The course of Covid-19 in patients with chronic kidney disease and the role of renal replacement therapy in shaping the outcomes of a new coronavirus infection in intensive care

The aim of the study to determine the role of chronic kidney disease (CKD) as a risk factor for adverse outcomes in COVID-19, and to compare the effectiveness of hemodiafiltration (HDF) and hemodialysis (HD) in reducing the risk of death in patients with CKD requiring renal replacement therapy (RRT).Цель исследования – Определить роль хронической болезни почек (ХБП) как фактора риска неблагоприятных исходов при COVID-19, а также сравнить эффективность гемодиафильтрации (ГДФ) и гемодиализа (ГД) в снижении риска летального исхода у пациентов с ХБП, требующих проведение заместительной почечной терапии (ЗПТ)

Strategies for Abatement of Contamination of Tableted Live Plague Vaccine at Different Stages of Manufacturing

Nowadays, problem of tableted drug form contamination with extraneous micro-flora is in the spotlight of scientists, as the specific share of these medical preparations in the world market amounts to more than 60 % and has a tendency to increase. Thus, objective of the study is to investigate the degree of contamination of the basic and auxiliary raw materials at different stages of live plague vaccine manufacturing, rapid dissolving tablets, and the ways to reduce it. Materials and methods. Utilized has been lyophilized Y. pestis live culture of the vaccine strain EV NIIEG, and the live plague vaccine, rapid dissolving tablets. Carried out has been assessment of “microbiological purity” at different stages of tableted live plague vaccine manufacturing: grinding, mixing, granulation, sublimation, and palletizing. Results and conclusions. Identified is the dynamic pattern of quantitative micro-flora composition of the mentioned above drug. Established is the alteration of microbial impurity at separate technological manufacturing steps. Specified is the technological stage with the most expressed contamination. Analysis of factors, which affect vaccine impurity, has revealed that finished dosage-form quality improvement is impossible without incoming control of stock and auxiliary materials, as well as enhancement of manufacturing procedure up to the level, complying with applicable pharmaceutical production standards. It is experimentally proved that series of tableted live plague vaccine, obtained using modernized technological equipment, provide for 3-fold reduction of contamination

Predictive value of burn sepsis, Sepsis I and Sepsis III in patients with major burns

The purpose of the study is to investigate predictive usefulness of SOFA scale, SIRS, bSIRS and BURN-6 criteria within patients with major burns and nosocomial infection.Цель исследования – изучить прогностическую значимость шкалы SOFA (Sepsis III), критериев SIRS (Sepsis I), bSIRS (American Burn Association, ABA 2007) и BURN-6 (критерии Mann-Salinas, 2013) в группе пациентов с тяжелой ожоговой травмой, осложненной госпитальной инфекцией

Development of a technology for the preparation of a dry nutrient medium for anthrax vaccine production

Currently, submerged cultivation of the Bacillus anthracis STI-1 strain for live anthrax vaccine production requires liquid nutrient media, which have disadvantages of a short shelf life (no more than one month) and a narrow range of storage temperatures (2–8 °С). Dry media, in contrast, have a number of indisputable advantages: such media are transportable and easy to use, have a standard capability to retain properties, and can be stored without preservatives at 2–30 °С for 2–5 years. The aim of this work was to develop a technology for the preparation of a dry nutrient medium for anthrax vaccine production. Materials and methods: The study used the Bacillus anthracis STI-1 vaccine strain and a nutrient medium for its cultivation, containing a 70:30 mixture of an enzymatic digest of casein and a pre-processed corn extract solution. Drying of the nutrient medium was carried out on a spray-drying unit. The authors evaluated physicochemical parameters of experimental medium batches. The shelf life was determined by an accelerated stability study. The dry nutrient medium was used to produce a live anthrax vaccine. Quality attributes of the vaccine were assessed for compliance with regulatory requirements. Results: The authors developed the dry media production technology. According to it, the liquid nutrient medium is fed to the drying unit at a rate of 20–25 dm3/h. The spray air pressure is 0.02 MPa. Temperatures at the drying chamber inlet and outlet are 118–122 °С and 85–90 °С, respectively. The technology was used to obtain 3 experimental batches of the dry medium. The study results demonstrate that the technology is reproducible, and the tested quality attributes of experimental medium batches are consistent with the requirements. According to the accelerated stability study, the shelf life of the dry nutrient medium at 2–30 °С is at least 3 years. Experiments demonstrated the possibility of using the dry nutrient medium for live anthrax vaccine production. Critical quality attributes of the vaccine obtained with the medium met regulatory requirements. Conclusions: The developed technology allows for the production of a standard dry nutrient medium with a prolonged shelf life, which is convenient for live anthrax vaccine production

Comparison of three anesthesia’s types for aorta-femoral bypass operations

Aim of the study was to find optimal method of anesthesia for aorta-femoral bypass operations in severe patient’s group with chronic obstructive pulmonary diseases.Materials and methods. Patients with peripheral atherosclerotic occlusive diseases, who underwent aorta-femoral (bifemoral) bypass, were enrolled in prospective randomized study (2003-2009). The delivery (DO) and consumption (VO) of oxygen (tetrapolar rheovasography) and serum level of cortisol (immunochemiluminescent method) during operations and in the early postoperative period were investigated. We also were measured P02/Fi02 ratio before and after operations.58 comparable patients were randomized in three groups: 1 - general anesthesia (6A) (sevofluran) - (n=19); 2 - total intravenous (TWA) (propofol and midasolam) - (n=19); 3 - continuous spinal anesthesia (CSA) (bupivocaine) - (n=20). Chronic obstructive pulmonary disease was registered in 100% of cases. Results. DO was significantly higher after induction in anesthesia and in the 1 -st hour after operations in CSA groups in comparison with GA and TWA groups. P02/R02 ratio was also significantly higher in CSA groups after operations in comparison with GA and TWA groups. For the patients under CSA in 1 -st and 2-nd days after operation the increasing of serum cortisol level was lower then in 6A and TWA patients, but statistically significant difference we got only between GA and CSA groups in the 2-nd day after operation.Conclusions We’ve got a few advantages in CSA groups in comparison with GA and TWA groups and we hypothesized that CSA can be more secure and suitable for patients with pulmonary co-morbidities.Цель исследования: оптимизация анестезиологической защиты пациентов с хронической обструктивной болезнью легких при реконструктивных операциях на брюшном отделе аорты. Материалы и методы: Пациентам, подвергнутым реконструктивным операциям на брюшной аорте при окклюзионных поражениях (2003-2009 гг.), в периоперационный период исследовали кислородтранспортную функцию крови (тетраполярная реовазография) и уровень кортизола плазмы (иммуно-хемилюминисцентный метод).58 сравнимых пациентов были рандомизированы на 3 группы: 1 гр. - общей анестезии (ОА) (севофлюран) -19:2 гр. - тотальной внутривенной анестезии (ТТВА) (пропофол, мидазолам) - 19; 3 гр. - продленной спинальной анестезии (СА) (бупивокаин) - 20 человек. Хроническая обструктивная болезнь легких (ХОБЛ) зарегистрирована в 100% случаев. Результаты. Доставка кислорода (002) имеет большие значения на зтапе индукции в анестезию и 1-ый час после операции в группе СА, в сравнении с ОА и ТВВА (р < 0.05).Установлено большее снижение коэффициента оксигенации в послеоперационном периоде в группе пациентов, оперированных под ОА и ТВВА по отношению к пациентам группы СА (р < 0.05). Зарегистрировано большее увеличение уровня кортизола в крови в 1-е и 2-е сутки после операции в группах ТВВА и ОА в сравнении с СА. Статистически достоверной является разница кортизола на вторые сутки между группами ОА и СА. Заключение. Продленная СА имеет ряд существенных преимуществ по сравнению с ОА и ТВВА при реконструктивных операциях на брюшной аорте у пациентов с ХОБЛ

Association between fluid balance and survival in critically ill patients with burn shock

We conducted a retrospective, cohort, comparative on the basis of Hospital No. 40 of Yekaterinburg. The study analyzed data from 89 resuscitation patients of the burn department.All patients were divided into quartiles (Q1 - Q4) depending on the fluid balance. The incidence of AKI among patients included in Q1 was n = 5 (22.7%); Q2 - n = 11 (50.0%); Q3 - n = 11 (50.0%); Q4 - n = 19 (82.6); (P = 0.001). Hospital mortality increased significantly depending on the fluid balance from 31.8% in the first quartile to 78.3% in the fourth (P = 0,007). When conducting a logistic regression analysis, independent death risk factors were determined: age (OR 1,04 (95% CI 1.00 – 1,07; P = 0,039); Charlson index (OR 2,05 (95% CI 1,48- 2,83; P <0,001); fluid balance (OR 1,77 (95% CI 1,01 – 3,10; P = 0,045). It is advisable to carefully assess the volume of infusion during burn shock therapy, as excessive fluid balance is independent a risk factor for death along with the area of burn injury and Charlson comorbidity index.Нами проведено ретроспективное, когортное, сравнительное на базе МАУ №40 г. Екатеринбурга. В исследовании были проанализированыданные 89 пациентов реанимации ожогового отделения. Все пациенты были разделены на квартили (Q1 – Q4) в зависимости от объема гидробаланса. Частота развития ОПП среди пациентов, входящих в Q1 составила n=5 (22,7%); Q2 – n=11 (50,0%); Q3 – n=11 (50,0%); Q4 – n=19 (82,6); (P=0,001). Госпитальная летальность значимо увеличивалась в зависимости от гидробаланса от 31,8% в первом квартиле до 78,3% в четвертом (P=0.007).При проведении логистического регрессионного анализа определены независимые факторы риска смерти: возраст (ОШ 1,04 (95%ДИ 1,00 – 1,07; Р=0,039); индекс Charlson (ОШ 2,05 (95%ДИ 1,48– 2,83; P<0.001); гидрробаланс (ОШ 1,77 (95%ДИ 1,01 – 3,10; P=0,045). Целесообразно тщательно оценивать объем инфузии во время терапии ожогового шока, т.к. избыточный гидробаланс является независимым фактором риска летального исхода наряду с площадью ожоговой травмы и индексов коморбидности Charlson

The NEWS score for the prediction of adverse outcomes in emergency department patients

The purpose of the study was to estimate the NEWS score as an outcome predictor in emergency department patients of Yekaterinburg City Clinical Hospital №40. The study was single-centered, prospective. Composite outcome of mortality and ICU length of stay > 1 day was the primary outcome of the study. The NEWS score AUROC was 0,856 (95% CI 0,797-0,915), it defines the NEWS score as a very good predictorИсследование ставило цель оценить шкалу NEWS в прогнозировании исходов у пациентов приемного отделения на базе ГКБ №40 г. Екатеринбурга. Исследование одноцентровое, проспективное. В качестве конечных точек исследования использовались летальный исход и/или пребывание в ОРИТ >1 суток. Площадь под ROC-кривой шкалы NEWS составила 0,856 (95% ДИ 0,797-0,915), что определяет шкалу NEWS как очень хороший предикто

The role of procalcitonin and lactate at single determination in the intensive care unit in the diagnosis and prognosis of hypovolemic and distributive (septic) shock

The aim of this study was to critically analyze the information value of the blood plasma content of lactate and procalcitonin (PCT) in patients with septic and hypovolemic shockЦель исследования — критический анализ информационной ценности содержания лактата и прокальцитонина (ПКТ) в плазме крови у пациентов с септическим и гиповолемическим шоко

Risk factors for adverse outcomes in burn injury

The article presents the materials we performed a retrospective, observational, epidemiological study in which pre-integrated data on 64 adult patients admitted to the intensive care unit and intensive care unit burn center on the basis of the MAU clinical hospital №40 of Ekaterinburg in 2017 are Excluded from further processing 2 patients due to the inconsistency of inclusion criteria (no data). In the final treatment, 62 patients with acute extensive burn injury were identified, 46 (74.19%) of them survived, 16 (25.81%) died. Inclusion criteria: age from 18 to 99 years, S (total burns) >20%, hospitalization >1 day. Exclusion criteria: no data. The main possible factors for adverse outcomes in burn injury are the following indicators: age (p=0.006), total area of burns >20% (p=0.005), indices, ABSI, Baux, PBI, RBS (pВ статье изложены материалы проведенного ретроспективного, обсервационного, эпидемиологического исследования, в которое предварительно были включены данные о 64 взрослых пациентах, госпитализированных в отделение реанимации и интенсивной терапии (ОРИТ) ожогового центра на базе МАУ ГКБ №40 города Екатеринбург в 2017 г. Исключены из дальнейшей обработки 2 пациента из-за несоответствия критериям включения (отсутствие данных). В окончательную обработку определены 62 пациента с острой обширной ожоговой травмой, из них выжили 46 (74,19%) пациентов, умерли 16 (25,81%). Критерии включения: возраст от 18 до 99 лет, S (общих ожогов) >20%, госпитализация >1 суток. Критерии исключения: отсутствие данных. Основными возможными факторами неблагоприятных исходов при ожоговой травме являются следующие показатели: возраст (p=0,006), общая площадь ожогов >20% (p=0,005), индексы ABSI, Baux, PBI, RBS (