Development Of Severe Complications Research Articles

Antibacterial Therapy and Prevention of Infectious Endocarditis in Modern Conditions

The problem of infectious endocarditis (IE) still retains its importance due to high mortality rates and the development of severe complications. Modern IE is a polyethological disease, the occurrence and development of which can be caused by pathogens that make up an extremely extensive list, which is updated almost annually. At the same time, serious obstacles standing in the way of effective antimicrobial therapy are both the increasing resistance of IE pathogens to antibiotics and the increasing etiological role of infectious agents that were previously very rare. This article presents the basic principles of treatment and prevention of IE, taking into account the latest recommendations of the experts of the European Society of Cardiology in 2023.

Management of patients with infective endocarditis: current state-of-art. Part I: clinical picture, diagnosis, differential diagnosis

The problem of infective endocarditis (IE) remains relevant due to the high mortality rate and the development of severe complications. IE is a polyetiological disease, the occurrence and development of which can be caused by an extremely extensive list of pathogens, which is replenished almost annually. The pronounced clinical polymorphism of IE determines the importance of its early diagnosis, including the use of new medical technologies. Timely informing physicians about the modern principles of monitoring of patients with IE is of great practical importance. Part I of the article describes the clinical features, basic principles of diagnosis and differential diagnosis of IE, taking into account the recommendations of the European Society of Cardiology 2023.

Phlebotomy improves kidney function in pediatric cyanotic nephropathy: A case report

Children with cyanotic congenital heart diseases (CCHDs) have several risk factors for the development of several complications, including cyanotic nephropathy (CN). However, due to poor awareness of this problem, CN occasionally progresses to chronic kidney disease (CKD). In the long term, kidney cells subjected to chronic hypoxia undergo further damage, which increases the risk of developing end-stage kidney disease. There are no standardized therapeutic approaches for these cases, especially for children, although phlebotomy is an option. Our case demonstrates a 12-year-old boy with an inoperable, complex CCHD and persistent proteinuria with decreased kidney function. After receiving consecutive treatment with an angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker, the proteinuria did not resolve, and the kidney function deteriorated. Phlebotomy was performed to treat the proteinuria, and the kidney function improved. Within the three months following the first phlebotomy procedure, the patient was less cyanotic and had improved hemodynamic stability. Proteinuria reduction and improvement of estimated glomerular filtration rate were noted; however, the proteinuria gradually worsened after three months. In conclusion, phlebotomy might delay CKD progression in children with CN due to inoperable, complex CCHD. The positive effects in our case were temporary; therefore, repeated therapeutic phlebotomies should be considered.

Association between polymorphism at codon 469 of the ICAM-1 gene and Henoch-Schönlein purpura in an Iranian cohort

Henoch-Schönlein purpura (HSP) is a common form of IgA1-mediated blood vessel inflammation affecting mainly children. Intercellular adhesion molecule-1 (ICAM-1) gene polymorphisms have been shown to be associated with HSP in different populations; in this study, we investigated its potential association and influence on the development of severe complications in Iranian HSP patients. Twenty-three patients diagnosed with IgAV/HSP according to the criteria of the American College of Rheumatology (ACR) with 53 age- and sex-matched control subjects were referred to us. Cases and controls were genotyped using Sanger sequencing. Based on our research data, we found an association between codon 469 K/E of the ICAM1 gene and risk of HSP. Our results revealed that KK genotype and allele K are more common in control than in the HSP group, therefore the subjects with KK genotype are protected against HSP. Our data also suggested that the genotype EE is associated with higher risk of HSP progression compared to KK genotype.

Does Portal Hypertension Increase the Risk of Helicobacter pylori Infection and Pre-Malignant Gastric Lesions?

Background and Aims: The presence of portal hypertension in cirrhotic patients is a major prognostic factor associated with the development of severe complications and increased mortality. The gold standard for diagnosing portal hypertension is the hepatic venous pressure gradient. More recently, spleen stiffness has emerged as a new and non-invasive diagnostic tool, and has already been included in the last Baveno VII guidelines. The exact prevalence of Helicobacter pylori infection, pre-malignant lesions and their relation to portal hypertension have never been described. The aim of our study was to evaluate the relationship between the presence of portal hypertension assessed via liver and spleen elastography and Helicobacter pylori infection and pre-malignant gastric lesions. Methods: An observational study was conducted, including consecutive patients admitted from December 2020 to December 2022. All patients underwent upper endoscopy and were also subjected to liver and spleen elastography (using the new probe of 100 Hz) by the same blinded operator in a tertiary center. Results: We included 155 cirrhotic patients, with a mean age of 64.1 years (±8.8), and 81.3% were male. The most common etiology was alcoholic liver disease (72.9%). The median value of liver stiffness measurement was 24.4 kPa [3.1-75.0], and the spleen stiffness measurement was 49.1 kPa [12.8-100.0]. Akin to endoscopic findings, 50.3% presented esophageal varices, 5.2% gastric atrophy, 11.6% gastric metaplasia, and 32.9% portal hypertension gastropathy. Regarding histologic findings, we found that 34.8% presented H. pylori infection, 35.5% gastric atrophy (OLGA 1-58.2%) and 38.7% gastric metaplasia (OLGIM 1-63.3%). Liver stiffness and spleen stiffness measurements were associated with the presence of portal hypertensive gastropathy (p < 0.01), but not with H. pylori infection or pre-malignant gastric lesions. Conclusions: Although present in almost one third of cirrhotic patients, H. pylori infection and pre-malignant gastric lesions are not associated with liver stiffness and spleen stiffness measurements. On the other hand, we found an association between liver stiffness and spleen stiffness measurements and portal hypertensive gastropathy.

A foreign body complicated by tracheal perforation in the esophagus of a two-year-old child (clinical observation)

Foreign bodies in the gastrointestinal tract remain one of the significant problems in pediatric practice. Ingestion of foreign bodies is typical for children of all ages, but especially for the first 5 years of life. Due to the anatomical features of children, foreign bodies are often located at the level of the first physiological narrowing – in 68% of cases. The mortality rate from foreign bodies is 1%, but with the development of severe complications, this figure increases to 45%. A disc-shaped battery is the most dangerous one for health, as it is capable of causing local infiltrative-necrotic changes, perforation of the esophagus. Disc-shaped batteries as FB (foreign body) form up to 10% of the total number of foreign bodies of the gastrointestinal tract in children. Unfortunately, parents do not immediately seek medical help, since the symptoms indicating the presence of FB are often absent or may manifest as non-specific symptoms. Endoscopic examination serves as a key method in the diagnosis of ingested FB among children and its removal less than 24 hours after ingestion, since any delay reduces the probability of successful intraluminal extraction. This article discusses the clinical observation of a prolonged presence of a foreign body in the esophagus of a toddler child. The clinical course manifested itself in the form of nonspecific symptoms, a foreign body was detected only after a number of studies and was removed by endoscopic method. During the examination of the patient, in addition to the chest X-ray, esophagogastroduodenoscopy and a number of bronchoscopies were performed. Accessible and highly informative methods of instrumental diagnostics available in each clinic of the regional scale, today remain the first stage of the diagnosis of foreign bodies.

ENDOTHELIAL GLYCOCALYX DAMAGE IN PATIENTS WITH SEVERE FUNCTIONAL INJURY

In modern medical science, endothelial glycocalyx, which is considered a target organ in many diseases, including severe traumatic injuries, is becoming one of the main objects of researchers' attention [1,2]. Trauma is the leading cause of death and disability worldwide, and despite the introduction of damage-controlled resuscitation, mortality remains very high. More than half of trauma patients are found to have laboratory-defined coagulopathy on admission, which further leads to increased mortality [3,4]. Laboratory-defined coagulopathy, also called trauma-induced coagulopathy, is described as either excessive activation of the protein C pathway accompanied by hyperfibrinolysis or as a manifestation of the hemorrhagic phenotype of disseminated intravascular coagulation. Common to both of these explanations is that, they are based on the measurement of concentrations of pro- and anticoagulant clotting factors, platelet counts, and fibrin degradation products [5,6]. Nowadays, evidence is accumulating for a key role of the glycocalyx as one of the first structures involved in the trauma-induced coagulopathic response and it may be one of the earliest signs of progression in the severity of patients. In our study of trauma patients using whole blood thrombelastography (TEG), we found that the hemostatic profile became increasingly hypocoagulative and hyperfibrinolytic with increasing severity of injury, Therefore, studies of the significance of glycocalyx in the development of severe complications in conditions of persistently high lethality in trauma patients [7,8], are a priority and primary task of science and practical health care. Glycocalyx is a birth of a new clinical paradigm, but the full understanding of its significance and functions is still far away and researchers are only at the beginning of the way. We study the role of the endothelial glycocalyx system and analyze the relationship between markers of glycocalyx degradation and the severity of the clinical course of the disease in severe traumatic injuries. It is expected that a deeper study of the glycocalyx, understanding the relationship between the mechanisms of its degradation and trauma is extremely important and will lead to the development of new scientific strategies for early diagnosis and the possibility of predicting disease outcomes in patients with severe traumatic injuries. The object of our scientific research were patients with severe combined trauma. The study was carried out taking into account the principles of evidence-based medicine. The obtained data were processed using standard methods of statistical analysis.

Modern possibilities of diagnostic and therapeutic interventions for decompensated liver cirrhosis: the focus is on «gut — liver — brain». Clinical case

The relevance of the issue of management of patients with decompensated liver cirrhosis (LC) is stipulated by its medical and socio­economic importance not only in Ukraine, but worldwide due to the high prevalence of etiological factors, as well as the development of severe complications that lead to fatal consequences. Chronic alcohol intoxication is considered the most common cause of LC. The understanding of the etiopathogenetic mechanisms of liver damage and the development of complications is constantly updated, which requires the improvement of approaches to the treatment of such patients. An important role in modern diagnostic and therapeutic interventions is given to the «gut/intestinal microbiota — liver — brain» axis. Today there is evidence that intestinal microbiota indirectly affects intestinal permeability, production of nitric oxide, release of biologically active peptides from enteroendocrine cells, production of short chain fatty acids — the main metabolic product of bacteria that feed cells of the mucous membrane, affect cognitive functions and the activation of the immune system. intestinal system. Research in recent years has proven that it is the liver that takes the leading place in the «gut/intestinal microbiota — liver — brain» axis system. Today, the pathogenesis of alcoholic liver disease is also associated with the hypothesis of «leakage» of the intestine, since alcohol significantly increases its permeability. Special attention in the development of encephalopathy with an imbalance of the microbiome is paid to bacterial translocation into the submucosa due to the violation of the integrity of the tight contacts of epithelial cells, with subsequent stimulation of the release of inflammatory mediators by smooth cells and lymphocytes, which leads to the development of the inflammatory process, increased vascular permeability in the portal, hepatic and systemic networks circulation.&#x0D; The authors presented a clinical case of the use of modern possibilities of diagnostic and therapeutic interventions for decompensated liver cirrhosis of the of toxic etiology based on the global and domestic recommendations with a detailed discussion of patient care tactics.&#x0D;

CLINICAL PRESENTATION AND OUTCOME IN HOSPITALIZED PATIENT WITH DECOMPENSATED CIRRHOSIS OF LIVER IN A TERTIARY CARE CENTRE OF NEPAL

Background: Decompensated liver cirrhosis is a progressive and potentially life-threatening condition characterized by the loss of liver function and the development of severe complications. This study aimed to assess the clinical presentation and outcomes among admitted decompensated liver cirrhosis patients. Methods: This hospital-based descriptive, cross-sectional study included 127 decompensated cirrhotic patients of college of medical sciences, Bharatpur, Nepal. Data were collected between August 2022 and April 2023. The data analysis was done using statistical package for the social sciences version 20. Statistical analysis was performed using descriptive statistics. Results: Abdominal distension, jaundice and hematemesis/melena were present in 43%, 23.6% and 15% of patients respectively. Common complications amongst the study population were upper GI bleeding (15 %), hepatic encephalopathy (12.6%), and hepatorenal syndrome (11%). Inpatient mortality was 12.6%, of which most common complication related to mortality was hepatorenal syndrome 43.7%. Presence of shock, severe sepsis, severe anemia, hyponatremia (&lt;130 mEq/L) were also common in mortality. Conclusions: Abdominal distension, jaundice and hematemesis/melena were the common presentation amongst the hospitalized decompensated cirrhotic patients. Hepatorenal syndrome, shock and severe sepsis complicating decompensated cirrhosis of liver were common in mortality.

A family case of a rare autoinflammatory disease associated with mutations in the NLRP3 and TNFRSF1A genes in the practice of a rheumatologist

The article presents a clinical case of a rare autoinflammatory disease – a family case of Muckle – Wells syndrome. The diversity of clinical manifestations and the impossibility of confirming the diagnosis without a genetic study by DNA sequencing determine the complexity of and delay in the diagnosis. The development of severe complications and, as a consequence, a fatal outcome necessitates early diagnosis. The described clinical case demonstrates the importance of DNA sequencing for the timely diagnosis of the disease, the features of the disease course, and the familial nature of the disease. The diagnosis of Mackle – Wells syndrome in young family members before the development of severe complications will allow to start adequate and timely treatment and prevent the development of amyloidosis.

A clinical case of ectopic ACTH syndrome: diagnostic difficulties

Ectopic adrenocorticotropic hormone (ACTH-ectopic syndrome) secretion is a rare variant of endogenous hypercortisolism. Development of severe complications in various organs, systems and complex differential diagnoses characterizes the complexity of disease. Also, surgical intervention requires rapid, confirmed diagnosis and localisations of tumours. The presented clinical case is a case with multiple comorbidities presented with hypercortisolism complicating the diagnostic process and demonstrates the difficulties in managing patients with this nosology.

Mixed infection with COVID-19 and tropical malaria (case report)

This article describes a clinical case of mixed infection with COVID-19 and tropical malaria. Patient Z., 37 years old, arrived from the Central African Republic with a diagnosis of New coronavirus infection COVID-19, confirmed (PCR RNA SARS-CoV-2+ from January 27, 2022) mild form. During an objective examination, the subictericity of the sclera and skin integument attracted attention. During thermometry, an increase in body temperature to 39.0C was found. Consciousness at the level of somnolence was observed. Hemodynamics was unstable, with episodes of arterial hypotension; heart rate was 96 beats per minute. Respiratory rate was 24 breaths in 1 minute, SpO2 95%, and with inspiratory dyspnea. According to the patients laboratory study results, severe thrombocytopenia, apparent signs of hepatic and renal insufficiency, hyperbilirubinemia, increased concentrations of C-reactive protein, and procalcitonin were revealed. A differential diagnostic search was performed between acute viral hepatitis and malaria. Blood microscopy revealed young trophozoites of Plasmodium falciparum (++++) using the thick drop method. Antimalarial therapy with Malacur was prescribed, which was then replaced with parenteral Quinine followed by mefloquine. In parallel, extracorporeal detoxification operations were performed. The patients condition was stabilized against adequate etiotropic therapy and complex intensive care measures. On the 40th day, the patient was discharged restored health.&#x0D; The purpose of demonstrating a clinical case is to attract increased attention to the problem of imported cases of malaria, which, when combined with COVID-19 infection, may remain unrecognized for a long time, especially in cases where the diagnosis of COVID-19 receives rapid laboratory confirmation.&#x0D; Adequate and timely antimalarial therapy, including a complex of intensive care measures supplemented with extracorporeal detoxification methods, is the basis for a successful outcome in patients with severe malaria with the development of severe complications.

Association between different dietary patterns and eating disorders and periodontal diseases.

Periodontal diseases is a highly prevalent chronic condition regulated by the host immune response to pathogenic bacterial colonization on the teeth surfaces. Nutrition is a critical component in the modulation of the immune system, hence the importance of a balanced diet. With the understanding of how dietary intake composition affects various health outcomes, nutrient diversity has been reported as a modifiable risk factor for periodontal disease. Eating disorders and different dietary patterns can be associated with periodontal diseases. In this sense, balanced and healthy nutrition plays a major role in maintaining the symbiosis between oral microbiota and periodontal health. Therefore, this review seeks to report the associations found in the literature between high- or low-fat/sodium/sugar, eating disorders and periodontal diseases. It was found that some dietary patterns such as high carbohydrate/sugar, high fat, and low fiber intake may be associated with periodontal disease. In addition, the presence of eating disorders can negatively impact patients' oral health and it is related to the development of several complications, including periodontal diseases. In both situations, nutritional and vitamin deficiencies can aggravate the periodontal condition. However, the relationship between periodontal disease, dietary patterns, and eating disorders still needs more scientific support to be well established, mainly in the sense of pointing out a protective relationship between both.

ОЦЕНКА ГЕМАТОЛОГИЧЕСКИХ ОТНОШЕНИЙ У ПАЦИЕНТОВ С СИНДРОМОМ ДИАБЕТИЧЕСКОЙ СТОПЫ

Background. Type 2 diabetes mellitus (DM 2) is one of the significant medical, social and economic problems in the Republic of Belarus due to the high prevalence and development of severe complications. The need to predict and prevent diabetic foot ulcer (DFU) is becoming one of the most urgent clinical tasks, which requires the introduction into practice of indicators available for routine determination that can predict the course of DFU. Objective. To study the prognostic significance of the hematological ratio in assessing the risk of occurrence and clinical course of DFU. Material and methods. A non-randomized study was performed, in which 74 patients participated. The entire sample was retrospectively divided into 2 groups: patients with DM 2 (control group, n=43) and patients with DM 2 who have DFU (experimental group, n=31). Venous blood was taken on an empty stomach to determine the level of neutrophils, lymphocytes, platelets, glycated hemoglobin (HbA1), neutrophil-lymphocytic ratio (NLR) and plateletlymphocytic ratio (PLR) were calculated. Results. It was revealed that the patients of the control and experimental groups did not differ in gender, age, body mass index (BMI), absolute number of lymphocytes and HbA1 level. It was found that in patients of the control group, the level of neutrophils, platelets, as well as NLR and PLR in the blood was statistically higher (p&lt;0.05). Spearman's correlation analysis showed that in the control and experimental groups, all the studied indicators do not correlate with the NLR. In the experimental group, the BMI indicator negatively correlates with PLR (r=0.52; p&lt;0.05), and Hba1c positively correlates with aphids (r=0.555; p&lt;0.05). The NLR was equal in patients of category 1-3 according to the classification of DFU of the University of Texas (N=15) – 2.06 (1.55; 2.21) nmol/l, in patients of category 4-6 (N=16) – 4.33 (3.28; 5.73) (p&lt;0.05). The PLR in patients with the smallest category was 95.88 (86.04; 108.63) nmol/l, in patients with the largest category – 174.98 (150.23; 210.64) (p&lt;0.05). The area under the ROC curve for the indicators of NLR and PLR was the largest – 0.761 and 0.708, respectively. Conclusions. 1. The content of neutrophils and platelets in the blood, NLR and PLR was significantly higher in patients with DFU compared with patients who have DM 2 without DFU. 2. In patients with DM2 complicated by DFU, the indicator PLR negatively correlates with BMI and positively correlates with HbA1. 3. The NLR and PLR in patients with DFU increase with an increase in the risk of possible amputation of the lower limb during the year. 4. In patients with DFU the NLR and PLR have the great diagnostic value as a laboratory criterion of DFU.

Caroli syndrome in children: a brief review and clinical observation

A review of domestic and foreign literature on the disease and Caroli syndrome is presented. The review includes a historical background and a modern view on the etiology and pathogenesis of the disease, its place among fibrocystic diseases of the liver. Caroli’s disease is a rare genetic pathology, characterized by a wide clinical and morphological polymorphism from severe variants with fibrosis in the neonatal period to cases with manifestation at a late age. The genetic causes of pathology, in particular, mutations associated with autosomal recessive and autosomal dominant forms of polycystic kidney disease, have been studied. A large number of described mutations and the predominance of complex heterozygotes among patients explains the diversity of clinical forms of pathology. The relationship between the genotype and phenotypic variants of pathology has not been determined. In Caroli’s disease, in addition to cystic changes in the liver and kidneys, damage to other organs and systems, in particular cerebral vessels, can be observed. Extrahepatic and extrarenal symptoms of the disease are described, as well as combinations with various genetic diseases. A clinical case of Caroli syndrome in a child observed by the authors from birth is presented. The disease manifested as congenital cystic transformation of the kidney. Hepatic pathology was detected at the age of 5 years. Subsequently, there was a rapid progression of liver damage with the development of severe complications: cirrhosis of the liver, portal hypertension, edematous syndrome, hepatic encephalopathy. At the age of 11 years, the patient successfully underwent orthotopic liver transplantation. The presented case demonstrates the late detection of hepatic damage, its rapid progression. Despite the presence of severe complications, liver transplantation was a success and the patient is currently in a stable condition compensated for all functions.

Прогнозирование роговичных осложнений у пациентов с паралитическим лагофтальмом

Introduction. Paralytic lagophthalmos can be accompanied by the development of severe complications up to the loss of visual functions and even the eye as an organ. Purpose. To identify the causes of severe corneal complications in patients with paralytic lagophthalmos. Material and methods. We conducted a retrospective analysis of 114 clinical cases of paralytic lagophthalmos. All the patients received tear replacement therapy. For diagnostics, all of them underwent ophthalmological examination, corneal estesiometry, eyeball mobility assessment, Schirmer test 1, photography of the corneal surface with and without fluorescein staining, Hertel exophthalmometry, measurement of the ocular slit parameters and determination of the severity of Bell's symptom. Results. In patients with preserved corneal sensitivity and a positive Bell's symptom, the cornea was transparent. Although, in patients with normal corneal sensitivity and a weakened Bell's symptom, regardless of the severity of lagophthalmos, there was epithelial roughness in the lower parts of the cornea and uneven staining were noted. All the patients with decreased corneal sensitivity had neurotrophic keratopathy with various pathological changes of the cornea, up to perforation, in combination with pronounced uneven staining of the epithelium over its entire surface. Conclusion. In paralytic lagophthalmos, the risk of developing corneal complications increases significantly in patients with decreased corneal sensitivity and weakened or negative Bell's symptom on the affected side. Keywords: Bell's symptom, protective function of the eyelids, facial nerve, oculomotor nerve, trigeminal nerve, tear replacement therapy, neurotrophic keratopathy

Parvovirus В19 infection: lecture

Parvovirus B19 infection is best known as erythema infectiosum. However, infection with parvovirus B19 can lead to damage to various organs and systems, the development of severe complications up to death. The infection is most dangerous for people with immunodeficiency and hematological diseases. Serious consequences are possible with intrauterine infection of the fetus. Knowledge about the characteristics of the pathogen, the pathogenesis of the disease, the variety of clinical manifestations will allow the doctor to avoid diagnostic errors and provide the patient with timely medical care.

ACUTE DIGITAL GANGRENE TRIGGERED BY COVID-19 COAGULOPATHY

ACUTE DIGITAL GANGRENE TRIGGERED BY COVID-19 COAGULOPATHY

Clinical Case of Treatment of Liver Metastasis in Our Practice

The golden standard for the treatment of colorectal liver metastases is surgical resection. However, less than 20% of patients can survive liver resection. Careful preparation for future liver resection, in the form of 3D modeling, segmentation, liver volumetry, and calculation of the future liver remnant (FLR), the remnant liver volume to body weight ratio (FLR/BWR ratio) significantly reduce the risk of post-hepatectomy liver failure (PHLF). This clinical case demonstrates that by following the basic principles of preoperative resection planning, careful surgical technique, using intraoperative ultrasound, and postoperative treatment, it is possible to perform large liver resections without the development of severe complications.

Celiac disease - a common autoimmune disease with significantly delayed diagnosis

Introduction: Celiac disease (CD) is an autoimmune disease that affects genetically predisposed individuals. In course of the disease, consumption of gluten causes damage to the small intestine. Due to various clinical manifestations, diagnosing CD poses a challenge to clinicians. It has been proven by several study groups that the diagnostic delay in CD is still too long and provokes severe health complications. Purpose: The aim of the study is to highlight the importance of diagnostic delay in CD, its consequences and possible solutions. Description of the state of knowledge: The diagnosis of CD is based on the clinical picture, serological test, duodenal mucosal biopsies and genetic tests. Many cases of CD remain undiagnosed in spite of published guidelines for CD diagnosis. Consequently, the diagnosis is significantly delayed: the mean duration of the diagnostic process in Poland was 7.3 years. In other countries, patients the time from the onset of the symptoms to establishing CD diagnosis was up to 10 years. The diagnostic delay leads to reduced quality of life and the development of severe complications, such as neoplastic disease. Summary: Diagnostic delay in CD is an issue of great importance. Because of the reduced quality of life and the possibility of neoplasm, it is crucial to take action in order to shorten the diagnostic process of CD.