Clinical Syndrome In Patients Research Articles

Frequency of major clinical syndromes in patients with drug-induced liver injury

Frequency of major clinical syndromes in patients with drug-induced liver injury

Удосконалення диференційної діагностики гострих пероральних та інгаляційних отруєнь сполуками талію, патогістологія та стратегія лікування (на основі групових випадків)

Analysis of literature data and own research showed an increase in the number of criminal and accidental acute poisonings with Tl compounds (Tl+) in all countries, in particular in Ukraine, which, including, is due to the availability of Tl+ on the Internet. Most often, these are group cases, often with fatal consequences or subsequent disability of patients, which is due to delayed diagnosis and late appointment of antidote therapy. It must be taken into account that in the conditions of war in Ukraine, the potential risk of using Tl+ for terrorist purposes is increased. Aim. Based on the analysis of the daily dynamics of the development of clinical manifestations, chemical-toxicological, biochemical, electroneuromyographic indicators and pathohistological data, improve the differential diagnosis of the main clinical syndromes in patients with acute oral and inhalation Tl+ compounds poisoning. Materials and Methods. A scientific analysis of literature data was carried out using reference databases of scientific libraries and own research on the daily increase of clinical, especially neurological symptoms specific for Tl+ poisoning against the background of gastrointestinal disorders. Clinical, laboratory, electroneuromyographic, toxicoanalytical and pathogistological research methods were used. Results. The daily sequence of the occurence and development of the main specific symptoms of acute Tl+ poisoning with low and high doses has been determined, which makes it possible to suspect poisoning in the first days and conduct a toxicological examination in a timely manner and prescribe antidote and detoxification therapy: in the first 2 days, the victims, against the background of gastrointestinal pathology, develop painful paresthesias not so much in the limbs, but in the oral cavity in case of oral poisoning and along the course of the upper respiratory tract, along with burning pains behind the sternum and a hoarse voice - in case of inhalation poisoning; on the 3rd-4th day before the appearance of alopecia, permanent paresthesias of the hair part of the head appear with the simultaneous appearance of focal pigmentation of the skin and darkening of the hair roots; in the first days of intoxication, intense burning symmetrical pains and paresthesias appear not only in the extremities, especially in the area of the feet, calf muscles, muscles of the inner surface of the thighs, shoulder girdle, chest, but also especially the scrotum in men and mammary glands in women. A comparison of clinical-toxicological and pathohistological indicators proved multi-organ damage to the body in case of poisoning with high doses of Tl+. Conclusions. The high toxicity of Tl+ compounds, the growth of criminal incidents, the potential risk of their use as terrorist purposes in the conditions of the war in Ukraine, determine the need for special control over the circulation of Tl+, blocking sites on the Internet that advertise the sale of highly toxic chemicals. The problem of ensuring the availability of a specific Ferrocin antidote in the pharmacy network, as well as the creation of an antidote reserve to eliminate the consequences of emergency situations, requires attention. Keywords: Tl compounds, acute criminal poisoning, sequence of symptoms, pathogistology.

Fatty infiltration of the cervical multifidus musculature and its clinical correlation to cervical spondylosis

PurposeFat infiltration (FI) of the deep neck extensor muscles has been shown to be associated with poor outcomes in cervical injury, mechanical neck pain, and axial symptoms after cervical spine surgery. However, information is scarce on the severity of FI in cervical extensors associated with different clinical syndromes in patients with cervical spondylosis.ObjectiveTo investigate the relationship between the severity of FI in the cervical multifidus musculature and its clinical correlates in the syndromes and sagittal alignment of patients with cervical spondylosis.MethodsThis study was conducted as a retrospective study of twenty-eight healthy volunteers (HV) together with sixty-six patients who underwent cervical radiculopathy (CR), degenerative myelopathy (DM), and axial joint pain (AJP) from January 2020 to March 2022. MRI was used to measure the fat cross-sectional area (FCSA), functional muscle cross-sectional area (FMCSA), total muscle cross-sectional area (TMCSA), FI ratio of the cervical multifidus musculature at each cervical level from the C3 to C6 segments and the cervical lordosis angle in the included subjects.ResultsThe difference in the FCSA and FI ratio in patient groups with cervical spondylosis was significantly greater than that of the HV group (P < 0.05), and the Cobb angle of the DM group, AJP group and HV group was significantly greater than that of the CR group (P < 0.05). The FI ratio comparison showed no significant difference by sex, and the comparison of FCSA, FMCSA, TMCSA and FI ratio showed no significant difference by age range from 35 to 69 in the included subjects. The FCSA and TMCSA in patients with cervical spondylosis were positively related to the Cobb angle (rs= 0.336, P = 0.006, rs =0.319, P = 0.009, respectively), and the FI ratio was inversely correlated with the Cobb angle (rs= -0.285, P = 0.020) and positively correlated with age (rs =0.261, P = 0.034). In the HV group, FMCSA was inversely correlated with age (rs= -0.400, P = 0.035), while the FI ratio had a positive correlation with age (rs= -0.423, P = 0.025).ConclusionCompared with healthy subjects, a more severe degree of FI in the multifidus musculature and sagittal imbalance were found in patients with cervical spondylosis. These two imaging features are considered to be important concomitant phenomena of cervical spondylosis, and the more severe FI is, the worse the sagittal imbalance. However, each syndrome had no obvious difference in FI in the multifidus musculature.

Management of Patients with Suspected or Confirmed Antibiotic Allergy: Executive Summary of Guidelines from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Allergy and Clinical Immunology (SEAIC), the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Intensive Medicine and Coronary Care Units (SEMICYUC).

Suspected or confirmed antibiotic allergy is a frequent clinical circumstance that influences antimicrobial prescription and often leads to the avoidable use of less efficacious and/or more toxic or costly drugs than first-line antimicrobials. Optimizing antimicrobial therapy in patients with antibiotic allergy labels has become one of the priorities of antimicrobial stewardship programs in several countries. These guidelines aim to make recommendations for the systematic approach to patients with suspected or confirmed antibiotic allergy based on current evidence. An expert panel (11 members of various scientific societies) formulated questions about the management of patients with suspected or confirmed antibiotic allergy. A systematic literature review was performed by a medical librarian. The questions were distributed among panel members who selected the most relevant references, summarized the evidence, and formulated graded recommendations when possible. The answers to all the questions were finally reviewed by all panel members. A systematic approach to patients with suspected or confirmed antibiotic allergy was recommended to improve antibiotic selection and, consequently, clinical outcomes. A clinically oriented, 3-category risk-stratification strategy was recommended for patients with suspected antibiotic allergy. Complementary assessments should consider both clinical risk category and preferred antibiotic agent. Empirical therapy recommendations for the most relevant clinical syndromes in patients with suspected or confirmed ß-lactam allergy were formulated, as were recommendations on the implementation and monitoring of the impact of the guidelines. Antimicrobial stewardship programs and allergists should design and implement activities that facilitate the most appropriate use of antibiotics in these patients.

Clinical features and predisposing factors of delirium due to COVID-19 pneumonia in intensive care units.

Delirium is an acute disorder in which attention, perception, memory, thought, mood, psychomotor activity and sleep-wake cycles change rapidly. Delirium is also a common clinical syndrome in patients hospitalized in intensive care units due to COVID-19 pneumonia. We reviewed clinical features and predisposing factors of delirium according to psychomotor subtype in patients hospitalized in the intensive care units due to COVID-19 pneumonia. 64 patients who were hospitalized in the intensive care units due to COVID-19 pneumonia were included. Delirium status and psychomotor subtype were determined by applying the Confusion Assessment Method for the Intensive Care Unit scale to the patients daily. The gender, age, comorbidity, treatments, intubation, and mortality rates of the patients were recorded. Multivariate analyses were performed by examining predisposing factors, arterial blood gases, hemograms, biochemistry, and brain magnetic resonance imaging. There were 64 patients in delirium clinic, 65.6% (n=42) of them were male. Hypokinetic delirium was more common in 60.9% (n=39). 79.4% of the patients who received ventilator support were male (p=0.013).When mortality was analyzed in this group, hypoactive delirium was found to be significantly higher (p=0.035). In addition, leukocyte levels were higher in patients with hypokinetic delirium (p=0.029). Ferritin and fibrinogen levels were higher in patients with hyperkinetic delirium (p=0.039, p=0.008, respectively). The presence of additional diseases such as advanced age, male gender, hypertension, coronary artery disease, dementia, and hypoxia were factors that increased the frequency of delirium. In addition, the mortality rate was higher in patients with hypokinetic delirium.

TCM Syndrome Recognition Model of Type 2 Diabetes Mellitus in Shanghai Based on TCM Inquiry Information.

Background Type 2 diabetes mellitus (T2DM) has become one of the serious public health problems in China, and it affects the quality of survival of patients significantly. The long-term monitoring and early warning of T2DM and its complications should be paid attention to. Artificial diagnosis of T2DM in traditional Chinese medicine (TCM) is subjective and unrepeatable at the present stage. It is important to develop standardized collection and objective analysis methods of TCM inquiry. Therefore, we are interested in establishing syndrome recognition models. Objective The establishment of the TCM syndrome recognition model of T2DM is helpful to the syndrome diagnosis of the disease, and the clear diagnosis of the syndrome is the prerequisite for the effective treatment of the disease by TCM. At present, there are few studies on syndrome recognition models of T2DM. Therefore, based on the inquiry information of TCM, we establish a latent structure model (LSM) of T2DM syndrome in Shanghai, hoping to provide services for the health management of TCM for diabetes in the future. Methods A total of 587 effective samples of T2DM patients in Shanghai were collected. The gender, course of disease, and chronic complications were analyzed by one-way ANOVA and frequency analysis. Inquiry symptoms that could be included in the model were screened. In the study, 30 symptoms were used as observable variables to analyze the symptom information of TCM inquiry, and then, the TCM syndrome recognition model was established. Results The clinical syndromes of patients with T2DM in Shanghai were mixed with deficiency and excess. The LSM divided the pattern of the disease into qi-yin deficiency pattern, yin deficiency pattern, qi deficiency pattern, and qi stagnation pattern. These patterns were mainly located in the spleen and stomach, liver, and kidney. Conclusion The results of the syndrome classification of T2DM by LSM are basically consistent with the TCM clinical characteristics of the disease, which could reflect its main etiology and pathogenesis. The LSM of TCM inquiry syndrome diagnosis of T2DM confirmed the objectivity of TCM syndrome differentiation to some extent, and it will lay a foundation for the development of a mobile APP for TCM health management of T2DM.

OXIDATIVE DAMAGE MARKERS IN ALCOHOLIC HEPATITIS

Alcohol hepatitis (AH) is a clinical syndrome in patients with excessive and chronic alcohol consumption. Ethanol metabolism produces free radicals: reactive oxygen species (ROS) and reactive nitrogen species (RNS). This contributes to cellular damage in AH. The malondialdehyde (MDA) and carbonylated proteins are markers of oxidative damage in lipids and proteins. Our objective is to evaluate the levels of serum MDA and carbonylated proteins in AH patients with. This transversal study included 147 individuals divided into two groups: the control group (n=100), which consists of individuals with alcohol consumption ≤ 10 g/day and AUDIT score ≤ 7, and the group with AH patients (n=47). We measured the serum levels of MDA (thiobarbituric acid method) and carbonylated proteins (DNPH reaction). The statistical analysis was performed by the Windows SPSS v22 software. Data were expressed as mean values ± SEM. Comparisons were carried out by analysis of variance (ANOVA). A p-value <0.05 was considered statistically significant. The control group (CT), with a mean of 30.47±0.52 years old, had a consumption of 2.32±0.21g of alcohol daily (gOH/day) and an AUDIT score of 2.24±0.10. The AH patients, with a mean of 41.68±1.3 years old, had a consumption of 354.25±39.54 gOH/day and an AUDIT score of 30±1.45. The AST, ALT, GGT, total and indirect bilirubin serum levels were higher in AH compared to CT (p<0.0001), with a ratio of AST/ALT ≥2. The albumin serum levels were lower (p<0.0001) in AH vs. CT. The carbonylated proteins serum levels were higher in patients with AH compared to CT (p<0.0001). No differences in MDA serum levels were found between both groups. We reported greater MDA serum levels (p=0.001) in alcoholic liver cirrhosis patients when compared to the control group; and an insignificant difference in carbonylated proteins serum level between both participant groups. The alcoholic hepatitis patients have an increase in carbonylated proteins oxidative damage while there is no lipidic damage. Our results suggest that carbonylated proteins may a damage oxidative marker in the AH Mexican population. This damage may increase the risk of malnutrition, susceptibility to infections and sepsis, deficient coagulation factors production, gastrointestinal bleeding, among other complications that increase mortality. It is necessary to counteract oxidative damage to improve and complement the actual treatment in alcoholic hepatitis. Competing interests. The authors declare they have no competing interests. This work was partially financed by CONACyT SALUD-2016-272579 and PAPIIT- UNAM TA200515

Клінічні особливості та характер перебігу гострого бронхіту в дітей дошкільного віку у поєднанні із синдромом еутиреоїдної патології та без нього

Acute bronchitis is a common disease in children. During inflammation, including the respiratory tract, the pituitary gland and thyroid gland are involved in the process, on the response of which the body's protective and adaptive stability depends. Therefore, the adequacy of the functioning of these organs depends on the nature of the course of acute infectious diseases, including acute bronchitis. Thus, children with this disease often develop a euthyroid sick syndrome, which manifests itself most often in the form of «low T3 syndrome». Purpose — to study the clinical features of acute bronchitis in preschool children in combination with euthyroid sick syndrome and without it. Materials and methods. 135 children of preschool age (from 3 to 6 years), patients with acute bronchitis (main group) and 28 healthy children (control group) were examined. All patients in the main group were divided into two. The first group consisted of children with acute bronchitis (92 children), and the second group — patients with acute bronchitis in combination with euthyroid sick syndrome (43 children). Clinical and anamnestic (collection of complaints, anamnesis of disease and life, physical examination) research methods were used. Results. It was found that in patients with acute bronchitis with signs of euthyroid sick syndrome, a greater number of cases of prolonged neonatal jaundice, perinatal CNS lesions and births weighing less than 2800 g were found. The leading clinical syndromes in patients with acute bronchitis were intoxication, catarrhal and hyperthermic. General weakness was the main symptom of intoxication syndrome in children with acute bronchitis without signs of euthyroid syndrome, while anxiety was more common in children of group II. The main symptom of catarrhal syndrome was a daytime dry cough. Hyperthermic syndrome was significantly more common with fever. Hectic body temperature was found in most children with acute bronchitis in combination with euthyroid sick syndrome than without it. Children who showed signs of euthyroid sick syndrome were ill for longer. Conclusions. Patients with acute bronchitis combined with euthyroid sick syndrome generally have a more severe history of life and disease, more severe acute bronchitis than patients without abnormalities in hormonal status. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: acute bronchitis, children, clinical features, euthyroid sick syndrome.

Acute-on-chronic liver failure: update on pathogenesis, therapeutic targets, predictive models, and liver transplantation.

Acute-on-chronic liver failure (ACLF) is a clinical syndrome in patients with chronic liver disease that is associated with multiple organ failures and a high short-term mortality. Systemic inflammation is suggested to play a key role in its pathogenesis, although the precise causative mechanism is unknown. The purpose of this review is to present and discuss new findings related to: mechanisms underlying ACLF, therapeutic targets, risk prediction models for developing ACLF, and liver transplantation for ACLF. Recent studies of ACLF pathophysiology classified the immunosuppressive phenotype in monocytes. Investigation of therapeutic strategies identified inhibition of toll-like receptor-4 (TLR-4) and glutamine synthetase (GLUL) as potential targets. Recent studies identified novel risk prediction models for developing ACLF and enhanced our understanding of liver transplantation for ACLF to guide clinicians in determining that patients will benefit from transplantation. Improved knowledge on the pathogenesis of ACLF and identification of TLR-4 and GLUL may lead to clinical trials to study the efficacy of these novel therapeutic targets for patients with ACLF. Liver transplantation is the only current treatment for ACLF. Given the limited availability of donor organs, recent studies have identified ACLF patients who may merit the highest waitlist priority.

Characterization of diagnostic certainty levels and clinical syndromes in patients with progressive supranuclear palsy in two German prospective cohorts

Background: In 2017, new diagnostic criteria for progressive supranuclear palsy (PSP) were published by the Movement Disorder Society (MDS-PSP criteria). Major novelties were the inclusion of variant PSP syndromes and the introduction of the new certainty level “suggestive of PSP”.

Protective role of cardiac-specific overexpression of caveolin-3 in cirrhotic cardiomyopathy.

Cirrhotic cardiomyopathy is a clinical syndrome in patients with liver cirrhosis characterized by blunted cardiac contractile responses to stress and/or heart rate-corrected QT (QTc) interval prolongation. Caveolin-3 (Cav-3) plays a critical role in cardiac protection and is an emerging therapeutic target for heart disease. We investigated the protective role of cardiac-specific overexpression (OE) of Cav-3 in cirrhotic cardiomyopathy. Biliary fibrosis was induced in male Cav-3 OE mice and transgene negative (TGneg) littermates by feeding a diet containing 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC; 0.1%) for 3 wk. Liver pathology and blood chemistries were assessed, and stress echocardiography, telemetry, and isolated heart perfusion studies to assess adrenergic responsiveness were performed. Cav-3 OE mice showed a similar degree of hyperdynamic contractility, pulmonary hypertension, and QTc interval prolongation as TGneg mice after 3 wk of DDC diet. Blunted systolic responses were shown in both DDC-fed Cav-3 OE and TGneg hearts after in vivo isoproterenol challenge. However, QTc interval prolongation after in vivo isoproterenol challenge was significantly less in DDC-fed Cav-3 OE hearts compared with DDC-fed TGneg hearts. In ex vivo perfused hearts, where circulatory factors are absent, isoproterenol challenge showed hearts from DDC-fed Cav-3 OE mice had better cardiac contractility and relaxation compared with DDC-fed TGneg hearts. Although Cav-3 OE in the heart did not prevent cardiac alterations in DDC-induced biliary fibrosis, cardiac expression of Cav-3 reduced QTc interval prolongation after adrenergic stimulation in cirrhosis.NEW & NOTEWORTHY Prevalence of cirrhotic cardiomyopathy is up to 50% in cirrhotic patients, and liver transplantation is the only treatment. However, cirrhotic cardiomyopathy is associated with perioperative morbidity and mortality after liver transplantation; therefore, management of cirrhotic cardiomyopathy is crucial for successful liver transplantation. This study shows cardiac myocyte specific overexpression of caveolin-3 (Cav-3) provides better cardiac contractile responses and less corrected QT prolongation during adrenergic stress in a cirrhotic cardiomyopathy model, suggesting beneficial effects of Cav-3 expression in cirrhotic cardiomyopathy.

CONGESTIVE HEART FAILURE SELF‐MANAGEMENT EDUCATION AND READMISSION AFTER HOSPITALIZATION

Background: Congestive Heart Failure (CHF) is a condition where the heart can no longer pump blood to the body tissues either to the entire body (systemic circulation) or to the lungs (pulmonary circulation). CHF is a clinical syndrome in patients with structural abnormalities and heart function. Heart function impairment may be a systolic or diastolic function disorder, heart rhythm disturbance, or preload and after load mismatch. This condition can cause death to the patient. Deaths from CHF range from 20-50% per year, in addition CHF is a disease that requires readmission . Frequency of CHF patient readmission by 45% per year.Purpose: This study aims to analyze the relationship of congestive heart failure self‐management education and readmission after hospitalizationMethods: The study was conducted at ICCU Tidar Magelang hospital with 27 CHF patients who had readmission. The sampling technique was done by consecutive sampling technique. Data analysis in this study using Chi square. The result of statistical test (Chi Square) shows that 2 cells (50%) with expected value &lt;5 means the cells (boxes) whose expected value is below 5 by 50%. The minimum expected value of 2.07 means no expected value &lt;1. Continuity Correction with p = 0,000. Fisher's Exact Test p value = 0,000.Resuts: The results of Symmetric Measure table (correlation test) obtained by the value of Contingency Coefficient (r) = 0.674 with p = 0,000.Conclusion: The conclusion of this statistical test is that there is a correlation between Experience of Self-Management Education (SME) and readmission of CHF patients.

Advances in the research of persistent inflammation-immunosuppression-catabolism syndrome in severe burn

Persistent inflammation-immunosuppression-catabolism syndrome (PICS) is a clinical syndrome in patients surviving from severe trauma or sepsis, which is characterized by prolonged stays in intensive care unit, persistent inflammation response, immune suppression, high protein catabolism, and high mortality. This article aims to review the proposed process of the concept, the mechanism, the clinical features, and the diagnosis and treatment progress of PICS, which is helpful for further understanding pathogenesis and pathophysiological mechanism of PICS in patients with severe burns and improving clinical curative efficacy and prognosis of patients with severe burns.

Characteristic of clinical syndromes in patients with primary defects in antibody production

Primary immunodeficiency is a rare disease with a high medico-social significance. Objective: to characterize principal clinical syndromes in 35 patients from 12 to 37 years old with primary immunodeficiency associated with an abnormal antibody production. The infectious syndrome is the most significant syndrome, it was revealed in all the patients, in some cases it was combined with autoimmune, atopic and lymphoproliferative syndrome. Thus, there isthe need to inform physicians of variousspecialties about this pathology. Conflict of interest: The authors of this article confirmed the lack of conflict of interest and financial support, which should be reported.

Clinical Peculiarities of the Mixed-Invasion of Giardiasis and Ascariasis

Intestinal parasitic diseases are widespread in the territory of almost the entire globe. Among them the most common are giardiasis and ascaridosis. In recent years, more and more cases of combined invasion by these organisms have been registered.&#x0D; The objective of the research was to study the clinical peculiarities of the course of giardiasis and ascariasis in patients with combined invasion.&#x0D; Materials in the methods. There were 42 patients under observation, who were divided into 3 groups. The first group (n=14) included patients with giardiasis, the second one (n=14) – patients with ascariasis, the third group (n=14) included patients with mixed infection of giardiasis and ascariasis.&#x0D; Results. The main clinical syndromes in patients with giardiasis, ascariasis and patients with mixed invasion by both pathogens have been analyzed. In all groups of patients, the manifestations of dyspeptic syndrome were most frequent. Signs of an allergic syndrome were observed as a polymorphic rash on the skin. Data on astheno-neurotic and intoxication syndromes took place somewhat less frequently.&#x0D; Conclusions. Clinical manifestations in patients with mycobacterial invasions of giardiasis and ascariasis were reported more frequently than in patients with monoinvasion, and more pronounced polymorphism was observed.

Acute-on-chronic liver failure: adiagnostic and therapeutic challenge for intensive care

ZusammenfassungDas akut-auf-chronische Leberversagen („acute-on-chronic liver failure“, ACLF) ist ein emergentes Krankheitssyndrom, das durch einen oder mehrere akute Trigger bei vorgeschädigter Leber ausgelöst wird und vom progressiven hepatalen und nichthepatalen Organversagen, einem gravierenden Risiko infektiöser Komplikationen sowie hoher kurzfristiger Letalität gekennzeichnet ist. Wenngleich pathophysiologisch noch weitgehend unverstanden erfordert das ACLF frühzeitige diagnostische und therapeutische Maßnahmen, die sich auf zugrunde liegende Ursachen sowie das Verhindern von Komplikationen richten, um die Prognose betroffener Patienten zu verbessern.

Gastrointestinal Metastases of Breast Cancer: Report of Two Cases and Review of the Literature

Breast cancer is the most common neoplasm in women. It often metastasizes to the bones, liver, lungs and brain. Nevertheless, gastrointestinal tract involvement is an exception. When it occurs, both clinical symptoms and endoscopic findings are nonspecific. Therefore it is essential to consider this clinical syndrome in patients with a history of breast cancer. We have performed an extensive search of the Cancer Registry of Principe de Asturias University Hospital between the years 2000 and 2016, both inclusive. We report on two patients with gastrointestinal metastases in different locations due to breast cancer.

Исследование системной микроциркуляции и основных клинических синдромов под влиянием внутривенного и комбинированного методов лазерной терапии при хроническом панкреатите

The purpose of this study was to investigate the systemic microcirculation and main clinical syndromes under the influence of combined and intravenous methods of low-intensive laser therapy (LILT) in patients with chronic pancreatitis (ChP) in acute phase. 123 patients aged 36-77 years old were examined and divided into 2 groups: the experimental (78 patients) and the control group (45 patients). 30 men were in addition surveyed who composed the healthy group. The experimental group has had a complex drug and laser therapy of various therapeutic techniques: I subgroup – intravenous laser blood irradiation (IVLT) and in II group - combined method of laser therapy (LT). Control group has had only drug therapy. The basic clinical syndromes in patients with chronic pancreatitis is the pain, incretory insufficiency, dyspeptic syndrome and asthenovegetative syndrome. The study of microcirculation was carried out by laser Doppler flowmetry on the device LAKK-02 («LAZMA» production, Russia). Heterogeneity of microcirculation types with tht reliable increase of the pathologic types – spastic, hyperemic, congestion-stasis was revealed on the examined patients. Essential improvement of microcirculation condition in patients of experimental group was established, positive influence was revealed on the basic clinical syndromes in phase of chronic pancreatitis exacerbation.

Upper gastrointestinal bleeding caused by severe esophagitis: a unique clinical syndrome.

We have recognized a unique clinical syndrome in patients with upper gastrointestinal bleeding who are found to have severe esophagitis. We aimed to more clearly describe the clinical entity of upper gastrointestinal bleeding in patients with severe esophagitis. We conducted a retrospective matched case-control study designed to investigate clinical features in patients with carefully defined upper gastrointestinal bleeding and severe esophagitis. Patient data were captured prospectively via a Gastrointestinal Bleeding Healthcare Registry, which collects data on all patients admitted with gastrointestinal bleeding. Patients with endoscopically documented esophagitis (cases) were matched with randomly selected controls that had upper gastrointestinal bleeding caused by other lesions. Epidemiologic features in patients with esophagitis were similar to those with other causes of upper gastrointestinal bleeding. However, hematemesis was more common in patients with esophagitis 86% (102/119) than in controls 55% (196/357) (p < 0.0001), while melena was less common in patients with esophagitis 38% (45/119) than in controls 68% (244/357) (p < 0.0001). Additionally, the more severe the esophagitis, the more frequent was melena. Patients with esophagitis had less abnormal vital signs, lesser decreases in hematocrit, and lesser increases in BUN. Both pre- and postRockall scores were lower in patients with esophagitis compared with controls (p = 0.01, and p < 0.0001, respectively). Length of hospital stay (p = 0.002), rebleeding rate at 42 days (p = 0.0007), and mortality were less in patients with esophagitis than controls. Finally, analysis of patients with esophagitis and cirrhosis suggested that this group of patients had more severe bleeding than those without cirrhosis. We have described a unique clinical syndrome in patients with upper gastrointestinal bleeding who have erosive esophagitis. This syndrome is manifest by typical clinical features and is associated with favorable outcomes.

Chapter 5 - Painful diabetic neuropathy: clinical aspects

Painful diabetic neuropathy (PDN) is one of several clinical syndromes in patients with diabetic peripheral neuropathy (DPN) and presents a major challenge for optimal management. The epidemiology of PDN has not been extensively studied. On the basis of available data, the prevalence of pain ranges from 10% to 20% in patients with diabetes and from 40% to 50% in those with diabetic neuropathy. Neuropathic pain can be disabling and devastating, with a significant impact on the patient's quality of life and associated healthcare cost. Pathophysiologic mechanisms underlying PDN are similar to other neuropathic pain disorders and broadly invoke peripheral and central sensitization. The natural course of PDN is variable, with the majority of patients experiencing spontaneous improvement and resolution of pain. Quantifying neuropathic pain is difficult, especially in clinical practice, but has improved recently in clinical trials with the development of neuropathic pain-specific tools, such as the Neuropathic Pain Questionnaire and the Neuropathic Pain Symptom Inventory. Hyperglycemia-induced pathways result in nerve dysfunction and damage, which lead to hyperexcitable peripheral and central pathways of pain. Glycemic control may prevent or partially reverse DPN and modulate PDN.