ВНЕБОЛЬНИЧНАЯ ПНЕВМОНИЯ: НЕМЕДИКАМЕНТОЗНЫЕ ФАКТОРЫ РИСКА ЛЕТАЛЬНОГО ИСХОДА

The objective of this study was to analyze risk factors of death in patients with community-acquired pneumonia (CAP). This was a retrospective analysis of medical records of 62 patients dead from CAP within a year in hospitals at Kazan city. We described clinical course of CAP leading to a patient's death. Predictors of fatal outcome of CAP were social status, delayed admission to a hospital, smoking history, alcohol abuse, mental and nutritive disorders, bilateral lung injury, pleural effusion, respiratory failure and haemodynamic instability.На основе ретроспективного изучения 62 медицинских карт пациентов, госпитализированных в течение 1 года в стационары Казани и впоследствии умерших от внебольничной пневмонии (ВП), проанализированы немедикаментозные факторы риска летального исхода при данном заболевании. При объективном осмотре были выделены особенности клинической картины ВП с летальным исходом.Отмечено, что социальный статус, позднее обращение, курение, коморбид алкогольной природы, нарушения ментального и нутритивного статуса, двусторонний характер пневмонии, плевральный выпот, признаки дыхательной недостаточности и нарушения гемодинамики следует признать немедикаментозными предикторами летального исхода

New integrable extension of the Hubbard chain with variable range hopping

New integrable variant of the one-dimensional Hubbard model with variable-range correlated hopping is studied. The Hamiltonian is constructed by applying the quantum inverse scattering method on the infinite interval at zero density to the one-parameter deformation of the L-matrix of the Hubbard model. By construction, this model has Y(su(2))$\oplus$Y(su(2)) symmetry in the infinite chain limit. Multiparticle eigenstates of the model are investigated through this method.Comment: 25 pages, LaTeX, no figure

Observations of GRB 060526 Optical Afterglow with Russian-Turkish 1.5-m Telescope

We present the results of the photometric multicolor observations of GRB 060526 optical afterglow obtained with Russian-Turkish 1.5-m Telescope (RTT150, Mt. Bakirlitepe, Turkey). The detailed measurements of afterglow light curve, starting from about 5 hours after the GRB and during 5 consecutive nights were done. In addition, upper limits on the fast variability of the afterglow during the first night of observations were obtained and the history of afterglow color variations was measured in detail. In the time interval from 6 to 16 hours after the burst, there is a gradual flux decay, which can be described approximately as a power law with an index of -1.14+-0.02. After that the variability on the time scale \delta t < t is observed and the afterglow started to decay faster. The color of the afterglow, V-R=~0.5, is approximately the same during all our observations. The variability is detected on time scales up to \delta t/t =~ 0.0055 at \Delta F_\nu/F_\nu =~ 0.3, which violates some constraints on the variability of the observed emission from ultrarelativistic jet obtained by Ioka et al. (2005). We suggest to explain this variability by the fact that the motion of the emitting shell is no longer ultrarelativistic at this time.Comment: 6 pages, 7 figures, Astronomy Letters, 2007, 33, 797, The on-line data tables and the original text in Russian can be found at http://hea.iki.rssi.ru/grb/060526/indexeng.htm

Transient events in the near-nuclear regions of AGNs and quasars as the sources of the proper motion imitations

We present a sample of SRG/eROSITA X-ray sources located in the eastern Galactic hemisphere (0<l<180 deg), with significant proper motions according to GAIA eDR3 measurements and whose extragalactic nature has been confirmed. The catalog consists of 248 extragalactic sources with spectroscopically measured redshifts. It includes all objects available in the Simbad database and matched to the identified optical component within a radius of 0.5 arcsec. Additionally, the catalog includes 18 sources with the spectral redshift measurements based on observations at the Russian-Turkish 1.5-m telescope RTT-150. The sources of the catalog are AGNs of various types (Sy1, Sy2, LINER), quasars, radio galaxies, and star-forming galaxies. The imitation of significant proper motions can be explained (previously known in astrometry as the VIM effect) by the presence of transient events on the line of sight in the field of view of AGN nuclei and quasars (within the GAIA resolution element). Such astrophysical phenomena may be the supernovae outbursts, tidal destruction events in AGNs with double nuclei, variability of large-mass supergiants, the presence of O-B associations in field of view of variable brightness AGN, etc. A model of flares with a fast rise and exponential decay profile allows to describe the variable positional parameters of most similar sources observed in GAIA. This cross-matching approach of the X-ray source catalogs of the SRG/eROSITA observatory and the optical catalog of the GAIA observatory can be used as an independent technique for detecting transient events in the neighborhood of AGN core (on scales of several hundred parsecs in the picture plane).Comment: 23 pages, 8 figures, 10 table

Additional spectroscopic redshift measurements for galaxy clusters from the First Planck Catalogue

We present the results of spectroscopic redshift measurements for the galaxy clusters from the first all-sky Planck catalogue of the Sunyaev-Zeldovich sources, that have been mostly identified by means of the optical observations performed previously by our team (Planck Collaboration, 2015a). The data on 13 galaxy clusters at redshifts from z=~0.2 to z=~0.8, including the improved identification and redshift measurement for the cluster PSZ1 G141.73+14.22 at z=0.828, are provided. The measurements were done using the data from Russian-Turkish 1.5-m telescope (RTT-150), 2.2-m Calar Alto Observatory telescope, and 6-m SAO RAS telescope (Bolshoy Teleskop Azimutalnyi, BTA).Comment: published in Astronomy Letter

Персонифицированная реабилитация пациентов после новой коронавирусной инфекции: опыт Республики Марий Эл

Two years after the onset of the COVID-19 pandemic, not only the diagnosis and treatment, but also rehabilitation of patients at different times after the disease became relevant.The aim. To develop and analyze the efficiency of personalized hospital-based rehabilitation programs for COVID-19 patients.Methods. Retrospective analysis of medical records of 109 patients with COVID-19 admitted to the rehabilitation department. A team of physiotherapist, pulmonologist and psychiatrist used simulators (bicycle ergometer, treadmill, motomed, and stepper), physiotherapeutic exercises, training of respiratory muscles with Threshold IMT (Philips, Netherlands) simulators, psychotherapy, and physiotherapy.Results. A total of 109 patients, 59 (54%) men and 50 (46%) women, aged 56.54 ± 11.73 уears suffered from moderate (41%), severe (40%) and very severe (19%) COVID-19. 25% of the patients had concomitant diabetes mellitus, 65% – arterial hypertension, and 22% – ischemic heart disease. Patients with 5 rehabilitation points (5RP) on Rehabilitation Routing Scale walked a median distance of 110 [40; 248] m in the 6-minute walk test (6MWT), 4RP – 300 [240; 350] m in 6MWT, 3RP — 400 [360; 431] m in 6MWT. The difference in 6MWT distance was significant only between 4RP and 3RP groups (p &lt; 0.001). By the end of rehabilitation program, 6MWT increased by 90 m in 5RP group, by 120 m – in 4RP group, and by 89 m in patients with 3RP (p = 0.036 between RPs and 4RP groups; р = 0.007 between 3RP and 5RP groups, respectively). SpO2 was over 95% in all patients by the end of rehabilitation.Conclusion. Comorbid patients after severe COVID-19 demonstrated better rehabilitation potential seen as improvement of exercise tolerance and respiratory status. The original personalized rehabilitation programs improve significantly impaired body functions early on after severe COVID-19.Спустя 2 года с начала пандемии COVID-19 (COronaVIrus Disease-2019) все более актуализируются не только задачи диагностики и лечения, но и вопросы реабилитации пациентов на разных сроках после перенесенного заболевания.Целью исследования явилась оценка эффективности оригинальных персонифицированных программ, нацеленных на восстановление пациентов c COVID-19 в условиях круглосуточного стационара.Материалы и методы. Проведен ретроспективный анализ медицинских карт 109 пациентов с COVID-19, госпитализированных в реабилитационное отделение. Реабилитация проводилась командой специалистов (врач физической и реабилитационной медицины, пульмонолог, психиатр), включала персонифицированные тренировки на тренажерах (велоэргометр, тредмил, мотомед, степпер), лечебную физкультуру, тренировки дыхательной мускулатуры с тренажерами Threshold IMT (Philips, Нидерланды), психотерапию, физиотерапию.Результаты. В исследовании участвовали 59 мужчин (54 %) и 50 (46 %) женщин; средний возраст – 56,54 ± 11,73 года. У 41 % обследованных течение COVID-19 было среднетяжелым, у 40 % – тяжелым, у 19 % – крайне тяжелым. В структуре коморбидности регистрировались сахарный диабет (25 %), гипертоническая болезнь (65 %), ишемическая болезнь сердца (22 %). При поступлении пациенты с оценкой 5 баллов (РБ5) по шкале реабилитационной маршрутизации проходили в среднем 110 [40; 248] м в 6-минутном шаговом тесте, больные с оценкой 4 балла (РБ4) – 300 [240; 350] м, 3 балла (РБ3) – 400 [360; 431] м. Различия результатов 6-минутного шагового теста (6-МШТ) в группах с РБ4 и РБ3 были достоверны (p &lt; 0,001). В динамике прирост расстояния в 6-МШТ составил 90 м при РБ5, 120 м – при РБ4, 89 м – при РБ3 (p = 0,036 при сравнении РБ3 и РБ4; р = 0,007 при сравнении РБ3 и РБ5). К завершению реабилитационных программ у всех пациентов нормализовались показатели сатурации кислорода.Заключение. У пациентов с тяжелым COVID-9 и сопутствующими заболеваниями выявлен хороший реабилитационный потенциал, выражавшийся в повышении толерантности к физической нагрузке и улучшении респираторного статуса. Это позволяет говорить о влиянии на возможности восстановления нарушенных функций организма после тяжелых форм COVID-19

Хроническая обструктивная болезнь легких: значимость факторов риска частых обострений, при которых требуется госпитализация

Aim. Identification of risk factors for readmissions associated with an exacerbation of chronic obstructive pulmonary disease (COPD) followed by evaluation of quality of the medical care in the outpatient and hospital settings.Methods. A retrospective analysis of the medical records of patients with an exacerbation of chronic obstructive pulmonary disease admitted to the multidisciplinary hospitals in Kazan from January 1, 2015 to December 31, 2018, was.Results. The identified risk factors for readmission were male gender (relative risk (RR) 3.49; 95% confidence interval (CI) 1.45 – 8.43; p &lt; 0.05), age over 70 years (RR 1.21; 95% CI 0.74 – 1.86; p &lt; 0.05), smoking experience more than 40 years (RR 1.6; 95% CI 0.87 – 3.0; p &lt; 0.05), duration of COPD at least 10 years (RR 3.48; 95% CI 2.27 – 5.34; p &lt; 0.05), the presence of three or more concomitant diseases (RR 2.0; 95% CI 1.23 – 3.4; p &lt; 0.05). The most significant reasons for readmissions were nonadherence in the outpatient settings, as well as defects in the therapy that was provided in the hospital and prescribed upon discharge.Conclusion. The identified risk factors are non-modifiable in most cases, so optimizing treatment and monitoring patient adherence are of paramount importance. Also, more attention should be paid to nonpharmacological treatment in the form of maintaining physical activity, early smoking cessation and psychological rehabilitation. The revealed defects of the quality of medical care for patients with severe exacerbations requiring repeated hospitalizations indicate the need to intensify the implementation of the federal clinical guidelines on chronic obstructive pulmonary disease in the real clinical practice.Целью исследования явилась идентификация факторов риска (ФР) повторных госпитализаций, связанных с обострением хронической обструктивной болезни легких (ХОБЛ), с последующей оценкой качества оказания помощи пациентам на амбулаторном и госпитальном этапах.Материал и методы. Проведен ретроспективный анализ медицинских карт больных с обострением ХОБЛ, госпитализированных в многопрофильные стационары Казани в период с 01.01.15 по 31.12.18.Результаты. Выявлено, что ФР повторных госпитализаций являются мужской пол (относительный риск (ОР) – 3,49; 95%-ный доверительный интервал (ДИ) – 1,45–8,43; р &lt; 0,05), возраст старше 70 лет (ОР – 1,21; 95%-ный ДИ – 0,74–1,86; р &lt; 0,05), стаж курения ≥ 40 лет (ОР – 1,6; 95%-ный ДИ – 0,87–3,0; р &lt; 0,05), длительность ХОБЛ ≥ 10 лет (ОР – 3,48; 95%-ный ДИ – 2,27–5,34; р &lt; 0,05), наличие ≥ 3 сопутствующих заболеваний (ОР – 2,0; 95%-ный ДИ – 1,23–3,4; р &lt; 0,05). Наиболее значимыми причинами последующих госпитализаций после выписки из стационара можно считать недостаточную приверженность пациентов терапии в амбулаторных условиях, а также дефекты терапии, проводимой в стационаре и рекомендуемой при выписке.Заключение. Установлено, что выявленные ФР в большинстве случаев относятся к немодифицируемым, поэтому первостепенное значение придается оптимизации лечения и контролю над приверженностью пациентов терапии. Больше внимания следует также уделять немедикаментозному лечению в виде сохранения физической активности, раннего отказа от курения и психологической реабилитации. Выявленные нарушения качества оказания медицинской помощи пациентам с тяжелыми обострениями, при которых требуется повторная госпитализация, свидетельствуют о необходимости активизации внедрения положений федеральных клинических рекомендаций по ХОБЛ в реальную врачебную практику

Fast optical variability of SS 433

We study the optical variability of the peculiar Galactic source SS 433 using the observations made with the Russian Turkish 1.5-m telescope (RTT150). A simple technique which allows to obtain high-quality photometric measurements with 0.3-1 s time resolution using ordinary CCD is described in detail. Using the test observations of nonvariable stars, we show that the atmospheric turbulence introduces no significant distortions into the measured light curves. Therefore, the data obtained in this way are well suited for studying the aperiodic variability of various objects. The large amount of SS 433 optical light curve measurements obtained in this way allowed us to obtain the power spectra of its flux variability with a record sensitivity up to frequencies of ~0.5 Hz and to detect its break at frequency =~2.4e-3 Hz. We suggest that this break in the power spectrum results from the smoothing of the optical flux variability due to a finite size of the emitting region. Based on our measurement of the break frequency in the power spectrum, we estimated the size of the accretion-disk photosphere as 2e12 cm. We show that the amplitude of the variability in SS 433 decreases sharply during accretion-disk eclipses, but it does not disappear completely. This suggests that the size of the variable optical emission source is comparable to that of the normal star whose size is therefore R_O \approx 2e12 cm \approx 30 R_sun. The decrease in flux variability amplitude during eclipses suggests the presence of a nonvariable optical emission component with a magnitude m_R=~13.2.Comment: 12 pages, 11 figures. Accepted for publication in Astronomy Letters. The original version in Russian is available at http://hea.iki.rssi.ru/rtt150/ru/ss433_pazh10/pss433_fast.pd

On the Change of the Inner Boundary of an Optically Thick Accretion Disk around White Dwarfs Using the Dwarf Nova SS Cyg as an Example

We present the results of our studies of the aperiodic optical flux variability for SS Cyg, an accreting binary systemwith a white dwarf. The main set of observational data presented here was obtained with the ANDOR/iXon DU-888 photometer mounted on the RTT-150 telescope, which allowed a record(for CCD photometers) time resolution up to 8 ms to be achieved. The power spectra of the source's flux variability have revealed that the aperiodic variability contains information about the inner boundary of the optically thick flow in the binary system. We show that the inner boundary of the optically thick accretion disk comes close to the white dwarf surface at the maximum of the source's bolometric light curve, i.e., at the peak of the instantaneous accretion rate onto the white dwarf, while the optically thick accretion disk is truncated at distances 8.5e9 cm ~10 R_{WD} in the low state. We suggest that the location of the inner boundary of the accretion disk in the binary can be traced by studying the parameters of the power spectra for accreting white dwarfs. In particular, this allows the mass of the accreting object to be estimated.Comment: 9 pages, 7 figures, Published in Astronomy Letter