Complicated Course Research Articles

Recurrent abdominal dislodgement of intrathecal pump and utility of infraclavicular site for patients with elevated body mass index: illustrative case.

Intrathecal baclofen, delivered via implanted pump, has been used to manage spasticity for approximately 40 years. The device is typically subcutaneously or subfascially implanted in the abdominal wall. There are very few cases reported of the pump being implanted in other locations. This case describes the complicated course of a patient presenting with multiple episodes of catheter malfunction related to pump flipping in the abdominal pocket. The patient was successfully treated with repositioning of the pump into the infraclavicular fossa. Infraclavicular placement of the implanted pump allowed for a more secure pocket base for this patient and less strain applied to the pump, minimizing the risk of disruption of pump positioning and interruption of drug delivery.

Long-Term Clinical and Toxicological Follow-up of Severe Cobalt and Chromium Intoxication—a Case Report

Cobalt intoxications from fractured hip endoprostheses have been described since the early 2000s. Typical symptoms include cardiomyopathy, neurological symptoms with visual and hearing loss and hypothyroidism. Less is known about long-term progression of these pathologies. This case report shows the long-term course of complications caused by cobalt and chromium exposure after substantial elimination of the source of intoxication. We report here a 63-year-old male Caucasian with severe cobalt and chromium intoxication. He presented 1 month after 2nd revision surgery of a broken hip endoprosthesis in a reduced general condition with signs of heart failure, pale skin and diminished hearing and vision. Blood analyses showed a cobalt concentration of 600 μg/L (reference value < 0.45 μg/L). Because the blood cobalt concentration decreased rapidly after surgery and symptoms improved, chelation therapy was not applied. Close clinical and toxicological monitoring was performed. The intoxication was not diagnosed until 6 years after the faulty hip joint revision and 3 years of clear signs of intoxication during a 2nd revision of the prosthesis. The patient’s ordeal could have been much shorter if his cobalt intoxication with neurologic, cardiac and thyroid symptoms had been detected earlier by toxicological blood tests. After the elimination of the source of poisoning, the long-term course showed constant excretion of cobalt and chromium over several years without chelation. Specific symptoms such as cardiomyopathy and neurological symptoms were declining. However, due to the continuous release of metal ions from the tissue, complete recovery did not occur.

Evaluation of critical care burden following traumatic injury from two randomized controlled trials

Trauma resuscitation practices have continued to improve with new advances targeting prehospital interventions. The critical care burden associated with severely injured patients at risk of hemorrhage has been poorly characterized. We aim to describe the individual and additive effects of multiorgan failure (MOF) and nosocomial infection (NI) on delayed mortality and resource utilization. A secondary analysis of harmonized data from two large prehospital randomized controlled trials (Prehospital Air Medical Plasma (PAMPer) Trial and Study of Tranexamic Acid during Air and Ground Medical Prehospital Transport (STAAMP) Trial) was conducted. Only those patients who survived beyond the first 24 hours post-injury and spent at least one day in the ICU were included. Patients were stratified by development of MOF only, NI only, both, or neither and diagnosis of early (≤ 3 days) versus late MOF (> 3 days). Risk factors of NI and MOF, time course of these ICU complications, associated mortality, and hospital resource utilization were evaluated. Of the 869 patients who were enrolled in PAMPer and STAAMP and who met study criteria, 27.4% developed MOF only (n = 238), 10.9% developed NI only (n = 95), and 15.3% were diagnosed with both MOF and NI (n = 133). Patients developing NI and/or MOF compared to those who had an uncomplicated ICU course had greater injury severity, lower GCS, and greater shock indexes. Early MOF occurred in isolation, while late MOF more often followed NI. MOF was associated with 65% higher independent risk of 30-day mortality when adjusting for cofounders (OR 1.65; 95% CI 1.04–2.6; p = 0.03), however NI did not significantly affect odds of mortality. NI was individually associated with longer mechanical ventilation, ICU stay, hospital stay, and rehabilitation requirements, and the addition of MOF further increased the burden of inpatient and post-discharge care. MOF and NI remain common complications for those who survive traumatic injury. MOF is a robust independent predictor of mortality following injury in this cohort, and NI is associated with higher resource utilization. Timing of these ICU complications may reveal differences in pathophysiology and offer targets for continued advancements in treatment.

Duration of Invasive Mechanical Ventilation Post-Liver Transplantation: Does One Size Fit All?

Duration of Invasive Mechanical Ventilation Post-Liver Transplantation: Does One Size Fit All?

Prediction of motor function in patients with traumatic brain injury using genetic algorithms modified back propagation neural network: A data-based study.

Traumatic brain injury (TBI) is one of the leading causes of death and disability worldwide. In this study, the characteristics of the patients, who were admitted to the China Rehabilitation Research Center, were elucidated in the TBI database, and a prediction model based on the Fugl-Meyer assessment scale (FMA) was established using this database. A retrospective analysis of 463 TBI patients, who were hospitalized from June 2016 to June 2020, was performed. The data of the patients used for this study included the age and gender of the patients, course of TBI, complications, and concurrent dysfunctions, which were assessed using FMA and other measures. The information was collected at the time of admission to the hospital and 1 month after hospitalization. After 1 month, a prediction model, based on the correlation analyses and a 1-layer genetic algorithms modified back propagation (GA-BP) neural network with 175 patients, was established to predict the FMA. The correlations between the predicted and actual values of 58 patients (prediction set) were described. Most of the TBI patients, included in this study, had severe conditions (70%). The main causes of the TBI were car accidents (56.59%), while the most common complication and dysfunctions were hydrocephalus (46.44%) and cognitive and motor dysfunction (65.23 and 63.50%), respectively. A total of 233 patients were used in the prediction model, studying the 11 prognostic factors, such as gender, course of the disease, epilepsy, and hydrocephalus. The correlation between the predicted and the actual value of 58 patients was R 2 = 0.95. The genetic algorithms modified back propagation neural network can predict motor function in patients with traumatic brain injury, which can be used as a reference for risk and prognosis assessment and guide clinical decision-making.

Predictors of complicated course of perioperative period in patients with rectal cancer and rectosigmoid junction

Aim of the investigation. Evaluation of significance of a number of clinical predictors of complicated course of perioperative period in patients with rectal cancer and rectosigmoid junction. Materials and Methods. Retrospective analysis of 170 patients with rectal cancer or rectosigmoid junction. Patients with adenocarcinoma of rectum or rectosigmoid junction which were operated in combination to partial or total mesorectumectomy were included to the study. In all cases an anastomosis was formed. There were 54.7% of men and 45.3% of women. The mean age of the patients was 63 years. Preoperative treatment was performed in 54 patients. Influence of various factors (gender, age, BMI, anatomical risk factors, neoadjuvant therapy, type of operation, ligation level of the inferior mesenteric artery, forced mobilization of the splenic flexure of the colon, surgical access, anastomosis type, anastomosis protection, duration of operation, preventive stoma) on the risk of perioperative complications and separately inconsistent anastomosis suture was estimated. Results. Neoadjuvant chemoradiotherapy increases the risk of intraoperative complications by 3.4 times. Risk of anastomosis inconsistency is 3,35 times increased in men, 2,6 times for forced mobilization of the splenic flexure of the large intestine and 10 times for intraoperative perforation of the large intestine. Predictors of complicated course of the postoperative period are adhesions, narrow pelvis, short mesentery of the sigmoid colon, dolichosygma (p<0,05). Conclusion. Presence of the above risk factors must lead to application of measures on prevention and elimination of consequences of perioperative complications.

Clinical and echocardiographic profile of patients one year after COVID-19 pneumonia depending on the left ventricular global longitudinal strain

Background. Studying the impact of complicated course of new coronavirus infection on the cardiovascular system in the long term after patient discharge from hospital is of high significance.Purpose. To compare the clinical and echocardiographic parameters of persons with history of verified COVID-19 pneumonia one year after discharge from hospital depending on the value of left ventricular (LV) global longitudinal strain (GLS).Material and Methods. A total of 116 patients (50.4% men) aged 49.0 ± 14.4 years (from 19 to 84 years) with history of verified COVID-19 pneumonia were examined one year ± three weeks after discharge. The parameters of left ventricular global and segmental longitudinal strain were studied in 80 patients with optimal quality of echocardiographic visualization. Patients were divided into groups depending on the LV GLS value: group 1 included 35 patients with normal LV GLS (&lt;–20%); group 2 comprised 45 patients with impaired LV GLS (≥–20%). The groups did not differ in age (p = 0.145), severity of lung injury during hospitalization (p = 0.691), duration of hospitalization (p = 0.626), and frequency of stay in the intensive care unit (p = 0.420).Results. Abnormal values of LV GLS one year after discharge were found in 57.5% of patients with optimal visualization quality while the LV ejection fraction (EF) was normal in all patients. The majority of patients in group 2 were men (71.1% vs 28.6%, p &lt; 0.001). A combination of coronary artery disease (CAD) and hypertension (AH) was more often diagnosed in this group (22% vs 6%, p = 0.040). The values of LV EF did not differ between the groups. The values of LV GLS were significantly worse in patients of group 2 (–17.6 ± 1.9% vs –21.8 ± 1.2%, p &lt; 0.001). Moreover, the parameters of diastolic function including the left atrial emptying volume index (1.3 ± 0.3 mL/m2 vs 1.4 ± 0.3 mL/m2, р = 0.052) and velocity of the lateral part of the mitral valve fibrous ring e’ (10.8 ± 4 .4 cm/s vs 12.8 ± 4.0 cm/s, p = 0.045) were also lower in this group.Conclusions. The LV GLS was impaired in 57.5% patients with normal LV EF one year after COVID-19 pneumonia. In the group with impaired LV GLS, men predominated; coronary artery disease was more often detected in combination with AH; and parameters of LV diastolic function were worse compared with the corresponding parameters in the group of patients with normal LV GLS.

Transcriptome Profiling of Developing Testes and First Wave of Spermatogenesis in the Rat.

Spermatogenesis is a complicated course of several rigorous restrained steps that spermatogonial stem cells undergo to develop into highly specialized spermatozoa; however, specific genes and signal pathways, which regulate the amplification, differentiation and maturation of these cells, remain unclear. We performed bioinformatics analyses to investigate the dynamic changes of the gene expression patterns at three time points in the course of the first wave of rat spermatogenesis. Differently expressed genes (DEGs) were identified, and the features of DEGs were further analyzed with GO (Gene Ontology), KEGG (Kyoto Encyclopedia of Genes and Genomes) and Short Time-series Expression Miner (STEM). A total of 2954 differentially expressed genes were identified. By using STEM, the top 10 key genes were selected in the profile according to the enrichment results, and the distinguishable biological functions encoded by these DEGs were automatically divided into three parts. Genes from 6, 8 and 10 days were related to biosynthesis, immune response and cell junction, and genes from 14, 15 and 16 days were related to energy metabolic pathways. The results also suggest that genes from 29, 31 and 35 days may shift metabolic to sperm motility, sperm flagellum and cilium movement.

Ischemic Changes in the Mucous Membrane of the Transverse Colon as a Complication of Acute Pancreatitis

Aim: to present a clinical case of a patient with a complicated course of acute pancreatitis.Key points. A 31-year-old patient was admitted to the surgical department with a clinical picture of acute alcoholic pancreatitis. Signs of anemia were regarded as a consequence of gastrointestinal bleeding. Computed tomography with contrast enhancement, along with an increase in the size of the pancreas, the presence of foci of pancreatic necrosis with multiple fluid accumulations in the parapancreatic space, revealed smoothed gaustration and thickening of the walls of the predominantly transverse colon. During colonoscopy, ischemic changes of the colon mucosa were detected in a timely manner. Negative results of analysis for toxins A and B of Clostridioides difficile and pathogenic intestinal flora were obtained. By the means of intensive care, it was possible to achieve complete stabilization of the patient's condition, normalization of laboratory blood parameters and relief of ischemic processes in the colon wall.Conclusion. Ischemic changes of the colon can serve as a complication of acute pancreatitis. A thorough analysis of the results of computed tomography at the first signs of colon lesion and colonoscopy contributed to the rapid detection of complications and prevention of irreversible colon ischemia.

Multidisciplinary Approach to Recurrent Upper Respiratory Tract Diseases in Children. Intermediate Study Results

The issue of recurrent upper respiratory tract diseases in children is common and relevant. Commonly this pathology is associated with other diseases that lead to the prolonged, complicated, or chronic course of the inflammatory process in the upper respiratory tract. Objective. The aim of the study is to improve management principles for children with recurrent upper respiratory tract diseases according to the developed multidisciplinary and personalized approach (modern methods of diagnosis and health monitoring) for achieving long-term remission. Methods. The study included 65 children aged from 3 to 17 years 11 months with recurrent upper respiratory tract diseases. Examination: nasal, nasopharynx and larynx endoscopy, abdominal ultrasound with aqueous-siphon test, tympanometry, and laboratory tests (complete blood count, evaluation of total and specific IgE levels, antistreptolysin O, nasopharynx and oropharynx microbiological study, enzyme-linked immunosorbent fecal analysis for Helicobacter pylori). Results. 88% of examined children showed allergic pathology according to our study results. Clinical signs of gastroesophageal reflux disease (GERD) were revealed in 30% of children with chronic oropharynx inflammation. GERD signs were revealed both via abdominal ultrasound with aqueous-siphon test and via fiberoptic laryngoscopy and later confirmed by esophagogastroscopy in 8.7% of patients. Obtained data indicates high prevalence of allergic and gastroenterological pathology in children with recurrent upper respiratory tract diseases. Conclusion. Obtained results allow us to establish scientifically multidisciplinary and personalized approach for the management of children with recurrent upper respiratory tract disease. This approach shall include key diagnostic methods required for improvement of comorbid conditions revealing, and achieving and maintaining control over the disease symptoms. The study is currently ongoing.

Нутрієнтна корекція клінічного перебігу та аліментарна профілактика наслідків, зумовлених туберкульозною інфекцією

Abstract. Food is a source of flexible, energetic and catalytical ingredients that stipulate the human organism’s life and development. Proteins on a par with other nutrients, form tissues, are a part of enzymes, hormones, participate in the processes of growth, development and restoration of organs and systems. The Aim. To scientifically substantiate the correction measures of the clinical course and alimentary prevention of complications caused by tuberculous infection. To list up the main sources of nutrients, to show their importance for the tuberculous infection course correction and the effect of essential substances on the prevention of complications caused by the disease. Materials and Methods. The complex of theoretical, empirical methods and full-scale observations was used for the investigation. Theoretical research methods were: bibliographic analysis, synthesis and abstraction, as well as generalization of available in scientific literature data and their classification and systematization. The methods of empirical research were traditional modern approaches: full-scale observations, interviews, polling, questionnaires, and expert evaluation. Methods of biological research: epidemiological, clinical, laboratory, physical-chemical, biochemical and medical-statistical. Results and Conclusions. The quality of the dietary structure was determined by the complex of amino acids, fatty acids, especially omega-3 PUFAs, vitamins, minerals, and the sufficiency of complex carbohydrates that stimulate intestinal peristalsis, which was important in a sedentary lifestyle. The actual food quality effect on the body’s supply of alimentary iron was described. The impact of the latter on the disease course was distinguished. It was shown that the excess of energy caused by the excessive simple sugars consuming, contributed to the exacerbation of the disease course and allergies. It was emphasized that the energy value of the diet should depend on the peculiarities of the disease course, the presence of associated complication, the patient’s body weight, as well as the type of work with preserved performance efficacy. Key Words: nutrient correction, essential substances, ideal protein, amino acids, recommended daily intake, food products, energy value of the diet, principles of the diet therapy, erythrocytes, lymphocytes, leukogram.

Characteristics, treatment, and outcome of patients with bowel perforation after immune checkpoint inhibitor exposure.

Exposure to immune checkpoint inhibitors (ICIs) can predispose to immune-related adverse events (irAEs) involving the gastrointestinal tract. The association between ICIs and bowel perforation has not been well studied. We aimed to describe the clinical course, complications, treatment, and outcomes of patients experiencing bowel perforation during or after ICI treatment. This retrospective, single-center study included adult cancer patients with bowel perforation that occurred between the first dose of ICI treatment and up to 1year thereafter between 1/1/2010 and 4/30/2021. Patients' clinical course, imaging, treatment, and outcomes related to bowel perforation were collected and analyzed. Of the 13,991 patients who received ICIs during the study period, 90 (0.6%) met the inclusion criteria. A majority were male (54.4%), the most common cancer type was melanoma (23.3%), and most patients had received PD-1/L1 inhibitor treatment (58.8%). Onset of perforation occurred after a median of four ICI treatment cycles. The most common symptom was abdominal pain (95.5%). The colon was the most common location for the perforation (37.7%). Evidence of diverticulitis, enterocolitis, or appendicitis was seen in 32 (35.6%) patients, and 6 (6.6%) patients had luminal cancer involvement at the time of perforation. The overall hospitalization rate related to perforation was 95.5%, with mortality of 15.5% during the same admission. Antibiotics were given in 95% of our sample; 37.8% of patients also required surgical/interventional radiology intervention. Forty-six patients (51.1%) had perforation-related complications (e.g., sepsis, fistula, abscess), which were associated with a higher mortality rate (30%). Our findings suggest a low incidence of bowel perforation after ICI treatment (0.6%), with 40% of patients having coexisting bowel inflammation as a potential contributing factor. Patients with bowel perforation had an aggressive disease course and high rates of hospitalization, complications, and mortality. Early recognition and prompt intervention is critical to improve patient outcomes. Future studies are warranted to further investigate the cause, predictive markers, and optimal treatment for this patient population.

Efficacy of enterosorption in treatment of Covid-19 in pregnant women

Objective. To optimize the treatment of pregnant women with a moderate form of COVID-19 by including a sorbent in complex therapy.&#x0D; Materials and methods. Pregnant women (n = 87) with a gestational term of 30 weeks or more were divided into 2 groups. Group 1 (n = 42) received standard treatment for COVID-19. Group 2 (n = 45) received an additional preparation of colloidal silicon dioxide. The following endotoxemia indicators were assessed: concentrations of C-reactive protein (CRP), interleukin-6 (IL-6), medium mass molecules (MМM). The course of pregnancy and complications of childbirth were evaluated.&#x0D; Results. At the peak stage of the disease, in patients of group 2 the level of МММ was 0,43 opt. units lower, CRP 7.1 mg / l lower, IL-6 2.3 ng / ml lower than in women of group 1.&#x0D; Anemia, fetal growth retardation, threatening preterm birth, fetoplacental insufficiency, polyhydramnios and oligohydramnios was diagnosed rarely in group 2; the average fetal weight was 256 g more, the average fetal height was 2.4 cm more than in group 1. In group 2, there were fewer children with moderate and severe asphyxia.&#x0D; Conclusions. The addition of colloidal silicon dioxide to the standard treatment of pregnant women with a moderate form of COVID-19 helps to reduce the level of endogenous intoxication, which is manifested by positive dynamics.

ХІРУРГІЧНЕ ЛІКУВАННЯ РІДКІСНИХ ЛЕГЕНЕВИХ УСКЛАДНЕНЬ ВИКЛИКАНИХ COVID-19: КЛІНІЧНИЙ ВИПАДОК ГІГАНТСЬКОЇ НЕСПРАВЖНЬОЇ КІСТИ ЛЕГЕНІ, УСКЛАДНЕНОЇ ГЕМАТОМОЮ

A lung cyst is a pathologic cavity filled with air or fluid content. According to the morphological structure, lung cysts are divided into true and false. The former are always congenital, while false lung cysts are acquired. In the population, lung cysts are found in patients of both sexes equally often. According to statistics, about 76 people per 1000 people have a history of lung cysts. With the onset of the COVID-19 pandemic, the widespread use of chest computed tomography (CT) has made it possible to identify a number of pulmonary pathologies, including rare complications of this viral infection. According to the literature, the incidence of pulmonary cysts in the studied patients was 9.0 %. The authors suggest that COVID-19 causes cyst formation in the lungs due to ischemic damage to the parenchyma or vascular occlusion, pulmonary fibrosis. Another cause is blockage of bronchioles by mucus and mucus plugs, accompanied by excessive alveolar distension and, as a result, rupture of the alveolar septum with subsequent formation of small cysts. The article presents our own experience of surgical treatment of rare pulmonary complications caused by COVID-19, namely false giant lung cyst complicated by hematoma. Conclusions. COVID-19 is a relatively new and poorly understood viral lung disease, and therefore each report of its atypical or complicated course will contribute to the systematization of knowledge about this pathology. Key words: COVID-19, VATS, hematoma, cyst, computed tomography

ПАТОГЕНЕТИЧЕСКИЕ БИОХИМИЧЕСКИЕ АСПЕКТЫ ПРИ ИСТИННОЙ И ИНФИЦИРОВАННОЙ СУБИНВОЛЮЦИИ

The aim of the study was to analyze the activity of cholinesterase, the content of norepinephrine, monoamine oxidase, TNF-α, procalcitonin, highly sensitive CRP in the blood serum of puerperas with various types of postpartum uterine subinvolution. A survey of 111 puerperas (mean age 25.1±2.3) who were hospitalized in the physiological department of the 3rd City Clinical Hospital named after E.V. Klumova, Minsk. All patients were divided into the following groups: 1st – 34 puerperas with infected subinvolution (mean age 22.6±2.0); 2nd – 45 puerperas with true true (mean age 23.0±2.1). The control group consisted of 32 puerperas with a physiological postpartum period (mean age 25.4±1.9). The obtained results demonstrated that an important link in the pathogenesis of postpartum subinvolution of the uterus is a decrease in the content of norepinephrine and an increase in the activity of cholinesterase in the blood serum. The threshold level of HoA concentration was 57.8 ng/ml (ROC-curve area 0.98±0.02; CI 0.95-1.0; p &lt; 0.001), PN was 97.0%, DS 94.0%. The threshold level of ChE activity was 4124 U/l (ROC-curve area 0.94±0.03; CI 0.88-1.0; p &lt; 0.001), PM was 93.0%, DS 88.0%. The conducted ROC-analysis allows us to regard the studied parameters as predictors of the development of SCI, which makes it possible to conduct a reliable and timely differential diagnosis of the normal and complicated course of puerperia. A significant increase in the level of C-reactive protein up to 17.4±1.2 mg/l (p = 0.001) and procalcitonin up to 0.8±0.03 mg/l (p = 0.001), as well as an increase in the concentration TNF-α up to 336.0±96.0 (p = 0.007) compared with normal data. Therefore, the treatment of postpartum subinvolution of the uterus, accompanied by hypotension and congestion in the uterine cavity, should be aimed at stimulating the adreno- and cholinergic parts of the ANS.

Эпидемиологическая характеристика ОРВИ и гриппа на территории Казахстана в эпидемические сезоны с 2018 по 2022 год

One of the most important medical and socio-economic problems worldwide is the incidence of influenza and acute respiratory viral infections (ARVI). The urgency of the problem is due to their widespread prevalence, economic costs, the high probability of a complicated course and exacerbation of chronic non-communicable diseases, the variability of viruses, and the formation of bacterial-associated respiratory diseases against their background. In recent years, the simultaneous circulation of influenza A(H1N1), A(H3N2) and type B influenza viruses has been observed during the epidemiological season. The COVID-19 pandemic has affected the situation of the incidence of ARVI and influenza in the Kazakhstan. Objective. To assess the epidemic situation in Kazakhstan during the epidemic seasons 2018–2019, 2019–2020, 2020–2021, and 2021–2022 and to identify influenza pathogens circulating among the population. Materials and methods. Epidemiological surveillance for ARVI and influenza in Kazakhstan includes several components. The routine system of registering ARVI cases based on appeal is carried out by organizations providing primary medical care. In 2008, epidemiological surveillance for ARVI and influenza was supplemented with sentinel epidemiological surveillance. Sentinel surveillance for influenza, ARVI, influenza-like illness, and SARS is carried out year-round, and the incidence of influenza in outpatients and inpatients is monitored. Records are kept of all requests for medical care in age groups of 0–4, 5–14, 15–29, 30–64, 65 years and older. During the research, the results of regular monitoring in the surveillance system for influenza, ARVI, influenza-like illness, and SARS in four seasons of ARVI and influenza incidence (epidemic seasons from 2018–2019 to 2021–2022, from 40 weeks of the first year to 20 weeks of the second year) were used. Data on the incidence of ARVI and influenza, the results of laboratory tests of the weekly monitoring of the Reference Laboratory for the Control of Viral Infections of the Scientific and Practical Center for Sanitary and Epidemiological Expertise and Monitoring and 16 regional virological laboratories of branches of the National Center for Expertise, combined into a single Information system "Tracking ARVI/influenza/pneumonia", were taken into account. During the study period, coverage in the Republic of Kazakhstan amounted to 2,408,525 cases of ARVI and influenza, including 93,233 hospitalizations. A total of 39,251 samples were examined for influenza, of which 5,553 PCR tests were positive. Sampling for sequencing is carried out after PCR, while samples with a high concentration of viral RNA (Сt ≤25) are taken. Sequencing methods are used for genotyping of influenza viruses. The research methods also included a molecular genetic study of samples from patients with ARVI and influenza. Results. The highest incidence rates of ARVI and influenza were observed in the epidemic season of 2021–2022, with their maximum levels recorded from the 40th to the 51st week and from the 3rd to the 5th week. In the epidemiological seasons 2018–2019 and 2019–2020, the influenza A(H1N1)pdm09 virus dominated, followed by the influenza A(H3N2) virus and the active circulation of the influenza B virus. In the 2020–2021 epidemiological season, 6,564 PCR studies of samples for the presence of the SARS-CoV-2 virus were conducted in the Republic of Kazakhstan, of which 421 (6%) were positive samples, and in the 2021-2022 epidemiological season – 820 (4%). Conclusion. The results of the analysis show that the circulation of influenza and other ARVI pathogens in the epidemiological season continues to play a leading role in the etiology of respiratory viral infections. Key words: influenza viruses, SARS-CoV-2 virus, influenza, morbidity, ARVI, epidemiological situation

МОДЕЛЬ ДЛЯ ОЦЕНКИ РИСКА ЗАМЕДЛЕННОГО ТЕЧЕНИЯ РАНЕВОГО ПРОЦЕССА У БОЛЬНЫХ С ИЗБЫТОЧНОЙ МАССОЙ ТЕЛА

Objective: Develop a model for predicting the risk of a delayed and complicated course of wound healing in obese patients Methods: The study included 49 patients above 30 years of age (mean age 46.98±7.10 years) with a body mass index (BMI) above 25 kg/m2 (mean value 31.64±5.04 kg/m2 ), who underwent augmentation mammaplasty and aesthetic anterior abdominal wall reconstruction in the period from 2016 to 2018. In the postoperative period, the patients were divided into three groups depending on the wound healing pattern: Group I – complicated wound healing (n=21; 42.86%); Group II – delayed wound healing (n=16; 32.65%); Group III – standard wound healing (n=12; 24.49%). The assessment of the prognostic risk of developing a delayed and complicated wound healing was carried out using a new mathematical model, taking into account the insulin level (mIU/l) and spontaneous secretion of interleukin-1β (pg/ml). Logistic regression analysis was used to determine the significance of prognostic factors. The decision tree model was used to stratify risk groups. A receiver operating characteristic (ROC) analysis was used to assess the quality of the constructed model. Results: Using the decision tree, three risk classes of delayed and complicated wound healing were identified. The highest risk of developing postoperative wound complications (risk=95.0%, n=20) was observed in patients with insulin levels ≥14.0 mIU/l. The average level of risk was determined at the value of insulin &lt;14.0 mIU/l and spontaneous production of interleukin-1β ≥51.0 pg/ml (risk=50.0%, n=2). The lowest risk level of complications (risk=3.7%, n=27) was found with a combination of factors: insulin &lt;14.0 mIU/l and interleukin-1β spontaneous production &lt;51.0 pg/ml. The predictive quality of the constructed model is high (the area under the ROC curve is 0.98). Conclusion: The proposed prognostic model will allow the identification of patients with a high risk of delayed or complicated wound healing in the preoperative period and timely adjust the treatment tactics. Keywords: Overweight, wound healing, prognosis, non-healing wounds.

Диагностическая эффективность контраст-усиленного ультразвукового исследования у пациентов с хроническими вирусными гепатитами

Aim: to determine the diagnostic efficiency of contrast-enhanced ultrasound of the liver in patients with chronic viral hepatitis B and C. Study Design: open randomized study. Materials and methods. 240 people were examined on the basis of the Smolensk Clinical Hospital No. 1 from 2019 to 2021: patients with chronic viral hepatitis who have been examined by contrast-enhanced ultrasound; patients with chronic viral hepatitis who have not been examined by contrast-enhanced ultrasound to determine the diagnostic effectiveness of the method in assessing the complicated course development, patients without chronic viral hepatitis who have been examined by contrast-enhanced ultrasound to determine the standardized CEUS parameters. Liver biopsy and shear wave elastography were used as reference methods. Results. It was found that the greatest changes in contrast-enhanced ultrasound parameters were observed in patients with F4 fibrosis stage according to the METAVIR score. It was also found that the assessment of qualitative parameters according to the proposed standardized program has the highest diagnostic potential, and among the quantitative parameters — the difference of quantitative parameters in the proximal and distal zones (time of arrival, time to peak, peak intensity, half-time washout). Conclusion. The use of a contrast agent increases the value of the ultrasound method in the diagnostic algorithm for patients with chronic viral hepatitis. Keywords: contrast-enhanced ultrasound, chronic viral hepatitis, contrast agent, arterial phase, portal venous phase, late venous phase, qualitative parameters, quantitative parameters.

Allergic adverse reactions in children following tuberculosis chemotherapy

Introduction. Tolerability of anti-TB chemotherapy in children is an urgent problem. The study is devoted to the characteristics of adverse reactions (AR) of an aller-gic type (allergic and toxic-allergic) and the factors con-tributing to their occurrence. Materials and methods. The retrospective study included 146 children aged 0 to 14 years with respiratory TB who received TB chemo-therapy, including 22 children with multidrug-resistant agent contact (MDR-TB). The spectrum of clinical and laboratory manifestations of АRs, frequency, risk factors were studied. Results. ARswith an allergic component were observed in 54 (37.0%) children, among them allergic in 32 (21.9%) and toxic-allergic in 22 (15.1%). The most common allergic reaction was asymptomatic eosinophilia (81.2%), in other cases, a combination of eosinophilia with dermatitis or only skin manifestations. A mild degree of eosinophilia prevailed, but in 3 patients it was severe (more than 20% of eosinophils in the leuk-ogram). In toxic-allergic reactions, signs of allergy were combined with an increase in liver enzymes in 59.0% of children, less often with other disorders. It was found that the early age of children, complicated course of TB, MDR-TB regimen, hyperergic skin tests do not increase the chance of developing allergic ARs. A burdened aller-gic history increases the chance of allergic АR to anti-TB drugs 2.8 times, and the presence of a primary affect in the lung 3.1 times. Temporary discontinuation or re-placement of drugs was required much more often in toxic-allergic reactions — 40.9% than in allergic ones — 18.7% (р &lt;0.05). Allergic and toxic-allergic reactions were reversible. Conclusion. In the development of АRs to anti-TB drugs in children, the allergic factor is of sig-nificant importance. The creation of laboratory methods for diagnosing allergic reactions to anti-TB drugs would be useful

Risk factors for the formation of congenital hyperplasia of blood vessels (infantile hemangioma)

The aim the study. To identify correlations between the development of blood vessel hyperplasia (GCS) and risk factors in pregnant women. To identify correlations between the development of blood vessel hyperplasia (GCS) and risk factors in pregnant women. A selective retrospective analysis of 173 case histories and outpatient records of patients of the Clinic of Pediatric Maxillofacial Surgery and Dentistry of the Central Research Institute of Dentistry and Maxillofacial Surgery for 2011-2021 was carried out. The obstetric history of the mother, chronic diseases of mothers during pregnancy and bad habits were studied. The interrelation of the influencing unfavorable factor on the isolation, prevalence and vastness of foci of infantile hemangioma was determined. There was no statistically significant relationship between the harmful habits of the mother and the number of lesions, as well as the isolation of the lesion of the mandibular-facial region (CHLO) and the prevalence of the process in the child. It was found that the prevalence of the process, the isolation of the lesion and the number of foci of CHLO did not have a reliable relationship with the complicated course of pregnancy in the mother. A reliable relationship was revealed between the number of lesions in the CHLO and chronic hypoxia, between the number of defects of the cardiovascular system and the prevalence of the process. But there was no reliable relationship between the number of CCC lesions and the number of lesions. 24 patients out of 173 were premature. In these patients, a statistical severity to the occurrence of GCS was revealed. There was no reliable relationship between the genetic predisposition on the line of both parents and the prevalence of the process, with the isolation of the lesion of CHLO and with the number of foci of CHLO lesions. Prematurity, chronic hypoxia, multiple malformations of the fetal cardiovascular system are risk factors for the development of vascular hyperplasia in children.