Additional Examination Methods Research Articles

Functional constipation in children

Constipation is one of the most common nosologies that a pediatric gastroenterologist deals with during outpatient visits. In the vast majority of children with constipation the problem is functional in nature. According to studies published in the Russian Federation, the frequency of constipation in children accounts for about 25–30%. The joint clinical guidelines of the European and North American Societies of Pediatric Gastroenterologists, Hepatologists and Nutritionists for the management of children with functional constipation were published in 2014. The national guidelines for the diagnosis and treatment of functional constipation are based on these guidelines. According to the clinical guidelines, the 2006 Rome III criteria should be used to establish the diagnosis of functional constipation in children. In May 2016, the Rome IV criteria that provide separate diagnostic criteria for infants and children under 4 years of age and children over 4 years and teenagers were adopted. A group of children with symptoms of constipation, who have already had toilet skills at the time of diagnosis, was identified among infants and children under 4 years of age. The presence of anxiety symptoms or refractory constipation (constipation that does not resolve within 3 months while taking adequate therapy) is considered an indication for use of additional examination methods, including instrumental ones. The manifestation of constipation is often associated with a change in eating habits - the period of introduction of complementary feeding in infants or the beginning of going to a day-care centre, inadequate fluid intake. The onset of constipation often coincides with the period of the development of hygiene skills (potty training). The voluntary stool retention by a child who is trying to avoid painful defecation experiences is the main mechanism for the development of constipation. The aim of functional constipation treatment is to soften the stools, which facilitates painless defecation and ensure that there is an urge to defecate. Clinical examples of the treatment of patients with functional constipation and chronic colonic stasis, functional constipation and encopresis are provided. The outcome of the treatment of functional constipation is to ensure painless defecation and the development of a stable defecation reflex. The drug therapy for functional constipation is based on the use of laxatives. Dietary advice and behavioral therapy also play an important role.

АГЕНЕЗИЯ ДИАФРАГМЫ: ОПИСАНИЕ КЛИНИЧЕСКОГО СЛУЧАЯ И КРАТКИЙ ОБЗОР ЛИТЕРАТУРЫ

Objective: Agenesis of the diaphragm (AD) in adults is an extremely rare congenital malformation. To date, only a few descriptions of this pathology have been published in the scientific literature. The article presents a case of detection of a left-sided AD in a 25-year-old patient operated on for diaphragmatic relaxation. Additional examination methods, including echocardiography and ultrasonography of the abdominal organs and retroperitoneal space, did not reveal any other malformations in this patient. Due to the lack of plastic material of the appropriate size and type, plastic replacement of the diaphragm was postponed to the second stage of surgery. Keywords: Congenital malformations, anomalies of the diaphragm, aplasia of the diaphragm, agenesis of the diaphragm, agenesis of the diaphragm in adults, diaphragmatic hernia, plastic surgery of the diaphragm.

ДОБРОКАЧЕСТВЕННОЕ ПОЗИЦИОННОЕ ПАРОКСИЗМАЛЬНОЕ ГОЛОВОКРУЖЕНИЕ (ДППГ) – НАШ ОПЫТ В АМБУЛАТОРНОЙ ПРАКТИКЕ

The most common cause of vertigo is benign paroxysmal positional vertigo (BPPV), which accounts for 17 to 35% of all peripheral vestibular disorders. The main reason for the development of BPPV is otolithiasis, more often in the posterior semicircular canal. Of the 514 complaints of BPPV, 63.3% went to the otorhinolaryngologist. Among the patients, women predominated (77.2%). The structure of the disease was dominated by the lesion of the posterior semicircular canal (82.4%). According to the survey data, only 21.3% of otorhinolaryngologists performed diagnostic and therapeutic position tests and maneuvers in patients with recurrent systemic vertigo. Additional methods of examination of patients with BPPV were referred to by 31.3% of doctors. Another specialist (neurologist, otoneurologist) was referred by 32.2% of otrinolaryngologists.

Невропатические болевые синдромы у больных с рассеянным склерозом: патогенез, диагностика, тактика ведения пациентов

Neuropathic pain syndromes (NPS), pathogenetically associated with the demyelinating process in the central nervous system and patient maladjustment, are commonly found in patients with multiple sclerosis (MS). Primarily, the diagnosis of NPS is based on a careful analysis of clinical symptoms, while the MRI data and neurophysiological methods are of auxiliary importance. Difficulties in the NPS treatment are due to the patterns of pathogenetic mechanisms that determine the chronic nature of NPS, as well as limited efficacy and common adverse events of the drug therapy. The review examines modern views concerning the main variants of NPS in MS (persistent extremity pain, trigeminal neuralgia, Lhermitte’s sign, painful tonic spasms), describes the patterns of pathogenesis and clinical manifestations of each syndrome, provides data on the information value of additional examination methods, analyzes existing methods to conservative therapy based on the randomized trials data. Particular attention is paid to the following points in patient management with NPS: setting adequate treatment goals, choosing medications, using rational combined pharmacotherapy and non-drug treatment methods, increasing patients’ adherence to therapy. KEYWORDS: multiple sclerosis, neuropathic pain syndromes, persistent extremity pain, trigeminal neuralgia, Lhermitte’s sign, painful tonic spasms, treatment tactics of neuropathic pain. FOR CITATION: Kiselev D.V., Spirin N.N., Baranova N.S., Karpova M.S. Neuropathic pain syndromes in patients with multiple sclerosis: pathogenesis, diagnosis, patient management. Russian Medical Inquiry. 2022;6(10):556–562 (in Russ.). DOI: 10.32364/2587-6821-2022- 6-10-556-562.

THE PROSTHODONTIC TREATMENT OF THE MANDIBLE EDENTULOUSNESS. CLINICAL CASE

The article presents a clinical case of the prosthodontic treatment of the mandible edentulousness.
 Edentulousness is a widespread pathology that depends on the social and economic situation in the country, the demographic situation, the level of dental care and prevention organization. The current worldwide trend of population aging leads to an increase in the number of the elderly, and this number is expected to increase in the future. According to the WHO, today about 600 million people are people over 60, and this number will have doubled by 2030 and will constitute 2 billion in 2050 mostly in developed countries. The situation in Ukraine is not better.
 Functional and aesthetic rehabilitation of patients with edentulousness requires a comprehensive approach to the prosthodontic treatment planning. Complete removable laminar dentures on the mandible have a number of disadvantages. Insufficient fixation, stabilization, diction problems, aesthetic problems, decreased self-esteem of the patient are among the key ones. Modern protocols of the prosthodontic treatment require the manufacture of dental prostheses based on intraosseous dental implants.
 Complete dentures based on intraosseous dental implants have a number of advantages over the fixed dentures. Compensation for deficient bone support of the facial soft tissues occurs by means of the basis. Patients’ possibility to remove a secondary restoration by themselves lead to proper hygiene of the oral cavity and peri-implant area in particular.
 The clinical research conducted by S. Wolfart (2016) showed the possibility of fixed/removable dental prosthesis fixation in 14-31 days (early loading) after the surgical stage of implantation provided that 4-6 intraosseous dental implants were installed. The maximum mobilization of the patient to comply with the recommendations and prescriptions is the main task considering the limited postoperative period before the dental prosthesis fixation.
 Our publication describes the treatment of a patient born in 1967, who was diagnosed with a mandible complete absence of teeth. Diagnosis, examination and treatment were performed on the basis of the Department of Dentistry Postgraduate Education of Ivano-Frankivsk National Medical University.
 The described prosthodontic treatment plan involves the manufacture of a complete denture with bar system based on four intraosseous dental implants according to the early loading protocol in a patient with primary treatment of mandible edentulousness.
 The choice of treatment plan was based on the results of past medical history, the patient’s disease, basic and additional methods of examination, analysis of individual indications and contraindications and readiness for the selected treatment plan.
 This treatment protocol has its advantages over the protocol of manufacturing a fixed prosthesis based on intraosseous dental implants such as a higher level of proprioceptive sensations, increased level of hygiene, lower complexity of clinical and laboratory stages, affordability.
 The term of clinical and laboratory stages of manufacturing (from the surgical stage of implant treatment to the fixation of the dental prosthesis) constituted 16 days.
 Additional opportunities for success in clinical and laboratory stages of treatment, the accuracy of manufacture and minimization of complications in the future were created as a result of the combination of digital and analog treatment methods in dental prosthesis manufacturing.

Hirayama disease. Clinical cases

Hirayama disease, or monomelic amyotrophy, is a rare neurological pathology manifested by unilateral or bilateral asymmetric paresis with atrophy of the distal upper extremities. The development of this disease is associated with the forward displacement of the posterior dural sac during neck flexion, which leads to compression of the spinal cord and venous stasis. The diagnosis of monomelic amyotrophy is based on the clinical picture and the results of magnetic resonance imaging of the cervical spine with flexion, showing segmental atrophy of the anterior horns of the spinal cord at C7 — Th1, detachment of the posterior dura mater and venous stasis. Most of the cases described in the literature are from India and Japan, with isolated cases diagnosed in North America and Europe. This article presents two clinical cases of progressive hand weakness in young men. The clinical picture of the disease and the results of additional examination methods are presented, which is necessary to establish a diagnosis of Hirayama’s disease.

A Contemporary View on the Anatomy of Parotid Gland

One of the up-to-date issues of contemporary medicine is the study of the features of individual anatomical structure variability of various organs. In recent years, the incidence of parotid gland diseases has been rising. This phenomenon can be associated with an absolute increase in this organ pathologies incidence as well as with the development of additional methods of examination and visualization of the gland. Most pathologies of major salivary glands, in particular the parotid gland, require surgical treatment. Knowledge of topographical relationship of the parotid gland with the adjacent vessels and nerve trunks is utterly necessary for planning and performing surgical interventions and reconstructive operations in the parotid region. According to the statistics, surgical interventions on the parotid gland take the leading place among the causes of damage to the facial nerve branches. This fact may also prove a large variation in the syntopy of the facial nerve and the parotid gland. The paper reviews the data of native and foreign literature on the anatomy of parotid gland and the place of radiation research methods in the study of its topographical and anatomical features. The analysis revealed a wide range of anatomical norm of parotid gland in many parameters, including shape, linear size, blood supply, and topographical features. The practice of using anthropometric studies aimed at structuring the existing knowledge and narrowing the borders of anatomical norm for various organs proved to be successful. However, in the pool of scientific papers, we have not found similar studies concerning parotid gland. The facts mentioned above make the background and justify further studies of parotid gland in the context of normal individual variability.

New in understanding the burden of migraine: semantic analysis of the voice of Russian patients – users of Web 2.0

Migraine is the second leading cause of maladjustment, and the burden of migraine is determined by its impact on work ability, social activity and family relationships.Objective: to identify the patterns of behavior of Russian patients with migraine, factors affecting their quality of life, and the level of awareness of the disease based on a semantic analysis of messages in Web 2.0.Patients and methods. The study is based on the results of semantic processing (automated analysis of natural language texts, taking into account their meaning) of anonymized messages from 6566 unique authors (patients and their relatives) from social networks and forums (over 73 thousand messages over 10 years, 2010–2020). In addition, the study was carried out exclusively according to the data indicated in the messages. In this regard, complete data for several parameters was not available for analysis. No personal data about the authors of the messages was collected or used. The sex was determined based on the text of the analyzed message. For the study, only open data from the Internet from social networks and forums was used.Results and discussion. A landscape of problems of persons complaining of migraine issues was formed. Factors affecting the quality of life were grouped into four main groups (“Lifestyle restrictions by triggers of migraine attacks”, “Loss of opportunity to work”, “Serious psychological problems”, “Family planning issues”); additional, rarer, but acute problems were also identified. The analyzed messages show that the average number of days with migraines is 9.4 per month; 21.8% of patients report daily migraines. Moreover, most patients have been suffering from attacks for 10 years or more, and 9% of patients – for 30 years or more. The analysis of diagnostic patterns showed that in most cases, patients independently resorted to additional examination methods, while only 13.1% of patients had experience of adequate preventive therapy.Conclusion. The study demonstrated the presence of a wide range of unmet needs, quality of life problems both in patients themselves and their caregivers, as well as a significant social and economic burden of this disease (including a long-term burden on the economy, which can be used as arguments for reimbursing the cost of migraine therapy) based on the text messages on migraine in open sources on the Internet.

СТОМАТОЛОГИЧЕСКИЙ СТАТУС И МИНЕРАЛЬНЫЙ СОСТАВ ТВЕРДЫХ ТКАНЕЙ ЗУБОВ У ДЕТЕЙ В ЗАВИСИМОСТИ ОТ УРОВНЯ АНТРОПОГЕННОЙ НАГРУЗКИ

Anthropogenic load significantly affects the human body. It used to think that children, due to the high metabolism, are most susceptible to the effects of the urban ecosystem. Unfavorable environmental factors affect children's health, including dental health. Heavy metals tend to accumulate in the human body, namely in bones, hair, nails, and teeth. This can serve as an indicator of the technogenic load on the body. The process of maturation of tooth enamel is closely related to the intake of mineral components into the child's body. The aim of the work is a comparative analysis of the dental status and mineral composition of hard dental tissues in children at different levels of anthropogenic load. Material and methods. With the help of basic and additional examination methods, a comparative analysis of the dental status of primary school children was carried out and described. Using atomic emission spectrometry, the mineral composition of the hard tissues of the teeth of the children under study was studied. Results. It was found that in children in an area with a high anthropogenic load, the prevalence of dental caries and the presence of systemic hypoplasia of the enamel of permanent teeth are higher. Also, these children showed a relatively low caries resistance of the enamel and the content of micro-macroelements in the hard tissues of the teeth. Conclusions. To study dental morbidity in children of primary school age at different anthropogenic loads, it is necessary to carry out a complete examination, including basic and additional research methods. Also, laboratory methods of examination are recommended, namely, the determination of the mineral composition of the hard tissues of the teeth.

Angiographic criteria for differential diagnosis of hemangiomas and arteriovenous malformations of different localization

Hemangiomas and microfistular arteriovenous malformations (AVMs) are vascular anomalies with high blood flow velocity. On angiographic examination, they look the same, in the form of a contrasting spot of varying degrees of intensity. A comparative analysis of the angiographic picture in dynamics, during the performance of subtraction angiography, allows for differential diagnosis and clearly identifies the type of vascular anomaly. Objective. to develop effective angiographic criteria for the differential diagnosis of hemangiomas and microfistular arteriovenous malformations (AVM) using subtraction angiography. Material and methods. Subtraction angiography of patients with congenital vascular anomalies based on 27 studies. Results. Analysis of angiographic data, performed in the subtraction mode, made it possible to identify characteristic angiographic differences between microfistular arteriovenous malformations and hemangiomas. The angiographic picture was studied in dynamics. The time between the onset of the arterial and venous contrasting phases, the duration of the parenchymal contrasting phase was calculated. In AVMs, outflow veins appear on the angiogram already in the first second of contrasting arteries due to rapid drainage of contrast through arteriovenous fistulas. The duration of contrasting the AVM shadow is no more than 2–3 seconds. Contrasting of the hemangioma parenchyma appears in the arterial phase at 2–3rd seconds and lasts for a long time from 3 to 10 seconds, due to a prolonged delay of the contrast medium in the cavernous structures of the hemangioma with late appearance of outflow veins. Conclusions. Performing and analyzing subtraction angiography in patients with congenital vascular anomalies allows instant differential diagnosis between hemangiomas and microfistular arteriovenous malformations without using additional examination methods. This increases the efficiency and quality of diagnostics of patients with vascular abnormalities, allows you to immediately transfer the diagnostic procedure to endovascular surgery. It makes the possible to provide specialized medical care to patients with hemangiomas and AVMs in one session, without additional endovascular intervention. Key words: hemangioma, arteriovenous malformation, differential diagnosis, angiography.

Особливості перебігу коронавірусної інфекції COVID-19 у дітей України

Актуальність. Пандемія коронавірусної хвороби COVID-19, спричинена новим коронавірусом SARS-CoV-2, на сьогодні є глобальною проблемою, однак досить обмеженими є дані щодо особливостей перебігу інфекції COVID-19 у дітей. Мета: провести узагальнюючий аналіз демографічних, епідеміологічних і клінічних особливостей перебігу COVID-19 у дітей різного віку з різних регіонів України. Матеріали та методи. З дотриманням принципів біоетики проведено багатоцентрове ретроспективне відкрите когортне дослідження 669 випадків інфекції у дітей, спричиненої коронавірусом SARS-CoV-2, у відділеннях госпітальних баз міст Києва, Вінниці, Чернівців та Одеси. У госпіталізованих дітей визначали комплекс клінічних, лабораторних та інструментальних маркерів перебігу інфекції, спричиненої коронавірусом COVID-19. Результати. До першої (І) групи ввійшли 67 дітей віком до 2 місяців, до другої (ІІ) групи — 320 хворих дітей у віковому проміжку від 60 днів до 6-річного віку, субгрупа зі 127 дітей молодшого та середнього шкільного віку сформувала третю (ІІІ) групу, а до складу четвертої (IV) вікової групи ввійшли 155 підлітків віком від 12 років. Ураження вірусом SARS-CoV-2 систем внутрішніх органів характеризувалося мультисистемним характером і проявлялося змінами з боку верхніх дихальних шляхів у 70,1 % випадків, ураженням нижніх дихальних шляхів — у 54,7 % спостережень, інфекційно-запальними змінами — у 57,2 % випадків, гастроінтестинальними симптомами — у 9,2 %, а також неврологічною симптоматикою — у 17,8 %. Загалом серед клінічних симптомів у загальній когорті пацієнтів найчастіше зустрічались лихоманка (51,1 %), загальна слабкість (51,6 %), біль у горлі (70,1 %), кашель (54,7 %) та зниження апетиту (52,8 %). Ураження паренхіми легень із відповідною клініко-рентгенологічною картиною як прояв коронавірусної хвороби COVID-19 визначалося із частотою від 23,9 до 25,9 % обстежених дітей у різних регіонах України з вірогідним зростанням шансів розвитку пневмонії у підлітковому віці. Найчастішими змінами у додаткових методах обстеження були лейкоцитоз (18,8 % випадків), тромбоцитоз (14,5 % хворих), лейкопенія (11,1 % пацієнтів), збільшення С-реактивного білка у 43,7 % дітей. Підвищений уміст тромбоцитів спостерігався переважно у дітей перших двох місяців життя (у 38,3 % випадків) і вірогідно зростав упродовж періоду стаціонарного лікування, що співпадало з тенденціями до зростання частоти підвищеного вмісту С-реактивного білка у цій віковій когорті. Висновки. Аналіз епідеміологічних, клінічних і лабораторних особливостей перебігу коронавірусної хвороби, викликаної SARS-CoV-2, у дітей різних вікових груп із різних регіональних госпітальних баз України узгоджувався із перебігом у дорослих пацієнтів із COVID-19, але більш високі шанси на легші форми захворювання серед дітей молодшого віку та ураження нижніх дихальних шляхів і вищі шанси тяжкого перебігу серед старших дітей.

Diagnostics of functional disorders of the gastrointestinal tract in patients with constipation

The purpose of the review is to acquaint general practitioners, therapists, gastroenterologists with the possibilities of diagnosing functional disorders of the gastrointestinal tract associated with constipation, as well as to draw attention to the need for additional examination methods for a comprehensive assessment of functional disorders of the gastrointestinal tract in patients with constipation on pathogenesis.Functional constipation is an urgent problem today due to its prevalence among different age groups, a negative impact on the quality of life, as well as the variability of the clinical forms of diseases associated with this symptom. The modern diagnostic algorithm for chronic constipation consists of several stages, including the identification of signs of the disease, according to the Rome criteria of the IV revision (2016), the identification of symptoms of “red flags” and laboratory and instrumental research. It should be borne in mind that functional constipation is often based on the pathology of the anorectal zone, which is an important factor in the diagnosis and development of further therapeutic strategies. The article provides an overview of modern and promising methods for diagnosing functional disorders of defecation, taking into account functional disorders of the anorectal zone associated with constipation.Functional methods such as anorectal manometry, rectal sensory test and balloon expulsion test are the most studied and obligatory tests for an objective assessment of the sensorimotor function of the anorectal zone. In Russia, these methods are used very little, which requires extensive familiarization of practitioners with the advantages of these techniques. Knowledge and application of the presented examination algorithms will help the clinician to increase the overall diagnostic efficiency and apply the most justified tactics of managing patients with functional pathology of the digestive system associated with constipation.

DYNAMICS OF THE NEUROOPHTHALMIC CHARACTERISTICS OF PERINATAL ACUTE STROKE AT THE STAGES OF CHILDREN'S DEVELOPMENT

The theoretical basis of these studies is based on the dynamics of functional and adaptive relationships of important integrative departments of the Developing Child Brain. It is no coincidence that in recent years studies of the dynamics of cerebral vision disorders in children with pre-and perinatal encephalopathy have expanded in the direction of hemodynamics of Central hemodynamics, general and local cerebral circulation, as well as orbital and intraocular hemodynamics. In the last 5 years, with the help and cooperation of the children's Neurological Hospital, a diagnosis of acute cerebral circulation disorder in the neonatal period of life was detected in 1500 children from 3500 to 3 years of age. In these children, consistent between clinical and laboratory examinations, the dynamics of these indicators of homeostasis-Sommar in blood of catecholamines, their excretion in the urine, differentiated daily, the dynamics of the amount of sugar and cortisol in the blood, as well as electrolytes in plasma and erythrocytes were monitored. While evaluating the results of the additional examination methods, epicrises given to children by children's Neurological Hospital, Republican perinatal Center and research pediatric institute were used. The reaction of Pulse, arterial pressure and respiration to vegetotropic drug preparations and physical load tests was investigated in order to confirm clinical and additional correlations of electrophysiological and Clinico-laboratory results obtained in the children we examined. With known methods, atropine, adrenaline and insulin tests were carried out, the reactivity of Pulse, arterial pressure and respiration to the administration of adrenaline (0.02 mg/kg) and atropine (0.01 mg/kg) into the muscle, as well as the increase in excretion of catecholamines with urine into insulin injection (0.25 unit/kg). Thus, in the neonatal period of life of 1500 children from 3500 to 6 years of age who were involved in the examinations, acute violations of cerebral circulation were diagnosed, as a result of many years of consecutive examinations and treatments, nearly 1000 children with pre – school clinical picture were evaluated for compensation – 15%, remissions – 75%, program walk – 10%. It is proved that the solutions of recovery options depend on the direction of hypothalamic-pituitary relations and homeostatic aberrations.

Importance of confirming the underlying diagnosis in patients with myocardial infarction and non-obstructive coronary arteries (MINOCA): a single-centre retrospective cohort study

BackgroundMany patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) are discharged without a known aetiology for their clinical presentation. This study sought to assess the effect of this ‘indeterminate MINOCA’ diagnosis on the prevalence of recurrent cardiovascular events and presentations to the Cardiac Emergency Department (CED).MethodsWe retrospectively analysed all patients meeting the diagnostic MINOCA criteria presenting at a large secondary hospital between January 2017 and April 2019.ParticipantsPatients were divided into the (1) ‘indeterminate MINOCA’, or (2) ‘MINOCA with diagnosis’ group. The primary outcome was the occurrence of major adverse cardiac events (MACE) defined as the composite of all-cause mortality, non-fatal myocardial infarction, stroke and any revascularisation procedure. Secondary outcomes were all recurrent visits at the CED, and MACE including unplanned cardiac hospitalisation.ResultsIn 62/198 (31.3%) MINOCA patients, a conclusive diagnosis was found (myocardial infarction, (peri)myocarditis, cardiomyopathy, or miscellaneous). MINOCA patients with a confirmed diagnosis were younger compared to those with an indeterminate diagnosis (56.7 vs. 62.3 years, p = 0.007), had higher maximum troponin-T [238 ng/L vs. 69 ng/L, p < 0.001] and creatine kinase (CK) levels [212U/L vs. 152U/L, p = 0.007], and presented more frequently with electrocardiographic signs of ischaemia (71.0% vs. 47.1%, p = 0.002). Indeterminate MINOCA patients more often showed recurrent CED presentations (36.8% vs. 22.6%, p = 0.048), however the occurrence of cardiovascular events was equal (8.8 vs. 8.1%, p = 0.86). Multivariable analysis showed that elevated levels of troponin-T and CK, ST-segment deviation on electrocardiography, reduced left ventricular ejection fraction, regional wall motion abnormalities, and performance of additional examination methods were independent predictors for finding the underlying MINOCA cause.ConclusionsOnly in one-third of MINOCA patients a conclusive diagnosis for the acute presentation was identified. Recurrent CED visits were more often observed in the indeterminate MINOCA group, while the occurrence of cardiovascular events was similar across groups.Trial registrationRetrospectively registered

SPECIFIC FEATURES OF VARIANT ANATOMY AND MORPHOMETRIC CHARACTERISTICS OF THE PALATAL VAULT IN ADULTS WITH DIFFERENT GNATHIC AND DENTAL TYPES OF ARCHES

Cone-beam computed tomograms of 68 people (age — 21–35) with physiological occlusion and various gnathic dental arches were analyzed by a method developed for identifying the palatal arch index, taken as a height (depth)-to-width dimension ratio. The results of the study revealed that palatal parameters are determined by main variants (types) of the palatal vault. In case of the mesopalatal type of the arch (index value — 35–45%), the width parameters exceeded the depth values by an average of 2.4 times, while the divergence angle of alveolar processes was 116.7 ± 5.6°. The dolichopalatal type of the arch (index value – above 45%) featured domination of the width parameters over the depth-related ones, by an average of 1.8 times, while the alveolar processes divergence angle made up 127.6 ± 6.1°. As far as the brachypalatal type of the arch is concerned (index value — below 35%), the width parameters exceeded the depth parameters by 4.0 times on average, the divergence angle of the alveolar processes being 113.5 ± 5.3°. The obtained data can be used in clinical orthodontics when diagnosing pathologies of the palatal vault, as well as to interpret data from additional methods of examination and to choose the right treatment for issues related to the dental arch shape and size.

Features of the functional state of the fetoplacental complex in pregnant women with a history of sexually transmitted infections

The objective: a study of the features for the formation and functioning of the fetoplacental complex in pregnant women with a history of sexually transmitted infections.Materials and methods. We examined 50 pregnant women with a history of sexually transmitted infections (I group – the main group). The control group consisted of 30 pregnant women without somatic and gynecological pathology, who had vaginal delivery. All pregnant women underwent a comprehensive clinical examination, taking into account complaints, medical history, objective and additional methods of examination. The levels of estriol, cortisol, placental lactogen and progesterone in the blood serum of pregnant women and the state of fetoplacental complex in terms of 18–20th, 28–30th and 38–40th weeks were determined.Results. In the pregnant women in I group, starting from the 18th weeks there was a significant decrease in the secretion of progesterone (160,8±15,9 nmol/L versus 202,4±5,5 nmol/L, respectively; p&lt;0,05), placental lactogen (77,5±13,2 nmol/L versus 91,3±23,8 nmol/L)/ This means that already in these stages of pregnancy there are signs of placental dysfunction in pregnant women with a history of sexually transmitted infections. The changes in the functional state of the fetoplacental complex at the 28–30th weeks are more pronounced, as evidenced by an increase in the frequency of early intrauterine growth restriction (12.0 %), disorders of fetal breathing (11.0 %) and fetal movements (18.0 %) (according to the biophysical profile score assessment); premature of the placenta, increased hormonal insufficiency of the fetoplacental complex and the first signs of hemodynamic disorders (an increased blood flow in the umbilical artery and uterine arteries and a slight decrease in blood circulation in the middle cerebral artery of the fetus). At the final assessment of the condition of the fetoplacental complex at the 38–40th weeks in pregnant women with a history of sexually transmitted infections, a satisfactory condition was observed in 24 % of cases, compensated ultrasound changes occurred in 46.0 % of cases; subcompensated – in 20.0 % and decompensated – in 10.0 % of cases, respectively, which causes a high frequency of obstetric and perinatal complications in this group of pregnant women.Conclusions. The formation and functional state of the fetoplacental complex in pregnant women with a history of sexually transmitted infections, from early pregnancy is characterized by a significant level of functional disorders of the fetus, placenta and the amount of amniotic fluid on the background of pronounced hemodynamic and endocrinological disorders, which requires prevention in the pre-pregnancy period.

Correlation between oral health and severity of respiratory coronavirus infection COVID-19

Aim. To establish the association between the presence of chronic infection in oral cavity and the severity of SARSCoV-2 infection.Materials and methods. The study was conducted among 30 people aged between18 and 22 who had had coronavirus infection from mild to severe cases. The assessment of oral health was carried out with main and additional examination methods, CFE index, PMA index, Greene, Wermillion oral hygiene index.Results. In group 1, the average value of CFE index was 4.2, in the second group – CFE index was twice higher at 7.8. PMA index in patients of group 2 was significantly higher (p&gt; 0.01) and was at the level of 41.5%. In group 1, the PMA index was 13.3%. It was found that 17% of the respondents in the control group and 70% patients in the experimental group had an episodic exacerbation of dental diseases during COVID-19.Conclusions. The data obtained indicates a correlation between oral diseases and the severity of COVID-19. It is necessary to consider that chronic infection in the oral cavity as well as poor oral hygiene can act as a risk of complications of viral infections, in particular, of COVID-19.

Analysis of Key Radiographic Characteristics of Early Invasive Breast Cancer, Stages T₁ₐ₋bN₀M₀ and DCIS

Relevance: The systematization of radiological signs of microcarcinomas will increase the frequency of detection of the disease at an early stage and maximize the effectiveness of breast cancer treatment.Purpose: To assess the key radiological characteristics of early forms of breast cancer (invasive tumors up to 1.0 cm and ductal carcinoma in situ).Material and methods: The key radiological characteristics were studied in 110 patients with verified early forms of breast cancer: ductal carcinoma in situ (DCIS), invasive breast cancer up to 1 cm in size according to the morphological examination of the surgical material in the absence of signs of regional and distant metastasis — stage p T₁ₐ₋bN₀M₀.Results: The main radiological signs detected in mammography (MG) in early breast cancer were the nodular mass without microcalcifications — in 26 cases (23.9 %), the nodule and microcalcifications — in 35 cases (32.1 %), in 27 patients (24.8 %) — microcalcifications without a tumor node. In addition, in 17 cases (15.6 %) there was a violation of the architectonics or focal asymmetry, and in 4 patients (3.7 %) no signs of a malignant process were revealed at all with MG. The revealed changes in the breast in most patients (83 cases, 76.1 %) were interpreted as BIRADS 5, which indicates an extremely high probability of the presence of a malignant neoplasm. In 9 cases (8.3 %) after mammography, the diagnosis was interpreted as BIRADS 4, in 16 (14.7 %) cases the category BIRADS 0 was assigned, which required additional examination methods, and only in 1 patient (0.9 %) the revealed changes were interpreted as benign.Conclusions: Mammography performed in 92 patients (84.4 %), based on the assessment of radiological signs, to establish the BIRADS 4/5 category, which served as the basis for performing a biopsy and verifying the diagnosis. However, in 15 % there were diagnostic difficulties in interpreting the data, which confirms the data of the world literature on the complexity of the differential diagnosis of microcarcinomas.

КЛИНИЧЕСКИЙ СЛУЧАЙ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ПЕПТИЧЕСКОЙ ЯЗВЫ ГАСТРОЭНТЕРОАНАСТОМОЗА

In the article a clinical case of surgical treatment of peptic ulcer of gastroenteroanastomosis complicated with perforation and gastrointestinal bleeding, is described. The patient was observed with the diagnosis: cholelithiasis, chronic calculous cholecystitis, for which planned laparoscopic cholecystectomy with draining of the abdominal cavity was performed. According to the discharge record, the operation ran without peculiarities. Later the patient was rehospitalized with complaints of weakness, nausea, vomiting, pain in the upper parts of the abdomen; he was diagnosed with ulcer of gastroenteroanastomosis and continuing bleeding that were indications for the surgical intervention for life-saving indications. From the patient words, a part of the stomach was resected more than 20 years before for gastric ulcer. Until the latest time, the patient felt satisfactory, but within 6 months pain in the abdomen reappeared, however, on examination cholelithiasis was identified, and the pain syndrome was attributed to this pathology. Assumably, after the first operation performed in 1995, a complication developed in the early postoperative period in the form of obstruction of gastroenteroanastomosis (anastomositis?), and additional gastroenteroanastomosis was applied. Conclusion. Peptic ulcer of anastomosis is an actual problem of the gastric surgery which may not only appear long time after the operation, but may give the same complications as «essential» peptic ulcer, and really threaten the life of patients. It should be noted that in some cases the intraoperative picture, experience and sensations of a surgeon play a decisive role in the diagnosis of surgical pathology even if they differ from the data of additional methods of examination.

Dental status and electromyography indicators of masticatory muscles in young people doing physical activities with weights

BACKGROUND: High emotional and physical loads of athletes, especially during the preparation for competitions with the use of weights, have an impact on individual human organs and tissues and are not fully understood at present. Against the background of exhausting and prolonged loads, especially in athletes working with weights, dental anomalies are more common, caries and non-carious lesions of teeth, inflammatory periodontal diseases, injuries of the maxillofacial region are also at a higher level. Recent studies have revealed that such behavioral factors lead to a higher risk of oral diseases. This is explained by the impact of odontogenic foci of chronic infection on systemic immunity and leads to a decrease in the effectiveness of sports achievements, and also proves the importance of timely monitoring and evaluation of the dental status of this population group, carrying out basic and additional methods of diagnosis of dental diseases, prevention and treatment.&#x0D; AIM: This study assessed the dental status and electromyography indicators of the masticatory muscle group in individuals doing physical activities with weights.&#x0D; MATERIAL AND METHODS: A total of 115 young men aged 2535 years were examined. Of these, 70 young people were actively involved in physical exercises (bodybuilding, powerlifting, and weightlifting), and 45 did not play sports. Examination data, questionnaire responses, and results of additional examination methods were evaluated. An index assessment of the state of the oral cavity was given. Electromyography made it possible to evaluate the functional state of the dentition. Indicators of the most common dental diseases of both groups, such as caries, periodontitis, dentoalveolar anomalies, enamel chipping, abnormal abrasion, sensitive dentin, and wedge-shaped defect are identified. A structural analysis of the data obtained from both groups was carried out.&#x0D; RESULTS: Analysis of electromyographic data showed that the background activity of the masticatory muscles in a state of functional tension chewing on the right and left is asymmetric and inconsistent (795.31.2 and 710.21.8, respectively). Indices of the prevalence of caries in the athlete group are localized mainly in people engaged in weightlifting (89.4%2.5%); periodontal diseases, dentoalveolar anomalies, and enamel chipping in powerlifting representatives (71.3%1.5%, 34.8%1.2%, and 25.1%3.5%, respectively); diseases of hard tissues of the teeth (sensitive dentin) in bodybuilders (36.1%2.6%), pathological abrasion and wedge-shaped defect in representatives of powerlifting (18.2%2.1% and 27.6%1.6%).&#x0D; CONCLUSIONS: The indices of dental morbidity, index assessment, and electromyographic study of the chewing muscles of athletes involved in weights were higher than that in the group of people not engaged in sports. The overall effect of training leads to functional disorders of the temporomandibular joint and masticatory muscles, higher rate of acquired dental hard tissue defects, caries, and periodontal inflammation.