[Study of the resistome of human microbial communities using a targeted panel of antibiotic resistance genes in COVID-19 patients].

AIM: To study overall drug resistance genes (resistome) in the human gut microbiome and the changes in these genes during COVID-19 in-hospital therapy. MATERIALS AND METHODS: A single-center retrospective cohort study was conducted. Only cases with laboratory-confirmed SARS-CoV-2 RNA using polymerase chain reaction in oro-/nasopharyngeal swab samples were subject to analysis. The patients with a documented history of or current comorbidities of the hepatobiliary system, malignant neoplasms of any localization, systemic and autoimmune diseases, as well as pregnant women were excluded. Feces were collected from all study subjects for subsequent metagenomic sequencing. The final cohort was divided into two groups depending on the disease severity: mild (group 1) and severe (group 2). Within group 2, five subgroups were formed, depending on the use of antibacterial drugs (ABD): group 2A (receiving ABD), group 2AC (receiving ABD before hospitalization), group 2AD (receiving ABD during hospitalization), group 2AE (receiving ABD during and before hospitalization), group 2B (not receiving ABD). RESULTS: The median number of antibiotic resistance (ABR) genes (cumulative at all time points) was significantly higher in the group of patients treated with ABD: 81.0 (95% CI 73.8-84.5) vs. 51.0 (95% CI 31.1-68.4). In the group of patients treated with ABD (2A), the average number of multidrug resistance genes (efflux systems) was significantly higher than in controls (group 2B): 47.0 (95% CI 46.0-51.2) vs. 21.5 (95% CI 7.0-43.9). Patients with severe coronavirus infection tended to have a higher median number of ABR genes but without statistical significance. Patients in the severe COVID-19 group who did not receive ABD before and during hospitalization also had more resistance genes than the patients in the comparison group. CONCLUSION: This study demonstrated that fewer ABR genes were identified in the group with a milder disease than in the group with a more severe disease associated with more ABR genes, with the following five being the most common: SULI, MSRC, ACRE, EFMA, SAT.

[Composition of oropharyngeal microbiota in patients with COVID-19 of different pneumonia severity].

AIM: To identify features of the taxonomic composition of the oropharyngeal microbiota of COVID-19 patients with different disease severity. MATERIALS AND METHODS: The study group included 156 patients hospitalized with confirmed diagnosis of COVID-19 in the clinical medical center of Yevdokimov Moscow State University of Medicine and Dentistry between April and June 2021. There were 77 patients with mild pneumonia according to CT (CT1) and 79 patients with moderate to severe pneumonia (CT2 and CT3). Oropharyngeal swabs were taken when the patient was admitted to the hospital. Total DNA was isolated from the samples, then V3V4 regions of the 16s rRNA gene were amplified, followed by sequencing using Illumina HiSeq 2500 platform. DADA2 algorithm was used to obtain amplicon sequence variants (ASV). RESULTS: When comparing the microbial composition of the oropharynx of the patients with different forms of pneumonia, we have identified ASVs associated with the development of both mild and severe pneumonia outside hospital treatment. Based on the results obtained, ASVs associated with a lower degree of lung damage belong predominantly to the class of Gram-negative Firmicutes (Negativicutes), to various classes of Proteobacteria, as well as to the order Fusobacteria. In turn, ASVs associated with a greater degree of lung damage belong predominantly to Gram-positive classes of Firmicutes Bacilli and Clostridia. While being hospitalized, patients with severe pneumonia demonstrated negative disease dynamics during treatment significantly more often. CONCLUSION: We have observed differences in the taxonomic composition of the oropharyngeal microbiota in patients with different forms of pneumonia developed outside hospital treatment against COVID-19. Such differences might be due to the presumed barrier function of the oropharyngeal microbiota, which reduces the risk of virus titer increase.

[Prevalence and prognostic value of gastroenterological manifestations of COVID-19: data from the Russian University Clinic].

AIM: Assessment of the prevalence and prognostic value of gastroenterological manifestations in patients with COVID-19. MATERIALS AND METHODS: A single-center retrospective cohort study was carried out. Only cases with laboratory confirmed detection of SARS-CoV-2 virus RNA using polymerase chain reaction in oro-/nasopharyngeal smear samples were subject to analysis. Patients with documented (according to anamnestic data and/or according to examination data during hospitalization) organic pathology of the gastrointestinal tract (GIT) and/or hepatobiliary system, malignant neoplasms of any localization, as well as pregnant patients were excluded from the general register of retrospective data. The final cohort was divided into two groups depending on the presence of gastrointestinal symptoms: COVID-19 with gastrointestinal symptoms (cases) and COVID-19 without gastrointestinal symptoms (control). RESULTS: The final sample consisted of 3764 patients, including 2108 (56%) women and 1656 (44%) men. The average age of the subjects included in the analysis was 58.0 years (95% confidence interval CI 48.663.0). In the study cohort, gastroenterological manifestations (alone or in combination) were recorded in 885 (23.51%) patients. Calculation of the odds ratio (OR) of unfavorable and lethal outcomes between the analyzed groups showed that the presence of gastroenterological symptoms significantly increases the chances of lethal outcome in a cohort of elderly and senile patients (OR 1.6817, 95% CI 1.03352.7364; p=0.0364), determines a higher risk of hospitalization or transfer to the intensive care unit (OR 1.2959, 95% CI 1.05471.5922; p=0.0136), development of acute respiratory distress syndrome (OR 1.5952, 95% CI 1.31641.9329; p0.0001), as well as the need for mechanical ventilation (OR 1.2849, 95% CI 1.0771.5329; p=0.0054). CONCLUSION: The present study has demonstrated that gastroenterological symptoms are detected in about one in four patients infected with the SARS-CoV-2 virus and multiply the risk of adverse and life-threatening complications of COVID-19.

[Optical coherence tomography and optical coherence tomography-angiography in the diagnosis of chiasmo-sellar region compression]. / Opticheskaya kogerentnaya tomografiya i opticheskaya kogerentnaya tomografiya-angiografiya v diagnostike kompressii khiazmal'no-sellyarnoi oblasti.

Preservation of visual functions in patients with chiasmo-sellar region compression (CSRC) is possible with early diagnosis and surgical decompression. PURPOSE: To analyze the parameters of optical coherence tomography (OCT) and optical coherence tomography-angiography (OCTA) in patients with CSRC. MATERIAL AND METHODS: The study included 10 patients (20 eyes) with CSRC, 15 healthy volunteers (30 eyes). OCT, OCTA was performed on Cirrus HD-OCT 5000 AngioPlex™ (Carl Zeiss Meditec, U.S.A.) with AngioVue system. RESULTS: Patients with CSRC were revealed to have decreased thickness of ILM-RPE in the nasal sector of outer circle (p<0.001) and average mGCIPL - total and for all six sectors (p<0.001), decreased RNFL in the inferior sector (p=0.017); decreased superficial vessel density (SVD) and perfusion density in the inner and outer circle areas and in all sectors of the ETDRS grid (p<0.001) except temporal; in the peripapillary area, decreased vessel perfusion density (VPD) in the inferior sector (p=0.025), capillary flux index (CFI) in all sectors (p<0.001; p=0.025 in the inferior sector). Informative diagnostic criteria included ILM-RPE in nasal sector of the outer circle (AUC=0.896); mGCIPL in the inferonasal sector (AUC=0.914), average (AUC=0.846), superior (AUC=0.829) and superonasal (AUC=0.846) sectors; average SVD (AUC=0.805) and SVD in the inner circle area (AUC=0.810); CFI in the inferior sector (AUC=0.806) with p<0.001. CONCLUSION: In CSRC, changes can be seen in OCT and OCTA parameters recorded in the macular and peripapillary regions before the changes in the central visual field. Informative diagnostic OCT and OCTA criteria can help diagnose the pathology early, expand the indications for decompression, and preserve the visual funcitons.

[Transcranial dopplerography in the combination with echopulsography in the assessment of intracranial and cerebral perfusion pressure in patients with intracranial hemorrhages].

OBJECTIVE: To study the possibilities of common ultrasound diagnostic methods in the evaluation of intracranial pressure (ICP) and central perfusion pressure (CPP) and to search for the ways of increasing the accuracy of these methods. MATERIAL AND METHODS: Thirty-eight patients, aged 28-66 years admitted to a neuroreanimation department of a hospital due to acute intracranial vascular and traumatic hemorrhages were examined. An instrumental study included transcranial dopplerography (TCDG) and digital echoencephalography. Accuracy of measurement was evaluated for ICP and CPP in clinical conditions. RESULTS: The data obtained confirm the possibility of quantitative assessment of ICP and CPP using TCDG. We suggest a new formula for more precise calculation of CPP. CONCLUSION: The complex use of noninvasive ultrasound methods allow in most cases to measure with acceptable accuracy and assess the degree of intensity of ICP and CPP changes at the acute stage of intracranial hemorrhages.

[Surgical reconstruction of posttraumatic defects and deformities of the orbit using frameless navigation].

PURPOSE: To explore the possibilities of frameless navigation surgery in patients with posttraumatic defects and deformities of the orbit. MATERIAL AND METHODS: In order to develop frameless navigation technique for surgical treatment of posttraumatic defects and deformities of the orbit, examination and surgery were performed on 21 patients of the N.V. Sklifosovsky Research Institute of Emergency Medicine. Multi-slice spiral computed tomography was used for preoperative simulation and intraoperative control. Virtual layer-by-layer reconstruction of missing bone fragments and modeling of anatomical position of dislocated bone fragments in frontal, axial, and sagittal images were performed. Implant position control was done with pointer device of the navigation system. RESULTS: Good functional (disappearance of diplopia in primary position of gaze) and cosmetic results were obtained in all patients. None developed complications in the postoperative period. CONCLUSIONS: The use of frameless navigation in surgical treatment of posttraumatic defects and deformities of the orbit allows to obtain good and stable functional and cosmetic results.

[Surgical treatment of cranioorbital injuries combined with brain trauma].

Cranioorbital injuries (COI) are combined with brain trauma in 45-53% of patients and in 21--24% of cases require surgical treatment. Aim of this study was to evaluate the results of surgical treatment of patients with COI in acute period of traumatic brain injury (TBI). Among 4078 patients with TBI admitted to neurosurgical department of Sklifosovsky Institute of Emergency Medicine, 428 (10,5%) had COI. In acute period of TBI reconstructive procedures were performed in 158 (36,9%) cases. In 78 (49,4%) patients reconstructive surgical procedures were done within 48 hours after injury, in 35 (22,2%) of them simultaneously with neurosurgical operation. In 53 (33,5%) patients underwent surgical treatment in 1 week after trauma or later. Majority of procedures were reconstructive operations with reposition and rigid fixation of fractured bones using different implants. Overall mortality in patients with COIl was 5,3%, postoperative mortality--4,6%. Postoperatively position of the eyeball was restored totally or partially in 127 (97,7%), oculomotor disorders regressed in 132 (98,5%) patients. Obtained results of surgical treatment of COI in acute period of TBI demonstrate high effectiveness and safety of active surgical tactics. Application of modern diagnostic methods and interdisciplinary approach in management of COI in early period after trauma provide good functional and cosmetic results.

[Plastic closure of anterior fossa with simultaneous reconstruction of superior and middle facial zones].

The article describes surgical treatment of a patient with traumatic brain injury combined with anterior fossa defect, CSF leak, bony fractures of superior and middle facial zones. Multidisciplinary surgical team including neurosurgeon, maxillofacial surgeon and ophthalmologist performed single-step operation which consisted of skull base defect closure, cranialization of frontal sinus and reconstruction of its anterior wall by titanium mesh, reposition and fixation of bony fragments of nasoorbital complex, maxilla, surgical fixation of occlusion by cortical screws. The surgery resulted in cessation of CSF leak, restoration of orbital geometry which lead to regression of diplopia and oculomotor disorders. Cosmetic defect was eliminated. This case report demonstrates high effectiveness of multidisciplinary approach in surgical treatment of complex craniofacial injuries.

[Noncontact impedancemetry for diagnosis of cerebral edema].

An original method of impedancemetry designed by the authors and applied in 88 cases of cerebral edema caused by brain aneurysm rupture (n = 23), by acute hemorragic stroke of hypertensive type (n = 13) and craniocerebral injury (n = 52) is described. Diagnostic value of the method, its safety and convenience for clinical practice are demonstrated.