Pathological Clinical Manifestations Research Articles

DENTAL STATUS OF PATIENTS WITH NEW CORONAVIRUS INFECTION COVID-19.

The aim of the investigation was to clarify the features of the clinical symptoms of patients with the new coronavirus infection COVID-19.
 Material and methods: A total of 156 patients undergoing treatment in COVID-hospitals were examined. The examination included the determination of the prevalence of: COVID 19 clinical symptoms, COVID 19 clinical manifestations in the oral cavity, concomitant diseases.
 Results. In the structure of general symptoms, complaints of hyperthermia, general weakness and cough (more often dry) played a leading role, which were noted by the overwhelming majority of the examined. Two-thirds of the patients reported body pain. The leading symptoms were also anosmia (in 68.6% of cases) and sweating (64.1%).More than half of the patients complained of shortness of breath (60.2%), difficulty in nasal breathing (55.1%), a feeling of tickling (58.3%) and pain (60.2%) in the throat. Among dental pathology, loss of taste (57.5%) and hyposalivation (38.5%) were the most common in patients. Bleeding gums were detected in 22.4% of the examined patients, which is most likely due to violations of the rheological properties of blood and changes in the hemodynamic provision of the periodontal during Covid19. Clinical manifestations of periodontal pathology do not occur immediately, but in the form of long-term complications. In this regard, it seems necessary to dynamically monitor the condition of patients who have undergone COVID-19 in different time periods.
 Conclusions. Hemostasis disorders characteristic of the new COVID-19 coronavirus infection certainly have an impact on the state of dental status, further destroying periodontal tissues. However, clinical manifestations of pathological effects may not occur immediately, but in the form of long-term complications. In this regard, it is necessary to dynamically monitor the condition of patients who have undergone COVID-19 in different time periods.

Клинический разбор случаев предрака слизистой оболочки полости рта и красной каймы губ

Early detection of diseases prone to malignancy is one of the most important problems in medicine. Elements of lesions on the mucous membrane of the oral cavity and the red border of the lips, characterized by a risk of degeneration, are available for visual inspection and can be detected during a general examination of the patient by a doctor of any specialty. A qualified description of clinical cases helps to familiarize specialists working in healthcare institutions with the clinical manifestations of pathology.

ИЗМЕНЕНИЯ АУТОФЛЮОРЕСЦЕНЦИИ ГЛАЗНОГО ДНАУ МОЛОДЫХ ЛИЦ С РАЗНЫМИ ВИДАМИ РЕФРАКЦИИ. СООБЩЕНИЕ 1

Purpose:to assess the state of the macular region of the retina using the study of autofluorescence (AF) of theeye fundus in young subjects with high visual acuity and different types of clinical refraction.Material and methods.104 healthy volunteers (208 eyes), 70 females and 34 males, aged 20 to 30 years, average age (24,5± 0,4) годаy.о., were examined. All patients had high visual acuity (1,0 and higher) and there were no signs of pathology in the macular region, which was established ophthalmoscopically and confirmed by optical coherence tomography (OCT) data. Such methods of the examination were performed in all subjects as visometry with correction, refractometry, ophthalmobiomi-ocroscopy with Goldmann's lens, OCT in the 3D mode of the macular region of the fundus and the study of fundus-AF with typing on known patterns: normal pattern, minimal changes, focal changes and reticular pattern. The analysis was carried outin10 subgroups depending on the type, the degree of clinical refraction and the presence of astigmatism.Results.4 main patterns of AF were identified in the examined subjects: normal, minimal changes, focal changes and reticular. The most common pattern in all refractive groups was the reticular pattern, the frequency of which ranged from 41,7 to 88,9%. The least common pattern was normal, the frequency of which ranged from 4,2 to 33,3%. A significant differencebetween the values of the thickness of the retina in the foveal zone with the reticular pattern and its average group value in different refractive groups was not found.Conclusion.In young subjects with high visual acuity without clinical manifestation of pathology of the macular zone, AF-patterns other than the normal picture may be present. The reticular pattern is noted as the most common in all analyzed groups with various types of refraction. Further studies of early changes in fundus AF may make it possible to determine thepredictors of the development of dystrophic pathology of the macular zone.

Drug-Induced Acute Kidney Injury.

Medications are a common cause of AKI, especially for patients admitted to hospital wards and the intensive care unit. Although drug-related kidney injury occurs through different mechanisms, this review will focus on three specific types of tubulointerstitial injury. Direct acute tubular injury develops from several medications, which are toxic to various cellular functions. Their excretory pathways through the proximal tubules contribute further to AKI. Drug-induced AKI may also develop through induction of inflammation within the tubulointerstitium. Medications can elicit a T cell-mediated immune response that promotes the development of acute interstitial nephritis leading to AKI. Although less common, a third pathway to kidney injury results from the insolubility of drugs in the urine leading to their precipitation as crystals within distal tubular lumens, causing a crystalline-related AKI. Intratubular obstruction, direct tubular injury, and localized inflammation lead to AKI. Clinicians should be familiar with the pathogenesis and clinical-pathologic manifestations of these forms of kidney injury. Prevention and treatment of AKI relies on understanding the pathogenesis and judiciously using these agents in settings where AKI risk is high.

Clinicopathological Spectrum of Cryoglobulinemic Glomerulonephritis without Evidence of Autoimmunity Disorders: A Retrospective Study from a Single Institute of China

Background: Cryoglobulinemic glomerulonephritis (Cryo-GN), caused by circulating cryoglobulins, has varied etiology and clinical-pathologic manifestations. This study aimed to investigate the clinicopathological spectrum and outcome of patients with various Cryo-GN in China. Methods: A retrospective review of 74 Chinese patients with biopsy-proven cryoglobulin-related renal lesions in Peking University First Hospital from 2010 to 2020 was performed. Results: The mean age at diagnosis was 52.9 ± 15.0 years, and the female-to-male ratio was about 2/5. For the etiology screening, serum/urine monoclonal immunoglobulin could be detected on immunofixation electrophoresis in 34% of patients, including 6 patients who had hematological malignancies. Fifty-seven percent of patients had HBV infection, far more than HCV infection (5%). Ten percent of patients had other infections, and 27% of patients were classified as essential or idiopathic. Eleven out of the 15 patients with type II cryoglobulinemia had a consistent monotype of serum monoclonal immunoglobulins and monoclonal cryoprecipitate. The clinical manifestations were similar between various types of cryoglobulinemia. Hematuria, proteinuria, hypertension, anemia, and chronic renal insufficiency were the most common features. Fifty-three percent of patients presented with nephrotic syndrome, and 32% experienced acute kidney injury. Hypocomplementemia, serum-positive rheumatoid factor activity, and skin lesions were reported in 45%, 29%, and 28% of patients, respectively. After a median of 24 months follow-up, 18 patients reached end-stage kidney disease. The clone-targeted treatment could retard the renal deterioration compared with immunosuppressive therapy. Conclusions: This was the largest single-center, clinicopathological retrospective study of Cryo-GN in China. Our data strongly support the association between monoclonal gammopathy and type II Cryo-GN. The renal responsive rate of immunosuppressant therapy is still suboptimal. The clone-targeted treatment shows promising effects in patients with type I or II Cryo-GN.

Ефективне лікування й профілактика часто рецидивуючої інфекції сечовивідних шляхів препаратом золотарника звичайного (Solidago virgaurea) Цисто-аурин®

Нами проведено дослідження клінічної та лабораторної ефективності, а також оцінка впливу на якість життя інтермітуючої терапії препаратом золотарника звичайного Цисто-аурин у 96 хворих на часто рецидивуючу інфекцію сечовивідних шляхів (ІСШ). Після отримання інформованої згоди хворі були розділені на три статистично однорідні групи. Протягом лікування пацієнтки всіх груп використовували стратегію поведінкової терапії та посткоїтальної профілактики. Пацієнтки групи А додатково отримували Цисто-аурин по 1 табл. 4 рази на день курсами по 15 днів кожного місяця протягом 6 місяців, групи В — той же препарат по 2 табл. 2 рази на день такими ж курсами, пацієнтки групи С (порівняння) спеціальної терапії не отримували. Упродовж дослідження отримані об’єктивні дані, що свідчать про вірогідне зниження числа рецидивів ІСШ на 92,3 і 73,3 % протягом 6 місяців лікування, залежно від кратності прийому препарату. Аналіз впливу досліджуваного препарату на лабораторні прояви часто рецидивуючої інфекції сечової системи показав позитивний ефект інтермітуючого режиму терапії щодо піурії, редукцію прозапальної активності та статистично вірогідне зменшення проявів запалення в сечовій системі. Ефективність редукції лейкоцитурії у хворих, які приймали препарат, становила 73,4 і 44,6 %, тобто лейкоцитурія була в 3,7 і 1,8 раза нижче вихідних значень. У той же час серед хворих групи С статистично значущої динаміки виявлено не було. Дискретна і кількісна оцінка впливу досліджуваного препарату на бактеріурію показала клінічно значущий і статистично вірогідний бактеріо­статичний ефект Цисто-аурину як в процесі лікування препаратом (на 41,0 і 27,6 % відповідно), так і в проспективному 6-місячному періоді спостереження після його прийому (на 30,3 і 18,0 % відповідно), що є важливим підтвердженням впливу препарату на персистенцію мікробів у сечовій системі. Структуризація антибактеріального ефекту щодо клінічно значущих уропатогенів підтвердила редукцію штамів E.сoli на 61,1 і 31,9 %, Klebsiella pneumoniae — на 33,1 і 17,1 %, P.mirabilis — на 19,1 і 12, 9 %, P.aeruginosa — на 21,1 і 14,1 %, Candida spp. — на 19,4 і 14,5 % відповідно. Оцінка впливу досліджуваного препарату на симптоматику рекурентного хронічного циститу (шкала UTISA) показала вірогідне зниження ключових клінічних симптомокомплексів рецидивної ІСШ: полакіурії (на 48,3 % в обох групах), імперативних позивів (59,8 і 30,1 %), болю й печіння (42,6 і 30,2 %), неповного випорожнення сечового міхура (53,8 і 30,9 %), а також інтегрального показника клінічних проявів патології (24,7 і 39,2 % відповідно). Динаміка показників якості життя, що пов’язана із здоров’ям (шкала SF-36), на тлі прийому препарату продемонструвала статистично значущу індукцію ключових доменів якості життя хворих на часто рецидивуючу ІСШ: психічного здоров’я (33,4 % проти 32,5 %) і кумулятивного показника загальної якості життя (19,6 % проти 14,6 % відповідно).

Vesicoureteral reflux as a manifestation of CAKUT-syndrome in children: the problem of late diagnosis

CAKUT-syndrome includes combined congenital abnormalities of the kidneys and urinary tract and is a complex problem in pediatrics, requiring an interdisciplinary approach of doctors of various specialties. One of the most severe manifestations of CAKUT-syndrome is vesicoureteral reflux, which is often the main manifestation of a congenital abnormality of the kidneys and urinary tract. Structural and urodynamic disorders in the organs of the urinary system in vesicoureteral reflux can lead to the formation of reflux nephropathy and chronic kidney disease. Low-symptom clinical manifestations of reflux nephropathy make it difficult to diagnose it early. Vesicoureteral reflux leads to intrarenal reflux, repeated attacks of pyelonephritis and sclerosis of the renal tissue, which in 25-60 % of cases causes end-stage chronic renal failure due to vesicoureteral reflux. Given the absence of specific pathognomonic clinical manifestations of reflux nephropathy, laboratory indicators are of fundamental importance in the diagnosis-levels of albuminuria, leukocyturia, urinary sediment fermenturia, urine osmolarity, daily urinary excretion of β2 – microglobulin and a wide arsenal of methods for diagnosing reflux nephropathy and scarring of the renal parenchyma: ultrasound with dopplerography of the renal blood flow, magnetic resonance imaging and computed tomography, radioisotope scanning. The imperfection of instrumental methods for visualizing the initial stages of kidney fibrosis dictates the need to develop alternative, more sensitive methods for early diagnosis of reflux nephropathy. One of the directions of this search is molecular diagnostics, which allows you to detect possible damage to the renal tissue at the subcellular level long before the clinical manifestations of pathology, personify nephroprotective therapy and prevention of reflux nephropathy. The article presents clinical observations from our own practice of late diagnosis of reflux nephropathy, in which renal pathology was first detected at stages 5 and 3 of chronic kidney disease in two boys aged 10 and 16 years, respectively, who were on inpatient treatment in the Nephrology Department of the Children's Republican clinical hospital.

Treatment Outcomes of Pulpectomy in Primary Maxillary Incisors Filled with ZOE and Metapex: A Two-year Retrospective Study.

To address a literature gap by evaluating, in a larger set of samples, the clinical and radiographic outcomes of pulpectomy in primary maxillary incisors using ZOE and calcium hydroxide/iodoform paste. To also identify the predisposing factors for treatment outcomes. Medical charts of 124 patients (aged 16 to 60 months) and radiographs of their incisors (309 incisors) were reviewed (128 with ZOE and 181 with Metapex). All incisors were restored with composite resin crowns. The radiographic success rates for ZOE and Metapex were: 85.9% and 82.9% at the 12-month recall, and 69.2% and 64% at the 24-month recall, with no statistically significant difference between the two groups. Clinical failures occurred more frequently in the Metapex group (P = 0.006), as clinical signs of pain and soft tissue pathosis were found in 6.2% of the Metapex cases at 24 months but none in the ZOE group. Significant predisposing factors for radiographic success were type of tooth, degree of obturation at recalls, and preoperative root resorption. The radiographic success rates are comparable between the ZOE and Metapex groups. Clinical pathological manifestations such as pain and soft tissue pathosis are seen in the Metapex group at recalls, but none in the ZOE group. Predisposing factors such as type of incisor, preoperative root resorption, and extent of filling at recalls are associated with the radiographic success rate.

ОБОСНОВАНИЕ ПРИМЕНЕНИЯ КОНСТРУКЦИОННЫХ МАТЕРИАЛОВ ПРИ ЯВЛЕНИЯХ НЕПЕРЕНОСИМОСТИ АКРИЛАТОВ

Introduction. Today, for the manufacture of prostheses with a plastic base, hot polymerization acrylic plastic is most often used, which contains a free monomer — methyl methacrylate. However, in some patients, after their placement in the oral cavity, as a result of orthopedic treatment, various clinical pathological manifestations may occur, which in general are defined as individual intolerance to dental materials. The aim is to carry out a systematic analysis of domestic and foreign literary sources to determine the most suitable base material in patients with intolerance to structural materials. Methodology. The research was carried out on the basis of the search for scientific papers, in the electronic scientific library elibrary.ru for the last 15 years, as well as in the search engines PubMed, Scopus and Wiley Inter Science for 2009–2020. The search was carried out by keywords. Results. The article analyzes the literature data indicating the importance of the choice of the base material in the pathogenesis of intolerance to dental materials. During the analysis of the literature, the positive properties of a new, alternative light-curing base material, which can be used in patients with acrylate intolerance, have been substantiated. Conclusions. The results obtained, in the course of the literature analysis, allow us to highlight the advantages of using a light-curing base material in comparison with acrylic plastics and thermoplastic resins. The results of the use of the light-curing base material in clinical practice will be communicated by us to the dental community in subsequent publications.

SIGNIFICANCE OF CLINICAL AND LABORATORY MARKERS IN DISORDERS OF THE FUNCTIONAL CONDITION OF THE HEPATOBILIARY SYSTEM IN NEONATAL JAUNDICE

INTRODUCTION: The liver is the central organ of metabolic activity in the body.
 OBJECTIVES: The purpose of this study was to determine predictors, major clinical features, and laboratory criteria for the severity of disorders of the functional state of the hepatobiliary system in newborns with neonatal jaundice (NJ). The study included 164 full-term infants. The main group - 92 children, with manifestations of pathological jaundice, was divided into two subgroups, depending on the severity of the pathology, considering concomitant perinatal pathology. IA group (46 children) includes children, condition of which was defined as moderate, IB (46 children) – children, condition of which was defined as severe, the control group consisted of 72 healthy term infants.
 METHODS: The complex of examination methods includes: collection of anamnesis of antenatal and perinatal periods in the mother, clinical examination of the newborn and laboratory methods of examination: blood biochemical analysis (TSB blood, bilirubin fractions, activity of ALT enzymes, AST, ALP , γ-GT, glucose level of blood serum, cholesterol, triglycerides) ultrasound examination of infants' liver.
 RESULTS: Clinical symptoms that confirmed the functional impairment of the hepatobiliary system (HBS) in newborns who had signs of NJ in perinatal pathology are: hepatosplenomegaly, impaired bowel function, hypoglycemia, anemic syndrome, hemorrhagic disorders. The results of biochemical studies of the blood showed an increase in the severity of the pathology, an increase in the level of TSB and the fraction of indirect bilirubin, activation of the cytolysis markers of ALT and AST, increase of LDH activity, decrease in the activity of g-GT and ALP, as well as decrease in the level of total protein, albumin, glucose, increase in the level of urea, cholesterol and triglycerides. The most explicit manifestations of HBS dysfunction were found in newborns with a severe condition at birth and in the early neonatal period caused both by the NJ and other comorbidities. Taking into account the revealed deepening of biochemical changes in indicators of blood serum in correlation with the increase of clinical manifestations of pathology, the diagnosis of changes in the early stages will allow to diagnose in time the disorders of the functional state of HBS in NJ for the purpose of appropriate therapeutic correction.
 CONCLUSION: The results of the analysis of anamnestic and clinical-laboratory parameters in newborns with NJ showed on the background of a clinical signs of dysfunction of the hepatobiliary system, the presence of significant biochemical changes, especially enzymatic activity, including, ALT, AST, LDH, ALP, and g-GT and, also an increase in TBS levels and an indirect bilirubin fraction, a decrease in total protein and albumin, glucose, a rise in urea, cholesterol and triglycerides.
 The use of a biochemical markers in newborns with clinical manifestations of neonatal jaundice, especially in cases of significant severity of the condition with concomitant perinatal pathology, requires more detailed analysis in order to determine the main pathogenesis of disorders of the functional state of the hepatobiliary system for the purpose of timely correction and improvement of the outcome of treatment.

Оценка выраженности эндогенной интоксикации при болезни Альцгеймера

The development of neurodegenerative pathologies, among which the leading positions worldwide belong to Alzheimer's disease, is accompanied by the activation of free radical processes in the tissues of the brain and in the patient's body as a whole, which leads to the accumulation of products of oxidative modification of proteins, lipids, nucleic acids, and the formation of a syndrome of endogenous intoxication. An integral indicator reflecting the severity of this syndrome is the level of substances of low and medium molecular weight in various biological media. It is known that changes at the molecular level in Alzheimer's disease occur 5-10 years before the clinical manifestation of pathology. The development of polymodal panels for biochemical screening, diagnostics, monitoring of the course of pathology is underway. The aim of this study was to determine the severity of endogenous intoxication in patients with Alzheimer's disease and vascular dementia. The object of the study was the blood plasma of patients, as well as fractionated leukocytes - mononuclear and polymorphonuclear. The choice of biological material for the study is dictated by the need to search for a prognostic marker of the disease available for diagnosis, as well as by the accumulated theoretical material on various metabolic changes in peripheral blood cells in neurodegenerative diseases. According to the results of the study, it was found that in patients with Alzheimer's disease in mononuclear leukocytes of peripheral blood, the level of substances of low and medium molecular weight is higher than in patients with vascular dementia and patients without signs of neurodegeneration. In addition, in this fraction of leukocytes, the concentration of hypoxanthine, inosine, xanthosine and their derivatives is high, which may be a consequence of the oxidative modification of nucleic acids in the cells under study.

Precursors of the treatment failure of mycobacteriosis in patients with HIV

Purpose. Analyze the dynamics of clinical and laboratory parameters, the outcomes of the disease on various treatment regimens. To identify the main markers of unfavorable outcome or protracted course of the disease. Materials and methods. The study included 70 patients with HIV and mycobacteriosis who received complex therapy (antiretroviral and specific antibacterial drugs). Depending on the outcome of the disease, two groups were distinguished: clinical cure (n = 38) and lethal outcome (n = 32). The clinical manifestations of pathology, laboratory indicators at different stages of treatment, the scheme and terms of the therapy being carried out were analyzed on the basis of data from medical histories and ambulatory patient records. A statistical analysis was performed, the efficacy of therapy was evaluated using the Kaplan-Meier method, the macrolide in the first line of antibacterial therapy used was taken as the basis. Results. All patients who died developed a disseminated form of the process. In cases when MAI developed within the unmasking immune restoration syndrome patients were prognostically more favorable (p <0,05). In the clinical cure group, a significantly higher level of CD4 lymphocytes was recorded before treatment (33,3 ± 7,1 versus 9,9 ± 3,2 cells / μl, p <0,05). A significant difference in the level of CD4 persisted after a month of complex therapy (79,0 ± 13,4 versus 32,2 ± 9,1, p <0.05). In addition to higher immunity values, the first group also had a higher hemoglobin level after a month of treatment (108,3 ± 3,2 g / l versus 76,7 ± 5,2 g / l, p <0,05). The regression of intoxication and fever was observed earlier in the cure group. When studying the used macrolide basis for the treatment of mycobacteriosis, it was found that survival term was significantly higher among patients who received clarithromycin in the first line (Kaplan – Meier, p <0,05 Breslow, Tarone-Ware). According to this sample, the introduction of aminoglycoside to the treatment regimen did not make significant changes in the timing and prognosis of treatment. Conclusion . Prolonged persistence of the symptoms of the disease, persisting deep immunodeficiency and anemia of moderate or severe degree are associated with an unfavorable outcome. According to this sample, clarithromycin should be considered the drug of choice for the treatment of mycobacteriosis in HIV.

ДИАГНОСТИЧЕСКИЕ КРИТЕРИИ ЧЕРЕПНО-КЛЮЧИЧНОЙ ДИСПЛАЗИИ В КЛИНИЧЕСКОЙ СТОМАТОЛОГИЧЕСКОЙ ПРАКТИКЕ

Subject. Cleidocranial dysplasia is a rare hereditary pathology found in general and dental clinical practice. According to current data in the world literature, to date about 500 cases of this disease have been described.
 Purpose — increased effectiveness of diagnostic maneuverin patients with cleidocranialdysplasia in clinical dental practice.
 Methodology. In order to ensure the regularization and systematization of scattered clinical and diagnostic information on the pathology studied, a meta-analysis of native and foreign reference, scientific and educational and methodological literary sources related to this problem has been carried out. Patients with cleidocranial dysplasia were examined, the formed diagnostic algorithm was tested, clinical manifestation of pathology was evaluated.
 Results. As a result of the analysis, a convenient and practically acceptable model of the main clinical signs of cleidocranialdysplasia has been developed for the formation of a diagnostic algorithm for dental practitioners. Two clinical cases are presented showing the results of the diagnostic process in patients with cleidocranialdysplasia, complex and questionableclinical situations in the oral cavity.
 Conclusion. The model of the main clinical signs of cleidocranial dysplasia is an effective diagnostic algorithm in dental practice, which forms in practical dentists professional skills and competence in routing and attracting to advise specialists of related specialties of dental and general medical profiles, in cases of detection of patients with this rarely occurring pathology on clinical reception. The presented clinical cases demonstrate the effectiveness of its application in the practice of the dentist, illustrating a detailed, competent and acceptable scheme of writing the history of the disease of patients with this pathology, complex and questionable clinical situations of a universal nature and in the oral cavity in the outpatient dentalappointment.

Homocysteine and IgA nephropathy: observational and Mendelian randomization analyses.

Background:High levels of plasma homocysteine occur almost uniformly in patients with end-stage renal disease (ESRD). IgA nephropathy (IgAN) is the most common form of primary glomerulonephritis and a common cause of ESRD in young adults. Here, we aimed to detect whether homocysteine was elevated and associated with clinical-pathologic manifestations of IgAN patients and tested its causal effects using a two-sample Mendelian randomization (MR) approach.Methods:For observational analysis, 108 IgAN patients, 30 lupus nephritis (LN) patients, 50 minimal change disease (MCD) patients, and 206 healthy controls were recruited from April 2014 to April 2015. Their plasma homocysteine was measured and clinical-pathologic manifestations were collected from medical records. For MR analysis, we further included 1686 IgAN patients. The missense variant methylenetetrahydrofolate reductase C677T (rs1801133) was selected as an instrument, which was genotyped by TaqMan allele discrimination assays.Results:Majority of IgAN patients (93.52%, 101/108) showed elevated levels of plasma homocysteine (>10 μmol/L). Plasma homocysteine in IgAN patients was significantly higher than that in MCD patients (median: 18.32 vs. 11.15 μmol/L, Z = −5.29, P < 0.01) and in healthy controls (median: 18.32 vs. 10.00 μmol/L, Z = −8.76, P < 0.01), but comparable with those in LN patients (median: 18.32 L vs. 14.50 μmol/L, Z = −1.32, P = 0.19). Significant differences were observed in sub-groups of IgAN patients according to quartiles of plasma homocysteine for male ratio (22.22% vs. 51.85% vs. 70.37% vs. 70.37%, χ2 = 14.29, P < 0.01), serum creatinine (median: 77.00 vs. 100.00 vs. 129.00 vs. 150.00 μmol/L, χ2 = 34.06, P < 0.01), estimated glomerular filtration rate (median: 100.52 vs. 74.23 vs. 52.68 vs. 42.67 mL·min−1·1.73 m−2, χ2 = 21.75, P < 0.01), systolic blood pressure (median: 120.00 vs. 120.00 vs. 125.00 vs. 130.00 mmHg, χ2 = 2.97, P = 0.05), diastolic blood pressure (median 80.00 vs. 75.00 vs. 80.00 vs. 81.00 mmHg, χ2 = 11.47, P < 0.01), and pathologic tubular atrophy and interstitial fibrosis (T) (T0/T1/T2: 62.96%/33.33%/3.70% vs. 29.63%/40.74%/29.63% vs. 24.00%/48.00%/28.00% vs. 14.81%/37.04%/48.15%, χ2 = 17.66, P < 0.01). The coefficient of each rs1801133-T allele on homocysteine levels after controlling age and sex was 7.12 (P < 0.01). MR estimates showed causal positive effects of homocysteine on serum creatine (β = 0.76, P = 0.02), systolic blood pressure (β = 0.26, P = 0.02), diastolic blood pressure (β = 0.20, P = 0.01), and pathologic T lesion (β = 0.01, P = 0.01) in IgAN.Conclusions:By observational and MR analyses, consistent results were observed for associations of plasma homocysteine with serum creatinine, blood pressures, and pathologic T lesion in IgAN patients.

Elevated hsa-miR-590-3p expression down-regulates HMGB2 expression and contributes to the severity of IgA nephropathy.

Peripheral blood mononuclear cells (PBMCs) play important roles in the pathogenesis of IgA nephropathy (IgAN). Our study aimed to provide a deep understanding of IgAN and focused on the dysregulation of hsa‐miR‐590‐3p and its target gene HMGB2 in PBMCs. Three gene expression profile datasets (GSE14795, GSE73953 and GSE25590) were downloaded from the GEO database. The DEGs (differentially expressed genes)‐miRNA network that was associated with IgAN was constructed by Cytoscape, and HMGB2 and hsa‐miR‐590‐3p were selected for further exploration. The dual‐luciferase reporter system was utilized to verify their interaction. Then, the expression levels of HMGB2 and hsa‐miR‐590‐3p in PBMCs were detected by qPCR in another cohort, and the correlation of their expression levels with the clinical pathological manifestations and serum Gd‐IgA1(galactose‐deficient IgA1) levels was also investigated. HMGB2 was identified as the target gene of hsa‐miR‐590‐3p. Furtherly, the elderly patients had higher HMGB2 expression levels than the expression levels of the younger patients. As the serum creatinine, serum BUN levels increased, the expression of HMGB2 decreased; Besides, the HMGB2 expression was positively correlated with serum complement 3(C3) levels, and it also had a negative correlation with the diastolic blood pressure, but not reach statistical significance. What is more, both hsa‐miR‐590‐3p and HMGB2 expression had a slight correlation tendency with serum Gd‐IgA1 levels in the whole population. In conclusion, HMGB2, the target gene of hsa‐miR‐590‐3p, was identified to correlate with the severity of IgAN, and this provides more clues for the pathogenesis of IgAN.

THE PATHOLOGY OF STOMACH AND DUODENUM IN SCHOOLCHILDREN OF THE REPUBLIC OF TYVA

The article presents the data of implemented in 2017 re-monitoring of prevalence of main forms of gastroduodenal pathology among 471 schoolchildren aged from 7 to 17 years in rural territory of the Republic of Tyva being a territory of extremely high morbidity of carcinoma of stomach of adult population, especially indigenous one. It is established that negative dynamics of prevalence of dyspepsia syndrome, a main clinical manifestation of pathology of stomach and duodenum observed during previous monitoring is absent among examined children. At that, among Caucasian schoolchildren there is an increasing of its rate as compared with data of analogous monitoring i 2008-2009. Besides, clinical course of dyspepsia has been changed: a pain alternative is marked more rarely in children of both populations. The positive result of monitoring of children of Tyva in 2017 is disappearance of cases of peptic ulcer from the structure of gastroduodenal pathology in indigenous residents. At that, on the whole in children no significant dynamics of structure of diseases of stomach and duodenum were detected. The results of monitoring testify positive dynamics in prevalence of gastroduodenal pathology in schoolchildren of the Republic of Tyva. The monitoring permits to obtain reliable data of prevalence of gastroduodenal pathology and main tendencies in their dynamics. The implementation of data collection and analysis of effecting social ecological factors during monitoring application will increase efficiency of prevention.

Correlations of ultrasonic features with severity of liver cancer and p16 expression in patients with liver cancer.

This paper analyzes the correlations of ultrasonic features with clinical-pathological manifestations and p16 expression in patients with liver cancer. A total of 84 patients with primary liver cancer were randomly enrolled. The characteristics of liver cancer were examined via conventional ultrasound and contrast-enhanced ultrasound (CEUS) before operation. The p16 protein expressions in liver cancer and para-carcinoma tissues were detected via immunohistochemistry (IHC), and the correlations of p16 positive expression with ultrasound parameters were also analyzed. It was manifested via ultrasound that 6.4% (3/47) of stage I-II liver cancer showed the equal-echo change in portal phase, while others faded and showed the equal-echo change with 32.4% (12/37) of stage III-IV liver cancer. There were no statistically significant differences in ultrasonic features of patients in stage I-II and stage III-IV in the arterial and delayed phases (p>0.05). The positive expression rate of p16 protein in para-carcinoma tissues was 85.71% (72/84) which was significantly higher than that in liver cancer tissues (30.95%, 26/84) (p<0.05). Maximum intensity (IMAX), time to peak (TTP) and mean transit time (mTT) had no statistically significant differences between the p16 positive and negative groups, but there were statistically significant differences in rising slope (RS) and washout time (WT) (p<0.05). Correlation analyses revealed that the positive expression of p16 had no significant correlations with IMAX, mTT and TTP (p>0.05), but it positively correlated with RS (correlation coefficient r=0.377, p<0.05) and negatively correlated with WT (r=-0.410, p<0.05). Conventional ultrasound and CEUS can evaluate the expression of p16 protein in liver cancer repeatedly and non-invasively. The evaluations therefore have great significance in clinical treatment of liver cancer.

PRINCIPLES OF DIAGNOSIS AND THERAPY OF DRUG-INDUCED LIVER INJURY IN CHILDREN WITH TUBERCULOSIS

Drug-induced liver injury is a disease that occurs during the administration of medications, which is controlled or has a positive dynamics after the drug administration is discontinued, and the renewed prescription of which causes a relapse of clinical and laboratory signs of liver injury. No unified diagnostic criteria have been developed yet. We used the following diagnosis criteria: any excess of the levels of total bilirubin, direct bilirubin, transaminases; temporary association with administration of medications; ruling out other causes of liver injury. Results. 114 children with tuberculosis, aged 3 to 14, were examined. Drug-induced liver injury during the anti-TB therapy was diagnosed in 77 (67.5%) children. In almost half of the cases (37 children, 48%), the liver injury was asymptomatic and was diagnosed with a biochemical blood test. The most common clinical manifestation of pathology include dyspeptic syndrome (in 42.9% of children), less frequent one is abdominal pain syndrome (in 29.9%). The most common biochemical variant of drug-induced liver injury (in 64% of children) was a mixed variant (increased levels of transaminases and bilirubin). Also cytolytic syndrome was pronounced in 54% (in 31 of 57 children) of cases. Conclusions. Drug-induced liver injury during the administration of potentially hepatotoxic drugs should be actively detected by a control biochemical blood test every 2 weeks. Early detection of minimal clinical and laboratory symptoms of liver injury in patients with tuberculosis and timely initiation of treatment will allow controlling quickly liver injury, reducing the number of cases of cancellation of TB treatment, improving the outcome and prognosis for both tuberculosis and hepatic conditions.

AUTOLOGOUS PLATELET‐RICH PLASMA: A REVIEW OF SCIENTIFIC ARTICLES ON THE STUDY OF EFFICIENCY IN TREATMENT OF ANDROGENETIC ALOPECIA IN MEN AND WOMEN

This article is an analysis of scientific publications that reflect the experience of using autologous plateletrich plasma in patients with androgenic alopecia (AGA), a multifactorial genetically predisposed disease caused by the influence of exogenous or endogenous triggers responsible for the clinical manifestations of pathology. Attention to this topic is due to the significant prevalence of AGA, as well as unsatisfactory results in achieving a positive therapeutic effect. Positive results were obtained during the 12 clinical studies among the conducted ones, no positive dynamics were observed in the end of other 2 studies. It can be noted that different methods and parameters of centrifugation were used to perform these experiments: PRP used differ or PRP activators were not used at all, variations were observed in methods for evaluating the obtained results, the multiplicity of procedures and intervals between them, the procedure technique (using a mezoroller, anesthetics, injections, etc.). Studies with a negative result were characterized by the smallest number of procedures performed (1 or 2 procedures), and methods for evaluating the results cannot be called sufficiently reliable (a magnifying glass). It is obvious that the use of PRP has a positive effect on the state of AGA and can be used with approved methods of this disease treatment. However, the published results of only a small number of clinical trials on the effectiveness of PRP for hair growth cannot be considered objective. In addition, there is no published agreed protocol for the standard use of PRP, and the use of growth factors and stimulants in the expression of their genes still requires comparative evaluation with preparations approved for the treatment of hair. Thus, the method of PRP using can be considered as a method of treating AGA, however, it is necessary to continue research for further study and standardization of this technique.

Sole Dependence on Urine Testing Strips and the Ability to Identify Clinically Significant Disease: Challenging the Current Paradigm for Heme Detection in General Clinical Situations.

The ability of health care professionals to provide patient care is potentially compromised when predicated on untested, although longstanding, perspectives. One such example is urinalysis testing, which has been currently simplified to use only urine testing strips for detection of microscopic hematuria. To determine whether urine testing strips are sufficient for identification of clinically significant findings in urinalysis. To determine the presence of microscopic hematuria, I examined a collection of urine specimens that had tested heme negative during the 3-month study period. Of the 342 patients from whom urine specimens were examined during this interval, 50 had microscopic hematuria, despite having tested negative for heme via urine testing strip. Also, 30% were not receiving any medication known to produce microscopic hematuria, and 18% had clinically significant pathology. Diagnosis of significant clinical pathologic manifestations would have been compromised had microscopic examination not been performed on the urine specimens from the cohort individuals. Examination of the novel approach of including microscopic examination of specimens in a specific clinical situation challenges the dominant paradigm of reliance on assaying using urine testing strips only, revealing that the current method is not only unreliable for determining microscopic hematuria but also is less than optimal in general clinical practice. The findings of this study provide evidence of the importance of microscopic evaluation as a routine component of urinalysis.