Category Of Patients Research Articles

Treatment of Patients with Local Stages of Newly Diagnosed Classical Hodgkin Lymphoma: A Literature Review, Current Approaches, and Our Own Experience

Aim. To determine an optimal amount of program therapy for patients with local (I/II) stages of newly diagnosed classical Hodgkin lymphoma (cHL) who are stratified into prognostic groups by different risk factors (RF).
 Materials & Methods. The present study is based on the clinical data from 125 patients with local (I/II) stages of newly diagnosed cHL. All of them were treated at the NN Blokhin National Medical Cancer Research Center from 2000 to 2022. The patients were aged 18–67 years (median 29 years), most of them were women (n = 90; 72 %). The patients were stratified into 3 prognostic groups with respect to the following RFs: В-symptoms, ESR level, bulky mediastinum, lesion number, and stage E. Group 1 regarded as prognostically favorable (stages I/IIA without RFs) included 22 (18 %) patients; group 2 with intermediate prognosis (stages I/IIA–В, ≥ 3 lesions and/or ESR ≥ 30 mm/h with B-symptoms or ESR ≥ 50 mm/h without them) consisted of 45 (36 %) patients; group 3 regarded as prognostically unfavorable (stages I/IIА, bulky mediastinum and/or extranodal lesions, i.e. stage Е) included 58 (46 %) patients. In group 1, there were no patients with B-symptoms. In group 3, patients with intoxication symptoms were excluded from the analysis. Chemotherapy programs in prognostic groups (risk groups) differed: 2–4 ABVD cycles in group 1 and 6 EACOPP-14 cycles in group 3. Both regimens were used in group 2. This was the category of patients with intermediate prognosis which required modifications in the drug therapy program due to the interim PET2 results and continued in the form of de-escalated treatment: 2 ЕАСОРР-14 cycles → PET2-negative status → 2 AVD cycles (n = 20). This model proved to be most effective by the present study and did not exclude the applicability of the programs either with 4 cycles of ЕАСОРР-14 alone (n = 12) or 4–6 cycles of ABVD alone (n = 13) in the group of intermediate prognosis. After completing the drug therapy phase, radiotherapy was performed in 113 (91 %) patients.
 Results. The median follow-up was 46 months. Taken as a whole, the treatment showed high efficacy: the 5-year progression-free survival appeared to be 93 %, and the 5-year overall survival was 99 %.
 Conclusion. The stratification of patients into 3 prognostic groups (favorable, intermediate, and unfavorable) provides the basis for determining a drug chemotherapy program which would be optimal in its amount, efficacy, and toxicity profile for patients with local stages of newly diagnosed cHL. Further study of escalation and de-escalation strategies in the program chemotherapy for patients with stages I/IIA of newly diagnosed cHL having or not having a bulky tumor mass in mediastinum, based on PET2 results, can help to improve, first of all, the quality of life of patients as well as short- and long-term chemotherapy outcomes in general. In this context, chemotherapy escalation is possible in the cases of PET2-positive status, whereas its de-escalation would be considered in the cases of PET2-negative status.

Multifocal motor neuropathy: long-term clinical and electrophysiological features of the disease

Little attention has been paid abroad to the problem of the long-term course of multifocal motor neuropathy (MMN). In our country, catamnestic studies of MMN have not been conducted at all. However, the results of such an analysis are extremely important for understanding the course and prognosis of the disease.Objective: to analyse the clinical and neurophysiological data of patients with MMN with a disease duration of more than 5 years.Material and methods. The study included 28 patients with MMN: 9 women (32%) and 19 men (68%); the median age at admission was 50 [44; 56] years; the median disease duration was 10 [8; 13] years. Medical documentation, medical history, complaints, neurological examination results (scored on the MRC and INCAT scales) and results of electroneuromyography (ENMG) of the long nerves of the hands were analysed.Results. The median time between onset of the disease and diagnosis was 5.5 [2; 10] years. Paresis <3 points on the MRC scale was found in the extensor muscles of the hand and fingers (12/28; 43%), in the median (15/28; 53%) and ulnar (20/28; 71%) muscle groups of the hands, in the extensors (11/28; 39%) and flexors (9/28; 32%) of the feet. The median total score for the degree of disability on the INCAT scale was 3 [2; 3] for the hands and 1 [0; 2] for the legs. The comparative analysis of the severity of the neurological deficits on the MRC and INCAT scales at the onset of the disease and in the long-term catamnesis revealed no significant differences (p>0.05). An objective assessment of sensory disorders revealed no changes when testing tactile, pain and temperature sensitivity, while half of the cases (14/28; 50%) showed a disturbance of vibration sensitivity in the lower extremities. The ENMG examination was consistent with the electrophysiological criteria of the disease, one third of the patients showed significant secondary damage to the axons of the motor fibers of the hand nerves, and in half of the cases a slight impairment of the axons of the sensory fibers was registered.Conclusion. MMN is a curable disease. Unfortunately, our retrospective analysis showed that in the Russian Federation there are problems with its diagnosis and quality care of this category of patients. Late diagnosis, delayed start of treatment and non-compliance with the schedule of pathogenetic therapy lead to persistent disability of patients.

Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: an overview of current practice and evidence.

Cardiac arrest (CA) is acommon and potentially avoidable cause of death, while constituting asubstantial public health burden. Although survival rates for out-of-hospital cardiac arrest (OHCA) have improved in recent decades, the prognosis for refractory OHCA remains poor. The use of veno-arterial extracorporeal membrane oxygenation during cardiopulmonary resuscitation (ECPR) is increasingly being considered to support rescue measures when conventional cardiopulmonary resuscitation (CPR) fails. ECPR enables immediate haemodynamic and respiratory stabilisation of patients with CA who are refractory to conventional CPR and thereby reduces the low-flow time, promoting favourable neurological outcomes. In the case of refractory OHCA, multiple studies have shown beneficial effects in specific patient categories. However, ECPR might be more effective if it is implemented in the pre-hospital setting to reduce the low-flow time, thereby limiting permanent brain damage. The ongoing ON-SCENE trial might provide adefinitive answer regarding the effectiveness of ECPR. The aim of this narrative review is to present the most recent literature available on ECPR and its current developments.

Comparison of luteal phase stimulation with follicular phase stimulation in poor ovarian response: a single-blinded randomized controlled trial

BackgroundIn the last decade, luteal-phase ovarian stimulation (LPOS) has been suggested as an alternative controlled ovarian stimulation (COS) protocol for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles mainly in women with a history of poor ovarian response (POR). The present randomized controlled trial study aimed to compare the outcomes of follicular phase ovarian stimulation (FPOS) and LPOS protocols in POR cases undergoing ICSI cycles.MethodsSeventy-eight POR patients who met the Bologna criteria and underwent an ICSI cycle were included. In this study, 39 POR cases were allocated to the FPOS group, and 39 POR cases were allocated to the LPOS group. The primary outcome was the number of metaphase II (MII) oocytes. In addition, the total number of oocytes, number of top-quality day 3 embryo, day 3 embryo development rate, chemical pregnancy and clinical pregnancy rates were defined as secondary outcomes.ResultsThe obtained results demonstrated that the number of MII oocytes significantly increased in the LPOS group compared to the FPOS group (P = 0.007). However, there was no significant difference between the two groups regarding the number of GV and MI oocytes, number of top-quality day 3 embryos and day 3 embryo development rate among both categories of patients. Also, the number of total and MII oocytes was significantly higher in the LPOS group (P = 0.016).ConclusionThese results suggest that LPOS protocol effectively increases the number of mature oocytes in women with a history of POR.Trial registrationIRCT20210405050852N1 (Registered at Iranian registry of clinical trials; available at https://en.irct.ir/trial/55402).

Post-traumatic seizures and factors associated among adult patients with depressed skull fractures at Mulago National Referral hospital; cross-sectional study

IntroductionPost-traumatic seizures (PTS) are common among patients with depressed skull fractures (DSF). Understanding the burden of post traumatic seizures and the factors associated among adult patients with DSF is important to improve clinical care. ObjectiveTo determine the prevalence and factors associated with post-traumatic seizures among adult patients with DSF at Mulago National Referral hospital (MNRH). MethodsA cross-sectional study was conducted among 333 study participants between March 2021 and February 2022. Socio-demographic, clinical laboratory factors and anti-seizure medications were collected using a study questionnaire. Data was analysed to determine the prevalence of PTS and factors associated with occurrence of PTS among patients with DSF. ResultsThe mean age (±SD) of study participants was 31.2, (±10.5) years, with a male to female ratio of 10.4:1. Nearly half of the study participants had attained secondary level of education, while 31.6 % (105) were peasants (subsistence farmers). The overall prevalence of PTS among DSF study participants was 16.2 % (54participants). Late presentation of PTS was the highest at 9.0 % (30) followed by early PTS at 3.9 % [13] and immediate PTS at 3.3 % [11]. Moderate Glasgow coma score (GCS: 9–13), p < 0.015, severe traumatic brain injury (GCS: 3–8), p < 0.026 at the time of admission and midline brain shift (≥5mm), p < 0.009 were associated with PTS. Phenytoin (94.3 %) was the most commonly used ASM followed by phenobarbitone (1.4 %) and Valproate (1.1 %) among study participants. ConclusionPatients with moderate and severe traumatic brain injury and midline brain shift were associated with post traumatic seizures. Early identification and intervention may reduce the burden of posttraumatic seizures in this category of patients.

Biological mechanisms of resistance to immune checkpoint inhibitors and overcoming this resistance: Challenges in medical oncology

Immune checkpoint inhibitors have opened up new possibilities in clinical oncology. Monoclonal antibodies have shown their high clinical efficiency. They block CTLA-4, PD-1, and PD-L1 receptors and activate the immune response. Many patients have stable and even complete responses. However, some patients have primary or acquired resistance. Therefore, the treatment results in this category of patients are not predictable. Mechanisms of resistance to immune checkpoint inhibitors have not been definitively studied. Many theories try to explain the mechanisms of this phenomenon. Our study aimed to structure and combine the data into groups depending on the etiological factor that reduces the immune response. In addition, based on understanding the mechanisms of resistance and the results of recent clinical studies, we aimed to identify the main ways to overcome it. Therefore, mechanisms that lead to resistance may be associated with tumor properties, tumor microenvironment, or patient characteristics. Tumor properties that reduce the immune response include a) low tumor mutation burden and loss of tumor neoantigens, b) changes in the processing or presentation of neoantigens, and c) changes in signaling pathways of tumor development and epigenetic modifications in genes. The tumor microenvironment is represented by stromal and immune cells, extracellular matrix, cytokines, and blood vessels. Each structure can enhance or reduce the immune response and contribute to the acquired resistance to immune checkpoint inhibitors. The effectiveness of the treatment depends not only on the cells in the tumor microenvironment but also on the metabolic background. In addition, the basic characteristics of the patient ( gender, gut microbiota, HLA-I genotype) can modify the immune response. Based on knowledge about the mechanisms of resistance to immune checkpoint inhibitors, several therapeutic strategies aimed at activating antitumor activity have been evaluated. All of them are based on combining immune checkpoint inhibitors with other drugs. One of the most common options is a combination of PD-1/PD-L1 and CTLA-4 inhibitors. Alternative immune checkpoints are TIM-3, LAG-3, TIGIT and VISTA. Combining immunotherapy with chemotherapy, targeted therapy, neoangiogenesis inhibitors, epigenetic modifiers, PARP or TGF-β inhibitors enhances antitumor response by preventing depletion of effector T cells, enhancing T cell infiltration in the tumor, changes on the tumor microenvironment, and decreasing the accumulation of immunosuppressive cells. This review explores the biological mechanisms of resistance and potential ways of solving this problem.

Organ-preserving technologies of surgical treatment of pulmonary tuberculosis using VAC therapy

This article demonstrates the possibilities of vacuum-assisted closure (VAC therapy) in surgical treatment of one of the most severe categories of patients — patients with chronic pulmonary tuberculosis with widespread drug resistance. The authors show the effectiveness of VAC therapy in various clinical situations: VAC therapy in combination with endoscopic valvular bronchoblocation, as an independent treatment method in a patient with bilateral fibrous-cavernous pulmonary tuberculosis, as well as a combination of VAC therapy with retrograde occlusion of bronchial fistula. The special feature of these cases is the performance of low-trauma organ-preserving operations in patients with no prospect of cure by conservative methods.

Recurrent Respiratory Infections in Children with Down Syndrome: A Review.

Down Syndrome (DS) is the most common chromosomal abnormality compatible with life. The life of patients suffering from DS can be strongly impacted by Recurrent Respiratory tract Infections (RRIs), leading to an increased rate of hospitalisation, a higher need for intensive care and fatality. With a literature review, we summarise here the main etiological factors for RRI in this category of patients, particularly focusing on airway malformations such as tracheomalacia, tracheal bronchus and bronchomalacia, comorbidities associated with the syndrome, like congenital heart diseases, dysphagia, gastroesophageal reflux, musculoskeletal involvement and obesity, and immunologic impairments, involving both innate and adaptive immunity. For these patients, a multidisciplinary approach is imperative as well as some preventive strategies, in particular vaccinations in accordance with their national schedule for immunization.

Effect of Vitamin D Receptor Gene Polymorphism (ВsmI, FokI) and its Concentration on the Severity of Covid-Associated Lung Damage

Objective. To identify the relationship between the serum vitamin B content and the polymorphism of the vitamin B receptor gene with the severity of the course of COVID-19-associated lung damage.To identify the relationship between serum vitamin D content and polymorphism of the vitamin D receptor gene with the severity of COVID-19- associated lung damage. Materials and methods. The paper presents the results of an examination of 200 people, after 1 month suffering COVID-associated lung damage in the period from June 1 to October 31, 2020. The patients were divided into groups of 50 people depending on the degree of lung damage based on the results of computed tomography: group 1 (CT-1), median by age was 51.5 [50.5; 54.8]; group 2 (CT-2), median by age 57.0 [53.1; 57.0]; group 3 (CT-3), median by age 52.5 [51.9; 55.0]; group 4 (CT-4), median 55.0 [53.2; 56.4]. The control group included 56 relatively healthy people who did not have coronavirus infection; the median age was 55.0 [51.1; 55.0]. All groups were comparable in age and gender. The concentration of total 25-hydroxyvitamin D (25(OH)D) was studied in blood serum. A molecular genetic study of the vitamin D receptor gene was also carried out: 283 A&gt;G (BsmI) and 2 A&gt;G (FokI). Results. It was revealed that insufficient levels of 25(OH)D in the blood are one of the risk factors for the development of COVID-19 infection, as well as a risk factor for worsening the course of COVID-19-associated lung damage. Analysis of the polymorphism of the vitamin D receptor gene VDR: 283 A&gt;G showed the predominant inheritance of allele A and homozygote A/A in patients with a high level of damage to lung tissue due to COVID-19 infection — KT-3, 4. Study of polymorphism of the vitamin D receptor gene VDR: 2 A&gt;G showed preferential inheritance of homozygote A/A among patients compared to the control group. When studying the concentration of vitamin D in patients with COVID-19-associated lung damage depending on the polymorphism of the vitamin D receptor genes VDR: 283 A&gt;G (BsmI) and VDR: 2 A&gt;G (FokI), no differences were found. Conclusion. Insufficient levels of 25(OH)D in the blood may be one of the factors contributing to the complicated course of coronavirus infection. Analysis of the vitamin D receptor gene polymorphism VDR: 283 A&gt;G showed preferential inheritance of the A allele and homozygote A/A in a more severe category of patients — with more than 50 % damage to the lung tissue (CT-3, 4) against the background of COVID-19 infection. A study of the polymorphism of the vitamin D receptor gene VDR: 2 A&gt;G revealed the most common carriage of the A/A homozygote among patients compared to the control group.

Splanchnic Vein Thrombosis: The State-of-the-Art on Anticoagulant Treatment.

Splanchnic vein thrombosis (SVT) is a rare type of venous thromboembolism occurring within the splanchnic venous system. Portal vein thrombosis is the most common presentation, while Budd-Chiari syndrome is the least common. Liver cirrhosis and abdominal solid cancer are the main local risk factors for SVT, whereas myeloproliferative neoplasms are the predominant systemic risk factors. Signs and symptoms of SVT are nonspecific and include abdominal pain, gastrointestinal bleeding, and ascites. Asymptomatic SVT is not uncommon, and the majority would be detected incidentally on routine abdominal imaging performed for the follow-up of liver diseases and tumors. The management of SVT aims to prevent thrombus progression, promote vessel recanalization, and prevent recurrent venous thromboembolism. Anticoagulation should be started early in order to increase the chances of vessel recanalization and reduce the risk of portal hypertension-related complications. Direct oral anticoagulants have been included in recent guidelines, as alternatives to vitamin K antagonists, after clinical stability has been reached; however, caution is required in patients with liver or kidney dysfunction. Treatment duration is based on the presence (or absence) and type (transient vs. permanent) of risk factors. This narrative review aims to summarize the latest evidence on SVT, with a particular focus on the anticoagulant treatment in special categories of patients (e.g., liver cirrhosis, solid cancer, myeloproliferative neoplasms, pancreatitis, incidentally detected SVT, Budd-Chiari syndrome, and chronic SVT).

Different ventilation intensities among various categories of patients ventilated for reasons other than ARDS––A pooled analysis of 4 observational studies

PurposeWe investigated driving pressure (ΔP) and mechanical power (MP) and associations with clinical outcomes in critically ill patients ventilated for reasons other than ARDS. Materials and methodsIndividual patient data analysis of a pooled database that included patients from four observational studies of ventilation. ΔP and MP were compared among invasively ventilated non–ARDS patients with sepsis, with pneumonia, and not having sepsis or pneumonia. The primary endpoint was ΔP; secondary endpoints included MP, ICU mortality and length of stay, and duration of ventilation. ResultsThis analysis included 372 (11%) sepsis patients, 944 (28%) pneumonia patients, and 2040 (61%) patients ventilated for any other reason. On day 1, median ΔP was higher in sepsis (14 [11-18] cmH2O) and pneumonia patients (14 [11-18]cmH2O), as compared to patients not having sepsis or pneumonia (13 [10-16] cmH2O) (P < 0.001). Median MP was also higher in sepsis and pneumonia patients. ΔP, as opposed to MP, was associated with ICU mortality in sepsis and pneumonia patients. ConclusionsThe intensity of ventilation differed between patients with sepsis or pneumonia and patients receiving ventilation for any other reason; ΔP was associated with higher mortality in sepsis and pneumonia patients. RegistrationThis post hoc analysis was not registered; the individual studies that were merged into the used database were registered at clinicaltrials.gov: NCT01268410 (ERICC), NCT02010073 (LUNG SAFE), NCT01868321 (PRoVENT), and NCT03188770 (PRoVENT–iMiC).

Personalizing Communication of Clinicians with Chronically Ill Elders in Digital Encounters-A Patient-Centered View.

Chronically ill elderly patients are concerned about losing the personal connection with clinicians in digital encounters and clinicians are concerned about missing nonverbal cues that are important for the diagnosis, thus jeopardizing quality of care. This study validated the expectations and preferences of chronically ill elderly patients regarding specific communication messages for communication with clinicians in telemedicine. The sample comprised 600 elderly chronically ill patients who use telehealth. We used a conjoint-based experimental design to test numerous messages. The outcome variable is elder patient expectations from communication with clinicians in telemedicine. The independent variables were known categories of patient-clinician communication. Respondents rated each of the 24 vignettes of messages. Mathematical clustering yielded three mindsets, with statistically significant differences among them. Members of mindset 1 were most concerned with non-verbal communication, members of mindset 2 prefer communication that enhances the internal locus of control, and members of mindset 3 have an external locus of control and strongly oppose any dialogue about their expectations from communication. The use of the predictive algorithm that we developed enables clinicians to identify the belonging of each chronically ill elderly patient in the clinic to a sample mindset, and to accordingly personalize the communication in the digital encounters while structuring the encounter with greater specificity, therefore enhancing patient-centered care.

Survival outcomes of TAVR and self-expanding versus balloon-expandable valves in patients with advanced cardiac dysfunction.

There is a growing body of literature on long-term outcomes post-transcatheter aortic valve replacement (TAVR), but to our knowledge, few research have focused on patients with advanced cardiac dysfunction. This challenging category of patients was excluded from the Partner 3 clinical trial. There are no data to guide the choice of valve type in patients with severely depressed ejection fraction. This study evaluates the safety, efficacy, and outcomes of TAVR in patients with severe aortic stenosis and left ventricular ejection fraction (LVEF)≤35%. It compares post-TAVR survival outcomes with self-expanding (SEV) versus balloon-expandable (BEV) valves in the context of cardiac dysfunction. A retrospective cohort was conducted on 977 patients who underwent TAVR at Toulouse University Hospital between January 2016 and December 2020. The study population included two groups: LVEF≤35% (N=157) and LVEF≥50% (N=820). The group of LVEF≤35% was divided into two subgroups according to the type of implanted device: self-expanding (N=66) versus balloon-expandable (N=91). The living status of each of study's participants was observed in December 2022. Patients with low ejection fraction were younger (82 vs. 84.6years) and commonly males (71.3% vs. 45.6%). Procedural success was almost 98% in both study groups (97.5% vs. 97.9%). The prevalence of all in-hospital post-TAVR complications [acute kidney injury (3.8% vs. 2.2%), major bleeding events (2.5% vs. 3.2%), stroke (1.3% vs. 1.6%), pacemaker implantation (10.2% vs. 10.7%), major vascular complication (4.5% vs. 4.5%), new onset atrial fibrillation (3.2% vs. 3.4%), and in-hospital death (3.2% vs. 2.8%)] were similar between groups (LVEF≤35% vs. LVEF≥50%). No difference in long-term survival has been revealed over 3.4years (P=0.268). In patients with LVEF≤35%, except for post-TAVR mean aortic gradient (7.8±4.2 vs. 10.2±3.6), baseline and procedural characteristics were comparable between SEV versus BEV subgroups. An early improvement in LVEF (from 29.2±5.5 to 37.4±10.8) was observed. In patients with LVEF≤35%, the all-cause mortality rate was significantly higher in BEV than that in SEV subgroups, respectively (40.7% vs. 22.7%, P=0.018). Kaplan-Meier curve showed better survival outcomes after SEV implantation (P=0.032). A Cox regression identified BEV as independent predictor of mortality [HR=3.276, 95% CI (1.520-7.060), P=0.002]. In the setting of low LVEF, TAVR remains a safe and effective procedure not associated with an increased risk of complications and mortality. SEV implantation may likely result in superior survival outcomes in patients with advanced cardiac dysfunction.

State-of-the-Art of Transcatheter Left Atrial Appendage Occlusion.

Left atrial appendage occlusion (LAAO) is an increasingly used alternative to oral anticoagulation in patients with atrial fibrillation, especially in patients with absolute/relative contraindications to these therapies. This review will cover three main aspects of the procedure. In the fist part of the manuscript, we focus on patient selection. We describe three main categories of patients with primary indication to LAAO, namely patients with previous or at a high risk of intracerebral bleeding, patients with a history of major gastrointestinal bleeding and patients with end-stage renal disease and absolute contraindication to novel oral anticoagulants. Some other potential indications are also described. In the second part of the manuscript, we review available devices, trying to highlight different aspects and potential specific advantages. The last section overviews different ways for pre-, intra- and postprocedural imaging, in order to improve procedural safety and efficacy and ameliorate patient outcome. The characteristics of available contemporary devices and the role of imaging in procedural planning, intraprocedural guidance and follow-up are described.

A modern approach to surgical tactics in patients with residual post-tuberculosis changes of lungs

In patients with residual changes after the treatment of destructive forms of tuberculosis (TB), the risk of recurrence of the disease increases significantly. The study of the surgical material of patients with pulmonary TB as a result of the progression of residual post-tuberculosis changes a year or more after the completion of anti-tuberculosis therapy makes it possible to justify the need for surgery in this category of patients. Objective. To substantiate surgical tactics in patients with residual post-tuberculosis lung changes. Materials and methods. The analysis of 1121 adult patients who underwent surgery from 2015 to 2021 for etiologically verified pulmonary TB and completed anti-tuberculosis therapy more than a year before the operation. Of these, 176 patients were divided into two comparable groups: the main group included 37 patients in whom non-tuberculosis mycobacteria (NTMB) DNA was found in the surgical material, the comparison group included 139 patients in whom NTMB was not found in the surgical material. All patients underwent a comprehensive microbiological and morphological examination of the surgical material. Results. In the comparison group, in the majority of operated patients with microbiological screening of surgical material, the etiological diagnosis was positive: the most informative method for both destructive forms of pulmonary TB and forms without destruction was the real-time PCR method: in 82.0% and 87.2% of positive results, respectively, and luminescent microscopy, which allowed to identify acid-resistant Mycobacteria in 67.2% of cases with destructive forms of TB and in 73.1% – without lung destruction In the comparison group, in 19 (13.2%) patients, no evidence of TB was obtained by any screening method, but morphologic examination of surgical material showed the presence of TB inflammation with high activity in 11 (58.0%) and moderate activity in 8 (42.0%) patients. In the main group species identification of NTMB in the surgical material was obtained in the majority of cases, both in forms without destruction of lung tissue and in destructive forms – in 72.2 and 63.3% of patients, respectively, slow-growing NTMB prevailing. Fast-growing NTMB were detected in isolated cases. Morphological examination of the surgical material in a group of patients with NTMB revealed structural changes in the lungs that affected the air parenchyma and/or small airways in areas of the lungs free from TB foci, which should be taken into account when planning surgical intervention. Conclusion. Surgical treatment immediately after completion of the course of anti-tuberculosis therapy in case of formation of residual post-tuberculosis changes is the method of choice in the complex treatment of this category of patients.

Оценка назальных симптомов в комплексе с нейрокогнитивным тестированием у пациентов с хроническим полипозным риносинуситом

The sinonasal symptoms inherent in chronic polypositis rhinosinusitis have a complex effect on the central structures of the patient's nervous system. The study of impaired cognitive and mnestic functions in this category of patients allows us to form a comprehensive understanding of the symptom complex of clinical manifestations and affect therapeutic tactics. Objective: to conduct a comprehensive comparative analysis of clinical and functional indicators characterizing nasal symptoms in patients with chronic polypous rhinosinusitis and cognitive tests in the pre- and postoperative period. Materials and methods: testing was performed in 45 patients with polypous rhinosinusitis (PRS) with a long history of the disease (M= 117 months). The age of the study group was from 22 to 65 years (M=48.964 years), without concomitant chronic pathology. The scope of clinical testing included the SNOT-22 sinonasal symptoms scale, Lund-Mackey tests and active anterior rhinomanometry (ml/sec). Changes in X-ray examinations (CT ONP) were evaluated on the Lund-Kennedy scale. Cognitive abilities were tested on the basis of the MoCA test in points with subsequent interpretation by a psychiatrist. The evaluation of the indicators was carried out before the surgical treatment of PRS, after 1 and 6 months. Results: The results were obtained to reduce the indicators of sinonasal symptoms on the SNOT-22 scale from M=31.42 before surgery and up to 4.04 points after 6 months; the Lund-Kennedy scale from M=7.87 to M=0.38 points; the Lund-Mackey scale from M=15.49 to M =0.47 points at the final stage. The indicators of active anterior rhinomanometry tended to increase from M=399.04 ml/sec before surgery and M=856.60 ml/sec after six months. Testing of neurocognitive disorders according to MoHS in patients preoperatively demonstrated average values of 21.49 points, which indicated the presence of mild variants of disorders. Further testing made it possible to obtain indicators of 25.38 points after 1 month, which were fixed during the study after 6 months. Conclusion. An interdisciplinary approach to the assessment of clinical manifestations in patients with polypous rhinosinusitis, based on the inclusion of testing of neurocognitive disorders in the study, allows for a more complete assessment of the impact of the pathological process on the patient's body. The inclusion of the MOS test in the complex of pre- and postoperative studies allows us to form an individualized approach to the implementation of therapeutic and rehabilitation measures in this category of patients.

High flow nasal oxygen vs. conventional oxygen therapy over respiratory oxygenation index after esophagectomy: an observational study.

Postoperative pulmonary complications after esophagectomy still represent a matter of concern. High flow nasal cannula (HFNC) early after major abdominal and thoracic surgery has demonstrated some advantages over conventional oxygen therapy. Data about respiratory effect of HFNC after esophagectomy is scarce. The primary aim of this study is to investigate if the early use of HFNC after esophagectomy could enhance patients' postoperative respiratory oxygenation (ROX) index and, ultimately, reduce postoperative pneumonia. In this single center retrospective study all patients undergoing to esophagectomy for cancer from May 2020 to November 2022 were evaluated. Historical cohort (HC) received postoperative oxygen supplementation with Venturi mask or nasal goggles, and a cohort was put under HFNC (HFNC cohort). ROX index, blood gas analysis, radiological atelectasis score (RAS), post-operative complications' data and information on hospital stay have been collected and analyzed. Seventy-one patients were included for the final statistical analysis, 31 in the HFNC and 40 in the HC cohort. Mean age was 64±10 years and body mass index (BMI) was 26 [24-29] kg/m2. ROX index was higher in the HFNC patients than in the HC, 20.8 [16.7-25.9] vs. 14.9 [10.8-18.2] (P<0.0001). In the HFNC cohort patients, pH was higher, 7.42 [7.40-7.44] vs. 7.39 [7.37-7.43] than HC, while PaCO2 was lower in HFNC cohort compared with HC, 39 [36-41] vs. 42 [39-45] mmHg, respectively (P=0.01). RAS was similar between the two cohorts of patients, 1.5±0.98 vs. 1.4±1.04 in the HFNC and the HC cohort, respectively (P=0.611). Lower acute respiratory failure (ARF) rate was recorded among HFNC than HC cohort, 0% vs. 13% respectively, P=0.06. No difference in pneumonia frequency between two cohorts was shown. HFNC improved the ROX index after esophagectomy through significant respiratory rate reduction. This tool should be considered for early respiratory support after extubation in this category of patients, not only as a rescue therapy for ARF, but also to optimize early postoperative respiratory function. Whether this will improve patients' outcomes requires further large randomized controlled trials.

A national survey of sedation practice and clinicians’ attitudes regarding sedation-related research in the UK paediatric intensive care units

AimsResearch involving analgo-sedation is a priority for parents and professionals in paediatric intensive care, and current guidelines are based on low-quality evidence. Future research will require an understanding of current practice and research priorities of healthcare professionals. This survey aimed to identify perceived barriers to research, describe the current UK analgo-sedation practice and assess outcome priorities for future research.MethodsA 26-question web-based survey was emailed to all Paediatric Critical Care Society members (n=1000) in April/May 2021. Responses were analysed either by ‘unit’ or at the individual respondent level. Questions related to four patient categories: ‘infant (< 3 months of age) ‘paediatric’ > 3 months of age, ‘cardiac’ and ‘non-cardiac’.ResultsTwo hundred sixteen healthcare professionals responded and responses were available from 100% of the UK paediatric intensive care units (n=29) for all questions. Most units (96%, 28/29) routinely use scoring systems for sedation adequacy but few routinely screen for delirium (24%, 7/29). The most highly prioritised outcome measure was the duration of mechanical ventilation. Respondents were most likely to agree to randomise paediatric general intensive care patients to trials comparing two different alpha agonists and least likely to randomise neonatal cardiac patients to trials comparing benzodiazepines with alpha agonists. The most common perceived barrier to research was unit familiarity with a particular regimen, followed by the perception that parents would not provide consent.ConclusionsThis study provides a snapshot of the UK analgo-sedation practice and highlights the importance of public involvement in planning future trials, as well as consultation work across the spectrum of stakeholder clinicians to maximise the acceptability of study design.

Temporal and spatial variability of dynamic microstate brain network in disorders of consciousness.

Accurately diagnosing patients with the vegetative state (VS) and the minimally conscious state (MCS) reached a misdiagnosis of approximately 40%. A method combined microstate and dynamic functional connectivity (dFC) to study the spatiotemporal variability of the brain in disorders of consciousness (DOC) patients was proposed. Resting-state EEG data were obtained from 16 patients with MCS and 16 patients with VS. Mutual information (MI) was used to assess the EEG connectivity in each microstate. MI-based features with statistical differences were selected as the total feature subset (TFS), then the TFS was utilized to feature selection and fed into the classifier, obtaining the optimal feature subsets (OFS) in each microstate. Subsequently, an OFS-based MI functional connectivity network (MIFCN) was constructed in the cortex. The group-average MI connectivity matrix focused on all channels revealed that all five microstates exhibited stronger information interaction in the MCS when comparing with the VS. While OFS-based MIFCN, which only focused on a few channels, revealed greater MI flow in VS patients than in MCS patients under microstates A, B, C, and E, except for microstate D. Additionally, the average classification accuracy of OFS in the five microstates was 96.2%. Constructing features based on microstates to distinguish between two categories of DOC patients had effectiveness.

СВЯЗЬ ВОСПАЛИТЕЛЬНЫХ МАРКЕРОВ И ТРЕВОЖНО-ДЕПРЕССИВНЫХ РАССТРОЙСТВ У ПАЦИЕНТОВ С ОСТРЫМ ИНФАРКТОМ МИОКАРДА

Abstract. Introduction. In recent years, the influence of anxiety and depressive disorders on the course of cardiovascular diseases has been increasingly discussed. The main psychosocial risk factors for the development of acute myocardial infarction include depression and anxiety (various anxiety syndromes and disorders). Currently, inflammation is considered as one of the leading links in myocardial infarction pathogenesis, course, and prognosis. Recent studies have linked the development of anxiety and depressive disorders with changes in the proinflammatory cytokine levels. Severity of immunoinflammatory reactions in patients with unstable forms of coronary heart disease is greater than in patients with a stable course of the disease. The aim of our investigation was to study the proinflammatory cytokine levels in patients with myocardial infarction depending on the presence of anxiety and depressive disorders. Materials and Methods. The study included 160 patients, averagely aged 56.2±1.4 years, who were admitted to the hospital with the ST-segment elevation myocardial infarction. The diagnosis of the said disease was set according to the generally accepted diagnostic criteria. In addition to the traditional clinical and instrumental studies, the patients of the groups under study underwent an assessment of the concentrations of inflammatory biomarkers in plasma and psychological tests using anxiety and depression rating scales, such as Zung Depression Scale and Spielberger-Khanin Anxiety Scale. Results and Discussion. Signs of depression were identified in 82 (51.25%) patients with acute myocardial infarction. Symptoms of mild depression were identified in 44 (53.7%) patients, moderate depression in 30 (36.6%) patients, and severe depression in 8 (9.7%) patients. It has been proven that the average depression score increases with the increase in the disease severity. The average score was 49.72+1.68 for personal anxiety in the group and 41.9±1.6 for reactive anxiety. As the class of infarction severity increased, a significant increase in anxiety levels was observed. An increase in the serum concentrations of CRP, IL-1β, IL-6, IL-8, and TNF-α was detected during the development of myocardial infarction, which was statistically significantly associated with the presence of anxiety-depressive disorders and some indicators of myocardial contractile function. Conclusions. Subclinical inflammation is one of the mechanisms of the negative impact of anxiety and depressive disorders on the prognosis for this category of patients. The presence of anxiety and depression symptoms is associated with higher levels of pro-inflammatory markers, i. e., CRP, IL-1β, IL-6, IL-8, and TNF-a. The degree of activation of proinflammatory markers depends on the severity of the myocardial damage signs and on the nature of complications.