Additional opportunities for using computer technologies in expert analysis of laboratory data

The presented work reflects the author’s algorithm of mathematical processing and possible interpretations of the results obtained when creating expert analytical systems using computer technology. As initial parameters for the construction of neural networks of the second level, it is proposed to use individual results of calculations of the ratios of a number of laboratory indicators capable of forming a single functional cluster (leukogram, indicators of water-electrolyte balance, protein fractions, etc.). Further, using the proposed calculation algorithm and the archive database, structural features in the ′deformation′ of the ratio panel were compared against the background of the growth of each indicator, a matrix table was built reflecting the degree (correlation coefficients, KCr) of the coincidence of the features of the formation of the structure of the obtained panels of the parameters determined in individual observations. At high values of KCr, a conclusion is made about their (determined parameters) unified participation in the mechanism of emerging disorders. Thus, the system allows you to establish a leading complex of associated relationships by changes in the structure of ratios in the selected panel, corresponding to the dynamics of deviation of the target (analyzed) indicator, thereby differentiating the different mechanisms of formation of pathological deviations in this patient, the manifestation and balance of their values in the system-wide response, to evaluate the specific value of the absolute indicator as the final result of such interaction at the time of examination of the patient. The approach used, proposed by the authors, allows us to evaluate not only quantitative relationships, but also the features of the manifestation of the functional properties of the evaluated indicators. All of the above significantly expands the informativeness of the obtained laboratory data, allowing us to build a reasonable paradigm of the connections of the emerging complex of pathological disorders in each individual case. In the list of references, the authors cite publications as concrete examples of the use of the proposed approach in assessing a complex of disorders with different pathological processes using different panels in calculations.

Central Pontine Myelinolysis in a Child: Clinical Case

Background. Central pontine myelinolysis (CPM) is limited symmetric non-inflammatory demyelination in the middle part of pontine. This disease is based on electrolyte balance disorders. Although CPM was firstly described in adults, but it can also occur in children. Every new case of CPM in children has undeniable interest and high scientific and practical significance due to its low incidence. Clinical case description. The child, 7 years old, had acute development, lethargy, multiple vomiting, subfebrile fever, pains in epigastric region. It has happened after drinking an unknown herb growing in the yard and previously covered with the insecticide "Akarin", according to the mother. The child was hospitalized in the pediatric department at the place of residence. The patient developed strabismus, swallowing disorder, and muscle weakness on infusion therapy. Biochemical blood test has shown hypokalemia and hyponatremia. Head MRI has shown symmetrical focal lesion of heterogeneous structure in pontine. Conclusion. Distinctive feature of this case is the development of CPM in a child on the ongoing therapy of hypokalemia and hyponatremia. The timely provision of qualified medical care has favoured the child's recovery.

Assessment of changes in the main homeostasis indicators in mammals after hyperthermic exposure

Introduction. The occupation of firefighters is characterized by the impact of both hazardous fire factors and a complex of harmful and dangerous characteristics of various natures, often exceeding the expected values. High air temperature is typical for almost all types of fire and is one of the main adverse physical factors affecting the body of firefighters. Experimental models on animals are of leading importance in studying extreme fire factors, including hyperthermic exposure. Material and methods. The study was carried out on 124 outbred white male rats of 3 months of age weighing 250-300 g, divided randomly into two groups. The first group (62 rats) was subjected to a single hyperthermic load. The second group (62 rats) was subjected to daily hyperthermic load during 14 days. The study of the leading indicators of the acid-base state and water-electrolyte balance, biochemical and clinical blood tests, cellular and humoral immunity was carried out before and after hyperthermic exposure. Results. The obtained data indicate high ambient temperatures cause changes in homeostasis indices in laboratory animals. At the same time, there are alterations in the indicators of water-electrolyte balance, acid-base state, clinical and biochemical blood tests and the immune system. Conclusion. An experimental model of extreme heat exposure on animals showed the emergence and persistence of changes in the leading indicators of homeostasis. In the group of single hyperthermia, these parameters were restored to the background levels in a day. In the group of multiple hyperthermia, they remained altered.

Post craniotomy and electrocardiographic monitoring

Background: Post craniotomy management mainly emphasizes monitoring complications that occur. Close supervision and monitoring are needed in post craniotomy patients, especially in the first 48 hours so that the patient is placed in the intensive care unit (ICU). Various studies have identified various complications that arise from mild complications to severe complications, namely the death of patients after craniotomy, so that hemodynamic monitoring tool are needed. Electrocardiography is one of the hemodynamic monitoring tools in the intensive care room which is very useful in monitoring heart rhythm abnormalities in post-craniotomy patients.Methods: This descriptive study was conducted on 30 respondents post craniotomy and were treated in the Intensive Care Unit (ICU) for 1-3 days of treatment. An electrocardiographic monitoring analysis was performed on 30 respondents, then confirmed by examination of blood electrolytes and blood gas analysis.Results: In this study 90% of respondents experienced electrocardiographic rhythm abnormalities, 50% sinus arrhythmia, 33.3% sinus tachycardia, 6.7% sinus bardycardia. The results of electrolyte examination 18 respondents experienced electrolyte balance disorders where 4 respondents experienced hyponatremia, 7 respondents experienced hypernatremia+hyperchloremia, 1 respondent experienced hyponatremia+hypochloremia, 5 respondents experienced hyperchloremia and 1 respondent experienced hypokalemia. There are 7 respondents experiencing acid-base balance disorders.Conclusions: in this study showed that most of the patients after craniotomy had heart rhythm abnormalities. The most common arrhythmia is sinus arrhythmia. The pathological conditions that accompany these rhythm disturbances are mostly caused by electrolyte balance disorders, acid-base balance disorders or a combination of the two disorders.

Kidney cell type specific changes in the chromatin and transcriptome landscapes following epithelial Hdac1and Hdac2 knockdown

Recent studies have identified at least 20 different kidney cell types based upon chromatin structure and gene expression. Histone deacetylases (HDACs) are epigenetic transcriptional repressors via deacetylation of histone lysines resulting in inaccessible chromatin. We reported that kidney epithelial HDAC1 and HDAC2 activity is critical for maintaining a healthy kidney and preventing fluid-electrolyte abnormalities. However, to what extent does Hdac1/Hdac2 knockdown affect chromatin structure and subsequent transcript expression in the kidney? To answer this question, we used single nucleus Assay for Transposase-Accessible Chromatin-sequencing (snATAC-seq) and snRNA-seq to profile kidney nuclei from male and female, control and littermate kidney epithelial Hdac1/Hdac2 knockdown mice. Hdac1/Hdac2 knockdown resulted in significant changes in the chromatin structure predominantly within the promoter region of gene loci involved in fluid-electrolyte balance such as the aquaporins, with both increased and decreased accessibility captured. Moreover, Hdac1/Hdac2 knockdown resulted different gene loci being accessible with a corresponding increased transcript number in the kidney, but among all mice only 24-30% of chromatin accessibility agreed with transcript expression (e.g. open chromatin, increased transcript). To conclude, although chromatin structure does affect transcription, ~70% of the differentially expressed genes cannot be explained by changes in chromatin accessibility and HDAC1/HDAC2 had a minimal effect on these global patterns. Yet, the genes that are targets of HDAC1 and HDAC2 are critically important for maintaining kidney function.

Correction of electrolyte balance in surgical patients with urgent surgical interventions

Annotation. Acute appendicitis is one of the most common acute pathologies of the abdominal cavity, which requires immediate surgical intervention and can lead to water-electrolyte imbalance. The aim of the study was to investigate the clinical significance of electrolyte imbalance in patients operated on for acute appendicitis and their correction. We examined 20 urgent surgical patients who were part of the control group and received “traditional” postoperative therapy and 23 patients of the study group who received oral rehydration therapy in the postoperative period to correct water-electrolyte disorders. To analyze the results of the study, profile analysis was used as a modification of multidimensional covariance analysis with repeated measurements. As can be seen from the results of testing the hypothesis of normalization of homeostasis due to the use of oral rehydration therapy schemes, the hypothesis was confirmed with a threshold significance of p=0.0642. The only significant effect of the rate of normalization of potassium concentration in blood plasma is the appointment of oral rehydration therapy with p=0.045. Also, the appointment of oral rehydration therapy is a significant effect of the rate of normalization of sodium and glucose in plasma (normalization of plasma glucose is significantly better in the dynamics of younger patients (p=0.045)). Thus, normalization of potassium and glucose, which correlates with the patient's age, was better in patients receiving oral rehydration mixture in the postoperative period than in patients receiving “traditional” postoperative therapy. Oral rehydration therapy is an acceptable alternative to infusion therapy in patients undergoing surgery for acute appendicitis in the postoperative period.

Overview on Fluid, Electrolyte and Nutrition Management of the Newborn and Pre-term Newborns

Often in extremely preterm newborns in the early postnatal daysproblems in fluid and electrolyte balance occur Due to excessive insensible water loss and renal immaturity. The dietary care of newborn newborns is challenged by the demands of growth and organ development. The stress of a serious disease makes it much more difficult to get enough nourishment. Newborns andespecially premature newborns must be assessed thoroughly for fluid and electrolytes balance. Calculating the fluid and electrolyte demand for sustaining metabolic activities, replacing losses (evaporative, third space, external), and considering pre-existing fluid imbalance are all part of effective fluid and electrolyte management. When a neonate's size or condition prevents them from receiving enteral nutrition, parenteral nutrition can help them grow and thrive. Although eating through the gastrointestinal tract is the recommended method of nutritional management, some situations necessitate the use of PN as an adjuvant or sole treatment. In this article we discuss fluid electrolytes and Nutritional management using parenteral nutrition.

Prior fluid and electrolyte imbalance is associated with COVID-19 mortality

Background The COVID-19 pandemic represents a major public health threat. Risk of death from the infection is associated with age and pre-existing comorbidities such as diabetes, dementia, cancer, and impairment of immunological, hepatic or renal function. It remains incompletely understood why some patients survive the disease, while others do not. As such, we sought to identify novel prognostic factors for COVID-19 mortality. Methods We performed an unbiased, observational retrospective analysis of real world data. Our multivariable and univariable analyses make use of U.S. electronic health records from 122,250 COVID-19 patients in the early stages of the pandemic. Results Here we show that a priori diagnoses of fluid, pH and electrolyte imbalance during the year preceding the infection are associated with an increased risk of death independently of age and prior renal comorbidities. Conclusions We propose that future interventional studies should investigate whether the risk of death can be alleviated by diligent and personalized management of the fluid and electrolyte balance of at-risk individuals during and before COVID-19.

The Renin-Angiotensin System: A Key Role in SARS-CoV-2- Induced COVID-19

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), was first identified in Eastern Asia (Wuhan, China) in December 2019. The virus then spread to Europe and across all continents where it has led to higher mortality and morbidity, and was declared as a pandemic by the World Health Organization (WHO) in March 2020. Recently, different vaccines have been produced and seem to be more or less effective in protecting from COVID-19. The renin–angiotensin system (RAS), an essential enzymatic cascade involved in maintaining blood pressure and electrolyte balance, is involved in the pathogenicity of COVID-19, since the angiotensin-converting enzyme II (ACE2) acts as the cellular receptor for SARS-CoV-2 in many human tissues and organs. In fact, the viral entrance promotes a downregulation of ACE2 followed by RAS balance dysregulation and an overactivation of the angiotensin II (Ang II)–angiotensin II type I receptor (AT1R) axis, which is characterized by a strong vasoconstriction and the induction of the profibrotic, proapoptotic and proinflammatory signalizations in the lungs and other organs. This mechanism features a massive cytokine storm, hypercoagulation, an acute respiratory distress syndrome (ARDS) and subsequent multiple organ damage. While all individuals are vulnerable to SARS-CoV-2, the disease outcome and severity differ among people and countries and depend on a dual interaction between the virus and the affected host. Many studies have already pointed out the importance of host genetic polymorphisms (especially in the RAS) as well as other related factors such age, gender, lifestyle and habits and underlying pathologies or comorbidities (diabetes and cardiovascular diseases) that could render individuals at higher risk of infection and pathogenicity. In this review, we explore the correlation between all these risk factors as well as how and why they could account for severe post-COVID-19 complications.