Безопасность в чрезвычайных ситуациях анализ оказания догоспитальной медицинской помощи пострадавшим в дорожно-транспортных происшествиях с сочетанными травмами в арктической зоне архангельской области
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A CASE OF HEMOLYTIC-UREMIC SYNDROME ASSOCIATED WITH ENTEROVIRUS INFECTION IN AN INFANTPoskotinova A.I. Arkhangelsk, Russia, Northern State Medical University. Department of infectious diseases. VI–year student of pediatric faculty. e-mail: anasta-anasta@mail.ru Supervisor: DSc, prof. Samodova O.V, CSc, MPH Krieger E.A Abstract: We presented a case report of hemolytic-uremic syndrome associated with enterovirus infection in an infant. Hemolytic-uremic syndrome showed a typical clinical course with a specific triad: acute renal failure, non-immune hemolytic anemia, thrombocytopenia. The patient completely recovered. This case highlights an uncommon etiology of HUS, which needs a very high index of suspicion keeping in mind the very high mortality associated with it. Keywords: hemolytic-uremic syndrome, enterovirus infection, children Hemolytic-uremic syndrome (HUS) is characterized by haemolysis, thrombocytopenia, and acute renal failure (ARF). HUS occurs with a frequency of 0.5-2.1 cases per 100,000 population per year, with a peak incidence in children under 5 years, in whom the incidence is 6.1 cases per 100,000 population per year [4]. HUS is the leading cause of acute renal failure in infants and young children [1]. HUS is usually caused by enterohaemorrhagic E.coli, producing exotoxin, Shigella dysenteriae, Str.pneumoniae, HIV. However, in rare cases the hemolytic-uremic syndrome may be associated with other microorganisms, in particular enterovirus. [3] We would like to describe a clinical case of hemolytic-uremic syndrome associated with a rare causative agent - enterovirus. A 11-months-old boy presented with impaired consciousness and acute renal failure. The episode began 2 days ago with repeated vomiting and malaise. His mother said that he child drank eagerly but did not eat as much as usual. Urinary output subsequently decreased. At the end of the first day of illness the child suffered a generalized tonic-clonic seizures with loss of consciousness lasting about 10 minutes. The body temperature remained normal. After the episode of seizures hemorrhagic rash on the body was observed. The child was hospitalized in the intensive care unit of pediatric hospital. Examination revealed a toxic child with altered consciousness level (stupor) andpositive meningeal symptoms. Oropharynx examination showed hyperemia of the posterior palate, pharynx, and tonsillar areaswith a few small vesicles and ulcers (signs of vesicular pharyngitis/herpanginacaused by enterovirus). The extremities were cool with a capillary refill time of 4-5 seconds. Cardiac auscultation revealed muffled heart sounds, regular rhythm, 145 beats/min. Blood pressure was normal. A soft liver edge was palpated 1.5 cm below the rightcostal margin. Skin was pale with punctulate haemorrhagic purpura covering the trunk. Ecchymosis were observed on the legs, andpinkpapular rash on the face. The swelling of soft tissues of the face was also noted. Urine output was reduced. Urine was yellow, transparent, in a small volume. Stool was liquid, dark- colored, without pathological impurities. Ultrasound examination revealed toxic kidneys damage, the partial reduction of intrarenal blood flow.Complete blood count showeda mild anemia (Hb 104 g / L, RBC 4.32*1012/l), thrombocytopenia 55*109/l, leukocytosis 18.8*109/L. Urinalysis revealed massive proteinuria (9.31 g/l), hematuria, leucocyturia. There were urea 22.1 mmol/l and creatinine 171mkmol/l in biochemical bloodanalysis. The Cerebrospinal fluid (CSF) cell count was 21 cells (lymphocytes) with the normal protein and glucose levels. CSF culture and stool culture were negative.Stool PCR detected RNA of enterovirus. Thus, the diagnosis of enterovirus infection was confirmed based on clinical (aseptic meningitis, skin rush, vesicular pharyngitis and enteritis)and laboratory data (enterovirus RNA in stool). Hemolytic - uremic syndrome with the typical signs (acute renal failure, anemia, thrombocytopenia) was considered a complication of enterovirus infection. During the next 7 days the patient’s condition was exacerbated. the patient developed anuric ARF, hyperasotemia and symptomatic edema due to fluid overload.Anemia and thrombocytopenia became more severe. Treatment included infusion therapy in a minimum amount, transfusion of erythrocyte mass (once), antibiotic therapy (ceftriaxone), anticoagulants, aggregation inhibitors, antithrombin III of, an inhibitor of angiotensin-converting enzyme, probiotics, enteral nutrition. 10 hemodialysis sessions were conducted. On the 8 day of illness the general condition of the patient improved. Urine output became normal, hemorrhagic rash was faded, intoxication disappeared. The patient was transferred to the somatic unit where surveillance and pathogenetic therapy were continued. On 36day of the disease, the patient was discharged from the hospital in satisfactory condition with normal renal function, and recommendations for further management and dispensary observation in an outpatient department [2]. Thus, this case highlights an uncommon etiology of HUS, which needs a very high index of suspicion keeping in mind the very high mortality associated with it. References 1. Adams DA, Jajosky RA, Ajani U, Kriseman J, Sharp P, Onwen DH, et al. Summary of notifiable diseases-United States, 2012// MMWR Morb Mortal Wkly Rep, 2014. P. 1-121. 2. Iijima K, Kamioka I, Nozu K. Management of diarrhea-associated hemolytic uremic syndrome in children.// Clin Exp Nephrol, 2008. N 1. P 9 – 16. 3. Salvadori M, Bertoni E. Update on hemolytic uremic syndrome: Diagnostic and therapeutic recommendations. // World J Nephrol. 2013. N 2(3). P 56-76. 4. Siegler R, Oakes R. Hemolytic uremic syndrome; pathogenesis, treatment, and outcome. // Curr Opin Pediatr. 2005. N 2. P 200- 204 EBOLA VIRUS DISEASE IN NIGERIA: OUTBREAK INVESTIGATION Rufai Adekola Arkhangelsk, Russia, Northern State Medical University, 5-year students of international faculty of general practitioner, e-mail: Kayonline009@yahoo.com Supervisor: CSc, MPH E.A. Krieger Key words: Ebola virus disease, outbreak. Background. The largest Ebola virus disease (EVD) outbreak had occurred in West Africa, particularly in Guinea, Liberia, Nigeria, Senegal and Sierra Leone, with a total of 7 178 reported cases including 3 338 deaths [1]. Rapid air travel has increased the potential for international spread of EVD. Analyses of data from the EVD outbreak in Nigeria can provide important information about the impact of the sudden introduction of EVD in large cities and on the control measures needed to stop outbreak. Objective. To analyze EVD transmission, to assess the fatality rate and to estimate the impact of control interventions on the size of the outbreak in Nigeria. Methods. We assessed the epidemiological data for the EVD outbreak in Nigeria published by World Health Organization from 20 July to 1 October 2014 [2]. We estimated the individual reproduction number (R0) of the index EVD case as the average number of secondary infections generated by an infectious index case at the beginning of an outbreak, while we refer to R, the reproduction number, when transmission is affected by control interventions [3]. The case fatality rate was calculated as the number of reported deaths divided by the number of reported cases. Confidence Intervals (CI) for proportions were calculated using Wilson's procedure. Results: Altogether 20 EVD cases (19 laboratory confirmed, 1 probable) have been reported in Nigeria. The 19 laboratory-confirmed cases were diagnosed by reverse transcription polymerase chain reaction at hospitals in Lagos. The diagnosis of the index case took approximately three days, while results of the tests for the other confirmed cases were typically available within 24 hours. Samples were also sent to the World Health Samples were also sent to the World Health Organization Reference Laboratory in Dakar, Senegal, for confirmation. Probable case was evaluated by a clinician and had contracted a confirmed EVD case. Of the 20 cases, 11 were healthcare workers; 9 of whom acquired the virus from the index case before the disease was identified in the country. Eight of the 20 EVD cases reported in Nigeria have died, giving an estimated case fatality rate of 40% (95% CI: 21.9–61.3). All 20 cases stemmed from a single importation from an air traveler returning from Liberia to the international airport in Lagos, Nigeria, on 20 July 2014. The Nigerian index case had visited and cared for a sibling in Liberia who died from the disease on 8 July 2014. The case had symptoms during his journey, and died on July 25, 2014, after being admitted to a private hospital in Lagos. A total of 894 contacts were subsequently linked to this index case, including the primary, secondary and tertiary contacts. The index case generated 12 secondary cases in the first generation of the disease. Five secondary cases were generated in the second generation and two secondary cases in the third generation. This leads to a rough empirical estimate of the reproduction number according to disease generation decreasing from 12 during the first generation, to approximately 0.42 and 0.4 during the second and third disease generations, respectively. Importantly, one of the primary contacts of the index case had travelled to Port Harcourt, the capital of Rivers State, at the end of July 2014 and was cared for by a healthcare professional who subsequently became infected and died on 22 August 2014. This deceased healthcare worker was in turn linked to a total of 526 contacts in Port Harcourt. The swift control of the outbreak was likely facilitated by the early detection of the index entering Nigeria from a country where disease is widespread, in combination with intense contact tracing efforts of all contacts of this index case and the subsequent isolation of infected secondary cases. All symptomatic contacts were initially held in an isolation ward. Following laboratory confirmation of EVD, all positive symptomatic contacts were immediately moved to an EVD treatment centre. Asymptomatic suspected contacts were separated from symptomatic contacts. Negative asymptomatic individuals were discharged immediately [4]. As of 1 October 2014, all contacts had completed the 21-day surveillance follow-up with no new report of incident cases. The World Health Organization is soon to officially declare Nigeria free of active Ebolavirus transmission [1]. Conclusion: Nigeria’s quick and forceful implementation of control interventions was determinant in controlling the outbreak rapidly. The mean reproduction number among secondary cases in Nigeria was 0.4 in the presence of control interventions. This number is below the epidemic threshold (R=1.0) for disease spread. The Nigerian experience offers a critically important lesson to countries in other regions of the world that risk importation of EVD and that must remain vigilant. References: 1.World Health Organization (WHO). WHO: Ebola response roadmap situation report. 1 October 2014. Geneva: WHO. [Accessed 9 March 2016]. Available from: http://apps.who.int/iris/bitstream/10665/135600/1/roadmapsitrep_1Oct2014_eng.pdf. 2.World Health Organization (WHO) Global Alert and Response. Disease outbreak news: Ebola virus disease, West Africa – update. Geneva: WHO. [Accessed 9 9 March 2016]. Available from: http://www.who.int/en. 3.Diekmann O, Heesterbeek JA. Mathematical epidemiology of infectious diseases: model building, analysis and interpretation. San Francisco, CA: Wiley; 2000. 4.Shuaib F., Gunnala R., Musa E.O., Mahoney F.J., Oguntimehin O., Nguku P.M., et al. Ebola virus disease outbreak - Nigeria, July-September 2014. MMWR Morb Mortal Wkly Rep. 2014; 63 (39): 867-72. SOME FEATURES OF THE IMPLEMENTATION OF THE RIGHTS OF PATIENTS IN THE ARCTIC ZONE. Smirnov N.I. Northern State Medical University. Department of Forensic Medicine and Law. 5th year student of medical faculty. Supervisor: Ivshin I.V. Annotation: The analysis of published data relating to the characteristics of the implementation of patients' rights in conditions of the Russian Arctic. Conclusions about the existing problems in this sphere, caused by including low legal literacy of patients, lack of legal awareness of medical workers. Keywords: rights of patient, the duties of medical workers, legal information, the Arctic zone. USE OF PATIENT STATUS INDEX (PSI) FOR THE MONITORING ANESTHESIA DEPTH IN LAPAROSCOPIC CHOLECYSTECTOMY Sokolova M. M.1,2, Rodionova L. N.1,2, IzotovaN. N.1, Telova O.N.1, Krylov A.V. 1Kuzkov V. V.1,2, Kirov M. Y.1,2 1 Northern State Medical University. Department of Anesthesiology and intensive care, Arkhangelsk, Russia 2 City clinical hospital #1, Arkhangelsk, Russia E-mail: sokolita1@yandex.ru Supervisor: prof. Kirov M. Y Abstract: Indicators of depth of anesthesia include autonomic reactions such as heart rate (HR), blood pressure (BP), sweating and lacrimation. However, these indicators are not always reliable due to effects of the drugs used perioperatively. The effect of sedative drugs on the electrical activity of the human brain was first described in 1937. Different methodologies were developed to simplify the EEG signal. Since most of drugs for anesthesia affect the brain electrical activity, it would be useful to monitor the depth of anaesthesia based on EEG analysis. We present the pilot results of using the patient state index (PSI) for monitoring anesthesia depth in laparoscopic cholecystectomy. Key words: Patient state index, depth of anesthesia, cognitive dysfunction. ПРОБЛЕМЫ ПЕДАГОГИКИ И ПСИХОЛОГИИ ВЫСШЕЙ ШКОЛЫ СОВРЕМЕННЫЕ ФОРМЫ РАЗВИТИЯ ИНТЕРНАЦИОНАЛЬНОЙ ДРУЖБЫ СТУДЕНЧЕСКОЙ МОЛОДЕЖИ Королева Е.А. Северный государственный медицинский университет. Кафедра Общественного здоровья, здравоохранения и социальной работы. Студент 5 курса факультета клиническая психология, социальная работа и адаптивная физическая культура, отделение социальной работы. E-mail: sheb29@mail.ru Научный руководитель: доцент, к.б.н. Шалаурова Е.В. |
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