Changes In Laboratory Parameters Research Articles

Retrospective evaluation of autotransfusion using a cell saver device versus allotransfusion in the perioperative management of acute hemoperitoneum in 43 dogs (2017–2021)

BackgroundCell saver (CS) technology is an increasingly popular approach for autotransfusion in small animal veterinary medicine for the treatment of patients with abdominal hemorrhagic effusion.ObjectiveTo evaluate the utility, effectiveness, and safety of autotransfusions collected with a CS device and to assess whether the use of the CS device reduces the demand for allogenic blood transfusions.Materials and methodsRetrospective study of dogs with acute hemoperitoneum of splenic origin treated surgically. Dogs were grouped by the type of transfusion received: allo- and autotransfusion (AA), allotransfusion only (AO), autotransfusion only (CS), and no transfusion (NT). Differences in changes of laboratory parameters (hematocrit and lactate), transfusion volume, and outcomes were analyzed across groups.ResultsForty-three dogs were included. Twenty-seven (62.8%) suffered from hemangiosarcoma, and 16 (37.2%) had a benign cause of hemoperitoneum. The classification into blood transfusion groups was as follows: 7/43 (16.3%) in the AA-group, 11/43 (25.6%) in the AO-group, 11/43 (25.6%) in the CS-group and 14/43 (32.6%) in the NT-group. Increase in hematocrit over time was similar in all subgroups that received any form of blood transfusion (AA-, AO-, CS-group). Total volume of transfused blood (autologous and allogenic) was significantly higher in the AA-group (median 54.0mL/kg, range 24.7–126.5mL/kg) than in the AO-group (median 7.6mL/kg, range 4.6–13.5mL/kg, p = 0.01) but not the CS-group (median 23.8mL/kg, range 14.1–50.0mL/kg, p = 0.22). No difference was found for the volume of allogenic blood transfused between the AA-group (median 9.4mL/kg, range 5.0–16.2mL/kg) and AO-group (median 7.6mL/kg, range 4.6–13.5mL/kg) (p = 0.68). The use of the CS device did not adversely affect the time from presentation to surgery, the duration of surgery, or the outcomes.DiscussionThe use of autologous blood transfusions obtained by CS device in dogs suffering from acute hemoperitoneum caused by a benign or malignant splenic disorder appeared safe and effective in the cases described. And therefore may emphasize its further application as an addition or alternative to traditional allogenic blood transfusions.

Efficacy and safety of post-discharge oral nutritional supplements for patients with gastric cancer undergoing gastrectomy: a meta-analysis of randomized controlled trials.

To report the first and largest systematic review and meta-analysis of randomized controlled trials (RCT) to evaluated the efficacy and safety of post-discharge oral nutritional supplements (ONS) for patients with gastric cancer undergoing gastrectomy. Systematic review and meta-analysis. RCT which evaluated the efficacy and/or safety of post-discharge ONS for patients with gastric cancer undergoing gastrectomy. We conducted a systematic literature retrieval via PubMed, Embase, Web of Science, and Cochrane until April, 2023 for relevant RCTs. Outcomes of meta-analysis included absolute change of body weight, % change of body weight, absolute change of body composition, absolute change of laboratory parameters and adverse events. All the relevant data were analyzed by Review Manager 5.4.1 and Stata 15.1. 5 RCTs including 1,586 patients (804 in ONS group versus 782 in control group) were included for meta-analysis. The two groups were comparable in age, gender (male), weight at baseline, BMI at baseline, albumin at baseline, and hemoglobin at baseline. Meta-analysis revealed a significant lower absolute body weight loss (WMD: 0.75; 95% CI: 0.11, 1.40; p = 0.02) and % body weight loss (WMD: 1.15; 95% CI: 0.20, 2.11; p = 0.02) in the ONS group compared with the control (regular diet/dietary advice) group. Moreover, this study did not observe a significant difference between the two groups for adverse events rate (RR: 1.11; 95% CI: 0.81, 1.53; p = 0.52). ONS was significantly effective and safe in improving postoperative weight loss for patients with gastric cancer undergoing gastrectomy. Identifier, CRD42023414678, https://www.crd.york.ac.uk/PROSPERO/.

Assessment of the state of mineral metabolism in patients with tooth loss during dental implantation against the background of vitamin D deficiency

Background. The widespread occurrence of mineral metabolism disorders in the modern world, including those due to vitamin D deficiency, affects the results of patient rehabilitation performed by dental surgeons using dental implants. The aim of the study was to assess the state of mineral metabolism during dental implantation in young and middle-aged patients with tooth loss due to vitamin D deficiency. Materials and methods. From 2011 to 2024, 450 patients aged 25–50 years with tooth loss due to identified vitamin D deficiency in the absence of other somatic pathology were examined and treated at Sechenov University and a private clinic. All patients underwent laboratory examination, including assessment of mineral metabolism indicators – the level of total calcium, vitamin D (25 (OH) D), parathyroid hormone, thyroid stimulating hormone. Also, 30 randomly selected patients underwent assessment of osteogenesis markers (bone matrix formation marker P1NP, serum cross-linked C-telopeptide of type I collagen CTX). Patients were referred to an endocrinologist due to detected vitamin D deficiency, therapy was prescribed. All patients underwent dental implantation and concomitant surgeries to increase bone volume, if necessary, considering the study group: in group 1 – until reference values of vitamin D were achieved, in group 2 – after. Comparison of parameters before and after drug therapy was performed using Student’s T-test or Mann-Whitney, the results were considered statistically significant at p < 0.05. Results. In the examined sample, 2.1 % of patients had a pronounced deficiency of (25(OH)D) (< 10 ng/ml), 60.4 % had a deficiency (< 20 ng/ml), and 37.5 % had insufficiency (20–30 ng/ml), with the initial level of vitamin D in both study groups not statistically different (< 20 ng/ml, p < 0.05). After the treatment, the level of (25(OH)D) in all patients reached the reference values (30–60 ng/ml, p < 0.05) also without statistically significant difference when compared by groups (median 1 = 42.75 and median 2 = 43.65, respectively, p > 0.05), but was significantly higher when assessed dynamically within eachgroup (p < 0.05). No deviations from reference values for osteogenesis markers were found over time, although a statistically significant slight decrease in both parameters within the normal range was noted after treatment compared to the initial level (p < 0.05). Conclusion. In young and middle-aged patients with tooth loss due to vitamin D deficiency, no significant changes in laboratory parameters (blood calcium levels, parathyroid hormone, and osteogenesis markers over time) were found during dental implantation and concomitant surgeries.

Laboratory markers predicting tofacitinib efficacy in Japanese patients with rheumatoid arthritis: A pooled analysis of Phase 2/3 randomised controlled clinical trials.

We characterised early changes in laboratory parameters in Japanese patients with rheumatoid arthritis (RA) and assessed whether these changes at Month (M)1 were predictive of tofacitinib efficacy at M3. This post hoc analysis included data from Japanese patients with RA receiving tofacitinib or placebo pooled from two Phase (P)2 studies in Japan (NCT00603512; NCT00687193) and one global P3 study (NCT00847613). Outcomes: changes from baseline in laboratory parameters (Week 2 and M1/3); efficacy endpoints (Disease Activity Score in 28 joints, based on C-reactive protein [DAS28-4(CRP)], DAS28-4, based on erythrocyte sedimentation rate [DAS28-4(ESR)], and American College of Rheumatology-N index) at M3. Univariate/multivariable analyses assessed whether changes in laboratory parameters at M1 were predictive of efficacy outcomes at M3. Overall, 467 patients receiving tofacitinib and 104 receiving placebo were included. Tofacitinib treatment was associated with decreases from baseline in CRP, ESR, neutrophils, and platelets, and increases in lymphocytes, haemoglobin, and lipids up to M3. Decreased platelet count and increased low-density lipoprotein cholesterol and haemoglobin at M1 were predictive of changes in efficacy outcomes at M3. Changes in laboratory parameters at M1 could potentially be used to assess whether tofacitinib therapy will be effective at M3; further investigation is needed.

Особенности системы гемостаза при истинной полицитемии у детей

Patients with polycythemia vera (PV) are at an increased risk for thrombosis. Abnormalities in coagulation parameters and global hemostasis tests can help with hypercoagulation recognition in PV. The purpose of this research was to analyze the features of changes in laboratory parameters of the hemostasis system in pediatric patients with PV. Materials and methods used: a single-center retrospective cohort study of clinical records of 32 (11 (35%) girls/21 (65%) boys aged 11.5 [0.8; 17.5] y/o) pediatric (all under the age of 18 y/o) PV patients who were admitted at the National Scientific and Practical Center for Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev (Moscow, Russia) in Jan. 2012-June 2024 was conducted. Laboratory parameters were determined prior to the beginning of the antiplatelet and cytoreductive therapy. Results: in 20 (62.5%) and 4 (12.5%) patients, mutations in the JAK2V617F and JAK2 ex 12 genes were detected, respectively, the remaining 8 (25%) children were JAK2-negative. In total, there were 8 (72%) JAK2-positive girls and 15 (71%) boys; gender did not statistically significantly affect the presence of a driver mutation (p=0.939). Both the median and the mean values of the main parameters of the blood coagulation system were within the reference values. The thromboelastography parameters did not deviate from the reference values for the parameters. According to the results of the thrombodynamics study, the average value of the initial clot growth rate among all patients was increased and amounted to 58.3±5.07 μm/min, the steady-state velocity also increased among all patients to 29.5±4.3 μm/min, the median and the mean values of the remaining parameters were within the reference intervals. Conclusion: the parameters of standard coagulogram and thromboelastography tests in pediatric PV patients had no deviations. The average values of thrombodynamics (initial and steady-state clot growth rate) were increased, which potentially indicates the hypercoagulation.

FC24 Zasocitinib (TAK-279), an oral, allosteric, highly selective TYK2 inhibitor, modulates disease-central cytokine pathways that define clinical response in patients with moderate-to-severe plaque psoriasis

Abstract Zasocitinib (TAK-279) demonstrated promising efficacy and was generally well tolerated in a completed Phase 2b study (NCT04999839) in patients with moderate-to-severe plaque psoriasis, with the primary endpoint [75% improvement in psoriasis area and severity (PASI75)] achieved at doses ≥5 mg vs. placebo at Week 12. In an exploratory analysis of this study, associations between zasocitinib treatment, psoriasis/tyrosine kinase 2 (TYK2) biomarkers, and clinical/histological response were investigated. Lesional/non-lesional serum samples and skin biopsies were obtained with consent at Day 1 (pre-dose) and Weeks 4 and 12 from patients receiving zasocitinib (2, 5, 15, and 30 mg) or placebo orally once daily. RT-qPCR, RNA-seq and immunohistochemistry were used to assess changes in lesion keratinocyte proliferation (KRT16 expression), psoriasis/TYK2 biomarkers and lesion gene signatures, and their associations with clinical (PASI75) and histological (plaque resolution) response. Serum samples from 252 patients and biopsy samples from 63 patients were analysed. At Week 12, most clinical responders (n = 21/24, 88%) experienced reductions in KRT16 expression of >87% vs. baseline lesion levels. Pooled analysis showed that, in most histological responders (n = 18/25, 72%), interleukin (IL)17A and IL17F expression reduced by >80% vs. baseline lesion levels. Reductions in lesional type I interferon, IL-12 and IL-23 pathway gene expression were observed at zasocitinib 15 and 30 mg doses compared with baseline levels (P < 0.05). Dose- and time-dependent reductions in serum IL-17A, IL-17C and IL-17F were observed in all zasocitinib groups vs. placebo. In the 15 and 30 mg groups (n = 23), expression of key psoriasis/TYK2 biomarkers (e.g. DEFB4A, IL36G, IL23A) reverted to non-lesional levels at Week 12. Among evaluable PASI90 responders at Week 12 (n = 12), 48/50 of the top upregulated genes in lesions reverted to non-lesional expression levels. In all dose groups, patients had reduced lesional epidermal thickness, CD3+ T-cell counts and CD11c+ myeloid dendritic cell counts with zasocitinib vs. baseline. Zasocitinib treatment did not result in clinically meaningful longitudinal changes in laboratory parameters associated with Janus kinase inhibition. Zasocitinib modulated psoriasis/TYK2 biomarkers were associated with clinical and histological response in patients with moderate-to-severe plaque psoriasis.

P120 Deucravacitinib, an oral, selective tyrosine kinase 2 inhibitor, in patients with moderate-to-severe scalp psoriasis: laboratory parameter results of a Phase 3b/4, multicentre, randomized, double-blind, placebo-controlled trial (PSORIATYK SCALP)

Abstract Introduction Deucravacitinib, an oral, selective, allosteric TYK2 inhibitor, is approved in the US, EU, and other countries for treatment of adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy. Scalp psoriasis occurs in ∼80% of patients with plaque psoriasis; is associated with itching, pain, and bleeding; disproportionately reduces quality of life; and is challenging to treat with topical agents. The 52 week, Phase 3b/4, double-blind PSORIATYK SCALP trial evaluated deucravacitinib efficacy and safety in patients with moderate-to-severe scalp psoriasis, including those with more limited overall psoriasis; these patients are candidates for systemic therapy according to IPC guidelines. Here, the effect of deucravacitinib on changes in laboratory parameters associated with Janus kinase (JAK) 1,2,3 inhibitors was evaluated. Methods Adults (aged ≥18 years) with moderate-to-severe scalp psoriasis defined by more focused and objective inclusion criteria (ss-PGA ≥3, scalp surface area involvement ≥20%, PSSI ≥12) and body surface area involvement ≥3% were randomized 1:2 to oral placebo or deucravacitinib 6 mg once daily through Week 16. Changes from baseline in lipid (total cholesterol, triglycerides), chemistry [creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST)], and haematology (lymphocytes, neutrophils, platelets, haemoglobin) parameters in blood were evaluated through Week 16 (primary endpoint). Laboratory parameter adverse events, CTCAE Grade ≥3 laboratory abnormalities, shifts from baseline in severity grade of laboratory abnormalities, and discontinuations due to laboratory abnormalities were evaluated. Results One hundred and fifty-four patients were randomized (placebo, n = 51; deucravacitinib, n = 103). No clinically meaningful mean changes from baseline or placebo were observed in any laboratory parameter, including triglycerides, ALT, and AST, through Week 16. Hypercholesterolaemia was reported in one patient in each group; an elevated liver function test was reported in one patient receiving placebo. Grade ≥3 laboratory abnormalities were rare in both groups (deucravacitinib, Grade 3 triglyceride elevation; placebo, Grade 4 triglyceride elevation). Most deucravacitinib-treated patients maintained their baseline laboratory abnormality grade or shifted to a lower grade. No treatment discontinuations or interruptions were reported due to laboratory abnormalities. No muscle-related events linked to creatine phosphokinase elevations were reported. Conclusions This laboratory parameter profile is consistent with results of the Phase 3 POETYK PSO-1, PSO-2, and long-term extension trials, in which deucravacitinib was safe and well-tolerated in patients with plaque psoriasis, including those with moderate-to-severe scalp psoriasis. Signature laboratory changes commonly seen with JAK1,2,3 inhibitors were not reported with deucravacitinib. These results support the safety profile of once-daily oral deucravacitinib in patients with moderate-to-severe scalp psoriasis including those with more limited overall plaque psoriasis.

Vertebral osteoporotic fractures: differential diagnosis, therapeutic approaches

Osteoporotic vertebral fractures (OVF) are a severe complication of osteoporosis associated adverse outcomes, acute and chronic pain syndrome. If vertebral fractures (deformities) are detected, osteoporosis is diagnosed regardless of bone mineral density and the 10-year absolute fracture risk scale of the Fracture Risk Assessment Tool, but subject to the exclusion of other metabolic osteopathies. The article presents differential diagnosis of OVF with osteopathies such as osteomalacia, tumors or metastatic lesions of the spine, Paget»s disease, myeloma, hyper parathyroid osteodystrophy, post-traumatic vertebral deformities, Scheuermann-Mau disease. Differential diagnosis between different types of osteopathies is based on features of the clinical picture, history, changes in laboratory parameters (calcium, phosphorus, alkaline phosphatase, parathyroid hormone, vitamin D3 and on data from X-ray of the skeleton examination. It is necessary to take into account conditions under which the vertebral fracture occurred, its localization, prevalence, peculiarities of changes in bone structures, presence or absence of osteoporotic background, degenerative-dystrophic changes in the spine. The tactics of managing the patients with OVF is determined by the time after the fracture, its severity, nature of the pain syndrome and includes non-drug and medical measures. Among non-pharmaceutical measures in the acute period of OVF, there are unloading of the spinal column, use of a corset, and physical therapy. Medical measures are aimed at pain relief using injectable and oral forms of nonsteroidal anti-inflammatory drugs, central acting muscle relaxants and anti-osteoporotic therapy. Dexketoprofen (Dexalgin) is the first-line drug for relief of acute pain in OVF which has a rapid and pronounced analgesic effect. For the anti-osteoporotic therapy, the drugs of choice are parenteral bisphosphonates, denosumab and teriparatide.

Evaluation of the Effect of “Honey Zufa” Herbal Syrup on Cough in Hospitalized Patients With COVID-19: A Double Blind Randomized Clinical Trial

Cough is one of the most prevalent symptoms of COVID-19, affecting over 60% of patients. This symptom significantly diminishes quality of life, causing fatigue, insomnia, dysphonia, musculoskeletal pain, and urinary incontinence. Honey Zufa herbal syrup is a well-known antitussive remedy in the Iranian market and was evaluated for its potential to alleviate this symptom. This study aimed to assess the efficacy and safety of Honey Zufa herbal syrup in treating acute cough resulting from mild to moderate COVID-19. A randomized controlled trial was conducted with 200 patients assigned to either the treatment group, receiving Honey Zufa herbal syrup, or the placebo group, receiving a placebo. Both groups also received standard cough control medications. Cough severity was measured using three different scoring systems. The impact of Honey Zufa on cough severity, the influence of other medications, and changes in laboratory parameters were monitored over a 14-day period. Honey Zufa herbal syrup significantly reduced cough severity compared to the placebo across all scoring systems. The treatment group experienced a greater reduction in cough severity than the placebo group. However, there was no significant difference between the groups in terms of antitussive medication regimens. Laboratory parameters remained stable, and no significant side effects were observed. Honey Zufa herbal syrup effectively reduces cough severity in patients with mild to moderate COVID-19, suggesting it could serve as a useful complementary and alternative treatment option for COVID-19-induced cough.

Evaluation of Changes in Laboratory Parameters from a Phase 2b Trial of Zasocitinib (TAK-279), an Oral, Selective TYK2 Inhibitor, in Patients with Moderate-to-Severe Plaque Psoriasis

Background: Zasocitinib (TAK-279) is an oral, allosteric, and highly selective tyrosine kinase 2 inhibitor. In a recent phase 2b trial (NCT04999839), more patients with moderate-to-severe plaque psoriasis treated with zasocitinib 15 and 30 mg once daily achieved 75% improvement in the psoriasis area and severity index at Week 12 (primary endpoint) than those receiving placebo (PBO; p < 0.001). Here we report an assessment of laboratory parameters from this study. Methods: In this randomized, multicenter, double-blinded, PBO-controlled study, adults with moderate-to-severe plaque psoriasis were randomized 1:1:1:1:1 to receive oral zasocitinib (2, 5, 15 or 30 mg) or PBO once daily for 12 weeks. The safety analysis set included all patients who received ≥1 dose of the assigned study treatment. Laboratory parameters assessed throughout the trial included creatine kinase (CK), as well as hematologic (neutrophils, lymphocytes, hemoglobin, platelets), hepatic and renal (alanine aminotransferase, aspartate aminotransferase, bilirubin, creatinine, estimated glomerular filtration rate), and lipid (cholesterol, triglycerides) parameters. Results: In total, 259 patients were included in the safety analysis set. Longitudinal changes in all laboratory parameters were generally similar in the PBO and zasocitinib groups. Mean values of most laboratory parameters remained within normal ranges during the study. There was no relationship between zasocitinib treatment and cytopenia. Some CK elevations were observed in both the PBO and zasocitinib groups, but most were transient or reversible and of Common Terminology Criteria for Adverse Events Grade 1 or 2 (Grade ≥2 events occurred in 2 [3.8%], 2 [4.0%], 6 [11.5%], 4 [7.5%] and 3 [5.8%] patients, in the PBO, and 2, 5, 15 and 30 mg groups, respectively), and were not associated with rhabdomyolysis. Mean triglyceride values were slightly higher than normal ranges at baseline and Week 12 in all treatment groups, including PBO, and were mainly asymptomatic, mild-to-moderate elevations. These changes were not accompanied by increases in serum cholesterol levels. Conclusion: Zasocitinib treatment did not result in adverse changes in hematologic, hepatic, renal or lipid parameters that are associated with Janus kinase (JAK) inhibition, suggesting that the mechanism of action of zasocitinib is distinct from that of JAK1/2/3 inhibition. Further phase 3 studies of zasocitinib in psoriasis are ongoing to confirm these observations (NCT06088043; NCT06108544).

Analysis of epidemiological and clinical manifestations of foodborne botulism in the Volgograd region

Aim. To analyze the situation regarding manifestations of foodborne botulism in the Volgograd region in the 2005–2023 period.Materials and methods. A retrospective analysis of 158 records of hospital patients with a diagnosis of foodborne botulism was carried out. The epidemiological data under analysis included transmission factors and outcomes. The clinical data under analysis were duration of the incubation period, severity of clinical manifestations at the time of admission and during the course of the disease, severity of changes in laboratory parameters, studies of biological material for the presence of botulinum toxin. Statistical data were processed using the MS Excel and Stastica 10.0 MS Office software packages. Results. Predominant sporadic cases of botulism were identified. The leading factors of infection transmission and the predominant type of botulinum toxin in the Volgograd region in the period from 2005 to 2023 were determined.Conclusion. Physicians and other specialists working in outpatient facilities and hospital emergency departments should maintain updated knowledge about this severe food bacterial poisoning.

CHARACTERISTICS AND OUTCOME OF LEFT MAIN STEM PCI AMONG WOMEN

Left main stem disease is a severe condition affecting a major coronary artery, traditionally treated with coronary artery bypass grafting. Recent advancements in percutaneous coronary intervention have made it a viable option, particularly for women who face unique risks and outcomes compared to men. Objective: This study aims to evaluate the characteristics and outcomes of percutaneous coronary intervention for left main stem disease in female patients, focusing on procedural outcomes and changes in laboratory parameters before and after the intervention. Methods: A prospective observational study was conducted from January to July 2024 with 68 female patients, aged 18 and above, from Fauji Foundation Hospital Rawalpindi. Various percutaneous coronary intervention techniques were used, and data on ejection fractions, access methods, and procedural specifics were collected. Pre- and post-procedural laboratory outcomes including haemoglobin, creatinine, platelet counts, and alanine aminotransferase levels were analyzed. Results: The mean age of participants was 63.6 years. Diabetes, hypertension, and dyslipidemia were common comorbidities. Laboratory results showed stable haemoglobin levels, slight increases in creatinine, and consistent platelet counts and ALT levels post-procedure. Statistical analysis revealed no significant changes in these parameters, indicating minimal impact on anaemia, renal function, and platelet or liver function. Conclusion: percutaneous coronary intervention for the left main stem in females generally results in stable laboratory outcomes with minimal impact on anaemia, renal function, and platelet or liver function. The procedure is safe with a low mortality rate. Continuous monitoring is recommended to manage any potential complications effectively.

The Effect of Corticosteroids on the Progression and Outcomes of Polytrauma in Children

Polytrauma in children are among the most common causes of death in the pediatric intensive care unit (ICU).The aim of this study was to evaluate the effect of systemic corticosteroids (SCS) on the progression, laboratory parameters, and outcomes of severe multiple injuries in children requiring ICU.Materials and methods. A retrospective, observational, multicenter (case-control and cross-sectional) study included 203 patients from pediatric ICUs across the Russian Federation. The Abbreviated Injury Scale (AIS) score was 36.81 (25–48), and the Pediatric Trauma Score (PTS) was 5.2 (2–8). SCS were administered to 113 (55.7%) children, 19 (9.36%) of whom died.Results. The most severe changes in laboratory parameters, such as an increase in amylase (35.3 vs. 18.3; P0.001) and activated partial thromboplastin time (APTT) (28.9 vs. 25.8; P0.001), were documented upon admission of children with multiple traumatic injuries to the hospital compared with subsequent days of treatment in the ICU. The average fluid volume (as a percentage of age-related fluid requirements) on the first day of treatment in the ICU was 118.53% and did not exceed 84.42% on subsequent days (P0.001). Higher systolic blood pressure (SBP) during the first three days of ICU treatment was observed in children treated without SCS. SBP tended to decrease by day 5, and then a tendency toward arterial hypertension emerged on days 6–7. In children treated with SCS, blood pressure remained stable during the first seven days in the ICU, contributing to a favorable outcome.Conclusion. The use of SCS in children with severe polytrauma from the first day of ICU treatment contributed to the stabilization of hemodynamic parameters and improved control of shock signs. A positive response to SCS in these patients can be considered a marker for a favorable disease course during ICU treatment.

Impact of Etonogestrel-releasing contraceptive implant use in cisgender women with Sickle cell disease

BackgroundSickle cell disease is a hereditary hemolytic anemia that exposes women to increased health risks especially in pregnancy, with serious implications for the woman and fetus. Acute pain episodes can occur multiple times per month and result in reduction of quality of life and disruption of her life. ObjectiveTo assess the clinical, including pain and metabolic parameters of women with sickle cell disease using etonogestrel-releasing contraceptive implants. MethodsWomen with sickle cell disease, aged 18–40 years, with reports of pain crises in the preceding 3 months were included and followed up for 12 months. Blood samples were collected to evaluate the blood count, reticulocytes, liver profile (alkaline phosphatase, gamma-glutamyl transferase, alanine aminotransferase, aspartate aminotransferase, and total bilirubin and its fractions), lipid profile, and lactate dehydrogenase levels before and 6 and 12 months after implant insertion. The following clinical variables were analyzed every 3 months: bleeding pattern, blood pressure, weight, body mass index, pain intensity (assessed using a visual analogic scale (VAS) from 0 to 10), and frequency of pain crises. ResultsTwenty-three women completed the study. There were no differences in laboratory variables between baseline and 6 and 12 months after implant insertion. Similarly, clinical variables did not differ, except for pain intensity (VAS pre-insertion = 8 vs. VAS 12 months post insertion = 4; p = 0.005) and frequency of pain crises (pre-insertion = 6 vs. 12 days/month post insertion = 0; p = 0.000). ConclusionsEtonogestrel-releasing contraceptive implants were associated with a reduction in the intensity and frequency of pain crises in women with sickle cell disease. Moreover, it was safety among these population due to no changes in laboratory parameters during the first 12 months of use.

Exploring variations in dengue symptoms: a comparative study of 2013, 2019, and 2023 in a tertiary care hospital of Bangladesh

Background: Dengue fever remains a major public health issue in Bangladesh, with repeated outbreaks. This study compares dengue symptoms in a tertiary care hospital during 2013, 2019, and 2023. The purpose of this study is to evaluate the variations in dengue symptoms among Bangladeshi dengue patients from 2013 and 2019 to 2023. Methods: This was a cross-sectional study, conducted on 100 dengue positive patients, admitted between 1st January to 7th August 2023, to the Medicine Department, Holy Family Red Crescent Medical College and Hospital, Dhaka. Demographic data, sign and symptoms and laboratory investigation reports were collected. These data were compared with a previously published study from the same institute comparing dengue symptoms between 2013 and 2019 among admitted dengue patients. The study employed a convenience sampling method for participant selection, and data analysis was carried out using SPSS version 26. Results: Analysis of 100 sero-positive dengue cases reveals a predominant occurrence in the 20 to 40 age group (51%), with the mean age of patients being 34.5 years. Among these cases, a higher prevalence is observed in males (62%) compared to females (38%). Symptomatology exhibits variations over time, with fever being consistently present. Other symptoms such as headache (90%, 23% and 12%), retroorbital pain (45%, 3% and 16%), skin rash (16%, 4% and 1%) and constipation (32%, 1% and 5%) showing fluctuations, respectively in 2013, 2019 and 2023. Notably, a significant proportion of patients in 2023 exhibit normal ultrasound findings (53%). Conclusions: In conclusion, our study provides a comprehensive analysis of Dengue infection dynamics over a decade, highlighting significant variations in clinical manifestations, laboratory findings, and abdominal ultrasound results among Bangladeshi patients. The findings suggest that Dengue remains a considerable public health concern, with fluctuations observed in symptomatology, including fever and other associated symptoms, and changes in laboratory parameters over time. BIRDEM Med J 2024; 14(3): 131-136

Experience of abrocitinib in atopic dermatitis

Atopic dermatitis is an autoinflammatory, genetically determined, itchy disease characterized by a long, relapsing course and a sharp decrease in the patient’s quality of life. Atopic dermatitis is caused by a complex interaction of immune dysregulation, epidermal gene mutations, and multi-environmental factors that affect the skin, causing intense itchy rashes. The disease often occurs among young children and subsequently has age-related clinical features. Currently, the treatment of atopic dermatitis has a wide range of options, including drugs from the group of small molecules recently registered in the Russian Federation. The drugs are intended for patients with moderate to severe atopic dermatitis. Baricitinib, abrocitinib and upadacitinib as Janus kinase inhibitors from the small molecule group have already demonstrated good tolerability, safety and a pronounced clinical effect in the vast majority of patients with atopic dermatitis in available clinical trials. The first clinical experience with the use of abrocitinib in adult patients with atopic dermatitis is presented. The interest of the presented clinical cases lies in the demonstration of high clinical efficacy and safety of mono- and combination therapy with the Janus kinase inhibitor abrocitinib. Despite the short period of treatment and observation (4 weeks), objective severity of atopic dermatitis manifestations (SCORAD index 60 points) and sharp decrease in the patients' quality of life (DLQI index 20 points), a reduction of clinical parameters exceeding 60% was achieved at a dose of 200 mg daily. During the whole observation period no adverse clinical reactions or changes in laboratory parameters were registered against the background of abrocitinib administration. The pilot results of abrocitinib use are encouraging and provide grounds for conducting longer and larger-scale studies to investigate the efficacy of the drug for its inclusion in the combination therapy of patients with moderate to severe atopic dermatitis.

Bariatric Surgery and Metabolic Status.

Background and Objectives: Obesity is associated with numerous co-morbidities, including dyslipidemia, insulin resistance and diabetes mellitus. Bariatric surgery is the mainstay of treatment for obesity as the only method with confirmed long-term effects in weight reduction and the remission of comorbidities. Postoperative recommendations leading to changes in dietary habits and changes in digestion and absorption in the gastrointestinal tract after bariatric surgery may additionally influence the levels of laboratory parameters that reflect the metabolic and nutritional status. The purpose of the study was to analyze the possible influence of changes in dietary habits after bariatric surgery on those laboratory results that reflect the metabolic and nutritional status. Materials and Methods: This was a retrospective study of 88 patients with a history of bariatric surgery. Data were gathered from before the surgery and at 6 months after the surgery and included diet structure and selected laboratory parameters reflecting the metabolic and nutritional status, i.e., levels of fasting glucose, glycated hemoglobin, cholesterol, low- and high-density lipoproteins, triglycerides, alanine and aspartate aminotransferases, proteins, ferrum, ferritin, vitamin B12, folic acid, vitamin D and calcium, the red blood cell count and the hematocrit. Results: Postoperative festive glucose levels were reduced by 14% and were more significant in patients after Roux-en-Y gastric bypass. There was an increase of 22% in concentrations of high-density lipoproteins. Triglyceride concentrations were reduced by 32%. Aminotransferase levels decreased by 43% for alanine aminotransferase and by 14% for aspartate aminotransferase. Among the changes in dietary habits, post-bariatric patients had a reduced consumption of red meat and an increased consumption of fish, milk and dairy products and wholegrain products. Vitamin D and ferrum levels were higher after the surgery, whereas vitamin B12 and folic acid levels remained unchanged. Conclusions: Improved dietary habits of patients after bariatric surgery may lead to changes in laboratory parameters that reflect the ameliorated metabolic and nutritional status of patients after bariatric surgery.

The influence of rehabilitation on the quality of life after radical treatment of endometrial cancer and atypical endometrial hyperplasia

Background. Gynecological cancers in women are a widespread type of oncology. Among them, endometrial cancer (EC) is often highlighted as one of the most common diseases in this group. The analysis of publications showed insufficient effectiveness of rehabilitation in patients with EC and recurrent atypical endometrial hyperplasia (rAEH).Objective: to compare the state of patients with rAEH or EC after hysterectomy with bilateral salpingo-oophorectomy, depending on the recovery tactics.Material and methods. The study included 119 patients diagnosed with rAEH (n=58) or stage IA EC (n=61) after hysterectomy with bilateral salpingo-oophorectomy. The group of women with rAEH was divided into two subgroups: 1A (“active” rehabilitation, n=27) and 1B (“passive” rehabilitation, n=31); two subgroups were also formed from the cohort of EC patients: 2A (“active” rehabilitation, n=29) and 2B (“passive” rehabilitation, n=32). “Active’ rehabilitation included a comprehensive, personalized program, “passive” one was based on standard rehabilitation protocols. Apart from standard clinical examination of patients, their quality of life (QoL), physical condition as well as the levels of cytokines and other biochemical blood parameters were assessed.Results. An analysis of the overall picture showed a high incidence of rAEH or EC in women aged 40–49 years. Comorbid pathologies, low QoL level and a number of significant changes in laboratory parameters were often observed. Regardless of the approach to rehabilitation, the patients' health improved over the course of 12 months. “Active” rehabilitation significantly improved psychological well-being, sexual function, overall QoL and a number of other objective health indicators of patients with rAEH or EC compared to standard rehabilitation course.Conclusion. The overall picture of rAEH or EC patients was presented, the main factors that reduce QoL in women with these diseases were identified. A system of integral QoL assessment in patients with rAEH or stage IA EC was developed including subjective and objective parameters obtained during general clinical examination, laboratory tests and analysis of questionnairing results, which should be used to adequately monitor the state of patients after surgery and the effectiveness of rehabilitation. The advantage of comprehensive rehabilitation over standard protocols in terms of efficiency and speed of recovery was shown.

Course and complications of influenza A in seniors over 65 years of age.

Influenza A and B viruses cause epidemics every year, with approximately 3-5 million serious cases and about 290,000 to 650,000 deaths worldwide. Most patients die from bacterial complications of influenza. The aim of our study was to describe the clinical pictures of influenza and the development of the complications in seniors over 65 years of age, who were treated in University Hospital Pilsen. The course of the disease and changes in laboratory parameters were evaluated with regard to the method of treatment performed. A descriptive retrospective study was performed. Clinical and laboratory data of seniors with the diagnosis of influenza were extracted from electronic medical records and later analysed. The data were processed with Excel 2016 and Statistica. A collection of 261 seniors, of whom 218 were hospitalized and 43 treated in an outpatient setting, has been studied. Patients who later developed complications had elevated values of CRP, procalcitonin, urea, and creatinine. The antiviral drug oseltamivir was administered to 226 of 261 seniors. Forty-seven seniors (18.0%) died from influenza and its complications (severe pneumonia with acute respiratory insufficiency or heart failure). The course of influenza in seniors was usually more severe and required hospitalization along with antiviral treatment. The mortality rate in the monitored group exceeded 18%. Annual timely vaccination, but also other preventive measures, and maybe considering other risk groups are methods to prevent severe or even fatal cases of influenza.

Unraveling Postoperative Bleeding Dynamics in Laparoscopic Roux-en-Y Gastric Bypass: Insights from a Single-Center Tranexamic Acid Study.

The efficacy of postoperative tranexamic acid (TXA) administration in mitigating bleeding after primary laparoscopic Roux-en-Y gastric bypass (RYGB), a prevalent complication associated with significant morbidities and mortality, and the use of sequential laboratory parameter changes in bleeding screening and TXA impact tracking were investigated. This retrospective analysis included RYGB patients (aged 18-65years, with a body mass index of 35-50kg/m2) over 5years who were categorized into three groups by evolving treatment regimens: Group A (n = 42) received standard pre- and postoperative enoxaparin (30mg) every 12h; Group B (n = 160) received enoxaparin and postoperative TXA (250mg every 6h); and Group C (n = 73) received TXA alone. Postoperative bleeding-related adverse events, vital signs, and laboratory changes were compared. Postoperative hemorrhage occurred in 3.6% (10/275) of patients, with no significant intergroup differences. Patients who experienced bleeding had greater decreases in hemoglobin (∆Hb) (2.1 vs. 1.4; p = 0.003), greater ∆Hb > 2 (50% vs. 15%; p = 0.013), and greater use of staples than did those who did not experience bleeding (8 vs. 7; p = 0.001). The ∆Hb values were lower in Groups B (1.4) and C (1.3) than in Group A (1.7, p = 0.011). No significant difference was noted between Groups C and B. This study emphasizes the potential of TXA to mitigate postoperative bleeding after RYGB, with no added benefit from excluding enoxaparin. Monitoring patients with a ∆Hb > 2mg/dl and increased stapler usage is crucial. Further research is needed to validate routine TXA use across different procedures.