USE OF EFFERENT THERAPY METHODS IN THE TREATMENT OF DESTRUCTIVE PANCREATITIS

Своевременное включение методов эфферентной терапии (гемодиафильтрация, плазмаферез) в комплексную интенсивную терапию сепсиса и септического шока у больных с острым деструктивным панкреатитом, находящихся на стационарном лечении в ЦГКБ г. Алматы, позволило быстро стабилизировать гемодинамику, респираторные нарушения и отказаться от применения адреномиметиков, а также значительно уменьшить клинические проявления тяжелой интоксикации, гипоксии и эндотоксикоза. Timely inclusion of efferent therapy methods (hemodiafiltration, plasmapheresis) in the complex intensive therapy of sepsis and septic shock in patients with acute destructive pancreatitis who are inpatient treatment at the Central city clinical hospital in Almaty, made it possible to quickly stabilize hemodynamics, respiratory disorders and abandon the use of adrenomimetics, as well as significantly reduce the clinical manifestations of severe intoxication, hypoxia and endotoxicosis.

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.

ON THE ISSUE OF DIFFERENTIAL DIAGNOSIS OF BACTERIAL INFECTIONS AND PEDIATRIC MULTISYSTEM INFLAMMATORY SYNDROME DURING THE COVID-19 PANDEMIC

During the COVID-19 pandemic, it is necessary to be wary of the development of pediatric multisystem inflammatory syndrome in children (PMIS) who have had a COVID-19 and had antibodies to the SARS-CoV-2 virus. The aim of this work is to describe two clinical cases in children with antibodies to SARS-CoV-2 against the background of yersiniosis in a 12-year-old child and salmonellosis in a 3-year-old child, which proceeded with a pronounced inflammatory reaction and required a differential diagnosis with multisystem inflammatory syndrome. These bacterial infections proceeded with severe intoxication and fever, had a polymorphic clinical picture with exanthema syndrome, conjunctivitis/scleritis, swelling of the palms/feet, diarrhea and toxic kidney damage, with a pronounced systemic inflammatory reaction – high leukocytosis with neutrophilia and lymphopenia, a significant increase in C-reactive protein, procalcitonin, hypercoagulability (increased fibrinogen, D-dimer). Etiotropic antibiotic therapy led to recovery in both cases. Conclusions: During the COVID-19 pandemic, if antibodies to the SARS-CoV-2 virus are detected in children in the presence of signs of systemic inflammation and corresponding symptoms, the alertness of doctors and a timely comprehensive examination are necessary to exclude bacterial infections, also characterized by signs of systemic inflammation, for the purpose of differential diagnosis of PMIS.

Non-suicidal intentional ingestion of iron tablets and severe intoxication: the result of adolescent boy’s impulsive risky behaviour in the school

Acute iron poisoning is a potentially fatal intoxication in children. As the Iron preparations are commonly administered to pregnant women, lactating mothers, toddlers, it is easily available at home. So younger children are prone to consume it accidently. Although iron is a therapeutic drug in recommended dosages, excessive iron in the free state can produce toxicity by affecting multiple cellular processes by catalysing redox reactions with lipid peroxidation and free radical formation. The severity of intoxication depends on the amount of elemental iron ingested. Serious toxicity is usually associated with a dose of >40 mg/kg of elemental iron. Levels more than 100 mg/kg are almost always fatal. We report a case where a 12-year male child intentionally taken 60 tablets of iron (ferrous fumarate) at his school as a part of competition or bet to other schoolmate and presented with acute iron poisoning with hepatic encephalopathy to us. Important initial laboratory parameters were AST-4,879 U/L, Prothrombin time-60 sec and Iron level-213 microgram/dl. With timely specific management i.e., deferoxamine infusion along with all required intensive care supportive management in PICU the patient was discharged successfully. We chose to report this case to highlight the risky behaviour of adolescence who usually grows physically and emotionally earlier but their prefrontal lobes are yet immature to take proper and correct decision. Thus, impulse activity may prove fatal for them.

Successful Treatment of Severe Lamotrigine Intoxication with CytoSorb Hemoadsorption

Severe intoxication with the anti-epileptic drug, lamotrigine can cause cardiovascular collapse, neurotoxicity – expressed as intractable seizures, and even death. As there is currently no known specific antidote, extracorporeal removal therapies such as CytoSorb hemoadsorption might represent a promising therapeutic option. We report on a deeply comatosed 60-year-old woman who was treated in our intensive care unit with severe lamotrigine intoxication. To support removal from the blood, combined treatment with continuous veno-venous hemodialysis and CytoSorb hemoadsorption was started. Pre- and post-adsorber drug level measurements showed the rapid elimination of lamotrigine accompanied by an impressive clinical improvement in the patient. Two days after treatment discontinuation, there were no more clinical signs of intoxication and the patient could be extubated, followed by transfer to the stroke unit in a stable condition the following day. In the absence of a viable antidote, for the efficient short-term removal of lamotrigine, hemoadsorption with the CytoSorb device could represent a feasible treatment option for patients with severe lamotrigine intoxication.

Rodenticide-induced acute liver failure – Uncommon presentation of commonly available poison

Rodenticide or ‘rat poison’ is easily available in a predominantly agrarian economy such as India. Metal phosphides or yellow phosphorous are two common rodenticides. Acute liver failure caused by accidental or suicidal poisoning with rodenticides has been infrequently reported in literature. Liver transplantation offers the best chances of survival in severe intoxication. However, the availability of liver transplantation in resource-limited settings presents a challenge. N-acetyl cysteine has been successfully used in paracetamol poisoning. Its use in rodenticide-induced acute liver failure is not so well known. We report three cases of rodenticide-related acute liver failure, one of them being a pregnant lady. All three patients were given N-acetyl cysteine and two patients improved. It is possible that the administration of N-acetyl cysteine contributed to the improvement in these two.

Clinical case in outpatient practice: acute tonsillitis against background of COVID-19

Over the past period of the COVID‑19 pandemic, experience has been gained on the ways of spreading the infection, new approaches to treatment have been formed, and preparations for vaccine prevention have been created. Information about COVID‑19 is updated with new data on the features of the clinical course, including rare manifestations of the disease. The clinical symptoms of CAVID‑19 are characterized by a significant variety and are due to the tropism of the SARS‑CoV‑2 virus to various tissues. The article describes a clinical case of COVID‑19. With severe intoxication syndrome, the patient was found to have concomitant acute tonsillitis. The article provides a review of the literature on the clinical symptoms of COVIND‑19 and the mechanisms of their development. The differential diagnosis of viral and bacterial tonsillitis is considered. Efficacy of antibacterial therapy of tonsillitis with cefixime. The clinical case is illustrated with photos.

CYP2D6 phenotype explains reported yohimbine concentrations in four severe acute intoxications

The indole alkaloid yohimbine is an alpha-2 receptor antagonist used for its sympathomimetic effects. Several cases of yohimbine intoxication have been reported and the most recent one involved four individuals taking a yohimbine-containing drug powder. All individuals developed severe intoxication symptoms and were admitted to the hospital. Even though all individuals were assumed to have taken the same dose of the drug powder, toxicology analyses revealed yohimbine blood concentrations of 249–5631 ng/mL, amounting to a 22-fold difference. The reason for this high variability remained to be elucidated. We used recently reported knowledge on the metabolism of yohimbine together with state-of-the art nonlinear mixed-effects modelling and simulation and show that a patient’s cytochrome P450 2D6 (CYP2D6) phenotype can explain the large differences observed in the measured concentration after intake of the same yohimbine dose. Our findings can be used both for the identification of safe doses in therapeutic use of yohimbine and for an explanation of individual cases of overdosing.

Can detox nutrition be an adjunct in the treatment and rehabilitation of patients infected with the COVID-19 virus?

В статье анализируется обоснование к применению и результаты использования детоксикационной нутритивной поддержки у пациентов с вирусной инфекцией COVID-19. Данные ряда публикаций указывают на то, что при инфицировании вирусом SARS-CoV-2 возникают гемотоксические и метаболические эффекты, аналогичные происходящим при накоплении тяжелых металлов. Интоксикация организма при коронавирусной патологии сопровождается нарушениями окислительных процессов и гиперпродукцией главным образом цитокинов («цитокиновый шторм»), что во многом связано с дефицитом потребления и накопления в организме микронутриентов и биологически активных веществ с выраженной антиоксидантной, противовоспалительной, гепатопротекторной и другими активностями. Результаты ранее проведенных исследований по оценке дезинтоксикационной активности диетического продукта питания дают основание предположить, что данный продукт может быть эффективен и при интоксикации, вызванной вирусными инфекциями, в частности коронавирусом SARS-CoV-2. Так, использование киселя у группы рабочих, трудившихся в условиях вредного производства, приводило к увеличению экскреции с мочой никеля, меди и кобальта, улучшению показателей окислительного стресса: снижению малонового диальдегида до 4,3 ± 0,06 мкмоль/л, повышению активности каталазы с 417,2 ± 20,6 до 564,2 ± 20,1 мккат/л, супероксиддисмутазы – с 13,7 ± 0,1 до 15,3 ± 0,08 у.е., церулоплазмина – с 287,4 ± 6,1 до 331,2 ± 8,5 мг/мл. Полученные данные, а также знания об особенностях патогенеза и течения COVID-19 позволили включить кисель в поддерживающую терапию пациентов с этим заболеванием. Анкетирование 283 лиц, перенесших коронавирусную инфекцию, показало наличие симптомов выраженной интоксикации. Нутритивная поддержка в течение месяца детоксикационным киселем способствовала значительному снижению симптомов интоксикации: слабости и утомляемости, колебаний температуры, исчезали страхи, тревожность, мнительность и др. Авторы рекомендуют более продолжительную (не менее 3-6 мес) нутритивную поддержку детоксикационными специализированными продуктами питания для полноценного восстановления организма и дальнейшей профилактики развития постковидных осложнений. The article analyzes the rationale for the use and the results of the use of detoxification nutritional support in patients with COVID-19 viral infection. Data from a number of publications indicate that when infected with COVID-19, hemotoxic and metabolic effects occur, similar to those that occur with the accumulation of heavy metals. Intoxication of the body in coronavirus pathology is accompanied by violations of oxidative processes and overproduction, mainly of cytokines («cytokine storm»), which is largely due to a deficit in the consumption and accumulation of micronutrients and biologically active substances in the body with pronounced antioxidant, anti-inflammatory, hepatoprotective and other activities ... The results of previous studies to assess the detoxification activity of the dietary food product suggested that this product may be effective in cases of intoxication caused by viral infections, in particular COVID-19 coronavirus. Thus, the use of jelly in a group of workers working in hazardous working conditions led to an increase in urinary excretion of nickel, copper and cobalt, an improvement in oxidative stress indicators: a decrease in malondialdehyde to 4,3 ± 0,06 μmol/l, increase in catalase activity from 417,2 ± 20,6 to 564,2 ± 20,1 μkat/L, superoxide dismutase from 13,7 ± 0,1 up to 15,3 ± 0,08 a.u., ceruloplasmin from 287,4 ± 6,1 to 331,2 ± 8,5 mg/ml. The obtained data, as well as knowledge about the peculiarities of the pathogenesis and course of COVID-19 infection, made it possible to include jelly in the maintenance therapy of patients with this disease. A survey of 283 people who have had a coronavirus infection showed the presence of symptoms of severe intoxication. Nutritional support for a month with detoxification jelly contributed to a significant reduction in symptoms of intoxication: weakness and fatigue, temperature fluctuations, fears, anxiety, suspiciousness, etc. disappeared. The authors recommend longer (at least 3-6 months) nutritional support by specialized detoxification food products for the full recovery of the body and further prevention of the development of post Сovid complications.

COVID-19 and recurrent respiratory infections in children of Kazakhstan

The study goal was to investigate the COVID-19 clinical course in children with recurrent respiratory infections (RRI) in Nur-Sultan, Kazakhstan. Material and Methods — we conducted the retrospective analysis of 94 children with RRI, diagnosed with COVID-19, in Nur-Sultan, Kazakhstan. The study involved 53 males and 41 females. The inclusion criterion for the study was the frequency of RRI at least six times per year. In the course of our study, we split the patients among three groups and identified two phenotypes. These groups included children with RRI and atopic phenotype (Group 1), with D-deficiency phenotype (Group 2), and control group (Group 3) encompassing children with RRI lacking these phenotypes. Results — The most common symptoms of 94 pediatric patients were dry cough (94.7%), fever (81.9%), along with a loss of appetite and fatigue (76.6%). Malaise was observed in 74.5% cases, rhinorrhea was noted in 71.2% of patients, sore throat was detected in 64.9 % of children, and dyspnea was established in 45.7% of cases. We observed no statistical differences in clinical manifestations of COVID-19 among three groups of children. However, duration of hospitalization period, of fever, and of the catarrhal period differed significantly among the groups (р<0.001). Conclusion — In children with RRI and vitamin D deficiency, who were diagnosed with COVID-19, the course of the infection was unfavorable (which was confirmed by a longer hospital stay and catarrhal period), and a more severe intoxication syndrome was observed. In the group of children with atopic phenotype, a prolonged residual cough was detected.