The objective: to develop a predictive model for assessing the risk of death in patients with COVID-19 admitted to the intensive care unit (ICU).

Subjects and Methods. This was a single-center retrospective cohort study of hospital mortality in patients admitted to ICU of V.P. Demikhov City Clinical Hospital from March 6 to June 3, 2020.

Results. Case histories of 403 patients were analyzed. In-hospital 30-day mortality among patients treated in ICU was 44.9% (181/403 patients). A multivariate analysis showed that significant predictors of death in patients with COVID-19 were the age of 60 years or more (adj. OR 3.84; 95% CI 1.56‒9.44, p = 0.003), COPD (adj. OR 2.35; 95% CI 1.12‒4.95, p = 0.024), peripheral artery diseases (adj. OR: 5.08; 95% CI 1.87‒13.76, p = 0.001) and CKD stage 3b and higher (adj. OR 4.58; 95% CI 2.36‒8.90, p < 0.001), LDH 300 IU/l or more (adj. OR 3.05; 95% CI 1.23‒7.58, p = 0.016), and CRP 200 mg/l or more (adj. OR 3.65; 95% CI 1.95‒6.85, p < 0.001). Predictive model quality: AUC = 0.811 [0.733‒0.874], p < 0.001.

Conclusions. A nomogram to assess the risk of death in patients with COVID-19 has been developed. It includes the assessment of age, history of COPD, CKD stage 3b and higher, peripheral artery diseases, and monitoring of LDH and CRP.

The objective: to evaluate the effect of inhalation of heated oxygen-helium mixture on the severity of cough in patients with coronavirus infection (COVID-19).

Subjects and Methods. A single-center randomized prospective study was conducted. Group 1 (control) (n = 32) included patients who received standard COVID-19 therapy. Group 2 (n = 29) included patients who had inhalations with heated oxygen-helium mixture (OHM) in addition to standard treatment. The severity of cough was assessed using 6-point scale (0 ‒ no cough; 1 ‒ single cough impulse; 2 ‒ rare cough during the day; 3 ‒ frequent cough that does not affect daytime activity, 4 ‒ frequent cough that reduces daytime activity due to cough; 5 ‒ severe cough in which daytime activity is impossible), and respiratory rate (RR) was also for 7 days from the moment of inclusion in the study.

Results. Cough symptoms of varying severity were detected in all patients included in the study. A prolonged coughing fit led to decrease in blood oxygen saturation. In the control group, intensive cough persisted for the first 4 days and subsequently decreased with the favorable course of the disease. In the group, where OHM was used, on the 3rd day, the severity of cough decreased to 2 scores compared to the initial 4 scores (p = 0,005). The use of OHM allowed reducing the severity of cough versus traditional therapy. The analysis of intergroup comparisons showed differences starting from day 3 (p = 0.014): in patients of Group 2 (with the use of OHM), cough was mostly rare during the day, at the same time, frequent cough persisted in patients of the control group according to assessment of the severity of daytime cough. When analyzing RR, it was revealed that in Group 2, RR from day 2 was below the one in the control group, in which no changes were detected during the entire observation period.

Conclusion. The use of inhalation of oxygen-helium mixture allows reducing the intensity of cough and respiratory rate in patients with COVID-19.

Acute myocardial dysfunction (AMD) remains prominent among extrapulmonary manifestations of COVID-19. Takotsubo syndrome (TS) is one of the causes of AMD development. TS incidence in patients with COVID-19 is currently unknown. The report presents a clinical case of an elderly female patient on maintenance hemodialysis with severe COVID-19. During the session of therapeutic plasma exchange (TPE), the patient had an episode of ventricular fibrillation followed by cardiogenic shock development and ECG changes, similar to myocardial infarction. Echocardiographic (Echo) data showed a distinctive pattern of biventricular TS with a significant systolic function decrease in both ventricles. Emergency CT angiography ruled out obstructive lesions of coronary arteries. Full recovery of both ventricles systolic function, regression of ECG changes, and complete resolution of cardiogenic shock were observed within the next week. The subsequent course of the disease was complicated by sepsis and multiple organ failure which determined the lethal outcome.

The autopsy findings excluded coronarogenic and viral myocardial damage. The presented case demonstrates a life-threatening TS pattern in patients with severe COVID-19. TPE procedure should be treated as a possible trigger of TS.

The objective is to study the effect of different concentrations of sevoflurane on activation of human neutrophils in an ex vivo model.

Subjects and Methods. The cell culture of venous blood neutrophils of 5 healthy men was used in this study. Neutrophil activation by lipopolysaccharide (LPS) and chemotaxis peptide N-formyl-methionine-leucine-phenylalanine (fMLP) as stimulants, was assessed by the expression level of CD11b and CD66b, IL-1β, IL-6 and IL-8, the level of phosphorylation of glycogen synthase β-kinase-3β (GSK-3β). Annexin V and propidium iodide were used to assess apoptosis. Neutrophils were exposed to 0.5, 1 and 1.5 MAC of sevoflurane to assess the effect of the drug on their activation.

Results. Incubation of neutrophils with LPS and fMLP statistically significantly increased the expression of these molecules: treatment with LPS at the dose of 200 ng/ml increased CD11b and CD66b expression by 2.3 and 2.2 times (p = 0.002 and p = 0.001, respectively), while treatment with fMLP at 100 nM increased expression by 1.7 and 2.0 times (p = 0.025 and p = 0.03, respectively). When neutrophils were incubated with the same concentration of LPS after exposure to sevoflurane at a dose of 1.5 MAC, the level of CD11b and CD66b expression increased versus intact neutrophils. In this experiment, the change in CD11b expression was statistically insignificant (p = 0.055), the change in CD66b expression was statistically significant (p = 0.007). Thus, sevoflurane exposure at a dose of 1.5 MAC reduces proinflammatory activation of neutrophils induced by LPS.

Conclusion. Stimulation of neutrophils by LPS was accompanied by dephosphorylation of GSK-3β, and exposure to 1.5 MAC of sevoflurane resulted in its phosphorylation. Thus, phosphorylation of GSK-3β in neutrophils by sevoflurane reduces the expression of CD11b and CD66b.

The objective. To increase the effectiveness of cardioprotection during coronary artery bypass grafting (CABG) by using a modified technique of remote ischemic preconditioning (RIPC).

Subjects and Methods. A prospective randomized study included 119 patients (aged 18 to 75 years) undergoing on-pump CABG. Patients were divided in 5 groups: Group 1 ‒ Sevoflurane control (ContrSevo), RIPC was not used, sevoflurane anesthesia (n = 24); Group 2 ‒ RIPC1 sevoflurane (RIP1Sevo), RIPC with ischemia-reperfusion of one lower limb, sevoflurane anesthesia (n = 26); Group 3 ‒ RIPC2 sevoflurane (RIP2Sevo), RIPC with ischemia-reperfusion of two lower limbs, anesthesia sevoflurane (n = 23); Group 4 ‒ Propofol control (ContrProp), RIPC was not used, propofol anesthesia (n = 22); Group 5 ‒ RIPC2 propofol (RIP2Prop), RIPC with ischemia-reperfusion of two lower limbs, propofol anesthesia (n = 24). The serum troponin I concentration (cTnI) (baseline, and 30 minutes, 12, 24, 36 and 48 hours after СPB weaning). Hemodynamic parameters and indicators of the clinical postoperative course also were evaluated. The impact ischemic-reperfused tissue mass of RIPC on the cardioprotection was assessed by comparing the groups of ContrSevo, RIPC1Sevo, and RIPC2Sevo. To assess the impact of propofol on the RIPC-induced cardioprotection, the groups of ContrProp and RIPC2Prop were compared.

Results. Statistically significant differences in cTnI were found between the ContrSevo and the RIPC2Sevo at points of 12, 24 and 36 hours: ContrSevo 1.83 (1.3; 2.24) ng/ml, RIP2Sevo 1.28 (0.75; 1.63) ng/ml after 12 hours (p = 0.02), ContrSevo 1.44 (0.98; 2.26) ng/ml, RIPC2Sevo 1.17 (0.55; 1.66) ng/ml after 24 hours (p = 0.046), ContrSevo 1.26 (0.86; 1.72) ng/ml, and RIPC2Sevo 0.81 (0.47; 1.24) ng/ml after 36 hours (p = 0.035). No differences in the cTnI were found between the groups of ContrSevo and RIPC1Sevo, RIPC1Sevo and RIPC2Sevo at any stage of the study. There were no statistically significant differences between the groups when comparing hemodynamic parameters. In the RIPC2Sevo Group, arrhythmias requiring cardioversion or drug therapy were significantly less frequent compared to ContrSevo (1 vs. 6) (p = 0.047). There were no other significant differences in the postoperative clinical course. When comparing the groups of ContrProp and RIP2Prop, no significant differences were found in cTnI and hemodynamic parameters as well as in the postoperative clinical course.

Conclusions. A greater mass of ischemic-reperfused peripheral tissue is accompanied by greater RIPC-induced cardioprotection. A modified protocol for RIPC with ischemia-reperfusion of two lower limbs with sevoflurane anesthesia enhances cardioprotection during on-pump CABG. The modified RIPC protocol with ischemia-reperfusion of two lower limbs with sevoflurane anesthesia reduces the risk of arrhythmias requiring cardioversion or drug therapy. Propofol inhibits the RIPC-induced cardioprotection with ischemia-reperfusion of two lower limbs.

The objective: to study in vitro adsorption properties of various devices for selective lipopolysaccharide (LPS) adsorption.

Subjects and Methods: Various methods of closed circuit circulating bovine serum endotoxin solutions were used. The serum was perfused using an LPS sorption device for 240 min. Serum samples were collected before the start of perfusion, and 30, 60, 120, 150, and 240 minutes after the start of circulation. LPS concentrations were measured by the turbidimetric method. One column for polymyxin hemoperfusion and three devices for selective adsorption of lipopolysaccharides were assessed.

Results: When using the device for polymyxin hemoperfusion, the concentration of endotoxin in bovine serum decreased by 61% during 120 minutes, and in 120 minutes after additional administration of endotoxin, it went down by 57%. When using the other three devices, these parameters made 9% and 6%, 10% and 8%, 5% and 10%, respectively. C

onclusion. By definition, an in vitro study cannot provide for complex pathophysiological reactions occurring in the body during sepsis. Тhis fact leads to limitations in extrapolating the results obtained to clinical practice.

The objective: to improve treatment results in patients with toxic rhabdomyolysis (RM) complicated by acute kidney injury (AKI) through using selective hemoperfusion (НР).

Subjects and Methods. The study included 45 patients aged 18 to 55 years diagnosed with toxic RM complicated by AKI. The patients were divided into two groups. Group 1 received standard conservative therapy. In Group 2, during the first day of treatment, HP was used to prevent AKI progression. Changes in clinical and laboratory parameters of RM and renal damage as well as treatment outcomes between the groups were analyzed and compared.

Results. Significantly better decrease in myoglobin blood level was revealed in Group 2 from day 1 to day 7 of treatment. In Groups 1 and 2, these parameters made 26.3% and 52.1%, respectively. The use of НР allowed reducing the urine concentration of KIM-1 by day 3 of treatment in Group 2 by 16.9%, in Group 1, the urine concentration of KIM-1 increased by 15.5%. The frequency of RRT initiation for urgent indications decreased from 75% to 52.9% when using HP, as a result, duration of inpatient treatment decreased from 19.5 (14; 22) to 16.5 (13; 19) days, as well as the period of ICU stay from 11 (9; 15) to 8 (6; 11) days.

Conclusions. The early use of НР as part of the complex intensive therapy of toxic RM complicated by the development of AKI is accompanied by an earlier and significant decrease in laboratory markers of RM and AKI compared to standard treatment, as well as shorter ICU and hospital stay

The objective: to assess changes of clinical and laboratory hemostasic parameters in children at the stages of orthotopic liver transplantation.

Subjects and Methods. A single-centre, prospective, pilot study of coagulation test scores was performed in 20 children aged 0 to 11 years with hepatoblastoma after a course of PRETEX IV chemotherapy who underwent liver transplantation from a related donor.

Results. Children from 0 to 11 years old with hepatoblastoma, after chemotherapy, retain the normal functional activity of the hemostasis system at the pre-hepatic stage of transplantation: APTT 34.6 (34.45; 38.65) s; prothrombin index (PI) 83.53 (74.09; 87.87) %; INR 1.22 (1.16; 1.42) in the 0‒2 year group, APTT 40.45 (34.9; 41, 68), PI 75.57 (64.41; 80.45) %, and INR 1.39 (1.36; 1.87) in the group aged 3‒11 years. Severe hypocoagulation develops by the end of the hepatic stage and in the first 15 minutes after the start of arterial blood flow through the graft: CT and CFT from 195.0 (189.0; 228.5) s and 163.0 (129.5; 171.5) s to 537.0 (456.0; 1,651.5) s and 468.0 (324.5; 611.5) s (p < 0.05), respectively, in the INTEM test. Hypocoagulation at this time develops due to deficiency of coagulation factors and the release of endogenous glycosaminoglycans from the endothelium transplant, as indicated by an increase in CT and CFT to 666.0 (468.5; 2,209.5) s and 254.5 (203.25; 305.75) s in INTEM, CT to 525.0 (389.0; 2028.0) s with p < 0.05 in HEPTEM in children under the age group of up to 2. Within 1 hour after the start of arterial blood flow, the effects of systemic heparinoid effects persist, which is confirmed by the dynamics of CT 360.0 (219.5; 2,116.5) s with up to 960.0 (560.5; 1,440.5) s with p < 0.05 in the EXTEM test.

Conclusion. Changes in hemostasis system parameters during surgery make it possible to judge about rapidly developing coagulation and anticoagulation disorders in children of the presented age groups. Specific changes in the coagulation profile at the stages of liver transplantation in children under the age of 11 inclusive, make it possible to do without routine correction of changes in the hemostasis system.

The safety and effectiveness of endoscopic rhinological operations in the treatment of chronic inflammatory diseases, as well as neoplasms of the paranasal sinuses, are largely achieved by reducing bleeding in the area of the surgical field. Even a small amount of blood can disrupt the view during endoscopy and prevent the intervention from being performed, thereby increasing the risk of complications.

The review presents modern methods of reducing the risk of intraoperative bleeding under general anesthesia. Each approach has its own characteristics, therefore, the benefit-risk ratio should be assessed for each patient before choosing a specific method for controlling intraoperative bleeding.

Severe pain and, as a result, limitation of function are the main disabling factors in knee osteoarthritis. In such cases, percutaneous denervation (cryo- and chemoneurolysis, radiofrequency ablation) is used as one of the methods to reduce the intensity of pain and improve the patient's quality of life. Unfortunately, the relative 6-month effectiveness of this minimally invasive manipulation varies greatly and, according to the literature, ranges from 10 to 63%. The article discusses the scope of the most obvious interrelated factors that can negatively affect the effectiveness of denervation. Thanks to the fundamental works of recent years the anatomical location of the target sensory nerves of the knee joint in relation to bone and soft tissue landmarks have become more clear. This revised anatomy can significantly increase the effectiveness of percutaneous denervation of this joint and needs to be validated in clinical trials.

Hemophagocytic lymphohistocytosis is an extremely rare disease requiring early diagnosis and specific treatment.

The objective: to demonstrate the clinical case of hemophagocytic lymphohistocytosis in an infant. The course of the disease in a 6-month-old child requiring treatment in the intensive care unit was retrospectively analyzed. The article presents the procedure of differential diagnosis of sepsis and hemophagocytic lymphohistocytosis in children, special attention is paid to the diagnostic criteria, and the clinical and laboratory differences of these diseases are described.

Conclusion. The presence of leukopenia, neutropenia, thrombocytopenia, hypoalbuminemia and hypocoagulation in an infant with persistent fever is the basis for a thorough differential diagnosis in order to eliminate severe systemic diseases that manifest as childhood infections and sepsis.

During pregnancy and delivery, the risk of cerebrovascular disorders increases due to several physiological changes. The elevated level of estrogen stimulates the production of clotting factors, which deteriorates the risk of thromboembolism. Increased plasma volume and total blood volume lead to the risk of hypertension, and the high level of progesterone in the third trimester of pregnancy promotes the permeability of small blood vessels. The risk of developing cerebrovascular complications remains high in the postpartum period. The article describes two clinical cases of postpartum ischemic stroke as a complication after surgical delivery in young women with an aggravated somatic medical history. The treatment and follow-up of these patients during their stay in the intensive care unit included changes in management tactics, use of antiplatelet, anticoagulant, and metabolic therapy, and subsequent rehabilitation. This article describes the case-management interventions and changes in neurological symptoms of these patients, also it discusses the most likely etiological factors of cerebrovascular disorders in these cases