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Background Limited data exist on the incidence and outcome of early coronavirus disease 2019 (COVID-19) in kidney transplantation recipients (KTR). Methods A retrospective multicenter research study was conducted across 12 centers in India. We explored the symptomatology, demographic, laboratory findings, and outcome of COVID-19 within 30 days of transplantation. The outcome was compared with the overall KTR and waitlisted patients acquiring COVID-19. Results The incidence of early COVID-19 was 2.6% (n = 22) for the cumulative 838 renal transplants performed since nationwide lockdown in March 2020 until May 2021. Overall, 1049 KTR were diagnosed with COVID-19 and 2% of those had early COVID-19. The median age of the early COVID-19 cohort was 43 (31-46) years. COVID-19 severity ranged from asymptomatic (18.2%), mild (59.1%), moderate (9.1%), and severe (13.6%). Among clinical symptoms, dyspnea and anosmia were frequent, and in laboratory parameters, neutrophil lymphocyte ratio, high-sensitivity C-reactive protein, and D -dimer were higher in patients requiring oxygen. The mortality in early COVID-19 was not higher than overall KTR (4.5% vs 8.5%; P = 1). COVID-19 severity (23.9% vs 15.7%; P = .0001) and mortality (15.5% vs 8.5%; P = .001) among waitlisted patients (n = 1703) were higher compared with overall KTR. Conclusions We report higher burden of COVID-19 in waitlisted patients compared with KTR and a favorable outcome in early COVID-19 in KTR. Our report will help the transplant physicians in dealing with the ongoing dilemma of halting or resuming transplantation in the COVID-19 era.

The article describes the main tendencies in anesthesiology, which have undergone the greatest changes in the last decade, according to the author. The article speculates on the choice of tactics and the qualitative components of peri-operative infusion therapy. The author gives an assessment of the current stage of studying the phenomenon of anesthetic preconditioning and acute heart failure management. And, finally, the challenges and achievements of the evidence-based medicine in anesthesiology are analyzed.

Background: There are few reports of peri-operative application of intra-aortic balloon pumping (IABP) in patients with coronary artery disease (CAD) and different grades of left ventricular dysfunction. This study aimed to analyze the early outcomes of perioperative application of IABP in coronary artery bypass grafting (CABG) among patients with CAD and left ventricular dysfunction, and to provide a clinical basis for the peri-operative use of IABP. Methods: A retrospective analysis of 612 patients who received CABG in the General Hospital of People’s Liberation Army between May 1995 and June 2014. Patients were assigned to an IABP or non-IABP group according to their treatments. Logistic regression analysis was performed to investigate the influence of peri-operative IABP implantation on in-hospital mortality. Further subgroup analysis was performed on patients with severe (ejection fraction [EF] ≤ 35%) and mild (EF = 36%–50%) left ventricular dysfunction. Results: Out of 612 included subjects, 78 belonged to the IABP group (12.7%) and 534 to the non-IABP group. Pre-operative left ventricular EF (LVEF) and EuroSCOREII predicted mortality was higher in the IABP group compared with the non-IABP group (P < 0.001 in both cases), yet the two did not differ significantly in terms of post-operative in-hospital mortality (P = 0.833). Regression analysis showed that IABP implantation, recent myocardial infarction, critical status, non-elective operation, and postoperative ventricular fibrillation were risk factors affecting in-hospital mortality (P < 0.01 in all cases). Peri-operative IABP implantation was a protective factor against in-hospital mortality (P = 0.0010). In both the severe and mild left ventricular dysfunction subgroups, peri-operative IABP implantation also exerted a protective role against mortality (P = 0.0303 and P = 0.0101, respectively). Conclusions: Peri-operative IABP implantation could reduce the in-hospital mortality and improve the surgical outcomes of patients with CAD with both severe and mild left ventricular dysfunction. Key words: Coronary artery disease; In-hospital mortality; Intra-aortic balloon pumping; Left ventricular dysfunction; Perioperative period

The object of research in the field of anesthesiology and intensive care is the functional systems of the host; this research includes original tasks, elaboration and making certain decisions especially for critically ill patients where as a rule the outcome of anesthesia and intensive care depends not only on the special professional skills but moral and ethic features of the doctor. The main feature of biomedical systems is that the human body is the system which is complex, open and stochastic, and if the man is ill it is especially complex. And the major part of information about the patient is non-verbal; so the classification is an important component providing an impact on the treatment outcome. If the principles of information classification are properly used, the doctor is fully armed for analyzing, comprehending, adopting, assessing and solving the task. It also facilitates the dissemination of acquired knowledge and experience among other specialists.

A rare manifestation during the post-anesthetic period may include the occurrence of functional neurological symptom disorder (FNSD). FNSD is described as neurological symptoms that are not consistently explained by neurological or medical conditions. We report a case series consisting of six patients who underwent a general anesthetic at a tertiary referral hospital and experienced FNSD in the immediate post-anesthetic period. Life-threatening causes were excluded based on benign physical exam findings and knowledge of past history. Five of six cases manifested with FNSD only in the immediate post-operative setting after exposure to anesthesia, and never otherwise experienced these symptoms during their normal daily lives. MEDLINE and Google Scholar were searched through October 2019 using a highly-sensitive search strategy and identified 38 published cases of post-anesthetic FNSD. Meta-analysis of pooled clinical data revealed that a significant proportion of patients were females (86%), reported a history of psychiatric illness (49%), reported a prior history of FNSD (53%), and underwent general anesthesia as the primary anesthetic (93%). The majority of patients were exposed to diagnostic studies (66% received radiographic tests and 52% received electroencephalogram) as well as pharmacologic therapy (57%). While no deaths occurred, many patients had unanticipated admission to the hospital (53%) or to the intensive care unit (25%). These data may help inform the anesthesia literature on presentation, risk factors, and treatment outcomes of FNSD in the context of anesthetic administration. We contemplate whether anesthetic agents may predispose a vulnerable brain to manifest with involuntary motor and sensory control seen in FNSD.

Goal: to familiarize Russian anesthesiologists with the most recent data of the evidence-based medicine about peri-operative infusion therapy. The right choice of the infusion therapy strategy and tactics is a mandatory component of the successful management of the peri-operative period. The most significant changes have recently occurred specifically in this field. First the concept of restrictive tactics of infusion therapy emerged and won its popularity very fast. Then some reasonable doubts appeared about feasibility and safety of using HES solutions. Both affect basic principles of infusion therapy and the recent changes are to be considered from the position of the evidence-based medicine. British and German experts attended these issues and published the relevant guidelines in 2011 and 2016. Comparison and analysis of the implementation opportunities in Russia and recommendations make the subject of this publication. Conclusion: It is necessary to implement the international recommendations for peri-operative infusion therapy with adjustment to relevant Russian regulations in the anesthesiology and intensive care departments.

Cytoreductive surgery and chemotherapy are cornerstones of ovarian cancer treatment, yet disease recurrence remains a significant clinical issue. Surgery can release cancer cells into the circulation, suppress anti-tumor immunity, and induce inflammatory responses that support the growth of residual disease. Intervention within the peri-operative window is an under-explored opportunity to mitigate these consequences of surgery and influence the course of metastatic disease to improve patient outcomes. One drug associated with improved survival in cancer patients is ketorolac. Ketorolac is a chiral molecule administered as a 1:1 racemic mixture of the S- and R-enantiomers. The S-enantiomer is considered the active component for its FDA indication in pain management with selective activity against cyclooxygenase (COX) enzymes. The R-enantiomer has a previously unrecognized activity as an inhibitor of Rac1 (Ras-related C3 botulinum toxin substrate) and Cdc42 (cell division control protein 42) GTPases. Therefore, ketorolac differs from other non-steroidal anti-inflammatory drugs (NSAIDs) by functioning as two distinct pharmacologic entities due to the independent actions of each enantiomer. In this review, we summarize evidence supporting the benefits of ketorolac administration for ovarian cancer patients. We also discuss how simultaneous inhibition of these two distinct classes of targets, COX enzymes and Rac1/Cdc42, by S-ketorolac and R-ketorolac respectively, could each contribute to anti-cancer activity.

Background Hyperglycaemia during and after hip surgery is associated with coagulation activation and an increased risk of venous thromboembolism. Whether lowering of glucose levels during hip surgery diminishes coagulation activation is unknown. We investigated the efficacy of the human GLP-1 analogue liraglutide to lower glucose during and after hip surgery and studied its influence on coagulation activation. Methods A total of 37 obese subjects who underwent hip surgery were randomized to subcutaneous liraglutide or placebo for 4 consecutive days, starting one day prior to surgery. Glucose levels and coagulation indices at three fixed time-points (pre-operative, 2 h post-operative and 3 days post-operative) were measured. Results Liraglutide reduced glucose at day three post-surgery (median glucose (IQR) liraglutide 5.5 (5.2–5.7) vs. placebo 5.8 (5.5–6.2); difference 0.3 mmol/L, P = 0.04). Changes in 6 out of 8 coagulation indices studied did not differ between the two groups. Only D-dimer levels were significantly lower in the liraglutide group at day three post-surgery and FVIII levels were significantly higher in the liraglutide group 2 h post-surgery. Conclusion Although the human GLP-1 analogue liraglutide moderately reduced post-operative blood glucose levels in non-diabetic and prediabetic obese patients undergoing elective hip surgery, no changes were observed with respect to coagulation activation., Highlights • Hyperglycaemia during hip surgery is associated with venous thromboembolism. • We examined the effect of perioperative glucose lowering on coagulation. • Perioperative glucose lowering was realized using the GLP-1 antagonist liraglutide. • Liraglutide moderately reduced glucose levels in non-diabetic and prediabetic hip surgery patients. • No effect of glucose lowering therapy on coagulation was found.

Introduction Contrast-enhanced ultrasound (CEUS) is a new technique that might enable portable and non-invasive organ perfusion quantification at the bedside. However, it has not yet been tested in critically ill patients. We sought to establish CEUS's feasibility, safety, reproducibility and potential diagnostic value in the assessment of renal cortical perfusion in the peri-operative period in cardiac surgery patients. Methods We recruited twelve patients deemed at risk of acute kidney injury (AKI) planned for elective cardiac surgery. We performed renal CEUS with destruction-replenishment sequences before the operation, on ICU arrival and the day following the admission. Enhancement was obtained with Sonovue® (Bracco, Milano, Italy) at an infusion rate of 1 ml/min. We collected hemodynamic parameters before, during and after contrast agent infusion. At each study time, we obtained five video sequences, which were analysed using dedicated software by two independent radiologists blinded to patient and time. The main output was a perfusion index (PI), corresponding to the ratio of relative blood volume (RBV) over mean transit time (mTT). Results All 36 renal CEUS studies, including 24 in the immediate post-operative period could be performed and were well tolerated. Correlation between readers for PI was excellent (R2 = 0.96, P < 0.0001). Compared with baseline, there was no overall difference in median PI's on ICU admission. However, the day after surgery, median PI's had decreased by 50% (P < 0.01) (22% decrease in RBV (P = 0.09); 48% increase in mTT (P = 0.04), both suggestive of decreased perfusion). These differences persisted after correction for haemoglobin; vasopressors use and mean arterial pressure. Four patients developed AKI in the post-operative period. Conclusions CEUS appears feasible and well-tolerated in patients undergoing cardiac surgery even immediately after ICU admission. CEUS derived-parameters suggest a decrease in renal perfusion occurring within 24 hours of surgery.