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Relevance. The pathogenesis of COVID-19 remains one of the most pressing. The literature discusses the role of iron as a factor supporting inflammatory processes, hypercoagulability and microcirculation crisis in severe COVID-19.The aim of study. was to identify changes in iron metabolism in patients with severe COVID-19 and hyperferritinemia.Material and methods. In this study, we used a content analysis of available scientific publications and our own observations of the peculiarities of the clinical picture and laboratory parameters in patients with a severe course of COVID-19 who had hyperferretinemia at the height of the disease. The main group consisted of 30 patients hospitalized in the Department of Anesthesiology, Resuscitation and Intensive Care of N.A. Semashko City clinical Hospital No. 38 with the diagnosis COVID-19, bilateral polysegmental pneumonia, severe course and hyperferritinemia. The diagnosis of a new coronavirus infection was confirmed by visualization of bilateral viral lung lesions with chest CT-scan, positive PCR test for SARS-CoV-2 and the presence of immunoglobulins to SARS-CoV-2. The control group consisted of 20 healthy volunteers. The study evaluated the biochemical parameters of iron metabolism, fibrinolysis and markers of inflammation. Changes associated with impaired iron metabolism were assessed by the level of serum iron, transferrin, daily and induced iron excretion in the urine. Statistical processing was carried out using nonparametric methods.Results. All patients with severe COVID-19 and hyperferritinemia showed signs of impaired iron metabolism, inflammation and fibrinolysis — a decrease in the level of transferrin (p˂0.001), serum iron (p˂0.005), albumin (p˂0.001), lymphocytes (p˂0.001) and an increase in leukocytes (p˂0.001), neutrophils (p˂0.001), CRP (p˂0.005), IL-6 (p˂0.001), D-dimer (p˂0.005), daily urinary iron excretion (p˂0.005) and induced urinary iron excretion (p˂0.001).Conclusions. The study showed that in the pathogenesis of the severe course of COVID-19, there is a violation of iron metabolism and the presence of a free iron fraction. The appearance of free iron can be caused by damage to cells with the “release” of iron from cytochromes, myoglobin, hemoglobin, or violation of the binding of iron to transferrin, which may be the result of a change in the protein structure or violation of the oxidation of iron to the trivalent state. When assessing the degree of viral effect on the body, one should take into account the effect of various regulators of iron metabolism, as well as an assessment of the level of free iron not associated with transferrin.

The aim of the study was to establish objective reliable morphological signs of fatal poisoning with 4-hydroxybutanoic acid (4-HBA).Material and methods. The 49 acts of forensic medical examination of corpses with «Acute poisoning with 4-hydroxybutanoic acid» as the main cause of death were analyzed. The work was done in the Saint Petersburg Bureau of Forensic Medical Expertise.The results of morphological (macro - and microscopic) as well as forensic chemical studies of biological tissues were evaluated.The results were statistically processed using Statistic for Windows software (version 10). The numerical characteristics of the variables (M ± SD, Me [Q25; Q75]), χ2 — Pearson's criterion, and Spearman's correlation coefficient were applied for statistical processing.Results. The average lethal dose of 4-HBA in arterial blood was found to be equal to 273,6 ± 125,1 mg/l. In a forensic chemical study the combined use of 4-HBA and other narcotic substances (NS) and psychoactive substances (PAS) was diagnosed in 48.9% of cases. Of the causes leading to death, non-violent and «non-criminal» death due to 4-HBA poisoning was established more often - in 67.3% (33) of cases, a fall of the victim from a height with a fatal outcome - in 22.4% (11), less often violent death as a result of blunt and acute trauma - in 4.09% (2) cases.Among the macroscopic signs of acute lethal poisoning with 4-HBA were an increased mass of internal organs (heart, lungs, spleen, liver) in direct connection with the concentration of the toxicant in the blood. Microscopic signs of acute lethal poisoning by a toxicant included blood circulation features characteristic of sudden death.Concomitant pathology was diagnosed in 32.6% of cases in the form of degenerative changes in internal organs. In turn, hepatitis C and human immunodeficiency virus (HIV) were detected in 26.5% (13) of the dead.Conclusions. Thus, the signs characteristic for acute fatal poisoning with 4-HBA include the features of hemocirculation characteristic of sudden death. The brain is most severely affected, which is manifested by destructive edema. Poisoning is also characterized by the presence of serous pulmonary edema. Macroscopic signs of poisoning were revealed, including an increase in the weight of the heart, lungs, spleen and liver in direct connection with the concentration of the toxicant in the blood.It should be noted that the concomitant pathology in the form of dystrophic changes in the internal organs indicates the long-term nature of the use of the toxicant leading to pronounced metabolic disorders.

It was found that for the period from X.2017 to III.2020 among patients admitted to a multidisciplinary hospital with acute poisoning with narcotic drugs (NV) and psychoactive substances (PAS), persons in whose biological environment GHB was detected ranged from 20,1 to 40,1%. The prevalence of acute poisoning of the studied class in male patients (86%) of working age (the average age was 34,2 ± 2,9 year) was proved. The patients used 1,4-butanediol (1,4-BD) as a toxicant (GHB) in 95% of cases. The dynamics of the incidence of acute GHB poisoning over a three-year period was uneven, with peaks of maximum values in August (Me = 168), March (Me = 90), and September (Me = 103) and low rates - in June (Me = 71) and total upward trend - y = 6,6573x = 343,23, R2 = 0,053. The severity of acute GHB poisoning at the time of admission on the PSS scale was 2,2 ± 0,57 points, PSSSP – 22,7 ± 2,17 points. Acute GHB poisoning was characterized by signs of toxic-hypoxic encephalopathy, clinically manifested in the form of depression of consciousness to the level of deep stunning - coma. The duration of inpatient treatment of patients was (1,76 ± 3,7, min = 1, max = 35) days, the period of stay in the intensive care unit (ICU) was 4,2 ± 0,4 hours. The increase in hospitalization (more than a day) was due to somatic complications of acute poisoning (nasocomial pneumonia, systemic rhabdomyolysis, acute renal failure) - in 14% of cases, severe withdrawal syndrome with delirious confusion - in 3,5% of cases. The post-intoxication period was characterized by moderate withdrawal symptoms – 13,7 ± 2,1 points, according to the CIWA-Ar scale. The delirious syndrome was characterized by a protracted course (9,5 ± 1,2 days), an atypical clinical picture, and metabolic disorders. The mortality rate due to acute GHB poisoning increased from 0,09 to 0,22%, in 2019 the cause of death was pronounced degenerative changes in internal organs and varying degrees of severity of microcirculation disorders.

In 21 male patients aged 20 to 40 years, metabolic disorders in post-toxic delirious syndrome caused by gamma-hydroxybutyric acid poisoning and its precursors were studied. In the examined group of patients, hyperammonemia was detected in 71.4% of cases, metabolic lactic acidosis was revealed in 76.2%. The direct correlation between the severity of metabolic disorders and delirious syndrome according to DRS-R-98 scale was established. The statistically significant increase in capillary blood levels of lactate on day 3 of psychotic period was 4.9 mlmol/L and ammonia on day 5 was 187.0 mmol/L. The greatest severity of metabolic disorders was found in patients over the age of 27 years who systematically use the studied substances with narcotic effects for 7 months or more and combine their intake with other psychoactive substances.

Introduction. The article presents the epidemiological analysis of the structure of acute poisonings with modern psychoactive substances.The aim of the study was to analyze the structure of acute poisonings with modern psychoactive substances among patients hospitalized in General hospitals for 2019 to improve preventive measures.Material and methods. There were used data obtained from the consolidated accounting documents of branches of the Centre for the treatment of acute poisoning. The aggregation of the material used numerical characteristics of the variables with the assessment of their accuracy and reliability, the significance of differences increased non-parametric Pearson criterion.Results. The prevalence in biological fluids in hospitalized patients of γ-hydroxybutyrate was 46.6% (1452), synthetic α-PVP - 20,2% (631), synthetic opioids (methadone) and 13.2% (413). In the overall structure of acute poisonings registered in 2019, the proportion of poisoning with modern drugs amounted to 22.2% (4442), the case-fatality rate is 0.3%, which proves its high epidemiological significance. In the course of studying the dynamic characteristics of the epidemiological process the main peaks of the detection of psychoactive substances among the total number of performed laboratory research were established to be noted in July (52%), August (60,8%) and November (54,3%) 2019 based on the analysis conclusions are made about the feasibility of improving the system of prevention of acute poisonings with modern psychoactive substances at the pre-hospital and hospital stages.

The article presents analyzis of the data of the clinical course of Covid-19 and probable pathogenetic mechanisms of lesions, which are presented in foreign and domestic literature The hypothesis about the hematotoxic effect of the SARS-CoV-2 virus is considered, which may cause its multi-system action An analogy is made of the pathogenesis of multiple organ lesions in case of viral infection and in acute poisoning with hemolytic poisons and iron preparations, in which the development of metabolic acidosis, toxic hemolysis, and an increase in free hemoglobin and iron ions in the blood plasma are the central link The article proposes to use a set of diagnostic measures aimed at confirming the hematotoxic component during SARS-CoV-2 infection and methods for assessing the severity of the condition, adopted in clinical toxicology Taking into account the experience of treating acute poisoning with hemolytic poisons, attention is focused on the importance of using alkalizing therapy in order to remove the products of hemoglobin breakdown and prevent acute nephritic failure When confirming the presence of a toxic factor, methods aimed at eliminating toxic products of hemolysis can be used - antidote therapy and methods of surgical detoxification This complex of therapeutic measures in clinical toxicology is effective, aimed at the prevention of acute renal failure and toxic coagulopathy The authors believe that the hypothesis of a hematotoxic factor in the pathogenesis of Covid-19 requires a targeted therapeutic strategy and targeted study В статье проанализированы данные клинического течения Covid-19 и вероятные патогенетические механизмы поражений, которые представлены в зарубежной и отечественной литературе Рассматривается гипотеза о гематотоксическом свойстве вируса SARS-CoV-2, которое возможно объясняет его мультисистемное действие Проведена аналогия патогенеза полиорганных поражений при вирусной инфекции и при острых отравлениях гемолитическими ядами и препаратами железа, в которых центральным звеном являются развитие метаболического ацидоза, токсический гемолиз, повышение свободного гемоглобина и ионов железа в плазме крови В статье предложены к использованию комплекс диагностических мероприятий, направленных на подтверждение гематотоксического компонента при инфицировании SARS-CoV-2 и методы оценки тяжести состояния, принятые в клинической токсикологии Учитывая опыт лечения острых отравлений гемолитическими ядами, акцентируется внимание на важность применения ощелачивающей терапии с целью выведения продуктов распада гемоглобина и профилактики острой почечной недостаточности При подтверждении наличия токсического фактора могут быть использованы методы, направленные на элиминацию токсических продуктов гемолиза - антидотная терапия и методы хирургической детоксикации Данный комплекс лечебных мероприятий в клинической токсикологии является эффективным, направленным на профилактику острой почечной недостаточности и токсической коагулопатии Авторы считают, что гипотеза гематотоксического фактора в патогенезе Covid-19 требует целевой терапевтической стратегии и целенаправленного изучения

This review presents current data on the mechanism of action, selective toxicity, toxicokinetics and toxicodynamics of diacetylmorphine (heroin). Acute diacetylmorphine poisoning is considered under taking into account the developing a critical state, in which the poisoning severity is determined by severe metabolic disorders associated with the progression of hypoxia. The main lifethreatening complications of acute diacetyl morphine poisoning are described including those associated with the nervous system, respiratory, circulatory and urinary systems. Since hypoxia is the principal damaging factor, the the mechanisms of oxygen transport disorders and the pathogenesis of activation of free radical oxidation in acute diacetylmorphine poisoning are discussed. The improvement of intensive care strategy for severe forms of acute diacetylmorphine poisoning by the inclusion of a substrate antihypoxant Reamberin into the list of routine critical care prescriptions is emphesized.

A case of acute oral poisoning by 1.4-butanediol, complicated by the development of severe hypoxia in a 34-year-old patient actively engaged in bodybuilding, is presented. The psychoactive substance was used by the patient to increase sexual activity and physical stamina. The duration of systematic daily intake was 4 months. The toxicogenic stage of acute poisoning was caused by a single dose of 50 ml of undiluted 13% 1.4-butanediol together with ethanol, manifested by convulsive syndrome, depression of consciousness to the level of coma II, acute respiratory failure with aspiration syndrome, respiratory acidosis (pH 7.22; partial pressure carbon dioxide 61.2 mm Hg), lactic acidosis up to 7 mmol / L, hyperammonemia up to 240 μmol / L, cerebral edema (decrease in white matter density to 21.6 ± 1.7 HU units), loss of vascular tone resistance (pareso arterioles) and a significant increase in cerebral blood flow rate to 115 ± 20.1 ml / 100 g per minute, increasing the volume of extracellular fluid (+ 130% of the proper volumes). Intensive therapy was complex, including infusion and detoxification therapy, correction of acid-base disorders, hypoxic disorders by using a substrate antihypoxant (Cytoflavin) in a daily dosage of 0.57 ml / kg body weight daily, for 9 days. The article discusses the toxicokinetics and toxicodynamics of 1.4-butanediol, radiation diagnostics and the clinical picture of acute poisoning, the features of its course, and pathogenetic approaches to therapy.Представлен случай острого перорального отравления 1,4-бутандиолом, осложнившегося развитием тяжелой гипоксии у пациента 34 лет, активно занимающегося бодибилдингом. Психоактивное вещество использовалось с целью повышения сексуальной активности и физической выносливости. Длительность систематического ежедневного приема составила 4 мес. Острое отравление возникло после однократного приема 50 мл неразведенного 13% 1,4-бутандиола вместе с этанолом, проявилось судорожным синдромом, угнетением сознания до уровня комы II, острой дыхательной недостаточностью с аспирационным синдромом, дыхательным ацидозом (pH 7,22; парциальное давление углекислоты 61,2 мм рт.ст.), лактатацидозом до 7 ммоль/л, гипераммониемией до 240 мкмоль/л, отеком головного мозга (снижение показателей плотности белого вещества до 21,6±1,7 ед. HU), утратой тонуса сосудистого сопротивления (парез артериол) и значительным повышением скорости церебрального кровотока до 115±20,1 мл/100 г в 1 мин, повышением объема внеклеточной жидкости (+130% от должных объемов). Интенсивная терапия носила комплексный характер и включала инфузионно-детоксикационную терапию, коррекцию нарушений кислотно-основного состояния, гипоксических расстройств путем применения субстратного антигипоксанта (Цитофлавин) в суточной дозировке 0,57 мл/кг массы тела ежедневно на протяжении 9 дней. Обсуждаются токсикокинетика и токсикодинамика 1,4–бутандиола, лучевая диагностика и клиническая картина острого отравления, особенности его течения, патогенетические подходы к терапии.

This review is focused on the substrate antihypoxant reamberin used in intensive therapy of acute poisoning with special reference to the mechanisms of its action consisting in the reduction of the severity of metabolic disorders manifested as a decrease of tissue hypoxia, recovery of antioxidant defense and suppression of the activity of lipid peroxidation and endotoxicosis. The antihyhypoxant activity of reamberin is apparent as the reduction of the hypoxic brain lesions in patients with acute poisoning which leads to a significant improvement in the clinical course of acute poisoning and decreases the number of adverse outcomes.

In this article materials obtained during treatment of 61 patients with acute poisoning with phenobarbital, which is part of Corvalol and Valocordin, are presented. It has already been established that phenobarbital acute poisoning in elderly and senile patients is accompanied by more frequent development of central nervous system, respiratory system (pneumonia) and cardiovascular system complications, which cause more severe clinical course and risk of an adverse outcome of acute poisoning. This research has shown that for hypoxia correction during phenobarbital acute poisoning in elderly and senile patients it is advisable to include Reamberin in the treatment regimen, which has no adverse effects on central haemodynamic parameters and effectively reduces severity of metabolic disorders.В статье рассмотрены результаты лечения 61 больного с острыми отравлениями фенобарбиталом, входящим в состав корвалола и валокордина. Установлено, что острые отравления препаратами, содержащими фенобарбитал, у больных пожилого и старческого возраста сопровождаются частым развитием осложнений со стороны ЦНС, системы дыхания (госпитальная пневмония) и сердечно-сосудистой системы, что является причиной тяжелого клинического течения и риска неблагоприятного исхода. Выявлено, что в схемы лечения острых отравлений препаратами, содержащими фенобарбитал, для коррекции гипоксических расстройств у больных пожилого и старческого возраста целесообразно включение Реамберина, не оказывающего негативного влияния на показатели центральной гемодинамики и эффективно снижающего глубину метаболических нарушений.

The article presents a case-report of delirium syndrome in a 29-year-old patient who systematically consumed 1.4-butanediol. Psychopathological symptoms developed in the toxicogenic phase and continued to increase during the first days of treatment, followed by transformation into a deliberate delirium and toxic nephropathy. Comprehensive treatment, including infusion-detoxification therapy, correction of acid-base and hypoxic disorders using cytoflavin, had a positive effect on the clinical course of poisoning and allowed for a favorable outcome of acute exogenous psychosis.Приведено наблюдение делириозного синдрома на фоне острого отравления у пациента 29 лет, систематически употреблявшего 1,4-бутандиол. Психопатологическая симптоматика развилась в токсикогенной фазе и продолжила нарастать в течение первых суток с последующей трансформацией в мусситирующий делирий и токсическую нефропатию. Проведенное лечение, включавшее инфузионно-детоксикационную терапию, коррекцию нарушений кислотно-основного состояния и гипоксических расстройств с применением цитофлавина, оказало положительное влияние на клиническое течение заболевания, что позволило обеспечить благоприятный исход острого экзогенного психоза.

A case of favourable outcome of the treatment of extremely severe acute poisoning after prolonged exposure to lethal doses of methanol is reported. The complex treatment included urgent and effective elimination of the poison (multiple gastric lavage, hemodialysis), antidote therapy (administration of ethanol), correction of decompensated metabolic acidosis (alkali therapy and infusion therapy with reamberin). These measures had beneficial effect on the clinical course of poisoning and ensured its favourable outcome.

The effect of cytoflavin upon bolus intravenous administration on the state of hemodynamic values and liquid sectors of the organism was studied in patients with toxicohypoxic encephalopathy caused by heavy acute poisoning. It is established that the bolus administration of cytoflavin is less effective than dropwise intravenous injection.

A total of 103 patients with acute alcoholic intoxication were examined and treated for alcohol-induced hepatic lesions. It was shown that remaxol reduced severity of metabolic disorders associated with hypoxic conditions and active lipid peroxidation and thereby decreased the frequency of alcoholic delirium to 10.8% (n=7) compared with ademetionine (10.8%, n=22). Improvement of metabolism resulted in the reduction of stay in the intensive therapy ward by 5.6+/-0.3 and 7.3+/-0.6 days after remaxol and ademetionine therapy respectively). The total duration of treatment decreased by 9.0+/-0.4 and 11.8+/-1.1 days. The use of remaxol reduced the cost of the treatment by 21.7% compared with ademetionine.

We studied the development of metabolic disorders related to tissue hypoxia in 54 patients with acute severe asaleptin intoxication complicated by acute respiratory insfficiency of mixed genesis. We also estimated the role of a substrate antihypoxant cytoflavin in the correction of these disorders and clinical features of acute intoxication. Cyroflavin was shown to accelerate normalization of metabolic disorders which in turn improves clinical symptoms of severe forms of acute asaleptin intoxication.

The article deals with the materials, which have been received in the process of the examination and treatment of 48 patients with acute severe carbon monoxide and burning products poisonings on fires. It has been registered that the including of citoflavin into the complex program of the intensive therapy of acute severe carbon monoxide and burning products poisonings on fires leads to a decrease of hypoxia and manifestations of acute toxicohypoxic cerebral deficiency, which significantly improves the clinics of acute severe poisonings.

The aim of this work was to test the usage of infusion of hepatoprotector "remaxol" in intensive therapy of acute ethanol poisoning accompanied with severe alcohol affections of the lever. In the result of the examination and treatment of 130 patients it was established that severe alcohol poisonings registered on alcohol abused patients with toxic hepatopathy, are always accompanied with serious metabolic violations. In the process of a comparative valuation of the using of heptral (ademethionin) and remaxol in the intensive therapy of alcohol poisonings it has been revealed that the using of remaxol led to improvement of the clinic of that poisonings, what had been registered as a decrease of frequency and duration of an alcohol delirium from 33,9% to 10,8%, a decrease of frequency of secondary lung complication from 18,5 to 3,1%, a decrease of a duration of treatment in intensive care unit from 7,3 +/- 0,6 to 5,6 +/- 0,3 and a hospital treatment duration from 11,8 +/- 0,5 to 9,0 +/- 0,3 days. Biochemical investigation has shown that using as heptral, as remaxol led to improvement of lever damages due to alcohol. However remaxol compared with heptral was better in the treatment of metabolic violations.

The efficiency of using remaxol and ademethionine in the therapy of patients with heavy acute alcohol intoxication on the background of toxic liver damage has been studied. The administration of remaxol led to improvement of the clinical treatment of alcohol intoxication, which is manifested by a decrease in the rate and duration of delirium tremens (from 33.9 to 10.8%), frequency of secondary lung disorders (from 18.5 to 3.1%), duration of stay in hospital (from 7.3 +/- 0.6 to 5.6 +/- 0.3 days), and total therapy duration (from 11.8 +/- 1.05 to 5.6 +/- 0.3 days). The results of biochemical investigations confirmed that remaxol and ademethionine provide effective treatment of the toxic liver damage. Remaxol decreases the degree of metabolic disorders to a greater extent than does ademethionine.

A total of 60 patients suffering acute poisoning with a mixture of psychotropic drugs were available for observation. The study focused on comparative estimation of reintegration of psychic conditions (recovery of consciousness, conceptualization of mnestico-intellectual functions) in these patients. It was shown that intensive therapy of toxic and hypoxic brain lesions with antihypoxic agent cytoflavin results in rapid and effective reintegration of psychic activity including recovery of consciousness and conceptualization of mnestico-intellectual functions.

The examination of 130 patients with an alcohol abused syndrome and a severe ethanol poison have revealed that ethanol action are accompanied by significant metabolic disturbances. The comparative evaluation of the inclusion of heptral and remaxol in the treatment has shown that remaxol improves the clinical course of mentioned disorders decreasing the frequency and duration of alcohol delirium. Patients treated with this drug spent less time in acute care and their treatment duration was shorter. Remaxol reduces more effectively the severity of metabolic disorders.

As a result of survey in process of treatment of 100 patients with severe acute poisoning of ethanol on the background of the toxic damage of the liver set that the severity of poisoning depends on the duration abuse of alcohol (Binge drinking). Inclusion in the intensive care infusion hepatoprotector remaxol compared with ademetionine leads to a faster dynamics of improvement of the patients condition, evaluated by the scale assessing the severity APACHE II. Also found, Use of remaxol can reduce development of complications such is alcoholic delirium on the background of long-term abuse of alcohol in percentage from 31.9% to 16%, as well as reduces the time of stay of patients in the departments of the resuscitation and intensive care unit from 7,3±0,6 to 5,6±0,3 days and duration of treatment of patients in the hospital from 11,8±1,1 to 9,0±0,4 days.

The article deals with the materials, which have been received in the process of the examination and treatment of 44 patients with acute severe methadone poisonings. It has been revealed, that gravity of these patient's condition depends on intensity of hypoxia due to breath deficiency because of the methadone. The development of hypoxia, in its turn, cause violations of antiradical protection system and intensification of processes of peroxide lipid oxidation. It has been registered that the including of reamberin into the complex program of the intensive therapy of acute severe methadone poisonings lead to a more rapid restoration of antiradical protection system and to a decrease of activity of processes of peroxide lipid oxidation. The correction of hypoxia and free-radical violations led to improvement of the acute poisonings clinic, what had been characterized by a decrease of coma-period duration, duration of treatment with artificial lung ventilation, a decrease of secondary lung complications and a decrease of lethality.

This article deals with materials, which have been received in the process of an examination and treatment of 69 patients with acute severe azaleptin (leponeks) poisonings. On the base of clinic data the special features of clinic of acute severe azaleptin (leponeks) poisonings has been shown. It has been registered that the using of substrate antihypoxant reamberin in the intensive therapy of severe forms of acute azaleptin (leponeks) poisonings led to significant improvement of clinic manifestations, such as a coma period duration, a duration of artificial lung ventilation, a period of holinolitic psychiatric violations and a decrease of lethal poisonings.

Based on investigation of a group of patients with heavy forms of sharp poisoning by neurotropic substances, it is established that inclusion if antihypoxant reamberin in intensive treatment of toxicohypoxic encephalopathy leads to a decrease in the depth of central nervous system depression. This is manifested by reduced duration of patient stay in coma and decreased total duration of resuscitation treatment. Improvement of the clinical picture is accompanied by a decrease in lipid peroxidation activity, increase in the level of antioxidant enzymes, and decrease in the level of NR2A auto-antibodies. That is objective evidence of the efficiency of neuroprotective therapy by reamberin.

The obtained materials were received in the process of examination and treatment of 134 patients in the early phase of severe acute poisoning with the development of opiate toxicohypoxic encephalopathy using a corrector of tissue metabolism Cytoflavinum. Positive clinical results were achieved: reduction of length of stay of patients in a comatose state, reduction of incidence of pulmonary complications and mortality. The results of immunological studies have established immunomodulatory effects of cytoflavinum in patients with severe acute poisoning opiates. These biochemical studies have shown that the effects cytoflavinum realized largely due to its ability correct the effects of tissue hypoxia.

The examination and treatment of 64 patients have shown that inclusion of complex antioxidant cytoflavin in intensive therapy at the postoperative period of diffuse peritonitis allows the hypoxia degree to be decreased that in its turn results in quicker recovery of the antioxidant system and decreased activity of peroxidation and endotoxicosis level. The clinical course of the postoperative period of diffuse peritonitis with cytoflavin included in intensive therapy is characterized by shorter terms of artificial lung ventilation, shorter time of staying in critical condition, more favorable course of complications.

Examination and treatment of 262 patients with severe acute intoxication by neurotropic poisons and unaffected oxygen delivery system showed that inclusion of cytoflavin in combined neurometabolic therapy of acute cerebral insufficiency significantly reduced severity of metabolic disorders. Specifically, tissue hypoxy, endotoxicosis, lipid peroxidation activity, and immunosuppression decreased while antioxidative protection and clinical picture were improved. Duration of comatose state and artificial lung ventilation was reduced from 64.5 +/- 15.1 to 28.8 +/- 10.2 hours and that of critical condition from 117.2 +/- 17.2 to 63.7 +/- 9.2 hours. Overall lethality dropped from 16 to 9.9%.

Examination and treatment of 66 patients severely intoxicated with neurotropic poisons showed that inclusion of reamberin in combined therapy decreased the degree of tissue hypoxia as apparent from increased oxygen consumption, oxygen utilization index, and arteriovenous oxygen difference. This in turn accelerated recovery of antioxidant protection and lowered activity of lipid peroxidation. The use of reamberin for the treatment of acute neurotropic intoxication improves clinical conditions of the patients by decreasing duration of the comatose state, requirement for intensive therapy, and lethality.

Results of the evaluation of clinical findings in a group of 36 patients with acute myocardial infarction (AMI) complicated by acute heart failure (AHF) of class II - IV [according to T. Killip and J. Kimball (1967)] show that the use of cytoflavin and perftoran favors a decrease in the patient critical situation length, duration of patient's stay in hospital, and lethality level. It is established that these drugs lead to a decrease in the depth of hypoxia and lipid peroxidation in tissues, improves oxygen utilization, and restores antioxidant system activity in AMI/AHF patients.

Examination of 784 patients with acute intoxication with neurotropic agents yielded criteria for a risk of acute lung injury in this pathology and methods for diagnosing and treating this complication.

The paper presents the results of examination and treatment of 147 patients in the early phase of severe acute intoxications with neurotropic poisons. The use of the methods of assessing the bioelectrical activity of the brain has been found to objectively evaluate the degree of CNS suppression, to clarify the nature of the damaging action of a toxic agent, and to evaluate the efficiency of therapy. The use of cytoflavin in intensive care for cerebral hypoxic lesions has been shown to substantially decrease the degree of brain lesions.