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Clinical and diagnostic features of the infectious lesions of the central nerve system in hiv-infected patients
belong to functional class Child-Turcotte- Pugh and the de- liver failure requires the use of decompressive endovascu-
velopment of recurrent bleeding. lar interventions in patients with bleeding of the esophagus
5. Endoscopic intervention is a treatment to stop the and stomach VV.
bleeding, but for the prevention of recurrent bleeding and
References:
1. Albillos A., Tejedor M. Secondary prophylaxis for esophageal variceal bleeding.//Clin Liver Dis. - 2014, May. - 18 (2): 359-70. PubMed PMID: 24679500.
2. Biecker E. Portal hypertension and gastrointestinal bleeding: diagnosis, prevention and management.//World J Gastroenterol. - 2013, Aug 21. - 19 (31): 5035-50. PubMedCentral PMCID: PMC3746375.
3. Cardenas A., Fernandez-Simon A., Escorcell A. Endoscopic band ligation and esophageal stents for acute variceal bleed-ing.//Clin Liver Dis. - 2014, Nov. - 18 (4): 793-808. PubMed PMID: 25438284.
4. Coelho F. F., Perini M. V., Kruger J. A., Fonseca G. M., Arahj o R. L., Makdissi F. F., Lupinacci R. M., Herman P. Management of variceal hemorrhage: current concepts.//Arq Bras Cir Dig. - 2014 Apr-Jun. - 27 (2): 138-44. PubMed PMID: 25004293.
5. Garcia-Pagan J. C., Barrufet M., Cardenas A., Escorsell A. Management of gastric varices.//Clin Gastroenterol Hepatol. -2014, Jun. - 12 (6): 919-28. PubMed PMID: 23899955.
6. Garcia-Tsao G., Bosch J. Management of varices and variceal hemorrhage in cirrhosis.//New Engl.J. Med. - 2010. -Vol. 362. - P. 823-832.
7. Gonzalez R., Zamora J., Gomez-Camarero J. et al. Metaanalysis: combination endoscopic and drug therapy to prevent vari-cealrebleeding in cirrhosis.//Ann. Intern. Med. - 2012. - Vol. 149. - P. 109-122.
8. Herrera J. L. Management of acute variceal bleeding.//Clin Liver Dis. - 2014, May. - 18 (2): 347-57. PubMed PMID: 24679499.
9. North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study.//New Engl. J. Med. -2011. - Vol. 319. - P. 983-989.
10. OrloffM.J., Hye R. J., Wheeler H. O., Isenberg J. I., Haynes K. S., Vaida F., Girard B., OrloffK.J. Randomized trials of endoscopic therapy and transjugular intrahepatic portosystemic shunt versus portacaval shunt for emergency and elective treatment of bleeding gastric varices in cirrhosis.//Surgery. - 2015, Jun. - 157 (6): 1028-45. PubMed PMID: 25957003.
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12. Triantos C., Kalafateli M. Endoscopic treatment of esophageal varices in patients with liver cirrhosis.//World J Gastroenterol. - 2014, Sep 28. - 20 (36).
Kuranbaeva Satima, Assistant of Tashkent Medical Academy, Republic Uzbekistan Atabekov Nurmat Satimniyazovich, Director of Republican centre struggle against AIDS Kalandarova Sevara Khujanazarovna, Doctor of of Tashkent Medical Academy, Republic Uzbekistan
E-mail:evovision@bk.ru
Clinical and diagnostic features of the infectious lesions of the central nerve system in hiv-infected patients
Abstract: Among the observed patients the dominant route of transmission of human immunodeficiency virus (HIV) infection was injecting. The most wide-spread reason of the infection central nervous system (CNS) in HIV-positive patients was Epstein-Barr virus, Toxoplasmosis and Mycobacterium tuberculosis. The disease developed mostly in young patients, regardless of gender. Infectious lesions CNS in HIV-positive patients progressed gradually as well as advanced against the background of clinically sthenic immunodeficiency.
Keywords: HIV-positive patients, immunodeficiency virus, Epstein-Barr.
HIV infection — a viral disease characterized by aggravat- and other systems of the body with the development of ac-
ing steadily, leading to destruction of the immune, nervous quired immunodeficiency syndrome (AIDS) [1; 2; 4].
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Section 8. Medical science
The affection of the nervous system occurs at any stage of HIV infection: in the subclinical phase — 20.0 %, in the advanced stage of the disease — 40-50 %, in the final stages — at 30-90 % [4; 5; 6]. Immunodeficiency virus circulates in the organism clinically unsuspected over a long period. In seroconversion phase virus penetrates to the blood-brain barrier and involves various brain structures. In the most cases virus affects the white matter, oligodendroglial cells and astrocytes [3]. Lesion of nervous system in HIV infection and AIDS are diverse and can be found in 50-80 % patients, especially 10-45 % of patients present neurological symptoms in onset of a disease.
Material and methods. Total 82 HIV-infected patients have been examined. The etiologic agent was determined by examining of cerebrospinal fluid by polymerase chain reaction (PCR) for the occurrence of DNA fragments of the herpes virus types 1, 2, 3, and 6; cytomegalovirus; Ep-stein-Barr virus (EBV), and Toxoplasmosis. To confirm the etiology of CNS tuberculosis was applied microscopic and microbiological laboratory methods.
The results and discussion. The amount of HIV-infected patients with CNS was 80, average age was 35.7 ± 1.3 years, among whom men were 45 (54.9 %) and women were 37 (45.1 %). HIV-infectious as etiological factors of CNS was established in 48 (58.5 %) patients. The etiology of the disease was not detected in 34 (41.4 %) patients.
The investigation of medical history assigned that in all patients disease began gradually. After the manifestation of the disease, the average time of hospitalization was 42 days.
Majority patients were admitted to hospital in a medium condition — 48 (60.0 %), in severe condition — 28 (35.0 %). Impairment of consciousness was observed in 24 (30.0 %) patients. The severity of the disease depended on the degree of intoxication and immunodeficiency, the severity of neurological symptoms as well as the development of complications such as edema, swelling of the brain, which was the direct cause of the death. The mortality rate was high — 15 (18.6 %).
73 (91.3 %) patients complained of general weakness; headache — 70 (87.5 %), which was often diffuse and augmented in the evening. Intensive headache accompanied by nausea — in 31.3 % of cases, vomiting — up to 52.5 % of cases. Dizziness was noticed in 85.0 % of patients.
Intensity of intoxication syndrome manifested by variegated fever. In details, 42.5 % of patients had febrile and sub febrile temperature.
The examination established disturbances in the orientation of the place, time and person, from 28.8 to 35.0 %
of patients. Only 21.3 % of patients had disorders of supreme integrative functions such memory loss. Psychiatric dysfunctions occurred in 17.5 % of patients.
Meningeal syndrome transpired as nuccal rigidity in 88.8 % of patients; Kernig’s sign — at 56.3 % and Brudz-inski’s sign — at 7.5 % of patients.
Movement disorders namely hemiparesis, paraparesis and tetraparesis were observed in all groups of patients (27.5 %). Epileptiform syndrome was considered in 2 (2.5 %) patients. Moreover, 27.5 % of the patients had pyramidal pathway symptoms indicating the severity of brain damage which was connected with nerve-point changes in brain tissue.
Cranial nerves (II-VII, IX, XII) dysfunction was diagnosed, as a consequence of implicating of the brain stem. For instance, 10 % of patients suffer from decreasing acuity of vision; 17.5 % patients had bulbar syndrome. Vestibular-ataxic syndrome was common and manifested in the form of dizziness in 82.5 %, unsteadiness walk — 60.0 %, imbalanced in Romberg’s test -51.3 % of patients.
Primary neuro-AIDS determined by the influence of HIV occurred in various clinical HIV forms: AIDS dementia (HIV encephalopathy), meningitis or meningoencephalitis, vascular neuro-AIDS, vacuolar myelopathy by type ascending or transverse myelitis, symmetrical distal sensory polyneuropathy chronic inflammatory demyelinating polyneuropathy, acute inflammatory demyelinating polyneuropathy (AIDP) by type of Guillain-Barre syndrome, encephalomyelopolyneuropathy ALS-like syndrome (ALS, amyotrophic lateral sclerosis)
X-ray examination in the third group of patients revealed specific inflammation of the lungs in 75 % cases, which leaded to the assumption of CNS tuberculosis.
Disquisition of immune status: in all groups of patients the level of CD4+ cells was less than 100 in 1 ml. Thereby, the average amount of CD4+ cells in the first group was 49 in 1 mkl., the 2nd — 55 in 1 mkl., 3 rd — 91 in 1 mkl.
Conclusions
The clinical presentation of the infectious lesions of CNS in HIV-positive patients has the specific features depending on the etiologic factor. The comprehensive examination of the neurological status of the patient as well as consideration of all discrete symptoms will assist to doctors to prognosticate particular etiology of CNS and administer early causal treatment. Furthermore, findings from the clinical examination and PCR tests of the spinal fluid can be estimated as a significant diagnostic approach on the validation the etiology of CNS.
References:
1. Евтушенко С. К., Деревянко И. Н. Диагностика и лечение поражений нервной системы у ВИЧ-инфицированных лиц при первичном и вторичном нейроСПИДе: метод. рекомендации. - Донецк, 2001. - С. 36.
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4. Gongora-Rivera F., Santos-Zambrano J., Moreno-Andrade T. The clinical spectrum of neurological manifestations in AIDS patients in Mexico.//Arch Med Res. - 2000. - Vol. 31. - P. 393-8.
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Estimation of haemocoagulation state in dynamics and risk factors of thrombotic complications at women with uterine...
5. BarttR. E. The Neurology of AIDS.//JAMA. - 2006. - Vol. 295. - 331 p.
6. Sacktor N., Lyles R. H., Skolasky R. HIV-associated neurologic disease incidence changes: Multicenter AIDS Cohort Study, 1990-1998//Neurology. - 2001. - Vol. 56. - P. 257-60.
Mamadjanova Nodira Nosirjonovna, Republican specialized scientific-practice medical center of obstetrics and gynecology, Tashkent, Uzbekistan, junior scientific explorer E-mail: nodira762901@mail.ru
Estimation of haemocoagulation state in dynamics and risk factors of thrombotic complications at women with uterine myoma exposed to the surgical treatment
Abstract: In purpose on to estimate of influence of the operative treatment to the haemocoagulation and to the risk of developing of thrombosis at women with uterine myoma we have carried out retrospective research of case histories of woman operated concerning a uterine myoma. The received results shown, that the surgical trauma directly influences increases of coagulation and thrombogen potential ofblood aggravating a condition ofhemostasis at women on the post operative period. Postoperative period complicated with deep vein thrombosis at 2 women from group II on the 27th day after discharging from hospital, and at 3 there is occurred secondary adhesion of postoperative wound. Women are elderly after 40 years are believe in thrombotic dangerous, carrying out of the expanded operative interventions allows to note them high group of the risk of development of thrombotic complications, demanding corresponding specific thromboprophylaxis. Thus, preventive maintenance with UFH at the present contingent patients does not allow to the result of coagulation potential in initial level, which at them were before operation.
Keywords: uterine myoma, hemostasis, thromboembolia.
Introduction. Treatment of myoma at all stages of development of medicine caused multiple discussions. The basic method of treatment of uterine myoma is the combination of conservative and surgical interventions. However, despite productive enough conservative methods, frequency of radical operations remains is high and makes 80 % [4]. Also it is more increases frequency of postoperative thrombotic complications among patients with uterine myoma. As a testifying this, dates received by Ozolini L. A. after retrospective research of case histories of patients with uterine myoma show, that thrombotic complication after vaginal hysterectomy originated in 7 % and after abdominal hysterectomy in 13 % cases [3; 4]. At the present, there are no doubts that fact, that at performing operative intervention there is a role of influence of complex stress factors including not only traumatic component, but also humoral reactions. It has established that operative intervention increases of the risk of thrombogenesis on 10 times [4; 5; 9], especially if it lasts more than 45 mines, expanded, and it is accompanied with massive hemorrhages. The urgency of the present position takes place is that in the majority cases (80 %) postoperative deep veins thromboses proceeds unsymptomatically, and moreover it will appearance clinically on the 27th day after discharging from hospital [3; 6; 8].
Purpouse. To estimate of hemocoagulation state, to study of influence of operative intervention to the impairing of coagulation system and developing of postoperative
thrombotic complications at woman with uterine myoma exposed to the surgical treatment.
Materials and methods. We have carried out a retrospective research of116 case histories ofwomen with the diagnosis of uterine myoma, which have performed uterine extirpation with its appendages or without them at the Department of operative gynecology of the Republican specialized scientific-practice medical centre of obstetrics and gynecology (RSSPMC O&G) during 2005-2008 years. Average age ofpatients was 45 ± 8 years old. In the general number of investigated patients 76 of them were women aged after 40 (group I), 40 were below 40 years old (group II) which have not being treated with hormonal therapy before due to myoma. All patients have admitted to the RSSPMC O&G for the operative treatment with the diagnosis of symptomatic uterine myoma, which further confirmed by histologically. In maj ority cases they have been spent spinal anesthesia, in those cases, at revealing of the contra-indications, that patients have been spent the general anesthesia. Besides antithrombotic nonspecific methods (elastic bandaging of lower limbs, early mobilization, abundant drink), all patient received pharmacological prophylaxis with unfractionated heparin (UFH) in dosage of 2500 ID subcutaneously each 8 hours prior to and of the postoperative period.
For comparison of haemostasiological pattern there is also studied haemostasis system of 20 rather somatically healthy women at the reproductive age without gynecologic diseases (control group).
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