Информативность маркеров метаболизма железа в дифференциальной диагностике анемии воспаления у детей с хронической HBV-инфекцией

Objective: To assess diagnostic importance of iron metabolism markers in the progression of anemia of inflammation (AI) in children with chronic HBV infection.Materials and methods: Among 148 examined children with chronic HBV infection 140 had AI, 60.7% of them with refractory (RA) and 39.3% with non-refractory (nRA) progression variant. Complete blood count was performed using hematologic automatic analyzer. Virologic verification of HBV was done by ELISA and PCR. ELISA was used to determine 25-hepcidin, serum iron, ferritin, trasferrin, sTfR, IL-1, IL-6. The index sTfR/log10Ft was calculated.Results: Performing the examination of children with chronic HBV infection we determined high prevalence of AI, equal to 94.6%, which was characterized by normocyte normochromic progression, thrombocytopenia, thrombocrit decrease in case of RA, and microcyte hypochromic progression with erythrocyte anisocytosis in case of nRA. Despite the high inflammatory index induced by HBV viral replication, children with RA had characteristic decrease in 25-hepcidin and transferrin parameters with background high values of ferritin, while nRA was characterized by rise of 25-hepcidin and transferrin spectrum with low values of serum iron and ferritin.Conclusions. In the genesis of AI in chronic HBV cases two pathogenic variants were determined: true iron deficiency with ferromarkers in the type of IDA characteristic for nRA and redistribution iron deficiency compliant to hemosiderosis characteristic for RA. Priority in the differential diagnosis of AI variants is given to the comparison of sTfR/log10Ft index parameters (RA<1.0; nRA>2.0) with reference level of 25-hepcidin<28,68ng/ml in case of RA, and >56,37ng/ml in case of nRA.Цель: оценить диагностическую значимость маркеров метаболизма железа в течении анемии воспаления при хронической HBV-инфекции у детей.Материалы и методы: обследовано 148 детей с хронической HBV-инфекцией. У 140 детей выявлена анемия воспаления, из них 60,7% с рефрактерным (РА), 39,3% с нерефрактерным (нРА) вариантом течения. Общий анализ крови проводили на гематологическом автоматическом анализаторе. Вирусологическую верификацию HBV проводили методом ИФА и ПЦР. Методом ИФА определяли гепсидин-25, сывороточное железо, ферритин (Ft), трансферрин (Tf), растворимые трансферриновые рецепторы (sTfR), провоспалительные цитокины (IL-1, IL-6). Вычислялся индекс sTfR/log10Ft.Результаты: в ходе исследования детей с хронической HBV-инфекцией установлена высокая частота анемии воспаления – 94,6%, которая при РА характеризовалась нормоцитарным нормохромным течением, тромбоцитопенией и снижением тромбокрита, при нРА – микроцитарным гипохромным течением с анизоцитозом эритроцитов. Несмотря на высокий воспалительный индекс, индуцированный HBV-вирусной репликацией, для детей с РА характерно снижение значений гепсидина-25 и трасферриновых параметров на фоне высоких значений ферритина, для нРА – повышение гепсидина-25 и трансферринового спектра на фоне сниженных значений сывороточного железа и ферритина.Заключение. При хронической HBV-инфекции у детей в генезе развития анемии воспаления установлено два патогенетических варианта: «истинный» дефицит железа с раскладкой ферромаркеров по типу железодефицитной анемии, характерный для нРА, и перераспределительный дефицит железа по типу гемосидероза, свойственный для РА. Приоритетом в дифференциальной диагностике вариантов анемии воспаления является сопоставление параметров индекса sTfR/log10Ft (РА<1,0; нРА>2,0) с ориентировочным уровнем гепсидина-25: при РА<28,68ng/ml, при нРА>56,37ng/ml. Своевременная дифференциальная диагностика вариантов течения анемии воспаления позволяет исключить необоснованное назначение препаратов железа и способствовать снижению развития прогрессирующих форм хронической HBV-инфекции у детей.

Хронический гепатит в у детей – носителей гена гемохроматоза HFE

Purpose: to establish the frequency and clinical significance of mutant variations of the HFE gene polymorphism in chronic hepatitis B (CHB) in children with iron overload syndrome (IOS).Materials and methods: 60 children with chronic hepatitis B with iron overload syndrome (IOS) were examined. When distributing children into groups, we took into account the criteria we developed for assessing the degree of life expectancy in children with CHB: CST>0.5 – mild degree of life expectancy (43,3% of children), CST˃0.5 – mild degree of life expectancy (43,3% of children), CST˂0,5 – moderate severity of life expectancy (31,7% of children) and CST˂0,2 – severe degree of SPL (25,0%). Virological verification of HBV was performed by ELISA and PCR. Using PCR Real Time and molecular genetic analysis, HFE gene C282Y, H63D, S65C mutations were detected from amplified DNA using the PRONTO Hemochromatosis reagent kit (Israel). The transferrin saturation coefficient (CST) was calculated using the formula CST = sTfR / log10.Ft. Results:Results: The study of the hemochromatosis gene HFE showed that the overwhelming majority (84,0%) of children with CHB with IOS were carriers of heterozygous, phenotypically different, mutant types. And only 16,0% of sick children were homozites of the wild (normal) HFE gene. Analysis of the phenotypic polymorphism of the hemochromatosis gene HFE revealed the presence of three point heterozygous mutations: H63D, S65C and combined variations in H63D / S65C, the latter of which is associated with severe forms of CHB and severe IOS.Conclusion. Children with CHB with IOS are characterized by a high incidence of heterozygous mutations in the HFE gene, the phenotypic manifestations of which were S65C, H63D, H63D / S65C. The comparability of the heterozygous combined mutation H63D / S65C with severe forms of CHB and a severe degree of IOS gives grounds to consider this phenotype of the HFE gene as a factor in the progression of the disease.Цель: установить частоту и клиническую значимость мутантных вариаций полиморфизма гена HFE при хроническом гепатите В у детей с синдромом перегрузки железом.Материалы и методы: обследовано 60 детей, больных хроническим гепатитом В с синдромом перегрузки железом. При распределении детей на группы учитывались разработанные нами критерии оценки степени синдрома перегрузки железом у детей с хроническим гепатитом В: КНТ>0,5 – легкая степень синдрома перегрузки железом (43,3% детей), КНТ<0,5 – среднетяжелая степень синдрома перегрузки железом (31,7% детей) и КНТ><0,2 – тяжелая степень синдрома перегрузки железом (25,0%). Вирусологическую верификацию HBV проводили методом ИФА и ПЦР. Методом PCR Real Time и молекулярно-генетического анализа проводили детекцию мутаций C282Y, H63D, S65C гена HFE из амплифицированной ДНК с использованием набора реактивов «PRONTO Hemochromatosis» (Israel). Вычисляли коэффициент насыщения трансферрина (КНТ) по формуле КНТ= sTfR/log10.Ft. Результаты: исследование гена гемохроматоза HFE показало, что подавляющее большинство (84,0%) детей, больных хроническим гепатитом В с синдромом перегрузки железом являлись носителями гетерозиготных, различных по фенотипу, мутантных типов. И только 16,0% больных детей являлись гомозитами дикого (нормального) гена HFE. Анализ фенотипического полиморфизма гена гемохроматоза HFE выявил наличие 3 точечных гетерозиготных мутаций: H63D, S65C и сочетанных вариаций H63D/S65C, последний из которых сопряжен с выраженными формами ХГВ и тяжелой степенью СПЖ. Заключение. Для детей, больных хроническим гепатитом В с синдромом перегрузки железом, характерна высокая частота развития гетерозиготных мутаций гена HFE, фенотипическим проявлением которых явились S65C, H63D, H63D/S65C. Сопоставимость гетерозиготной сочетанной мутации H63D/S65C с выраженными формами ХГВ и тяжелой степенью СПЖ дает основание рассматривать данный фенотип гена HFE как фактор прогрессирования заболевания.>˃ 0,5 – легкая степень синдрома перегрузки железом (43,3% детей), КНТ˂ 0,5 – среднетяжелая степень синдрома перегрузки железом (31,7% детей) и КНТ˂ 0,2 – тяжелая степень синдрома перегрузки железом (25,0%). Вирусологическую верификацию HBV проводили методом ИФА и ПЦР. Методом PCR Real Time и молекулярно-генетического анализа проводили детекцию мутаций C282Y, H63D, S65C гена HFE из амплифицированной ДНК с использованием набора реактивов «PRONTO Hemochromatosis» (Israel). Вычисляли коэффициент насыщения трансферрина (КНТ) по формуле КНТ= sTfR/log10.Ft.Результаты: исследование гена гемохроматоза HFE показало, что подавляющее большинство (84,0%) детей, больных хроническим гепатитом В с синдромом перегрузки железом являлись носителями гетерозиготных, различных по фенотипу, мутантных типов. И только 16,0% больных детей являлись гомозитами дикого (нормального) гена HFE. Анализ фенотипического полиморфизма гена гемохроматоза HFE выявил наличие 3 точечных гетерозиготных мутаций: H63D, S65C и сочетанных вариаций H63D/S65C, последний из которых сопряжен с выраженными формами ХГВ и тяжелой степенью СПЖ.Заключение. Для детей, больных хроническим гепатитом В с синдромом перегрузки железом, характерна высокая частота развития гетерозиготных мутаций гена HFE, фенотипическим проявлением которых явились S65C, H63D, H63D/S65C. Сопоставимость гетерозиготной сочетанной мутации H63D/S65C с выраженными формами ХГВ и тяжелой степенью СПЖ дает основание рассматривать данный фенотип гена HFE как фактор прогрессирования заболевания

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

The Parallelism of Dream in the Works of Nizami Ganjavi and Yunus Emre: in the Context of Spirit and Body

The article deals with an analysis of the frequency of using the archetype of a dream in the poetry of both poets. We shed light on the matters related to the symbols of the dream. The ideas of the authors treating this problem from various standpoints are analyzed. The article touches upon the reality of the scientific ideas expressed by the great Azerbaijani poet Nizami Ganjavi. It is known that the poet used the archetype of dream both in the epic plots and in the lyrical works as literary details. In this article, the matter of description of the dream is touched upon and the development of this archetype in various forms is stressed. It sheds light on the physiological and psychological sides of dreaming in connection with the mentioned problem. Despite the century passed between 12 and 13-the centuries, the author tries to analyze the proximity of ideas regarding this problem and the different sides are indicated. Finally, Islamic thought is investigated regarding the problem of dreaming

Synthesis of fe/ni bimetallic nanoparticles and application to the catalytic removal of nitrates from water

This work investigated the effectiveness of zerovalent iron and Fe/Ni bimetallic nanoparticles in the treatment of water polluted by a high concentration of nitrates. Nanoparticle synthesis was carried out by a sodium borohydride reduction method in the presence of sodium oleate as a surfactant. The particles were characterized by XRD and SEM. Batch experiments were conducted on water samples contaminated by 300 mg L−1 of nitrate. The parameters investigated were the Fe/Ni dosage (0.05, 0.1, 0.2, 0.3, and 0.4 g L−1) and the reaction pH (unbuffered; buffered at pH = 3; initial pH = 3, 5, and 10). The results showed that almost complete nitrate removal (>99.8%) was always achieved after 15 min at a concentration of bimetallic nanoparticles higher than 0.2 g L−1 . The optimization of bimetallic nanoparticle dosage was carried out at a fixed pH. Kinetic study tests were then performed at different temperatures to assess the effect of temperature on the nitrate removal rate. By fixing the pH at acidic values and with an operating temperature of 303 K, nitrates were completely removed after 1 min of treatment

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice

Safety and efficacy of intraperitoneal drain placement after emergency colorectal surgery. An international, prospective cohort study

Intraperitoneal drains are often placed during emergency colorectal surgery. However, there is a lack of evidence supporting their use. This study aimed to describe the efficacy and safety of intraperitoneal drain placement after emergency colorectal surgery. Method: COMPlicAted intra-abdominal collectionS after colorectal Surgery (COMPASS) is a prospective, international, cohort study into which consecutive adult patients undergoing emergency colorectal surgery were enrolled (from 3 February 2020 to 8 March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included rate and time-to-diagnosis of postoperative intraperitoneal collections, rate of surgical site infections (SSIs), time to discharge and 30-day major postoperative complications (Clavien-Dindo III-V). Multivariable logistic and Cox proportional hazards regressions were used to estimate the independent association of the outcomes with drain placement. Results: Some 725 patients (median age 68.0 years; 349 [48.1%] women) from 22 countries were included. The drain insertion rate was 53.7% (389 patients). Following multivariable adjustment, drains were not significantly associated with reduced rates (odds ratio [OR] = 1.56, 95% CI: 0.48-5.02, p = 0.457) or earlier detection (hazard ratio [HR] = 1.07, 95% CI: 0.61-1.90, p = 0.805) of collections. Drains were not significantly associated with worse major postoperative complications (OR = 1.26, 95% CI: 0.67-2.36, p = 0.478), delayed hospital discharge (HR = 1.11, 95% CI: 0.91-1.36, p = 0.303) or increased risk of SSIs (OR = 1.61, 95% CI: 0.87-2.99, p = 0.128). Conclusion: This is the first study investigating placement of intraperitoneal drains following emergency colorectal surgery. The safety and clinical benefit of drains remain uncertain. Equipoise exists for randomized trials to define the safety and efficacy of drains in emergency colorectal surgery