Objective. To study the morphological changes of the cardiac conduction system and the working myocardium in HIV-infected drug-dependent patients who died from infective endocarditis and generalized tuberculosis, and to compare these data with the results of in vivo electrocardiographic studies. Material and methods. Morphological and electrocardiographic data of 59 HIV-infected drug-dependent patients who died from infective endocarditis (37) or generalized tuberculosis (22) have been analized. The study of the morphological structure of the cardiac conduction system was performed according to the modified method proposed by Yu.G. Parkhomenko et al., that includes the preparation and microscopy of micropreparations containing elements of the cardiac conduction system and other heart structures. Results. Morphological changes in the cardiac conduction system (degenerative, inflammatory, necrobiotic, circulatory disorders, myocardiosclerosis) were found an average of 10-20% less than in the working myocardium and amounted to 70% of cases of infective endocarditis and 82%-generalized tuberculosis, at that inflammatory changes prevailed in infectious endocarditis and dystrophic changes-in generalized tuberculosis. When analyzing electrocardiograms non-specific changes dominated in both groups characterize the state of the working myocardium, which is confirmed by histological data: the most severe morphological changes were observed in the working myocardium at endocarditis involving the left heart and generalized tuberculosis. Сonduction disorders (blockage of the right and left His bundle branches, atrioventricular conduction slowing) were recorded on an electrocardiogram in 14% of deaths from infective endocarditis and in 23% of deaths from the generalized tuberculosis and morphologically corresponded to maximum changes of certain elements of the cardiac conduction system. Both morphological and electrocardiographic data in both groups showed a predominant involvement of the right and left His bundle branches, more rarely the atrioventricular node and bundle were affected, and the most rare was the lesion of sinoatrial node. Special attention is given to the detection of elongated Q-T interval on electrocardiograms in both groups (9 and 11% of cases at infective endocarditis and generalized tuberculosis, respectively), which is the predictor of life-threatening arrhythmias and refers to HIV-associated cardiovascular complications. Histologically the cases of elongated Q-T interval were characterized by non-specific changes in the form of edema and dystrophy of working cardiomyocytes. Conclusion. The basis of electrocardiographic changes at infectious endocarditis and generalized tuberculosis are morphological changes in the cardiac conduction system and working myocardium, however, the frequency of detection of the pathology of heart conduction system structure is several times higher than of its functional manifestations, which indicates its high compensatory capacity. The pattern in the defeat of various depart...
The article describes the clinical observation with an unfavorable outcome of the generalized form of salmonella infection caused by Salmonella typhimurium group B in a woman of 60 years without immunodeficiency, complicated by the development of multiple abscesses of the lower parts of abdominal cavity, probably of appendicular origin. In a short literary review, the pathogenetic mechanisms that contribute to the formation of generalized and extraintestinal forms of salmonella infection are discussed.
Introduction. Diseases that are not directly related to obstetric pathology and childbirth fade into the back-ground and are not always included in the maternal mortality, but their significance can hardly be overes-timated. A special group of such pathologies comprises infectious diseases, the prevalence of which varies significantly in different countries. As a rule, these diseases are characterized by a severe course and are life-threatening for the mother and the child. The most relevant among them are HIV infection, tuberculosis, infectious endocarditis, and sepsis. The aim of the study was to consider the leading extragenital causes of maternal mortality and to assess the importance of infectious pathology based on the pathological findings. Materials and methods. The study included 38 pathological autopsies, 10 of which are described in more detail. Medical documentation, autopsy protocols for deceased pregnant women, women in labor, and women in childbirth were examined. Causes of death were classified according to the ICD-10 criteria. A clinical and morphological study was carried out, and supportive laboratory techniques were used (microbiological, histobacterioscopic, molecular genetic, serological, and cytological tests). Results. As it follows from the autopsy report data from 2013 to 2019 in Moscow, the extragenital pathology accounted for 38 lethal cases (46.9% of all maternal deaths), of which 10 (26.3%) cases were associated with infectious pathology. Conclusion. Extragenital pathology, although not a leading cause of maternal mortality, remains a crucial obstetric problem. Infectious diseases, primarily HIV infection, are the significant cause of extragenital morbidity. Keywords: maternal mortality, extragenital infectious pathology, tuberculosis, HIV infection, infectious endocarditis, drug addiction, Kaposi’s sarcoma
The course and outcome of edema and swelling of the brain (OSB) essentially depend on many factors, including the feature of the pathogenesis of the disease associated with the factors ofpathogenicity of the causative agent. There was developed the multivariate mathematical analysis of the clinical picture of OSB with the using of an alternative algorithm of the distributions offrequencies of symptoms in differentiated groups of patients with the presence of OSB and without of OSB signs of this complication that permitted to make more accurately diagnose of OSB and judge the effectiveness of the taken therapy. The lack of clinical effect of antibiotic therapy is caused among other things the low bioavailability of the pathogen. BBB is not associated with an HLB so attempts on the base of the measurement of the spinal fluid pressure to detect the presence and severity of OSB have not been scientifically justified. The analysis of CSF indices - lactate, protein, glucose, D-DF, pH level against the background of OSB will allow to avoid unsound replacement of etiotropic drugs
The objective of the study was to investigate risk factors for the development of non-Hodgkin's lymphoma (NHL) in HIV-infected patients with hepatitis С virus (HCV) coinfection. A total of 37 HIV-positive subjects with NHL treated in the Moscow Center for Prevention and Control of AIDS between 2009 and 2013 were included in the study. HIV patients were divided into 2 groups: 23 cases with HCV coinfection and 14 patients without HCV coinfection. At the time of making the diagnosis of NHL 90% of patients had CD4 cell count < 350 cell/mm 3. The mean CD4 cell count in the first group (120±123 cell/mm 3) was significantly lower (p=0,035), than in patients without HCV coinfection (267±253 cell/mm3). At the time of making the diagnosis of NHL 70% of patients had HIV viral load ≥5,00 log10. The mean viral load was 5,47±1,09 log10 copies/ml in the first group and 4,06±2,03 log10 copies/ml in the second group (p=0,033). At the time of making the diagnosis of NHL 78% of patients did not receive combination antiretroviral therapy (cART). In most patients who received cART virologic suppression unsufficient and CD4 cell count remained to be low. Risk factors associated with an increased risk of NHL in HIV-infected patients with HCV coinfection are low CD4 cell count, high HIV viral load and lack of effective cART. Timely initiation of cART followed by complete virologic suppression and CD4 recovery are key factors to prevent NHL in HIV-infected patients.
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