Bacterial Complications Research Articles

Practical Importance Use Of Modern Probiotics In Complex Treatment Of Adenoviral Conjunctivitis

Adenoviral conjunctivitis is an inflammatory disease of the conjunctiva that spreads at the epidemic level, the main reason for which is explained by the fact that it is rapidly spread by airborne and domestic routes and has a high degree of contagiousness. In clinical practice, viral eye pathologies develop the background of upper and lower respiratory (especially rhinitis, sinusitis, tonsillitis, bronchitis) and antibiotics are often used to treat bacterial complications in this category of patients. As a result, the balance of the immunomicrobiological environment in the intestines of some patients is disturbed [1,2,7] In this contingent of patients, eye pathologies of viral etiology persist for a long time. In modern practice, an integrated approach is used to increase the effectiveness of the prevention and treatment of adenoviral conjunctivitis. In addition, complex treatment of adenoviral conjunctivitis is required that the adequate use of antiviral and immunomodulatory drugs, as well as the inclusion new group of drugs in the treatment algorithm for increasing effectiveness and eliminate symptoms of this disease [3,5]. Probiotics stimulate the body's specific (antibody and immune system) and non-specific (skin, mucous membranes and tears) immunity by restoring the normal intestinal microflora balance, resulting in activation of cellular and humoral immune processes. The use of modern probiotics during treatment period decreased the production of cytokines in the patient's body in the same time increased of endogenous interferon’s concentration in the blood [1,3,4,6]. Even during an epidemic of adinoviral conjunctivitis, the inclusion of multi-component probiotics such as Bifolak Zincum + C + D3 in the complex treatment plan is effective and safe.

Frequency of infectious complications and features of systemic inflammatory response in patients with prolonged disorders of consciousness

Objective: investigate epidemiology of infectious complications, intensity of antibacterial therapy, and features of the systemic inflammatory response in patients with prolonged disorders of consciousness.Materials and methods: retrospective case histories analysis of 102 patients with prolonged disorders of consciousness who were treated in the department of anesthesiology and intensive care of Polenov Neurosurgical Institute from 2010 to 2019.Results: during hospitalization all patients (100%) had signs of tracheobronchitis, 86 patients (84,3%) had urinary tract infection, 34 (33,3%) pneumonia, 10 patients (9,8%) meningoventriculitis, and in 9 (8,8%) cases sepsis was diagnosed. Identified bacterial complications required systemic antibacterial therapy. With an average length of hospital stay of 51±42 days, duration of antibiotic therapy was 37±41 days. One-component therapy was applied in half of the cases (54%), slightly less often (43,2%) treatment consisted of two antibiotics, in some cases patient’s condition required prescription of three antibiotics (2,8%). Even in the absence of a focus of infection, temperature and laboratory markers of inflammation in blood samples of patients with prolonged disorders of consciousness were higher than the reference values. CRP was increased with addition of any bacterial complications. Count of white blood cells significantly increased only in case of pneumonia and sepsis. Procalcitonin test was positive in 16,6% observations of urinary tract infection, 30,4% of pneumonia, and 28% of meningoventriculitis.Conclusion: most informative proinflammatory marker of bacterial complications in patients with prolonged disorders of consciousness was CRP. Mild leukocyte response can be explained by immunosuppression in long-term ill patients. Limited value of procalcitonin test may be due to the insufficiency of the semi-quantitative method sensitivity with a threshold level of 0,5 ng/ml, as well as reduced proinflammatory response to local infection in patients with prolonged disorders of consciousness as a result of massive antibacterial therapy, colonization of opportunistic microflora and presence of sympathicotonia (non-infectious systemic inflammatory reaction).

Network analysis of Down syndrome and SARS-CoV-2 identifies risk and protective factors for COVID-19

SARS-CoV-2 infection has spread uncontrollably worldwide while it remains unknown how vulnerable populations, such as Down syndrome (DS) individuals are affected by the COVID-19 pandemic. Individuals with DS have more risk of infections with respiratory complications and present signs of auto-inflammation. They also present with multiple comorbidities that are associated with poorer COVID-19 prognosis in the general population. All this might place DS individuals at higher risk of SARS-CoV-2 infection or poorer clinical outcomes. In order to get insight into the interplay between DS genes and SARS-cov2 infection and pathogenesis we identified the genes associated with the molecular pathways involved in COVID-19 and the host proteins interacting with viral proteins from SARS-CoV-2. We then analyzed the overlaps of these genes with HSA21 genes, HSA21 interactors and other genes consistently differentially expressed in DS (using public transcriptomic datasets) and created a DS-SARS-CoV-2 network. We detected COVID-19 protective and risk factors among HSA21 genes and interactors and/or DS deregulated genes that might affect the susceptibility of individuals with DS both at the infection stage and in the progression to acute respiratory distress syndrome. Our analysis suggests that at the infection stage DS individuals might be more susceptible to infection due to triplication of TMPRSS2, that primes the viral S protein for entry in the host cells. However, as the anti-viral interferon I signaling is also upregulated in DS, this might increase the initial anti-viral response, inhibiting viral genome release, viral replication and viral assembly. In the second pro-inflammatory immunopathogenic phase of the infection, the prognosis for DS patients might worsen due to upregulation of inflammatory genes that might favor the typical cytokine storm of COVID-19. We also detected strong downregulation of the NLRP3 gene, critical for maintenance of homeostasis against pathogenic infections, possibly leading to bacterial infection complications.

Ways to prevent acute viral infection and its bacterial complications

Viruses of the ARVI group that are tropic to the epithelium of the upper respiratory tract are able to inhibit the function of the mucociliary system to a certain extent, which contributes to the attachment of bacterial infection. Thus, in respiratory inflammatory diseases, the infection is often combined. This means, that the question about approaches to treatment at the stage of prevention of the development of complications of ARVI arises. A significant increase in the relapse of chronic sinusitis has been observed over the past 10 years. According to A.I. Kryukov et al. the relapse of inflammatory diseases of the paranasal sinuses, the chronic process has no tendency to decrease, aided by the unfavorable ecological situation, the growth of allergic and viral respiratory diseases, poor nutrition to which the body is not evolutionarily adapted. Worsening of chronic sinusitis contributes to many factors, but the starting point is almost always viral infections. Relapse, as a rule, begins with viral rhinitis, which is rarely an independent disease. Most often, a runny nose is a symptom of ARVI or ARI (influenza, parainfluenza, adenovirus infection, etc.). The entrance gate of infection is the epithelial cells of the respiratory tract. The main pathological process in sensitive cells develops both as a result of the penetration of the virus from the outside, and due to the activation of latent or chronic viral infection under the influence of various factors, including other infection.The appointment of drugs with anti-inflammatory, immunomodulatory, adaptogenic activity is one of the promising options for the prevention of both primary viral infection and the development of bacterial complications.We have included a drug that combines adaptogenic and immunomodulatory activities in the treatment of chronic sinusitis. Trekrezan belongs to the group of adaptogens – low-toxic compounds, it is recommended as a measure for the treatment and prevention of viral infections and increasing resistance to various stress factors (hypoxia, hypothermia) and adverse environmental effects.

Simultaneous colonization by gram-negative hospital pathogens

Objectives . Assessment of the probability of simultaneous infection with two or more pathogens of clinical substrates of transplant patients. Materials and methods . The retrospective analysis of bacteriological studies of clinical isolates among transplant patients operated from January to July 2020 is performed. This study included 93 patients. Results and discussion . Тhe risk of bacterial complications in the postoperative period is associated with representatives of the gram-negative pathogens Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa. All the studied strains were resistant to antibiotics. A significant number of coinfections with two or three pathogens cases were recorded in the current period – 20.4 %. For the two and more pathogens’ colonization the highest mortality rate is shown, 42.1 %. Conclusions . Modern epidemiological feature is the Acinetobacter baumannii predominance among the microflora of transplant patients. It has been shown that the incidence of co-colonization by ≥ 2 different gram-negative pathogens is significant and increases the mortality rate.

The influence of disease-inducing agents other than Dermatophilus congolensis on the severity of bovine dermatophilosis

This study was designed to assess the influence of disease-inducing agents other than Dermatophilus congolensis on the incidence of bovine dermatophilosis from cattle farms in Federal University of Agriculture, Abeokuta and Olabisi Onabanjo University, Ogun State and also from Akinyele cattle market in Oyo State. Skin scrapings collected from cattle with typical lesions of dermatophilosis were examined for the presence of bacteria, fungi and ectoparasites. Out of the 57 animals examined with typical skin lesions of dermatophilosis, Dermatophilus congolensis organism was cultured from 23 cases. Other bacterial organisms identified included Staphylococcus aureus (28 cases), Staphylococcus albus (35 cases), Bacillus mycoides (14 cases), Bacillus cereus (1 case), haemolytic Streptococcus (5 cases) Pseudomonas aeruginosa (13 cases), Escherichia coli (16 cases), Proteus spp (4 cases) and Norcardia spp (5 cases). Ticks (mostly Amblyomma variegatum) were seen in all the 57 animals while Demodex bovis, Sarcoptes scabiei var bovis and lice were seen in 15, 4 and 8 cases respectively. It was inferred that secondary bacterial invasions are associated with the pathogenesis and severity of the infection and the presence of ticks and mange mites may serve as the portal of entry for dermatophilosis infection. The control of dermatophilosis should take into account of arthropod vectors and secondary bacterial complications.

Titanium-Tantalum Alloy Surface Modification by Hydroxyapatite Layer on TiO2 Nanotubes: Effect on Microbial Activity

Abstract One of the major health security challenges of the 21st century is the occurrence of microbial infections and bacterial complications that could affect 10 million people by 2050. On the biomaterial field, implant metallic currently replaces partial or total body parts and can fail to be integrated into the body due to infections. This study performs two combined surface modifications on Ti-30Ta alloy, in order to obtain an infection-resistance and osseointegration surface on metallic implants to be tested within bacterial biofilm. The Group 1 investigated surface modifications by the anodization process in the electrolyte glycerol + NH4F 0.25% at 30V- 9 hours and annealed in 530°C (5°C/min). The Group 2 underwent the same process as Group 1 and, additionally, the samples were immersed in 0.3 M CaCl2 and 0.5 M Na2HPO4 solutions for hydroxyapatite growth. The substrate was characterized using scanning electron microscopy (SEM), X-ray diffractometer (XRD) and dynamic contact angle. S. epidermidis bacterial adhesion and biofilm formation. The results indicated that the Group 1 shows a higher antimicrobial activity, hydrophilic behavior and potential to be used for metallic implant applications. The Group 2 with the hydroxyapatite film coating did not have an improvement in the antimicrobial response.

Photobiomodulation and Antiviral Photodynamic Therapy in COVID-19 Management.

Coronavirus disease 2019 (COVID-19) has shocked the world by its spread and contagiousness. There is no approved vaccine and no proven treatment for this infection. Some potential treatments that have already been associated with antiviral and anti-inflammatory effects are under investigation. Photobiomodulation therapy (PBMT) is a photon-based therapy that uses light to mediate a variety of metabolic, analgesic, anti-inflammatory, and immunomodulatory effects. Antiviral photodynamic therapy (aPDT) is a branch of photodynamic therapy based on the reaction between a photosensitizing agent and a light source in the presence of oxygen, which can produce oxidative and free radical agents to damage the viral structures such as proteins and nucleic acids. This chapter aims to discuss the potential therapeutic benefit of PBMT and aPDT in the context of the novel coronavirus. Studies indicate that PBMT and aPDT could be useful in many viral and bacterial pulmonary complications like influenza, SARS-CoV, and MERS, but we found no direct study on SARS-CoV-2. With a combination of PBMT and aPDT, we may be able to combat COVID-19 with minimal interference with pharmaceutical agents. It might improve the efficacy of PBMT and aPDT by using monoclonal antibodies and preparing new photosensitizers at the nanoscale that target the lung tissue specifically. More animal and human studies would need to take place to reach an effective protocol. This chapter would encourage other scientists to work on this new platform.

ХІРУРГІЧНЕ ЛІКУВАННЯ ТОРАКАЛЬНОЇ ПАТОЛОГІЇ У ХВОРИХ НА КОРОНАВІРУСНУ ІНФЕКЦІЮ

THORACIC SURGICAL TREATMENT IN PATIENTS WITH CORONAVIRUS INFECTION M. S. Opanasenko, B. M. Konik, S. M. Belokon, O. V. Tereshkovich, S. M. Shalagai, L. I. Levanda, M. I. Kalinichenko, V. I. Lysenko, M. U. Shamrai, A. M. Stepanyuk, O. D. Shestakova Abstract Aim. To familiarize physicians of different specialties with thoracic pathology in patients with coronavirus infection (COVID-19). Materials and methods. Since the beginning of the COVID-19 pandemic 63 patients were treated at the department of surgical treatment of tuberculosis and NLD, complicated by purulent-septic infections: 47 (74.6%) — with various complications of coronavirus infection, and 16 (25.4%) — COVID-19 and conditions, requiring thoracic surgery, not associated with COVID-19. Results. Pleural empyema was the most common bacterial complication — 18 (28.5%) cases. Only 6 (9.5%) patients were diagnosed with broncho-pleural fistula, while 12 (19.6%) patients already had a functioning broncho-pleural fistula at the stage of hospitalization. In 15 (23.8%) patients, the destructive cavities remained on admission, and only 3 (4.7%) had isolated pleural empyema without destruction of pulmonary parenchyma (complete scarring of abscesses). 17 (26.9%) patients with empyema underwent videothoracoscopic (VATS) drainage of the pleural cavity with polydrainage and the use of long-term active aspiration in the postoperative period. In 1 (1.5%) case, due to the extremely severe condition of the patient, only drainage of both pleural cavities was performed. 1 (1.5%) patient with bilateral pleural empyema died of progressive respiratory and cardiovascular failure. Nonspecific exudative pleurisy was diagnosed in 8 (12.6%) patients after coronavirus infection. Spontaneous pneumothorax without development of pleural empyema was diagnosed in 7 (11.1%) patients and in 3 (4.7%) cases pneumo hemothorax occurred. in 2 (3.1%) cases there was a need for parietal pleurectomy (there was a significant area of detachment of the visceral pleura and the impossibility of imposing intracorporeal sutures). All patients were discharged from the hospital with recovery. 6 (9,5 %) patients with necrotizing pneumonia comprised a challenging group of patients with large, treatment-resistant cavities. In 4 (6.3%) cases antibacterial therapy was ineffective, so transthoracic cavity drainage was performed. All 6 patients underwent radical resection interventions following long pre-operative period: 3 (4.7%) cases - pleurolobectomy, 2 (3.1%) — sublobar resection and 1 (1.5%) - resection of the 6th segment of right lung). Conclusions. Pulmonary purulent-destructive COVID-19 complications may occur much more rarely if timely treatment was used. Videothoracoscopic intervention is a preferred option of treatment of these conditions. Key words: COVID-19, thoracic pathology pneumohemothorax, pleurodesis. Ukr. Pulmonol. J. 2021;29(3):31–35:

Влияние иммуномодулирующей терапии на течение острых респираторных инфекций вирусной этиологии: метаанализ клинических исследований эффективности и безопасности препарата Эргоферон в лечении гриппа и других острых респираторных вирусных инфекций

Objective. To evaluate the efficacy and safety of Ergoferon in children and adults with acute respiratory viral infections (ARVIs). Material and methods. We have analyzed the results of 10 randomized controlled trials involving 1732 patients. The outcome measures included duration of fever, disease severity, frequency of deteriorations, number of adverse events (AEs), and assessment of drug interaction. We have conducted statistical analysis of pooled data and meta-analysis using logistic regression. Results. Patients receiving Ergoferon were 1.5 times more likely to have shorter period of fever than those receiving placebo (ОR = 1.499, р = 0.0002). Patients in the Ergoferon group had milder ARVI and influenza than patients in the placebo group (according to the AUC analysis: 32.83 ± 18.12 vs 36.94 ± 19.08 units in the placebo group, p = 0.0083). The frequency of deterioration in the Ergoferon group was 7 times lower than that in the placebo group (0.6% vs 4.4% of cases). Treatment safety was confirmed by fewer patients having AEs in the experimental group (0.6% vs 10.8%, p = 0.0006.) and no drug interactions. Conclusion. Our findings suggest that Ergoferon significantly reduced duration of fever in patients with ARVI and influenza compared to placebo. Ergoferon alleviated the disease and reduced the incidence of bacterial complications. Moreover, this drug demonstrated good tolerability and compatibility with other drugs. Key words: ARVI, influenza, meta-analysis, ARVI treatment, influenza treatment, Ergoferon

Бактериальные лизаты: традиционные представления и новая парадигма

This paper addresses published data on therapeutic, preventive efficacy, and safety of bacterial lysates (BLs) in pediatric practice. Studies on the mechanisms of action of BLs are discussed. Experimental evidence demonstrates that the preventive effect of BLs is maintained even in the high level of bacterial lysis characterized by the presence of only small peptides or even their fragments without antigenic properties. The authors discuss the potential involvement of BLs in the development of trained immunity, whose effects last less time than a conventional epitope-specific adaptive immune memory. The article provides a pathogenic basis for BL use to prevent and manage recurrent respiratory infections and control respiratory allergic diseases as a part of complex treatment. Our data demonstrate a high efficacy of polyvalent mechanical BL to prevent acute and recurrent respiratory infections in children of organized communities, a reduced rate of bacterial complications, and the rate of antibiotic prescription when using BLs. Good tolerability and the lack of adverse and side effects of BLs are emphasized. KEYWORDS: bacterial lysates, asthma, children, immunity, immune prophylaxis, polyvalent mechanical bacterial lysate, respiratory infections, recurrent respiratory infections, trained immunity. FOR CITATION: Zaplatnikov A.L., Girina A.A., Svintsitskaya V.I. et al. Bacterial lysates: conventional views and a new paradigm. Russian Journal of Woman and Child Health. 2021;4(3):284–291 (in Russ.). DOI: 10.32364/2618-8430-2021-4-3-284-291.

Клиническая фармакология антибактериальных препаратов в педиатрии

Currently, the use of antibacterial drugs is one of the most frequently recommended methods for treating a large number of infectious diseases. However, there are many cases of unjustified antibacterial therapy, errors in the use of antibiotics, irrational combinations, and undesirable drug reactions. And that is why the problem of rational antibiotic therapy remains relevant in modern medicine - the rational use of antibacterial drugs, compliance with strict indications for the use of antibiotics, certain schemes and principles of their use, and the creation of protocols for antibacterial therapy in pediatric practice. The purpose — to present the key issues of clinical pharmacology of antibacterial drugs in Pediatrics. Results. A large number of different microorganisms act as etiological factors of frequent, repeated respiratory diseases. Antibacterial drugs should be prescribed for inflammatory diseases of bacterial etiology and for perioperative prevention. Antibiotics should not be used in the treatment of uncomplicated acute viral respiratory diseases, since they do not have an antiviral effect, do not reduce the temperature, and do not prevent the development of bacterial complications. Conclusion. Thus, today a doctor has a large arsenal of antibacterial drugs and faces a very important task — to use this arsenal rationally. When choosing antibiotics, there are problems associated with the presence of a large number of drugs, the proposed combinations and treatment regimens, polypragmasia, ignorance of modern treatment standards, and a low level of knowledge of clinical pharmacology. In the treatment of life-threatening infections, the cost of the antibiotic should not prevail over the factors of effectiveness and safety.

374. Complication with Bacterial Pneumonia in Hospitalized Patients with Coronavirus Disease 2019 (COVID-19)

BackgroundEarly reports have indicated widespread empiric antimicrobial usage in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As data regarding bacterial complications in patients with Coronavirus Disease 2019 (COVID-19) are limited and emerging, it is important to delineate the burden of complications with bacterial pneumonia in patients with COVID-19 and its implication on antimicrobial usage.MethodsWe conducted a retrospective cohort study of all hospitalized patients diagnosed with COVID-19 based on detection of SARS-CoV-2 on RT-PCR from March 1, 2020 to May 10, 2020. Data were collected retrospectively to determine the presence of bacterial pneumonia among patients hospitalized with COVID-19 and to identify demographics, comorbidities, or laboratory values that may help to distinguish patients with bacterial pneumonia. Fisher’s exact test was used to analyze categorical data and Student’s t test was used to analyze differences between means.ResultsAmong 99 patients hospitalized with COVID-19 during the study period, complication with bacterial pneumonia was seen in 17 (17%) based on sputum, tracheal aspirate or lower respiratory tract cultures performed 8.9 ± 7.8 (mean ± SD) days from the detection of SARS-CoV-2 on RT-PCR. Staphylococcus aureus was the causative organism in 8 (47%) cases while Enterobacteriaceae were isolated in 7 (41%) cases, Burkholderia cepacia in one (6%) and Rahnella aqualitis in one (6%) case. There were no significant differences in demographics, comorbidities, or laboratory findings between patients with or without complication with bacterial pneumonia. However, those with complication with bacterial pneumonia were more likely to be intubated (24% vs. 88%, p< 0.01), on vasopressors (23% vs. 82%, p < 0.01), and require intensive care unit admission (37% vs. 94%, p< 0.01). ConclusionNosocomial and ventilator-associated pneumonia were commonly seen among hospitalized patients with COVID-19 requiring intubation and intensive care use admission. With complications of bacterial pneumonia common among critically-ill patients infected with SARS-CoV-2, widespread antimicrobial usage may increase the selective pressure for antibiotic resistance in this patient population.Disclosures All Authors: No reported disclosures

COVID-19: Immunogenetics and Immuno-Epidemiological Parameters

As of February 15, 2020, 51,800 cases of COVID-19 disease, including more than 1,600 COVID-19-related deaths, had been laboratory-confirmed in mainland China, mainly in Hubei province. Additionally, 526 laboratory-confirmed cases have been reported across 25 other countries. Approximately, 15% of cases reported to the World Health Organization (WHO) are severe, 3% are critical, and 82% are mild clinical manifestations, whereas the estimated overall case fatality rate is approximately 2% but the figure outside of Hubei province is approximately 0.05% or less, not different from the fatality identified in the seasonal influenza. The mean age of COVID-19 patients is 52.4 years, whereas children and adolescents are the least likely group to be infected with the COVID-19, occurring in only 2 % of cases 19 years of age or younger. When the younger-age group get sick, they will get a mild form of COVID-19 without serious complications, with an average death rate of 0.2 %. Men constitute more than two-thirds of the reported COVID-19 cases (73 % vs. 27 %) and are more than 1.5 times more likely to die from COVID-19 (death rate : 2.8 % vs. 1.7 %). This sexual distinction of the anti-viral immunity between men and women is due to the genetic factors, hormonal factors, and environmental factors. The unanswered questions include the pathophysiology of pulmonary clinical infection, influenza and other viral co-infection, and the rate of bacterial complications. SARS-CoV-2 (COVID-19) infection has evolved to become a pandemic, in contrast to infections with SARS and MERS, whereas SARS-CoV-2 (COVID-19) has demonstrated having the similarities of genome sequence, receptor affinity, pathogenesis, and disease manifestation. In conclusion, although genomic evidence does not support the belief that COVID-19 is a laboratory construct, currently it is impossible to disprove or prove the theories of its origin. To identify the COVID-19 origin, obtaining virus sequences from immediate non-human animal sources would be the most definite method. In the absence of proper cure of COVID-19, it is necessary to identify the factors that may assist in assessment of the COVID-19 disease severity before rapid progression of the disease

Patient blood management

Background. Blood transfusions (BT) remain one of the most common medical procedures: about 110,000 doses of whole blood are collected annually and almost as many are transfused. Approximately every 10th patient who undergoes invasive procedures in the hospital needs BT. However, 40-60 % of BT in patients without bleeding are inappropriate.&#x0D; Objective. To describe modern views on the BT.&#x0D; Materials and methods. Analysis of the literature on this issue.&#x0D; Results and discussion. The triad of major risk factors for perioperative complications includes three interrelated factors: blood loss, anemia, and BT. The use of blood products is accompanied by an increase in the number of complications (not directly related to BT) and 30-day mortality. Fatal consequences of blood transfusion are also possible. They include acute lung damage associated with BT, hemolytic and bacterial complications, circulatory overload, anaphylaxis. Patient blood management (PBM) includes early detection and treatment of preoperative anemia, especially in patients at high risk of bleeding; minimization of blood loss and maximally blood-saving tactics; rational and guideline-adequate administration of allogenic blood products. About 39 % of patients scheduled for surgery have preoperative anemia. Absolute iron deficiency (ID) is present in 62 % of patients with preoperative anemia. Ferritin level &lt;30 μg/L is an indicator of such anemia. Preoperative anemia is an independent risk factor for mortality and complications, so in presence of anemia, major emergency surgery should be postponed until hemoglobin returns to normal. The target level of the latter in the treatment of preoperative anemia should be 130 g/L for both sexes. If surgery is scheduled 6-8 weeks after the revealing of ID with or without anemia, oral replacement therapy should be performed. Parenteral forms of iron are used if there are &lt;6 weeks left before the planned operation or the hemoglobin level is &lt;100 g/L. If necessary, BT can be performed according to a liberal (BT is prescribed at a hemoglobin level &lt;90-100 g/L) or restrictive (&lt;70-80 g/L) strategy. According to a large-scale meta-analysis, the latter almost halves the risk of erythromass transfusion compared to the former. As recommended by the National Institute for Health and Care Excellence, it is advisable to apply a single-dose strategy with reassessment of BT requirements after each blood transfusion. Decisions in patients with chronic BT-dependent anemia and cancer should be made individually. The use of intravenous iron supplements before surgery can reduce the number of BT in the postoperative period. Sufer (“Yuria-Pharm”) is a trivalent iron for intravenous use, which effectively, quickly and safely increases hemoglobin levels. As it was mentioned, another element of the PBM is the minimization of blood loss. Tranexamic acid preparations (Sangera, “Yuria-Pharm”) can be prescribed for this purpose. Tranexamic acid is a lysine-like inhibitor of fibrinolysis; it is recommended for the prevention of bleeding with expected moderate and severe blood loss (&gt;500 ml). In patients with trauma with massive blood loss or with a high risk of intracranial hemorrhage, it is also advisable to use tranexamic acid. Its activity is 26 times higher than the activity of aminocaproic acid. Tranexamic acid is highly effective; it reduces the need for BT without increasing the risk of thrombosis.&#x0D; Conclusions. 1. The triad of major risk factors for perioperative complications includes three interrelated factors: blood loss, anemia, and BT. 2. PBM includes early detection and treatment of preoperative anemia, minimization of blood loss and adequate administration of allogenic blood products. 3. In conditions of preoperative anemia, it is advisable to correct diabetes with oral or parenteral forms of iron. 4. Tranexamic acid drugs are prescribed to minimize blood loss.

АКТУАЛЬНЫЕ ВОПРОСЫ ИНФЕКЦИОННОЙ РЕСПИРАТОРНОЙ ПАТОЛОГИИ У ДЕТЕЙ

Acute respiratory infections (ARI) are still topical, holding the first place in the structure of infectious pediatric pathology. The most common causative agents of ARI are viruses. Currently, about 200 respiratory viruses are known, among which the most significant are influenza and parainfluenza viruses, rhinoviruses, respiratory syncytial virus, adenoviruses. Relatively recently, previously unknown serotypes of coronaviruses (SARS-CoV, MERS-CoV, NL63 and HKU), bocaviruses and metapneumovirus were described, and at the end of 2019 a new coronavirus SARS-CoV-2 was discovered, which causes COVID-19 infection. Pneumotropic bacteria Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, etc. contributed to the incidence of respiratory infections. Pertussis remains a serious infection for young children, which in recent years, despite the typical clinical picture, presents certain difficulties for diagnosis. The ability of ARI to provoke the development of secondary bacterial complications (bronchitis, bronchiolitis and pneumonia) often dictates the unjustified prescription of antibiotic therapy, which has led in recent years to an increase in antibiotic resistance. Thus, the relevance of ARI at the present stage is not in doubt, and the above problems dictate the need for an individual approach to each patient.

Perspectives of treatment of influenza and influenza-like illnesses with Enisamium yodide – Antiviral with anti-inflammatory effect

Background: Enisamium iodide (EI) is a Russian drug whose molecule was developed in the Institute of Pharmacology and Toxicology of Ukraine as an anti-inflammatory and antipyretic agent. Later, other properties of EI were found: inhibition of the influenza virus hemagglutinin, increasing the production of interferon-γ, level of Th1, blood antioxidant activity, inhibition TNF-α and other pro-inflammatory cytokines, activation of macrophages and lysozyme activity. The aim of study was to evaluate the efficacy of antiviral therapy with EI in out-patient patients with influenza and influenza-like illnesses (ILI) without risk factors for severe course of disease. Methods and materials: 124 patients aged 18–55 years with influenza and ILI within 6–48 h of symptoms onset were randomized into 2 groups. 1st group (n = 66) was treated with EI 500 mg tid 5 days, 2nd group (n = 63) received placebo according to the same scheme. In the 1nd group the proportion between influenza and other respiratory viruses was 32.2%: 67.8%, in the 2nd group 31.7%: 68.3%, accordingly. Duration of disease and main clinical symptoms, frequency of complications and speed of the virus elimination from the nasopharynx were estimated. Results: The number of cases with complete recovery within 96 h was 56 (84.8% ± 4.2%) in 1st group and 44 (69.8% ± 5.8%) in 2nd group (p = 0.047). The duration of fever was 68.0 ± 2.8 h in 1th group and 77.1 ± 2.9 h in 2nd group (p = 0.044), muscle pain – 52.3 ± 2.3 and 60.6 ± 2.6 h (p = 0.041), headache-52.1 ± 2.6 and 65.1 ± 2.5 h (p = 0.032), weakness – 75.5 ± 2.3 and 90.4 ± 2.5 h (p = 0.001), accordingly. On the 4th day of treatment the viruses were isolated in 37.8 ± 5.9% of cases in the 1st group and 57.1 ± 6.2% in 2nd group; p = 0.048. Bacterial complications were observed in 3.0 ± 2.1% and 12.6 ± 4.2% accordingly, p = 0.048. Conclusion: The study is demonstrated the effectiveness of EI in the treatment of influenza and ILI in adult outpatient patients. The antiviral and anti-inflammatory effects of the drug, which was administered within 48 h of the symptoms onset were demonstrated by a more rapid reduction of clinical symptoms, frequency of bacterial complications and reduction in the time of virus elimination. Continuation of EI clinical trials are necessary for more full evaluation of its effectiveness.

Analysis of clinical experience of children with toxic epidermal necropysis

Toxic epidermal necrolysis (TEN) is a severe drug allergy. The objective was to analyze the clinical experience of 17 children of different age with toxic epidermal necrolysis. The authors found that medications against infection diseases were the most common reason for the development of the disease. In some cases we observed the delayed diagnosis, therapy without consideration of causative agents, and wrong doses of corticosteroids. The majority of cases require combined use of corticosteroids and intravenous immunoglobulins, however bacterial complications are possible in some cases.

Zinc deficiency may play a crucial role in dialysis-associated bacterial infections

Introduction: Systemic bacterial infections are a common cause of mortality and morbidity in hemodialysis patients. Zinc has a critical role in several immune system functions. Patients who have enough amounts of zinc are able to better face infections caused by various pathogens in comparison to those with zinc insufficiency Objective We sought to assess the role of zinc deficiency in dialysis-associated bacterial infections. Patients and Methods: Eighty-Three adult patients with end-stage renal disease (ESRD) on hemodialysis including 43 patients with bacterial infectious complications and 40 non-infected patients as well as 41 healthy individuals were enrolled. Clinical data, laboratory values including serum zinc level and imaging findings were collected. SPSS was utilized to analyze the data with a significance cutoff set at P &lt; 0.05. Results: Out of 124 participants, 80 (64.51%) were males and 44 (35.49%) were females. The mean age of infected hemodialysis group, non-infected hemodialysis group, and healthy controls were 50.8 ± 16.25, 49.1 ± 18.1, and 56.3 ± 18.2 years, respectively. Catheter site infection (37.3%) and urinary tract infection (30.2%) were the most common infections. The mean serum zinc concentration was significantly lower in the infected patients, compared to non-infected patients and healthy individuals (P &lt; 0.001). Conclusion: The ESRD patients on hemodialysis have lower serum zinc levels which are associated with increased risk of bacterial infection. The role of screening for zinc deficiency and use of supplemental zinc in these patients need to be studied.

Optimizing the management of smoking patients with acute rhinosinusitis

Introduction. Viral infection is the main cause of damage to the ciliated epithelium of the nasal cavity mucosa, which in turn leads to disruption of mucociliary transport, increased viscosity and mucus hypersecretion in the sinuses and deceleration of its evacuation. Smokers suffer from chronic obstructive pulmonary diseases, in particular obstructive bronchitis. Their cough symptom complex sharply increases in acute respiratory viral infection (ARVI), especially when the mucociliary airway system is affected. The etiotropic treatment of this combined pathology is a therapy capable of affecting the entire mucociliary system of the upper and lower respiratory tract, including a drug based on ivy leaf extract, with the active ingredient of the saponin group.Aim of the study. To determine the effectiveness of phytopreparation in preventing exacerbation of chronic bronchitis of smokers in patients with acute viral rhinosinusitis.Materials and methods. Complex examination of 20 active smokers suffering from acute viral rhinosinusitis (AVR), including computed tomography of the lungs, was conducted. The randomized study included the use of phytopreparations in the complex therapy of acute rhinosinusitis in patients with obstructive bronchitis.Results and discussion. Use of medicines based on ivy extract in the complex treatment of acute rhinosinusitis in smokers allowed to achieve reduction of AVR symptom complex complicated by exacerbation of chronic bronchitis by the 5th day of the disease. Dynamics of cough complaints reduction in comparison groups reflects the beneficial effect of ivy extract in smokers with ARVI, complicated by AVR, and in the absolute majority of cases allows avoiding bacterial complications.Conclusion. The conducted study proved the effectiveness of Gedelix in the complex treatment of viral acute rhinosinusitis in smokers. In the absolute majority of cases (80% of the total number of patients in the group) it was possible to avoid long-term exacerbation of chronic bronchitis and bacterial complications.