[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.

Multidisciplinary approach in the diagnosis of idiopathic nonspecific interstitial pneumonia.

The article provides a modern classification of interstitial lung diseases. The focus is on the poorly studied and difficult to diagnose idiopathic nonspecific interstitial pneumonia, isolated in a separate nosological form and included in the classification only in 2002. The paper presents the features of the clinical, radiological, histological picture of idiopathic nonspecific interstitial pneumonia in comparison with idiopathic pulmonary fibrosis. The presented materials are based on the results of the largest study conducted by the working group of the American Thoracic Society, which shows the importance of the interaction of specialists in the diagnosis of idiopathic nonspecific interstitial pneumonia. A comprehensive assessment of the examination of patients conducted in collaboration with the clinician and radiologist, after their cooperative discussion, in many cases can help to avoid lung biopsy, and the study of morphological material is more often necessary only in difficult diagnostic situations.

[Shifts in the electrolyte and energy metabolism of rat myocardium in experimental hypercorticism]. / Sdvigi v elektrolitnom i energeticheskom metabolizme miokarda krys pri eksperimental'nom giperkortitsizme

Experiments were conducted on 612 albino male rats; a complex study was made in the myocardium of K+, Na+, Ca2+, Mg2+, Cl-, water, creatinphosphate, inorganic phosphorus, adenylic system components. A study was made of the effect of exogenous hypercorticism created by the administration of prednisolone, hydrocortisone and DOCA on the cardiac metabolism. Potassium-sodium tissue homeostasis in the myocardium proved to be stable under these conditions. Glucocorticoid hypercorticism was characterized by a reduction of creatinphosphate and by the accumulation of inorganic phosphate. DOCA administration failed to be significantly reflected on the balance of the phosphate macroerg balance. Glucocorticosteroids caused an increase in the Mg2+ and a reduction of the Cl- level, whereas DOCA brings about an increase of Ca2+ and Cl- in the myocardium. Dosaged sharp physical load is accompanied by the K+ cumulation in the myocardium. In the case of 2-hour swimming this is combined with a "stable" condition of the energy processes. When swimming is continued up to 5 hours there occurs a distinct disturbance of the balance of disintegration and resynthesis of the phosphate macroergs in the cardiac muscle. Administration of the corticosteroids under study against this background produced no significant influence on the character of the shifts in the electrolyte-energy metabolism, and failed to prevent the normal course of the restorative processes in the myocardium at the immediate period after the exercises.