Intoxication Syndrome Research Articles

The effectiveness of a synthetic analogue purine nucleoside bases in the treatment of acute respiratory viral infections

Introduction. The aggravation of the comorbid background of patients with ARVI is the main reason for the addition of secondary pathogenic and conditionally pathogenic bacterial flora and, as a result, the development of local and general complications.Аim. To conduct a clinical assessment of the efficacy and safety of the drug Triazavirin based on riamilovir in the treatment of acute respiratory viral infections.Materials and methods. The study conducted on the basis of the medical center of the Federal State Budgetary Educational Institution of the Russian Ministry of Health involved 56 patients with acute recurrent viral infection. Regarding the prescribed therapy, the patients were divided into 2 groups: group 1 (n = 27) from day 2, triazavirin was taken as an antiviral drug (riamilo- vir) 250 mg (1 capsule) 3 times a day for 5 days; group 2 (n = 29) – as an antiviral drug, Kagocel took 2 tablets 3 times a day for 2 days, then 1 tablet 3 times a day for 5 days. The effect of the therapy was assessed by the severity of intoxication syndrome, rhinorrhea, difficulty in nasal breathing, decreased olfactory function, pain syndrome localized in the nasopharynx and throat, cough severity and laboratory results.Results. In patients with 7 days of therapy, the indicator of psychological health increased by 34.7 points in the first group, by 28.8 points in the second group. Vital activity increased by 33.7 points in patients of group 1 and by 23.8 points in the second group. Physical activity tended to increase by 19.5 points and 6.0 points in the first and second groups, respectively.Conclusions. The analysis of changes in the severity of clinical symptoms affecting the quality of life of patients confirmed the effectiveness and safety of the drug Triazavirin.

Influenza and non-influenza ARVI in children. A relationship between cytokine profile, parameters of the “lipid peroxidation – antioxidant defense system” as well as clinical and laboratory indicators

Influenza and acute respiratory viral infections (ARVI) impose a substantial damage to the population health in the Russian Federation due to their seasonal circulation and predominantly affect young children. A very few data on the cytokine profile, the nonspecific LPO — AOD system and their relationships with clinical characteristics in such diseases in preschool children are available. The aim of this study was to assess the cytokine profile, LPO — AOD system parameters and their relationship with the clinical and laboratory characteristics of diseases in preschool children with influenza and other ARVI. 86 preschool children (3–6 years old) were examined: with an established diagnosis of influenza (n = 31), non-influenza ARVI (n = 28), apparently healthy children (control group (n = 27). All pediatric samples were analyzed by enzyme-linked immunosorbent assay assessing blood serum concentrations of C-reactive protein and cytokines IL-1β, IL-4, IL-6, IL-8, TNFα, IFNα, IFNγ. Spectrophotometric, fluorometric and enzyme immunoassay methods to assess the state of the “LPO — AOD” system were used. In the group of children with influenza vs other ARVI, a higher incidence of intoxication syndrome was revealed. Cytokine profile in children from both clinical groups compared with control cohort was featured with higher indicators of both pro-inflammatory and anti-inflammatory origin. Children with non-influenza ARVI, had increased magnitude of LPO final products in the nonspecific LPO — AOD system along with lowered concentration of fat-soluble vitamins, general antioxidant activity, GSH level, and SOD activity. In the group with influenza, the level of primary and final lipid peroxidation products was increased, whereas that of for retinol,α-tocopherol, and total antioxidant activity was decreased paralleled with higher GSSG and SOD levels. Numerous correlations were noted in the group of children with ARVI: IL-1β/ketones, IL-6/ketones, IL-8/ketones, TNFα/ketones, IL-4/ketones, IFNg/shortness of breath, IFNα/cough, double bonds/fever, double bonds/AST, SO/intoxication, retinol/fever, GSSG/cough. The influenza group differed in the following relationships: IL-4/ketones, IL-4/fever, IFNα/ketones, CDs/AST. It can be concluded that in preschool children with ARVI and influenza, changes in the cytokine profile are accompanied by increased pro- and anti-inflammatory cytokine levels, increased intensity of lipid peroxidation reactions along with reduced magnitude of antioxidant factors. In the group with ARVI, there was a relationship between the final toxic products of lipid peroxidation — Schiff bases — and the intoxication index, as well as the presence of protective mechanisms in the form of connections between interferons and disease clinical manifestations. The group with influenza was distinguished by the presence of protective relations, which may have a beneficial effect in the context of developing pathological process. The data obtained will help expand the understanding of the pathogenetic mechanisms related to immune reactivity and nonspecific lipid peroxidation reactions in preschool patients and formulate appropriate measures for correction.

Temperature Dependence of the Pre-Chromatographic ‘Lawrence’ Method for Bivalves Contaminated with Paralytic Shellfish Poisoning Toxins

AbstractSaxitoxins are potent neurotoxins originating the acute human neurological syndrome of paralytic shellfish poisoning (PSP) via bivalve vectors. The official testing method in the European Union, commonly known as the ‘Lawrence method’, involves pre-column oxidation steps. The Portuguese monitoring adopted the hydrogen peroxide oxidation screening approach for bivalves contaminated with Gymnodinium catenatum toxins, which can quantify chromatographically at once 6 out of 10 analogues commonly found in bivalves. Seasonal fluctuation in the fluorescence yield of calibration curves was observed across years in a consistent manner. It correlated with fluctuations in average monthly air temperature in Lisbon, highlighting the importance of recording the room temperature during the oxidation steps as a matter of routine practice. Incubation experiments also showed an increase in fluorescence yield with temperature, more pronounced for the 11-hydroxysulphate analogues (dcGTX2 + 3, C1 + 2, GTX2 + 3) than for the 11-H toxins (dcSTX, GTX5[B1], STX). Temperature can be exploited to increase fluorescence yield, assisting in spectral confirmation, but must not exceed 40–50 °C to avoid toxin decomposition or production of extra oxidation products.

The Level of Vitamin D in Patients with Susceptible Pulmonary Tuberculosis and Evaluation of its Influence on the Clinical Course of the Disease

Vitamin D insufficiency or deficiency is defined as a very common condition in the general population. On the one hand, vitamin D deficiency is associated with several adverse health conditions, on the other hand, vitamin D supplements are inexpensive and safe to use, which makes it an attractive therapeutic option for both doctors and patients, especially for groups risk among the population. Several researchers claim that vitamin D metabolites play an important role in the coordinated work of the body’s immune system by inducing the migration of phagocytes, modulating the Th1—Th2 cell balance, and differentiating T-regulatory cells. Objective — to determine the level of vitamin D in patients with susceptible pulmonary tuberculosis and to evaluate its influence on the clinical course of the disease. Materials and methods. The randomized case-control study included 45 patients with newly diagnosed pulmonary tuberculosis of the lungs with preserved sensitivity and 30 practically healthy individuals (PHI) of the control group. The level of vitamin D in blood serum was examined using the VD (Vitamin D) ELISA Kit (Optics Valley Biomedical Industrial Park, Wuhan, China (430075)), for the quantitative detection of vitamin D in blood serum, number: EU2541, parameter: 1.563—100 ng/ml. Results and discussion. According to the results of our study, it was established that the average level of 25(OH)D concentration in the blood serum of patients with pulmonary tuberculosis was (18.46 ± 4.23) ng/ml, in the control group it was (28.834 ± 5.79) ng/ml and was statistically significant (p = 0.001). Our multivariate studies with binary logistic regression showed a strong direct relationship between the presence of a specific tubercular process and vitamin D deficiency (< 20 ng/ml) (OR 2.817, 95 % CI 1.287—4.894, p < 0.005. Conclusions. Vitamin D deficiency was noted in 94 % of patients with pulmonary tuberculosis with severe intoxication syndrome (7—10 points). In tuberculosis with moderate intoxication syndrome (4—6 points), 69.7 % of patients had a vitamin D deficiency, which practically did not differ from indicators in patients with mild intoxication syndrome (1—3 points) — 67.2 % of people.

Experience of practical use of enterosorbents in the treatment of HIV-infected children with diarrhea syndrome

Despite advances in antiretroviral therapy (ART), diarrhea is common among people living with HIV (PLHIV) and negatively impacts quality of life. Although diarrheal diseases caused by opportunistic infections have decreased in the ART era, the overall prevalence of diarrhea remains unchanged, estimated at 28% to 60% of PLHIV.The aim of the study: to conduct a comparative assessment of the clinical efficacy of enterosorbents in the treatment of diarrheal syndrome in children with HIV infection.Materials and methods. The study material included 80 HIV-infected children who experienced acute infectious diarrhea aged 5 to 14 years. The main group included 40 children who received enterosgel, 2 times 1 tablespoon included in the traditional treatment regimen, and the control group included 40 children who received the drug lactofiltrum against the background of traditional therapy, 1 tablet 3 times a day. The duration of treatment was 10 days.Results and discussion. During the treatment of acute diarrhea in children with HIV infection with Enterosgel, a significant decrease in the daily amount and in the duration of diarrhea was observed, which leads to a noticeable loss of signs of dehydration (P<0.05). Elimination of acute diarrhea in children with HIV infection may also have eliminated the underlying intoxication syndrome due to the underlying and burning disease, which may lead to a reduction in health care costs and socioeconomic burden.Conclusion. During the treatment of acute diarrhea in children with HIV infection with Enterosgel, a decrease in the daily amount and in the duration of diarrhea is reliably observed, which leads to a significant disappearance of signs of dehydration (р<0.05).

CLINICAL AND IMMUNOLOGICAL FEATURES OF THE COURSE OF ACUTE OBSTRUCTIVE BRONCHITIS IN CHILDREN INFECTED WITH CHLAMYDIA

Aim. To improve the prognosis of the course of acute bronchitis based on the study of the etiological factor, clinical and anamnestic and laboratory and instrumental characteristics of acute bronchitis in children infected with chlamydia. Materials and methods. 73 children with acute obstructive bronchitis (AOB) were studied, including 32 children with AOB infected with chlamydia and 41 children with AOB not infected with intracellular infection (ICI). Results. For patients with AOB infected with chlamydia, in comparison with non-infected patients, the presence of febrile fever, intoxication syndrome, absence of expiratory shortness of breath and whistling wheezes, as well as a longer duration of treatment (more than 10 days) are characteristic. In patients infected with chlamydia compared to the norm, there is an increase in the number of T- and B-lymphocytes, which is manifested by an increase in the absolute number of CD3, CD8, CD25, CD4, CD22, the relative content of CD8, CD4, CD16 and CD22, as well as the level of serum IgA, IgG and IgM on against the background of suppression of innate immunity in the form of a decrease in the absorbing function of phagocytes, phagocytosis, phagocytic number and their digestive function; spontaneous and stimulated HST-test, the index of activity of stimulated neutrophils and the level of lysosomal-cationic proteins. That is, the child's immune system in conditions of persistence of ICI is in the mode of overload and imbalance. In patients with chlamydia infection, compared to patients without infection, in relation to T-lymphocytes, the following were found: higher values of the absolute number of CD3, CD4, CD8 and the relative number of CD3, as well as lower values of the absolute number of CD4, CD16, CD25 and the relative content of CD16; relative to B-lymphocytes: higher values of the relative amount of CD22, the level of serum IgA and a low level of IgG in the blood serum; in relation to indicators of innate immunity: a higher value of the phagocytic number, spontaneous HCT test and low values of phagocytosis, phagocytic index; relative to the non-specific humoral link of immunity – a higher level of CIC with 3.5% PEG. Conclusions. The revealed reliable differences in clinical and immunological indicators between groups of patients with AOB, depending on the presence of chlamydia infection, provide a basis for their use for diagnostic purposes as a supplement to traditional, protocol methods of diagnosis.

MANIFESTATIONS OF ENDOGENOUS INTOXICATION SYNDROME DEPENDING ON ITS ACTIVITY ACCORDING THE LEVEL OF MEDIUM-MASS MOLECULES

Substances of endogenous intoxication syndrome (EIS), which belong to medium-mass molecules (MMM), have cardiovascular toxicity; their content is increased in conditions of chronic heart failure. However, the influence of EIS activity has been studied not enough, which determined the relevance and expediency of our study.Aim. In order to compare the laboratory-instrumental features of the course of metabolically associated liver steatosis (LS) under the conditions of pronounced and insignificant activity of EIS, 19 patients (10 men, 9 women; average age 61,8 years) with coronary artery disease (CAD), atherosclerotic cardiosclerosis, HF of I-II FC and sonographically diagnosed LS were examined. Depending on the level of MMM, patients were divided into two groups with pronounced EIS (MMM >0,6 units) and moderate activity (MMM <0,6 units), which were identical in gender and age composition, hemodynamic indicators, body mass index and area body surface. Photometric determination of MMM total and at wave lengths of 238, 254, 266, 282 nm in blood and urine was carried out; determination of blood L-arginine and urine nitrites, leptin were provided; aromaticity coefficient 238/282, hepato-steatosis index, AST/platelet ratio, nuclear intoxication index (NII), the ratio of lymphocytes and neutrophils to monocytes were calculated. All results were calculated statistically, the level of significance was taken as p<0.05.The results. Among the examined patients, 36.8% had high EIS activity (grades 2-3), and in 63.2% it was moderate (grade 1). Patients with pronounced EIS activity were characterized by hypoalbuminemia, dyslipidemia, low leptin content and higher arginine level, peripheral blood lymphopenia, and relative thinning of the heart walls. The content of MMM254,266,282 in blood was correlated with the size of the left ventricle in diastole, MMM266,282 in urine - with total cholesterol, low and very low density its particles and triglycerides, the aromaticity coefficient - with urinary nitrites. Integral hematological NII was directly proportional to diastolic pressure, and the lymphocyte/monocyte ratio - to systolic pressure. The ratio of neutrophils to monocytes and AST/platelets were correlated with the content of total bilirubin; and the hepato-steatosis index - with high-density lipoproteins and the coefficient of atherogenicity.Conclusion. Patients with concomitant metabolic-associated steatosis of the liver and a high level of EIS were characterized by metabolic disorders. Specific indicators of EIS correlated with parameters of lipid metabolism and hemodynamics.

Substance-Use Disorders in Critically Ill Patients: A Narrative Review.

Substance-use disorders (SUDs) represent a major public health concern. The increased prevalence of SUDs within the general population has led to more patients with SUD being admitted to intensive care units (ICUs) for an SUD-related condition or with SUD as a relevant comorbidity. Multiprofessional providers of critical care should be familiar with these disorders and their impact on critical illness. Management of critically ill patients with SUDs is complicated by both acute exposures leading to intoxication, the associated withdrawal syndrome(s), and the physiologic changes associated with chronic use that can cause, predispose patients to, and worsen the severity of other medical conditions. This article reviews the epidemiology of substance use in critically ill patients, discusses the identification and treatment of common intoxication and withdrawal syndromes, and provides evidence-based recommendations for the management of patients exposed to chronic use.

A case of neonatal sepsis, early diagnosis and preventive intensive care

Neonatal sepsis is a pathological process that occurs as a complication of any infectious processes and is a life-threatening condition for newborns. Aim. To inform practitioners with the case of neonatal sepsis, when timely diagnosis and intensive care helped to prevent the development of septic shock and multiple organ failure. Materials and methods. A child was treated in the Department of Anesthesiology and Intensive Care of Newborns of Zaporizhzhia City Pediatric Hospital No. 5. He underwent clinical and biochemical blood tests, microbiological, radiological and ultrasound examinations using the hospital equipment. Results. The child with a complicated prenatal history was born by emergency caesarean section for severe pre-eclampsia at 34 weeks’ gestation. On the tenth day of life, the infant developed a worsening intoxication syndrome and febrile temperature. X-ray examinations revealed right-sided pneumonia; clinical blood count showed leukocytosis with acute inflammatory changes, thrombocytopenia, and an elevated procalcitonin level. A day later, the inflammatory changes dramatically deteriorated, and the cerebrospinal fluid cytosis was increased up to 850 cells and dominated by neutrophils. Blood cultures tested positive for Enterobacter cloacae. The child was prescribed antibacterial therapy according to the de-escalation principle (meronem and vancomycin) with subsequent changes according to the results of microbiological examinations, infusion therapy with parenteral nutrition, immunosupportive (intravenous immunoglobulin) and antifungal therapy. As a result of intensive therapy, clinical blood count inflammatory abnormalities were regressed, cerebrospinal fluid was completely restored to health, procalcitonin and C-reactive protein levels were normalized, and pneumonia was resolved within a week. Positive laboratory changes were correlated with the general condition: normalization of body temperature, increased activity, and enteral feeding ability. Conclusions. Timely diagnosis and intensive care of neonatal sepsis caused by gram-negative flora helped to prevent the development of multiple organ failure and septic shock. The use of antibiotic therapy according to the de-escalation principle is justified in newborns at high risk of developing septicaemia.

Clinical and laboratory prognostic factors in patients with mixed infection of erythema form of ixodic tick-borne borreliosis and tick-borne encephalitis

Background. Early diagnosis of the mixed infection of ixodic tick-borne borreliosis and tick-borne encephalitis can be difficult without laboratory confirmation of the diagnosis.The aim. To assess clinical and laboratory predictors in patients for building the models of early differential diagnosis between mixed infection of erythema form of ixodic tick-borne borreliosis and febrile form of tick-borne encephalitis and monoinfection of erythema form of ixodic tick-borne borreliosis.Materials and methods. The clinical study included 26 patients with mixed infection of the erythema form of ixodic tick-borne borreliosis with tick-borne encephalitis (mean age – 46.7 years) and 30 patients with monoinfection of the erythema form of ixodic tick-borne borreliosis (mean age – 48.5 years). 59 clinical, epidemiological and laboratory parameters, including 6 leukocyte blood indices, standard and extended hemogram profiles were studied in these patients the first week of the disease. For statistical analysis, we used Pearson and Mann – Whitney goodness-of-fit tests, ROC analysis with calculation of the area under curve (AUC) and logistic regression. Results. Patients with mixed infection, compared to the patients with monoinfection, had increased odds of having febrile fever, weakness, headache and orbital pain; meningism symptoms occurred only in patients with mixed infection. Early predictors of a preliminary diagnosis of mixed infection were elevated values of fever (AUC = 0.87), intoxication syndrome score (AUC = 0.71), leukocyte count (AUC = 0.64) and neutrophils (AUC = 0.71) in the hemogram, levels of leukocyte intoxication index according to V.K. Ostrovsky (AUC = 0.67) and neutrophil-leukocyte index (AUC = 0.65), as well as a decrease in the number of platelets (AUC = 0.77), eosinophils (AUC = 0.72) and basophils (AUC = 0.79) in peripheral blood. Two prognostic models which included clinical and laboratory parameters demonstrated excellent prediction of mixed infection (AUC = 0.90 and AUC = 0.91).Conclusion. Early clinical and laboratory predictors have been established and models have been developed that make it possible, with excellent prognosis quality, to calculate in patients the probability of a preliminary diagnosis of mixed infection of the erythema form of ixodic tick-borne borreliosis with tick-borne encephalitis in comparison with borreliosis monoinfection.

THE IMPACT OF VACCINATION STATUS ON THE CLINICAL CHARACTERISTICS OF MEASLES COURSE

Measles is a dangerous and highly contagious viral disease with a tendency to spread rapidly. The incidence of measles is cyclical with outbreaks occurring every 5-6 years and is directly related to the level of vaccination against the disease. Measles can become severe clinical course and have serious, sometimes fatal consequences. The purpose of the study is to compare the clinical course of measles depending on the vaccination status of patients. We analysed medical records of 218 patients aged 18 to 55 years who were inpatients with a diagnosis of measles at the Poltava Regional Clinical Infectious Diseases Hospital. The clinical features of measles were compared based on vaccine status using descriptive statistics methods in accordance with the analysis requirements. Comparison of the clinical course of the disease depending on vaccination status did not reveal a statistically significant difference in clinical symptoms between the groups of vaccinated and unvaccinated individuals. However, in the group of unvaccinated patients, a severe course of measles was significantly more often observed compared to those who were vaccinated (p = 0.003). The incidence of complications was studied and found to be lower in vaccinated individuals than in non-immune patients (p = 0.051), specifically pneumonia (p = 0.006). No cases of complications such as measles encephalitis and enterocolitis were recorded among vaccinated individuals. Thus, the course of the disease was characterised by typical clinical signs with a predominance of intoxication syndrome, the appearance of a typical rash, its stages, the presence of catarrhal and, less often, intestinal syndromes. It was found that vaccinated individuals had significantly less frequent severe measles, and the incidence of complications, including pneumonia, was was significantly lower than in unvaccinated patients.

Feline Calicivirosis in the catteries

Cat breeding has become very popular nowadays. The presence of these animals in catteries, especially in conditions of imperfect compliance with sanitary and hygienic requirements, often causes outbreaks of viral diseases, the causative agents of which are transmitted mainly by the aerogenic transmission mechanism. Calicivirosis is the most common kennel disease; it can occur as a mono-infection and can also be associated with other viral respiratory diseases. The study aimed to evaluate the epizootic features and clinical course of feline calicivirus in catteries. It was found that the disease's stationary focus was in the experimental cattery. Depending on the year's season, the morbidity increase begins in April, peaks (40 %) in July, and gradually decreases until September. The most vulnerable age group is kittens aged 2–6 months due to imperfect immune mechanisms at this age. The disease occurs mainly manifestly in this age group, with characteristic pronounced clinical signs. Sick cats have sub febrile or pyretic fever, lack of appetite, and salivation with viscous saliva. Ulcers develop on the mucous membranes of the oral cavity. Also, erosions and ulcers are noted in the nasal mirror and on the mucous membrane of the larynx. There was conjunctivitis with serous to catarrhal-purulent exudate. Laboratory tests revealed leukopenia, acceleration of erythrocyte sedimentation rate, left shift of the nucleus, lymphocytosis, and monocytosis, which indirectly determine the viral disease and stimulation of immune functions, and the development of a systemic inflammatory response. Biochemical tests revealed the development of intoxication syndrome, hepatitis liver failure, and renal failure. The data obtained prove the systemic nature of the impact of calicivirus infection, the development of complications in the form of a systemic inflammatory response, which affects various organs and systems, particularly the liver and excretory system. The development of multiorgan pathology in feline calicivirus infection requires an integrated approach to treatment, including pathogenetic and symptomatic measures in the treatment protocol.

COVID-19 and the flu: clinical and immunological features in children

In conditions of co-circulation of COVID-19 pathogens and other acute respiratory infections, the risk of simultaneous infection with SARS-CoV-2 and other pathogens, in particular influenza viruses, increases. Previously published data on the mutual influence of such combined infectious processes are very contradictory.Purpose. To determine the clinical and immunological features of the combined course of COVID-19 and influenza in children.Material and methods. Among 3,983 hospitalized children with COVID-19, 48 patients (1.2%) co-infected with influenza A and B viruses were identified by PCR. 31 children with a combination of COVID-19/Influenza were subjected to in-depth examination. The comparison group consisted of 30 children with SARS-CoV-2 monoinfection. In addition to standard physical, instrumental and laboratory studies, serum levels of IgM and IgG to SARS-CoV-2 S protein were determined in patients of the compared groups using ELISA.Results. In children with a combination of influenza and infection caused by both delta and omicron variants of SARS-CoV-2, acute bronchitis was more common, regardless of age, compared with patients with SARS-CoV-2 monoinfection. Co-infection with the influenza virus did not change the incidence of pneumonia in patients with omicron-SARS-CoV-2 infection, and in patients with delta-SARS-CoV-2 infection it decreased it. In co-infected children, the severity of intoxication syndrome and the level of D-dimer in the blood were higher. In addition, patients with a combination of COVID-19 and influenza showed lower concentrations of IgM and IgG to S-protein in comparison with patients with SARS-CoV-2 monoinfection.Conclusion. Co-infection with influenza viruses alters the clinical course of COVID-19, while the nature and vector of changes depend on the SARS-CoV-2 gene variant. A decrease in the severity of the humoral immune response to SARS-CoV-2 in co-infected children was found.

Dishomeostatic phenomena in acute pancreatitis of variable severity

Acute pancreatitis remains one of the most dangerous pathologies in the structure of emergency abdominal surgery. This is due to many reasons, including an increase in the frequency of destructive forms of the disease, high mortality, and frequent unfavorable outcomes. The aim of this study was to investigate a number of leading components of homeostasis in patients with acute pancreatitis of varying severity. A retrospective study was conducted on 50 patients with acute pancreatitis of diff erent severity levels who were hospitalized at the Republican Clinical Hospital named after S.V. Katkovа (Saransk, Russia). The patients were divided into groups: the fi rst group (control, n = 30) consisted of patients with mild acute pancreatitis, and the second group (main, n = 20) consisted of patients with severe acute pancreatitis. The study evaluated the endogenous intoxication syndrome, the activity of lipid peroxidation and phospholipase systems, microcirculation status, liver function, and the activity of the coagulation-lytic blood system. The results showed that in the early stages of acute pancreatitis, several pathological processes were observed: the development of endotoxemia syndrome, activation of lipid peroxidation and phospholipase systems, microcirculation disorders, changes in the coagulation and fibrinolytic links of the hemostasis system, and liver function suppression. The severity of these disorders was associated with the severity of the pathology. In cases of mild severity, the changes in the parameters studied were reversible, while in severe cases they were stable and oftenirreversible. The presence of toxemia, oxidative stress, dysmicrocirculation, and hemostatic disorders should be considered as risk factors for disease progression and complications.

Evaluation of the Microorganism Present in Garri Sold within Local Market and Garri Producers in Ozoro Community

This study evaluated the microorganisms (bacteria and fungi) present in garri sold within local market and garri producers at Ozoro Community. This was achieved through microbial analysis of samples to determine microbial count and strains available. Contamination of sample was observed for garri sold at different locations with the bacteria count seen to be higher at the local market 1 (42x106cfu/10g) and garri producer (41x106cfu/10g) than at local market 2 (38x106cfu/10g) which shows that market activity may not be the contamination source. Bacteria isolates indicated the presence of pathogen associated with disease and food poisoning syndrome such as E. coli, Staphylococcus, Bacilli and Pseudomonas. Staphylococcus and Escherichia coli were observed to be the dominant strains of microbes in garri sold across all assessed location which poses health risk due to their pathogenicity. Fungi were detected in garri samples assessed from all three locations with an increasing trend from producer to sales point which is an indication that garri contamination with fungi must have occurred from post production activities in the market and sales point. The fungi isolates obtained from the samples areAsperillus flavus Penicilum spp.and Candida albican. Asperillus flavus andPenicilum spp. were observed to be the dominant strains of microbes in garri sold across all assessed location. The samples of garri sold around Ozoro are unsafe since they did not meet with the recommended limit by Food and Agriculture Organization (FAO) of 1x104cfu/g for bacteria count and 1x104cfu/g for fungi count and E.coli count of 0. Hygienic practices should be strictly adhered to prevent contamination of garri produced.

ВОЗМОЖНОСТИ УЛУЧШЕНИЯ РЕЗУЛЬТАТОВ ЛЕЧЕНИЯ У ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ ЭМПИЕМОЙ ПЛЕВРЫ НА ФОНЕ БРОНХОПЛЕВРАЛЬНЫХ СВИЩЕЙ

Background. Treatment of pleural empyema in combination with bronchial fistula is aggravated by severe purulent-resorptive intoxication, which often leads to long periods of treatment with chronicity of the process and is still considered an urgent problem of modern pulmonology and thoracic surgery. Objective. To analyze the results of treatment of patients with chronic pleural empyema accompanied by bronchopleural fistulas using controlled vacuum aspiration, including in combination with the installation of a reverse endobronchial valve. Material and methods. The results of treatment of 38 patients with chronic pleural empyema in combination with bronchopleural fistula using controlled vacuum aspiration technology, including implantation of an endobronchial blocker in 15 of them were analyzed. Results. A method of hybrid surgical treatment of pleural empyema based on application of vacuum aspiration with implantation of an endobronchial blocker was developed. The technique of using adjustable vacuum aspiration in combination with endobronchial blocker implantation provides long-term and adequate blocking of the fistula-bearing bronchus without the risk of pneumonic complications in the blocked part of the lung. Vacuum aspiration based on the creation of local negative pressure accelerates the healing process of empyema cavity and eliminates intoxication syndrome, while their combination makes it possible to reduce the average duration of unstable pneumostasis from 295 days to 3 days, to shorten the total duration of treatment measures almost 4 times as well as to decrease mortality (from 6.2% in the comparison group to 0% in the main group). Conclusions. The use of endobronchial blocking in combination with vacuum aspiration of contents from the purulent cavity for the treatment of patients with chronic pleural empyema reduces the average duration of pneumostasis stabilization, the total duration of therapeutic measures as well as mortality.

Descriptive Study of Chicken Pox in the Post Graduated Hospital Khost Afghanistan

Chicken pox is an acute infectious disease of viral etiology, characterized by the appearance of characteristic blistering rash against the background of a general intoxication syndrome. (13, 14) The causative agent of chickenpox is the herpes virus type 3, transmitted from a patient by airborne droplets. Chickenpox is one of the most common childhood infections. It is manifested by characteristic abundant itchy blistering rashes that appear at the height of fever and general infectious manifestations. (15, 16) A typical clinic allows you to diagnose the disease without conducting any additional research. Treatment of chickenpox is mainly symptomatic. To prevent secondary infection, antiseptic treatment of rash elements is recommended. Infants and Children are affects in all ages, but most severely infants, who experience the highest age-specific incidence and account for almost all Chickenpox hospitalizations and deaths. (17, 18, 19) Research Goal: Case of Chickenpox in the Khost post graduated hospital from the 1399/06/01 to 1399/12/30. Methodology: This is a descriptive study that was conducted in the form of a case series. This study was conducted on 43 patients affected by chicken pox.

Features of the clinical course of chronic pancreatitis in patients with chronic obstructive pulmonary disease

Aim. The purpose of the study is to determine the intensity of the manifestation of clinical syndromes in the comorbid course of chronic pancreatitis (CP) in patients with chronic obstructive pulmonary disease (COPD) in comparison with the isolated course of CP and to assess the intensity of the mutual burden syndrome. Material and methods. A prospective cohort study was conducted, analyzing the medical records of 212 inpatients. The first group comprised 96 individuals with an isolated course of chronic pancreatitis (CP), while the second group included 116 patients with CP and comorbid chronic obstructive pulmonary disease (COPD), categorized as Group E. The study focused on subjective manifestations of pain syndrome in CP, the extent of exocrine pancreatic insufficiency, clinical blood analysis, biochemical research regarding the content of markers indicating pancreatic enzyme deviation in the blood, and the level of elastase-1 in feces. Additionally, ultrasonographic examination of the organs in the abdominal cavity was performed. Results. Patients in group 2 exhibited manifestations of abdominal pain syndrome 1.2 times more frequently than those in group 1 (p < 0.05). The frequency of pain in the pancreas radiating to the right subcostal region was 1.9 times higher in group 2 compared to group 1 (p < 0.05), along with a 2.1 times increase in the symptom of girdled pain radiating to the back (p < 0.05). Although the frequency of dyspeptic syndrome was slightly higher in group 2 (1.3 times, p > 0.05), astheno-vegetative syndrome was significantly more pronounced, exceeding the frequency in group 1 by 1.7 times (p < 0.05). Ultrasonography parameters of the pancreas in both groups revealed characteristic signs of chronic pancreatitis (CP). The analysis of pancreatic functional state indicators during exacerbation indicated hyperenzymemia syndrome, with α-amylase activity significantly higher in patients of both groups compared to the control group – by 1.8 and 2.6 times, respectively (p < 0.05). Conclusions. CP with chronic obstructive pulmonary disease (COPD) is characterized by a significantly lower frequency of paroxysmal abdominal pain syndrome but a higher frequency of constant aching pain in the pancreas area. Additionally, it is associated with the maximum intensity of inflammation, hyperfermentemia, a decrease in the activity of elastase-1 in feces, and a higher intensity of astheno-vegetative, painful, dyspepsia, intoxication syndromes. Moreover, there is a more pronounced exocrine dysfunction of the pancreas and more significant changes in the sonographic structure of the pancreas compared to cases with the isolated course of CP.

Headache as the leading syndrome of intoxication due to environmental pollution. Ways to solve the problem

Headache is the leading syndrome of many diseases caused by a polluted environment. Processing of human waste reduces the negative impact of landfills of human health. The conducted survey of residents of Vinnytsia and Ternopil found that the vast majority (99 %) of respondents understand that environmental pollution poses a threat to health, causes many diseases accompanied by headaches and requires a solution to waste disposal. Almost all respondents (93 %) are ready to sort garbage, provided the appropriate conditions are provided, which are improve the environment and help reduce the prevalence of headache syndrome in the human population

An integrated approach in the treatment of a patient with pulmonary tuberculosis and tracheobronchial tree with psychological support

One of the complications of the tuberculosis process is tuberculosis of the tracheobronchial tree, which tends to grow in recent years. Many studies indicate the incidence of bronchial tuberculosis from 10% to 40%, taking into account the level of diagnostic measures to detect tuberculosis and the availability of endoscopic services. An important problem in the treatment of tuberculosis is psychological problems in patients, including those with drug-resistant tuberculosis. In phthisiology, attention is drawn to the widespread history of stress in patients with tuberculosis and the complexity of psychological rehabilitation against the background of treatment. In relation to such patients, it is advisable to use a comprehensive medical and psychological approach, including specialized care based on the developed models of psychological rehabilitation. A large number of studies show that among patients with tuberculosis of the trachea and bronchi, young women, non-smokers with a high level of education and income are about 2 times more likely. An important problem is also unstable compliance and low stress tolerance in patients with neurotic personality organization, prone to actualization of maladaptive stereotypes of responding to the difficulties of the treatment process. This clinical example demonstrates the high efficiency of complex treatment of the tuberculosis process, which included anti-tuberculosis therapy, inhalation therapy, surgical treatment and psychological correction. Despite the late diagnosis of the tuberculosis process, relief of intoxication syndrome, cessation of bacte excretion and improvement of the clinical condition were achieved by 2 months of treatment. This approach in the complex treatment of the tuberculosis process is extremely important and relevant to achieve high treatment results.