Predicting the severity of viral bronchiolitis in children

Acute viral bronchiolitis is one of the common causes of hospitalization and mortality, especially among children in the first year of life who have risk factors (prematurity, congenital heart defects, bronchopulmonary dysplasia, immunosuppression). As factors associated with the severe course of bronchiolitis, along with the traditional ones, single nucleotide polymorphisms of the genes of the immune response molecules can be considered.The aim. Based on the analysis of clinical, laboratory and molecular genetic parameters, to identify prognostic criteria for the severe course of acute viral bronchiolitis in children.Materials and methods. The study included 106 children with acute viral bronchiolitis (severe course – 34, mild course – 72), the etiology of which in 67.9 % was respiratory syncytial virus. Forty-seven anamnestic, clinical, traditional laboratory and molecular genetic parameters were assessed as prognostic criteria. Determination of SNP genes of cytokines IL-4 (C-589T), IL-10 (G-1082A), IL-10 (C-592A), IL-10 (C-819T), TNF-α (G-308A), IL-17A (G197A), IL-17F (His161Arg), TLR2-753ArgGln, TLR6-Ser249Pro in venous blood was carried out by the polymerase chain reaction method.Results. An additional criterion for the risk of developing a severe course of bronchiolitis can be the mutant genotype (AA) SNP of the IL-10 gene (C-592A), which was detected exclusively in the group of patients with severe bronchiolitis, increasing the risk of developing a severe disease by 16.11 times (OR = 16.11; 95 % CI: 0.81–121.22, p = 0.02) in conjunction with already established modifying factors: the presence of congenital heart disease, bronchopulmonary dysplasia, prematurity, birth weight < 1500 g. Based on a comprehensive assessment of the established risk factors, a method has been developed that allows calculate the likelihood of developing a severe course of acute viral bronchiolitis. Conclusion. The use of the developed prediction method will not only increase the likelihood of developing severe acute viral bronchiolitis in children, but also determine the priority group among children with predictors of severe viral bronchiolitis for priority immunoprophylaxis against RS-virus infection

Financial statements of a company as an information base for decision-making in a transforming economy

In connection with the development of transforming the economy, the need for forecasting and analyzing the consequences of managerial decisions becomes more pressing. To substantiate and evaluate such decisions, a tool for prospective analysis of financial statements of companies is used. In recent years, the content and structure of a company's financial statements have undergone significant changes. With the development of economic relations, the principles of organization and methodology of accounting and reporting are also dynamically changing. The issues of reforming financial statements of a company are constantly discussed at international congresses of accountants and other professional forums. The purpose of the study is to improve the concept of preparing financial statements of a company as an information base for taking decisions in a transforming economy. As a result of the research, the economic essence of company's financial statements is substantiated from the point of view of an integrated approach; the importance of financial statements of an organization for effective management is determined; the main financial and non-financial indicators are systematized; it is proposed to introduce a mandatory requirement for disclosure of non-financial indicators in the corporate reporting system; proposals have been elaborated to improve the methods for analyzing financial statements as a tool for managing a company.peer-reviewe

DETECTION OF CRYPTOSPORIDIUM AND CHARACTERIZATION OF THE INTESTINAL MICROFLORA IN CHILDREN WITH ACUTE INTESTINAL INFECTIONS

This paper presents results, which were obtained during investigation of 106 children with acute intestinal infections in order to determine the presence of cryptosporidia and to evaluate their intestinal microbial status. The cryptosporidia's oocysts were found in 31 of children (29,2 %) that were mainly under the 3 age old. At the same time the authors found the dysbacteriosis of the second and. third, degrees in 92,5 % of patients. Six patients (5,7 %) became cryptosporidium negative and improved their intestinal microbial status. The obtained results showed that lactobacterias containing probiotics are effective in treatment of children with acute intestinal infections for normalizing of intestinal biocenosis and. to eradicate cryptosporidia

ОБОСНОВАНИЕ ВЫБОРА ОПТИМАЛЬНОЙ ПРОБИОТИЧЕСКОЙ ТЕРАПИИ ОСТРЫХ КИШЕЧНЫХ ИНФЕКЦИЙ У ДЕТЕЙ С ФУНКЦИОНАЛЬНОЙ И ХРОНИЧЕСКОЙ ПАТОЛОГИЕЙ ЖЕЛУДОЧНО-КИШЕЧНОГО ТРАКТА

Studied the comparative efficacy of probiotics with different composition of strains in the complex treatment of acute intestinal infection in 89 children with functional disorders and chronic gastrointestinal tract. Conducted a dynamic study of the intestinal microflora bacteriological method and gas-liquid chromatography with the definition of short-chain fatty acid content of the level of carbohydrates in the feces and stool data. Set different dates for stopping diarrhea and features state of the intestinal ecosystem indicators after treatment in patients receiving comprehensive probiotic containing bifidobacteria and enterococcus, or probiotic containing lactobacillus. Изучена сравнительная эффективность применения пробиотиков с различным штаммовым составом в комплексном лечении острой кишечной инфекции у 89 детей с функциональной и хронической патологией желудочно-кишечного тракта. Проведено динамическое исследование состояния кишечной микрофлоры классическим бактериологическим методом и методом газожидкостной хроматографии с определением короткоцепочечных жирных кислот, содержания уровня углеводов в фекалиях и копроцитологических данных. Установлены различные сроки ликвидации диареи и особенности состояния показателей кишечной экосистемы после лечения в группах пациентов, получавших комплексный пробиотик, содержащий бифидобактерии и энтерококки, или лактосодержащий препарат.

Some mechanisms of inflammation development in type 2 diabetes mellitus

Inflammation plays a key role in the development and progression of type 2 diabetes (T2DM), a disease characterized by peripheral insulin resistance and systemic glucolipotoxicity. The main source of inflammation in the early stages of the disease is visceral adipose tissue (VT). Macrophages are innate immune cells that are present in all peripheral tissues, including VT. Violation of the response of VT (MT) macrophages to changes in the microenvironment underlies aberrant inflammation and the development of local and systemic insulin resistance. The inflammatory activation of macrophages is regulated at several levels: stimulation of cell surface receptors, intracellular signaling, transcription, and metabolic levels. Which are activated by the transformation of macrophages along the pro-inflammatory or anti-inflammatory pathways. Such polarization of macrophages in modern immunology is divided into classical anti-inflammatory M1 polarization and alternative anti-inflammatory M2 polarization of macrophages. The M1 / M2 ratio of macrophages in the process of inflammation ensures the resolution of inflammation at different stages of its development. The review considers the main mechanisms involved in VT inflammation and the development of insulin resistance in T2DM, supported with the participation of immunocompetent cells, M1 / M2, as well as growth factors and humoral immunity factors secreted during this process

Prevalence and Severity of Breast Arterial Calcification on Routine Mammography

Aim. To determine the frequency of detection and severity of breast arterial calcification (BAC) among women undergoing mammography on the basis of medical institutions in Moscow.Material and methods. The analysis included 4274 digital mammograms of women aged 40-93 who underwent preventive or diagnostic mammography. Standard full-format digital mammograms were performed in craniocaudal and mediolateral oblique projections. In addition to the standard diagnosis of breast disease, all mammograms were evaluated for the presence of BAC. The severity of BAC was assessed on a 12-point scale: mild 3-4 points, moderate 5-6 points, severe 7-12 points.Results. The average frequency of BAC was 10.1%, in the middle age group 50-59 years – 6.0%. The incidence of BAC increased with age, from 0.4% to 0.6% in women <50 years of age to >50% in women ≥80 years of age. A statistically significant and pronounced correlation was found between the woman's age and the presence of BAC r Pearson =0.769 (p<0.001). There was also a less noticeable but statistically significant correlation between age and severity of BAC r Spearman =0.319 (p<0.001). Regression analysis made it possible to estimate the probability of CAD depending on age. In women <50 years of age, only mild to moderate calcification occurred, while those ≥65 years of age had a significant increase in the incidence of severe CAD.Conclusion. There was an expected increase with age in both prevalence and severity of BAC. Cases of severe BAC in women younger than 65 years of age and any BAC in women younger than 50 years of age are atypical and require clarification of their association with cardiovascular and other diseases

Роль полиморфизма генов некоторых молекул иммунного ответа в развитии острого вирус-индуцированного бронхиолита

The aim of research: To investigate the genetic polymorphism of immune response molecules (TNFα-308G> A (rs1800629), IL4-589C>T (rs2243250), IL10-592C> A (rs1800872), IL10-819C> T (rs1800871), IL10-1082G>A (rs1800896), IL-17A-197G> A (rs2275913), IL- 17F-161His> Arg (rs763780), TLR-2-753Arg>Gln (rs5743708), TLR-6-249Ser>Pro (rs5743810) and assess their prognostic value in the development of acute virus-induced bronchiolitis.Materials and methods. The study included children of the first year of life, whose average age was 4.2 ± 3.7 months. The main group consisted of 106 patients with moderate and severe acute viral bronchiolitis, more often associated with respiratory syncytial virus (56.6%). The control group consisted of 100 healthy children of the same age who had no signs of acute respiratory infection at the time of examination and did not receive passive immunoprophylaxis of respiratory syncytial infection. Genotyping was performed using the polymerase chain reaction method. The analysis of the results included the compliance with the Hardy-Weinberg law, the χ 2 test, the relative chance, and its 95% confidence interval. To assess the distribution of the claimed gene polymorphisms and their alleles, we used the general (χ2 test, df =2) and multiplicative (χ2 test, df =1) inheritance models.Results. It was revealed that the risk of developing acute viral bronchiolitis is increased compared to the healthy population in carriers of the following genotypes: CC, ST gene IL10-819C> T (rs1800871), GG, AA gene IL-17A-197G> A (rs2275913), HisHis gene IL-17F-161His> Arg (rs763780), SerSer, SerPro gene TLR-6-249Ser> Pro (rs5743810), GG gene TNF-α-308G>A (rs1800629). The TT genotype of the IL10-819C>T (rs1800871) gene is associated with a high risk of developing bacterial complications (pneumonia) in viral bronchiolitis. Carriers of genotypes AA, CC of the IL10-592C> A (rs1800872) gene have an increased likelihood of a severe course of viral bronchiolitis.Conclusion. Genetic analysis of gene polymorphism IL10-592C> A (rs1800872), IL10-819C> T (rs1800871), IL-17A-197G> A (rs2275913), IL-17F-161His> Arg (rs763780), TLR-6-249Ser> Pro (rs5743810), TNF-α-308 G>A (rs1800629) can be used as a personalized developmental criterion acute virus-induced bronchiolitis in children, determining the severity of its course and the likelihood of complications.Цель: исследовать генетический полиморфизм молекул иммунного ответа (TNFα-308G>A (rs1800629), IL4-589C>T (rs2243250), IL10-592C>A (rs1800872), IL10-819C>T (rs1800871), IL10-1082G>A (rs1800896), IL-17A-197G>A (rs2275913), IL-17F-161His>Arg (rs763780), TLR2-753 Arg>Gln (rs5743708), TLR-6-249 Ser>Pro (rs5743810) и оценить их прогностическое значение в развитии острого вирус-индуцированного бронхиолита.Материалы и методы. В исследование включены дети первого года жизни, средний возраст которых составил 4,2±3,7 месяца. Основная группа – 106 пациентов с острым вирусным бронхиолитом средней и тяжелой степени тяжести, чаще ассоциированным с респираторно-синцитиальным вирусом (56,6%). Группа контроля – 100 здоровых детей аналогичного возраста, не имевших признаков острой респираторной инфекции на момент обследования и не получавших пассивную иммунопрофилактику респираторно-синцитиальной инфекции. Генотипирование проведено методом полимеразной цепной реакции. Анализ результатов включал соответствие закону Харди – Вайнберга, χ2-тест, относительный шанс и его 95% доверительный интервал. Для оценки распределения заявленных полиморфизмов генов и их аллелей использовали общую (χ2-тест, df=2) и мультипликативную (χ2-тест, df=1) модели наследования.Результаты. Выявлено, что риск развития острого вирусного бронхиолита повышен по сравнению со здоровой популяцией у носителей следующих генотипов: СС, СТ гена IL10-819C>T (rs1800871), GG, АА гена IL-17A-197G>A (rs2275913), HisHis гена IL-17F-161His>Arg (rs763780), SerSer, SerPro гена TLR-6-249Ser>Pro (rs5743810), GG гена TNF-α-308G>A (rs1800629). Генотип ТТ гена IL10-819C>T (rs1800871) ассоциирован с высоким риском развития бактериальных осложнений (пневмонии) при вирусном бронхиолите. Носители генотипов АА, СС гена IL10-592C>A (rs1800872) имеют повышенную вероятность тяжелого течения вирусного бронхиолита.Заключение. Генетический анализ полиморфизма генов IL10-592C>A (rs1800872), IL10-819C>T (rs1800871), IL-17A-197G>A (rs2275913), IL-17F-161His>Arg (rs763780), TLR-6-249Ser>Pro (rs5743810), TNF-α-308G>A (rs1800629) может использоваться в качестве персонифицированного критерия развития острого вирус-индуцированного бронхиолита у детей, определения тяжести его течения и вероятности формирования осложнений

Модифицированные блокады надключичного и грудных нервов при имплантации внутривенной порт-системы у онкологических пациентов

Ultrasound-guided regional anesthesia can be an effective way to achieve analgesia during implantation of permanent intravenous port systems.The aim of the study was to improve the quality of perioperative analgesia during placement of permanent intravenous port systems.Material and methods. The prospective randomized study included 93 patients with malignant neoplasms. Patients were randomized into 3 groups, 31 people each, who were implanted with a permanent intravenous port system in 2019–2022. Group 1 patients were implanted under local infiltration anesthesia (LIA). Ultrasound-guided pectoral nerves block (PECS1) in group 2 was supplemented by LIA. In group 3 ultrasoundguided selective supraclavicular (SC) nerve block was supplemented with LIA. Pain intensity was assessed on a 100 mm visual analog scale (VAS) at rest and while moving at 8, 16, 32 and 72 hours after implantation. The inflammatory postoperative stress response was assessed by the dynamics of C-reactive protein (CRP), interleukin 1-β (IL 1-β), interleukin-6 (IL-6). We also analyzed the correlation of proinflammatory cytokines levels with VAS-measured pain intensity at the stages of the study taking into account a potential relationship between IL-6 and IL-1β fluctuations and the severity of inflammatory and neuropathic pain.Results. In groups 2 (PECS1) and 3 (SC nerve block), pain intensity measured by VAS at rest and while conducting daily activities was significantly lower than in group 1 (LIA). CRP levels were also significantly lower in group 2 and 3 patients as compared to group 1. The lowest IL-6 and IL-1β concentrations after port implantation were revealed in a group 3 in 24 hours after the procedure, persisting through day 3. There was a correlationbetween proinflammatory cytokines levels and pain intensity.Conclusion. Implantation of an intravenous port system under local infiltration anesthesia causes a significant inflammatory response in cancer patients, which can be balanced by regional techniques. Selective supraclavicular nerve block in combination with a local anesthesia for intravenous port implantation demonstrated the greatest analgesic potential and requires significantly reduced amounts of local anesthetic compared to pectoral nerves block in combination with LIA, or only local infiltration anesthesia.Методы регионарной анестезии под контролем ультразвука могут быть эффективным средством анальгезии при имплантации постоянных внутривенных порт-систем.Цель исследования. Улучшение качества периоперационной анальгезии при установке постоянных внутривенных порт-систем.Материал и методы. В проспективное рандомизированное исследование включили 93 пациентов со злокачественными новообразованиями, рандомизированных на 3 группы по 31 человеку в каждой, которым в 2019–2022 гг. имплантировали постоянную внутривенную порт-систему. Пациентам 1-й группы имплантацию выполняли под местной инфильтрационной анестезией (МИА). Пациентам 2-й группы проводили блокаду грудных нервов (БГН)+МИА под контролем ультразвука, дополненную МИА. У пациентов 3-й группы использовали селективную блокаду надключичного нерва (СБНН) под контролем ультразвука, дополненную МИА. Интенсивность боли оценивали по визуальной аналоговой шкале (ВАШ) в покое и при движении, используя 100 мм линейку, через 8, 16, 32 и 72 ч от имплантации. Воспалительный послеоперационный стресс-ответ оценивали по динамике С-реактивного белка (СРБ), интерлейкина 1-β (IL 1-β), интерлейкина-6 (IL-6). Учитывая связь изменений IL-6 и IL-1β с выраженностью воспалительной и нейропатический боли, провели анализ корреляции содержания провоспалительных цитокинов с показателями боли по ВАШ на этапах исследования.Результаты. В группах 2 (БГН) и 3 (СБНН) выраженность боли по ВАШ в покое и при движении была значительно меньше, чем в группе 1 (МИА). Концентрация СРБ у пациентов 2-й и 3-й групп, в сравнении с таковой у пациентов 1-й группы, была также существенно ниже. Отметили, что концентрация IL-6 и IL-1β после имплантации порт – системы была наиболее низкой через сутки в 3-й группе, причем отличия по IL-6 в той же группе сохранялись и на 3-и сут. Выявили корреляционную зависимость между содержанием провоспалительных цитокинов и выраженностью боли.Заключение. Имплантация внутривенной порт-системы, выполненная под местной инфильтрационной анестезией, вызывает значимый воспалительный ответ у онкологических пациентов, который может быть нивелирован использованием регионарных методов. Селективная блокада надключичного нерва в сочетании с местной анестезией при имплантации внутривенных порт-систем обладает наибольшим анальгетическим потенциалом и требует значительно меньшего количества местного анестетика, в сравнении с блокадой грудных нервов в сочетании с местных анестезий, а также — только местной инфильтрационной анестезией

Assessment of the Severity of Breast Artery Calcification on a Mammogram: Intraoperator and Interoperator Reproducibility

Purpose. To study approaches to the quantitative assessment of breast arterial calcification (BAC) – a new surrogate marker of high cardiovascular risk in women, to determine the most detailed way to quantify BAC and to assess the reproducibility of these parameters.Material and methods. Mammograms of 1,078 women were analyzed for the presence of BAC. The intraoperator reproducibility of the assessment of the severity of BAC using a 12-point scale (Margolies L et al., 2016) was studied by analyzing 20 mammograms by the same operator twice with an interval of at least 2 weeks. Inter-operator reproducibility was studied by analyzing 99 mammograms by two independent operators.Results. When assessing the intraoperative reproducibility of the total score for each mammary gland, the exact coincidence of the results was noted in 70% (95% confidence interval [CI] 53.5-83.4), in cases of difference of no more than 1 point – in 27.5% (95%CI 14.6-43.9), only in 1 case the difference in assessments was 2 points. No systematic error was found between the two measurements (p=1.0), the correlation coefficient was rs=0.973. The assessment of inter-operator reproducibility showed that the exact coincidence of indicators was present in 48.5% (95%CI 41.3-55.7), in 91.4% (95% CI 86.6-94.9) cases, the total score for each the mammary gland differed by no more than 1 point. There was no systematic error between the measurements of the two experts (p=0.438), the correlation coefficient was rs=0.942.Conclusion. A good intraoperator and interoperator reproducibility of indicators of the severity of BAC on a 12-point scale has been shown, which makes it possible to recommend it for use in science and practice