Complicated Course Research Articles

Primary undifferentiated pleomorphic sarcoma of the jejunal mesentery with a complicated course: A case report

A primary Undifferentiated Pleomorphic Sarcoma (UPS) of the mesentery is a rare form of malignancy, most commonly usually affecting the soft tissues of the extremities. Due to their location in the abdominal cavity distant from the intestinal loops they remain asymptomatic for a long time. In this study, an incidental finding on imaging is presented in a 66-year-old woman. CT imaging revealed a large mass in her abdomen, with difficulty pinpointing its exact origin. Exploratory laparotomy was performed to remove the mass in its entirety. Examination of the mass showed findings consistent with an undifferentiated pleomorphic sarcoma. She recovered well after her surgery. However, on follow-up imaging, a solitary metastatic lesion in her lung was detected. The prognosis of UPS is historically dismal with invasive treatment options currently being the preferred methods for management.

Assessment of angiogenesis-related parameters in juvenile idiopathic arthritis-associated uveitis.

Juvenile idiopathic arthritis-associated uveitis (JIAU) may run a chronic and treatment-resistant course, and occasionally, alterations of the iris vasculature may be observed clinically. Iris tissue (IT), aqueous humor (AH) and serum samples from patients with clinically inactive JIAU (n = 30), acute anterior uveitis (AAU; n = 18), and primary open angle glaucoma (POAG; n = 20) were obtained during trabeculectomy or cataract surgery. Samples were analyzed by RNA-Seq, qRT-PCR, LC-IMS, Western-Blot, and LEGENDplex™ analysis. Pattern of iris vasculature in JIAU patients was assessed qualitatively via fluorescein and indocyanine green angiography (FLA/ICGA). RNA-Seq of IT showed significantly differential expression (DE) of 136 genes between JIAU and POAG, of which 15 were associated with angiogenesis. qRT-PCR, performed to validate RNA-Seq results, showed upregulation of the angiogenesis-related genes Kdr, Angpt-1, Tie-1, Tie-2 and Mmrn2 in IT (JIAU vs POAG, p > 0.05). LC-IMS of IT revealed a total number of 56 DE proteins (JIAU vs POAG), of which Angiopoetin, Lumican and Decorin were associated with angiogenesis and showed increased (p > 0.05) expression on Western-Blot analysis. LEGENDplex™ analysis showed upregulation of ANGPT-2 in AH from JIAU compared to AAU and POAG, whereas VEGF was upregulated in AAU. Iris vascular leakage, hypoperfusion and neovascularization were observed by FLA/ICGA in JIA patients with treatment-refractory complicated course of uveitis. Angiogenesis-related factors could play a role in long-standing complicated JIAU, leading to clinically visible alterations in selected cases.

Treatment and Outcome of AL Amyloid After Heart Transplantation: Is It Viable?

<h3>Purpose</h3> In the past, light chain (AL) amyloid has been associated with poor outcomes after heart transplantation (HTx), mainly due to its complicated course. Many AL amyloid patients will require stem cell transplant following HTx. It is not known whether these patients have acceptable outcomes after HTx. <h3>Methods</h3> Between 2008 and 2020, we assessed all AL amyloid patients undergoing HTx. Patients were divided into those that required stem cell therapy and those that did not. Both groups were compared to age-matched control that did not have amyloid. Endpoints included 1-year survival, freedom from cardiac allograft vasculopathy (CAV), non-fatal major adverse cardiac events (NF-MACE), and rejection (any treated rejection [ATR], acute cellular rejection [ACR], antibody-mediated rejection [AMR], biopsy-negative rejection [BNR]). <h3>Results</h3> There was no difference between AL amyloid patients with and without stem cell therapy in 1-year survival, or freedom from CAV, NF-MACE, or ATR. Compared to matched controls, post-transplant outcomes were similar. (See table.) <h3>Conclusion</h3> In the current era, therapies for AL amyloid post-heart transplant appear successful with acceptable outcome compared to non-amyloid patients. AL amyloid is not a contraindication for heart transplantation.

Magnet-related foreign body aspiration in two children requiring thoracotomy: A concerning report

With the increase in use of smaller magnets in gadgets and toys at home, magnets pose a growing aspiration risk in children. We present two simultaneous cases of magnet-related foreign body aspiration (FBA) in two children, in two different cities: Karachi, and Lahore. They presented with similar signs and symptoms: tachypnea, tachycardia and asymmetric breath sounds on auscultation. They were initially diagnosed with the help of a chest X ray. Both the cases were complicated by failed bronchoscopy attempts due to the slippery texture of the magnet. Due to the failed bronchoscopy, both patients had a prolonged and complicated course including a 24–48 hour stay in the PICU prior to magnet removal. They eventually had to undergo thoracotomy for successful removal of the magnet. Both had an unremarkable post-operative course and were discharged in good health.

IDF21-0616 Observational study on covid 19 and type 1 diabetes in the Chronic Care Center Lebanon

Background: The Centers for Disease Control and Prevention states that individuals with diabetes are at higher risks for severe illness with covid19 and poorer health outcomes. Aim: This study aims to examine patients’ characteristics and outcomes among people with Type1 Diabetes (T1D) and confirmed covid19 in the Chronic Care Center, the only center specialized for the treatment of T1D in Lebanon that ensures continuous access to care, education and treatment. Method: Patients were diagnosed as having covid-19 if they had been tested positive through a molecular test (RT – PCR) using samples collected from nasopharyngeal swabs. Data were collected from 1/5/2020 till 31/5/2021 using patients’ survey. 160 patients got infected with covid19 among 2995 persons with T1D registered at the Chronic Care Center, the survey was sent to 151 patients, 139 replied. Results: The mean age of the studied population was 20 years, the average duration of diabetes 11 years.•43.9% over 21 years of age•25.9% between 17 and 21•22.3% between 11 and 16•7.9% less than 10 years The main source of infection was family members. 51.1%, 57.6% of the infected patients were females versus 42.4% males. 64.4% of the females reported moderate to severe symptoms versus 35.6% of the males. The Hba1c results pre corona were distributed as follow:•36% < 7.5%•34.5% between 7.5 and 8%•19.4% between 8 and 9%•10.1% over 9% 16.5% have comorbidities, 14.4% suffer from complications of diabetes. The most common symptoms reported among the covid-19 patients with T1D were: 86.3% flu, 51.8% lost the taste and smell, about 20% had pulmonary and gastrointestinal symptoms, less than 11% experienced no symptoms. 33.1% reported weight loss. As for the severity, the 8.6% persons who reported severe symptoms had a duration of diabetes of 17 years. The symptoms lasted for less than 5 days in 50.4% of the patients, only 12.9% reported symptoms for more than 10 days. The BG results were perceived to be good in 43.2% of our patients, 38.1% had fluctuating results. 18.7% experienced hyperglycemia, 5.8% reported ketonuria. As for the treatment 89.9% took vitamins, 29.5% antibiotics and less than 5% needed steroids, anticoagulant and antidiarrheal. Regarding hospitalization 5.8% were admitted to hospital, 6.5% received treatment in the emergency room. The main causes of hospitalization were Hypoxia, dyspnea, ketonuria, renal problems and diarrhea. 35.3% of the patients had their PCR negative in 14 days, 37.4% didn’t repeat the test. No significant correlation was found between the hospitalization, duration and severity of symptoms with the Hba1c, and the presence of comorbidities and complications of diabetes. Discussion: In summary, we didn’t find, in our descriptive study, a complicated course of covid19 infection among our patients with T1D; most probably this could be related to close follow up of this population in a multidisciplinary center where they are relatively well controlled. Further comparison could be done with other diabetic population in different centers. This emphasizes the importance of a multidisciplinary strict management of type1 diabetes and the continuous access to care.

Iatrogenic Tracheal Rupture After Successful LVAD-Explantation

<h3>Introduction</h3> Cardiac recovery followed by LVAD-explantation is rare and happens only in 1-2% of the cases. Tracheal rupture during tracheotomy is an even more rare but dreaded complication. <h3>Case Report</h3> We report the case of a 60 year old female patient who had received LVAD therapy (HeartWare) six years ago for DCM caused by myocarditis. She had an uncomplicated course for four years, had one medically treated episode of systemic infection after five years and recently sepsis together with minor cerebral bleeding. After recovery, a CT-scan showed infection of the LVAD including the outflow graft. As echocardiography and right heart catheterization revealed sufficiently recovered cardiac function, the decision for LVAD-explantation was made. The device was successfully explanted via a median re-sternotomy and the complete outflow graft was removed. The patient was stable and extubated on the 1. POD, but needed to be re-intubated on the 4. POD due to pneumonia. As prolonged weaning from the respirator was expected, the patient underwent a tracheotomy. Shortly after, she developed a severe emphysema, could not be sufficiently ventilated and received an emergency implantation of a VV-ECMO. Bronchoscopy showed a large laceration of the back wall of the trachea. This was repaired surgically by direct suture and two days later a re-operation to cover the tracheal laceration with an intercostal muscle flap was required. After this, the patient developed recurrent bleedings with hemothorax and the need for multiple re-thoracotomies. The patient was on VV-ECMO for two weeks without ventilation or blockage of the tube-cuff to allow the trachea to heal. After bronchoscopic confirmation of good tracheal healing, careful ventilation was initiated. The pulmonary function recovered and the ECMO could be explanted after 36 days. Further along the patient was discharged to a pulmonary weaning clinic. She further recovered and is currently in good shape with NYHA class I-II. Interestingly, during the course of this dramatic complication, the patient was always in good cardiac function without any need of inotropic support. <h3>Summary</h3> After complete cardiac recovery and successful LVAD-explantation even a close to fatal complication like a tracheal rupture can be survived with good clinical outcome. Avoiding mechanical stress to the lacerated trachea under VV-ECMO might be a promising strategy.

PROCALCITONIN DETERMINATION IN ONCOLOGY – RESULTS AND PROSPECTS: A LITERATURE REVIEW

Relevance: Modern requirements for laboratory diagnostics of complicated courses of diseases provide for using particular and hightech research methods like determining the level of procalcitonin (PCT). The PCT level increases only with the generalization of a bacterial&#x0D; infection and reflects the degree of abstraction. Of practical value are an increase in the PCT level and the degree of such increase, a progressive increase, or a long-term (more than 3-5 days) high level. The assessment of this data over time, in combination with the changes&#x0D; in other clinical and laboratory parameters, allows for timely diagnosis and prediction of the outcome of the disease.&#x0D; The study aimed to assess the feasibility of the PCT level dynamic control for timely diagnosis of the overlay or generalization of an&#x0D; infectious process in the form of septic complications in cancer patients.&#x0D; Methods: A thematic search was carried out by keywords in the journal Malignant Tumors and Cochrane, PubMed, Oncology.ru,&#x0D; elibrary.ru, Medscape, and NCBI databases and libraries.&#x0D; We analyzed the results of studies of changes in PCT dynamics in oncological patients who developed and generalized a nonspecific&#x0D; infectious process that proceeded in the form of septic complications.&#x0D; Results: Various research papers have confirmed the need to determine the PCT level and its inclusion in the diagnostic algorithms.&#x0D; The reliability and significance of these studies correspond to the highest levels of evidence-based medicine.&#x0D; PCT shows its high specificity in identifying the infectious component compared to other less informative indicators in oncological&#x0D; pathologies, such as the level of leukocytosis, CRP, and others.&#x0D; In some tumor processes, the initial level of PCT may be higher than the average (0.5 ng/l). Still, dynamic control will show the effectiveness of the therapeutic measures taken and the direction of development of the infectious process.&#x0D; The frequency and intervals of determining the PCT level are of particular importance. In some instances, if an infectious component&#x0D; is suspected in risk groups, the PCT level determination could be included in the initial examination algorithm.&#x0D; Conclusion: Despite the ambiguity of the PCT study results in oncological practice, the determination of systemic inflammation biomarkers in complex antitumor therapy will allow timely setting of indications for prescribing or intensifying antibiotic treatment, predicting&#x0D; the duration, and monitoring its effectiveness in oncological patients.

PEDAGOGY OF THE OPPRESSED: PAULO FREIRE’S PEDAGOGIC CRITIQUE OF POETRY-1 SYLLABUS AT MATERS LEVEL (ENGLISH) AT UNIVERSITY OF SWABI, PAKISTAN

This paper aims to evaluate the students’ feedback of Poetry course. This course includes a total of thirty-four poems of prominent poets ranging from the 14th century till18th century. The course contents are annexed as A. This study will evaluate the pedagogical appropriateness of the overall course and with a zero lecture in the course to critically evaluate the pedagogical appropriateness of the following four poems in particular. The study also aims at the evaluation of the course design to see whether management of course curriculum has an impact on the course overall success. The study applied the theory of ‘Pedagogic Critique’ presented and explicated in the work of Paulo Freire titled as ‘Pedagogy of the Oppressed (Paulo Freire, 2000)’. Freire explains that power dynamics behind everything determines the way how any educational course and setting get underway and proceeded. Books, according to him, are never rated beyond their scope until they are associated with their expected readers and audience (Patton, 2017). The study finds out a mixture of complicated feedback from the students who appeared in their MA English course. The study was devised through a questionnaire indexed at the end of the paper. Their feedback was analysed and the conclusion was made. Most of the students through a resultant questionnaire were unable to reply exactly to the course they read and some of the students could not appropriately connect their initial aptitude to the courses they read and what they had initially antipiated. The study also finds out that some of the students selected their course vaguely without having any firsthand knowledge about they would later on study. Prologue to the Canterbury Tales were considered to be most complicated course since it has a little complicated archaic diction, whereas Spencer’s Faerie Queene was considered through a feedback to be outmoted and less universally applied to modern teaching practicum and literary pragmatics. Most pragmatic and creative work that was recommended and liked by both the teachers and studetns was ‘Paradise Lost’. The study eventually conludes that the potery-1 course should stand modied and there is a lot of room for research on this aspect. The course needs an overhauling to better engineer it for the students’ comprehension and understability. Keywords: Pedagogy; poetry; syllabus; Pakistan

PROCALCITONIN DETERMINATION IN ONCOLOGY – RESULTS AND PROSPECTS:&#x0D; A LITERATURE REVIEW

Relevance: Modern requirements for laboratory diagnostics of complicated courses of diseases provide for using highly specific and high-tech&#x0D; research methods like determining the level of procalcitonin (PCT). The PCT level increases only with the generalization of a bacterial infection&#x0D; and reflects the degree of generalization. Of practical value are an increase in the PCT level and the degree of such increase, a progressive increase,&#x0D; or a long-term (more than 3-5 days) high level. The assessment of this data over time, in combination with the changes in other clinical and laboratory parameters, allows for timely diagnosis and prediction of the outcome of the disease.&#x0D; The study aimed to assess the feasibility of the PCT level dynamic control for timely diagnosis of the overlay or generalization of an infectious&#x0D; process in the form of septic complications in cancer patients.&#x0D; Methods: A thematic search was carried out by keywords in the journal Malignant Tumors and Cochrane, PubMed, Oncology.ru, elibrary.ru,&#x0D; Medscape, and NCBI databases and libraries.&#x0D; We analyzed the results of studies of changes in PCT dynamics in oncological patients who developed and generalized a nonspecific infectious&#x0D; process that proceeded in the form of septic complications.&#x0D; Results: The need to determine the PCT level and its inclusion in the diagnostic algorithms has been confirmed in various research papers. The&#x0D; reliability and significance of these studies correspond to the highest levels of evidence-based medicine.&#x0D; PCT shows its high specificity in identifying the infectious component compared to other less informative indicators in oncological pathologies,&#x0D; such as the level of leukocytosis, CRP, and others.&#x0D; In some tumor processes, the initial level of PCT may be higher than the average (0.5 ng/l), but dynamic control will show the effectiveness of&#x0D; the therapeutic measures taken and the direction of development of the infectious process.&#x0D; The frequency and intervals of determining the PCT level are of particular importance. In some instances, if an infectious component is suspected in risk groups, the PCT level determination could be included in the initial examination algorithm.&#x0D; Conclusion: Despite the ambiguity of the PCT study results in oncological practice, the determination of systemic inflammation biomarkers in&#x0D; complex antitumor therapy will allow timely setting of indications for prescribing or intensifying antibiotic therapy, predicting the duration, and&#x0D; monitoring its effectiveness in oncological patients.

Characteristics of the period of early adaptation and key predictors of its complicated course in underweight and small for gestational age newborns

Objective. To assess the characteristics of early neonatal adaptation in underweight and small for gestational age newborns and to determine the key predictors of its complicated course.Materials and methods. The study was conducted at the Republican Scientific and Practical Center “Mother and Child” and included a group of 115 full-term newborns. The main group consisted of 77 newborns with low body mass index (BMI) at birth, among whom 2 subgroups were distinguished: study group 1 (Gr1) ‒ 52 underweight and small for gestational age newborns with adaptation disorders, study group 2 (Gr2) ‒ 25 newborns without signs of maladaptation. Lipid status indicators, levels of adipokines and vitamin D were studied in mother-child dyads. To control the correct operation of the identified predictors and the regression model, an examination sample including 38 underweight newborns was studied.Results. Maternal history of placental insufficiency, fetal growth retardation, and hypertensive disorders was associated with a significant increase in the risk of maladaptation in the early neonatal per (p = 0.036, p &lt; 0.001, and p = 0.029, respectively). Pregravid body weight and BMI of the Gr1 women were significantly higher (p = 0.026 and p = 0.035). It has been found that the most significant quantitative neonatal factors associated with the risk of maladaptation in underweight for gestational age newborns, were gestational age (p = 0.002), z-score BW at birth (p=0.003), mean corpuscular volume erythrocyte (p = 0.001), cord blood leptin level (p = 0.033). A multifactor model has been developed to determine the probability of a complicated course of the early neonatal period in underweight for gestational age newborns. AUC = 0.95 ± 0.025 (0.902–0.998), p &lt; 0.001. A high degree of reproducibility of the developed model was established on the examination sample of underweight newborns.Conclusion. The search for objective criteria for the development of neonatal maladaptation is an important and complex task of modern neonatology. A comprehensive assessment of the totality of ante-, intraand postnatal predictors has a high accuracy in predicting the likelihood of a complicated course of the neonatal period.

Соматичний та репродуктивний анамнез вагітних, які мали ускладнення із групи великих акушерських синдромів

Purpose - to conduct retrospective clinical and statistical analyses of somatic, reproductive history of mowen, with complications from the group of great obstetrical syndromes (GOS). Materials and methods. We conducted retrospective clinical and statistical analyses of somatic and reproductive history of 239 pregnant women (Ist - main group), who had coplications from the group of GOS, who were subdivided into 3 groups: Ia group (n=103) pregnant with severe preeclampsia, Ib group (n=67) pregnant with placenta insufficiency, with clinical manifestation by intrauterine growth retardation syndrome (IUGR); Ic group (n=69) pregnant with preterm delivery with gestational term 22-34 weeks. Control group (CG) was formed by 56 practically healthy pregnant with favourable reproductive history and non complicated course of current pregnancy. Statistical analyses was conducted by using standart programs Microsoft Excel 5.0 and Statistica 6.0. Results. We stated, that in I group the incidence of complicated heredity of cardiovascular pathology was significantly higher: 69 (28.8%) in I group (χ2=5.46, р=0.03, OR=2.79, CI 95% 1.14-6.79), in CG this factor was diagnosed only in 4 (7.1%) of patients. In subgroup Ib (patients with IUGR of 2-3 stage) the incidence of abortions and miscarriages in history was higher: in subgroup Ib these parameters were 0.83 (1.37) and 0.32 (0.59) correponding, and in CG - 0.19 (0.85) and 0.07 (0.42) corresponding (р&lt;0.05). The most reasonable difference compated to CG were diagnosed in patients from Ic subgroup (patients with spontaneous preterm deliveries). The highest incidence of patiens with obesity was diagnosed in subgroups Ia and Ic - 18 (17.5%) and 16 (23.2%), the difference compared to CG clinically significant (р&lt;0.01). A high incidence of anemia was noted in pregnant, especially among the ones with pregnancy complications - in I group anemia was diagnosed in more that half of patients - in 179 (74.8%), in CG - every third - in 18 (32.1%) (χ2=21.48, р&lt;0.01, OR=2.95, CI 95% 1.85-4.71). The data in CG are approximately the same as the incidence of this pathology in population of pregnant women of Ukraine. Diseases, characterized by elevated blood pressure in group I were diagnosed several times higher, compared to CG - 41 (17.1%) compared to 5 (8.9%) (χ2=11.1, р&lt;0.01, OR=6.08, CI 95% 1.84-20.1). In subgroup Ia the incidence of patients with this pathology was the highest - 25.2% (n=26) (χ2=20.78, р&lt;0.01, OR=11.03, CI 95% 3.21-37.9). Results. Peculierities of somatic and reproductive history of pregnant were gisgnosed in pregnant, who had complications grom GOS group that may be high risk factors of significant increase of obstetrical and perinatal complications from materal and fetal side. The usage of routine treatment and prophylactic measures were not effective enough, that is quite convincing reason for making up a new approach for decreasing the incidence and severity of GOS in these patients, and their prophylaxis is a relevant problem of modern obstetrics. The research was conducted according to principles of Declaration of Helsinki. Protocol of research was proved by local ethical committee, mentioned in institution’s work. A informed sonsennt was collected in order to carry out the research. No conflict of interests was declared by the author. Key words: retrospective analys, clinical and statistical analyses, somatic history, reproductive history, great obstetrical syndromes.

Severe Pulmonary Bleeding after Assist Device Implantation: Incidence, Risk Factors and Prognostic Impact.

Background: Continuous flow left ventricular assist devices (CF-LVAD) improve survival in patients with advanced heart failure but confer risk of bleeding complications. Whereas pathophysiology and risk factors for many bleeding complications are well investigated, the literature lacks reports about pulmonary bleeding. Therefore, it was the aim of the present study to assess incidence, risk factors, and clinical relevance of pulmonary bleeding episodes after LVAD implantation. Methods: We retrospectively analyzed our institutional database of 125 consecutive patients who underwent LVAD implantation between 2008 and 2017. Demographic and clinical variables related to bleeding were collected. The primary endpoint was incidence of severe pulmonary bleeding (SPB). Results: Nine out of 125 patients suffered from SPB during the postoperative course (7.2%) 11 days after surgery in the median. None of them had a known history of lung disease or bleeding disorder. History of prior myocardial infarction (0% vWD. 42.2%, p = 0.012) and ischemic cardiomyopathy (25.0% vs. 50.0%, p = 0.046) were less frequent in the SBP group. Concomitant aortic valve replacement was more common in the group with SPB (33.3% versus 7.0%, p = 0.034). Surgical (blood loss 9950 vs. 3800 mL, p = 0.012) as well as ear-nose-throat (ENT) bleedings (33% vs. 4.6%, p = 0.015) were observed more frequently in patients with SPB. SPB was associated with a complicated postoperative course with a higher incidence of acute kidney failure (100% versus 36.7%, p = 0.001) and delirium (44.4% versus 14.8%, p = 0.045); a higher need for red blood cell (26 packs versus 7, p < 0.001), fresh frozen plasma (18 units versus 6, p = 0.002), and platelet transfusion (8 pools versus 1, p = 0.001); longer ventilation time (1206 versus 171 h, p = 0.001); longer ICU-stay (58 versus 13 days, p = 0.002); and higher hospital mortality (66.7% vs. 29%, p = 0.029). Conclusion: SPB is a rare but serious complication after LVAD implantation and is significantly associated with higher morbidity and mortality. The pathophysiology and potential risk factors are unknown but may include coagulation disorders and frequent suctioning or empiric bronchoscopy causing airway irritation.

Endometriosis does not seem to be an influencing factor of hypertensive disorders of pregnancy in IVF / ICSI cycles

IntroductionTo evaluate whether the incidence of hypertensive disorders of pregnancy (HDP) in pregnant women was related to endometriosis (EM), ovulation and embryo vitrification technology.MethodsA retrospective cohort study was conducted on the clinical data of 3674 women who were treated with IVF / ICSI in the Reproductive Medicine Center of the First Affiliated Hospital of Sun Yat-sen University and maintained clinical pregnancy for more than 20 weeks. All pregnancies were followed up until the end of pregnancy. The follow-up consisted of recording the course of pregnancy, pregnancy complications, and basic situation of newborns.ResultsCompared with NC-FET without EM, HRT-FET without EM was found to have a higher incidence of HDP during pregnancy (2.7% V.S. 6.1%, P<0.001); however, no significant difference was found in the incidence of HDP between NC-FET and HRT-FET combined with EM (4.0% V.S. 5.7%, P>0.05). In total frozen-thawed embryo transfer (total-FET), the incidence of HDP in the HRT cycle without ovulation (HRT-FET) was observed to be higher than that in the NC cycle with ovulation (NC-FET) (2.8% V.S. 6.1%, P<0.001). In patients with EM, no significant difference was found in the incidence of HDP between fresh ET and NC-FET (1.2% V.S. 4.0%, P>0.05).ConclusionEM does not seem to have an effect on the occurrence of HDP in assisted reproductive technology. During the FET cycle, the formation of the corpus luteum may play a protective role in the occurrence and development of HDP. Potential damage to the embryo caused by cryopreservation seems to have no effect on the occurrence of HDP.

The predictive value of preoperative frailty screening for postoperative outcomes in older patients undergoing surgery for non-metastatic colorectal cancer

The predictive value of preoperative frailty screening for postoperative outcomes in older patients undergoing surgery for non-metastatic colorectal cancer

Potential of natural phenolic antioxidant compounds from Bersama abyssinica (Meliathacea) for treatment of chronic diseases

Chronic diseases including cardiovascular, diabetes and cancer persist for a long time in the course of treatment affecting health and are currently the cause of many deaths. In most cases, the treatment of chronic infectious diseases especially Tuberculosis relies on conventional drugs which are currently becoming fruitless due to drug resistance and unpredicted complications in course of treatment. However, herbal medicines have for a long time been used in prevention and treatment of chronic diseases including asthma and heart diseases in Africa. In this study, we extracted metabolites and screened for active compounds with potential free radical scavenging and pharmacological activities from Bersama abyssinica, the plant commonly used in traditional medicine in Tanzania. B. abyssinica root, stembark and leaf were air dried, sequentially extracted in various solvents including petroleum ether, dichloromethane, ethylacetate and methanol to yield extracts and fractions. The extracts and fractions were tested for the presence of several metabolites and antioxidant activity. The analysis of chemical compounds from resultant extracts was done by GC–MS for non-polar factions and LC-MS/MC for moderate polar extracts.High amount of phenolic acid, flavonoids and tannin were identified in ethylacetate fraction compared to ethanol, dichloromethane and petroleum ether. The GC–MS analysis of petroleum ether extract of B. abyssinica stem back yielded twelve (12) compounds with varying composition. The most abundant compounds were 2-Butenoic acid, 3-methyl-, ethyl ester comprising 33.8%, n-Hexadecanoic acid comprising 16.7% and Ethanolpentamethyl- yielded in 16.7%.The LC-MS/MS analysis of Ethyl acetate fractions yielded 20 compounds including; Mangiferin and Isoquercitin were abundant in leaves, stembark and roots. Lastly, ethyl vanillate was identified in both roots and leaves whereas Quercitrin and 7,8-Dimethoxycoumarin were found in stembark and root.These findings indicated that B. abyssinica is rich in phenolic compounds ranging from phenolic acids, flavonoids and coumarin that possess high antioxidant and pharmacological properties potential for treatment of chronic diseases.

Medical and social portrait and clinical features of patients with endometrial hyperplasia

Introduction. Today more and more attention is paid to the influence of various external factors and health status on the development of specific features of the course of different diseases, that is to the pathomorphosis in its clinical (narrow) sense.The aim of the study was comparative analysis of the medical and social profile and clinical features of the patients with endometrial hyperplasia (EH) without atypia in the cohorts of 2016-2018 and 2006-2008 in the light of the pathomorphosis study.Materials and methods. A retrospective study of medical and social profile and clinical features of EH without atypia has been performed in 52 patients who were under observation in 2016 – 2018 (1st group) and in 52 women who underwent medical treatment of this disease in 2006-2008 (2nd group) to investigate the problem of EH without atypia from the point of view of the pathomorphosis study.Results. The following are the characteristic features of today’s patients with EH without atypia: younger age of disease development, specific formation of menstrual function (a later menarche), specific somatic status (predominance of the diseases of the urinary system and gastrointestinal tract), predominance of non-inflammatory diseases of the reproductive organs over sexually transmitted infections, low parity, complicated course of labor (increase in the proportion of premature delivery). Heavy menstrual bleeding (HMB) was the main clinical manifestation of the EH without atypia.Discussion. Our data on the clinical picture of EH without atypia and the high frequency of the combination of EH with chronic endometritis coincide with the results of other modern studies. However, at present, in the clinical picture of EH, along with HMB, we observe a tendency to an increase in the frequency of asymptomatic EH, and the revealed high frequency of the combination of EH with chronic endometritis confirms the conclusions of a number of researchers about the important role of chronic endometritis in the formation of EH.Conclusions. The above stated specific features of the medical and social profile and clinical course of the EH without atypia could be interpreted as pathomorphosis in the clinical (narrow) sense.

Bronchoscopy in the management of children from developing countries undergoing congenital heart surgery.

ObjectivesTo study the clinical characteristics and impact of bronchoscopy in children from developing countries, referred for cardiac surgery, through the "Save a Child's Heart" (SACH) organization.MethodsWe performed a retrospective hospital‐chart review of SACH children (0–18 years old) referred between 2006 and 2021 who underwent fiberoptic bronchoscopy. We examined demographics, congenital‐heart‐disease (CHD) types, bronchoscopy's indications and findings, subsequent recommendations, number of ventilation, and intensive‐care‐unit days. The primary outcome was percent changes in management and diagnosis, following the bronchoscopy. We included a control group matched‐for‐age and CHD type, who did not undergo bronchoscopy.ResultsWe performed 82 bronchoscopies in 68 children: 18 (26.5%) preoperatively; 46 (67.6%) postoperatively; and four (5.9%) both. The most prevalent CHDs were Tetralogy‐of‐Fallot (27.9%) and ventricular‐septal‐defect (19.1%). The main indications were persistent atelectasis (41%) and mechanical ventilation/weaning difficulties (27.9%). Bronchoscopic evaluations revealed at least one abnormality in 51/68 (75%) children. The most common findings were external airway compression (23.5%), bronchomalacia (19.1%), and mucus secretions (14.7%). Changes in management were made in 35 (51.4%) cases, with a major change made in 14/35 (40%) children. Compared to the control group, the children undergoing bronchoscopy were both ventilated longer (median 6 vs. 1.5 days, p < 0.0001) and stayed longer in the intensive care unit (median 1.5 vs. 18.5 days, p < 0.0001).ConclusionA bronchoscopy is an important tool in the diagnosis and management of the unique group of children from developing countries with CHD referred for cardiac surgery. The results of our study, reveal a more complicated clinical course in children requiring bronchoscopy compared to controls.

Incidence, Disease Severity, and Follow-Up of Influenza A/A, A/B, and B/B Virus Dual Infections in Children: A Hospital-Based Digital Surveillance Program.

Influenza virus (IV) coinfection, i.e., simultaneous infection with IV and other viruses, is a common occurrence in humans. However, little is known about the incidence and clinical impact of coinfection with two different IV subtypes or lineages (“dual infections”). We report the incidence, standardized disease severity, and follow-up of IV dual infections from a hospital-based digital surveillance cohort, comprising 6073 pediatric patients fulfilling pre-defined criteria of influenza-like illness in Berlin, Germany. All patients were tested for IV A/B by PCR, including subtypes/lineages. We assessed all patients at the bedside using the mobile ViVI ScoreApp, providing a validated disease severity score in real-time. IV-positive patients underwent follow-up assessments until resolution of symptoms. Overall, IV dual infections were rare (4/6073 cases; 0.07%, incidence 12/100,000 per year) but showed unusual and/or prolonged clinical presentations with slightly above-average disease severity. We observed viral rebound, serial infection, and B/Yamagata-B/Victoria dual infection. Digital tools, used for instant clinical assessments at the bedside, combined with baseline/follow-up virologic investigation, help identify coinfections in cases of prolonged and/or complicated course of illness. Infection with one IV does not necessarily prevent consecutive or simultaneous (co-/dual) infection, highlighting the importance of multivalent influenza vaccination and enhanced digital clinical and virological surveillance.

Prediction of the complicated early neonatal period in large for gestational age newborns

The aim of the study is to develop a method for predicting the complicated course of the early neonatal period in the large newborns for gestational age in order to optimize and increase the efficiency of medical care for this category of children.A survey of 157 large newborns large for gestational age was carried out. The study group consisted of 105 large newborns for gestational age. The control of the correct operation of the regression model was carried out on an examination sample of children with large birth weight (n = 52). The control group consisted of 221 newborns with the physical development corresponding to the gestational age (appropriate for the gestational age). The anamnestic, clinical, laboratory, instrumental, morphological data were analyzed with a subsequent determination of the most significant factors associated with early adaptation disorders in newborns. The predicted event was considered to be a complicated course of the early neonatal period, which was determined by the presence of one or more diseases in a newborn.Based on the multivariate regression analysis, it was found that the most significant prognostic factors associated with the disadaptation risk of large newborns were the pregravid maternal body weight of more than 70 kg, the delivery mode, the harmonicity coefficient (ponderal index) at a birth of 26.5 kg/m3 or more, the neutrophils level in the complete blood count on the 1-2 days of life. A mathematical model was developed for determining the probability of a complicated course of the early neonatal period in the large newborns large for gestational age. The threshold value was calculated and a classification scheme was created, allowing one to calculate the infant's belonging to the risk group of the complicated course of the early neonatal period based on the calculation of points for timely correction. It is shown that the developed multivariate mathematical model and the classification scheme based on it work steadily on the examination sample and can be used in practice in health care organizations at all levels of perinatal care.

Magnetic resonance neuroimaging after laser for twin-twin transfusion syndrome with single fetal demise

Neurologic injury in the surviving twin is a risk after single fetal demise in a monochorionic pregnancy. This study aimed to describe fetal magnetic resonance neuroimaging findings in pregnancies complicated by single fetal demise after laser photocoagulation for twin-twin transfusion syndrome. This was a single-center retrospective analysis of a cohort of prospectively collected patients in a monochorionic twin registry who had fetoscopic laser photocoagulation for twin-twin transfusion syndrome with single fetal demise at follow-up. Magnetic resonance neuroimaging was offered 3 to 4 weeks after the demise to assess for potential neurologic sequelae. Magnetic resonance images were interpretedby 2 board-certified neuroradiologists and classified as normal, mildly abnormal, or severely abnormal. The groups were compared on the basis of recipient vs donor demise using the Fisher exact test and Mann-Whitney U test. Multivariate logistic regression was performed to determine risk factors for abnormal magnetic resonance neuroimaging. In 378 laser photocoagulation procedures, 64 cases (16.9%) of single demise were identified (36 in the donor group and 28 in the recipient group). Of note, 6 patients had rupture of membranes with nonviable delivery (3 from each group). Moreover, 40 patients (69%) underwent magnetic resonance imaging. Of those patients, 12 (30%) had abnormal findings: 10 (83%) were associated with mild changes, and 2 (17%) were associated with severe findings. Abnormal magnetic resonance neuroimaging was seen in 3 of 22 patients (14%) after donor demise and 9 of 18 patients (50%) after recipient demise (P=.02). Logistic regression revealed that recipient vs donor demise was an independent risk factor for abnormal magnetic resonance imaging. In addition, 2 pregnancies with severe magnetic resonance imaging findings had complicated courses. Mildly abnormal magnetic resonance neuroimaging findings were common after laser photocoagulation for twin-twin transfusion syndrome complicated by single fetal demise and were more common in cases of recipient demise than donor demise. Severe magnetic resonance neuroimaging findings in this series were limited to patients with complicated peri- or postoperative courses.