Concomitant Chronic Diseases Research Articles

ПЭТ/КТ всего тела человека с 18F-ФДГ-глюкозой в клинической оценке жизнеспособности паренхимы почек

AIM to perform a comparative analysis of the results of morphofunctional and morphoanatomical studies for the clinical assessment of the viability of the renal parenchyma. MATERIALS AND METHODS Based on a random sampling method, the results of whole-body PET/CT scan with 18F-FDG glucose in 134 patients with various non-urological disorders were analyzed. However, 13.3% of the participants had concomitant chronic kidney diseases without exacerbation. At the same time, the morphological and anatomical manifestations of chronic kidney disease were studied in 32 patients of the same age and sex in order to evaluate the severity of structural changes in nephron. RESULTS It was found that among individuals undergone to whole-body PET/CT scan with 18F-FDG glucose for various diseases without a urological history and patients with chronic kidney disease, the parenchyma tropism to energy-intensive labeled glucose molecules had certain differences that correlated with morphoanatomical manifestations of structural changes in the nephron in chronic kidney disease. CONCLUSIONS The modern morphofunctional PET/CT study of the whole-body viability with 18F-FDG glucose, including the kidneys, is an advanced diagnostic tool that may supplement the results of morphoanatomical studies and monitor the efficiency of treatment.

Study of the vessels of the upper extremities and the rhythm of heart activity in patients with vibration disease in the post-СOVID period

Currently, there are many consequences of the new coronavirus infection. We shall study the actual long-term consequences of this disease for population health in the coming years. It is necessary to consider concomitant chronic diseases in patients who are particularly dangerous in the post-COVID period. Vibration disease is one of the leading occupational pathologies in the Russian Federation. Symptoms of vibration disease are vegetative-vascular disorders, cold, cyanosis, paresthesia, violation of regional blood circulation of the extremities. As is known from numerous sources, the defeat of the cardiovascular system (CVS) against the background of COVID-19 infection occurs through angiotensin-converting enzyme (ACE-2) receptors, which presents in large numbers in the endothelium of veins and arteries. The study aims to research hemodynamics features in patients with vibration disease after a new coronavirus infection. In the clinic of occupational pathology, the researchers examined 28 patients with a previously established diagnosis of VD after a coronavirus infection. We did a Holter ECG, ultra-sound examination of the arteries and veins of the upper extremities. Arrhythmias in the form of supraventricular extrasystoles, paroxysms of atrial fibrillation, positional sinus tachycardia occur in patients with VB after a new coronavirus infection on an ECG and daily monitoring of the ECG by Holter. As is known, cardiac arrhythmias are essential in the development of acute and chronic vascular pathology, characterized by a decrease in arterial blood filling and changes. Ultrasound of the vessels of the upper extremities revealed moderate expansion of the radial and ulnar veins, insufficiency of the valve apparatus during functional tests, increased venous outflow. There was also an increase in the indicators of peripheral vascular resistance, which indicates violations of the tonic properties of the vessels of the upper extremities and violations of vasodilation. Scientists identified violations of the tonic properties of blood vessels in patients with vibration disease in the post-COVID period on ultrasound, arrhythmias in the form of supraventricular extrasys-toles, paroxysms of atrial fibrillation, positional sinus tachycardia on daily ECG monitoring.

Hospitalization of Patients With (But Not for) Heart Failure: An Opportunity for Accelerated Guideline-Directed Medical Therapy Optimization?

For every primary hospitalization for heart failure (HF) in the United States, there are approximately 3.5 hospitalizations where HF is listed as a secondary diagnosis. 1 Jackson Sandra L. Xin Tong King Raymond J. Fleetwood Loustalot Yuling Hong Ritchey Matthew D National burden of heart failure events in the United States, 2006 to 2014. Circulation Heart Fail. 2018; 11e004873 PubMed Google Scholar Large-scale registries, such as the Get With The Guidelines-Heart Failure program (ClinicalTrials.gov Identifier: NCT02693509), include patients with HF admitted for either primary (acutely decompensated HF) or secondary (admitted for other reasons) diagnoses. Although guidelines acknowledge the importance of tailored management of patients hospitalized with decompensated HF, limited guidance is provided for the much greater number of hospitalizations where HF is a secondary diagnosis. This framework may originate from the notion that hospitalization is currently structured to address primary admission indications, reimbursement and quality metrics are linked to primary diagnoses, and limited resources are devoted to treatment of concomitant chronic diseases during hospital admission. Given the frequency of secondary HF hospitalizations, we explore a paradigm where hospitalization goals are restructured in the IMPLEMENT-HF study: treating presenting conditions while also optimizing background therapies for chronic HF via dedicated, multidisciplinary HF care teams (Fig. 1). Such an approach may improve outcomes and challenge the notion of sharply defined “acute” and “chronic” states in patients with HF.

Chronic obstructive pulmonary disease and concurrent cardiovascular conditions: safety of tiotropium/olodaterol combination

One of the important features of the chronic obstructive pulmonary disease is the presence of concomitant chronic diseases in most of patients. And cardiovascular conditions occupy a special place among these comorbidities. The most common diseases associated with COPD are hypertension, coronary heart disease, and heart failure. They aggravate the clinical manifestations of the disease and have negative effect on the prognosis. In addition, concomitant cardiovascular conditions determine the need for a thorough safety assessment of the ongoing pharmacotherapy for COPD. Core of the treatment is bronchodilators. The priority pharmacological strategy is the use of fixed-dose combinations of long-acting β2 -agonists and long-acting anticholinergic medications.The purpose of this review was to evaluate the safety profile of tiotropium/olodaterol in COPD.Methods. This article presents the data obtained from studies of the safety of the use of tiotropium/olodaterol in patients with COPD and concomitant cardiovascular conditions.Results. The studies showed no increase in the risk of cardiovascular events when using this combination in patients of this category.Conclusion. А good safety profile of tiotropium/olodaterol was confirmed in patients with COPD and concomitant cardiovascular conditions.

Monitored Home-based Exercise Rehabilitation for Patient with Chronic Respiratory and Cardiovascular Diseases During Covid-19 Pandemic: A Case Report ABSTRACT

ABSTRACTIntroduction: In patients with Chronic Obstructive Pulmonary Disease (COPD), due to shared-risk factors, concomitant chronic cardiovascular diseases include Congestive Heart Failure (CHF) are common and resulting in increase overall morbidity and mortality.Case Report: A female patient, 52 years, came for pulmonary rehabilitation 2 weeks after hospitalization due to acute exacerbation of COPD. One week before the exacerbation, she showed symptoms of CHF. Physical examination showed signs of right and left heart failure, oxygen desaturation, and limited chest expansion. Functional assessment showed disability in self-care, instrumental activities of daily living (ADL), deconditioning, depression, and anxiety. Supporting examination confirmed very severe restriction and obstruction, bronchopneumonia, cardiomegaly, and pulmonary hypertension. Rehabilitation problems include cardiorespiratory, ADL, and psychological problems. The Covid-19 pandemic causing prohibition of supervised cardiorespiratory rehabilitation. Home-based exercise program was given for 5 months. Monitoring was done via video call before and after each exercise and through analysis of exercise diary. Psychological counseling also given at the beginning of the program. Patient did all of prescribed exercises. At the end, symptoms decreased, patient can do ADL and hobbies, no exacerbation or exercise intolerance, patient does not look anxious and consents to leisure activities.Conclusion: Monitored-home based exercise programs can be used as safely alternative to hospitalbased, if done according to the prescription. However , monitoring by physician is mandatory.Keywords: chronic obstructive pulmonary disease, congestive heart failure, covid-19 pandemic, homebased exercise, rehabilitation

Monitored Home-based Exercise Rehabilitation for Patient with Chronic Respiratory and Cardiovascular Diseases During Covid-19 Pandemic: A Case Report

ABSTRACTIntroduction: In patients with Chronic Obstructive Pulmonary Disease (COPD), due to shared-riskfactors, concomitant chronic cardiovascular diseases include Congestive Heart Failure (CHF) arecommon and resulting in increase overall morbidity and mortalit y.Case Report: A female patient, 52 years, came for pulmonary rehabilitation 2 weeks after hospitalizationdue to acute exacerbation of COPD. One week before the exacerbation, she showed symptoms of CHF.Physical examination showed signs of right and left heart failure, oxygen desaturation, and limitedchest expansion. Functional assessment showed disability in self-care, instrumental activities ofdaily living (ADL), deconditioning, depression, and anxiety. Supporting examination confirmed verysevere restriction and obstruction, bronchopneumonia, cardiomegaly, and pulmonary hypertension.Rehabilitation problems include cardiorespiratory, ADL, and psychological problems. The Covid-19pandemic causing prohibition of supervised cardiorespiratory rehabilitation. Home-based exerciseprogram was given for 5 months. Monitoring was done via video call before and after each exercise andthrough analysis of exercise diary. Psychological counseling also given at the beginning of the program.Patient did all of prescribed exercises. At the end, symptoms decreased, patient can do ADL and hobbies,no exacerbation or exercise intolerance, patient does not look anxious and consents to leisure activities.Conclusion: Monitored-home based exercise programs can be used as safely alternative to hospitalbased,if done according to the prescription. However , monitoring by physician is mandatory.Keywords: chronic obstructive pulmonary disease, congestive heart failure, covid-19 pandemic, homebasedexercise, rehabilitation

Study of the effect of Baricitinib on the Course of COVID-19

The aim of the study was to determine the effect of the inhibitor of janus kinase – baricitinib ("Olumiant") on the course of COVID-19. This drug baricitinib is able to suppress the systemic inflammatory response, which is one of the common causes of death in COVID-19, is an urgent problem of the study. The study was carried out in the Regional Specialized Budget Infectious Diseases Hospital of Stavropol (Russian Federation, Stavropol Region). In a multivariate analysis, it was shown that the use of baricitinib was associated with a decrease in the frequency of the primary endpoint of death/need for invasive lung ventilation. The use of baricitinib was quite safe, but in some patients there was an increase in the level of transaminases. No cases of hypercoagulation have been reported while taking baricitinib. It was found that patients with a normal BMI are more sensitive to therapy than those who are overweight.75% of patients in the first group had a temperature above 38.0oC. However, against the background of taking the standard treatment regimen and baricitinib, it was noted that the temperature stabilized during the day and did not rise again. Against the background of taking baricitinib, the elimination of the phenomena of respiratory failure and the refusal of an oxygen mask occurred 3.1 times more often than without baricitinib. The authors concluded that the use of baricitinib can be considered as an additional therapy for moderate forms of pneumonia in patients over 65 years or in patients with concomitant chronic diseases in order to suppress the reactions of systemic inflammation and the development of serious respiratory and other system lesions caused by COVID-19.

Особенности патогенеза и клинического течения нефролитиаза на фоне хронических заболеваний сердечно-сосудистой системы

Aim To study the pathogenetic and clinical features of nephrolithiasis in patients with concomitant chronic cardiovascular diseases (CVD), particularly the chemical composition of renal stones, the frequency of relapses, as well as the daily dynamics of the urine specific gravity and acidity level as the main factors of stone formation. Materials and methods A total of 270 patients were treated in the Department of the urology No. 1 of the Main Military Clinical Hospital named after N. N. Burdenko of the Ministry of Defense of the Russian Federation during the period from 2008 to 2018. The main group included 184 patients suffering from nephrolithiasis, of which 72 had hypertension in combination with coronary heart disease, and in other 112 patients chronic heart failure (CHF of stage I, IIA and IIB in 55, 37 and 20 patients, respectively) was previously diagnosed. Data on the CVD were obtained from medical records; if necessary, patients were referred to an internist and/or cardiologist. The CHF was staged in accordance with the Strazhesco-Vasilenko (1935) classification. In the control group there were 86 patients with urolithiasis without any cardiovascular disorders. A retrospective analysis of the stone composition was performed using a NICOLET iS10 spectral analyzer. The urine specific gravity and acidity (pH) was determined using a semi-automatic analyzer CLINITEK Status Plus three times a day (both during hospital stay and 3 months after discharge). Statistical analysis was done using the SPSS program v.19. The absolute values (M+/-m) were calculated, as well as Min, ME, Mo, Max. Relative values, including Fischer criterion, were evaluated, taking into account the Bonferroni correction. Differences were significant if p-value was Results There was no difference between groups in age (32; 64; 83). In both groups men were predominated (~ 75-78%). According to chemical analysis, stone composition in the control group was as following: oxalates (76.6%), uric acid (9.3%), phosphates (8.1%); mixed stones (6.7%). Independent of stage of CHF, respective figures were 51.4, 23.6, 8.3 and 16%, respectively. The follow-up of patients for 5 years showed that patients were admitted to the urological hospital with a stone recurrence on average 1.8 times, compared to 3 and 3.8 times with concomitant CVD and CHF, respectively. The most concentrated (specific gravity of 1035) and the most acidic (pH =5.5-5) urine in patients with CHF was found in the evening. Conclusion Chronic CVD has a significant impact on the clinical manifestations of urinary stone disease. The most pronounced changes are associated with CHF. Features of nephrolithiasis in patients with a CVD include the predominance of uric acid and urate stones, more frequent recurrences, shift in the peak of acidity and urine specific gravity from morning to evening hours.

Novel сoronavirus infectious disease COVID-19: features of comprehensive cardiac and respiratory rehabilitation

In the Consensus of experts from Russian societies, issues of comprehensive medical rehabilitation of patients with a new coronavirus infection are being discussed. Coronavirus Disease 2019 (COVID-19) is a contagious infectious disease that can cause respiratory, cardiac, motor, metabolic, neurocognitive and mental disorders, i.e. multiple organ dysfunction. Patients who survived COVID-19, especially after a severe course, face serious psychological and physical problems, post-traumatic stress, cognitive dysfunction, nutritional deficiencies and exacerbation of concomitant chronic diseases. Some patients, regardless of the severity of the coronavirus infection, have a long-term course of disease ("chronic COVID", "long-term COVID"). There is evidence of the development of "post-COVID-19 syndrome". In this regard, patients with COVID-19 need rehabilitation. The Consensus of experts from Russian societies provides general principles, stages and aspects of medical rehabilitation after COVID-19, indications and contraindications for rehabilitation interventions. The Consensus includes recommendations on comprehensive cardiac and respiratory rehabilitation, as well as the features of the rehabilitation of patients with different clinical course of COVID-19 within the framework of the national three-stage medical rehabilitation system.

Congestive heart failure and comorbidity as determinants of colorectal cancer perioperative outcomes

There has been an increase in surgical interventions in frailer elderly with concomitant chronic diseases. The purpose of this paper was to evaluate the impact of aging and comorbidities on outcomes in patients who underwent surgery for the treatment of colorectal cancer (CRC) in Veneto Region (Northeastern Italy). This is a retrospective cohort study in patients ≥ 40 years who underwent elective or urgent CRC surgical resection between January 2013 and December 2015. Independent variables included: age, sex, and comorbidities. We analyzed variables associated with the surgical procedure, such as stoma creation, hospitalization during the year before the index surgery, the surgical approach used, the American Society of Anesthesiologists (ASA) score, and the Charlson Comorbidity Index score. Eight thousand four hundred and forty-seven patients with CRC underwent surgical resection. Patient age affected both pre- and post-resection LOS as well as the overall survival (OS); however, it did not affect the 30-day readmission and reoperation rates. Multivariate analysis showed that age represented a risk factor for longer preoperative and postoperative LOS as well as for 30-day and 365-day mortality, but it was not associated with an increased risk of 30-day reoperation and 30-day readmission. Chronic Heart Failure increased the 30-day mortality risk by four times, the preoperative LOS by 51%, and the postoperative LOS by 33%. Chronic renal failure was associated with a 74% higher 30-day readmission rate. Advanced age and comorbidities require a careful preoperative evaluation and appropriate perioperative management to improve surgical outcomes in older patients undergoing elective or urgent CRC resection.

Coronavirus disease 2019: features of comprehensive cardiac and pulmonary rehabilitation

The expert consensus of the Russian communities discusses the issues of comprehensive medical rehabilitation of patients with coronavirus disease 2019 (COVID-19). COVID-19 is a contagious infectious disease that can cause pulmonary, cardiac, motor, metabolic, neurocognitive and mental disorders, that is, multiple organ dysfunction. COVID-19 survivors, especially after a severe clinical course, face serious psychological and physical problems, posttraumatic stress, cognitive dysfunction, nutritional deficiencies and exacerbation of concomitant chronic diseases. Some patients, regardless of the COVID-19 severity, have a long clinical course of the disease (“chronic-COVID”, “long COVID”). There is evidence of post-acute COVID-19 syndrome. In this regard, patients after COVID-19 will need rehabilitation measures. The expert consensus of the Russian communities presents general principles, stages and aspects of medical rehabilitation after COVID-19, indications and contraindications for rehabilitation interventions. The paper includes recommendations on comprehensive cardiac and pulmonary rehabilitation, as well as specifics of rehabilitation care for different COVID-19 courses within the national three-stage rehabilitation system.

Мodern opportunities of organizing complex obstetric and gynecological care using hospitalreplacing technologies

The authors analyzed their 25-year experience in organizing obstetric and gynecological care in outpatient settings of the branch clinical and diagnostic center of PJSC Gazprom using inpatient replacement technologies. Effective use of modern clinical, laboratory and instrumental methods of examination allows at the stage of primary treatment in the shortest possible time to establish a clinical diagnosis and determine the plan of invasive diagnostic and therapeutic measures. Cost-effectiveness of hospital-replacing forms of care delivery involves a significantly lower cost of services in day hospital, as well as a shorter average length of treatment in comparison with a day and night facility. Social efficiency is determined by the fact that treatment in a day hospital has a significant “deontological” advantage, most of the time the patient is at home, in a familiar comfortable environment, surrounded by the family which increases satisfaction with health care. Medical effectiveness of hospital-replacing forms of care delivery is determined by continuity of inpatient and outpatient care, ensuring continuity of the entire treatment process. Reduction of temporary disability in the patient, reduction of postoperative complications, nosocominal infections are high efficiency of the developed model of organization. The experience accumulated over 25 years in the organization of surgical gynecological care allowed us to reach the level when the patient’s age, the presence of several concomitant chronic diseases, compensated diabetes mellitus type 2, obesity of any degree, cicatricial adhesion of any prevalence have ceased to be absolute and relative contraindications for laparoscopic benefits under general anesthesia and sling operations for genital prolapse under general or regional anesthesia in the surgical day care center of the clinic of high medical technologies of the clinical diagnostic center.

Post-COVID 19 Period: Modern State and Clinical Features

Coronavirus disease (COVID-19) has proven to be a major global public health crisis, as evidenced by the steady increase in re-infected patients. In spite of the fight against this infection going on for more than a year, the unpredictable consequences of COVID-19, with or without concomitant chronic diseases, are still insufficiently studied, which undoubtedly is an additional burden on the outpatient health care unit. This article is a review of the available modern literature on the features of the course and duration of the post-COVID period. More than fifteen studies have been analyzed, in which the authors evaluated the incidence of symptoms in post-COVID period and its clinical characteristics.

Etiology of influenza-like illnesses in the population of Novosibirsk city in the 2018–2019 epidemic season

Influenza and other acute respiratory viral infections lead to a substantial incidence of severe cases and hospitalizations and so remain a global health problem. Within the frame of the Global Influenza Hospital Surveillance Network (GIHSN), we assessed the contribution of influenza and other respiratory viruses to severe cases of influenzalike diseases in patients hospitalized to the Novosibirsk infectious hospitals in the years 2018–2019. We analyzed 484 nasopharyngeal swabs collected from patients admitted to the hospitals with acute respiratory infections (ARI) using real-time polymerase chain reaction commercial kits. We confirmed viral etiology of ARI in 69.8% cases. Influenza viruses were detected in 47.1% cases, wherein concomitant circulation of influenza A(H1N1)pdm09 and A(H3N2) viruses was observed in 20.7% and 26% of patients, respectively, whereas influenza B virus was detected only in one sample. All analyzed influenza A viruses were antigenically similar to vaccine strains. Genetically, the Novosibirsk strains were closely related to influenza A viruses distributed in Russia and worldwide. Influenza A(H1N1)pdm09 virus was detected in all patients aged 0 to 14 years and required intensive care. Other respiratory viruses were detected in 36.4% of children and 5.8% of adults, and 8.3% of children had viral coinfection, whereas no cases of coinfection were detected in adults. The most common viruses in children were metapneumovirus — 12.8%, rhinovirus — 9.3% and respiratory syncytial virus — 8.0%. In adults, metapneumovirus, adenovirus, parainfluenza virus and rhinovirus were detected with a detection rate no exceeding 2%. In this study, we found no differences in the detection rate of the influenza virus due to concomitant chronic diseases, pregnancy, or smoking habits. At the same time, the detection rate of other respiratory viruses in non-smokers vs. smokers was significantly lower than in smokers and former smokers (26.15%, 66.67% and 62.50%, respectively). In addition, the level of detection of respiratory viruses in children with vs. without chronic pathology was significantly higher (55.3% and 38.7%, respectively). Thus, our and similar studies are important for monitoring and control of the infection.

THE PSYCHOLOGICAL COMPONENT OF THE QUALITY OF LIFE WAS RELATED TO COMPOSITE ENDPOINT IN TREATED PATIENTS WITH ARTERIAL HYPERTENSION

Objective: The aim of our study was to determine association between composite endpoint and quality of life (QL) scale scores in treated patients with arterial hypertension (AH). Design and method: We analyzed database of treated AH patients (n = 125) with concomitant chronic diseases without exacerbation. We assessed relationships between the initial ambulatory blood pressure monitoring (ABPM) data, socio-demographic indicators, QL scale scores, Asthma Control Questionnaire (ACQ) indices and composite endpoint (death for any reason, angina pectoris, transient ischemic attack, development of chronic heart failure, arterial revascularization, frequent ventricular extrasystoles, atrial fibrillation) after 30.1 ± 7.6 months from the inclusion visit. QL questionnaires (J.Siegrist et al.), ACQ (45 patients had asthma) was completed initially, after 6 months and after 12 months, the ABPM session was performed initially and after 12 months, antihypertensive therapy was corrected at all visits. We analyzed the following QL scale scores: 0 scale: mood at the doctor's visit, I scale: physical well-being; II scale: physical performance; III scale: positive psychological well-being; IV scale: negative psychological well-being; V scale: psychological performance; VI scale: social well-being; VII scale: social performance. We used ANOVA for statistical analysis. Results: The baseline mean daytime systolic BP (SBP) was 125.1 ± 10.5; diastolic (DBP) - 76.1 ± 7.3 mm Hg. We found negative correlations between composite endpoint and: III scale scores (positive psychological well-being) (F = -5.3, p < 0.05); 0 scale (mood at the doctor's visit) (F = -5.6, p < 0.05). We identified a positive correlation between endpoint data and V scale scores (psychological performance) (F = 12.2, p < 0.001). The composite endpoint was not correlated with sex, age, BMI, smoking, ambulatory and clinical blood pressure, the number of drugs in concomitant therapy, pulmonary forced vital capacity. At the end of the study, we registered 21 cases included in the composite endpoint: death (2), transient ischemic attack (1), arterial revascularization (4), frequent ventricular extrasystole (3), atrial fibrillation (8), angina pectoris (3). Conclusions: Thus, psychological QL component such as good mood at the doctor's visit (scale 0), positive psychological well-being (scale III) had negative relationship with composite endpoint, at the same time the psychological performance (scale V) had positive correlation with composite endpoint results.

Гистопатологическая характеристика мультиорганных поражений у пациентов с COVID-19

The main cause of death in COVID-19 patients is acute respiratory distress syndrome (ARDS) and multi-organ failure, which is often caused by extrapulmonary dissemination and the direct damaging effect of SARS-COV-2 on the vital organs tissues. However, the nature of histopathological changes in vital organs and their significance in the thanatogenesis of COVID-19 remain insufficiently studied. Purpose of the research. To study the nature of histopathological changes in organs in COVID-19 patients, and to conduct a comparative analysis of the data obtained with the results of foreign countries’ studies with high mortality rates. Materials and methods. A pathologic study of 179 deceased COVID-19 patients was conducted. The median age of patients was 71 years. In 83.8% (150/179) of cases, COVID-19 was the main disease, and in 16.2% (29/179) of cases, it was concomitant. Results and discussion. Histopathological changes in COVID-19 were multi-organ in nature, which caused ARDS in 91.62%, cardiovascular insufficiency in 27.4%, brain edema – in 20.1%, pulmonary edema – in 3.9%, and pulmonary embolism – in 3.9% of cases. The morphological signs of ARDS in COVID-19 were: lung mass increase in 78.2% of cases, foci of pulmonary parenchyma compaction – 74.8%, discoloration of lung tissue – 60.3%, signs of congestion – 58.1%, the histological basis of which was diffuse alveolar damage. Conclusion. Old age and concomitant chronic diseases of vital organs are the main risk factors for death in COVID-19. Histological changes in organs can be the result of both direct exposure to the virus and hypoxic, metabolic, and ischemic damage.

Prognostic factors for progression-free and overall survival in malignant pleural mesothelioma.

BackgroundMalignant pleural mesothelioma is an infrequent neoplasia with a poor prognosis and the majority of patients already have advanced disease at the time of presentation. Exposure to asbestos is the most important risk factor for malignant pleural mesothelioma. Mesothelioma is a neoplasia with a long preclinical stage that can span from 15 to 40 years.MethodsThis was a descriptive, observational, retrospective study of 136 patients with a confirmed diagnosis of mesothelioma, which compared histological subtypes, immunohistochemical biomarkers, concomitant chronic degenerative diseases, tobacco use, age at the time of diagnosis, clinical stage and chemotherapy agents used or other treatments such as radiotherapy and surgery to identify all the factors that impact in the prognosis of overall survival (OS) and progression‐free survival (PFS).ResultsA total of 136 patients were included in the study. In the total study population, 84 patients were male (61.8%) and 52 were female (38.2%). Median PFS was nine months (95% confidence interval [CI]: 8.4–9.5 months) and median OS was 12 months (95% CI: 11.3–12.6). The results indicated that the most determining prognostic factors for OS and PFS were cell differentiation measured by immunohistochemical biomarkers, the treatment chosen, and that RECIST was the most significant in the evaluation of patient response to treatment.ConclusionsMalignant pleural mesothelioma is a cancer with a poor prognosis usually diagnosed at an advanced stage of disease. Our study revealed that the prognostic factors for OS and PS were cell differentiation, the treatment chosen and RECIST.

Topical issues of diagnostics, examination and treatment of patients with COVID-19-associated pneumonia in different countries and continents

The lack of effective etiotropic methods of treatment and prevention of the new coronavirus infection (COVID-19), which caused the pandemic in 2020, determines the relevance of the review of researches of medicines for etiotropic and pathogenetic therapy. Most patients are diagnosed with pneumonia, the disease is especially difficult in people with concomitant chronic diseases, since COVID-19 leads to their decompensation, which can lead to death. To assess risk factors for mortality, scientists are developing programs to transfer the patient to appropriate treatment in a timely manner. This article analyzes the clinical efficacy of various agents for etiotropic and pathogenetic treatment of a new coronavirus infection based on data from international researches. Etiotropic medicines used at the beginning of the pandemic did not show their effectiveness in reducing the duration of treatment, the development of death, and preventing the transition to the use of mechanical ventilation. There are described researches of vaccines against a new coronavirus infection, developed in the Russian Federation, the USA, Germany and the UK, which showed the greatest efficiency (more than 90%) in preventing COVID-19. The World Health Organization initiated the international clinical research SOLIDARITY, according to which all medicines participating in the trials have little or no effect on overall mortality, the onset of ventilation requirements and the length of hospital stay in hospitalized patients. Now, only systemic glucocorticosteroids have proven effective against severe and critical forms of COVID-19. Thus, effective etiotropic drugs for the treatment of COVID-19 have not been developing, however, an active search for these funds and the development of vaccines to prevent the incidence of coronavirus infection are underway.

Mycoplasma as one of causal factors of exacerbation of community-acquired pneumonia

Objective. To improve the effectiveness of treatment in exacerbation of community-acquired pneumonia among military recruits with chronic inflammatory respiratory tract processes.
 Materials and methods. The study included the data from 266 medical histories of military recruits aged 18-26, who had community-acquired pneumonia confirmed clinically and X-ray, as well as concomitant chronic respiratory diseases and a spectrum of isolated microorganisms in the sputum. When pneumonia worsened in patients who were admitted to the hospital, the level of blood serum antibodies to M. hominis was measured.
 Results. The study results showed that in military recruits, suffering from community-acquired pneumonia with concomitant chronic respiratory diseases, in case of undetected microorganisms in the sputum, the measurement of blood serum IgM antibodies to Mycoplasma hominis has a clinical value.
 Conclusions. Mycoplasma hominis occupies a special place in the etiological structure of pathology among patients with community-acquired pneumonia.

Rehabilitation of the elderly patients after pneumonia caused by SARS-COV-2: the continuity of inpatient and outpatient stages

Relevance: the steady increase in the number of patients with respiratory diseases caused by the new SARS-CoV-2 coronavirus, among which pneumonia accounts for up to 22%, creates global problems associated with the treatment of patients and their subsequent rehabilitation. The insufficiently understood long-term consequences of COVID-19 in combination with concomitant chronic diseases and geriatric syndromes require special tactics of rehabilitation, observation and treatment of older people, including remotely. Aim: to present up-to-date data on the feasibility, efficacy and safety of approaches to the rehabilitation of older patients after pneumonia caused by SARS-CoV-2 Material and Methods: the analysis of modern domestic and foreign literature on the rehabilitation of older patients after pneumonia caused by SARS-CoV-2 was carried out, the experience of organizing rehabilitation in real clinical practice was studied, taking into account the continuity of the inpatient and abulatory stages of rehabilitation. Results: the most promising for respiratory rehabilitation are the first two months after the acute period of coronavirus infection. The priority goals of providing medical care to older people within the framework of rehabilitation are to prevent or slow down functional impairments, helplessness, disability, maintain mobility and maintain mental health. Conclusion: rehabilitation of older patients at the outpatient stage after suffering from COVID-19 should begin, if possible, as early as possible. A thorough assessment of the clinical and functional status and a comprehensive treatment plan, which focuses on functional activity and return to participation in the life of society, depending on the individual characteristics of the person and the volume of medical services, will help each patient to maximize their condition and quality of life.