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Vol 76, No 4 (2021)

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OBSTETRICS AND GYNAECOLOGY: CURRENT ISSUES

Oligohydramnion in the First Half of Pregnancy in the Fetuses with Congenital Abnormalities: Ultrasound Diagnostics and Obstetric Outcomes

Voevodin S.M., Shemanaeva T.V., Serova A.V.

Abstract

Background. Oligohydramnion in the first half of pregnancy, combined with congenital abnormalities in the fetus has objective difficulties in diagnosis. The morphology features and type of defects associated with oligohydramnion, which manifests in the first half of pregnancy, are not sufficiently studied at the present stage. 

Aims — to evaluate the clinical significance of diagnosing oligohydramnion in the first half of pregnancy in women with congenital fetal malformations. 

Materials and methods. The analysis of the course of pregnancy and perinatal outcomes in 77 women with low water content in combination with congenital malformations of the fetus and 72 patients with a normal amount of amniotic fluid and no congenital malformations of the fetus was performed. The patients of the main group were divided into two subgroups depending on the severity of oligohydramnion: the 1st subgroup (n = 54) —patients with severe oligohydramnion and the 2nd subgroup (n = 23) — patients with moderate oligohydramnion. The amount of amniotic fluid was determined by 3D/4D ultrasound (13–21 weeks of gestation) and the structure of fetal abnormalities associated with oligohydramnion was analyzed. We evaluated perinatal outcomes in women with congenital malformations of the fetus in combination with oligohydramnion and the effect of its severity on the outcome of pregnancy. 

Results. In the main group (n = 77), fetal abnormalities were detected in patients: urinary system — 39 (50.6%), respiratory system — 4 (5.2%), heart — 1 (1.3%), chromosomal and genetic abnormalities — 14 (18.2%), central nervous system — 3 (3.9%), osseous system — 3 (3.9%), multiple — 13 (16.9%). In the main group (n = 77), pregnancy was terminated for medical indications in 47 (61%) cases, in 6 (7.8%) spontaneous miscarriage occurred, in 5 (6.5%) — antenatal fetal death. 19 (24.7%) children were born alive, and surgical treatment in the neonatal period was required in 8 (10.4%) cases. In the 1st subgroup (n = 54) in 53 (98.1%) cases, there was a loss of the fetus, in 1 (1.9%) — the newborn died on the 9th day. In the 2nd subgroup (n = 23), fetal death occurred in 5 (21.7%) cases, 18 (78.3%) children were born alive, and 8 (44.4%) newborns were operated on in the neonatal period. In the control group, all pregnancies ended with the birth of healthy children. A decrease in ultrasound imaging of internal organs in the fetus was observed when a pregnant woman was obese (BMI more than 35). 

Conclusions. Oligohydramnion in the first half of pregnancy in combination with fetal malformation should be considered an extremely unfavorable clinical sign for the prognosis of pregnancy and the health of the fetus and newborn. 3D/4D ultrasound scanning allows you to reliably determine oligohydramnion in the first half of pregnancy, and the degree of its severity to assume the nature of complications.

Annals of the Russian academy of medical sciences. 2021;76(4):341-350
pages 341-350 views

INFECTIOUS DISEASES: CURRENT ISSUES

Modern Tendencies of the Use and Development of Drugs of Bacteriophages

Bakhrushina E.O., Anurova M.N., Aleshkin A.V., Demina N.B., Krasnyuk I.I., Pyatigorskaya N.V., Beregovykh V.V.

Abstract

The article discusses the main uses of bacteriophages as an alternative or supplement to antibiotic therapy. The authors characterize the drugs of bacteriophages and perfume and cosmetic products containing bacteriophages presented on the pharmaceutical market of the Russian Federation. Prospects and algorithms for the extemporal manufacture of medicinal forms with bacteriophages for personalized therapy, developed in countries of Europe, USA, China, Russian Federation are considered. The analysis of scientific publications on the main international databases shows the interest of the developers in the problem of the creation of new bacteriophages preparations with stable titer in different medicinal forms for routes of medication administration. One of the problems of pharmaceutical development of such products is the insufficient regulatory framework. It was noted that for the first time in the State Pharmacopoeia of the Russian Federation a general pharmacopaedic article “Bacteriophages medicinal-prophylactic” and private pharmacopaedic articles about the main bacteriophages and their cocktails produced by the Russian industry were introduced. It has been shown that expansion of the range of medicinal forms and ways of introducing bacteriophages, extemporal manufacture of effective and stable preparations along with their industrial production — an attainable task.

Annals of the Russian academy of medical sciences. 2021;76(4):351-360
pages 351-360 views

A Prospective Multicenter Randomized Study State of Humoral Immunity after a New Coronavirus Infection (COVID-19) of a Mild or Asymptomatic Course

Kryukov E.V., Trishkin D.V., Salukhov V.V., Sadovnikov P.S., Andreychuk Y.V., Chugunov A.A., Kotiv B.N.

Abstract

Background. The rapid spread of COVID-19 in the world, the severity of disease, high morbidity and mortality have rightly made the COVID-19 pandemic a major threat to humanity. Therefore, one of the most urgent problems for practical health care is the issue of development of immunity for COVID-19 survivors, the possibility of re-infection, and the appropriateness of vaccination. The article presents the interim results of the study was named “RESPONSE” devoted to assessing the immunity for 90 days from patients that survived COVID-19 in a mild or asymptomatic course. 

Aims — to study of the dynamics of generation of SARS-CoV-2 adhesive (S) protein neutralizing antibodies (IgG) and specificities of humoral immunity from COVID-19 survivors with light and asymptomatic form of disease in depending on gender and age. 

Materials and methods. Joint study by the Military Medical Academy n.a. S.M. Kirov and Laboratory Service “Helix” is being undertaken in the period from January 06, 2020 to August 1, 2021 on the basis of Academy clinics and Helix diagnostic centers in Saint Petersburg. The study was included 1109 males and females aged 18 to 70 (average age 38.2), who received to outpatient treatment of light and asymptomatic form of New Coronavirus Infection. All patients included in the investigation were done survey of quantitative neutralizing antibodies of class IgG to S-protein SARS-CoV-2 content in venous blood in 30, 45, 60 and 90 days from the last result of positive polymerase chain reaction with reverse transcription (OT-PCR) for determining nucleic acid SARS-CoV-2 in biological material by immunochemiluminescent analysis (LIAISON XL, DiaSorin S.p.A., made in Italy). 

Results. The IgG class antibody to the S-protein SARS-CoV-2 were not diagnosed 30 days after the survived infection only 0.9% of young women (18–44 years) and 0.8% of men in the same age bracket. In other age groups, antibodies were defined in all participants of study. Titer of IgG gradually increases to peak concentration after 45 days, it’s kept at this level to the 60th day, and then it has a decreasing trend after 90 days from the onset of the disease. 

Conclusions. The results show the timing of generation and duration of the humoral response in survived patients COVID-19 in a mild or asymptomatic form. For 45 days, antibodies were determined in all participants of the study, reflecting the development of post-infectious humoral immunity, which was maintained in patients with the mild or asymptomatic forms of COVID-19 at least 3 months.

Annals of the Russian academy of medical sciences. 2021;76(4):361-367
pages 361-367 views

CARDIOLOGY AND CARDIOVASCULAR SURGERY: CURRENT ISSUES

Associated Pathology in Case of Death from Circulatory Circulatory Diseases According to the Analysis of Multiple Causes

Zubko A.V., Sabgayda T.P., Ivanova A.E., Evdokushkina G.N., Zaporozhchenko V.G., Starodubov V.I.

Abstract

Background. Comorbidity of diseases deteriorates health and often increases the risk of death. Identification of comorbidities with diseases of the circulatory system (DCS) will help find additional measures to increase life expectancy. 

Aims — to identify causes associated with death from DCS and to analyze their interrelation based on the multiple cause analysis. 

Materials and methods. Data on DCS deaths of the Death registration in the Moscow Unified Medical Information and Analytical System (RFS-EMIAS) in 2019 (46 000 deaths) and from April to May 2020 (11 000 deaths) excluding perinatal mortality were analyzed. The association analysis was carried out across groups of the ICD-10 DCS blocks by calculating the corresponding frequency. Effect of SARS-CoV-2 was analyzed in the infected deceased and those free from infection. Comparison was carried out by the Chi-square test. 

Results. The following Diseases of the circulatory system are associated with Diabetes mellitus: Hypertension, Coronary heart disease, Cerebrovascular diseases, and Diseases of arteries, arterioles and capillaries. A synergetic effect has been identified in comorbidity with the diseases characterized by high blood pressure and Chronic rheumatic heart diseases, “other forms of heart disease”(I30–I52), Cerebrovascular diseases and Diseases of arteries, arterioles and capillaries; the latter and Coronary heart disease and Cerebrovascular diseases; “other forms of heart disease” and Mental disorders due to psychoactive substance use; Diseases of veins, lymphatic vessels and lymph nodes and Pulmonary circulation disorders. Effect of the increased risk of death in non-symmetric associations of causes has been detected for comorbidity of Diseases of veins, lymph vessels and lymph nodes and Chronic viral hepatitis; Coronary heart disease and “other forms of heart disease”; Hypertension and Coronary heart disease; in males – comorbidity of Obesity and Hypertension, and Diseases of arteries, arterioles and capillaries and Hypertension. Associations between DCS and their complications have been identified in females: Diseases of veins, lymph vessels and lymph nodes and Phlegmon, and Cerebrovascular diseases and Decubital ulcers. 

Conclusion. SARS-CoV-2 increases mortality from Chronic coronary heart disease, ICD-10 I67.8 code for Other specified cerebrovascular diseases and Hypertension in females 1.5-fold. The infection rate in females died from DCS is significantly lower compared to the one in males.

Annals of the Russian academy of medical sciences. 2021;76(4):368-376
pages 368-376 views

HEALTH CARE MANAGEMENT: CURRENT ISSUES

Development of Minimally Invasive Cardiac Surgery Technologies as a Direction That Affects the Reduction of Mortality from Cardiovascular Diseases (on the Example of the Nizhny Novgorod Region)

Pereslegina I.A., Levanov V.M., Bolshev A.S., Varenova L.E.

Abstract

Background. Cardiovascular diseases (CVD) are the leading cause of death in the population. It is necessary to assess the priority areas of investment and development of medical technologies that can effectively influence the reduction of mortality. 

Aims— to study the impact of minimally invasive surgical interventions on population mortality. 

Materials and methods. During the period from 2009 to 2019 was conducted analysis and assessment of the effect of the number of percutaneous coronary interventions (PCI) performed in the Nizhny Novgorod region, on mortality, including mortality from CVD, ischemic heart disease (IHD) and acute myocardial infarction (AMI) To study the relationship between these indicators were calculated the Spearman rank correlation coefficient. The prediction was performed using the multiple regression method. To evaluate the initial and predicted data (regression model), we used the cook and Mahalanobis distance indicators. 

Results. Over 11 years, the region has seen a significant increase in the number of PCI-from 220 to 6048 (27.5 times). During the same time, the total death rate in the region decreased from 17.42 to 14.60 per 1000 population (by 16.2%), from СМВ by 30.7%. A strong negative correlation was found between the number of PCI and mortality from CVD (r = –0.892), from CHD (r = –0.856), and from AMI (r = –0.904). A regression model of the result was developed, taking into account mortality rates and the number of PCI. The cook and Mahalanobis distance indicators indicate a change in the development vector of data variance since 2014, which may be due to changes in the infrastructure and volumes of cardiological and cardiac surgery care. 

Conclusion. The results of the analysis indicate the high feasibility of further development of cardiac surgery in the region. The resulting regression model can be used in planning the volume of medical care, taking into account the achievement of target demographic indicators and available health resources.

Annals of the Russian academy of medical sciences. 2021;76(4):377-383
pages 377-383 views

OPHTHALMOLOGY: CURRENT ISSUES

Clinical and Functional Characteristics of Secondary Geographic Atrophy Against the Background of Exudative Age-Related Macular Degeneration

Neroev V.V., Zueva M.V., Neroeva N.V., Katargina L.A., Losanova O.A., Ryabina M.V., Tsapenko I.V.

Abstract

Background. Studies demonstrate the need for long-term follow-up of patients with wet age-related macular degeneration (AMD) treated with inhibitors of angiogenesis to monitor long-term vision outcomes and assess the safety of antiangiogenic therapy in relation to the risk of secondary geographic atrophy. 

Aims — to determine the characteristic clinical and functional signs of secondary GA that developed against the background of wet AMD. 

Methods. In 22 patients (25 eyes) with wet AMD and 18 healthy subjects comparable in age and sex standard ophthalmological and instrumental studies were performed and photopic electroretinograms (ERGs) were recorded according to ISCEV standards, flicker-ERGs, multifocal ERGs and electrooculogram. 

Results. The appearance of the area of secondary atrophy against the background of wet AMD in eyes treated with inhibitors of angiogenesis is clinically indistinguishable from areas of geographic atrophy that developed as an outcome of dry AMD. The ERG-signs of secondary atrophy are described, which are similar to the biomarkers of primary atrophy and specifically differ from them. Secondary atrophy is characterized by the dependence of the increase in the b/a ratio on the atrophic area, reducing of the 8.3 Hz-flicker-ERG amplitude in the absence of 24 Hz-flicker ERG changes. In eyes with secondary atrophy, a significant decrease in the density of the multifocal ERG P1-peak was shown not only in the first hexagon but also in the parafoveal zone. The electrooculography results showed a sharper dark trough’s decrease in with an increase in Arden’s ratio in patients with secondary atrophya on the background of wet AMD, in contrast to the previously described changes in primary geographic atrophy. 

Conclusion. Comparison of the change in the b/a ratio with secondary atrophy area in patients with wet AMD may have clinical implications for assessing retinal dysfunction and predicting visual function. Secondary atrophy is associated with a pronounced inhibition of photoreceptor activity with better preservation of cone bipolar cells. The ERG and electrooculography data taking together indicate a more significant dysfunction of the retinal pigment epithelium in GA against the background of wet AMD and the associated deterioration of photoreceptor function than the changes characterizing primary geographic atrophy.

Annals of the Russian academy of medical sciences. 2021;76(4):384-393
pages 384-393 views

RHEUMATOLOGY: CURRENT ISSUES

Role of Dendritic Cells in the Rheumatic Diseases Pathogenesis: Review

Kurochkina Y.D., Korolev M.A.

Abstract

Dendritic cells (DCs) are professional antigen presenting cells that can as stimulate immune response as suppress immune inflamma tion. Recently the role of DCs in the pathogenesis of autoimmune diseases and the possibility of their application as diagnostic markers and methods of treatment has been studied more and more. It was shown that subpopulations DCs play different role in pathogenesis various autoimmune diseases. Thus, pathogenesis of rheumatoid arthritis and ankylosing spondylitis is associated with activity of myeloid DCs and their possibility to present arthritogenic peptides to T-cells. While plasmocytoid DCs are more important in pathogenesis systemic lupus erythematosus and systemic sclerosis. The review presents the results of the latest registered clinical trials about applications DCs in different autoimmune diseases as well as current ideas about functional features DCs during autoimmune diseases. The existing data confirm their possible use as well as the safety of DC in treatment.

Annals of the Russian academy of medical sciences. 2021;76(4):394-401
pages 394-401 views

The Value of Trabecular Bone Score in Patients with Rheumatic Diseases

Kolpakov K.I., Korolev M.A., Ubshaeva Y.B.

Abstract

Background. Trabecular bone score obtained by lumbar spine Dual-energy X-ray Absorptiometry is a novel and insufficiently explored instrument of accessing trabecular bone quality. One of its promising applications is early diagnostics of osteoporosis (OP) before fragility fractures appear. Meanwhile most of systemic inflammatory rheumatic diseases affect bone tissue either directly and indirectly by glucocorticoids consumption. Both factors potentiate OP development and can influence the trabecular bone score. 

Aims — to evaluate the possibilities of trabecular bone score using in rheumatology. 

Materials and Methods. Data analysis of domestic and foreign scientific publications. 

Results and Discussion. Authors of analyzed publications note stable association of low trabecular bone score with vertebral fractures, its correlation with local inflammatory markers in lumbar spine and ankylosing spondylitis structural progression. In most studies trabecular bone score do not have association with systemic inflammatory activity and treatment. 

Conclusion. Trabecular bone score is effective in OP diagnostics in rheumatic patients, evaluation of local inflammatory activity in the lumbar spine and structural progression of ankylosing spondylitis.

Annals of the Russian academy of medical sciences. 2021;76(4):402-411
pages 402-411 views

EPIDEMIOLOGY: CURRENT ISSUES

Characteristics of the COVID-19 Epidemiological Situation in the Russian Federation in 2020

Akimkin V.G., Kuzin S.N., Semenenko T.A., Ploskireva A.A., Dubodelov D.V., Tivanova E.V., Pshenichcnaya N.Y., Kalenskaya A.V., Yatsyshina S.B., Shipulina O.Y., Rodionova E.N., Petrova N.S., Soloveva I.V., Kvasova O.A., Vershinina M.A., Mamoshina M.V., Klushkina V.V., Kudryavceva E.N., Churilova N.S., Panasyuk Y.V., Vlasenko N.V., Ostroushko A.A., Balmasov E.S., Mosunov A.V.

Abstract

Background. The COVID-19 epidemic in the Russian Federation, which began in March 2020, caused serious damage to health of the population and led to severe economic losses. By December 28, 2020, 3 078 035 cases of COVID-19 and 55 265 lethal outcomes were registered in the country. The population of all territorial subjects of the country is involved in the epidemic process of COVID-19. The severe epidemiological situation made it necessary to conduct an analysis to identify the factors that determine the high intensity of the epidemic process, as well as the population groups with the highest risk of SARS-CoV-2 infection. 

Aims — to study the patterns of SARS-CoV-2 spread and the epidemiological features of the initial stage of the COVID-19 pandemic in the Russian Federation in 2020. 

Methods. An epidemiological analysis of the COVID-19 situation in the Russian Federation was carried out to determine the dynamics of morbidity, the gender proportion and age structure of patients, the proportion of hospitalized patients, the ratio of various forms of infection, the social and professional status of patients. Standard methods of descriptive statistics Microsoft Excel and STATISTICA 12.0 (StatSoft, USA) were used for statistical processing. The mean values were estimated with a 95% confidence interval [95% CI] (the exact Klopper – Pearson method). 

Results. During the observation time (2020), several periods were identified in the dynamics of the new COVID-19 cases detection: the period of importation of SARS-CoV-2 and the increase in morbidity, the period of epidemic decline, the period of autumn growth, the period of sustained high incidence of COVID-19. It was found that people over 70 years of age are the group with the highest risk of infection and a more severe course of COVID-19. The presence of target contingents among social and professional groups of the population, which should include medical workers, retired person, employees of educational institutions, law enforcement agencies, transport, who require special attention and medical and social support, was shown. 

Conclusions. The analysis showed that the large-scale spread of COVID-19 requires in-depth epidemiological studies and the development of additional disease control measures, taking into account the dynamics of the incidence of this socially significant infection.

Annals of the Russian academy of medical sciences. 2021;76(4):412-422
pages 412-422 views

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