Clinical Examination Of Patients Research Articles

A systematic review about the importance of neuropsychological features in heart failure: is at heart the only failure?

Heart failure can lead to cognitive impairment that is estimated to be present in over a quarter of patients. It is important to intervene at a cognitive level to promote brain plasticity through cognitive training programs. Interventions transformed by technology offer the promise of improved cognitive health for heart failure patients. This review was conducted on studies evaluating the role of cognitive rehabilitation in patients with heart failure. We examined clinical trials involving patients with heart failure. Our search was performed on Pubmed, Web of Science and Cochrane library databases. Of the initial 256 studies, 10 studies met the inclusion criteria. Cognitive rehabilitation training has important implications for the treatment and prevention of cognitive decline in heart failure patients with significant recovery for delayed recall memory and a significant time effect for total recall memory and delayed, psychomotor speed and IADL performance. It is important to include the assessment of cognitive functioning in the routine clinical examinations of patients with heart failure, discover the relationship between cognitive function and heart failure, and target cognitive rehabilitation programs that promote brain plasticity.

Clinical case of pulmonary alveolar proteinosis in a newborn

Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by the accumulation of protein-lipid complexes in the alveoli due to impaired utilization of surfactant by alveolar macrophages; it is most often idiopathic and occurs in healthy men and women aged 30–50 years. The congenital form of PAP is extremely rare, its diagnosis is complicated by the fact that it is impossible to conduct functional lung tests in newborns, and lung biopsy is used extremely rarely. Against this background, data obtained by computed tomography (CT) of the lungs of newborns are of particular importance. The article presents a clinical case of treatment of a newborn with respiratory failure (RF) and signs of pulmonary hypertension, who was admitted to the neonatal intensive care unit of the Children’s City Multidisciplinary Clinical Specialized Center for High Medical Technologies at the age of the first day of life. The article reflects the role of computed tomography in diagnosing the causes of respiratory failure in newborns, as well as the importance of anamnesis and a thorough clinical examination of patients. The presented clinical case demonstrates the need for a multidisciplinary approach to the diagnosis of newborns with pulmonary alveolar proteinosis.

Follicular Ameloblastoma of Maxillary: A Case Report

Introduction: Ameloblastoma is a benign odontogenic tumor that appears in the mandible and maxilla. Ameloblastoma has slow growth that takes several years for symptoms to appear, but ameloblastoma in the maxilla has a more aggressive clinical course compared to the mandible. The lack of initial symptoms leading to diagnosis at an advanced disease when the tumour has already extended beyond maxilla. The cancellous structure of the maxillary bone makes it easier for tumors to spread to the nasal cavity, paranasal sinuses, orbitals, parapharyngeal tissue and skull base. This article reports a case of resection of maxillary ameloblastoma. Case Report: A 63 year old female patient came with complaints of a lump on her right cheek since 2 years back that gradually increased in size. Since 2 months ago, pus and blood have been coming out of the lump. Extra oral examination revealed a well-defined mass with a solid and hard consistency, there were no ulcers or fistulas. Intraorally, a mass measuring 5x5x3cm was found in the region of teeth 12 to 15 which extended to the buccal-palatal area. History of allergies and weight loss was denied. Supporting examinations including panoramic radiography, PA chest radiography, CT-Scan, FNAB, and biopsy resulted in a diagnosis of ameloblastoma. Treatment was carried out by resection of the right maxillary tumor mass under general anesthesia. Discussion: In this case, the patient's clinical examination showed a hard and large palpable swelling in the right maxilla area which extended from the region of tooth 12 to tooth 15 which caused facial asymmetry and no tooth mobility was found. This hard and painless swelling takes about 2 years before the patient experiences symptoms of pus and blood discharge. The post-maxillectomy defect in this case was covered with an intraoral prosthesis in the form of a post-surgical obturator made of acrylic resin. The obturator functions to hold the surgical packing, and prevent food or dirt contamination in the defect area which can cause infection and slow healing. The use of a prosthesis also helps restore swallowing and speech function to the patient. Conlussion: In principle, the treatment for ameloblastoma is resection of the involved bone, as in this case the action taken is a maxillectomy. Maxillectomy can result in facial and oral cavity deformities characterised by facial disfigurement and alterations in oral functionality.Therefore, maxillary reconstruction is needed to treat maxillary defects after surgical procedures involving the loss of part or all of the maxilla.

Comparison of ultrasonography-based masticatory muscle thickness between temporomandibular disorders bruxers and temporomandibular disorders non-bruxers

To compare masticatory muscle thickness in patients with temporomandibular disorders (TMDs) during rest and clenching, and by body position, using ultrasonography. This prospective study included 96 patients with TMD (67 females, 29 males; mean age: 40.41 ± 17.88 years): group 1, comprising 66 patients with TMD without bruxism (TMD_nonbruxer), and group 2, comprising 30 patients with concurrent TMD and bruxism (TMD_bruxer). In patients with TMD, bruxism was correlated with the presence of tinnitus, muscle stiffness, sleep problems, psychological stress, and restricted mouth opening. The masseter muscle significantly thickened during clenching (11.16 ± 3.03 mm vs 14.04 ± 3.47 mm, p < 0.001), whereas the temporalis muscle showed no significant increase in thickness from resting to clenching in an upright position (7.91 ± 1.98 vs 8.39 ± 2.08, p = 0.103). Similarly, during clenching in the supine position, the masseter muscle was significantly thicker compared with rest (11.24 ± 2.42 vs 13.49 ± 3.09, p < 0.001), but no significant difference was observed in temporal muscle thickness (8.21 ± 2.16 vs 8.43 ± 1.94, p = 0.464). In comparison between two groups, the average thickness of the masseter muscle was greater among TMD_bruxers than among TMD_nonbruxers in both the upright and supine positions (all p < 0.05). In the generalized lineal model, female sex (B = − 1.018, 95% confidence interval [CI] − 1.855 to − 0.181, p = 0.017) and bruxism (B = 0.868, 95% CI 0.567 to 1.169, p = 0.048) significantly predicted changes in masseter muscle thickness. Female sex (B = − 0.201, 95% CI − 0.299 to − 0.103, p = 0.011), increased age (B = − 0.003, 95% CI − 0.005 to 0.000, p = 0.038), and muscle stiffness (B = − 1.373, 95% CI − 2.369 to − 0.376, p = 0.007) were linked to decreased temporal muscle thickness. Comparing TMD nonbruxer and bruxer muscle thicknesses in upright and supine positions revealed significant increased thickness in the masseter muscle during clenching but not in the temporalis muscle. Masseter muscle thickness varied significantly by sex, body position, and resting/clenching, notably influenced by bruxism. These findings emphasize the relevance of these factors in clinical examinations of patients with TMD.

Learning Spatio-Temporal Radon Footprints for Assessment of Parkinson’s Dyskinesia

Parkinson’s disease is a severe neurodegenerative disorder that leads to loss of control over various motor and mental functions. Its progression can be limited with medication, particularly through the use of levodopa. However, prolonged administration of levodopa often results in disorders independent of those caused by the disease. The detection of these disorders is based on the clinical examination of patients, through different type of activities and tasks, using the Unified Dyskinesia Rating Scale (UDysRS). In the present work, our aim is to develop a state-of-the-art assessment system for levodopa-induced dyskinesia (LID) using the joint coordinate data of a human skeleton body depicted on videotaped activities related to UDysRS. For this reason, we combine a robust mathematical method for encoding action sequences known as Spatio-temporal Radon Footprints (SRF) with a Convolutional Neural Network (CNN), in order to estimate dyskinesia’s ratings for six body parts. We introduce two different methodological approaches: Global SRF-CNN and Local SRF-CNN, based on the set of skeletal points used in the encoding scheme. A comparison between these approaches reveals that Local SRF-CNN demonstrates better performance than the Global one. Finally, Local SRF-CNN outperforms the state-of-the-art technique, on both tasks, for UDysRS dyskinesia assessment, using joint coordinate data of the human body, achieving an overall performance in mean RMSE value of 0.6198 for Drinking task and 0.4885 for Communication, compared to 0.6575 and 0.5175, respectively. This illustrates the ability of the proposed machine learning system to successfully assess LID.

Adult-Onset Still's Disease: A Rare Cause of Pyrexia Of Unknown Origin (Case Report with Literature Review)

Adult-onset Still's disease (AOSD) is a remarkably rare illness. One well-known pathogenic process that results in systemic manifestations is auto-inflammatory disease. We report on a young man who complained of joint pain, sore throat, and a high spiking fever. After a thorough assessment using the Yamaguchi criteria, the patient's clinical examination, elevated serum ferritin and C-reactive protein (CRP), absence of serologic markers (RA factor, Antinuclear antibody levels), and lymphadenopathy all contributed to the diagnosis of AOSD. He was treated with analgesics, steroids, and disease-modifying anti-rheumatic drugs (DMARDs). Three weeks later, at the follow-up, his symptoms and lab parameters had improved.

Sleep, Behavioral, and Cognitive Complaints in Children with Neurofibromatosis Type 1: A Public Health Challenge

Abstract Background: Neurofibromatosis type I (NF1) is a genetic and neurodevelopmental condition impacting the peripheral nervous system. Predominant clinical features include "café au lait" spots, neurofibromas, and cognitive challenges. While some clinical reports suggest a link between NF1 and alterations in sleep, there is a lack of studies exploring this connection specifically in children. This becomes crucial, given that sleep significantly influences a child's neurobehavioral, neurocognitive, and psychosocial development. Objective: To describe sleep, cognitive, and behavioral complaints in Brazilian children diagnosed with Neurofibromatosis type 1. Methods: Parents of children within the age range from 1 to 12 years old answered an online questionnaire composed of 24 questions related to sleep habits, sleep patterns, and cognitive and behavioral complaints. Results: Data was collected from 41 children, who were categorized between preschoolers (32%) and school-aged (68%). 63% of the entire sample reported sleep complaints. 66% of the children slept less than 10 hours a day, 26% of them being preschoolers and 74% school-aged. 85% of the children used electronics devices at night, and more than half (54%) of the sample had more than 2 hours of daily screen time. 66% of the children had a late bedtime. Easy crying (31%) was the most reported behavioral complaint in preschoolers, and anxiety (32%) was more prevalent in school-aged children. Alterations in attention and focus (44%) was the most frequent cognitive issue in the entire sample. Conclusion: This is the first study carried out in Brazil that assesses sleep, behavioral and cognitive complaints, and sleep patterns in children with NF1. It was reported that children with NF1 have significant sleep complaints and insufficient sleep duration. Additionally, behavioral, and cognitive complaints were widely reported. We reinforce the relevance of sleep assessment during routine clinical examination of patients with NF1. Keywords: Neurofibromatosis 1, Child, Sleep, Cognition, Behavior.

Clinical Examination of Patients with Chronic Rhinitis Using Paranasal Sinus Radiography Technique: A Case Study

Chronic rhinitis is a disease that causes hypertrophy of the nasal concha which can lead to sinusitis, especially in the maxilla sinus and ethmoid sinus. Early detection of chronic rhinitis can use paranasal sinus radiographic techniques with parietoacanthial (PA) waters closed mouth and postero-anterior (PA) caldwell projections. The purpose of the study was to determine the reasons and role of using PA waters closed mouth and PA caldwell projections in paranasal sinus radiographic techniques in the early detection of chronic rhinitis cases. In this study, data analysis was obtained from observation data, interviews, documentation, literature studies, and questionnaires processed using SPSS 23 calculations. This study shows the technique of paranasal sinus radiography in cases of chronic rhinitis there is no special preparation, the patient only removes metal objects around the object being examined. Tools and materials imaging plate size 18 x 24 cm with collimation area adjusted to the object, conventional aircraft CR, bucky stand, marker and processing tools. The reason for using projections from the validity test results using SPSS 23 is seen from the effects of chronic rhinitis which can cause sinusitis, especially the maxilla sinus and ethmoid sinus, the PA waters closed mouth projection of the maxilla sinus anatomy looks very good and PA caldwell projection of the ethmoid sinus anatomy looks good. The role of both projections is able to show the thickening of the nasal concha, fluid boundaries in the maxilla sinus, septum nasi, cavum nasi, ethmoid sinus, frontal sinus, and maxilla sinus.

Оценка факторов риска развития интраоперационного синдрома девиации инфузионных потоков с учетом анатомо-топографических особенностей переднего отрезка

Relevance. Despite continuous improvement in cataract surgery technology, intraoperative fluid misdirection syndrome remains an underestimated problem. Purpose. To evaluate intraoperative fluid misdirection syndrome clinical manifestation in patients with pseudoexfoliation syndrome (PXS) and without it; to assess intraoperative fluid misdirection syndrome risk factors according to anatomical and topographical features of anterior segment. Material and methods. There were two groups of patients who underwent phacoemulsification in the prospective study. Study group (50 eyes) included patients with complicated cataract, PXS and drug-induced mydriasis less than 6 mm. Control group (50 eyes) included patients with senile cataract, no PXS and drug-induced mydriasis more than 6 mm were enrolled in the control group. Clinical examination of patients included optical biometry, pupillometry using rotational Scheimpflug imaging, ultrasound biomicroscopy for evaluation of iris thickness and sectional area of posterior chamber under drug-induced mydriasis. Results. The average pupil diameter in 1 hour after instillation of mydriatics was 5.46±0.46 mm in the study group and 6.6±0.43 mm in the control group. The sectional area of posterior chamber was 0.67±0.28 mm² and iris thickness – 0.53±0.05 mm in the study group. The sectional area of posterior chamber was 0.43±0.15 mm² and iris thickness – 0.64±0.07 mm in the control group. The results revealed positive correlation between pupil diameter and iris thickness, and negative correlation between pupil diameter, iris thickness and sectional area of posterior chamber. Lens floaters were determined after phacoemulsification in 9 eyes (18%) in the study group and in 3 eyes (6%) in the control group. The results showed statistically significant difference between groups (p≤0.05). Conclusion. Lens floaters in the retrolental space as one of the main manifestations of the intraoperative fluid misdirection syndrome were observed in 18% patients of study group and in 6% patients of control group (p≤0.05). Combination of PXS and drug-induced mydriasis less than 6 mm is considered to be the predictive factor of intraoperative fluid misdirection syndrome. Key words: intraoperative fluid misdirection syndrome, pseudoexfoliation syndrome, anterior vitreous face

Methodology of Examination of Patients with Osteoarthritis and Aseptic Necrosis of Hip and Knee Joints when Using Regenerative Interventional Technologies

Background. Diagnosis of osteoarthritis of the hip and knee joints, as of today, would seem to be a well-studied issue. Radiography, magnetic resonance imaging, ultrasonography - each of these methods makes it possible to make a diagnosis. At the same time, the use of new methods of treatment of osteoarthritis requires new approaches to its diagnosis.&#x0D; Objective: to develop a methodology for examining patients with osteoarthritis and aseptic necrosis of the hip and knee joints during treatment with regenerative technologies.&#x0D; Material and Methods. The material for the study was case histories of 233 patients with osteoarthritis and 58 patients with osteoarthritis of the hip and knee joints. Clinical, laboratory, and instrumental research methods were used.&#x0D; Results. The methodology of clinical examination of patients when using regenerative technologies is based on filling out quality of life questionnaires. A feature of the methodology of laboratory examination of patients with osteoarthritis and aseptic necrosis of the hip and knee joints when using regenerative technologies is oncological screening in the case of the use of biotechnological products containing MSCs, with the determination of epigenetic markers of the risk of oncogenesis in the form of miRNA.&#x0D; Conclusions. The methodology of the instrumental examination of patients with osteoarthritis is as follows: the key is an X-ray examination with the establishment of the stage of osteoarthritis according to the Kellgren-Lawrence classification and the subsequent ultrasound and MRI examination in order to assess the extent of damage to the soft tissues of the hip and knee joints, subchondral bone and paraarticular structures. In patients with aseptic necrosis of the hip and knee joints, when using regenerative technologies, the key is an MRI study followed by X-ray and ultrasound examination.

Spontaneous Rupture of the Spleen: A Case Report

Spontaneous splenic rupture is a rare yet life-threatening condition often overlooked during the diagnosis of abdominal pain. This case report presents a 61-year-old male who reported to the emergency department with sudden abdominal pain and vomiting, resembling a previous episode experienced a month prior. Despite a lack of significant medical or trauma history, the patient's clinical examination revealed signs of internal bleeding. Imaging studies, including ultrasound and contrast-enhanced CT scan, confirmed an enlarged and disrupted spleen. Hemoglobin levels further supported the diagnosis, along with the retrieval of bloody ascitic fluid during paracentesis. The patient remained clinically stable throughout observation and vigilant monitoring. This case underscores the importance of considering spontaneous splenic rupture in patients presenting with acute abdominal pain, especially when no other plausible cause can be identified and aims to enhance the understanding and management of this rare condition, ultimately aiding in the improved prognosis of future patient.

Effect of clinical experience and training with visual feedback on standardized palpation outcomes-Potential implications for assessment of jaw muscle sensitivity.

The evaluation of muscle pain and sensitivity by manual palpation is an important part of the clinical examination in patients with myalgia. However, the effects of clinical experience and visual feedback on palpation of the masticatory muscles with or without a palpometer are not known. To estimate the effects of clinical experience and visual feedback on the accuracy of palpation in standardized settings. Thirty-two dentists (age 35 ± 11 years) classified as either specialists (n = 16) or generalists (n = 16) participated in this experiment. All dentists were instructed to target force levels of 500- or 1000-gf, as determined on an electronic scale using either standardized palpometers or manual palpation (MP). All dentists participated in four different tests: MP, MP with visual feedback (MPVF), palpometer (PAL) and PAL with visual feedback (PALVF). Actual force values for each type of palpation from 0 to 2, 2 to 5 and 0 to 5 s were analysed by calculating target force level. The relative differences during 2-5 and 0-5 s with 1000 gf were significantly lower for generalists than for specialists (p < .05). In generalists and specialists, the coefficients of variation and the relative differences during 2-5 s were significantly lower for PAL and PALVF than for MP (p < .05). These findings suggest that the use of a palpometer, but not clinical experience with palpation of masticatory muscles, increases the accuracy of palpation, and ≥2 s of palpation with a palpometer is optimal for masticatory muscles.

Quantitative fluid overload in severe aortic stenosis refines cardiac damage and associates with worse outcomes

Abstract Background Cardiac decompensation in aortic stenosis (AS) involves extra-valvular cardiac damage (CD) and progressive fluid overload (FO). FO can be objectively quantified using bioimpedance spectroscopy (BIS). Objectives We aimed to assess the prognostic value of FO beyond established CD markers to guide risk stratification. Methods Consecutive patients with severe AS scheduled for transcatheter aortic valve implantation (TAVI) underwent prospective risk assessment with BIS and echocardiography. FO by BIS was defined as ≥1.0L (0.0L=euvolemia). The extent of CD was assessed by echocardiography according to an established staging classification. Right-sided CD (rCD) was defined as pulmonary vasculature/tricuspid/right ventricular CD. Heart failure hospitalization (HHF) and/or death served as primary endpoint. Results In total, 880 patients (81±7y/o, 47% female) undergoing TAVI were included. 360 (41%) had FO. Clinical examination in patients with FO was unremarkable for congestion signs in &amp;gt;50%. A quarter had FO but no rCD (FO+/rCD-). FO+/rCD+ had the highest CD markers, including NT-proBNP levels. After 2.4±1.0 years of follow-up, 236 patients (27%) had reached the primary endpoint (29 HHF, 194 deaths, 13 both). Quantitatively, every 1.0L increase in BIS was associated with a 12% increase in event hazard (adjHR 1.12, 95% CI 1.05-1.20, P=0.001). FO provided incremental prognostic value to traditional risk markers (NT-proBNP, EuroSCORE-II, CD on echocardiography). Stratification according to FO and rCD yielded worse outcomes for FO+/rCD+ and FO+/rCD-, but not FO-/rCD+, compared to FO-/rCD-. Conclusion Quantitative FO in patients with severe AS improves risk prediction of worse post-interventional outcomes compared to traditional risk assessment.

Differential diagnosis of juvenile idiopathic arthritis and multiple epiphyseal dysplasia: Experience of multidisciplinary interaction

Introduction. Juvenile idiopathic arthritis (JIA) is a common multifactorial disease characterized by the presence of chronic inflammation in the joints, entheses and other structures of the musculoskeletal system in combination with a certain range of extraskeletal disorders. Vast variety of JIA clinical variants and the variability of the disease course make primary and differential diagnosis difficult, which often leads to a delayed start of treatment and an inadequate choice of medical therapy or, conversely, an excess of medication. In the range of differential diagnostic conditions that have similar symptoms and are manifested by severe arthralgia, gait disturbance, joint stiffness, as well as the presence of effusion and gradual progression of bone destruction mainly in the epiphyseal plate, one should remember about hereditary skeletal dysplasias, primarily from a genetically heterogeneous group of multiple epiphyseal dysplasias (MED). The aim of the study – description of the clinical and genetic characteristics of three patients with various genetic variants of MED and defining approaches for their differential diagnosis with JIA. Materials and methods. There were three patients from three unrelated families aged from 7 to 13 years old under our supervision. To clarify the diagnosis, a genealogical analysis, a clinical examination of patients and first-degree relatives, as well as an assessment of X-ray images of long tubular bones were carried out. Molecular genetic confirmation of the MED diagnosis types 1 and 2 was based on the results of custom panel sequencing consisting of 166 genes responsible for the development of hereditary skeletal pathology. To clarify the molecular genetic diagnosis of MED type 4, an analysis of the SLC26A2 gene was performed using automated Sanger sequencing. Results. Anamnestic, clinical, radiological, and molecular genetic characteristics of three unrelated patients with different genetic types of MED caused by variants in the COMP, SLC26A2, and COL9A2 genes were analyzed. The first symptoms of the disease in observed patients with three different genetic variants of MED occurred at the age of 2–3 years old and were characterized by gait disturbance and climbing stairs difficulties. Gradually, these symptoms were accompanied by pain in large joints. According to the ultrasound examination of the joints, signs of synovitis were noted, as a result they were diagnosed with JIA (polyarticular variant, seronegative for rheumatoid and antinuclear factor) and immunosuppressive therapy were prescribed without significant effect. The atypical course of the JIA was the reason for additional examination of patients by an orthopedist and geneticist. Careful analysis of the large joints radiographs made it possible to suspect one of the variants of MED in our patients based on the detection of distinctive signs, which were characterized by abnormal ossification (diminished size and flattening) of the epiphyses and abnormal shape and structure of the femoral head epiphysis. Molecular genetic analysis was performed to confirm the diagnosis. As a result, a pathogenic variant of the nucleotide sequence in the COMP gene was detected in one of the patients, two pathogenic variants in the SLC26A2 gene in another patient, and one pathogenic variant in the COL9A2 gene in the third patient, which made it possible to confirm the final diagnosis of MED type 1 with an autosomal dominant type of inheritance, MED type 4 with an autosomal recessive type of inheritance and MED type 2 with an autosomal dominant type of inheritance, respectively. Based on the results of our own research and analysis of the literature data, key directions for the differential diagnosis of MED and JIA were formulated. It is shown that the analysis of the X-ray images of patients is essential in differential diagnosis. Conclusion. Despite the significant overlap of the clinical symptoms between JIA and MED, the key to the early diagnosis of MED is a comprehensive examination, which included genealogical analysis, features of clinical manifestations and disease course in combination with distinctive radiological signs including delayed ossification of the epiphyses of tubular bones typical for MED. However, the question remains about the probability of a combined nature of osteoarticular disorders, i. e., the possible development of JIA in patients with hereditary skeletal dysplasias which requires in-depth study in the future.

ChatGPT performance in laryngology and head and neck surgery: a clinical case-series.

To study the performance of ChatGPT in the management of laryngology and head and neck (LHN) cases. History and clinical examination of patients consulting at the Otolaryngology-Head and Neck Surgery department were presented to ChatGPT, which was interrogated for differential diagnosis, management, and treatment. The ChatGPT performance was assessed by two blinded board-certified otolaryngologists using the following items of a composite score and the Ottawa Clinic Assessment Tool: differential diagnosis; additional examination; and treatment options. The complexity of clinical cases was evaluated with the Amsterdam Clinical Challenge Scale test. Forty clinical cases were submitted to ChatGPT, accounting for 14 (35%), 12 (30%), and 14 (35%) easy, moderate and difficult cases, respectively. ChatGPT indicated a significant higher number of additional examinations compared to practitioners (p = 0.001). There was a significant agreement between practitioners and ChatGPT for the indication of some common examinations (audiometry, ultrasonography, biopsy, gastrointestinal endoscopy or videofluoroscopy). ChatGPT never indicated some important additional examinations (PET-CT, voice quality assessment, or impedance-pH monitoring). ChatGPT reported highest performance in the proposition of the primary (90%) or the most plausible differential diagnoses (65%), and the therapeutic options (60-68%). The ChatGPT performance in the indication of additional examinations was lowest. ChatGPT is a promising adjunctive tool in LHN practice, providing extensive documentation about disease-related additional examinations, differential diagnoses, and treatments. The ChatGPT is more efficient in diagnosis and treatment, rather than in the selection of the most adequate additional examination.

Hepatoprotective effect of hydromethanol extract of Otostegia integrifolia benth leaves in isoniazid and rifampicin induced Swiss albino mice

IntroductionDrug-induced liver injury is the most common cause of acute liver failure. Off-Target effect “hepatotoxicity “frequently detected during clinical examination of patients on anti-Tb medication particularly isoniazid (INH), and rifampin (RMP). However, there is no any treatment option against isoniazid and rifampicin induced hepatotoxicity. It is, therefore, necessary to search for effective affordable and safe drugs from medicinal plants for the prevention of liver toxicity caused by isoniazid and rifampicin. The aim the current study is to evaluate hepatoprotective effect of hydro methanol extract from Otostegia integrifolia leaves in isoniazid and rifampicin-induced hepatotoxicity in Swiss albino mice. MethodsO. integrifolia leaves powder was macerated in hydromethanol and thirty Swiss albino mice 29.0–40.6 g were grouped in to five groups. Group I were given 20 ml/kg distilled water, group II were given 100 mg INH and 150 mg RIF per kg body weight. Group III, group IV, and group V were given 200 mg extract, 400 mg extract, and 100 mg of N-acetyl cysteine respectively per kg 1hr before induction with 100 mg INH plus 150 mg RIF per kg. The treatments were followed for 14 days. On the 15th day, all mice were anaesthetized with diethyl ether; blood samples were collected for the assessment liver enzyme and function test. ResultsGroup II mice's serum ALT, AST and total bilirubin levels were significantly increased and serum total protein and albumin levels were significantly decreased as compared with group I mice. The groups of mice treated with O. integrifolia at a dose of 400 mg/kg and N-acetyl cysteine AST, ALT and total bilirubin level were significantly decreased; and total protein and albumin levels were significantly (P < 0.05) increased as compared with group II. The liver index of the group IV showed decreased (P < 0.05) as compared to the group II. ConclusionEvidence from our study revealed that the hydromethanol extract of O. integrifolia has a hepatoprotective effect against isoniazid and rifampicin-induced hepatotoxicity in Swiss Albino mice. This protective effect of O. integrifolia extract may be based on its metal ion reducing power, free radical scavenging activity, and anti-inflammatory activity and could be used as a potential therapeutic option.

Use of 3-Dimensional Stereophotogrammetry to Detect Disease Progression in Craniofacial Morphea

Objectively determining disease progression in craniofacial morphea (CM) is challenging, as clinical findings of disease activity are often lacking. To evaluate the utility of 3-dimensional (3D) stereophotogrammetry in detecting disease progression in CM over time. This prospective cohort study included 27 pediatric and adult patients with CM from 2 hospitals in Boston (Boston Children's Hospital and Brigham & Women's Hospital) consecutively enrolled from April 1, 2019, to March 1, 2023. Review of 3D stereophotogrammetry images and data analysis occurred from March 1 to April 1, 2023. Clinical and 3D stereophotogrammetry assessments were performed at 2- to 12-month intervals, depending on the clinical context. The 3D stereophotogrammetry images were then qualitatively rated as demonstrating no progression or definitive progression by an expert (board-certified plastic craniofacial surgeon) and nonexpert (board-certified dermatologist) in 3D stereophotogrammetry. In addition, κ coefficients were calculated for interrater reliability. Of 27 patients with CM (19 female; median age, 14 [range, 5-40] years) and 3D stereophotogrammetry images obtained from a minimum of 2 time points (median, 4 [range, 2-10] images) spaced a median of 3 (range, 2-12) months apart, 10 experienced progression of their disease based on clinical assessments performed during the study period. In all cases in which clinical progression was favored, blinded qualitative assessment of 3D stereophotogrammetry images also favored progression with substantial interrater reliability (κ = 0.80 [95% CI, 0.61-0.99]). Furthermore, review of 3D stereophotogrammetry detected occult progression of asymmetry not noted on clinical examination in 3 additional patients. In this prospective cohort study, blinded assessment of sequential 3D stereophotogrammetry images in patients with CM not only corroborated clinical assessment of disease progression but also detected occult progression of facial asymmetry not appreciable on clinical examination alone. Therefore, 3D stereophotogrammetry may serve as a useful adjunct to clinical examination of patients with CM over time. Future investigations are warranted to validate 3D stereophotogrammetry as an outcome measure in CM.

ОСОБЕННОСТИ ТЕЧЕНИЯ ВНЕБОЛЬНИЧНОЙ ПНЕВМОНИИ И ОЦЕНКА ЭФФЕКТИВНОСТИ КОМПЛЕКСНОЙ ТЕРАПИИ

Introduction. Community-acquired pneumonia is an urgent problem of our time due to its high prevalence, increasing resistance of microflora to antibacterial therapy, a large number of complications and high mortality. Aim. The aim of the study was features of the course of community-acquired pneumonia and evaluation of the effectiveness of complex therapy. Material and methods. A survey of 120 patients was conducted, with a diagnosis of moderate and severe pneumonia. The patients were divided into 2 groups: group 1 (70 patients), in which, along with the standard therapy of pneumonia, the drug meglumine sodium succinate was included, and group 2 (50 patients), which received standard therapy of pneumonia. In addition to the standard clinical examination of patients with pneumonia, concomitant pathology from other organs and systems was studied. In addition to anamnesis and objective research methods, laboratory and instrumental methods of studying the respiratory and hepatobiliary systems were used. Additionally, procalcitonin was determined in blood serum by immunochromatography, and hepatocyte growth factor and endothelin-1 were determined by enzyme-linked immunosorbent assay. Statistical processing of the results of the study was carried out using parametric and nonparametric methods. Results and discussion. Community- acquired pneumonia is characterized by a moderate course, segmental or lobular lung damage, and the development of a number of complications. With community-acquired pneumonia, the hepatobiliary system is affected and often community-acquired pneumonia occurs against the background of cardiovascular pathology. Conclusion. When meglumine sodium succinate was included in the complex therapy of community-acquired pneumonia, in addition to the positive dynamics of the clinical and laboratory picture of the underlying disease, and a significant reduction in the average duration of hospitalization. In the course of therapy of patients with community-acquired pneumonia with meglumine sodium succinate, a significant decrease in inflammation indicators and an increase in hepatocyte growth factor concentration were observed. When meglumine sodium succinate was included in the therapy of patients with pneumonia, there was a tendency to increase the number of endotheliocytes and a significant increase in the content of endothelin-1, which may reflect an increase in the sanogenetic ability of the body to systemic inflammation in community-acquired pneumonia.

MODERN VIEWS ON THE ETIOLOGY, CLINICS, AND DIAGNOSIS OF DISC DISPLACEMENTS AND INFLAMMATORY-DEGENERATIVE DISEASES OF THE TMJ AND THEIR COMBINATIONS

In more than 50% of patients with temporomandibular disorders (TMDs), the simultaneous course of several disorders is detected. A combination of anterior disc displacement (DD) and inflammatorydegenerative diseases (IDD) of the temporomandibular joints (TMJs) is common.&#x0D; The purpose of the study is to highlight modern views on the combination of DD and IDD of the TMJ, their etiology, clinic and diagnostic features.&#x0D; A review of the literature was conducted by processing scientific and metric databases, as a result of which 56 articles were selected for study the full text.&#x0D; To diagnose TMDs, researchers suggest using The Diagnostic Criteria for Temporomandibular Disorder (DC/TMD), which is a standardized tool. MRI and cone-beam computed tomography (CBCT) are used to verify DD and IDD of the TMJ.&#x0D; Many articles are devoted to the signs and symptoms of DD and IDD of the TMJ separately, however, there are very few studies that analyze the signs and symptoms in patients with a combination of DD and IDD. The clinical diagnosis of the above diseases is based on the presence of sounds in the TMJ, pain, degree and nature of mouth opening. In the case of the simultaneous course of DD and IDD, the symptoms may combine or overlap each other and, as a result, complicate differential diagnosis. According to the results of the clinical examination of patients, in the case of suspicion of the simultaneous course of DD and IDD of the TMJ, it is necessary to involve different radiological examination methods. A promising way to diagnose the combination of DD and IDD is to combine CBCT and MRI images. This approach allows simultaneous assessment of bone and soft tissue structures of the TMJ. Regarding ultrasonography of the TMJ, the authors advise using it rather to exclude the diagnosis of TMD than to confirm it.&#x0D; Conclusions. The combination of DD and IDD of the TMJ remains understudied and requires the study of clinical features of the course, the development and application of improved modifications of modern radiological methods.

Cognitive function in patients with irritable bowel syndrome: impairment is common and only weakly correlated with depression/anxiety and severity of gastrointestinal symptoms

Objective To investigate cognitive function in patients with irritable bowel syndrome (IBS) and its relation to anxiety/depression and severity of gastrointestinal (GI) symptoms. Methods Patients with IBS (n = 65) and healthy controls (HCs, n = 37) performed the ten subtests of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Age-normed index scores of five cognitive domains (Immediate memory, Visuospatial function, Language function, Attention, Recall) and a total (Fullscale) score were derived from the performance. Emotional function was assessed using the Hospital Anxiety and Depression Scale (HADS), and the IBS Symptom Scoring System (IBS-SSS) was used to define the severity of GI symptoms. Results Patients with IBS reported significantly higher scores than the HC group on symptom measures of anxiety and depression, and significantly lower scores on the Immediate memory, Recall, and Fullscale RBANS indexes. Approximately 30% of the IBS patients obtained index scores at least one standard deviation below the population mean, and more than 50% scored above the screening threshold for an anxiety disorder. The severity of GI symptoms was significantly correlated with the severity level of anxiety symptoms (p=.006), but neither the severity level of emotional nor GI symptoms was significantly correlated with the RBANS index scores in the IBS group. Conclusion Cognitive and emotional function were more severely affected in patients with IBS than in HCs. The weak correlation between the two functional areas suggests that both should be assessed as part of a clinical examination of patients with IBS.