Hypothesis/aims of study. Diabetes mellitus (DM) is associated with an increased risk of obstetric complications, including preterm birth (PB). The incidence rate of PB in women with DM is higher than in the general population and amounts to 3040%. Nevertheless, there are still open questions on the structure of PB, pharmacological approaches to its prevention and treatment, as well as the feasibility of prolonging the timing of glucocorticoid therapy to reduce perinatal morbidity and mortality. The objective of this study was to research the features of structure and clinical approaches in the case of PB in women with different types of DM, based on a literature review. Study design, materials and methods. The study was performed using literature search, screening, data extraction, and analysis of publications collected in world databases such as MEDLINE, EMBASE, CNKI, and Cochrane. Results. The rate of PB is the highest in women with pregestational DM: 2130% in type 1 DM and 1940% in type 2 DM. The incidence of PB in gestational DM (710%) is almost equal to the general population level (79%) and depends on the type of diabetes therapy: insulin 16%, diet 7%. Risk factors for PB in women with DM are poor glycaemic control, microvascular complications of DM, hypertension, obesity, infection, age, fetal macrosomia, polyhydramnios, and congenital malformations. Adequate glycemic control from early gestation is an important condition for PB prevention. The structure of PB in patients with pregestational DM changes due to an increase in both spontaneous and induced PB proportions. The most common indications for early delivery in DM are preeclampsia, premature placental abruption, impaired renal function in diabetic nephropathy, severe forms of carbohydrate metabolism disorders, diabetic fetopathy, and fetal distress. The risk of fetal respiratory distress syndrome in newborns of mothers with DM is higher than in the general population. The maturity of the lungs of a newborn may be insufficient, even in the case of term delivery. The use of antenatal corticosteroids is effective prophylaxis of respiratory disorders. However, these corticosteroids can increase the risk of neonatal hypoglycemia. Conclusion. Despite the term weight and height, the newborn of a mother with DM may remain immature, therefore, delivery at term is recommended. The gestational age, until which it is advisable to prescribe corticosteroids for pregnant women with DM, and the mode of delivery in the case of PB, remain a matter of debate.
For the first time the acute interstitial pneumonitis as a main cause of adult idiopathic respiratory distress syndrome was described in 1933–35 by the American medical scholars Louis Virgil Hamman and Arnold Rice Rich as “acute fibrosing alveolitis” later given the eponymous name Hamman-Rich syndrome. This disease targets the interstitium of the lungs and characterized by fulminant onset, acute respiratory disorder with possibility of respiratory failure, being clinically similar to respiratory distress syndrome with the pathomorphologically revealed diffuse alveolar damage. Hamman-Rich syndrome is characterized by rapid progression from symptoms of common cold such as cough, fever, chills and dyspnea to severe respiratory failure. The syndrome affects apparently healthy individuals and is not associated with any anamnestic chronic lung diseases, smoking habits, neither with patients’ age or sex. The aetiology and pathogenesis of the Hamman-Rich syndrome are not clear yet. The familiar genetic predisposition is of definite meaning, especially related to mutations of surfactant proteins and their metabolism. The possible mechanistic links of this fulminant lung disease involve: NK-cells, auto-aggressive immune activation and certain types of cytokines during their excessive systemic action, so-called cytokine storm (e.g. interleukin-18 and interleukin-2), which play the leading part in the patho-genesis of acute lung cell injury resulting in diffuse non-remitting pneumofibrosis. But all these clinical and pathogenetic features are also common for severe COVID-19. Computed tomography is used for instrumental diagnosis of Hamman-Rich syndrome and also gives the lung images quite similar to that of COVID-19, including ground glass opacity symptoms. The authors hypothesize that the same link(s) of pathogenesis underlie the severe course of COVID-19 and Hamman-Rich syndrome. It is possible that cases of Hamman-Rich syndrome were due to the circulation in populations of a less virulent, unrecognized coronavirus, which interacts with the immune system of genetically susceptible individuals in a way similar to SARS-CoV2. For sure, the identification of the characteristics of the genome of patients with Hamman-Rich syndrome will shed light on the genetic mechanisms that predispose to the severe course of COVID-19 and vice versa — the experience of severe COVID-19 treatment can be applied to the therapy of Hamman-Rich syndrome as well.
The live BCG vaccine, causing a complex response of both innate and cellular as well as humoral adaptive immunity, is a biological adjuvant. It serves as a trigger for a "trained" immune system response, characterized by the activation of monocytes, macrophages, natural killer cells, and lymphoid elements of inborn populations, all contribute to the early activation of non-antigen-specific protective programmes of the body fight against a number of viral, fungal, protozoan infections and neoplastic clones. One of the infections, altered by BCG vaccination, may be COVID-19. The pathogenesis of the development of acute interstitial pneumonia/respiratory distress syndrome caused by COVID-19 is characterized by the triggering of excessive systemic action of inflammatory mediators, in particular, cytokines, due to violation of the focal inflammatory barriers. Gamma-interferon, produced by lymphocytes after BCG vaccination, modulates the activity of a number of interleukins, which in turn may attenuate course of COVID-19 by reducing the activity of IL-12 and IL-18 -dependent reactions. There is an antigenic cross-reaction between the peptides from causative agents of mycobacterioses and SARS-CoV2 because of their proteins' homology. Unlike many adjuvants, BCG decreases the incidence of lymphoid malignancies and its effect on various autoimmunopathies is different, not necessarily harmful. The peculiar character of BCG vaccination effect may be related to its very early impact on immature immune system and symbiotic character of host-BCG interactions. Geo-epidemiological data on the relationship between the historical practice of using BCG vaccination in different countries and the current incidence of new coronavirus infection and mortality from it are presented. Historically, the medical and social reasons for the different national policies of health authorities regarding the use of the BCG vaccine are considered.
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