Development Of Chronic Pathology Research Articles

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Abstract. Recent pandemic caused by the SARS-CoV-2 virus has united researchers from all over the world. However, despite their efforts, many questions remain unsolved: how the immune system is effective against this viral infection, how long the immunity persists in convalescents, what are the consequences of the disease. The inflammatory process, which is based on multicomponent immunological disorders, is one of the leading pathogenetic links of the disease caused by the SARS-Cov-2 virus. In this regard, a precise study of the immune status peculiarities in patients � convalescents after COVID-19 and their possible role in the further development of chronic pathology are relevant. The aim of the work is to investigate peculiarities of immune disorders in convalescents after acute respiratory disease COVID-19 in relation to the severity of the disease and the timing of the examination after the acute period. Methods. We examined 91 convalescents after COVID-19, aged 21-67 years, treated as inpatients during the acute period of the disease. After the acute period these patients received a course of rehabilitation treatment in the Government Institution �The Scientific-Practical Medical Centre �Rehabilitation��. For comparison, a group of 45 patients with bacterial community-acquired pneumonia of medium severity were examined. As a control for laboratory indices, 24 practically healthy persons were examined. Cytokine status was studied by determining the levels of pro- and anti-inflammatory cytokines using immunoenzymatic method. Non-specific resistance was investigated on the base of phagocytic activity and phagocytic number of monocytes. Indicators of cellular immunity were evaluated using an indirect immunofluorescence reaction using monoclonal antibodies (CD3+, CD22+, CD4+, CD8+, CD16+) and on this basis index values were calculated that characterize the relationships of the studied subpopulations. When analyzing these data, the severity of the COVID-19 and the time of examination after the acute period of the disease were taken into account. Results. At the beginning of the course of recovery treatment, a pronounced imbalance in the ratio of pro- and anti-inflammatory cytokines with a significant predominance of the first one, was revealed. These changes can contribute to the persistence of the inflammatory process with further formation of the chronic pathology. This imbalance did not depend significantly on the severity of COVID-19, persisted for a long time and was 1.9 times more pronounced than in bacterial community-acquired pneumonia. In the period of convalescence, suppression of the monocytes� phagocytic activity and significant changes in the T-cells link of immunity were also revealed. It should be noted that disorders of cellular immunity depended on the severity of COVID-19 and were most pronounced in patients with its severe course. These changes persisted for a long time (examinations were carried out 2-3 weeks and 2-3 months after the acute period), which determines the need for recovery treatment during the convalescence period. Conclusions. 1. In convalescents after acute respiratory disease caused by the SARS-CoV-2 virus, certain disturbances of the immune status remain, which significantly affect the functional state of the organism as a whole and may be the basis for a persistent inflammatory process and the development of chronic pathology in the future. 2. Immune defense of convalescents after COVID-19 is characterized by a significant decrease in non-specific protection indices and the cellular link of immunity with manifestations of cytokine imbalance and these changes persist for a long time, which can contribute to the formation of post-COVID syndrome. 3. The obtained data serve as a pathogenetic basis for carrying out complex immunorehabilitation measures in convalescents after COVID-19 in order to recover the normal functioning of immune system, correcting protective reserves of the organism and preventing the development of chronic pathology. Key words: COVID-19, cytokine status, non-specific defense, cellular immunity

Difficulties in monitoring of premature infants in outpatient facilities (third stage of nursing)

Premature birth remains an urgent problem of modern healthcare around the world. At the same time, the improvement of neonatal care for premature babies has led to a significant decrease in infant mortality and an increase in the survival rate of children with very low and extremely low body weight. Nursing and monitoring such children requires a special approach. A premature baby has one or more reasons for the early development of chronic pathology and needs a long-term, differentiated, continuous monitoring, provided a clear continuity of all stages of nursing.The article presents the results of observation of premature babies in 20 polyclinics of Saint Petersburg in the first year of life at the time of the study. The authors analyzed medical histories (form 112/y) of 88 children born prematurely (from 22 to 36 weeks of gestation). It has been determined that most often the dispensary observation groups include children with pathology of the central nervous system, organs of vision, and surgical pathology. Insufficient coverage with vaccine prophylaxis (from 33 to 78% for various vaccine-preventable infections) was revealed not only with additional drugs for the risk group, but also with the main vaccinations of the National Calendar. Monitoring premature babies, their rehabilitation and habilitation are the responsibility of the third (outpatient) level of nursing. However, the lack of uniform approaches to dispensary observation, rehabilitation treatment of premature babies, the lack of clear routing create difficulties in the management of such children in a polyclinic. The authors proposed options for solving this important problem in order to increase the efficiency of the primary pediatric care for premature babies at the place of residence of the child.

Study of the Stages of Cardiorehabilitation in Patients with Acute Coronary Syndrome

According to Russian clinical guidelines, there are three main stages of cardiorehabilitation associated with the periodization of the disease. Acute coronary syndrome is one of the most dangerous conditions in the world of modern cardiology, after which patients are at high risk of the appearance and development of chronic pathologies, in particular the development of type 2 diabetes mellitus. According to the latest data, there was a statistically significant increase in the number of new cases of diabetes mellitus after an episode of acute coronary syndrome. Doctors should provide high-quality assistance in the rehabilitation of patients after acute coronary syndrome, especially at the last stage of cardiorehabilitation, which is carried out in outpatient settings.

The role of hypoxia-inducible factors in the development of chronic pathology

This review highlights the current understanding of hypoxia-inducible factors (HIFs) role as regulators of oxygen-dependent reactions and inducers of genes expression in human organism. The focus is on the most significant relationships between the activation or inhibition of the HIFs intracellular system and development of the inflammatory process in various organs, chronic diseases of gastrointestinal tract, osteoarticular system, kidneys as well as hematological, endocrine and metabolic disorders.

TREATMENT OF ODONTOGENIC INFLAMMATORY DISEASES IN FREQUENTLY ILL CHILDREN

Epidemiological studies indicate that, on average, every child suffers from 3 to 5 episodes of acute respiratory viral infectious diseases (ARVI) per year. The greatest incidence of acute respiratory infections is observed in young children, preschoolers and primary school children. Children of the first 3 years of life get SARS within a year 2-2. 5 times more often than children aged 10 years and older. Recurrent respiratory infections lead to violations of the functional state of the body, can cause a breakdown of adaptation and cause the development of chronic pathology [Klyuchnikov S. O. with savt., 2017].

Long-term neuropsychiatric outcomes of deeply premature infants, prospects for diagnosis and correction

Objective: to study long-term neuropsychiatric outcomes in deeply premature infants with neonatal complications Material and methods . The authors analyzed long-term neuropsychiatric outcomes during a three-year follow-up of 97 children born with a weight less than a 1000g in the department of catamnesis of premature children. Results. The authors found the following predictors of the development of chronic pathology in a premature children: extremely low body weight at birth, long-term (more than 30 days after birth) use of additional oxygen, intraventricular hemorrhages of 3—4 degree and periventricular leukomalacia, the formation of broncho-pulmonary dysplasia in combination with low rates of physical (less than 10 centiles) and psychomotor development by 12 months of corrected age. The most significant factors that have a protective effect on the brain include: breastfeeding, protective regimen, developmental techniques, minimization of post-neonatal infection, prevention of broncho-pulmonary dysplasia. Conclusion. The study of the health of deeply premature children during their first three and even more years of life is necessary to develop measures to improve antenatal, obstetric and neonatal care in order to increase survival and reduce disability among premature babies.

APOCYNIN, AN INHIBITOR OF THE NADPH OXIDASE COMPLEX

Apocynin is a phenolic compound isolated from the plant Picrorhiza kurroa Royle ex Benth. Such a compound has been extensively investigated for its therapeutic potential in diseases involving inflammatory processes or oxidative stress due to its ability to inhibit the NADPH oxidase multienzyme complex. This complex consists of two transmembrane proteins (Nox2 and p22phox) and four cytosolic regulatory proteins (p67phox, p47phox, p40phox, and GTPase-Rac) and their activation occurs after the stimulation of phagocytic cells by the mediation of the enzyme myeloperoxidase (MPO). NADPH oxidase is the only enzyme complex that is intended for the production of superoxide anion that is precursor of highly oxidizing substances classified as reactive oxygen species (ROS). NADPH oxidase is an enzyme complex that produces superoxide anion from molecular oxygen. Ta the same time, the superoxide anion is a precursor to reactive oxygen species (ROS) catalyzed by enzymes.These oxidative species, when in excess, can induce burst, causing irreparable tissue damage. They can act by modifying the redox state of DNA, protein or lipid molecules, playing a central role in the development of chronic pathologies and various health complications. One can cite vascular problems, hyperglycemia, diabetes, hypertension, Alzheimer's disease, and cancer, among others. Apocynin, previously activated by MPO, blocks the enzyme complex and prevents the formation of these oxidative species. Therefore, the central biological function of compound is to modulate the action of NADPH oxidase, promoting a positive effect in the prevention/remediation of inflammatory diseases.

HYGIENIC CONDITIONS OF SUPPLEMENTARY EDUCATIONAL ORGANIZATIONS AND HEALTH OF CHILDREN

The aim: hygienic assessment of the conditions of stay and the study of the health status of children attending supplementary educational organizations (SEO). Methods: We performed comprehensive sanitary and hygienic examination of SEO and analysed children's health using the data from the "Children's Medical Records for Educational Institutions" (registration form 026 / у-2000). Incidence, prevalence and structure of chronic pathology as well as anthropometric characteristics were studied using the centile method based on regional standards. Results. The proportion of children with frequent acute diseases was lower among children attending SEO than among schoolchildren without additional educational load: 34.4% vs. 15.6% in group 1(p = 0,015); 12,5 % - in the 2nd (рх2 = 0,004); 10,9 % in the 3rd group (рх2 = 0,002). Better health indicators among children visiting SEO were observed. We found statistically significant differences in the proportion of schoolchildren caliber without deviations in physical development, in the prevalence of chronic pathology, as well as in the number of children belonging to the first and the second health groups. Correlation analysis showed the presence of significant associations between the number of SEO visitors and the number of chronic diseases in a child, as well as inverse correlation between the level of the dynamic component in the classes and the formation of chronic pathology. Conclusions. We observed an effect of the number of SEO visitors and the feedback effect of the level of the dynamic component in the study structure on the development of chronic pathology in children (the proportion of the variance of the studied parameters was 2-4 %).

Parenteral vaccination protects against transcervical infection with Chlamydia trachomatis and generate tissue-resident T cells post-challenge

The optimal protective immunity against Chlamydia trachomatis (C.t.) is still not fully resolved. One of the unresolved issues concerns the importance of resident immunity, since a recent study showed that optimal protection against a transcervical (TC) infection required genital tissue-resident memory T cells. An important question in the Chlamydia field is therefore if a parenteral vaccine strategy, inducing only circulating immunity primed at a nonmucosal site, should be pursued by Chlamydia vaccine developers. To address this question we studied the protective efficacy of a parenteral Chlamydia vaccine, formulated in the Th1/Th17 T cell-inducing adjuvant CAF01. We found that a parenteral vaccination induced significant protection against a TC infection and against development of chronic pathology. Protection correlated with rapid recruitment of Th1/Th17 T cells to the genital tract (GT), which efficiently prevented infection-driven generation of low quality Th1 or Th17 T cells, and instead maintained a pool of high quality multifunctional Th1/Th17 T cells in the GT throughout the infection. After clearance of the infection, a pool of these cells settled in the GT as tissue-resident Th1 and Th17 cells expressing CD69 but not CD103, CD49d, or CCR7, where they responded rapidly to a reinfection. These results show that a nonmucosal parenteral strategy inducing Th1 and Th17 T cells mediates protection against both infection with C.t. as well as development of chronic pathology, and lead to post-challenge protective tissue-resident memory immunity in the genital tract.

Human filarial Wolbachia lipopeptide directly activates human neutrophils in vitro.

The host inflammatory response to the Onchocerca volvulus endosymbiont, Wolbachia, is a major contributing factor in the development of chronic pathology in humans (onchocerciasis/river blindness). Recently, the toll-like pattern recognition receptor motif of the major inflammatory ligands of filarial Wolbachia, membrane-associated diacylated lipoproteins, was functionally defined in murine models of pathology, including mediation of neutrophil recruitment to the cornea. However, the extent to which human neutrophils can be activated in response to this Wolbachia pattern recognition motif is not known. Therefore, the responses of purified peripheral blood human neutrophils to a synthetic N-terminal diacylated lipopeptide (WoLP) of filarial Wolbachia peptidoglycan-associated lipoprotein (PAL) were characterized. WoLP exposure led to a dose-dependent activation of healthy, human neutrophils that included gross morphological alterations and modulation of surface expressed integrins involved in tethering, rolling and extravasation. WoLP exposure induced chemotaxis but not chemokinesis of neutrophils, and secretion of the major neutrophil chemokine, interleukin 8. WoLP also induced and primed the respiratory burst, and enhanced neutrophil survival by delay of apoptosis. These results indicate that the major inflammatory motif of filarial Wolbachia lipoproteins directly activates human neutrophils in vitro and promotes a molecular pathway by which human neutrophils are recruited to sites of Onchocerca parasitism.

Chagas disease: still many unsolved issues.

Over the past 20 years, the immune effector mechanisms involved in the control of Trypanosoma cruzi, as well as the receptors participating in parasite recognition by cells of the innate immune system, have been largely described. However, the main questions on the physiopathology of Chagas disease remain unanswered: “Why does the host immune system fail to provide sterile immunity?” and “Why do only a proportion of infected individuals develop chronic pathology?” In this review, we describe the mechanisms proposed to explain the inability of the immune system to eradicate the parasite and the elements that allow the development of chronic heart disease. Moreover, we discuss the possibility that the inability of infected cardiomyocytes to sense intracellular T. cruzi contributes to parasite persistence in the heart and the development of chronic pathology.

Trypanosoma cruzi culture used as vaccine to prevent chronic Chagas' disease in mice.

The development of chronic pathology in mice at 2 to 10 months after inoculation of 10(2) T. cruzi trypomastigotes can be prevented by preimmunization with live, attenuated culture parasites (strain TCC). Swiss mice received one or three immunizing inoculations of 10(6) TCC organisms and were challenged with 10(2) Tulahuén blood trypomastigotes. Control groups received only the immunizing or the challenge inoculations. Immunized groups as compared with nonimmunized controls had lower mortality rates at 2 months postchallenge (9% versus 23%; P = 0.059), lower early peaks of parasitemia, lower percentages of positive xenodiagnoses at 5.5 months (40 versus 80%; P = 0.061), and lower incidences of tissue lesions in the skeletal muscle (P less than 0.005) at 2,6, and 10 months postchallenge. Tissue lesions in the heart and smooth muscle were also reduced, reaching statistical significance after 10 months (P less than 0.02). Chronic pathology parameters were never enhanced in preimmunized groups. In spite of the putative role that autoimmunity may play in the development of chronic chagasic lesions, the preventive effect of vaccination is readily exerted upon the chronic murine model of Chagas' disease.