The Level Assessment of Extracellular Nucleic Acids in the Blood of Pregnant Women with Chronic Hypertension with Superimposed Preeclampsia

BACKGROUND: Preeclampsia, chronic arterial hypertension is one of the causes of maternal and perinatal morbidity and mortality. AIM: The aim of our study was to assess the level of extracellular nucleic acids in red blood cells and blood plasma in pregnant women with severe preeclampsia, severe chronic hypertension, and pregnant women with chronic hypertension with superimposed preeclampsia. METHODS: A total of 107 pregnant women were examined who were hospitalized at the Regional Clinical Hospital and at the Regional Perinatal Center in Karaganda and 29 healthy non-pregnant women. Pregnant women were divided into four groups: 1 group – 32 pregnant with severe chronic hypertension, 2 group – 48 pregnant women with severe preeclampsia, 3 group – 35 women entered the group with chronic hypertension with superimposed preeclampsia, and group control – 29 healthy non-pregnant women of child bearing age (4th group – control). RESULTS: The content of ecNA in the erythrocytes of pregnant women with chronic hypertension with superimposed preeclampsia sharply increases relative to the control and comparison groups; in pregnant women with severe hypertension and severe preeclampsia, the level of ecNA is moderately higher relative to the control, but lower than in the main group. CONCLUSION: Our data indicate significant changes in the level of ecNA in pregnant women with various types of hypertension and require further research, but now, changes in the concentration of ecNA can be considered as one of the links in the pathogenesis of preeclampsia

The Role of Presepsin in Patients with Acute Surgical Diseases

AIM: The purpose of this study was to determine the level of significance of markers in the development of intra-abdominal hypertension in patients with acute surgical diseases of the abdominal cavity. METHODS: The authors surveyed 100 patients who were monitored at the Regional Clinical Hospital, Karaganda. The criterion for inclusion in the study was the informed consent of patients to participate in the study, the presence of acute surgical pathology, and the monitoring of intra-abdominal pressure over time. The exclusion criteria for patients from the study is the presence of sub and decompensation of associated diseases: trauma (hematoma of the bladder), bladder tumour and impaired integrity of the pelvic ring. The design of the study was by the legislation of the Republic of Kazakhstan, international ethical norms and normative documents of research organizations, approved by the ethics committee of the Karaganda State Medical University. RESULTS: According to the world scientific literature, there are 4 indicators that change their value in response to increases in pressure in the abdominal cavity: fibrinogen and prothrombin index (the main indicators of the coagulogram); marker of blood clots D-dimer; early marker of translocation of bacterial flora into the bloodstream sCD14 (presepsin). CONCLUSION: The authors concluded that the obtained data indicate that an increase in intra-abdominal pressure in acute surgical diseases of the abdominal cavity causes hypercoagulation and an increase in presepsin. Monitoring IAP with simultaneous measurement of the level of presepsin significantly improves the stratification of critical patients in need of emergency surgery

Diagnostic value of determining the level of purine metabolism intermediates in pregnant women with chronic hypertension and superimposed preeclampsia

Introduction: Chronic hypertension and related cardiovascular diseases are some of the leading causes of maternal and perinatal morbidity and mortality in the world. Objectives: The aim of the study was to evaluate the diagnostic value of purine metabolism products in plasma and blood erythrocytes in pregnant women with chronic hypertension with superimposed preeclampsia. Patients and Methods: Around139 patients were examined, including 110 pregnant women and 29 healthy non-pregnant women of childbearing age (control group). The content of purine metabolism intermediates was determined; guanine, hypoxanthine (HX), adenine, xanthine (X) and uric acid (UA) - in plasma and erythrocytes. We also determined the level of blood platelets, proteinuria in the general analysis of urine in pregnant women with chronic arterial hypertension, severe preeclampsia, and in pregnant women with chronic hypertension with superimposed preeclampsia. Results: The level of purine catabolism intermediates significantly exceeds in the blood of pregnant women with chronic hypertension and superimposed preeclampsia compared to control group. It was determinate that purine intermediates a significant increase in pregnant women with chronic hypertension with superimposed preeclampsia compared to pregnant women with isolated chronic hypertension, pregnant women with severe preeclampsia. An analysis of correlations showed that the increase in purine intermediates in blood in pregnant women with chronic hypertension and superimposed preeclampsia is associated with an increase in proteinuria and thrombocytopenia. It indicates a diagnosis of preeclampsia to chronic hypertension. It can be an additional diagnostic criterion, along with proteinuria and thrombocytopenia. Conclusion: Determination of purine intermediates can be used as an additional diagnostic criterion in pregnancy with chronic hypertension

Presepsin (soluble CD14 subtype) as a risk factor for the development of infectious and inflammatory complications in operated colorectal cancer patients

Purpose In this pilot study the dynamic of presepsin (soluble CD14 subtype, sCD14-ST) in blood serum was assessed as a possible risk factor for the development of systemic inflammatory response syndrome (SIRS) and infectious and inflammatory complications in operated colorectal cancer patients. Methods To determine sCD14-ST by enzyme-linked immunosorbent assay method venous blood was taken 1 hour before surgery and 72 hours after it (3rd day). The presence of SIRS and organ dysfunctions (ODs) according to the Sequential Organ Failure Assessment scale were assessed. Results Thiry-six patients with colorectal cancer were enrolled in the study. sCD14-ST level before surgery was 269.8±103.1 pg/mL (interquartile range [IQR], 196.7–327.1 pg/mL). Despite the presepsin level on the 3rd day being higher (291.1±136.5 pg/mL; IQR, 181.2–395.5 pg/mL), there was no statistical significance in its dynamics (P=0.437). sCD14-ST value both before surgery and on the 3rd day after it was significantly higher in patients with bowel obstruction (P=0.038 and P=0.007). sCD14-ST level before surgery above 330 pg/mL showed an increase in the probability of complications, SIRS, and OD (odds ratio [OR], 5.5; 95% confidence interval [CI], 1.1–28.2; OR, 7.0; 95% CI, 1.3–36.7; and OR, 13.0; 95% CI, 1.1–147.8; respectively). Patients with OD had higher levels on the 3rd day after surgery (P=0.049). Conclusion sCD14-ST level in operated colorectal cancer patients was much higher if they were admitted with complication like bowel obstruction. Higher preoperative levels of sCD14-ST increase the probability of postoperative complications, SIRS, and OD. Therefore, further studies with large sample size are needed

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Purpose In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes