Cytolysis Syndrome Research Articles

Зміни мікробіоценозу товстої кишки у хворих на неалкогольну жирову хворобу печінки при TORCH-інфекції

Introduction. The results of recent studies investigate the relationship between the formation of metabolic disorders in the body, including non-alcoholic fatty liver disease (NAFLD), and the intestinal microbiocenosis disorder, especially in patients with TORCH infection. The purpose of the study: to investigate the peculiarities of changes in the quantitative and qualitative composition of the colon microflora in patients with NAFLD infected with TORCH infection. Object and research methods. There were examined 72 patients with NAFLD. The patients were divided into two groups: the first group was included the patients with NAFLD who have detected antibodies of the IgG class to TORCH infections group (n=40); The II group was consisted of patients on NAFLD, who has had the test negative for infections of the TORCH group (n=32). All examined patients were undertaken general clinical examinations, as well as determination of the state of the quantitative and qualitative composition of the colon microflora. Research results and their discussion. Analysis results of biochemical blood analysis shows strongly marked detection of syndromes of cytolysis and cholestasis in NAFLD patients infected with pathogens of the TORCH group. The results of the anthropometric study indicate an inaccurate measure of the body mass index (BMI) in the vast majority of examined patients with NAFLD of both groups. At the same time, excess body weight is diagnosed more often in patients with NAFLD infected with pathogens of the TORCH group, while obesity of Class I and II is identified in patients of the II group. Analyzing the degree of severity of dysbiotic changes in patients of the I group the degree of dysbiosis (Ddys) II and III was diagnosed mainly in 47.% and in 30.0% of patients accordingly and dysbiosis of the IV degree was determined in 7.5% of patients, while in the II group patients dysbiosis of the II and I degrees mainly Conclusions. 1. Mainly dysbiosis of the II and III degrees was determined in NAFLD patients infected with pathogens of the TORCH group 47.5% and 30.0% of the examined respectively. 2. A direct dependancy between the severity of cholestatic and cytolytic syndromes and dysbiosis of the II degree in patients with NAFLD infected with pathogens of the TORCH group (r= 0.86; p<0.01 and r= 0.74; p<0, 05 respectively) was identified.

EFFICACY OF COMPREHENSIVE TREATMENT OF NONALCOHOLIC FATTY LIVER DISEASE IN PATIENTS WITH PREDIABETES.

The aim: To evaluate the effectiveness of the proposed treatment recommendations, which included lifestyle changes, as well as the treatment with ursode¬oxycholic acid, rosuvastatin, and omega-3 PUFA, on the severity of cytolytic and cholestatic syndromes in patients with NAFLD and prediabetes. Materials and methods: Fifty-five patients with confirmed prediabetes and concomitant NAFLD underwent a comprehensive clinical examination and were treated with rosuvastatin 10 mg/d, omega-3 PUFA at a dose of 1000 mg/d and ursodeoxycholic acid at a dose of 10 mg/kg/d. Results: The data obtained after 12 months of proposed treatment revealed a statistically significant improvement of indicators of cytolytic syndrome in patients with prediabetes and NAFLD. There was no significant difference between mean values of ALT and AST of treated patients and the corresponding indicators of apparently healthy persons, which confirms the effectiveness of the recommended treatment. Conclusions: Proposed therapy which included recommendations for lifestyle changes and treatment with ursodeoxycholic acid, rosuvastatin and omega-3 PUFA significantly improved hepatic steatosis and cytolytic syndrome in patients with prediabetes and NAFLD.

Возможности использования электрических и вязкоупругих параметров эритроцитов для диагностики стеатогепатита у пациентов с жировой болезнью печени

Aim: to study the possibilities of using electrical and viscoelastic parameters of erythrocytes to differentiate steatohepatitis from liver steatosis. Patients and Methods: 84 men (48.9±2.5 years) with fatty liver disease diagnosed by abdominal ultrasound were examined. Liver fibrosis severity, which did not exceed grade 1, was determined by indirect elastometry on the FibroScan® 502 Echosens device (France), with confirmation using the FibroTest–ActiTest test system (BioPredictive, France). Patients were divided into 2 groups according to the severity of hepatic necroinflammatory activity, assessed using the same test system. Group 1 (n=44) included patients with hepatic steatosis with minimal histologic disease activity (A 0–1); group 2 (n=40) included patients with steatohepatitis with significant necro-inflammatory activity (A 2–3). The electrical and viscoelastic parameters of erythrocytes were determined by dielectrophoresis at 4 frequencies of an inhomogeneous alternating electric field. Results and Discussion: the most significant electrical and viscoelastic indicators allowing to differentiate steatohepatitis from fatty liver disease were reduced values of strain amplitude at a frequency of 1 MHz (p=0.0003), dipole moment (p=0.009), capacity (p=0.014) and cell polarizability at a frequency of 1 MHz (p=0.03) and more high summarized viscosity (p=0.006), rigidity (p=0.005) and electrical conductivity (p=0.008). Diagnostic panel, including a set of electrical and viscoelastic parameters of erythrocytes, for the differentiation of steatohepatitis from steatosis demonstrated the following: AUC 0.904, sensitivity 0.9, specificity 0.83. Correlations of erythrocyte parameters with indicators of cytolysis syndrome (transaminase activity, serum iron levels, direct bilirubin) and serum inflammatory markers (fibrinogen, C-reactive protein, ferritin) were established. Conclusion: the electrical and viscoelastic parameters of erythrocytes studied using the dielectrophoresis should be considered as a new promising method in determining the severity of fatty liver disease. KEYWORDS: fatty liver disease, steatohepatitis, steatosis, electrical and viscoelastic parameters, erythrocytes, dielectrophoresis, diagnostic model. FOR CITATION: Kruchinina M.V., Parulikova M.V., Belkovets A.V., Gromov A.A. Possibilities of using electrical and viscoelastic parameters of erythrocytes for the diagnosis of steatohepatitis in patients with fatty liver disease. Russian Medical Inquiry. 2023;7(5):249–257 (in Russ.). DOI: 10.32364/2587-6821-2023-7-5-2.

HEPATITIS A. THE FEATURES OF DISEASE COURSE IN ADULTS.

The aim: To analyze the incidence of Hepatitis A in Ukraine and Poltava region and to study the clinical and epidemiological features of the course of Hepatitis A in adult patients. Materials and methods: The course of HA in 96 hospitalized patients was analyzed. The diagnosis of HA was established on the basis of clinical and epide¬miological data and confirmed by the results of laboratory studies (serological and molecular biological). Results: In 2019, in the Poltava region, there was an increase in the incidence of Hepatitis A with a predominance among sick people of working age, among the urban population. This part of people aged from 60 to 75 years old constitutes 9.4%. This study showed that the waterway was the dominant way of HA transmission. The course of the disease in most hospitalized patients was typical and cyclic, with a predominance of a mixed variant of the pre-jaundice period and jaundice. One third of patients survey that they had fever, which persisted with jaundice. Conclusions: The findings of this study indicates that the patients older than 40 years were more likely to have concomitant chronic pathology than younger patients, and Hepatitis A was more severe with the development of prolonged cholestasis, wave-like course and recurrence. In most patients under the age of 40, the course of Hepatitis A was mild, but splenomegaly and severe cytolytic syndrome were more common.

DYNAMICS OF THE ACTIVITY OF LIPID PEROXIDATION OF THE LIVER, MANIFESTATIONS OF CYTOLYSIS SYNDROME AND ENDOTOXICOSIS UNDER CONDITIONS OF CLOSED ABDOMINAL TRAUMA COMPLICATED BY INTERNAL BLEEDING

RNAL BLEEDINGAbstract. Traumatism is one of the urgent problems of today. Their structure is dominated by combined and multiple lesions with secondary damage to internal organs and the formation of multi- organ failure. Much more serious consequences arise in the case of direct impact of the traumatic factor on the body cavities. Under the conditions of traumatic damage to the abdomen, there is a direct impact of the impact energy on the internal organs and blood loss. However, until now there are no convincing data to what extent the presence of blood in the peritoneal space can deepen the manifestations of insuffi ciency of the organs of the gastrointestinal tract, in particular, the liver.Goal. To fi nd out the activity of lipid peroxidation in the liver, manifestations of cytolysis syndrome and endotoxicosis under the conditions of closed abdominal trauma complicated by internal bleeding.Material and methods. 132 sexually mature white male Wistar rats were used in the experiments. In experimental group 1, under thiopental sodium narcosis, TTS was simulated. In experimental group 2, external bleeding (20% of circulating blood volume) was additionally induced by transection of the femoral vein. In experimental group 3, also after TTS, bleeding was induced in a similar volume, which was administered intraperitoneally. After 1, 3, 7 and 14 days, the content of reagents to thiobarbituric acid (TBK-active products of POL) was determined in the homogenate of the liver of the experimental rats, in the blood serum – alanine aminotransferase activity (AlAT activity) and the content of the fraction of molecules with an average mass of 280 nm (MSM280). The probability of diff erences was assessed by the non-parametric Mann- Whitney test.The results. Applying only TTZ signifi cantly deepens the processes of lipid peroxidation in the liver, activates the processes of cytolysis and endotoxicosis. The content of TBK-active processes of LPO gradually increases with a maximum after 7 days, AlAT activity and the content of the MSM280 fraction in blood serum reach a maximum by the 3rd day of the experiment, followed by a decrease that does not reach the control level by the 14th day. Applying TT in combination with acute blood loss naturally leads to deepening of the studied processes. Compared with rats that were modeled only with TSH, the content of TBC-active products of LPO, ALT activity, and the content of the MSM fraction in blood serum signifi cantly increased. Comparison of the depth of violations under conditions of blood loss of diff erent origins. showed that the same volume of blood loss with blood fl ow into the intraperitoneal space compared to external blood loss is accompanied by signifi cantly greater violations of the studied indicators.Conclusions. Internal bleeding against the background of TTS, compared to blood loss of a similar volume after external bleeding, causes greater violations of the studied indicators of lipid peroxidation with the maximum manifestation after 3-7 days of the experiment, cytolysis – after 7 days, endotoxicosis – after 7-14 days.

Influence of Placenta Cryoextract on the Liver Metabolic and Functional State in Case of D-Galactosamine Hepatitis

Background. Viral hepatitis is one of the most common and dangerous diseases in the world and is the third most common infectious disease. The development of new, more effective and safer hepatoprotective drugs is an urgent task of biomedicine. A wide range of proven biological properties in cryoextract of human placenta, in particular the presence of antioxidant, immunomodulating and anti-inflammatory effects, suggests that it has a hepatoprotective effect. A model of D-galactosamine toxic hepatitis, which is similar to human viral hepatitis in terms of morphological and biochemical changes in the liver, was chosen for the study. Objective. We are aimed to study the effect of the therapeutic and preventive administration of cryopreserved placenta extract on the metabolic and functional state of the liver in the model of D-galactosamine hepatitis in rats. Methods. The study was conducted on 28 male rats weighing 200–220 g. Hepatitis was simulated by a single intraperitoneal injection of a 20% aqueous solution of D-galactosamine at a dose of 400 mg/kg. The cryoextract was administered in the treatment-prophylactic mode – 1 time per day for 3 days before the administration of D-galactosamine and another 2 days after the administration of the aminosugar (5 administrations in total). Results. The development of experimental D-galactosamine hepatitis in rats leads to the formation of functional and metabolic disorders in the form of the activation of lipid peroxidation processes, a violation of pigment metabolism, a decrease in the protein-synthesizing function and the development of cytolytic syndrome, which were indicated by an increase (p < 0.001) in the level of reactants with thiobarbituric acid in liver homogenates by 2.2 times, an increase (p < 0.001) in the level of total bilirubin by 2.5 times, a decrease (p < 0.001) in the albumin-globulin ratio by 46.8% and an increase (p < 0.001) in the level of alanine-aminotransferases by 2.2 times and the level of aspartate-aminotransferases by 70.3% compared to the values ​​of intact animals. Against the background of the administration of placenta cryoextract in experimental hepatitis, the level of reactants with thiobarbituric acid decreased (p < 0.001) by 43.8%, the level of alanine-aminotransferases decreased (p < 0.001) by 2.4 times, and the level of aspartate-aminotransferases decreased (p < 0.001) by 45.3%; the level of total protein increased (p < 0.01) by 17.4%, and the level of total bilirubin decreased (p < 0.001) by 53.5% compared to the indicators of untreated animals. Conclusions. Administration of cryopreserved placenta extract normalized metabolic processes in the liver and restored its functional state due to antioxidant and membrane-stabilizing effects, which weakened the cytolytic syndrome caused by the administration of D-galactosamine and restored the protein-synthesizing function of the liver. In addition, administration of the specified cryoextract neutralized D-galactosamine-induced hyperbilirubinemia.

Drug-induced liver injury after high-dose methylprednisolone: Clinical case

We present a clinical case of acute hepatitis confirmed by liver biopsy. A 24-year-old patient underwent pulse therapy with methylprednisolone due to the onset of multiple sclerosis. The liver enzyme values were within the normal range 15 days later. Blood tests revealed the development of cytolysis syndrome during an unrelated medical examination two months later. Obvious causes of hepatitis were excluded, and liver biopsy was performed to verify the diagnosis. The biopsy showed a picture of acute hepatitis with high histological activity and development of submassive necrosis. The situation was interpreted as drug-induced liver injury after pulse therapy with methylprednisolone. Oral prednisone therapy was prescribed, and the inflammation and liver injury were reverted. The presented clinical case highlights the importance of follow-up of patients receiving high doses of methylprednisolone.

Cytolytic syndrome in patients with COVID-19

. Identify cytolysis syndrome among patients with COVID-19 and explore the potential relationship between the course of COVID-19 and liver damage. Materials and methods. 450 people with a diagnosis of "U07.1 - Coronavirus infection COVID-19, virus identified" were examined, undergoing and inpatient and outpatient treatment at Tuymazinskaya Central District Hospital. CT scan of the chest organs, biochemical blood test with calculation of ALT, AST, total protein, glucose, total bilirubin, APTT, PTI, INR, fibrinogen were evaluated. Results. The presence of cytolytic syndrome was detected in 217 (48.2%) patients. The ALT level was 60 [23;72] U/L, and the AST level was 45 [22;57] U/L. Between the severity of the course and the ALT level, a direct, strong significant correlation was revealed (ρ=0.724, t=22.26, p>95%). A direct, significant correlation of moderate strength was found between the severity and percentage of lung parenchymal lesions (ρ=0.68, t=19.62, p>95%), AST level (ρ=0.68, t=19.53, p>95%), age of patients (ρ=0.51, t=12.55, p>95%), BMI (ρ=0.4, t=9.44, p>95%). Comparing the degree of damage to the lung parenchyma with the level of AST, a direct, significant correlation of moderate strength (ρ=0.5, t=12.38, p>95%) was revealed, as well as with the level of ALT (ρ=0,5, t=11.98, p>95%), total protein level (ρ=0.38, t=8.8, p>95%), age (ρ=0.35, t=7.85, p>95%. Conclusion. Clinical manifestations of COVID-19 are characterized by polysyndromicity, including a cytolytic syndrome. Changes in liver function parameters found in COVID-19 are associated with the severity of the infection, age and BMI. An important point in the post-COVID rehabilitation of patients is inclusion of hepatoprotectors.

STUDY OF THE EFFECT OF CRYOPRESERVED PLACENTA EXTRACT ON THE PROCESSES OF CYTOLYSIS AND LIPID PEROXIDATION IN CCL4-INDUCED LIVER DAMAGE

Abstract. The search for new strategies for the correction of exogenous toxic liver lesions is due to the steady increase in the incidence of hepatitis and cirrhosis among the working population, which is an important medical and social problem.
 The aim is to determine the effect of cryopreserved placenta extract (CEP) on the state of the liver of rats with tetrachloromethane (CCl4)-induced damage by indicators of lipid peroxidation (LP) and markers of cytolysis.
 Materials and methods. Experimental studies were conducted on 28 male rats. Acute CCl4-induced hepatitis was reproduced by a single injection of 50.0% CCl4 oil solution. KEP was administered 1 time per day for 5 days before the introduction of CCl4. The material for the study was whole blood and liver homogenates, in which the content of reactants with thiobarbituric acid (TBA-RP), catalase activity, superoxide dismutase (SOD) activity, alanine aminotransferase (AlAt) and aspartate aminotransferase (AsAt) activity, as well as γ-glutamyl activity were determined. γ-glutamyl transpeptidases (γ-GTP) and alkaline phosphatase (AP) according to standard methods.
 Results and discussion. The study showed that the content of TBA-RP in liver homogenates was lower (p<0.01) by 35.6% in rats that were prophylactically injected with CEP compared to rats with simulated CCl4-induced hepatitis without treatment (control group). An increase in the level of catalase (p=0.02) with the use of CEP was established by 33.8% and an increase in the activity of SOD (p<0.01) by 45.5% compared to the indicators of rats in the control group. It is also shown that the level of AlAt after administration of CEP decreased (p<0.001) by 56.0%, the level of AsAt decreased (p<0.001) by 48.6%, the level of γ-HTP decreased by 37.8% compared to the rats with untreated CCl4-induced hepatitis.
 Conclusions. Prophylactic five-day administration of CEP leads to the leveling of CCl4-induced LP activation and signs of cytolysis syndrome.

The Prevalence of Liver Cytolysis in Children with Helicobacter pylori Infection.

(1) Background: The relationship between Helicobacter pylori (H. pylori) infection and liver disease has been discussed for many years, but the association between the infection and liver cytolysis in children has been insufficiently explored. In our study, we evaluate this relationship in a pediatric population from the northeast of Romania. (2) Methods: A retrospective study of children with H. pylori infection and liver cytolysis was conducted on a group of 1757 children, admitted to a pediatric gastroenterology regional center in northeast Romania over 3 years. (3) Results: Liver cytolysis syndrome was present in 112 children of both sexes. Of the 112 children, 20 children (17.9%) also had H. pylori infection. In the statistical analysis, we noted a significant association between liver cytolysis syndrome and H. pylori infection (χ2; p < 0.001). (4) Conclusions: This relationship requires further in-depth studies that also consider certain parameters that may influence the results of these correlations. In addition, we point out the need for further analyses evaluating, in terms of the histopathological changes in each liver disease, the efficacy of H. pylori eradication.

Informativeness of biochemical markers of connective tissue metabolism in canine babesiosis

The aim: to analyze the diagnostic informativeness of biochemical markers of connective tissue in the blood of dogs with babesiosis.&#x0D; Materials and methods. German Shepherd (n=7), Labrador Retriever (n=3) and Rottweiler (n=2) dogs aged 1 to 5 years and diagnosed with babesiosis were studied. As a control group, clinically healthy dogs were used, which came to the veterinary clinic for a preventive examination, the age of the animals was from 1 to 5 years (n=10). The animals were examined according to the following scheme: collection of anamnestic data, clinical examination according to generally accepted methods, general and biochemical blood analysis, urine examination. Glycoproteins in blood serum were determined according to Shteinberg – Dotsenko, sialic acids – according to the Hess method, chondroitin sulfates – Nemeth–Csoka in the modification of L.I. Slutsky.&#x0D; Results. The biochemical examination of the blood revealed the presence of acute cytolytic syndrome and cholestasis in the animal's body. Cholestasis in sick animals was characterized by an increase in the content of bilirubin and the activity of alkaline phosphatase, as well as an increase in the content of β-lipoproteins. The increase in the content of total bilirubin in the blood was obviously due mainly to its unconjugated fraction, since intravascular hemolysis took place. In the blood serum of patients with babesiosis in dogs, there was an increase in the content of markers of connective tissue metabolism – glycoproteins by 1.63, sialic acids – by 1.36, and chondroitin sulfates by 1.8 times, respectively.&#x0D; Conclusions. Glycoproteins have "acute phase proteins" in their composition, which are indicators for assessing the degree of the inflammatory process in the body of dogs with babesiosis. Sialic acids are components of sialoproteins, which are also markers of the inflammatory process and destructive changes in the body. An increase in the content of chondroitin sulfates in the blood during babesiosis indicates the development of a compensatory reaction, associated with the action of toxic hemolysis products on the endothelium of blood vessels. Thus, the increased content of biochemical markers of connective tissue in the blood of dogs with babesiosis indicates the presence of a systemic inflammatory-protective reaction in animals, which makes it possible to recommend them for assessing the acute phase of the inflammatory process in the body and protecting blood vessels from damage due to toxic hemolysis

Liver pathology in COVID-19

СOVID-19 is a systemic disease with dysfunction of the immune system and damage to internal organs, including the liver. The purpose of the study is to fnd out the impact of the SARS-CoV-2 virus on the liver, the possibility of its recovery after a coronavirus infection. We examined 112 patients with a positive test for COVID-19. А clinical examination, clinical and biochemical blood tests, computed tomography of the chest, pulse oximetry, ultrasound examination of the abdomen were performed. All patients were divided into two groups based on the presence or the absence of cytolytic syndrome. It was found that liver pathology was detected in 48.2% of patients. These changes were accompanied by statistically signifcant lower levels of oxygen in the blood and a greater amount of damage to the lung tissue, disorders of the platelet germ of hematopoiesis. Three months after a coronavirus infection with liver damage, a third of patients had cytolysis syndrome. The use of ademetionine at a dose of 800–1600 mg per day led to the elimination of clinical symptoms, normalization of the liver.Conclusion. Liver damage during coronavirus infection was common and had a hepatocellular nature, accompanied by hypoxia, increased lung tissue damage and changes in platelet count. Patients need to be examined to identify the presence of liver pathology, treatment of disorders using ademetionine.

Clinical-epidemiologic and serologic characteristics of Lyme disease in the Zaporizhzhia region (a retrospective analysis for 2015–2019 according to the Municipal Institution “Regional Infectious Hospital” of Zaporizhzhia Regional Council)

The aim of the work is to clarify the clinical and laboratory features of Lyme disease in the Zaporizhzhia region on the basis of a retrospective clinical, epidemiological and serological analysis of this disease cases in the period from 2015 to 2019. Materials and methods. A retrospective analysis of 62 medical cards of stationary patients with Lyme disease for the period from 2015 to 2019 was carried out. The age of the patients ranged from 18 to 79 years. There were 38 men and 24 women. All the patients were given a traditional complex clinical-laboratory examination; ELISA was used to defined serum IgM and IgG to Borrelia burgdorferi. Results. According to the study results it was found that Lyme disease in the Zaporizhzhia region had a clear seasonal prevalence in summer (56.5 %) and spring (25.8 %). The vast majority of patients (80.6 %) clearly indicated the tick bite. The disease was mostly acute (90.3 %) with a predominance of erythema (94.6 %). In the acute course of the disease, patients were seropositive in 75.0 % of cases with simultaneous detection of both IgM and IgG to Borrelia burgdorferi, and positive IgM in the absence of IgG. Seronegative 25.0 % of patients required clear clinical and epidemiological data to confirm the diagnosis. Under prolonged and chronic conditions, patients had positive IgG to Borrelia burgdorferi (100 %) and IgM (50.0 %). Certain clinical and laboratory features at different course of Lyme disease were revealed. So, the acute course was characterized by the predominance of erythema (94.6 %), mild or no manifestations of general intoxication syndrome, lack of pathological changes in the hemogram in most patients (80.4 %). In the prolonged and chronic course, there was no history of erythema, clinical symptoms were polymorphic, half of the patients had increased erythrocyte sedimentation rate in the absence of changes in blood count, mild cytolytic syndrome and hyperbilirubinemia. Conclusions. As a result of the retrospective analysis of Lyme disease cases in the period from 2015 to 2019, certain patterns of epidemiological, clinical and serological changes in different courses of this infection in the Zaporizhzhia region were revealed, namely the clear seasonality of the disease, in the acute course – the predominance of erythema and different variants of serological profile in patients, and in prolonged and chronic course – polymorphism of all clinical symptoms and no history of erythema.

Hemophagocytic syndrome associated with leishmaniasis: case report

Secondary hemophagocytic syndrome (sHLH) is a hyperinflammatory reaction which manifests with fever, cytopenia and organ damage. possible causes of sHLH include leishmaniasis. The article describes a clinical case of sHLH in patient with visceral leishmaniasis. A female 30 years old developed hectic daily fever up to 40 °C, pancytopenia, cytolytic syndrome, hyperferritin- and hypertriglyceridemia, immunoglobulin G to capsid antigens of the Epstein-Barr virus, enlarged liver and spleen a one and a half month after returning from Spain. based on the HLH-2004 and H-Score criteria, a sHLH was diagnosed, presumably associated with the Epstein-Barr virus. Immunosuppressive treatment with dexamethasone, cyclosporin-A and etoposide was started under the HLH-2004 program. Apyrexia, reduction of splenomegaly and resolution of cytolysis were achieved. The fever resumed 20 days after the start of chemotherapy, the spleen enlarged again, and therefore a diagnostic splenectomy was performed. Morphological analysis of the removed spleen revealed leishmania. After amphotericin-B therapy, the patient recovered. Chemotherapy of sHLH led to a temporary improvement for a period sufficient to verify the diagnosis and conducting of successful treatment.

A clinical case of Streptococcus equi subsp. ruminatorum infection in a 9-year-old child

Streptococcus equi subsp. ruminatorum is a zoonotic disease that can cause serious morbidity in immunocompromised people. The first case of infection in human was described in 2007. We describe a case of infection in a 9-year-old child with a history of liver transplantation, who was hospitalized for differential diagnosis of high fever on continuous immunosuppressive therapy with Tacrolimus. The examination revealed an increase in the level of systemic inflammatory response markers, cholestasis and cytolysis syndrome markers, which indicated cholangitis. Acute graft rejection was excluded. Streptococcus. equi subsp. ruminatorum was identified in the patient’s blood cultures, which made it possible to diagnose a generalized zoonotic infection (the child was often in contact with horses) with a possible focus in the bile ducts, which required antibiotic therapy in combination with short-term, within 1 day, withdrawal and then a lower dose of immunosuppressive therapy (temporary adjustment of tacrolimus dosage). During the treatment, clinical and laboratory signs of the infectious process improved, and the functional state of the liver graft normalized. Therapy was stopped after negative blood cultures were obtained. This case confirms that S. equi subsp. ruminatorum can cause human disease. We emphasize the utility of molecular biological tests and MALDI-TOF mass spectrometry to be performed in patients with infections caused by group C streptococci.

Comparative Assessment of Isolated Liver Chemoperfusion Techniques

Background. Metastatic liver injury is a distinct oncological problem, irrespective of primary malignancy. Resection surgery is not always feasible in such patients. Isolated liver chemoperfusion is a promising treatment option in multiple small-focal metastatic organic lesions. This technique is technically complex, which limits its broader evaluation and adoption in clinical practice. The diversity of isolated liver chemoperfusion techniques does not allow an adequate assessment of world experience and requires further research. The important considerations with introducing isolated liver chemoperfusion are: an optimal surgical technique, liver isolation control method, as well as physiological arterial and portal blood flow maintenance.Materials and methods. A total of 21 patients were surveyed over June 2020 — December 2021. The patients were divided into 3 prospective cohorts: A) arteriocaval chemoperfusion, midline laparotomy access, technical-guided liver isolation, B) arteriocaval chemoperfusion, “in J laparotomy” access, ICG-guided liver isolation, C) arterio-porto-caval chemoperfusion, “in J laparotomy” access, ICG-guided liver isolation. A procedure’s tolerance was assessed with: the duration of surgery, postoperative ICU bed-days, total postoperative bed-days, hepatic cytolysis rates, chemotherapy side-effects severity.Results and discussion. The duration of surgery shortened with “in J laparotomy”. Haemotoxicity did not differ between cohorts A and B, albeit appearing significantly lower in cohort C. The cytolytic syndrome duration statistically significantly reduced in C vs. A and B cohorts.Conclusion. All the isolated liver chemoperfusion techniques employed are patient-safe. In ICG-guided liver isolation, the agent leakage into systemic blood flow is less likely, indicating a lower haemotoxicity. Arterioportal isolated chemoperfusion is more physiological compared to other techniques, thus facilitating lower hepatotoxicity. The use of “in J laparotomy” significantly reduces liver mobilisation and vascular cannulation times.

Contribution of Endoscopic Ultrasound (EUS) in Biliopancreatic Pathology: Experience of the Hepato Gastroenterology Moroccan Department

Introduction: Endoscopic ultrasound (EUS) is a method of exploration in gastroenterology, it combines ultrasound and endoscopy for the examination of the digestive tract and nearby structures. It is an ultrasound technique that allows the use of high-definition ultrasound transducers. Materials and methods: It is a descriptive retrospective study covering a period of 34 months, from 01/2019 to 10/2021. It concerned 100 patients who had endoscopic ultrasound for biliopancreatic pathology, in the and the university hospital Sheikh Khalifa. We noted the demographic, clinical and morphological data, such as transcutaneous ultrasound, abdominal CT scan and MRI as well as the EUS. The results of the EUS were compared with the imaging and histology data when performed. We were therefore able to evaluate the reliability of each examination and thus its strong and weak points. Results: The average age of our patients was 58 years, with a sex ratio: 1.05. The symptomatology was dominated by abdominal pain and jaundice, the biology by cytolysis and biological cholestasis syndrome. We noted a predominance of tumor pathology with 42% followed by inflammatory pathology: acute pancreatitis as part of the etiological assessment. The reliability of EUS in the diagnosis of pancreatic cancer is 88% with a reliability of abdominal CT of 68%. Our study also allowed us to evaluate with precision the reliability of detection of lymph node and vascular invasion of biliopancreatic cancers, which was 88%. We also noted other pathologies for which EUS was a good diagnostic tool, main bile duct stones but also cystic lesions of the pancreas. Conclusion: In view of the comparative study of these results with the other types of explorations, of which the EUS, proved to be more effective in the exploration of the pancreatic region especially in for the assessment of tumor extension and diagnosis of choledocholithiasis and characterization of cystic lesions. The EUS has a therapeutic interest ....

ANALYSIS OF RISK FACTORS AND CLINICAL AND PARACLINICAL MANIFESTATIONS OF GASTROINTESTINAL DYSFUNCTION IN NEWBORNS IN PERINATAL PATHOLOGY

In recent decades, there has been a worldwide trend toward increasing rates of functional and organic pathology of the gastrointestinal (GI) tract in children. Presently, diseases of digestive organs rank second in frequency among pathologies of the pediatric population after acute respiratory diseases. Development of functional disorders of the gastrointestinal tract in children in the first year of life is mainly caused by anatomic and physiological characteristics of the digestive system, as well as high sensitivity and ease of damage of all its parts. Current literature suggests that children born to mothers during difficult pregnancy or childbirth are at increased risk for developing this pathology.Objective of the study: To determine perinatal risk factors and clinical and paraclinical features of gastrointestinal functional disorders in newborns with perinatal pathology.Materials and methods. The study enrolled 82 full-term infants with severe perinatal pathology, with clinical manifestations of gastrointestinal dysfunction (Group I), and 50 healthy infants (Group II) as a comparison group. Exclusion criteria for the study were: congenital malformations, low birth weight, clinical manifestations of infection. To assess metabolic disorders, a comprehensive assessment of the biochemical blood spectrum with the level of total protein and albumin, total bilirubin and its fractions, glucose, urea and uric acid, cholesterol and triglycerides; activity of AlAT, AsAT, LDH, LF, GGTP. Biochemical studies were performed using a Cormay ACCENT biochemical analyzer (Poland, Cormay reagents).Results and discussion. Disorders of postnatal adaptation of newborns are noted in the conditions of mothers’ somatic disadvantages, implementation of unfavorable factors during pregnancy and labor. Analysis of somatic anamnesis, antenatal and intrapartum problems has made it possible to identify the main causes of neonatal adaptation disorders in the early neonatal period. The most important, taking into account maternal anamneses, in the patients of the main group were: cardiovascular system pathology in 30 (36, 59%) cases, urinary system pathology in 22 (26, 83%) cases, endocrine system pathology in 17 (20, 73%) cases, digestive system pathology in 11 (13, 41%) cases, and respiratory system pathology in 8 (9, 76%) cases; gynecological pathology was diagnosed in 16 (19, 51%). The antenatal period was complicated by: placental dysfunction in 10 (12.20%) cases, hydramnios in 8 (9.76%) cases, fetal distress in 10 (12.20%) cases, and cord entanglement around the neck in 5 (6.10%) cases. Overall, there were 14 (17.07%) cases with a poor obstetric history. Caesarean section was performed in 24 (29.27%) cases, vacuum-assisted delivery in 4 (4.88%) cases.The list of diseases responsible for the severity of the newborn's condition was presented according to the main diagnosis: 66 (80.5%) cases had central nervous system involvement in the form of hypoxic-ischemic lesion/neonatal encephalopathy, 27 (32.9%) cases had severe respiratory distress, 13 (15.9%) cases had moderate asphyxia and 11 (13.4%) cases had severe asphyxia, 10 (12.2%) cases had moderate respiratory distress and 2 (2.4%) cases had hemolytic disease in newborn. All patients of the main group also had concomitant diagnoses. The condition of the main group neonates was characterized by more severe somatic and neurological status disorders, formation of MOD syndrome with the development of signs of food intolerance due to complex disorders of the gastrointestinal system. Complex disorders of food tolerance were observed in 71 (86,59%) children, regurgitation/stasis - in 66 (80,49%) neonates, paresis/weak intestinal peristalsis - in 47 (57,32%) patients, flatus - in 3 (3,66%) cases, meconium retention - in 3 (3.66%) cases, isolated absence of sucking reflex/ wobbly sucking was found in 3 (3.66%) cases, enlargement of liver and spleen - in 1 (1.22%) patient. The complex of serum biochemical studies showed significant dysmetabolic changes, which to some extent explain the pathophysiological mechanisms of gastrointestinal dysfunction. In particular, revealed violations of protein-synthetic function of the liver and delays in the production and excretion of bile, enzyme deficiency and cytolytic syndrome.Conclusions. Disorders of the digestive system in newborns is one of the manifestations of general body dysfunction in conditions of hypoxia with the implementation of unfavorable factors of pregnancy and childbirth in the mother.Clinical signs of food intolerance in newborn infants are regurgitation/stasis, paresis/weak intestinal peristalsis, flatus, meconium retention, absence of sucking reflex/wobbly sucking, enlarged liver and spleen.Complex serum biochemical studies in newborns with gastrointestinal disorders showed impaired protein-synthetic liver function, delayed production and excretion of bile, enzymatic insufficiency and cytolytic syndrome.

Association of autoimmune hepatobiliary pathology with inflammatory bowel diseases in children

Introduction. Hepatobiliary pathology (HBP) occurs in approximately 30% of patients with inflammatory bowel disease (IBD). However, the features of its course in the pediatric cohort of patients remain insufficiently studied. Purpose: to study the features of the course of autoimmune forms of HBD in children with IBD. Materials and methods. A comprehensive clinical, laboratory and instrumental examination was carried out in 84 children with autoimmune forms of HBP in combination with IBD (HBP+IBD), which made up the main group, and 79 patients with isolated forms of IBD included in the comparison group. Results. The prevalence of autoimmune HBP in IBD children was 10.2%. Primary sclerosing cholangitis (PSC) was diagnosed in 64.3% of cases, which was mainly associated with ulcerative colitis. The incidence of autoimmune hepatitis (AIH) was 8.3%. In the structure of the overlap syndrome, the most frequent combination was AIH+PSC (15.5%). The debut of the disease was manifested by diarrhea, abdominal pain syndrome, cytolysis and cholestasis syndromes, haemicolitis. With HBP+IBD, there was an increase in serum concentrations of alanine (ALT) and aspartate aminotransferases (AST), total protein, γ-glutamyl transferase (GGT), alkaline phosphatase, direct bilirubin and IgG. Approximately with the same frequency in PSC, antibodies to saccharomycetes (ASCA) - 80% and antibodies to the cytoplasm of neutrophils (ANCA) - 75% were detected. In AIH, antinuclear antibodies (ANA) and antibodies to liver and kidney microsomes (anti-LKM1) were detected in 100%. HBP-IBD equally (28.6%) revealed moderate fibrosis and cirrhosis, no fibrosis in 20.6%, moderate fibrosis in 15.9% of cases, mild fibrosis in 6,3%. Cirrhosis of the liver in 55.6% of cases was the outcome of the course of PSC, in 16.7% - AIH, in 27.8% was associated with the course of the overlap syndrome. Conclusion. Various forms of autoimmune HBP occur in 10.2% of cases, are more often associated with UC, are represented by PSC and AIH, occur in males, at the onset signs are clinically presented by diarrhea, abdominal pain syndrome, cytolysis and cholestasis syndromes, and haemicolitis.

Pregnancy and COVID-19 - liver damage.

This review examines information from systematic reviews and meta-analyses, research studies, and case reports to present current knowledge about liver damage in pregnant patients having Covid-19 during pregnancy. Problems with diagnosis and differential diagnosis are examined in the context of the need to rule out other causes of liver dysfunction, including pregnancy-related liver disease. In this paper we give an overview of COVID-19 liver problems during pregnancy. Mechanisms of liver involvement in COVID-19 infection are being examined. An overview of the assessment of abnormal liver biological syndromes in pregnant patients is provided. Differential diagnostic algorithms for primary liver damage established in a pregnant woman in the context of the Covid-19 pandemic are presented. Challenges in diagnosis and etiology assessment methods and customized management options are described. The management of pregnant women with hepatic dysfunction onset on the Covid-19 background and subsequently aggravated is discussed. The importance of anticoagulant therapy as an essential measure of symptomatic management of Covid-19 in pregnant women is emphasized, as both pregnancy and COVID-19 are thrombogenic. Hypercoagulability appears to adversely affect the pregnant women liver with Covid-19 and post Covid-19 and anticoagulant therapy has benefits in the management of liver damage associated with Covid-19. The COVID-19 liver problems in a 33-year-old woman who was not vaccinated for Covid-19, without a history of chronic liver disease, was tested positive for Covid-19 at 33 weeks of gestation is discussed. The report of the diagnostics, differential diagnosis, and management questions in the context of liver dysfunction manifested by a significant increase in alanine aminotransferase cytolysis syndrome. The positive effect of anticoagulant therapy in resolving cytolytic syndrome is emphasized. The good maternal and perinatal result is also mentioned.