Lethal Outcome In Patients Research Articles

Complications and causes of mortality in patients with primary necrotizing systemic vasculitis

The article reviews the clinical symptoms, main complications in patients with ANCA-associated systemic vasculitis (granulomatous with polyangiitis, microscopic polyangiitis, eosinophilic granulomatous with polyangiitis) and polyarteritis nodosa during the first three years of the disease. We evaluated the relationship between complications and long-term glucocorticosteroid therapy. Patients with granulomatosis had the most unfavourable course of the disease with a high risk of complications. A high incidence of ischemic strokes and chronic kidney disease in patients with microscopic polyangiitis has been identified. We also analyzed cases of lethal outcomes in patients with primary systemic vasculitis.

C-reactive protein and Neutrophil-Lymphocyte Ratio as predictors of clinical severity of COVID-19

COVID-19 is an infectious disease that can manifest quite differently. In this study we examined the relationship between the value of serum CRP(C-reactive protein) andneutrophil-lymphocyte ratio (NLR) as predictor factors for the development of a severe clinical manifestation in COVID19 patients. Materials and methods: We followed 95 COVID-19 positive patients who were hospitalized at the University Clinic for Eye Diseases - COVID Center. We analyzed the initial laboratory parameters of white blood cells and CRP on admission of the patients and the results of laboratory analyses performed before they left the Clinic, or the last parameters before the lethal outcome in those patients who died. Several models of logistic regression were tested to analyze the predictive value of these markers of inflammation for lethal outcome in patients hospitalized for COVID-19. Results: Bivariate analysis demonstrated that the length of hospital stay was significantly shorter in patients with lethal outcome (p=0.001). The NLR was significantly higher in patients with lethal outcome at both times (p=0.005; and p=0.017). Leukocyte’s count (p=0.046, and p<0.001) and CRP (p=0.013,and p=0.005) were also significantly higher in patients with lethal outcome at both times. The increase on the NLR scale both at hospitalization and at discharge (or the last analysis before death) leads to increase in the odds of lethal outcome (T1:40.4% increased odds; T2:36% increased odds). Conclusion: CRP and NLR are laboratory parameters that can predict the severity of the clinical manifestation in patients with COVID-19.

Surgical treatment of ruptured right middle cerebral artery mycotic aneurysm and central nervous system aspergillosis: Clinical case and literature review

Background: Central nervous system (CNS) aspergillosis is more often met in patients with expressed immune suppression. Still, in 50% of cases of meningitis caused by Aspergillus spp., it is observed in patients without expressed immune suppression. The prognosis of CNS aspergillosis is unfavorable with the general rate of lethality around 70%.Case Description: Clinical case of a 58-year-old man who developed an Aspergillus abscess in the chiasmosellar region and an associated mycotic aneurysm of the right middle cerebral artery (MCA) and intracerebral hemorrhage. Microsurgical clipping of the fusiform-ectatic aneurysm of the right MCA in the conditions of rupture was performed. An extra-intracranial micro anastomosis was formed on the right. An open biopsy of the neoplasm in the chiasmosellar region was made. The neoplasm was yellow and destroyed the bone plate of the skull base. Biopsy results: Mycotic lesion (aspergillosis). The analysis of surgical treatment for mycotic aneurysms in the acute period of hemorrhage in patients with aspergillosis revealed a high rate of lethality. The issue of the feasibility and effectiveness of complicated revascularization interventions in the patients with hemorrhage and aspergillosis remains unsolved.Conclusion: The lack of generally accepted tactics of the treatment of this pathology requires further studies and systemic analysis. A high risk of the lethal outcome in patients with invasive mycotic infection and rupture of mycotic aneurysm highlight the importance of timely diagnostics and the beginning of antimycotic therapy. WThe issue of the evaluation of the revascularization methods effectiveness in patients after surgical treatment of a mycotic aneurysm associated with cerebral aspergillosis remains poor.

Факторы риска летального исхода после хирургического лечения больных хронической перипротезной инфекцией тазобедренного сустава

Abstract. Introduction Periprosthetic joint infections (PJI) are serious complications of total hip arthroplasty (THA) and affect the patient's life expectancy. The aim of the study was to identify independent factors influencing the risk of death in patients with PJI after revision THA. Materials and methods The study included 51 lethal outcomes in patients with chronic PJI of the hip. Results and discussion In our cohort of 434 patients, 13 (2.99 %) patients died within the first year after surgery (p > 0.05), which is 2.2 times less than similar published data. The result of gender analysis showed no statistically significant differences in the risk of death between men and women (OR1.05 CI 0.59–1.89, p = 0.87). It was found that in patients over 70 years old, the risk of death was significantly higher (OR 2.05 CI 1.09–3.87, p = 0.031). Additional independent risk factors of death are diseases of the cardiovascular system. It was not possible to find a statistically significant effect of the nature of infection on the risk of death: no growth (OR 2.23, CI 0.52–9.61), monomicrobial infection (OR 1.98, CI 0.45–8, 73), polymicrobial infection (OR 3.2, CI 0.71–14.45, p > 0.05). Conclusion The mortality rate during the first year after revision THA in patients with PJI was 2.99 %, which is lower than the results of other researchers. In the next 2–3 years, the rate of death increases 3.9 times. The main independent risk factors are the age of patients and concomitant diseases of the cardiovascular system.

Hospital mortality in hematogenous vertebral osteomyelitis

Objective. To analyze lethal outcomes in patients with hematogenous vertebral osteomyelitis.Material and Methods. Study design: retrospective analysis of medical records. A total of 209 medical records of inpatients who underwent treatment for hematogenous vertebral osteomyelitis in 2006–2017 were analyzed. Out of them 68 patients (32.5 %) were treated conservatively, and 141 (67.5 %) – surgically. The risk factors for lethal outcomes were studied for various methods of treatment, and a statistical analysis was performed.Results. Hospital mortality (n = 9) was 4.3 %. In patients who died in hospital, average time for diagnosis making was 4 times less (p = 0.092). The main factors affecting mortality were diabetes mellitus (p = 0.033), type C lesion according to the Pola classification (p = 0.014) and age over 70 years (p = 0.006). To assess the relationship between hospital mortality and the revealed differences between the groups, a regression analysis was performed, which showed that factors associated with mortality were Pola type C.4 lesions (OR 9.73; 95 % CI 1.75–54.20), diabetes mellitus (OR 5.86; 95 % CI 1.14–30.15) and age over 70 years (OR 12.58; 95 % CI 2.50–63.34). The combination of these factors increased the likelihood of hospital mortality (p = 0.001). Sensitivity (77.8 %) and specificity (84.2 %) were calculated using the ROC curve. In the group with mortality, the comorbidity index (CCI) was significantly higher (≥4) than in the group without mortality (p = 0.002). With a CCI of 4 or more, the probability of hospital death increases significantly (OR 10.23; 95 % CI 2.06–50.82), p = 0.005. Long-term mortality was 4.3 % (n = 9), in 77.8 % of cases the cause was acute cardiovascular pathology, and no recurrence of vertebral osteomyelitis was detected.Conclusion. Hospital mortality was 4.3 %, and there was no mortality among patients treated conservatively. The main risk factors were diabetes mellitus, type C lesion according to Pola and age over 70 years. There was a significant mutual burdening of these factors (p = 0.001). With CCI ≥4, the probability of death is higher (p = 0.005).

Circulating Syndecan-1 as a Predictor of Persistent Thrombocytopenia and Lethal Outcome: A Population Study of Patients With Suspected Sepsis Requiring Intensive Care.

Background: Sepsis is defined as life-threatening organ dysfunction caused by dysregulated host responses to infection. Recent studies have suggested that endotheliopathy may be the common basis for multiple organ failure in sepsis. Under septic conditions, accumulation of proteases accelerates shedding of proteoglycans, such as syndecan-1, from the endothelial surface, resulting in augmented leukocyte adhesion to the vascular wall, enhanced vascular permeability, and intravascular coagulation. The purpose of this study was to determine the potential utility of syndecan-1 as a biomarker linking endotheliopathy to organ failure.Methods: One hundred patients with suspected infections who were admitted to the intensive care unit (ICU) at Kagoshima University Hospital were consecutively enrolled in the study. Serum syndecan-1 levels were measured using an in-house enzyme-linked immunosorbent assay. The difference between serum syndecan-1 levels in 28-day survivors and non-survivors was analyzed by the Mann–Whitney U-test. Receiver-operating characteristics curve analysis with area under the curve calculation was used to quantify the predictive performance of serum syndecan-1 for 28-day mortality. The correlations between serum syndecan-1 and coagulation markers were analyzed by Spearman's rank correlation test.Results: Serum syndecan-1 levels in non-survivors were significantly higher than those in survivors on Day 1 and Day 3 (P < 0.01). Among multiple organ failures, coagulation failure and renal failure were significantly correlated with serum syndecan-1. Spearman's rank correlation test indicated that serum syndecan-1 was weakly but significantly correlated with disseminated intravascular coagulation score (rho = 0.33, P < 0.01). Patients with serum syndecan-1 ≥21.4 ng/mL showed delayed recovery from thrombocytopenia relative to patients with serum syndecan-1 <21.4 ng/mL.Conclusions: Elevated circulating syndecan-1 on the first day of ICU admission was associated with persistent thrombocytopenia and lethal outcome in patients with suspected sepsis.

Predictors of Lethal Outcomes in Patients with Refractory Septic Shock

Early prediction of disease severity helps clinicians prevent adverse events and/or minimize losses in the event of a life-threatening complication. This provision fully applies to refractory septic shock, in which norepinephrine administration at a dose exceeding 0.5 μg/kg-1/min-1 is needed to maintain mean arterial pressure.The objective: to determine predictors of lethal outcomes in patients with refractory septic shock.Subjects and methods. A retrospective study included 79 patients with refractory septic shock aged from 42 to 74 years (59.7 ± 7.8), with severity of the condition as per SOFA varying from 8 to 16 scores. The predictive value of indicators was assessed using univariate and multivariate analyses.Results. In multivariate analysis, the only significant predictor of an unfavorable outcome was the SOFA score (adj. OR: 1.626 [95% CI: 1.313; 2.014], p &lt; 0.001). Other putative indicators (age, oxygenation index, lactate and procalcitonin concentrations, and norepinephrine dose) had no predictive value.Conclusion: The SOFA score is an independent predictor of lethality in adult patients with refractory septic shock (аdj. OR: 1.26 [95% CI: 1.313; 2.014], p &lt; 0.001). According to the results of the ROC analysis, along with SOFA, norepinephrine dose was also a significant predictor (AUC 0.989 [95% CI 0.934; 1.000], p &lt; 0.001).

A relationship between causative agents of infectious diarrhea and fatal outcomes in pre-school children

Infectious diarrhea is one of the leading causes of fatal outcomes in young children. Differential diagnostics of such infections within the first hours of illness poses significant objective obstacles. Data from laboratory studies of autopsy material and pathological studies provide valuable information for understanding the spectrum of differential diagnostics and etiological structure of infectious diarrhea with fatal outcomes in young children. Materials and methods. There were analyzed 100 cases of fatal outcomes in children under the age of six years registered in Russia from November 2011 to December 2019, who was diagnosed with infectious diarrhea at different levels of the healthcare system. The data were assessed based on available medical case reports and the laboratory testing of autopsy samples performed by using nucleic acid amplification methods. Results. The diagnosis of infectious diarrhea was revised in 24 patients, based on the data of a set of intravital and post-mortem studies. In patients with unconfirmed diagnosis of acute intestinal infections, pneumonia was the most often detected — in 45.8% (11/24), sepsis — in 29.2% (7/24), meningitis/meningoencephalitis, acute surgical pathology and asphyxiation associated with vomit aspiration — in 16.7 % (4/24) cases. The causative agents of infectious diarrhea were identified in 71 of 76 patients with confirmed diagnosis of acute intestinal infections. Most prevalent were group A rotaviruses — 52.6% (40/76), group F adenoviruses — 17.1% (13/76), and noroviruses — 13.2% (10/76). Combination of pathogens was detected in 29 cases (38.2%). Prehospital lethal outcomes in patients with infectious diarrhea were observed in 17 cases (22.4%). In total, rate of neonatal deaths due to acute intestinal infections accounted for 62.2% and 2-year-old toddlers — 20.3%. 64 of 76 (84%) children had no unfavorable premorbid background. The most common pathologies associated with infectious diarrhea with developing fatal outcomes were pneumonia (including aspiration pneumonia) in 22.4% (17/76) and aspiration asphyxia in 6.6% (5/76). Hemolytic-uremic syndrome associated with diarrhea was diagnosed in 7.9% (6/76) of children. Conclusions. Within the first years of life children comprise a risk group for developing fatal outcomes during infectious diarrhea. Lack of unfavorable premorbid background should not be considered as a reliable positive prognostic criterion. Diagnostics of pneumonia should be included in the mandatory examination plan for children with severe infectious diar rhea. Based on study of clinical and autopsy material, group A rotaviruses were the lead causative agents among those resulting in infectious diarrhea with fatal outcomes in young children. Special attention should be paid to preventing vomit aspiration within the first days after disease onset.

КОМПЬЮТЕРНАЯ ТОМОГРАФИЯ ОРГАНОВ ГРУДНОЙ КЛЕТКИ ПРИ ПНЕВМОНИИ, ОБУСЛОВЛЕННОЙ COVID-19, У ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ ПОЧЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ

The study aims to evaluate the signs and extent of lung damage in patients with pneumonia affected by COVID-19, associated with end-stage renal disease (ERSD) and without kidney disease, according to the data of computed tomography (CT) of the chest organs. Material and methods. The group of patients with pneumonia and ERSD had 53 people and the group without kidney disease consisted of 59 people. Despite the appropriate treatment, all patients died. The autopsy confirmed the presence of pneumonia caused by COVID-19. The average age of the patients was 68.40 ± 14.63 years. All 112 patients had chest CT 2.12 ± 0.94 days before death. Results. The lethal outcome in patients with pneumonia caused by COVID-19 and long-term ESRD occurred when the extent of the lung damage equaled 40.64 ± 18.50% with fluctuations from 3 to 69%. Among the patients without kidney disease, the extent of lung damage was 56.63 ± 19.17%, (p < 0.05) with fluctuations from 18 to 94%. According to CT data the ground-glass opacification, crazy-paving, and consolidation signs were observed in 100.0% of patients in both groups. These signs were referred to as the main ones for the purposes of the study. The frequency of other signs such as air bronchogram, pleural thickening, pleurisy, lymphadenopathy, atelectasis, local emphysema, nodules, reticulation, calcifications, fibrosis, bronchiectasis, and pulmonary edema ranged from 2 to 73%. There was no statistically significant difference in the frequency of the signs in both groups. The most frequent locations of pneumonia were the lower (94.4%) and posterior (98.2%) parts of the lungs, regardless of the group observed. The percentage of the severity of the main signs in the lungs was significantly lower among the patients with long-term ERSD.

Predictors of postoperative atrial fibrillation

Review purpose: to study the occurrence predictors of postoperative atrial fibrillation (PAF), effective predicting and treating methods according to global literature.Currently, PAF is considered one of the most frequent events among all cardiovascular complications as it develops in 30–65% of cases in patients after heart surgery. In recent decades, the PAF incidence has steadily increased despite advances in surgery and anesthesiology. PAF is a significant complication that affects the course of the postoperative period and requires special attention, since it leads to a longer hospital stay, increased treatment costs and can also lead to lethal outcomes in patients in this category. Considering PAF consequences, many studies have been performed to identify factors associated with the atrial fibrillation pathophysiology, to develop preventive measures aimed at treating high risk patients and minimize the side effects of antiarrhythmic drugs. The review and analysis of the global literature on the PAF causes, prevention and treatment are presented.

Raman spectroscopy for glutathione measurements in Mycobacterium tuberculosis strains with different antibiotic resistance

AbstractThe Mycobacterium tuberculosis (MbT) drug resistance remains a serious problem to global public health and usually leads to a lethal outcome in patients with such strain MbT. Precise and rapid identification of a specific MbT strain is vital for the appointment of anti‐tuberculosis therapy. We continue investigation of deactivated MbT strains of the Beijing family by Raman spectroscopy method and focus on glutathione (GSH) as a potential biomarker for strains identification. Strains under the study have different drug sensitivity: sensitive, multi, and extensively drug resistant. Samples were investigated by Raman spectrometry with He‐Ne (633 nm) laser excitation source in the “fingerprint” region. As a result, GSH vibrational bands for potential strain discrimination were determined. These differences can be described for drug‐sensitive and drug‐resistant strains taken of pulmonary and extra‐pulmonary forms of tuberculosis. We suppose that the obtained results can be useful for new diagnostic tools development for identification of different MbT strains in clinical medicine and research practice.

Prediction of lethal outcomes in COVID-19 cases based on the results chest computed tomography

The objective: to predict lethal outcomes in patients with COVID-19 based on the result of chest computed tomography (chest CT) using a semi-quantitative visual scale of the pulmonary parenchyma lesion.Subjects and methods. Inclusion criteria: patients who underwent chest CT from March 2 to May 1, 2020, inclusively, upon referral of a general practitioner due to suspected community-acquired pneumonia caused by COVID-19. Chest CT was performed in 48 medical organizations providing primary medical care to the adult population in Moscow. Exclusion criteria: patients whose chest CT was not assessed by CT 0-4 score; patients who were not confirmed as COVID-19 positive.In the Russian Federation, CT 0-4 score is recommended to be used for assessment of the extent of lung parenchyma lesion in cases with suspected COVID-19.Data on fatal outcomes were received on May 4, 2020 inclusive.Results: data of 13,003 patients from the Unified Radiological Information Service were retrospectively included in the study according to inclusion and exclusion criteria. The test aimed to detect a trend of directional changes in the proportion of deceased patients among various categories using CT 0-4 score demonstrated a statistically significant result (p &lt; 0.0001). The chance of a lethal outcome increases directionally from CT-0 to CT-4. The test for deviations from the linear trend also provided p &lt; 0.0001, i.e. when moving to higher scores (CT-3 and CT-4), there was an accelerated increase in the risk of death. Analysis of overall survival using the Cox regression model showed that the assessed factors (age and CT 0-4 score) were statistically significantly associated with the time to death from COVID-19 (p &lt; 0.05). The risk of death increased with age, on average, 8.6% for every 5 years (95% CI 0.8-17.0%). When transferring from one category of CT to the next one, the risk increased by 38% on the average (95% CI 17.1-62.6%). There was no statistically significant association of gender factor with overall survival (p = 0.408).The visual score of CT 0-4 recommended for use in the Russian Federation to assess lung parenchyma lesions according to chest CT data, is a predictor of a lethal outcome in patients with COVID-19. CT 0-4 score is convenient for practical use.

Predictors of lethal outcome in patients with tuberculosis, resistance to rifampicin, and HIV infection

The objective : to identify and rank the predictors of lethal outcome in patients with tuberculosis resistance to at least rifampicin and concurrent HIV infection ( T B -R / HIV ). Subjects and methods. 130 cases T B -R / HIV notified in Rostov Region in 201 7-2 018 were included in an observational retrospective cohort study. Two cohorts were formed: cohort A consisted of 31 patients with a documented fatal outcome within 12 months after registration for treatment, cohort B included 99 patients didn't die at least during the first year after registration for treatment. At the first stage of the study, the statistical significance of differences of certain signs in patients of cohorts A and B was determined. The signs with confirmed statistical significance of differences were included in the second stage of the study, during which their sensitivity as predictors of lethal outcome was determined. For this, automated artificial neural networks were used. Results. The following can be used as predictors of lethal outcome for T B -R / HIV patients (in decreasing order of significance): homelessness (people who have no place of residence), addiction to alcohol or drugs, interruption of ant i- T B chemotherapy in the past, low body mass index, low hemoglobin level, including anemia (but not severe), low level of CD 4 T-l ymphocytes (the prognosis is especially unfavorable with less than 100 cell s/ μ l). The level of total protein may also be a potential predictor, however, the selection criteria for this indicator require further clarification.

PECULIARITIES OF DIAGNOSIS OF TUBERCULOSIS IN HIV-INFECTED IN THE REPUBLIC OF KARELIA

The features of clinical and radiological forms of tuberculosis (TB) and the informativeness of various methods of etiological diagnosis of TB among 175 patients with co-infected HIV + TB for the period 2001-2017 in the Republic of Karelia (RK) were studied. Timely execution of PCR diagnostics reliably reduces the likelihood of a lethal outcome in patients with a co-infection, as it made it possible to quickly detect not only the presence of MBT, but also determine multidrug resistance (MDR) and prescribe adequate chemotherapy on the first day of detection, which significantly reduces the risk of death. It was established that among patients with co-infection with HIV + pulmonary TB, decay cavities in the lung tissue were detected less frequently (40.7%), however, bacteria excretion was significantly more frequent (68.3%) than among patients with pulmonary TB in the Republic of Kazakhstan (data f.8).It has been established that improving the organization of sputum collection can significantly increase (by no less than 20%) the incidence of MBT in patients with pulmonary TB and HIV infection, which is important in the rapid diagnosis of TB and the appointment of adequate therapy, especially considering that among patients ½ (50.5%) co-infection of MBT had MDR.

Neutrophil to Lymphocyte Ratio as a Predictor of Adverse Outcome in Patients with Decompensated Liver Cirrhosis

The natural history of liver cirrhosis (LC) is characterized by two stages: compensated and decompensated. Current clinical and laboratory prognostic models, such as Child-Pugh and MELD scales, do not take into account immune dysregulation, as well as it potential impact on the LC decompensation and the survival. Neutrophil to lymphocyte ratio (NLR) is simple and affordable parameter, representing the imbalance of two distinct immune pathways.Aim:to evaluate relationship between NLR level, mortality and SIRS development in patients with DC.Materials and methods.In this retrospective study 36 patients with DC which were hospitalized in Hepatology Department of V.H. Vasilenko clinic of propaedeutics and internal diseases, gastroenterology and hepatology, Sechenov University from January 2009 to December 2017 were enrolled. Correlation analysis, univariate and multivariable analysis were provided to find factors statistically significantly associated with lethal outcome and SIRS. The optimal cut-off levels for the NLR associated with adverse outcome were determined.Results.AIn multivariable analysis, NLR &gt; 4 (p &lt; 0,001) was statistically significantly associated with lethal outcome in patients with DC during hospitalization (OR: 1.57, [95 % CI 1.125–2.209], p = 0.008). Sensitivity and specificity of this cut-off is 100 % and 79.17 %, respectively. NLR &gt; 4.8 was associated with SIRS development during hospitalization (OR: 1.484, [95 % CI 1.103–1.997], p = 0.009) with 100 % sensitivity and 90 % specificity.Conclusions.NLR is an independent risk factor of lethal outcome and SIRS development in patients with decompensated liver cirrhosis.

PBK overexpression promotes metastasis of hepatocellular carcinoma via activating ETV4-uPAR signaling pathway.

Invasion and metastasis are the predominant causes of lethal outcomes in patients with hepatocellular carcinoma (HCC). However, the molecular mechanism underlying the invasive or metastatic process are still insufficiently understood. Here, we first integrated several public databases and identified a novel protein kinase, PDZ-binding kinase (PBK) that was frequently upregulated and correlated with poor prognosis in patients with HCC. Gain- or loss-of-function analysis revealed that PBK promoted migration and invasion of HCC cells both in vitro and in vivo. Mechanistically, PBK enhanced uPAR expression by activating its promoter activity. Chromatin immunoprecipitation (ChIP) assay showed that ETV4 directly bound to the core region of uPAR promoter while PBK could enhance the binding of ETV4 to uPAR promoter. In orthotopic mouse model, PBK knockdown markedly inhibited the lung metastasis of HCC cells, while this effect was significantly restored by uPAR overexpression. Finally, there was a positive correlation between PBK and uPAR, ETV4 and uPAR in HCC clinical samples. Collectively, these findings revealed that PBK acted as a crucial kinase by promoting invasion and migration via the ETV4-uPAR signaling pathway, and it therefore could be a promising diagnostic biomarker and therapeutic target for HCC metastasis.

Analysis of risk factors for lethal outcomes of ST-segment elevation acute myocardial infarction

The purpose of the study was to objectively assess lethal outcomes in patients with the final diagnosis of 'ST-segment elevation acute myocardial infarction' (STEAMI) in order to reveal the circumstances and peculiarities of an unfavourable outcome. The work was performed on the basis of the medical records over 2014-2016, retrospectively analysing cases of STEAMI: a total of 131 lethal outcomes regardless of reperfusion therapy and 1,004 patients having survived after percutaneous coronary intervention (PCI). The data statistically significantly (p<0.05) distinguishing lethal outcomes were as follows: prevalence of female patients - 59.5%; transmural myocardial lesion - 90.1%; recurrent myocardial infarction - 32.1%; a history of functional class I-III angina of effort - 31.3%; a high average value of acute heart failure according to T. Killip classification - 2.4±0.2; cardiogenic shock - 30.6%; high frequency of previously endured acute cerebral circulatory impairments - 9.9%, a history of type 2 diabetes mellitus - 32.8% and degree I-III obesity - 35.1%. Amongst the deceased patients with AMI complicated by postinfarction cardiosclerosis and preexisting FC I-III angina of effort there was a low proportion of coronary angiography (CAG) (8.4%) and coronary operations (6.9%) previously performed. Also registered was a low frequency of reperfusion treatment (45.8%), which was associated with early mortality (within the first 2 hours of admission - 51.9%, within 3 to 24 hours - 16.8%). A decrease in efficacy of the interventions performed was influenced by syndromes of slow or absent blood flow (20.7% of PCI), as well as a multivessel haemodynamically significant lesion of three and more coronary arteries (56.2% of the CAGs performed). The obtained data concerning concomitant pathology and the condition are used to draw up a portrait of a patient jeopardised by a lethal outcome associated with AMI. These factors should be taken into consideration at the outpatient stage for a more active reperfusion policy aimed at preventing AMI.

Анализ летальных исходов у пациентов с коинфекцией ВИЧ/туберкулез, находившихся на стационарном лечении в пенитенциарных учреждениях

Анализ летальных исходов у пациентов с коинфекцией ВИЧ/туберкулез, находившихся на стационарном лечении в пенитенциарных учреждениях

House Hold Remedies in Phosphide Poisoning

Phosphide poisoning is known worldwide, especially in developing countries like India. It is being consumed frequently and exclusively for suicidal purpose. Among phosphide cereal preservatives (Aluminium phosphide-CELPHOS) and rodenticide (Zinc phosphide ) are used quite rampantly .Considering the lethal outcome in patients remained untreated for longer duration , a measure to restrict release and absorption of phosphine various house hold measure being used ,but majority i.e.- use of mustard oil, soap water and salt solution to induce emesis result in corrosive gastritis and bleeding which facilitate increased release and absorption of phosphine in turn increases toxicity and lethal outcome. Thus awareness cum health education campaign was launched in 16 gram panchayat head quarter of Warisaliganj block of Nawada district of Bihar to use Egg albumin Or Ghreet after any incident of phosphide poisoning (Aluminium phosphide Or Zinc phosphide) as early as possible and transfer the patient to appropriate centre for proper treatment. Material & Method After these awareness program 1525 patients of phosphide consumption admitted at Centre for Critical Care, RA. Hospital & Research Centre, Warisaliganj (Nawada) Bihar were considered, interrogated, clinically examined, investigated and duly treated. Result Out of all 1525 cases 945 cases have used either Egg albumin Or Ghreet within 1-2 hours and admitted at our centre within 3 hours of consumption ,had complete recovery in 99.5% patient (941/945 )within 12 hours while other attending within same time and given similar treatment only 228(39.3%) survived after rigorous and vigil observation for 36 hours but with altered haematological ,hepatic, renal and neurological deficit .Conclusion Administration of Egg albumin Or Ghreet acting as physicochemical barrier restrict phosphide dissolution ,release and absorption of phosphine as phosphide is non-miscible to both ,thus markedly improve therapeutic outcome. Keywords : Phosphide, Aluminium phosphide, Release, Absorption.

Structural and Functional Fundamentals of Alcoholic Disease

Aim. To suggest a new perspective on chronic alcohol intoxication by means of investigating the associated severe multiple organ pathology, which frequently becomes the cause of lethal outcome in patients suffering from drunkenness and alcoholism.Key points. The empirical basis of the study consisted in the analysis of autopsy results obtained from 1,115 corpses of persons having abused alcohol during their lifetime. In addition, 800 experiments on rats were carried out. As a result, a concept of alcoholic disease (AD) is proposed. AD is defined as a condition, in which chronic ethanol intoxication leads to the development of morphological changes in organs and systems: from minimal injuries of the microcirculatory pathway to a multiple organ pathology showing signs of alcoholism. AD pathogenesis is demonstrated to undergo 3 major stages, from (1) episodic alcohol intoxication, through (2) drunkenness and to (3) alcoholism. It is noted that, while the morphological changes are considered to be reversible during the first two stages, they become irreversible at the stage of alcoholism.Conclusion. It is concluded that the forms of the disease that involve the described morphological changes in organs and systems should be primarily treated by physicians, not by psychiatrists and narcology practitioners who are only capable of dealing with the psychological aspect of the problem.