State Clinical Hospital Research Articles

Glucosuria as a major mechanism-associated effect of sodium-glucose cotransporter 2 inhibitors: Is there cause for concern?

Introduction. One of the main mechanisms of action of SGLT2 inhibitors is an increase in renal excretion of glucose and sodium, development of glucosuria against the background of decreased levels of daily glycemia. The frequency of glucosuria development in patients without DM/prediabetes, receiving SGLT2 inhibitors for the treatment of CHD or CKD, as a consequence of the mechanism of action of SGLT2 inhibitors inhibitors is poorly studied and seems to be very interesting.Aim. To evaluate in real clinical practice the frequency of the development and severity of glucosuria in patients with CHF treated with inhibitors of SGLT2 inhibitors both on the background of concomitant DM2 and without type 2 DM.Materials and methods. Within the framework of a one-stage, prospective, observational study we evaluated the frequency of development and severity of glucosuria in patients with CHF, receiving SGLT2 inhibitors inhibitors, who were in the cardiology department of V.P. Demikhov State Clinical Hospital of Moscow. A total of 230 patients were included in the analysis.Results. The mean age of the patients was 74 [66; 83] years. Median LVEF was 36 [29; 44] %, NTproBNP 1019 [423; 2355] pg/ml. Heart failure with reduced ejection fraction (HFrEF) was recorded in 64.81% of patients, 17.13% had HF with mildly reduced ejection fraction and 18.06% had a СHF preserved ejection fraction. DM2 was present in 38.7 percent of patients with СHF. Among patients with CHF, the ‘glucosuria phenomenon’ due to the administration of SGLT2 inhibitors was observed in 31.16% of those without DM2, and in 52.27% of СHF patients with concomitant DM2.Conclusion. In patients with CHF receiving SGLT2 inhibitors therapy, the ‘glucosuria phenomenon’ developed in one in three patients without overt carbohydrate metabolism abnormalities and one in two with DM2. The findings suggest that the glucosuria effect of SGLT2 inhibitors is not a required event even in patients with DM2, which may influence the incidence of adverse events in general clinical practice. And the cardioprotective benefits of SGLT2 inhibitors may be due to other mechanisms unrelated to glucose excretion, which, according to recent studies, is considered a surrogate predictor of favorable prognosis concerning CHF and renal outcomes. Nevertheless, additional clinical and experimental studies are required to determine the cardioprotective mechanisms of SGLT2 inhibitors and the predictive value of drug-induced glucosuria.

Systemic amyloidosis in a patient with acute heart failure

Aim. To describe a clinical case of transthyretin amyloidosis, the first manifestation of which was an episode of acute heart failure.Materials and methods. Patient V., 58 years old, was taken to the intensive care unit for patients with myocardial infarction V.P. Demikhov State Clinical Hospital with a preliminary diagnosis: acute coronary syndrome without ST segment elevation, pulmonary edema. It is known from the anamnesis that the patient was disturbed for 3 months by a pronounced dry cough, hoarseness of voice, weakness with minor physical exertion.Results. The complexity of the diagnosis of postmortem diagnosis of systemic amyloidosis was explained by the absence of any clinical manifestations that made it possible to suspect a deadly disease before hospitalization for pulmonary edema. This clinical case demonstrates the rapid development of symptoms of systemic amyloidosis. From the moment of the first symptoms (persistent dry cough, hoarseness of voice) to death as a result of heart failure, about 3 months have passed. The addition of peripheral polyneuropathy to the clinical picture made it possible to suspect a systemic disease.Conclusion. This clinical case proves the relevance and importance of timely diagnosis of amyloidosis, as well as the need to raise awareness of doctors of various specialties about this disease.

LARYNGOPHARYNGEAL RECONSTRUCTION IN A PREGNANT WOMAN: A CLINICAL CASE

Relevance: Cancer in pregnancy is a very serious clinical condition that seriously affects women and their families, as well as the medical staff who provide care. Diagnostic and therapeutic solutions must balance the appropriate treatment with the risk to the fetus. In developed countries, cancer in pregnant women has become more common over the past 30 years due to an increase in the number of older women giving birth. Melanoma, lymphoma, leukemia, and cancers of the breast, cervix, ovaries, gastrointestinal tract, and genitourinary system are the most common malignant neoplasms in pregnant women. Head and neck cancers are rare in pregnancy. A total of 3 cases of locally advanced laryngopharyngeal cancer were recorded in patients aged 23 to 28 years in 2017-2023 at the State Clinical Hospital of the Akimat of Astana Multidisciplinary Medical Center. This article describes a case of advanced squamous cell carcinoma of the laryngeal region in a young pregnant woman and also discusses the diagnosis and treatment of head and neck cancer in pregnant women. The study aimed to describe a clinical case of squamous cell carcinoma of the larynx in a pregnant patient. Methods: The description of a clinical case presents data from laboratory, instrumental, and physical research methods of a pregnant patient with hypopharynx squamous cell carcinoma, who was examined, treated, and followed up at the State Clinical Hospital of the Akimat of Astana Multidisciplinary Medical Center. The patient was diagnosed with IVA laryngopharyngeal cancer T4aN2cM0. Grade III dysphagia. Laryngeal stenosis. Grade II cachexia” and received three courses of neoadjuvant polychemotherapy. Then, she underwent surgical intervention in the volume of laryngopharyngectomy and reconstructive surgery using a free radial flap and was administered adjuvant external beam radiation therapy. Results: The article presents the results of laryngopharyngectomy for locally advanced squamous cell carcinoma of the hypopharynx. The postoperative period was without complications, the patient was discharged 14 days after surgery in satisfactory condition and continued adjuvant radiation therapy. Conclusions: The reviewed clinical case demonstrates the importance of an integrated approach to treating laryngopharyngeal cancer, including effective reconstruction of postoperative defects using free fasciocutaneous flaps.

Results of the use of an integrated risk scale for postoperative complications in patients with colorectal cancer

Inroduction. Polymorbidity significantly increases the risk of complications in the early postoperative period, especially in patients with colorectal cancer, taking into account the initial nutritional status disorder. At present, several scales of postoperative complications risk assessment (POSSUM, RCRI, MUST) are used, but they do not fully meet the needs of modern oncosurgery, so we consider it necessary to compare their effectiveness and propose a new integrated scale.Aim. To establish the most significant factors influencing the outcome of surgical treatment and length of hospitalization in comorbid patients with colon cancer with the development of a surgical risk assessment scale that is most adapted for this group of patients.Materials and methods. We analyzed the data of hospital charts of patients undergo surgery for colorectal cancer in the oncoproctologic department of the S. P. Botkin State Clinical Hospital of the Moscow Healthcare Department in the period from 2019 to 2022. Inclusion criteria: histologically verified colorectal adenocarcinoma; colorectal cancer in stage cT4, cN0, cM0 or cT1–4, cN1–2, cM0; presence of one or more concomitant diseases in the patient. Exclusion criteria: presence of distant metastases of colorectal cancer; absence of confirmed comorbidities; early forms of colorectal cancer (cT1–2, cN0). All patients were assessed for risk of perioperative complications using ASA, POSSUM, MUST, and RCRI scales. The study endpoints were number of days in intensive care, number of days of hospitalization, and 30-day mortality. An Excel database with POSSUM, RCRI, and MUST scale calculators was created for the study. The evaluation of parameters influencing the outcome of hospitalization was performed using ROC analysis and correlation analysis using Pearson’s criterion. To identify the most sensitive parameters affecting the outcome of hospitalization, commonly used calculators were studied in detail.Results. 200 patient records were analyzed. The results of treatment were compared with the data obtained using the postoperative risk scales POSSUM, MUST, RCRI. A comparative analysis of the scales presented above with our proposed integral scale of postoperative complications risk assessment was carried out. It was found that the parameters of our proposed integral scale showed the highest sensitivity (Se >70 %) and specificity (Sp >70 %) to the risk of postoperative complications. Our proposed integral scale showed a moderate correlation with the age of patients (r = 0.475, p = 0.01) and preoperative weight loss (r = 0.592, p = 0.01), as well as a high correlation with POSSUM (r = 0.649, p = 0.01; r = 0.852, p = 0.01) and MUST (r = 0.655, p = 0.01).Conclusion. The developed scale for assessment of surgical risk in comorbid patients with colorectal cancer showed a higher correlation with the outcome of surgical treatment than similar known scales, which indicates its effectiveness and possibility of application in clinical practice after its validation in prospective studies.

The Role of Leu-Enkephalin Synthetic Analogue in Regulation of Systemic Inflammatory Response and Prevention of ARDS in Severe Combined Injury

The aim of the study. To study the effect of ley-enkephalin synthetic analogue on the dynamics of inflammatory response markers and organ dysfunction in patients with severe combined trauma.Materials and methods. A prospective clinical study with historical control from two clinical centers — N. I. Pirogov State Clinical Hospital No. 1 and N.V. Sklifosovsky Clinical and Research Institute for Emergency Medicine — included men and women with severe combined trauma and the ISS scores values of 18–44, aged 18 to 70 years. Diagnostic and therapeutic approaches in all patients followed current international, national& local protocols and 2022 clinical recommendations of the Russian Society of Surgeons «Combined and multiple trauma in combination with shock (Polytrauma)». In the study group, treatment was supplemented with extended (72 hours from the admission) infusion of the test drug through a syringe dispenser following the study protocol. Effects of the test drug prolonged infusion were evaluated for the following laboratory parameters: levels of cortisol, procalcitonin, interleukin 6, NTproBNP and leukocyte count. Laboratory tests were performed at 4 time points: prior to test drug infusion, 24 hours and 72 hours after initiation of infusion, and on Day 7. The study evaluated patient’s dynamics using APACHE II, SOFA and SAPS II scales and percentage of patients developing organ dysfunction (renal, respiratory, cardiovascular), rates of sepsis complications and mortality.Results. Patients who received the test drug had significantly lower concentrations of systemic inflammatory response markers, i. e. PCT (P=0.001) and IL-6 (P=0.010) after 24 hours of follow-up vs the control group patients. The incidence of ARDS has also decreased in the study group (P=0.011 vs control). Acute kidney injury (AKI) rate was insignificantly higher in the control group (P=0.349). The duration of hospital stay in the control group was 35 (17; 51) days vs 18 (14; 30) days in the study group (P=0.140)Conclusion. The use of ley-enkephalin synthetic analogue inhibits production of such key systemic inflammatory response markers as PCT and IL-6, and reduces PCT concentrations within 24 hours in patients with severe combined trauma. ARDS developed less frequently in the study group, but there was no significant difference in the incidence of AKI, AHF and infectious complications between the groups.

A rare disease in children – croupous bronchitis: history of study, pathogenesis, therapy strategy

Plastic bronchitis is a rare disease. Despite the fact that the clinical signs of plastic bronchitis were first described by Galen more than 1800 years ago, the pathogenesis of the disease remains poorly understood to this day. As a result, it is not always possible to choose a therapy that allows for complete clinical and laboratory remission or complete recovery of the patient. Treatment of plastic bronchitis should be multifaceted, including the appointment of medications, hardware and physiotherapy methods. Despite the increasing relevance of the topic, the number of published works dealing with the problems of plastic bronchitis, both in world literature and domestic, is small. This review presents historical information on the study of plastic bronchitis, discusses the pathogenesis of the disease, taking into account the results of research over the past decades, lists the main and secondary clinical signs and symptoms, discusses the principles of modern therapy, including both invasive and non-invasive, physiotherapy, and treatment methods. As a clinical example, a case of plastic bronchitis in a 3-year-old boy who was treated in the intensive care unit and then in the infectious diseases department of the Z.A. Bashlyaeva State Clinical Hospital with a diagnosis of Idiopathic plastic bronchitis during one of the relapses of the disease from March 7, 2020 to March 22, 2020 is given. The diagnosis was previously made at the Morozov City Clinical Hospital.

Симптомокомплекс дивертикула уретры у женщин.

Introduction. Urethral diverticulum in women is one of the rarest urological diseases, its frequency ranges from 0.02 to 6%. Urethral diverticulum clinically manifests itself in patients between the third and fourth decades of life and its diagnosis is often difficult because urethral diverticulum can mimic other pelvic floor diseases. Often, incorrect diagnosis leads to the prescription of erroneous treatment for recurrent urinary infection, overactive bladder, urinary incontinence, chronic pelvic pain, etc. The aim of this article is to determine the correlation between the topographic-anatomical parameters of the diverticulum, clinical manifestations and results of surgical treatment. Methods and materials. For the purposes of the study, 50 patients with urethral diverticulum were included in the study. All patients were examined and operated on at the Department of Urology of A.I. Yevdokimov Moscow State University of Medicine and Density, on the basis of the S.I. Spasokukotsky State Clinical Hospital in the 3rd and 4th urological departments in the period 2019 to 2022. The duration of postoperative follow–up is 2 years. The results of the study were statistically processed. Results. Most often, patients with urethral diverticulum experience the classic triad of symptoms: dysuria, dispareunia, dribbling, as well as symptoms associated with an infectious-inflammatory process in the bladder and urethra. Analysis of symptoms showed that their presence and severity do not correlate with the size of the diverticulum. A statistically significant relationship was revealed between the size of the urethral diverticulum and the presence of postoperative complications. The larger the diverticulum, the higher the chance of complications in the postoperative period. The location of the urethral diverticulum does not affect the development of complications in the postoperative period. Conclusions. Based on the results of the study and analysis of the data obtained, the dependence of the frequency of complications (periodic increase in body temperature, weak stream during urination and stress form of urinary incontinence) after diverticulectomy via vaginal access on the size of the urethral diverticulum can be traced.

FEATURES OF THE MORPHO-FUNCTIONAL MYOCARDIUM STATE AND RELATIONSHIP WITH GALECTIN-3 IN PATIENTS WITH CHRONIC HEART FAILURE OF ISCHEMIC ORIGIN ON THE BACKGROUND OF METABOLIC PATHOLOGY

The aim. To evaluate the presence and nature of changes in the morpho-functional state of the myocardium in patients with coronary heart disease (CHD) with concomitant type 2 diabetes mellitus (T2DM) and obesity, depending on the functional class (FC) of chronic heart failure (CHF) and the relationship with the concentration of galectin-3 in blood serum.
 Materials and methods. The study involved 75 patients with CHD with concomitant metabolic diseases such as T2DM and obesity, who were treated in the cardiology department of the State Clinical Hospital No. 27. Patients were divided into groups according to the FC of CHF. Group 1 included 30 patients with CHF FC II, group 2 – 24 patients with CHF FC III, group 3 – 21 patients with CHF FC IV.
 Results. In patients with СHD and metabolic disorders with CHF FC III, the levels of end-systolic dimension (ESD) and end-diastolic dimension (EDD) were higher by 16.3 % and 17.9 %, respectively, compared with FC II, end-systolic volume (ESV) and end-diastolic volume (EDV) also increased significantly in patients of this cohort with FC III compared with CHF FC II by 35.8 % and 16.5 %, respectively. Significantly increased ESV, EDV by 42.9 % and 37.8 %, respectively, as well as the size of the left atrium by 14.3 % in patients of the study group who had CHF FC IV compared with FC III. The ejection fraction (EF) index decreased in patients of this cohort with CHF FC IV by 14.4 % compared with FC III. The size of the right ventricle was larger by 10.8 % in CHF FC IV than in FC III in patients with CHD on the background of comorbid metabolic pathology. Indicators of the thickness of the LV posterior wall, LV relative wall thickness and intraventricular septum were lower in patients with FC IV compared with FC II, left ventricle mass (LVM) and left ventricle mass index (LVMI) increased by 32 % and 33 %, respectively. Сomparing the levels of Ea/Es in patients with CHF FC II and IV in СHD with concomitant T2DM and obesity, a significant increase in this indicator was found in FC IV (p<0.05). The level of galectin-3 in patients with CHF FC III and IV of ischemic origin against the background of concomitant metabolic disorders was higher than in patients with FC II. Сomparing the concentration of galectin-3 in patients with CHF FC III and IV in patients with CHD with comorbid metabolic pathology, significantly higher levels were found in FC IV (p<0.05). The study of the relationship between the fibrosis factor galectin-3 and cardiohemodynamic parameters revealed probable links, namely direct links between galectinemia and ESV (r=0.52; p<0.05), EDV (r=0.58; p<0.05), Еа/Es (r=0.51; p<0.05).
 Conclusions. The growth of the functional class of chronic heart failure is accompanied by dilatation of the left cavities of the heart, a decrease in the inotropic function of the left ventricle, an increase in myocardial-arterial stiffness, and an increase in the levels of the galectin-3 fibrosis factor in the studied patients.

Case report of ultrasound-assisted nerve blockade of fascial plane by erector spine block in acute pancreatitis

Introduction. Pain in the intensive care unit is a common problem in patients with acute pancreatitis of various etiologies. Given the severity of the pain syndrome, as well as the low effectiveness of nonsteroidal anti-inflammatory drugs or antispasmodic therapy, it is often necessary to resort to the administration of opioid analgesics or epidural analgesia. Each of these pain management methods has certain disadvantages and contraindications, which makes it urgent to search for a safe and effective method of relieving pain in patients with pancreatitis or pancreonecrosis.Goal. To determine the effectiveness blockade of the nerves of the fascial space of the muscles’ erector spine in acute pancreatitis. Clinical observation. Patient X., 58 years old, was arrived to the emergency department of the V.M. Buyanov State Clinical Hospital with severe pain in the epigastric region (10 points out of 10 on the visual-analog scale).Conclusions. ESPB in a patient with acute biliary pancreatitis complicated by pancreonecrosis allowed to control pain syndrome quickly and safely. Further randomized clinical trials will allow to implement and optimize the technique, improving the clinical outcome.

АНЕМИЯ РАЗЛИЧНОЙ СТЕПЕНИ ТЯЖЕСТИ У ПАЦИЕНТОВ С ИНФАРКТОМ МИОКАРДА С ПОДЪЕМОМ СЕГМЕНТА ST

Abstract. Introduction. Anemia associated with cardiovascular diseases, particularly with myocardial infarction, is a significant risk factor for adverse outcomes. At the same time, it is poorly known about the issue of acute blood circulatory disturbances during myocardial infarction in the setting of anemia of varying severity degrees. Our aim was to study the at-admission hemoglobin levels in patients with ST-elevation myocardial infarction with favorable and fatal outcomes of hospitalization. Material and Methods. We selected 177 records of patients with fatal outcomes of and 380 records of patients discharged with favorable outcomes of ST-elevation myocardial infarction from the emergency departments for patients with acute coronary syndrome of State Clinical Hospital 7, Kazan. The study included 349 men and 208 women aged 32 to 96 years, median age being 67 (58–76) years. Results and Discussion. Incidence of anemia (hemoglobin lower than 130 g/l in men and 110 g/l in women) in the group of patients under study with favorable and fatal hospitalization outcomes was significantly different and amounted to 8.7% and 18.1%, respectively (p = 0.001). Probability of unfavorable outcomes in the group of patients with anemia was 2.32 times higher than that in the group of patients without anemia, the differences in odds were statistically significant (95% CI: 1.38 - 3.92; p = 0.001). Moderate and severe anemia (Hb <90 g/l) was more common in patients with unfavorable outcomes than in patients with favorable outcomes of hospitalization, i.e., in 43.8% and 15.2% of cases, respectively. Odds of an unfavorable outcome were 4.35 times higher in patients with moderate to severe anemia than in patients with mild anemia, the difference in odds was statistically significant (95% CI: 1.34 - 14.08, p = 0.015). Conclusions. Anemia in an ST-elevation myocardial infarction patient is associated with a 2.32 greater chance of an unfavorable outcome. A decrease in hemoglobin level below 90 g/L in a patient with ST-elevation myocardial infarction is associated with a 4.35 times greater chance of an unfavorable outcome.

Endoscopic experience of treatment of patients with thyroid and parathyroid gland pathology at S.S. Yudin State Clinical Hospital

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The level of stress in pregnant women during hospitalization in the Pregnancy Pathology department

Introduction and aims. Pregnancy is a physiological state for a woman. However, if pathology develops, the course of pregnancy is affected by both mental and biological stress. Stress experienced during pregnancy may irreversibly alter the cerebral structures in the foetus. Moreover, chronic stress is likely to cause miscarriage, preterm delivery, IUGR, low birth weight, etc.
 The aim of the study was to analyse the stress level in hospitalized pregnant women with account forsociodemographic factors.
 Material and methods. The study was carried out in a group of 140 pregnant women hospitalized in the Department of Pregnancy Pathology, Independent State Clinical Hospital No.1 in Lublin. Inclusion criteria for the study were: age 18 or older, established pregnancy, and hospitalization for more than 2 weeks in a pregnancy pathology department. The participants were diagnostically surveyed by the Perceptible Stress Scale (PSS-10) and a questionnaire created for the study.
 Results. Almost every second (76; 54.3%) pregnant woman demonstrated low level of stress, 13.6% (n=19) respondents showed average level, and high level was detected in 32.1% (n= 45) of the respondents. A statistically significant correlation was found between the level of perceived stress and education (p=0.031), financial situation (p=0.017).
 Conclusions. During hospitalization, nearly every third pregnant woman was affected by a high level of stress. The very fact that the health of the child and/or pregnant mother is found to be at risk is already a source of stress for the woman. Higher intensity of stress - statistically significant concerned mothers with professional education and average financial situation. Data from reports in the literature indicate that stress during pregnancy can also negatively affect the health of the psycho-physical diady- mother child. Further research in this area is needed, along with the possibility of taking measures to promote the psychophysical comfort of hospitalized mothers.

Pharmacoepidemiological analysis of the consumption of antibacterial drugs for the treatment of patients with nosocomial infections associated with previous hospitalization in multidisciplinary hospitals in the Tomsk region

BACKGROUND: Healthcare-associated infections (HAIs) are one of the common complications associated with patients stay in a medical organization. An urgent practical problem is the choice of antibiotic therapy for the treatment of patients with nosocomial infections because these infections are caused by antibiotic-resistant strains. HAIs associated with previous hospitalization (HAPH) manifest in patients after discharge from the hospital, and their risk of isolating resistant strains often remains unrecognized by specialists. Thus, more studies are required to examine the structure of HAPH pathogens and patterns of consumption of antibacterial drugs for the treatment of HAPH to further determine antibiotic therapy in these patients.
 AIMS: To analyze the use of antibiotic therapy for the treatment of HAPH with known etiological agents and the level of antibiotic resistance.
 MATERIALS AND METHODS: The study analyzed the results of a multicenter descriptive retrospective study based on the Clinics Siberian State Medical University and the State Clinical Hospital No. B.I. Alperovich (Tomsk). A total of 108 HAPH cases were examined according to the medical records of inpatients (Form 003/y). For pharmacoepidemiological analysis, the anatomical therapeutic chemical/defined daily dose (DDD) methodology was used, and antibiotic intake was assessed using the number of established daily doses. The etiological structure of HSV microorganisms was evaluated using the AMRcloud online platform. Quantitative and qualitative indicators were presented as shares (%) and absolute numbers.
 RESULTS: In total, 116 isolates from patients with HAPH were assessed. Klebsiella pneumoniae, Klebsiella oxytoca, Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli were the dominant pathogens causing HAPH in the overall distribution of pathogens. For the treatment of these patients, a wide range of drugs was used, including 13 groups of antibiotics. In most cases, the parenteral route of drug administration was used: intravenous route, 56.0%; intramuscular, 28.0%; and oral, 16.0%. The DDD analysis showed that antibiotic intake for the treatment of patients with HAPH was 137.8 NDDD/100 bed-days; surgical infection, 48.2 NDDD/100 bed-days (35.0%); and pneumonia, 89.6 NDDD/100 bed-days (65.0%). Cephalosporins were the most commonly used group of antibiotics for both surgical infection and pneumonia, mainly third-generation cephalosporins.
 CONCLUSION: Etiological agents of HAPH are phenotypically similar to nosocomial strains. Among antibacterial drugs, cephalosporins and fluoroquinolones were mainly consumed, and HAPH isolates had unfavorable resistance profiles to these drugs.

Clinical and laboratory characteristics of patients with type 2 diabetes and diabetic foot syndrome

Background: Diabetes mellitus (DM) is one of the most common chronic diseases, leading to the development of many complications includingdiabetic foot syndrome (DFS). The problem of a progressive increase in the number of patients with DFS and the high risk of amputation in the population of patients with DM requires research to identify risk factors and specify ways to correct them.Aim: To study the clinical and laboratory characteristics of patients of the limb rescue center suffering from type 2 diabetes (DM2).Materials and Methods: A retrospective analysis of 729 medical histories of patients with T2D hospitalized in the foot rescue department of the limb rescue center of the State Clinical Hospital named after V.P. Demikhov in the period between 2019 and 2020 was carried out. An analysis of anamnestic data, clinical and laboratory parameters, drug therapy, the nature of surgical intervention and the outcome of hospitalization was performed. The statistical analysis was carried out using STATISTICA 8.0.Results: The study included 729 patients with T2D. Men dominated among patients (58%). The median of age was 66 [59.0; 73.0] years. 50.89% had experience of diabetes for more than 10 years. 53% of these patients had DFS, 79.2% had diabetic polyneuropathy, 45% had previously undergone amputation of the lower extremity, 24.8% had revascularization. A significant proportion of patients at admission had uncontrolled high level of glycemia. The median of glucose level was 9.9 mmol/l [7.2; 13.8]. Median meaning of HbA1c was 7.8% [6.7; 9.1]. BMI and lipid profile were not evaluated in all patients. In the department 224 patients were diagnosed with DFS for the first time. Gangrene prevailed among the ulcerative-necrotic complications of DFS. Arterial hypertension (AH) prevailed among the concomitant pathologies. GFR ˂ 60 ml/min/1.73m2 was observed in 45.36% of patients. According to X-ray data, 27.16% of patients (107 out of 394) showed signs of impaired bone density. In the department, 113 patients underwent revascularization, 372 — amputation of the lower limb, while 37 patients (9.95%) underwent amputation at the level above the knee, and 335 (90.05%) — at the level below the knee. Only 244 patients received local treatment among patients with DFS. A total of 718 patients were discharged; 11 patients died. The median duration of hospitalization of discharged patients was 13.0 [9.0; 18.0] bed days, the average duration of hospitalization of deceased patients was 11.31±2.21 (95% CI 6.49–16.13) bed days.Conclusion: Most of the patients with DM2 and DFS had prolonged decompensation of carbohydrate metabolism, dyslipidemia, increased BMI, hypertension. The study concluded that it is important to monitor and correct risk factors to improve the prognosis of the disease.

Acetylsalicylic acid as the only pharmacological method for the prevention of preeclampsia: A retrospective study

Background. Preeclampsia (PE) complicates 28% of pregnancies worldwide, negatively impacting the pregnant woman and the fetus. Therefore, its prevention remains relevant. It is believed that the cause of PE, especially early PE, is a placentation disorder. It warrants studying drugs that can improve placenta development. The leadership in this matter is maintained by acetylsalicylic acid, which, according to the ASPRE study, reduced the incidence of PE at 34 weeks of pregnancy by 82%. The use of low molecular weight heparins (LMWH), dipyridamole, and antioxidants for PE prevention remains controversial and continues to be studied by foreign and Russian scientists.
 Aim. To assess the efficacy of acetylsalicylic acid, LMWH, dipyridamole (Curantyl), and bovine blood derivates (Actovegin) in the Russian population of pregnant women at high risk for PE prevention.
 Materials and methods. The study included 244 patients. We reviewed the archived case records of 103 patients diagnosed with severe PE, who delivered in 2019 at the State Clinical Hospital №24, and 141 pregnant women from the Maternity clinic №3 at the Veresaev Moscow State Clinical Hospital, where the risk of PE was assessed as high, according to the results of extended combined screening of the first trimester of pregnancy. Eighty-nine pregnant women received acetylsalicylic acid at a dose of 75 mg and 54 at a dose of 150 mg. In addition, 22 patients received LMWH, 6 dipyridamole, and 3 Actovegin. The absolute risks, the risk ratio, and statistical significance when taking drugs in each risk group were calculated to assess the efficacy of acetylsalicylic acid and other drugs for PE prevention in the above risk groups.
 Results. The resulting weak inverse correlation (r=-0.31) between the PE severity at delivery and the dose of acetylsalicylic acid indicates that an increase in the acetylsalicylic acid dose was associated with a decrease in the PE severity. The effectiveness of combinations of various drugs for PE prevention was assessed by analyzing factor correspondences. Two-dimensional scaling of the most likely combinations showed that most patients received acetylsalicylic acid in the high-risk group with no PE. Additional use of LMWH, Curantyl, and Actovegin did not reduce the risk of PE.
 Conclusion. Acetylsalicylic acid is the only pharmaceutical method for preventing PE in high-risk groups. Higher doses of acetylsalicylic acid are associated with lower PE severity.

Study of blood microcirculation in the area of purulent inflammatory process in patients with phlegmon of the maxillofacial region with the analyzer “LASMA PF”

The article is devoted to the assessment of the state of the microcirculatory bed of the skin in the purulent-inflammatory process in patients with phlegmon of the maxillofacial region who were treated in the maxillofacial department of the Moscow Pirogov State Clinical Hospital. Microcirculation parameters were recorded by laser Doppler flowmetry (LDF) with simultaneous temperature recording directly from the skin in the area of purulent-inflammatory infiltrate, by applying the apparatus of the analyzer «LASMA PF» to the patient’s skin. The diagnosis by the analyzer «LAZMA PF» is based on the simultaneous assessment of the activity of the tissue coenzyme of the reduced nicotinamide adenine dinucleotide (NADH) by fluorescence spectroscopy and indicators of microcirculation of blood flow by laser Doppler flowmetry. It is concluded that the differences obtained during the study between microcirculatory disorders in the purulent-inflammatory process and the healthy side indicate the need for drug therapy that regulates blood rheology and the state of the microcirculatory bed.

Treating patients with deep mycoses of the maxillofacial region against a COVID-19 background

BACKGROUND: Complications characterized by necrosis of the nasal mucosa and the hard palate, as well as the middle and lower nasal concha with exposure of the alveolar process, destruction of the posterior wall of the maxillary sinus and the bottom of the orbit caused by a fungal infection were noted during the COVID-19 pandemic. By January 2022, such cases had been documented in 18 countries worldwide. The main predisposing factors for this condition are diabetes mellitus and inadequate use of corticosteroids. Rhinocerebral mucormycosis or zygomycosis is a rare disease caused by filamentous fungi affecting the nose, paranasal sinuses, and brain.
 AIM: To present the treatment strategy for patients with deep mycoses of the maxillofacial region against a background of transferred COVID-19 in the State Clinical Hospital named after F.I. Inozemtsev DZM.
 MATERIAL AND METHODS: Fifteen patients with a cerebral form of mucormycosis of the maxillofacial region arose against a background of a new coronavirus infection associated with SARS-CoV-2.
 RESULTS: The study shows the importance of timely initiation of radical surgical treatment for the rhinocerebral form of mucormycosis in the maxillofacial region, which arose against the background of SARS-CoV-2, to prevent the spread of osteomyelitic foci in bone tissue.
 CONCLUSION: Early diagnosis of mucormycosis, timely treatment with antipsychotic medications and surgical intervention, control of the level of glycemia, and reasonable use of corticosteroids prevented the development of complications.

A case of polymorphic leukocytoclastic vasculitis associated with renal neoplasia

Objective: to describe a clinical case of polymorphic leukocytoclastic vasculitis (PLCV) associated with renal neoplasia.Materials and methods. Patient K., a man, 67 y. o., was admitted to the surgical department No. 2 of the N. I. Pirogov State Clinical Hospital No. 1 with cardiac complaints and heart failure decompensation symptoms, severe respiratory insufficiency associated right lower lobe pneumonia. Besides cardiac function evaluation and pneumonia managing there was a conducting of differential diagnostic search to clarify the genesis of ulcerative necrotic rashs among systemic vasculitis, paraneoplastic syndrome including hematologic problems and sepsis.Results. It was no data for systemic connective tissue diseases and systemic vasculitis during clinical examination and immunological diagnostics. On contrast-enhanced multispiral computed tomography of abdomen and retroperitoneal space there was latent malignant neoplasia of left kidney Т2аN1M0. PLCV was considered to paraneoplastic syndrome associated with malignancy. Due to the progression of vasculitis and the patient’s refusal of surgical treatment was prescribed GC 0.5 mg / kg / day as a result positive dynamics was noted.Conclusion. This clinical case demonstrates necessity of providing examination aimed at malignancy excluding for early neoplasm’s detecting for patients with vasculitis.

ЛИПОМА КАК СЛУЧАЙНАЯ НАХОДКА В АБДОМИНАЛЬНОЙ ХИРУРГИИ

Primary neoplasms of the abdominal cavity are rare and usually have a mesenchymal origin. Lipoma is a benign mature tumor of adipose tissue, it occurs more often in women aged 30 to 50 years. Retroperitoneal lipoma is a rare variant of lipoma, manifested by various signs and symptoms that can mislead specialists. Lipomas are more common in abdominal surgery in the gastrointestinal tract. In this localization, the main pathognomonic complication is intestinal intussusception. Diagnosis is difficult, due to the relatively slow growth of education, characteristic clinical manifestations may be absent for a long time. X-ray imaging is the preferred diagnostic method. To date, surgical resection is the priority method of treatment of this pathology. The analysis of scientific literature on the occurrence of abdominal lipomas is carried out. The diagnostic significance in assessing the condition and complications of lipomas has been studied. Clinical cases from personal practice on the basis of the State Clinical Hospital named after him are presented. Yudina. Patients with diagnoses of giant retroperitoneal lipoma and complicated small intestine lipoma by female intussusception aged 62 and 78 years, respectively. The first clinical case demonstrates the randomness of the determination of lipoma in a patient admitted to the clinic with a closed craniocerebral injury and a wound of the soft tissues of the head. Ultrasound of the abdominal cavity showed the presence of a large retroperitoneal formation of an inhomogeneous consistency. During laparotomy, a giant fatty tumor with clear boundaries was revealed, closely adjacent to the adipose tissue of the retroperitoneal space. Lipoma was removed, drainage of the abdominal cavity and retroperitoneal space was performed. Histopathological examination confirmed the diagnosis of retroperitoneal lipoma. The weight of the lipoma was 10.610 kg. The postoperative period proceeded without complications. The second clinical case shows how a long-term undiagnosed lipoma of the gastrointestinal tract leads to a complicated course, namely intussusception. Patient A. 78 years old with discomfort and abdominal pain during the last few weeks, small intestine invagination was detected using ultrasound. Diagnosis upon admission: acute pancreatitis. A resection of the altered section of the small intestine was performed. The postoperative period was favorable. The patient was discharged on the 10th day. The presented clinical cases of this disease once again confirm the importance of timely dispensary diagnosis of abdominal tumors.

Chronic Liver Diseases and COVID-19: Database of General Hospital

Patients with chronic liver diseases (CLD) are at high risk of infection and severe COVID-19 (Corona Virus Disease).Aim: to create a database of patients with CLD, including an analysis of the frequency of detection of SARS-CoV-2 markers, the causes of hospitalization, an assessment of 30-day mortality in the presence of COVID-19 markers and in the absence of infection.Materials and methods. A one-time retrospective observational comparative study was conducted, the result of which was the creation of a database. 693 electronic case hystories of patients with CLD of various etiologies hospitalized in the V.M. Buyanov State Clinical Hospital for the period 01.04.2020–01.10.2021 were analyzed. Th e analysis included the following parameters: gender, age, etiology of the disease, reasons for hospitalization, the presence of ribonucleic acid (RNA) SARS-CoV-2 in a smear of the nasal mucosa and oropharynx, antibodies to SARS-CoV-2 immunoglobulins of classes M, G (IgM, IgG), the outcome of the disease (30-day mortality).Results. Markers of past new coronavirus infection (IgG) were detected in 268 (38,7 %), SARS-CoV-2 RNA was detected in 67 (9,7 %). Th e analysis of the causes of hospitalization revealed the predominance of edematous ascitic syndrome (64,5 %), an increase in hepatic encephalopathy (31,6 %) and an increase in the number of cases of portal vein thrombosis (PVT) (8,9 %). When assessing the 30-day mortality, signifi cant diff erences were found in patients with Alcohol-related liver disease (ARLD), chronic viral hepatitis in the presence of COVID-19 markers and in cases of their absence.Conclusion. SARSCoV-2 markers were found in 335 (48,3 %) of patients with CLD. Th e main reason for hospitalization is the appearance /increase of edematous ascitic syndrome, including due to PVT. 30-day mortality in the postcovid period is signifi cantly higher (р = 0,0246) in ARLD compared with patients without COVID-19 (218 (34,9 %) и 300 (25,3 %), respectively, р = 0,0246).