[Risk factors for the early development of septic shock in patients with severe COVID-19].

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.

[Bronchial asthma and pregnancy]. / Bronkhial'naia astma i beremennost'.

The review of the data available in the literature dedicated to the problems of the diagnosis, clinical picture, and treatment of bronchial asthma (BA) in females during pregnancy. BA is shown to belong to the diseases whose pattern changes during pregnancy and despite that there are a great deal of papers on the above problem, the genesis of these changes has not been determined. Asthmatic attacks during gestation exert a significant negative impact on the development of pregnancy and the fetus; its main cause is hypoxia; however, there is no unambiguous evidence for this; today there are available several hypotheses that are presented in this paper. The data available in the literature show that most investigators consider it necessary to perform medical treatment for these disease; however, its nature has not been defined yet.

[Does "pulmogenic hypertension" exist?]. / Sushchestvuet li 'pul'monogennaia gipertenziia'?

Validity of criteria of so called "pulmogenic hypertension" in chronic obstructive pulmonary diseases was assessed with the use of a questionnaire and simultaneous 24 hour monitoring of blood pressure and peak expiratory rate in 80 and 28 patients, respectively. This method of bifunctional monitoring allowed to study relationship between blood pressure level and degree of bronchial obstruction. The results did not confirm the presence of "pulmogenic hypertension" as a special form of arterial hypertension.

[Treatment of arterial hypertension in patients with bronchial asthma]. / Lechenie arterial'noi gipertenzii u bol'nykh bronkhial'noi astmoi.

Treatment of arterial hypertension in patients with concurrent chronic obstructive diseases of the lungs has limits in prescription of antihypertensive drugs. STAMLO--long-acting calcium antagonist--is proposed for monotherapy of mild and moderate hypertension in patients with bronchial asthma. The drug decreases hypertension in the greater and lesser circulation, improves bronchial permeability.

[Clinical characteristics and diagnosis of stenocardia in persons with normal coronary vessels]. / Klinicheskie osobennosti i diagnostika stenokardii u lits s normal'nymi koronarnymi sosudami.

To date, the clinical pattern and electrocardiographic diagnosis of only one variant of coronary heart disease (CHD) with unchanged coronarogram, Prinzmetal's angina, have been worked out, while the diagnosis of other variants remains undeveloped. Clinical symptoms and possibilities of CHD diagnosis in the presence of intact coronary arteries have been evaluated in 67 coronary patients, the coronarograms being normal in 46 of those. The diagnosis of CHD was verified by means of various instrumental methods, including electrocardiographic tests and myocardial metabolic studies in conditions of frequent atrial stimulations. The results were computerized, using a specifically designed programme. Sets of signs identifying coronary patients with intact coronary arteries at questioning and noninvasive investigation are presented.

[Use of a universal formalized questionnaire in the differential diagnosis of cardiac and noncardiac pain]. / Ispol'zovanie universal'noi formalizovannoi ankety v differentsial'noi diagnostike koronarogennykh i nekoronarogennykh bolei.

A standard questionnaire, capable of describing chest pain sensations, has been offered for patients with coronary disease and neurocirculatory dystonia, and its diagnostic value is assessed. The questionnaire comprises five sections, each corresponding to a certain type of pain. A diagnostic statement is made after each section. The questionnaire can be analysed by a physician on the basis of individual clinical experience, or computer-processed. It possesses high sensitivity and specificity in detecting typical and atypical angina and cardialgia of different types. The questionnaire can identify a category of patients with chest pains, who require instrumental diagnostic investigation to specify their origin.