[Surgical treatment of COVID-19 patients during the pandemic]. / Opyt khirurgicheskogo lecheniya patsientov s COVID-19 v period pandemii.

OBJECTIVE: To analyze the results of emergency surgery in COVID-19 patients with viral pneumonia. MATERIAL AND METHODS: A retrospective study included 75 COVID-19 patients who underwent emergency surgical interventions. Comorbidities included cardiac diseases, nonspecific lung diseases, type 2 diabetes, kidney diseases, overweight, and cancer. Various combinations of these diseases were also noted. RESULTS: We carried out emergency surgeries for abdominal, thoracic, soft tissue and venous diseases. Postoperative mortality was 42.6%. The best results were obtained after minimally invasive interventions without mechanical ventilation. Extended surgery with mechanical ventilation was followed by fast progression of pneumonia according to clinical and CT data. CONCLUSION: Surgical interventions undoubtedly worsen prognosis of treatment in patients with COVID-19. Emergency minimally invasive surgery without mechanical ventilation can reduce the risk of unfavorable outcomes in patients with viral pneumonia, especially in case of concomitant cancer and other severe comorbidities.

[THE COMBINATION OF HIGH-FREQUENCY ELECTRICAL STIMULATION AND FIBRIN GLUE IN THE TREATMENT OF DECUBITAL ULCERS IN PATIENTS AFTER BRAIN DAMAGE: A PILOT STUDY].

Aim - to improve the results of treatment of decubital ulcers (DU) in combination therapy of high-frequency electrical stimulation (HFS) and fibrin glue (FG). The authors carried out a comparative analysis of the effectiveness of the combined method of treatment of decubital ulcers using high-frequency electrical stimulation (HFS) and fibrin glue (FG). All patients included in the pilot project, 22 people with a stage III pressure ulcer and who are in chronic critical condition after various brain damage. During the dressings, high-frequency stimulation was carried out with an EHVCh-250 "KiK Medimaster" electrosurgical apparatus, which generates alternating currents of the radio frequency (RF) range (0.3-3.0 MHz) for 28 days, and then (the main group), cryoprecipitate (fibrin glue) within 21 days. For comparison, the results obtained were compared with those in 25 people with DU treated according to the generally accepted method with the use of standard drugs (levomekol, levosin). HFS has a beneficial effect on all stages of a complicated wound process, promotes wound cleansing, activation of early granulation growth and marginal epithelialization. And the subsequent use of fibrin glue causes an even greater prevalence of proliferative processes over inflammatory processes in the tissues, which also contributes to a decrease in exudation, further growth of granulation tissue and an increase in epithelization processes. The use of this combination in the treatment of decubital ulcers can be used in complex conservative therapy in the treatment of pressure ulcers.

ROLE OF THROMBODYNAMICS GLOBAL COAGULATION TEST IN IMPROVING TREATMENT RESULTS IN PATIENTS WITH CORONAVIRUS INFECTION AT A COVID-19 HOSPITAL.

The aim of the study was to evaluate the effectiveness of the global coagulation test of thrombodynamics for monitoring and correcting the hemostatic system and improving the results of complex treatment in patients with SARS-CoV-2 in the COVID hospital. From April 2020 to December 2020 on the basis of the University Clinical Hospital No. 4 of the First Moscow State Medical University named I.M. Sechenov (Sechenov University) of the Ministry of Health of the Russian Federation 245 patients between the ages of 27 and 89 with SARS-CoV-2 associated pneumonia were treated. The mean age of the patients was 56.7 ± 4.2 years. All patients participating in the study were divided by simple randomization into two groups. The volume of lesion of the lung parenchyma was assessed according to the data of computed tomography. All patients were treated for SARS-CoV-2 in a comprehensive manner in accordance with the temporary guidelines of the Ministry of Health of the Russian Federation with the mandatory prescription of low molecular weight heparins (LMWH). Assessment and correction of the hemostasis system in 177 patients (47.7%) of group 1 was carried out daily using local coagulation tests (LCT), including APTT, PT, TT, PTI, INR, Fibrinogen and D-dimer level. The second group included 128 patients (52.3%), who, in addition to local coagulation tests, used the integral coagulation test - the thrombodynamics test- to assess and correct the state of the hemostatic system. Assessment and correction of hemostasis were performed at the control points (1, 7, 14 days) of the study. Compared to LCT, the thrombodynamics test reliably more often revealed the state of hypercoagulability, which was promptly corrected by increased doses of LMWH in group 2. Positive dynamics of clinical symptoms were detected in patients of group 2 1.8 times more often than in group 1 (p<0.05): fever and shortness of breath in group 2 decreased faster, the SpO2 index recovered more rapidly, especially in patients with severe hypoxia (with SpO2<90), the number of patients with moderate and severe severity by the third point of the study in group 2 was 1.8 times less than in group 1 (p<0.05). Severe forms of lung damage (CT-3 and CT-4) were detected in group 2 3.2 times less frequently (p <0.01) compared with group 1, and the number of deaths was 3.3 times less frequent (p<0.01) by the end of the study. The average bed-day in group 2 of patients (15±1.6 days) was 1.6 times shorter than in group 1 (24±7.2 days). Hemorrhagic complications were not recorded, despite the therapeutic doses of LMWH in patients of group 2. The severity of the condition of patients with SARS-CoV-2 and the dynamics of their symptoms depend on the state of microcirculation in the lungs and in the periphery and on the volume of thrombotic lesions. Anticoagulant therapy prescribed as early as possible in adequate therapeutic doses in patients with SARS-CoV-2 associated viral pneumonia made it possible to achieve positive treatment results. The use of the global coagulation thrombodynamics test has shown high efficiency for the timely assessment and correction of the state of the hemostasis system.

[Results of a sociological survey of the prevention of malaria in the Surkhandaryinsk Region, Republic of Uzbekistan].

A sociological survey was made in the Sariasiysk and Uzun districts of the Surkhandaryinsk Region in October 2010 within the project UZB-809-G04-M "Consolidation of the achieved results and support of measures to eliminate malaria in Uzbekistan". These districts were selected due to the high susceptibility and vulnerability of the areas and to the results of surveys within the Global Fund project during 2005-2010. The results of the inquiry demonstrate progress in a number of indicators of awareness about malaria. In particular, 63% of the population knew the main symptoms of malaria, 65% could call main ways to prevent malaria; 97% was aware of that insecticide-impregnated canopies were the basic means of protection against mosquito bites, and 80% told all basic measures that could reduce the size of mosquitoes and to prevent their reproduction. Public population in the Sariasiysk district was much better than that in the Uzun district. Men were well aware than women; young people were less aware than adults. Awareness among persons with higher education exceeded that among those without professional education. Medical workers are the main source of information for the population. The role of mass media and local bodies was lower. Most of the population expressed their readiness to obtain expanded information on malaria.

[Monitoring of the malaria situation and the assessment of antimalaria measures in the Republic of Uzbekistan].

In 2008, the major malaria vectors An.superpictus and An. pulcherrimus amounted up to 50 specimens per premise in the Surkhandaryinsk and Kashkadaryinsk Regions. The high density of larvae in the water reservoirs (as many as 30-50 specimens per square meter) and rice fields (8-60 specimens per square meter) was noted in the Surkhandaryinsk, Namangan, Ferghana, and Tashkent Regions. There is a high susceptibility of the territory due to increased migration between Uzbekistan, Kyrgyzstan, and Tajikistan. In 2008, a total of 4,958,685 subjects passed through 68 border checkpoints, among them there were 835 (0.02%) individuals with suspected infectious diseases, including malaria. The foci of irrigation-ditch area and their conjugate foci of the floodplain-river one of the Surkhandaryinsk Region are most dangerous. Analysis of the trend of malaria foci showed a reduction in the number of new active foci from 44 in 2006 to 6 to 2008. The increased number of residual inactive and sanitized foci suggests that the malaria situation has considerably improved.

[A complex method of detection of Helicobacter pylori in patients with duodenal ulcer]. / Kompleksnyi metod vyiavleniia Helycobacter pylori u bol'nykh iazvennoi bolezn'iu dvenadtsatiperstnoi kishki.

A method for measurements of blood antigen-binding lymphocytes sensitized to Helicobacter antigens is suggested. Use of this method together with urease test will improve Helicobacter infection detection rate by 22%.