Development Of Severe Complications Research Articles

Удосконалення діагностики й лікування гепатобіліарної патології в підлітків з ожирінням

Актуальність. Серед підлітків сьогодні спостерігається зростання захворюваності на ожиріння, з яким часто пов’язана патологія гепатобіліарної системи. Проведення своєчасної діагностики й лікування порушень стану печінки, у тому числі неалкогольної жирової хвороби печінки, і функціональних розладів біліарного тракту запобігає розвитку тяжких ускладнень при ожирінні. Мета: оцінити структурно-функціональний стан гепатобіліарної системи методом динамічної ехографії й оптимізувати лікування розладів гепатобіліарної системи в підлітків з ожирінням. Матеріали та методи. Під спостереженням перебувало 27 підлітків 12–17 років з ожирінням. Проводилося комплексне клінічне й лабораторно-інструментальне обстеження, що включало динамічну ехографію з використанням препарату Хофітол. Вивчалися терапевтичні можливості призначення Хофітолу. Результати. Проведені дослідження показали, що в підлітків з ожирінням переважали скарги на підвищений апетит, біль у животі, нудоту. При біохімічному аналізі крові були виявлені ознаки помірної атерогенної дисліпідемії. У 88,8 % пацієнтів за даними ехографії спостерігалися ознаки стеатогепатозу. Гіпокінезія жовчного міхура зустрічалася в 92,6 % хворих, у переважної більшості мав місце гіпотонічно-гіпокінетичний тип функціональних розладів. Комплексне лікування з використанням препарату Хофітол упродовж 1 місяця привело до позитивних змін: поліпшилося самопочуття, зменшилися диспептичні прояви, больовий синдром; у 52,0 % хворих зменшились розміри печінки, у 32,0 % — відбулася нормалізація ехогенності печінкової паренхіми; у 28,0 % підлітків покращилася скорочувальна функція жовчного міхура. Висновки. У більшості підлітків з ожирінням визначаються ознаки стеатогепатозу й функціональні розлади біліарного тракту за гіпотонічно-гіпокінетичним типом. Динамічна ехографія з використанням препарату Хофітол дозволяє оцінювати функцію як жовчного міхура, так і сфінктерного апарату. За наявності в підлітків з ожирінням ознак стеатогепатозу й функціональних розладів біліарного тракту за гіпокінетичним типом є обґрунтованим призначення в складі комплексної терапії препарату Хофітол.

Спонтанная ремиссия бронхиальной астмы как дебют атипично протекающей болезни Иценко — ​Кушинга

Представлен случай поздней диагностики болезни Иценко — Кушинга у пациентки вследствие неполной и атипичной клинической картины гиперкортицизма. В повседневной практике нужна настороженность специалистов в отношении своевременной диагностики болезни Иценко — Кушинга у лиц с синтропной патологией (диспластическое ожирение, гипертоническая болезнь, нарушение углеводного обмена). Доказано, что нераспознанный гиперкортицизм значительно увеличивает кардиоваскулярные риски. Своевременная и правильная диагностика заболевания, до развития тяжелых осложнений, позволит значительно улучшить прогноз пациентов.

The role of influenza vaccination in the prevention of pulmonary and cardiovascular diseases

Influenza is an acute respiratory disease that causes annual epidemics and periodic pandemics with high mortality. It is characterized by the development of severe complications, the main of which are pulmonary and cardiovascular ones. The only effective method of preventing influenza, and therefore the influenza-associated complications, is vaccination, which is carried out annually on the basis of World Health Organization influenza vaccines composition recommendations. This article provides the review of the research data confirming the effective role of influenza vaccination in the prevention of pulmonary and cardiovascular pathologies (bibliography: 12 refs).

COVID-19 Vaccination Issues in Solid Organ Transplant Recipients

The aim of this workis to provide basic answers to questions related to the vaccination of solid organ transplant recipients based on the latest literature sources and clinical guidelines. Vaccination of solid organ transplants and persons in constant contact with them is a mandatory measure, the provision of which is a vital measure that effectively reduces the risk of death from COVID-19. Doubts about less effectiveness in conditions of immunosuppression or the potential risk of developing adverse reactions are significantly inferior to the risk of death and the development of severe complications. Until new data become available, the vaccination regimen must strictly comply with the instructions for medical use of the drug. Before transplantation, the patient should be examined according to the screening protocol, and also consulted by the transplant doctor who supervises him. It is possible that whole virion vaccines (CoviVac) have an advantage over others when vaccinating solid organ recipients, but clinical experience in this matter has not yet been obtained.

Non-papillary Percutaneous Puncture: A Safe Approach to Consider

Percutaneous nephrolithotomy (PCNL) is the ‘gold standard’ treatment modality for renal stones larger than 2 cm. It can be also applied to manage smaller renal stones and large, impacted stones located in the proximal ureter. Nevertheless, even in experienced hands, the PCNL procedure is associated with the development of several complications. Despite the existing extensive research in this field, studies evaluating the effect of puncture site on perioperative bleeding are very few. In part, this can be explained by the dogma that the safest way to perform kidney puncture is through the renal papilla. In this paper, the authors summarise their experience of non-papillary PCNL and demonstrate this puncture technique for PCNL tract establishment.

Impact of liver cirrhosis on the clinical outcomes of patients with COVID-19: a nationwide cohort study of Korea.

Background/AimsThe impact of liver cirrhosis (LC) on the clinical outcomes of patients with coronavirus disease 2019 (COVID-19) remains elusive. This study evaluated the association between LC and the development of severe complications from COVID-19.MethodsWe used the National Health Insurance claims data of Korea. We included 234,427 patients older than 19 years who tested for severe acute respiratory syndrome coronavirus 2. Patients with LC who were infected with COVID-19 (n = 67, LC+ COVID+) were matched with those with cirrhosis only (n = 332, LC+ COVID−) and those with COVID-19 only (n = 333, LC− COVID+) using a propensity score in a 1:5 ratio. The primary outcome was the development of severe complications.ResultsOf the matched patients, the mean age was 60 years and 59.7% were male. Severe complications occurred in 18, 54, and 60 patients in the LC+ COVID+, LC+ COVID−, and LC− COVID+ groups, respectively. After adjusting for comorbidities, there was no significant difference in the risk of developing severe complications from COVID-19 between the LC+ COVID+ and LC− COVID+ groups but significant difference exists between the LC+ COVID+ and LC+ COVID−. Older age, hypertension, cancer, chronic obstructive pulmonary disease, and a higher Charlson comorbidity index were associated with a higher risk of severe complications in patients with cirrhosis and COVID-19.ConclusionsOur study suggests that LC was not independently associated with the development of severe complications, including mortality, in patients with COVID-19. Our results need to be evaluated through a large, prospective study.

Assessment of Endoscopic Colonic Stenting outcomes in Patients with Acute Malignant Colonic Obstruction

Background: The traditional method of treating patients with acute malignant colonic obstruction (AMCO) is emergency surgery, which is often accompanied by the development of severe complications and high mortality. Endoscopic colonic stenting with self-expandable metal stents (SEMS) is considered to be a promising way to treat such patients. However, its capabilities are not yet fully explored. This paper presents a cross-sectional study of the results of endoscopic colonic stenting using SEMS in AMCO patients, performed in 2016 - 2020.Objective: to clarify the outcomes of endoscopic stenting with SEMS in AMCO patients and identify the factors that influence its result.Materials and Methods. The study included 218 patients with AMCO in whom surgeons made an attempt to eliminate the acute colonic obstruction using the method of endoscopic stenting. The capabilities of endoscopic stenting were assessed on the basis of calculated technical and clinical efficacy, the incidence of complications and mortality. To identify the factors that can predict the outcome of a stenting attempt, all patients were divided into two groups: a group of clinical success (182 patients) and a group of clinical failure (36 patients). The groups were subjected to comparative analysis.Results. The analysis of the obtained results registered that the technical efficiency of endoscopic stenting of the colon is 91.7% and its clinical efficiency is 83.5%, the incidence of intra-abdominal complications is 8.3%, the incidence of somatic complications is 11.9%, the mortality is 5%. Comparative analysis of the groups revealed differences (with p <0.05) for the oncological process stage, the duration and the severity of intestinal obstruction. Conclusion. Endoscopic stenting of the colon with SEMS is an effective way to treat patients with AMCO. Its success can vary depending on the severity of trophic disorders in the intestinal wall.

Сlinical and morphological case of cervical cancer due to HIV-associated infection

Cervical cancer ranks second in the structure of mortality of malignant tumors of the female reproductive system. Of particular interest is cervical cancer in patients with HIV infection, which develops more rapidly than in HIV-negative women. In this regard, the purpose of our study was to analyze the clinical and morphological case of the development of cervical cancer with HIV infection and to describe the features of metastasis in a young patient.Materials and methods. A postmortem examination was carried out, the material of the accompanying documentation (case history, outpatient card) was studied, a histological examination of the material was carried out (staining with hematoxylin and eosin, immunohistochemical examination for CK5/14, p16, p63).Research results. In a young patient (41 years old), HIV-infected, the cervix is revealed with destructive changes, ulceration, with signs of infiltrative growth, with the growth of the tumor structure into the surrounding tissues. Squamous cell non-keratinizing cancer of the cervix of a moderate degree of differentiation was histologically exposed. In the analyzes — CD4+ lymphocytes 18 cells/ml. The peculiarity and rarity of the presented clinical and morphological case is that against the background of the aggressive course of cervical cancer, there is an absence of characteristic metastases, there is a pronounced infiltrating growth and germination of atypical cells into the surrounding tissues, with the development of severe complications.

The Impact of Angiotensin Converting Enzyme Inhibition and/or Angiotensin Receptor Blockade on Tissue Expression of the SARS‐CoV‐2 Receptor ACE2 in Mice

The angiotensin‐converting enzyme 2 (ACE2) is an established receptor and entry point for the novel SARS‐CoV‐2 coronavirus, as the spike protein on the viral envelope binds the ACE2 receptor. Published histological profiling revealed ACE2 to be highly expressed on human lung alveolar epithelial cells and on enterocytes of the small intestine, as well as on arterial and venous endothelial cells. Given the widespread abundance of ACE2 across tissues, there has been much speculation regarding whether ACE inhibitors (ACEi) and/or Angiotensin Receptor Blockers (ARB) might alter tissue ACE2 expression and thereby change the risk of transmission or development of severe complications. Therefore, the aim of this ongoing study is to measure the impact of ACEi and ARB singly and in combination versus placebo control on tissue distribution of ACE2 in male and female mice.A factorial design was employed with the following exposures: ACEi (lisinopril, 10 mg/kg/day), ARB (losartan, 10 mg/kg/day), both drugs, or water control. Drugs were delivered via drinking water. C57BL/6J Mice were 8 weeks of age at the start of the experiment. After 21 days of treatment, four mice (two males and two females) from each treatment group were euthanized, followed by perfusion and tissue collection. 12 more untreated mice were combined with the placebo group to increase the sample size of this reference group to 16 (8 males, 8 females). ACE2 protein abundance in brain, kidney, liver, lung, and small intestine was measured by ELISA (Abcam) and normalized to BCA‐measured total protein. Two‐way ANOVA was performed to test for differences in ACE2 levels by organ or sex among untreated mice; Mann‐Whitney tests were performed to compare each drug treatment group to the control group.Among untreated mice, ACE2 levels differed by organ (p < 0.01), but there were no differences between males and females for a given organ (p = 0.20). Males and females were combined for subsequent analyses. After 21 days of treatment, ACEi, ARB, and the combination therapy lowered ACE2 tissue abundance compared to untreated mice in the brain (ACEi p = 0.04; ARB p = 0.04; ACEi+ARB p = 0.01), kidney (ACEi p = 0.03; ARB p = 0.02; ACEi+ARB p = 0.02), and lung (ACEi p = 0.01; ARB p = 0.01; ACEi+ARB p = 0.01). ACEi, but not ARB or combination therapy, lowered ACE2 tissue abundance in the liver (p = 0.02). None of the treatments changed ACE2 tissue abundance in the small intestine.These results indicate that ACEi, ARB, or combination therapy reduces levels of ACE2, the SARS‐CoV‐2 receptor, in key tissues affected by the virus, including lung, kidney, and brain. An ongoing validation study will evaluate ACE2 protein and gene expression at earlier time points, as well as after discontinuation of treatment. These results will provide valuable insight into the risk or potential benefit of starting or stopping ACEi, ARB, or combination therapy during the COVID‐19 pandemic.

Predictive Value of Clinician "Gestalt" in Pediatric Community-Acquired Pneumonia.

Validated prognostic tools for pediatric community-acquired pneumonia (CAP) do not exist. Thus, clinicians rely on "gestalt" in management decisions for children with CAP. We sought to determine the ability of clinician gestalt to predict severe outcomes. We performed a prospective cohort study of children 3 months to 18 years old presenting to a pediatric emergency department (ED) with lower respiratory infection and receiving a chest radiograph for suspected CAP from 2013 to 2017. Clinicians reported the probability that the patient would develop severe complications of CAP (defined as respiratory failure, empyema or effusion, lung abscess or necrosis, metastatic infection, sepsis or septic shock, or death). The primary outcome was development of severe complications. Of 634 children, 37 (5.8%) developed severe complications. Of children developing severe complications after the ED visit, 62.1% were predicted as having <10% risk by the ED clinician. Sensitivity was >90% at the <1% predicted risk threshold, whereas specificity was >90% at the 10% risk threshold. Gestalt performance was poor in the low-intermediate predicted risk category (1%-10%). Clinicians had only fair ability to discriminate children developing complications from those who did not (area under the receiver operator characteristic curve 0.747), with worse performance from less experienced clinicians (area under the receiver operator characteristic curve 0.693). Clinicians have only fair ability to discriminate children with CAP who develop severe complications from those who do not. Clinician gestalt performs best at very low or higher predicted risk thresholds, yet many children fall in the low-moderate predicted risk range in which clinician gestalt is limited. Evidence-based prognostic tools likely can improve on clinician gestalt, particularly when risk is low-moderate.

Streptococcus agalactiae (Group B Streptococcus) – An Uncommon Cause of Postpartum Spinal Epidural Abscess

Spinal epidural abscess is a medical emergency because of the possible development of severe complications, including irreversible paralysis. The most common infecting pathogen is Staphylococcus aureus. Streptococcus agalactiae (Group B haemolytic streptococcus, GBS) has infrequently been described

Admission levels of Soluble Urokinase Plasminogen Activator Receptor (suPAR) are Associated with the Development of Severe Complications in Hospitalised COVID-19 Patients: A Prospective Cohort Study

ObjectiveTo examine the association between plasma levels of the soluble urokinase plasminogen activator receptor (suPAR) and the incidence of severe complications of COVID-19. Methods403 RT-PCR-confirmed COVID-19 patients were recruited and prospectively followed-up at a major hospital in the United Arab Emirates. The primary endpoint was time from admission until the development of a composite outcome, including acute respiratory distress syndrome (ARDS), intensive care unit (ICU) admission, or death from any cause. Patients discharged alive were considered as competing events to the primary outcome. Competing risk regression was used to quantify the association between suPAR and the incidence of the primary outcome. Results6.2% of patients experienced ARDS or ICU admission, but none died. Taking into account competing risk, the incidence of the primary outcome was 11.5% (95% confidence interval [CI], 6.7–16.3) in patients with suPAR levels >3.91 ng/mL compared to 2.9% (95% CI, 0.4–5.5) in those with suPAR ≤3.91 ng/mL. Also, an increase by 1 ng/mL in baseline suPAR resulted in a 58% rise in the hazard of developing the primary outcome (hazard ratio 1.6, 95% CI, 1.2–2.1, p = 0.003). ConclusionsuPAR has an excellent prognostic utility in predicting severe complications in hospitalised COVID-19 patients.

Identification of People with Diabetes Treatment through Lipids Profile Using Machine Learning Algorithms.

Diabetes incidence has been a problem, because according with the World Health Organization and the International Diabetes Federation, the number of people with this disease is increasing very fast all over the world. Diabetic treatment is important to prevent the development of several complications, also lipid profile monitoring is important. For that reason the aim of this work is the implementation of machine learning algorithms that are able to classify cases, that corresponds to patients diagnosed with diabetes that have diabetes treatment, and controls that refers to subjects who do not have diabetes treatment but some of them have diabetes, bases on lipids profile levels. Logistic regression, K-nearest neighbor, decision trees and random forest were implemented, all of them were evaluated with accuracy, sensitivity, specificity and AUC-ROC curve metrics. Artificial neural network obtain an acurracy of 0.685 and an AUC value of 0.750, logistic regression achieve an accuracy of 0.729 and an AUC value of 0.795, K-nearest neighbor gets an accuracy of 0.669 and an AUC value of 0.709, on the other hand, decision tree reached an accuracy pg 0.691 and a AUC value of 0.683, finally random forest achieve an accuracy of 0.704 and an AUC curve of 0.776. The performance of all models was statistically significant, but the best performance model for this problem corresponds to logistic regression.

PEPTIC ULCER BLEEDING. ANALYSIS OF TREATMENT RESULTS AND CAUSES OF ADVERSE OUTCOME

The article analyzes the results of treatment of patients with peptic ulcer bleeding in two clinics. One of the main reasons for the adverse outcomes of treatment is rebleeding. Early identification of patients with a high risk of rebleeding will allow timely preventive measures to be taken and avoid the development of severe complications, which ultimately will reduce mortality. The use of endoscopic hemostasis in patients with ulcerative bleeding in routine practice can reduce the number of operations, total and postoperative mortality.

Extragenital endometriosis with lesions of the small and large intestine, the formation of a pathological cavity draining to the anterior abdominal wall (case report)

Extragenital endometriosis is one of the most severe benign diseases of the female reproductive system, characterized by different site of target organs. This pathology is associated with the development of severe complications, the treatment of which requires a multidisciplinary approach. This case report is dedicated to the experience of treating a patient with a history of multiple surgical procedures and long-term undiagnosed deep infiltrative endometriosis, complicated by abdominocutaneus endometriotic fistula.

ФЕТАЛЬНЫЕ ВНУТРИЖЕЛУДОЧКОВЫЕ КРОВОИЗЛИЯНИЯ: СЕРИЯ КЛИНИЧЕСКИХ НАБЛЮДЕНИЙ

Fetal intraventricular hemorrhage (IVH) is a severe injury to the immature fetal brain in the prenatal period with the development of severe complications that significantly aggravate the postnatal neurological prognosis of the child. Timely antenatal diagnostics of FIVH allows to route a pregnant woman to a level 3 maternity facility and provide specialized neurological and neurosurgical care to the child. This report presents 4 clinical observations of fetal IVH, which required neurological and neurosurgical support of children in the postnatal period.

Ischemic stroke at a young age on the context of chronic myeloleukosis

The article describes the clinical search for diagnosis and treatment of a patient who developed a severe ischemic stroke at a young age, when specifying the cause of which chronic myeloleucosis was identified. The unavailability of patient compliance and non-compliance with the recommended examination at the outpatient stage led to the development of severe complications. It would seem that the diagnosis of chronic myeloid leukemia, which does not represent excessive complexity, with the development of an acute condition in a young patient, such as an ischemic stroke, results in a complex diagnostic search, complicated by developing comorbidities due to general decompensation of the body.

Neoplastic potential for malformations of the development of ecto- and mesodermal structures

Introduction.Malformations of ecto- and mesodermal structures represent various forms of abnormality of intrauterine systemic and local morphogenesis, arising at different times of embryonic development due to environmental factors, genomic, chromosomal or gene mutations. Dysregulation of cellular functions due to mutations and accumulation of defective proteins initiates tumor transformation of tissues e.g. hereditary diseases of ectomesodermal origin phakomatosis (hamartomatosis).&#x0D; The aim of the studywas to determine organ specificity, clinical manifestations, morphological features and the degree of progression of tumors of the nervous system and internal organs in hereditary diseases of ectomesodermal origin.&#x0D; Materials and methods.103 patients with hereditary phakomatosis were examined. All of them underwent a comprehensive clinical imaging examination, including magnetic resonance imaging, echocardioscopy, ultrasound examination of the abdominal organs, kidneys, retroperitoneal space, and computed tomography of the abdominal cavity and lungs.&#x0D; Results.The reason for the treatment of patients was the occurrence of focal neurological symptoms, focal and/or generalized epileptic seizures. Clinical manifestations were determined by the form of the disease. The risk of the development and progression of various neoplasms is the highest in neurofibromatosis type III, tuberous sclerosis, neurocutaneous melanosis, multiple endocrine neoplasia, angiomatosis of HippelLindau, Louis-Bar . Favorable benign and stable course, low malignant potential are distinguishing characteristics of pigment-vascular phakomatoses type IV.&#x0D; Conclusion.Knowledge of the clinical manifestations of various malformations of the skin, blood vessels, and the nervous system associated with tumor growth in cells and tissues is practically significant. Early diagnosis and the use of modern technologies of conservative and surgical treatment allow achieving a predictable result, prevent the development of severe complications, and significantly improve the quality of life of patients with this pathology.

Rare clinical observation of primary tracheal cancer

The article describes a clinical example of primary adenoid cystic carcinoma of the trachea, characteristics of its clinical course, diagnosis and the choice of treatment. We noted the non-specificity of complaints and clinical manifestations of tracheal cancer, the period between its beginning and diagnosis, the development of severe complications in the respiratory and cardiovascular systems due to the long asymptomatic course of the disease, the need for an integrated approach by various specialists in the treatment of such a complex category of patients. An approach to the surgical treatment of tracheal cancer is described taking into account its extension to the subglottic larynx, which required laryngeal extirpation. We showed the possibility of radical treatment of patients with tracheal cancer in large medical centers with such specialists as head and neck cancer surgeons, thoracic surgeons, endoscopists, anesthesiologists and resuscitators, therapists, radiologists, and chemotherapists.

SARS-CoV-2 Infection in Cancer Patients: Effects on Disease Outcomes and Patient Prognosis.

Simple SummaryCancer patients are a highly vulnerable subgroup in this coronavirus disease 2019 (COVID-19) pandemic. This crisis has dramatically disrupted the continuous care provided to cancer patients, as well as diagnostic and therapeutic procedures. Thus, studies that help gain insights into COVID-19 prevalence, disease severity, prognosis, and clinical outcomes in cancer patients are of great importance. In this review, we outline the current knowledge of disease outcomes and prognoses for cancer patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and learn if the severity is exacerbated by cancer type, anticancer therapies, gender, behavioral risk factors (e.g., smoking, alcohol consumption), and comorbidities. Our article will help clinicians determine cases where treatment can be postponed during the pandemic and will encourage further research to better understand the impact of SARS-CoV-2 infection on cancer patients.The severity of coronavirus disease 2019 (COVID-19) symptoms and outcomes vary immensely among patients. Predicting disease progression and managing disease symptoms is even more challenging in cancer patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cancer therapies, including chemotherapy, radiotherapy, and immunotherapy, often suppress the immune system, rendering cancer patients more susceptible to SARS-CoV-2 infection and the development of severe complications. However, data on the effects of immunosuppression on COVID-19 outcomes in cancer patients remain limited. Further investigations are warranted to better understand the implications of SARS-CoV-2 infection in cancer patients, particularly those that are immunocompromised. In this review, we outline the current knowledge of the effects of SARS-CoV-2 infection in cancer patients.