Complicated Course Research Articles

МИКРОБИОТАСИСТЕМЫ КОРНЕВОГО КАНАЛА У ПАЦИЕНТОВ С ДЕСТРУКТИВНЫМИ ФОРМАМИ ХРОНИЧЕСКОГО АПИКАЛЬНОГО ПЕРИОДОНТИТА ДО И ПОСЛЕ СТАНДАРТНОГО ЭНДОДОНТИЧЕСКОГО ЛЕЧЕНИЯ И СОВРЕМЕННЫЕ ВОЗМОЖНОСТИ ВОЗДЕЙСТВИЯ НА НЕЁ

Abstract. Introduction. Despite the modern achievements of endodontics, it is possible to obtain a positive effect in the treatment of destructive forms of chronic apical periodontitis in 80-85% of cases. In other patients, progressive pathology becomes the main cause of tooth loss with subsequent deformation of the dentition, changes in the temporomandibular joint, the development of purulent- inflammatory processes of the maxillofacial region or complicated course of somatic diseases. Aim. The aim of the study was to study the dynamics of microbiological parameters in patients with chronic apical periodontitis before and after standard endodontic treatment, as well as the possibility of exposure to blood autoplasm and hydroxyapatite gel.Material and methods. The study was conducted in 32 patients with destructive forms of chronic apical periodontitis. 82 scraping smears obtained from the apical third of the canal before its primary drug treatment were studied.Results anddiscussion.The study of the microflora of root canals in patients with destructive forms of chronic apical periodontitis after performing the main stages of the standard endodontic protocol showed that by the 10th day of treatment, small associations of microorganisms consisting of gram-positive and gram-negative coccoid, rod-shaped, convoluted forms, as well as fungal microflora, mainly Candida albicans, were found in the area of the root apex. An in vitro study of the antibacterial properties of blood autoplasm and hydroxyapatite gel showed that hydroxyapatite has a pronounced bactericidal effect on international test strains of bacteria Staphylococcus aureus ATCC 25923 and Candida albicans SSM 885, platelet-enriched blood autoplasm has a weak bactericidal effect, and the combined use of these drugs has no antibacterial effect.Conclusion. Taking into account the high osteoinductive properties of these substances, in order to achieve their positive effect on the course of inflammatory and regenerative processes, a scheme of their sequential inclusion in endodontic treatment can be used in order to optimize the existing standard protocol for destructive forms of chronic apical periodontitis, which is the subject of subsequent study.

THE RISK OF COMBINED PATHOLOGY OF DIABETES MELLITUS AND TUBERCULOSIS

Objective: The aim of the study is a comprehensive retrospective assessment of the prevalence, features, course of treatment of multidrug-resistant tuberculosis and diabetes mellitus. Design and method: Our study is based on analysis of statistical data obtained from a retrospective study of 762 case histories and cases of MDR-TB in the register of tuberculosis patients for 2015-2019. Results: Depending on the type of TB case in our patients, we found that in both groups of the study the recurrence of TB prevailed – 49 cases (55.7%) against TB 39 cases (44.3%) of people in the main group; 363 cases (53.9%) against 311 (46.1%) in the control group (p < 0.05). The rate of successful treatment in gr.2 is probably higher than in gr. 1 (64.7% vs. 61.4%; (p < 0.05)). However, a more significant probable difference is characterized by the treatment rate, which in the main group is 27.3% versus 40.3% in the control group (almost 2 times; p < 0.05). The rate of ineffective treatment, which in patients with comorbidity was 27.3% (almost every third patient) against 17.6% in group 2 is also important for scientists and practitioners. Conclusions: There is a clear tendency to an increase the combined pathology and chemoresistance in the structure of the incidence of tuberculosis, the proportion of recurrences of tuberculosis in the presence of diabetes mellitus The pulmonary tuberculosis developed significantly more often in middle-aged patients with type 2 diabetes mellitus with moderate and severe states, the subcompensated form, with a complicated course. In patients with diabetes more often was registered a common tuberculous process in the lungs (79.5% of patients) and in all 100% of patients with syntropy bacterial excretion was registered, as well in all 100% of patients with syntropy bacterial excretion was registered. The rate of successful treatment for the presence of MDR-TB / diabetes syntropy is probably lower in the main group (61.4% vs. 64.7%; (p < 0.05)).

Some factors affecting on the severity of Acute Psychoses in Alcohol Withdrawal

IntroductionAlcohol withdrawal delirium is severe complication of alcohol withdrawal leading to high mortality. Early identification of severe course of psychosis and complications threatening the patient’s life is the most important problem in the treatment of these patients.ObjectivesUnder supervision were 690 men, dependent on alcohol, in the state of withdrawal with acute psychotic disorder (primary hospitalization in the framework of this study); the average age - (39,9 ± 3,4 years), the average age of alcohol abuse - (9,7 ± 1, 1 years). The patients were examined in a dynamics after a re-hospitalization after 5-7 years. This allowed us to verify the differential diagnostic approach to acute psychotic disorders in a state of abandonment, to investigate the impact of chronic acute psychotic disorders on the course of alcohol dependence, including the formation of deficits.Methodsclinical, clinical and psychopathological, methods of quantified scales and mathematical statistics.ResultsThere were estimated factors influencing the severity of alcohol withdrawal with delirium: total amount of alcohol consumed per week, drunken alcoholics, persistent alcohol abuse, social disadaptation, cognitive impairment, psychological disorders, reducing the quality of alcohol consumed, food pattern characterized total calorie mostly due to alcohol, life trajectory, severe or chronic somatic diseases, rate of progression of alcohol dependence.ConclusionsThe severity of acute psychotic disorder in the state of alcohol withdrawal mostly depended situational factors such as the number of days of severe drinking before a psychotic disorder, the pattern of nutrition, the quality and quantity of alcohol consumed, the presence of acute somatic diseases.DisclosureNo significant relationships.

1162-P: Clinical Characteristics and Outcomes in Patients Hospitalized with Diabetic Ketoacidosis

Background: Diabetic ketoacidosis (DKA) is an acute complication of uncontrolled diabetes that is associated with increased morbidity and mortality. Objective: We aimed to examine clinical characteristics and care outcomes for patients hospitalized for DKA. Methods: We reviewed the hospital database for patients who were admitted with DKA from 2015 to 2020 in government hospitals in Qatar. Clinical characteristics, laboratory data, the severity of DKA, complications, need for admission to the intensive care unit, length of hospital stay, time to resolution of DKA, and mortality rates were evaluated in patients with type 1 diabetes (T1DM) compared to those with type 2 diabetes (T2DM) . Results: A total of 1613 episodes of DKA in 1330 patients (39.3% with T1DM and 60.7% with T2DM) were evaluated. Non-adherence to therapy was the commonest cause (40.5%) of DKA in patients with T1DM, while infection was the commonest cause (32.9%) in those with T2DM. There was no difference in the severity of DKA, mean serum glucose, mean serum sodium, and arterial pH on presentation in both groups of patients. Both groups had poorly controlled glucose (mean HbA1c of 10.1% and 10.5% in T1DM and T2DM groups respectively) . There was no difference in the time to resolution of DKA (18 hours in the T1DM group and 20 hours in the T2DM group) . Patients with T2DM had higher rates of admission to the intensive care unit (39.1% vs. 26.9% for T1DM, p<0.001) , longer hospital stay (mean 5 days vs. 2 days in the T1DM group, p<0.001) , while patients with T1DM had higher rates of recurrent DKA (35.6% vs. 21.2% in the T2DM group, p<0.001) . Mortality rates were significantly higher in patients with T2DM compared to those with T1DM patients (7.6% vs. 0.95%, respectively, p<0.001) . Conclusion: In this cohort study, poorly controlled glucose was prevalent among patients admitted with DKA. Despite higher rates of recurrent DKA in patients with T1DM, those with T2DM had more complicated hospital course and higher mortality. Disclosure M.Eledrisi: None. S.A.Beshyah: None. M.K.Aboawon: None. H.M.Alkabbani: None. A.A.Ali: None. I.Alabdulrazzak: None. M.Elhaj: None. A.O.E.Ahmed: None. H.Alqahwachi: None. J.Daghfal: None.

SURVIVING AGAINST ALL ODDS: A CASE OF MULTI-ORGAN FAILURE IN THE SETTING OF COVID-19

TYPE: Late Breaking Case Report TOPIC: Critical Care INTRODUCTION: COVID-19 is a novel virus and our understanding of the infection is still evolving. Even though may remain asymptomatic, severity of disease can vary from mild symptoms to multi-organ failure. We report an African-American female who survived severe multi-organ failure secondary to COVID-19. CASE PRESENTATION: 67-year old female with a past medical history significant for coronary artery disease was admitted to the ICU with respiratory failure requiring intubation and mechanical ventilation secondary to COVID-19 pneumonia. Her course was complicated by renal failure requiring renal replacement therapy. She developed septic shock requiring pressors, PEA cardiac arrest requiring advanced cardiac life support, disseminated intravascular coagulopathy, and upper gastrointestinal bleed. She received 30 units of packed red blood cells and multiple platelet and cryoglobulin transfusions. She also developed recurrent episodes of sustained bradycardia and sinus pauses for up to 1 minute, thus requiring a pacemaker. She underwent tracheostomy and percutaneous endoscopic gastrostomy tube placement. She was discharged to a subacute rehabilitation facility where she was successfully liberated from the ventilator. She is home and fully independent of her activities of daily living. DISCUSSION: Anticipated clinical course for this patient was initially grim as she endured a very complicated hospital course. The case demonstrated the difficult prognostication of COVID-19, especially in the setting of being a novel disease. CONCLUSIONS: Mortality for patients on prolonged mechanical ventilation is very high; however, without prior knowledge of COVID-19 and its long term effects, it is important to understand the potential for full recovery even against all odds as this case illustrates. DISCLOSURE: Nothing to declare. KEYWORD: covid

Clinical outcome and characteristics of Turkish breast cancer patients during SARS-Cov-2 pandemic: Single center experience.

e13049 Background: COVID-19 pandemic has placed an unprecedented burden on health care system. Patients with cancer are reported to have a higher risk of infection and a more complicated COVID-19 course. Breast cancer (BC) is the most common cancer in women in Turkey. We aimed to evaluate the clinical outcome of breast cancer patients who had a diagnosis of COVID-19. Methods: Medical records of breast cancer patients who had COVID-19 between July 2020-2021 at our center were retrospectively rewieved. We recorded pathological, clinical, treatment characteristics, and the clinical outcome of COVID-19 infection. Results: A total 82 breast cancer (BC) patients had COVID-19 between July 2020-2021. All patients were female, with a median age of 49 (43-64 years). Eighty-five % of all patients had early and 14.6% had advanced stage BC. COVID-19 had a mild clinical course in 73%, hospitalization was required in 27% of patients. Twenty-five patients who required hospitalization were discharged. Three (3,6%) patients who had heavily pretreated metastatic breast cancer, required ICU and died due to COVID-19. Metastatic disease (p 0.002) and chemotherapy within 7 days of COVID-19 diagnosis (p = 0.024) have been associated with increased mortality. Conclusions: In our breast cancer cohort, most patients had a mild COVID-19 course. Advanced disease and chemotherapy within 7 days of diagnosis were the two risk factors for increased mortality.

Features of the course of non-ST elevation myocardial infarction in patients with a history of COVID-19

Aim To study the clinical course of non-ST segment elevation myocardial infarction (NSTEMI) in hospitalized patients after COVID-19 and to evaluate the effect of baseline characteristics of patients on the risk of complications.Material and methods The study included 209 patients with NSTEMI; 104 of them had had COVID-19. The course of myocardial infarction (MI) was analyzed at the hospital stage, including evaluation of the incidence rate of complications (fatal outcome, recurrent MI, life-threatening arrhythmias and conduction disorders, pulmonary edema, cardiogenic shock, ischemic stroke, gastrointestinal bleeding).Results Mean age of patients after COVID-19 was 61.8±12.2 years vs. 69.0±13.0 in the comparison group (p<0.0001). The groups were comparable by risk factors, clinical data, and severity of coronary damage. Among those who have had СOVID-19, there were fewer patients of the GRACE high risk group (55.8 % vs. 74.3 %; p<0.05). Convalescent COVID-19 patients had higher levels of C-reactive protein and troponin I (p<0.05). The groups did not significantly differ in the incidence of unfavorable NSTEMI course (p>0.05). However, effects of individual factors (postinfarction cardiosclerosis, atrial fibrillation, decreased SpO2, red blood cell concentration, increased plasma glucose) on the risk of complications were significantly greater for patients after COVID-19 than for the control group (p<0.05).Conclusion Patients with NSTEMI, despite differences in clinical history and laboratory data, are characterized by a similar risk of death at the hospital stage, regardless of the past COVID-19. Despite the absence of statistically significant differences in the incidence of in-hospital complications, in general, post-COVID-19 patients showed a higher risk of complicated course of NSTEMI compared to patients who had not have COVID-19. In addition, for this category of patients, new factors were identified that previously did not exert a clinically significant effect on the incidence of complications: female gender, concentration of IgG to SARS-CoV-2 ≥200.0 U/l, concentration of С-reactive protein ≥40.0 mg/l, total protein <65 g/l. These results can be used for additional stratification of risk for cardiovascular complications in patients with MI and also for development of individual protocols for evaluation and management of NSTEMI patients with a history of COVID-19.

The Value of Transrectal Ultrasound in the Preoperative Diagnosis of Complex Anal Fistula (CAF): Based on a Retrospective Cohort Study.

The Value of Transrectal Ultrasound in the Preoperative Diagnosis of Complex Anal Fistula (CAF): Based on a Retrospective Cohort Study.

Association between Masseter Muscle Area and Thickness and Outcome after Carotid Endarterectomy: A Retrospective Cohort Study.

Low muscle mass is associated with adverse outcomes after surgery. This study examined whether facial muscles, such as the masseter muscle, could be used as a proxy for generalized low muscle mass and could be associated with deviant outcomes after carotid endarterectomy (CEA). As a part of the Vascular Ageing study, patients with an available preoperative CT-scan, who underwent an elective CEA between December 2009 and May 2018, were included. Bilateral masseter muscle area and thickness were measured on preoperative CT scans. A masseter muscle area or thickness of one standard deviation below the sex-based mean was considered low masseter muscle area (LMA) or low masseter muscle thickness (LMT). Of the 123 included patients (73.3% men; mean age 68 (9.7) years), 22 (17.9%) patients had LMA, and 18 (14.6%) patients had LMT. A total of 41 (33.3%) patients had a complicated postoperative course and median length of hospital stay was four (4–5) days. Recurrent stroke within 5 years occurred in eight (6.6%) patients. Univariable analysis showed an association between LMA, complications and prolonged hospital stay. LMT was associated with a prolonged hospital stay (OR 8.78 [1.15–66.85]; p = 0.036) and recurrent stroke within 5 years (HR 12.40 [1.83–84.09]; p = 0.010) in multivariable logistic regression analysis. Masseter muscle might be useful in preoperative risk assessment for adverse short- and long-term postoperative outcomes.

The disease severity index for inflammatory bowel disease is associated with psychological symptoms and quality of life, and predicts a more complicated disease course.

SummaryBackgroundThe Disease Severity Index (DSI) is a novel tool to predict disease severity in inflammatory bowel disease (IBD). However, its ability to predict disease complications and the presence of psychosocial comorbidity is unclear. Aims: To assess prospectively associations between the DSI and psychological symptoms, quality‐of‐life (QoL) and disease outcomes in an IBD cohort.MethodsPatients with IBD undergoing ileocolonoscopy were followed prospectively for 12 months. DSI, psychological symptoms (perceived stress (PSS‐10), depression (PHQ‐9), anxiety (GAD‐7)) and QoL (IBDQ‐32) scores were assessed at baseline. Logistic regression identified variables predicting a complicated IBD course at 12 months (composite outcome of need for escalation of biological/immunomodulator for disease relapse, recurrent corticosteroid use, IBD‐related hospitalisation and surgery). Receiver operating characteristics (ROC) analysis identified optimal DSI thresholds predicting a complicated disease course and multivariable logistic regression assessed the risk of reaching this outcome.ResultsOne hundred and seventy‐two patients were recruited (100 Crohn's disease, 91 female). Median DSI was 21 (IQR 11–32) and 97 patients had endoscopically active disease at baseline. The DSI was significantly higher in patients with symptoms of moderate–severe stress (PSS‐10 > 14, p < 0.01), depression (PHQ‐9 ≥ 10, p < 0.01), anxiety (GAD‐7 ≥ 10, p < 0.05) and impaired quality‐of‐life (IBDQ‐32 < 168, p < 0.01). Only the baseline DSI (OR 1.05, p < 0.01) and endoscopically active disease (OR 6.12, p < 0.01) were associated with a complicated IBD course. A DSI > 23 was strongly predictive of a complicated IBD course (OR 8.31, p < 0.001).ConclusionsThe DSI is associated with psychological distress, impaired QoL and predicts a more complicated disease course in patients with IBD.

Course of uncomplicated acute gastroenteritis in children presenting to out-of-hours primary care

BackgroundThe aim of this article is to describe the courses of vomiting, diarrhea, fever, and clinical deterioration, in children with uncomplicated gastroenteritis at presentation. This study was performed as a 7-day prospective follow-up study in an out-of-hours primary care service. The course of vomiting, diarrhea, and fever was analyzed by generalized linear mixed modeling. Because young children (≤ 12 months) and children with severe vomiting are at increased risk of dehydration, the potentially more complicated courses of these groups are described separately. The day(s) most frequently associated with deterioration and the symptoms present in children who deteriorated during follow-up were also described.ResultsIn total, 359 children presented with uncomplicated acute gastroenteritis to the out-of-hours primary care service. Of these, 31 (8.6%) developed a complicated illness and needed referral or hospitalization. All symptoms decreased within 5 days in most children (> 90%). Vomiting and fever decreased rapidly, but diarrhea decreased at a somewhat slower pace, especially among children aged 6–12 months. Children who deteriorated during follow-up had a higher frequency of vomiting at presentation and higher frequencies of vomiting and fever during follow-up.ConclusionsThe frequency of vomiting, not its duration, appears to be the more important predictor of deterioration. When advising parents, it is important to explain the typical symptom duration and to focus on alarm symptoms. Clinicians should be vigilant for children with higher vomiting frequencies at presentation and during follow-up because these children are more likely to deteriorate.

Navigating challenges in management of drug resistant tuberculosis: Case experience from Nepal

Drug resistant tuberculosis (DR TB) a severe form of TB is a disease of concern. Its treatment requires multiple toxic drugs for prolonged duration because of which, often have complicated course requiring close supervision, continuous encouragement from physician, management of side effects and modification of drug regimen for successful outcome. In this report, we are presenting a case of diabetic patient suffering from DR TB highlighting key diagnostic and management challenges.

Early post-liver transplant thrombocytopenia in children: Clinical characteristics and significance.

Post-liver transplant thrombocytopenia is common and associated with worse outcome in adults. In children, however, the prevalence, course, and significance of post-liver transplantation thrombocytopenia are not described. Therefore, we aimed to assess this phenomenon in children. A retrospective chart review of children who underwent liver transplantation at a single tertiary center between 2004 and 2021. Overall, 130 pediatric liver transplantations were reviewed. During the first 28 POD, thrombocytopenia was evident in 116 (89%, 95% CI 83%-94%). The median nadir platelet count was 54 K/μl (IQR: 37-99). Nadir platelet count was reached in half the patients by the third POD (IQR: 1-6). In multivariate analysis, preoperative platelet count (p= .024), volume of intraoperative packed cell transfusion (p= .045), and hypersplenism (p= .007) were associated with lower postoperative platelet counts. Patients with platelet count lower than the 50th centile on the first POD suffered from a more complicated course leading to a longer PICU admission (p= .039). Early post-liver transplant thrombocytopenia appears to be common in children and associated with preoperative thrombocytopenia, hypersplenism, and higher intraoperative blood transfusion volumes. A low first POD platelet count (<86 K/μl) was found to be independently associated with a more complicated postoperative course, suggesting the need for heightened surveillance.

High-Value Care During the COVID-19 Pandemic: Lessons Learned and Future Opportunities.

High-Value Care During the COVID-19 Pandemic: Lessons Learned and Future Opportunities.

Clinical Guidelines of the Russian Society of Surgeons, the Russian Gastroenterological Association, the Association of Surgeons-Hepatologists and the Endoscopic Society “REndO” on Diagnostics and Treatment of Chronic Pancreatitis

Aim:to present modern methods of diagnosis and treatment of chronic pancreatitis for gastroenterologists, general practitioners and physicians.Chronic pancreatitis (CP) is a long-term inflammatory disease of the pancreas, manifested by irreversible morphological changes in the parenchyma and pancreatic ducts, which cause pain and/or persistent impairment of function. Current concept on the etiology of CP is reflected by the TIGAR-O classification. The criteria for establishing the diagnosis of CP include typical attacks of abdominal pain and/or clinical and laboratory signs of exocrine, endocrine insufficiency with the mandatory detection of characteristic morphological changes (calcifications in the parenchyma and pancreatic ductal stones, dilatation of the main pancreatic duct and its branches). CT, MRCP, and pancreatobiliary endosonography are recommended as the methods of choice to verify the diagnosis of CP. Conservative treatment of patients with CP is provided for symptom relief and prevention of complications. Individual cases with severe non-interactable abdominal pain, as well as a complicated course of the disease (development of ductal hypertension due to main pancreatic duct stones or strictures, obstructive jaundice caused by compression of the common bile duct, symptomatic postnecrotic cysts, portal hypertension due to compression of the portal vein or thrombosis of the splenic vein, persistent duodenal obstruction, pseudoaneurysm of the celiac trunk basin and the superior mesenteric artery) serve as an indication for endoscopic or surgical treatment. The Guidelines set out modern approaches to the diagnosis, conservative, endoscopic and surgical treatment of CP, and the prevention of its complications.Conclusion.The implementation of clinical guidelines can contribute to the timely diagnosis and improve the quality of medical care for patients with chronic pancreatitis.

False lumen/true lumen wall pressure ratio is increased in acute non-A non-B aortic dissection

OBJECTIVESWe aimed to determine whether non-A non-B aortic dissection (AD) differs in morphologic and haemodynamic properties from type B AD.METHODSWe simulated and compared haemodynamics of patients with acute type B or acute non-A non-B AD by means of computational fluid dynamics. Wall pressure and wall shear stress (WSS) in both the true lumen (TL) and false lumen (FL) at early, mid- and late systole were evaluated. Morphology, WSS and the FL/TL wall pressure ratio were compared between groups.RESULTSNineteen patients (type B, n = 7; non-A non-B, n = 12) were included. The median age (51 [46, 67] vs 53 [50, 63] years; P = 0.71) and a complicated course (14% vs 33%; P = 0.6) did not differ between the type B group and the non-A non-B group. However, the median entry tear width was increased in the non-A non-B group (9.7 [7.3, 12.7] vs 16.3 [11.9, 24.9] mm; P = 0.010). Streamlines showed, in patients with non-A non-B AD, blood from the TL flowed into the FL via the entry tear. Prevalence of a FL/TL wall pressure ratio >1.0 (type B versus non-A non-B) at early, mid- and late systole was 57% vs 83% (P = 0.31), 43% vs 83% (P = 0.13) and 57% vs 75% (P = 0.62), respectively. WSS did not differ between the groups.CONCLUSIONSThe increased FL/TL wall pressure ratio observed during systole in non-A non-B AD may beget a complicated presentation.

Hearing impairment in Angolan children with acute bacterial meningitis with and without otitis media.

Bacterial meningitis (BM) is a common cause of hearing loss in childhood. Our aim was to investigate bacterial aetiology, hearing impairment and outcome in childhood BM with vs. without otitis media (OM) in Angola. Hearing was tested by auditory brainstem response in 391 (76%) children with confirmed BM. The bacteria identified from the ear discharge were compared to those from cerebrospinal fluid (CSF). The hearing findings were compared among children with vs. without OM on days 1 and 7 of hospitalization, and at follow-ups of 1, 3 and 6month(s). No correlation was found in bacteriology between the ear discharge and CSF. On day 7 in hospital, hearing impairment (>40dB) was common, regardless of whether concomitant OM or not (in 27% vs. 30%, respectively). Any hearing deficit on day 7 was associated with a higher risk of complicated or fatal clinical course (OR 2.76, CI95% 1.43-5.29, p=0.002). No significant difference prevailed in hearing thresholds between children with or without OM in hospital on day 7 or at later follow-ups. Any hearing impairment during hospital stay associated with a higher risk for complicated clinical course or death.

Features of hereditary thrombosis (analysis of clinical cases in newborns)

Background. Dysfunctions of hemostasis include conditions occurring both with hemorrhagic syndrome and in the form of thrombosis, the number of which is growing due to the intensification of the therapy. The relevance of the topic is determined by the prevalence of these pathological conditions in newborns, the peculiarities of the hemostasis system in the neonatal period, as well as the difficulties of diagnosis and interpretation of laboratory parameters.&#x0D; Aim. Studying the features of clinical manifestations and genetic markers in newborns with clinical thrombosis on the background of primary thrombophilia.&#x0D; Materials and methods. A retrospective continuous analysis of the case histories of newborn children with thrombophilia who were hospitalized at the Krasnoyarsk Regional Clinical Center for Maternity and Childhood Protection in the period from January 2014 to January 2020 was carried out.&#x0D; Results. The debut of thrombosis in newborns is represented mainly by venous thrombosis of various localizations. Genetic mutations were identified in these patients, which are mainly associated with the work of the folate and methionine cycles (MTHFR: g.677CT, MTHFR: g.1298AC, MTRR: g.66AG and MTR: g.2756AG). A complicated course was noted in the presence in the genome of the combinations MTHFR: g.677CT, MTR: g.2756AG and MTRR: g.66AG and/or homozygous carriage of MTHFR: g.677CT, MTHFR: g.1298AC. The main trigger was peripheral vascular catheterization.&#x0D; Conclusion. A decrease in the levels of natural anticoagulants in newborns with some physiological features of hemostasis deserves close attention of neonatologists and clinicians, requires an integral assessment of the hemostasis system and additional examinations, including the analysis of genetic changes not only in the hemostasis system, but also in folate and methionine cycles.

Pregnancy Outcome in Acute Viral Hepatitis E

Background: Hepatitis E is associated with poor feto-maternal outcome. Patients with acute hepatitis E who are pregnant usually require hospital admission and monitoring with liver function tests and clotting profile. Objective: To evaluate maternal and fetal outcome among pregnant women who have positive serology for hepatitis E IgM. Methods: Data of women with clinical presentation of jaundice during pregnancy and who were diagnosed as acute hepatitis E was collected on pre-structured questionnaire after obtaining consent. Data were entered in Statistical Package for Social Sciences for analysis. Results: Three hundred and thirty three women had positive serology for hepatitis E IgM. Out of these three hundred were in last trimester of their pregnancy. The gestational age of two hundred and thirty two (77%) women was less than 37 weeks at presentation. Six (2%) pregnancies ended up in miscarriage, fifty four (16 %) had fetal demise in maternal womb while two hundred and seventy three (82%) were viable fetus. One third of live born babies were kept in NICU. Indications of neonatal admission were respiratory distress in 57(72%), jaundice neonatorum in 12(15%), asphyxia neonatorum in 9(12%), while one (1%) had transient tachypnea. Neonates who died in first week of their life were 18(23%).The cause of neonatal death was respiratory distress in 12 (67%) and anoxia in remaining 6 (33%) neonates. Most of the women were discharged home however maternal mortality was recorded in 80(24%) patients, mainly in postpartum period 73(91%). Conclusion: Pregnant women with acute hepatitis E have more complicated course of this viral infection with adverse fetal and maternal implications.

Effect of modifying high-risk factors and prehabilitation on the outcomes of colorectal cancer surgery: controlled before and after study.

BackgroundLow functional capacity, malnutrition, and anaemia are associated with an increased risk of complications after surgery. These high-risk indicators can be improved through preoperative interventions. The aim of the study was to examine the effect of screening for modifiable high-risk factors combined with targeted interventions on postoperative complications in patients undergoing colorectal cancer surgery.MethodsA controlled before-and-after study was conducted including patients with colorectal cancer undergoing elective curative surgery between August 2015 and October 2018, in two institutions (intervention and control hospital). The intervention consisted of a screening for anaemia, low functional capacity, and nutritional status and their implementation (iron supplementation, prehabilitation, nutritional supplements, and consultation with a dietician), for a minimum of 4 weeks before surgery. The primary outcome was a composite measure consisting of unplanned admission to the intensive care unit, complications with Clavien–Dindo score of 3a or above, length of hospital stay less than 10 days, readmission, or death within 30 days during the postoperative course.ResultsA total of 1591 patients were included for analysis with 839 at the intervention hospital and 752 at the control hospital. In a difference-in-difference analysis, adjusted for age, sex, smoking, stage of disease, ASA score, surgical approach, and surgical procedure, the intervention was associated with a 10.9 per cent (95 per cent c.i. 2.1 to 19.7 per cent) absolute risk reduction of a complicated postoperative course, primarily due to a reduction in severe complications.ConclusionThe combined intervention of screening and prehabilitation was associated with a decreased risk of a complicated course, primarily in a reduction of severe complications.