Refractory feline sporotrichosis: a comparative analysis on the clinical, histopathological, and cytopathological aspects

ABSTRACT: Sporotrichosis is a chronic fungal infection caused by Sporothrix species. The occurrence of cases that are resistant to long-term treatment, especially in the nasal planum of cats, emphasizes the importance of studying its pathogenesis. The purpose of this study was to analyze and compare the inflammatory process of cutaneous lesions of feline refractory sporotrichosis to clinical aspects through cytopathological and histopathological examination. Moreover, the study included 13 cats with cutaneous lesions that had been resistant to itraconazole treatment for more than a year. Cutaneous lesions samples were collected for cytopathological, histopathological, and fungal culture analyses. Tissue fragments were processed and stained with hematoxylin-eosin (HE) and Grocott methenamine silver (GMS). Further, two clinical presentations had the highest occurrence: the localized cutaneous form in animals with good general condition and stable disease (n=9, 69.2%) and the disseminated cutaneous form in cats with poor general condition (n=4, 30.8%). In cats with refractory sporotrichosis, the nasal planum (84.6%) was the most common location of lesions. In the cytopathological study, cats with fewer than two lesions and in good general condition (n=9, 69.2%) showed absence or mild yeast intensity (up to 5 yeasts per field), lower intensity of macrophages and neutrophils, and higher intensity of epithelioid cells, lymphocytes, plasma cells, and eosinophils. On the other hand, (n=4, 30.8%) of the cats with disseminated sporotrichosis and a poor general condition had a marked intensity of yeasts, which were mostly phagocytosed by an increased number of macrophages and neutrophils. Of those animals with good general condition, the majority (n=6, 66.7%) had higher eosinophil intensity. In histopathology, malformed suppurative granuloma was the predominant type (n=9, 69.2%) in feline sporotrichosis lesions, followed by well-formed granulomas (n=4, 30.8%). Malformed granulomas showed mild to moderate fungal intensity (55.6%) in animals with good general condition and localized lesions while marked fungal intensity (44.4%) in cats with the disseminated form of the disease and poor general condition. Well-formed granulomas (n=4, 30.7%) had mild to moderate intensity of fungal load, and 75% of the animals with this type of granuloma had only one lesion and were in good general condition. Long-term itraconazole treatment in these cats with refractory sporotrichosis can keep the infection under control and localized lesions stable; however, fungus reactivation can occur, resulting in an exuberant and inefficient immune response.

CLINICAL-ANAMNESTIC AND ECHOCARDIOGRAPHIC MARKERS OF NEONATAL SEPSIS AT DIFFERENT GESTATION AGE OF NEWBORN

neonatal sepsis remains one of the leading causes of morbidity and mortality in the neonatal age. The involvement of the myocardium in sepsis remains insufficiently studied, in particular in neonatology, where issues of myocardial dysfunction in neonatal generalized infection seem even more controversial, especially in neonatal sepsis at different gestational terms. Objective. To study specific clinical and anamnestic and echocardiographic parameters in infants depending on gestational age for optimization of the prognosis in neonatal sepsis. Material and research methods. To achieve this goal, we observed 57 newborns with a verified diagnosis of "Neonatal sepsis". Group I (23 patients – 40.3%) included newborns with a gestational age of 37-42 weeks, Group II – 34 premature infants (59.7%) with a gestation of up to 36 weeks. The latter group, depending on the gestational age, was divided into IIA subgroup, which was formed by 21 prematurely born patients with NS with a gestational age of 32-36 weeks, and the IIB subgroup – 13 newborns born before 32 weeks of gestation. Research results. The analysis showed that the severity of the impairment in the general condition of the examined newborns general condition was assessed as severe in 47.8% of newborns of group I, in 88.2% of cases in group II (PI: II <0.05), in 85.7% of representatives of subgroup IIA (PI: IIA <0.05) and in 92.3% of children of subgroup IIB (PI: IIB <0.001). It is shown that every third child (30.4%) of group I, 67.6% of newborns of group II (PI: II <0.05), half (52.4%) of the representatives of subgroup IIA (PII: IIA <0.01) and all seriously ill patients (92.3%) of subgroup IIB (PI: IIB, IIA: IIB <0.05) required cardiopulmonary resuscitation in the delivery room. Thus, in relation to full-term patients, the risk of this significant postnatal factor of emergency is likely to increase: for group II: OR - 4.77 (95% CI 2.63-8.68), RR - 2.17 (95% CI 1.57-3.0), AR = 0.37; and for premature babies with a gestational age of less than 32 weeks (IIB subgroup), respectively: OR – 27.44 (95% CI 11.73-64.19), RR – 7.55 (95% CI 5.58-10.21 ), AR – 0.65. The correlation analysis showed that in premature infants suffering from NS, the increase in the functional capacity of the left ventricular myocardium was associated with the female sex (for EF r = 0.94, P = 0.0001, for FS - r = 0, 94, P = 0.0001) and the number of days of inotropic support (for EF r = 0.68, P = 0.043, for FS - r = 0.71, P = 0.03). Conclusions. The analysis of echocardiographic parameters in the group of premature infants revealed a direct correlation between the ejection fraction and cardiovascular resuscitation immediately after birth (r = 0.64) and the duration of inotropic drugs (r = 0.68).

Modern View on the Problem of Systemic Lupus Erythematosus with and without Comorbid Lesions of the Circulatory System (Literature Review, Clinical Case Description) – Second Notice

Introduction. The prevalence and incidence of systemic lupus erythematosus (SLE) in the world is significant. In recent years, there has been a tendency of the SLE prevalence increase. Despite the undoubted progress in understanding the etiology and pathogenesis of SLE, its diagnosis and treatment, the mortality of patients, including ones at young and working age, is higher than in the general population, and circulatory system lesions are ones of its main reasons in these cases. The aim of the study. To analyze the literature, devoted to the modern view on the problem of systemic lupus erythematosus with and without comorbid lesions of the circulatory system, describe the clinical case. Materials and methods. Content analysis, method of system and comparative analysis, bibliosemantic method of studying the current scientific studies on modern principles of diagnosis and treatment of patients with SLE are used. A clinical case is described. Results. A clinical case of a 43-year-old patient S., who was hospitalized for SLE, she considers herself ill for eighteen years and she has been constantly taken outpatient and periodically inpatient treatment due to the frequent deteriorations in her general condition, clinical and laboratory parameters, is described. Based on the received results of the examinations, applying the method of determining the functional class of SLE, the patient was diagnosed with a clinical diagnosis indicating comorbid lesions of various organs and systems (skin, joints, kidneys, vessels, heart, blood system, immune system, eyes). The generally accepted basic medical complex of the patient includes drugs, taking into account the lesions to the circulatory system. The conducted complex pathogenetic treatment gave a positive result. Conclusions. In the described clinical case demonstrated the development of comorbid lesions of many organs and systems, including circulatory system, in a patient with systemic lupus erythematosus. Inclusion in the treatment complex in addition to basic and drugs for the treatment lesions of circulatory system has improved the general condition of the patient, stabilized clinical and laboratory parameters, as evidenced by a prospective study during three years. The information provided in our clinical case is consistent with the results of the literature review. Systemic lupus erythematosus needs further in-depth study due to its widespread prevalence among young and people of working age, lack of accurate knowledge about the etiology and pathogenesis of the disease, comorbid lesions of many organs and systems, including circulatory system, the development of severe and often life-threatening manifestations, the lack of clear recommendations that would predict the differentiated use of drugs taking into account comorbid syntropic lesions. Keywords: SLE, circulatory system lesions, atherosclerosis, diagnosis and treatment of SLE.

DIAGNOSTIC VALUE OF MALONIC ALDEHYDE IN URINE AS A MARKER OF RENAL DYSFUNCTION IN FULL-TERM NEONATES WITH PERINATAL PATHOLOGY

Introduction. One of the mechanisms of pathologic oxidative stress in neonates is intensification of membrane lipid peroxide oxidation. Malonic aldehyde (MA) is a secondary product used as an indicator of lipid peroxidation processes and therefore a marker of cellular membrane damage. Meanwhile, nowadays the mechanisms determining organ peculiarities of lipid and protein peroxidation as well as resistance to ischemic kidney damage are not studied completely and require further development. Objective: to determine diagnostic value of MA in urine as a marker of renal dysfunction in full-term neonates with perinatal pathology of various degrees of severity. Material and methods. One-centered cohort prospective study was carried out including 41 full-term children with disorders of general condition of a moderate degree of severity (І group); 36 full-term children with disorders of general condition of a severe degree without acute kidney damage (ІІА group); 30 full-term children with disorders of general condition of a severe degree with acute kidney damage (ІІB group) and 40 healthy children (ІІІ group). МА level in urine was determined by means of reaction with thiobarbituric acid at the end of the 3rd day of life. Results. The lack of a negative test diagnostic value with determination of MA in urine was determined when renal dysfunction had been found in full-term neonates with signs of perinatal pathology of a moderate severity. It was evidenced by AUROC 0,53 (95% CІ 0,50; 0,65, р>0,05) with a threshold value of the parameter ≤9,57 mcmol/L. A perfect discriminating ability to determine MA level in urine was demonstrated in diagnostics of disorders of the functional kidney state in children who had signs of severe postnatal adaptation disorders. It was evidenced by AUROC 0,81 (95% CІ 0,71; 0,91, р<0,001) with a threshold value of the parameter ≥ 9,58 mcmol/L; specificity 97,6% (95% CІ 87,1%; 99,9%), prognostic value of a positive result 95,7% (95% CІ 75,7%; 99,4%) and likelihood ratio of a positive result 25,1 (95% CІ 3,55; 76,7). Diagnostics of acute kidney injury in critically sick term neonates found a proper quality of the diagnostic pattern with determination of MA level in urine. It was evidenced by AUROC 0,80 (95% CІ 0,66; 0,89, р<0,05) with a threshold value of the parameter ≥12,9 mcmol/L; specificity 91,4% (95% CІ 76,9%; 98,2%), %), prognostic value of a positive result 85,7% (95% CІ 66,2; 94,9%) and likelihood ratio of a positive result 7,0 (95% CІ 2,28; 21,5). Conclusions. Considering the value of reactions of pathologic oxidative stress in the formation of maladjustment syndromes, determination of MA in urine is suggested to be used as one of the possible markers of renal dysfunction in neonates which reflects the state of lipid peroxidation processes in the kidney structures and degree of their damage.

ONE OF THE METHODS OF PREVENTING THE OCCURRENCE OF POSTOPERATIVE VENTRAL HERNIAS

Снижение количества коллагена первого типа, существенно влияет на развитие ПВГ. Снизить частоту развития послеоперационных вентральных грыж можно вследствие раннего диагностирования факторов риска снижения коллагена на амбулаторном этапе подготовки к лапаротомии. Чем раньше сделана операция, тем меньше выражены изменения в тканях и органах, а само хирургическое вмешательство является менее сложным и более эффективным. При гладком течении и заживлении после первой операции можно оперировать послеоперационную грыжу спустя 6-8-10 месяцев в зависимости от вида и обширности первого вмешательства, общего состояния больного, величины и динамики роста грыжевого выпячивания. При склонности к ущемлению, а также при развивающемся синдроме спаечной непроходимости следует оперировать в возможно ранние сроки. Если в анамнезе есть указания на тяжело протекавший послеоперационный период в связи с обширным нагноением в ране, длительной тампонадой брюшной полости, тяжелой интоксикацией, перитонитом либо весьма длительным пребыванием в стационаре по поводу релапаротомии, следует выждать больший срок, примерно 12-18 месяцев. На это время надо назначить больному определенный режим, принять меры к улучшению общего состояния, уменьшению страданий в связи с развитием спаечного процесса в грыжевом мешке и в брюшной полости. По показаниям следует рекомендовать ношение хорошо прилаженного бандажа. Тhe decrease in the amount of collagen of the first type significantly affects the development of PVG. It is possible to reduce the incidence of postoperative ventral hernias due to early diagnosis of risk factors for collagen loss at the outpatient stage of preparation for laparotomy. The earlier the operation, the less pronounced changes in tissues and organs, and the surgery itself is less complex and more effective. When you smooth over and heal after the first operation can be operated incisional hernia after 6-8-10 months depending on the type and extensiveness of the first intervention, the patient's General condition, size and growth of hernial protrusion. With a tendency to infringement, as well as with the developing syndrome of adhesive obstruction, it is necessary to operate as early as possible. If in the history there are indications of a difficult postoperative period due to extensive suppuration in the wound, prolonged tamponade of the abdominal cavity, severe intoxication, peritonitis or a very long stay in the hospital for relaparotomy, you should wait a longer period, about 12-18 months. At this time, it is necessary to assign the patient a certain regime, take measures to improve the General condition, reduce suffering in connection with the development of adhesions in the hernia SAC and in the abdominal cavity. According to the indications, it should be recommended to wear a well-adjusted bandage.

USE OF "INTRAFEN" IN MILD TO MODERATE COVID-19

Повышение температуры тела человека-это своеобразная реакция на воздействие какого-либо агента и/или возбудителя, попавшего в организм человека. При каких-либо инфекционных заболеваниях в организме человека повышается температура тела человека. Также в настоящее время повышение температуры тела при распространенной коронавирусной инфекции является одним из симптомов заболевания. Цель: в нашей статье мы хотели бы рассмотреть клиническую ситуацию с больными COVID-19 и отметить, что был проведен ряд наблюдений и анализов для оценки эффективности и безопасности применения препарата «Интрафен» с целью снятия повышенной температуры, что дает положительный эффект лекарственного средства. Материалы и методы: рекомендовать пациентам с симптомами заболевания короновирусной инфекцией легкой и средней тяжести, С целью снижения повышенной температуры тела, противовоспалительного и улучшения общего состояния пациента, что мы достигнем положительного результата путем введения препарата интрафен в Вену. Результат: на основании анамнезных данных, полученных от больного, результатов клинических, лабораторных, инструментальных исследований выявлено эффективное действие препарата интрафен. Вывод: пациентам легкой и средней тяжести, перенесшим короновирусную инфекцию, можно увидеть, что введение препарата интрафен в Вену эффективно влияет на кратковременное снижение повышенной температуры тела, противовоспалительное действие, улучшение общего состояния больного. An increase in a person's body temperature is a self-contained response to the action of some agent and/or pathogen that has entered the body. With any infectious diseases in the human body, a person's body temperature increases. In addition, with the current coronavirus infection, an increase in body temperature is one of the symptoms of the disease. Purpose: in our article, we would like to consider the clinical situation of patients with COVID-19 and draw attention to the fact that a number of observations and analyses were carried out to assess the effectiveness and safety of using the drug "Intrafen" in order to relieve elevated fever. Materials and methods: in order to reduce elevated body temperature, anti-inflammatory and improve the general condition of the patient, to suggest that we will achieve a positive result by injecting the drug intrafen into the vein in patients with mild to moderate severity with symptoms of coronavirus infection disease. Result: based on Anamnesis data obtained from the patient, the results of Clinical, Laboratory, and instrumental studies, the effective effect of intrafen was determined. Conclusion: by injecting the drug intrafen into the vein in patients of mild and moderate severity who have had a Coronavirus infection, it can be seen that it has an effective effect on the short-term reduction of elevated body temperature, anti-inflammatory effect, improvement of the general condition of the patient.

EVALUATION OF THE EFFECTIVENESS OF NEPHROPROTECTIVETHERAPY IN PATIENTS WITH NEPHROLITHIASIS

В современном мире заболеваемость уролитиазом в мире достигает 3-7%. К наиболее частым осложнениям мочекаменной болезни относятся различные гнойно-воспалительные процесс мочевых путей, гипертония, сморщивание почек и развитие почечной недостаточности. С точки зрения многих исследователей литогенеза, именно гипертония является одним из наиболее распространенных и постоянно прогрессирующим осложнением нефролитиаза, ухудшающим общее состояние больного. In the modern world, the incidence of urolithiasis in the world reaches 3-7%. The most common complications of urolithiasis include various purulentin ammatory processes of the urinary tract, hypertension, kidney shriveling and the development of renal failure. From the point of view of many researchers of lithogenesis, it is hypertension that is one of the most common and constantly progressive complications of nephrolithiasis, which worsens the general condition of the patient.

The Role of Probiotics in Chronic Rhinosinusitis Treatment: An Update of the Current Literature

Chronic rhinosinusitis (CRS) is a significant health problem. It affects 5–12% of the general population. The causes that underlie the onset of CRS are not yet well known. However, many factors may contribute to its onset, such as environmental factors and the host’s general condition. Medical treatment mainly uses local corticosteroids, nasal irrigation, and antibiotics. In recent years, a new therapeutic approach that employs the use of probiotics emerged. Probiotics have been extensively studied as a therapy for dysbiosis and inflammatory pathologies of various parts of the body. We aimed to examine the studies in vivo and in vitro and clinicals reports in the existing literature to update probiotics’ role in rhinosinusitis chronic medical treatment.

Experience in Using Antiviral Agents for the Treatment of Novel Coronavirus Infection (COVID-19) in Kyrgyzstan

The national clinical guidelines for the treatment of novel coronavirus infection (COVID-19) are the main source of information and the reference point for clinical decision-making by healthcare professionals in the Kyrgyz Republic. The recommendations presented in these documents are largely based on data from real clinical practice, but the efficacy and safety of a number of antiviral agents, the indications for which have been expanded to include COVID-19 treatment, remain unclear.The aim of the study was to conduct a retrospective pharmacoepidemiological analysis of lopinavir+ritonavir use in hospitals in the Kyrgyz Republic for the treatment of COVID-19 during the period from March until April 2020.Materials and methods: the paper describes a retrospective study of 145 medical records of patients with confirmed COVID-19 who were hospitalized in infectious disease departments/hospitals of the Kyrgyz Republic. Statistical processing was performed using Microsoft Excel 2017.Results: between 16 March 2020 and 25 April 2020, 145 patients were prescribed lopinavir+ritonavir at a dose of 200 mg + 50 mg, 2 tablets twice a day—in line with the dosage regimen recommended by the national guideline. The national guideline recommended the treatment duration of 10 days, while the actual treatment duration was 1–12 days (5.5 days on average) depending on the tolerability of the drug. The use of the drug was accompanied by adverse drug reactions (ADRs) in 78 patients (53.8%), and caused deterioration in the general condition of 73 of these patients (94.8%) which resulted in discontinuation of the drug. The most common ADRs were nausea, vomiting, diarrhoea, decreased appetite, yellowness of the skin, and, according to laboratory studies, an increase in serum levels of bilirubin, creatinine, glucose, aspartate aminotransferase and amylase activity. A retrospective assessment of the causal relationship probability according to the Naranjo scale showed an interrelation between the use of lopinavir+ritonavir and ADR development.Conclusions: the use of the lopinavir+ritonavir drug in COVID-19 patients led to deterioration of their general condition, which was severe in some cases. The data obtained indicate that the use of this drug for COVID-19 treatment is clinically unreasonable and irrational. Lopinavir+ritonavir was excluded from subsequent revisions of the clinical guidelines for the diagnosis and treatment of COVID-19 in the Kyrgyz Republic.

Asymptotic Separation of Solutions to Fractional Stochastic Multi-Term Differential Equations

In this paper, we study the exact asymptotic separation rate of two distinct solutions of Caputo stochastic multi-term differential equations (Caputo SMTDEs). Our goal in this paper is to establish results of the global existence and uniqueness and continuity dependence of the initial values of the solutions to Caputo SMTDEs with non-permutable matrices of order α∈(12,1) and β∈(0,1) whose coefficients satisfy a standard Lipschitz condition. For this class of systems, we then show the asymptotic separation property between two different solutions of Caputo SMTDEs with a more general condition based on λ. Furthermore, the asymptotic separation rate for the two distinct mild solutions reveals that our asymptotic results are general.