Clinical Laboratory Tests in Some Acute Exogenous Poisonings.

BACKGROUND: There is no specific toxicological screening of clinical laboratory parameters in clinical toxicology when it comes to acute exogenous poisoning. AIM: To determine routine clinical laboratory parameters and indicators for assessment of vital functions in patients with acute intoxications. MATERIALS AND METHODS: One hundred and fifty-three patients were included in the present study. They were hospitalized in the Department of Clinical Toxicology at St. George University Hospital, Plovdiv for cerebral toxicity inducing medication (n = 45), alcohol (n = 40), heroin abuse (n = 33). The controls were 35. The laboratory tests were conducted in compliance with the standards of the clinical laboratory. We used the following statistical analyses: analysis of variance (the ucriterion of normal distribution, the Student's t-test, dispersion analysis based on ANOVA) and non-parametric analysis. RESULTS AND DISCUSSION: Based on the routine hematological parameters with statistically significant changes in three groups of poisoning are: red blood cells, hematocrit, hemoglobin (except alcohol intoxication) and leukocytes. We found statistically significant changes in serum total protein, sodium and bilirubin. The highest statistical significance is the increased activity of AST and ALT. CONCLUSION: We present a model for selection of clinical laboratory tests for severe acute poisoning with modern equipment under standardized conditions. The results of the study suggest that the clinical laboratory constellation we used can be used as a mandatory element in the diagnosis of moderate and severe intoxication with the mentioned toxic substances.

Endoscopic diagnosis of intramural hematoma in the colon sigmoideum in a child with high titer inhibitory hemophilia A.

Lower gastrointestinal bleeding is a rare condition in childhood pathology. The incidence of this disorder in the general population of Bulgarian children is unknown. We report a case of a 7-year-old child with diagnosed hemophilia A and high titer of factor VIII inhibitor; the patient was admitted into the Department of Pediatrics and Medical Genetics for rectorrhagia after falling onto his buttocks while playing. Colonoscopy showed submucosal hematoma 25 cm from the anocutaneous line occluding the intestinal lumen with a lesion of the overlying mucosa as long as 20 mm. If a patient presents with rectorrhagia, timely and carefully planned colonoscopy could identify the source of bleeding, determine the severity of bleeding and the size of hematoma, and assess the need for surgical intervention. The reported case supports the modern view that patients with inhibitor hemophilia should not be denied interventional procedure or surgical intervention for fear of uncontrolled bleeding.

Cystic fibrosis and celiac disease--multifaceted and similar.

Celiac disease and cystic fibrosis share a number of clinical manifestations. The comorbidity rate of these diseases is low: 1:200000. We present a case of a child aged 1 year and 5 months, born to a mixed-marriage parents, with concomitant cystic fibrosis and celiac disease manifesting initially with chronic diarrhea. Diagnosis of cystic fibrosis was made on the basis of changes in pulmonogram and three positive sweat tests with the malabsorption managed. Celiac disease was demonstrated through immunological tests (serological test of anti-transglutaminase antibodies of IgA class), histological tests (altered duodenal mucosa) and the therapeutic effect of a gluten-free diet. This case is the first ever reported case of a child with concomitant cystic fibrosis and celiac disease in Bulgaria. The case suggests the need for targeted screening for celiac disease in children with cystic fibrosis.

Ventilator-associated pneumonias in children (I)--diagnostic criteria, etiology and pathogenesis.

Ventilator-associated pneumonias have been estimated to be the second most common nosocomial infections among children treated in intensive care units. They occur in mechanically ventilated patients through intubation tube or tracheostomy, the inflammation usually involving the lung parenchyma. The ventilator-associated pneumonia is associated with a longer antibiotic treatment, greater duration of mechanical ventilation (MV) and higher mortality rates in children. The condition is also associated with a higher cost of the treatment. This paper reviews and comments in detail the criteria formulated by the National Nosocomial Infection Surveillance (NNSI) and the Centers for Disease Control and Prevention (CDC) for diagnosis of ventilator-associated pneumonias in children. The disease etiology is associated with the typical causes of nosocomial infections in this age: P. aeruginosa, E. coli and K. pneumoniae. The pathogenesis of the condition is inadequately studied but the aspiration of gastric contents and immune deficiency are proven risk factors. Two mechanisms have a major role in the development of the disease--micro-aspiration of gastric contents and colonization of the lower airways with pathogens.

Ventilator-associated pneumonias in children (II)--prophylaxis and treatment.

Ventilator-associated pneumonia (VAP) is the second most common nosocomial infection among children treated in intensive care units. The risk factors for developing this condition are generated by the patient's bedside conditions, the equipment used and the specific treatment administered to the child. Prophylaxis of VAP should necessarily include all measures that have been proven to be efficient in this respect such as rigorous hygiene control of hands and protective clothing of attending staff, changing breathing circuits of ventilators only if they malfunction or if they are visibly contaminated, preference of orotracheal intubation (instead of nasotracheal intubation) and use of endotracheal tubes with dorsal lumens to allow respiratory secretions to drain, and introduction of a uniform approach to patient care and staff training. Prophylaxis of the microbial colonization in children by antibiotics does not reduce the incidence of VAP-causing poly-resistant bacteria. Therapeutic management includes early initiation of broad spectrum empirical antibiotic therapy, the right choice of antibiotic requiring regular monitoring and good knowledge of the antibiotics sensitivity of the most common microbial isolates in the ward.