ABSTRACT
Currently, thrombotic microangiopathy (TMA) is a common finding in the histological examination of kidney biopsy specimens, while verification of the nosological diagnosis is difficult due to the many etiological factors and the variety of clinical phenotypes. Today, along with primary TMAs, which include thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS), a large group of secondary TMAs associated with a variety of diseases and conditions, considered secondary HUS, is attracting more and more attention. The article presents a clinical case of the development of thrombotic microangiopathy in a 48-year-old man with a history of intravenous drug user who suffered from severe arterial hypertension for a long time. A feature of the disease was clinically – the almost complete absence of hematological manifestations with a progressive nature of nephropathy with an outcome in end-stage kidney disease, morphologically – mainly chronic changes in small extraglomerular vessels (arteries and arterioles), which led to severe ischemic damage to the glomeruli. Considering the predominantly chronic nature of the morphological manifestations of TMA, the absence of signs of acute TMA, and hematological syndrome, the patient did not undergo plasma therapy. In connection with the development of end-stage kidney disease, hemodialysis was initiated. The presented observation illustrates the complex genesis of secondary TMA in a patient with a history of drug addiction and severe arterial hypertension approaching malignant downstream. The presence in the anamnesis of such complement-activating conditions as intravenous drug use, severe arterial hypertension, as well as vaccination against a new coronavirus infection preceding the clinical manifestation, allowed us to interpret this condition as secondary HUS, which, however, does not exclude the presence of protein gene mutations, regulators of the alternative pathway of complement activation, which could act as a predisposing factor, which requires a genetic study of the complement system, since the information obtained will determine the tactics of management in case of kidney transplantation. In addition, this clinical observation demonstrates the importance of a thorough history taking in such patients, the analysis of which will help to identify complement-activating conditions and thereby accelerate the verification of the diagnosis. © 2022 Authors. All rights reserved.
ABSTRACT
Introduction. Wearing a face mask causes adverse reactions in part of the population. These reactions can be associated with the workplace conditions. The study aims to analyze subjective reactions to the wearing of masks by employees of transport companies during the COVID–19 pandemic. Materials and methods. In September 2021 the researchers have conducted a survey of transport companies' workers in various regions of the Russian Federation. Specialists from Sechenov University have developed a questionnaire. The workers gave the subjective assessment of wearing comfort, frequency and severity of adverse reactions to wearing a mask: skin reactions, facial hyperhidrosis, breathing discomfort, and headache. Results. We have conducted a survey of 4,732 employees (72.3% men) who used non-woven, neoprene and cotton masks during the pandemic. The wearing comfort of workers with an energy consumption of less than 139 watts was significantly higher than that of all others. In workers with an energy consumption of 233–290 watts, almost all reactions were more pronounced compared to workers with the lowest energy consumption. In women, reactions appeared more often and were more pronounced than in men. In persons working in the warmest climatic region (IV), all reactions were the least pronounced, and comfort was maximal. Those working more than 12 hours a day noted a more frequent and pronounced appearance of all reactions compared to those working 8 hours. Wearing a mask was more comfortable for those working mainly indoors. Conclusion. Studies allow us to conclude that the portability of masks depends more on the level of energy consumption during operation. The climatic region, the duration of the work shift and the preferred place of work (indoors / outdoors) are somewhat less important. Limitations. In this study, scientists analyzed the effect of only working conditions on the appearance of adverse reactions to wearing a mask. We have not considered the influence of the mask material and the duration of its wearing, which is the topic of a separate publication. Experts have conducted the study only based on the analysis of subjective assessments of anonymous survey participants. During an objective examination, the dermatologist did not conduct an examination of the appearance of skin reactions. However, a large sample size allows us to draw reliable conclusions. Ethics. The study was approved by the local Ethics committee (Protocol No. 15-21 of 01.09.2021). © 2022, Izmerov Research Institute of Occupational Medicine. All rights reserved.
ABSTRACT
Relevance. To date, there is ample evidence that diabetes mellitus (DM) and obesity are predictors of a severe course and adverse outcome of COVID-19. The SARS-CoV-2 virus is known to have deleterious effects on the pancreas, exacerbating insulin resistance The SARS-CoV-2 virus is known to have deleterious effects on the pancreas, exacerbating insulin resistance. Long-term data have been accumulated regarding pneumococcal infection and influenza, both of which are severe in patients with diabetes and obesity. The aim is to analyze scientific publications on the problems of vaccinating patients with diabetes and obesity against SARS-CoV-2, pneumococcal infection, and influenza. Conclusions. Vaccination against COVID-19 in patients with DM and obesity is an effective preventive measure. Experience with vaccination against COVID-19 using the following vaccines: Moderna mRNA-1273, PfizerBioNTech, BNT162b2, AstraZeneca COVID-19 vaccine AZD1222, SII Covishield, SK Bioscience, Sputnik V showed similar safety and efficacy profiles among obese and DM patients and those at risk. Researchers in numerous publications have emphasized the importance of routine vaccination for people living with diabetes amid a pandemic of a new coronavirus infection. Researchers in numerous publications have emphasized the importance of routine vaccination for people living with diabetes in the face of a new coronavirus pandemic. Analysis of the literature reviewed in this review suggests that vaccination against SARS-CoV-2, especially for those at risk, will be an intensive area of research in the coming years and that vaccination against coronavirus infection is likely to be routine for people with diabetes and obesity. © 2022, Numikom. All rights reserved.