Modern approach to the diagnosis and treatment of thrombocytopenia

Normally, the number of platelets in a healthy adult is in the range of 150-320 x 10⁹. A condition in which their number falls below 150x10⁹ is called thrombocytopenia. It can be both associated with a violation of the process of platelet formation in the bone marrow (in particular, with aplastic anemia, hemoblastosis, thrombocytopenic purpura), and be a concomitant pathology, for example, be a consequence of drug treatment of a number of somatic diseases. In the pathogenesis of thrombocytopenia, three main directions are distinguished: a decrease in platelet production, an acceleration of their decay and a violation of the distribution of the platelet pool with their sequestration in the spleen. Most often, drug thrombocytopenia develops against the background of the use of cytostatics, chloramphenicol, antithyroid drugs, NSAIDs. The decrease in the number of platelets can also be influenced by the regular use of alcohol, some infectious diseases, and immunodeficiency states. The main clinical manifestation of thrombocytopenia is hemorrhagic syndrome, proceeding as petechial rashes or ecchymosis, however, in some cases, clinical manifestations may be absent, and then the diagnosis is made on the basis of a clinical blood test. Treatment of thrombocytopenia is carried out taking into account the etiological factor that caused it.

Metabolic diseases in cattle

The main trend in the development of dairy farming in the Russian Federation suggests maximising milk yield and reducing milk net cost. The economic effectiveness of industrial dairy farming is largely determined by adequate feeding, as well as effective system of measures to ensure animal health and prevent infectious and non-infectious mass diseases. The main reason for the premature retirement of highly productive cows is based on the factors typical of the intensive technologies used in dairy cattle breeding, which lead to the occurrence of metabolic diseases. It is established that the intensity of metabolism is directly linked to the high productivity of cows. With a highly concentrated, mainly silage-based type of feeding, an imbalance of nutrients is often recorded, in particular as regards the sugar/ protein ratio, leading to deep metabolic disorders and the development of immunodeficiency states. Metabolic disorders in highly productive cows occur as a result of unbalanced diets as far as protein, carbohydrates, vitamins and minerals are concerned. Acidosis, ruminitis and hepatosis are recorded in disordered cows and heifers. The service period exceeds 100 days in 70–75% of cows. Hepatosis and immunodeficiency states are often found in calves born to cows with signs of deep metabolic disorders. Metabolic disorders often remain unnoticed and become apparent only when pronounced pathological changes occur resulting in decreased productivity and ability to reproduce resistant young animals, as well as culling of animals. Metabolic diseases were recorded in 30–70% of cows examined in large dairy farms. The average lifetime productivity of high-yielding cows is (2.1 ± 0.15) lactations in Russia. The results of epidemiological investigations and laboratory testing of sera samples showed that emulsion inactivated vaccines administered to immunodeficient cattle induce higher titres of virus-specific antibodies than those in animals vaccinated with adsorbed vaccines.

COVID-19 Outcomes in Patients Undergoing B Cell Depletion Therapy and Those with Humoral Immunodeficiency States: A Scoping Review

Background: The role of humoral immunity has been well established in reducing infection risk and facilitating viral clearance in patients with COVID-19. However, the relationship between specific antibody responses and severity of COVID-19 is less well understood. Methods: To address this question and identify gaps in knowledge, we utilized the methodology of a scoping review to interrogate risk of infection and clinical outcomes of COVID-19 in patients with iatrogenic and inborn humoral immunodeficiency states based on existing literature. Results: Among patients with iatrogenic B-cell depletion, particularly with agents targeting CD20, our analysis found increased risk of severe COVID-19 and death across a range of underlying disease states. Among patients with humoral inborn errors of immunity with COVID-19, our synthesis found that patients with dysregulated humoral immunity, predominantly common variable immunodeficiency (CVID), may be more susceptible to severe COVID-19 than patients with humoral immunodeficiency states due to X-linked agammaglobulinemia and other miscellaneous forms of humoral immunodeficiency. There were insufficient data to appraise the risk of COVID-19 infection in both populations of patients. Conclusions: Our work identifies potentially significant predictors of COVID-19 severity in patients with humoral immunodeficiency states and highlights the need for larger studies to control for clinical and biologic confounders of disease severity.

Human papilloma virus in the urethra in HIV-infected men in the Рrimorsk region

Objective of the study: identification of HPV and identification of the most common types in urethral swabs taken from HIV-1- infected men, as well as determination of the dependence of the presence of HPV in patients with HIV viral load (VL) and CD4 + T-lymphocyte count.Materials and methods. The study included 34 HIV-1-infected men being monitored at the Center for the Prevention and Control of AIDS and Infectious Diseases (Vladivostok). They were asked to undergo a urological examination, including the collection of urethral swabs, as well as a face-to-face interview to collect socio-demographic, behavioral and clinical-anamnestic data.Results. HIV-1-infected patients (34 people) included in the study were 25–60 (37,8±7,1) years old. HPV was detected in 23 (67,6%) patients aged 25–45 (37,8±5,5) years. The vast majority of patients with multiple HPV infection reported having had sex with three or more sexual partners and did not always use a condom, and 17.4% of the men surveyed said they never used one. In the past, 47.8% of HPV-positive patients used narcotic substances, and 30.4% of the respondents, at the time of the survey, were active users of psychoactive substances. In 23 HIV 1-infected men, 9 genotypes were identified — 6 (HPV-HP), 16, 18, 33, 35, 52, 53, 58, 73 (HPV-VR) — belonging to 5 types of HPV: AlphaPV-6, AlphaPV-7, AlphaPV-9, AlphaPV-10, AlphaPV-11. In 5 patients, coinfection of two genotypes was revealed, in 3 — two types of HPV. The most common genotype was HPV-16 (30,4%) and HPV-18 (26,1%), the least HPV-{6, 58, 73} (1/23≈4,3%). The presented results indicate the need to create diagnostic programs focused on early detection of cancer of the anogenital region in persons of both sexes in patients with immunodeficiency states, primarily in HIV 1-positive patients with HPV-HR.

COVID-19 Outcomes in Patients Undergoing B Cell Depletion Therapy and Those With Humoral Immunodeficiency States: A Scoping Review

The role of humoral immunity has been well established in reducing infection risk and facilitating viral clearance in patients with COVID-19. However, the relationship between specific antibody responses and severity of COVID-19 is less well understood. To address this question and identify gaps in knowledge, we utilized the methodology of a scoping review to interrogate risk of infection and clinical outcomes of COVID-19 in patients with iatrogenic and inborn humoral immunodeficiency states based on existing literature. Among patients with iatrogenic B cell depletion, particularly with agents targeting CD20, our analysis found increased risk of severe COVID-19 and death across a range of underlying disease states. Among patients with humoral inborn errors of immunity with COVID-19, our synthesis found that patients with dysregulated humoral immunity, predominantly common variable immunodeficiency (CVID), may be more susceptible to severe COVID-19 than patients with humoral immunodeficiency states due to X-linked agammaglobulinemia and other miscellaneous form of humoral immunodeficiency. There were insufficient data to appraise the risk of COVID-19 infection in both populations of patients. Our work identifies potentially significant predictors of COVID-19 severity in patients with humoral immunodeficiency states and highlights the need for larger studies to identify clinical and biologic confounders of disease severity.

SECONDARY IMMUNODEFICIENCY STATES IN THE ACTIVITY OF A GENERAL PRACTITIONER – FAMILY MEDICINE AND PHYTOTHERAPEUTICWAYS OF THEIR CORRECTION (LECTURE)

Keywords: secondary immunodeficiency states, diagnosis, treatment, phytoimmunomodulators. Topicality. Secondary immunodeficiency states (SIS) is a fairly common phenomenon in the clinic of internal medicine as an “addition” for many diseases, which has no clear clinical signs, so it is not often diagnosed by primary care physicians. However, untimely detection and correction of SI significantly worsens the overall results of treatment and contributes to recurrence of the underlying disease.There is a prospect of further increase in the prevalence of SI, the success of correction of underlying desease due to doctors’ understanding of their clinical and pathogenetic features and knowledge of treatment strategies and tactics, including the use of phytotherapeutic agents. The aim is to highlight modern approaches to the diagnosis and treatment of SI with the use of phytotherapeutic agents. Materials and methods. Materials of the main domestic and foreign printed sources of information using methods of comparison, analysis and generalization are used. Results. Information on the classification, diagnosis, strategy and tactics of treatment and prevention of SIS depending on their severity with the use of various phytotherapeutic agents, criteria for treatment effectiveness, age and somatic aspects of rehabilitation at the outpatient stage are analyzed. The importance of timely diagnosis of secondary immunodeficiency and the use of phytotherapeutic agents in the context of the “WHO Strategy in the field of folk medicine for 2014-2023” as the latest and most effective approach in the treatment of complex pathological phenomena.

Comorbidity in patients with lymphoproliferative diseases

Purpose of the study. To make an informed assessment of comorbidity in patients with lymphoproliferative diseases. To evaluate the effectiveness of comorbidity scales CCI and CIRS-G in patients with lymphoproliferative diseases under treatment. To evaluate the effect of the conducted immunochemotherapy on the general comorbidity in this category of patients.Material and methods. Two scales were used for calculations: Charlson Comorbidity Index (CCI) and Cumulative Illness Rating Scale for Geriatrics (CIRS-G). 127 primary patients with lymphoproliferative diseases aged 19 to 95 years old (the average age was 51.4) were examined from January 2018 till October 2019. The distribution of patients was based on the types of diseases: non-Hodgkin’s lymphomas — 59 (46.46%), Hodgkin’s lymphoma — 35 (27.56%), multiple myeloma — 20 (15.77%), chronic lymphocytic leukemia — 7 (5.51%) people, Waldenstrom’s macroglobulinemia — 3 (2.36%); each of the following diseases: hairy cell leukemia, T-cell leukemia of large granular lymphocytes, T-cell prolymphocytic leukemia - 1, amounted to 0.78% each.Results. Comorbidity was detected in 46 patients who received immunotherapy, chemotherapy, combined chemoradiotherapy, which amounted to 36.22% of the total number of patients. Lesions of the peripheral and central nervous system — 20 (43.48%) patients, were diagnosed most frequently. Immunodefi ciency states — 19 (41.30%) people, came next, and diseases of the cardiovascular system — 12 (26.08%) patients, appeared to be least frequent.Conclusions. When recalculating comorbidity on the CCI and CIRS-G scales, a significant aggravation of comorbidity after treatment, an increase in moderate and severe comorbidity were noted. According to the effectiveness of the CCI and CIRS-G scales in the treated patients, comorbidity is evaluated only approximately, since the Charlson Comorbidity Index does not include polyneuropathy, immunodeficiency states, thrombosis, ischemic heart disease, cardiac arrhythmias, gastritis, and thromboembolic complications and immunodeficiency states are absent in the CIRS-G scale. It is advisable to develop scales for assessing comorbidity, free from disadvantages mentioned above.

HIV infection in nurse practice

This article focuses on the issues of classification, clinical manifestations, and approaches to the diagnosis of HIV infection and the possibility of using the domestic drug Licopid in the therapy of secondary immunodeficiency states.

The use of the immunomodulating effects of Immunomax® in the practice of a therapist

The analysis of the clinical and immunological effectiveness of the drug Immunomax® in the treatment of chronic diseases of bacterial, viral, or mixed etiology. Analysis of bibliographic systems shows an increase in publications devoted to the analysis of the clinical and immunological efficacy of the Immunomax® drug, which indicates the attention of researchers to this immunomodulator, the validity of its use in dysfunctions of factors of innate and adaptive immunity arising from bacterial and viral infections, secondary immunodeficiency states with impaired killer, phagocytic functions of secretory mechanisms, the process of generating and maintaining the balance of cytokines.

Violation of the factors of antimicrobial protection of the oral cavity and their correction

The article presents an analysis of the factors of protection of the oral cavity, the reasons for their violation are determined. We found that the activation of pathogenic microflora of the oral cavity depends on local and general immunity. Based on the clinical and laboratory manifestations of immunodeficiency states of the oral cavity, they described the principles of biological treatment and immunoprophylaxis of the main diseases of the oral cavity.