Prognostic Value of Subclinical Pulmonary Congestion With Stress Ultrasound of the Lungs in the Development of Heart Failure in Patients With Primary Myocardial Infarction and Percutaneous Coronary Intervention.

Aim      To determine the clinical and prognostic significance of subclinical pulmonary congestion, as evaluated by stress ultrasound (stress-US) examination of the lungs, in the development of heart failure (HF) during the postinfarction period after acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI).Material and methods  This prospective observational study included 103 patients with no history of HF and with the first AMI and successful PCI. Standard laboratory tests, including the measurement of NT-proBNP, echocardiography, stress-US of the lungs with a 6-min walk test (6MWT), were performed for all patients. Pulmonary congestion was diagnosed with the total number of B lines ≥2 during stress: mild (2-4 B lines), moderate (5-9 B lines), and severe (≥10 В lines). Subclinical pulmonary congestion implied the absence of clinical signs of congestion in the presence of ultrasonic signs of pulmonary congestion (>2 В lines) during stress. The phenomenon of "wet" lung was identified when the total number of B lines was <2 at rest ("dry" lung) and ≥2 after stress. When the total number of B lines was >2 at rest ("wet" lung at rest) and ≥2 after stress, the phenotype was identified as "very wet" lung. The endpoint was hospitalization for HF during 1.5 years.Results The study showed a high incidence of subclinical pulmonary congestion as determined by the results of stress-US test of the lungs, mild (18.4 %), moderate (37.9 %) and severe (42.7 %), and of "wet" and "very wet" lung phenotypes (65 %). The "wet/very wet" lung phenotypes correlated with the body weight index (R=0.236; p=0.016), troponin concentration upon admission and at 6-12 h (R=0.231; p=0019 and R=0.212; p=0.033, respectively), NT-proBNP concentration (R=0.276; p=0.035), Е peak (R=0.241; p=0.019), global longitudinal strain (GLS) (R=-0.208; p=0.034), and left ventricular end-diastolic dimension (R=0.351; p=0.0004). The higher probability of hospitalization for HF during 1.5 years after the discharge from the hospital correlated with a LV EF ≤48 % (OR, 4.04; 95 % CI: 1.49-10.9; р=0.006), a post-stress total number of B lines ≥10 (OR, 3.10; 95 % CI: 1.06-9.52; р=0.038), a pulmonary artery systolic pressure >27 mm Hg (OR, 3.7; 95 % CI: 1.42-9.61; р=0.007).Conclusion      Stress-US of the lungs with evaluation of the total number of B lines should be performed for patients after the first AMI and PCI and with no clinical signs of congestion, for stratification of the risk for HF in the postinfarction period.

[Molecular genetic analysis of malaria mosquitoes of the Anopheles maculipennis (Diptera, Culicidae) complex in Azerbaijan].

Molecular genetic analysis of malaria vectors in the Republic of Azerbaijan has identified three species of malaria mosquitoes of the Anopheles maculipennis complex: An. maculipennis, An. sacharovi, and An. persiensis. An. melanoon has not been found. An. sacharovi has been ascertained to predominate in the low-lying areas of the country. An. maculipennis prevails in the north, on the foothills of the Great Caucasus and it is also observed in the south, on the Talysh foothills and mountains. An. persiensis has been first recorded for the malaria mosquito fauna in the CNS. This species has been detected only in the south of the republic (Lenkoran and Astar districts).

Local environment and dynamics of PO4 tetrahedra in Na-Al-PO3 glasses and melts.

Glasses and melts in the system (NaPO3)(1-x)(Al(PO3)3)x were studied with the aim of obtaining information about the structure on the next larger scale beyond the PO4 group. Magic angle spinning NMR was applied to the pure NaPO3 glass and Raman scattering to systems with x = 0.00, 0.03, 0.06, 0.15, and 0.60 in the temperature range T = 300-1100 K. Comparison of the 31P chemical shift between glass and crystalline forms revealed that polymerization of the metaphosphate into tricyclophosphatelike (PO3)3(3-) rings is the dominant structure, ca. 80%, formed by the twofold vertex-joined PO4 groups in the glass. In the Raman study we focused on the prominent polarized band at ca. 1170 cm(-1) which is due to the symmetric breathing mode of the tetrahedral PO4 group. This band was decomposed into a few Gaussian lines. These component lines could be identified using the NMR results: two narrow components are due to PO4 groups in the tricyclophosphatelike rings, which have either a Na or an Al counterion and a third broad component is due to chain-polymerized (PO3(-))n. The variations of the component lines (peak positions, widths, and intensities) with respect to x and T are presented. We derive the shifts of the symmetric breathing mode frequency which are caused by Na or Al counterions, by ring closure, by x > 0, etc. The relative intensities of the narrow and broad components in the 1170-cm(-1) band of the Raman spectra are discussed. The amount of ring-to-chain transformation on addition of Al3+, and as functions of T and x, is derived. Indications for ordering on a next larger scale, derivable from Raman, NMR, and thermodynamics, are compared.

[The etiology of El Tor cholera]. / Etiologiia kholery él'tor.

Vibrio cholerae eltor has been shown to exist in two variants: epidemic (V. cholerae eltor Hly-, tox+) and nonepidemic, or endemic (V. cholerae eltor Hly+, tox-); each of these variants determines the corresponding form of manifestation of the infection among the population and requires a differentiated complex of antiepidemic measures, as well as different tactics for the treatment of patients.

[Injuries of the heart]. / Raneniia serdtsa.

The authors had 53 patients with heart injuries under observation; 52 patients were operated on for vital indications. The heart wound was sutured, the concomitant injuries to other organs were removed, and the pericardial and pleural cavities were drained. Air-tightness of the injured heart muscle was attained in all cases. Seven of the patients who were operated on died. One patient who did not undergo operation died suddenly in complete well-being from acute cardiac tamponade 2 days after injury to the chest inflicted with a pin-like object. The authors emphasize the importance of organizational measures promoting earliest performance of the operation.

[Traumatic injuries and diseases of the diaphragm]. / Travmaticheskie povrezhdeniia i zabolevaniia diafragmy.

The article analyses experience in diagnosing the pathological condition and treating 125 patients with acute injury to the diaphragm (61 patients) and chronic traumatic diaphragmatic hernias (64 patients). The authors indicate the therapeutic and diagnostic means in this pathological emergency due to the acute trauma of the chest and abdomen or incarceration of the abdomen. The diagnostic errors and their consequences are analysed. Operation was conducted on 104 patients. In ruptures of the diaphragm in the zone of the esophageal hiatus the cardia was drawn downwards and fastened under the diaphragm; in cases of fractures of the bony framework of the chest with the formation of fragments, panel fixation of the costal fragments and the sternum was carried out by the authors' methods. The results of the surgical interventions are shown (18 patients--17.4% died) with emphasis on the character of the disorders and the lapse of time from the development of the emergency to the application of therapeutic aid.

[The characteristics of a cholera outbreak in Pushkino District, the Azerbaijan SSR]. / Nekotorye osobennosti vspyshki kholery v Pushkinskom raione Azerbaidzhanskoi SSR.

The outbreak of cholera in the Pushkino District of the Azerbaijan SSR, caused by the penetration of Vibrio cholerae into the water of the irrigation system, is described. Altogether 2 cholera patients and 39 Vibrio carriers were detected. The etiological agent of this infection was V. cholerae eltor, serovar Ogawa, with typical phenotype characteristics. From all patients and 37 carriers virulent strains and from 2 carriers faintly virulent strains were isolated. In this outbreak family foci were clearly observed, but the transmission of infection through everyday contacts was practically of no importance. The foci with multiple cases were formed due to the action of one transmission factor: contaminated water.