ОСОБЛИВОСТІ ДОСЛІДЖЕННЯ МОРАЛЬНОЇ ШКОДИ В КРИМІНАЛЬНОМУ ПРОЦЕСІ

The paper considers contradictions which arise after entering amendments in 2014 into article 242 of the Criminal Procedural Code of Ukraine, in which an obligatory appointment of psychological examination for the determination of moral harm amount in criminal trial is allocated. The thought on inexpediency of appointment of the person moral sufferings examination within the limits of criminal proceedings on the basis ofsuch positions is subtatiated: 1) before pronouncement of a court sentence on criminal proceedings a person’s guilt is not proved, in this case forensic psychological examination will be based on not proved premise - possibility of guilt which conflicts to an innocence presumption according to the Criminal Code of Ukraine. The expert conclusion is one of procedural sources ofproofs. Carrying out forensic psychological examination of moral harm within criminal proceedings, the expert, being based on the inadmissible assumption of guilty, creates the proof; 2) if the question of moral sufferings presence is considered within criminal proceedings, the fact of absence of the claimantfault has to be established by the court along with definition of the respondent fault degree; 3) pronouncement of a court sentence with definition of the parties guilty degree is an important point for definitive qualitative and quantitative formalizing moral sufferings. At the stage «before a sentence» the psychological trauma has not been yet led to the fullforming ofmoral sufferings, therefore during carrying out psychological research on the materials of criminal proceedings the amount of compensation should be defined only as "a preliminary"; 4) for the determination of the depth and heaviness of the person’s sufferings a psychologist needs to conduct a research only in 1 yearfrom the moment of injuring events (the person should go through stages of distress after losing close relative, to be treated and feel consequences at health damage).Зазначено суперечності, які виникли після внесення змін до ст. 242 КПК України, де було закріплено обов’язкове призначення психологічної експертизи моральної шкоди в кримінальному процесі. Розглянуто шляхи їх подолання. Обґрунтовано думку про недоцільність призначення експертизи моральних страждань особи в межах кримінального провадження

Manifestations and diagnosis of reactive arthritis

Objective: Studying of peculiarities of etiology and clinical process of Reactive Arthritis. Materials and Methodology: the research studied 56 patients where 18 were males and 38 were females (with average age range spanning from 35+10,2 years old). All examinees undergone physical, laboratory, x-ray, ultrasound, immunological, and microbiological check-up. The criteria for diagnosis of Reactive Arthritis were based on those accepted during the III International Meeting on Reactive Arthritis in Berlin in 1996. Results: The results of the study showed the prevailing of Urological Reactive Arthritis (87,5%) with the tendency towards the age increase (45-46 years old), towards Chlamydia aetiology (Ch. thrachomatis, Ch. pneumonia and Ch. Psitaki and their combination). Chlamidia were found in 20% of studied patients with Reactive Arthritis, whereas 50% of cases showed the combination of Micoplasma, Ureaplasma and Intestinal Infection. The trigger factors for Reactive Arthritis development of 57,1% of the studied patients were combined infection. In more frequently occurred cases the clinical picture was blurred. The study showed that Monoarthritis was encountered with more often than Polyarthritis. A quarter of the studied patients had 3-4 affected joints. The inflammation process involved legs joints, that is, those of ankle and knee. 98,2% of the patients with Reactive Arthritis had Enthesitis. 100% of the patients had the signs of Sinovitis which went along with Periarthritis in the form of Bursitis or Tendinitis. All of the patients had their ureal channel affected. All of the patients had the affection of eyes in anamnesis. No changes were found in 21,43% of the cases throughout the study. The affection of skin was seen as Keratoderma of soles, Onychodystrophy, Dermatitis, Pink Papulosis Rashes, and Nodular Erythema. The I-II degree of activity process was shown as prevalent. Conclusion: At Reactive Arthritis development was found to be mixed infection where Chlamydia prevailed. Monoarthritis with the affection of mainly lower extremities joints turned to appear with the frequency. In comparison with x-ray examination, Arthrosonography Method stays as more precise (p<0,001) and more informative in diagnosis of Arthritis. It is necessary to prescribe antibiotics during the treatment process as well as to use active anti-inflammation therapy.Цель. Изучить особенности этиологии и клинического течения РеА. Материал и методы. Обследовано 56 больных, из них 18 мужчин и 38 женщин (средний возраст 35+10,2 лет). Всем было проведено физикальное, лабораторное, рентгенологическое и ультразвуковое, иммунологическое и микробиологическое обследование. Диагноз РеА ставился на основании критериев, принятых на III Международном совещании по РеА в Берлине в 1996 г. Результаты. Преобладал урогенный РеА (87,5%) с тенденцией к увеличению возраста больных (45-46 лет), хламидийной этиологии (Chlamidia thrachomatis, Chlamidia pneumonia и Chlamidia psitaki и их сочетание). Хламидии были у 70% больных РеА, а в 50% сочетались с микоплазменной, уреаплазменной и кишечной инфекциями. У 57,1 % больных триггерным фактором развития РеА явилась смешанная инфекция. Преобладала стертая клиническая картина. Моноартрит встречался чаще, чем полиартрит. У четверти больных поражались 3-4 сустава. В воспалительный процесс преимущественно вовлекались суставы ног: голеностопный и коленный. У 98,2% больных РеА имелся энтезит, у 100% больных - синовита, который сочетался с периартритом в виде бурсита или тендинита. У всех больных отмечалось поражение урогенитального тракта. Поражение глаз в анамнезе имели все пациенты, но изменения на момент обследования отсутствовали у 21,43%. Поражения кожи были в виде кератодермии подошв, ониходистрофии, дерматита, розовой папулезной сыпи, узловатой эритемы. Преобладала I-II степень активности процесса. Выводы. При РеА чаще выявлялась смешанная инфекция, среди которой преобладали хламидии. Чаще имелся моноартрит с преимущественным поражением суставов нижних конечностей. В диагностике артрита метод артросонографии является достоверно (р<0,001) более информативным по сравнению с рентгенологическим исследованием. В лечении необходимо назначение антибиотиков, а также проведение активной противовоспалительной терапии

Comparative Analysis of Drug Interactions with Antibacterial Agents in the Treatment of Community-Acquired Pneumonia

According to the World Health Organisation, pneumonia and other lower respiratory tract infections are one of the leading causes of death all over the world. Simultaneous treatment of pneumonia with antibacterial drugs and concomitant medicines may result in adverse drug reactions (ADRs). The aim of the study was to analyse ADRs resulting from drug-drug interactions in different empiric antibiotic treatment regimens used for mild community-acquired pneumonia (CAP), taking into account the concomitant symptomatic non-antibacterial treatment and chronic disease treatment. Materials and methods: the authors analysed spontaneous reports in the VigiBase global database (starting from the date the database was created and until 15 February 2021) on ADRs resulting from interactions of medicinal products included in the Russian clinical guidelines for CAP.Results: the authors compiled a list of antibacterial drugs (amoxicillin+clavulanic acid, amoxicillin, ampicillin, azithromycin, clarithromycin, levofloxacin, moxifloxacin, cefotaxime, ceftriaxone, linezolid), as well as lists of medicinal products for symptomatic and concomitant treatment, based on the approved guidelines for management of CAP and frequent comorbid chronic diseases. They searched VigiBase for ADRs that may have resulted from drug-drug interactions involving these medicinal products. Conclusions: the analysis of adverse reactions used for mild CAP treatment demonstrated that the largest number of ADRs were associated with drug-drug interactions involving azithromycin, while the smallest number of ADRs were associated with cefotaxime and ceftriaxone. Further study of drug-drug interactions will help to prevent potential ADRs, identify rational drug combinations, and improve the existing patient management strategies

Use of Gene-Activated Demineralized Bone Allograft in the Therapy of Ulnar Pseudarthrosis. Case Report

© 2016, Springer Science+Business Media New York.This paper presents a clinical case of successful ulnar pseudarthrosis treatment using a gene-activated bone allograft containing VEGF (vascular endothelial growth factor) and BMP2 (bone morphogenetic protein 2) in the form of a multicystron plasmid. Demineralized bone matrix with applied recombinant plasmid DNA was grafted into the bone defect using the classical open surgical approach. Two months after the surgery, the patient noticed the disappearance of pain including pain during activity. On X-rays of ulna, signs of union in the form of callus formation were found

Evaluation of the Effect of Comorbidity on the Efficacy and Safety of β-Lactam Antibiotics in Patients with Community-Acquired Pneumonia

Lower respiratory tract infections, which include community-acquired pneumonia (CAP), are the most common cause of death among all infectious diseases. The presence of a comorbid pathology in a patient with CAP suggests a possibility of mutual influence and changes in the course of both the underlying disease and comorbidities, as well as changes in the effectiveness and safety of ongoing drug therapy. The aim of the study was to analyse literature data on the structure of comorbidity in CAP patients and its impact on the efficacy and safety of therapy with β-lactam antibiotics. It has been established that CAP most often occurs in patients with chronic obstructive pulmonary disease, cardiovascular diseases (ischemic heart disease, arterial hypertension, and chronic heart failure), cerebrovascular disease, chronic kidney disease, diabetes mellitus, bronchial asthma, leukemia, anemia, dementia, neurological disorders, and cancer. The most common causative agent of CAP, regardless of the patient’s age and comorbidity, is pneumococcus (Streptococcus pneumoniae), followed by intracellular pathogens (mycoplasmas, chlamydia) and Haemophilus influenzae, as well as respiratory viruses. With this in mind, the initial empiric therapy for CAP mainly includes β-lactam antibiotics, which are effective against pneumococcus. If patients with CAP have concomitant chronic diseases and conditions, the spectrum of pneumonia pathogens may differ from that in the general population and include rare pathogens and multidrug-resistant strains. The effectiveness of antibiotic therapy in such patients is reduced, which leads to a worsening of the course of both CAP and concomitant diseases. This patient population may require longer treatment with antibiotics, including β-lactams, or the use of antibiotics at doses that provide a higher minimum inhibitory concentration, which is associated with a high risk of adverse reactions and a decrease in the safety of antibiotic therapy

Risk Factors and Characteristics of Adverse Reactions Associated with the Use of Beta-Lactam Antibiotics in Older Patients

The frequency of adverse drug reactions (ADRs) in older patients is approximately 11.0%, according to scientific literature. Antibiotics are the third largest group (19.5%) of medicinal products in terms of ADR frequency in geriatric patients. Beta-lactam antibiotics are the empiric treatment of choice for older outpatients and inpatients with community-acquired pneumonia. The mortality in this group of patients accounts for 85% of the overall mortality from community-acquired pneumonia. The aim of the study was to analyse scientific data on risk factors and characteristics of adverse drug reactions associated with the use of beta-lactam antibiotics in older patients. Specificity of ADRs to beta-lactam antibiotics in this group of patients is due to age-related changes in pharmacokinetics and pharmacodynamics as well as polymorbidity and polypharmacy. The analysis of scientific literature demonstrated that there have not been so many pharmacoepidemiological studies in this group of patients, and their results have been inconsistent. The frequency, causes, and clinical manifestations of ADRs in geriatric patients are diverse and differ considerably from those in younger patients. Of the most widely used antibiotics, ceftriaxone and cefaclor exhibited a statistically lower risk of ADRs in older patients than in younger patients. At the same time, ceftriaxone was associated with a relatively higher frequency of serious ADRs in older patients as compared to younger patients, whereas the frequency of serious ADRs was lower with cefaclor. The likelihood of nephrotoxic, neurotoxic, and hepatotoxic ADRs associated with the use of beta-lactam antibiotics is becoming more and more obvious but it is still underestimated in clinical and geriatric practice. Safety monitoring, therapeutic drug monitoring with due consideration of ADR risk factors in older patients, and inclusion of older patients in clinical trials of antimicrobial drugs, would improve efficacy and safety of antibiotic treatment

Phenotypic Manifestation of Homozygous Partial Deletion of the Chromosome 1 Segment Spanning Cfhr3 Region

This article presents two clinical cases of patients with a homozygous deletion of segment of chromosome 1, which covers regions of genes associated with complement factor H, in particular CFHR3. Patients underwent in-depth clinical studies, heredity assessment, laboratory, instrumental and genetic diagnostics. The first clinical case describes a clinical case with deleted chromosome 1 segment in a 9-year-old girl who was diagnosed with atypical hemolytic-uremic syndrome. This is a complement-dependent disease that affects both adults and children. It is known that a defect in any proteins included in the alternative complement activation pathway can lead to atypical hemolytic-uremic syndrome. However, this syndrome is most often caused by defects in chromosome 1 region, including gene sequences associated with complement factor H-CFHR1 and CFHR3. Modern treatment of atypical hemolytic uremic syndrome involves targeted pathogenetic treatment, therefore, the genetic diagnosis seems to be a necessary step for differential diagnosis and confirmation. The patient had fairly typical clinical symptoms, including signs of thrombotic microangiopathy, thrombocytopenia, hemolytic anemia and increasing renal failure. It is also known that her mother had congenital hydronephrosis, and the pregnancy proceeded against a background of ureaplasma, mycoplasma, cytomegalovirus infection, chronic pyelonephritis, and preeclampsia. The second clinical case of a deleted chromosome 1 region, involving the CFHR3 gene, is a description of the disease in a boy of 8 years old, while the disease manifested with alopecia at the age of 4. Intermittent alopecia was the main symptom, while there were no signs of renal failure, thrombocytopenic purpura, and other symptoms characteristic of atypical hemolytic-uremic syndrome. The boy also revealed some congenital defects of the urinary system: Bladder diverticulum, unilateral ureterohydronephrosis, and bilateral dilatation of the pyelocaliceal system. The detected genetic defect is usually associated with atypical hemolytic uremic syndrome. However, the phenotype, i.e., clinical manifestations, determined a completely different diagnosis-primary immunodeficiency, a group of complement defects, and a deficiency of complement factor H-related protein. After analyzing the given clinical cases, we can conclude that clinical manifestations may vary significantly in carriers of same gene mutations. This suggests that there are additional factors (genetic or environmental) that can influence the formation of various phenotypic manifestations of this pathology. © 2020 Russian Association of Allergologists and Clinical Immunologists, St. Petersburg Regional Branch (SPb RAACI). All rights reserved

Safety of Antibacterial and Antiprotozoal Medicinal Products

The experts of the Scientific Centre for Expert Evaluation of Medicinal Products analysed administrative decisions of foreign regulatory authorities on the recalls of antibacterial and antiprotozoal medicinal products and/or the need for labelling updates due to changes in the safety profile. The analysis revealed 16 decisions containing information on the following medicines registered in Russia: ertapenem, сeftriaxone, cefazolin, аmoxicillin, сefoperazone+sulbactam, piperacillin+tazobactam, сlindamycin, teicoplanin, rifampin, co-trimoxazole, hydroxychloroquine

Analysis of the Causes for Renal Dysfunction during Antibiotic Therapy in a Patient with Lyme Disease

Adverse drug reactions (ADRs) are recorded throughout the lifecycle of a medicinal product. In the post-marketing period, new ADRs are primarily identified via drug safety signals. In order to assess a signal and establish causality between an adverse drug reaction and a suspected medicinal product, it is necessary to evaluate the signal strength and quality.The aim of the study was to analyse the information submitted to Russian regulatory authorities by a patient and check it for a potential causal association of acute tubulointerstitial nephritis (ATIN) with the use of ceftriaxone and with the patient’s principal diagnosis, Lyme disease.Materials and methods: the authors analysed the patient’s submission received by the Ministry of Health of the Russian Federation in 2022 with a complaint that the treatment of Lyme disease with ceftriaxone had caused ATIN. The probability of a causal relationship between the medicinal product and the ADR was evaluated using the Naranjo algorithm.Results: according to the review of literature and the spontaneous reports collected in Pharmacovigilance 2.0, the database in the Automated Information System of the Russian Federal Service for Surveillance in Healthcare, both ceftriaxone and the underlying condition (Lyme disease) may cause renal abnormalities. Ceftriaxone is potentially nephrotoxic; it mainly affects the tubular system of the kidneys. Borreliosis may cause kidney damage as well; such damage manifests clinically as rapidly progressing and fatal damage to the glomeruli.Conclusions: the probability of a causal relationship between the development of ATIN in the complainant and the use of ceftriaxone was categorised as “possible”. However, the information available did not allow for establishing a definite relationship between kidney damage and the use of the medicinal product. Further monitoring of similar cases is necessary to minimise the risks of developing this pathology during treatment with ceftriaxone

Complex experiment on studying the microphysical, chemical, and optical properties of aerosol particles and estimating the contribution of atmospheric aerosol-to-earth radiation budget

The primary objective of this complex aerosol experiment was the measurement of microphysical, chemical, and optical properties of aerosol particles in the surface air layer and free atmosphere. The measurement data were used to retrieve the whole set of aerosol optical parameters, necessary for radiation calculations. Three measurement cycles were performed within the experiment during 2013: in spring, when the aerosol generation is maximal; in summer (July), when atmospheric boundary layer altitude and, hence, mixing layer altitude are maximal; and in late summer/early autumn, during the period of nucleation of secondary particles. Thus, independently obtained data on the optical, meteorological, and microphysical parameters of the atmosphere allow intercalibration and inter-complement of the data and thereby provide for qualitatively new information which explains the physical nature of the processes that form the vertical structure of the aerosol field