Introduction. The recently introduced cardiovascular-kidney-metabolic syndrome (CVKMS) is defined as a health disorder associated with obesity, diabetes mellitus, chronic kidney disease, and cardiovascular disease. Patients with CVKMS are at risk for postoperative complications. Postoperative hyperlactatemia is independently associated with an increased risk of death after major surgery.The objective was to conduct a comparative analysis of the dynamic parameters of blood lactate level with postoperative complications and duration of treatment of patients with metabolic syndrome (MetS) and CVKMS in non-cardiac surgical interventions.Materials and methods. 48 patients were divided into the CVKMS group (n = 16) and MetS group (n = 32). Both the peak concentration and clearance of blood serum lactate in the first 0, 6, 12, 18, 24 and 48 hours after surgery were calculated. Lactate concentration greater than 2.0 mmol/L was defined as hyperlactatemia. Endpoints were the severity of complications according to the Clavien–Dindo classification and the duration of postoperative treatment.Results. Peak lactate concentrations were statistically significantly higher and lactate clearance was significantly lower in the CVKMS group in comparison with MetS group. 54% of patients developed hyperlactatemia. Lactate clearance after surgery was significantly lower in patients with hyperlactatemia. In patients with CVKMS, the degree of severity of postoperative complications and the length of stay were significantly bigger.Conclusions. Elderly patients with CVKMS as compared to patients with MetS have a significantly higher blood lactate concentrations, more postoperative complications that require longer treatment. The identification of patients with CVKMS makes it possible to stratify the risks of postoperative complications.

Introduction. To date, reliable information about the “ideal” infusion therapy regimen for critically ill preterm infants in the early neonatal period is not known.The objective was to determine the indications for the transition to restrictive tactics of infusion therapy in critically ill preterm infantsMaterials and methods. The design was a prospective, observational study. The development included 110 newborns < 32 weeks of gestation (birth weight less than 1500 grams). 11 of them died.Results. In deceased newborns, right ventricular mean pressure (RVMP) was higher in the first 3 days of intensive care and the left ventricular ejection fraction (LVEF) was higher by the third day of treatment they had a higher vasoactive inotropic index. The critical threshold value of RVMP was 29.0 mmHg. The “separation point” regarding the risk of death depending on the volume of infusion therapy was 100 ml/kg/day. The threshold value of the nSOFA score regarding the need to limit the volume of infusion therapy based on ROC analysis was 5.0 points.Conclusion. Preterm infants with a high risk of death (nSOFA score > 5 points) require restrictive infusion therapy. The critical threshold value for the volume of fluid administered may be 100 ml/kg/day.

Introduction. Sepsis is a serious life-threatening disease, accompanied by high mortality and long-term decline in the quality of life of surviving patients. Recent recommendations from the US Society of Critical Care Medicine presented the Phoenix Sepsis Score as the optimal system for assessing organ dysfunction in children with sepsis.The objective of study was to compare the discriminatory ability of the Phoenix Sepsis Score, pSOFA and PELOD 2 scores after 24, 72 and 120 hours of intensive care.Materials and methods. The study design was retrospective, observational, and multicenter. 140 children met the inclusion and exclusion criteria, 29 (20.7%) patients died. The discriminatory power of the study scores was assessed based on ROC analysis.Results. The area under the ROC curve in the first 24 hours was comparable for the analyzed scores (within 0.600, the significance of the differences between the Phoenix Sepsis Score and pSOFA was 0.57, Phoenix Sepsis Score – PELOD 2 = 0.80, pSOFA – PELOD 2 = 0.74 ). On the third day of intensive therapy, the information value of the scores turned out to be good (Phoenix Sepsis Score– 0.704 ± 0.100, pSOFA – 0.748 ± 0.079, PELOD 2 – 0.810 ± 0.073), but they also did not differ statistically significantly from each other. On the fifth day of treatment, all scores showed excellent and comparable discrimination ability (AUG ROC about 0.900).Conclusions. The information ability of the Phoenix Sepsis Score, pSOFA and PELOD 2 in children with sepsis is comparable. The Phoenix Sepsis Score can be used to monitor the severity of organ dysfunction during intensive care of pediatric sepsis

INTRODUCTION: To date, there remains an urgent need to identify clinical data that can serve as valid criteria for diagnosing sepsis in children, applicable both in global settings and in situations reflecting different clinical situations. In 2024 society critical care medicine USA experts presented the Phoenix Score Sepsis scale for this purpose. OBJECTIVE: A comparative assessment of the discriminatory ability of the Pediatric Sequential Organ Failure Assessment (pSOFA) и Pediatric Logistic Organ Dysfunction (PELOD) 2 and Phoenix Sepsis Score scales for sepsis in children in the healthcare t of the Russian Federation. MATERIALS AND METHODS: Study design: retrospective, observational, multicenter. Inclusion criteria: children over 9 months of age. under 17 years of age who have been diagnosed with septic shock. The end point of the study was 28-day mortality. Demographic and clinical data are presented as median values with interquartile ranges of means and standard deviations. Continuous variables were compared using the Mann-Whitney U test. The discriminatory power of the scales was determined by calculating the area under the receiver operating characteristic curve. RESULTS: In the first 24 hours of hospitalization, the prognosis of survival in children with sepsis was comparable for the scales studied. None of the scoring systems were able to predict disease outcomes in shock. CONCLUSIONS: Our studies have shown that in Russian conditions the information value of the Phoenix Sepsis Score scale is comparable to the pSOFA and PELOD 2 scales. Therefore, it seems rational to use all these scales, although the Phoenix Score Sepsis system must still undergo additional external international validation in countries with limited funding.

OBJECTIVE:To evaluate the clinical efficacy of long-term spinal and sacral programmable neurostimulation for pelvic organ dysfunction in patients with myelodysplasia and chronic dysfunction of the bladder and rectum.MATERIAL AND METHODS:A retrospective study included 32 children aged 1-17 years (mean 10.7) with myelodysplasia, pelvic organ dysfunction and ineffective therapy including botulinum therapy and exclusion of tethered spinal cord syndrome. All children underwent comprehensive urodynamic examination with analysis of bladder and residual urine volume, mean flow rate, intravesical pressure and total urine volume, as well as electromyographic examination. Examination was carried out before surgery, after 6, 12 and 36 months. We applied urinary diary, NBSS questionnaire and urodynamic examination data. All patients underwent neurological examinations (neurological status, magnetic resonance imaging of the spinal cord, computed tomography and radiography of the spine, electroneuromyography). The study was conducted at the neurosurgical department of the Republican Children's Clinical Hospital in Ufa between 2014 and 2022. There were 32 implantations of epidural neurostimulators for pelvic organ dysfunctions.RESULTS:Patients used epidural spinal and sacral stimulation up to 6 times a day for 10-15 min turning on the pulse generator. This method significantly increased urinary volume, decreased episodes of urinary leakage and fecal incontinence, residual volume after urination and number of periodic catheterizations compared to baseline data. Sixteen patients were very satisfied, 10 ones were moderately satisfied, and 2 patients were not satisfied with therapy. The number of bladder catheterizations per day decreased by 51.1%. Urine volume significantly increased from 131.5±16.1 to 236±16.7 ml, intravesical pressure decreased from 23.5±4.2 to 18.5±2.1 cm H2O (by 20.3%).CONCLUSION:Chronic epidural spinal and sacral stimulation can improve the quality of life in patients with pelvic organ dysfunction. This technique may be effective for pelvic organ dysfunction caused by myelodysplasia.

АКТУАЛЬНОСТЬ: Новая коронавирусная инфекция (НКИ), вызванная коронавирусом SARS-CoV-2, и ассоциированное заболевание НКИ COVID-19 сопровождаются высокой частотой развития острого респираторного дистресс-синдрома (ОРДС) и пневмонии с дыхательной недостаточностью. Кортикостероиды являются терапевтическим вариантом лечения.‎ ЦЕЛЬ ИССЛЕДОВАНИЯ: Определить преимущество персонифицированного дозирования кортикостероидов для уменьшения воспаления при пневмонии у пациентов с коморбидными заболеваниями. МАТЕРИАЛЫ И МЕТОДЫ: Проспективное сравнительное исследование было проведено среди взрослых пациентов с мая 2020 г. по май 2021 г. Пациенты были разделены на две группы: персонифицированное назначение кортикостероидов в соответствии с уровнем биомаркера воспаления С-реактивного белка (СРБ) (n = 30) в сравнении с обычной терапией (n = 28). Измерения уровней СРБ в образцах крови проводили на момент госпитализации и далее ежедневно в течение первых 5 сут лечения. РЕЗУЛЬТАТЫ: В группе вмешательства было меньше дней респираторной поддержки (9,4 [6,2–15,6] vs 14,3 [7,1–21,4]; р = 0,003) и отсутствие различий в кумулятивном исходе (стойкая зависимость от респираторной поддержки или смерть) и частоте развития нозокомиальной инфекции в сравнении с группой обычной терапии. Суточное распределение биомаркера СРБ показало статистически значимо более низкие уровни на 2–4-е сут лечения в группе вмешательства в сравнении с контрольной группой. ВЫВОДЫ: У критически больных пациентов с пневмонией, вызванной НКИ COVID-19, и коморбидными заболеваниями персонифицированный подход к назначению кортикостероидов незначительно уменьшил частоту неэффективности лечения и статистически значимо уменьшил длительность респираторной поддержки.

Цель работы — оценка частоты носительства аллельных вариантов генов, предрасположенности к артериальной гипертензии взрослых в зависимости от срока гестации недоношенного новорожденного. Дизайн исследования: проспективное, контролируемое, одноцентровое, нерандомизированное. Изучались образцы геномной ДНК у новорожденных детей с экстремально низкой массой тела (ЭНМТ) и гестационным возрастом <28 недель (n=95), недоношенных новорожденных (НН) с гестационным возрастом >28 но <34 недель (n=105), а также популяционной выборки взрослых (n=100). Для анализа были выбраны локусы с уже известной ассоциацией с развитием артериальной гипертензии и ишемической болезнью сердца: AGT (rs4762), AGTR1 (rs5186), ACE (Ins\Del), ADRB1 (rs1801253), ADD1 (rs4961), CYP11B2 (rs1799998), eNOS (rs1799983), eNOS (rs1549758), eNOS (rs2070744). Проводилось сравнение распределения частот аллелей и генотипов между исследуемыми группами лиц. Недоношенные дети достоверно чаще являются носителями аллеля С гена AGT. У новорожденных с ЭНМТ дополнительно выявлена более частая встречаемость мутантных аллелей гена eNOS и редкого генотипа GG гена ADRB1. Установлено, что новорожденные с ЭНМТ, в отличие от популяции недоношенных детей, являются носителями большего числа рисковых аллелей генов предрасположенности к артериальной гипертензии. The aim of the study was to evaluate the frequency of allelic variants of the genes of predisposition to arterial hypertension in adults, depending on the gestation period of a premature newborn. The study design is prospective, controlled, single — center, non-randomized. Genomic DNA samples were studied in newborns with extremely low body weight (ELBW) and gestational age <28 weeks (n=95), premature newborns (NN) with gestational age >28 but <34 weeks (n=105), as well as a population sample of adults (n=100). For the analysis, loci with already known association with the development of arterial hypertension and coronary heart disease were selected: AGT (rs4762), AGTR1 (rs5186), ACE (Ins\Del), ADRB1 (rs1801253), ADD1 (rs4961), CYP11B2 (rs1799998), eNOS (rs1799983), eNOS (rs1549758), eNOS (rs2070744). The distribution of allele frequencies between the study groups was compared. Premature infants are signifi cantly more likely to carry the allele C of the AGT gene. In newborns with ELBW, we additionally found a more frequent occurrence of mutant alleles of the eNOS gene and the rare GG genotype in the ADRB1 gene. It is established that newborns with extremely low body weight, in contrast to the population of premature babies, are carriers of a greater number of risk alleles of genes predisposing to arterial hypertension.

BackgroundCOVID-19 disease has infected more than 772 million people, leading to 7 million deaths. Although the severe course of COVID-19 can be prevented using appropriate treatments, effective interventions require a thorough research of the genetic factors involved in its pathogenesis.MethodsWe conducted a genome-wide association study (GWAS) on 7,124 individuals (comprising 6,400 controls who had mild to moderate COVID-19 and 724 cases with severe COVID-19). The inclusion criteria were acute respiratory distress syndrome (ARDS), acute respiratory failure (ARF) requiring respiratory support, or CT scans indicative of severe COVID-19 infection without any competing diseases. We also developed a polygenic risk score (PRS) model to identify individuals at high risk.ResultsWe identified two genome-wide significant loci (P-value <5 × 10−8) and one locus with approximately genome-wide significance (P-value = 5.92 × 10−8-6.15 × 10−8). The most genome-wide significant variants were located in the leucine zipper transcription factor like 1 (LZTFL1) gene, which has been highlighted in several previous GWAS studies. Our PRS model results indicated that individuals in the top 10% group of the PRS had twice the risk of severe course of the disease compared to those at median risk [odds ratio = 2.18 (1.66, 2.86), P-value = 8.9 × 10−9].ConclusionWe conducted one of the largest studies to date on the genetics of severe COVID-19 in an Eastern European cohort. Our results are consistent with previous research and will guide further epidemiologic studies on host genetics, as well as for the development of targeted treatments.

Введение. Основными факторами риска неблагоприятных исходов у пациентов с COVID-19 пневмонией являются возраст и коморбидные заболевания. Для точной стратификации риска важна комплексная динамическая оценка клинических, лабораторных и гемодинамических факторов пациентов. Цель исследования — оценка факторов риска развития летального исхода у пациентов с COVID-пневмонией с коморбидными заболеваниями на основе анализа временных трендов клинико-лабораторных характеристик. Материалы и методы. Ретроспективное обсервационное мультицентровое исследование 125 пациентов в возрасте от 18 до 75 лет с лабораторно подтвержденным COVID-19 и/или с диагнозом U07.1 по МКБ-10, госпитализированных с острой дыхательной недостаточностью, было проведено с марта 2020 г. по май 2022 г. Критерий невключения — рефрактерный септический шок. Демографические, клинические и лабораторные данные пациентов были записаны на момент госпитализации и в первые 5 суток лечения. Результаты. При анализе операционных характеристик и кривых выживаемости Каплана–Мейера возраст пациентов >71 года, индекс массы тела >29,8 кг/м2 и уровни D-димера >1600 нг/мл и прокальцитонина >3,4 нг/мл были статистически значимо связаны с риском смерти. Для двух параметров (уровни D-димера и прокальцитонина) прогностическая величина временного тренда была статистически значимо выше в сравнении с их суточными значениями. Заключение. Увеличение риска смерти пациентов с COVID-19 пневмонией и коморбидными заболеваниями связано с пожилым возрастом и высоким индексом массы тела, но не с коморбидными заболеваниями. Временные тренды D-димера и прокальцитонина обладают большей прогностической ценностью в сравнении с их суточными значениями.

Введение. Основными факторами риска неблагоприятных исходов у пациентов с COVID-19 пневмонией являются возраст и коморбидные заболевания. Для точной стратификации риска важна комплексная динамическая оценка клинических, лабораторных и гемодинамических факторов пациентов. Цель исследования — оценка факторов риска развития летального исхода у пациентов с COVID-пневмонией с коморбидными заболеваниями на основе анализа временных трендов клинико-лабораторных характеристик. Материалы и методы. Ретроспективное обсервационное мультицентровое исследование 125 пациентов в возрасте от 18 до 75 лет с лабораторно подтвержденным COVID-19 и/или с диагнозом U07.1 по МКБ-10, госпитализированных с острой дыхательной недостаточностью, было проведено с марта 2020 г. по май 2022 г. Критерий невключения — рефрактерный септический шок. Демографические, клинические и лабораторные данные пациентов были записаны на момент госпитализации и в первые 5 суток лечения. Результаты. При анализе операционных характеристик и кривых выживаемости Каплана–Мейера возраст пациентов >71 года, индекс массы тела >29,8 кг/м2 и уровни D-димера >1600 нг/мл и прокальцитонина >3,4 нг/мл былистатистически значимо связаны с риском смерти. Для двух параметров (уровни D-димера и прокальцитонина) прогностическая величина временного тренда была статистически значимо выше в сравнении с их суточными значениями. Заключение. Увеличение риска смерти пациентов с COVID-19 пневмонией и коморбидными заболеваниями связано с пожилым возрастом и высоким индексом массы тела, но не с коморбидными заболеваниями. Временные тренды D-димера и прокальцитонина обладают большей прогностической ценностьюв сравнении с их суточными значениями. Introduction. The main risk factors for adverse outcomes in patients with COVID-19 pneumonia are age and comorbidities. For accurate risk stratification, a comprehensive dynamic assessment of clinical, laboratory, and hemodynamic factors of patients is important. The aim of the study was to assess the risk factors for the development of a lethal outcome in patients with COVID-19 pneumonia with comorbid diseases based on the analysis of time trends in clinical and laboratory characteristics. Materials and Methods. A retrospective observational, multicenter study of 125 patients aged 18 to 75 years with laboratory-confirmed COVID-19 and/or ICD-10 U07.1 hospitalized with acute respiratory failure was conducted from March 2020 to May 2022. Demographic, clinical, and laboratory data of patients were recorded at the time of hospitalization and during the first 5 days of treatment. Results. In the analysis of operational characteristics and Kaplan–Meier survival curves, the age of patients >71 years, body mass index >29.8 kg/m2, and D-dimer levels >1600 ng/mL and procalcitonin >3.4 ng/mL were statistically significantly associated with the risk of death. For two parameters (D-dimer and procalcitonin levels), the prognostic value of the temporal trend was statistically significantly higher compared to their daily values. Conclusion. The increased risk of death in patients with COVID-19 pneumonia and comorbid diseases is associated with older age and high body mass index, but not with comorbid diseases. Temporal trends in D-dimer and procalcitonin have a greater predictive value compared to their daily values.

INTRODUCTION: Septic shock is the most severe stage of sepsis in children accompanied by a highest mortality. OBJECTIVE: The aim of the work is to compare an informative significance of pSOFA, PELOD 2 scales and VIS as predictors of mortality in children with septic shock. MATERIALS AND METHODS: The design of the study is retrospective, observational, single-center trial. The study was performed in the Children's Regional Clinical Hospital of Krasnodar. The inclusion criteria were children with septic shock from 9 months to 17 years old. The endpoint of trial was 28-day mortality. Demographic and clinical characteristic were presented with median and average values, also interquartile intervals were counted. Mann-Whitney U-test was used for comparison data received. The discriminatory power, sensitivity and specificity were defined with receiver operating characteristic (ROC) analysis and determination of area under ROC curve (AUC). RESULTS: No one of this trial’s score provides a prediction of children’s survival with sepsis and shock during first 24 hour PICU stay. PELOD 2 and pSOFA scores allow to estimate a prediction from day 3 from PICU stay. Furthermore PELOD 2 score shows a higher informative significance. The VIS has an ability to predict survival on day 5 from admission. CONCLUSIONS: Only the PELOD 2 score has a good discriminatory power regarding the prognosis of survival in children with septic shock after 48 hours of intensive care. The VIS scale allow to assess a severity of cardiovascular dysfunction in children with refractory septic shock with threshold critical value more than 21 points.

The objective was to identify predictors of polytrauma outcome in children on the first day of treatment in ICU.Materials and methods. Design – multicenter, cohort, retrospective, observational study. 225 children with polytrauma were examined. The average age of children was 10 (4–14) years. There were 148 (65.8%) boys. In 65.2% of cases, the injury was received as a result of a traffic accident, catatrauma occurred in 32.6% of polytrauma. The AIS score was 34 (25–48) and the PTS score was 5 (2.0–8.0). The duration of artificial lung ventilation was 12 (0–97) hours, and treatment in ICU – 5 (2–8) days. Death was in 14.2% of cases. Results. An increase in Glasgow Coma Scale (GCS) and SpO2 by one unit (1 point, 1%) was found to reduce the risk of adverse outcome by 44% and 9%, respectively, and an increase in creatinine concentration and international normalized ratio by one unit increased the probability of patient death by 4.3 and 15.8 times, respectively. A mathematical formula was developed to assess the risk of an unfavorable outcome of polytrauma in children at the time of admission to the ICU: OR = exp (3.74–0.58 · [GCS score] – 0.09 · [SpO2] + 0.06 · [Creatinine] + 2.62 · [INR]. Its accuracy is 96.4%; sensitivity 83.4%; specificity 98.7%.Conclusion. Predictors of unfavorable outcome of polytrauma in children at admission to ICU are low scores on the Glasgow Coma Scale, severe hypoxemia, coagulopathy and kidney damage.

The objective was to study the safety and efficacy of a personalized opioid-sparing pain relief protocol in the context of enhanced rehabilitation after advanced robot-assisted pelvic surgery.Materials and methods. The prospective study included 19 patients who underwent surgery under combined thoracic epidural anesthesia/analgesia: general anesthesia was administered with propofol or sevoflurane/desflurane with ketamine + 6–8 ml/hour of 0.25% ropivacaine, in the postoperative period 0.125% bupivacaine was administered at a rate of 8–15 ml/hour. In the comparison group (n = 21), opioids were used as a component of general anesthesia and multimodal analgesia. Intra- and postoperative opioid consumption, pain severity, opioid-related side effects, and timing of postoperative rehabilitation were evaluated.Results. In the study group, the median milligram equivalents of morphine were significantly lower than in the control group (103 versus 148 and 91 versus 404, respectively; p = 0.001 for both comparisons). The values of the numerical pain scale did not differ significantly between the groups. Side effects were significantly lower in the treatment group (26% vs. 62%; p = 0.026). There were significant differences in the timing of intestinal function recovery, initiation of regular diet and transfer from the recovery room in favor of opioid-sparing pain relief (p = 0.037; p = 0.046; and p = 0.023; respectively).Conclusions. The use of a personalized opioid-sparing pain relief protocol in the context of enhanced rehabilitation of patients underwent the advanced robot-assisted pelvic surgery helped to reduce opioid consumption, side effects, and postoperative rehabilitation without affecting the severity of pain.

INTRODUCTION: A new coronavirus infection caused by the SARS-CoV-2 coronavirus and the associated disease COVID-19 is accompanied by a high incidence of acute respiratory distress syndrome (ARDS) and pneumonia with respiratory failure. Corticosteroids are a therapeutic treatment option. OBJECTIVE: To determine the advantage of personalized corticosteroid dosing to reduce inflammation in pneumonia in patients with comorbid diseases. MATERIALS AND METHODS: A prospective comparative study was conducted among adult patients in the Republican Clinical Infectious Hospital and the Clinical Emergency Hospital (Ufa, Republic of Bashkortostan) from May 2020 to May 2021. Patients were divided into two groups: personalized corticosteroid administration in accordance with the level of the inflammation biomarker C-reactive protein (CRP) (n = 30) compared with conventional therapy (n = 28). Measurements of CRP levels in blood samples were carried out at the time of hospitalization and then daily during the first 5 days of treatment. RESULTS: The intervention group had fewer days of respiratory support (9.4 [6.2–15.6] vs. 14.3 [7.1–21.4]; p = 0.003) and no differences in cumulative outcome (persistent dependence of respiratory support or death) and the incidence of nosocomial infection compared with the control group. Daily distribution of the biomarker CRP showed significantly lower levels on 2–4 days of treatment in the intervention group compared with the control group. CONCLUSIONS: In critically ill patients with pneumonia caused by COVID-19, and comorbid diseases, a personalized approach to the corticosteroids prescribing slightly reduced the frequency of treatment ineffectiveness and statistically significantly reduced the duration of respiratory support.

АКТУАЛЬНОСТЬ: Септический шок у детей — это наиболее тяжелая стадия сепсиса, сопровождающаяся максимальной летальностью. ЦЕЛЬ ИССЛЕДОВАНИЯ: Выполнить сравнительную оценку информационной значимости шкал pSOFA, PELOD 2 и VIS в качестве предикторов прогноза летальности при септическом шоке у детей. МАТЕРИАЛЫ И МЕТОДЫ: Дизайн исследования — ретроспективное, обсервационное, одноцентровое. Исследование было осуществлено на базе Детской краевой клинической больницы г. Краснодара. Критерии включения — дети в возрасте от 9 мес. до 17 лет, у которых был диагностирован септический шок. Конечная точка исследования — 28-дневная летальность. Демографические и клинические данные представлены в виде медианных значений с межквартильными интервалами средних и стандартных отклонений. Непрерывные переменные сравнивали с использованием U-теста Манна—Уитни. Дискриминационную способность шкал определяли путем вычисления площади под ROC-кривой. РЕЗУЛЬТАТЫ: В первые 24 ч госпитализации прогноз выживаемости у детей с сепсисом и шоком не способна обеспечить ни одна из анализируемых нами оценочных систем. По завершении 2 сут интенсивной терапии прогноз позволяют осуществить шкалы PELOD 2 и pSOFA, причем лучшей информационной значимостью обладает система PELOD 2. Шкала VIS способна прогнозировать выживаемость лишь к 5-м сут лечения детей с септическим шоком.

Значимость особенностей генотипа в исходах тяжелой дыхательной недостаточности у новорожденных с экстремально низкой массой тела пока не ясна. Целью исследования являлась оценка взаимосвязи выживаемости с носительством некоторых генов предрасположенности к адверсивному течению респираторного дистресс - синдрома у новорожденных с экстремально низкой массой тела (ЭНМТ). Методы. Дизайн - контролируемое, проспективное, нерандомизированное, одноцентровое исследование. Критерии включения: новорожденные с ЭНМТ менее 1000 г и гестационным возрастом 28 недель и менее, ИВЛ более 3 суток. Критерии исключения: множественные пороки развития, гестационный возраст менее 26 недель, гибель в первые 48 часов жизни. В разработку включено 88 пациентов. Исследовался полиморфизм генов белка сурфактанта В (SFTPB 1580 C>T), интерлейкина-1β (IL1B 3953 C>T), рецепторного антагониста ИЛ-1 (VNTR полиморфизм интрона 2 IL-1RN), интерлейкина-10 (IL10 627 С>A), фактора некроза опухоли (TNF-α 308 G>A), гена протромбина (F2-20210 G>A), гена 5-го фактора свертывания (Лейдена) (F5-1691 G>A), гена проконвертина (F7-10976 G>A), гена фактора Хагемана (F13), гена фибриногена В (FGB 455), гена интегрина - альфа тромбоцитов (ITGA2 807 C>T), гена бета - субъединицы фибриногена тромбоцитов (ITGB3-1565 T>C), гена ингибитора активации плазминогена 1-го типа (PAI-1 675). Результаты. Полученные данные указывают на отсутствие взаимосвязи между распределением аллелей и генотипов исследуемых генов и выживаемостью пациентов. Заключение. Носительство изученных генов предрасположенности к развитию респираторного дистресс - синдрома новорожденных, инфекционных осложнений и тромбофилии у новорожденных с ЭНМТ не ассоциировано с их выживаемостью в неонатальном периоде.

INTRODUCTION: Intensive care does not always require only a large amount of resources. An important aspect is the formation of a multidisciplinary team involved in the treatment of patients in critical condition. OBJECTIVE: To demonstrate the need for the staff of intensive care units to use protocols for the diagnosis and treatment of critical conditions on the example of sepsis in children. MATERIALS AND METHODS: The analysis of publications devoted to the study of the impact of the implementation of the clinical recommendations of the Surviving Sepsis Campaign for the treatment of sepsis in children on the outcomes of the disease. The articles were searched in the abstract databases PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science Core Collection and Google Scholar for the period from 2011 to July 2022. Keywords were used: “pediatric sepsis”, “implementation”, “protocolized treatment”, “adherence”. RESULTS: During the search, only thirteen observational studies were found, nine of which were presented retrospectively, which can be attributed to the design flaws of the submitted works. It was revealed that the use of the entire complex of diagnostic and therapeutic measures presented in clinical recommendations and protocols for intensive therapy of sepsis in children can significantly improve the results of treatment, but the commitment of doctors to their use in routine clinical practice remains low and does not exceed 40 %. CONCLUSIONS: The main reason for the lack of commitment to the implementation of recommendations and standards for the treatment of sepsis in children is not only in the presence of organizational obstacles, but also in the absence of reasonable algorithms for its implementation.

Значимость особенностей генотипа в исходах тяжелой дыхательной недостаточности у новорожденных с экстремально низкой массой тела пока не ясна. Целью исследования являлась оценка взаимосвязи выживаемости с носительством некоторых генов предрасположенности к адверсивному течению респираторного дистресс - синдрома у новорожденных с экстремально низкой массой тела (ЭНМТ). Методы. Дизайн - контролируемое, проспективное, нерандомизированное, одноцентровое исследование. Критерии включения: новорожденные с ЭНМТ менее 1000 г и гестационным возрастом 28 недель и менее, ИВЛ более 3 суток. Критерии исключения: множественные пороки развития, гестационный возраст менее 26 недель, гибель в первые 48 часов жизни. В разработку включено 88 пациентов. Исследовался полиморфизм генов белка сурфактанта В (SFTPB 1580 C>T), интерлейкина-1β (IL1B 3953 C>T), рецепторного антагониста ИЛ-1 (VNTR полиморфизм интрона 2 IL-1RN), интерлейкина-10 (IL10 627 С>A), фактора некроза опухоли (TNF-α 308 G>A), гена протромбина (F2-20210 G>A), гена 5-го фактора свертывания (Лейдена) (F5-1691 G>A), гена проконвертина (F7-10976 G>A), гена фактора Хагемана (F13), гена фибриногена В (FGB 455), гена интегрина - альфа тромбоцитов (ITGA2 807 C>T), гена бета - субъединицы фибриногена тромбоцитов (ITGB3-1565 T>C), гена ингибитора активации плазминогена 1-го типа (PAI-1 675). Результаты. Полученные данные указывают на отсутствие взаимосвязи между распределением аллелей и генотипов исследуемых генов и выживаемостью пациентов. Заключение. Носительство изученных генов предрасположенности к развитию респираторного дистресс - синдрома новорожденных, инфекционных осложнений и тромбофилии у новорожденных с ЭНМТ не ассоциировано с их выживаемостью в неонатальном периоде. The significance of genotype features in the outcomes of severe respiratory failure in newborns with extremely low body weight (ELBW) is not yet clear. The aim of the study was to assess the relationship of survival with the carrier of certain genes of predisposition to the reversible course of respiratory distress syndrome in newborns with ELBW. Methods. Design - controlled, prospective, non - randomized, single - center research. Inclusion criteria: newborns with ENMT less than 1000 g and gestational age of 28 or less weeks, ventilator for more than 3 days. Exclusion criteria: multiple malformations, gestational age less than 26 weeks, death in the first 48 hours of life. 88 patients were included in the development. Polymorphism of genes of surfactant B protein (SFTPB 1580 C>T), interleukin-1β (IL1B 3953 C>T), IL-1 receptor antagonist (VNTR polymorphism of intron 2 IL-1RN), interleukin-10 (IL10 627 C>A), tumor necrosis factor (TNF-α 308 G>A), prothrombin gene (F2-20210 G>A), coagulation factor 5 (Leiden) gene (F5-1691 G>A), proconvertin gene (F7-10976 G>A), Hageman factor gene (F13), fibrinogen B gene (FGB 455), platelet integrin - alpha gene (ITGA2 807 C>T), platelet fibrinogen subunit betta gene (ITGB3-1565 T>C), a type 1 plasminogen activation inhibitor gene (PAI-1 675). Results. The data obtained indicate that there is no relationship between the distribution of alleles and genotypes of the studied genes and the survival of patients. Conclusion. The carriage of the studied genes of predisposition to the development of respiratory distress syndrome of newborns, infectious complications and thrombophilia in newborns with ELBW is not associated with their survival in the neonatal period.

Introduction. The problem of an adequate assessment of the prognosis of the outcome of severe community-acquired pneumonia (CAP) is particularly difficult if it is caused by an unusual pathogen for it, in particular Klebsiella pneumoniae . The objective was to develop the approach for predicting the survival of a heterogeneous population of patients with CAP caused by Klebsiella pneumoniae using statistical approaches based on artificial neural networks. Materials and methods. The design is a retrospective, multicenter, controlled, non-randomized study. Inclusion criteria: clinical, laboratory and radiological diagnosis of CAP associated with Klebsiella pneumoniae with a SOFA score of 2 or more points. The development included 100 patients. 50 died. The prognostic significance of the SOFA, APACHE II, PSI/PORT, Glasgow and Charlson comorbidity index, procalciotonin, C-reactive protein scales was evaluated. The data obtained were evaluated in the StatPlus 7 and Pycharm GPT programs. Results. None of the stated scales has shown its significance. There were no statistically significant differences between the surviving and deceased patients in terms of the level of biomarkers studied. In this regard, we have compiled a logistic regression equation for assessing the prognosis based on a combination of the SOFA score, the Charlson index and the procalcitonin level. Conclusion. In assessing the prognosis of outcome in patients with CAP caused by Klebsiella pneumoniae , it is advisable to use a combination of data from the SOFA score, Charlson comorbidity index and procalciotonin levels. Threshold critical values are SOFA score of more than 4 points, Charlson comorbidity index of more than 7 points, procalciotonin level of more than 2 ng/ml.