Infections of Biliary Tract

Biliary tract infections include cholangitis and cholecystitis. They are associated with high morbidity and mortality in elderly patients with comorbid disease. The most common infecting organisms are Enterobacteriaceae ascending from the gastrointestinal tract, Gram-positive pathogens like Enterococci spp.; the infections are rarely caused by fungi, viruses, and parasites. The prime reason for biliary tract infections is the ascending infection due to the reflux of duodenal contents and also the blood-borne infection or infection spreading through the portal-venous channels. The other predisposing conditions causing biliary tract infections include critical illnesses such as trauma, burns, sepsis, HIV infection, immunosuppression, diabetes, non-biliary surgery, and childbirth. The infection is reduced by β-lactam antibiotics or their derivatives, cephalosporins, carbapenems, fluoroquinolones, etc. Empiric treatment with piperacillin/tazobactam or a cephalosporin with or without metronidazole is recommended for moderate and severe acute cholecystitis irrespective of whether there is growth by culture. Patients with severe cholecystitis are unfortunately difficult to identify properly, both clinically and radiologically, because clinical symptoms are unexpected, and imaging investigations are frequently ambiguous. However, there are significant differences in morbidity and death rates between individuals with mild cholecystitis and those with severe cholecystitis. Preventing related consequences requires early identification and effective therapy of individuals at risk of severe cholecystitis.

Development of a mouse model of ascending infection and preterm birth

Background Microbial invasion of the intraamniotic cavity and intraamniotic inflammation are factors associated with spontaneous preterm birth. Understanding the route and kinetics of infection, sites of colonization, and mechanisms of host inflammatory response is critical to reducing preterm birth risk. Objectives This study developed an animal model of ascending infection and preterm birth with live bacteria (E. coli) in pregnant CD-1 mice with the goal of better understanding the process of microbial invasion of the intraamniotic cavity and intraamniotic inflammation. Study design Multiple experiments were conducted in this study. To determine the dose of E. coli required to induce preterm birth, CD-1 mice were injected vaginally with four different doses of E. coli (103, 106, 1010, or 1011 colony forming units [CFU]) in 40 μL of nutrient broth or broth alone (control) on an embryonic day (E)15. Preterm birth (defined as delivery before E18.5) was monitored using live video. E. coli ascent kinetics were measured by staining the E. coli with lipophilic tracer DiD for visualization through intact tissue with an in vivo imaging system (IVIS) after inoculation. The E. coli were also directly visualized in reproductive tissues by staining the bacteria with carboxyfluorescein succinimidyl ester (CFSE) prior to administration and via immunohistochemistry (IHC) by staining tissues with anti-E. coli antibody. Each pup’s amniotic fluid was cultured separately to determine the extent of microbial invasion of the intraamniotic cavity at different time points. Intraamniotic inflammation resulting from E. coli invasion was assessed with IHC for inflammatory markers (TLR-4, P-NF-κB) and neutrophil marker (Ly-6G) for chorioamnionitis at 6- and 24-h post-inoculation. Results Vaginally administered E. coli resulted in preterm birth in a dose-dependent manner with higher doses causing earlier births. In ex vivo imaging and IHC detected uterine horns proximal to the cervix had increased E. coli compared to the distal uterine horns. E. coli were detected in the uterus, fetal membranes (FM), and placenta in a time-dependent manner with 6 hr having increased intensity of E. coli positive signals in pups near the cervix and in all pups at 24 hr. Similarly, E. coli grew from the cultures of amniotic fluid collected nearest to the cervix, but not from the more distal samples at 6 hr post-inoculation. At 24 hr, all amniotic fluid cultures regardless of distance from the cervix, were positive for E. coli. TLR-4 and P-NF-κB signals were more intense in the tissues where E. coli was present (placenta, FM and uterus), displaying a similar trend toward increased signal in proximal gestational sacs compared to distal at 6 hr. Ly-6G+ cells, used to confirm chorioamnionitis, were increased at 24 hr compared to 6 hr post-inoculation and control. Conclusion We report the development of mouse model of ascending infection and the associated inflammation of preterm birth. Clinically, these models can help to understand mechanisms of infection associated preterm birth, determine targets for intervention, or identify potential biomarkers that can predict a high-risk pregnancy status early in pregnancy.

Inflammatory changes in the placenta in ischemic-cervical insufficiency

Introduction. The high frequency of inflammatory changin the placenta in isthmic-cervical insufficiency may be primarily associated with an ascending infection as a result of a violation of the barrier function of the cervix, however, premature remodeling of the cervix may also be secondary due to an already existing process. The study of the features of the spread of the infectious process and thnature of the inflammatory reaction in various structures of the placenta and fetal membranes can contribute to the understanding of pathogenetic mechanisms of preterm birth in isthmic-crvical insufficiency. Aim of the study — to evaluate the frequency and structure of inflammatory changes in the placenta in women with isthmic-cervical insufficiency. Materials and methods. A prospective cohort study was conduct, which included 154 pregnant women taken by the continuous sampling method. All patients were divided into two groups: group 1 consisted of 100 pregnant women with isthmic-cervical insufficiency, group 2 — pregnant women without isthmic-cervical insufficiency. All women after childbirth underwent a pathomorphological examination of the afterbirth. Results and discussion. In women with isthmic-cervical insufficiency, inflamatory changes in the placenta were detected in 71% (71) of cases, which was significantly more frequent compared to group 2 — 38.9% (21). Membranitis was significantly more frequent in isthmic-cervical insufficiency, amounting to 16% (16) versus 3.7% (2) comparison group (OR=4.32, 95% СI=1.03-18.09, p=0.023). Chorioamnionitis was 6 times more common in the afterbirth in women of group 1, accounting for 12% (12), versus 1.9% (1) in group 2 (OR=6.48, 95% CI=0.87-48.51, p=0.031). Involvement of the umbilical cord in the inflammatory process occurred only in pregnant women with isthmic-cervical insufficiency: funiculitis was combined with membranitis in 4% (4) of cases (p=0.137), the combination of funiculitis with choriomnionitis was detcted in 7% (7) of women p=0.047). Conclusion. The frequencof detection of inflammatory changes in the placenta in ICN was 71% (71). In the structure of inflammatory changes of the afterbirth in patients with ICN, the defeat of the fetal membranes prevails, which may indicate a predominatly ascending path of infection in this pathology. Damage membranes prevails, which may indicate a predominatly ascending path of infection in this pathology. Damage to the umbilical cord in ICN can occur both wth total inflammation of all structures of the placenta, and directly through the fetal membranes, without involving the chorion in the process.

Citrate therapy for ur olithiasis in postmenopausal women

A tendency towards growing life expectancy in old age can be clearly observed in most countries of the world over the past number of decades. This tendency is also seen in our country. Despite the fact that people started living longer, which would seem to be a good indicator of the country’s socio-economic development, the doctors have encountered a rather difficult challenge to overcome. The question at issue is that health specialists are faced with many somatic diseases due to the fact that people started living longer. When life expectancy was much less, many of them have never encountered such a volume of diseases. Today, the share of the elderly in the population has significantly increased and they live longer, which, accordingly, has an impact on the number of nosological units in the clinical practice of almost any health specialist. This article is focused on the issue of non-decreasing incidence of urinary tract diseases; in particular, the challenges of bladder stone disease (BSD) are considered. According to the latest data, the disease prevalence does not tend to decrease. Moreover, the incidence of BSD in women has increased significantly, although this pathological condition is more typical for men. In light of the fact that female patients spend about a third of their lives in the postmenopausal period, it is worth paying special attention to some features of the woman’s body functioning during this time period due to the likelihood of the formation of an inflammatory process, which often mediates the development of the BSD. Older female patients are often concerned about inflammatory bladder diseases, which can lead to the development of BSD by ascending infection in the future. Therefore, it is crucially important to know what therapeutic capabilities doctors have today to effectively fight the BSD.

Histocompatibility Antigen, Class I, G (HLA-G)’s Role during Pregnancy and Parturition: A Systematic Review of the Literature

Introduction: Immune homeostasis of the intrauterine cavity is vital for pregnancy maintenance. At term or preterm, fetal and maternal tissue inflammation contributes to the onset of labor. Though multiple immune-modulating molecules are known, human leukocyte antigen (HLA)-G is unique to gestational tissues and contributes to maternal–fetal immune tolerance. Several reports on HLA-G’s role exist; however, ambiguity exists regarding its functional contributions during pregnancy and parturition. To fill these knowledge gaps, a systematic review (SR) of the literature was conducted to better understand the expression, localization, function, and regulation of HLA-G during pregnancy and parturition. Methods: A SR of the literature on HLA-G expression and function reported in reproductive tissues during pregnancy, published between 1976–2020 in English, using three electronic databases (SCOPE, Medline, and ClinicalTrials.gov) was conducted. The selection of studies, data extraction, and quality assessment were performed in duplicate by two independent reviewers. Manuscripts were separated into three categories: 1) expression and localization of HLA-G, 2) regulators of HLA-G, and 3) the mechanistic roles of HAL-G. Data were extracted, analyzed, and summarized. Results: The literature search yielded 2554 citations, 117 of which were selected for full-text evaluation, and 115 were included for the final review based on our inclusion/exclusion criteria. HLA-G expression and function were mostly studied in placental tissue and/or cells and peripheral blood immune cells, while only 13% of the studies reported data on amniotic fluid/cord blood and fetal membranes. Measurements of soluble and membranous HLA-G were determined mostly by RNA-based methods and protein by immunostaining, Western blot, or flow cytometric analyses. HLA-G was reported to regulate inflammation and inhibit immune-cell-mediated cytotoxicity and trophoblast invasion. Clinically, downregulation of HLA-G is reported to be associated with poor placentation in preeclampsia and immune cell infiltration during ascending infection. Conclusions: This SR identified several reports supporting the hypothesized role of immune regulation in gestational tissues during pregnancy. A lack of rigor and reproducibility in the experimental approaches and models in several reports make it difficult to fully elucidate the mechanisms of action of HLA-G in immune tolerance during pregnancy.

The State of Cellular Immunity and Cytokine Balance in Pregnant Women at Intrauterine Infection

The question of studying changes in the immune responses of mother and foetus against the background of infections acquired via various routes remains relevant. This study aimed to assess the state of T-cell immunity and cytokine balance in pregnant women with various pathways of intrauterine infection and the condition of newborns. The study involved 205 pregnant women at high risk for intrauterine infection. In the 1st trimester, bacteriological and DNA analysis of the lower urogenital tract and cytological examination of the cervical canal were performed, blood levels of immunoglobulins M and G for herpes simplex virus type 1 and 2, cytomegalovirus infection, toxoplasmosis, and rubella were determined. In the whole blood of the women, lymphocyte immunophenotyping was performed using CYTO-STAT® triCHROMETM CD8-FITC/CD4-RD1/CD3-FITC monoclonal antibodies; the content of cytokines (IL-6, IL-10) was analysed by means of enzyme-linked immunosorbent assay. After delivery, a pathomorphological examination of the placenta was performed in line with the generally accepted method. According to the results of the study, the following groups of women were identified: 1) without infectious or inflammatory changes (n = 59); 2) with confirmed ascending infection (n = 69); 3) with haematogenous infection (n = 33); 4) with mixed infection (n = 44). The condition of newborns was assessed with the help of laboratory and instrumental methods, using the INTERGROWTH-21st charts and the Apgar score. We found that the functioning of the immune system of pregnant women is affected by viral infections acquired via the haematogenous route, resulting in a relative increase in suppressor T cells and a decrease in helper T cells, as well as ina growing absolute number of lymphocytes in the blood. The identified inhibition of IL-6 and IL-10 production in the groups with signs of placental lesions due to infection at 16–18 weeks can indicate a strain on the immune processes and development of placental insufficiency. Newborns with morphological signs of haematogenous infection are characterized by changes in the cytological parameters of residual cord blood, signs of placental insufficiency, low birth weight, and hypoxic-ischemic damage to the central nervous system.

Bacterial and Host Determinants of Group B Streptococcal Vaginal Colonization and Ascending Infection in Pregnancy

Group B streptococcus (GBS) is a gram-positive bacteria that asymptomatically colonizes the vaginal tract. However, during pregnancy maternal GBS colonization greatly predisposes the mother and baby to a wide range of adverse outcomes, including preterm birth (PTB), stillbirth, and neonatal infection. Although many mechanisms involved in GBS pathogenesis are partially elucidated, there is currently no approved GBS vaccine. The development of a safe and effective vaccine that can be administered during or prior to pregnancy remains a principal objective in the field, because current antibiotic-based therapeutic strategies do not eliminate all cases of invasive GBS infections. Herein, we review our understanding of GBS disease pathogenesis at the maternal-fetal interface with a focus on the bacterial virulence factors and host defenses that modulate the outcome of infection. We follow GBS along its path from an asymptomatic colonizer of the vagina to an invasive pathogen at the maternal-fetal interface, noting factors critical for vaginal colonization, ascending infection, and vertical transmission to the fetus. Finally, at each stage of infection we emphasize important host-pathogen interactions, which, if targeted therapeutically, may help to reduce the global burden of GBS.

NEUROLOGICAL EXAMINATION AND TREATMENT OF CHILDREN OPERATED ON FOR SPINAL HERNIA

Among the most severe consequences of spinal hernia surgery (SHG) are spinal neurogenic bladder (SNGB) and impaired bowel movement. SNGB, in addition to its main manifestations in the form of violations of the accumulative function of the bladder and the function of emptying, is dangerous for the development of complications – vesicoureteral reflux, ascending infection of the urinary system and chronic kidney disease. Clinical manifestations of SNGB do not always accurately indicate a variant of bladder dysfunction. The authors presented variants of the results of urodynamic studies in children operated on for SHG SHG. The state of the detrusor – hyperactivity or atony and the sphincter – insufficiency or hyperactivity and the selection of a pathogenetically justified treatment option are described.

Twin presentation of rhinocerebral mucormycosis and parotid abscess with facial nerve palsy in a case of unrevealed uncontrolled diabetes mellitus

<p class="abstract">Rhinocerebral mucormycosis is a saprophytic invasive fungal infection of the nose and paranasal sinuses. The angio-invasive nature of the disease and rapid spread to the surrounding vital structures makes this infection more fatal. Parotid abscess is a rare disease in both adults and children due to an ascending infection from the oral cavity via the parotid duct. Diabetes mellitus is an immuno-compromised state in which patients are more prone for several infections. Both these diseases can lead to fatal complications due to their spread and toxicity, but the one rare complication of both these diseases is Facial nerve palsy. We are presenting a case of Diabetes mellitus with Rhinocerebral mucormycosis and Parotid abscess. There have been very few documented cases of co-existing Rhinocerebral mucormycosis and Parotid abscess in a patient with facial nerve palsy as complication.</p>