Clinical Blood Analysis Research Articles

Investigation of hematological, biochemical and coagulological markers, their diagnostic effectiveness in toxic hepatitis in patients with COVID‑19

This article discusses hematological, biochemical and coagulological markers for the diagnosis of toxic hepatitis in patients with COVID-19. The analysis of the effectiveness of these markers in a large sample of patients confirmed their importance for the early detection of toxic hepatitis b in patients with COVID-19. Blood parameters such as platelets, ALT, AST, bilirubin, as well as coagulograms and markers of protein metabolism (albumin) conducted among patients divided into control and experimental groups were analyzed. It was found that in patients with concomitant toxic hepatitis c COVID-19, the tendency of thrombocytopenia is most common in clinical blood analysis. Among the biochemical parameters of blood, liver markers increase (ALT, GGT, alkaline phosphatase, etc.). It should be noted that in 1/3 of patients, the activity of liver enzymes alanine aminotransferase and aspartate aminotransferase increases, which indicates a violation of liver function.The analysis of these data using ROC analysis showed high diagnostic accuracy of these markers in the detection of toxic hepatitis in patients with COVID-19. These studies may be important for more effective screening and further monitoring of appropriately selected treatment in such clinical situations and contributes to more effective management of this condition, leading to an improved prognosis of this disease. This study is important in the context of understanding the effects of COVID-19 on liver function.

Dynamics and prognostic repeatability of qualitative and quantitative blood characteristics in patients with new coronavirus infection

The study presents the possibility of using clinical blood test indicators characterizing the red hematopoietic germ in diagnosing the severity of the clinical condition of patients with COVID-19.Aim: Dynamic monitoring of changes in the quantitative and qualitative characteristics of erythrocytes and reticulocytes to identify parameters that characterize the severe course of a new coronavirus infection in patients with cardiovascular pathology.Material and Methods. The study included 94 patients with a confirmed diagnosis of a novel coronavirus infection (NCI), hospitalized in the department for the treatment of patients with CVD and COVID-19 with intensive care unit on the basis of the Academician L.S. Barbarasha between February and March 2022. Clinical blood analysis was performed on the 1st, 3rd and 7th day of hospitalization. Whole blood with K2EDTA was studied on a Sysmex XN-1000 hematological analyzer.Results. To determine the diagnostically significant indicators of a clinical blood test, patients were divided into 2 comparison groups: group 1 – 71 people with a mild infection, group 2 – 23 people with moderate, severe and extremely severe NCI. On the first day of observation, 70% of patients in the group of unfavorable course were diagnosed with anemia, while in the group of mild course, 38% of patients were diagnosed. In patients with unfavorable development of the disease, normoblastemia was observed, which, according to the results of regression analysis, increased the risk of an unfavorable course by 5 times OR 0.24 (95% CI 0.07–0.884). Also in the severe group, there was a decrease in hemoglobin saturation of reticulocytes, which was expressed in deficient Ret-He and negative Delta-Hb values. Using binary logistic regression, it was found that a negative Delta-Hb 6 times increases the risk of an unfavorable course of NCI, OR 6.18 (95% CI 1.971–19.3).Conclusion. The parameters of a clinical blood test that characterize the hemoglobinization of reticulocytes reflect the severity of the course of a new coronavirus infection and can be used to assess the clinical condition of patients with this infection.

Clinical and epidemiological aspects of primary immunodeficiencies in the Republic of Karakalpakstan

Studying the prevalence of primary immunodeficiency disorders (PID) is an important aspect of epidemiological research, as it allows for assessing the frequency of these diseases occurring in different regions. The distribution of PID may vary depending on ethnic background and geographical location. Information on the prevalence of PID at regional, national, and international levels enables a more accurate determination of the scale of the problem and the development of effective prevention and treatment strategies. Studying the epidemiological and clinical profile of congenital immune disorders (PID) in the Republic of Karakalpakstan is crucial for understanding the prevalence, age and gender structure, as well as the spectrum of nosological forms of these rare diseases. The aim of this study was to investigate the epidemiological and clinical characteristics of congenital immune disorders, primary immunodeficiencies in the Republic of Karakalpakstan. The study material consisted of data on patients receiving inpatient treatment at a multidisciplinary children’s hospital in the Republic of Karakalpakstan and those under the care of an allergist-immunologist in the outpatient clinic at district medical centers in the Republic of Karakalpakstan. The average delay in diagnosis from the onset of clinical manifestation of PID in the region was 2.7 years. It was found that the mortality rate was 2.8%. Screening tests for verifying PID in the diagnostic search stage included clinical and biochemical blood analyses, and determination of serum immunoglobulins. At the time of diagnosis, patients exhibited a significant decrease in IgG and IgA immunoglobulin levels. In addition to the disorder in the humoral branch of adaptive immunity, children with this disease showed a decrease in the absolute number of T lymphocytes. The data obtained from the study indicate insufficient diagnosis of primary immunodeficiencies in the Republic of Karakalpakstan, which may serve as a basis for the development of educational programs aimed at increasing awareness of primary immunodeficiencies. Further research and systematization of information on patients with primary immunodeficiencies are necessary for the development of regional programs for the implementation of screening diagnostics.

Impact of Comorbid Pathology and Severity of Clinical Course on Anti-infective Protection in Patients with COVID-19

Objective — to establish and evaluate the impact of comorbid pathology and the severity of the clinical course on the activity of anti-infective protection in patients with coronavirus disease 2019 (COVID-19), based on the analysis of the absolute and relative counts of major immune cell populations in peripheral blood. Materials and methods. A cross-sectional prospective study was conducted involving 204 patients with COVID-19-associated pneumonia of mild, moderate and severe stages. The cohort included 106 (51.97 %) women and 98 (48.03 %) men, with an average age of (55.93 ± 8.75) years. Anti-infective ­protection was studied using comprehensive clinical blood analysis, including the count of major immune-competent cells. Patients were categorised into groups based on comorbi­dity, taking into account the predominant concurrent pathology at the time of examination (endocrine, cardiovascular or other). Results and discussion. More severe COVID-19 cases were characterised by leukopenia, relative and absolute granulocytopenia, neutropenia, a slight hyporegenerative nuclear shift to the right and a reduction in the number of segmented neutrophils by 24.63—34.72 % (p ≤ 0.047—0.009) and eosinophilic granulocytes by 52.94—70.59 % (p ≤ 0.004—0.001). This was accompanied by relative and absolute agranulocytosis due to lymphocytosis (by 20.10—63.33 %; p ≤ 0.05—0.003) and monocytosis (by 40.0—74.12 %; p ≤ 0.046—0.049), indicating an active inflammatory infectious process of viral etiology against a background of decreased resistance and increased activity of the lymphocyte-macrophage link with the beginning of the formation of specific immune protection (cellular and humoral response to coronavirus intervention). Mild cases of COVID-19 showed a higher absolute count of peripheral blood granulocytes (by 48.25 %; p = 0.018), neutrophils, particularly segmented neutrophils and eosinophilic granulocytes, compared to moderate and severe cases (by 32.36—53.18 % (p ≤ 0.049—0.01) and 3.4 times (p ≤ 0.005—0.002)) and the lowest content of monocytes (by 35.41—42.57 %; p ≤ 0.049—0.046). In cases with concurrent endocrine and cardiological pathologies against a background of a more severe clinical course of COVID-19, immunoinflammatory changes intensified due to absolute and relative leukopenia, neutrophilic granulocytopenia, neutropenia, with the presence of relative lymphocytosis and monocytosis, and normal ESR indicators, confirming the inflammatory process of viral etiology, which, in the absence of treatment, may tend to form post-COVID and/or long-term effects of COVID-19 with multisystem involvement. Conclusions. The study found an enhancement of the immunoinflammatory response and an increase in the depletion of cellular factors of non-specific anti-infective protection with the progression of the clinical manifestations of COVID-19, particularly against the backdrop of comorbid endocrine and/or cardiological pathology.

CLINICAL AND LABORATORY CHARACTERISTICS OF PATIENTS WITH CORONAVIRUS INFECTION COVID-19 AND ITS COMORBIDITY

Introduction. The coronavirus disease has reached an alarming epidemic scale with extraordinary morbidity and mortality rates for the entire world population. The majority of patients with COVID–19 note damage to the respiratory tract and state a more severe course of the disease with the development of systemic damage. A more severe course of COVID-19 is associated with the presence of comorbid diseases. Aim. To investigate and analyze clinical and laboratory manifestations and to determine the main comorbidities of patients with COVID-19 infection. Materials and methods. The research was carried out in accordance with bioethical norms and rules. 179 patients with COVID-19 (the main group) and 42 people of the control group were examined. Diagnosis and treatment of the COVID-19 coronavirus infection was carried out taking into account the relevant national recommendations. The average value and standard deviation were statistically determined. The probability of differences was performed using the Mann-Whitney U-test and the Wilcoxon W-test of signed ranks. The threshold value of the level of statistical significance of all calculated features was taken as 0.05 (p=0.05). Results. A high comorbidity with cardiovascular system pathology was found – 40.2%, type 2 diabetes – 22.3%, respiratory system diseases – 20.7%. Disorders of the functional state of the cardiovascular system were determined: pulse values – 91.01±13.44, systolic (127.9±15.19) and diastolic (79.3±11.6) blood pressure. Changes in clinical blood analysis were noted: erythrocytes – 4.38±0.65 x1012/l, hemoglobin – 127.6±21.2 g/l, hematocrit – 0.37±0.07, leukocytes – 10.7±7, 32 x109/l, segmented (65.4±14.8%) and rod-nuclear (9.03±9.99%) neutrophils, platelets – 226.1±90.6 x109/l, lymphocytes – 20.24±12.43%, monocytes – 6.60±4.37% and erythrocyte sedimentation rate (ESR) – 25.4±14.9 mm/h. Significant (almost fourfold) increases in IL-6 levels (24.56±22.9 pg/ml) and blood glucose concentrations (7.40±3.42 mmol/l) were determined. Conclusions. A significant comorbidity of COVID-19 was determined and a significant prevalence of indicators of the functional state of the cardiovascular system and a decrease in the average levels of the quantitative composition of erythrocytes and indicators of hemoglobin and hematocrit were established. Significant leukocytosis, neutrophilia, lymphocytosis and monocytosis, significant excesses of ESR and IL-6 and blood serum glucose were determined, which confirmed the presence of a significant inflammatory reaction in response to infection with COVID-19.

A case of varicose necrotic phlegmon of the orbit in a child

AIM: This study aimed to analyze the peculiarities of a clinical case of orbital cellulitis in a child with varicella-zoster virus infection. MATERIAL AND METHODS: In this report of a rare case, necrotizing orbital cellulitis developed on day 6 from the onset of varicella-zoster disease in a 5-year-old child. The child was hospitalized in a serious condition at the intensive care unit of an infectious disease hospital and was subsequently transferred to an ophthalmology department of another hospital. The patient was subjected to comprehensive laboratory examinations and received conservative and surgical treatments. Computed tomography was performed to detect changes in the status of the orbits. RESULTS: The disease manifested with a pronounced pain syndrome in the right orbit, intoxication, and hyperthermia. Exophthalmos, purulent discharge, and necrosis of the conjunctiva of the affected eye were also observed. Computed tomography revealed infiltration of the right orbit without changes in the sinuses. The clinical blood analysis demonstrated leukocytosis, left shift in neutrophils, eosinophilia, and high levels of C-reactive protein and lactate dehydrogenase. The coagulogram demonstrated a proclivity toward hypercoagulation, as evidenced by diminished prothrombin activity according to Quick’s test, increased active partial thromboplastin time, and high D-dimer levels. Urinalysis revealed leukocyturia. Cultures from the conjunctival cavity yielded Streptococcus pyogenes, and a polymerase chain reaction tested positive for S. pyogenes. Antiviral, antibacterial, and symptomatic treatments were initiated. Necrotic masses were obtained during the drainage of the orbital cavity. The child was hospitalized for 21 days. The symptoms were controlled, and the patient’s condition was satisfactory at discharge. Visual functions remained fully preserved. At the examination 1.5 months later, a slight residual exophthalmos was detected. CONCLUSION: Employing a complex multidisciplinary approach, timely prescription of antibacterial and antiviral therapy, and surgical assistance (drainage of the orbit) ensures a successful disease outcome.

ТРУДНОСТИ ДИАГНОСТИКИ ОСЛОЖНЕНИЙ ДИВЕРТИКУЛЯРНОЙ БОЛЕЗНИ ДВЕНАДЦАТИПЕРСТНОЙ КИШКИ

Abstract. Introduction. Duodenal diverticulum is a hernia‒like protrusion of the duodenal wall. In terms of prevalence, this disease ranks second among all diverticula of the gastrointestinal tract after colonic diverticula. Aim. To substantiate the difficulty of diagnosing duodenal diverticulum perforation, based on a clinical case. Materials and Methods. A clinical case dated December 2021 of successful diagnostics and treatment of duodenal diverticulum perforation in female patient A. aged 68 is presented, based on the practice of the surgeons of the Surgery Unit in the Clinic of Hospital Surgery of Samara State Medical University. A set of laboratory investigations was performed, such as clinical blood analysis, biochemical blood analysis, coagulation profile, clinical urine analysis, and blood tests for HIV, viral hepatitis, and syphilis. Instrumental diagnostic methods were used, such as ultrasound (Aloka SSD 1700 (Japan)), CT (Revolution EVO (Russia)) of abdominal organs, review radiography, and Napalkov test. Results and Discussion. Laboratory and instrumental diagnostics, such as ultrasound and survey radiography, and primary laparotomy turned out to be insufficient for correct diagnosis and reasonable treatment. Napalkov test was performed, which revealed the contrast agent flow into retroperitoneum. The patient underwent relaparotomy, during which the duodenal diverticulum perforation by a foreign body (a fragment of a laurel leaf) was found. Conclusions. The case presented is an example of timely diagnosis of duodenal diverticulum perforation. The surgeons’ experience allowed them to suspect perforation in a short time, which helped avoid serious complications and contributed to the patient’s recovery. With timely diagnosis of such a rare and grave complication as duodenal diverticulum perforation, its clinical cure is justified.

Combined peripheral and central ultrasound for the diagnosis of PAH‐SSc patients

AbstractBackgroundSystemic Sclerosis (SSc), an intricate autoimmune disease causing tissue fibrosis, introduces cardiovascular complexities, notably pulmonary hypertension (PH), affecting both survival and quality of life. This study centers on evaluating echocardiographic parameters and endothelial function using flow‐mediated dilatation (FMD) in SSc patients, aiming to differentiate those with and without pulmonary arterial hypertension (PAH). The emphasis lies in early detection, given the heightened vulnerability of the right ventricle (RV) in the presence of PH.MethodsFifty‐nine SSc patients and 48 healthy subjects participated, undergoing clinical examinations, echocardiography, FMD assessments, blood analyses, and right heart catheterization (RHC) according to the ESC/ERS guidelines for diagnosis and treatment of PH.ResultsSSc‐PAH patients displayed lower FMD, higher frequency of TAPSE < 18 mm, RA area > 18 cm2, act RVOT < 105 ms and TRV > 280 cm/s compared to those without PAH and healthy controls. Resting resistivity index (RI) was higher in SSc patients, with no significant difference between those with and without PAH. Lower FMD% serves as a predictive marker for adverse cardiovascular outcomes in both SSc and SSc‐PAH patients. Stratification by TRV levels and PAH presence reveals notable FMD% variations, emphasizing its potential utility.ConclusionsEarly identification of endothelial dysfunction and impaired RV echocardiographic parameters, such as TAPSE and TRV, could aid in predicting right ventricular dysfunction and PAH in SSc patients.

#1202 Long-term evaluation of coronary calcifications in kidney transplanted patients: a single center follow up of 15 years

Abstract Background Patients with chronic kidney disease (CKD) have a relevant cardiovascular (CV) risk. Vascular calcification, particularly at coronary levels, have been related to the increased CV mortality. Few data are available on the long-term behavior of coronary artery calcifications (CAC) in kidney transplantation (KTx). In a previous paper (Alfieri C et al. Sci Rep. 2019 May 3;9(1):6869), our group explored the prevalence, the clinical and biochemical factors related with CAC and the factors implicated with CAC progression in a group of 64 KTx patients (KTXps) followed up for 5 years. Here we present the preliminary data about CAC follow up of the same population followed up for 15 years after KTx. Methods In 2007 we studied a total of 67 KTxps transplanted in our unit between 2007 and 2008. At the present time, 19 of them were lost from the follow up: 8 died, 4 because of major cardiovascular event (MACE), 11 KTxps had a graft loss and the other 20 did not adhere to the control. For this study, we evaluated 28 KTxps (M = 18; mean age 60 ± 9 yrs). Clinical parameters, blood and urinary analyses were recorded for 15 years, with particular attention for the year before CAC evaluation. For the statistical analysis the mean values of these evaluations were considered. At baseline and after 15 years from KTx, coronary TC for the evaluation of CAC using Agatson score was performed. According to the score obtained, patients were categorized in 4 groups both at baseline and at 15th year: 1) 0-10; 2) 10-100; 3) 100-400; 4) >400. The progression of CAC was determined considering the modification in CAC category (Cat-Prog+T15) and using the formula proposed by Sevrukov (AJR, 2005 Dec;185(6):1546-53) (Prog+). Results At baseline and at 15 yrs after KTx, 46% and 18% of pts were in the 1st group, 14% and 25% in the 2nd, 29% and 18% in the 3rd and 11% and 39% in 4th, respectively. CAC at 15yrs were significantly higher than baseline (156 ± 50 vs 334 ± 71 p < 0.0001). Both at baseline and after 15yrs CAC correlated directly with age (p = 0.0001; p = 0.01 resp.) and with each other (p < 0.0001). In the 79% Cat-Prog+T15 was found, in the 10,7% of more than 1 class of CAC. Prog+ was discovered in the 71% of KTxps. They were characterized to have higher systolic blood pressure levels (P = 0.05, with no difference in specific therapy), lower mean Hb and Ca levels (p = 0.02; p = 0.07 resp). In a logistic model, mean Ca Levels resulted the only independent factor inversely related with CAC15prog+ (p = 0.04). During the 15 years of KTx a MACE was experienced by the 25% of KTxps, just older than the others. Apparently, no impact for CACs was found in MACE. Conclusions To the best of our knowledge, our study is the first one to evaluate CACs in the same cohort of KTxps for such a long time. According to the preliminary data obtained, the prevalence of CAC in KTxps is quite high, and is related to age. CAC worsening, after 15 years of KTX was observed in a consistent part of the cohort and was related to different parameters, especially to Ca levels. Future researches, possibly involving a higher number of KTxps could explain better these findings and explore more deeply the relation of CACs with MACE in the long term.

Preventive Efficacy, Safety, Immunogenic Activity, and Evaluation of Post-Vaccination Responses Following Immunization with Combined Trivalent Vaccine Vaktrivir (Measles-Rubella-Parotitis) in Premature Infants

Background. Registration of combined trivalent vaccine Vaktrivir (measles-rubella-parotitis) in Russia necessitates studies on its preventive efficacy, safety, immunogenic activity, and post-vaccination responses following the immunization of premature infants. Objective. The aim of the study is to evaluate efficacy, safety, and immunogenic activity of combined trivalent vaccine (measles-rubella-parotitis) and level of post-vaccination responses following the immunization of premature infants. Methods. Experimental studies were conducted to evaluate safety, immunogenicity, and postvaccinal responses after immunization of premature infants with combined within prospective comparative clinical observation. Results. Administration of the combined trivalent vaccine Vaktrivir (measles-rubella-parotitis) in premature infants has shown: no cases of measles, rubella or parotitis among vaccinated persons within prospective clinical observation for 2 years; no disturbances in parameters of clinical blood analysis, biochemical blood count, total IgE, IgA, IgM, IgG (immunogram), or urine analysis among vaccinated children over time; no subjective perceptions, adverse events signs at physical examination among vaccinated compared to baseline parameters; low post-vaccination reactions (6.7%) and similar tolerance of trivalent vaccine Vaktrivir among full-term infants (3.3%) (p = 0.301). Conclusion. Administration of the combined trivalent vaccine Vaktrivir (measles-rubella-parotitis) in premature infants has demonstrated high safety profile and immunogenic properties for measles, rubella and parotitis components, good tolerability, and low post-vaccination responses after immunization, comparable to vaccination of full-term infants.

Hematological manifestations of paraneoplastic syndromes in dogs

Hematological paraneoplastic syndromes are common but poorly studied complications in veterinary oncology, manifested by a variety of hematological changes associated with the system effects of malignant neoplasms on the animal's body. The article presents the results of studying hematological paraneoplastic syndromes, the research involves 131 dogs with spontaneous malignant neoplasms. We used a comprehensive methodological approach, including clinical, instrumental, morphological and hematological research methods. During the morphological study we found out that carcinomas were diagnosed in 33.6% of cases in dogs, of which breast carcinoma was registered in 24.4%, in other cases lung, liver, kidney and abdominal lesions were noted. We also discovered: sarcomas in 22.1% of cases, including hemangiosarcoma of the spleen in 7.6%; and gastrointestinal lymphoma in 16.8% of cases and lymph nodes; in 16.8% of mastocytomas. in 4.6% of melanomas of the skin and mucous membranes; squamous cell carcinoma in 6.1% of cases. As a result of hematological studies, it was revealed that anemia syndrome (18.4%), lymphopenia (16.8%) and thrombocytopenia (15.4%) are the most frequent changes in clinical blood analysis in dogs with oncological diseases. Neutrophilic leukocytosis, leukopenia and thrombocytosis had an identical incidence, which was 12.2% of cases. Monocytosis and lymphocytosis were diagnosed less frequently, in 4.6% of cases. Leukogram changes were observed in 75.4% of cases: in 66.2%, an increase in the percentage of neutrophils was found, with a shift to the left in 38.5% of cases, a decrease in the percentage of lymphocytes in 18.5% of cases, monocytes in 6.2% of cases, eosinophils in 4.6% of cases. The frequency of hematological changes in the general clinical blood analysis of dogs depended on the histogenesis of the tumor. Hematological paraneoplastic syndromes can be used as an early marker of the oncological process, and they can also prevent timely prescription of treatment. Anemia and thrombocytopenia are absolute contraindications for chemotherapy and radiation therapy.

Endothelin Level in Menopausal Women with Comorbidity of the Acute Phase Middle Severity COVID-19 with Arterial Hypertension and Type 2 Diabetes Mellitus.

The levels of endothelins were assessed in menopausal women with arterial hypertension (AH) and type 2 diabetes mellitus (T2DM) in the acute phase of the moderate COVID-19. Women under observation (age 45-69 years) were divided into two groups. Control group consisted of women (n=16) who did not have COVID-19, were not vaccinated, and had no antibodies to SARS-CoV-2 (IgG). The main group included women (n=63) in the acute phase of the moderate COVID-19 accompanied by pneumonia. According to the clinical and anamnestic data analysis, the main group was divided into subgroups: without AH and T2DM (n=21); with AH and without T2DM (n=32); and with AH and T2DM (n=10). The parameters of clinical blood analysis, as well as endothelin-1, endothelin-2, and endothelin-3 levels were assessed. In women with a moderate COVID-19, the endothelin-1 and endothelin-2 levels were increased compared to the control regardless of AH and T2DM status. We found no statistically significant differences in the studied parameters of endothelial dysfunction between the subgroups of menopausal women in the acute phase of the moderate COVID-19.

Identification of mononucleosis by automatic and microscopic methods (clinical case)

Infectious mononucleosis is an acute anthropogenic viral disease caused by the Epstein-Barr Virus (EBV). According to statistics from the Public Health Centre of the Ministry of Health of Ukraine, the number of cases in the period from 2018 to 2021 was 5,482; 5,467; 2,431; and 1,023; respectively. 5,467 people developed infectious mononucleosis in Ukraine in 2019. In particular, 863 cases were recorded in non-city dwellers, and 4,597 in children under 17. This indicates an increase in morbidity among urban residents, which determines the relevance of the study of infectious mononucleosis. The development of this disease is accompanied by fever, tonsillar pharyngitis, maculopapular skin rash and the appearance of atypical lymphocytes in the peripheral blood, which make up more than 10% of the total number of lymphocytes. Splenic rupture is the most dangerous complication of this disease. The article analyzes the clinical case of a child who complained of increased body temperature and enlarged lymph nodes. Attention is paid to the indicators of clinical blood analysis, namely to atypical mononuclear cells, which are an indicator of infectious mononucleosis. The results of a quantitative automated hematological analyzer with a microscopic (manual) method of diagnosis were analyzed. It has been established that if, when receiving the results on the analyzer, the indicators are outside the normal range, then it is necessary to use the microscopic method of counting, which will not only clarify but also expand the limits of diagnosis in making the final diagnosis. Thus, the increase in morbidity, difficulties in diagnosis and possibility of complications (splenomegaly and hepatomegaly) make it important to study infectious mononucleosis caused by EBV. This disease is an important scientific and practical problem of modern clinical laboratory diagnostics. Keywords: infectious mononucleosis, Epstein-Barr virus, atypical lymphocytes.

Artificial intelligence in routine blood tests

Routine blood tests drive diagnosis, prognosis, and monitoring in traditional clinical decision support systems. As a routine diagnostic tool with standardized laboratory workflows, clinical blood analysis offers superior accessibility to a comprehensive assessment of physiological parameters. These parameters can be integrated and automated at scale, allowing for in-depth clinical inference and cost-effectiveness compared to other modalities such as imaging, genetic testing, or histopathology. Herein, we extensively review the analytical value of routine blood tests leveraged by artificial intelligence (AI), using the ICD-10 classification as a reference. A significant gap exists between standard disease-associated features and those selected by machine learning models. This suggests an amount of non-perceived information in traditional decision support systems that AI could leverage with improved performance metrics. Nonetheless, AI-derived support for clinical decisions must still be harmonized regarding external validation studies, regulatory approvals, and clinical deployment strategies. Still, as we discuss, the path is drawn for the future application of scalable artificial intelligence (AI) to enhance, extract, and classify patterns potentially correlated with pathological states with restricted limitations in terms of bias and representativeness.

Serological markers of sarcopenia in ages 65 and over

Aim. To determine serological markers of sarcopenia (SP) for use in general medical practice in people aged 65 years and older living independently.Materials and methods. The study included 230 people aged 65 years and older (70 men and 160 women, median age 75 [68; 79] years) were consulted in a medical institution in St. Petersburg. The diagnosis of SP was made according to the criteria of EWGSOP2 (2018). The laboratory examination included clinical and biochemical blood analysis, determine the level of 25(OH)D, parathyroid hormone (PTH), C-reactive protein (CRP).Results. The risk of SP increased at levels 25(OH)D less than 21 ng/mL (odds ratio 4.989; 95 % confidence interval 1.321–12.626; р = 0.0420), total protein less than 65 g/l (OR 8.567; 95 % CI 2.658–27.617; р = 0.00032), serum CRP 6 mg/l or more (OR 14.279; 95 % CI: 3.511–58.071; р = 0.00020) and decrease in the estimated glomerular filtration rate (eGFR) less than 62 ml/min/1.73 m2 (OR 12.108; 95 % CI 3.944–37.170; р = 0.00001). Conclusion. Serological markers of SP, such as vitamin D, total protein, C-reactive protein in blood serum and eGFR can be used in general medical practice.

Changes in indicators of local and systemic inflammation in patients with uncomplicated diverticular disease in combination with obesity

Changes in indicators of local and systemic inflammation in patients with uncomplicated diverticular disease in combination with obesity

Community-acquired pneumonia in young children living in various climatogeographic zones of the Republic of Dagestan

Introduction. Community-acquired pneumonia (CAP) in early childhood continues to cause significant morbidity and remains one of the most common serious infections in childhood. Each region of the Russian Federation exhibits specific manifestations of CAP morbidity. Knowledge of CAP etiology is crucial for planning therapeutic and preventive measures. 
 Aim. To determine the etiological and immunological features of CAP in early childhood, residing in various climatogeographical zones of the Republic of Dagestan.
 Materials and methods. The material includes the results of examination and treatment of CAP 204 young children. living in lowland, foothill and mountain climatogeographical zones of the Republic of Dagestan. The selection criterion was the clinical-radiological diagnosis of CAP, using the classification of clinical forms of bronchopulmonary diseases in children.
 Results. The study revealed a rise in the incidence of respiratory organ diseases, including CAP, among children in the Republic of Dagestan (RD) over the past 5 years. Among infants under one year, the CAP rate was twice as high. The prevalence can be attributed to the climatogeographical conditions of children’s living environments. Streptococcal infection was also observed to predominate in the ethnostructure of CAP in early childhood across all climatogeographical zones. Streptococcus pneumoniae (48.1%) was more frequently isolated in all climatogeographical zones, while Staphylococcus aureus (13.3%) dominated in the mid-mountain zone. In mild pneumonia, cellular immunity components, represented by reduced CD3, CD4, CD25, CD71, react primarily. Disease exacerbation leads to depletion of CD8, CD16, CD20. Severe pneumonia triggers the involvement of humoral immunity, leading to changes in clinical blood analysis — leukocytosis and an increase in mature and immature forms of neutrophils. The levels of IL-1, IL-6, IL-8 in blood serum increase depending on the area of inflammation and the CAP severity. In observed children with focal-draining and segmental CAP, their levels significantly increased. For empirical antibacterial therapy of CAP, recommendations include amoxicillin, protected ampicillins, third-generation cephalosporins, macrolides, and vancomycin in mono- or combination therapy.
 Conclusion. The conducted research highlights the need for managing ethnological monitoring with antibiotic sensitivity testing of infectious agents causing CAP in children.

Features of the clinical course of chronic pancreatitis in patients with chronic obstructive pulmonary disease

Aim. The purpose of the study is to determine the intensity of the manifestation of clinical syndromes in the comorbid course of chronic pancreatitis (CP) in patients with chronic obstructive pulmonary disease (COPD) in comparison with the isolated course of CP and to assess the intensity of the mutual burden syndrome. Material and methods. A prospective cohort study was conducted, analyzing the medical records of 212 inpatients. The first group comprised 96 individuals with an isolated course of chronic pancreatitis (CP), while the second group included 116 patients with CP and comorbid chronic obstructive pulmonary disease (COPD), categorized as Group E. The study focused on subjective manifestations of pain syndrome in CP, the extent of exocrine pancreatic insufficiency, clinical blood analysis, biochemical research regarding the content of markers indicating pancreatic enzyme deviation in the blood, and the level of elastase-1 in feces. Additionally, ultrasonographic examination of the organs in the abdominal cavity was performed. Results. Patients in group 2 exhibited manifestations of abdominal pain syndrome 1.2 times more frequently than those in group 1 (p < 0.05). The frequency of pain in the pancreas radiating to the right subcostal region was 1.9 times higher in group 2 compared to group 1 (p < 0.05), along with a 2.1 times increase in the symptom of girdled pain radiating to the back (p < 0.05). Although the frequency of dyspeptic syndrome was slightly higher in group 2 (1.3 times, p > 0.05), astheno-vegetative syndrome was significantly more pronounced, exceeding the frequency in group 1 by 1.7 times (p < 0.05). Ultrasonography parameters of the pancreas in both groups revealed characteristic signs of chronic pancreatitis (CP). The analysis of pancreatic functional state indicators during exacerbation indicated hyperenzymemia syndrome, with α-amylase activity significantly higher in patients of both groups compared to the control group – by 1.8 and 2.6 times, respectively (p < 0.05). Conclusions. CP with chronic obstructive pulmonary disease (COPD) is characterized by a significantly lower frequency of paroxysmal abdominal pain syndrome but a higher frequency of constant aching pain in the pancreas area. Additionally, it is associated with the maximum intensity of inflammation, hyperfermentemia, a decrease in the activity of elastase-1 in feces, and a higher intensity of astheno-vegetative, painful, dyspepsia, intoxication syndromes. Moreover, there is a more pronounced exocrine dysfunction of the pancreas and more significant changes in the sonographic structure of the pancreas compared to cases with the isolated course of CP.

Indicators of hemostasis and fibrinolysis systems, clinical blood count and C-reactive protein in patients with chronic obstructive pulmonary disease after SARS-CoV-2 infection

Objective. To study in a comparative aspect the level of markers of the state of hemostasis and fibrinolysis systems, indicators of clinical blood analysis and C-reactive protein (CRP) in patients with chronic obstructive pulmonary disease (COPD) of severe and extremely severe severity, who underwent and did not undergo infection caused by SARS-CoV-2. Material and methods. A prospective cohort study of 56 patients with severe and extremely severe COPD in the acute stage. Patients were divided into 2 groups: 1st (n=28) – patients with COPD and SARS-CoV-2 infection; 2nd (n=28) – patients with COPD without SARS-CoV-2 infection. The indicators of hemostasis and fibrinolysis systems, clinical blood analysis and CRP were evaluated. Results. It has been established that in patients with severe and extremely severe COPD who have had an infection caused by SARS-CoV-2, a hypercoagulable shift is more often observed compared to patients who have not had COVID-19. This was evidenced by the most frequent shortening of activated partial thromboplastin time, prothrombin time and an increase in fibrinogen levels. The frequency of increased D-dimer levels in the group of patients who had an infection caused by SARS-CoV-2 was twice as high compared with patients who did not have an infection caused by SARS-CoV-2. A decrease in the index of the relative width of platelet distribution was observed in both groups of patients. The indicator of systemic inflammation – CRP in the compared groups did not differ significantly. Conclusion. Patients with severe and extremely severe COPD who have had COVID-19 are more likely to have a hypercoagulable shift with manifestations of intravascular coagulation compared with COPD patients who have not had COVID-19.

Hematological analysis as a method of monitoring physiological status of medium carnivorous mammals in the Russian Far East

Clinical blood analysis is considered not only a method of assessing the health status of individuals, but also their fitness and welfare, although the interpretation of the obtained data is complicated by the combined influence of various factors. For most wild carnivore species, there is insufficient information about the effect of environmental factors on hematological parameters. Mammals in the Far East are exposed to hard seasonal climate changes, and therefore have physiological adaptations that enable them to survive the cold season. The aim of this study was to estimate the hematological parameters of three widespread species of medium carnivorous mammals in this region, namely Meles leucurus amurensis, Prionailurus bengalensis euptilura, and Nyctereutes procyonoides ussuriensis, taking into account such factors as sex, age and season in the Ussuriisky State Nature Reserve (Russia), as well as to identify the most informative blood indicators of the animal physiological status. In spring and autumn of 2014–2023, blood samples were collected from 103 individuals of the studied carnivores. The animals were captured, immobilised, blood-sampled and released in the wild at the capture site. The number of leucocytes was counted in the field, and their ratio was detected on the blood smears in the lab. The absence of sex differences and the presence of age differences in the studied species were revealed, which corresponds to the already known data on the parameters of mammalian blood. In spring, Nyctereutes procyonoides ussuriensis had higher leucocyte count (14.77 ± 1.76 mln/ml and 12.33 ± 1.08 mln/ml (hereinafter, in spring vs. autumn, respectively)), the ratio of neutrophils to lymphocytes (4.87 ± 0.47 and 3.02 ± 0.28), and the percentage of segmented neutrophils (73.12 ± 1.77% and 62.95 ± 2.29%), and the lower percentage of lymphocytes (20.35 ± 1.45% and 25.64 ± 1.49%) compared to autumn. Similar blood patterns were observed in two other species. This may be the result of a decrease in body mass and poor condition of animals, i.e. physiological stress after a long winter period and a lack of food resources. In addition, Nyctereutes procyonoides ussuriensis had higher percentages of eosinophils, basophils, and band neutrophils (7.85 ± 1.61%, 3.69 ± 1.26%, 2.15 ± 0.34%, respectively) than Meles leucurus amurensis (2.55 ± 1.09%, 0.45 ± 0.17%, 0.55 ± 0.18%, respectively) and Prionailurus bengalensis euptilura (1.48 ± 0.59%, 0.30 ± 0.16%, 1.74 ± 0.47%, respectively). These differences are probably determined by the biological characteristics of Nyctereutes procyonoides ussuriensis, since this species is an ideal host and carrier of various diseases, and it also has specific morphological features of blood cells. Thus, our results demonstrate the importance of systematic blood tests and the necessity of considering both species-specific characteristics and environmental factors for assessing animal health.