Lately due to the increase of childbearing age of women, high prevalence of cardiovascular diseases, and, presumably, due to the usage of some medications, there was an increase in myocardial infarction (MI) cases in pregnant women. Risk factors and pathophysiological mechanisms of MI in pregnant women differ from the general population, and are heterogeneous. Pregnancy and childbirth can be defined as ‘physiological stress’ for the cardiovascular system, which can cause MI. Abrupt changes in hemodynamics and increased coagulation state during pregnancy, in childbirth or in the early postpartum period can provoke sudden constriction (vasospasm) of a coronary artery (CA), as well as non-atherosclerotic spontaneous CA dissection, which leads to a critical decrease in the supply of oxygen to the heart muscle. The frequency of hemodynamically significant atherosclerosis of CA is also increasing. The incidence of maternal, perinatal mortality and obstetric complications is higher than in women without history of acute coronary syndrome. Over the past few decades, the diagnosis and treatment of myocardial infarction improved, the number of primary percutaneous coronary interventions in pregnant women increased, and there is now less inpatient mortality. However, due to the absence of large randomized clinical trials on the MI in pregnant women it is impossible to develop a unified algorithm for the management and preventive measures for this condition, thereby it is difficult to select an optimal treatment tactic, and hard to predict subsequent cardiovascular events. In this article we analyzed current data on MI during pregnancy, childbirth, and the postpartum period.

Purpose. To study the levels of average molecules in patients with myocardial infarction against the background of chronic obstructive disease depending on the presence of complications in the acute period of the infarction.

Materials and methods. We studied 225 patients with STEMI. In 195 of them the MI developed against the background of COPD, and in 130 of them it was mono-inflammatory. Among mono-nososologic patients there were 85 patients with acute MI without any complications and 45 patients with complications. Among patients with COPD, 62 patients had uncomplicated MI, and 133 had complicated MI. The comparison group consisted of 110 somatically healthy individuals. Average molecules were determined according to M. Ya. Malakhova (1995) method by direct spectrometry. Statistical data processing was performed using SPSS 26.0 software package.

Results of the study. The levels of LMWP and OP in various biological fluids in patients with complicated MI were statistically significantly higher both among patients with MI as a mononosomal disease and in the presence of COPD. Patients with complications registered higher levels of catabolic pool, endogenous intoxication index and lower values of intoxication coefficient. Among MI patients without complications stage I of endogenous intoxication prevailed, and among the patients with complicated MI and with uncomplicated MI against COPD – stage II, and among the patients with complicated MI against COPD – stage III.

Conclusion. Complicated myocardial infarction is characterized by more pronounced endogenous intoxication. In comorbid patients with complicated MI, endogenous intoxication is more pronounced than in complicated MI without COPD. The demonstrability of the LMWP and OP levels allows us to recommend their use in prognostic algorithms for the development of coronary pathology in comorbid patients.

The aim of the study. To develop a mathematical model for predicting the development of thromboembolic complications and bleeding in patients after mitral valve replacement with mechanical prostheses based on an analysis of a number of risk factors – age, compliance, heart rate at the postoperative stage, prosthesis manufacturer, hemostasis indicators.

Materials and methods. There were examined 260 patients. The following risk factors were analyzed: patient compliance (Morisky-Green test), heart rate at the postoperative stage, prosthesis manufacturer (MedInzh, Carbomedics, ATS, On-X), hemostasis indices (international normalized ratio, activated partial thromboplastin time, D-dimer, fibrinogen, soluble fibrin-monomeric complexes).

Results of the study and conclusion. The frequency of thromboembolic complications was 5.2 cases, bleeding 4.7 cases per 1000 patient-months. With an increase in the level of soluble fibrin-monomeric complexes by 1 g/L, the risk of thromboembolic complications increases by 1.63 times, the presence of a MedInzh’s prosthesis increases the risk of thromboembolic complications by 2.04 times compared to prostheses of other companies, with paroxysmal or permanent forms of atrial fibrillation the risk thromboembolic complications increase 16.29 times compared with patients with sinus rhythm. In compliant patients, the risk of bleeding is 52.5 (1/0.08) times lower than in non-compliant patients; with an increase in the activated partial thromboplastin time by 1 sec, the risk of bleeding increases by 1.07 times.

Transcatheter aortic valve implantation is the main treatment for severe aortic stenosis in patients with high surgical risks. There are undeniable advantages such as minimally invasive access, better portability in patients and decreased risk of postoperative complications compare to open surgery. Unfortunately, most aortic stenoses have the same etiology with coronary artery diseases and it necessitates invasive treatment. Cardiac artery catheterization and providing of stable instrument position are complications in post TAVI patients. It is not always possible to perform angioplasty from diagnostic radial access in post TAVI patient and there is an option of changing access to femoral to provide more safe and stable position of instruments during manipulation.

The aim. To study predictors of contrast-induced acute kidney injury (CI-AKI) in hemodynamically stable patients with myocardial infarction (MI).

Materials and methods. 487 hemodynamically stable patients with MI were under observation after emergency percutaneous coronary intervention (PCI). CI-AKI was defined as an increase in the level of creatinine in the blood within 48 hours after administration of the radiopaque drug (RCP) by ≥ 26.5 mmol from the baseline level. To detect independent risk factors of CI-AKI, the method of multiple logistic regression was used.

Results. The observation group consisted of 48 patients with MI who developed CI-AKI (mean age 64.2 ± 5.18 years), the comparison group of 439 patients with MI without CI-AKI (mean age 55.6 ± 6.03 years). In the observation group were observed more often patients older than 70 years (13 [27.1 %] vs 29 [13.4 %]; p = 0.011), with arterial hypertension (45 [93.8 %] vs 329 [74.9 %]; p = 0.003), postinfarction cardiosclerosis (18 [37.5 %] vs 98 [22.3 %]; p = 0.019), glycemic level ≥ 6.1 mmol/l at admission (22 [45.8 %] vs 129 [29.4 %]; p = 0.019) and left ventricular ejection fraction ≤ 40 % (14 [29.2 %] vs 71 [16.2 %]; p = 0.024). In patients with CI-AKI, the frequency of three vascular pathologies of the coronary bed was higher (29 [60.4 %] vs 195 [44.4 %]; p = 0.035), two or more stents were implanted more often in PCI (31 [64.6 %] vs 184 [41.9 %]; p = 0.003) and the volume of сontrast volume ≥ 145 ml was used (30 [62.5 %] vs 206 [46.9 %]; p = 0.040).

Findings. The probability of CI-AKI in hemodynamically stable MI patients was associated with the level of glucose in venous blood at admission ≥ 6.1 mmol/l, the сontrast volume used ≥ 145 ml and implantation of two or more stents in emergency PCI.

V. Rosman (Tver, Russia) proposed a method for three-dimensional mapping of the spatial distribution of alpha-band frequencies over thesurface of the head based on the dispersive analysis. The results of the application of this method in patients with mental illnesses have been carried out on the basis of huge case statistics and are presented in many publications. The electroencephalographic assessment of threedimensional dispersion maps in disorders of mental functions is based on the interpretation of the state of the systemic-functional organization of the bioelectrical activity of the brain as a whole. The most diverse spatial mosaic of alpha distribution is encountered visually. We have identified three main types of spatial distribution of the alpha rhythm according to dispersion maps: scattered, organized, and excessively consolidated. Evaluation of the state of the systemic-functional organization of cortical rhythm using three-dimensional analysis of dispersion maps greatly facilitates the solution of the difficult interpretational problem of decoding the EEG in mental disorders, and finally allows this method to be pulled out of the routine level.

Transcutaneous two-wave pulse oximetry is the most popular and prevalent method for studying blood oxygenation. However, during its implementation, smokers do not take into account the level of carboxyhemoglobin, which leads to an erroneous overestimation of hemoglobin saturation with oxygen. The computer program developed by us makes it possible, without the use of additional diagnostic equipment, to correct the results of monitoring blood oxygenation for the level of carboxyhemoglobin, correcting the indicated diagnostic inaccuracy in assessing the saturation of hemoglobin by oxygen in smokers.

The analysis of the current state of thermal imaging screening diagnostics and monitoring of the treatment of occupational pathology affecting the thermotopography of the upper extremities is carried out. The possibilities of thermal imaging in the diagnosis of hand-arm vibration syndrome (HAVS) and cold injury syndrome are considered in detail.

Respiratory biomechanics of the lungs describes the static and dynamic state of the human respiratory system in normal and in various pathological conditions. Assessment of respiratory biomechanics indicators is one of the most important tools for reasoned optimization of respiratory support parameters. Modern ventilators have wide opportunities for monitoring the biomechanics of respiration, which helps to optimize the parameters of the patient’s respiratory pattern. Expert class ventilators provide an opportunity for in-depth monitoring of biomechanics, which is extremely important in the treatment of severe respiratory disorders. The review presents the basics of the lungs respiratory biomechanics, the principles for assessing its indicators, interpretation and application in clinical practice.

Introduction. Glucocorticoids are used worldwide to control hyperinflammation in hospitalized COVID‑19 patients. Nevertheless, the debate on the appropriate initiation time, effective treatment duration and modes of administration is still ongoing.

The aim of this retrospective group analysis was to evaluate the influence of early methylprednisolone (MP) administration mode on acute respiratory distress syndrome (ARDS) dynamics in patients with COVID‑19.

Materials and methods. We performed a retrospective analysis of 61 patients, who received MP treatment in the infection unit of our institution. The patients were retrospectively grouped by the MP administration method: either pulse boluses (group 1), or initial loading bolus followed by continuous infusion (group 2). MP administration was initiated on day 3–4 after hospital admission, i. e., within the first 10 days of the manifestation of symptoms. This is an earlier corticoid administration start, than is being described in most publications.

Results. The positive dynamics in the setting of MP therapy was more pronounced in the continuous infusion group. Intensive care unit (ICU) transfer was necessary for 10 patients (33.3 %) of group 2 and for almost twice as many (19 patients, 61.2 %) of group 1. Patients of group 1 required respiratory support escalation (to mechanical lung ventilation) more often. Overall survival at hospital discharge was 77.5 % in the bolus group (group 1) and 90.0 % in the continuous infusion group (group 2).

Conclusion. Based on our experience and the results of statistical analysis, the early use of MP (within 10 days of the first symptoms manifestation) in the ‘bolus followed by continuous infusion’ mode in the setting of the infection unit may reduce disease severity, decrease the need for respiratory support escalation, lower the number of cases of non-invasive and invasive lung ventilation and increase survival of COVID‑19 patients. These results must be further studied in randomized controlled studies.

Objectives. The article summarizes the indications for surgical tracheostomy (STS) and puncture dilatation tracheostomy (PDT) in patients who underwent mechanical ventilation in the intensive care units (ICU). Based on analysis of 502 case histories, the advantages and disadvantages of different types of tracheostomies were determined. The microbiota of the tracheobronchial tree of 40 patients after PDT was studied, the algorithm of postoperative management of patients who underwent tracheostomy in the ICU was described. We also reviewed endoscopic diagnostic and treatment methods for postintubation changes in the larynx and trachea and the main aspects of postoperative care. The revised approach to decannulation of patients allowed to reduce the duration of hospital stay.

Results: Among patients after PDT (group 1; n = 164), 25 complications (15.2 %) were observed. Intraoperative complications (n = 4, 16 %): 3 technically difficult cases (12 %), when PDT had to be continued as an open surgical procedure; 1 case (4 %) of subcutaneous emphysema. Postoperative complications (n = 21, 84 %): 4 cases (16 %) of tracheoesophageal fistulas (TEF), 2 cases (8 %) of tracheomediastinal fistulas(TMF), 2 cases (8 %) of bleeding, 2 cases (8 %) of bilateral paresis of the larynx and 2 cases (8 %) of grade III ulcerative tracheitis, 6 cases (24 %) of a granulation process in the cervical trachea; 3 patients (12 %) required retracheostomy in the late postoperative period. According to the microbiological study, Klebsiella pneumoniae and Pseudomonas aeruginosa prevailed on days 1–3, Proteus mirabilis and Acinotobacter sp. on days 5–7, and Candida sp. was noted on day 10. Among patients after STS (group 2; n = 338), complications were noted in 20 (5.9 %), including 3 (15 %) intraoperative: 1 case (5 %) of pneumothorax, 2 cases (10 %) of damage to the membranous wall of the trachea with thedevelopment of TMF. Postoperative complications were observed in 17 cases (85 %), including 4 cases (20 %) of tracheal stenosis, 2 cases (10 %) of retracheostomy; 2 cases (10 %) of TMF; 3 cases (15 %) of a granulation process in the tracheostomy area, 1 case of bilateral paresis of the larynx (5 %), 3 cases (15 %) of grade III ulcerative tracheitis; 1 case (5 %) of mucosal pressure ulcer of the upper third of the posterior wall of the trachea, 1 case (5 %) of TEF.