Thrombocytopenia complicating the clinical course of leptospiral infection

Leptospirosis can present with a wide clinical spectrum, and haematological manifestations are often apparent. We retrospectively analysed platelet counts in 49 patients with leptospirosis. Forty-three patients (87.8%) had thrombocytopenia. Mean baseline platelet counts rose from 69 x 10(9)/l to 151 x 10(9)/l following treatment. Haemorrhagic episodes were observed in 11 patients. Platelet nadir was 29 x 10(9)/l in the group experiencing bleeding and 64 x 10(9)/l in the remainder. Six patients died due to bleeding and one due to sepsis. Thirty-six patients (73.5%) had acute renal failure; their means platelet count was 46 x 10(9)/l. Liver enzyme levels were elevated in all patients. Thrombocyte count, liver enzyme levels and bilirubin levels were significantly correlated. Forty-three (87.8%) patients showed signs of sepsis; mean thrombocyte count was 46 x 10(9)/l in these patients, and 133 x 10(9)/l in those without sepsis. Multiple organ involvement and fulminant disease is usually associated with renal failure and/or thrombocytopenia in leptospirosis.     

Coping with the disease phenomenon and peculiarities of the course of bronchial asthma

The aim of the study was to evaluate coping stratages (the degree of coping with the disease, CD) in 239 patients with moderate or severe bronchial asthma (BA). A method making it possible to calculate coping with the disease index (CDI) and thus to divide the patients into groups with a high (1) or low (2) degree of CD, was used. In addition, the levels of sputum eosinophilia, bronchial permeability, and pulmonary hemodynamics, were studied in both groups by two control examinations (after 6 and 10 to 12 months). The absence of severe cases of BA, stable results achieved during the first stage of treatment, stable remission on a smaller dose of inhaled glucocorticosteroids after 6 months with a significant growth of the number of well-controled BA and a decrease in pulmonary hypertension by the end of follow-up period, were typical of patients with a high CD. Evaluation of CDI allows for differentiation of BA patients into the groups with prognostically favorable and unfavourable BA, rationalizing therapeutic strategy, and lowering the probability of pulmonary hypertension progression.     

Clinical course of hepato-gastro-duodenal diseases

AIM: To characterize clinical course of hepatogastroduodenal diseases (HGDD). MATERIALS AND METHODS: 897 patients with HGDD were examined aged 15 to 82 years. RESULTS: Three groups of patients were recognized: with predominant symptoms of pains in epigastric and hepatic area; with motor-evacuatory disturbances of the stomach and duodenum; with prevailing symptoms of asthenovegetative and depressive disorders. CONCLUSION: Distribution of the patients by type of clinical course provides algorithm of examination and helps to formulate optimal therapeutic policy.