[Predictive role of erythrocytes in assessment of COVID-19 outcomes].

INTRODUCTION: The search for affordable and accurate predictors of the outcome of COVID-19 is extremely important, as it provides the possibility to effectively correct the patient treatment tactics. AIM OF THE STUDY: To develop simple and accurate criteria based on the dynamics of red blood counts that predict the outcome of COVID-19. MATERIALS AND METHODS: Observations were carried out in 125 patients with severe and extremely severe COVID-19, in whom indicators characterizing the state of red blood were determined in dynamics on days 1, 5, 7, 10, 14 and 21 after the hospitalization. ROC analysis was performed to calculate the threshold predictive values for survival and mortality. RESULTS: The total number of erythrocytes and the level of hemoglobin in severe and extremely severe patients did not go beyond the acceptable limits, although showed a tendency to decrease in the group of fatal cases. On the 1st and 21st days, the number of MacroR in the deceased patients was reduced compared to those in group of survivors. It has been established that the RDW-CV test can predict the outcome of the COVID-19 with a high degree of probability at a relatively early stage of disease. RDW-SD test can be an additional predictive criterion of COVID-19 outcome. CONCLUSION: The RDW-CV test can be used as an effective predictor of disease outcome in patients with severe COVID-19.

[Morphological compound and indicators of the blood clotting system in severe COVID-19 patients of middle aged and elderly during treatment of Tocilizumab and Thymalin.]

The aim of the work was a comparative study of Tocilizumab and Thymalin effects on the morphological composition and indicators of the blood clotting system in COVID-19 of middle aged and elderly patients. Severe COVID-19 patients were divided into 3 groups: 1st - control (basic therapy), 2nd - basic therapy +Tocilizumab, 3rd - basic therapy +Thymalin. Hospital mortality in COVID-19 patients after standard therapy, Tocilizumab and Thymalin application was 40,9; 28,4 and 20,6% accordingly. The number of platelets increased by 1,5 times, the concentration of fibrinogen in blood decreased by 78% and activated partial thromboplastin time decreased by 9,3% in patients taking Tocilizumab. Under the influence of Tocilizumab, the platelet/white blood cell and platelet/lymphocyte ratios increased by 1,6 and 1,4 times, which may be a predictor of an unfavorable outcome of COVID-19. Thymalin increased the number of lymphocytes and monocytes by 2 times, the number of leukocytes - by 1,3 times, the number of platelets in the blood - by 1,5 times. Thymain decreased the platelet/lymphocyte and neutrophil/lymphocyte ratios by 1,4 times and 2 times. The use of Thymalin decreased the level of fibrinogen, lactate dehydrogenase and D-dimer in the blood by 1,2; 1,8 and 1,7 times, respectively. Thymalin, compared with Tocilizumab, meets the principles of pathogenic therapy for severe COVID-19 of middle aged and elderly patients to a greater extent, having a normalizing effect on the morphological composition and indicators of the blood clotting system.

Possibilities of Multilayer Perceptron in Complexing Risk Factors of Diabetic Foot Syndrome.

The levels of markers of endothelial dysfunction, MMP9, and polymorphisms of genes of vascular tone regulation factors, platelet receptors, vascular wall remodeling and prothrombotic factors, and markers of endothelial dysfunction were studied in patients with complicated and uncomplicated diabetes mellitus. It was found that the neural network analysis of these data makes it possible to predict the development of diabetic foot syndrome with an accuracy of 92.9%. The high accuracy of neural network analysis is due to the multifactorial nature of the diabetic foot syndrome.

Changes in Some Vascular Biomarkers in Patients with Severe COVID-19 with Various Degrees of Pulmonary Hypertension.

The aim of the study was to evaluate the levels of cardiac biomarkers endothelin 1, B-natriuretic peptide (BNP), N-terminal pro-B-type natriuretic peptide (Nt-proBNP), NO2, and NO3 in patients with COVID-19 pneumonia and various degrees of pulmonary hypertension. Group 1 included patients with pulmonary artery systolic pressure <25 mm Hg, group 2 with 25-40 mm Hg, and group 3 with 40-60 mm Hg. In the group of patients with pulmonary artery systolic pressure <25 mm Hg, the level of NT-proBNP was higher than in the rest two groups by 41.3% (p=0.015) and 38.2% (p=0.015), respectively. The levels of nitrites and nitrates in group 1 patients were lower: NO2 was reduced by 31.1% (p=0.026) and 62.8% (p=0.008), and NO3 was reduced by 28% (p=0.029) and by 54.6% (p=0.006), respectively. No other changes in the parameters in patients receiving oxygen therapy were found. These findings suggest that severe course of COVID-19 in patients with severe pulmonary hypertension is associated with impaired nitrite and nitrate metabolism and reduced levels of Nt-proBNP.

[Retroperitoneal drainage for apostematous pyelonephritis in a patient with severe COVID-19 infection and diabetes mellitus type 1]. / Retroperitoneal'noe drenirovanie pri apostematoznom pielonefrite na fone tyazhelogo techeniya Covid-19 pri sakharnom diabete 1-go tipa.

The authors report successful surgical treatment of apostematous pyelonephritis complicated by sepsis in an 18-year-old patient with severe COVID-19 pneumonia (CT-2) and diabetes mellitus type 1. Active surgical approach with retroperitoneal drainage and decapsulation of the right kidney ensured positive dynamics in the treatment of destructive pyelonephritis, course of diabetes mellitus and elimination of sepsis. These aspects determined favorable outcome of disease.

The State of Microcirculatory Hemodynamics in Patients with Moderate and Severe COVID-19.

Microcirculatory hemodynamic indexes (HI) were assessed in patients with moderate and severe COVID-19. In both groups, a significant increase in the absolute spectral indexes (HI1, HI2, and HI3) and the ratio of low-frequency to high-frequency component (HI1/HI3) was revealed. In the group of severe infection, only the "slow" index (low-frequency HI1) of microcirculatory hemodynamics was significantly lower. The oscillatory indices MAYER1-3 and RESP1-3 were reduced in patients of both groups. The aggravation of the disease course was accompanied by depression of the low-frequency index HI1. Regulatory shifts compensate for disturbances in microcirculatory processes in moderate COVID-19, but severe course was associated with their decompensation.

[Surgical procedures at the city hospital for patients with Covid-19. A 9-month experience]. / Khirurgicheskie vmeshatel'stva v gorodskoi bol'nitse v period ee deyatel'nosti v kachestve monostatsionara dlya patsientov s Covid-19. Devyatimesyachnyi opyt.

OBJECTIVE: To report our experience in surgical treatment of patients with COVID-19. MATERIAL AND METHODS: There were 7815 patients with COVID-19 for the period from April 1, 2020 to December 31, 2020. During this period, 172 operations were performed in this group. RESULTS: The most common procedures were tracheostomy (n=86, 50.0%), pleural puncture and drainage (n=20, 11.6%), caesarean section (n=22, 12.7%). There were 24 (14.0%) abdominal surgeries including 11 laparoscopies, 5 appendectomies, 3 bowel resections and others. Six lower limb amputations were carried out. We should emphasize common soft tissue hematomas and effusions. This complication is associated with anticoagulation recommended for patients with COVID-19. CONCLUSION: Surgical interventions using personal protective equipment is a significant challenge. According to our experience, round-the-clock surgical care in a specialized hospital is required.

[Retroperitoneoscopic technologies in retroperitoneal procedures].

The active development of minimally invasive procedures on retroperitoneal organs using endoscopic technology raises the question of the most rational approach. The studies dedicated to the comparison of transperitoneal and retroperitoneoscopic approach are analyzed in the article. The advantages and the most common complications, as well as the factors limiting the widespread use of retroperitoneoscopic approach, are reviewed.

Lymphocyte-platelet interactions in patients with deep frostbites with various nutritional statuses.

The purpose of the study was to determine the relative number and degree of lymphocyte-platelet adhesion in patients with frostbites of III-IV degree of extremities with malnutrition and eutrophia. Methods: Non-randomized prospective controlled study was performed in 49 patients of both sexes, aged from 16 to 60 years, with frostbites of III-IV degree of extremities. The object of the study was the blood plasma. Test subjects were divided into two groups according to the trophic status on the scale of Luft V.M and Kostyuchenko A.L. By the original method of the Professor Vitkovsky Yu.A. (1999) number of lymphocyte-platelet coaggregations was counted in 100 cells (percentage), which is relative number of the lymphocyte-platelet adhesion (LTA). In this case lymphocyte which adhered to its surface one or more platelets was named the coaggregation. Lymphocyte-platelet index (LTI) or the degree of LTA was determined as the arithmetic mean of the number of platelets which have adhered to a single lymphocyte. Results: The relative number of LTA greater in patients with eutrophia (n = 19) vs. (p<0.001) the control group (n = 20) and vs. (p = 0.008) patients with malnutrition (n = 20). The relative number of LTA is not different in patients with malnutrition vs. (p = 0.085) the control group. LTI greater in patients with eutrophia vs. the control group (p<0.001), and vs. patients with malnutrition (p = 0.020). LTI greater in patients with malnutrition vs. the control group (p = 0.006). Conclusion: It was established that LTI increased irrespective of premorbid trophic status, and LTA percentage increased only in patients with eutrophia. In patients with malnutrition LTA degree and LTA percentage were detected less than in patients with normal nutritional status.

[Complicated form of A/HINI (2009) influenza in pregnant women].

We undertook prospective and retrospective analysis of 120 cases of A/HINI (2009) influenza complicated by pneumonia in pregnant women with the purpose of comprehensive assessment of these conditions taking into account relevant risk factors and preventive measures. Control groups were comprised of 100 pregnant women with uncomplicated influenza and 100 ones who did not fall ill during flu pandemic. The risk of severe disease and probability of its fatal outcome in pregnant women were 2.5 and 2.4 times those in the general population. Most women developed pneumonia in the 3d trimester Risk factors offlu complications included smoking, obesity, underlying respiratory and cardiovascular diseases, sexually transmitted infections. Combined prophylaxis reduced probability of pandemic influenza in pregnant women by 5.6-7 times. Severe forms of the disease were due to manifest symptoms of intoxication and concomitant pneumonia. The clinical picture of lethal cases was characterized by severe pneumonia with subtotal lung involvement, rapid progress of acute respiratory distress syndrome, and development of polyorgan insufficiency.

[Immunological and bacteriological monitoring of patients with pneumonia and influenza A/H1N1 infection].

AIM: To study features of immune status and causative agents of severe pneumonia in patients with influenza A/H1N1. MATERIALS AND METHODS: Fifty-seven isolates from 43 patients with pneumonia, which complicated pandemic influenza A/ H1N1 and treated in Chita city clinical hospital No.1 as well as 32 immunograms were retrospectively studied. Comparison of immunologic and epidemiologic status of patients with influenza A/ H1N1 complicated by pneumonia was performed. Data on dynamics of epidemic process and outcomes are presented. RESULTS: It was established that severe course of influenza A/H1N1 complicated by pneumonia characterized by relative lymphopenia, 2-fold decrease of CD3+ cells, 2.9-fold decrease of CD4+ cells, and 1.7-fold decrease of CD8+ lymphocytes. Degree of changes in parameters of cellular immunity corresponded to severity of pneumonia. Bacteriologic tests showed that there was contamination of respiratory tract of patients with influenza A/H1N1 by opportunistic microflora, predominantly by Streptococcus mitis. CONCLUSION: In patients with severe form of influenza A/H1N1, which complicated by development of pneumonia, depression of T-cell immunity with contamination of respiratory tract by opportunistic microflora and prolonged course of pathologic process was observed.

[Collagen-binding activity of Willebrand factor and thrombocyte aggregation in patients with frostbite].

In the article was quoted data about the thrombocyte aggregation and collagenbinding activity of Willebrand factor in the blood of 50 patients with local frostbite of third and forth degree. Thrombocyte aggregation was studied with the help of photometry. Collagenbinding activity of Willebrand factor was determined with the help of enzyme-linked immunosorbent assay. It was established that decrease of intensity, potential and rate of induced thrombocyte aggregation took place in patients. Collagenbinding activity of Willebrand factor in blood plasma increase in 1, 7-2, 6 times.

[Peculiarities of changes in circulatory parameters of microcirculation in local freezing injury of the upper limbs].

The condition of the microcirculatory bed in frostbitten tissues has the decisive importance in the course of the injury. The objective of the work was to investigate the dynamics of the parameters of microcirculation in patients with an endured local frostbite injury of the upper extremities. Evaluated were oscillations of the bloodstream by means of laser Doppler flowmetry. The study was carried out in a total of sixty 18-to-45-year-old patients presenting with a degree II-IV local frostbite injury of the upper extremities at various periods of the injury. In the prereactive period, when there are no significant deviations of the blood-flow oscillation parameters, using the occlusion test makes it possible to reveal alterations in the condition of the microcirculatory bed. The early and late reactive periods of a localfrostbite injury of the upper limbs are characterized by an increase in the neurogenic and myogenic components of vascular tonicity, as well as the by-pass index, thus suggesting a vascular spasm and increased by-pass blood flow. Degree II-IV frostbites of the upper extremities in the early and late reactive periods of the injury are accompanied by decreased reactivity of the vascular wall in response to occlusion, decreased potential of the active mechanisms of regulation of vascular tonicity, and maintenance of an adequate tissue blood circulation, with a 1.5-2-fold decrease in the blood flow reserve. The revealed alterations in the parameters of microcirculation and regulation of vascular tonicity explain a lingering course of the wound process in frostbites. Using the method of laser Doppler flowmetry makes it possible to determine the condition of microcirculation and vascular tonicity, to evaluate efficiency of the methods of treatment, and to predict the course of frostbite.

[The role of lymphocyte-platelet adhesions, cytokines and endothelial dysfunction in pathogenesis of cold-induced lesions].

We studied the role of lymphocyte-platelet adhesion, IL-1beta, TNFalpha and endothelial dysfunction in pathogenesis of damage in local frostbites. Examination of 60 patients aged 17-50 years with frostbites of the second-forth degree has demonstrated that in patients with local frostbites the number of lymphocyte-platelet adhesions, circulating desquamated endothelial cells increases as well as the level of proinflammatory cytokines, while nitrites concentration decreases.

[Cold injury as a cause of stable changes in microcirculation].

Using laser Doppler flowmetry comparative evaluation of microcirculatory condition and regulatory components of vascular tone in lower limbs was carried out in 40 patients with local cold injuries in late reactive period and 12 reconvalescents with trophic disturbances. Microcirculation index decreased in all patients while neurogenous and myogenous vascular tone increased. Peak oscillation amplitude decreased in the endothelial range. At the same time in reconvalescents changes in passive regulatory components of vascular tone increase and frequency of peak amplitude neurogenous variation decrease. Thus, cold impact results in stable changes of microcirculation and therefore in dysthrophic changes in affected tissues.

[Some problems in teaching anesthesiology and reanimatology at a higher medical educational establishment].

The paper describes the experience of the Department of Anesthesiology and Resuscitation, Chita Medical Academy, in upgrading the quality of teaching at the pre- and postgraduate stages of education and the prestigiousness of the specialty for students. The forms of collaboration of the department's collective body with the Academy's governing body and the territory's health care structures are described. These undertakings have doubled the hours of teaching the subjects that are a sphere of anesthesiology and resuscitation at the pregraduate stage. The authors' experience suggests that 2-year clinical residency is the minimum training period under the present conditions. The innovation approach to solving the organizational and professional problems, which is proposed and tested by the authors, resulted in the provision of the health care facilities of the Transbaikal Territory with educated anesthetists-resuscitators (by 98.8%). The use of innovation educational technologies, including internet bases and internet libraries, and audiovisual and telecommunication technologies for distance education and counseling, makes an educational process interesting to young specialists and, overall, serves to increase the prestigiousness of the specialty.

[Changes in components of the vascular tone and microcirculation indices in frostbites of lower extremities].

The state of the microcirculation bed was assessed by the method of laser Doppler flowmetry in 40 patients with frostbites of lower extremities of the II-IV stages. In the proximal zone segments there was less inflow of blood to the arterial bed, increased neurogenic and myogenic components of vascular tone, decreased nutritive and, in a less degree, shunt blood flow. In aggravation of the injury severity the changes in question become more pronounced.

[Optimization of the components of regulation of vascular tone and microcirculatory hemostasis during prolonged regional block in local cold injury].

The impact of prolonged conduction block of the brachial plexus on the regulatory components of vascular tone, the state of vascular platelet hemostasis, and the activity of an inflammatory process was studied in patients with second-to-fourth degree local arm frostbites. The block alleviated arterial spasm, indirectly lowered myogenic tone, and decreased shunt blood flow. Nutritive circulation increased in the presence of a total increase in blood flow to the arm. There were increases in the intensity, rate, and potential of platelet aggregation. The concentration of proinflammatory cytokines reduced. This resulted in more efficient treatment.