Adequate Therapy Research Articles

Intractable complicated course of tricuspid valve infective endocarditis due to non-compliance of treatment with clinical guidelines with a decisive role of molecular biological study in etiological diagnosis: a case report

A clinical observation of the treatment non-compliance consequences with clinical guidelines and principles of empirical therapy selection in a female patient with intravenous drug abuse, viral hepatitis C and HIV infection, with a history of a COVID-19 and the development of uncontrolled staphylococcal infective endocarditis (IE) of the tricuspid valve, complicated recurrence of early prosthetic IE is presented. Successful treatment was achieved only by a combination of tricuspid valve replacement and the appointment of etiotropic therapy for S. aureus (MSSA). The typical clinical scenario was not accompanied by the choice of adequate empirical antibiotic therapy, despite the high suspicion of association with MSSA, which determined the complicated course of IE. Only the polymerase chain reaction of the heart valve tissue played a key role in the etiological diagnosis. The use of valve tissue polymerase chain reaction in addition to traditional microbiological methods is a valuable diagnostic study.

Prospects for the use of adequate external therapy for atopic/allergic dermatitis in children

The article focuses on the most frequent skin diseases in young children. Atopic/allergic dermatitis is one of the most common diseases in children. Approximately 45% of patients develop their first symptoms within the first 6 months after birth, 60% show the onset of atopic dermatitis during the first year of life and 80-85% at the age of 1 to 5 years. The article also speaks about the issue of allergic contact dermatitis (diaper rash in newborns). The disease represents non-specific inflammatory skin changes in the contact area in infants, the onset of which occurs mostly at the age of 1 to 15 months. The factors responsible for causing these diseases, the pathogenesis of their development and the potential of topical therapy mainly targeted at the reduction of clinical manifestations and frequency of exacerbations, improvement of the quality of life and prevention of infectious complications are considered. As an initial treatment, the authors consider a drug containing methylprednisolone aceponate with ceramides of domestic manufacturing. Its effectiveness and safety in the combination therapy of young children suffering from atopic/allergic and contact dermatitis may be evaluated in clinical practice. Clinical case reports of treatment of children with dermatitis of various etiologies aged from 4.5 months up to 3 years are presented. The outcomes of the use of Komfoderm K in children with AD demonstrated a significant decrease in the severity of inflammation, reduction of the skin lesion area and the intensity of symptoms, decreased need for additional intake of antihistamines and anti-inflammatory drugs, and the ability to achieve stable clinical remission.

Stress and stress-associated disorders in children

Stress in childhood affects not only the current health status of children, but also their psychosocial and somatic functioning at a more mature age, which leads to grave consequences in the long term, as well as higher frequencies of use of healthcare financial resources. The ability of a physician to identify clinical manifestations of stress in children with somatic diseases or during dispensary examination, on the one hand, is important for prescribing adequate therapy, helps determine a preventive approach to the management of children with stress-related consequences, and also to form a relevant set of actions to increase their stress resistance and create an adequate adaptive reserve and reactions at all levels of the body. On the other hand, it is important to identify children under chronic stress (the so-called point of no return), who have a high risk of developing psychosomatic diseases. The article also discusses the basics of a healthy lifestyle for children that makes it possible to not only increase adaptive capabilities, but also essentially mitigate the effects of chronic stress. For example, it addresses recommendations such as complete and proper nutrition, regular physical activity combined with rest, coping skills training. However, the authors emphasize that the most difficult part of all recommendations is their direct fulfilment by children themselves and by their environment (parents, teachers). Therefore, the issues of compliance with the prescribed therapy and preventive actions become very important, especially in situations where their fulfilment is associated with subjective and objective difficulties. The authors tried to suggest some ways of overcoming the latter.

Increasing of New CA-MRSA Infections Detected in people living with HIV Who Engage in Chemsex in Barcelona: An Ambispective Study.

There are no data on community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in the context of the chemsex phenomenon. This study aimed to characterize CA-MRSA-related infections in a cohort of people living with HIV (PLWH) who engage in chemsex. At the Hospital Clinic of Barcelona, from February 2018 to January 2022, we analyzed CA-MRSA infections diagnosed in a cohort of PLWH who engage in chemsex. Epidemiological, behavioral and clinical variables were assessed. Mass spectrometry identification and antimicrobial susceptibility testing were performed on MRSA isolates. Pulse field electrophoresis was used to assess the clonality of the MRSA strains. The presence of Panton-Valentine leukocidin was also investigated. Among the cohort of 299 participants who engage in chemsex, 25 (8%) with CA-MRSA infections were identified, 9 at baseline and 16 with incident cases; the cumulative incidence was 5.5% (95% CI: 3.2%, 8.8%). The most common drugs were methamphetamine (96%) and GHB/GBL (92%). Poly-consumption and slamming were reported by 32% and 46%, respectively. CA-MRSA was isolated from the infection sites of 20 participants, and CA-MRSA colonization was confirmed in the remaining 5 persons. Seventy-one percent had used antibiotics in the previous year. All participants presented with skin and soft tissue infections, 28% required hospitalization, and 48% had recurrence. Of the 23 MRSA isolates further studied, 19 (82,6%) belonged to the same clone. Panton-Valentine leukocidin was detected in all isolates. PLWH who engage in chemsex may present with CA-MRSA infections. Clinical suspicion and microbiological diagnosis are required to provide adequate therapy, and CA-MRSA prevention interventions should be designed.

Esophagoprotective agent in the treatment of gastroesophageal reflux disease in children

Gastroesophageal reflux disease (GERD) prevalence in children and adolescents is estimated as high. GERD has a wide variety of clinical signs that significantly reduce the patients' quality of life. Typical symptoms include heartburn, belching, and regurgitation (regurgitation). Extraesophageal symptoms are mainly represented by complaints indicating the involvement of the respiratory, ENT organs, and oral cavity organs in the process. In addition, gastroesophageal reflux disease is a major risk factor for Barrett's esophagus and esophageal adenocarcinoma. The main factors predisposing to the development of gastroesophageal reflux disease in children are obesity, overeating, congenital anomalies of the esophagus, surgical interventions at the cardioesophageal junction, immature autonomic nervous system, nervous system diseases, administration of certain drugs, as well as vices such as smoking and alcohol drinking in adolescence. The mainstay of treatment of gastroesophageal reflux disease is antisecretory therapy with proton pump inhibitors. However, some patients using proton pump inhibitors at a standard dosage fail to achieve the clinical and endoscopic remission of the disease. The causes of the gastroesophageal reflux disease refractoriness to the adequate therapy most often include impaired barrier function and increased esophageal mucosal permeability. The use of esophagogastroprotective agents contributes to the optimization of therapy of gastroesophageal reflux disease and aims at achieving the disease remission in a larger number of patients. Clinical case reports of diagnosis and treatment of patients aged 12 and 16 years with gastroesophageal reflux disease are presented. The use of the esophagoprotective agent provided rapid relief of both esophageal and extraesophageal symptoms of the gastroesophageal reflux disease. In addition, complete healing of erosive esophagitis was achieved during its therapy.

Difficulties in diagnostics of urea synthesis cycle disturbance

Introduction. Hereditary metabolic diseases include a large group of diseases caused by genetic mutations with a high potential risk of transmitting this disorder to future offspring. Manifesting at any age and accompanied by recurrent and progressive clinical symptoms, some of these mutations become incompatible with life, while most lead to gross violations of the normal physiological process of child development. The paper presents a clinical case of hereditary urea synthesis disorder caused by deficiency of ornithine transcarbamylase of mitochondrial matrix in liver (hyperammonemia type 2) as a result of mutation of the OTC gene (MIM 300461). The disease recessive, linked with the X-chromosome and is associated with a high risk of mortality due to accumulation of toxic concentrations of ammonia. Materials and methods. The boy E., born in 2015. Introduction of protein-based complimentary foods and increase in its portion volume is associated with decrease in appetite, regurgitation, nausea, vomiting, flatulence, dyspepsia appear, and sharp weakness progresses. There is a significant increase in the blood concentration of intracellular liver enzymes. Physical development is slowed due to poor weight gain, and neuropsychiatric development lags significantly. Repeatedly examined in the hospital at the place of residence. Results obtained. A total of 47 genes with mutations causing hereditary diseases with predominant liver damage were studied by mass parallel sequencing. Substitution of c.523G>A (p.Asn175Asp) in the OTC gene in hemizygous state was detected. Clinical diagnosis was established: urea cycle metabolism disorder, hyperammonemia, ornithine transcarbamylase deficiency, E 72.2. Dietary recommendations were given. Carbaglu, Recordati, France at the rate of 100 mg/kg/24 h was prescribed on vital signs. Against the background of the therapy and dietary recommendations the condition of the child had a pronounced positive trend. Conclusions. Since the true incidence of this pathology in Russia has not been established (many cases of metabolic disorders of the urea cycle remain undiagnosed), the presented clinical case will allow clinicians, using modern possibilities of structural and functional analysis of the human genome, to make a timely diagnosis and prescribe adequate therapy, thereby not only prolonging the life of a young patient but also significantly improving its quality.

A Prospective Randomized Controlled Pilot Study to Assess the Response and Tolerability of Cold Atmospheric Plasma for Rosacea

Introduction: Rosacea is a common, facial, chronic inflammatory skin disease. Due to its complex pathogenesis, adequate therapy of rosacea can be challenging. An innovative recent therapeutic tool is cold atmospheric plasma (CAP), which is already established in the treatment of chronic wounds and promising in different other skin diseases. Methods: In a split-face pilot study we investigated dielectric-barrier-discharged CAP in erythemato-telangiectatic (ETR) and/or papulopustular rosacea (PPR). CAP treatment was applied on lesional skin of a randomized side once daily (90 s/area) for 6 weeks. The other untreated side served as control. Co-primary endpoints were ≥1 improvement of the Investigator Global Assessment (IGA) score on the treated side compared to control and a decline of the Dermatology Life Quality Index (DLQI) after 6 weeks. Secondary endpoints included inflammatory lesion count (papules and pustules), skin redness intensity and erythema size. Adverse events (AEs) were recorded constantly. Additionally, participants were weekly assessed for symptoms, skin condition, trigger factors, skin care, treatment success, and local tolerance parameters. All p values were calculated using the Wilcoxon signed-rank test. Results: Twelve subjects (ETR, n = 3; ETR and PPR, n = 9) completed the study. DLQI was significantly improved after 6 weeks (p = 0.007). On the CAP-treated side, lesions (p = 0.007) and erythema size (p = 0.041) were significantly reduced compared to the control. IGA (p = 0.2) and skin redness intensity (p = 0.5) did not differ significantly between control and CAP-treated side. No serious AEs occurred and treatment was well tolerated. Conclusion: CAP is a promising new treatment of rosacea, especially for PPR.

Retropharyngeal Abscess as an Uncommon Cause of Torticollis in a Child

Torticollis is a clinical manifestation of musculoskeletal pathologies and it is often underestimated as the first symptom of an infection of the retropharyngeal space. It accounts for about one-fourth of retropharyngeal abscess (RPA) presentations in children. Early imaging studies may help to get the diagnosis of RPA and to offer prompt surgical intervention to avoid complications such as upper airway obstruction. Thus, torticollis should not be only treated symptomatically without the exclusion of serious retropharyngeal abscess because a delay in the definitive diagnosis and implementation of adequate therapy may be fatal.

MALDI-TOF MS: A Quick Method to Detect the Susceptibility of Fusarium spp. Clinical Isolates to Amphotericin B.

Disseminated fusariosis is treated with amphotericin B and voriconazole. To determine adequate therapy, the minimal inhibitory concentration (MIC) is used. However, MIC analysis is based on visual observation and requires a long period of fungal incubation. The measure of the minimal profile change concentration (MPCC) using MALDI-TOF MS is a quick spectral method that has presented good results in determining the antimicrobial resistance of yeasts. However, there is a lack of information on filamentous fungi. In the present work, 13 Fusarium spp. clinical isolates and two reference strains were used. MIC was obtained according to the M38-A2 protocol of the Clinical Laboratory Standards Institute, while MPPC was obtained following the initial steps of the M38-A2 protocol. Both Biotyper and the Rstudio environment were used to analyze mass spectra. For some fungal strains, the data obtained from the software MALDI Biotyper Compass 4.1 led to fuzzy heatmaps resulting in difficult interpretation, while heatmaps obtained using Rstudio tools generated better MPCC resolutions. Herein, 86.6% of the AMB MPCC values were highly correlated with the gold-standard AMB MIC. MALDI-TOF MS is a prominent tool used to determine MPCCs quicker, cost-effectively, and more accurately for Fusarium spp. strains. However, better statistical analyses could help measure the technique's limit detection.

A Severely Neglected Paediatric Case: Congenital Hypothyroidism

Introduction: Congenital hypothyroidism is a common endocrinal disorder of newborn. Early diagnosis and management is essential to prevent the irreversible complication of congenital hypothyroidism. So, widespread implementation of newborn screening for this condition is very important [1]. Case report: A 14- year- old boy presented with short stature, chronic constipation, intellectual disability and delayed puberty as a result of untreated congenital hypothyroidism. Conclusion: This case shows the importance of early diagnosis and management of congenital hypothyroidism by routine newborn screening and adequate replacement therapy.

How to Treat Today? Oral and Facial Cancer-Associated Venous Thromboembolism.

The exact incidence of cancer-associated venous thromboembolism (CA-VTE) in patients with oral and facial cancer (OFC) is not exactly known, and this risk is empirically considered to be low. However, this suggestion may result in disease underdiagnosis, prolong the initiation of adequate therapy, and consecutively increase CA-VTE-related morbidity and mortality. In addition, there might be specific clinical problems in the treatment of CA-VTE in patients with oral and facial cancer, such as swallowing difficulties, that might limit the possibilities of oral anticoagulation. Finally, there are limited data regarding the optimal treatment of CA-VTE in patients with oral and facial cancer, and this includes data on novel therapeutic strategies, including the use of direct oral anticoagulants. This article reviews current data on the optimal treatment strategy for CA-VTE in patients with OFC.

Sympathetic denervation — a promising method for treatment of ventricular tachyarrhythmia in children

Ventricular tachycardia is a rare but potentially life-threatening arrhythmia. Ventricular tachycardia in patients with structural pathology and cardiac channelopathies is associated with the highest risk of sudden cardiac death. The stratification of patients depending on the risk of developing a life-threatening arrhythmia determines the choice of treatment method. Left cardiac sympathetic denervation is a surgical method of treatment aimed at preventing attacks of ventricular tachycardia. The antiarrhythmic effect of sympathetic denervation has been proven in both experimental and clinical studies. Currently, the technique of left cardiac sympathetic denervation consists of a video-assisted sympathectomy by thoracoscopic access, which makes the procedure safe and effective. Left cardiac sympathectomy is used in the treatment of patients with recurrent ventricular tachycardia despite adequate medical therapy. The authors recommend the use of left cardiac sympathectomy in those types of channelopathies, in which stress is the main proven provoking factor of ventricular tachycardia.

The use of anakinra in a patient with gout and long-term follow-up of rheumatoid arthritis

Gout is a chronic inflammatory arthropathy, caused by articular and periarticular sodium monourate (MUN) crystals deposition on the background of chronic hyperuricemia. Gout belongs to the group of autoinflammatory diseases characterized by activation of the innate immune system. In some cases, especially in women, with a long course of the disease and absence of adequate therapy, chronic arthritis is detected, which has little difference from that in rheumatoid arthritis (RA). At the same time, until recently, the combination of RA and gout was considered casuistry due to the inhibition of crystal formation by specific factors associated with RA, what is more mechanisms of inflammation development characteristic of these diseases are completely different. However, according to the latest data, the coexistence of these two diseases in one patient is possible, and the therapy of both, gout and RA (in some patients) can be successful when prescribing biological disease modifying antirheumatic drugs, in particular inhibitors of the interleukin 1 receptor (IL1r).The article presents a rare clinical case of chronic tophi gout in an elderly patient who was followed up for a long time with a diagnosis of RA, a significant improvement was achieved on therapy with the IL1r antagonist anakinra.

Combined use of non-steroidal anti-inflammatory drugs and symptomatic slow-acting drugs in musculoskeletal diseases

Musculoskeletal diseases, such as osteoarthritis (OA), nonspecific back pain (NBP), and periarticular soft tissue pathology (PSTP – tendinitis, enthesitis, bursitis, etc.) are one of the most common reasons for visiting general practitioners. The treatment of this pathology is based on the complex use of drugs and non-drug methods for maximum pain control and lost function restoration. Considering the common pathogenesis of musculoskeletal pain in OA, NBP, and PSTP, it is advisable to base the therapy of these diseases on a single algorithm. Of course, when prescribing treatment, one should take into account "red flags" (symptoms of life threatening diseases), features of the clinical course, patient's psycho-emotional condition, and comorbid diseases.Development of a unified tactic for the treatment of musculoskeletal pain will significantly reduce the time spent on a diagnostic search and the choice of adequate therapy, which will facilitate the work of a general practitioner. Thus, non-drug approaches (patient education, kinesiotherapy, psychotherapeutic methods, etc.), non-steroidal anti-inflammatory drugs (NSAIDs) and symptomatic slow-acting drugs (SYSADOA) seem to be the most rational approach in the debut of the treatment of OA, NBP and PSTP. Among NSAIDs, celecoxib seems to be one of the optimal drugs in terms of efficacy and safety, and among SYSADOAs – diacerein. There is evidence that the combined use of these drugs may increase their analgesic and anti-inflammatory potential.

Obliterative bronchiolitis in rheumatoid arthritis (clinical case)

Obliterative (constrictive) bronchiolitis (OB) is a rare disease characterized by destruction of the bronchiolar epithelium and subsequent progressive airway obstruction. OB is most common in rheumatoid arthritis (RA) compared to other systemic rheumatic diseases. Clinical manifestations of OB are found mainly with a long duration of RA and the absence of adequate therapy for articular manifestations. We present a clinical observation, demonstrating the distal respiratory tract involvement in a patient with RA during the first year of the disease, which is observed in no more than 10–20% of cases. The nonspecificity of respiratory symptoms on the background of immunosuppressive therapy led to a diverse differential diagnostic spectrum of pulmonary pathology. For timely diagnosis and optimization of therapeutic approaches, clinical suspicion for respiratory lesions in patients with RA and interdisciplinary cooperation are necessary.

(284) EXPECTATIONS AND GENETIC KNOWLEDGE WITHIN AUSTRIAN ANDROLOGIST: A NATIONWIDE SURVEY ANALYSIS. TRUTH OR ILLUSION?

Abstract Objectives Recent advances in genetics are shedding light on previously unknown topics in male infertility in the last decade, thus gaining higher importance to these diagnostics. Meanwhile, therapeutic management become often determined by novel genetic/epigenetic findings, therefore, it is essential for practising andrologists to have an adequate knowledge armamentarium. Methods To assess individual genetic knowledge correlated to male infertility and doctors’ expectations we performed an anonymous online survey among Austrian Andrologists and compared these results to one global survey of experts in the field. All Austrian Andrological Working Group members were invited to fill in a short online questionnaire independently. Results The survey was viewed 67 times, 34 experts started it with a completion rate of 85.29% by 5 dropouts after starting. Average time to complete: 3,5 min. Interviewed for the request for genetic investigations in infertile men with NOA/OAT syndrome, only 73.33 % responded with yes, whereas 13.33% no. Overall-Matrix-Scorecard (for maximal 5-score) rating about the importance of genetic investigations in such men is reported in Table 1. Karyogram-analysis will be performed in 32,8%, AZF-microdeletion-mutations-investigations in 31,34% and CFTR-mutation in 22,39% for such men, even less the majority is believing that more sophisticated genetic investigations will help understand male infertility (probably and absolutely yes in 64% and 28%). Regarding their own training in genetics, respondents are believing that they are adequately prepared in 26.67% and not at all in 23.23%; 6,67 % answered somehow, but interestingly 43.33% responded that it could definitively be better. Conclusions The online survey showed exemplary that there is obviously a desire for better knowledge of basic genetic knowledge for adequate therapy of male infertility Furthermore, the current practice is not guideline-oriented. Andrologist specialists appear not comfortable with their own medical education in human genetics. Finally, these national results are in line with the international survey. Conflicts of Interest None

Mallignant ischemic stroke: clinical and biochemical features of diagnosis

Ischemic stroke (IS) remains the most common neurological pathology [1,2] and can manifest itself in the form of malignant ischemic stroke (MIS), leading not only to severe disability of the patient, but to life-threatening conditions [3,4]. Malignant ischemic stroke is one of the most formidable manifestations of ischemic stroke, threatening disability of the working population and the likelihood of death without the appointment of timely therapy. Diagnosis:“Malignant ischemic stroke” can occur no earlier than 12-24 hours, during which time irreversible changes in the brain may occur, accompanied by its pronounced edema, with the threat of subsequent herniation, therefore, the appointment of adequate and timely therapy is necessary as soon as possible [5,6] . Taking into account the peculiarities of the course of the disease, there is a need to search for predictors of MIS. In order to timely predict irreversible consequences, in the above literature review, we consider modern approaches to diagnosing the malignant course of ischemic stroke. The analysis of the literature data allows us to determine some clinical and laboratory predictors of the development of malignant ischemic stroke and methods for assessing the severity of ischemic stroke. Various possibilities of using the studied markers for the purpose of practical use in the early diagnosis of MIS are considered. Based on the literature data, the possibilities of diagnostics were analyzed in order to prescribe timely and adequate therapy before the onset of irreversible changes in the brain.

Bacteremia due to Serratia rubiadae

Introduction: Serratia rubidaea is a gram-negative bacillus. it is an opportunistic pathogen bacterium rarely isolated in humans, usually found in the respiratory tract, bile , stools or wounds, but also in the blood. Case report: 40-years-old patient followed for a currently relapsing lymphoma, hospitalized to receive a salvage treatment. The patient had an arterial catheter in place two weeks previously. Four blood cultures were positive for S. rubidaea within the first 48 hours. The clinical and biological evolution were favorable after the establishment of adequate antibiotic therapy according to the results of the antibiogram. Discussion and conclusion: S. rubidaea infections are exceptional. the bacteraemic form is rarely described. This bacterium is most often isolated from the respiratory tract. Adequate antibiotic therapy after carrying out an antibiogram allowed a favorable evolution of the patient then a better support.Introduction: Serratia rubidaea is a gram-negative bacillus. it is an opportunistic pathogen bacterium rarely isolated in humans, usually found in the respiratory tract, bile , stools or wounds, but also in the blood. Case report: 40-years-old patient followed for a currently relapsing lymphoma, hospitalized to receive a salvage treatment. The patient had an arterial catheter in place two weeks previously. Four blood cultures were positive for S. rubidaea within the first 48 hours. The clinical and biological evolution were favorable after the establishment of adequate antibiotic therapy according to the results of the antibiogram. Discussion and conclusion: S. rubidaea infections are exceptional. the bacteraemic form is rarely described. This bacterium is most often isolated from the respiratory tract. Adequate antibiotic therapy after carrying out an antibiogram allowed a favorable evolution of the patient then a better support.

Physical fitness, hormonal profile, nutritional and psychological aspects assessment of transgender women volleyball players submitted to physical tests: protocol paper of a prospective cohort

To evaluate aerobic capacity, strength and other physiological, nutritional, and psychological variables which may influence the performance of transgender women (TW) athletes and compare them to cisgender women (CW) and...

PROTECTED BETA-LACTAM PRESCRIPTION FOR PATIENTS WITH SEPTIC SHOCK

The purpose of this retrospective study is to evaluate the clinical efficacy of two protected drugs, imipenem/cilastine/relebactam and piperacillin/tazobactam, in the treatment of septic shock. The material of the study and observation included 17 patients with septic shock, 9 of them (Group 1) were treated with imipenem/cilastin/Relebactam, 8 of them (Group 2) were treated with piperacillin/tazobactam. All patients received adequate anti-shock therapy, invasive or non-invasive ventilation, and renal replacement therapy. Bacteriological examination showed the presence of four gram-negative pathogens in the biological material of patients. A multidrug-resistant strain of Acinetobacter baumanii with high resistance to both the studied antibiotics and Pseudomonas aeruginosae. Further phenotyping and genotyping confirmed the production of metallo-β-lactamases in both cases and class D carbapenem hydrolyzing oxacillinase in Acinetobacter bau- manii. Treatment of patients with septic shock caused by these strains was equally ineffective with both IMI/REL and PTZ and resulted in death. The results obtained can be used in the meta-analysis and planning of further clinical trials of inhibitor-protected beta-lactams.