[Factors of the hemostasis system as biomarkers of severe course of acute viral infections]. / Faktory sistemy gemostaza kak biomarkery tyazhelogo techeniya ostrykh virusnykh infektsii.

The authors give literature review of hemostasis and immune system factors intraction as main biomarkers of a severe cause of viral infectious diseases. Pro-inflamatory cytokines as the main markers of inflammation, can serve both as biomarkers of the clinical severity of the infectious process and reflect the state of the hemostatic and fibrinolytic systems, since components of these systems are present in various structures of the central nervous system and affect the development of neurons and synaptic plasticity. An inverse correlation has been proven between the concentration of D-dimer and the oxygenation index, and the development of DIC is not associated with the presence of respiratory failure in patients with influenza type A, while the ferritin concentration directly reflects the severity of the disease. One of the markers of endothelial damage may be soluble thrombomodulin, which, however, is rarely used in routine clinical practice. Cytoflavin is a highly effective pathogenetic drug that affects various parts of the hemostasis system, has anti-ischemic, antioxidant, antihypoxic, immunocorrective effect, which is indicated for any generalized infectious disease since its debut.

[Immunopatological and genetic aspects of pathogenesis of CNS lesions in VZV infection]. / Immunopatologicheskie i geneticheskie aspekty patogeneza porazhenii TsNS pri VZV-infektsii.

The review article provides information about the features of the Varicella-zoster virus (VZV), about the clinical manifestations of CNS damage in acute and chronic VZV infection in children and adults, about the mechanisms of interaction of the pathogen with the immune system during the development of the disease. The question of whether to consider neurological disorders in VZV infection as a complication or manifestation of the disease caused by a defective virus or the presence of subclinical immunodeficiency is discussed, which is confirmed by modern scientific studies. The critical mechanisms of immune defense against VZV, which are the main reason for the penetration of the virus into the CNS and the development of neurological disorders, as well as the relationship between VZV genotypes, the presence of mutations in the gE gene and the nature of the course, the identification of rare variants of the POLR3A, POLR3C, POLR3E and POLR3F genes associated with violation of IFNs induction, and the development of severe VZV infection, in which vasculopathy also occurs, which is the basis for the use of vascular drugs of complex action, such as Cytoflavin, the effectiveness of which has been proven by the authors. A special place is given to the analysis of intrathecal immunopathogenesis, which is likely to be associated with the presence and severity of neurological manifestations, their relapses. The issue of the causes of the development of a severe course of the disease in patients vaccinated against chickenpox, as well as the issue of resistance to specific antiviral drugs, probably associated with the presence of mutations responsible for the resistance of the virus to therapy, is discussed.

[The markers of damage of neurons and glia in cerebrospinal liquor under meningitis in children.]

The actuality of analysis of cerebrospinal fluid under meningitis in children is conditioned by severity of course of disease with development of residual aftermaths in part of patients. The appearance of proteins specific for neurons, astro- and oligodendroglia in liquor and blood serum can serve as a marker of severity of damage of cerebral parenchyma and as a predictor of development of neurological deficiency. The analysis was applied to samples of liquor obtained during diagnostic lumbar puncture in 44 children (33 with viral serous meningitis, 11 with bacterial purulent meningitis). The detection of protein S-100, glial fibrillar acid protein and and neuron-specific enolase was implemented using solid-phase immune enzyme technique. The maximal increasing of concentrations of protein S-100 and glial fibrillar acid protein was detected at initial stage of bacterial purulent meningitis with consequent decreasing of at the stage of re-convalescence. Under serous meningitis at acute stage maximal high proved to be average value of concentration of neuron-specific enolase with tendency to its increasing at the stage of re-convalescence. The multi-directional correlation relationships are established concerning levels of of neuron-specific enolase, glial fibrillar acid protein and protein S-100 with standard liquorologic indices and their direct mutual relationships. The variability of levels of neuron-specific proteins in liquor is established associated with clinical characteristics of course of meningitis in children that testifies possibility of their application for specifying involvement into pathological process of different brain structures and necessity of further studying of relationship of infection affection of brain with development of neurological aftermaths at the residual period.

[Pathogenetic mechanisms of demyelinating diseases of the central nervous system in children].

OBJECTIVE: To study cerebrospinal fluid and protein indices characterizing the permeability of the hematoencephalitic barrier and intrathecal immunoglobulin synthesis in children with different course and outcome of demyelinating diseases of the central nervous system. MATERIAL AND METHODS: We examined 72 children with demyelinating diseases of the central nervous system and 16 children of a control group (without neuroinfections). RESULTS: Differences in the concentration of myelin basic protein, immunoglobulin G, albumin and immunoglobulin indices in the cerebrospinal fluid were determined depending on acute, prolonged, chronic course of disseminated encephalitis and multiple sclerosis in children. The maximum value of the immunoglobulin index and the intrathecal immunoglobulin synthesis index was identified in multiple sclerosis. The correlations of cerebrospinal fluid indicators and protein factors in the acute period of demyelinating diseases and the formation of neurologic deficiency in the disease outcome were determined that can be used for prognostic purpose. CONCLUSION: The alterations in the indices obtained in this study can be included in the algorithm of laboratory examination. The results prove the involvement of various mechanisms in the pathogenesis of demyelinating diseases of the central nervous system in children.

[The prognostic value of biochemical indicators under neonatal hepatitis of different etiology].

Recently, the share of children with verified neonatal hepatitis induced by genetic predisposition, malformations of biliary tracts, inborn infections with affection of hepatobiliary system increased. The comprehensive biochemical examination of 62 children aged from 1.5 months to 2 years old with diagnosis of neonatal hepatitis. The changes of standard indicators of cytolysis, cholestasis and protein metabolism were on average moderate in group with reliable increase of protein concentration of acute phase of inflammation. The peak changes of biochemical indicators during primary examination are revealed in group of children with malformations of hepatobiliary system conditioned by viruses of herpetic group and in the process of development of expressed fibrosis of liver up to first year of life. The detection of proteins of acute phase makes it possible to objectively evaluate the presence of prolonged inflammatory process in liver and to promote prognosis of course of neonatal hepatitis in children of early age and timely correction of therapy and improvement of outcomes of disease. The detection of C-reactive protein, alpha2-macroglobulin and alpha1-antitripsin is recommended to be included into algorithm of examination of children with neonatal hepatitis.

[Minimization of endogenous intoxication syndrome by individual choice of drugs for therapy of chronic hepatitis].

The results of clinical and laboratory examination of 107 children suffering from chronic hepatitis B or C were analysed. The biochemical criteria of the endogenous intoxication were investigated. Specific blood tests with antiviral drugs were conducted before the treatment and individual therapy schemes were assigned according to the tests' results. The early and sustained virological response rates during the individual antiviral treatment of the children with chronic hepatitis C proved to be 70.83 and 62.5% respectively.

[Laboratory evaluation of the severity of intoxication syndrome in children with bacterial infections].

For the laboratory evaluation of the severity of intoxication syndrome, the spectral characteristics of low and median molecular weight substances (LMMWS) were studied in the plasma and red blood cells of 129 children with bacterial infections, among whom there were 76 children with acute intestinal infections (Flexner's dysentery, Sonne dysentery, and salmonellosis) and 53 children with bacterial purulent meningitis of hemophilic and meningococcal etiology. In the acute period, all the examinees were found to have considerable qualitative and quantitative distinctions of blood spectrograms from the normal values. There was an association of the spectral characteristics of blood LMMWS with the nosological entity, etiology and stage of disease, and the severity of intoxication syndrome. The maximum distinctions from the normal values were detected in children with bacterial meningitis running with complicating the course of acute intestinal infection. There was an increase in the blood levels of LMMWS with the concomitant intercurrent diseases occurring, as compared with the smooth uncomplicated course of disease. The studies of the natural history of disease have indicated a gradual normalization of blood spectrograms; however, in bacterial meningitis, insignificant deviations preserved at the stage of convalescence. The spectral characteristics of plasma and red blood cell LMMWS are proposed to use for the objective appraisal of the severity of intoxication syndrome and the reserve detoxification capacities of blood in children with bacterial infections.