Correction Of Metabolic Disturbances Research Articles

Awareness raising and dealing with methanol poisoning based on effective strategies

Intoxication with methanol most commonly occurs as a consequence of ingesting, inhaling, or coming into contact with formulations that include methanol as a base. Clinical manifestations of methanol poisoning include suppression of the central nervous system, gastrointestinal symptoms, and decompensated metabolic acidosis, which is associated with impaired vision and either early or late blindness within 0.5–4 h after ingestion. After ingestion, methanol concentrations in the blood that are greater than 50 mg/dl should raise some concern. Ingested methanol is typically digested by alcohol dehydrogenase (ADH), and it is subsequently redistributed to the body's water to attain a volume distribution that is about equivalent to 0.77 L/kg. Moreover, it is removed from the body as its natural, unchanged parent molecules. Due to the fact that methanol poisoning is relatively uncommon but frequently involves a large number of victims at the same time, this type of incident occupies a special position in the field of clinical toxicology. The beginning of the COVID-19 pandemic has resulted in an increase in erroneous assumptions regarding the preventative capability of methanol in comparison to viral infection. More than 1000 Iranians fell ill, and more than 300 of them passed away in March of this year after they consumed methanol in the expectation that it would protect them from a new coronavirus. The Atlanta epidemic, which involved 323 individuals and resulted in the deaths of 41, is one example of mass poisoning. Another example is the Kristiansand outbreak, which involved 70 people and resulted in the deaths of three. In 2003, the AAPCC received reports of more than one thousand pediatric exposures. Since methanol poisoning is associated with high mortality rates, it is vital that the condition be addressed seriously and managed as quickly as feasible. The objective of this review was to raise awareness about the mechanism and metabolism of methanol toxicity, the introduction of therapeutic interventions such as gastrointestinal decontamination and methanol metabolism inhibition, the correction of metabolic disturbances, and the establishment of novel diagnostic/screening nanoparticle-based strategies for methanol poisoning such as the discovery of ADH inhibitors as well as the detection of the adulteration of alcoholic drinks by nanoparticles in order to prevent methanol poisoning. In conclusion, increasing warnings and knowledge about clinical manifestations, medical interventions, and novel strategies for methanol poisoning probably results in a decrease in the death load.

A "crush" course on rhabdomyolysis: risk stratification and clinical management update for the perioperative clinician.

Rhabdomyolysis, the release of myoglobin and other cellular breakdown products from necrotic muscle tissue, is seen in patients with crush injuries, drug overdose, malignant hyperthermia, muscular dystrophy, and with increasing frequency in obese patients undergoing routine procedures. For the perioperative clinician, managing the resultant shock, hyperkalemia, acidosis, and myoglobinuric acute kidney injury can present a significant challenge. Prompt recognition, hydration, and correction of metabolic disturbances may reduce or eliminate the need for long-term renal replacement therapy. This article reviews the pathophysiology and discusses key issues in the perioperative diagnosis, risk stratification, and management of rhabdomyolysis.

The Difficult Diagnosis of Hypophosphatemic Rickets-A Review of 8 Clinical Cases

Hypophosphatemic rickets is a rare, usually genetic disease associated with decreased phosphate reabsorption in the proximal renal tubule and vitamin D resistance. Several genetic mutations have been discovered, the most common being the X-linked PHEX mutation with high fibroblast growth factor 23 (FGF23) circulating levels. The hypophosphatemic type osteomalacia is usually hereditary or tumour-induced (TIO). In the past 20 years, we have discovered, treated and followed up overall 8 cases of the disease-3 women and 5 men, aged 18 to 52 years. In all patients the diagnostic process was long (a mean of 2-3 years) and involved multiple clinical consults, laboratory evaluations: Biochemical Standard Research, Hormonal Tests [PTH, 25 (OH) D, 1,25 (OH) 2D], Specialized Research (FGF23), Instrumental Research (Ultrasonography of whole body; Computed tomography; Magnetic resonance imaging; DXA examination with an assessment of T-score and Z-score of spine/hip). All of these studies aimed at ruling out different neurological, hematological, oncological, rheumatic, gastroenterological, urological, nephrological diseases and conditions. One of the patients had Fanconi syndrome, five had X-linked hypophosphatemia (XLH) and two had TIO. In the last two patients, we found a high level of FGF23 secreting a small lung neoplasm in the first case and a mesenchymal tumor in the median upper part of the right thigh in the second case. The surgical removal of the tumor mass lead to a fast decrease in FGF23 levels and correction of metabolic disturbances. We present clinical cases with hypophosphatemic rickets/osteomalacia and discuss the etiopathogenesis and treatment of this rare disease. Historically until now phosphate supplementation and therapy using analogs of highly active vitamin D (calcitriol, alfacalcidol, paricalcitol) have been used to manage conditions involving hypophosphatemia. In recent years there has been a progression of clinical trials for monoclonal anti-FGF23 antibodies for the treatment of XLH. These monoclonal anti-FGF23 antibodies may have potential for treating other conditions associated with FGF23 overactivity. However, clinical trials to support that possibility are not available at present.

Мочекаменная болезнь. Часть 5. Лекарственные средства, применяемые в медикаментозной метафилактике мочекаменной болезни

The stages of postoperative metaphylaxis, drugs used for correction of metabolic disturbances are reviewed. In addition, the basic principles of drug metaphylaxis in various types of stone formation are described.

The Effect of Different Types of Bariatric Surgery on Metabolic and Hormonal Parameters in Rats with a Decompensated Form of Type II Diabetes Mellitus

Bariatric surgery (BS), including sleeve gastrectomy (SG), gastric bypass (GB), and ileal transposition (IT), is one of the approaches currently used for the correction of metabolic disturbances in type 2 diabetes mellitus (DM2) with obesity. However, the efficiency of these approaches and their impact on hypothalamic signaling and hormonal status in severe forms of DM2 without obesity remain poorly characterized. The aim of this work is to study the effect of IT, SG, and GB on insulin, leptin, ghrelin, and glucagon-like peptide-1 (GLP-1) levels in the blood and on the expression of the genes encoding the main components of the hypothalamic signaling systems in rats with a decompensated form of DM2 induced by a high-fat diet (three months) and a single low dose of streptozotocin (25 mg/kg, two months after the start of the diet). Pronounced hyperglycemia, impaired glucose tolerance, a decrease in the glucose-stimulated GLP-1 level, a slight decrease in the insulin and leptin levels, and a slight increase in the ghrelin level are detected in diabetic rats. Expression of genes encoding the GLP-1 receptor, the orexigenic agouti-related peptide (AgRP), and phosphotyrosine phosphatase 1B and SOCS3, the negative regulators of the leptin and insulin pathways, is increased in the hypothalamus. IT in diabetic rats leads to a reduction of glucose levels 120 min after glucose loading, an increase of basal and glucose-stimulated GLP-1 levels, and normalization of the expression levels of the phosphotyrosine phosphatase 1B, SOCS3, AgRP, and GLP-1 receptor genes, which is indicative of restoration of the hypothalamic signaling responsible for the control of energy metabolism and insulin sensitivity. Glucose tolerance is improved in the case of SG and GB, and an increase in the basal and glucose-stimulated GLP-1 levels is demonstrated in the case of SG, but no significant effects on the expression of the hypothalamic genes are observed in SG and GB. Thus, IT is the most efficient bariatric surgical intervention among those studied for the treatment of severe DM2 forms without obesity.

Фармакологическая коррекция метаболических нарушений при экспериментальном остром панкреатите на фоне хронической алкогольной интоксикации

Фармакологическая коррекция метаболических нарушений при экспериментальном остром панкреатите на фоне хронической алкогольной интоксикации

ВОПРОСЫ МЕТАФИЛАКТИКИ НЕФРОЛИТИАЗА У ДЕТЕЙ В ЭНДЕМИЧЕСКОМ ОЧАГЕ

Objective: Improving the diagnosis, treatment and metaphylaxis of nephrolithiasis in children. Methods: Under observation was 201 patients with nephrolithiasis aged from one to 14 years. The following risk factors were identified: urological diseases in the immediate family, which was accompanied by metabolic disorders (68.5%); abnormalities of the urinary tract (37%); the age of mothers over 40 (43.3%); related marriages (16.7%). Results: Conducted conservative treatment was effective only in 14 patients with small kidney stones, in other cases, an open surgical removal of stones: pyelolithotomy (98), sparing nephrolithotomy (68), calicolithotomy (11). Nephroureterectomy with calculous pyonephrosis performed on four patients (1.9%). With obstructive purulent calculous pyelonephritis, a radical technique of primary nephrolithotomy with nephrostomy was used. For the purpose of metaphylaxis, after discharge from the hospital, systematic observations of children conducted in a polyclinic. Conclusion: The main metaphylaxis measures for urolithiasis at the outpatient stage should be aim to the sanation of the urinary tract, normalization of urine pH, correction of metabolic disturbances, and treatment of concomitant somatic diseases. Keywords: Urolithiasis, prophylaxis, operative treatment, metaphylaxis, ambulatory care.

Вплив біомаси Phaffia rhodozyma й антиоксидантів на ензими системи глутатіону у тканинах білих щурів за дії афлатоксину В1

Вплив біомаси Phaffia rhodozyma й антиоксидантів на ензими системи глутатіону у тканинах білих щурів за дії афлатоксину В1

ДОКАЗАТЕЛЬСТВА ФУНКЦИОНАЛЬНЫХ СВОЙСТВ И ЭФФЕКТИВНОСТИ БАД «ТОКСФАЙТЕР ЛЮКС» В НАТУРНЫХ НАБЛЮДЕНИЯХ

The enterosorbent of new generation – biologically active additive (BAA) “Toxfighter Lux” is developed, which is a bioactive form of enterosorbent based on dietary fibers with enzymes, probiotics and herbal complex. The materials of full-scale studies of effectiveness and functional orientation are presented. Clinical trials have been performed on patients with metabolic syndrome, providing their diet with 1 teaspoon of specialized product per day in an amount of 3.5 grams during 21 days. The content of sugar, total cholesterol, thymol test are studied; biochemical blood tests, coprological survey are conducted. The assessment of the quality of life is carried out with the help of the questionnaire specially designed for this purpose. It is shown that the prescription of BAA for patients with metabolic syndrome has a positive effect on the functioning of the gastrointestinal tract, improves biochemical status, reduces the symptoms of clinical manifestations of metabolic syndrome, which, in general, ensures the normal functioning of organs and systems. It is recommended as enterosorbent for efferent treatment of considered diseases and correction of metabolic disturbances. It can be used by healthy people as a preventive measure. It is established that self-therapy has a less favorable effect than the use of BAA “Toxfighter Lux”.

Early Metabolic Outcome After Laparoscopic Sleeve Gastrectomy in Morbid Obese Patients

Background :Morbid Obesity (BMI > 40 kg/m2) is a substantial health problem that is related to many metabolic disorders including diabetes, hypertension and hypercholesterolemia and several cardiovascular diseases. This study we aimed to investigate the early metabolic changes which occur after Laparoscopic Sleeve Gastrectomy. Methods: One hundred morbid obese patients (65 females and 35 males) aged between 18 to 50 years with BMI range between 40-50 kg/m2 were enrolled in this study. Patients were followed up after 3 and 6 months post operation to monitor their BMI, serum glucose level, insulin, serum cholesterol level, triglycerides and systolic blood pressure. Results :A significant correlation was found between the percent decrease in BMI and the percent decrease in the measured metabolic parameters especially cholesterol and triglycerides levels at three and six months postoperatively. Conclusion: From the above results we can conclude that LSG is not only an effective bariatric procedure for loss of weight but also it plays and important and effective role in correction of metabolic disturbance associated to obesity especially diabetes type 2 very early after the operation. Statistically analysis used: Continuous variables are expressed as mean and Standard Deviation. Categorical variables are expressed as frequencies and percent. All statistical procedures were carried out using SPSS version 15 for Windows (SPSS Inc, Chicago, IL, USA).

TREATMENT FOR ACUTE INTOXICATIONS WITH VENOMS: COBRA SNAKEBITES

Objective: to study the specific features of the clinical course of acute intoxications with venoms due to the bites of Naja (cobra) naja and Naja kaouthia and those of intensive therapy in patients with the severest forms of this condition. Subjects and methods. Two clinical cases of acute intoxications with venoms due to Naja naja and Naja kaouthia bites were examined. The specific features of their clinical picture over time, changes in clinical and biochemical indicators, blood gas composition, and acidbase balance, coagulogram readings, ECG and radiological findings were studied. Results. Acute intoxication with venoms due to serious cobrabites was found to be characterized by the development of toxicohypoxic encephalopathy, toxic myopathy with skeletal and respiratory muscle paresis to develop acute respiratory and cardiovascular failure, coagulopathy, and metabolic disorders. Specific therapy (with an anti-ophidic serum in one case) resulted in drastically worsening health conditions as fulminant acute respiratory distress syndrome. A package of intensive therapy measures should include actions based on general resuscitation approaches — maintenance of life support systems (breathing, blood circulation), anti-sensitizing therapy, correction of metabolic disturbances with substrate antihypoxants (cytofavin, reamberin), and antimicrobial therapy. Conclusion. In the severest acute intoxications due to cobra snakebites, specific therapy methods (with anti-ophidic serum) should be used with extreme caution and particular emphasis should be laid on the general resuscitation-based principles.

The Clinical Course and Correction of Metabolic Disturbances in Patients with Severe Methadone Poisoning

Objective: to study the clinical patterns due to course of severe methadone poisoning and to assess the results of reamberine use in the complex of intensive therapy for this condition. Subjects and methods. Sixty-eight patients with acute severe methadone poisoning were examined and treated. The clinical manifestations of intoxication and impairment in the tissue component of oxygen transport were evaluated. Results. The severity of its clinical picture, besides directly toxic effect of methadone was characterized by the depth and magnitude of hypoxia that clinically manifested both as cerebral edema/swelling and pulmonary edema and, in cases of hyperhypoxia, as severest disorders in the cardiovascular system. The incorporation of the antihypoxant reamberine into an intensive care program for severe acute methadone poisoning was found to result in a rapider reduction of tissue hypoxia, which substantially diminished the degree of occurring complications and improved the clinical course of acute intoxications. Conclusion. Thus, correction of metabolic aftereffects and alleviation of hypoxic lesions result in a reduction in the duration of coma, the length of stay on mechanical ventilation, the rate and severity of secondary pulmonary complications and mortality rates.

Metabolic (cytoprotective) therapy of menopausal disturbances

The paper presents modern views on cardiovascular aspects of menopause and metabolic therapy of menopausal disturbances with meldonium (Mildronate®). The role of estrogen deficiency in climacteric disturbance development, key pathogenetic mechanisms of menopausal metabolic syndrome (MS), and relevant features of arterial hypertension and endothelial dysfunction development are discussed. The data on Mildronate® clinical use for cardiovascular prevention are summarized. The wide prevalence and multiple clinical manifestations of menopausal disturbances point to the need for their complex therapy. Mildronate® therapy is a new approach for systemic correction of metabolic disturbances in women with climacteric symptoms and menopausal MS.

Perioperative Correction of Metabolism in Patients with Lung Cancer

Objective: to reveal the features of perioperative metabolic disturbances in patients with lung cancer after pulmonectomy and a possibility of their correction with perioperative «Standard» formula sipping and with postoperative intravenous cytoflavin. Subjects and methods. The paper presents the results of a prospective randomized study of the efficiency of correction of metabolic disturbances in patients with lung cancer with perioperative enteral «Standard» formula sipping (5 days before surgery and 12 days after surgery). The study was conducted in 326 men aged 36 to 68 years. Arterial blood metabolic parameters (glucose, lactate, and pyruvate) and daily urine urea were estimated. Results. There was an association of preoperative metabolic disturbances with body mass index (BMI). Inclusion of sipping into perioperative therapy did not exert a considerable impact on the cause of postoperative metabolic disturbances. Key words: lung cancer, pul-monectomy, body mass index, sipping, cytoflavin.

Nutritional Support in Children after Cardiosurgical Operations

Objective: to comparatively analyze nutritional support with breast milk, standard adapted and semielementary formulas. Subjects and methods. Three groups of patients aged 3 months to 1 year who had undergone cardiac surgery under extracorporeal circulation were retrospectively studied. The criteria for enteral feeding efficiency were biochemical parameters on postoperative days 1, 2, and 5, weight accretion rates by day 10, rates of flatulence, tubal expulsion or regurgitation, and stools. Results. In Group 2, unlike Group 3, there was no adequate correction of metabolic disturbances by day 5, not only a reduction in the level of total protein and albumin, but also later recovery of hemoglobin and urea levels. Conclusion. Breast milk is not the infant food of choice in the early postoperative period.

Mitigation of Cytokine Storm by Intraoperative Use of Renal Replacement Therapy During Combined Liver-Kidney Transplantation

Background Combined liver-kidney transplantation (CLKT) is a widely used multiorgan transplantation with good graft survival rates. Previous studies have shown beneficial effects of renal replacement therapy in critically ill patients. This observation led us to use intraoperative continuous veno-venous hemofiltration (CVVH) during multiorgan transplantations. Methods We analyzed (CRP) inflammatory response parameters of tumor necrosis factor (TNF)α, interleukin(IL)-6, procalcitonin (PCT) and C-reactive protein (CRP) at various stages of the combined transplantations. Results All patients survived with well-functioning grafts. Mean ± SD follow-up was 32.8 ± 14.2 months. During the whole operation we used intraoperative CVVH starting at the beginning and continuing in the intensive care unit (ICU) afterward (mean ± SD, 11.2 ± 8.4 hours). Intraoperative TNFα, IL-6, CRP, and PCT were measured before surgery, during hepatectomy in the anhepatic phase, before and after liver reperfusion, exactly before kidney reperfusion, after kidney reperfusion, and upon arrival in the ICU. The wash-out of cytokines together with hemodynamic stability gave optimal circumstances for recovery of the transplanted organs. Conclusions CVVH-based therapy offered stable intraoperative parameters, prevention of fluid overload, correction of metabolic disturbances, and wash-out of cytokines, which gave optimal circumstances for recovery of transplanted organs.

Metabolic changers in oxygen transport in patients with diabetes mellitus type 2. Possibilities for correction

Diabetes mellitus type 2 (DM2) - is an independent predictor of development of heart failure (HF). Spiroergometry - is a method for studying blood gas exchange parameters, commonly used for specification of HF. The purpose: 1. To study features of gas exchange at patients with DM2 without cardiovascular diseases in comparison with healthy control. 2. To estimate efficiency of metoprolol for correction of metabolic disturbances in patients with DM2. Materials and methods: 12 patients with DM2, aged 48,4±8, without history of cardiovascular diseases and 15 control subjects, aged 43,6±8 underwent cardio-pulmonary exercise test on treadmill, according to Bruce protocol. Exercise energy, VO2 peak, MET, VE max, VCO2 production were observed. Results: Patients with DM2 had a reduced exercise duration (p

Impact of Intraaortic Therapy on Metabolic Changes in Patients with Peritoneal Sepsis Complicated by Multiple Organ Dysfunction

The study was undertaken to analyze the parameters of metabolism and lipid peroxidation when intraaortic infusion therapy was used in combination with sodium hypochlorite. The time course of changes in lactate and glucose levels, appropriate indices, LPO/AOS parameters shows the preference of a complex of intraaortic therapy in the volume of 50—60 ml/kg/day and daily intraaortic injection of 400—500 ml of 0.06% sodium hypochlorite solution and 800 ml of reamberin to other modes of intraaortic correction of metabolic disturbances.

Anesthesia for pancreas transplantation alone or simultaneous with kidney

Improvements in perioperative care, namely, organ preservation solutions, immunosuppression, and increased experience of surgical, anesthetic, and intensive care teams, have contributed to the success of pancreas transplantation. The objective of this study was to present data on anesthesia for pancreas transplantation alone (PTA) or simultaneous with kidney (SPKT), evaluating crystalloid, albumin and blood component infusions, graft ischemic times, and weights and ages of recipient. We evaluated patients undergoing SPKT ( n = 73), PTA ( n = 49), or SPKT with kidney living donor ( n = 8). Agressive monitoring and therapy were used to avoid hypoperfusion, optimized with intravenous fluids, vasoative drugs, and correction of metabolic disturbances. Three SPKT patients were not extubated at the end of surgery. There were no other complications related to anesthesia in any patient. Although it is a high-risk surgery, PTA or SPKT is routine in our practice. Adequate perioperative care is important not only for the safety of the procedure but also for graft viability, contributing to a promising long-term treatment of insulin-dependent diabetic patients.

Bone Marrow Transplantation for Infantile Malignant Osteopetrosis

Most patients diagnosed with malignant osteopetrosis die during infancy or early childhood from hemorrhage and infection due to bone marrow failure. Allogeneic bone marrow transplantation (BMT) has been reported to provide curative therapy for this disorder. We report our experience with eight patients with malignant osteopetrosis who underwent BMT. Between May 1987 and August 1992, eight children with malignant osteopetrosis underwent allogeneic BMT. Median age at BMT was 9 months (range, 2-36 months). Six patients received marrow from HLA-identical sibling donors, one from phenotypically matched father, and one from a one antigen mismatched father. BMT conditioning for all patients was busulfan 16 mg/kg and cyclophosphamide 200 mg/kg each administered over 4 days. Graft versus host disease (GVHD) prophylaxis included cyclosporin A in six patients or cyclosporin A and methotrexate in two patients. Six patients, including those who received bone marrow from their father's, engrafted as documented by bone marrow biopsy showing an increase in osteoclasts in all cases and by chromosomal analysis in four patients. Two patients died without engraftment. Three out of six patients engrafted are alive and well at the follow-up of 48, 63, and 81 months. Serum calcium, alkaline, and acid phosphatase levels normalized within 2 months. These patients have full bone marrow reconstitution. Serial radiologic studies revealed bone marrow remodelling and a new nonsclerotic bone formation. Vision improved dramatically in the youngest patient. BMT offers cure to patients with malignant osteopetrosis with reconstitution of bone marrow and correction of metabolic disturbances. In our experience, reversibility in neurosensory deficit is possible when BMT is done at an early age.