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Kazlouskaya V.,Gomel State Medical University | Wittmann C.,New Hill | Tsikhanouskaya I.,Vitebsk State Medical University
International Journal of Dermatology | Year: 2014

Background: Pustular syphilis is an extremely rare manifestation of secondary syphilis. Failure to recognize the disease can have devastating consequences. Methods: We present three patients with pustular syphilis as the primary manifestation of secondary syphilis. Results: Patient 1 was initially diagnosed by Venereal Disease Research Laboratory (VDRL) test (titers 1 : 32) and confirmed by enzyme immunoassay (EIA) for Treponema pallidum. Patient 2 was screened for syphilis by VDRL (titers 1 : 64), yielding a positive result, and tested negative for HIV. Secondary syphilis was confirmed by EIA. In Patient 3, a diagnosis of secondary syphilis was established by VDRL (titers 1 : 128) and EIA. Treponema pallidum was detected by dark field microscopy in three patients. Testing for HIV infection was negative in all patients. Conclusions: Diagnosis in secondary syphilis remains challenging because of the diversity of clinical presentations. The most commonly observed cutaneous presentation is a generalized, non-pruritic, papulosquamous eruption varying from pink to violaceous to brown, with mucous membrane involvement. The diagnostic methods used to identify secondary syphilis are the same as those used to diagnose other stages of syphilitic infection. The persistence of syphilis in both developed and underdeveloped regions highlights the importance of considering syphilitic infection in the setting of a cutaneous pustular eruption, especially one that fails to respond to standard therapy. Testing for other sexually transmitted diseases, including HIV, should be performed in all patients diagnosed with syphilis. © 2014 The International Society of Dermatology.

Parkhomenko T.A.,Russian Academy of Sciences | Buneva V.N.,Russian Academy of Sciences | Tyshkevich O.B.,Novosibirsk State University | Generalov I.I.,Vitebsk State Medical University | And 2 more authors.
Biochimie | Year: 2010

DNase autoantibodies (Abzs) can be found in the blood of patients with several autoimmune diseases, while the blood of healthy donors or patients with diseases with an insignificant disturbance of the immune status does not contain DNase Abzs. Here we present the first analysis of the DNase Abzs activity in the patients with tick-borne encephalitis (TBE). Several strict criteria have been applied to show that the DNase activity is an intrinsic property of IgGs from the sera of TBE patients but not from healthy donors. The relative activity of IgGs has been shown to vary extensively from patient to patient, but most of the preparations (91%) had detectable levels of the DNase activity. Polyclonal DNase IgGs were not active in the presence of EDTA or after a dialysis against EDTA, but could be activated by several externally added metal ions, with the level of activity decreasing in the order Mn2+ + Ca2+ ≥ Mn2++ Mg2+ ≥ Mn2+ ≥ Mg2+ + Ca2+ ≥ Co2+ ≥ Mg2+ > Ca2+, while K+, Na+, Ni2+, Zn2+, and Cu2+ did not stimulate DNA hydrolysis. Affinity chromatography on DNA-cellulose separated the DNase IgGs into many subfractions with various affinities for DNA and very different levels of the relative activity. Possible reasons for catalytic diversity of polyclonal human Abzs are discussed. © 2010 Elsevier Masson SAS.

Gorodetskaya I.V.,Vitebsk State Medical University | Gusakova E.A.,Vitebsk State Medical University
Biomeditsinskaya Khimiya | Year: 2015

The alarm-stage of stress reaction (an hour after the stress of swimming of rats in a cage during an hour) is characterized by the stimulation of trypsine-like activity (TLA) in the liver, and especially in the blood. At the resistance stage (48 hours after the stress) there is normalization of TLA in the blood and limitation of its growth in the liver. At the stage of exhaustion (an hour of stress during 10 days) the most significant increase of TLA in the liver and blood develops. Experimental hypothyroidism (25 mg/kg merkazolil within 20 days) per se causes a reduction of TLA, defines more pronounced stimulation of proteolysis in the alarm-stage, prevents its normalization at the resistance-stage, and promotes its excessive activation at the stage of exhaustion. Introduction of small doses of L-thyroxine (1.5-3.0 g/kg during 28 days) does not affect the system of proteolysis, limitis the increase of TLA at the alarm- and exhaustion stages, prevents its stimulation at the resistance-stage. The dependence of the changes in the proteases/inhibitors system under stress from the level of iodine-containing thyroid hormones in the blood is due to their influence on the activity of endogenous proteinase inhibitors (α1-antitrypsin and α2-macroglobulin) and on the permeability of lysosomes membranes.

Boer-Auer A.,Dermatologikum Hamburg | Jones M.,Charles Nicolle Hospital | Lyasnichaya O.V.,Vitebsk State Medical University
Journal of Cutaneous Pathology | Year: 2012

Background: The histopathologic pattern of clonal seborrheic keratosis (SK) is quite similar to the nested pattern of pagetoid Bowen's disease [squamous cell carcinoma in situ (SCCIS)], and differentiation between the two can be challenging, especially when only small pieces are available for interpretation. Methods: Eleven examples of clonal SK and 13 examples of pagetoid SCCIS were examined histopathologically (tabulating necrotic keratinocytes, suprabasal mitoses, infiltrate, parakeratosis housing plump nuclei, crowding of nuclei) and immunohistochemically (using Ki-67, bcl-2, cytokeratin 7 and cytokeratin 10). Sensitivity, specificity, p-values (Fisher's exact test, two-tailed) and positive/negative likelihood ratios (+LR/-LR) were calculated. Results: Significant differences were seen with regard to crowding (p = 0.0009) and mitoses (p = 0.0006); however, only complete absence of necrotic keratinocytes or of crowding appeared to be diagnostically convincing for a diagnosis of clonal SK (-LR > 0.01). Significant differences were also seen with bcl-2 (p = 0.0005) and cytokeratin 10 antibodies (p < 0.00001). Both markers displayed a typical nested pattern in clonal SK, nests being bcl-2-positive and cytokeratin 10-negative. Cytokeratin 10-negative nests were the most convincing criterion for differentiation between clonal SK and pagetoid SCCIS (+LR > 10, -LR < 0.01). Conclusions: The most reliable marker to distinguish clonal SK from pagetoid SCCIS is cytokeratin 10 when it spares nests. Other criteria that assist in the differential diagnosis are bcl-2 expression, absence of crowding and of mitoses. Copyright © 2012 John Wiley & Sons A/S.

Konorev M.R.,Vitebsk State Medical University
Terapevticheskii Arkhiv | Year: 2012

Aim. To evaluate the efficiency of first-line Helicobacter pylori eradication therapy with glucosaminylmuramyldipeptide (Licopid JSC «Peptek», Russia). Subjects and methods. Eradication therapy was performed in 128 patients (84 men and 34 women; mean age 44.1 ±13.5 years) with duodenal bulb ulcer associated with H. pylori. The latter was detected in the gastroduodenal mucosa by a morphological study and rapid urease test before and 6-8 weeks after treatment and discontinuation of all drugs. Gastric metaplasia areas in the duodenum were revealed by periodic acid-Schiff and Alcian blue staining. The patients were divided into 4 groups according to the treatment protocol: 1) omeprazole (O) 0.04 g/day, clarithromycin (C) 1 g/day, amoxicillin (A) 2 g/day for 7 days (OCA7; n=33); 2) the above drugs for 14 days (OCA14; n=34); 3) O 0.04 g/day, C1 g/day, A 2.0 g/day for 7 days, and glucosaminylmuramyldipeptide (Licopid) (L) 0.001 g/day for a day (OCA7L1 ; n=34) and 4) the above drugs and L 0.01 g/day for 10 (OCA7L10; n=27). Results. According to trie data of intention-to-treat analysis and per protocol, the H. pylori eradication rate was 81.8 and 87.1% for OCA7; 82.4 and 93.3% for OCA14; 88.2 and 93.8% for OCA7L1; 88.9 and 96% for OCA7L10 after PT and RRT, respectively. The rate of side effects was as follows: 6.1% for OCA7; 17.6% for OCA14 (5.9% stopped treatment); 5.9% for OCA7L1; 7.4% for OCA7L10. The cost of the treatment protocols was $ 32 for OCA7; $ 64 for OCA14; $ 40 for OCA7L1; $ 67 for OCA7L10. The intake of glucosaminylmuramyldipeptide (licopid) 0.001 g/day during 7-day triple anti-Helicobacter pylori therapy increased eradication by 6.4% (ITT) and 6.7% (PP), without raising the rate of side effects. Conclusion. H. pylori-positive patients with duodenal bulb ulcer should be given glucosaminylmuramyldipeptide (Licopid) 0.001 g/day during 7-day first-line eradication therapy as alternative to the 14-day treatment regimen.

Ziankou A.,Vitebsk State Medical University
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery | Year: 2015

OBJECTIVE: To carry out the comparative analysis of early and midterm results of no-touch aorta multivessel small thoracotomy coronary artery bypass grafting (MVST CABG), conventional off-pump (OPCABG) and on-pump CABG (ONCABG). METHODS: From 2007 to 2014, 537 consecutive patients underwent CABG by the same surgeon. Propensity score computer matching was performed, and a total of 453 patients were successfully matched in 3 groups of 151 patients. RESULTS: Significant differences were found in the intraoperative blood loss: 220 (180; 300) mL in MVST CABG versus 400 (300; 550) mL in OPCABG vs 350 (250; 435) mL in ONCABG group; first 24-hour postoperative blood loss: 170 (100; 280), 320 (200; 470), and 380 (200; 500) mL, respectively; operation time: 352.4 ± 74.4, 289.3 ± 55.0, and 280.4 ± 56.4 minutes, respectively; median time to return to full physical activity: 14, 56, and 56 days, respectively (P < 0.05); rate of deep wound infection: 0.0%, 2.0%, and 2.0%, respectively; and postoperative length of stay (surgical department): 4.5, 7.0, and 7.5 days, respectively (P < 0.1). No significant differences were observed in rates of severe in-hospital events (P > 0.05), cumulative midterm survival, and freedom from major adverse cardiac and cerebrovascular events (P > 0.05). CONCLUSIONS: The MVST CABG seems as safe as OPCABG and ONCABG and is associated with less wound infections, perioperative blood loss, shorter hospital length of stay and time to return to full physical activity. Multivessel small thoracotomy CABG can be applied to most patients with coronary heart disease saving the effectiveness during midterm follow-up. The MVST CABG can be introduced avoiding a prolonged learning curve. ©2015 by the International Society for Minimally Invasive Cardiothoracic Surgery.

Kupchenko A.M.,Vitebsk State Medical University
Novosti Khirurgii | Year: 2014

Objectives. To study the etiological structure and sensitivity of aerobic microorganisms of peritoneal exudate to antibacterial preparations in patients with generalized purulent peritonitis in regards to the current condition.Methods. At Vitebsk Emergency Hospital the peritoneal exudate in 92 patients with generalized purulent peritonitis has been studied by the developed test systems "ID - ENT", "AB - ENTER", "AB - GRAM (-)", "AB - STAF", "AB - PSEUD". Pathogenetic significance of enterobacteria and Gram Negative Aerobic microorganisms as well as their specious composition and sensitivity to antibacterial preparations has been defined.Results. In the majority (73%) cases the conducted microbiological examination has manifested the generalized purulent peritonitis caused by mixed aerobic and anaerobic flora (only by anaerobes - in 14%, only aerobes - in 13%). The representatives of the genus Enterobacteriaceae have dominated among the isolated 80 strains of aerobic and facultative - Anaerobic microorganisms. The aerobic microflora of peritoneal exudate components was represented by E. coli - 53,75%, Enterococcus spp.- 10%, Streptococcus spp. - 8,75%, Klebsiella spp. - 10%, Proteus spp. - 5%, Staphylococcus spp. - 6,25%, Pseudomonas aeruginosa - 6,25%. In studying the sensitivity of main aerobic pathogens of generalized purulent peritonitis to antimicrobial agents the existence in the vast majority of strains of multiple drug resistance has been established. Carbapenems (meropenem - 94,4% of the sensitive microorganisms, imipenem - 88,7%), the third-generation aminoglycosides (amikacin - 87,3%), fluoroquinolones (moxifloxacin - 87,3%, ciprofloxacin - 84,5%, norfloxacin - 83,1%), the fourth generation cephalosporins (cefepime - 80,3%) exhibit maximal antibacterial effect on the aerobic component.Conclusion. The obtained data concerning the etiological structure of aerobic microflora of peritoneal exudate in patients with generalized purulent peritonitis will assist in creating of new effective antibiotic therapy schemes available to reduce mortality rate and improve pharmacoeconomic treatment results of given morbility.

Plotnikov P.V.,Vitebsk State Medical University
Novosti Khirurgii | Year: 2014

Objectives. To determine the effectiveness of the miltimodal treatment of pyogenic wounds depending on the ability of the isolated pathogen to form biofilm.Methods. During the research, the comprehensive examination and treatment of 48 patients with pyogenicinflammatory processes of soft tissues have been conducted in the Republican Scientific and Practical Center "Infection in Surgery" on the basis of the pyogenic surgery department of ME "Vitebsk Regional Clinical Hospital" during the period of 2012-2014. The control group patients (n=31) were subjected to a standard treatment, the main group patients (n=17) received the suggested integrated treatment of the pyogenic wounds taking into account the ability of pathogens to form biofilm based on the application of the vacuum-instillation therapy with the dimeksid solution as a rinsing liquid. There were no reliable differences in age, sex as well as in nosologic forms of diseases in the investigated groups.Results. Antiseptics widely used in clinical practice have been studied. Dimeksid, inol, isopropyl alcohol destroied the biofilm most intensively. These antiseptics are considered to be recommended for treatment of wounds, associated with pathogens capable to form biofilm. Statistically significant reduction term of the clearance wound, the appearance of granulation tissue, the marginal epithelialization beginning and the length of treatment in the patients underwent the miltimodal treatment of the pyogenic wounds according to the worked out method have been revealed.Conclusion. The performed research has proved the efficacy of the suggested method of pyogenic wounds treatment taking into account the ability of some pathogens to form biofilm. The application of proposed method can reduce treatment terms of patients with pyogenic wounds by 6 days (p=0,03).

Ovsianik D.M.,Vitebsk State Medical University
Novosti Khirurgii | Year: 2014

Objectives. To study the indicators of endothelial dysfunction in acute pancreatitis and assess their potential for differential diagnosis of infected and sterile pancreatic necrosis.Methods. A prospective investigation of indicators of endothelial dysfunction - the number of circulating endothelial cells and concentration of stable degradation products of nitric oxide in the blood of patients (n=92) with various forms of acute pancreatitis has been carried out. The results of a study of healthy volunteers (n=15) were used as a control. For diagnostic test evaluation of sensitivity/specificity for forecast verification and diagnosis of infected pancreatic necrosis the Receiver Operating Characteristic (ROC) analysis has been applied.Results. In case of the edematous form of acute pancreatitis a statistically significant increase of circulating endothelial cells number and the level of nitrate/nitrite in the blood by 1.5-folds compared to healthy persons (=0,0051; =0,0206) have been observed. An expressive clinical manifestation of endothelial dysfunction has been occurred in pancreatic necrosis, as for its sterile course the tendency to regress have been appeared. In the infected pancreatic necrosis the negative dynamics demonstrating this disease usually was found in increase of the number of circulating endothelial cells in the blood. Within the first week of hospitalization the level of nitrate/nitrite - >36 uM/L (sensitivity - 81,8%, specificity - 60,3%, AUC=0,7; =0,0323) may be used in prediction of infected pancreatic necrosis. The presence of 39 and more circulating endothelial cells in 100 ul. plasma (sensitivity - 84 %, specificity - 86%, AUC = 0,834; p <0,001) happen to be one of diagnostic signs of infection of pancreatic necrosis in the second phase of disease.Conclusions. The received results testify to expediency of the research of endothelial dysfunction by determination of the number of circulating endothelial cells in the blood of patients with acute pancreatitis as a method should be applied for early detection of infection of pancreatic necrosis.

Kozlov A.I.,Vitebsk State Medical University
22nd International Congress on Sound and Vibration, ICSV 2015 | Year: 2015

Some different equations derived as second-order approximations to complete system of equations of nonlinear acoustics of Newtonian media such as Lighthill-Westerwelt equation, Kuznetsov one, et cetera are usually solved numerically or at least approximately. A general exact analytical method of solution of such problems based on a short chain of changes of variables is presented in the work. Three types of possible solutions were found depending on parameters of each initial equation: a so-called Taylor shock (or diffusive soliton), a monotonously decaying solution as well as a periodic one.

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