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The study investigated the influence of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 on the reproductive health indicators of cadets of military educational organizations. In the Department of Assisted Reproductive Technologies at the Clinic of Obstetrics and Gynecology of the Kirov Military Medical Academy, 183 male cadets aged 21–27 years were divided into two groups and examined. The first group consisted of 132 cadets who had mild and moderate COVID-19, and the second group included 51 cadets without COVID-19 in the anamnesis. COVID-19 was found negatively affect the reproductive health of cadets. Individuals who previously had COVID-19 were found to have a significant decrease in the level of total testosterone and decreased concentration and mobility of sperm in the ejaculate. Moreover, in cadets without COVID-19 who were vaccinated with the combined vector vaccine "Gam-COVID-Vac,” the indicators of the hormonal profile and spermograms were within the reference values. The results indicate the need for further investigation of the effect of various negative factors, including severe acute respiratory syndrome coronavirus 2, on the reproductive health of cadets of military educational organizations. Moreover, the development of preventive, therapeutic, and rehabilitation measures will reduce the risk of infertility and reproductive losses, which is consistent with the interests of national projects on healthcare and demography. The article can be used under the CC BY-NC-ND 4.0 license © Authors, 2022.
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Digital twins and artificial intelligence have shown promise for improving the robustness, responsiveness, and productivity of industrial systems. However, traditional digital twin approaches are often only employed to augment single, static systems to optimise a particular process. This article presents a paradigm for combining digital twins and modular artificial intelligence algorithms to dynamically reconfigure manufacturing systems, including the layout, process parameters, and operation times of numerous assets to allow system decision -making in response to changing customer or market needs. A knowledge graph has been used as the enabler for this system-level decision-making. A simulation environment has been constructed to replicate the manufacturing process, with the example here of an industrial robotic manufacturing cell. The simulation environment is connected to a data pipeline and an application programming interface to assist the integration of multiple artificial intelligence methods. These methods are used to improve system decision-making and optimise the configuration of a manufacturing system to maximise user-selectable key performance indicators. In contrast to previous research, this framework incorporates artificial intelligence for decision -making and production line optimisation to provide a framework that can be used for a wide variety of manufacturing applications. The framework has been applied and validated in a real use case, with the automatic reconfiguration resulting in a process time improvement of approximately 10%.
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SARS-CoV-2 infected patients show heterogeneous clinical presentations ranging from mild symptoms to severe respiratory failure and death. Consequently, various markers reflect certain disease presentations. Our cohort included moderate (n = 10) and severe (n = 10) COVID-19 patients, and 10 healthy controls. We determined plasma levels of nine acute phase proteins by nephelometry, full-length (M65), caspase-cleaved (M30) cytokeratin 18, and ADAMTS13 (a disintegrin-like and metalloprotease with thrombospondin type-1 motif 13) by ELISA. In addition, we examined whole plasma N-glycosylation by capillary gel electrophoresis coupled to laser-induced fluorescence detection. When compared to healthy controls, COVID-19 patients had significantly lower concentrations of ADAMTS13 and albumin (ALB) but higher M30, M65, alpha-1-acid glycoprotein, alpha1-antitrypsin (AAT), ceruloplasmin, haptoglobin, and highsensitivity C-reactive protein. The concentrations of alpha1-antichymotrypsin, alpha2-macroglobulin and serum amyloid A proteins did not differ. We found significantly higher levels of AAT and M65 but lower ALB in severe compared to moderate COVID-19 patients. N-glycan analysis of the serum proteome revealed increased levels of oligomannose and sialylated di-antennary glycans, while the non-sialylated di-antennary glycan A2G2 significantly decreased in COVID-19 patients compared to controls. COVID-19-associated changes in levels and N-glycosylation of specific plasma proteins highlight involvement of different pathophysiological mechanisms and grant further investigations.
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AIM. To evaluate the expected effectiveness of post-COVID rehabilitation strategies. MATERIAL AND METHODS. The study was conducted August, 2021 – March, 2022 in the republican and federal rehabilitation centers: Krasnodar Territory (n=25), the Republic of Buryatia (n=25), and Moscow (n= 25). The data were obtained by a retrospective analysis of medical records and by interviewing the study participants who had an indication or had been treated in a rehabilitation centre for post-acute COVID-19 syndrome (U 09.9). The average length of time after the onset of the acute period of the disease was 6.5 ± 2.5 months. A prognostic model was constructed to estimate the expected effectiveness of the rehabilitation programme, as measured by a reduction in the severity of dyspnea. Nonlinear maximum likelihood logit regression was used to build the model. RESULTS AND DISCUSSION. According to the presented model, the best expected rehabilitation effectiveness was found in the National Medical Research Center (Moscow) (β=-1.788685, p=0.009964604), a slightly lower expected rehabilitation effectiveness was observed in the resort with a curative climate (Krasnodar Territory) (β=0.9913501, p=0.182944), the lowest expected effectiveness was registered in the regional rehabilitation center (the Republic of Buryatia) (β=1.054594 p=0.2642723). The need for an integrated approach in the treatment of patients with post-acute COVID-19 syndrome was pointed out by many domestic and foreign researchers, however, the choice and content of treatment strategies is debatable. Our study provides a preliminary answer to this question. CONCLUSION. The developed model of the expected effectiveness of the rehabilitation of patients suffering from shortness of breath after undergoing COVID-19 has a specificity of 54.54%, sensitivity of 91.3% and an overall accuracy of 84.21%. The best expected rehabilitation effectiveness was found in the National Medical Research Center of Rehabilitation and Balneology of the Ministry of Health of the Russian Federation (Moscow) (β=-1.788685, p=0.009964604), somewhat lower in the resort with a curative climate (Krasnodar territory) (β=0.9913501, p=0.182944), the lowest expected efficiency was registered in the regional rehabilitation center (the Republic of Buryatia) (β=1.054594 p=0.2642723). © 2022, Irina A. Grishechkina, Andrey A. Lobanov, Sergey V. Andronov, Andrey I. Popov, Mikhail V. Nikitin, Marina V. Terentiyeva.
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Background. The relationship between pathogens of new diseases and tick-borne infections is an underinvestigated direction in the problem of infectious diseases. The aim. To show the features ofidentifying the markers ofBorrelia burgdorferi, tick-borne encephalitis and SARS-CoV-2 pathogens on the example of a case of a triple mixed infection (Lyme disease, tick-borne encephalitis and COVID-19) and using comprehensive studies. Methods. In 2019-2021, a comprehensive study of 7 blood samples from a patient with mixed infection was carried out. We used real-time polymerase chain reaction (PCR), enzyme immunoassay (ELISA) and determined antigen, IgM, IgG antibodies, and avidity index (AI) of IgG antibodies. Results. Ixodid tick-borne borreliosis was diagnosed in a patient 5 months after contagion. Only high-avid Lyme-IgG antibodies were detected. Low-avid Lyme-IgG antibodies appeared against the background of a reduced general condition. Atthe same time, high-avidIgG(cut-offindex (COI)- 7.8)andIgM(COI= 1.2)antibod-ies to the TBE virus were detected. In July 2020, the patient was infected with SARS-CoV-2. TBE virus which passed into the body simultaneously with Borrelia in the fall of 2019 was activated. Although the patient did not have specific symptoms of TBE, in subsequentbloodsamples (No. 4, 5, 6)we foundTBEVantigen (opticaldensity (OD) - 4.3;1.9and2.0respectively)andIgM(COI= 1.3;0,9and0respectively). These results were recognized as TBEV activation, which contributed to an increase in the avidity of IgG antibodies (AI = 65 %;100 % and 63 % respectively). IgM antibodies to SARS-CoV-2 virus were not detected, as opposed to the high levels of IgG (COI = 8.2;8.1;8.4 and 14.7 respectively). Conclusions. Therefore, using not only the common methods of diagnosing (PCR andELISA), butalso the determination ofthe antibody avidity degree, we have shown that when analyzing a case of a triple mixed infection, B. burgdorferi dominates in the human body and causes a long-term chronic course of the disease. © 2022 Acta Biomedica Scientifica. All rights reserved.
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The worldwide COVID-19 pandemic leads to the development of stress disorders, increased anxiety in the society. One of the strongest factors leading to the development of anxiety, stress in society during a pandemic is the Mass Media. The mechanisms of stressogenic effects of Mass Media remain not completely clear. The aim of this study was to evaluate age-specific characteristics of gaze behavior related to the perception of anxiety-provoking information. The study was performed basing on the 189 volunteers (164 participants aged between 17 and 22 years old (students, control group), 25 people aged between 59 and 71 aged 59 to 71 (experimental group). We surveyed participants to determine their level of stress, depression, and anxiety and analyzed eye-tracking data during the text perception by using web-tracking (EyePass). Results showed the significant age-related differences in gaze behavior while reading text with negative text elements. Aged adults had shorter median fixation duration. There was no difference between groups in the amount of the fixation. We can assume that except age factor other ones might contribute to our result, namely the occupation of participants, professors at the Institute of Journalism, with developed professional skills (reading pattern, method of information perception) but from other side higher vulnerability to adverse COVID-19 outcomes compared to younger adults. © 2022 IEEE.
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Background: COVID-19 can affect the platelets function. A vital feature of the impact is the tendency to excessive thrombosis against the background of platelet hyperactivation. Aim(s): The aim was determine the effect of COVID-19 on platelet parameters in ST-elevation myocardial infarction (STEMI). Method(s): This retrospective case-control study included 66 patients (33 pairs) matched in terms of gender, age, and STEMI (Table 1). In each pair one of these patients was hospitalized with COVID-19, and the other was hospitalized without COVID-19, according to routing to different hospitals. The Mindray BC-5150 automatic hematology analyzer was used to assess blood parameters. Erythrocyte sedimentation rate (ESR) analysis was performed by the Panchenkov method. Statistica data analysis package was used for statistical processing. Signed Informed Voluntary Consent form was obtained from all patients. The study was approved by the Local Ethics Committee of the Ural State Medical University. "Statistica" data analysis package was used for statistical processing. Result(s): By the time of admission (see Table 2), white blood cells (WBC) count was lower in the group with STEMI and COVID-19 compared with group without COVID-19;mean platelet volume (MPV), platelet crit (PCT), ESR were higher in patients with COVID-19. One week after, differences in MPV between the groups still persisted. In patients with STEMI and COVID-19, there was a positive correlation between platelet count and WBC count (Spearman's rho=0.42;p < 0.05) and a positive correlation between platelet count and ESR (Spearman's rho=0.41;p < 0.05) at the time of admission. In patients without COVID-19, these correlations were not found. Conclusion(s): Patients with STEMI and COVID-19 have higher MPV than patients without COVID-19 at hospital admission and one week after. In patients with STEMI and COVID-19, platelet count is positively correlated with WBC count and ESR;it may indicate an association between platelet count and inflammation in patients with COVID-19 and STEMI. (Table Presented).
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The novel coronavirus disease (COVID-19) caused by SARS-CoV-2 virus represents a danger to many human organs and systems, hemostasis is one of them. Characteristic feature of hemostasis lesion is the tendency to excessive thrombus formation and the subsequent occurrence of thrombotic complications. Coagulopathy uniqueness in novel coronavirus infection is associated with an increased level of fibrinogen, D-dimer and platelet hyperactivation due to a decrease in platelets number along with their increased destruction and reduced production. The review presents an analysis of publications describing the frequency, supposed reasons and pathogenesis of thrombocytopenia and thrombosis observed in COVID-19. Direct impact of novel corona-virus infection on platelet function as well as on the release of biologically active factors by platelets, is considered. © 2022, Hemostasis and Rheology LLC. All rights reserved.
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The objective: to define hemogram parameters in smokers with COVID-19 and acute coronary syndrome when they are admitted to hospital. Subjects and Methods. 62 male smokers hospitalized due to acute coronary syndrome (ACS) were enrolled into a case-control study. Group 1 (n = 31) had ASC and COVID-19, Group 2 (n = 31) had ACS and no COVID-19. The groups were adjusted by age, body mass index and the date of hospitalisation. According to the current routing procedures, from September to December 2020, the subjects were referred to different hospitals in Sverdlovsk Region depending on COVID-19 status. Inpatient medical records were used to collect the data. Blood parameters were examined by Mindray BC-5150 (China) automatic hematological analyzer performing complete clinical blood count and differentiating 5 leukocyte subpopulations. Statistical processing was performed using Statistica 13.0. The significance of differences was taken at p < 0.05. Results. Smoking men with COVID-19 and ACS unlike those GOVID-19 negative had a lower level of diastolic blood pressure, significantly more often were diagnosed with low degrees of hypertension, higher BPD with the same frequency of detection and functional characteristics of chronic heart failure and chronic obstructive pulmonary disease. The hemogram showed a lower level of the number of leukocytes, the percentage of neutrophils, erythrocytes, hemoglobin, hematocrit, the average concentration of hemoglobin in the erythrocyte;a higher level of monocytes, erythrocyte sedimentation rate, and average platelet volume. The above changes can be associated with spesific features of the COVID-19 course. © 2022 New Terra Publishing House. All rights reserved.
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Aim. To evaluate the effectiveness and safety of aquatic training in diluted sodium chloride bromine brine in restoring the functional state of the organism of patients with portcovid syndrome in comparison with aquatic training in fresh water. Material and methods. Specialists of the National Medical Research Centre of Rehabilitation and Balneology of the Ministry of Health of Russia conducted an open, prospective, randomized study to evaluate the effect of a course of aquatic training in a bromine sodium chloride brine pool. The study included 28 subjects, who were divided into 2 equal groups. Patients in both groups were comparable for gender (χ2 =0.45;p=0.31) and age (U=99.5;p=0.7) and all had post COVID-19 (U 09.9) as their primary diagnosis. The intervention group received a course of aquatic training (7 treatments) in a pool with bromine sodium chloride brine (well No. 69, 32 Novy Arbat Street, Moscow) with mineralization of 120 g/dm3 and its preliminary dilution to 40 g/m3. Control group - a course of aquatic-exercises (7 treatments) in a fresh water pool. Patients, after signing informed consent, underwent load tests: 6-minute walking test, laser Doppler flowmetry (“LASMA ST”, Russia), cardiointervalography (“Health Reserves-R”, Russia). Results and discussion. These data confirm the “null” hypothesis of a more favorable effect of the chemical composition of the diluted brine that acts during aquatic training on the patient's body compared to fresh water, especially in the presence of microcirculation disorders after suffering COVID-19. The group of patients who received aquatic training in the pool with bromine sodium chloride brine revealed a significant decrease in excessive sympathetic nervous system activity (T-11.0;p=0.02) at the end of the study. According to LAZMA-ST data, there was a twofold increase in the oxidative metabolism of the cell (IOM T-16.0;p <0.01), an increase in exercise tolerance (6-minute walk test T-10.0;p = 0.01). IOM increased statistically significantly threefold (U-32.0;p<0.001), mean microcirculation doubled (U-120.0;p<0.05) and BMI decreased by 20.0% (U-58.0;p<0.05) in the intervention group compared with the control group. There were no significant differences between patient groups on safety parameters (χ2= 1.36;p>0.05). These data confirm the “null” hypothesis of a more favorable effect of the chemical composition of the diluted brine that acts during aquatic training on the patient's body compared to fresh water, especially in the presence of microcirculation disorders after suffering COVID-19. Conclusion. Aquatic training in sodium chloride bromide brine effectively reduces the sympathetic nervous system activity, increases oxidative metabolism and improves microcirculation compared to aquatic training in fresh water. © 2022 Rostovskii Gosudarstvennyi Meditsinskii Universitet. All rights reserved.
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Introduction. The challenge of the pandemic forced educational organisations in Russia to resort to massive transition to distance learning and accelerated digital transformation of schools. It has become more obvious than ever that the digital transformation of a school is not limited to a simple technical update of its information resources but implies a fundamental rethinking of the school activities based on the capabilities of digital technologies. The aim of the study was to investigate the experience of digital transformation and the Russian school principals' notions about it as a systemic process. The subject of the study is the notion about the systemic impact of digital transformation processes on schools;the experience of complexity in the introduction of information technologies in the educational process and school management, the assessment of the progress of digitalisation;the notions about the factors of successful digital transformation, which require a critical understanding of the experience of implementing information technologies in the school, highlighting key success factors. Methodology and research methods. The authors analysed 7189 questionnaires using computer methods for processing the natural language. The questionnaires were completed in general education organisations of 66 regions from all federal districts of Russia. The respondents' answers were categorised in accordance with the European Framework for Technologically Competent Educational Organisations (DigCompOrg). Results. The research findings demonstrated the significant imbalance in the frequency of responses: the most frequent answers belong to the “Infrastructure” category, while the least frequent ones belong to the categories of pedagogical aspects of digital transformation affecting changes in the educational content and methods for assessing educational outcomes. It is concluded that the respondents' replies reflect the institutional position of school principals in the current educational system: a head of a government-funded school positions herself/himself as an administrative executor and a representative of the founder, rather than a leader of the teaching team. Consequently, the provision of educational achievements and students' personal development are largely not perceived by principles of Russian schools as a priority management task. Scientific novelty of the present research lies in the attempt to answer the question of how systematically the digital transformation of the principle is perceived, to apply DigCompOrg to the assessment of these categories by the European Framework of technologically competent educational organisations, as well as to use natural language processing methods to process text answers to open-ended questions of the questionnaire, which made it possible to obtain results on a large sample with wide geographical coverage. Practical significance. The research findings can be used in the development and implementation of advanced training programmes for school and college administrations in accordance with the ongoing digitalisation of Russian educational system. © 2021 Russian State Vocational Pedagogical University. All rights reserved.
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The coexistence of various pathogens inside the patient's body is one of the poorly studied and current issues. The aim of the study is to identify the relationship between the indicators of complex laboratory diagnostics and the clinical manifestations of a mixed disease during subsequent infection with the SARS-CoV-2 virus using the example of a case of chronic encephalitis-borreliosis infection. Seven blood serum samples were collected from the patient over the course of a year. For the etiological verification of the causative agents of TBE, Lyme disease and COVID-19, the methods of ELISA and PCR diagnostics were used. The patient was diagnosed with Lyme disease on the basis of the detection of IgG antibodies to Borrelia 5 months after the onset of the disease, since she denied the tick bite. In the clinical picture, there was an articular syndrome and erythema migrans. Later, IgG antibodies to the TBEV were found in the blood. Throughout the study, IgM antibodies to Borrelia were not detected. The exacerbation of Lyme disease could be judged by the clinical manifestations of this disease and by the growth of specific IgG antibodies. A feature of this case was that during an exacerbation of the Lyme disease, an infection with the SARS-CoV-2 virus occurred. Treatment (umifenovir, hydroxychloroquine, azithromycin, ceftriaxone) was prescribed, which improved the condition of the underlying disease, decreased joint pain, decreased IgG levels to borrelia. However, during this period, serological markers of TBEV appear: antigen, IgM antibodies, and the titer of IgG antibodies increases. Most likely, this was facilitated by the switching of the immune system to the SARS-CoV-2 virus, with the simultaneous suppression of borrelia with antibiotics and the appointment of hydroxychloroquine, which has an immunosuppressive effect. Despite the activation of the virus, clinical manifestations of TBE were not observed in the patient, which is most likely associated with infection with a weakly virulent TBEV strain. The further course of tick-borne infections revealed the dominant influence of B. burgdorferi in relation to TBEV. Laboratory studies have shown that suppression of the activity of the borreliosis process by etiotropic treatment subsequently led to the activation of the persistent TBEV.
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COVID-19 , Coinfection , Encephalitis Viruses, Tick-Borne , Encephalitis, Tick-Borne , Lyme Disease , Tick-Borne Diseases , Female , Humans , Lyme Disease/complications , Lyme Disease/diagnosis , Lyme Disease/drug therapy , SARS-CoV-2 , Tick-Borne Diseases/diagnosis , Tick-Borne Diseases/drug therapyABSTRACT
The objective: To provide pathogenetic justification for the need for extracorporeal blood purification in the new coronavirus infection. Results: The article analyzes guidelines and the first experience of using extracorporeal methods in the new coronavirus infection in different countries. It has been demonstrated that methods of extracorporeal blood purification have complex pleiotropic (multiple) effects and can quickly normalize the level of cytokines and other pathogenic factors, thereby preventing/reducing the severity of organ disorders. The article specifies the criteria for choosing an extracorporeal method, as well as indications for its early and late use. © 2020 Messenger of Anesthesiology and Resuscitation. All rights reserved.
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Objectives: Ischemic cardiomyopathy is the principal cause of heart failure. In patients with left ventricular (LV) dilatation,low ejection fraction (EF), and transmural scar in anteroseptal distribution, surgical ventricular reconstruction (SVR) can beconsidered, although it is an invasive surgical procedure. Less Invasive Ventricular Enhancement (LIVE) technique emergedas a unique intervention to exclude scarred myocardium, improving symptoms and quality of life. We aim to present LIVEcontemporary short and mid-term outcomes. Methods: LIVE procedure has evolved from open sternotomy to a hybrid procedure done with right internal jugular veinaccess and a left minithoracotomy. LV shape and size are restored without extracorporeal circulation by plication of thescarred myocardium. This is achieved by implantation of a series of internal and external microanchors brought togetherover a poly-ether-ether-ketone (PEEK) tether to make a longitudinal approximation between the LV free wall and theanterior septum. Internal anchors are deployed by a transcatheter technique, through the right internal jugular vein, on theright side of the ventricular septum. Result: Between July 2018 and August 2020, a total of 71 patients (84.5% men;mean age 61 ± 12.3 years) weresubmitted to the LIVE procedure in 18 institutions in Europe, North America, and Asia. Procedural success was 100%. Amean of 2.4 anchor pairs (median 3) was used to reshape the LV. Echocardiographic data showed an increase in LV EF from31.0 ± 9.2 to 38.9 ± 12.6% (change +29.8%, p < 0.001) and LV end-systolic volume index (LVESVI) reduction from 68.0 ± 28.8 mL/m2 to 42.3 ± 20.7 mL/m2 (change: -37.9%, p < 0.001) after the procedure. No sternotomy conversion was needed.New onset tricuspid valve regurgitation was observed in one patient. There was no case of ventricular septal defect.Observed mortality was 2.8% (2 patients): one due to severe contrast dye induced anaphylactic shock and another one dueto COVID-19. In the follow-up, NYHA class improved a median of 1 grade and there was no late mortality. Conclusion: Hybrid LV reshaping and volume reduction has proven to be a useful solution for patients with symptomaticheart failure after left anterior descending territory myocardial infarction. These results from the latest iteration of thetechnique show that this approach is safe, reproducible, and has a significant short and mid-term impact on improving EFand reducing LV size.
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Aim. To evaluate mortality and risk factors for death in patients with COVID-19 who required admission to intensive care units (ICU) for respiratory support in Russia.Material and methods. In a retrospective study, we collected medical records of the consecutive ICU patients submitted by the local COVID-19 hospitals across Russia to the Federal Center at the Sechenov University (Moscow) betweenMarch 16 to May 3, 2020. All patients have completed their hospital stay (death or recovery). Diagnosis of SARS-CoV-2 pneumonia was established both by polymerase chain reaction (PCR) and CT. In patients with inconclusive or negative results of PCR, the SARS-CoV-2 pneumonia was defined as severe acute respiratory infection with typical CT findings and no other obvious aetiology. We used Cox proportional hazards regression model adjusted for age, sex and other risk factors to estimate hazard ratios (HR) and 95% confidence intervals (CI).Results. We studied 1522 ICU patients with SARS-CoV-2 induced acute respiratory distress syndrome (ARDS), including 864 males and 658 females at the median age of 62 years. Nine hundred twenty two records (60.1%) were submitted from Moscow and Moscow province, and 600 records (39.4%) were received from the hospitals located in 70 regions of Russia. SARS-CoV-2 was verified by PCR in 995 (65.4%) patients. Among 1522 patients enrolled in the study,995 patients (65.4%) died, and 527 (34.6%) patients recovered. The most common causes of death were ARDS (93.2%), cardiovascular events (3.7%) and pulmonary embolism (1.0%). The mortality rate was low in patients with less severe pneumonia requiring oxygen therapy (10.1%). However, it increased significantly in patients who were placed on noninvasive or invasive ventilation (36.8% and 76.5%, respectively). Risk of death increased with age, and in males older than 50 years it was significantly higher than in females of similar age. In a unvariate analysis, arterial hypertension, coronary artery disease (CAD), history of stroke, atrial fibrillation, type 2 diabetes, obesity and malignancies were associated with an increased risk of death. However, only CAD (HR1.257, 95% CI 1.064-1.485, p=0.007), type 2 diabetes (HR1.300, 95% CI 1.131-1.494, p<0.0001) and obesity (HR1.347,95% CI 1.166-1.556, p<0.0001) retained statistical signicance in multiple factor analysis.Conclusion. In ICU patients with COVID-19, severity ofARDS (i.e. requirement in mechanical ventilation), age, malegender, CAD, obesity and type 2 diabetes were associatedwith a higher risk of death. Цель. Изучение летальности и факторов рискасмерти больных с COVID-19, госпитализированных для респираторной поддержки в отделения реанимации и интенсивной терапии(ОРИТ) лечебных учреждений Российской Федерации.Материал и методы. Ретроспективноеисследование было выполнено в Федеральномдистанционном консультативном центре анестезиологии и реаниматологии для взрослыхпациентов с COVID-19 на базе Первого МГМУим. И.М. Сеченова. В исследование включаливсех пациентов с известными исходами (смертьот любых причин или выздоровление) SARS-CoV-2 пневмонии, осложнившейся острым респираторным дистресс синдромом (ОРДС),которые были проконсультированы с 16 мартапо 3 мая 2020 г. Факторы риска смерти анализировали с помощью многофакторной регрессионной модели Кокса.Результаты. В исследование были включены 1522 пациента, 864 (56,8%) мужчины и 658(43,2%) женщин. Медиана возраста - 62 года.922 (60,6%) больных находились в ОРИТ стационаров Москвы и Московской области, 600(39,4%) - лечебных учреждений в 70 регионахРоссийской Федерации. У 995 (65,4%) больных диагноз SARS-CoV-2 инфекции был подтвержден с помощью ПЦР. Умерли 995 (65,4%)пациентов, выжили 527 (34,6%). Основнымипричинами смерти были ОРДС (93,2%), сердечно-сосудистые осложнения (3,7%) и тромбоэмболия легочной артерии (1,0%).Летальность была низкой у пациентов, находившихся на оксигенотерапии (10,1%), изначительно повышалась у больных, которыхприходилось переводить на неинвазивную(36,8%) или инвазивную (76,5%) вентиляциюлегких. Риск смерти увеличивался с возрастоми в возрастных группах старше 50 лет у мужчинбыл достоверно выше, чем у женщин. В однофакторных моделях заболеваниями, ассоциировавшимися с развитием летального исхода,были артериальная гипертония, ИБС, инсульт,фибрилляция предсердий, сахарный диабет 2типа, ожирение и солидные опухоли, однако вмногофакторной модели, построенной по всемпризнакам с коррекцией по полу и возрасту,статистическое значение сохранили толькоИБС (отношение рисков [ОР] 1,257, 95% доверительный интервал [ДИ] 1,064-1,485,p=0,007), сахарный диабет 2 типа (ОР 1,300,95% ДИ 1,131-1,494, p<0,0001) и ожирение(ОР 1,347, 95% ДИ 1,166-1,556, p<0,0001).Заключение. Основными факторами рискасмерти больных с COVID-19, переведенных вОРИТ для респираторной поддержки, былитяжесть ОРДС, прежде всего необходимость вИВЛ, пожилой возраст, мужской пол, а такжеИБС, ожирение и сахарный диабет 2 типа.
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AIM: In a retrospective study, we evaluated factors associated with the early development of septic shock in patients with severe COVID-19. MATERIALS AND METHODS: We collected medical records of the intensive care unit patients submitted by the local COVID-19 hospitals across Russia to the Federal Center for the Critical Care at the Sechenov First Moscow State Medical University (Sechenov University). Septic shock in crticially ill patients requiring mechanical ventilation was defined as a need in vasopressors to maintain blood pressure. RESULTS: We studied 1078 patients with severe COVID-19 who were admitted to the intensive care units for respiratory support. There were 611 males and 467 females. The mean age was 61.013.7 years. Five hundred twenty five medical records (48.7%) were received from the Moscow hospitals, 159 (14.7%) from the Moscow region, and 394 (36.5%) from the hospitals located in 58 regions of the Russian Federation. In 613 (56.9%) patients, diagnosis of SARS-CoV-2 infection was confirmed by PCR, and in the other cases it was established on the basis of the clinical picture and the results of the chest CT scan. Septic shock developed in 214 (19.9%) of 1078 patients. In the logistic regression model, the risk of septic shock in patients older than 50 years was higher than in patients of a younger age (OR 2.34; 95% CI 1.533.67; p0.0001). In patients with more severe SARS-CoV-2 infection, there was an increase in the prevalence of cardiovascular diseases, including coronary heart disease and atrial fibrillation, type 2 diabetes and malignant tumors. The risk of septic shock in patients with three or more concomitant diseases was higher than in patients without any concomitant chronic diseases (OR 1.76; 95% CI 1.762.70). CONCLUSION: The risk of septic shock in patients with acute respiratory distress syndrome induced by SARS-CoV-2 is higher in patients older than 50 years with concomitant diseases, although a severe course of the disease is also possible in younger patients without any concomitant disorders.
Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Shock, Septic , Female , Humans , Male , Middle Aged , Moscow/epidemiology , Retrospective Studies , Risk Factors , Russia/epidemiology , SARS-CoV-2 , Shock, Septic/diagnosis , Shock, Septic/epidemiology , Shock, Septic/etiologyABSTRACT
The article examines the problems of digital competence as a phenomenon of modern life, especially aggravated in connection with the COVID-19 pandemic. Digital competence as the latest concept, skills necessary for the modern, connected with the scientific and technical implementation of new technologies in education, economy, politics and production. The development of digital literacy concepts relies on both traditional and diverse media. However, the main difficulty in its development is associated with the digital divide, overcoming which depends on many factors. In the educational environment, digital competence should take into account the age-related physiological, mental and psychological characteristics of schoolchildren, and in preparation for professional activity-support for professional digital competence. The work also provides the author's version of the definition of the concept of digital competence. © Published under licence by IOP Publishing Ltd.
ABSTRACT
The article presents the materials on the 18 days treatment of a 72 - year - old patient who had been for 18 days at the P.V.Mandryka Central Military Clinical Hospital with a severe form of coronavirus infection COVID - 19, complicated by bilateral polysegmental pneumonia. Comorbid pathology: type 2 diabetes mellitus, subcompensation of carbohydrate metabolism;cardiac ischemia;exertional angina, II functional class;atherosclerotic cardiosclerosis;paroxysmal supraventricular tachycardia;chronic heart failure 2A degree;hypertension stage 2, arterial hypertension - 1, risk 4. The patient was admitted in a stable condition without signs of respiratory failure. During the day, there was a lightning - fast deterioration requiring a transfer to the lungs’ artificial ventilation, followed by ventilation in the prone position. On the 8th day, extubation was performed. On the 18th day, he was discharged in a satisfactory condition. Изложены материалы лечения пациента 72 лет, в течение 18 сут находившегося на лечении в Центральном военном клиническом госпитале им. П.В.Мандрыка с тяжелой формой COVID - 19, осложненной двусторонней полисегментарной пневмонией, острым респираторным дистресс - синдромом. Основная коморбидная патология: сахарный диабет 2 типа;ишемическая болезнь сердца;стенокардия напряжения, II функциональный класс;хроническая сердечная недостаточность 2А степени;гипертоническая болезнь 2 стадии. Поступил в стабильном состоянии без признаков дыхательной недостаточности. В течение суток произошло молниеносное ухудшение состояния, потребовавшее перевода на искусственную вентиляцию легких с последующей вентиляцией в прон - позиции. На 8-е сутки проведена экстубация, на 18-е сутки выписан в удовлетворительном состоянии.