[Characteristics of Inferior Myocardial Infarction With a Special Electrocardiographic Pattern (Aslanger) in Metabolic Syndrome]

AIM

To evaluate the features of ST-segment elevation myocardial infarction with the Aslanger pattern in comparison with traditional forms of inferior myocardial infarction in metabolic syndrome.

MATERIAL AND METHODS

This study included 30 patients with inferior myocardial infarction in the presence of metabolic syndrome: 9 patients with the Aslanger electrocardiographic pattern (group 1, age 59.7 [58.4; 63.1] years) and the rest with one of the traditional forms (control group, 59.9 [57.2; 63.8] years, matched by all criteria of metabolic syndrome). All patients underwent primary percutaneous intervention with assessment of the angiographic picture. The magnitude of ST-segment elevation was measured in lead III at the J point and following 0.06 seconds, and the optimal threshold value of this indicator was determined for a new picture of myocardial infarction.

RESULTS

The infarct-related artery in the Aslanger pattern was more often the circumflex artery (p=0.0099), and coronary thrombosis was characterized by a lower TIMI thrombus grade (p=0.014). SYNTAX values for the Aslanger pattern and for the traditional picture of inferior infarction with ST elevation in lead II≥III were higher than for a similar picture with ST elevation in lead III>II. The level of cTnI at admission (p=0.013) and after 24 hours (p=0.0017), the platelet count (p=0.0011) and mean volume (p=0.0047) in group 1 had smaller values than with traditional inferior infarction. The ST elevation at J point and at J+0.06 s point for lead III with the Aslanger pattern was significantly lower than values of such shift in lead III>II and lead II≥III with traditional inferior infarction (p<0.001). An elevation value ≤1.5 mm at J point +0.06 s was a predictor of infarction with the Aslanger pattern. Constructing the ROC curve made it possible to determine that with the Aslanger pattern, the best cutoff value for this index is 2 mm.

CONCLUSION

Myocardial infarction with the Aslanger pattern as compared with traditional lower infarction in metabolic syndrome is characterized by specific individual angiographic signs, lower ST segment elevation, cTnI level, and thrombotic disorders.

[The problem of antibiotic resistance in patients with urinary tract infection]

OBJECTIVE

To analyze the incidence and resistance of microorganisms to antibacterial drugs isolated in urine cultures of patients with urinary tract infections from 2012 to 2019.

MATERIALS AND METHODS

In the Pirogov City Clinical Hospital No1 and in the Bauman City Clinical Hospital No 29 analyzed the results of 15083 urine cultures in 12554 patients from 2012 to 2019.

RESULTS

Enterococcus faecalis (41%), Escherichia coli (36.4%), Klebsiella pneumonia (23.4%) and Proteus mirabilis (7.6%) predominate in the occurrence of complicated UTIs. the number of strains resistant to certain groups of antibacterial drugs increased: mesitillin-resistant staphylococci (+ 4%), producers of -lactamases (+ 19.8% (for E. coli) and + 34.7% (for Klebsiella pneumoniae)), vancomycin-resistant enterococci (+ 1.89%), carbapenemase producers (+ 32.9%). A high level of resistance among Enterococcus faecalis strains to ciprofloxacin (23.1%) and gentamicin (38.4%) was revealed. Among strains of Escherichia coli, an increase in resistance to ampicillin (85.7%), ceftazidime (66.7%), ciprofloxacin (54.1%) and nitrofurantoin (42.9%) was noted. The appearance of carbapenem-resistant strains is noted. Among the strains of Klebsiella pneumonia, there is a significant increase in resistance to all antibacterial drugs used. Separately, one can note a sharp (27.1%) increase in resistance to carbapenems. A high level of resistance was found in Proteus mirabilis to ciprofloxacin (66.7%), ampicillin (75%). There is an increase in resistance of Pseudomonas aeruginosa to ciprofloxacin (66.7%), meropenem (50%). There is a high level of resistance for Acinetobacter baumannii to amikacin (94.9%), imipenem (92.3%), ceftazadime (100%), ciprofloxacin (100%), tigecycline (53.6%). Relatively high sensitivity remains to polymyxin E (88.9%).

CONCLUSIONS

The results of our analysis demonstrate a rapid increase in resistance to most antibacterial drugs among community-acquired and hospital-acquired strains.

[Analysis of the results of ERAS protocol in real-life clinical practice AFTER radical cystectomy (the first prospective multicenter study in Russia)]

AIM

to carry out a multicenter prospective analysis of the results of the ERAS protocol in patients undergoing radical cystectomy in real-life clinical practice. The aims of the study were to assess the complication and mortality rate after radical cystectomy using the ERAS protocol and to assess how often ERAS protocol was imple- mented.

MATERIALS AND METHODS

a multicenter study was carried out in 4 clinics in Russia. A total of 134 patients who underwent radical cystectomy in 2017 were prospectively analyzed. Open and laparoscopic radical cystectomy was performed in 35 (26.1%) and 99 (73.9%) patients, respectively. Bricker procedure prevailed as a method for urine derivation (91.7%). Complication and mortality rate, and each principle of ERAS protocol was analyzed both in the general sample of patients and separately for open and laparoscopic radical cystectomy.

RESULTS

length of hospitalization before the radical cystectomy was 1 (1-2) day. The median duration of surgery was 260 (205-300) minutes, median blood loss was 300 (200-400) ml. The median of the patients time in ICU was 1 (0-2) day. A total of 95 (70%) complications were recorded in the 90-day period after the surgery, including Clavien I-II category in 52 (38.8%) cases and Clavien III-IV in 43 (32%) cases. Of these, gastrointestinal tract complications were predominated. Gastroparesis requiring a nasogastric tube was observed in 16 (11.9%) patients. Ileus developed in 43 (32.1%) cases, and 22 patients (16.4 %) were managed conservatively; however, 21 patients (15.7%) undergone to reoperation. A 90-days mortality reached 5.2% and the main causes included multiple organ failure as a complication of peritonitis, acute heart failure after myocardial infarction and massive bleeding. Re-hospitalization rate was 9.7% (n=13). Length of stay was 12 (9-16) days. According to univariate and multivariate analysis, an absence of antibacterial prophylaxis, a history of coronary heart disease and the patients age more than 75 years were predictors of an increased complication rate. A 30-days mortality rate is 5.2%, and re-hospitalization was required in 9.7% (n=13) cases. An average length of stay was 12 (9-16) days. Frequency of implementation of ERAS protocol in each of the participating clinic varied. Open and laparoscopic radical cystectomy have insignificant differences in some intra- and postoperative parameters, but, in general, both approaches are comparable in terms of complications, mortality, and length of stay.

CONCLUSION

1. Despite the use of the ERAS protocol, radical cystectomy has a high frequency of complications (up to 70%); most of them are Clavien I-II. A 30-days mortality rate is 5.2%, and re-hospitalization is required in 9.7% cases. 2. Univariate and multivariate analysis showed that an absence of antibacterial prophylaxis, a coronary heart disease and the patients age more than 75 years are predictors of an increased complication rate. 3. Open and laparoscopic radical cystectomy have insignificant differences in some intra- and postoperative parameters, but, in general, both approaches are comparable in terms of complications, mortality, and length of stay. 4. To obtain more convincing data on the ERAS protocol after radical cystectomy, long-term studies are required.

[A clinical case of visceral toxocariasis as a cause of eosinophilic polyserositis]

The aim of the present report is to describe a clinical case of toxocariasis. 37-year - old man was admitted to Pirogov Municipal Clinical Hospital No.1 in Moscow. He was presented with intense generalized abdominal pain. Three months before the described hospitalization, the patient had acute bronchitis, then pneumonia. During the examination there were found hyperthermia, ascites, shortness of breath, sweating, hypereosinophilia. Patient lost 8 kilos over the last 6 months. There were arisen many hypotheses, however, after a more detailed survey about patient's life it turned out that he travelled a lot. So that the parasitosis became the main conjecture, which later was confirmed by serological tests.

[Clinical Case of Successful Nephrectomy and Stenting of the Coronary Arteries in Acute Period of Myocardial Infarction in a Patient With Kidney Cancer]

We describe in this case report the clinical situation of development of massive macrohematuria at the background of dual antiplatelet therapy in a patient in the acute period of myocardial infarction with an established diagnosis of kidney cancer and a burdened cardiac anamnesis. Despite the high anesthetic and operational risk of complications, due to the need for coronary angiography with possible stenting of the coronary arteries, left ventricular thrombus and the impossibility of canceling antiplatelet agents and anticoagulants, the patient underwent radical nephrureterectomy, which allowed further stenting of the anterior interventricular artery occlusion and thus to reduce the risk of developing a repeated myocardial infarction.

PREDICTION SCORE IN SURGICAL COMPLICATIONS ESTIMATION IN THE PRACTICE OF INTERNIST

Recently, development of medicine leads to the increase of the number and complexity of surgical interventions, explaining high significance of the risk assessments for post­surgical complications and probability of fatal outcome; this requires participation of internist in patients management with correction of therapy. The article is focused on the main scores and indexes utilized in clinical practice for prediction of possible complications, incl. cardial. A detailed description provided, for every calculator, features and limitations for usage and results interpretation.