Infective endocarditis and COVID-19: the impact of SARS-CoV-2 infection on diagnostics, course, and prognosis

Aim. To study the impact of coronavirus disease 2019 (COVID-19) pandemic on hospitalization rates, diagnosis, and outcomes of infective endocarditis (IE) with a subanalysis of IE course in combination with COVID-19.Material and methods. This prospective cohort study included 168 patients with definite or probable IE (DUKE 2015) hospitalized in the V.V. Vinogradov City Clinical Hospital from July 2017 to July 2022. All patients underwent a conventional examination in accordance with current clinical guidelines. We studied clinical, paraclinical and etiological parameters, as well as outcomes.Two clinical observations of the combination of IE and COVID-19 are presented.Results. When assessing the local registry of patients with IE, a trend towards an increase in hospitalizations rate of IE in 2021-2022 was shown, with a decrease during the period of long-term lockdowns in Moscow and a subsequent surge after their cancellation. Patients with IE during the COVID-19 pandemic had a more favorable clinical profile, a 2-fold increase in IE diagnosis (due to late hospitalization), frequent detection of Staphylococcus aureus MSSA (32,6%), and frequent surgical treatment (up to 87,6% with a combination of IE and COVID-19), as well as high in-hospital mortality, but without a tendency to increase (30,4%). Clinical observations of IE and COVID-19 combination are presented, which demonstrates the contribution of COVID-19 as the only risk factor for native tricuspid valve IE in a patient without predisposing causes, as well as a factor in the unfavorable prognosis for native aortic valve IE after the addition of COVID-19, which led to lethal outcome.Conclusion. The present study demonstrates the profile of patients with IE and COVID-19 depending on the epidemiological situation of COVID-19 and the association with SARS-CoV-2 infection. The data obtained make it possible to discuss the potential relationship between COVID-19 and IE. The "endocarditis team" determines the timely implementation of surgery and the absence of an increase in inhospital mortality, regardless of the epidemiological situation

Clinical and diagnostic value of including PCR blood test in the traditional algorithm for identifying causative agents of infective endocarditis: a cohort study of 124 patients

Background. If infective endocarditis (IE) is suspected, the determination of the etiology is of fundamental importance for the verification of the disease and the appointment of effective therapy. Microbiological diagnostic features are important, but they often need to be supplemented by culture-independent studies of pathological agents. Aim. To investigate of the diagnostic advantage and value of quantitative analysis of molecular biological methods (polymerase chain reaction PCR, sequencing) in addition to microbiological examination of whole venous blood in IE. Materials and methods. We examined 124 patients with suspected or significant IE (DUKE 2015) hospitalized in the Vinogradov City Clinical Hospital (20152021). All patients underwent parallel microbiological (cultural) and molecular biological (PCR or PCR followed by sequencing) examination of venous whole blood samples. Results. The introduction of an early parallel PCR study into the algorithm for the etiological diagnosis of IE made it possible to obtain an additional advantage in 43/124 (34.7%) patients, which made it possible to exclude unreliable results in the determination of CoNS skin commensals and pathogens atypical for IE or contamination and identify the true pathogens, and also for the first time to isolate the etiopathogenetic pathogen with a negative microbiological study. It was shown that in IE associated with CoNS, the association with the disease was confirmed by PCR in 21.4% (3/14) and refuted in 71.4% (10/14). The coincidence of the results of microbiological and PCR studies of blood samples was obtained only in 35/95 (36.8%). Positive results of PCR analysis of blood of biological material with negative results of culture were obtained in 22/51 (43.1%), of which 2/22 (9.0%) were able to confirm the presence of Bartonella spp DNA. The presented complex algorithm made it possible to significantly increase the possibility of intravital identification of the pathogen in the blood from 58.9 to 76.6%. IE with unknown etiology was present in 29/124 (23.4%) patients. A parallel PCR study allowed timely correction of antibiotic therapy in 43/124 (34.7%) patients. Conclusion. Expansion of indications for the use of PCR studies, primarily whole venous blood samples, is justified, not only in IE with negative results of microbiological examination, but also as a control method for the reliability of the results of traditional (cultural) diagnostic methods

Association of Heart Rate Variability with the Psychosocial Stress Level in Men 41-44 Years Old Living in Moscow

Aim. Research of the association of heart rate variability (HRV) with the level of psychosocial stress (PS) and other indicators of the risk of cardiovascular diseases in a sample of 41-44-year-old men living in Moscow.Material and methods. A total of 299 men aged 41-44 years were examined. The study included a clinical examination and a survey using a standard questionnaire. The categorization of risk factors (RF) for cardiovascular diseases (CVD) was carried out in accordance with generally accepted criteria The psychosocial stress was assessed using the Reeder scale. Depending on the psychosocial stress level, all surveyed men were divided into 3 groups by terciles: group 1 (3,28-4,0 points) – mild stress, group 2 (2,71-3,14) – moderate stress, group 3 (1,28-2,57) – severe stress. The analysis of HRV was performed on the basis of a short recording of an electrocardiogram using the original software package.Results. Nonparametric ANOVA showed that the mean [M (95% CI)] values of the HRV time domain (SDNN, rMSSD and the state of regulatory reserves) were lower in the group of men with high PS compared with the group with low PS [25.3 ms (20.9-29.7) versus 40.5 ms (30.7-50.3), p=0.007; 29.5 ms (24.6-34.3) versus 49.5 ms (36.7-62.3), p=0.030; and 46.7 (44.7-48.6) versus 49.7 (48.1-51.4), p=0.019; respectively]. On the contrary, the mean values [M (95% CI)] of the integral indicators of HRV (SI and IVR) were higher in the group of men with high PS [635.8 c.u. (556.2-715.4) versus 488.9 (423.8-554.1), p=0.005; 1172.6 (1045.1-1300.1) versus 904.7 (790.0-1019.4), p=0.003; respectively]. The results of correlation and multiple regression analysis confirmed that these HRV indicators are statistically significantly associated not only with PS, but also with other indicators (age, waist / hip ratio, diastolic blood pressure). However, their predictive value turned out to be low, and the proportion of the explained variance of HRV indices ranged from 2.5 to 13.1%.Conclusion. The weakening of the autonomous regulation of the heart rate with a decrease in the activity of the parasympathetic link, the activation of the central circuit of regulation with the prevalence of sympathetic influences, a decrease in the functional reserves of the heart rate regulation system are associated with an increase in the level of PS and other indicators of the risk of cardiovascular diseases

Retrospective Analysis of Enterovirus Infection Morbidity Rate in the Territory of the Amur Region and Peculiarities of Epidemic Process in the Period of Large-Scale Flood

There has been observed a tendency to increment of enterovirus morbidity rate over the past seven years. Foci of this infection have been formed in the area from time to time, with minor forms of the disease being predominant in clinical findings. Genetically enteroviruses circulating in the Amur Region have been characterized as homogenous; however there is a genetic relation among them with and, consequently, epidemiologic connection to enteroviruses originated from China. However, since May, 2013 there has been detected a boost activation of epidemic process as regards enteroviral infection, followed by the formation of two major foci with clustered infection, due to importation from Thailand as well. Emergency situation under conditions of flood (August-September, 2013) has contributed to aggravation of epidemiological situation on enteroviral infection. It has led to the increase in numbers of the exposed up to the maximum level for the past few years. In the territory of the temporal accommodation sites, where affected by high water and exposed to the infection population was placed, registered have been the cases of clustered enterovirus infection

Розробка методики якісного аналізу грициків звичайних трави для включення у проект національної монографії до державної фармакопеї України

Грициків трава описана у ДФ СРСР ХІ видання, Британській трав’яній фармакопеї (BHP,1996 «Shepherd´s Purse»), Французькій фармакопеї (Pharmacopee Francaise, 1998 «Bourse A Pasteur») та Німецькому фармацевтичному кодексі (Монографія DAC 2004 «Hirtentäschelkraut»). Раніше повідомлялося, що у ДФ СРСР ХІ видання відсутні сучасні методи ідентифікації біологічно активних речовин трави грициків звичайних, а наводиться ідентифікація лише за зовнішніми та мікроскопічними діагностичними ознаками. Розробка методик ідентифікації грициків звичайних трави методом ТШХ, гармонізованих з вимогами ДФУ до ЛРС для включення до проекту національної монографії «Грициків звичайних трава». Для досягнення поставленої мети використовували уніфіковані методики аналізу фенольних сполук та амінокислот методом ТШХ, які описані в монографіях Державної фармакопеї України. Виходячи із хімічного складу, застосування у медицині та підходів до стандартизації, для ідентифікацій методом ТШХ обрані такі класи сполук: флавоноїди, гідроксикорічні кислоти та амінокислоти. Розробку методик проводили сумісно з їх валідацією відповідно до вимог загальної статті ДФУ. Обґрунтована передумова розробки розділу «Ідентифікація» для включення у ДФУ монографії «Грициків трава». Розроблено методики ідентифікації флавоноїдів сумісно з гідроксикоричними кислотами, а також амінокислот за допомогою метода ТШХ. Проведено аналіз різних зразків трави грициків звичайних методом ТСХ в умовах розроблених методик. Підтверджено можливість включення розділів «Ідентифікація С» ідентифікація флавоноїдів та «Ідентифікація D» ідентифікація амінокислот у проект національної монографії «Грициків трава» методом ТШХ за розробленими методикамиShepherd’s purse herb is described in the State Pharmacopoeia of the USSR XI edition, the British Pharmacopoeia (BHP, 1996 «Shepherd´s Purse»), French Pharmacopoeia (Pharmacopee Francaise, 1998 «Bourse A Pasteur»), and German Pharmaceutical Codex (DAC Monograph 2004 «Hirtentäschelkraut»). Previously, it was reported that the modern methods for identification of biologically active compounds of Shepherd’s purse herb were absent in the State Pharmacopoeia of the USSR XI edition, but identification was carried out by external and microscopic diagnostic features. Development of methods, harmonized with the SPhU requirements to herbal material, for identification of Shepherd’s purse herb using TLC method, for implementation to the Draft national Monograph “Shepherd’s purse herb”. To achieve the mentioned goal, standardized methods of analysis of phenol compounds and amino acids by TLC method, described in the State Pharmacopoeia of Ukraine monographs, were used. Concerning chemical composition, medicinal use, and approaches to standardization, the following classes of compounds were selected for TLC identification: flavonoids, hydroxycinnamic acids, and amino acids. Development of the methods was carried out together with their validation according to the SPhU general article requirements. Premise for “Identification” partition development for implementation to the SPhU Monograph “Shepherd’s purse herb” was substantiated. TLC methods for identification of flavonoids together with both hydroxycinnamic acids and amino acids, were developed. The analysis of different samples of Shepherd’s purse herb was carried out under the developed methods conditions. The possibility of including of “Identification C” flavonoids identification and “Identification D” amino acids identification into the Draft national Monograph “Shepherd’s purse herb” using TLC by the developed methods was confirme

Multiannual Analysis of Epidemiological Process Manifestations as Regards Enteroviral Infection in the Khabarovsk Territory, and the Key Factors that Predetermine Aggravation of Epidemiological Situation under the Terms of Flood

Carried out has been retrospective analysis of epidemiological process manifestations as regards enteroviral infection in the Khabarovsk Region over the period of 7 years, prior to rainfall floods in 2013. Revealed is the possibility of aggravation of epidemiological situation during hydrological emergency situation. The premises are as follows: persistent due to specific climate conditions prevalent in the Khabarovsk Territory (high air and surface water temperatures, and high humidity rates) unfavorable epidemiological situation on enteroviral infections, virus-carriage in “healthy” people and extensive dissemination of enteroviruses in the water bodies of ambient environment. Moreover, widespread circulation of different enterovirus genotypes, including the isolates with high genetic similarity to the strains identified earlier in the adjoining People’s Republic of China, takes place

МРТ В ДИАГНОСТИКЕ И ОЦЕНКЕ ЭФФЕКТИВНОСТИ ЛЕЧЕНИЯ САРКОМ МЯГКИХ ТКАНЕЙ (ОБЗОР ЛИТЕРАТУРЫ)

The review presents the diagnostic value of magnetic resonance imaging (MRI) in the diagnosis of soft tissue sarcoma in the pre-hospital period and during combined modality treatment was studied. Findings of using MRI in the assessment of local tumor extent and diffusion-weighted MRI and dynamic contrast-enhanced MRI in the estimation of the effectiveness of preoperative treatment were presented.В обзоре литературы представлены данные о современных возможностях магнитно-резонансной томографии (МРТ) в комплексной диагностике сарком мягких тканей на догоспитальном этапе и на этапах комбинированного лечения. Представлены результаты использования МРТ в оценке местного распространения опухоли, а также диагностических возможностях диффузионно-взвешенной МРТ и МРТ с динамическим контрастированием в оценке эффективности предоперационного лечения

Sanitary-Hygienic and Microbiological Monitoring over the Water Supply Sources and Surface Water Reservoirs during Natural Disaster in the Amur-River Territory

Emergency situation in summer 2013 due to flooding of extensive areas of the Russian Amur-River territories (including residential areas with different level of development of public services and amenities, agricultural land, sites of cattle grazing and stock-keeping) resulted in the increased microbiological, virologic and physical-chemical load upon water reservoir ecosystems. The results of monitoring over water supply sources, quality of drinking water and surface reservoir waters in the devastated territories were analyzed by the specialists from Rospotrebnadzor and specialized anti-epidemic teams No. 1 and 2. Complex approach presuming increase in extent and frequency of the examinations, performance of operative epidemiological analysis along with daily adequation of preventive and anti-epidemic measures allowed for taking control over the situation and to avoid epidemic complications as regards acute water-borne intestinal infections

Epidemiological Characteristics of Enterovirus Infection in the Khabarovsk Territory under Hydrologic Emergency Situation

The paper contains the data on the role of high waters (2013) in changing epidemiological situation on enterovirus infections in the Khabarovsk Territory. The incidence rate in the region was characterized by the significant increase even before the flood, 2013. Thus, two peaks of enterovirus morbidity curve were identified for the period of a week: one - more intensive, another - coincident with flood outbreak. Enterovirus epidemiological process was notified by the changes in clinical picture among the infected population and cohort age-related structure. The percentage of the patients with enterovirus infections in the foci clusters and the index of people infected due to possible exposure to shattering impact of the flood, turned out to be low. However, revealed was high rate of heterogeneity of the circulating enterovirus strains, non-specific for the Khabarovsk territory and mostly originating from countries of Asia-Pacific region - coxsackie A viruses, which might stand for a possible cause of unfavorable epidemiological situation in 2013