Digestive manifestations of SARS-COV2 infection in Togo

Objective: to identify the main digestive manifestations related to SARS-CoV-2 in Togo and to determine their impact on the prognosis of the disease. Patients and method: This was a cross-sectional study with retrospective and prospective collection, with descriptive and analytical aims, conducted from May 1, 2020 to April 30, 2021 at the national center for the management of infectious diseases of Lome. Patients of both sexes and of any age, tested positive for SARS-CoV-2 by PCR on nasopharyngeal and oropharyngeal samples and hospitalized at the national center for infectious disease management of Lome were included in this study. Digestive manifestations were divided into gastrointestinal manifestations and hepatobiliary manifestations. The threshold of significance of the tests was retained for a p value less than or equal to 0.05. Results: out of 876 patients hospitalized during the study period, 215 presented with digestive manifestations, corresponding to a prevalence of 24.54%. the predominance was male, with a male/female sex ratio of 1.74. the mean age was 46.07+/-16.14 [02 months – 82 years]. gastrointestinal manifestations were found in 11.98% of cases. abdominal pain was the most frequent digestive symptom (15.35%). hepatobiliary manifestations were represented by cytolysis syndrome (44.19%) and cholestasis syndrome (36.28%). digestive manifestations were associated with renal failure (p=0.03) and thrombocytosis (p<0.01). The occurrence of death was associated with a decrease in HDL-cholesterol (p<0.001) and the presence of renal failure (p=0.027). The cure rate in our study was 83.72% with a lethality of 16.27%. Conclusion: the digestive manifestations constitute a not negligible form of revelation of the disease with coronavirus 2019. The best prevention is the vaccination and the respect of the measures of social distanciation.

Features of Changes in Blood Parameters of Some Laboratory Syndromes and their Constellations in Patients with Liver Cirrhosis with Disorders of Bone Mineral Density

Introduction. Investigation of changes in certain laboratory blood parameters, and verification with their help of laboratory syndromes, and detection of constellations of laboratory syndromes in patients with liver cirrhosis (LC), which is possible for clinicians of all levels of medical care, need to clarify their features, which would suspect or verify disorders of bone mineral density (DBMD). The aim of the study. Investigate the features of changes in blood parameters of some laboratory syndromes and their constellations in patients with liver cirrhosis with disorders of bone mineral density. Materials and methods. 90 patients (27 women (30.0 %) and 63 men (70.0 %) aged 18 to 66 years) with LC were stratified into several groups: experimental (EG) (patients with LC with DBMD) (72 patients (80.0 %))), from which two subgroups were formed - EG A (patients with LC with osteopenia) (46 patients (63.9 %))), and EG B (patients with LC with osteoporosis) (26 patients (36.1 %)))) and the comparison group (CG) (patients with LC without DBMD) (18 patients (20.0 %))). Among the laboratory syndromes and their blood parameters were studied such as: cytolysis (increased in plasma alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST)), mesenchymal-inflammatory syndrome (increased thymol test (TT) and/or gamma-globulins), hepatocellular insufficiency (decreased fibrinogen, prothrombin index (PTI), total protein, or albumin), cholestasis (increased alkaline phosphatase (AP), gamma-glutamyltranspeptidase (GGTP), total bilirubin), porto-systemic shunting (decreased sodium and/or potassium, and/or increased creatinine) and dyslipidemia (increased serum cholesterol, B-lipoproteins, triglycerides, low-density lipoprotein (LDL), decreased high-density lipoprotein (HDL)). The study was performed in three stages, the first of which studied the features of laboratory syndromes and blood parameters that characterize them, the second - constellations of laboratory syndromes, and the third - the simultaneous manifestation of a number of different laboratory syndromes in patients with LC with DBMD, osteopenia and osteoporosis. Each stage involved three steps: the first was to study the frequency of laboratory syndromes and their laboratory blood parameters in patients with LC and determine their share in each of the study groups, the second was to identify significant differences in the frequency of cases, and the third was to identify a direct stochastic relationship between the studied trait and DBMD, including osteopenia and osteoporosis. Results. After performing all three stages and each of the planned steps, it was found that laboratory syndromes and their constellations are more common among patients with bone lesions. However, there are statistically significant differences in the frequency of cases between EG and CG in the case of a decrease in HDL and the simultaneous manifestation of five different laboratory syndromes; between EG A and CG - decrease in HDL and simultaneous manifestation of two and three different laboratory syndromes; between EG B and CG - increase in AP, decrease in HDL and simultaneous manifestation of five different laboratory syndromes; between EG A and EG B - cytolysis syndrome, increase in AST, gamma-globulins, AP, constellation of cytolysis syndrome with hepatocellular insufficiency syndrome or cholestasis syndrome and constellation of all three syndromes. Confirmed direct stochastic association was found: with all manifestations of DBMD - increase in TT, a decrease in HDL, and constellations of cytolysis, mesenchymal-inflammatory and dyslipidemic syndrome, which may be supplemented by hepatocellular insufficiency syndrome and/or cholestasis syndrome; with osteopenia - increase in TT, increase in blood cholesterol, decrease in HDL, and constellations containing dyslipidemia syndrome and supplemented by mesenchymal-inflammatory, and/or cytolysis and/or hepatocellular insufficiency and/or cholestasis syndromes, and simultaneously only two laboratory syndromes in a patient with LC; with osteoporosis - increase in blood AST, TT, gamma-globulins, AP, decrease in PTI, potassium, HDL, the presence of cytolysis, cholestasis syndromes, constellations of cytolysis syndrome with hepatocellular insufficiency syndrome and/or cholestasis syndrome, which are supplemented by mesenchymal-inflammatory and dyslipidemic syndrome, and the simultaneous manifestation only three or five different laboratory syndromes. Conclusions. Laboratory syndromes, blood parameters that characterize them, and constellations of laboratory syndromes have certain features in patients with cirrhosis of the liver with disorders of bone mineral density, as in most cases are more common in patients with bone lesions and have a confirmed stochastic relationship with disorders of mineral density bone tissue in general, and osteopenia and osteoporosis separately. Keywords: cirrhosis, bone mineral density, osteopenia, osteoporosis, cytolysis, mesenchymal-inflammatory, hepatocellular insufficiency, cholestasis, porto-systemic shunting, dyslipidemia, alanine aminotransferase, aspartate aminotransferase, thymol test, total protein, albumin, gamma-globulin, fibrinogen, prothrombin index, alkaline phosphatase, gamma-glutamyltranspeptidase, bilirubin, sodium, potassium, creatinine, cholesterol, B-lipoproteins, triglycerides, low-density lipoproteins, high-density lipoproteins.

Functional state of the hepatobiliary system in newborns with manifestations of hyperbilirubinemia in perinatal pathology

Neonatal jaundice in most cases is a benign condition in the newborn that does not require additional interventions other than observation. However, the manifestations of hyperbilirubinemia under certain conditions may be one of the first clinical signs of disorders of the functional state of the hepatobiliary system (HBS), in which case this process is not considered physiological and requires appropriate clinical observation and additional examination. Contributing factors to the development of HBS dysfunction in newborns may be: concomitant perinatal pathology, isoimmunization, congenital defects in the metabolism of enzymes involved in the transformation and excretion of bilirubin, and so on. Purpose — based on a comprehensive analysis of specific clinical and laboratory indicators to determine the most characteristic pathogenetic syndromes, which are the basis for the formation of disorders of the functional state of the hepatobiliary system in the presence of clinical manifestations of jaundice in newborns. Materials and methods. 164 full-term infants were included in the study. The main study group І (92 children with clinical manifestations of jaundice on the background of perinatal pathology) was divided into 2 subgroups depending on the severity of the newborn in the early neonatal period: IA subgroup (46 pers.) — children with moderate severity and IB subgroup (46 people) — children whose condition was assessed as severe. Group II (comparison group) consisted of 72 healthy full-term newborns. Biochemical studies of serum in newborns were performed using an analyzer «ULTRA» company «Kone» (Finland, reagents of the company) and an apparatus for electrophoresis «PARAGON» company «Bekman» (Austria, reagents of the company) in the biochemical laboratory of the maternity hospital. For reliable analysis of statistical data, the assessment was performed using the software SpssStatistica, 2010; Excel, 2016. Procedures, logic and interpretation of the obtained analysis results were based on the main provisions of medical and biological statistics. The comparison of quantitative indicators with the normal distribution was performed using Student's t-test. Results. Analysis of the functional status of HBS in newborns with hyperbilirubinemia with perinatal pathology showed the following clinical signs of dysfunction: jaundice, hepatosplenomegaly, intestinal dysfunction, manifestations of hypoglycemia, anemic and hemorrhagic syndrome. Disorders of bilirubin metabolism were confirmed by an increase in the blood serum level of bilirubin due to the indirect fraction. Indicators of ALT and AST activity tended to increase considering the severity of perinatal pathology. The value of LDH also correlated with the severity of the condition and was highest in children of the IB subgroup. The activity of ALP tended to increase in children of the IA subgroup, while children of the IB subgroup showed lower activity compared to control. GGT activity in neonates of the observation subgroups showed a tendency to decrease compared with the control. Analysis of the white blood spectrum revealed a decrease in the level of both total protein and albumin levels in children of IA and IB subgroups compared with the control, with more expressed changes observed in newborns with severe perinatal pathology. It was found that the main pathogenetic syndromes and formation of dysfunction of the hepatobiliary system in the presence of clinical signs of hyperbilirubinemia in perinatal pathology are: cytolysis syndrome, cholestasis and protein-synthetic insufficiency, the severity and prevalence of which corresponds to the clinical symptoms and severity of the disease. Conclusions. The main clinical manifestations of disorders of the functional state of the hepatobiliary system in hyperbilirubinemia in perinatal pathology in newborns are: jaundice, hepatosplenomegaly, intestinal dysfunction, in more severe cases — hypoglycemia, anemia and hemorrhagic disorders. In-depth analysis of biochemical parameters of blood in newborns showed that the main syndromes of the pathogenesis of HBS dysfunction are: cytolysis syndrome, which is characterized by increased activity of AST, ALT and LDH; cholestasis syndrome, which is manifested by an increase in blood levels of total bilirubin, cholesterol, increased activity of ALP enzymes, GGT and protein — synthetic deficiency syndrome, which is confirmed by a decrease in total protein, albumin, cholinesterase, urea and glucose. Significant violations of the functional state of the hepatobiliary system in the presence of jaundice in severe perinatal pathology in newborns that were discovered indicate the need for timely diagnosis for appropriate therapeutic correction. The research was carried out according to the principles of the Declaration of Helsinki. The study protocol was approved by the BSMU LEK for all the participants. Examination of children was conducted with the consent of parents after a preliminary explanation of the purpose, methods and scope of laboratory research methods. No conflict of interest was declared by the authors. Key words: newborn, jaundice, hepatobiliary system.

Children who have cytolysis syndrome in debut of genetic diseases: analysis of primary morbidity

Background. Cytolysis syndrome often helps to suspect liver pathology. However, a rare genetic disease may manifest under the guise of increased transaminases. No true etiology of the disease is then identified with the standard examination algorithm. It is not recognized for a long time. Patients diagnosed with unspecified hepatitis receive irrational treatment, which in turn leads to deterioration in the quality of medical care.Purpose. To analyze the medical history, laboratory test results and list of clinical symptoms in pediatric patients with genetic diseases in the debut, and to correlate an identified symptom complex with increased transaminases.Methods. The article presents the results of a retrospective study of 17 randomly selected cases of children with a first established diagnosis of Duchenne — Becker muscular dystrophy, glycogen storage disease, mucopolysaccharidosis followed up in 2010–2019. We used data from patient complaints, anamnesis vitae and anamnesis morbi, laboratory test results and list of clinical symptoms in the debut of genetic diseases. The statistical processing was performed by using parametric and nonparametric methods. Confirmation of the diagnosis was obtained by molecular genetic techniques and the test for expression of urine glycosaminoglycans. Confirming diagnostic technologies were used in the laboratory of molecular diagnostics and the laboratory of inherited metabolic diseases at the Bochkov Research Centre for Medical Genetics (Moscow).Results. A comparative analysis of medical history and clinical and laboratory data was performed in 9 patients with Duchenne — Becker muscular dystrophy, 5 patients with glycogen storage disease, and 3 children with mucopolysaccharidosis. Prolonged neonatal jaundice was observed in 22.2% of newborns with Duchenne muscular dystrophy. In myopathies, elevated transaminases originate from destroyed muscle fibers and are not associated with the breakdown of the liver cells. This fact is also confirmed by our discovery of a direct correlation between AST (r = 0.76) and ALT (r = 0.72) values with high activity of creatine phosphokinase (CPK), p < 0.05. Prolonged neonatal jaundice was observed in 40% of children with glycogen storage disease. Hepatomegaly was detected in all cases, due to which the volume of the abdomen increases giving a specific form to patients against the background of overweight, lag in physical development due to low growth in 80% of cases and a “puppet face” in 100% of children. There is strong correlation between the increased alkaline phosphatase and AST (r = 0.78), ALT (r = 0.81), p < 0.05. In the third group, there are three children with mucopolysaccharidosis. We did not find any significant increase in transaminases in this group of children.Conclusion. Against the background of progressive Duchenne — Becker muscular dystrophy, hyperenzymemia is detected in each male patient. There is correlation between elevated transaminases and high creatine phosphokinase. Cytolysis syndrome was found only in some cases of glycogen storage disease, and hyperenzymemia occurs against the background of typical clinical symptoms of the disease. In cases of mucopolysaccharidosis we have found no elevated transaminases, but there is hepatomegaly. In case of prolonged unexplained cytolysis syndrome, the pediatrician should conduct a diagnostic search to identify or exclude genetic diseases.

Clinical case of mixed infection of Viral hepatitis E and Infectious mononucleosis

The article considers a case from clinical practice: mixed infection of viral hepatitis E and infectious mononucleosis caused by Epstein-Barr virus in a boy of 15 years. The patient was long observed by a pediatrician with a diagnosis of lacunar tonsillitis, hospitalized on the 10th day of the disease in an infectious diseases hospital with a preliminary diagnosis of infectious mononucleosis. Objectively, in addition to acute tonsillitis, detected polylithionite, hepatosplenomegaly. The biochemical analysis of blood revealed a pronounced cytolysis syndrome, a study on the markers of viral hepatitis (revealed anti-HEV IgM). Discharged on the 28th day of the disease with residual effects.

Clinical and epidemiological characteristics of measles in adults residents of the Altai territory

The aim of the study is to determine the clinical and epidemiological features of measles in the Altai territory. Materials and methods: a retrospective analysis of 92 medical histories of inpatient patients with a confirmed diagnosis of «Measles» at the age of 17 to 54 years, who were treated in the Infectious Departments of City Hospitals № 5 and №11 in Barnaul in 2015–2018, was made. Results: the epidemic situation of measles in the Altai territory is characterized by an increase of morbidity rate in 2015, as well as isolated cases in 2017–2018. The peculiarity of the outbreak of the disease was in-hospital infection of patients upon admission to medical hospitals and late diagnosis of measles, as well as the importation of infection from adjacent territories (regions of Russia and the Republic of Kazakhstan), which is confirmed by genotyping of the virus in patients. The development of the disease in 23,9% of those,who were vaccinated, was routinely observed in the age group older than 30 years. In the clinical picture of measles at the present stage, along with the classical manifestations, in 15.2% of patients in the first days of the disease gastroenteritis was marked, in 40,2% of patients the signs of hepatitis (cytolysis syndrome) were observed. Conclusion: the prevalence among the patientspersons, older than 30 years, may indicate the extinction of post-vaccination immunity. Timely immunization against measles in adulthood (after 30 years), will increase the effectiveness of measures to implement the program of elimination of measles in the Altai territory. The development of gastroenteritis up to the 5 days of the disease (on average 2,5±0.9 days), hepatitis in the period of height of the disease (in 15,2% and 40,2% of patients, respectively), determined the erroneous diagnosis of «Enterovirus infection», pseudotuberculosis, etc. and deserved the attention of practitioners.

Metabolic responses in endurance horses at exhausted syndrome

The article shows the results of the study of biochemical blood indices in sports horses. It is shown that in horses after exercise developing the metabolic syndrome which is a result of insufficient supply of organs and tissues of energy accompanied by development of dehydration, cytolysis syndrome, uremic syndrome, electrolyte imbalance. Evaluation of cardiac output in horses must be performed during and after physical exertion, when during latent disease manifests itself clinically. It is important to know the ways of flowing the course of metabolic processes that occur in the body of horses during physical activity of varying intensity. The most common reason for excluding horses from sports events is metabolic disorders and cardiovascular dysfunction. The aim of the work was to investigate changes in biochemical blood parameters in sports horses after physical exertion. The material for research was horses, which are used in classical equestrian sports. In all horses the general analysis and biochemical parameters of blood, characterizing the functional state of the organs (heart, liver, kidneys) were investigated. The most frequent in horses for physical overstrain is registered increased fatigue, dyspnea, tachycardia, less frequent arrhythmias. In sports horses after exercise develops dehydration (hyperproteinemia), uremic syndrome (increasing the concentration of urea and creatinine), cytolysis syndrome (activity increase of AST and ALT), electrolyte imbalance (decrease in serum sodium and potassium). Hyperlactatemia that occurs in horses during exercise causes changes in the permeability of cardiomyocytes and exit enzymes in the blood and can play a key role in the pathogenesis of myocardial dystrophy. Installed tests can serve for early diagnosis of metabolic syndrome in horses for exercise.