Infusion rate assessment at a pre-hospital stage in hemorrhaging shock

The article deals with fundamental formulas for infusion rate assessment as well as usage features of tranexamic acid at a pre-hospital stage.В статье рассмотрены основные формулы для расчета скорости инфузии, а также особенности использования транексамовой кислоты на догоспитальном этап

Протективные технологии современных методов респираторной поддержки в неонатальной практике

The article  presents  an analysis of literature data  on modern  protective regimens  for invasive respiratory support  in premature newborns  with respiratory distress  syndrome. We have considered positive and negative  aspects of the used methods  of invasive ventilation of the lungs, which are currently widely used as a method  of respiratory therapy  in obstetric hospitals  at any level, even in the category  of children  with extremely and very low birth weight. Modern  protective mechanical ventilation provides for 2 main directions for reducing ventilator-induced lung damage: a decrease in tidal volume (Vt) and the principle  of tolerable  (permissive) hypercapnia. The use of the technique of permissive hypercapnia and regimens with a target volume can reduce the likelihood of ventilator-induced lung injury in newborns. Despite the limited indications for mechanical ventilation in modern neonatology and the widespread use of non-invasive ventilation, for patients who really need mechanical ventilation, the use of volume-targeted regimens offers the best chance of reducing  ventilation complications.Представлен анализ литературы по применению современных протективных режимов инвазивной респираторной поддержки недоношенных новорожденных с респираторным дистресс-синдромом. Рассмотрены положительные и отрицательные стороны используемых методов инвазивной вентиляции легких, которые в настоящее время нашли широкое применение в качестве метода респираторной терапии в акушерских стационарах любого уровня, в том числе у категории детей с экстремально и очень низкой массой тела при рождении. Современная протективная ИВЛ предусматривает два основных направления снижения вентилятор-индуцированного повреждения легких: уменьшение дыхательного  объема (Vt) и принцип  допустимой  (пермиссивной) гиперкапнии. Применение методики  пермиссивной гиперкапнии и режимов с целевым объемом позволяет  снизить вероятность вентилятор-индуцированного повреждения легких у новорожденных детей. Несмотря на ограничение показаний к ИВЛ в современной неонатологии и широкому применению неинвазивной вентиляции, для пациентов, действительно нуждающихся в ИВЛ, применение режимов с целевым объемом дает лучшие шансы на уменьшение осложнений вентиляции

Search for socioanamnestic factors influencing the choice of a COVID-19 vaccine

The aim of the study - to determine the influence of socio-anamnestic factors of patients on the choice of a vaccine against COVID-19 of domestic or foreign production.Цель исследования - определить влияние социоанамнестических факторов пациентов на выбор вакцины от COVID-19 отечественного или зарубежного производств

Comparative efficacy and safety of mycophenolate mofetil and azathioprine in combination with corticosteroids in the treatment of lymphocytic myocarditis

Aim. To study the efficacy and safety of mycophenolate mofetil (MM) in combination with corticosteroids in the treatment of lymphocytic myocarditis in comparison with a standard combination of corticosteroids and azathioprine.Material and methods. The study included 46 patients aged 18 years and older with severe and moderate lymphocytic myocarditis (men, 34; women 12; mean age, 53,5±13,0 years). The diagnosis was verified using endomyocardial biopsy. Symptom duration averaged 9,5 [4; 20.25] months. All patients had class 3 [2,75; 3] heart failure (HF). The main group included 29 patients who received MM 2 g/day, including six patients — instead of azathioprine, which was canceled due to cytopenia (n=3) or insufficient effect (n=3). The comparison group included 17 patients who received azathioprine 150 [100; 150] mg/day. Patients of both groups also received methylprednisolone at a starting dose of 24 [24; 32] and 24 [24; 24] mg/day and standard HF therapy. In 7/2 patients, the parvovirus B19 genome was detected in the myocardium. In all cases, an increase in anticardiac antibody titers was evidence of immune activity. The average follow-up period was 24 [12; 54] months (at least 6 months).Results. The groups were completely comparable in age, initial characteristics and standard drug therapy. In both groups, a comparable significant increase in the ejection fraction (EF) was noted as follows: from 31,2±7,6 to 44,7±8,3% and from 29±9,1 to 46±11,9% (p<0,001). An excellent response to treatment (an increase in EF by 10% or more) was noted in 68,2% and 66,7% of patients, a good response (by 9-5%) — in 27,3% and 14,3%, a poor response (an increase in less than 5% or a decrease in EF) — in 4,5% and 19,0%, respectively. In both groups, we noted the same significant (p<0,01) decrease in pulmonary artery systolic pressure (36,3±12 to 28,1±6,1 mm Hg in the MM group and from 44,1±8,5 to 30,7±12,1 mm Hg in the azathioprine group), left ventricular (LV) end-diastolic dimension (from 6,4±0,6 to 6±0,7 cm and from 6,2±0,5 to 5,8±0,6 cm), LV end-diastolic volume (from 188,7±55,2 to 178,8±57,1 ml and from 167,8±47,5 to 163,3±61,8 ml), LV end-systolic volume (from 130,3±44,1 to 98,4±32 ml and from 118,1±39 to 94,1±46 ml), left atrial volume (from 98,3±30,3 to 86,7±32,6 ml and from 105±27,4 to 91,2±47,3 ml, p<0,05), as well as mitral regurgitation grade. The incidence of deaths was 2 (6,9%) and 2 (8,7%), transplantation — 1 (3,4%) and 1 (4,3%) patients, death+transplantation end point — 3 (10,3%) and 2 (11,8%) without significant differences between the groups. The presence of the parvovirus B19 genome did not affect the results of treatment. The incidence of infectious complications was comparable in both groups (in one case, MM was completely canceled), no new cytopenia cases were noted during the follow-up period.Conclusion. In patients with moderate and severe virus-negative (except for parvovirus B19) lymphocytic myocarditis, the combination of moderate-dose corticosteroids with mycophenolate mofetil 2 g/day is at least no less effective than the standard regimen of immunosuppressive therapy. There was a tendency towards a more pronounced decrease in anticardiac antibody titers in combination with better tolerance (no cases of cytopenia) in MM group. MM in combination with corticosteroids can be recommended as an alternative treatment regimen for lymphocytic myocarditis

The study of a professional syndrome of emotional burnout in emergency medical specialists

The aim of the study - to identify the level of formation of emotional burnout in doctors and paramedics of emergency medical care of Yekaterinburg and the Sverdlovsk region during the COVID-19 pandemic.Цель исследования – выявить уровень сформированности СЭВ у врачей и фельдшеров скорой медицинской помощи (далее – СМП) г. Екатеринбурга и Свердловской области в период пандемии COVID-19

MULTISPIRAL COMPUTED TOMOGRAPHY VERSUS MYOCARDIAL BIOPSY IN DIAGNOSTICS OF YOCARDITIS AND PROGNOSIS EVALUATION OF DILATION CARDIOMYOPATHY SYNDROME

Aim. To study the role of contrast-enhanced multispiral computed tomography (MSCT) of the heart in diagnostics of myocarditis in patients with the syndrome of dilation cardiomyopathy (DCMP) comparing to morphological investigation of myocardium.Material and methods. Into the main group of study, 127 patients included (92 males, 46,9±11,8 y.o.) with DCMP syndrome (mean end diastolic size (EDS) of the left ventricle (LV) 6,6±0,8 cm, mean ejection fraction (EF) 29,7±9,5%, 3 [2; 3] FC by NYHA). All underwent 320-slice MSCT of the heart with i.v. contrast, 50 underwent morphological investigation of myocardium (endomyocardial byopsy in 30, intraoperational in 7, autopsy in 9, explanted heart study in 4). Also, viral infection markers were studied, as the level of anticardiac antibodies, EchoCG (all patients), scintigraphy (n=42), magnete-resonance tomography (MRI) (n=21), coronary arteriography (CAG, n=48). Comparison group included 18 patients (12 males, 69,2±8,5 y.o.) with coronary atherosclerosis (stenosis form 40%) by MSCT and absence of DCMP criteria (mean EDS LV 4,7±0,5 cm, mean EF LV 59,3±4,9%, 0 [0; 2] FC by NYHA).Results. By the data from complex investigation, myocarditis as the main cause of DCMP syndrome was diagnosed in 79 (62,2%) patients of the main group, its comorbidity with genetic cardiomyopathies — in 19 else (15%). In MSCT of the heart the areas of lower accumulation were found in 4 patients from main group (3,1%, type 1 by the proposed evaluation score), delayed accumulation of the contrast in myocardium — in 72 (56,7%) patients: in 12 subendocardial (type 2), in 4 intramyocardial (type 3), in 44 subepicardial (type 4), in 12 transmural (type 5); in 51 patient there was no delayed accumulation. Sensitivity and specificity of all types of delayed accumulation in diagnostics of myocarditis were 63,3% and 78,7%, positive and negative predictive value 86,1% and 50,7%, subepicardial and transmural types — 49,0%, 83,0%, 85,7%, 43,8%, respectively. While comparing the data of MSCT directly with morphological study of myocardium, diagnostic significance of all types of delayed accumulation in myocarditis revealing was 66,7%, 84,6%, 87,5%, 61,1%, subepicardial and transmural types — 52,4%, 92,3%, 91,7%, 54,5%, respectively.By MSCT in the main group also the non-compaction myocardium was found (n=29, 22,8%), coronary atherosclerosis (n=33, 26,0%), confirmed by CAG in 16 patients. Presence/absence of delayed accumulation by our proposed score correlated with 1) diagnostical signs: duration of illness (r=-0,185, p<0,05), acute onset (r=0,196, p<0,05), connection of onset and infection (r=0,332, p<0,001); 2) functional signs as the class of heart failure (r=0,183, p<0,05), VTI (r=-0,303; р<0,05); 3) mortality rate (r=0,176, p<0,05).Conclusion. MSCT with the evaluation of delayed contrast accumulation (and synchronic CT-angiography of coronary arteries) can be used for non-invasive diagnostics of myocarditis in patients with DCMP syndrome, including if MRI contraindicated. Delayed accumulation of contrast in myocardium correlates with myocarditis presence, the grade of functional disorder and prognosis