This research studied the interrelationship between the immune and oxidative-antioxidant systems in a group of individuals who had lived for a long time in areas contaminated with radionuclides after the Chernobyl catastrophe and as a result experienced prolonged exposure to small doses of ionizing radiation. We have examined a group of 100 students aged 18–24, where 50 of them formed the control group and the remaining 50 belonged to the experimental group as they arrived from the territories of enhanced radioecological control (IV radiation zone, density of soil contamination by isotope 137Cs 3.7 x 104 – 18.5 x 104 Bq/m2). Here we determined the level of cortisol, leukocytes and their populations, the levels of lymphocyte subpopulations with phenotypes CD3+, CD5+, CD4+, CD8+, CD16+, CD72+, immunoregulatory index CD4+/CD8+, indicators of phagocytic activity of neutrophils and monocytes, IgG (H), IgM (H), IgA (H), malondialdehyde (MDA), ceruloplasmin (CP), transferrin (Tr), sulfhydryl (SH); and also calculated the oxidative stress index (OSI). We performed the analysis twice: in the absence/presence of additional emotional stress such as an examination session. The studies showed an increase in the oxidative stress index in the group examined from the experimental cluster, especially in terms of emotional stress. At the same time, the neutrophil level increased, but phagocytic activity of neutrophils and monocytes, the relative and absolute number of lymphocytes with phenotypes CD3+, CD5+, CD4+, CD4+/CD8+, and IgG levels decreased. Consequently we revealed the negative correlation between the indexes of oxidative stress in the group of examined (the oxidative stress index (ISO)/the level of malonic dialdehyde (MDA)) and the parameters of phagocytic activity of monocytes, the immunoregulatory index CD4+/CD8+, and the number of lymphocytes with the CD16+ phenotype. In this study we demonstrated the decrease in the participation of ceruloplasmin (CP) as an important antioxidant factor in maintaining the immune homeostasis of the group examined from radiation-contaminated areas compared with control group. The evidence of this is the lack of reliable correlation between ceruloplasmin level and immune system parameters. Moreover we found that radiation-induced intensification of oxidative processes in the experimental group grew in conditions of additional stresses of an emotional nature. Besides, it was accompanied by a significant correlation in the level of oxidative stress and phagocytic activity parameters. Reducing phagocytic activity and the CD4+/CD8+ index on the background of oxidative stress increase can be considered as a sign of immune system ageing, while a decrease in the number of lymphocytes with the CD16+ phenotype is a sign of antitumor defense inhibition. Thus, we draw the conclusion that the inhabitants of the territories of strengthened radioecological control, undergoing exposure to small doses of ionizing radiation from birth, show a significant imbalance of redox homeostasis, which creates the preconditions for immunoreactivity pathology development at the level of both innate and acquired immunity.
Fluid accumulation in the peri-pancreatic region and the distal areas of the abdominal cavity is widespread in the early stage of acute severe pancreatitis. The fluid is mainly hemorrhagic ascites, rich in activated lipolytic and proteolytic enzymes, vasoactive substances and inflammatory cytokines, and is aseptic at the onset of the disease. Evacuation of a fluid rich in potentially toxic mediators from the abdominal cavity is supported in a number of publications as a rational measure to alleviate the burden of disease in critically ill patients.The purpose of the study was to analyze recent publications on surgical tactics for enzymatic peritonitis and its impact on acute severe pancreatitis.A thorough analysis of the literature made it possible to draw the following conclusions related to the state of this problem. To date, randomized clinical trials and publications show controversial data on the efficacy of surgical interventions for acute pancreatitis complicated by ascites-peritonitis. International recommendations have a low level of evidence regarding the effectiveness of drainage, lavage and video-laparoscopic rehabilitation due to inclusion of patients with non-severe pancreatitis into individual Українська медична стоматологічна академія, м. Полтава, Україна A -концепція та дизайн дослідження; B -збір даних; C -аналіз та інтерпретація даних; D -написання статті; E -редагування статті; F -остаточне затвердження статті Накопичення рідини в перипанкреатичній області та віддалених ділянках черевної порожнини поширене на ранній стадії гострого тяжкого панкреатиту. Рідина найчастіше є геморагічним асцитом, багата активованими ліполітичними і протеолітичними ферментами, вазоактивними речовинами та запальними цитокінами, на початку захворювання асептична. Евакуація з черевної порожнини рідини, багатої на потенційно токсичні медіатори, в низці публікацій описана як раціональний захід для полегшення страждань хворих у критичному стані.Мета роботи -проаналізувати публікації останніх років щодо хірургічної тактики при ферментативному асцит-перитоніті та її впливу на перебіг гострого тяжкого панкреатиту.Висновки. Рандомізовані клінічні дослідження і публікації демонструють суперечливі дані щодо ефективності хірургічних утручань при гострому панкреатиті, що ускладнений асцит-перитонітом. Міжнародні рекомендації мають низький рівень доказовості щодо ефективності дренування, лаважу та відеолапароскопічної санації, який пов'язаний із залученням в окремі дослідження пацієнтів із нетяжким панкреатитом. Оптимізація хірургічної тактики в пацієнтів з асцит-перитонітом при тяжкому панкреатиті може бути пов'язана з визначенням тяжкості стану пацієнта з асцит-перитонітом, вираженості парапанкреатиту, рівня токсичності асцит-перитоніту, показань та оптимального часу дренування/лаважу. Для розв'язання цих питань необхідно продовжити проспективні дослідження.Хирургическая тактика при остром панкреатите, осложненном асцит-перитонитом В. В. Касьян, О. Ю. Черкун, Д. А. Сытник, В. Д. Шейко Накопление жидкости в перипанкреатической ...
The aim of the study was to analyze the prognostic potential of procalcitonin in acute pancreatitis complicated by ascites-peritonitis. Materials and methods: The study analyzed the results of a comprehensive examination and treatment of 18 patients with acute pancreatitis complicated by enzymatic ascites-peritonitis, including 13 patients who were treated in the surgical department of KP “Poltava Regional Clinical Hospital. MV Sklifosovsky POR “, and 5 patients of other emergency hospitals in Poltava, in the period from 2017 to 2019. In addition to standard screening methods, these patients were additionally tested for procalcitonin to predict an adverse course in the early period. Results: To assess the relationship between the presence of elevated procalcitonin levels at the time of hospitalization of 0.5 ng / ml and above and unsatisfactory treatment results, differences were assessed using an accurate Fisher test. When comparing differences in the development of infectious complications in the dynamics of the disease in patients of the study group depending on the presence of elevated concentrations of procalcitonin or its absence at the time of hospitalization, a significant difference was found (p <0.05). Conclusions: In our opinion, the use of procalcitonin as a predictor of infectious complications in the dynamics of the disease will determine the category of patients in whom reducing the risk of flora translocation through the use of early oral antibiotic prophylaxis and parenteral drugs tropic to pancreatic tissue may reduce the incidence of purulent complications. In another category of patients, antibacterial therapy is not advisable due to the low risk of purulent-septic complications. KEY WORDS: acute pancreatitis, procalcitonin, ascites-peritonitis, severity of the condition
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