Aim. To assess the structure of cardiovascular pathology in patients with new coronavirus infection (NCI), to identify factors of poor prognosis in these individuals. Material and methods. The study was conducted on the basis of the COVID-19 infectious diseases hospital of the City Hospital No. 33 of Nizhny Novgorod. The study included 284 patients after applying inclusion and exclusion criteria. All subjects were divided into groups: the main group (n = 207) — patients with NCI and cardiovascular diseases (CVD), as well as comorbid diseases, the comparison group (n = 24) with NCI and CVD, the control group (n = 53) with NCI without any comorbid diseases. Demographic indicators, BMI, laboratory parameters, comorbidity and therapy were analyzed. Results. During the study, it was revealed that the most severe course of COVID-19 is characteristic of the main group, and only among them there were fatal outcomes (25% of cases). Analyzing the prevalence of CVD, it turned out that arterial hypertension was the most common in the main group and in the comparison group, coronary heart disease and heart failure were registered somewhat less frequently. The development of acute cardiovascular accidents occurred only in the main group. A mathematical model was developed to determine the risk of death in patients with NCI who are in the hospital. This model is statistically significant (p < 0.001). Conclusion. The older age of patients, the development of acute myocardial infarction, first identified atrial fibrillation and a decrease in saturation contributed to an increased risk of mortality in patients with NCI and CVD. Among drug therapy, the administration of favipiravir, tocilizumab and statins had a beneficial effect on the outcome of diseases.

Aim. To identify predictors of fatal outcome of COVID-19 in comorbid patients hospitalized in a specialized сovid-hospital in Nizhny Novgorod. Design. A single-center retrospective study. Material and methods. The data of 284 patients admitted to the specialized covid hospital in Nizhny Novgorod were analyzed. Three study groups were identified: the main group (n = 207) included people with new coronavirus infection (NCI) who had cardiovascular (CVD) and comorbid diseases, the comparison group consisted of patients with NCI and CVD without a burdened comorbid background (n = 24), the control group included the remaining patients with NCIS without CVD and comorbid pathology (n = 53). A comprehensive analysis of clinical and demographic, laboratory, instrumental indicators, the structure of comorbid pathology, as well as therapeutic approaches was Performed. Results. The assessment of the occurrence of CVD showed that hypertension was diagnosed in the majority of hospitalized patients — 226 (79.6%) persons, about half of the studied (146 (51.4%) people) had coronary heart disease, in 148 (52.1%) cases there was chronic heart failure, atrial fibrillation of various forms was in every fifth patient — in 59 (20.8%) cases. The analysis of the comorbid status among the main group (n = 207) demonstrated the widespread occurrence of chronic kidney disease (CKD) of various stages, which was recorded in 192 (92.7%) patients, and type 2 diabetes in 76 (36.7%) patients. The peculiarities of the course of COVID-19 among patients on hemodialysis were established: they had a tendency to hypercoagulation, estimated by the level of D-dimer (p = 0.045), sepsis developed more often, respiratory failure progressed more rapidly, requiring artificial lung ventilation (p = 0.011). Among people with CKD C5, mortality was also statistically significantly higher than in patients with other stages of CKD (p = 0.048). A mathematical model was developed to determine the risk of death among hospitalized patients with NCI. According to this model, the risk of death increased with the development of acute myocardial infarction, newly diagnosed atrial fibrillation, sepsis, decreased saturation, with increasing age of patients, with a decrease in the level of C-reactive protein (CRP), and an increase in D-dimer. Taking favipiravir, tocilizumab and statins reduced the risk of death. Conclusion. The most common cardiovascular pathology in patients hospitalized for NCI was hypertension, and atrial fibrillation prevailed among cardiac arrhythmias. It was noted that CKD prevails in the structure of comorbid pathologies. In people with severe NCI, who have CVD and CKD C5, a greater predisposition to the development of sepsis and an increase in respiratory failure was estamblished, which was the cause of progressive deterioration of the condition and subsequently led to death. In addition, we have shown that the probability of death in patients with CVD and COVID-19 was influenced by the older age of the patient, a decrease in saturation, a decrease in CRP, and an increase in D-dimer. As a drug therapy, the most beneficial effect on survival was the administration of favipiravir, tocilizumab and statins. Keywords: COVID-19, comorbidity, cardiovascular diseases, mortality, hemodialysis

Objective of the Review: to analyze the available data on the etiology, pathogenesis, diagnosis and treatment of a new coronavirus infection. Key points. In 2020, the whole world was engulfed by a pandemic of a new viral disease, which was called the coronavirus disease СOVID-19. We have considered aspects of the etiology, pathogenesis, diagnosis, and treatment of this infection. One of the most difficult issues is the therapy of COVID-19, since the course of the disease exacerbates the development of a cytokine storm. Conclusion. When choosing a patient's treatment tactics, it is necessary to comprehensively assess possible adverse events, strive to minimize their occurrence. Keywords: new coronavirus infection, COVID-19, angiotensin i converting enzyme 2, cytokine storm.

The aim of the study was to examine the clinical phenotypes of hypoxia in patients with COVID-19 in relation to the severity of acute respiratory failure (ARF). Material and methods . Sixty patients with severe COVID-19 and manifestations of acute respiratory failure admitted to the infectious disease hospitals of Nizhny Novgorod were enrolled in the study. The study included patients with transcutaneous saturation (SpO 2 ) below 93% on spontaneous breathing, who required correction of respiratory alterations according to the Interim Clinical Guidelines for the Treatment of Patients with COVID-19. All patients were divided into 2 groups of 30 patients each according to the nature of respiratory impairment. Group 1 included patients without breathing difficulties who had respiratory rate up to 25 per minute. Group 2 patients had breathing difficulties and respiratory rate over 25 per minute. In addition to SpO 2 , severity of respiratory difficulties, respiratory rate (RR), forced breathing (FB), heart rate (HR), acid-base balance (ABB) and arterial and venous blood gases, capillary refill time, blood lactate level were assessed. The severity of lung involvement was determined using chest computed tomography, and severity of disease was assessed using the NEWS score. Respiratory treatment required for ARF correction and the outcome of hospitalization were also considered. Results . In group 1, the mean age was 66 (56; 67) years and the disease severity was 8 (7; 10) points. Group 1 patients had minor tachycardia and tachypnoea, there were no lactate elevation or prolonged capillary refill time. Mean SpO 2 was as low as 86 (83; 89)%. Venous blood pH and pCO2 values were within normal reference intervals, mean BE was 6 (4; 9) mmol/l, pO 2 was 42 (41; 44) mm Hg, and SO 2 was 67 (65; 70)%. Mean arterial blood pO 2 was 73 (69; 75) mm Hg, SO 2 was 86 (83; 90)%, and O 2 was 37 (35; 39) mm Hg. Oxygen therapy with the flow rate of 5-15 l/min in prone position helped correct ARF. All patients of this group were discharged from hospital. In group 2, the mean age was 76 (70;79) years and the disease severity was 14 (12; 18) points. Anxiety was observed in 15 patients, prolonged capillary refill time was seen in 13 patients, and increased lactate level in 18 patients. Mean RR was 34 (30; 37) per minute, HR was 110 (103; 121) per minute, and SpO 2 was 76 (69; 83)%. Mean venous blood pH was 7.21 (7.18; 7.27), pCO 2 was 69 (61; 77) mm Hg, BE was -5 (-7; 2) mmol/l, pO 2 was 25 (22; 28) mm Hg, SO 2 was 47 (43; 55)%. Mean arterial blood pO 2 was 57 (50; 65) mm Hg, SO 2 was 74 (69; 80)%, and pCO 2 was 67 (58; 74) mm Hg. In the group 2 patients, the standard oxygen therapy in prone position failed to correct ARF, and high flow oxygen therapy, noninvasive CPAP with FiO 2 of 50-90% or noninvasive CPAP+PS were administered. Fourteen patients were started on invasive lung ventilation. There were 10 fatal outcomes (33%) in this group. Conclusion . Two clinical phenotypes of hypoxia in patients with COVID-19 can be distinguished. The first pattern is characterized by reduced SpO 2 (80-93%), no tachypnoea (RR >25 per minute) and moderate arterial hypoxemia without tissue hypoxia and acidosis («silent hypoxia»). It is typical for younger patients and associates with less lung damage and disease severity than in patients with severe ARF. Hypoxemia can be corrected by prone position and oxygen therapy and does not require switching to mechanical ventilation. The second pattern of hypoxia is characterized by significant arterial hypoxemia and hypercapnia with tissue hypoxia and acidosis. Its correction requires the use of noninvasive or invasive mechanical ventilation.

Тромботическая микроангиопатия (ТМА) – клинико-морфологический синдром, в основе которого лежит повреждение эндотелия сосудов микроциркуляторного русла, вызванное разными причинами, но проявляющееся сходной клинической симптоматикой и гистологическими признаками. Одним из важнейших триггеров возникновения ТМА является беременность. Во время беременности возможно развитие вторичной ТМА – при тяжелой преэклампсии и HELLP-синдроме или после тяжелой кровопотери, осложнившейся синдромом диссеминированного внутрисосудистого свертывания крови (ДВС-синдромом). Первый клинический пример иллюстрирует роль в индукции атипичного гемолитико-уремического синдрома (аГУС) многочисленных акушерских осложнений и ДВС-синдрома, возникшего в результате своевременно некомпенсированной кровопотери. Их можно рассматривать как дополнительные комплемент-активирующие состояния. Представленное наблюдение иллюстрирует классическое течение вторичного аГУС с характерными признаками ТМА. Прекращение трансфузий свежезамороженной плазмы (СЗП) и начало таргетной комплемент-блокирующей терапии (экулизумаб) привело к значительному улучшению состояния и обратному развитию ТМА. Во втором наблюдении клинико-лабораторные признаки указывали на наличие вторичной ТМА, вызванной преэклампсией, HELLP-синдромом при отсутствии острого повреждения почек. Назначенная базовая терапия преэклампсии, а также введение СЗП и антикоагулянта позволили прервать внутрисосудистый гемолиз. Thrombotic microangiopathy (TMA) is a clinical morphological syndrome developing as a result of microvascular endothelium damage caused by various reasons but manifesting similar clinical symptoms and histological signs. Pregnancy is one of the most critical TMA triggers. Pregnancy may be accompanied with secondary TMA development in case of severe preeclampsia and HELLP-syndrome or after massive blood loss complicated with disseminated intravascular coagulation (DIC). The first clinical case demonstrates the role of multiple obstetric complications and DIC emerged as a result of failure to timely compensate blood loss in atypical haemolytic-uremic syndrome (aHUS) induction. They may be viewed as additional complement-activating conditions. The described observation illustrates classic progress of secondary aHUS with typical TMA signs. Stopping of fresh frozen plasma (FFP) transfusions and beginning of a target complement blocking therapy (eculizumab) led to significant improvement of condition and TMA involution. In the second observation clinical laboratory signs indicated secondary TMA caused by preeclampsia and HELLP-syndrome without acute renal injury. Prescribed basic therapy of preeclampsia, as well as administration of FFP and anticoagulant, allowed to interrupt intravascular hemolysis.

Recently the financing of the medical stage of rehabilitation has significantly increased due to the funds of compulsory medical insurance; therefore, it became possible to carry out rehabilitation of patients depending on the degree of dysfunction and limitation of life in a 24-hour hospital, day hospital, in outpatient conditions, sanatorium-resort conditions and at home with the involvement of mobile multidisciplinary teams. Meanwhile, important theoretical foundations of rehabilitation began to be forgotten; the goal of rehabilitation measures has always been to obtain a social effect, that is, the restoration of social status, material independence and social adaptation of patients.The purpose of the study was to identify the characteristics of the contingent of patients sent to the round-the-clock rehabilitation department and determine ways to improve this activity of the medical organization.Materials and methods. The source of information was the documents of patients who left the hospital, the day care department at the hospital, the day hospital at the outpatient clinic and the hospital at home (f. 066/y-02). 937 hospital cards for 2017 in the rehabilitation department were studied. Data analysis was carried out by the method of tabular summaries, as well as the calculation of extensive and intensive indicators.Results and discussion. The study showed that the contingent of persons entering the rehabilitation department was composed of people, mostly over 60 years old, who had serious illnesses and injuries.Conclusions. The inpatient rehabilitation department is very important for the medical organization, since it allows to extend the necessary treatment in case of severe long-term current diseases and to start individual recovery measures in severe elderly patients earlier; elderly people with severe pathology - these are patients of a specialized gerontological department, on the basis of which medical, psychological and social rehabilitation measures should be taken; persons of working age, including those of pre-retirement age, who need complex rehabilitation should be sent to the department mainly.

The feature of expertise of temporary disability is that expert decisions are considered according legislation as a basis of providing patients with various types of social protection and, in particular, exemption from work during acute period of disease. Since this is an issue of spending budget funds and extra-budgetary funds for these activities, all the procedures of expertise of temporary disability are regulated by legislative and regulatory acts that not always clearly define actions of doctors in various situations, and sometimes do not correspond to constantly changing conditions in the system of medical organizations functioning. The recent alterations in the legislative base led to a significant increase of burden on medical commission of the prolongation of medical certificates, which was already high enough due to appeals related to referral of patients to medical social expertise, medical examination of citizens, etc. The article presents the analysis of medical commission functioning of a large hospital-polyclinic association related to prolongation of medical certificates. The authors pursued the goal of identifying unfavorable trends in the medical commission functioning and identify ways to optimize it. The assessment of current status of the medical commission functioning demonstrated that prevention of injuries, especially domestic ones, as well as prevention of exacerbations of chronic diseases, including within the framework of dispensary observation of corresponding contingents of patients are of great importance for reducing the temporary disability of citizens.

The feature of expertise of temporary disability is that expert decisions are considered according legislation as a basis of providing patients with various types of social protection and, in particular, exemption from work during acute period of disease. Since this is an issue of spending budget funds and extra-budgetary funds for these activities, all the procedures of expertise of temporary disability are regulated by legislative and regulatory acts that not always clearly define actions of doctors in various situations, and sometimes do not correspond to constantly changing conditions in the system of medical organizations functioning. The recent alterations in the legislative base led to a significant increase of burden on medical commission of the prolongation of medical certificates, which was already high enough due to appeals related to referral of patients to medical social expertise, medical examination of citizens, etc. The article presents the analysis of medical commission functioning of a large hospital-polyclinic association related to prolongation of medical certificates. The authors pursued the goal of identifying unfavorable trends in the medical commission functioning and identify ways to optimize it. The assessment of current status of the medical commission functioning demonstrated that prevention of injuries, especially domestic ones, as well as prevention of exacerbations of chronic diseases, including within the framework of dispensary observation of corresponding contingents of patients are of great importance for reducing the temporary disability of citizens.

The article deals with the fact that the prevalence of the pathology of the digestive organs is well known. The most common diseases, for example, gastritis most often appear in the examination of temporary disability. In the case of severe pain syndrome, dyspeptic disorders, body weight deficiency, significant disorders of the secretory and motor-evacuation function of the gastro-duodenal system, as well as pancreatitis, cholecystitis, hepatitis with a sharp disruption of the liver and pancreas, the authors recommend to solve the question of referring to medical and social expertise for establishing a group of disabilities. There are problems in the direction and examination of citizens in institutions of medical and social expertise (MSE). The reasons for not meeting the standards of medical care are mainly low resource and information provision and low legal literacy of medical workers. The purpose of the study was to conduct an analysis of the contingent of citizens sent to the medical commission with a view to prolonging the sheets of disability and referral to MSE. Methods and materials of the study: a large hospital-polyclinic association with a hospital for 637 beds and a polyclinic for 834 visits per shift was selected for study. On average, 69% of all patients who underwent inpatient treatment in the study organization were sent to the hospital on an emergency basis every year. Results and their discussion: the study showed that among the total number of complaints to the medical commission for the purpose of prolonging the leaflet of disability, appeals for diseases of the digestive organs were 9.9%, of which 39.2% were treatment for malignant tumors with localization in the digestive organs. The main conclusions were the following: over the past 5 years, the incidence, prevalence and primary disability of patients with pathology of the digestive system have increased in the Nizhny Novgorod region, and the primary exit to disability of patients with malignant neoplasms, including many tumors of the gastrointestinal tract; persons with malignant neoplasms of the digestive system constitute the main contingent of gastro-enterological patients, directed to MSE, both primarily and repeatedly.

The peculiarity of the current stage of the development of medical and social expertise (MSE) is, first of all, the ratification of the Convention on the Rights of Persons with Disabilities in the Russian Federation. An attempt to ensure the participation of citizens with restrictions in activities in the civil, political, social and cultural life of the society required significant changes and additions to the regulatory and legislative framework of the Russian Federation that regulates various aspects of the life of Russian citizens. Changes in regulatory and legislative acts increase the role and importance of medical organizations in MSE in terms of establishing and formulating a medical diagnosis of the patient, determining the nature and persistence of disorders of the body’s functions, developing and implementing intra-institutional rehabilitation programs for people with disabilities. In this regard, it is important to take into account the readiness of medical organizations to respond promptly to changes in expert legislation and to make contributions into the provision of the continuity, consistency, succession and complexity of the expert - rehabilitation process. The purpose of this study was to identify the main trends in the work of disability evaluation boards of medical organizations on the example of a large hospital-polyclinic association for the referral of patients for MSE. It was succeed to clarify out that to date the procedure for referral citizens to MSE in the association is well managed, targeted at individuals, both of senior and middle ages and their need for examination, taking into account results of rehabilitation. During the period of observation, there was noted the gain in the number of people referred for MSE, mainly at the expense of persons referred for the reassessment, which is related both with the severity of the contingent appealing to the organization and using modern treatment technologies requiring a long rehabilitation period and with the accumulation of a contingent disabled people. Therefore, in examination persons of the older age group, the participation of geriatricians will probably be necessary.

There has been described a case of surgical management of bilateral synchronous renal carcinoma with metastatic brain lesions. The feature of the observation is tree-stage treatment: the initial resection of the secondary brain lesion followed by the left nephrectomy 14 days later and the right nephrectomy a month later. 40% right kidney was preserved. The patient required no substitution therapy in the postoperative period.

The aim of the investigation was to assess the reliability of main sonoelastographic diagnostic criteria of thyroid cancer and determine sonoelastography efficiency in pre-operative diagnostics of thyroid nodules based on a complex of radiological, cytologic and histologic methods.Materials and Methods. The study involved 372 patients with thyroid nodules, among them there were 87 (13%) male and 285 (87%) female patients; mean age being 44.90 +/- 0.30 years. All the patients underwent standard diagnostic procedures: an endocrinal examination, a hormone laboratory test, an ultrasound investigation using color flow Doppler supplemented by sonoelastography, as well as fine-needle aspiration biopsy of nodules followed by cytologic analysis.Results. Diagnosis of "adenoma or cancer" in 80 patients (95%) made on the basis of sonoelastographic and cytologic findings was confirmed by histologic examination of surgical materials. Sonoelastography sensitivity in thyroid cancer detection is 95.3%, specificity 98.2%, diagnostic accuracy - 96%.Conclusion. Qualitative elastographic characteristics of nodules (blue staining) and quantitative value of strain ratio, which equals to over 4, are high-specific in pre-operative thyroid cancer diagnosis. Sonoelastography application improves the diagnostic accuracy of a pre-operative diagnostic complex of thyroid nodule facilitating the management of patients with thyroid pathology.

The article analyzed risk factors after operations for pancreatonecrosis in order to predict a course of the disease and carefully plan the treatment. It was revealed that the lethality level depended on different factors: the sex, age, a period of admission to the hospital, prevalence of necrotic suppurative process and severity of operative trauma. The authors made a conclusion of radical change to treatment approach. The open operations should be reduced at the expense of introduction of low-invasive methods of treatment in the case of pancreatonecrosis.

Nizhny Novgorod State Medical Academy, Minin and Pozharsky Square, 10/1, Nizhny Novgorod, Russian Federation, 603005The aim of the investigation was to assess the reliability of main sonoelastographic diagnostic criteria of thyroid cancer and determine sonoelastography efficiency in pre-operative diagnostics of thyroid nodules based on a complex of radiological, cytologic and histologic methods.Materials and Methods. The study involved 372 patients with thyroid nodules, among them there were 87 (13%) male and 285 (87%) female patients; mean age being 44.90±0.30 years. All the patients underwent standard diagnostic procedures: an endocrinal examination, a hormone laboratory test, an ultrasound investigation using color flow Doppler supplemented by sonoelastography, as well as fine-needle aspiration biopsy of nodules followed by cytologic analysis.Results. Diagnosis of “adenoma or cancer” in 80 patients (95%) made on the basis of sonoelastographic and cytologic findings was confirmed by histologic examination of surgical materials. Sonoelastography sensitivity in thyroid cancer detection is 95.3%, specificity — 98.2%, diagnostic accuracy — 96%.Conclusion. Qualitative elastographic characteristics of nodules (blue staining) and quantitative value of strain ratio, which equals to over 4, are high-specific in pre-operative thyroid cancer diagnosis. Sonoelastography application improves the diagnostic accuracy of a pre-operative diagnostic complex of thyroid nodule facilitating the management of patients with thyroid pathology.Key words: thyroid cancer; sonoelastography; thyroid nodules.For contacts: Orlinskaya Natalia Yurievna, phone +7 920-071-21-07; е-mail: orlinskaya@rambler.ru

Objective. To assess sonoelastography opportunities in differential diagnosis of prostatic diseases; to place sonoelastography in general algorithm of prostatic diseases diagnostics.Materials and methods. 91 patients under examination were divided into three groups. The first group included 21 patients (23.1 %) with suspected prostate carcinoma, later they underwent puncture multifocal biopsy of prostate with morphological verification of prostate carcinoma. The second group consisted of 51 patients (56.0 %) with benign prostatic hyperplasia, and in the third group there were 19 patients (20.9 %) with acute and chronic prostatitis.Results. 91 patients with different prostatic diseases were examined. There were defined PSA (prostate specific antigen) level, and performed TRUS (transrectal ultrasound), biopsy and sonoelastography of prostate. In 72 patients SEG (sonoelastography)-picture of prostate was compared to morphological diagnosis. According to SEG findings, 43 (81.1 %) patients were revealed to have the areas of reduced compliance due to what malignancy in prostate gland (PG) was excluded. Morphological diagnosis of prostate carcinoma was confirmed in 21 patients. In 51 patients SEG-picture corresponded to benign process confirmed by histology.Conclusion. Sonoelastography is a modern diagnostic technique of prostatic diseases, seminal vesicles, paraprostatic space. The distinguished mapping types enable to make differential diagnosis of different prostatic pathological processes. Sonoelastography improves prostate carcinoma diagnostics and staging, and also has economic significance value when compared to MRP (magnetic resonance tomography) with bolus contrast.

There is presented a case of treatment of disseminated tumour of pelvic organs. The degree of prostatic involvement was diagnosed by a new technique of diagnostic ultrasound - sonoelastography that enabled to perform radical cystprostatectomy with sigmoid and rectum resection, with a Mainz-Pouch III reservoir formation.