An abnormal circadian pattern of melatonin was found in a group of young adults with an extreme autism syndrome. Although not out of phase, the serum melatonin levels differed from normal in amplitude and mesor. Marginal changes in diurnal rhythms of serum TSH and possibly prolactin were also recorded. Subjects with seizures tended to have an abnormal pattern of melatonin correlated with EEG changes. In others, a parallel was evidenced between thyroid function and impairment in verbal communication. There appears to be a tendency for various types of neuroendocrinological abnormalities in autistics, and melatonin, as well as possibly TSH and perhaps prolactin, could serve as biochemical variables of the biological parameters of the disease.

To the Editor: Chalela et al. 1 reported early white matter injury in anoxic-ischemic encephalopathy (AIE) in seven relatively young (median age 31.5 years) patients. Causes of AIE were varied, and included patients with cardiac arrest, carbon monoxide intoxication, or drug abuse. They suggested that the high fatality rate (5/7) might indicate that anoxic white matter injury carries a worse prognosis. 1 To determine whether demyelination occurs in AIE and could eventually be taken as an initial prognostic factor, we studied prospectively 27 patients with AIE (myocardial infarction or ventricular arrhythmias, 85%; respiratory failure or arrest, 15%). Serum level of galactosylceramide, a major component of myelin, has been proved to be a reliable index of demyelination. 2 Galactosylceramide, undetectable in normal individuals, is detected in sera of patients with MS, stroke, or intracranial neoplasm. 2 All patients had a Glasgow Coma Scale score and galactosylceramide level determination at admission and every second day, until discharge or death. Galactosylceramide levels (initial, maximum, and final-within 2 days before death or discharge) were correlated with final outcome, time to death or discharge, and Glasgow Coma Scale score.Twelve patients (6 men, 6 women, mean age 58.9 years) were discharged from the hospital; 15 patients (6 men, 9 women, mean age 58.2 years) died in coma (fatality rate 15/27). Patients who died in coma had a lower mean initial Glasgow Coma Scale score on admission than patients discharged (4.65 Ϯ 1.72 vs 9.42 Ϯ 4.23, p Ͻ 0.01). 3 Positive values of galactosylceramide (Ն2.0 nmol/ mL) were obtained at least once during the course of hospitalization in 85% of patients (80% of those who died in coma and 92% of those discharged-nonsignificant difference). However, no significant association was observed between initial, maximal, or final galactosylceramide level and outcome (death while in coma vs discharge), or between mean level of galactosylceramide and mean Glasgow Coma Scale score.We conclude that demyelination occurs in nearly all cases of anoxic-ischemic brain injury, reflecting destruction of the myelin by the metabolic process of hypoxia. Unfortunately, galactosylceramide level could not be taken as a prognostic indicator.

According to the State program of the Russian Federation «Health care development» till 2020 approved by the decree of the Russian Federation government dated 24.12.2012 N 2511-p, the principle of the cluster approach became the one of the directions of informatization of healthcare. Subsystem perinatal cluster is the continuous monitoring of pregnant women. Its main advantage is the formation of a unified information space of the hospitals in the region that allows you to reliably group out pregnant females according to the risk of complications of pregnancy and childbirth, to determine the routing for all the patients. The goal of the system is a significant improvement of the assistance within a cluster (group), the formation of a standardized approach to the medical care, management of emergency situations in the occurrence of life-threatening conditions, the reduction of maternal and perinatal mortality rate. Computerization of medical care in obstetrics was implemented in the automated system «Program monitoring for pregnant females».

Introduction. In the article we discuss the use of information technology in obstetric care during the COVID-19 pandemic. The aim was reached by continuous monitoring of all cases of upper respiratory infection in pregnant women, women in labor and postpartum women in each specific medical organization and in the whole Sverdlovsk region with subsequent information digiti- zation and automated analysis of different COVID – 19 forms: suspicious, probable and confirmed. Materials and methods. «Regional obstetric monitoring (AIST «ROM») digital system was used for automated COVID-19 diagnosis in pregnant women, women in labor and postpartum women, as well as for detection of suspicious cases. AIST «RAM» allows to analyze patient’s epidemiological data and objective indicators of their physical status and automatically generate signal information. Results. The automatic analysis of the data on the COVID-19 situation in the region is implemented. A register of pregnant patients with COVID-19 is being formed, taking into account the severity of the disease and gestation time. A situational awareness is main- tained using the algorithms of AIST «ROM»: each participant of the process receives information about patient’s condition and his passage through the routing stages. Conclusions. A database, containing information about pregnant and postpartum women, who have COVID-19, is created. This data could be used in further large-scale studies.