Pathoanatomical Diagnosis Research Articles

POST-PROCEDURAL REHABILITATION: NICE TO DO OR NEED TO DO?

Patients with musculoskeletal disorders who are recalcitrant to formal rehabilitation may seek non-surgical interventions such as orthobiologics. The care pathway following an orthobiologic procedure may include but is not limited to ancillary modalities, supplements, booster injections, and formal rehabilitation. In some cases, the decision to pursue post-procedural rehabilitation may be questioned due to a paucity of evi-dence supporting efficacy and safety following orthobiologic procedures. Moreover, patients and physicians may possess a level of uncertainty in pursuing an intervention that may have been previously unsuccessful. Although higher-level evidence does not exist to support routine post-procedural rehabilitation, a body of evidence supports enhanced physical functioning as well as cellular and molecular effects synergistic to orthobiologics. Given the potential benefits of post-procedural rehabilitation, there would seem to be little downside to participation, provided that the physician and rehabilitation specialist consider individual patient characteristics such as the current pathoanatomical diagnosis, stage of acuity, and pre-morbid activity levels.

General practitioners’ decision-making process to prescribe pain medicines for low back pain: a qualitative study

BackgroundPain medicines are widely prescribed by general practitioners (GPs) when managing people with low back pain (LBP), but little is known about what drives decisions to prescribe these medicines.ObjectivesThe aim...

Surgery of Schwannoma in the upper limb – sensitivity and specificity of preoperative magnetic resonance imaging and relation between tumour size and symptoms

BackgroundBenign peripheral nerve tumours consist of different types, most commonly Schwannomas. Preoperative Magnetic Resonance Imaging (MRI) is commonly performed before surgery and Pathoanatomical Diagnosis (PAD) confirms the diagnosis. Our aims were to study the utility of MRI and the relation between tumour size and symptoms.MethodsRetrospectively, patients, surgically treated for benign nerve tumours between 2008 and 2019, were identified and preoperative MRI, with measurement of tumour size, PAD, symptoms, peroperative details, and symptomatic outcomes of surgery, were analysed.ResultsThe sensitivity and specificity to correctly identify Schwannomas with preoperative MRI were 85% and 50%, respectively, based on 30 Schwannomas and nine neurofibromas that were identified. Tumour size did not affect the presence of preoperative symptoms, but patients with sensory dysfunction at last follow-up had larger Schwannomas (p < 0.05). Symptoms as a palpable tumour, paraesthesia and pain improved by surgical excision (p < 0.001, p < 0.001 and p < 0.012, respectively), but sensory and motor dysfunction were common postoperatively. No malignant peripheral nerve sheath tumours (MPNST) were found. Using a surgical microscope, instead of only loop magnification, lowered the risk of perioperative nerve injuries (p < 0.05), but did not further diminish postoperative symptoms.ConclusionsEarly and accurate diagnosis of Schwannomas is valuable for adequate presurgical preparation and prompt surgical intervention. Preoperative examination with MRI has a high sensitivity, but low specificity; although recent advancement in MRI technology indicates improvement in diagnostic precision. Surgical excision is preferably performed early in conjunction with symptomatic debut to improve outcome.

Benign nerve tumours in the upper limb: a registry-based study of symptoms and surgical outcome

Surgery for benign nerve tumours is performed for pathoanatomical diagnosis and symptomatic relief, but might cause residual problems. We aimed to assess patient-reported symptoms and disability before and after surgery at a national level. In total, 206 cases surgically treated for a benign peripheral nerve tumour 2010–2019 registered in the Swedish Quality Registry for Hand Surgery (HAKIR; response rates 22–34%) were analysed. Surgery reduced overall disability in the affected limb (QuickDASH 18/100 [IQR 5–36] preoperatively and 5/100 [IQR 0–22] 12 months postoperatively), improved ability to perform daily activities (HQ-8; 11/100 [IQR 0–50] preoperatively and 0/100 [IQR 0–20] 12 months postoperatively) and decreased three evaluated pain modalities: pain at rest (HQ-8; 20/100 [IQR 0–40] preoperatively and 0/100 [IQR 0–10] 12 months postoperatively), pain on motion without load (HQ-8; 20/100 [IQR 0–40] preoperatively and 0/100 [IQR 0–10] 12 months postoperatively), and pain on load (HQ-8; 24/100 [IQR 1–69] preoperatively and 1/100 [IQR 0–30] 12 months postoperatively). Cold sensitivity was a minor problem both before and after surgery (HQ-8; 0/100 [IQR 0–30] preoperatively and 1/100 [IQR 0–40] 12 months postoperatively). We conclude that surgery for benign peripheral nerve tumours provides good symptomatic relief with low risk for residual problems.

Diagnostic Imaging Vs. Pathoanatomical Diagnosis in Low Back Pain: A Change in Approach: A Case Study

Abstract Back pain is an unpleasant and disturbing experience in everyone’s life and is a common lifetime health disorder. Involvement of many spinal structures can be the cause of low back pain (LBP), which can lead to difficulty in identifying and diagnosing the cause precisely. There is uncertainty about the optimal approach and a wide variation in patient care, which has led to different beliefs that conservative management is effective and radiological investigation is unnecessary and vice versa. Systemic reviews have concluded that only 1% of the individual coming to primary care needs diagnostic imaging for serious pathology, and this will save individuals from labeling their diseases and not adding up psychological factors. This may also limit the overdiagnosis and over treatment approach. Retrolisthesis, one of the causative factors for LBP, is not common. Very few studies have been documented for physical therapy rehabilitation in retrolisthesis, and so far no new protocol emerged in chronic cases. People suffering usually have anxiety, depression, and reduced quality of life. Apprehension of pain with avoidance of physical activity leads to secondary structural changes and recurrence of back pain. Physical therapy tailored to stretch and strengthening exercises is the most evidence-based treatment for retrolisthesis. This case report presents a unique case of the retrolisthesis which was not responding to conventional treatment of exercises and interestingly got dramatic results with a change in approach. This will give new dimensions to contemporary practice.

Primary tuberculosis with miliary hematogenous generalization in old age

Currently, the problems of the mechanisms of immune and inflammatory response aging, which determine the mechanisms of the development of the inflammatory process in the elderly, are being actively studied. A sectional observation of senile tuberculosis in a patient K., 78 years old, who had been treated for 4 months in the University Clinical Hospital No. 4 of the First Sechenov Moscow State Medical University in 2018 is presented. After autopsy, histological, histochemical and PCR examination, the following pathoanatomical diagnosis was made: primary (senile) tuberculosis with hematogenous and lympho-vascular generalization, with a focus of caseous pneumonia in the III segment of the right lung; caseous lymphadenitis of bifurcation, thoracic and abdominal paraaortic lymph nodes; miliary and large-focal generalization in the lungs, parietal and visceral pleura on the left, spleen and liver (acid fast stain; PCR study No. 18-5935 dated 08/13/2018 (Central Research Institute of Tuberculosis) detected DNA of mycobacterium tuberculosis complex). A feature of senile tuberculosis is the course of primary tuberculosis with hematogenic generalization and predominantly exudative-necrotic tissue reaction. Its pathogenesis is mainly due to the phenomenon of "aging immune system" (immunosenescence), as well as inflammaging — features of the inflammatory response in old age. Their main characteristics are the preactivated status of the immune system even before the recognition of the antigen, characterized by a basal level of circulating cytokines, as well as a sharp weakening of the adaptive immune response in the presence of an antigen associated with impaired functioning of the immune system with a large number of memory T cells lacking naive T-cells.

Functional connectivity analysis of the depression connectome provides potential markers and targets for transcranial magnetic stimulation

BackgroundDespite efforts to improve targeting accuracy of the dorsolateral prefrontal cortex (DLPFC) as a repetitive transcranial magnetic stimulation (rTMS) target for Major Depressive Disorder (MDD), the heterogeneity in clinical response remains unexplained. ObjectiveWe sought to compare the patterns of functional connectivity from the DLPFC treatment site in patients with MDD who were TMS responders to those who were TMS non-responders. MethodsBaseline anatomical T1 magnetic resonance imaging (MRI), resting-state functional MRI, and diffusion weighted imaging scans were obtained from 37 participants before they underwent a course of rTMS to left Brodmann area 46. A novel machine learning method was utilized to identify brain regions associated with each item of the Beck's Depression Inventory II (BDI-II), and for 26 participants who underwent rTMS treatment over the left Brodmann area 46, identify regions differentiating rTMS responders and non-responders. ResultsNine parcels of the Human Connectome Project Multimodal Parcellation Atlas matched to at least three items of the Beck's Depression Inventory II (BDI-II) as predictors of response to rTMS, with many in the temporal, parietal and cingulate cortices. Additionally, pre-treatment mapping for 17 items of the BDI-II demonstrated significant variability in symptom to parcel mapping. When parcels associated with symptom presence and symptom resolution were compared, 15 parcels were uniquely associated with resolution (potential targets), and 12 parcels were associated with both symptom presence and resolution (blockers or biomarkers). ConclusionsMachine learning approaches show promise for the development of pathoanatomical diagnosis and treatment algorithms for MDD. Prospective studies are required to facilitate clinical translation.

Combination of new coronavirus infection and HIV infection

Objective. Evaluation of different options for the formulation of a pathoanatomical diagnosis in the combined course of HIV infection and a new coronavirus infection COVID19Materials and methods. The study included the protocols of clinical autopsies performed at the S. P. Botkin Clinical Infectious Diseases Hospital from March 2020 to September 2021, with the simultaneous diagnosis of HIV infection and the new coronavirus infection COVID19.Results and discussion. Among the secondary diseases in HIV infection in combination with a new coronavirus infection, no significant difference was found in comparison with HIV monoinfection. On the part of the new coronavirus infection, no relationship was found between the course of the infection and the manifestations of secondary diseases in HIV infection. In cases with a protracted new coronavirus infection against the background of a mild HIV infection, the dominant disease in thanatogenesis is COVID-19. In the presence of severe secondary diseases of HIV infection, it acts as the main infection. In cases of the presence of other competing diseases in PAD, they play a leading role in thanatogenesis, or have a significant impact on the course of the disease.Conclusion. Based on the analysis of autopsy protocols with the simultaneous diagnosis of HIV infection and the new coronavirus infection COVID19, various options for the formulation of pathoanatomical diagnosis and encryption of observations are justified

Problems of pathoanatomical diagnosis and morphological characteristics of COVID-19

The study of the human corpses who died from the coronavirus infection COVID-19 allows to define the exact cause of death, which helps clinicians in choosing a timely and effective treatment to reduce mortality. The study analyzed the current literature with the results of studies of cadaveric material and described our own pathological observations the macro- and microscopic picture that was encountered during autopsies. The description of cases of autopsies of patients who died from COVID-19 is necessary, and certainly important for a comprehensive analysis of this problem and is of high clinical and epidemiological interest.

ИСХОД ХРОНИЧЕСКОЙ ЛУЧЕВОЙ БОЛЕЗНИ ПОДОСТРОГО ТЕЧЕНИЯ В ГИПОПЛАСТИЧЕСКУЮ АНЕМИЮ

Purpose: A retrospective analysis of the clinical observation of chronic radiation sickness (CRS) culminating in the development of aplastic anemia. Material and methods: The object of the examination was the medical history of a 25-year-old man, an apparatchik at the Mayak Production Association, who worked under conditions of external exposure and internal intake of radionuclides from July 1948 to December 1949. Results: When he was employed, he was practically healthy. During the work, according to the data of individual dosimetric control, he received external relatively uniform exposure in a total dose of 1.72 Gy. During the entire observation period (2 years 4 months) in the 2nd therapeutic department of the Medical Unit No. 71 (from 12/15/49 to 01/15/52) and then in a special clinic of the IBP of the Ministry of Health of the USSR (from 01/17/52 to 03/24/52). It was noted the excretion of radioactive substances in the daily urine 8.3‒28.3 Bq, in the feces – 13.3–1133.3 Bq, without a decrease in their number in subsequent studies. Sick since August 1949. Taking into account the professional history, the presence of sepsis, severe hemorrhagic syndrome, complete aplasia of the bone marrow, long-term carriage and release of radioactive substances, in 1952 the final clinical diagnosis was formulated: Chronic recurrent form of radiation injury due to ingestion of radioactive substances, in a state of exacerbation. Aplastic anemia. Septicopyemia. General hemorrhagic syndrome. Parenchymal changes in internal organs. Meningoencephalitis. Myocarditis. Left-sided pneumonia with pleurisy. Residual effects of subarachnoid hemorrhage. Trophic ulcers of the left buttock. Pyoderma with necrosis of both elbows. Infiltration of the upper third of the right thigh along the back surface. On March 24, 1952, the patient died. The clinical diagnosis fully coincided with the pathoanatomical diagnosis. Conclusion: The case history of patient E. is a vivid illustration of the subacute course of CRS with a rapid lethal outcome. The presence of a significant internal intake of osteotropic radionuclides led to the predominance of destructive processes in the bone marrow over regenerative ones and, accordingly, predetermined the development of aplastic anemia with a fatal outcome.

The profile of comorbid conditions and the structure of mortality in patients with rheumatoid arthritis in the Stavropol Territory: preliminary results

Objective: to study the comorbid background and mortality structure of patients with rheumatoid arthritis (RA) in the Stavropol region in a cohort of patients of the Stavropol Regional Clinical Hospital (SRCH) within the period 2015–2021. Materials and methods: There was carried out systematic review of the literature. There was carried out the analysis of the protocols of autopsies in the pathoanatomical department of the SRCH within 2015-2021. There were studied the comorbidity component and lethal outcomes of patients with RA in the pathoanatomical diagnosis. Results: the structure of the comorbid pathology of RA patients in the SRCH cohort included coronary heart disease (CHD), autoimmune thyroiditis (AT), respiratory diseases (RD), hypertension (HT), “Blastomatosis”, diabetes mellitus (DM), COVID-19 infection. The comorbidity profile of patients with RA in decreasing order of the incidence of the pathological condition was as follows: CHD (35.29%) &gt; RD (29.41%) &gt; (“Blastomatosis”, СOVID-19 by 11.75%) &gt; (AT, HT, DM by 5.88%). The structure of the conditions that led to the death of patients with RA included: acute myocardial infarction (40.0%), hemorrhagic stroke (6.67%), breast cancer (13.33%), thyroid cancer (6.67%), viral pneumonia (20.0%), sepsis (13.33%). Conclusions: the data obtained provide information that can be used by rheumatologists to optimize the strategy for managing RA and the risk of comorbid conditions.

43. Comparison of radiographic adjacent segment pathology at five years following minimally invasive compared to open lumbar 1- to 2-level fusion surgery

<h3>BACKGROUND CONTEXT</h3> Adjacent segment pathology remains a major cause of morbidity among patients receiving posterior lumbar instrumented fusion. Its occurrence is proposed to be secondary to the increased motion and biomechanical stresses from fused to unfused segment. Additionally, progressive degenerative processes in the spine can also be influenced by surgery-related factors that alter the spine biomechanics as a result of muscle destruction and facet joint violation. Controversy in the rates of radiographic adjacent segment pathology (RASP) after lumbar fusion surgery has stemmed by and large from variable reporting in the literature with short long-term follow-up periods and no comparison between muscle splitting minimally invasive (MIS) approach and posterior midline open fusions. We report a single-center cohort analysis of patients undergoing lumbar fusion surgery and describe the rate of RASP between patients undergoing minimally invasive tubular approach (MIS) vs open posterior fusion technique. <h3>PURPOSE</h3> The objective of this study is to evaluate the rate of RASP between MIS and open lumbar fusion surgery within 5-year follow-up period. <h3>STUDY DESIGN/SETTING</h3> Observational study. <h3>PATIENT SAMPLE</h3> Adults with degenerative lumbar disease who underwent 1- to 2-level open and MIS fusion at our institution from January 2006 to December 2016. <h3>OUTCOME MEASURES</h3> Rate of radiographic adjacent segment pathology. <h3>METHODS</h3> The authors conducted a retrospective chart review of patients diagnosed with degenerative lumbar disease who had undergone 1- to 2-level fusion between January 2006 to December 2016. Cases with upright lumbar radiographs were included in this sub-analysis. The patients were divided into an MIS fusion group and an open surgery group based on the surgical technique performed. The two groups were compared for baseline demographic features, surgical variables and diagnosis at index surgery. Adjacent segment pathology was evaluated using radiographs taken at the 5-year follow-up period. RASP is defined by the presence of any one or combination of (1) disc degeneration (height loss), (2) development of spondylolisthesis and (3) coronal deformity/lateral listhesis. Analysis was confined to rates of development of RASP with no attempt of correlating with symptomatic adjacent segment pathology. Logistic regression analysis was performed to assess relationship of demographic factors with development of RASP <h3>RESULTS</h3> A total of 165 patients were included: MIS (n = 73) and (n = 92) open. There was no significant difference between two groups in age, sex, diagnosis at index surgery, level of fusion and baseline RASP. Fusion involved one level in 72.7 % of cases and 2 levels in 27.3%. The overall incidence of RASP was 41.2%, with incidence of 36.9% in MIS group and 44.6% in the open surgery group, showing no significant difference between the two groups (p = 0.5246). In those with RASP, the most common radiographic finding was disc degeneration (height loss) for both cohorts (100% vs 87.8%, p = 0.264) with the majority occurring cephalad to previous instrumentation. Logistic regression analysis did not show significant correlation between sex, age, index diagnosis, presence of baseline RASP and the prevalence of RASP at 5 years. <h3>CONCLUSIONS</h3> The prevalence of radiographic adjacent segment pathology did not statistically differ between MIS and open lumbar fusion surgery at minimum of 5-year follow-up. Baseline demographics or primary pathoanatomical diagnosis did not correlate to the presence of RASP 5 years following surgery in either group. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

An atypical case of Edwards syndrome in a pediatrician’s practice

Introduction. Edwards syndrome is characterized by multiple congenital malformations and peculiar phenotypic signs. The presence of important phenotypic signs, including manifestations of the musculoskeletal system in almost 90% of newborns with this pathology allows improving the chances of early diagnosis of chromosomal diseases, while their absence cannot deny the presence of this disease. A genetic examination is necessary to clarify the diagnosis. The purpose of the description of the clinical case was an atypical course of a previously known disease. Case description. There is presented a description of a clinical case of a newborn with Edwards syndrome, which was observed from birth. Owing to the introduction into clinical practice of the method of prenatal (ultrasound and biochemical) screening at the time of 16/3 weeks, an increased genetic risk for the development of chromosomal abnormalities and /or congenital malformations in the fetus was revealed according to the age factor of the mother (42 years). Postnatally, the birth of a newborn with a non-classical manifestation of the phenotype of Edwards syndrome caused difficulties in making a diagnosis. The genetic research made it possible to establish trisomy 18, meiotic non-divergence, Edwards syndrome, trisomal form (Q91.0) in the infant during the first month who died at the age of 2 months. Comparison of clinical and pathoanatomical diagnosis allowed presenting the completeness of clinical manifestations of this disease. The presented clinical example demonstrates the important role of pre- and neonatal screening in the early diagnosis of chromosomal diseases and emphasizes the importance of continuous medication support, including work with parental stress and parental support. An atypical manifestation of a chromosomal disease does not deny its presence and a genetic study is necessary to clarify the diagnosis.

Diagnostics errors as the reasons for the discrepancy between clinical and pathoanatomical diagnoses

Relevance. The development of medical science has made it easier for clinicians to diagnose specific diseases, often leading to the reduction of traditional diagnostic methods, including differential diagnosis. As a result, there is an increase in medical errors in diagnosis, the choice of treatment tactics, including in cases with the development of an unfavorable outcome. The aim of the study was to identify typical errors in the differential diagnosis of diseases in cases with a fatal outcome in the departments of both therapeutic and surgical profiles. Materials and Methods. At the first stage of the retrospective cohort study, fatal cases were analyzed for the correctness of the final post-mortem clinical diagnosis and the results of its comparison with the pathoanatomical diagnosis based on the results of the examination of the quality of medical care in compulsory health insurance. Errors in the formulation of the post-mortem clinical diagnosis were identified, and their causes were determined. At the second stage, the scenario method determines three variants of risk realization in the case of divergence of the final clinical and pathoanatomical diagnoses, with an assessment of the frequency of risk variants realization in the surgical and therapeutic profiles . Results and Discussion. When analyzing cases of fatal outcomes with a discrepancy between the final clinical and pathoanatomical diagnoses, the main errors in the formulation of the final clinical diagnosis were identified. In the first variant of risk realization, the reason for the discrepancy is the incorrect formulation of the final post-mortem diagnosis. In the case of the second scenario, violations relate to incorrect diagnostic tactics when a new disease or exacerbation of a chronic disease occurs. In the third scenario, violations are associated with incorrect differential diagnosis: the initial restriction of the range of nosologies for diagnostic search. Conclusion. Typical violations of diagnosis and differential diagnosis leading to a discrepancy between the final clinical and pathoanatomical diagnoses are identified. As part of the provision of medical care in surgical specialties, the second scenario is more often identified: incorrect diagnostic tactics when a new disease appears or a chronic disease worsens. When providing medical care in therapeutic specialties, violations are more often detected in the third scenario: incorrect differential diagnosis, initial restriction of the range of nosologies for diagnostic search. The second and third scenarios create legal risks for the doctor and the medical organization when evaluated by the relevant authorities.

Diagnostics errors as the reasons for the discrepancy between clinicaland pathoanatomical diagnoses

Relevance. The development of medical science has made it easier for clinicians to diagnose specific diseases, often leading to the reduction of traditional diagnostic methods, including differential diagnosis. As a result, there is an increase in medical errors in diagnosis, the choice of treatment tactics, including in cases with the development of an unfavorable outcome. The aim of the study was to identify typical errors in the differential diagnosis of diseases in cases with a fatal outcome in the departments of both therapeutic and surgical profiles. Materials and Methods. At the first stage of the retrospective cohort study, fatal cases were analyzed for the correctness of the final post-mortem clinical diagnosis and the results of its comparison with the pathoanatomical diagnosis based on the results of the examination of the quality of medical care in compulsory health insurance. Errors in the formulation of the post-mortem clinical diagnosis were identified, and their causes were determined. At the second stage, the scenario method determines three variants of risk realization in the case of divergence of the final clinical and pathoanatomical diagnoses, with an assessment of the frequency of risk variants realization in the surgical and therapeutic profiles . Results and Discussion. When analyzing cases of fatal outcomes with a discrepancy between the final clinical and pathoanatomical diagnoses, the main errors in the formulation of the final clinical diagnosis were identified. In the first variant of risk realization, the reason for the discrepancy is the incorrect formulation of the final post-mortem diagnosis. In the case of the second scenario, violations relate to incorrect diagnostic tactics when a new disease or exacerbation of a chronic disease occurs. In the third scenario, violations are associated with incorrect differential diagnosis: the initial restriction of the range of nosologies for diagnostic search. Conclusion. Typical violations of diagnosis and differential diagnosis leading to a discrepancy between the final clinical and pathoanatomical diagnoses are identified. As part of the provision of medical care in surgical specialties, the second scenario is more often identified: incorrect diagnostic tactics when a new disease appears or a chronic disease worsens. When providing medical care in therapeutic specialties, violations are more often detected in the third scenario: incorrect differential diagnosis, initial restriction of the range of nosologies for diagnostic search. The second and third scenarios create legal risks for the doctor and the medical organization when evaluated by the relevant authorities.

A RARE OBSERVATION OF SMALL INTESTINAL TUBULAR ADENOCARCINOMA WITH A NEUROENDOCRINE COMPONENT

Аbstract. Neoplasia of the small intestine are extremely rare. A special place is occupied by tubular adenocarcinomas of the small intestine with a neuroendocrine component, the intravital diagnosis of which is difficult. Materials and methods. The paper presents a clinical observation of a 61-year-old patient who after resection of the small intestine was found to have tubuLar adenocarcinoma with a neuroendocrine component. Results. Morphoimmunohistochemical examination of the tumor revealed tubular adenocarcinoma with a neuroendocrine component (chromogranin A+, NSE+, aLcian+) with invasion into the subserous base. Conclusions. Tubular adenocarcinoma of the small intestine with a neuroendocrine component is a rare neoplasm of the gastrointestinal tract. In vivo pathoanatomical diagnosis of an intestinal tumor should include morphological, histochemical, immunohistochemical studies with the detection of tumor neuroendocrine cells and assessment of malignant potential.

Load-modifying interventions for shin pain: A systematic and critical review of the evidence

Introduction: Activity-related shin pain commonly presents in high-performance and community-level athletes. Pathoanatomical diagnoses and management are typically within a tissue pathophysiology, clinical-reasoning paradigm. Oftentimes a loading mechanism is conceptualised, including relative acute and accumulating energy exposures, and tissue responses, typically with discernible clinical presentations. It is therefore postulated that the spectrum of shin pain diagnoses could all respond to load-modifying interventions, regardless of the pathoanatomical diagnosis. Taking this approach, we conducted a systematic review and critique of evidence on load-modifying interventions for activity-related shin pain conditions. Methods: A systematic review was conducted according to PRISMA guidelines. Five databases were searched for randomised controlled studies investigating any non-surgical intervention that could conceivably modify tibial region tissue load, intending to manage activity-related anterior-anteromedial shin pain. We were interested in effect(s) on self-reported symptoms and function, physical performance, biomechanical measures, safety and feasibility. Study quality was evaluated with the Cochrane Collaboration Risk of Bias Tool V2 with the GRADE method determining the level of certainty for the findings. Available evidence was further critically reviewed to propose practice recommendations and clinical utility. Results: Of 16 468 studies screened, six individual studies reporting seven comparisons were included. Interventions considered to modify tibial load included braces, anti-pronation taping, a compression stocking and a stretch/strengthening program. These studies were assessed as having unclear or high risk of bias meaning there is low confidence in the aggregated study findings. Braces were associated with adverse effects and acceptability was limited by inconvenience, aesthetics and brace discomfort. Discussion: The low-quality evidence, which focused on passive interventions and/or failed to determine the effects of graded return to activity programs, does not support the clinical utility of any specific load-modifying interventions. No studies investigated other potentially load-modifying interventions including weight-loss, relative rest or gait modification. We therefore recommend clinical management is based on mechanistic principles of load management and pain science, with a contemporary patient-centred approach and consideration of the range of load-modification opportunities and the whole person’s symptom experience. The paucity of high-quality evidence demonstrating intervention efficacy for people with activity-related shin pain furthermore supports the urgent need for research to inform clinical practice. Conflict of interest statement: The authors have no conflict of interest to declare in relation to this study.

The impact of pathoanatomical diagnosis on elective spine surgery patient expectations: a Canadian Spine Outcomes and Research Network study.

Patients undergoing spine surgery generally have high expectations for improvement postoperatively. Little is known about how these expectations are affected by the diagnosis. The purpose of this study was to examine whether preoperative expectations differ based on diagnostic pathoanatomical patterns in elective spine surgery patients. Patients with common degenerative cervical/lumbar pathology (lumbar/cervical stenosis, lumbar spondylolisthesis, and cervical/lumbar disc herniation) who had given their consent for surgery were analyzed using the Canadian Spine Outcomes and Research Network (CSORN). Patients reported the changes they expected to experience postoperatively in relation to 7 separate items using a modified version of the North American Spine Society spine questionnaire. Patients were also asked about the most important item that would make them consider the surgery a success. Sociodemographic, lifestyle, and clinical variables were also collected. There were 3868 eligible patients identified within the network for analysis. Patients with lumbar disc herniation had higher expectations for relief of leg pain compared with stenosis and lumbar degenerative spondylolisthesis cohorts within the univariate analysis. Cervical stenosis (myelopathy) patients were more likely to rank general physical capacity as their most important expectation from spine surgery. The multinomial regression analysis showed that cervical myelopathy patients have lower expectations for relief of arm or neck pain from surgery (OR 0.54, 0.34-0.88; p < 0.05). Patient factors, including age, symptoms (pain, disability, depression), work status, and lifestyle factors, were significantly associated with expectation, whereas the diagnoses were not. Patients with degenerative spinal conditions consenting for spine surgery have high expectations for improvement in all realms of their daily lives. With the exception of patients with cervical myelopathy, patient symptoms rather than diagnoses had a more substantial impact on the dimensions in which patients expected to improve or their most important expected change. Determination of patient expectation should be individualized and not biased by pathoanatomical diagnosis.

Features of clinical and pathomorphological picture in spontaneous infection of a domestic cat (lat. Félis cátus) with SARS-CoV-2 coronavirus

Today, cases of infection of various animal species with the new SARS-CoV-2 coronavirus have become increasingly common. This virus has been isolated from numerous representatives of the feline family, European mink, ferret, raccoon dog, domestic dog, a number of primates and a number of other animals. In most susceptible animals, infection with this virus is manifested by certain clinical symptoms, the intensity of which depends on the type and age of the animals, on the presence of concomitant diseases. The pathological process can end in death with the development of characteristic pathoanatomical and histological changes. According to the results of preliminary studies conducted in the Republic of Belarus, the circulation of SARS-CoV-2 was detected in domestic cats. All the animals had a history of contact with COVID-19-infected owners. The aim of this work was to determine the features of clinical and pathoanatomical manifestations, histological changes in domestic cats infected with SARS-CoV-2. The studies were conducted among various sex and age groups of domestic cats. In total, we conducted a study of 300 flushes from various sexes and ages and pedigreed, autopsy of 10 corpses. The work was carried out in the Vitebsk State Academy of Veterinary Medicine, the Vitebsk Regional Veterinary Laboratory, the RSPC "Epidemiology and Microbiology" in Minsk, in the Belarusian State Veterinary Center. The circulation of SARS-CoV-2 in animals was determined by polymerase chain reaction (RT - PCR). When dissecting the corpses of animals, the nature and severity of pathomorphological changes were taken into account, a pathoanatomical diagnosis was made, and macrophotography was performed in natural light. The main clinical symptoms of the disease in adult animals are depression, refusal to feed, cough, shortness of breath; in young animals, rhinitis, conjunctivitis, diarrhea are often observed. When dissecting dead animals, macro-changes and micro-changes in organs and tissues are noted, indicating the development of pathological processes, both in the acute course of the disease and in the chronic one. Thus, the conducted studies and the results obtained confirmed and supplemented the data of world researchers, made it possible to determine the leading clinical symptoms of the disease and pathoanatomical changes in the domestic cat when infected with SARS-CoV-2. The obtained data of histological changes allowed a deeper and more detailed assessment and study of the pathogenesis of the disease, which will contribute to a rational approach in choosing the means of therapy of this disease. Key words: cats, coronavirus, SARS-CoV-2, clinical symptoms, pathoanatomical changes, histological examination.

ЛЕЧЕБНО-ПРОФИЛАКТИЧЕСКИЕ МЕРОПРИЯТИЯ ПРИ КОЛИБАКТЕРИОЗЕ В ПРОМЫШЛЕННОМ ПТИЦЕВОДСТВЕ

The aim of the research is improving measures for the prevention of periodic colisepticaemia infection of hens in industrial poultry farming. To ensure reliable protection of the poultry flock and break the epizootological chain, an optimal scheme of therapeutic measures was developed for chickens of the Rhodonit 3, Hajseks Braun, Braun Nik crosses. Therapeutic measures were carried out in private farms as of causative agent of infection for industrial poultry farming. In the course of conducting an administrative control of private farms of entrepreneurs engaged in incubation, breeding and keeping in exercise pens chickens, guinea fowls, pheasants and turkeys in exercise pens, it was found that periodic mortality of birds from colisepticaemia was the result of violations or non-implementation of therapeutic and preventive measures. Past-mortem examination of non-incubated chickens, tur-keys, guinea fowls and pheasants revealed pathanatomical changes in liver, lungs, heart, and kidneys. In the ex-periment with colistin antibiotic use, of the polypeptide group, which is active in regard to colibacillosis, the flock of 126990 heads participated. With oral use, colistin is practically not absorbed, it is not exposed to digestive en-zymes, thus creating a high colistin antibacterial concentration in the intestine. In an experimental poultry farm, 30- and 60-days-old chickens were treated with the colistin AVZ antibiotic. The drug was prescribed at the rate of 1 liter of the antibiotic colistin AVZ per 4000 liters of drinking water. The colistin AVZ solution was prepared just before drinking and chickens had it during 2 hours after morning feeding for 7 days (the same procedure was repeated until the flock reached 60 days of age). Chickens were not given antibiotics of the controlled farm. After the antibiotic treatment, the safety of the flock was controlled on the daily basis. A Past-mortem examination was performed with a pathoanatomical diagnosis determination and subsequent laboratory test of the pathological material. The bird mortality in the experimental poultry farm was significantly less (949 heads for the entire period of the experiment) than that in the control group &#x0D; (6931 heads).