Difficulties in diagnosing atypical hemolytic uremic syndrome

The paper presents the case of clinical observation of a patient with atypical hemolytic-uremic syndrome (aHUS). aHUS is a disease characterized by an unfavorable prognosis (severe or catastrophic course with rapid development of terminal renal or multi-organ failure). The aim of the study is to evaluate the approaches to differential diagnosis of aHUS in clinical practice.Material and methods. The study was conducted on the basis of the Nephrology Department of Kemerovo Regional Clinical Hospital n.a. S.V Belyaev. The clinical observation of patient D., aged 26 years old, is discussed.Results and discussion. Diagnosing aHUS requires: 1) diagnosing thrombotic microangiopathy (TMA: thrombocytopenia or decrease in platelet count by more than 25 % of original, visceral damage (kidneys, CNS, gastrointestinal tract, heart, lungs)); 2) ruling out HUS associated with Shiga toxin-producing Escherichia coli (STEC-HUS; negative for Shiga-toxin in blood and stool), thrombotic thrombocytopenic purpura (TTP), systemic connective tissue disease, catastrophic antiphospholipid syndrome, HIV infection; 3) assessing the activity of ADAMTS13 (decrease confirms the aHUS diagnosis); 4) proving normal content of complement components C3 and C4 as an additional argument in favor of aHUS diagnosis. At the first stage, the patient was diagnosed with TMA (platelet content 37 x 109/l, hemoglobin content 59 g/l), LDH up to 824 E/l), liver damage (AST, ALT and LDH activity 55, 60 and 824 U/l, respectively), kidney damage (acute renal damage), lungs, heart, and brain damage. At the second stage the following diagnoses were ruled out: STEC-HUS (Shiga toxin in blood and stool was not detected), TTP (ADAMTS13 activity level was 66 %, whereas reference values are 93-113 %, in TTP - below 5-10 %); systemic connective tissue diseases catastrophic antiphospholipid syndrome, HIV infection sepsis. Normal values of C3 (0.9 g/l) and C4 (0.23 g/l) complement components did not rule out the diagnosis of aHUS

Tactics for Specialized Anti-Epidemic Team (SAET) Deployment under the Conditions of Large-Scale High Water in the Far Eastern Territory. Communication 1. Peculiarities of the Rospotrebnadzor SAET Operation in the Amur Region

Abnormal rainfall flood in the Amur-River region, July-September, 2013, set the scene for aggravation of epidemiological situation on diarrheal diseases, as well as droplet spread infections, and natural-focal infections and diseases, common for both humans and animals. To stabilize the situation in flooded areas of three territorial entities in the Far East region involved were SAETs of the Irkutsk Research Anti-Plague Institute: SAET 1 (the Amur region) and SAET 2 (the Khabarovsk Territory and Jewish Autonomous Region). Within the frames of Rospotrebnadzor Decree implementation SAET 1 was transported to the Amur Region by means of airlift. Mobile unit performed its operations independently, in an autonomous mode. Laboratory facilities were set up on the base of pneumo-framed modules. The aim of the SAET consisted in carrying out a complex of measures related to sanitary-hygienic and epidemiological monitoring in the territory of the municipal entities devastated by floods. SAET 1 completed its mission successfully

PTTG1 Attenuates Drug-Induced Cellular Senescence

As PTTG1 (pituitary tumor transforming gene) abundance correlates with adverse outcomes in cancer treatment, we determined mechanisms underlying this observation by assessing the role of PTTG1 in regulating cell response to anti-neoplastic drugs. HCT116 cells devoid of PTTG1 (PTTG1−/−) exhibited enhanced drug sensitivity as assessed by measuring BrdU incorporation in vitro. Apoptosis, mitosis catastrophe or DNA damage were not detected, but features of senescence were observed using low doses of doxorubicin and TSA. The number of drug-induced PTTG1−/− senescent cells increased ∼4 fold as compared to WT PTTG1-replete cells (p<0.001). p21, an important regulator of cell senescence, was induced ∼3 fold in HCT116 PTTG1−/− cells upon doxorubicin or Trichostatin A treatment. Binding of Sp1, p53 and p300 to the p21 promoter was enhanced in PTTG1−/− cells after treatment, suggesting transcriptional regulation of p21. p21 knock down abrogated the observed senescent effects of these drugs, indicating that PTTG1 likely suppresses p21 to regulate drug-induced senescence. PTTG1 also regulated SW620 colon cancer cells response to doxorubicin and TSA mediated by p21. Subcutaneously xenografted PTTG1−/− HCT116 cells developed smaller tumors and exhibited enhanced responses to doxorubicin. PTTG1−/− tumor tissue derived from excised tumors exhibited increased doxorubicin-induced senescence. As senescence is a determinant of cell responses to anti-neoplastic treatments, these findings suggest PTTG1 as a tumor cell marker to predict anti-neoplastic treatment outcomes

Results of Work of the Specialized Anti-Epidemic Teams of the Irkutsk Research Anti-Plague Institute in the Amur Region, Khabarovsk Territory and the Jewish Autonomous Region in 2013

Displayed are the major results of work of the specialized anti-epidemic teams from Irkutsk Research Anti-Plague Institute, aimed at the provision for sanitary-epidemiological welfare of the population in the Amur Region, Khabarovsk Territory and the Jewish Autonomous Region, devastated by the abnormally high water, in 2013. Represented are the data on sanitary-hygienic and epidemiological monitoring over the territory of the worst-hit areas. Revealed are the findings as regards examination of water samples obtained from the centralized and decentralized water supplies, surface water reservoirs and treatment facilities for presence of Vibrio cholerae , and of clinical material - for intestinal viruses, as well as serological screening of the decreed groups and foreign citizens temporarily working in the Russian Federation. Presented are the results of epizootiological-epidemiological inspection of the endemic areas for natural-focal infections, and also potentially hazardous areas as concerns anthrax, situated within the bonds of the flooded territories. Total of 3626 samples have been tested, 15502 analyses for 23 nosological entities have been performed

Tactics for Specialized Anti-Epidemic Team (SAET) Deployment under the Conditions of Large-Scale High Water in the Far Eastern Territory. Communication 2. Peculiarities of Operational Activities of the Laboratory-Epidemiological SAET Reinforcement Unit Deployed in the Khabarovsk Territory and the Jewish Autonomous Region

Taking into consideration emergency conditions of rainfall flooding in the Khabarovsk Territory and the Jewish Autonomous Region in August-September 2013, forming premises for aggravation of the epidemiological situation a decision was made to deploy a laboratory-epidemiological SAET reinforcement unit No. 2 (SAET-2) from Irkutsk Research Anti-Plague Institute into the exposed area. SAET-2 staff was step-by-step relocated to the site of emergency to participate in the inspectional operations. Withdrawal of specialists was also performed on a stage-by-stage basis as the work advanced. For the first time ever SAET was established right at the natural disaster site and recruited from experts who are on regular SAET-2 staff of the Irkutsk Research Anti-Plague Institute, and from personnel reserve of the Rospotrebnadzor institutions in the Khabarovsk Territory. Complex approach, applied for the management of its work, allowed for alliance of forces and facilities of various Rospotrebnadzor territorial establishments, Rosselkhoznadzor and veterinary medicine institutions into the uniform mobile specialized brigade avoiding overlap of responsibilities and interference into day-to-day operational activities of Rospotrebnadzor territorial institutions. SAET-2 was to implement a complex of measures for sanitary-hygienic and epidemiological surveillance over the municipal territories suffered from flood. Team operational activities were carried out on the basis of stationary laboratories at the territorial establishments of Rospotrebnadzor in the Khabarovsk Territory and the Jewish Autonomous Region that were converted for working under emergency conditions mode. The mobile brigade has performed the tasks successfully. It has provided sanitary-epidemiological welfare of the population under emergency conditions of rainfall flood

Влияние биогенных элементов на фитоэкстракцию кадмия из загрязненной почвы

The influence of substances containing biogenic elements (potassium chloride, sodium phosphate, ammonium nitrate, potassium and urea nitrate) on phytoextraction degree of cadmium from soil by cultivated oat (Avena sativa L.), cutting lettuce (Lactuca sativa L.) and charlock (Sinapis arvensis L.) has been investigated. As the results of experiment the factors used for estimation of relationship between the environment and a physiological role of a chemical element, and also for revealing of its share in biotic turnover and of a role of organisms-indicators and organisms-concentrators have been calculated: phytotoxic effect and factor of biological absorbing of cadmium by plants. It is shown that potassium nitrate promote the extraction of cadmium from soil in a greater degree in comparison with other substances containing biogenic elements.Исследовано влияние веществ , содержащих биогенные элементы ( хлорида калия , фосфата натрия , нитрата аммония , нитрата калия и мочевины ) на степень фитоэкстракции кадмия из почвы овсом посевным (Avena sativa L.), салатом листовым (Lactuca sativa L.) и горчицей полевой (Sinapis arvensis L.). По результатам эксперимента рассчитаны показатели, использующиеся для оценки связи среды и физиологической роли химического элемента, а также для выявления его участия в биотическом круговороте, роли организмов-индикаторов и организмов-концентраторов: фитотоксический эффект и коэффициент биологического поглощения кадмия растениями. Показано, что нитрат калия в большей степени, по сравнению с другими веществами, содержащими биогенные элементы, способствует извлечению кадмия из почвы

Lineage-Specific Restraint of Pituitary Gonadotroph Cell Adenoma Growth

Although pituitary adenomas are usually benign, unique trophic mechanisms restraining cell proliferation are unclear. As GH-secreting adenomas are associated with p53/p21-dependent senescence, we tested mechanisms constraining non-functioning pituitary adenoma growth. Thirty six gonadotroph-derived non-functioning pituitary adenomas all exhibited DNA damage, but undetectable p21 expression. However, these adenomas all expressed p16, and >90% abundantly expressed cytoplasmic clusterin associated with induction of the Cdk inhibitor p15 in 70% of gonadotroph and in 26% of somatotroph lineage adenomas (p = 0.006). Murine LβT2 and αT3 gonadotroph pituitary cells, and αGSU.PTTG transgenic mice with targeted gonadotroph cell adenomas also abundantly expressed clusterin and exhibited features of oncogene-induced senescence as evidenced by C/EBPβ and C/EBPδ induction. In turn, C/EBPs activated the clusterin promoter ∼5 fold, and elevated clusterin subsequently elicited p15 and p16 expression, acting to arrest murine gonadotroph cell proliferation. In contrast, specific clusterin suppression by RNAis enhanced gonadotroph proliferation. FOXL2, a tissue-specific gonadotroph lineage factor, also induced the clusterin promoter ∼3 fold in αT3 pituitary cells. As nine of 12 pituitary carcinomas were devoid of clusterin expression, this protein may limit proliferation of benign adenomatous pituitary cells. These results point to lineage-specific pathways restricting uncontrolled murine and human pituitary gonadotroph adenoma cell growth

The Role of Anti-Plague Institutions in Provision of the Epidemiological Well-Being During the Preparation and Carrying out of the APEC 2012 Summit

Summarized are the results of the work on provision of sanitary and epidemiological well-being during the arrangement and carrying out the APEC Summit on the Russky Island. The set of organizational and prophylactic measures aimed at prevention of potential danger of emergency situation of sanitary and epidemiological character is presented. Measures on provision of epidemiological well-being of the participants and guests of the APEC Summit, based upon interaction of the regional plague-control institutions with anti-epidemic and health services of the Primorsky Region, demonstrated their efficiency. Epidemiological situation on the Russky Island and Vladivostok city was safe. The materials presented can be used to develop a set of measures ensuring the epidemiological well-being during large scale political and economic events holding at the national and international levels

Forecasting of the Epizootiological-Epidemiological Situation Development as Regards Anthrax Infection in the Flooded Territories (Amur River Basin and Its Feeders) in the Khabarovsk Region, as well as Jewish Autonomous, and the Amur Regions for 2014

Anthrax animal burial sites and potentially hazardous as regards anthrax territories (PHT) of the three municipal entities in the Far Eastern Federal District (FEFD) were exposed to the Amur River flood (the Amur River basin, river inflows, and near-by territories), the emergency situation in August-September 2013. In order to estimate epizootiological-epidemiological situation on the infection carried out was retrospective analysis of morbidity rates among the population and the livestock animals of the region. Studied were the peculiarities of anthrax spatial distribution and sanitary conditions of PHT and animal burial sites (including anthrax ones). Laboratory investigations of soil and bone samples for the presence of Bacillus anthracis were conducted. Thus based on the results obtained the short-term forecast for epidemiological situation development in the post-flood period was worked out, and a complex of anti-anthrax actions was recommended

ТРУДНОСТИ ВЕДЕНИЯ ГЕМОДИАЛИЗ-ЗАВИСИМЫХ ПАЦИЕНТОВ С ОСТРЫМ ИНФАРКТОМ МИОКАРДА. КЛИНИЧЕСКИЙ ПРИМЕР

The clinical case reports a personalized expert approach to the management of a patient with myocardial infarction receiving programmed hemodialysis. The challenges facing by cardiologists with antiplatelet therapy, statin therapy, betablockers and renin-angiotensin-aldosterone system blockers as basic therapy have been discussed. The experience of performing coronary angiography with a limited dosage of the contrast agent followed by the stenting in the patient intolerant to unfractionated heparin is presented The complexity of post-puncture hemostasis before dialysis is highlighted. A particular attention has been paid to the existing difficulties in selecting rational loading doses of antiplatelet agents for these patients due to poor evidences on the elimination of clopidogrel metabolites from the blood flow.Представленный клинический пример демонстрирует персонифицированный экспертный коллегиальный подход к ведению пациентки с инфарктом миокарда, находящейся на программном гемодиализе. Разобраны вопросы назначения кардиологом антитромбоцитарной терапии, терапии статинами, бета-адреноблокаторами и блокаторами ренин-ангиотензин-альдостероновой системы в качестве базовой терапии. Обсужден опыт проведения интервенционным хирургом коронарографии и стентирования в условиях непереносимости нефракционированного гепарина, ограниченном объеме введения контрастного препарата, сложности постпункционного гемостаза до диализа. Отражены существующие сложности в подборе больной рациональных нагрузочных доз дезагрегантов, с учетом дефицита знаний о возможностях элиминации метаболитов клопидогреля из кровоток