Background: High-Flow Nasal Cannula (HFNC) oxygen therapy emerged as the therapy of choice in COVID-19-related pneumonia and moderate to severe acute hypoxemic respiratory failure (AHRF). HFNC oxygen therapy in COVID-19 has been recommended based its use to treat AHRF of other etiologies, and studies on assessing outcomes in COVID-19 patients are highly needed. This study aimed to examine outcomes in COVID-19 patients with pneumonia and severe AHRF treated with HFNC.Materials and methods: The study included 235 COVID-19 patients with pneumonia treated with HFNC. Data extracted from medical records included demographic characteristics, comorbidities, laboratory parameters, clinical and oxygenation status, clinical complications, as well as the length of hospital stay. Patients were segregated into two groups based on their oxygen therapy needs: HDU group, those who exclusively required HFNC and ICU group, those whose oxygen therapy needed to be escalated at some point of hospital stay. The primary outcome was the need for respiratory support escalation (noninvasive or invasive mechanical ventilation) and the secondary outcome was the in-hospital all-cause mortality.Results: The primary outcome was met in 113 (48%) of patients. The overall mortality was 70%, significantly higher in the ICU group [102 (90.2%) vs. 62 (50.1%), p < 0.001]. The rate of intrahospital infections was significantly higher in the ICU group while there were no significant differences in the length of hospital stay between the groups. The ICU group exhibited significant increases in D-dimer, NLR, and NEWS values, accompanied by a significant decrease in the SaO₂/FiO₂ ratio. The multivariable COX proportional regression analysis identified malignancy, higher levels of 4C Mortality Score and NEWS2 as significant predictors of mortality.Conclusion: High-Flow Nasal Cannula oxygen therapy is a safe type of respiratory support in patients with COVID-19 pneumonia and acute hypoxemic respiratory failure with significantly less possibility for emergence of intrahospital infections. In 52% of patients, HFNC was successful in treating AHRF in COVID-19 patients. Overall, mortality in COVID-19 pneumonia with AHRF is still very high, especially in patients treated with noninvasive/invasive mechanical ventilation.

Background. The aim of the study was to assess the effect of baricitinib on 28-day all-cause mortality and the progression of respiratory failure in patients needing transfer to the intensive care unit (ICU) with COVID-19 pneumonia treated with high-flow oxygen therapy. Methods. This retrospective study included hospitalized patients with COVID-19 pneumonia treated with high-flow oxygen non-invasive ventilation receiving standard of care (SOC) or SOC in addition to baricitinib. Data on patients’ characteristics, pro-inflammatory markers, D dimer, and National Early Warning Score 2 (NEWS2) values were collected and compared between groups. The primary endpoint was 28-day all-cause in-hospital mortality and the secondary outcome was transfer to the ICU. Results. The study included 125 patients. The primary outcome was observed in 44.8% of them: 27% in the baricitinib group vs. 62% in the SOC group, p < 0.001. Transfer to the ICU ward was significantly lower in the baricitinib group: 29% vs. 81%, p < 0.001. A significant improvement was observed when the baricitinib group was compared to SOC in procalcitonin, CRP, D-dimer, neutrophil-to-lymphocyte ratio values, and NEWS2. Conclusion. Treatment with baricitinib in addition to SOC was associated with reduced mortality and a lower prevalence of transfer to the ICU in hospitalized patients with COVID-19 pneumonia treated with high-flow oxygen non-invasive therapy.

Introduction. Left ventricular hypertrophy is defined as an increase in the left ventricular mass. Electrocardiography is a widely used and cost-effective method for the initial screening of the condition, but it has limited sensitivity and specificity. The Sokolow-Lyon and Cornell criteria are still most commonly used in diagnosing the disease; their sensitivity, however, is low. On the contrary, the Romhilt-Estes scoring system incorporates atrial abnormalities and repolarization phases making this scoring system a better diagnostic tool. This study explores the correlation between electrocardiography and echocardiography in the diagnosis of left ventricular hypertrophy. Material and Methods. The study enrolled 30 patients with median age of 62, diagnosed with arterial hyperten­sion, who underwent a 12-lead electrocardiogram and transthoracic echocardiogram. The analysis included the assessment of correlation between the relevant electrocardiographic parameters and the left ventricular mass index, as well as calculation of their diagnostic capability including the area under the ROC curve. Re­sults. Positive correlation of moderate intensity has been observed between the left ventricular mass index and Sokolow-Lyon (ρ=0.479), Cornell index (ρ=0.366), and Cornell product (ρ=0.423). Cornell product had the highest sensitivity (0.82), while the Romhilt-Estes criteria exhibited the highest specificity (0.85). Sokolow-Lyon yielded the highest area under the curve (0.733), followed by Cornell product (0.640), Cornell voltage (0.622), and Romhilt-Estes criteria (0.570). Conclusion. The Sokolow-Lyon criterion exhibited the best balance between sensitivity and specificity, the highest and significant area under the ROC curve and the strongest correlation with the left ventricular mass index.

Background/Aim. Biomarkers for predicting disease course could facilitate treatment selection in primary glomerulonephritis (PGN). Data on the role of neutrophil gelatinase-associated lipocalin (NGAL) in PGN are limited. The aim of this study was to evaluate the significance of NGAL in predicting treatment outcomes in PGN. Methods. The study included a total of 60 PGN patients followed between 2012 and 2024. At diagnosis, serum NGAL (sNGAL) and urinary NGAL (uNGAL) were measured. Renal function parameters (serum creatinine, proteinuria) and disease outcome–development of end-stage renal disease (ESRD)–were assessed at baseline, after 5 years, and at the end of the follow-up period. The association between NGAL and clinical outcomes was analyzed using appropriate statistical tests. Results. At baseline, median sNGAL and uNGAL levels were 154.71 ng/mL and 13.94 ng/mL, respectively. During a median follow-up of 112 months, 8.33% of patients were lost to follow-up, and 20% developed ESRD. Patients who developed ESRD had higher sNGAL levels (p = 0.027). Using sNGAL, ESRD was fairly predictive (AUC = 0.709; p = 0.036), and sNGAL was associated with time-to-ESRD (Kaplan-Meier analysis, p <0.001). The group with the highest sNGAL showed the lowest 5-year renal survival. Patients with stable or improved estimated glomerular filtration rate (eGFR) had higher uNGAL/creatinine ratio values (p = 0.049). Changes in proteinuria correlated negatively with sNGAL (p < 0.001) and uNGAL (p = 0.005). Conclusion. In PGN, sNGAL could be a predictor of ESRD development, potentially reflecting its pro-fibrotic activity. In contrast, the correlation between NGAL levels and change in proteinuria, as well as the associations between higher uNGAL/creatinine ratios and improved eGFR, suggest a complex and potentially protective role of NGAL in disease progression.

Background/Aim. Central venous catheters (CVC) in hemodialysis (HD) patients are associated with serious complications, particularly catheter-related bloodstream infection (CRBSI) and thrombosis, leading to increased morbidity and mortality. The aim of this study was to evaluate the effectiveness of three different catheter lock solutions in preventing major catheter-related complications. Methods. This prospective, randomized, controlled, single-center study, conducted between June 2018 and June 2023, included 96 adult HD patients. Depending on the solutions they received, the patients were equally divided into three groups: gentamicin-citrate twice weekly plus taurolidine/urokinase after the third weekly session (TAURO); gentamicin-citrate three times weekly (GENTAM); unfrac-tionated heparin 5,000 international units/mL three times weekly (HEPARIN). Lock solutions were administered for a minimum of three months post-CVC insertion and continued until catheter removal. Measured outcomes included CRBSI incidence, catheter thrombosis, and adverse events. Results. Over the course of 10,770 catheter-days, eight CRBSI episodes were recorded, with Staphylococcus aureus as the most common pathogen (50%). The incidence of CRBSI (per 1,000 catheter-days) was 0.27 in the TAURO group, 0.83 in the GENTAM group, and 1.15 in the HEPARIN group, without statistical significance (p = 0.526). Thrombosis incidence was similar across groups (1.09?1.15; p = 0.990). Cox proportional hazards analysis revealed no significant differences, although the TAURO group demonstrated a trend toward lower CRBSI risk compared to the HEPARIN group (hazard ratio = 0.236; 95% confidence interval 0.026?2.116). Conclusion. None of the evaluated lock regimens significantly reduced the risk of CRBSI or thrombosis. Nonetheless, the lowest CRBSI incidence was observed in the TAURO group, suggesting a potential bene-fit that warrants confirmation in larger, multicenter studies.

Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder primarily known for progressive kidney cysts, and it is the most common hereditary syndrome linked to intracranial aneurysms (IAs). Approximately 5–20% of ADPKD patients have IAs (versus ~3% in the general population). Key risk factors for IAs in ADPKD include a family history of aneurysmal subarachnoid hemorrhage (SAH), early-onset or poorly controlled hypertension, and possibly more severe kidney disease (e.g., large total kidney volume and reduced kidney function). The PKD1 and PKD2 mutations in ADPKD lead to polycystin-1/-2 dysfunction in vascular cells, causing intrinsic vessel wall weakness. This weakness—compounded by chronic hemodynamic stress and inflammation—predisposes ADPKD patients to aneurysm formation. Clinically, most aneurysms in ADPKD are small (<7 mm), asymptomatic, and located in the anterior cerebral circulation. Their growth and rupture risk appears similar to aneurysms in non-ADPKD patients; however, ruptures in ADPKD occur at younger ages, underscoring the need for vigilant management. This narrative review provides a nephrology-oriented overview of intracranial aneurysms in ADPKD, including pathophysiology, epidemiology, and clinical management. Key Messages: -ADPKD carries a higher prevalence of intracranial aneurysms (≈5–20%) than the general population (≈3%). Key risk factors include a family history of aneurysm/SAH, early or poorly controlled hypertension, and possibly advanced renal disease. -Guidelines support targeted rather than universal screening, mainly in patients with family history or prior SAH. -Non-contrast MRA is the preferred modality, usually initiated around age 30 in at-risk individuals. -Most aneurysms are small and asymptomatic; small lesions are monitored with BP control and imaging, while larger or high-risk aneurysms are treated prophylactically. -Broader screening remains debated. Future genetic insights may improve risk stratification, but current practice requires balancing rupture prevention against over screening.