Botkin Hospital Research Articles

Ischemic stroke in cancer patients: possibilities of reperfusion therapy in elderly patients

Globally, stroke and malignancies represent a major public health burden. Cancer and stroke are two clinical manifestations that are related: cancer patients have twice the risk of stroke than the general population [1]. Types of cancer most commonly associated with ischemic stroke are lung cancer, pancreatic cancer, breast cancer and prostate cancer [2]. An analysis of patients with ischemic stroke and concomitant cancer who underwent inpatient treatment at the regional vascular center in Botkin Hospital. A total of 199 patients with ischemic stroke and malignancy were analyzed. 68 patients received reperfusion therapy and 131 patients did not receive reperfusion therapy. As a result of the analysis, it was concluded that reperfusion therapy is possible and necessary for patients with malignant tumors. The risk of developing extracranial hemorrhages associated with the oncological process is extremely low, and the development of intracranial hemorrhagic complications does not significantly worsen the outcome of the disease. The severity of stroke in the presence of cancer was for the most part due to the stroke itself, its size and location, and depended less on the stage of cancer.

Glycemia control after total pancreatoduodenectomy

Aim. To study the features of correction of carbohydrate metabolism disorders and nutritional deficiency in patients after total pancreatoduodenectomy; to develop a unified protocol for managing patients after total pancreatoduodenectomy. Materials and methods. From 2007 to 2022, 62 patients underwent total pancreatoduodenectomy in the Hepatopancreatic Surgery Unit of the Botkin Hospital. The patients were divided into two groups, comparable in terms of basic parameters. The first group included patients (n = 32) who underwent “classical” total pancreatoduodenectomy with gastric resection and splenectomy. The second group consisted of patients (n = 30) who underwent total pancreatoduodenectomy in the modification of Botkin Hospital. In the perioperative period, patients of both groups were examined for carbohydrate metabolism with the selection and assessment of the average daily dose of short-acting and long-acting insulin, assessment of enzyme and protein deficiency with the selection of enzyme replacement therapy and nutritional support. For a more accurate assessment of carbohydrate metabolism disorders, all patients underwent continuous monitoring of the level of glycemia intraoperatively and in the early postoperative period (FreeStyle Libre flash monitoring system, Abbott). The glycated hemoglobin level was assessed on day 90 and body mass index – on days 30, 60 and 90 after surgery. Results. The mean level of glycemia in patients after total pancreatoduodenectomy in the modification of the Botkin Hospital accounted for 8.0 mmol/l and the variability (daily fluctuations in glycemia) comprised 39 %, which was significantly lower compared to the group of “classical” total pancreatoduodenectomy with 7.6 mmol/l and 48 %, respectively. Seven patients (21.9 %) after total pancreatoduodenectomy in the modification of the Botkin Hospital experienced a severe hypoglycemic episode, while a similar severe hypoglycemic episode was noted in 25 patients (80.6 %) after pancreatectomy in its “classical” variant, of which 18 patients (60 %) required hospitalization in the endocrinology unit in order to correct the sugar-lowering therapy. In turn, only three patients (9.4 %) after total pancreatoduodenectomy modified by the Botkin Hospital required hospitalization due to severe hypoglycemia. The mean level of glycated hemoglobin in patients of the first and second groups on day 90 accounted for 7.2 % and 7.7 %, respectively (p = 0.789). The average body mass index on day 90 after surgery was higher in the group of organ-preserving total pancreatoduodenectomy: 24 kg/m2, compared to the “classical” pancreatectomy with 21.2 kg/m2 (p = 0.001). The daily dose of both short-acting and long-acting insulin was higher in the organ-preserving total pancreatoduodenectomy group of 17.4 ± 5.6 U/day and 12 ± 4.6 U/day, respectively, compared to the group of “classical” total pancreatoduodenectomy of 13.8 ± 4.6 U/day and 10.8 ± 2.7 U/day, respectively. This can be attributed to the faster normalization of the patient's body weight and the preserved function of physiological digestion due to the pylorus-preserving variant of total pancreatoduodenectomy. Conclusion. Management of patients after total pancreatoduodenectomy is claimed to be an extremely complex task that requires a multidisciplinary approach involving surgeons, intensivists, endocrinologists and gastroenterologists at all stages of patient management. Organ-preserving modification of total pancreatoduodenectomy with preservation of the stomach, spleen and splenic vessels in the modification of the Botkin Hospital improves treatment results and simplifies the selection of insulin therapy for this group of patients.

Fluorescent signal lymph node mapping using indocyanine green in early breast cancer patients (Botkin Hospital experience)

Modern diagnostic methods with more accurate staging of the tumor process and effective high-tech treatment of breast cancer are very relevant, since this disease ranks first in the structure of cancer morbidity and mortality among women. Mapping of the signal lymph node is an alternative to axillary lymphatic dissection in patients with clinically intact regional lymph nodes (cN0). This allows patients to avoid such formidable, often and disabling complications of lymphatic dissection as prolonged postoperative lymphorrhea and lymphatic swelling of the upper extremity (lymphostasis). Radioisotope is the standard method of performing lymph node mapping, but recent years there have been more and more scientific studies and publications on the effectiveness of the non-toxic and non-radioisotope method in oncosurgery – fluorescent lymphography with indocyanine green.This article analyzes the experience and results of performing a mapping signal lymph node by a fluorescent method with indocyanine green at an early staged breast cancer in the Botkin Hospital, Moscow.

Liver Abscesses in Patients Who Have Had a New Coronavirus Infection

Aim of study To analyze clinical, laboratory, instrumental and microbiological data in patients with diagnosed liver abscesses who had previously had a new coronavirus infection.Material and methods An analysis of the work carried out with 13 patients who received treatment at the surgical clinic of the Botkin Hospital in the emergency surgical department No. 76 from September 2021 to October 2022 for liver abscesses and previous COVID-19 is presented.Results All presented patients were comprehensively examined. Surgical intervention was performed — transcutaneous drainage of liver abscesses under ultrasound guidance. Positive changes were revealed in the course of complex therapy, including antibacterial (based on the Results of a microbiological study with determination of the sensitivity of the flora to antibacterial drugs), anti-inflammatory, and daily sanitation of the abscess cavity. All patients were discharged for outpatient follow-up treatment in stable, satisfactory condition. Nine patients (69.2%) were discharged with drain under the supervision of clinic doctors. In 5 patients (30.8%) with regression of the abscess cavity, drainage from the abscess cavity was removed before discharge.Conclusion Patients with previous COVID-19 may develop liver abscesses. It is important to conduct thorough diagnostic measures in patients who present with fever and (or) abdominal pain after a coronavirus infection. Further prospective studies are needed, including morphological assessment of liver changes (upon autopsy in case of death).

The first experience in the treatment of small bowel biliary obstruction using tulium laser (Tm:YAG) in a patient with Bouveret syndrome

Cholelithiasis complicated with a bilioenteral fistula and small bowel biliary obstruction is an absolute indication for surgical treatment. To date, modern capabilities of high-tech specialized intra-luminal operative endoscopy with laser lithotripsy can prevent the routine surgical intervention, thus reducing the risk of adverse events and length of hospital stay. This clinical case describes diagnostics of the pathology and the first experience in treating the Bouveret syndrome with lithotripsy and thulium laser (Tm:YAG) light.Purpose: to improve outcomes in patients with small bowel biliary obstruction and a bilioenteral fistula using thulium laser (Tm:YAG) light as the first and final method of surgical (endoscopic) treatment.Material and methods: a patient with pains in the upper abdomen, weakness, vomiting after eating was admitted to the Botkin Hospital. Complete blood analysis, biochemical blood analysis, transabdominal ultrasound and X-ray examination of abdominal organs were made at the reception department. After that, she was transferred to the surgical department where computed tomography, magnetic resonance cholangiopancreatography and esophagogastroduodenoscopy were performed.Results: The performed instrumental diagnostics revealed a large calculus with diameter up to 4.5 cm in the bulb of the duodenum and a fistula passage connecting to the gallbladder with diameter of up 2.0 cm. Because of long disease duration and a formed internal fistula the patient was simultaneously made esophagogastroduodenoscopy and lithotripsy to resolve small bowel obstruction. The calculus was removed using thulum laser (Tm:YAG) technique, a lithotriptor basket and an endoscopic loop for fragments extraction. The performed endoscopic procedure with thulium laser light has showed its high efficiencyConclusion: The effectiveness of laser medical technique with Tm:YA in patients with Bouveret syndrome has been proven by the authors

Modern approaches to perioperative management of patients undergoing carotid endarterectomy in acute period of ischemic stroke

This article presents the Moscow Botkin Hospital experience of using combination of general and superficial cervical plexus regional anesthesia during carotid endarterectomy performed in patients in the acute period of atherothrombotic genesis ischemic stroke. The result of reliable antinociceptive protection of the body from the activation of the sympatho-adrenal system against the background of surgical manipulations was the prevention of episodes of critical hypertension and ensuring normalization of systemic hemodynamics. By reducing the need for opioids, patients’ awakening is accelerated, and their time in the operating room is minimized. In addition, the time of necessary observation in the intensive care unit and the need for anesthesia at the immediate postoperative period, is also reduced. The above factors, as well as a multidisciplinary approach to the patient, allowed not only to provide reliable prevention of recurrent vascular incidents in the acute period of ischemic stroke, but also to improve the neurological outcomes.

Effect of delayed graft function on immediate and long-term kidney transplant outcomes

Objective: to analyze the immediate and long-term outcomes of kidney transplantation (KT) depending on the duration of delayed graft function (DGF). Materials and methods. The study conducted a retrospective analysis of KT outcomes in 312 patients operated on at Botkin Hospital from June 2018 to December 2022. Exclusion criteria were primary non-function, severe surgical complications that required emergency transplantectomy in the first week after KT and cases where a comprehensive approach to DGF prevention was applied. DGF was defined as the need for dialysis within the first 7 days of KT. The severity of this complication was assessed by the time it took the transplanted kidney function to normalize from mild DGF to severe. We analyzed the immediate and long-term outcomes of KT depending on the presence of initial function and the severity of DGF. Results. DGF developed in 25.3% of cases. The mean time for graft function normalization was 16.5 ± 6.8 days. Mild DGF occurred in 68% of cases, severe DGF was determined in the remaining cases (32%). The incidence of complications was statistically significantly higher in the severe DGF group: 14/25 (56%) vs. 15/54 (27.8%) (p = 0.047). There were also no significant differences in the rate of complications between recipients with immediate and mild DGF: 43/233 (18.4%) vs. 15/54 (27.8%) (p > 0.05). Severe DGF lasting for more than 2 weeks had a statistically significant association with postoperative complications (p = 0.047) and with decreased long-term graft survival (log-rank p = 0.021). Conclusion. Development of severe DGF mainly depends on donor characteristics, timing and peculiarities of graft preservation. Nevertheless, other factors, such as acute calcineurin inhibitor nephrotoxicity, should not be ignored. Therefore, prevention of all potentially modifiable risk factors for DGF should go hand in hand with the expansion of the indications for donation.

Protocol of treatment of patients with neuroendocrine pancreatic tumors of Botkin Hospital

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Experience in Implementing an Additional Professional Advanced Training Program “Extracorporeal Membrane Oxygenation. Basic Course" at the Training and Accreditation Center — Medical Simulation Center of the Botkin Hospital

Training of anesthesiologists-resuscitators under the additional professional advanced training program “Extracorporeal membrane oxygenation. Basic course "(18 academic hours) at the Medical Center of the Botkin Hospital.

Phenomenon of Demikhov. At N.V. Sklifosovsky Institute (1960–1986). V.P. Demikhov and his experiments in the field of organ transplantation in 1968–1973

The article analyzes the experimental studies of V.P. Demikhov conducted by him in 1968-1973, by studying the content of his report on the work done during this period of time and presented at the Meeting of the Academic Council of N.V. Sklifosovsky Institute in July 1973 for the re-election for the position of the Head of the Organ Transplantation Laboratory for a new 5-year term. It follows from the analyzed document that the extent of the research made by V.P. Demikhov and his staff significantly exceeded the data that were presented in the Institute's reporting documents for 1973, in the Research Plans for 1974, and the plans for implementing the research results in healthcare practice in 1974. The Table that illustrated the report indicated that in 1968–1973 V.P. Demikhov conducted more than 485 different experiments, including transplantation of vital organs, experiments on perfusion of isolated organs, resuscitation of cadaveric hearts, and heterogeneous blood transfusion. He actively collaborated with surgeons from many clinical institutions in Moscow (Institute of Tuberculosis, S.P. Botkin Hospital, Hospitals of the Moscow Military District) and other cities of the country (Frunze, Tyumen), conducting joint experimental and clinical studies with them. However, attempts to introduce the methods developed by him into clinical practice were futile. Of all his achievements in different years, the method of upper limb reimplantation was successfully applied in clinic in 1971 by Professor B.D. Komarov.

Integrated strategy for preventing delayed renal graft function

Objective: to determine the efficacy and safety of an integrated strategy aimed at preventing delayed renal graft function (DGF).Materials and methods. From June 2018 to December 2022, 478 deceased-donor kidney transplants were performed at Botkin Hospital, Moscow. The patients were divided into two groups: Group I consisted of 128 patients who did not use the integrated strategy; Group II included 67 patients in whom the DGF prevention strategy was used at the perioperative stage. The integrated strategy involved the use of hypothermic oxygenated machine perfusion (HOPE) using expanded criteria donors, the use of a second warm ischemia (SWI) elimination device, personalized initial calcineurin inhibitor (CI) dosing, and use of alprostadil for high vascular resistance in renal graft arteries.Results. DGF occurred in 5 of 44 patients (11.4%) that used the integrated strategy, and in 13 of 44 patients (29.5%) in the control group. The differences were statistically significant (p = 0.034), there was a medium strength relationship between the traits (V = 0.225). The use of the integrated DGF prevention approach reduced the chances of developing DGF by a factor of 0.3 (95% CI: 0.1–0.95). The risk of DGF in the integrated strategy group was 61.3% of the risk of DGF in the non-strategy group, thus the relative risk (RR) is 1.63 (95% CI: 1.1–2.4). Median duration of graft function normalization was statistically significantly lower in group II: 5 (IQR: 3–9) versus 15 (IQR: 7–19) days (p = 0.012). Mean length of hospital stay was 19.1 ± 4.2 (95% CI: 14.5–26.1) bed-days in group I and 13.9 ± 3.4 (95% CI: 9.3–17.2) bed-days in group II. Differences in this indicator were also statistically significant (p = 0.043).Conclusion. The set of DGF prevention measures, developed at Botkin Hospital, evidence-based and implemented in clinical practice, can reduce the burden of modifiable risk factors of this complication significantly, thereby improving treatment outcomes for kidney transplant recipients considerably.

Clinical, Morphological Justification and First Experience in the Use of Radiofrequency as Well as Microwave Ablation Treatment Methods of Liver Echinococcosis.

The current study considers a new direction of surgical treatment of liver echinococcosis - the use of minimally invasive treatment methods of parasitic cysts. After clinical and morphological substantiation of the very possibility of carrying out such procedures, 9 microwave ablations (MWA) and 3 radiofrequency ablations (RFA) of cysts were performed in patients with liver echinococcosis from 2017 to 2021 in the surgical clinic of Botkin Hospital, Moscow, Russia. A comparative analysis of treatment results of patients with echinococcal liver cysts (12 patients who underwent "percutaneous puncture, aspiration, injection and reaspiration" (PAIR) procedure and 12 patients - MWA and RFA) was carried out. The number of complications according to Clavien-Dindo classification was as follows: 8 after PAIR procedure, 3 after RFA and 3 after MWA. The median hospital length of stay (LOS) after PAIR procedure was 6.46 days versus 4.7 and 4 in the groups of patients who underwent RF and MW ablation, respectively. The frequency of relapses within the first year after PAIR procedure was 25%. The patients who underwent ablation procedures had no relapses of liver echinococcosis during observation. The presented clinical and morphological substantiation and the experience of using various types of ablation techniques on echinococcal cysts, as well as a comparative analysis with a commonly used PAIR treatment method, demonstrated the safety of RFA and MWA for the patient and efficacy in relation to the hydatid process.

Combination of hypomethylating agents and inhibitor of BCL-2 in treatment of patients with relapsed acute myeloid leukemia: S.P. Botkin hospital experience

Background . Treatment results in patients with relapsed and refractory acute myeloid leukemia (AML) remain unsatis‑factory. Treatment options for these patients are limited. Aim . To retrospectively analyze the efficacy and safety of combined therapy with hypomethylating agents and venetoclax (VenHMA) in patients with relapsed AML and also to compare the results with the cohort of patients who received azacitidine as a monotherapy. Materials and methods . The study included patients with relapsed AML, over 50 years old, who received VenHMA therapy from 01.09.2019 to 01.06.2022 and azacytidine monotherapy from 01.03.2016 to 01.06.2022. In total we identified 38 patients who received VenHMA and 30 patients who received azacytidine alone. Results . The median age of patients in the VenHMA cohort was 66 years (range 51–84). The median number of previous therapy lines was 1.5 (range 1–3), and 12 (32 %) patients had AML evolving from prior myelodysplasia. The median follow-up was 6.2 months, with 20 patients monitored for more than 6 months. Complete response was obtained in 13 (34 %) patients, complete remission with incomplete recovery in 8 (21 %), leukemia-free state in 2 (5 %) patients. Thus, overall response was achieved in 23 (60 %) patients. The median time to achieve overall response was 2.6 months. At the time of the final analysis, 16 patients were still receiving treatment. The median of relapse-free survival in patients with response was not achieved; the median of overall survival was 15.6 months. The groups of patients receiving VenHMA or azacitidine alone were comparable in terms of the main characteristics, with the exception of initial thrombocytopenia <50 × 109/L, which was more frequently encountered in VenHMA cohort (47 % versus 20 %). The median time to the next therapy in the VenHMA group was 10.16 months, in the azacitidine group 6.7 months (hazard ratio (log-rank) 2.02; 95 % confidence interval 1.15–3.5; p = 0.013). The median overall survival in the VenHMA group was 15.6 months, in the azacitidine group 8.5 months (hazard ratio 2.49; 95 % confidence interval 1.36–4,5; p = 0.0044). In a multivariate analysis of factors, associated with adverse outcome (age >65 years, secondary AML, azacytidine monotherapy) only secondary AML was a significant factor for overall survival. Conclusion . The results of our retrospective study show the superiority of the combination regimen of venetoclax and azacitidine in the treatment of AML relapses, both in terms of the quality of remissions and their duration. Patients with relapse and primary refractory AML represent cases of poor cytogenetic prognosis, and have an aggravated somatic status. To date, the use of the VenGMA regimen allows finding the optimal balance between the intensity and toxicity of therapy.

Long-term functional results of revision hip replacement using Burch-Schneider cages

IntroductionOne of the most common and effective treatments for end-stage hip osteoarthritis is total hip arthroplasty (THA). According to the WHO, 1.5 million, more than 500,000, and approximately 100,000 THAs are performed annually in the world, in the USA, and in Russia, respectively. The use of Burch-Schneider cages has progressively increased since their introduction in 1975, with more than 125,000 cages being implanted by 2006. This design for revision surgery remains valid today.The objectives were to conduct a retrospective analysis of anti-protrusion cages in revision THA and evaluate long-term functional results. MethodsFifty-eight revision surgeries were performed at Botkin Hospital from 2003 to 2020 with anti-protrusion Burch-Schneider cages because of aseptic loosening of the acetabular component. The average age of the examined patients was 61.2 (±12.9) years. The maximum follow-up duration was 17 years. The average follow-up duration was 10.5 (±4.1) years. We used the functional Harris, WOMAC, SF-36, and FJS-12 scales to evaluate functional results. The patients were distributed into the following groups according to the Paprosky classification: 2C, 3A, and 3B. ResultsGroup 2C showed good functional results, with a Harris score of 87 (±6.9), an FJS-12 score of 63.2 (±4.8), a WOMAC score of 175 (±16.7), and an Oxford Hip score of 39.06 (±9.1). Group 3A also showed good functional scores, with a Harris score of 78 (±7.1), an FJS-12 score of 61.2 (±5.1), a WOMAC score of 168 (±17.1), and an Oxford Hip score of 42.12 (±8.7). Group 3B showed satisfactory functional results, with a Harris score of 70 (±5.9), an FJS-12 score of 58.9 (±4.4), a WOMAC score of 166 (±18.1), and an Oxford Hip score of 48.4 (±9.4).Among patients who underwent revision surgery using Burch-Schneider rings, 16 needed to undergo repeat revision surgery. Periprosthetic infection occurred in 5 patients, aseptic loosening in 7, and periprosthetic fracture in 3. ConclusionsThe anti-protrusion Burch-Schneider system is a necessary and up-to-date element of THA and can be used with great efficacy in revision THA. Despite the rapid development of technologies and the appearance of new, highly efficient devices, there is still room for systems such as Burch-Schneider rings. However, there are relatively few indications for their use, with the main indications for the use of anti-protrusion systems being conditions related to bone defects of the acetabular roof and bone mass loss of the acetabular floor.

Initial results of use and prospects of hospital-substituting technologies in gynecology

Background. The first day-care hospital (DCH) in the Russian Federation with 30 beds was established in the departments of general surgery, urology, and gynecology of the Botkin Hospital in 2016 in Moscow.
 Aim. To analyze the six-year experience of the gynecological DCH based on the Botkin Hospital.
 Materials and methods. The six-year experience (20162021) of the gynecological DCH based on the Botkin Hospital was analyzed.
 Results. The number of patients treated in the DCH increased progressively from 2016 to 2019. Due to the gain in the experience of DCH, patients with a broader spectrum of diseases can receive care in DCH settings, the number of hospitalized patients with a higher anesthetic risk has increased, and the proportion of patients over 65 years of age has also increased.
 Conclusion. Analysis of the activities of the DCH based on the Botkin Hospital showed that the pilot project can be considered successful due to good clinical and economic indicators. This activity format can be widely implemented, and it is optimal to establish such hospitals in multidisciplinary clinics.

Retrospective Analysis of the Results and Causes of Penetrating Keratoplasty with Native Donor Material in a Multidisciplinary Hospital (Along the Example of MCOC Botkin Hospital)

Penetrating keratoplasty (PC) is an operation of choice for urgent and planned conditions of the pathologic cornea. Moscow City Ophthalmological Center “Botkin Hospital” together with the Moscow Coordination Center for Organ Donation) over the past five years, has been performing corneal transplants using native donor material. In the available literature sources, we could not find publications devoted to conducting PC with native donor material in a multidisciplinary hospital. This publication analyzes our own experience of end-to-end corneal transplantation with native donor material for the period from 2018 to 2022.

Morphological justification of organ-preserving methods of surgical treatment of patients with liver echinococcosis

The purpose of the research is the study of the morphological structure of echinococcal cysts to assess the possibility of using organ-preserving methods of surgical treatment.Materials and methods. A clinical, instrumental, and morphological fundamental study was performed in the Surgical Clinic of the Botkin Hospital when radiation and morphological data in addition to clinical data were studied for 28 patients who underwent surgical treatment for liver echinococcosis. Excised gross specimens were examined to study the capsule structure, and the penetration of germinal elements of the cysts through membranes of the parasite (64 successively excised primary operated echinococcal cysts).Results and discussion. The fibrous capsule of the echinococcal cyst is a good barrier against Protoscolexes penetrating into the liver tissue. None of the 64 specimens studied in detail was found to have germinal elements of any echinococcal cyst penetrating through its fibrous capsule. The morphological justification of organ-preserving methods in the treatment of patients with liver echinococcosis allows a conclusion that these interventions are safe and radical.

Efficacy of the combination of venetoclax and hypomethylating agents in the treatment of patients with primary, relapsed and/or refractory acute myeloid leukemia

Relevance and goals. Treatment of patients with acute myeloid leukemia has traditionally been highly intensive and includes induction therapy using cytarabine and anathracyclines. In addition to new opportunities in the treatment of acute myeloid leukemia, the problem of toxicity of high-intensity therapy in elderly and young somatically burdened patients is quite acute. International clinical trials of phases I-III demonstrated a combination of high efficacy and acceptable hematological toxicity of combinations of hypomethylating agents and venetoclax in the first line of therapy, as well as in the treatment of resistant forms and relapses of acute myeloid leukemia in the older age group, which contributed to the study of the effectiveness of combinations of hypomethylating agents and venetoclax in the treatment of similar groups of young comorbid patients. In this work, we evaluated the efficiency of a combination of hypomethylating agents and venetoclax and overall and disease-free survival in patients with acute myeloid leukemia in routine practice.Methods. In the period from October 2017 to December 2021 on the basis of the Department of Hematology No. 11 and the Department of Bone Marrow and Hematopoietic Stem Cell Transplantation No. 56 of the Botkin Hospital (Moscow, Russia) 33 patients with acute myeloid leukemia received venetoclax therapy in combination with decitabine or azacitidine: 14 (42%) men and 19 (58%) women, median age was 60 years (23–83 years). In 42% (14 of 33) of cases, the regimen was prescribed for resistant course or relapse of acute myeloid leukemia and in 61% (20 of 33) as induction therapy. Three patients (15%) out of 19 from the group of newly diagnosed acute myeloid leukemia received this treatment regimen in the first line, taking into account the ECOG status 3-4. By August 2022, 13 (39%) patients are alive, 20 (61%) people have died. Overall survival, the rate of complete remission and complete remission with incomplete recovery, the rate of achieving negativity of minimal residual disease, the frequency of hematological toxicity and infectious complications were assessed. Statistical data processing used: frequency analysis using contingency tables (Fisher's exact test), survival analysis using the Kaplan-Meier method.Results. Complete remission and complete remission with incomplete recovery were achieved in 72.72% (24 of 33) of patients. In the group of primary acute myeloid leukemia, remissions were observed in 80% (16 out of 20) of cases, in the group with resistant course or recurrence of acute myeloid leukemia in 67% (8 out of 12) (p = 0.3). Determination of minimal residual disease by flow cytometry after the 1st course was performed for 54.54% (18 of 33) patients, while negativity was stated in 84.2% (14 of 18 patients) cases. In both groups, the incidence of hematological toxicity and infectious complications are comparable to those according to the literature data. The median follow-up was 9.5 months (1–47). Median overall survival was 39 months, 2-year overall survival was 63%, and overall 4-year survival was 39%. The disease-free survival rate was 33%.Conclusion. The combination of hypomethylating agents and venetoclax showed good efficacy and fairly high overall survival in patients of all age groups, both for primary acute myeloid leukemia and for relapses and resistant forms, regardless of previous therapy. Given the moderate hematological toxicity, as well as the relatively low rates of infectious complications during therapy, including the rather low mortality rates in case of COVID-19 infection in comparison with those on the background of high-intensity courses of therapy for acute myeloid leukemia, this scheme can be widely used not only in patients of the older age group, but also in young comorbid patients.

Рroblems of PCR diagnostics OF COVID-19

To date, an adequate and timely assessment of the number of cases is the basis of effective measures aimed at preventing the spread of COVID-19 infection. Real-time reverse transcription polymerase chain reaction (RT-PCR) remains the gold standard for confirming COVID-19.The purpose of the work: to analyze the experience of the city virological center of the S.P. Botkin Clinical Infectious Diseases Hospital (Botkin Hospital) for the examination for the presence of SARS-CoV-2 coronavirus by PCR in the period from 2020 to 2022.Materials and methods. The systematization of PCR studies on COVID-19 for the period 2020-2022 was carried out. A total of 221,901 people were examined, positive results were obtained in 55,372 (24.95%). Among the contingents of the examined patients, patients who underwent inpatient treatment at the Botkin Hospital.Conclusions. This study analyzed the possible causes of false-positive and false-negative PCR results. The correlation of the number of positive results with the dynamics of detection of new cases of COVID-19 in St. Petersburg during the 2020-2022 pandemic is shown. It has been established that the proportion of patients examined more than 3 times during the period of hospitalization remains significant. This fact requires the closest attention, given the high cost and laboriousness of PCR studies.

Clinical Infectious Diseases Hospital named after S.P. Botkin: 140 years of service to people

In 2022, the Clinical Infectious Diseases Hospital named after S.P. Botkina (Botkin Hospital) celebrated its 140th anniversary. The name of this famous medical institution is associated with the history of domestic infectology, the history of the fight against infectious diseases, including the development of disinfection in Russia. The review presents historical data on the activities of the Botkin Hospital in different eras of our country. Particular attention is paid to scientific developments introduced into the practice of the institution.