Objective: Cytokine storm is considered as the immune hyperinflammatory process which may deteriorate the course of COVID-19. Interleukin (IL-6) inhibitors can be used in severe COVID-19 patients due to their anti-inflammatory and antiimmune effects. We aimed to assess the therapeutic effect of tocilizumab (Actemra) in patients with severe COVID-19 pneumonia. Methods: Overall, 1382 patients were admitted to a temporary hospital during July outbreak of COVID-19. Of these, 282 patients were hospitalized. Baseline clinical, radiological and laboratory data were collected from patient records. Laboratory markers prior to discharge were also collected. Wilcoxon rank sum test was conducted to show the significance of change of laboratory markers. Results: Eleven of the 282(3.9%) hospitalized patients who had severe pneumonia confirmed by either chest radiography (CXR) or computed tomography (CT) received tocilizumab (Actemra). Polymerase chain reaction (PCR) viral markers of COVID-19 were positive in three cases. Hypoxemia and surrogate markers of cytokine storm improved after the prescription of tocilizumab (p=0.003 in all laboratory parameters). Two of the patients who received tocilizumab have been transferred to reference centers. No mortality or adverse reactions case was registered. Conclusion: Our observational study demonstrated significant improvement in oxygen saturation, reduction in inflammatory markers-leukocytosis, CRP and D-dimers and 83% recovery without need for mechanical ventilation and no mortality in patients with COVID-19 with severe multilobar bilateral pneumonia and CT score 3-4 receiving tocilizumab in addition to standard treatment.

In this article, we provided summary of knowledge on left ventricular posterior wall rupture as a complication of mitral valve replacement surgery and shared our experience with such complication.

We aimed to retrospectively analyze morbidity and mortality in recipients of kidney and liver transplant receiving immunosuppressive therapy (tacrolimus and cyclosporine with mycophenolate mofetil and mycophenolic acid). Overall, 228 patients who underwent kidney and liver transplantation were included in the study. The overall graft survival of patients who underwent kidney and liver transplantation from 1999 to 2017 was 84.2%. Combinations including cyclosporine, were associated with high rate of complications acute rejection, CMV and candida infections as compared to tacrolimus. The most unfavorable in terms of mortality was combination of cyclosporine -mycophenolate mofetil.

In our study we conducted survival analysis of 204 patients visited Scientific-Research Institute of Heart Surgery and Organs transplantation and who underwent renal transplantation in Kyrgyzstan and other Eurasian countries between 2005 and 2016 years (age range: 9-71 years, mean: 38.21 (12.74) years, median: 34.0 (0.89) years; gender: 142 male (69.6%)). During follow-up period, mortality event was observed in 16 (7.84%) patients. Survival function probabilities of patients and rational risk factors of survival functions were evaluated by Kaplan-Meier and Cox regression analyses, respectively. According to Kaplan-Meier results survival probabilities calculated for 1st year: 0.96 (0.014), for 3rd year: 0.94 (0.018), for 5th year: 0.86 (0.04), for 7th year: 0.75 (0.10). Among age groups 28-39 age ranges prevailed by 11 patients. Nevertheless, that difference did not show statistical significance: p˃0.322. The intensity of transplantation also analyzed according to years, which revealed increasing in numbers of operations by time. For instance, when in 2006 only two cases were registered in our center, but numbers of transplanted patients reached up to 48 in 2015. The association of mortality states and years of transplantation found significantly by Kaplan-Meier test (Breslow p˂0.001). The survival analysis was compared according to countries and revealed significant results (Breslow p˂0.05). From other factors influencing mortality, sex did not show strong impact on survival by Kaplan-Meier analysis, but significant association was found by Cox regression analysis.

AsbtractWe describe a rare case of surgical management of multiple echinococcosis of left ventricle.