Exacerbation Of Infection Research Articles

Antiviral therapy in prevention of complications of cosmetic procedures

The procedures of most medical cosmetic manipulations are accompanied by a violation of the integrity of the skin, which primarily increases the risk of infectious complications. Among other risk factors influencing the development of such complications, one can single out the action of the active components of the drugs, violation of the technology for performing procedures. Reactivation of herpes virus infection is one of the complications of minimally invasive cosmetic procedures (laser ablation, injection techniques, microneedling, peeling). Quite a lot of cosmetologists underestimate the increased risks of complications of cosmetic procedures, in particular the reactivation of a herpes infection, and are not aware of the need for preventive courses of antiherpetic therapy, including short-term (episodic) and long-term regimens of suppressive treatment with antiviral drugs. The best strategy for managing herpes virus infection in the context of cosmetic procedures with a potential risk of virus reactivation is prevention. Preventive measures should include a thorough history taking followed by an analysis of the risks of exacerbation of herpes virus infection and the selection of personalized suppressive therapy. In this regard, valaciclovir (Valcicon) is the most reasonable choice and can be recommended for use in wide clinical practice for suppressive short-term and long-term therapy. Therapy for exacerbations of herpes viral infection should include a 2-component scheme for the use of an antiviral systemic drug (valaciclovir) and an external drug (ribavirin).

Changes in Serum Immunoglobulin G Subclasses during the Treatment of Patients with Chronic Obstructive Pulmonary Disease with Infectious Exacerbations.

Despite the theoretical importance of serum immunoglobulin (Ig) in the outcome of COPD exacerbations, the existing evidence for this has not been enough. This study was performed to evaluate changes in serum Ig levels and their relationship with outcomes of acute infectious exacerbations in patients with COPD. The prospective study was conducted at Military Hospital 103 from August 2017 to April 2019. Group D patients with COPD with infectious exacerbation were selected for participation in the study. The control group consisted of 30 healthy people. The patients were provided clinical examination and laboratory service; simultaneously, we measured their serum Ig levels (total IgG, IgG1, IgG2, IgG3, IgG4) at two time points: at admission (T1) and the final health outcome (T2). The median levels of total IgG in patients at times T1 and T2 were significantly lower compared with those in the healthy group (1119.3 mg/dL and 1150.6 mg/dL compared with 2032.2 mg/dL) (p < 0.001). Regarding changes among IgG subclasses, the IgG1, IgG3, and IgG4 levels measured at T1 and T2 were reduced significantly compared with the control group (p < 0.05); the IgG3 levels at T1 were significantly higher than those at T2. IgG3 levels in patients with life-threatening exacerbations were significantly lower than the remaining ones (24.6 (26.8-155.5) mg/dL and 25.6 (29.5-161.2) mg/dL, respectively, p = 0.023). In group D patients with COPD with infectious exacerbations, there was a decrease in the serum IgG, IgG1, IgG3, and IgG4 levels. IgG3 levels were associated with the severity of COPD exacerbation.

Sputum Culture and Antibiogram in Infective Acute Exacerbation of Chronic Obstructive Pulmonary Disease in a Tertiary Care Hospital in India

Sputum Culture and Antibiogram in Infective Acute Exacerbation of Chronic Obstructive Pulmonary Disease in a Tertiary Care Hospital in India

Virtual reality wraparound learning modules: an innovative approach to self-debriefing to augment learner experience

Virtual Reality (VR) simulation has opened to a lot of trainees an ability to experience various clinical scenarios in a virtual space at a time and place that suits them [1]. It also gives an opportunity for deliberate practice as one can repeat the scenario as many times as one likes till proficiency is reached. Research over the years has shown most of the learning occurs during the debriefing [2] and the VR scenario gives a unique opportunity for self-debriefing or peer-peer debriefing in small groups [3]. However, in the current VR scenarios available to trainees, there is no provision of any link at the end of the scenario to access current best practice guidelines on the topic/scenario which the learner could use as part of their self-debriefing. The project aims to create wraparound learning module around the Virtual Reality clinical scenario to include a patient journey through the hospital, current guidelines, and teaching videos so that learners could conceptualize and consolidate their learning from the VR experience VR scenarios available to Foundation doctors were chosen and a review of the topic and related standard best practice guidelines were reviewed on NICE, BTS, and similar resources. We also searched for real patient stories and easy to access procedural videos related to the topic and incorporated them on the module. Wraparound learning modules were created using a blended learning approach on Bridge online platform on topics like pneumothorax and infective exacerbation of Chronic Obstructive Pulmonary Disease. More modules are being created for the benefit of the Foundation doctors across East of England. Throughout the module reflection is encouraged and the topic is aligned to the Foundation curriculum and reviewed for quality assurance. A Likert scale survey would be sent out to the trainees who have completed the modules to assess the increase in their confidence in managing a clinical case after finishing the wraparound module. The results of the pre-course and post-course levels of knowledge, skills and confidence are being analysed. Wraparound learning modules could potentially improve learners’ experience of the VR scenario and improve learning and confidence in the clinical setting. 1. Cheng A, Kolbe M, Grant V, Eller S, Hales R, Symon B, Griswold S, Eppich W. A practical guide to virtual debriefings: communities of inquiry perspective. Advances in Simulation. 2020;5(1):1–9. 2. Rudolph JW, Simon R, Dufresne RL, Raemer DB. There’s no such thing as ‘non-judgmental’ debriefing: a theory and method for debriefing with good judgment. Simul Healthcare. 2006;1(1):49–55. 3. Pottle J. Virtual reality and the transformation of medical education. Future healthcare journal. 2019;6(3):181–185.

Three layer test in bronchiectasis

A 52 year old woman having bronchiectasis, presented to us with worsening cough which was productive with profuse, foul smelling sputum of a week’s duration. A clinical diagnosis of infective exacerbation of bronchiectasis was made. She was started on antibiotics based on her previous sputum culture sensitivity reports. She was asked to collect an entire day’s sputum in a transparent container which demonstrated the classical three layer sputum (Figure 1). Her high resolution CT scan of the thorax was suggestive of cystic bronchiectasis, predominantly involving the right lung (Figure 2). Some of the cysts contained fluid levels also, indicating active infection.

Проявление цитомегаловирусной инфекции в офтальмологической практике на фоне вторичного иммунодефицита после перенесенного COVID-19

During the COVID-19 pandemic, there has been an increase in the number of patients who applied with manifestations of the clinical picture of cytomegalovirus retinitis. The exacerbation of a chronic infection is associated with secondary immunodeficiency after an illness with the SARS-CoV-2 virus. The tactics of managing and treating these patients creates a separate group of increased observation, since in the absence of causal therapy, the initial lesion of one eye takes on a bilateral character and leads to complete loss of vision. In the provided clinical case, the tactic of treating patient was developed through the joint work of ophthalmologists and infectious disease specialists. Keywords: cytomegalovirus infection, retinitis, secondary immunodeficiency, clinical case, COVID-19

Autoantibody-mediated Macrophage Dysfunction in Patients with Severe Asthma with Airway Infections.

Rationale: Localized autoimmune responses have been reported in patients with severe eosinophilic asthma, characterized by eosinophil degranulation and airway infections. Objective: To determine the presence of autoantibodies against macrophage scavenger receptors within the airways and their effects on macrophage function and susceptibility to infection. Methods: Anti-EPX (eosinophil peroxidase), anti-MARCO (macrophage receptor with collagenous structure) IgG titers, and T1 and T2 (type 1/2) cytokines were measured in 221 sputa from 143 well-characterized patients with severe asthma. Peripheral monocytes and MDMs (monocyte-derived macrophages) isolated from healthy control subjects were treated with immunoprecipitated immunoglobulins from sputa with high anti-MARCO titers or nonspecific IgG to assess uptake of Streptococcus pneumoniae or response to the bacterial product LPS. Measurements and Main Results: Anti-MARCO IgG was detected in 36% of patients, with significantly higher titers (up to 1:16) in patients with mixed granulocytic sputa, indicative of airway infections. Multivariate regression analysis confirmed increased frequency of degranulation (free eosinophil granules), increased blood eosinophils (indicative of high T2 burden), increased sputum total cell count, peripheral blood leukocytes (indicative of infection), and lymphopenia were associated with increased anti-MARCO IgG titers; IL-15 (odds ratio [OR], 1.79; confidence interval [CI], 1.19-2.70), IL-13 (OR, 1.06; CI, 1.02-1.12), and IL-12p70 (OR, 3.34; CI, 1.32-8.40) were the associated cytokines. Patients with anti-MARCO antibodies had higher chances of subsequent infective versus eosinophilic exacerbations (P = 0.01). MDMs treated with immunoprecipitated immunoglobulins (anti-MARCO+ sputa) had reduced bacterial uptake by 39% ± 15% and significantly reduced release of IL-10 and granulocyte-macrophage colony-stimulating factor (GM-CSF) (P < 0.05) in response to an LPS stimulus. Conclusions: Autoantibodies against macrophage scavenger receptors in eosinophilic asthma airways may impede effective host defenses and lead to recurrent infective bronchitis.

A refractory wound healing hydrogel with integrated functions of photothermal anti-infection, superoxide dismutase mimicking activity, and intelligent infection management

Promoting refractory wound healing remains a challenging issue. Currently, dressings with intelligent infection management functions built on infection eradication and reactive oxygen species (ROS) scavenging abilities are lacking. In this study, an approach based on Cu2+-imidazole coordination cross-linked histidine grafted chitosan (CS-His) and carbon quantum dots (CQDs) was developed to engineer superoxide dismutase (SOD) mimicking centers with photothermal anti-infection and intelligent anti-infection abilities, beyond typical ROS scavenging activity. The cross-linked coordination network was further promoted with tanshinol-encapsulated ZIF-8 frameworks (ZIF-8@Ts) to achieve intelligent infection management behaviors. These designs generate a refractory wound-healing hydrogel with integrated functions of photothermal anti-infection, SOD mimicking activity, and intelligent infection management. In response to infection exacerbation, the SOD mimicking centers and ZIF-8@Ts nanoparticles could release CQDs for anti-infection and Ts for antioxidation, respectively. In vitro results revealed photothermal anti-infection, ROS scavenging, and intelligent infection management capacities of the hydrogel. These abilities promoted the M2 transformation of macrophages and rescued the inhibitory effect of infection on fibroblast proliferation and migration. The hydrogel exhibited high regenerative efficacy in a rat model of chronically infected diabetic wounds. These results demonstrated the immense potential of the intelligent hydrogel integrated with multifunctions for refractory wound healing.

Potential mechanisms by which impaired ketogenesis links metabolism to T-cell dysfunction in patients with severe COVID-19.

Potential mechanisms by which impaired ketogenesis links metabolism to T-cell dysfunction in patients with severe COVID-19.

Recurrence of bilateral polysegmental pneumonia associated with COVID-19 (clinical case)

COVID-19 (clinical case)We describe a clinical case of long-term follow-up of a patient who had experienced bilateral polysegmental pneumonia associated with COVID-19 twice within 16 months.Patient, 52 years old, resident of the countryside. He fell ill acutely on 01/06/2020. He turned to the rural outpatient clinic with a paramedic complaining of an increase in body temperature up to 39.0 °С, shortness of breath with little physical exertion, cough with massive sputum production. He began treatment at the regional hospital, later continued at the Ternopil Regional Phthisiopulmonology Medical Center. A clinical diagnosis was made — community-acquired bilateral polysegmental pneumonia, severe course, group III. COPD, group B (GOLD 2) infectious exacerbation. P I II, intoxication syndrome. After inpatient treatment, a partial improvement was clinically determined, and radiographically, the resorption of inhomogeneous infiltration, but an increase in matte consolidation fields. It was during this period that a lockdown was introduced in the country in connection with the COVID-19 pandemic. Considering certain clinical and, in particular, radiological features of the course of the disease in a patient, COVID-19 can be suspected, at that time a PCR test was not yet performed. Until August 2020, the patient received outpatient treatment and was observed by a family doctor at the place of residence. In August 2020, the patient underwent a follow-up examination. Clinical and radiological improvement was noted. But the condition deteriorated sharply in the second half of November 2020. From 11/27/2020 to 12/14/2020, he was treated at the regional CRH for COVID-19, PCR+, severe course of community-acquired bilateral pneumonia. On the control CT scan (December 30, 2020) — in dynamics from August 13, 2020, progression — an increase in the area of ​​the lesion. Treatment continued at the Ternopil Regional Phthisiopulmonological Medical Center, and after discharge on an outpatient basis. At the control examination (06/16/2021), in the dynamics from 12/30/2020, the resorption of fibrous seals, a decrease in the intensity of consolidation areas. Conclusion: CT picture of chronic fibrosing lung disease, resorption phase.The patient was diagnosed with bacterial-viral pneumonia, which clinically and radiologically resembled pneumonia associated with COVID-19. Clinical and radiographic findings showed improvement after 7 months of treatment. After 10 months from the date of the first detection of the disease, the patient was re-diagnosed with pneumonia associated with COVID-19. Long-term inpatient and outpatient treatment was carried out, as a result of which it was possible to achieve clinical and radiological stabilization of the process and resorption of changes in the lungs.

Pathomorphological characteristics of cotyledons with weak contrasting of the blood flow in the placenta of women who have undergone exacerbation of cytomegalovirus infection during the second trimester of pregnancy

Aim. To give pathomorphological characteristics of placental cotyledons with weakly contrasted bloodstream in women who had an exacerbation of cytomegalovirus infection (CMVI) in the second trimester of pregnancy.Materials and methods. A study was made of involutive-destructive processes in 153 cotyledons of the placenta with well and weakly contrasted bloodstream in women with pregnancy, uncomplicated and complicated by exacerbation of CMVI at 21-24 weeks of gestation. The first group included 36 cotyledon placentas from women with CMV-seronegative uncomplicated pregnancy with well contrasted blood vessels; the second group – 67 cotyledon placentas from patients with chronic compensated placental insufficiency (CCPI) and poorly contrasted vascular network; the third group – 30 cotyledon placentas from women with chronic subcompensated placental insufficiency (CSPI) with indistinctly visualized blood vessels; the fourth group – 20 cotyledon placentas from patients with chronic decompensated placental insufficiency (CDPI). Dosed introduction of red lead on drying oil (1:3) into the blood vessels of the placenta was carried out through the umbilical cord vein. Obtaining X-ray images of cotyledons with well and weakly contrasted blood vessels in the marginal part of the organ was carried out on the apparatus RUM-20M with X-ray image intensifier Sapphire (Russia). Cotyledon biopsy specimens for histometry and histochemical analysis were taken before their contrasting, and for survey microscopy – after injection of the contrast mass.Results. In the first group, the amount of fibrinoid in the stroma of the villi was 1.35±0.09%, perivillous fibrinoid − 1.02±0.08% in the absence of pseudonecrosis and calcifications. In the second group, unlike the first one, cotyledons prevailed, in which in 40-50% of cases weakly expressed contours of blood vessels were found, an increase in the specific volume of stromal fibrinoid by 1.82 times was observed (p&lt;0.001), and fibrinoid around villi by 2.04 times (p&lt;0.001); pseudonecrosis accounted for 2.29±0.13%, and calcificates − 1.50±0.12%. In the third group, in comparison with the second one, cotyledons were more common with 50-70% of indistinctly contoured vessels, villi with edematous changes and stromal collagenization; the concentration of stromal fibrinoid increased by 1.47 times (p&lt;0.001), the proportion of perivillous fibrinoid – 1.46 times (p&lt;0.001), pseudonecrosis – 1.41 times (p&lt;0.001) and the accumulation of calcium salt – 1.57 times (p&lt;0.001). In the fourth group, compared to the third one, cotyledons were more common, in which more than 70% of weakly contrasted blood vessels were determined, while the number of collagen fibers and acid glycosaminoglycans increased in the villi; there was an increase in the amount of fibrinoid around the villi by 1.24 times (p&lt;0.01), pseudonecrosis – by 1.23 times (p&lt;0.05) and calcificates – by 1.32 times (p&lt;0.01).Conclusion. In women with an exacerbation of CMVI in the second trimester of gestation and CSPI, in contrast to patients with a similar infectious disease and CCPI, a decrease in the flow of contrast into the bloodstream of cotyledons is due to more pronounced edema, the formation of collagen fibers, fibrinoid and calcium salts in the stroma of the villi, as well as perivillous fibrinoid. In CDPI of cytomegalovirus etiology, compared with CSPI, weak contrasting of the vascular bed of cotyledons is associated with increasing changes in the stroma involved in the regulation of the resistance of draining veins and intracotyledon blood vessels.

Сeftazidime/avibactam in the treatment of exacerbation of a chronic respiratory infection in patients with cystic fibrosis: dynamics of clinical, microbiological, and functional parameters

Multidrug resistance of pulmonary pathogens in patients with cystic fibrosis (CF) requires new therapeutic solutions.The aim. To assess the effect of ceftazidime/avibactam (cef/avi) on clinical outcomes of pulmonary exacerbation of cystic fibrosis.Methods. This open single-group observational prospective non-interventional study was conducted in the routine clinical practice settings. Patients over 18 years with a confirmed diagnosis of CF and an exacerbation of a pulmonary infection were included into the study after physician’s decision to prescribe cef/avi. The examinations were performed at baseline and on Days 5 to 7, 21, and 30.Results. The analysis included data from 32 patients, 12 (38%) males and 20 (63%) females. The mean age was 31.6 years. Symptoms of exacerbation persisted in 97 % of patients on Days 5 to 7 of therapy and only in 3% at Day 21. FEV1, FVC, SpO2 also improved by Day 21 of the study (all – p &lt; 0.001). By Day 21, proportion of patients with CRP above 10 mg/ml grew from 71 to 9%. The average density of sputum contamination decreased from 7.2 to 5.5 CFU/ml. Quality of life according to Cystic Fibrosis QuestionnaireRevised (CFQ-R) questionnaire also improved.Conclusion. In patients with CF, exacerbation of lung infection in most cases is caused by multidrug resistant strains of Pseudomonas aeruginosa sometimes in combination with Staphylococcus aureus. Infectious agents (P. aeruginosa) remain highly sensitive to cef/avi (up to 91%) in this population so this justifies the use of cef/avi in treatment of a CF exacerbation. cef/avi administration led to relief of the exacerbation symptoms in 97% CF patients, as well as to significant improvement in spirometry parameters, increase in the oxygenation index, decrease in CRP and density of sputum contamination, and improved the quality of life. cef/avi administration was not associated with lethal outcomes, ICU admission, or serious adverse drug reactions.

Comparative Study of Bacteriological Profile in Infective Exacerbation of Chronic Obstructive Pulmonary Disease and Community-Acquired Pneumonia

Background: Community-acquired pneumonia is a differential diagnosis of acute exacerbation of chronic obstructive pulmonary disease (COPD); further both have similar pathogenic spectra. Both the American Thoracic Society and the European Respiratory Society follow similar empirical antibiotic choices for the two conditions. However, there are some differences in the bacterial spectra between the two conditions, particularly when the severity of the disease differs. In the present study, we want to study the differences in the clinical features, bacteriological spectra, and antibiotic susceptibilities in patients with community-acquired pneumonia versus patients with COPD exacerbation and provide a scientific basis for antibiotic selection. Aims: 1. To analyze the differences in the pathogenic spectra and antibiotic sensitivity profile between COPD exacerbation and community acquired pneumonia. 2. To study the differences in the clinical features and outcomes of the two conditions. Subjects and Methods: The study was a prospective observational study conducted from November 2019 to May 2020 in Bangalore Medical College and Research Institute on 30 patients diagnosed with acute exacerbation of COPD and 30 patients diagnosed with community acquired pneumonia. Detailed history, physical examination, and standard laboratory tests were taken on admission. The presence of new consolidation on chest radiograph was recorded. Sputum specimens collected by expectoration and tracheal suctioning or bronchoalveolar lavage were analyzed by Gram staining and microscopy and also by culture. The isolates were also tested for antibiotic sensitivity. The severity of Chronic obstructive pulmonary disease (COPD) exacerbation was assessed by the DECAF score and the severity of the CAP group was assessed by the Pneumonia Severity Index. The differences between the two groups were analyzed. The progression of the disease and the outcomes were observed. Results: Out of 30 (100%) participants in each group, both pneumonia and COPD participants had higher percentage of male participants; 24 (80%) and 26 (86.7%) participants, respectively. The COPD-exacerbation group was significantly older than the community-acquired pneumonia group (63.20 ± 11.82 vs. 43.73 ± 16.58). Klebsiella pneumoniae, Pseudomonas, Streptococcus pneumoniae, and Escherichia Coli were the most commonly isolated species in COPD subjects, whereas S. pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and other organisms were more commonly isolated from pneumonia participants. The drug-resistance rates of S. pneumoniae to penicillin, macrolide and quinolone antibiotics commonly used empirically to treat community acquired pneumonia was 52.6%, 79% and 79% respectively. The sensitivity of Pseudomonas to Carbapenems was 50% and to fluoroquinolones was 16.7% while all the strains were found to be resistant to Aminoglycosides, Penicillin, Cephalosporins, and Macrolides. Conclusions: In our study, we found that K. pneumoniae was the most common pathogen in patients with an exacerbation of COPD while S. pneumoniae was the most common pathogen in patients with community acquired pneumonia. In our study the organisms responsible for community acquired pneumonia were largely resistant to penicillins, macrolides, and tetracyclines, which are the antibiotics of choice for empirical treatment. Similarly, in patients with exacerbation of COPD, the organisms isolated had a far greater degree of resistance to the above-mentioned antibiotics than that seen in our patients with pneumonia. We conclude that antibiotic regimens should be culture driven rather than empirical to be effective while also countering drug resistance.

P339 A study of environmental risk factors in chronic rhinosinusitis

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM ObjectivesChronic rhinosinusitis (CRS) is a complex disease that incorporates many different conditions. Our aim is to determine the role of environmental risk factors in chronic rhinosinusitis.MethodsThis was a case-control study where forty cases of CRS in the age group of 18-62 years were recruited from the ENT-OPD of UCMS and GTB Hospital, Delhi, a tertiary care hospital, along with 40 age-appropriate healthy controls. Informed and written consent was obtained from all the subjects. Detailed history and examination along with routine blood and radiological investigations were done. Subjective assessment of disease was done using visual analog scales of SNOT 22 questionnaire, environmental questionnaire, and saccharine test. Objective assessment was done using endoscopic grading according to Lund and Kennedy scoring. CT scores were also obtained using Lund and Mackay staging system. Passive air sampling was done by the settle plate method and Anderson six-stage cascade impactor was used for active air sampling. Blood agar and Sabouraud dextrose agar plates were inserted on the six stages of the cascade impactor, which were later incubated at 35°C and 25°C respectively, for 18-24 hours. Bioaerosol concentrations were calculated and MicroScan WalkAway system was used to identify bacterial and fungal growth. The correlation between total bioaerosol concentration and the symptom score was done by spearman's correlation coefficient; a comparison of mean total bioaerosol concentration between the case and control groups was done by Mann-Whitney U-test.ResultsThe mean total bio-aerosol concentration from active air sampling in the case group was 458.52 CFU/m3 and 437.63 CFU/m3 in control, which was not significant. It was found to be negatively correlated, but not significant with various parameters in case groups like SNOT 22 score, environmental exposure score, saccharine test, smoking, and endoscopic score. A positive but insignificant correlation was found between total bioaerosol concentration and absolute eosinophilic count and CT score. The mean CFU/100 mm3 counted after passive air sampling between case and control group was 34.03 and 30.88 CFU/100mm3 which was not significant. Fungal growths were mostly Aspergillus flavus and A. Niger followed by Cladosporium spp.ConclusionThe fungal burden was high in all the households of the case as well as control groups, although, a significant correlation could not be established. The environmental conditions found in this study were found to be conducive to future risk of exacerbation of preexisting fungal infections for which, indoor air quality needs to be monitored.

Bronchiectasis: A pulmonary disease with systemic consequences.

Bronchiectasis: A pulmonary disease with systemic consequences.

КЛИНИЧЕСКИЕ И ЦИТОЛОГИЧЕСКИЕ ОСОБЕННОСТИ СТОМАТОЛОГИЧЕСКИХ ПРОЯВЛЕНИЙ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ SARS-COV-2 У ПАЦИЕНТОВ СТАРШИХ ВОЗРАСТНЫХ ГРУПП

Subject. Clinical and cytological manifestations of a new coronavirus infection in the oral cavity.&#x0D; Objectives. Identification, description and systematization of the main clinical and laboratory manifestations of a new coronavirus infection in the oral cavity in older patients.&#x0D; Methodology. The clinical study involved 50 elderly (60–74 years old) and senile (75–90 years old) patients who visited a dentist after an infection from September 2020 to February 2022. Study group 1 included patients with dystrophic syndrome, study group 2 – with inflammatory periodontal syndrome, study group 3 – with occlusive syndrome. Patients underwent dental and general clinical examination. The cytological study included an assessment of the cytoplasmic and karyological abnormalities level, calculating the integral indices of the buccal cytogram.&#x0D; Results. Most often, dental manifestations of a new coronavirus infection occur in older patients. All manifestations in the oral cavity are nonspecific, and the pathognomonic syndrome has not been established. The most common clinical manifestations are candidiasis, exacerbation of chronic periodontitis, exacerbation of herpes infection, etc. The cytological changes in the buccal epithelium reflect a general trend towards an increase in degenerative-dystrophic changes in cells, the predominance of apoptosis processes.&#x0D; Conclusion. Patients with dystrophic syndrome showed the greatest polymorphism of clinical manifestations associated with a new coronavirus infection (candidiasis in 59%, exacerbation of herpes infection in 47% of patients). In patients with inflammatory periodontal syndrome, exacerbation of chronic periodontitis was noted in 100% of cases. In patients with occlusive syndrome, there is an aggravation of the teeth hyperesthesia. Analysis of the integral indices of the buccal cytogram showed signs of accumulation of cytogenetic disorders after the infection.

Determination of the main causes, outcome, and prognostic factors of patients with rheumatologic diseases admitted to the medical intensive care unit in Southern Iran.

BackgroundSystemic rheumatic diseases (SRD) are a heterogeneous group of diseases that can involve several organ systems and occasionally requires intensive care unit (ICU) admission because of severe systemic disease, life-threatening organ involvement, or complication of treatment. The objective of this study is to determine the causes, outcome, and prognostic factors of patients with rheumatologic diseases admitted in teaching medical ICUs in southern Iran.MethodsA retrospective case review of all patients with rheumatologic diseases admitted in the academic medical ICUs in two referral hospitals in southern Iran, from March 2015 to January 2020. Patients’ data were documented from their hospital records and the cause of admission, in-hospital outcome, and prognostic factors was evaluated.ResultsNinety-one patients were included, of which 71.4% were female. Systemic lupus erythematosus (54.9%) was the most common disease. Nineteen (20.9%) patients were new cases of rheumatological disease. The most frequent symptom for admittance was dyspnea (54.9%) and hemoptysis (20.9%). The in-hospital mortality rate was 48%, and the leading cause of death was infection (29 patients; 65.5%) followed by disease activity (18 patients; 40.9%). Also, the death of 29.5% of patients was presumed due to both disease activity and infection. Factors associated with mortality included renal insufficiency (p < 0.028), infection (p < 0.001), pneumonia (p < 0.042), dyspnea (p < 0.042), loss of consciousness (p < 0.046), azathioprine consumption (p < 0.004) during 1 month before ICU admission, mechanical ventilation (p < 0.001), renal replacement therapy (p < 0.001), CNS involvement (p < 0.009), and ICU medications such as cyclosporine and azathioprine (0.03 and 0.03, respectively) or treatments such as plasmapheresis (p < 0.018).ConclusionThe ICU mortality rate of patients with SRD was high. Infection and disease exacerbation are the leading reasons for ICU admission in systemic rheumatic diseases. Intensivists must keep in mind that SRD exacerbation may require immunosuppressive agents along with lifesaving interventions, more particularly in newly diagnosed SRDs. Key Points• The ICU mortality rate of patients with SRD was high.• Infection and disease exacerbation are the leading reasons for ICU admission in systemic rheumatic diseases.• 63.8% of our patients fall into this category of new cases of rheumatologic disease and disease flare-up.

Mechanisms of blood flow regulation in the uterine arteries during the formation of chronic placental insufficiency caused by exacerbation of cytomegalovirus infection during the second trimester of gestation

Aim. To evaluate the mechanisms of regulation of blood flow in the uterine arteries during the formation of chronic placental insufficiency caused by an exacerbation of cytomegalovirus infection (CMVI) in the second trimester of pregnancy.Materials and methods. The concentration of IL-1β, IFN-γ, IL-4, IL-2 and the systolic-diastolic ratio (SDR) in the right (RUA) and left uterine arteries (LUA) were determined in 90 women in the second trimester of pregnancy, uncomplicated and complicated by exacerbation of CMVI. Retrospectively, 2 groups were distinguished. Group 1 (control) was represented by 30 women with CMV-seronegative physiological pregnancy, group 2 (main) included 60 patients with acute phase of chronic CMVI and consisted of subgroups 1 and 2. Subgroup 1 included 30 women with exacerbation of CMVI, initiating the development of chronic compensated placental insufficiency (CCPI), subgroup 2 − 30 patients with acute phase of chronic CMVI, leading to the formation of chronic subcompensated placental insufficiency (CSPI) in the third trimester of gestation.Results. In women of the 1st group in the blood serum, the concentration of IL-1β (Me [Q1- Q3]) was 18.0 [13.4-36.3] pg/mL, IFN-γ − 134.4 [114.2-151.3] pg/mL, IL-4 − 26.2 [20.3-51.3] pg/mL and IL-2 − 27.9 [18.2-38.0] pg/mL; SDR in RUA – 1.95 [1.87-2.30] relative units and SDR in LUA – 1.84 [1.73-2.25] relative units. In patients of subgroup 1, in comparison with the control one, the concentration of IL-1β increased to 87.3 [55.6-98.2] pg/mL (p=0.000001), IFN-γ − up to 237.3 [191.4-318.6] pg/mL (p=0.000001) and IL-2 − up to 77.1 [58.6-92.3] pg/mL (p=0.000001) in the absence of statistically significant changes IL-4 level. There was an increase in SDR in RUA up to 2.45 [2.35-3.46] relative units (p=0.000001) and SDR in LUA up to 2.80 [2.31-3.05] relative units (p=0.000001). In subgroup 2, in comparison with subgroup 1, higher values of IL-1β were recorded (1.67 times, p=0.000001), IFN-γ (1.38 times, p=0.000015), IL-2 (1.36 times, p=0.00808), SDR in RUA (by 1.35 times, p=0.0105) and SDR in the LUA (by 1.08 times, p=0.0307), as well as a decrease in the level of IL-4 (by 1.84 times, p=0.000002). In women of subgroup 1, there was a direct relationship between the level of IL-1β, IFN-γ, IL-2 and SDR in the RUA (r=0.54, p&lt;0.01; r=0.74, p&lt;0.001 and r=0.58, p&lt;0.001, respectively). The correlation between IFN-γ and SDR in the LUA was determined (r=0.40; p&lt;0.05). In subgroup 2, there was a relationship between IL-4 and SDR in RUA (r=-0.59; p&lt;0.001), as well as IL-2 and SDR in RUA (r=0.39; p&lt;0.05). A correlation was recorded between the concentration of IL-1β, IFN-γ, IL-2 and the SDR value in the LUA (r=0.39, p&lt;0.05; r=0.58, p&lt;0.001 and r=0.57, p&lt;0.001, respectively).Conclusion. Exacerbation of CMVI in women in the second trimester of gestation, leading to the formation of CSPI, in contrast to a similar viral infection that initiates the development of CCPI in the third trimester of pregnancy, is characterized by a more pronounced activation of the systemic inflammatory response, an increase in resistance to blood flow, as well as differences in immuno-hemodynamic relationships that determine the maintenance of vascular tone in the basin of the right and left uterine arteries.

Chronic bronchitis in the practice of a family doctor

Chronic bronchitis is the most common chronic nonspecific lung disease (CNSLD). The prevalence of chronic bronchitis in the Russian Federation ranges from 10 to 20%, and the increase in the incidence of chronic nonspecific lung diseases is 6–7% for the urban and 2–3% for the rural population per year. The recent increase in the incidence of bronchitis in most countries of the world is associated with air pollution with dust particles and gases, the popularity of smoking, and allergies of the population. The article tells about the modern principles of diagnosis and treatment of chronic bronchitis. Particular attention is paid not only to the optimal choice of antibiotic therapy for infectious exacerbation of chronic bronchitis (CB), but also to the role of topical antibacterial drugs (ABD) in this case. The basic points outlined in the article can be useful for general practitioners and pulmonologists who are faced with this disease.

Heterogenous Disease Course and Long-Term Outcome of Children's Interstitial Lung Disease Related to Filamin A Gene Variants.

Rationale: Variable disease course and outcomes have been reported in children's interstitial lung disease associated with FLNA (Filamin A gene) variants. Objectives: To further delineate long-term respiratory outcomes and identify potential contributing factors to severe disease course. Methods: We retrospectively collected longitudinal data from three centers on nine cases (one male) with FLNA variants and early respiratory disease onset (within the first 24 mo of life). Clinical, radiographic, and histopathologic data were analyzed, focusing on cardiorespiratory disease course. Results: All required early respiratory support (three invasive ventilation, three noninvasive ventilation, three supplemental oxygen), and all experienced frequent severe infective respiratory exacerbations. Three died in infancy from refractory respiratory failure and pulmonary hypertension (PH). The six surviving individuals were 3, 10, 11, 15, 18, and 33 years old at time of reporting. The extent of functional respiratory impairment decreased with age; at last follow-up, there were no individuals on home invasive ventilation, one on nocturnal noninvasive ventilation, four on oxygen, and one on no respiratory support. Spirometry consistently demonstrated moderate to severe obstructive defects (forced expiratory volume in 1 s/forced vital capacity [FVC] z-score, -3.76 to -1.77; percent predicted FVC, 31.5% to 92.1%). Seven required PH treatment in early childhood (7/9), and three of the survivors (3/6) still receive treatment. Radiologic and histopathologic findings were consistent among cases. Conclusions: Early mortality was common, but many survivors stabilized even after severe symptoms in infancy. All survivors had persistent obstructive defects on spirometry, and half have persistent or recurrent PH. These typical findings are suggestive of this rare diagnosis and should prompt consideration of genetic testing.