Clinical and morphological comparison of respiratory failure in patients with COVID-19 who died under different options of respiratory support

The aim. Based on the study of the effect of invasive mechanical ventilation and NIV in the CPAP mode on the pathomorphosis of lung damage in patients with HRF caused by SARS-nCoV-2 and deaths in intensive care unit (ICU), determine the safest method of respiratory support. Materials and methods. The study included morphological material from 20 patients with HRF caused by SARS-nCoV-2 (COVID-19) who died in ICU. Group 1 included patients who received non-invasive lung ventilation in CPAP mode through a face mask (n=10), group 2 - patients who underwent invasive ventilation (n=10). The prepared sections, 5 μm thick, were stained according to the Van Gizon method. Photomicrographs were taken using Zeiss ZENliteimaging. Data are presented as M [25-75] and P±Sp. Statistical analysis of the results was performed using the program “Statistica 10”. Significance of differences in indicators was assessed using the nonparametric Wilcoxon test, the parametric Student's test. The results were considered reliable at values of p<0.05. Results The morphological structure of the lungs of patients of group 1 corresponded to the exudative phase of DAD with severe edematous-hemorrhagic syndrome, signs of interstitial pneumonia with desquamation of alveolocytes and the formation of hyaline membranes. In patients of group 2 in the lung tissue there was a picture of the proliferative phase of DAD with signs of interstitial pneumonia, and the development of focal fibrosing alveolitis. Thus, invasive mechanical ventilation, can accelerate the development of irreversible processes in the lungs in the form of fibrosing alveolitis and promote the formation of ventilator-associated pneumonia Conclusions. CPAP NIV is a promising method of respiratory support in patients with ARDS caused by SARS-nCoV-2 virus (COVID-19), which needs further study

ANTISYNTHETASE SYNDROME AND THE POSITION OF CLINICAL IMMUNOLOGIST

Antisynthetase syndrome is a clinical and laboratory syndrome that develops in patients with idiopathic inflammatory myopathy and is characterized by the development of interstitial lung disease, namely fibrosing alveolitis syndrome, resistance to traditional corticoid therapy and the presence of myositis-specific antibodies.We present a clinical case of an antisynthetase syndrome in a middle-aged patient who has presented severe myalgic syndrome, photodermatosis, Raynaud’s phenomenon. The disease debuted with cutaneous (heliotropic erythema, erythematous rash on the skin of the upper torso) and myalgic symptoms, fever with next adding of the joint syndrome, as well as lung damage (pulmonitis and infiltrates). Immunological testing revealed anti-Jo-1, anti-PL-12-, anti-PL-7 antibodies («Polycheck», BIOCHECK, Germany). Since years, the patient has got the diagnosis of antisynthetase syndrome. The use of combined pulse therapy with cyclophosphamide and methylprednisolone, as well as the addition of high doses of vitamin D3 has contributed to the regression oflung damage and reduction of dermatomyositis activity.

Computed tomography in the differential diagnosis of interstitial lung diseases in occupational health

High-resolution computed tomography made it possible to assess changes in the lungs from the effects of industrial aerosols in the development of interstitial pulmonary diseases of professional and non-professional Genesis in 342 patients: pneumoconiosis, hypersensitive pneumonitis, allergic and fibrosing alveolitis, sarcoidosis, pulmonary tuberculosis. High-resolution computed tomography was an additional method in the diagnosis of various forms of lung diseases.

Idiopatic fibrosing alveolitis in a newborn

The article describes a clinical case of idiopathic fibrosing alveolitis – a rare antenatal disease of a newborn. The disease began with the clinical manifestations of transient tachypnea in a full-term child born in the operative way. Chest X-ray was used for dynamic control of lung tissue damage. Due to the absence of specific clinical symptoms of interstitial lung damage, the disease was considered as a course of congenital pneumonia. The researchers used antibacterial and symptomatic therapy. Despite treatment, the respiratory failure progressed, resulting in fatal outcome.

Hamman–Rich syndrome in a young child

Hamman–Rich syndrome (idiopathic fibrosing alveolitis) is a lung disease of unknown nature, characterized by non-infectious inflammation of the interstitium, alveoli and terminal bronchioles with an outcome in progressive pulmonary fibrosis. Idiopathic fibrosing alveolitis in young children, despite the timely verification of the diagnosis and therapy, is characterized by an unfavorable prognosis and rapidly progressive course. The article describes the clinical case of Hamman–Rich syndrome in a child of 8 months, its main clinical manifestations and diagnostic features.

Homicidal Paraquat Poisoning Following Ligature Strangulation

We report a case of homicidal paraquat poisoning preceded by attempted manual strangulation. The poison had been forcibly ingested when the victim was unconscious due to pressure on the neck. The victim survived for ten days and died due to development of fibrosing alveolitis. The autopsy showed classic features of proliferative stages of paraquat poisoning and healing signs of ligature strangulation.