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1.
Khirurgiia (Mosk) ; (10): 5-14, 2022.
Article in Russian | MEDLINE | ID: covidwho-2067394

ABSTRACT

OBJECTIVE: To analyze the causes of mortality in patients with acute appendicitis in Russia. MATERIAL AND METHODS: We retrospectively studied mortality in patients with acute appendicitis in the Russian Federation in 2020. We surveyed the hospitals with mortality reported in the electronic database of annual reports to the chief surgeon of the Ministry of Health of the Russian Federation. RESULTS: There were 259 deaths among 150.393 patients with acute appendicitis aged ≥18 years (in-hospital mortality 0.17%). We obtained data about 95.8% (n=248) of lethal cases including 86.3% (n=214) complicated and 13.7% (n=34) uncomplicated forms of disease. Two patients died without surgery (0.8%). Among the deceased, 58.2% (n=145) were men and 41.8% (n=103) were women. Mean patient age was 66.2 years [0.95% CI 64.2-68.1]. The main cause of death in complicated appendicitis was late presentation (after 4.9 days [0.95% CI 4.3-5.4]) that resulted peritonitis and sepsis in 71.5% (n=153) of patients. Cardiovascular diseases were noted in 23.4% (n=50) of cases. A new coronavirus infection was detected in 7.0% (n=15) of patients. However, COVID-19 as a direct cause of death was recognized in 2.8% (n=6) of cases. Other reasons accounted for 2.3% (n=5). In uncomplicated appendicitis, cardiovascular diseases were the main cause of mortality (73.5%, n=25). Peritonitis and sepsis were found in 11.8% (n=4) of cases, COVID-19 - in 5.9% (n=2). Other causes accounted for 8.8% (n=3). Diagnostic, tactical, technical problems and their combination were revealed in 54.4% of lethal outcomes. CONCLUSION: Mortality from acute appendicitis in the Russian Federation is low, comparable with international data, and mainly associated with delayed treatment and complicated course of disease. However, the impact of diagnostic, tactical and technical errors on the outcome of acute appendicitis is significant.


Subject(s)
Appendicitis , COVID-19 , Cardiovascular Diseases , Laparoscopy , Peritonitis , Sepsis , Acute Disease , Adolescent , Adult , Aged , Appendectomy/methods , Appendicitis/diagnosis , Appendicitis/epidemiology , Appendicitis/surgery , Cardiovascular Diseases/surgery , Female , Humans , Laparoscopy/adverse effects , Male , Peritonitis/etiology , Retrospective Studies , Sepsis/surgery
2.
Research Institute for Healthcare Organization and Medical Management, Moscow Healthcare Department ; 2020.
Article in English | MEDLINE | ID: covidwho-1151386

ABSTRACT

This Atlas is the result of the autopsies performed by the Moscow Pathology Service for the posthumous diagnosis of presentations and complications of COVID-19 in 2000 cases, the largest number of autopsies of COVID-19 cases in the world. This was accomplished because in Moscow an autopsy is performed in 100 % of fatal cases with suspected COVID-19 with a detailed clinical and morphological analysis. The results of the studies formed the basis of a new methodology that expands upon WHO Guidelines for Certification and Classification (Coding) of COVID-19 as Cause of Death. Transferring this methodology into practice allowed not only to improve reporting of COVID-19-related deaths, but also had a significant impact on the management strategies of COVID-19 patients. A contribution to the theory of pathology is the introduction of the concept of clinical and morphological "masks" of COVID-19. Atlas presents a wide range of signs and complications of COVID-19, which outline ways for further study of their pathogenesis and morphogenesis, improvement of diagnostics and treatment of patients, and a detailed classification of the causes of death directly or indirectly associated with COVID-19. Atlas is intended for pathologists, forensic experts, as well as doctors of all clinical specialties and students in medical schools, including those in advanced training programs of continuing medical education.

3.
Annals of HPB Surgery ; 25(3):72-87, 2020.
Article in Russian | EMBASE | ID: covidwho-994695

ABSTRACT

Purpose. To assess the liver density according to the data of native CT studies in patients with COVID-19, depending on the severity of the pulmonary parenchyma damage and the prescribed treatment, to compare the data with biochemical indicators, and also to demonstrate changes in density indicators over time. Material and methods. Lung CT data from 200 patients with COVID-19 were retrospectively analyzed. The density of the liver, spleen, and subcutaneous fat tissue was measured in all patients on the images of the upper abdominal cavity that entered the scan area. The ratio of the density of the liver to the spleen and to the density of the fat tissue was assesed. These indicators were compared with each other in two groups of lung tissue damage: CT 1-2 and CT 3-4. The CT 3-4 group was assessed in detail: the density indicators of the liver were studied in dynamics, and their relationship with biochemical indicators - during the initial study. A comparison was also made between two subgroups: patients taking tocilizumab and those without tocilizumab. Results. A decrease in liver density and the ratio of liver density to spleen density was observed in 35.5% and 47.5% of patients respectively. Liver density and the ratio of liver density to spleen density were lower in the CT 3-4 group than in the CT 1-2 group, and amounted to 43.9 HU versus 49.3 HU (p < 0.008) and 0.9 versus 1.0 respectively (p < 0.014). In the initial study, there were a moderate (r = −0.30;p < 0.05) and weak (r = −0.26;p < 0.05) negative correlation of liver density and the ratio of liver density to spleen density with serum albumin. When assessing the dynamics in patients in the CT 3-4 group, with each subsequent study, an increase in the density of the liver parenchyma and the ratio of liver density to spleen density was noted. The difference between the mean values of liver density at the first and at the fourth CT examinations was 11.85 HU. Liver density values were independent of treatment with tocilizumab. Conclusion. Liver density values were lower in patients with COVID-19 with the degree of lung parenchyma lesion CT 3-4, increased during treatment and did not depend on the prescription of tocilizumab. Evaluation and monitoring of the dynamics of liver density could become a useful parameter in determining the severity of the disease course. No strong relationships were found between the density parameters during primary CT and any of the biochemical parameters. A more detailed analysis of these changes in dynamics is required, which may suggest the prevailing mechanism of liver damage in COVID-19.

4.
Pulmonologiya ; 30(5):519-532, 2020.
Article in Russian | Scopus | ID: covidwho-937764

ABSTRACT

The research aim is to study the morphological features of COVID-19 in the lungs of patients who died in Moscow from March 20 to June 6, 2020. Methods. Autopsy material of the lungs from 123 deceased (54 women, 69 men) with COVID-19 coronavirus infection (confirmed by PCR) was analyzed, the median age was 71 (30 - 94) years, and the duration of the disease was 14 (3 - 65) days. In all cases, the patient's medical records and autopsy reports were analyzed. Macro- and microscopic changes in the lungs were evaluated in all the observations. Results. The pathology of the lungs in COVID-19 corresponds to various phases of diffuse alveolar damage (DAD). The exudative phase of DAD was detected in 54 (43.9%), the proliferative phase - in 21 (14.63%), and their combination - in 51 (41.46%) of the deceased. Histological features of different phases of DAD are described. Conclusion. An analysis of autopsy material revealed a mismatch between the duration of the course of the disease and the phase of diffuse alveolar damage. A significant portion of the dead found a combination of exudative and proliferative phases of the disease. Histological signs that indirectly indicate a violation of the coagulation system during COVID-19 are described. © 2020 Medical Education. All rights reserved.

5.
Kardiologiia ; 60(7): 4-10, 2020 Jun 19.
Article in Russian | MEDLINE | ID: covidwho-903120

ABSTRACT

Aim      Despite the regular heart damage in patients with coronavirus pneumonia caused by SARS-Cov-2, a possibility of developing lymphocytic myocarditis as a part of COVID-19 remains unsubstantiated. The aim of this study was to demonstrate a possibility of lymphocytic myocarditis and to study its morphological features in patients with the novel coronavirus infection (COVID-19) with a severe course.Material and methods   Postmortem data were studied for 5 elderly patients (74.8±4.4 years; 3 men and 2 women) with the novel coronavirus infection and bilateral, severe polysegmental pneumonia (stage 3-4 by computed tomography). COVID-19 was diagnosed based on the typical clinical presentation and positive polymerase chain reaction test in nasopharyngeal swabs. All patients were treated in different hospitals repurposed for the treatment of patients with COVID-19. A standard histological study was performed with hematoxylin and eosin, toluidine blue, and van Gieson staining. Serial paraffin slices were studied immunohistochemically with antibodies to CD3, СD68, CD20, perforin, and toll-like receptors (TLR) 4 and 9.Results In none of the cases, myocarditis was suspected clinically, added to the diagnosis or indicated as a possible cause of death. IHD and acute myocardial infarction were mentioned as error diagnoses not confirmed by the postmortem examination. The morphological examination of the heart identified signs of lymphocytic myocarditis consistent with Dallas criteria for this diagnosis. Myocardial infiltrate was characterized in detail, and a combined inflammatory damage of endocardium and pericardium was described. The immunohistochemical study with cell infiltrate typing confirmed the presence of CD3-positive Т lymphocytes and the increased expression of TLR-4. A picture of coronaritis, including that with microvascular thrombosis, was found in all cases.Conclusion      A possibility for development of lymphocytic viral myocarditis in COVID-19 was confirmed morphologically and immunohistochemically. Specific features of myocarditis in COVID-19 include the presence of coronaritis and a possible combination of myocarditis with lymphocytic endo- and pericarditis.


Subject(s)
Betacoronavirus , Coronavirus Infections , Myocarditis , Pandemics , Pneumonia, Viral , Aged , COVID-19 , Female , Humans , Male , Myocarditis/diagnosis , SARS-CoV-2
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