Summary

Among patients with acute abdominal pathology who were hospitalized in surgical hospitals, about 5% are patients with acute pancreatitis. Moreover, in recent decades there has been a multiple increase in the incidence rate. According to many studies in industrialized countries, the incidence of acute pancreatitis is in the range of 200 to 800 new cases of acute pancreatitis per 1 million population per year. According to many researchers, one of the main factors causing severe acute pancreatitis is the invasion of gram-negative bacteria from the colon, through pathological bacterial translocation. This mechanism may play a major role in the development of septic complications - "death begins in the colon, which in acute abdominal pathology turns into an undrained abscess." The article presents and analyzes the results of ultramicroscopic study of changes in the structure of the mucous membrane of the colon in patients with destructive forms of acute pancreatitis. 75 microphotographs were analyzed. It was found that in acute pancreatitis, the main foci of destruction were localized in the surface layers of the mucous membrane of the colon. The changes found at the ultrastructural level are considered to be a morphological manifestation of pathological bacterial translocation in the studied pathology.

Keywords: pancreas, colon, pathological bacterial translocation

Abstract: Introduction: Nowadays, the coronavirus disease COVID-19 is a global problem for the population of the whole world which has acquired the character of a pandemic. Under physiological conditions, in a healthy person, erythrocytes make up 96% of all blood cells, leukocytes 3%, and hrombocytes about 1%. In healthy individuals, erythrocytes are mostly shaped like a biconcave disc and do not contain a nucleus. The diameter of the erythrocyte is 8 microns, but the peculiarities of the cell structure and the membrane structure ensure their great ability to deform and pass through capillaries with a narrow lumen of 2-3 microns. Therefore, the study of the morpho-functional state of blood cells, namely erythrocytes, in this category of patients is relevant and deserves further research.

The Aim: To figure out the effect of the coronavirus disease COVID-19 on the ultrastructural blood cell changes, in particular erythrocytes, in patients with ischemic heart disease (IHD) and diabetes mellitus type 2.

Materials and Methods: Twelve patients with COVID-19 who had an acute myocardial infarction were examined. The comparison group consisted of 10 people with acute myocardial infarction without symptoms of COVID-19. The average age of the patients was 62 ± 5,6 years. The functional state and ultrastructure of blood cells were studied using electron microscopy.

Results: In the presence of COVID-19, we detected both calcification and destruction of erythrocytes and platelets. Reticulocytes were detected much more often in these individuals than in the comparison group. In patients with acute myocardial infarction in the presence of type 2 diabetes and COVID-19, a significant number of markedly deformed, hemolyzed erythrocytes or with signs of acanthosis, which stuck together and with other destructively changed blood cells, were found. We also detected «neutrophils extracellular traps» (NETs).

Conclusions: Morphological changes of blood cells in COVID-19 varied according to the disease course and severity especially in the background of a weakened immune system in older and elderly people, in the presence of diabetes, excessive body weight, cardiovascular diseases and occupational hazards. Under the influence of COVID-19, blood cells are destroyed by apoptosis and necrosis. Therefore, hypoxia and ischemia of vital organs of the human body occur.

The aim of this study was to assess the level of nitric oxide production and arginase activity in patients with arterial hypertension and type II diabetes mellitus during infection with SAR S-CoV-2. The study groups included patients with arterial hypertension, patients with arterial hypertension combined with a severe course of COVID-19 and patients who, in addition to arterial hypertension and COVID-19, were suffering from type II diabetes mellitus. The volunteers without any clinical signs of diseases and normal blood pressure formed the control group. It has been established that arterial hypertension, combined with COVID-19 occurs along with reduced L-arginine, nitric oxide, superoxide dismutase activity and increased arginase activity. At the same time, the presence of arterial hypertension in patients with diabetes and coronavirus disease is accompanied by a decline in the content of L-arginine and arginase activity. Our study’s results may help scientists find new pharmacological targets in the future treatment of coronavirus disease and comorbid disorders.

About 200 million cases of viral community-acquired pneumonia occur every year-100 million in children and 100 million in adults [3, p. 1265]. In children, respiratory syncytial virus, rhinovirus, human metapneumovirus, human bocavirus, and parainfluenza viruses are the agents identified most frequently in both developed and developing countries. Presence of viral epidemics in the community, patient's age, speed of onset of illness, symptoms, biomarkers, radiographic changes, and response to treatment can help differentiate viral from bacterial pneumonia [1, p. 5]. No clear consensus has been reached about whether patients with obvious viral community-acquired pneumonia need to be treated with antibiotics. Further studies are needed to better understand the cause and pathogenesis of community-acquired pneumonia. Furthermore, regional differences in cause of pneumonia should be investigated, in particular to obtain more data from developing countries. In addition to well-known symptoms, such children are also characterized by disorders of the autonomic nervous system. There are the cause of a decrease in the quality of life in children, which leads to a lengthening of the recovery period of adaptation after the disease.

Insulin resistance is the major sign of etiology and pathogenesis of type 2 diabetes mellitus and metabolic syndrome and can precede its development for many years. Early identifying the beginning of insulin resistance in children is important to prevent diabetes mellitus in adult life. The purpose was to identify metabolic and somatic changes in children with insulin resistance.

Material and methods. Out of 182 children of the general sample, who was estimated fasting plasma insulin and glucose, HOMA-IR, and glucose/insulin ratio, 2 groups were formed: group 1 — children with IR — 56 (30.8 %) and group 2 — 126 (69.2 %) children with normal insulin sensitivity. In children anthropometric data, lipid metabolism (total cholesterol, triglycerides, HDL-C, LDL-C, VLDL-C), blood pressure, leptin were determined.

Results. From examined subjects 56 children were generally obese (BMI > 95th percentile), 71 children were abdominally obese (WC > 90th percentile), 55 children were with normal body mass (BMI < 90th percentile). Insulin resistance was identified in 21 (37.5 %) children with general obesity more rarely, than in 38 (39.4 %) children with abdominal obesity (p = .049) and in 7 (12.7 %) children with normal BMI (p = .003). In insulin-resistant children BMI, waist and hip circumference was larger than in children with normal insulin sensitivity. The lipid profile in children with different insulin sensitivity did not differ, but in insulinresistant children an association of basal glucose with TG/HDL-C ratio (r = .53; p = .001), blood insulin with TG (r = .34; p = .018), and TG/HDL-C ratio (r = .54; p = .001) was estimated. The HOMA-IR significantly correlated with VLD-C (r = .40; p = .005), TG (r = .49; p = .001), TG/HDL-C ratio (r = .43; p = .002). The glucose/insulin ratio was in significant association with the TG/non-HDL-C ratio. The incidence of hypetension (> 95th percentile) diagnosis in insulin-resistant children was by 33.8 % higher (p = .001). Blood leptin concentration was 1.8 falled higher in insulin-resistant children and significantly correlates with waist circumference, fasting insulin, HOMA-IR, and diastolic blood pressure.

Conclusions. Insulin resistance is related to cardiometabolic risks, such as general and abdominal obesity, hypertension, dyslipidemia, hyperleptinemia, and leptin resistance, and is a screening biomarker for children and adolescents with an increased risk of cardiometabolic diseases.

Інсулінорезистентність є базовим фактором етіології та патогенезу цукрового діабету 2-го типу та метаболічного синдрому і може передувати їм за багато років. Раннє виявлення початку інсулінорезистентності та пов’язаних з нею метаболічних факторів ризику у дітей запобігає розвитку цукрового діабету в дорослому житті. Мета: виявити метаболічні і соматичні зміни у дітей з інсулінорезистентністю.

Матеріали та методи. З 182 дітей загальної вибірки, у яких визначено рівень базального інсуліну і глюкози, HOMA-IR та індексу глюкоза/інсулін сформовано дві групи: група 1 — 56 (30,8 %) дітей з інсулінорезистеністю, група 2 — 126 (69,2 %) дітей з нормальною чутливістю до інсуліну. Дітям проведено антропометрію, ліпідограму (загальний холестерин, тригліцериди, ХС ЛПВЩ, ХС ЛПНЩ, ХС ЛПДНЩ), лептин.

Результати. З обстеженої когорти 56 дітей мали генералізоване ожиріння (ІМТ > 95-го перцентиля), 71 дитина — абдомінальне ожиріння (окружність талії > 90-го перцентиля), 55 дітей — нормальну масу тіла (ІМТ < 90-го перцентиля). Інсулінорезистентність виявлена у 21 (37,5 %) дитини з генералізованим ожирінням, 38 (39,4 %; p = 0,049) дітей з абдомінальним ожирінням і 7 (12,7 %) дітей з нормальним ІМТ (p = 0,003). У інсулінорезистентних дітей ІМТ, окружність талії і стегон були більшими, ніж в інсуліночутливих дітей. Ліпідний профіль у дітей з різною чутливістю до інсуліну не відрізнявся, проте встановлена висока кореляційна залежність ранішньої глюкози з індексом тригліцериди/ХС ЛПВЩ (r = 0,53; p = 0,001), базального інсуліну з тригліцеридами (r = 0,34; p = 0,018) та індексом тригліцериди/ХС ЛПВЩ (r = 0,54; p = 0,001). HOMA-IR корелював з ХС ЛПДНЩ (r = 0,40; p = 0,005), тригліцеридами (r = 0,49; p = 0,001), індексом тригліцериди/ХС ЛПВЩ (r = 0,43; p = 0,002). Індекс глюкоза/інсулін перебував у тісній залежності з індексом тригліцериди/ХС ЛПВЩ. Частота діагностики артеріальної гіпертензії у дітей з інсулінорезистеністю на 33,8 % перебільшувала аналогічний показник у інсуліночутливих дітей. Рівень сироваткового лептину у дітей з інсулінорезистентністю був в 1,8 раза вищим.

Висновки. Інсулінорезистентність пов’язана з кардіометаболічними факторами ризику, такими як генералізоване та абдомінальне ожиріння, гіпертензія, дисліпідемія, гіперлептинемія і лептинорезистентність, і є біомаркером скринінгу кардіометаболічних захворювань.