Endogenous Intoxication In Patients Research Articles

Геронтологические особенности влияния новой коронавирусной инфекции на показатели интерлейкинового профиля, воспаления и эндогенной интоксикации у пациентов зрелого и пожилого возраста с ишемической болезнью сердца

Background: Coronary heart disease (CHD) is considered as an independent risk factor for COVID19, however, the indicators of inflammation and endogenous intoxication in patients with CHD 3-4 weeks after recovery from COVID-19 have not been the subject of scientific research. The aim of the study: Assessment of the gerontological features of the effect of the transferred new coronavirus infection on the indicators of the interleukin profile, inflammation and endogenous intoxication of mature and elderly patients with coronary heart disease in the early stages of recovery. Materials and methods: The study included 58 mature-age patients with coronary heart disease 3-4 weeks after recovery from COVID-19 of moderate severity, who made up the comparison group. The main group of patients was represented by 62 elderly people with coronary heart disease who had suffered a new coronavirus infection and were examined in the same way as the previous group, 3-4 weeks after recovery. The level of C-reactive protein and highly sensitive C-reactive protein in the blood was studied using the Nicomed-reader express analyzer, and antistreptolysin-O was studied using an immunoturbidimetric method on the Cobas 600 analyzer (Switzerland). The blood levels of bilirubin, urea, creatinine and sialic acids were studied using the ROKI biochemical analyzer. The content of systemic cytokines was determined by the Beckton Dickinson FACS Canto 2 (USA). The level of anxiety and depression was studied on the HADS scale. Results: 3-4 weeks after recovery from COVID-19, antistreptolysin-O levels ranged from 120.9 МЕ/ml to 208.1 МЕ/ml. Significant changes among the considered parameters of inflammation and endogenous intoxication in patients with coronary heart disease in old age during recovery from a new coronavirus infection were accompanied by a change in the content of highly sensitive C-reactive protein in peripheral blood. In the early stages of recovery after COVID-19, in elderly patients with coronary heart disease, the concentration of many studied cytokines in blood plasma remained elevated compared with those aged 45-59 years. The excess of reference values in both groups was found for IL-17, TNF-α and IFN-α, and among elderly patients – for IL-3, IL-4, IL-6, IL-7, IL-17. Conclusion: Antistreptolysin-O, highly sensitive C-reactive protein, C-reactive protein can be considered markers of recovery in patients with combined coronary heart disease in the early stages after a new coronavirus infection.

Dental markers of endogenous intoxication in patients with non-alcoholic fatty liver disease

Objective — to determine some dental markers of endogenous intoxication in the treatment of patients with non‑alcoholic fatty liver disease (NAFLD).
 Materials and methods. Examinations involved 44 patients with verified NAFLD diagnosis (the main group). The control group consisted of 20 somatically healthy subjects, representative in terms of gender and age. Clinical dental examinations were carried out twice, before and after the treatment, with an interval of 10 days. A questionnaire survey was conducted to assess the discipline of oral hygiene care. The level of oral hygiene was studied using the Greene–Vermillion index. The level of endotoxin in venous blood and oral fluid was assessed by immunoenzymatic method. The degree of endogenous intoxication was evaluated based on the structural and optical properties of a drop of oral fluid on a glass slide using an electron microscope. An analysis of correlations between non‑invasive and invasive techniques has been carried out.
 Results. More than half of the patients in the main group (61.3%) cleaned their teeth once a day. The value of the Greene–Vermillion oral hygiene index was equal to 2.3 points, which indicated an unsatisfactory state of hygienic care. In patients of the main group, the level of endotoxemia was equal to 0.9 EU/ml, and the level of LPS in oral fluid was 33.5 U/ml, which exceeded similar parameters in the control group by 2 and 1.6 times, respectively. In the micro preparations of oral fluid facies, 71.0% of patients in the main group had markers of endogenous intoxication (EI) of 3rd grade, 20.4% — EI of 2nd grade, and only 9.0% had EI of 1st grade. After 10 days, according to the re‑questioning data, 72.7% of patients in the main group followed full hygienic care of the oral cavity, and the Greene–Vermillion index decreased to 1.6 points, which was assessed as a satisfactory condition. In the micro preparations of facies of oral fluid, markers of EI of the 2nd grade were observed in 56.8% of the main group and markers of EI of 1st grade in 22.7% of subjects. The number of patients with EI markers of the 3rd grade decreased in 3.5 times compared to the first visit.
 Conclusions. Proper hygienic care of the oral cavity of patients with NAFLD results in the reduction of endogenous intoxication degree.

HEPATIC ENCEPHALOPATHY CAUSED BY ENDOGENOUS INTOXICATION IN PATIENTS WITH DIABETES MELLITUS COMPLICATED BY PURULENT-SEPTIC LESIONS OF SOFT TISSUES, WAYS OF THEIR CORRECTION

Objective:to study hepatic encephalopathy caused by endogenous intoxication in patients with diabetes mellitus (DM) complicated by necrotic soft tissue lesion (PNSTL) and ways of their correction. Materials and methods:58 patients with diabetes mellitus complicated by purulent-necrotic soft tissue lesion and the effect of endotoxicosis on the functional state of the liver were examined in the intensive care unit, with optimization of correction of hepatic encephalopathy. In addition to traditional therapy, hepatoprotectionsand drugs that stop transaminase activity are included in patients. Conclusions:Early detection of hepatic encephalopathy before clinical manifestations and timely correction is pathogenetically justified and optimizes the outcomes of such a formidable complication as hepatic encephalopathy and coma.

Clinical and biochemical characteristics of endogenous intoxication in patients with acantholytic pemphigus

The purpose of the study: to assess the state of endogenous intoxication, taking into account the study of the sorption capacity of erythrocytes and the level of middle molecule peptides and nitric oxide in patients with acantholytic pemphigus, and identify its role in the course of this dermatosis. Material and methods of the research: clinical, cytological, biochemical, immunological, and statisti cal methods of research were used in patients with acantholytic pemphigus. Results of the study: in patients with acantholytic pemphigus, endogenous intoxication of the body develops, which is expressed by an increase in the sorption capacity of erythrocytes and the level of middle molecule peptides and nitric oxide. Moreover, an increase in the content of endogenous toxins in the blood serum, in particular, middle molecule peptides and nitric oxide, determines the severity of the clinical course in patients with acantholytic pemphigus.

Pathogenetic mechanisms of mental disorders: endogenous intoxication

There is described the existence of the syndrome of endogenous intoxication in patients with mental disorders. Oxidative stress, middle-mass endotoxic molecules, disorders in functional properties of the blood albumin and the thiols of the albumin, disturbances in the state of the neurotrophic factors and in the activity of several enzymes, including monoamine oxidase and semicarbazide-sensitive amine oxidase, contribute to the development of the endogenous intoxication. We introduce the scheme of the possible pathogenetic mechanisms of the development of the endogenous intoxication and the ways of its overcoming.

THE ROLE OF ENDOTOXICOSIS AND INFLAMMATION IN DEEPENING THE PANCREATIC FUNCTIONAL INSUFFICIENCY IN CHRONIC PANCREATITIS IN COMBINATION WITH TYPE 2 DIABETES.

Aim: To analyze the state of parameters of inflammation, endotoxicosis, and their influence on the functional capacity of the pancreas in the comorbid course of chronic pancreatitis and type 2 diabetes mellitus (DM2). Materials and methods: 115 patients with CP in the phase of mild therapeutic exacerbation in combination with DM2 in the stage of subcompensation were examined. To assess the impact of comorbid DM2 on the clinical condition of patients with CP, a comparison group of 25 patients with CP in the exacerbation phase was included in the study. The assessment of the presence and depth of pancreatic exocrine insufficiency (PEI) was carried out according to the "gold standard" - determination of the content of fecal α-elastase-1, which was determined by the method of enzyme immunoassay using standard kits. As the main criterion for diagnosis and monitoring of DM, the measurement of HbA1c was used, which was determined by the method of ion exchange chromatography. C-reactive protein (CRP) was determined by the immunoturbidometry method by photometric measurement of the antigen-antibody reaction to human CRP antibodies; reference values of CRP in blood serum are up to 3 mg/l. Endogenous intoxication (EI) was assessed based on the levels of medium-mass molecules (MMM) - MMM1 and MMM2 at wavelengths 254 and 280 nm. The level of circulating immune complexes (CIC) was determined by the method of selective precipitation in 3.75% ethylene glycol followed by photometry. Results: Moderate and moderate inverse correlations were established between CRP and fecal α-elastase in CP and CP-DM2 comorbidity (r=-0.423 and r=-0.565, p<0.05). This proved a reliable influence of the depth of inflammation according to the content of CRP on the increase in PEI according to the level of fecal α-elastase, which was higher in the CP-DM2 comorbidity compared to CP. A deeper level of secretory insufficiency of the pancreas was established in CP with concomitant DM2, which deepened when the CRP level increased, compared to that in isolated CP: an increase in the strength of reliable direct moderate HbA1c-CRP correlations in patients with CP in combination with DM2 was proved in relation to such cases isolated CP (respectively r=0.313 and r=0.410, p<0.05). Conclusions: We proved a reliable influence of the index of endogenous intoxication on the level of PEI according to the level of fecal α-elastase, which was higher in the CP-DM2 comorbidity compared to isolated CP: moderate and medium-strength inverse correlations were established IEI-fecal α-elastase in patients with CP and CP-DM2 comorbidity (r=-0.471 and r=-0.517, p<0.05). An increase in the strength of reliable direct, moderate, and moderate correlations between the levels of HbA1c and the index of endogenous intoxication in patients with isolated CP and CP-DM2 comorbidity (r=0.337 and r=0.552, p<0.05), which proved a deeper level of secretory pancreas insufficiency with concomitant DM2, which worsened with increasing endotoxicosis according to the value of the index of endogenous intoxication.

FEATURES OF CHANGES IN INTEGRATIVE INDICATORS OF ENDOGENOUS INTOXICATION, REACTIVITY, INFLAMMATION ACTIVITY IN PATIENTS WITH CHRONIC VIRAL HEPATITIS AND CHRONIC RENAL FAILURE

The aim: to study the peculiarities of changes in integrative indicators of endogenous intoxication, reactivity and activity of inflammation in patients with chronic viral hepatitis B and C, and with chronic renal failure undergoing hemodialysis. Materials and methods. 19 patients with chronic viral hepatitis B (HBV) and chronic viral hepatitis C (HCV) with chronic renal failure and patients with chronic kidney disease (KD) were examined. Comparison group included 40 healthy blood donors. Epidemiological, clinical and laboratory examination was performed. Indicators of endogenous intoxication, nonspecific reactivity and inflammatory activity were calculated and analyzed using statistical criteria (M±m, Student's test and Mann–Whitney test). Results: an increase in the integrative indicators of endogenous intoxication in patients with the combined pathology of chronic KD and chronic viral hepatitis (VH) is a consequence of the activation of tissue disintegration, cytolysis of hepatocytes and a significant impairment of liver function. A change in the indices of non-specific inflammation indicate expressed activity of the inflammatory process and immunological disorder of reactivity. These changes also suggest decompensated endotoxicosis, as a possible consequence of a chronic infectious process and decompensated endogenous intoxication. Indicators of leukocyte intoxication index (LII), leukocyte shift index (ISL), hematological intoxication index (HII), intoxication index severity (IIS), immunoreactivity index (IR), neutrophil-monocyte ratio (NMR) are increased in all patients with chronic KD, which may be related to the actual cause of development – glomerulonephritis, chronic pyelonephritis, concomitant pathology. More pronounced deviations were found in men of both groups than in women, which may be related to greater adherence to diet, water load between hemodialysis procedures in the latter. Conclusions. Patients receiving invasive manipulations, including hemodialysis, belong to the risk group and are more susceptible, taking into account immunodeficiency, to infection with hepatitis viruses than the general population. CVH is one of the most common types of lesions in them. The obtained changes, namely, a more pronounced increase in the integrative indicators of endogenous intoxication, in patients with the combined pathology of CKD and CVH indicate the activation of the processes of tissue decay, cytolysis of hepatocytes and significant liver function impairment. At the same time, a change in indices of non-specific inflammation indicates a pronounced activity of the inflammatory process and an immunological disorder of reactivity. A clear systemic reaction to inflammatory processes in the body of patients is determined, the probable development of decompensated endogenous intoxication, which is possible consequence of a chronic infectious process. A simultaneous increase in ISL and a decrease in ILG was established, which is associated with the development of endogenous intoxication and a violation of immunological reactivity due to autointoxication of the body. A decrease in Ilymph indicates an active adaptive reaction of white blood cells and a cell-type immunodeficiency, in particular, a decrease in non-specific anti-infective protection. Indicators of LII, ISL, HII, IIS, IR, NMR are increased in all patients with CKD, which may be related to the actual cause of development – glomerulonephritis, chronic pyelonephritis, etc. The difference of integrative indicators between men and women was established, more pronounced deviations from normal were found in men of both groups than in women, which may be associated with greater adherence to diet, water load between hemodialysis procedures in the latter.

Ендотоксикоз і запалення як предиктори поглиблення функціональної недостатності підшлункової залози при хронічному панкреатиті у поєднанні із цукровим діабетом 2 типу

According to scientists, a significant role in the progression of chronic pancreatitis (CP) and diabetes mellitus (DM), as well as in the occurrence of complications of these diseases, is played by inflammation and endogenous intoxication by the products of protein breakdown as a result of the inflammatory process, fibrosis, and degradation of connective tissue in the patient’s body, in particular, and in the pancreas. The aim is to analyze the state of parameters of inflammation, endotoxicosis, and their influence on the functional capacity of the pancreas in the comorbid course of chronic pancreatitis and type 2 diabetes mellitus (DM2). Materials and methods. 112 patients with CP in the phase of mild therapeutic exacerbation in combination with DM2 in the stage of subcompensation were examined. The results. Moderate and moderate inverse correlations were established between CRP and fecal α-elastase in patients with CP and comorbidity of CP and DM2 (respectively r=-0.423 and r=-0.565, p&lt;0,05). An increase in the strength of reliable direct moderate correlations between the levels of HbA1c and CRP in patients with CP in combination with DM2 compared to those with isolated CP (respectively r=0.313 and r=0.410, p&lt;0,05) was proved. Conclusions: We proved a reliable influence of the index of endogenous intoxication on the level of pancreatic functional insufficiency according to the content of fecal α-elastase, which was more significant in the combined course of CP and DM2 compared to that in isolated CP. An increase in the strength of reliable direct, moderate, and moderate correlations between HbA1c levels and the index of endogenous intoxication in patients with isolated CP and CP in combination with DM2 has been proven.

Prognostic value of molecules of average mass in patients with chronic obstructive pulmonary disease

Background. Chronic obstructive pulmonary disease is a socially significant disease affecting patient’s quality of life. Assessment of endogenous intoxication in patients with chronic obstructive pulmonary disease will allow to understand pathogenetic features of different phenotypes of this disease, which can be taken into account when predicting its course.The aim of the study. To determine the prognostic value of levels of mediumand low-molecular-weight substances and oligopeptides in patients with chronic obstructive pulmonary disease.Materials and methods. One hundred and four patients with chronic obstructive pulmonary disease (COPD) and 110 somatically healthy individuals were examined. Molecular weight medium and low molecular weight substances (LMWSM) and oligopeptides (OP) were determined in blood plasma, erythrocytes and urine. Based on these indicators mathematically calculated indices of endogenous intoxication and coefficient of elimination were defined. Statistical processing of the data was performed using the SPSS 26.0 software package (IBM Corp., USA).Results. In all biological fluids, the levels of average molecules and calculated indices in the COPD patients’ group were statistically significantly different from those in the control group. The indices characterizing endotoxin accumulation were statistically significantly higher, while those characterizing toxin elimination were lower. The level of endotoxemia was correlated with the frequency of exacerbations, clinical manifestations severity, quality of life, COPD group and phenotype.Conclusions. Frequent exacerbations, groups C and D, bronchitic and mixed COPD phenotypes are characterized by more severe endotoxicosis manifested by high levels of LMWSM, OP and calculated indices.

ПРОТЕИНУРИЯ И ЭНДОГЕННАЯ ИНТОКСИКАЦИЯ У БОЛЬНЫХ ЦИРРОЗОМ ПЕЧЕНИ

In patients with liver cirrhosis, structural changes develop in the renal parenchyma, accompanied by a violation of the total renal function. These processes lead to the aggravation of endogenous intoxication and to the progression of the underlying disease. The aim of the study was to define the relationship between proteinuria and urine albumin/creatinine ratio with indicators of endogenous intoxication in patients with liver cirrhosis.&#x0D; 146 patients with liver cirrhosis with various etiologies were examined. In all patients, the presence of proteinuria, middle molecules level, creatinine and albumin levels in the urine were determined, urine albumin/ creatinine ratio was calculated, and the ratio of indicators of integral leukocyte indices was studied.&#x0D; It was established that the urine albumin /creatinine ratio in patients with liver cirrhosis correlate with indicators of endogenous intoxication and it`s a predictor of the adverse course of liver cirrhosis.

Analysis of indicators of endogenous intoxication in patients with communityacquired pneumonia associated with COVID-19

Aim. To assess the prognostic significance of hematological parameters of endogenous intoxication syndrome at the stage of routing patients with pneumonia associated with COVID-19.Materials and methods. 146 case histories of patients were analyzed, divided into 2 groups: patients who were referred for treatment to intensive care units based on the results of routing in the admission and diagnostic department (ADD) and patients referred for treatment to pulmonology departments. Upon admission of patients to the hospital, according to the case histories at the stage of ADD, an assessment of the clinical blood test was made, the calculation of hematological indicators of intoxication. Based on the data obtained, a ROC analysis was performed to determine the prognostic significance of hematological indicators of intoxication.Results. In patients who were in intensive care units, at the stage of sorting in the ADD, the concentration of leukocytes and the percentage of neutrophils were higher by 25.9 and 16.2%, respectively, in comparison with patients referred for treatment to the pulmonology departments, however, the percentage of lymphocytes and the quantitative concentration of erythrocytes was lower by 26.6 and 8.3%, respectively. The integral indicator of intoxication in patients in intensive care was higher by 38.6%, the leukocyte index of intoxication by 74.3% and the index of the ratio of neutrophils to lymphocytes by 81.5%. In patients of the same group, the index of the ratio of neutrophils to monocytes was lower by 28.7%, the index of the ratio of lymphocytes to monocytes by 44.9%. The sensitivity of the integral indicator of intoxication was 73.3%, the specificity was 51.2%; in the leukocyte index of intoxication – 57.3 and 51.2%, respectively; the sensitivity of the index of the ratio of neutrophils to monocytes was 57.3%, the specificity was 59.1%; the same figures for the index of the ratio of neutrophils to lymphocytes were 68 and 60%, respectively.Conclusion. It can be concluded that there is a rather high clinical prognostic value in the routing of patients with community-acquired pneumonia caused by COVID- 19 at the stage of initial examination in the ADD, such hematological parameters of intoxication as the integral index of intoxication and the index of the ratio of neutrophils to lymphocytes. We believe that hematological indicators of intoxication can complement prognostic scales and be used as another criterion in determining the routing of patients in ADD.

УРОВЕНЬ ВЕЩЕСТВ СРЕДНЕЙ И НИЗКОЙ МОЛЕКУЛЯРНОЙ МАССЫ И ОЛИГОПЕПТИДОВ У БОЛЬНЫХ ИНФАРКТОМ МИОКАРДА НА ФОНЕ ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНИ ЛЁГКИХ С ОДНО- И МНОГОСОСУДИСТЫМ ПОРАЖЕНИЕМ КОРОНАРНЫХ АРТЕРИЙ

Introduction. The presence of endogenous intoxication syndrome in somatic pathology worsens the course and prognosis of diseases. It is especially urgent to study this syndrome in comorbid pathology, in particular, in myocardial infarction development in patients with chronic obstructive pulmonary disease. The objective markers of endogenous intoxication are medium and low molecular weight substances and oligopeptides. Aim. The aim is to estimate the severity of endogenous intoxication syndrome by studying the levels of medium and low molecular weight substances and oligopeptides in patients with myocardial infarction developed against the background of chronic obstructive pulmonary disease depending on the number of coronary arteries affected. Material and meth- ods. 225 patients with myocardial infarction were examined. In 130 of them the infarction developed as monosomal disease, and in 195 - against the background of previously documented chronic obstructive pulmonary disease. Among patients with myocardial infarction as monoinflammation, 71 (64.5%) had a single-vessel lesion and 59 (35.5%) had a multivessel lesion. Among patients with myocardial infarction against chronic obstructive pulmonary disease, lesion of the 1st coronary artery was found in 50 patients (25.6%), and multivessel lesion was found in 145 (74.4%). The comparison group included 110 somatically healthy subjects. We used direct spectrometry (according to M.Y. Malakhova, 1995) to determine the levels of medium and low molecular weight substances and oligopep- tides. Statistical data processing was carried out using software package SPSS 26.0. Results and discussion. In the group of patients with myocardial infarction the levels of medium and low molecular weight substances and oligopeptides and calculated indices showed significant differences in single- and multivessel lesions. In the 1st coronary artery lesion, the indices in most cases were comparable with the values in the control group. In the group of myocardial infarction patients with multivessel lesions, the values of medium and low molecular weight substances and oligopeptides increased significantly. In patients with myocardial infarction against the background of chronic obstructive pulmonary disease, all intoxication parameters were significantly higher compared not only with the control, but also with patients with myocardial infarction as monoinflammation. However, the values in the subgroups with single and multivessel lesions did not demonstrate statistical reliability. Conclusion. The number of affected vessels, and hence the volume of ischemic myocardium, affects the severity of endogenous intoxication in patients with myocardial infarction as mononasal. In this case, the elimination function of the excretory organs is not impaired, which means that the level of intoxication is due to the production of toxins in conditions of ischemia and myocardial necrosis. In conditions of cardiorespiratory comorbidity chronic obstructive pulmonary disease con- tributes significantly to the development of endogenous intoxication, aggravating it and levelling the differences occurring in monosensing.

СRITERIA FOR ASSESSING ENDOGENOUS INTOXICATION IN PATIENTS WITH MULTIPLE PERITONITIS.

The aim: To determine the diagnostic significance of the level of malondialdehyde (MDA) in various biological media for RP for assessing and predicting the course of the disease. Materials and methods: Our study included The work was based on the results of surgical treatment of 60 patients with RP: according to MPI I - in 17 (28.3%), MPI II - in 23 (38.4%) and MPI III - in 20 (33.3%) patients. Surgical intervention for RP was aimed at sanitation and drainage of the abdominal cavity. The control group included 15 practi¬cally healthy people, whose blood and urine biochemical parameters served as the norm. According to the clinical course of the disease, the patients were divided depend on admission, The secondary product of lipid peroxidation - MDA was studied in blood serum, peritoneal exudate and urine in patients with RP, depending on the severity of the pathological process according to the Mannheim peritoneal index (MPI) - I severity (I), II severity (II), III severity (III). The work was based on the results of surgical treatment of 60 patients with RP: according to MPI I - in 17 (28.3%), MPI II - in 23 (38.4%) and MPI III - in 20 (33.3%) patients. Results: Analyses of results showed that the average value of MDA in various biomedicals of recovered (n = 18) and subsequently died (n = 5) patients with MPI II are given in Table. 2. As can be seen from the presented data, the average value of MDA in blood serum and peritoneal exudate in patients with a lethal outcome is significantly higher than in those who have recovered. This fact indicates a more pronounced endogenous intoxication in patients who died from RP. Conclusions: The content of MDA in the blood serum before surgery in patients with a lethal outcome was 190% (p <0.001). The level of MDA in urine in patients according to MPI II who subsequently died before surgery was 110% (p <0.001), and in those who recovered by 300% (p <0.001) it was higher than the norm. exudate taken during the operation averaged 4.14 ± 0.33 nmol / ml, then in the recovered - 2.89 ± 0.08 nmol / ml. A high level of MDA in the blood serum, peritoneal exudate with a decrease in the elimination of MDA in the urine in the postoperative period are prognostically unfavorable signs in patients, indicating the continuation of endogenous intoxication and a possible death.

Liver functional status and prevention of endogenous intoxication in patients with gynecological cancers after surgery with multimodal analgesia

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Анализ влияния вариантов мультимодального анестезиологического обеспечения на функциональное состояние печени и уровень маркеров эндогенной интоксикации (ЭИ) у пациентов, оперированных по поводу онкогинекологических заболеваний после неоадъювантной химиотерапии (НАХТ). <h3>МАТЕРИАЛ И МЕТОДЫ</h3> <i></i> Проведено проспективное рандомизированное исследование эффективности различных вариантов мультимодальной анестезии (ММА) у 122 пациентов в возрасте 36—76 лет после НАХТ. Больные разделены на 2 группы. Пациентам 1-й группы (<i>n</i>=59) выполняли анестезию севофлураном с эпидуральной аналгезией, пациентам 2-й группы (<i>n</i>=63) интраоперационно проводили ТАР-блок. Аналгезию поддерживали инфузией лидокаина, сернокислой магнезией, фентанилом, нестероидными противовоспалительными препаратами. Группы разделены на подгруппы — А и Б. У пациентов подгрупп А обеих групп в составе ММА с целью уменьшения проявлений ЭИ и гепатопатии использовали Ремаксол за 2 ч до хирургического вмешательства, интраоперационно и в первые трое суток. У пациентов подгрупп Б использование Ремаксола не предполагалось. Изучены биохимические показатели: общая (ОКА) и эффективная концентрация (ЭКА) альбумина, связывающая способность альбумина, содержание С-реактивного белка и ферментов печени. <h3>РЕЗУЛЬТАТЫ</h3> <i></i> У всех пациентов преморбидный фон характеризовался ЭИ, интенсификацией системного воспалительного ответа, гепатопатией. На этапах исследования динамика изучаемых показателей зависела от вариантов ММА. У пациентов, получавших Ремаксол, наблюдалось повышение ЭКА и ОКА, свидетельствующее о значительном снижении ЭИ. Уменьшался расход опиоидных аналгетиков. <h3>ЗАКЛЮЧЕНИЕ</h3> Включение в состав мультимодальной анестезии препарата Ремаксол обеспечивает уменьшение выраженности проявлений гепатопатии и эндогенной интоксикации, снижение расхода опиоидсодержащих аналгетиков в интра- и послеоперационном периодах.

P11‐6: Indices of endogenous intoxication in patients with COVID‐19 associated pneumonia

P11‐6: Indices of endogenous intoxication in patients with COVID‐19 associated pneumonia

Изменения цитокинового профиля в зависимости от тяжести эндогенной интоксикации при механической желтухе

Aim. Study of the reaction of the cytokine pofil to the severity of the course of endogenous intoxication in patients with obstructive jaundice.Material and methods. The study involved 84 patients with obstructive jaundice (MJ) caused by malignant tumors of the biliopancreatoduodenal zone (BPDZ). There were 55 men (65.5%), women - 29 (34.5%). The average age of the patients was 59.1 ± 2.3 years. The severity of endogenous intoxication and the cytokine profile of patients with breast cancer were assessed by determining the concentration of medium molecular peptides (MMP) and proinflammatory cytokines TNF-α and IL-6 in blood plasma and bile.Conclusion. In patients with breast cancer of tumor genesis, there is a multiple increase in the concentration of proinflammatory cytokines in blood serum and bile. There is also a manifold increase in apoptosis indices of blood lymphocytes and the content of MMP. Adequate and timely decompression of the biliary tract in breast cancer ensures the elimination of factors that cause endogenous intoxication and an increase in the inflammatory process, which makes it possible to prepare the patient for the second stage of radical surgical treatment after of the aplication of a percutaneous-transhepatic cholangiostomy.

Method of Enteral Insufficiency Syndrome Correction in Patients &#x0D; with Generalized Peritonitis

Introduction. Mortality in generalized peritonitis (GP) reaches 30%, and with the development of multiple organ failure, the lethal outcome is observed in 80-90% of cases. Enteral insufficiency syndrome (EIS) plays a leading role in the progression of generalized peritonitis.&#x0D; The aim of the study was to develop a differentiated approach of enteral insufficiency syndrome correction in patients with generalized peritonitis.&#x0D; Material and methods. This research was a retrospective prospective study. The study included 50 patients with GP, who received treatment at the Surgery Department of the Samara Regional Clinical Hospital in the period from 2017 to 2019. Depending on the chosen treatment tactics, the patients were divided into two clinical groups. Group I included 29 patients, admitted in the period from 2017 to 2018, who had received the standard GP treatment. A long-term endogenous intoxication in patients of this group associated with the progressive enteric failure led to the repeated surgeries; at the same time, a high frequency of postoperative complications was preserved. The analysis of the results in patients of Group I necessitated development of the therapeutic and diagnostic algorithm aimed at early diagnostics and timely correction of EIS. Group II included 21 patients with GP, admitted in the period from 2018 to 2019, who was treated using the new algorithm.&#x0D; Results. The objective criteria for the relief of EIS in GP in patients of the study groups were a decrease in the level of serum albumin and C-reactive protein, a significant decrease in the amount and qualitative change in the intestinal discharge via an intestinal tube, a decrease in the recovery time of the functions of the small intestine and start of defecation. On the 6th postoperative day, in patients of Group II there was no significant albumin level reduction in comparison with the 1st day of monitoring (28.310.77 g/l vs 37.334.69 g/l). Whereas in Group I the albumin level was significantly lower (19.30.51 g/l) than the same parameter in Group II, and in comparison with the 1st day of monitoring (19.30.51 g/l vs 39.56.05 g/l; р = 0.00001). On the 6th postoperative day, the C-reactive protein level differed significantly between the groups as well: Group I 104.7613.49 mg/l, Group II - 58.0029.05 mg/l, p = 0.003. The control of GP in patients of the Group I was reached after 4.52.5 repeated abdominal interventions, while in patients of Group II generalized peritonitis was arrested after 2.30.9 surgical interventions (p = 0.000171), which is 1.9 times less.&#x0D; Conclusions. The proposed algorithm of EIS control is based on the individual approach to the treatment of patients with GP. The developed EIS rating scale allows determining not only the degree and dynamics of the pathological process, but also monitoring the effectiveness of treatment options applied in a particular patient.

Оценка выраженности эндогенной интоксикации при болезни Альцгеймера

The development of neurodegenerative pathologies, among which the leading positions worldwide belong to Alzheimer's disease, is accompanied by the activation of free radical processes in the tissues of the brain and in the patient's body as a whole, which leads to the accumulation of products of oxidative modification of proteins, lipids, nucleic acids, and the formation of a syndrome of endogenous intoxication. An integral indicator reflecting the severity of this syndrome is the level of substances of low and medium molecular weight in various biological media. It is known that changes at the molecular level in Alzheimer's disease occur 5-10 years before the clinical manifestation of pathology. The development of polymodal panels for biochemical screening, diagnostics, monitoring of the course of pathology is underway. The aim of this study was to determine the severity of endogenous intoxication in patients with Alzheimer's disease and vascular dementia. The object of the study was the blood plasma of patients, as well as fractionated leukocytes - mononuclear and polymorphonuclear. The choice of biological material for the study is dictated by the need to search for a prognostic marker of the disease available for diagnosis, as well as by the accumulated theoretical material on various metabolic changes in peripheral blood cells in neurodegenerative diseases. According to the results of the study, it was found that in patients with Alzheimer's disease in mononuclear leukocytes of peripheral blood, the level of substances of low and medium molecular weight is higher than in patients with vascular dementia and patients without signs of neurodegeneration. In addition, in this fraction of leukocytes, the concentration of hypoxanthine, inosine, xanthosine and their derivatives is high, which may be a consequence of the oxidative modification of nucleic acids in the cells under study.

Indices of proteins’ and lipids’ peroxidation and the state of antioxidant system in patients with snoring

Aim: to investigate the intensity of proteins and lipids peroxidation, the state of the antioxidant system and biochemical indices of endogenous intoxication in patients with snoring. Materials and Methods: Blood serum of 20 patients with snoring and 19 healthy persons without any manifestation of respiratory complications at sleeping were studied. All patients were divided into two groups. Group I included 10 patients with moderate manifestation of snoring, and group II with the hard one. Results: An increase of the proteins’ oxidative modifications in patients with snoring without obstructive apnea at sleep were moderate and severe, that is reflected by an increase of the levels of neutral- and basiccharacter aldehyde-dinitrophenyl-hydrazones and basic-character ketone-dinitrophenyl-hydrazones has been established. The level of thiobarbiturate-positive products in patients with the moderate degree of snoring was in the value of control group. At progression of this pathology this index increased, too in compare to control group. The level of catalase activity in patients of both group was increased where as the content of free thiol groups was decreased. The content of medium weight molecules in patients of both groups was on the level of control, but at progressing of the disease it increased. The content of tyrosine-containing peptides was increased in the serum of patients in both groups. Our data prove for the intensification of the proteins’ and lipids’ peroxidation, for the changes in antioxidant system and for the development of endogenous intoxication in patients with severe level of snoring.

Antioxidant stress as an indicative marker of diagnosis and vector verification of treatment of generalized parodontitis with anorexia nervosa

Purpose of the study. To study the balance of fatty acid spectrum of oral lipids as a marker of oxidant-antioxidant stress in patients with generalized parodontitis with anorexia nervosa.&#x0D; Materials and methods. The study metabolic disorders of fatty acids oral fluid was conducted in 28 patients with GP, primary-I, I–II degree, chronic course associated with anorexia nervosa, (average age 26 ± 3,8) – the main group (M). The comparison group (C) included 23 patients with GP, primary-I, I–II degree, chronic course with no eating disorders. The control group consisted of 25 healthy individuals of the same age category. Patients' oral fluid was used as the object of study. In the spectrum of fatty acids of lipids of the oral fluid, the 9 most informative fatty acids were identified: myristic C 14:0,&#x0D; pentodecane C 15:0, palmitic C 16:0, margarine C 17:0, stearic C 18:0, oleic C 18:1, linoleum C 18:2, linolen C 18:3, arachidone C 20:4. Quantification of the spectrum of lipid fatty acids was performed by the method of normalization of planes and determined the proportion of acids in percents.&#x0D; Results. The fatty acid content of the oral fluid of patients in the main group was significantly different from the control parameters. 12% in patients with anorexia nervosa significantly increased the amount of saturated fatty acids by increasing the content of palmitic acid (C 16 0) and reducing stearic acid (C 18:0) by 2 times compared with control.&#x0D; It was established that the sum of unsaturated fatty acids was reduced by 2 times due to polyunsaturated fatty acids, and this level was significantly reduced by 2 times in comparison with control group due to 3 times reduction of linoleum fatty acid (C 18:2), linolenic fatty acid (C 18:3) 2-fold and unreliable increase in arachidone fatty acid (C 20:4), in comparison with the control, which in our opinion, reflects disturbance of the oxidant-antioxidant balance and is a marker of stress as an indicator of endogenous intoxication in patients with GP and anorexia nervosa.&#x0D; In patients with generalized parodontitis of primary-I, I–II degree, chronic course of anorexia nervosa in the oral fluid there was a significant violation of lipid metabolism – increase in the content of palmitic fatty acid (C 16:0) and decrease in the content of linoleic fatty acid (C 18:2).&#x0D; Conclusions. The revealed features of the course of GP in patients with anorexia nervosa indicate the need for additional treatment and prophylactic measures in this group of patients. Disorders of the fatty acid spectrum of the oral fluid in these patients were necessitate the inclusion in the traditional scheme of treatment of GP aimed at correcting the processes of antioxidant protection, which increase the effectiveness of therapeutic and prophylactic effects.