Cause of death based on systematic post-mortem studies in patients with positive SARS-CoV-2 tissue PCR during the COVID-19 pandemic.

IMPORTANCE: Assessment of the causative association between the COVID-19 and cause of death has been hampered by limited availability of systematically performed autopsies. We aimed to present autopsy-confirmed causes of death in patients who died with COVID-19 and to assess the association between thrombosis and diffuse alveolar damage consistent with COVID-19 (DAD). METHODS: Consecutive forensic (n = 60) and clinical (n = 42) autopsies with positive post-mortem SARS-CoV-2 PCR in lungs (age 73 ± 14 years, 50% men) were included. The cause of death analysis was based on a review of medical records and histological reports. Thrombotic phenomena in lungs were defined as pulmonary thromboembolism (PE), thrombosis in pulmonary artery branches or microangiopathy in capillary vessels. RESULTS: COVID-19 caused or contributed to death in 71% of clinical and 83% of forensic autopsies, in whom significant DAD was observed. Of the patients with COVID-19 as the primary cause of death, only 19% had no thrombotic phenomena in the lungs, as opposed to 38% amongst those with COVID-19 as a contributing cause of death and 54% amongst patients whose death was not related to COVID-19 (p = 0.002). PE was observed in 5 patients. Two patients fulfilled the criteria for lymphocyte myocarditis. CONCLUSIONS: Vast majority of all PCR-positive fatalities, including out-of-hospital deaths, during the SARS-CoV-2 pandemic were related to DAD caused by COVID-19. Pulmonary artery thrombosis and microangiopathy in pulmonary tissue were common and associated with the presence of DAD, whilst venous PE was rarely observed. Histology-confirmed lymphocyte myocarditis was a rare finding.

[The current course of Brill's disease]. / O sovremennom techenii bolezni Brilla.

The paper presents the data on the clinical course and laboratory diagnosis of Brill's disease in 30 patients. The absence of absolute and not infrequently basic and indicating signs of the disease as well as its frequent course in the presence of the concurrent diseases significantly hinder its clinical diagnosis, particularly at the initial stage of the disease. Unwanted clinical and epidemiological consequences could be avoided only in case of a constant medical alertness and understanding of specificity of the current course of Brill's disease as well as a provisional hospitalization within 5 days of all the patients with unclear diagnosis who have fever into the infectious department of a hospital.

[The differential diagnosis of acute intestinal infections]. / O differentsial'noi diagnostike ostrykh kishechnykh infektsii.

The authors evaluate contemporary possibilities of clinico-epidemiological and laboratory diagnosis of intestinal yersiniosis in the clinical practice. Data are reported on infestation of the environment with yersiniosis pathogen in this territory and the clinical picture of gastrointestinal form of yersiniosis and its symptomatology that is of help in the diagnosis. Perfection of laboratory diagnosis is of great importance in this respect.

[Use of diuretics in the treatment of patients with viral hepatitis]. / Primenenie mochegonnykh sredstv pri lechenii bol'nykh virusnym gepatitom.

The effectiveness of intensification of diuresis by means of hypothiaside and furosemide has been studied during treatment of 135 patients with viral hepatitis A and B. Both these agents were found to posses the same effect which was manifested by lessening of the intoxication syndrome, total blood toxicity and convalescence terms. A therapeutic effect of diuretics is most pronounced in moderately severe form of the disease.