[Clinic and functional features of chronic obstructive pulmonary disease after virus-induced acute exacerbations.]

AIM: To establish symptoms, lung function and to evaluate subsequent exacerbations of chronic obstructive pulmonary disease (COPD) during a year after virus-induced COPD exacerbations. MATERIALS AND METHODS: Patients hospitalized with viral (n=60), bacterial (n=60) and viral-bacterial (n=60) COPD exacerbations were enrolled to single-center prospective observational study. COPD was diagnosed according spirography criteria. Viral infection was established in bronchoalveolar lavage fluid or sputum by real-time reverse transcription-polymerase chain reaction for RNA of influenza A and B virus, rhinovirus, respiratory syncytial virus and SARS-CoV-2. Symptoms, lung function, COPD exacerbations were assessed. Patients were investigated at the hospitalization onset and then 4 and 52 weeks following the discharge from the hospital. RESULTS: After 52 weeks in viral and viral-bacterial COPD exacerbations groups the rate of forced expiratory volume in one second (FEV1) decline were maximal - 71 (68; 73) ml/year and 69 (67; 72) ml/year versus 59 (55; 62) ml/year after bacterial exacerbations. Low levels of diffusion lung capacity for carbon monoxide (DLco/Va) - 52.5% (45.1%; 55.8%), 50.2% (44.9%; 56.0%) and 75.3% (72.2%; 80.1%) respectively, of 6-minute walk distance; p<0.001 in relation to bacterial exacerbations. In Cox proportional hazards regression analyses viral and viral-bacterial exacerbations were associated with increased risk of subsequent COPD exacerbations by 2.4 times independent of exacerbations rate before index event and FEV1. In linear regression models the relationships between airflow limitation and respiratory syncytial virus, rhinovirus and influenza virus infection, between low DLco/Va and rhinovirus, influenza virus and SARS-CoV-2 infection. CONCLUSION: COPD after virus-induced exacerbations were characterized by progression of airflow limitation, low DLco/Va, low 6-minute walking test distance, subsequent COPD exacerbations risk.

Efficacy of 13-valent pneumococcal conjugate vaccine in healthcare workers.

AIM: To establish the efficacy of 13-valent pneumococcal conjugate vaccine (PCV13) for healthcare workers protection from occupational acquired infection and impact of healthcare staff vaccination on the risk of transmission to patients. MATERIALS AND METHODS: Healthcare personnel (n=157 of whom 105 critical care department staff) and 1770 patients of that critical care department observed. Healthcare workers received PCV13. Infections caused by Str. pneumoniae, respiratory infections regardless of etiology, work absenteeism in healthcare workers during 12 month before and after vaccination assessed. In the same time monitoring of hospital-acquired infections in patients of critical care department performed. Statistical analysis was done using SPSS 24, relationships were assessed by rate ratio, Cox regression, logistic regression and Kaplan-Meier estimator. RESULTS: Healthcare workers' vaccine coverage in critical care department was 97.2%. In healthcare personnel the rate of all pneumococcal infections, asymptomatic carriage of Str. pneumoniae and respiratory pneumococcal infections were decreased after vaccination by 2.1, 2.2 and 2.1 times accordingly. The rate of respiratory infections regardless of etiology was decreased by 30%, р<0.05. Cumulative percent of subjects without pneumococcal respiratory infections during 12 month was 87.9 before and 94.3 after vaccination, р=0.015. Work absenteeism due to respiratory infections was reduced. In patients of critical care department decreasing of all respiratory infections by 58%, pneumococcal respiratory infections by 66%, hospital acquired pneumonias by 46% were seen, р<0.05. CONCLUSION: Healthcare personnel vaccination with PCV 13 is effective in protection from occupational acquired pneumococcal respiratory infections and asymptomatic carriage and promotes decreasing of hospital acquired infections among patients.

[General anesthesia and intensive care for patients surgically treated for deep neck odontogenic infections]. / Osobennosti anesteziologicheskogo obespecheniia i intensivnoi terapii bol'nykh pri khirurgicheskom lechenii odontogennykh flegmon dna polosti rta.

The study objectives were to determine the significance of deep neck odontogenic infections severity to predict the postoperative morbidity. Observational study was conducted in 2014-2015. A continuous sample of 38 patients who were urgently hospitalized in the Novosibirsk Regional Clinical Hospital with deep neck odontogenic infections and operated on the day of hospitalization was analyzed. SAPS scale rates correlated positively with the duration of the artificial lungs ventilation (ALV). The positive balance of the introduced and withdrawn liquid in the first day of the postoperative period is associated with the ALV duration, which requires accurate dosing of the infusion volumes. The described protocol of perioperative care significantly decreases morbidity in patients with deep neck odontogenic infections.

[Experience With Serelaksin for Acute Right Ventricular Failure due to Pulmonary Embolism in Acute Ischemic Stroke].

OBJECTIVE: to demonstrate effects of serelaxin in treatment of acute right ventricular failure (ARVF) caused by pulmonary embolism (PE).

[The experience of submental intubation for severe maxillofacial injuries]. / Opyt submental'noi intubatsii trakhei pri tyazhelykh chelyustno-litsevykh povrezhdeniyakh.

Oral and nasal routes for intubation are often not feasible in maxillofacial fractures. The paper presents our experience of midline and paramedial approaches for submental intubation in the airway management of facial trauma patients. The prospective study included 47 patients with maxillofacial trauma in whom submental orotracheal intubation was performed in 2005-2014. When using midline approach the tube does not always accurately fit into the mandibular lingual groove creating an inconvenience for the surgeon. By paramesial approach the working conditions for the surgeon were the most comfortable. The average duration of the procedure was 5-6 minutes. At the end of the surgery the tube was reversed, the submental wound was stitched, patients were extubated (10 of them were extubated through the submental approach). Eight patients required short-term post-operative mechanical ventilation. In all patients the submental intubation allowed simultaneous reduction and fixation of fractures and intraoperative control of the dental occlusion without interference from the tube during the operation. There were no significant operative or postoperative complications. Submental intubation is a simple, secure and effective procedure for operative airway control in maxillofacial traumas. It is an attractive alternative to tracheotomy in the surgical management of selected cases of maxillofacial trauma.

[Effect of acute and chronic alcoholic intoxication on immunological status of patients with generalized peritonitis in the course of therapy].

Generalized peritonitis is one of the most adequate clinical models of inflammatory processes with pronounced polyorgan insufficiency in which immunological reactivity may be substantially modified by any intoxicant of exogenous origin, e.g., alcohol. The aim of the present work was to assess immunological status of patients with generalized peritonitis associated with acute and chronic alcoholic intoxication treated by discrete plasmapheresis. A total of 152 men (mean age 49.7 +/- 1.2 years) were examined in Novosibirsk city clinical hospital No 2. Peritonitis developed within the average of 48.2 hours. All the patients with peritonitis experienced a change of immunological responsiveness under effect of such powerful complicating factor as alcoholic intoxication.

[Acute and chronic alcoholic intoxication as a cause of modified immunological reactivity in patients with generalized peritonitis].

The importance of assessment of immunological reactivity in patients with generalized peritonitis suffering alcoholic intoxication ensues from the possibility to use it for the prediction of abdominal inflammation dynamics and thereby for the optimization of organ-protective therapy in critical situations.

[Correction of endotoxicosis in alcoholic pancreatitis in elderly and senile patients using discrete plasmapheresis].

The majority of critical conditions in man occur in diseases accompanied with development of endogenic intoxication syndrome. The search for universal criterion and design of highly effective programs for correction of this condition are of great importance for internal medicine and surgical practice. Discrete plasmapheresis for endotoxicosis in elderly and gerontological patients has its specific features which should be taken into consideration because of low adaptation abilities of such group of patients.