Secondary thrombotic microangiopathy or secondary HUS: drugs or malignant hypertension to blame? Case report and review of the literature

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.

[Modern features of fertility in lowand middle-income countries, including in the context of the COVID-19 pandemic].

The main issues in the problem of fertility in countries with low and middle incomes of the population are the high prevalence of complications and maternal deaths during childbirth, as well as the high incidence of such indicators of the birth of an infant with low growth and weight indicators for their gestational age, malnutrition of pregnant women and mothers, frequent abortions, short intervals between births due to the educational status of the mother and the financial wealth of households, high prevalence of teenage motherhood, low availability of cesarean section, high cost of educating children as a factor in fertility. The impact of the COVID-19 pandemic on fertility in low- and middle-income countries has been most pronounced due to disruptions in the health care system, a surge in domestic violence, teenage pregnancy and female genital mutilation.

The role of the digital diaspora in overcoming the vulnerabilities of migrants under the covid-19 pandemic (the case of Moldovan migrants)

Contemporary information-communication technologies contribute to the development of the quasi-institution ‘transnational migrant community’ in the form of digital diaspora. It has several functions: maintaining ties with the country of origin, ensuring transnational interaction, constructing the identity of migrants, consolidating their ethnic community and social adaptation, expressing the subjectivity of the diaspora in the public sphere, psycho-emotional support. The relevance of the study of the digital diaspora’s role in overcoming vulnerabilities of migrants under the pandemic is determined by the need to consider the adaptation of migrants in the context of the transformation of migrations and the use of contemporary information-communication technologies by migrants. The object of the study is the online groups of Moldovan migrants, which are characterized by the rapid institutionalization of diaspora organizations. The authors focus on the mechanisms of social adaptation of Moldovan migrants, which serve to overcome their vulnerabilities and risks under the pandemic with information-communication technologies. The study is based on the concept “digital diaspora” and the secondary analysis of the data from the Representative Office of the International Organization for Migration in Moldova on the Internet practices of Moldovan migrants (2017) and on the situation of migrants under the pandemic (2020). The main research method is the analysis of the content of the largest Internet groups of Moldovan migrants in the social network with the techniques “problem tree” and “decision tree”. The study showed that during the pandemic, the Internet groups of Moldovan migrants became a platform for their self-organization and overcoming vulnerabilities, and also performed informational, organizational, representative, mobilization and recreational functions. The authors believe that the experience of the Internet groups of Moldovan migrants can be extrapolated to other migrant communities and other contexts supporting the political, economic and social-cultural subjectivity of migrants. © 2022, RUDN UNiversity. All rights reserved.

The activity of noncommercial organizations providing medical social care to migrants in conditions of COVID-19.

The article considers actual topic concerning acquisition by migrant associations of certain importance in the public sphere of different countries. The analysis demonstrated that these public structures begin to act as actors of intersectorial cooperation within the framework of state policy in the fields of migration and health care. It is substantiated that various institutions of civil society remained in shadow of state and commercial structures for a long time. Only recently, Russian socially oriented noncommercial organizations acquired status of suppliers of social services, including medical social care of population. At that, they became a subject of cooperation in order to provide medical social care to population, which is provided not only to Russian citizens within the framework of mandatory medical insurance, but also to migrants. It is proved that during the pandemic, many noncommercial organizations expanded scope of cooperation with government, business and public structures of medical and social profile. Some noncommercial organizations that were originally organized as associations of migrants and had character of diasporas are now legitimate NGOs. Such organizational and functional changes can be interpreted as a result of development in the field of care of migrants and their integration into the Russian noncommercial sector. As a consequence of transnational commitment of migrants themselves and their interest in development of their native countries. Also, as a result of institutional integration, and consequence of spreading of COVID-19 and intensification of need in medical and social care to countrymen and their families. It is concluded that institutional changes allow NGOs to establish more open relations with associations of migrants of various origins, as well as to attract additional resources for planning, financing and implementing projects that are strategically important both for survival of organizations themselves and for helping migrants in pandemic conditions.

[HEALTHY LIFESTYLE OF THE POPULATION IN THE CONTEXT OF A PANDEMIC: EXPERT OPINIONS OF RESEARCHERS AND EMPLOEES OF NON-PROFIT ORGANIZATIONS].

The article presents the results of a study aimed at identifying the problems of maintaining a healthy lifestyle in the context of the COVID-19 pandemic. The results of the study showed that not only people of older age groups are infected, but also young people with chronic diseases. Forced isolation, uncertainty of the future and stress have significantly worsened the physical, social and mental health of the population of all age groups. Therefore, people began to strengthen their own physical, social and psychological health, to carry out preventive health measures. The problems of maintaining a healthy lifestyle in the context of the COVID-19 pandemic can be effectively solved by using an integrated approach to public health, jointly provided by state and public organizations.

[The attitude of the youth to vaccine prevention of influenza in conditions of COVID-19 pandemic].

The article considers the problem of attitude of the youth to vaccine prevention of influenza. The study was organized on the basis of qualitative research methods (focus groups) of students of two universities in the Central and Volga Federal Okrugs. The data about attitudes towards vaccination and refusal motivation was obtained. The need in increasing awareness of the youth about vaccine prevention as an actual health-preserving technology was substantiated.

[The COVID-19 pandemic as transformation factor of domestic violence].

The article presents the results of project targeted to identify specifics of transformation of domestic violence while anti-pandemic measures are in force. The sociological survey was organized on the basis of the Crisis center for women in difficult life situations (Belgorod region, Russia). The sampling consisted of 46 women aged from 20 to 45 years endured domestic violence. The primary information was collected using semi-structured interview technique. Also, semi-structured interviews of experts from among sociologists and crisis center personnel were carried out. It is established that COVID-19 pandemic significantly impacted on family relationships. The conditions of forced isolation and anti-pandemic measures observance significantly increase risk of domestic violence.