Publications by authors named "T Khorobrykh"

32 Publications

ROLE OF THROMBODYNAMICS GLOBAL COAGULATION TEST IN IMPROVING TREATMENT RESULTS IN PATIENTS WITH CORONAVIRUS INFECTION AT A COVID-19 HOSPITAL.

Georgian Med News 2021 Apr(313):72-79

First Moscow State Medical University I.M. Sechenov (Sechenov University), Russian Federation.

The aim of the study was to evaluate the effectiveness of the global coagulation test of thrombodynamics for monitoring and correcting the hemostatic system and improving the results of complex treatment in patients with SARS-CoV-2 in the COVID hospital. From April 2020 to December 2020 on the basis of the University Clinical Hospital No. 4 of the First Moscow State Medical University named I.M. Sechenov (Sechenov University) of the Ministry of Health of the Russian Federation 245 patients between the ages of 27 and 89 with SARS-CoV-2 associated pneumonia were treated. The mean age of the patients was 56.7 ± 4.2 years. All patients participating in the study were divided by simple randomization into two groups. The volume of lesion of the lung parenchyma was assessed according to the data of computed tomography. All patients were treated for SARS-CoV-2 in a comprehensive manner in accordance with the temporary guidelines of the Ministry of Health of the Russian Federation with the mandatory prescription of low molecular weight heparins (LMWH). Assessment and correction of the hemostasis system in 177 patients (47.7%) of group 1 was carried out daily using local coagulation tests (LCT), including APTT, PT, TT, PTI, INR, Fibrinogen and D-dimer level. The second group included 128 patients (52.3%), who, in addition to local coagulation tests, used the integral coagulation test - the thrombodynamics test- to assess and correct the state of the hemostatic system. Assessment and correction of hemostasis were performed at the control points (1, 7, 14 days) of the study. Compared to LCT, the thrombodynamics test reliably more often revealed the state of hypercoagulability, which was promptly corrected by increased doses of LMWH in group 2. Positive dynamics of clinical symptoms were detected in patients of group 2 1.8 times more often than in group 1 (p<0.05): fever and shortness of breath in group 2 decreased faster, the SpO2 index recovered more rapidly, especially in patients with severe hypoxia (with SpO2<90), the number of patients with moderate and severe severity by the third point of the study in group 2 was 1.8 times less than in group 1 (p<0.05). Severe forms of lung damage (CT-3 and CT-4) were detected in group 2 3.2 times less frequently (p <0.01) compared with group 1, and the number of deaths was 3.3 times less frequent (p<0.01) by the end of the study. The average bed-day in group 2 of patients (15±1.6 days) was 1.6 times shorter than in group 1 (24±7.2 days). Hemorrhagic complications were not recorded, despite the therapeutic doses of LMWH in patients of group 2. The severity of the condition of patients with SARS-CoV-2 and the dynamics of their symptoms depend on the state of microcirculation in the lungs and in the periphery and on the volume of thrombotic lesions. Anticoagulant therapy prescribed as early as possible in adequate therapeutic doses in patients with SARS-CoV-2 associated viral pneumonia made it possible to achieve positive treatment results. The use of the global coagulation thrombodynamics test has shown high efficiency for the timely assessment and correction of the state of the hemostasis system.
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April 2021

[TELOMERASE ACTIVITY AS A POTENTIAL BIOMARKER FOR PREOPERATIVE DIFFERENTIAL DIAGNOSIS OF CYSTIC NEOPLASMS OF THE LIVER].

Georgian Med News 2021 Mar(312):31-36

I.M. Sechenov First State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation.

The goal of the study was to find ways to improve the quality of preoperative diagnosis of mucinous cystic liver neoplasms using such tumor markers as CA 19-9 and telomerase activity. We conducted a retrospective analysis and a prospective study that included the results of treatment of 80 patients with cystic neoplasm of the liver (31 with MCNL, 36 with multichamber non-parasitic cysts (NPC), 13 with stage II (WHO classification) echinococcus liver cysts. Our study showed the presence of telomerase activity in 29 (93.5%) patents with MCNL (in case of IMCNL, the TA was high both in the tumor itself and the CNL content).16 patients demonstrated high TA (+++) both in the tumor itself and the CNL content; 11 and 2 patients had moderate (++) and low (+) TA, respectively. 12 (38.7%) patients with MCNL had the CA 19-9 level above 1000 U/L, 14 (45.1%) - above 10,000 U/L, and 3 (9.6%) - above 100,000 U/L, while only 1 (6.5%) patient had the CA 19-9 level <1000 U/L. The analysis of data showed the absence of TA in the CNL content in 33 of 36 patients with NPC. However, three patients demonstrated a low activity of telomerase. CA 19-9 levels were below 1000 U/L in 27 (75%) of 36 patients with NPC. It was established that the determination of TA and the level CA 19-9 in the contents of the CNL is a valuable method, which makes it possible to carry out a preoperative differential diagnosis of CNL with a high probability.
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March 2021

[COMPLEX TREATMENT OF PATIENTS WITH VENOUS TROPHIC ULCER IN THE CONDITIONS OF COVID-19 HOSPITAL].

Georgian Med News 2021 Mar(312):7-14

Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of the Russian Federation.

The aim of the study was to study the effectiveness of complex treatment of decompensated chronic venous insufficiency (CVI) using innovative techniques and proteolysis inhibitors with a wide spectrum of activity in patients with SARS-CoV-2 (COVID-19) in COVID hospital. This study was performed in the surgical department of COVID hospital on the basis of the Clinical Hospital No. 4 of the First Moscow State Medical University named I.M. Sechenov (Sechenov University). During the period from April 2020 to February 2021, 32 patients with confirmed SARS-CoV-2 (COVID-19) and the presence of venous trophic ulcers (VTU) of the lower extremities were treated. All patients underwent complex therapy for viral pneumonia in accordance with the order of the Ministry of Health of the Russian Federation. The protease inhibitor Aprotinin (Gordox ™) was used to improve microcirculation and prevent the development of a "cytokine storm". To accelerate the cleansing and epithelialization of venous trophic ulcers, the surface of the trophic ulcer was treated with an air plasma flow of NO and injections into the trophic ulcer of autoplasma. Against the background of complex treatment, all patients showed positive dynamics of the clinical picture: relief of hyperthermia, increase or stabilization of SpO2 values from 95% and above, significant decrease in CRP, LDH, D-dimer indices, increase in the number of lymphocytes, decrease in the VTU area by 1.5 times, active granulation and marginal epithelialization of the ulcer. In 14 patients (43.8%), complete epithelialization of the VTU defect was noted by the end of the third week. According to the CIVIQ-20 questionnaire, all 32 patients participating in the study showed positive dynamics. There were no lethal outcomes. Multicomponent therapy of decompensated forms of CVI of the lower extremities in the COVID hospital in patients with moderate severity of coronavirus infection with the use of proteolysis inhibitors leads to a rapid relief of symptoms of intoxication, prevents the progression of lung tissue and parenchymal organ damage and contributes to the positive dynamics of healing of ulcerative defects in the vast majority of patients.
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March 2021

[Administration of the immunomodulatory drug aminodihydrophthalazinedione sodium for prevention of progression pneumonia induced COVID-19].

Ter Arkh 2020 Dec 26;92(11):65-70. Epub 2020 Dec 26.

Sechenov First Moscow State Medical University (Sechenov University).

Aim to determine the efficacy of drug aminodihydrophthalazinedione sodium (Galavit) for prevention of progression of the coronavirus infection pulmonary complications: acceleration of regression of pulmonary infiltrates and resolution of COVID-induced pneumonia. 22 patients with medium and severe COVID-induced pneumonia were included in the study. The study included 8 men and 14 women, the average age was 62.17.4 years. Patients with more than one adverse prognostic factor made 82%. Average volume of pulmonary tissue affection (computer tomography CT-2, 2550% of lung volume) was registered in 13 (59.1%) patients, significant volume (CT-3, 5075% of lung volume), in 9 (40.9%) patients. All patients had progressive respiratory failure manifestations due to hypoxemia and related diseases. Aminodihydrophthalazinedione sodium was administered for 714 days from the beginning of disease, at the end of the course of standard complex therapy, in case of preservation of signs of intoxication, negative dynamics according to computer tomography data. Administration of aminodihydrophthalazinedione sodium had a positive effect on the dynamics of clinical scores. The progression of respiratory failure was halted and there was an increase in SpO2 values. According to the control computer tomography data the stabilization of the pulmonary parenchyma affection degree was noted, as well as reduction of the size of the compacted areas in the pulmonary tissue and formation of the picture of organising pneumonia that contributed to reduction of respiratory failure grade. The use of aminodihydrophthalazinedione sodium in complex therapy of COVID-induced pneumonia has a modulating effect on the immune system, prevents the progression of pulmonary tissue affection, promotes regression of infiltration foci, preventing the development of excessive pneumofibrosis and the progression of respiratory failure.
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December 2020

[Multiple primary synchronous colon cancers in patients with advance gastric cancer].

Khirurgiia (Mosk) 2021 (3):62-65

Sechenov First Moscow State Medical University, Moscow, Russia.

Two patients with locally advanced gastric cancer are reported. Both patients underwent colonoscopy in preoperative period. Preoperative examination revealed synchronous colorectal cancer. Preoperative colonoscopy in patients with gastric cancer ensured timely diagnosis of synchronous colorectal cancer and adequate minimally invasive treatment with favorable results.
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http://dx.doi.org/10.17116/hirurgia202103162DOI Listing
April 2021