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Vasculitis affecting the nervous system is a rare disease that can not only present with nonspecific initial symptoms, but also run a severe course without accurate treatment. Although improvements have been achieved, diagnosis of vasculitis remains challenging, because many classification criteria are unspecific or inconclusive with regard to central nervous system (CNS) manifestations. Currently, beside an isolated primary CNS vasculitis, several systemic types of vasculitis are known to affect the nervous system. In this review, we provide an overview of the pathophysiology, current therapeutic guidelines, and highlight novel treatment strategies for CNS vasculitis.

У статті висвітлено деякі складові вибухової хвилі, що формують у подальшому клініко-неврологічну картину гострої черепно-мозкової травми. Виявлено, що у хворих у гострому періоді бойової черепно-мозкової травми, яка обумовлена вибуховою хвилею, формуються неспецифічні сенсомоторні гемісиндроми. Показано, що ця травма має клінічно більш тяжкий перебіг, ніж побутові черепно-мозкові травми.

The aim of the study is to evaluate the clinical and pathogenetic value of the changes of adsorptive-rheological properties of blood serum (ARPB) in patients with different clinical forms of gouty arthritis.Eighty nine patients and 30 practically healthy people of the controlled group (mainly males) undergone interfacial tensiometry of blood. There were used computer equipment MPT2-Lauda, ADSA-Toronto and PAT2-Sinterface. intermitting type of arthritis has been observed in 63 % of cases and chronic one in 37 %, mild clinical course of articular syndrome was found in 19 % of cases, moderately severe course was observed in 51 % and severe — in 30 %. There have been determined surface viscosity (SV), elasticity (SE), tension (ST), viscoelastic module (VE), relaxation time (RT), angulation and tensigram phase angle (PhA), angle of real viscoelasticity (ARVE) and integral angle of viscoelasticity (IAVE). Gouty arthritis is accompanied by the significant increase in parameters of blood serum RT on 26 % and IAVE is twice increased whereas SE decreases on 8 %, VE — 26 %, ST — 4 % and ARVE — 11 % that is observed in 45, 39, 36, 48, 44 and 38 % of patients respectively. Gouty arthritis is associated with sexual dimorphism, depends on the form (SE, PhA, IAVE) and the severity of the course (SV, RT, ST) of the articular syndrome, osseous tophi presence (SV, RT, PhA, IAVE) and sonographic signs of articulations lesion. ARPB changes reflect the character of gouty arthritis course, some indices take part in pathogenetic construction of the disease and might have prognostic significance.

The article deals with the study of nutritional status in patients with chronic inflammatory bowel disease (CIBD) using bioimpedancemetry. 40 patients with CIBD were examined. The high prevalence of deviations in the percentage of fat mass in the body (87.5 %) has been detected, with a predominance of nutritional deficiency (65.0 %) associated with a decrease in the body’s adaptive capabilities and severe course of the disease. 70.0 % of patients were characterized by redistribution of water sectors of the body due to increased amount of extracellular fluid and reduced amount of intracellular fluid, which was more significant in patients with increased nutritional status compared to patients with nutritional deficiency. More expressed changes of the component composition of the body were in patients with Crohn’s disease.

BACKGROUND AND OBJECTIVE: COVID-19 was declared pandemic by March 2020. Clinical, analytical, and radiological findings have been reported. Detailed different evolution of patients of the same local outbreak has been scarcely reported. We report 6 selected cases of such an evolution. PATIENTS: The clinical, radiological, analytical evolution of six patients is reported. Patients were selected as it were epidemiological close contacts, and showed particular different clinical evolution. RESULTS: The clinical course at the start of infection (first week) was similar among patients. In relationship with clinical evolution, middle to severe course were related with inflammation markers levels evolution (D-dimer, IL-6, ferritin, lymphocytes count, etc.). Specially lung alterations were observed, but neurological/neuropsychiatric findings are still common. In evolution, two patients showed middle symptoms, but the two most severely affected died. CONCLUSIONS: It remains to be elucidated the different evolutive pathways and outcomes of COVD-19. In our six patients of the same local outbreak, clinical, laboratory and radiological features were different. We discuss some aspects of the pathophysiology of the disease, other than the widely described of the respiratory system.

Currently, the number of publications on specific features of the clinical course and outcomes of new coronavirus infection COVID-19 in children is steadily increasing, but there are practically no works demonstrating the effectiveness of intensive care interventions, which served as the basis for the present analysis.The objective is to assess the effectiveness of primary intensive care interventions in children with a severe course of new coronavirus infection.Subjects and Methods. 94 patients were examined. Evaluation of intensive care measures was carried out upon admission to ICU.Results. It was found that corticosteroids were used only in 55 (58.5%) patients (χ2 = 5.254, p = 0.022, Pearson conjugation criterion = 0.130). A moderate correlation was established between the unjustified prescription of prednisolone and the unfavorable disease outcome (χ2 = 27.98, p < 0.001, Pearson conjugation criterion = 0.296). The moderate strength of the association between the prescription of antibacterial drugs and the disease outcome was noted (χ2 = 34.01, p < 0.001, Pearson conjugation criterion = 0.331). In all lethal cases, there was volume overload due to excessive intravenous fluid administration (χ2 = 5.14, p = 0.024).Conclusion: individual therapeutic strategies do not have a direct significant impact on outcomes of new coronavirus infection in children, however, the delivery of comprehensive intensive care presented in clinical guidelines is associated with the patient's recovery.

280 patients with COVID-19 were examined (average age 53.9±8.1 years;gender index 1.37:1.0 (162 men and 118 women). It was revealed that young people (especially women) were more common with a mild course of the disease (64.2%), middle-aged people-with a moderate-severe variant of COVID-19 (54.8%), In the group of patients with a severe course of coronavirus infection, female patients prevailed among the elderly, and among middle-aged men - 47.8% and 48.4%, respectively. The comorbid background before the disease CAVID-19 and the neurological complications that appeared on the background of CAVID-19 in the percentage ratio prevailed in males. There were no significant differences in the frequency of complications from the severity of the COVID-19 disease. It was revealed that at the time of hospitalization, all the studied markers of coagulation activity were changed and statistically significantly differed from the reference interval, which indicated the activation of the pro coagulation potential. In the group of female patients, these indicators were more pronounced. CT examination revealed that the percentage of damage to both lungs was significantly higher in female patients compared to male patients. © 2021. This is an open access article under the CC BY-NC-ND license.

Case in the paper is of a 24-year-old woman presenting to Baqiyatallah hospital, Tehran, Iran with the occasional fever, weakness, myalgia, fatigue, body aches, and headache who was diagnosed with Coronavirus disease-19 (COVID-19) PCR test. Chest computed tomography (CT) showed spontaneous pneumomediastinum (SPM) and pneumopericardium (SPP). Here, we described SPM, and SPP in a patient with COVID-19, presenting a severe course of the disease.

Введение. В современных условиях одними из важнейших аспектов, направленных на борьбу с пандемией новой коронавирусной инфекции COVID-19, считаются вопросы, связанные с вакцинацией. В настоящей статье произведена попытка представить результаты вакцинации, которые были получены за более чем полугодовой период применения вакцин против COVID-19 в Красноярском крае. Цель: Оценка популяционной эффективности вакцинации среди населения Красноярского края. Методы: В качестве материала обсервационного сравнительного исследования использованы данные Федерального регистра лиц, больных COVID-19, о заболевших COVID-19 среди населения Красноярского края и Федерального регистра вакцинированных от COVID-19 на момент 30 июля 2021 года. Проанализированы доля пациентов, которым необходимо стационарное лечение, летальность, доля пациентов, находящихся в крайне тяжелом и тяжелом состоянии, а также доля пациентов, которым потребовалась искусственная вентиляция легких и госпитализация в отделения реанимации и интенсивной терапии среди вакцинированных и невакцинированных, а также иммунизированных и неиммунизированных больных COVID-19. Результаты: Установлено, что вакцинированное (независимо от сроков заболевания после вакцинации) и иммунизированное (по прошествии 42 дней с момента введения первого компонента вакцины) население значительно реже болеет COVID-19 (14,6 больного на 1 000 вакцинированных и 16,8 на 1 000 иммунизированных против 116,9 больного на 1 000 невакцинированных и 112,1 на 1 000 неиммунизированных соответственно), а в случае заболевания отмечается значительно более легкое течение, с меньшей частотой требующее госпитализации в стационар (18,3 % против 24,5) и отделения реанимации и интенсивной терапии (0,8 % против 1,6), искусственной вентиляции легких (0,6 % против 1,3), и как следствие, COVID-19 значительно реже приводит к летальным исходам (2,1 % против 3,3). Вывод: Результаты исследования говорят о более благоприятном течении COVID-19 в случае его возникновения у вакцинированных и иммунизированных лиц. Полученные результаты соответствуют результатам, свидетельствующим об эффективности вакцинации против COVID-19, а также о роли массовой вакцинации в борьбе с COVID-19.Alternate abstract:Introduction: Vaccination is considered to be the most important measure to control the pandemic of the new coronavirus infection COVID-19. This artic e attempts to present the results of vaccination campaign against COVID-19 during a six-months period in the Krasnoyarsk Territory. The aim: To assess the effectiveness of vaccination against COVID-19 infection among adults in the Krasnoyarsk Territory. Methods: We used population-based data from the Federal Register of Infected with COVID-19 on COVID-19 cases in the Krasnoyarsk Territory and the Federal Register of Vaccinated against COVID-19 by July 30, 2021. Differences in mortality, proportions of patients who need in-hospital treatment, proportions of patients in extremely serious and serious conditions, proportions of patients who required artificial ventilation and hospitalization in intensive care between vaccinated and non-vaccinated, as well as immunized and non-immunized COVID-19 patients were calculated. Results: Those who were vaccinated (regardless of the timing of the disease after vaccination) and those who were immunized (42 days after the introduction of the first component of the vaccine) were significantly less likely to suffer from COVID-19 (14.6 patients per 1 000 vaccinated and 16.8 per 1 000 immunized versus 116.9 patients per 1 000 unvaccinated and 112.1 per 1 000 non-immunized, respectively), and in the case of the disease after vaccination, there is a much lighter course of disease with a lower proportion of cases requiring hospitalization (18.3 % versus 24.5 %) or treatment in intensive care units (0.8 % versus 1.6 %), artificial ventilation (0.6 % versus 1.3 %) and low case fatality(2.1 % versus 3.3 %). Conclusion: The study provides the evidence on less severe course of COVID-19 among vaccinated and immunized individuals supporting earlier reports on the effectiveness of vaccination against COVID-19 and in role of mass vaccination in combating COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic has disrupted the normal activities of various settings, including clinics, laboratories, and libraries. As the world deals with the fast-mutating causative virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), apart from the search for the best vaccine candidate, efforts towards repurposing existing molecules to save lives must continue. Considerable interest has centered around the implications of vitamin D deficiency and its supplementation on the outcomes in patients with COVID-19. We hypothesize that vitamin D supplementation has the potential to confer protection against SARS-CoV-2 infection and a severe COVID-19 course. Various animal, human observational as well as interventional studies have shown a protective role of vitamin D in COVID-19. More robustly designed studies where vitamin D is supplemented prophylactically and administered to those already infected are needed to determine the precise contribution of this supplementation in preventing SARS-CoV-2 infection and modifying the course of COVID-19.

В статье рассмотрены причины, патофизиология, современное лечение и опыт авторов по лечению синдрома Гийена — Барре. Редкость крайне тяжелого течения заболевания, смазанная клиническая картина, шаблонность подхода к лечению могут привести к трудностям для врача интенсивной терапии и осложнениям для пациента. Несмотря на изученность проблемы, смертность в развитых странах от острой аутоиммунной демиелинизирующей полинейрорадикулопатии в специализированных центрах составляет 5 %, что говорит о необходимости дальнейшего изучения этой патологии.

Objective: To study the transcription factor FoxP3 in children with acute and chronic spontaneous urticaria as a possible predictor of the severity and chronicity of urticaria.Materials and Methods: A total of 264 children of both sexes aged from 6 to 16 years old with diff erent variants of urticaria course were examined. Clinical methods of the study included the analysis of anamnestic data and an objective examination of the child with the determination of the severity of urticaria. Immunological methods of the study included the identifi cation of T-regulatory lymphocytes with the CD4+CD25+ Foxp3+CD45+immunophenotype.Results: A signifi cant decrease in the level of transcription factor FoxP3 was found in children with severe acute urticaria and chronic urticaria compared to the control group.Conclusion: Th e degree of reduction in the level of FoxP3 signifi cantly aff ected the likelihood of the development of a severe course of acute urticaria and possible chronization of the disease.

Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is a recently detected syndrome whose criteria were first established in May 2020 (Royal College of Paediatrics and Child Health). The clinical course varies from mild to severe, life-threatening cases. This paper presents a case of an extremely severe course of PIMS with symptoms resembling Kawasaki syndrome in a previously healthy 13-year-old boy with obesity. A complication of the severe course of PIMS was the development of critical illness polyneuropathy in the patient.

Background. Coronavirus disease (COVID-19) is the biggest challenge the whole modern world has faced. Physicians and scientists are trying to find a solution to this problem. That is why many guidelines for the management of patients with ­COVID-19 have been created recently and they are constantly updating because of new results of the latest studies. But it is noticeable that there is a lack of protocols for certain special groups of the population the management of which differs from the treatment of the general population. Such groups include children, pregnant and postpartum women, the elderly, and patients who need surgery. The purpose of our study is to evaluate the management of pregnant and postpartum women in the Municipal Non-Profit Enterprise “Lviv Clinical Emergency Care Hospital”. Materials and methods. From September 2020, at the premises of the Municipal Non-Profit Enterprise “Lviv Clinical Emergency Care Hospital”, treatment has been carried out for pregnant and postpartum women with ­COVID-19; three case reports are presented. Results. Unfortunately, the treatment does not always lead to positive outcomes, sometimes it can be fatal, as the course is often accompanied by bacterial complications on the background of immunosuppression. However, it was found that the best treatment regimen is still a combination of antibiotics, anticoagulants and hormones and excludes the widespread use of antiviral or antimalarial drugs. Continuous monitoring of vital functions and assessment of liver, kidney, and heart function is essential to prevent complications or detect them at an early stage. Conclusions. During treatment of pregnant women in the intensive care units, it is important to choose the right empirical therapy, think about delivery done in time and oxygen therapy, based on theoretical and practical principles of ventilation., Актуальність. COVID-19 — це найбільший виклик, з яким зіткнувся увесь сучасний світ. Медики та науковці намагаються відшукати вирішення цієї актуальної проблеми. Саме тому останнім часом створено багато гайдлайнів для ведення пацієнтів з COVID-19, які постійно оновлюються з урахуванням результатів останніх досліджень для того, аби забезпечити пацієнтів найкращою допомогою. Але помітно, що існує нестача протоколів для певних особливих груп населення, ведення яких відрізняється від лікування загальної популяції. До таких груп належать діти, вагітні та породіллі, люди похилого віку, пацієнти, які потребують хірургічного втручання. Мета. Оцінювання допомоги вагітним та породіллям в умовах комунального некомерційного підприємства «Клінічна лікарня швидкої медичної допомоги міста Львова» (КНП «КЛШМД м. Львова»). Матеріали та методи. Із вересня 2020 року на базі КНП «КЛШМД м. Львова» проводилося лікування вагітних та породіль з COVID-19, три випадки з яких подано вашій увазі. Результати. На жаль, проведене лікування не завжди веде до позитивних наслідків і може закінчитися летально, оскільки перебіг часто супроводжується бактерійними ускладненнями, картина яких особливо яскраво проявляється на фоні імуносупресії. Проте визначено, що найкращою схемою лікування залишається поєднання застосування антибіотиків, антикоагулянтів та гормонів і виключає широке застосування противірусних або протималярійних препаратів. Визначальним чинником також залишається постійний моніторинг вітальних функцій та оцінка функціонування печінки, нирок, серця з метою запобігання розвитку ускладнень чи виявлення їх на ранній стадії. Висновки. При лікуванні вагітних у відділенні анестезіології та інтенсивної терапії важливо правильно підібрати емпіричну терапію, вчасно провести розродження та здійснювати кисневу терапію, ґрунтуючись на теоретичних і практичних принципах штучної вентиляції легень.

Ebola virus disease — natural focal, extremely dangerous infection with severe course characterized by fever, hemorrhagic syndrome and multiple damage to vital organs and body systems. The article describes the epidemiological situation related with the registration of cases, provides the characteristics of the pathogen, mechanisms of development, peculiarities of disease in children. Methods of the treatment and prevention of this disease are described from the modern point of view., В статье освещена эпидемиологическая ситуация, связанная с регистрацией случаев геморрагической лихорадки Эбола, охарактеризованы возбудители, механизмы развития, особенности течения болезни у детей. С современных позиций описаны методы лечения и профилактики заболевания. Геморрагическая лихорадка Эбола — природно-очаговая особо опасная инфекция с тяжелым течением, характеризующаяся лихорадкой, геморрагическим синдромом и полиорганными повреждениями жизненно важных органов и систем организма., У статті висвітлено епідеміологічну ситуацію, пов’язану з реєстрацією випадків геморагічної лихоманки Ебола, охарактеризовано збудник, механізми розвитку, особливості перебігу хвороби в дітей. Із сучасних позицій описано методи лікування й профілактики захворювання. Геморагічна лихоманка Ебола — природно-вогнищева особливо небезпечна інфекція з тяжким перебігом, що характеризується лихоманкою, геморагічним синдромом і поліорганними пошкодженнями життєво важливих органів і систем організму.

Background. Searching for the fundamental pathogenic mechanisms of atopic dermatitis (AD) and improvement of options for prevention and treatment, increasing attention is paid to the state of trace elements supply of the child’s body. Particular role is given to zinc, which is one of the most versatile trace elements. The purpose was to study the features of atopic dermatitis in children depending on the serum content of zinc. Materials and me­thods. The paper presents the materials of clinical observation, clinical laboratory and instrumental examination of 168 children aged 7 to 18 years with AD. The control group consisted of 60 healthy children. The serum zinc content was determined by atomic absorption spectroscopy on a C-115-M1 spectrophotometer according to the instructions that are attached to the device. Results. More than half of children (55.6 %) had very low levels of zinc (0.35 ± 0.11 mg/l), while another 22.2 % had extremely low levels (0.12 ± 0.02 mg/l). Several features of AD clinical course were noted: more frequent episodes of acute respiratory infection, predominance of mode­rate and severe course with periorbital, perioral, perianal dermatitis, dystrophic changes and hyperkeratosis of the nails, increased hair brittleness, expressed skin dryness (2.31 ± 0.73 vs. 1.92 ± 0.69 points, p, Актуальность. В поисках основных патогенетических механизмов атопического дерматита (АД) и улучшения вариантов профилактики и лечения все больше внимания уделяется обеспечению организма ребенка микроэлементами. Особая роль принадлежит цинку, который является одним из самых многофункциональных микроэлементов. Цель: изучить особенности клинического течения АД у детей в зависимости от содержания цинка в сыворотке крови. Материалы и методы. В работе представлены материалы клинического наблюдения, клинико-лабораторного и инструментального обследования 168 детей в возрасте от 7 до 18 лет с АД. Контрольную группу составили 60 практически здоровых детей. Содержание цинка в сыворотке крови определяли методом атомно-абсорбционной спектроскопии на спектрофотометре С-115-М1, согласно инструкциям, прилагаемым к прибору. Результаты. Более половины детей (55,6 %) имели очень низкий уровень цинка — 0,35 ± 0,11 мг/л, еще 22,2 % — крайне низкий (0,12 ± 0,02 мг/л). Отмечен ряд особенностей клинического течения АД: более частые эпизоды острых респираторных вирусных инфекций, преобладание среднетяжелого и тяжелого течения с периорбитальным, периоральным, перианальным дерматитом, дистрофическими изменениями и гиперкератозом ногтей, повышенной ломкостью волос, выраженной сухостью кожи (2,31 ± 0,73 балла против 1,92 ± 0,69 балла; p < 0,01). Выявлены обратные корреляционные связи между концентрацией цинка в сыворотке крови и сухостью кожных покровов (р = 0,001; r = –0,67; t = –2,99), значением индекса SСORAD (р = 0,01; r = –0,49; t = –2,34) и длительностью течения АД (р = 0,001; r = –0,46; t = –2,13). Установлены достоверно более низкие показатели роста (p, Актуальність. У пошуках основних патогенетичних механізмів атопічного дерматиту (АД) і покращення варіантів профілактики й лікування все більше уваги приділяється забезпеченню мікроелементами організму дитини. Особлива роль надається цинку, який є одним із найбільш багатофункціональних мікроелементів. Мета: вивчити особливості клінічного перебігу АД в дітей залежно від вмісту цинку в сироватці крові. Матеріали та методи. У роботі наведені матеріали клінічного спостереження, клініко-лабораторного та інструментального обстеження 168 дітей віком від 7 до 18 років із АД. Контрольну групу становили 60 практично здорових дітей. Уміст цинку в сироватці крові визначали методом атомно-абсорбційної спектроскопії на спектрофотометрі С-115-М1, згідно з інструкціями, що додаються до приладу. Результати. Більше половини дітей (55,6 %) мали дуже низький рівень цинку — 0,35 ± 0,11 мг/л, ще 22,2 % — украй низький (0,12 ± 0,02 мг/л). Відзначена низка особливостей клінічного перебігу АД: частіші епізоди гострих респіраторних вірусних інфекцій, переважання середньотяжкого та тяжкого перебігу з періорбітальним, періоральним, періанальним дерматитом, дистрофічними змінами і гіперкератозом нігтів, підвищеною ламкістю волосся, вираженою сухістю шкіри (2,31 ± 0,73 бала проти 1,92 ± 0,69 бала; p < 0,01). Виявлено зворотні кореляційні зв’язки між концентрацією цинку в сироватці крові і сухістю шкірних покривів (р = 0,001; r = –0,67; t = –2,99), значенням індексу SСORAD (р = 0,01; r = –0,49; t = –2,34) і тривалістю перебігу АД (р = 0,001; r = –0,46; t = –2,13). Встановлено вірогідно нижчі показники зросту (p < 0,05), особливо в дітей із дуже низьким вмістом цинку (0,12 ± 0,02 мг/л). Висновки. У дітей, хворих на атопічний дерматит, вміст цинку в плазмі крові вірогідно нижчий, ніж у здорових дітей. У дітей зі зниженим вмістом цинку в організмі відзначена низка особливостей клінічного перебігу атопічного дерматиту (більш тяжкий та затяжний перебіг із періорбітальною та періанальною локалізацією, часті респіраторні інфекції, виражені дистрофічні зміни придатків шкіри, затримка зросту).

The aim of the study was to determine of melatonin level in the blood serum in rats of different sexes and age in ulcerative lesions of the stomach. Materials and methods. Using the method of alcohol-prednisolone injury, we have simulated ulcerative lesions of the stomach. The level of melatonin in the blood serum in rats of different age and sexes with ulcerative lesions of the stomach was determined by enzyme-linked immunosorbent assay. Experimental animals were divided into groups by the age, namely 3, 9, 15 and 20 months, corresponding to the human age of 14, 29–30, 43–44, 55–56 years, respectively. Results. In the course of the research, it was found that rats with the ulcerative lesions of the stomach had significant (r ≤ 0.05) reduction of serum melatonin in animals of all experimental groups. In males, the lowest levels of melatonin in ulcerative lesion were in groups of 9 and 20 months — (174.0 ± 12.9) pmol/L and (141.5 ± 21.4) pmol/L, respectively. The level of melatonin in males aged 9 months was significantly lower (p ≤ 0.05), by 26 %, than in rats aged 3 months, and by 16 % — compared with rats aged 15 months (p ≤ 0.05). In rats aged 20 months, melatonin levels were reduced by 40 and 32 % with respect to experimental groups of animals aged 3 and 15 months (p ≤ 0.05). Relatively to the control group, among male rats the greatest reduction also observed in animals ages 20 months — 43 % and 9 months — 39 % (p ≤ 0.05). In male rats aged 3 months, melatonin level was lower by 22 %, and in the age group of 15 months — by 29 % relative to control animals (p ≤ 0.05). In females, reduction of melatonin levels occurred gradually with age: from the highest in females aged 3 months to significantly lowest compared to other age groups — females aged 20 months in the control and experimental groups. The females rats with ulcerative gastric lesions had a decrease in melatonin levels by 21–23 % relative to controls in all age groups (p ≤ 0.05). Discussion. The results indicate that ulcerative lesions of the stomach is likely to result in injury of enterochromaffin cells of the gastric mucosa, accompanied by a significant reduction in levels of melatonin in rats of both sexes and all age groups. Thus, it was found that despite no significant difference between levels of melatonin in males and females on the background of ulcerative lesions of the stomach, the overall level of melatonin reduction in males is 22–43 % higher relative to controls than in females — 21–23 %. The biggest gender differences in melatonin levels decrease were found at the age of 9 months (corresponds to the human age of 29–30 years) — by 39 % in males and by 23 % in females relative to controls and 20 months (corresponds to the human age of 55–56 years) — 43 and 22 %, respectively. The results suggest that in men aged 29–30 and 55–56 years, ulcerative lesions result in significant damage to extrapineal sources of melatonin synthesis and more severe course of the stomach ulcer with the development of complications. Conclusions. 1. Ulcerative lesions of the stomach lead to reduce levels of melatonin in the blood serum in rats of different sexes and age. 2. The greatest reduction in levels of melatonin in experimental gastric ulcer occurs in rat males aged 9 and 20 months corresponding to the human age of 29–30 and 55–56 years.

Актуальность. Хронический панкреатит (ХП) — это заболевание с тяжелым течением, приводящее со временем к нарушению всех видов обмена и прогрессированию трофологической недостаточности с увеличением возраста пациентов. Цель. Лабораторное исследование ряда показателей витаминного и минерального обмена в крови пациентов с ХП в зависимости от их биологического возраста. Материалы и методы. Обследование 218 больных ХП в возрастном аспекте на основании количественного исследования некоторых показателей витаминного и минерального обмена в крови. Результаты. Исследование трофологической недостаточности пациентов с ХП в зависимости от их биологического возраста свидетельствует о том, что возраст больных является предиктором витаминной и минеральной недостаточности, а также накопления токсических минералов в сыворотке крови обследуемых пациентов. Выводы. Полученные данные свидетельствуют о том, что возраст больных ХП является предиктором витаминной и минеральной недостаточности, накопления токсических минералов, что необходимо учитывать при формировании комплексного лечения данной категории пациентов.

There are as yet no data pointing to any increase in the incidence of the novel coronavirus infection (COVID-19) or a more severe course of illness in patients with epilepsy. However, considering the high prevalence of epilepsy in patients over 60 years of age, the high comorbidity of epilepsy and a whole series of somatic diseases, and the need to maintain the opportunity for constant access to antiepileptic medications and follow-up of epilepsy patients, we can expect a whole set of difficulties in the management of these patients in the conditions imposed by the COVID-19 pandemic. This article addresses the main principles of the management of epilepsy patients in the conditions of the COVID-19 pandemic: the need to follow regimes; preservation of regular and continuous taking of antiepileptic drugs, including consideration of interdrug interactions; and switching patients to i.v. forms of antiepileptic drugs where necessary.

Background: There are two variants of spontaneous bacterial peritonitis (SBP) include, culture negative neutrocytic ascites (CNNA) and culture positive SBP. Some suggested that, the clinical presentation of two variants is nearly similar, however, other reported that, patients with culture positive have a more severe course and higher mortality than CNNA. The aim of this study is to determine the clinical characteristics and predictors of CNNA in comparison to culture positive SBP. Materials and methods: This study included 300 consecutive patients with HCV related cirrhotic ascites. All patients underwent abdominal paracentesis and the ascitic fluid was processed for cell count and culture. Clinical and laboratory parameters of these patients were recorded at index admission.. Results: Out of 300 patients included in the study, 150 patients had SBP. Among the 150 patients with SBP, 100 patients were culture positive SBP (culture positive SBP with ascitic fluid PMNL ≥250 cells/m3) and 50 patients were CNNA (culture negative SBP with ascitic fluid PMNL ≥250 cells/m3). Compared to patients with culture positive SBP, patients with CNNA showed, a significant decrease as regards, fever, prevalence of DM, hepatic encephalopathy, platelets, blood PMNL and ascetic PMNL. Logistic regression analysis demonstrated that, decreased platelets count, blood PMNL and ascetic PMNL were independent predictor factors for CNNA. Conclusion: Patients with CNNA have a lower incidence of fever, prevalence of diabetes mellitus, hepatic encephalopathy, blood PMNL and ascetic PMNL versus culture positive SBP. Independent predictors of culture negative SBP are decreased platelets, blood PMNL and ascetic PMNL.

Microcirculatory hemodynamic indexes (HI) were assessed in patients with moderate and severe COVID-19. In both groups, a significant increase in the absolute spectral indexes (HI1, HI2, and HI3) and the ratio of low-frequency to high-frequency component (HI1/HI3) was revealed. In the group of severe infection, only the "slow" index (low-frequency HI1) of microcirculatory hemodynamics was significantly lower. The oscillatory indices MAYER1-3 and RESP1-3 were reduced in patients of both groups. The aggravation of the disease course was accompanied by depression of the low-frequency index HI1. Regulatory shifts compensate for disturbances in microcirculatory processes in moderate COVID-19, but severe course was associated with their decompensation.

Currently, in pandemic settings, the new coronavirus infection is the leading cause of adult fatalities and may cause death of children with comorbidities.The objective of the study is to identify predictors of the fatality of the new coronavirus infection in children.Subjects and Methods. 230 patients with the new coronavirus infections were examined. The main group of 94 patients with severe COVID-19, the fatal outcome occurred in 25 (26.6%) children. The comparison group consisted of 126 children with a moderate degree of severity, and there were no lethal outcomes.Results. Children older than 10 years of age (43%) prevailed in the study cohort. Every fifth patient in the main group suffered from shock, and 79 (84%) children had failure of two or more systems/organs. The presence of pronounced manifestations of the disease was associated with a 20-fold increase in the probability of a severe course of COVID-19 (OR = 0.04). Involvement of two organs and systems doubled the risk of death. An acceptable discriminatory ability of the pSOFA score for predicting COVID-19 outcomes in children was identified: sensitivity 83%, specificity 61%, cut-off point 5.6 points.Conclusion. Predictors of death in severe new coronavirus infection in children include failure of two or more organs and systems, acute renal injury and the pSOFA score above 5.

Atopic dermatitis is a chronic inflammatory skin disease with periods of remission followed by periods of exacerbation. Atopic dermatitis affects the quality of life of the child and his entire family. Topical corticosteroids are the gold standard for treating the disease. Topical calcineurin inhibitors are prescribed from the age of two as a second-line therapy. In cases of severe, resistant to traditional therapy of the course of the disease, cyclosporin A and extremely rarely oral glucocorticoid-containing drugs are used. Biological therapy is one of the modern treatment options, probably replacing the immunosuppressive and hormonal treatment of atopic dermatitis with a progressive course of the disease.

The article presents a description of a clinical case of a child 3 years 8 months old with Rett syndrome caused by the mutation of p.Val485fs in theMECP2gene. According to electroencephalography data at the age of 1 year and 6 months, diffuse continued epileptiform activity in the form of high-amplitude (up to 300 μV) acute – slow wave complexes (continuous spike-waves during slow-wave sleep, CSWS) with an index of 90–100 % was revealed. At the control examination at the age of 2 years and 10 months diffuse epileptiform activity was replaced by multifocal activity with an index of up to 70–80 % at certain epochs, in general, not exceeding 50–60 %. During the entire observation period there were no epileptic seizures. It remains unknown whether the presence of CSWS at such an early age is a predictor of a more severe course of Rett syndrome – in our observation the girl did not acquire walking skills and a delay in psychic and speech development was evident already before the 12 month of life. more research is needed on the frequency of the CSWS phenomenon and its role in the development of clinical features in Rett syndrome.

ZusammenfassungDie Corona-Pandemie stellt die urologische Praxis vor besondere Herausforderungen, da die meisten Urologischen Patienten aufgrund von Alter und Begleiterkrankungen zur Hochrisikogruppe für einen schweren Verlauf der COVID19-Erkrankung zählen. Effektivste Schutzmaßnahmen sind eine priorisierte Reduktion von Patientenkontakten unter Zuhilfenahme von telemedizinischen Kontakten und das konsequente Tragen von FFP2-Masken bei direktem Kontakt. Weitere Maßnahmen wie Zugangskontrollen, Schutzwände und Luftfilterung können das Infektionsrisiko weiter senken. Letztlich führt nur ein flächendeckendes Impfen aus den pandemiebedingten Einschränkungen für die Behandlung urologischer Erkrankungen.

Background. Many patients with neurological disorders have an increased risk of infection and the severe course of COVID-19. Studies on positive predictors of seizure outcomes with the 2019 novel coronavirus disease remain limited.The objective is to study predictors for positive health outcomes after COVID infection in patients with epilepsy based on analysis of clinical observations.Design and Methods. Study design - the work is a part of a prospective observational study of seizure dynamics after COVID infection in patients with epilepsy.Results. The presented clinical observation demonstrates a positive health outcome after COVID infection in a young patient with the genetic generalized epilepsy with sustained clinical and electroencephalographic seizure remission on the next generation AED monotherapy (brivaracetam).Conclusion. Predictors for positive health outcome after the 2019 novel coronavirus disease in patients with epilepsy include a young age, absence of somatic comorbidities, seizure remission, modern drug use with no interaction among AEDs and antibiotics and antivirals for the coronavirus disease treatment. Despite the encouraging data on the favourable course of epilepsy in cases of developing COVID-19, further research is needed to continue.

The aim of the work was to determine frequency of lupus anticoagulant (LA) detection in patients at various degrees of COVID-19 severity as well as duration of LA circulation after the infectious disease. The study included 103 patients with COVID-19. The patients were observed during the hospital care and in ambulance, if required. The patients were admitted to the departments of infectious diseases arranged at the V.I.Kulakov National Medical Research Center for Obstetrics, Gynecology, and F.I. Inozemtsev City Clinical Hospital. Treatment schedules and stratification of the patients by clinical severity was carried out in accordance with Interim Guidelines issued by the Ministry of Health of the Russian Federation for the prevention, diagnosis and treatment of new coronavirus infection (version 9). The following groups were formed: mild (n = 27), moderate (n = 55) and severe (n = 20). The patients were tested for LA positivity in the course of disease: on the day of starting medical care (with outpatient observation), or on the day of hospitalization; repeated tests were made before discharge (inpatients), and later, 1-2 months and 7 months after recovery. Lupus anticoagulant was determined by two independent tests (dRVVT and SCT), i.e., as a screening test and a confirmation test. At initial examination, LA was found in 50 patients (49%). The effect of LA in 98% of cases was observed with dRVVT test, as an increase of normalized ratio (NR). The maximum median value of NR was 1.54 (0.97: 2.1) was revealed in patients with severe course of COVID-19 (p 0.0001) compared with other groups and correlated with severity of the infectious process (r = 0.491, p 0.0001). In mild cases of COVID-19, LA was detected less often (4 cases, 14.8%) than in moderate severity cases (27, 49.1%), and severe patients (19, 95%) (p 0.05). Re-examinations of the patients before discharge from the hospital and 1-2 months later revealed high frequency of LA (p 0.05). However, no LA-positive test was found 7 months after discharge. In patients with COVID-19, high frequency of circulating LA was registered, depending on severity of the infectious process. In addition, we have first shown that persistence of the circulating LA over post-infectious period does not exceed 7 months.

Adult-onset Still’s disease is a rare inflammatory disorder usually affecting young adults. Elderly-onset Still’s disease (EOSD) is reported in some cases, commonly in Japan, the USA and Europe. One of the most commonly used criteria for diagnosing EOSD is Yamaguci criteria. In elderly patients more severe course of the disease and more complications may be expected than in the younger group of patients with Still’s disease. The lungs involvement is rather rare manifestation of this disease. In our article we discuss the problem of both the development of Still’s disease in the elderly and interstitial lung changes in the course of the disease, based on available literature and own cases from one centre.

The article presents a clinical case of a severe course of a novel coronavirus infection (COVID-19) that complicated the postpartum period in a patient who underwent cesarean section and resulted in lethal outcome on day 43 after delivery. This observation demonstrates the variety of clinical manifestations of a novel coronavirus infection, masking a severe systemic intravascular catastrophe in a puerperal woman.

Interstitial lung diseases refer to a large group of diseases with a severe course and unfavorable prognosis, since the most forms of these diseases cause irreversible fibrosis of the lung tissue and severe respiratory failure. Lung transplantation remains the only way to save the patient’s.The article highlights the current state of the problem, achievements and prospects in the study, diagnosis and approaches to the treatment of interstitial lung diseases in children. The authors emphasize that this direction is one of the most relevant in pediatric pulmonology and clinical medicine in general.

The aim of the study was to investigate the use of serial measurements of TSH-receptor autoantibodies (TRAb) with the newest available assay technology to predict the course of Graves’ Orbitopathy (GO) during the first 24 months from disease onset. Serial serum samples from patients with GO (103 mild/135 severe) were collected between 2007 and 2017 and retrospectively analyzed. The course of GO were classified into mild/severe 12 months after manifestation (severe: NOSPECS≥5; mild

We examined 74 patients with acute decompensation of alcoholic liver cirrhosis: 34 (45.9%) with bacterial infection (group 1) and 40 (54.1%) without bacterial infection (group 2). The degree and index of acute-on-chronic liver failure (ACLF) were determined using an on-line CLIF-C ACLF Calculator and the levels of cytokeratin-18 fragments, TNFα, IL-1β, IL-4, IL-6, and IL-8. In group 1, AST, cytokeratin-18, TNFα, IL-1β, IL-6, degree and score of ACLF were significantly higher than in group 2. ACLF developed in 18 (52.9%) patients in group 1 and in 11 (27.5%) (p

The extent, severity, and radiological findings of ovarian growth in infants with genetic syndromes of insulin resistance have not been fully described. We report a rare case of reversible massive ovarian enlargement in a female infant with a congenital insulin resistance syndrome, likely Rabson-Mendenhall syndrome given the less clinically severe course. The patient presented with neonatal diabetes with hyperinsulinemia and hyperglycemia due to congenital insulin resistance. She developed increasing severe bilateral ovarian enlargement which peaked at 4 months of age, followed by gradual decrease in size of the ovaries following treatment with insulin-sensitizing drugs and improved hyperinsulinemia. The ovarian enlargement is postulated to be secondary to the trophic effects of insulin acting in a gonadotropin-independent mechanism. Hyperinsulinemia in congenital insulin resistance can also result in hypertrophy of other organs. Understanding the pathophysiology behind massive ovarian enlargement in the setting of congenital insulin resistance syndromes can help guide appropriate therapy.

Relevance. The question about HIV-infected people as a risk group of morbidity and severe course of COVID-19 is still open.Aim of our scientific work is to determine the prevalence and severity of COVID-19` clinical course in HIV-infected people in comparison with the general population.Materials and methods. The information resources of COVID-19 registration in HIV-infected and HIV-negative people in Perm Region were studied for 2020.Results. The prevalence of COVID-19 among HIV-infected people is lower than among HIV-negative people. There were no significant differences in the severity of COVID-19 clinical course in HIV-infected and HIV-negative people. There was no statistically significant dependence of the severity of COVID-19 clinical course in HIV-infected patients on the number of CD4 + T cells and the degree of viral load.Conclusion. HIV-infected people are not a risk group of morbidity and severe course of COVID-19.

AIM: Searching for predictors of cytokine storm in patients with COVID-19 and creating a risk scale for this complication for practical implementation. MATERIALS AND METHODS: The study included 458 patients with confirmed COVID-19 with signs of viral lung lesion according to computer tomography. The patients were divided into 2 groups: with a stable course of moderate severity (100 patients) and with progressive moderate, severe and extremely severe course (358 patients). RESULTS: It has been established that the main risk factors for the development of cytokine storm in COVID-19 patients are interleukin-6 concentration 23 pg/ml, the dynamics of the index according to the NEWS scale 0, ferritin concentration 485 ng/ml, D-dimers 2,1, C-reactive protein 50 mg/l, the number of lymphocytes in the blood 0,72 ∙ 109/l, age 40 years. Cytokine storm incidence correlates with an increase in the number of risk factors. For practical use the scale is applied in 3 groups. In the patients of the first group (0-1 factor) almost no cytokine storm risk was detected, in the second group (2-3 factors) the probability of a storm was 55 % (increased by 35.5 times), in the third group (4 risk factors) reaches 96 % (increased by 718 times). CONCLUSIONS: Diagnostic and monitoring criteria of cytokine storm in the patients with COVID-19 were established. The developed prognostic scale allows to identify patients at high risk of developing cytokine storm for early anti-inflammatory therapy.

The year 2020 will undoubtedly be marked by the coronavirus disease 2019 (covid-19) pandemic, caused by the novel coronavirus SARS-CoV-2. It has been shown that in diabetes patients, covid-19 occurs in a more severe form, with these patients being more prone to the need for mechanical ventilation and having higher mortality rates than non-diabetic patients. In the present article, we describe possible pathophysiological mechanisms that could explain a more severe course of covid-19 in diabetes patients. We also describe the recommendations for use and discontinuation of anti-diabetic drugs during infection, and continue by explaining how to adjust the management of this chronic disease during an epidemic. In conclusion, our own experience in organizing outpatient diabetes clinic during the covid-19 epidemic at the University Medical Centre Ljubljana is described. Covid-19 still carries many unknowns, so it will not surprise us, if we soon realize that the findings described so far, are outdated. Nonetheless, the present recommendations for the treatment of diabetes patients during the epidemic will remain in force and will hopefully help to improve and optimize the treatment of our patients, even after the pandemic.

Pandemic has been a challenge for many months. Coronavirus infections have crucial impact on health care in outpatient clinics and at hospitals. The COVID-19 pandemic has disturbed treatment of patients with chronic conditions, including diabetes mellitus. The important goal is to prevent deterioration of patients’ condition and treatment due to telemedical services and limited contact with doctors. Modification of antidiabetic therapy and time-limited insulin therapy might be necessary in hospitalized patients suffering from SARS-CoV-2 infection. Carbohydrate metabolism disturbances are frequent in patients with and without previous diagnosis of diabetes. Prevalence of diabetes increased in recent year. The exact mechanism is unknown, pancreatic islet beta-cell dysfunction might be effect of coronavirus infection. Patients suffering from diabetes mellitus are concerned whether diabetes increases risk of coronavirus infection and severe course of the disease.

Clinical and epidemiological characteristics of botulism in the Astrakhan region for the period from 2013 to 2019 are presented. 37 people with a diagnosis of Botulism were under observation. It was found that most often (28 (75.7%) cases) patients associated their disease with the use of canned home-made products. Canned vegetables (cucumbers, tomatoes, vegetable salad, eggplant, cabbage) were consumed by 18 (48.7%) people, mushrooms 10 (27%), dried fish 7 (18.9%), herring-balyk 1 (2.7%) and home-made liver pate-1 (2.7%) patient. The incubation period in the observed patients was on average 2.4 days. It lasted 12 days in 24 (64.9%) patients, 3-5 days in 12 (32.4%) patients, and 6 days in 1 (2.7%) patient. According to the severity of the condition, 17 (45.9%) patients were hospitalized in the intensive care unit. Severe course of the disease was in 17 (45.9%) patients, moderate-in 20 (54.1%) patients. Early and persistent symptoms in all patients were marked muscle weakness, in 78.4% of patients dizziness, in 83.8% of patients difficulty walking and unsteadiness of gait. In 34 (91.9%) patients, the most pronounced symptoms were ophthalmoplegic: blurred vision, fog, flies in front of the eyes, inability to read the text. In General, up to 10 cases of botulism are registered annually in the Astrakhan region. Almost half of the patients (45.9%) have severe botulism. The disease is mostly sporadic and is associated with the use of canned vegetables and home-made mushrooms. In addition, cases of botulism associated with the use of dried fish have become more frequent in the Astrakhan region. Late hospitalization was observed in 1/3 of patients (11 (29.7%) cases) with botulism. This is due to untimely diagnosis at the pre-hospital stage and late access of patients to medical care.

Objective: to study the use of RRT methods and their influence on the results of treatment of patients with severe COVID-19.Subjects and methods. We retrospectively analyzed the data of 283 patients with COVID-19 in the intensive care units of Moscow City Hospital no. 40 in 2020 who had received RRT as one of the treatment methods.Results. Frequency of RRT in COVID-19 patients in ICU of Moscow City Hospital no. 40 for 2020 made 5.7% (504 out of 8.711 patients treated in ICU received RRT). In 86% of cases, RRT was performed for renal indications. At the time of initiation of RRT, the studied groups did not differ according to SOFA score. The frequency of using dialysis units with high and low cut-off point in the groups of survived and deceased patients differed significantly. The surgery itself started at relatively the same time from the onset and statistically significantly earlier in the group of survivors from the beginning of tracheal intubation (4.9 ± 0.5 vs 6.8 ± 0.3 days, p = 0.0013). Against the background of ongoing therapy, overall severity of the state progressed in the group of deceased patients to 9.9 ± 0.2 SOFA scores, while in the group of survivors there was an improvement to 6.1 ± 0.4 scores.

Objective: to assess the state of the pro-oxidant/antioxidant system in children with hereditary spherocytosis (HS) depending on its severity.Material and methods. The study involved 44 HS patients at the age from 1 to 17 who were divided into 2 groups depending on the disease severity: mild course (n = 24) and moderate or severe course (n = 20). The control group included 23 practically healthy children who were comparable with the main group by gender and age. The state of the pro-oxidant/antioxidant balance of blood plasma was assessed by the method of luminol-dependent chemiluminescence (LDCL) with the determination of the maximum luminescence intensity (Imax, %) and the light sum of chemiluminescence (S, %). The activity of superoxide dismutase (SOD) and catalase was determined in the erythrocytes of the examined children.Results. On average, the parameters of the pro-oxidant/antioxidant status in the HS patients significantly differed from those of the control group (p Conclusion. HS patients develop oxidative stress (decreased activity of the antioxidant system associated with increased accumulation of prooxidant substances), the degree of which is higher in patients with a severe course of the disease. This allows of considering plasma LDCL indicators as an additional marker for the assessment of the severity of the disease and of justifying the necessity to include antioxidants in the HS treatment regimen.

ZusammenfassungWährend die Zahl an Personen, die sich mit SARS-CoV-2 infizierte, über eine lange Zeit stieg, nahmen die Behandlungskapazitäten in den Krankenhäusern entsprechend ab. Um Patienten nicht zu gefährden und gleichzeitig Ressourcen zu schonen, ist eine frühzeitige Differenzierung zwischen prognostisch leichten und schweren Verläufen erforderlich. Zur Identifikation von COVID-19-Fällen mit stationärem Behandlungsbedarf wurde zu Beginn der Pandemie ein COVID-19-Risikoscore basierend auf einer Literaturrecherche und ersten klinischen Erfahrungen erstellt und im Rahmen einer retrospektiven Kohortenstudie mit 155 Patienten validiert. Aufgrund des hohen prädiktiven Wertes und der Diskriminierungsfähigkeit kann der etablierte COVID-19-Risikoscore ein unterstützendes Instrument für klinisch tätige Ärzte an der Sektorengrenze zwischen ambulantem und stationärem Bereich darstellen.

The article is devoted to the creation of the prevention of severe course of COVID-19 molecular model from the standpoint of the Titov’s phylogenetic theory of general pathology. The role of the renin-angiotensin and kallikrein-kinin systems in the severe course of COVID-19 is discussed. Using the example of activation of the renin-angiotensin system in non-communicable diseases, the importance of controlling traditional risk factors for the prevention of severe COVID-19 is shown.