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INTRODUCTION: The morbidity and mortality of severe acute pancreatitis (SAP) remains high. Intensive therapy aimed at stopping hypovolemia, systemic endotoxicosis is a debatable problem. OBJECTIVE: Improving treatment results in patients with SAP by assessing the dynamics of volumetric criteria and the degree of fluid therapy (FT). MATERIALS AND METHODS: The study included 25 patients. First, study group of 9 patient, used standard therapy in conjunction with selective hemoperfusion and continuous veno-venous hemofiltration. Second, control group of 16 patients, who received standard intensive care. FT in the groups was 2.5–3.5 ml/kg/h. Volemic parameters were measured by transpulmonary thermodilution. The central venous pressure and the diameter of the vena cava inferior were assessed. Comparative analysis was performed between two groups. RESULTS: FT in the amount of 58.7 (52.4–59.4) ml/kg/day in group 1, and 58.3 (54.2–61.4) ml/kg/day in group 2 in the first day, up to 83.9 (72.4–86.1) and 79.3 (72.4–84.1) ml/kg/day, was observed by day 3 (p < 0.05), according to the results of transpulmonary thermodilution. From the 1st to the 3rd day, Global end-diastolic volume index increased from 345 (328–412) to 648 (590–690) ml/m2 in group 1, and from 375 (348–413) to 654 (599–701) ml/m2 in group 2 (p < 0.05). Intrathoracic blood volume index increased from 440 (420–510) to 780 (750–40) ml/m2 in group 1 and 430 (417.5–465) to 750 (665–780) ml/m2 in group 2 (p < 0.05). Extravascular lung water index and pulmonary vascular permeability index by 5 days in group 2 increased by 1.8 — 11 (10.5–11.8) and 2.2 times — 6.5 (5.75–7), respectively (p < 0.05). CONCLUSIONS: FT 3.5 ml/kg/h, reaches isovolemia by the 3rd day of therapy. The use of extracorporeal detoxification methods in complex therapy is accompanied by an improvement in clinical and laboratory parameters.

INTRODUCTION. The literature has accumulated enough data on the treatment of children with acute bronchiolitis (OB). However, this information is formed mainly on the general population of patients with OB and is often not applicable to patients with a severe course of the disease. From the standpoint of evidence-based medicine, routine use of medications is not recommended in modern consent documents, and there are also no clear recommendations on respiratory support and certain aspects of intensive care in children with OB. OBJECTIVES. To analyze approaches to therapy in children with severe acute course in need of intensive care, and to assess the validity, effectiveness and safety of the use of the analyzed groups of drugs and respiratory strategies. MATERIALS AND METHODS. The analysis of publications in the electronic databases PubMed and the Russian Scientific Citation Index on the keywords “bronchiolitis”, “intensive care units”, “critical care”, “fluid therapy”, “respiratory therapy”, “ventilation”, “co-morbidity”; “respiratory syncytial virus”; “hypertonic saline” was carried out, “corticosteroids”; “epinephrine”; “high-flow oxygen therapy”, “inhalation”, “infant”, “bronchiolitis in children”. The date of the last search is January 15, 2022. RESULTS. This systematic review provides information on the etiology and risk factors of severe acute respiratory syndrome in children, from the standpoint of evidence-based medicine, studies on the treatment of severe acute respiratory syndrome are characterized, including in the intensive care unit with glucocorticosteroids, inhalations of bronchodilators, epinephrine, 3 % hypertonic sodium chloride solution, respiratory support, high-flow oxygenation, noninvasive ventilation, artificial ventilation, antibiotics, air-helium mixture. CONCLUSIONS. Currently, there is more information that infants with OB show a high degree of heterogeneity, while the main uncertainty lies in a misunderstanding of the processes, which patients will benefit most from a particular treatment method. Further research is needed to fill the research deficit in children with a severe course of OB.

Proximal femoral fractures (PFF) are one of the most common reasons for admission of patients to a traumatological and orthopedic hospital. For the vast majority of patients with PFF, such injury means a loss of the previous degree of mobility. Clinical guidelines are the main working tool of a practicing physician, both a specialist and a narrow practice doctor. Conciseness, structuredness of information about a particular nosology, methods of its diagnosis and treatment, based on the principles of evidence-based medicine, allow to give in a short time one or another answer to a question of interest to a specialist, to achieve maximum efficiency and personalization of treatment. These clinical guidelines include data on the classification, clinical presentation, diagnosis, and treatment of proximal femoral fractures. In addition, they provide methods for the rehabilitation of patients with this pathology.

We analyze the perioperative management results among patients with proximal femur fractures after surgical treatment in the Traumatology Department of the Kotovsk City Clinical Hospital in 2021. An increase in the proportion of the elderly and senile population (60–90 years old) inevitably leads to an increase in the number of proximal femur fractures, which obliges the traumatology departments in hospitals to allocate more forces and funds to assist this category of patients, to introduce and apply not only modern surgical and anesthesiological techniques, but also new approaches to the perioperative management of patients and especially patients over 60 years old, who, as a rule, have several concomitant diseases complicating the course of the underlying disease. The use of a multidisciplinary approach, a full-fledged laboratory and instrumental examination, detection of concomitant pathology and its correction, performing surgical interventions no later than 48 hours from the moment of admission to the hospital, adequate high-quality anesthesia, early initiation of mobilization measures no later than 24 hours, correct calculation of the permissible load on the operated limb allow achieving good results in the surgical treatment of patients with proximal femur fractures. This contributes to improving the quality of life among patients after surgery and their return to an active full-fledged life, despite their age.

Objective and design The aim of this double-blind, placebo-controlled, phase III CORONA clinical trial was to evaluate the efficacy and safety of IL-6 receptor inhibitor levilimab (LVL) in subjects with severe COVID-19. Subjects The study included 217 patients. The eligible were men and non-pregnant women aged 18 years or older, hospitalized for severe COVID-19 pneumonia. Treatment 206 subjects were randomized (1:1) to receive single subcutaneous administration of LVL 324 mg or placebo, both in combination with standard of care (SOC). 204 patients received allocated therapy. After the LVL/placebo administration in case of deterioration of symptoms, the investigator could perform a single open-label LVL 324 mg administration as the rescue therapy. Methods The primary efficacy endpoint was the proportion of patients with sustained clinical improvement on the 7-category ordinal scale on Day 14. All efficacy data obtained after rescue therapy administration were considered missing. For primary efficacy analysis, all subjects with missing data were considered non-responders. Results 63.1% and 42.7% of patients in the LVL and in the placebo groups, respectively, achieved sustained clinical improvement on Day 14 (P = .0017). The frequency of adverse drug reactions was comparable between the groups. Conclusion In patients with radiologically confirmed SARS-CoV-2 pneumonia, requiring or not oxygen therapy (but not ventilation) with no signs of other active infection administration of LVL + SOC results in an increase of sustained clinical improvement rate. Trail registration The trial is registered at the US National Institutes of Health (ClinicalTrials.gov; NCT04397562).

We describe the technique of combined two-level spinal-epidural anesthesia with the use of a new method of fixing an epidural catheter in the subcutaneous canal using a modified spinal needle in the surgical treatment of hip fractures. The quality of this method of anesthesia and postoperative anesthesia depends on the reliability and safety of fixing the epidural catheter. We have developed and tested in clinical practice a method of conducting and fixing an epidural catheter in the subcutaneous canal using a modified spinal needle. The peculiarity of this method is that the modified spinal needle used can be used to conduct and fix the epidural catheter in the subcutaneous canal. The characteristics of this needle, such as small outer diameter, sharp sharpening and length from 88 to 120 mm, made the tunneling of the epidural catheter safe and fixation reliable. The new method of fixing the epidural catheter in the subcutaneous canal has reduced the number of cases with clinically significant dislocation of the epidural catheter by 2.7 times, and cases with catheter loss from the epidural space by 3 times compared to the method of fixing the epidural catheter with a patch sticker, which is the most common in anesthesiological practice.

Study the impact of various combinations of comorbid original diseases in patients infected with COVID-19 later on the disease progression and outcomes of the new coronavirus infection.The ACTIV registry was created on the Eurasian Association of Therapists initiative. 5,808 patients have been included in the registry: men and women with COVID-19 treated at hospital or at home.gov ID NCT04492384.Most patients with COVID-19 have original comorbid diseases (oCDs). Polymorbidity assessed by way of simple counting of oCDs is an independent factor in negative outcomes of COVID-19. Search for most frequent combinations of 2, 3 and 4 oCDs has revealed absolute domination of cardiovascular diseases (all possible variants). The most unfavorable combination of 2 oCDs includes atrial hypertension (AH) and chronic heart failure (CHF). The most unfavorable combination of 3 oCDs includes AH, coronary heart disease (CHD) and CHF; the worst combination of 4 oCDs includes AH, CHD, CHF and diabetes mellitus. Such combinations increased the risk of lethal outcomes 3.963, 4.082 and 4.215 times respectively.Polymorbidity determined by way of simple counting of diseases may be estimated as a factor in the lethal outcome risk in the acute phase of COVID-19 in real practice. Most frequent combinations of 2, 3 and 4 diseases in patients with COVID-19 primarily include cardiovascular diseases (AH, CHD and CHF), diabetes mellitus and obesity. Combinations of such diseases increase the COVID-19 lethal outcome risk.Цель. Изучить влияние различных комбинаций сопутствующих заболеваний, существовавших у пациентов исходно, до инфицирования вирусом SARS-CoV-2, на тяжесть течения и исходы новой коронавирусной инфекции. Материалы и методы. Регистр АКТИВ создан по инициативе Евразийской ассоциации терапевтов. В регистр включены 5808 пациентов: мужчины и женщины с диагнозом COVID-19, находящиеся на лечении в стационаре или получающие лечение на дому. Регистрация регистра: идентификатор ClinicalTrials.gov: NCT04492384. Результаты. Подавляющее большинство пациентов с COVID-19 имеют исходные сопутствующие заболевания (иСЗ). Полиморбидность, оцененная методом простого подсчета иСЗ, является самостоятельным фактором негативного прогноза больных COVID-19. Поиск наиболее часто встречающихся комбинаций из 2, 3, 4 и более СЗ выявил абсолютное доминирование сердечно-сосудистых заболеваний во всех возможных вариантах. Наиболее неблагоприятной при сочетании 2 иСЗ была комбинация, включающая артериальную гипертензию (АГ) и хроническую сердечную недостаточность (ХСН), при сочетании 3 иСЗ комбинация, включающая АГ, ишемическую болезнь сердца (ИБС), ХСН, и при сочетании 4 иСЗ комбинация, включающая АГ, ИБС, ХСН и сахарный диабет. Наличие таких комбинаций приводило к росту риска летального исхода в 3,963, 4,082, 4,215 раза соответственно. Заключение. Полиморбидность, определенная методом простого подсчета заболеваний, может использоваться в реальной практике как фактор риска летальности в остром периоде COVID-19. В состав наиболее часто встречающихся комбинаций из 2, 3, 4 заболеваний у пациентов с COVID-19 входят преимущественно сердечно-сосудистые заболевания (АГ, ИБС, ХСН), сахарный диабет и ожирение. Комбинации этих заболеваний повышают риск летального исхода при COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic is probably the most studied one in history from both clinical and molecular-epidemiological perspectives Nonetheless, data on the correlation between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral genotypes and COVID-19 symptoms caused by them are still scarce In this report, we present a moderately severe COVID-19 case in a healthcare worker in Moscow, Russia, supplemented with the data on its causative agent's phenotype regarding in vitro and full-genome characterization The 44-year-old male healthcare worker who had frequent professional contacts with COVID-19 patients was hospitalized with a viral pneumonia diagnosis and soon started to exhibit fever, dry paroxysmal cough, loss of smell, and typical ground-glass opacities found in both lungs on chest CT scans The COVID-19 diagnosis was verified by real-time quantitative polymerase chain reaction (qRT-PCR), immunochromatography, and immunochemiluminescent assays The patient was treated with hydroxychloroquine, azithromycin, paracetamol, and enoxaparin, leading to his recovery after two weeks from the disease onset The virus was successfully isolated from the nasopharyngeal swab sample taken on the fifth day of the disease onset using the Vero E6 cell line and exhibited a pronounced cytopathic effect (CPE) with a viral titer reaching 10(6) TCID50/ml in the cell culture medium The full genome sequence of the viral isolate was obtained and 8 nucleotide and 5 amino acid mutations compared to the Wuhan-Hu-1 reference genome were identified Viral isolate belonged to GR / 20B / B 1 1 genetic lineage (GISAID, Nextstrain, Pangolin nomenclatures, respectively) - the most prevalent genotype found in Russia to date