Comorbid Background Research Articles

Evaluating the COVID-19 Vaccines Effectiveness in Patients Hospitalized with Severe Acute Respiratory Infections

The pandemic of the COVID-19 coronavirus infection, which is caused by a new strain of coronavirus – SARS-CoV-2, has caused a rapid increase in the number of cases and high mortality worldwide. Comorbid patients are the most vulnerable group with a particularly high risk of adverse outcomes. The widespread introduction of vaccination helps to reduce the severity of the course and complications of a new coronavirus infection. The purpose of this research is to conduct a comparative analysis of the effectiveness of vaccines against COVID-19 in patients hospitalized with a comorbid background and a severe course of the disease. Methods. Analysis and analysis of previously published studies by foreign and domestic authors, statistical analysis of medical records of 212 patients undergoing inpatient treatment with SARI. Results. In the course of the conducted analysis in the group of vaccinated patients, despite the fact that initially all were comparable with each other in terms of the severity of lung tissue damage, as well as the presence of concomitant pathology, the severe course of the disease and deaths amounted to 7%. They were discharged for further observation at the outpatient stage with an improvement of 93% of patients. Whereas in unvaccinated patients the mortality rate was 16.1%, 83.9% of patients were discharged with improvement. The duration of hospitalization in vaccinated patients was much shorter, averaging 7 days, whereas in non-vaccinated patients hospitalization lasted 12 days. Conclusions. According to the conducted research, the Russian Sputnik-V showed a statistical advantage. A negative trend of severe disease course was revealed among unvaccinated patients with a comorbid background.The results obtained allow us to assess the high importance of vaccination to reduce the lethal outcomes of COVID-19.

Персонифицированный подход к ведению больногоCOVID-19 с осложненным коморбидным фоном

Персонифицированный подход к ведению больногоCOVID-19 с осложненным коморбидным фоном

The Role of rs2238296 of the Mitochondrial DNA Polymerase Gamma Gene in Combination with Polymorphic Variants of Antioxidant Defense Genes in the Development of Postinfarction Left Ventricular Aneurysm

Studied the relationship of the polymorphic variant of the mitochondrial DNA polymerase gamma gene (POLG rs2238296) in combination with single-nucleotide polymorphic variants of the genes of the antioxidant system of the body (mitochondrial transcription factor A (TFAM rs1937), superoxide dismutase (SOD2 rs4880), glutathione peroxidase (GPX1 rs1050450), catalase (CAT rs1001179), paraoxonase 1 (PON1 rs854560) and NADP-H oxidase (CYBA rs4673)) with features of postinfarction remodeling of the left ventricle (LV). One hundred and fifty-three patients with coronary heart disease (137 men and 16 women) aged 56 (50; 60.5) years were examined. Genotyping was carried out using a polymerase chain reaction followed by analysis of the polymorphism of the lengths of restriction fragments. No significant difference was found in the SOD2, GPX1, CAT, PON1, TFAM genes in the studied groups. Significant differences were found with respect to the POLG and CYBA genes: the CC rs2238296 genotype of the POLG gene was found in every third patient with LV aneurysm (30.3%), where as in the group without aneurysm – only in every eighth case (12.3%, p = 0.006). The CC rs4673 genotype of the CYBA gene was found in every second patient with an aneurysm (51.8%) and in 32% without LV aneurysm (p = 0.01). Patients with a combination of CC (POLG) and CC (CYBA) genotypes were represented exclusively by younger men, who were characterized by a less burdened comorbid background, in comparison with patients with a different genotype of these genes. At the same time, the LV ejection fraction in such patients was significantly lower (40 (27; 52) and 50 (40; 61), p = = 0.006), and the development of LV aneurysm was recorded in 73% of cases.

Effect of comorbid conditions on the course of COVID-19 in patients with chronic diseases of the cardiovascular and pulmonary systems

The pandemic of the novel coronavirus infection COVID-19 has become a serious challenge to humanity. Prior to this period, cardiovascular diseases (CVS) were a major health problem in all countries, including hypertension (AH), which is a leading risk factor for vascular disasters; acute disorders of cerebral circulation, myocardial infarction. Hypertension makes a significant contribution to the structure of mortality and disability from cardiovascular diseases. The year 2020 changed the decades-old perception of diseases that pose a threat to health on a global scale. The leading clinical symptoms of COVID-19 in patients with background diseases CVS and hypertension are described. An important aspect of COVID-19 is the course of infection in patients with a burdened comorbid background, while the role of hypertension as a risk factor for severe forms is noted. The data obtained will serve to understand the systemic effects, including cardiovascular, that COVID-19 has, which will optimize the provision of timely comprehensive medical care to patients, develop an algorithm for the tactics of management and observation in different periods of the COVID-19 disease.

Predictors of high risk of atypical clinic of myocardial infarction

Objective: analysis of predictors allowing to predict a high probability of atypical clinical course of myocardial infarction (MI) at an early stage of development of acute coronary insufficiency before complex diagnostic procedures.Materials and methods: the study included patients from the Tomsk population with confirmed MI in the period 2001–2017, registered in the database "Register of Acute Myocardial Infarction" (ROIM) (n=7775). In 79.6% (n=6188), the clinical picture of MI was characterized by typical manifestations in the form of a prolonged angina attack (group 1), in the remaining 20.4%; patients (n=1587) recorded atypical manifestations of MI (group 2).Results: patients with atypical clinical manifestations of MI were more often represented by women, had an older age and a burdened comorbid background. The anamnesis of IM and coronary artery revascularization were more commonly recorded in a cohort of patients with typical clinical manifestations of coronary catastrophe. All parameters that demonstrated significant differences in patients with different types of clinical flow IM were included in the logistic regression model. As a result of a step-by-step procedure for elimination of factors, independent associations with the development of atypical symptoms of acute MI showed the following indicators: female sex, elderly age, IM history, type 2 diabetes mellitus, history of myocardial revascularization, atrial fibrillation, alcohol consumption before MI, obesity, smoking.Conclusion: female gender, elderly age, the presence of atrial fibrillation, diabetes mellitus, obesity and condition after alcohol intoxication predisposes to atypical acute MI, whereas male gender transferred to IM or revascularization, as well as smoking are currently more common in patients with a typical clinical pattern.

The evolution of personalized medicine: publications review

The personalized medicine is based on suggestion that each person has unique characteristics at molecular, physiological, ecological and behavioral levels. In case of development of disease one is to be treated considering these unique characteristics. This belief was to some extent confirmed by application of such newest technologies as DNA sequencing, proteomics, imaging protocols and application of wireless health monitoring devices which established large inter-individual differences.The purpose of the study was to summarize and systematize the results of publications on personalized medicine and its development.The search for scientific articles was carried out, including the published in peer-reviewed journals indexed in Pubmed, WoS, Scopus and RSCI. The review covers 49 articles considering new technologies that make possible the personalized medicine possible, new experience, modes of verification and application of individualized medications as well as potential means of treating people with fertility problems and infertility.The individualization of medical practice in particular cases is probably inevitable all the more the individual approach to patient becomes more effective and cost-effective. The accessibility of modern biomedical technologies, emergence of wireless monitoring devices allows to implement "personalized" approach to early, subclinical diagnostic, individualization of treatment in order to obtain maximal efficiency and minimal toxicity of therapy, prevention of relapse of disease and its prevention. The technology of cell avatars will permit to prognose development of diseases and, possibly, life expectancy too. The personalized approach in reproductology based on genetic research will permit to eliminate a number of hereditary, orphan diseases in XXI century the same way as studies in immunology and development of vaccines made it possible to eliminate black smallpox in XX century.Conclusion. The future challenges consist not only in looking for new manifold modes of characterizing patient, but also in personalization of therapy, development of individual medication and disease prevention schemes. It is presumably that applying more relevant models based on human cell cultures will allow not only to study pharmacodynamics of medications, but also to implement personalized selection of medication therapy, considering nature of disease and comorbid background of patient.

Diagnosis and treatment of periprosthetic infection after hip replacement (a review)

Introduction. The frequency of hip arthroplasty is steadily increasing throughout the world and, although this operation has become routine, the likelihood of postoperative complications reaches 4.3 % [1]. The most dangerous of them are infectious lesions in the area of the endoprosthesis and adjacent tissues. At the same time, in addition to the threat of generalization of the infectious process, there are functional disorders in the joint area and a general deterioration in the quality of life of the patient. Timely diagnosis and treatment of the infectious process and related disorders can minimize the adverse effects of infection.Target. The purpose of this review is to analyze modern methods for diagnosing and treating periprosthetic infection resulting from hip replacement.Materials and methods. The subject literature was searched using the PubMed and Google Sholar databases.Results. The main methods for diagnosing periprosthetic infection include histological and bacteriological examination of the biopsy specimen, determination of sensitivity to antibiotics, blood, and synovial fluid analysis for the content of leukocytes, IL-6, CRP, PCR diagnostics of infectious agents. Treatment consists of re-intervention and/or antibiotic therapy.Conclusion. The most optimal method for diagnosing periprosthetic infection is a bacteriological study of biopsy specimens taken intraoperatively. The preferred method of treatment is determined by the severity of the infection, the degree of involvement of tissues adjacent to the prosthesis, the comorbid background, the nature of the infectious agent, and includes repeated revision surgery.

Structure and frequency of comorbid background in patients with osteoarthritis

Structure and frequency of comorbid background in patients with osteoarthritis

Administration Details of Genetically Engineered Biologic Drug (Ustekinumab) in Children with Psoriasis and Comorbid Metabolic Syndrome or in Case of Previous Biological Therapy Failure: Case Studies

Background. Psoriasis is a chronic immune-mediated disease with multifactorial nature. It often requires administration of genetically engineered biologic drugs. They have a number of features and risks that depend on various factors. The results of ustekinumab administration as a drug of choice in patients with comorbid metabolic syndrome in a child with Down syndrome, as well as a case of inefficacy of previous biologic therapy with inhibitors are considered.Clinical cases description. Two clinical cases of ustekinumab administration in children with severe psoriasis have been described. In the first case, we had to choose systemic therapy for the child suffering from Down syndrome and having complex comorbid background: obesity and steatohepatitis. The second case was interesting due to the family history of psoriasis in the patient, who received methotrexate for a long time, and then etanercept with subsequent loss of efficacy and severe disease aggravation without any pathogenetic therapy.Conclusion. Ustekinumab is the favorable genetically engineered biologic drug (according to the studies results and the clinical cases data) for children with severe psoriasis who have comorbid pathologies and who require the change in biologic agent due to its inefficacy.

A clinical case of COVID-19 infection in a young patient with a соmorbid pathology

Background: The COVID-19 pandemic has caused a rapid increase in the number of cases and high mortality worldwide. Here we report a clinical case of severe COVID-19 with the development of lethal complications in a young patient with an unfavorable comorbid background. Description of the case: Patient R., a 36-year-old male, was admitted to the infectious diseases department with the complaints of frequent unproductive cough, pyretic body temperature, headache. Computed tomography of the chest revealed bilateral polysegmental pneumonia with the damage of up to 65% of the lung tissue. PCR for SARS-CoV-2 mRNA was positive. The medical history mentioned arterial hypertension for five years, obesity (BMI 41.5). The disease lasted for about 7 days, the patient took antipyretic, antibacterial medication without noticeable improvement. Despite the ongoing therapy for two days, the signs of pulmonary heart failure increased, culminating in the cardiac arrest, unsuccessful resuscitation and biological death of the patient. A sectional study revealed signs of pronounced edema in the lungs with a hemorrhagic component, hemolyzed erythrocytes were found in the lumen of the alveoli. In the heart, a histological examination revealed unevenly hypertrophied cardiomyocytes with areas of fragmentation. In the epithelium of the renal tubules, signs of karyorrhexis were found, and multiple areas of erythrocyte infiltration were found in the stroma. Conclusion: The clinical case demonstrates a rapid fulminant course of COVID-19 in a young patient with arterial hypertension and obesity, who developed viral-bacterial pneumonia, which led to the development of pulmonary heart failure, pulmonary edema, and necronephrosis.

КЛИНИЧЕСКИЕ ХАРАКТЕРИСТИКИ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ У ДЕТЕЙ

Currently it is about impossible to discuss whether children and adolescents carry the infectious process caused by the SARS-CoV-2 virus only in a mild and asymptomatic form. Ambiguous conclusions can be drawn from the reviewed publications of a number of recent studies in which children and adolescents with complicated course of the new coronavirus infection were under observation. More and more relevant are reports from scientists around the Globe about somatic symptoms that persist after the new coronavirus infection. The purpose of the study was to summarize and analyze the widely available data on the clinical features of the new coronavirus infection in children and adolescents in Russia and worldwide. The bibliographical research was carried out in the reviewed periodicals’ databases as follows: PubMed®, ScienceDirect, Cochrane Library, Google Scholar, eLIBRARY, and CyberLeninka. The keywords for the search were as follows: COVID-19, children, clinical features, clinical symptoms, post COVID syndrome, long-term symptoms after SARS-CoV-2, physical and mental health, new coronavirus infection, clinical manifestations, cognitive impairment. The reviewed period of publications screened: 2020 to 2022 (to date). In total 152 sources were analyzed, from which 60 most representative studies were selected, that in its turn provide data on the clinical features of SARS-CoV-2 in children during different periods of the disease, starting with the onset of the disease in different age groups. Children are as vulnerable to the SARS-CoV-2 infection as adults but more frequently suffer from the disease in mild forms. The main clinical manifestations during the acute period of COVID-19 in children are as follows: fever, respiratory symptoms (rhinorrhea, nasal congestion, cough, shortness of breath), gastrointestinal manifestations (nausea/vomiting, diarrhea), signs of sensory impairment (anosmia, ageusia), arthralgia/myalgia, weakness, fatigue. At the same time the new coronavirus infection can rapidly progress in a severe/life-threatening form in some children that would require intensive care and respiratory support. In addition, the aggravated comorbid background in the anamnesis of severe/critical cases has a significant value. The cardiological and neurological pathology has a special prognostic value as well. A number of publications have proven the indisputable fact of long-term COVID-19 symptoms in children. According to a number of studies more than 70% of those who recovered from COVID-19 complain of one or more symptoms after the end of the acute period of the disease; in some cases, these complaints can persist for up to 10 weeks, and even up to 6 to 7 months after the recovery (in a number of cases described). The prospect for the in-depth study of the course and consequences of COVID-19 in childhood will provide an opportunity to obtain a clear view on the most frequent clinical features of the disease, factors predisposing to the development of severe/critical/life-threatening conditions, and would allow to develop the clear-cut treatment and prevention algorithms.

Clinical genetic counselling and rehabilitation treatment of a patient with Guillain–Barré syndrome after COVID-19

The authors present a clinical case of rehabilitation after the development of GuillainBarr syndrome, an acute autoimmune inflammatory polyradiculoneuropathy, in a patient who underwent a SARS CoV-2 infection. The patient previously manifested with severe comorbidities (arterial hypertension, hypercholesterolemia, type 2 diabetes mellitus, stenosing atherosclerosis of brachiocephalic arteries). A diagnostic panel of single nucleotide gene polymorphisms associated with risk factors of cardiovascular diseases, metabolic disorders, immunopathology, pharmacogenetics was applied using PCR-RT Genetic Passport test system, and the results were interpreted in order to predict potential complications, adverse drug reactions and the choice of biomarkers for preventive measures. We have compared clinical manifestations, comorbid background and the identified genotype features, as follows: minor homo- and heterozygous variants of ACE, AGT, CYP1A2, NOS3, PPARD, EDN, PALLD, SNX19 genes associated with predisposition to cardiovascular diseases, increasing the risk of dysregulation of blood pressure, development of endothelial dysfunction. The following gene variants were revealed: FXII, ITGA2, ITGB3, MTHFR, MTRR, MTR, PAI-1 that increase the risk of venous and arterial thrombosis, along with gene variants of ADRB3, FTO, INSIG2, KCNG11, LEP, PPARD, TCF7L2, ApoC3, PON1 associated with carbohydrate and lipid metabolism disorders; polymorphisms in the genes determining the immune response, i.e., IL4, IL6, IL8, IL10, CDH1, BDNF1, CRP, CCR5 (with del32 allele considered a risk factor of severe SARS-CoV-2), homozygous polymorphism of a gene of FCGR2 associated with risk of antigen-antibody-complement-mediated cytotoxicity, circulation arrest, deposition of immune complexes in endothelium of microvessels, decreased antithrombotic effects and increased procoagulant activity. Pharmacogenetic study revealed a variant of the CYP4F2 gene, a CYP2C19 gene polymorphism associated with delayed metabolism of a number of pharmaceuticals which requires higher drug dosage, or choosing a drug with a different mechanism of action; gene variants of CYP1A2, GSTP1, GSTT1 reducing efficiency of the cellular detoxification system; NAT2*5 and NAT2*6 variants determining a decrease in appropriate enzyme activities when administering a standard dose of drugs with slowdown of their detoxification, accumulation of toxic metabolites causing clinical adverse effects (hepatotoxicity, dyspepsia, lupus-like syndrome, polyneuritis). Based on the genotype that determines pathogenesis of the multifactorial pathology (including immune-mediated complications of COVID-19), a personalized approach is recommended to the patient, in terms of treatment and prevention of complications. On the basis of testing the biochemical, immunological and blood coagulation biomarkers, an adequate choice of pharmaceuticals is recommended for the patient.

Modern Aspects of Risk Factors for the Formation of Bronchial Asthma in Children

The purpose of our study was to study the nature of clinical manifestations and risk factors for the development of bronchial asthma (BA) in children. We examined 120 children aged 5 to 15 years with asthma who were on inpatient treatment in the department of pulmonology and allergology. With moderate and severe asthma, there was a longer manifestation of shortness of breath, oral wheezing, wet cough and wet wheezing in the lungs, emphysematous lung enlargement on both sides with horizontal standing of the ribs. In the presence of severe bronchospasm, the symptoms of intoxication and respiratory failure were more pronounced, which is manifested by long-term clinical signs of the disease. Among the main risk factors for the development of AD, hereditary burden, peculiarities of maternal nutrition during pregnancy and lactation, early transfer of the child to mixed and artificial feeding, unfavorable course of the peri–, intranatal periods and comorbid background can be distinguished.

Characteristics of clinical manifestations of gout in the elderly people

Introduction. Gout in elderly patients is characterized a pronounced comorbid background [2,8-10], which causes difficulties in their management [9]. Objectives of the study. Analysis of the comorbid background for gout in different age groups. Identification of risk factors characteristics, the onset and evolution of gout in elderly people compared to middle-aged patients. Material and methods. To achieve the goal of the cross-sectional study, 237 patients with gout (average age for the men 60±8.0 years and for the women 63±9.0 years) were examined. Results. The patients were separated into two groups, depending on the age of onset of gout: the age of onset up to and including 59 years (group I, 146 people) and the age of onset after 60 years inclusive (group II, 91 people). The average age in group I was 58.1±11.7 years, in group II - 72.8±4.1 years (p<0,1). Conclusions. The average number of concomitant diseases is 2 times higher in the group of gout patients aged 60 years and older (4.0 [3.0; 5.0]) than in the group of patients with gout under the age of 59 years inclusive (2.0 [2.0;3.0], p <0,1), in patients with the onset of gout at the age of 59 years inclusive, the development of coronary artery disease, chronic heart failure and nephrolithiasis occurs significantly earlier than in patients with the onset of gout at the age of 60 years and older (48,4±6,9 years and 59,1±5,0 years; 53,6 ± 3,4 years and 65,6±9,0 years; 37,3±8,9 years and, respectively, 54,9±14,6 years, p<0,05 in all cases).

Патогенетические аспекты катарактогенеза с позиции коморбидной патологии

Relevance. Research by ophthalmologists, biologists, biochemists, biophysicists, physiologists have shown the significance of xeno- and endobiotic effects on the induction of cataracts and other degenerative diseases of the structures and membranes of the eye. Objective research goal was an evaluation of comorbid background in people of different ages with a diagnosis of senile cataract. Material and methods an analysis of the case histories of 173 patients of an independent sample with a diagnosis of "senile cataract" admitted for planned inpatient surgical treatment was carried out. The evaluation was carried out by decades of human life: younger than 40 years old, 41–50 years old, 51–60 years old, 61–70 years old, 71–80 years old and over 80 years old. The Charlson method was used to calculate the comorbidity index. Results patients who had senile cataract and concomitant somatic diseases, the most frequent- diseases of the cardiovascular system – 129 (74.6 %); violation of carbohydrate metabolism – 35 (20.2 %); diseases of the central nervous system – 33 (19.1 %); musculoskeletal system – 30 (17.3 %); diseases of the respiratory system – 19 (11.0 %). Conclusions. 1. A human's age of 51–60 years should be considered critical for the occurrence of senile cataract. 2. In the decade of life 51–60 years, there is an increase in persons with senile cataract by 3.3 and the frequency of concomitant somatic pathology (according to the index of comorbidity) by 2.25. Keywords: senile cataract, age, somatic diseases, index of comorbidity

The profile of comorbid conditions and the structure of mortality in patients with rheumatoid arthritis in the Stavropol Territory: preliminary results

Objective: to study the comorbid background and mortality structure of patients with rheumatoid arthritis (RA) in the Stavropol region in a cohort of patients of the Stavropol Regional Clinical Hospital (SRCH) within the period 2015–2021. Materials and methods: There was carried out systematic review of the literature. There was carried out the analysis of the protocols of autopsies in the pathoanatomical department of the SRCH within 2015-2021. There were studied the comorbidity component and lethal outcomes of patients with RA in the pathoanatomical diagnosis. Results: the structure of the comorbid pathology of RA patients in the SRCH cohort included coronary heart disease (CHD), autoimmune thyroiditis (AT), respiratory diseases (RD), hypertension (HT), “Blastomatosis”, diabetes mellitus (DM), COVID-19 infection. The comorbidity profile of patients with RA in decreasing order of the incidence of the pathological condition was as follows: CHD (35.29%) > RD (29.41%) > (“Blastomatosis”, СOVID-19 by 11.75%) > (AT, HT, DM by 5.88%). The structure of the conditions that led to the death of patients with RA included: acute myocardial infarction (40.0%), hemorrhagic stroke (6.67%), breast cancer (13.33%), thyroid cancer (6.67%), viral pneumonia (20.0%), sepsis (13.33%). Conclusions: the data obtained provide information that can be used by rheumatologists to optimize the strategy for managing RA and the risk of comorbid conditions.

Contribution from MHC-Mediated Risk in Schizophrenia Can Reflect a More Ethnic-Specific Genetic and Comorbid Background.

The immune system seems to play a significant role in the development of schizophrenia. This becomes more evident with the emerging role of MHC complex and cytokines in schizophrenia. In the recent past, several GWAS have implied that the 6p21 region was associated with schizophrenia. However, the majority of these studies were performed in European populations. Considering tremendous variations in this region and the probability of South Indian populations being quite different from the European gene-pool from an immunogenetic point, the present study was initiated to screen SNPs in the 2.28 MB region, spanning the extended MHC locus, in 492 cases and controls from a South Indian population. We found a very strong association of rs3815087 with schizophrenia at both allelic and genotypic levels with a 7.3-fold increased risk in the recessive model. Interestingly, the association of none of the earlier reported GWAS hits, such as rs3130375, rs3131296, rs9272219, or rs3130297 were found to be replicable in our study population. rs3815087 lies in the 5′UTR region of the psoriasis susceptibility 1 candidate 1 (PSORS1C1) gene, which further suggests that inflammatory processes might be an important common pathogenic pathway leading to both schizophrenia and psoriasis. The study hints at ethnic specific gene–environment interaction in determining the critical threshold for disease initiation and progression.

COVID-19-induced alopecia: a clinical case of diffuse focal alopecia in a patient with generalized pustular psoriasis after a new coronavirus infection

The clinical picture of dermatological diseases in synergy with the pandemic of coronavirus infection demonstrates various, additional, more striking features of the course of dermatoses. The proposed case of observation illustrates the development of diffuse alopecia in a patient with torpid generalized pustular psoriasis, metabolic syndrome, endocrinopathy against the background of a coronavirus infection complicated by polysegmental pneumonia.
 In the presented clinical observation, the severity of the lesion of the skin and skin appendages correlated with the severity of the course of COVID-19, which was the trigger point of the general pathological process ― immune-mediated T-cell inflammation. In the manifestation of psoriasis and its exacerbation, a significant role was played by viral load and a pronounced comorbid background ― autoimmune thyroid disease and metabolic syndrome. Thus, the severe course of COVID-19 with involvement in the pathological process of the microcirculatory bed, coagulopathy, hypoxia of hair follicles as a result, as well as the reduced estrogenic background of the sixty-one-year-old patient contributed not only to the exacerbation of psoriasis, but also led to diffuse hair loss. The degree of hair loss according to SALT criteria was 82%, which corresponded to a severe degree of lesion. The use of prolonged-acting injectable corticosteroids in the complex treatment of various forms of alopecia was an effective method of therapy in this patient, which is associated with the immunosuppressive effect of corticosteroids in autoimmune damage to hair follicles, a decrease in inflammation of the microvascular bed in various infectious and inflammatory conditions. In the presented case, the high efficiency may also have been associated with the mechanisms of reducing the damaging effect of cytokine inflammatory factors, expressed both with the existing background disease psoriasis and with coronavirus complicated infection.
 As numerous observations show, COVID-19 is a potential trigger for many dermatological conditions. Examination and treatment of patients with skin pathology infected with COVID-19 requires a systematic integrated approach.

XENOPERICARD COMBINED WITH NPWT (NEGATIVE PRESSURE WOUND THERAPY) IN THE TREATMENT OF ADVANCED PLEURAL EMPYEMA WITH BRONCHOPLEURAL FISTULA (CLINICAL FOLLOW-UP)

The development of bronchopleural fistula (BPS) against the background of advanced pleural empyema, as a result of severe pneumonia, is a formidable complication. The most significant obstacle in the surgical treatment of this group of patients is: a pronounced comorbid background, low functional indicators of patients, high requirements for surgical technique when performing reconstructive plastic interventions in BPS. Multiple surgical methods for treating bronchopleural fistulas are suggested. The first of these were to suture the defect. However, access through the infected pleural cavity leads to suture eruption and recurrence of the fistula, despite the fact that some authors have proposed combining these operations with various variants of myoplasty, thoracoplasty, removal of the fibrous capsule of empyema. Unsatisfactory functional and cosmetic outcomes during these surgical interventions led to the development of endoscopic, minimally invasive surgical interventions. Modern technologies allow temporary endoscopic bronchiococclusion, which stops the release of air from the defect. However, at the same time, she "turns off " part of the lung tissue from the gas exchange. Prolonged bronchial occlusion leads to the development of pneumonia with an outcome in the destruction of lung tissue. Our team of authors treatment of bronchopleural fistula with xenopericardium in combination with negative pressure therapy. This area seems to us very promising, and in this work we would like to share our first experience.

IL6-inhibitors in treatment of SARS COVID19

The aim of this study was to evaluate the clinical efficacy and safety of a two-dose approach in the administration of tocilizumab in patients with SARS COVID19
 Material and methods. The study was carried out on the basis of the Odrex Medical House in 2000-2021. The total sample included 4,112 patients hospitalized in a specialized department with coronavirus pneumonia. Of this sample, 150 patients were prescribed tocilizumab at a dose of 8 mg/kg of patient weight, including 36 (24.0 %) cases when tocilizumab was administered in a two-dose regimen. In the case of a two-dose regimen, the second dose was administered no earlier than 24 hours after the first one.
 All patients were examined according to the current clinical protocols. The hemogram, the content of CRP, ferritin, interleukin-6 were assessed. All patients received dexamethasone intramuscularly at a dose of at least 6 mg per day.
 Statistical processing was carried out by methods of analysis of variance using the software Statistica 13.0.
 Results. After the use of tocilizumab, the patients had a decrease in body temperature and a decrease in the need for oxygen support. At the same time, the normalization of indicators of the activity of the systemic inflammatory response was observed.
 Mortality after the use of tocilizumab was 29.3 %; in all cases, the deaths had an extremely severe course of coronavirus infection and a significant comorbid background. There were no manifestations of anaphylaxis and cases of secondary infection after the appointment of tocilizumab.
 Conclusions. The use of tocilizumab could significantly improve the condition of patients with SARS COVID19. There were no signs of anaphylaxis and cases of secondary infection after the administration of tocilizumab. In the absence of a pronounced clinical effect within 24 hours after the first dose of tocilizumab in patients with severe SARS COVID19, it is advisable to re-administer the drug (two-dose regimen)