreak of the COVID-19 pandemic, it has been obvious that virus infection poses a serious threat to human health on a global scale. Certain plants, particularly those rich in polyphenols, have been found to be effective antiviral agents. The effectiveness of Alchemilla viridiflora Rothm. (Rosaceae) methanol extract to prevent contact between virus spike (S)-glycoprotein and angiotensin-converting enzyme 2 (ACE2) and neuropilin-1 (NRP1) receptors was investigated. In vitro results revealed that the tested samples inhibited 50% of virus-receptor binding interactions in doses of 0.18 and 0.22 mg/mL for NRP1 and ACE2, respectively. Molecular docking studies revealed that the compounds from A. viridiflora ellagitannins class had a higher affinity for binding with S-glycoprotein whilst flavonoid compounds more significantly interacted with the NRP1 receptor. Quercetin 3-(6″-ferulylglucoside) and pentagalloylglucose were two compounds with the highest exhibited interfering potential for selected target receptors, with binding energies of -8.035 (S-glycoprotein) and -7.685 kcal/mol (NRP1), respectively. Furthermore, computational studies on other SARS-CoV-2 strains resulting from mutations in the original wild strain (V483A, N501Y-K417N-E484K, N501Y, N439K, L452R-T478K, K417N, G476S, F456L, E484K) revealed that virus internalization activity was maintained, but with different single compound contributions.

Unusual complications of non-invasive mechanical ventilation (NIV) and high-flow nasal cannula (HFNC): A systematic review.

The first application of modern non-invasive mechanical ventilation (NIV) can be traced back to over 30 years ago when a patient suffering from Duchenne Muscular Dystrophy was successfully ventilated. Since then, the use of NIV has been on the rise throughout the world. Although a very modern and safe therapy, complications during its application are inevitable. In addition to some well-known complications, others have described more rare entities. In this article, we described such rare complications as pneumoperitoneum, pneumocephalus, parotitis, gastric perforation, and barotrauma. The purpose of this review was to describe unusual complications of NIV, their prevalence, and the mechanisms by which such complications arise. We performed a clinical review by searching PubMed, Embase, and Cochrane libraries with Mesh terms: 'non-invasive mechanical ventilation', 'high-flow nasal cannula', 'rare complication', 'unusual complication', and 'unexpected complication'. These terms were cross-referenced with other keywords: 'pneumoperitoneum', 'parotitis', 'pneumocephalus', 'gastric insufflation', and 'barotrauma'. We included 26 research papers. When applying mechanical ventilation, it is necessary to have a strong knowledge of the mechanics of the device as well as familiarity with the complications that may occur during its use, including less common ones. Prompt and effective treatment of such complications is required, as well as careful consideration of the potential causes of such events, during the application of NIV or HFNC.

Complex Regional Pain Syndrome (Sudeck Atrophy) Prevention Possibility and Accelerated Recovery in Patients with Distal Radius at the Typical Site Fracture Using Polarized, Polychromatic Light Therapy.

Objective: Distal radius fracture (DRF) is one of the most frequent population fracture mostly affecting women, and frequently leading to complex regional pain syndrome (CRPS). Management of DRF and CRPS in gerontology is complex. The aim was to evaluate the use of polarized, polychromatic, low-energy light therapy combined with conventional treatment after DRF in gerontology and to follow up patients for CRPS emergence. Materials and methods: After plaster removal, female patients (n = 52) were divided into two groups. Group 1 (n = 26) was treated with exercises and cryotherapy on the wrist and dorsal hand (control). Group 2 (n = 26) was additionally treated with light therapy (Bioptron). Results: While pain decreased and supination and pronation improved in all patients after 15 days of therapy, pain reduction was accelerated and supination enhanced in the light therapy-treated group (p < 0.05). None of the patients in the light therapy-treated group developed CRPS during the 6-month follow-up, compared with four patients (15.4%) in the control group (p < 0.05). Complete hand fist-forming capacity was achieved in 19 patients (73.1%) in the light therapy-treated group compared with 16 patients (61.5%) in the control group (p > 0.05). Conclusions: Bioptron light therapy combined with conventional therapy improves patient outcome after DRF in gerontology, compared with conventional treatment alone.

Thiamazole-Induced Agranulocytosis Leading to Abscessus Pneumonia-Rare, But Challenging / Agranulocitosis inducida por tiamazol que lleva a absceso pumonar. Un reto infrecuente

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Systemic Lupus Erythematosus Presenting as Acute Lupus Pneumonitis / Lupus eritematoso sistémico manifestado como neumonitis lúpica aguda

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Morphological, Chemical and Molecular Characterization of 'Old olive' (Olea europaea L.) from Montenegro

ABSTRACT Thousands of years of tradition of olive cultivation in Montenegro is witnessed with the 'Old olive' estimated to be more than 2000 years old. 'Old olive' draws attention to its genetic potential and the relation to the closest grown olive cultivars. Therefore, the aim of this paper was to give the basic description of 'Old olive' (through 20 morphological and 37 chemical properties) as well as to determine its DNA profile and to examine the closeness with major olive cultivar grown, cv. 'Žutica'. The obtained data showed the differences between examined samples. 'Old olive' started flowering (27. May) more than 10 days later than cv. 'Žutica' (14. May), and began ripening 15 days later (20th October and 5th October, respectively). From 21 morphological parameters analysed all traits of fruit (weight 2.11g in 'Old olive' and 3.55g in cv. 'Žutica'), and inflorescence density (6.39 versus 5.55) showed very significant and significant differences, respectively. The chemical properties also showed very significant differences in olive oil content in the fresh (11.28 versus 19.68%) and dry matter (27.97 versus 47.78%), and significant differences in the content of linolenic acid (0.76 versus 0.54g/100 of FA and of campesterol (3.4 versus 3.1%). Three out of eleven SSR markers (DCA05, DCA09, DCA16) distinguished obtained DNA fragments, and showed as important tool in differentiation of two samples. Further study of the 'Old olive' as a living memory of olive cultivation in Montenegro, should be to examine its relation with other ancient olive trees and local varieties.

Association between walking, dysphoric mood and anxiety in late pregnancy: A cross-sectional study.

Relationship between physical activity and mental disorders in late pregnancy is unclear. In this work, we demonstrate that there is a significant association between the time spent on walking and symptoms of depression and anxiety in antenatal period. The cross-sectional study was done on a sample of 200 healthy women in 9th month of physiological pregnancy at Health center Kraljevo, Serbia during 2015. Each participant was given a questionnaire consisting of general questions regarding physical activity, pregnancy, and other parameters. Also, each participant completed a Beck depression inventory (BDI) and Zung anxiety scale (ZAS). There was a statistically significant negative correlation (p<0.05) between the BDI score and the daily time spent on walking. There was also a strong positive connection between the daily time spent on walking and level of anxiety (p<0.01). To our knowledge this is the first study to jointly test the relationship between scores of Beck depression inventory and Zung anxiety scale, and time spent on walking as physical activity in antenatal period. The results represent the basis for further research in the field of gynecological psychology, psychiatry and behavioral physiology.

THE REGULATION ROLE OF CAROTID BODY PERIPHERAL CHEMORECEPTORS IN PHYSIOLOGICAL AND PATHOPHYSIOLOGICAL CONDITIONS.

INTRODUCTION: The major oxygen sensors in the human body are peripheral chemoreceptors. also known as interoreceptors- as connected with internal organs, located in the aortic arch and in the body of the common carotid artery. Chemoreceptor function under physiological conditions. Stimulation of peripheral chemoreceptors during enviromental hypoxia causes a reflex-mediated increased ventilation, followed by the increase of the muscle sympatic activity, aiming to maintain tissue oxygen homeostatis, as well as glucosae, homeostatis. Besides that, peripheral chemoreceptors interact with central chemoreceptors. responsible for carbon dioxide changes . and they are able to modulate each other. Chemoreceptor function in pathophysiological conditions. Investigations of respiratory function in many pathological processes, such as hypertension, obstructive sleep apnea, congestive heart failure and many other diseases that are presented with enhanced peripheral chemosensitivity and impaired functional sy mpatholysis ultimately determine the peripheral chemorcceptor role and significance of peripheral chemoreceptors in the process of those pathological conditions development. Considering this, the presumed influence of peripheral chemoreceptors is important in patients having the above mentioned pathology. CONCLUSION: The importance and the role of peripheral chemoreceptors in the course of the breathing control is still controversial, despite many scientific attempts to solve this problem. The main objective of this review is to give the latest data on the peripheral chemoreceptor role and to highlight the importance of peripheral chemoreceptors for maintaining of oxygen homeostasis in pateints with hypoxia caused by either physiological or pathological conditions.

Sport-specific influences on respiratory patterns in elite athletes / Influências específicas do esporte nos padrões respiratórios em atletas de elite

ABSTRACT OBJECTIVE: To examine differences in lung function among sports that are of a similar nature and to determine which anthropometric/demographic characteristics correlate with lung volumes and flows. METHODS: This was a cross-sectional study involving elite male athletes (N = 150; mean age, 21  4 years) engaging in one of four different sports, classified according to the type and intensity of exercise involved. All athletes underwent full anthropometric assessment and pulmonary function testing (spirometry). RESULTS: Across all age groups and sport types, the elite athletes showed spirometric values that were significantly higher than the reference values. We found that the values for FVC, FEV1, vital capacity, and maximal voluntary ventilation were higher in water polo players than in players of the other sports evaluated (p < 0.001). In addition, PEF was significantly higher in basketball players than in handball players (p < 0.001). Most anthropometric/demographic parameters correlated significantly with the spirometric parameters evaluated. We found that BMI correlated positively with all of the spirometric parameters evaluated (p < 0.001), the strongest of those correlations being between BMI and maximal voluntary ventilation (r = 0.46; p < 0.001). Conversely, the percentage of body fat correlated negatively with all of the spirometric parameters evaluated, correlating most significantly with FEV1 (r = −0.386; p < 0.001). CONCLUSIONS: Our results suggest that the type of sport played has a significant impact on the physiological adaptation of the respiratory system. That knowledge is particularly important when athletes present with respiratory symptoms such as dyspnea, cough, and wheezing. Because sports medicine physicians use predicted (reference) values for spirometric parameters, the risk that the severity of restrictive disease or airway obstruction will be underestimated might be greater for athletes.

RESUMO OBJETIVO: Analisar as diferenças na função pulmonar em atletas praticantes de esportes de natureza semelhante e determinar quais características antropométricas/demográficas se correlacionam com os fluxos e volumes pulmonares. MÉTODOS: Estudo transversal com atletas de elite do sexo masculino (N = 150; média de idade de 21  4 anos), praticantes de um dos quatro esportes investigados. Os atletas foram classificados de acordo com o tipo e a intensidade de exercício relacionado ao esporte. Todos os atletas foram submetidos a antropometria completa e testes de função pulmonar (espirometria). RESULTADOS: Em todas as faixas etárias e tipos de esporte, os atletas de elite apresentaram valores espirométricos significativamente maiores que os valores de referência. Os valores de CVF, VEF1, capacidade vital e ventilação voluntária máxima foram maiores nos praticantes de polo aquático que nos praticantes dos outros esportes avaliados (p < 0,001). Além disso, o PFE foi significativamente maior em jogadores de basquete do que em jogadores de handebol (p < 0,001). A maioria dos parâmetros antropométricos/demográficos apresentou correlações positivas com os parâmetros espirométricos avaliados. O IMC se correlacionou positivamente com todos os parâmetros espirométricos avaliados (p < 0,001), sendo a correlação mais forte entre o IMC e a ventilação voluntária máxima (r = 0,46; p < 0,001). De forma contrária, o percentual de gordura corporal se correlacionou negativamente com todos os parâmetros espirométricos, mais significativamente com VEF1 (r = −0,386; p < 0,001). CONCLUSÕES: Nossos resultados sugerem que o tipo de esporte praticado tem um impacto significativo na adaptação fisiológica do sistema respiratório. Esse conhecimento é particularmente importante quando os atletas apresentam sintomas respiratórios tais como dispneia, tosse e sibilância. Visto que os especialistas em medicina do esporte utilizam valores previstos (de referência) para os parâmetros espirométricos, o risco de se subestimar a gravidade de doença restritiva ou obstrução de vias aéreas pode ser maior nos atletas.

Effect of viscosity on the wave propagation: Experimental determination of compression and expansion pulse wave velocity in fluid-fill elastic tube.

The velocity by which the disturbance travels through the medium is the wave velocity. Pulse wave velocity is one of the main parameters in hemodynamics. The study of wave propagation through the fluid-fill elastic tube is of great importance for the proper biophysical understanding of the nature of blood flow through of cardiovascular system. The effect of viscosity on the pulse wave velocity is generally ignored. In this paper we present the results of experimental measurements of pulse wave velocity (PWV) of compression and expansion waves in elastic tube. The solutions with different density and viscosity were used in the experiment. Biophysical model of the circulatory flow is designed to perform measurements. Experimental results show that the PWV of the expansion waves is higher than the compression waves during the same experimental conditions. It was found that the change in viscosity causes a change of PWV for both waves. We found a relationship between PWV, fluid density and viscosity.

The impact of elevated blood pressure on exercise capacity in elite athletes.

OBJECTIVES: Hypertension is one of the most prevalent cardiovascular disorders in athletes. The aims of our study were to assess the impact of elevated blood pressure (BP) on exercise capacity in athletes and evaluate the differences in left ventricular structure and function. METHODS: Elite male athletes (n=517, aged 23±5years) underwent Doppler echocardiography with tissue Doppler imaging. Diastolic function was assessed by measuring peak early and late transmitral (E and A) and annular diastolic filling velocities (e' and a'). Maximal cardiopulmonary exercise testing was performed to measure maximal oxygen consumption (VO2max), ventilatory anaerobic threshold (VAT) and heart rate reserve (HRR). After BP measurement, they were grouped according to the ESH/ESC guidelines on: optimal (OBP), normal (NBP), high normal BP (HNBP), and hypertensive (HT). RESULTS: We found significantly lower VO2max, VAT and HRR in the groups with HNBP and HT, after the adjustment for the type of sport, body fat content and age. There was an increasing trend in resting HR among groups (p<0.001). Although none of the subjects had impaired diastolic function, the HT group had higher left atrial volume, and lower e' and e'/a'. Resting systolic BP (p<0.05), HR (p<0.001), HRR (p<0.001) and e'/a' (p<0.01) independently predicted VO2max. Indexes E/e' and e'/a' were associated with resting systolic BP (p<0.05). CONCLUSION: Even in the absence of structural or functional heart damage, elevated BP in elite athletes, together with the presence of autonomic dysfunction, leads to decrease in exercise capacity. Staging of hypertension according to the BP level, on the one hand, and reflexion of BP on cardiopulmonary capacity, on the other, may be coupled for further risk stratification.

Sport-specific influences on respiratory patterns in elite athletes.

OBJECTIVE: To examine differences in lung function among sports that are of a similar nature and to determine which anthropometric/demographic characteristics correlate with lung volumes and flows. METHODS: This was a cross-sectional study involving elite male athletes (N = 150; mean age, 21  4 years) engaging in one of four different sports, classified according to the type and intensity of exercise involved. All athletes underwent full anthropometric assessment and pulmonary function testing (spirometry). RESULTS: Across all age groups and sport types, the elite athletes showed spirometric values that were significantly higher than the reference values. We found that the values for FVC, FEV1, vital capacity, and maximal voluntary ventilation were higher in water polo players than in players of the other sports evaluated (p < 0.001). In addition, PEF was significantly higher in basketball players than in handball players (p < 0.001). Most anthropometric/demographic parameters correlated significantly with the spirometric parameters evaluated. We found that BMI correlated positively with all of the spirometric parameters evaluated (p < 0.001), the strongest of those correlations being between BMI and maximal voluntary ventilation (r = 0.46; p < 0.001). Conversely, the percentage of body fat correlated negatively with all of the spirometric parameters evaluated, correlating most significantly with FEV1 (r = -0.386; p < 0.001). CONCLUSIONS: Our results suggest that the type of sport played has a significant impact on the physiological adaptation of the respiratory system. That knowledge is particularly important when athletes present with respiratory symptoms such as dyspnea, cough, and wheezing. Because sports medicine physicians use predicted (reference) values for spirometric parameters, the risk that the severity of restrictive disease or airway obstruction will be underestimated might be greater for athletes.

Surgical treatment of female stress urinary incontinence: retropubictransvaginal tape vs. transvaginal tape obturator.

AIM: To compare two different operative techniques for stress urinary incontinence in women, transvaginal tape obturator(TVT-O) and retropubictransvaginal tape(TVT). METHODS: The study included 63 women, of which 32 received TVT-O and 31 were treated with TVT. Follow-up for all patients was done after 1, 3, 6 and 12 months, and yearly thereafter. Each visit included objective evaluations (post-voig residual and stress test). RESULTS: The average operating time was 13.19±3.72 minutes in TVT-O group and 26.92±4.77 minutes for TVT. Average time of catheter removal was 1.19±0.4 and 1.26±0.44 for TVT-O and TVT, respectively. Average hospital stay was 2.38±0.75 days in TVT-O group and 2.03±0.91 for TVT. Appearance of complications such as trauma of urethra, bladder perforation, injury of vessels, hematoma and wound infection were not registered. Two (6.3%) of the patientswho underwent TVT-O had urinary infection. One (3.1%) of the patients who underwent TVT-O had pelvic pain. De novo urgency appeared in five(15.6%)patients for TVT-O and in four (12.9%) patients for TVT. The success rate in TVT-O group was 90.6% and 90.3% for TVT. CONCLUSION: Both procedures hada very high success rate, with a low rate of perioperative and late postoperative complications.

Body composition assessment in athletes: a systematic review.

Body composition represents an unbreakable unity of the human body basic structure elements and involves a relative representation of the various constituent elements of the human total body weight. It is well known that body composition changes under the influence of continuous physical activity, and, therefore, it is one of the major components of fitness, and general health of the athletes. Therefore, this topic has become a major field of interest for many exercise and sport scientists as well as clinicians who specialize not only in different training methods but also in the prevention of and rehabilitation from major injuries. To date, having considered issues of accuracy, repeatability and utility, there is no universally applicable criterion or 'gold standard' methodology for body composition assessment in athletes. The main objective of this review was to give a short overview of methods for body composition analysis in athletes and to show and compare the latest data on their usefulness and reliability in order to find the best solution for practical everyday work.

Our experience with intraoperative cell salvage during cesarean delivery in women with uterine myomas--four case reports.

INTRODUCTION: Cesarean section is more frequent in pregnant women with uterine myomas, and is usually complicated with perioperative hemorrhage. In some cases, cesarean myomectomy represents an inevitable surgery, adding risk of hemorrhage occurrence. Massive obstetric hemorrhage is the most common cause of maternal mortality and morbidity. The aim of this study was to show our experience and results of the implementation of intraoperative blood salvage during cesarean section in the patients with uterine myomas. MATERIAL AND METHODS: The study encompassed four patients with uterine myomas who had cesarean delivery at our Department in the period from 2010 to 2011. RESULTS: Postoperative transfusion of packed red blood cells was given to one patient. No complications resulting form the intraoperative blood salvage were recorded in our research. CONCLUSION: Intraoperative blood salvage should be applied in patients with uterine myoma, and certainly in those who are planned for cesarean myomectomy and particularly in cases when massive intraoperative hemorrhage is expected.