Complicated Course Research Articles

Early Changes in Clinical and Laboratory Parameters in Patients Died of COVID-19

261,435,768 COVID-19 infections were detected worldwide, of them 5,207,634 deaths were registered. Identifying markers of the patient severity early in the course of the disease can facilitate the assessment of the risk of adverse outcome.The objective: To compare values of laboratory parameters and their changes during treatment of patients with a complicated course of COVID-19 infection.Subjects and Methods. 56 patients were included in the study, all of them were hospitalized to COVID Hospital of the Clinic of Bashkir State Medical University, Russian Ministry of Health, from September 30, 2021 to November 15, 2021, and their complicated course of the disease necessitated transfer to the intensive care unit (ICU). The laboratory evaluation included the following: a general blood and urine counts, blood chemistry including urea and creatinine, liver transaminases, and blood coagulogram (prothrombin time (PTT), prothrombin index (PTI), thrombin time, fibrinogen, and blood clotting time).Results. In the group of patients with a fatal outcome on the day of transfer to ICU, lymphocytopenia, eosinopenia, elevated values of creatinine, total bilirubin, transaminases, C-reactive protein, D-dimer, and ferritin were noted. Also on this day, microscopic hematuria, proteinuria and cylindruria were detected in the urine tests of most patients in this group during treatment.Conclusion. Critical deviations in the results of hematological and biochemical tests were revealed. Particular attention should be paid to such parameters as the level of erythrocytes, lymphocytes, eosinophils, glucose, urea, creatinine, total bilirubin, aspartate aminotransferase, alanine aminotransferase, creatine kinase, C-reactive protein, D-dimer, and ferritin.

Subtotal Fenestrating Cholecystectomy: A Safe and Effective Approach to the Difficult Gallbladder

IntroductionSubtotal laparoscopic cholecystectomy (SUB) is an alternative to total laparoscopic cholecystectomy (TOT) when the critical view of safety (CVS) cannot be achieved. Little is known about the clinical factors and postoperative outcomes associated with SUB. The objective was to determine predictive factors and outcomes of SUB as compared to TOT. MethodsClinical data from patients admitted from our emergency department to the acute care surgery service who underwent SUB or TOT by an acute care surgery surgeon for acute biliary disease (2017-2019) were reviewed. Wilcoxon rank-sum and Fisher's exact tests were used. Results355 patients underwent cholecystectomy for acute cholecystitis; 28 were SUB (7.9%). SUB patients were more likely to be older (57 versus 43 y; P = 0.015), male (60.7% versus 39.3%; P < 0.001), have a history of cirrhosis or liver disease (14.3% versus 2.1%; P = 0.007), and have a higher Charlson-Comorbidity Index (1 versus 0, P = 0.041). SUB had greater leukocytosis (14.6 versus 10.9; P < 0.001), higher total bilirubin (0.9 versus 0.6; P = 0.021), and a higher Tokyo grade (2 versus 1; P < 0.001), and had operative findings including gallbladder decompression (82.1% versus 23.2%; P < 0.001) and inability to achieve the CVS (78.6% versus 3.4%; P < 0.001). SUB patients had an increased length of stay (4 versus 2 d; P < 0.001) and more 1-y readmissions. No major vascular injuries occurred in either group with one biliary injury in the TOT group. ConclusionsSUB patients present with more significant markers of biliary disease and have more complicated intraoperative and postoperative courses. However, the lack of biliary or vascular injuries suggests that SUB may represent a safe alternative when the CVS cannot be achieved.

ANALYSIS OF POSTOPERATIVE COMPLICATIONS IN THE TREATMENT OF PATIENTS WITH LUNG CANCER

Summary. The aim of the study. Based on the analysis of the nature and course of postoperative complications in the treatment of patients with lung cancer, to improve the results of surgical treatment of this category of patients.&#x0D; Materials and methods. The results of the analysis of postoperative complications of 363 patients with lung cancer who were treated in the oncological department of the thoracic cavity of the clinic of the Communal Non-Commercial Enterprise «Regional Center of Oncology» in Kharkiv for the period from 2017 to 2021 are presented. There were 234 men (64.6 %) , women - 128 (35.4 %), the age of patients ranged from 43 to 84 years, the average age was (59.8±2.4 years). All patients underwent radical surgery for primary lung cancer. Lobectomies were performed most often. In this volume, 296 patients were operated on, which was 81.5 %. Pneumonectomy was performed on 51 patients, which was 14.1 %. Anatomical segmentectomy was performed in 16 patients (4.4 %). Postoperative complications and factors causing them were analyzed.&#x0D; Research results and their discussion. The main complications typical for the postoperative period of lung cancer patients are highlighted. Complications in the postoperative period occurred in 10.5 % of patients. Complications related to failure of bronchus stump sutures and tracheobronchial tree anastomoses occurred in 8 patients (2.2 %). In two patients, this led to the development of pleural empyema and death.Thanks to early diagnosis, 4 patients underwent rethoracotomy, bronchus stump suturing, resection or final pneumonectomy.&#x0D; Cardiovascular complications (acute myocardial infarction, acute cardiovascular failure, stroke, pulmonary embolism) were found in 5 patients (1.4 %). 3 patients died of stroke, acute myocardial infarction and acute cardiovascular failure. Two patients survived, and one of them was diagnosed with Pulmonary embolism (PE), COVID-19 and bilateral pneumonia.&#x0D; Postoperative mortality was 2.5 % (9 patients died). Two patients (0.6 %) died from failure of the bronchus stump sutures, which led to empyema of the pleura. Two patients (0.6 %) died from the consequences of intrapleural bleeding. Another 2 (0.6 %) patients died of acute myocardial infarction. One patient each (0.3 %) died of stroke, postoperative pneumonia, and pericux abscess, which led to empyema of the pleura.&#x0D; Conclusions. The surgical method of treating patients with lung cancer remains the main one despite the number of postoperative complications, the majority of which are «non-surgical». Analysis of the nature and course of postoperative complications in the treatment of patients with lung cancer, and the improvement of the method of determining functional operability, made it possible to reduce the frequency of complications and form a concept for improving the results of surgical treatment of this category of patients.

Differential diagnosis of the complicated course of COVID-19 pneumonias and infectious lung destruction

BACKGROUND. At present radiological criteria for diagnosis of viral pneumonia associated with SARS-CoV-2 have been defined. However, with the further course of the pandemic, physicians began to observe more and more often destructive processes developing in the lungs of patients with non-hospital pneumonia of viral etiology (COVID-19). Due to the development of surgical complications (pneumothorax, pneumomediastinum, vanishing lung syndrome) the question of their differential diagnostics with purulent-destructive lung diseases became actual.&#x0D; OBJECTIVE. To show the possibilities of differential diagnostics of infectious lung destruction (ILD) with cyst-like changes in the lungs at COVID-19 using clinical examples and data of computed tomography (CT) scan of the chest and pathomorphological study.&#x0D; MATERIALS AND METHODS. CT of the patients with ILD (lung abscess) and 90 patients with non-hospital pneumonia of viral etiology (COVID-19), who were treated in the National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of the NAMS of Ukraine were analyzed.&#x0D; RESULTS AND DISCUSSION. There were analyzed 90 CT scans of the whole body of patients with non-hospital pneumonia of viral etiology (COVID-19); among them 27 cases (15 male and 12 female, aged from 23 to 78 years) with radiological signs of vanishing lung syndrome were revealed, which made 30 % of all patients with a complicated course of the disease. Chest CT findings and pathomorphologic findings in cyst-like changes in patients with COVID-19 were compared with those in patients treated for lung abscess.&#x0D; CONCLUSIONS. Clinical picture, pathogenesis and pathomorphological changes of pulmonary parenchyma at ILD differ greatly from non-hospital pneumonia of viral etiology (COVID-19) and form specific changes, which are revealed by chest CT. Necessary development of indications for surgical treatment in vanishing lung syndrome which occurs in patients with complicated course of COVID-19.

The effect of L-arginine and L-carnitine preparations on the dynamics of indicators of endogenous intoxication and systemic capillary leakage in patients with a complicated course of diabetes

ABSTRACT. In order to study the effect of drugs containing L-arginine and L-carnitine on the indicators of endogenous intoxication and systemic capillary leakage in patients with complicated diabetes mellitus, 30 patients with diabetic ketoacidosis, representative by age, sex, comorbidity were examined. Among the patients were 13 men and 17 women, with a mean age of 52.36±2.87 years. It is shown that the use of the drug Tivorel in the treatment of such patients reduces the severity of systemic capillary leakage syndrome and manifestations of endogenous intoxication.

Stroke, Seizures, Hallucinations and Postoperative Delirium as Neurological Complications after Cardiac Surgery and Percutaneous Valve Replacement.

(1) Background: Neurological complications such as acute ischemic stroke or postoperative delirium are frequent after cardiac surgery or percutaneous valve replacement. This study aimed to identify corresponding risk factors. (2) Methods: 297 patients with percutaneous valve replacement or cardiac surgery were postoperatively screened for neurological complications such as delirium, stroke, seizures and hallucinations twice daily for three days. Pre- and perioperative risk factors were evaluated in a multivariate model. (3) Results: Neurological complications occurred in 43.8% (n = 130) as composed of delirium (43.43%, n = 129), stroke (2.7%, n = 8), seizures (1.35%, n = 4) and real hallucinations (3.36%, n = 10). Multiple logistic regression revealed an association of neurological complications with lower Montreal Cognitive Assessment scores (Exp(B) 2.042; 95% CI, 1.183-3.525, p = 0.010), older age (Exp(B) 1.071; 95% CI, 1.036-1.107, p &lt; 0.001), red blood cell transfusions until postoperative day 3 (Exp(B) 1.157; 95% CI, 1.030-1.300, p = 0.014), history of heart failure (Exp(B) 1.985; 95% CI, 1.130-3.487, p = 0.017) and increased CRP levels (Exp(B) 1.004; 95% CI, 1.000-1.008, p = 0.037). (4) Conclusions: Postoperative delirium remains a frequent complication after cardiac surgery, while stroke and seizures occur rarely. A preoperative risk profile including older age, history of heart failure and cognitive impairment was identified for a complicated postoperative course. However, the impact of an intense inflammatory response must not be neglected.

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.

The level of microRNA expression in cardiac surgery patients depends on postoperative multiorgan failure

Aim: To assess the level of microRNA expression in the serum of patients who had undergone cardiac surgery depending on the postoperative complications (presence or absence of multiorgan failure, MOF).&#x0D; Materials and methods: The study group included 87 patients who had undergone heart surgery with cardiopulmonary bypass. The patients without postoperative complications comprised group 1 (n = 51), whereas those with postoperative MOF were in group 2 (n = 36). In all patients, blood samples were collected at two time points: before surgery and at 36 to 48 hours after surgery. The following miRNAs were chosen for the study: hsa-miR-486-5p (478128_miR), hsa-miR-191-5p (477952_miR), hsa-miR-192-5p (478262_miR), hsa-miR-146a-5p (478399_miR), hsa-miR-26a-5p (477995_miR), hsa-miR-30d-5p (478606_miR), hsa-miR-23a-3p (478532_miR), and hsa-miR-320a-5p (481049_miR). Polymerase chain reaction results were normalized to hsa-miR-16-5p (4427975).&#x0D; Results: Up-regulating miRNAs. Compared to baseline, there was a significant postoperative increase in miR-486-5p microRNA expression (group 1, 41.83 [19.86; 74.6] vs 940 [434.7; 1212.0]; group 2, 72.55 [21.37; 100.2] vs 492.4 [201.2; 998.0]; both p 0.001). An increase in the of microRNA miR-192-5p expression in the postoperative period was found both in the no-MOF group (from 0.39 [0.16; 1.07] at baseline to 5.96 [3.74; 10.35] after surgery, p = 0.002), and in the MOF group (from 1.74 [0.45; 3.35] at baseline to 17.16 [4.70; 24.96] after surgery, p = 0.003), with a statistically higher level of expression in group 2 (p = 0.028). Similar changes over time were observed for miR-30d-5p expression: group 1, 1.61 [0.47; 4.36] at baseline vs 5.03 [2.93; 6.56] after surgery (p = 0.002), group 2, 0.89 [0.32; 4.27] at baseline and 6.63 [3.92; 12.82] after surgery, respectively (p = 0.0045).&#x0D; Down-regulating miRNAs. The miR-191-5 and miR-146a-5p families demonstrated a significant increase in group 1 after surgery (3.85 [1.64; 5.6] vs 7.7 [5.48; 9.68], p = 0.021; and 18.1 [6.52; 19.9] vs 37.27 [29.13; 47.07], p = 0.016, respectively) and a significant postoperative decrease in group 2 (3.67 [2.60; 7.61] vs 1.66 [0.52; 2.36], p = 0.023; and 14.75 [12.79; 21.77] vs 5.96 [2.8; 8.2], p = 0.034, respectively), with between-group difference in the postoperative expression levels being also significant. As regards to miR-26a-5p и miR-23a-3p families, there was a similar trend: the group with uncomplicated postoperative course was had virtually no changes over time in their expression (the increase was non-significant), whereas the MOF group had lower postoperative values for this microRNA family. The between-group differences after surgery were significant for miR-26a-5p (group 1, 6.79 [3.38; 8.46], group 2, 0.26 [0.18; 1.9], p = 0.037) and for miR-23a-3p (14.14 [11.92; 26.63] and 2.0 [1.02; 4.18], respectively, p 0.001).&#x0D; Conclusion: When comparing microRNA expression before surgery, we did not find any significant differences between the patients groups without and with MOF. Assessment of microRNA expression in the no-MOF group after surgery showed an increase in the expression of microRNAs responsible both for up regulation (miR-486-5p, miR-192-5p, miR-30d-5p) and for down regulation (miR-191-5p, miR-146a-5p). In the group with a complicated postoperative course and with MOF, changes over time in the up-regulating microRNAs were characterized by increased expression (miR-486-5p, miR-192-5p, miR-30d-5p), whereas the down-regulating microRNAs (miR-191-5p, miR-146a-5p) demonstrated significantly decreased expression, which was different both that in the no-MOF group and from the baseline values.

IMPROVEMENT OF CYSTOSTOMY TECHNIQUE FOR SMALL PETS

The present study was carried out to evaluate an innovative veterinary catheter for cystostomy that we have developed for small pets, while the technique is for the management of clinical cases of obstructive urolithiais, this operation including the new catheter is devoted to emergency and usual cases in order to minimize most frequent complications engender by other catheters and other procedures that are the most widely used in veterinary practice with urinary obstruction. Fifteen cats aged between 1 and 18 years formed the material of the study. Undoubtedly all animals were diagnosed with a complicated course of urolithiasis with complete urinary tract obstruction. Diagnosis of the disease was made based on anamnesis data besides to physical and ultrasonographic examinations, and equally important, urine and blood tests were also done. The confirmed cases of obstructive urolithiasis were handled via surgery, where the proposed catheter for cystostomy was used rather than other types of catheters which are the most commonly utilised in these cases. The surgical techniques was assessed on the basis of clinical parameters, blood and urine analysis, postoperative complications, furthermore and above all, the success level. After the operations the method has successfully removed the symptoms of urinary tract obstruction, haematobiochemical alterations returned to normalcy and the survival rate was complete.

Assessing Resuscitation Needs in Burn Patients with Varying Degrees of Liver Disease

INTRODUCTION: Liver disease patients present a complicated course for concomitant thermal injury. Although patient pathophysiology is complex, there is minimal literature and lack of consensus among burn practitioners on how to resuscitate thermally injured patients with liver disease. We seek to analyze the urine output (UO) in burn patients with varying levels of liver disease, as a preliminary assessment to determine if these patients demand more aggressive/alternative resuscitation strategies. METHODS: Using the electronic health record, we retrospectively obtained 346 patients from the University Medical Center hospital who had a total body surface area of burn 20% or greater, were older than 18 years, and were admitted since January 2010. We then calculated patient MELD scores, stratified them by MELD groups, and calculated UO within the first 24 hours of the burn. RESULTS: MELD groups were categorized as follows: Group 1 (MELD 6 to 7, n = 113), Group 2 (MELD 8 to 11, n = 167), Group 3 (MELD 12 to 15, n = 32), Group 4 (MELD 16 to 20, n = 23), Group 5 (MELD 21 to 25, n = 10), and Group 6 (MELD greater than 25, n = 1; Figure). The UO (mL) for these groups was 2,331.4, 1,999, 2,137, 1,205, 879, and 624, respectively (p < 0.001, 1-way ANOVA).FigureCONCLUSION: In these burn patients, first 24 hour UO decreased as severity of liver disease increased. Although resuscitation amounts are standardized for all patients, lack of UO with increased liver disease suggests a new strategy is required. We believe this study provides insight into resuscitation of liver disease patients, not only in burns but also in other pathologies including trauma, sepsis, and various forms of shock.

Changes in the Metabolism of Nitric Oxide, Hydrogen Sulfide of the Oral Fluid Taking into Account Age and Dental Status

The relevance of the study is conditioned by the prevalence of dental pathology, its complicated course in senior age and the search for the age-associated metabolic markers of oral fluid.&#x0D; Objective. The aim of the study is: to determine the age peculiarities of the content of nitric oxide and hydrogen sulfide metabolism in the oral fluid of patients, taking into account their dental status.&#x0D; Materials and Methods. Indicators of nitric oxide metabolism, L-arginine/arginase, hydrogen sulfide content in oral fluid, dental status of different aged people under conditions of intact dentitions, their defects and against the background of correction with different types of dentures, were studied.&#x0D; Results. It was determined that with age, changes in oral fluid are characterized by an increase in nitrite ion, the amount of nitrites and nitrates, increasing the formation of peroxynitrite against the background of lower levels of L-arginine and hydrogen sulfide, inhibition of arginase activity. The results obtained are confirmed by the presence of close correlations between the concentrations of hydrogen sulfide and peroxynitrite (reverse, strong), caries intensity and: the total level of nitrites and nitrates (direct, strong), peroxynitrite content (direct, medium strength).&#x0D; Conclusion. The studied biomarkers of oral fluid depend more on age, hygienic condition of the oral cavity, intensity of dental caries and defects of dentitions than types of dentures. Therefore, age-related changes in the biochemical composition of oral fluid, metabolic, somatic, comorbid pathologies are likely to be a trigger for structural-functional disorders of the dental-maxillofacial system.

Early CRP Trends in Childhood Osteomyelitis Predict Complicated Disease.

Acute hematogenous osteomyelitis (AHO) remains a cause of severe illness among children. Contemporary research aims to identify predictors of acute and chronic complications. Trends in C-reactive protein (CRP) after treatment initiation may predict disease course. We have sought to identify factors associated with acute and chronic complications in the New Zealand population. A retrospective review of all patients younger than16 years with presumed AHO presenting to a tertiary referral centre between 2008 and 2018 was performed. Multivariate was analysis used to identify factors associated with an acute or chronic complication. An "acute" complication was defined as the need for 2 or more surgical procedures, a hospital stays longer than 14 days, or recurrence despite intravenous antibiotics. A "chronic" complication was defined as growth or limb length discrepancy, avascular necrosis, chronic osteomyelitis, pathologic fracture, frozen joint, or dislocation. One hundred fifty-one cases met the inclusion criteria. The median age was 8 years (69.5% male). Within this cohort, 53 (34%) experienced an acute complication and 18 (12%) a chronic complication. Regression analysis showed that contiguous disease, delayed presentation, and failure to reduce CRP by 50% at day 4/5 predicted an acutely complicated disease course. Chronic complication was predicted by the need for surgical management and failed CRP reduction by 50% at day 4/5. CRP trends over 96 hours after the commencement of treatment differentiate patients with AHO likely to experience severe disease. Level II, retrospective study.

Pathogen-specific molecular imaging and molecular testing methods in the prognosis of the complicated course of diabetic foot syndrome, the risk of amputation, and patient survival

The aim of this review was to provide extended information on current trends in the diagnosis of complicated diabetic foot syndrome (DFS), the most frequent and severe complication of diabetes mellitus, including hightech medical imaging methods and instrumental and laboratory predictors of the complicated course and risk of amputation in DFS.The article provides an analytical review of modern publications over the past 5 years on diagnosis and therapy. Pilot data on the use of high-tech medical imaging methods, assessment of skin microbiota and ulcers in DFS, molecular testing methods in terms of predicting the amputation risk and survival of patients with DFS, as well as the effectiveness of biosensing systems have been systematized, summarized, and subjected to analytical evaluation.The review provides an expert assessment of the capabilities of pathogen-specific molecular imaging using modern positron emission tomography (PET), single-photon emission computed tomography (SPECT), and highenergy radionuclides in bacterial infection to understand its pathogenesis, minimize diagnostic problems, improve antimicrobial treatment, and address fundamental and applied aspects of DFS. Literature data on the assessment of foot perfusion in diabetic patients with varying degrees of limb ischemia by hybrid technologies (SPECT / CT and PET / CT) and new modalities of magnetic resonance imaging (MRI) are also systematized, which contributes to new understanding of the response to revascularization, surgical shunting, and stimulation of angiogenesis within ischemic tissue, as well as potentially to healing of foot ulcers.The review is aimed at substantiating a multidisciplinary approach in DFS, selection, development, and implementation of innovative strategies for diagnostic modalities to identify diabetic foot pathologies, and choice of an adequate method for treating and monitoring the results of therapy in the context of personalized medicine.

Genetic pattern of the COVID-19 course and reinfection

A new coronavirus infection (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) broke out at the end of 2019 in Wuhan (China). The disease has become a global pandemic and claimed more than 6 million lives after spreading rapidly around the world. Issues related to the complicated course of COVID-19 mechanisms continue to be the subject of active study. It is known that morbidity and mortality increase dramatically with increasing age and concomitant diseases, including obesity, diabetes, cancer, and cardiovascular diseases. Although most infected people recover, even young and otherwise healthy patients can get sick with this disease. In this regard, an urgent task is to search for specific genetic factors that can explain the predisposition of people to infection and the development of a severe COVID-19 form. Human genetic determinants can provide the scientific basis for disease prediction and the development of personalized therapies to counteract the epidemic. In addition, cases of repeated infection with SARS-CoV-2 are increasingly being registered, which occurs 16 months after initial infection on average and depends on the virus genome structure. Studies conducted on sequencing viral genomes have shown that some patients were re-infected with the same strain of coronavirus, while others were different. This, in turn, causes researchers concerns about the effectiveness of immunity after infection and vaccine reliability. The genetic characteristics of a person and a virus commonly determine the tendency for reinfection. It is difficult to determine the true COVID-19 reinfection prevalence, which is explained by the low detectability of asymptomatic reinfection and the fact that many patients with a mild course of the disease were not tested at an early stage of the pandemic. Therefore, the true prevalence of reinfection with COVID-19 does not reflect the current reality. There are many more cases of reinfection than are described in the literature. In this regard, the true contribution of a virus genetic features to reinfection of COVID-19 can be determined only after population studies, and when developing immunization programs against a COVID-19, it is necessary to take into account the prevalence of reinfection in the population.

High-Dose Methotrexate in Patients With Lymphoma: Predictors of a Complicated Course.

High-dose methotrexate (HDMTX; > 500 mg/m2) is an important component of lymphoma therapy. Serum MTX monitoring at 48 hours is the standard approach to identify those at increased risk of developing MTX toxicity. Our aim was to characterize the incidence of complications and their association with MTX levels. A retrospective review of our institutional electronic medical record was conducted to identify patients with lymphoma who received HDMTX between January 1, 2002, and December 31, 2018. We characterized the incidence of acute kidney injury (AKI), intensive care unit (ICU) admission, length of hospital stay (LOS), and 30-day mortality across 48-hour MTX levels. To establish an association between 48-hour MTX levels and the complications listed, we performed chi-square analysis for dichotomous variables and Kruskal-Wallis for nonparametric data. Receiver operator characteristic curve analysis was performed to identify the MTX level where AKI grade ≥ 2 was more likely. Multivariate logistic regression analysis was performed to identify risk factors for this MTX level. We identified 642 patients with 2,804 cycles of HDMTX. The incidence of AKI was 19.1% with AKI grade ≥ 2 making up 21% of cases. Rates of AKI, ICU admission, and 30-day mortality are associated with elevated 48-hour MTX levels. There was a significant increase in median LOS with elevated MTX levels (P < .001). Receiver operator characteristic curve analysis for AKI grade ≥ 2 demonstrated a 48-hour MTX level threshold of 1.28 μmol/L. Multivariate logistic regression analysis revealed age, male sex, elevated body surface area, higher MTX dose, monotherapy, and first cycle as independent factors. Elevated MTX levels are associated with a significant increased rate of AKI, ICU admission, prolonged LOS, and 30-day mortality. Elevated 48-hour MTX levels, particularly > 1.28 μmol/L, should alert clinicians for complications and to initiate measures to reduce MTX levels.

Schwere ambulant erworbene Pneumonie im Kindes- und Jugendalter

BackgroundApproximately 20% of children and adolescents with pediatric community-acquired pneumonia (pCAP) experience severe disease courses. These are characterized by hospitalization and/or occurrence of complications, such as pleural effusion, empyema and lung abscesses.ObjectiveThis article summarizes the data on clinical features, diagnostics and treatment of severe pCAP.Material and methodsThis article is based on national and international guidelines for the treatment of pCAP, especially the current guidelines of the Association of the Scientific Medical Societies in Germany (AWMF), as well as further literature from PubMed.ResultsPersistent fever (> 38.5 °C), hypoxemia, respiratory distress or lack of improvement in the child’s clinical condition after initiation of appropriate antibiotic therapy can be a reflection of a severe disease course. In cases of unequal bilateral breathing sounds, chest pain and weight loss, local complications must also be considered. In severe pCAP, the pathogens causing the disease should always be confirmed and comprehensive laboratory testing for infections can be helpful in the estimation of the severity and also assessment of the course. Important diagnostic methods include X‑ray imaging, sonography and multislice imaging procedures. The basis of treatment is usually antibiotic therapy, which is mostly chosen empirically according to the epidemiological conditions and resistance; however, in cases of a confirmed viral etiology, antibiotic treatment can be omitted. Interventional procedures, sometimes with the use of fibrinolytic treatment, are of importance in complicated courses of disease. Surgical treatment is only necessary in exceptional cases with failure of conservative treatment.PrognosisWith adequate treatment the prognosis of severe pCAP in children is good.

OC-090 Heterotopic Ossification in a Laparostomy Wound Complicating Reconstruction– a Case Report

Abstract Introduction Heterotopic Ossification (HO) is a benign process of osseous matrix deposition in extra-skeletal tissues; it is well recognised in the orthopaedic setting, especially after blast injury, but is a rare phenomenon following abdominal surgery and is likely under reported. The aetiology is unclear but may be due to differentiation of local mesenchymal cells into osteoblasts leading to calcification of the extracellular matrix, or damage to xiphoid or pubis causing liberation of bone-forming cells into the wound. Case Report A 46-year-old man, presented with perforated diverticulitis and underwent an emergency Hartmann's procedure with temporary abdominal closure. Sequential returns to theatre failed to achieve fascial closure and he was managed as a laparostomy. Two years later he underwent reversal of Hartmann's with complex abdominal wall reconstruction (CAWR) – the procedure was complicated by an unrecognised ring of HO around the edge of his laparostomy wound, which necessitated additional excision of fascia. Only partial fascial closure could be achieved leaving an 8×4cm bridge over polypropylene mesh. After a complicated post-operative course, he was discharged home with intestinal continuity and healed abdominal wounds. Discussion Pre-operative review of the 2-D axial CT images failed to identify the almost complete ring of HO clearly evident on 3-D reconstructions which impacted on the outcome of the CAWR; 3-D reconstructions should be routinely reviewed. It is commoner in males, those with prolonged ICU intubation, hollow viscus injury and non-closure of the fascia. Restoration of intestinal continuity can be safely performed with complex abdominal wall reconstruction.

Psychoemotional state and quality of life of nulliparous women with recurrent squamous epithelial exocervical dysplasia of the cervical epithelium in the perimenopausal period

The objective: to study the features of the psychoemotional state and quality of life of nulliparous women with recurrent squamous epithelial exocervical dysplasia of the cervical epithelium in the perimenopausal period.Materials and methods. 60 nulliparous women with recurrent cervical epithelial flat dysplasia that occurred after treatment with surgical methods in the perimenopausal period (the main group) and 38 women without gynecological and somatic pathologies in the perimenopausal period (control group) were examined. All patients were examined in accordance with the regulatory orders of the Ministry of Health of Ukraine. The assessment of neurovegetative and psychoemotional manifestations was carried out according to the Kupperman index, indicators of the quality of life and the Lusher color test.Results. The data of the medical history and clinical examination of patients were evaluated. This makes possible to identify a risk group among nulliparous women in the perimenopausal period for the development of recurrent squamous epithelial exocervical dysplasia of the cervical epithelium.In the main group, an increase in the Kupperman menopausal index by almost 1.5 times was found, as well as a significant decrease in indicators of psychosocial adaptation according to Lusher test to 40% and quality of life (physical component of health was 72.5±6.4 and 93,1±4,7 points in the main and control groups, respectively, mental component – 54.2±4.1 and 91,4±2,3 points, respectively).Conclusions. In infertile women with the menopausal changes, the recurrent squamous epithelial exocervical dysplasia of the cervical epithelium is a form of complicated course of dysplasia, and has a multifactorial genesis, in which conditions arise for the implementation of the neoplastic process. The clinical manifestations of the complicated course of the perimenopausal period significantly worsen the quality of life and general health in nulliparous women, especially on the background of recurrent squamous epithelial exocervical dysplasia of the cervical epithelium after surgical treatment, which is evidenced by more pronounced climacteric manifestations, reduction of physical and social activities, and emotional status.

Role of innate errors of immunity in the group of children with fatal outcomes during the first year of life

In the modern world, inborn errors of immunity (IEIs), or primary immunodeficiencies (PIDs), are among of the main causes of childhood disability and mortality, determining the demographic state of mankind not only at present, but also in the future. In the Sverdlovsk Region over the past 5 years, there were about 30% of children who died from severe combined primary immunodeficiency. This retrospective study is devoted to the study of the nosological profile of mortality in the children with immune-dependent disorders in the Sverdlovsk Region, as well as to assess information significance of extrachromosomal circular DNA molecules (TREC and KREC) analysis. Some anamnestic data on the course of prenatal period in the current and previous pregnancies were considered the signs of suggested diagnosis of primary immunodeficiencies, i.e., threats of pregnancy loss at the early terms, documented cases of early childhood death, persistent viral and bacterial infections in the mother, complicated course of pregnancy in the mother, as well as some clinical manifestations, including fungal-bacterial sepsis, generalized viral infection, repair disorders, reduced physiological tolerance accompanied by autoimmune organ damage and uncontrolled systemic inflammation. The study demonstrated a wide range of nosological entities of innate errors of immunity in the structure of early childhood mortality, including both classical forms of primary immunodeficiencies and the disorders not directly related to innate errors of immunity, but those showing phenotypically pronounced immunodeficiency and their immediate role in statistical deviations. Among the main criteria that may presume possible presence of an immune-dependent pathology in the early neonatal period we considered the molecular markers of naive T and B cells (TREC and KREC, respectively) revealed in 70% of the cases studied, with, at least, one of these indexes found to be reduced. It is important to understand that primary immunodeficiencies are not as rare as previously thought. Therefore, it is necessary to carry out timely and high-quality diagnostics, in order to avoid unavoidable deaths.

Features of diagnosis and course of acute appendicitis during the COVID-19 pandemic

This article provides a brief description of acute appendicitis, methods of its diagnosis, discusses typical clinical cases, examples of tactics for managing patients with acute appendicitis. The sequence of management of a patient with acute appendicitis, steps to a speedy recovery of the patient, including surgical interventions, his discharge with positive dynamics are summarized. Special attention is paid to the course and further development of complications of acute appendicitis during the COVID-19 pandemic. The need for timely treatment of the population for medical care is emphasized in order to avoid the development of complications (in particular, from acute conditions), for a qualitatively better prognosis and a speedy recovery in the postoperative period. Aim of the research : to identify possible complications and course of appendicitis in a pandemic coronavirus infection. Objectives : to study and analyze clinical cases in patients with appendicitis during a pandemic coronavirus infection. Materials and methods : clinical cases, case histories, educational literature. Conclusions : the course of acute appendicitis was accompanied by various complications that developed due to untimely medical care, due to the huge burden on the sphere of health protection of the Russian Federation. There was a tendency for the transition of acute appendicitis to peritonitis, abscess of the stump of the appendix, pilefl ebitis, due to coronavirus infection. Pathological activity of the immune system was also revealed in patients with appendicitis (lymphatic infi ltration of appendix tissues).