Drug Intolerance: Age Related Aspects

Aim: Identification of age-specific drug intolerance. Materials and methods: The study was conducted over the period from 2017 to 2020 and included 200 outpatient medical history forms of people diagnosed as having an unspecified pathological reaction to a drug or medication. All drug reactions are reported by patients own statements and were allocated to dichotomous variables. The results were analyzed by nonparametric statistics. Results: Three groups of patients: 18-44 years (n=49); 45-60 years (n=60); 61 and over (n=91). The odds of incomprehensible reactions were 2.2 times higher in patients in group 3 than in patients in the other groups. Group 3 patients were 12 times more likely to have an itchy reaction to medications than patients in the other groups. Group 1 patients were 3 times more likely to have urticaria than patients in groups 2 and 3. The odds of drug intolerance to ACE inhibitors were 2.6 times higher in group 3 patients than in patients in other groups. When comparing clinical manifestations of drug intolerance to penicillin- and cephalosporin-type antibiotics, no significant differences were found in all patients. The presence of allergies and somatic pathology of 3 or more systems did not significantly affect the possibility of reactions of varying severity to 3 or more drugs in these groups. Conclusions: Patients age has no effect on the possibility of reactions to certain groups of drugs. The exception was ACE inhibitors, which is most likely due to the higher frequency of prescribing antihypertensive therapy in patients in this age group. The aggravation of clinical manifestations and the occurrence of polypharmacy are not associated with age and comorbid background. It should be noted that correlation between age and non-life-threatening clinical manifestations of drug intolerance was revealed, which indicates the absence of reliable effect of age on the possibility of anaphylactic shock or angioedema.

Forms of drug allergy and various variants of its manifestation

Lately, the problem of drug allergy is becoming more and more urgent, which is a consequence of the wide availability of drugs and the widespread use of counterfeit drugs. According to some authors, the incidence of drug allergy reaches 60%. This pathological reaction is the result of the patient's individual intolerance to one or another medication, and is not inherently its side effect. In some cases, the ingestion of a minimum dose of a drug into the body is sufficient for a severe reaction to develop. Theoretically, any drug can cause an allergy, but there is a group of certain medications, to the ingestion of which an allergic reaction develops most often - these include antibiotics of the penicillin series, sulfonamides, analgesics, some antihypertensive drugs, B vitamins. An allergic reaction can develop with lightning speed, or it can manifest itself within a day. The most common forms of drug allergy include urticaria, Quincke's edema, and itchy rash (toxidermia). The most formidable manifestations of drug allergy are anaphylactic shock and Lyell's syndrome, which manifests itself in the form of total damage to the skin and mucous membranes.

Features of Psychotherapy in Elderly Patients with Affective Disorders in the Outcome of a Pathological Reaction of Grief

The relevance of the work is due to the high prevalence and insufficient degree of study of the outcomes of the pathological reaction of grief (PRG) at a late age. Approaches to the treatment of these disorders, often carried out without taking into account the age factor, are not sufficiently developed. The various psychotherapeutic techniques used in PRG are contradictory and poorly structured. Solving these problems will not only achieve good quality remissions, but also prevent endogenization and chronification of mental disorders. The appearance of a new coronavirus infection, accompanied by high mortality, makes the problem of PRG therapy particularly relevant. Objective: to study the features of psychotherapy of depression in late-aged people with a history of PRG. Design: the work is a fragment of an open non-randomized study of patients with PRG, conducted in the Department of geriatric Psychiatry of the Federal State Budgetary Institution of the National Research Center. Inpatient patients over 60 years of age were studied. The clinical-psychopathological and catamnestic methods were used. Pharmaco-and psychotherapy was used. Results: 60 patients were examined, the majority were women, the average age was 66 years, patients with a first — time depressive episode prevailed-45% and recurrent depressive disorder — 28%. The majority (97.7%) of patients had delayed symptoms of PRG. The features of personality, age factors affecting the course of the disease and the peculiarities of psychotherapy are analyzed. Conclusions: the use of an integrated approach (a combination of psychopharmacotherapy and various types of psychotherapy) to the treatment of depressive disorders in the outcome of PRG is justified.

miR-146a in cardiovascular diseases and sepsis: an additional burden in the inflammatory balance?

The new concept of thrombosis associated with an inflammatory process is called thromboinflammation. Indeed, both thrombosis and inflammation interplay one with the other in a feed forward manner amplifying the whole process. This pathological reaction in response to a wide variety of sterile or non-sterile stimuli eventually causes acute organ damage. In this context, neutrophils, mainly involved in eliminating pathogens as an early barrier to infection, form neutrophil extracellular traps (NETs) that are antimicrobial structures responsible of deleterious side effects such as thrombotic complications. Although NETosis mechanisms are being unraveled, there are still many regulatory elements that have to be discovered. miRNAs are important modulators of gene expression implicated in human pathophysiology almost two decades ago. Among the different miRNAs implicated in inflammation, miR-146a is of special interest because: (i) it regulates among others, TLR/NF-B axis which is of paramount importance in inflammatory processes, (ii) it regulates the formation of NETs by modifying their ageing phenotype, (iii) it has expression levels that may decrease among individuals up to 50%, controlled in part by the presence of several polymorphisms. In this manuscript, we will review the main characteristics of miR-146a biology. In addition, we will detail how miR-146a is implicated in the development of two paradigmatic diseases in which thrombosis and inflammation interact, cardiovascular diseases and sepsis, and their association with the presence of miR-146a polymorphisms and the use of miR-146a as a marker of cardiovascular diseases and sepsis.

New approaches to the impact on the pathogenetic links of sepsis

Sepsis is a systemic pathological reaction that arise because of a severe infection. Now, sepsis is considered as one of the most serious diseases and materially expensive nosology’s. For instance, out of 100% of cases of sepsis, only 40% survive. Thus, there is a high mortality rate and a wide prevalence (up to 300 thousand patients with sepsis are registered in Europe), which makes it possible to identify serious problems and the need to improve the clinical approach to the management strategy and tactics of such patients. The number of cases of detection and registration of sepsis has been expanding expansively since the thirties of the last century, and continues to grow dynamically, which obviously requires an improvement in the pathognomonic approach to therapy. The main reasons for the growth of septic conditions are the increasing use of invasive methods in medical practice, the pandemic of diabetes mellitus, the use of cytostatic and immunosuppressants, as well as the increasing number of antibiotic-resistant strains of pathogenic and conditionally pathogenic bacteria, total disruption of mucosal microbiocenoses, unreasonable use of probiotics with production strains containing foci of pathogenicity in patients with primary or secondary immunodeficiencies. Now, the main etiopathogenetic therapy of sepsis remains drugs aimed at the destruction of pathogenic microorganisms. However, based on the pathogenesis of the septic state, it seems effective to search for drugs with new points of application to individual pathogenesis links of the systemic inflammatory response. Today, studies aimed at establishing the effectiveness of influence on any individual links in the pathogenesis of sepsis - inflammatory mediators, have not yet yielded clear results.

Pneumoconioses

Pneumoconiosis describes the pathological reaction of the lung to inhaled dust, most often, but not exclusively, related to exposures occurring at work. It may be defined as a permanent alteration of lung structure due to the inhalation of mineral dust and the tissue reactions of the lung to its presence, excluding bronchitis and emphysema. The causes of pneumoconiosis are many and varied, but coal worker’s pneumoconiosis, asbestosis, and silicosis are most common. Many epidemiological studies have shown an exposure–response relationship between the total mass of respirable dust to which workers have been exposed and their risk of developing disease. These form the basis of regulations specifying limits to permitted levels of exposure. Workers who develop pneumoconiosis as a consequence of their employment may be entitled to compensation in some countries.

Sidero-Siliko Tuberkulosis pada Penderita Efusi Pleura Masif Dekstra yang Awalnya Dicurigai Keganasan

Background: Pneumoconiosis defined as the accumulation of dust in the lungs and causes tissue reactions to mineral materials from various industries that affect the respiratory system. Among the causes of pneumoconiosis are silica dust (silicosis) and iron dust (ciderosis). Pneumoconiosis provides a pathological reaction in lung tissue due to inhaled deposition of mineral particulate dust or persistent fiber material. The risk of infection with tuberculosis is higher in patients with pneumoconiosis, especially silicosis. Most cases of pleural effusion are found in malignancies or infections such as tuberculosis but can also be a complication of pneumoconiosis. Case: A man, 55 years old, reported with a 2-week congested complaint that was getting worse, with a cough for almost 1 month. Patients with work history as iron lathers for 25 years with comorbid diabetes mellitus. From the results of our chest x-rays we get a picture of massive pleural effusion with a total evacuation of approximately 9 liters, whereas on the chest CT scan get a solid mass picture in the right lung field with multiple nodules in the liver. The results of bronkoalveolar rinses obtained silica and iron content, and obtained Mycobacterium tuberculosis culture in pleural fluid culture. Conclusion: Illustration of a case report of a 55-year-old man diagnosed as a sidero-silico-tuberculosis with a periodic picture of tuberculosis and pleural effusion in the right lung undergoing resolution with OAT treatment.

Peculiarities of the systemic hemodynamics reaction and peripheral blood flow to reactive hyperhemia in young women with arterial hypotension

The aim of the study was to study a vascular reaction to a test with reactive hyperemia in young women with idiopathic arterial hypotension. 72 women with hypotension (SBP 98 mmHg or less) and 37 women with SBP 120-129 mmHg were examined. A comparative analysis of the response of systemic and peripheral hemodynamics to a test with reactive hyperemia by Celermajer D. In hypotension, occlusion was characterized by an increase in SBP, a change in the diameter and velocity of peripheral arterial and venous blood flow. Thus, the pathological reaction of systemic and peripheral hemodynamics in reactive hyperemia in women with hypotension is a sign of remodeling of the cardiovascular system.