Modern concepts of antimicrobial therapy regimens for exacerbation of chronic obstructive pulmonary disease: A review

The publication discusses modern antimicrobial therapy regimens in patients with exacerbation of chronic obstructive pain. Lung diseases from the perspective of the updated version of national recommendations. Indications for prescribing antibiotics, etiological exacerbation risk factors, risk factors for encountering microorganisms with antibiotic resistance mechanisms, selection algorithm antimicrobial drug

Unusual Excimer/Dimer Behavior of a Highly Soluble C,N Platinum(II) Complex with a Spiro-Fluorene Motif.

In this work, we introduce a spiro-fluorene unit into a phenylpyridine (CN)-type ligand as a simple way to deplanarize the structure and increase the solubility of the final platinum(II)···complex. Using a spiro-fluorene unit, orthogonal to the main coordination plane of the complex, reduces intermolecular interactions, leading to increased solubility but without significantly affecting the ability of the complex to form Pt···Pt dimers and excimers. This approach is highly important in the design of platinum(II) complexes, which often suffer from low solubility due to their mainly planar structure, and offers an alternative to the use of bulky alkyl groups. The nonplanar structure is also beneficial for vacuum-deposition techniques as it lowers the sublimation temperature. Importantly, there are no sp hybridized carbon atoms in the cyclometalating ligand that contain hydrogens, the undesired feature that is associated with the low stability of the materials in OLEDs. The complex displays high solubility in toluene, ∼10 mg mL , at room temperature, which allows producing solution-processed OLEDs in a wide range of doping concentrations, 5-100%, and EQE up to 5.9%, with a maximum luminance of 7400 cd m . Concurrently, we have also produced vacuum-deposited OLEDs, which display luminance up to 32 500 cd m and a maximum EQE of 11.8%

An observation of Lagenorhynchus albirostris (Delphinidae, Odontoceti) in Kola Peninsula, Barents Sea in 2011

Lagenorhynchus albirostris is one of the most common Cetacean species in the Barents Sea. However, there is not a mention of its appearance in the Kola Bay. The present report confirms the appearance of a group of Lagenorhynchus albirostris in the Kola Bay near the aquacomplex of the Murmansk Marine Biological Institute of the Kola Research Centre of RAS, Polyarny town, in autumn 2011

The possibilities of impulse oscillometry in the diagnosis of the lung function disorders after COVID-19

Background. Impulse oscillometry (IOS) is an effort independent method of studying lung mechanics. Aim. To study the diagnostic significance of IOS in assessing lung mechanics after COVID-19. Materials and methods. Spirometry, body plethysmography, diffusion test (DLco), IOS parameters were analyzed in 315 patients (the median age 48 years), the median period from the beginning of COVID-19 to the study was 50 days. Statistical analysis included descriptive statistics, correlation analysis and one-dimensional logistic regression analysis with an assessment of odds ratios. Results. In general group, spirometry and body plethysmography parameters were in normal values, while DLCO was reduced in 61% of patients. Parameters of IOS were analyzed in the general group and between the groups, depending on the value of DLco and total lung capacity (TLC): normal or reduced. In general group, reactance area (AX), hererogeneity of resistance Rrs5–Rrs20, resistance at 5 Hz (Rrs5), reactance at 5 Hz (ΔXrs5) were increased in 29.8%, 17.8%, 6%, 4.8% of patients, respectively, and were statistically significantly higher in the group with reduced TLC, whereas in the group with reduced DLco AX, Rrs5–Rrs20 were statistically significantly higher. Logistic regression analysis showed that patients with Rrs5-Rrs200.07 kPa×sec/l or AX0.32 kPa/l had a 1.99-fold and 2.24-fold increased risk for decrease DLco, respectively, while the risk of decrease in TLC was 2.25-fold (p=0.012) and 3.16-fold (p0.001) higher, respectively. Conclusion. IOS allow to detect both dysfunction of small airways (if AX or Rrs5–Rrs20 are increased) and the risk of restrictive pattern and lung diffusion impairment after COVID-19

Development of polyresistance in microorganisms during antibiotic therapy in a multidisciplinary hospital during a pandemic COVID-19

Background. Irrational and excessive use of antimicrobials drugs (AMD) creates conditions for the development of a global crisis of health systems around the world associated with antibiotic resistance. Aim. To conduct a retrospective study of the impact of the use of AMD on the change in the microbiological landscape and the sensitivity of microorganisms in the conditions of pandemic of the new coronavirus infection (COVID-19) in 2020–2021 in intensive care departments (ICD) of a multidisciplinary hospital. Materials and methods. In the course of the work, strains of microorganisms isolated from patients and from the surfaces of the hospital environment and changes in their sensitivity to significant groups of AMD in ICD for somatic and infectious patients with COVID-19 were compared. The sensitivity of the isolates was evaluated in accordance with the criteria of requirements of European Committee on Antimicrobial Susceptibility Testing – EUCAST, version 10.0, 2020. Results. A total of 1,394 isolates were studied, including 1,379 clinical and 15 isolates from the surfaces of the hospital environment. It was found that in all ICD in 2020–2021, gram-negative microorganisms prevailed in infectious loci in 70% of cases or more. In 2021, in the ICD in infectious patients with COVID-19, the persistent dominance of the Acinetobacter baumannii microorganism was revealed with an increase in the number of poly- and pan-resistant strains – 48.7%. While in the ICD for somatic patients Klebsiella Pneumoniae prevailed among gram-negative microorganisms – 37.5% in 2020 and 43.7% in 2021. It has been shown that in one department or in adjacent departments of the same medical institution, various nosocomial microorganisms with an unequal set of resistance genes and sensitivity to AMD may appear over time. Conclusion. The necessity of conducting constant microbiological monitoring and a passport of the medical department with mandatory registration of not only isolated strains of microorganisms, but also resistance genes in order to optimize the appointment of timely adequate empirical antimicrobial therapy is substantiated. The period of the latter should be as short as possible, and confirmed by convincing clinical signs of bacterial infection, and subsequently by the isolation of nosocomial flora from the biomaterial of critical loci from patients

Диагностика трудных дыхательных путей: обзор литературы

АКТУАЛЬНОСТЬ: Осложнения, возникающие при поддержании проходимости дыхательных путей, в практике анестезиолога-реаниматолога остаются наиболее опасными для жизни и здоровья пациента. Проблема прогнозирования трудных дыхательных путей (ТДП) изучается не одно десятилетие, однако до сих пор не решена. ЦЕЛЬ ИССЛЕДОВАНИЯ: Провести анализ литературы по теме диагностики ТДП. МАТЕРИАЛЫ И МЕТОДЫ: Литературный поиск по базам данных PubMed (MEDLINE), eLibrary, Google Scholar проводился за период с января 1985 г. по январь 2022 г. по ключевым словам: difficult airways prediction, difficult airways, difficult intubation, mask ventilation, endoscopy intubation, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), трудные дыхательные пути, трудная интубация, трудная ларингоскопия, масочная вентиляция, ультразвуковая диагностика, компьютерная томография (КТ), магнитно-резонансная томография (МРТ). Критерии включения: оригинальные, обзорные статьи, рандомизированные и нерандомизированные клинические исследования, метаанализы и систематические обзоры, посвященные диагностике ТДП. Критерии исключения: клинические случаи, комментарии к статьям, авторефераты диссертационных работ. РЕЗУЛЬТАТЫ: Анализ литературы показал, что на сегодняшний день в практике врача анестезиолога-реаниматолога не существует убедительных тестов и симптомов диагностики ТДП. Инструментальные методы исследования позволяют с большей уверенностью диагностировать трудные дыхательные пути при различных клинических ситуациях и у различных категорий пациентов. Толщина языка, расстояние от кожи до надгортанника или голосовых складок, длинный надгортанник могут достаточно точно предсказывать трудности на различных этапах поддержания проходимости дыхательных путей от вентиляции лицевой маской до ларингоскопии и интубации трахеи. Наиболее оптимальным методом диагностики ТДП следует считать ультразвуковое исследование, которое в отличие от рентгенологических и магнитно-резонансных методов могут проводиться практически в любых условиях. ВЫВОДЫ: Инструментальные методы диагностики ТДП более эффективны по сравнению с физикальными

Возможности импульсной осциллометрии в диагностике обструкции дыхательных путей легкой степени выраженности

The aim of this study was to investigate a role of impulse oscillometry (IO) for detection of mild bronchial obstruction. Methods. The study involved 87 patients with different respiratory diseases. Bronchial obstruction according to spirometry results was found in 50 patients (the study group). The control group patients did not demonstrate any abnormalities in spirometry, body plethysmography and lung diffusing test. Results. An abnormal increase in frequency-dependent resistive component of respiratory impedance (Rrs) at the oscillation frequency of 5Hrz and 10 Hrz [both the relative oscillation frequency (Rrs5–Rrs20)/Rrs20 and the absolute oscillation frequency (Rrs5–Rrs20)] was found in patients with mild bronchial obstruction. The resonance frequency (fres) shifted towards higher frequency; reactance area (AX) increase and expiratory airflow (DXrs5) limitation were also found in those patients. Rrs5, Rrs20, and the reactive resistance (Xrs5) were within the normal range. Conclusion. Rrs5 и Xrs5 could detect mild bronchial obstruction only in 32 % of the cases. AX is more useful parameter as it increased in 64% of the patients. The severity of bronchial obstruction diagnosed with IO or spirometry was not identical in some cases.Нередко начальным проявлением заболеваний легких являются функциональные нарушения, а именно – нарушение проходимости бронхов. Выявление обструктивного типа вентиляционных расстройств на ранних стадиях является важной клинической задачей, т. к. позволяет своевременно диагностировать болезнь и начать лечение, улучшив тем самым прогноз заболевания. Одним из самых доступных методов, позволяющих выявлять бронхиальную обструкцию, является спирометрия. Необходимое условие проведения спирометрии – правильное выполнение дыхательных маневров, однако при этом требуется хорошая кооперация пациента с медицинским персоналом, что не всегда выполнимо. Импульсная осциллометрия (ИОМ) отличается тем, что измерения осуществляются при спокойном дыхании, активного участия пациента не требуется. Однако остается много неизученных и спорных вопросов, касающихся интерпретации результатов ИОМ. Целью данного исследования явилось изучение возможности ИОМ при диагностике обструкции дыхательных путей легкой степени выраженности. Материалы и методы. Обследованы пациенты (n = 87) с разнообразной бронхолегочной патологией, при этом выявлены вентиляционные нарушения обструктивного типа легкой степени (n = 50). В группе сравнения (n = 37) нарушений по данным спирометрии, бодиплетизмографии и диффузионного теста не отмечено. Результаты. У больных с легкой степенью бронхиальной обструкции, установленной по данным спирометрии, наблюдалось патологическое увеличение частотной зависимости резистивного компонента дыхательного импеданса (Rrs) при частоте осцилляций 5 и 20 Гц (как относительной (Rrs5–Rrs20) / Rrs20, так и абсолютной (Rrs5–Rrs20)), смещение резонансной частоты (fres) в область высоких частот, увеличение площади реактанса (АХ) и экспираторное ограничение потока (DXrs5) при сохранении в пределах нормальных значений Rrs5, Rrs20 и реактивного сопротивления (Xrs5). Заключение. Показано, что при использовании базовых параметров Rrs5 и Xrs5 обструкция легкой степени выраженности, установленная при помощи традиционных функциональных методов, наблюдалась только в 32 % случаев. АХ явился более информативным методом, поскольку изменялся значительно чаще – его увеличение зарегистрировано у 64 % пациентов. Выраженность обструктивных нарушений по данным ИОМ не всегда совпадало с выраженностью нарушений, определяемых при помощи спирометрии

Динамика функционального состояния системы дыхания через 4 месяца после перенесенного COVID-19

The end of the acute period of COVID-19 does not mean complete recovery. Observation of patients in the post-COVID-19 period showed that a significant number of people experience shortness of breath, fatigue, muscle weakness, sleep disorders, cough, palpitations, so the term post-COVID-19 syndrome was coined. The examination to identify the causes of complaints of COVID-19 convalescents should include lung function assessment.The aim of the study was to assess the dynamics of lung function 4 months after hospitalization for COVID-19.Methods. 31 patients (26 males, the median age was 49 years) underwent traditional pulmonary function tests (PFTs) (spirometry, body plethysmography, test of diffusing lung capacity) and impulse oscillometry (IOS). Results. During the 1st visit, the average PFTs and IOS parameters were within the normal range in the whole group, apart from the diffusing lung capacity (DLCO), which was reduced mildly (on the border with moderate) in 77% of patients. During the 2nd visit, which was conducted on average 102 days after the 1st one, 58% of patients demonstrated abnormal lung diffusion capacity. The second assessment revealed a statistically significant increase in the slow and forced vital capacity (VC and FVC), the forced exhalation volume in 1 second (FEV1), total lung capacity (TLC), DLCO, and a decrease in the ratio of FEV1/FVC and the residual lung volume to TLC ratio.Conclusion. Post-COVID-19 patients show a statistically significant improvement of their lung function 4 months after hospital discharge. A systematic follow-up is essential for such patients to detect lung function abnormalities and correct them.Окончание острого периода COVID-19 не означает полного выздоровления. При наблюдении за пациентами в постковидный период показано, что у части из них сохраняется широкий спектр жалоб – одышка, усталость, утомляемость, мышечная слабость, нарушения сна, кашель, сердцебиение, что способствовало появлению нового термина «постковидная болезнь». С целью выявления причин жалоб у перенесших COVID-19 пациентов необходимо проводить функциональную диагностику системы дыхания.Целью исследования явилась оценка динамики функциональных показателей системы дыхания через 4 мес. после госпитализации по поводу COVID-19.Материалы и методы. В исследование были включены пациенты (n = 31: 26 (84 %) – мужчины; средний возраст – 49 лет), перенесшие COVID-19. В рамках исследования проводились традиционные легочные функциональные тесты (спирометрия, бодиплетизмография, исследование диффузионной способности легких по монооксиду углерода (DLCO) и импульсная осциллометрия (ИОС).Результаты. Во время 1-го визита в среднем по группе показатели легочных функциональных тестов и ИОС составляли нормальные значения, кроме DLCO, которая была снижена у 77 % пациентов в легкой (на границе с умеренной) степени. Во время 2-го визита (через 102 дня после 1-го) в среднем по группе нарушение DLCO сохранялось у 58 %. При сравнительном анализе изучаемых показателей во время 1-го и 2-го визитов выявлено статистически значимое увеличение спокойной и форсированной жизненной емкости легких (ФЖЕЛ) и объема форсированного выдоха за 1-ю секунду (ОФВ1), общей емкости легких (ОЕЛ), DLCO, а также снижение соотношений ОФВ1 / ФЖЕЛ и остаточного объема легких / ОЕЛ при повторном исследовании.Заключение. У пациентов, перенесших COVID-19, через 4 мес. после выписки из стационара отмечается статистически значимое улучшение вентиляционной функции и DLCO. Целесообразно проводить оценку функциональных показателей системы дыхания в постковидный период с целью выявления и своевременной коррекции нарушений

Cyclometalation Geometry of the Bridging Ligand as a Tuning Tool for Photophysics of Dinuclear Ir(III) Complexes

Bridging ligands play a crucial role in design of luminescent dinuclear metal complexes. Bis-cyclometalating ligands gave rise to a large family of highly efficient emitters. Herein, we investigate the effect of switching the cyclometalating function of the bridging (chromophoric) ligand on photophysical properties of dinuclear Ir(III) complexes. The new dinuclear Ir(III) complex (Ir-1), comprising a bridging chromophoric ligand with two terminal cyclometalating phenyl derivatives, conjugated to the central twice nitrogen-coordinating thiazolo[5,4-d]thiazole derivative, displays red phosphorescence of decent efficiency in CH2Cl2 solution at room temperature (Phi(PL) = 12%, tau = 1.5 mu s, and lambda = 635 nm). This is several times more efficient compared to the properties of the earlier reported dinuclear Ir(III) complex IrIr, with a bridging ligand comprising terminal nitrogen-coordinating pyridine derivatives and a central cyclometalating thieno[3,2-b]thiophene derivative, under the same conditions (Phi(PL) = 3.5%, tau = 2.9 mu s, and lambda = 714 nm). This "C/N swap" within the bridging ligand caused blue-shifted and improved efficiency of phosphorescence of Ir-1. The origin of this effect is the significantly reduced exchange interaction in state T-1 and, consequently, smaller Delta E(S-1 - T-1) energy gap. According to the density functional theory calculations, this comes from the more even (wider) distribution of the highest occupied molecular orbital within the bridging ligand and increased participation of the metal centers and halide atoms in the formation of states S-1 and T-1. Modulation of the substituent pattern on the bridging ligand in complex Ir-2, analogous to Ir-1, afforded selective tuning of the phosphorescence rate, whereas other properties of phosphorescence remained similar under the same conditions (Phi(PL) = 15%, tau = 3.1 mu s, and lambda = 632 nm)

Halide-Enhanced Spin–Orbit Coupling and the Phosphorescence Rate in Ir(III) Complexes

The spin-forbidden nature of phosphorescence in Ir(III) complexes is relaxed by the metal-induced effect of spin-orbit coupling (SOC). A further increase of the phosphorescence rate could potentially be achieved by introducing additional centers capable of further enhancing the SOC effect, such as metal-coordinated halides. Herein, we present a dinuclear Ir(III) complex Ir2I2 that contains two Ir(III)-iodide moieties. The complex shows intense phosphorescence with a quantum yield of FPL(300 K) = 90% and a submicrosecond decay time of only tau(300 K) = 0.34 mu s, as measured under ambient temperature for the degassed toluene solution. These values correspond to a top value T-1 -> S-0 phosphorescence rate of kr = 2.65 x 10(6) s(-1). Investigations at cryogenic temperatures allowed us to determine the zero-field splitting (ZFS) of the emitting state T1 ZFS(III-I) = 170 cm(-1) and unusually short individual decay times of T1 substates: t(I) = 6.4 mu s, tau(II) = 7.6 mu s, and t(III) = 0.05 mu s. This indicates a strong SOC of state T1 with singlet states. Theoretical investigations suggest that the SOC of state T1 with singlets is also contributed by halides. Strongly contributing to the higher occupied molecular orbitals of the complex (e.g., HOMO, HOMO - 1, and so forth), iodides work as important SOC centers that operate in tandem with metals. The examples of Ir2I2 and of earlier reported analogous complex Ir2Cl2 reveal that the metal-coordinated halides can enhance the SOC of state T-1 with singlets and, consequently, the phosphorescence rate. A comparative study of Ir2I2 and Ir2Cl2 shows that the share of halides in total contribution (halides plus metals) to the SOC of state T-1 with singlets increases strongly upon exchange of chlorides for iodides. The exchange also led to the decrease in values of ZFS of the T-1 state from ZFS(III-I) = 205 cm(-1) for Ir2Cl2 to T1 ZFS(III-I) = 170 cm(-1) for Ir2I2. This results in a more efficient thermal population of the fastest emitting T-1 substate III, thus further enhancing the roomtemperature phosphorescence rate