Laboratory diagnosis of community-acquired bloodstream infection in therapeutic pathology.

Community-acquired bloodstream infections (CBSIs) occur in the out-of-hospital setting (44%) and increase the overall mortality from bloodstream infections (BSIs) by 7.2% per year. The development of CBSIs depends on both comorbid and polymorbid diseases and the patients' age. The causes of CBSIs are: respiratory, hepatobiliary gastrointestinal and urogenital tracts and dental interventions. The etiology of CBSIs is characterized by the isolation of coagulase-negative staphylococci (CNS) (32%), E. coli (27%). To investigate community-acquired bloodstream infection in therapeutic patients. The study included out-of-hospital patients (n=382). 4.5 ml of blood were taken intravenously into a closed vacuum system in order to obtain a buffy coat of blood, which was put on glasses for microscopy and Petri dishes with blood agar for cultivating under aerobic and anaerobic conditions. Microorganisms were identified by mass spectrometry. Microscopy of blood smears was used for rapid diagnosis of infection in the bloodstream. BSI was diagnosed in 183 (48.0%) out of 382 out-of-hospital patients. The etiology of CBSIs was studied on 297 isolated strains of microorganisms. CBSIs rather often complicated the underlying disease in women and young people. The spectrum of CBSI pathogens included aerobic and anaerobic bacteria and fungi. Gram-positive cocci with the leadership of S.epidermidis (25.7%) were more often isolated among bacteria. 70% of all isolated pathogens grew under anaerobic conditions. CBSIs were characterized by polymicrobiality (33.5%) of two to four different microorganisms in one blood culture; the species of associates of polymicrobial blood cultures are shown. Microscopic examination of blood smears revealed microorganisms in 97.1% of cases, including associations of bacteria with fungi (66.9%). CBSIs occurred after contour plastic, in diseases of the respiratory system, genitourinary system, oral cavity, skin and subcutaneous tissue. Microbiological examination of the buffy coat is an alternative microbiological method of CBSIs diagnosis, which includes microscopy and blood cultivating and has a high diagnostic efficiency (97.1% and 48% respectively). It can become an option for replacing imported blood culture automated systems.

[The ophthalmological complications encountered in the practical work of the plastic surgeons during preparation and performance of blepharoplastic interventions]. / Oftal'mologicheskie oslozhneniia v praktike plasticheskikh khirurgov pri podgotovke i provedenii operatsii blefaroplastiki.

The article presents the results of a commission inspection of the results of the forensic medical expertise performed by the specialists of a state-owned forensic medical bureau in connection with the civil case concerning the judicial appeal of the 58 year-old suitress S. against a private plastic surgery clinic. It is shown that the carelessness of the surgeons with the fact of chronic diseases in the patient and the application of the vasoconstrictor medications during the surgical treatment (blepharoplasty) resulted in optic nerve atrophy in the immediate postoperative period with the complete loss of vision in the only seeing eye. The expertise has revealed a number of additional defects as well as diagnostic and surgical errors in the actions of the surgeons of this private clinic considered to be responsible for the resultant disablement of the patient.