«CHEST PAIN» AT PRE-HOSPITAL STAGE

The article is devoted to the questions of differential diagnostics in patients with chest pain at pre-hospital stage of medical care. On the basis of literary data the principle of construction of diagnostic algorithm by the physician for this group of patients is defined. Summarized literary data allowed to reveal the tendency of mutually burdening influence of different pathology, that is accompanied with chest pain, on the pathogenesis of basic disease. The principles of medical care for the patients with chest pain at pre-hospital stage are determined

Condition of entomophilic fauna on Hyssopus officinalis L. crops depending on ecotope conditions

Species diversity and number of potential pollinator species on H. officinalis seed crops in various ecotopes of farm fields were studied under the influence of "Bi-58 new" insecticide treatment and without preliminary treatment. The presence of 16 insect species belonging to four families of the genus Hymenoptera (Megachilida, Apidae, Halictidae and Vespidae), two families of the Diptera row (Syrphidae and Stratiomyidae) and one family of the genus Lepidoptera (Lycaenalidae) has been identified on the seed crops of H. officinalis. The insecticidal treatment in general did not significantly affect the total number of pollinators, but changed the species composition of pollinators and their number on the field area. As much as possible, the decrease in the prevalence and number of the Megachilida species was affecte

Рентгенохирургия ятрогенного повреждения желчных протоков после лапароскопической холецистэктомии (опыт одного центра)

IM OF STUDY To show the possibilities of antegrade X-ray surgical techniques in the treatment of iatrogenic bile duct injuries after videolaparoscopic cholecystectomy.MATERIAL AND METHODS The study included 24 patients with “minor” and 20 patients with “major” (according to Strasberg) iatrogenic injuries of the extrahepatic biliary tract. Antegrade endobiliary intervention was performed in 26 patients, including the “bridge-procedure” variant preceding the reconstructive surgery. Endobiliary drains were maintained during the reconstructive surgery and in the early postoperative period to control the viability of the anastomosis.When a stricture of the biliodigestive anastomosis (BDA) was detected, balloon dilatation of the anastomotic area was performed. In the subgroup of “minor” injuries, external drainage of the subhepatic biloma in 18 people were supplemented with endoscopic papillotomy in 12 cases.RESULTS In all patients with “minor” injuries of the biliary tree, X-ray surgical techniques were effective. In 11 patients with “major” bile duct injuries, cholangiostomy drainage was gradually transformed into external-internal drainage. In 2 trauma cases of classes D and E temporary antegrade stenting of the duct injury area with a coated self-expanding endobiliary stent was performed. The follow-up period after removal of the antegrade frame drainage ranged from 8 months to 14 years. There were no stricture or failure of BDA.CONCLUSION Short-term external biliary drainage, including the use of rendezvous techniques, may be suffi cient to eliminate the failure of the cystic duct stump. Cholangiostomy drainage, temporary endobiliary stent allow preparing the patient for reconstructive intervention. Drainage marking of the damaged area facilitates the verifi cation of tubular structures in the reconstruction area. Preservation of drainage after reconstructive intervention is the prevention of failure of the biliodigestive anastomosis in the early postoperative period, the development of its stricture in the long term.ЦЕЛЬ Показать возможности антеградных рентгенхирургических методик в лечении ятрогенных по­вреждений желчных протоков после видеолапароскопической холецистэктомии.МАТЕРИАЛ И МЕТОДЫ В исследование включены 24 пациента с «малыми» и 20 пациентов с «большими» (по Strasberg) ятрогенными повреждениями внепеченочных желчных путей. Антеградное эндобилиарное вмешательство было выполнено 26 пациентам, в том числе в варианте “bridge-procedure”, предшествовавшем реконструктивной операции. Эндобилиарные дренажи сохранялись во время рекон­структивной операции и в раннем послеоперационном периоде для контроля состоятельности анастомоза. При выявлении стриктуры билиодигестивного анастомоза (БДА) выполняли баллонную дилатацию зоны анастомоза. В подгруппе «малых» повреждений наружное дренирование подпеченочной биломы у 18 человек было дополнено эндоскопической папиллотомией в 12 наблюдениях.РЕЗУЛЬТАТЫ У всех пациентов с «малыми» повреждениями желчного дерева рентгенохирургические методики оказались эффективными. У 11 пациентов с «большими» повреждениями желчных протоков холангиостомический дренаж этапно был трансформирован в наружно-внутренний. В 2 наблюдениях при травме классы D и Е использовали временное антеградное стентирование зоны повреждения протоков покрытым саморасширяющимся эндобилиарным стентом. Сроки наблюдения после удаления антеградного каркасного дренажа составили от 8 месяцев до 14 лет. Стриктуры и несостоятельности БДА отмечено не было.ЗАКЛЮЧЕНИЕ Кратковременное наружное билиарное дренирование, в том числе с применением «рандеву методик», может оказаться достаточным для устранения несостоятельности культи пузырного протока. Холангиостомический дренаж, временный эндобилиарный стент позволяют подготовить пациента к реконструктивному вмешательству. Дренажная маркировка зоны повреждения облегчает верификацию трубчатых структур в области реконструкции. Сохранение дренажа после реконструктивного вмешательства является профилактикой несостоятельности билиодигестивного анастомоза в раннем послеоперационном периоде, развития его стриктуры в отдаленные сроки

Infectious disease testing of UK-bound refugees: a population-based, cross-sectional study

Background: The UK, like a number of other countries, has a refugee resettlement programme. External factors, such as higher prevalence of infectious diseases in the country of origin and circumstances of travel, are likely to increase the infectious disease risk of refugees, but published data is scarce. The International Organization for Migration carries out and collates data on standardised pre-entry health assessments (HA), including testing for infectious diseases, on all UK refugee applicants as part of the resettlement programme. From this data, we report the yield of selected infectious diseases (tuberculosis (TB), HIV, syphilis, hepatitis B and hepatitis C) and key risk factors with the aim of informing public health policy. Methods: We examined a large cohort of refugees (n = 18,418) who underwent a comprehensive pre-entry HA between March 2013 and August 2017. We calculated yields of infectious diseases stratified by nationality and compared these with published (mostly WHO) estimates. We assessed factors associated with case positivity in univariable and multivariable logistic regression analysis. Results: The number of refugees included in the analysis varied by disease (range 8506–9759). Overall yields were notably high for hepatitis B (188 cases; 2.04%, 95% CI 1.77–2.35%), while yields were below 1% for active TB (9 cases; 92 per 100,000, 48–177), HIV (31 cases; 0.4%, 0.3–0.5%), syphilis (23 cases; 0.24%, 0.15–0.36%) and hepatitis C (38 cases; 0.41%, 0.30–0.57%), and varied widely by nationality. In multivariable analysis, sub-Saharan African nationality was a risk factor for several infections (HIV: OR 51.72, 20.67–129.39; syphilis: OR 4.24, 1.21–24.82; hepatitis B: OR 4.37, 2.91–6.41). Hepatitis B (OR 2.23, 1.05–4.76) and hepatitis C (OR 5.19, 1.70–15.88) were associated with history of blood transfusion. Syphilis (OR 3.27, 1.07–9.95) was associated with history of torture, whereas HIV (OR 1521.54, 342.76–6754.23) and hepatitis B (OR 7.65, 2.33–25.18) were associated with sexually transmitted infection. Syphilis was associated with HIV (OR 10.27, 1.30–81.40). Conclusions: Testing refugees in an overseas setting through a systematic HA identified patients with a range of infectious diseases. Our results reflect similar patterns found in other programmes and indicate that the yields for infectious diseases vary by region and nationality. This information may help in designing a more targeted approach to testing, which has already started in the UK programme. Further work is needed to refine how best to identify infections in refugees, taking these factors into account

Analysis of the infectious agent’s structure and antibiotic resistance parameters in patients in intensive care units of a multidisciplinary hospital

Introduction.  Nosocomial infections are a common complication in patients treated in the intensive care unit (ICU). Microorganisms with multidrug resistance are one of the significant risk factors for death in this category of patients. Aim. To study structure of infectious agents in ICU patients and parameters of their antibiotic resistance.  Materials and methods. Retrospective pharmacoepidemiological study of medical records of adult patients with infections diagnosed in ICU who were treated in City Clinical Hospital No. 24 of the Department of Health (Moscow, Russian Federation) in the period 08/20/2022 — 07/31/2023 (n=199). The analysis (gender, age of patients, localization of the infectious process, data on the structure of pathogens and sensitivity to antibacterial drugs) included records with data on bacterial culture ( n=141). Results. In the structure of pathogens detected in ICU patients, gram-negative microflora predominated (54 %). Among the pathogens with a clinically significant growth, leaders were  K. pneumoniae (22 %), Candida spp. (20 %) and  Staphylococcus  spp. (19 %). K. pneumoniae was characterized by resistance to beta-lactams, aminoglycosides, and levofloxacin, the highest susceptibility was reported to colistin, 88.9 %.  Candida  spp. was overwhelmingly susceptible to all drugs used. Among Staphylococ caceae, S. aureus  was the most common (70 % resistance to ampicillin and cefoxitin).  Conclusion.  In the structure of infectious agents detected in ICU patients, a predominance of ESKAPE pathogens (the most prognostically important microorganisms: Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp.) was observed, including K. pneumoniae, S. aureus, A. baumannii, P. aeruginosa.  For all these microorganisms, except for Staphylococcaceae, a high level of antibiotic resistance was demonstrated

Some ways of filling of the vascular bed of domestic animals

In this work the assessment of some methods of filling of the mammals blood channels is presented. As injection masses there were used the gelatine solution of 5%, painted with the ink by Borisevich V.B. technique and the solution consisting of Bustilat-M glue and the water in a proportion of 2:1. The conducted researches showed that the most successful, in terms of simplicity of execution, is filling of vessels with the solution consisting of Bustilat-M glue and water, as it allows with the little effort and with the smallest expenses to fill in both large and average vessel

Biological resources of natural forage grassland of the cretaceous south of the European Russia

The main objective of the made researches was assessment of territorial confinedness of economic and valuable plant species and also a status and productivity of a natural forage grassland within agrolandscapes of the cretaceous South of the European Russia (the territory of the Belgorod region). Biological and vegetable resources of the natural forage grasslands of the East part of the Belgorod region in a subband of the southern forest-steppe were studie

Morphological features of wild boar individuals of semifree content

The article reflects the results of the study of morphological features of wild boars of semi-free content on the basis of their comparison with the corresponding parameters of wild boar

Ecological features of species diversity and pollinator species on m. sativa seed crops

The condition and dynamics of the entomophilic fauna of Medicago sativa L. seeds in the cultivated lands of the Belgorod region were studied, using insecticides and without treatment. The species composition of pests, entomophages and pollinators on seed crops M. sativa is found. 17% of pollinator species have been found to belong to the family Megachilidae. The species density of the entomofauna of potential pollinators after treatment with insecticide decreased by a factor of 2. The Menhinick index is also down on 50%, indicating a decrease in species diversit

Cardiopulmonary Test As A Component in the Diagnostic Algorithm for Heart Failure with Preserved Left Ventricular Ejection Fraction in Patients with Atrial Fibrillation

Background: Patients with heart failure with preserved ejection fraction account for more than half of all hospitalizations because of heart failure. On the other hand, atrial fibrillation and heart failure are quite often diagnosed together and one disease influences the development of the other. Timely and accurate diagnosis of heart failure with preserved ejection fraction is the basis for effective treatment of this category of patients. In 2019, the HFA-PEFF algorithm of diagnosis heart failure with preserved ejection fraction (including patients with atrial fibrillation) was proposed. However, the algorithm implies cardiac catheterization in patients at intermediate risk, which involves certain difficulties and cannot be used in routine practice. As an alternative to cardiac catheterization in the diagnosis of heart failure with preserved ejection fraction, we proposed a noninvasive diagnostic method cardiopulmonary test. However, the value of cardiopulmonary test technique has not been conclusively studied, especially in patients with a combination of chronic heart failure and atrial fibrillation. Aim: The aim of the study was to evaluate the role of the cardiopulmonary test in the diagnosis of heart failure with preserved ejection fraction in patients with atrial fibrillation. Methods: 138 patients with atrial fibrillation were included in our study. Using HFA-PEFF algorithm (algorithm for diagnosis of heart failure with preserved left ventricular ejection fraction) all patients were initially divided into 3 groups: low probability of heart failure 23 patients, intermediate probability 96 and high probability 19 patients. The stress-test allowed to precisely assess of patients at intermediate risk and finally form the groups: Group 1 without heart failure, 85 patients (61.6%); Group 2 patients with heart failure and preserved ejection fraction, 53 patients (38.4%). The next diagnostic stage was cardiopulmonary test. Results: During cardiopulmonary test, the anaerobic exercise threshold was 6.8 and 4.85 METs for the first and second groups, respectively (p 0.001), reflecting lower exercise tolerance in the second group of patients. Analysis of variance (ANOVA) demonstrated a statistically significant increase in pro-BNP levels with a decrease in peak VO2 (p 0.001). Also, analysis of variance demonstrated a significant statistical difference with respect to systolic pulmonary artery pressure in the subgroups with severely, moderately reduced oxygen consumption and in the group with normal peak VO2 (p=0.01). ROC analysis determined a peak VO2 of 20 ml/kg/min, above which the HFA-PEFF algorithm was unlikely to detect heart failure (AUC 0.73; confidence interval 0.650.82; p=0.043; sensitivity 85%; specificity 51%). Conclusion: The cardiopulmonary test is a reliable instrumental non-invasive method in the diagnosis of heart failure with preserved ejection fraction