Clinical Forms Of Disease Research Articles

Stavovi i informisanost među studentima medicine o prevenciji i farmakoterapiji COVID-19 infekcije u Srbiji

Introduction: COVID-19 infection represents a worldwide health issue. To prevent the infection, it is necessary to possess adequate knowledge regarding the virus itself, transmission routes, clinical forms of disease and prevention measures. Also, it is crucial to stay informed about protocols and pharmacotherapeutic options in the treatment of patients infected with the SARS-CoV-2 virus. Aim: This study aimed to investigate knowledge and attitudes about prevention and pharmacotherapy of COVID-19 infection among students of the Faculty of Medicine, University of Belgrade as well as compare differences between 1st, 3rd and 6th year students. Material and methods: A cross-sectional study was conducted among 479 students of all six years of study. The questionnaire was distributed online and it was available between November 30 and December 20, 2021. Results were obtained and analyzed in statistical software SPSS 22.0 (IBM Corp. IBM SPSS Statistics for Windows. Armonk, NY: IBM Cor; 2017). Results: Most of the students that took the part in the survey were females (72%) and the majority of our participants were vaccinated against COVID-19 infection at the time of the survey (92.7%). The vaccination rate in 1st year students was 78.8%, in 3rd year 97.3% and 97.4% in 6th year students. Different than the 6th year students, 1st year students tend to believe that vaccine is the most efficient preventive measure (medium value ± standard deviation; 1.2 ± 0.1 vs 0.7 ± 0.1; p < 0.001). The results showed that there is a significant difference in knowledge about pharmacotherapy of this infection between students at the beginning of the studies and older peers (p < 0.001). Conclusion: Students showed progress in understanding pharmacotherapy during their studies in the Faculty of Medicine, meaning that courses they take in Pharmacology and Toxicology and clinical experience improve their knowledge and skills when it comes to therapeutic approaches.

Cytokine markers of clinical variants of infective endocarditis

Introduction. Infective endocarditis is a bacterial disease. Pathogen is localized mainly on heart valves and endocardium. This condition is accompanied by immunopathological manifestations and potential generation of septic process being unfavorable prognosis for disease outcome. Currently, the causes of death of patients with endocarditis have been increasingly presented as thromboembolic complications, which severity depends on variant of the disease course. An important role in imbalanced immune system in the infectious process is assigned to altered intercellular interaction mediated via cytokine network. Activated immune cells produce cytokines, which investigating is important in terms of interpreting changes in immune system functionality, assessing the severity of diseases and controlling therapeutic effectiveness. Infective endocarditis remains a severe disease associated with high mortality despite current advances in diagnostics and treatment. A timely diagnostic process and early initiation of treatment are major factors for successful patient management necessitating to improve diagnostics of various clinical variants of endocarditis course, taking into account pathogenetically relevant cytokines. Objective was to comparatively evaluate the importance of serum cytokine concentrations in patients with uncomplicated course of infective endocarditis and its thromboembolic complications and determine cytokine markers of various variants of endocarditis course. Materials and methods. An immunological examination of 119 blood serum samples from patients with confirmed diagnosis of infectious endocarditis and 20 samples from apparently healthy persons was carried out. Depending on the clinical disease form, the patients were divided into 4 groups: group 1 primary infective endocarditis (PIE) with thromboembolic complications (n = 24), 2 PIE without thromboembolic complications (n = 34), 3 secondary IE with thromboembolic complications (n = 27), 4 secondary IE without thromboembolic complications (n = 34). The control group consisted of 20 apparently healthy subjects. Immunological studies of serum cytokine concentrations were conducted in all groups. Results. Statistically significant increase in serum concentration of IL-10, IL-6, VEGF-A, IL-18, IL-1Ra and IL-8 was revealed in all clinical groups of patients compared to those in control group (p 0,05). By correlation analysis, we found a significant positive relationship between IL-10 and IL-18 or IL-6. An increase in the concentration of IL-10 leads to increased level of pro-inflammatory IL-18 and IL-6. The marker of secondary endocarditis was observed as increased level of serum concentrations of IFN. A characteristic feature of primary infective endocarditis with thromboembolic complications was revealed as significantly increased serum concentration of IL-8, IL-1Ra and IL-6. Markers of secondary complicated endocarditis were identified as increased level of IL-6, VEGF-A and IL-18.

Tetanus

Tetanus is acquired through exposure to the environmental spore-forming Gram-positive bacillus Clostridium tetani, which may infect human wounds and cause disease by production of an exotoxin (tetanospasmin). There is no human-to-human transmission. The disease occurs worldwide and it is sporadic in high-income countries with universal access to well-accepted immunization programs. It is more common in agricultural regions and in low-income countries where contact with animal excreta is more likely and immunization programs are inadequate. Neonatal tetanus (NNT) following unclean deliveries and poor postnatal hygiene is still responsible for the majority of tetanus cases and deaths; the majority of NNT occurs in poor Asian and African countries, whereas in high-income countries the disease is extremely rare. Three forms of clinical disease can be distinguished: the most common form is generalized tetanus, whereas local tetanus and cephalic tetanus are rare. Neonatal tetanus (NNT) is a form of generalized tetanus in newborns. The case fatality rate of tetanus is high, 3%–95% depending on age, immune- and immunization-status, form of disease, and availability of proper medical care. The efficacy of tetanus toxoid vaccines was never formally studied, but cases in adequately vaccinated subjects are extremely rare and impact data (e.g. for NNT) convincingly show high vaccine effectiveness. WHO estimates that in 2018, 25,000 newborns died from NNT, an 88% reduction from the situation in 2000.

Genetic diversity of enteroviruses in patients with respiratory infection

Enterovirus genetic variability underlies the variety of clinical forms of diseases they cause. The aim of the presented study was to establish the genetic diversity of enteroviruses (EVs) that caused acute respiratory infection (ARI) in 2016–2019. Biological samples were obtained from 203 patients with various forms of ARI, EV detection was carried out by RT-PCR, followed by sequencing of the main capsid protein gene and phylogenetic reconstruction. EV RNA was detected in 34.4 % of samples, most often in children aged 1–6 years (53.1–54.8 %). Coxsackieviruses B were found in patients with respiratory enterovirus infection (EVI) significantly more often than other EVs, the dominant serotypes were Coxsackievirus B4, B5. Despite the significant genetic diversity of EVs identified in patients with ARI (three genetic lines of Coxsackievirus B5, two genotypes of Coxsackievirus B2, one genotype of Coxsackievirus B3, three genovariant Coxsackievirus B4, one genovariant Coxsackievirus B1), there is no evidence of their connection with the formation of the respiratory form of EVI.The high level of genetic variability of EVs requires regular molecular-epidemiological surveillance for the identification of emerging genetic variants and assessment of their epidemic potential.

The Influence of Infection by Different Leishmania (Viannia) braziliensis Isolates on the Pathogenesis of Disseminated Leishmaniasis.

Disseminated Leishmaniasis (DL) is an emerging and severe form of Leishmania (Viannia) braziliensis infection defined by the presence of 10 and up to more than 1,000 skin lesions. The mechanisms underlying parasite dissemination remain unknown. Genotypic differences among species of L. braziliensis have been associated with different clinical forms of disease. The present work compared the function of monocytes obtained from patients with cutaneous leishmaniasis (CL) and DL in response to infection with L. braziliensis isolates of both these two clinical forms of disease. Mononuclear cells obtained from DL and CL patients were infected with different L. braziliensis isolates, and numbers of infected cells, parasite load, respiratory burst, TLR2 and TLR4 expression and cytokine production were evaluated. DL isolates infected more monocytes, induced greater respiratory burst, and more cytokine production compared to isolates from CL patients regardless of the origin of monocytes (DL or CL). However, greater parasite multiplication and higher TLR2 and TLR4 expression were seen in monocytes from DL patients compared to CL following infection with DL isolates. Our results indicate the participation of both parasite genotype and host factors in the pathogenesis of DL.

MICA and KIR: Immunogenetic Factors Influencing Left Ventricular Systolic Dysfunction and Digestive Clinical Form of Chronic Chagas Disease.

Tissue damage observed in the clinical forms of chronic symptomatic Chagas disease seems to have a close relationship with the intensity of the inflammatory process. The objective of this study was to investigate whether the MICA (MHC class I-related chain A) and KIR (killer cell immunoglobulin-like receptors) polymorphisms are associated with the cardiac and digestive clinical forms of chronic Chagas disease. Possible influence of these genes polymorphisms on the left ventricular systolic dysfunction (LVSD) in patients with chronic Chagas heart disease was also evaluated. This study enrolled 185 patients with positive serology for Trypanosoma cruzi classified according to the clinical form of the disease: cardiac (n=107) and digestive (n=78). Subsequently, patients with the cardiac form of the disease were sub-classified as with LVSD (n=52) and without LVSD (n=55). A control group was formed of 110 healthy individuals. Genotyping was performed by polymerase chain reaction-sequence specific oligonucleotide probes (PCR-SSOP). Statistical analyzes were carried out using the Chi-square test and odds ratio with 95% confidence interval was also calculated to evaluate the risk association. MICA-129 allele with high affinity for the NKG2D receptor was associated to the LVSD in patients with CCHD. The haplotype MICA*008~HLA-C*06 and the KIR2DS2-/KIR2DL2-/KIR2DL3+/C1+ combination were associated to the digestive clinical form of the disease. Our data showed that the MICA and KIR polymorphisms may exert a role in the LVSD of cardiac patients, and in digestive form of Chagas disease.

Salmonella – still a threat? Epidemiological analysis of infecion

Salmonella infection causes morbidity and mortality throughout the world with the host immune response varying depending on whether the infection is acute and limited, or systemic and chronic. Global Salmonella infection, especially in developing countries, is a health and economic burden. These pathogen are responsible for millions of cases of food-borne illness each year, with substantial costs measured in hospitalizations and lost productivity. The growing number of bacteria resistant to the antibiotics commonly used to treat infections with this bacterium increases the use of alternative treatments. The species Lactobacillus and Bifidobacterium are the most commonly used probiotics to treat infectious diseases, including antibiotic diarrhea and traveler's diarrhea.It is a Gram-negative, non-spore-forming, rod-shaped and facultative anaerobic bacterium. However, they have the ability to survive inside infected cells. These bacteria cause various clinical forms of disease. The most dangerous sticks of typhoid fever (Salmonella typhi) and paradurium (Salmonella paratyphi) multiply only in the human body and cause a very serious infectious disease - typhoid fever. In turn, non-malignant salmonella, Salmonella bongori and countless serological varieties of Salmonella enterica colonize the digestive tract of many animal species and are pathogenic to humans, causing gastroenteritis, i.e. acute salmonellosis, sometimes classified as food poisoning. All Salmonella infections begin with ingestion with contaminated food or water.

Radiological characteristics of COVID-19 patients and correlation of chest CT severity index with different clinical forms of disease in SKIMS medical college and hospital Kashmir, India

Background: The objective of this paper was to study the radiological characteristics of COVID-19 patients and to establish a possible correlation of chest CT severity index (CTSI) with different clinical forms of disease.Methods: All the patients who routinely underwent non contrast CT chest and tested positive for COVID-19 by RT-PCR of respiratory secretion obtained by broncho alveolar lavage and nasopharyngeal swab test had been included in the given study. The collected data was analyzed to find a possible correlation of chest CTSI with different clinical forms of disease.Results: COVID-19 patients reflected some interesting radiological features like ground glass opacity (GGO) in (90.1%) followed by consolidation in (70.4%) patients. However, (67.6%) patients reflected both GGO and consolidation features. Peripheral distribution was most common in patients accounting for (90.1%) versus (60.6%) with central distribution but (60.6%) had both peripheral and central distribution. We observed that there is significant correlation (p value <0.001) between severity of disease as per oxygen saturation level and severity of disease on the basis of CTSI.Conclusions: We concluded that COVID-19 pneumonia patients significantly exhibit some radiological features that include GGO and consolidation with peripheral and central distribution. Therefore in addition to other clinical parameters CT severity score can be treated as a reliable diagnostic tool to determine the severity status of disease.

Orális candidiasis, klinikai jellegzetességei, diagnosztikája és kezelése

Candidiasis oris a leggyakoribb opportunista infekció, amelyet egy gomba, a Candia albicans okoz. Mivel a Candida albicans tagja a normális orális flórának, és gyakorisága különböző népcsoportokban 40% körül mozog, a patogenezise még mindig nem teljesen tisztázott.Jelen közlemény célja, hogy összefoglalja e gyakori opportunista infekció potenciális lokális és szisztémás rizikófaktorait, valamint áttekintse a különböző orális klinikai manifesztációit. Számos lokális és szisztémás hajlamosító tényező ismert. Az orális candidiasis előfordulhat akár mint primer, akár secunder infekció. A gomba képes megtapadni a hámon és penetrálni a nyálkahártyát. A lokális prediszponáló faktorok elősegítik a gomba megtapadását és növekedését, míg a szisztémás tényezők negatívan hatnak a természetes vagy szerzett immunitásra, amely felelős a gomba terjedésének kontrolljában. Több klinikai manifesztációja ismert. Előfordulhat akut és krónikus formában. A legsúlyosabb formája a pseudomembranous candidiasis. Ez valódi primer infekció, amely többnyire csak súlyos immunhiányos egyénekben alakulhat ki. A krónikus forma is leggyakrabban AIDS-es betegekben fordul elő. Ilyenkor gyakran találkozhatunk terápia-rezisztens, nagyon hosszú ideje fennálló állhártyás Candida fertőzéssel. A betegség egyéb klinikai formái közé tartozik az erythemas candidiasis, a krónikus nodularis vagy plakkos candidiasis. A leggyakoribb klinikai forma a stomatitis protetika (denture stomatitis). További Candida asszociált szájnyálkahártya betegség a cheilitis angularis és a glossitis mediana rhombica. A klinikai diagnózis a jellegzetes objektív és szubjektív klinikai tünetek alapján legtöbbször egyszerű. A Candida-infekció laboratóriumi identifikálása azonban nem egyszerű, elsősorban azért, mert a Candida tagja a normál szájflórának és így sok egészséges egyénben is kimutatható. A leggyakoribb laboratóriumi diagnosztika technikák közé tartozik a kaparékból nyert citológiai vizsgálat és a gomba tenyésztése. A betegség kezelése komplex és sokszor komoly kihívást jelent az orvos számára. Fontos, hogy feltárjuk és amennyiben lehetséges, elimináljuk a hajlamosító tényezőket. A leggyakrabban használt gombaellenes szerek a polyen és azol csoportba tartoznak. Mivel a legtöbb orális Candida-infekció csak a felszínes nyálkahártya rétegeket érinti, elsőnek lehetőleg helyi gombaellenes kezelést alkalmazzunk. Ez annál is inkább indokolt, mert nagyon sok gombaellenes készítménynek komoly mellékhatásai lehetnek.

Mycobacterium leprae induces a tolerogenic profile in monocyte-derived dendritic cells via TLR2 induction of IDO.

The enzyme IDO‐1 is involved in the first stage of tryptophan catabolism and has been described in both microbicidal and tolerogenic microenvironments. Previous data from our group have shown that IDO‐1 is differentially regulated in the distinctive clinical forms of leprosy. The present study aims to investigate the mechanisms associated with IDO‐1 expression and activity in human monocyte‐derived dendritic cells (mDCs) after stimulation with irradiated Mycobacterium leprae and its fractions. M. leprae and its fractions induced the expression and activity of IDO‐1 in human mDCs. Among the stimuli studied, irradiated M. leprae and its membrane fraction (MLMA) induced the production of proinflammatory cytokines TNF and IL‐6 whereas irradiated M. leprae and its cytosol fraction (MLSA) induced an increase in IL‐10. We investigated if TLR2 activation was necessary for IDO‐1 induction in mDCs. We observed that in cultures treated with a neutralizing anti‐TLR2 antibody, there was a decrease in IDO‐1 activity and expression induced by M. leprae and MLMA. The same effect was observed when we used a MyD88 inhibitor. Our data demonstrate that coculture of mDCs with autologous lymphocytes induced an increase in regulatory T (Treg) cell frequency in MLSA‐stimulated cultures, showing that M. leprae constituents may play opposite roles that may possibly be related to the dubious effect of IDO‐1 in the different clinical forms of disease. Our data show that M. leprae and its fractions are able to differentially modulate the activity and functionality of IDO‐1 in mDCs by a pathway that involves TLR2, suggesting that this enzyme may play an important role in leprosy immunopathogenesis.

Delayed diagnosis of fatal pneumonic canine plague: clinical and pathologic features in two naturally infected Colorado dogs

BackgroundPlague caused by Yersinia pestis is a highly infectious and potentially fatal zoonotic disease that can be spread by wild and domestic animals. In endemic areas of the northern hemisphere plague typically cycles from March to October, when flea vectors are active. Clinical forms of disease include bubonic, septicemic, and pneumonic plague. All clinical forms are uncommon in dogs and the pneumonic form is exceedingly rare.Case presentationTwo mixed breed young-adult male domestic dogs presented to Colorado veterinarians with fever and vague signs that progressed to hemoptysis within 24 h. Case 1 presented in June 2014, while Case 2 occurred in December 2017. Thoracic radiography of Case 1 and 2 revealed right dorsal and right accessory lobe consolidation, respectively. In Case 1 initial differential diagnoses included pulmonary contusion due to trauma or diphacinone toxicosis. Case 1 was euthanized ~ 24 h post presentation due to progressive dyspnea and hemoptysis. Plague was confirmed 9 days later, after the dog’s owner was hospitalized with pneumonia. Case 2 was treated as foreign body/aspiration pneumonia and underwent lung lobectomy at a veterinary teaching hospital. Case 2 was euthanized after 5 days of hospitalization when bacterial culture of the excised lobe yielded Yersinia pestis. Both dogs had severe diffuse necrohemorrhagic and suppurative pneumonia at post mortem examination.ConclusionsBoth dogs were misdiagnosed due to the atypical lobar presentation of an extremely rare form of plague in a species that infrequently succumbs to clinical disease. Presentation outside of the typical transmission period of plague was also a factor leading to delayed diagnosis in Case 2. Erroneous identification by automated bacterial identification systems was problematic in both cases. In endemic areas, plague should be ruled out early in febrile dogs with acute respiratory signs, hemoptysis, lobar or diffuse pathology, and potential for exposure, regardless of season. Seasonal and geographic distributions of plague may shift with climate change, so vigilance by primary care veterinarians is warranted. Timely submission of samples to a veterinary diagnostic laboratory could expedite accurate diagnosis and reduce potential for human and domestic animal exposure.

The place of cholespasmolytics in the conservative treatment of diseases of the biliary tract in children

The article presents modern data on etiology and pathogenesis of biliary tract diseases in children. Clinical forms of diseases are described, taking into account the anatomical and physiological age-related features of a child’s organism. The features are shown of conservative and drug therapy of biliary tract diseases in children. We present our own experience in the treatment of pain and dyspeptic disorders in children with biliary tract diseases against the background of various biliary dysfunctional disorders and associated diseases of the upper gastrointestinal tract. The article is intended for pediatricians, gastroenterologists, surgeons, and internists.

Monitoring of CMV-specific cell-mediated immunity with a commercial ELISA-based interferon-γ release assay in kidney transplant recipients treated with antithymocyte globulin.

Monitoring for cytomegalovirus (CMV)-specific cell-mediated immunity (CMV-CMI) may be useful for individualizing valganciclovir (VGCV) prophylaxis after kidney transplantation (KT). We performed a commercial ELISA-based interferon (IFN)-γ release assay (QTF-CMV) from posttransplant months 2-5 (362 points) in 120 CMV-seropositive KT recipients that received antithymocyte globulin as induction therapy and VGCV prophylaxis (median of 92days). Forty-seven patients (39.3%) had CMV infection after discontinuation of prophylaxis. The QTF-CMV assay was reactive, nonreactive, and indeterminate in 264 (72.9%), 90 (24.9%), and 8 points (2.2%). The QTF-CMV assay at prophylaxis discontinuation exhibited suboptimal accuracy for predicting protective CMV-CMI (sensitivity: 77.4%; specificity: 34.3%; positive predictive value [PPV]: 64.1%; negative predictive value [NPV]: 50.0%), with no differences in 1-year CMV infection rates between patients with negative (nonreactive or indeterminate) or reactive results (45.8% vs 36.1%; P=.244). Specificity and PPV to predict protective CMV-CMI improved by elevating the IFN-γ cutoff value to 1.13IU/mL (65.7% and 71.4%) and 7.0IU/mL (85.7% and 76.2%), although NPVs decreased. The QTF-CMV assay as per manufacturer's interpretative criteria performed poorly to predict protection from CMV infection following discontinuation of VGCV prophylaxis among ATG-treated CMV-seropositive KT recipients. This performance is slightly improved by modifying the IFN-γ positivity threshold.

Опыт применения растворов для тумесцентной анестезии при эндовенозной радиочастотной облитерации: сравнительное исследование

The incidence of varicose disease of the lower extremities throughout the world remains at a fairly high level. Given its socio-economic significance, low-impact surgical treatment methods continue to improve, as well as methods of anesthesia for them. In most cases, the mixtures used for infiltration anesthesia during endovenous surgery include lidocaine and adrenaline. The active substance of adrenaline, epinephrine hydrochloride, has a direct stimulating effect on α- and β-adrenergic receptors, and can cause serious disturbances in the cardiovascular system. It is not recommended for patients with CVD and endocrine system pathologies. Aim. minimize pain when performing tumescent anesthesia during endovenous radiofrequency obliteration of veins. Material and Methods. A comparative study was performed in which 192 patients with clinical forms of chronic C2-C6 venous disease took part. All patients using the envelope method were divided into three groups: patients of the first group (I) planned to perform RFO and miniphlebectomy using Klein mixture for tumescent anesthesia, the pH of which was 6.6, lidocaine concentration 0.04%. Patients of the second group (II) planned anesthesia using a solution, the pH of which was 7.3, the concentration of lidocaine was 0.02%. In patients of the third group (III), a solution with a pH of 7.4 was used, the concentration of lidocaine was 0.08%. The level of pain during the administration of the anesthetic was evaluated using two scales – the verbal descriptive scale of pain assessment (VASOB) and the visual analogue scale (VAS). Results. Patient groups were comparable in age, sex, clinical form of the disease. When assessing pain on a verbal descriptive scale, 50% of patients (27) in group II noted a complete absence of pain during tumescent anesthesia, in group III – 54.5% (48). Very severe pain (8 points) was noted by 4 patients from Group I, who were anesthetized by administering a Klein mixture, which constituted 8%; unbearable pain (10 points) also noted two patients from this group (4%). According to YOUR, the average pain in the first group was 3.02 ± 1.07, in the second – 1.13 ± 0.23, in the third – 0.93 ± 0.27 (p = 0.05). Pronounced pain (more than 5 cm according to YOUR) was noted only in the first group in 12 patients (24%). Conclusion. None of the test solutions completely removed pain during tumescent paravasal anesthesia. But the use of a solution with a pH of 7.3-7.4 is less painful when administered and significantly reduces pain during tumescent anesthesia, which was used in patients of groups II and III.

Surgical approach in multi- and extensively drug-resistant tuberculosis: resection and thoracomioplasty

Objective:To define a surgical approach in treatment of multi- and extensively drug-resistant tuberculosis.Design:The article described a retrospective analysis of surgical treatment of 246 multi- and extensively drug-resistant tuberculosis patients who were divided into 3 groups: 152 multi-drug-resistant tuberculosis patients operated during the chemotherapy with second-line anti-tuberculosis drugs, 65 multi-drug-resistant tuberculosis patients operated during the chemotherapy with first-line anti-tuberculosis drugs, and 29 extensively drug-resistant tuberculosis patients who were treated with second- and third-line drugs.Results:Resection methods of treatment produce positive results in 98.0% of multi-drug-resistant tuberculosis cases when rational chemotherapy is available. In case of extensively drug resistance a choice of surgical intervention depends on a degree of lung involvement, clinical form of disease. With restrictive lung involvement it is possible to use resection methods and with extensive lung involvement it is preferable to apply collapse surgical methods of treatment.Conclusion:A surgical approach in treatment of multi- and extensively drug-resistant tuberculosis patients depends on a spectrum of anti-tuberculosis drug resistance, degree of involvement, and clinical form of disease.

Clostridium difficile Infection in Western Romania: Correlations Between Ribotype and Clinical Form One year observational retrospective study

Clostridium difficile is a globally significant enteric pathogen with rapid emergence in the USA, Asia, Oceania and Europe. It is reported to be the leading cause of infectious diarrhea in healthcare facilities of developed nations, and the burden of disease caused by this pathogen is receiving increasing recognition. The objectives of the present study consisted in determining the incidence of the C. difficile infection during the last year, correlating the ribotype with the clinical form of disease, as well as the quantification of the importance of the ATLAS score in the evolution of enterocolitis with C. difficile. Also, the secondary objectives of the study were: observation of the pathogens circulation in cases transferred from other hospital units and correlation of the current treatment versus existing antimicrobial guidelines. We have performed an observational retrospective study of Clostridium difficile enterocolitis cases in the Hospital of Infectious Diseases and Pneumophtisiology Victor Babes Timisoara, during January 2018- December 2018. Between January and December 2018, 207 patients with C. difficile acute enterocolitis were hospitalized. The Atlas scores remain of great utility in determining the prevalence of the infection. Of the 207 hospitalized patients in 18 cases, ribotyping was positive. All the 18 ribotypes were with binary toxin (cdt) and genotype 027, a strain commonly found in the west of the country, but also in countries with neighboring borders. Compared to the previous years, there is an alarming increase in the number of cases with C. difficile infection, ribotype 027. These isolates had another characteristic that no doubt contributed to their ability to spread quickly in a healthcare environment, they produced very high levels of spores compared to other C. difficile strains.

The physical and occupational activity of patients with multiple sclerosis depending on the form of clinical disease

<br/><b>Introduction:</b> The progressive nature of multiple sclerosis (MS) is associated with numerous neurological deficits, leading gradually to deteriorating health and to disability. <br/><b>Purpose:</b> The aim of this study was a subjective assessment of the physical and occupational activity of individuals with MS depending on the clinical form of the disease. <br/><b>Materials and methods:</b> We used the original to conduct the research, with 28 closed questions. The study was carried out from December 1, 2018, to January 31, 2019, following approval by the Bioethics Committee of the Medical University of Bialystok, among persons belonging to the Association for Helping Sick People for Multiple Sclerosis in Białystok and patients of the Neurology Department of the University Clinical Hospital in Bialystok. The study sample comprised 50 people diagnosed with MS, 41 women and 9 men. <br/><b>Results:</b> The most frequently occurring clinical form of MS was relapsing-remitting (68%). In this form, most participants had good physical fitness (44%). In those with the progressive-recurrent form (50%), very poor physical fitness was subjectively noted. Of those with the relapsing-remitting type of MS, 50% were professionally active, while none of the participants with the progressive-recurrent form were. Both the physical and occupational activities of MS patients were frequently limited by fatigue, balance disturbances, and movement difficulties. Fatigue was the most common symptom for most individuals with MS (82%). <br/><b>Conclusion:</b> MS has a significant impact on both the physical activity and occupational functioning of patients. In the clinical form of MS, relapsing-remitting, patients’ physical fitness was better.

THE EVALUATION OF RISK OF DEVELOPMENT AND COURSE OF BRONCHIAL ASTHMA ON THE BASIS OF POLYMORPHISM OF GENE TNFA

The bronchial asthma is one of the most widespread multi-factorial diseases developing in interaction of environmental and genetic factors. The purpose of this study was to analyze association of polymorphism of gene TNFA with risk of development of bronchial asthma considering clinical form of disease. The polymerase chain reaction technique was applied to analyze polymorphic locus rs1800629 of gene TNFA in patients with bronchial asthma (n=133) and control group (n=195). The analysis of rate of polymorphism of gene TNFA established reliable increasing of rate of allele A in group of patients with bronchial asthma as compared with control sample. According the coefficient of chances ratio, the risk of development of bronchial asthma if there is allele A of polymorphic locus rs1800629 of gene TNFA increases more than twice (OR=2,53; 95% CI 1,45-4,43). At that, various firms of bronchial asthma have specific features in distribution of rates of genotypes of polymorphic locus rs1800629 of gene TNFA. It is demonstrated that among agents of genotypes GA of polymorphic modification of rs1800629 of gene TNFA patients with mixed form of bronchial asthma were found more frequently than among agents of genotypes GG. The obtained results provide ground to suppose that polymorphic modification of rs1800629 of gene TNFA shows certain damaging effect under various clinical forms of bronchial asthma.

CLINICAL AND METABOLIC ANALYSIS OF DISORDERS IN PSORIATIC PATIENTS

Introduction: Elucidation of the primary nature of biochemical shifts in psoriatic disease and prediction of interconnected subsequent changes in metabolic and inflammatory processes are important in foreseeing the dynamic development of pathological process and the choice of individual treatment. The aim of the research was to assess the disorders and correlations between main indicators of protein, fat, hydrocarbon and pigment metabolism and specifics of inflammatory processes in psoriatic patients against the clinical course of dermatosis. Materials and methods: We analysed the results of clinical and laboratory examinations conducted in 62 psoriatic patients. All these patients have been analysed as per their age,sex, prevalence and the type of skin rash as well as per the clinical disease form. Biochemical examinations were conducted using appropriate sets of reagents. To establish the possible correlation between the indicators of biochemical blood analysis, we calculated the correlation coefficient, which determines the nature of correlation between the studied variables. Results: The analysis of results received upon examining psoriatic patients indicated that microbial-viral associations, stress factors and genetic predisposition were the most frequent trigger factors of psoriatic disease, which corresponds to the data from literary sources. We detected that the duration of psoriaric disease up to 5 years was the most common, and relapses were manifested in its limited form against the background of the disease advanced stage; the prevalent psoriasis was more common at the hospital stage. Our study justifies that metabolic changes occurred in the overwhelming majority of examined patients of different age groups. At that, abnormalities of a number of indicators of protein, lipid, hydrocarbon and enzyme metabolism have been established. In addition, the expressiveness of corresponding changes correlated with the prevalence of skin psoriatic process and the duration of dermatosis course as well as the presence of pathology of a number of internal organs, in particular of gastrointestinal tract, hepatobiliary and cardiovascular systems, that suggest the presence of systemic disorders at psoriasis. Conclusions: The identification of independent mechanisms existing between some changes in metabolic process parameters in psoriasis has a theoretical and practical significance in dermatology, which involves the use of medications to regulate the detected disorders, the possibility to restore correlations, and it will inevitably contribute to the achievement of clinical and preventive effect.

The Experience of the Retrospective Epidemiological Analysis of Outbreaks of Pertussis in the Moscow Suburbs

Background Pertussis outbreaks are continuously observed in different countries despite many years of specific prophylaxis measures for this infection, use of whole-cell and acellular vaccines and use of different schemes of immunization. In our country, even with the overall morbidity stabilization, outbreaks of pertussis continue to be recorded even in regions where the situation was satisfactory previously. As a rule, the majority of epidemic pertussis foci were limited to 1 case of disease (without spread of infection) -86.4% in average. The prevalence of mild clinical forms of disease that are hard to detect, poor effectiveness of the bacteriological method used for examination of exposed persons, and a decrease in the number of examined persons suggest underreporting of whooping cough cases. The most reliable information on the epidemic process manifestations of pertussis can be obtained during outbreaks. Therefore, we conducted a review of outbreaks of pertussis in a small town of district subordinance. Materials and methods As methods of our study we used retrospective epidemiological analysis, serological and molecular genetic methods. The main sources of information were emergency reports and epidemiological investigation of pertussis. Results and discussion From July 28, 2015 to March 24, 2016 year 58 cases of pertussis were observed. Three secondary schools, two grammar schools, five kindergartens, one trade school and the children not attending any educational facility were affected by the outbreak of whooping cough. In the end, during the outbreak, there were 6 foci in kindergartens, 1 focus in the trade school, 18 -in secondary schools, 53 household foci, with the number of patients ranging from 1 to 18. Age distribution was as follows: 50 children (86.2%), 6 adolescents (10.3%) and 2 (3.5%) adults. Among those, 9 people have not been vaccinated against pertussis, with three more also considered un-vaccinated due to an unknown vaccination status, and three children received just one dose of the DPT vaccine; 43 patients had been vaccinated against pertussis, including one who received three doses of the vaccine, 41 had a booster pertussis vaccination. In most cases the source of infection could not be established. 44 patients had a mild form of whooping cough, while 1 case was a combination of pertussis and parapertussis, and 13 patients had medium or severe form of the disease. Conclusion The almost simultaneous identification of whooping cough cases by a number of institutions suggest the existence hidden pertussis cases. Despite the fact that vaccination in household foci is not indicted, it is still possible to prevent the spread of pertussis. It was enough to suspect whooping cough in children coughing for more than 7 days and order laboratory examination to avoid any prolonged stay of an infection source in an organized collective. Overcrowded accommodation in neighbourhoods, close contacts of children at neighborhood playgrounds in neighborhoods and supplementary education classes were the factors that allowed the infection to spread to many institutions of the city.