[Prevention of impulsive suicide with antidepressants in outpatients]. / Preventsiya impul'sivnogo suitsida s primeneniem antidepressantov u ambulatornykh patsientov.

Self-poisoning is a common method of suicide, for which various medications are used, including antidepressants. A non-systematic review of Russian-language and English-language publications, by keywords, in the databases: ELibrary.ru, PubMed, Cochrane Database of Systematic Reviews. The purpose of the review was to analyze the literature on new risk factors and methods of their reduction in suicides with self-poisoning with antidepressants. Every fifth (20%) self-poisoning performed with antidepressants. In self-poisoning attempts, one drug used in 55% of cases, and more than one drug was used in 45% of cases. Impulsive suicides account for up to half of all suicide cases. Risk factors for impulsive suicides include the presence of impulsive character traits, female gender, young age, and the use of psychostimulants. The WHO Regional Office for Europe's mhGAP-IG guidelines recommend limiting access to a patient at risk of suicide to a weekly dose of an antidepressant. Preferably, the use of antidepressants from the group of SSRIs in small forms of release.

[Surgical treatment of mega aorta syndrome: a single-center experience]. / Khirurgicheskoe lechenie sindroma megaaorty: opyt odnogo tsentra.

OBJECTIVE: To present our experience in the treatment of severe patients with mega aorta syndrome. MATERIAL AND METHODS: There were 49 patients with mega aorta syndrome for the period from May 2015 to March 2021. All patients underwent total aortic replacement from sinotubular junction (with staged aortic root repair, if necessary) to abdominal aorta bifurcation. All surgeries were elective. All patients were divided into two groups: group I (n=33; 67.3%) - staged replacement, group II (n=16; 32.7%) - one-staged replacement of the aorta via thoracophrenolumbotomy. The primary endpoints were mortality, perioperative parameters and complications. We also analyzed long-term freedom from aortic redo surgery and survival rate. RESULTS: Both groups were comparable by pre-, intra- and postoperative parameters. The interval between surgeries for staged approach was 7.1±2.3 months. Rehabilitation time considering two stages was longer in group I (13±2 vs. 5.5±1.1 months, p=0.0001). Between-stage mortality rate was 12% (n=4). Intraoperative mortality was absent in both groups. In-hospital mortality was 3% and 12% (p=0.25), overall mortality with between-stage interval - 10.2% and 12% (p=1.000), respectively. The follow-up period was similar (18±22.7 (range 1-71) and 23.3±19.1 (range 1-51) months, respectively (p=0.63)). In group I, 1-year, 3-year and 5-year survival rate considering between-stage mortality was 89% (95% CI 78-100%), 77.1% (95% CI 60.1-98.8%), 77.1% (95% CI 60.1-98.8%), respectively. In group II, 1-year and 3-year survival rate was 86.5% (95% CI 70.5-100%), plog-rank=0.88. Overall freedom from redo surgery was 92.9% (95% CI 80.3-100%) vs. 90.9% (95% CI 75.4-100%), plog-rank=0.072. CONCLUSION: One-stage total aortic replacement via thoracophrenolumbotomy is safe surgical treatment for mega aorta syndrome, especially in young patients with low surgical risk. Favorable outcomes may be expected in specialized centers with extensive experience in aortic surgery. Compared to staged approach, total aortic replacement eliminates the risks of between-stage aortic rupture. Therefore, it is a worthy alternative to other methods.

[Apathy syndrome in depressed patients previously treated with selective serotonin reuptake inhibitors]. / Sindrom apatii u depressivnykh patsientov, poluchavshikh lechenie selektivnymi ingibitorami obratnogo zakhvata serotonina.

This review of literature considers apathy syndrome induced by selective serotonin reuptake inhibitors (SSRI). Epidemiology and etiology of this phenomenon are not clear. Clinical features, diagnosis of apathy, differentiating and correlations between apathy and depression are presented. The possible mechanisms of onset and strategies of therapy of SSRI-induced apathy are discussed. It has been concluded that, despite the clinical evidence of the relationship between apathy and SSRI treatment, evidence-based research is needed.

Improvement in quality of oocytes in polycystic ovarian syndrome in programs of in vitro fertilization.

Inositol therapy is aimed at improving the quality of oocytes during preconception care in patients with polycystic ovarian syndrome (PCOS), a cause of infertility and reproductive dysfunction. The objectives of this observational comparative multicentre study were to evaluate the effectiveness of inositol in improving the quality of oocytes/embryos and IVF cycle outcome. Group 1 patients (N = 133) received inositol 1000 mg (Inofert or Nutrilinea) + folic acid 0.1 mg. Group 2 consisted of patients with preserved ovarian reserve without PCOS (N = 137), not administered inositol prior to pregnancy. Effectiveness criteria were numbers of mature oocytes and good quality embryos, pregnancy rates per ET, 'take home baby' index and miscarriage rates. Pregnancy rates per ET (87.0% vs. 87.4%), 'take home baby' index (79.6% vs. 89.4%) and miscarriage rates (14.3% vs. 10.6%) were comparable. Use of inositol in patients with PCOS during preconception care is an effective method allowing improvement of oocytes quality and positively affecting IVF cycle prognosis. High pregnancy rates per ET and 'take home baby' index after treatment are justifying inositol usage in patients with PCOS and infertility.

[CLINICAL ASPECTS OF THE BLOOD LACTATE DYNAMICS DURING OPERATIONS ON THE HEART AND THE AORTA IN CONDITIONS OF CARDIOPULMONARY BYPASS.]

BACKGROUND: The frequency and the causes for the development of hyperlactatemia during operations on the heart and aorta in conditions of cardiopulmonary bypass (CB) is not adequately described in the literature. THE AIM: To study the clinical significance of the lactate dynamics in arterial blood depending on the source ofpathology, stages of operation, basic parameters of cardiopulmonary bypass, the characteristics of the post-perfusion period, and to identify ways to prevent the development of intraoperative hyperlactatemia in surgical interventions on the heart and aorta. MATERIALS AND METHODS: 420 adult cardiac surgery patients operated on the heart and ascending aorta were examined. All patients were operated on under balanced General anesthesia, CB in hypothermic or normothermic mode. Lactate level in arterial blood and the frequency of hyperlactatemia were analyzed at the following stages of operation: after induction of anesthesia, prebypass period, during CB, in the postbypass period and at the time of admission of the patient in the ICU. During CB we analyzed the duration of the CB, the degree of hemodilution, calculated value of oxygen delivery. Oxygen consumption was recorded in the current mode, the monitor CDI-500. Hyperlactatemia was considered the concentration of lactate above 3 mmol/L. RESULTS: Preperfusion period in all groups of cardiac surgery patients was characterized by a normal level of blood lactate in the absolute majority ofpatients, the frequency of hyperlactatemia did not exceed 1%. Hemodynamic stability was achieved without the use of catecholamines by optimizing volemia and heart rate. While CB showed a trend of increasing lactate on average in comparison with the previous period in patients operated on the heart. Duration CB less than 3 hours was not a factor in the development of hyperlactatemia, provided that oxygen delivery in all patients during perfusion exceeded 300 ml/min/m2, hematocrit ofperfusate at the end of CB was at 25-27% in most patients. To maintain it at a large hemodilution the ultrafiltration hemoconcentration was used. The frequency of hyperlactatemia was 3%. A significant increase in lactate concentration at the end of the CB to 3.39k1,3 mmol/l (range of 2.1-7.2 mmol/l) on the background of metabolic acidosis found only in patients with circulatory arrest due to receipt of blood products of anaerobic glycolysis after the resumption of the CB. They have frequency of hyperlactatemia risen to 29%. The lac- tate average value at admission ofpatients in the ICU with application of 50-60% ofpatients in dopamine/dobutrex at a dose of 5 mcg/kg/min and reaching the targets of transfusion therapy was slightly higher in the baseline period and corresponded to the upper level of normal values. Only during operations on the aortic arch under conditions of circulatory arrest, the concentration of lactate at the end of the operation was 3,4+1,1 mmol/l with a tendency to decrease in comparison with the period of the CB. From 88 to 93% patients during operations on the heart and ascending aorta without circulatory arrest and 64% ofpatients after operations on the aortic arch with circulatory arrest were admitted to the ICU with a normal lactate level in arterial blood Conclusion. The duration ofperfusion less than 3 hours in the conditions of these indicators preservation is not a risk factor for the development of hyperlactatemia. In postbypass period during operations on the heart and aorta without circulatory arrest about 90% ofpatients transferred to the intensive care unit (ICU) with normal values of lactate. During operations on the aortic arch with circulatory arrest about 60% ofpatients have normal levels of lactate at admission from the operating room to the ICU.

[Strategy of transfusion in cardiac and aortic surgery].

Current trend in transfusion is a decreasing of the donor's blood use due to possible complications. The article deals with analysis of intraoperative blood loss in different surgeries on the heart and aorta and of a role of blood-saving factors in decreasing of the donor's blood transfusion. We found a correlation between the blood components need and type of surgery and assessed a preoperative provision of autoplasma and intraoperative autohemotransfusion with a blood sampling from the right atrium before the beginning of artificial circulation (Complex use of the blood-saving methods with a prophylactics and treatment of hemostasis disturbances allowed the significantly decreasing of the donor's blood use. 50-70% of patients did not receive components of the donor's blood during cardiac surgery.

Study of the frequency of occurrence of genetic and acquired thrombophilia in infertile women prior IVF.

This study of infertile women prior in vitro fertilization (IVF) is focused at the genetic and acquired thrombophilia before the IVF program, the identification of the frequency of occurrence of thrombophilia in them, the impact of thrombophilia of the offensive, the course and outcome of pregnancies, to improve the quality of cycles in terms of a pregnancy and childbirth. Forty-five women with infertility were examined. Thirty-two (71%) were identified thrombophilia: genetic thrombophilia in 32 cases (100%), among them a combination of several forms of genetic thrombophilia - 21 (63%) of them, other forms of thrombophilia (genetic and acquired) - in 5 of them (16%). In IVF 23 (72%) women became pregnant. In 87% of pregnancies ended in spontaneous birth, in 13% of cases of preterm birth.

[Obstructive sleep apnea syndrome in patients with chronic obstructive pulmonary disorder].

Sleep obstructive apnea syndrome (SOAS) is a life-threatening respiratory disorder. Its combination with COPD further deteriorates respiratory distress and accelerates the development of pulmonary hypertension (crossover syndrome). Systemic inflammation with concomitant oxidative stress in patients with SOAS and COPD suggests their influence on the development of circulatory disorders. Night-time cyclic hypoxia in patients with SOAS triggers systemic inflammation, oxidative stress, and atherogenesis which accounts for the frequent complications more severe in combination of SOAS and COPD than in either of these diseases. Intermittent hypoxia in patients with SOAS is associated with hypoventilation resulting from COPD, deteriorates clinical conditions of the patients, and requires the choice of specific methods of respiratory support.

[The specific features of respiratory support in patients with obstructive sleep apnoea syndrome concurrent with chronic obstructive pulmonary disease (crossing-syndrome)].

AIM: To determine the specific features of respiratory support in patients with obstructive sleep apnoea syndrome (OSAS) concurrent with chronic obstructive pulmonary disease (COPD). SUBJECTS AND METHODS: Thirty-six patients with OSAS concurrent with COPD were examined. External respiration function, apnoea/hypopnoea index, and arterial gas composition were determined in all the patients. The efficiency of continuous positive airway pressure (CPAP) therapy was evaluated in all the patients with the crossing-syndrome (CS). RESULTS: The prevalence of CS among the patients with OSAS was 18.8%. The CS patients' need for bilevel positive airway pressure (BiPAP) therapy was 27.8%. These patients and those treated with CPAP had at baseline a daytime hypercapnia level of 50.7 +/- 1.8 and 42.0 +/- 1.2 mm Hg (p = 0.005) and a nocturnal blood oxygen saturation level of 83.6 +/- 1.3 and 88.8 +/- 0.9% (p = 0.004), respectively. BiPAP therapy resulted in a 1.8-fold reduction in the desaturation index than did CPAP therapy. CONCLUSION: On choosing a respiratory support method in patients with OSAS, one should assess the presence of chronic lower airway obstruction, the degree and type of chronic respiratory failure, and the presence and magnitude of clinical, functional, and laboratory signs of alveolar hypoventilation. Bilevel lung ventilation is more effective in patients who have CS, daytime hypercapnia, and nocturnal hypoxemia uncorrected by CPAP therapy and who need high therapeutic pressure.

[Improvement of epidural anesthesia in reconstructive surgery of the aorta in Leriche's syndrome]. / Optimizatsiia épidural'noi anestezii pri rekonstruktivnykh operatsiiakh na aorte po povodu sindroma Lerisha.

Fifty-six patients subjected to aortofemoral bilateral shunting under prolonged epidural anesthesia are examined. Swan-Gans catheter was used to evaluate central and pulmonary hemodynamics. Ganglionic blocking with pentamine for taxiphylaxis was carried out in 31 patients prior to catheterization of the epidural space. Epidural anesthesia with ganglional blocking is associated with reduced vasodilation and hypotension and attenuates the hemodynamic reactions during clamping and unclamping of the aorta, thus decreasing the incidence of intra- and postoperative complications.

[Effects of school environment factors on enterobiasis morbidity among students]. / Vliianie faktorov vnutrishkol'noi sredy na z zabolevaemost' uchashchikhsia énterobiozom.

The authors examined 20 general educational schools in Rostov-on-Don and identified 8 informative determinants of enterobiasis prevalence among them, such as the frequency of wet cleaning, the number of recreational rooms and gymnasia, over-crowding, the presence of extended-day groups, water supply, shower-rooms in the gymnasia, and shifts of educational processes.

[Significance of personal hygiene habits in the prevention of enterobiasis]. / Znachenie navykov lichnoi gigieny v profilaktike énterobioza.

The pupils from Rostov-on-Don were interviewed by a questionnaire on medical helminthology. They were found to poor knowledge in this sphere. They do not observe elementary personal hygienic rules. The ways of improving the hygienic education of pupils.

[The primary and secondary prevention of enterobiasis today]. / Pervichnaia i vtorichnaia profilaktika énterobioza na sovremennom étape.

The paper provides evidence for dividing the prevention of enterobiasis, which is the major human helminthiasis in Russia, into social and medical ones. It proposes to implement 4 directions of medical prophylaxis: behavioral, sanitary and hygienic, functional and biological, and therapeutic and health-improving actions. The paper also characterizes measures underlying each of them.

[Study of risk factors of enterobiasis in schoolchildren and development of a prognostic table for primary screening]. / Izuchenie faktorov riska pri énterobioze u shkol'nikov i razrabotka prognosticheskoi tablitsy dlia pervichnogo skrininga.

Risk factors for enterobiasis were qualitatively and quantitatively assessed by a questionnaire given to 277 health schoolchildren and 277 schoolchildren who suffered from enterobiasis. A prognostic table was developed for primary screening of risk groups. Preventive measures are recommended in the paper.

[The hygienic bases for the prevention of enterobiasis]. / Gigienicheskie osnovy profilaktiki énterobioza.

Evidence is provided for the value and priority of sanitary and hygienic measures and hygienic education of the population in the prevention of enterobiasis. It is emphasized that preventive work can be successful only when the parents, tutors of preschool institutions and teachers of schools are obligatorily attracted to it.