Atypical Forms Research Articles

Evolution of Vestibular Findings During and Between the Attacks of Meniere Disease: Update.

The diagnosis of Meniere disease (MD) has based on characteristics of vertigo and findings of audiologic evaluation. This review focuses on the recent findings of the evolution of vestibular function and their underlying physiology during and between the attacks of MD and thus aims to help identify this common disorder with many faces according to the phase. During the attacks, the direction of spontaneous nystagmus changes over time, beating initially toward the affected ear (irritative nystagmus), then toward the healthy ear (paretic nystagmus), and finally back toward the affected ear again (recovery nystagmus). Apart from these direction changes, atypical forms of spontaneous nystagmus, such as downbeat, discordant horizontal-torsional, and aperiodic alternating nystagmus, can be observed. Head impulse tests (HITs) are mostly normal during the irritative/recovery phases, but positive in more than half of patients during the paretic phase. By contrast, caloric tests are usually abnormal irrespective of the phases, although paradoxical caloric hyper-responsiveness can be observed in 18% of patients during the irritative/recovery phases. Thus, dissociation in the findings of caloric tests-HITs can be observed during and between the attacks. Horizontal head shaking tends to augment spontaneous nystagmus during each phase, while skull vibration mostly induces nystagmus beating toward the healthy ear irrespective of the phases. During the attacks, ocular vestibular-evoked myogenic potentials (VEMPs) may be enhanced, whereas cervical VEMPs are usually decreased during stimulation of the involved ear. Recognizing these evolutions of vestibular findings during and between the attacks of MD would provide insights into its pathophysiology and aid in treatments and diagnosis.

Differences in the dynamics of schizophrenia with the formation of episodic and persistent apathetic depressions

IntroductionApathy in endogenous depressions is a complex mental phenomenon (it is characterized by indifference and loss of interests, reduced incentives and motivation, decreased mental and physical activity). Apathy becomes the cause of pronounced social maladaptation and untimely seeking medical help. Different depressions vary in psychopathological features of apathy, in addition, there are also different dimensions of the general dynamics of endogenous disease.ObjectivesStudy of the features of the course of schizophrenia, in which apathetic depressions develop with episodic and persistent type of dynamicsMethodsThe study included 36 patients (15 men, 21 women, average age 34.9 years) with schizophrenia. In 17 cases, apathetic depressions occurred as short-term episodes, in 19 cases, depression took a persistent (close to chronic) course.Results Schizophrenia with an episodic type of dynamics of apathetic depressions was characterized by: the predominance of cases with early onset of the disease; alternation of apathetic and other type depressions; equal occurrence of mono- and bipolar types of desease; low severity of negative symptoms and slight changes in social and labor functioning. Apathy has always been present during the whole lenght of depression, its picture was dominated by a motivational decline. The studied cases were prognostically favorable. The features of the course of schizophrenia with chronic apathetic depression were: hyperthymic (10 out of 19 observations) and sensitive schizoid (6 out of 19 observations) premorbid personality; bipolar forms of the disease (94.7%, p < 0.05); the predominance of apathetic depression over other depression types, atypical form of depression; short duration of remissions; frequent course of the disease with the presence of only apathetic depressions (12 out of 19, 63.1%, p < 0.05); significant severity of negative symptoms. Apathy occupied only as a part of the duration of the state, as a rule, after anxiety depression. The picture of apathy was dominated by a decrease in initiative or motivation. This clinical group is the most prognostically unfavorable.ConclusionsSchizophrenia, occurring with the presence of persistent forms of apathetic depression, has a greater impact on the functioning of patients and has a less favorable prognosis.Disclosure of InterestNone Declared

A RARE CASE OF OVARIAN AGENESIS AND HYPOPLASTIC UTERUS IN A PREPUBERTALGIRL WITH NORMAL 46, XX KARYOTYPE

Delayed onset of puberty and primary amenorrhea pose diagnostic challenges, often associated with diverse etiologies including hypothalamic-pituitary disorders, gonadal dysgenesis, and müllerian duct malformations.Historically, such syndromes have been associated with XY chromosomal components, but rare cases in karyotypically normal females (46, XX) have been reported. Comparisons with similar cases, including atypical forms of Mayer-Rokitansky-Küster-Hauser (MRKH) syndromeare made, highlighting the rarity of this condition. Despite advancements, the genetic basis remains unspecified, underscoring the need for further research. We present a unique case of gonadal agenesis and hypoplastic uterus in a 46,XX individual, without associated organ system anomalies, contributing to primary amenorrhea. Diagnostic evaluations including hormonal assessment, and pelvic MRI confirmed the absence of ovaries and severe hypoplasia of paramesonephric duct (PMND) derivatives. Treatment with 17beta estradiol successfully induced puberty, highlighting the clinical importance of timely intervention. Early detection of such cases is crucial for providing comprehensive support and improving patient outcomes.

Dirofilariasis presenting as subcutaneous nodule: a case report and review of literature

Dirofilariasis is an emerging rare zoonotic disease in which man is a dead-end host and it is transmitted by mosquitoes. The cases of dirofilariasis are increasing over the past few years. Several species of the genera Culex spp., Aedes spp., and Anopheles spp. are involved in the transmission of this parasite. These species represent a constant risk of infection because they feed on both animal and human hosts. For this reason, dirofilariasis is considered an emerging public health problem because of its zoonotic potential. Most of the cases are ocular and subcutaneous presentations are rare. Here, we present a rare case of dirofilariasis presenting as a subcutaneous swelling near the knee joint. Dirofilariasis should be kept in mind as one of the differential diagnosis of subcutaneous nodule. In endemic areas, it can present in atypical forms like rash similar to this case; therefore, clinicians should be aware about this disease.

The employee and their social security in flexible forms of employment on the example of Poland – selected issues. Part I

The regulation of employment and social policy – with safe and secure conditions of employment in terms of remuneration, safe employment conditions, protection in the event of dismissal, social dialogue, personal data protection, work-life balance, and finally a healthy, safe and well-adjusted work environment – constitutes the foundations of decent working conditions. At the same time, the task of a democratic state is to adjust the dynamically changing economic and market realities to ensure the maximum level of protection in the areas mentioned above relevant to each employee. This situation is also due to the radically progressing digitization that is changing the challenges of the modern labour market. In this article, the author endeavours to address the social security issue of selected flexible (atypical) forms of employment, including employee and non-employee forms of employment. The author chose fixed-term contracts and employment on digital platforms as the subject of analysis, while remaining aware of the multifaceted nature of social security. In this paper, she defends the thesis that the so-called “flexibility of employment relations” should be subject to the broader impact of social security regulations in situations where there are no normative obstacles to them being extended.

Outbreak of African Swine Fever in Government Pig Farm at Ranchi, Jharkhand

An atypical form of African swine fever was recorded in pigs of Government pig farm at Ranchi Jharkhand. In this outbreak a total of 1240 pigs died within 30 days. Upon laboratory examination the disease was confirmed to be African swine fever.Immediately rest of the pigs were isolated and biosecurity measures were ensured. The present case report deals with the outbreak of African swine fever virus in a Government Pig Farm at Kanke, Ranchi (Jharkhand) with 95.3% mortality in pigs.

Atypical Form of Unilateral Optic Neuropathy Caused by Ocular Toxocariasis

Purpose: To report an atypical form of ocular toxocariasis presenting as unilateral optic neuropathy.Case summary: A 75-year-old man was referred to our clinic owing to the recently developed visual difficulty in his right eye. The visual acuity of the right eye was 0.4, a relative afferent pupillary defect was positive in the right eye. On slit lamp biomicroscopy, anterior chamber inflammation and vitreous cells and haze were detected in the right eye. On fundus examination, optic disc swelling and focal retinitis around the optic disc were found in the right eye. Fluorescein angiography revealed focal retinitis along with leakage near the optic disc in the right eye. Serology was positive for Toxocara IgG. Under the suspicion of an atypical form of ocular toxocariasis, the patient was treated with local and oral steroids and albendazole. Subsequently, optic disc swelling and vitreous inflammation improved, but the final visual acuity was 0.125 with pale optic disc and central visual field defects in the right eye.Conclusions: In patients suspected of optic neuritis, when the anterior chamber and vitreous inflammation and uveitis are accompanied, ocular toxocariasis can present atypically and requires attention because may have a bad prognosis owing to irreversible optic nerve damage.

The Atypical Forms of Employment Acceptance by Polish Full-Time Employees as per Modern Labour Market Rules in an EU-Country Context

This manuscript is dedicated to atypical forms of employment which are a response to transactional relations between the employee and the employer on the modern labour market. The general research question is whether employees who accept atypical forms of employment (or “AFE”; readiness to providing work) obtain benefits in the form of high employability and well-being as well as low levels of job insecurity. The assumptions and the research scheme are new compared to previous studies. A quantitative CAWI study was conducted on a sample of Polish full-time employees (N = 543), as potentially voluntarily declaring their acceptance of AFE. In addition, well-being was operationalised according to C. Ryff ’s approach as a sense of agency in the creation of the professional environment. The respondents were divided into two groups – those accepting AFE and those accepting traditional, long-term employment, in reference to the concept of transactional and relational psychological contract. The regression analysis shows that the first group had a high level of employability. However, they achieved low levels of well-being, and job insecurity was not significant. These are individuals in managerial positions in the private sector. On the other hand, the group that accepts the traditional form of relationships are public sector employees and have high job insecurity only. An important determinant of the acceptance of AFE is the so-called “Big Five trait” openness. In addition, the level of acceptance decreases with age. Gender and education are not statistically significant. The focus in this paper on full-time employees, and the benefits of AFE, fill the research gap in this area. It also delivers recommendations for labour market practices and policy on how to support employees on the modern labour market in EU countries.

Isolated anterior cerebral artery occlusion: an atypical form of moyamoya disease

BackgroundThe relationship between anterior cerebral artery (ACA) occlusion and moyamoya disease (MMD) has rarely been studied. In this study, we focused on a special type of MMD: isolated ACA-occlusive MMD....

Clinical features and management of women with Mayer-Rokitansky-Küster-Hauser syndrome in a Thai population.

This study aimed to describe the clinical features, associated extragenital anomalies, and management of Mayer- Rokitansky-Küster-Hauser (MRKH) syndrome in a Thai population. This retrospective study analyzed the medical records of 96 patients with MRKH syndrome diagnosed and treated at a university hospital and tertiary referral center in southern Thailand between 2000 and 2022. The study included 96 patients with MRKH syndrome. The most common symptom was primary amenorrhea (88.5%), followed by difficulty or inability to engage in sexual intercourse (9.4%) and pelvic mass (2.1%). Notably, 80.3% of the patients did not have extragenital malformations and were diagnosed with MRKH type I (typical form), whereas 19.7% were categorized as MRKH type II (atypical form). Skeletal malformations were the most frequent extragenital anomalies and were present in 19.5% of patients, with scoliosis being the most common skeletal condition. Other extragenital malformations included renal (8.5%) and neurological (1.0%) abnormalities. Clinical vaginal examination revealed complete atresia in 21.8% and vaginal hypoplasia (median vaginal length, 3 cm) in 78.2% of the patients. Half of the patients did not receive treatment because they had not engaged in sexual intercourse. In this cohort, 41.7% of the patients had no difficulty performing sexual intercourse. Hence, self-dilation therapy or concomitant dilation was recommended. Only eight patients (8.3%) underwent surgical reconstruction of the vagina. This study confirmed the complexity and heterogeneity of the phenotypic manifestations of MRKH, including the degree of vaginal atresia and types and rates of associated malformations.

Peculiarities of the Clinical Picture of Hirschsprung’s Disease in Children of the First Year of Life Taking Into Account the Extent of Aganglionosis

The aim of the work. To investigate the peculiarities of the clinical course of Hirschsprung’s disease in children of the first year of life and to determine the significance of symptoms in the verification of the disease.
 Research materials and methods. Since 1980 up to 2021, at the pediatric surgery clinic of the National Medical University named after O.O. Bohomolets on the basis of the National Children’s Specialized Hospital “OKHMATDYT” and in the pediatric surgery clinic of the Ivano-Frankivsk National Medical University on the basis of the Ivano-Frankivsk Regional Children’s Clinical Hospital, there were examined and treated 483 children of the first year of life suffering from Hirschsprung’s disease.
 Results of the study. The clinical manifestation and course of aganglionosis varied in length at the time of hospitalization and depended on the time after birth. During the first month of life, 97 (20.08%) patients were hospitalized; of them 39 (8.07%) patients had an atypical clinical picture due to: colonic atresia in 15 (3.10%), colonic atresia + gastroschisis in 3 ( 0.62%), ileal atresia in 9 (1.86%), esophageal atresia in 3 (0.62%), cleft of the hard and soft palate in 9 (1.86%) patients. Depending on the age, there were 280 (57.97%) patients under 6 months, and 203 (42.03%) patients between 6 months and 1 year. The classic typical clinical picture was in 444 (91.93%) patients, which was characterized by the absence of meconium excretion, abdominal distension in 444 (91.93%) patients, delayed physiological weight gain against the background of nutritional insufficiency with the development of hypotrophy in 327 (67.70%) patients, vomiting of stagnant gastric and intestinal contents in 417 (86.34%) patients. On the other hand, there occurred enterocolitis in 315 (65.22%) patients, toxic megacolon in 16 (3.31%) patients, and anemia of various degrees in 241 (49.89%) patients, among the complications that arose during the examination of patients with Hirschsprung’s disease. According to the results of a comprehensive examination, the following extent of aganglionosis was determined: rectal form in 100 (20.70%) patients, rectosigmoid form – in 192 (39.75%), subtotal – in 150 (31.06%) and total in 41 (8.49%) patients. Concomitant malformations were found in 98 (20.29%) patients: renal malformations were diagnosed in 7 (1.45%) patients, concomitant heart malformations in 18 (3.73%) patients. Associated intraoperative findings were: Meckel’s diverticulum in 5 (1.03%) patients, and congenital cyst of the right ovary in 1 (0.21%) patient. The clinical course was affected by the concomitant malformations: incomplete bowel rotation in 10 (2.07%) patients and internal abdominal hernia in 2 (0.42%) patients.
 Conclusions. Clinical manifestations and course of HD primarily depend on the presence of accompanying developmental defects, which may prevail during the examination due to vital disorders. In the clinical course of Hirschsprung’s disease, it is necessary to distinguish between typical and atypical forms. Typical clinical symptoms were in 444 (91.93%), and atypical in 39 (8.07%) patients.

Features of clinical manifestations of secondary syphilis in a HIV infected patient

Syphilis and human immunodeficiency virus (HIV) infection are diseases of an infectious nature with a predominantly sexual route of infection. Despite the decrease in the incidence of syphilis in recent years in Russia, there is an increase in HIV infection.
 The combination of several infections in one patient leads to changes in clinical manifestations, which sometimes significantly complicates their diagnosis, leading to a late start of treatment. Syphilis against the background of HIV infection proceeds in stages, but usually it has a malignant, aggressive and severe course, often with the development of atypical forms and complications.
 The primary syphilis against the background of HIV infection is characterized by the appearance of ulcerative-necrotic character of the hard chancre, such severe complications as phagedenism and gangrenization, the frequent addition of a secondary infection, severe soreness of the hard chancre. Secondary syphilides in HIV-infected patients are characterized by the appearance of ulceration with the formation of necrotizing vasculitis, extraordinary infectiousness of the elements. The disease progresses rapidly and over a few months from the moment of infection, manifest neurosyphilis or tertiary syphilis may develop due to immunodeficiency.
 The authors describe the features of the manifestations of syphilis in its different periods against the background of HIV infection. A clinical case of a 35-year-old woman who was diagnosed with secondary syphilis and HIV infection is presented. The patient had numerous skin rashes, which were interpreted differently by doctors of different specialties for 2 months. The patient was diagnosed with pyoderma, "allergy", infectious exanthema, however, against the background of the treatment, there was a negative dynamics of the skin process. The authors have demonstrated the effectiveness of specific therapy: complete resolution of skin rashes.

Mapping social protection coverage for platform workers: A comparative analysis of Belgium, Italy and the Netherlands

The aim of this paper is to examine if and how the reclassification of platform workers from self-employment status to employment status can provide them with adequate social security protection. Little is known about how this transition would guarantee platform workers adequate social protection within the social protection scheme for employees. National social security schemes, in particular income replacement benefit schemes, often (still) depart from the standard employment relationship, leading to lower protection for atypical work forms. Platform workers combine several of the characteristics of atypical forms of work, such as low earnings, irregular working patterns and working. Integrating platform workers into employee social security schemes faces additional challenges due to the online nature of their work, algorithmic management, high levels of unpaid labor, and employer identification difficulties. This paper focuses on unemployment protection, as EU Member States struggle to provide adequate protection for workers with irregular work patterns and income fluctuations, in the case of (short term) income replacement benefits. By constructing nine ideal work patterns reflective of diverse nature of platform work and current practices among platform work, we analyse how different types of ‘employed’ platform workers may fare within the legislation of three EU countries (Belgium, Italy, and the Netherlands). This approach allows us to assess the applicability of unemployment protection to different working patterns among 'employed' platform workers, considering formal, effective, and adequate access to unemployment schemes as outlined in the Council Recommendation on access to social protection for workers and the self-employed (2019).

Association between sacroiliac joint forms and subchondral changes in patients with Crohn's disease.

To assess the relationship between anatomical variants of sacroiliac joint (SIJ) and subchondral changes detected in magnetic resonance enterography (MRE) in patients with Crohn's disease (CD). This was a retrospective study of 60 CD patients, who were divided into two groups: with (n = 16) and without SIJ (n = 44) involvement, depending on the presence of inflammatory (bone marrow edema) and structural changes (sclerosis and erosions) in MRE. Anatomical variants of SIJ were assessed in CT of the abdomen and/or pelvis, distinguishing typical form with convex iliac surface and atypical forms. Univariate and multivariate analyses were performed to reveal an association between joint changes and forms. Our study included 60 patients (38 males; mean age 38.72 years ± 13.33). Patients with SIJ changes were older (p = .044). No significant differences in CD localization and behavior were found. The most common SIJ lesions were structural changes (in 75% of patients); the main atypical form was the iliosacral complex. The univariate and multivariate analyses showed a significant association of atypical forms with total subchondral changes (odds ratio [OR]: 3.429, 95% confidence interval [CI] 1.043-11.268; p = .042; OR: 5.066, 95% CI: 1.273-20.167; p = .021, respectively), and with structural changes (OR: 4.185, 95% CI: 1.155-15.160; p = .029; OR: 5.986, 95% CI: 1.293-27.700; p = .022, respectively). Atypical forms of SIJ are a risk factor for the occurrence of structural joint changes in CD patients. An association between bone marrow edema and atypical forms was not found.

“Waiters’ dictatorship…”. The fight of food establishments in Warsaw and Lublin in 1919 in the local press

Poland’s regaining of independence in 1918 contributed to increased activi­ty of workers’ movements. Employees who wanted improved working con­ditions, normalised work hours and increased wages in many cases organi­sed demonstrations to achieve their goals. Members of the Trade Union of Waiters with the central office in Warsaw, who could not communicate with the stubborn owners of restaurants and cafes, undertook atypical forms of striking, which sometimes became a threat to the health and lives of the customers. Members of the Lublin branch, following the example of the wa­iters from Warsaw, organised many protests in restaurants, at the same time disputing with their employers in the local press.

Identification of Factors Associated with Mortality in the Elderly Population with SARS-CoV-2 Infection: Results from a Longitudinal Observational Study from Romania.

The progression of SARS-CoV-2 infection has been linked to a hospitalization rate of 20%. The susceptibility of SARS-CoV-2 infection increases with age, resulting in severe and atypical clinical forms of the disease. The severity of SARS-CoV-2 infection in the elderly population can be attributed to several factors, including the overexpression of angiotensin-converting enzyme 2 (ACE2) receptors, immunosenescence, and alterations in the intestinal microbiota that facilitate the cytokine storm. In light of these observations, we conducted a retrospective analysis based on prospectively collected data between 23 December 2021 and 30 April 2022 (the fourth wave of SARS-CoV-2 infection). We analyzed patients aged over 60 years who were hospitalized in a county hospital in Romania. The primary objective of our study was to assess the risk factors for an unfavorable outcome, while the secondary objective was to assess the clinical and baseline characteristics of the enrolled patients. We included 287 cases with a complete electronic medical record from this available cohort of patients. We aimed to retrospectively evaluate a group of 127 patients that progressed, unfortunately, toward an unfavorable outcome versus 160 patients with a favorable outcome. We used the Combined Ordinal Scale of Severity that combines the WHO ordinal scale and the degrees of inflammation to assess the severity of the patients at the time of the initial assessment. The age group between 70 and 79 years had the highest percentage, accounting for 48.0%-61 patients, of the deceased patients. We noted statistically significant differences between groups related to other cardiovascular diseases, nutritional status, hematological diseases, other neurological/mental or digestive disorders, and other comorbidities. Regarding the nutritional status of the patients, there was a statistically significant unfavorable outcome for all the age groups and the patients with a BMI > 30 kg/m2, p = 0.004. The presence of these factors was associated with an unfavorable outcome. Our results indicate that with the presence of cough, there was a statistically significant favorable outcome in the age group over 80 years, p ≤ 0.049. In terms of the presence of dyspnea in all groups of patients, it was associated with an unfavorable outcome, p ≤ 0.001. In our study, we analyzed laboratory test results to assess the level of inflammation across various WHO categories, focusing on the outcome groups determined by the average values of specific biomarkers. Our findings show that, with the exception of IL-6, all other biomarkers tend to rise progressively with the severity of the disease. Moreover, these biomarkers are significantly higher in patients experiencing adverse outcomes. The differences among severity categories and the outcome group are highly significant (p-values < 0.001). CART algorithm revealed a specific cut-off point for the WHO ordinal scale of 4 to stand out as an important reference value for patients at a high risk of developing critical forms of COVID-19. The high death rate can be attributed to proinflammatory status, hormonal changes, nutritional and vitamin D deficiencies, comorbidities, and atypical clinical pictures.

Research progress on the pathogenesis of chest tightness variant asthma characterized by chest tightness.

Chest tightness variant asthma (CTVA) is an atypical form of asthma with chest tightness as the sole or predominant symptom. The underlying receptors for chest tightness are bronchial C-fibers or rapidly adapting receptors. The nerve impulses are transmitted via the vagus nerve and processed in different regions of the cerebral cortex. Chest tightness is associated with sensory perception, and CTVA patients may have heightened ability to detect subtle changes in lung function, but such sensory perception is unrelated to respiratory muscle activity, lung hyperinflation, or mechanical loading of the respiratory system. Airway inflammation, pulmonary ventilation dysfunction (especially involving small airways), and airway hyperresponsiveness may underlie the sensation of chest tightness. CTVA patients are prone to comorbid anxiety and depression, which share similar central nervous system processing pathways with dyspnea, suggesting a possible neurological basis for the development of CTVA. This article examines the recognition and mechanisms of chest tightness, and explores the pathogenesis of CTVA, focusing on its association with airway inflammation, ventilation dysfunction, airway hyperresponsiveness, and psychosocial factors.

MURCS Syndrome: Atypical form of Mayer–Rokitansky–Kuster–Hauser Syndrome

MURCS Syndrome: Atypical form of Mayer–Rokitansky–Kuster–Hauser Syndrome

Pyoderma Gangrenosum in Inflammatory Bowel Disease: A Rare Case Involving Mandibular, Elbow, and Pubic Ulcers

Pyoderma gangrenosum (PG) is a rare, inflammatory skin condition primarily characterized by painful ulcers with undermined borders, commonly occurring on the lower extremities. In approximately fifty percent of cases, PG is associated with underlying systemic diseases, including inflammatory bowel disease (IBD), inflammatory arthritis, or myeloproliferative disorders. PG is notorious for its variable clinical manifestations, which can closely resemble other dermatological conditions, often leading to misdiagnosis and inappropriate treatment. This case underscores the importance of including PG in the differential diagnosis for patients with ulcerative skin lesions to ensure prompt diagnosis and treatment. Furthermore, it highlights the necessity of screening for IBD in patients diagnosed with PG.

The morphofunctional state of pregnant sheep in the last stages of gestation is normal and with symptoms of eclampsia

Sheep in the last stages of pregnancy showed signs of eclampsia, such as proteinuria, hypertension, swelling of the abdominal wall, and coma. Based on the diagnoses, two groups of 20 sheep with eclampsia were created: typical and atypical signs, in each, and one group of clinically healthy animals. From each group, 5 animals were slaughtered. In sheep suffering from eclampsia, a decrease in the total mass of the placenta and its cotyledons, as well as an increase in the length of the umbilical cord, was also found. Standard histological and histochemical studies were performed on the obtained placental samples. As a result, it was found that the average thickness of the integumentary epithelium of the caruncles in ewes with a typical form of eclampsia was 14.3 ± 1.7 μm, and in sheep with an atypical form - 15.5 ± 1.9 μm, compared with 27.9 ± 1 .9 µm in the physiological course of gestation. This leads to a general decrease in the thickness of the layers of connective tissue separating the crypt and villi of the cotyledons. In addition, the cytoplasm of cells exhibits dystrophic modifications along with a decrease in the ability to store glycogen. Dystrophic changes are present in the cytoplasm of cells, which contributes to a decrease in glycogen storage.