Development Of Life-threatening Complications Research Articles

Traumatic tracheal rupture in closed chest trauma (a clinical case)

The purpose was to present a clinical case of a soldier with a rupture of the cervical and thoracic parts of the trachea due to closed chest trauma. Early and complete diagnosis of chest injuries, which includes mandatory X-ray and fibrobronchoscopy, can save the life of an injured person, helps choose the optimal method of treatment and improve its outcomes. When choosing the therapeutic approach in patients with traumatic tracheal injuries, it is extremely important to take into account the mechanism of injury, the nature of tracheal damage, the presence and severity of post-traumatic complications, the general condition of the patient, and capacities of a healthcare institution. Given the frequent occurrence in the acute period of life-threatening complications due to traumatic tracheal injury, the formation of gross scarring with the development of tracheal stenosis is possible in the long term, preference is given to active surgical correction of traumatic changes in the tracheal wall. Traumatic injury to the tracheobronchial tree should be suspected in all injured patients with subcutaneous emphysema, hemoptysis, and dyspnea. Adequate examination and treatment of patients with traumatic tracheal rupture requires highly specialized medical care that is based on knowledge, experience, and skills for managing such trauma. X-ray and fibrobronchoscopy must be included in the examination algorithm of such patients. When choosing the treatment approach in patients with traumatic tracheal injuries, it is extremely important to take into account the mechanism of injury, the general condition of the patient, the presence of post-traumatic complications, and capacities of a healthcare institution. Conservative treatment for traumatic tracheal rupture with timely use of minimal surgical interventions can be successful in complete ruptures of the membranous wall of the medium length without development of life-threatening complications.

Electronic sanitary database: a new potential tool to identify occult chronic liver disease in general population

Chronic liver disease (CLD) is a leading global cause of mortality, morbidity, and healthcare resource utilization. However, the burden of CLD is underestimated because the course of the disease is often asymptomatic until clinical decompensation and the development of life-threatening complications. In this study, we assessed the use of available blood tests from electronic medical records for identifying individuals with undiagnosed CLD in the general population. We analyzed a total of 202,529 blood tests obtained from 99,848 adults recorded in the Electronic Health Records of the Padova Teaching Hospital. Transaminases levels > 1.5 times the normal value indicated occult CLD, while platelet counts < 120,000/μL identified occult cirrhosis. We characterized patients using Italian Medical Exemptions (IME), excluding oncologic cases. Overt and occult cirrhosis prevalence was 1% and 4.18%, respectively, while overt and occult CLD affected 2.85% and 4.61% of the population. The epidemiology of patients with overt and occult cirrhosis was similar but significantly different from that of the controls. Among subjects aged 60–70 years, working disability was twofold higher in those with occult cirrhosis compared to those with overt cirrhosis. Occult CLD and cirrhosis had higher prevalence rates than diagnosed cases in the general population. Electronic medical record data may serve as a valuable tool for CLD identification, potentially reducing cirrhosis development and clinical decompensation. This, in turn, may lead to a decrease in the economic impact on the healthcare system.

Basic therapeutic approaches to the management of hematology/oncology patients with new coronavirus infection (COVID-19)

In December 2019, cases of severe respiratory infection were reported in Wuhan, China. The disease was caused by a new, previously undescribed coronavirus, structurally similar to the then known SARS-CoV virus. The World Health Organization has named the new virus SARS-CoV-2 and the disease it causes COVID-19. The problem of COVID-19 is exacerbated by the rapid spread of the SARS-CoV-2 virus and the development of life-threatening complications, the main of which is pneumonia. Due to the severity of the condition, from 5 to 10 % of patients are treated in intensive care units.SARS-CoV-2 initially attacks the respiratory system and causes symptoms such as fever, vomiting, headache, dizziness, general weakness, and diarrhea. Then these symptoms intensify in different directions, and the disease can often lead to death.Initially, only a few methods of symptomatic treatment were available and clinical trials of drugs that had previously shown their effectiveness against infection with the MERS-CoV and SARS-CoV viruses began. Temporary recommendations have appeared suggesting the use of some drugs both in monotherapy and in combination.In patients with hematologic malignancies, the immune response to the SARS-CoV-2 coronavirus is significantly reduced, which explains the high mortality rate (up to 38 %) of these patients hospitalized for SARS-CoV-2 infection. Recently, antiviral drugs and monoclonal antibodies have become available for pre- or post-exposure prophylaxis, as well as for early treatment of COVID-19. These treatments should be offered to patients at high risk of severe COVID-19 and to those who have not responded to vaccination. However, as changes in the genetic structure of the virus accumulate, some treatments may lose their clinical effectiveness against new variants.The combination of hematological malignancies and new coronavirus infection causes a more severe course of COVID-19 compared to the population and high mortality. Factors for an unfavorable prognosis for new coronavirus infection in patients with hematological malignancies include age over 60 years, a high comorbidity index, diagnoses such as acute leukemia, especially acute myeloid leukemia and myelodysplastic syndrome, disease status (relapse, progression, as well as newly diagnosed acute leukemia), severe COVID-19, agranulocytosis (myelotoxic or tumor).

Combination Treatment for Severe Forms of Mucopolysaccharidosis, Type I (Hurler Syndrome): Case Report

Background. Hurler syndrome (mucopolysaccharidosis, type I) is a rare hereditary disease with chronic course. The main methods for Hurler syndrome management are hematopoietic stem cell transplantation (HSCT) and enzyme replacement therapy (ERT). In recent years, combination treatment (ERT administration both before and after HSCT) has shown its efficacy in case of disease progression. Clinical case description. The presented clinical cases demonstrate the efficacy of ERT administration in patients with Hurler syndrome after HSCT: in the first clinical case due to the decrease in alpha-iduronidase activity 2 years after HSCT, in the second clinical case due to the aggravation of the patient's condition (cardiovascular and respiratory systems, hepatomegaly, although the level of enzyme and glycosaminoglycans in the patient's urine remained within normal values). Conclusion. Combination treatment including ERT not only before HSCT, but also in case of clinical state worsening after HSCT, plays significant role in stabilizing the patient's condition, preventing rapid progression of symptoms and development of life-threatening complications (especially cardiovascular ones).

Modern methods of therapy in the development of life-threatening complications in a patient after repeated allogeneic hematopoietic stem cell transplantation: review of the literature and clinical case

There is no doubt that allogeneic hematopoietic stem cell transplantation (allo-HSCT) is one of the most effective treatments for many serious diseases. However, despite significant progress, allo-HSCT is still associated with a high rate of complications and mortality in the posttransplant period due to the toxicity of conditioning regimens, infectious and immune conditions. Acute complications such as endothelial injury, acute and chronic graft-versus-host disease (GVHD) remain the main causes of mortality after allo-HSCT. In our clinical case, we demonstrated an example of the development of such life-threatening complications as transplant-associated thrombotic microangiopathy and GVHD in a patient after repeated allo-HSCT, as well as the successful relief of these complications by modern therapeutic methods, including the introduction of closely related donor mesenchymal stem cells and the complement blocker eculizumab.

Duration of Invasive Mechanical Ventilation Post-Liver Transplantation: Does One Size Fit All?

Duration of Invasive Mechanical Ventilation Post-Liver Transplantation: Does One Size Fit All?

ШЕЕЧНО-ПЕРЕШЕЕЧНАЯ БЕРЕМЕННОСТЬ: КЛИНИЧЕСКИЙ СЛУЧАЙ ВЫНАШИВАНИЯ И РОЖДЕНИЯ РЕБЕНКА

Cervical-isthmian pregnancy is a very rare form of ectopic pregnancy, characterized by the localization of the fetus in the isthmus and cervix. This pathology is associated with disorders of ovum fixation in the uterine body in patients with a burdened obstetric and gynecological history and is characterized by a high risk of maternal mortality due to the possible development of life-threatening complications (DIC syndrome, bleeding). But, unlike other forms of ectopic pregnancy, it is with her that you can carry and give birth to a child. The article presents such a case.

Toxicity profile of the new compound XC221GI from pre-clinical studies

The major feature of COVID-19 is intensive virus-induced inflammation in vital body organs and spatiotemporal dysregulation of pro- and anti-inflammatory cytokines and chemokines synthesis. All this leads to unpredicted clinical progression and high risk of "cytokine storm" development. The "cytokine storm" is the pathogenetic basis for further development of life-threatening complications. Thus, there is a huge need to select effective and safe approaches that allow to control virus-induced inflammation as a part of preventive anti-inflammatory therapy.&#x0D; This article presents toxicological characteristics of the original low-molecular compound XC221GI (1-[2-(1-methylimidazole-4-yl)-ethyl]perhydroazin-2,6-dione) from pre-clinical studies.&#x0D; The obtained results demonstrate that the XC221GI does not have any toxic effect in repeated long-term administration. The compound was well tolerated by all animals. The no-observed-adverse-effect level (NOAEL) was 30 mg/kg per day for dogs and 450 mg/kg per day for rats. There were no effects of XC221GI on blood count, hematopoiesis and hemostasis. As well as no cytotoxic, mutagenic, genotoxic, carcinogenic properties or anaphylactogenic and immunotoxic activity were revealed for XC221GI. All known data enable to classify XC221GI as a low toxic compound and consider its safety profile as reasonably favorable.

Differentiated Approaches to the Choice of Timing of Surgical Treatment for Intrathoracic Lymph Node Tuberculosis in Children during Increasing Incidence of Multiple Drug Resistant Tuberculosis

The objective: to develop differentiated approaches to the choice of timing of surgical treatment of intrathoracic lymph node tuberculosis (ITLNTB) in children during the increasing incidence of multiple drug resistant tuberculosis (MDR-TB).Subjects and Methods. 52 patients of 2-12 years old had their intrathoracic lymph nodes removed at different stages of anti-tuberculosis therapy. All children had massive (more than 10-15 mm) conglomerates in their intrathoracic lymph nodes. Additionally to changes in intrathoracic lymph nodes, 12 people had active tuberculous changes in the lungs or bronchial tuberculosis.Results. 5 patients were operated before chemotherapy, 35 patients after 2 months of treatment, and 12 patients underwent surgery afterwards. The elective surgery was performed in 51 children, and 1 child had surgery before the start of chemotherapy due to vital indications (the threat of breakthrough of caseous masses into the trachea).Planned surgical treatment in children with tuberculosis of intrathoracic lymph nodes should be carried out within the following timing: before the start of anti-tuberculosis therapy in the absence of clinical, laboratory and radiological signs of the disease being active; as soon as possible from the start of chemotherapy (it is enough to focus on the results of the first CT control after 2 months of treatment (there should be no tendency to involution of pathological changes) in the presence of minimal signs of tuberculosis activity). The choice of timing of planned surgical treatment is individual and determined by the timing of stabilization of pulmonary changes or the cure of bronchial tuberculosis (after 6, 9, 12 months) in patients with newly diagnosed active tuberculosis of intrathoracic lymph nodes in combination with lung and/or bronchial lesions. The development of life-threatening complications is an absolute indication for emergency surgery.

Endoscopic vacuum therapy for the treatment of suture failure after resection of the esophageal wall for removal of an enterogenic cyst in a 9-year-old child

INTRODUCTION. Intrathoracic esophageal postoperative suture’s failure occurs in 8–26 % after distal esophagectomy and 3–12 % after total gastrectomy, also this leads to the development of life-threatening complications and a rather high mortality rate. Endoscopic vacuum therapy is an actively developing and modern method of treating defects in the wall of hollow organs.CINICAL EXAMPLE. 9-year-old patient had resection of the esophageal wall for an enterogenic cyst. The failure of the postoperative suture was clinically diagnosed after the 1st day of operation, confirmed by endoscopic and X-ray findings. We decided to use endoscopic vacuum therapy with Suprasorb sponge. The sponge was replaced at intervals of 3–5 days. On the 9th twenty-four hours after the operation, a delimited cavity into the mediastinal pleural space with a length of 8 cm and a width 1.5 cm with fibrin deposits on the walls was diagnosed. The size and shape of the sponge depended on the size of the defect of the esophageal wall and the volume of the delimited cavity. Conservative and rehabilitation therapy was also carried out. On the 40th day after the operation, complete epithelialization of the esophageal wall defect was noted. The patient was discharged in a satisfactory condition. Due to the results of our clinical observation, we reached a conclusion that endoscopic vacuum therapy is applicable in clinical practice, because it is an effective method of treatment for the of intra-thoracic esophageal suture’s failure. The technique is relatively safe, contributes to the complete elimination of the full-wall defect, reducing the period of social recovery and maintaining a high quality of life after treatment.

Intercellular interactions and their role in fibrogenesis in chronic hepatitis C

Introduction. The development of life-threatening complications in chronic hepatitis C (CHC) is based on progressive fibrogenesis. The developing of liver fibrosis is provided by intercellular interactions, first of all, of lymphocytes, macrophages and stellate cells (SC), the patterns of mutual influences of which have not been sufficiently studied at the moment.The objective was to study the features of intercellular interplay of nonparenchymal liver cells at different histological activity, at different stages of CHC fibrosis, and at different genotypes of the hepatitis C virus (HCV).Methods and materials. The object of the study was 64 liver biopsies of adult patients with natural course of CHC. Нistological, immunohistochemical and immunohistomorphometric methods were used.Results. The increasing histological activity is accompanied by an increase in the number and size (area) of CD68 + macrophages and SMA-alfa + SC. Correlation relationships of intercellular interactions at low and moderate histological activity had significant differences. In mild fibrosis, a relationship was found between the number of CD8 + lymphocytes, the number and area of CD68 + macrophages and SMA-alfa + SC. HCV genotype 1 is characterized by a predominance of the interactions between the number of CD8 + lymphocytes, the number and area of CD68 + macrophages in the liver, for genotype 3 – between the number of CD8 + lymphocytes, the number and area of SMA + SC.Conclusions. The maximum activation of SC and macrophages occurs even with moderate histological activity and persists with an increase. The consolidation of the immunopathological nature of the intercellular interplay between lymphocytes, macrophages and SC occurs at the stage of mild fibrosis. Intercellular interactions have significant differences depending on the HCV genotype, which can determine a poor prognosis of the disease.

Role of gut microbiota in the pathogenesis of type 2 diabetes mellitus (literature review)

Type 2 diabetes mellitus is an extremely common disease that leads to the development of life-threatening complications but its pathogenesis remains poorly understood. One of the promising directions in this area is the study of disorders of gut microbiota. Literature data indicate that a number of quantitative and qualitative changes in the composition of the gut microbiota are the most important factors in the pathogenesis of type 2 diabetes mellitus. Bacteria of the genera Ruminococcus, Fusobacterium and Blautia are most involved in the pathogenesis of this disease. The participation of the gut microbiota in the pathogenesis of type 2 diabetes mellitus is due to its metabolites, which play an important role in the regulation of the permeability and integrity of the intestinal wall, the expression of specific intestinal receptors, incretin secretion, gluconeogenesis activity, chronic subclinical inflammation, and even in adipose tissue remodeling. Further in-depth study of gut microbiota disorders is promising in order to develop fundamentally new approaches to the treatment and prevention of type 2 diabetes mellitus.

32. Host Immune-Protein Signature Combining TRAIL, IP-10 and CRP for Early and Accurate Prediction of Severe COVID-19 Outcome

BackgroundAccurately identifying COVID-19 patients at-risk to deteriorate remains challenging. Dysregulated immune responses impact disease progression and development of life-threatening complications. Tools integrating host immune-protein expression have proven useful in determining infection etiology and hold potential for prognosticating disease severity.MethodsAdults with COVID-19 were enrolled at medical centers in Israel, Germany, and the United States (Figure 1). Severe outcome was defined as intensive care unit admission, non-invasive or invasive ventilation, or death. Tumor necrosis factor related apoptosis inducing ligand (TRAIL), interferon gamma inducible protein-10 (IP-10) and C-reactive protein (CRP) were measured using an analyzer providing values within 15 minutes (MeMed Key®). A signature indicating the likelihood of severe outcome was derived generating a score (0-100).Description of derivation cohort RT-PCR, reverse transcription polymerase chain reaction.ResultsBetween March and November 2020, 518 COVID-19 patients were enrolled, of whom 394 were eligible, 29% meeting a severe outcome. Age ranged between 19-98 (median 61.5), with 59.1% male. Patients meeting severe outcomes exhibited higher levels of CRP and IP-10 and lower levels of TRAIL (Figure 2; p < 0.001). Likelihood of severe outcome increased significantly (p < 0.001) with higher scores. The signature’s area under the receiver operating characteristic curve (AUC) was 0.86 (95% confidence interval: 0.81-0.91). Performance was not confounded by age, sex, or comorbidities and was superior to IL-6 (AUC 0.77; p = 0.033) and CRP (AUC 0.78; p < 0.001). Clinical deterioration proximal to blood draw was associated with higher signature score. Scores of patients meeting a first outcome over 3 days after blood draw were significantly (p < 0.001) higher than scores of non-severe patients (Figure 3). Moreover, the signature differentiated patients who further deteriorated after meeting a severe outcome from those who improved (p = 0.004) and projected 14-day survival probabilities (p < 0.001; Figure 4).TRAIL, IP-10, CRP and the severity signature score are differentially expressed in severe and non-severe COVID-19 infection Dots represent patients and boxes denote median and interquartile range (IQR)The signature score of patients meeting a severe outcome on or after the day of blood draw is significantly (p < 0.001) higher than the signature score of non-severe patients. Dots represents patients and boxes denote median and IQRKaplan-Meier survival estimates for signature score bins ConclusionThe derived signature combined with a rapid measurement platform has potential to serve as an accurate predictive tool for early detection of COVID-19 patients at risk for severe outcome, facilitating timely care escalation and de-escalation and appropriate resource allocation. Disclosures Alon Angel, n/a, MeMed (Employee, Shareholder) Niv Samuel Mastboim, BSc, MeMed (Employee, Shareholder) Oded Shaham, PhD, MeMed (Employee, Shareholder) Tahel Ilan Ber, MD, MeMed (Employee, Shareholder) Roy Navon, MSc, MeMed (Employee, Shareholder) Einav Simon, PhD, MeMed (Employee, Shareholder) Michal Rosenberg, PhD, MeMed (Employee) Yael Israeli, PhD, MeMed (Employee) Mary Hainrichson, PhD, MeMed (Employee, Shareholder) Noa Avni, PhD, MeMed (Employee) Eran Reiner, MD, MeMed (Employee) Kfir Oved, MD, PhD, MeMed (Board Member, Employee, Shareholder) Ilya Kagan, MD, MeMed (Scientific Research Study Investigator) Shaul Lev, M.D, MeMed (Scientific Research Study Investigator) Dror Diker, MD, MeMed (Scientific Research Study Investigator) Amir Jarjou’i, MD, MeMed (Scientific Research Study Investigator) Ramzi Kurd, MD, MeMed (Scientific Research Study Investigator) Guy Danziger, MD, MeMed (Scientific Research Study Investigator) Cihan Papan, MD, MeMed (Scientific Research Study Investigator) Sergey Motov, MD, MeMed (Scientific Research Study Investigator) Maanit Shapira, Ph.D, MeMed (Scientific Research Study Investigator) Tanya Gottlieb, PhD, MeMed (Employee, Shareholder) Eran Eden, PhD, MeMed (Board Member, Employee, Shareholder)

Diagnosis difficulties in elderly patients with atrial fibrillation and complete atrioventricular block

The association of atrial fibrillation (AF) with complete atrioventricular block (CAVB) is a common clinical feature in elderly patients. It is characterized by the loss of specific symptoms of AF (palpitations, intermissions); in the first place may come CAVB symptoms: dizziness, Morgagni–Adams–Stokes (MAS) attacks. Aim. The article objective is to illustrate the dynamic changes in the course of AF with the development of CAVB on the example of a clinical case and to discuss the difficulties in timely diagnosis and therapy correction. Case presentation. A 75-year-old male was diagnosed with a rapid ventricular response form of AF. The onset of CAVB caused the transition from rapid ventricular response form of AF to slow ventricular response form, which was initially accompanied by a subjective improvement in the patient’s condition. As the disease progressed, the patient’s condition worsened due to the development of MAS attacks. The elderly patients with a permanent form of AF require constant cardiac monitoring by an experienced specialist who has appropriate vigilance in management of patients with arrhythmias, awareness about possible concomitant conduction disorders. This provides comprehensive cardiac support, including timely pacemaker implantation which gives more options for AF symptoms monitoring and heart rate control, has a positive modifying effect on drug therapy. Conclusions. Changes in the clinical picture of AF after development of CAVB can lead to late diagnosis of CAVB, inadequate therapy and untimely pacemaker implantation, as a consequence, to progression of concomitant pathology and the development of life-threatening complications, as in our clinical case.

Dynamics of morbidity of the population with respiratory diseases in the pandemic COVID-19 period in the Far Eastern Federal District

Introduction. Currently, COVID-19, which is rapidly spreading around the world in the form of a pandemic, is a serious public health problem that poses a significant epidemiological and medico-social threat to the population and its quality of life, and affects all spheres of public life and economy. Aim. To assess the degree of influence of the pandemic of the new respiratory viral infection COVID-19 on the level of registered primary morbidity by classes of diseases, including the class "Diseases of the respiratory system" in the territory of the Far Eastern Federal District.Materials and methods. To implement the tasks of the study, a complex of analytical, epidemiological and statistical studies was carried out. Methods used: epidemiological analysis and monitoring, statistical, comparative and correlation analysis and methods for analyzing time series. Epidemiological and statistical assessment of the incidence of the population was carried out on the basis of ICD-10 according to the data of the state statistical monitoring of the incidence of the population of the Russian Federation for 2019-2020 using the database of the Ministry of Health of the Russian Federation, the Central Research Institute of Organization and Informatization of Healthcare of the Ministry of Health of the Russian Federation.Results. The pandemic of the new respiratory viral infection COVID-19 significantly changed the dynamics of the registered morbidity in the adult population, which dropped sharply in all ICD-10 classes, most intensively in the classes "Diseases of the endocrine system" (by 27.8%), "Diseases of the blood and hematopoietic organs" (by 22.6%), "Neoplasms" (by 21.1%), "Diseases of the circulatory system" (by 18.5%), with the exception of the class "Diseases of the respiratory system", the level of primary morbidity for which in the territory of the Far Eastern Federal District in 2020 increased by 23.9%. The most common and severe clinical manifestation of COVID-19 is bilateral pneumonia, the incidence of which among the adult population in the Far Eastern Federal District increased 2.7 times, and in the territory of the Russian Federation – 3.8 times. At the same time, the incidence of pneumonia in the child population decreased by 36.4%. Along with the growth of acute forms of respiratory pathology during the COVID-19 pandemic in the Far Eastern Federal District, the level of registered primary morbidity of chronic respiratory diseases decreased: chronic bronchitis (by 22.3%), bronchialasthma (by 20.8%), COPD (by 3, 6%).Conclusion. The negative dynamics of the growth of the registered morbidity of the population can have negative consequences due to the late detection and untimely diagnosis of chronic forms of pathology, including respiratory diseases, their progression and the development of life-threatening complications of the disease and, as a consequence, an increase in mortality from these causes of the population, who did not receive timely and adequate medical assistance.

Dynamics of morbidity of the population with respiratory diseases in the pandemic COVID-19 period in the Far Eastern Federal District

Introduction. Currently, COVID-19, which is rapidly spreading around the world in the form of a pandemic, is a serious public health problem that poses a significant epidemiological and medico-social threat to the population and its quality of life, and affects all spheres of public life and economy. Aim. To assess the degree of influence of the pandemic of the new respiratory viral infection COVID-19 on the level of registered primary morbidity by classes of diseases, including the class "Diseases of the respiratory system" in the territory of the Far Eastern Federal District.Materials and methods. To implement the tasks of the study, a complex of analytical, epidemiological and statistical studies was carried out. Methods used: epidemiological analysis and monitoring, statistical, comparative and correlation analysis and methods for analyzing time series. Epidemiological and statistical assessment of the incidence of the population was carried out on the basis of ICD-10 according to the data of the state statistical monitoring of the incidence of the population of the Russian Federation for 2019-2020 using the database of the Ministry of Health of the Russian Federation, the Central Research Institute of Organization and Informatization of Healthcare of the Ministry of Health of the Russian Federation.Results. The pandemic of the new respiratory viral infection COVID-19 significantly changed the dynamics of the registered morbidity in the adult population, which dropped sharply in all ICD-10 classes, most intensively in the classes "Diseases of the endocrine system" (by 27.8%), "Diseases of the blood and hematopoietic organs" (by 22.6%), "Neoplasms" (by 21.1%), "Diseases of the circulatory system" (by 18.5%), with the exception of the class "Diseases of the respiratory system", the level of primary morbidity for which in the territory of the Far Eastern Federal District in 2020 increased by 23.9%. The most common and severe clinical manifestation of COVID-19 is bilateral pneumonia, the incidence of which among the adult population in the Far Eastern Federal District increased 2.7 times, and in the territory of the Russian Federation – 3.8 times. At the same time, the incidence of pneumonia in the child population decreased by 36.4%. Along with the growth of acute forms of respiratory pathology during the COVID-19 pandemic in the Far Eastern Federal District, the level of registered primary morbidity of chronic respiratory diseases decreased: chronic bronchitis (by 22.3%), bronchialasthma (by 20.8%), COPD (by 3, 6%).Conclusion. The negative dynamics of the growth of the registered morbidity of the population can have negative consequences due to the late detection and untimely diagnosis of chronic forms of pathology, including respiratory diseases, their progression and the development of life-threatening complications of the disease and, as a consequence, an increase in mortality from these causes of the population, who did not receive timely and adequate medical assistance.

КЛИНИЧЕСКИЕ СЛУЧАИ АНТИФОСФОЛИПИДНОГО СИНДРОМА В ПРАКТИКЕ ВРАЧА-ГЕМАТОЛОГА

In this article, 2 clinical cases of patients with hemostatic problems are considered. 1 case during pregnancy, with confirmed APS and received therapy. The pathology of the hemostasis system of congenital or acquired genesis against the background of pregnancy can lead to an unfavorable outcome in the form of non-developing pregnancy and miscarriage, and maternal mortality. 2 case with autoimmune nature of APS diagnosed at late stages. It is concluded that excessive examination for non-informative indicators can lead to an incorrect interpretation of blood parameters and, as a consequence, to polypharmacy and a protracted course of the disease with the development of life-threatening complications.

Association of baseline frailty status and age with postoperative morbidity and mortality following intracranial meningioma resection.

Although numerous studies have established advanced patient age as a risk factor for poor outcomes following intracranial meningioma resection, large-scale evaluation of frailty for preoperative risk assessment has yet to be examined. Weighted discharge data from the National Inpatient Sample were queried for adult patients undergoing benign intracranial meningioma resection from 2015 to 2018. Complex samples multivariable logistic regression models and receiver operating characteristic curve analysis were performed to evaluate adjusted associations and discrimination of frailty, quantified using the 11-factor modified frailty index (mFI), for clinical endpoints. Among 20,250 patients identified (mean age 60.6years), 35.4% (n = 7170) were robust (mFI = 0), 34.5% (n = 6985) pre-frail (mFI = 1), 20.1% (n = 4075) frail (mFI = 2), and 10.0% (n = 2020) severely frail (mFI ≥ 3). On univariable analysis, these sub-cohorts stratified by increasing frailty were significantly associated with the development of Clavien-Dindo grade IV (life-threatening) complications (inclusive of those resulting in mortality) (1.3% vs. 3.1% vs. 6.5% vs. 9.4%, p < 0.001) and extended length of stay (eLOS) (15.4% vs. 22.5% vs. 29.3% vs. 37.4%, p < 0.001). Following multivariable analysis, increasing frailty (aOR 1.40, 95% CI 1.17, 1.68, p < 0.001) and age (aOR 1.20, 95% CI 1.05, 1.38, p = 0.009) were both independently associated with development of life-threatening complications or mortality, whereas increasing frailty (aOR 1.20, 95% CI 1.10, 1.32, p < 0.001), but not age, was associated with eLOS. Frailty (by mFI-11) achieved superior discrimination in comparison to age for both endpoints (AUC 0.69 and 0.61, respectively). Frailty may be more accurate than advanced patient age alone for prognostication of adverse events and outcomes following intracranial meningioma resection.

Dural Arteriovenous Fistula with Retrograde Drainage into the Cortical Veins (Case Report)

We present clinical case of a patient who was referred for brain MRI to clarify the cause of a first-time seizure. MRI examination showed cortical and medullary veins ectasia in the left cerebral hemisphere with multiple cerebral microbleeds around the medullary veins. The revealed changes were considered as a manifestation of regional venous hypertension, however, its cause remained unclear. We decided to perform non-contrast 3D-TOF angiography that revealed a dural arteriovenous fistula between the left occipital artery and the sigmoid venous sinus with retrograde drainage into cortical veins (Borden type II, Cognard type IIb). Early diagnosis and treatment of «aggressive» dural arteriovenous fistulas avoids the development of lifethreatening complications (an annual hemorrhage rate of 8,1%).

Aspartate Aminotransferase-To-Platelet Ratio Index: a Potential Predictor of Prognosis in the Most Common Types of Cirrhosis.

Cirrhosis is often an asymptomatic disease. Its early diagnosis before the development of life-threatening complications is an important step to prevent the progression of the disease. The aim of the present study was the identification of parameters that are significantly changed in cirrhosis, are not affected by the cause of cirrhosis, and are associated with fatal complications of cirrhosis. Demographic and pre-transplant ultrasound and laboratory findings were reviewed in patients with viral- (n = 27), autoimmune hepatitis- (n = 27), alcohol- (n = 18), primary sclerosing cholangitis- (PSC) (n = 36), and nonalcoholic steatohepatitis-related cirrhosis (n = 42). Among laboratory findings, only the aspartate aminotransferase-to-platelet ratio index (APRI) value in cirrhotic patients was significantly higher than that of healthy individuals (p < 0.001) and, meanwhile, its value was not different among cirrhotic patients with various etiologies (p = 0.240) but was associated with the ascites, as a cirrhosis life-threatening complication (p < 0.001). The APRI has acceptable potential to predict prognosis in cirrhosis. So, it can be a possible parameter to the prediction of the lethal complications of cirrhosis.