Intoxication Index Research Articles

Evaluation of endogenous intoxication indicators in the dynamics of experimental periodontitis and immobilization stress

The aim of our work was to investigate the peculiarities of changes in endogenous intoxication rates: medium mass molecules (MMM) and erythrocyte intoxication index (EII) in the blood of guinea pigs in the formation of combined pathology - experimental periodontitis (EP) and immobilization stress (IS).The results of biochemical studies showed that at all stages of development of combined pathology - experimental periodontitis and immobilization stress there is a consistent increase in the degree of endogenous intoxication, which dominated on the 15th day of the experiment, namely increased content of medium mass molecules (МMМ254 , MMM280) and EII in the blood by 58.5% (p≤0.05), 80.3% (p≤0.05) and 95.7% (p≤0.05), respectively, compared with the first group of animals is a clear manifestation of the formation of endogenous intoxication. These changes are obviously the result of insufficient elimination of toxic products on the background of the inflammatory process in periodontal tissues and stress.

Nonspecific adaptive reactions of hen’s body under the influence of light wavelength

The sources of artificial light of the latest generation in poultry farming are LED lamps, which are able to give monochrome light. It is known that the wavelength of light affects the behavior, well-being and productivity of birds, but the effect of changing the wavelength of light under monochrome light has not yet been studied. Nonspecific adaptive reactions of hens under the influence of light wavelength of monochrome light have been studied. For this purpose, in the conditions of a modern complex for food eggs production, 4 groups of hens of industrial herd «Hy-Line W-36» were formed, each of which was kept in a separate poultry house-analogue in terms of area and cage equipment. Hens of the 1st group were kept using LED lamps with a peak light wavelength of 460 nm, the 2nd group — 600 nm, the 3rd group — 630 nm and the 4th group — 650 nm. To assess the adaptive and overall reactive immunological potential of hens, integrated immunohematological indices of intoxication, inflammatory activity and nonspecific reactivity were determined on the ba­sis of an extended general blood test. It was found that a decrease in the wavelength of light increases the indices of leukocyte shift, the heterophiles to leukocytes ratio, immunoreactivity, the heterophiles to monocytes ratio, the lymphocytes to monocytes ratio and the lymphocytes to eosinophils ratio. This indicates a shift of the leukocyte formula to the left, the predominance of nonspecific protective cells due to a functional increase in bone marrow proliferative activity and is expressed in increased heterophiles, increased activity in the microphage-macrophage immune response system and indicates the presence of high levels in the body and impaired immunological reactivity, and can inform about the autoimmune nature of the pathological process. It is shown that at the same time there is a decrease in lymphocytegranulocyte index, leukocyte-ESR ratio, total and lymphocyte indices, which confirms the shift of the leukocyte formula to the left and indicates a predominance of activation of the cellular link due to intoxication. Simultaneous increase in the leukocyte shift index and decrease in the lymphocyte-granulocyte index indicates the development of endogenous intoxication in hens and impaired immunological reactivity due to autointoxication of the body during the destruction of its own cells.

Influence of systemic inflammation predictors on the premature labor of hiv-infected women living in Subarctic region

The goal is to conduct a comparative analysis of the characteristics of blood counts of pregnant women with HIV living in the subarctic climatic zone of the Khanty-Mansiysk District, as predictors of a systemic inflammatory reaction on the background of infection and pregnancy complicated by preterm delivery.Material and methods. A retrospective analysis of 78 stories of pregnant women with HIV (main group II) was carried out, in 2016–2018. observed in one antenatal clinic in the city of Surgut. Control group (I) comprised 20 histories of pregnant women without HIV. Clinical-anamnestic and blood parameters were compared, including indicators of T-helpers, T-suppressors and viral load, leukocyte intoxication indices, hemoglobin, erythrocytes and platelets by trimesters of pregnancy. The material was processed using the Statistica-10 software system. The critical level of statistical significance was taken at p<0,05.Results. A comparative analysis of blood counts of pregnant women living in the subarctic region showed a relationship between the preterm labor of patients with HIV with a progressive decrease in the T-cell level of immunity, an increase in the level of lymphocytes and leukocyte blood indices, a decrease of hemoglobin, erythrocytes, platelets, against the background of persisting viral load for the remainder of pregnancy. A decrease of T-lymphocyte counts indicates the development of a systemic inflammatory response on the background of HIV infection, depletion of the immune defense organs and the progression of the disease, while a low level of CD4 lymphocytes stimulates the activation of granulocytes in the blood and indicates further depletion of T-lymphocytes. Activation of a systemic inflammatory response that promotes the release of inflammatory mediators and prostaglandins and, with a high probability, underlies the mechanisms of rejection of the fetus and placenta and the spontaneous preterm labor. The comorbid background of pregnant women with HIV and preterm labor is associated with low adherence to HAART therapy and high detectable viral load throughout gestation.

Predictive risk factors for the development of diseases with lymphoproliferative syndrome in children

Background. Harmful environmental factors and negative social trends have an adverse effect on the adaptive resources of the child’s body, which in combination reduces the health index in the child population. An ambiguous epidemiological situation, an increase in morbidity rates in children, a variety of clinical manifestations of Epstein – Barr viral infection, recurrent respiratory diseases, adenovirus infection complicate their differential diagnosis in the early stages. In this regard, the assessment of risk factors and early prognosis of the development of primary form of Epstein – Barr viral infection (EBVI), recurrent respiratory diseases (RRD), adenovirus infection (ADVI) in children is an urgent task.The aim: to study the significance of risk factors influencing the development of diseases with lymphoproliferative syndrome in children.Materials and methods. Clinical and laboratory examination and analysis of case histories of 336 children and adolescents held with diseases with lymphoproliferative syndrome. Data from 30 apparently healthy children and adolescents of the same age were used as a comparison group. The Bayesian method with sequential Wald analysis was used to assess risk factors. ROC-analysis was used to check the adequacy of the forecasting models. The quality of the built models was evaluated by their sensitivity and specificity.Results. It has been established that predictors of diseases with lymphoproliferative syndrome in children are intrauterine fetal hypoxia, low or, on the contrary, high birth weight, neonatal jaundice, low Apgar score, as well as maternal factors (somatic pathology and SARS during pregnancy, gestosis, gestational anemias, young or mature age of the pregnant women). Additional predictors of the development of this pathology can be considered a decrease in the indicator of the cell-phagocytic potential to 337.1 ± 2.3 CU, a decrease in the immune-lymphocytic potential to 237.0 ± 8.2 CU, an increase in the load-erythrocyte coefficient to 0.67 ± 0.03 CU and a decrease in the leukocyte index of intoxication to 0.40 ± 0.05 CU.Conclusion. The combination of clinical and anamnestic factors with indicators of general reactive potential increases the integral general informative value of the prognostic model. The accounting by specialists of the general medical and preventive network of the identified predictors of the development of diseases with lymphoproliferative syndrome will contribute to the timely diagnosis of the primary form of Epstein – Barr viral infection, recurrent respiratory diseases and adenovirus infection in children.

Comprehensive non-drug programs in the treatment of acute inflammatory diseases of the maxillofacial region

The article presents the results of treatment of patients with acute inflammatory diseases of the maxillofacial region using non-drug methods of treatment. Study material: 60 patients with acute purulent-inflammatory diseases of the maxillofacial region (phlegmons and abscesses), who were divided into 2 groups: the main group — 30 patients who underwent a course of complex application of broadband electromagnetic therapy and low — frequency alternating electrostatic field and the control group — 30 patients who were treated with drug therapy (antibiotics, metronidazole group drugs, antihistamines, multivitamins, detoxification therapy, local treatment of the wound process), which served as the background in the main group. Objective: to develop and scientifically substantiate the complex application of broadband electromagnetic therapy and low-frequency alternating electrostatic field in patients with inflammatory diseases of the maxillofacial region. Results. In a comparative aspect, the dynamics of the indicators of the leukocyte intoxication index (LII) and the main indicators of the morphological picture of the blood before and after treatment in patients with HIA CHLO under the influence of the developed complex was studied. Conclusion. The developed complex, which includes a low-frequency alternating electrostatic field and broadband electromagnetic therapy, contributes to the formation of pronounced anti-inflammatory and detoxifying effects in patients with inflammatory diseases of the maxillofacial region due to a significant reduction in endogenous intoxication, which allows us to recommend it for inclusion in complex therapeutic and rehabilitation programs after surgical interventions to accelerate the time of purulent wound cleansing and reduce the length of hospital stay.

NEW POSSIBILITIES OF ANTIBIOTIC THERAPY IN THE TREATMENT AND PREVENTION OF I NFECTED ACUTE PANCREATITIS

Summary. Introduction. One of the most difficult problems in surgery today is the treatment of acute pancreatitis, which remains the third most frequent acute surgical disease. The frequency of the latter is growing every year. Despite the achievements of pharmacotherapy and infusion therapy, mortality in acute pancreatitis remains at the level of 15–45 %, and in the development of purulent complications it reaches 70–80 %.
 The urgency of the problem. The use of antibiotics for complicated pancreatic necrosis is obvious, but antibiotic therapy does not always lead to the desired result. Given this, the attitudes of surgeons to the use of antibiotics do not coincide, especially when it comes to their preventive use. The above determines the urgency of the problem.
 Purpose of work. To study the possibilities of new ways of supplying antibiotics to the pancreas in its acute inflammation.
 Materials and methods. We have studied the immediate results of the use of antibiotics in acute pancreatitis in the conditions of their introduction by the lymphotropic route. The examination of patients was performed according to generally accepted methods, including ultrasound at admission and on the 4th day of treatment.
 Results and discussion. During the first 4 days of treatment, the patient’s condition almost normalized: the pain in the first day was localized in the epigastrium, changing from cutting and «tearing» to dull; weakness, dry mouth disappeared and the temperature returned to normal. The number of leukocytes decreased from (10,5 ± 3,8)×109/l to (6,6 ± 2,4) × 109/l. The leukocyte index of intoxication according to Calf-Calif decreased by (2,63 ± 0,7) cu, ESR – normalized, the amount of blood amylase decreased on average from 500 cu. up to 50 cu. This was due to a decrease in the volume of the pancreas in the head, body, cauda by 6,4 – 3,9 – 7,0 mm, respectively.
 Conclusions. The lymphotropic route of administration of antibiotics to the inflamed pancreas contributed to its reduction, which was accompanied by an improvement in the indicators of the inflammatory process according to Calf-Caliph, a decrease in the number of leukocytes and ESR, reduced gland volume and elimination of pain and other signs of the disease by the 4th day.

Клініко-лабораторне обгрунтування удосконалення методу лікування фурункулів та карбункулів щелепно-лицевої ділянки

Selection of medications to apply locally for treatment of abscessive forms of boils and carbuncles of maxillofacial area still remains a debatable issue, despite their wide range. Alternative means for application use in surgical interventions in maxillofacial area are medications of natural origin. Drugs of natural origin that have anesthetic and anti-inflammatory properties include cayenne pepper fruits (Capsicum annuum). Therapeutic properties are caused by the presence in their structure of the main active ingredient – capsaicin alkaloid and other biologically active compounds (vitamins, flavonoids, minerals, etc.) which influence the main pathogenetic inflammation bonds. Capsaicin has a distinct keratoplastic effect and normalizes microcirculation in the tissues. Phytogel with anti-inflammatory and anesthetic action (patent for utility model No. 30032 “Phytogel with anti-inflammatory and anesthetic action”) was developed for clinical use based on phytosubstance of pepper cayenne fruits (patent for utility model No. 19547 “Method of obtaining phytosubstance with anti-inflammatory action”). The purpose of the study was to increase treatment efficiency of boils and carbuncles of maxillofacial area by using a medication based on the capsicum annuum fruits. Materials and methods. The analysis of inspection and treatment results of 45 patients having boils and carbuncles of maxillofacial area at abscessing stage is carried out. On the first, third, seventh and tenth day of treatment, a number of clinical indicators (presence and intensity of edema and infiltrate, condition of regional lymph nodes, presence and intensity of pain in the inflammation site, time of wound exudate clearance, intensity of regeneration, length of hospital stay treatment) and indicators obtained by laboratory methods (total number of leukocytes, leukocyte intoxication index, erythrocyte sedimentation rate) were studied and compared with the same parameters in the control group, where traditional treatment was carried out; and when using the comparison medication - 3% propolis ointment. Results and discussion. Analysis of the results showed that despite the similarity of the clinical picture and laboratory parameters on admission to the hospital, the healing of purulent wounds under the influence of capsicum annuum phytogel was more effective comparing with traditional methods of surgical treatment. Thus, wound epithelialization of patients in the experimental group No. 1 was observed on average on the seventh day, which was significantly faster than in other experimental groups. Sanation of the inflammatory focus also decreased body intoxication, which can be traced by the dynamics of changes in the degree of leukocytosis, leukocyte intoxication index, erythrocyte sedimentation rate. On the tenth day, the clinical blood parameters of patients of the experimental group No. 1 were close to the average norm. As a result, the length of stay in hospital was significantly reduced. The average bed-day for the experimental group No. 1 was 7.5 days, which is authentically less than for patients of the control and experimental group No. 2. Conclusion. According to the results of clinical and laboratory studies, the efficiency of the proposed method has been proved in comparison with traditional treatment of boils and carbuncles of maxillofacial area

Клиническое течение и распространенность ожирения в сочетании с дисфункцией сфинктера Одди по панкреатическому типу у подростков

Актуальность. Гастроэнтерологические проявления ожирения являются актуальной проблемой медицины вследствие взаимоотягощающего характера. Цель работы: изучить распространенность и клинические особенности течения у подростков с алиментарно-конституциональным ожирением и сопутствующей дисфункцией сфинктера Одди по панкреатическому типу и без данного сочетания. Материалы и методы. Обследованы 120 подростков с алиментарно-конституциональным ожирением в сочетании с дисфункцией сфинктера Одди по панкреатическому типу, которые находились на лечении в областной детской клинической больнице г. Ивано-Франковска за период с 2016 по 2019 год включительно. Больные подлежали комплексному обследованию в соответствии с современными протоколами диагностики и лечения. Результаты. Распространенность ожирения по Украине, по данным статистики, составляла 13,4 % на 1000 детского населения. Среди пациентов преобладали мальчики (70,0 и 30,0 %, р < 0,05). Продолжительность болезни у большинства детей с сочетанной патологией составила 6,0 ± 2,1 года, а в случае изолированного течения заболевания — 4,5 ± 3,1 года. К доминирующим факторам риска вовлечения поджелудочной железы в патологический процесс относились: генетическая предрасположенность (наличие ожирения или избыточной массы тела у одного или двух родителей), гиподинамия и нарушение рациона питания (преобладание мучных изделий и сладостей), реже — недостаточный питьевой режим. Среди клинических проявлений сочетанной патологии доминировала спастическая боль с локализацией в левом подреберье и продолжительностью несколько часов, которая плохо снималась спазмолитиками (75,0 и 25,0 %, c2 = 17,69, р < 0,05). Общий диспептический индекс (вздутие живота и понос) у детей с сочетанной патологией был выше, чем у остальных обследованных (5,01 ± 0,06 и 3,02 ± 0,04 балла, р < 0,05). Интоксикационный индекс за счет общей слабости был самым высоким в когорте детей с алиментарно-конституциональным ожирением и функциональным панкреатическим расстройством (7,02 ± 0,06 и 3,50 ± 0,02 балла, р < 0,05). Выводы. Ожирение часто сочетается с функциональной патологией поджелудочной железы, а отдельные клинико-лабораторные маркеры и факторы риска вовлечения поджелудочной железы в патологический процесс должны лечь в основу обновленных протоколов диагностики и лечения.

The intensity of endogenous intoxication syndrome and methods of its therapy for the urinary system infection in children

Endogenous intoxication syndrome is one of the leading syndromes in high urinary system infection activity in children. The study of clinical and laboratory manifestations of endogenous intoxication syndrome with the aim of optimizing its methods of therapy is topical. The examination was conducted in 52 children aged 3–7 years, including 22 children with active forms of pyelonephritis and 30 almost healthy children (control group). Endogenous intoxication syndrome was determined by clinical signs and by the level of leukocyte index of intoxication and medium-sized molecular peptides in blood plasma. Statistical analysis was carried out on the basis of Student’s t-test (p<0.05), the frequency of symptom occurrence (q) in relation to the totality in the group taken for 1 and the coefficients (Q) of the ratio of the comparable indicators in groups. In the control group, the leukocyte intoxication index did not exceed 1.0, the average molecular peptides— 0.24 conditional units. Most patients (q-0.73) had a moderately severe course, expressed symptoms of intoxication, pain abdominal syndrome (q-0.73), dysuria (q-0.73), high temperature (q-0.73). In complex therapy, prebiotic (complex fructoolygosaccharides, inulin and maltodextrin) was prescribed in age dosage for three weeks. Detoxification therapy contributed, first of all, to the positive dynamics of clinical manifestations of the intoxication syndrome. During the first two days, the temperature reaction decreased; on the 4-5th day, the general condition improved, other symptoms of intoxication disappeared; highly reliable (p<0.001) positive changes in the studied indicators were found within 3 weeks. They were characterized by the normalization of the level of leukocyte index of intoxication and medium-sized molecular peptides, which justifies the use of prebiotic products in the complex therapy of urinary system infection in children.

Diagnosis of severity and choice of tactics for the treatment of pelvic inflammatory diseases in women

Purpose of the study: to analyze the diagnosis of severity and the choice of treatment tactics for pelvic inflammatory diseases in women.Material and methods. The analysis of clinical studies of 14 women with pelvic inflammatory diseases, including 9 women who were treated conservatively and 5 patients who underwent urgent surgical treatment in the City Clinical Hospital №1 of the city of Odesa in 2020-2021, was carried out. For the diagnosis of the severity of the disease and the choice of tactics for the treatment of pelvic inflammatory diseases, the level of procalcitonin and the data of calculations of the leukocyte index of intoxication of Kalf-Kalif were taken into account.Results. The average age of the patients participating in the study was 34.1 ± 1.2 years, the median was 33.5 years, and the mode was 32 years. The average age of patients who were operated on for pelvic inflammatory diseases was 37.4 ± 1.3, while the average age of patients treated conservatively reached 32.2 ± 1.4 years. The patients were in the hospital for 4 to 10 days, on average - 6.9 ± 0.4 days. In patients who underwent conservative treatment, the level of procalcitonin averaged 1.14 ± 0.3 ng / L, while in operated women, it was 3.67 ± 0.6 ng / L. At the same time, the average index of the leukocyte index of intoxication in women receiving conservative therapy was 2.2 ± 0.1, and in patients who were subsequently operated on 2.9 ± 0.2. A comparative assessment determines the strong and direct relationship between procalcitonin and leukocyte intoxication index (rS = 0.78; p <0.05). There was a significant increase in the level of procalcitonin and the leukocytic index of intoxication in women who were subsequently operated on OR = 2.0; RR = 7.2.Conclusions1. In a comparative assessment of the severity state, strong and direct relationships between procalcitonin and the leukocyte intoxication index (rS = 0.78; p <0.05) are determined in women with pyoinflammatory diseases of the pelvic organs.2. In women who were subsequently operated on, a significant increase in the level of procalcitonin and the leukocyte index of intoxication OR = 2.0 was revealed; RR = 7.2.3. The analysis for the content of procalcitonin in most cases requires time (up to 1 working day), which is sometimes unacceptable when it is necessary to make a clinical decision on further treatment tactics.4. The data for calculating the leukocyte index of intoxication can be used after receiving the results of a general blood test. But the calculation of the leukocyte index of intoxication also takes time and is not always convenient. Therefore, it makes sense to use a simplified and more mobile intoxication index.5. The data obtained require more extensive and detailed analysis and should be used in a prospective study with a larger sample to choose the tactics for treating women with pelvic inflammatory diseases and the possibility of predicting postoperative purulent-septic complications.

Effects of flavonol quercetin on syndrome of endogenous intoxication in experimental periodontitis

The article presents the results of study effect of quercetin on the indicators of endogenous intoxication syndrome under conditions of experimental periodontitis. One of the key links in the pathogenesis of any inflammatory disease, including maxillofacial area, is endogenous intoxication, an important pathophysiological mechanism of which is the activation of lipid peroxidation. The experimental animals were treated by intramuscular injections with water-soluble quercetin for 7 days. For further research the blood serum was selected in which was determined the content of middle molecular weight molecules and erythrocyte intoxication index. Excessive lipoperoxidation was accompanied by accumulation of peroxidation products and depletion of antioxidant reserves, which led to accumulation of toxic substances. That is why the study of the level of middle molecular weight molecules and erythrocyte intoxication index in simulated bacterial-immune periodontitis is a reliable criterion. Quercetin was able to reduce the expression of endogenous intoxication syndrome in experimental bacterial-immune periodontitis.

Characteristics of endotoxicosis in pulmonary gangrene

Aim. The study of various indicators of endotoxicosis, including lymphological, with gangrene of the lungs.Materials and methods. The study group consisted of 21 adult patients with extensive and limited pulmonary gangrene, who were drained of the thoracic or right lymphatic ducts for the treatment of endotoxicosis with subsequent lymphosorption and lymph reinfusion. The control group included 22 adult patients with pulmonary abscesses in the convalescent stage, for whom the right or thoracic lymphatic ducts were drained for therapeutic purposes, followed by lymphosorption and lymph reinfusion for 3 days. The main clinical parameters were studied: the intensity of cough and the daily volume of excreted sputum, its ichorous smell, pain at the site of pathology, body temperature, pulse, respiratory rate, liver size, sleep and appetite. The laboratory parameters were determined – in the blood tests, leukocytosis, toxic granularity of neutrophils, and the leukocyte index of intoxication were detected. Studied the number of molecules of average weight in the blood and lymph. New methods for the diagnosis of endotoxicosis were developed and applied, based on indicators of extravascular fluid of the lungs and indicators of continuous measurement of the volumetric flow rate of lymph flow from the lymphatic ducts.Results. Pulmonary gangrene is accompanied by severe and extremely severe de grees of endotoxicosis, while the indices of endotoxicosis in the lymph are significantly higher than in the blood. The greatest parameters of endotoxicosis in pulmonary gangrene were determined in the lymph of the right lymphatic duct, which drains 2/3 of the pulmonary lymph. When draining the right or thoracic lymphatic ducts with gangrene of the lungs, the most accurate method for the study of endotoxicosis is the priority method of continuous measurement of the volume rate of lymph flow, taking into account the back pressure of the venous blood pressure.

Assessing the relationship of respiratory muscle strength and cytokine status in patients with community-acquired pneumonia

Aim. Assessment of the role of cytokine-mediated changes in the development of respiratory muscle (RM) dysfunction in patients with community-acquired pneumonia (СAP). Methods. 84 men aged 18 – 26 years with a median of age 19.5 [18.4; 22.8]. Mild to moderate CAP (MCAP) was diagnosed in 62 (73.8%) patients and severe (SCAP) in 22 (26.2%). The expiratory (MEP, MRPDout) and inspiratory (MIP, MRPDin. SNIP) strength indices of RM were recorded on a MicrоRPM apparatus (CareFusion, UK). The severity of endogenous intoxication was verified using the following indices: hematologic (HII), leukocyte (LII), and nuclear. Serum concentrations of interleukins-2, -8, -10, basic fibroblast growth factor, transforming growth factor-beta, tumor necrosis factor-alpha (TNF-α), and a soluble receptor for TNF-α. Data processing was performed by cluster and correlation analysis methods. Results. Three clusters of patients with CAP were identified by the characteristic combinations of indicators of RM strength, endogenous intoxication, and cytokine status. The first cluster had MCAP, the second – both MCAP and SCAP, the third – SCAP. In the first cluster, dysfunction of expiratory RM prevailed, and in the second and third – dysfunction of inspiratory RM. In the midst of CAP, significant negative correlations of RM strength indicators with LII, HII, TNF-α, IL-10, IL-8, and IL-2 levels were recorded. The endogenous intoxication indices reached control values in all patients during recovery. The first cluster showed a decrease in the level of analyzed cytokines against isolated dysfunction of expiratory RM. The second cluster showed a tendency toward restoration of TNF-α and IL-8 levels, and only their SNIP index was normal. The third cluster showed minimal medians of RM strength against the continuing imbalance in the profile of pro- and anti-inflammatory cytokines during recovery. Conclusion. RM dysfunction in CAP is associated with cytokine-mediated dysfunction. The degree of cytokine involvement in this process depends on the severity of endogenous intoxication and the volume of alveolar inflammation.

Electrochemical detoxification in cancer patients after multiorgan surgery with severe endogenous intoxication

Background. Enteral insufficiency syndrome accompanies the development of many acute diseases of the abdominal cavity. According to the statistics, advanced and multi-organ surgical intervention in oncosurgery within the period from 2019 to 2020 resulted in enteral insufficiency being a complication in 39% of all cases, regardless of anatomical and physiological area, while complications in the form of endogenous intoxication syndrome made up 68% of cases.
 Purpose – studying the effectiveness of treatment of enteral insufficiency syndrome in cancer patients after multiorgan surgery with severe endogenous intoxication by means of indirect electrochemical detoxification with sodium hypochlorite solution.
 Materials and methods. The study involved 71 cancer patients who underwent multi-organ surgery on different anatomical and physiological areas. The patients were divided into 2 groups: treatment group (n=36) provided with indirect electrochemical detoxification by means of sodium hypochlorite solution at a concentration of 0.06%, comparison group (n=35) undergoing treatment according to standard schemes. The groups were comparable in age and anatomical and physiological areas that were operated on (surgery was performed on the chest and mediastinum as well as abdominal organs).
 Results. The method of electrochemical detoxification with sodium hypochlorite reducing the indicators that reflect blood toxicity and intoxication level was used for treating patients with enteral insufficiency. This was evidenced by decreased concentration of bilirubin by 23.1%, urea by 91.6%, creatinine by 99.4%, LII (leukocytal intoxication index) by 47.2% and procalcitonin by 68.2%. Being applied this method has made it possible to achieve a detoxifying effect early on day one.
 Conclusions. The findings of complete physical examination of cancer patients after multiorgan surgery with severe endogenous intoxication have shown a practical significance of sodium hypochlorite being included in comprehensive post-surgery treatment in enteral insufficiency syndrome cases. Infusions of 0.06% NaClO solution within 24 hours have been proved to provide a detoxifying effect: they significantly reduce elevated concentrations of bilirubin, creatinine, urea, LII and improve blood rheology.
 Administering sodium hypochlorite in the suppre-ssion of antioxidant defense mechanisms leads to the activation of oxidative processes.
 Including sodium hypochlorite in comprehensive post-surgery treatment in enteric insufficiency syndrome has shown a high efficiency.

Діагностичні критерії гострого деструктивного панкреатиту

The relevance of the emergence of innovative technologies, more sophisticated diagnostics methods, opportunities for intensive therapy, antibacterial prophylaxis, surgical methods of treatment involving minimally invasive surgery, does not solve the problem of high overall mortality in severe acute pancreatitis at this time. This indicator for the last ten years remains at a high level (10-30%), and in case of inflammatory forms of severe pancreatitis, reaches 85%. Traditional laboratory criteria for the diagnosis of pancreatic necrosis may involve leukocytosis with the destruction of the leukocyte formula and appearance of myelocytes and metamylocytes in it; improvement of leukocyte index of intoxication; improvement of the nuclear index of the destruction; blood glucose growth; growth of blood urea; growth of neutrophil-lymphocytic coefficient; change in endogenous creatinine clearance; improvement of blood transaminases. The indicator enzymes have the greatest value for the diagnosis of gastrointestinal pancreatitis in the diagnostic plan. The determining of α-amylase activity is a sensitive and valuable criterion for diagnostics of gastrointestinal pancreatitis and control over the effectiveness of treatment. Also, talking about laboratory diagnostics of acute pancreatitis it is worth noting about acute-phase proteins. The increase in the level of acute-phase proteins in inflammation is a compensatory reaction associated with the ability to inhibit cells released during destruction and cause secondary tissue damage by proteolytic enzymes, as well as to suppress autoimmune aggression. Due to this, the inflammatory process in the body is limited and autoaggression is restrained. The purpose of the study was to study the proteins of the acute phase in the blood of patients with acute pancreatitis of varying severity. Materials and methods. The study is based on the results of examination of 88 patients with acute pancreatitis of varying severity who were treated at the V.T. Zaytsev Institute of the General and Urgent Surgery of Academy of Medical Sciences of Ukraine, Kharkiv, as well as 45 donors (control group). Results and discussion. The determination of the activity of serum enzymes in the dynamics of acute destructive pancreatitis was carried out. The parameters were verified before the operation and after the operative treatment in dynamics, as well as before and after the second operation in the dynamics. Markers of tissue destruction can simultaneously serve as indicators of the severity of the inflammatory process in the pancreas and determine the quality of the performed surgical intervention. The diagnostic value of ferritin and lactofferin as markers of an acute destructive process was proved on the basis of a significant increase in their level in blood serum and exudates of patients. It has been shown that ferroproteins are reliable markers of the inflammatory process, among others, including classical acute phase proteins. At the same time, their identification is distinguished by its explicitness in the diagnosis of not only latent destructive states. Conclusion. The detected changes in the concentration of clinical and laboratory parameters of alpha-2-macroglobulin, lactoferrin, C-reactive protein, ferritin in the blood serum correlate with the degree of the inflammatory process and purulent-destructive changes in the pancreas

The Effect of Endogenous Intoxication on the Dynamics of Recovery from Traumatic Injuries of the Lower Jaw

An impact of the endogenous intoxication on the treatment efficacy of the lower jaw fractures is not well-studied. Therefore, the aim of the present study was to examine the effect of endogenous intoxication on the dynamics of recovery from traumatic injuries of the lower jaw. Thirty-two patients with the open bilateral traumatic fracture of the lower jaw were enrolled in present study. All the patients were subjected for general blood analysis; the biochemical and hemostasis parameters and leukocyte intoxication index were also included. The patients were divided into the 3 experimental groups. Group 1 was composed of patients (26.3%) with low leukocyte intoxication index (< 1.0). The patients included into group 2 (47.4%) exhibited the index ranging from 1.0 to 1.4. For the patients included in group 3 (26.3%), this index exceeded 1.5. All the examinations were performed on day 1 after the injury and on day 5 after the reposition of fragments of the lower jaw. Thirteen patients were also examined for the macro- and microelement content and ratios in the oral fluid. We observed that due to the adverse effects of endogenous intoxication, the patient may develop the opposite reactions, including the restoration to normal values or development of sensitization of the body and tissue necrobiosis. We also found that significant changes in leukocyte intoxication index during the recovery period in all experimental groups. For example, in group 1, the leukocyte intoxication index decreased up to 0.88 ± 0.05 (p < 0.001), whereas in group 2, this index decreased up to 1.27 ± 0.04 (p < 0.001). Group 3 demonstrated a substantial decreased of this index, e.g., 2.0 ± 0.22 (p < 0.05). The precise molecular mechanisms of this phenomenon are unknown and remain to be further elucidated. We showed here for the first time that endogenous intoxication during the traumatic injuries of the lower jaw might trigger the development of sensitization or necrobiosis of the surrounding tissues, which has a significant impact on duration of the treatment and recovery period.

Influence of different types of anesthesia on the inflammatory response in laparoscopic hysterectomy

The aim of the study was to evaluate the influence of different variants of anesthesia, including low-opioid (LOA) and opioid-free anesthesia (OFA), on the dynamics of the inflammatory response during laparoscopic hysterectomy.&#x0D; Materials and methods: 102 patients were randomly allocated into 3 groups: 37 women assigned to receive a standard opioid-based anesthesia (OBA group), 33 women – LOA group and 32 patients – OFA group. In the LOA group, the amount of fentanyl was halved and lidocaine infusion and ketamine were additionally infused during induction. In the OFA group, ketamine, lidocaine and dexmedetomidine were additionally infused instead of fentanyl.&#x0D; Results: Conducting a laparoscopic hysterectomy is accompanied by the activation of the inflammatory process and is manifested by an increase in the content of leukocytes and granulocytes, and a decrease in the number of lymphocytes, which is accompanied by an increase in the leukocyte index of intoxication. These changes were most significant in patients undergoing standard anesthesia. The activation of the inflammatory process is confirmed by an increase in the level of pro-inflammatory IL-6 in all groups from 28.8 % to 92.9 %, and it was most pronounced in patients who underwent LOA. In the same group, the greatest increase in the level of anti-inflammatory IL-10 was also noted, the level of which was 115.4 % higher (p=0.036) than in the control group. An increase in the content of the pro-inflammatory cytokine IL-6 in each group and a parallel increase in anti-inflammatory IL-10 in groups 2 and 3, with a simultaneous decrease in it in group 1 led to a significant increase in the IL-6 / IL-10 ratio in the control group. This indicator was significantly higher than in groups 2 and 3 by 42.3 % (p=0.043) and 52.7 % (p=0.041), respectively, while the IL-6 / IL-10 ratio in these groups was not differed from the initial state.&#x0D; Conclusion: Laparoscopic hysterectomy is accompanied by activation of the inflammatory process and is manifested by an increase in the content of leukocytes and granulocytes and a decrease in the number of lymphocytes, which is accompanied by an increase in the leukocyte index of intoxication. These changes were most significant in patients undergoing standard anesthesia. The use of LOA and OFA is accompanied by a lower activation of the inflammatory response in laparoscopic hysterectomy than in standard anesthesia, but requires further study

Experimental Validation of the Use of Immobilized Form of Miramistin &#x0D; in the Treatment of Advanced Peritonitis

Introduction. Mortality in generalized peritonitis ranges from 16% to 30%.The aim of research was to experimentally study the effect of the immobilized form of 0.01% miramistin on the basis of sodium salt of carboxymethylcellulose on the course of the inflammatory process in generalized purulent peritonitis.Materials and methods. The experimental study included 288 male Wistar rats, divided into 3 groups, 96 animals each. Animals of the 1st group (control) were exposed to laparotomy and lavage of the abdominal cavity with saline under aseptic conditions 24 hours after the introduction of fecal suspension into the abdominal cavity. Simultaneously, animals of the 2nd group (comparison) underwent a thorough sanitation of the abdominal cavity with saline with removal of purulent effusion and fibrin films at the first stage, and at the second stage, they were injected 5 ml of an aqueous solution of 0.01% miramistin. In animals of the 3rd (experimental) group, 5 ml of 0.01% miramistin gel was evenly distributed over the entire surface of the peritoneum after laparotomy and sanitation of the abdominal cavity with saline solution. The anti-inflammatory activity of the dosage forms was assessed by the dynamics of leukocytosis and the leukocyte index of intoxication, and the anti-inflammatory activity was assessed by the dynamics of the number of microorganisms in the abdominal exudate. The lethality of animals in each group was estimated. The following areas were taken for histological examination: small and large intestine, parietal peritoneum, pancreas, liver.Results. The anti-inflammatory activity of the immobilized form of 0.01% miramistin on the basis of sodium carboxymethylcellulose was superior to the aqueous solution of miramistin 0.01% on the 1st day - 1.3 times, on the 3rd day - 1.6 times, on the 7th day - 1.5 times. Antimicrobial activity in animals of the experimental group was 1.3 times higher on the 1st day, 1.9 times higher on the 3rd day, and 1.7 times higher on the 7th day than in the comparison group. The mortality rate in animals of the experimental group was 1.5 times lower on the 1st day, and 1.4 times lower on the 3rd and 7th days than in animals of the comparison group. On the first day, the morphological picture of peritonitis in animals of the experimental and comparison groups had no significant differences. On the 3rd day in animals of the comparison group, the inflammatory process in the abdominal cavity was pronounced, and in the experimental group, the intensity of peritonitis began to decrease, and by the 7th day it was completely eliminated.Conclusion. The results of the study allow recommending the use of the immobilized form of 0.01% miramistin based on sodium carboxymethylcellulose in the treatment of generalized peritonitis.

Интегральные гематологические индексы интоксикации как маркеры осложненного течения инфаркта миокарда у больных с хронической обструктивной болезнью легких

Интегральные гематологические индексы интоксикации как маркеры осложненного течения инфаркта миокарда у больных с хронической обструктивной болезнью легких

Вплив комплексного лікування пневмоконіозу у поєднанні з хронічним обструктивним захворюванням легень на деякі показники інтоксикації у працівників гірничорудної та металургійної промисловості

Objective:We studied the efficiency of the comprehensive treatment of ore mining and iron and steel industry workers having the pneumoconiosis combined with chronic obstructive pulmonary disease in terms of intoxication indicators as an assessment of measures aimed at treatment and prevention of this occupational pulmonary pathology. Results: It was established that conducted treatment in the patients, ore mining and iron and steel industry workers with the use of bronchodilator, mucoregulator, anti-inflammatory agent of a complex vitamin medication, as well as sessions of hyperbaric oxygenation at 1.3 atm led to a decrease in the activity of inflammation processes with regard to the content in the peripheral blood of the total number of leukocytes, their stab and segmented subpopulations, and a decrease in most intoxication indices: the leukocytic index of intoxication, the granulocytic-agranulocytic index, the general index of intoxication, the sinistroposition index, the index of the ratio of leukocytes to erythrocyte sedimentation rate, which indicates a decrease in the systemic inflammation activity with the simultaneous suppression of intoxication phenomena. In comparison with the patients with other occupational lung pathology, the comprehensive treatment led to a more significant decrease in the content of segmented and stab leukocytes, as well as the main integral intoxication indices: the leukocytic index of intoxication, the granulocytic-agranulocytic index, and the general index. Thus, the comprehensive treatment of ore mining and iron and steel industry workers having the pneumoconiosis combined with the chronic obstructive pulmonary disease is an important link in the system of measures aimed at treatment and prevention ofthis occupational pulmonary pathology. Conclusions: In the ore mining and iron and steel industry workers having the pneumoconiosis combined with the chronic obstructive pulmonary disease,the comprehensive treatment with the use of bronchodilator, mucoregulator, nebulizer-administered anti-inflammatory agent, a complex vitamin B medication administered intramuscularly, as well as sessions of hyperbaric oxygenation led to an improvement in some inflammation indicators and intoxication indices which is a predictor of a positive course of the disease. The assessment of the results of the conducted comprehensive treatment of the workers indicates a significant positive dynamics of intoxication processes and makes it possible to regard this treatment as an important link in the system of measures aimed at treatment and preventionofthisoccupational pulmonary disease.