[Exudative pericarditis with tamponade after COVID-19. Case report].

A description of a COVID-19 patient with the development of exudative pericarditis complicated by cardiac tamponade is provid. A peculiarity of this case is the presence of an underlying disease in the patient (chronic lymphocytic leukemia), which was in remission for 1.5 years after chemotherapy. Another feature of the patient was the relatively small area of lung damage and the hemorrhagic nature of the pericardial effusion, which persisted for a long time. The insignificant activity of inflammatory markers was noteworthy. Possible mechanisms of development and features of the course of exudative pericarditis in the described patient, issues of diagnosis and treatment of this category of patients are discusse.

[Review of international and European registers on infective endocarditis].

The article reviews international and European registries of infectious endocarditis and observational studies based on these registries. Methods of data collection, results, and conclusions are analyzed. Prospects of using registries for research, optimizing the quality of health care, and estimating costs are discussed.

[Clarithromycin for community-acquired pneumonia in adults: focus on anti-inflammatory properties].

AIM: To evaluate clinical efficacy, anti-inflammatory and immunomodulatory activity of clarithromycin in adults with severe community-acquired pneumonia (sCAP). MATERIALS AND METHODS: A prospective observational study recruited adult hospitalized patients with verified sCAP. Clarithromycin was prescribed as a component of combination antibiotic therapy (ABT) with a ß-lactam antibiotic (AB). The choice of ß-lactam AB was carried out by the attending physician in accordance with national clinical guidelines and routine practice of the medical institution. Along with assessment clinical efficacy, the dynamics of inflammatory markers in blood serum was recorded: C-reactive protein, procalcitonin (PCT), tumor necrosis factor α, interleukins 1-beta (IL-1) and interleukin 6 (IL-6). The total duration of ABT was 7-14 days. RESULTS: Altogether 20 patients (13 males, 7 females) aged from 18 to 84 years old were enrolled. As a result of the use of combined ABT with ß-lactam AB and clarithromycin, a significant decrease in the level of C-reactive protein was noted by the 3-5th day of therapy (from 74.6 to 14.1 mg/l). An increase in serum PCT was observed in half of the patients; during treatment, the level of PCT significantly decreased. Similar dynamics was detected for IL-6 - its content in the blood serum decreased by the time of the end of ABT by 6.8 times compared with the baseline. A decrease in the level of tumor necrosis factor α to the reference value was observed in most patients already in the early stages - by 3-5 days of ABT. The majority of patients showed positive dynamics of clinical signs and symptoms with resolution of respiratory failure and other complications of sCAP. In almost half of the patients, the criteria for clinical stability were achieved in the early stages, which made it possible to switch to oral ABT. CONCLUSION: The results of the study are consistent with literature data indicating a rapid decrease in inflammatory markers when clarithromycin is administered to patients with sCAP. Its results can be a starting point for comparative randomized trials assessing both clinical outcomes and immunological parameters when using different classes of antibiotics for the treatment of sCAP.

[Relationships between body composition and hematological parameters in long-living patients with coronary artery disease.]

The study objective to investigate hematological parameters and determine the relationships between these indicators and body composition in centenarians with coronary artery disease. This work is a cross-sectional study, which enrolled 239 patients over 90 years old hospitalized with a diagnosis of coronary artery disease; most of them (67,8%) were women. The age of the patients ranged from 90 to 106 years, averaging 92,8 (±2,5) years. Body composition was analyzed by dual energy X-ray absorptiometry. Anemia was detected in 108 (45,2%) patients, while a significant direct correlation was found between the hemoglobin level and all indicators of bone mineral density (p=0,004-0,00002). Patients with osteoporosis had lower levels of hemoglobin (p=0,002) and blood iron (p=0,02). Direct correlations were established between the hemoglobin level and lean tissue mass (p=0,06-0,003). Patients with obesity had higher levels of hemoglobin (p=0,007), erythrocytes (p=0,03), leukocytes (p=0,04), lymphocytes (p=0,01) and monocytes (p=0,05). A direct correlation was registered between the platelets count and fat tissue mass (p=0,04-0,00006) along with an inverse correlation between platelets and lean tissue (p=0,001-0,0004). The study results indicate significant relationships between the parameters of body composition and hematological indicators.

[Etiology of severe community - acquired pneumonia in adults: results of the first Russian multicenter study].

AIM: to study the etiology of severe community - acquired pneumonia (SCAP) in adults in Russian Federation. SCAP is distinguished by high mortality and socio - economic burden. Both etiology and antimicrobial resistance are essential for appropriate antibiotic choice. MATERIALS AND METHODS: A prospective cohort study recruited adults with confirmed diagnosis of SCAP admitted to multi - word hospitals of six Russian cities in 2014-2018. Etiology was confirmed by routine culture of blood, respiratory (sputum, endotracheal aspirate or bronchoalveolar lavage) and when appropriate, autopsy samples, urinary antigen tests (L. pneumophila serogroup 1, S. pneumoniae); real - time PCR for identification of "atypical" bacterial pathogens (M. pneumoniae, C. pneumoniae, L. pneumophila) and respiratory viruses (influenza viruses A and B, parainfluenza, human metapneumovirus, etc.) was applied. RESULTS: Altogether 109 patients (60.6% male; mean age 50.8±18.0 years old) with SCAP were enrolled. Etiological agent was identified in 65.1% of patients, S. pneumoniae, rhinovirus, S. aureus and K. pneumoniae were the most commonly isolated pathogens (found in 43.7, 15.5, 14.1 and 11.3% of patients with positive results of microbiological investigations, respectively). Bacteriemia was seen in 14.6% of patients and most commonly associated with S. pneumoniae. Co - infection with 2 or more causative agents was revealed in 36.6% of cases. Combination of bacterial pathogens (mainly S. pneumoniae with S. aureus or/and Enterobacterales) prevailed - 57.7% of cases; associations of bacteria and viruses were identified in 38.5% of patients, different viruses - in one case. CONCLUSION: S. pneumoniae was the most common pathogen in adults with SCAP. A high rate of respiratory viruses (mainly rhinovirus and influenza viruses) identification both as mixt infection with bacteria and mono - infection should be taken into account.

C-reactive protein evaluation in communityacquired pneumonia with comorbid chronic heart failure as criterion of antibiotic prescription.

AIM: To prove that diagnostic algorithm based on additional measurement of serum C-reactive protein (CRP) for administration of systemic antibacterial therapy (ABT) to patients with suspected community-acquired pneumonia (CAP) and concomitant chronic heart failure (CHF) does not influence outcomes of disease. MATERIALS AND METHODS: This open, single-center, randomized, prospective, noninferiority study included 160 adult patients with documented functional class II-IV CHF who had been admitted with a preliminary diagnosis of non-severe CAP. Patients were randomized at 1:1 to two groups; group 1 - with additional measurement of CRP (n=80) and group 2 - with the use of routine diagnostic methods (n=80). In group 1, systemic ABT was administered only when serum CRP was >28.5 mg / l (threshold level of the biomarker calculated at the previous stage of the study); group 2 received a standard treatment. Noninferiority test result for both algorithms was evaluated by the number of patients with clinical success on days 12-14 (primary endpoint). Non-inferiority margin was δ=-13.5 %. In addition secondary endpoints (early clinical response on days 3-5; early in-hospital adverse events (development of complications; admission to intensive care unit (ICU); death), death, recurrent CAP or CHF worsening with readmission at 28 day; mortality at 90 and 180 days) were estimated. Standard statistical tools were used for all intergroup comparisons. RESULTS: 76 patients of each group reached the primary endpoint. Systemic ABT was administered to 51 (67.1 %) patients in group 1 and 76 (100 %) patients in group 2 (p<0.05). Both groups were comparable (p>0.05) regarding all endpoints: clinical success, 70 (92.1 %) vs. 69 (90.8 %), Δ=1.3 % (one-sided 97.5 % CI: - 8.25 % for non-inferiority margin δ=-13.5 %); early clinical response, 66 (86.8 %) vs. 68 (89.5 %); admission to ICU, 1 (1.3 %) vs. 1 (1.3 %); development of complications, 20 (26.3 %) vs. 22 (28.9 %); readmission, 5 (6.6 %) vs. 6 (7.9 %); in-hospital mortality, 2 (2.6 %) vs. 1 (1.3 %), mortality at 28 day, 3 (3.9 %) vs. 2 (2.6 %), at 90 day, 5 (6.6 %) vs. 4 (5.3 %), at 180 day, 8 (10.5 %) vs. 9 (11.8 %) cases, respectively. CONCLUSION: additional measurement of serum CRP in patients with CHF and suspected non-severe CAP was able to reduce rate of systemic ABT administration without outcomes and prognosis worsening.

[Systemic Antimicrobials Consumption and Expenditures in Departments of Surgery of Multi-Profile Hospitals in the Russian Federation and the Republic of Belarus: Results of Multicentre Pharmacoepidemiological Study].

The results of the systemic antimicrobials (AM) consumption and expenditures assessment in the departments of surgery of multi-profile hospitals in different regions of the Russian Federation and the Republic of Belarus in 2009-2010 based on retrospective collection and analysis of the data from the hospital expenditure notes using ATC/DDD methodology are presented. The average AM consumption and expenditure rates in the above mentioned departments varied from 24.9 DDD/100 bed-days to 61.7 DDD/100 bed-days depending on the department profile, with beta-lactams (cephalosporins and penicillins) share in the consumption being as high as 70-90%, followed by fluoroquinolones and aminoglycosides. Only 55-70% of the consumed AM belonged to the drugs of choice, whereas the improper AM consumption and expenditure rates amounted up to 10-18%. The study outputs can be used for the budget allocation and AM distribution improvement in the departments of surgery, as well as for the development and efficacy control of the local antimicrobial stewardship programs.

[Development and use of the assay for Legionella pneumophila detection based on fluorescent real-time/endpoint polymerase-chain reaction].

The aim of the work was to develop a PCR-based assay for detection of L. pneumophila and L. micdadei in environmental samples as well as in clinical samples from low respiratory tract and to assess its analytic characteristics. The assay was used during investigation of the outbreak developed in July 2007 in town Verkhnyaya Pyshma (Sverdlovsk region). Polymerase-chain reaction (PCR)with fluorescent detection,sequencing and cloning of DNA fragments were used. Developed assay based on the PCR with fluorescent real-time/ endpointdetection is able to detect L. pneumophila in clinical and environmental samples and to quantify amount of bacterial DNA in water. Specificity of analysis (100%) was assessed using the panel of bacterial strains and samples from healthy individuals. Analytic sensitivity of assay and quantitation limit was 1000 GU in 1 ml. Sensitivity of the assay of artificially contaminated biological samples was 1000 bacteria in 1 ml. During outbreak investigation L. pneumophila DNAwas detected in 4 lung samples from 4 fatal cases, from 1 of 2 sputum samples, 1 of 2 bronchoalveolar lavage samples with X-ray confirmed pneumonia. Legionella's DNA was found in samples from cooling towers, central hot water supply as well as from showerheads in apartments of 3 patients. Fountain and drinking water samples were PCR-negative. Specificity of PCR-positive results was confirmed by sequencing. Use of the assay during outbreak in- vestigation allowed to confirm the diagnosis in fatal cases and quickly identify the possible source of infection.

[Pharmacotherapy of acute tonsillitis-pharyngitis in ambulatory practice: results of a multicenter pharmaco-epidemiological study]. / Farmakoterapiia ostrogo tonzillofaringita v ambulatornoi praktike: rezul'taty mnogotsentrovogo farmakoépidemiologicheskogo issledovaniia.

AIM: To analyse current practice of pharmacotherapy (PT) in outpatient treatment of acute tonsillopharyngitis (ATP) in different regions of Russia. MATERIAL AND METHODS: Case reports for 1333 outpatients (493 male and 840 female, age 16-76 years) with ATP from 7 cities of Russia have been studied. Each ATP case was documented on a special chart to contain the following information: demographic data, history of the disease, bacteriological findings, PT regimens, complications, treatment outcomes. RESULTS: PT of ATP was made primarily with antibiotics. Most frequent of them was ampicillin (about half the cases). Further antibiotics by frequency of use were: erythromycin, ciprofloxacin, doxicyclin, amoxicillin, midecamycin, ampicillin/oxacillin. Among other drugs, wide use was registered of antihistamine drugs, throat disease drugs, analgetic and antipiretic drugs, vitamins. Bacteriological examinations were conducted rarely. CONCLUSION: The problems of PT of ATP patients consist in overuse of systemic antibiotics as a result of adequate differential diagnosis of this infection and choice of antibiotics without consideration of current recommendations on the treatment of streptococcal ATP.

[Analysis of parameters of the antibacterial treatment of acute otitis media in adults: results of a multicenter study]. / Analiz osobennostei antibakterial'noi terapii ostrogo srednego otita u vzroslykh: resul'taty mnogotsentrovogo issledovaniia.

The programme was aimed at audit of the parameters of antibacterial therapy for acute otitis media in adult outpatients in 8 cities of Russia (Smolensk, Volgograd, Ekaterinburg, Yaroslavl, Nizhny Novgorod, Tyumen, Ryazan, Vladivostok). The information sources were the case records. The data from the records were structurally fixed in specially designed individual registration charts for further computer processing. The analysis of the results showed that the real practice of the antibacterial therapy for acute otitis media was not based on a unique approach and did not mainly correspond to the present standards. Ampicillin proved to be preferential, whereas it is known that the drug of choice for such cases is amoxicillin. Antibacterial agents with low activity against the basic pathogens of the infection (doxycycline and others) and high toxicity (co-trimoxazol) were often prescribed, while the recommended up-to-date antibiotics (amoxicillin/clavulanate and others) were prescribed extremely rare or not prescribed at all. Scientifically unreasonable combined antibiotic therapy and prescription of parenteral drugs not rational for the treatment of outpatients were practiced.

[Antibacterial therapy of acute sinusitis in outpatient practice: results of a multicenter trial]. / Analiz antibakterial'noi terapii ostrogo sinusita v ambulatornoi praktike: rezul'taty mnogotsentrovogo issledovaniia.

Now there is no generally accepted practice of antibacterial therapy of acute sinusitis in outpatient clinics of Russia. Choice of antibacterial drugs is often made without consideration of the most probable causative agents of the infection. Out-of-date antibiotics used in many cases do not satisfy modern requirements. Clinically essential features of pharmacokinetics are in some cases ignored. Parenteral administration is often unjustified, combined antibiotic treatment is not always validated.