Vol 76, No 2 (2021)

Over the past decade, the healthcare system of the Russian Federation has undergone progressive changes in the system of maternity care, which relate to the development of infrastructure and the introduction of new organizational models. In particular, a three-level system of providing medical care to mothers and children has been created, including a network of perinatal centers for patients at high perinatal and obstetric risk. Field events of specialists of National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of Ministry of Healthcare of Russian Federation to the medical organizations of maternity care in various regions of Russia revealed “hot spots” that require primary attention: acute shortage of staff for the implementation of diagnostic and therapeutic measures at the modern methodological level, as well as for ensuring epidemiological safety in the medical organizations (medical microbiologists (bacteriologists), clinical pharmacologists and epidemiologists); the lack of registration of healthcare-associated infections, which is associated with the prevailing in the country mainly “punitive” methods of combating hospital infections. In modern conditions of nursing preterm babies, newborns with various severe somatic and surgical pathologies, it is necessary to know the real indicators of morbidity in order to reasonably and promptly carry out therapeutic and preventive measures; the need to organize modern microbiological laboratories in the perinatal centers with the availability of “fast” methods (proteomic and molecular-genetic) diagnostics, allowing for microbiological monitoring in specialized departments of newborns and promptly respond to the changes in the epidemiological situation in the hospital, to prevent the development of clinically pronounced cases of healthcare-associated infections.

Background. In coronary artery disease, a change in the adipocytokine content of local fat depots of the heart is observed. However, it has not yet been established whether the expression levels of the studied parameters are really related to the degree of atherosclerotic lesion of the spacecraft.

Aims — to identify the features of the expression of adiponectin, leptin and IL-6 by adipocytes of epicardial, perivascular and subcutaneous adipose tissue depending on the degree of atherosclerotic lesion of the coronary channel in coronary heart disease.

Materials and methods. The study conducted at the “Research Institute for Complex Issues of Cardiovascular Disease” in 2017–2020, included 84 patients with coronary heart disease (CAD), of which 39 with a moderate degree of atherosclerotic lesion of the coronary artery (CA) (≤ 22 points on the SYNTAX Score scale), 20 with severe (23–31 points) and 25 with extremely severe (≥ 32 points). Biopsies of subcutaneous (SAT), epicardial (EAT) and perivascular adipose tissue (PVAT) were obtained during elective coronary artery bypass grafting (CABG). The expression of adipocytokine genes was determined using polymerase chain reaction (real-time PCR) using TaqMan probes and the concentration of the studied adipocytokines in adipocyte culture medium by enzyme immunoassay. Statistical analysis was performed using Statistica 9.0, a one-dimensional and multi-dimensional logistic regression analysis.

Results. In CAD in adipocytes of the cardiac fat depot, a shift in the balance of adipocytokines is observed towards increased expression and secretion of leptin, IL-6 and a decrease in adiponectin with maximum manifestation in severe and extremely severe coronary lesions. Adipocytes of EAT were characterized by the minimal expression of the adiponectin gene against the background of the maximum — leptin and IL-6 in comparison with adipocytes SAT and PVAT.

Conclusions. Low expression of the adiponectin in EAT and PVAT against the background of increased expression of leptin and IL-6 is associated with an increase in the degree of atherosclerotic lesion of the coronary channel.

Mast cells (MC) are widely distributed throughout the body of animals and humans, mainly in barrier tissues. This review provides new information on the hematopoietic origin of MCs from early erythromyeloid progenitors (EMPs), late EMPs, and definitive hematopoietic stem cells. As well as information on the maturation of MSs and heparin synthesis already in the embryonic period. Many physiological functions of MCs are determined by the properties of heparin, which forms the basis of the matrix of granules, since the heparin molecule is a strong polyanion, capable to forming complexes with many biologically active substances and regulating their properties. In a new hypothesis about the participation of MCs in pathological processes, it is assumed that this is due to the depletion of the heparin pool. In such cases, injections of exogenous heparin can help replenish MCs heparin stores. As a result of the restoration of the physiological functions of MCs and the action of exogenous heparin, the pathological process will be converted into an adaptive one. In clinical practice, unfractionated heparin (UFH) obtained from natural sources and low molecular weight heparin (LMWH) obtained by the biochemical route are used. Most often, UFH and LMWH are used in the clinic only as anticoagulants. The worldwide spread of a disease named COVID-19 in 2020 showed that UFH and LMWH are multifunctional drugs that have saved many people. The pandemic caused by COVID-19 has been an unprecedented social and health emergency worldwide. Depression, anxiety and post-traumatic stress disorder (PTSD) have been reported in populations of many countries. This review provides new information on experimental studies on the successful treatment of pathology with low doses of UFH in modeling PTSD in animals. Consequently, heparin can be considered as a promising multifunctional drug for effective pharmacological correction of comorbid diseases under the influence of extreme factors.

Background; Events associated with a risk of death are the most serious complications of pharmacotherapy; One of these complications is prolongation of the QT interval leading to Torsades de Pointes, a life-threatening condition that can result in asystole and sudden death. Factors contributing to the development of the long QT syndrome include heredity, structural abnormalities of the heart, electrolyte disorders, female gender, advanced age, use of drugs with certain electrophysiological properties, and drug-drug interactions. Consideration of all these factors can help achieve the most accurate and objective assessment of the risk of these rhythm disturbances.

Aims — to assess the risk of prolongation of the QT interval and the development of Torsades de Pointes in psychiatric inpatients.

Methods. The study enrolled 500 patients who received medical care in a psychiatric inpatient setting. The risk of QT interval prolongation and development of Torsades de Pointes was assessed using the MedSafety Scan® medical decision support system.

Results. Of the 500 patients treated in the psychiatric inpatient setting, 224 had a risk of QT interval prolongation and developing Torsades de Pointes; the incidence was highest in the group of elderly patients. The mean risk score was 7.59 ± 3.29 in general, 6.02 ± 3.14 in patients aged under 65 years, and 9.16 ± 2.62 in subjects over 65 years of age. An analysis of the frequencies of risk factors for prolongation of the QT interval and Torsades de Pointes revealed that patients aged over 65 years most commonly had atrial fibrillation, chronic heart failure, heart valve disorders, hypertension, and a history of myocardial infarction. Patients under 65 years of age more commonly received medicinal products prolonging the QT interval and drug combinations that can lead to potential drug-drug interactions of relevant clinical significance.

Conclusion. The obtained results indicate the importance of assessing the risk of QT interval prolongation and development of Torsades de Pointes in psychiatric inpatients as an affordable preventive tool that can increase the safety of drug therapy.

The article analyzes the evolution of views on the concept of “epidemiology” in various phrases, provides a critical rationale and assessment of individual groups of definitions of “epidemiology”, presents a substantiated description of new scientific directions in epidemiology. Additions and changes to the existing structure of epidemiology have been developed and proposed, taking into account modern scientific data on infectious and somatic pathology. The formation of new directions in epidemiology has significantly enriched it not only in scientific but also in applied terms. The section “epidemiology of infectious diseases forms” the fundamentality of the science of epidemiology, which is constantly developing, which cannot be said about non-infectious epidemiology. Taking into account current trends, the author proposes his own vision of the modern structure of epidemiology as a science. The epidemiology of noncommunicable diseases is still at a lower stage of development than the epidemiology of infectious diseases. It lacks a full-fledged theoretical basis, both in general and in individual sections. There is no epidemiological terminology generally accepted in world medical science.

May 6, 2021 marks the 70th anniversary of the birth of a Corresponding Member of the Russian Academy of Sciences, Head of the Department of Histology, Cytology and Embryology of I.M. Sechenov, Doctor of Medical Sciences, Professor Sergei Lvovich Kuznetsov.