Prevalence of viral pneumonia COVID-19 among health care workers in the Saint- Petersburg (according to high resolution computed tomography data of the lungs)
Transcranial electrostimulation in pediatrics: modern concepts(review)
Evdokimova N.V., Trukhmanov M.S. 65
Сorrelation of clinical manifestations of systemic lupus erythematosus from the presence or absence of antibodies to thyroxine and triiodothyronine and thyroid pathology
PUBLIC HEALTH, ORGANIZATION AND SOCIOLOGY OF HEALTH CARE
Syndrome of substance abuse, violence and HIV-infection/AIDS (SAVA) and some related factors among men who have sex with men in three cities in Russian Federation
Сorrelation of clinical manifestations of systemic lupus erythematosus from the presence or absence of antibodies to thyroxine and triiodothyronine and thyroid pathology
HYGIENIC ASSESSMENT OF TELEVISION FOOD ADVERTISING TARGETED AT CHILDREN
E.V. Fedorenko, S.I. Sychik, V.G. Tsyhankou, Ju.N. Polyanskaya,T.N. Pronina, M.A. Hutsich, E.V. Andrievskaja, M.Ju. Karnakova, T.I. Viarshyla, A.Ju. Ezerskaya, Zh.A. Filipouskaya, M.F. Kovalenko, A.V. Zelenko,O.K. Siniakova Scientific and Practical Centre of Hygiene. Republic of Belarus, 220012, Minsk, Akademicheskaya street, 8
Аbstract Introduction. The promotion of «unhealthy» food products is one of the likely etiological factors in the development of overweight and obesity in children. The above-mentioned factor makes relevant the necessity to assess the exposure of the children to the national TV advertising. The aim of the study was to analyze some qualitative and quantitative characteristics of television food advertising targeting the children's audience. Materials and methods. National TV channels with the highest children TV viewing figures were selected and a record of 320 hours of broadcasting was made. Commercials were coded and profiled based on publicly available information about the nutritional value of the advertised products, using the methodology of the World Health Organization. Results and discussion. TV food commercials comprising 1/3 of all advertisements, and more than half of them are not acceptable for children according to the criteria of the World Health Organization. The broadcasting of such commercials intensifying from 8 a.m. to 12 p.m. (32.2%). The average number of commercials was 30.5 per hour, where unallowed for children's marketing were shown 16.7 times per hour. The demonstration density on the certain channels ranged from 0.8 to 9.7 times per hour. Conclusion. Children, representing 1.9 to 9.5 percent of the TV audience, are highly exposed to the food advertising shown on national TV. The share of such advertising was predominant, reaching 29.9%, while 54.6% of the commercials did not meet the acceptability criteria. The frequency of such advertisements averaged 1.1 hours per hour. Food labelling legislation have to be improved in terms of adequate information on salt, added sugar and saturated fat. The methodology for studying advertising requires national adaptation in terms of addition of certain food categories and determining their acceptability in children's diets. Key words: childhood obesity, food, social health risk factors, product advertising and labelling.
DIAGNOSIS, TREATMENT, EPIDEMIOLOGY, PREVENTION OF DISEASES
INFLUENCE OF NUTRITIONAL SUBSTRATE AND FEEDING METHOD ON COMPONENT COMPOSITION OF THE BODY IN PATIENTS WITH CEREBRAL PALSY
D.O. Ivanov, A.N. Zavyalova, V.P. Novikova, M.V. Gavshchuk, M.N. Yakovleva, K.A. Klikunova Saint Petersburg State Pediatric Medical University. Russia, 194100, Saint Petersburg, Litovskaya street, 2 Abstract Introduction. Oropharyngeal dysphagia accompanies low-mobility patients with cerebral palsy. Aim of the study was to identify the features of the body composition of a patient with and without dysphagia in different age groups, with different feeding methods and different food substrates. Materials and methods. In a cross-sectional cohort retrospective multicenter study with a prospective assessment of outcomes, bioimpedancemetry was performed in 810 children from 3 to 18 years. Statistical processing of the material was carried out using the IBM SPSS Statistics 26 application package. Results. In the group of teenagers and youth, the predominance of fat over the active cell mass is more common (p<0.001). With an increase in the level of the GMFCS scale, a decrease in active cell mass and a tendency to increase in fat mass in percentage terms (p=0.077) was noted. Severe malnutrition with loss of muscle mass was detected among toddlers with dysphagia, who received formulas for artificial feeding of children up to a year (p<0.001), with low-protein and low-calorie (p<0.001). In patients with severe malnutrition receiving specialized enteral formulas composed of deeply hydrolyzed proteins with the replacement of part of the fat component with medium chain triglycerides, a decrease in the percentage of active cell mass was observed, but without a clear predominance of fat over active cell mass. Conclusions. Assessment of body composition provides a complete picture of nutritional status problems. It is necessary to choose the right food substrate in accordance with age, the presence of dysphagia and nutritional status Key words: bioimpedancemetry, children, cerebral palsy, dysphagia, enteral nutrition, gastrostomy.
RETROSPECTIVE ANALYSIS OF COLONIZATION/INFECTION BY VANCOMYCIN-RESISTANT ENTEROCOCCI IN NEONATAL INTENSIVE CARE UNIT
A.V.Lubimova1, 2, M.A.Chervyakova1, 3, Е.V. Matveeva2, T.S.Kurchikova2 , N.T. Gonchar 1 1 North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint Petersburg, Kirochnayastreet, 41 2Children’s city hospital No 17. Russia, 190121, Saint Petersburg, Dekabristovstreet, 40 A 3North-Western district scientific and clinical center named after L. G. Sokolov Federal Medical and Biological Agency. Russia, 194291, Saint Petersburg,Kulturyprospect., 4
Abstract Introduction. Colonization of vancomycin-resistant enterococcus in theneonatal intensive care unitsmay exceed 30%.Infectionscaused by vancomycin-resistant enterococcusled to negative outcomes and significant coasts. The aim of the study isto identify the epidemiological features of infections/colonization caused by VRE in a neonatal intensive care unit during 2001-2020. Materials and methods. The data of microbiological monitoring of the neonatal intensive care units for the period of 20 years were analyzed (26344 strains of enterococci were isolated, while 1299 strains were vancomycin-resistant). Results.During the analyzed period, vancomycin-resistant enterococci were detected in 204 newborns (2.6 per 100 patients). Up to 2004, this pathogen was not detected, in the period from 2004 to 2011 there were single cases of colonization – 32 cases (0.88 per 100 admitted patients). In the period from 2011 to 2020, 172 cases of colonization/infection were detected (4.9 per 100 admitted patients). The increase of colonization by vancomycin-resistant enterococci in 2018 was contributed by the activation of the circulation of vancomycin-resistant S.haemolyticus, S.sciuri and S.xylosus. In 2020, for the early detection of vancomycin-resistant enterococcicarriers, all stool samples were sentto microbiological examination. The frequency of carrier detection increased 10-fold – 0.48 to 4.45 per 100 patients. Conclusion.
• To analyze the vancomycin resistance, it is necessary to monitor the spread of not only vancomycin-resistant enterococci, but also other vancomycin-resistant microorganisms.
• Low birth weight is not a risk factor for colonization/infection with vancomycin-resistant enterococci.
• With a high prevalence of vancomycin-resistant enterococci, the duration of hospitalization is not a risk factor for colonization by vancomycin-resistant enterococci. Key words: vancomycin-resistant enterococci, antibiotic resistance, newborns, infection, colonization, retrospective analysis, microbiological monitoring, epidemic process.
EPIDEMIOLOGICAL CHARACTERISTICS OF HEALTHCARE ASSOCIATED INFECTIONS IN PEDIATRIC CARDIAC SURGERY
A.S. Nabieva1,2, B.I. Aslanov2, E.M. Shilohvostova1, A.A. Malashenko3, A.K. Zabrodskaya1 1Saint Petersburg State Pediatric Medical University. Russia, 194100, Saint Petersburg, Litovskaya street, 2 2North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint-Petersburg, Kirochnaya street, 41 3Saint-Petersburg children’s municipal multi-specialty clinical center of high medical technology named after K.A. Rauhfus. Russia, 190961, Saint-Petersburg, Ligovsky avenue, 8
Abstract Introduction. The development of a medical care system and the improvement of the treatment approaches of congenital heart defects, resulted in an increase in the number of cardiac surgery patients, including newborns, exposed to risk factors for healthcare associated infections (HAI). The aim of the study was to identify the epidemiological features of HAI in pediatric cardiac surgery. Materials and methods. A descriptive epidemiological study was performed. The study included children with congenital heart defects born in the perinatal center of St. Petersburg transferring from other medical facilities and who underwent cardiac surgery during 2014 -2021. The descriptive epidemiological characteristics of HAI among patients of different ages, including newborns (0-28 days), were analyzed. Microbiological studies were used to determine the HAI pathogens and antimicrobial resistance. Results. In total, the study included 603 pediatric patients, who underwent 643 surgical interventions. As a result of the study, the incidence density of HCAI was determined - 15.6 (13.26-18.32) per 1000 patient days. Among all types of HAIs, lower respiratory tract infections predominate, the incidence density rate (IDR) per 1000 ventilator days was 18.1 (14.18-22.80). The IDR of urinary tract infections was 8.2 (5.49-11.74) per 1000 days of bladder catheterization; bloodstream infections IDR - 2.9 (1.94-4.09) per 1000 central line days. The incidence rate of surgical site infections was 3.3 (2.03-4.95) per 100 surgeries.
The main causative agents of HAI in pediatric cardiac surgery have been identified. Conclusion. It was revealed that in pediatric cardiac surgery the incidence rates of HAI are high. The etiological structure of causative agents of HAI after cardiac surgery is represented by a wide variety of pathogens. Colonization of patients with pathogens at various stages of medical care might be epidemiologically important and could increase a risk of HAI. In medical facilities accumulating patients from various hospitals, active monitoring of circulating pathogens is necessary, with the determination of antimicrobial susceptibility. Key words: health care associated infections, congenital heart.
Radiobiology of high-dose stereotactic radiation therapy (REVIEW)
A.I. Arseniev 1,2, S.N. Novikov 1, S.V. Kanaev 1, S.A. Tarkov 1, E.A. Arseniev1, A.A. Barchuk1, Yu.S. Melnik 1, A.O. Nefedov 3, R.V. Novikov 1, K.E. Gagua 1, N.Y. Aristidov1,2, F.E. Antipov 1, Yu.O. Merezhko 1, A.Yu. Zozulya1, Yu.V. Semiletova 1,2, A.A. Ryazankina 1,2 1N.N. Petrov National Medical Research Center of Oncology. Russia, 197758, Saint-Petersburg, Leningradskaya street, 68 2 North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint-Petersburg, Kirochnaya street, 41 3 Saint-Petersburg State Research Institute of Phthisiopulmonology. Russia, 191036, Saint Petersburg, Ligovsky avenue, 2-4
Abstract The scientific review is devoted to the main problems of radiobiology defining the basics of radiation therapy, describing the reactions of normal and pathological tissues to radiation and their mechanisms. The implementation of various variants of hypofractionation, high-dose irradiation, including stereotactic radiation therapy and radiosurgery has shown that the radiobiology of tumors and normal tissues using these methods does not correspond to traditional concepts typical for classical fractionation, and 4R/5R radiobiology concepts couldn’t adequately explain the occurred effects. At high doses of radiation, indirect tumor cell death prevails, caused by ischemia after lethal damage to endothelial cells and destruction of microvessels, which provides an immediate severe vascular reaction and subsequent activation of the immune response. A number of modified models have been proposed to eliminate the discrepancy between the isoeffects of conventional fractionation and stereotactic irradiation, however, none of them provides an accurate assessment of cell survival in the high dose range. The basic concepts of radiobiology could be reduced to several interrelated models: linear-quadratic, vascular, immune and nontargeted. The necessity of creating a single complex model combining the previous ones is substantiated. The combined use of ionizing radiation, systemic therapy and immunotherapy could generate synergistic effects by affecting all links of the antitumor response. Key words: radiobiology, high-dose radiation, stereotactic radiation therapy, isoeffects, modified linear-quadratic models, vascular, immune and nontargeted radiation models.
FEATURES OF THE MICROBIOME STRUCTURE OF THE UPPER RESPIRATORY TRACT OF OUTPATIENT AND IPATIENTS WITH A NEW CORONAVIRUS INFECTION
A.S. Mokhov1,3, D.V. Azarov1,3, V.V. Kolodzhieva1, K.D. Vasiliev1, E.A. Lebedeva1,3, E.R. Tsoy2, V.V. Gostev4, A.E. Goncharov1,3, A.V. Romanov5, B.I. Aslanov1 1North-Western State Medical University named after I.I. I. I. Mechnikov. Russia, 191015, Saint- Petersburg, Kirochnaya street, 41 2 City Mariinsky Hospital. Russia, 191014, St. Petersburg, Liteiny prospect, 56 3Institute of Experimental Medicine. Russia, 197376, Saint-Petersburg, Academician Pavlova street, 12 4Children's Scientific and Clinical Center for Infectious Diseases of the Federal biomedical agency. Russia, 197022, Saint- Petersburg, Professor Popov street, 9 5City Polyclinic No. 17. Russia, 195176, Saint- Petersburg, Metallistov prospect, 56
Abstract Introduction:Currently, the role of changes in the structure of the normal microbiota of the respiratory tract, as a risk factor for complications of novel coronavirus infection, is poorly understood. In this regard, research in this area remains relevant. The aim of the studywas to perform a comparative analysis of the pharyngeal microbiome structure in hospitalized patients with novel coronavirus infection and patients, who did not require hospitalization, based on targeted metagenomic sequencing of the 16S rRNA gene. Material and methods.The study included patients with a confirmed diagnosis of novel coronavirus infection, who was admitted to medical organizations in October-December 2020. The case-control study was performed to obtain the features of the pharyngeal microbiota associated with the risk of hospitalization. The group of "cases" consisted of 18 patients, who were hospitalized in a specialized hospital. These patients were examined twice: during the first day of hospitalization; and on 6-12 days of hospitalization).
The control group included 18 patients who were not hospitalized during outpatient treatment. Results. It was found that the risk of hospitalization is associated with the absence of Akkermansia spp., Sneathia spp. in the pharyngeal microbiota structure and a decrease in lactobacilli, and with more frequent detection of Megasphaera spp. in hospitalized patients. Conclusions.The obtained data substantiate the need for the use of molecular genetic methods aimed at qualitative and quantitative determination of these microorganisms by defining the risk groups for hospitalization and for severe novel coronavirus infection. Keywords: novel coronavirus infection, outpatients, hospitalized patients, pharyngeal microbiome, targeted metagenomic sequencing of 16S rRNA, colonization resistance, case-control study.
PREVALENCE OF VIRAL PNEUMONIA COVID-19 AMONG HEALTH CARE WORKERS IN THE SAINT- PETERSBURG (ACCORDING TO HIGH RESOLUTION COMPUTED TOMOGRAPHY DATA OF THE LUNGS)
M.V. Chashchin1, E.G. Bolshakova2, V.E. Golic1, D.M. Chashchina1, V.R. Belyaev2, V.P. Chashchin1,2 1North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint-Petersburg, Kirochnaya street, 41 2 North-West Public Health Research Center. Russia, 191036, Saint - Petersburg, 2nd Sovetskaya street, 4
Abstract Introduction. There are not enough scientific publications on the assessment of the prevalence of viral pneumonia of varying severity among the health care workers, who have been integral to response new coronavirus infection. The analysis of such indicators is important for planning social support measures, rehabilitation volumes, and developing new state measures for the medical prevention of occupational infectious diseases The aim of the study was to identify the prevalence of coronavirus disease 2019 among health care workers providing medical care to patients, and to assess the presence of statistically significant relationships between some risk factors and the severity of radiological pathological manifestations in lung tissue. Materials and methods. The objects of the study were patients who applied to the center of computed tomography with symptoms of new coronavirus infection in the period from 05/01/2020 to 07/01/2020. The study involved 622 health care workers and 6077 people who, in their work activities, are not related to the provision of medical care. The study results and main conclusions are based on a retrospective analysis of patients' medical records. Results. An analysis of cases of applying to the center of computed tomography showed that among all patients, 10.2% of cases are health care workers. The prevalence of viral pneumonia was the highest among employees providing primary health care (63.9% of the number of cases in this group), and the lowest - 57.7% of cases among workers associated with the provision of clinic medical care. It has been established that the presence of one of such concomitant diseases as diabetes mellitus (ICD-10 E10-E14), hypertension (ICD-10 I10-I15) or chronic diseases of the lower respiratory tract (ICD-10 J40-J47), increased the relative risk of developing viral pneumonia with a lesion volume from 25 to 50% of lung tissue to 2.24 (95% CI 1.1090 - 4.5401) (p<0.05) compared with healthcare workers without comorbidity. The Spearman rank correlation coefficient, which expresses the degree of association between a decrease in the severity of CT scan manifestations of viral pneumonia in health care workers and a higher level of personal protective equipment they use, was statistically significant and amounted to 0.105 (p = 0.009). Conclusion. The inclusion of computed tomography centers in the state system for routing patients with suspected symptoms of new coronavirus infection made it possible not only to increase the effectiveness of further tactics for treating patients at the outpatient or inpatient level, but also to conduct an assessment based on the principles of evidence-based medicine of the prevalence of viral pneumonia among health care workers participating in providing medical care to patients with COVID-2019. The results of the study demonstrate that the problem of a high risk of contracting new coronavirus infection in the performance of their work duties is relevant for all positions of employees of medical organizations. The evidence obtained in the study of the relationship between the presence of certain concomitant chronic diseases in medical workers and the severity of the CT scan picture of pneumonia, dictate the need to develop criteria for individual susceptibility of a person to a new coronavirus infection and include them in the list of medical contraindications during mandatory preliminary medical examinations for positions associated with any category of work related risk. Key words. New coronavirus infection 2019, health care workers, computed tomography of the chest.
TRANSCRANIAL ELECTROSTIMULATION IN PEDIATRICS: MODERN CONCEPTS (REVIEW)
N.V. Evdokimova, M.S. Trukhmanov Saint Petersburg State Pediatric Medical University. Russia, 194100, Saint Petersburg, Litovskaya street, 2 Abstract
Transcranial electrical stimulation is a physiotherapeutic method aimed at activating the stress-limiting system, affecting cytokine networks and stimulating the opioidergic system. To date, the role of nonspecific adaptive mechanisms in the pathogenesis of certain diseases has been reliably studied. Understanding the phenomenon of and its implementation in clinical practice in pediatrics in addition to drug treatment has great potential. Key words: physiotherapy, children, transcranial electrical stimulation, opioidergic system, β-endorphins.
FEATURES OF COVID-19 CLINICAL COURSE IN PRIMARY CARE PATIENTS DURING VARIOUS PERIODS OF INCREASED MORBIDITY
O.Yu. Kuznetsova, K.V. Ovakimyan, O. Yu. Pankratova, R.V. Ambartsumyan, V.S. Dranets, A.V. Litvinova North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint Petersburg, Kirochnaya street, 41
Abstract Introduction. Currently, there are a number of variants of SARS-CoV-2, five of which are with the increased transmissibility or virulence (according to WHO on December 11, 2021). Study on the detection of clinical manifestations of a new coronavirus infection in the outpatient departments may contribute to earlier disease detection, timely diagnosis and prescribing preventive measures and treatment. The aimof the study was to assess the clinical manifestations of a new coronavirus infection in out-patients during various periods of a new coronavirus infection incidence from March 2020 to February 2022. Materials and methods. The study was performed on the basis of the Family Medicine Center of the North-Western State Medical University. I.I. Mechnikov. The study was designed as a retrospective cohort study based on the analysis of out-patient records of Family Medicine Center within the compulsory health insurance. For all those who applied for outpatient care in the periods from March 19, 2020 to June 30, 2020 (Group 1), from October 1, 2021 to November 30, 2021 (Group 2) and from January 18, 2022 to February 28 .2022 (Group 3), epidemiological and clinical anamnestic data were recorded for: gender, age, vaccination or transferred COVID-19, concomitant diseases, complaints, physical data, data from laboratory and instrumental studies. Results. The study included 343 patients: 39.9% men (n=137) and 60.1% women (n=206). The average age of patients in all studied groups was 47.4 ± 16.9 years. It was observed an increase in the frequency of the following symptoms: nasal congestion, rhinorrhea, sore throat in patients of Group 3, while wet cough, chest congestion, shortness of breath, anosmia and ageusia were less common in the same group (p<0, 05). Weakness and headache were unexpectedly more common in the Group 2 (p<0.05). Severe and a very severe course of the diseases, the number of patients with diagnosed pneumonia was significantly less common for Group 3. The risk factors of a severe COVID-19 development were old age and at least one chronic non-communicable disease (p<0.05). Key words: new coronavirus infection, COVID-19, clinical course, symptoms, different periods of incidence.
PUBLIC HEALTH, ORGANIZATION AND SOCIOLOGY OF HEALTH CARE
SYNDROME OF SUBSTANCE ABUSE, VIOLENCE AND HIV-INFECTION/AIDS (SAVA) AND SOME RELATED FACTORS AMONG MEN HAVING SEX WITH MEN IN THREE CITIES IN RUSSIAN FEDERATION
A. N. Barinova1, A.A. Lebedeva, N.N. Ladnaya2, TaytsB.M.1, E.E. Zaytseva3, S.L. Plavinskij1 1North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint Petersburg, Kirochnayastreet, 41 2Central Research Institute for Epidemiology. Russia, 111123, Moscow, Kosmodamianskayaembankment. 22, building 1A 3Open Health Institute Foundation. Russia, 117 461, Moscow, Kachovka street, 25
Abstract Introduction.Social determinants of health are often a major topic for syndemic research. This is consistent with the fundamental idea of syndemic conditions that share common social factors and bio-social interactions. One of the earliest syndemies was the reported abuse of psychoactive substances in the United States, the experience of victimization from interpersonal violence and HIV infection (SAVA). The aimof the study was to assess the prevalence of SAVA syndrome and its relationship with risk factors for HIV infection in key groups - female sex workers (SW) and men who have sex with men (MSM). Materials and methods. The analysis is based on data from a biobehavioral study carried out in 4 cities of the Russian Federation and involving 817 SWs (time-place sampling) and in 3 cities of the Russian Federation involving 753 MSM (respondent-driven sampling). The study included a questionnaire survey and determination of HIV status. Results. The prevalence of SAVA syndemics in the groups of SWs and MSM was relatively low because of decreased (in comparison with IDUs) prevalence of HIV infection. Full syndemics occurred in 1.27%, [95% CI = 0.30 ... 2.24%] female sex workers and in 3.7%, [95% CI = 1.6 ... 5.7%] MSM. Incomplete syndemics (excluding HIV infection from definition) was detected in 7.31%, [95% CI = 4.59 ... 10.02%] of SW and 13.5%, [95% CI = 9.2 ... 17, 8%] of MSM. SWs who were physically and sexually abused had HIV infection in 16.7% of cases, only physically abused - in 10% of cases, while among those who denied violence against them - only 6.5%. Among MSM presence of signs of the syndemics without taking into account HIV status increased likelihood of HIV infection: the prevalence in individuals without signs of SAVA was 16.4% (95% CI = 12.1 ... 20.6%) versus 27.1% (95% CI = 14.5-39.7%) in individuals with signs of SAVA (OR = 1.90, 95% CI = 1.15-3.15, p = 0.015). Those who reported that they were subjected to physical violence, most frequently turned out to be HIV-infected. The prevalence of HIV infection was 26.2% (95% CI = 13.8-38.5%) versus 15.9% (95% CI = 13.0-19.0%) among those who did not experience violence (OR = 1.87, 95% CI = 1.09-3.19, p = 0.025). MSM with signs of SAVA were more likely to face verbal abuse and physical abuse, as well as denied employment and have difficulties to access medical care (for all questions, p <0.001). Thus, the level of stigmatization of MSM with SAVA in this study found to be increased. Keywords: HIV infection, SAVA syndemics, interpersonal.
CLINICAL LABORATORY DIAGNOSTICS
COAGULATION ACTIVATION MARKERS AND THROMBIN GENERATION TEST RESULTS IN COMPLICATED PREGNANCY
V.S. Vlasov1, A.O. Godzoeva1, O.A. Kudryashova2, O.V. Kozina3, I.E. Zazerskaya1, T.V. Vavilova1 1Almazov National Medical Research Centre. Russia, 197341, Saint-Petersburg, Akkuratova street, 2 2«HEMOSTATICA» LLC. Russia, 121165, Moscow, Studencheskaya street, 26 – 22 3Kamchatka Regional Center for Prevention and Control of AIDS and Infectious Disease. Russia, 683003, Petropavlovsk-Kamchatsky, Leningradskaya street, 112, building 2
Abstract Introduction. Premature abruption and placenta praevia are the leading causes of maternal mortality from bleeding. However, there is a lack of information on the hemostasis system state in these patients. Another dangerous pregnancy complication is preeclampsia. Despite the increased risk of venous thromboembolic complications preeclampsia is not an independent indication for antenatal thromboprophylaxis. The aim of the study was to determine the significance of fibrin monomer concentration and thrombin generation test measurement in group of pregnant women with preeclampsia, placenta praevia and placenta accreta. Materials and methods. The study included 204 women: group I - 86 pregnant women with preeclampsia; group II - 11 pregnant women with placenta praevia and placenta accrete (laboratory results are indicated for two time-points: group IIa - at 36-37 weeks of gestation and group IIb - within 24 hours after caesarean section); group III - control, 107 women with uncomplicated pregnancy during I (n = 95) and II-III trimesters (n = 12) of gestation. Routine blood clotting tests, fibrin monomer and D-dimer concentrations, as well as thrombin generation test parameters were measured. Results. An increase of the fibrin monomer and D-dimer concentration was found in groups I, IIa and IIb in comparison with group III. Thrombin generation test results in groups I, IIa and IIb were characterized by a significant proportion of pathological findings. A correlation between the fibrin monomer level and the blood loss volume and with the risk of postpartum hemorrhage (r = 0.70 and r = 0.67, respectively; p <0.05)was found in group IIa.The fibrin monomer cut-off value for the prediction of postpartum hemorrhage development (AUC 0.893±0.118 (95% CI 0.567–0.996), p = 0.001, sensitivity 75%, specificity 100%) was determined as 8.25 µg/ml. Conclusion. Measurement of fibrin monomer concentration in the group of pregnant women with preeclampsiais a perspective approach for pregnancy outcomes improvement, also as for blood loss and postpartum hemorrhage prediction in the group of pregnant women with placenta praevia and placenta accreta. Thrombin generation test has advantages in clinical cases associated with necessity of comprehensive blood hemostatic potential assess. Key words: fibrin monomer, thrombin generation test, D-dimer, pregnancy, preeclampsia, placenta praevia and placenta accreta.
CORRELATION OF CLINICAL MANIFESTATIONS OF SYSTEMIC LUPUS ERYTHEMATOSUS FROM THE PRESENCE OR ABSENCE OF ANTIBODIES TO THYROXINE AND TRIIODOTHYRONINE AND THYROID PATHOLOGY
O.I. Emelyanova, A.S. Trofimenko, O.A. Rusanova Research Institute of Clinical and Experimental Rheumatology named after A.B. Zborovsky. Russia, 400138, Volgograd, Zemlyachki street, 76
Abstract Introduction. Systemic lupus erythematosus (SLE) is a systemic disease characterized by multiple organ involvement including thyroid gland. It couldn’t be excluded that euthyroid pathology may be a consequence of immune mediated injury to the thyroid gland in systemic lupus erythematosus with the formation of autoantibodies to thyroid hormones: triiodothyronine and thyroxine (T3 and T4, respectively). The aim of the study was to analyze the clinical manifestations of SLE, as well as manifestations of comorbid thyroid pathology, depending on the presence of serum antibodies to T3 and T4. Materials and methods. The study included 63 patients with systemic lupus erythematosus: 41 of them were SLE patients without autothyroid pathology (ATP) and 22 SLE patients with ATP. All patients were hospitalized in a specialized department of Volgograd Municipal Emergency Hospital No. 25; 30 volunteers without identified chronic diseases were included as a control group. Anti-T3 and anti-T4 antibodies were measured by ELISA using magnetic sorbents. Results. In the examined SLE patients high concentrations of antibodies to T3 and T4 were detected much more often in the presence of autothyroid pathology (ATP), than in the control group and SLE patients without thyroid damage. It was found that the most frequent clinical manifestations were skin lesions - 73.6%, joints damage - 92.1%, cardiovascular system disease - 89.4%, nervous system disorders - 36.8%. Conclusion. The obtained study results allow to conclude that all SLE patients need to undergo the careful monitoring of antibodies to thyroid hormones (T3 and T4) in order to exclude such patients from involvement in the pathological process of the thyroid gland and for timely correction in their treatment to prevent the development of hypothyroidism. Keywords: systemic lupus erythematosus, antibodies, triiodothyronine thyroxine, magnetic sorbents.
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