Clinical Observations Research Articles

Long-Term Outcome of Surgically Repaired and Non-repaired Double Aortic Arch in Children.

Introduction A double aortic arch (DAA) is a rare congenital vascular anomaly that encircles the trachea and esophagus, resulting in compression of both structures and causing variable symptoms of wheezing, stridor, increased work of breathing, or dysphagia. DAA usually presents in infancy but can be incidentally found later in life. The standard management of DAA is surgical repair. However, observation and follow-up have been recommended in asymptomatic or mild cases. The long-term outcome of surgical repair versus observation is not well-reported. We described the long-term clinical outcome of patients with DAA who were surgically repaired versus non-repaired at our institution. Methods Electronic medical records were searched for the patients diagnosed with DAA before the age of 18 years. Data from clinical, radiological, and bronchoscopic findings, pulmonary function test(PFT), and cardiopulmonary exercise testing (CPET) were extracted. A structured phone questionnaire of patients' parents regarding past and current symptoms was also conducted. Results A total of 12 patients (eight males four females) with DAA were identified. Median age was 8.5 (1.5-17) years. The age at diagnosis was 60 (1-192) months. Post diagnosis follow-up period was 20 (2-156) months. Five patients were surgically repaired, and seven patients were not repaired. The median age of surgery was five (1-15) years in repaired patients. The phone questionnaire was completed in only 10 patients (five repaired and five non-repaired). Respiratory symptoms in infancy were reported in all repaired and non-repaired patients and were resolved in all five repaired patients and in four of the five non-repaired patients. One non-repaired patient complained of intermittent dyspnea on exertion. Gastrointestinal symptoms were present in infancy in three repaired and three non-repaired patientsand were improved in two repaired and one non-repaired patient. PFT was performed in five patients (one repaired, four non-repaired) and showed normal forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC in all patients. Low peak expiratory flow (PEF) was seen in the repaired patient and in three of the non-repaired patients. CPET was conducted in four non-repaired patients and showed maximal oxygen consumption (VO2-max) of 66% predicted (58-88), maximal ventilation (VE-max) of 75% predicted (70-104), and ventilatory reserve of 55% predicted (48-104). Conclusion Long-term clinical outcome is favorable in both repaired and non-repaired patients with DAA even though both groups reported respiratory symptoms during infancy. Therefore, clinical observation is a legitimate option in certain DAA patients.

Long-term oral administration of Kelisha capsule does not cause hepatorenal toxicity in rats

Ethnopharmacological relevanceKelisha capsules (KLS) are often used to treat acute diarrhoea, bacillary dysentery, heat stroke, and other diseases. One of its components, Asarum, contains aristolochic acid I which is both nephrotoxic and carcinogenic. However, the aristolochic acid (AA) content in KLS and its toxicity remain unclear. Aim of the studyThe aims of this study were to quantitatively determine the contents of five aristolochic acid analogues (AAAs) in Asarum and KLS, and systematically evaluate the in vivo toxicity of KLS in rats. Materials and methodsUltra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) was used to determine the content of the five AAAs in Asarum and KLS. Sprague–Dawley rats were administered KLS at 0, 0.75, 1.5, and 3.0 g/kg respectively, and then sacrificed after 4 weeks of administration or after an additional 2 weeks of recovery. The endpoints assessed included body weight measurements, serum biochemistry and haematology indices, and clinical and histopathological observations. ResultsThe AAAs content in Asarum sieboldii Miq. (HB-ESBJ) were much lower than those of the other Asarums. The contents of AA I, AA IVa, and aristolactam I in KLS were in the ranges of 0.03-0.06 μg/g, 1.89-2.16 μg/g, and 0.55-1.60 μg/g, respectively, whereas AA II and AA IIIa were not detected. None of the rats showed symptoms of toxic reactions and KLS was well tolerated throughout the study. Compared to the control group, the activated partial thromboplastin time values of rats in the 1.5 and 3.0 g/kg groups significantly reduced after administration (P < 0.05). In addition, the serum triglycerides of male rats in the 0.75 and 1.5 g/kg groups after administration, and the 0.75, 1.5, 3.0 g/kg groups after recovery were significantly decreased (P < 0.01 or P < 0.001). No significant drug-related toxicological changes were observed in other serum biochemical indices, haematology, or histopathology. ConclusionsThe AA I content in KLS met the limit requirements (<0.001%) of the Chinese Pharmacopoeia. Therefore, it is safe to use KLS in the short-term. However, for safety considerations, attention should be paid to the effects of long-term KLS administration on coagulation function and triglyceride metabolism.

Dry eye syndrome associated with traumatic keratitis

Dry eye syndrome (DES) is an urgent problem in healthcare practice worldwide. Various diseases of the eye are of particular importance for the development of this syndrome. A special place among the diseases leading to symptomatic DES with ocular surface lesion belongs to corneal injuries of traumatic origin. The frequency of post-traumatic complications of the eye, especially the cornea, remains high due to its anatomical location. And often these patients are at risk of secondary DES. For the pathogenesis of DES after ke­ratitis, ultrastructural changes in the cells of different corneal layers and the toxic effect on the tear film layers of preservative-containing drugs used in the treatment of keratitis are important. The purpose of the study was to assess the severity of secondary DES in patients after traumatic keratitis and the effectiveness of hyaluronic acid combined with antioxidants in the treatment of this pathology. An ophthalmological examination, functional tests were made, and the Ocular Surface Disease Index was used to evaluate the symptoms and severity of the disease. The criteria for the effectiveness of the therapy with hyaluronic acid in combination with vitamins A and E four times a day were: reduction of corneal syndrome, increase in the tear film break-up time, a decrease in subjective discomfort. Clinical observation of patients with DES after traumatic keratitis showed that the use of hyaluronic acid can result in a significant reduction or complete disappearance of subjective symptoms of the disease, sustained improvement in vision and increased stability of the tear film. The use of these eye drops makes it possible to reach compliance and shorten the treatment period.

Considerations for the use of inhaled antibiotics for Pseudomonas aeruginosa in people with cystic fibrosis receiving CFTR modulator therapy

The major cause of mortality in people with cystic fibrosis (pwCF) is progressive lung disease characterised by acute and chronic infections, the accumulation of mucus, airway inflammation, structural damage and...

Interdisciplinary Management of Vascular Anomalies in the Head and Neck.

Vascular anomalies in the head and neck area are usually rare diseases and pose a particular diagnostic and therapeutic challenge. They are divided into vascular tumours and vascular malformations. A distinction is made between benign tumours, such as infantile haemangioma, and rare malignant tumours, such as angiosarcoma. Vascular malformations are categorised as simple malformations, mixed malformations, large vessel anomalies and those associated with other anomalies. Treatment is interdisciplinary and various modalities are available. These include clinical observation, sclerotherapy, embolisation, ablative and coagulating procedures, surgical resection and systemic drug therapy. Treatment is challenging, as vascular anomalies in the head and neck region practically always affect function and aesthetics. A better understanding of the genetic and molecular biological basis of vascular anomalies has recently led to clinical research into targeted drug therapies. This article provides an up-to-date overview of the diagnosis, clinic and treatment of vascular anomalies in the head and neck region.

Cost-effectiveness analysis of routine computed tomography angiography (CTA) for lower extremity penetrating trauma

BackgroundRoutine evaluation with CTA for patients with isolated lower extremity penetrating trauma and normal ankle-brachial-indices (ABI) remains controversial. While prior literature has found normal ABI's (≥0.9) and a normal clinical examination to be adequate for safe discharge, there remains concern for missed injuries which could lead to delayed surgical intervention and unnecessary morbidity. Our hypothesis was that routine CTA after isolated lower extremity penetrating trauma with normal ABIs and clinical examination is not cost-effective. MethodsWe performed a decision-analytic model to evaluate the cost-effectiveness of obtaining a CTA routinely compared to clinical observation and ABI evaluation in hemodynamically normal patients with isolated penetrating lower extremity trauma. Our base case was a patient that sustained penetrating lower extremity trauma with normal ABIs that received a CTA in the trauma bay. Costs, probability, and Quality-Adjusted Life Years (QALYs) were generated from published literature. ResultsClinical evaluation only (no CTA) was cost-effective with a cost of $2056.13 and 0.98 QALYs gained compared to routine CTA which had increased costs of $7449.91 and lower QALYs 0.92. Using one-way sensitivity analysis, routine CTA does not become the cost-effective strategy until the cost of a missed injury reaches $210,075.83. ConclusionsPatients with isolated, penetrating lower extremity trauma with normal ABIs and clinical examination do not warrant routine CTA as there is no benefit with increased costs.

Acute watery diarrhoea cases during cholera outbreak in Syria: a cohort study

ObjectivesThe aim of this study is a descriptive presentation of cases of acute watery diarrhoea (AWD) that were presented to Aleppo University Hospital (AUH) during the recent cholera outbreak in...

Predicting Clinical Pharmacokinetics/Pharmacodynamics and Impact of Organ Impairment on siRNA-Based Therapeutics Using a Mechanistic Physiologically-Based Pharmacokinetic-Pharmacodynamic Model.

Approved and emerging siRNA therapeutics are primarily designed for targeted delivery to liver where the therapeutic gene silencing effects occurs. Impairment of hepatic/renal function and its impact on siRNA pharmacokinetics/pharmacodynamics (PKs/PDs) are yet to be mechanistically evaluated to describe the unanticipated clinical observations for this novel modality. We developed pathophysiologically relevant models for organ impairment within a physiologically-based PK-PD (PBPK-PD) modeling framework focusing on modality-specific mechanistic factors to evaluate impact on siRNA PKs and PDs. PBPK-PD models for two US Food and Drug Administration (FDA) approved siRNAs inclisiran and vutrisiran were developed as case studies leveraging available tissue-specific data and translated to humans. Key determinants of the clinical PK and PD of N-acetylgalactosamine conjugated siRNAs (GalNAc-siRNAs) with varying sequences were also identified to inform effective clinical translation strategies for emerging GalNAc-siRNA candidates. A 30-70% reduction in hepatic asialoglycoprotein receptors concentrations still allowed for sufficient amount of free cytoplasmic siRNA for RISC-loading to produce PD effects comparable in extent and duration to normal liver function. This included severe hepatic impairment for which no clinical data are available. Inclusion of other modality agnostic physiological changes relevant to organ impairment did not alter the findings. Changes in renal physiologies, including changes in GFR across various degrees of impairment, well predicted minimal changes in PD for inclisiran and vutrisiran. This work provides a quantitative mechanistic framework and insights on modality-specific factors that drive clinical translation and patient/disease-related factors that impact specific dosing considerations and clinical outcomes to help accelerate the optimal development of siRNA therapeutics.

Short report: Twins with 20p13 duplication. Case report and comprehensive literature review.

Trisomy 20p is a rare genetic condition caused by a duplication of the short arm of chromosome 20. We employed clinical observation and molecular genetic testing (SNP microarray), to study identical twin males with an unknown dysmorphic syndrome. We conducted a literature review of trisomy 20p and collated the clinical and molecular genetic findings on 20 affected subjects reported since 2000. Identical twin males, whose prenatal course was complicated by a twin-to-twin transfusion, manifested profound language and neurocognitive delays as well as distinctive facial dysmorphisms when evaluated at 2 years of age. SNP microarray identified identical duplications of 20p13 with no other chromosomal aberrations. A literature survey of 20p trisomy syndrome identified 20 other examples of this condition reported since 2000, which we collated with 33 summarized by Sidwell etal. (2000). Within the combined total of 55 affected individuals, we found a distinctive clinical phenotype that provides insight on the effects of abnormal dosage of genes in 20p13. These loci include FAM110A (OMIM 611393), ANGPT4 (OMIM 603705), RSPO4 (OMIM 610573), PSMF1 (OMIM 617858), SNPH (OMIM 604942), SDCBP2 (OMIM 617358), FKBP1A (OMIM 186945), TMEM74B, C20orf202, and RAD21L1 (OMIM 619533). Gene profiling highlighted that syntaphilin (SNPH) is highly expressed in mammalian brain, where it is considered critical for mitochondrial transport in neuronal axons, and to directly influence axonal morphogenesis and function. We propose that abnormal activity of syntaphilin engendered by the trisomy is primarily responsible for the language, neurocognitive, and gross motor delays reported in individuals with 20p trisomy. Additional studies, for example, characterization of cerebral organoids generated from affected patients may help to better understand this condition, and potentially suggest rational remedies to improve the lives of affected individuals and their families.

Breast cancer prognosis through the use of multi-modal classifiers: current state of the art and the way forward.

We present a survey of the current state-of-the-art in breast cancer detection and prognosis. We analyze the evolution of Artificial Intelligence-based approaches from using just uni-modal information to multi-modality for detection and how such paradigm shift facilitates the efficacy of detection, consistent with clinical observations. We conclude that interpretable AI-based predictions and ability to handle class imbalance should be considered priority.

Assessment of the dalargin effect on the level of vitamin D and melatonin in blood serum in patients with malignant bone tumors and polymorbidity

Background. Involved in many cascades of biological regulatory reactions, calcium, vitamin D and melatonin create a single metabolic pattern, maintaining the dynamic balance of bone tissue homeostasis. Nevertheless, these regulatory molecules, as structural and functional elements of bone tissue, play a crucial role in various cellular processes associated with oncogenesis and tumor progression. Synthetic peptide dalargin has wound healing, reparative, anti-inflammatory, antioxidant, immunomodulatory, anticarcinogenic, antitumor, and antimetastatic effects. The purpose of the study was to investigate the synthetic neuropeptide dalargin influence on the dynamics of vitamin D and melatonin blood serum le­vels as part of the treatment algorithm of patients with bone malignant tumors of the lower extremities and pelvis with polymorbidity and endoprosthetics. Materials and methods. The study inclu­ded a control (first) group and a main (second) group of clinical observation of patients with malignant bone lesions. The serum melatonin content was measured by enzyme immunoassay using reagent kits (No. RE54021) from IBL-Hamburg GmbH (Germany). Serum levels of 25-hydroxycalciferol (25(OH)D) were determined by the immunochemiluminescent method on an ARCHITECT 25-OH Vitamin D Controls automatic analyzer. Results. In patients who received dalargin, more pronounced positive dynamics were established in the normalization of 25(ОН)D and melatonin levels, and there was no exacerbation of concomitant diseases. In contrast to the data of patients who did not receive dalargin, in the group where it was used, there were no relapses or metastases of the tumor du­ring 14 months. A comparison of the 25(ОН)D and melatonin le­vels in patients 6–7 months and 12–14 months after treatment shows a tendency to recovery of indicators only in patients who were additionally treated with dalargin (p &lt; 0.01). Conclusions. The study showed the possibility of using the neuropeptide dalargin to increase the effectiveness of the treatment of patients with primary malignant tumors with the burden of polymorbidity by influencing the levels of vitamin D and melatonin in the blood serum.

A case of Brucellosis with neurological and dermatological findings in a thoroughbred Arabian horse

Brucellosis, a zoonotic infection, exhibits varying prevalence across different geographical regions, with a notable incidence in Mediterranean countries, contributing to considerable economic losses. This study focuses on an 11-year-old purebred male Arabian horse, presenting symptoms including weight loss, weakness, environmental indifference, joint swelling, and diverse dermatological manifestations despite sufficient feed intake. A pivotal clinical observation from anamnesis and examination is the animal's inclination to lean its head against walls or fixed objects. In conjunction with hematological and biochemical analyses, the Brucella Rose Bengal plate test (RBPT) and serum agglutination test (SAT) were conducted, revealing seropositivity for brucellosis in the patient. Consequently, it is imperative for professionals in the equine breeding sector, particularly clinical veterinarians, to adhere to biosafety protocols concerning brucellosis cases exhibiting atypical clinical symptoms in horses. Proper diagnostic methods should be employed to assess suspicious cases, underscoring the significance of safeguarding both public and animal health.

СЛУЧАЙ ИЗ ПРАКТИКИ: ЭПИЗОДИЧЕСКАЯ ПАРОКСИЗМАЛЬНАЯ МОЗЖЕЧКОВАЯ АТАКСИЯ 2 ТИПА

Instability walking is a fairly common complaint made by patients who come to be examined by a neurologist in polyclinics and hospitals. From a medical point of view, this symptom is included in the concept of "ataxia". Neurologists distinguish four types of ataxia depending on the localization of the pathological process: cortical, cerebellar, vestibular, and sensitive. There are often combinations of different types of ataxia in the same patient, for example, cortical-vestibular, sensitive-cerebellar. In addition to establishing the variant of the atactic syndrome, there is an urgent question of verifying the etiological factor that led to this pathology. Pathological heredity becomes the least obvious. In this article, we draw attention to a similar case from practice in order to form the alertness of doctors regarding hereditary coordination disorders. Episodic ataxia is a group of rare hereditary diseases of the nervous system, the main clinical manifestation of which are paroxysms of cerebellar ataxia of varying duration and frequency. The most studied from a genetic and clinical point of view are episodic cerebellar ataxia of the first and second types. The authors present a clinical case of episodic paroxysmal cerebellar ataxia type 2 in a 22-year-old patient. The diagnosis of the disease was based on a typical clinical picture and confirmed by a molecular genetic study that revealed a mutation in the CACNA1A gene. The article discusses aspects of the pathogenesis of the main forms of episodic paroxysmal ataxia, age of onset, frequency and duration of seizures, features of the clinical picture, neurological status. This clinical observation draws the attention of practitioners to the possibilities of modern methods of molecular genetic diagnosis and treatment of these conditions.

Establishment of health food safety evaluation method-In vivo genotoxicity evaluation by micronucleus assay

In recent years, various factors such as shifts in health consciousness, changes in lifestyle habits, increased focus on dietary intake, the promotion of alternative medical concepts, and advancements in life sciences and technology have propelled the robust growth of the health food industry. An increasing number of reports suggest that "functional foods," containing beneficial functional components, may enhance short-term well-being and are increasingly regarded as healthful. Building upon these findings, this study aims to enhance the production capacity of high-value agricultural products. However, for quality assurance, toxicity assessment of functional foods is imperative. There is a growing necessity to employ in vivo genotoxicity assays to evaluate the carcinogenic potential of these products. In this study, we tried to establish another in vivo genotoxicity evaluation platform via acridine orange induction. According to all results in this study, during the experiment, there were no statistically significant differences in BW between the negative control group and the normal control group (p &gt; 0.05). Moreover, the clinical observations of the experimental mice showed that all mice survived until the end of the experiment, and no abnormal clinical symptoms were observed. The mouse’s food consumption in each group were monitored during the experiments. The food consumption of mice was recorded daily after the experiment. During the experiments, there were no significant difference between two groups on the food consumption. The percentage of RETs/1,000 RBCs in the negative control group was significantly decrease than the normal control group (p &lt; 0.001). RETs/1,000 RBCs (‰) in ICR mice (n = 5/group) in the negative control group and the normal control group at 48th and 72th hours-experiment were respectively 18 ± 4.6 / 45.6 ± 4.0 (48th hours-experiment) and 19 ± 4.8 / 47.6 ± 4.8 (72th hours-experiment). The percentage of Mn-RETs/1,000 RETs in the negative control group was significantly increase than the normal control group (p &lt; 0.001). Mn-RETs/1,000 RETs (‰) in ICR mice (n = 5/group) in the negative control group and the normal control group were 10.6 ± 2.1 / 0.4 ± 0.5 and 8.2 ± 1.8 / 0.4 ± 0.5, respectively. Taken all results of RET/RBCs (‰) and MN-RET/RETs (‰) together, the genotoxicity in the negative control group has been successfully induced. In light of these requirements, we propose utilizing the mammalian erythrocyte micronucleus assay to detect damage induced by test substances to erythroblast chromosomes. This study endeavors to establish a sensitive and stable method for quantifying micronuclei formation in erythrocytes in vivo. The resulting data will facilitate the evaluation of potential toxicity associated with agricultural functional products in the future.

ESKİ MISIRDA ARTERİOSKLEROZ

Aim; This study was planned to investigate the formation of arteriosclerosis in ancient times. Materials and Methods; The HORUS study, which investigated the vascular structures of mummified people in the ancient Egyptian civilization, was taken as a basis and the results of this study were evaluated with fractional tomography. These results, evaluated with virtual angiography, were evaluated non-parametrically with clinical observations. Results; Various degrees of atherosclerosis were observed in all vascular structures of the examined mummies. Significant mitral annular calcification was detected in one case. Conclusion; In the light of these studies, it was concluded that arthriosclerosis is a disease of all periods.

Beyond the fractures: A comprehensive Comparative analysis of Affordable and Accessible laboratory parameters and their coefficients for prediction and Swift confirmation of pulmonary embolism in high-risk orthopedic patients

BackgroundPulmonary embolism (PE) poses a significant challenge in diagnosis and treatment, particularly in high-risk patient populations such as those hospitalized for orthopedic reasons. This study explores the predictive and diagnostic potential of laboratory parameters in identifying PE among orthopedic patients. ObjectivesThe purpose of this study was to determine whether selected (inexpensive and readily available) laboratory parameters and their coefficients can be used to diagnose pulmonary embolism and whether they are applicable in predicting its occurrence. Material and methodsSelected laboratory parameters were determined twice in 276 hospitalized orthopedic patients with suspected PE: PLT, MPV, NEU, LYM, D-dimer, troponin I, age-adjusted D-dimer and their coefficients. Depending on the angio-CT results, patients were divided into groups. Selected popular laboratory coefficients were calculated and statistically analyzed. Optimal cutoff points were determined for the above laboratory tests and ROC curves were plotted. ResultsD-dimer/troponin I [p = 0.008], D-dimer [p = 0.001], age-adjusted D-dimer [p = 0.007], NLR/D-dimer [p = 0.005] and PLR [p = 0.021] are statistically significant predictors of PE. D-dimer/troponin I [p < 0.001], troponin I [p = 0.005] and age-adjusted D-dimer [p = 0.001] correlated with the diagnosis of PE after the onset of clinical symptoms. ConclusionsIn the context of orthopedic patients, cost-effective laboratory parameters, particularly the D-dimer/troponin I ratio and age-adjusted D-dimer, exhibit considerable potential in predicting and diagnosing PE. These findings suggest that combining readily available laboratory tests with clinical observation can offer a viable and cost-effective diagnostic alternative, especially in resource-constrained settings. Further studies with larger and diverse patient populations are recommended to validate these results.

Duchenne Muscular Dystrophy-Associated Neurobehavioral Difficulties: Insights from Clinical Practice

Background: Emerging evidence underscores the high prevalence of neurobehavioral difficulties like ADHD, ASD and OCD, in patients with Duchenne muscular dystrophy (DMD). The substantial impact of these complex behavioral challenges in addition to motor function decline on the well-being of affected individuals and their families is increasingly evident. However, a uniform approach for effective screening, assessment and management of the neurobehavioral symptoms remains elusive. Objective: We explored strategies used by healthcare professionals with clinical expertise in DMD to address neurobehavioral symptoms, in order to uncover diverse practices and to identify potential directions for clinical approaches in managing DMD neurobehavioral symptoms. Methods and results: Twenty-eight respondents from 16 different countries completed an online survey. Only 35% of the centers systematically screened for neurobehavioral difficulties in their DMD population. Predominant screening methods included history taking and clinical observation. Common neurobehavioral difficulties encompassed learning challenges, dependency from adults, anxiety, concentration difficulties, and social deficits. The participating centers frequently employed parental counseling and liaison with psychosocial healthcare professionals for psychosocial intervention. Conclusion: This study underscores the complex behavioral landscape in DMD, highlighting the need for validated screening, assessment and management strategies and collaborative efforts in implementing these. We advocate for international consensus recommendations for screening, assessment and management of neurobehavioral difficulties in DMD to enhance patient care and communication across healthcare settings.

Variability in Intracranial Vessel Diameters and Considerations for Neurovascular Models: A Systematic Review and Meta‐Analysis

BACKGROUND In vitro experiments are critical for understanding the impact of medical devices and techniques on blood vessels and blood flow. However, their interpretation is often limited by anatomical models’ inability to capture the wide range of vessel sizes observed in real‐world practice. The current study aims to address this limitation by describing the distribution of vessel diameters in a real‐world population. METHODS This systematic literature review using the PubMed database analyzed cerebral vessel diameters in patients from 2000 to 2022. The diameter measurements of various vessels within the neurovasculature were extracted. Random‐effects meta‐analyses were performed to synthesize vessel diameters across studies. Predicted distributions were generated from the meta‐analytical results. RESULTS Seventy‐six studies were included in the analysis. The M1 segment, internal carotid artery (cervical and communicating segments), A1 segment, V2 segment, V4 segment, and basilar artery had sufficient data for generating predicted distributions of vessel diameters. Predicted mean diameters were as follows: M1 segment, 2.55 ± 0.42 mm (95th interpercentile range [IPR]: 1.71–3.38); internal carotid artery‐cervical segment, 4.74 ± 0.64 mm (95th IPR: 3.49–5.99); internal carotid artery‐communicating segment, 3.40 ± 0.64 mm (95th IPR: 2.15–4.66); A1 segment, 1.89 ± 0.34 mm (95th IPR: 1.23–2.55); V2 segment, 3.36 ± 0.67 mm (95th IPR: 2.05–4.67); V4 segment, 2.42 ± 0.74 mm (95th IPR: 0.98–3.86); and basilar artery, 2.96 ± 0.52 mm (95th IPR: 1.94–3.97). CONCLUSION Cerebral vessel diameter measurements can vary substantially due to patient‐specific factors and imaging techniques. This literature review highlights the diverse range of vessel sizes observed in different patient populations, emphasizing the need for anatomical models that accurately represent clinical observations.

Relapsing polychondritis (clinical observations)

Relapsing polychondritis (RPC) is an autoimmune disease manifested by both repeated attacks and a persistent inflammatory process with progressive destruction of cartilaginous structures, in particular, chondritis of the ears, nose, larynx, bronchi, and joints. RPC is a rare disease (about 1000 cases have been described worldwide). Diagnosis of RPC and the choice of treatment tactics are very difficult, which is associated with the rarity of the pathology, undulating, unpredictable course, and the lack of specific laboratory markers.The clinical observations presented in the article confirm the complexity of diagnosing RPC. Before the disease was verified, both patients repeatedly consulted different specialists: the first patient was diagnosed 3 months after the onset of characteristic symptoms of RPC, and the second patient – 1.5 years later. Late diagnosis and the lack of a unified approach to treatment were the reason for the development of prognostically unfavorable lesions in the second patient – chondritis and perichondritis of the larynx.

SAFETY ASSESSMENT OF AYURVEDIC GOLD MEDICATION SUVARNA BHASMA, IN WISTAR RATS

Suvarna bhasma (SB) contains gold and lead, which are highly potent metals and are toxic in their crude form. This study evaluated the safety profile of the medication. Suvarna bhasma was administered for 90 consecutive days orally at three doses (10.23 mg kg-1, 40.92 mg kg-1 and 102.3 mg kg-1 body weight) to wistar rats. Clinical observations, feed and water consumption, and body weight changes were noted during the study period. On the 91st day, hematological, biochemical and histopathological changes were studied. There was a significant decrease in body weight of rats at a low dose (10.23 mg kg-1) at fourth week, which could not be correlated with feed and water consumption findings. Thus, change was not considered as a treatment-related effect. Suvarna bhasma showed no evident untoward effect in haematological, biochemical and histopathological parameters in the 90 day-subchronic toxicity study (OECD 408 guidelines) and was safe in Wistar rats.