Pregnancy and chronic pyelonephritis: Clinical and immunological aspects (a review)
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BACKGROUND: The most dangerous disease in the structure of urinary tract infections during pregnancy is pyelonephritis. Favorable ground for its occurrence is created by anatomical and physiological changes in the urinary system in pregnant women against the background of gestational restructuring of the body. It seems very relevant to study the constitutional features of pregnant women with pyelonephritis and reference points - markers associated with the risk of developing pyelonephritis, the individual characteristics of its course and the effectiveness of therapy using the fundamental basis of clinical anthropology. AIM: Evaluation and comparative analysis of anthropometric and bioelectrical impedance body parameters in pregnant women with pyelonephritis. MATERIALS AND METHODS: The study included 94 pregnant women with pyelonephritis hospitalized in the urological department of the Clinical Regional Hospital (Krasnoyarsk) from 2019 to 2021. In addition to traditional tests, anthropometric and bioelectrical impedance analysis was carried out to assess the constitutional features and criteria of normal and pathological variability boundaries of pregnant women with pyelonephritis. The control group included 39 women with physiological course of pregnancy without urological diseases. RESULTS: The constitutional identification in the group of women with pyelonephritis in pregnancy was dominated by the mesomorph body type, with a smaller proportion presenting the endomorph type and the rarely detected central and ectomorph types. Vector analysis of soma components in pregnant women with pyelonephritis are characterized by high mesomorph scores reflecting the degree of skeletal and muscular development compared to the control group, with the lowest ectomorph values. According to bioelectrical impedance analysis, most patients have significant differences in a number of body composition parameters. Morphometric features of the pelvicalyceal system on the affected side are most prominent in the representatives of endomorph and central body types. There are significant correlations between the degree of pelvicalyceal system dilatation on the affected side and anthropometric and bioimpedance parameters of body composition. CONCLUSION: The study revealed a number of clinical and anthropometric parallels and constitutional features of pregnant women with pyelonephritis with the characteristics of the component body composition. Relationships have been established between various indicators, which at first glance are not related to each other, but have a significant impact on the clinical manifestations of gestational pyelonephritis. The results of the pilot study and further development of the methodology will make it possible to determine the most significant constitutional predictors of the development of pyelonephritis in pregnancy and the possibility of conducting preventive therapy.
BACKGROUND: The most dangerous disease in the structure of urinary tract infections during pregnancy is pyelonephritis. Favorable ground for its occurrence is created by anatomical and physiological changes in the urinary system in pregnant women against the background of gestational restructuring of the body. It seems very relevant to study the constitutional features of pregnant women with pyelonephritis and reference points - markers associated with the risk of developing pyelonephritis, the individual characteristics of its course and the effectiveness of therapy using the fundamental basis of clinical anthropology. AIM: Evaluation and comparative analysis of anthropometric and bioelectrical impedance body parameters in pregnant women with pyelonephritis. MATERIALS AND METHODS: The study included 94 pregnant women with pyelonephritis hospitalized in the urological department of the Clinical Regional Hospital (Krasnoyarsk) from 2019 to 2021. In addition to traditional tests, anthropometric and bioelectrical impedance analysis was carried out to assess the constitutional features and criteria of normal and pathological variability boundaries of pregnant women with pyelonephritis. The control group included 39 women with physiological course of pregnancy without urological diseases. RESULTS: The constitutional identification in the group of women with pyelonephritis in pregnancy was dominated by the mesomorph body type, with a smaller proportion presenting the endomorph type and the rarely detected central and ectomorph types. Vector analysis of soma components in pregnant women with pyelonephritis are characterized by high mesomorph scores reflecting the degree of skeletal and muscular development compared to the control group, with the lowest ectomorph values. According to bioelectrical impedance analysis, most patients have significant differences in a number of body composition parameters. Morphometric features of the pelvicalyceal system on the affected side are most prominent in the representatives of endomorph and central body types. There are significant correlations between the degree of pelvicalyceal system dilatation on the affected side and anthropometric and bioimpedance parameters of body composition. CONCLUSION: The study revealed a number of clinical and anthropometric parallels and constitutional features of pregnant women with pyelonephritis with the characteristics of the component body composition. Relationships have been established between various indicators, which at first glance are not related to each other, but have a significant impact on the clinical manifestations of gestational pyelonephritis. The results of the pilot study and further development of the methodology will make it possible to determine the most significant constitutional predictors of the development of pyelonephritis in pregnancy and the possibility of conducting preventive therapy.
Introduction. Urinary tract drainage for pyelonephritis in pregnancy (PiP) is a topic that is rarely covered in the literature. Available sources are based on personal experience and personal opinions of researchers. In this way, a wide range of tactical decisions is born in such conditions.Purpose of the study. To evaluate the effectiveness of the «traditional» draining treatment tactics for pyelonephritis in pregnant women.Materials and methods. The study included 124 cases of PiP with dilatation of the pyelocaliceal system. Signs of urolithiasis and congenital malformations of the upper urinary tract have not been identified. The average age of the patients was 25 (15–40) years. PiP in the first trimester was diagnosed in 11.3% of women, in the second trimester is in 57.3%, in the third trimester is in 31.4%. In 60.5% of cases, a right-sided PiP was observed, in 24.2% is a left-sided PiP, and in 16.1% it was bilateral PiP. Assessment of dilatation of the upper urinary tract revealed a slight and moderate hydronephrosis in 94.4% of patients, and significant in 5.6%. During treatment, all patients underwent stenting of the ureters. Scheduled stent replacement was performed 6–8 weeks after the initial stenting or drainage replacement. Conversion to percutaneous puncture drainage was required in 4 (3.3%) patients.Results. The early draining tactics of PiP was accompanied by a relatively rapid relief of hyperthermia (96.8% within 3 days) and leukocytosis (88.7% of patients within 4 days). The average hospital bed day for PiP was 4.6. 77.4% of patients required stent replacement during gestation. Stent-associated symptoms of varying severity were noted by 74% of women. Recurrent attack of pyelonephritis under stent drainage was observed in 19.4% of patients, the development of septicemia in 6.5%. In 5.7% of patients, a re-development of the pyelonephritis` attack was noted after removal of the internal drainage stent up to 2 months after delivery. Information was available on the birth and condition of the child at birth for 119 women. Delivery in term was observed in 89.5% of patients, premature spontaneous birth in 10.5%, of which with provocation of labor in 8.9%, with termination of pregnancy for medical reasons in 1.6% (development of preeclampsia, progression of the sepsis phenomena). Self-abortion, intrauterine fetal death or stillbirth was not observed in any woman.Conclusion. The relatively rapid relief of hyperthermia, leukocytosis, a short period of inpatient treatment, the absence of fetal death cases, maternal and infant mortality positively characterize the «traditional» draining tactics. At the same time, a high percentage of the frequency of the preterm delivery threat, maintenance therapy on the stent (16.1%), recurrent attacks of pyelonephritis in drainage conditions (19.6%) during gestation, and also after stent removal in the postpartum period (5.7%), other variations of stent-associated symptoms and complications create the basis for reflection, the search for more optimal tactical and therapeutic approaches.
Criminal liability for sexual offences against minors in the United States, Canada and the United Kingdom
The subject of the study is the types and forms of criminally punishable sexual violence against children available in the legislation of the United States of America, Canada and the United Kingdom. The author examines in detail the descriptions of the circle of persons who may be subjects of sexual acts with minors, enshrined in various legal norms of these countries. Their comparative characteristics are carried out, positive trends that can be implemented in the criminal legislation of the Russian Federation are identified. The concepts of "statutory rape" and "age of sexual consent", unknown to the Russian legal doctrine, are considered. The issues of compensation for harm caused to minors who suffered from sexual acts are investigated. Based on the dialectical method of cognition of the surrounding reality, the study is based on a comparative analysis of the provisions of US criminal law on the example of legislative acts of various states, Canada and the United Kingdom on combating child sexual abuse. The main conclusions of the study are: the legislation of the Anglo-Saxon countries recognizes various types of sexual violence against minors as acts of special public danger: the severity and effectiveness of punishment for these acts are quite high; The degree of elaboration of definitions concerning sexual crimes is more extensive and detailed, fixed in the norms of criminal legislation. Legally, the concepts are given and the measure of responsibility for such actions with minors as incest, sodomy, pederasty, oral copulation is defined, the pitchforks of obscene or lascivious actions and a number of others are described in detail. The additional civil liability of an adult who has had sexual intercourse with a minor in the form of monetary compensation deserves attention. The legislation of foreign countries is able to enrich the domestic norms of the criminal code in the case of the implementation of certain substantive provisions.
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