Случай аденовирусной инфекции, осложненной диффузным альвеолярным кровотечением у пациента, вернувшегося из Шри-Ланки

The article describes a rare case of adenovirus infection complicated by diffuse alveolar hemorrhage in a 29 y.o. immunocompetent patient which developed during a trip to Sri Lanka. The course of the disease was accompanied by severe anemia and respiratory insufficiency, etiology of the disease was confirmed by polymerase chain reaction of pharyngeal swabs and sputum sample. After successful supportive treatment, the patient was discharged on the 13th day of hospital stay to continue treatment in the out-patient settings. This case demonstrates the possibility of severe complications in case of adenovirus infection.Представлен редкий случай аденовирусной инфекции, осложненной диффузным альвеолярным кровотечением у ранее здорового 29-летнего иммунокомпетентного пациента во время посещения Шри-Ланки. Заболевание протекало c тяжелой анемией и дыхательной недостаточностью, подтверждено ПЦР-исследованием образцов глоточных смывов и мокроты. После проведения поддерживающей терапии пациент выписался из стационара на 13-й день госпитализации в удовлетворительном состоянии.Данный случай демонстрирует возможность тяжелых осложнений при аденовирусной инфекции

Раннее выявление риска клинического ухудшения у пациентов детского возраста при острых респираторных вирусных инфекциях

Purpose: The aim of this study was to determine significant indicators of the pediatric early warning system (PEWS) in patients with common cold of moderate severity. Design and methods. The study was conducted in the children infectious disease hospital at the Moscow Multidisciplinary Clinical Center «Kommunarka» from September 1, 2022, to November 30, 2022. The analysis of 512 clinical records of children with a clinical picture of uncomplicated common cold who received treatment at the infectious disease hospital was carried out. All patients had a moderately severe form of the disease. For early detection of the risk of clinical deterioration in children, the PEWS scale, developed in the UK, was used. Results. Upon admission to the hospital, the PEWS score was counted in all children. In 63 patients (main group) the overall PEWS score was 3 points or higher, in 449 patients (comparison group) the PEWS score did not exceed 2 points. We found that in children with common cold and a moderate course of the disease, an increase in the total PEWS score in the main and comparison groups was registered due to changes in the cardiovascular system in 50 (79.4 ± 10.9%) and 108 (24, 1 ± 4.1%) patients, respectively; and respiratory system in 37 (58.7 ± 12.8%) and 40 (8.9 ± 2.6%) patients, respectively, P < 0.05.Conclusion. In this study for the first time in the Russian Federation the PEWS scale was used in children with common cold to early identify the risk of clinical deterioration.Цель работы: определение значимых показателей шкалы PEWS в клинике среднетяжелого течения ОРВИ. Материалы и методы. Исследование проводилось в детском инфекционном стационаре ММКЦ «Коммунарка» в период с 1 сентября по 30 ноября 2022 года. Был проведен анализ данных 512 историй болезни детей с клинической картиной неосложненной ОРВИ, находившихся на лечении в инфекционном стационаре. У всех пациентов заболевание протекало в среднетяжелой форме. Для раннего выявления риска развития клинического ухудшения у детей использовалась шкала PEWS, разработанная в Великобритании. Результаты. При поступлении в приемное отделение всем детям проводился подсчёт баллов по шкале PEWS. У 63 пациентов (основная группа) общий показатель PEWS был 3 балла и выше, у 449 пациентов (группа сравнения) показатель PEWS не превышал 2 баллов. Нами установлено, что у детей с ОРВИ и среднетяжелым течением заболевания повышение общего балла шкалы PEWS в основной группе и группе сравнения отмечалось за счет изменения показателей сердечно-сосудистой системы у 50 (79,4 ± 10,9%) и 108 (24,1 ± 4,1%) пациентов соответственно; дыхательной системы у 37 (58,7 ± 12,8%) и у 40 (8,9 ± 2,6%) пациентов соответственно, P < 0,05.Заключение. В проведенном исследовании впервые в РФ применен опыт использования шкалы PEWS в педиатрической практике у пациентов с ОРВИ с целью раннего выявления риска развития клинического ухудшения

Поражение печени при кори

Objective: to determine the incidence of liver damage with measles, the specificity of these changes, to identify risk groups, to assess the dynamics of the development of hyperfermentemia in various stages of the disease.Materials and methods: a retrospective cohort study of medical records of patients hospitalized with measles (n = 101), divided into 4 groups: children (n = 23), men (n = 32), women (n = 24) and pregnant women (n = 22). Patients with laboratory-confirmed influenza (n = 61) were taken as a comparison group. The analysis of the frequency of detecting changes in biochemical parameters, average values, standard error and confidence intervals.Results: An increase in ALT in measles patients was observed in 56 (55.4%), above 5 norms – in 15 patients (14.8%), an increase in AST was detected in 80 (79.2%) patients, above 5 norms – in 10 (9.9%). These changes are specific for measles, which was established by comparing the indicators of patients with measles and influenza. The greatest frequency and severity of the observed changes was observed in men. Determination of bilirubin concentration was carried out in 95 patients. An increase in total bilirubin above 20 μmol / L was observed in 10 (10.5%), direct above 5 μmol / L – in 13 (13.6%) patients.Conclusion: given the frequency of occurrence of the identified changes, it is advisable to conduct a biochemical blood test for measles patients. Therapeutic tactics should be determined taking into account the possible development of hepatitis with measles. Цель: определение частоты развития гепатита при кори, специфичности данных изменений, определение групп риска, оценка динамики развития гиперферментемии в различных стадиях заболевания.Материалы и методы: ретроспективное когортное исследование медицинских карт пациентов, госпитализированных с диагнозом «Корь» (n=101), с разбивкой на 4 группы: дети (n=23), мужчины (n=32), женщины (n=24) и беременные (n=22). В качестве группы сравнения взяты больные с лабораторно подтвержденным гриппом (n=61). Проведен анализ частоты выявления изменений в биохимических показателях, средних величин, стандартной ошибки и доверительных интервалов.Результаты: повышение АЛТ у больных корью наблюдалось у 56 (55,4%), выше 5 норм – у 15 человек (14,8%), повышение АСТ выявлено у 80 (79,2%) больных, выше 5 норм – у 10 (9,9%). Данные изменения специфичны для кори, что было установлено при сравнении показателей больных корью и гриппом. Наибольшая частота и выраженность наблюдаемых изменений отмечалась у мужчин. Определение концентрации билирубина было проведено у 95 больных. Повышение общего билирубина выше 20 мкмоль/л отмечалось у 10 (10,5%), прямого выше 5 мкмоль/л – у 13 (13,6%) пациентов.Заключение: учитывая частоту встречаемости выявленных изменений, целесообразно проводить биохимический анализ крови больным корью. Лечебная тактика должна определяться с учетом возможного развития гепатита при кори.

Септический шок в акушерстве: клинические рекомендации Общероссийской общественной организации «Федерация анестезиологов и реаниматологов»

В статье отражены основные положения клинических рекомендаций по септическому шоку в акушерстве, утвержденных Общероссийской общественной организацией «Федерация анестезиологов и реаниматологов» в 2022 г. Актуальность проблемы связана с высокими показателями летальности и заболеваемости от сепсиса и септического шока в акушерстве. Последовательно представлены основные вопросы этиологии, патогенеза, клинической картины, методов лабораторной и инструментальной диагностики, особенности применения шкал qSOFA, SOFA, MOEWS, SOS, MEWC, IMEWS для верификации сепсиса. В статье представлена стартовая интенсивная терапия (первые 6–12 ч) лечения септического шока в акушерстве с учетом особенностей организма беременной женщины. Описана стратегия назначения вазопрессоров (норэпинефрин, фенилэфрин, эпинефрин), инотропных препаратов (добутамин), представлены антибиотики и оптимальные схемы антибактериальной терапии, особенности инфузионной и адъювантной терапии. Обсуждены вопросы хирургического лечения очага инфекции и показания к гистерэктомии, а также организация медицинской помощи и реабилитация пациенток, перенесших сепсис и септический шок. Описаны основные принципы профилактики развития сепсиса и септического шока в акушерстве. Представлены критерии качества оказания медицинской помощи пациенткам с септическим шоком и алгоритмы действий врача при диагностике и интенсивной терапии пациенток с септическим шоком в акушерстве

Этиология и клинические проявления острых кишечных инфекций у детей, по данным стационара г. Москвы за 2016—2018 гг.

The aim of the study was to study the etiology and clinical manifestations of acute intestinal infections (AII) in children aged 1 month to 18 years old who were hospitalized in the infectious diseases ward of a Moscow city hospital  in 2016—2018.A retrospective analysis of 9076 case histories was performed. Etiological interpretation was carried out using bacteriological examination of feces, latex agglutination reaction, immunochromatographic analysis, polymerase chain reaction (PCR), serological reactions (indirect hemagglutination test).The majority of children hospitalized with AII (62.2%) were 1—6 years of age. The etiology of AII was deciphered in 32% of cases. Acute intestinal infections of viral etiology prevail (64%), among them — rotavirus (73%), less often — norovirus (21%). AII of bacterial etiology accounted for only 14%, among them salmonellosis remains significant (5.6%), and in young children — staphylococcal infection (1.7%). There were also mixed infections (22%), mainly of viral and bacterial etiology. Noteworthy is the increase in the frequency of occurrence of bacterial AII in the winter season. The leading topical diagnosis in the vast majority of patients (85.1%) was gastroenteritis with the development of exsiccosis (77.6%).Целью исследования было изучение этиологии и клинических проявлений острых кишечных инфекций (ОКИ) у детей в возрасте от 1 месяца жизни до 18 лет, госпитализированных в инфекционное отделение стационара города Москвы в 2016—2018  гг. Проведен ретроспективный анализ 9076  историй болезни. Этиологическая расшифровка осуществлялась с использованием бактериологического исследования кала, реакции латекс-агглютинации (РЛА), иммунохроматографического анализа (ИХА), полимеразной цепной реакции (ПЦР), серологических реакций (РНГА, РПГА).Большинство госпитализированных с ОКИ детей (62,2%) были в возрасте 1—6 лет жизни. Этиология ОКИ была расшифрована в 32% случаев. Преобладают острые кишечные инфекции вирусной этиологии (64%), среди них — ротавирусной (73%), реже — норовирусной (21%). ОКИ бактериальной этиологии составили  лишь 14%, среди них значимым остается сальмонеллез (5,6%), а у детей раннего возраста — стафилококковая инфекция (1,7%). Также встречались  микст-инфекции (22%), преимущественно вирусно-бактериальной этиологии. Примечательно увеличение частоты встречаемости бактериальных ОКИ в зимний период года. Ведущим топическим диагнозом у подавляющего большинства больных (85,1%) был гастроэнтерит с развитием эксикоза (77,6%)

Safety and tolerability of antiepileptic drugs in women with epilepsy (literature review and own data)

Women with epilepsy are at particular risk of developing side effects due to antiepileptic drugs (AED). Neuroendocrine disorders in women can be caused by both epilepsy itself and the therapy. This literature review aims to evaluate safety and tolerability of different AED in girls and women of reproductive age, incidence of neuroendocrine disorders associated with AED, and pregnancy outcomes in women with epi­lepsy. We also provide some own research results. We conducted a retrospective analysis of data for 345female patients aged between 15 and 40 years that were followed up at the Svt. Luka’s Institute of Child Neurology and Epilepsy between 2000 and 2018. We also performed a separate analysis of neuroendocrine disorders and pregnancy outcomes in these women. We found that 65 patients (18.8 %) developed pronounced neuroendocrine reproductive and cosmetic disorders (menstrual disorders, including dysmenorrhea, opsomenorrhea, amenorrhea, anovulatory cycles, and infertility; cosmetic neuroendocrine disorders, including obesity, hirsutism, and hair loss; adverse pregnancy outcomes), which significantly reduced the quality of life. Neuroendocrine disorders were observed in 55patients, whereas adverse pregnancy outcomes were registered in 10 (14.2 %) out of 70pregnancies.Our findings suggest that the majority of women with epilepsy successfully gave birth to healthy children. The outcome of pregnancy depends on many factors, including the use of different AED. Valproic acid has the highest teratogenic potential. In our study, neuroendocrine repro­ductive disorders were primarily reported by women receiving valproic acid. Carbamazepines were the second most common AED associated with teratogenic effects and reproductive disorders. The most favorable results were observed in women receiving new AED, including oxcar- bazepine, topiramate, and levetiracetam

MUTATIONS IN THE ARX GENE: CLINICAL, ELECTROENCEPHALOGRAPHIC AND NEUROIMAGING FEATURES IN 3 PATIENTS

The Aristaless-related homeobox (ARX) gene is a member of the paired-type homeodomain transcription factor family with critical roles in embryonic development, particularly in the developing brain. Mutations in ARX gene demonstrate striking intra- and interfamilial pleiotropy together with genetic heterogeneity and lead to a broad spectrum of diseases. They give rise to 4 key phenotypic features: a different types of brain malformation, abnormal genitalia, epilepsy and intellectual disability. Authors present 3 clinical cases: a girl with duplication on the short arm of X-chromosome (Xp11.22-p22.33), which include genes ARX and CDKL5; a girl and a boy with a missense mutation in ARX gene that have not been previously described (chrX:25031522C>A), causes the substitution of an amino acid in the 197 protein position (p.Gly197Val, NM_139058.2). All patients suffer from severe epilepsy, that is refractory to antiepileptic drugs, and all of them have different degrees of psychomotor delay. The patients with missense mutation also have movement disorders: stereotypic movements in the girl and choreo athetosis and dystonia in the boy. Electroencephalographic abnormalities have been identified in all patients, and there were not significant abnormalities on magnetic resonance imaging in all cases. The described cases broaden the clinical spectrum of mutations in ARX gene

EPILEPSY IN 11 PATIENTS WITH TYPICAL RETT SYNDROME CAUSED BY MECP2 MUTATION: CLINICAL AND ELECTROENCEPHALOGRAPHIC CHARACTERISTICS, COURSE, THERAPY (RESULTS OF THE AUTHORS’ OBSERVATIONS)

Examinations were made in 11 female patients aged 3 to 23 years with Rett syndrome and typical mutation in the MECP2 gene, who had been followed up from 2006 to 2015. The investigators evaluated neurological and psychic status (systematically) and performed continuous video electroencephalographic (EEG) monitoring (if clinically indicated), magnetic resonance imaging, and molecular cytogenetic examination. Epilepsy was diagnosed in 6 (54.5 %) patients: symptomatic focal epilepsy in 5 cases and symptomatic generalized epilepsy in 1. The mean age at epilepsy onset was 3 years and 9 months. Generalized epileptic seizures were noted in 60 % of cases and focal ones in 40 %. EEG changes were revealed in 9 patients, 5 with slowing of background activity, 2 with regional epileptiform activity, and 1 with diffuse epileptiform activity that corresponded to that of the benign epileptiform patterns of childhood. Five patients were recorded to have multiregional epileptiform activity

Liver damage with measles

Objective: to determine the incidence of liver damage with measles, the specificity of these changes, to identify risk groups, to assess the dynamics of the development of hyperfermentemia in various stages of the disease.Materials and methods: a retrospective cohort study of medical records of patients hospitalized with measles (n = 101), divided into 4 groups: children (n = 23), men (n = 32), women (n = 24) and pregnant women (n = 22). Patients with laboratory-confirmed influenza (n = 61) were taken as a comparison group. The analysis of the frequency of detecting changes in biochemical parameters, average values, standard error and confidence intervals.Results: An increase in ALT in measles patients was observed in 56 (55.4%), above 5 norms – in 15 patients (14.8%), an increase in AST was detected in 80 (79.2%) patients, above 5 norms – in 10 (9.9%). These changes are specific for measles, which was established by comparing the indicators of patients with measles and influenza. The greatest frequency and severity of the observed changes was observed in men. Determination of bilirubin concentration was carried out in 95 patients. An increase in total bilirubin above 20 μmol / L was observed in 10 (10.5%), direct above 5 μmol / L – in 13 (13.6%) patients.Conclusion: given the frequency of occurrence of the identified changes, it is advisable to conduct a biochemical blood test for measles patients. Therapeutic tactics should be determined taking into account the possible development of hepatitis with measles

Epileptic trances – focal motor epileptic seizures: past, present and a little bit of future

This article provides a detailed description of clinical and electroanatomical characteristics of epilepsy in patients suffering from epileptic trances – a rare type of focal motor seizures with ambulatory automatism manifesting as an unplanned travel. We reviewed the currently available data on the nature of psychical seizures in patients with epilepsy and the role of social and legal expertise for this disease. We developed the criteria for differential diagnosis between epileptic trances and other conditions with similar manifestations (for example, epileptic fugues) and identified a diagnostic minimum. We also proposed a hypothesis of ictal spatial migration. We emphasized the efficiency of surgical treatment in the case of compliance with a proper diagnostic algorithm