BackgroundNosocomial CNS infection (NI-CNS) is a common and serious complication in neurocritical care patients. Timely, accurate diagnosis of NI-CNS is crucial, yet current infection markers lack specificity and/or sensitivity. Presepsin (PSP) is a novel biomarker of macrophage activation. Its utility in NI-CNS has not been explored. We first determined the normal range of cerebrospinal fluid (CSF) PSP in a control group without brain injury before collecting data on CSF PSP levels in neurocritical care patients. Samples were analyzed in four groups defined by systemic and neurological infection status.ResultsCSF PSP levels in 15 control patients without neurological injury were 50–100 pg/ml. Ninety-seven CSF samples were collected from 21 neurocritical care patients. In patients without NI-CNS or systemic infection, CSF PSP was 340.4 ± 201.1 pg/ml. Isolated NI-CNS was associated with CSF PSP levels of 640.8 ± 235.5 pg/ml, while levels in systemic infection without NI-CNS were 580.1 ± 329.7 pg/ml. Patients with both NI-CNS and systemic infection had CSF PSP levels of 1,047.7 ± 166.2 pg/ml. In neurocritical care patients without systemic infection, a cut-off value of 321 pg/ml gives sensitivity and specificity for NI-CNS of 100 and 58.3%, respectively.ConclusionCSF PSP may prove useful in diagnosing NI-CNS, but its current utility is as an additional marker only.

Extracorporeal membrane oxygenation (ECMO) is increasingly used to treat severe cases of acute respiratory or cardiac failure. Hemorrhagic complications represent one of the most common complications during ECMO, and can be life threatening. The purpose of this study was to elucidate pathophysiological mechanisms of ECMO-associated hemorrhagic complications and their impact on standard and viscoelastic coagulation tests. The study cohort included 27 patients treated with VV-ECMO or VA-ECMO. Hemostasis was evaluated using standard coagulation tests and viscoelastic parameters investigated with rotational thromboelastometry. Anticoagulation and hemorrhagic complications were analyzed for up to seven days depending on ECMO duration. Hemorrhagic complications developed in 16 (59%) patients. There were 102 discrete hemorrhagic episodes among 116 24-hour-intervals, of which 27% were considered to be clinically significant. The highest number of ECMO-associated hemorrhages occurred on the 2 nd and 3 rd day of treatment. Respiratory tract bleeding was the most common hemorrhagic complication, occurring in 62% of the 24hour intervals. All 24-hours-intervals were divided into two groups: "with bleeding" and "without bleeding". The probability of hemorrhage was significantly associated with abnormalities of four parameters: increased international normalized ratio (INR, sensitivity 71%, specificity 94%), increased prothrombin time (PT, sensitivity 90%, specificity 72%), decreased intrinsic pathway maximal clot firmness (MCFin, sensitivity 76%, specificity 89%), and increased extrinsic pathway clot formation time (CFTex, sensitivity 77%, specificity 87%). In conclusions, early ECMO-associated hemorrhagic complications are related to one traditional and two novel viscoelastic coagulation abnormalities: PT/INR elevation, reduced maximum clot firmness due to intrinsic pathway dysfunction (MCFin), and prolonged clot formation time due to extrinsic pathway dysfunction (CFTex). When managing hemostasis during ECMO, derangements in PT/INR, MCFin and CFT ex should be focused on.

The modern integrated approach to the treatment of ischemic stroke (IS), in addition to pharmacotherapy, provides for the impact of physical factors. Among them is injectable carboxytherapy (ICBT). Objective. The aim of the study was to evaluate the effi cacy and safety of using ICBT in combination with a standard treatment program in patients with acute ischemic stroke. Material and methods. The main group (MG) included 39 patients with acute IS, the comparison group (GC) — 31 patients. On the second day of hospitalization, patients with MG underwent ICBT on the background of standard therapy, and GC — procedures that mimic ICBT. Clinical, laboratory and instrumental data, IS outcomes, complications, timing were assessed.Results. There were no statistically signifi cant diff erences in physiological parameters (heart rate, blood pressure, SpO2) between MG and GC during and after the course of treatment. Positive dynamics of the neurological status was observed in both groups in the form of a decrease in the NIHSS score — in the MG from 6 to 4 (p = 0.047), in the GC — also from 6 to 4 (p = 0.25). In patients with MG, trophic disorders were less likely to develop in comparison with GC — 1 (2.6%) versus 6 (19.4%), p = 0.039. ICBT did not aff ect the duration of hospitalization of patients, the duration of treatment in the intensive care unit and carrying of resuscitation and also did not contribute to reducing mortality. Changes in the indicators of the acid-base state of the blood were compensatory in nature and did not lead to changes in the pH of the blood. The decrease in pH from 7.5 to 7.4 in 30–90 minutes after the procedures was a physiological reaction of the body to the introduction of CO2 and was not accompanied by negative consequences. Conclusions. ICBT is a safe method, does not aff ect the duration of hospital stay and mortality, help lower the likelihood of complications.

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BACKGROUND: Minimally invasive microsurgery has become popular in neurosurgery. Burr hole microsurgery is another more modern minimally invasive technique that allows surgical treatment of various intracranial pathologies through an extreme small craniotomy. This article presents the first application of the burr hole approach for microsurgical clipping of cerebral aneurysms. OBJECTIVE: To assess the feasibility and outcomes of using the burr hole microsurgical technique in cerebral aneurysm surgery. METHODS: From March 2020 to August 2020, 3 patients with unruptured middle cerebral artery aneurysms underwent burr hole microsurgical clipping. RESULTS: Three patients with middle cerebral bifurcation aneurysms were successfully treated. The duration of surgery was from 62 to 83 min (median 72.5). Postoperatively, no new neurological symptoms, complications, or mortality were observed in all the cases. CONCLUSION: Burr hole microsurgery is an advanced neurosurgical method. Although the surgery is performed through a small burr hole approximately 14 mm in size, safe and successful treatment of normal-sized middle cerebral artery aneurysms using standard microsurgical principles and technique is possible.