The aim of this clinical trial was to control the cytokine storm by administering mesenchymal stem cells (MSCs) to critically-ill COVID-19 patients, to evaluate the healing effect, and to systematically investigate how the treatment works. Patients with moderate and critical COVID-19 clinical manifestations were separated as Group 1 (moderate cases, n = 10, treated conventionally), Group 2 (critical cases, n = 10, treated conventionally), and Group 3 (critical cases, n = 10, treated conventionally plus MSCs transplantation therapy of three consecutive doses on treatment days 0, 3, and 6, (as 3 × 10⁶ cells/kg, intravenously). The treatment mechanism of action was investigated with evaluation markers of the cytokine storm, via biochemical parameters, levels of proinflammatory and anti-inflammatory cytokines, analyses of tissue regeneration via the levels of growth factors, apoptosis markers, chemokines, matrix metalloproteinases, and granzyme-B, and by the assessment of the immunomodulatory effects via total oxidant/antioxidant status markers and the levels of lymphocyte subsets. In the assessment of the overall mortality rates of all the cases, six patients in Group-2 and three patients in Group-3 died, and there was no loss in Group-1. Proinflammatory cytokines IFNγ, IL-6, IL-17A, IL-2, IL-12, anti-inflammatory cytokines IL-10, IL-13, IL-1ra, and growth factors TGF-β, VEGF, KGF, and NGF levels were found to be significant in Group-3. When Group-2 and Group-3 were compared, serum ferritin, fibrinogen and CRP levels in Group-3 had significantly decreased. CD45 +, CD3 +, CD4 +, CD8 +, CD19 +, HLA-DR +, and CD16 + / CD56 + levels were evaluated. In the statistical comparison of the groups, significance was only determined in respect of neutrophils. The results demonstrated the positive systematic and cellular effects of MSCs application on critically ill COVID-19 patients in a versatile way. This effect plays an important role in curing and reducing mortality in critically ill patients.

The epigenetic features contribute to variations in host susceptibility to SARS-CoV-2 infection and severity of symptoms. This study aimed to evaluate the relationship between the relative expression of microRNAs (miRNAs) and the severity of the disease in COVID-19 patients. The miRNA profiles were monitored during the different stages of the disease course using reverse transcription–quantitative polymerase chain reaction (RT-qPCR). The expression levels of the selected 11 miRNAs were measured in the blood samples collected from 73 patients (moderate, n = 37; severe, n = 25; critically ill, n = 11, a total of 219 longitudinal samples) on hospitalization day and days 7 and 21. Expression changes were expressed as “fold change” compared to healthy controls (n = 10). Our study found that several miRNAs differed according to disease severity, with the miR-155-5p the most strongly upregulated (p = 0.0001). A statistically significant negative correlation was observed between the expression of miR-155-5p and its target gene, the suppressor of cytokine signaling 1 (SOCS1). The relative expression of miR-155-5p was significantly increased and SOCS1 was significantly decreased with the disease progression (r = −0.805 p = 0.0001, r = −0.940 p = 0.0001, r = −0.933 p = 0.0001 for admission, day 7, and day 21, respectively). The overexpression of miR-155-5p has significantly increased inflammatory cytokine production and promoted COVID-19 progression. We speculated that microRNA-155 facilitates immune inflammation via targeting SOCS1, thus establishing its association with disease prognosis.

COVID-19,intensive care,intensive care unit,pandemic,follow-up

Should I Change Anticoagulane in Veno-Venous ECMO? - Turkish Journal of Anaesthesiology and Reanimation

Ekstrakorporeal membran oksijenasyonu (ECMO) desteğinin etkin ve güvenli bir şekilde uygulanabilmesi için vasküler kanülasyon adımı büyük önem taşımaktadır. Çalışmamızda koronavirüs hastalığı-2019 akut solunum sıkıntısı sendromu gelişen ve V-V ECMO desteği alan 3 hastada ECMO damar kanülasyonu ile ilgili yaşadığımız çeşitli sorunlar (malpozisyon, tromboz, rekanülasyon, kollaps) ve bunların yönetimindeki deneyimlerimizi paylaşmayı amaçladık. Uygun vasküler kanül boyutu, vasküler kanül yapısı, vasküler kanülasyon bölgesinin seçimi ve hassas vasküler kanülasyon, ECMO desteğini daha etkili ve güvenilir hale getirebilir.

Background and Objectives: The development of acute kidney injury (AKI) in the post-cardiopulmonary resuscitation (post-CPR) period is a common pathology that has not been adequately investigated but contributes significantly to morbidity and mortality. We aimed to investigate the causes of AKI in the early post-CPR period. Materials and Methods: This study was performed retrospectively in 82 adult patients who survived for at least 2 days out of 312 patients admitted to the intensive care unit after cardiac arrest in 2013–2022. AKI developed in 40 (48.7%) of these 82 patients (AKI 1–3 patient, respectively: 14, 13, 13). Binary logistic regression analysis was performed separately to determine the risk factors for AKI and mortality. Results: Each unit increase in BMI increased the risk of developing AKI by 1.272-fold, and the increase was statistically significant [OR (95%CI) = 1.272 (1.089–1486); p = 0.002]. The use of VSP and INO treatment alone increased the risk of AKI by approximately 14-fold, and this increase was statistically significant [OR (95%CI) = 14.225 (1.172–172.669); p = 0.037]. The combined use of VSP and INO treatment increased the risk of AKI by approximately 42-fold, and this increase was statistically significant [OR (95%CI) = 42.089 (2.683–660.201); p = 0.008]. The COVID-19 period alone increased the risk of developing AKI by 2.8-fold compared to the non-COVID-19 period, but the statistical significance of this increase was limited [OR (95%CI) = 2.801 (0.859–9.126); p = 0.088]. The development of AKI was not associated with mortality [OR (95%CI) = 2.194 (0.700–6.872); p = 0.178]. Conclusions: Having VSP and/or INO support and high BMI in the post-CPR period are the most important reasons for the development of AKI. COVID-19 may also increase the risk of developing AKI.