scholarly journals The Analysis of Toxicological Situation According to Three Specialized Centers of Russian Federation

2020 ◽  
Vol 8 (4) ◽  
pp. 373-378
Author(s):  
I. A. Shikalova ◽  
A. N. Lodyagin ◽  
I. M. Barsukova ◽  
A. R. Nasibullina ◽  
D. Y. Kalloyda
Keyword(s):  
Carbon Monoxide Poisoning ◽  
Synthetic Cannabinoids ◽  
Absolute Number ◽  
Acute Poisoning ◽  
Social Significance ◽  
Synthetic Drugs ◽  
Regional Features ◽  
Number Of Patients ◽  
Analytical Research ◽  
Toxicological Pathology

The relevance of the study is associated with the exceptional medical and social significance of the issues of toxicological assistance. In order to improve toxicological assistance to the population, we analyzed the dynamics of patient admission to major toxicological centers in St. Petersburg, Novosibirsk and Kazan in 2011–2017, which revealed a significant increase in the number of patients with a toxicological pathology and unidirectional changes in the structure of acute poisoning. We used statistical and analytical research methods. According to the results of the study, in all three centers the proportion of poisoning by narcotic substances increased, and the qualitative characteristics of poisoning changed (compared to 2011). Poisonings with opioid alkaloids and heroin haven’t been substantially found recently; the main proportion of poisonings was associated with the use of synthetic drugs (phencyclidines, piperazines, synthetic cathinones, synthetic cannabinoids, amphetamines, γ-butyrolactone and 1,4-butanediol, etc.). The proportion of patients with ethanol poisoning increased significantly: the number grew by 2.5 times in St. Petersburg, 3.0 times in Novosibirsk and 30% in Kazan. At the same time, the number of drug poisoning decreased in all three centers by an average of 20–30%. The number of carbon monoxide poisoning has also decreased in St. Petersburg and Novosibirsk. Data were obtained on some regional features of poisoning. The prevalence of poisoning by cauterizing agents in Novosibirsk and by plant poisons in Kazan. Despite a decline of mortality, the absolute number of deaths by acute poisoning during the study period increased. The study resulted in an attempt to identify the main problems and tasks of the toxicological service at present and to develop mechanisms for its improvement, taking into account modern changes in the volumes and structure of acute poisonings.Authors declare lack of the conflicts of interests.

scholarly journals The structure of acute chemical poisoning in patients with HIV infection in the emergency hospital

2018 ◽  
pp. 3-13
Author(s):  
М.М. Поцхверия ◽  
М.В. Белова ◽  
С.А. Солонин ◽  
М.А. Годков
Keyword(s):  
Hiv Infection ◽  
Virus Transmission ◽  
Pairwise Comparison ◽  
Simple Random Sampling ◽  
Immunoblot Analysis ◽  
Acute Poisoning ◽  
Economic Problem ◽  
High Risk Group ◽  
Emergency Hospital ◽  
Number Of Patients

Употребление психоактивных веществ (ПАВ) с немедицинскими целями является огромной медико-социальной, экономической проблемой, и становится наиболее частой причиной инфицирования ВИЧ. Наркозависимые лица представляют особо уязвимую группу для заражения. Цель исследования: изучить структуру веществ, вызвавших острые отравления у ВИЧ-инфицированных пациентов, госпитализированных в стационар скорой медицинской помощи. Пациенты и методы исследования: ретроспективно проанализированы структура острых отравлений химической этиологии (ООХЭ) и результаты освидетельствования на ВИЧ-инфекцию 19 061 пациента, госпитализированных (простая случайная выборка) в отделение лечения острых отравлений НИИ СП им. Н.В. Склифосовского (ОЛОО НИИ СП) в 2013-2016 гг. Диагноз ООХЭ верифицирован методом хромато-масс-спектрометрии. Диагностику ВИЧ-инфекции осуществляли с использованием иммуноферментного анализа и иммуноблотинга. Для попарного сравнения распределения частот выявляемости ВИЧ у лиц ООХЭ использовали точный тест Фишера. Различия оценивали как статистически значимые при p<0,05. Результаты исследования. Выявляемость ВИЧ-инфекции у пациентов с ООХЭ варьировала от 5,7 до 7,7%. Среди пациентов с ВИЧ подавляющее большинство обращений было связано с отравлениями опиатами, лекарственными средствами и различными смесями ПАВ. За три года количество пациентов с ВИЧ и передозировками опиатов сократилось в 2,3 раза (p<0,0001). Значительно чаще стали встречаться отравления психодислептиками, смесями ПАВ и веществами немедицинского назначения. Среди ВИЧ-инфицированных значительную долю составляли лица с отравлениями несколькими видами наркотических и/или лекарственных веществ. При этом снизились доли отравлений опиатами в сочетании с метадоном и психофармакологическими средствами. У пациентов с ВИЧ обнаружен высокий удельный вес интоксикации этанолом и его суррогатами. Выводы. Динамика выявляемости ВИЧ-инфекции у пациентов с ООХЭ свидетельствует о высокой поражённости этой категории лиц. Причины увеличения частоты обнаружения ВИЧ-инфекции могут быть связаны с изменением ассортимента принимаемых ПАВ и путей передачи вируса. Пациенты ОЛОО являются группой высокого риска распространения ВИЧ-инфекции и могут рассматриваться как фокусная группа, отражающая общие тенденции в потреблении наркотических и ПАВ в г. Москве. The use of psychoactive substances (PS) with non-medical purposes is a huge medical, social and economic problem. It becomes the most frequent cause of HIV infection. Drug addict individuals are vulnerable group for HIV. Aim: study the structure of substances that caused acute poisoning in HIV-infected patients hospitalized in an emergency hospital. The object and methods: it has been retrospectively analyzed the structure of acute poisoning of chemical etiology (APCE) and prevalence of HIV infection among 19061 patients hospitalized (simple random sampling) at N.V. Sklifosovsky’s Research Institute for Emergency Medicine department of acute poisoning treatment (DAPT) in 2013-2016 years. The diagnosis of APCE was verified by chromatography-mass spectrometry. Diagnosis of HIV infection was carried out using immunoassay and immunoblot analysis. Fisher’s exact test was used for a pairwise comparison of the prevalence HIV in individuals with APCE. Differences were assessed as statistically significant at p <0.05. Results. The prevalence of HIV infection in patients with APCE ranged from 5.7 to 7.7%. Among the patients with HIV the vast majority of cases were associated with poisoning with opiates, drugs and various PS mixtures. For the period from 2013 to 2016 the number of patients with HIV infection and opiate overdoses decreased by 2.3 times (p <0.0001). More common became poisoning with psychotomimetic substance, PS mixtures and non-medical substances. Among HIV infected patients significant share were people poisoned several types of drugs and/or medicines. At the same time, the share of poisoning with opiates decreased in combination with methadone and psychopharmacological medicines. In patients with HIV were detected a high proportion of ethanol and its surrogates’ intoxication. Conclusions. The prevalence of HIV infection in patients with APSE indicates of the high affection of this category persons. The reasons of increasing the prevalence of HIV infection can be associated with a change in PS consumption assortment and the ways of virus transmission. Patients with APSE are a high risk group for HIV spreading and can be considered as a focus group reflecting general trends in the drug consumption in Moscow.

scholarly journals Study of the influence of vacuum therapy on the wound process in patients with diabetic foot syndrome

2019 ◽  
Vol 74 (4) ◽  
pp. 283-288
Author(s):  
Petr A. Gerasimchuk ◽  
Alexander V. Shidlovskyi ◽  
Dmitriy B. Fira ◽  
Andrey V. Pavlyshyn
Keyword(s):  
Diabetes Mellitus ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Chronic Wound ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome ◽  
Vacuum Therapy ◽  
Social Significance ◽  
Number Of Patients ◽  
Bed Days

Background: According to the International Diabetes Federation (IDF), the number of patients on diabetes mellitus is now more than 415 million people on Earth, until 2030 it will increase to 439 million, and by 2035 ― will reach 592 million. Throughout life, 4.625% of patients with diabetes mellitus develops a diabetic foot syndrome with the formation of wounds, whose treatment, can not yet be considered satisfactory, since in 1525% of patients are the direct cause of high amputations of the lower limbs. This requires finding new effective methods for treating wound defects in patients with diabetic foot syndrome, one of which can be vacuum wound therapy. Aims: To study the effectiveness of vacuum therapy in the treatment of acute and chronic wound process in patients with diabetic foot syndrome, depending on the pathogenetic form of the lesion. Materials and methods: The effect of vacuum therapy on the course of acute and chronic wound process in 231 patients with neuropathic and ischemic form of diabetic foot syndrome was studied during 20142017. Evaluation of the dynamics of the wound process was carried out on the basis of clinical, planimetric, microbiological, morphological methods, as well as microcirculation indices in the area round the wound. Results: Vacuum therapy of acute and chronic wounds in patients with different pathogenetic forms of diabetic foot syndrome, allows to stabilize the course of wound process, stimulate regenerative processes in the wound, improve local microcirculation (p0.05). This, in turn, allows a shorter time to prepare a wound for closure by one of the methods of plastic surgery or create favorable conditions for its independent epithelization. In patients with ischemic lesions (chronic arterial insufficiency of the third degree), the carrying out of vacuum therapy by standard method leads to an intensification of the pain syndrome. This causes the need to apply an initial negative pressure in the system in the range of 7080 mm Hg, which makes it possible to stop pain during the day. At 23 days of the postoperative period, negative pressure is established at standard values. Conclusions: Vacuum therapy of wounds in patients with diabetic foot syndrome is an effective method of treatment that allows the doctor to reduces the duration of treatment of patients in hospital with a neuropathic form of diabetic foot syndrome on average (4.31.7) bed-days, and patients with ischemic form ― on average (4.11.9) bed-days, which has both medical and social significance.

Recent epidemiological trends in extrapulmonary TB in Galicia, Spain

2021 ◽  
Vol 25 (5) ◽  
pp. 373-381
Author(s):  
L. Ferreiro ◽  
A. Ruano-Raviña ◽  
R. Otero-Mallo ◽  
C. Pou-Álvarez ◽  
V. Riveiro-Blanco ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Prevention And Control ◽  
Extrapulmonary Tuberculosis ◽  
Absolute Number ◽  
Incidence Rates ◽  
Age Group ◽  
Number Of Patients ◽  
Epidemiological Trends ◽  
And Control ◽  
Epidemiological Characteristics

OBJECTIVE: To describe the epidemiological trends and characteristics of extrapulmonary tuberculosis (EPTB) in Galicia, Spain, from 2000 to 2019.METHODS: This was a retrospective cohort study based on data from the Galician TB information system.RESULTS: Of the total number of TB cases (n = 15,871), 5,428 (34.2%) had EPTB. The absolute number of cases and incidence of EPTB decreased dramatically (from 480 cases and 17.8 cases/100,000 in 2000, to 172 and 6.4 cases/100,000 in 2019, respectively), with a mean annual decrease of respectively 64% and 4.7% for absolute cases and incidence rates. The risk for EPTB was higher in men than in women (RR 3.86, 95% CI 3.66–4.07). The most frequent age group was 15–44 years (2,234 patients, 41.2%); overall reductions per age group were 82% (0–14 years), 75% (15–44 years), 44% (45–64 years) and 63% (≥65 years), with statistically significant differences. The most frequently locations were the pleura (1,916 cases; 35.3%) and the lymph nodes (1,504; 27.7%).CONCLUSION: The incidence of EPTB in Galicia has decreased significantly in the last 20 years. The epidemiological characteristics have not changed, except for the number of patients with risk factors. This improvement of EPTB epidemiological trends coincides with the implementation of the programme for the prevention and control of TB, which suggests that it has been very effective in the control of the EPTB.

Celiac Disease Screening in Southern and East Asia

2015 ◽  
Vol 33 (2) ◽  
pp. 167-174 ◽  
Author(s):  
Govind K. Makharia
Keyword(s):  
Celiac Disease ◽  
Western Europe ◽  
Meta Analysis ◽  
Free Food ◽  
Absolute Number ◽  
Population Based ◽  
Medical Community ◽  
Number Of Patients ◽  
Global Epidemiology ◽  
Uncommon Disease

Until 1970s, celiac disease (CD) was considered to be an uncommon disease except in Western Europe. The global epidemiology of CD continues to evolve with improvement in the diagnostic tests, simplification of the diagnostic criteria and increase in awareness about the disease. The Asian region is currently at the crossroads of the frontier of knowledge and awareness of CD. In many Asian nations, CD is still considered to be either nonexistent or very rare. A notable exception is India, where CD has been well recognized, especially in the northern part, and 2 population-based studies have revealed a prevalence of 0.3-1.04%. Initial reports from Malaysia, China, Japan and Singapore suggest the existence of CD in these countries. Furthermore, a meta-analysis of the predisposing factors predicts a high probability of occurrence of CD in fair numbers in China. There are no formal reports on CD from Malaysia, Indonesia, Korea, Taiwan and many other nations in this region. With the impending CD epidemic in Asia, there are many challenges. Some of the efforts which are required include determination of prevalence of CD across the region, spreading of awareness among physicians and patients, training of dieticians for proper counseling and supervision of patients, creation of gluten-free food infrastructure in the food supply and creation of patient advocacy organizations. Although the absolute number of patients with CD at present is not very large, this number is expected to increase over the next few years/decades. It is thus appropriate that the medical community across Asia define the extent of the problem and get prepared to handle the impending CD epidemic.

scholarly journals In-Hospital Stroke in a Multidisciplinary Hospital

2021 ◽  
Vol 9 (4) ◽  
pp. 504-510
Author(s):  
S. S. Petrikov ◽  
G. R. Ramazanov ◽  
S. B. Binnatova ◽  
M. V. Tikhomirova
Keyword(s):  
Thrombolytic Therapy ◽  
Hospital Admissions ◽  
Underlying Disease ◽  
Cerebrovascular Event ◽  
Social Significance ◽  
Therapeutic Algorithms ◽  
Number Of Patients ◽  
Systemic Thrombolytic Therapy ◽  
Persistent Disability ◽  
Secondary Cerebral Ischemia

Introduction. Acute cerebrovascular event (ACVE) is the leading cause of persistent disability and death in the world. Due to the high medical and social significance, much attention is paid to the problem of out-of-hospital stroke, and the issues of diagnostics and treatment of in-hospital stroke are practically not studied.Relevance. In-hospital stroke is defined as stroke that develops in a patient hospitalized for other reasons. It is known that the incidence of in-hospital stroke ranges from 2 to 19% of all acute cerebrovascular accidents recorded in the hospital, 0.04–0.06% of all hospital admissions. It was found that patients with inhospital stroke have significant restrictions on thrombolytic therapy, mortality can reach 60%, and the diagnosis is often made with long delays and deviations in examination protocols. The most common pathogenetic subtype of in-hospital ischemic stroke is the cardioembolic subtype. The explanation for this is that in most cases, in-hospital ischemic strokes develop in patients after open cardiac surgery with prosthetics of one or more valves, bypass surgery in conditions of artificial circulation, carotid endarterectomy. In the overwhelming majority of patients, the first symptoms of in-hospital stroke are observed not by doctors, but by nurses, patients or their relatives. Mortality in in-hospital stroke is significantly higher than in non-hospital stroke, which is due to the high incidence of extracerebral complications in this cohort of patients, as well as initially more severe stroke.Aim of study. To analyze the incidence of in-hospital stroke and the tactics of its treatment in a multidisciplinary hospital.Material and methods. The study included 975 patients with ACVE hospitalized at the N.V. Sklifosovsky Research Institute for Emergency Medicine from January 1, 2018 to January 1, 2019. The inclusion criterion was any case of CVE - out-of-hospital or in-hospital. The study did not include patients with subarachnoid hemorrhage (SAH) where secondary cerebral ischemia developed against the background of vasospasm. Also, we did not include patients with stroke, transferred from other hospitals for neurosurgical treatment.Results. In total, in 2018 at the N.V. Sklifosovsky Institute ACVE were diagnosed in 975 patients, of which in-hospital and out-of-hospital strokes were diagnosed in 109 (11.2%) and 866 patients (88.8%), respectively. The proportion of in-hospital stroke was 0.03% of the total number of patients treated at the institute in 2018. Systemic thrombolytic therapy (sTLT) is the main method of treating patients with IS. However, patients with in-hospital stroke may have a large number of contraindications to this type of therapy. Systemic TLT was performed in 1 patient (1%) with in-hospital stroke, while in out-of-hospital stroke, thrombolysis was performed in 36 patients (4.7%). After analyzing the reasons for refusing to perform sLT in patients with in-hospital and out-of-hospital IS. The leading reason for the impossibility of sTLT in patients with in-hospital stroke was the unspecified time of disease development - 44 (43.2%). In 35 patients (34.3%) with in-hospital stroke, refusal to perform sLTT was associated with late IS diagnosis, despite the fact that the stroke developed in the hospital.Conclusion. Thus, an in-hospital stroke aggravates the course of the underlying disease and, as a consequence, the outcome of the disease, leads to an increase in social and medical and economic costs. In this regard, there is a need to study the prevalence, risk factors, clinical features of in-hospital stroke, as well as the development of diagnostic and therapeutic algorithms in order to improve the efficiency of care for patients with in-hospital stroke.

scholarly journals Ten-year profile of acute poisoning patients presenting to an Accident and Emergency Department requiring intensive care in a regional hospital of Hong Kong

2018 ◽  
Vol 26 (1) ◽  
pp. 3-14
Author(s):  
Fu Ng
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Hong Kong ◽  
Intensive Care ◽  
Substance Abusers ◽  
Carbon Monoxide Poisoning ◽  
Acute Poisoning ◽  
Accident And Emergency ◽  
Accident And Emergency Department ◽  
Emergency Medicine Ward

Background: Hong Kong Poison Information Centre publishes annual reports on all poisoning cases received by the Centre in that year since 2006. However, there is little data about acute poisoning cases requiring intensive care unit admissions in Hong Kong. Objective: To report and analyze the 10-year poisoning data of acute poisoning patients presenting to an Accident and Emergency Department requiring intensive care in a regional hospital of Hong Kong. Methods: This was a retrospective study on patients presented from January 2007 to December 2016. These cases were retrieved from Clinical Data Analysis and Reporting System of the Hospital Authority, Hong Kong. Clinical data of these cases were then retrieved from patients’ electronic records. Results: A total of 270 cases were analyzed during the period. There were 152 (56.3%) male patients and 118 (43.7%) female patients. The middle aged group (age 30–39 and age 40–49) constitutes nearly half (48.6%) of all these admissions. Around 50% of them had history of psychiatric illness. Nearly 40% of them were known substance abusers. Majority of the patients (66.7%) were admitted directly from Accident and Emergency Department. The commonest cause was suspected self-harm (56.3%). When ethanol (13%) was excluded, the five commonest types of poisons were benzodiazepine (26.3%), opioids (20.7%), zopiclone (18.5%), carbon monoxide poisoning (13%), and household products (10.7%). Twenty-seven patients (10%) had decontamination done in Accident and Emergency Department or Emergency Medicine Ward. 112 patients (41.5%) were given one or more antidotes in Accident and Emergency Department and Emergency Medicine Ward. Altered mental status was the most frequently found complications (72.2%) in these patients. 76 patients (28.1%) required endotracheal intubation in Accident and Emergency Department. The length of stay in Intensive Care Unit ranged from 1 to 7 days with an average of 2.1 days. There were 25 deaths (9.3%) and 31 patients with major effects (11.5%). Conclusion: An estimate of 9.4% of acute poisoning patients presenting to Accident and Emergency Department might need Intensive Care Unit care at certain stage of their hospital stay. Benzodiazepine, opioids, zopiclone, carbon monoxide poisoning, and ethanol were the top five poisons in our series from 2007 to 2016. The mortality rate (9.3%) was high in our series given that there were more substance abusers.

scholarly journals Setting Up and Expanding a Home Dialysis Program: Is There a Recipe for Success?

Kidney360 ◽  
2020 ◽  
Vol 1 (6) ◽  
pp. 569-579 ◽  
Author(s):  
Masood Ahmad ◽  
Eric L. Wallace ◽  
Gaurav Jain
Keyword(s):  
Medical Center ◽  
Clinical Care ◽  
Academic Medical Center ◽  
The United States ◽  
Absolute Number ◽  
Team Approach ◽  
Home Dialysis ◽  
Education Of Patients ◽  
Number Of Patients ◽  
Experienced Nurse

Home dialysis modalities remain significantly underused in the United States despite similar overall survival in the modalities, and recent incentives to expand these modalities. Although the absolute number of patients using home modalities has grown, the proportion compared to in-center hemodialysis (ICHD) continues to remain quite low. Well known barriers to home dialysis utilization exist, and an organized and team-based approach is required to overcome these barriers. Herein, we describe our efforts at growing our home dialysis program at a large academic medical center, with the proportion of home dialysis patients growing from 12% to 21% over the past 9 years. We prioritized individualized education for patients and better training for physicians, with the help of existing resources, aimed at better utilization of home modalities; an example includes dedicated dialysis education classes taught twice monthly by an experienced nurse practitioner, as well as the utilization of the dialysis educator from a dialysis provider for inpatient education of patients with CKD. The nephrology fellowship curriculum was restructured with emphasis on home modalities, and participation in annual home dialysis conferences has been encouraged. For timely placement and troubleshooting of access for dialysis, we followed a complementary team approach using surgeons and interventional radiologists and nephrologists, driven by a standardized protocol developed at UAB, and comanaged by our access coordinators. A team-based approach, with emphasis on staff engagement and leadership opportunities for dialysis nurses as well as collaborative efforts from a team of clinical nephrologists and the dialysis provider helped maintain efficiency, kindle growth, and provide consistently high-quality clinical care in the home program. Lastly, efforts at reducing burden of disease such as decreased number of monthly visits as well as using innovative strategies, such as telenephrology and assisted PD and HHD, were instrumental in reducing attrition.

Some features of the epidemic spread of the new coronavirus infection (COVID-19) in the Rostov Region

2020 ◽  
Vol 11 (4) ◽  
pp. 99-106
Author(s):  
E. V. Kovalev ◽  
S. S. Slis ◽  
E. G. Yanovich ◽  
N. L. Pichurina ◽  
S. V. Volovikova ◽  
...  
Keyword(s):  
Process Intensification ◽  
Human Welfare ◽  
Epidemic Process ◽  
Regional Features ◽  
Rostov Region ◽  
Number Of Patients ◽  
Coronavirus Infection ◽  
Spread Of Infection ◽  
Very High ◽  
Epidemiological Situation

Purpose: to analyze the epidemiological situation for a new coronavirus infection (COVID-19), to identify some regional features of the Rostov region that contribute to spread of infection.Materials and methods: when assessing the epidemiological situation for a new coronavirus infection in the Rostov region, we used information provided by the Department of the Federal service for supervision of consumer protection and human welfare in the Rostov region. Processing of statistical data was performed by means of generally accepted method.Results: the spreading of a new coronavirus infection in the Rostov region is uneven in nature. When differentiating the territories of the region we identified groups of municipalities with a very high, medium and low number of patients. The administrative territories division of the Rostov region into the “Rostov urban agglomeration” and cluster of municipalities in which pronounced factors and conditions determining the “pendulum” migration of the population are absent, allow analyzing the specific features of the region and identification of territory with the highest risk of epidemic process intensification of a new coronavirus infection.Conclusions: the carried out differentiation of municipalities made it possible to identify and analyze some territorial features of the Rostov region, contributing to the spread of a new coronavirus infection. The obtained results could be used for development of measures aimed at reducing intensification of the epidemic process COVID-19 in condition infection. 

Myositis associated with carbon monoxide poisoning

2019 ◽  
pp. 63-67
Author(s):  
Lindell K. Weaver ◽  
◽  
L. Christine Oliver ◽  
Kayla Deru ◽  
Anat O. Stemmer-Rachamimov ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Clinical Investigation ◽  
Carbon Monoxide Poisoning ◽  
Inflammatory Myopathy ◽  
Acute Poisoning ◽  
Thigh Muscle ◽  
Co Poisoning ◽  
Engine Exhaust ◽  
Reactive Protein ◽  
Occult Malignancy

Introduction: Carbon monoxide (CO) poisoning causes hypoxia and inflammation, which could adversely affect muscle. We could find no published information about CO poisoning causing myositis. Case report: A 53-year-old previously healthy female semi-truck driver had CO poisoning from a faulty diesel engine exhaust intermittently over three months, culminating in an episode of acute CO poisoning, with syncope after exiting the truck at the end of the three-month period. Neuropsychological symptoms immediately after the acute poisoning event were followed by the development of fatigue, weakness and myalgias within two months and a diagnosis of “polymyositis” within four months. C-reactive protein and creatine kinase were elevated. Electromyogram showed pure myopathy without sensory abnormalities. Occult malignancy was ruled out. Thigh muscle biopsy revealed severe inflammatory myopathy and myonecrosis. Muscle specialist pathologists interpreted the biopsy as toxic or viral inflammatory myopathy, not polymyositis, with CO poisoning as the likely etiology. She received steroids and mycophenolate. Nineteen months later, a repeat biopsy was negative for inflammation or myopathic process. Alternative diagnoses were ruled out by clinical investigation and her course over the next five years. Conclusions: This patient’s presentation and clinical course support a diagnosis of myositis from CO poisoning, although it is possible that the myositis was either idiopathic or post-viral (without evidence of a causative virus).

MAIN ISSUES OF CHILDREN'S INCIDENCE OF ACUTE OTITIS MEDIA AND PROSPECTS TO SOLVE THEM

2021 ◽  
pp. 73-76
Author(s):  
O. O. Kulikova ◽  
Yu. V. Lozova
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Otitis Media ◽  
Rapid Development ◽  
Cranial Nerves ◽  
Acute Otitis Media ◽  
Sensorineural Hearing ◽  
Social Significance ◽  
Number Of Patients ◽  
Medical Histories

The problem of acute otitis media in children is relevant because of the prevalence, social significance, possibility of rapid development of both life−threatening intracranial and intralabyrinthine, mastoid complications, as well as acute or prolonged dysfunction of adjacent cranial nerves, especially auditory, vestibular ones. In order to determine the frequency of various forms of acute otitis media, the nature and extent of its complications in children of different ages there was conducted a retrospective analysis of medical histories of patients treated at the City Clinical Hospital № 30 Kharkiv within 2015−2019. There was stated that the biggest group was composed by the patients with a purulent form of the disease, a slightly smaller number of patients had secretory and viral processes. But when analyzing the data over the years, of interest is the fact that during the period when the number of purulent forms decreased, the number of viral ones increased. Complications include mastoiditis, acute sensorineural hearing loss, cerebrospinal fluid and hypertension and intoxication syndromes. It is important that in acute purulent and viral otitis there is an intoxication syndrome along with the manifestations of acute sensorineural hearing loss. Signs of vestibular dysfunction in children can be disguised as symptoms of intoxication, they are much more difficult to detect. Considering the fact that the snail and the labyrinth are washed by the same liquid, it is logical to assume that in this situation the vestibular analyzer suffers together with the auditory one. Therefore, along with otoneurological research it is necessary to apply instrumental methods for establishment of latent disturbances of function of the vestibular analyzer. According to the research results it was concluded that a more detailed study of vestibular analyzer dysfunction in children with acute otitis media, as they are disguised as symptoms of intoxication. Key words: acute otitis media, frequency, complications, vestibular disorders, children.

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