Manifestations Of Intoxication Research Articles

Features of baseline and lipopolysaccharide-induced cytokine secretion in mononuclear leukocyte cultures from patients with the erythema migrans form of acute lyme borreliosis based on clinical parameters

Introduction. Features of cytokine production in mononuclear cell cultures from Lyme borreliosis patients based on clinical data remained poorly studied. The study aim was to estimate the patterns of baseline and lipopolysaccharide-induced cytokine-secretory activity of peripheral blood mononuclear leukocytes from patients with erythema migrans form of acute Lyme borreliosis based on clinical parameters. Materials and methods. Groups of 22 and 12 patients with the diagnoses of mild or moderate severity of monoinfection and co-infection with tick-borne encephalitis of Lyme borreliosis with erythema migrans were examined twice: on week 1 after disease onset and day 14. The control group included 17 healthy donors. Basal and lipopolysaccharide-induced IL-6, IL-10, and TNFα secretion levels were assessed in mononuclear leukocyte culture supernatants applying enzyme immunoassay. Statistical analysis was performed by using the Mann–Whitney U-test, Wilcoxon test, and Spearman’s rank correlation. Results. The group of moderate severity patients was clinically distinguished by severer fever and intoxication manifestations. At the disease onset, the basal TNFα, IL-6 and IL-10 secretion levels in the moderate severity patient cultures were significantly higher than in those of the other groups. After antibiotics treatment, the baseline TNFα and IL-10 levels tended to decrease. At the onset, lipopolysaccharide-induced cultures from the moderate severity patients showed significantly suppressed TNFα production and increased IL-10 secretion as compared to the other groups. Lipopolysaccharide-induced IL-6 secretion in the moderate vs. mild severity group supernatants was significantly lower. In dynamics, the induced TNFα levels in the moderate severity patients were increased to the magnitude exceeding that in the controls. Positive correlations between the IL-6 and TNFα basal levels and maximum body temperature or the C-reactive protein serum concentrations were revealed in the patients. Induced TNFα levels showed negative correlations with fever levels or with IL-10 secretion. Conclusions. It was demonstrated that basal TNFα, IL-6 and IL-10 secretion levels in the mononuclear cell cultures of acute Lyme borreliosis patients increased with the increasing disease severity. Suppression of lipopolysaccharide-induced TNFα production in the moderate severity patient cultures was presumably associated with the regulatory cytokine IL-10 effects.

Diarrhea in COVID‑19: Causes and approaches to therapy

The article presents the results of a study of the frequency of diarrheal syndrome in patients with COVID‑19. The pathogenesis of diarrhea and its differences from other acute respiratory infections are considered in detail, including on a clinical example.Objective. To study the frequency of registration, features and results of pathogenetic therapy for diarrhea in patients with confirmed COVID‑19.Materials and methods. 286 case histories of male and female patients aged 18–96 years old who received outpatient treatment from June 2020 to February 2021 in connection with the confirmed diagnosis of COVID‑19 were analyzed.Results. Diarrhea was noted in 72 (25.0%) patients. In 4 (1.4%) patients, it was the only symptom of COVID‑19, in 15 (20.8%) – manifesting, followed by the addition and increase of catarrhal symptoms and manifestations of intoxication. In most cases (in 53 patients – 73.6%), diarrheal syndrome appeared simultaneously with other complaints or somewhat later.Conclusions. 1). According to the study, COVID‑19 in 25% of patients is accompanied by diarrhea, in most cases of a watery nature. 2). Different pathogenesis of diarrheal syndrome is possible in patients with COVID‑19. 3). The use of rehydration solutions with additional components, cytomucoprotective and probiotic therapy can reduce the period of diarrhea in patients with COVID‑19 to 1–3 days and prevents adverse effects.

Clinical approval of intra-peritoneal instilation of recombinant human granulocyte colony-stimulating factor for the treatment of acute peritonitis

To conduct a preliminary evaluation of the clinical use of recombinant human granulocyte colony-stimulating factor (G-CSF) for the treatment of acute peritonitis (AP).Material and methods. 20 patients. The causes of AP were perforated gastroduodenal ulcers – 7, colon perforation – 7, acute appendicitis – 3, small bowel perforation – 2, one case each of mesenteric thrombosis and uterine perforation. Diffuse AP was detected in 4 (20%) patients, generalized – in 16 (80%). The 1st, control, group and the 2nd, experimental groupб included 10 patients each. Similar basic treatment was used in both groups. Patients of the 2nd group at the end of the operation were injected intraperitoneally with a solution of G-CSF with 0.9% NaCl (5 μg/1 ml) at a dose of 10 μg per 1 kg of body weight. After the operation, the amount of glucose (AG), creatinine (AC) in blood plasma, prothrombin index (PI), nuclear index (NI), stress index (SI), leukocyte intoxication index (LII), neutrophil-lymphocyte index (NLI), neutrophil-mononuclear index (NMI), lymphocyte-monocyte index (LMI), immunological reactivity index (IRI).The results. NI in the 2nd group increased after a day (p<0.01), then prevailed almost all the time. SI after a day in both groups was almost not different. On the 3rd day, the SI in the 1st group significantly increased, and in the 2nd group, it decreased. Later there were opposite changes. After a day, LII decreased in both groups. After 3 days, LII decreased in the 1st group (p<0.05). In the 2nd group, after 3 days, LII increased significantly (p<0.01) and decreased after 7 days. NLI indicators changed similarly. In the 1st group, NMI significantly (p<0.05) decreased after 3 days and remained low. NMI significantly prevailed in the 2nd group, increased (p<0.01) after 5 days. In the 1st group, LMI decreased all the time. In the 2nd group, LMI increased (p<0.01) after 2 days, decreased after 3 days, and increased (p<0.05) after 5 days. IRI in the 1st group, after it increased for 3-5 days, then decreased. In the 2nd group, IRI changed like LMI. AG in the 1st group prevailed all the time. In the 1st group, AC increased for 5 days, in the 2nd group - it constantly decreased. PI in the 1st group decreased for 5 days, in the 2nd group it normalized after 3 days, then increased.Conclusions. 1. According to the complex of integral evaluation criteria, in patients with AP who underwent intraperitoneal instillation of G-CSF solution, signs of adequate functioning of cellular components of immune protection were found after the operation. 2. According to the complex of biochemical criteria, signs of an early reduction in the manifestations of intoxication and recovery of kidney and liver function were found in such patients. 3. The results of clinical approbation indicate the possibility and perspective of using this method of treatment for patients with AP.

Molecular epidemiological and clinical aspects of enterovirus infection in the south of Russia

Objective: the study of molecular epidemiological and clinical aspects of EVI in the Rostov region for the period 2006-2020. to improve the disease surveillance system. Research methods: epidemiological, virological, molecular biological (PCR, sequencing, phylogenetic analysis), microbiological, statistical. Materials and methods: the analysis of medical records of 139 patients with EVI was carried out. Samples of biomaterial (feces, throat swab) from 17293 people, samples from environmental objects (2710 samples), strains of enteroviruses (EV) in the amount of 142 specimens were studied. Results: in the Rostov region until 2013. sporadic incidence of EVI prevailed with registration from 1 to 38 cases per year. June 2013 there was a sharp increase in the incidence of EVI with the formation of local foci in organized groups, associated with the circulation of a new genotype — EV 71 type of subgenotype C4 of “Chinese” origin (622 patients with EVI were registered, one death). The clinical features of the disease were determined: acute onset with manifestations of intoxication, foot and mouth disease-like syndromes, followed by the development of CNS pathology in 37.4% of patients. According to the results of sequencing of biomaterial samples from patients and virus carriers for the period 2006-2020. EVs of 22 types were detected. Conclusions: EVs are subject to intense genetic variability, due to which new genovariants pathogenic for humans may appear. The change in EV genotypes, which dominated the circulation among the population of the Rostov region, determined the rise in the incidence of EVI in 2013. A significant diversity of non-polio EV genotypes was revealed, while the structure of EV genovariants changed in different years.

Норовірусна інфекція: особливості епідеміології та клініко-лабораторних проявів на сучасному етапі

Гострі кишкові інфекції вірусної етіології набувають все більшої актуальності. У даній роботі проведено аналіз клініко-епідеміологічних особливостей норовірусної кишкової інфекції у дітей. Наведені дані власних досліджень, проведених за 2013–2016 роки. Норовірусна інфекція характеризується гострим початком, помірною лихоманкою, водянистою діареєю, циклічністю перебігу. Пацієнтам віком до 1 року властивий розвиток вододефіцитного ексикозу. Групою ризику є діти перших трьох років життя. Клінічний перебіг норовірусної інфекції залежить від віку і преморбідного фону.

Клінічні особливості перебігу кору в дітей віком до 3 років

Measles occurs at any age. Outbreaks appear to be exacerbated during periods of low vaccination coverage. In Ukraine in 2016, the level of vaccinations with the first dose was only in 45% of children, and the second — in 31%. Thus, during 2017 only in the Odessa region the number of measles patients reached 1 016. The purpose was to identify the features of the clinical course of measles in young children and infants. Materials and methods. A retrospective study of the medical histories of 111 young children, 68 of them in the first year of life. Results. Measles in children 3 years old retains the typical features of acute onset, manifestations of intoxication (71.82%), fever (99.09%), cough (94.55%), catarrhal phenomena and rash. At the same time, rhinitis (95.59%) and puffiness of the face (100%) are characteristic of children under one year compared with children 1–3 years (51.16% and 58.14%, respectively) p<0.001. Measles severity depends on the age of the child (in children (35.29%) younger than 12 months there was a severe course, and in (55.62%) children younger than 6 months). Complications were found in (44.14%) children. Among them, pneumonia (32.35%) is more common in children under 1 year of age, bronchitis (18.6%) and pneumonia (16.28%) in children aged 1–3 years are approximately the same in frequency. Otitis media (7.35%) was found only in children under 12 months. Conclusions. Thus, the clinical manifestations, severity and complications of measles depend on the age of the child, and the presence of children less than 6 months (28.81%) indicates the existence of a non3immune layer among women of childbearing age. 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 the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: measles, complications, young children, infants.

Diagnosis of acute poisoning by addictive and psychotropic substances based on the toxidrome

Diagnosis of acute poisoning by addictive and psychotropic substances based on the toxidrome

The efficiency of the drug based on butaphosphane, B vitamins and L-carnitine in the treatment of horses

An important feature of living organisms, acquired in the process of evolution, is the ability to adapt to various external influences and changes in the environment, to maintain homeostasis and regulatory processes in organs, systems and the body as a whole. However, with modern breeding technologies, the physiological capabilities of the animal's body are often unable to change as quickly as required by the conditions of industrial maintenance, which leads to stress. Vitamin preparations and biologically active feed additives are widely used by veterinary medicine specialists to increase resistance to stressful situations, disease prevention, increase resistance, safety and productivity of farm animals. Preparation L-tsyn, solution for injection (manufactured by BIOTESTLAB LLC), is a drug, the action of which is due to the prescription combination of active substances, namely: butaphosphane, B vitamins (vitamin B12, vitamin B3) and L-carnitine. The aim of the study was to investigate the effectiveness of the drug L-tsyn on horses under the influence of stressors of various natures. Two experiments on working horses with constant, excessive physical activity with chronic exercises and with complex therapy of intoxication with signs of acute renal failure in horse were conducted. Clinical trials of the drug were performed on working horses aged 5–15 years, of different sexes. The drug was administered in a dose of 20–25 ml per animal, 1 time per day for 5 consecutive days. The clinical condition of the experimental animals was observed for 21 days from the start of the drug. The morpho-functional state of the animal's body before and after the drug was established according to the indicators of the clinical condition, morphological and biochemical parameters of the blood, which were determined according to generally accepted methods. In working horses under excessive load the drug L-tsyn activated the processes of hematopoiesis, improved the physiological state of the body and contributed to the increase the general tone of the body. The drug as part of complex therapy in the treatment of intoxication, showed hepato- and nephroprotective properties, reduced the manifestations of intoxication, helped to restoration of the animal’s normal physiological state. According to the results of clinical, hematological and biochemical studies, it can be concluded that the drug L-tsyn has a stimulating effect on metabolic processes in the animals’ body, shows tonic properties, increases the body's resistance to toxins and adverse environmental factors and can be used as monotherapy and for the complex treatment of diseases of various etiologies in horses.

Treatment of influenza and other acute respiratory viral infections in children: multicenter double-blind placebo-controlled randomized comparative clinical trial

The article presents the main results of a randomized clinical trial of the efficacy and safety of Panavir®, rectal suppositories 100 μg, in children with influenza and other acute respiratory viral infections (ARVI).Characteristics of children and research methods. The trial included 40 children from 12 to 17 years old, the children were randomized into 2 groups: 20 children were treated with Panavir®, 1 rectal suppository per day for 7days, 20 children received placebo according to Panavir® regimen on the background of standard symptomatic therapy. The scientists monitored the efficacy criteria: the primary criteria: recovery time and the number of patients with successful treatment (normalization of axillary body temperature no later than 48 hours of therapy); the main secondary criteria: the timing of the normalization of body temperature, the disappearance of intoxication and catarrhal symptoms and satisfaction with the results of treatment by the parents /adoptive parents of patients on the IMPSS scale.Results. In the Group of Panavir®, the authors registered shorter mean recovery periods (4.5 days versus 7.4 days in the Group of Placebo), normalization of body temperature (39.1 hours versus 76.1 hours) and regression of intoxication manifestations (2.9 days versus 4.3 days) and catarrhal (3.4 days versus 5.6 days) syndromes (with statistical significance of intergroup differences). The treatment success was achieved in 85% of cases in the Panavir® Group versus 30% of cases in the Placebo Group; according to this criterion Panavir® exceeded placebo by at least 24.7%. At the end of the therapy course, 80% of the parents /adoptive parents were satisfied with the treatment results in the Panavir® Group versus 25% of cases in the Placebo Group. The authors determined a comparable incidence of adverse events in the Panavir® and Placebo Groups. There were no adverse events associated with the administration of Panavir®.Conclusion. This study established the efficacy and safety of Panavir® in the treatment of children of 12-17 years old with influenza and other acute respiratory viral infections. This drug with a combined antiviral and immunomodulatory effect is promising for pediatric practice.

Botulinum Toxin as a Biological Warfare Agent: Poisoning, Diagnosis and Countermeasures.

Botulinum toxin is a neurotoxin produced by Clostridium botulinum and some other relative species. It causes a lethal disease called botulism. It can enter the body via infections by Clostridium (e.g. wound and children botulism) or by direct contact with the toxin or eating contaminated food (food-borne botulism). Botulinum toxin is also considered as a relevant biological warfare agent with an expected high number of causalities when misused for bioterrorist or military purposes. The current paper surveys the actual knowledge about botulinum toxin pathogenesis, the manifestation of poisoning, and current trends in diagnostics and therapeutics. Relevant and recent literature is summarized in this paper.

Pharmacological protection of the detoxification activity of animals’ liver with the help of phospholipid and polysaccharide nature substances complex

Currently, among chemical pollutants a significant danger to the health of animals and humans represent oxygen-containing nitrogen compounds nitrates and nitrites, which are widely used as mineral fertilizers. The article presents data on the study of chronic nitrate intoxication, reproduced in laboratory animals and its pharmacological correction with a complex of substances of phospholipid and polysaccharide nature. The introduction of sodium nitrate to non-linear rats for 30 days at a dose of 3.8 mg per animal leads to the development of intoxication in rats with dominant signs of liver damage. On this background, the use of the complex of beet fiber and rapeseed lecithin leads to a weakening of nitrate toxicosis, which is demonstrated by an increase in rats’ body weight, weakening of the clinical manifestations of intoxication, a decrease in cytolytic syndrome, intrahepatic cholestasis and impaired protein synthesis function of liver.

Investigation of the thiol-disulfide system state of rats with encephalopathy caused by the effect of antituberculous drugs

Objective. To determine in an experimental study the nature of changes in the status of the thiol-disulfide system of rats with encephalopathy, due to the influence of complex of anti-tuberculosis drugs for the treatment of chemoresistant tuberculosis and the possibility of their drug correction with the use of ademetionine 1,4-butanedisulfonate.Materials and methods. The study was conducted on 30 Wistar rats, which were divided into 3 groups: 10 – intact group, 10 – control group (treated with antituberculosis drugs) and 10 – main group (treated with antituberculosis drugs and ademetionine as means of correcting toxic effects). The state of the glutathione system and the content of homocysteine and nitrotyrosine were investigated.Results. Experimental therapy with ademetionine in rats treated with antituberculosis drugs helps to reduce the intensity of chronic oxidative stress in nerve tissue. The introduction of ademetionine establishes the most optimal ratio between the levels of reduced and oxidized thiol groups, as well as glutathione, which indicates the active mobilization of the thiol-disulfide system and the neutralization of products of free-radical oxidation. Under the conditions of nitrosative and oxidative stress, the studied agents increase the resistance of nervous tissue to the manifestations of intoxication. Thus, one of the links of the neuroprotective effect of ademetionin was its ability to stabilize the thiol-disulfide equilibrium.Conclusions. In the functioning of the glutathione-dependent enzymatic system in the tissues of the brain of rats treated with anti-tuberculosis drugs, there was decreased activity of glutathione s-transferase, glutathione peroxidase and glutathione reductase by 2.0, 1.7 and 2.4 times, respectively. Under the conditions of ademetionin therapy, there was increase by 1.7 times in the reduced intermediates of the thiol-disulfide system – SH-group, and an increase of the level of reduced glutathione by 1.9 times, against the background of a significant decrease in the content of its oxidized form – 1.4 times. The use of ademetionin also led to a decrease of the content of potentially neurotoxic compounds - nitrotyrosine and homocysteine by 1.4 and 1.5 times, respectively in the brain tissues, which increases the resistance of nervous tissue to the effects of intoxication.

Pre-clinical stody of subchronic toxicity of ormustine in dogs

Introduction . In N. N. Blokhin National Medical Research Center of Oncology were made preclinical toxicological studies of drmustine, a new antitumor drug from the class of nitrosoureas. The paper presents some results of study the subchronic toxicity ofdrmustine in dogs. Objective. The objective of the present study was to investigate the subchronic toxicity of о rmustine on dogs with a daily intravenous administration during 3 days. Materials and methods . The study was performed in 12 dogs of the English beagle breed of males and females. Ormustine was adminis¬tered intravenously daily during 3 days in total doses of 1, 5, 10, 20 and 30 mg/kg. During the experiment, to study the damaging effect of ormustin on organs and tissues, clinical and lab tests andpathomorphological examinations were performed. Results . Ormustin in doses of 20 and 30 mg/kg caused the death of animals on the 7th and 8th day of observation against the background of severe hemato-and gastrointestinal toxicity. In dogs receiving the drug in all doses, there were external manifestations of intoxication and changes in behavioral reactions, weight loss during the entire observation period. It was found that the drug had a dose-related myelosuppressive effect. Ormustin caused pronounced morphological changes of varying degrees of reversibility in the small intestine, kidneys, thyroid gland, liver, lymph nodes, spleen, heart and gonads; less pronounced — in the large intestine, stomach and bladder. Conclusion. According to the study, the total doses of ormustin 20 and 30 mg/kg were characterized as lethal, 5 and 10 mg/kg — high toxic, 1 mg/kg — low toxic dose.

Dynamics of Carbohydrate Metabolism Indices during the Treatment of Pulmonary Tuberculosis Patients with the Use оf Pathogenetic Therapy

Objective. To assess the dynamics of carbohydrate metabolism indices during the treatment of pulmonary tuberculosis patients with the use of pathogenetic therapy
 Materials and methods. We examined 40 patients with newly diagnosed destructive pulmonary tuberculosis with bilateral infiltrative changes and massive mycobacteria excretion. Exclusion criteria were: HIV infection/AIDS, diabetes mellitus, chronic hepatitis, extrapulmonary tuberculosis and pulmonary tuberculosis without destruction and without bacterial excretion. Standardized four-component anti-TB treatment regimen was prescribed to all patients. The subjects were randomly distributed between two groups of 20 people. The treatment regimen for patients of group 2 was supplemented with a 10-day course of intravenous infusion of xylitol with a volume of 400 ml once a day. An oral glucose tolerance test (OGTT) was performed, fasting insulin levels were determined, the insulin resistance index (HOMA-IR) and body mass index (BMI) were calculated, and clinical manifestations of intoxication were evaluated. For statistical data processing, the Statistica for Windows version 13.2 generalpurpose data processing software package was used.
 Results and discussion. At the beginning of treatment, patients of both groups had complaints typical for intoxication syndrome and signs of carbohydrate metabolism disorders in the form of the development of insulin resistance. The median value of the HOMA-IR index in group 1 was 3.03, and in group 2 it was 3.36. During the treatment, in group 2, whose patients received xylitol, a decrease in the average term of relief of intoxication symptoms was observed compared with group 1 (7±2 days vs 11±3 days) (p<0.05). In group 2 the median of insulin level decreased at a statistically significant level (p<0.05) (from 16.5 mcU/mL to 11.4 mcU/mL), and the insulin resistance index HOMA-IR decreased from 3.36 to 2.0, which allows us to suppose the positive effect of xylitol on the carbohydrate metabolism of patients with infiltrative pulmonary tuberculosis with destructive changes and mycobacteria excretion.
 Conclusions. Based on the obtained data, it can be concluded that xylitol has a positive modeling effect on the dynamics of carbohydrate metabolism in patients with destructive pulmonary tuberculosis with bacterial excretion.

Study of the functional state of liver in HIV-infected persons with the first diagnosed pulmonary tuberculosis

Simultaneous administration of anti-TB and antiretroviral therapy to patients with HIV contributes to the development of hepatotoxicity, which may be accompanied by a change in the laboratory and functional parameters of the liver. The purpose of the work is to investigate the functional state of the liver in HIV-infected persons with the first diagnosed pulmonary tuberculosis without combining with chronic hepatitis C. 49 patients were examined. The control group consisted of 25 patients with the first diagnosed pulmonary tuberculosis, the main – 24 patients with VDTB/HIV co-infection. The data of clinical, laboratory (ALT, AST, total bilirubin and its fractions, total protein of blood) and ultrasound examination before treatment and after the completion of the intensive phase of anti-TB therapy were evaluated. Clinically manifestations of intoxication were regressed more quickly in the control group. There was a statistically significant increase ALT in the main group compared to the control group after the intensive phase of treatment (p<0.05). Levels of total bilirubin and protein in both groups were not statistically different (p>0.05). The level of total bilirubin in both groups remained within the limits of physiological norm both before and after therapy. There was no significant increase those indicators, which could show the development of cholestasis syndrome. In the routine ultrasound study, conducted before and after the intensive phase, increased echogenicity of the liver, heterogeneity of the structure of the organ parenchyma, expansion of the intrahepatic ducts, hepatosplenomegaly. The presence of liver damage in patients with HIV/TB-co-infection was established at the pre-treatment stage, which wasn’t accompanied by severe clinical symptoms, consequently, in patients with HIV/TB co-infection it is expedient to conduct active monitoring of marker enzymes for cytolysis and ultrasound evaluation of liver status. The prevention of the development of medical liver damage in patients with HIV/TB co-infection contributes to the adequate implementation of an intensive phase of TB treatment.

Features of diagnostics of the hepatobiliary system diffuse lesions in children with herpes viral infection caused by Epstein-Barr virus (both isolated and in the form of mixed herpesvirus infection)

Purpose: to improve the treatment quality and prognosis of herpesvirus infection in children caused by the Epstein-Barr virus (both isolated and in the form of mixed herpesvirus infection) based on the study of clinical, biochemical and immunological parameters of the hepatobiliary system. Materials and methods: We examined 95 children aged 3 to 7 years with herpesvirus infection, who were divided into three groups (the I group – children with acute Epstein-Barr infection, the II group – children with Epstein-Barr infection in combination with cytomegalovirus infection, the ІІІ group – children with Epstein-Barr infection and herpesvirus infection type 6). Age-matched healthy control group consisted of 20 children. The diagnosis was verified using a polymerase chain reaction. Biochemical studies included determination of total protein and its fractions, total bilirubin and its fractions, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, thymol index. All patients underwent echosonography of the liver. The level of cytokines (IL-1β, IL-4) and antiviral protection parameters – the content of natural killers (CD16+), T-helper (CD4 +) and/or cytotoxic lymphocytes (CD8 +) were evaluated. Results. In all examined children the disease started acutely from general intoxication syndrome, lesion of the nasopharynx and oropharynx, which were more pronounced in the children of the 1st and 2nd examined groups. Manifestations of the viral exanthema and enanthema were more commonly and pronounced in children of the III group. Most children (61.8 %) with Epstein-Barr infection in combination with herpesvirus infection type 6 had disturbances in the central nervous system. The lesions of lymphoid tissue occurred in 73 (76.7 %) children and were more prevalent in the 1st and 2nd surveyed groups. The constant symptom of the disease was hepatomegaly. Splenomegaly was observed in 82 (86.7 %) patients. We have noted an increase in the levels of aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase in the examined children. These changes were more pronounced in children of the 2nd group. Herewith, cytolysis of hepatocytes in most cases among children of all examined groups was not accompanied by hyperbilirubinemia. The jaundice of the skin and mucous membranes occurred only in 18.5% of all examined patients, who were diagnosed with moderate hyperbilirubinemia (60.0 ± 4.6 μmol/l). Proteinogram parameters in the examined patients in the acute period were characterized by a decrease in albumin content, an increase in the content of α1-, α2- and γ-globulins and a decrease in the albumin / globulin ratio. These indicators were significantly changed in the 2nd surveyed group. The majority of examined patients had coagulogram indices on average matched to the age norm. One third of patients showed moderately elevated fibrinogen levels. Immune disorders, that accompany the herpesvirus infection, are characterized by an imbalance of proinflammatory and anti-inflammatory cytokines. Indicators of portal hemodynamics in patients of the I group in the acute period of the disease were characterized by moderate changes such as a decrease in hepatic artery and portal vein blood flow without viscoelasticity and peripheral vascular resistance violations. In the II group the decrease in the diameter of the common hepatic artery and the increase in the diameter of the portal vein, the decrease in the vessels blood flow with a decrease in their viscoelasticity and peripheral vascular resistance was noted. In the III group of patients the hepatic artery and portal vein hemodynamic changes, which had a compensatory character, were identified. Conclusions: Taking into account the revealed clinical changes, it can be noted that lesions of the nasopharynx, more pronounced manifestations of intoxication and hepatolienal syndromes prevailed in infants with herpesvirus infection. Proinflammatory cytokines overactivity in patients with Epstein-Barr viral infection in combination with cytomegalovirus infection causes a longer intoxication period, pronounced liver enlargement, elevation of transaminases and inhibition of liver albumin synthesis. It could be reasonable to prescribe vasoactive therapy for patients with Epstein-Barr virus infection in combination with cytomegalovirus infection both in the acute and reconvalescence period of the disease followed by structural-functional and hemodynamic state of the liver monitoring at the stages of medical rehabilitation.

FOR HIGHLY PATHOGENIC INFLUENZA A(H1N1) IN PREGNANCY AND IMPACT ON BIRTH OUTCOMES

The purpose of this study was to improve the diagnosis of influenza A (H1N1) in pregnant women and to determine the risk of developing various types of pathology in newborns, depending on the gestation period at which the infection influenza occured. Materials and methods. A total of 94 pregnant women, an average age of 28.7 ± 0.48, who were on treatment with influenza diagnosis in the Specialized Infectious Disease Clinical Hospital of the Ministry of Health of the Krasnodar Territory during the epidemic rise of influenza A (H1N1) from December 2015 to February 2016. The diagnosis of influenza A (H1N1) was confirmed in all cases by the isolation of RNA of influenza A (H1N1) virus by PCR in a nasopharyngeal scrap. Patients applied for medical care on average 2.74 ± 0.16 days of illness. Pregnancy at the gestational age corresponding to the first trimester was in 20 (21.3%), in the term of the second trimester - in 36 (38.3%), and in the third trimester - in 38 (40.4 %) of women. The results of the laboratory examination were evaluated. Pregnancy outcomes were traced in 94 women, a telephone questioning of women was conducted 3-6 months after childbirth, the state of children at birth was analyzed based on the results of a retrospective analysis of 91 neonatal card in the maternity hospital. Results. Highly pathogenic influenza A (H1N1) in pregnant women during early treatment and prescription of antiviral therapy was mainly in medium-heavy form (96.81%). In the first day of the disease, subfebrile fever predominated - 63.3%, febrile fever subsequently developed in 53.33%, headache, and other intoxication manifestations were less than in the case of epidemical influenza A. Catarrhal syndrome is not bright, often characterized by early joint cough. The main complication of influenza, determining the severity of the patient state, was pneumonia, developed in one third of patients. Early antibacterial and antiviral therapy in most cases prevented the formation of severe lung lesions and abortion. Pregnancy ended with urgent deliveries in 89 women (94.68%); in three cases, in women who had influenza at 6, 15 and 29 weeks of gestation, abortion with fetal death (3.19%) occurred. Premature delivery at 28 and 33 weeks of gestation with the birth of a viable child occurred in two cases (2.13%). The development of influenza in the first trimester resulted in complications in 42% of cases, increasing the risk of abortion and developmental anomalies, mainly from the cardiovascular system (26.31%). Infection of pregnant women with influenza in the second trimester led to a different pathology of newborns in 49% cases. Among them, acute intranatal asphyxia prevailed (14.29%), pathology of the nervous system (11.43%), less frequently developed intrauterine infection, pneumonia (5.71%). Special attention is required by women with influenza in the third trimester of pregnancy, in this group, the pathology of the newborns was noted in 54% of cases, mainly in the form of acute intranatal asphyxia (29.73%) against the background of intrauterine infection, pneumonia (16.22%), central nervous system pathology (8.11%). The conclusion. Despite the medium-heavy course, the woman’s influenza had an adverse effect on the formation of the fetus and the condition of the newborn at birth. On the background of influenza infection, the degree and nature of exposure depended on the gestation period.

FOR HIGHLY PATHOGENIC INFLUENZA A(H1N1) IN PREGNANCY AND IMPACT ON BIRTH OUTCOMES

The purpose of this study was to improve the diagnosis of influenza A (H1N1) in pregnant women and to determine the risk of developing various types of pathology in newborns, depending on the gestation period at which the infection influenza occured. Materials and methods. A total of 94 pregnant women, an average age of 28.7 ± 0.48, who were on treatment with influenza diagnosis in the Specialized Infectious Disease Clinical Hospital of the Ministry of Health of the Krasnodar Territory during the epidemic rise of influenza A (H1N1) from December 2015 to February 2016. The diagnosis of influenza A (H1N1) was confirmed in all cases by the isolation of RNA of influenza A (H1N1) virus by PCR in a nasopharyngeal scrap. Patients applied for medical care on average 2.74 ± 0.16 days of illness. Pregnancy at the gestational age corresponding to the first trimester was in 20 (21.3%), in the term of the second trimester - in 36 (38.3%), and in the third trimester - in 38 (40.4 %) of women. The results of the laboratory examination were evaluated. Pregnancy outcomes were traced in 94 women, a telephone questioning of women was conducted 3-6 months after childbirth, the state of children at birth was analyzed based on the results of a retrospective analysis of 91 neonatal card in the maternity hospital. Results. Highly pathogenic influenza A (H1N1) in pregnant women during early treatment and prescription of antiviral therapy was mainly in medium-heavy form (96.81%). In the first day of the disease, subfebrile fever predominated - 63.3%, febrile fever subsequently developed in 53.33%, headache, and other intoxication manifestations were less than in the case of epidemical influenza A. Catarrhal syndrome is not bright, often characterized by early joint cough. The main complication of influenza, determining the severity of the patient state, was pneumonia, developed in one third of patients. Early antibacterial and antiviral therapy in most cases prevented the formation of severe lung lesions and abortion. Pregnancy ended with urgent deliveries in 89 women (94.68%); in three cases, in women who had influenza at 6, 15 and 29 weeks of gestation, abortion with fetal death (3.19%) occurred. Premature delivery at 28 and 33 weeks of gestation with the birth of a viable child occurred in two cases (2.13%). The development of influenza in the first trimester resulted in complications in 42% of cases, increasing the risk of abortion and developmental anomalies, mainly from the cardiovascular system (26.31%). Infection of pregnant women with influenza in the second trimester led to a different pathology of newborns in 49% cases. Among them, acute intranatal asphyxia prevailed (14.29%), pathology of the nervous system (11.43%), less frequently developed intrauterine infection, pneumonia (5.71%). Special attention is required by women with influenza in the third trimester of pregnancy, in this group, the pathology of the newborns was noted in 54% of cases, mainly in the form of acute intranatal asphyxia (29.73%) against the background of intrauterine infection, pneumonia (16.22%), central nervous system pathology (8.11%). The conclusion. Despite the medium-heavy course, the woman’s influenza had an adverse effect on the formation of the fetus and the condition of the newborn at birth. On the background of influenza infection, the degree and nature of exposure depended on the gestation period.

ANALYSIS OF LETHAL OUTCOMES AMONG CHILDREN WITH ETHANOL IN BLOOD SAMPLES

Cases of consumption of alcoholic beverages by children and adolescents are rare. Children’s bodies are considered to be much less resistant to toxic effects of alcohol. However, there are described cases of the non-lethal ethanol poisoning in children when its blood concentration exceeded 5 g/L. The aim of the study. The forensic medical evaluation of the toxic action of ethanol in children depending on age, blood concentration of alcohol taking into account causes of death. Material. Data from statistical reporting, the Bureau of forensic medical examination for the Moscow region over the period of 2003-2017. Results. In lethal outcomes of children the prevalence rate of a positive result of the forensic chemical test of blood for the presence of ethyl alcohol was 1:6. Detected ethanol concentration in corpse blood would correspond to clinical manifestations of intoxication, from mild to severe. Conclusion. Children, whose blood alcohol content formally met the criterion of severe intoxication or alcohol poisoning, can take actions.

Correction of toxic impact of anti-tuberculosis drugs on the liver in patients with first-time diagnosis of pulmonary tuberculosis

Introduction. The liver, being the main organ of detoxification, is experiencing the greatest burden in the process of chemotherapy. Disorders of the liver function in patients with respiratory tuberculosis can occur due to various factors, leading to the development of toxic reactions up to acute and chronic hepatitis. Numerous studies point to pronounced hepatotoxic effect of all anti-TB drugs and development of toxic hepatitis in patients treated with these drugs. This suggests the need to use hepatotropic drugs in complex treatment of TB.The aim of the study – to learn biochemical markers of liver function abnormalities in patients with newly diagnosed pulmonary tuberculosis and with severe intoxication syndrome before and two months after TB inpatient treatment, and the feasibility of using domestically-produced “Antral“ medication to treat functional disorders of the liver in these patients.Research methods. Two groups of people were involved in the study. Group I (control) consisted of evidently healthy donors, 27 individuals; Group II (31 individuals) consisted of patients with newly diagnosed pulmonary tuberculosis and with severe intoxication syndrome before and two months after of anti-TB therapy. This group was randomly divided into two subgroups: IIA(15 individuals), patients that only received standard anti-TB treatment and IIB (16 individuals), patients along with the standard anti-TB therapy received “Antral“ medication in the dose of 200 mg 3 times a day for the duration of treatment intensive phase. Results and Discussion. Results of the study indicate that when examining patients with pulmonary tuberculosis and severe intoxication syndrome markers of cytolysis and cholestasis should be measured prior to start of the treatment. With the increase of such indicators, in particular, ALT, AST, general and direct bilirubin, LDH, GGTP should be appointed hepatoprotector, in particular "Antral" drug. The use of this drug during the intensive phase of treatment normalizes the parameters of not only cytolytic but also cholestatic syndromes of liver function disorders in patients. Use of this medication in the treatment of tuberculosis contributed to ceasing release of the bacteria after intensive phase of treatment in 71.2 % of cases in subgroup IIB (43.9 % in subgroup IIA), and disappearance of clinical manifestations of intoxication in subgroup IIB in 79.8 % of cases (49.6 % in subgroup IIA). Significant reduction in markers of cytolysis and cholestasis was observed in patients that received “Antral“ medication during intensive phase of the treatment.Conclusions. Patients with newly-detected pulmonary tuberculosis and severe intoxication syndrome had significantly increased markers of cytolysis and cholestasis even before start of the treatment. “Antral“ is a medication with hepatoprotective action. Use of this medication alongside with the complex therapy of pulmonary tuberculosis contributed to normalization of liver function, significant reduction in the markers of cytolysis and cholestasis, faster termination of bacterial release and disappearance of clinical manifestations of intoxication.