[The problem of diagnosis and differential diagnosis of botulism in pregnant women. Case report].

The article describes a clinical observation of a severe course of a sporadic case of foodborne botulism in a woman at 32 weeks gestation with a successful resolution of pregnancy by independent childbirth. No adverse effects of botulism on pregnancy, delivery, and fetal development were noted. Anti-botulinum serum was administered to the patient no earlier than 96 hours from the onset of the disease. The paper analyzes the clinical picture of botulism, on the basis of which it is necessary to carry out a differential diagnosis.

Prevalence of Intestinal Parasitic Infections among the Bulgarian Population Over a Three Year Period (2015 - 2017).

The aim of the present study is to perform a retrospective analysis of the prevalence of intestinal parasitic infections among the Bulgarian population over the period 2015 - 2017. The study involved all Bulgarians and foreign nationals residing in the country who had been tested for intestinal protozoa and helminths. A total of 23,785 infections have been revealed, of which 17,712 (74.47 %) were helminth and 6,073 (25.53 %) protozoan invasions. Enterobiasis was found to be the most prevalent among patients infected with intestinal helminths (81.75 %), while giardiasis (62.05 %) was the most common among those diagnosed with protozoan infections. In spite of improved living conditions and increasing public health awareness, parasitic diseases in general, and intestinal parasitic infections in particular, still represent a significant part of the overall morbidity in Bulgaria, thus posing a major issue for the public health care system.

[Current view on Blastocystis species: clinical forms, diagnosis and treatment].

The symptomatic form of Blastocystis spp. infection not only with mild diarrhea or dysentery-like syndrome, but also with the development of severe ulcerative necrotic lesions of the intestine. Meanwhile, the pathogenicity of these microorganisms should not be exaggerated, due to majority asymptomatic cases or infection transmission with minor impaired bowel function.

[Listeriosis of the Central nervous system].

OBJECT: To study the main causes of severe course and high mortality in patients with nervous form of listeriosis. MATERIALS AND METHODS: The analysis of the course of Listeria meningoencephalitis (LM) in 36 patients aged from 9 to 85 years, who were treated in the Infectious clinical hospital No. 2 DZM (IKB No. 2 DZM). Along with standard examination methods, blood and cerebrospinal fluid (CSF) polymerase chain reaction tests were performed to identify Listeria monocytogenes. The sensitivity of the pathogen to antibiotics was determined by serial dilutions on the WalkAway 96 Plus device of Siemens, USA. RESULTS: LM in 84% of cases developed in patients with disorders in the immune system, in particular, with infection with the human immunodeficiency virus - in 25% of cases. The clinical picture of the disease, changes in CSF were not typical for bacterial purulent meningitis of another etiology. It is noted that LM is characterized by early involvement of the substance and ventricles of the brain in the process. CONCLUSION: Severe course and high mortality are due to atypical picture of the disease, late diagnosis, low bioavailability of the pathogen for antibiotics (intracellular persistence of the pathogen) and frequent resistance to them. The mortality from the nervous form of listeriosis was 33.3%.

High-Resolution Thermochemical Study of Phase Stability and Rapid Oxygen Incorporation in YBaCo4- xZn xO7+δ 114-Cobaltites.

The formation thermodynamics of YBaCo4- xZn xO7+δ ( x = 0, 1, and 3) oxides was determined by high-temperature oxide melt solution calorimetry. All of the studied oxides are thermodynamically metastable due to the tendency of cobalt to increase the oxidation state under oxidizing conditions as well as to significant bond valence sum mismatch for Ba and Y in 114-oxides. Complex phase evolution in YBaCo4O7+δ at 350-400 °C upon oxygen absorption was revealed using incremental precise oxygen dosing. The calorimetric results support phase changes seen during in situ X-ray diffraction structural studies and provide high-resolution measurement of the amount and energetics of oxygen absorbed by YBaCo4- xZn xO7+δ under equilibrium conditions.

The problem of diagnosis of generalized and focal forms of salmonellosis.

The article describes the clinical observation with an unfavorable outcome of the generalized form of salmonella infection caused by Salmonella typhimurium group B in a woman of 60 years without immunodeficiency, complicated by the development of multiple abscesses of the lower parts of abdominal cavity, probably of appendicular origin. In a short literary review, the pathogenetic mechanisms that contribute to the formation of generalized and extraintestinal forms of salmonella infection are discussed.

[Difficulties in the diagnosis of diarrhea-associated hemolytic uremic syndrome in adults]. / Trudnosti diagnostiki gemolitiko-uremicheskogo sindroma, assotsiirovannogo s diareei, u vzroslykh.

Hemolytic uremic syndrome (HUS) is a rare, but menacing condition registered mainly in children. The paper gives a detailed description and analysis of a clinical case of HUS with a favorable outcome in an adult woman who developed the syndrome in the presence of bloody diarrhea. It considers an update on the etiology, pathogenesis, and clinical features of HUS associated with diarrheal syndrome and discusses differential diagnostic features, diagnostic problems, and characteristics of management tactics for patients.

[PECULIARITIES OF ISOLATION AND MOBILIZATION OF ADIPOSE­CUTANEOUS FLAPS OF A NIPPLE­LIKE AREA WHILE PERFORMING LOWER RITIDECTOMY, TAKING INTO ACCOUNT PECULIARITIES OF THE SKIN BIOMECHANICS].

Procedure of lower ritidectomy performance, taking into account analysis of parameters of the adipose/cutaneous flaps stretching and relaxation, was improved. Results of treatment of 30 patients, suffering involution ptosis of facial lower third, were analyzed. In 15 of them lower ritidectomy, using results of biochemical and morphological investigations, was conducted, and 15 were operated on in accordance to routine methods.

[PECULIARITIES OF ISOLATION AND MOBILIZATION OF ADIPOSE­CUTANEOUS FLAPS OF A NIPPLE­LIKE AREA WHILE PERFORMING LOWER RITIDECTOMY, TAKING INTO ACCOUNT PECULIARITIES OF THE SKIN BIOMECHANICS].

Procedure of lower ritidectomy performance, taking into account analysis of parameters of the adipose/cutaneous flaps stretching and relaxation, was improved. Results of treatment of 30 patients, suffering involution ptosis of facial lower third, were analyzed. In 15 of them lower ritidectomy, using results of biochemical and morphological investigations, was conducted, and 15 were operated on in accordance to routine methods.

[BIOMECHANICAL SUBSTANTIATION OF ONE-AXIS DEFORMITY OF ADIPOSE-CUTANEOUS FLAPS OF TEMPORAL AND ZYGOMATIC AREAS WHILE PERFORMANCE OF UPPER RHYTIDOPLASTY].

The urgency of the problem of determining the biomechanical features adipose-cutaneous grafts due to a significant increase in the frequency of performing cosmetic surgery and the lack of a unified concept for such interventions. In 32 women aged 35 to 65 years, which will eliminate the excess soft tissues in the implementation ritidectomy and other surgical interventions, isolated patches of adipose-cutaneous flaps to determine the mechanisms of its plastic deformation. Based on the analysis of biomechanical research targeted the optimal stretching the boundaries of adipose-cutaneous flaps zygomatic--to (0.45 ± 0.021) cm and temporal--by (0.0165 ± 0.002) cm refer to areas that allowed to perform surgery with preservation of natural topographoanatomic relations persons in the performance of the upper ritidectomy.

[Mapping of meiotic genes in rye (Secale cereale L.): localization of sy18 mutation with impaired homologous synapsis using microsatellite markers].

The recessive spontaneous sy18 mutation with nonhomologous synapsis was mapped in rye. The sy18 gene was located in the centromeric region of chromosome 2R in relation to three rye SSR (simple sequence repeats) loci, i.e., Xrems1130, Xrems1203, and Xscm43, and one wheat SSR locus Xgwm132. The desynaptic sy18 gene is located in the interval between Xrems1130 and Xrems1203 markers at a distance of 0.5 cM and 3.1 cM, respectively. The possible evolutionary relationships of the mapped gene with homologous loci of the related species are discussed.

[Mapping of meiotic genes in rye (Secale cereale L.): localization of sy19 mutation, impairing homologous synapsis, by means of isozyme and microsatellite markers].

The sy19 mutation, which impairs the homology of meiotic chromosome synapsis in rye, were mapped using a specially created F2 population by means of isozyme Acph 1 locus and microsatellite (SSR) markers. The sy19gene was localized in the chromosome 7R in the pericentromeric region of long armbased on the linked inheritance with the Acph 1 locus. The locus was linked with five rye SSR markers, with the Xrems 1234 locus being located closest to the sy19 gene (6.4 cM). The genetic map of the analyzed chromosome 7R region includes ten markers and the sy19 locus. A possible function of the Sy1 and Sy19 genes based on the data on comparative genomics is discussed.

[Human babesiasis].

The paper describes a case of imported babesiasis caused by Babesia microti. This is an account of the second case of babesiasis in the Russian-language medical literature. Its clinical picture and laboratory data in the course of the disease are depicted and analyzed. Its clinical differential diagnosis with malaria and an update on the diagnosis and treatment of babesiasis are discussed.

FACTORS AFFECTING MECHANISMS OF INCREASED BONE DENSITY FORMATION IN CHILDREN LIVING ON RADIOLOGICALLY CONTAMINATED TERRITORIES AFTER THE ChNPP ACCIDENT. / ChYNNYKY, IaKI VPLYVAIuT' NA MEKhANIZMY FORMUVANNIa PIDVYShchENOÏ ShchIL'NOSTI KISTKOVOÏ TKANYNY U DITEI, ZhYTELIV RADIOAKTYVNO ZABRUDNENYKh TERYTORII, PISLIa AVARIÏ NA ChAES.

OBJECTIVE: to determine the causes of increased bone mineral density (BMD) based on case history, clinical and laboratory data, including the assay of hormones involved in ossification processes in children, living on radiologically contaminated territories (RCT) after the accident at the ChNPP, compared to the normative BMD patterns. MATERIALS AND METHODS: There were 289 children involved in the study. The 1st group included persons with a BMD above 100 IU, 2nd group - with normative BMD (100-85 IU). Family history of diseases was assessed featuring cancer and endocrine diseases, cholelithiasis, and urolithiasis. Weight of the child at birth, frequency of bone fractures, complaints about osalgia, jaw abnormalities, dental caries, presence or absence of obesity, peripheral blood count, blood biochemical parameters (total protein, creatinine, iron, alkaline phosphatase, calcium), serum pituitary thyroid-stimulating hormone and cortisol were accounted. Children's radiation doses were calculated according to the materials of the «General dosimetric certification of settlements of Ukraine that were exposed to radioactive contamination after the Chornobyl accident¼. RESULTS: Higher than normative BMD values were found in children after puberty, while normative ones - in puberty (р < 0.001), regardless of gender. A direct correlation between the bone fractures frequency was established in children with increased BMD (р < 0.01). Jaw anomalies and dental caries occurred at that significantly less often than in normative BMD (р > 0.05). A direct correlation was established between the obesity and BMD (р < 0.001).Increased alkaline phosphatase activity was inversely correlated with BMD (rs = -0.21; р < 0.05). In children with elevated BMD a direct correlation was established between the level of iron and endocrine disorders in the family history (р > 0.001). Serum level of cortisol was directly correlated with dental caries (р < 0.05). In children, regardless of BMD value, a direct correlation was established between the radiation dose, age and obesity (р < 0.001). CONCLUSIONS: Higher than normative BMD is accompanied by an increased frequency of bone fractures, jaw abnormalities, metabolic changes in bone tissue and bone tissue hormonal regulation in children, which requires application of pathogenetic therapy for the osteogenesis.

EFFECT OF IRON ON BONE TISSUE METABOLISM AND THYROID FUNCTION IN CHILDREN LIVING ON RADIOLOGICALLY CONTAMINATED TERRITORIES SINCE THE ChNPP ACCIDENT. / VPLYV ZALIZA NA PROTsESY METABOLIZMU V KISTKOVII TKANYNI TA FUNKTsIIu ShchYTOPODIBNOÏ ZALOZY UDITEI, IaKI ZhYVUT' NA RADIOAKTYVNO ZABRUDNENYKh TERYTORIIaKh PISLIa AVARIÏ NA ChAES.

OBJECTIVE: To assess the metabolic processes in bone tissue and state of thyroid gland depending on iron metabolism parameters in children of pre-pubertal, pubertal and post-pubertal age, living on radiologically contaminated territories after the ChNPP accident. MATERIALS AND METHODS: Children (n = 119) aged 6 to 18 years were examined and the 4 study groups were formed, featuring the childhood, pre-pubertal, pubertal and post-pubertal life periods. Clinical symptoms, iron metabolism parameters (serum iron (SI) and ferritin (SF) content, transferrin saturation coefficient), parameters of bone tissue metabolism (serum creatinine and alkaline phosphatase (APh)), and amino acid content in urine were taken into account. Functional state of thyroid, titers of antibodies to thyroperoxidase (TPOAb) and thyroglobulin (TgAb) were assayed. Results and their discussion are presented depending on the age of children, biochemical parameters of blood, iron metabolism findings, thyroid gland function and individualized radiation doses. RESULTS: In 13.4 % of pubertal and post-pubertal children an elevated content of SI and SF was observed. APh levels were increased in 20.2 % of children (758.9 ± 16.3 U/l) being directly correlated with SI levels (rs = 0.50; р < 0.01). In 16.3 % of children of pubertal and post-pubertal age, in whom the level of SI was above 27 µmol/l, a direct correlation with serum thyroid-stimulating hormone (TSH) level was established in case of the hormone content above 2.5 mU/l (rs = 0.50; р < 0.05). Serum creatinine level directly correlated with glycine content in urine (rs = 0.70), which is a part of collagen, and inversely correlated with serum APh (rs = -0.47), (р < 0.05). Under the levels of SI higher than (15.1 ± 1.2) µmol/l and SF higher than (87.5 ± 6.4) ng/ml, the TPOAb titer was higher than at lower iron concentrations (U-test = 64.5, р < 0.05). The TgAb titer directly correlated with SI (rs = 0.39) and TSH (rs = 0.81) levels (р < 0.01). The average effective radiation dose in children was (0.75 ± 0.10) mSv. A direct correlation was established between the child's radiation dose and age (rs = 0.33; р < 0.05). CONCLUSIONS: Bone metabolism depends on the age of children, characteristics of pubertal period, excess of iron in the body, and functional state of thyroid system, which is involved in collagen formation and protein metabolism.

ASSESSMENT OF QUALITATIVE CHANGES IN PERIPHERAL BLOOD CELLS IN CHILDREN - RESIDENTS OF RADIOLOGICALLY CONTAMINATED TERRITORIES IN THE LATE PERIOD AFTER THE ChNPP ACCIDENT. / OTsINKA IaKISNYKh ZMIN V ELEMENTAKh PERYFERYChNOÏ KROVI U DITEI ­ MEShKANTsIV RADIOAKTYVNO ZABRUDNENYKh TERYTORII U VIDDALENYI PERIOD PISLIa AVARIÏ NA ChAES.

OBJECTIVE: to establish the relationship between quantitative and qualitative parameters of peripheral blood cells(lymphocytes, neutrophilic granulocytes, monocytes, platelets) depending on the type of somatic diseases andannual internal radiation doses from 137Cs in children - residents of radiologically contaminated territories in thelate period after the Chornobyl Nuclear Power Plant (ChNPP) accident. MATERIALS AND METHODS: There were 175 children included in the study comprising residents of radiologically con-taminated territories (n = 79) aged from 4 to 18 years. Annual internal radiation doses in children from 137Cs rangedfrom 0.004 to 0.067 mSv. Certain blood parameters were assessed in a comparative mode in children having got theradiation doses up to 0.01 mSv and higher. The comparison group (n = 96) included children living in settlementsnot attributed to the radiologically contaminated ones. Incidence and type of somatic diseases and its impact onquantitative and qualitative changes in blood parameters (i.e. lymphocyte, neutrophilic granulocyte, monocyte, andplatelet count) were studied. The cell size, state of nucleus, membranes and cytoplasm, signs of proliferative anddegenerative processes were taken into account. RESULTS: Incidence and type of somatic diseases in children did not depend on the annual internal radiation dose.Number of cases of monocytosis was significantly higher among the children exposed to ionizing radiation than inthe comparison group (16.6 % vs. 7.3 %). There were, however, no correlation between these changes and radiationdoses. Number of activated blood monocytes with cytoplasmic basophilia and residues of nucleoli in nuclei washigher in individuals with internal radiation doses > 0.01 mSv. A direct correlation between the qualitative param-eters of monocytes and internal radiation doses was established (rs = 0.60; р < 0.001), as well as a direct correlationof different strength between qualitative parameters of blood cells, indicating their unidirectional pattern depend-ing on the somatic morbid conditions. Regardless of annual internal radiation dose, there was an increase in thenumber of degenerative and aberrant cells vs. the comparison group (р < 0.05), which could be due to the role ofnon-radiation factors. CONCLUSIONS: Results of the assessment of quantitative and qualitative parameters of peripheral blood cells reflect-ed the state of morbid conditions in children and are of a diagnostic value. The identified dose-dependent changesin monocyte lineage of hematopoiesis may be the markers of impact of long-term radionuclide incorporation withfood in children living in environmentally unfavorable conditions after the ChNPP accident.

[Molecular genetic mapping of the sy1 and sy9 asynaptic genes in rye (Secale cereale L.) using microsatellite and isozyme markers].

Studies of phenotypical expression of synaptic mutations in combination with the localization of corresponding genes on a genetic map permit individual stages of the meiotic process to be differentiated. Two rye asynaptic genes, sy1 and sy9, were mapped with the use of microsatellite markers (SSR) in the pericentromeric regions of the long chromosome arms 7R and 2R, respectively. The sy9 gene cosegregated with two SSR markers Xscm43 and Xgwm132. The asynaptic gene sy1 was mapped within the interval between the isozyme locus Aat2 and two cosegregating loci Xrems1188 and Xrems1135 that are located at a distance of 0.4 cM proximally and 0.1 cM distally with respect to the gene lous. Possible evolutionary relationships of the mapped genes with homeological loci of the Triticeae species and more distant cereal species, such as maize and rice, are discussed.

[Impairment of homologous chromosome synapsis in meiosis in rye Secale cereale L. caused by a recessive mutation of the sy18 gene].

AExpression and inheritance of the sy18 mutation causing impairment of synapsis homology were studied. It was established that the abnormal phenotype is determined by a recessive allele of the sy18 gene. Univalents and multivalents are observed in homozygotes for this mutant allele. According to the electron microscopic analysis of synaptonemal complexes in mutants, homologous synapsis occurs together with nonhomologous synapsis. The sy18 gene was found to have no allelism with asynaptic genes sy1 and sy9 and with genes sy10 and sy19 causing, like sy18, disturbances in synapsis homology.

FEATURES OF CLINICAL SYMPTOMS AND SIGNS, HEMATOLOGICAL AND BIOCHEMICAL PARAMETERS IN CHILDREN WITH JOINT HYPERMOBILITY IN A LATE PERIOD UPON THE CHORNOBYL NPP ACCIDENT. / OSOBLYVOSTI KLINIChNOÏ SYMPTOMATYKY, GEMATOLOGIChNYKh TA BIOKhIMIChNYKh POKAZNYKIV U DITEY̆ Z GIPERMOBIL'NISTIu SUGLOBIV U VIDDALENYY̆ PERIOD PISLIa AVARIÏ NA ChORNOBYL'S'KIY̆ AES.

OBJECTIVE: establishing the types and frequency of disembriogenetic stigma in children with joint hypermobility given the clinical and laboratory features, genetic component and endocrine regulation of these disorders in a late period upon the accident. MATERIALS AND METHODS: Children (n = 109) inhabiting the radiologically contaminated territories and having the connective tissue dysplasia (CTD) signs were involved in the study. Diseases in family history, ossalgia complaints, fractures in a personal history, bone disembriogenetic stigma, joint hypermobility, type of somatic diseases, blood serum biochemical parameters (namely calcium, alkaline phosphatase, total protein, cholesterol, creatinine, iron, ferritin content), serum cortisol, free thyroxine, pituitary thyroid-stimulating hormone (TSH) levels, free amino acid composition in urine and radiation dose were considered. RESULTS: Radiation doses in children having the CTD ranged from (0.37 ± 0.11) mSv to (0.56 ± 0.10) mSv with no difference from that in those without CTD. Joint hypermobility (JHM) correlated with cancer in family history (rs = 0.53) and lower extremity varicose vein disease (rs = 0.40) (p < 0.05). Incidence of ossalgia, easy fatigability, and bone fractures was higher in children with CTD. Anomalies of the dentofacial system were first in line (38.5 %) in these children. Proportion of children with grade II JHM and platypodia was lower (rs = 0.42), but with lower extremity deformations was higher (rs = 0.68) (p < 0.05) vs. in the control group. Iron and ferritin deficiencies both with lymphocytosis were more common in children with CTD than in the comparison group (p < 0.05). The increased content of oxyproline, lysine, proline both with glycine deficiency were detected in children having the CTD, i.e. an imbalance of amino acids from the collagen content was observed featuring a predominance of catabolic processes over anabolic ones. There was a direct correlation between the TSH level and the JHM grade (rs = 0.49), although the values of hormone concentration in these children did not exceed the reference range (maximum values were 3.3 µIU/ml). CONCLUSIONS: The revealed abnormalities in amino acid content, ferrokinetics, and thyroid function indices can affect the collagen formation, organic matrix structure of bone tissue and significantly deregulate the hemato- poiesis. The later can underlie the pathways of haematologic malignancy development.

PROGNOSIS OF THE COURSE OF CHORNOBYL-ORIGINATED ACUTE LYMPHOBLASTIC LEUKEMIA IN CHILDREN IN UKRAINE DEPENDING ON THE REASON OF STANDARD CHEMOTHERAPY INTERRUPTION. / PROGNOZ PEREBIGU GOSTRYKh LIMFOBLASTNYKh LEY̆KEMIY̆ ChORNOBYL'S'KOGO POKhODZhENNIa U DITEY̆ UKRAÏNY ZALEZhNO VID PRYChYN PERERV PRY PROVEDENNI STANDARTNOÏ KhIMIOTERAPIÏ.

OBJECTIVE: Estimation of the bone marrow haemopoietic status depending on the reasons and duration of breaks in a standard chemotherapy (BFM-ALL protocol) to predict the course of acute lymphoblastic leukemia (ALL) in chil- dren exposed to low doses of ionizing radiation after the Chornobyl accident. MATERIALS AND METHODS: The ALL patients (n = 34) were examined within 5 stages of a program chemotherapy. The clinical symptoms, hemogram and myelogram data were analyzed. The radiation dose on bone marrow, initial leuko- cyte count, variants and prognosis of ALL course were accounted. Days of the stopped chemotherapy, type and fre- quency of complications (septic processes, febrile neutropenia, toxic hepatitis, granulocytopenia degree), and the prognosis of disease course (child living status, i.e. alive or died) were estimated. RESULTS: There were abnormal differentiation processes and high percentage of lymphoblasts (86.2 ± 3.3) % in bone marrow in the 1st acute period. Hematological remission was established in all patients on the 33rd day of chemothe- rapy. In a half of cases the haematopoietic recovery occurred by a granulocyte-monocyte type. One third of patients presenting an erythroid type of haemopoiesis died later. The inverse correlation was found between the number of myelocaryocytes and disease prognosis (rs = -0.49). Breaks in chemotherapy for various reasons were recorded. The number of patients with granulocytopenia was greater at the phase 1 and 2 of protocol I and protocol M application, coinciding with a higher incidence of complications. An inverse correlations between the prediction of ALL course and sum of days of breaks between the protocol M and phase 1 of protocol II (rs = -0.56), as well as the duration of the phase 2 of protocol II (rs = -0.62) were found. The radiation dose on bone marrow was (5.37 ± 1.23) mSv. No relationship was found between the radiation doses, ALL variants and disease course. CONCLUSIONS: Prognosis of ALL course in children depends on the type of haemopoietic recovery and reasons of breaks in a standard chemotherapy. Interaction between the haemopoiesis functioning and microenvironment and that of their regulation are the key mechanisms of above-mentioned abnormalities, which is the basis for further research.