Vol 31, No 3 (2023)

INTRODUCTION: The ongoing pandemic of a new coronavirus infection COVID-19 (COronaVIrus Disease 2019) places high demands on the activity of PCR-laboratories (laboratories performing polymerase chain reaction). The medical personnel experience overloads due to stay in the ‘red zone’ wearing the individual protection means, and also in association with a high personal responsibility for the result of their work. One of the criteria that is proposed for professional selection with the aim of increasing the effectiveness of the work of personnel of PCR-laboratories, is the emotional quotient (EQ).

AIM: To analyze the state of systemic hemodynamics and heart rate variability in medical workers of PCR-laboratories with different emotional intelligence working in condition of COVID-19 pandemic using means of individual protection against the biological factor.

MATERIALS AND METHODS: The extent of health risk and tension of adaptation mechanisms during the work were evaluated by parameters of systemic hemodynamics (tonometry, pulse oximetry) and heart rate variability (cardiorhythmography). Thirty three individuals with the working period in a PCR-laboratory from 1 to 33 months were examined. The average age of the participants at the time of inclusion in the study was 32.4 ± 1.44 years. In 33.7%, EQ corresponded to the medium level (81–120 points), and in 66.7% — to the high level (121–168 points).

RESULTS: Before the start of the work shift, increased blood supply to tissues in personnel with high EQ was achieved by increased heart activity: cardiac output (CO) — 3938.9 ml/min, interquartile range (IQR) = 3404.2–4230.2 ml/min — with the underlying reduction of vessel tone: total peripheral vascular resistance (TPVR) — 1922.8 dyn × s/cm⁵, IQR = 1636.5–2085.8 dyn × s/cm⁵. After the end of the shift, to these compensatory mechanisms (CO — 4284.7 ml/min, IQR = 3935.4–4688.8 ml/min; TPVR — 1692.4 dyn × s/cm⁵, IQR = 1584.6–1903.1 dyn × s/cm⁵), increased myocardial oxygen consumption (MOC; 7917.5 RU, IQR = 7430.2–8811.0 RU) added as a reaction to the muscular component of labor activity. In individuals with average EQ, these mechanisms were less pronounced in considerable mental stress: before the shift CO — 3722.0 ml/min, IQR = 3163.1–3739.0 ml/min, p = 0.013; TPVR — 2303.1 dyn × s/cm⁵, IQR = 2058.1–2402.1 dyn × s/cm⁵, p = 0.016; after the shift CO — 3375.0 ml/min, IQR = 3372.0–4402.0 ml/min, p = 0.010; TPVR — 2010.5 dyn × s/cm⁵, IQR = 1972.6–2351.9 dyn × s/cm⁵, p = 0.017; MOC — 7450.0 RU, IQR = 6653.3–7867.3 RU, p = 0.023.

CONCLUSION: The extent of tension of mechanisms of self-regulation of systemic circulation, apart from characteristics of used technical means and the working regime, significantly depends on the level of emotional intelligence. With this, personnel with high emotional intellect are preferable for the work in the ‘red zone’ because of lower tension of regulatory mechanisms.

INTRODUCTION: Chronic tuberculous pleural empyema (CTPE) is a severe form of tuberculous lesion characterized by a purulent-destructive process in the residual pleural cavity, gross irreversible morphofunctional specific alterations in the pleura forming within three-five months after appearance of clinical signs of pleurisy. Patients with respiratory tuberculosis (RT) complicated with pleural empyema, are the most severe contingent of patients in tuberculosis (TB) hospitals.

AIM: To study effectiveness of surgical treatment of patients with RT complicated with CTPE depending on spread of pathological alterations in the parietal pleura.

MATERIALS AND METHODS: The study included 65 patients (43 men, 66.2%, aged 23–61 years; 22 women, 33.8%, aged 26–65 years) with RT complicated with CTPE, who underwent surgical treatment in the volume of pleurectomy with decortication of lung. Patients were divided to 3 groups depending on spread of pathological alterations in the parietal pleura: group 1 (n = 40, 61.5%) with spread of CTPE not exceeding the surface area of one anatomical wall of the pleural cavity; group 2 (n = 15, 23.1%) with CTPE involving 2–3 anatomical walls of the pleural cavity; group 3 (n = 10, 15.4%) with CTPE involving all anatomical walls of the pleural cavity.

RESULTS: The effectiveness of complex treatment of patients with RT complicated with CTPE was 92.3% (n = 60). In the period from 2014 to 2021, the rate of postoperative complications after pleurectomy with decortication of lung including simultaneous resection, was 12.3%, mortality rate 0% and postoperative recurrences of empyema 7.7%. Despite adequate postoperative conservative treatment, the achievement of clinical effect and the absence of postoperative recurrences were directly proportional to the spread of intrapleural alterations. The destructive widespread forms of PT with multiple and wide-range drug resistance of mycobacterium tuberculosis are more common among the patients with subtotal and total forms of CTPE.

CONCLUSION: The obtained results evidence a high effectiveness of surgical treatment of the given category of patients irrespective of spread of pathological alterations in the pleura and lung.

INTRODUCTION: The epidemic of a new coronavirus infection (COVID-19) required a restructure of the entire healthcare system of the Russian Federation within a limited period of time. Here, the mortality of patients is the most important effective parameter that reflects successfulness of organization measures for improvement of the activity of medical institutions. The initial preparedness of the infrastructure permitted to rapidly deploy a hospital on the base of the Clinical Centre of Sechenov University for providing medical assistance to patients with COVID-19.

AIM: To analyze the in-hospital mortality of patients with COVID-19 at the Clinical Center of Sechenov University.

MATERIALS AND METHODS: The COVID-19 database (n = 19 230) of the Clinical Centre of Sechenov University for 2020–2022 was analyzed.

RESULTS: The overall in-hospital mortality in COVID-19 hospitals of the Clinical Centre of Sechenov University was 8.5%, which is the lower level compared to the data of foreign studies (Italy, Spain, Great Britain, USA, Iran). The main predictors of mortality are: basic — male gender, age (mainly > 75 years); existence of malignant neoplasms, diseases of the nervous system, diseases of the cardiovascular system, diseases of the endocrine system in patients; diseases occurring in the course of hospital treatment — artificial lung ventilation, past surgical interventions.

CONCLUSION: The working experience of the Clinical Center of Sechenov University shows a possibility for quick salvation of organizational tasks facing the healthcare system in the period of COVID-19 pandemic, with the results characterized by low lethality of hospitalized patients.

INTRODUCTION: At present, the issue of optimal antithrombotic therapy (ATT) in patients with myocardial infarction (MI) and atrial fibrillation (AF) has not been finally resolved, it requires an individual approach and is of interest for study.

AIM: To study the dynamics of prescribing ATT to patients with AF of non-valvular etiology hospitalized in cardiology hospital in 2016–2021 for MI.

MATERIALS AND METHODS: The study included 599 patients with MI and AF: in 2016–2017 — 104 patients, in 2018–2019 — 256 patients, in 2020–2021 — 239 patients. The median and interquartile range of age of patients hospitalized in 2016–2017 were 70 (61.0; 78.0) years, in 2018–2019 — 71 (65.0; 79.3) years, in 2020–2021 — 72 (65.0; 80.0) years, p = 0.09.

RESULTS: In 2016–2017, 76.9% of patients with MI and AF were prescribed double antiplatelet therapy (DAPT) from the first day of hospitalization; 16.3% of patients were prescribed therapy with oral anticoagulants (OACs), here, in 6.7% — as part of triple ATT, in 8.7% — as part of double ATT (OACs + antiplatelet agent), in 1.0% — as monotherapy with OACs; in 3.8% monotherapy with an antiplatelet agent was prescribed; in 2.9% of cases ATT was not prescribed. In 2018–2019, DAPT was used in 37.9% of cases; therapy with OACs — in 54.7% of cases: in 44.9% cases as part of triple ATT, in 9.8% as part of double therapy; in 7.4% of cases monotherapy with antiplatelet agent was prescribed. In 2020–2021, DAPT was prescribed in 15.9% of cases; therapy with OACs in 74.5%, of them in 59.8% — triple АТТ, in 14.2% — double АТТ; monotherapy with an antiplatelet agent - in 7.5%; in 1.7% АТТ was not prescribed.

CONCLUSION: In the study, the frequency of prescription of triple ATT to patients with AF and MI in 2020–2021 increased 1.3 times as compared to 2018–2019, and 8.9 times as compared to 2016–2017 and made 59.8% (p < 0.001 for all periods). The frequency of OAC also increased 1.3 times as compared to 2018–2019 and 4.6 times as compared to 2016–2017 and made 74.5% (p < 0.001 for all periods). This dynamics of increase in the frequency of prescription of oral anticoagulants to patients with a combination of AF and MI should be considered a positive result of introduction of the Clinical recommendations in the treatment of cardiologic patients.

INTRODUCTION: In childhood, the immune system is actively formed, among other things, through the contact with viral and bacterial pathogens. Children over 5 years who suffer from acute respiratory diseases more than 4 times a year, are referred to the group of frequently ill children (FIC) requiring increased attention of doctors.

AIM: To identify peculiarities of the autonomic regulation, metabolic, regulatory parameters of immune system cells in FIC of the primary school age.

MATERIALS AND METHODS: The study involved 114 children aged 7–11 years. On the basis of the data of the card of child’s individual development, a group of FIC was identified with recurrence rate of acute respiratory diseases more than 4 times a year (n = 28). A control group included episodically ill children (1–3 times a year, n = 86). The condition of the autonomic system of a child was evaluated by the data of heart rate variability using ORTO Valeo hardware–software complex. The content of serotonin and catecholamines in blood lymphocytes was determined using luminescent histochemical method. Activity of succinate dehydrogenase and acid phosphatase were evaluated by cytochemical methods.

RESULTS: The study of regulatory-metabolic parameters of immune cells in the group pf FIC showed reduced activity of succinate dehydrogenase (р < 0.01) and reduced content of serotonin (р < 0.01), and high activity of acid phosphatase (р < 0.05) and catecholamines (р < 0.001) in comparison with the control group. The analysis of parameters of autonomic regulation in FIC group showed predominance of parameters characterizing the sympathetic division of the autonomic nervous system and reduction of parameters characterizing the activity of the parasympathetic division (р < 0.05).

CONCLUSION: The results evidence a sharp imbalance between metabolic and catabolic processes in the immune system of FIC of the primary school age with the underlying predominant activity of the sympathetic nervous system. This gives the ground to study the reasonability of administration of medications and physiotherapeutic procedures for correction of the parameters of the autonomic regulation in the inter-recurrence period with the aim of improving the general adaptive capacities of FIC of the primary school age.

INTRODUCTION: Chronic periodontal inflammation is provoked by persistence of subgingival bacterial flora and is mediated through the production of proinflammatory cytokines that induce the innate immune reactions.

АIM: To establish the interrelation of secretion of interleukin 1ß and immune component of soluble CD14 co-receptor with the main periodontopathogenic microorganisms in patients with chronic generalized periodontitis.

MATERIALS AND METHODS: A clinical and laboratory examination of patients with chronic generalized periodontitis (n = 100) and individuals with the intact parodontium (n = 63) was conducted. Molecular genetic studies (isolation of periodontal pathogens by polymerase chain reaction in real time), immune enzyme assay (isolation of interleukin 1ß and soluble CD14 co-receptor) and statistical analysis of the data obtained were performed.

RESULTS: The frequency of isolation of periodontopathogenic bacteria in patients with the diagnosis of chronic periodontitis was 96.4% (T. forsythia — 81%, р < 0.001; P. gingivalis — 69%, р < 0.001; Tr. denticola — 63%, р = 0.054). In 25% of cases, C. Albicans (р < 0.001), in 37% — Pr. intermedia (р < 0.001) and in 30% — A. actinomycetemcomitans (р < 0.001) were isolated. The average concentrations of soluble CD14 co-receptor were 2.13 [1.89; 2.76] pg/ml in the control group and 20.3 [17.3; 22.5] ng/ml in the group of patients with chronic periodontitis (р < 0.001). Concentrations of interleukin 1ß were 3.187 [2.356; 4.633] pg/ml in the control group and 33.68 [17.255; 56.915] pg/ml in the group of patients with chronic periodontitis (р < 0.001).

CONCLUSION: Inflammation of periodontal tissues is supported by the factors of aggression and toxins not only of known periodontal pathogens, but also by their associations, which leads to enhancement of virulence factors and increase in secretion of interleukin 1ß and soluble CD14 co-receptor, which, in turn, causes destruction of alveolar bone.

INTRODUCTION: First type secondary endoleaks (EL) require quickest elimination, primarily using the endovascular methods. Despite the existence of a sufficiently large number of methods of their elimination, the results of treatment remain ambiguous.

AIM: Analysis of our own experience of elimination of the first type ELs in patients after endoprosthetics of infrarenal abdominal aortic aneurysm.

MATERIALS AND METHODS: The study is retrospective with prospective observation. All patients underwent computed tomography (CT) for identification of the type of EL and choosing a method of its elimination. The term ‘first type secondary EL’ was understood as EL which developed in the long-term period after the primarily negative CT-angiography after endoprosthetic repair of the aorta.

RESULTS: ELs of Ia type were diagnosed in 14 cases, in one case EL of Ib type was identified. On average, first type secondary ELs were identified in 34 months after the primary operation for endograft implantation. In 2 of 15 patients, EL were symptomatic. The elimination of the first type EL required an individualized approach in all cases. The main methods of elimination of the first type EL were: elongation using Jotec E-iliac (n = 1); coiling with implantation of Gore cuff and Chimney-stenting of the left renal artery (LRA; n = 2); implantation of Gore cuff (n = 4); reinforcement with Aptus EndoAnchors (n = 2); Cuff Gore implantation and LRA stenting by Chimney-technique (n = 1); implantation of Cuff Jotec and reinforcement with Aptus EndoAnchors (n = 1); aneurysmal sac coiling (n = 2); Gore cuff implantation with fixation with EndoAnchors and LRA stenting using Chimney-technique (n = 1). The technical success of EL elimination was 100% (in all cases, the success was confirmed by intraoperative angiography, as well as by CT angiography or ultrasound duplex scanning with contrast enhancement after surgery), there were no deaths. In the long-term period (from 6 to 60 months), re-interventions were performed in two cases, fatal outcome happened in one case, after a late open conversion for elimination of EL.

CONCLUSION: In 13% of cases, first type ELs were symptomatic, and their elimination required individual approach with taking into account anatomical factors and the implanted graft. The medium-term results of the elimination of the first type EL are good, no fatal cases have been reported, and the number of reinterventions has reached 20%, which requires monitoring in the postoperative period.

INTRODUCTION: The use of synthetic cannabinoids (SCs) is an urgent healthcare problem, due to, among other things, a high number of complications.

AIM: To systematize the peculiarities of clinical presentation, somatic complications, effectiveness of empirical approaches to therapy, and probable outcomes of delirium induced by exposure to SCs.

MATERIALS AND METHODS: The analysis of scientific publications selected by the keywords in eLibrary, СNKI, PubMed databases, was conducted. According to PRISMA recommendations, 20 articles were taken for analysis.

RESULTS: Today, it is impossible to predict the period when SC-induced delirium may occur. It can start after one-time intake of even small dose, and can occur both due to intoxication and with the underlying withdrawal state — on the 2^nd–4^th days after the last use. Besides classic symptoms, the clinical picture of delirium is characterized by many symptoms of schizophrenic psychoses: hallucinations of threatening or drug-addicted content; secondary paranoid delusion, less expressed than hallucinations; aggressiveness and agitated behavior; some formal thinking disorders; rarely, Kandinski–Clerambault and oneiroid syndromes. There are reported cases of severe somatic complications in the form of depression of consciousness, rhabdomyolysis, acute renal failure, cardiomyopathy, myocardial infarction, epilepsy, infectious complications with the underlying weakened immunity. Therapy of SC-induced delirium includes detoxification and metabolic therapy, administration of antipsychotics and tranquilizers; use of resuscitation measures in case of depression of consciousness and development of life-threatening conditions. SC-induced delirium lasts from several hours to several days. In most cases, it terminates with complete recovery with amnesia of the period of confusion and asthenia, but in some cases fatal outcomes are reported caused not only by accidents such as road accidents or suicide, but also by somatic complications (most often of infectious character, or multi-organ failure).

CONCLUSION: SСs remain relevant due to high frequency of their use and continuous emergence of new analogs to substances of this group. They have multidirectional effect, and so far it is difficult to predict at what period the delirium induced by them may occur.

INTRODUCTION: Currently, the number of pediatric patients urgently hospitalized with different variants of gastrointestinal perforations complicated with peritonitis, remains high. In the given work, the variants of the surgical treatment depending on the location of the perforation defect (stomach, duodenum, small intestine) are presented, and the most common causes of such conditions encountered in clinical practice, are described (perforation of Meckel’s diverticulum, spontaneous perforation of small intestine and stomach in children with extremely low body mass, patients with Ehlers–Danlos syndrome).

AIM: To determine the most relevant variants of surgical tactics in children with perforations of different parts of the gastrointestinal tract (in particular, stomach, small intestine) in conditions of peritonitis.

MATERIALS AND METHODS: In the process of studying the literature, 142 scientific publications were analyzed on Google Academy, PubMed, eLIBRARY information resources, published from 2002 to 2022. With this, works describing intestinal perforation with the underlying necrotic enterocolitis, were excluded from the study, since this category of patients requires a separate discussion and description of approaches to treatment.

CONCLUSION: According to the results of the analysis of scientific literature, variants of surgical tactics used in perforations of the gastric wall include (in the order from the most commonly used to the least common): laparotomy and suturing with excision of the edges of the defect; suturing in conditions of laparoscopy; atypical resection with the formation of a gastric ‘tube’ on the probe; resection of stomach. In duodenal perforations, the following methods are used: rhomboid duodeno-duodenoanastomosis according to Kimura, intracorporeal suture with endovideosurgical access; laparotomy and suturing of the defect in extensive necrosis. In spontaneous perforation in the small intestine, resection of the part of the intestine is advisable — anastomosis according to Santulli in combination with terminal ileostomy, simultaneous end-to-end anastomosis or application of intestinal stomas.