Hemostasis indices in assessment of rheumatoid arthritis activity

The goal of research was to define the opportunity of using hemostasis system's indices for estimating activity of inflammation process in case of rheumatoid arthritis (RA). The research is based on results of laboratory examination of 104 adults with RA, diagnosed according to criteria of American Rheumatism Association. The estimation of hemostasis system was conducted by certified equipment with using standardized methods and «Technologia-standart» reagents (Russia). It is found that heightened activity of inflammation in RA is followed by the quantity of platelets increase, by the secondary thrombocytopathy, hyperfibrinogenemia, significant thrombinemia. The total activity of fibrinolytic system is decreased without changing of physiological anticoagulant's activity. The determination of fibrinogen level is the most informative test in estimation the activity of inflammation process in RA.Задачей исследования было определить возможность использования показателей системы гемостаза в оценке активности воспалительного процесса при РА. Исследование основано на результатах лабораторного обследования 104 взрослых пациентов с диагнозом «ревматоидный артрит», установленного в соответствии с критериями Американской коллегии ревматологов. Оценку системы гемостаза проводили на сертифицированном оборудовании стандартизованными методами с использованием реагентов фирмы «Технология-стандарт», Россия. В результате анализа полученных данных выявлено, что повышение активности воспалительного процесса при РА сопровождается увеличением количества тромбоцитов, вторичной тромбоцитопатией, гиперфибриногенемией, значительной тромбинемией, снижением суммарной активности фибринолитической системы без изменения активности физиологических антикоагулянтов. Наиболее информативным тестом в оценке активности процесса при РА является определение уровня фибриногена

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Оценка специфического Т-клеточного иммунитета у переболевших и вакцинированных против COVID-19

Introduction. In the context of a pandemic of a new coronavirus infection (COVID-19), research on the peculiarities of the formation of an immune response to SARS-CoV-2 in patients who have been ill and vaccinated is of particular relevance. However, most studies are currently devoted to evaluating only the humoral link of immunity, and its cellular component remains insufficiently studied.The aim of the study was to evaluate the features of the formation and changes of the T-cell link of immunity in patients with a new coronavirus infection and vaccinated against this disease.Materials and methods. The study was performed on the basis of the clinical and diagnostic laboratory of the European Medical Center “UMMC-Health “LLC. Specific T-cell immunity was evaluated using ELISPOT technology. In the course of the study, 72 blood samples of employees of medical organizations were analyzed, including 26 from those who had a new coronavirus infection, 23 from persons who were intact according to COVID-19 before vaccination and 23 from the same employees after vaccination («Gam-CovidVac»).In addition, each of the study participants was examined to determine specific class G antibodies (IgG) by solid-phase enzyme immunoassay using SARS-CoV-2-IgG-ELISA-BEST test systems (manufactured by VECTOR-BEST JSC).Results and discussion. In the group of patients (26 people), T-lymphocytes capable of specifically reacting to SARSCoV-2 antigens were detected in 100% of cases, even in individuals with IgG elimination. It should be noted that the response was more pronounced when meeting with M-and N-pepdids, compared with S-protein.22 out of 23 COVID-19 intact individuals had no T-cell immunity to coronavirus infection before vaccination, but one employee had a response to 3 proteins-M, N, S, which indicates that he had previously encountered the SARS-CoV-2 virus. After vaccination with the drug “Gam-Covid-Vac”, 22 (95.6%) employees revealed a T-cell response, while 21-only to S-protein, and an employee with a previously detected immune response-after vaccination, the response to M -, Nproteins remained almost at the same level, and the cellular response to S-peptide doubled.Conclusion. Thus, based on the results of the study, important materials were obtained on the peculiarities of the formation of a specific T-cell immune response to a new coronavirus infection. The obtained data provide a broader understanding of the immune response in new coronavirus infection in patients who have been ill and vaccinated and can be used in the future when planning preventive and antiepidemic measures.Введение. В условиях пандемии новой коронавирусной инфекции (COVID-19) особую актуальность приобретают исследования по изучению особенностей формирования иммунного ответа к SARS-CoV-2 у переболевших и вакцинированных. Однако большинство исследований в настоящее время посвящены оценке лишь гуморального звена иммунитета, а его клеточный компонент остается недостаточно изученным.Цель – оценить особенности формирования и изменений Т-клеточного звена иммунитета у переболевших новой коронавирусной инфекцией и вакцинированных против этого заболевания.Материалы и методы. Исследование выполнено на базе клинико-диагностической лаборатории Европейского медицинского центра «УГМК-Здоровье». Оценку специфического Т-клеточного иммунитета проводили с использованием технологии ELISPOT. В процессе исследования был проведен анализ 72 образцов крови сотрудников медицинских организаций, в том числе 26 – от переболевших новой коронавирусной инфекцией, 23 – от интактных по COVID-19 лиц перед вакцинацией и 23 – от тех же сотрудников после прививки («Гам-КовидВак»).Помимо этого, каждый из участников исследования проходил обследование для определения специфических антител класса G (IgG) методом твердофазного иммуноферментного анализа с использованием тестсистем SARS-CoV-2-IgG-ИФА-БЕСТ (производитель АО «ВЕКТОР-БЕСТ»).Результаты и обсуждение. В группе переболевших лиц (26 чел.) Т-лимфоциты, способные специфически реагировать на антигены SARS-CoV-2, были выявлены в 100% случаев, даже у лиц с элиминацией IgG. Необходимо отметить, что более выраженный ответ был при встрече с М- и N-пепдидами, по сравнению с S-белком.У 22 из 23 интактных по COVID-19 лиц до вакцинации Т-клеточный иммунитет к коронавирусной инфекции отсутствовал, однако у одного сотрудника установлен ответ на 3 белка – M, N, S, что свидетельствует о том, что он ранее уже встречался с вирусом SARSCoV-2. После вакцинации препаратом «Гам-Ковид-Вак» у 22 (95,6%) сотрудников выявлен Т-клеточный ответ, при этом у 21 – только на S-белок, а у сотрудника с ранее выявленным иммунным ответом – после прививки сохранился ответ на M-, N-белки практически на том же уровне, а клеточный ответ на S-пептид увеличился вдвое.Заключение. Таким образом, по итогам проведенного исследования получены важные материалы по особенностям формирования специфического Т-клеточного иммунного ответа к новой коронавирусной инфекции. Полученные данные дают более широкое представление об иммунном ответе при новой коронавирусной инфекции у переболевших и вакцинированных и могут быть использованы в перспективе при планировании профилактических и противоэпидемических мероприятий

Screening policies, preventive measures and in-hospital infection of COVID-19 in global surgical practices

Background: In a surgical setting, COVID-19 patients may trigger in-hospital outbreaks and have worse postoperative outcomes. Despite these risks, there have been no consistent statements on surgical guidelines regarding the perioperative screening or management of COVID-19 patients, and we do not have objective global data that describe the current conditions surrounding this issue. This study aimed to clarify the current global surgical practice including COVID-19 screening, preventive measures and in-hospital infection under the COVID-19 pandemic, and to clarify the international gaps on infection control policies among countries worldwide. Methods: During April 2-8, 2020, a cross-sectional online survey on surgical practice was distributed to surgeons worldwide through international surgical societies, social media and personal contacts. Main outcome and measures included preventive measures and screening policies of COVID-19 in surgical practice and centers' experiences of in-hospital COVID-19 infection. Data were analyzed by country's cumulative deaths number by April 8, 2020 (high risk, >5000; intermediate risk, 100-5000; low risk, <100). Results: A total of 936 centers in 71 countries responded to the survey (high risk, 330 centers; intermediate risk, 242 centers; low risk, 364 centers). In the majority (71.9%) of the centers, local guidelines recommended preoperative testing based on symptoms or suspicious radiologic findings. Universal testing for every surgical patient was recommended in only 18.4% of the centers. In-hospital COVID-19 infection was reported from 31.5% of the centers, with higher rates in higher risk countries (high risk, 53.6%; intermediate risk, 26.4%; low risk, 14.8%; P < 0.001). Of the 295 centers that experienced in-hospital COVID-19 infection, 122 (41.4%) failed to trace it and 58 (19.7%) reported the infection originating from asymptomatic patients/staff members. Higher risk countries adopted more preventive measures including universal testing, routine testing of hospital staff and use of dedicated personal protective equipment in operation theatres, but there were remarkable discrepancies across the countries. Conclusions: This large international survey captured the global surgical practice under the COVID-19 pandemic and highlighted the insufficient preoperative screening of COVID-19 in the current surgical practice. More intensive screening programs will be necessary particularly in severely affected countries/institutions

Screening policies, preventive measures and in-hospital infection of COVID-19 in global surgical practices

Background In a surgical setting, COVID-19 patients may trigger in-hospital outbreaks and have worse postoperative outcomes. Despite these risks, there have been no consistent statements on surgical guidelines regarding the perioperative screening or management of COVID-19 patients, and we do not have objective global data that describe the current conditions surrounding this issue. This study aimed to clarify the current global surgical practice including COVID-19 screening, preventive measures and in-hospital infection under the COVID-19 pandemic, and to clarify the international gaps on infection control policies among countries worldwide.Methods During April 2-8, 2020, a cross-sectional online survey on surgical practice was distributed to surgeons worldwide through international surgical societies, social media and personal contacts. Main outcome and measures included preventive measures and screening policies of COVID-19 in surgical practice and centers' experiences of in-hospital COVID-19 infection. Data were analyzed by country's cumulative deaths number by April 8, 2020 (high risk, >5000; intermediate risk, 100-5000; low risk, <100).Results A total of 936 centers in 71 countries responded to the survey (high risk, 330 centers; intermediate risk, 242 centers; low risk, 364 centers). In the majority (71.9%) of the centers, local guidelines recommended preoperative testing based on symptoms or suspicious radiologic findings. Universal testing for every surgical patient was recommended in only 18.4% of the centers. In-hospital COVID-19 infection was reported from 31.5% of the centers, with higher rates in higher risk countries (high risk, 53.6%; intermediate risk, 26.4%; low risk, 14.8%; P<0.001). Of the 295 centers that experienced in-hospital COVID-19 infection, 122 (41.4%) failed to trace it and 58 (19.7%) reported the infection originating from asymptomatic patients/staff members. Higher risk countries adopted more preventive measures including universal testing, routine testing of hospital staff and use of dedicated personal protective equipment in operation theatres, but there were remarkable discrepancies across the countries.Conclusions This large international survey captured the global surgical practice under the COVID-19 pandemic and highlighted the insufficient preoperative screening of COVID-19 in the current surgical practice. More intensive screening programs will be necessary particularly in severely affected countries/institutions

Impact of asymptomatic COVID-19 patients in global surgical practice during the COVID-19 pandemic.

CorrespondenceImpact of asymptomatic COVID-19patients in global surgical practiceduring the COVID-19 pandemi