Multiple Organ Failure Syndrome Research Articles

RENAL DYSFUNCTION IN PRETERM INFANTS WITH PERINATAL PATHOLOGY: RISK FACTORS, SENSITIVITY AND SPECIFICITY OF LABORATORY MARKERS OF DAMAGE

The main burden of neonatal morbidity in critically ill preterm infants, despite signifi cant achievements and rapid development of care technologies, is most often associated with neonatal sepsis, perinatal asphyxia and the development of multiple organ failure syndrome. As a component of this syndrome, newborns with combined perinatal pathology in the early neonatal period manifest severe renal dysfunction up to acute kidney injury, which is closely correlated with increased mortality. The incidence of acute kidney injury in critically ill preterm infants varies widely, ranging from 25 to 77 % according to diff erent neonatal data. A major problem in the fi eld of neonatal nephrology is the lack of uniform approaches for the diagnosis of moderate and severe renal dysfunction at the subclinical stage, which would allow the timely formation of risk groups and the optimization of interventional strategies.Aim of the study. To analyze the data on clinical characteristics, risk factors, and results of additional paraclinicalexaminations in preterm infants with gestational age of 34-36/6 weeks who had severe and moderate perinatal pathology during the early neonatal period.Material and methods. A comprehensive study of 91 premature infants with moderate and severe perinatal pathology wasconducted, of which group I consisted of 30 children with severe perinatal pathology at 34-36/6 weeks’ gestation, group II – 30 children with moderate perinatal pathology at 34-36/6 weeks’ gestation; group III (control) consisted of 31 conditionally healthy premature infants at 34-36/6 weeks’ gestation.The diagnosis of acute kidney injury in neonates in the comparison groups was made according to the International Criteriafor Kidney Disease: Improving Global Outcomes as modifi ed by J. G. Jetton and D. J. Askenazi (2015). The international scaleNeonatal Multiple Organ Dysfunction Score was used to assess the severity of multiorgan dysfunction in perinatal pathology.The eff ectiveness of therapeutic interventions was assessed using the international scale Neonatal Therapeutic Intervention Scoring Scale, and the severity of the patient’s condition in dynamics was assessed using the neonatal scale Score for Neonatal Acute Physiology.Methods of laboratory research. The study of the biochemical spectrum of urine in children of the observation groups,in particular, the determination of the level of markers of kidney damage – alpha-1-microglobulin, beta-2-microglobulin,microalbumin, cystatin C was carried out on the basis of the problematic research laboratory of the Bukovinian State Medical University of the Ministry of Health of Ukraine using the automatic analyzer «ACCENT-200» and «ACCENT-200 II CEN». Urine was collected on the 3rd day of life (between 48-72 hours of life), in sterile disposable containers, in the amount of at least 5 ml.At the same time, a blood sample for cystatin C determination was taken in the amount of 0.5-1.0 ml, in accordance with the rules of asepsis and antisepsis in disposable sterile tubes. A turbodimensional immunoassay was used to determine the concentration of cystatin C and urinary microalbumin. Determination of alpha-1-microglobulin was performed using an ACCENT-200 automated analyzer by measuring agglutination by change in absorbance (572 nm), with actual concentration determined by interpolation from a calibration curve constructed using calibrators of known concentration. The concentration of beta-2-microglobulin in urine was determined by the method of competitive chemiluminescence analysis.The studies were conducted in accordance with the basic provisions of GCP (1996), the Convention of the Council of Europeon Human Rights and Biomedicine (April 4, 1997), the World Medical Association Declaration of Helsinki on Ethical Principlesfor Research Involving Human Subjects (1964-2008), Order of the Ministry of Health of Ukraine No. 690 of September 23, 2009 (as amended by Order of the Ministry of Health of Ukraine No. 523 of July 12, 2012).Statistical analysis of the results was performed using Statistica 10 software (StatSoft Inc., USA, 2010), MedCalc software(version 16.1) with calculation of chi-squared, odds ratio (OR), 95 % confi dence interval (CI), statistically signifi cant diff erences between the study groups were considered at a value of p<0.005. Receiver operating characteristic (ROC) curves, area under ROC (AUROC), sensitivity (SN), and specifi city (SP) were analyzed using MedCalc software (version 16.1). The research work was carried out within the framework of research of the Department of Pediatrics, Neonatology andPerinatal Medicine of the Bukovinian State Medical University: Research project «Improvement of directions of prognostication, diagnosis and treatment of perinatal pathology in newborns and infants, optimization of schemes of catamnestic observation and rehabilitation» (State registration number 0115U002768, term of implementation 2015-2019); Research project «Chronobiological and adaptive aspects and features of vegetative regulation in pathological conditions in children of diff erent age groups» (State registration number 0122U002245, term of implementation 2020-2024).Study results. The data obtained showed statistically signifi cant associations between the risk of severe renal dysfunctionand a number of antenatal and postnatal factors that adversely aff ect the course of the early neonatal period. These included fetal distress during pregnancy and delivery, emergency cesarean section, risk of spontaneous abortion and preterm birth, and impaired fetal- placental blood fl ow. Statistically signifi cant associations with the development of moderate and severe renal dysfunction are associated with a burdened history of maternal extragenital pathology, namely cardiovascular, urinary system, and anemia (p<0.005). The structure of perinatal pathology in preterm infants is often combined and diffi cult to diagnose.A signifi cant proportion of newborns had clinical manifestations of multiple organ failure syndrome, including signs of renal dysfunction. Therefore, it is expedient to study a set of the latest potential biomarkers of renal dysfunction, such as cystatin C, alpha-1-microglobulin, beta-2-microglobulin and microalbumin, in order to create an appropriate prognostic model and timely form risk groups among this category of children.
 Conclusions. The basis for the development of moderate and severe renal dysfunction in premature infants with perinatalpathology is polyetiology against the background of morphological and functional immaturity of the body, which has a clearrelationship with gestational age and birth weight. The compensatory and adaptive properties of the «immature» kidneys at birth are limited, which, in the presence of combined pathology, plays a signifi cant role in shaping the severity of the course of the disease. Early prognosis and diagnosis of renal dysfunction in the early stages of its development makes it possible to improve the quality and eff ectiveness of medical care and improve treatment outcomes.

Pathogenetic and pharmacodynamic features of succinic acid derivative application for various diseases of the cardiovascular and nervous systems

This study revealed the pathogenetic patterns of the development of hypoxic and ischemic disorders in various pathological conditions and substantiated approaches to the use of drugs with antihypoxic activity. The role of the receptor interaction of succinic acid in the composition of succinate-containing antihypoxants with succinate receptor SUCNR1 has been demonstrated. The pharmacodynamic properties of the combined preparation of succinic acid that also contains vitamin precursors of the cofactors of Krebs cycle dehydrogenases nicotinamide (precursor of NAD) and riboflavin mononucleotide (precursor of FAD) and precursor of purine nucleotides (inosine) (cytoflavin) for intravenous drip and oral administration were analyzed. Literature data were also analyzed to evaluate the effectiveness of the use of the metabolic corrector of energy-dependent and hypoxic conditions (cytoflavin) in various central nervous system and cardiovascular diseases. In the case of ischemic disorders of cerebral and coronary blood flow, the effects of the drug are concentrated on the penumbra zone (ischemic penumbra), which is associated with the intravenous administration of the drug to its metabolic activity by influencing endothelial cells, restoring microcirculation, and enhancing the oxygen transport function of the blood. Among the new areas of drug use, the use of cytoflavin in the complex therapy of traumatic brain injuries, traumatic shock, acute respiratory distress syndrome, toxic lesions of the central nervous system, multiple organ failure syndrome, and post-COVID syndrome is promising.

Immediate and medium-term results of aortic valve replacement with biological prosthesis in elderly patients: experience of one center

Objective. To analyze the immediate and medium-term results of prosthetics of the aortic valve (AV) using biological prosthesis in elderly patients.
 Material and methods. The study included 198 patients with AV pathology [85 men (42.9 %)/113 women (57.1 %)]. The median age was 70 [66–73] years. There were 175 (88.4 %) patients with sclerodegenerative AV, 5 (2.5 %) – with infectious endocarditis and 30 patients (15.2 %) had bicuspid AV.
 Results. The hospital mortality was 4.5 %. The causes of mortality were multiple organ failure syndrome, in 1 case – developed peritonitis. In 14 patients (7.1 %) there was a rhythm disturbance in the form of AF, in 9 (4.5 %) – a complete AV block, in connection with which a permanent pacemaker was implanted. Four patients (2 %) underwent resternotomy for bleeding. Two patients (1 %) underwent pericardiocentesis. 8 (4 %) patients developed a stroke. No wound complications were detected. In the long-term period, 31 patients died. The causes of mortality were the following: cardiovascular diseases – 13 patients, malignant neoplasms – 5 patients, gastrointestinal diseases – 2, urinary system disease – 1 patient, COVID-19 – 1 patient, unknown cause – 9 patients. Thus, the five-year survival rate after the surgery was 63 %, respectively. During the follow-up period, 2 patients (2.9 %) underwent repeated intervention on AV.
 Conclusions. The five-year freedom from re-operation was 97.1 %. The five-year survival rate was 63 % due to the presence of a history of severe concomitant pathology as well as the middle age of patients 70 years.

Toxic Shock Syndrome: A Literature Review.

Toxic shock syndrome (TSS) is a rare, life-threatening, toxin-mediated infectious process linked, in the vast majority of cases, to toxin-producing strains of Staphylococcus aureus or Streptococcus pyogenes. The pathophysiology, epidemiology, clinical presentation, microbiological features, management and outcome of TSS are described in this review. Bacterial superantigenic exotoxins induces unconventional polyclonal lymphocyte activation, which leads to rapid shock, multiple organ failure syndrome, and death. The main described superantigenic exotoxins are toxic shock syndrome toxin-1 (TSST-1) and enterotoxins for Staphylococcus aureus and Streptococcal pyrogenic exotoxins (SpE) A, B, and C and streptococcal superantigen A (SsA) for Streptococcus pyogenes. Staphylococcal TSS can be menstrual or nonmenstrual. Streptococcal TSS is linked to a severe group A streptococcal infection and, most frequently, to a necrotizing soft tissue infection. Management of TSS is a medical emergency and relies on early detection, immediate resuscitation, source control and eradication of toxin production, bactericidal antibiotic treatment, and protein synthesis inhibiting antibiotic administration. The interest of polyclonal intravenous immunoglobulin G administration as an adjunctive treatment for TSS requires further evaluation. Scientific literature on TSS mainly consists of observational studies, clinical cases, and in vitro data; although more data on TSS are required, additional studies will be difficult to conduct due to the low incidence of the disease.

Prediction of Subclinical and Clinical Multiple Organ Failure Dysfunction in Breast Cancer Patients-A Review Using AI Tools.

This review explores the interconnection between precursor lesions of breast cancer (typical ductal hyperplasia, atypical ductal/lobular hyperplasia) and the subclinical of multiple organ failure syndrome, both representing early stages marked by alterations preceding clinical symptoms, undetectable through conventional diagnostic methods. Addressing the question "Why patients with breast cancer exhibit a tendency to deteriorate", this study investigates the biological progression from a subclinical multiple organ failure syndrome, characterized by insidious but indisputable lesions, to an acute (clinical) state resembling a cascade akin to a waterfall or domino effect, often culminating in the patient's demise. A comprehensive literature search was conducted using PubMed, Google Scholar, and Scopus databases in October 2023, employing keywords such as "MODS", "SIRS", "sepsis", "pathophysiology of MODS", "MODS in cancer patients", "multiple organ failure", "risk factors", "cancer", "ICU", "quality of life", and "breast cancer". Supplementary references were extracted from the retrieved articles. This study emphasizes the importance of early identification and prevention of the multiple organ failure cascade at the inception of the malignant state, aiming to enhance the quality of life and extend survival. This pursuit contributes to a deeper understanding of risk factors and viable therapeutic options. Despite the existence of the subclinical multiple organ failure syndrome, current diagnostic methodologies remain inadequate, prompting consideration of AI as an increasingly crucial tool for early identification in the diagnostic process.

Кандидозный эзофагит у пациентов с COVID-19

The purpose is to examine the incidence and clinical characteristics of сandidiasis esophagitis in COVID-19 patients. Material and methods. We conducted a retrospective observational study by analyzing the medical records of 68 patients with COVID-19 and esophageal candidiasis. All of the patients received in-patient treatment at the Republic Clinical Infectious Diseases Hospital in Kazan from 2020 to 2022. Results. From 2020 to 2022, 1177 fibrogastroduodenoscopies (FGDS) were performed on patients with COVID-19 at the Republic Clinical Infectious Diseases Hospital in Kazan. Esophageal candidiasis was diagnosed in 68 (5.8%) of the examined patients, Mostly often, elderly patients with chronic pathology of the gastrointestinal tract (65%) and diabetes mellitus (29%). Esophageal candidiasis developed in patients with different severity of COVID-19, including mild forms of infection. According to the Kodsi scale, grade I of esophageal damage was diagnosed in 63.3%, grade II in 27.9%, grade III in 4.4%, grade IV in 4.4% of patients. Patients complained of epigastric pain (34.6%), chest pain (7.7%), dysphagia (7.7%), nausea and vomiting (13.4%), heartburn (1.9%), hiccups (1.9%). 41.5% of patients had no “esophageal” complaints. Antimycotic therapy for candidal esophagitis was carried out with fluconazole at a daily dose of 400 mg, then 200 mg for 14 days. 92.5% of patients were discharged with improvement or clinical recovery. Death occurred in 5 (7.5%) patients. The cause of death was COVID-19 complications (ARDS, PE, multiple organ failure syndrome, acute kidney failure, etc.). Conclusion. The development of esophageal candidiasis is possible in patients with any severity of COVID-19. Esophageal candidiasis can be asymptomatic. The severity of fungal infection of the esophagus correlates with the severity of coronavirus infection. Patients with severe forms of COVID-19 may develop grades III and IV of esophageal damage. If esophageal candidiasis is detected in a patient with COVID-19, a mycological test of blood, urine and bronchoalveolar lavage should be performed to identify other localizations of invasive candidiasis.

APPLICATION OF AMPLITUDE-INTEGRATED ELECTROENCEPHALOGRAPHY IN PATIENTS OF NEONATAL INTENSIVE CARE UNITS

Intriduction. Amplitude-integrated electroencephalography is a technique for monitoring continuous cerebral function, when electroencephalographic signal is filtered, scaled and compressed in time.
 Objective of the study is to elucidate peculiarities of interpreting findings of the amplitude-integrated electroencephalography in patients of neonatal intensive care units, and represent a clinical case of establishing diagnosis by using the amplitude-integrated electroencephalography for a critically sick neonate.
 Materials and methods. A comprehensive literature review was conducted across international and national databases, including Elsevier, PubMed, Medline, Web of Science, Scopus, Cochrane Central Register of Controlled Trials, and Google Scholar, covering the period from 2019 to 2023. The search focused on the keywords "amplitude-integrated electroencephalography" and/or "aEEG" and "neonates" and/or "term infants" and/or "preterm infants." The clinical case presented took place at the neonatal intensive care unit of the Maternity Home "Central Municipal Clinical Hospital", Chernivtsi, Ukraine. Permission for publication was obtained from both parents of the child.
 Results. The main indications for conducting the amplitude-integrated electroencephalography in neonates include the assessment of the cerebral function and the degree of cerebral damage with hypoxic-ischemic encephalopathy or asphyxia at birth (often combined with therapeutic hypothermia); assessment of sleep-wake cycle; identification of seizures; assessment of cerebral function maturity in preterm neonates.
 The underlying cerebral activity is estimated according to the amplitude-integrated electroencephalography findings by means of a simple recognition of visual images corresponding to the five main patterns: Continuous Normal Voltage, Discontinuous Normal Voltage, Burst Suppression, Low Voltage, and Flat Trace. A typical neonatal single seizure fit on the amplitude-integrated electroencephalography looks like a “hump” or lower edge elevation interrupting the background recording. Repeated fits (epileptic status) look like a “saw” of repeated “humps”, one of each represents one attack. The article presents a clinical case of the diagnostic search in the neonate with congenital pneumonia and development of multiple organ failure syndrome including seizure syndrome. Clinical tonic-clonic seizures of the infant were associated with electroencephalographic criteria of status epilepticus both on the amplitude-integrated electroencephalography (repeated symmetrical elevations of the lower edge in the left and right) and on the standard electroencephalography (different variations of seizure graphic elements in the right and left). Considering the results of the clinical and instrumental examination, an adequate anticonvulsant therapy was administered.
 Conclusions. Continuous recording of the video-amplitude-integrated electroencephalography and standard electroencephalography in infants from the risk group is a good strategy of the neurological status effective monitoring. It enables to assess the underlying cerebral electric activity and it maturity, diagnose seizures and manage anticonvulsant therapy correctly. An adequate training of the staff who are at the patient’s bedside 24/7 is an important part of the interdisciplinary collaboration which is essential for a safe and effective management of patients in the neonatal intensive care units, prevention of early complications and disability in the future.

Pathogenetic detection, retrospective and pathogenicity analysis of a fatal case of Vibrio vulnificus in Shenzhen, China

We report a 36-year-old male patient died of V. vulnificus-induced septicaemia and multiple organ failure syndrome after oyster consumption at a restaurant. We isolated and identified V. vulnificus vv16015 from the patient’s blood sample and antibiotic susceptibility tests indicated sensitivity to all 21 antibiotics. Oyster samples were subsequently collected from the restaurant’s supplier and three strains of V. vulnificus were isolated. Whole genome sequencing and analysis revealed vv16015 to be distantly related to these strains and confirmed that V. vulnificus contamination was present in the seafood of the restaurant and supplier. Using a Galleria mellonella larvae infection model, the virulence of vv16015 was determined to be higher than that of comparison strains isolated from a surviving patient (vv15018) and an oyster (vv220015). The human and environment distribution of V. vulnificus in Shenzhen is sporadic and heterogeneous, and vv16015 is highly virulent compared to other strains.

EXPERIMENTAL AND MORPHOLOGICAL JUSTIFICATION OF THE ENTERAL INSUFFICIENCY DEVELOPMENT IN ABDOMINAL SEPSIS

Abstract. Abdominal sepsis continues to remain the most frequent and formidable complication that complicates the course of acute surgical diseases of the abdominal cavity in 15-25 % of cases, and the mortality rate in various forms of peritonitis, depending on the form and its spread, is from 4 % to 60 %, reaching 90 % in postoperative peritonitis.The aim of the study. To study the dynamics of morphological changes of internal organs in animals with simulated acute diff use peritonitis, depending on the stage of the infl ammatory process of the peritoneum.Material and methods. The object of experimental research was 54 white sexually mature non-linear rats weighing 0.18-0.20 kg, kept in the vivarium of the Bukovinian State Medical University, which were divided into two groups. The main group consisted of 28 animals that were simulated with abdominal sepsis. Control group – 26 intact rats. All animals had free access to food and water. Abdominal sepsis in rats was modeled according to our proposed method, which consisted in infecting the peritoneal cavity with the contents of the hollow organs of the abdominal cavity. Animals were removed from the experiment on 1, 3, and 7 days of simulated peritonitis by decapitation under thiopental anesthesia.The results. On the fi rst day of simulation of peritonitis in the animals of the main group, a histological examination of the peritoneum revealed focal purulent peritonitis with damage to the parietal peritoneum. Diff use hyperemia, focal edema of the connective tissue, which is most developed in the submesothelial layers, was observed. Areas of swollen connective tissue contain a slight but diff use mononuclear infl ammatory infi ltrate. We did not detect morphofunctional changes in the liver and kidneys of animals of the main group on the fi rst day of experimental peritonitis. However, already on the third day of the study, the structure of the liver lobe was only partially preserved. The central veins were well visualized, slightly dilated, and contained a small number of erythrocytes. Changes were also found in the lung tissue of animals with peritonitis: enlarged alveoli and congestion of small vessels and hemorrhages. Hemorrhagic syndrome is not excluded as an early manifestation of acute pulmonary insu ffi ciency. On the seventh day, the structure of the liver lobe was signifi cantly disturbed in the animals. The central veins were well visualized, slightly dilated and contained a large number of erythrocytes. Sinusoids were not visualized in the vast majority of fi elds of view, sometimes they were detected only centrilobularly. The beam organization of hepatocytes was disturbed throughout the size of the lobule. During the histological examination of the kidney tissue of the animals on the 7th day of Клінічна анатомія та оперативна хірургія – Т. 22, № 4 – 2023 27 the experiment, we observed that in the cortical layer of the kidney, the glomeruli were somewhat enlarged and dilated, their vessels were fi lled with blood, serous exudate was observed in the lumens, and individual glomeruli were shrunken and collapsed. The vessels of the venous bed were somewhat dilated, full of blood, and small perivascular spot hemorrhages were visualized.Conclusion. Morphological changes occur already during the reactive phase of abdominal sepsis and indicate the stages of multiple organ failure syndrome.

Acute gastrointestinal injury: Stages, role in formation and progression of multiple organ failure syndrome, main stages of intensive therapy (literature review)

Acute gastrointestinal injury develops in more than half of all patients in the intensive care unit, regardless of the underlying pathology and it is one of the main reasons for the onset and progression of multiple organ failure and systemic inflammatory response syndrome. The severity of the acute gastrointestinal injury correlates with the risk of death. A deeper understanding of the pathogenetic mechanisms of dysfunction of the gastrointestinal tract in critically ill patients is necessary for the development and implementation of an intensive care regimen that allows to quickly restore the function of the gastrointestinal tract and break the vicious circle of pathophysiological changes, which will ultimately lead to improvement treatment outcomes for critically ill patients and reduced mortality.  

Una sindrome infiammatoria multisistemica fredda complicata da shock

<b>Rationale -</b> In clinical practice there are numerous factors influencing the correct process of diagnosis and treatment, especially in the context of complex clinical cases such as severe and atypical forms of "multisystem inflammatory syndrome" (MIS-C): several studies have observed that in the Emergency Department fewer than half of cases of hemodynamic shock are treated according to Paediatric Advanced Life Support (PALS) guidelines.<br> <b>Objectives -</b> To favour the recognition of MIS-C in its atypical form and to provide indications on the correct treatment in the course of its acute complications such as mixed shock (distributive-cardiogenic). <br> <b>Materials and methods -</b> Starting from the analysis of a clinical case, the literature about MIS-C and the management of mixed shock in the Emergency Department was reviewed. The paper describes the case of a patient with atypical MIS-C characterized by multiple organ failure syndrome, highlighting possible interventions of good clinical practice aimed to improve the outcome of patients affected by these disorders.<br> <b>Results -</b> The analysis of the literature and guidelines has allowed new management guidelines for atypical MIS-C syndrome to be produced, in order to obtain a better outcome, despite a highly severe clinical scenario. <br> <b>Conclusions -</b> Although there are no studies on the treatment of MIS-C shock in the literature, in view of the pathogenic continuum between MIS-C and Kawasaki syndrome, the adapted application of the American Heart Association guidelines allows the achievement of a good outcome even in cases of MIS-C with severe presentation.

Diagnosis of hemostatic disorders in patient with sepsis caused by a triple infection of <i>M. tuberculosis, P. aeruginosa, Kl. pneumoniae</i>

The article describes a clinical case of successful treatment of the patient (37 years old) with focal tuberculosis of the single left lung in the consolidation phase, empyema of the right pleural cavity, who developed multiple organ failure syndrome, hypercoagulation and sepsis, caused by a triple coinfection with M. tuberculosis, P. aeruginosa, and Kl. pneumoniae.

Current View on the Use of Extracorporeal Detoxification Methods for the Treatment of Rhabdomyolysis (Review)

Rhabdomyolysis is a syndrome caused by destruction and necrosis of muscle tissue, which is accompanied by the release of intracellular contents into the systemic circulation. The etiology of rhabdomyolysis is multifaceted, however, regardless of the etiological factor, the central element of its pathophysiology is systemic endotoxemia with multiple organ failure syndrome. Acute renal failure is one of the most common manifestations of organ dysfunction. Considering the pathogenetic model of the development of systemic endotoxemia, the timely use of extracorporeal therapy, which reduces mortality in organ failure, seems promising. All the current types of extracorporeal therapy can be divided into convection (hemofiltration), diffusion (hemodialysis), convection/diffusion (hemodiafiltration), sorption (hemoperfusion) and plasma exchange (plasmapheresis, plasma exchange, plasma sorption, etc.) methods based on physical principle.The aim of the reviewwas to summarize the available clinical data on extracorporeal treatments for rhabdomyolysis and to assess the feasibility and best indications for these methods based on the current pathogenetic model of rhabdomyolysis.Material and methods.The search for information was carried out in the Web of Science, Scopus, Medline, PubMed, RSCI, E-library and other databases. Eighty-one sources were identified containing current therapeutic approaches and relevant data of clinical and scientific research on the subject of this review.Results.In this review, the main etiological, epidemiological and pathogenetic models of acute renal injury in rhabdomyolysis have been discussed. The main methods of extracorporeal therapy have been reviewed and evaluated based on current understanding, and latest clinical data on their effectiveness have been summarized.Conclusion.The choice of the optimal extracorporeal treatment method, the time of initiation and duration of the procedure still remain controversial. The solution to this issue can potentially help to better correct the electrolyte disturbances and could protect against organ dysfunction, which would improve the outcome in patients with rhabdomyolysis.

STAGES OF MORPHOLOGICAL CHANGES OF TARGET ORGANS IN EXPERIMENTALLY SIMULATED ACUTE PERITONITIS

One of the urgent problems in urgent abdominal surgery remains acute disseminated peritonitis (AP), the mortality rate of which remains high due to the development of multiple organ failure syndrome, despite the use of modern methods of diagnosis and treatment.The purpose of the study. To substantiate the possibility of using laparoscopic methods of treatment depending on the severity and stage of morphological changes of the target organs and the duration of peritonitis simulated in the experiment.Material and methods. The experiment used 150 sexually mature non-linear female rats, weighing 180.0-220.0 grams, which were kept on the standard ration of the vivarium of the Central Research Laboratory with maintenance of food and drinking regimes recommended by the norms of keeping laboratory animals. The animals were divided into 5 groups – a control group (30 rats) and 4 experimental groups (120 rats), which underwent HP simulation by intraperitoneal injection of 1 ml of 30 % autocal. The animals of the research group were removed from the experiment under sodium thiopental anesthesia by bloodletting on the 1st, 3rd, 5th, and 7th days. Results of the study. Morphohistochemical study of the target organs on the 1st day of the experiment: singleorgan changes were observed (examination of the peritoneum revealed its pronounced swelling). A slight vascular reaction of the basal membrane of the mucous membrane was established in the small intestine. On the 3rd day, the changes remained monooraneous with increases in infl ammatory phenomena. On the 5th day, the spread of the systemic infl ammatory response to the lungs and kidneys was confi rmed. Areas with foci of dystrophic- necrotic changes in the epithelium of the tubules were visualized in individual excretory tubules in the kidneys.In the lungs: the number of erythrocytes and fi brin increased in the cellular component. On the 7th day of the experiment, the heart and liver were involved in the process. In the heart, dystonia and paresis of microcirculatory vessels, erythrocyte stasis, and the formation of cell aggregates in the lumen of vessels were observed. In the liver, it is observed: congestion of the central veins, manifestations of venous stasis.Conclusion. Based on the stages of morphological changes of the studied organs at diff erent times, the simulation of acute peritonitis allowed us to theoretically justify a diff erentiated approach to the selection of the type of surgical interventions. 

Heatstroke-induced acute kidney injury and the innate immune system.

Heatstroke can cause multiple organ failure and systemic inflammatory response syndrome as the body temperature rises beyond the body's ability to regulate temperature in a hot environment. Previous studies have indicated that heatstroke-induced acute kidney injury (AKI) can lead to chronic kidney disease. Therefore, there is an urgent need to elucidate the mechanism of heatstroke-induced AKI and to establish methods for its prevention and treatment. Recent reports have revealed that innate immunity, including neutrophils, macrophages, lymphocytes, and mast cells, is deeply involved in heat-induced AKI. In this review, we will discuss the roles of each immune cell in heat-induced renal injury and their potential therapeutic use.

Non-Invasive and Label-Free On-Chip Impedance Monitoring of Heatstroke.

Heatstroke (HS) is a life-threatening injury requiring neurocritical care which could lead to central nervous system dysfunction and severe multiple organ failure syndrome. The cell-cell adhesion and cell permeability are two key factors for characterizing HS. To investigate the process of HS, a biochip-based electrical model was proposed and applied to HS. During the process, the value of TEER is associated with cell permeability and CI which represents cell-cell adhesion decreases that are consistent with the reduction in cell-cell adhesion and cell permeability characterized by proteins (occludin, VE-Cadherin and ZO-1) and RNA level. The results imply that the model can be used to monitor the biological process and other biomedical applications.

Management of Hemorrhagic Pancreatitis: Review of the Current Literature

Pancreatitis is the disease that affects the organ of the pancreas and should be given early attention, since its complications are quite lethal and can involve other organs. This research work provides a compilation of important information that expresses, through its development, the most common complications associated with pancreatitis, especially in its hemorrhagic presentation, as well as the necessary treatments used in this condition. In the course of pancreatitis, the first two to four days of symptoms are the most important because this is the period during which 15% to 25% of patients progress to its severe form. According to clinical and experimental data, this period is characterized by an initial state of hypovolemia. The morbidity of severe acute pancreatitis is known to occur in two stages. The first two weeks are characterized by a systemic inflammatory response syndrome (SIRS), which results from the release of inflammatory mediators. Organ failure is common and usually occurs even in the absence of infection. The early mortality rate is 42 to 60%. The second stage begins approximately two weeks after symptom onset and is characterized by sepsis-related complications resulting from infection of pancreatic necrosis. Therefore, there is an association with systemic complications, such as pulmonary failure, renal failure, and cardiovascular failure, known as multiple organ failure syndrome (MOFS).

A Retrospective Analysis of Risk Factors and Impact of Acute Kidney Injury in Critically Ill Children.

Acute kidney injury (AKI) is a serious clinical condition in critically ill children and is associated with worse outcomes. A few pediatric studies focused on the risk factors of AKI. We aimed to identify the incidence, risk factors, and outcomes of AKI in the pediatric intensive care unit (PICU). All the patients admitted to PICU over a period of 20 months were included. We compared both groups the risk factors between AKI and non-AKI. A total of 63 patients (17.5%) of the 360 patients developed AKI during PICU stay. The presence of comorbidity, diagnosis of sepsis, increased PRISM III score, and positive renal angina index were found to be risk factors for AKI on admission. Thrombocytopenia, multiple organ failure syndrome, the requirement of mechanical ventilation, use of inotropic drugs, intravenous iodinated contrast media, and exposure to an increased number of nephrotoxic drugs were independent risk factors during the hospital stay. The patients with AKI had a lower renal function on discharge and had worse overall survival. AKI is prevalent and multifactorial in critically sick children. The risk factors of AKI may be present on admission and during the hospital stay. AKI is related to prolonged mechanical ventilation days, longer PICU stays, and a higher mortality rate. Based on the presented results early prediction of AKI and consequent modification of nephrotoxic medication may generate positive effects on the outcome of critically ill children.

Outcomes of acute kidney injury in critically ill children who need renal replacement therapy.

Aim To determine an outcome of acute kidney injury (AKI) in critically ill children (CIC) who needed renal replacement therapy (RRT) and were admitted to the Paediatric and Neonatal Intensive Care Unit (PICU and NICU) at the Paediatric Clinic, University Clinical Centre Sarajevo (UCCS). Methods The research included 81 children with AKI. The Kidney Disease: Improving Global Outcomes (KDIGO) criteria to define AKI was used. Other laboratory findings and imaging tests were made depending on children's primary disease that led to the AKI. Results Among 81 children with AKI, 38 were girls and 43 boys. A total of 39 (48.1%) patients died; the death was due to the nature of the primary disease and multiple organ failure syndromes. Out of the total of 81 patients the highest mortality rate was found in children in the first year of life, 22 (56.4%), while 17 (43.6%) patients died after the first year of life. Conclusion Without an accurate diagnosis at the right time, due to the lack of adequate biomarkers for AKI screening, the heterogeneity of AKI, comorbidities often lead to unfavourable outcomes of the disease, among CIC, especially in infants with low birth weight and extreme immaturity. Some causes of AKI are preventable and can be reduced by a better organization of primary and secondary health care.

How COVID-19 affects children: a review article

Coronavirus disease 2019 (COVID-19) has affected 550,369 confirmed cases, with 8,856 fatalities. COVID-19 was more common in adults over 15 during the early outbreak, and the proportion of confirmed cases among youngsters was relatively low. In addition, children with COVID-19 are asymptomatic or have mild clinical symptoms compared to adults. The present study reviewed the clinical features, signs, symptoms, and effect of COVID-19 in children. This review was performed through an electronic literature search for relevant studies identified using keywords on the MEDLINE database between 2020 and 2021, inclusive: COVID-19, COVID-19 in children, coronavirus, novel coronavirus in children, COVID-19 symptoms in children, COVID-19 effect in children. Similar keywords were used to peruse and identify relevant articles on Google Scholar. The articles were chosen based on defined inclusion criteria. The current review included papers published between 2020 and 2021. The review was written under specific titles in the discussion part. This review concluded that children of all ages are susceptible to getting COVID-19 due to human-to-human transmission. COVID-19 has a milder clinical course, quicker recovery, and a better prognosis in children than adults. Infants less than 1 year and children with underlying chronic disorders were at higher risk of having severe forms of COVID-19. Septic shock, toxic encephalopathy, multiple organ failure syndromes, disseminated intravascular coagulation, and status epilepticus were the most common consequences identified in children with severe forms of COVID-19. Infection prevention by isolation of diseased children is critical, as is thorough surveillance, early diagnosis of illness complications, and the ability to treat patients on time while preventing secondary dissemination.