Mechanisms of COVID-19-induced kidney injury and current pharmacotherapies

The COVID-19 pandemic created a worldwide debilitating health crisis with the entire humanity suffering from the deleterious effects associated with the high infectivity and mortality rates. While significant evidence is currently available online and targets various aspects of the disease, both inflammatory and noninflammatory kidney manifestations secondary to COVID-19 infection are still largely underrepresented. In this review, we summarized current knowledge about COVID-19-related kidney manifestations, their pathologic mechanisms as well as various pharmacotherapies used to treat patients with COVID-19. We also shed light on the effect of these medications on kidney functions that can further enhance renal damage secondary to the illness.

     

Ultrasound characteristics and outcome of prenatally diagnosed fetal cholelithiasis

Aim: To investigate ultrasound characteristics and outcome in fetuses with cholelithiasis.

Materials and methods: We report a small case series of three patients with prenatally diagnosed fetal cholelithiasis. Ultrasound features, pregnancy outcome and neonatal follow-up are presented and discussed.

Results: Sonographic pattern associated to fetal cholelithiasis is variable. Pregnancy issue is globally good with no ominous fetal or neonatal events.

Conclusions: Prenatally diagnosed fetal cholelithiasis is a rare finding and doesn’t seem to carry an adverse effect on the pregnancy.     

Jet ventilation in a case of tracheal obstruction secondary to a retrosternal goitre

Intermittent jet ventilation was used during anaesthesia in a 66-yr-old woman who had severe tracheal narrowing secondary to compression by a retrosternal goitre. The trachea was intubated by a smallbore tube, which was placed above the site of narrowing. An injector was connected to the proximal end of the tracheal tube on one side and to the anaesthesia circuit on the other. Intermittent jets of 66% nitrous oxide in oxygen via the injector resulted in adequate oxygenation and carbon dioxide elimination. Arterial blood gas analysis during jet ventilation showed PaO₂ 150 mmHg, PaCO₂ 35 mmHg and pH 7.4. It is concluded that lowfrequency jet ventilation may provide adequate oxygenation and carbon dioxide elimination in the presence of tracheal narrowing.     

Nutritional Status of Lebanese Hospitalized Patients With Chronic Disease: A Cross-Sectional Study

Background: In a hospitalized setting, malnutrition is known to increase patient’s mortality and lower the quality of life; therefore, it is essential to detect such cases and intervene at the earliest possible. The goal of this study is to estimate the rate of malnutrition in hospitalized Lebanese patients, explore its association with different factors, and create a simple tool to detect patients at high risk of malnutrition. Methods: One hundred and fifty Lebanese hospitalized patients, suffering at least from one chronic disease, were randomly chosen from Centre Hospitalier Universitaire Notre Dame de Secours (CHU-NDS) hospital. The Mini Nutritional Assessment (MNA) score was used to assess nutritional status. Results: A total of 34.7% of patients in our sample were at risk of malnutrition and 9.3% were malnourished. A higher risk of malnutrition was found in patients with a low body mass index, who were physically inactive or admitted to the hospital more than once in the past 6 months. The nutritional status was not associated with certain chronic diseases more than others. We designed a simple decision tree model based only on 3 questions to detect patients at high risk of malnutrition/malnourished. This tool has a sensitivity of 62% and a specificity of 77%. Conclusion: The prevalence found in our study was comparable with previous data. However, factors associated with poor nutritional status were somewhat different. Further studies are needed to validate our screening tool and to examine the effect of specific diseases on malnutrition on a larger scale.     

Factor V R506Q Mutation-Leiden: An Independent Risk Factor for Venous Thrombosis but not Coronary Artery Disease

Background: A specific point G-A transition at nucleotide position 1691 in the factor V (FV) gene, FV-Leiden, was associated with increased risk of venous thromboembolism (VTE). Insofar as the association of FV-Leiden with coronary artery disease (CAD) remains poorly defined, the aim of this study was to determine the prevalence of FV-Leiden in a sample of 68 VTE patients, 69 CAD patients, and 192 randomly selected healthy subjects. Methods: Total genomic DNA was extracted from the peripheral blood of study subjects and was used for PCR analysis. The presence (or absence) of FV-Leiden was assessed by PCR using primers flanking the mutant site (nt 1691), followed by hybridization with wild-type (G) and mutant (A) biotinylated DNA probes; detection was by DNA enzyme immunoassay (DEIA). Results: While the prevalence of FV-Leiden in CAD patients was not statistically different from that of healthy subjects (14.5%% vs. 15.1%%; P=0.890, odds ratio 0.95; 95%% confidence interval 0.43–2.06), a significant increase in FV-Leiden prevalence was seen in VTE patients (70.6%% in VTE patients; P<0.001, odds ratio 13.4, 95%% confidence interval 6.9–25.8). Of the 48 VTE patients who tested positive for FV-Leiden, 42 were heterozygotes (G/A), while 6 were homozygotes (A/A) (allele frequency 0.397). All 10 CAD patients positive for FV-Leiden were heterozygote carriers (allele frequency 0.072). While gender was not a factor in FV-Leiden expression, higher prevalence in FV-Leiden was seen in younger (45 years) VTE patients (38/51 vs. 10/17). Conclusion: FV-Leiden is a major inherited risk factor for VTE, with a peak incidence in younger patients, but does not appear to play any role in CAD pathogenesis in the population studied.