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CONTENTS MEDICAL SCIENCE PREVENTIVE MEDICINE Risk-oriented approach to ranking of waterworks of the leningrad region A.V. Mel’tser, S.A. Gorbanev, N.V. Erastova, Ju.A. Novikova, E.S. Akulov.........5 Hygienic aspects of usage of alternative fuel from solid municipal waste at the enterprises on production of cement A.O. Karelin, V.V. Buchikhin, A.Yu. Lomtev, G.B. Yeremin, A.V. Mel’tser …...11 Modern approaches to the definition of rehabilitation potential in the examination of the able-bodied patients with obliterating atherosclerosis of the lower extremities A.Sh. Kalichava, R.T. Skljarenko, V.S. Luchkevich, L.A. Karasaeva..................17 CLINICAL MEDICINE Application nitroglycerin patients with acute myocardiall infarction: pros and cons V.E. Marusanov, T.P. Mishina, V.H. Kudashev, V.A. Semkichev.......................23 The influence of selenium replacement therapy on the course and outcome of severe traumatic brain injury T.P. Mishina, H.S. Nucalova, V.E. Marusanov...................................................28 Diagnostic significance of st segment depression in the left chest leads in lower myocardial infarction I.Y. Loukianova, K.Y. Glavatskikh.......................................................................34 Molecular genetic markers of occupational asthma D.O. Karimov, A.U. Shagalina, A.B. Bakirov.....................................................41 Preventive reinforcement of proximal femur osteoporosis with a system of older persons. Experimental study A.l. Matveev, V.Er. Dubrov, B.Sh .Minasov, T.B. Minasov, A.V. Nehogin.........46 Osteoprotegerin and hormonal and metabolic parameters in patients with type 2 diabetes mellitus, gout, and their combination A.F. Verbovoy, I.A. Tsanava, N.I. Verbovaya.....................................................53 Clinical and microbiological assessment of the effectiveness of using individually selected probiotics in patients with metabolic syndrome and impaired microbiocenosis colon E.I. Tkachenko, V.V. Zakrevskii, D.V. Kopchak, Е.А. Оrichak, L.U. Nilova......60 Not suicidal autoaggression in the structure of a psychopathic syndrome among the patients with paranoid schizophrenia who are on compulsory treatment V.T. Sevryukov, I.V. Kravchenko.........................................................................67 The prognostic value of interleukin-6 and d-dimer for infectious complications in patients with acute neuroleptic poisoning V.V. Shilov, V.A. Lukin, L.P. Pivovarova, M.E. Malyshev................................. 71
PREVENTIVE MEDICINE
RISK-ORIENTED APPROACH TO RANKING OF WATERWORKS OF THE LENINGRAD REGION A.V. Mel’tser 1, S.A. Gorbanev 2, N.V. Erastova 1, Ju.A. Novikova 1,2, E.S. Akulov 1
1 North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia 2Federal Service on Surveillance for Consumer rights protection and human well-being in the Leningrad region, Saint-Petersburg, Russia Abstract Introduction. The assurance of guaranteed access of the population to high quality drinking water in the Russian Federation is assumed as a national priority. The condition of drinking water supply remains to be one of the urgent tasks to ensure the sanitary-epidemiological welfare of the population of the Leningrad region, as long as existing water treatment technologies do not always allow to receive drinking water that meets health standards. Purpose. The assessment of the effectiveness of water treatment at waterworks in Leningrad region using the method of integral assessment of drinking water by indicators of chemical harmlessness for the improvement of quality management system of the drinking water. Materials and methods. The ranking of waterworks by the efficiency of water treatment was carried out in accordance with methodical recommendations MR 2.1.4.0032-11. «Integral assessment of drinking water of centralized systems by indicators of chemical harmlessness». We used the results of research works of drinking water of 2008-2013, which were performed by accredited testing laboratory center of the Federal budget healthcare institution «Center of hygiene and epidemiology in Leningrad region» in the framework of social-hygienic monitoring at waterworks that supply drinking water in Vsevolozhsk and towns named after Sverdlov, Morozov and Dubrovka. Results. For the purpose of our study we developed a list of the foreground sanitary-chemical indicators of drinking water in the Leningrad region taking into account the regional features and existing hygienic requirements. The calculations and risk analysis for each waterworks were performed. Total risks from exposure of substances which have organoleptic, toxic and carcinogenic impact were estimated. The calculations of the integral indicators of drinking water harmlessness were made on the basis of total risk as well as the waterworks were ranked and waterworks were being ranked. Conclusions. The research allowed to evaluate the effectiveness of water treatment technologies at waterworks of the Leningrad region, to rank waterworks in terms of harmlessness of drinking water, to determine the most effective activities to improve quality management system of the drinking water. Key words: water supply, drinking water quality, harmlessness of drinking water, integral assessment of drinking water harmlessness, health risk assessment.
HYGIENIC ASPECTS OF USAGE OF ALTERNATIVE FUEL FROM SOLID MUNICIPAL WASTE AT THE ENTERPRISES ON PRODUCTION OF CEMENT Karelin A.O.1,3, Buchikhin V.V.2, Lomtev A.Yu.2, 3 , Yeremin G.B.2,3, Mel’tser A.V.3
1First Saint-Petersburg State Medical University named after I.P. Pavlov, Saint-Petersburg, Russia 2Institute of Design, Ecology and Hygiene, Saint-Petersburg, Russia 3North-Western State Medical Universitynamed after I.I. Mechnikov, Saint-Petersburg, Russia
Abstract Purpose of the study. Investigation of harmful (contaminating) substances containing in the air pollution from enterprise on the production of cement in the case of partial replacement of the traditional fuel (coal) with the alternative fuel (RDF) from solid municipal waste. Materials and methods of the study. Objects of the study: Scientific publications on questions of usage the alternative fuel from solid municipal waste in enterprises on the production of cement. Results of chemical analysis of: - the composition of the air pollution without the alternative fuel; - the composition of the air pollution with the alternative fuel. Work of the stove aggregates, including stove refrigerator, cyclonic heat-exchanger, system of serve of alternative fuel was under control. Research methods. Methods of scientific hypothetical deductive cognition, sanitary-chemical methods, general logical methods and approaches of researches: analysis, synthesis, abstracting, generalization, induction. Results. Partial replacement of the traditional fuel (coal) with the alternative fuel (RDF) from solid municipal waste caused decrease in consumption of gas burner fuel by 16%. The analysis of the received materials showed that the usage of the alternative fuel did not cause increase of the air pollution of the majority of contaminating substances. So СО concentrations decreased by 9,35%, SO2 from 2,0 mg/m3 to 0 mg/m3, СО2 were practically unchanged. Concentrations of nitrogen oxides were only slightly increased (by 4,2%). Sharp decrease in emissions of the polychlorinated dibenzo-p-dioxine and dibenzofurana took place, that reached on the top limit of emissions of 19 times (in kg/h) and on concentration – 20 times. Conclusions. Stoves of enterprises on the production of cement do not need substantial reconstruction for the usage of the alternative fuel from solid municipal waste and they are effective for that. Production of alternative fuel (RDF) from SMW conduces to reduction of wastes and improvement of sanitary condition of grounds, dumps and depositories of solid municipal waste, that are substantial sources of environmental pollution. Cement stoves are effective devices for utilization of solid municipal waste because the high temperature (1500-2000оC) of the working zone of stove and time of contact (7 sec) provide decomposition of toxic organic substances. The analysis of the received materials enables to state that the usage of the alternative fuel did not cause increase of the air pollution of the majority of contaminating substances but cause their decrease in the air. Key words: alternative fuel, solid municipal waste, traditional fuel (coal), technology of p, roduction of alternative fuel, dibenzo-p-dioxine and dibenzofurana, cement stoves, air pollution of harmful (contaminating) substances.
MODERN APPROACHES TO THE DEFINITION OF REHABILITATION POTENTIAL IN THE EXAMINATION OF THE ABLE-BODIED PATIENTS WITH OBLITERATING ATHEROSCLEROSIS OF THE LOWER EXTREMITIES A.Sh. Kalichava1, R.T. Skljarenko1, V.S. Luchkevich2, L.A. Karasaeva1
1Saint-Petersburg Postgraduate Institute of Medical experts, Saint-Petersburg, Russia 2North-Western State Medical University named after I.I Mechnikov, Saint-Petersburg, Russia
Аbstract The purpose of the study – the formation of a system of criteria for the rehabilitation potential of the differentiated approach in making decisions by expert group about disability and disabled patients due to arteriosclerosis obliterans of the lower limbs. Materials and Methods: We examined and analyzed the survey results of 1120 patients with obliterating atherosclerosis of the lower extremities, intended for inspection in the office of ITU in St. Petersburg. Were assessed the socio-demographic, clinical expertise, welfare, psychological and socio-environmental characteristics of the patients. Subjected to detailed analysis clinical and organizational aspects of rehabilitation, in particular: the disease, duration of the disease, early and regular conservative treatment, type of surgery and postoperative treatment in the presence of the stump - the period from the onset of a disease to amputation, etc. Using correlation and discriminative analysis were handled obtained qualitative and quantitative indicators. The strength of the functional connection with the correlation coefficient (h) <0,3 was assessed as weak, with 0,7 ≥ (h) ≥ 0,3 - moderate, (h)> 0,7 – strong. The reliability, the importance of the correlation coefficient was evaluated by the Student t-test. Results: Was obtained reliable communication between different socio-hygienic, clinical expertise, medico-social and socio-environmental performance, contributing objectification of expert solutions in establishing different groups of disability in patients with atherosclerosis obliterans of the lower limbs. For the purpose of probabilistic forecasts primary amputation marked signs that are most significant effect on the outcome (disability), such as age, severity of labor, method of travel, duration of the disease, the presence of the stump, using a prosthesis, the time from the onset to amputation, ankle-brachial Index (LPI), the degree of chronic arterial insufficiency, concomitant diseases with complicated, the results of the initial examination. Consideration of received parameters allowed quite accurate (F-test = 73,789, Wilks' Lambda = 0,40179) and significantly (p<0.0001) to determine the probability of primary amputation among patients with atherosclerosis obliterans of the lower limbs, consideration of which is important in making decisions in the expert Bureau of ITU. In order to improve cooperation between the departments of Health and medico-social expertise and improve the efficiency of their work they were formed and marked the important medical and social indicators affecting the expert decision in the exercise of examination of patients with obliterating atherosclerosis of the lower extremities. Conclusion: For the purpose of objectification of expert solutions in the medical and social examination of sick and disabled, suffering from atherosclerosis obliterans of the lower limbs, should take into account the following important clinical expert indicators: age, socioeconomic status, occupation, the severity of the physical and the degree of intensity of mental work, the level of the prevalence of vascular process, severity of ischemia, the degree of limitation of movement at the time of the survey, co-morbidities and complications. Doctors of medical organizations while directing patients with obliterating atherosclerosis of the lower extremities for inspection in the office of the ITU and in the design of the corresponding clinics "Directions to the ITU," are absolutely necessary to consider not only the common clinical and functional parameters, but also the above-mentioned clinical and expert performance. This information should be written by physicians with the maximum fullness directing patients to ITU. Received criteria of the likelihood of primary amputation among patients suffering from atherosclerosis obliterans of the lower limbs, are significant indicators of expertise, influencing the outcome of medical and social expertise. In carrying out the study were highlighted indicators that allow us to estimate the level of rehabilitation potential, which in turn, causes the possibility of a differentiated approach when deciding on the disability group Key words. Disabled person, medico-social examination, rehabilitation, obliterating atherosclerosis of the lower extremities, rehabilitation potential.
CLINICAL MEDICINE
APPLICATION NITROGLYCERIN PATIENTS WITH ACUTE MYOCARDIALL INFARCTION: PROS AND CONS V.E. Marusanov 1, T.P. Mishina1, V.H. Kudashev 2, V.A. Semkichev 1
1North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia 2City Alexander's hospital, St. Petersburg, Russia Abstract The nitrates used in medicine for over 100 years, but is regularly open not only new beneficial effects of the drug, but also revealed its shortcomings. The aim of our study was to study the influence of nitrates on the main indices of Central hemodynamics in acute anterior myocardial infarction with ST-segment elevation. Material and methods: In our study, we observed the dynamics of the main indicators of the Central blood circulation in 2 groups of patients with anterior myocardial infarction with ST-segment elevation: group 1 (18 patients) without intravenous nitroglycerin; group 2 – (18 patients) with intravenous nitroglycerin (0.01% solution 10-50 mcg/min). Results: it was Found that infusion of nitroglycerin during the first 6 hours leads to an increase in stroke volume, infusion over 6 hours leads to a decrease in stroke volume that may result from the therapeutic effect of nitroglycerin, and the result of oppression heart activity negative properties of the oxide. Conclusions: During treatment with nitrates is the development of tolerance, decrease cardioprotective effect affects the clinical outcome of the therapy. Key words: nitroglycerin, anterior myocardial infarction with ST-segment elevation, cardiac output, total peripheral vascular resistance, nitric oxide
THE INFLUENCE OF SELENIUM REPLACEMENT THERAPY ON THE COURSE AND OUTCOME OF SEVERE TRAUMATIC BRAIN INJURY. T.P. Mishina1, H.S. Nucalova2, V.E. Marusanov1
1 North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia 2 Republican clinical hospital, Makhachkala, Republic of Dagestan, Russia
Abstract Objective: to study the relationship of disease course and outcome in severe head injury patients with substitution selenourea in the acute phase of injury. Material and methods: Surveys 2 groups of patients: group 1 (25 patients) – the main, in which patients in neyroreanimatsionnom office from the first day of a planned therapy included a formulation containing selenium (sodium selenite pentahydrate) at a dose of 1000 mg / day for 12 days of treatment neyroreanimatsionnom in the department, group 2 (25 patients) – a comparison group, which included patients without replacement selenoterapi. Results: In the group of patients treated selenium reliably lower time for AVL (p=0.001), no 28-day mortality, in contrast to the 2nd group of patients not treated with selenium, where the mortality rate was 16%. Conclusions: The study shows the usefulness of the substitution therapy selenium patients with severe craniocerebral trauma. Keywords: selenium, craniocerebral injury, early post-traumatic period, intensive care, the level of consciousness.
DIAGNOSTIC SIGNIFICANCE OF ST SEGMENT DEPRESSION IN THE LEFT CHEST LEADS IN LOWER MYOCARDIAL INFARCTION Loukianova I.Y., Glavatskikh K.Y.
North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia Abstract Introduction. Indentifying risk factors in patients with acute myocardial infarction is considered to be one of the most important diagnostic tasks, which ensures the selection of appropriate treatment approaches and decrease of adverse outcomes. ST depression in the left precordial leads in patients with lower myocardial infarctions can be regarded as a particularly significant factor, which indicates that such patients should be treated as high-risk at the stage of pre-hospital care. Purpose. Assessment of the diagnostic potential of ST segment depressions in V4-V6 leads based on ECG and CAG data. Materials and methods. The study included 31 patients with a lower myocardial infarction and an ST segment elevation. ECG and CFG diagnostic methods were applied. Results and Discussion. 1. ST depression in V4-V6 segments in patients with lower myocardial infarctions is likely to indicate important stenoses in the LCA system (sensitivity 76%, specificity 80%); 2. ST depression in V4-V6 segments in patients with lower myocardial infarctions and an ST elevation are more likely to have a lowered ejection fraction (EF) than patients without ST depressions (r=0, 41); 3. ST depressions in V4-V6 segments in patients with lower myocardial infarctions and an ST elevation should be regarded as indicators of ischemia in the LCA area, which is not related to the myocardial infarction. Conclusion. ST depression in left precordial leads in patients with lower myocardial infarctions and an ST elevation allows for treating such patients as high risk at the stage of prehospital care based on concurrent ischemia in the LCA area and the likelihood of heart failure. Key words: lower myocardial infarction, ST segment, coronary angiography, coronary arteries
MOLECULAR GENETIC MARKERS OF OCCUPATIONAL ASTHMA Karimov D.O., Shagalina A.U., Bakirov A.B.
Ufa Research Institute of Occupational Medicine and Human Ecology, Ufa, Russia
Abstract Introduction. The problems of early diagnosis and prevention of occupational asthma (OA) are considered to be essential in reducing the number of occupational diseases. Purpose. To determine the role of polymorphisms of interleukin 5 and the level of its expression in the development of occupational asthma. Materials and methods. Genotyping and analyzing the level of expression was carried out with the help of specific oligonucleotide primers and DNA probes on a thermocycler with the real time detection of the results. The study involved 105 patients diagnosed with OA who were hospitalized in the department of Occupational allergology and immunorehabilitation of "Ufa Institute of Occupational Medicine and Human Ecology". The control group consists of 354 non-relative individuals showing no symptoms of OA at the time of sample collection. Results. There was a significant difference in the distribution of alleles and genotypes frequencies between the group of patients with OA and the healthy ones in the polymorphic locus rs2069812 of IL5 gene. It is shown that the presence of the T allele increases the expression level of IL5 gene almost by two fold. Increased serum levels of IL5 gene are responsible for many atopic and autoimmune diseases. It is shown that in patients with OA the IL5 gene expression level before treatment was increased almost by 3-fold. Conclusion. The analysis of the frequency distribution of genotypes and interleukin 5 gene alleles has showed that the CC genotype (OR = 3,23; 95% CI 1,92-5,42) and C allele (OR = 2,07; 95% CI 1,52-2,8) of the polymorphic locus rs2069812 of IL5 gene were the markers of the occupational asthma increased risk. Kеy words: interleukin 5, polymorphic locus, expression, occupational asthma
PREVENTIVE REINFORCEMENT OF PROXIMAL FEMUR OSTEOPOROSIS WITH A SYSTEM OF OLDER PERSONS. EXPERIMENTAL STUDY. A.l. Matveev1, V.Er. Dubrov2, B.Sh .Minasov3, T.B. Minasov3, A.V. Nehogin4
1Central City hospital Novokuibyshevsk, Novokuibyshevsk, Russia 2Lomonosov Moscow State University, Moscow, Russia 3Bashkir State Medical University, Ufa, Russia 4Samara State Technical University, Samara, Russia
Relevance. The problem arose, the treatment and prevention of fractures of the proximal femur from older persons with systemic osteoporosis is relevant and is confirmed by the statistics. The purpose of the study. Development and validation of a technique of Internal fixation reinforcement of the proximal femur using original implants of its own design, on which the patents of the Russian Federation. Materials and methods. A methodology has been developed preventive reinforcement of hip, which received a patent for the invention of the RF and the construction of the original implants for the conduct of the proposed method, which also obtained patents of the Russian Federation. Mathematical modeling of the proximal part of femur using finite elements with virtual introduction of implants in the model of the proximal part of the femur. Conducted testing system "bone-implant" with a load in the vertical and horizontal planes at the head of the femur. The results. Mathematical modelling showed that the technique of prophylactic implant in bone tissue contributes to the enhancement of the critical voltage bones when load deformation on 11.6-12.1% at the points where the destruction. Bench tests convincingly show that the strength of the bone-implant system "increases to 73-93% depending on the type and combination of used implants. Conclusion. Experimental studies have shown that reinforced the bone can withstand greater load than Undamaged bone. When low-energy trauma preventive method of reinforcement can help prevent fractures. Key words: proximal femur, prophylactic, reinforcement, implants, mathematical modeling.
OSTEOPROTEGERIN AND HORMONAL AND METABOLIC PARAMETERS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS, GOUT, AND THEIR COMBINATION A.F. Verbovoy, I.A. Tsanava, N.I. Verbovaya
Samara State Medical University, Russia, Samara Abstract Scientific relevance. Nowadays there is a growing number of patients with type 2 diabetes and gout. Cardiovascular diseases associated with atherosclerosis are considered to be the main cause of death in these conditions. Purpose. To evaluate the relationship between osteoprotegerin and hormonal and metabolic disorders in patients with type 2 diabetes mellitus, gout, and their combination. Materials and methods. The study involved 64 men aged 41 to 70 years, who were divided into 3 groups. The first group included 18 patients with type 2 diabetes, the second - 25 patients with gout, and a third group consisted of 21 men with a combination of type 2 diabetes and gout. In case of all patients there was measured anthropometric indicators, studied lipid and carbohydrate metabolism, uric acid, and the content of osteoprotegerin. Results. In patients of all three groups there were increased levels of total cholesterol, triglycerides, immunoreactive insulin, uric acid, and osteoprotegerin. Conclusion. In patients with type 2 diabetes, gout and their combination on the background of abdominal obesity and insulin resistance are revealed compensatory hyperinsulinemia, atherogenic dyslipidemia. Increased osteoprotegerin plays a role in the development of atherogenic dyslipidemia. Key words: type 2 diabetes, gout, osteoprotegerin, atherosclerosis.
CLINICAL AND MICROBIOLOGICAL ASSESSMENT OF THE EFFECTIVENESS OF USING INDIVIDUALLY SELECTED PROBIOTICS IN PATIENTS WITH METABOLIC SYNDROME AND IMPAIRED MICROBIOCENOSIS COLON E.I. Tkachenko, V.V. Zakrevskii, D.V. Kopchak, Е.А. Оrichak, L.U. Nilova
North-Western State Medical University named after I.I. Mechnikov, Sankt-Petersburg, Russia Abstract Purpose: To evaluate the clinical and microbiological efficacy of the use of individually selected probiotics among patients with metabolic syndrome and impaired microbiocenosis colon. Materials and methods: The study involved 117 patients with metabolic syndrome (MS) and dysbiosis colon 1-2 degrees living in the therapeutic area. There were formed three observation groups. The main criteria for assigning patients to different groups of observations is the difference in adhesion, biocompatibility and the degree of antagonism of microorganisms isolated in the feces. The study of body composition before and after treatment was done using the diagnostic monitor complex "Diamond", biochemical serum lipid spectrum were determined using automatic biochemical analyzer Cobas Integra 400 plus, microbiological studies of feces was carried out in accordance with the methods described in US Patent number 2,428,468. To study the properties of probiotics in the effectiveness of elimination UPM has been used 5 probiotic food products and 5 of probiotic drugs and dietary supplements containing bifidobacteria and lactobacilli. Resuits: Patients in Group 1 after treatment with individually selected probiotics showed a significant decrease from baseline in body weight, BMI, fat mass, the content of triglycerides, total cholesterol and VLDL in the serum, accompanied by a decrease in atherogenic factor, as well as microbiological indicators faeces. Conclusions: 1. The use of the individually selected probiotics with high adhesion (4-5) and antagonism, not suppress indigenous lactobacilli and bifidobacteria in the background calorie diet helps to normalize microbiological parameters in the feces of patients, and it is more effective in reducing anthropometric and biochemical indices of blood lipid spectrum. 2. Individual selection of probiotics given adhesiveness, and the degree of antagonism suppress indigenous lactobacilli and bifidobacteria reduces the risk of the use of probiotics, which can suppress an indigenous microbiota own of particular patient and extends the range of optimally selected probiotic preparations for the patient. Key words: microbiocaenosis, metabolic syndrome, probiotics, probiotic food product, adhesion, biocompatibility, antagonistic activity.
NOT SUICIDAL AUTOAGGRESSION IN THE STRUCTURE OF A PSYCHOPATHIC SYNDROME AMONG THE PATIENTS WITH PARANOID SCHIZOPHRENIA WHO ARE ON COMPULSORY TREATMENT V.T. Sevryukov1, I.V. Kravchenko2
1North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia 2Interdistrict office of recovery treatment at policlinic of № 38, Saint-Petersburg, Russia
Abstract Purpose: to clarify a role of not suicidal autoagressive actions in structure of a psychopathic syndrome among the patients of paranoid schizophrenia who were on compulsory treatment Materials and methods: in total with a help of clinic follow up method it was studied 79 patients with paranoid schizophrenia who committed 198 acts of not suicidal autoaggression and were being on compulsory treatment at St. Petersburg mental hospital of specialized type with intensive supervision during the period from 2005 to 2014. Results: it is established that not suicidal autoaggression is a main element of behavioral disorders among such patients. It reflects the level of person adaptation to surrounding microsocial conditions under compulsory treatment. Conclusion: not suicidal autoaggression is the leading component of psychopathic behavior among patients with paranoid schizophrenia. It shows the level of microsocial adaptation in the conditions of compulsory treatment. A change of not suicidal autoaggression role in the structure of psychopathic behavior reflects the formation of pseudo-adaptation condition of the person, with preservation of initially low level of adequate social functioning among investigated patients. Key words: paranoid schizophrenia, compulsory treatment, not suicidal autoaggression, social adaptation, pseudo-adaptation
THE PROGNOSTIC VALUE OF INTERLEUKIN-6 AND D-DIMER FOR INFECTIOUS COMPLICATIONS IN PATIENTS WITH ACUTE NEUROLEPTIC POISONING V.V. Shilov1, V.A. Lukin2, L.P. Pivovarova2, M.E. Malyshev2 1North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia 2Saint- Petersburg Research Institute of Emergency Care named after I.I. Dzhanelidze, Saint-Petersburg, Russia Abstract Purpose: Algorithm construction for the infectious complications prognosticating of nosocomial pneumonia in severe acute neuroleptics poisoning based on the detection the following contents in the blood: the mediator of acute inflammation interleukin-6 (IL-6) and a marker of coagulation activation D-dimer. Material and methods: There were examined 46 patients aged 42.6±6.2 years with severe acute poisoning by neuroleptics (clozapine). The content of interleukins 1β, 6, 8, 10, TNFα, and PCT were used as indicators of inflammation activity. The tests were performed at the time of admission and on the 1st, 3rd and 5th days after acute poisoning. Among the studied indices of nonspecific resistance in patients with severe acute poisoning with neuroleptics the levels of IL-6, IL-10, CRP, PCT and D-dimer in the blood were most consistently associated with the development of pneumonia (p<0.05) a y after the admission. Assessment of markers predictive value and the choice of the threshold values were peformed using ROC-curves in the first day. Results: All patients observed demonstrated signs of systemic inflammatory response syndrome. The character of changes in investigated laboratory parameters and significant differences between them detected at 1st day after exposure to toxic, allowed the use of IL-6 and D-dimer concentrations for this day as early predictors of the pneumonia development in patients with acute neuroleptics poisoning. Conclusion: Application of ROC-analysis revealed reliable laboratory criteria of nosocomial pneumonia development risk in patients with severe acute neuroleptic poisoning. These laboratory markers can be used as predictors of pneumonia development. The IL-6 and D-dimer concentration above 84 pg/ml and 1.31 mg/ml, respectively, indicates a high risk of nosocomial pneumonia developing in patients with severe acute neuroleptics poisoning. Such findings allow to begin
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