[Treatment of toxic hepatitis in COVID-19 patients].

BACKGROUND: The article reflects the clinical significance of the early diagnosis of toxic hepatitis in patients who have undergone a new coronavirus infection with the determination of clinical and laboratory predictors of the response to therapy. A dynamic analysis of the effectiveness of toxic hepatitis therapy in patients of three experimental groups and a control group is presented. AIM: The aim of the present study is to increase the effectiveness of the treatment of toxic hepatitis in patients who have undergone COVID-19. MATERIALS AND METHODS: On the basis of the newly created infection centers of the Central Clinical Hospital "RZhD-Medicine" and Vishnevsky 3-rd Central Military Clinical Hospital 996 patients with COVID-19, who had clinical and laboratory signs of toxic liver damage (cytolytic and/or cholestatic syndromes) against the background of COVID-19 therapy. RESULTS: On the 14th day from the start of therapy in group 3, there was a significant decrease in the clinical manifestations of jaundice in 163 (72.8%) patients, on the 21st day of treatment, this symptom was stopped in all patients. In groups 1 and 2, the decrease in clinical manifestations of jaundice was significantly lower - 122 (55.2%) and 134 (58.8%); p<0.05. At the end of therapy, no manifestations of jaundice were observed in all experimental groups, while in the control group, symptom reduction was achieved only in 47 (14.5%) patients. CONCLUSION: The use of drugs with hepatoprotective effect in the form of monotherapy in groups 1 (UDCA) and 2 (ademethionine) showed a low therapeutic effect with positive dynamics of clinical and laboratory indicators of toxic hepatitis activity. The use of combined treatment in group 3 (UDCA and ademethionine) demonstrated the maximum therapeutic effect, pronounced positive dynamics in the form of normalization of clinical and laboratory indicators of toxic hepatitis activity.

[Clinical efficacy of neurometabolic therapy of dissomical disorders in asthenic syndrome]. / Klinicheskaia éffektivnost' neirometabolicheskoi terapii dissomnicheskikh rasstroistv pri astenicheskom sindrome.

AIM: To analyze the efficacy of cytoflavin in the complex treatment of sleep disorders in asthenic syndrome. MATERIAL AND METHODS: One hundred patients with sleep disorders and asthenic syndrome of various etiology and severity were studied. The patients were divided into three groups depending on the type of therapy: the first group received intravenous infusions of cytoflavin for 10 days; the second group, in addition to cytoflavin, received per os melatonin (3 mg or 5 mg) at bedtime; the third group in addition to cytoflavin received per os zopiclone (7.5 mg) at bedtime. RESULTS: On the 14th day of the study, a decrease in severity or complete relief of asthenia manifestations (according to the SHAS scale) and, accordingly, improvement or normalization of sleep in 97% of patients was found. At the same time, during polysomnographic study, the data obtained are characteristic for improving the quality of sleep phases mainly in the first and second groups of patients and, to a lesser extent, in the third group. CONCLUSION: Cytoflavin effectively suppresses the main manifestations of asthenic syndrome, including sleep disorders.

[The choice of antibiotic according the results of standard bacteriological analysis and express-method without isolation of pure cultures.]

The efficiency of choosing antibiotics using two methods was analyzed. The first method is based on standard laboratory analysis including isolation of pure cultures of prospective agent and detection of their individual sensitivity to antibiotics. The second method is based on a new express-technique permitting to simultaneously evaluate effect of pharmaceuticals on cultivated and not cultivated yet bacteria without isolation of pure cultures. At that, the second method permits to determine efficiency of antibiotics namely in those concentrations that can be made in the given nidus of infection. The study demonstrated existence of discrepancy between results obtained by using the given methods. The cause of discrepancy can be presence of not cultivated yet bacteria in pathologic sample. In favor of this assumption testify the received data concerning samples from patients where were presented a significant number of spore-former bacteria having additional mechanisms of resistance to antibiotics. Furthermore, the implemented study established antibiotics characterized by the greatest discrepancy of results obtained by applied methods that indicates the necessity of revision of schemes of implementation of start or empiric therapy.

Comparative analysis of cells with combined apoptosis and proliferation markers in thyroid tissue specimens from patients with cancer, adenoma, and autoimmune diseases.

Combined phenotypes of cells with membrane and intracellular expression of apoptosis and proliferation regulation markers (p53, bcl-2, CD95, CD95L, Ki-67) were studied by flow cytometry of cell suspension from thyroid tissue specimens from patients with autoimmune diseases, adenoma, and thyroid cancer. The incidence of cell groups with phenotypes p53/Ki-67, p53/CD95, bcl-2/Ki-67, bcl-2/CD95, CD95/Ki-67, p53/CD95L, CD95/CD95L, and bcl-2/CD95L was evaluated and the density of receptor distribution on/in each cell group are presented. Patients with autoimmune diseases had high incidence of cells with phenotypes p53/Ki-67, p53/CD95, bcl-2/Ki-67, bcl-2/CD95, CD95/Ki-67, p53/CD95L, CD95/CD95L, and bcl-2/CD95L; cells with the bcl-2/CD95 phenotype were the most incident. Patients with thyroid adenoma had high levels of cells with p53/CD95L phenotype, while patients with thyroid cancer had significantly lower levels of p53 expression in the p53/CD95L cell group. The density of CD95L receptors on CD95/CD95L-positive cells was 4-7-fold higher in patients with thyroid tumors; the density of CD95L receptors on CD95/CD95L cells was maximum in thyroid adenoma and minimum in thyroid cancer. These data indicate differences in the expression of apoptosis and proliferation markers in thyroid adenoma, cancer, and autoimmune diseases. Analysis of the expression of these markers in the above diseases can be useful for differential diagnosis.

[Plasminogen activators of urokinase and tissue types and their inhibitor (PAI-1) in cytosol fraction in thyroid diseases]. / Aktivatory plazminogena urokinaznogo i tkanevogo tipov i ikh ingibitor (PAI-I) v tsitozol'noi fraktsii pri zabolevaniiakh shchitovidnoi zhelezy.

Enzyme immunoassay (ELISA) was used to estimate the levels of plasminogen activators of urokinase (uPA) and tissue (tPA) types and one of their inhibitors (PAI-I) in the cytosolic fraction of the thyroid in 129 patients with malignant and benign tumors and various non-cancer diseases of the gland. Tumors from patients with thyroid cancer displayed the lowest levels of tPA and the highest levels of uPA and PAI-I, while those from patients with benign thyroid diseases, including adenoma, had high concentrations of tPA and relatively low levels of uPA and PAI-I in the tissue of the diseased organ. At the same time, the lowest levels of uPA and PAI-I were found in patients suffering from toxic goiter with and without adenomatosis. In terms of uPA and PAI-I levels, patients with nodular colloidal goiter were intermediate between those with toxic goiter and adenoma, on the one hand, and those with thyroid cancer, on the other.

[The gas-exchange properties of membrane blood oxygenators with immobilized heparin]. / Gazoobmennye svoistva membrannykh oksigenatorov krovi s immobilizovannym geparinom.

Gas-exchange properties of membrane oxygenators (MO) "MOST-122" with immobilized heparin have been studied during 18 open heart surgeries. It has been shown that heparin immobilization on MO surfaces that are in contact with blood is accompanied by enhanced MO ability to oxygenate blood and remove CO2.

[The use of selective cytopheresis following cardioplegia during open heart surgery]. / Ispol'zovanie selektivnogo tsitofereza posle kardioplegii vo vremia operatsii na otkrytom serdtse.

The analysis of 20 operations on the open heart performed with selective cytopheresis (apparatus PK-0.5) or without it has demonstrated that in pharmacological and ice-chip cardioplegia the technique to a great extent prevents the loss of the patient's own blood removed with cardioplegic solution and makes it possible to reduce donor blood consumption by 27%. The course of the postoperative period improves considerably: blood loss is reduced, the recovery of blood cellular composition becomes more intensive. Cardioplegia performed in combination with selective cytopheresis does not exclude certain protein loss (up to 15 g/l during one session), which confirms the necessity of adequate homeostasis correction with protein blood preparations.

[The use of immobilized heparin in perfusion systems with membrane oxygenation during heart surgery]. / Ispol'zovanie immobilizovannogo geparina v perfuzionnykh sistemakh s membrannoi oksigenatsiei pri kardiokhirurgicheskikh vmeshatel'stvakh.

The analysis of 65 cases of cardiopulmonary bypass surgery using systems distinct in the type of the oxygenator used (contact, membrane) and the degree of thromboresistance of blood-contacting surfaces has demonstrated that the use of heparin-covered membrane blood oxygenators and systems allows of a considerable reduction in blood trauma during perfusion and a 5-6-fold decrease of heparin doses employed for extracorporeal membrane blood oxygenation.