Predictors Of Unfavorable Course Research Articles

TLR3 and TLR7 prognostic role in early pediatric rotavirus infection

Introduction. Rotavirus infection is an urgent problem for pediatric infectology. The disease does not always proceed smoothly, it is assumed that TLR3 and TLR7 play an important role in its prognosis. The initial number of cells expressing such receptors in early children can probably be considered a predictor of unfavorable course and outcomes of rotavirus infection.
 Materials and methods. Infants with rotavirus infection were divided into groups depending on the initial count of TLR3- and TLR7-expressing immunocompetent cells. All patients were examined using general clinical methods. Rotavirus infection was diagnosed by molecular genetic (RNA detected by PCR) and immunochromatographic (determination of antigen) method. Parameters of cellular immunity were assessed by flow cytometry. Statistical data processing was carried out using the Statistica 8.0 program for independent samples using the nonparametric MannWhitney criterion and the Pearson criterion c2.
 Results. It was found that in patients with an initially small vs. high count of TLR3-expressing cells, the symptoms of exicosis were observed significantly longer, which determined a significantly longer infusion rehydration therapy. In patients with an initially small count of TLR7-expressing cells, no significant differences were observed during disease course. However, only this group similar to infants with a small count of TLR3-expressing cells were treated with antibiotics due to concomitant bacterial infections. Only convalescents with small count of simultaneously TLR3- and TLR7-expressing cells had repeated episodes of ARI and allergic diseases in catamnesis, whereas infants with extremely low count of TLR3-expressing cells developed additionally an unfavorable outcome such as reactive pancreatopathy.
 Conclusion. The initially low count of TLR3- and TLR7-expressing immunocompetent cells leads to a more severe course of rotavirus infection in infants requiring adjusted therapy by introducing antibacterial drugs and in some cases also contributes to arising adverse outcomes and consequences in 612 month catamnesis.

Prediction of unfavorable course of heart failure in patients with concomitant thyroid pathology

The aim — to determine the predictors of unfavorable course of heart failure (HF) with account of thyroid status of patients.
 Materials and methods. A comprehensive examination involved 381 patients with HF, developed against the background of coronary heart disease (CHD) after infarction cardiosclerosis. All patients were hospitalized in Cardiology department due to HF decompensation. From them, 57.22 % had comorbid thyroid pathology (TP): 92 (24.15 %) non­toxic goiter (NG) and 126 (33.07 %) autoimmune thyroiditis (AIT). 142 patients (37.3 %) were diagnosed with low triiodothyronine syndrome (LT3S), and 26 (6.82 %) were diagnosed with subclinical hypothyroidism. The results of the study were processed using the statistical package of IBM®SPSS® Statistics, 20.0 and MedCalc, 16.4 (free version). To identify adverse factors for the course of HF in patients with concomitant TP in comparison with patients without this comorbidity, a regression analysis of Cox (proportional risk model (Cox proportional hazards model)) was used. Kaplan­Meyer graphs were constructed.
 Results. The prognostic factor was calculated based on the data of Cox’s regression analysis. With account of β-coefficients of the variables included in the model, the Cox regression equation was developed, which determines the probability of rehospitalization (RH) of HF patients within 24 months. During the ROC analysis it was found that the RH risk in patients with HF due to decompensation of the disease increases when reaching the optimal distribution point for the value of HR > 0.104 (sensitivity — 51.61 %, specificity — 96.47 %, p < 0.0001). The RH risk chance ratio for 2 years was 21.60 (6.34 — 73.63), χ2 = 31.543; p = 0.0001). Repeated ROC analysis revealed that in patients with HF in combination with TP, the risk of RH due to decompensation of the disease increases when reaching the optimal distribution point for the value of HR > 0.043 (sensitivity — 80.77 %, specificity — 74.00 %, p < 0.0001). GHG risk chance ratio for 2 years = 11.95 (3.74 — 38.21), χ2 = 18.35; p = 0.0001). The use of ROC­analysis in the group of patients with CH without TP did not allow to establish a probable prognostic value of the HR index. The model of predicting the adverse course of HF in patients with TP was tested on a separate group of 66 patients with HF against the background of coronary heart disease, which was not included in the development of Cox prognostic regression model. These groups did not differ in age, sex, TP and RH frequency. The sensitivity of the specified value of the coefficient was 86.36 %, specificity = 78.57 %. The prognostic value of the positive result was 86.4 %.
 Conclusions. The cumulative rehospitalization risk in patients with HF against the background of coronary heart disease with concomitant TP is higher compared to patients without this comorbid pathology. The risk is highest in patients with concomitant emergency situations. The high risk of unfavorable HF course in patients with comorbid TP was stipulated by presence of the low triiodothyronine syndrome. According to Cox regression analysis, the following predictors that cause an unfavorable HF course in patients with concomitant TP were defined: levels of low­density lipoprotein cholesterol, interleukin­4 and free triiodothyronine. The risk of unfavorable HF course increases with the value of the hazard ratio: for the regression model > 0.043 (OR = 11.960).

Features of the course of myocardial infarction in the elderly

Cardiovascular disease is a major contributor to morbidity, mortality and quality of life in people aged 60 and over. However, this age group of patients was not sufficiently included in large studies, in this regard, the management of elderly patients is an urgent problem in modern medicine. The purpose of this review is to analyze of literature data on the characteristics comorbid pathology and senile asthenia as a predictor of unfavorable course and outcomes of acute myocardial infarction in patients 60 years of age and older. To analyze the literature, we searched for information on this issue in PubMed / MEDLINE, PMC, Web of Science, Scopus, The Сocrane Library. Recent research data show that there are plenty of risk factors for worsening the course of AMI in patients aged 60 and over. The most important of them are considered to be high comorbidity, multivessel lesion of several pools, the presence of senile asthenia. All together lead to difficulties in diagnosing myocardial infarction, to forced polypharmacy and in some cases refraining from early invasive strategy, which worsens the course of the disease, increases the duration of hospital treatment, leads to frequent complications, thereby affects the prognosis of the disease and leads to the development of early disability in patients 60 years of age and older In the vast majority of elderly patients, the development of acute myocardial infarction occurs against the background of a high prevalence of comorbid pathology, which in turn accelerates the development of senile asthenia and its progression.

Особенности показателей иммунитета полости рта у пациентов с флегмонами челюстно-лицевой области на фоне инсулиннезависимого сахарного диабета

Objective: studying the interrelations of the local oral immunity indicators which allow to predict the severity of phlegmons course in patients with maxillofacial region phlegmons against the background of insulin-independent diabetes mellitus. Materials and methods. 44 patients were included in this prospective study. The main group: 19 patients with the maxillofacial region phlegmons and the type 2 diabetes mellitus as a concomitant pathology (PH+DM). The comparison group: 20 patients with the maxillofacial region phlegmons with no diabetes mellitus among the concomitant pathologies (PH). The control group: 5 patients were undergoing routine surgical treatment in the maxillofacial surgery department. The groups were comparable in age, gender, and phlegmon treatment (p > 0.05). Levels of the proinflammatory and anti-inflammatory cytokines, the humoral immunity factors and the microbial adsorption reaction (MAR) index to the oral epithelial cells were determined in the saliva of patients on the 1st and 5th days. The obtained data were statistically processed. Results. On the 1st day of hospital treatment the PH+DM group revealed an increase in interleukin-6, a decrease in interleukin-10 and lactoferrin as compared to the PH and control groups (p < 0.05). On the 5th day of the treatment the interleukin-6 and tumor necrosis factor-α levels did not differ between PH+DM and the control groups (p < 0.05). The interleukin-4 and interleukin-10 levels were lower in the PH+DM and PH groups than in the control group on the 5th day (p < 0.05). The lactoferrin level in the PH+DM group was lower than in the PH and control groups (p < 0.05). The significant negative correlation was found between the MAR index values and SOFA (Sequential organ failure assessment score) points in patients with sepsis, R = -0.9 (p < 0.05). Conclusion. The delayed regression of the saliva inflammation indicators was specific for the PH+DM group patients in comparison with the PH group patients. The MAR index below 10% may be a predictor of unfavorable course of the phlegmon development.

Predictors of unfavorable course of acute myocarditis with reduced left ventricular ejection fraction

Early prediction of myocarditis clinical course still remains one of the actual tasks of cardiological science, which has a significant practical value. The purpose of the study was to determine the predictors of unfavorable course of myocarditis with reduced ejection fraction (EF) of the left ventricle (LV) on the basis of follow-up during 24 months. The study included 90 patients with acute myocarditis and reduced LV EF, who were examined in the first month after the disease onset, after 6, 12 and 24 months of follow-up. All patients underwent for echocardiography, Holter monitoring of the electrocardiogram and cardiac magnetic resonance imaging. Statistical processing of the results was performed using the Excel XP software (Місrosoft Office, USA) and Statistica for Windows v. 6.0 (Statsoft, USA). It was found that restoration of cardiac contractility in patients with myocarditis and reduced LV EF began with an increase in the index of LV longitudinal global systolic strain, which occurred 6 months after the debut of the disease and was associated with a decrease in the number of LV segments affected by the inflammatory process, and a significant increase of LV EF and a decrease of LV end-diastolic volume were observed only 1 year after the disease onset. The predictors of cardiovascular events in patients with acute myocarditis during the next 24 months from the onset of the disease, were detected in the 1st month from the debut of the disease and included following pathological changes: value of the LV EF ≤ 30%; reduction of LV longitudinal global systolic strain ≤ 7.0%; evidence of non-sustained ventricular tachycardia, presence of inflammatory changes in ≥6 LV segments, presence of delayed enhancement in ≥ 5 LV segments. Prospects for further research are the creation of registries of patients with myocarditis on the basis of multicenter clinical trial results on a large number of patients surveyed in order to improve diagnosis, prediction of clinical course and identification of early diagnostic markers of cardiovascular events and quantitative risk assessment of their development.

Clinical neurological characteristics of ischemic stroke subtypes in acute phase

Objectives. The aim of the present study was to clarify clinical neurological characteristics and different ischemic stroke subtypes unfavorable course predictors in acute phase. Material and Methods. 482 patients with different ischemic stroke subtypes were observed. Among them there were 125 (25.9 %) with cardioembolic infarct (CEI), 119 (24.7 %) with large artery atherosclerosis (LAAS) infarct, 122 (25.3 %) with lacunar stroke (LAC), 116 (24.1 %) with stroke of undetermined etiology (UDE). The comparative analysis of clinical picture was performed. The predictors of unfavorable course of acute phase were established. Results. We have found out that severe neurological deficit, high mortality and the worst functional outcome during the first 14 days were observed in patients with CEI and LAAS. The highest frequency of early neurological deterioration (END) was detected at LAC (in 22.7 % of patients). There was a relationship between END and presence of transient ischemic attack (TIA) in past medical history, the level of systolic blood pressure (SBP) at the beginning of the disease and the degree of carotid arteries stenosis on the side of lesion. The patients with LAC had mild neurological deficit and better prognosis compared with other ischemic stroke subtypes. Among the clinical factors that have impact on the CEI, LAAS and UDE acute phase course were: the size of lesion, the level of consciousness on the 1st day, the baseline SBP, patient’s age. At LAAS, the presence of transient ischemic attack (TIA) in past medical history and low SBP in the onset of the disease (less than140 mm Hg) has an additional prognostic value for an unfavorable functional outcome. The severity of LAC in acute period depended on its localization and size. Localization of LAC in the internal capsule, thalamus and pons were characterized by the highest severity. Conclusions. Clinical neurological features of ischemic stroke depend on its subtype and have some prognostic value for the course of different ischemic stroke subtypes in acute phase.

Prognostic indicators in pediatric clinically isolated syndrome.

To assess prognostic factors for a second clinical attack and a first disability-worsening event in pediatric clinically isolated syndrome (pCIS) suggestive of multiple sclerosis (MS) patients. A cohort of 770 pCIS patients was followed up for at least 10 years. Cox proportional hazard models and Recursive Partitioning and Amalgamation (RECPAM) tree-regression were used to analyze data. In pCIS, female sex and a multifocal onset were risk factors for a second clinical attack (hazard ratio [HR], 95% confidence interval [CI] = 1.28, 1.06-1.55; 1.42, 1.10-1.84, respectively), whereas disease-modifying drug (DMD) exposure reduced this risk (HR, 95% CI = 0.75, 0.60-0.95). After pediatric onset MS (POMS) diagnosis, age at onset younger than 15 years and DMD exposure decreased the risk of a first Expanded Disability Status Scale (EDSS)-worsening event (HR, 95% CI = 0.59, 0.42-0.83; 0.75, 0.71-0.80, respectively), whereas the occurrence of relapse increased this risk (HR, 95% CI = 5.08, 3.46-7.46). An exploratory RECPAM analysis highlighted a significantly higher incidence of a first EDSS-worsening event in patients with multifocal or isolated spinal cord or optic neuritis involvement at onset in comparison to those with an isolated supratentorial or brainstem syndrome. A Cox regression model including RECPAM classes confirmed DMD exposure as the most protective factor against EDSS-worsening events and relapses as the most important risk factor for attaining EDSS worsening. This work represents a step forward in identifying predictors of unfavorable course in pCIS and POMS and supports a protective effect of early DMD treatment in preventing MS development and disability accumulation in this population. Ann Neurol 2017;81:729-739.

Treatment of Acute Colon Obstruction with Cancer

Актуальность: в последние годы появились сообщения о стентированиях просвета кишечника при явлениях острой об-турационной толстокишечной непроходимости опухолевого генеза, как этапа для дальнейшего радикального лечения. Од-нако, имеются данные о высокой частоте ранних послеоперационных осложнений после стентирования (перфорация ки-шечника и опухоли, кровотечения, дистальная миграция стента), что требует дифференцированного подхода в тактикелечения данной патологии.Цель исследования: выявить клинико-морфологические параллели некробиотических процессов в толстой кишке, как пре-диктора неблагоприятного течения острой опухолевой обтурационной кишечной непроходимости после внутрикишечногостентирования.Материалы и методы: в настоящем исследовании выполнен ретроспективный анализ клинико-морфологических паралле-лей у 100 пациентов, в зависимости от изменений в стенке кишки, взятой интраоперационно.Выводы: выявлены клинические симптомы, сочетающиеся с некротическими явлениями в стенке кишки, которые можносчитать предикторами неблагоприятного исхода стентирования просвета толстого кишечника у пациентов с обтура-ционной кишечной непроходимостью.Ключевые слова: колоректальный рак, острая кишечная непроходимость, стент, стеноз.