Aim. To study serum concentrations of trace and macro elements and their correlations in children and adolescents after antitumor therapy, depending on the presence or absence of caries.Materials and methods. The study included 98 patients aged 4 to 17 years who were in remission after an antitumor therapy performed for acute leukemia or lymphomas. Patients with carious tooth lesions were included in group 1 (n = 34) and without caries – in group 2 (n = 64). We used inductively coupled plasma mass spectrometry to calculate the content of essential, conditionally essential and toxic elements in blood serum. The median and interquartile range were calculated, the Mann-Whitney U-test was applied to compare groups, and the Kendall rank correlation coefficient (τ) was calculated for tandem elements.Results. In both groups, the concentrations of the studied elements were within the reference ranges. In group 1, compared with group 2, higher concentrations of potassium, arsenic, iodine and boron and lower concentrations of lithium and tungsten (p < 0.05) were noted. There were no differences in the concentration of phosphorus, calcium, magnesium, manganese, gold, silver, platinum, aluminum, beryllium, bismuth, cadmium, cobalt, chromium, copper, iron, mercury, lithium, molybdenum, nickel, rubidium, antimony, tin, vanadium, zinc, zirconium and thallium between the groups. Significant correlation coefficients in both groups were obtained for the iron/manganese tandem (τ = 0.24, p < 0.05). Different values of τ were got for nickel/ manganese, cobalt/iron, manganese/phosphorus, beryllium/lithium tandems: τ = 0.342 and τ = 0.14; τ = 0.363 and τ = 0.033; τ = –0.111 and τ = –0.326; τ = –0.365 and τ = 0.42, respectively, for groups 1 and 2.Conclusion. In patients in remission after antitumor therapy, an association of caries with an increase (within reference values) in the concentration of essential (potassium, iodine) and conditionally essential elements (arsenic, boron), a decrease in the concentration of lithium and tungsten; as well as a change in the ratio of nickel/manganese, cobalt/iron, manganese/ phosphorus and change the direction of the correlation in the beryllium/lithium tandem was revealed.
The study of the elemental status in the modern paradigm of medical diagnostics occupies an increasingly large niche due to the possible use of trace elements as possible predictors of cerebrovascular pathologies. Moreover, the great importance of the elemental component in the main enzymatic systems of metabolism allows us to consider them also as a therapeutic target. There are many mechanisms in the pathophysiology of stroke development, each of which, in one way or another, is mediated through the interaction of regulatory proteins with trace elements as cofactors. Therefore, it is necessary to pay close attention to elemental homeostasis in the focus of ischemic pathologies. Aim. Systematization of the known pathogenetic effects of the most metabolic homeostasis important elements on the course of stroke, both contributing factors to earlier rehabilitation and minimal neurological deficit after the ischemic event itself, and factors aggravating the recovery process and leading to serious neurological consequences. This pursues not only a prognostic goal to determine the severity of ischemia or to identify risk groups with certain shifts in elemental constants, but also the therapeutic one — to replace the falling functions of the dropping metabolic agents, as happens with the elements involved in antioxidant systems. It is also necessary to develop a methodology for stopping the excess of nerve cells mediating excitotoxicity with calcium ions, which closes the vicious circle of vascular necrosis with additional destruction of the nervous tissue. Conclusion. The conclusions that we can summarize quite convincingly indicate a significant contribution of the elemental status to the pathogenesis of ischemic stroke. Dysregulation of the elemental component can force the damaging effect of ischemia on brain cells. At the same time, many elements show a surplus during an ischemic event: Li, I, Mn, Zn, As, Se, Pb, Sr, Ni, however, not all of the presented elements negatively affect the course of stroke, since an increase in the level of some metals may be compensatory in nature, and for their further applicability as diagnostic and therapeutic agents, similar analytics are required.
The optimal interval for initiating tocilizumab therapy in patients with COVID-19 (COronaVIrus Disease 2019) has not been determined. The aim of the study was to evaluate the effectiveness of prescribing tocilizumab depending on the duration of persistent hyperthermia > 38 °С in patients with SARS-CoV-2 (Severe Acute Respiratory Syndrome-related CoronaVirus 2) associated pneumonia who received tocilizumab according to the Interim Guidelines of the Ministry of Health of the Russian Federation (version at the time of inclusion in the study). Methods. A retrospective cohort study was conducted in hospitalized patients (n = 163) with SARS-CoV-2-associated pneumonia from May 2020 to May 2021. Patients were retrospectively divided into 2 groups depending on the time of tocilizumab administration: ≤ 7 days (n = 61) or ≥ 8 days (n = 102) from the disease onset. Results. Patients who received tocilizumab in the first 7 days had the lower need for CPAP (Continuous Positive Airway Pressure) therapy on day 3 after tocilizumab therapy (HR (Hazard Ratio) – 0.129 (0.039 – 0.430); p = 0.001), a higher probability of a decrease in the volume of lung lesions on computed tomography > 25% a week after the use of tocilizumab (HR – 1.065 (1.036 – 1.093); p = 0.001), the lower probability of hemoglobin oxygen saturation below 92% on day 3 (HR – 0.807 (0.750 – 0.869); p = 0.001), and day 7 (HR – 0.825 (0.772 – 0.883); p = 0.001) after tocilizumab therapy. If CPAP therapy was required on day 3 after administration of tocilizumab, each day of delay in prescribing the drug increased the risk of an adverse outcome 18-fold (HR – 18.24 (5.328 – 62.438); p = 0.001). The duration of hospitalization was significantly lower in the early group than in the late group (10 (8.5 – 15) vs 13.5 (10 – 18) days, respectively; p = 0.02). The mortality was similar (5 (8.2%) vs 6 (5.9%) patients, respectively; p = 0.748). Conclusion. The administration of tocilizumab in the first seven days from the onset of the disease in patients with COVID-19 who developed systemic inflammation and lung damage may prevent the need for escalation of respiratory support and accelerate recovery compared with the later tocilizumab administration.
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