Immunodeficiency States Research Articles

<i>Camphora</i> Augments Humoral Mediated Immunity and Decreases Delayed type Hypersensitivity in BALB/c Mice

Background: Immunomodulation encompasses all therapeutic interventions aimed at modifying the immune response. The immune response augments are desirable to prevent infection in immunodeficiency states and fight established diseases. In this context, the present study investigated the effect of the homeopathic medicine, Camphora, in 6CH, 30CH, and 200CH potencies on immunomodulation in experimental animals. The acute oral toxicity study was also carried out in 6CH, 30CH, and 200CH potencies to determine the safe dose volume for the immunomodulatory study. Methodology: Acute oral toxicity studies of Camphora in 6CH, 30CH, and 200CH potencies were carried out as per OECD guideline 423 with slight modifications in Wistar albino rats. Humoral immunity, i.e., primary and secondary humoral responses, was assessed by measuring the hemagglutination titre of sheep red blood cells. Delayed-Type Hypersensitivity (DTH) was evaluated by measuring footpad thickness in BALB/c mice. Results: Camphora in 6CH, 30CH and 200CH potencies at a dose volume of 2000 µl/kg did not cause any mortality in the rats when administered as a single dose. Camphora in 6CH, 30CH and 200CH potencies showed augmented primary and secondary humoral responses against the SRBC antigen in BALB/c mice. However, the values were statistically non-significant except in the case of 6 CH potency (p<0.01), which showed statistically significant primary anti-SRBC antibodies. In the DTH assay, Camphora in 6CH, 30CH and 200CH potencies significantly decreased the paw volume ratio after 24 hrs of SRBC injection in the paw, thus insinuating its role in reducing cell-mediated immunity. Camphora in 6CH, 30CH and 200CH potencies also showed enhanced antibody titres and decreased paw volume compared to vehicle control, i.e. dispensing alcohol, suggesting that the effect was imminent because of Camphora. Conclusion: The study results indicate that Camphora in 6CH, 30CH, and 200 CH potencies is safe up to a dose volume of 2000 µl/kg when administered as a single dose, augments the primary and secondary humoral immunity, and decreases DTH in experimental animals. The current study’s findings suggest that Camphora might be useful as an immunomodulator in treating immune system disorders and infectious diseases and require further investigation to investigate its mechanism of action.

Molecular Markers of Blood Cell Populations Can Help Estimate Aging of the Immune System.

Aging of the immune system involves functional changes in individual cell populations, in hematopoietic tissues and at the systemic level. They are mediated by factors produced by circulating cells, niche cells, and at the systemic level. Age-related alterations in the microenvironment of the bone marrow and thymus cause a decrease in the production of naive immune cells and functional immunodeficiencies. Another result of aging and reduced tissue immune surveillance is the accumulation of senescent cells. Some viral infections deplete adaptive immune cells, increasing the risk of autoimmune and immunodeficiency conditions, leading to a general degradation in the specificity and effectiveness of the immune system in old age. During the COVID-19 pandemic, the state-of-the-art application of mass spectrometry, multichannel flow cytometry, and single-cell genetic analysis have provided vast data on the mechanisms of aging of the immune system. These data require systematic analysis and functional verification. In addition, the prediction of age-related complications is a priority task of modern medicine in the context of the increase in the aged population and the risk of premature death during epidemics. In this review, based on the latest data, we discuss the mechanisms of immune aging and highlight some cellular markers as indicators of age-related immune disbalance that increase the risk of senile diseases and infectious complications.

SARS-CoV-2 (COVID-19) infection in patients with HTLV-1 infection in Peru - case series

Introduction: Peru has suffered a prolonged sanitary emergency and has the highest COVID – 19 mortalities per capita in the world. Some risk factors (diabetes, HIV, cardiovascular diseases, etc.) are currently considered by the CDC to develop severe COVID-19 infection. CDC considers as possible risk factors (evidence is mixed), other immunodeficiency conditions, one of them would be infection by HTLV-1 (human T-cell lymphotropic virus type 1). It is not known whether subjects with HTLV – 1 infection have a higher risk for severe COVID – 19 disease. Materials and methods: We identified 51 patients with HTLV-1 and COVID-19. The patients recruited for this article belong to the HTLV-1 cohort of the Institute of Tropical Medicine Alexander von Humboldt - Cayetano Heredia Hospital and to the study cohort: "The effect of Strongyloides Stercoralis on HTLV-1 disease progression”. Periodic telemedicine follow-up was carried out on our patients during the lockdown from April 2020 to November 2021, and information related to SARS-CoV-2 infection was recorded. Results: 51 patients from cohorts were diagnosed with COVID-19 during the pandemic between April 2020 and October 2021. The majority are female (29 patients, 56.85%). 76.47% (39 patients) underwent a molecular/PCR, antigenic or serological test; while 23.53% (12 patients) developed symptoms compatible with COVID-19 in a context of family outbreak and positive direct contact. 74.51% (38 patients) developed a mild form of the disease, 15.69% (8 patients) a moderate form and 9.80% (5 patients) were asymptomatic. The most frequent symptoms were general malaise and/or fever (82.35%), headache (80.39%) and cough (76.47%). Discussion: the course of SARS-CoV-2 in patients infected with HTLV-1 follows similar patterns in percentage and symptoms compared to the general population. 81% usually develop a mild condition, while for our data 74.51% did. 14% usually develop moderate to severe disease worldwide, in our cohort, 15.69% developed moderate disease. The patients show a clinical picture similar to what is described in the literature as a common presentation of SARS-CoV-2. American studies show that the most frequent symptoms are headache (76%) and sore throat (65%); in our cohort, 80.39% reported headache and 35.29% sore throat. Conclusion: Patients with HTLV-1 who become infected with SARS-CoV-2 develop mild or moderate disease in similar proportions to the general population. More studies are needed to elucidate the risk of developing severe SARS-CoV-2 disease in patients infected with HTLV-1 and its associated comorbidities.

T-cell deficiency induces deficits in social behavior and dyslipidemia in mice.

Patients with neuropsychiatric disorders often exhibit an altered metabolic status. However, the underlying factors that induce behavioral and metabolic dysfunctions remain poorly understood. Therefore, we investigated whether behavioral and metabolic alterations could be induced in immunodeficient conditions. We found that T-cell-deficient Cd3e-/- mice exhibit deficits in social behavior associated with dyslipidemia. Cd3e-/- mice exhibited abnormal social novelty preference, but normal anxiety-like behavior. We also detected decreases in the concentrations of plasma triglyceride and the lipid transporter molecule fatty acid-binding protein 2. Furthermore, the adoptive transfer of T-cells to Cd3e-/- mice ameliorated the deficits in social behavior and recovered plasma triglyceride concentration. Thus, we found that T-cell disruption can induce defects in social behavior and systemic lipid homeostasis in mice. Given these findings, we believe that Cd3e-/- mice represent a useful tool for investigating the mechanisms of causal relationships among immune dysfunction, behavior, and metabolism.

Chronic diseases and mortality among hospitalised COVID-19 patients at Bafoussam Regional Hospital in the West region of Cameroon.

Reducing mortality among COVID-19 cases is a major challenge for most health systems worldwide. Estimating the risk of preexisting comorbidities on COVID-19 mortality may promote the importance of targeting at-risk populations to improve survival through primary and secondary prevention. This study was conducted to explore the contribution of exposure to some chronic diseases on the mortality of COVID-19. This was a case control study. The data were collected from the records of all patients hospitalised at Bafoussam Regional Hospital (BRH) from March 2020 to December 2021. A grid was used to extract data on patient history, case management and outcome of hospitalised patients. We estimated the frequency of each common chronic disease and assessed the association between suffering from all and each chronic disease (Diabetes or/and Hypertension, immunodeficiency condition, obesity, tuberculosis, chronic kidney disease) and fatal outcome of hospitalised patients by estimating crude and adjusted odd ratios and their corresponding 95% confidence intervals (CI) using time to symptom onset and hospital admission up to three days, age range 65 years and above, health professional worker and married status as confounder's factors. Of 645 included patients, 120(20.23%) deaths were recorded. Among these 645 patients, 262(40.62%) were males, 128(19.84%) aged 65 years and above. The mean length of stay was 11.07. On admission, 204 (31.62%) patients presented at least one chronic disease. The most common chronic disease were hypertension (HBP) 73(11.32%), followed by diabetes + HBP 62 (9.61%), by diabetes 55(8.53%) and Immunodeficiency condition 14(2.17%). Diabetes and Diabetes + HBP were associated with a higher risk of death respectively aOR = 2.71[95%CI = 1.19-6.18] and aOR = 2.07[95% CI = 1.01-4.23] but HBP did not significantly increased the risk of death. These results suggest that health authorities should prioritize these specific group to adopt primary and secondary preventive interventions against SARS-CoV-2 infection.

Application of Immunological Control for Prognosis the Productivity of Karakul Sheep

The article provides recommendations on the use of immunological methods and criteria for assessing the level of natural resistance, in order to select animals with high natural resistance. Karakul sheep of the sur (brown) color having a concentration of common immune proteins of serum blood (CIPSB) with a quantitative method of 32–50 mg/ml and a semi–quantitative method of 1.1–2.0 conventional units, cellular immunity according to the skin reaction (delayed hypersensitivity reaction DHR) of 7.0–9.0 mm are classified as highly resistant; with CIPSB 18–31 mg/ml and 0.71–1.0 conv. units, DHR on a skin test of 5–6 mm to medium–resistant and respectively CIPSB of 13–17 mg/ml and 0.4–0.66 conv. units, DHR on a skin test of 3–4 mm and lower to a low–resistant group of animals. The indexes of common immune proteins of serum blood of 8–12 mg/ml and less according to the quantitative method and 0.25–0.45 conv. units according to the indicator method, T–cell activity according to the skin test of 1.0–2.0 mm characterize the immunodeficiency condition. Studies have shown that the productivity of karakul sheep with a high level of natural resistance was higher than that of low–resistant ones. Karakul lambs with medium and high level of immunological reactivity quickly regained body weight after the stress factors of the weaning period, were better fed and weighed 33.6±0.45 and 34.5±0.35 kg at 8 months of age, the gain during the pasture fattening period was 8.2 ± 0.16 and 8.4± 0.11 kg, respectively, the average daily weight gain 91.1 g and 93.3 g, while animals with low immune reactivity weighed 30.3 ± 0.46 kg, where the gain over the entire period of pasture fattening was 6.7 ± 0.12 kg with an average daily gain of 74.4 g. Body weight of lambs which suffered immunodeficiency conditions in various colostral–milk periods was 28.1 ± 0.75 kg, weight gain 6.2 kg ± 0.08 kg and average daily weight gain 68.8 g. The meat productivity (slaughter weight) of lambs with medium and high immune reactivity was 2.03 kg and 2.71 kg or 14.03 % and 17.9 % higher than in lambs with low natural resistance, and 3.24 kg and 3.92 kg or 22.4 % and 25.9 % higher compared to lambs which had immunodeficiency syndromes.

How to use COVID-19 antiviral drugs in patients with chronic kidney disease.

Antiviral drugs such as Remdesivir (Veklury), Nirmatrelvir with Ritonavir (Paxlovid), Azvudine, and Molnupiravir (Lagevrio) can reduce the risk for severe and fatal Coronavirus Disease (COVID)-19. Although chronic kidney disease is a highly prevalent risk factor for severe and fatal COVID-19, most clinical trials with these drugs excluded patients with impaired kidney function. Advanced CKD is associated with a state of secondary immunodeficiency (SIDKD), which increases the susceptibility to severe COVID-19, COVID-19 complications, and the risk of hospitalization and mortality among COVID-19 patients. The risk to develop COVID-19 related acute kidney injury is higher in patients with precedent CKD. Selecting appropriate therapies for COVID-19 patients with impaired kidney function is a challenge for healthcare professionals. Here, we discuss the pharmacokinetics and pharmacodynamics of COVID-19-related antiviral drugs with a focus on their potential use and dosing in COVID-19 patients with different stages of CKD. Additionally, we describe the adverse effects and precautions to be taken into account when using these antivirals in COVID-19 patients with CKD. Lastly, we also discuss about the use of monoclonal antibodies in COVID-19 patients with kidney disease and related complications.

Evolutionary aspects of thymology in pediatric practice

The thymus is now considered a derivative of the immune system being, to greater extent, its central organ. Immunodeficiency states and immune dysregulation also depend on the quality of the thymus, which may be determined both genetically and by fetopathic approach as well as due to the possibility and mode of its intravital injuries, age-related involution over different periods of life. Not accidentally, there are various morphometric bipolar states of the thymus gland in the pediatric population (3-7%), whereas its size may be sufficiently larger or smaller than the reference variable values. In certain cases, the phenomenon of thymomegaly (for example, in newborns) is considered a result of genetic errors (neuro-endocrine-immune syndrome with thymomegaly) induced by the mutated Hox genes. This syndrome may also be associated with congenital heart disorders. Moreover, the excessive morbidity in respiratory infections (commonly, viral by their etiology) among young children with bipolar thymus conditions remains the subject of sharp discussions. Some works assessing immune status in the children subjected to forced thymectomy, e.g., during heart surgery, yielded quite controversial results, even in cases of subtotal removal of thymus gland.Dialectically, the concepts of “morphology” and “organ function” could not be separated from one another. The morphometric transformations in organs (even transient ones) occuring within the range of > 95 and < 5 percentiles, should be almost always underlied by a certain pathomorphosis which require verification of their causes and origin. Even today, however, the assessment of thymus pathomorphology in the deceased children is not always critical, being often descriptive. This situation is, probably, associated with extreme complexity of thymic morphology assessment. The final point seems to be not set in the discussion about immunodeficiency states or immune dysregulation among children with bipolar thymus transformations. This is due to current absence of reliable immune-mediated biomarkers, the limited availability of genetic diagnostics in primary immunodeficiency conditions, and a decreased interest of clinical science in the issues of bipolar conditions of the thymus gland at the early age, in the absence of longitudinal observations in this category of patients, etc. In this article, the authors attempt to draw attention of researchers to this problem.

Herpes zoster

Chickenpox, like herpes zoster, is caused by the same varicella-zoster virus, which belongs to the herpesvirus family. After chickenpox, the varicella-zoster virus can remain latent for life in the trigeminal ganglia and dorsal root ganglia. Reactivation of the virus occurs in immunodeficiency states against the background of malignant neoplasms, HIV infection, stress effects, and the use of immunosuppressive therapy. Internal organs may also be involved in the pathological process. Unlike chicken pox, the leading pathogenetic mechanism in herpes zoster is neurotropism. The incidence of herpes zoster is obser ved in persons who have had chick enpox.

Comparative study of hematopoietic reconstitution in patients of the Arnaldo Milian Hospital from Santa Clara

A mathematical model was applied to the hematopoietic reconstitution study of a group of thirteen patients with Hodgkin and Non-Hodgkin Lymphoma after having undergone Autologous Transplantation of Hematopoietic Progenitors in the Hematology Service of the Surgical Clinical University Hospital "Arnaldo Malian". Based on the model, the recovery process dynamics were computationally simulated, and the hematopoietic recovery times of each patient collected in the clinical data were compared with the times predicted by the simulations. Despite the simplicity of the mathematical model, it is surprising how well the reconstitution curves coincide with the clinical data collected, in such a manner that the model is able to predict with acceptable accuracy when hematopoietic recovery occurs. Model forecasts can be used to estimate the average duration of the pre-implant period, in which severe aplasia and immunodeficiency condition the occurrence of hemorrhagic and infectious complications that are often severe. In addition, it is an important tool for planning next patient´s transplant by the team, thereby reducing the time spent in planning the logistics required between one transplant and the next, which, in turn, will increase the number of patients benefited by this procedure.

Aspergillosis of the brain: diagnostic difficulties. Case report

Background: Neuroaspergillosis has nonspecific clinical manifestations and a severe course. Cases of central nervous system aspergillosis are becoming more frequent. Its lifetime diagnosis is very difficult. At the same time, a timely diagnosis makes it possible to conduct an adequate specific therapy and save the patient's life.
 Clinical case description: We report a clinical case of a patient with a lethal damage to the brain by filamentous fungi, who did not have the risk factors described in the literature human immunodeficiency virus (HIV), neutropenia, organ and tissue transplantation, long therapy with immunosuppressive drugs or corticosteroids.
 Conclusion: One needs to consider a possibility of this pathology in patients even in the absence of a fever and immunodeficiency conditions. A specific study of biological fluids for the presence of the galactomannan antigen may allow one to establish a timely correct diagnosis and apply an adequate treatment.

Acupuncture for cancer patients with nausea and vomiting: A protocol for systematic review and meta-analysis.

Nausea and vomiting are among the most common adverse effects experienced by cancer patients undergoing treatment worldwide. Their treatment with pharmacologic therapy can often be complicated by medication interactions and other unwanted side effects. The aim of this systematic review and meta-analysis protocol is to assess the effectiveness and safety of acupuncture therapy for treating nausea and vomiting in patients with cancer. Three electronic databases and 2 clinical registry platforms will be searched from inception to May 2022: the MEDLINE via PubMed, Embase via Ovid, the Cochrane Central Register of Controlled Trials via the Cochrane Library, the World Health Organisation International Clinical Trials Registry Platform, and National Institutes of Health Clinical trials.gov. Search terms will include nausea, vomiting, cancer, and acupuncture. Two researchers will independently select studies, extract data and assess the risk of bias. The primary outcome will be the incidence of nausea and/or vomiting or other validated outcome measures. Meta-analysis will be carried out using RevMan V.5.4. The quality of evidence from randomized clinical trials will be evaluated with the Grading of Recommendations Assessment, Development and Evaluation System tool. The results will provide a high-quality synthesis of evidence for clinicians in the field of oncology. The conclusion is expected to provide evidence to determine whether acupuncture is an effective and safe treatment for cancer patients with nausea and vomiting.

CONGENITAL IMMUNODEFICIENCY DISORDERS IN THE PEDIATRIC PRACTICE

Introduction. Congenital immunodeficiency disorders are genetic pathology that affect the immune system function and is important problem of modern medicine.
 Material and methods. This dates are performed the clinical case of the child with congenital complement deficiency.
 Results. Patient was diagnosed with allergic skin symptoms (atopic dermatitis, eczema), persistent bacterial infections of the upper and lower respiratory tract, late teething, diarrhea, chronic diseases of the gastrointestinal tract. That signs were manifestations of immunodeficiency states. During clinical and paraclinical examination the following data was detected in immunological blood test: decreased levels of CD3+-lymphocytes, CD3+CD8+-cytotoxic lymphocytes, CD19 +-lymphocytes. Gene panel of boy identifies one pathogenic variant in С8B (c. 1282C>T (p.Arg428*)), heterozygous, one pathogenic variant in C3 (c.2402C>T (p.Thr801Met)), heterozygous, which is associated with autosomal recessive and dominant. Uncertain significance variants were detected. Genetic signs in family members were also detected.
 Conclusion. Genetic testing for identifying of congenital defects is very important in primary immunodeficiency diagnostic process.

Immune responses to human fungal pathogens andtherapeutic prospects.

Pathogenic fungi have emerged as significant causes of infectious morbidity and death in patients with acquired immunodeficiency conditions such as HIV/AIDS and following receipt of chemotherapy, immunosuppressive agents or targeted biologics for neoplastic or autoimmune diseases, or transplants for end organ failure. Furthermore, in recent years, the spread of multidrug-resistant Candida auris has caused life-threatening outbreaks in health-care facilities worldwide and raised serious concerns for global public health. Rapid progress in the discovery and functional characterization of inborn errors of immunity that predispose to fungal disease and the development of clinically relevant animal models have enhanced our understanding of fungal recognition and effector pathways and adaptive immune responses. In this Review, we synthesize our current understanding of the cellular and molecular determinants of mammalian antifungal immunity, focusing on observations that show promise for informing risk stratification, prognosis, prophylaxis and therapies to combat life-threatening fungal infections in vulnerable patient populations.

A case of extensive verrucosis in 45-year-old women and CD4 lymphopenia treated with electrodessication using general anesthesia and isoprinosine

The human papilloma virus (HPV) is a viral infection that has a broad variety of clinical manifestation. The clinical manifestation really depends on the type of HPV virus and the immunity status of the host, particularly the cell-mediated immunity. Extensive verrucosis is one of the significant clinical manifestation of a disseminated HPV infection that is related with a severe immunodeficiency status. Electrodessication or laser surgery is a method of treatment that could directly destroy the lesion in one time. We described a case of a 45 years-old woman with extensive verrucosis. The patient complained multiple warts lesion on the hands, face, neck, lower arms and lower extremities since eight years ago. Physical examination revealed on the dorsum and palmar hands, both of finger nails (I, II, III, and IV), face (forehead and cheeks), anterior of neck, lower arms and 2/3 distal of lower extremities part anterior, there were single and groups of flesh coloured papules and flesh coloured plaques, skin colour papules with flat topped, greyish papules and greyish plaques with verrucous surfaces and brownish crusts. The CD4 count of the patient was 91 cells/µL. Skin biopsy and histopathology examinations showed hyperkeratosis, papillomatosis, and acanthosis with vacuole cell (koilocytes). The patient was treated with electrodessication using general anaesthesia and isoprinosine 3x500 mg. The result after two weeks post-treatment showed that there were no new lesions appeared on post electro surgery site. This case highlights the importance of the treatment for the success of extensive verrucosis with CD4 lymphopenia.

ПРИЧИНИ РЕЦИДИВІВ ТУБЕРКУЛЬОЗУ ЛЕГЕНЬ

Being a significant source of tuberculosis (TB) spread and the factor adversely affecting its epidemiological parameters, the relapses of TB remain a relevant problem. Aim: to establish the causes of pulmonary TB relapse (PTBR) and to evaluate its significance. Materials and methods – 80 phthisiologists have been interviewed using a special PTBR questionnaire. According to the results, the causes were divided into medical, organizational and social ones. Statistical analysis determined the degree of their significance (low, medium, high). Results. The most significant medical causes of PTBR were inadequate treatment, immunodeficiency, HIV infection, comorbidities, advanced TB, extensive residual lesions, drug adverse reactions. The organizational causes included low coverage of the population with fluorography, lack of follow-up, active detection and prophylaxis of cases in groups of risk, financial and infrastructure difficulties, poor medical-social support and population TB awareness, lack of fast diagnostics, poor management of comorbidities, lack of closed-type hospitals, stigma of TB patients, imperfect legislative base. The list of social causes consisted of low compliance to therapy, poor living and working conditions, low sanitary culture, migration of population and low social support. Among the significant (1-3 ratings) of social causes of RTBL respondents are: interrupted treatment (91,2 %), low commitment to treatment (83,7 %) and poor working conditions (71,2 %); p <0.05, among the average significant-unsatisfactory financial conditions, stay in prison and unemployment (65,0–35,0 %); p > 0,05, among others – careless attitude to one’s own health, low sanitary culture of the population, loneliness, low informative level of social institutions, migration of the population, homelessness, bad habits, poor nutrition, stress. Conclusions. The most significant medical factors of RTB development are: inadequate treatment of TB, immunodeficiency states, HIV infection, concomitant diseases, abandoned TB, major residual changes, side effects of medicines; organizational: low coverage of fluorography, lack of dispensary and active detection and prevention of TB in risk groups, financial and infrastructure difficulties, insufficient medical and social support, inaccessibility of rapid diagnosis absence of closed-type hospitals, stigma patients with TB, imperfect legislative framework; social: the disadvantage of treatment, unsatisfactory social and living conditions, low sanitary culture, population migration, social insecurity. Since the most threatening causes of PTBR were the limitations with the treatment of the newly detected TB cases we proposed considering “completion of the treatment course” as a conditionally effective treatment outcome and continue follow-up until final cure confirmation. Identifying a significant number of organizational limitations, as indicated by phthisiologists, raises the doubts about the transfer of out-patient management and follow-up of TB risk groups patients to primary care practitioners, who are not ready for this, mainly psychologically, and refusing from follow-up of newly detected TB and a significant reduction of the TB service. We believe that it would be advisable to restore dispensary follow-up (1 to 5 years) in the presence of such risks of PTBR as the extensive residual lesions, various immunodeficiency states, severe concomitant diseases and HIV infection. A considerable number of social factors for PTBR, aggravated by current war, will lead to a deterioration of the epidemic situation with TB, including the increase in the number of PTBR. In order to prevent a significant deterioration of the epidemiological situation with TB due to PTBR, we plan to develop the preventive organizational measures. Key words: tuberculosis, relapses, causes, questionnaires.

Oral Manifestations of Sinonasal Mucormycosis in Post-COVID Patients with Diabetes Mellitus: Three Case Reports

ABSTRACT Sinonasal mucormycosis is a debilitating disease known to affect the nose, paranasal sinuses, orbit, and brain parenchyma caused by a group of opportunistic fungal organisms called mucormycetes. The incidence of mucormycosis cases had increased during the pandemic. Mucormycosis commonly involves the rhinomaxillary region in patients with uncontrolled diabetes mellitus, hematological malignancies, prolonged corticosteroid therapy, or immunodeficiency state but has lately been reported as one of the post-COVID-19 complications. For more than a century, diabetic patients have been considered as immunosuppressed due to defects in phagocytosis and microbial killing. Post-COVID-19 patients with mucormycosis often report to the dentist at an early stage with tooth pain usually radiating or later with facial swelling and periodontally weakened teeth. Early diagnosis of this potentially life-threatening disease and prompt treatment are of prime importance in reducing the morbidity and mortality associated with the disease. This article presents three cases of sinonasal mucormycosis in post-COVID-19/non-COVID-19 pneumonia-like symptoms recovered diabetic patients. This paper stresses the importance of identifying oral signs and symptoms that will help in the management of disease at an early stage and about the oral rehabilitation options in maxillectomy cases. CLINICAL RELEVANCE TO INTERDISCIPLINARY DENTISTRY As healthcare providers, we play a vital role in the early detection of mucormycosis cases.

Особенности проявления синдрома делеции 22Q11.2 хромосомы в раннем возрасте

DiGeorge syndrome is characterized by conotruncal heart defects, an immunodeficiency state, and underdeveloped parathyroid glands. Contemporary medicine describes more than 180 clinical forms of this disease, which are usually classified under the heading “chromosome 22q11.2 deletion syndrome” (D 82.1). Along with the above abnormalities, there are other malformations and pathological conditions in 22q11.2DS that not only complicate diagnosis, neonatal nursing, and further management, but also lead to an increased frequency of surgical interventions. This article presents 8 clinical cases of 22q11.2DS with multiple congenital disorders. The children under observation had malformations of the central nervous, maxillofacial, genitourinary, musculoskeletal systems, anorectal region, as well as diaphragmatic and inguinal hernias. Key words: multiple congenital disorders, 22q11.2 deletion syndrome, DiGeorge syndrome, conotruncal congenital heart defects, cleft lip and palate, anorectal malformations, hypoparathyroidism, delayed speech and psychomotor development, primary immunodeficiency

СОВРЕМЕННЫЕ ВОЗМОЖНОСТИ ДИАГНОСТИКИ И ЛЕЧЕНИЯ ОТОМИКОЗОВ

Оtomycosis is a fungal infection affecting the structures of the external auditory canal, middle ear, as well as the postoperative cavity of the mastoid process after mastoidotomy. Despite the rapid progress of modern medicine, the number of patients with fungal infections of the ENT organs, in particular the outer and middle ear, including the postoperative cavity of the middle ear, is growing every year. Fungi make up a vast group of lower chlorophyll-free plants. The group of fungi pathogenic for humans includes multicellular and unicellular microorganisms of various origins, different habitats and living conditions. Conditionally pathogenic fungi are widespread in the environment and constantly come into contact with the macroorganism, being commensals, the inflammatory process caused by them should be considered as a manifestation of a violation of the biological protective barriers of the body. The reasons for this are: immunodeficiency states, the use of broad-spectrum antibiotics, corticosteroids and mechanical trauma to the ear. The author analyzes the literature and statistical data about the prevalence of certain types of fungi in case of ear affection, the clinical picture depends on the pathogen, as well as what methods of treatment and diagnostics are used to treat otomycosis. Modern methods of conservative therapy have good results in the treatment of otitis externa. However, there are very few data on the topic of surgical treatment of fungal lesions of the middle ear, as well as postoperative cavities. In general, this topic is relevant for modern society, written in good language in compliance with all the rules for the publication of scientific works and is recommended for publication in the open press.

Risk factors for and incidence of hospital-acquired infections after cardiac surgery in children with congenital heart disease: a single center experience.

The epidemiology of hospital-acquired infections (HAIs) has been less well studied in critically ill children in pediatric cardiothoracic intensive care units. This study aimed to investigate independent risk factors for and incidence of HAIs after cardiac surgery in children with congenital heart disease (CHD). Our study included 574 patients who underwent congenital heart surgery and were followed up in the cardiothoracic intensive care unit between September 2016 and December 2020. All patients were divided into four groups according to age: 0-1 months, 1-6 months, 6-12 months, and 1-18 years, and into two subgroups according to HAI development. The patients` median age and weight at surgery were 3.28 (interquartile range [IQR]): 0.43-8.1) months and 4.34 (IQR: 4.34-6.69) kg, respectively. HAIs and infection-related deaths were observed in 223 and 21 patients, respectively. Age at surgery, weight at surgery, concomitant syndromes and immunodeficiency status, presence of cyanotic heart disease, intubation, and use of antibiotics during hospitalization were statistically significant between the two groups with and without infection (p < 0.05). In logistic regression analysis, surgical weight < 5 kg (odds ratio [OR]: 2.55; 95% confidence interval [CI]: 1.56-4.17; p < 0.001), preoperative mechanical ventilation (OR: 2.0; 95% CI: 1.26-3.12; p=0.003), complexity of cardiac surgery according to the risk-adjusted congenital heart surgery classification score 3 (OR: 3.13; 95% CI: 1.24-7.92; p=0.016), presence of an concomitant syndrome (OR: 1.56; 95% CI: 1.02-2.88; p=0.040), age (OR: 1.01; 95% CI: 1.01-1.04; p=0.044) were independent risk factors for HAIs after cardiac surgery in children with CHD. In this study, younger age, presence of an associated syndrome, preoperative mechanical ventilation, and weight less than 5 kg were found to be independent risk factors for HAI after cardiac surgery in children with CHD.