CHARACTER AND FREQUENCY OF COMPLICATIONS IN PATIENTS WITH POLYTRAUMA AND CHRONIC ALCOHOL INTOXICATION

Purpose. Identify patterns of traumatic disease and characterize complications in patients with polytrauma (PT) and chronic alcohol intoxication (CAI). Materials and methods. Case histories of 39 victims with PT and alcohol history at age 19-60 years who were undergoing treatment at the Prof. Meshchaninov Kharkov City Clinical Emergency Hospital in 2016. Patient inclusion criteria: age 19-60, damage of two or more anatomical functional areas, severity of traumatic injury on the ISS scale 9-25 points, Glasgow coma scores ≥14 at the time of admission, absence of craniocerebral trauma, the absence of general anesthesia. Results. The average age of patients was 37.4 ± 9.4 years. Among these groups of patients were 29 men (74%), which is 2.9 times the number of women 10 (26%). Attention is drawn to the fact that the most important part of the victims (28.2%) was precisely the patients of the young able-bodied age. Infectious complications that developed in the early and late period of traumatic disease in victims with CAI are the main causes of death in PT - patients and induce a negative prognosis for survival. During analyzing the timing of the development of purulent-septic complications in this group of patients, we came to the conclusion that they occur on average at 7.2 ± 2.4 days. Among the infectious complications of PT in patients with CAI were pneumonia (28.2%), sepsis (7.6%), peritonitis (7.6%), pleural empyema (5.1%), osteomyelitis (5.1%). Non-infectious complications, in contrast to infectious, manifested from the first hours of injury and reached maximum development during the period by 2.3 ± 0.8 days, they were the main trigger for the development of severe infectious complications in the early period of traumatic disease. Noninfectious complications were consisted by delirium - in 29 patients, which increased the patients duration at intensive care unit on 39,6 ± 5 3 hours. These complications significantly increased the severity of the PT patients with CAI. With a higher incidence, it occurred in hyperactive, (62%) patients with delirium, and mixed (38%) form. Attention is drawn to the fact that patients with fatal outcome (29 cases), delirium was observed significantly more frequently (χ2 to include Yeats = 3.641, p <0.05) was found in 25 patients. Less frequently in patients occurred thrombosis 5(12.8%) and fat embolism syndrom 2 (5.1%). Conclusions. Most often, multiple injuries with history of alcohol use are obtained by young working aged men. The cause of injury in more than 60% of cases is accidents. 82% of the victims were in the state of alcohol intoxication during their hospitalization. On average, the terms of stay of patients with ICU are 64.9 ± 23.7 hours, although with the development of complications, these terms increase to 103.2 ± 14.2 hours. In patients with CAI there is a complicated course of traumatic disease. Among the infectious complications that develop at 7.2 ± 2.4 days, pneumonia, sepsis and peritonitis predominate. The most common non-infectious complications were delirium, thrombophlebitis thrombosis, fat embolism. Risk of fatal outcome in patients with delirium in 6.25 times higher than in patients without acute encephalopathy. Thus, the treatment of patients with a history of with polytrauma and chronic alcohol intoxication is an extremely important medical problem that needs further study and improvement.

Morphofunctional State and Circadian Rhythms of the Liver under the Influence of Chronic Alcohol Intoxication and Constant Lighting

A study of the influence of chronic alcohol intoxication, constant illumination and their combined effects on the morphofunctional state of the rat liver and the circadian rhythms (CR) of the studied parameters of the organism was carried out. It was found that both alcohol and constant illumination caused significant changes in the structure of the liver, as well as in the circadian rhythmicity of micromorphometric parameters of hepatocytes, ALT, and total and direct bilirubin rhythms; however, the combined effects of ethanol and constant illumination had the most significant effect on the studied parameters of the organism. These two factors caused disturbances in the circadian rhythms of the micromorphometric parameters of hepatocytes, disruption of the circadian rhythms of total protein, albumin, AST, ALT, and direct and total bilirubin, as well as disturbances in the expression and rhythmicity of the studied clock genes against a background of the development of an inflammatory process in the liver.

Mallory bodies and their role in the patho- and morphogenesis of alcoholic disease

The authors consider alcohol disease (AD) as an independent disease, the pathogenesis of which passes 3 stages: episodic alcohol intoxication, drunkenness and alcoholism. In the last 2 stages, severe changes in organs and tissues develop. In this case, Mallory bodies appear in the liver, which is considered to be a marker of chronic alcohol intoxication (CAI). They are observed in most patients with alcoholism and very rarely in those suffering from alcoholism. The authors believe that the alcoholic hyaline Mallory bodies, appearing in the liver and other organs in CAI, is an autoantigen to which the body responds with an autoimmune inflammatory response that is not curable. Therefore, drunkenness, in which there are no Mallory bodies, is curable when alcohol is consumed within the basal metabolism of the liver and treated by therapists, and the treatment of alcoholism is futile. Therefore, the problem of CAI can be solved only with the active treatment of the stage of drunkenness by therapists with the participation of psychiatrists.

Alcohol-induced damage to skeletal muscles in women with chronic alcohol intoxication

In Russia, there is a high level of alcohol consumption among women in doses that represent a high risk of developing alcoholic diseases, manifested, in particular, by damage to skeletal muscles.The purpose of the study. Analysis of clinical, biochemical, neurophysiological, as well as morphometric and immunohistochemical features of alcoholic skeletal muscle damage in women with chronic alcohol intoxication.Material and methods. A clinical and laboratory examination of 30 women aged 20 to 60 years with chronic alcohol intoxication was performed, which included the determination of creatine phosphokinase (CPK) and insulin-like growth factor I (IGF-I) in blood plasma, stimulation and needle electromyography (EMG), as well as morphological and immunohistochemical examination of biopsies of the quadriceps femoris.Results. Myopathic syndrome in the form of proximal para-or tetraparesis was observed in 73.3% of the examined women in combination with a decrease in IGF-1 at normal values of CPK in blood plasma. The EMG results indicated the absence of changes in the parameters of the potentials of motor units, characteristic of primary muscular lesions, and of conduction disturbances along the femoral nerve. Morphometric and immunohistochemical studies of skeletal muscle biopsies showed a decrease in the cross-sectional area of muscle fibers of types I and II without signs of muscle tissue necrosis.Conclusion. Chronic alcoholic myopathy is a common manifestation of alcoholic disease in women with long-term alcohol intoxication. The severity of the atrophic process in the skeletal muscle is comparable to the degree of proximal paresis. Violations of systemic protein synthesis and acceleration of apoptosis are considered as pathogenetic mechanisms of the atrophic process in the muscles in chronic alcoholic myopathy in women.

The investigation of adaptogenic and hepatoprotective properties of Ilex paraguariensis on experimental models in vivo

This work is devoted to the study of the effect of Ilex paraguariensis decoction for energy and carbohydrate metabolism in conditions of increased physical activity, the analysis of the stabilisation possibilities of liver injury and lipid peroxidation markers in rats in an experimental model of chronic alcohol intoxication. It’s established that I. paraguariensis exhibits antioxidant and hepatoprotective effects in rats with experimental alcoholic liver, comparable to the action of classical plant hepatoprotector – Silybum marianum, has a stimulating and adaptogenic effects in experimental model of physical activity, comparable to the energy drink «Wild Jaguar». The results obtained may be due to the presence of flavonoids, ascorbic and chlorogenic acids, exhibiting an antioxidant effect, as well as caffeine, which is known to stimulate the work of the central nervous and cardiovascular systems.

Changes in the dopaminergic system in the hypothalamus and midbrain of rats at chronic complex alcohol-morphine intoxication

Recently, there have been more and more indications of alcoholic pathology burdened by drug use and vice versa. It is evident that the dopamine system plays an important role in the development of addiction when using drugs and alcohol. Experimentally, the long-term combined effect of psychoactive substances on neuromendatory changes in the dopaminergic system in the brain is poorly understood and requires more detailed consideration.The aim of the study was to examine the changes in the dopaminergic system in the hypothalamus and midbrain of rats during chronic alcohol intoxication, as well as a complex administration of morphine and ethanol.The experiments were carried out on white outbred male rats. Using the HPLC method, the levels of dopamine and its metabolites were determined in the regions of the brain during chronic alcohol intoxication, as well as with a combined administration of morphine and ethanol with various durations (7, 14 and 21 days).Chronic alcohol intoxication led to the signs of acceleration of the dopamine turnover only in the hypothalamus on the 7th and 14th days and its accumulation during three weeks of alcoholization. In the midbrain, a decrease in the concentration of the neurotransmitter was revealed when ethanol was injected for 7 days. Co-administration of surfactants was accompanied by slightly different changes: complex 7- and 21-day alcohol-morphine intoxication is accompanied by the dopamine accumulation in the hypothalamus and the decrease in the neurotransmitter turnover in the midbrain on the 14th and 21st days.

THE CONTENT OF SULFUR-CONTAINING AMINO ACIDS AND RELATED COMPOUNDS IN THE BLOOD PLASMA OF RATS WITH DIFFERENT TYPES OF ALCOHOL INTOXICATION

Background. Change of the content of sulfur-containing amino acids and their metabolites is one of the pathochemical mechanisms of alcohol intoxication. Purpose of the study. To study the effect of chronic and intermittent alcohol intoxication on the content of sulfurcontaining amino acids and related compounds in the rat blood plasma. Material and methods. Thirty white outbred rats weighing 180-220 g. The content of free amino acids and biogenic amines was determined by HPLC. Results. A 14-day chronic alcohol intoxication was accompanied by a significant decrease in the level of methionine and an increase in the level of homocysteine in the blood plasma. The concentration of glutathione increased by 5%. In the intermittent alcohol intoxication IAI-4 group, the homocysteine content also increased, as did the level of homoserine and cystathionine in the IAI-1 group. Conclusions. Сhronic and intermittent alcohol intoxications cause similar violations of the level of sulfur-containing amino acids and their metabolites in the rat blood plasma.