THE EFFECT OF HYPOXIC BRAIN DAMAGE ON THE SURVIVAL OF PREMATURE INFANTS

The central nervous system injuries are a common neonatal pathology, hypoxia being one of the main causes of cerebral dysfunction. The purpose of this study was studying the incidence of hypoxic cerebral disorders in premature infants with an extremely low body weight and a very low birth weight and revealing the risk factors that adversely affected the disease outcome. The subject of the study was preterm infants whose gestational age did not exceed 31 weeks. The main criterion for inclusion into the study was the presence of hypoxic-ischemic and hypoxic-hemorrhagic brain damage. To reveal the perinatal risk factors, the somatic health of mothers, and pregnancy and childbirth peculiarities were studied. The structure of children’s pathology and intensive care techniques were analyzed. Cerebral disorders were verified in 42 out of 176 patients (23.5 %). 2–3rd-degree intraventricular hemorrhage was diagnosed in 34 newborns (80.9 %), severe ischemia in 8 children (19.1 %). To determine the structure of the disease outcome, all children were divided into deceased and survivors. A fatal outcome was observed in 14 cases (33.3 %). The mothers of deceased children were more likely to have obstetric and concomitant extragenital pathologies. Analysis of pediatric pathology showed that the hemodynamically significant functioning arterial duct and severe asphyxia in childbirth were much more frequent in deceased children. Intensive therapy of deceased children included «hard» parameters of artificial ventilation and high doses of cardiotonic drugs. Thus the presented risk factors can be considered as predictors of an unfavorable outcome in children with this pathology

Differential diagnosis of hypercalcemia in a patient with CKD G5D

Patients with chronic kidney disease are characterized by the development of mineral disorders due to a decrease in the number of functioning nephrons. These changes manifest by the development of secondary hyperparathyroidism (the overproduction of intact parathyroid hormone (PTH) associated with the serum hypocalcemia, hyperphosphatemia), dysfunctional vitamin D metabolism, bone mineralization and also extraosseous calcifications. Decreased serum PTH levels associated with hypercalcemia are suspicious for adynamic bone disease, but at the same time requires an extended differential diagnostic search (e.g. metastatic processes). One of the rare causes of hypercalcemia is a defect in 24-hydroxylase (CYP24A1). We present a case of a patient on hemodialysis with atypical secondary hyperparathyroidism and an established CYP24A1 defect

Dihydrotachysterol: a bad choice in the treatment of chronic hypoparathyroidism

Hypoparathyroidism is an endocrine disease caused by damage of the parathyroid glands and characterized by underproduction of parathyroid hormone. This can lead to severe hypocalcemia and its associated complications. The chronic hypoparathyroidism requires lifelong therapy including calcium and vitamin D analogues. The goal of treatment is to maintain the target parameters of phosphorus-calcium metabolism. At the same time, there is a risk of iatrogenic hypercalcemia on the standard therapy, up to the hypercalcemic crisis, often complicated by the acute renal failure. Moreover, chronic hypercalcemia acts as a predisposing factor for nephrolithiasis, nephrocalcinosis, chronic renal failure including pre- and dialysis stages.Dihydrotachysterol is a synthetic analogue of vitamin D, which was previously widely prescribed for hypocalcaemic hypoparathyroidism. In accordance with modern Russian and international guidelines, this drug should not be used in the treatment of chronic hypoparathyroidism. The main features in the metabolism of dihydrotachysterol (long elimination period, lack of feedback regulation of the active metabolites, high biological activity) and a narrow therapeutic window cause the frequent development of hypercalcemia and associated disorders.We present several clinical cases of patients with hypoparathyroidism treated with dihydrotachysterol, which was complicated by severe hypercalcemia and acute renal failure

The experimental model of laboratory animals’ intoxication by polyacrylonitrile pyrolysis products

Purpose of research – To develop an experimental model of intoxication of laboratory animals by polyacrylonitrile pyrolysis products. Materials and methods. The study was performed on the rats. Pyrolysis of polyacrylonitrile fibers was carried out at temperature of 270–350 °C. The laboratory animals were exposed to static inhalation intoxication by pyrolysis products for 15 min. Vital signs were determined in animals before and 5 minutes after intoxication. Arterial blood oxygenation index and acid-base state parameters were evaluated at 10 min after exposure. Qualitative detection of cyanides in brain and myocardial samples obtained 15 minutes after intoxication was carried out by gas chromatography. Results and discussion. It was found that the weight of the material (containing 85 % polyacrylonitrile), which pyrolysis products lead to the death of 50 % of laboratory animals within 24 hours after exposure, was 0.81 ± 0.15 g. The animals showed signs of poisoning by substances interrupting the processes of cell bioenergy when exposed to pyrolysis products obtained under specified conditions. The evident bradycardia and bradypnea (p < 0,05), and significant decrease in rectal temperature was marked. The exposed animals did not differ (p > 0,05) from the rats of the control group by the parameters of oxygenation. The signs of decompensated metabolic acidosis were detected in blood. The cyanide peak was detected by gas chromatography with a retention time of 3.78 min in brain and heart muscle biopsies. The experimental model, in which inhalation exposure of pyrolysis products of polyacrylonitrile fibers led to severe intoxication of laboratory animals, was developed. The model can be used to search for means of etiotropic and pathogenetic therapy of poisoning by combustion products of nitrogen-containing polymeric materials

Soluble endoglin as a perspective marker of endothelial dysfunction in patients with primary hyperparathyroidism: a pilot study

BACKGROUND: Primary hyperparathyroidism  (PHPT), one of the most common endocrine pathologies, is associated with a higher incidence of cardiovascular diseases, in particular, those caused by endothelial dysfunction. Evaluation of endothelial dysfunction in patients with PHPT will predict the development of cardiovascular pathology and determine the optimal tactics for PHPT management.AIM: To evaluate the concentration  of soluble endoglin  and photoplethysmographic parameters as potential markers of endothelial dysfunction in patients with PHPT.MATERIALS AND METHODS:  A single-center interventional single-stage study was carried out. 2 groups were formed. The first group included 50 patients with verified PHPT who did not have cardiovascular or other concomitant somatic pathologies in anamnesis. The comparison group included 21 healthy volunteers comparable in sex and age. All participants underwent a biochemical blood test (total calcium, ionized, albumin, lipidogram, urea, uricacid, glucose, creatinine, alkaline phosphatase), parathyroid hormone, 25 (OH) D and endoglin concentrations were evaluated. In addition, echocardiography, ultrasound of the brachiocephalic arteries and arteries of the lower extremities, as well as photoplethysmography were performed.RESULTS: The groups differed in mineral parameters associated with PHPT; no differences were found in parameters of lipid, uric acid and carbohydrate metabolism. Serum levels of endoglin  were lower in PHPT patients (p=0.002). We found a negative correlation between the concentration of albumin-corrected calcium and PTH with endoglin (r1=-0.370, p1=0.003 and r2=-0.475, p2<0.001, respectively) and a positive correlation between the concentration of endoglin  and phosphorus (r=0.363, p=0.003). These associations s were accompanied by changes in photoplethysmographic parameters that indicate an increase in the vascular wall stiffness.CONCLUSION: The serum level of soluble endoglin  is lower in patients with PHPT than in healthy volunteers, negatively correlates with calcium and PTH concentrations and positively with serum phosphorus concentrations. Further studies will make it possible to establish the pathogenetic mechanism of the identified relationships and evaluate the role of endoglin as a potential predictor of cardiovascular pathology in PHPT population

Changes of metabolic parameters in patients with primary hyperparathyroidism of different age groups

BACKGROUND: Studies have shown a high incidence of metabolic disorders and cardiovascular diseases in patients with primary hyperparathyroidism (PHPT). PHPT is usually diagnosed in people of age over 50 years and therefore age-associated changes of metabolism should be excluded. Researching predictors of cardiovascular pathology contributes to choosing optimal approaches to personalized patient management.AIM: To determine the features of metabolic disorders in patients of various age groups with confirmed active stage of PHPT.MATERIALS AND METHODS: A single-center observational retrospective comparative study of patients with active PHPT at the age of 18-49 years (Group 1, n=66) and over 50 years (Group 2, n=290) was carried out. The exclusion criteria for both groups were: persistent PHPT or recurrence after surgical treatment of the disease in history; clinical/genetically confirmed multiple endocrine neoplasia syndrome; for Group 1 — pregnancy, lactation. The assessment of laboratory parameters of mineral, carbohydrate, fat and purine metabolism obtained during a hospital examination was carried out, the frequencies of various metabolic disorders were determined and compared between age groups.RESULTS: There were no significant differences in parathyroid hormone and serum calcium levels between age groups, however, there were more severe hypercalciuria, a tendency to active bone metabolism and lower vitamin D level in Group 1. Patients of Group 2 had statistically significantly lower glomerular filtration rate and a higher frequency of bone complications. In the same group glycaemia and triglycerides levels were higher (the latter difference has the level of a statistical tendency). These patients also had a higher body mass index and, as a result, a higher incidence of obesity (37% vs 20%, p=0.006) and diabetes mellitus type 2 (12.5% vs 3%, p=0.013). At the same time, patients did not significantly differ in the rates of hypercholesterolemia (62% in Group 1 vs 70% in Group 2, p=0.228), hypertriglyceridemia (27% vs 32%, p=0.433) and hyperuricemia (42% vs 50%, p=0.302), significantly exceeding similar indicators in the general Russian population.CONCLUSION: Carbohydrate disorders are more often observed in patients older than 50 years, providing an increased prevalence of diabetes mellitus type 2 among patients with PHPT compared with the general population. The high incidence of various types of dyslipidemia and hyperuricemia in the primary parathyroid pathology has no age specific features. Thereby these disorders are significant risk factors of cardiovascular diseases, even in young people with PHPT

Micelle mediated extraction of americium and europium by calix[4]arene phosphine oxides from nitric acid media

© 2016, Akadémiai Kiadó, Budapest, Hungary.152Eu and 241Am recovery from HNO3 by conventional and micelle mediated extraction are studied. It is stated that radionuclides distribution ratios D (KD) in micelle mediated extraction are significantly higher than those of conventional extraction, with 241Am is slightly less extracted than 152Eu. Distribution ratios dependence on medium acidity is similar for both processes, with extraction maximum at C (HNO3) = 0.2–1 mol L−1. Microscopic research and dynamic light scattering prove micellar nature of calixarene solutions. Nano-scale of particles, which accumulate radionuclides, is confirmed by ultramicrofiltration. This method is also applied for studies of radionuclides re-extraction and electrochemical deposition

The case of oncogenic hypophosphatemic osteomalacia

Osteomalacia is a systemic bone disease, characterized by an excessive accumulation of non-mineralized osteoid and an imbalance in the organic matrix formation and mineralization. A rare cause of disease is tumor-induced osteomalacia, most often due to phosphaturic mesenchymal tumors (PMT). Usually there are benign small tumors, affecting the soft tissues and bones of any location. The basic pathogenesis of underlying oncogenic osteomalacia is a decreased renal tubular reabsorption of phosphate consequent to hyperproduction of fibroblast growth factor 23 in PMT. Clinical features are nonspecific, the average period from the symptoms onset to diagnosis reaches 3 years and at least 5 years before surgical treatment. Finding the tumour is crucial, as complete removal is curative. We present a clinical case of tumor-induced osteomalacia due to PMT required the complex differential diagnosis with other rare diseases

Study of the basic drinking regime of students

The aim of the study – to analyze the drinking regime of students during the educational process at the university.Цель исследования – проанализировать питьевой режим студентов во время учебного процесса в университете