[Infectious complications in acute period after traumatic brain injury]. / Infektsionnye oslozhneniya u patsientov v ostrom periode cherepno-mozgovoi travmy.

Patients with traumatic brain injury (TBI) are at high risk of infection. OBJECTIVE: To delineate infections in acute period of TBI, association between intracranial lesion type and risk of infection, as well as to estimate treatment outcomes in these patients depending on infection. MATERIAL AND METHODS: This study included 104 patients with TBI (80 men and 24 women) aged 33.01±14.35 years. All patients met the inclusion criteria: admission within 72 hours after TBI, age 18-75 years, ICU-stay >48 hours, available brain MRI data. Mild, moderate and severe TBI were diagnosed in 7%, 11% and 82% of patients, respectively. Analysis of infections was performed in accordance with the definitions of the Centers for Disease Control/National Healthcare Safety Network (CDC/NHSN). RESULTS: Acute period of TBI is associated with high incidence of infection (73%), and prevalent infection is pneumonia (58.7%). Severe intracranial damage in acute period of TBI (grade 4-8 according to MR-based classification by A.A. Potapov and N.E. Zakharova) is associated with higher incidence of infection. Infectious complications more than twice increase duration of mechanical ventilation, ICU- and hospital-stay. CONCLUSION: Infectious complications significantly affect treatment outcomes in acute period of TBI increasing duration of mechanical ventilation, ICU- and hospital-stay.

[Differential diagnosis of pneumonia as a complication of nasal liquorrhea in the context of the COVID-19 pandemic: Case report].

Nasal liquorrhea the outflow of cerebrospinal fluid from the cerebrospinal fluid spaces of the cranial cavity into the nasal cavity or paranasal sinuses due to the presence of a congenital or acquired defect in the bones of the skull base and meninges of various etiologies. Nasal liquorrhea leads to potentially fatal complications: meningitis, meningoencephalitis, pneumocephalus, brain abscess. Also, with nasal liquorrhea, less dangerous complications may occur: aspiration bronchopneumonia and gastritis. The article presents a case of aspiration pneumonia in two patients with nasal liquorrhea treated at the Burdenko National Medical Research Center for Neurosurgery during the COVID-19 pandemic. Both patients noted the profuse nature of the nasal liquorrhea, complained of coughing in a horizontal position. In both cases, no RNA virus (SARS-CoV-2) was detected during the polymerase chain reaction. Antibodies (IgG, M) to coronavirus were not detected. Computed tomography of the chest organs in both cases revealed areas of frosted glass darkening. Since no data was obtained for coronavirus infection (negative tests for coronavirus, lack of antibodies), changes in the lungs were interpreted as a consequence of constant aspiration of CSF. The patients were admitted to a separate ward. Both patients underwent endoscopic endonasal plasty of the skull base defect. The postoperative period in both cases was uneventful. In both cases, the patients underwent computer tomography scan of the chest organs one month later. On the photographs, the signs of pneumonia completely regressed.

[Nosocomial meningitis in endoscopic transsphenoidal surgery]. / Nozokomial'nye meningity v endoskopicheskoi transsfenoidal'noi khirurgii.

One of the main problems of transsphenoidal surgery is the risk of infectious complications. Nosocomial meningitis (NCM) can lead to increased length of hospital stay and financial costs, poor treatment outcomes and even mortality. This complication is an indicator of the quality of medical care for patients with neurosurgical diseases. The purpose of the review was to study the main risk factors of NCM, modern schemes for antibiotic prophylaxis and treatment of this complication after endoscopic transsphenoidal surgery. The main risk factors of meningitis are intra- and postoperative CSF leakage, overweight, diabetes mellitus, previous transsphenoidal surgeries and radiotherapy. To date, there are no generally accepted periods for antibiotic prophylaxis in nasal CSF leakage, installed external ventricular / lumbar drains or tampons in nasal cavity. Antibiotic prophylaxis should not exceed 3 postoperative days due to the risk of cultivating the drug-resistant organisms. If NCM is detected, treatment should be initiated immediately with a broad spectrum of antibiotics.

[Risk factors of nosocomial meningitis in neurological intensive care unit. Results of a five-year prospective study]. / Faktory riska razvitiya nozokomial'nykh meningitov u patsientov neirokhirurgicheskogo profilya v otdelenii reanimatsii i intensivnoi terapii. Rezul'taty pyatiletnego prospektivnogo issledovaniya.

Nosocomial meningitis (NM) is a serious complication in neurosurgery. Understanding the risk factors of nosocomial meningitis is important for their prevention. OBJECTIVE: To determine the main risk factors of NM in neurological intensive care unit. MATERIAL AND METHODS: A prospective study included all patients (n=2140) treated at the neurological intensive care unit for more than 48 hours between October 1, 2010 and October 31, 2015. Cases of nosocomial meningitis were registered. We analyzed risk factors in 2 groups of patients (with and without NM). RESULTS AND DISCUSSION: The incidence of NM in neurological intensive care unit was 8.4% (95% CI 6.8-10.0) (n=180). Relative risk of NM under external ventricular drainage was 3.98 (99 cases of NM, p<0.05). Relative risk of NM in patients with CSF leakage (including nasal CSF leakage after transsphenoidal surgery) was 5.2 (49 cases of NM, p<0.05). The incidence of nosocomial meningitis was significantly higher among patients with surgery time ≥8 hours (17.68%, p<0.01). Nosocomial meningitis was also significantly more common after redo surgery (13.07%, p<0.05). Insertion of intracranial pressure sensor was not a significant risk factor of NM. The risk of meningitis was 2.67% if the above-mentioned factors were absent. Extracranial factors are not specific for NM. No significant relationship between certain neurosurgical disease and NM was found. CONCLUSION: We found higher risk of NM in ICU patients with the following factors: external ventricular drainage, CSF leakage, redo surgery and surgery time.

The sensitivity of planktonic cultures and biofilms of gram-negative bacteria to commercial disinfectant and antiseptic preparations.

The in vitro antibacterial activity of 11 commercial disinfectant preparations and 8 antiseptics against 10 strains of the bacteria Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Enterobacter cloaceae and Providencia stuartii obtained from international collections and isolated from neuroresuscitation patients in Moscow in 2018 was studied. The sensitivity of planktonic cultures to the preparations was determined by the method of serial dilutions in broth and the spot method on solid nutrient media, the sensitivity of biofilms by the applicator method. A general pattern was revealed: the level of sensitivity to tested disinfectants in clinical strains was lower than in reference strains. It was found that the disinfectants «Mikrobak-Forte¼, «SAT-22¼, «Neobak-Oksi¼ at the concentrations recommended by the manufacturers were effective against bacteria of all test strains, both in the plankton state and in the form of biofilms. On the contrary, the disinfectant preparations «Biodez-Optima¼, «Biodez-Extra DVU¼, «Novodez-Aktiv¼, «Triosept-Oksi¼, «Tristel Fusion for Surfaces¼, «Effect-Forte Plus¼, «Lactic-Oxy¼ did not have sufficient effectiveness in the concentrations recommended by the manufacturers, therefore it is proposed to use these drugs in higher concentrations. It was found that the disinfectant «Biodez-Extra DVU¼ is able to inhibit the growth of biofilms of bacteria of the species K. pneumoniae. The ability to suppress the growth of bacterial biofilms of K. pneumoniae, A. baumannii, P. aeruginosa was revealed for the «Triestel Fusion for surfaces disinfectant¼. The bacteria of all used test strains in the planktonic state were sensitive to all tested antiseptic preparations. However, the biofilms of the clinical strains of P. aeruginosa and P. stuartii. possessed resistance to the antiseptics «Octenidol¼, «Octenisept¼, «Miramistin¼, «Hexoral¼. Our studies indicate the need for sensitivity analysis of antibacterial drugs in representatives of hospital pathogens, including the modeling of bacterial biofilms, which is a very relevant and important scientific direction, necessary to improve the control of nosocomial infections in the Russian Federation.

[Monitoring of adverse event triggers as a tool for managing the medical care quality at a neurosurgical clinic. Invitation to the discussion]. / Monitoring triggerov neblagopriiatnykh sobytii kak instrument upravleniia kachestvom meditsinskoi pomoshchi v neirokhirurgicheskoi klinike. Priglashenie k diskussii.

Management of the healthcare quality and safety is one of the priorities of state policy for protecting health of Russian citizens. We describe modern technologies for managing the quality of medical care and patient safety based on a systematic approach. Potential applications of these technologies in neurosurgical practice are defined. Quantitative, qualitative, and basic indicators are proposed for evaluation of outcomes (results) as part of implementation of an integrated quality management system in neurosurgical practice.

[Intra-optic nerve and chiasmal abscess caused by methicillin-resistant Staphylococcus aureus (a case report and literature review)]. / Abstsess intrakranial'noi chasti zritel'nogo nerva i khiazmy, vyzvannyi metitsillinorezistentnym zolotistym stafilokokkom (klinicheskoe nabliudenie i obzor literatury).

A 27-year-old immunocompetent male with headache, transient polydipsia, and polyuria suddenly developed visual impairment (predominantly in the left eye) and, 2 days later, left-sided amaurosis. MRI in T1, T2, DWI, and FLAIR modes revealed a space-occupying lesion of the left intracranial optic nerve and chiasm. According to the clinical X-ray picture, malignant chiasmal glioma was suspected; another and less likely variant was lymphoma. An open biopsy of the space-occupying lesion of the chiasmal-sellar region revealed purulent-necrotic masses. Material from the operative wound was positive for a Staphylococcus aureus strain. The polymerase chain reaction of a cerebrospinal fluid sample revealed methicillin-resistant Staphylococcus aureus. The patient underwent systemic and intrathecal antibiotic therapy with linezolid and vancomycin, respectively, with a good clinical effect: there was an improvement in the vision in a right single sighted eye and normalization of the cerebrospinal fluid composition.

[Drainage-associated meningitis in neurocritical care patients. The results of a five-year prospective study]. / Drenazh-assotsiirovannye meningity u patsientov otdeleniia neiroreanimatsii. Rezul'taty piatiletnego prospektivnogo nabliudeniia.

AIM: to determine the incidence rate and risk factors for drainage-associated meningitis in neurocritical care patients. MATERIAL AND METHODS: The prospective study included 539 patients who spent more than 48 h at the Department of Neurocritical Care and underwent external ventricular drainage. The incidence rate and risk factors for drainage-associated meningitis were evaluated. RESULTS: Over a 5-year period, 2140 patients have been hospitalized to the Department of Critical and Intensive Care (DCIC) for more than 48 h; of these, 539 patients underwent external ventricular drainage (EVD). Drainage-associated meningitis developed in 99 patients, which amounted to 19.8 (CI 16.3-23.3) per 100 patients with drainage and 18.3 (CI 14.3-22.2) per 1000 days of drainage. The incidence rate of drainage-associated meningitis did not significantly correlate with different neurosurgical diseases, but there was a tendency for meningitis to predominate in EVD patients with vascular pathology of the central nervous system (CNS). The rate of artery catheterization for direct measurement of systemic BP and the use of vasopressor agents were significantly higher in the group of patients with drainage-associated meningitis (p<0.05). ALV was used in 98 (99%) of 99 patients with drainage-associated meningitis; respiratory support was used in 325 (80.8%) patients without meningitis (p<0.01). An analysis of the ventricular drainage duration revealed a significantly (p<0.05) larger number of days of using EVD in the group of patients with drainage-associated meningitis. In most critical care patients (57.6%), meningitis developed during the first week of drainage. Cerebrospinal fluid leakage occurred significantly more frequently in patients with drainage-associated meningitis than in patients with EVD and without meningitis (p<0.01). Based on a microbiological examination, the etiology of drainage-associated meningitis was established in 57.1% of cases. The leading pathogens were coagulase-negative staphylococci (48.3%) and Acinetobacter baumannii (18.3%). CONCLUSION: The incidence rate of drainage-associated meningitis was 19.8 per 100 patients and 18.3 per 1000 days of drainage. The risk factors significantly predominating in patients with drainage-associated meningitis include the duration of drainage, association with external CSF leakage, as well as factors associated with indicators of the overall severity of the condition.

Phagebiotics in treatment and prophylaxis of healthcare-associated infections.

We have developed a phagebiotic composition using 8 virulent bacteriophages (2 strains of each species) which are able to lyse Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus. The unique character of the developed composition is ensured by particular properties of each bacteriophage comprising the preparation, including their range of lytic activity toward specific bacterial pathogens, morphology of their plaques, cycle of their development, restriction profile of their DNAs, specificity of their genomes (based on complete genome sequencing), and other properties. The preparation did not produce any signs of acute or chronic intoxication in the experimental animals. Therapeutic and prophylactic efficiency of the phagebiotic composition was demonstrated in the prevention and treatment of the experimental acute K. pneumoniae infection in mice. The investigations have shown that the preparation possesses a high therapeutic efficiency and is highly competitive with ciprofloxacin which is very effective against the infective strain K. pneumoniae. Our small-scale clinical trial was aimed to evaluate therapeutic effectiveness of the phagebiotic composition in an epidemiological emergency situation in an intensive care unit, caused by multi-resistant strains of Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. Seventy nine per cent of the initial samples from 14 patients' endotracheal aspirate, blood and urine were contaminated. Twenty-four hours after the 3-day phage therapy (20 ml of cocktail at a titer for each phage 108 pfu/ml were introduced intragastrically through a tube once a day) contamination level dropped to 21%. Hence the obtained results enabled us to create a new phagebiotic composition that may be used as an alternative to antibiotics to treat these healthcare-associated infections.

[Features of the course of nosocomial meningitis in patients of neurosurgical intensive care unit].

OBJECTIVE: To determine the incidence rate and risk factors of nosocomial meningitis in patients with complicated postoperative period. MATERIAL AND METHODS: We report the results of prospective observation of the course of bacterial meningitis in patients with complicated postoperative period at neurosurgical intensive care unit in 2010-2014. RESULTS: Nosocomial meningitis (NM) developed in 146 patients, which accounted for 12.6±1.0% (CI, 10.74-14.66). Patients with meningitis were characterized by longer stay at ICU, prolonged mechanical ventilation, need for central venous access and invasive hemodynamic monitoring, as well as longer course of antibacterial therapy. Frequency of invasive monitoring of intracranial pressure was similar in these two groups of patients. Bloodstream infections (14.8% vs. 4.9%; p<0.000), respiratory tract infections (55% vs. 35.6%; p<0.000), and urinary tract infections (56.4% vs. 30.9%; p<0.000) were more frequently observed in patients with NM. The following significant differences were observed between the group of NM patients and the control group: more frequent use of external ventricular drain (72.5% vs. 26.1%; p<0.000), number of reoperations (64.7% vs. 36.3%; p<0.000), and the total operating room time (417.3 min vs. 337.5 min; p<0.000). Etiology was ascertained in 61.0±4.0% of cases of nosocomial meningitis. CoNS (33.0%) and Acinetobacter baumannii (21.3%) were the main pathogens isolated from cerebrospinal fluid. The mortality in patients with meningitis was 31.5±3.8%. CONCLUSION: External ventricular drain, repeated surgery, long-term stay in the operating room, as well as other types of infections may be considered as risk factors for developing nosocomial meningitis in neurosurgical patients at ICU.

[Risk factors of postoperative meningitis in patients with chiasm-sellar tumors].

UNLABELLED: Postoperative intracranial infectious complications are one of the most topical problems of neurosurgical intensive care due to theirs significant capability to impair outcomes of the main disease. PURPOSE OF THE STUDY: To define the risk factors of postoperative meningitis in patients with chiasm-sellar tumors. RESEARCH OBJECTIVES: 1. to define the effect of somatic and intracranial risk factors on occurrence of postoperative meningitis in patients after transsphenoidal and transcranial approaches to the tumor. 2. To define the effect of postoperative meningitis on outcomes of treatment in patients after transsphenoidal and transcranial approaches to the tumor. MATERIALS AND METHODS: Somatic and intracranial risk factors of occurrence of postoperative meningitis (pneumonia, urinary tract infection, sepsis, intra-abdominal hypertension, the presence of external ventricular and lumbar drainage, monitoring of intracranial pressure, cerebrospinal fluid, and reoperation) were fixed every day. The study was conducted in the ICU of the Burdenko from October, 2010 to July, 2012. The 34 patients (19 males, 15 females) were included in the study (average age 47.5 years). The patients were divided into two groups; 17 patients each group. The group-1 included patients after transcranial approach to the tumor and the group-2 included patients after transsphenoidal approach. RESULTS: In the group-1 a meningitis occurred in 3 patients (17.6% +/- 9.2%, DI [-0.4 - 35.6]). In the group-2 a meningitis occurred in 7 patients (41.2% +/- 11.9) DI 95% [17.8 - 64.4]. Accumulation of cerebrospinal fluid under the skin flap authentically increased a risk of a meningitis occurrence in patients after transcranial approach to the tumor (p = 0.031). There was no defined statistical significance of other risk factors. But there was defined a trend of the increasing of meningitis occurrence in patients after transsphenoidal approach in case of lumbar drainage or reoperation. Duration of mechanical ventilation and ICU stay in patients with meningitis was authentically longer than in patients without meningitis in both groups. In the group-2 the duration of mechanical ventilation and ICU stay was significantly shorter than in the group-1. CONCLUSIONS: Meningitis is not a typical complication of postoperative period in patients with transcranial approach to the tumor. After transsphenoidal approach a meningitis occurrence is likely in case of postoperative liquorrhea, lumbar drainage or reoperation. Subcutaneous accumulation of cerebrospinal fluid is a single defined statistically significant risk factor of meningitis. Postoperative meningitis impairs a condition of patients with chiasm-sellar tumors, increases the duration of mechanical ventilation and impairs treatment outcomes.

[Molecular genetic characteristics of HIV-1 variants circulating in Cherepovets, Vologda region: the second case of the epidemic outbreak caused by the recombinant gagAenvB].

HIV-1 variants circulating in the town of Cherepovets, Vologda Region, were genetically analyzed. It was shown that that were predominantly two HIV-1 variants: IDU-A (19%) and the recombinant strain UDU-AIB (77%) that circulated in the region. Amongst the IDU-A strains, there were genotypes containing characteristic secondary drug resistance mutations in the pol gene of V771 and A62V, as well as variants of the wild type. Amongst IDU-AIB strains, only one variant of the virus had genotype V771. The recombinant form of HIV-1 was more common in injective drug users while a group of heterosexuals had both recombinant virus and the variant IDU-A, that is typical of other regions of Russia. Thus, the epidemic outbreak due to the recombinant HIV-1 strain IDU-AIB was first registered in Russia, outside the Kaliningrad Region.

[Prevalence of HBV and HCV markers in patients of specialized medical institutions].

240 medical histories of patients admitted to Moscow clinical narcological hospital No. 17 with "opium addiction" diagnosis in 2000 and 2003 (120 histories for each year) were analyzed. From 1997 to 2003 4220 patients registered in narcological dispensary of Cherepovets city (Vologda region) were tested for HBsAg and anti-HCV. It has been shown that in new injection opiate drug users young patients (15 - 19 y.o.) predominated (41.7%). Tendency to development of drug addiction in younger age was revealed - in 2003 compared to 2001 percent of new injection drug users aged 11 - 14 years admitted to hospital raised in 1.5 times. In 2000 and 2003 in Moscow markers of HIV and/or HBV/HCV infection were detected in 84.2 and 91.7% of injection drug users respectively. Maximal rates of HBV and HCV infection in injection drug users in Cherepovets city were detected in 2001 - 11.7 and 83.1% respectively. Leading role of injection drug users in maintenance of HBVand HCV epidemic process activity in Russia was established.

[The postradiation use of vitamin-containing complexes and a phycocyanin extract in a radiation lesion in rats]. / Postradiatsionnoe primenenie vitaminsoderzhashchikh kompleksov i ékstrakta fikotsianina pri luchevom porazhenii krys.

Wistar rats have been exposed to X-rays with a dose of 5 Gy. Significant decrease in dehydrogenase activity, energy-rich phosphate level and efficiency of antioxidant defence and significant increase in pyruvate amount were observed within 4 weeks. It was also found that the feeding of exposed rats with phycocyanin extract from blue-green algae Spirulina platensis lead to correcting effect. The same result was observed after injections of tocopherol or complex of six water-soluble vitamins. The combination of above mentioned compounds had more marked effect, especially at the presence unitiole and Na2Se.

[Reduction of cytochrome p-450 content and activity by porphyrins after damage to the microsomal membrane by tetrachloromethane]. / Vosstanovlenie porfirinami soderzhaniia i aktivnosti tsitokhroma P-450 posle povrazhdeniia mikrosomal'noi membrany tetrakhlormetanom.

Natural porphyrin (hemin and its synthetic analogue--tetraphenylporphyrin with iron TPP-Fe3+) has been studied for its effect on activity of monooxygenase responses and cytochrome P-450 content against a background of introduction of four-chlorine carbon in the in vitro experiments. The reducing effect of hemin and TPP-Fe3+ on cytochrome P-450 and dependent enzymes: N-demethylase, n-hydroxylase and benz(a)pyrene hydroxylase has been noticed; the synthetic analogue of heme was more efficient.

[Inhibition of cytochrome P-450-dependent enzymes in rat liver microsomes by tetraphenylporphyrin and its metal complexes]. / Ingibirovanie tsitokhrom P-450-zavisimykh fermentov mikrosom pecheni krys tetrafenilporfirinom i ego metallokompleksami.

Tetraphenyl porphyrin (TPP) and its complexes with Fe3+, Co2+, Cu2+, Zn2+ and Ni2+ inhibited cytochrome P-450-dependent enzymes in rat liver microsomes. Content of cytochrome P-450 was decreased by 27% or 49% depending on the substance administered (TPP or its metal complexes, respectively). N-demethylase was inactivated by about 30%; the rate of aniline p-hydroxylation was decreased by 30-45% depending on the type of the metal complex. But these substances did not affect practically the benz(alpha)pyrene hydroxylase activity. The inhibitory effect of TPP of its metal complexes appears to occur due to activation of lipid peroxidation and of hemoxygenase, which is responsible for biodegradation of hem in cytochrome P-450.

[Stimulation of lipid peroxidation in rat liver microsomes by tetraphenylporphine and its metallocomplexes]. / Stimuliatsiia perekisnogo okisleniia lipidov v mikrosomakh pecheni krys tetrafenilporfinom i ego metallokompleksami.

It is shown that tetraphenylporphyrin (TPP) and its complexes with metals decrease the rate of the diene conjugate formation. The above compounds increase the malonic dialdehyde accumulation. The effect of TPP and its complexes with metals is connected with stimulation of lipid peroxidation in biomembranes.