Management of patent ductus arteriosus in premature infants.

Closure of hemodynamically significant patent ductus arterios (HSPDA)  is one of the most important questions in modern neonatal intensive care, especially for preterm babies. Long-term functioning of the hemodynamically significant  arterial duct leads to a large number of complications in premature babies, such as: bronchopulmonary dysplasia, periventricular leucomalacia, intraventricular hemorrhage, retinopathy of the premature. To prevent all these complications, the PDA should be closed pharmacologically or surgically as soon as possible without any hesitation. COX inhibitors are commonly used nowa days. Ibuprofen and indomethacin show the equal efficacy and no significant adverse events. But some patients still need surgical treatment. The aim of the study was to determine the feasibility, effectiveness and safety of using various volumes of infusion in combination with COX inhibitors and to determine its effect on the timing of the closure of PDA. 91 premature infants with a gestational age of 26-31 weeks with manifestations of respiratory distress syndrome and НSPDA were studied retrospectively. Premies were divided into 2 groups. Research groups were representative as to gestational age, gender, and weight (1205.0±435.0 g). Therapy for PDA closure included the use of various volumes of restrictive or liberal infusion therapy (from 50 to 100 ml/kg/day) and COX inhibitors (indomethacin, ibuprofen). The volume of infusion therapy was limited in the first group. Preemies received 53.5±6.4 ml/kg/day on DOL1 and 2. From the third day urine excretion increased and the volume of infusion therapy also raised to 63.6±5.6 ml/kg/day, and on day 5 – to 89.7±6.8 ml/kg/day. In the second group there was no strict limitation of the volume of infusion therapy (especially in the first 5 days). Delayed period of PDA closure (on average from 14.55±0.56 DOL) was associated with absence of limitation of the infusion volume. In the first group, volume of infusion therapy was restricted in the first 5 days, and the closure of the ductus arteriosus occurred extremely early (on 2.35±0.48 DOL). COX inhibitors were prescribed according to the standard scheme: in the first 3 days indomethacin was administered orally in doses of 0.2/0.1/0.1 mg/kg/day. If the premature baby had symptoms of intestinal paresis ( this restricted oral administration of indomethacin), ibuprofen was prescribed in a three-day course in doses of 10/5/5 mg/kg/day intravenously or 20/10/10 mg/kg/day in rectal form. In all  groups, standard PDA closure therapy was used. In the more remote periods (14 and 28 days), there was no fundamental difference in the volume of infusion in all groups. For early PDA closure limitation of infusion therapy in the first 3-5 days in combination with COX is principle

Power spectrum features of the near-Earth atmospheric electric field in Kamchatka

Power spectrum of the diurnal variations of the quasi-electrostatic field Ez in the near-Earth atmosphere have been presented for the first time. The Ez power spectrum variations in the period of fine weather have been shown to exhibit two bands of the periods of natural atmospheric oscillations with T = 1-5 and 6-24 h. These oscillations are the modes of the internal gravity and tidal waves in the lower atmosphere. On the days under atmospheric precipitation, the spectral power of Ez increases by an order of magnitude. During the pre-earthquake period, when the diurnal Ez variation had an anomaly, the intensity of harmonics with T = 1.8, 2.2, and 3.8 h increased by an order of magnitude or more in comparison with the Ez spectra in fine weather. Two additional spectral bands with T = 0.6 and 1 h have appeared simultaneously

Management of patent ductus arteriosus in premature infants

Closure of hemodynamically significant patent ductus arterios (HSPDA) is one of the most important questions in modern neonatal intensive care, especially for preterm babies. Long-term functioning of the hemodynamically significant arterial duct leads to a large number of complications in premature babies, such as: bronchopulmonary dysplasia, periventricular leucomalacia, intraventricular hemorrhage, retinopathy of the premature. To prevent all these complications, the PDA should be closed pharmacologically or surgically as soon as possible without any hesitation. COX inhibitors are commonly used nowa days. Ibuprofen and indomethacin show the equal efficacy and no significant adverse events. But some patients still need surgical treatment. The aim of the study was to determine the feasibility, effectiveness and safety of using various volumes of infusion in combination with COX inhibitors and to determine its effect on the timing of the closure of PDA. 91 premature infants with a gestational age of 26-31 weeks with manifestations of respiratory distress syndrome and НSPDA were studied retrospectively. Premies were divided into 2 groups. Research groups were representative as to gestational age, gender, and weight (1205.0±435.0 g). Therapy for PDA closure included the use of various volumes of restrictive or liberal infusion therapy (from 50 to 100 ml/kg/day) and COX inhibitors (indomethacin, ibuprofen). The volume of infusion therapy was limited in the first group. Preemies received 53.5±6.4 ml/kg/day on DOL1 and 2. From the third day urine excretion increased and the volume of infusion therapy also raised to 63.6±5.6 ml/kg/day, and on day 5 – to 89.7±6.8 ml/kg/day. In the second group there was no strict limitation of the volume of infusion therapy (especially in the first 5 days). Delayed period of PDA closure (on average from 14.55±0.56 DOL) was associated with absence of limitation of the infusion volume. In the first group, volume of infusion therapy was restricted in the first 5 days, and the closure of the ductus arteriosus occurred extremely early (on 2.35±0.48 DOL). COX inhibitors were prescribed according to the standard scheme: in the first 3 days indomethacin was administered orally in doses of 0.2/0.1/0.1 mg/kg/day. If the premature baby had symptoms of intestinal paresis ( this restricted oral administration of indomethacin), ibuprofen was prescribed in a three-day course in doses of 10/5/5 mg/kg/day intravenously or 20/10/10 mg/kg/day in rectal form. In all groups, standard PDA closure therapy was used. In the more remote periods (14 and 28 days), there was no fundamental difference in the volume of infusion in all groups. For early PDA closure limitation of infusion therapy in the first 3-5 days in combination with COX is principle

Pathogenic characteristics of intracellular infection in chlamydiosis

This review analyzes scientific data and systematized information regarding microbiological aspects and pathogenesis of chlamydia infection. Chlamydia are obligate intracellular microorganisms that are sensitive to any human cells where energy parasitism is possible: various types of epithelium, fibrocytes, histiocytes, glial and muscle cells, squamous epithelium of the meninges and eyeball, neurons, monocytes, macrophages. Structure, chemical composition and enzymatic activity of Chlamydia closely resemble those in Gram-negative bacteria, as they retain their morphological identity throughout the life cycle, possess cell wall, ribosomes, DNA, RNA, biochemical elements of glycolysis, tissue respiration, peptose production being sensitive to some broad-spectrum antibiotics, and are able to vegetative form division. In recent decades, the pathogenesis and clinical symptoms of chlamydial lesions in the urogenital tract, nervous, cardiovascular, musculoskeletal and bronchopulmonary systems have been actively studied, and new approaches and treatment schemes for chlamydia-infected patients are still developing. Over many decades, Chlamydia infection has been an important and urgent problem, not only due to its high prevalence, but also because of high rate of complications negatively affecting populational health and related demographic parameters. Chlamydia causes multiple diseases resulting in chronization of inflammatory process in all human organs and systems, and affects reproduction of population. Mandatory statistical recording of chlamydiosis cases introduced as early as in 1994 in the Russian Federation does not reflect the actual incidence rate. A rise in number of inflammatory diseases of the upper respiratory tract caused by Chlamydia undoubtedly increases its etiological importance, but data regarding etiopathogenetic role of Chlamydia in ENT pathology are ambiguous and contradictory. Available publications describe a large range of variation in rate of detected Chlamydia due to poor awareness of doctors about the microbiological properties of chlamydia, pathogenetic and clinical features of clinical signs of this infection, and lack of common and clear understanding on the algorithms for identifying and treating chlamydiosis. Since the majority of chlamydia-associated nosological forms are asymptomatic, knowing pathogenetic features of related will allow to prevent the spread of the infection and reduce subsequent socio-economic consequences

INTRA-FAMILY CHLAMYDIA CONTAMINATION IN UPPER SEGMENTS OF RESPIRATORY TRACT

The paper presents the results of studying of 44 families of patients with diseases of upper segment of respiratory tract, associated with Chlamydia infection. Control group included. 43 families of ENT-patients without Chlamydia infection. Diagnostics of Chlamydia infection was provided by using the complex of laboratory methods (direct fluorescence immunoassay and immune-enzyme analysis, polymerase-chain reaction). The presence of a patient with respiratory chlamydiosis in a family promotes infecting of other members of the family with Chlamydia

ЭФФЕКТИВНОСТЬ ПРИМЕНЕНИЯ ЦИКЛИЧНОЙ ПОЛИАНТИБИОТИКОТЕРАПИИ ПРИ ХЛАМИДИЙНОМ ПОРАЖЕНИИ ОКОЛОНОСОВЫХ ПАЗУХ У ДЕТЕЙ

This article presents a scheme of antibiotic treatment of children with acute sinus infections, paired with Chlamydial  infection, which is based on the use of cyclic poliantibiotikoterapii macrolide drugs. The most significant advantage of this therapy is the high degree of eradication of Chlamydial agent (87.5 %), which allows high-quality conduct antichlamydial treatment prevents the chronization inflammation, disseminated infection and helps reduce the number of complications. Recommended for use in medical practice physicians otorhinolaryngology for the treatment of acute sinusitis in children,  coupled with the Chlamydial infection.В настоящей статье представлена схема антибактериального лечения детей с острым воспалением  околоносовых пазух, сопряженным с хламидийной инфекцией, которая базируется на применении цикличной полиантибиотикотерапии препаратами группы макролидов. Наиболее значимым преимуществом данной терапии является высокая степень эрадикации хламидийного возбудителя (87,5%),  что позволяет  качественно  провести противохламидийное  лечение, предотвращает  хронизацию воспалительного процесса, диссеминацию инфекции и способствует снижению числа осложнений. Рекомендуется к применению в практическом здравоохранении врачами оториноларингологами для лечения острого синусита у детей, сопряженного с хламидийной инфекцией

Effect of the Surface on the Electron Quantum Size Levels and Electron g-Factor in Spherical Semiconductor Nanocrystals

The structure of the electron quantum size levels in spherical nanocrystals is studied in the framework of an eight--band effective mass model at zero and weak magnetic fields. The effect of the nanocrystal surface is modeled through the boundary condition imposed on the envelope wave function at the surface. We show that the spin--orbit splitting of the valence band leads to the surface--induced spin--orbit splitting of the excited conduction band states and to the additional surface--induced magnetic moment for electrons in bare nanocrystals. This additional magnetic moment manifests itself in a nonzero surface contribution to the linear Zeeman splitting of all quantum size energy levels including the ground 1S electron state. The fitting of the size dependence of the ground state electron g factor in CdSe nanocrystals has allowed us to determine the appropriate surface parameter of the boundary conditions. The structure of the excited electron states is considered in the limits of weak and strong magnetic fields.Comment: 11 pages, 4 figures, submitted to Phys. Rev.

Myocardial infarction in the population of some Russian regions and its prognostic value

Aim. To study the prevalence of myocardial infarction (MI) in the population of Russian regions and its contribution to cardiovascular events.Material and methods. The analysis material was representative samples of the population aged 35-64 years from 11 Russian regions,  examined within the multicenter study “Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions  of Russian Federation”. The response rate was about 80%. The study used a community-based  systematic stratified multiply random sample. During the study, information on prior MI was obtained using a standard questionnaire. Anthropometry and measurement of blood pressure (BP) and heart rate (HR) with an automatic BP monitor were performed. Resting electrocardiography (ECG) was performed, followed by Minnesota coding. Major and minor QQS waves and STT segments were considered as ischemic  ECG abnormalities. Biochemical parameters were determined using an Arkhitect 000 Clinical Chemistry Analyzer. The median prospective  follow-up was 6,21 [5,25; 6,75] years. A composite endpoint (CE) was analyzed, including cardiovascular death and non-fatal MI. During the follow-up period, 363 all-cause deaths were detected,  of which 134 were from cardiovascular diseases, while 196 — CEs. Statistical analysis was carried out in R 3.6.1 environment.Results. The MI prevalence among the Russian population was 2,9%; 5,2% for men and 1,5% for women,  increasing  with age. Men with prior MI were  more likely to take statins and beta-blockers  than women as follows: 39,0% vs 25,6% and 29,3% vs 27,1%, respectively. MI newly diagnosed within the follow-up  period was associated with the following risk factors (RFs): smoking, increased BP, HR, triglycerides and glucose.  For individuals with prior MI, a significant relationship was found only with smoking.  Multiple comparison  of the contribution of RFs, ECG abnormalities,  and prior MI showed  that the inclusion of ischemic ECG abnormalities in the analysis significantly increases  the risk of cardiovascular events in individuals without prior MI compared with individuals without both MI and ECG changes.  A high CE risk was noted in patients with prior MI: relative risk (RR), 4,73 (2,92-7,65); the addition of ischemic ECG abnormalities increased the RR to 5,75 (3,76-8,8).Conclusion. The RR of CEs in patients  with prior MI without or with ischemic ECG changes  is 4,73 and 5,75 times higher than in patients without MI and ECG abnormalities. The risk factors  identified  in this case cannot explain such an increase  in CEs. It is obvious  that people  with prior MI need  rehabilitation. The presence of RFs in patients with newly diagnosed  MI indicates insufficient primary prevention, which suggests  that strengthening preventive measures to eliminate conventional risk factors in patients with newly diagnosed  MI will help reduce the risk of recurrent MI or cardiovascular  mortality

Non-High Density Lipoprotein Cholesterol: A Modern Benchmark for Assessing Lipid Metabolism Disorders

Aim. To perform a population analysis of Non-High Density Lipoprotein Cholesterol level (non-HDL-c) in Russian population and to evaluate its association with cardiovascular events.Material and Methods. The material consisted of results obtained from 11 regions of the ESSE-RF1 Study and from 4 regions of the ESSE-RF2 Study. Study protocols were identical. The studies were performed in 2012-2014 and 2017, respectively. Endpoints were assessed in 19041 people aged 35-64 years. The median follow-up was 6.5 years in ESSE RF (1) and 3.8 years in ESSE RF(2). Analysis was performed for three lipid variables: total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and non-HDLC in two samples: the general population sample and the same sample without individuals with coronary heart disease (CHD), myocardial infarction (MI) and/or stroke history and not taking statins (the population sample of "without a history of cardiovascular diseases [CVD]". The analysis of nonlinear associations was performed using the generalized additive Cox model. The combined cardiovascular endpoint was represented by cardiovascular death and nonfatal MI and stroke. Traditional and laboratory FRs, socio-demographic parameters were analyzed. The significance level for all tested hypotheses was set to be 0.05.Results. The prevalence of elevated non-HDL-C level (>3.7 mmol/l) was found to be 74.6%. No gender differences were found: there was 74.6% for men and 74.5% for women. Both mean values and prevalence of elevated non-HDL-C were increased with age in women, and its level was slightly decreased in men after 55 years old. Almost all analyzed RFs were significantly associated with elevated non-HDL-C in these two population samples. In both samples elevated total CH and elevated LDL-C were associated with all-cause mortality after correction for all RFs. On the contrary, the non-HDL-C was associated with CVD combined end pints. It has been shown that the risk of these end points increases uniformly with increase in levels of non HDL cholesterol, no nonlinear associations were found.Conclusion. The results of a population-based analysis of non-HDL-C performed in the Russian population for the first time confirmed that elevated non-HDL-C levels contribute significantly to determining the risk of cardiovascular events in the medium term. It can be assumed that the new risk scales (SCORE2 and SCORE OP) proposed by the European Society of Cardiology and the European Society of Preventive Cardiology, which include non-HDL C instead of TC, will allow adequate assessment of 10-year cardiovascular risk for Russians. However, continued monitoring of endpoints in order to obtain stable associations is required