Features of nephropathy in various types of thrombotic microagniopathies in obstetric practice

Introduction. We assessed the features of kidney injury in patients with different types of TMA during pregnancy, taking into consideration the fact that the acute kidney injury (AKI) that occurs during pregnancy or in the early postpartum period is main- ly caused by various types of thrombotic microangiopathies (TMA), and AKI itself is a serious obstetric complication with the risk of serious complications and mortality for both mother and fetus.Objective of the study. To study the features of nephropathy in different types of pregnancy-associated TMA.Materials and methods. The study included 313 pregnant women, women in childbirth and puerperas, of which 71 women had atypical hemolytic uremic syndrome (aHUS), 124 – HELLP syndrome, 70 – varying degrees of severity of PE, a group of patients with more rare causes of TMA was also identified: TTP, CAPS and sepsis (13 patients) and 45 patients for the control group. We assessed and compared the main clinical, laboratory and instrumental data, and assessed the outcome of labour. Also, histological examination of the kidneys was performed in five patients with aHUS.Results and discussion. The results of the study have shown that the most severe manifestations of TMA in the form of target organ injury and nephropathy are usually occur in patients with aHUS, where all women developed AKI, in some cases with the formation of chronic kidney disease. In the HELLP syndrome group, AKI was recorded in 39%, but renal function quickly restored. It was found that the very fact of the presence of AKI points to a more unfavourable prognosis not only for the patients themselves, but also for the child, being the main risk factor for perinatal death. The findings of urinary sediment tests and morphological evaluation indicate that the resulting ischemia of the renal tissue in cases of aHUS, HELLP syndrome and other types of TMA can lead to tubular necrosis as compared with PE. Our results suggest that it is AKI in HELLP syndrome that is the main risk factor for perinatal death. Alas, this relationship is difficult to trace in patients with aHUS, as all of them had AKI.Conclusions. Timely recognition of the AKI phenomenon in all cases of obstetric TMA can reduce the risks for both mother and fetus. Both the prognosis for mother and the prognosis for child depend on AKI, and timely therapy can lead to a regression of AKI phenomena and the complete restoration of renal function

Avascular osteonecrosis in a young patient with a novel coronavirus infection

COVID‑19 continues demonstrating possible complications after recovery. One of these complications is avascular osteonecrosis, which can lead to bone destruction and patient disability. Cases of the development of osteonecrosis associated with coronavirus infection were widely reported during and after the SARS epidemic in 2003. They also appear to be common in COVID‑19 infection. All patients who have recovered from COVID‑19 infection, especially who received glucocorticoids, are threaten of osteonecrosis development.We describe a case of bone necrosis in a healthy young woman without additional risk factors with a mild course of COVID, who received a short course of glucocorticoids.This is the first described case of COVID‑induced osteonecrosis in our country, although due to the large‑scale use of glucocorticoids, there are probably more such cases. Early diagnosis is important to prevent disease progression. Therefore, clinical alertness is necessary in all patients with COVID‑19

How do methanol masers manage to appear in the youngest star vicinities and isolated molecular clumps?

General characteristics of methanol (CH3OH) maser emission are summarized. It is shown that methanol maser sources are concentrated in the spiral arms. Most of the methanol maser sources from the Perseus arm are associated with embedded stellar clusters and a considerable portion is situated close to compact HII regions. Almost 1/3 of the Perseus Arm sources lie at the edges of optically identified HII regions which means that massive star formation in the Perseus Arm is to a great extent triggered by local phenomena. A multiline analysis of the methanol masers allows us to determine the physical parameters in the regions of maser formation. Maser modelling shows that class II methanol masers can be pumped by the radiation of the warm dust as well as by free-free emission of a hypercompact region hcHII with a turnover frequency exceeding 100 GHz. Methanol masers of both classes can reside in the vicinity of hcHIIs. Modelling shows that periodic changes of maser fluxes can be reproduced by variations of the dust temperature by a few percent which may be caused by variations in the brightness of the central young stellar object reflecting the character of the accretion process. Sensitive observations have shown that the masers with low flux densities can still have considerable amplification factors. The analysis of class I maser surveys allows us to identify four distinct regimes that differ by the series of their brightest lines.Comment: 8 pages, 4 figures, invited presentation at IAU242 "Astrophysical Masers and their environments

Pathological changes of the spleen in mice infected with influenza against the background of the use of saponin tauroside Sx1

Background. It is well known that viral infections are able to cause an imbalance of the interferon system and inhibition of cellular and phagocytic reactions of the body. One of the possible solutions of the flu treatment problem may be the application of immunomodulators of native plant origin since the influenza virus possesses a suppressive effect on cellular immunity and the interferon system.The aim. To evaluate the effect of saponin tauroside Sx1 obtained from Crimean ivy leaves on histological changes in the spleen of mice infected with influenza A/WSN/1/33(H1N1) virus.Material and methods. We used 78 male BALB/c mice weighing 16–18 g which were divided into the groups: control (K; n = 12); healthy animals treated with saponin (KS; n = 22); animals infected with influenza virus A/WSN/1/33(H1N1) (V; n = 22); infected animals treated with saponin tauroside Sx1 twice a day for 3 days (SV; n = 22). Histological studies of the spleen were performed on the 4th (subgroups V, SV, KS) and 14th day (2V, 2SV, 2KS).Results. The spleen tissue of the KS subgroup demonstrated hyperplasia of the white pulp in the form of lymphoid nodules expansion. On the 4th day in the KS subgroup a statistically significant increase in the total area of the lymphoid nodules by 3.9 times compared to the K subgroup was observed. In subgroup V, there was a sharp decrease in the area of white pulp and in 2V the lymphoid nodules zones were practically indistinguishable. Applied correction in the SV and 2SV subgroups significantly ceased the damaging effect of the virus: the lymphoid nodules area increased by 2.7 times in the 2SV subgroup compared to 2V.Conclusion. Infection with the H1N1 influenza virus leads to compensatory activation of the immune response, however, on the 14th day, a pronounced depletion of the splenic white pulp occurred. The introduction of saponin tauroside Sx1 enhanced the functional activity of the spleen due to an increase of the white pulp area

A clinical case of the development of a rare manifestation of cat scratch disease

The aim of study was to demonstrate a rare clinical case of chorioretinitis against the background of a 10-year-old child’s bartonellosis.Цель работы – продемонстрировать редкий клинический случай хориоретинита и птоза на фоне бартонеллеза у ребенка 10 лет

Influence of displose of connecting tissue on the state of cognitive and neuropsychological functions in patients with young age with subarachnoidal blood diffusion

The aim: to assess the severity of the violation of some cognitive and neuropsychological functions in young patients with SAK for the subsequent development of algorithms for differentiated treatment and rehabilitation. Material and methods of the study: a group of the examined patients who underwent SBA under the age of 45 years was 135 people, the average age was 39.5 ± 3.4 years. After repeated randomization, this group was divided into patients with phenotypic signs of DST (99 people-73.3% -basic group) and without it (36 people-26.7% - comparison group). A general examination and examination of internal organs, a neurologic examination according to a conventional scheme using traditional methods with an assessment of the main functional systems and determining the depth of their damage, determination of constitutional types, evaluation of the degree of phenotypic manifestations of DST, neuropsychological examination, general clinical laboratory, neurovisualizational, and statistical were conducted. The analysis of the obtained results showed that by the end of the acute period of the SAK, a qualitatively different structure of errors occurred in a neuropsychological study in groups of young patients with SAK with signs of connective tissue dysplasia and without it. It can be assumed that the revealed risk factors for the development of SAK already in the premorbid period create conditions for the formation of chronic cerebral ischemia in both groups, but just in the main group - dysplastic changes in the vessels, and in the comparison group - traditional vascular risk factors. The relationship between the presence of signs of DST and the restoration of neuropsychological functions of the patient is traced. Patients of a young age with phenotypic and visceral signs of DST are distinguished by the best regression of the neurological deficit in the dynamics of the disease in comparison with the comparison group without signs of DST. The obtained data can be useful for the subsequent development of algorithms of the differentiated approach of treatment and rehabilitation of this category of patients.Цель исследования: оценить выраженность нарушения некоторых когнитивных и нейропсихологических функций у больных молодого возраста с САК для последующей разработки алгоритмов дифференцированного подхода к лечению и реабилитации. Материал и методы исследования: группа обследованных больных, перенесших САК в возрасте до 45 лет составила 135 человек, средний возраст - 39,5±3,4 лет. После повторной рандомизации эта группа была подразделена на больных с фенотипическими признаками ДСТ (99 чел-73,3%-основная группа) и без таковых (36 чел-26,7%- группа сравнения). Проводился общий осмотр и исследование внутренних органов, неврологический осмотр по общепринятой схеме с использованием традиционных методов с оценкой основных функциональных систем и определением глубины их повреждения, определение конституциональных типов, оценка степени выраженности фенотипических проявлений ДСТ, нейропсихологическое исследование, общеклинические лабораторные, нейровизуализационный, статистический. Анализ полученных результатов показал, что к концу острого периода САК имела место качественно отличающаяся структура изменений при нейропсихологическом исследовании в группах больных молодого возраста с САК с признаками ДС и без таковой. Можно предположить, что выявленные факторы риска развития САК уже в преморбидном периоде создают условия для формирования хронической церебральной ишемии в обеих группах, только в основной группе – это диспластические изменения сосудов, а в группе сравнения – традиционные сосудистые факторы риска. Прослеживается взаимосвязь между наличием признаков ДСТ и восстановлением нейропсихологических функций пациента. Пациентов молодого возраста с фенотипическими и висцеральными признаками ДСТ отличает лучший регресс неврологического дефицита в динамике заболевания по сравнению с группой сравнения без признаков ДСТ. Полученные данные могут быть полезны для последующей разработки алгоритмов дифференцированного подхода к лечению и реабилитации данной категории больных

Успешное применение комбинированной экстракорпоральной поддержки жизнеобеспечения при лечении новой коронавирусной инфекции, осложненной развитием полиорганной дисфункции у беременной

Pregnant and postpartum women are at a higher risk of infection with SARS-CoV-2 as well as a higher risk of adverse outcomes for the mother and fetus. Standard approaches to the management of COVID-19-associated multiple organ dysfunction may not always be implemented in this category of patients. In the clinical case of a patient, who developed multiple organ dysfunction syndrome (severe ARDS, coagulopathy) associated with COVID-19 in the postpartum period, we demonstrate the successful use of combined extracorporeal life support that included veno-venous extracorporeal membrane oxygenation, therapeutic plasma exchange and renal replacement therapy with the universal oXiris set.Беременные и родильницы подвержены более высокому риску заражения новой коронавирусной инфекцией и неблагоприятным исходам как для матери, так и для плода. Стандартные подходы к ведению полиорганной дисфункции, ассоциированной с COVID-19, не всегда могут быть осуществлены в этой группе больных за счет измененной физиологии дыхательной системы у беременных и неблагоприятного влияния на плод. На примере пациентки, у которой на фоне COVID-19 развился синдром множественной органной дисфункции (острый респираторный дистресс-синдром тяжелой степени (PaO2/FiO 2 96), коагулопатия), продемонстрировано успешное применение в послеродо­вом периоде комбинированной экстракорпоральной поддержки жизнедеятельности, сочетающей в себе вено-венозную экстракорпоральную мембранную оксигенацию, терапевтический плазмообмен и заместительную почечную терапию с использованием универсального сета oXiris

Macroeconomic policy interaction: State dependency and implications for financial stability in UK: A systemic review

The association between economic and financial stabilities and influence of macroeconomic policies on the financial sector creates scope of active policy role in financial stability. As a contribution to the existing body of knowledge, this study has analysed the implications of macroeconomic policy interaction/coordination for financial stability, proxied by financial assets, i.e. equity and bonds price oscillation. The critical review and analysis of the existing literature on the subject suggests that there is also ample evidence of interdependence between monetary and fiscal policies and this interrelation necessitates coordination between them for the sake of financial stability. There is also a case for analysing the symmetry of financial markets responses to macroeconomic policy interaction. On methodological and empirical grounds, it is vital to test the robustness of policy recommendations to overcome the limitation of a single empirical approach (Jeffrey–Lindley’s paradox). Hence, the Frequentist and Bayesian approaches should be used in commentary manner. The policy interaction and optimal policy combination should also be analysed in the context of institutional design and major financial events to gain insight into the implications of policy interaction in the periods of stable economic and financial environments as well as period of financial and economic distress