Genetic predisposition to CAP and NP is attributed to the cumulative contribution of polymorphisms at the CYP1A1, IL-6, and ACE genes, independently of age, gender, causative pathogen, and the use of mechanical ventilation, in patients in the Russian Federation.
Nosocomial pneumonia (NP) -is a disease associat ed with a formation of new focal and infiltrative changes on the chest X ray 48 hrs after the hospitalization along with the clinical data confirming their infectious nature (fever, purulent sputum or purulent discharge from the tracheo bronchial tree, leukocytosis, etc.), excluding infections which were incubated on the admission [1].Nosocomial pneumonia -is the most prevalent intensive care unit infection. The high prevalence of NP is due to the widespread and irrational use of antibiotics and artificial pulmonary ventilation. The Russian National data confirm that NP incidence in surgical patients is 6% after elective surgery and 15% after emergency surgery. The inci dence of ventilator associated pneumonia is 22% after elec tive surgery in ventilation longer than 2 days and 34,5% after emergency abdominal surgery; up to 55% in acute res piratory distress syndrome. Every day in intensive care unit stay increases the risk of NP by 3%. Nosocomial pneu monia significantly deteriorates the course of any disease, increase the duration of intensive care unit stay by 4,3-6,1 days and mortality. The attributable mortality of NP is between 5,8 to 27% [2][3][4][5].The pathogenesis of NP in critically ill patients is based on an imbalance between the lung protective mecha nisms and microbial aggression. The lung can be infected either exogenously or endogenously. Aspiration of pharyn
Genetic susceptibility may partially explain the clinical variability observed during the course of similar infections. To establish the contribution of genetic host factors in the susceptibility to critical illness, we genotyped 750 subjects (419 at high risk of critical illness) for 14 single nucleotide polymorphisms (SNPs) in the xenobiotics detoxification/oxidative stress and vascular homeostasis metabolic pathways. In the group of nosocomial pneumonia (NP; 268 patients) the risk of acute respiratory distress syndrome (ARDS) is significantly higher for the carriers of CYP1A1 rs2606345 T/T genotypes and AhR rs2066853 G/A-A/A genotypes. AGTR1 rs5186 allele C is more common among NP non-survivors. The duration of stay in intensive care units (ICU) is higher for NP patients with ABCB1 rs1045642-T allele. The cumulative effect of the risk alleles in the genes comprising two sets of genes partners (xenobiotics detoxification: CYP1A1, AhR and RAS family: ACE, AGT, AGTR1) is associated with the development of both NP and ARDS.
В обзоре описана морфология и физиология эритроцитов человека, а также изменения структуры и функции эритро цитов человека при различных критических, терминальных и постреанимационных состояниях. Ключевые слова: кровь, эритроцит, мембрана эритроцита, реология, критические состояния.The review describes the morphology and physiology of human red blood cells, as well as changes in their structure and function in various critical, terminal, and postresuscitation states.
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