Gastrointestinal Pathology Research Articles

Deep convolutional neural networks for filtering out normal frames in reviewing wireless capsule endoscopy videos

Wireless capsule endoscopy (WCE) has emerged as a valuable non-invasive technique for visualizing the entire gastrointestinal (GI) tract. However, manual evaluation of WCE videos is a time-consuming and costly process. In this study, we present a novel diagnostic assistant system that employs deep convolutional neural networks (DCNNs) to accelerate the evaluation process. Our primary objective is to achieve a high negative predictive value (NPV), which is essential for the efficient identification of normal frames. Six distinct DCNN models were developed and implemented with this objective in mind. The models were trained on a limited dataset encompassing common GI pathologies that reflect real clinical scenarios. Each DCNN architecture comprises a convolutional part derived from renowned pre-trained networks and a custom-designed classifier block optimized for high NPV and classification accuracy. Following a comprehensive assessment utilizing the 5-fold cross-validation approach, the VG_BFCG model was identified as the most effective, exhibiting an average test accuracy of 0.946 and an NPV of 0.983. Moreover, in the event of encountering novel pathologies not present in the training data, our models exhibited robustness in NPV, which is of great importance for practical applications. For example, the DN_BFCG model demonstrated consistent performance, with an NPV exceeding 0.99 across a range of new pathologies. This validates the reliability of our models in clinical settings. Our findings suggest that our developed DCNN architectures have the potential to enhance the efficiency and accuracy of WCE video analysis, which could transform the landscape of gastroenterological diagnostics.

The significance of chronic hyperglycemia for the reduced efficacy of eradication therapy in patients with type 2 diabetes mellitus and for Helicobacter pylori survival

Aim: This study aims to determine the significance of chronic hyperglycemia for the reduced efficacy of eradication therapy in patients with type 2 diabetes mellitus (T2DM) and Helicobacter pylori (H. pylori)-associated upper gastrointestinal tract pathology as well as for H. pylori survival. Methods: A prospective randomized study with the participation of 180 patients (87 men and 93 women) with H. pylori-associated upper gastrointestinal pathology was carried out. Ninety of these patients were with T2DM and 90 were without diabetes mellitus (DM). The patients were divided into 4 groups of 45 patients: the group 1 included non-diabetic patients treated with the classical triple eradication scheme; the group 2 included patients with T2DM treated with the classical triple eradication scheme; the group 3 included non-diabetic patients treated with bismuth quadro-therapy; the group 4 included patients with T2DM treated with bismuth quadro-therapy. The presence of H. pylori and evaluation of eradication efficacy was carried out using the Helix breath test. Results: The effectiveness of 1st line anti-Helicobacter therapy was higher (88.2%) in patients without diabetes in comparison with the group of patients with concomitant T2DM (74.7%). The efficacy of classical triple eradication therapy in patients with concomitant T2DM was 69.1%, and quadro-therapy was 80.5%. There was significantly lower effectiveness (P < 0.017) of eradication therapy in patients with T2DM and glycated hemoglobin (HbA1c) level ≥ 7.0% as compared with the group of patients in whom the target (≤ 6.5%) level of HbA1c was achieved. Conclusions: Chronic hyperglycemia has a favorable effect on the viability of H. pylori bacteria in patients with T2DM. A hypothesis explaining the reduced efficacy of eradication therapy in patients with hyperglycemia has been proposed.

Analysis of the structure of comorbidity in children with gastrointestinal tract pathologies

Diseases of the gastrointestinal tract take the second place in the structure of somatic pathology in children and adolescents. The number of cases of comorbid pathology also tends to increase. The combination of the most common diseases can be both random and causal relationship, the determination of which is important for improving the health care of the child population.
 Objective — to analyse of comorbidities in children with gastrointestinal diseases based on the results of the city specialized children’s gastroenterological department work.
 Materials and methods. The performance indicators of Kharkiv City Children’s Clinical Hospital No19 for the period from 01.01.2019 to 31.12.2019 were studied. During 2019, 2633 children aged 5 to 18 years (average age: 10.6±2.9 years) with diseases of the digestive system were hospitalized.
 Results. The presence of comorbidity was established in 73.6% of children. The most common among children with diseases of the gastrointestinal tract were manifestations of diseases of the nervous system — 31.8%. Diseases of the endocrine system — 15.4% and cardiovascular system — 15.7% were equally represented. A fairly common pathological condition in patients with gastrointestinal diseases was anemia, which was established in 8.1%. Visual impairment was found in 2.7% children, which coincides with the prevalence of this pathology among the general children’s population.
 Conclusions. The leading place is held by the gastroduodenal pathology, notably chronic gastroduodenitis. The presence of comorbidity from other organs and systems was established in 73.6% of children with gastrointestinal diseases. The most common comorbidity in diseases of the gastroduodenal zone are diseases of the nervous system. The greatest chances of combining pathological conditions with the development of comorbid pathology are diseases of the gastroduodenal zone and nervous system, intestines and autoimmune thyroiditis, gastroesophageal reflux diseases and obesity. The results suggest the necessity of additional examination of children with gastrointestinal pathology in order to early diagnosis of comorbidity and provide the required comprehensive assistance.

COVID-19 and gastroenterological pathology. Review

SARS‑CoV‑2 has led to numerous cases of coronavirus disease (COVID‑19) around the world. In addition to fever and respiratory symptoms, some COVID‑19 patients also have manifestations from digestive system. On the other hand, patients with chronic diseases of the gastrointestinal tract (GIT) also suffer from coronavirus disease.
 Objective — to provide an understanding of the characteristics, possible mechanisms and consequences of gastrointestinal damage caused by SARS‑CoV‑2 infection, in particular in patients with gastrointestinal tract pathology.
 Literature search was carried out using such databases as Scopus, Web of Science. Clinical studies of patients with COVID‑19 have shown that gastrointestinal (GI) symptoms such as anorexia, nausea, vomiting, abdominal pain and diarrhea precede or follow respiratory syndromes with a frequency of about 10 to 60%. Literary sources were studied regarding the relationship of COVID‑19 and such gastroenterological pathologies as gastrointestinal bleeding, hepatitis, pancreatitis and inflammatory bowel diseases. Lesions of the digestive system both in patients without chronic pathology and with existing diseases, apparently, are associated with a high concentration of angiotensin converting enzyme 2 (ACE2) throughout the entire GIT, including the intestine, liver, and pancreas. Some studies have shown that the spike (S) SARS‑CoV‑2 protein has a high affinity for human ACE2, while SARS‑CoV‑2 mainly enters cells through the ACE2 receptor. In addition, endothelial injury and thrombus inflammation and dysregulated immune responses may contribute to extrapulmonary manifestations of COVID 19. This requires an appropriate correction of the diagnostic search and therapy.

Bovine nebovirus infection (review)

Animal husbandry is one of the main agricultural industries in most countries over the world as well as in the Russian Federation, and its profitability is determined by three main factors: the animal genetic potential, complete diet and freedom from infectious, invasive and mass non-infectious diseases. One of the most significant and difficult tasks is to generate and rear healthy young cattle. Digestive disorders clinically manifested by diarrhea resulting in apparent dehydration, toxemia, enophthalmos, membrane pathology, immunodeficiency and metabolic disorders are prevalent among neonatal calf diseases in early postnatal period. Massive diarrhea in neonatal calves is characterized by significant polymorphism, involving a wide range of various factors including genetic, physiological, sanitary and hygienic as well as infectious factors. Infectious agents are the main causes of massive gastroenteritis in neonatal calves. In most cases viruses serve as triggers for gastrointestinal pathology development and bacteria play the secondary role. For a long time, rotaviruses, coronaviruses and pestiviruses have been believed to play the main role in etiology of massive neonatal calf diarrhea. In recent years, a number of new and understudied viruses, including kobuvirus, nebovirus, norovirus, torovirus and astrovirus, have been detected in fecal samples from diarrheic calves and their role in diarrhea development has not been definitively determined. Their role as primary pathogens, coinfection agents or commensals remains unclear. Recently these animal pathogens have widely spread in different countries of the world. At the end of the XX century – beginning of the XXI century, large numbers of cattle were imported to the Russian Federation, including cattle from the nebovirus-infected countries. Data on nebovirus infection (occurrence, pathogen characteristics, disease clinical signs and epizootological features) are given in the paper.

The impact of bariatric surgery on admissions for gastrointestinal complications and conditions associated with obesity: A nationwide study.

Obesity worsens various gastrointestinal pathologies. While bariatric surgery ameliorates obesity, it substantially modifies the gastrointestinal system depending on surgery type, with limited data on subsequent impact on obesity-related gastrointestinal admissions. Using the 2012-2014 Nationwide Readmission Database, we included individuals with obesity who received vertical sleeve gastrectomy (VSG), Roux-en-Y gastric bypass (RYGB), or hernia repair (HR-control surgery). Our main focus was the adjusted odds ratio (aOR) for gastrointestinal inpatient admissions within 6months following surgery compared to the 6months preceding it, while controlling for several confounding factors. Gastrointestinal admissions were grouped into postoperative complications or obesity-associated gastrointestinal conditions. Our cohort included 140,103 adults with RYGB, 132,253 with VSG, and 12,436 HR controls. Postoperative gastrointestinal complications were most common after RYGB, prominently obstruction (aOR=33.17, 95%CI: 18.01, 61.10), and Clostridium difficile infection (aOR: 12.52, 95%CI: 6.22, 25.19). VSG also saw significantly increased but less frequent similar conditions. Notably, for gastrointestinal conditions associated with obesity, acute pancreatitis risk was higher post-VSG (aOR=6.26, 95%CI: 4.02, 9.73). Post-RYGB patients were most likely to be admitted for cholelithiasis with cholecystitis (aOR: 4.15, 95% CI: 3.24, 5.31), followed by chronic liver disease (aOR: 3.00, 95% CI: 2.33, 3.87). The risk of noninfectious colitis admissions was threefold higher after RYGB and VSG. No gastrointestinal conditions showed an increase after HR. Despite weight loss, bariatric surgery was associated with an increased risk of hepato-pancreatobiliary and colitis admissions related to obesity in the first six postoperative months, with considerable variations in rates of gastrointestinal conditions by surgery type.

The structure of gastrointestinal tract pathology in patients receiving hemodialysis treatment

BACKGROUND. Hemodialysis patients are characterized by a wide range of concomitant diseases, including cardiovascular, bone mineral, nutritional, cognitive, various metabolic disorders and anemia. Meanwhile, gastrointestinal tract disorders in these patients remains largely unexplored. Patients receiving treatment with programmed hemodialysis are characterized by a wide range of concomitant diseases, including cardiovascular, bone mineral, nutritional, cognitive, various metabolic disorders and anemia. Meanwhile, the pathology of the gastrointestinal tract in this category of patients remains largely unexplored.AIM: to investigate the structure of digestive diseases in patients receiving hemodialysis treatment.PATIENTS AND METHODS. This study included 180 hemodialysis patients. The median age was 60[47;68] years. Gastrointestinal Symptoms Questionnaire (GSQ) was used to evaluate gastrointestinal symptoms over the last month. The results of abdomen ultrasound, gastroscopy, colonoscopy, and complex laboratory examination were also analyzed.RESULTS. The overall prevalence of gastrointestinal symptoms was 77.2 % (139/180). The most frequent complaints were constipation (46.8 %) and abdominal pain (41 %). The most common stool frequency was one bowel action per day. The third, fourth, fifth type of stool according to the Bristol Stool Form Scale were noted by the majority of participants. Abdominal ultrasound revealed diffuse liver changes in 115 (63.9 %), signs of cirrhosis – in 7(3.9 %) patients. Ultrasound pathology of the gallbladder was represented by anomalies of its shape in 11.1 %, signs of chronic cholecystitis – in 10 %, stones (sludge) – in 7.2 %, polyps – in 2.2 % of patients. Diffuse changes in pancreatic parenchyma, steatosis, pseudocysts and dilatation of the main pancreatic duct were diagnosed respectively in 39(21,7 %), 21(11,7 %), 10(5,6 %) and 3(1.7 %) hemodialysis patients. According to 154 gastroscopies, the most common endoscopic finding in the stomach was chronic gastritis, detected in 86(55.8 %) of the subjects. Erosive gastritis was diagnosed in 22(14.3 %), gastric ulcer – in 3(2.0 %) patients. Endoscopic duodenal pathology was represented by erythematous duodenitis in 53(34.4 %), erosive duodenitis in 15(9.7 %), ulcer in 2(1.3 %), duodenal bulb abnormalities in 23(14.9 %) patients. Combined gastric and duodenal lesions were found in 88(57.1 %) patients. Сolonoscopy was performed in 56 patients, of whom 15 (26.8 %) had signs of colitis (mainly sigmoiditis), 2(3.6 %) – diverticulitis, 10(17.9 %) – diverticulosis, 12(21.4 %) – colon polyps, 8(14.3 %) – angiodysplasia mucosa, in 3(5.4 %) – dolichocolon. Despite the abundance of gastrointestinal symptoms and instrumental findings, no significant deviations in laboratory parameters (including an increase in AST, ALT, total bilirubin, amylase, lipase) were found.CONCLUSION. Hemodialysis patients are characterized by a high prevalence of gastrointestinal symptoms and various pathological changes in the gastrointestinal tract, the diagnosis and treatment of which require an individual multidisciplinary approach.

Alternative therapy for pregnant and breastfeeding women with gastro-intestinal pathology in psychiatric practice

Introduction. Drug treatment during pregnancy and breastfeeding period presents certain risks, especially in patients with concomitant mental disorders and somatic pathologies. The purpose of the research was to study the potential effects of medicinal plants and biological supplements during pregnancy and lactation in psychiatric patients with gastro-intestinal pathology. Materials and methods. We analyzed 504 herbs and active biological nutritional supplements including their alternative names: 299 in gastroenterology and 205 in psychiatry. From these, 40 alternative names of plants could be used in gastroenterology and psychiatry and 33 alternative names of plants and active biological nutritional supplements that could be used in psychiatry were selected. Results. Only one herb, damiana (Turnera diffusa), is described as having “no known side effects” during pregnancy and breastfeeding. According to other sources, this herb should not be used during pregnancy and breastfeeding due to the serious risks involved. Another plant Moringa oleifera is found to have multiple protective functions in mental health and gastro-intestinal diseases, being described as potentially safe during pregnancy and breastfeeding, but with specific indications. Conclusions. Prescribing herbs and active biological nutritional supplements during pregnancy and breastfeeding carries certain risks. The information is contradictory, requiring further research and informing patients about the risk-benefit ratio.

Does Virtual Video Endoscopy simulation training aid postgraduate endoscopy trainee learning of pathology in the era of COVID-19?- A single centre experience in a Dublin Teaching Hospital

COVID-19 has had a significant impact on post-graduate gastrointestinal endoscopy education in Ireland. The signature pedagogy of endoscopy education is the hands-on apprenticeship model however this was impeded during the restrictions imposed by the pandemic. To progress endoscopy learning at a time when exposure was reduced, we, as consultant trainers, focused on teaching pathology recognition, a known deficit in the current endoscopy curriculum. A series of five virtual endoscopy simulation sessions consisting of endoscopic videos and pictures demonstrating upper gastrointestinal pathology were taught to six endoscopy trainee specialist registrars in a single Dublin teaching hospital. Pathology quizzes were administered to trainees pre and post undertaking the sessions to measure learning. Semi-structured interviews were used to assess the utility of the sessions and a qualitative analysis of responses was undertaken. Amongst the six trainees, virtual video endoscopy simulation training led to a statistically significant increase in endoscopy trainees’ pathology recognition scores in the post-intervention quiz. All trainees found the virtual video simulation sessions to be useful and relevant to their stage of training, with demonstration of active learning after the teaching sessions. However, the personal and professional effect of the pandemic on trainees was profound, with senior trainees being disproportionally affected. Trainees also identified that the current apprenticeship model for endoscopy learning is no longer fit for purpose. Given the effect of the pandemic on trainee learning it is important that we take a systematic approach to analyse teaching tools that were used during the pandemic to ensure that they are helping trainees reach their learning goals.

Heartburn’s Hidden Impact: A Narrative Review Exploring Gastroesophageal Reflux Disease (GERD) as a Cardiovascular Disease Risk Factor

Gastroesophageal reflux disease (GERD) is a very common disease with an estimated 442 million cases worldwide. It is a well-documented independent risk factor for many gastrointestinal pathologies, however, its role in cardiovascular disease (CVD) is unclear, despite its high prevalence in patients with CVD. Although traditionally considered a causative agent of noncardiac chest pain, a common imitator of cardiac chest pain, or an incidentally shared comorbidity in patients with CVD, a number of studies have implicated GERD and its therapies as risk factors for CVD. This narrative review will explore the relationship between GERD and CVD, including medical and mechanical therapeutic approaches for GERD that could potentially impact the incidence, progression, and mortality of CVD.

Spectrum of Lymphomas involving Gastrointestinal tract in a Single Institution: A Retrospective Analysis

Abstract Introduction/Objective Lymphomas affecting the gastrointestinal (GI) tract are relatively uncommon occurrences. Given that GI biopsies are primarily evaluated by pathologists specializing in GI pathology, a comprehensive understanding of GI lymphomas is essential for accurate diagnosis and appropriate referral. However, there is limited updated studies of the prevalence and distribution of GI lymphoma subtypes in diverse patient populations. Therefore, the objective of this study was to address this knowledge gap by characterizing the prevalence and distribution patterns of GI lymphoma subtypes in a diverse patient population residing in the west coast region. Methods/Case Report A comprehensive retrospective review was conducted on patients diagnosed with lymphomas involving GI tract between 2015 and 2023 at a single institution over 8 years. Clinical and pathological data, including age, gender, tumor locations, and histological diagnoses, were collected and analyzed. Results (if a Case Study enter NA) A total of 32 cases diagnosed with lymphomas involving GI tract were included in this study. The patient population consisted of 44% female and 56% male, with an average age of 61 years (range: 35 to 93 years). The most common tumor locations (figure 1) were the stomach (53%), followed by the duodenum (16%), ileum and colon (8%). The other less frequent locations such as the pancreas, jejunum, and rectum and esophagus (each 3%). Notably, 38% (12 cases) of the total cases exhibited involvement of two or more anatomical sites. Conclusion Our study findings are consistent with previous literature, confirming that Diffuse Large B-cell Lymphoma (DLBCL) remains the most prevalent subtype of gastrointestinal (GI) lymphoma. The high frequency of stomach involvement aligns with the recognized association between Helicobacter pylori infection and lymphomagenesis. However, it is worth noting that the prevalence of MALT lymphoma has decreased, potentially indicating improved eradication efforts through antibiotic treatment. The observed proportion of cases with involvement of multiple anatomical sites highlights the diagnostic challenge of GI lymphomas and emphasizes the need for comprehensive evaluation.

Cardiotoxic effects of antitumor therapy for colorectal cancer

Fluoropyrimidines (5-fluorouracil, capecitabine) are the main chemotherapeutic agents in the treatment of gastrointestinal oncologic pathology. However, therapy with these drugs may be associated with the development of cardiotoxic effects. The article discusses risk factors, the main proven mechanisms of cardiotoxic effects development; possible measures of primary and secondary prevention, peculiarities of fluoropyrimidines cardiotoxicity treatment are outlined. Clinical cases are presented that demonstrate the complexity of the pathophysiological mechanisms of development of fluoropyrimidine (capecitabine) cardiotoxicity and the difficulties of its prediction. In this case, drugs with a vasodilating effect can be effectively used as part of secondary prevention.

Aerogels as Carriers for Oral Administration of Drugs: An Approach towards Colonic Delivery.

Polysaccharide aerogels have emerged as a highly promising technology in the field of oral drug delivery. These nanoporous, ultralight materials, derived from natural polysaccharides such as cellulose, starch, or chitin, have significant potential in colonic drug delivery due to their unique properties. The particular degradability of polysaccharide-based materials by the colonic microbiota makes them attractive to produce systems to load, protect, and release drugs in a controlled manner, with the capability to precisely target the colon. This would allow the local treatment of gastrointestinal pathologies such as colon cancer or inflammatory bowel diseases. Despite their great potential, these applications of polysaccharide aerogels have not been widely explored. This review aims to consolidate the available knowledge on the use of polysaccharides for oral drug delivery and their performance, the production methods for polysaccharide-based aerogels, the drug loading possibilities, and the capacity of these nanostructured systems to target colonic regions.

Cancelled STEMI patients: what happen to them?

Abstract Introduction In the STEMI care network, the number of inappropriate cases sent to cathlab remains high 1. The use of technological innovations to share the diagnostic ECG tracing with the cardiology department has been shown to be effective in improving patient discrimination. Objective Our aim was to study the characteristics and prognosis (at discharge and 1-year follow-up) of patients whose transfer to the cathlab was cancelled. Material and Method Prospective study analysing all STEMI alert activations in 2022. Information on ECG pattern and clinical history was transmitted using an APP (ODiSEA 2-3) and used for cancellation. Patient characteristics, myocardial infarction, ECG activation pattern, angiography results, final diagnosis and clinical events during admission and 1-year follow-up were recorded. Patients who underwent urgent coronary angiography were excluded from the study. Results A total of 406 infarction codes were activated through the ODISEA APP. 122 (30%) of these were cancelled. The characteristics of the patients are shown in Table 1. Reasons for cancellation based on ECG pattern are shown in Figure 1.B. The most common were ST depression (23%) and intraventricular conduction disturbances (22.9%). The final diagnosis was ACS in 32.8% (STEMI 2.5%, NSTEMI 27% and unstable angina 3.3%). In the remaining 67.2%, the final diagnosis was atypical chest pain with negative biomarkers in 22.9%, arrhythmia in 17.2%, pericarditis in 9%, gastrointestinal pathology in 4.9%, heart failure in 4.9%, aortic dissection in 3.2%, PTE in 1.6% and other pathologies in 3.5%. (Figure 1.A). Coronary angiography was performed in 41 patients (33.6%). There were 36.6% with one vessel, 9.8% with two vessels and 22% with three vessels. Percutaneous revascularisation was required in 70% of patients. Discharge from the emergency department occurred in 46% of the patients. Hospital mortality occurred in 14 patients (11.4%). Of these, 3 (2.4%) were due to cardiac causes. Regarding events at 12 months, 6 (4.9%) were deaths (5 natural deaths and 1 due to cancer). 5 patients (4%) had ACS, 3 patients (2.4%) had stroke and 1 patient (0.8%) had digestive bleeding. Conclusions STEMI alert cancelled transfer patients are older, have more comorbidities and are less likely to have a final diagnosis of ACS or to have coronary lesions. They have a high rate of non-cardiovascular in-hospital mortality and a low rate of cardiovascular events at one year of follow-up.A.Final diagnosis. B. ECG patternTable 1.Patients characteristics

Morbidity and Mortality of Newborns with Gastrointestinal Surgical Pathology Admitted to the Neonatology Service of the Vicente Corral Moscoso Hospital

Morbidity and mortality in newborns with gastrointestinal malformations are high, even more so in low- and middle-income countries due to the need for immediate surgical care. However, the literature on these anomalies is scarce in Ecuador. This research aims to increase the registered data on the morbidity and mortality of newborns with gastrointestinal surgical pathology in Cuenca, Ecuador. A descriptive and cross-sectional study was carried out, involving 63 newborns with gastrointestinal surgical pathology admitted to the neonatology service of the Vicente Corral Moscoso Hospital. Data collection was done by reviewing medical records, using a form. The results showed that the mortality rate was higher in 2020. The majority of live newborns had esophageal atresia, they were male, born at term, with middle-aged mothers from urban areas. Of the deceased, the majority had a congenital diaphragmatic hernia, they were children of mothers from rural areas, and half died within 24 hours of being born, mainly from septic shock. In conclusion, the results of this study should not be considered definitive due to the omission of 23 clinical histories; moreover, a low mortality rate is evidenced. It was also observed that they died mainly from septic shock, a preventable cause of mortality from the first level of care with the detection of maternal risk factors.
 Keywords: morbidity, mortality, malformation, surgical neonate.
 Resumen 
 Antecedentes: la morbimortalidad en recién nacidos con malformaciones gastrointestinales es elevada, más aún en países de ingresos medios y bajos debido a la necesidad de atención quirúrgica inmediata, sin embargo la literatura sobre estas anomalías es escasa en el Ecuador. Objetivos: incrementar los datos registrados sobre la morbimortalidad de recién nacidos con patología quirúrgica gastrointestinal en Cuenca, Ecuador. Métodos: se realizó un estudio descriptivo y transversal, participaron 63 recién nacidos con patología quirúrgica gastrointestinal ingresados en el servicio de neonatología del Hospital Vicente Corral Mosoco. La recolección de datos se realizó mediante la revisión de historias clínicas, empleando un formulario. Resultados: la tasa de mortalidad fue mayor, en el año 2020. La mayoría de recién nacidos vivos tenían atresia esofágica, eran hombres, nacidos a término, con madres de edad media, procedentes de zonas urbanas. De los fallecidos, la mayoría tenía hernia diafragmática congénita, eran hijos de madres procedentes de zonas rurales, la mitad murió a las 24 horas de nacido, principalmente de shock séptico. Conclusiones: los resultados de este estudio no deben considerarse como definitivos, debido a la omisión de 23 historias clínicas, se evidencia una baja tasa de mortalidad. También se observó que fallecieron principalmente de shock séptico, una causa de mortalidad prevenible desde el primer nivel de atención con la detección de factores de riesgo maternos.
 Palabras Clave: Morbilidad. Mortalidad. Malformación. Neonato quirúrgico.

Post-COVID-19 immune homeostasis among 50–60 years old men with comorbidities living in the Аrctic region

BACKGROUND: The Northern and Arctic territories are known for their harsh natural and climatic conditions. It is important to prioritize the health of the population in these regions, as people are the primary resource for the Russian Federation’s long-term plans for the development of the Arctic. One unique aspect of immune regulation in the relatively healthy residents of the Arctic region is a decrease in adaptive immunity activity, particularly in the humoral link (HLA-DR+, IgE), alongside heightened cell-mediated cytotoxicity (CD8+). The COVID-19 pandemic has affected all districts of the Arkhangelsk region, further highlighting the importance of health in these remote areas. In addition to common regional pathologies such as upper respiratory tract diseases, inflammatory gastrointestinal pathologies are also prevalent in the Arctic region. AIM: To study cellular immune response in 50–60 years old men with a history of gastrointestinal diseases(erosive gastritis), who have survived the COVID-19 in the Arctic region. MATERIAL AND METHODS: An immunological examination was conducted on 26 men aged 50–60 from Arkhangelsk, who had a history of chronic erosive gastritis in long-term remission and had experienced mild cases of COVID-19. The examination included the determination of leukocytes, lymphocytes, and their phenotypes (CD5+, CD8+, CD10+, CD95+). RESULTS: In men 6–11 months after COVID-19 infection, the adaptive immune response was marked by a deficiency of CD3+ T-cells in 88.5% of cases, elevated concentrations of CD10+ cells in 23.1%, increased levels of leukocytes, lymphocytes, and neutrophils (by 15.4%, 34.6%, 30.8%, respectively), eleveted CD8+ cell-mediated cytotoxicity (65.4%), and an increase in CD95+ cells in 38.5% of the cases. CONCLUSIONS:The cellular immune response observed in the study is characterized by a 65.4% increase in cytotoxicity (CD8+), a significant deficiency of T-lymphocytes (CD3+) in 88.5% of cases, and a low level of phagocytic protection in 38.5% of individuals. These findings indicate a poor prognosis for the recurrence of chronic diseases.

Application of a diagnostic algorithm for differential diagnosis in a patient with recurrent abdominal pain

Introduction Among the diseases of urgent pathology the leading place belongs to acute pancreatitis, which is second only to acute appendicitis and acute cholecystitis. Moreover, a significant share is occupied by mild forms, which account for 85%. In the Clinical Recommendations for Acute pancreatitis in the section “Prevention and dispensary monitoring”, the authors recommend regular dispensary monitoring by a gastroenterologist and a surgeon. However, this nosology according to the Order of the Ministry of Health of the Russian Federation from 03.15.2022 No 168N is not included in the dispensary observation. In this regard, patients remain without proper attention of doctors when they are discharged from hospitals, or when they refuse hospitalization after examination in the emergency room.The aim of the work – is to present the result of applying the diagnostic algorithm of differential diagnosis of diseases and detection of gastrointestinal tract pathology on the clinical example of a patient with recurrent abdominal pain syndrome.Materials and methods The analysis of medical records of a 59-year-old patient who repeatedly applied to the network of polyclinics and hospitals providing emergency specialized medical care for recurrent abdominal syndrome was carried out.Results and discussion In this clinical observation of recurrent abdominal syndrome in a patient, the biliary mask of acute pancreatitis was revealed. In outpatient conditions using the developed diagnostic algorithm, choledocholithiasis, juxtapapillary diverticulum of the duodenum and hernia of the esophageal aperture of the diaphragm were detected. The diagnosis made it possible to perform the treatment competently and lead to the patient's recovery. Thanks to the dispensary observation and additional methods of investigation according to the developed algorithm, the following were detected: juxtapapillary diverticulum of the duodenum, which may not be visualized at video esophagogastroduodenoscopy with direct optics, as well as ductal stones, which are not always visualized at transabdominal ultrasound and are detected at endoscopic retrograde cholangiopancreatography or endoscopic ultrasonography. Difficulties may arise in the diagnosis of gastrointestinal diseases due to the variability of the clinical course and polymorphism of symptoms in this category of patients. Such a course of diseases causes difficulties at the stage of patients' admission to the emergency room of clinics, can lead to diagnostic errors that lead to incorrect treatment tactics.Conclusion The application of an algorithm based on the assessment of clinical criteria in conjunction with instrumental imaging methods and laboratory tests allowed to optimize the diagnostic process and facilitated the choice of optimal therapy and surgical tactics for the treatment of the patient with recurrent abdominal pain syndrome.

Dermatitis herpetiformis and other forms of wheat sensitivity

Wheat sensitivity is acollective term for several, especially gastrointestinal, diseases that occur as part of ahypersensitivity reaction after wheat consumption. The symptoms, which are mostly similar to those of irritable bowel syndrome, are often accompanied by skin lesions. In addition to celiac disease and dermatitis herpetiformis, the cutaneous manifestation of celiac disease, wheat sensitivity also includes nonceliac gluten sensitivity (NCGS), allergic nickel contact mucositis, wheat allergy, amylase-trypsin inhibitor intolerance, and fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) intolerance. This review article aims to provide an overview of the clinical, especially dermatological and gastrointestinal features of the different forms of wheat sensitivity. Diagnosis and therapeutic management are also discussed. Aselective literature search was carried out with evaluation of our own clinical data. The skin lesions in dermatitis herpetiformis are very disease-specific. In contrast, wheat allergy often shares signs and symptoms with many other diseases. Other forms of wheat sensitivity cause primarily gastrointestinal abnormalities, but extra-intestinal manifestations can also occur. Their diagnosis is often complex and requires cross-disciplinary collaboration with experts in gastroenterology. The therapy consists of awheat- or gluten-free diet. Knowledge of the different and frequently occurring dermatological signs of wheat sensitivity is of great importance, because dermatological manifestations associated with gastrointestinal pathology, intolerance reactions, and allergies appear more and more frequently.

Prevalence of gastroenteritis in dogs

Currently, gastrointestinal pathology in small animals reaches up to 50% of the total number of non-communicable diseases and ranks first among them. This article provides a comprehensive examination of the prevalence of gastroenteritis in dogs, offering valuable insights into the frequency and impact of this gastrointestinal ailment in the canine population.

Ultrasonographic Evaluation of Nontraumatic Gastrointestinal Emergencies in Children

AbstractAcute, nontraumatic gastrointestinal pathologies are commonly encountered in the pediatric emergency department. They often pose a diagnostic dilemma with an assemblage of various etiologies, depending on the age and clinical features. Despite the advent of computed tomography, various issues pertinent to children make ultrasonography (USG) the initial imaging modality of choice in investigating acute gastrointestinal pathologies. This article discusses the ultrasonographic approach to acute gastrointestinal pathologies in children, and how sonography is instrumental in guiding diagnosis and treatment. Characteristic USG findings of common pediatric gastrointestinal emergencies—including acute appendicitis, intussusception, Meckel's diverticulitis, midgut volvulus, bowel perforation, and abdominal tuberculosis—are illustrated in this pictorial review.