Myocardial damage in new coronavirus infection (review)

Introduction. Myocardial damage characteristic of novel coronavirus infection is a confirmed risk factor for its severe course and high mortality. There are biomarkers of this condition correlating with an unfavorable prognosis for the patient. However, the information on the problem of myocardial damage in the available literature is not fully systematic. It concerns pathogenesis, differential diagnosis of its causes, routing of patients with acute coronary syndrome. All the above is very important for choosing the right tactics of examination and treatment of patients, who are often limited in time. Aim. To summarize the data available at the time of writing from domestic and foreign researchers on the problem of myocardial damage and its main causes (acute coronary syndrome, myocarditis, stress cardiomyopathy) in COVID-19. Materials and methods. This review summarizes the data from articles published over the past two years found in PubMed, Google Scholar and eLIBRARY. Results. The authors tried to form a generalized modern understanding of the causes and structure of cardiovascular pathology and risk factors of its destabilization in patients infected with SARS-CoV-2, the markers of increased risk of COVID-infected heart and vascular diseases, the tactics of examination and treatment of this category of patients, routing individuals with acute coronary syndrome and its differential diagnosis with non-coronary heart diseases. The questions of organization and availability of the medical care in the conditions of the pandemic and social aspects of the world cardiology problems in the current situation have been studied. Conclusion. Patients with cardiovascular disease have a more severe prognosis of the severity and outcome of COVID-19, which is explained by its pathogenesis. The group at highest risk of lethal events is composed of individuals with signs of myocardial damage, the causes of which are the above mentioned conditions. Their differential diagnosis is a difficult clinical task, which requires a systematic analysis of the dynamics of clinical syndromes and data of additional diagnostic methods from routine to the most modern (high-tech) and, of course, deep knowledge of the present problem. The correct determination of the cause of myocardial damage and the choice of the right patient’s route through the treatment network determines the effectiveness of treatment and, therefore, the prognosis of the patient’s life.

Effect of COVID-19 on development and progression of endocrinopathies in children

Introduction. An outbreak of coronavirus (COVID-19) declared an emergency of international public health importance. More information is now available on how COVID-19 affects people, including children and adolescents. SARS-CoV-2 is a new virus, and so far, there is insufficient data on what endocrinopathies it can cause in children, and how it affects patients with a history of endocrine pathology. Aim. Review containing data from foreign studies on the effects of coronavirus infection on the development and progression of child and adolescent endocrinopathies. Materials and methods. An analysis of publications containing data from studies of COVID-19 cases in children was carried out. Results. Currently, foreign studies indicate the provoking effect of COVID-19 on the development and progression of endocrinopathies in children and adolescents. Conclusion. Future studies should include a comprehensive assessment of the endocrine system during the acute phase and recovery phase after undergoing COVID-19, as there is no long-term follow-up until the significant impact of this virus on the development of endocrinopathies in children can be ruled out.

Clinical observation of a patient with hemangiomatosis involving skin, subcutaneous tissue, lung, stomach, intestinal, liver, kidney, spine

Aim. The work demonstrates a clinical case of an extremely rare pathology ‒ hemangiomatosis with damage to the skin, subcutaneous tissue, lungs, stomach, intestinal, liver, kidneys, and spine. Results. Patient L., born in 1994 with multiple hemangiomas. No heredity was observed for vascular tumors. In childhood, several large hemangiomas had to be surgically removed. She resorted to the Amur Regional Perinatal Center about her first pregnancy. There was a high risk of hemorrhagic complications due to damage to internal organs, primarily the lungs. Since there were multiple lesions of the vertebrae, it was decided not to use neuraxial methods of anesthesia. Total intravenous anesthesia and artificial ventilation of the lungs under the control of bronchoscopy were chosen by the method of anesthesia. Hemangiomatosis with lesions of internal organs was the indication for a Cesarean section. The operation took place without complications. The child was born healthy. Conclusion. In most cases, cosmetic defects are a significant problem of hemangiomatosis. However, in a number of situations, for example during pregnancy, there is a high risk of rupture of hemangiomas and the development of bleeding. In this case, the choice of the method of delivery and anesthesia depends on the location of the hemangiomas.

Electrical activity of expiratory muscles in type 2 diabetes mellitus

Aim. To study the functional state of the expiratory muscles in patients with type 2 diabetes mellitus on the basis of changes in their electrical activity when using a functional test with a static expiratory effort. Materials and methods. 47 patients with type 2 diabetes mellitus and 40 patients without disorders of carbohydrate metabolism were examined. To study the electrical activity of the expiratory muscles, surface electromyography (EMG) of the external oblique abdominal muscle (OAM), rectus abdominis muscle (RAM), and internal intercostal muscles (IIM) was performed using a functional test with a static expiratory effort. Results. When performing a functional test with a static expiratory effort in both groups, a decrease in the frequency and an increase in the amplitude of EMG was observed, however, in patients with type 2 diabetes mellitus, these changes were less pronounced. There were also differences in the dynamics of changes in EMG indicators. In patients with type 2 diabetes mellitus, the decrease in the frequency of EMG OAM began from 10 seconds of the test, IIM – from 15 seconds, in the comparison group – from 5 and 10 seconds, respectively. The OAM EMG amplitude in the main group did not change significantly, in the comparison group it increased from 5 seconds of expiratory effort. At the 10th second of the test, the amplitude index of the EMG OAM in patients with type 2 diabetes mellitus was 10.4% lower (p=0.027) than in the comparison group, and at the 15th second – by 10.5% (p=0.033). Conclusion: The change in the electrical activity of the expiratory muscles in patients with type 2 diabetes mellitus is due to the slowed down dynamics of the frequency-amplitude characteristics of the EMG OAM, uncompensated IIM fatigue, as well as lower values of the OAM EMG amplitude when performing a functional exercise test with a static expiratory effort.

Some opportunistic infections in the structure of premature birth causes

Aim. To determine the structure and detection rate of some opportunistic infections in premature birth.Materials and methods. The study was carried out at the premises of the Research Institute of Maternity and Childhood Protection and the Pathology Department of the Khabarovsk Perinatal Center. We studied 62 placentas from women whose pregnancy ended prematurely and placentas and organ samples (heart, lungs, liver, and kidneys) from 14 premature infants who died in the early neonatal period. Thirty placentas of women who delivered full-term live babies were classified as a control group. Genomes of Chlamydia trachomatis, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma species (Ureaplasma urealyticum + Ureaplasma parvum), Cytomegalovirus, Herpes simplex virus, Human herpesvirus 4 type, Human herpesvirus 6 type, Parvovirus B19, Listeria monocytogenes, Streptococcus agalactiae, Streptococcus species, Streptococcus pyogenes, Haemophilus influenza, Klebsiella pneumoniae, Candida albicans were detected by polymerase chain reaction (PCR) in samples of placental tissue and samples of internal organs of deceased newborns. Results. The rate of opportunistic agent detection in the placentas from women with preterm birth made 59.6% and in the sectional material from premature newborns who died in the early neonatal period (78.6%), which figures exceeded the same indicator in the control group (30.0%) respectively, by 2.0 (p=0.007) and 2.6 (p=0.002), respectively. In 47.9±7.2% of cases of all positive results, the material from women with preterm birth presented with various combinations of two, three, and four infectious agents, having common pathogenic links, which contributes to the aggravation of pathogenic processes, comorbidity or multimorbidity. According to the detection rates, in terms of total monoinfections and mixed infection components, pathogens detected during preterm birth were distributed as follows: U. urealyticum ‒ 34,2±5,4%; S. agalactiae ‒ 17,1±4,3%; M. hominis ‒ 15,8±4,1%; S. species (S. sanguis, S. salivarius, S. mitis, S. mutans) ‒ 13,1±3,8%; Cytomegalovirus ‒ 11,8±3,7%; Human herpesvirus 4 type – 9,2±3,3%; M. genitalium ‒ 2,6±1,8%. Conclusion. PCR testing showed that placentas from women whose pregnancy ended prematurely and samples of placenta and organs of premature infants who died in the early neonatal period presented with opportunistic agents colonizing female genital tract (streptococci, mycoplasmas) or ubiquitous herpesviruses persistent and reproduced in human lymphocytes (Cytomegalovirus, Human herpesvirus 4 type). Associations of microorganisms that cause comorbidity or multimorbidity account for a significant portion of the infectious agents detected. The context for a microbiota-integrated opportunistic agent to transform into a pathogenic strain, identification of transformation predictors, and possible tools to correct the disorders – all these require further research.

Resources of modern radiation diagnostics of sarcoidosis (review)

Introduction. Sarcoidosis is a significant social and medical problem. Diagnosis is based on consistency of the clinical picture, histological evidence of granulomatous inflammation, exclusion of alternative diseases, and evidence of systemic involvement. There is no “gold” diagnostic standard for sarcoidosis. Aim. Review of the latest world literature data on the possibilities of modern radiation diagnosis of sarcoidosis. Materials and methods. The review summarizes data from literature published mainly over the past five years in PubMed and eLibrary. Earlier publications were also included as necessary. Results. In the literature review, modern medical imaging methods used to diagnose sarcoidosis, which in some cases can avoid biopsy, are considered. First of all, these are X-ray methods. Today, high-resolution multispiral computed tomography with three-dimensional imaging, as the method with the highest sensitivity, plays a decisive role in the diagnosis and monitoring of sarcoidosis. The use of magnetic resonance imaging and low-dose computed tomography is not well understood in patients with sarcoidosis. Quantitative computed tomography and radiomics techniques have only been partially tested in sarcoidosis. Conclusion. The imaging of sarcoidosis is the subject of a large number of publications that provide detailed descriptions of X-ray and computed tomography techniques. Nevertheless, despite the introduction of new computerized tools for the analysis of chest imaging, traditional X-ray techniques still remain an important role in both the diagnostic and prognostic assessment of changes characteristic of sarcoidosis

Role of Toll-like receptors in COVID-19 pathogenesis

Introduction. This review summarizes the available information on the role of Toll-like receptors (TLRs) in the pathogenesis of the novel coronavirus infection COVID-19 induced by SARS-CoV-2. The exact pathogenesis of COVID-19 and the role of each component of innate and adaptive immunity are still unknown. Aim. Discussion of the possible role of TLRs in the immune response in COVID-19 infection. Results. Analysis of the literature in the PubMed database showed that the mechanism of penetration of SARS-CoV-2 and lysis of type II alveolocytes is the binding of the spike S-glycoprotein or capsid protein M of the virus to the receptor-binding domain of ACE2 on the surface of epithelial cells. Migration and infiltration of inflammatory cells leads to overactivation of TLR4 on the surface of alveolocytes and bronchial epithelium, shifting the process to MyD88-dependent acute inflammatory signaling and hypersecretion of proinflammatory cytokines that cause a “cytokine storm” and the development of severe complications of COVID-19 infection, in particular, acute respiratory infections, respiratory distress syndrome, pathology of internal organs, and, in some cases, the death of the patient. Conclusion. It is possible to suggest that TLRs have an impact on the immune response in COVID19 infection. Both antagonists and agonists of TLRs, depending on their type, can be examined to determine the therapeutic and negative effects of COVID-19 infection. Further research is needed to investigate TLRs and pathways for activating cytokine expression, as they indicate a direct relationship with mortality and virus susceptibility. Bioinformatic research can also help to better understand the interaction of TLRs with proteins and RNA of the SARS-CoV-2.

Effect of the water-soluble cholesterol-methyl-β-cyclodextrin complex on the development of pulmonary edema with an analysis of the osmotic resistance of erythrocytes in rats

Introduction. Methyl-β-cyclodextrin is a potent acceptor of cellular membrane cholesterol and, at the same time, used as a solubilizer, which makes it a potential target for targeted delivery of hydrophobic compounds.Aim. To assess the effect of administration of methyl-β-cyclodextrin containing cholesterol on the degree of lung hydration and osmotic resistance of erythrocytes against the background of pulmonary edema in adult rats caused by the administration of mezaton.Materials and methods. We investigated the degree of hydration of the lungs by the value of the pulmonary coefficient and their dry residue. Osmotic resistance of erythrocytes were assessed by the intensity of their hemolysis in a series of hypotonic sodium chloride solutions in adult male Wistar rats (220±40 g) of the control group (intact, n=10) and two experimental groups with pulmonary edema caused by the administration of mezaton (n=10) and with the subsequent introduction of a water-soluble complex cholesterol-methyl-β-cyclodextrin against the background of the development of pulmonary edema (n=10). We used additional criteria for assessing the osmotic resistance of erythrocytes: minimum resistance – the concentration of sodium chloride solution, at which the first “weak” erythrocytes begin to hemolyze; maximum resistance is the concentration of sodium chloride solution at which all or almost all erythrocytes hemolyzed.Results. The introduction of mezaton led to the development of pronounced hemolysis and hydration of the lungs with the development of their edema and a narrowing of the range of minimum and maximum osmotic resistance of erythrocytes. The introduction of a complex of cholesterol with methyl-β-cyclodextrin after edemogenic exposure led to a decrease in the severity of pulmonary edema, determined by a decrease in the pulmonary coefficient and an increase in the dry residue, and to an increase in the osmotic resistance of erythrocytes with an expansion of the range of their minimum and maximum osmotic resistance.Conclusion. The introduction of a water-soluble complex of cholesterol with methyl-β-cyclodextrin against the background of the development of hemodynamic pulmonary edema significantly reduced the degree of hydration of the lungs, which combined with an increase in the osmotic resistance of erythrocytes.

Regression analysis to estimate the response of the respiratory organs to exposure of air microtoxicants in chronic obstructive pulmonary disease

Inroduction. The assessment of the respiratory system is of particular importance in the context of increasing impact of anthropogenic factors on human health. Aim. Evaluation the response of the lung function indices to the effects of micro-suspensions and toxic metals in patients with chronic obstructive pulmonary disease (COPD), using regression models. Materials and methods. The study involved 60 patients with stable mild-to-moderate COPD and 30 healthy people (the control group). The analysis of lung function was carried out by spirometry and body plethysmography. Arterial oxygen saturation (SaO2 ) was measured by pulse oximetry. Exhaled CO2 concentration and blood carboxyhemoglobin (COHb%) concentration were assessed using a portable analyzer MicroCO Meter. The pollution of the city atmosphere was assessed by aerosol suspensions of solid particles in the areas of residence of the examined patients. Fractional composition of suspended particles (0-1, 1-10, 10-50, 50-100, 100-400, 400-700,> 700 μm; %) were analyzed in the areas of residence of the examined patients. Toxic metal (Pb, Cr, Mn, Fe, Co, Ni, Cu, Zn; μg/L) levels in the air samples were determined. The statistical module "Multiple regression" was used for assessing the response of functional parameters of the respiratory system. Results. The analysis of one-factor and multi-factor regression models made it possible to identify both trigger factors of dust and technogenic air pollution and the synergistic effect of the influence of dominant factors. It has been shown that multifactorial reactions to technogenic impact manifest as altered blood oxygen saturation and carboxyhemoglobin level and thereby contribute to the development of respiratory failure. Conclusion. Patients with COPD exhibited increased bronchial resistance to the effect of the trigger factor (Pb – 1 hazard class) associated with high motorization of the city. The response of pulmonary gas exchange (SaO2 ) to Pb in the control group indicates prolonged exposure to toxic metals can cause developing respiratory failure even in the healthy population of the city.

Impact of the COVID-19 pandemic on mortality dynamics in the Far Eastern Federal District

Introduction. New viral respiratory infections in humans make it possible to speak of corona viruses as extremely dangerous human pathogens. They are characterized by a high mortality rate and pose a significant medical and social threat to society due to life-threatening complications of the disease. In this regard, it seems necessary to answer the questions about the dynamics of mortality of the population of the region for different classes of ICD-10 in the prepandemic and pandemic period, including various nosological forms of respiratory diseases. Aim. To assess the degree of influence of the pandemic of the new respiratory coronavirus infection COVID-19 on the mortality rate of the population for various classes of ICD-10, including the class “Diseases of the respiratory system” in the Far Eastern Federal District.Materials and methods. To implement the tasks of the study, a complex of analytical, epidemiological and statistical studies was carried out. Methods used: descriptive statistics, epidemiological analysis and monitoring; mathematical; structural and comparative analysis, methods of time series analysis and content analysis of publications on the problem. Epidemiological and statistical assessment of mortality was carried out on the basis of ICD-10 using the database of the Federal State Statistics Service for 1999-2020 in the territory of the Far Eastern Federal District. For the analysis and processing of statistical information, modern information systems and computer programs (MS Excel-2016) were used. Results. The pandemic of COVID-19 has had a significant impact on the level and structure of mortality across the entire spectrum of the main causes of death, and its magnitude (98.8 per 100,000, 2020), as a new cause of death, exceeds the whole the class of causes of death ICD-10 (J00-J99) by 33.3%, changing the pace and direction of demographic processes in Russia. At the same time, the dynamics of mortality due to respiratory diseases is unprecedented, the level of which in the Russian Federation in the first year of the COVID-19 pandemic increased by 38.8%, and in the Far Eastern Federal District – by 27.7% against the background of the previous long-term stable a downward trend in mortality rates. Especially high growth rates of mortality rates are observed in pneumonia, the level of which has increased by 3.5 times over the last decade, and among city residents – by 4.2 times (Amur Region). Features of the socio-economic and natural-climatic living conditions of the population of the region determine a significant differentiation of regions in terms of mortality rates, including due to respiratory diseases, the gradients of which among the subjects of the Far Eastern Federal District in the first year of the pandemic period (2020) amounted to 2.5 times with a minimum the level in the Republic of Sakha (Yakutia) (40.9 per 100,000 population) and the maximum – in the Jewish Autonomous Region (101.7 per 100,000 population), which indicates the ambiguous degree of influence of the new viral infection on the dynamics of mortality. At the same time, the variability in mortality rates due to respiratory diseases in the previous period (1999-2019) was even more pronounced, and among the subjects of the Far Eastern Federal District, during this period, higher mortality rates were also demonstrated, which are not even comparable to the current level of the pandemic period. These circumstances require a detailed study and a substantive analysis of the degree of influence of a COVID-19 on the mortality rate of the population using mechanisms and methods for its detection, record and registration. Conclusion. The pandemic of COVID19 had a significant impact on the level and structure of mortality across the entire spectrum of major causes of death, especially in the ICD-10 class “Respiratory diseases”, changing the pace and direction of demographic processes.