Lethal Outcome Research Articles

Genes, Antibodies, and Cytokines in Systemic Lupus Erythematosus: Update of Potential Biomarkers

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown aetiology, with the broad range of antibodies affecting various organs and tissues, leading to rapid disability and even to lethal outcome. Our objective was to make an analysis of the results of relevant global studies about genetic mutations, spectrum of antibodies and cytokines involved in the pathogenesis of SLE. The search was conducted in PubMed and Google Scholar platforms using keywords “systemic lupus erythematosus”, “genetic mutations”, “autoantibodies”, “cytokine production”, “sequencing”, “NGS" and "exome". Several genes were found to be involved in the pathogenesis of SLE, the majority of which were associated with B- and T-cell abnormal activation. The results of different studies revealed an association of active SLE with the increase in specific circulating autoantibodies. Based on the results of the current review, a preliminary list of autoantibodies, genes and cytokines associated with the development of SLE was prepared. Future directions will include the assessment of association of genes, antibodies and cytokines in SLE patients from the local Kazakh population, and the development of genetic-immunologic panel for the early diagnosis of this disease.

Effects of palivizumab prophylaxis on respiratory syncytial virus (RSV) infections in Montenegro.

Respiratory syncytial virus (RSV) is one of the most common pathogens causing severe lower respiratory tract disease in infancy and childhood. In newborns, young infants, and in infants with co-morbidities, the risk of severe infection is increased. Current protection against severe RSV infection is immunoprophylaxis with the monoclonal antibody palivizumab. The study aimed to assess the effects of palivizumab prophylaxis in the Republic of Montenegro in comparison to the pre-prophylaxis period. The study was conducted in prospective/retrospective single center format in Montenegro in the Clinical Center of Podgorica, for the period 2009-2019. A total of 104 high-risk infants in the palivizumab prophylaxis program (2014-2019 RSV seasons) and 168 high-risk children without palivizumab prophylaxis (2009-2013 RSV seasons) were enrolled. A total of 51 children (49.0%) received prophylaxis for prematurity, 33 (31.7%) for bronchopulmonary dysplasia (BPD), 13 (12.5%) for hemodynamically significant heart disease/defect (HSCHD), and 7 (6.8%) for "miscellaneous" indications. In the control group most children had prematurity (101, 60.1%), followed by BPD (59, 35.1%), HSCHD (3, 1.8%), and "miscellaneous" (5, 3.4%) conditions. Readmission to the pediatric intensive care units (PICU) due to RSV infection was significantly lower in prophylaxis group (0.0 vs 16.1%, p<0.001). No lethal outcomes were observed in high-risk children with palivizumab prophylaxis compared to 2.4% in the control group. The introduction of RSV immunoprophylaxis as well as other new protective treatment strategies for high-risk newborns led to significant improvements in infant and childcare in Montenegro. This is the first report on palivizumab prophylaxis in Montenegro, demonstrating the effectiveness and safety of palivizumab use in clinical settings.

Fatal case of haemorrhagic fever with renal syndrome

The Far Eastern Federal District comprises an epidemic focus of hemorrhagic fever with renal syndrome (HFRS), where the incidence is determined by two orthohantaviruses: Hantaan (including its variant Amur) and Seoul. In Primorsky Krai, the average long-term incidence rate for 13 years (2011–2023) accounted for 2.7% (in some years up to 4.4% per 100 thousand population), and the mortality rate comprised 3.2% (9.1% in 2018). The distribution of clinical forms of the disease over the past 13 years revealed the prevalence of its moderate forms (66%), severe forms accounted for about 30% of all cases. The study presents a clinical case of severe course of HFRS with lethal outcome in a young male with no concomitant pathology.

Clinical Course of Methylmalonic Aciduria in Siblings: Two Clinical Cases

Background. Methylmalonic aciduria (MMA) is a rare disease from the group of hereditary metabolic diseases. The MMA clinical picture is polymorphic and meanwhile similar to other metabolic disorders. Determination of specific metabolites in biological fluids and molecular genetic testing are crucial to diagnose this disease. Timely diagnosis mainly determines the treatment efficacy and, therefore, the prognosis of MMA development. Clinical case description. Two siblings with MMA caused by methylmalonyl-CoA mutase deficiency (OMIM #251000) have shown duplication chr6-49459106-T-TA: NM_000255.4c.360dupT (p.Lys121fs) in homozygous state in exon 2 of the MMUT gene. The disease was diagnosed in the first child with underlying metabolic crisis that finally led to irreversible changes in organs and systems and lethal outcome. The diagnosis in the second child was established antenatally, thus, therapy was initiated from the first day of life. Favorable clinical course of the disease was observed during 5 months of follow-up. Conclusion. Timely MMA diagnosis (antenatal or during neonatal screening) is crucial for effective management and relatively favorable life prognosis for infants.

Infant Mortality in the Chechen Republic: Comparative Analysis and Major Trends

Background. Despite the clear trend towards infant mortality decrease in our country, there are significant differences in values in some federal districts and regions of Russian Federation. Thus, the assessment of infant mortality rates and health indicators is crucial topic of scientific analysis. Objective. The aim of the study is to investigate selected child health indicators and infant mortality rates in the Chechen Republic. Methods. We have conducted the retrospective cross-sectional study of infant mortality rates, prematurity incidence, infant and newborn morbidity, and mortality of children born sick or got sick. The study was based on the data from official statistics and from the extraction of statistical reporting forms No. 12 and No. 32. Results. The Chechen Republic belongs to the regions with high infant mortality rate, however, it has decreased by 11.6% from 6.9 to 6.1‰ in 2018–2022. The major diseases causing lethal outcomes in infants in this region, and in Russia as a whole, were certain conditions that occur in the perinatal period, and congenital disorders. Meanwhile, mortality from respiratory diseases and some infectious and parasitic diseases exceeded the national average. Prematurity incidence in the republic was 1.5 times lower than the national average, newborns morbidity was 1.7 times lower, infants morbidity was 4.0 times lower. Trend analysis has revealed that prematurity incidence and newborns morbidity have slightly changed over 5 years (+2.2% and –1.0%), while infants morbidity had significant trend (–40.2%). All morbidity rates of children who died at the age under 1 year were significantly lower than the national average for all classes of diseases that are the most common for infants mortality. The mortality rates among children born sick or got sick were on average 5.4 times higher than similar indicators in Russia. The highest mortality rate was observed among children who died from perinatal conditions, congenital disorders, external causes, and some infectious and parasitic diseases. The level of the maternal and child health service performance was 0.44 on average over the 5-year interval, that corresponds to the average level of efficacy. Conclusion. This study has allowed to reveal that there is an urge to improve the organization of medical care for infants in the Chechen Republic.

Lithium levels in drinking water predicted the ratio of attempted to completed suicides in regions with high incidence of affective disorders: Insights from ecological study

IntroductionLithium has demonstrated significant antisuicidal effects: it significantly reduces the high excess overall mortality of patients with affective disorders. MethodsPublic drinking water samples were collected in 53 Lithuanian municipalities during a two-month period. Linear models used lithium level in public drinking water as predictor and ratio of suicide attempts to suicide mortality as outcomes across the municipalities. ResultsLithium in drinking water predicted the ratio of attempted to completed suicides (A/S) nonlinearly, described by a U-shaped curve. The curves for visualization of the association of incidence of affective disorders and suicide standard mortality rate with lithium level displayed significant suicide curve decrements and invers direction in affective disorders curve. Multivariate regression model for ratio A/S in high lithium exposure group (> 7 µg/L, N = 26) suggests that the lithium level can explain 54.3 % of variance of ratio A/S in municipalities with exposure of lithium above median and with high incidence of affective disorders. ConclusionsThe findings provide confirmatory evidence that in municipalities with high incidence of affective disorders higher lithium levels in the public drinking water are associated with higher ratio A/S due to an unchanging number of suicide attempts and due to decreasing suicide lethal outcomes. LimitationsNevertheless, the methods employed detected several factors with well-established associations with suicide. Finally, cohort, prospective or intervention studies are needed to verify the causal inverse relationship of these variables and to speculate the mechanism for this relationship.

Endoscopic Changes of Tracheobronchial Tree Caused by Mucormycosis in Patients with a Novel Coronavirus Infection

The most severe manifestation of COVID-19 is bilateral pneumonia with development of acute respiratory distress syndrome accompanied by cytokine storm, pulmonary edema and death of the patient. In a number of patients, occurrence of mucormycosis of mucous membranes was one of the stages of the lethal outcome development. The arctile presents a clinical case of mucormycosis of the tracheobronchial tree detected by bronchoscopy several days before death in a patient with COVID-19 who was on mechanical ventilation. The endoscopic signs (endoscopic image) are described.

Clinical and epidemiological risk factors associated with hospitalization and mortality rate of COVID-19 patients in Banja Luka County: A retrospective observational cohort study on 40,000 patients.

Since beginning of the coronavirus disease (COVID-19) it became clear that severe forms of this infection have primarily affected patients with chronic conditions. The aim of the study was to explore clinical and epidemiological characteristics associated with COVID 19 outcomes. The retrospective observational study included 40,692 citizens of Banja Luka County, Bosnia and Herzegovina, who were confirmed as reverse transcriptase polymerase chain reaction (RT-PCR) positive on COVID-19 at a primary healthcare centre from March 2020 to September 2022. Epidemiological data were obtained from Web-Medic medical records of patients. The COVID-19 data were obtained from COVID-19 data sheets comprised of patients' RT-PCR testing forms, surveillance forms for severe acute respiratory syndrome coronavirus-2 status, and a map of their positive and isolated contacts. Differences regarding the distributions of patients between groups were analysed using the Pearson chi-square test and Mantel-Haenszel chi-square test for trends, while differences in mean values were compared using an independent sample t-test. The average age of hospitalised patients was significantly higher compared to the age of non-hospitalised patients (P < 0.001). The average age of patients with lethal outcomes was nearly twice as high in comparison to patients with non-lethal outcomes (P < 0.001). Male patients had a higher hospitalization and mortality rate (P < 0.001). The highest hospitalization rate was in patients with chronic renal failure (CRF), diabetes and cardiovascular diseases (CVDs), while the death rate was the highest among patients with CRF and hearth comorbidities. Patients with fatigue and appetite loss had a higher percentage of lethal outcomes. Vaccinated patients had a significantly lower rate of lethal outcome. Clinical symptoms, signs and outcomes, are posing as predictive parameters for further management of COVID-19. Vaccination has an important role in the clinical outcomes of COVID-19.

Mucocutaneous Ulcers Unmasking Severe Systemic Methotrexate Toxicity – A Case-Series and Review of Literature

Abstract Background: Methotrexate is a widely used immunosuppressant with good efficacy and cost-effectiveness. However, one of the drawbacks of methotrexate has been toxicity due to accidental overdose. During the COVID pandemic, there was an alarming increase in the number of patients with methotrexate toxicity which prompted us to do this study. Objective: To evaluate the clinical features and contributing factors in patients presenting with methotrexate toxicity. Materials and Methods: A detailed evaluation of the clinical features, laboratory indices, contributing factors, and outcomes of the patients presenting with methotrexate toxicity was analyzed. Results: A total of 19 cases were seen during the study period. All of the patients had oral mucositis and several developed cutaneous ulcerations. Laboratory abnormalities included cytopenia, transaminitis, and renal impairment. While sixteen patients recovered successfully, three people died as a result of delays in medical assistance. In addition to comorbidities, pandemic-induced restrictions played a major role in patients accidentally overdosing with methotrexate. Conclusion: This study highlights the fact that even low-dose methotrexate taken incorrectly can result in a lethal outcome, which is preventable.

SARS-CoV-2 infection-induced immune thrombocytopenia: a systematic review of current reports.

Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by a low platelet count with increased risk of bleeding, and viral infection may trigger ITP. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection-induced ITP has been increasingly reported. We systemically reviewed the previously reported cases of SARS-CoV-2 infection-induced ITP and identified a total of 105 patients from 68 studies. The median age was 61years, and 14 patients (12%) were < 18years old (pediatric cases). In adult cases, a total of 53% patients were classified as moderate to severe SARS-CoV-2 infection. The median platelet count at diagnosis and nadir were 6,000/µL and 4,000/µL, respectively. When comparing platelet levels between non-severe SARS-CoV-2 infection and moderate to severe SARS-CoV-2 infection, the median values of platelet levels at diagnosis were not significantly different between the groups (4,000/µL in non-severe SARS-CoV-2 infection and 9,000/µL in moderate to severe SARS-CoV-2 infection, p-value = 0.22). Median nadir platelet levels were also not significantly different between groups (4,000/µL in non-severe SARS-CoV-2 infection and 8,000/µL in moderate to severe SARS-CoV-2 infection, p-value = 0.27). More than half of the cases (53 patients) were treated with combination therapy including steroid, intravenous immunoglobulin, and eltrombopag. Major bleeding and intracranial hemorrhage occurred in ten (11%) and six (6.6%) cases, respectively. The overall mortality rate was 7%. In pediatric cases, none of the patients experienced major bleeding and lethal outcomes.

Surviving the Storm: The Role of Poly- and Depolyploidization in Tissues and Tumors.

Polyploidization and depolyploidization are critical processes in the normal development and tissue homeostasis of diploid organisms. Recent investigations have revealed that polyaneuploid cancer cells (PACCs) exploit this ploidy variation as a survival strategy against anticancer treatment and for the repopulation of tumors. Unscheduled polyploidization and chromosomal instability in PACCs enhance malignancy and treatment resistance. However, their inability to undergo mitosis causes catastrophic cellular death in most PACCs. Adaptive ploid reversal mechanisms, such as multipolar mitosis, centrosome clustering, meiosis-like division, and amitosis, counteract this lethal outcome and drive cancer relapse. The purpose of this work is to focus on PACCs induced by cytotoxic therapy, highlighting the latest discoveries in ploidy dynamics in physiological and pathological contexts. Specifically, by emphasizing the role of "poly-depolyploidization" in tumor progression, the aim is to identify novel therapeutic targets or paradigms for combating diseases associated with aberrant ploidies.

Micro–Nanoplastics as Potential Carriers of Dioxins and Toxoplasma gondii in Patients with Carotid Atheromas

A recent major study has shown that there is an increased risk of myocardial infarction, stroke and lethal outcomes in patients affected by carotid atheromas that contain micro-nanoplastics (MNPs) compared to subjects that do not have MNPs in their lesions [...]

What do we know about the perpetrators of sexual homicide of adult victims? A systematic review and qualitative meta-synthesis

Introduction: sexual homicide is defined as lethal violence associated with sexual elements or motivations, predominantly perpetrated by men against women. Despite being a less frequent crime, there is a growing clinical and forensic interest in its specificities and the characteristics of the aggressor. Objective: to review the scientific literature on men who commit sexual homicide against adult victims. Methods: systematic review with MeSH ((“Sex Offenses”[Mesh]) AND “Homicide”[Mesh]) in the databases of MEDLINE, LILACS, MENDELEY and SciELO, between 1992 and 2023. The PICO strategy was used with the studied population (male sexual offenders), intervention (homicide of adult victims), context (sexual violence), and outcome (potential relationship between the issues). The stages of article selection and analysis involved two independent researchers. Original studies were included, excluding reviews, editorials, conference proceedings, books and chapters, theses, and dissertations. The selected articles were presented through qualitative meta-synthesis. Results: of the 70 selected articles, 66 articles (94.2%) adopted quantitative methods, 2 (2.9%) qualitative design, and 2 (2.9%) case reports. We found 41 articles (58.6%) conducted in North America and 22 articles (31.4%) in Europe, totaling 63 articles (90.0%). Another five articles (7.1%) were from Asia, one (1.4%) from Africa, and one (1.4%) from Oceania. In 52 articles (74.3%), there was an emphasis on aspects related to psychiatric, behavioral, or psychological disorders of the perpetrator, sexual sadism, or forms of sexual violence or lethal outcomes employed. Conclusion: sexual homicidal men possess characteristics that set them apart from other homicidal offenders or those who commit sexual violence, directing their crimes towards a heterogeneous group of adult victims. Studies have focused on the psychiatric and behavioral disorders of the perpetrator, as well as the relationship with traumatic experiences in childhood.

Venous thromboembolism in patients with isolated moderate to severe traumatic brain injury

Background. Traumatic brain injury (TBI) remains a big problem of modern neurosurgery, accompanied by high rates of disability and lethality. Venous thromboembolism (VTE) including venous thrombosis and pulmonary embolism (PE) plays a significant role in the structure of mortality in this pathology. Regimens and schemes of pharmacological prevention of VTE in TBI as well as corresponding preventative measures are not yet determined completely.Aim. To identify the frequency of VTE in patients with isolated moderate and severe TBI, and to evaluate the results of prevention and treatment of these complications in patients of this category.Materials and methods. Over a 3‑year period (from 2020 to 2023) 73 patients with isolated moderate and severe TBI (51 men and 22 women, mean age 61.0 ± 13.0 years) were treated in the V. M. Buyanov City Clinical Hospital. Of these, 31 patients received only conservative therapy, and 42 patients underwent surgery (craniotomy with hematoma removal, closed external hematoma drainage, and installation of intracranial pressure sensor). Ultrasound examination of the lower limb veins was performed at patient admission, then every 7 days until discharge from the hospital. Pharmacological prevention of VTE using low molecular weight heparin in non‑surgical patients was started after 1–2 days if computed tomography of the brain 24 h after admission showed no negative hematoma dynamics. Surgical patients were prescribed preventive medications 24 h after surgery if computed tomography confirmed intracranial hemostasis.Results. Venous thrombosis was detected in 22 (30.1 %) of 73 patients. PE complicated the underlying disease in 1 (1.4 %) case and was non‑fatal. There was no fatal PE in the study group. An increase of the initial intracranial hematoma volume occurred in 3 (4.1 %) patients, in 2 (2.8 %) patients the recurrence of hemorrhage occurred before the beginning of heparin administration, and in 1 (1.4 %) case against the background of therapeutic doses of anticoagulants prescribed for venous thrombosis. In the majority of cases (82.0 %; 18 of 22 patients) thromboses were localized in deep veins of the lower leg and were asymptomatic. Intrahospital mortality was 23.3 % (17 patients), all lethal outcomes were due to the course of traumatic brain disease.Conclusion. VTE is a frequent complication of TBI with intracranial hemorrhage. Regular ultrasound diagnostics makes it possible to diagnose asymptomatic distal venous thrombosis in a timely manner and to prescribe therapeutic doses of low molecular weight heparin in time which in turn allows to avoid fatal PE. Currently, there are no clear domestic recommendations for the prevention and, most importantly, for the treatment of these complications in patients with isolated moderate and severe TBI, which requires further active study of this problem.

Hantavirus Infections: Review of the Epidemiological Situation around the World. Analysis of the Epidemiological Situation on Hemorrhagic Fever with Renal Syndrome in the Russian Federation in 2023 and Forecast of Its Development for 2024

The paper describes the epidemiological situation in the countries of the world in terms of the incidence of Hantavirus diseases. The results of an epidemiological analysis of the incidence of hemorrhagic fever with renal syndrome (HFRS) in the Russian Federation in 2023 by federal districts are presented and a forecast for 2024 is made. In 2023, 5 093 cases of HFRS were registered in the Russian Federation (3.47 per 100 thousand population). The incidence was reported in 7 out of 8 federal districts of the country. The age structure was dominated by people in the 30–59 age category (65.7 %); 247 cases of the disease were noted among children under 17 years of age. The proportion of the male population was 70.3 %. 63.2 % of the total number of cases was registered among the urban residents. The mortality rate was at the level of 0.49 % – 25 lethal outcomes. Analysis of the data has revealed a decrease in the incidence of HFRS in Russia by 27.2 % as compared to the previous year. However, the data from epizootiological monitoring and the results of laboratory research of field material indicate a continuing tense situation in the country as a whole. In a number of regions, a high risk of complications of the epidemiological situation is predicted (mainly, in the constituent entities of the Volga and Central Federal Districts). Moderate risks of developing local complications of the epidemiological situation at the level of long-term average morbidity are expected to be realized in the entities of the Northwestern, Ural and Far Eastern Federal Districts. Sporadic cases of the disease in the territory of the Southern Federal District are not excluded. The aggravation of the situation on HFRS in the territory of the North-Caucasian and Siberian Federal Districts is not anticipated in 2024.

The role of cytokine gene polymorphic variants in predicting COVID-19 outcomes

The COVID-19 pandemic has shown that the outcomes of the disease depend on many factors and, above all, genetic mutations in the immune system. A special role in the outcome of COVID-19 is attributed to a defect in the genes of inflammatory cytokines, the excess of which leads to endothelial dysfunction with damage to vital organs, often with lethal outcome. The aim of the study was to investigate polymorphisms of IL-1β (T-31C), TNF-α (G-308A), IL-10 (G-1082A), IL-17(G-197A), IL-4 (C-589T) genes in COVID-19 patients depending on the outcome of the disease. Methods. We examined 142 patients diagnosed with COVID-19, of whom 122 patients ended the disease with recovery (group 1) and 20 patients died (group 2). Polymorphisms of IL-1β (T-31C), TNF-α (G-308A), IL-10 (G-1082A), IL-17(G-197A), IL-4 (C-589T) genes by genetic method were investigated in COVID-19 patients depending on the outcome of the disease. Results. Analysis of IL-1β (Т-31С), TNF-α (G-308A), IL-10 (G-1082A), IL-17(G-197A), IL-4 (С-589Т) gene polymorphisms in COVID-19 patients showed no statistical differences in recovered patients compared to deceased patients. Statistically significant differences were found in IL-10 gene (genotype -1082A/A). It was found to be recorded 3.8 times more frequently in the group of COVID-19 deceased patients compared to recovered patients (p=0.001; OR=1.027). Conclusion. Among the studied polymorphic variants of IL-1β (T-31C), TNF-α (G-308A), IL-10 (G-1082A), IL-17(G-197A), IL-4 (C-589T) genotype -A/A polymorphism of IL-10(G-1082A) was a significant marker of increased risk of COVID-19 lethal outcome, which can be used as a possible predictor of unfavorable outcome of the disease.

Short Registry of Terminal Forms of Chronic Heart Failure in the Samara Region.

To study the clinical characteristics and prognosis of patients with functional class (FC) III-IV chronic heart failure (CHF) who meet the criteria for inclusion in the palliative care program. A short registry of severe CHF forms was conducted at 60 outpatient and inpatient clinics in the Samara region for one month (16.05.2022-15.06.2022). The registry included patients with FC III-IV CHF who sought medical help during that period. Lethal outcomes were assessed at 90 days after the inclusion in the registry using the Mortality Information and Analytics system. 591 patients (median age, 71.0 [64.0; 80.0] years were enrolled, including 339 (57.4%) men, of which 149 (24.1%) were of working age (under 65 years). The main cause of CHF was ischemic heart disease (64.5%). 229 (38.7%) patients had left ventricular ejection fraction &lt;40%. During the past year, 513 (86.8%) patients had at least one hospitalization for decompensated CHF. 45.7% of patients had hydrothorax, and 11.3% of patients had ascites. Low systolic blood pressure was observed in more than 25% of patients; 14.2% required in-hospital inotropic support; and 9.1% received it on the outpatient basis. 4.2% of patients received outpatient oxygen support and 0.8% required the administration of narcotic analgesics. 12 (1.9%) patients were on the waiting list for heart transplantation. In this study, there was an inconsistency in the number of patients with ventricular tachycardia and/or left bundle branch block (LBBB) who were implanted with cardiac resynchronization therapy devices (CRTD) or an implantable cardioverter defibrillator (ICD), a total of 19 patients (11 patients with CRTD and 8 patients with ICD), while 58 (9.8%) patients had indications for CRTD/ICD implantation. Within 90 days from inclusion in the registry, 59 (10.0%) patients died. According to binary logistic regression analysis, the presence of LBBB, hydrothorax, the requirement for outpatient oxygen support, and a history of cardiac surgery were associated with a high risk of death. Patients with severe forms of CHF require not only adequate drug therapy, but also dynamic clinical observation supplemented with palliative care aimed at improving the quality of life, including the ethical principles of shared decision-making and advance care planning to identify the priorities and goals of patients in relation to their care.

Clinical and Therapeutic Intervention of Hypereosinophilia in the Era of Molecular Diagnosis.

Hypereosinophilia (HE) presents with an elevated peripheral eosinophilic count of >1.5 × 109/L and is composed of a broad spectrum of secondary non-hematologic disorders and a minority of primary hematologic processes with heterogenous clinical presentations, ranging from mild symptoms to potentially lethal outcome secondary to end-organ damage. Following the introduction of advanced molecular diagnostics (genomic studies, RNA sequencing, and targeted gene mutation profile, etc.) in the last 1-2 decades, there have been deep insights into the etiology and molecular mechanisms involved in the development of HE. The classification of HE has been updated and refined following to the discovery of clinically novel markers and targets in the 2022 WHO classification and ICOG-EO 2021 Working Conference on Eosinophil Disorder and Syndromes. However, the diagnosis and management of HE is challenging given its heterogeneity and variable clinical outcome. It is critical to have a diagnostic algorithm for accurate subclassification of HE and hypereosinophilic syndrome (HES) (e.g., reactive, familial, idiopathic, myeloid/lymphoid neoplasm, organ restricted, or with unknown significance) and to follow established treatment guidelines for patients based on its clinical findings and risk stratification.

Comparative evaluation of robot-assisted, laparoscopic and open surgical interventions in the combined treatment of stomach cancer

Introduction. Gastric cancer ranks fifth in incidence and fourth in mortality among all oncological diseases worldwide. According to recent clinical data, for stage cT2N0 and beyond, a combined approach using various schemes and regimens of anticancer drug therapy is recommended. Currently, indications for the use of minimally invasive techniques in the surgical treatment of locally advanced gastric cancer are not defined. Research objective. Comparative assessment of the immediate outcomes of robot-assisted, laparoscopic, and open surgical interventions in patients with gastric cancer of different localizations who underwent neoadjuvant polychemotherapy. Materials and methods. The study is based on a retrospective analysis of 81 medical histories of patients with locally advanced gastric cancer of different localizations operated on from 2018 to 2022 in the Department of Abdominal Oncology of City Hospital №40 in St. Petersburg. All patients underwent preoperative cycles of anticancer drug treatment within perioperative polychemotherapy schemes: FLOT – 64 (79%) patients, mFOLFOX6 – 9 (11.1%) patients, and FLOT+Тrastuzumab – 8 (9.9%) patients. Laparoscopic, traditional open, and robot-assisted surgical interventions were performed using the da Vinci surgical system. Results. Thirty-seven (45.7%) robot-assisted operations were performed, (22/27.2% – distal subtotal resections of the stomach (DSRS), 15/18.5% – gastrectomies (GE), 19 (23.5%) laparoscopic (11/13.6% – LDSRS, 8/9.9% – LGE), and 25 (30.9%) operations via laparotomy (9/11.1% – DSRS, 16/19.7% – GE). All patients underwent D2 and D2+ lymphadenectomy. Statistically significant differences were noted in groups for parameters such as operative intervention time, intraoperative blood loss, and length of hospital stay. Open surgical intervention group had significantly higher blood loss volume – median 275 (90.00; 300) ml (p&lt;0.001) and postoperative hospital stay duration – median 10.00 (9.00–14.00) days (p=0.017). Operation time was significantly shorter compared to minimally invasive interventions – median 150.00 (97.50–210.00) minutes for distal resections and 150.00 (96.25–207.50) minutes for GE (p&lt;0.005). There were no statistically significant differences in complication rates (p&gt;0.05) and the number of removed lymph nodes (p=0.334). However, the percentage of early postoperative complications, including lethal outcomes, was higher in the open intervention group (n=4/16%) compared to laparoscopic (n=2/10.5%) and robot-assisted (n=2/5.4%). The overall frequency of postoperative complications IIIA–V according to the Clavien-Dindo classification was 9.9%. One (1.2%) case had a lethal outcome after open gastrectomy. Histological examination showed no tumor growth in the resection margins (R0) for all patients. Complete regression of the gastric tumor (CAP-0) was noted in one case (1.23%) after combined treatment. Nearly complete response to therapy was observed in 13 cases (16%) (CAP-1), partial response in 28 cases (34.6%) (CAP-2), and no response to neoadjuvant therapy in 39 cases (48.1%) (CAP-3). Conclusions. Minimally invasive surgical interventions in the combined treatment of locally advanced gastric cancer are feasible, safe, and oncologically justified. Robot-assisted surgery demonstrates advantages over open and laparoscopic surgery in parameters such as intraoperative blood loss, number of removed lymph nodes, activation and hospitalization periods.

PECULIARITIES OF DIAGNOSTICS AND THERAPEUTIC TACTICS IN BLEEDING IN THE EARLY POSTOPERATIVE PERIOD AFTER BARIATRIC SURGERIES

Methods. We retrospectively analyzed the results of diagnostics and treatment of 14 patients who had internal bleeding in the early postoperative period after bariatric surgeries. The following parameters were studied: age and sex of the patients, average body mass index, comorbidities, volume of the performed bariatric surgery, type of internal bleeding (intraluminal/intra-abdominal), technical peculiarities of each operation, average postoperative bed-day, efficiency of instrumental diagnostic methods, types and methods of hemostasis. Results. Clinical manifestations of bleeding in all patients operated on for morbid obesity were detected on 1-2 postoperative days. The main symptoms: weakness and dizziness - in 12 cases (86%), BP decrease up to 90±60 mmHg. - in 4 (28%), tachycardia (HR 100 and more beats per minute) - in 100% of cases. Development of melena and vomiting with blood admixture was noted in 6 (42%) cases, blood flow by drainage - in 8 (58%). In 4 patients (28%) the development of bleeding was preceded by BP increase up to 180-200/100-110 mmHg. In all 14 patients hemoglobin level decreased: in 6 (42%) not lower than 100g/L (but more than 20% of the initial hemoglobin level), and in 8 (58%) - below 100g/L. Esophagogastroduodenoscopy (EGDS) was used to diagnose bleeding inside the lumen of the stomach, intestine, anastomosis, and computerized tomography (CT) of the abdominal cavity with intravenous and oral contrast for intra-abdominal bleeding. In 6 patients with intra-abdominal bleeding revision laparoscopy was performed as an emergency procedure. When the source of bleeding from the stapler line was revealed, the bleeding zone was additionally sutured with Vicryl 3\0 thread using separate knotted sutures. In case of bleeding from the trocar wound, hemostasis was performed with the help of Bersi needle using 1/0 capron thread.No lethal outcomes were observed. All patients were discharged in satisfactory condition. The average bed-day due to the complication increased on average by 2-3 days. Conclusion. Effective methods of diagnostics and treatment of intraluminal bleedings are endoscopic techniques with the possibility of reliable hemostasis. In case of intra-abdominal bleeding relaparoscopy with stitching or clipping of the bleeding source is shown.