Smoking and Its Consequences in Pregnant Women in Ukraine

Smoking during pregnancy increases the risk of a number of complications of pregnancy and can have adverse effects on the child. This study provides data from Ukraine that are consistent with the international literature on the effects of smoking during pregnancy. The study of nearly 700 women in Ukraine examined the rate of smoking during pregnancy and factors related to continued smoking. It documents the outcomes of pregnancy in women who smoked prior to pregnancy, and who smoked during pregnancy compared to those who did not. It also looks at pregnancy outcomes with respect to the baby’s father smoking. Smoking during pregnancy is at low levels in Ukraine (<5% of pregnant women), but is associated with family structure, the baby’s father smoking, and the number of previous abortions. It is also associated with placental insufficiency, low birth weight, fetus hypotrophy, and hip joint dysphasia. The father’s smoking is associated with decreased fertility, late toxicosis, miscarriage threat in third trimester, small baby, and lower infant functional status. There was no evidence that information on the dangers of smoking while pregnant encouraged cessation.World Bank by the Swedish International Development Cooperation Agency (SIDA) and the US Centers for Disease Control, Office on Smoking and Healt

Large Deviations of the Maximum Eigenvalue in Wishart Random Matrices

We compute analytically the probability of large fluctuations to the left of the mean of the largest eigenvalue in the Wishart (Laguerre) ensemble of positive definite random matrices. We show that the probability that all the eigenvalues of a (N x N) Wishart matrix W=X^T X (where X is a rectangular M x N matrix with independent Gaussian entries) are smaller than the mean value =N/c decreases for large N as $\sim \exp[-\frac{\beta}{2}N^2 \Phi_{-}(\frac{2}{\sqrt{c}}+1;c)]$, where \beta=1,2 correspond respectively to real and complex Wishart matrices, c=N/M < 1 and \Phi_{-}(x;c) is a large deviation function that we compute explicitly. The result for the Anti-Wishart case (M < N) simply follows by exchanging M and N. We also analytically determine the average spectral density of an ensemble of constrained Wishart matrices whose eigenvalues are forced to be smaller than a fixed barrier. The numerical simulations are in excellent agreement with the analytical predictions.Comment: Published version. References and appendix adde

Особенности муковисцидоза у пациентов, жителей Чувашской Республики

Summary. The paper presents an analysis of clinical, genetic, microbiological and functional findings of 51 patients with cystic fibrosis living in the Chuvash Republic. Data of neonatal screening for cystic fibrosis in this region are shown. The findings suggest a significant prevalence of the "mild" E92K mutation in the patients' genetic profile. Clinically, the "mild" genotype was related to the absence of pancreatic injury as one of the major CF signs and significantly fewer digestive complications. Several aspects of СF treatment are highlighted in the article. Early, immediately after diagnosis, administration of dornase alpha (Pulmozyme) could prevent chronic inflammation in the lungs. Regular treatment with dornase alpha could delay development of irreversible pulmonary complications, improve quality of life of the children during an intensive growth and maintain lung function. Improved adherence to treatment in adult patients could improve the prognosis and bring hope to a long active life.Резюме. В статье представлены результаты анализа клинико-генетических, микробиологических и функциональных методов исследования у 51 пациента с муковисцидозом (МВ), все – жители Чувашской Республики. Приведены показатели неонатального скрининга на МВ в данном регионе. Полученные данные свидетельствуют о значительном преобладании "мягкой" мутации E92K в генетическом профиле больных. "Мягкий" генотип в клинической картине выражен отсутствием важнейшей в диагностике МВ симптоматики поражения поджелудочной железы, значительно меньшим числом осложнений со стороны органов пищеварения. Освещены некоторые аспекты терапии заболевания. Раннее, сразу после установления диагноза, назначение препарата Пульмозим способствует профилактике развития хронического воспаления в легких. Регулярное лечение препаратом Пульмозим предупреждает раннее развитие необратимых легочных осложнений, улучшает качество жизни детей в период интенсивного роста, дает возможность сохранить легочную функцию, близкую к нормальной. Повышение приверженности лечению среди взрослых пациентов улучшает прогноз жизни, дает надежду на долгую активную взрослую жизнь

COVID-19 у больных муковисцидозом

Since the beginning of the COVID-19 epidemic, the European cystic fibrosis society (ECFS) has decided to launch a special ECFS-COVID-19 program to collect information on the of COVID-19 characteristics in the patients with cystic fibrosis (CF). The results of the program should help timely and efficiently provide the patients with CF with the necessary care. Initially, it was assumed that COVID-19 would be severe in CF patients. The aim. Тo assess the prevalence and characteristics of COVID-19 in patients with cystic fibrosis (CF) in the Russian Federation (RF). Methods. 6 cases (4 children and 2 adults) of COVID-19 in Russian CF patients were analyzed. Results. There are 405,843 infected with SARS-CoV-2 in Russia, the incidence of coronavirus infection in Russia was 1.4 cases per 1 thousand people. According to the Ministry of Health of the RF, as of December 2019, there were 3,931 patients with CF (2,823 children and 1,108 adults). The incidence of COVID-19 was 1.5 per 1000 patients with CF (1.4 : 1,000 for children and 1.8 : 1,000 for adults). The incidence was not higher than in the General population. The diagnosis of COVID-19 was confirmed in 4 boys and 2 women, 3 of the patients were infected with Pseudomonas aeruginosa and 2 – with Achromobacter spp. Mild disease was seen in 5 patients including all the children. Pneumonia was registered in 3 patients. One child with COVID-19 had abdominal syndrome. 2 patients – 1 adult and 1 child – needed in-patient care. Additional antibiotics were given to 4 patients, 2 of them received i/v antibiotics. One adult patient was on the lung transplantation waiting list. This woman had long-term oxygen therapy and BiPAP noninvasive respiratory support before the infection with SARS-CoV-2, FEV1 was 24 %pred. Conclusion. Despite the fact that patients with CF are at risk of severe COVID-19, to date, in the described cases, COVID-19 infection has not led to a significant deterioration of the symptoms of CF. Not a single fatal outcome in Russian patients with CF has been recorded.С начала эпидемии COVID-19 Европейским обществом по муковисцидозу (European Cystic Fibrosis Society – ECFS) инициирована специальная программа наблюдения ECFS-COVID-19 для сбора информации по особенностям течения COVID-19 у пациентов с муковисцидозом (МВ). Ожидается, что данная программа должна помочь своевременно и качественно оказывать необходимую помощь пациентам с МВ. Первоначально предполагалось, что на фоне МВ COVID-19 протекать будет тяжело. Целью исследования явилась оценка распространенности и течения COVID-19 у пациентов с МВ в Российской Федерации. Материалы и методы. Проанализированы 6 (4 ребенка и 2 взрослых) случаев заболевания COVID-19 у российских пациентов с МВ. Результаты. В Российской Федерации SARSCoV-2 инфицированы 405 843 человека, заболеваемость коронавирусной инфекцией составила 1,4 случая на 1 тыс. населения. Учитывая численность пациентов в регистре МВ (по данным Министерства здравоохранения Российской Федерации, на декабрь 2019 г. в регистр включен 3 931 пациент: 2 823 ребенка и 1 108 взрослых), заболеваемость SARS-CoV-2 составила около 1,5 на 1 тыс. пациентов с МВ (1,4 : 1 000 – для детей и 1,8 : 1 000 – для взрослых), что не превышает таковую в общей популяции. Заболеваемость COVID-19 на 01.08.20 среди пациентов с МВ составила 3,8 (0,38 %) на 1 тыс. пациентов (2,1 : 1 000 – для детей и 8,8 : 1 000 – для взрослых). Диагноз COVID-19 подтвердился у 4 детей (все мальчики) и 2 взрослых женщин, при этом 3 больных были инфицированы Pseudomonas aeruginosa, 2 – Achromobacter spp. В легкой форме заболевание протекало у 4 из 6 пациентов, включая всех детей, пневмония зарегистрирована у 3 пациентов. У одного из 4 детей с COVID-19 отмечался абдоминальный синдром при отсутствии респираторных проявлений; 2 пациента (1 взрослый и 1 ребенок) нуждались в стационарном лечении. Антибактериальная терапия назначена 4 пациентам, двум из них – внутривенно. Одна взрослая пациентка, объем форсированного выдоха за 1-ю секунду у которой составлял 24 %долж. , зарегистрирована в листе ожидания на трансплантацию легких, до заражения SARS-CoV-2 у нее проводились длительная кислородотерапия и неинвазивная респираторная поддержка BiPAP. При подтверждении коронавирусной инфекции она была выписана из больницы. Заключение. Несмотря на то что пациенты с МВ находятся в группе риска тяжелого течения заболевания, на сегодняшний день в описанных случаях COVID-19 инфекция не привела к значительному ухудшению состояния по основному заболеванию. У российских пациентов с МВ не зарегистрировано ни одного летального исхода

ТРАНСПЛАНТАЦИЯ ЛЕГКИХ ПРИ МУКОВИСЦИДОЗЕ С ХРОНИЧЕСКИМ ИНФИЦИРОВАНИЕМ ДЫХАТЕЛЬНЫХ ПУТЕЙ BURKHOLDERIA CEPACIA (первое наблюдение в Российской Федерации)

Cystic fibrosis (CF) is the third most common indication for lung transplantation. The recipients with CF have shown the best early and late survival rates after surgery. The special group of CF patients consists of those, whose airways were infected with Burkholderia cepacia (B. cepacia), since the recurrence of B. cepacia infection after transplantation are coupled with extremely high risk of death. Up to the present, the question whether the patients in such conditions should be included onto the lung transplant waiting list is still unanswered. We describe a case of lung transplantation in the patient with late postoperative complication in the form of severe pyoseptic infl ammatory process caused by the recurrence of B. cepacia infection. The success of the treatment of this patient was achieved thanks to combined multidisciplinary approach. This therapeutic approach could be considered as a standard treatment protocol in case of its validation by further clinical experience.Муковисцидоз (МВ) занимает третье место среди показаний к трансплантации легких, при этом реципиенты с этим заболеванием имеют наилучшие ранние и отдаленные результаты после операции. Особую группу пациентов с МВ составляют те, у которых дыхательные пути инфицированы Burkholderia cepacia (B. cepacia), так как рецидив этой инфекции в послеоперационном периоде сопряжен с крайне высоким риском летального исхода. До настоящего времени в мировом научном медицинском сообществе обсуждается вопрос о необходимости и возможности включения таких пациентов в лист ожидания. Мы приводим собственное наблюдение трансплантации легких такому пациенту с развитием в позднем послеоперационном периоде тяжелого гнойно-септического процесса, обусловленного рецидивом инфекции B. cepacia. Успех в лечении рассматриваемого пациента был обусловлен комплексным мультидисциплинарным подходом, который может претендовать на стандартный протокол в случае подтверждения его эффективности дальнейшим клиническим опытом.

Динамика выживаемости больных муковисцидозом в Москве и Московской области за периоды 1992–2001 и 2002–2011 гг.

Summary. The aim of this study was to evaluate changes in survival of patients with cystic fibrosis (CF) in Moscow and Moscow region and to determine factors influencing the survival. We analyzed outpatient medical records of patients followed-up in Moscow CF centers by the 1st of January, 2002, and by the 1st of January, 2012.Median survival for 2002–2012 was 37.2 years; this was significantly higher that the similar value for the previous decade (25.9 years). A total number of CF patients was more than doubled due to increased survival and improved diagnosis of the disease.Improved survival was due to improved work of CF centers and to implementation of effective medications, primarily dornase alfa (Pulmozyme) and some inhaled and systemic antibiotics and macrolides in subinhibitory concentrations, in routine clinical practice. Gram-negative infection, especially Burkholderia cepacia, was shown to decrease survival in CF patients in contrary to "mild" mutations that are better prognostic factors.Резюме. Целью работы явилось определение динамики числа и выживаемости больных муковисцидозом (МВ) в Москве и Московской области, а также определение факторов, влияющих на выживаемость. Были проанализированы амбулаторные карты больных, состоящих на учете в московских центрах муковисцидоза на 01.01.2002 и 01.01.2012.Медиана выживаемости больных за периоды 2002–2011 гг. составила 37,2 года, что достоверно выше, чем аналогичный показатель за предыдущее 10-летие – 25,9 года. Отмечено более чем 2-кратное увеличение общего количества больных, обусловленное ростом выживаемости и улучшением диагностики.Увеличение выживаемости обусловлено оптимизацией работы центров МВ и началом рутинного применения различных эффективных медикаментозных препаратов, прежде всего дорназы альфа (Пульмозим), а также некоторых ингаляционных и системных антибиотиков, макролидов в субингибирующих концентрациях. Показано, что инфицирование грамотрицательной инфекцией, особенно Burkholderia cepacia, снижает выживаемость пациентов с МВ, а наличие "мягкого" генотипа является более благоприятным прогностическим фактором

STUDY OF THE INFLUENCE OF EMPLOYED COEFFICIENTS ON PROGNOSTIC DURATION OF THE COMPETITIVE BALANCE OF HEALTH DEVELOPMENT PARTICIPANTS

The aim of the work – to study the influence of weight coefficients on the prognostic validity of the competition score; by means of mathematical substantiation the optimal values of these coefficients are determined, which will ensure the maximum validity of competitive selection. Materials and Methods. The study of the success of higher education students of the first year of full-time education by specialty 226 «Pharmacy» was conducted. The estimation of the linear interconnection power between the competition score (and its components) and the indicators of the current success of higher education was obtained by calculating the Pearson correlation coefficient. Statistical processing is done using Microsoft Excel. Results and Discussion. The article examines the possibility and feasibility of using the results of external testing to identify entrants who can successfully continue their studies at a higher school. The mathematically based recommendations for improving the quality of competitive selection for identifying entrants who will be able to successfully study at higher educational institutions are offered. The recommendations are based on a statistical analysis of the data on the success of higher education students of the first year of specialization 226 «Pharmacy» in the field of knowledge «Health», entered the National Pharmaceutical University (NUPh) in 2015 in comparison with the competition point. It has been proved that by purposefully changing the weighting factors used in the calculation of the competition, the university can positively influence the qualitative composition of higher education graduates. The value of weight coefficients, at which the maximum validity of competitive selection is achieved, is obtained. Conclusions. According to the results of the study, the correlation between the competition score of the student and the current achievement of the applicant of higher education during the first and second semester of the study was established

Observational study of the use of 7% sodium chloride solution combined with 0,1% hyaluronic acid in therapy of adults with cystic fibrosis

A non-interventional prospective cohort study was conducted on adult patients with cystic fibrosis, who received mucolytic therapy with 7% NaCl solution combined with 0.1% hyaluronic acid (medical product Hyaneb) and 7% NaCl solution for 4 and 8 weeks. Materials and methods: A total of 24 CF patients over 18 years old were enrolled in the study. A comparative analysis of respiratory function, therapy satisfaction, efficacy and safety of treatment was conducted following 4 weeks of therapy in 7% NaCl Solution Group (n = 12) and MP Hyaneb Group (n = 12), and the dynamics of these parameters was assessed against the background of the use of MP Hyaneb for 8 weeks (n = 12). Results: At week 4 of treatment, a significantly smaller number of patients complained of nasal congestion, ears and or accumulation of mucus in the throat and chest, irritation of the throat and unpleasant taste in the MP Hyaneb Group. No significant differences in the onset and increase in the intensity of cough were achieved. No significant differences between the groups in terms of spirometry parameters were identified. Findings: MP Hyaneb showed the best tolerability compared to 7% NaCl solution in adult patients with cystic fibrosis. The use of MP Hyaneb reduces the frequency and severity of irritation of the pharyngeal mucosa, cough and nasal congestion following administration for one month