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OBJECTIVES: To identify risk factors for nosocomial bloodstream infections (BSIs) in intensive care unit (ICU) patients with COVID-19 and to build a predictive model for BSIs. PATIENTS AND METHODS: The retrospective case-control study included 236 ICU COVID-19 patients with BSIs group and 234 patients in the control group. Demographic and laboratory data, comorbidities, drug use, invasive procedures and identified pathogens were recorded separately for patients directly admitted and transferred to ICU. Fine and Gray's multi-variate competing risk model was used to build a predictive model for patients transferred to ICU. RESULTS: The risk factors were: interleukin inhibitors (HR = 6.1 (95% CI: 2.0-18.5)) and dexamethasone (HR = 3.0 (95% CI: 1.3-7.1)) use in previous hospitalization, glomerular filtration rate <60 mL/min per 1.73 m2 (HR = 4.0 (95% CI: 2.1-7.6)) and blood glucose >9 mmol/L (HR = 2.5 (95% CI: 1.4-4.6)) in patients directly admitted to ICU; and dexamethasone use in previous hospitalization (HR = 4.5 (95% CI: 1.8-11)), the total dexamethasone dose before transfer to ICU (HR = 1.2 (95% CI: 1.06-1.37)), diabetes mellitus (HR = 1.4 (95% CI: 1.1-1.9)), alanine transaminase (ALT) ≥35.5 U/L on hospital admission (HR = 1.5 (95% CI: 1.1-2.1)), and the use of low-flow oxygen versus high-flow oxygen therapy or non-invasive mechanical ventilation on admission to ICU ((HR = 2.7 (95% CI: 5.6-11.1)) in patients transferred to ICU. A predictive model had sensitivity of 63-73% and specificity of 71-83% at different times of ICU stay. CONCLUSIONS: Our findings may help clinicians detect patients at high risk of developing BSIs.
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COVID-19 , Infección Hospitalaria , Sepsis , Humanos , COVID-19/epidemiología , SARS-CoV-2 , Estudios Retrospectivos , Estudios de Casos y Controles , Unidades de Cuidados Intensivos , Factores de Riesgo , Infección Hospitalaria/epidemiología , Dexametasona/uso terapéuticoRESUMEN
BACKGROUND: Mortality and COVID-19 related factors are thoroughly analyzed. Given the large number of hospitalized patients, the potential short- and long-term COVID-19 related complications, further research is needed on the possible consequences of hospitalization, especially in higher-risk patients, after prolonged hospitalization and intensive care admission. AIM: To study the clinical course and outcomes of severe COVID-19 in elderly patients with asthma at the hospital and early post-hospital stages. MATERIALS AND METHODS: The study included 131 elderly patients (WHO, 2020) >60 years old, n=131 with asthma, hospitalized for severe COVID-19. Of these, 86 (65.6%) patients survived, 30 (22.9%) died in the hospital, and 15 (14.9%) patients died after discharge from the hospital (in the 90-day post-hospital period). COVID-19 was confirmed by laboratory tests (SARS-CoV-2 PCR RNA test) and/or clinically and radiologically. All patients had a documented history of asthma. Patients were followed up during the hospital stay and for 90 days after discharge. RESULTS: Comparison of outcomes showed that in the groups of patients with a fatal outcome (regardless of the stage), the Charlson comorbidity index, respiratory rate, extent of lung damage assessed by computed tomography, the absolute leukocyte and neutrophil number and the ratio of neutrophils to lymphocytes were statistically significantly higher. The absolute number of eosinophils was lower in these groups. In the group of patients who died during hospitalization, severe (IV-V) asthma (p=0.03), steroid use during the previous year (p=0.02), chronic heart failure with a reduced ejection fraction (p=0.009) were more common, and atopic asthma phenotype was less common (p=0.02). In those who died after discharge, more common were non-invasive ventilation and diabetes mellitus (p<0.001). The multivariate regression analysis model revealed the most significant predictors of mortality at the hospital and early post-hospital stages. CONCLUSION: Adverse outcomes of severe COVID-19 in elderly patients with asthma include hospital and post-hospital mortality. The most significant predictors of mortality are the comorbidity index and low eosinophil count. Hospital mortality is associated with a higher ratio of neutrophils to lymphocytes and lower total protein levels; early (90-day) post-hospital mortality is associated with extensive lung damage shown by computed tomography and diabetes mellitus.
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Asma , COVID-19 , Diabetes Mellitus , Humanos , COVID-19/complicaciones , SARS-CoV-2 , Factores de Riesgo , Hospitalización , Hospitales , Asma/complicaciones , Asma/epidemiologíaRESUMEN
In modern diabetology, the most important condition for a personalized approach to patient management is to determine the type of diabetes mellitus. Particular attention is drawn to a large, but at the same time insufficiently studied group of patients with diabetes mellitus due to diseases of the pancreas or as a result of surgical interventions on the pancreas, in particular, patients who, for a number of vital indications, undergo total pancreatectomy and the mechanism of development of impaired glucose homeostasis have not been studied in these patients. To date, there are no specific algorithms for managing this category of patients. This clinical example emphasizes that the management of glycemia in patients with diabetes mellitus as a result of total pancreatectomy is an extremely difficult task that requires a multidisciplinary approach in the treatment of this category of patients, the participation of an endocrinologist at all stages of patient treatment.
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Diabetes Mellitus , Pancreatectomía , Humanos , Pancreatectomía/efectos adversos , Glucemia , PáncreasRESUMEN
Tetrodotoxin (TTX) is a potent neurotoxin frequently occurring in marine organisms along with its numerous analogues. To determine the total TTX content, we developed an enzyme-linked immunosorbent assay (ELISA) technique utilizing polyclonal antibodies against TTX. The technique was tested using extracts of marine worms of the phylum Nemertea and confirmed by HPLC-MS/MS. It proved to be suitable for a preliminary assessment of the toxicity of marine organisms.
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Organismos Acuáticos/química , Tetrodotoxina/toxicidad , Animales , Cromatografía Líquida de Alta Presión , Ensayo de Inmunoadsorción Enzimática/métodos , Espectrometría de Masas en Tándem/métodosRESUMEN
The article describes 5 cases of capsular block syndrome (CBS). This late cataract surgery complication has not been sufficiently covered in Russian scientific literature. Diagnostics were based mainly on slit-lamp biomicroscopy and anterior segment optical coherence tomography. In all cases, examination revealed a retro-optical space filled with content of different transparency and homogeneity (transparent liquid, opaque liquid, regenerative lens material). The condition caused visual acuity to decrease in each case. Patient management included follow-ups (2 cases), yttrium-aluminum-garnet laser (YAG-laser) puncture of posterior lens capsule (1 case) or YAG-laser posterior capsulotomy (2 cases). YAG-laser treatment resulted in visual functions improvement.
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Lesiones Oculares , Terapia por Láser , Cápsula Posterior del Cristalino , Humanos , Federación de Rusia , Agudeza VisualRESUMEN
For the first time search for tetrodotoxin (TTX) and its analogues in the extracts of nemerteans using HPLC-MS/MS was performed. TTX analogues were detected in two nemertean species in addition to TTX: 7 analogues were detected in the extract of Cephalothrix simula, 3 analogues - in the extract 11-norTTX of Kulikovia manchenkoi. Presence of 5-deoxyTTX, 11-deoxyTTX, 5,6,11-trideoxyTTX and -6(R)-ol in nemerteans was shown for the first time.
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Organismos Acuáticos/química , Tetrodotoxina/análogos & derivados , Tetrodotoxina/análisis , Animales , Organismos Acuáticos/metabolismo , Cromatografía Líquida de Alta Presión/métodos , Invertebrados/química , Invertebrados/metabolismo , Japón , Océano Pacífico , Espectrometría de Masas en Tándem/métodos , Tetrodotoxina/química , Tetrodotoxina/metabolismoRESUMEN
BACKGROUND: To-day, obesity spreads dramatically fast all over the world not only among the adults but also among the children. According to the data available from the scientific literature, the number of adolescents suffering from obesity in Russia increased more than 1.5 times during the period from 2006 till 2015. The combination of non-drug therapeutic measures (including diet therapy, therapeutic physical exercises, and psychophysiological technologies) constitutes the basis for the treatment of obesity. Russia has gained a vast experience with the management of this condition with the use of natural and preformed therapeutic agents. AIM: The main objective of the present study was the comparative assessment of the effectiveness of the rehabilitation programs for the obese subjects with based on the application of alternative and complementary therapeutic modalities for the treatment of the adolescent girls with obesity. MATERIAL AND METHODS: The study included 86 girls with obesity at the age of 13-17 years who were randomly divided into 3 groups matched for the age and anthropometric characteristics. All the patients were prescribed a treatment course, including motivational training and aerobic exercise, in addition to the routine recommendations for the short-term modification of eating habits. The vacuum therapy was additionally included in the combined treatment protocol for the patients of the first group (n=28) while the patients of the second group (n=29) received the treatment in the spa capsule (SC) and the girls of the third group (n=29) underwent transcranial magnetic stimulation therapy. RESULTS: The analysis of the results obtained in this study has demonstrated a significant reduction of the body weight, waist and hip circumferences in the patients of all study groups (p<0.05). The comparison of these results with the baseline characteristics showed that the use of combined physiotherapy including the treatment in the spa capsule had significant advantages over local vacuum therapy in terms of weight dynamics (p=0.009), body mass index (p=0.009), hip circumference (p=0.019) and the chest skinfold thickness (p=0.02). CONCLUSION: The use of alternative and complementary therapeutic modalities in the combination with motivational training and aerobic exercises effectively contributes to the weight loss in the obese adolescent girls, with the combined pysiotherapeutic treatment having advantages over local therapy methods.
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Obesidad Infantil/rehabilitación , Adolescente , Femenino , Humanos , Rehabilitación/métodosRESUMEN
The year 2016 marked the 50th anniversary of the discovery by S. Osaki who first showed that ceruloplasmin (CP, ferro:O2-oxidoreductase or ferroxidase) is capable of oxidizing Fe(II) to Fe(III) and favors the incorporation of the latter into transferrin (TF). However, much debate remains in the literature concerning the existence of a complex between the enzyme oxidizing iron and the protein facilitating its transport in plasma. We studied CP in exocrine fluids and demonstrated its high-affinity interaction with transferrin found in breast milk and in lacrimal fluid, i.e. with lactoferrin (LF). Here we present data obtained by comparing the interaction of CP with LF and TF using surface plasmon resonance and Hummel-Dreyer chromatography. Binding of apo-LF within the range of concentrations 1.6-51.3 µM with CP immobilized on a CM5-chip is characterized by KD = 1.07 µM. Under similar conditions, the KD for apo-TF was measured and appeared to be higher than 51.3 µM. Hummel-Dreyer chromatography of CP with 51 µM apo-LF/apo-TF in the effluent demonstrated the absence of interaction between apo-TF and CP in solution, contrary to efficient interaction between apo-LF and CP. In contrast to LF, the interaction of apo-TF with CP is probably not stable within the physiological range of concentrations of TF.
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Ceruloplasmina/metabolismo , Lactoferrina/metabolismo , Leche Humana/química , Lágrimas/química , Transferrina/metabolismo , Femenino , Humanos , Leche Humana/metabolismo , Unión Proteica , Lágrimas/metabolismoRESUMEN
AIM: The objective of the present study was the improvement of the effectiveness of medical rehabilitation of the children presenting with the disturbances of the locomotor function using a «LymphaVision¼ apparatus for the selective electrical stimulation. MATERIALS AND METHODS: The study included 42 patients with movement disorders divided into two groups depending on the method of non-drug therapy. The main group was comprised of the patients receiving the treatment by electrical stimulation with the use of the «LymphaVision¼ apparatus while the remaining patients made up the group of comparison (they were treated with by means of Vermel electrophoresis with the use of a 1% sodium bromide solution). The increase of the muscular strength evaluated based on the scoring system and the number of motor skills were used as the criteria of the effectiveness of the treatment. The applied Statistica for Windows package, version 6.0 («StatSoft¼, USA). Was employed for the statistical analysis of the data obtained. The significance and number of differences between two independent samples of the quantitative features were assessed using the Mann-Whitney U test. The Wilcoxon matched pairs test was used to compare the two matched groups. RESULTS: The children comprising the group treated by means of selective exposure to electrical stimulation with the use of the «LymphaVision¼ apparatus in the course of the rehabilitation process exhibited a significant increase in the strength of the muscles of the lower extremities and the trunk over the baseline values (p=0.003 and p=0.04 respectively) and acquired a significantly greater number of the new motor skills (p=0.02). CONCLUSION: The application of the proposed method is characterized by the highly pronounced clinical efficiency. This approach is pathogenetically well-substantiated for the treatment of the children presenting with the locomotor disorders developing as the consequences of perinatal lesions in the central nervous system and promotes the restoration of the capabilities of the child's body, such as normalization of the muscle tone, increase of the motor activity and muscle strength.
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Terapia por Estimulación Eléctrica/métodos , Terapia por Ejercicio/métodos , Trastornos Motores/rehabilitación , Modalidades de Fisioterapia , Niño , Preescolar , Terapia por Estimulación Eléctrica/instrumentación , Femenino , Humanos , Lactante , Masculino , Destreza Motora/fisiología , Fuerza Muscular/fisiología , Resultado del TratamientoRESUMEN
PURPOSE: To investigate life expectancy and the structure of causes of death in patients with primary glaucoma, residents of a large industrial city of Siberia. MATERIAL AND METHODS: The database of the Novokuznetsk Public Health Department information analysis center on registration forms 025 (outpatients) and 066 (inpatients) for 2004-2011 was analyzed. RESULTS: A total of 5424 primary glaucoma patients were registered during 2004-2011, of whom 441 (8.1%) subsequently died. Age at death of patients with primary glaucoma was 69.0 +/- 7.2 years. The difference between age at death and at diagnosis of glaucoma was 2.6 +/- 1.8 years. CONCLUSION: The correlation suggests that primary glaucoma is a predicting factor for vascular events, such as stroke or myocardial infarction. The authors assume that topical administration of beta blockers without consulting a physician and/or a cardiologist may lead to ischemic stroke.
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Glaucoma/mortalidad , Esperanza de Vida , Anciano , Ciudades/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Siberia/epidemiologíaRESUMEN
The paper summarizes results of experimental studies and clinical observations of the pathogenesis and effectiveness of respiratory, non-respiratory and pharmacological treatment methods for acute respiratory distress syndrome caused by direct and indirect damaging factors. The article deals with differences and peculiarities of morphological changes and lung functional disorders, clinical, laboratory and instrumental signs of various origins in ARDS and justifies necessity of differential diagnosis and differential treatment of ARDS, depending on the reasons for its development. Furthermore the article discusses an algorithm for differential diagnosis and differential treatment for ARDS caused by direct and indirect damaging factors.
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Fluorocarburos/uso terapéutico , Pulmón/patología , Surfactantes Pulmonares/uso terapéutico , Síndrome de Dificultad Respiratoria/etiología , Síndrome de Dificultad Respiratoria/terapia , Terapia Respiratoria/métodos , Adolescente , Adulto , Anciano , Animales , Fenómenos Biomecánicos , Terapia Combinada , Diagnóstico Diferencial , Modelos Animales de Enfermedad , Supervivencia sin Enfermedad , Quimioterapia Combinada , Femenino , Fluorocarburos/administración & dosificación , Humanos , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Surfactantes Pulmonares/administración & dosificación , Ratas , Síndrome de Dificultad Respiratoria/diagnóstico , Síndrome de Dificultad Respiratoria/tratamiento farmacológico , Pruebas de Función Respiratoria , Adulto JovenRESUMEN
The trace formula for the density of single-particle levels in the two-dimensional radial power-law potentials, which nicely approximate up to a constant shift the radial dependence of the Woods-Saxon potential and its quantum spectra in a bound region, was derived by the improved stationary phase method. The specific analytical results are obtained for the powers α=4 and 6. The enhancement of periodic-orbit contribution to the level density near the bifurcations are found to be significant for the description of the fine shell structure. The semiclassical trace formulas for the shell corrections to the level density and the energy of many-fermion systems reproduce the quantum results with good accuracy through all the bifurcation (symmetry breaking) catastrophe points, where the standard stationary-phase method breaks down. Various limits (including the harmonic oscillator and the spherical billiard) are obtained from the same analytical trace formula.
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Gas-phase acids in light duty diesel (LDD) vehicle exhaust were measured using chemical ionization mass spectrometry (CIMS). Fuel based emission factors (EF) and NOx ratios for these species were determined under differing steady state engine operating conditions. The derived HONO and HNO3 EFs agree well with literature values, with HONO being the single most important acidic emission. Of particular importance is the quantification of the EF for the toxic species, isocyanic acid (HNCO). The emission factors for HNCO ranged from 0.69 to 3.96 mg kgfuel(-1), and were significantly higher than previous biomass burning emission estimates. Further ambient urban measurements of HNCO demonstrated a clear relationship with the known traffic markers of benzene and toluene, demonstrating for the first time that urban commuter traffic is a source of HNCO. Estimates based upon the HNCO-benzene relationship indicate that upward of 23 tonnes of HNCO are released annually from commuter traffic in the Greater Toronto Area, far exceeding the amount possible from LDD alone. Nationally, 250 to 770 tonnes of HNCO may be emitted annually from on-road vehicles, likely representing the dominant source of exposure in urban areas, and with emissions comparable to that of biomass burning.
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Cianatos/química , Gases/química , Emisiones de VehículosRESUMEN
With the help of the molecular-biological method of cell hybridization in situ (FISH), the abundance of a physiologically active hydrolytic prokaryotic complex in chernozem and gley-podzolic soils is determined. The total proportion of metabolically active cells, which were detected by hybridization with universal probes as representatives of the domains Bacteria and Archaea, in samples of the studied soil, was from 38% for chernozem up to 78% for gley-podzolic soil of the total number of cells. The differences in the structure of chitinolytic and pectinolytic prokaryotic soil complexes are detected. Along with the high abundance of Actinobacteria and Firmicutes in the soils with chitin, an increase in phylogenetic groups such as Alphaproteobacteria and Bacteroidetes is observed.
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Archaea , Bacterias , Microbiología del Suelo , Actinobacteria/clasificación , Actinobacteria/genética , Actinobacteria/aislamiento & purificación , Alphaproteobacteria/clasificación , Alphaproteobacteria/genética , Alphaproteobacteria/aislamiento & purificación , Archaea/clasificación , Archaea/genética , Archaea/aislamiento & purificación , Bacterias/clasificación , Bacterias/genética , Bacterias/aislamiento & purificación , Bacteroidetes/clasificación , Bacteroidetes/genética , Bacteroidetes/aislamiento & purificación , Quitina/aislamiento & purificación , Hidrólisis , Hibridación de Ácido Nucleico/genética , Filogenia , SueloRESUMEN
On August 18, 2012, 90 years have passed since the birth of the former head of the Military field therapy Department of The Military-Medical Academy named after S. M. Kirov--the main radiologist of the Ministry of Defence of Russian Federation, the corresponding member of the Soviet Union Academy of Medical Science and the Russian Academy of Medical Science, the major- general of a medical service G. I. Alekseyev, who had been working in the department since its foundation till the last day of his life. Being the head of the department for twelve years, G. I. Alekseyev made a considerable contribution to the formation and development of native military radiology, training of medical and scientific skilled specialists. Professor G. I. Alekseyev's scientific ideas and views in the sphere of radiology were realized and developed in further educational, research and medical work of the department. Nowadays the staff of the Military field therapy Department remembers G. I. Alekseyev with special gratitude and appreciation and successfully realizes his ideas and plans in work.
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Academias e Institutos/historia , Medicina Militar/historia , Radiología/historia , Aniversarios y Eventos Especiales , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Federación de RusiaAsunto(s)
Enfermedad de Alzheimer/diagnóstico , Neuroimagen/métodos , Enfermedad de Alzheimer/diagnóstico por imagen , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , Imagen Multimodal , Placa Amiloide/metabolismo , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos XRESUMEN
Modern concept of medical-prophylactic measures in the time of mass radiation affection is presented in the present article. Moreover the past changes in organization-regular structure of medical service of the Armed Forces of the Russian Federation and appearance of new time-board equipment were taken into account. Recommendations about the rendering of all types of therapeutic aid on all stages of medical evacuation--first, premedical, medical assistance, qualified and specialized--are given.
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Medicina Militar , Traumatismos por Radiación/terapia , Transporte de Pacientes , Humanos , Medicina Militar/métodos , Medicina Militar/organización & administración , Medicina Militar/normas , Salud Radiológica/métodos , Salud Radiológica/organización & administración , Salud Radiológica/normas , Federación de Rusia , Transporte de Pacientes/métodos , Transporte de Pacientes/organización & administración , Transporte de Pacientes/normasAsunto(s)
Actinobacteria/clasificación , Actinobacteria/metabolismo , Quitina/metabolismo , Proteobacteria/clasificación , Proteobacteria/metabolismo , Microbiología del Suelo , Actinobacteria/genética , Actinobacteria/aislamiento & purificación , Biodegradación Ambiental , Ecología , Hibridación Fluorescente in Situ , Proteobacteria/genética , Proteobacteria/aislamiento & purificación , ARN Ribosómico 16S/genética , TemperaturaRESUMEN
The paper presents the results of a clinical trial using the new modified gelatin-based drug hemofusin to correct dyshidria in patients with blood loss and sepsis. Based on the findings, the authors provide evidence for the high clinical efficacy of this drug and the expediency of its incorporation into a complex of infusion therapy in this patient contingent.