Intoxication Syndrome Research Articles

APPLICATION OF GALVANOENTEROSORPTION IN MULTIMODAL TREATMENT OF PATIENTS WITH THERMAL BURNS

Abstract. Aim – to investigate the influence of enterosorption and its combination with intra-tissue electrophoresis (ITE) of antibacterial preparations on the proteolytic and fibrinolytic activity of blood plasma in patients with common thermal burns.
 Material and methods. Enterosorbtion detoxification by enterosgel was used in the multimodal treatment of 28 patients with thermal burns of II-IV stages. The drug was prescribed from 2-3 days after burn for 7-14 days, depending on the severity of the injury and manifestations of the intoxication syndrome. In 24 patients the treatment was complemented by galvanization of burn wounds with the preliminary introduction of antibacterial drugs. ITE began with 3-4 days after burn, taking into account the sensitivity of the microflora to antibiotics. The comparison group was made up of 30 patients with similar areas and depths of thermal burns receiving traditional treatment.
 Results and discussion. It was discovered that the inclusion of enterosorption in multimodal therapy of burns diminished the level of unlimited proteolysis, favoured the increase of the level of blood plasma fibrinolytic activity. Its combination with ITE of antibacterial agents (galvanoenterosorption) ensured a higher therapeutic effect. Common deep thermal burns are accompanied by a significant increase in proteolytic and fibrinolytic activity (FA) of blood. Inclusion of enterosorbtion in the integrated therapy of burns provides reduction of proteolytic activity and maintenance of a high level of FA of plasma, which reduces the risk of thromboembolic complications.
 Conclusion. Combined use of enterosorption and ITE of antibacterial agents (galvanoentersorption) with thermal burns provides a higher therapeutic effect.

Profile of patients attending psychiatric emergency care during the coronavirus 2019 (COVID 19) pandemic: a comparative cross-sectional study between lockdown and post-lockdown periods in Lombardy, Italy

Objective To assess the long-term impact of early COVID-19 lockdown phase on emergency psychiatric consultations in two psychiatric emergency departments located in Italy. Methods We conducted a cross-sectional study comparing the number and characteristics of emergency psychiatric consultations during post-lockdown with respect to the lockdown period. Sociodemographic data, clinical characteristics, referred symptoms, diagnosis, information on multiple psychiatric consultations and hospitalisation were collected. Results A rise of almost 60% in emergency psychiatric consultations during the post-lockdown compared to the lockdown period was observed. Emergency psychiatric consultations in the post-lockdown period were associated with lower rates of cannabis (aOR = 0.42, p = 0.011) and cocaine use (aOR = 0.39, p = 0.011). Despite a lower occurrence of two or more psychiatric consultations was observed during post-lockdown phase (aOR = 0.44, p = 0.008), subjects who had anxiety disorders (aOR = 3.91, p = 0.000) and substance intoxication or withdrawal (aOR = 6.89, p = 0.000) were more likely to present to emergency psychiatric consultations during post-lockdown period compared to the lockdown one. Conclusions Substance intoxication or withdrawal and anxiety disorders increased after the COVID-19 lockdown. The findings of this study suggest to address more economic and professional sources to the mental health areas potentially more affected by the different phases of a pandemic. KEYPOINTS COVID-19 pandemic and lockdown measures increased mental health unmet needs. According to our findings, a rise in emergency psychiatric consultations during the post-lockdown compared to the lockdown period was observed. Patients with substance intoxication or withdrawal syndrome and anxiety disorders were significantly more likely to present to emergency psychiatric consultations during post-lockdown. Lockdown was associated with higher rates of both cannabis and cocaine use disorders as well as of multiple psychiatric consultations. Alternative strategies to improve mental health such as e-health technologies should be promoted.

Сolloidal silicon dioxide use (Polisorb MP) at food allergy skin and gastrointestinal manifestations

Background. At present, due to high prevalence of allergic diseases which start in early childhood, the search for new prevention and treatment methods is in great demand. Aim. To study the effectiveness of the Russian-produced enterosorbent colloidal silicon dioxide in the treatment of patients with food allergies combined with atopic dermatitis and gastrointestinal manifestations. Materials and methods. An open, randomized, comparative clinical study of the enterosorbent (colloidal silicon dioxide) effectiveness has been conducted in parallel groups of infants and preschool children with food allergy skin and gastrointestinal manifestations. The main groups (1 67 children with food allergies and atopic dermatitis skin manifestations, 3 60 children with food allergies and gastrointestinal manifestations) received, along with basic medication, colloidal silicon dioxide enterosorbent day at an age-specific dosage twice a for 1014 days. Control groups (2 60 children with food allergies and atopic dermatitis skin manifestations, 4 60 children with food allergies and gastrointestinal manifestations) did not receive enterosorbent. All children underwent a clinical, functional and laboratory status assessment, including medical records analysis, a pediatrician clinical examination, narrow specialists (allergist-immunologist) examination, laboratory and instrumental research. The treatment effectiveness was being evaluated on the 14th day after the initiation of therapy and after 30 days. The therapy effectiveness was assessed based on regression of skin syndrome clinical and gastrointestinal manifestations, intoxication syndrome and laboratory parameters (IgE, hemogram eosinophilia duration). The study was conducted from 2017 to 2019. On the basis of LLC Modern Medical Technologies Clinics (Kemerovo). Results. Therapy with colloidal silicon dioxide increases the significance of food allergy skin manifestations positive dynamics, which makes it possible to reduce the volume of medication and the duration of topical glucocorticosteroids use to 5.340.35 days, in the compared group 10.520.85 days (p=0.002). All patients with food allergy combined with atopic dermatitis in the main and control groups noted positive clinical dynamics, appearing as decrease in the skin inflammatory reaction area and intensity. However, the of colloidal silicon dioxide use accelerates skin syndrome condition normalization significantly (group 1 skin syndrome persisted in 2.92.0% after 14 days, in group 2 18.34.9%; p=0.003). Colloidal silicon dioxide use accelerates humoral immunity state normalization (IgE) and peripheral blood parameters (hemogram eosinophilia). Colloidal silicon dioxide therapy accelerates food allergy gastrointestinal manifestations positive dynamics in children. Two weeks after the sorbent therapy started, gastrointestinal tract lesions symptoms frequency is less than in patients in the compared group. Diarrhea frequency before treatment started was 48.36.5%, 45.06.4% in the compared groups. After two weeks it decreased to 6.73.2% with the Polisorb therapy and to 16.64.8% in the compared group (p=0.003). Abdominal pain was noted by patients of both groups equally often before the study began. After 2 weeks, abdominal pain was noted by ten percent 10.03.9% of patients taking colloidal silicon dioxide and 25.05.6% of the compared group (p=0.009). Conclusion. Taking into account the composition of the colloidal silicon dioxide, it makes sense to include this medication in childrens food allergies complex treatment starting from infancy, which contributes to a more rapid relief of gastrointestinal system damage symptoms, life quality improvement for children and their parents, and decrease in medication load. When using colloidal silicon dioxide in children with food allergies, a faster dynamics of disease symptoms relief (p=0.003) was noted, which allows us to conclude that it is highly effective in the treatment of allergic diseases associated with food sensitization.

Clinical case in outpatient practice: acute tonsillitis against background of COVID-19

Over the past period of the COVID‑19 pandemic, experience has been gained on the ways of spreading the infection, new approaches to treatment have been formed, and preparations for vaccine prevention have been created. Information about COVID‑19 is updated with new data on the features of the clinical course, including rare manifestations of the disease. The clinical symptoms of CAVID‑19 are characterized by a significant variety and are due to the tropism of the SARS‑CoV‑2 virus to various tissues. The article describes a clinical case of COVID‑19. With severe intoxication syndrome, the patient was found to have concomitant acute tonsillitis. The article provides a review of the literature on the clinical symptoms of COVIND‑19 and the mechanisms of their development. The differential diagnosis of viral and bacterial tonsillitis is considered. Efficacy of antibacterial therapy of tonsillitis with cefixime. The clinical case is illustrated with photos.

Commentary on Minhas et al.: Food addiction--the role of substance and environmental factors.

Food addiction is associated with individual differences implicated in addictive disorders (e.g. impulsivity) and clinically significant problems (e.g. obesity). The addictive nature of highly processed foods plays a key role in driving addictive eating and the modern food environment contributes to the prevalence of food addiction in adults and children. Addiction is a complex disorder that results from an interaction between (1) the addictive nature of a substance/behavior, (2) individual differences that increase risk (e.g. impulsivity) and (3) socio-environmental factors that increase the accessibility, availability and social acceptability of the addictive substance/behavior. Minhas and colleagues investigate the role of individual differences (e.g. impulsivity) in food addiction [1]. It is also important to consider the other factors that contribute to addiction: the addictive nature of the substance and the socio-environmental setting. The modern food environment has become dominated by highly processed (HP) foods (e.g. chocolate, ice cream, chips, pizza) in the last 50 years [3]. These HP foods have unnaturally high levels of refined carbohydrates and fat [4] and are more effective at activating reward systems than minimally processed (MP) foods (e.g. fruits, vegetables) [5, 6]. These HP foods are mood-altering (e.g. increase pleasure, reduce negative affect) and trigger addictive responses, such as loss of control over consumption, intense cravings and an inability to cut down despite negative consequences [4, 7]. However, can these HP foods truly be considered addictive? As a field, we frequently debate what substances can trigger addiction. One of the last big debates surrounded tobacco products (e.g. cigarettes), which are legal, accessible and heavily marketed. They are created by an industry that optimizes tobacco's reinforcing properties to keep people hooked [8]. Tobacco does not cause an intoxication syndrome or severe physical withdrawal symptoms, which contributed to the controversy over whether it was truly addictive or just a bad habit [8, 9]. When the Surgeon General's report labeled tobacco as addictive in 1988, tobacco products were estimated to be contributing to more than 300 000 cases of preventable death each year and 75–80% of quit attempts failed [8]. Like cigarettes, HP foods are legal, accessible and heavily marketed by an industry that designs these novel products to maximize ‘cravability’ and create ‘heavy users’ [10]. Like cigarettes, HP foods are not intoxicating and do not cause severe physical withdrawal symptoms. However, frequent HP food consumption is associated with a 31% higher risk of all-cause mortality [11], and most dietary change attempts fail in the long term [12]. Although we need to eat to survive, HP foods are detrimental for health and replace intake of more nutritious MP foods [3]. In sum, HP foods are highly reinforcing, mood-altering substances that trigger the diagnostic indicators of addiction (e.g. loss of control, cravings), have stark public health consequences and high relapse rates. All these factors support the conceptualization of HP foods as addictive substances. Environmental factors that increase the harm of other addictive substances (e.g. cheap, accessible, marketed) [13] also define the HP food environment. The magnitude of individual risk (e.g. impulsivity) needed to develop addictive patterns of intake in a food environment dominated by cheap, accessible and heavily marketed HP food is probably much lower. Given that children and teens are generally more impulsive than adults [14], they may be particularly vulnerable to the negative effects of the HP food environment. Food addiction is prevalent in children and teenagers, which is related to obesity and poorer mental health [15, 16]. Personalized interventions that target addictive mechanisms may increase the success rates of current diet-change interventions for adults and children. However, environmentally focused approaches have been essential to reducing the public health consequences associated with other addictive substances (e.g. cigarette taxes, removing cigarette vending machines, marketing restrictions) [17]. If scientific consensus builds that HP foods are addictive, environmental approaches will probably play an essential role in reducing the harms associated with food addiction (e.g. obesity, lower quality of life) throughout the life-span. None.

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.

Antioxidant status of the organisms of young bulls in the conditions of lead-cadmium load and effect of correcting factors

Prolonged ingress of heavy metals into the organisms of animals, even in low concentrations, causes a number of toxic impacts, affecting various organs and systems. The objective of this study was to research parameters of enzymatic and non-enzymatic links of the system of antioxidant protection of the organism of young cattle in the condition of lead-cadmium load and the effect of Metisevit Plus feed additive. Studies were conducted on the basis of the Private Agricultural Company “Ukraina”, located in Dubrovytsia district of Rivne Oblast, using 12 six-month old bulls of Ukrainian Black Pied Dairy breed divided into two groups, each consisting of 6 animals. Bulls of the control group received the standard diet. The bulls of the experimental group were fed with Metisevit Plus feed additive in the dose of 0.5 g/kg of feed. The contents of lead and cadmium in feed at the enterprise were determined to be high. According to the conducted studies, it was determined that in conditions of cadmium and lead load, there is a decrease in activity of glutathione link of the system of antioxidant protection of the organism of bulls. Feeding the bulls of the experimental group with Metisevit Plus feed additive for 30 days led to increase in the levels of non-enzymatic and enzymatic activities of the glutathione system. Significant increase in the level of reduced glutathione was recorded on days 30 and 40 of the experiment. Consumption of Metisevit Plus by the animals of the experimental group promoted increase in the activity of catalase and superoxide dismutase starting on the 20th day of the experiment. On days 30 and 40 of the experiment, the activity of the studied enzymes ranged within the physiological values. Therefore, the studies conducted on the bulls indicate that in the conditions of cadmium and lead load the feed additive Metisevit Plus fed to the bulls activated the system of antioxidant protection by increasing the levels of enzymatic and non-enzymatic links. When feeding bulls of the experimental group with Metisevit Plus feed additive, we determined significant decreases in diene conjugates and TBA-active products in their blood starting already on the 10th day of the experiment. On days 20 and 30 of the experiment, the level of diene conjugates in the blood of animals of the experimental group decreased by 14.5% and 24.0%. Efficiency of the feed additive may be explained by the effect of its constituents on the main pathogenic links of the pathological process caused by cadmium and lead. As indicated in the studies, liquidation of the syndrome of endogenous intoxication restores the functional condition of cellular membranes of the liver, protein-synthesizing function of the liver, increases the antioxidant status of the organisms of bulls. The studies we conducted confirm the expedience of using feed additive Metisevit Plus to prevent lead-cadmium toxicosis.

Eco-dependent osteopenia as a manifestation of eсo-pathology in children

The research aim is to identify epigenetic factors of eco-dependent osteopenia occurrence and progression in children.
 Materials and Methods. The research focuses on analyzing the medical documentation of 41 children aged between 3 and 16 from ecologically unfavorable locations (Burshtyn, Kalush, Dolyna towns) and 73 children of the same age from an ecologically friendly location (Gorodenka town) in Ivano-Frankivsk Region. The children underwent clinical examination and diagnostic instrumental studies.
 Results and Discussion. We analyzed and compared the nature and incidence of complaints in children from ecologically unfavorable and ecologically friendly locations. The significant number of complaints were associated with the syndrome of general nonspecific intoxication, which was confirmed by clinical manifestation of eco-pathology. Ultrasound densitometry was used to determine bone mineral density (BMD). Blood and urine Ca levels were also measured.
 Conclusions. The skeletal pathology manifested by osteopenic syndrome was diagnosed in most of examined children. This indicates a high incidence of eco-dependent osteopenia in children from ecologically unfavorable regions. The identified patterns were confirmed in the examined children by ultrasound densitometry, hypocalcemia, and hypercalciuria.

Хвороба Вільсона—Коновалова: гострий початок, перебіг, діагностика та лікування (клінічний випадок)

The article presents information on the main etiology and pathogenesis of Wilson–Konovalov disease, as hepato-lenticular degeneration associated with excessive accumulation of copper in body tissues due to an inherited autosomal recessive defect of a protein that transports copper. A rare case of the onset and course of the disease in a patient who was examined and treated at the Ivano-Frankivsk Regional Children's Clinical Hospital is described. The main focus is on the acute, atypical onset of the disease, in particular the signs of severe intoxication syndrome caused by manifestations of hepatic encephalopathy, steroid-induced diabetes, anemia of complex genesis, coronavirus disease, pyoderma. The difficulties of diagnosing the disease against the background of delayed manifestation of the main pathognomonic manifestations and the absence of reliable signs of the disease are shown. The clinical picture of this clinical case, features of the course are described, the indicators of the main clinical and laboratory research methods are given, the results of instrumental diagnostic methods and genetic examination methods are shown, both in laboratories of Ukraine and abroad, which confirmed the diagnosis of Wilson–Konovalov disease. The treatment of this clinical case is described in detail not only at the local level but also in the main leading research institution of Ukraine «OHMATDYT» and «National Institute of Surgery and Transplantology named after O.O. Shalimov». Recommendations for further observation and treatment of the child at the place of residence after orthotopic transplantation of the left lobe of the liver from a living family donor. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: Wilson-Konovalov disease, etiology, pathogenesis, clinical picture, diagnosis, examination, treatment.

Combination ozone therapy as an effective method of radiomodification in chemoradiation treatment of patients with cervical cancer.

e17515 Background: The purpose of the study was to evaluate advantages of combination ozone therapy as an effective factor of radiomodification and radioprotection in the treatment of patients with cervical cancer. Methods: The study included 20 patients with stage IIIb cervical cancer T3бNхM0, the mean age 52 years. Controls (n = 10) received standard chemoradiation therapy; the main group (n = 10) received combination ozone therapy in addition to chemoradiation therapy. Systemic ozone therapy involved intravenous administration of 250 ml ozonized solution of 0.9% sodium chloride, 15 sessions during external beam radiotherapy. Local ozone therapy involved 15-minute instillations into the vagina during brachytherapy. All patients received standard chemoradiation therapy, total irradiation dose to the primary focus 80 Gy, plus weekly cisplatin 40 mg/m2. Results: In the main group, pain and discomfort in the lower abdomen were managed in 20% patients by the 5th session of ozone therapy; 30% - on the 10th day; in 50% - on the 14th day. In the control group, such symptoms in 40% of patients were reduced after 20 days. The main group showed a more rapid regression of tumor infiltration, disappearance of purulent discharge, relief of intoxication syndrome. Manifestations of gastrointestinal toxicity were observed in 10% of the main group and in 100% controls; leukopenia developed in 7 patients in the control group and was not registered in the main group. MRI showed complete clinical regression in 90% in the main group and in 65% in the control group. The treatment was completed within 7 weeks in the main group and 8.5 weeks in the control group. Conclusions: Combination ozone therapy causes a more pronounced antitumor effect, and its radioprotective effects significantly reduce the severity of chemotherapy-induced disorders. It does not aggravate concomitant pathology and shortens the treatment period.

Endogenous intoxication syndrome in pyelonephritis and methods of its therapy with the use of nutrient support

Endogenous intoxication syndrome in pyelonephritis and methods of its therapy using nutritional support G.M. Letifov FSBEI HE «Rostov State Medical University Ministry of Health of Russia Rostov-on-Don Summary The aim of the study was to scientifically substantiate and determine the prospects for the use of nutritional support in the form of the use of dietary supplements containing a complex of natural dietary fibers, inulin (from artichoke), effective probiotics-short-chain fructooligosaccharides, maltodextrin 1.5 teaspoon 2 times a day. The course of treatment is 3 weeks. The appointment of a prebiotic complex, prevention of dysbiosis and restoration of the intestinal barrier function significantly reduced the risk of re-entry of opportunistic intestinal flora into the urinary system, thereby reducing the need for antibacterial prophylaxis of recurrent pyelonephritis.

АКТИВНОСТЬ АЛЬФА-АМИЛАЗЫ СЛЮНЫ И УРОВЕНЬ ГИГИЕНЫ РОТОВОЙ ПОЛОСТИ ПРИ НЕКОТОРЫХ КЛИНИЧЕСКИХ СОСТОЯНИЯХ

Subject. Changes in the activity of certain saliva enzymes, due to certain factors and in certain clinical conditions of the human body, can affect oral hygiene, as well as indirectly on the activity of the carious process. Of particular interest is the enzyme — alpha-amylase, which is due to its ability to cleave dextrans and levans, which are the basis of the matrix of the bacterial film. The article presents data on changes in the activity of saliva alpha-amylase in microecological disorders in the intestine and acute respiratory viral diseases, as well as its effect on the level of oral hygiene.
 The goal — the assessment of changes in the activity of saliva alpha-amylase in microecological disorders in the intestine and acute respiratory diseases, taking into account the level of oral hygiene.
 Methods. To determine the activity of alpha-amylase, a set of reagents "Amylase-Vital" was used according to the manufacturer's instructions, proportionally reducing the volume of reagents for the procedure in titration plates. The volunteers, divided into groups with severe acute respiratory syndrome, microecological intestinal disorders, and a control group, received mixed saliva and evaluated their oral hygiene status.
 Results. The inverse relationship between the severity of intoxication syndrome in severe acute respiratory syndrome and the level of saliva alpha-amylase activity is shown. In addition, a correlation was established between an increase in human body temperature and a decrease in the activity of alpha-amylase. There is also a link between the presence of decompensated intestinal dysbiosis in humans and the activity of the enzyme. The dependence between the decrease in the activity of the studied enzyme and the increase in biofilm formation on the organs of the oral cavity was revealed.
 Conclusions and Relevance. The conducted studies open up a promising direction for the development of additional diagnostic criteria based on the determination of the activity of saliva alpha-amylase. In addition, the data obtained on the deterioration of oral hygiene indicate the need for a comprehensive approach to the treatment of patients in this category with the mandatory involvement of a dentist.

Types of constitutional diatheses in children with tuberculosis infection

Diathesis or constitutional abnormality is a polygenically inherited tendency of an organism to diseases, objectively recognized by deviations from the normal phenotype. There are 4 types of diatheses: exudative-catarrhal, lymphatic-hypoplastic, neuro-arthritic and allergic. The aim of the work was to identify and determine the frequency of diathesis in children with different course of tuberculosis infection. 225 children aged from 1 to 14 years were examined: 108 children with active forms of tuberculosis; 54 children with residual post-tuberculosis changes; 63 children with latent tuberculosis infection. It was found that among patients with active tuberculosis, children with lymphatic-hypoplastic (17.6 ± 3.7%) and neuro-arthritic diathesis (16.7 ± 3.6%) are most common, and children with allergic diathesis (11.1 ± 3.0% of cases) are less common. Children with lymphatic-hypoplastic diathesis often develop a complicated course of tuberculosis (26.3 ± 10.1%), there is a pronounced intoxication syndrome (58.0± 11.3%). The frequency of occurrence of children with allergic diathesis is higher in patients with residual post-tuberculosis changes (29.6 ± 6.2%) and with latent tuberculosis infection (33.3 ± 6.0%) than in patients with active tuberculosis (11.1 ± 3.0%).

Hand, foot and mouth disease associated with streptococcus infection in a child (clinical case)

In the presented clinical case, the combination of two pathogens (enterovirus and streptococcus) caused a severe and atypical course of the hand-foot-mouth syndrome in a child of primary school age. EVI from the first days of the disease represented by the typical localization of the primary elements of the rash and the characteristic intoxication syndrome was confirmed by the detection of enterovirus RNA in the feces. The course of the disease was undulating. In the first wave, skin rashes accompanied by soreness and itching corresponded to the classical EVI in terms of the nature of the elements, their localization and were combined with lesions of the epithelium of the oral mucosa. Starting from the 5th day of the disease, against the background of an increase in the severity of intoxication syndrome, bullous elements appeared on the skin of the extremities, an excess of the permissible values of antistreptolysin-O was found 12 times, and when sowing material from cracks in the corner of the mouth, Streptococcus pyogenes 106 KUO was isolated, which indicated a combination of the syndrome Hand-foot-mouth with streptococcal infection. Onychomadesis in the period of convalescence retrospectively testified to the dominant role of enterovirus in the presented clinical case.

COVID-19 and recurrent respiratory infections in children of Kazakhstan

The study goal was to investigate the COVID-19 clinical course in children with recurrent respiratory infections (RRI) in Nur-Sultan, Kazakhstan. Material and Methods — we conducted the retrospective analysis of 94 children with RRI, diagnosed with COVID-19, in Nur-Sultan, Kazakhstan. The study involved 53 males and 41 females. The inclusion criterion for the study was the frequency of RRI at least six times per year. In the course of our study, we split the patients among three groups and identified two phenotypes. These groups included children with RRI and atopic phenotype (Group 1), with D-deficiency phenotype (Group 2), and control group (Group 3) encompassing children with RRI lacking these phenotypes. Results — The most common symptoms of 94 pediatric patients were dry cough (94.7%), fever (81.9%), along with a loss of appetite and fatigue (76.6%). Malaise was observed in 74.5% cases, rhinorrhea was noted in 71.2% of patients, sore throat was detected in 64.9 % of children, and dyspnea was established in 45.7% of cases. We observed no statistical differences in clinical manifestations of COVID-19 among three groups of children. However, duration of hospitalization period, of fever, and of the catarrhal period differed significantly among the groups (р<0.001). Conclusion — In children with RRI and vitamin D deficiency, who were diagnosed with COVID-19, the course of the infection was unfavorable (which was confirmed by a longer hospital stay and catarrhal period), and a more severe intoxication syndrome was observed. In the group of children with atopic phenotype, a prolonged residual cough was detected.

SOME CLINICAL ASPECTS AND COMPARATIVE CHARACTERISTICS OF ENTEROPATHOGENIC AND ENTEROINVASIVE ESCHERICHIA COLIINFECTIONIN CHILDREN

The clinical course of enteropathogenic (EPEC) and enteroinvasive escherichiosis (EIEC) in children was studied and their comparative characteristics were carried out. We examined 82 sick children with early age Escherichiosis, caused in 28 byenteroinvasive, in 54 with enteropathogenic strains. In children with EPEC, secretory diarrhea was observed, and EIEC —colitis. A more pronounced manifestation of intoxication syndrome was observed in children with EPEC. The manifestations of diarrheal syndrome and electrolyte disturbances, assessed by the degree of dehydration, are more typical for children with EPEC. If in children with EPEC such complications as hypovolemic shock and acute renal failure were encountered, then in children with EIEC in the form of complications of infectious toxic shock, neurotoxicosis and disseminated intravascular coagulation.

Клініко-параклінічні маркери активності запального процесу при гострих тонзилофарингітах у дітей

Purpose — to study clinical and paraclinical markers of inflammatory activity in acute non-streptococcal and streptococcal tonsillopharyngitis in children to address rational treatment tactics. Materials and methods. To achieve this goal, a comprehensive examination of 102 children with acute tonsillopharyngitis, which was divided into two clinical groups depending on the isolation of beta-hemolytic streptococcus group A during a culture of smears from the mucosa of the tonsils/pharynx. The first (I) clinical group included 68 patients in whom bacteriological examination did not reveal BGSA — GTP of non-streptococcal etiology (nGTP). And 34 children in whom the streptococcal etiology of the disease was determined formed the second (II) clinical group — streptococcal acute tonsillopharyngitis (cGTP). Results. The presence of a subfebrile body temperature in the child increased its post-test probability by 27.4%, and higher fever figures reduced the probability of non-streptococcal GTP by only 4.3%. The absence of symptoms of intoxication syndrome in children with a high degree of specificity — 91.4% confirms the non-streptococcal nature of the disease. Expressive layers on the tonsils are more characteristic of streptococcal GTP, and the assessment of their severity <3 points was much more common in patients with non-streptococcal disease. When using the determination of the content of C-reactive protein <50.0 mg/l in the venous blood of children as a test, allows you to verify the non-streptococcal nature of acute tonsillopharyngitis with a fairly high sensitivity — 73.5% (95% CI 63.7–81.8), however, low specificity — 35.3% (95% CI 26.0–45.5). Conclusions. Indicators of local inflammation and clinical manifestations of the general inflammatory reaction were less pronounced in patients with non-streptococcal GTP. Indicators of C-reactive protein <50.0 mg/l in venous blood with high sensitivity (73.5%; 95% CI 63.7–81.8) and relative risk 1.2 (95% CI 1.0–1.5) probably testified in favor of the nonstreptococcal nature of acute tonsillopharyngitis. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: acute tonsillopharyngitis, children, clinic, C-reactive protein.

Workflow of the pre-chromatographic ‘Lawrence’ method for bivalves contaminated with Gymnodinium catenatum's paralytic shellfish poisoning toxins

Saxitoxin and its analogues are potent neurotoxins that originate the acute human neurological syndrome of paralytic shellfish poisoning (PSP) via bivalve vectors. The prechromatographic oxidation method, known commonly as the ‘Lawrence method’, was approved as the official testing method to replace mouse testing in the European Union. For solving the complex overlap of toxin oxidation products, it resorts to two solid-phase extraction steps (SPE) and two oxidation steps, making it a very labour-intensive method. For bivalves contaminated with Gymnodinium catenatum, hydrogen peroxide oxidation can quantify at once several N1–H analogues: dcGTX2+3, dcSTX, C1+2 and B1 toxins. For the remaining N1–OH analogues: dcNEO, C3+4 and B2, separate SPE and oxidation steps are required, leading to sample dilution and often adding a null result to the total quantifiable toxicity. In order to refine the routine application of the Lawrence method, a PSP episode that took place in the Autumn of 2018 in Portugal due to a G. catenatum bloom was studied in detail. A workflow was prepared based on total detectable toxin concentration obtained by the peroxide oxidation to investigate whether the steps leading to the quantification of dcNEO, C3+4 and B2 will be further required or not. For samples containing a concentration of N1–H toxins below 1.6 μmol/kg, no further processing was required. For all samples above 3 μmol/kg, B2 and dcNEO should be quantified. For all samples above 10 μmol/kg, C3+4 should be quantified. Between 1.6 and 3.2 μmol/kg, although B2 could be quantified in more than 65% of the samples, its low toxicity would add to total toxicity an average of only 42 μg STX.2HCl equiv./kg. This workflow is not valid for species with extensive carbamoylase activity or in the case of Alexandrium profiles.

Clinical and laboratory characteristics of influenza infection in hospitalized adult patients during the 2018-2019 epidemic season

Despite the success in prevention and therapy, influenza remains a mass disease with mortality rate up to 0.01—0.2% worldwide.Purpose. Conducting clinical and laboratory analysis of influenza infection cases and evaluating their etiological significance in adult hospitalized patients during 2018—2019 epidemic season. Materials and methods. There were analyzed 569 case histories of patients hospitalized at the Clinical Infectious Diseases Hospital named after S.P. Botkin. Patients were examined by PCR that resulted in verified influenza virus in 260 cases. Nasopharyngeal swabs collected from 36 patients were examined by virological method on MDCK cell culture. 24 influenza virus strains were isolated and identified.Results. The study allowed to identify a viral landscape represented by influenza viruses A and B found in 98.5% and 1.5% cases, respectively. Influenza viruses isolated on cell culture in 50% of cases were identified. Among the influenza viruses isolated on cell culture there were identified serotype A influenza viruses (H1N1) closely related to the pandemic influenza A (H1N1)pdm09. Some isolates (41.7%) belonged to serotype A (H3N2), which were related to strain A/Singapore/16-0019/16. Influenza B virus strain of the Victoria lineage isolated from a hospitalized patient possessed a triple deletion in hemagglutinin gene, which antigenic properties substantially differed from those of the influenza virus strain being included into current influenza vaccines. Upon admission, the condition of most patients was estimated as moderate (males — 48.7%, females — 51.3%). The median patient age was 35 years old, with comorbidities being registered in 50% cases. The clinical picture for 2018—2019 seasonal influenza displayed no distinctive features as compared to previous epidemic seasons. The duration of intoxication and catarrhal syndrome was 4.3±0.13 and 6.9±0.29 days, respectively, with median body temperature ranging within 39.2±0.06°С. All patients received standard pathogenetic therapy. Complications were noted in 86.7% cases such as pneumonia — 11.1%, sinusitis — 6.9%, bronchitis — 56.9%. The bed day length was 5.93±0.29, no lethal outcomes were recorded.Conclusion. It was found that influenza A viruses were dominant in patients observed comprising up to 98.5% cases, whereas influenza viruses B were found in as few as 1.5% patients. The clinical picture was characterized by severe intoxication and catarrhal syndrome, being frequently associated with complications.

Clinical and microbiological aspects of <i>Enterococcus faecalis</i> -associated urinary tract infection

Urinary tract infections (UTIs) pose a topical problem in current pediatrics, pediatric nephrology and urology. UTI-related clinical picture in childhood is polymorphic, sometimes being rather subtle and undergoing age-related alterations. Often, typical UTI symptoms in infants and early children occur subclinically. Microbe-related properties colonizing renal tissues dominate among multiple factors involved in developing UTI. In recent years, etiological importance of Enterococcus faecalis in development of such pathology has been increased. Our study was aimed to determine E. faecalis-associated UTI clinical signs in children and unveil their biological characteristics to assess related clinical significance.Materials and methods. A nine-year pediatric UTI etiological pattern was analyzed at the multi-field pediatric clinical hospital. The data of clinical and laboratory examination of 181 UTI children aged 3 days — 17 years as well as microbiological study of 60 E. faecalis strains isolated from patient urine were obtained.Results. Clinical and laboratory characteristics of E. faecalis-associated UTIs, age-related symptom variability were presented. Intoxication syndrome and fever dominated in the clinical picture. A key sign of UTIs was gastrointestinal dysfunction (in neonates and one-year old children) and pain in the lumbar region (in older children). The identified clinical symptoms may be associated with the upper urinary tract damage, concomitant diseases, and the pathogenic properties of E. faecalis. Other symptoms were less common, consistent with the age of the patients, although abdominalgia was equally common for children in all age groups. Data of laboratory examination also depended on patient age. It was noted that leukocytosis and thrombocytosis were more prominent in neonates, whereas leukocyturia and proteinuria — in children above one year of age, although clinical symptoms in this group were less overt. Specific features and clinical significance of E. faecalis-related biological properties, their heterogeneity related to patient age were noted. An inter-connected relationship between pathogenic properties and certain clinical symptoms was revealed.Conclusion. The dominant clinical symptoms (intoxication, hyperthermia), indicative of damaged upper urinary system is related, among other things, to the set of E. faecalis biological properties exerting tissue-damaging and cytolytic effects.