Dynamics Of Laboratory Parameters Research Articles

Dynamics of laboratory markers of systemic inflammation in neurosurgical operations using α-2-adrenoagonists

The objective was to study the degree of deviations of laboratory parameters of the systemic inflammatory response syndrome (SIRS) under the conditions of modulation of the reactions of the sympathetic nervous system by various α-2-adrenergic receptors during neurosurgical interventions for the removal of the brain tumor of subtentorial localizationMaterials and methods. The laboratory data of 179 patients operated for the brain tumor of subtentorial localization were analyzed. The operations were performed under conditions of total intravenous anesthesia. The patients were divided into two groups depending on the α-2-adrenergic agonist used in the structure of the anesthetic aid: clonidine was used in the first group, dexmedetomidine was used in the second group. Laboratory tests included analysis of the levels of cytokines (IL-8, IL-6, IL-10, TNF-α), CRP, fibrinogen. Blood sampling for the study was carried out in five stages: 1 – one day before the operation, 2 – on the day of the operation before the introductory anesthesia, 3 – after the induction anesthesia, 4 – after removal of the tumor (at the stage of hemostasis); 5 – on the first day after surgery.Results. The dynamics of laboratory parameters were similar in both study groups and reflected the manifestations of the systemic inflammatory response of the body to intracranial intervention. The levels of pro-inflammatory cytokines IL-6, IL-8, TNF-α, and C-reactive protein (CRP) increased in the fourth and fifth stages of the study. The increase in the level of IL-6 and fibrinogen in the fifth stage of the study in the second group was more significant, which was explained by the less pronounced anti-inflammatory effect of dexmedetomidine compared to clonidine.Conclusions. Changes in laboratory parameters of SIRS as the reaction to surgical intervention on the brain were transient. Under conditions of total intravenous anesthesia with the use of α-2-adrenergic agonists, modulation of the inflammatory response was demonstrated, which ensured adequate consistency of the inflammatory process.

Wilson’s disease: a review of clinical guidelines, literature and a case report

Wilson’s disease (hepatocerebral dystrophy) is a rare hereditary disease that is caused by impaired copper metabolism affecting many organs, but mainly the liver and nervous system. Interest in the problem does not subside, because diagnosis and management of patients presents certain difficulties. The article highlights the literature data, clinical recommendations when discussing their own clinical observation of two patients (brother and sister) in whom the disease was diagnosed in childhood. Presented are clinical data, dynamics of laboratory parameters during 15 years of follow-up against the background of adequate chelation therapy with D-penicylamine and zinc sulfate, as well as during interruption of treatment. The necessity of adherence to a lifelong regimen of therapy is emphasized, since it is this tactic that demonstrates effectiveness in improving the prognosis of the disease.

The first experience of cord blood stem cells application in kidney transplantation: A descriptive study

Abstract. Kidney transplantation is recognized as the optimal method of end-stage kidney disease treatment, but chronic renal allograft rejection remains an unresolved issue and leads to transplanted organ function loss. Recent studies show positive effects of stem cell injections in a variety of diseases, including kidney transplantation.
 The present study aimed to analyze the first experience of umbilical cord blood stem cells application in living-related kidney transplantation in Shalimov’s National Institute of Surgery and Transplantation, give a preliminary assessment of their effectiveness and safety, evaluate the clinical course and especially the dynamics of laboratory parameters in the recipient’s postoperative period.
 Methods. The study group included 6 male, adult recipients of kidney transplants, who performed the first kidney allotransplantation from a living family donor in the Shalimov’s National Institute of Surgery and Transplantology in 2020 – 2021. Before surgery, all patients received intravenous administration of a fraction of nuclear cells from human umbilical cord blood at a dose of 2-3 x 106/kg body weight in combination with standard three-component immunosuppressive therapy. Immune system studies were performed before kidney transplantation, on the first and third days of the postoperative period, at the end of the first and second week, as well as on the first, third, sixth, and twelfth months, following kidney transplantation. Renal graft function was assessed by serum creatinine and glomerular filtration rate. Monitoring of clinical and laboratory parameters of blood and urine, the concentration of calcineurin inhibitors (C0) was carried out regularly three times a week for the first month, twice a month for 2-3 months, and once a month until the end of the year.
 Puncture biopsy of the transplanted kidney was performed three months after surgery to diagnose the pathology of the graft, namely the manifestations of acute and chronic rejection, the nature and degree of which were determined according to the Banff classification.
 The state of the immune system of the recipients was characterized by indicators of cellular and humoral immunity.
 Statistical processing of research results was performed using the statistical package StatSoft (2010) STATISTICA 9.1 for Windows StatSoft Inc, Tusla.
 Results. All patients received cord blood stem cells without complications. On the first day after surgery, an average diuresis was 9415 ± 928.1 ml. Normalization of graft function was observed on the second or third day (GFR more than 90 ml/ min/1.73 m2). There were no rejections of grafts and signs of opportunistic infections in the patients during 1 year follow-up period. Morphological studies did not reveal signs of significant pathological changes in transplanted kidneys in patients who received stem cells as induction therapy.
 The study of the state of the immune system of recipients in the dynamics, given the insufficient number of patients, requires further research.
 Conclusions. The administration of cord blood stem cells to recipients prior to kidney transplantation is safe and promotes rapid recovery of renal allograft function. There were no signs of morphological proven chronic graft rejection, which allows us to predict its long-term functioning in the future. To assess the response of the recipient's immune system to the application of cord blood stem cells requires the accumulation of additional data.

Efficacy and safety of ultra-low dose inhaled melphalan in the treatment of hospitalized patients with COVID-19

Background. One of the most important components of COVID-19 therapy is the suppression of the hyperergic immune response. There is an urgent need of creating the optimal tactics of efficient and safe anti-inflammatory therapy. A new method of treatment of COVID-19 with inhalation of ultra-low (non-cytotoxic) doses of the alkylating drug melphalan is proposed, based on previous experimental, preclinical, and clinical data on its use in severe bronchial asthma.The aim. To evaluate the efficacy and safety of inhalation of ultra-low doses of melphalan in hospitalized patients with COVID-19-associated lung damage.Materials and methods. A prospective, open, controlled, blind for the central expert study was conducted. Sixty adult patients were included, 30 patients were consecutively admitted to the hospital and received nebulized inhalations of 0.1 mg of melphalan for 7 days. Thirty patients of the control group were selected by an independent expert retrospectively using the computer algorithm for selecting «close» patients based on the «case-control» principle. The primary endpoints were the dynamics on the WHO Clinical Improvement Scale and the dynamics of dyspnea according to the modified Borg scale, secondary – assessment of adverse events, dynamics of indicators of clinical, biochemical blood tests, lungs computed tomography data from the beginning of inhalations in the melphalan group and from the corresponding day in the control group.Results. Inhalations of melphalan led to a significant improvement in the clinical condition of patients according to the WHO scale, decrease in the intensity of dyspnea on day 7 of treatment and by the time of discharge, a significant anti-inflammatory effect. Adverse events and dynamics of laboratory parameters did not differ from the control group.Conclusion. The method of treatment of COVID-19 by inhalation of ultra-low doses of the alkylating drug melphalan is safe and leads to a significant clinical improvement of hospitalized patients with COVID-19-associated lung damage.

EFFICIENCY OF USING OZONE THERAPY IN TREATMENT OF INFLAMMATORY DISEASES IN GYNECOLOGICAL PATIENTS

Annotation: Examination and treatment of 85 women aged 18 to 40 years with acute and subacute inflammatory diseases of the genitals were carried out. All patients underwent a comprehensive clinical and laboratory study, including a general clinical examination, an assessment of the gynecological status with an ultrasound scan, a serological examination for chlamydia, viral infections, as well as a bacteriological and bacterioscopic examination of the vaginal flora and the detachable cervical canal. The patients were prescribed specific anti-inflammatory treatment, taking into account the etiology of the pathogen. Ozone therapy was used as an additional treatment in 45 patients (infusion of ozonized physiological solution of ORF, 200 ml, concentration 4 - 6 mg / l for 5 - 8 days, and in 40 cases - large ozonized autohemotherapy of BAP). A pronounced clinical effect of ozone therapy was noted in all patients: a rapid regression of pain and intoxication sy In addition, a significant positive dynamics of laboratory parameters was revealed (an increase in the percentage of lymphocytes, a decrease in the content of poorly differentiated forms of leukocytes, normalization of the protein fraction of blood serum). All patients with a specific etiology of the inflammatory process showed positive dynamics of specific immunological parameters of blood serum. ndromes, an improvement in overall well-being. Patients who received ozone therapy showed a rapid recovery of their general condition, which made it possible to shorten the hospitalization time. Bacteriological and bacterioscopic control after the treatment showed the absence of specific and nonspecific pathogens and the normalization of the vaginal microflora.

Leukocyte and platelet markers of blood in the dynamics of the hospital period in patients with acute myocardial infarction: the ability to predict the development of long-term adverse events

The aim – to create a new method of assessing the development of long-term complications in STEMI patients by studying blood cell composition and its adaptation to practical application in general clinical practice.Materials and methods. The study was involved 148 patients with acute myocardial infarction (AMI) who was admitted from January 2014 to June 2020 to the intensive care unit. Some patients were evaluated retrospectively and were in group 1 (n=92). Group 2 – 56 patients, who were studied prospectively. The groups of patients did not differ in clinical and anamnestic characteristics and treatment. The study provided an annual observation period. The endpoint in group 1 was: death, stroke, exacerbation of coronary heart disease – including the need for revascularization, the developement or decompensation for heart failure, which led to hospitalization (in addition, group 2 was analyzed for onset of cardiac death).Results and discussion. There complex indicators were built, based on the analysis of the clinical profile and dynamics of laboratory parameters in patients with the onset of the endpoint – a modified leukocyte index (mLI), which contains the values ​​of the number and percentage of granulocytes, lymphocytes and monocytes on days 1, 3 and 10 of STEMI and leukocyte-platelet index (mLPI), which additionally includes indicators of platelet inhomogeneity in size (PDWc and P-LCR). These indices with their limit values ​​(mLI > 140 units and mLPI > 242 units) were more informative in predicting distant cardiovascular events than other laboratory markers (including neutrophil-leukocyte ratio, NLR). In a prospective study branch (group 2), the mLI and mLPI indicators also turned out to be more informative than other markers (in particular, the NLR indicator) in determining the propensity to occur as a combined endpoint (area under the curve 0.71 for both; p<0.0001), so and death (areas under the curve 0.78 and 0.84, respectively; p<0.0001). Based on the data obtained, a computer algorithm has been created that simplifies the risk assessment in AMI patients using the developed indicators.Conclusions. Created leukocyte and leukocyte-platelet indices are highly informative in predicting the risk of complications in patients within a year after AMI.

Anticoagulant therapy for stroke prevention in patients with severe COVID-19

During the pandemic of the new coronavirus infection, there is increasing evidence of neurological complications associated with COVID-19. There is no doubt that stroke can be a major complication in patients with severe disease course.Objective: to determine the safest and most effective anticoagulant for stroke prevention in patients with severe COVID-19.Patients and methods. A prospective study enrolled 520 patients with severe COVID-19. We used the following criteria for severe COVID-19: SpO2 <92% on room air at sea level, PaO2 /FiO2 <300 mm Hg, respiratory rate >30 breaths/min, lung infiltrates >50% on computed tomography. The study included 509 patients, divided into three groups depending on the type of anticoagulant therapy: patients of the 1st group received 24–36 thousand IU of heparin, patients of the 2nd group – enoxaparin at a dose of 1 mg/kg per day, patients of the 3rd group – rivaroxaban at a dose of 20 mg/day. The duration of anticoagulant administration depended on the severity of the patient's condition, dynamics of laboratory parameters (D-dimer, fibrinogen, international normalized ratio, activated partial thromboplastin time, platelet count), and varied from 2 to 6 weeks. In addition, we studied the incidence of ischemic and hemorrhagic strokes and transient ischemic attacks during a 6-week follow-up period. The article also presents a clinical case of large artery thrombosis in a young patient with severe COVID-19 without stroke risk factors.Results and discussion. Even against the background of active primary prevention, stroke incidence was 2.6% (0.6% for ischemic stroke, 1.4% for venous stroke, and 0.6% for hemorrhagic stroke). The highest stroke incidence was observed in the group of patients receiving heparin. In contrast, the prevention of thrombotic complications in patients receiving low-molecular-weight anticoagulants or rivaroxaban showed the best results with minimal morbidity and mortality in severe COVID-19.Conclusion. Stroke can be a complication of COVID-19, and preventive anticoagulant therapy using low-molecular-weight heparin or a factor X inhibitor effectively prevents this complication.

EVALUATION OF IMMUNOLOGICAL CHANGES IN PATIENTS WITH DIFFUSE FORM OF AUTOIMMUNE THYROIDITIS DURING LASER PHOTODYNAMIC THERAPY

The purpose of the study. To study the nature and dynamics of changes in humoral and local immunity during laser photodynamic therapy in patients with diffuse forms of autoimmune thyroiditis. Materials and methods. Laboratory tests of blood plasma were performed on 160 patients with long-lasting autoimmune thyroiditis in different age groups to determine humoral and local immunity. Here, information on the level of immunoglobulins A, G, M (IgA, IgG, IgM), the amount of interleukin-1 β (IL-1 β), tumor necrosis factor α (TNF-α) was determined in blood samples by the immunoenzyme method. The dynamics of laboratory parameters in all three groups of patients were studied on days 7 and 15 of treatment. These values were determined using reactives from “VectorBest” LLC (Russia). Results. In elderly patients with long-term autoimmune thyroiditis, a downward trend in TNF indices has been observed, which is an indication of the severity of the pathological process. The higher the amount of α2-MG in autoimmune thyroiditis and diffuse toxic urination, and the slower the normalization during treatment, the higher the probability of recurrence of the process. Conclusion. The combined use of modern laser technology in the treatment of patients with autoimmune thyroiditis expands the possibilities of conservative therapy and complements the arsenal of effective methods of treatment of this disease. The simplicity of the methods, ease of application, reliability, the absence of thermal effects on the thyroid gland creates ample opportunities for the application of this method in clinical practice.

Динамика клинико-лабораторных показателей у тяжелобольных и умерших от новой коронавирусной инфекции COVID-19 на фоне лечения 8 мг дексаметазона

В статье приведен обзор литературы об эффективности глюкокортикоидов при вирусных инфекциях, в том числе при новой коронавирусной инфекции COVID-19. Приведены результаты собственных исследований относительно динамики лабораторных показателей у больных, которые выздоровели и умерли. Средний возраст больных, получавших 8 мг дексаметазона, которые выздоровели, был меньше, чем у умерших. Средний день, на который были госпитализированы в отделение реанимации и интенсивной терапии больные, которые получали 8 мг дексаметазона, в обеих группах был одинаковым (в среднем на 7-е сутки). Обращает на себя внимание то, что у больных, которые выздоровели, до госпитализации чаще регистрировалась фебрильная температура, в то время как у тех, которые умерли, — чаще субфебрильная. Температура при госпитализации у всех категорий больных в среднем достигала субфебрильных цифр. Частота дыхания при госпитализации у всех категорий больных существенно не отличалась и в среднем составляла около 19/мин (до 20/мин у 50 % больных, которые выздоровели, и у 58,3 % умерших). У тех больных, которые выздоровели, при поступлении чаще регистрировалась нормальная частота пульса, но тахикардия реже, чем у тех, которые умерли. У больных, которые в последующем умерли, уже при поступлении чаще регистрировался низкий уровень сатурации. В первые 3 дня после госпитализации среди больных, которые получали 8 мг дексаметазона и выздоровели, несколько чаще регистрировались лейкоцитоз и количество лиц с гранулоцитозом, было увеличено количество палочкоядерных нейтрофилов и число лиц с ними. Среди больных, которые в последующем умерли, чаще регистрировались лейкопения, более выраженная лимфопения и число лиц с ней, более выраженная тромбоцитопения (но количество больных с ней не отличалось от показателей тех, которые выздоровели), более высокая скорость оседания эритроцитов. У больных, которые в последующем умерли, за период наблюдения отмечалось постепенное увеличение количества лейкоцитов, но постепенное уменьшение количества лимфоцитов, уровень креатинфосфокиназы с 7–9-х суток пребывания в стационаре увеличивался, уровень лактатдегидрогеназы на 4–6-е сутки пребывания в стационаре существенно увеличивался с последующим его снижением до уровня, который был выше, чем у тех, которые выздоровели. У больных, которые выздоровели, сначала отмечался рост лейкоцитов с постепенным их снижением, постепенный рост уровня лимфоцитов, снижение уровня креатинфосфокиназы, лактатдегидрогеназы. У всех категорий больных в динамике наблюдалось постепенное уменьшение количества палочкоядерных нейтрофилов, также со временем отмечался постепенный рост количества тромбоцитов, но у тех, которые выздоровели, их уровень был несколько выше; в обеих группах со временем наблюдался рост уровня мочевины, но у тех, которые умерли, ее уровень с 7-х суток и позже был значительно выше, чем у тех, которые выздоровели; у больных в обеих группах со временем наблюдался рост уровня креатинина, но у тех, которые умерли, его уровень с 7-х суток и позже был значительно выше, чем у тех, которые выздоровели; в обеих группах со временем наблюдалось снижение уровня С-реактивного белка, но у тех, которые умерли, уже с самого начала пребывания в стационаре и на протяжении всех периодов наблюдения его уровень был выше по сравнению с теми, которые выздоровели.

Динамика лабораторных показателей у пациентов ожогового отделения при проведении инфузионно- трансфузионной терапии

Динамика лабораторных показателей у пациентов ожогового отделения при проведении инфузионно- трансфузионной терапии

Evaluation of cardioprotective effect of exenatide in type 2 diabetes mellitus and acute myocardial infarction in the clinic and experiment

Background. Insulin therapy is associated with the risk of hypoglycemia, high variability of glycemia. Therefore, therapy with analogues GLP1 becomes relevant for patients with myocardial infarction and diabetes mellitus type 2. These drugs can reduce glycemic variability and risk of hypoglycemia. Objective. The effects of combination therapy analogue GLP1 and insulin should be studied in rats with experimental myocardial infarction and the impact of such therapy should be studied on the level of markers of myocardial damage, BNP, dynamics of the echocardiographic parameters and level of glycemia in patients with diabetes mellitus type 2 and myocardial infarction. Design and methods . Neonatal streptozotocin diabetes mellitus was modeled in an experiment in rats. Groups of animals were formed depending on the time of the beginning of insulin therapy, analogue GLP1(exenatide) or a combination of these drugs — before or after experimental myocardial infarction. Morphological assessment of ischemia and necrosis areas was carried out and glycemic variability was assessed. Two groups of patients with type 2 diabetes mellitus and myocardial infarction were formed in the clinical part. The first group received standard insulin therapy, the second group received combination therapy with insulin and exenatide. Parameters of glycemia, markers of myocardial damage, BNP, dynamics of echocardiography were evaluated. Results. The decrease of the area of necrosis, was observed in the combination therapy group in the experiment. Troponin I and CPK MV levels did not differ initially in all groups of patients. Reducing glycemic variability, a positive trend of level BNP, and EF was noted in patients with exenatide. Conclusion. Exenatide has the most pronounced positive effect on the course of myocardial infarction at the introduction before the start of reperfusion. Exenatide had no effect on the dynamics of markers of myocardial damage, but reduced the glycemic variability, improved the dynamics of laboratory parameters in patients.

Clinical and laboratory features of primary acute myocardial
 infarction in patients with non-obstructive atherosclerotic lesions of the coronary arteries.

Currently, the pathogenetic mechanisms of myocardial infarction (MI) in non-obstructive coronary artery disease (CA) are being actively studied, but such clinical situations still cause difficulties due to conflicting information about the clinical manifestations of myocardial ischemia, the dynamics of laboratory parameters, electrocardiographic and echocardiographic picture in this category of patients. Purpose. To study clinical and laboratory features ofprimary MI development and course in patients with non-obstructive CA lesions. Material and methods. The study included patients hospitalized with a diagnosis of “primary acute MI” in 2015-2016 : patients with acute MI and 100% acute occlusion of the only heart attack-responsible KA - obstructive atherosclerotic lesion of KA-and patients with acute MI and non-obstructive atherosclerotic lesion of KA, according to coronary angiography. Results. Surveyed 1,240 patients; the 1st group was 21.9%, 2nd group-7.7% of patients. The mean age of patients in groups 1 and 2 was 56.59±11.6 and 67.9±11.5 years, respectively (p<0.001). Among patients with non-obstructive atherosclerotic lesion of SC, the comorbid background was marked as burdened compared to patients with obstructive atherosclerotic lesion of SC: diabetes mellitus-20.8% vs. 7.4%, chronic kidney disease-25% vs. 11.8%, chronic obstructive pulmonary disease-25% vs. 11.8%. The most common symptom of myocardial ischemia in groups 1 and 2 was chest pain (89.7% vs. 54.2%, p<0.05). In 37.5% of patients of group 2 non-specific symptoms were revealed. ST segment elevation was recorded in 76.5 and 37.5% (p<0.01) patients, respectively. Non-specific electrocardiographic changes were registered in 33.3% of patients of group 2. In the analysis echocardiographically indicators of significant differences indicators in the groups were not observed. Analysis of cardiospecific enzymes showed consistent dynamics of the concentration of troponin I in the 1st and 2nd groups at admission - 0.13 ng/ml (95% CI 0,03 0,31-) against 0.20 ng/ml (95% CI 0,04 - 3,23, p=0,8); after 6 h -20,21 ng/ml (95% CI 8,25 - 45,25) against 1.8 ng/ml (95% CI 0.87 to - of 7.06, p<0.0001). The natural dynamics of the level of creatine kinase and its MB fraction were detected only in patients of the 1st group. Significant changes in the 2nd group is not marked. Elderly patients, mostly women, with a burdened General somatic history are subject to primary MI with non-obstructive atherosclerotic lesion of SC. In the clinical picture of myocardial ischemia, 54.2% ofpatients have chest pain, in other cases-shortness of breath and nonspecific symptoms. In 33.3% of patients on the ECG revealed nonspecific changes that complicate the diagnosis of THEM.