1st Degree Research Articles

Efficacy of manual correction of cervical spine osteochondrosis in the treatment of arterial hypertension syndrome and prediabetes

To evaluate the therapeutic effect of non-pharmacological methods of restoring brainstem blood supply in patients with AH and prediabetes. The number of patients equal 125 (57 men and 68 women, mean age 63.3±11.5 and 65.4±11.8 y.o., respectively) with prediabetes and 1st degree of AH without target organs damage, among whom 102 patients with prehypertension or 1st degree of hypertension and 24 ones with 2nd degree of hypertension, were examined. The original method of manually restoring brainstem blood supply developed in the Shishonin's Clinic was applied to all patients. The control group included patients with the same disorder, who did not receive manipulations. Blood pressure (BP) measurement, ultrasound and triplex ultrasonography of vertebral arteries, biochemical blood test, and estimation of glycemia and glycated hemoglobin were performed. All patients of the study group had decreased levels of systolic BP (by 23.8±10.7 mm Hg for men and 32.8±11.9 mm Hg for women), an increase of flow velocity in vertebral arteries (by 20.6±7.5 and 21.5±7.2 cm/s, respectively), a decrease of glycated hemoglobin concentration (by 0.32±0.51 and 0.34±0.41%, respectively). In the comparison group, there were no patients with improvement in these indicators. The effectiveness of the author's manual method of cervical spine osteochondrosis correction in the reduction of BP and glycemia levels in the early stages of the disease is shown.

Effects of ketamine, propofol and isoflurane on electrocardiographic variables in clinically healthy dogs premedicated with medetomidine and midazolam.

The purpose of this study was to investigate the effects of three anesthetic agents, with premedication of medetomidine and midazolam, on electrocardiographic variables in dogs. Ten adult mixed breed dogs were used in a crossover design study, where they received ketamine, propofol and isoflurane treatments with a one-week washout period between them. In all three groups, medetomidine was administered first followed by midazolam after 15 min. Then, after 20 min, group 1 received ketamine intravenously (IV), group 2 received propofol (IV), and group 3 received isoflurane (inhalation). In all dogs, electrocardiographs were taken before and after premedication's, as well as every 15 min during anesthesia. Medetomidine significantly decreased heart rate and P wave amplitude and increased PR interval, R wave amplitude, QT interval, and T wave amplitude. Midazolam increased the amplitude of the R and T waves. Ketamine increased the heart rate and PR interval. Propofol increased the heart rate for up to 15 min, decreased the PR interval for up to 30 min, and the QT interval for up to 45 min. Isoflurane increased the heart rate and decreased the amplitude of R and T waves. The results showed that the drugs used in this study did not have many side effects on electrocardiographic variables and could be used without serious concern. The most important side effects observed were a severe reduction in heart rate and 1st degree atrioventricular (AV) block and, to a lesser extent, 2nd degree AV block caused by medetomidine and midazolam which were masked by the anesthetics.

Possibilities of bioregulation therapy in the treatment of patients with chronic tonsillitis

Background. There are numerous diagnostic methods and therapy regimens for chronic tonsillitis (CT). Different methods of treatment in certain conditions do not always show high efficiency, so the search for new ways of conservative management of CT is needed, the main task of which is palatine tonsils preservation.Objective: to evaluate the efficacy and tolerability of a multicomponent preparation with low dosage of active substances Lymphomyosot® in adult patients with CT and cervical lymphadenopathy in real clinical practice.Material and methods. A total of 170 male and female patients aged 18–65 years with CT (simple form and 1st degree toxic-allergic form) and cervical lymphadenopathy were included in an observational, open, prospective study. In the main group (n=85), a combined therapy consisting of standard CT therapy (a course of palatine tonsils lavage with 0.9% NaCl solution) with the addition of Lymphomyosot® was administered. In the control group (n=85), topical non-steroidal anti-inflammatory drugs or phytotherapy were used instead of the studied drug. Ultrasound examination of regional cervical lymph nodes with measuring of their diameter (longitudinal, transverse) was chosen as a parameter of objective assessment of patients' condition dynamics. The results of therapy at Visit 1 and Visit 2 (12±2 days after Visit 1) were compared. The effectiveness of treatment regimens was analyzed according to the following parameters: complaints related to CT; oropharyngoscopic data; evaluation of CT indicators by the doctor and the patients; dynamics of cervical regional lymph nodes size; satisfaction of the doctor and the patients with the clinical effect and tolerability of therapy.Results. The dynamic observation showed a significant decrease in the number of complaints and symptoms according to objective examination, oropharyngoscopy, as well as evaluation of symptoms by the doctor and the patients at Visit 2 in both groups (p<0.001). However, in the main group, where Lymphomyosot® was administered in the complex treatment, there was a more significant decrease in cervical lymph nodes size compared to the control group (p<0.01).Conclusion. The study demonstrated that Lymphomyosot® increased the efficacy of complex therapy, reducing cervical lymphoadenopathy and other manifestations of the disease in patients with CT (simple and 1st degree toxic-allergic forms).

The effect of a physical therapy programme on the condition of upper limb muscles in patients with rheumatoid arthritis

Introduction and aim. Rheumatoid arthritis is a chronic progressive systemic disease of the connective tissue affecting the joints, mainly small, of the erosive-destructive polyarthritis type, and frequent systemic inflammatory damage to internal organs. The purpose of the research is to evaluate the effectiveness of physical therapy on the muscles of upper limbs in patients with rheumatoid arthritis by the dynamics of muscle strength and strength index. Material and methods. To determine the strength of the muscles of the affected upper limbs were used dynamometry, calculated strength index as a percentage to assess the functional ability of the affected limb. All patients were divided into control (n=92) and main (n=96) groups, taking into account the functional insufficiency of the joints. Results. After 6 months of physical therapy, muscle strength indicators in the main group of patients with 1st degree of functional joints insufficiency (FJI) in the affected right limb increased by 3.1 kg, in the left by 3 kg; with 2nd degree FJI – in the right limb by 4.2 kg, in the left – by 3.7 kg, significantly exceeded the same indicators in patients of the control group (р<0.05). Similarly, there was an increase in the strength index in the patients of the main group. Conclusion. Physical therapy technology has been developed and implemented effectively influenced the increase in muscle strength and strength index of affected upper limbs of the main group of patients with rheumatoid arthritis.

THE TYPICAL STATE MEDALS AND REWARDS AS AN OPTION OF ENCOURAGEMENT OF ODESA CITY MAYORS IN THE CITY SELF- GOVERNMENT STRUCTURE WITHIN THE PERIOD FROM THE SECOND HALF OF THE 19TH CENTURY TO THE BEGINNING OF THE 20TH CENTURY

The article considers one of the possible characteristics for encouraging the activity of historical figures in the professional field as awards and honors. Preference was given primarily to the state award system, which extended to various sectors of the population, including professional groups – elected positions of city mayors. In the second half of the 19th – at the beginning of the 20th century the municipal self-government of Odesa was headed by nine people – Semen Vorontsov, Mykola Novoselskyi, Grigory Marazli (Grigorios Maraslis), Valerian Ligin, Petro Kryzhanovskyi, Pavlo Zelenyi, Vasyl Protopopov, Mykola Moiseyev and Borys Pelikan. On the basis of the collected sources and the works of researchers, a list of the most typical state orders among the figures of city heads with a chronological reference and brief generalizations regarding the conditions of awarding was revealed. With the beginning of the creation of the post of city mayor, the duties performed did not provide for a normalized and regular financial reward, which is one of the motivating elements in the work process of a person. Awards were one of the options for encoura- gement – thanks from the government, provincial administration, national awards, distinctions, etc. According to the City Regulation of 1870, to represent the power and status of the mayor, was introduced a badge with the image of the city coat of arms on a large silver chain, with the right to the 5th category uniform of the Ministry of Internal Affairs to the heads of provincial cities and cities that were equated to them. Over the years of their life and various activities, Odessa mayors could receive many awards and distinctions that affected their status and position. Among the typical national awards, the following three orders were identified: St. Volodymyr (2nd and 3rd degrees), St. Anna (1st, 2nd and 3rd degrees) and St. Stanislav (1st degree). During the years of activity in the post of mayor, only five people received orders – M. Novoselskyi, G. Marazli, V. Ligin, M. Moiseyev and B. Pelikan. P. Zelenyi worked for a long time in self-governing institutions at the zemstvo level. P. Kryzhanovskyi and V. Protopopov are known for their professional judicial career, which contributed to receiving orders. The first mayor of the post-reform period, S. Vorontsov, was a military man, and he won his main awards on the battlefield.

The Role of Bioimpedance Analysis of Body Composition in the Diagnosis of Metabolic Disorders in Patients with Obesity of the 1st Degree

Obesity and overweight have become common phenomena in today’s realities. The degree of obesity only allows to determine the presence of excessive body weight, but does not assess the real state of the problem. An excess of visceral adipose tissue is the main risk factor for the development of metabolic disorders and dysfunction of all human organs and systems. The mechanism of development of obesity and insulin resistance attracts the greatest attention of doctors. The objective: to study the influence of the percentage of visceral fat on the state of metabolic indicators in patients with obesity of the 1st degree. Materials and methods. The study included 70 patients (44 women and 26 men) with a body mass index (BMI) 30–35 kg/m2. The average age of the study participants was 47.1±1.65 years old. The degree of obesity, body fat mass, percentage of fat in the body, metabolic age, indicators of visceral obesity were determined using bioelectrical resistance analysis technology. Fasting plasma glucose (FPG), total cholesterol, low-density lipoprotein cholesterol (LDL-C) were determined in all patients. Descriptive statistics were conducted to obtain demographic data. Results. A positive relationship was determined between the level of visceral obesity and BMI, slowing down of the general metabolism, and increasing the metabolic age of patients. A positive relationship between metabolic age and FPG was also registered (CI 95%) = 1.70(0.33/3.07), p=0.01; between age difference and LDL-C level (CI 95%) = 1.12 (0.36/3.88), p=0.02. Conclusions. Obesity is a serious disease that requires great attention and a special treatment approach. Assessing the level of visceral adiposity and metabolic age provides more useful information for physicians to find new approaches to obesity treatment.

STUDY OF RISK FACTORS FOR CARDIOVASCULAR DISEASES AND CENTRAL HEMODYNAMICS IN SENIOR STUDENTS

HighlightsThe article examines the prevalence of risk factors for cardiovascular diseases (CVD) and the state of central hemodynamics (CHD) in senior students. Aim. To study the risk factors for CHD and CVD in senior students with the aim of early detection of arterial hypertension (AH) and the implementation of therapeutic and prophylactic measures.Methods. The study involved 223 senior students of medical universities in Moscow aged 20-27 years (the mean age was 22.8±0.17 years). The following cardiovascular risk factors were assessed for each student: age, gender, smoking, physical activity, genetic predispositions; body mass index. The indicators of CHD were studied by volumetric compression oscillometry using a portable automated software-hardware complex for non-invasive research of central hemodynamics (“SHCNIR CHD vco-“Globus” device).Results. The presence of CVD risk factors in senior students was revealed in 52.5% of cases; more than two risk factors were found in 19.3% of cases; 1st degree arterial hypertension (AH) in 11.2% of cases; “white coat hypertension” in 10.8% of cases; genetic predisposition to CVD in 30.0% of cases; overweight in 17.0% of cases; obesity in 5.4% of cases; low physical activity in 23.8% of cases; smoking in 16.1% of cases. An altered CHD profile was found in 62.1% of students. An increase in total peripheral vascular resistance at normal blood pressure levels was noted in 31.8% of cases. Indicators of total peripheral vascular resistance, mean blood pressure, systolic and diastolic blood pressure were significantly higher in the group of students with CHD risk factors.Conclusion. Outpatient follow-up groups should include students with established risk factors for cardiovascular diseases, diagnosed AH, and with altered indicators of CHD. Preventive examinations should include a simple method for studying hemodynamics – compression oscillometry.

Advantages of using ultrasound diagnostic methods in the practice of an anesthesiologist on the example of neurosurgical interventions in the sitting position in pediatric patients with brain tumors

The purpose of the publication is to improve the results of treatment of children with brain tumors with the help of high-quality monitoring during neurosurgical operations with the localization of pathological formations that require the patient to be in a sitting position; encourage anesthesiologists to acquire the necessary additional skills in ultrasound diagnostics.For the description of the clinical case, the authors obtained the written informed consent of patients No. 1 and No. 2 to use the materials of his medical history in the article, in accordance with the Ethical Standards of Legal Regulation of Relations.Two clinical cases of anesthesiological management of patients with neurooncopathology (neoplasm of the left cerebellar peduncle with prolapse in the IV ventricle area and volume formation of the pineal area) operated on in the sitting position with standard monitoring (pulse oximetry, electrocardiography, non-invasive measurement of arterial blood pressure, thermometry, capnography, other gas analyzer), supplemented by invasive measurement of central venous pressure, bispectral index (BIS) monitoring, neurophysiological parameters, transesophageal echocardiography (the sensor is selected according to the patient's age). Clinical, laboratory, biochemical, ultrasound, endoscopic, x-ray methods, computer and magnetic resonance imaging were used to establish a diagnosis, determine the nature of complications, choose access and methods of surgical intervention, evaluate the effectiveness of treatment and diagnostics.The sitting position during surgery is the neurosurgeon’s choice because this position improves access to the tumor, reduces the volume of blood loss and intracranial pressure, but increases the risk of intraoperative complications, in particular, air embolism, which was diagnosed by echocardiography. The National Children’s Specialized Hospital «Okhmatdyt» has the necessary equipment (in particular, a neurosurgical chair) for performing neurosurgical interventions in a sitting position. During the surgical intervention, in one clinical case, an air embolism of the 2nd degree according to the Tubingen scale was recorded, without other changes according to the measurement of arterial and central venous pressure, BIS and neurophysiological monitoring. In the second case, an air embolism of the 1st degree was recorded. Both patients were extubated on the operating table at the end of the operation and were observed during the day in the intensive care unit. The early postoperative period was uneventful. According to the control magnetic resonance imaging, postoperative moderate pneumocephalus developed, which did not require repeated surgical intervention. During the operation, monitoring was carried out using pulse oximetry and electrocardiography.This article does not aim to review the specific indications for transesophageal echocardiography or a comprehensive description of all complications that can be visualized using this method during operative neurosurgical interventions. This article presents two cases that demonstrate the success of using this method by an anesthesiologist. According to the authors, it is advisable to introduce the use of ultrasound methods into the daily practice of an anesthesiologist.High-quality monitoring is important for early detection and prevention of complications. Thanks to the professionalism and expanded arsenal of practical skills of the team of doctors of the NCSH «Okhmatdit», in particular, anesthesiologists, in both cases, high-tech medical care was provided with a good prognosis for the future life of these patients.

PATHOGENETIC SIGNIFICANCE OF THE CHARACTER OF WOMAN’S UROGENITAL INFECTION IN THE DEVELOPMENT OF ADENOMYOSIS

Adenomyosis is one of the important problems of modern gynecology, which leads to impaired reproductive function, reduced work capacity and quality of life of women. The prevalence of endometriosis in the female population ranges from 20-55% in patients of reproductive age. An important role in the occurrence and development of adenomyosis is played by genetic predisposition, hormonal changes and the influence of immunological factors. Of great interest is a new concept regarding the significant role of bacterial contamination of the genital tract in patients with adenomyosis. The study of the influence of microorganisms on the mechanisms of activation of the inflammatory reaction associated with the progression of endometrioid lesions is relevant and requires the search for new approaches to diagnosis and treatment of the disease.
 The purpose of the work is to study the influence of the woman’s urogenital infection in the development of adenomyosis.
 Materials and methods. 85 patients with 1st and 2nd degree adenomyosis and 30 healthy fertile women were examined. The average age of the examined was 27.3±1.6 years. A comprehensive clinical examination, ultrasound, colposcopic, hysteroscopic studies were conducted. Microbial flora analysis included bacterioscopic, bacteriological research methods with determination of sensitivity to antibiotics, and PCR method. The concentration of cytokines in the culture medium (supernatant) was determined by the enzyme immunoassay. Statistical data processing was performed using the Statsoft Statistica v6.0 and Microsoft Excel 97 software packages.
 Results. In the structure of gynecological diseases, 95.6% of patients with adenomyosis had inflammatory diseases of female genital organs, chronic herpes and cytomegalovirus infection was found in almost 93%. In women with adenomyosis, the II-III stage of vaginal cleanliness prevails with an “intermediate” type of biocenosis, which is characterized by a reduced content of lactobacilli, the presence of various types of morphotypes of gram-positive and gram-negative rods and cocci, and dysbiosis (49.4%), when a mixed bacterial flora prevails microflora, a high percentage of the combination of adenomyosis with chronic inflammatory diseases of the pelvic organs justifies the need to use antimicrobial therapy in this category of patients. When studying the cytokine profile of the cervical contents and endometrium, an increase in the concentration of the main proinflammatory cytokines IL-1β, IL-6, TNFα and a factor with chemotoxic properties IL-8 was found. The obtained data indicate that the development of adenomyosis is facilitated by a previous immuneinflammatory reaction, which is accompanied by a violation of the local cytokine balance.
 Conclusions. Microbiological examination of patients with adenomyosis revealed a violation of the microbial landscape of the reproductive tract in most of the examined. The obtained data indicate a high percentage of the combination of adenomyosis with chronic inflammatory diseases of the pelvic reproductive organs. Previous adenomyosis is an immunoinflammatory reaction, accompanied by a violation of the local cytokine balance. Increased cytokine activity and the presence of infectious agents are associated with the spread of adenomyosis.

Identification of factors associated with the management of childhood obesity: Results from a French pediatric cohort study

BackgroundsChildhood obesity is a real public health concern because of its association with a higher risk of adulthood obesity and comorbidities (metabolic, cardiovascular, etc.). The factors associated with the effectiveness of care are poorly described. The objective of this study was to identify factors associated with body mass index (BMI) variation in the management of childhood obesity. Material and MethodsChildren followed up for obesity in the Pediatric Endocrinology Department of the University Children Hospital of Nancy were included. Data were retrospectively collected in medical files. The characteristics of patients with a decrease in BMI (in standard deviation score, SDS) were compared with patients with an increased BMI (SDS)after 1 year of follow-up through univariate analysis. ResultsOverall, 141 patients were included, and for 107 patients (55 girls and 52 boys) there were 1-year follow-up data. The mean BMI variation after 1 year of follow-up was−0.068 SD and for 63 patients (58.9%) there was a decrease in BMI SDS. Female patients (66% vs. 41%, p=0.012), hypercholesterolemia (33% vs. 4%, p=0.049), and type 1 diabetes (14% vs. 2%, p=0.019) were more frequent in patients with an unfavorable evolution of BMI SDS at 1 year. A family history of bariatric surgery (36% vs. 11%, p=0.042) or eating behavior disorders (76% vs. 24% of patients; p<0.001) or diabetes (1st or 2nd degree;81% vs. 60%, p=0.044) were also more frequent in children with an unfavorable evolution of BMI SDS at 1 year. ConclusionSeveral negative factors in the evolution of BMI were identified such as female sex, hypercholesterolemia, family history of bariatric surgery, or eating behavior. Early identification of these patients at risk of failure of obesity management is important to control BMI during childhood.

Assessment of body resonse on integral health indicators in seafarers at sea: cohort study

OBJECTIVE. To assess the influence of sea habitat conditions on a vessel on military seamen’s health according to integral health indicators using a computer program.&#x0D; MATERIALS AND METHODS. Before going to sea and after returning to the base there were measurements of weight and body length, chest circumference, lung capacity, leading hand strength, heart rate, systolic and diastolic pressure at rest, after the load and recovery period (Martinet test) as well as blood lymphocyte content. Physical development, nutritional status, index of functional changes, the state of general non-specific adaptive response and cognitive body functions were defined; integral health assessment was held using computer programs.&#x0D; RERESULTS. Initially 66,7% had increased nutrition, after returning – 62,0%; normal status - 37,0% and 40,7%, excessive nutrition – 48,1% and 44,4%, obesity of 1st degree – 11,1% and obesity of 2nd degree – 3,7%. The proportion of seafarers with physical development above average decreased by 18,5%, adaptive response - by 7,1% (р=0,001) and body functionality - by 11,5% (р=0,006). Cognitive mental functions did not change. Standard of health decreased by 16,7% (р=0,001).&#x0D; DISCUSSION. There was confirmed negative impact of living conditions on seafarers’ health. Somatometric and physiometric indices showed negative tendencies in physical development and functionality, nonspecific adaptive body response. Stress test revealed the deterioration of aerobic capacity.&#x0D; CONCLUSION. The use of algorithm for assessing morphofunctional indicators, cognitive functions and lymphocyte content with computer processing of the results allows to evaluate the health in professional activities of seafarers.

CINCA Syndrome: about a Series of 5 Cases

CINCA is a chronic auto-inflammatory syndrome of childhood characterized by a combination of skin, joint and neurological involvement, including sensory organs, due to a mutation in the NLRP3 gene responsible for uncontrolled activation of innate immunity. Our objective is to establish the epidemiological, clinical, genetic, therapeutic and evolutionary characteristics of the CINCA syndrome. Materials &amp; Methods: Retrospective analysis spread over 16 years (2000 to 2016) of 05 cases of CINCA syndrome, followed up at the pediatric rheumatology department and consultation at the Rabat children's hospital. Results: There were 03 boys and 02 girls, the mean age at diagnosis was 2 years and 02 months. 01 patient was from consanguineous parents (1st degree). Clinical signs were recurrent fever in all patients, osteoarticular involvement in 80% with patellar hypertrophy in 01 patient, skin involvement in 80%, neurological involvement in 60%, no sensory involvement, dysmorphic facies in 60% of cases, and staturo-ponderal retardation in 60%. None of the patients had renal amyloidosis. Biological tests revealed an inflammatory syndrome in all our patients, and joint radiographs showed a modelling disorder of the lower femoral metaphyses associated with osteoporosis in one patient, and epiphyseal remodelling with irregular ossification of the patellae in another. A genetic study was carried out in only 01 cases, revealing a mutation in the CIAS 1 gene. Biotherapy was not used in view of the clinical and biological improvement with NSAIDs and/or corticosteroids. CINCA syndrome is rare but can be serious and often goes unrecognized. Diagnostic and therapeutic management must be rapid in order to avoid serious complications, particularly ocular and renal, and to improve vital and functional prognosis.

Cardiovascular disease screening in homeless individuals-a feasibility study

Abstract Background The risk and burden of cardiovascular disease (CVD) are higher in homeless than in housed individuals, yet population-level CVD screening largely excludes homeless individuals. Purpose (i)To investigate feasibility of dedicated mobile CVD screening for homeless individuals; and (ii)To estimate prevalence of risk factors and burden of CVD Methods With patients, health professionals and researchers, we co-developed and implemented a 15-minute CVD assessment for homeless individuals as an add-on service to the Find&amp;Treat service (a peer-led, multi-disciplinary outreach team across London) during scheduled, routine visits to homeless hostels. We included a questionnaire (demographic, past medical history and symptom data) as well as clinical assessment (blood pressure, ABPI, cholesterol, HDL, HDL ratio, glucose, HbA1c and mobile ECG to detect atrial fibrillation, AF). Results Among 656 individuals screened in 75 routine visits between May 2019 and January 2023, we recruited 524 (79.9%) individuals. Mean age was 47 (SD 13.1) years (range 18-87). Male gender (79%) and white ethnicity (55%) were more common. Current or previous smoking (79%), previous CVD (stroke, myocardial infarction, or peripheral arterial disease) (15%) and family history of heart attack in a 1st degree relative&amp;lt;60 years (27%) were common. Although only 2% reported previously diagnosed hypercholesterolaemia, 24% of screened individuals had total cholesterol&amp;gt;5.0 mmol/L. Prevalence of AF was high, particularly among those aged 18-30 (7/57, 12.3%). Asian and British Asian individuals had highest prevalence of raised HbA1C levels (&amp;gt;6%) (8/33, 24.2%), compared to black and black British (22/120, 18.3%) and white (15/283, 5.3%) individuals. Among individuals aged 25 – 84 with no previous CVD, one third had a 10-year QRISK score of ≥10% (120/362, 33.1%), consistent across different ethnic groups: white (75/233, 32.2%), black (24/77, 31.2%) and Asian (6/17, 35.3%). Conclusions A simple, pragmatic CVD assessment for homeless individuals was feasible and acceptable, and identified gaps in diagnosis and prevention. There is a high burden of CVD risk factors and CVD amongst homeless individuals, which could be addressed by integration of CVD screening into existing inclusion health outreach frameworks.

Abstract 17127: Rapid Progression of Conduction System Disease in Suspected Fulminant Nivolumab Myocarditis

Background: Immune checkpoint inhibitors (ICI) have shown efficacy in treating a wide spectrum of malignancies, but have a known risk of cancer therapy related cardiac toxicity. We present a case that demonstrates how conduction system disease can rapidly progress in a patient with suspected nivolumab (PD1) induced fulminant myocarditis. Case: An 82-year-old male with a history of esophageal carcinoma presented with agonal breathing and altered mental status. He had received his second dose of PD1 therapy three days prior. He was intubated and admitted for hypoxic respiratory failure and elevated troponin. His initial EKG demonstrated new marked 1st degree AV block with right bundle branch block (RBBB) morphology. A stat echocardiogram noted an EF of 60-65% with no wall motion abnormalities. Decision-making: On Day 2, Mobitz Type I block was appreciated on telemetry. The patient met criteria for acute myocarditis with his clinical presentation, new conduction system disease, and high sensitivity troponin of 13,000. Given recent PD1 therapy, lack of infectious prodrome, and lack of prior heart disease, suspicion for ICI induced myocarditis was high. High dose steroid therapy was initiated. On Day 3, the patient was noted to have alternating left bundle branch block and RBBB. On Day 4, he progressed to complete heart block, prompting transvenous pacemaker (PM) placement with subsequent permanent PM placement. A repeat echo showed global hypokinesis with an EF of 40-45% and reduced RV function. He also required vasopressor support meeting criteria for fulminant myocarditis. Due to his hemodynamic instability and low clinical suspicion, he did not receive cardiac catheterization. Cardiac MRI and cardiac biopsy were not readily available in this institution. Conclusion: The clinical findings, lack of infectious prodrome, and worsening arrhythmia requiring pacing and vasopressor support, in patient with recent PD1 treatment suggests nivolumab induced fulminant myocarditis. In institutions without advanced testing infrastructure, rapid recognition of progressive conduction system disease may be used as an early marker for diagnosis, treatment initiation, and referral to tertiary care centers for advanced management of fulminant ICI myocarditis.

The association between postpartum perineal laceration with anatomy and pelvic floor muscle strength

Link of Video Abstract: https://youtu.be/lrnQiVZyH8Q Background: Perineal lacerations damage the tissues around the vagina and rectum and can cause disruption of the anatomy and function of the pelvic floor. The incidence of perineal lacerations after vaginal delivery ranges from 53-89%. This anatomical damage and muscle dysfunction can cause urinary incontinence, anal incontinence, and uterovaginal prolapse. This study aims to evaluate the effects of postpartum perineal lacerations on the anatomy and strength of the pelvic floor muscles. Methods: The sample of this study is primiparous women who experienced perineal lacerations. Sampling was carried out prospectively using the consecutive sampling method. Pelvic floor anatomy and strength were measured using a POP-Q system and a perineometer. The 1st and 2nd degree laceration group measurements will be compared using the chi-square, and Mann-Whitney tests will be carried out. Results: Of the 123 research samples that met the criteria, a significant difference was found in the strength of the pelvic floor muscles in the first-degree perineal laceration and second-degree perineal laceration groups at 1st day and 12 weeks postpartum (p = 0.000 and p = 0.042). The only significant difference found for pelvic floor muscle anatomy is in perineal body length at 12 weeks postpartum. Conclusion: The degree of perineal laceration is related to the strength of the pelvic floor muscles after delivery and the length of the perineal body 12 weeks postpartum.

Risk factors for premature rupture of membranes after twenty-eight complete weeks of gestation

Purpose: To identify the risk factors for premature rupture of membranes (PROM). Materiel and methods: This case-control study was carried out between 1st February and 31st July 2021. Files of women who delivered after having PROM or not were examined. The main variables recorded included maternal age and parity, familial, medical and obstetrical histories, the presence or not of nuchal cord at delivery, gestational age at delivery, birth weight and sex of newborn. Fisher exact test, t-test and logistic regression were used for comparison. P&lt;0.05 was considered statistically significant. Results: Our frequency of PROM was 6.2% (94/1524 births). PROM occurred mostly at or after 37 weeks gestation (77.6%). Significant risk factors for PROM were 1st degree family history of PROM (aOR 31.36, 95%CI 2.57-382.11), fetal weight ≥4000g (aOR 14.78, 95%CI 2.72-80.20), cord round neck (aOR 6.36, 95%CI 1.17-34.66), past history of preterm delivery (aOR 3.42, 95%CI 1.02-11.52) and parity 4 or 5 (aOR 3.27, 95%CI 1.25-8.56). Conclusion: Women with these risk factors should be well followed up during pregnancy, especially during the third trimester, to allow prevention, if not, early diagnosis of PROM

Expansion of the γδT cell population in peripheral blood: a response of immune system to the damage of gastrointestinal mucous membranes in older age groups

γδT cells are unique lymphocytes that take an intermediate position between the cells of innate and adaptive immunity. Even at the stage of differentiation in the thymus, they acquire the status of effectors with cytotoxic activity and become powerful cytokine producers. The antigen-recognizing receptor of γδT cells formed by γ and δ chains and is assigned an important role in activation of these cells in tissues: it recognizes infected and tumor cells by the presence of intracellular stress molecules. γδT cells are found in the blood and mucous membranes. Today, researchers’ attention is focused on two subpopulations of γδT cells: γδ1 and γδ2. The first is abundantly represented in the mucous membranes, the second forms the bulk (90%) of circulating γδT cells. The aim of this study was to assess the level of circulating γδT cells in patients of older age groups with proven pathologies affecting mucous surfaces at various segments of the digestive tract. We have recruited older patients from the Russian Gerontological Research and Clinical Center aged 60 to 90 years. The main group (n = 28) included patients with lesions of the gastric mucosa and duodenum with erosive ulcerative foci. The age-matched comparison group (n = 33) consisted of patients without gastrointestinal manifestations and did not have indications for gastroduodenoscopy. A separate group (n = 35) included patients with varying degrees of colon dysbiosis. The number of γδT cells in the blood was determined by two-color flow cytofluorometry using monoclonal antibodies. Presence of erosive and ulcerative foci in the mucous membranes of the stomach and duodenum was associated with increased numbers of circulating γδT cells population. An impaired function of intestinal barrier is considered a detrimental consequence of colon dysbiosis. Among patients with severe dysbiosis (3rd degree), the proportion of patients with a high content of γδT cells was significantly higher than among patients with the 1st (milder) degree of dysbiosis. Hence, the circulating population of γδT cells in the patients of the older age group responds by increased numbers to the damage (severity of damage) of the mucous membrane observed at different segments of digestive tract. The nonspecific nature of this response is obvious. Nevertheless, the expansion of this population in the circulating blood may be a sign of particular pathological process thus requiring further advanced diagnosis.

A Preoperative Evaluation Revealing a Rare Coagulation Factor Deficiency

Constitutional factor II deficiency is a rare coagulation disorder. The autosomal recessive form has an estimated prevalence of 1-2 million. Clinical symptoms depend on the rate of factor II deficiency. We report a fortuitous discovery of an isolated factor II deficiency in a 9-year-old girl of 1st degree consanguineous parents, following a preoperative assessment of drainage of her abundant pericardial effusion, the biological assessment showed a factor II rate &lt; 1%, a prothrombin rate at 3% and a TCA &gt; 120 sec, the dosage of the other coagulation factors are without anomalies. Through this observation we recall the rarity of this deficit and thought about it in the face of unusual bleeding in newborns of consanguineous parents, as well as the necessity of collaboration with international registries to establish codified diagnostic and therapeutic guidelines. Keywords: Factor II; Congenital Hemorrhagic Diseases; Rare Coagulation Factor Deficiency Abbreviations: FFP: Fresh Frozen Plasma

Psychophysiological Assessment of Individual Personality in Two Patients with Severe Local Radiation Injuries (LRI) of Hand and Acute Radiation Sickness (ARS) I Degree (30 Years of Follow-up)

Psychophysiological examination was carried out on two patients, former border guards, who suffered on October 05, 1982 as a result of accidental contact with a source of gamma radiation (137Cs) while on duty while serving on the Iranian-Azerbaijani border in the ranks of the Soviet army. They suffered ARS of the 1st degree with extremely uneven gamma irradiation in the form of local radiation injuries of the hands of varying severity. The assessment of the aver -age dose for the whole body according to the frequency of dicentrics in cultures of peripheral blood lymphocytes in patient No. 1 and patient No. 2 is the same and is 0,26 Gy. Psychophysiological research was carried out in dynamics in 2001-2013 using the automated software and methodological complex «Expert». According to the MMPI data, both victims have a hyperthymic type of psychophysiological adaptation with varying degrees of severity. Patient No. 2 is a chronically hyperthymic personality with a significant increase in the profile on the 9th scale and with its gradual increase in dynamics, which reflects the persistence of hyperthymic personality traits and causes an overstrain of mental adaptation, with an increase in the dynamics of the tendency to explain their difficulties and problems by somatic distress (1Hs). Patient No. 1 has a hyperthymic personality type with a moderate increase in profile dynamics on the ninth scale. A personality trait is indicated by a high, growing in dynamics, indicator on the K scale, which determines behavior depending on social approval and concern for one’s social status. The appearance in dynamics (2013) of a peak on scales 1 (preoccupation with the state of health) and 4 (emotional tension in direct behavior) determines the insufficient ability to internalize the social norm, i.e. insufficient ability to perceive this norm as part of one’s own settings (a combination of profile peaks on scales 4 and 9). The presence of profile peaks on the 7th scale and the scales of the neurotic triad reflect the tendency to various options for the implementation of antisocial attitudes in a socially acceptable way, the desire to appear in a favorable light (scale L). Sufficiently high intelligence and demonstrative behavior determine good adaptation to the environment with self-confidence, high social adaptability, and resilience in overcoming difficulties.

Ventricular pacing dependency after transcatheter aortic valve replacement: a prospective cohort.

Atrioventricular conduction disturbance occurs in a significant number of patients undergoing transcatheter aortic valve replacement (TAVR). However, not all cases are ventricular pacing-dependent. Thus, we aimed to study the incidence, predictors, and outcomes of new ventricular pacing dependency (VpDep) after TAVR. We prospectively analyzed 130 consecutive transfemoral TAVR cases performed in Ramathibodi Hospital between 2015 and 2020. Three patients with prior ventricular pacing-dependent on cardiac implantable electronic devices (CIEDs) were excluded. The endpoints were VpDep at 1 month and all-cause mortality at the follow-up period end in 2021. The effects of variables on VpDep and all-cause mortality were evaluated using multivariate binary logistic regression and Cox regression analyses, respectively. First-degree atrioventricular block (AVB) was considered severe when the PR interval was >300 ms. Of the 127 patients [mean age, 81.8 years; 62.2% females; 67.7% balloon-expandable (BE) device], 7 patients (5.5%) had CIEDs implanted before TAVR that were not ventricular pacing-dependent. TAVR was successfully performed in 126 (99.2%) patients. Periprocedural stroke, cardiac tamponade, and major bleeding occurred in 2 (1.6%), 4 (3.1%), and 4 (3.1%) patients, respectively. The VpDep incidence at 1 month was 7.9% (n=10) among all patients and 34.5% among those with CIEDs (n=29). VpDep was more likely to occur in patients with pre-existing right bundle branch block (RBBB) [odds ratio (OR), 21.38; 95% confidence interval (CI): 3.28-139.33; P=0.001] and severe 1st degree or Mobitz I AVB (OR, 14.79; 95% CI: 1.65-132.74; P=0.016). After a mean follow-up of 25.8 months [standard deviation (SD), 21.2 months], death from any cause occurred in 18 patients (14.2%). However, VpDep was not associated with an increased mortality. In this real-world cohort, pre-existing conduction abnormalities were significantly associated with a higher risk of VpDep. Mortality was similar between patients with and without VpDep.