Development Of Critical Conditions Research Articles

Role of proteins MRP8 (S100A8) and MRP14 (S100A9) in the development of critical condition in patients with pneumonia with A/H1N1 influenza

Background . Today, the critical care medicine is actively developing, and rapid progress is closely related to the achievements of molecular biology, immunology, and pathological physiology. The study of the role of individual molecular structures in the realization of the reactions of innate and adaptive immunity, which underlie the pathogenesis of critical conditions, is an urgent scientific direction and is of interest. Aims. To assess the contribution of the protein complex MRP-8/14 to the development of systemic inflammation by determining its plasma concentration in patients with pneumonia with influenza A/H1N1. Materials and methods . 85 patients with pneumonia associated with influenza A/H1N1 were examined. Of these, 30 patients with severe pneumonia, 55 with non-severe pneumonia. The plasma concentration of the S100A8/A9 protein complex (MRP-8/14) was determined by flow cytometry on an analyzer (Beckman Coulter, USA). Results. It was found that in patients with severe pneumonia with influenza A/H1N1, the concentration of MRP-8/14 increased in 1.9 times compared with healthy. At the same time, in patients with severe pneumonia with influenza A/H1N1 with a fatal outcome, the concentration of MRP-8/14 increased in 2.1 times. Conclusion. An increase in the level of MRP-8/14 in patients with severe pneumonia associated with influenza A/H1N1, on the one hand, reflects the severity of the course of systemic inflammation, on the other hand, the molecules MRP-8 and MRP-14, acting as damage-associated molecular patterns (DAMPs) stimulate a pro-inflammatory response and contribute to the development of critical state. Thereby, the protein complex MRP-8/14 can be considered as a potential point of application of pharmacological action in the intensive care of critical conditions.

Comparison of Comorbidities in Relation to Critical Conditions among Coronavirus Disease 2019 Patients: A Network Meta-Analysis.

Severe illness and poor outcome are mainly associated with aging or certain medical comorbidities, especially chronic diseases. However, factors for unfavorable prognosis have not been well described owing to relatively small sample sizes and single-center reports. Therefore, this study aimed to compare the contribution of comorbidities in the development of critical conditions in coronavirus disease 2019 (COVID-19) patients. Pooled estimates of relative risks (RRs) and their 95% confidence intervals (CIs) were calculated by conducting a meta-analysis and network meta-analysis of 18 studies. Chronic obstructive pulmonary disease (COPD) was most strongly associated with the overall critical condition (RR = 4.22, 95% CI = 3.12 - 5.69), followed by cardiovascular disease (CVD) (RR = 3.00, 95% CI = 2.41 - 3.73), malignancy (RR = 2.91, 95% CI = 2.16 - 3.91), cerebrovascular accident (CVA) (RR = 2.86, 95% CI = 1.95 - 4.19), diabetes (RR = 2.10, 95% CI = 2.16 - 3.91), hypertension (RR = 2.02, 95% CI = 1.82 - 2.23), and chronic kidney disease (RR = 2.00, 95% CI = 1.36 - 2.94). The presence of comorbidities except for chronic liver disease and chronic kidney disease significantly increased the risk of severe infection, intensive care unit (ICU) admission, and cardiac injury in the subgroup analysis by types of critical conditions. Preexisting hypertension and diabetes additionally increased the risk of acute respiratory distress syndrome (ARDS). Among comorbidities, COPD had the highest probability of leading to severe COVID-19, ICU admission, and liver injury, while malignancy was most likely to cause ARDS and cardiac injury. In summary, preexisting COPD, CVD, CVA, hypertension, diabetes, and malignancy are more likely to worsen the progression of COVID-19, with severe infection, ICU admission requirement, and cardiac injury development.

ФАКТОРЫ РИСКА РАЗВИТИЯ КРИТИЧЕСКИХ СОСТОЯНИЙ, ТРЕБУЮЩИХ ГОСПИТАЛИЗАЦИИ В ОТДЕЛЕНИЕ ИНТЕНСИВНОЙ ТЕРАПИИ И РЕАНИМАЦИИ, У ПАЦИЕНТОВ С ТУБЕРКУЛЕЗОМ

The mortality rate among tuberculosis patients requiring intensive care is high. The development of severe conditions in patients with tuberculosis may be associated with the course of the underlying disease and with concomitant pathology. The aim of this work was to study the risk factors for the development of severe conditions in patients with tuberculosis to prevent death. A retrospective study of risk factors for the development of critical conditions, depending on the nature of the tuberculosis process, co-infection, concomitant diseases and bad habits, was carried out in 154 patients with pulmonary tuberculosis and extrapulmonary tuberculosis hospitalized in the intensive care unit. In a cohort of patients admitted to the intensive care unit and intensive care unit, statistically significant factors influencing the development of critical conditions were: the presence of extrapulmonary localization of the tuberculous process; the presence of bilateral tuberculous lung lesions; the presence of destructive forms of tuberculosis; the presence of tuberculous meningitis/encephalitis; the presence of multidrug-resistant and extensively drug-resistant tuberculosis; application of the traditional "old" treatment regimen; the presence of concomitant HIV infection with a CD4 cell count of less than 200/ul; the presence of concomitant diabetes.

Disorders of carbohydrate metabolism in critical conditions

Objective. To characterize the features of the occurrence and treatment of disorders of carbohydrate metabolism in critical conditions.
 Materials and methods. The search of publications was conducted using the engines PubMed and Google Scholar and analyzed the available domestic literature sources on the topics: carbohydrate metabolism disorders and critical conditions.
 Results and discussion. In critical conditions, the following disorders of carbohydrate metabolism develop: diabetic and non-diabetic ketoacidosis, hyperosmolar syndrome, hypoglycemia and lactic acidosis. Carbohydrate disorders in critical conditions develop against the background of the underlying disease, masked by it and worsen the patient’s condition. To diagnose these conditions, a nitroprusside ketonuria test is often used, which does not reflect the actual level of ketonuria (β-oxybutyric acid) and responds to their level in a delayed manner, so most ketosis is diagnosed late – in a decompensated state. Therefore, it is necessary to be guided first of all by a condition of the patient and clinical signs of existence of ketoacidosis. Xylitol (Xylat) solutions are used to treat these conditions. It is believed that xylitol has the greatest antiketogenic effect among all known substances. In particular, Xylat reduces the amount of free fatty acids; increasing of the formation of pyruvic acid, which promotes the oxidation of acetyl-coenzyme A in the Krebs cycle; enhances glycogen production in the liver; stimulates insulin secretion. Do not wait for the appearance of “4+” acetone in the urine analysis. If the patient has nausea, vomiting, dizziness, drowsiness, dry skin and dry mouth, deep noisy breathing and frequent urination on the background of hyperglycemia (>13.9 mmol/l) – should use xylitol-containing drug (Xylat) at a dose of 6-10 ml/kg intravenously.
 Clinical case. Patient M., 67 years old, was admitted to the trauma department with a hip fracture. He was treated conservatively (skeletal traction) for 3 weeks. Sudden deterioration of state of health is registered: periodically non-contact, loses consciousness. Blood pressure is not determined, heart rate cannot be calculated due to high frequency. On ECG – ventricular tachycardia. Bolus administration of amiodarone had no effect. Carefully analyzed history (diabetes does not get sick, but 3 weeks did not eat enough, almost starved). The level of glycemia is 5.2 mmol/l, ketonemia is 8.4 mmol/l (N=1.7 mmol/l). Diagnosed with non-diabetic ketoacidosis. Xylat infusion (7.5 ml/kg) was performed and amiodarone was reintroduced. As a result, sinus rhythm was restored, the patient regained consciousness.
 Conclusions. With the development of critical conditions, patients often have disorders of carbohydrate metabolism, which are often stopped by the introduction of xylitol (Xylat).

Study of the effectiveness of using decamethoxin-based antiseptic compositions for treating endotracheal tubes in order to prevent the development of ventilator-associated pneumonia in intensive care patients

Annotation. The use of artificial lung ventilation in patients of intensive care unit often leads to airway contamination of conditionally pathogenic microorganisms and the development of ventilator-associated pneumonia. The clinical manifestations of ventilator-associated pneumonia can vary widely from mild to development of critical conditions accompanied by septic shock. This significantly worsens the patient's condition and prognosis for effective treatment. The paper presents the results of the study of the use of adhesive antiseptic compositions based on the domestic antiseptic drug decamethoxin in order to give antimicrobial properties to intubation tubes. An antibacterial adhesive was applied to the surface of segments of the endotracheal intubation tube, after which the samples were dried in a sterile box. The sensitivity of the microorganisms to the components of the antiseptic compositions was studied by the diameter of the growth retardation zone around the studied fragments of endotracheal intubation tubes placed in the thickness of the pre-seeded microorganism’s dense nutrient medium. The results were statistically analyzed using standard application package for biomedical research “STATISTICA 5.5”. It has been proved that adhesive film-forming compositions based on decamethoxin confer pronounced antimicrobial properties to endotracheal intubation tubes. The most susceptible to antimicrobial activity were gram-positive microorganisms of the genus Staphylococcus, and the most resistant were representatives of gram-negative bacteria of the genus Acinetobacter. The obtained research results allow us to predict the effectiveness of the use of adhesive hydrophilic and hydrophobic antiseptic compositions based on the domestic antiseptic decamethoxin to provide protective properties of the surface of endotracheal tubes, prevent the process of bacterial film formation and prevention of ventilator-associated patients.

Развитие острого повреждения почек у детей с острыми кишечными инфекциями

Acute intestinal infections are the fourth most common cause of death among children under 5 years of age and the fifth most common cause of lost years of life worldwide. High incidence of se-vere forms and complications, as well as frequent development of critical conditions requiring hospitalization in the intensive care unit necessitate further investigation of pathogenesis and development of diagnostic and treatment methods for this polyetiological group of diseases. This article provides the latest data on the pathogenesis of acute kidney injury (AKI), its incidence among children with intestinal infections, diagnostic tactics, including the use of early markers, features of AKI in patients treated in hospital, and outcomes, including the transition to chronic kidney disease. Doctors of different specialties should be careful about AKI in children with various infectious diseases, particularly those with diarrhea, in order to prevent AKI progression, exclude nephrotoxic drugs, and monitor kidney function in dynamics. Key words: children, acute intestinal infection, acute kidney injury

MORPHOFUNCTIONAL FEATURES OF THE PLACENTA OF NEWBORNS IN BIRTH-INDUCED CRITICAL CONDITIONS: THE RESULTS OF A RETROSPECTIVE COHORT STUDY

Background. The placenta condition is the health marker of newborns and it can be considered in the early diagnosis of the development of severe pathological conditions in a child. Objective: Our aim was to study the relationship between the placenta characteristics and the risk of a birth-induced critical condition in a child and the risk of having children with the APGAR score of < 4 points.Methods. The data of macro- and microscopic studies of the placenta of newborns who have experienced birth-induced critical conditions was retrospectively analyzed. Birth-induced critical conditions were the APGAR score at 1 min after birth < 4 points and/or the presence of severe perinatal hypoxia, cerebral ischemia requiring respiratory support and intensive care in the intensive care unit.Results. We examined 92 placentas of mothers who gave birth to children in a critical condition. Depending on the APGAR score at 1 min after birth, the main group (n = 56, < 4 points) and the comparison group (n = 36, > 4 points) were singled out. In multivariate analysis, it was established that the appearance of a birth-induced critical condition with the APGAR score < 4 points was associated with pathological attachment of the umbilical cord (odds ratio, OR, 2.8, 95% confidence interval, CI, 1.1–7.0), placenta weight (OR 5.4, 95% CI 1.9–14.9), signs of chronic fetoplacental insufficiency (OR 7.3, 95% CI 2.9–18.8), impaired blood circulation in the placenta (OR 13.7, 95% CI 4.7–39.3), placental hypoplasia (OR 8.9, 95% CI 2.4–32.4), fetal-placental ratio (OR 8.9, 95% CI 2.4–32.4) as well as low birth weight of a newborn (OR 2.9, 95% CI 1.2–6.9). Conclusion. Morphological characteristics of the placenta are prognostic markers for the development of critical conditions with the APGAR score at birth < 4 points.

Pathogenetic Role of Cholesterol and Triglyceride Metabolic Disturbances in the Development of Critical Conditions

The review considers mechanisms for the development of respiratory failure caused by lipid metabolic disturbances. It gives data on the lung surfactant composition and lipid imbalance in severe concomitant injury, sepsis, and gestosis. Information on the prenatal and postnatal synthesis of triglycerides and cholesterol is detailed.

GENETICALLY SPECIFIED DISORDERS OF FOLATE METABOLISM IN NEONATES WITH CRITICAL CONDITIONS

The paper deals with the influence of genetic polymorphisms on the features of folate metabolism and antioxidant protection in newborns with critical conditions in neonatal period. The objective of the study was to examine changes in folate metabolism, antioxidant defense indicators and their relationship with genetic polymorphism to determine the contribution of genetically determined folate metabolism disorders in the development of critical conditions in newborns. To perform the work 45 infants were examined (gestational age 38-40 weeks) with critical conditions of the early neonatal period (the main group) and 30 infants (gestational age 38-40 weeks) with physiological early neonatal period (the comparison group). Examined children were in obstetric and neonatal intensive care units of the Regional Maternity Hospital in Poltava. There were significant differences in the indices of homocysteine, folate and serum glutathione transferase activity in newborns of the examined groups during the first three days of life, with varying strength correlation found. Dynamics of the indices of folate metabolism on the third day of life as compared to the first day was significantly different in the newborns from the main groups and correlated with the indices of antioxidant protection. The peculiarities of the dynamics of folate metabolism indices, characterizing antioxidant and folate dependent metabolic processes in the perinatal period, were determined. The analysis of the intergenic interaction impact on the development of folate metabolism disorders and critical conditions revealed association with polymorphisms of GSTT1, GSTM1, MTHFR, ACE, TNF-a, AT2R1 genes. Synergistic interaction between polymorphic variants of genes GSTT1 and GSTM1, MTHFR and ACE was found. Polymorphic variants of these genes associated with changes in the dynamics of folate metabolism indicators. In the course of the study the best predictive model of intergenic interaction in the development of critical conditions and genetically determined folate metabolism disorders in newborns was found (predictive value - 91.47%). Analysis of unfavorable polymorphic variants in GSTT1, GSTM1, MTHFR, ACE, TNF-a, AT2R1 genes is a perspective one to predict unfavourable early neonatal period in newborns in clinical practice.

Monitoring the Microcirculation in Critical Conditions: Possibilities and Limitations

The paper provides an analytical review of the references on the role of microcirculatory disorders in the development of critical conditions, the significance of circulatory monitoring, specifically, to make a presumptive prognosis of multiple organ dysfunction. It defines main directions in the diagnosis and correction of microcirculatory disorders as direct (infusion therapy) and indirect (influence on the components of a systemic inflammatory response, by extending to microcirculatory correction) microcirculatory exposures. Key words: critical conditions, multiple organ dysfunction, procedures to evaluate and correct microcirculation.

Recognition of early risky factors in patients suffering from critical influenza A H1N1

To investigate clinical risky factors and improve the ability to discover critically ill patients suffering from influenza A H1N1 in emergency department. A retrospective study of 65 cases with severe influenza A H1N1 was conducted. Univariate analysis and multivariate Logistic regression analysis were used to identify independent predictors of critically ill cases. Goodness of Fit test was performed on an established clinical predicting scoring (prediction of critically ill with influenza score, PCIS) system. Univariate analysis showed that significant difference between critically ill and severe group consisted of eight factors including age distribution, more than one comorbidity, chronic cardiovascular disease, oncologic diseases, sputum, myalgia/arthralgia, dyspnea and oxygen saturation at admission. A multivariate Logistic regression showed an association between development of critical illness and more than one comorbidity [odds ratio (OR)=7.611, 95% confidence interval (95%CI) 1.635-35.429], myalgia/arthralgia (OR=7.523, 95%CI 1.462-38.716), dyspnea (OR=11.090, 95%CI 1.373-89.565), and oxygen saturation<0.95 at admission (OR=8.088, 95%CI 1.019-84.969, all P<0.05). The prognostic criteria had a good discriminative ability [area under receiver operating characteristic curve (AUC) was 0.922, 95%CI 0.860-0.985, P=0.000]. The PCIS scoring system was established according to the level of four high risk factors. Low risk (PCIS 0-1), intermediate risk (PCIS 2), high risk (PCIS 3), and very high risk (PCIS≥4) were categorized for predicting the occurrence of critical illness, and the Goodness of Fit test was good (R(2)=0.940 6, P=0.030 1). Emergency physician can predict the development of critical condition in patients with influenza A H1N1 by using clinical characteristics including comorbidity, myalgia/arthralgia, dyspnea, and oxygen saturation at admission, and it is helpful in making clinical decision.

The Value of an Accelerator Release Signal

The value of a signal shown on the rear of an automobile when the accelerator is released was investigated by measuring (1) the magnitude of decelerations in coasting passenger cars, (2) the ability of drivers to detect coasting of a vehicle they are following, and (3) coasting periods used by a number of drivers on various trips. Coasting decelerations of a sample of passenger vehicles did not exceed 3 ft/sec 2. The driver's sensitivity (ΔH), the change in spacing necessary to detect coasting of a lead vehicle, was a direct function of the initial headway (H) with a median value ΔH = 0.12H. Instrumentation of a motor-pool automobile showed that most coasting durations were between 0.5 and 5 sec. with speed reductions of less than 4 mph. Release of the accelerator pedal was followed by braking on less than 50% of the coasting occasions. It was concluded that a coasting signal could not reliably indicate that braking would follow and was largely unnecessary for detection of coasting, but could aid in reducing the development of critical conditions when coasting periods exceed about 5 sec. A signal given only when coasting duration exceeds 5 sec. would not occur frequently and would provide valid information on most occasions.