Development of Data Processing Skills of Physics Students in Intermediate Laboratory Course

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Антибиотикорезистентность уропатогенов у пациентов с нефролитиазом на фоне сопутствующей ишемической болезни сердца

Objective: to identify the main causative agents of chronic calculous pyelonephritis and determine their antibiotic resistance in patients with nephrolithiasis combined with coronary heart disease (CHD).Material and methods. A retrospective case-control study included 181 patients aged 57 to 82 years old who were treated at the urological center of branch no. 1 of Burdenko Main Military Clinical Hospital in 2014–2019. All patients long-term suffered from urolithiasis complicated by chronic calculus pyelonephritis in combination with CHD. Clinically significant results of bacteriological urine examinations (CFU≥103) were analyzed. The midstream urine specimen cultivation was performed sectorally on Endo agar. The minimum suppressive concentration of the test antibacterial preparations for each of the detected microorganisms was determined by dilution on a dense Müller–Hinton agar culture medium (BBL, USA). The results were processed using the Shapiro–Wilk, Kolmogorov–Smirnov, and χ2 Pirson criteria. The values of p≤0,05 were considered as statistically significant.Results. Specimen culturing revealed Escherichia coli – 24.8%, Klebsiella pneumoniae – 18.3%, Pseudomanas aeruginosa – 11%. Staphylococcus spp., and Enterococcus spp. were most important among gram-positive pathogens (total 26.6% of cases). The sensitivity of the detected infectious agents to basic antibacterial drugs turned out to be sharply reduced. It is noteworthy that 65% of P. aeruginosa strains were sensitive to meropenem.Conclusion. In patients with recurrent urolithiasis combined with CHD, the proportion of gram-positive coccas was increased on the background of calculous pyelonephritis with a simultaneous decrease in the proportion of poly-resistant gram-negative infectious agents (nosocomial strains of E. coli and K. pneumoniae).Цель: выявить основных возбудителей хронического калькулезного пиелонефрита и определить их антибиотикорезистентность у пациентов с нефролитиазом, сочетающимся с ишемической болезнью сердца (ИБС).Материал и методы. Проведено ретроспективное эпидемиологическое исследование по типу «случай–контроль», в которое вошел 181 пациент в возрасте от 57 до 82 лет, пролеченный в урологическом центре филиала № 1 Главного военного клинического госпиталя им. академика Н.Н. Бурденко в 2014–2019 гг. Все больные длительно страдали мочекаменной болезнью (МКБ), осложненной хроническим калькулезным пиелонефритом, в сочетании с ИБС. Изучены клинически значимые результаты бактериологических анализов мочи (КОЕ≥103). Посев средней порции мочи выполняли секторным методом на агаре Эндо. Минимальную подавляющую концентрацию исследуемых антибактериальных препаратов для каждого из выявленных микроорганизмов определяли методом разведения на плотной питательной среде агара Мюллера–Хинтон (BBL, США). При статистической обработке результатов использовали критерии Шапиро–Уилка, Колмогорова–Смирнова и χ2 Пирсона. Статистически значимыми считали значения р≤0,05.Результаты. При посеве у пациентов выявлены: Escherichia coli – в 24,8% случаев, Klebsiella pneumoniae – в 18,3%, Pseudomanas aeruginosa – в 11%. Среди грамположительных возбудителей наибольшее значение имели Staphylococcus spp. и Enterococcus spp. (суммарно 26,6% случаев). Чувствительность обнаруженных инфекционных агентов к основным антибактериальным препаратам оказалась резко сниженной. Обращает на себя внимание тот факт, что к меропенему чувствительными были 65% штаммов P. aeruginosa.Заключение. У пациентов с рецидивирующей МКБ в сочетании с ИБС на фоне калькулезного пиелонефрита увеличена доля грамположительных кокков с одновременным снижением доли полирезистентных грамотрицательных инфекционных агентов (нозокомиальные штаммы E. coli и K. pneumoniae)

Epidemiological aspects of nephrolithiasis and chronic diseases of the cardiovascular system combination

Purpose of the study. To analyze prevalence and characteristics of the cardiovascular diseases (CVD) in patients with urolithiasis, revealed for the first timeMaterials and methods. In a period between 2009 and 2018, was made a retrospective analysis of medical histories of 2311 patients with urolithiasis, which were treated in in the urology departments of the branch No. 1 of the MCHG named after N.N. Burdenko (n=1487) and GBUZ MO Krasnogorsk City Hospital No. 1 (n=824). In 67,6% of the cases (1562 patients) the diagnosis of urolithiasis was diagnosed for the first time on admission. Isolated urolithiasis was recorded in 676 cases (43,3%), in other 154 cases (9,8%) nephrolithiasis was combined with different variants of cardiovascular diseases (CVD) and diabetes. From 732 respondents with urolithiasis and associated cardiovascular diseases (CVD), were formed 3 groups, in the first group (I) were included patients (n=363) with hypertension and arterial hypertension: the second group (II; n=79) was formed from patients with isolated coronary heart disease. In the third group (III) were included 290 patients which had urolithiasis combined with hypertension, arterial hypertension and coronary heart disease. The stages of hypertension and degree of expression of arterial hypertension were given according to the recommendations of Russian science society of cardiology (2004). Stages of congestive heart failure were defined according to c NYHA (New York Heart Association) classification. Functional class of stable angina was defined according to Canadian Cardiovascular Society classification (1970,1976). The obtained data was analyzed using descriptive statistics methods.Results. Average age of patients was 65,4 +– 3,27; 78% of the patients were men. On an emergency basis were hospitalized 30,9% from group I, 27,6% from group 2, and 31,3% from group III. In group I more often were recorded hypertension I + arterial hypertension I (32,5%) and hypertension II + arterial hypertension II (40,2%). In group II effort angina was recorded in 30 cases (38%). Congestive heart failure occurred among 153 patients (20,9%); most often it occurred among patients from III – in 102 cases (35,2%). In the whole sample, congestive heart failure of I and II degrees prevailed – in 88 (12%) and 57 (7,9%) patients. Kidney stones were found in 59,4% of patients, in the ureters – in 30,9% of patients, in kidneys and in the ureters – in 9,9% of patients. Share of the patients with kidney stones in the shape of corals is 3,4% of the whole sample. Average sizes of kidney stones of the patients with congestive heart failure are 9,2–11,8 mm which is different from the sizes in whole sample – 6,9–9,5 mm.Conclusion. During the observation period, share of the patients with first time revealed urolithiasis, complicated with the cardiovascular diseases (CVD) increased in 1,9 times (16,7 versus 31,7%). Congestive heart failure, which was registered in 20,9% of patients, was charged with I and II degrees. The presence chronic cardiovascular diseases (CVD), especially complicated by congestive heart failure in patients with first time revealed nephrolithiasis, implies changes in the algorithms of metaphylactic of nephrolithiasis (regime of water loads, selection of diuretics and anticoagulants)

Incidence and risk factors for persistent symptoms in adults previously hospitalized for COVID-19

Background: The long-term sequalae of COVID-19 remain poorly characterized. We assessed persistent symptoms in previously hospitalized patients with COVID-19 and assessed potential risk factors. Methods: Data were collected from patients discharged from 4 hospitals in Moscow, Russia between 8 April and 10 July 2020. Participants were interviewed via telephone using an ISARIC Long-term Follow-up Study questionnaire. Results: 2,649 of 4755 (56%) discharged patients were successfully evaluated, at median 218 (IQR 200, 236) days post-discharge. COVID-19 diagnosis was clinical in 1291 and molecular in 1358. Most cases were mild, but 902 (34%) required supplemental oxygen and 68 (2.6%) needed ventilatory support. Median age was 56 years (IQR 46, 66) and 1,353 (51.1%) were women. Persistent symptoms were reported by 1247 (47.1%) participants, with fatigue (21.2%), shortness of breath (14.5%) and forgetfulness (9.1%) the most common symptoms and chronic fatigue (25%) and respiratory (17.2%) the most common symptom categories. Female sex was associated with any persistent symptom category OR 1.83 (95% CI 1.55 to 2.17) with association being strongest for dermatological (3.26, 2.36 to 4.57) symptoms. Asthma and chronic pulmonary disease were not associated with persistent symptoms overall, but asthma was associated with neurological (1.95, 1.25 to 2.98) and mood and behavioural changes (2.02, 1.24 to 3.18), and chronic pulmonary disease was associated with chronic fatigue (1.68, 1.21 to 2.32). Conclusions: Almost half of adults admitted to hospital due to COVID-19 reported persistent symptoms 6 to 8 months after discharge. Fatigue and respiratory symptoms were most common, and female sex was associated with persistent symptoms