Oligosymptomatic Course Research Articles

Radiochemotherapy in Pancreatic Cancer.

Despite the advancements made in oncology in recent years, the treatment of pancreatic cancer remains a challenge. Five-year survival rates for this cancer do not exceed 10%. Among the reasons contributing to poor treatment outcomes are the oligosymptomatic course of the tumor, diagnostic difficulties due to the anatomical location of the organ, and the unique biological features of pancreatic cancer. The mainstay of treatment for resectable cancer is surgery and adjuvant chemotherapy. For unresectable and metastatic cancers, chemotherapy remains the primary method of treatment. At the same time, for about thirty years, there have been attempts to improve treatment outcomes by using radiotherapy combined with systemic treatment. Unlike chemotherapy, radiotherapy has no established place in the treatment of pancreatic cancer. This paper addresses the topic of radiotherapy in pancreatic cancer as a valuable method that can improve treatment outcomes alongside chemotherapy.

Acquired thrombotic thrombocytopaenic purpura of an atypical, oligosymptomatic course in an adolescent girl – case report

Acquired thrombotic thrombocytopaenic purpura of an atypical, oligosymptomatic course in an adolescent girl – case report

COVID-19 pandemic influence on self-reported health status and well-being in a society

To assess the frequency of persisting symptoms after SARS-CoV-2 infection and assessment of the effects of COVID-19 pandemic on selected parameters of self-reported health status and well-being half a year after the disease. The study population consisted of 3 groups: post-COVID-19 group I—172 patients; group II—172 patients with chronic disease, who have not suffered from COVID-19; group III—81 patients from a population study cohort—Bialystok PLUS. A standardized interview questionnaire was used to collect data in the three groups using the CATI (computer assisted telephone interviewing) technique. Interviews were conducted between October 2020 and January 2021, thus during the second wave of the pandemic in Poland. The subjective state of health in comparison with the state of health before the COVID-19 pandemic deteriorated in COVID-19 convalescents. Patients, who suffered from symptomatic COVID-19 were more prone to nervousness, anxiousness, tension than patients with oligosymptomatic course of the disease. Moreover, anxiety, fear and irritability were more frequent in Group I and II in comparison to Group III, whereas Group I and II did not differ significantly. The decrease in physical activity observed in COVID-19 patients mirrored the changes in general population. The most frequent persistent symptoms after COVID-19 are: general malaise, cough, smell and taste disorder, dyspnea. COVID-19 convalescents who experienced symptomatic disease are more prone to development of nervousness, anxiousness, tension and anxiety than patients with oligosymptomatic course of the disease. Females and younger patients who suffered from COVID-19 are more prone to development of mental distress than healthy population. No significant differences between COVID-19 convalescents and healthy population was observed as far as the attitude towards physical activity is concerned.

Неалкогольная жировая болезнь печени и послеоперационный гипотиреоз у женщин: клинико-патогенетические параллели

Objective – to establish the clinical and pathogenetic patterns of the formation and course of non-alcoholic fatty liver disease in women with postoperative hypothyroidism. Material and methods. In a single-stage study of the "case-control" type of 170 women (Me aged 50 years), anthropometric data, parameters of carbohydrate, lipid, and protein metabolism, liver function tests were studied in the presence and absence of postoperative hypothyroidism. Results. It was found that in 86.2% of women with postoperative hypothyroidism, non-alcoholic fatty liver disease develops mainly in the form of steatohepatosis without distinct functional liver disorders. Insulin resistance and atherogenic dyslipidemia are found in the vast majority of them, the degree of their severity is determined by the presence of excess body weight with android and intermediate types of fat distribution. The greatest diagnostic value in the aspect of the probability of developing non-alcoholic fatty liver disease and metabolic disorders have a body mass index of Ketle and the ratio of the waist to the circumference of the hips. For the detection of metabolic disorders, the most significant insulin resistance index HOMA-IR, HDL, VLDL, ApoB, ApoB/ApoA1 index. Conclusion. In women with postoperative hypothyroidism in 86.2% of cases non-alcoholic fatty liver disease develops mainly in the form of steatohepatosis, characterized by a oligosymptomatic course without distinct functional liver disorders, the development of insulin resistance and atherogenic dyslipidemia, the severity of which is determined by the body mass index and the type of fat distribution

Intralobar Pulmonary Sequestration with Anomalous Artery Arising from the Celiac Trunk

Pulmonary saequestration is a rare congenital malformation characterized by a dysplastic portion of lung parenchyma supplied by an anomalous artery originating from the aorta or its branches. The worldwide incidence of pulmonary sequestration among all congenital lung malformations in children ranges from 1.5% to 6.4%. There are two main types of pulmonary sequestration according to the localization of the malformation, i.e., intrapulmonary sequestration (dysplastic tissue located inside a lobe of the normal lung) and extrapulmonary sequestration. Our case presentation aims to make physicians aware of this rare anomaly which may be difficult to diagnose because of its oligosymptomatic course prior to first presentation. We present the case of a 10-year-old girl who suffered from a second episode of prolonged pneumonia of the left lower lobe. Contrast-enhanced-computed-tomography (CT) scan of the thoraco-abdominal segment of the aorta and its branches revealed intrapulmonary sequestration localized at the left lower lobe of the lung. The intrapulmonary sequester was perfused by a large artery arising from the celiac trunk. The girl underwent open surgery with ligation of the anomalous feeding artery and atypical pulmonary resection of the affected area of the left lower lobe. Postoperatively, the child recovered without any complications.

Laboratory markers included in the Corona Score can identify false negative results on COVID-19 RT-PCR in the emergency room.

After December 2019 outbreak in China, the novel Coronavirus infection (COVID-19) has very quickly overflowed worldwide. Infection causes a clinical syndrome encompassing a wide range of clinical features, from asymptomatic or oligosymptomatic course to acute respiratory distress and death. In a very recent work we preliminarily observed that several laboratory tests have been shown as characteristically altered in COVID-19. We aimed to use the Corona score, a validated point-based algorithm to predict the likelihood of COVID-19 infection in patients presenting at the Emergency rooms. This approach combines chest images-relative score and several laboratory parameters to classify emergency room patients. Corona score accuracy was satisfactory, increasing the detection of positive patients’ rate.

P0171NON COMPLIANCE AND ACUTE DEHYDRATION ARE MAIN REASON FOR ACUTE KIDNEY FAILURE IN NON-INFANTILE PRIMARY HYPEROXALURIA TYPE I (PH I)

Abstract Background and Aims Patients with primary hyperoxaluria type 1 have an increased risk of acute or chronic kidney failure (AKF/CKF). There are two risk groups: first the infantile oxalosis patients with an unremarkable family history and second, the adult patients with only an oligosymptomatic course (minor stone events), who get into end-stage renal disease (ESRD) due to oxalate-induced chronic inflammatory processes in the kidney. We were interested in the prevalence of acute kidney failure in the PH1 patients seen in our Hyperoxaluria Center over the last 10 years. Method We retrospectively analyzed the database of the German Hyperoxaluria Center for those patients being routinely seen in our outpatient clinic for AKF and its specific reason. AKF was defined as patients with a sudden onset of kidney failure and the necessity of dialysis installment, but a documented stable kidney function (no worse than stage 2-3 CKD) prior to onset of AKF. Results Currently, we routinely follow (3-4 times a year) 49 of 117 patients with genetically proven PH1. For the patients not routinely seen, we act as the reference center and primary lab. Out of the 117 PH1 patients, 6 had infantile oxalosis and thus early ESRD; 8 patients are currently on dialysis; and 6 patients have died, 2 patients each either post liver or liver/kidney transplantation (LTx, LKTx), under dialysis or as sudden death, the latter two due to systemic oxalosis. Transplantations were performed in 35 patients with PH1 (LKTx in 28 patients, LTx in 4 patients and 3 had an isolated kidney transplantation). Out of the 49 PH1 patients we routinely follow, AKF was diagnosed in 8 patients aged 11-56 years (one pediatric patient, 3 patients 18-19 years old, and 4 patients 29-56 years old), which has led to CKF and hence, maintenance hemodialyis in 7/8 and even death in one patient. Non-compliance regarding either medication or recommended fluid intake was the reason for AKF in 6 of the 8 patients, the 11 year-old girl, 2 adult patients and the 3 young adults being on the edge of leaving pediatric care. Acute massive diarrhea without adequate fluid substitution led to AKF in 2 middle aged male patients. Conclusion AKF is not uncommon in patients with PH1 and is frequently related to either non-compliance or to situations of severe fluid losses with inadequate fluid substitution. In the situations described, AKF is not based on already extremely altered renal function. Therefore, interruption of medication or lack of fluid intake, even for short periods of time, can lead to severe clinical consequences in these patients.

Mixed connective tissue disease, undifferentiated connective tissue disease and overlap syndromes

Systemic lupus erythematosus, systemic sclerosis, inflammatory myopathy and rheumatoid arthritis are systemic connective tissue disorders which are characterized by heterogeneous clinical symptoms and variable course. To date, updated diagnostic criteria for early diagnosis of each of the diseases of this group have been proposed. At the same time, a proportion of patients already have at the onset of the disease or over time, a combination of signs characteristic of different diseases. Such conditions are referred to as mixed connective tissue disease, undifferentiated connective tissue disease or overlap-syndrome, whose nosological identity remains the subject of discussion. Formerly there has been a kind of terminological confusion and similar conditions were described under different names, depending on the author's preferences. It was also believed that these conditions were an early stage or a clinically "incomplete" form of a connective tissue disease. However, as the observations of large patient groups have shown, whose disease was represented by a number of individual signs of several connective tissue diseases, the clinical manifestation remains unchanged for many years in the majority of them. To recognize the right for nosological independence, one should account for the fact that only for a mixed connective tissue disease various authors and research groups have proposed four variants of diagnostic criteria. These criteria have small differences in the number of clinical signs; however, all criteria include a mandatory sign, i.e. the presence of antibodies to U1-ribonucleoprotein in high titers. Clinical signs common to all these diagnostic criteria include the Raynaud's syndrome, arthritis, myositis and finger swelling or sclerodactyly. Another patient category includes those with mono- or oligosymptomatic manifestations characteristic of systemic connective tissue diseases, but without any specific immunological markers. Some of these patients in a fairly short time, usually from several months to 1–2 years, develop other clinical symptoms and signs corresponding to a reliable diagnosis of a connective tissue disease. At the same time, a significant part of patients with the oligosymptomatic course demonstrate a long-term stability without any further evolution of the disease. Such cases are defined as an undifferentiated connective tissue disease. To avoid the erroneous diagnosis of the transient form or an early stage of any connective tissue disease, the proposed classification criteria, along with the inclusion criteria, also embrace clinical and serological exclusion criteria. A separate category consists of patients with a combination of clinical signs sufficient for a definitive diagnosis of at least two systemic connective tissue diseases. These patients are diagnosed with the overlap-syndrome with indication of the components of connective tissue diseases in each individual case, as it largely determines the individual treatment and prognosis. The possibility of such clinical variants of systemic connective tissue diseases is becoming increasingly justified due to the concept of polyautoimmunity, which has attracted great interest of researchers in the last few years.

Leaving a foreign object in the body of a patient during abdominal surgery: still a current problem.

Leaving a foreign object (retained surgical item, or RSI) during surgery involving the abdominal cavity and pelvis minor is a relatively frequent, underestimated phenomenon which is dangerous to the health of the patient and the legal security of the medical personnel. These adverse events are easy to avoid through the use of appropriate means of prevention. The aim of the present paper is the collection of epidemiological data and determination of risk factors, symptomatology, health effects, and prevention methods associated with RSIs. Analysis of global scientific publications in the databases PubMed, ClinicalKey, Google Scholar, ScienceDirect, and Scopus related to the subject of RSIs. The frequency of RSI incidents ranges from 1 to 10 in 10,000 surgeries, which results in at least one case in an average multispeciality hospital on a yearly basis. The items most frequently left behind include soft foreign objects, such as swabs and bandages (90%). Risk factors include emergency surgical procedures, high patient BMI, significant loss of blood during surgery, and neglect in counting the material and surgical tools. The postoperative course, although in many cases asymptomatic, may be complicated by inflammation, bleeding, or perforation, leading to the necessity of a second operation and, in 2 to 4% of cases, even ending in death. Imaging tests are effective diagnostic tools. Effective methods of preventing RSIs are based on checklists and systems for counting and monitoring the location of material and tools. The globally occurring problem of RSIs requires education of the operating block personnel regarding risk factors and identification with elimination of adverse events of this type. Diagnostics based on imaging should take into account non-specific complaints resulting from a possible oligosymptomatic course. An RSI should not be regarded as a medical error. Changes in the perception of the phenomenon aim aimed at minimising the legal liability of the staff in the event of leaving a foreign object in a patient's body.

Clinical and laboratory characteristics of chronic hepatitis C on the early stages of development

Aim of the research – to assess the clinical and laboratory parameters in patients with chronic hepatitis C (CHC) on the early stages of development and their comparison with the level of galectin3. The study included 78 patients with oligosymptomatic course of the disease and minimal liver fibrosis in the most cases. In the most patients with stages of the disease exceeding 8 years, viral load was over a million copies/ml. In 10 % of patients on the early stages of the disease, changes corresponding to severe liver fibrosis and cirrhosis F3 and F4 were detected. Moderate correlation of ALT activity, viral load and low severity with the duration of the disease was identified. There is a trend towards a higher level of galectin3 in a long course of CHC in comparison with earlier stages of its development, with significantly higher average level of galectin-3 in patients with minimal liver fibrosis (F0–F1) as compared to advanced stages, suggesting its importance in the launching and initial mechanisms of fibrogenesis.

Autoimmune Pulmonary Alveolar Proteinosis: A Case Report

Autoimmune pulmonary alveolar proteinosis (APAP) is a rare interstitial lung disease characterised by abnormalities in surfactant metabolism. It is typically diagnosed in the 3rd or 4th decade of life with cough and dyspnoea being the most common manifestations. The condition is generally mild. The most advanced cases, in which the dyspnoea leads to limitation in daily activity, require treatment, and whole-lung lavage is the treatment of choice. We report a case of a 37-year-old female with incidental diffuse changes on a plain chest X-ray. The initial high-resolution computed tomography (HRCT) scan suggested allergic alveolitis, but due to the oligosymptomatic course of the disease and only mildly abnormal pulmonary function no further diagnostic tests were performed and the patient was left under observation. Due to the persistence of the radiographic abnormalities a decision was made to perform an open lung biopsy. Based on the histopathology results and the presence of antibodies to granulocyte-macrophage colony-stimulating factor (GM-CSF) the final diagnosis of APAP was made.

Arterial Hypertension and Cardiac Damage

Arterial hypertension still represents the most common preventable cause of morbidity and mortality, worldwide, and the WHO states that high blood pressure levels are responsible for 62% of cerebrovascular events and 49% of ischaemic heart diseases globally. Effective antihypertensive treatment significantly reduces individual total cardiovascular risk. Both cardiac and vascular consequences of arterial hypertension derive from structural and functional abnormalities of peripheral arteries, and these clinical conditions strongly predispose to developing major hypertension-related cardiovascular events. Due to the asymptomatic or oligo-symptomatic course, before being clinically evident, of hypertensive cardiopathy (e.g. hypertensive disease), the appropriate and periodic evaluation of structural and functional cardiac damage represents an important diagnostic and prognostic outcome for driving therapeutic strategy in the clinical management of hypertension. The present guidelines, endorsed by the Joint Committee of the Italian Society of Hypertension, the Italian Society of Cardiology, and the Associazione Nazionale Medici Cardiologi Ospedalieri, are aimed to help physicians to choose the best diagnostic and therapeutic approach in the clinical management of any individual hypertensive patient.