Summary. Purpose: to identify early immunoinflammatory predictors of the development of disorders of the hemostasis system (coagulation, anticoagulation, and fibrinolysis) in patients with urgent cardiac and vascular surgical pathology in the conditions of joining the SARS-Cov-2 viral infection and in the long term after infection. The results. For patients with COVID-19, a characteristic excessive long-term activation of the complement system was revealed, which is manifested by an increase in the level of C3 and C4 components (in the acute period of Covid-19, the level of the C3 component of complement was increased by 83 % and 157 %, respectively, for patients with vascular and cardiac pathology, and the level of the C4 component in these groups exceeded the reference level by 96 % and 124 %, respectively). It was shown that the content of C-reactive protein significantly exceeded the reference level in the acute period of Covid-19 in vascular pathology by 22.7 times, in cardiac pathology by 10.6 times, in the post-covid period this ratio was maintained, namely, in vascular pathology in 26.6 times, with cardiac pathology 15.5 times, that is, in vascular pathology, C-reactive protein was always increased significantly more than in cardiac. Thrombocytopenia, detected in all groups, especially in the acute period of SARS-Cov-2 infection, (vascular pathology — a decrease in the number of platelets by 2 times or by 50 %, cardiac pathology — by 15 %), (vascular pathology in the post-covid period — a decrease by 38 %, cardiac pathology — a decrease of 22.7 %), due to the activation of platelets due to increased thrombin formation and subsequent clearance by the reticulo-endothelial system, activation of thrombus formation and consumption coagulopathy, direct viral-platelet interaction, interaction with immune complexes (antigen + antibody + complement), clearance of platelets due to pronounced endotheliitis in main and capillary vessels. Excessive activation of the complement system along with a significant increase in the content of CRP has a prognostic value for the duration and severity of immunoinflammatory reactions and clinically expressed complications in the distant post-covid period against the background of surgical pathology. A significantly increased concentration of IL-6 in vascular pathology was revealed in the acute period of viral infection by 27.7 times, in the post-viral period by 24.4 times. In cardiac pathology, the concentration of IL-6 was significantly increased in the acute period by 2.5 times, and in the post-epidemic period by 3.2 times due to pro-compensatory and adaptive reactions against the background of suppression of the adhesive and absorbing properties of phagocytic neutrophils. A significant increase in the concentration of IL-18 in the blood serum of all examined patients in the acute period was found: in vascular pathology by 24.6 %, in heart pathology by 70 %, indicating long-term activation of macrophages. Different degrees of increase in complement components and cytokines in the acute period of Covid-19 infection and in the post-covid period may indicate the predominance of one or another inflammatory mechanism in vascular and cardiac pathology. In 100 % of patients with vascular pathology in the acute period, a 79-fold increase in procalcitonin was observed, in the post-covid period — in 50 %, a significant increase of 42 times, with cardiac pathology in the acute period — in 50 % - 43 times, in the post-covid period — in 58 % by 46 times, which indicated the formation of a spectrum of cytotoxic molecules when a bacterial infection occurred and required antibiotic therapy. A significant increase in the concentration of fibrinogen, fibrin, and soluble fibrin-monomeric complexes (FSMC) was observed in all examined groups of patients in all periods. It was proved that the activity of thrombus formation was 4.6 times more pronounced in vascular pathology in the acute period, while in cardiac pathology it was 2 times more pronounced, and in the postoperative period in vascular pathology it was 2.3 times, in cardiac pathology it was 1,8 times. For the first time, it was found that in all examined groups of patients, the concentration of the native physiological anticoagulant antithrombin III was reduced, and this was most pronounced in the group of cardiac pathology in the post-covid period than in vascular, therefore, in cardiac pathology, the anticoagulant properties were the most lost, perhaps even due to not only dependent on viral infection, but also genomic predictors. The change in another link of the hemostasis system indicated the activation of fibrinolysis at the first stage, namely, a significant increase in the concentration of D-dimers in all types of pathology as in acute (vascular pathology — 4.2-fold increase, cardiac pathology — 2.7-fold), and in the post-epidemic periods (vascular pathology — 7.7 times, cardiac pathology — 2.4 times), while it is most pronounced in the group of cardiac pathology in the acute viral period. Against the background of a significant increase in the content of IL-6 both in the acute and in the remote period after infection with SARS-Cov-2, in 100 % of patients with cardiac pathology, fibrinolytic activity was significantly reduced in connection with the inhibited activity of plasminogen due to the inhibition of the activity of this pro-inflammatory interleukin activator plasminogen. A decrease in the concentration of plasminogen in all examined groups of patients by 18-29.5 % indicated the phenomenon of consumption of plasminogen for the formation of plasmin during the preliminary activation of fibrinolysis against the background of an actual increase in the concentration of fibrin. Possible clinical consequences of a decrease in the concentration of the native physiological anticoagulant antithrombin III and plasminogen in the acute period of SARS-Cov-2 infection and the post-covid period are a decrease in anticoagulant activity, a threat of thrombus formation, a decrease in fibrinolytic activity, and in combination with an increase in the concentration of fibrin, fibrinogen, soluble fibrin monomers complexes and D-dimers — the threat of DIC-syndrome formation. Hemostasiological markers of DIC in the hypercoagulable phase were detected in 6 patients, namely, in the acute period of SARS-Cov-2 infection in 2 patients with cardiac pathology and 1 patient with vascular pathology, in the post-COVID period in 2 patients with cardiac pathology and in 1 patient with abdominal pathology. DIC in the hypocoagulation phase was not detected in any patient. Therefore, the immune-inflammatory reaction to the SARS-CoV-2 viral infection leads to a noticeable activation of coagulation — the process of thrombosis — with signs of systemic endothelial inflammatory damage, namely — endotheliitis, and the subsequent loss of the physiological properties of the endothelium. The general thing, as a rule, is the presence of common patterns, which are manifested in the fact that the SARS-Cov-2 virus interacts with complement proteins and endothelial cells and platelets, which causes an inflammatory reaction in all organs and systems. Conclusions. 1. Immunopathological mechanisms formed against the background of the interaction of SARS-Cov-2 proteins with endothelial cells and proteins of the complement system, which form membrane-attacking complexes, lead to violations of the structural and functional organization of endothelial cells in both main and capillary vessels, which leads to pathologies of various organs and pathologies of the hemostasis system. 2. Thus, the processes occurring in the endothelium are characterized by inflammatory changes that cause activation of the plasma link of hemostasis, which includes coagulation, anticoagulation, and fibrinolysis factors, activation of the complement protein system, changes in the function of platelets and their interaction with endothelial cells, which in various combinations indicate risk of thrombogenicity or DIC. 3. The revealed regularities of the interaction of factors of innate immunity and the SARS-Cov-2 virus, which contribute to the development of a long-term immunoinflammatory reaction in the form of endotheliitis, require personalized treatment for comorbid conditions, taking into account changes in indicators of immunoresistance and the hemostasis system.
Perfusion scintigraphy of the myocardium was carried out with the help of the Millennium MG gamma camera (USA) in synchronization with the ECG in 141 patients aged of from 5 to 15 years. Patients were divided into four groups: 30 chronic myocarditis (CM) patients, 30 hypertrophic cardiomyopathy (HCMP) patients, 30 dilated cardiomyopathy (DCMP) cases and 21noncompact cardiomyopathy (NCMP) patients. The left ventricular (LV) ejection fraction was established to be preserved in CM and HCMC patients (in cases without signs of obstruction), a significant reduction in the ejection fraction was found in NKMP and DCMP patients. The thickness of the myocardium of the LV significantly increased only in HCM patients. The expansion of the LV cavity was detected in all patients, but its decrease was present only in HCM cases. The contractility of the myocardium was impaired in all the patients examined. Disturbances of the myocardial perfusion were the most pronounced in NKMP and DCMP patients. Signs of fibrosis were detected in most patients, but HCM patients. In 40% of CM patients, scintigraphic signs of inflammation were determined. In 17% of all examinations there was noted hyperperfusion of the right ventricular myocardium. The authors believe myocardial tomoscintigraphy to be the unique method for analyzing myocardial viability in various forms of cardiac pathology that can be used for the evaluation of the effectiveness of the treatment.
Possibilities of legal regulation of cyber bullying are considered in modern conditions. Aggressive behavior in the Internet space is gaining momentum in its distribution among adolescents not only in Russia but throughout the world. Cyber bullying is one of the newest, most dangerous, and also depressing emotional states of a teenager in terms of the consequences of the risk they face. The concept of “cyber bullying” is considered; its forms are specified; proposals aimed at neutralizing the bullying that occurs among adolescents in the Internet space are formulated.
Summary. Goal. Investigation of the interactions of coagulation, anticoagulant and fibrinolytic systems with factors of immunoresistance in hepatosplenomegaly syndrome (SHSM). Materials and methods. Materials — сells and blood serum of 58 patients with SHSM against the background of liver cirrhosis complicated by portal hypertension, with the etiological factor — HCV / HBV virus infection (group I, 22 people) and the etiological factor — CMV / VEB virus infection (group II, 36 people), who were admitted to the hospital for bleeding from esophageal varicose veins. Methods - photometric on a biochemical analyzer Stat Fax 1904 Plus (USA). (C3 and C4 components of complement, antithrombin III and plasminogen, concentration of circulating immune complexes (CIC), determination of the coagulation time of venous blood Lee-White, calculation of the prothrombin index, fibrinogen content by the Rutberg gravimetric method. Protein C activity (PrS) by the clotting method on a coagulometer K 3002 Spectramed (Poland). Peripheral blood platelet counts were performed using immersion microscopy according to the Fonio method. Results. Multidirectional changes in the functions of the hemostasis system were revealed: a decrease in antithrombin III activity, protein C content, fibrinogen concentration, a decrease in plasminogen activity, a decrease in platelet counts, an increase in platelet antibodies, an increase in the concentration of the C3 component and a decrease in the C4 component of complement. Conclusions. Hemorrhagic and thrombotic complications of HCV, life-threatening and affecting the tactics and results of surgical and minimally invasive treatment, can occur both in the HCV group on the background of HBV/HCV viral hepatitis, and in the HCV group on the background of herpes virus CMV/VEB infection, but in group I both hemorrhagic and thrombotic complications were dominated by plasma risk factors for and in group II - platelet and immunological (complement component C3) risk factors for hemorrhagic complications, plasma factors of thrombotic complications.
Summary. Purpose: to identify the features of lipid metabolism in patients with hepatosplenomegaly syndrome (HSS) of various origins to develop an individualized approach to the treatment of patients with this pathology. Materials and methods: blood serum of 73 patients with HSS on the background of liver cirrhosis complicated by portal hypertension, divided into 3 groups 1) with the etiological factor of hepatitis viruses HCV / HBV, 2) with autoimmune hepatitis with the etiological factor of the herpes group viruses CMV / VEB, 3) against the background of liver hepatosis and fermentopathies. Results and its discussion. In patients with HSS, multidirectional changes in the synthesis of lipid fractions were observed, also associated with impaired protein metabolism, namely: - with HSS against the background of viral hepatitis B and C, hypocholesterolemia and hypobetacholesterolemia were observed due to a decrease in cholesterol synthesis in hepatocytes; a decrease in the concentration of HDL is also associated with a violation of the process of cholesterol esterification due to a deficiency of the enzyme lecithin cholesterol acyltransferase, and an increase in the concentration of LDL is associated with a deficiency of the enzyme lipoprotein lipase in viral damage to hepatocytes. - with HSS against the background of autoimmune hepatitis, no significant changes were observed in the synthesis of lipid fractions; - in hepatosis (fermentopathies), type 5 hyperlipidemia with hypercholesterolemia and hypotriglyceridemia was found, which are a consequence of impaired formation and excretion of lipids from the liver, probably as a result of a decrease in the synthesis of apoproteins and indicate the accumulation of fat in hepatocytes and the formation of hepatosis. Conclusion: Surgical or endovascular treatment of HSS against the background of liver cirrhosis or hepatosis needs to be supplemented with individualized metabolic drug therapy, including lipid-lowering therapy. When detecting hypocholesterolemia and hypobetacholesterolemia in the first group, lipid-lowering therapy is not indicated, whereas if type 5 hyperlipidemia with hypercholesterolemia and hypotriglyceridemia is detected in the group of patients with fatty hepatosis, lipid-lowering therapy is necessary.
Summary. Introduction. The combination of pathogenetic factors of the main surgical pathology, multiple organ dysfunction, acute respiratory distress syndrome and cytokine storm against the background of SARS-Cov-2 infection justifies the relevance of this study. Materials and methods. We examined 13 patients with acute COVID-19 and 29 patients with SARS-Cov-2-associated urgent surgical pathology. Investigated the concentration of C-reactive protein (CRP) by latex agglutination, C3 and C4 components of the complement by immunoturbidimetry, the content of interleukins IL-6 and IL-18 by ELISA, determination of autoantibodies by luminescence microscopy. Results. In patients with SARS-Cov-2-associated urgent surgical pathology, certain patterns of changes in the markers under study were revealed: in all examined groups of patients, an increased concentration of C-reactive protein was observed, which indicated a systemic inflammatory response both in the acute and in the postcovid period. In the postcovid period of viral infection, the most significant are the high frequency of the maximum increase in the concentration of CRP, C3- and C4-complement components, and a significant or moderate increase in the content of interleukins IL-6 and IL-18, more pronounced than in the acute period of infection. The maximum increase in pro-inflammatory cytokines was found in patients with abdominal surgical pathology against the background of COVID-19 (postcoid period), while in the acute period of COVID-19, an increase in the concentration of IL-6 had no diagnostic value. A cytokine storm was detected in 20.5% of the examined patients with COVID-19-associated urgent surgical pathology. Conclusions. For COVID-19-associated surgical pathology, the formation of autoimmune conditions is characteristic, which is expressed in the presence of a wide range of autoantibodies to nuclear structures. Thus, for the prevention and complex treatment of COVID-19-associated urgent surgical pathology, it is advisable to use personified step-by-step immunotropic therapy.
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