Complicated Course Research Articles

Revolutionizing radical prostatectomy - a comparative study of traditional and modern automated surgical techniques

Introduction and purpose:
 Prostate cancer is a common malignancy seen worldwide and second most common cancer among Polish men as well as globally. The symptoms of prostate cancer depend on severity of the cancer. Prostate cancer diagnosis is typically established through physical examination- digital rectal examination (DRE), PSA (prostate specific antigen) testing and confirmed by histopathological examination. The choice of treatment method depends on many factors: disease severity, risk assessment (based on PSA, TNM and Gleason score), age of the patient and expected survival time. Treatment include surgery, hormone therapy, radiation therapy or chemotherapy. In some cases, the combination of methods can be used to achieve better outcomes. 
 One of available treatment option is radical prostatectomy which includes open radical prostatectomy (ORP), laparoscopic and laparoscopic robot assisted radical prostatectomy (RARP). We aimed at presenting various outcomes comparing open radical prostatectomy and robot assisted radical prostatectomy.
 State of knowledge: 
 In order to carry out the review of the topic we began to collect information and comprehensive research in PubMed database. The analysis focused on the treatment of prostate cancer especially radical prostatectomy methods, the course of surgical procedure, postoperative care, oncological results, intraoperative and postoperative complications.
 Conclusion:
 ORP and RARP ae two surgical procedures used in prostate cancer treatment. Both of them involve removal of the prostate gland but also have a multiplicity of differences. RARP is safe and less invasive alternative to ORP with shorter postoperative hospitalization. However, ORP is known for no necessity for expensive specialized equipment such as Da Vinci or Versius robot surgery system and shorter operative time.

Pediatric opsoclonus myoclonus ataxia syndrome in the setting of COVID-19 (P5-9.010)

<h3>Objective:</h3> To describe peri-infectious opsoclonus myoclonus ataxia syndrome (OMAS) in the setting of COVID-19 infection in children. <h3>Background:</h3> OMAS is well described in pediatric patients with peripheral neuroblastic tumors and less defined in the setting of peri-infectious etiologies such as SARS-CoV-19 which is better appreciated in adults. <h3>Design/Methods:</h3> We describe two separate cases of peri-infectious COVID-19 OMAS in pediatric patients at a tertiary Children’s Hospital in 2022, both previously healthy female patients, 2 years and 18 months of age. <h3>Results:</h3> Patient A is a two year-old female who initially presented with ataxia in context of acute COVID-19 infection at 16 months of age and later developed abnormal eye movements, myoclonus and irritability with multiple relapses over a nine month period. Patient B is a 18 month-old female presenting with acute onset abnormal eye movements and ataxia at age 14 months and later developed myoclonic jerks and irritability with sleep disturbance, subsequently found to have COVID-19 antibodies, now with remission of symptoms. Both patients had comprehensive work up for malignancy, toxic-metabolic encephalopathy, structural central nervous system disease, infectious meningoencephalitis and genetic ataxia syndromes. Both were treated with IVIG and high dose steroids. Patient A had subsequent relapses and required escalation of treatment to ACTH. Patient A had a more complicated course which included treatment with acetazolamide and levetiracetam for myoclonus. Her myoclonic jerks demonstrated intermittent electrographic correlates on EEG. <h3>Conclusions:</h3> While OMAS associated with neuroblastic tumors is well described in the pediatric literature, it is less well known in relation to peri-infectious phenomena, particularly SARS-CoV-2 infection in children. Prior published reports of OMAS related to COVID-19 infection in adults indicated a favorable prognosis after initial treatment. However, we present a case with repeated relapses and the need for more aggressive treatment. The present report broadens the phenotypic spectrum for OMAS outside of paraneoplastic etiologies. <b>Disclosure:</b> Dr. Yakir has nothing to disclose. Dr. Most has nothing to disclose. Dr. Hermel has nothing to disclose. Dr. Zimbric has received personal compensation in the range of $0-$499 for serving as a Survey volunteer with Opinionsite. An immediate family member of Dr. Friedman has received personal compensation in the range of $0-$499 for serving as a Consultant for Sinopia Biosciences. An immediate family member of Dr. Friedman has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Pet Dx. Dr. Friedman has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for MedLink Neurology. Dr. Friedman has stock in Friedman Bioventure . Dr. Rho has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Eisai. Dr. Rho has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Nutricia. Dr. Rho has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerecin. Dr. Rho has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mallinckrodt. Dr. Rho has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biocodex. Dr. Rho has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Zogenix. Dr. Rho has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Aquestive. The institution of Dr. Rho has received research support from National Institutes of Health. Dr. Rho has received publishing royalties from a publication relating to health care.

Expression profile of plasma microRNAs and target genes in patients with complicated pregnancy

Aim: comparative analysis of the expression profile of plasma microRNAs and target genes in patients with complicated pregnancy.Materials and Methods. A prospective observational comparative study in parallel groups was carried out. The study included 73 women divided into three groups: the main group – 42 patients with preeclampsia (PE), the comparison group – 12 pregnant women with fetal growth retardation (FGR), the control group – 19 clinically healthy women with uncomplicated pregnancy. An examination was performed, which included the analysis of clinical characteristics and the study of microRNA expression in blood plasma using the real-time polymerase chain reaction.Results. MicroRNA hsa-miR-210-5p and hsa-miR-1972 were not identified in any plasma sample. Analyzing plasma microRNAs in group of women with PE showed significant changes in the expression levels of hsa-miR-517a-3p (p = 0.025), hsa-miR-517c-3p (p = 0.036), hsa-miR-574-5p (p = 0.015), hsa-miR-517a-3p (p &lt; 0.001) and an increase in miR-20a-5p (p = 0.046) compared to control group. No significant differences were found in the miRNA expression profile in group of women with FGR compared to control group. Assessing an influence of the studied microRNAs on regulatory signaling pathways allowed to establish that hsa-miR-miR-146a-5p, -181a-5p, -210-3p, -517a-3p, -517c-3p, -574-3p, -574-5p, -1304-5p are potential regulators of the reaction cascades involved in the PE pathogenesis.Conclusion. The changes revealed in the circulating blood plasma miRNA level indicate the presence of specific transcriptomic alterations during complicated course of pregnancy.

Prepancreatic postduodenal portal vein: a case report and literature review

BackgroundAmong congenital anomalies of the portal venous system, prepancreatic postduodenal portal vein (PPPV) is very rare and has only been reported to date. Herein, we report a case of PPPV identified in preoperative examinations for hepatocellular carcinoma and a literature review.Case presentationA 63-year-old man was admitted to our hospital for treatment of a liver tumor. After examination, he was diagnosed with hepatocellular carcinoma with a diameter of 40 mm in segment 8. Contrast-enhanced computed tomography scan showed a portal vein passing between the duodenum and pancreas, hence called PPPV. At the hepatic hilus, the portal vein branched off in a complicated course with some porto-portal communications. We determined that anatomical resection with manipulation of the hepatic hilum in this case resulted in major vascular injury. Therefore, we performed partial liver resection, and the patient was discharged uneventfully on postoperative day 14.ConclusionsAlthough PPPV is an extremely rare congenital vascular variant, it is important to carefully identify vascular patterns preoperatively and to recognize the possibility of such an anomaly to avoid misidentification and inadvertent injuries during surgery.

Rheumatoid arthritis and cardiovascular diseases: close relatives or friends?

The problem of comorbidity is widely discussed in modern medical literature. Its role in rheumatic diseases is of particular interest due to their multifactorial nature and the involvement of a wide range of pathogenetic mechanisms. For many years, researchers around the world have noted correlations between the presence of active autoimmune disorders and the complicated course of cardiovascular diseases. A deeper understanding of the pathogenetic mechanisms at the present stage of development of rheumatology allows us to take a fresh look at the relationship between atherosclerosis and rheumatoid arthritis. The definition of multimorbidity developed in recent years and the results of recent scientific studies may contribute to a more correct choice of tactics for managing patients with a combination of these two diseases.

Diphyllobothriasis: diagnosis, treatment, prophylaxis

Helminthiases are found in the group of the most common and socially significant human infectious diseases. According to current data, at least 1 billion people are infected with helminths or pathogenic infections. One of the most important and widespread human biohelminth parasites in the Russian Federation is the broad-spectrum tapeworm (Diphyllobothrium latum). The absence of specific clinical diagnosis, as well as the predominance of latent forms, determines the presence of diphyllobothriasis disease. The aim of the study was to summarize current data on the epidemiology, pathogenesis, clinical and laboratory manifestations and therapy of diphyllobothriasis. Materials and methods. Clinical cases of diphyllobothriasis were analyzed among patients who were treated in January to November 2022 in the departments of the daytime period of clinical observation of the infectious diseases hospital named after S.P. Botkin, as well as the department of incidents detected and the clinical diagnostic center of Pediatric Research and Clinical Center for Infectious Diseases. Cases of the use of diseases, data from laboratory and instrumental studies, and therapy were evaluated. The most informative of them is given as a clinical example. The article also describes in detail the current biological and epidemiological features of Diphyllobothrium latum, the characteristic clinical picture of diseases and the most frequent complications. Results. Diphyllobothriasis still remains one of the most vulnerable biohelminthiases in Russia, typical for some patients of different ages. Verification of the diagnosis of “diphyllobothriasis” can be of the nature of an “accidental finding” during screening scatological or instrumental studies; upon admission, patients themselves begin to suspect helminthiasis when fragments of the strobila worm are found in the feces. To identify a conditional diagnosis of the pattern of clinical and laboratory infection (exclusion of a complicated course of diseases, helminthiases of a different etiology) and to determine risk factors for the transmission of diseases for the prevention of infections.

Effective preconception preparation for women with iron deficiency

Introduction. Latent iron deficiency, which has a high prevalence among women of childbearing age, most often, in the absence of therapy, progresses in pregnant women into manifest iron deficiency, manifested by clinical symptoms of anemia and associated with a complicated course of pregnancy, childbirth, the postpartum period, unfavorable outcomes of newborns. The above justifies the need for correction of iron deficiency at the preconception period.Aim. To evaluate the effectiveness of therapy latent iron deficiency at the stage of preconception period.Materials and methods. The study included 32 women at the stage of pregnancy planning with latent iron deficiency. All women taking the drug Ferretab 1 pill per day for 1 month. The level of blood parameters was assessed at 3 months before the intended conception, in the I, II and III trimesters of pregnancy, in the 3rd day after delivery. In newborns, the indicators of a clinical blood test were evaluated on the 2nd day after birth. We evaluated such indicators as the level of hemoglobin, erythrocytes, hematocrit, the average content of hemoglobin in erythrocytes, serum ferritin, serum iron, transferrin.Results. Evaluation of laboratory data in the course of the study confirmed the effectiveness of the use the complex drug Ferretab. Patients already at the first visit to the doctor during pregnancy had a positive trend and a significant increase in the level of hematological parameters.Conclusions. Oral administration of the complex drug Ferretab showed high efficiency in the treatment of latent iron deficiency at the stage of preconception period, significantly increasing the levels of hematological parameters, good tolerance and a small number of side effects, contribute to the high adherence of patients to therapy, which allows achieving significant clinical results.

Influence of changes in the human intestinal microbiota on slowing the wound process in overweight persons

Overweight and imbalance of the intestinal microbiota are risk factors for disruption of reparative processes during the healing of postoperative wounds. Given the scale of the obesity epidemic in the modern world, the number of overweight patients undergoing surgery for various reasons is also increasing. Potentiation of the risk of a delayed and complicated course of the wound process with a combination of obesity and disturbances in the composition of the intestinal microbiota determines the relevance of this study. Purpose of the study : to study the composition of the intestinal microbiota in patients with overweight and obesity, who have a slowdown in the course of the wound process and the development of complications in the postoperative period. Material and methods . The composition of the intestinal parietal microbiota was studied by microbial markers in the blood using gas chromatography in 49 overweight women who underwent planned surgical interventions for aesthetic indications aimed at correcting body contours from 2019 to 2020. After surgery, women were followed up for 6 months, assessing the timing of wound healing. A comparative analysis of the composition of the intestinal microbiota was carried out in different courses of the wound process, the prognostic significance of individual indicators of the intestinal microbiota was studied in relation to the risk of delayed and complicated wound healing. Results . In the postoperative period, three groups were formed: 1st − complicated wound process (n = 21), 2nd − slow wound process 16 (n = 16), 3rd − standard wound process (n = 12). There were statistically significant differences between the 1st and 2nd groups in terms of “ Peptostreptococcus anaerobius (Gr 1) ≥ 562.0 · 105 cells/g”, p = 0.025) and “ Propionibacterium ≥3.2 · 105 cells/g”, p = 0.0136). Differences were found between the 1st and 3rd groups in terms of “Endotoxin ≥0.7 nmol/ml”, p = 0.051). The highest risk of complicated and delayed postoperative wound healing is observed when the value of the indicators « Propionibacterium ≥32.0 · 105 cells/g”, “ Peptostreptococcus anaerobius (Gr 1) ≥7.0 · 105 cells/g” and “Endotoxin ≥0.7 nmol/ml”. On the basis of the decision tree method, 4 risk classes of a delayed and complicated course of the wound process were identified. The highest risk is in patients with a combination of factors “ Propionibacterium ≥ 3.2 · 105 cells/g” and “Endotoxin ≥ 0.7 nmol/ml”. Conclusion . A number of indicators of intestinal microbiota have a high prognostic value in relation to the risk of developing a complicated and delayed course of the wound process in overweight individuals. The data obtained can be used to predict unfavorable healing of surgical wounds.

The Choice of Tactics for Surgical Treatment of Acute De Bakey Type I Aortic Dissection in a Multidisciplinary Surgical Hospital

BACKGROUND Acute proximal aortic dissection (Stanford type A) remains the most common fatal pathology of the thoracic aorta. Despite the improvement of surgical technologies, hospital mortality after emergency surgical interventions is 17–25%, in complicated cases it can reach 80–90%.AIM OF STUDY Description of the perioperative treatment tactics adopted at the N.V. Sklifosovsky Research Institute for Emergency Medicine as well as the evolution of approaches that make it possible to obtain satisfactory hospital and long-term results in the treatment of aortic dissection.MATERIAL AND METHODS the study included 278 patients operated on from 2015 to 2021 in the acute stage of aortic dissection (less than 48 hours from the moment of manifestation of the disease). The operated patients were divided into two groups, depending on the presence of complicated forms: group A, 102 patients with uncomplicated course of the disease; group B, 176 patients with complicated course of the disease. Additionally, patients were divided depending on the level of distal reconstruction performed: group I, 83 patients, surgery was limited to prosthetics of the ascending aorta, without removing the clamp; group II, 137 patients who underwent hemi-arch surgery; group III, 58 patients, with distal reconstruction involving the aortic arch.RESULTS Total hospital mortality was 28.1%: 25.3% in group I, 29.1% in group II, 29.3% in group III. In the group of uncomplicated dissection, postoperative mortality was 18.6%, while in the group of complicated dissection it was 33.5%.CONCLUSION An integrated multidisciplinary approach with the formation of an “aortic team”, an individual approach to surgery, depending on the anatomy of the dissection and the clinical status of the patient, will improve the results of the treatment of acute aortic dissection, as the most severe and multiple organ pathology of the aorta.FINDING 1. Hospital mortality of complicated forms of dissection remains significantly higher — 33.5% versus 18.5% of uncomplicated course. 2. The most optimal method of distal reconstruction in patients with the peracute stage of dissection is an open anastomosis with the aorta using the “hemi-arch” technique. 3. If it is necessary to extend the surgical intervention on the aortic arch, a distal anastomosis in areas 0, 1, 2 with the possibility of a subsequent endovascular stage is the priority.

Value of increased soluble suppressor tumorigenicity biomarker 2 (sST2) on admission as an indicator of severity in patients with COVID-19

BackgroundSoluble suppressor of tumorigenicity-2 (sST2) is a biomarker for heart failure and pulmonary injury. We hypothesize that sST2 could help predict severity of SARS-CoV-2 infections. MethodssST2 was analyzed in patients consecutively admitted for SARS-CoV-2 pneumonia. Other prognostic markers were also measured. In-hospital complications were registered, including death, ICU admission, and respiratory support requirements. Results495 patients were studied (53% male, age: 57.6±17.6). At admission, median sST2 concentrations was 48.5ng/mL [IQR, 30.6–83.1ng/mL] and correlated with male gender, older age, comorbidities, other severity biomarkers, and respiratory support requirements. sST2 levels were higher in patients who died (n=45, 9.1%) (45.6 [28.0, 75.9]ng/mL vs. 144 [82.6, 319] ng/mL, p<0.001) and those admitted to ICU (n=46, 9.3%) (44.7 [27.5, 71.3] ng/mL vs. 125 [69.0, 262]ng/mL, p<0.001). sST2 levels>210ng/mL were a strong predictor of complicated in-hospital courses, with higher risk of death (OR, 39.3, CI95% 15.9, 103) and death/ICU (OR 38.3, CI95% 16.3–97.5) after adjusting for all other risk factors. The addition of sST2 enhanced the predictive capacity of mortality risk models. ConclusionssST2 represents a robust severity predictor in COVID-19 and could be an important tool for identifying at-risk patients who may benefit from closer follow-up and specific therapies.

Independent validation of the Tanta University Risk Model for intensive care requirement in acutely poisoned adults

Objective To independently validate the predictive value of the Tanta University Risk Model for intensive care requirement in unselected poisoned patients. Method Retrospective chart review of 293 poisoned patients. The Tanta University Risk Model was calculated as follows: Tanta University Risk Model = −1.966*Glasgow Coma Scale − 0.329*oxygen saturation − 0.212*diastolic blood pressure + 0.27*respiratory rate − 0.33*standard bicarbonate. It was then compared to a composite endpoint indicating an intensive care unit requirement (death in hospital, vasopressors, need for intubation). Results Nineteen of 293 patients had a complicated clinical course as defined by meeting the primary endpoint definition. Receiver operating characteristic analysis revealed the area under the curve to be 0.79 (95% confidence interval 0.73–0.83). A positive Tanta University Risk Model was defined >−73.46. Fifteen out of 84 patients with a positive Tanta University Risk Model had a complicated course, while four of 209 patients with a negative Tanta University risk model had a complicated course (P<0.0001, Fisher’s exact test). The negative predictive value of the Tanta University Risk Model was 0.98 (95% confidence interval 0.95–0.99), the sensitivity was 0.79 and that specificity was 0.75. Conclusion Poisoned patients with a negative Tanta University Risk Model score are unlikely to need an intensive care unit level of care.

Complicated Course of Meckel's Diverticulum as a Cause of Chronic Iron Deficiency Anemia

The paper focuses on a clinical case of a complicated course of Meckel's diverticulum in a 27-year-old patient; the disease was manifested by signs of iron deficiency anemia, without signs of overt or latent bleeding. A brief review of the literature presents major features and potential complications of Meckel's diverticulum. Special attention is paid to specific diagnostic options. The authors discuss the need for surgical removal of uncomplicated Meckel's diverticulum.

Prediction of the Complicated Wound Process in Overweight Patients Depending on the Composition of the Intestinal Microbiota

Introduction. Overweight and imbalance of the intestinal microbiota are risk factors for disruption of reparative processes during the postoperative wound healing. Given the scale of the obesity epidemic in the modern world, the number of overweight patients undergoing surgery for various reasons is also increasing. The potentiation of the risk of a delayed and complicated course of the wound process combined with obesity and violated composition of the intestinal microbiota determines the relevance of this study.The aim of the study was to investigate the composition of the intestinal microbiota in patients with increased body weight, with long-term non-healing and complicated surgical wounds.Methods. The composition of the parietal intestinal microbiota was studied by microbial markers in the blood using gas chromatography in 49 overweight women who underwent planned surgical interventions for aesthetic indications in the period from 2019 to 2020, aimed at correcting body contours. After the operation, women were observed for 6 months, with assessment of the timing of wound healing. We carried out a comparative analysis of the composition of the intestinal microbiota in the different course of the wound process, studied the prognostic significance of individual parameters of the intestinal microbiota in relation to the risk of delayed and complicated wound healing.Results. In the postoperative period, all patients were divided into three groups: group 1 - complicated wound process (n=21), group 2 - delayed wound process 16 (n=16), group 3 - conventional wound process (n=12). Statistically significant differences were found between groups 1 and 2 in terms of "Peptostreptococcus anaerobius (Gr 1) 562.0" (621.76962.03 versus 101.75371.90, respectively, p=0.025) and "Propionibacterium 3.2" (77.57 48.57 vs. 40.44 38.15, respectively, p=0.014). Differences were found between groups 1 and 3 in terms of Endotoxin 0.7 (0.730.58 nmol/ml versus 0.860.48 nmol/ml, respectively, p=0.051). The most risk of the complicated and delayed postoperative wound healing is observed when the values of the parameters were "Propionibacterium 32.0", "Peptostreptococcus anaerobius (Gr 1) 7.0" and "Endotoxin 0.7". Based on the decision tree analysis, 4 risk classes of delayed and complicated course of the wound process were identified. Patients with a combination of Propionibacterium 3.2 and Endotoxin 0.7 had the highest risk.Conclusion. A number of parameters of the intestinal microbiota have a high prognostic value regarding the risk of developing a complicated and delayed course of the wound process in overweight individuals. The data obtained can be used to predict unfavorable healing of surgical wounds. Further research is needed in this area on a larger sample of patients, including males.

Trends in cyclicity and amplitudes on amplitude-integrated electroencephalography during transition in extremely low gestational age infants.

The aim of the study was to describe amplitude integrated electroencephalography (aEEG) cyclicity, background pattern, voltage margins and maturation scores in extremely low gestational age neonates (ELGANs) in the first 72 h. Fifty infants with gestational age (GA) 23+0-27+6 weeks were prospectively studied. Infants with intraventricular haemorrhage ≦ Grade I and no disorders of transition (persistent pulmonary hypertension, hypotension, pulmonary haemorrhage) belonged to the 'Uncomplicated' group and those with intraventricular haemorrhage > Grade I and/or disorders of transition, to the 'Complicated' group. Thirty-six infants without opioid exposure were included: 23 with GA 25.9 (23.1-27.7) weeks in the 'Uncomplicated' group and 13 with GA 24.6 (23.3-27.4) weeks in the 'Complicated' group. Cyclicity was more common in the 'Uncomplicated' group [20/23 (87%) vs. 7/13 (54%), p = 0.045] with more cycles/hour [0.2 (0-0.78) vs. 0.03 (0-67), p = 0.036]. Age at appearance of cyclicity was similar [20 (7.7-40.7) hours in 'Uncomplicated' vs. 23.7 (5.4-60) hours in 'Complicated' group, p = 0.8]. In the 'Uncomplicated' group, maturation scores (p = 0.02), high (p < 0.0001) and low (p = 0.03) base voltage increased over time. During the first 72 h, clinically stable ELGANs without neurological injury demonstrate increased cyclicity compared to those with a complicated course. Maturation score, high and low base voltage increase over time.

Pneumomediastinum in COVID-19 disease: Clinical review with emphasis on emergency management.

Pneumomediastinum can be primary (spontaneous) or secondary to iatrogenic, traumatic, and non-traumatic causes. The incidence of spontaneous and secondary pneumomediastinum is higher in patients with coronavirus disease 2019 (COVID-19) compared to the general population. So, pneumomediastinum should be considered in the differential diagnosis of any patient with COVID-19 presenting with chest pain and breathlessness. A high level of suspicion is required to diagnose this condition promptly. Unlike in other disease conditions, pneumomediastinum in COVID-19 has a complicated course with higher mortality in intubated patients. No guidelines exist for managing pneumomediastinum patients with COVID-19. Therefore, emergency physicians should be aware of the various treatment modalities besides conservative management for pneumomediastinum and life-saving interventions for tension pneumomediastinum.

The history of the study of acute appendicitis from antiquity to the present day.

The author dwells in detail on the search in the medical literature of the nineteenth - twenty-first centuries for various options for describing the anatomy, physiology and pathological physiology of the appendix, as well as its acute inflammation, complicated course, the spectrum of principles of its treatment, as well as their outcomes from antiquity to the present day. At the same time, the emphasis is placed on the study of foreign literature reviews and the search for primary sources of priority works to identify historical facts described in previously unquoted works and unknown to domestic specialists, in order to familiarize domestic specialists in the history of medical science with important details of the formation of general surgery.There is a two-hundred-year period between the anatomical description of the appendix and the recognition that it is the appendix that is the focus of acute inflammatory disease in the lower right quadrant of the abdomen. This truth was not widely recognized until the publication of R. Fitz's work 120 years later. The disease of acute appendicitis has a social character and, apparently, influenced the course of history. A comparative analysis of the possibilities of treatment of acute appendicitis and their results allowed us to establish five stages in the history of the study of acute appendicitis

Literary Traditionalism in Romanian Russian-Language Publications of the Second Half of the 20th Century

The author examines Romanian Russian-language publications by the representatives of literary traditionalism issued after the Second World War. The article reveals the features of Romanian literary traditionalism and the specifics of its reflection in the large magazine “Mysl”, which was the main printing body of this trend in the period between the two World wars. The article presents the history and landmarks of this magazine. The author explains complicated post-war political course attitude towards literature, aspirations of which often did not coincide with the requirements of the time. The paper concludes about the positive and negative sides of the publications of traditionalist writers in the 1960s — 1980s, where the very possibility of such publications was a positive event, and the negative one was the concealment of a much larger number of unpublished parts of the heritage of Romanian literary traditionalism behind a small number of publications. From the circle of authors of the “Mysl” magazine, successive traditionalist writers are singled out, whose works in the post-war period were published in translations into Russian. Within the framework of Romanian literary traditionalism, the author distinguishes its main directions — autochthonism and expressionism. The analysis of the differences and similarities between them is supported by the consideration of the texts of the works of representatives of both directions, reflected in Russian translations. The paper concludes on the complex three-part model of Romanian literary traditionalism, the core of which is the concept of “village”; and the author highlights the features of interaction of all the components around the centre of this model. The relevance of the article is due to the small number and inaccessibility of these publications caused by the one-time and olden publications abroad, rare publications in our country and the lack of republications.

Первичная отсроченная хирургическая помощь пациенту с боевым ранением глаза

Currently, injuries to the visual organ are one of the most important causes of blindness and disability due to the complicated course of the post-traumatic process and an unfavorable functional outcome, in the vast majority of cases of the able-bodied population. The timeliness of providing highly specialized ophthalmic surgical care is a fundamental factor that allows for the medical and social rehabilitation of patients with various visual organ injuries in the shortest possible time. In turn, the prolongation of the terms of primary surgical treatment dictates slightly different approaches to the conservative and surgical treatment of such patients. Objective. To evaluate the effectiveness of primary delayed simultaneous surgical care for a patient with a penetrating comminuted battle wound of the eye. Material and metods. Patient K., 35 years old, was admitted to the ophthalmological department of the State Medical Institution «OOKB» of Orenburg with complaints of decreased visual acuity of the left eye with the diagnosis: OS – Multiple military trauma. Consequences of penetrating eye injury. Corneal scar. Traumatic cataract. Partial hemophthalmos. Local retinal detachment. Intraocular foreign bodies. From anamnesis: a month ago, during military operations, he received a shrapnel wound to the head. An open penetrating comminuted fracture of the left temporal bone was performed in a military hospital. I did not receive surgical ophthalmological care. Ophthalmological status: Vis OD = 1,0: OS = movement of the shadow at the face. The IOP of both eyes is normal. OS – conjunctiva is injected, a metallic foreign body is embedded in the sclera at the meridian of 7 hours, 5 mm from the limb, the cornea is transparent, the corneal scar, the anterior chamber is shallow, the moisture is transparent, the iris is edematous, the pupil in the center is deformed, tightened for 7 hours, the pupil reaction is slowed down, inhomogeneous opacities in the lens. The reflex is dim, the details of the fundus and vitreous are not ophthalmoscoped. Preparatory measures were carried out before the surgical intervention: antibacterial and anti-inflammatory therapy. At the first stage, phacoemulsification of traumatic cataract with posterior continuous capsulorexis was performed in the conditions of medical mydriasis. The second stage was a standard three-port vitrectomy of 25 G with the removal of organized vitreous blood clots and the removal of the posterior hyaloid membrane. During the revision, a parietal foreign body with local retinal detachment is visualized in the middle outer part. A 23 G tweezers were used to remove the foreign body, which required the replacement of one of the ports. Delimitative endolasercoagulation was performed. The foreign body was removed through the posterior capsulorexis: brought to the iris in the anterior chamber of the eye, then evacuated through a tunnel incision of 2.75 mm. Then a perfluoroorganic compound (PFOS) was introduced, the retina was attached, additional retinal endolasercoagulation was performed. At the third stage, a simultaneous replacement of PFOS with silicone oil was carried out. The Miol-soft intraocular lens was implanted. At the last stage, the embedded foreign body of the sclera was removed, the conjunctival wound was sutured. On the fifth day after surgical treatment, the patient was discharged for outpatient follow-up with the functions of vis OS = 0.2 sph (+) 4.0 = 0.4 with recommendations. Conclusions. As a result of simultaneous high-tech vitreoretinal surgical treatment against the background of anti-inflammatory and antibacterial therapy, high functional results were achieved. Keywords: injury, penetrating wound of the eye, foreign body of the eye, local retinal detachment

Genetic polymorphism of some genes of toll-like receptors in patients with influenza A (H3N2)

Background.Among all infectious diseases that occur in the human population, only acute respiratory viral infections, including influenza, lead to massive outbreaks, often taking on the character of epidemics and pandemics. Polymorphism of cytokine genes can be both a factor of predisposition and resistance to infection, the development of the disease, and a long, complicated course of influenza.&#x0D; Aim.Study of the genetic polymorphism of the genes of toll-like receptorsrs5743708 (Arg753Gln, G2258A),TLR3 rs3775291 (Phe412Leu, C1234T),TLR4 rs4986790 (Asp299Gly, A896G),TLR4 rs4986791 (Thr399Ile, C1196T)in healthy individuals and in patients with influenzaA(H3N2).&#x0D; Material and methods.The study, using the continuous sampling method, included patients with influenzaA (H3N2; 89people) who were treated at the Regional Clinical Infectious Diseases Hospital in Chita during the epidemic seasons of 20162017 and 20172018. The control group consisted of 96practically healthy donors. To analyze the polymorphism of theTLR2 rs5743708 (Arg753Gln, G2258A), TLR3 rs3775291 (Phe412Leu, C1234T), TLR4 rs4986790 (Asp299Gly, A896G),andTLR4 rs4986791 (Thr399Ile, C1196T)genes the method of polymerase chain reaction with electrophoretic detection using standard kits from Scientific and Production Company Litekh (Moscow) was applied.Statistical analysis was carried out in accordance with the principles of the International Committee of Medical Journal Editors and the Statistical Analysis and Methods in the Published Literature recommendations. Pearson's 2test was used for comparative evaluation of qualitative nominal data.&#x0D; Results.Patients with influenzaA (H3N2) more often had heterozygousTLR2 753Arg/Glnvariants [2=8.26, p=0.02; odds ratio (OR) 3.00; 95% confidence interval (CI) 1.336.73], homozygousTLR3 412Leu/Leuvariants (2=11.68, p=0.003; OR=2.39; 95% CI 1.043.61), heterozygous variants ofTLR4 299Asp/Gly(2=6.97; p=0.03; OR=2.15; 95% CI 1.024.70) and399Thr/Ile(2=8.39; p= 0.01; OR=2.30; 95% CI 1.064.88) compared with a group of healthy donors.&#x0D; Conclusion.The genotypes753Arg/Glnof theTLR2gene,412Leu/Leuof theTLR3gene,299Asp/Glyof theTLR4gene,Thr399Ileof theTLR4gene predispose to the development of influenzaA (H3N2); carriage of genotypes753Arg/Argof theTLR2gene,412Phe/Pheof theTLR3gene,299Asp/Aspof theTLR4gene,399Thr/Throf theTLR4gene reduces the likelihood of the influenzaA(H3N2) development.

FEATURES OF THE INTERRELATIONSHIP OF PERIODONTAL DISEASES AND SOMATIC DISEASES (LITERATURE REVIEW)

The interrelationship of periodontal diseases and somatic diseases has a two-way aggravating character.&#x0D; An analysis of modern scientific literature concerning the connection between periodontal diseases and systemic diseases of the human body has been realized. To collect information for this review, a search was conducted for the scientific literature presented in three databases (Pubmed, Scopus, Web of Science) for the past 2 years. Thirty-four studies, including reviews and original articles, were selected for qualitative analysis based on their relevance to the main content of this review.&#x0D; Numerous studies confirm the significant relationship between the severity of the course of oral inflammatory diseases, the state of its microbiome and the unfavorable prognosis of cardiovascular diseases, diseases of the respiratory system, metabolic syndrome, obesity, rheumatoid arthritis, etc. The presence of periodontitis in patients increases the risk of developing cardiovascular diseases, particularly coronary heart disease and stroke. A high prevalence of periodontal tissue diseases in people with chronic diseases of the digestive organs is noted, which is associated with a violation of all types of metabolism. Severe forms of periodontitis often coexist with diabetes of the first and second types and are considered the most frequent complications of diabetes. Recent studies have clearly substantiated the role of certain periodontal pathogenic microorganisms in the etiopathogenesis and complicated course of rheumatoid arthritis.&#x0D; Highly pathogenic microorganisms of the oral cavity, penetrating through the damaged epithelium of the vascular wall of the periodontal tissues into the systemic circulation, cause chronic bacteremia and affect distant organs and tissues. Since we cannot directly influence on the function of definite organs, it is advisable to prescribe not only basic periodontal treatment, but also the drugs that affect the vascular component of the inflammatory process, namely, strengthen the vascular wall and improve microcirculatory channel trophicity.