Endocrine disorders in burn disease. Literature review

The purpose of the review is to highlight clinically hidden variants of hormonal dysfunctions in burn disease, which strongly determine the peculiarities of the course of the pathological condition but are often overlooked by clinicians. Based on available literary sources, this study provides a comprehensive analysis of specialised medical reports from both domestic and foreign researchers. The focus of this analysis was on compensatory and pathological shifts in hormonal regulation of the body in individuals suffering from local heat injury. The collected scientific data is expected to be useful to practitioners in the field of combustiology in their practical activities. Damage to the endocrine glands is one of the key pathogenetic factors of local thermal injury, but the intracellular mechanisms of the influence of burn disease on these processes remain poorly understood. The criticality of burn injuries often leads to hypodiagnosis of endocrine disorders, which are indeed typical and rapidly developing. The neuroendocrine response to severe burns is a multisystem coordinated response of the body, which can not only maintain homeostasis and play a protective role in critical conditions but also cause tissue damage, realising the properties of a “double-edged sword.” Burns covering more than 40 % of the total surface area of the body are accompanied by a stress reaction and hyperinflammation with a steady increase in the secretion of catecholamines, glucocorticoids, and cytokines. Classic studies confirm that a sharp post-burn increase in stress hormones (adrenaline, norepinephrine, glucagon, and cortisol) contributes to the development of hyperglycemia, a systemic catabolic state, and multiple organ dysfunction. It has been established that the hypothalamic-pituitary axis is responsible for fluctuations in the content of pituitary hormones in the blood serum of patients with local thermal lesions. After severe burns, the plasma renin-angiotensin-aldosterone system is activated, and the level of some hormones increases for more than 2 months after the injury

Kidney damage in burn disease. Part 2. Biochemical markers (literature review)

Recently discovered specific markers open up new possibilities for the diagnosis of acute kidney injury (AKI) in burn disease in order to optimize the treatment of such patients. Early diagnosis with the involvement of biomarkers prevents the sudden death of burn patients and allows predicting the course of the pathological condition. There are several characteristics that an “ideal” AKI biomarker should conform to: being non-invasive, locally specific, highly sensitive, being a stable molecule at different temperatures and pH values, having the ability to rapidly increase in response to kidney injury (quantify it), remaining at high levels during the episode and decreasing during the recovery period. There is a difference between the biomarkers that can be freely filtered in the glomerulus, so any increase in their plasma concentration (due to damage to other renal tissues) can lead to a high concentration of indicators in the urine (loss of specificity), and high-molecular-weight markers that are not freely filtered and therefore are more specific when measured in urine. Renal function in burn patients is usually determined by blood and urine tests, as biopsy can cause iatrogenic damage and is not commonly used in this cohort. After the onset of AKI, the level of biomarkers remains elevated for a certain period. None of the described indicators is monospecific for AKI; this makes estimating the time of AKI quite difficult. It has been proven that the combination of three biomarkers at two different time points in adults and the combination of two indicators at two time intervals in children allows to increase the reliability of determining AKI up to 0.78. Нещодавно виявлені специфічні маркери відкривають нові можливості для діагностики гострого пошкодження нирок (ГПН) при опіковій хворобі з метою оптимізації лікування таких хворих. Рання діагностика із залученням біомаркерів запобігає раптовій смерті опікових пацієнтів і дозволяє прогнозувати перебіг патологічного стану. Існує кілька характеристик, яким повинен відповідати «ідеальний» біомаркер ГПН: бути неінвазивним, локально специфічним, високочутливим, бути стабільною молекулою при різних температурах і pH, мати здатність швидко підвищуватися у відповідь на ураження нирок (кількісно його відображати), залишатися на високих рівнях протягом усього епізоду та знижуватися в період відновлення. Існує різниця між біомаркерами, що можуть вільно фільтруватися в клубочках, тому будь-яке збільшення їх концентрації в плазмі (внаслідок пошкодження інших ниркових тканин) може призвести до високої концентрації індикаторів у сечі (втрачається специфічність), і високомолекулярними маркерами, які не фільтруються вільно і тому є більш специфічними при вимірюванні в сечі. Функцію нирок у пацієнтів з опіками, як правило, визначають за показниками крові та сечі, оскільки біопсія може спричинити ятрогенне пошкодження та зазвичай у цій когорті не використовується. Після виникнення ГПН рівень біомаркерів залишається підвищеним протягом певного часу. Жоден з описаних індикаторів не є моноспецифічним для ГПН. Це робить оцінку часу перебігу ГПН досить складною. Доведено, що комбінації трьох біомаркерів у двох різних часових точках у дорослих та поєднання двох індикаторів у двох часових проміжках у дітей здатні збільшити достовірність визначення ГПН до 0,78

Kidney damage in burn disease. Part 2. Biochemical markers (literature review)

Recently discovered specific markers open up new possibilities for the diagnosis of acute kidney injury (AKI) in burn disease in order to optimize the treatment of such patients. Early diagnosis with the involvement of biomarkers prevents the sudden death of burn patients and allows predicting the course of the pathological condition. There are several characteristics that an “ideal” AKI biomarker should conform to: being non-invasive, locally specific, highly sensitive, being a stable molecule at different temperatures and pH values, having the ability to rapidly increase in response to kidney injury (quantify it), remaining at high levels during the episode and decreasing during the recovery period. There is a difference between the biomarkers that can be freely filtered in the glomerulus, so any increase in their plasma concentration (due to damage to other renal tissues) can lead to a high concentration of indicators in the urine (loss of specificity), and high-molecular-weight markers that are not freely filtered and therefore are more specific when measured in urine. Renal function in burn patients is usually determined by blood and urine tests, as biopsy can cause iatrogenic damage and is not commonly used in this cohort. After the onset of AKI, the level of biomarkers remains elevated for a certain period. None of the described indicators is monospecific for AKI; this makes estimating the time of AKI quite difficult. It has been proven that the combination of three biomarkers at two different time points in adults and the combination of two indicators at two time intervals in children allows to increase the reliability of determining AKI up to 0.7

Kidney damage in burn disease. Part 1. Pathomorphophysiology (literature review)

Acute kidney injury (AKI) is a common complication in critically ill burn patients and is associated with serious adverse outcomes, including increased length of hospital stay, development of chronic kidney disease, and increased risk of mortality. The incidence of AKI among burn patients in the intensive care units is 38 (30–46) %. A high percentage of the total burn surface area and a number of individual predisposing factors are considered to be the leading risk factors for AKI. Pathophysiological and morphological changes in the body under the combination of burn disease and kidney damage have certain discrepancies with the classical course of the pathological process in some nosological forms. Despite significant progress in the technologies of fluid resuscitation, intensive care and renal replacement therapy in recent years, the morbidity and mortality rate in such patients remain quite significant. A better understanding of clinical characteristics, early detection and prevention of risk factors for kidney damage in burns, as well as timely medical intervention can effectively reduce morbidity and progression of the pathological process, and also optimize the prognosis in the long run

Fluorescent Glycine-Coated Silver Nanoparticles as Bio-Imaging Agents for the Neural Stem Cells

We study experimentally the photoluminescence of small glycine-coated silver nanoparticles and their application as the bio-imaging markers of the neural stem cells. In addition we study nanoparticle’s toxic effects on the neural stem cells. Glycine-coated silver nanoparticles were synthesized using a thermal reduction of silver nitrate in a glycine matrix and size-separated via centrifugation. The properties of the nanoparticles were characterized using transmission electron microscopy, extinction and photoluminescence spectroscopy. Our results indicate that the nanoparticles have deleterious effects on the cells and showed an amplified increase in their death rates. In fixed cells the particles penetrate the membranes within an hour and 25 minutes of incubation, but do not penetrate into the body of the cell

Socio-psychological portrait of a modern medical intern in a ten-year dynamics

We analyzed over 3,000 anonymous surveys of interns who studied the Emergency medicine course this year and 10 years ago. We were studying their psychological features and social behavior in ten-year dynamics. The main characteristics of representatives of generation Y in medicine were determined. Representatives of this generation need an individual personal approach, which would allow transforming the downsides of mosaic thinking, features of behavior and attitude to the educational process, modern passion for gadgets and manner of communication into positive qualitie

Advantages and Disadvantages of Distance Learning of Medical Interns of Different Specialites

We analyzed more than 300 anonymous survey responses of interns who studied Emergency Medicine course remotely. The remote andragogical process is acceptable and useful only as a component of the dual form of higher medical education. Distance learning in large classrooms has many disadvantages, so classes should be conducted in small groups. The transition to remote learning during the pandemic is a forced, but the only possible measure that will save the health and lives of learning subjects

Psychological Features of the Modern Intern

Based on the anonymous survey with a ten-year interval, we created a comparative description of the dynamics of psychological characteristics among interns, such as social behavior and the ability to remember, reproduce, systematize and use the obtained information in practice. Construction of the educational process in accordance with the needs of the curriculum should take into account its own tasks in the setting of progressive changes in the young people’s way of thinking

Psycho-neurological disorders in accidental general cold injuries (review)

У наведеному літературному огляді автори намагалися розкрити основні особливості перебігу психо-неврологічних порушень в умовах загального переохолодження в динаміці залежно від ступеню патологічного процесу. Холодова травма у теперішній час залишається проблемою сучасної медицини. Це обумовлено тим, що дана травма носить виключно сезонний характер, зустрічається у всіх частинах планети і в структурі травматизму мирного часу складає від 1,0 до 8,0% за різними авторами. Переохолодження в приміщенні часто має несприятливий результат, тому що воно, як правило, вражає людей похилого віку, а діагноз часто встановлюється на пізній стадії. Ненавмисна гіпотермія також має значний і недостатньо визнаний вплив на ризик смертності від серцево-судинних та неврологічних розладів. Ненавмисному загальному переохолодженню організму сприяють наступні фактори: гостре порушення мозкового кровообігу, травма головного та спинного мозку, діабетична полінейропатія, атеросклероз, онкопатологія, зловживання алкоголем, прийом лікарських засобів, які впливають механізми терморегуляції, попередні патологічні стани, порушення поведінкової реакції та інші чинники. Важливо підкреслити, що сам по собі холод не спричиняє в організмі незворотних порушень, доки в клітинах не утворюються кристали льоду і до останніх стадій гіпотермії кровопостачання і оксигенація тканин головного мозку підтримуються на достатньому. При тривалому загальному переохолодженні психо-неврологічні розлади виникають у прямій залежності від зниження центральної температури організму, тобто від стадії патологічного процесу. Зібрана інформація може бути корисною для спеціалістів рятівних служб, лікарів першого контакту та персоналу відділень інтенсивної терапії під час спасіння та лікування постраждалих з ненавмисною гіпотермією. The aim of this literature review is to disclose the main features of hypothermiainduced psycho-neurological pathogenesis depending on hypothermia severity. Cold injury is still an urgent issue of modern medicine as being seasonal, occurring throughout the world and accounting for 1.0 - 8.0% of peace-time injuries, according to various authors. Indoor hypothermia often leads to an unfavorable outcome as usually affects the elderly and are detected at advanced stages. Accidental hypothermia is a significant and under-recognized contributor to cardiovascular and neurological mortality risk. The enablers of accidental general hypothermia are as follows: acute cerebrovascular accident, brain and spinal cord injury, diabetic polyneuropathy, atherosclerosis, oncopathology, alcohol abuse, medications affecting thermoregulation, previous pathological conditions, and other behavioral disorders. It is important to stress that cold itself does not cause irreversible damage to the human body, subject to sufficient blood supply and oxygenation of brain tissue, until intracellular ice crystals have been formed and severe hypothermia has been developed. Under prolonged general hypothermia, development of psycho-neurological disorders is positively correlated with decrease of central body temperature, i.e. hypothermia severity. The information collected can be useful to rescue professionals, first-line physicians, and intensive care personnel for managing persons with accidental hypothermia

Socio-psichologocal image of a modern medical intern in a fifteen-year dinamics

Over 5000 anonimus surveys of interns who studied the Emergency medicine course this year and 15 years ago be analized. We where tried to study their psichological features and social behavior in fifteen-year dinamics. The main characteristics of representatives of generation Y in medicine were determined. Outdated educational methods require specific revision and rethinking, maximum adaptation to changes in consciousness and modern bechavioral stereotipes. Methodological ways of resolving the existing contradiactions are proposed