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Observations of pigmented (melanoblastic) and non-pigmented (achromatic) superficial melanomas of the skin are described, for the differential diagnosis of which, along with traditional histological examination, precision (immunohistochemical, molecular genetic) methods of studying the morphological substrate of the tumor were used. Based on the results of Raman spectroscopy of samples of both tumors, their multiplex analysis was carried out, with the help of which a significant number of molecules of various analytes were simultaneously identified in one individual sample of a biological object.

Introduction . The choice of the method and time of initiation of extracorporeal detoxification (ECD) in septic shock (SSh) complicated by acute kidney injury (AKI) is a debatable problem.The objective was to evaluate the influence of various ECD tactics on the dynamics of markers of systemic endotoxicosis and acid-base status (ABS) in patients with SSh complicated by AKI.Materials and methods. Study included 57 patients. Group 1 – 36 patients used continuous veno-venous hemodiafiltration (CVVHDF) for urgent indications. Group 2 – 21 patients used early combined ECD (LPS-sorption and CVVHDF). A comparative analysis of the main laboratory parameters between the groups was performed.Results. Early combined ECD made it possible to reduce the concentration of leukocytes by the 3rd day of therapy from 20.6 to 12.5 ·109/l (39.3 %) from the initial level in group 2, and from 22.2 to 19.15·109/l (13.7 %) in group 1 ( p=0.04); C-reactive protein by the 5th day of therapy from 284 to 145 mg/l (48.9 %) in group 2, and from 299.3 to 199.8 mg/l (33.2 %) in group 1 ( p=0.02); procalcitonin by the 5th day of therapy from 7.2 to 1.6 ng/ml (77.8 %) in group 2, and from 7.8 to 4.45 ng/ml (42.9 %) in group 1 ( p= 0.02); pH by the 3rd day of therapy from 7.17 to 7.37 in group 2, and from 7.19 to 7.27 in group 1 (p =0.04); IL-6 level by the 5th day of therapy from 764.9 to 361.7 pg/ml (52.7 %) in group 2, and from 700.1 to 542.5 pg/ml (22.5 %) in group 1 (p=0.007).Conclusions. Early combined ECD more quickly reduces markers of systemic endotoxicosis and eliminates impairment of ABS, than CVVHDF.

Competent triage of patients with COVID-19 pneumonia is not only about efficient allocation of hospital resources, but also about making timely decisions that can ultimately save the patient's life. When healthcare facility is overloaded, computed tomography to assess the severity of COVID-19-associated pneumonia in each individual case is not always possible. Alternative solutions, however, are opted.The aim of the study was to develop Lung UltraSound (LUS) protocols with high diagnostic potential for assessing the severity of pneumonia caused by COVID-19, which can be reliably used instead of CT during triage in an emergency setting.Materials and methods. We conducted a retrospective analysis of data on 161 hospitalized patients with confirmed pneumonia caused by COVID-19, subjected to both CT and LUS within 24 hours after hospitalization. Three consecutive LUS protocols, including two LUS developed by the NMHC (National Medical Surgical Center) authors, were tested to choose the most reliable protocol for assessing the severity of lung damage in pneumonia caused by COVID-19 (based on correlation with chest CT results). We also checked the applicability of LUS for the prognosis of the disease.Results. Moderate (50% CT) and severe (50% CT) lung damage can be distinguished when using both - the 16-zone and 12-zone LUS NMHC scanning protocols. The AUC for the ROC curves was almost identical: 0.83 (95% CI: 0.75–0.90 and 0.81 (95% CI: 0.73–0.88) for the 16-zone and 12-zone LUS NMHC protocols, respectively. The 16-zone LUS NMHC had an optimal threshold of 20 scores with a sensitivity of 67% and a specificity of 82%, while the 12-zone LUS NMHC provided an optimal threshold of 15 scores with the same sensitivity but lower specificity — only 73%. Neither the 16-zone nor the 12-zone NMHC LUS protocols could predict the outcome.Conclusion. The newly developed 16- and 12-zone LUS NMHC scanning protocols for patients with pneumonia caused by COVID-19 proved to be easy to implement, demonstrating a strong correlation with CT results. The 16-zone LUS NMHC protocol is probably more relevant for triage of patients with more than 50% of pulmonary tissue involvement based on CT data. Both protocols can be useful in emergency settings and in medical institutions with limited or no access to CT.

АКТУАЛЬНОСТЬ: Экстренные операции аортокоронарного шунтирования (АКШ) сопряжены с риском постперфузионного системного воспалительного ответа (СВО). Профилактическое применение высоких дозировок аскорбиновой кислоты, обладающей антиоксидантным и иммуномодулирующим эффектом, может быть обоснованным, но в данной клинической ситуации недостаточно изучено. ЦЕЛЬ ИССЛЕДОВАНИЯ: Определить возможности профилактики аскорбиновой кислотой СВО при экстренном АКШ в условиях искусственного кровообращения. МАТЕРИАЛЫ И МЕТОДЫ: В проспективное ранодомизированное исследование было включено 60 пациентов (32 мужчины и 28 женщин, средний возраст 63 (59; 70) года, перенесших операцию АКШ (3 ± 1 шунт), выполненную по экстренным показаниям в условиях искусственного кровообращения 95 (77; 122) мин. Пациентов рандомизированно разделили на две группы. Пациентам основной группы (n = 30) превентивно за 1 ч до кожного разреза внутривенно вводили 4 г аскорбиновой кислоты, пациентам контрольной группы (n = 30) проводили стандартную предоперационную профилактику СВО. РЕЗУЛЬТАТЫ: Применение аскорбиновой кислоты (n = 30) сопровождалось снижением частоты проявлений СВО (20 и 47 %; p = 0,048) и сокращением сроков послеоперационной госпитализации (9 [8; 10] и 11 [10; 16] сут; p = 0,013). ВЫВОДЫ: Профилактическое применение аскорбиновой кислоты безопасно, позволяет снизить частоту отдельных проявлений СВО и длительность послеоперационной госпитализации.

ЦЕЛЬ ИССЛЕДОВАНИЯ: Обосновать рекомендации по внедрению концепции и технологий цифровизации службы анестезиологии и реаниматологии (АиР) в многопрофильных стационарах для решения задач обеспечения безопасности пациентов и медицинского персонала. МАТЕРИАЛЫ И МЕТОДЫ: В исследовании представлены данные по внедрению информационных технологий в практику службы АиР на основании сведений, полученных при анкетировании 235 специалистов по АиР, работающих на руководящих должностях в различных категориях учреждений здравоохранения. Метод сбора информации: самостоятельное заполнение экспертами онлайн-версии анкеты. Принцип построения выборки: преднамеренный. Период проведения опроса: 12 апреля 2023 г. — 4 августа 2023 г. РЕЗУЛЬТАТЫ: В 87 % стационаров медицинская информационная система (МИС) службы АиР является частью МИС учреждения. Лишь в 23 % больниц все рабочие места врача — анестезиолога-реаниматолога подключены к МИС. Вход на персональное электронное рабочее место по правам доступа на любом из персональных компьютеров подтвердили 87 % респондентов. Стационары, в которых анестезиологическое и реанимационное оборудование не интегрировано в МИС, составляют 89 %. В случае отделений с локальной информационной системой АиР к ней подключено оборудование в 44 % аналогичных отделений. По данным опроса, только в 51 % медицинских учреждений информационная система АиР получает данные с лабораторной информационной системы, показатели интегрированности с радиологической информационной системой еще ниже и составляют всего 34 %. Исследование выявило значимую проблему с внедрением в МИС клинических рекомендаций, справочников лекарственных средств, а также протоколов профилактики и манипуляций, различных требований, и особенно шкал/индексов для оценки состояния пациентов. ВЫВОДЫ: Для полноценного функционирования МИС необходимы организационные решения, направленные на реализацию первостепенных и перспективных задач. Разработка и применение современных МИС в АиР будут способствовать дальнейшему развитию специальности и обеспечению безопасности пациентов и надлежащего качества оказания медицинской помощи. Необходима унификация требований к разработчикам МИС по основным составляющим, обязательным в функционале.

АКТУАЛЬНОСТЬ: Инфузионная терапия — основной метод коррекции патологических изменений, которые возникают в фазу «асептического» воспаления при остром панкреатите. ЦЕЛЬ ИССЛЕДОВАНИЯ: Обобщить актуальные данные о схемах инфузионной терапии у больных с острым деструктивным панкреатитом, целесообразности применения различных инфузионных растворов и вариантов мониторинга эффективности терапии. МАТЕРИАЛЫ И МЕТОДЫ: Исследование выполнено в соответствии с международными требованиями отчетности для обзоров (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Поиск осуществлялся в поисковых системах сети Интернет Pubmed и Cochrane Controlled Clinical Trials Register. Для отбора статей также был применен метод поиска по ссылкам литературы. Стратегия поиска не предусматривала ограничений по языку, типу и дате статьи. РЕЗУЛЬТАТЫ: Проведенный анализ данных литературы выявил два подхода к инфузионной терапии. Первоначальный интерес к «агрессивным» (4 л/сут и более) схемам инфузионной терапии в первые 24 ч заболевания в настоящее время сменился тенденцией к менее «агрессивным» схемам в связи с появившимися работами о высокой частоте различных осложнений (прогрессирование органной дисфункции, местные осложнения). Рассматривая качественный состав инфузионной терапии, безусловно, предпочтение следует отдавать кристаллоидам. Базовый мониторинг инфузионной терапии должен включать неинвазивные методы: частоту сердечных сокращений, среднее артериальное давление, темп диуреза. ВЫВОДЫ: Анализ продемонстрировал различные подходы к тактике инфузионной терапии у данной категории больных. Необходимо дальнейшее исследование вопросов эффективности и безопасности инфузионной терапии с учетом различной степени тяжести острого панкреатита, возможности влияния качественного состава инфузии на течение данного заболевания и формирование рекомендаций стартовой и поддерживающей инфузионной терапии, основанных на принципах персонализированной медицины.

АКТУАЛЬНОСТЬ: В настоящее время данные об эмоциональном выгорании и о его предикторах недостаточно изучены среди сотрудников отделений анестезиологии и реанимации. При этом выгорание связано со снижением качества медицинской помощи, безопасностью пациентов, а также с качеством жизни самих врачей. Анонимное исследование было проведено в нескольких клиниках России. ЦЕЛЬ ИССЛЕДОВАНИЯ: Оценить уровень удовлетворенности жизнью, благополучие, эмоциональное выгорание и депрессию сотрудников отделений анестезиологии-реанимации. МАТЕРИАЛЫ И МЕТОДЫ: Опросник выгорания Маслач (Maslach Burnout Inventory). Проективная психологическая методика «Незаконченные предложения» (на основе Sacks sentence completion test), апробированная Г.Г. Румянцевым. Шкала безнадежности Бека (Beck Hopelessness Inventory). Шкала депрессии Бека (Beck Depression Inventory). Satisfaction with Life Scale — шкала удовлетворенности жизнью (E. Diener, R.A. Emmons, R.J. Larsen, S. Griffin). Brief Inventory of Thriving (BIT) (R. Su, L. Tay, E. Diener) — шкала процветания, психологического благополучия. РЕЗУЛЬТАТЫ: Средний уровень удовлетворенности жизнью анестезиологов составил 14,7 балла, что соответствует уровню неудовлетворенности, у реаниматологов и сестер/санитаров 19 баллов и 17,7 балла соответственно — ниже среднего уровня. Средний и высокий уровни выгорания по всем трем субшкалам имели: 32,77 % анестезиологов, 52,26 % реаниматологов, 33,7 % сестер/санитаров. Симптомы депрессии разной степени выраженности выявляются у 83,62 % анестезиологов, 80 % реаниматологов и у 51,7 % сестер/санитаров. ВЫВОДЫ: Необходимым сегодня является не только своевременное выявление первых симптомов выгорания, но и оценка уровня удовлетворенности жизнью и работой врачей, поскольку данные показатели могут непосредственно влиять на качество оказываемой медицинской помощи. Возможно, что еще больший интерес к проблеме выгорания врача и большее количество публикаций по данной теме станут тем элементом, который стимулирует медработников обратиться за психологической помощью.

АКТУАЛЬНОСТЬ: Частота развития, спектр и патофизиологические взаимосвязи основных клинических проявлений системного воспалительного ответа при экстренном аортокоронарном шунтировании (АКШ) не до конца изучены. ЦЕЛЬ ИССЛЕДОВАНИЯ: Определить клиническое значение системного воспалительного ответа (СВО) при экстренном АКШ, выполняемом в условиях искусственного кровообращения (ИК). МАТЕРИАЛЫ И МЕТОДЫ: Обследовали 60 пациентов (мужчины, n = 38, и женщины, n = 22; средний возраст 65 ± 9 лет), перенесших экстренное АКШ (3 ± 1 шунт) в условиях ИК (97 ± 47 мин). Ретроспективно изучили клинико-лабораторные данные периоперационного и раннего послеоперационного периода при экстренном и плановом АКШ. РЕЗУЛЬТАТЫ: У экстренно оперированных пациентов (n = 30) в раннем послеоперационном периоде отметили большую частоту (53,3 и 13,3 %; p = 0,0022) развития системных проявлений воспалительного ответа (нейтрофильный лейкоцитоз, лихорадка, постперфузионная вазоплегия), а также респираторных осложнений (70 и 10 %; p

Purpose of the study: differential diagnosis of tumors arising from the mediastinum, as well as the analysis of the biological potential of the tumor, taking into account the relatively low incidence of these tumors among the population.Material and Methods. Macroscopic and microscopic examinations of the surgical specimen were performed using routine H&E staining. Immunohistochemical staining of paraffin-embedded tissue sections was performed using a Roche Ventana BenchMark Ultra system. The results obtained were evaluated taking into account the available literature data published on this nosology.Description. We present a rare case of a benign neoplasm of the thymus, lipofibroadenoma (LFA), which was localized in the left pleural cavity and originated from the anterior mediastinum with partial compression of the lower lobe of the left lung in a 59-year-old man. The tumor was revealed during a routine medical examination. The patient underwent left-sided thoracotomy with complete excision of the tumor and anterior mediastinal lymph node dissection. Macroscopic examination reveled that the tumor was predominantly composed of adipose tissue with fibrous layers. Histological examination showed a tumor composed of mature adipocytes of various sizes, among which remnants of the thymus with Hassal’s bodies and small number of lymphocytes and calcifications were found. Areas of fibrous stroma predominated over narrow strands of anastomosing epithelial cells with clear nuclei. Epitheliocytes formed slit-like structures infiltrated with lymphocytes, resembling the structure of breast fibroadenoma. Immunohistochemical examination revealed that epithelial cells were positive for PanKeratin and CK19, lymphocytes were positive for CD3 and CD20, and thymic cells expressed TdT. In this case, the neoplasm was almost asymptomatic, in contrast to previously published observations, which described an association with erythrocyte aplasia.Conclusion. Considering the clinical, histological and immunohistochemical data, it was feasible to make a differential diagnosis of the neoplasm and determine the histological type of the tumor as lipofibroadenoma.

АКТУАЛЬНОСТЬ: Относительно эффективности эритропоэтина в сочетании с пероральной ферротерапией для коррекции послеродовой анемии имеются ограниченные данные. ЦЕЛЬ ИССЛЕДОВАНИЯ: Оценить эффективность эритропоэтина в сочетании с пероральными добавками железа по сравнению с пероральной ферротерапией у родильниц, перенесших послеродовое кровотечение. МАТЕРИАЛЫ И МЕТОДЫ: В MEDLINE, Scopus, EBSCOhost и 5 других базах (с января 1980 г. по февраль 2023 г.) проведен поиск статей о применении пероральных препаратов железа в комбинации с эритропоэтином и без него для лечения постгеморрагической анемии у родильниц. Первичные конечные точки: уровень гемоглобина, прирост гемоглобина, гематокрит, число гемотрансфузий, вторичные: уровень ферритина, сывороточного железа, способность к лактации. Анализ выполнен в соответствии с руководством PRISMA, 2020. РЕЗУЛЬТАТЫ: Проанализировано 4 исследования, 198 женщин. При использовании эритропоэтина в сочетании с пероральной ферротерапией накопленное значение прироста концентрации гемоглобина через 5 дней, 2 нед. от начала лечения значимо выше по сравнению с контролем (разность средних, mean difference [MD] 11,83 г/л, 95%-й доверительный интервал [95% ДИ] 4,43–19,23; p = 0,002; MD 10,13 г/л; 95% ДИ 4,97–15,29; р = 0,0001) соответственно. Накопленное среднее значение концентрации гемоглобина через 40 дней значимо выше в группе эритропоэтина (MD 11,00 г/л, 95% ДИ 1,70–20,30; р = 0,02). Накопленное среднее значение гематокрита через 2 нед. значимо выше в группе эритропоэтина (MD 3,35 %, 95% ДИ 0,31–6,39); р = 0,03). Применение эритропоэтина в комбинации с пероральной ферротерапией снижает вероятность гемотрансфузии (относительный риск 0,12, 95% ДИ 0,02–0,95; р = 0,04). ВЫВОДЫ: Показан более быстрый гематологический ответ при сочетанном применении эритропоэтина с пероральной ферротерапией по сравнению с монотерапией препаратами железа при коррекции постгеморрагической анемии у родильниц. Требуются дальнейшие исследования с достаточными объемами выборок.

В статье представлены основные положения клинических рекомендаций по септическому шоку у взрослых, утвержденных Общероссийской общественной организацией «Федерация анестезиологов и реаниматологов» в 2023 г. Актуальность проблемы связана со значительной распространенностью и высокими показателями летальности при септическом шоке. Рекомендации включают вопросы этиологии, патогенеза, клинической картины, методов лабораторной и инструментальной диагностики септического шока. Представлена стартовая интенсивная терапия септического шока, включая подходы по назначению вазопрессорных и инотропных препаратов, рекомендации по выбору антибактериальных препаратов, особенности инфузионной и адъювантной терапии, в том числе при рефрактерном к терапии септическом шоке. Обсуждены вопросы хирургического лечения очага инфекции. Представлены критерии качества оказания медицинской помощи взрослым пациентам с септическим шоком и алгоритмы действий врача при диагностике и интенсивной терапии пациентов с септическим шоком.

Rhabdomyolysis (RM) is a clinical and laboratory syndrome accompanied by systemic endotoxicosis, a consequence of myocyte destruction and is manifested by acute kidney injury (AKI). The use of extracorporeal detoxification in the early stages of AKI is currently not recognized due to the lack of proven effectiveness.The objective: to demonstrate the effectiveness of selective hemoperfusion (HP) and hemodiafiltration (HDF) in a patient with toxic RM complicated by AKI.Subjects and methods. The article presents a clinical observation of an 18-year-old patient after the use of 4-methylmethcathinone (mephedrone) with development of AKI. Clinical, laboratory, diagnostic, toxicological and instrumental methods of examination were used. HP and HDF were used together with standard intensive therapy.Results. Combined use of HP and HDF was accompanied by regression of markers of endotoxicosis and AKI. A decrease in myoglobin level was noted by 50.3%, 80.3% and 94.1%, respectively, after the 1st and 2nd procedures and by the 5th day. CPK (creatine phosphokinase) decreased by 47.7%, 81.5% and 97.8%, respectively. Cystatin-C went down by 19.3%, 39.9% and 69.9%, respectively.Conclusions. Earlier and justified use of HP and HDF was accompanied by a rapid improvement of clinical and laboratory parameters, which is reflected in the duration of ICU stay, hospital stay and the outcome of the disease in general.

Rhabdomyolysis (RM) is a clinical and laboratory syndrome with the underlying destruction of myocytes and the release of intracellular debris into the systemic circulation. In more than 55% of cases, RM is complicated by acute kidney injury (AKI), which necessitates various methods of extracorporeal detoxification and currently is a controversial issue.Aim: to improve the results of treatment of patients with RM of toxic origin complicated by AKI by using early selective hemoadsorption (SH).Material and methods. The study included 36 patients divided into 2 groups. Group 1 included 24 patients who received standard therapy and hemodiafiltration (HDF) as a life-saving intervention. Group 2 comprised 12 patients who underwent early SH to prevent the progression of AKI. We performed a comparative analysis of clinical and laboratory parameters and treatment outcomes in the groups.Results. The use of SH was associated with reduced level of myoglobin on day5 of therapy from 384.1 to 112.4 gg/l (70.7%) vs 335.15 to 219.1 gg/l (34.6%) reduction in the conservative therapy group. By day 7, this parameter was 18.8 (95.1%) and 142.4 (57.5%), respectively (7=0.012). The level of cystatin-C decreased on day 5 from 17.3 to 3.2 mg/l (81.5%) in group 2 and from 14.9 to 11.7 mg/l (21.5%) in group 1. By day 7, this parameter decreased to 2.5 (85.6%) and 14.1 (5.3%) mg/l, respectively (7=0.001). The length of ICU stay in group 2 was 7 (6; 9) days, while in the conservative therapy group it was 12 (7; 13) days (7=0.04). The hospital stay was 12 (10; 16) and 22 (14,5; 24,5) days, respectively (7=0.028).Conclusion. The early use of SH in the intensive therapy helped decrease the levels of markers of endogenous intoxication, AKI severity, improve the filtration capacity of the kidneys, and reduced the length of stay in the ICU and hospital.

The objective: to study changes and prognostic significance of the blood NT-proBNP in the patients with pulmonary sepsis.Subjects and Methods. The study included 34 patients aged 54.5 ± 2.9 years with pulmonary sepsis or septic shock. Lethality in the intensive care unit (ICU) was 47.1%. NT-proBNP, procalcitonin (PCT) levels, blood lactate and hemodynamic parameters were registered on the 1st day (stage 1) and on the 4th-5th day of the ICU stay (stage 2). Hemodynamics was assessed through transpulmonary thermodilution. The differences were considered statistically significant at p < 0.05.Results: At stage 1, NT-proBNP level was 5,220 [1,380‒17,850] pg/ml, did not decrease (p = 0.726) at stage 2 and amounted to 1,760 [631‒847] pg/ml. At stage 1, NT-proBNP correlated with extravascular lung water index (rho = 0.445; p = 0.038) and systolic pulmonary artery pressure (rho = 0.414; p = 0.023). At stage 2, NT-proBNP correlated with PCT (rho = 0.569; p = 0.003), blood lactate (rho = 0.525; p = 0.001), and mean arterial pressure to norepinephrine dosage ratio (rho = -0.422; p = 0.035). At stage 1, NT-proBNP was no predictor of lethality in the ICU: OR 1.0000; 95% CI 1.0000-1.0001. At stage 2, NT-proBNP > 4,260 pg/ml (sensitivity 87.5%, specificity 94.4%) was a predictor of lethality: OR 1.0004, 95% CI 1.0000-1.0008, p = 0.046 (AUC 0.893, 95% CI 0.732-0.974). Any increase of NT-proBNP level (> 0 pg/ml) between stages 2 and 1 was a predictor of lethality (sensitivity 87.5%, specificity 94.4%): OR 119.0, 95% CI 9.7432‒1,453.4241, p = 0.0002 (AUC 0.903, 95% CI 0.751-0.977).Conclusion: Patients with pulmonary sepsis are characterized by a significant increase of blood NT-proBNP. At stage 1, the biomarker correlated with pulmonary hypertension and moderate pulmonary edema and was no predictor of lethality. At stage 2, NT-proBNP correlated with the indices of infection and sepsis severity (procalcitonin, blood lactate, and mean arterial blood pressure/norepinephrine dosage ratio). At this stage, NT-proBNP levels greater than 4,000 pg/mL and/or any degree of increase in blood levels of the biomarker were both sensitive and specific predictors of a lethal outcome. Specific features of etiopathogenesis of BNP hyperproduction in pulmonary sepsis make it difficult to interpret the elevation of NT-proBNP as an indicator of septic cardiomyopathy but does not reduce its value as a sensitive and specific predictor of lethality.

Aim of study To develop a new safe and reliable method of fixing an epidural catheter (EC), to study and compare the results of this method of fixing EC in the subcutaneous canal using a modified spinal needle (MSN) and an adhesive tape with a standard method of fixing an EC using only an adhesive tape when performing the combined double-segment spinal-epidural anesthesia (CDSEA) in the surgical treatment of fractures of the bones of the lower limb.Material and methods A comparative study of two methods of EC fixation was carried out in patients undergoing CDSEA during the surgical treatment of fractures of the bones of the lower limb. The patients were divided into two groups. The Group 1 (comparison, n=65), where EC was fixed at the site of epidural access with adhesive tape and the Group 2 (study, n=65), where EC was fixed in the subcutaneous canal using MSN and adhesive tape at the site of EC exit on the skin.Results In the study group, where EC was fixed in the subcutaneous canal using MSN and adhesive tape at the site of EC exit to the skin, there were 32.3% fewer cases with clinically significant dislocation (more than 15 to 30 mm) than in the comparison group, where EC was fixed at the site of epidural access only with adhesive tape.Conclusions A used spinal needle in a modified version can be used to perform EC in the subcutaneous canal. The dimensions of the MSN allow tunneling of the EC less traumatic and at a great distance from the site of the epidural access, which provides more reliable fixation of the EC, the number of cases with clinically significant + dislocation decreases, this allows for a longer and better postoperative epidural analgesia. This method does not solve all the problems of EC fixation; it is required to develop new methods of EC fixation, including fixation in the subcutaneous canal.

The objective: to study hemodynamic and clinical effects of levosimendan depending on the clinical outcome in patients with sepsis and impaired cardiac pumping function.Subjects and Methods. the retrospective study involved 31 patients of 52.7 ± 2.8 years old with sepsis or septic shock which were treated with levosimendan at the dose of 0.16 [0.15‒0.17] mg/kg (0.11 [0.1‒0.12] μg × kg-1 × min-1) on days 1–4 of ICU stay. The patients were divided into the following groups: Group 1 ‒ survivors (n = 19) and Group 2 – non-survivors (n = 12). Central hemodynamics was assessed through transpulmonary thermodilution. The differences were considered statistically significant at p < 0.05.Results. Most of the hemodynamic parameters and vasopressors and inotropes doses had no differences between the groups before levosimendan administration. There were no differences in the cardiac index (3.8 ± 0.3 vs 3.5 ± 0.3 L/min/m2; p = 0.479) between the groups following levosimendan administration, however, Group 1 demonstrated the following parameters to be lower versus Group 2: central venous pressure (7 ± 0.7 vs 11 ± 1 mm Hg; p = 0.005), blood lactate (1 [0.9‒1.8] vs 2.4 [2.2‒3.3] mmol/L; p = 0.04), norepinephrine dosages (0.2 [0.15‒0.35] and 0.5 [0.4‒0.6] ng/kg/min; p = 0.023 ), global end-diastolic volume index (693 [688‒28] vs 870 [779‒961] mL/m2; p =0,0009) and the level of NT-proBNP (1,590 [1,080‒3,160] vs 35,000 [21,400‒35,000] pg/mL; p = 0,0001). Global heart ejection fraction (23 [21‒27] vs 15 [12‒20]%; p = 0.015) and heart function index (6 [5‒8] vs 3 [ 3-4] min-1; p = 0.003) ) were higher in Group 1 versus Group 2. APACHE II >19 (AUC 0.906; p < 0.0001), SOFA > 9 (AUC 0.805; p = 0.0002); heart rate > 114 min-1 (AUC 0.755; p = 0.0095), and index of total peripheral vascular resistance < 1,700 dyn × s × cm-5 × m2 (AUC 0.806; p = 0.001) before levosimendan administration were the independent predictors of death in patients treated with levosimendan.Conclusion: non-survivors patients with sepsis had significantly higher APACHE II and SOFA scores, higher heart rate and lower index of total peripheral vascular resistance before levosimendan infusion. In survivors levosimendan infusion at a standard dose led to a significant improvement in the heart pumping function accompanying by global heart ejection fraction and heart function index increasing and NT-proBNP decreasing. In non-survivors such favorable central hemodynamics changes did not occur, although the cardiac index increased after inodilator administration. Further studies of levosimendan efficacy in patients with sepsis of varying severity are advisable. It is necessary to specify the indications and contraindications for levosimendan administration to patients with sepsis.

Background. The incidence of COVID-19 novel coronavirus infection has a wave-like pattern with surges in new cases followed by declines. Viral mutations, changes in viral properties, and new strains continue to emerge and are regularly reported.The aim of the study is to present a comparative analysis of clinical and epidemiological characteristics of hospitalized patients with COVID-19 during different periods of the coronavirus infection pandemic in Moscow.Materials and methods. A two-center, retrospective observational epidemiological study was performed using medical records of patients hospitalized with the confirmed diagnosis of COVID-19 in Moscow from March 2020 to March 2022 (34,354 patients).Results. Within 2 years of the pandemic, there were significant differences in the age structure of hospitalized patients. During the early months (March–June 2020) of the pandemic, age groups of 18–45 and 46–65 yearolds accounted for higher percentages of hospitalizations. Later on (July 2020 – February 2021), the proportion of older age groups demonstrated an upward trend. From spring 2021 (the emergence of the SARS-CoV-2 delta strain) to March 2022 (dominance of the omicron strain), the proportion of hospitalized working-age adults increased once again.The proportion of severe and critically severe cases among the patients hospitalized during different periods remained at steady levels: 7.7% (6.6–8.8%) and 5.5% (4.4–6.6%), respectively. The highest death rates were observed during the delta strain surge, while the lowest death rates were reported for the omicron strain. Throughout the pandemic, the older age and chronic diseases remained risk factors contributing to the severity of the disease and adverse outcomes.Conclusion. The emergence of new variants of SARS-CoV-2 causing a shift of the need for hospitalization towards younger age groups, the persistent high rates of severe cases and death rates among people of retirement age are pressing for the unfailing readiness for implementing preventive and epidemic control measures focusing on the above groups of population.

Rhabdomyolysis is a syndrome caused by destruction and necrosis of muscle tissue, which is accompanied by the release of intracellular contents into the systemic circulation. The etiology of rhabdomyolysis is multifaceted, however, regardless of the etiological factor, the central element of its pathophysiology is systemic endotoxemia with multiple organ failure syndrome. Acute renal failure is one of the most common manifestations of organ dysfunction. Considering the pathogenetic model of the development of systemic endotoxemia, the timely use of extracorporeal therapy, which reduces mortality in organ failure, seems promising. All the current types of extracorporeal therapy can be divided into convection (hemofiltration), diffusion (hemodialysis), convection/diffusion (hemodiafiltration), sorption (hemoperfusion) and plasma exchange (plasmapheresis, plasma exchange, plasma sorption, etc.) methods based on physical principle.The aim of the review was to summarize the available clinical data on extracorporeal treatments for rhabdomyolysis and to assess the feasibility and best indications for these methods based on the current pathogenetic model of rhabdomyolysis.Material and methods. The search for information was carried out in the Web of Science, Scopus, Medline, PubMed, RSCI, E-library and other databases. Eighty-one sources were identified containing current therapeutic approaches and relevant data of clinical and scientific research on the subject of this review.Results. In this review, the main etiological, epidemiological and pathogenetic models of acute renal injury in rhabdomyolysis have been discussed. The main methods of extracorporeal therapy have been reviewed and evaluated based on current understanding, and latest clinical data on their effectiveness have been summarized.Conclusion. The choice of the optimal extracorporeal treatment method, the time of initiation and duration of the procedure still remain controversial. The solution to this issue can potentially help to better correct the electrolyte disturbances and could protect against organ dysfunction, which would improve the outcome in patients with rhabdomyolysis.

Aim. To analyze newly diagnosed diseases and features of the post-COVID course in patients after a coronavirus disease 2019 (COVID-19) within 12-month follow-up.Material and methods. A total of 9364 consecutively hospitalized patients were included in the ACTIV registry. Enrollment of patients began on June 29, 2020, and was completed on March 30, 2021, corresponding to the first and second waves of the pandemic. Demographic, clinical, and laboratory data, computed tomography (CT) results, information about inhospital clinical course and complications of COVID-19 during hospitalization were extracted from electronic health records using a standardized data collection form. The design included follow-up telephone interviews with a standard questionnaire at 3, 6, and 12 months to examine the course of post-COVID period.Results. According to the ACTIV registry, 18,1% of patients after COVID-19 had newly diagnosed diseases (NDDs) over the next 12 months. Hypertension (HTN), type 2 diabetes and coronary artery disease (CAD) prevailed in the NDD structure. Comparison of the age-standardized incidence of NDDs (HTN, CAD, diabetes) in the post-COVID period in the ACTIV registry with NDD incidence in 2019 according to Rosstat and the expected incidence of NDDs according to the EPOHA study revealed that HTN, diabetes, CAD in patients after COVID-19 were registered more often as follows: HTN by 7,0 and 4,4 times, diabetes by 7,3 and 8,8 times, CAD by 2,3 and 2,9 times, respectively. NDDs most often developed in patients aged 47 to 70 years. Comparison of the actual and expected number of cases of newly diagnosed HTN, CAD and diabetes depending on age showed that the actual number of cases in the population of patients in the ACTIV register is significantly higher than expected for patients aged 45-69 years and for patients with hypertension or diabetes and aged

АКТУАЛЬНОСТЬ: Создание протоколов эффективной эмпирической антимикробной терапии невозможно без анализа актуальных данных чувствительности к антибиотикам. ЦЕЛЬ ИССЛЕДОВАНИЯ: Анализ изменения этиологической значимости ведущих возбудителей бактериемий в отделении реанимации и интенсивной терапии (ОРИТ) в период с 2003 по 2021 г. и их чувствительности к антибиотикам; изучение типов карбапенемаз у наиболее актуальных возбудителей — Klebsiella pneumoniae и Acinetobacter baumannii. МАТЕРИАЛЫ И МЕТОДЫ: В анализ были включены все клинически значимые микроорганизмы, выделенные из крови пациентов, находившихся ОРИТ общего профиля, рассчитанном на 12 коек, в скоропомощном стационаре г. Москвы в период с 2003 по 2021 г. Идентификацию микроорганизмов и определение чувствительности к антибиотикам проводили в автоматическом анализаторе PHOENIX и стандартизированным диско-диффузионным методом. Детекцию карбапенемаз осуществляли методом полимеразной цепной реакции. РЕЗУЛЬТАТЫ: Исследовано 17 034 образца крови, из которых было выделено 6372 микроорганизма. В указанный период доля грамотрицательных микроорганизмов увеличилась с 21,0 до 52,8 %, преимущественно за счет K. pneumoniae (1,0–24,5 %) и A. baumannii (0–9,1 %). Устойчивость этих микроорганизмов к карбапенемам с 2008 по 2021 г. значительно увеличилась: K. pneumoniae — с 2,3 до 70,3 %, A. baumannii — с 7,5 до 99,5 %. Штаммы K. pneumoniae продуцировали следующие типы карбапенемаз: OXA-48 (73,8 %), KPC (6,2 %), NDM (1,5 %), NDM + OXA-48 (15,4 %), KPC + OXA-48 (3,1 %). Все штаммы A. baumannii продуцировали карбапенемазы OXA-40. Продуценты карбапенемазы OXA-48 были устойчивы к колистину и тигециклину в 14,6 и 44,8 % случаев соответственно, к цефтазидиму/авибактаму — в 4,2 % случаев. ВЫВОДЫ: Увеличение уровня антимикробной резистентности в последние годы среди доминирующих в бактериемии грамотрицательных микроорганизмов является очень значимой проблемой в ОРИТ. Большинство штаммов K. pneumoniae характеризуются множественной резистентностью и около 10 % — экстремальной, или панрезистентностью. Практически все штаммы A. baumannii относятся к категории экстремально резистентных.

В статье отражены основные положения клинических рекомендаций по септическому шоку в акушерстве, утвержденных Общероссийской общественной организацией «Федерация анестезиологов и реаниматологов» в 2022 г. Актуальность проблемы связана с высокими показателями летальности и заболеваемости от сепсиса и септического шока в акушерстве. Последовательно представлены основные вопросы этиологии, патогенеза, клинической картины, методов лабораторной и инструментальной диагностики, особенности применения шкал qSOFA, SOFA, MOEWS, SOS, MEWC, IMEWS для верификации сепсиса. В статье представлена стартовая интенсивная терапия (первые 6–12 ч) лечения септического шока в акушерстве с учетом особенностей организма беременной женщины. Описана стратегия назначения вазопрессоров (норэпинефрин, фенилэфрин, эпинефрин), инотропных препаратов (добутамин), представлены антибиотики и оптимальные схемы антибактериальной терапии, особенности инфузионной и адъювантной терапии. Обсуждены вопросы хирургического лечения очага инфекции и показания к гистерэктомии, а также организация медицинской помощи и реабилитация пациенток, перенесших сепсис и септический шок. Описаны основные принципы профилактики развития сепсиса и септического шока в акушерстве. Представлены критерии качества оказания медицинской помощи пациенткам с септическим шоком и алгоритмы действий врача при диагностике и интенсивной терапии пациенток с септическим шоком в акушерстве.

The objective: to improve treatment results in patients with toxic rhabdomyolysis (RM) complicated by acute kidney injury (AKI) through using selective hemoperfusion (НР).Subjects and Methods. The study included 45 patients aged 18 to 55 years diagnosed with toxic RM complicated by AKI. The patients were divided into two groups. Group 1 received standard conservative therapy. In Group 2, during the first day of treatment, HP was used to prevent AKI progression. Changes in clinical and laboratory parameters of RM and renal damage as well as treatment outcomes between the groups were analyzed and compared.Results. Significantly better decrease in myoglobin blood level was revealed in Group 2 from day 1 to day 7 of treatment. In Groups 1 and 2, these parameters made 26.3% and 52.1%, respectively. The use of НР allowed reducing the urine concentration of KIM-1 by day 3 of treatment in Group 2 by 16.9%, in Group 1, the urine concentration of KIM-1 increased by 15.5%. The frequency of RRT initiation for urgent indications decreased from 75% to 52.9% when using HP, as a result, duration of inpatient treatment decreased from 19.5 (14; 22) to 16.5 (13; 19) days, as well as the period of ICU stay from 11 (9; 15) to 8 (6; 11) days.Conclusions. The early use of НР as part of the complex intensive therapy of toxic RM complicated by the development of AKI is accompanied by an earlier and significant decrease in laboratory markers of RM and AKI compared to standard treatment, as well as shorter ICU and hospital stay

Aim. To investigate on post-COVID period in patients of the Eurasian region.Material and methods. A total of 9364 consecutively hospitalized patients were included in ACTIV registry. Enrollment of patients began on June 29, 2020, and was completed on March 30, 2021, corresponding to the first and second waves of the pandemic. Demographic, clinical, and laboratory data, computed tomography (CT) results, information about inhospital clinical course and complications of COVID-19 during hospitalization were extracted from electronic health records using a standardized data collection form. The design included follow-up telephone interviews with a standard questionnaire at 3, 6, and 12 months to examine the course of post-COVID period.Results. According to ACTIV register, 63% of patients after COVID-19 had new adverse symptoms or exacerbations of the existing symptoms lasting for up to 1 year. After hospital discharge, 79,8% of patients sought unscheduled medical attention in the first 3 months, 79,1% at 4-6 months, and 64,8% at 7-12 months. Readmission rate was 11,8% in the first 3 months, 10,9% at 4-6 months, and 10,1% at 7-12 months. The most common reasons for unscheduled treatment in the first 3 months were uncontrolled hypertension, decompensated type 2 diabetes, destabilization of coronary artery disease, gastrointestinal disease, AF episodes, exacerbation of asthma and chronic obstructive pulmonary disease, decompensated heart failure (HF). The 12-month mortality of COVID-19 survivors after the discharge was 3,08%. Multivariate analysis showed that independent risk factors for fatal outcome were age (direct correlation), the levels of hemoglobin (inverse correlation), oxygen saturation (inverse correlation), and aspartate aminotransferase (direct correlation), as well as class III-IV HF, prior stroke, cancer, inhospital acute kidney injury. Based on these identified risk factors, a nomogram was constructed to determine the 3-month mortality risk after discharge.Conclusion. Analysis of ACTIV register showed that end of the acute phase of COVID-19 does not imply a complete recovery.

Aim. To study the lipid profile in hospitalized patients with coronavirus disease 2019 (COVID-19) depending on the outcome of its acute phase according to the AKTIV international registry.Material and methods. The AKTIV registry included men and women over 18 years of age with a diagnosis of COVID-19, who were treated in a hospital. A total of 9364 patients were included in the registry, of which 623 patients were analyzed for levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglycerides on days 1-2 of hospitalization. The level of high-density lipoprotein cholesterol (HDL-C) was calculated using the Friedewald equation.Results. We found that a decrease in LDL-C level was significantly associated with an unfavorable prognosis for hospitalized patients with COVID-19. This pattern persisted in both univariate and multivariate analyses. LDL-C levels in the final multivariate model had a significant relationship with the prognosis (an increase in the death risk by 1,7 times with a decrease per 1 mmol/l). In addition, we found that the survival of patients with an indicator level of

Of all cases of acute kidney injury (AKI), 45-70% are associated with sepsis. Lethality in sepsis-associated AKI requiring renal replacement therapy (RRT) ranges from 40 to 50%, and in AKI combined with other organ dysfunctions - 60-80%. In order to improve the results of treatment of sepsis and septic shock, various methods of extracorporeal detoxification (ECD) have been developed. The effectiveness of these methods is controversial. In the treatment of sepsis, RRT is used not only to replace the impaired detoxification function of kidneys, but also to remove excess cytokines from the systemic bloodstream. The literature describes mainly positive results of the use of dialyzers with an adsorbing membrane, however, these data do not have the necessary degree of evidence. Currently, there are no clear criteria for the initiation of RRT, its duration and doses, the choice of methodology determined by specific clinical and laboratory parameters, and staging of this therapy. All this highlights the need for further research in this field.

Coagulopathy and associated thrombotic complications are common conditions seen in COVID-19. Therefore, anticoagulants are an integral part of the treatment of patients with COVID-19.The aim of the study was to compare the efficacy of oral anticoagulants and low molecular weight heparins in the prevention of pulmonary embolism and their safety in terms of major bleeding incidence, as well as to evaluate the cost-effectiveness of using oral anticoagulants in the treatment of COVID-19.Materials and methods. Two stages of patient management were compared: before and after the start of a widespread use of oral anticoagulants (OAC). The incidence of pulmonary embolism and gastrointestinal bleeding during the compared time periods was analyzed to assess the efficacy and safety of anticoagulants. To assess the cost-effectiveness, we compared the cost of anticoagulants per day of treatment and per patient.Results. The incidence of pulmonary embolism and gastrointestinal bleeding did not differ during the compared time periods. Despite the increased frequency of anticoagulant use, the costs per day of treatment and per patient decreased after the start of a widespread use of OACs.Conclusion. According to the results of the study, inclusion of OACs in COVID-19 management protocols allows to reduce treatment costs without compromising its efficacy and safety. However, the short period of comparison does not allow drawing any firm conclusions. Additional large-scale comparative studies are needed.

Objective: to study the use of RRT methods and their influence on the results of treatment of patients with severe COVID-19.Subjects and methods. We retrospectively analyzed the data of 283 patients with COVID-19 in the intensive care units of Moscow City Hospital no. 40 in 2020 who had received RRT as one of the treatment methods.Results. Frequency of RRT in COVID-19 patients in ICU of Moscow City Hospital no. 40 for 2020 made 5.7% (504 out of 8.711 patients treated in ICU received RRT). In 86% of cases, RRT was performed for renal indications. At the time of initiation of RRT, the studied groups did not differ according to SOFA score. The frequency of using dialysis units with high and low cut-off point in the groups of survived and deceased patients differed significantly. The surgery itself started at relatively the same time from the onset and statistically significantly earlier in the group of survivors from the beginning of tracheal intubation (4.9 ± 0.5 vs 6.8 ± 0.3 days, p = 0.0013). Against the background of ongoing therapy, overall severity of the state progressed in the group of deceased patients to 9.9 ± 0.2 SOFA scores, while in the group of survivors there was an improvement to 6.1 ± 0.4 scores.

Amidst the new COVID-19 pandemic, there is a need for a reliable medical tool to monitor patients’ vital conditions with clinical information continuity. This tool is essential for timely detection of the risk of the patient’s clinical state deterioration throughout all the stages of medical assistance. The objective is to assess results of the NEWS2 score implementation at the in-patient stage of medical care.Methods. 183,732 scores of the NEWS2 score in 10,290 hospitalized patients were analyzed. All the assessed results of the NEWS2 score were retrospectively analyzed. The NEWS2 score results were added to the United Medical Information and Analytical System of Moscow (EMIAS) database through the NEWS2 mobile application. The researchers analyzed the descriptive statistics of the score; the prognostic significance of NEWS2 in the prediction of the disease outcome was assessed as well as the accuracy of the used methods. Results. As the result of the research, deviations from standard methods in the application of the NEWS2 score were outlined, which allowed the researchers to develop the corrective measures. The received data confirmed that interval assessment by the NEWS2 score and the trend analysis were important when making clinical and organizational decisions. Specific parameters of the score use during the COVID-19 pandemic were outlined, which helped to adjust the in-hospital procedures for clinical decision-making process, routing, and the continuity of all stages of medical assistance was established. Conclusion. The use of the NEWS2 score in medical practice makes it possible to predict the risks of clinical deterioration in the patient's condition, conduct bedside monitoring of therapy effectiveness, and optimize in-hospital routing. However, to ensure the validity of the score, it is necessary to plan activities for the personnel training and motivation, as well as to monitor careful adherence to the protocol.

The objective: to predict lethal outcomes in patients with COVID-19 based on the result of chest computed tomography (chest CT) using a semi-quantitative visual scale of the pulmonary parenchyma lesion.Subjects and methods. Inclusion criteria: patients who underwent chest CT from March 2 to May 1, 2020, inclusively, upon referral of a general practitioner due to suspected community-acquired pneumonia caused by COVID-19. Chest CT was performed in 48 medical organizations providing primary medical care to the adult population in Moscow. Exclusion criteria: patients whose chest CT was not assessed by CT 0-4 score; patients who were not confirmed as COVID-19 positive.In the Russian Federation, CT 0-4 score is recommended to be used for assessment of the extent of lung parenchyma lesion in cases with suspected COVID-19.Data on fatal outcomes were received on May 4, 2020 inclusive.Results: data of 13,003 patients from the Unified Radiological Information Service were retrospectively included in the study according to inclusion and exclusion criteria. The test aimed to detect a trend of directional changes in the proportion of deceased patients among various categories using CT 0-4 score demonstrated a statistically significant result (p < 0.0001). The chance of a lethal outcome increases directionally from CT-0 to CT-4. The test for deviations from the linear trend also provided p < 0.0001, i.e. when moving to higher scores (CT-3 and CT-4), there was an accelerated increase in the risk of death. Analysis of overall survival using the Cox regression model showed that the assessed factors (age and CT 0-4 score) were statistically significantly associated with the time to death from COVID-19 (p < 0.05). The risk of death increased with age, on average, 8.6% for every 5 years (95% CI 0.8-17.0%). When transferring from one category of CT to the next one, the risk increased by 38% on the average (95% CI 17.1-62.6%). There was no statistically significant association of gender factor with overall survival (p = 0.408).The visual score of CT 0-4 recommended for use in the Russian Federation to assess lung parenchyma lesions according to chest CT data, is a predictor of a lethal outcome in patients with COVID-19. CT 0-4 score is convenient for practical use.

Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period.

This review focuses on the practical aspects of prevention and treatment of fungal infections in surgical patients. It covers epidemiology and risk factors for invasive candidiasis, updates on the etiological structure of fungal infections in patients in critical conditions, and provides the information on drug sensitivity of Candida species. The authors discuss the limitations of cultural and non-cultural diagnostic methods used in invasive candidiasis, emphasizing the importance of analyzing the existing risk factors in combination with a comprehensive assessment of clinical and laboratory data for timely initiation of adequate antifungal therapy. The review provides a brief description of currently available antimicotics, including polyenes, triazoles, and echinocandins. It also describes the benefits of anidulafungin, which does not interact with other drugs and has no negative effect on the liver and kidney. The article also covers indications for antifungal agents in surgical intensive care units in accordance with international and Russian guidelines. A cohort of patients with abdominal diseases requiring preventive and empirical treatment with antimicotics is described. In additions to that, the manuscript contains a rationale for the use of echinocandins in targeted therapy of invasive candidiasis.

Purpose of the study: to investigate the epidemiology of sepsis in patients with different locations of the infection focus, who were admitted to the intensive care unit (ICU) of a multi-specialty hospital in 2014 and 2016.Material and methods. A retrospective analysis of examination and treatment of 860 patients admitted to ICU of a multi-specialty hospital with the diagnosis ‘sepsis’ in 2014 and 2016 was carried out. Sepsis was diagnosed pursuant to the Sepsis-2 Guidelines and verified by blood procalcitonin test. The gender, age, main diagnosis, patient’s severity at the time of admission to ICU, duration in ICU, and peculiarities of intensive care and outcomes were studied.Results. Sepsis was diagnosed at admission in 2014 in 361 (8.6%) patients out of 4175 patients, in 2016 — in 499 (10.5%) out of 4726 patients who were admitted to ICU and had infection foci of different location. Abdominal sepsis was diagnosed in 72.3% of patients, pulmonary — in 19.7%; in 8% of patients, sepsis complicated the terminal stage of various, mostly oncological, diseases. In 2016, sepsis detectability at admission to ICU increased by 22.1% vs. the 2014 level assumed as 100% (χ2=9.281; P=0.003). In case of the abdominal sepsis, mortality amounted to 50.3% and was not different from mortality in pulmonary sepsis — 52.1% (χ2=0,163; P=0.687). The ICU in-patient duration in case of pulmonary sepsis was considerably longer than in case of abdominal. The age was a predictor of mortality in case of abdominal sepsis (the age older than 65 years predicted the risk of lethal outcome with sensitivity equal to 58.8% and specificity equal to 59.9%), which was not true for pulmonary sepsis. The mortality prognosis during abdominal sepsis was improved by combined analysis of the SOFA score and patient’s age at admission: AUROC of the combined index was equal to 0.816 (95%-confidence interval: 0.783–0.846). Depending on the infection focus location, specificity of influence rendered on mortality by different clinical indices and management methods was determined.Conclusion. Patients admitted to ICU with sepsis represent a group of a high mortality risk amounting to 50% approximately. During chronological analysis, sepsis detectability increases but mortality does not change. Patients with pulmonary sepsis at admission to ICU are characterized by a greater severity of condition due to multiple organ failure than in case of abdominal sepsis; in such patients it is impossible to predict the risk of mortality based on APACHE II and SOFA score. Taking into account heterogeneity of the sepsis patient population, deepening of the knowledge about peculiarities of pathogenesis and clinical pattern of abdominal and pulmonary sepsis is the basic requirement for improvement of the results of treatment of this complication.

The international AKTIV register presents a detailed description of out- and inpatients with COVID-19 in the Eurasian region. It was found that hospitalized patients had more comorbidities. In addition, these patients were older and there were more men than among outpatients. Among the traditional risk factors, obesity and hypertension had a significant negative effect on prognosis, which was more significant for patients 60 years of age and older. Among comorbidities, CVDs had the maximum negative effect on prognosis, and this effect was more significant for patients 60 years of age and older. Among other comorbidities, type 2 and 1 diabetes, chronic kidney disease, chronic obstructive pulmonary disease, cancer and anemia had a negative impact on the prognosis. This effect was also more significant (with the exception of type 1 diabetes) for patients 60 years and older. The death risk in patients with COVID-19 depended on the severity and type of multimorbidity. Clusters of diseases typical for deceased patients were identified and their impact on prognosis was determined. The most unfavorable was a cluster of 4 diseases, including hypertension, coronary artery disease, heart failure, and diabetes mellitus. The data obtained should be taken into account when planning measures for prevention (vaccination priority groups), treatment and rehabilitation of COVID-19 survivors.

The organizer of the registers “Dynamics analysis of comorbidities in SARSCoV-2 survivors” (AKTIV) and “Analysis of hospitalizations of comorbid patients infected during the second wave of SARS-CoV-2 outbreak” (AKTIV 2) is the Eurasian Association of Therapists (EAT). Currently, there are no clinical registries in the Eurasian region designed to collect and analyze information on long-term outcomes of COVID-19 survivors with comorbid conditions. The aim of the register is to assess the impact of a novel coronavirus infection on long-term course of chronic non-communicable diseases 3, 6, 12 months after recovery, as well as to obtain information on the effect of comorbidity on the severity of COVID-19. Analysis of hospitalized patients of a possible second wave is planned for register “AKTIV 2”. To achieve this goal, the register will include men and women over 18 years of age diagnosed with COVID-19 who are treated in a hospital or in outpatient basis. The register includes 25 centers in 5 federal districts of the Russian Federation, centers in the Republic of Armenia, the Republic of Kazakhstan, the Republic of Kyrgyzstan, the Republic of Belarus, the Republic of Moldova, and the Republic of Uzbekistan. The estimated capacity of the register is 5400 patients.

COVID-19 is a severe infection with high mortality. The concept of the disease has been shaped to a greater extent on the basis of large registers from the USA, Spain, Italy, and China. However, there is no information on the disease characteristics in Caucasian patients.Therefore, we created an international register with the estimated capacity of 5,000 patients — Dynamics Analysis of Comorbidities in SARS-CoV-2 Survivors (AKTIV SARS-CoV-2), which brought together professionals from the Russian Federation, Republic of Armenia, Republic of Kazakhstan, and Kyrgyz Republic. The article presents the first analysis of the register involving 1,003 patients. It was shown that the most significant difference of the Caucasian population was the higher effect of multimorbidity on the mortality risk vs other registers. More pronounced effect on mortality of such diseases as diabetes, obesity, hypertension, chronic kidney disease, and age over 60 years was also revealed.