[Fatal case of rhinocerebral mucormycosis on the background of type II diabetes mellitus]. / Letal'nyi sluchai rinotserebral'nogo mukormikoza na fone sakharnogo diabeta 2-go tipa.

Mucormycosis is a disease caused by fungi of the Mucorales family, widespread in the environment, with pronounced angiotropism and the ability to angioinvasion, leading to thrombosis with surrounding necrosis. The main triggers for the development of mucormycosis are: immunodeficiency states, use of glucocorticosteroid drugs, decompensation of diabetes mellitus, concomitant diseases, age > 65 years. We present a clinical case of rhinocerebral mucormycosis in a 79-year-old patient against the background of uncontrolled type 2 diabetes mellitus with ketoacidosis, a condition after previous glucocorticosteroid therapy for COVID-19 (according to the severity of the disease). After suffering a new coronavirus infection caused by the SARS-CoV-2 virus, she was admitted to the hospital with complaints characteristic of mucormycosis. On the 5th day of hospital stay, the patient's condition worsened significantly, despite the correction of the therapy, and on the 12th day the patient died. According to the results of the autopsy, it was established that the rhinocerebral mucormycosis was complicated by thrombosis of the anterior and posterior left cerebral arteries with subsequent infarctions in the frontal lobe and parieto-occipital region of the brain left hemisphere, cerebral edema, which was the immediate cause of death.

[COVID-19-associated mucormycosis in ophthalmological practice in the Volgograd region]. / COVID-19-assotsiirovannyi mukormikoz v oftal'mologicheskoi praktike Volgogradskogo regiona.

The problem of fungal infections in the era of COVID-19 has acquired special significance. This infection, directly or indirectly, through the use of glucocorticoids and antibiotics in its treatment, as well as poorer self-management of chronic diseases, has led to a wide spread of risk factors for fungal diseases among people who have had a novel coronavirus infection. The article presents two cases of COVID-19-associated mycosis, more related to mucormycosis, which were diagnosed by ophthalmologists in the Volgograd region. In the first case, the severe course of rhino-orbito-cerebral form of mucormycosis required a number of surgical interventions and prolonged treatment in the intensive care unit. In the second case, the patient asked for help without signs of aggravation of the general condition, but with irreversible local manifestations. In both cases, the eyeball was removed. Morphological examination revealed aseptal ribbon hyphae of different diameters, branching mainly at right angles, more typical for fungi of the Mucorales family. Due to the severe consequences of the disease, clinicians, including ophthalmologists, need to be especially alertness in patients with the described symptoms and risk factors in the post-COVID period.

[Features of pathological anatomy of COVID-19 according to autopsy results in the Volgograd Region]. / Osobennosti patologicheskoi anatomii COVID-19 po rezul'tatam autopsii v Volgogradskoi oblasti.

In connection with the ongoing pandemic of the novel coronavirus infection, the study of its morphopathology and the analysis of autopsy data are relevant. At the same time, attention should be paid to thromboses that play a significant role in the development of fatal outcomes in COVID-19, even taking into account the prescription of anticoagulant therapy to most patients. OBJECTIVE: To make an assessment of morphological changes and a statistical analysis of the structure of mortality in COVID-19 on the basis of autopsy results in the Volgograd Region in 2020. MATERIAL AND METHODS: The study was based on data from «The system for information on the work of the Volgograd Regional Autopsy Bureau¼ with a search for cases according to U07.1 code (the COVID-19 virus was identified) in January 1, 2020, to December 31, 2020, as well as on the autopsy materials of the Volgograd Regional Autopsy Bureau, and microscopic examination with photo fixation. Statistical processing was performed using the R programming language. RESULTS: During the above period, 1119 deaths were identified with a confirmed diagnosis of COVID-19. Anatomopathological examination of the autopsy material showed that 77.54% of cases had blood clots mainly in the vessels of the pulmonary microvasculature, often only in the single veins during the applied anticoagulant therapy.Analysis of variance indicated that the obtained result statistically significantly differed from the random distribution, and the probability of the presence of blood clots of specified localization was 3.17 times higher (CI 2.3-4.4; p<0.05) than their absence, as evidenced by logistic regression. In addition, perivascular and intra-alveolar diapedesis hemorrhages were noted in most fatal cases. CONCLUSION: Thus, this investigation has revealed that the high frequency of thrombosis detected in the presence of perivascular and intra-alveolar diapedesis hemorrhages in COVID-19 confirms the tendency of patients with a severe course of the disease to manifest hemostatic disorders, significant blood vascular endothelial injury, and obvious vascular impermeability.

[Myorenal syndrome in forensic practice: molecular aspects of etiology and pathogenesis]. / Miorenal'nyi sindrom v sudebno-meditsinskoi praktike: molekulyarnye aspekty etiopatogeneza.

The objective of the study is to analyze the publications on biochemical aspects of myorenal syndrome (crush-syndrome) pathogenesis. Factors of trauma and other etiologies significant in terms of forensic practice that cause muscle tissue destruction are presented. Molecular processes in rhabdomyolysis and subsequent renal damage, the establishment of the sequence of which is important for forensic medicine, are outlined. The study results will improve our understanding of the of myorenal syndrome pathophysiology, its biochemical features, and optimize methods for its forensic diagnosis.

[Retrolental amyloidosis of the vitreous body (case study)]. / Retrolental'nyi amiloidoz steklovidnogo tela (klinicheskoe nablyudenie).

Accumulations of pathological amyloid protein in the vitreous can be a pathognomonic morphological sign of systemic amyloidosis, which is characterized by deposition of insoluble fibrillar protein aggregates (amyloid) in various organs and tissues. The article describes a clinical case of a female 65-year-old patient with bilateral vitreous floaters and histologically confirmed vitreous amyloidosis on the right eye. The patient had undergone YAG laser vitreolysis of the right eye 3 years ago on the Ultra Q Reflex system («Ellex¼, Australia) to treat an atypical Weiss ring. Diagnosis of vitreous amyloidosis was confirmed using the following equipment: video slit lamp SL9900 («CSO¼, Italy), optical coherence tomography system Solix («Optovue¼, USA), B-scan Plus («Accutome¼, USA), microscope CX41RF («Olympus Corporation¼, Japan). Due to significant visual deterioration in the right eye, the patient underwent vitrectomy. Microscopic examination of the surgical sample showed the presence of amyloid deposits revealed by the brick-red specific staining with congo red dye and apple-green birefringence of the stained areas in polarized light.

[Features of the morphological manifestations of COVID-19-associated with acute hemorrhagic necrotizing encephalopathy in adults]. / Osobennosti morfologicheskikh proyavlenii assotsiirovannoi s COVID-19 ostroi gemorragicheskoi nekrotiziruyushchei entsefalopatii vzroslykh.

A case of COVID-19-associated acute hemorrhagic necrotizing encephalopathy in adults in combination with comorbid pathology was analyzed. The key data of the medical history, the results of laboratory and instrumental studies are presented. The results of postmortem forensic medical diagnostics with demonstration and description of macro- and microscopic changes in the examined organs are presented.

[Clinical and anatomical features of SARS-COV-2 with acute hemorrhagic necrotizing encephalopathy]. / Kliniko-anatomicheskie osobennosti SARS-COV-2 s ostroi gemorragicheskoi nekrotiziruyushchei entsefalopatiei.

Autopsy material and medical history were studied and analyzed in a 20-year-old male patient who had died from COVID-19 infection with the development of acute SARS-CoV-2-associated hemorrhagic necrotizing encephalopathy in adults with obvious endothelial dysfunction confirmed by virological examination of the autopsy material. In this case, the brain structures displayed the main found histopathologic signs: widespread vasculitis (endotheliitis) with varying degrees of segmental and total endothelial destruction; thrombosis mainly of the vessels of the microcirculatory bed; parenchymal hemorrhagic necrosis and inflammation (encephalitis); severe necrobiotic damage to neurons. Cerebrovascular immune damages and hypercoagulable states, which were observed in some acute viral neuroinfections, are the basis for the neurological complications of COVID-19. In this case of bicausal diagnosis (the presence of a comorbidity), the primary disease contributed to the acute progression of the background disease (secondary infiltrative tuberculosis with the development of specific pleuritis and pneumothorax with the addition of acute bilateral focal confluent bronchopneumonia with a history of undifferentiated immunodeficiency syndrome. Emphasis is laid on the possibility and importance of involving the brain structures in the process in COVID-19 for the timely diagnosis of emerging neurological disorders. A brief literature review is given.

[Clinical and morphological features of Merkel's carcinoma in elderly patients (literature review).]

Merkels cell carcinoma (MCC) is a rare and aggressive neuroendocrine skin tumor with a high rate of recurrence and local metastasis. The average age at which MCC is diagnosed is 75 years. The identification of the role of somatic mutations and DNA repair in aging mechanisms raises the question of their direct connection with the processes of differentiation, age-related characteristics of the immune system, programmed cell death and malignant growth. In this regard, there remains a need for research aimed at improving the early diagnosis and pathogenetic treatment of elderly patients.

[Features of granulomatous inflammation in helminthiasis, mycoses and human protozoal diseases in forensic medical practice]. / Osobennosti granulematoznogo vospaleniya pri gel'mintozakh, mikozakh i protozoinykh zabolevaniyakh cheloveka v sudebno-meditsinskoi praktike.

THE AIM OF THE STUDY: Is to draw the attention of forensic experts and histologists to the problem of infectious diseases occurring with the formation of granulomas. Was reviewed the general patterns of granulomatous diseases, as well as the peculiarities of pathomorphosis in helminthiasis (schistosomiasis, paragonimiasis, onchocerciasis, dirofilariasis, ascariasis, cysticercosis), mycoses (cryptococcosis, chromomycosis, coccidioidosis) and protozoal diseases, toxosomes. The article includes photomicrographs from the authors' personal archive, including those collected during their work in African countries Text is based on scientific data from articles, monographs, educational literature, personal experience and cases of forensic medical practice.

[Pulmonary larval paragonimiasis mimicking lung cancer]. / Legochnyi larval'nyi paragonimoz, imitiruiushchii rak legkogo.

Larval paragonimiasis is a parasitic disease caused by lung fluke larvae. Unlike the classic form of paragonimiasis, the larval form occurs with a large number of clinical manifestations. However, this fact only complicates the diagnosis of larval paragonimiasis, for the abundance of clinical manifestations results in the misdiagnosis of other diseases. Another feature of this form of paragonimiasis is the tendency to generalize and mimic the clinical presentation of malignant neoplasms. The performed diagnostic measures failed to give an accurate view of the nature of the disease, therefore diagnostic thoracoscopy was carried out and biopsy specimens were taken from the subpleural region of dissemination, followed by urgent histologic examination suggestive of glandular cancer. This circumstance became the reason for atypical resection of the affected portion, which was done; however, the patient died from pulmonary thromboembolism on postoperative day 2. The main diagnosis of chronic pulmonary generalized paragonimiasis (cystic and pneumosclerotic phases) with neoplastic syndrome was posthumously made.

[COMPARATIVE MORPHOFUNCTIONAL CHARACTERISTICS OF ADULT AND OLD RAT VENTRAL HIPPOCAMPUS TO COMBINED STRESS INFLUENCE].

Animals were subjected to seven days combined stress in a special chamber (6 isolated compartments of equal area) with removable multi-modal stressors (noise, vibration, pulsating bright light) every 5 minutes on the stochastic scheme with restraint and temperature rise in the chamber during 30-minute stressing time sessions. After exposure to combined stress in the ventral hippocampus of old rats (24 months) compared with adult animals (12 months) following changes were revealed: marked dystrophic changes and increased inducible nitric oxide synthase expression in pyramidal neurons of CA3 field, signs of impaired hemodynamic disorders in the microvasculature, perivascular edema, decreased endothelial nitric oxide synthase expression in microvascular endothelial cells, as well as decreased expression of serine racemase in the neuropil of the radial layer of CA1 field.

[IS AGE-RELATED MACULAR DEGENERATION A MANIFESTATION OF ALZHEIMER'S DISEASE?].

The review conducts clinical morphological and pathogenetic parallels between Alzheimer's disease and age-related macular degeneration. The common embryology, anatomy and physiology of the brain and eye create the preconditions for the emergence of the friendly processes, including pathological aggregation of ß-amyloid and neurodegeneration. Based upon the data the authors justify the need for a thorough ophthalmic status study in the daily practice of an ophthalmologist. According to the authors this is promising for the early diagnosis and monitoring of Alzheimer's disease.

[Beta-amyloidopathy as a manifestation of proteinopathy in age-related macular degeneration].

AIM: To investigate clinical and morphological features of amyloidogenesis in age-related macular degeneration (AMD), which is thought to be associated with proteinopathy, namely beta-amyloidopathy. MATERIAL AND METHODS: A total of 111 eyes with morphological signs of AMD as well as brain samples from 56 cadavers (aged at death 60 and over) were assessed with selective methods of amyloid detection. RESULTS: Amyloid deposits were present in 39% of eyes with dry AMD and 80% of eyes with wet AMD. Combined accumulation of amyloid (that is both in eyes and the brain) was found in 50.6% of cases. CONCLUSION: The results allow to suggest that common etiopathogenetic and morphological features of AMD and Alzheimer's disease (AD) are due to the same metabolic pathway of the transmembrane amyloid precursor protein (APP) responsible for aggregation of beta-amyloid (Aß), an abnormal fibrillar protein, and the development of beta-amyloidopathy in eyes and brains. It has been demonstrated that beta-amyloidopathy is the keynote of both AMD and AD pathogenesis leading to cytotoxicity, neurodegeneration and pathological apoptosis. Such views on the problem may promote the development of neuroprotective and ophthalmic geriatric medications effective at all stages of pathogenesis, including beta-amyloid formation and aggregation.

[Alzheimer's disease and geriatric eye diseases in the aspect of amyloid genesis].

Geriatric eye diseases (age-related macular regeneration, pseudoexfoliation syndrome, pseudoexfoliative glaucoma, senile cataract) are one of the most important problems of modern ophthalmology. Meanwhile, the treatment of these diseases continues to be primarily empirically based for lack of not only valid data on their etiology, but even consensus of opinion on their pathogenesis. This review gives the current views on the commonness of the etiopathogenetic and morphological manifestations of Alzheimer's disease and age-related eye diseases in the aspect of amyloid genesis. This approach is a promising attempt to specify the mechanisms responsible for the occurrence and development of neurodegenerative diseases, their markers, and new perspectives in their treatment.

[The eye as an object of forensic medical identification].

The present review is focused on the literature publications concerning various aspects of significance of the human eye as an object of forensic medical identification. The data discussed in this review may provide a basis for the development of the algorithm of forensic ophthalmological studies of both living subjects and corpses; moreover, they can be used to determine the human age from the morphometric characteristics of eye tissues for the purpose of forensic medicine and criminal investigations. The authors emphasize the importance of purpose-oriented studies of various eye structures as a source of additional information for the application of the existing methods designed for personality identification. Changes in the eyes associated with congenital defects and ageing, surgical interventions, and their complications are discussed with special reference to their application in the practical work of forensic medical experts.

[Dirofilariasis in the Volgograd region--a new disease in the region]. / Dirofiliarioz v Volgogradskoi oblasti--novoe zabolevanie regiona.

Due to the availability of factors whose reasons have not been studied so far for this area. Volgograd and Volgograd Region should be recognized to be a dirofilariasis-endemic zone. The lack of an actual system of prevention, as well as other objective and subjective factors are responsible for constantly increasing numbers of ill human beings and animals. The disease awaits further thorough studies to reveal the causes of this disease in the area; to elaborate a package of preventive measures, and to improve methods of diagnosis, surgical and medical treatments.

[Role of local amyloidosis of the fundus oculi tissues in the pathogenesis of senile maculopathy]. / Rol' lokal'nogo amiloidoza tkanei dna glaza v patogeneze senil'noi makulopatii.

Histological, histochemical, and electron microscopic studies of tissues of the fundus oculi in 111 eyes with senile maculopathy revealed amyloid in the nodules. Bruch's membrane, and between the basal membrane of retinal pigmented epithelium and the internal collagen layer of Bruch's membrane in the center of the fundus oculi. The detected amyloid incorporations are referred to senile amyloidosis and reliably differ from amyloid in generalized amyloidosis. Comparative analysis of morphologic changes in tissues of the macular and paramacular areas of the fundus oculi and of the incidence of amyloid incorporations in them permit us to propose that accumulation of local senile amyloid is conductive to development and aggravation of senile maculopathy. A relationship between the degree of pigmented epithelium degeneration and accumulation of amyloid in the fundus oculi was revealed. The authors put forward a hypothesis of the pathogenesis of some stages of senile maculopathy, in which the principal role in the formation and deposition of abnormal protein, amyloid, is played by degenerative cells of pigmented epithelium. It is followed by amyloid destruction of Bruch's membrane and accumulation of amyloid under it and the basal membrane of pigmented epithelium. this in its turn, promoting neovascularization and formation of fibrovascular membrane.

[Position of ocular amyloidosis among various forms of amyloidosis]. / Mesto amiloidoza glaza sredi razlichnykh form amiloidoza.

New data, concerning incidence, morphology, clinical manifestations of eye amyloidosis are obtained following its study using modern verification methods. Eye amyloidosis is represented either by its local forms or is associated with a generalized amyloidosis. Local eye amyloidosis predominated and may be isolated and combined. Isolated amyloidosis is represented by two variants: with an involvement of the anterior part of the eye in the form of pseudoexfoliative amyloidosis (PEA) and involvement of the posterior part of the eye with the development of senile macular degeneration (SMD). Local amyloidosis may be associated with senile cerebral amyloidosis, insular amyloidosis of pancreas and both. Predominant involvement of the eye vessels and extraocular structures is an important feature of the ocular amyloidosis as a manifestation of generalized forms. Vitreous body is involved mainly in FAP. New clinico-morpho-pathogenetic classification is suggested.

[Senile amyloidosis of the eye as a manifestation of senile cerebral amyloidosis]. / Starcheskii amiloidoz glaza kak proiavlenie starcheskogo tserebral'nogo amiloidoza.

Senile amyloidosis affects brain vessels and meninges, eye vessels and extraocular structures, and appears during the 6th decade of the life. Its, incidence in patients with senile or presenile dementia and senile plaques is higher than in patients having only senile plaques (the data are based on the examination of 165 patients who died at psychiatric clinics and charitable institutions for old people in Volgograd from 1987 to 1992.

[Amyloidosis of the eye combined with other senile pathology]. / Sochetanie amiloidoza glaza s ego drugoi starcheskoi patologiei.

478 eyes of 313 patients aged from 25 to 90 years and older were investigated (postmortem and surgical material was used). Patients had cataracts, glaucoma, diabetes mellitus. The goal of the study was establishing the amyloid nature of the pseudoexfoliative material (PEM) in the anterior part of the eye. The study showed PEM to be a variety of the amyloid-pseudoexfoliative amyloid (PEA) which was found in 66 (14%) eyes. The localisation and morphology of PEA in various parts of the eye are described in detail. PEA may be the only manifestation of the senile eye amyloidosis, but may be combined with insular amyloidosis of the pancreas.