Symptom Complex Research Articles

The effect of a preservative-free prostaglandin analogue on the condition of the ocular surface in patients with glaucoma

PURPOSE. The study aimed to evaluate the antihypertensive effectiveness and the condition of the ocular surface in patients with glaucoma during monotherapy with the drug Traviolan® (travaprost 0.05%).METHODS. This longitudinal, randomized, prospective study included 27 patients (59.6% women, 40.4% men; mean age 64.1±6.4) with uncompensated primary open-angle glaucoma in early and moderate stages receiving mono-therapy with β-blockers or carbonic anhydrase inhibitors. This was a longitudinal, randomized, prospective, observational study. All patients underwent a complete ophthalmological examination and assessment of dry eye symptoms using a questionnaire (Ocular Surface Disease Index, OSDI). An objective assessment of the condition of the ocular surface was carried out using the Sirius corneal topography device, which is used for assessment of tear film breakup time (TBUT). All patients were re-examined after 12 weeks.RESULTS. Intraocular pressure was significantly reduced at all study visits and amounted to 5.9±2.8 mm Hg at week12 (25.9%). There was a significant reduction in symptoms of dry eye, irritation, itching, and foreign body sensation (p<0.05 for each parameter). A significant improvement was also noted in terms of the condition of the ocular surface, and in most patients the symptom complex was classified as mild dry eye syndrome (p<0.05). Additionally, there was also a significant improvement in the OSDI score (p<0.05) with a mean of 17.95±5.35 points. The tear film breakup time by the end of observation increased by 4.1±2.3 sec and amounted to 7.4±3.1 sec.CONCLUSION. The drug Traviolan® has high antihypertensive effectiveness and good tolerability, and improves the condition of the ocular surface.

On the question of the features of pain syndrome in oncopediatric practice

Background. Nociceptive and neuropathic pains are characteristic of oncological diseases and can be complicated by a psychogenic component, the conditions for the formation of which in juvenile cancer patients are poorly studied.Aim. A clinical analysis of a psychogenic pain symptom complex acting in isolation or as a component of a pain disorder with somatic prerequisites.Materials and methods. Using the clinical and psychopathological method, 60 patients aged 10–17 years undergoing treatment in an oncological hospital were studied.Results and conclusion. Psychogenic pain is a component of polymorphic psychogenic education (nosogenic reaction), it develops in children with a special characterological warehouse when they get into a situation of hospital stress.

Characterisation of internal tremors and vibration symptoms

ObjectivesTo describe the experiences of patients who have postacute sequelae SARS-CoV-2 infection with internal vibrations and tremors as a prominent component, we leveraged the efforts by Survivor Corps, a grassroots...

CLINICAL AND NEUROLOGICAL FEATURES OF ISOLATED AND COMPLICATED CHIARI MALFORMATION TYPE I

The review article, based on the analysis of modern literature data, presents symptoms, syndromes and symptom complexes of isolated Chiari malformation type I (MCI) and in combination with syringomyelia, scoliosis, hydrocephalus. It was concluded that the possession of such information for outpatient and hospital health care doctors will allow them to suspect a malformation and continue diagnosis at the level of neuroimaging. The critical importance of a detailed neurological status of the patient in determining the indications for conservative treatment or surgical intervention, choosing the technique and extent of the operation is also emphasized.

Bortezomib Induced Peripheral and Severe Autonomic Neuropathy Characterized By Dizziness, Orthostatic Hypotension and Weight Loss

Background It is well known that Bortezomib (B), a proteasome inhibitor used in the treatment of Multiple Myeloma (MM) causes peripheral neuropathy in an estimated 75% of patients and compromises their quality of life. There are reports of dizziness, muscle weakness and other unusual neurologic complications caused by B. Among patients that received B based induction, we observed peripheral neuropathy as expected. In addition, in a small subset we observed profound weight loss, dizziness, orthostatic hypotension (OH) and diarrhea. Some patients with weight loss required appetite stimulants and patients with OH/dizziness required medication for symptom control. The conglomeration of symptoms frequently impairs patients' performance status requiring interruption of therapy. B was given in combination with lenalidomide and dexamethasone (VRD) but we feel the neuropathic symptoms are more due to B since the combination of just lenalidomide and dexamethasone is not known to cause such complications. There are few publications on autonomic neuropathy (AN) caused by B but we believe it is under recognized and under diagnosed. Herein we report a series of patients managed at our center that presented with significant weight loss and dizziness suggestive of AN, prompting us to explore further and bring awareness to this problem. Methods From January 2018 to July 2023, patients with MM treated in our own practice and patients induced by our referring practices and sent to our center for transplant were evaluated. We identified patients who complained of significant weight loss and dizziness and reviewed medical records, looked at the characteristics they exhibited, and identified a pattern of symptoms and clinical course. Statistics are descriptive and this retrospective study was approved by our Institutional review board. Results Sixteen patients were noted to have symptoms suggestive of AN. 13 of 16 received VRD and 3 received Daratumumab, B and dexamethasone-based induction. B was administered subcutaneously and given twice weekly. The median age was 62.5 years (range 51-76). Ten were African American and 6 White; 6 female, 4 had diabetes but no neuropathy, 10 had bone disease, 5 renal failure at presentation. The interval between initiation of therapy and AN symptoms was a median of 117 days (range 50-219) and the median B dose was 20.8 mg/M 2 (range 11.7-40.3 mg/M 2). All 16 patients had weight loss and was the most recognizable symptom. The median weight loss and percentage weight loss (compared to baseline weight) were 18.2 Kgs (range 6.7-39.14 Kgs) and 19% (range 6-41%) respectively. 10 of 16 patients had loss of appetite and 9 had diarrhea. Further treatment was held due to decline in performance status in 14 patients. Nine patients received appetite stimulants; 2 megestrol and 7 dronabinol. OH and an increase in heart rate in the standing position was seen in all 16 patients. 11 of the 16 patients had dizziness; 3 patients received fludrocortisone and one received midodrine. 14 of 16 patients also had peripheral neuropathy of whom 13 required medications for neuropathic pain and 14 required narcotic analgesics. Conclusion 14 of 16 patients received a transplant and 2 declined. Transplant was delayed by 6 months (range 2-11) to enable recovery and the end-point was weight gain, resolution of OH and clinical improvement. Post-transplant 4 patients had persistent diarrhea and 1 had persistent dizziness. One patient developed severe mucositis, dysphagia, poor appetite and required hyperalimentation, nasogastric feeding and a feeding gastrostomy tube. 9 of 14 patients had persistent peripheral neuropathy and are using medications. Two of the 16 patients progressed and received salvage treatment one of the two is now deceased. With a median follow up of 26.35 (range 8.47-53.6) months, the median survival since diagnosis is 28.72 months. Severe AN characterized by weight loss, dizziness, OH in association with loss of appetite, diarrhea and painful neuropathy is an under recognized complication of Bortezomib. This generally results in interruption of disease directed therapy and delays autologous transplantation. Transplantation without resolution of symptoms could possibly worsen the morbidity and delay post-transplant recovery. To the best of our knowledge, we are the first group to report a series of patients with this symptom complex and strongly feel it requires further study in a larger cohort.

Rehabilitation of Adult Patients with Pulmonological Manifestations of Long COVID: a Review

INTRODUCTION. The most common symptoms in patients who have had a new coronavirus infection (COVID-19) are associated with pulmonary lesions (shortness of breath, chest pain, cough) and the same complaints persist in the majority of those suffering from long COVID the occurrence and prevalence of which in the population is inextricably linked with the number recovered from COVID-19.
 AIM. To study the current state of the problem of diagnosis, treatment and rehabilitation of patients with pulmonological manifestations of long COVID at the stage of a specialized rehabilitation hospital in order to formulate basic practical recommendations for the management of this category of patients.
 MATERIALS AND METHODS. During the period from January 1, 2021 to December 1, 2022, we performed a systematic search of the MEDLINE, Cyberleninka, and eLIBRARY.RU databases on the topic of pulmonary manifestations of long COVID and methods of their rehabilitation in adult patients that gave 678 matches. After further filtering steps according to the methodology outlined in the PRIZMA guidelines, we selected 60 publications for the final analysis.
 RESULTS. Pulmonary manifestations of long COVID, including, first of all, shortness of breath, rank second after fatigue in terms of frequency of occurrence in long COVID. Diagnostic findings include radiologic pulmonary tissue changes recorded in a proportion of patients under one year, restrictive abnormalities on spirometry, and impaired pulmonary diffusion capacity. Many patients who have had COVID-19 recover quite quickly, but some of them have a long-term symptom complex of dyspnea and physical fatigue, for which rehabilitation in a specialized centers is indicated.
 The most effective treatment is possible with the involvement of a multidisciplinary rehabilitation team in the rehabilitation process and the appointment of rehabilitation programs created in accordance with the conceptual basis of respiratory rehabilitation, including, first of all, a wide range of methods of therapeutic physical culture.
 The most effective treatment is possible by involving a multidisciplinary rehabilitation team in the rehabilitation process and prescribing rehabilitation programs designed in accordance with the conceptual framework of respiratory rehabilitation, including, above all, a wide range of therapeutic physical education techniques.
 CONCLUSION. Current knowledge of the clinical picture, diagnosis, treatment and rehabilitation measures in long COVID is constantly reassessed and expanded. This literature review gives an analysis of research papers focused on the treatment and rehabilitation of pulmonary manifestations in adults, combining the etiopathogenetic and syndromic approaches characteristic of the “classical Russian therapeutic” and, closest to it, the “German” schools. The information extracted both from documents published by World Health Organization (WHO) and from local Russian and European clinical guidelines will allow a specialist engaged in the rehabilitation of adults with pulmonary manifestations of long COVID to create an effective and personalized individual rehabilitation plan for each patient.

Treatment options for situational anxiety in the neurology physician practice

Recent decades have been characterized by high stress levels, which inevitably leads to neuroticism and psychopathization of the population. Emotional stress and the anxiety that follows it can be the cause and provocateur of some pathological processes and diseases. Unlike normal anxiety, intended to adapt the body, protect it and preserve life, pathological anxiety is inadequate to the intensity of the threat, is long-lasting, severe, and disrupts the quality of a person’s life and his activities. Activation of the hypothalamic-pituitary-adrenal axis caused by stress leads to the development of psycho-vegetative syndrome – a complex of somatic, vegetative, and mental symptoms. However, in clinical practice, doctors usually encounter the fact that the patient more often presents various multisystem somatic complaints, ignoring emotional experiences. Undiagnosed anxiety can lead to chronicity or relapse of the disease, the prescription of only symptomatic therapy and aggravation of the course of the missed anxiety disorder. For a doctor to qualitatively assess the clinical picture, it is necessary to understand the structure of autonomic dysfunction in various systems and “recognize” the manifestations of anxiety. Managing such patients, especially comorbid ones, is a complex task, the solution of which will be most effective through joint efforts with psychiatrists and psychotherapists. Psychotherapy, cognitive-behavioral therapy, art therapy, music therapy, medications are an integral part of the therapy for this category of patients. Psychotropic drugs can reduce both anxiety and vegetative symptoms. For subclinical anxiety disorder with somatic manifestations, herbal sedatives or drugs based on them are used in outpatient practice, which have a favorable safety profile with sufficient effectiveness. The drug of choice may be Valocordin, which has sedative, antispasmodic, and hypnotic effects, which corresponds to the goals of treating psychovegetative syndrome.

Clinical manifestations and possible predictors of the formation of post-COVID syndrome in neurological practice

Introduction. Studying clinical manifistations and prognostic factors for the development of post-covid syndrome (PCS) remains an actual task for doctors of various specialties.Aim. To study the clinical manifestations and probable predictors of the formation of PCS in neurological practice.Materials and methods. The study included 34 patients aged 18 to 65 years undergoing treatment at the A.Ya. Kozhevnikov Clinic of Nervous Diseases for the underlying disease: tension headaches (GBN), migraine (M), musculoskeletal pain (SMB), who had a documented coronavirus infection (CI) COVID-19. The main group (OG) consisted of 21 patients (average age 47.95 ± 12.21 years), in addition to the manifestations of the underlying disease, complaining of memory impairment, decreased concentration and performance, fatigue, anxiety and internal tension, low mood background and unwillingness to do anything, headache that occurred for the first time during, immediately after the end or within 2 months after the transferred CI, which met the criteria of the PCC. The comparison group (GS) included 13 patients (average age 38 ± 12 years) who complained only about their underlying diseases and did not note any peculiarities in their course due to the transferred CI. In addition to the main research methods, questionnaires were used: fatigue (MFI-20 scale), anxiety (Spielberger – Khanin scale), depression (Beck scale), cognitive impairment (MOCA test), impaired concentration (Munsterberg test), symptoms of central sensitization (CSI), quality of life (SF-36).Results. Clinical manifestations of PKS consisted in mild or subjective cognitive impairment (CN) without a change in concentration and asthenic symptom complex. OG patients were older, had moderate and severe acute period of CI and risks of cardiovascular pathology, statistically significantly differed from HS with higher scores on the scales: Beck depression, Spielberger – Khanin, CSI, MFI-20 and a lower score on the MOCA scale.Conclusions. Possible predictors of the formation of PKS can be: age over 40 years, moderate and severe course of CI, the presence of risks of cardiovascular pathology, depression and increased personal anxiety, higher rates of central sensitization.

Caring for patients during voluntarily stopping of eating and drinking (VSED): experiences of a palliative care team in Germany

BackgroundHealth-care professionals are confronted with patients who wish to end their lives through voluntarily stopping eating and drinking (VSED). During VSED, symptoms such as agitation, thirst or psychological distress may arise, thus making close medical accompaniment necessary. Dealing with these symptoms can put a high burden on palliative care teams. Furthermore, divergent perceptions of the ethical classification of VSED may lead to moral distress. The aim of this study was to assess the influence of experience gained over time on the burden of palliative care professionals while accompanying patients during VSED and to assess the perceptions of coping strategies.MethodsThis is a prospective single-centre study conducted at the Interdisciplinary Centre for Palliative Care at University Hospital Duesseldorf, Germany. At two points in time (T1, T2) one year apart, team members of all professions who were actively involved in the accompaniment were eligible to complete a pretested questionnaire.ResultsTeam members perceived the symptom complex of psychological distress, anxiety, and agitation to be the most burdensome symptoms for the patients (T1: 28/49, 57.1%; T2: 33/59, 55.9%). Thirst was the second most observed symptom (T1: 17/49, 34.7%, T2: 19/59, 32.2%). These were also the most burdensome symptoms for individual team members. Most team members found there were no general moral concerns. There was a decrease in the perceived importance of support strategies such as ethical counselling (85.7% versus 63.6%).ConclusionsAccompanying patients during VSED is a challenge for health-care professionals. When comparing T2 to T1, less emphasis lies on the importance of ethical counselling or psychiatric assessment to build a foundation for the accompaniment. Moral and ethical concerns seem to play a minor role. More in-depth studies covering a bigger sample size as well as qualitative studies are needed.

Ендокринна і гінекологічна захворюваність у жінок із непліддям та посттравматичним стресовим розладом

Post-traumatic stress disorder is a complex of mental symptoms of an anxious, obsessive and avoidant nature that persist for more than 6 months after the impact of the traumatic factor. Purpose - to study the reproductive history of patients with infertility and post-traumatic stress disorder to improve preparation to additional reproductive technologies use. Materials and methods. The study analyzed the reproductive anamnesis, gynecological and endocrine morbidity of 67 patients with infertility, who were divided into 2 groups: the Group I - 36 women with impaired fertility before the action of a traumatic factor, the Group II - 31 women with infertility due to stress disorder The Comparison group consisted of 45 women with infertility without symptoms of post-traumatic stress disorder, the Control group - 30 healthy women. Results. The patients of the Group I had mostly primary infertility (80.5%), in the Group II, the vast majority of women had pregnancies and deliveries. 44.4% of women in the first group had a duration of infertility of 5 years or more, in the Group II 64.1% - up to 3 years. In the Group I, patients were characterized by late menarche (22.2%, in the Group II - 6.5%), uterine bleeding during adolescence (33.3%) and reproductive (27.8%) periods (in the Group II - 9.7% and 12,9%, respectively). Patients of the Group I more often had accompanying diabetes (33.3%; in the Group II - 16.2%), obesity (38.9%; in the Group II - 29.0%), hyperandrogenemia (27.8%; in the Group II - 16.2%). Every third patient with infertility and post-traumatic stress disorder had an increased concentration of prolactin. Conclusions. Post-traumatic stress disorder is a powerful factor of impaired fertility, because in the group of women with infertility registered after a traumatic factor, the previous history was uncomplicated (the vast majority of them had given birth - 77.5%), the frequency of endocrine disorders corresponds to the indicator of healthy women (carbohydrate metabolism disorders - 16.2% and 20.2%, respectively), obesity (29.0% and 23.3%, respectively), hyperandrogenemia (16.2% and 13.3%, respectively). Patients with post-traumatic stress disorder, who had infertility before the impact of the traumatic factor, mostly had the primary form of fertility disorder (80.5%), late menarche (22.2%; in the Control group - 6.6%), juvenile (33.3%; in the Control group - 6.6%) and abnormal uterine bleeding in the reproductive period (27.8%; in the Control group - 10%). Endocrine disorders were also more common in this group - carbohydrate metabolism disorders (33.3%), obesity (38.9%), hyperandrogenemia (27.8%). 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 the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Ovarian cancer symptoms in pre-clinical invasive epithelial ovarian cancer – An exploratory analysis nested within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

ObjectiveUKCTOCS provides an opportunity to explore symptoms in preclinical invasive epithelial ovarian cancer (iEOC). We report on symptoms in women with pre-clinical (screen-detected) cancers (PC) compared to clinically diagnosed (CD) cancers. MethodsIn UKCTOCS, 202638 postmenopausal women, aged 50–74 were randomly allocated (April 17, 2001-September 29, 2005) 2:1:1 to no screening or annual screening till Dec 31,2011, using a multimodal or ultrasound strategy. Follow-up was through national registries. An outcomes committee adjudicated on OC diagnosis, histotype, stage. Eligible women were those diagnosed with iEOC at primary censorship (Dec 31, 2014). Symptom details were extracted from trial clinical-assessment forms and medical records. Descriptive statistics were used to compare symptoms in PC versus CD women with early (I/II) and advanced (III/IV/unable to stage) stage high-grade-serous (HGSC) cancer. ISRCTN-22488978; ClinicalTrials.gov-NCT00058032. Results1133 (286PC; 847CD) women developed iEOC. Median age (years) at diagnosis was earlier in PC compared to CD (66.8PC, 68.7CD, p = 0.0001) group. In the PC group, 48% (112/234; 90%, 660/730CD) reported symptoms when questioned. Half PC (50%, 13/26PC; 36%, 29/80CD; p = 0.213) women with symptomatic HGSC had >1symptom, with abdominal symptoms most common, both in early (62%, 16/26, PC; 53% 42/80, CD; p = 0.421) and advanced (57%, 49/86, PC; 74%, 431/580, CD; p = 0.001) stages. In symptomatic early-stage HGSC, compared to CD, PC women reported more gastrointestinal (change in bowel habits and dyspepsia) (35%, 9/26PC; 9%, 7/80CD; p = 0.001) and systemic (mostly lethargy/tiredness) (27%, 7/26PC; 9%, 7/80CD; p = 0.017) symptoms. ConclusionsOur findings, add to the growing evidence, that we should reconsider what constitutes alert symptoms for early tubo-ovarian cancer. We need a more nuanced complex of key symptoms which is then evaluated and refined in a prospective trial.

Показатели вегетативной нервной системы и эндотоксикоза у коров при физиологической и осложненной гестозом беременности

The purpose of the study was to study the state of the autonomic nervous system and the level of endogenous intoxication markers in animals during pregnancy, physiological and complicated by gestosis and toxic liver dystrophy (hepatosis) and their combination. Materials and methods were used in accordance with the assigned tasks. In the conditions of two farms specializing in the production of milk and located in the Belgorod and Pskov regions, studies were conducted, the object of which were cows of the Red-and-White and Holstein Black-and-White breeds at the age of 3–6 years with a gestational age of 240–250 days. As a result of experimental tests, it was revealed that in cows with moderate gestosis, in addition to traditional hypertension, proteinuria and edema, there is an increase in heart rate variability, tachycardia, hypersympathicotonia, neutrophilocytosis, lymphocytopenia and resorptive endotoxication. With a combination of gestosis and hepatosis, the appearance of new (integral) and strengthening of pathophysiological phenomena specific to each of these pathologies is observed. As a result, a symptom complex of severe pathology is formed with bradycardia, vagotonia, resorptive and metabolic endogenous intoxication, leukogram imbalance with a predominance of young cells, monocytopenia, eosinopenia, more pronounced neutrophilocytosis and lymphocytopenia, as well as a decrease in adaptive potential. The scientific novelty lies in the fact that, according to the data obtained, one of the directions of the progression of preeclampsia (gestosis) may be the development of comorbid pathology. At the same time, the deterioration of the animal's condition is a consequence of the aggravation of each of the associated pathologies and the formation of integral pathogenetic integration in the body. In this case, the choice of therapies should be focused on eliminating or alleviating the manifestation of gestosis and associated pathologies, as well as on leveling the pathogenetic mechanisms of comorbidity.

Efficacy and safety of isotretinoin Lidose®

Introduction. Acne is a common chronic inflammatory disease, which is accompanied by severe social stress and reduces the quality of life of patients. Isotretinoin is the gold standard for the treatment of severe and moderate forms of acne, and is also used when there is a risk of developing a post-acne symptom complex and when previous treatment methods are ineffective.Purpose of the study. To determine the effectiveness and safety of various isotretinoin regimens at a dose of 0.4–0.8 mg/kg in patients with moderate to severe acne vulgaris and in patients with adult acne.Materials and methods. A single-center, prospective, parallel, controlled study involved 139 patients with acne vulgaris and adult acne, who were divided into 3 groups. 72 patients with acne vulgaris of moderate severity according to the IGA scale (group A1) and 37 patients with adult acne (group B) received isotretinoin (Accutane) at a dose of 0.4 mg/kg/day (cumulative dose 100 mg/kg) for 8 months. 30 patients with severe forms of acne vulgaris (group A1) received Accutane at a dose of 0.8 mg/kg/day (cumulative dose 120 mg/kg) for 8 months. The study lasted 24 months. and consisted of 4 visits (1st visit, 4, 8 and 24 months), at each visit photocontrol was performed, the number of inflammatory and non-inflammatory elements was calculated, the DAI index and the degree on the IGA scale were determined.Results. All 139 patients achieved ‘clear’ or almost ‘clear’ skin according to the IGA scale after 8 months of therapy. There was also a statistically significant decrease in non-inflammatory and inflammatory elements in all groups after 4 and 8 months. (p < 0.001). The total DIA score after 8 months was reduced in group A1 by 89.2%, in group A2 by 83.78% and in group B by 80.3%. Acne recurrence after 24 months was determined in five patients.Conclusions. Various regimens of Accutane for moderate and severe acne vulgaris, as well as adult acne, have demonstrated high efficacy and a favorable safety profile.

Metabolic Signature and Obstructive Sleep Apnea in Nepalese Patients

Introduction: Untreated Obstructive Sleep Apnea (OSA) causes sleep related symptoms and also causes increased incidence of RTA, cardiovascular diseases and all cause mortality. Currently OSA has been recognized as the consequence of number of interrelated metabolic and oxidative pathologies. As there are limited data of association of OSA with metabolic stress and its correlation with severity of OSA, study of metabolic profile of these patients in view of defining the Metabolic signature of OSA was carried out in eastern Nepal.
 Objectives: To study metabolic profile of OSA and its association with clinical severity. Methods: Hospital based descriptive cross sectional study. Biochemical profile results related to metabolic –oxidative pathway of the OSA patients were obtained. Quantitative and qualitative data were obtained. Quantitative data were compared using Mann–Whitney test while qualitative variables compared using Pearson χ2. Correlation was carried out using Pearson and Spearman’s test. P-value<0.05 considered significant.
 Results: 33 patients of OSA were enrolled. Majority of patients had deranged metabolic and oxidative parameters despite mild OSA. Among metabolic stress parameters, most commonly deranged were decreased high density lipoprotein (HDL), increased mean arterial pressure (MAP), waist circumference (WC) and raised fasting blood sugar (FBS). Increased MAP and increased WC was significantly corelated with severity.
 Conclusion: Besides symptom complex, OSA is also harbinger of metabolic stress that can lead to various cardiometabolic diseases and premature mortality thus early recognition and treatment can mitigate these consequences.

Trace Amine-Associated Receptors and Monoamine-Mediated Regulation of Insulin Secretion in Pancreatic Islets.

Currently, metabolic syndrome treatment includes predominantly pharmacological symptom relief and complex lifestyle changes. Trace amines and their receptor systems modulate signaling pathways of dopamine, norepinephrine, and serotonin, which are involved in the pathogenesis of this disorder. Trace amine-associated receptor 1 (TAAR1) is expressed in endocrine organs, and it was revealed that TAAR1 may regulate insulin secretion in pancreatic islet β-cells. For instance, accumulating data demonstrate the positive effect of TAAR1 agonists on the dynamics of metabolic syndrome progression and MetS-associated disease development. The role of other TAARs (TAAR2, TAAR5, TAAR6, TAAR8, and TAAR9) in the islet's function is much less studied. In this review, we summarize the evidence of TAARs' contribution to the metabolic syndrome pathogenesis and regulation of insulin secretion in pancreatic islets. Additionally, by the analysis of public transcriptomic data, we demonstrate that TAAR1 and other TAAR receptors are expressed in the pancreatic islets. We also explore associations between the expression of TAARs mRNA and other genes in studied samples and demonstrate the deregulation of TAARs' functional associations in patients with metabolic diseases compared to healthy donors.

Magnetic resonance imaging in assessing the staging of intracerebral hemorrhages in children

The purpose of the study was to evaluate the possibilities of MRI in determining the stage of hemorrhagic stroke (HS) depending on structural and perifocal changes in children.Materials and methods. The study included 46 patients (including 19 boys and 27 girls) aged from the 29th day of life to 18 years, with a clinical picture of cerebrovascular accident and the presence of HS in the brain substance (BS) during an MRI study. For statistical analysis, patients were divided into two groups: group 1 – patients examined in the first 48 hours from the onset of neurological symptoms (21 people), group 2 – after 48 hours (26 people). Comparison in two groups was carried out according to MR signs: the presence of perifocal cytotoxic edema, the presence of perifocal hemorrhagic impregnation, the presence of a cytoplasmic rim. Intergroup comparisons on a qualitative basis were carried out using Fisher's exact test.Results. As a result of the study, differential diagnostic criteria for the stages of HS in children were determined by analyzing the MRI semiotics of hematoma in combination with the symptom complex of perifocal changes (CPC) in the form of perifocal cytotoxic edema, perifocal hemorrhagic impregnation and cytoplasmic rim. Statistically significant differences in the frequency of occurrence of signs of perifocal cytotoxic edema and perifocal hemorrhagic impregnation in the groups were found. The presence of perifocal cytotoxic edema was statistically significant (p = 0.027) more common in group 1 (47% (n = 10), 95% CI 26–69) than in group 2 (16% (n = 4), 95% CI 5–36). The presence of perifocal hemorrhagic soaking was statistically significantly (p = 0.003) more common in group 1 (81% (n = 17), 95% CI 57–93) than in group 2 (36% (n = 9), 95% CI 18–57). In addition, a statistically significant (p = 0.005) difference was found in the incidence of CPC, which was observed in group 1 (28% (n = 6), CI 12–52) and was not observed in group 2 (0%, (n = 0), 95% CI 0–17).Conclusions. The use of T2, T1, FLAIR, SWI and DWI modes (b = 1000) in combination with ADC in the protocol of MRI examination of children is mandatory, and only a comparison of the characteristics of the MR signal from a hematoma in combination with an analysis of perifocal changes allows us to differentiate the stage of hemorrhage. HS in the acute and early subacute stages has a similar MRI semiotics, therefore, it is necessary to assess the complex of perifocal changes, which allows to differentiate these stages, as it is determined in patients examined in the first 48 hours (p < 0.05) and is not observed after two days. SWI analysis makes it possible to differentiate the late subacute stage of hematoma from chronic due to different characteristics of the MR signal, and also allows you to establish the presence of perifocal hemorrhagic impregnation, which contributes to the differential diagnosis of hemorrhage in the early stages of the pathological process.

Contact Allergy in Atopic Patients

Summary Atopic dermatitis (AD) is a chronic inflammatory disease based on genetic and immune alterations and is part of the atopic symptom complex, including allergic rhinitis, allergic conjunctivitis, and bronchial asthma. A disturbed barrier function facilitates antigen penetration through the skin, with the subsequent development of allergic contact dermatitis (ACD). The gold standard for diagnosing ACD is epicutaneous (patch) testing, also applied to objectify contact sensitization in AD. This study aimed to determine the frequency of contact allergy (CA) among individuals with atopic history and the allergens that caused ACD in those cases. We studied 453 individuals tested in the period 2009-2022. Of these, a subpopulation of 189 individuals with atopic diathesis was identified. A retrospective analysis was used. Using clinical and allergological methods, we divided the tested patients according to sex, age, professional occupation, and areas of the body affected by dermatitis and identified the most common contact allergens that cause positive reactions and ACD. In conclusion, our results highlight the possibility of developing ACD in people with atopic diathesis. As far as we know, our study is the first one in Bulgaria to examine the frequency of contact sensitization in AD patients.

Development of a rapid, sensitive detection method for SARS-CoV-2 and influenza virus based on recombinase polymerase amplification combined with CRISPR-Cas12a assay.

Respiratory tract infections are associated with the most common diseases transmitted among people and remain a huge threat to global public health. Rapid and sensitive diagnosis of causative agents is critical for timely treatment and disease control. Here, we developed a novel method based on recombinase polymerase amplification (RPA) combined with CRISPR-Cas12a to detect three viral pathogens, including SARS-CoV-2, influenza A, and influenza B, which cause similar symptom complexes of flu cold in the respiratory tract. The detection method can be completed within 1 h, which is faster than other standard detection methods, and the limit of detection is approximately 102 copies/μL. Additionally, this detection system is highly specific and there is no cross-reactivity with other common respiratory tract pathogens. Based on this assay, we further developed a more simplified RPA/CRISPR-Cas12a system combined with lateral flow assay on a manual microfluidic chip, which can simultaneously detect these three viruses. This low-cost detection system is rapid and sensitive, which could be applied in the field and resource-limited areas without bulky and expensive instruments, providing powerful tools for the point-of-care diagnostic.

A personalized approach to the management of breastfed infants with functional gastrointestinal disorders and cow’s milk allergy. The role of nutritional recommendations for a nursing mother

Introduction. Functional gastrointestinal disorders (FGID) in infants are a complex of symptoms from the gastrointestinal tract that cannot be explained by structural or biochemical disorders. To alleviate the symptoms of functional disorders, a set of measures is required, first of all, psychological support for the mother and, of course, rational feeding, which includes maintaining breastfeeding, optimizing the nutrition of the nursing mother. Despite the abundance of professional information on this issue, previous studies demonstrate a low level of women’s awareness of nutrition during breastfeeding. The aim of the work is to determine the effectiveness of recommendations on nursing mother’s nutrition in the complex treatment of breastfed children with FGID and allergy to cow’s milk proteins.
 Materials and methods. Seventy five mother–child pairs were included in the study. 1–4 months infants exclusively breastfed during the study were divided into two groups: 1 — FGID infants (n = 51) and 2 — infants with suspected cow’s milk allergy (CMA) n = 24. In addition to the comprehensive treatment of the child, mothers of both groups were given recommendations on the nursing woman’s nutrition. Mothers of children from group 2 were assigned a diagnostic dairy-free diet for a period of 1 month. 
 Results. On the 2nd visit, when analyzing the symptoms of the FGID in group 1, the number of children with symptoms of regurgitation of more than 2 episodes per day decreased by 28% (p < 0.001), crying for more than 3 hours per day — by 52% (p < 0.001). Children of group 2 with a clear positive effect from the diagnostic dairy-free diet therapy of the mother (n = 20) were diagnosed with Allergic and alimentary gastroenteritis and colitis (K52.2 — 10th revision of ICD-10), the continuation of the dairy-free diet for the mother and the supervision of an allergist were prescribed. The survey of women showed that all nursing women were interested in nutrition issues during lactation, 92% of the surveyed mothers searched for this information on the Internet. At the same time, only 12% of women considered this information to be sufficient. Evaluating the presented materials on nutrition, the overwhelming majority of respondents replied that they helped them to adjust their diet and expand nutrition, as well as to maintain breastfeeding.
 Conclusion. Thus, an integrated approach in the management of FGID infants and gastrointestinal manifestations of food allergies, including the use of nutrition recommendations developed in the National Medical Research Center of Children’s Health for nursing women, allows achieving a positive effect on the side of symptoms both in FGID and CMA patients, and also contributes to the improvement of the psycho-emotional state of a woman and prolonged breastfeeding.

Clinical and epidemiological characteristics of acute flaccid myelitis cases in children registered in the Russian Federation in 2015–2019

Acute flaccid myelitis is a syndrome characterized as the development of acute flaccid paralysis of one or more limbs due to lesions of the anterior horns of the spinal cord, which occurs against the background of a viral infection. More than 300 acute flaccid paralysis cases are registered in the Russian Federation annually, most of them are of a non-infectious etiology. In some cases, patients develop a complex of symptoms similar to poliomyelitis, but without isolation of polioviruses from stool samples. Clinical characteristics of such cases include acute onset, fever, persistent peripheral asymmetric paresis/paralysis of predominantly proximal parts of the limbs, and absence of pathological reflexes, pelvic disturbances, or pyramidal symptoms. In literature, such complex of symptoms is referred as acute flaccid myelitis. We provide an analysis of 18 cases of acute flaccid myelitis detected in the Russian Federation in the period from 2015 to 2019. A clear seasonality of the disease from July to November was noted. Studies of faecal samples, cerebrospinal fluid and blood samples did not reveal the pathogen. In all patients, regardless of therapy, there was a positive trend, but complete recovery was not achieved: paresis of varying severity persisted, mainly in the proximal extremities Therefore, acute flaccid myelitis cases as acute flaccid paralysis cases of unknown etiology require an additional observation and an expanded algorithm of laboratory investigation aimed to finding a possible pathogen.