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Vol 13, No 1 (2021)

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Myocardial infarction type 2 and myocardial injury: The current state of the problem

Oblavatskiy D.V., Boldueva S.A., Solovyeva M.V.


Today, the most difficult in terms of diagnosis and treatment today among various types of myocardial infarction (MI) is MI type 2 (MI-2). The lack of clinical guidelines for management of patients with this type of MI, as well as the literature data on prevalence, patient characteristics and prognosis contributes to the scientific relevance of the further research.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(1):5-13
pages 5-13 views

Therapeutic potential of the stromal vascular fraction in COVID-19

Pavlov V.N., Kazikhinurov A.A., Kazikhinurov R.A., Agaverdiyev M.A., Gareev I.F., Beylerli O.A., Mazorov B.Z.


The new coronavirus infection (COVID-19) is already known to cause serious respiratory illnesses such as pneumonia and lung failure. COVID-19 has caused catastrophic damage to the public health, economic and social stability. As COVID-19 has resulted in enormous human toll and serious economic loss that poses a global threat, urgent understanding of the current situation and the development of strategies to mitigate the spread of the virus is required. Today, many studies are being carried out around the world to study the pathogenesis of COVID-19, where the development of a “cytokine storm” or pulmonary fibrosis is a serious complication that can lead to unfavorable outcomes. This leads to the fact that a deeper understanding of the nature of the virus will allow to develop new approaches in pathogenetic therapy. In this regard, the stromal vascular fraction has tremendous therapeutic potential in COVID-19. Stromal vascular fraction provides anti-inflammatory and immunomodulatory effects and promotes the restoration and regeneration of damaged tissues. The availability, the ability to obtain a significant volume of viable cells of the stromal vascular fraction population, such as adipose tissue stem / stromal cells, as well as their use by the intravenous route, has proven safe and effective in other forms of lung disease, including fibrotic diseases. In other words, the goal of this therapy for COVID-19 is to eliminate the inflammatory process, restore trophic and regenerate damaged tissues, and remodel fibrous and connective tissue. However, stromal vascular fraction is not currently approved for the prevention or treatment of COVID-19 cases. However, clinical trials are ongoing to ensure maximum understanding in terms of efficacy and safety. In this paper, we will discuss this new approach to the use of stromal vascular fraction therapy, which serves as a “ray of hope” in the fight against severe forms of COVID-19

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(1):15-26
pages 15-26 views

Clinical, laboratory and instrumental evaluation of structural and functional changes of the liver in patients with heart failure

Kisliuk K.A., Bogdanov A.N., Shcherbak S.G., Apalko S.V.


Heart failure is detected in 2% of the population. The leading causes of heart failure are coronary heart disease, arterial hypertension, and valvular heart disease. The number of patients with chronic heart failure continues to increase despite the new methods of diagnosis and treatment. A special contribution is made by damage to target organs in the development of cardiovascular pathology. Impaired liver function or congestive liver is common in heart failure and increases the risk of death and requires further study. The mechanism of liver damage in chronic heart failure is complex and multicomponent. The sensitivity and specificity of standard clinical, laboratory and instrumental methods for the diagnosis of congestive liver are insufficient. With the increase, severity and duration of venous congestion, structural changes in the architectonics occur, leading to the formation of liver fibrosis. The development of cardiac liver fibrosis leads to a complication of the course of chronic heart failure and an increase in mortality.

Among the new diagnostic methods, the most important are serological markers of liver fibrosis, which have high diagnostic accuracy, as well as histological determination of fibrosis, as well as ultrasound examination of the liver in B-mode and determination of liver stiffness by elastography. Direct and indirect serological markers have a higher diagnostic value when using their combination in the composition of panels in the development of hepatopathy of different origins. An increase in the concentration of markers of fibrosis and liver stiffness during elastography correlates with the severity of heart failure and a long-term prognosis for mortality, including from extrahepatic diseases. Performing liver elastography in dynamics allows to monitor the course and treatment of heart failure. The optimal diagnostic method is a combination of direct and indirect markers of fibrosis, ultrasound diagnostics and elastography, in addition to clinical assessment of signs and direct assessment of hemodynamic parameters.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(1):27-37
pages 27-37 views

Original research

Profile of immunological markers in skin biopsies from patients with probable and confirmed systemic lupus erythematosus

Lila V.A., Mazurov V.I.


The purpose of this study was to determine the profile of immunoreactants deposited in intact skin biopsies from the patients with confirmed and probable systemic lupus erythematosus. The study involved 94 patients who, along with a standard clinical and laboratory examination, underwent a biopsy of clinically healthy skin in the deltoid muscle area (lupus band test). The nature and combination of immune deposits in the skin, the strength of immunofluorescence, and the location were evaluated. In the patients with significant systemic lupus erythematosus (n = 56), lupus band test was positive in 60.7 % of the cases and correlated with disease activity according to SLEDAI 2K (p = 0.001). At the same time, the skin biopsy often revealed the immunoreactant IgM (85.3 %), the degree of fluorescence of which had direct correlations with the increased level of antibodies to dsDNA (p < 0.05). In the examined patients with probable systemic lupus erythematosus, positive lupus band test was detected in 47 % of cases, and IgM was detected in 72.2% of patients, which brought them closer to the group of patients with confirmed systemic lupus erythematosus. However, 33.3% of patients with probable systemic lupus erythematosus had isolated deposits of any one immunoreactant, while the association of immunoreactants (IgM+IgG) and (IgM+IgG+C3) characteristic of confirmed systemic lupus erythematosus occurred in only 27.7 and 5.5% of cases, respectively. It should be noted that the C1q immunoreactant was detected in the skin biopsies with both confirmed (38.2%) and probable systemic lupus erythematosus (39%). The data obtained suggest that lupus band test with the presence of a specific pattern of immunoreactants can be used as an additional diagnostic test for the diagnosis of systemic lupus erythematosus.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(1):39-48
pages 39-48 views

Major predictive risk factors for cytokine storm in COVID-19 patients (Clinical trials)

Anisenkova A.Y., Apalko S.V., Asaulenko Z.P., Bogdanov A.N., Vologzhanin D.A., Garbuzov E.Y., Golota A.S., Kamilova T.A., Klitsenko O.A., Minina E.M., Mosenko S.V., Urazov S.P., Khobotnikov D.N., Sherbak S.G.


AIM: Searching for predictors of cytokine storm in patients with COVID-19 and creating a risk scale for this complication for practical implementation.

MATERIALS AND METHODS: The study included 458 patients with confirmed COVID-19 with signs of viral lung lesion according to computer tomography. The patients were divided into 2 groups: with a stable course of moderate severity (100 patients) and with progressive moderate, severe and extremely severe course (358 patients).

RESULTS: It has been established that the main risk factors for the development of cytokine storm in COVID-19 patients are interleukin-6 concentration >23 pg/ml, the dynamics of the index according to the NEWS scale ≥0, ferritin concentration >485 ng/ml, D-dimers >2,1, C-reactive protein >50 mg/l, the number of lymphocytes in the blood <0,72 ∙ 109/l, age ≥40 years. Cytokine storm incidence correlates with an increase in the number of risk factors. For practical use the scale is applied in 3 groups. In the patients of the first group (0-1 factor) almost no cytokine storm risk was detected, in the second group (2-3 factors) the probability of a storm was 55 % (increased by 35.5 times), in the third group (≥4 risk factors) reaches 96 % (increased by 718 times).

CONCLUSIONS: Diagnostic and monitoring criteria of cytokine storm in the patients with COVID-19 were established. The developed prognostic scale allows to identify patients at high risk of developing cytokine storm for early anti-inflammatory therapy.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(1):49-58
pages 49-58 views

Prognostic value of cytokines in COVID-19 associated pneumonia

Tkachenko O.Y., Pervakova M.Y., Lapin S.V., Mazing A.V., Kuznetsova D.A., Moshnikova A.N., Kholopova I.V., Blinova T.V., Surkova E.A., Kulikov A.N., Vorobyev E.A., Vorobyeva S.V., Stanevich O.V., Polushin Y.S., Shlyk I.V., Afanasyev A., Gavrilova E.G., Titova O.N., Volchkova E.V., Potapenko V.G., Khudonogova S.V., Mazurov V.I.


BACKGROUND: Coronavirus disease 2019 (COVID-19) is often complicated by cytokine storm syndrome. Although many interleukins (IL) have predictive value, the sensitivity and specificity of a single marker is limited.

AIM: The purpose of the study is to develop an objective and informative cytokine storm scale for assessing the risk of developing a critical course in patients with COVID-19 associated pneumonia.

MATERIALS AND METHODS: A total of 226 cases of COVID-19 were investigated, 36 (16 %) of which were with poor outcomes. The cytokines IL-1b, IL-2, IL-6, IL-8, IL-10, IL-18, TNF-á, IFNá, IFN-ã were studied by enzyme immunoassay, commercial kits manufactured by Vector-Best, RF.

RESULTS: Since IL-6, IL-10, IL-18, and procalcitonin were associated with disease severity and death, these indicators were integrated into a 12-point scale called the cytokine storm scale. The patients who scored more than 6 points had a high risk of a poor outcome of the disease. According to ROC analysis, the area under the curve for the cytokine storm scale was larger than for each of the four markers separately [AUC 0.90 (95% CI 0.8455–0.9592), p < 0.001].

CONCLUSIONS: Thus, the cytokine storm scale system presents superior performance in determining patients with favorable and fatal outcomes to each individual cytokine.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(1):59-69
pages 59-69 views

Correction of eating behavior in patients with erosive reflux esophagitis

Tikhonov S.V., Simanenkov V.I., Bakulina N.V., Lishchuk N.B., Topalova Y.G.


AIM: To compare the efficacy of 1-month inhibitors of H+,K+-ATPase therapy and eating behavior correction over 6 months with initial 1-month and 5-month maintenance inhibitors of H+,K+-ATPase therapy in overweight and obese patients with erosive esophagitis.

MATERIALS AND METHODS: The randomized clinical study included 29 patients 54.8 ± 13.5 years with erosive esophagitis. 13 (45%) patients were overweight, 16 (55%) — obese, 26 (90%) had abdominal obesity. The patients were randomized into 2 groups: control group — 15 patients received 20 mg of omeprazole twice a day during 4 weeks and 20 mg of omeprazole once a day during 5 months; intervention group — 14 patients participated in the eating behavior correction program and received 20 mg of omeprazole once a day for 4 weeks initially. Clinical symptoms, the endoscopic and histological data , anxiety, depression and quality of life, motor disorders were under investigation.

RESULTS: At the end of the 4-week therapy, the control group had a lower frequency of heartburn (1.8 ± 0.08 vs 2.4 ± 0.6 points), intensity of heartburn (1.13 ± 0.51 vs 1.78 ± 0.89 points), healing of erosive esophagitis was more common (13 (86%) vs 5 (35%) patients), more % weakly acidic (2.5 ± 1.6 vs 0.8 ± 0.4) and % weakly alkaline time (0.44 ± 0.3 vs 0.15 ± 0.2) in the esophagus, more alkaline gastroesophageal refluxes (9.1 ± 9.8 vs 2.8 ± 3.9). By the end of the sixth month, the control group had higher frequency (3.46 ± 0,5 vs 2.28 ± 0.7 points) and the intensity of regurgitation (1.6 ± 0.5 vs 1.07 ± 0.26 points), more % weakly acidic (2.32 ± 1.86 vs 0.89 ± 0.57) and % weakly alkaline time (0.54 ± 0.72 vs 0.22 ± 0.28), lower quality of life according to GH scale and RE scale SF-36 questionnaire.

CONCLUSIONS: The superiority of an eating behavior correction strategy over inhibitors of H+,K+-ATPase therapy was demonstrated in this study. Weight loss leads to fewer symptoms of gastroesophageal reflux disease and improved gastroesophageal motility.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(1):71-84
pages 71-84 views

Chronic gastritis and precancerous diseases of the stomach: Is there a chance of a correct diagnosis?

Tryapitsyn A.V., Malkov V.A., Gasanov E.M., Belyakov I.


AIM: The purpose of the study is to investigate the occurrence of the main forms of chronic gastritis, metaplastic and dysplastic changes in the gastric mucosa, the degree of their severity, and to assess their potential risk for the development of gastric cancer.

MATERIALS AND METHODS: The study involved 2982 patients who underwent esophagogastroduodenoscopy with a standard biopsy of the gastric mucosa for morphological assessment and bacterioscopy. If autoimmune gastritis was suspected, an additional serological diagnosis was performed. When detecting intestinal metaplasia of the gastric mucosa as well as neoplastic changes according to the histological report, the description of this report was analyzed in order to identify possible equivalents in the macroscopic description of the mucous membrane.

RESULTS: Out of 2982 histological studies of gastric mucosa biopsies, 1273 cases (42.7%) were found to contain H. pylori contamination. In 726 cases (24.3%), intestinal metaplasia. 66 biopsies (2.21%) showed the presence of low-grade intraepithelial neoplasia of the mucosa, 2 biopsies showed indeterminate neoplasia and 4 biopsies showed high-grade neoplasia. In 3 out of the total number of the samples, intravascular gastric adenocarcinoma was detected. In 168 cases (5.6%), gastritis was detected with predominant inflammation of the fundal region characteristic of autoimmune gastritis. In 286 biopsies (10.6%), inflammatory and/or atrophic changes and/or metaplastic changes were preserved, which, as a rule, did not have high activity and pronounced inflammation. In the remaining 1279 cases (42.9%), there was no significant inflammation or atrophic changes. The analysis of endoscopic findings showed that the detectability of intestinal metaplasia of the gastric mucosa without a biopsy study was 13.3%.

DISCUSSION OF THE RESULTS: According to the results of the conducted research and analysis, it can be stated that at present, the correct diagnosis of chronic gastritis with the establishment of the etiological factor, prognosis and risks of stomach cancer development is practically not feasible within the modern health care system. This not only deprives a doctor of the opportunity to make a correct diagnosis and prescribe adequate treatment to a patient, but also makes almost all cascades of carcinogenesis, including early cancer, “invisible”.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(1):85-102
pages 85-102 views

The results of using endovascular methods for stopping ulcerative gastroduodenal bleeding

Sinenchenko G.I., Verbitskiy V.G., Demko A.E., Sekeyev A.N., Alentyev S.A., Kiselev M., Parfenov A.O., Alimov P.A.


This article presents the results of treatment of patients with ulcerative gastroduodenal bleeding who were treated in the 2nd clinic (surgery for the improvement of doctors) Military Medical Academy at the I.I. Dzhanelidze Research Institute of Emergency Medicine. A retrospective analysis was conducted of the frequency of rebleeding, surgical activity and mortality in groups with the use of transcatheter arterial embolization with and without it. The criteria for inclusion in the study were: the presence of ulcerative gastroduodenal bleeding, confirmed by laboratory and instrumental methods of examination, severe general somatic condition of patients. The comparison was carried out in the main and control groups. The main group consisted of 20 patients who underwent endovascular hemostasis. The control group included 46 patients without the use of X-ray surgical methods. The average age of patients in the main and control groups was 65.5 ± 3.7 and 60.7 ± 3.9 years. In both groups, most patients were admitted later than 24 hours after the onset of the disease and with severe blood loss. The severity of the somatic state of the intervention was assessed according to the APACHE II multiple organ failure assessment scale, according to which, patients in the main group were somatically more severe than in the control group. In the groups, bleeding from stomach ulcers prevailed (up to 75%). Most often, endovascular hemostasis is performed at a high risk of recurrent bleeding, and adhesive compositions and spirals were used as an embolizing agent. Angiography revealed direct or indirect signs of bleeding (extravasation, hypervascularization, aneurysmal dilatation) in 12 cases, and preventive embolization was performed in 8 cases. In 70% of cases, the source of bleeding was the left gastric artery. In the control group, recurrent bleeding and surgical activity accounted for 26%. In the main group, 20% and 15%, respectively. In the main group, recurrent bleeding occurred in 4 cases, 1 patient underwent repeated endoscopic hemostasis, 3 patients underwent open surgical interventions. All 4 patients had a fatal outcome, against the background of massive blood loss and aggravated somatic pathology. The overall mortality rate in the control group was 44%, in the main group 35%. Transcatheter arterial embolization did not significantly improve the results of treatment of ulcerative gastroduodenal bleeding due to the severity of the general somatic condition of the patients included in the study.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(1):103-108
pages 103-108 views

Parameters of intracardiac hemodynamics in iron deficiency in patients with chronic heart failure

Smirnova M.P., Chizhov P.A., Baranov A.A., Ivanova Y.I.


BACKGROUND: Iron deficiency is a common comorbidity in many patients with chronic heart failure.

AIM: To study the parameters of intracardiac hemodynamics in the patients with chronic heart failure in the presence of iron deficiency.

MATERIALS AND METHODS: We examined 179 patients (36 men and 143 women, mean age 71.6 ± 7.9 years) with heart failure of functional class 2-4 (NYHA). All the patients underwent a clinical examination, a 6-minute walk test, a general blood test; the level of NT-proBNP, iron, transferrin, and ferritin in blood serum were studied; the percentage of transferrin saturation with iron was calculated. The presence of iron deficiency was assessed based on a decrease in the level of serum ferritin less than 100 μg/L or ferritin ranging from 100 to 299 μg/L and saturation of transferrin with iron less than 20%. All the patients underwent echocardiography in one-dimensional, two-dimensional and Doppler modes (pulse-wave, constant-wave and tissue) in standard positions according to the generally accepted technique.

RESULTS: It was found that in the patients with chronic heart failure and iron deficiency compared with the patients without iron deficiency; the end systolic volume of the left ventricle, the size of the right ventricle and the systolic pressure in the pulmonary artery were significantly higher, and the speed of movement of the fibrous ring of the mitral and tricuspid valves and the working capacity were lower. Significant correlations were established between the concentration of iron and ferritin and the parameters of intracardiac hemodynamics.

CONCLUSIONS: Iron deficiency in the patients with chronic heart failure without anemia contributes to an early initial decrease in cardiac contractility with an intact ejection fraction.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(1):109-115
pages 109-115 views

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