Vol 75, No 4 (2020)

Preterm delivery (PTB) is one of the most common and serious complications of pregnancy. PTB accounts for approximately 70% of neonatal deaths and is a major cause of neonatal morbidity including respiratory distress syndrome, necrotising enterocolitis and long-term neurological disabilities. Prevention of PTB and its complications include identification among symptomatic women those at high risk of immediate delivery requiring prenatal corticosteroids administration. Transvaginal ultrasonographic evaluation of the cervical length (CL) is predictive of PTB and a value < 15 mm identifies among symptomatic women approximately 70% of women who will deliver within one week. In the range of CL within 15 and 30 mm biomarkers in cervical-vaginal fluids (fetal fibronectin, phosphorylated insulin-like growth factor protein-1, placental alpha-microglobulin-1, cytokines) and other ultrasonographic cervical variables (posterior cervical angle, elastography) improve the identification of women at risk. In asymptomatic women CL can be applied as screening and has been proposed as a universal screening during the second trimester in singleton gestations. The finding of a CL ≤ 25 mm is associated with an increased risk of subsequent PTB with a sensitivity between 30 and 60% that is improved with the combination of biomarkers. Asymptomatic women with a CL ≤ 25 mm should be offered vaginal progesterone treatment for the prevention of preterm birth and neonatal morbidity. The role of cerclage and pessary is still controversial. In this review we discuss the evidence-based role of ultrasonographic cervical assessment and cervicovaginal biomarkers in the prediction of PTB in symptomatic and asymptomatic women.

The coronavirus disease 2019 (COVID-19) has rapidly swept the world. Patients with cancer could be at particular risk of COVID-19, since they are often immunosuppressed by their therapy. Assessing the risk-benefit ratio of potentially immunosuppressive treatment for patients with cancer with insufficient knowledge of this new disease and balancing individual and community benefits poses acute ethical dilemmas for oncologists. Researchers provided the first guidelines for cancer patients treatment. Individual treatment plans should be adjusted to minimise routine visits, procedures and tests. Patients should be categorised into different priorities for receiving active cancer therapy during the pandemic. Oncologists should consider changing intravenous treatments to subcutaneous or oral routes, as well as suspending radiation therapy or using hypofractionation. In case of developing COVID-19 patients with cancer should be treated in the respiratory or intensive care units rather than in the oncology units. Preventive measures and emergency plans to help patients should also be developed. The COVID-19 pandemic has had a devastating impact on clinical research in haematology and oncology. A dramatic reduction in the number of participants in current research and delays in planned haematology and oncology research, as well as adverse financial consequences and potential delays in the delivery of promising drugs to patients should be expected. Regulatory agencies provided guidelines on managing clinical trials during the COVID-19 pandemic, emphasising the importance of pragmatism and flexibility in routine visits, procedures and tumour assessments and clearly documenting protocol deviations. Ensuring patients’ safety during the pandemic is of primary priority. Every trial participant should be contacted before the planned visit to ensure they don’t have any COVID-19 symptoms. Laboratory and radiological assessments should be done at the closest to patient medical facility, and some investigational products, such as oral medications, should be delivered directly to patient to avoid hospital visits. The COVID-19 pandemic has had a serious negative impact on both treatment of cancer patients and research in this area. The support of all stakeholders is the only thing that can help ensure the best possible care for patients at this difficult time.

Rationale. Cardiovascular diseases remain the leading cause of human death in the world. Studying the role of regulatory non-coding RNAs, which include short single-stranded miRNA molecules, allows a more detailed understanding of the pathological processes underlying the progression of atherosclerosis.

Objective — to compare the levels of circulating miRNAs in patients with coronary heart disease, confirmed by multislice computed tomography-coronarography (MSCT-CA), with risks of cardiovascular complications and clinical and demographic characteristics. To compare the profiles of circulating miRNAs in groups of patients with stable and unstable atherosclerotic plaques.

Methods. MicroRNA levels in the plasma of peripheral blood of patients with coronary heart disease were determined using the miScript miRNA PCR Array MIHS-105Z kit (Qiagen). The significance of differences in miRNA levels between the compared groups was determined using the Mann–Whitney U-test. The correlations of the levels of circulating miRNAs with clinical and demographic parameters were evaluated using the Spearman correlation coefficient. Risk assessment of cardiovascular complications in these patients was carried out using validated scales (ACC/AHA, Framinghm, SCORE, MESA). Atherosclerotic plaque stability was evaluated using MSCT-CA.

Results. The study showed a significant (p < 0.05) decrease in miR-16, miR-211, miR-195 miRNA levels in the plasma of patients with coronary heart disease, which correlated with an increase in cardiac vascular risk (CVR) according to ACC/AHA, Framingham and MESA. When comparing groups of patients with stable and unstable atherosclerotic plaques, the latter revealed an increase in the level of let-7b-5p circulating microRNA (p < 0.05).

 Conclusion. Significant associations of the three studied microRNAs with the estimated risk of CVR were identified. It is important to find circulating let-7b-5p in a group of patients with unstable atherosclerotic plaques. Correlations were established between the levels of circulating microRNAs and clinical and demographic characteristics of patients. The study shows the involvement of some microRNAs in the regulation of atherosclerosis.

Recently published data on the pathogenesis and cutaneous manifestations of a new coronavirus infection (COVID-19) are presented. The most described lesions are urticarial, papulo-vesicular, erythematous rash, purpura, livedo-angiitis, as well as chilblains. Eruptions mainly appear together with main COVID-19 symptoms or a few days later. The treatment of new coronavirus infection may lead to a quick regression of skin lesions along with improvement of the general state of the patient. The review also provides data on the fact that COVID-19 patients with severe psoriasis and atopic dermatitis receiving biologic therapy (guselkumab, ustekinumab, adalimumab, secukinumab, ixekizumab, etanercept, dupilumab) and phosphodiesterase-4 inhibitors experience mild or asymptomatic COVID-19. Moreover, such patients do not develop cutaneous manifestations of COVID-19. The specific COVID-19 treatment has not been developed yet. We think that these findings might provide better understanding of mechanisms of action of biologic drugs in COVID-19.

The analysis of scientific publication, dedicated to human pathogenic orthopoxviruses over the past 40 years is generalized. The essential activation of focies of monkeypox in Central Africa, cowpox in Europe, buffalopox in South-East Asia, camelpox in South-West and Central Asia and vaccinia-like viruses in Southern America is marked on the background of the apperance of three novel representatives of orthopoxviruses in North America (agents of volepox, raccoonpox and skunpox) and two representatives of African orthopoxviruses (agents of Uasingishu, named self-titled province of Kenya and taterpox).It is concluded, that this is facilitated by almost complete absence of anti-smallpox immunity after the elimination of smallpox and stopping immunization in the world on the background of active human intervention in the nature. Expert do not exclude, that as a result of a mutation of one of orthopoxviruses of animal, similar to smallpox virus agent will exist. Whereat the world will face a threat, much more serious that swine flu or avian flu. It is concluded that modern scientific and methodological approaches to study of orthopoxvirus infections evolution allow to predict threats, related on biological safety of Russian Federation.

The spread of a new coronavirus infection worldwide since the end of 2019 has becomes a pandemic. Thrombotic complications are the leading cause of death in this disease. After entering the human body, the virus starts a cascade of reactions leading to the development of a cytokine storm, activation of all parts of the hemostasis and complement systems and other changes that result in disturbances in the circulation system with the development of multiple organ failures. Numerous studies have shown that a predictor of a severe course of COVID-19 is a sharp increase of D-dimer concentration in the blood and rise of some other markers of hemostasis activation. Based on the pathogenesis, the developed schemes for the prevention and treatment of COVID-19 severe complications include low molecular weight heparins (LMWH) which are also recommended for an outpatient COVID-19 patient. The prescription of low molecular weight heparin, the duration of their use and doses should be decided on the basis of a risk assessment of factors for each individual patient in combination with laboratory monitoring.

The emergence of viral respiratory pathogens with high pandemic potential, such as the SARS-CoV-2, poses a serious public health problem, with a very limited arsenal of effective tools and techniques to prevent and treat a new pandemic infection. The literature on the involvement of reactive oxygen species in the pathogenesis of coronavirus infections and the potential for antioxidant therapy was reviewed. Because of available evidence on the involvement of oxidative stress in the mechanisms of initiation and maintenance of homeostasis disorders in SARS-CoV-2, approaches combining reduction of ROS synthesis, inhibition of virus replication, anti-inflammatory action, reduction of hypoxia, and reduction of the toxic effects of drug therapy may be very effective. The hypothesis of the expediency of treating systemic inflammation aimed at “quenching” the cytokine “storm”, caused largely by the production of reactive oxygen species, seems essential. In this connection, it is pathophysiologically justified to use for prophylactic and therapeutic purposes antioxidant drugs, which have proven themselves on the example of other viral respiratory infections. Thus, the high activity of preparations of vitamin C, N-acetylcysteine, melatonin, quercetin, glutathione, astaxanthin, polyphenols, polyunsaturated fatty acids, etc. was noted. In addition, these drugs effectively protect the vascular wall, which has been proven for a number of cardiovascular diseases and that can be effective in developing with COVID-19 vasculitis. There is a more pronounced combined effect of these drugs, which is already used in treatment protocols for patients with SARS-CoV-2. Special attention should also be paid to the use of antioxidant drugs as a means to reduce the toxic manifestations of antiviral therapy. Thus, the use of drugs with antioxidant activity can be justified and will certainly improve the effectiveness of the fight against the pandemic of new coronavirus infection.

In the context of the COVID-19 pandemic, 50 patients and 30 medical personnel were infected in a psychiatric hospital in Wuhan (Hubei Province, China), which required the Ministry of Health of China to urgently analyze the situation and develop a set of measures aimed at containing the spread of the virus and organizing a full and safe psychiatric care. The reasons for this situation could be the lack of reserve beds for psychiatric patients, low awareness of psychiatrists in diagnosing and treating infectious diseases, the separation of the psychiatric care system between the two departments, and the cramped living conditions of patients in psychiatric hospitals. More than 500 psychiatrists from across the country were sent to Wuhan to fill staff. Psychiatric patients with mild to moderate COVID-19 were transferred to temporary psychiatric hospitals organized in gymnasiums and exhibition centers. Severely ill psychiatric patients COVID-19 were transferred to hospital infectious diseases. A single patient routing system was organized, a shift schedule for doctors was introduced. To reduce the burden on public transport, the outpatient unit of psychiatric care was taken to regional hospitals, which had previously dealt only with forensic psychiatry and the control of patients with addictive disorders. Based on the experience of Wuhan, psychiatric communities from different countries proposed a list of practical recommendations designed to reduce the risks of spreading the infection and optimize the work of psychiatric care. Before admission to the general department of a psychiatric hospital, a fourteen-day observation of incoming patients in a separate room is necessary. It is necessary to ensure full remote monitoring of outpatients. It is necessary to increase the awareness of staff about infectious diseases, methods for their diagnosis and treatment. All hospitals should have a reserve bed capacity, which can be used for the rehabilitation and socialization of patients in quiet times. Hospitals must be provided with a sufficient number of tests, drugs, and personal protective equipment. Outpatients need to be fully provided with access to medical and psychotherapeutic therapy using telemedicine technologies to minimize the risk of infection. It is crucial to restructure the appointment of doctors by introducing work on a shift schedule: two weeks in two weeks, which will not only ensure a good rest but also allow doctors to be quarantined after each shift.

Background. Pregnancy and diabetes mellitus (GDM) developed during this period are extremely unfavorable combinations for both the mother and the fetus, leading to severe consequences in the gestational period. GDM significantly increases the frequency of undesirable outcomes of pregnancy and childbirth, and also poses a serious medical and social problem for both the mother and the fetus.

Aims — to study the level of cytokines (TGFβ and IL-1β), oxytocin and relaxin in patients with gestational diabetes mellitus (GDM) in the blood serum and placenta and to show their role in the choice of delivery tactics.

Materials and methods. We examined 230 women who made up 2 groups — the control (with the physiological course of pregnancy, n = 95) and the main (with gestational diabetes, n = 135). All studies were performed in the blood serum and placenta of women of these groups. The content of TGFβ and IL-1β was determined by enzyme-linked immunosorbent assay using the R&D system (USA) and Cytimmune systems (USA) kits, and the level of relaxin and oxytocin was measured using BIOSOURCE (USA) kits.

Results. We studied the production of cytokines and relaxants in the blood serum and placenta of women with GDM is in close relationship, which is confirmed by the revealed correlation dependencies: between relaxin before birth and after they have ended (among themselves, r = 0.79; p < 0.05), as well as oxytocin (among themselves, r = 0.78; p < 0.05) in the same period. After the end of labor, a negative relationship was found in the placenta between relaxin and IL-1β (r = –0.61; p < 0.01).

Conclusions. The ratios of relaxin to oxytocin in blood serum revealed by us can be considered as possible prognostic indicators for choosing the tactics of labor management. The use of identified biochemical markers will allow timely selection of the method of delivery in women with GDM in order to reduce the risk of complications in childbirth and thereby favorably influence perinatal outcomes and reduce the incidence of newborns.