Acute myocardial damage in new coronavirus infection (COVID-19)

Introduction. Acute respiratory distress syndrome (ARDS) and cardiovascular events, acute myocardial injury being the most frequent of the latter, are among the leading causes of death in COVID-19 patients. The lack of consensus on acute myocardial injury pathogenesis mechanisms, the patients management, treatment an rehabilitation logistics, the anticoagulant treatment in identified SARS-CoV-2 or suspected COVID-19 patients setting indicates the need to assess, analyze and summarize the available data on the issue.Materials and methods. Scientific publications search was carried out in PubMed, Google Scholar databases for the period from December 2019 to September 2021.Results and Discussion. Cardiospecific troponin I increase beyond reference limits is reported to occur in at least every tenth patient with identified SARS-CoV-2, the elevated troponin detection rate increasing among persons with moderate to severe course of the infection. The mechanisms of acute myocardial injury in patients with COVID-19 are poorly understood. By September 2021, there are several pathogenesis theories. A high frequency viral myocarditis direct cardiomyocytes damage is explained by the high SARS-CoV-2 affinity to ACE2 expressed in the myocardium. The cytokine storm related myocardial damage is reported a multiple organ failure consequence. Coagulopathy may also trigger myocardial microvessels damage. Up to every third death of SARS-CoV-2 infected persons is related to the acute myocardial injury. At the same time, due to the high incidence of the acute myocardial injury, it is rather difficult to assess the true incidence of acute myocardial infarction in patients with COVID-19. In the pandemic setting, the waiting time for medical care increases, the population, trying to reduce social contacts, is less likely to seek medical help. In this regard, in order to provide effective medical care to patients with acute myocardial infarction, it is necessary to develop algorithms for providing care adapted to the current epidemiological situation.Conclusion. The treatment of patients with probable development of acute myocardial damage against the background of new coronavirus infection should be performed in accordance with the current clinical guidelines. Anticoagulant therapy should be administered in a prophylactic dose under control of hemostasis parameters and a wide range of biochemical parameters.

Development of thyroid pathology in medical workers with chronic exposure to low doses of ionizing radiation

Introduction. The literature review deals with the effects of ionizing radiation and radiation on the body of medical personnel.Materials and methods. 50 actual sources were analyzed. The relevance of the study of the constant, long-term influence of low doses of radiation is shown, in view of the increasing use of sources of ionizing radiation in various fields of scientific and practical human activity, including medicine.Results. Thanks to the analysis of numerous literature data, it was revealed that operating doctors, who are faced in their work with sources of ionizing radiation, often do not have a sufficient level of protection of the thyroid tissue from radiation. It was revealed that the overwhelming majority of studies highlighting thyroid pathology in medical personnel working with X-rays are aimed at identifying the risks of thyroid cancer and does not take into account the pathology of non-tumor genesis. Analyzed the data of scientific publications, allowing to draw a conclusion about the effects of chronic exposure to ionizing radiation, namely X-rays, in low doses on the thyroid tissue from a morphological and functional point of view.Discussion. It was established on the basis of the analysis of experimental data that under the influence of low-dose X-ray radiation, the intercellular contacts of thyrocytes are disconnected, which can lead to a decrease in the synthesis of thyroid hormones and, as a consequence, to the development of hypothyroidism.Conclusion. Based on the analysis of the experimental data, it has been established that under the influence of low-dose X-rays there is a disconnection of intercellular contacts of thyrocytes, which may lead to a decrease in the synthesis of thyroid hormones and, consequently, to the development of hypothyroidism.

Significance of endometrial dysfunction markers in the pathogenesis of chronic endometritis in women with reproductive losses

Introduction. A review of the literature considering the problem of reproductive health against the background of chronic endometritis is presented. According to the literature, in the etiology and pathogenesis of infertility and habitual miscarriage, the main cause is the «uterine factor» (24-62%). Chronic inflammation in the uterine mucosa can lead to infertility, which increases the significance of this pathology. It is proved that most often the causative agents of this disease are representatives of conditionally pathogenic microflora. Chronic endometritis is an unexplored pathology associated with unfavorable reproductive outcomes, such as unsuccessful implantation and repeated miscarriage. Most scientists assume that inflammation develops against the background of a long-term persistence of an infectious agent. According to other scientists, the cause of the occurrence and development of chronic endometritis is an autoimmune process that contributes to the progression of inflammation. The article describes the mechanisms of impaired receptivity, endometrial microcirculation and changes in the ratio of cells of the immune system. In this article, we aim to give an overview of the diagnosis, etiology, pathophysiology and treatment of chronic endometritis, its effect on endometrial receptivity and its relationship with reproductive dysfunction.The aim of the study is to identify the main discussed aspects of the management of patients with chronic endometritis, to determine promising diagnostic methods.Materials and methods. The analysis and systematization of the data were carried out on the basis of scientific publications in the common database of Cyberleninka and PubMed.Results and Discussions. The article discusses the methods of laboratory, ultrasound and instrumental diagnostics used in Russia and abroad. The» gold standard « of diagnostics is a histological examination of the endometrial tissue material on the 7th10th day of the menstrual cycle. The article describes the mechanisms of impaired receptivity, endometrial microcirculation and changes in the ratio of cells of the immune system.Conclusion. Chronic endometritis remains an important problem in modern society, as it has a social significance: the frequency of reproductive losses is at a high level. There is a need to further study the features of the etiology and pathogenesis of chronic endometritis in order to improve the presentation of the course of the inflammatory process and improve the methods of therapy and prevention of this disease for the realization of reproductive function.

Cytological evaluation of a single cell culture of Luminal A subtype breast carcinoma cells

Introduction. Despite significant advances in the creation of stable cell lines, the focus of research has recently shifted toward the creation of primary cell cultures derived directly from patient tumor samples, which include both tumor cells and microenvironmental cells.The aim of the study was to compare the morphological characteristics of the cells of a breast carcinoma sample when cultured over three passages.Materials and methods. Material for the study was obtained during surgical intervention in a patient diagnosed with breast carcinoma. Slices were prepared from the tumor sample according to the standard histological protocol and stained with monoclonal antibodies to estrogen, progesterone, Ki-67, Her2/neu receptors. Cell nuclei were stained with hematoxylin. Immunohistochemical reaction was performed in DAKO autostainer (Denmark). Part of the material was placed in Hanks' solution with 5% antibiotic antimycotics and delivered to the Cell Culture Laboratory, where after performing the standard protocol for obtaining cell culture, tumor cells were diluted in Mammocult nutrient medium and placed in culture vials. For morphological evaluation, cells were stained by Pappenheim. For immunocytochemical analysis in determining the belonging of cells to epithelial cells using anti-Pan Keratin Primary Antibody antibody. The number of cells was counted in an automatic TC20 counter, and culture growth was monitored using an Eclipse TS100 microscope, Nikon (Japan).Results and Discussion. On the basis of immunohistochemical study, the tumor sample was classified as Luminal-A subtype. During the study several groups of cells were isolated and cytologically evaluated. The results of immunocytochemical analysis of the cultured cells confirm that the tumor cells retained their epithelial phenotype during culturing. In spite of the manifestation of cell polymorphism in BML cell culture, during three passages the cultured tumor cells retained their epithelial nature and showed a tendency to form a monolayer.Conclusion. A detailed study of cytomorphology and immunocytological characteristics of cultured cells of different immunohistochemical PBMC subtypes will help to evaluate the main regularities of tumor cell vital functions in vitro and allow a more differentiated approach to the creation of personalized cell cultures in order to develop a targeted chemotherapeutic effect on tumors of specific patients.

Anesthesiologic management of elective endovascular stenting of coronary artery

Introduction. Ischemic heart disease is the most common cause of death in the Russian Federation and in the world. One of the main methods of surgical treatment is endovascular stenting of the coronary arteries. Despite the minimally invasive method, there is a need to ensure sedation of the patient during the intervention. The main type of anesthetic aid for this procedure is monitored sedation.The aim of the study was to conduct a comparative analysis of the two most frequently used regimens of monitored sedation for elective endovascular interventions in world practice.Materials and methods. From January to July 2021, a prospective cohort study was conducted that included 70 patients. A comparison was made between the sedation group using phenazepam (n = 38) with the analgosedation group (n = 32) — a combination of sibazone and fentanyl. The comparison was made by the level of sedation (RASS scale), the severity of anginal pain at the stage of stenting of the coronary arteries according to the VAS; vital indicators of patients (sBP, dBP, avgBP, HR, SpO2).Results. The use of a monitored sedation regimen (sibazone + fentanyl) leads to deeper sedation according to the RASS and a more significant decrease in heart rate in patients at the stage of coronary artery stenting compared with the use of benzodiazepine (phenazepam) alone. Despite this, the incidence of anginal pain during the intervention did not differ statistically significantly between the comparison groups.Discussion. In this work, we compared two approaches to anesthetic protection when performing planned endovascular stenting of coronary arteries, which are most often used in foreign and domestic interventional practice.Conclusions. The use of analgosedation (sibazone + fentanyl) for elective endovascular stenting of coronary arteries has no significant advantages over sedation with benzodiazepines (phenozepam) for these types of interventions. It becomes obvious that it is necessary to continue the search for more effective and safer schemes of anesthetic management during planned endovascular stenting of coronary arteries.

Assessment of the predictive value of the NTISS scale for neonatal outcomes

Introduction. Improving the disease severity scoring systems at the stages of inter-hospital transportation remains an actual in neonatal intensive care. Therapeutic scales remain poorly studied and their predictive value and practical applicability. The aim of the work is to determine the predictive value of the NTISS scale at the stage of pre-transport preparation in relation to the treatment outcomes of newborns.Materials and methods. The cohort study included data from 604 visits of the resuscitation and consultation center transport team. The evaluation was performed on the NTISS scale, and the outcomes were studied. The AUC ROC curve of the NTISS scale was calculated in relation to the binary outcomes. The correlation analysis of the quantitative data was performed by Spearman's criterion.Results. AUC greater than 0.8 was observed for the risk of death (AUC=0,823 (0,758-0,888)), 7-day mortality (AUC=0,827 (0,752-0,901)), late onset sepsis (AUC=0,808 (0,737-0,879)), bronchopulmonary dysplasia (AUC=0,810 (0,763-0,856)), severe intraventricular hemorrhage (AUC=0,847 (0,804-0,889)) иocclusivehydrocephalus(AUC=0,830 (0,757-0,904)). Similarresultswereobtained analyzing the outcomes among the surviving patients. For other binary outcomes, the scale shows an AUC of less than 0.8. The analysis of outcomes among the surviving patients showed a weak correlation between the NTISS score and the duration of intensive care, r=0.492, p<0.0001, and the duration of hospitalization, r=0.498, p<0.0001.Discussion. The NTISS scale demonstrated an acceptable level of accuracy (AUC>0.8) in predicting hospital mortality, late neonatal sepsis, bronchopulmonary dysplasia, severe intraventricular hemorrhage, and the formation of occlusive hydrocephalus, among both surviving patients and general sample. The observed results are comparable with the information content of other neonatal scales of various types.Conclusion. The predictive value of NTISS in relation to the outcomes of the hospital stage is comparable to the physiological scales described in the literature.

Complicated urinary tract infection in a patient with severe COVID-19

Introduction. At the end of 2019, the world faced a pandemic of infection caused by the SARS-CoV-2 coronavirus. The disease caused by this virus is referred to as COVID-19, and is characterized by multiorgan lesion. The leading syndrome is the syndrome of immune response disregulation or the «cytokine storm». According to the studies, which were used as the basis of patient management clinical protocols, antiinterleukin-6 agents, and glucocorticosteroids, are the most effective in stopping the «cytokine storm». At the same time, the use of immunosuppressive drugs increases the risk of secondary infectious complications not associated with the COVID-19 viral infection.The aim of the study was to present a successful case of treating a secondary bacterial infection in a patient with a severe new coronavirus infection in the context of a limited choice of antimicrobial therapy.Materials and methods. The report presents a clinical case of a complicated urinary tract infection associated with an extremely resistant Kl.pneumoniae strain in a 58-year-old patient hospitalized with severe COVID-19. Due to comorbidity, combined with long-term hospitalization, the need in immunosuppressive therapy, and long-term catheterization of the urinary tract, the patient got affected by Kl.pneumoniae. This pathogen demonstrated microbiological and clinical resistance to all studied classes of antibiotics, including carbapenems, aminoglycosides and polymyxins. The patient developed an abscess of the prostate, and orchiepididymitis, which required repeated surgical interventions.Results and Discussion. The multidisciplinary approach to patient treatment, as well as the use of local and regional epidemiological data made it possible to choose the most effective drug therapy. The combination of adequate surgical debridement and combined antibiotic therapy (ceftazidime/avibactam and aztreonam) led to regression of the complicated urinary tract infection manifestations and clinical recovery.Conclusions. The use of ceftazidime/avibactam and aztreonam combination is a promising therapeutic option for the treatment of infections caused by extremely resistant strains of Enterobacterales, in which the combined production of serine proteases and metallobetalactamases is expected.

Organization of medical care in FMBA institutions of the siberian federal district during the pandemic of new coronavirus infection (COVID-19): challenges and solutions

Introduction. The experience of organization of medical activity in the medical institutions subordinate to the FMBA of Russia in the Siberian Federal District during the I-III epidemic waves of COVID-19, the procedure for making and implementing organization and managerial decisions on building the health care system; the analysis of the experience gained in the formation and operation of consolidated mobile emergency response teams was made.Materials and methods. The study was performed on the basis of the statistical data, regulations on the organization of medical care for patients diagnosed with COVID-19, including medical care provision in the extreme conditions.Results and Discussion. The rational distribution of infectious diseases hospitals, human resources and equipment made it possible to create bed capacity reserve, as a result of which, even during the peak episodes of the pandemic process, the average occupancy of beds in the serviced area was no more than 92-93% and there was always the possibility to receive new patients in hospitals; the capacity of the laboratory was gradually increased 25 times: from 200 tests per day in the pre-pandemic period to 5,000 tests per day. Thanks to the introduction of the new management solutions, digitalization of medical processes has been ensured: accounting of results in the medical information system, transmission of results directly to medical institutions within 12-14 hours, which is 4 times faster than the standard time. The legal regulations of interaction with the rescue centres of the Ministry of Emergency Situations of Russia, the Ministry of Defense and other power structures, the improvement of the material and technical equipment of basic mobile hospitals and emergency medical teams were proposed for discussion.Conclusion. A scheme has been worked out for the involvement of the MOF of the Federal Medical and Biological Agency of Russia in the timely organizational measures for mobilization of forces and means in order to ensure the re-profiling of medical activities to work on providing medical care in the COVID-19 pandemic conditions.

Physical development and its relationship to the metabolic activity of the intestinal microbiota in young children

Introduction. The metabolic activity of the intestinal microbiota is an important indicator of the functioning of the digestive tract, one of the main functions of which is the absorption of nutrients.The aim of the study was to analyze the content of short chain fatty acids in feces and assess their relationship with the indicators of physical development in children 3 years of age.Materials and methods. A prospective cohort study was conducted in 89 children 3rd year of life. The 1st observation group included children of the I and II health groups, the children of the 2nd group underwent surgical treatment on the intestine in the first months of life, the children of the3rd group are with atopic dermatitis. FD assessment was carried out in accordance with WHO recommendations (2017) the spectrum of FGC in feces was determined by gas-liquid chromatography.Results. It was determined the features of the rates of FD in healthy children, children with a history of intestinal resection and children with atopy in relation to the indicators of metabolic activity of the intestinal microbiota. The percentile distribution of the values of FGC in feces and their comparative assessment in the observation groups are given.Discussion. The content of FGM in feces has differences depending on the health status of children of the 3rd year of life. Different level of FGC shows a close relationship with the indicators of FD. Conclusions. A decrease in growth rates (body length SD: from -1 to -2) was revealed at low values (<25%) of the amount of acids, with an increase in propionate (25%) in feces. Reduced nutrition (body weight SD: from -1 to -2) it was associated with low values of the sum of isoacids and AI(-) (<25%); by 3rd year of life, the risk of low nutrition decreased in 4 times with high values (75%) of the sum of acids in feces (OR=4.33[1.09-17.71]). The multidirectionality of the content of fecal matter in young children and their influence on the indicators of FD emphasizes the versatility of the functions of the intestinal microbiota, which has a local and systemic effect on the human body.

The role of procalcitonin and lactate at single determination in the intensive care unit in the diagnosis and prognosis of hypovolemic and distributive (septic) shock

Introduction. The greatest difficulties arise in the differential diagnosis of hypovolemic or distributive (septic) shock. The aim of this study was to critically analyze the information value of the blood plasma content of lactate and procalcitonin (PCT) in patients with septic and hypovolemic shock.Materials and methods. The diagnosis of «Sepsis» and «Septic shock» in the study was established according to the criteria of «Sepsis-3». 143 IRCs were filled, 34 of them with septic shock, 44 IRCs with hypovolemic, 65 IRCs with sepsis and organ dysfunction (OD).Results. When determining the content of PCT in the blood plasma in patients with septic and hypovolemic shock, we found a statistically significant difference. The level of PKT in infectious shock —33.3 (95% CI 7.9 — 58.0) ng / ml was higher than hypovolemic-0.9 (95% CI 0.43 — 6.45) ng/ml on average more than 30 times. In contrast to PCT, the content of lactate in the blood plasma did not carry a differential diagnostic value. Once measured at admission to the ICU, the level of PCT has no informational significance and does not indicate a likely outcome of the disease, complicated by the development of septic and hemorrhagic shock. Together with the low predictive ability of the nature of shock, lactate was highly informative in relation to the outcome of the disease, complicated by the development of shock syndrome.Discussion. In our analysis, it is obvious that there were observations when the PCT level during hypovolemia was noticeably higher than normal, reaching a maximum of 6.4 ng / ml. Apparently, there was a combination of factors with an obvious activation of a trigger that affects its libration or the presence of endotoxinemia in hypovolemic shock in these specific patients. The informational value of PCT is not absolute and, according to meta-analyzes, is about 80%.Conclusion. The blood content of procalcitonin in shock of an infectious nature was more than 30 times higher than the hypovolemic level on average. The informational value of procalcitonin in terms of predicting the course of the disease in septic and hypovolemic shock is absent. In the absence of predicting the nature of the shock, lactate is informative about the outcome of the shock. The possibility of increasing the blood lactate content in severe hemorrhagic shock with renal damage was noted.