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Emergency Medicine (Medicina neotložnyh sostoânij)
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This is an Open Access Journal

Open Access journal
ISSN (Print) 2307-1230 - ISSN (Online) 2224-0586
Published by Publishing House Zaslavsky

[9 journals]

Appeal of editor-in-chief
- Authors: No authors
  Abstract: No abstract
  PubDate: 2023-11-12
  DOI: 10.22141/2224-0586.19.6.2023.1616
  Issue No: Vol. 19, No. 6 (2023)
Pandemics and their geographical distribution
- Authors: N. Komilova, N. Mukhammedova, N. Ermatova, Z. Ibragimova, S. Bafoeva
  Pages: 386 - 392
  Abstract: Background. The relevance of the presented article is due to an increase in the incidence of COVID-19 and the pandemic getting out of control. In the current conditions, the experience of previous generations and ancient pandemics will be useful for further study of the situation. The purpose of the article is to compare and analyze the experience of overcoming and passing through pandemic states and periods in the history of mankind, as well as to draw up possible theoretical methods for influencing the current situation through this experience. Materials and methods. To reveal the topic, authors used the methods of comparative analysis, historical perspective, induction and deduction, as well as an appeal to archival sources and international authors. Results. Thanks to the derived statistics of the incidence of coronavirus, preventive measures have been created against the spread of the pandemic, the use of which in the future will significantly reduce the risks of morbidity. Conclusions. In the field of studying COVID-19, the experience of previous epidemic periods of history has not been applied on a global scale, which determines the novelty of the presented article.
  PubDate: 2023-11-12
  DOI: 10.22141/2224-0586.19.6.2023.1617
  Issue No: Vol. 19, No. 6 (2023)
Methods for assessing portal hypertension
- Authors: S.M. Chooklin, S.S. Chuklin
  Pages: 393 - 401
  Abstract: Many researchers and clinicians have taken the value of hepatic venous pressure gradient (HVPG) as an essential prognostic factor in subjects with chronic liver diseases. HVPG ≥ 10 mmHg indicates the presence of clinically significant portal hypertension, the main predictor of the risk of variceal bleeding, hepatic decompensation, and mortality. However, HVPG measurement is invasive and requires high expertise, so its routine use outside tertiary care centers or clinical trials is limited. Clinically significant portal hypertension also might be detected using non-invasive options such as ultrasonography, elastography, magnetic resonance imaging, and indices derived from laboratory parameters. Our review aims to present the feasibility and applicability of HVPG in modern clinical practice in patients with liver cirrhosis, including invasive and non-invasive methods, based on literary sources from the MEDLINE database.
  PubDate: 2023-11-12
  DOI: 10.22141/2224-0586.19.6.2023.1618
  Issue No: Vol. 19, No. 6 (2023)
Prospects for the study of some electrophysiological parameters in the
diagnosis of fetal growth restriction
- Authors: I.V. Lakhno, A.V. Martynenko, G. Raimondi, V.I. Shulgin
  Pages: 402 - 406
  Abstract: Background. Fetal growth restriction is a clinical syndrome that has adverse effects on both perinatal outcomes and human health in adulthood. Traditional approaches to the diagnosis of this syndrome are based on ultrasound biometry and dopplerometry of uteroplacental and fetal-umbilical blood flow. The equipment used for such research is very expensive, and the training of a qualified specialist takes a long time. Non-invasive electrocardiography makes it possible to evaluate fetal heart rate variability and morphological parameters of the pQRST complex. The purpose: to determine indices of heart rate variability and morphological parameters based on the data of fetal non-invasive electrocardiography, which can be used to diagnose fetal growth restriction. Materials and methods. Two hundred and twenty pregnant women aged 18 to 40 years on 24–41 weeks of gestation were enrolled in the study. All of them were divided into two groups: 108 women with fetal growth restriction were included in group I, and 112 patients with healthy fetuses in group II. The fetal electrocardiogram was recorded in abdominal lead for 30–60 minutes. Results. The performed work made it possible to detect statistically significant changes in some indices of heart rate variability on the background of fetal growth restriction: SI, TP, AC/DC, LF, LF/HF ratio, as well as morphological parameters: QTc duration, QRS complex width and T/QRS ratio. The obtained data demonstrated a violation of autonomic regulation following fetal growth restriction and reflected the tension of regulatory systems, namely, the degree of dominance of the activity of central regulatory mechanisms over autonomous ones. Impaired de- and repolarization processes were a consequence of fetal myocardium remodeling due to ischemia. Conclusions. The development of algorithms for the diagnosis of fetal growth restriction using non-invasive electrocardiography requires further research of the following parameters: SI, TP, AC/DC, LF, LF/HF ratio, QTc duration, QRS complex width, and T/QRS ratio.
  PubDate: 2023-11-12
  DOI: 10.22141/2224-0586.19.6.2023.1619
  Issue No: Vol. 19, No. 6 (2023)
Donor heart preconditioning during orthotopic transplantation
- Authors: O.А. Loskutov, M.М. Goncharenko, M.V. Goncharenko
  Pages: 407 - 413
  Abstract: Background. To date, there are about 500 patients in the heart transplant waiting list in Ukraine. The study included 20 donors for orthotopic heart transplantation. Their average age was 32.3 years. The study evaluated the preparation of the donor heart in terms of its protection against ischemia-reperfusion injury during transplantation and the effect of donor heart preconditioning in a recipient after orthotopic heart transplantation. Тhe purpose was to evaluate the effectiveness of donor heart preconditioning for increasing myocardial resistance to ischemia-reperfusion injury and its preparation for orthotopic transplantation. Materials and methods. The work is based on the results of 20 donors who were diagnosed with brain death and authorized for the use of transplantation of human anatomical materials. Then changes in the main biochemical parameters (lactate, troponin, acid-base balance, creatinine clearance, blood glucose) and the functional state of systemic hemodynamics (blood pressure, heart rate, central venous pressure, ejection fraction, cardiac index) were analyzed at the time of donor heart explantation. Results. It was found that in 100 % of donors, norepinephrine was used for inotropic support, in 40 % — dobutamine and in 25 % — dopamine. Lactate levels were higher than normal in 75 % of cases and troponin levels were increased in all donors, indicating a possible microcirculatory dysfunction that led to a deterioration in donor preconditioning and enhanced ischemia-reperfusion injury to the transplant. According to the correlation coefficient between time and cardiac index, there was a tendency to the deterioration in the donor’s condition depending on the time of making a decision about heart transplantation before heart explantation. Conclusions. The study showed that in 100 % of donors, norepinephrine was used for inotropic support — more often than dobutamine or dopamine. Lactate levels were higher than normal in 75 % of donors and troponin levels were increased in all donors, indicating a possible microcirculatory dysfunction that led to a deterioration in donor preconditioning and increased ischemia-reperfusion injury to the transplant. According to the correlation coefficient between time indicators and cardiac index, it is noted that the longer the time of authorization for orthotopic heart transplantation, the greater the deterioration in the donor’s condition, which is expressed in a decreased myocardial contractility. Based on the correlation coefficient between time indicators and troponin, it was concluded that the growth of troponin complexes was observed with an increase in the time of making a decision for obtaining permission to transplant human anatomical materials, which indicated the onset of ischemic changes in the myocardium.
  PubDate: 2023-11-12
  DOI: 10.22141/2224-0586.19.6.2023.1620
  Issue No: Vol. 19, No. 6 (2023)
Impact of the CD40-CD40L system on pain severity in children after
anterior abdominal wall surgery using various anaesthesia techniques
- Authors: Ya.V. Semkovych
  Pages: 414 - 418
  Abstract: Background. The aim of the study was to assess changes in the serum CD40L level and its potential relationship with pain severity in children after anterior abdominal wall surgery on the background of general anaesthesia and its combination with various regional anaesthesia techniques. Materials and methods. The study included 87 children who underwent anterior abdominal wall surgery using different analgesic techniques. All children were divided into 3 groups: group I (n = 33) — general anaesthesia using morphine; group II (n = 27) — general anaesthesia with the transversalis fascia plane block (TFPB); group III (n = 27) — general anaesthesia using the TFPB combined with the quadratus lumborum block (QLB-4) via a single injection. Results. In group I, the mean serum level of CD40L two hours after surgery was 4,283 pg/ml, with a slight downward trend at discharge (Mann-Whitney U test = 52.5; р = 0.593). In group II, CD40L reduced significantly, by 25.3 % (U = 10.0; р = 0.002); 24 hours after surgery, it decreased by 15.1 % (U = 26.0; р = 0.20). At discharge, the level of CD40L in this group reduced significantly, by 54.4 % (U = 7.0; р = 0.003). In group III during all observation periods, the mean serum level of CD40L was 4–7.6 times lower (U = 0.0; р = 0.000) than corresponding levels in children of group II. Conclusions. The indicators of CD40L signaling were found to increase in paediatric anterior abdominal wall surgeries. There was a close positive correlation between postsurgical pain severity and CD40L serum levels. Single-injection TFPB + QLB-4 resulted in the lowest serum CD40L levels, an indicative of the lowest intensity of postsurgical pain.
  PubDate: 2023-11-12
  DOI: 10.22141/2224-0586.19.6.2023.1621
  Issue No: Vol. 19, No. 6 (2023)
Hematological disorders as a complication of COVID-19
- Authors: Yu.I. Markov, I.A. Markova, N.V. Goriainova, B.M. Kuiavovych
  Pages: 419 - 426
  Abstract: Background. Coronavirus disease (COVID-19) can affect the blood and hemostasis systems and lead to complications that require intensive care. The aim is to detect such common complications by studying literary sources and clinical experience. Materials and methods. The search for relevant literature was conducted in PubMed, and in the other databases such as Science Direct, Google Scholar, Scopus and Web of Science. The literature search was done using the keywords “COVID-19”, “SARS-CoV-2” in combination with “coagulation dysfunction”, “coagulopathy”, “hematological manifestations”, “hematological parameters”, “deep vein thrombosis”, “pulmonary embolism”, “arterial thrombosis”, “D-dimer”, “fibrinogen”, “lymphopenia”, “thrombocytopenia”. Results.
  COVID-19-associated coagulopathy is characterized by high levels of D-dimer and fibrin degradation products in blood plasma, changes in prothrombin time, activated partial thromboplastin time, fibrinogen, and platelet count. Endothelial dysfunction caused by coronavirus leads to an increased risk of thrombotic complications, both in venous and arterial systems, additionally to the existing higher risk of thrombosis in the intensive care unit. The venous thromboembolism frequency among unvaccinated hospitalized patients and during ultrasound screening is significantly higher. Coronavirus disease can lead to arterial thrombosis in areas such as the aorta, kidneys, cerebral and peripheral arteries. COVID-19 can cause enhanced-fibrinolytic-type disseminated intravascular coagulation or limited thrombotic microangiopathy. According to research, patients with severe COVID-19 usually had leukocytosis, lymphopenia, and an elevated neutrophil-to-lymphocyte ratio. Thrombocytopenia is observed not only during the acute coronavirus disease, but also in the post-COVID-19 period. Both thrombosis and bleeding can occur in patients undergoing extracorporeal membrane oxygenation. Conclusions. A high level of D-dimer, a prolongation of prothrombin time, an increase or a quick decrease in fibrinogen level, lymphopenia, neutrophilia, and an increase in the neutrophil-to-lymphocyte ratio are considered prognostic factors for the severity of coronavirus disease. Deep vein thrombosis and pulmonary embolism are the most common thrombotic events in patients with COVID-19. Arterial thrombosis occurs more often in the cerebral arteries and arteries of the extremities.
  PubDate: 2023-11-12
  DOI: 10.22141/2224-0586.19.6.2023.1622
  Issue No: Vol. 19, No. 6 (2023)
The influence of air pollutants on COVID-19 severity in the administrative
and industrial city of Kharkiv
- Authors: A.P. Podavalenko, M.A. Georgiyants, O.V. Vysotska, O.M. Korzh, A.P. Porvan, V.S. Maslova, V.I. Bereznyakov, O.I. Babaieva
  Pages: 427 - 436
  Abstract: Background. Despite the official statement by the World Health Organization regarding the end of coronavirus disease (COVID-19) pandemic, the risk of an epidemic rise in morbidity remains due to the active circulation of the pathogen and its mutation. Social, natural, environmental, and other factors can contribute to the spread of COVID-19. Air pollutants are extremely dangerous for humans, and a mixture of aerosols and dust particles in the air can serve as factors for the severe acute respiratory syndrome coronavirus 2 transmission. So, the purpose of the study was to reveal the impact of air pollutants on COVID-19 severity in Kharkiv. Materials and methods. The influence of environmental factors on the manifestations of COVID-19 epidemic was assessed for 425 days. 16,723 cases of hospitalizations, 1,883 deaths, and 15,146 confirmed cases of COVID-19 in various age groups were studied. There were on average 4,663 active cases every day. Statistical analysis on assessing the impact of environmental factors on COVID-19 morbidity with different degrees of severity was performed using the non-parametric Kruskal-Wallis test in the IBM SPSS Statistics software package, and the normality of the distribution was checked using the Kolmogorov-Smirnov test. Microsoft Office Excel 2016 spreadsheet tools were used for some auxiliary calculations and graphing. Results. The influence of sulfur dioxide, nitrogen dioxide, nitrous oxide, hydrogen sulfide, phenol, soot, and formaldehyde on COVID-19 morbidity in different severity of infection course with incubation periods of 3–4, 6–7, and 10–14 days was revealed. The effect of high concentrations of nitrogen dioxide, nitrogen oxide, and formaldehyde was most significant on active, confirmed, hospitalized, and fatal cases of COVID-19. At the same time, a rise in active cases of COVID-19 was observed with increasing concentrations of sulfur dioxide and hydrogen sulfide, and high concentrations of phenol and soot had an impact on severe forms. Conclusions. Air pollution can contribute to the spread of COVID-19 and lead to its severe forms, which should be considered when predicting morbidity at different levels (national, regional, local) of epidemiological surveillance. Further research is needed to reveal causal relationships between the incidence of COVID-19 and air pollutants, considering the influence of social and natural factors.
  PubDate: 2023-11-12
  DOI: 10.22141/2224-0586.19.6.2023.1623
  Issue No: Vol. 19, No. 6 (2023)
Studying the effect of different combinations of neuroprotectors on
biochemical markers of inflammation, endothelial dysfunction and apoptosis
in patients with ischemic stroke
- Authors: R.F. Karimulin, A.I. Semenenko
  Pages: 437 - 442
  Abstract: Background. Preservation and restoration of neurons in the ischemic penumbra by developing new methods for neuroprotection is one of the urgent issues of modern medicine. The purpose was to study the effect of different combinations of neuroprotectors with different mechanisms of action by analyzing markers of inflammation, endothelial dysfunction, and apoptosis in the blood serum of patients with ischemic stroke. Materials and methods. A randomized prospective controlled study was conducted on the use of neuroprotective complexes (NPC): NPC 1 (cerebrolysin + mexidol) and NPC 2 (cerebrolysin + citicoline), in patients with moderate and severe ische-mic stroke. They were randomly divided into groups: 1) comparison group — standard therapy; 2) NPC 1 along with standard treatment; 3) NPC 2 against the background of standard treatment. Laboratory studies on assessing interleukin-6, endothelin-1 and caspase-8 in blood serum were performed in dynamics, on days 1, 4 and 7. Results. In terms of anti-inflammatory activity, the therapy scheme, which included the administration of NPС 2, was 1.6–2.1 times (p < 0.01) ahead of standard treatment, as well as 1.2–1.4 times (p < 0.05) — of standard treatment combined with NPC 1. The regimen, which included NPC 2, in terms of endothelium protection and antiapoptotic effect exceeded standard treatment alone by 1.8–3.5 and 1.5–2.3 times (p < 0.01), respectively, as well as by 1.2–1.5 and 1.2–1.3 times (p < 0.05) — standard treatment combined with the use of NPС 1. Conclusions. The use of NPС 2 (cerebrolysin + citicoline) for the treatment of moderate and severe ischemic strokes in combination with standard therapy showed the most pronounced and reliable neuroprotective effect (p < 0.05).
  PubDate: 2023-11-12
  DOI: 10.22141/2224-0586.19.6.2023.1624
  Issue No: Vol. 19, No. 6 (2023)