The possibility of a favourable outcome and reversibility of severe ankle joint damage on the example of a clinical observation

The problem of aseptic talus necrosis consists of the following features: a) manifestation of the disease in the form of acute articular syndrome without typical symptoms; b) inevitable serious consequences in the form of disfiguring deforming arthrosis of the ankle joint, development of gross deformities of the rearfoot, etc., resulting in disability. The lack of methods for monitoring the dynamics of the disease also plays an important role. This is particularly so with such an important issue as the substantiation of stopping immobilization and allowing the load on the foot in order to avoid collapsed talus and subsequent complications. It is believed that treatment started before radiographic changes helps to avoid severe complications, but for a number of reasons patients arrive already at the stage of late severe destructive changes. All of the above explains the high relevance of the problem of treatment of patients with aseptic talus necrosis. The importance of the presented clinical case and the value of this information can be considered several points: its  example demonstrates the possibility of early diagnosis of severe talus damage cause by aseptic necrosis; based on objective data, a substantiation was made for allowing the load on the leg with body weight in the complex of rehabilitation measures; the possibility of regression of pathological changes associated with aseptic talus necrosis and the dynamics of the course of aseptic talus necrosis with a favorable outcome were demonstrated, which is confirmed by modern research methods. Thus, the need for magnetic resonance imaging has been confirmed for all referred patients with a clinical picture of local articular syndrome in the ankle joint, the possibility of complete regression of avascular necrosis symptoms in case of conservative treatment at the early stages and the possibility of resolving the load on the leg in the complex of rehabilitation treatment have been demonstrated

A clinical case of post-COVID-19 myoendocarditis and arrhythmic syndrome at the outpatient stage

Background: Infection with the SARS-CoV-2 virus entails the development of complications which affect the prognosis of the underlying disease. More than 40% of COVID-19 complications represent diseases of the cardiovascular system, most of which are the rhythm and conduction disturbances. In order to avoid these complications, it is necessary to detect cases of infection in a timely manner at the outpatient stage. Clinical case description: A 40-year-old patient came to the clinic with complaints of interruptions in the heart rhythm that appeared after the coronavirus infection. The laboratory examination (CBC) revealed signs of systemic inflammation (leukocytosis 12.6×109 U/l; erythrocyte sedimentation rate 18 mm/h, C-reactive protein 18 mg/l); the instrumental examination of the heart revealed the rhythm disturbances in the form of frequent ventricular ectopic activity and weakness of the SA node. The patient received propafenone (150 mg, 3 times a day) as a therapy with a positive effect. Against the background of improvement in the patient’s condition and despite the history of myocarditis and a positive result of enzyme immunoassay for antibodies to SARS-CoV-2 (IgG, 10 BAU/ml), the patient was prescribed immunization with the CoviVac vaccine. After the immunization, the condition worsening was observed in the form of an increase in the rhythm disturbances, which required an inpatient treatment. A clinical diagnosis of recurrent ventricular arrhythmia — ventricular extrasystole was established, and the therapy was corrected. The outcome was favorable. Conclusion: Myocarditis is one of the most common complications of SARS-CoV-2 and should be kept in mind at all stages of medical care. This clinical case demonstrates the importance of the correct diagnosis and treatment of post-COVID myocarditis, as well as the need to assess contraindications for SARS-CoV-2 vaccination in patients with cardiac complications

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Molecular Structure of the Product of the Self-Condensation of Anthranilic Acid

The eight-membered heterocycle of the tetrameric product of the self-condensation of anthranilic acid, which is a model of the elementary unit of the corresponding polyquinazolones, has the boat conformation with flexure angles of 53–56‡, which significantly exceed the values usually observed for cyclooctatetraene systems (39–45‡). This should produce substantial steric hindrance in the corresponding polymer chain taking account of the cis arrangement of the quinazolone fragments relative to the eight-membered ring

Molecular Structure of the Product of the Self-Condensation of Anthranilic Acid

The eight-membered heterocycle of the tetrameric product of the self-condensation of anthranilic acid, which is a model of the elementary unit of the corresponding polyquinazolones, has the boat conformation with flexure angles of 53–56‡, which significantly exceed the values usually observed for cyclooctatetraene systems (39–45‡). This should produce substantial steric hindrance in the corresponding polymer chain taking account of the cis arrangement of the quinazolone fragments relative to the eight-membered ring

Intensifying separating processes of high-concentration uranyl solutions and fine-dispersed suspended solids

The investigations on intensifying separation processes of highly concentrated uranylnitrate solutions and solid fine-dispersed suspended particles (ferric, silicon, molybdenum oxides and others) applying organic coagulants and flocculants have been carried out. It is shown that in the investigated regions of uranium concentrates of 300...450 g/l, nitric acid of 0,5...3,0 mole/l at optimal temperature 30...50 °С for effective phases separation the introduction of 100...200 mg/l of coagulant FLOQULATTM FL 45 С (or an analogue VPK-402) and 5...10 mg/l of flocculant FLOPAMTM FO 4140 PWG type is enoug

Features of the Intestinal Microbiota in Patients with Inflammatory Intestinal Diseases

Introduction. Inflammatory bowel diseases (IBD) occupy a leading position in the structure of diseases of the gastrointestinal tract (GIT), as they are a progressive chronic pathology with an autoimmune type of inflammation. Changes in the composition of the gut microbiota can determine morphological changes at the latent stage of the disease. Aim of the study. To assess the genus-­species biodiversity of the microbiota in patients with IBD. Patients and methods. 16S rRNA sequencing of the intestinal microbiota was performed in 15 patients with confirmed ulcerative colitis (UC) and 20 healthy controls. The parameters of the full blood count and the serum level of C-reactive protein (CRP) were analyzed. The analysis of the obtained data was carried out using Microsoft Excel and Statistica software. Results. Among the studied laboratory parameters in patients with IBD, there was a significant increase in CRP, leukocyte and neutrophil counts compared to the control group. Sequencing of the gut microbiota showed a decrease in the normobiota, as well as an increase in the representatives of the pathogenic cluster. Conclusion. In the present study, we demonstrated a decrease in the biodiversity of the gut microbiota in patients with IBD compared to the control group, a significant change in the pathogenic cluster, and an imbalance between the representatives of Bacteroidetes and Firmicutes

Barriers to sustainable tuberculosis control in the Russian Federation health system.

The Russian Federation has the eleventh highest tuberculosis burden in the world in terms of the total estimated number of new cases that occur each year. In 2003, 26% of the population was covered by the internationally recommended control strategy known as directly observed treatment (DOT) compared to an overall average of 61% among the 22 countries with the highest burden of tuberculosis. The Director-General of WHO has identified two necessary starting points for the scaling-up of interventions to control emerging infectious diseases. These are a comprehensive engagement with the health system and a strengthening of the health system. The success of programmes aimed at controlling infectious diseases is often determined by constraints posed by the health system. We analyse and evaluate the impact of the arrangements for delivering tuberculosis services in the Russian Federation, drawing on detailed analyses of barriers and incentives created by the organizational structures, and financing and provider-payment systems. We demonstrate that the systems offer few incentives to improve the efficiency of services or the effectiveness of tuberculosis control. Instead, the system encourages prolonged supervision through specialized outpatient departments in hospitals (known as dispensaries), multiple admissions to hospital and lengthy hospitalization. The implementation, and expansion and sustainability of WHO-approved methods of tuberculosis control in the Russian Federation are unlikely to be realized under the prevailing system of service delivery. This is because implementation does not take into account the wider context of the health system. In order for the control programme to be sustainable, the health system will need to be changed to enable services to be reconfigured so that incentives are created to reward improvements in efficiency and outcomes

Health system frailties in tuberculosis service provision in Russia: analysis through the lens of formal nutritional support

OBJECTIVE: The aim of this study was to describe health system challenges faced by tuberculosis (TB) treatment facilities in Russia through an analysis of formal institutional dietary provisions to patients in an inpatient facility that provides care for poor patients. METHODS: Analysis of formal dietary provisions by institutions and financing data from TB hospitals in Samara Oblast, Russia. RESULTS: Formal dietary provision for inpatients with TB has fallen substantially in recent years. In a hospital providing inpatient care for the poorest patients with fewest social support networks, this has been very pronounced. The likely reason for this is that financial support for other budget lines, principally salaries, has required protection. CONCLUSION: Formal institutional nutritional support in institutions providing care for the poorest patients with TB is unlikely to be enhancing the speed of recovery, or reducing the duration of infectiousness. Furthermore, the role that hospital may have played in the past in enabling patients to regain weight lost before admission may have been limited by reductions in formal financing. Reductions in state provision of food for patients may serve as an important illustration of wider TB control system frailties in the Russian Federation