Presence Of Concomitant Diseases Research Articles

Analysis of the Epidemiological Situation on the Pneumonia with Signs of Coronavirus Infection among the Population of the Republic of Kazakhstan

New coronavirus infection caused by SARS-CoV-2 (COVID-19), as well as pneumonia with signs of coronavirus infection, continues to spread around the world, but the epidemiological situation is not the same in different countries.
 The aim of the study: to analyze the epidemiological situation of coronavirus infection and pneumonia with signs of coronavirus infection in the Republic of Kazakhstan.
 Material and methods of the research: retrospective epidemiological analysis of the incidence of coronavirus infection and pneumonia with signs of coronavirus infection in the republic according to official statistical reporting, as well as a statistical analysis of discharge records of patients diagnosed with coronavirus infection (no virus identified) in a small town of Karaganda region was carried out.
 Results: An increase in cases, sick persons, recovered persons and lethal cases in population with positive PCR for COVID-19, as well as pneumonia with signs of coronavirus infection in the Republic of Kazakhstan was registered for the period from 08/01/2020 to 12/31/2021. The number of cases of coronavirus increased in 10.93 time, those who recovered – in 15.78 times, deaths – in 16.4 time, respectively. The increase in the number of cases of pneumonia with signs of coronavirus infection also increased in 16.24 time, the number of those who recovered at the beginning of the observation was not established, by the end the number of recovered was 76,989 people, the number of deaths increased in 173.83 time.
 Conclusion: An analysis of the discharge records of patients with pneumonia with signs of coronavirus infection revealed that 54.2% of the patients were females and 45.8% were males. The disease was registered in 21.8% of patients older than 60 years in the presence of concomitant diseases. Concomitant diseases were represented in 42% by arterial hypertension, in 26% by ischemic heart disease, in 14% by pyelonephritis. The same percentage of cases (12%) were chronic obstructive pulmonary disease and iron deficiency anemia, 11%

Epidemiological surveillance of surgical site infections in large joint replacement

Joint replacement is a reliable and effective surgery that allows profound pain relief and restores joint function in patients. Despite the progress made and the experience gained in joint replacement, surgical site infection is one of the leading postoperative complications. It can proceed as a periprosthetic joint infection, osteomyelitis, sepsis and lead to disabled or dead outcomes. Systematization of risk factors for infectious complications plays an important role as an element of epidemiological surveillance system optimization. Age, the presence of concomitant diseases (for example, diabetes mellitus, cancer, arthritis and systemic collagenosis), carriage of antimicrobial-resistant microorganisms, infectious and inflammation both outside and in the area of surgery, and external factors (surgery duration, correct antibiotic prophylaxis and surgeon's experience) are the most significant risk factors for periprosthetic joint infection. In world practice, the National Nosocomial Infections Surveillance System surgical site infection risk index is used. This criterion does not consider all potential risk factors. It is important to analyze and rank the identified risk factors according to the impact on the development of infectious complications in organizing an epidemiological surveillance system process in a medical organization. Risk factors analysis will identify the most significant modifiable factors for the development, implementation and execution of organizational, preventive measures and epidemic control. The creation and implementation of a standardized preoperative protocol based on a risk factors assessment will allow predicting the surgery outcome and arguing the strategy and tactic of preventive measures.

Role and place of radiotherapy in neoadjuvant treatment of pancreatic cancer

Background. Myocardial revascularization is a life-saving technology, which contributes to increase in lifespan, reduction in myocardial infarction recurrences and repeated surgeries along with improved life quality of the patients with coronary artery disease (CAD). Estimation of the risks, severity of coronary bed lesion, presence of concomitant diseases, and area of hibernating myocardium, as well as patient’s agreement are the basis of treatment method selection. Positive structural and functional changes in myocardium (increase in area of viable myocardium), restoration or improvement of systolic function of left ventricle (increase in ejection fraction and decrease in end-diastolic volume), reduction of angina symptoms are the expected results from the surgical treatment.
 Purpose – to determine the influence of risk factors for coronary artery disease on the outcome of surgical treatment by the method of aorto-coronary artery bypass grafting with the help of diagnostic evaluation of myocardial scintigraphy parameters.
 Materials and methods. For the implementation of the clinical objectives, 62 patients with coronary artery disease were examined. The average age of the patients was 59.6 ± 8.2 years. Myocardial scintigraphy was performed in the SPECT mode with ECG synchronization (Gated SPECT). 99mTc-MIBI with an activity of 555-740 MBq was used. Myocardial scintigraphy was conducted over time of treatment (before and after coronary artery bypass grafting) according to One Day Rest protocol.
 Results. The influence of risk factors was assessed using dynamic and static integral indices. The dynamic integral index didn’t reveal statistically significant risk factors: smoking (p = 0.54), left ventricular contractility impairment (p = 0.43), history of myocardial infarction (p = 0.4), stage of heart failure (p = 0.53), and functional class of angina (p = 0.08). The static integral index didn’t reveal statistically significant influence as well: smoking (p = 0.13), left ventricular contractility impairment (p = 0.58), history of myocardial infarction (p = 0.1), stage of heart failure (p = 0.11), and functional class of angina (p = 0.6).
 Conclusions. The studied risk factors for coronary artery disease, namely: history of myocardial infarction, left ventricular contractility impairment, stage of heart failure, functional class of angina, and smoking in the study group of patients had no registered influence on the revascularization effect by coronary artery bypass grafting method (integrated static and dynamic indices p > 0.05).

Influence of clinical presentation, site, and extent of venous thrombosis on decision about duration of anticoagulation: Data from the international, prospective, observational WHITE study

BackgroundLow attention has generally been dedicated to the influence of clinical presentation, extent of venous thrombosis and presence of residual vein obstruction (RVO) on the decision about the duration of secondary prophylaxis after a first venous thromboembolism (VTE). AimThis study aimed at investigating the role of the mentioned VTE characteristics on the therapeutic decision using the information collected in the international, prospective, observational WHITE study. Results1240 patients were recruited by 79 clinical centers in 7 countries (China, Czechia, Poland, Portugal, Russia, Slovakia, and Tunisia). 35 patients had as index event a pulmonary embolism (PE) without a deep vein thrombosis (DVT), and all continued anticoagulation. We focused on the 1205 subjects with DVT. The treatment decision differed among countries; altogether, more than 85% of patients with proximal (with or without distal) DVT continued a prophylactic treatment with anticoagulants, or antithrombotics; 34% of patients with isolated distal DVT stopped treatment, and more than 85% of patients with a PE associated to a DVT continued treatment. At multivariable analysis, the presence of proximal DVT, signs of post-thrombotic syndrome (PTS), residual vein obstruction (RVO), maintenance <180 days and concomitant diseases was associated with increased probability to continue secondary prophylaxis. ConclusionThe presentation as proximal DVT (with or without PE) or isolated PE influenced the treating physicians' decision in favor of extension of secondary prophylaxis, together with the presence of concomitant diseases and local conditions which may increase the risk of post-thrombotic syndrome.

The Effect of Nosocomial Infection on the Severity and Outcome of the Disease in Patients with Severe and Extremely Severe COVID-19

The mechanisms of development of nosocomial infectious complications in COVID-19 and the contribution of bacterial and mycotic superinfection to the formation of extremely high mortality among patients with severe and extremely severe course of this disease have not yet been fully revealed. The objective: to study epidemiology, risk factors for the development of nosocomial superinfection, and its effect on the severity and outcome of the disease in patients with COVID-19.Subjects and Methods. 383 cases of severe and extremely severe COVID-19 were retrospectively analyzed. Demographic data, the presence of concomitant diseases, community-acquired co-infection at the time of hospitalization, data on the methods used to treat new coronavirus infection, severity of the course of the disease, developed infectious complications and their etiology, and the disease outcome were studied. Risk factors for the development of secondary infectious complications and the contribution of nosocomial superinfection to the severity of COVID-19 and the disease outcome were evaluated.Results. Risk factors for the development of secondary infectious complications include age over 65 years (OR 1.04; 95% CI 1.03–1.06; p &lt; 0.0001), concomitant cardiovascular pathology (OR 3.82; 95% CI 2.02‒7.19; p &lt; 0.0001), chronic kidney disease, including requiring renal replacement therapy (OR 2.01; 95% CI 1.33–3.02; p = 0.0007), and glucocorticoid therapy (OR 1.62; 95% CI 1.02–2.69; p = 0.04). The development of nosocomial infectious complications in patients with COVID-19 is associated with a more severe course of the disease and unfavorable prognosis (OR 13.44; 95% CI 8.23‒21.92; p &lt; 0.0001).Conclusion. Identification of risk factors for the development of secondary infectious complications in COVID-19 allows developing differentiated approaches to the pathogenetic treatment of patients with severe COVID-19, increasing alertness in terms of the development of nosocomial infections, ensuring their timely diagnosis and treatment.

Clinical analysis of dogs with parvovirus

This study aimed to classify the clinical profile of dogs affected by parvovirus at the Veterinary University Hospital of a higher education institution in Rio Grande do Sul. The clinical histories of the animals seen at the hospital from January 2017 to July 2019 were reviewed, using the patients’ medical records. During this period, 176 animals were suspected to have parvovirus. The prevalence of disease was 44.3% (78/176). Positive patients were classified according to breed, gender, age, and vaccination status, then separated according to the bodily systems involved: digestive, neuromuscular, multisystemic, hematopoietic, respiratory, lymphatic, ophthalmic, urinary and cutaneous; clinical signs and the presence of concomitant diseases. Parvovirus occurs more often in males up to one year old and without predisposition for particular breeds. The researchers observed that most dogs had no previous vaccination history. This study highlights the infection patterns of this viral diseases, which mainly affects young unvaccinated animals, reinforcing the notion that preventive measures are essential for the control of the disease and the protection of the health of canine populations.

Relationship of coronary heart disease and comorbide dental background

Cardiovascular disease has serious economic and social consequences that affect people, health systems and societies around the world. Ischemic heart disease is one of the main global causes of death of the population, and its growth is predicted in the coming years. This fact continues to be of serious concern to health, social and economic services. Cardiovascular disease remains the most common cause of death, and age-standardized rates are higher for men than for women. Cardiovascular comorbidity increases significantly with age.The combination of ischemic heart disease and comorbid pathology is noted in cancer incidence, bronchial asthma, non-alcoholic fatty liver disease, type 2 diabetes mellitus, chronic obstructive pulmonary disease, periodontal disease, etc. It is necessary to analyze the existing disease with past diseases, risk factors and predictors available in the patient. The presence of concomitant diseases quite often requires additional diagnostic methods and changes in the tactics of treating coronary heart disease due to the fact that some of them are a contraindication to the use of certain groups of drugs. Periodontal disease includes a wide range of inflammatory conditions that affect the supporting structures of the teeth, which can lead to tooth loss and contribute to systemic inflammation. Periodontal disease is associated with several systemic diseases, one of which is coronary artery disease. It is imperative that clinicians understand the link between periodontal disease and cardiovascular disease. Comprehensive treatment of periodontitis and restoration of a healthy periodontium can help reduce overall inflammation in the body and reduce the risks of coronary heart disease.

Role of Genetic and Environmental Factors in Determining the Response to Metformin

Metformin is one of the most commonly prescribed drugs for the treatment and prevention of type 2 diabetes mellitus (T2DM). Numerous evidence accumulates indicating that both genetic and environmental factors underlie adverse side effects of metformin, as well as individual differences in patient response to treatment The present review summarizes information on genetic factors and environmental modifiers determining patients’ individual response to metformin treatment. The data on the role of polymorphism of the most significant genes and protein products encoded by them both in the development of adverse effects and in determining the therapeutic response are summarized, and the place of metformin in the realization of the phenotypic effects of these genes is discussed.Endogenous conditions and exogenous effects modifying the response to metformin are considered. Among them are factors that affect the functional state of the genome (the level of methylation of genes, one way or another associated with the response to metformin, etc.), reflecting the biological characteristics of the organism (gender, age), health level (the presence of concomitant diseases, the supply of biometals and vitamins), taking other medications, etc. Thus, there is a wide range of factors modifying the response to metformin, which, unlike genetic characteristics, are largely controllable. At the same time, both genetic and environmental factors may differ in significance in different ethno-territorial groups of the population. This information should be taken into account when developing a personalized approach to prescribing metformin for the treatment of type 2 diabetes, as well as when recommending its use for the treatment of other diseases.

Случаи кетоацидоза на фоне приема сахароснижающих препаратов из группы ингибиторов натрий-глюкозного котранспортера у пациентов с сахарным диабетом

The diabetic ketoacidosis (DKA) is the most frequent urgent condition in patients with diabetes mellitus which requires hospitalization and results to mortality. The most common causes of DKA are the presence of concomitant diseases in diabetic patients, as well as the violation of the insulin therapy regimen. With the appearance of hypoglycemic drugs from the group of sodium-glucose co-transporter inhibitors (iSGLT2), isolated cases of DKA associated with their intake began to be recorded. This article describes 4 cases of ketoacidosis in patients with type 2 diabetes mellitus and type 1 diabetes mellitus taking dapagliflozin which is a hypoglycemic drug from the group of inhibitors of the sodium-glucose co-transporter.

Primary Analysis of the Risk Factors for Severity and Mortality in COVID-19 Patients in Uzbekistan

A retrospective analysis of 561 patients with confirmed COVID-19 was performed to determine the risk factors for severity and mortality which could predict the disease outcome in early stages. Patients were divided into 4 groups in accordance with disease severity: mild, moderate, severe and critical. And initial clinical and laboratory parameters of patients at admission were studied. The age of severe and deceased patients was significantly higher than patients with mild and moderate course (р=0.003). Patiens with severe disease and fatal outcome had higher incidence of concomitant diseases compared to patients with mild and moderate course (p=0.01). The time passed from onset of first symptoms and hospital admission was shorter in patients with mild and moderate disease than patients with severe and critical disease (р=0.0001). The leukocytosis, significant lymphopenia (р=0.0001), high D-dimer and ferritin levels were associated with severe disease. Male gender, old age, presence of concomitant diseases should be considered as risk factors for severe course and death at COVID-19.

Delayed cutaneous manifestations in patients with COVID -19 caused by SARS -COV-2. Clinical observations in the Russian Far East

Chung M. K., Zidar D. A., Bristow M. R., et al. (2021) warn that a historic pandemic due to the coronavirus disease, COVID-19, could have negative potential consequences for the cardiovascular system for millions of survivors worldwide [1]. At the present stage, mechanisms of the long-term consequences of COVID-19 disease caused by SARS-COV-2 are not studied well; any assumptions regarding to the consequences of SARS-Cov-2 are hypothetical. Therefore, long-term effects require indepth research in the dynamics of recovery process after severe infections and rehabilitation of survivors. This will facilitate and increase the effectiveness of the treatment protocol for this disease and its complications [2]. The duration of the incubation period of the disease, the presence of sometimes not expressed or absent symptoms makes identification of the disease caused by SARS-CoV-2, COVID-19 infection, in some cases, too complicated [3]. The duration of the rehabilitation time, the complexity of pathogenetically based treatment do not yet have comprehensive information, therefore, it is difficult to resolve the issue of the timing of vaccination of patients who have recovered from COVID-19 infection. All the data obtained for each case of the disease, depending on age, the presence of concomitant diseases and individual terms of health recovery with the characteristics of complications in the late periods after recovery, has high relevance and great importance [4]. According to Wu Y., Guo C., Tang L., (2020), the excretions of recovered patients remains dangerous for others around 5 weeks after clinical recovery [5]. At the moment, there is practically no exact information about the duration and intensity of immunity in an infection caused by SARS-CoV-2 [6]. To develop protocols of COVID-19 treatment, principles and paradigms for the development of alternative effective vaccines for the prevention COVID-19 affects the health of consumers of the vaccine, which requires long-term monitoring in the post-recovery

РАДЖАСТАН ШТАТЫНДАГЫ (ИНДИЯ) ЭКИ ШААРДАГЫ КОРОНАВИРУСТУК ИНФЕКЦИЯНЫН АГЫМЫНЫН САЛЫШТЫРМА МҮНӨЗДӨМӨСҮ

Today, the covid 19 pandemic continues around the world. India, with 12.2 million cases, has the third largest number of detected cases of coronavirus infection after the United States and Brazil. The situation with coronavirus infection in India, as well as around the world, remains tense and urgent, due to the rapid spread, with a large number of cases and deaths. This article presents a comparative clinical characteristics of coronavirus infection in two cities of India in the state of Rajasthan (Kota and Jaipur), with the study of the epidemiological history, age, and gender of the patients. Special attention is paid to the peculiarities of the course of infection in children and elderly patients, the presence of concomitant diseases and the development of severe complications.

Lifestyle factors and medical activity of patients with COVID-19 treated on an outpatient basis using telemedicine technologies

The study of lifestyle factors (LS) and MA was conducted by an anonymous survey of 7,743 patients with COVID-19. The patients' health was assessed based on the study of the course of the underlying disease and the presence of concomitant diseases, which were detected in 24.3% of COVID-19 patients according to the data of copying information from medical records. It was revealed that the prevalence of tobacco smoking was 33.25 cases per 100 respondents, 45.4% of respondents were overweight, 75.6% of patients had a low level of physical activity, 68.2% and 53.8% of patients had low medical literacy and MA, respectively. It is established that the greatest impact on the health status of the patients interviewed was provided by the bio-social activity (Smoking) (h = 0.702; m = 0.0063; p = 0.0022), physical activity (h = 0.624; m = 0.0026; p < 0.001, health behavior (h = 0.527; m = 0.0030; p < 0.001) and health literacy (h = 0.532; m = 0.0028; p < 0.001). The studied risk factors affecting the health status of COVID-19 patients, most of which are manageable, should be taken into account when forming therapeutic and preventive measures.

Possibilities of application a fixed combination of alogliptin and pioglitazone for type 2 diabetes mellitus treatment

Hyperglycemia in T2DM is based on three main mechanisms: insulin resistance, progressive β-cell dysfunction, and excess glucose production by the liver.The onset of T2DM is usually preceded by a long period of insulin resistance. Prescribing sugar drugs that affect different links of pathogenesis, reducing a steady decrease in glycemia. To date, in clinical practice, various combinations of hypoglycemic drugs are used, the choice of which is determined by the characteristics of the course of diabetes in the patient, the presence of concomitant diseases and complications of diabetes, as well as the dominant clinical problem. This resolution provides an expert council opinion on the feasibility of using a combination of alogliptin and pioglitazone in patients with type 2 diabetes.

Temporary urethral stent with perineal fixation for posterior urethral stenosis (preliminary results)

Introduction. Urethroplasty is the “gold standard” treatment of urethral stenosis. However, often in connection with old and senile age, as well as due to the presence of concomitant diseases, it is not possible to carry out urethroplasty due to its certain invasiveness. In such cases, one of the methods of treatment is the installation of a urethral stent. But this method has not found practical application due to the frequent migration of stent and the high frequency of its incrustation. The approach developed by us avoids stent migration.Purpose of the study. To evaluate the immediate results of the placement of a urethral stent with fixation through the perineum.Materials and methods. A total of 18 patients with urethral stenosis aged 68 to 84 years have been operated on since February 2019. Ten patients had stenosis of the urethrocystoneoanastomosis after radical prostatectomy, 6 patients had iatrogenic stenosis of the prostatic urethra, 1 patient had post-radiation stenosis of the bulbo-membranous urethra. All patients in the preoperative and postoperative periods underwent: IPSS-QoL questioning, uroflowmetry, bladder ultrasound with residual urine volume evaluation, urethroscopy, ascending and micturition urethrocystography. The first stage was an internal optical urethrotomy according to the standard technique. Then, a urethral stent was installed in the area of dissected stenosis. The second stage was an incision in the perineum, the urethra was isolated, and under optical control, through the perineum, the stent was fixed to the urethra with non-absorbable suture material. The stent was removed endoscopically after 6 months.Results. The median surgery duration averaged 45 minutes. Patients were discharged 2 to 3 days after surgery. The maximum observation period was 20 months. During the observation period, not a single case of stent migration was recorded. All patients showed a persistent increase in Qmax and no residual urine. Six patients had a stress component of urinary incontinence, 4 patients had total urinary incontinence. According to control urethrocystoscopy 6 months after stent removal, clinically insignificant urethral stenosis was noted in all patients. In all cases, moderate signs of stent encrustation were identified. Dysuric phenomena disturbed 5 patients, who were stopped by rectal suppositories with NSAIDs, as well as taking herbal uroseptics. The data from the IPPS-QoL questionnaires confirm the positive effect of the treatment.Conclusions. Temporary placement of a urethral stent for urethral stenosis is an effective minimally invasive treatment. The technique of fixation through the perineum allows preventing migration in all cases. This approach to treatment significantly improves the quality of life of patients who were contraindicated for urethroplasty for one reason or another. However, the technique requires longer observation and analysis.

Спонтанный пневмоторакс: некоторые аспекты этиологии, патогенеза и лечения (обзор литературы)

The review article discusses the prevalence, etiology, pathogenesis, and treatment of spontaneous pneumothorax. The vascular, mechanical, obstructive, infectious, and enzymatic theories of the occurrence of emphysematous lung changes as the main cause of developing spontaneous pneumothorax are described; the role of smoking as the main etiological factor and its influence on the recurrence rate of spontaneous pneumothorax are studied. The issues of choosing primary cure tactic are considered. The effectiveness of conservative treatment, puncture and drainage of the pleural cavity as methods of treatment and pleurodesis for the prevention of recurrences of spontaneous pneumothorax are described. A comparativeassessment of various methods of pleural cavity obliteration is given: chemical pleurodesis (by sterile talc, minocycline, povidone-iodine, 50% glucose solution, autologous blood and its components, autologous adipose tissue, pseudomonas aeruginosa sensitive hemagglutinin, picibanil), apical pleurectomy, pleuroabrasion. The experience of using YAG-ND and CO2 as methods of physical pleurodesis, intraoperative Staple Line Coverage with polyglyconic acid and fibrin gel is described. The necessity of active surgical tactic in the treatment of patients with spontaneous pneumothorax developed on the base of undifferentiated connective tissue dysplasia has been substantiated. The advantages, disadvantages, indications and contrindications to different ways of surgical treatment (thoracotomy, video-assisted minithoracotomy, thoracoscopy) are discussed. The strategy for choosing treatment methods depending on the volume of pneumothorax, the severity of bullous changes, the presence of concomitant diseases, chronic obstructive pulmonary disease, and the value of the Charlson comorbidity index is considered. The expediency of using video-assisted minithoracotomy as the safest and most effective method of surgical treatment of spontaneous pneumothorax has been substantiated. The effectiveness of surgical interventions depending on the timing of their implementation is considered.

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.

Інсиденталома надниркової залози: що це таке? Частина 1

Огляд літератури та власні роздуми автора присвячені питанням виявлення різних форм патології, які, будучи часто доброякісними, могли б існувати тривалий час, якщо не все життя. Автором пропонується визначення терміна. Інсиденталома надниркової залози— це збірна робоча категорія (група), що містить різні форми патології надниркової залози, переважно неопластичні, доброякісні або злоякісні, з ознаками гормональної активності або без них, а також утворення запального, інфекційного, паразитарного походження, наслідки травм, аномалії розвитку, які випадково виявляються при обстеженні хворих із приводу позанаднирникових захворювань. Розглядаються епідеміологічні аспекти інсиденталом надниркової залози. В основному це пухлини коркової або мозкової речовини надниркових залоз, пухлиноподібні утворення (кіста, запальна пухлина, гематома). Інсиденталоми наднирників випадково виявляються при обстеженні осіб із захворюваннями шлунково-кишкового тракту, заочеревинного простору, нирок, хребта, грудної клітки, малого таза. Іншим джерелом виявлення інсиденталом наднирників є системні дані автопсії та рідко— операції на органах черевної порожнини. Поширеність інсиденталом наднирників досягає 2–6%. Найбільш об’єктивні дані можуть бути отримані за матеріалами автопсії. Частота прижиттєво виявлених інсиденталом надниркових залоз залежить від типу використовуваних візуалізуючих методик дослідження (ультразвукової, комп’ютерної томографії, магнітно-резонансної томографії), віку, характеру обстежуваних контингентів осіб, наявності супутніх захворювань (артеріальна гіпертензія, цукровий діабет та ін.), кваліфікації дослідника. Нещодавно опубліковані клінічні настанови, які пропонують діагностичний та терапевтичний алгоритм, що може допомогти в клінічній практиці, однак низка аспектів цієї проблеми все ще залишаються дискусійними і потребують подальших досліджень.

Drug-induced hypersomnia

Daytime somnolence may be a symptom of different somatic, neurological and psychiatric diseases and develop due to abuse and/or discontinuation of various medications. Drug- induced hypersomnia (DIH) is defined as hypersomnolence caused by the intake of multiple drugs. DIH is one of the most frequently reported effects and/or side effects of drugs. DIH prevalence varies widely and can be as high as 75% in patients receiving specific medications. DIH risk factors include elderly and senile age, impaired drug metabolism, serum drug concentration, method and frequency of drug administration, single and daily doses of drugs, etc., as in many other drug- induced diseases and syndromes. DIH can occur both due to sedative agents administration and withdrawal of psychostimulants and other activating psychotropic medications. Most often, the development of DIH is associated with the use of levodopa-carbidopa, antipsychotics, antidepressants. The pathogenesis of DIH is complex and multifactorial and is associated with the mechanism of action of individual drugs and the presence of concomitant diseases. The article discusses the risk assessment of DIH development due to various medications, diagnosis and management tactics of patients with DIH.

The value of ultrasound in the multivariate assessment complications of permanent vascular access for hemodialysis

Background. The maximum duration of vascular access for hemodialysis functioning rarely exceeds 4 years. The main tool for diagnosing access dysfunction is duplex ultrasound. Dynamic ultrasound examination of vascular access is not included in the standard examination of patient undergoing hemodialysis in Russia.Objective. To study the structure of complications and changes in hemodynamics in the vascular access for hemodialysis and to determine the risk factors contributing to its development.Design and methods. Ultrasound, clinical and laboratory examination was performed in 550 patients undergoing program hemodialysis, 517 (94.0 %) of them had arteriovenous fistula, 33 (6.0 %) patients had arteriovenous graft.Results. Vascular access complications occurred in 26.7 % (147 patients), there was no significant difference in the detection rate of thrombosis (26.5 %), stenosis (23.8 %), and aneurysm (21.1 %). A combination of two complications was observed in 20.4 %, the steal syndrome — in 8.2 %. A correlation was established between the presence of significant stenosis, aneurysm of the outflow vein and the development of thrombosis, between the presence of concomitant diseases of the peripheral arteries and the development of steal syndrome and stenosis of the inflow artery and the anastomosis zone.Conclusion. Duplex ultrasound allows to diagnose complications of vascular access for hemodialysis and determine its causes.