Manifestations Of Syndrome Research Articles

Telerehabilitation Guidelines for Patients with Breast Cancer

This article provides a comprehensive analysis of the current developments in telerehabilitation, focusing on the regulatory and legal frameworks for delivering telerehabilitation services, the clinical manifestations of postmastectomy pain syndrome, and the role and significance of the International Classification of Functioning, Disability, and Health (ICF) in the telerehabilitation of patients with breast cancer (BC). The document also explores telerehabilitation interventions for BC. A detailed description of the software and hardware tools is provided, including the structural and functional overview of the Telerehabilitation Platform (TRP), software modules such as "Telerehabilitation," "Medical Reports," the Administrative Subsystem, the Information-Analytical Subsystem, which encompass the PM&R physician’s digital workspace, the PM&R Expert Subsystem, and the Patient’s digital workspace. It also covers existing and prospective scales for evaluating the effectiveness of telerehabilitation, as well as the specifics of working with identified patients in accordance with the eHealth (Electronic Healthcare System of Ukraine) requirements. The guidelines conclude with organizational and methodological aspects for implementing telerehabilitation programs, including initial and stage-specific rehabilitation assessments, basic ICF sets, and various patient-specific telerehabilitation programs. These include a patient-centered program for the preoperative stage of telerehabilitation and individualized programs for the post-acute and long-term phases. The eight appendices include questionnaires, physical therapy programs, protocols, diaries, and requirements for the equipment and staff of the telerehabilitation/telemedicine office, among other resources.

Chronic pelvic pain syndrome in women of reproductive age: An observational cohort clinical ultrasound study

Background. The annual number of new cases of chronic pelvic pain syndrome in women of reproductive age is increasing worldwide. The high prevalence of this condition among the able-bodied female population leads to higher state expenditures on the treatment of this category of patients. New methods of diagnosis and early prophylaxis contribute to reducing economic burden associated with chronic pelvic pain syndrome in women and improving health of the female population as a fundamental demographic factor.Objectives. To determine somatic, obstetric-gynecological, anatomical, and psycho-emotional predictors of chronic pelvic pain syndrome.Methods. An observational cohort clinical and ultrasound study involved 60 patients of reproductive age. The study was conducted on the basis of the clinic for women, Voronezh City Outpatient Clinic No. 1 — clinical base of the Department of Obstetrics and Gynecology No. 2, Voronezh State Medical University named after N. N. Burdenko, Russia. According to clinical and laboratory data, the participants were divided into 2 groups. Group 1 (n = 30) included women of reproductive age without clinical manifestations of chronic pelvic pain syndrome; Group 2 (n = 30) enrolled women of reproductive age clinically diagnosed with chronic pelvic pain.Results. The mean age of the study participants in the main group comprised 27.4 ± 6.30 and 26.3 ± 7.25 years in the control group, p > 0.05. Diseases of gastrointestinal tract, endocrine, cardiovascular, musculoskeletal and urinary systems, as well as neurocirculatory and vegetative disorders prevailed in the structure of somatic pathology in the main group, p < 0.001. Analysis of obstetric and gynecologic anamnesis revealed no statistically significant differences in the incidence of gynecologic pathology in the study groups. However, according to the detailed analysis of the delivery history of the participants, 23 patients of the main group (76 %) and 3 patients (6.6 %) of the control group underwent episiotomy during labor, p < 0.001. The evaluation of the comparison groups in terms of pain component in myofascial syndrome involved the pain rating index, number of selected descriptors, sensory index of the selected descriptors, emotional index of the selected descriptors, and pain intensity. Statistically significant differences were revealed for all of the above indicators, thereby confirming a reliable picture of pathopsychological changes in the compared groups of women. The analysis of the ultrasound parameters of topographic and anatomical relationships demonstrated the relevant change in the following parameters: urethral length, diameter of the external urethral sphincter, angle between the external urethra and the body of the bladder, direct and transverse dimensions of the levator hiatus in the studied groups under the muscle tension.Conclusion. An issue of early diagnosis and prophylaxis of chronic pelvic pain syndrome in women of reproductive age remains urgent and requires interdisciplinary participation of medical specialists. The development of new approaches to ultrasound evaluation of pelvic floor will increase the effectiveness of therapeutic and prophylactic measures and reduce the economic burden of this nosology in the morbidity structure of the able-bodied female population.

Anticipated prehospital decision delay in response to different symptom clusters in acute coronary syndrome: Results from the Spanish Cardiobarometer study

Background and objectiveReducing patient decision delay – the time elapsed between symptom onset and the moment the patient decides to seek medical attention – can help improve acute coronary syndrome survival. Patient decision delay is typically investigated in retrospective studies of acute coronary syndrome survivors that are prone to several biases. To offer an alternative approach, the goal of this research was to investigate anticipated patient decision delay in the general population in response to different symptom clusters. MethodsWe developed scenarios representing four commonly experienced symptom clusters: classic (chest symptoms only), heavy (a large number of very intense symptoms including chest pain), diffuse (mild symptoms including chest pain), and weary (mild symptoms without clear chest involvement). The scenarios were administered in random order in a representative survey of 1002 adults ≥55 years old from the non-institutionalized general population in Spain. We measured help-seeking intentions, anticipated patient decision delay (waiting >30 min to seek help), and symptom attribution. ResultsPatient decision delay was most common in the diffuse scenario (55%), followed by the weary (34%), classic (22%), and heavy (11%) scenarios. Attributing the symptoms to a cardiovascular cause and intentions to call emergency services were least frequent in the weary and diffuse scenarios. Women were less likely to intend to seek help than men in the classic (OR = 0.48, [0.27, 0.85], diffuse (OR = 0.67, [0.48, 0.92]), and weary (OR = 0.66, [0.44, 0.98]) scenarios, despite being more likely to attribute symptoms to cardiovascular causes. Participants with traditional cardiovascular risk factors (e.g., diabetes, hypercholesterolemia, hypertension) reported faster help-seeking, whereas participants with obesity and history of depression were more likely to delay. DiscussionThe diverse manifestations of acute coronary syndrome generate fundamentally different appraisals. Anticipated patient decision delay varies as a function of socio-demographic characteristics and medical history, supporting findings from studies with patients who experienced ACS. Measuring anticipated patient decision delay in the general population can help reveal potential barriers to help-seeking and capture effects of population interventions.

Features of the course of menopause in women under chronic stress: An observational cohort study

Background. Functional processes in the female organism at the stage of reproductive function failure in menopause attract considerable interest of researchers. The paper presents a study of great medical, biological and social importance into reproductive function failure in women living in the territories with permanent military operations for a long time and, thus, suffering from post-traumatic syndrome, which significantly affects the character of menopause. Objectives. To identify the features of menopausal syndrome in women who have been living under chronic stress (6–8 years) in the zone of ongoing military operations, namely in the Donetsk and Luhansk People’s Republics, and in women from Rostov Oblast — the region free from active military operations.Methods. An observational cohort study involved 60 women (refugees), long-term residents of the territories with ongoing military operations and 60 long-term residents of the territories without military operations, aged 50–65 years, with clinical manifestations of menopausal syndrome; all women were patients of the Research Institute of Obstetrics and Pediatrics, Rostov State Medical University. In accordance with the Stages of Reproductive Aging Workshop (STRAW+10) classification and clinical manifestations of menopause, two clinical groups (n = 30) were formed from the representatives of each region of residence. Group I included 30 women, aged 50–55, from the Donetsk and Luhansk People’s Republics, who had late menopausal transition (stage -1 of STRAW+10) and menopausal syndrome. Group II involved 30 postmenopausal patients (stages +1 and +2 of STRAW+10), aged 60–65, with menopausal syndrome. Group 1 enrolled 30 residents of Rostov Oblast, aged 50–55, who had late menopausal transition (stage -1 of STRAW+10) and menopausal syndrome, group 2 included 30 postmenopausal patients (stages +1 and +2 of STRAW+10), aged 60–65, with menopausal syndrome. Modified menopausal index was considered as the main indicator of the study. Statistical data processing was carried out by means of Statistica 10.01 (StatSoft, USA), Microsoft Excel 2010 (Microsoft, USA), IBM SPSS 24.0 (IBM, USA), and MedCalc (MedCalc Software, Belgium).Results. Long-term female residents of the territories with ongoing military operations were reported to develop menopausal syndrome more often. Rostov Oblast female residents in the late menopausal transition revealed a statistically significant prevalence of a mild degree of menopausal syndrome in 63.3 % of cases compared to 36.7 % of a similar severity of menopausal syndrome in residents of the Donetsk and Luhansk People’s Republics. Meanwhile, women from the Donetsk and Luhansk People’s Republics were indicated with moderate menopausal syndrome in 50.0 % of cases in late menopausal transition and severe syndrome in 33.3 % in postmenopause versus 23.4 % and 10 % of women from Rostov Oblast, respectively. The intensity of neurovegetative and psycho-emotional disorders in women of both regions increases with the aging process of the reproductive system and appears most pronounced in the postmenopausal period.Conclusion. Residents of the Donetsk and Luhansk People’s Republics, who live in the war zone and are exposed to constant threat to life, develop post-traumatic syndrome which significantly intensifies and modulates the already existing functional and hormonal restructuring in the brain subsystems during perimenopause. Non-uniform functional shifts at different levels of the central nervous system under conditions of chronic stress lead to a significant change in intracerebral processes and to an increase in the occurrence and severity of various dysfunctional deviations.

Kurarinol restrains non-alcoholic fatty liver disease-associated hepatocellular carcinoma (HCC) progression by suppressing EGFR signaling

Non-alcoholic fatty liver disease (NAFLD) is a hepatic manifestation of metabolic syndrome and a key factor for hepatocellular carcinoma (HCC) development. As a metabolic hepatic damage, there is still a lack of efficient therapy for NAFLD-HCC. Kurarinol (KUR) is a flavanone extracted from the root of Sophora flavescens, and exerts excellent hepatoprotective and lipid-lowering activities. But its potential on NAFLD-HCC still remains unclear, and thus was explored in our present study. Firstly, in vitro experiments revealed that KUR treatments markedly reduced lipid deposition and inflammatory response in hepatocytes under palmitate and oleic acid stimulation (PO) with decreased expression levels of fatty acid synthesis markers including fatty acid synthase (FASN), stearoyl-CoA desaturase-1 (SCD1) and sterol receptor element binding protein-1 (SREBP-1). Importantly, the proliferation of HCC cell lines was strongly limited by KUR in a dose-dependent manner. Of note, PO stimulation accelerated the proliferative capacity of HCC cells, whereas being significantly suppressed by KUR. Mechanistically, we found that epidermal growth factor receptor (EGFR) and its phosphorylation protein expression levels were highly down-regulated in hepatocytes and HCC cell lines under PO stimuli. More importantly, the functions of KUR to restrain lipid accumulation and HCC cell proliferation were diminished upon EGFR overexpression, confirming that EGFR suppression was necessary for KUR to treat NAFLD-HCC. Murine mouse models were finally established by the use of diethylnitrosamine (DEN) with high-fat/high-cholesterol diet (HFHC) feeding to determine the role of KUR in NAFLD-HCC. Oral gavage of KUR efficiently suppressed NAFLD-HCC formation in mice, as evidenced by the decreased tumor number and loading. KUR also ameliorated lipid accumulation, liver dysfunction, fibrosis and HCC cell proliferation in DEN/HFHC-challenged mice, along with decreased EGFR expression. Collectively, KUR may be an effective strategy for NAFLD-HCC prevention via EGFR signaling suppression.

Management of carcinoid heart disease

Carcinoid Heart Disease (CaHD) is defined as the constellation of all cardiac manifestations that occur in patients with carcinoid tumors. Cardiac manifestations are generally due to the paraneoplastic effects of vasoactive substances secreted by carcinoid tumors. These primarily cause cardiac valve dysfunction and resultant heart failure. Successful management of patients with CaHD requires a multidisciplinary team to address both the classical manifestations of carcinoid syndrome, as well as the additional manifestations of cardiac dysfunction. While the cornerstone of medical management for carcinoid syndrome are somatostatin analogs (SSAs), there is no evidence to suggest that the usage of SSAs influences the development or progression of CaHD. Additionally, while liver-directed therapies provide a survival benefit to symptomatic carcinoid syndrome patients with resectable disease, there are conflicting data on the survival benefit of hepatic resection among patients with CaHD. Cardiac surgery in patients with CaHD is a complex undertaking, and is the only definitive treatment for symptom management in CaHD with significant survival benefit for patients in advanced disease states. Two crucial surgical decisions to be made are determining which valve(s) should be replaced, and what prosthetic should be utilized. While challenging in this often medically frail population, cardiac surgery confers a survival benefit and should be pursued in cases of symptomatic CaHD or progressive right ventricular dysfunction.

TP53 variants underlying pediatric low-hypodiploidy B-cell acute lymphoblastic leukemia demonstrate diverse origins and may persist as a hematopoietic clone in remission.

Pediatric low-hypodiploidy B-cell acute lymphoblastic leukemia (LH-ALL) with TP53 variants has been proposed to be considered a manifestation of Li-Fraumeni syndrome (LFS). However, our study demonstrates that of the majority the pathogenic variants in the TP53 gene are somatic (70.5%), and only 12.5% of patients with germline fulfilled the criteria of LFS. We also describe the first case of hypodiploid BCP-ALL with a mosaic pathogenic mutation in TP53 and the first case of the persistence of clonal hematopoiesis with the TР53 gene mutation in the child during 3-year minimal residual disease-negative remission, similar to what has been described in adults.

Successful treatment of acute promyelocytic leukemia with initial hyperleukocytosis, differentiated syndrome and massive intracranial hemorrhage in a child

Introduction. The development of hemorrhagic syndrome at the onset of the disease in patients with acute promyelocytic leukemia (APL) is one of the main causes of therapy failures and the most common cause of death in the early stages of remission induction. The risk of severe hemorrhagic complications increases in patients with the microgranular APL variant, often accompanied with hyperleukocytosis.Aim — to present a clinical case of successful diagnosis and treatment of primary APL with initial hyperleukocytosis in a patient with massive intracranial hemorrhage and differentiated syndrome.Main findings. A clinical observation of the diagnosis and treatment of APL in a 13-year-old patient with initial hyperleukocytosis, massive intracranial hemorrhage and differentiation syndrome is presented. Data on the variable manifestations of hemorrhagic syndrome in patients with APL and its effect on survival outcomes are also given. Diagnostic criteria and approaches in the treatment of differentiation syndrome are presented on the example of a clinical observation, when early clinical diagnosis and timely initiation of special antitumor treatment in the intensive care unit made it possible to achieve clinical, hematological and molecular remission, avoiding the fatal consequences of massive intracranial hemorrhage.

Metabolic associated fatty liver disease (MAFLD): assessing the knowledge and practice of primary care doctors in Seremban District, Negeri Sembilan.

Metabolic-associated fatty liver disease (MAFLD) is the liver manifestation of metabolic syndrome, which is commonly seen in primary care settings. This study aimed to determine the knowledge and practice of primary care physicians regarding MAFLD in Seremban District, Negeri Sembilan. This cross-sectional study was conducted among medical officers in 14 health clinics in Seremban District, using a validated, self-administered online questionnaire. A total of 240 medical officers from 14 health clinics in Seremban District, participated in this study. Most participants (85.4%) passed the knowledge test. Their practice was acceptable, but only a minority were familiar with non-invasive testing of liver fibrosis (e.g. APRI or FIB-4), medication and specific diet for the treatment of MAFLD. Most primary care physicians in Seremban District are knowledgeable in identifying risk factors and managing patients with MAFLD. However, there are still areas to improve in terms of management, particularly regarding the use of silymarin, vitamin E and pioglitazone.

Papulonodular Lesions in Photo Exposed Areas as First Manifestation of IgG4-Related Disease

IgG4-related disease (IgG4-RD) or IgG4 syndrome is a chronic inflammatory condition of presumed autoimmune etiology, affecting mainly men in their sixth decade of life. It has a good prognosis following instituted treatment and is characterized by infiltration of IgG4 + plasma cells, predominantly in the pancreas, bile duct, lymph nodes, kidneys, retroperitoneum, lungs and salivary, parotid, submandibular and lacrimal glands. Skin manifestations of IgG4 syndrome are uncommon but should be known to the dermatologist. This report details arare case of IgG4 syndrome involving cutaneous and lymph nodes. A 53-year-old woman described a 15-year history of erythematous and pruritic papulo-nodular lesions, mostly in photoexposed areas of the face, neck and upper limbs. She explained that the lesions evolved with ulceration, healing and residual dyschromia. Furthermore, she reported relapsing lymphadenomegaly 2 years ago, primarily in the cervical, axillary and inguinal chains.

Unlocking Cholesterol Metabolism in Metabolic-Associated Steatotic Liver Disease: Molecular Targets and Natural Product Interventions.

Metabolic-associated steatotic liver disease (MASLD), the hepatic manifestation of metabolic syndrome, represents a growing global health concern. The intricate pathogenesis of MASLD, driven by genetic, metabolic, epigenetic, and environmental factors, leads to considerable clinical variability. Dysregulation of hepatic lipid metabolism, particularly cholesterol homeostasis, is a critical factor in the progression of MASLD and its more severe form, metabolic dysfunction-associated steatohepatitis (MASH). This review elucidates the multifaceted roles of cholesterol metabolism in MASLD, focusing on its absorption, transportation, biosynthesis, efflux, and conversion. We highlight recent advancements in understanding these processes and explore the therapeutic potential of natural products such as curcumin, berberine, and resveratrol in modulating cholesterol metabolism. By targeting key molecular pathways, these natural products offer promising strategies for MASLD management. Finally, this review also covers the clinical studies of natural products in MASLD, providing new insights for future research and clinical applications.

Pathophysiological Relationship between Type 2 Diabetes Mellitus and Metabolic Dysfunction-Associated Steatotic Liver Disease: Novel Therapeutic Approaches.

Type 2 diabetes mellitus (T2DM), often featuring hyperglycemia or insulin resistance, is a global health concern that is increasing in prevalence in the United States and worldwide. A common complication is metabolic dysfunction-associated steatotic liver disease (MASLD), the hepatic manifestation of metabolic syndrome that is also rapidly increasing in prevalence. The majority of patients with T2DM will experience MASLD, and likewise, individuals with MASLD are at an increased risk for developing T2DM. These two disorders may act synergistically, in part due to increased lipotoxicity and inflammation within the liver, among other causes. However, the pathophysiological mechanisms by which this occurs are unclear, as is how the improvement of one disorder can ameliorate the other. This review aims to discuss the pathogenic interactions between T2D and MASLD, and will highlight novel therapeutic targets and ongoing clinical trials for the treatment of these diseases.

Approbation and validation of Russian version of the interstitial cystitis symptoms and problem index

BACKGROUND: Improving the effectiveness of diagnosing and treating patients with primary bladder pain syndrome is crucial in current urology owing to the high prevalence of the condition, its significant impact on the quality of life, and the similarity of its clinical manifestations to other diseases. The clinical manifestations of primary bladder pain syndrome is typically evaluated using specialized questionnaires, with one of the most commonly utilized being the Interstitial Cystitis Symptoms and Problem Index. AIM: This study aimed to validate the Russian version of the Interstitial Cystitis Symptoms and Problem Index and thus assess its reliability and validity in accurately measuring the symptoms and problems associated with interstitial cystitis. MATERIALS AND METHODS: The study included 62 participants and divided them into two groups. Group A included 32 patients diagnosed with primary bladder pain syndrome, comprising 26 women and 6 men, with an average age of 55 years. Group B consisted of 30 conditionally healthy volunteers, comprising 20 men and 10 women, with an average age of 46 years. All participants were required to complete the Russian version of the Interstitial Cystitis Symptoms and Problem Index, Pelvic Pain and Urgency/Frequency (PUF) scale, and International Prostate Symptom Score (IPSS) and maintain a voiding diary. Additionally, patients with PBPS underwent cystoscopy with bladder hydrodistention. Data collected from the participants were utilized to determine the internal consistency, external validity, and test–retest reliability of the questionnaires using the interclass correlation coefficient. RESULTS: The mean of the Interstitial Cystitis Symptoms and Problem Index total in group A was 31.55 ± 7.07, which significantly (p 0.001) exceeded the score of group B (2.90 ± 1.47). The Cronbach’s alpha of the total and “ICSI” and “ICPI” domains was 0.990, 0.834, and 0.854 respectively, confirming the high internal consistency of the Russian version of the Interstitial Cystitis Symptoms and Problem Index. External validity was verified by the relevant correlations with other questionnaires. Moreover, the total score of the questionnaire correlated with the clinical manifestations of primary bladder pain syndrome, the presence of Hunner’s lesions, and bladder capacity. CONCLUSIONS: The study findings indicate that the Russian version of the Interstitial Cystitis Symptoms and Problem Index exhibits good validity and reliability. Therefore, it can be recommended for use in clinical practice as an effective tool for assessing symptoms and problems associated with interstitial cystitis.

Comparison of clinical and serological features in thrombotic antiphospholipid syndrome patients, with and without associated systemic lupus erythematosus, followed for up to 42 years: A single centre retrospective study.

To assess the impact of concomitant systemic lupus erythematosus (SLE) on the clinicopathological manifestations of thrombotic antiphospholipid syndrome (APS). This single-centre, retrospective study compared clinical and antiphospholipid antibody (aPL) data from 118 patients, 58 with SLE-associated APS (SLE-APS), and 60 with primary APS. Median follow-up was 13.9 (IQR 7.7-19.3) and 8.6years (3.5-10.6) for the SLE-APS cohort and PAPS cohort, respectively. Age at diagnosis of APS was lower in the SLE-APS cohort (mean 35.9 vs PAPS: 46.7years; p < 0.05). Distribution of aPL subtypes was similar across cohorts. 198 thrombotic events were identified overall (index plus recurrent), with venous thromboembolism (VTE) and arterial thrombosis each occurring in just over half of patients in both cohorts. Microvascular thrombosis (12.1% vs 0%), and a mixed (any combination of venous, arterial and microvascular) thrombotic phenotype (19.0% vs 6.7%, p = 0.05) were more prevalent in SLE-APS patients. Recurrent thrombosis incidence rates (∼0.5 events/10-patient years), and Kaplan-Meier recurrence-free survival after index thrombosis, were similar. In the PAPS cohort, only: (i) triple-aPL-positivity was associated with a significantly higher recurrent thrombosis event rate (incidence rate ratio 2.22, p = 0.03) and lower recurrence-free survival after first thrombosis (log-rank test p = 0.01); (ii) lupus anticoagulant (LA)-positivity was associated with higher prevalance of arterial thrombosis (RR 2.69, p = 0.01), and lower prevlance of VTE (RR 0.48, p < 0.001), versus LA-negativity. Concomitant SLE does not appear to modify long-term recurrent thrombosis risk, or aPL phenotypes, in patients with APS. Triple-aPL-positivity and LA-positive status may have less influence on thrombotic outcomes in patients with SLE-APS compared to PAPS.

Osteonecrosis as a manifestation of Long-COVID Syndrome: a systematic review.

Purpose SARS-CoV-2 is an RNA virus responsible for COVID-19 pandemic. Some authors described the set of persistent symptoms COVID-related as "Long-COVID Syndrome." Several cases of post-COVID-19 osteonecrosis (ON) are described. Our primary aim was to study the hypothetical correlation between SARS-CoV-2 infection and ON; our secondary aim was to understand if ON can be considered part of Long-COVID. Materials and methods We performed a systematic review following the Preferred Reporting Items for Systematic Reviewers and Meta-analysis (PRISMA) guidelines. Because COVID-19 is a recently described disease, we included all levels of evidence studies. We excluded studies lacking specification regarding the use of corticosteroids (CCS) and studies not related to COVID-19. The variables extracted were age, sex, risk factors, affected joints, signs and symptoms, magnetic resonance imaging (MRI) and X-ray features, histology, treatment of COVID-19, dose and duration of treatment with CCS, treatment of ON, follow-up, and treatment outcome. Results A total of 13 studies were included, involving 95 patients and 159 joints. Time between the diagnosis of COVID-19 and the onset of symptoms related to ON was 16weeks on average. Time between the onset of symptoms and the MRI was 6weeks. An average of 926.4mg of prednisolone equivalent per patient were administered. On average, CCS were administered for 20.6days. Conclusions Patients with a history of COVID-19 infection developed osteonecrosis prematurely and with a lower dose of CCS than usually reported in the literature. Symptoms of osteonecrosis occur within the interval of the period described as Long-COVID. Surgeons should not underestimate the persistence of arthralgia when a history of SARS-CoV-2 infection and use of CCS is reported.

The burden of steatotic liver disease

The steatotic liver disease is one of the most common etiologies of chronic liver diseases, especially in developed countries. It is in direct correlation with the prevalence of the metabolic syndrome and the western lifestyle. Thus, we aimed to study the impact of fatty liver disease globally, depending on geographic distribution, age, gender, and associated risk factors, using the searche engines PubMed and Google Scholar. It has been observed that steatotic liver disease is a globally prevalent disease, which is more common in men and post-menopausal women, suggesting the protective role of female sex hormones. Steatotic liver disease is also considered the hepatic manifestation of the metabolic syndrome, being frequently diagnosed among patients with type 2 diabetes and/or obesity. The increased incidence of the disease was also noted in children, overweight / obese adolescents. Steatotic liver disease is a burden both for the patient and society as a whole, requiring the need for screening and early diagnosis.

Clinical evaluation of the efficiency of combined phytotherapy in the postoperative period in patients with uterus cancer

As it is well known, that operative procedures which influence on ovary functions and relieve the patient of some suffering and danger from diseases, are realized by pronounced changes in hormonal self-regulation, homeostasis disturbance, deep psycho-emotional disorders, which leads to a change in the quality of life, an increased risk of long-term complications development (cardiac vascular pathology, osteoporosis, etc.).Some authors explain the changes in neurovegetative and endocrine homeostasis after hysterectomy not only by the insufficient development of collateral blood flow, but also by the removal of one of the links of the self-regulatory system – APUD – the uterine system, which causes the disorders in hypothalamic-pituitary-ovarian relationships. Menopausal symptoms with the appearance of neurovegetative, psychoemotional disorders, urological disorders, sexual dysfunction, as well as metabolic manifestations do not always provide an opportunity to assess the parameters of a woman’s health, which are combined into the concept of quality of life.The article presents the results of a study on the use of Cimicifuga racemosa for the treatment and prevention of post-hysterectomy syndrome in patients with uterine cancer in the postoperative period.The objective: to study the clinical effectiveness of the drug, which contains the estrogen receptor modulator Cimicifuga racemosa, in patients after surgical treatment for hormone-dependent uterine tumors.Materials and methods. The study included 50 uterine cancer patients after hysterectomy. 30 patients (main group) of them had rehabilitation therapy in the postoperative period (postoperative antibacterial prophylaxis, analgesic therapy, vaginal sanation) and, starting from the second month, they additionally received a herbal preparation with an extract of Cimicifuga racemosa, 1 tablet 1 time a day for 4 months.The control group included 20 women who received only rehabilitation therapy after surgery.Quality of life was assessed after 6 months of therapy based on a comprehensive assessment using the modified MENQOL scale and the study of such important indicators as energy, sleep, emotional reactions, social isolation, physical activity, and pain.All types of statistical processing were performed using the standard package «Statistica for Windows – 10».Results. The use of selective combined herbal therapy of the post-hysterectomy syndrome in patients with hormone-dependent tumors after 6 months of treatment leads to a decrease in the frequency of hot flashes by 63.3%, profuse sweating by 63.4%, sleep disturbances by 43.3%, increased fatigue by 40.0%, depressive disorders – by 36.7% and irritability – by 33.3%.Additional use of the herbal preparation with Cimicifuga racemosa extract reliably (p&lt;0.05) reduces the manifestations of post-hysterectomy syndrome, improves the quality of life, is well tolerated and has no side effects.Conclusions. The use of selective combined herbal therapy in the postoperative period in patients with cancer of the uterine body allows to reliably improve the quality of life of patients and reduce the clinical manifestations of post-hysterectomy syndrome, which is especially relevant in patients with cancer of the uterine body, for whom replacement hormone therapy is contraindicated. Selective herbal therapy is well tolerated by patients and can be used for a long time.

Pediatric SAPHO syndrome with pleural effusion: case report of a unique finding in a rare disease.

Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome is a rare autoinflammatory disease characterized by bone inflammation and skin manifestations including acne, palmoplantar pustulosis, psoriasis, or hidradenitis suppurativa. SAPHO syndrome is considered on the same spectrum as chronic nonbacterial osteomyelitis/chronic recurrent multifocal osteomyelitis (CNO/CRMO), the former often being the nomenclature in adults and the latter in children. The diagnosis is made on patterns of clinical manifestations and is a diagnosis of exclusion. While skin and bone manifestations are commonly described with SAPHO syndrome, pleural involvement is rare, and few cases have been described in the literature, especially in pediatric patients. Herein we present a 14-year-old female with a past medical history of hidradenitis supprtiva, eczema, psoriasis, and a prior episode of culture-negative osteomyelitis who presented to the emergency room with chief complaints of right sided pain with inspiration and back pain. Exam revealed palmoplantar pustulosis, hidradenitis supprativa, psoriasis, and tenderness of vertebrae. Imaging showed a right sided pleural effusion and multiple sites of osteitis. Laboratory evaluation revealed elevated inflammatory markers, an exudative pleural effusion with neutrophilic predominance, and no evidence of malignancy, infection, or immunodeficiency. The patient was diagnosed with SAPHO syndrome and treated with naproxen, methotrexate, and golimumab with significant improvement including resolution of the pleural effusion. Pediatric SAPHO syndrome is a rare disease that classically causes osteitis and skin manifestations. This case highlights that pleural effusion can be a rare manifestation of pediatric SAPHO syndrome. Patients with suspected SAPHO syndrome with respiratory symptoms should be evaluated for pleural effusion.

Post-COVID-19 syndrome: a discussion of onset timing

Introduction. Post-COVID syndrome (alternatively: chronic COVID syndrome, post-acute sequelae of COVID-19, long-haul COVID, long COVID, PASC, CCS) is a state of permanent or permanent presence of symptoms of a pathological process after COVID-19. Currently, there is no consensus on the timing of the onset of post-COVID-19 syndrome. The purpose of this study was to analyze the appearance of some post-COVID symptoms 1, 2 and 3 months after infection with the SARS-CoV-2 virus. Materials and methods. The analysis of clinical and laboratory data of 59 medical workers who had a mild or moderate form of COVID-19 was carried out. Three groups were formed: with the assessment of post-COVID-19 changes 1 month after the onset of the disease; with the detection of changes after 2 months; and with the detection of dysfunctions after 3 months. Results and discussion. It was found that 57.7% of respondents complained of fatigue, weakness, sleep disorders in the first month of observation. After 2 months, the frequency of complaints decreased by 42.3%, and by 3 months it increased again by 15.6%. A month after COVID-19, several cases were recorded when employees were unable to perform any, even very light, work. However, by 3 months of follow-up, 96.2% of the surveyed declared full recovery of efficiency. The appearance of muscle, joint, and spinal pain was reported more often in the first month after COVID-19, then the number of complaints decreased by half to 23–25% of the total number of observations. The assessment of the severity of the infection among the respondents of the three groups did not reveal significant differences between the data in 1, 2 and 3 months after COVID-19. Conclusion. An analysis of some post-COVID symptoms showed that in mild and moderate COVID-19, manifestations are observed 1, 2 and 3 months after infection with the SARS-CoV-2 virus. Multidirectional change dynamics were revealed, more often accompanied by a decrease in the manifestation of post-COVID syndrome 2 months after coronavirus infection, which may create a false impression of an absence of signs of post-COVID syndrome during this period.

Fatty liver as a risk factor for cardiovascular diseases: retrospective analysis of data from patients of the Geriatrics Clinic of University Clinical Hospital in Wrocław

Non-alcoholic fatty liver disease (NAFLD) is currently the most common liver disorder affecting about 25% of the global population. The causes of its development include poor diet, low physical activity, overweight, obesity, older age, diabetes, and lipid disorders. Non-alcoholic fatty liver disease is identified by some researchers as a hepatic manifestation of metabolic syndrome. It has been observed that patients with NAFLD have an increased risk of cardiovascular events, as well as a higher number of deaths from myocardial infarction compared to the general population. A retrospective analysis was conducted on the data of 237 patients diagnosed with hepatic steatosis, treated in the Department of Geriatrics at the University Clinical Hospital in Wrocław from 2019 to 2022, focusing on coexisting overweight, obesity, and concomitant diseases. Laboratory results and the degree of left ventricular muscle hypertrophy were analyzed. Parameters assessed by echocardiography, including interventricular septal thickness in diastole (IVSd), left ventricular posterior wall thickness in diastole (LVPWd), and IVSd + LVPWd/2, were used to evaluate left ventricular hypertrophy. Data from 237 patients were analyzed: 79 men (age: 77.2±7.1 years) and 158 women (age: 78.4±7.7 years). Body mass index (BMI) values for men and women were 30.5±5.0 kg/m² and 31.9±5.6 kg/m², respectively. There was a positive correlation between BMI and the degree of left ventricular hypertrophy for the parameters IVSd (ρ = 0.36, p < 0.001), LVPWd (ρ = 0.36, p < 0.001), and IVSd + LVPWd/2 (ρ = 0.38, p < 0.001). The study demonstrated a moderate positive correlation between BMI and the degree of left ventricular hypertrophy in patients diagnosed with hepatic steatosis. These findings indicate the necessity of actively searching for cardiovascular risk factors, including the evaluation of echocardiographic parameters in patients with NAFLD. Med Pr Work Health Saf. 2024;75(3):223-231.