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Introduction. Even now — a year after the pandemic announcement by WHO, there is lack of clinical evidence to confirm the efficacy of the majority of anti-COVID drugs, evenly for general and critically ill patients. Objective. To estimate the efficacy and safety of some anti-COVID-19 drugs as well as the impact of the demographic data and comorbidity on clinical outcomes of critically ill patients. Materials and methods. The single-center retrospective cohort study was performed on critically ill patients admitted to the ICU of Moscow Municipal Hospital No. 68 from March 6 to June 3, 2020. Anthropometric parameters, severity of the condition and comorbidities, as well as CT data, treatment in the ICU, duration of mechanical ventilation and the patients’ length of staying the ICU were taken into account and analyzed. Results. Overall, 403 patients (231 male, average age: 62.4 ± 15.3 years, range from 21 to 97 years) were enrolled into the study. In hospital mortality rate appeared to be 44.9 % (181/403) and was equal for men and for women (p = 1,000). The application of low molecular weight heparin was the single one significant predictor of mortality reduction according to the results of multivariate analysis — HR = 0.742 (0.545–0.991), p = 0.045. The main unmodifiable predictors for mortality elevation in the ICU were: age 65+ (RR 2.116 [1.680–2.664], p < 0.001) and Charlson’s comorbidity index (HR 1.136 [1.087–1.188], p < 0.001). The group of patients with a fatal outcome had a higher comorbidity index, the number of points on the SOFA scale (p < 0.001), as well as a larger median number of days in the ICU (p = 0.012). Conclusions. Current study has convincingly proved that low molecular weight heparin to be used for while treating severe acute respiratory syndrome coronavirus 2 patients in intensive care settings.

To evaluate the results of preventive endovascular hemostasis in patients with high risk of recurrent bleeding from the upper gastrointestinal tract.We analyzed treatment outcomes in 158 patients with ulcerative gastroduodenal bleeding and high risk of recurrence (≥17 scores), Forrest 1-2 A/B and mortality (SAPS II score ≥30). Endovascular embolization of the left gastric or gastroduodenal artery was performed to prevent recurrent bleeding.Endovascular hemostasis was technically successful in 94.4% of cases (153 patients). Embolization could not be performed due to technical reasons in 5 patients. One patient developed retroperitoneal hematoma as a complication after transcatheter angiography and embolization that required surgical intervention. Recurrent bleeding after technically successful embolization occurred in 11 (7%) patients. The PVA microemboli and spirals were used for embolization of the left gastric and gastroduodenal arteries, respectively. Additional PVA microemboli were also used in gastroduodenal artery in some cases. Twenty-six (16.5%) patients died.Endovascular hemostasis in patients with severe comorbidities (SAPS II score ≥30) and high risk of recurrent bleeding (≥17 scores) reduced the incidence of recurrent bleeding to 6.96% and mortality to 17%.Оценка результатов применения профилактического эндоваскулярного гемостаза у больных с высоким риском рецидива кровотечения из желудка и двенадцатиперстной кишки.Работа основана на изучении результатов лечения 158 пациентов с язвенным гастродуоденальным кровотечением и высоким риском его рецидива (17 баллов и более по системе прогноза рецидива кровотечения), Forrest 1—2 A/B и летального исхода (30 баллов и более по SAPS II). Для профилактики рецидива кровотечения выполняли эндоваскулярную эмболизацию левой желудочной либо гастродуоденальной артерий.Технический успех эндоваскулярного гемостаза достигнут у 153 (94,4%) пациентов. У 5 пациентов эмболизацию выполнить не удалось по техническим причинам. Осложнение после транскатетерной ангиографии и эмболизации — забрюшинная гематома, потребовавшая хирургического вмешательства, отмечено в одном случае. Рецидив кровотечения после технически успешной эмболизации зафиксирован у 11 (7%) пациентов. Для эмболизации левой желудочной артерии использовали микроэмболы PVA, гастродуоденальной артерии — спирали и в некоторых случаях дополнительно микроэмболы PVA. Умерли 26 (16,5%) пациентов.Использование эндоваскулярного гемостаза у пациентов с тяжелыми соматическими заболеваниями (30 баллов и более по SAPS II) и высоким риском рецидива кровотечения (17 баллов и более по системе прогноза рецидива кровотечения) позволило снизить частоту повторных кровотечений до 7%, а летальность до 16,5%.

Introduction. It is the recommendations for treatment of sepsis and septic shock combined with rheumatologists’ recommendations for monoclonal antibodies therapy that guide severe COVID-19 management in ICU. However, those recommendations may not be fully applied to patients with acute respiratory distress-syndrome associated with SARS-CoV-2, as there exists a difference in pathogenesis between sepsis and virus-associated pneumonias. Monoclonal antibodies therapy may contribute to cytokine cascade severity and promote lung injury. Cytokine storm aggravates the course of the disease. At present, there are two groups of methods described in literature for cytokine storm control and therapy: pharmacological and extracorporeal approaches.Materials and methods. We have performed a retrospective analysis of five COVID-19 patients with acute respiratory syndrome. Cytokine adsorption start criteria were respiratory insufficiency and IL-6 levels greater than 500 pg/ml. Adsorption therapy was initiated within 24 hours of ICU admission and continued for 48–120 hours in hemoperfusion mode on Multifiltrate machine (Fresenius Medical Care). The length of a single session of CytoSorb (Cytosorbents Inc.) therapy was 24 hours.Results. All patients demonstrated SpO2/FiO2 ratio growth and IL-6 concentration decrease by the end of hemoadsorption. We noted lymphocyte count rise as well as IgM и IgG SARS-CoV-2 antibodies titer substantial increase.Conclusions. Our observations suggest that the early start of hemoadsorption associates with gas-exchange stabilization and hinders respiratory distress progression. Hemoadsorption allows for pro-inflammatory cytokines concentrations decrease and prevents secondary lung injury. According to our data, hemoadsorption is beneficial to form a coronavirus infection specific immune response. Further research is needed for a detailed study of the results we here describe.

Introduction. The Vasoactive-Inotropic Score has been shown as a good predictor of adverse events in postoperative period. Nevertheless, the score is not included in modern predictive models. Objectives. To modify the nomogram that was created as a result of the E-CABG registry trial, and to evaluate the efficacy of the modification to predict 30-day mortality after elective cardiac surgery with cardiopulmonary bypass. Materials and methods. Pre- and intraoperative data of 158 patients who underwent elective cardiac surgery with cardiopulmonary bypass was analyzed. Based on the obtained results, the SYNTAX value in the original nomogram was replaced with the VIS value. The predictive model was evaluated in ROC-analysis. Results. The frequency of 30-day mortality in group was 5,06 %. According to the results of ROC-analysis the modified nomogram has AUC = 0,897 (0.844– 0.951) (p < 0.001). The cut-off value was 12.75 points (sensitivity — 87.5 %; specificity — 86.7 %). Conclusions. The modified nomogram has an excellent predictive ability for 30-day mortality.

Objective(s) : Since there is increasing evidence of serious deterioration in long-term Quality of Life (QoL) in COVID-19 intensive care unit (ICU) survivors, we identified predictors of poor quality of life in these patients. Design : Prospective cohort study. Setting : Research hospital repurposed in to a COVID-19 center. Participants : Consecutive patients admitted in COVID-19 ICU between March and June 2020. Interventions : A SF-36 questionnaire, which includes physical and mental items, was used 6 months after patients discharge. Measurements and Main Results : 403 patients were managed in the ICU with a hospital mortality of 181/403 (44.9%) while 16 (4.0%) further patients died within 6 months. Among the 125 questionnaire responders, only 32.0% and 52% had a normal quality of life in terms of the physical and mental component of health. Multivariable analysis identified low-molecular-weight heparin treatment in ICU as the only modifiable factor associated with an increase in physical component of QoL OR: 3.341 (95%CI 1.298-8.599), p=0.012, while age ≥52 years OR 0.223 and female sex OR 0.321 were significantly associated with a decrease in the physical component. Medical history of cerebrovascular insufficiency was significantly associated with a decrease in mental component of QoL OR: 0.125, while the only factor associated with an increase in the mental health component was BMI ≥ 27.6 kg / m2 OR 7.466. Conclusions : In COVID-19 intensive care unit survivors we identified treatment with low molecular weight heparin as a predictor of improved physical component of QoL at 6-months., Graphical abstract Image, graphical abstract

Aims Valid measures to identify harmful alcohol use are important. Alcohol Use Disorders Identification Test (AUDIT) is a validated questionnaire used to self-report harmful drinking in several cultures and settings. Phosphatidylethanol 16:0/18:1 (PEth) is a direct alcohol biomarker measuring alcohol consumption levels. The aim of this study was to investigate how PEth levels correlate with AUDIT-QF and weekly grams of alcohol consumed among patients in two urban hospitals. In addition, we wanted to investigate the predictive value of PEth in identifying harmful alcohol use as defined by AUDIT-QF and weekly grams of alcohol cutoffs. Methods A cross-sectional study comprising acute medically ill patients with measurable PEth levels (≥0.030 μM) admitted to two urban hospitals in Oslo, Norway (N = 931) and Moscow, Russia (N = 953) was conducted using PEth concentrations in whole blood, sociodemographic data and AUDIT-QF questionnaires. Results PEth levels from patients with measurable PEth were found to be positively correlated with AUDIT-QF scores, with PEth cutpoints of 0.128 μM (Oslo) and 0.270 μM (Moscow) providing optimal discrimination for harmful alcohol use defined by AUDIT-QF (the difference between cities probably reflecting different national drinking patterns in QF). When converting AUDIT-QF into weekly grams of alcohol consumed, the predictive value of PEth improved, with optimal PEth cutpoints of 0.327 (Oslo) and 0.396 (Moscow) μM discriminating between harmful and non-harmful alcohol use as defined in grams (≥350 grams/week). Conclusions By using PEth levels and converting AUDIT-QF into weekly grams of alcohol it was possible to get an improved rapid and sensitive determination of harmful alcohol use among hospitalized patients., Short Summary: AUDIT-QF among acute medically ill patients was found to be positively correlated with the alcohol biomarker PEth, with improved predictive value of PEth when converting AUDIT-QF to weekly grams of alcohol. PEth may be used to discriminate harmful alcohol use in clinical settings.

ObjectivesThe use of psychoactive prescription medication is increasing in the general population. This is a cause for concern, particularly among the elderly, where physiological changes related to senescence increase the risk for adverse effects. While previous studies regarding psychoactive substance use have generally been population based, we sought to determine the frequency of such use among acutely hospitalised patients.SettingTwo emergency departments (EDs), one in Oslo and one in Moscow, admitting patients to Departments of Internal Medicine.Participants5583 patients aged ≥18 years participated, distributed evenly between genders and study locations. Patients unable to give informed consent were excluded. The study sites did not admit patients with surgical conditions and/or injuries.Primary and secondary outcomesThe presence of psychoactive substances was determined through blood analysis using liquid chromatography-mass spectrometry. Secondary outcomes comprised demographic data (including age, gender, employment and marital status), degree of psychological distress, concurrent alcohol use, and self-reported alcohol, psychoactive drug and illicit substance use.Results32.3% in Oslo and 12% in Moscow were positive for one or more psychoactive medicinal drugs (benzodiazepines, z-hypnotics, opioids or barbiturates). In Oslo, medicinal drug use was associated with being aged 61 to 70 years (OR 2.40, 95% CI 1.61 to 3.58) compared with 18 to 40 years, and psychological distress (OR 2.61, 95% CI 2.06 to 3.30). In Moscow, psychoactive medicinal drug use was also associated with psychological distress (OR 1.68, 95% CI 1.18 to 2.39), and was less common among patients aged 41 to 60 years (OR 0.62, 95% CI 0.43 to 0.88) than among patients aged 18 to 40 years.ConclusionA significant proportion of admitted patients used one or more psychoactive medicinal drugs, in particular benzodiazepines (Oslo and Moscow) and opiates (Oslo). We suggest formalised screening for inappropriate prescription drug use and increased adherence to clinical prescription guidelines.

To evaluate the effectiveness of hybrid interventions, i.e. endovascular mechanical thrombectomy from intracranial arteries combined with open thrombectomy or carotid endarterectomy from extracranial internal carotid artery.We analyzed 16 patients who underwent mechanical thrombectomy/thrombaspiration combined with open surgery between January 2014 and March 2021. All patients had occlusion of extracranial and intracranial segments internal carotid artery or initial segments of the middle cerebral artery. Baseline data, diagnostic algorithm, timing and results of treatment were analyzed. Study endpoints were technical success of revascularization, clinically significant hemorrhagic transformation, NIHSS and modified Rankin score of neurological impairment, as well as outcome of disease within 90 days.We restored patency of ICA and intracranial arteries in 13 out of 16 patients. In 9 patients, we obtained a positive effect with significant regression of neurological symptoms (mRS2). In 3 patients, severe neurological deficit persisted throughout the entire follow-up period. Four patients died. Thus, effectiveness of technique was 56.2% (Hybrid interventions for tandem occlusions of carotid arteries can significantly increase efficiency and accelerate recanalization of great extracranial vessels in patients with tandem lesions in acute phase of ischemic stroke. Moreover, hybrid interventions significantly reduce the cost of reperfusion procedure. In case of severe atherosclerotic stenosis, simultaneous open endarterectomy from common and internal carotid arteries has a significant advantage over stenting due to no need for antithrombotic therapy.Оценить эффективность гибридных вмешательств: эндоваскулярная механическая тромбэктомия/тромбаспирация из внутричерепных артерий в сочетании с «открытой» тромбэктомией или каротидной эндартерэктомией из экстракраниальных отделов ВСА.Проведен анализ лечения 16 пациентов, которым выполняли механическую тромбэктомию/тромбаспирация в сочетании с открытым хирургическим вмешательством с января 2014 по март 2021 г. У всех пациентов имелась полная окклюзия экстракраниальных отделов ВСА и окклюзия внутричерепного отдела ВСА или начальных сегментов средней мозговой артерии (СМА). Были проанализированы исходные данные пациентов, диагностический алгоритм, сроки и результаты лечения. Критериями оценки результатов — технический успех реваскуляризации, наличие клинически значимой геморрагической трансформации, динамика неврологического дефицита по шкале NIHSS и модифицированной шкале Рэнкин, и исход заболевания в течение 90 дней.Из 16 оперированных пациентов у 13 удалось добиться технического успеха в виде восстановления проходимости ВСА и внутричерепных артерий. У 9 пациентов удалось добиться положительного эффекта в виде значительного регресса неврологической симптоматики (mRS2). У троих пациентов тяжелый неврологический дефицит сохранялся на всем периоде наблюдения, 4 больных скончались. Таким образом, эффективность методики составила 56,2% (Применение гибридных вмешательств при тандемных окклюзиях каротидных артерий позволяет существенно повысить эффективность и сократить время восстановления кровотока по крупным экстракраниальным сосудам у больных с тандемными поражениями в острейшей фазе ишемического инсульта, а также значительно снизить стоимость процедуры реперфузии. При наличии значимых атеросклеротических стенозов, одномоментная открытая эндартерэктомия из ОСА и ВСА имеет значительное преимущество в сравнении со стентированием, за счет отсутствия необходимости назначения антитромботической терапии.

To optimize the treatment strategy for acute mesenteric ischemia (AMI).The study included 43 patients aged 76.4±10.3 years. CT angiography and endovascular repair of mesenteric vessels underlie the new treatment approach.CT angiography according to the established criteria was performed in 31 patients with suspected AMI throughout 1 year. Sensitivity was 90.0%, specificity - 100%, accuracy - 95%. Endovascular interventions were applied in 13 patients (successful in 8 cases and unsuccessful in 5 patients). Mortality rate was 37.5%. Fifteen patients with clinical signs of peritonitis or after previous unsuccessful interventional revascularization underwent open surgery. Mortality rate was 86.7%.CT angiography is valuable to diagnose AMI at the stage of reversible changes in bowel wall in some cases. Endovascular revascularization as the first-line treatment has certain prospects.Оптимизация тактики при острой мезентериальной ишемии (ОМИ).В исследование включены 43 пациента. В основу нового подхода положено активное применение КТ-ангиографии (КТ-АГ) и эндоваскулярных вмешательств на мезентериальных сосудах.За год применения КТ-АГ по предложенным критериям исследование выполнено у 31 пациента с подозрением на ОМИ. Чувствительность составила 90%, специфичность — 100%, точность — 95%. Эндоваскулярные вмешательства применены у 13 больных: в 8 случаях успешно, в 5 случаях безуспешно. Уровень летальности составил 37,5%. У 15 больных с клиникой перитонита либо после безуспешных попыток реваскуляризации интервенционным способом выполнены полостные вмешательства с уровнем летальности 86,7%.Активное использование КТ-АГ позволяет в определенных случаях диагностировать ОМИ на стадии обратимых изменений кишечной стенки. Применение эндоваскулярных вмешательств первым этапом лечения имеет перспективы.

Background The aim was to estimate the prevalence of harmful alcohol use in relation to socio-demographic characteristics among acutely ill medical patients, and examine identification measures of alcohol use, including the alcohol biomarker phosphatidylethanol 16:0/18:1 (PEth). Methods A cross-sectional study, lasting one year at one hospital in Oslo, Norway and one in Moscow, Russia recruiting acute medically ill patients (≥ 18 years), able to give informed consent. Self-reported data on socio-demographics, mental distress (Symptom Check List-5), alcohol use (Alcohol Use Disorder Identification Test-4 (AUDIT-4) and alcohol consumption past 24 h were collected. PEth and alcohol concentration were measured in whole blood. Results Of 5883 participating patients, 19.2% in Moscow and 21.1% in Oslo were harmful alcohol users, measured by AUDIT-4, while the prevalence of PEth-positive patients was lower: 11.4% in Oslo, 14.3% in Moscow. Men in Moscow were more likely to be harmful users by AUDIT-4 and PEth compared to men in Oslo, except of those being ≥ 71 years. Women in Oslo were more likely to be harmful users compared to those in Moscow by AUDIT-4, but not by PEth for those aged Conclusions The prevalence of harmful alcohol use was high at both study sites. The prevalence of harmful alcohol use was lower when assessed by PEth compared to AUDIT-4. Thus, self-reporting was the most sensitive measure in revealing harmful alcohol use among all groups except for women in Moscow. Hence, screening and identification with objective biomarkers and self-reporting might be a method for early intervention.