Provoking Factor Research Articles

A 12-Year Review of Upper Extremity Deep Vein Thrombosis-Are They the Same as Lower Extremity Deep Vein Thrombosis?

Background: Upper extremity deep vein thrombosis (UEDVT) is uncommon but not insignificant. The current literature is limited, and the management is largely extrapolated from the treatment of lower extremity DVTs (LEDVT). Methods: A retrospective review was conducted on patients diagnosed with UEDVT at Northern Health, Victoria, Australia, between December 2010 and December 2022. Medical records were reviewed to assess baseline characteristics and treatment outcomes. The results were compared to our previously collected data for LEDVTs. Results: 137 patients with UEDVT were identified (52.6% females; median age 62 years, IQR 46-74 years). A total of 105 patients (76.6%) had at least one provoking factor at the time of diagnosis, most commonly malignancy (45.7%) and/or indwelling venous devices (58.1%). Fourteen patients (10.1%) were subsequently diagnosed with Paget-Schroetter syndrome, with nine receiving endovascular or surgical intervention. A total of 109 patients (79.6%) received limited therapeutic anticoagulation (median 3 months, IQR 1.5-6.0 months) with enoxaparin, the most common anticoagulant used. Six patients had major bleeding (5.2/100-patient-years), and seven developed clot progression while on anticoagulation (6.0/100-patient-years). Ten patients had recurrent VTE following anticoagulation cessation (4.6/100-patient-years). There were no significant differences seen in the complication rate between catheter-related UEDVT and other UEDVTs. Compared to LEDVT, UEDVT was more likely provoked with comparable complication rates. Conclusions: UEDVTs were commonly associated with a provoking factor, with indwelling catheters and/or malignancies being the most common. Interestingly, catheter-related UEDVT had comparable clot progression/recurrence and major bleeding compared to other UEDVTs and LEDVTs, which may be confounded by relatively high rates of malignancy.

Changes in Cellular and Humoral Immunity of Children with Respiratory Diseases Living in Areas of Kyrgyzstan at Different Altitudes

Immunological aspects of respiratory diseases due to altitude can have a significant impact on the pathogenesis and clinical course of the disease. Research objectives: to study changes in cellular and humoral immunity in children with respiratory diseases living in areas of Kyrgyzstan located at different altitudes above sea level. This study used methods to assess cellular and humoral immunity in 209 children living at various altitudes above sea level in Kyrgyzstan. Research results contribute to a deeper understanding of the immunological mechanisms underlying respiratory diseases in children at high altitudes, which may be of practical importance for the development of more effective methods for diagnosis, prevention and treatment of such diseases. It is assumed that at high altitude the number of allergens in the body decreases, in particular, the number of dust mites, which often act as a provoking factor in allergic respiratory diseases.

МАРКЕТИНГОВЫЕ ИССЛЕДОВАНИЯ ФАРМАЦЕВТИЧЕСКОГО РЫНКА СЕДАТИВНЫХ ЛЕКАРСТВЕННЫХ СРЕДСТВ, РАЗРЕШЁННЫХ К ПРИМЕНЕНИЮ НА ТЕРРИТОРИИ РОССИЙСКОЙ ФЕДЕРАЦИИ

In the modern world, stressful situations and stress-related disorders have become widespread among the population, representing one of the most pressing medical and social problems. Experts from around the world have traced a clear connection between stress and the development of many diseases, both from the somatic, mental and behavioral levels. Regardless of gender and age, social and cultural status, any person is susceptible to stress, and physical, emotional, informational and/or any other impact can act as a provoking factor [7,8]. When diagnosing disorders caused by stressful events, medical specialists rely on patient complaints arising at the somatic level, without taking into account the mental component, while timely treatment of ordinary stressful conditions that reduce the response adaptive functions of the body, using sedatives, will help to avoid overstrain of the body and prevent the stage of exhaustion [1,7]. The purpose of the study is to analyze the pharmaceutical market for sedative drugs registered in the Russian Federation Federation. During the research, official sources of information on the nomenclature of sedatives were used: the State Register of Medicines, the Register of Medicines and the Vidal Medicines Directory with up-to-date information for 2023. The main analysis methods used in this article are: methods of grouping, retrospective, logical, graphic and structural analysis, content analysis. As a result of the study, the main trends in the development of the range of sedative drugs were determined, and a macro-contour of the pharmaceutical market of the group under study was compiled according to the main leading characteristics of drugs.

К вопросу о тиреоидной функции щитовидной железы беременных, проживающих в йододефицитном районе (Республика Дагестан, Ахтынский район, 1675 м над уровнем моря)

The work shows that currently diseases associated with iodine deficiency in the diet are one of the most common non-communicable human diseases. Iodine deficiency contributes to a decrease in the synthesis and secretion of thyroid hormones, during pregnancy leads to the formation of the neuropsychiatric status of the fetus. Thyroid pathology is more common in women than in men. During pregnancy, thyroid pathology increases dramatically – pregnancy itself is a provoking factor. One of the important reasons is the deterioration of the environmental and radiation situation, the changing nature of the population's diet. The impact of the ecosystem on the health of the population can be determined based on data on the incidence of thyroid diseases in women of reproductive age in rural areas with iodine deficiency. The article presents data on the examination and treatment of 120 pregnant women (First Trimester of pregnancy) aged 20–40 years who are registered in the women's clinic of the Akhtyn regional hospital.

Analysis of the course and treatment of COVID-19: the experience of the Morozov Children’s City Clinical Hospital

Morozov Children’s City Clinical Hospital, almost in the first months of the development of the COVID-19 epidemic, began to admit not only patients with acute infection, but mainly with combined comorbid pathology. Based on a retrospective analysis of 290 medical records of children hospitalized with COVID-19 at the Children’s City Clinical Hospital, an analysis of children admitted to the hospital with predominantly comorbid pathology was carried out between April 2020 and September 2020. Six of these children had a fatal outcome. Most children were in the first 3 years of life (38,4 %) and puberty (37,3 %). The diagnoses of hospitalized patients were varied: pneumonia — 41 (14,4 %), surgical pathology and trauma — 69 (24,3 %), somatic pathology — 120 (42,3 %), including: diseases of the gastrointestinal tract, kidneys and urinary tract pathways, hematological diseases, neurological, type I diabetes mellitus, joint diseases, diseases of the newborn period, oncological diseases, diseases of the cardiovascular system. To diagnose covid pneumonia, along with rapid methods of SARS-COV2, computed tomography of the lungs was used. Analyzing the course of diseases in surgical children, it can be noted that coronavirus infection did not affect the course of the underlying disease. At the same time, COVID-19 infection in hematological patients provoked a worsening of the condition with symptoms of an acute respiratory viral infection (hyperthermia, weakness, cough, rhinitis). In patients with symptomatic focal epilepsy and in patients with increased intracranial pressure, SARS-COV-2 caused activation of seizures. It should be noted that the onset of type 1 diabetes was observed in 5 out of 6 admitted children. In these cases, COVID-19 infection was a provoking factor; it also caused an exacerbation in 1 child who had “long-term” diabetes. The article presents case histories and diagnoses of 6 children aged 3 years 9 months to 17 years with deaths, severe comorbid pathology (leukemia, brain stem tumor, immunodeficiency state), in whom COVID-19 infection aggravated the course of the underlying disease with the development of generalized combined bacterial infection, sepsis, bleeding.

Venous Thromboembolism Among People With HIV: Design, Implementation, and Findings of a Centralized Adjudication System in Clinical Care Sites Across the United States.

People with HIV (PWH) are at increased risk for venous thromboembolism (VTE). We conducted this study to characterize VTE including provoking factors among PWH in the current treatment era. We included PWH with VTE between 2010 and 2020 at 6 sites in the CFAR Network of Integrated Clinical Systems cohort. We ascertained for possible VTE using diagnosis, VTE-related imaging, and VTE-related procedure codes, followed by centralized adjudication of primary data by expert physician reviewers. We evaluated sensitivity and positive predictive value of VTE ascertainment approaches. VTEs were classified by type and anatomic location. Reviewers identified provoking factors such as hospitalizations, infections, and other potential predisposing factors such as smoking. We identified 557 PWH with adjudicated VTE: 239 (43%) had pulmonary embolism with or without deep venous thrombosis, and 318 (57%) had deep venous thrombosis alone. Ascertainment with clinical diagnoses alone missed 6% of VTEs identified with multiple ascertainment approaches. DVTs not associated with intravenous lines were most often in the proximal lower extremities. Among PWH with VTE, common provoking factors included recent hospitalization (n = 134, 42%), infection (n = 133, 42%), and immobilization/bed rest (n = 78, 25%). Only 57 (10%) PWH had no provoking factor identified. Smoking (46%), HIV viremia (27%), and injection drug use (22%) were also common. We conducted a robust adjudication process that demonstrated the benefits of multiple ascertainment approaches followed by adjudication. Provoked VTEs were more common than unprovoked events. Nontraditional and modifiable potential predisposing factors such as viremia and smoking were common.

Development of idiopathic eruptive macular pigmentation in an 11-year-old boy

A case of idiopathic eruptive macular pigmentation in a child demonstrates a variant of skin hyperpigmentation of uncertain etiology. We described an 11-year-old boy with light brown spots in the torso and limbs that developed against the background of normal skin without an established provoking factor. On examination, it was found that the disease had developed within one year. Initially, the process was localized to the elbow folds and axillary areas, but later the rash spread to the trunk, neck and extremities. No inflammatory changes were observed at the base of the rash elements. The patient was examined for the presence of diseases that could underlie the skin manifestations, and histological examination was performed to verify the diagnosis. The established diagnosis of idiopathic eruptive macular pigmentation made it possible to choose a wait-and-see approach in treating the patient, due to the available literature data on the self-resolution of this pathology and ineffectiveness of the availabledermatosis treatment options.

Management of new onset atrial fibrillation during acute medical illness

New-onset atrial fibrillation (AF) occurring during acute medical illness or post-operatively has long been considered a benign phenomenon, and its recurrence risk was deemed low. However, recent data suggest a high risk of AF recurrence, and a thromboembolic risk similar to the risk associated with AF occurring without a provoking factor. As we lack interventional data, there are currently no guidelines on the long-term management of new-onset AF occurring during an acute medical condition. This paper aims to review current knowledge on epidemiology, recurrence risk, thromboembolic risk and anticoagulation strategies in the setting of new-onset AF occurring transiently with acute stress.

THE INFLUENCE OF THE TYPE OF ANESTHESIA ON EARLY POSTOPERATIVE RECOVERY IN PATIENTS WITH ABDOMINAL WALL HERNIAS

Introduction. Pathways to improved recovery after surgery are aimed at reducing surgical stress, maintaining physiologic homeostasis and returning to the patient's baseline functional level prior to surgery.A significant number of patients are operated on each year for hernias of the abdominal wall. One of the unwanted frequent complications is chronic postoperative pain. It can begin as an acute postoperative pain that is difficult to control, the provoking factor can be opioid hyperalgesia. A multimodal analgesia strategy involves combinations of analgesics to achieve clinically necessary analgesia while minimizing significant side effects and reduces dependence of any drug and is an important component of enhanced recovery after surgery (ERAS) protocols.
 Goal. To assess the efficiency of the types of anesthesia regarding postoperative analgesia and the speed of recovery from the standpoint of patient safety.
 Materials and methods. 66 patients who underwent surgical treatment of abdominal wall hernias took part in the study. They were divided into 3 groups according to the type of anesthesia (general, neuraxial and fascial blockades of the abdominal wall). Analyzed according to the risk of anesthesia. At different stages of the perioperative period, the use of analgesics was analyzed, the speed of awakening and the intensity of pain according to the VAS scale on the first day were assessed.
 Results and discussion. The number of patients with the risk of ASA II was greater in the first group (general anesthesia), with the risk of ASA III in the second and third groups (neuraxial anesthesia and fascial blocks), which to some extent affected the choice of the type of anesthesia. According to the Aldrete awakening scale, after the operation, the patients of group 3 had the highest score, respectively, and the shortest time of transfer to the postoperative ward. 42% of patients in group 1 and all patients in group 2 received postoperative analgesia with the use of narcotic analgesics once. Patients in group 3 did not receive narcotic analgesics for postoperative analgesia.
 Conclusions. The choice of anesthesia method is important to achieve effective results of rapid recovery. Neuraxial and fascial blocks promote faster recovery and allow to reduce or avoid the use of opioid analgesics during surgery. Fascial blocks of the abdominal wall provide long-term and adequate analgesia in the first day of the postoperative period after hernioplasty of the abdominal wall.

Clinical Characteristics, Treatment, and Outcomes of Provoked Acute Cerebral Sinovenous Thrombosis in Patients

Background Cerebral sinus venous thrombosis (CSVT) is a rare pediatric condition with an estimated incidence of 0.7 per 100,000 children. However, amongst pediatric venous thromboembolism (VTE), the proportion of CSVT is high, at about 10% of all pediatric VTE. Key risk factors include perinatal stressors in cases of neonatal CSVT and acute infections, especially head and neck infections, in older children. To date, few multinational trials of pediatric VTE treatment have reported findings specifically among CSVT patients. Aims We sought to describe the clinical characteristics, treatment strategies, and outcomes of the patients with provoked acute CSVT enrolled in the Kids-DOTT trial and to compare these features to those of Kids-DOTT participants with non-CSVT VTE. Methods Kids-DOTT was an NIH-sponsored multinational randomized clinical trial (RCT) comparing 6 weeks vs. 3 months of anticoagulation for provoked acute VTE treatment in patients <21 years, with two non-randomized cohort arms run in parallel to the RCT for patients with persistent antiphospholipid antibodies or complete veno-occlusion at 6 weeks post-diagnosis of the index VTE. The primary RCT findings were recently published. In the present analysis, descriptive statistics were used to summarize patient and thrombus characteristics, treatments, and outcomes, and variables were compared between CSVT and non-CSVT VTE groups using Mann-Whitney U test for continuous variables and Chi-squared or Fisher's exact test, as appropriate, for categorical variables. All statistical analyses were performed using R Core Team, 2021. A P-value of <0.05 was considered statistically significant. Results Among 532 patients enrolled in the Kids-DOTT trial, the index VTE was a CSVT in 75 (14%). Age distribution differed significantly ( P=0.002) between CSVT and non-CSVT VTE patients, with the CSVT more likely to occur in neonates and children, compared to non-CSVT VTE more likely to occur in adolescents. CSVT was less likely to be CVC-related compared to non-CSVT VTE. The frequency of any infection (56.9% vs 26%, p<0.001) and specifically infection of the head/neck (35.4% vs 2%; P<0.001) as a provoking factor was significantly higher for CSVT vs. non-CSVT VTE. Non-head and neck infections were less likely to be associated with CSVT compared to non-CSVT VTE. One-third of CSVT patients received 6 weeks, while two-thirds received > 3 months, of anticoagulation (Table 2). No patients developed ISTH-defined symptomatic recurrent VTE or clinically relevant bleeding. Conclusions These multinational trial findings substantiate those of retrospective studies implicating head/neck infection as an important provoking factor for CSVT in young patients. The absence of recurrent VTE or clinically relevant bleeding among CSVT patients managed with anticoagulation in Kids-DOTT serve to augment recent RCT findings of CSVT treatment in children involving direct oral anticoagulants, demonstrating the safety and efficacy of therapeutic anticoagulation for pediatric CSVT.

FRI512 Thyrotoxic Periodic Paralysis With Extreme Hypokalemia Precipitated By Acute Alcohol Intoxication In A Patient With Graves’ Disease

Abstract Disclosure: J. Batra: None. A.R. Ankireddypalli: None. J. Kaur: None. Introduction: Thyrotoxic periodic paralysis (TPP) is a muscle and electrolyte disorder, mostly seen in the setting of hyperthyroidism. It is characterized by reversible painless muscle weakness and hypokalemia. Prevalence is highest in East Asian populations, approximately 2%, and 0.1-0.2% in other populations. Males are much more likely to be affected. Common provoking factors include exercise, fasting, and changes in diet. Clinical case: A 29-year-old male of East Asian ethnicity presented to the hospital with the complaint of multiple bouts of inability to lift his extremities for 1 day. He also complained of generalized weakness. He did not have any changes in his mental status and was fully oriented at the time of the presentation. No breathing difficulty was reported. He had been drinking the night before with his friends and drank 1 L of vodka. His past medical history was significant for hyperthyroidism secondary to Graves’ disease, which was diagnosed a year ago. He had been prescribed methimazole but had not been adherent to the medication. The basic metabolic panel revealed undetectable serum potassium of <1.5 (3.4 to 5.3 mmol/L). The rest of the electrolytes and renal function were unremarkable. TSH was suppressed at <0.01 (0.3 to 4.20 uIU/L) and free T4 levels were significantly elevated at 7.77 (0.9 to 1.70 ng/dL). The thyrotropin receptor antibody was 33 (0.00 to 1.75 IU/L). EKG showed sinus tachycardia with nonspecific T-wave abnormalities. Thyroid ultrasound showed diffusely heterogenous parenchyma with diffusely increased blood flow throughout the thyroid on doppler. Echocardiogram showed a normal ejection fraction of 55-60% with mild concentric left ventricular wall thickening consistent with left ventricular hypertrophy. He was initially treated with intravenous potassium replacement and high doses of propylthiouracil, hydrocortisone, and propranolol, leading to the resolution of his symptoms. He was discharged on methimazole and propranolol therapies. Learning points: • Patients with Graves’ disease are routinely counseled against tobacco use to avoid worsening of orbitopathy. Hyperthyroid patients should also be counseled regarding avoidance or moderation of alcohol intake to avoid this rare but potentially life-threatening complication of thyrotoxic periodic paralysis. • The incidence of TPP is significantly higher in the East Asian populations, especially among males (8.7-13%). Counseling regarding provoking factors, the importance of adherence to medications, and the maintenance of euthyroidism to avoid TPP is essential. Presentation: Friday, June 16, 2023

Fungal Keratitis. Part 1. Etiomorphology, Historical Aspects, Epidemiology, Risk Factors, Pathogenesis and Clinical Features

Fungal keratitis (FK) is 8–30 % in the structure of infectious inflammation of the cornea. There are 2 main types of mushroom growth — mycelial and yeast. Mycelial (mold) fungi grow in the form of special branched microscopic tubes — hyphae. Yeast fungi form compact colonies of individual oval cells. Due to the peculiarities of the yeast structure, the tendency to rapid spread in the tissues is reduced, which determines the less aggressive clinical course of such keratomycosis compared to mold. Until the 50s of the 20th century, the occurrence of FK in the world was low. However, probably with the introduction of corticosteroid and antibacterial drugs into medicine, their prevalence began to grow. The highest frequency of occurrence of FK is in regions with a hot climate and high involvement of the population in agriculture. The main provoking factor for the appearance of FK is corneal injury with damage to the epithelium and adhesion to the Bowman’s membrane or stroma components. Highly adhesive fungi (Aspergillus spp., Candida spp.) trigger a cascade of immune inflammatory reactions, production of reactive oxygen species and matrix metalloproteases-9, which leads to the destruction of lamellae. Fungi with low adhesive ability (Fusarium spp.) can grow parallel to lamellae for a long time and indefinitely without inducing pronounced inflammation. Symptoms of FC are similar to those observed in other forms of infectious keratitis, but more often they develop more slowly (5–10 days) and are less acute. A defect against the background of mycelial FC is more often characterized by jagged edges, a raised slough, and a non-yellow color. Yeast FK is manifested by oval ulceration of the epithelium with expanding, more sharply demarcated, densely focal suppuration.

Retrospective analysis of cases of transient global amnesia admitted to the hospital

Introduction. Transient global amnesia (TGA) is a clinical syndrome, the main clinical manifestation of which is sudden development of anterograde and retrograde amnesia, lasting not more than 24 hours, without other general cerebral or focal neurological symptoms.The aim of the work was to reveal the peculiarities of clinical manifestations and data of additional methods of examination of patients with TGA syndrome referred to the primary vascular department with suspected acute cerebral circulation disorder (ACCD).Materials and methods. The study included 16 patients with transient global amnesia diagnosed according to the diagnostic criteria of Hodges and Warlow (1990). All patients underwent a detailed neurological and general medical examination. Electrocardiography, multispiral computer tomography of the head, echocardiography, ultrasound duplex scanning of the main arteries of the head and neck, laboratory examination (lipid spectrum) were performed. The Brief Mental Status Rating Scale was used to assess cognitive impairment.Results. The majority of patients had elevated blood pressure (BP). The leading trigger factor of transient global amnesia was stress. The duration of amnesia ranged from 1.5 to 5 hours. There was a significant impairment of short-term memory. On the first and second days of hospitalization, 50% of patients had normal cognitive functions on a brief mental status assessment scale, but by the 5th−7th day only 12.5 % of patients had abnormalities. Ultrasound markers of atherosclerosis in the form of intima-media complex thickening and dyslipidemia were found in 6 patients. Signs of left ventricular hypertrophy were found in the majority of patients. Discussion TGA is a relatively rare condition and an understudied syndrome. Due to its suddenness of clinical manifestation, TGA requires differential diagnostics with acute cerebral circulatory disorders, epilepsy, acute hypertensive encephalopathy and psychogenic amnesia.Conclusion. The clinical features of TGA identified in the patients were a history of arterial hypertension, elevated BP during an episode of TGA. The leading provoking factor was stress. TGA episode occurred predominantly in the first half of the day. The majority of patients had complaints of headache on admission. Cognitive disorders detected in patients on the first and second days of the disease quickly regressed to normal. Left ventricular hypertrophy was detected in most patients.

Sympathetic denervation — a promising method for treatment of ventricular tachyarrhythmia in children

Ventricular tachycardia is a rare but potentially life-threatening arrhythmia. Ventricular tachycardia in patients with structural pathology and cardiac channelopathies is associated with the highest risk of sudden cardiac death. The stratification of patients depending on the risk of developing a life-threatening arrhythmia determines the choice of treatment method. Left cardiac sympathetic denervation is a surgical method of treatment aimed at preventing attacks of ventricular tachycardia. The antiarrhythmic effect of sympathetic denervation has been proven in both experimental and clinical studies. Currently, the technique of left cardiac sympathetic denervation consists of a video-assisted sympathectomy by thoracoscopic access, which makes the procedure safe and effective. Left cardiac sympathectomy is used in the treatment of patients with recurrent ventricular tachycardia despite adequate medical therapy. The authors recommend the use of left cardiac sympathectomy in those types of channelopathies, in which stress is the main proven provoking factor of ventricular tachycardia.

Reproductive health and environment

In this world, unfortunately, one of the urgent and vital problems is the polluted ecology, which is bad for not only health, but also for reproduction. In particular, one of the big environmental conditions is: water, polluted air, etc. Fertility is greatly affected, and it is the result of an unhealthy environment that is the main cause of conception. Rates of congenital malformations and other reproductive problems. According to the Centers for Disease Control and Prevention (CDC), infertility rates are on the rise. In 1950, there was an average of 5 children per woman, but in 2020 this rate has significantly decreased (to 2 children) and has fallen. Southern and Eastern Europe and East Asia have the lowest fertility rates: 1.5 children per woman. Infertility couples have a problem with a man, a third with a woman, and in the case of another third, representatives of both sexes have it, which is also noteworthy. These theses are discussed in the following article, in particular, how the location, unhealthy environment affects human fertility, what mechanisms are involved, and what is the correlation between fertility and ecology. Therefore, how dangerous our own careless actions are for the reproductive health of both women and men. How ecology becomes the driving force of infertility is the main provoking factor, namely, falsified structures, pelvic inflammatory response, oogenesis disorders or aspermia.

Anticoagulant treatment for pediatric splanchnic vein thrombosis: a systematic review and meta-analysis

BackgroundThe clinical characteristics of splanchnic vein thrombosis (SVT) in pediatric patients and its optimal treatment strategies are unknown. ObjectivesThis study aimed to assess the effectiveness and safety of anticoagulant therapy for pediatric SVT. MethodsMEDLINE and EMBASE databases were searched up to December 2021. We included observational and interventional studies that enrolled pediatric patients with SVT and reported anticoagulant treatment and outcomes, including rates of vessel recanalization, SVT extension, venous thromboembolism (VTE) recurrence, major bleeding, and mortality. Pooled proportions of vessel recanalization were calculated with their 95% CI. ResultsA total of 506 pediatric patients (aged 0-18 years) across 17 observational studies were included. The majority of patients had portal vein thrombosis (n = 308, 60.8%) or Budd-Chiari syndrome (n = 175, 34.6%). Most events were triggered by transient provoking factors. Anticoagulation (heparins and vitamin K antagonists) was prescribed in 217 (42.9%) patients, and 148 (29.2%) patients underwent vascular interventions. The overall pooled proportions of vessel recanalization were 55.3% (95% CI, 34.1%-74.7%; I2 = 74.0%) among anticoagulated patients and 29.4% (95% CI, 2.6%-86.6%; I2 = 49.0%) among non-anticoagulated patients. SVT extension, major bleeding, VTE recurrence, and mortality rates were 8.9%, 3.8%, 3.5%, and 10.0%, respectively, in anticoagulated patients and 2.8%, 1.4%, 0%, and 50.3%, respectively, in non-anticoagulated patients. ConclusionIn pediatric SVT, anticoagulation appears to be associated with moderate recanalization rates and a low risk of major bleeding. VTE recurrence is low and comparable to that reported in pediatric patients with other types of provoked VTE.

On the issue of diagnosis and treatment of skin pseudolymphoma on the example of a clinical case

Pseudolymphomas of the skin are a heterogeneous group of diseases manifested by benign lymphoid infiltrates that clinically and/or histologically mimic skin lymphoma.
 The group of pseudolymphomas of the skin includes actinic reticuloid, benign lymphocytoma of the skin, true pesvdolymphoma, postscabious lymphoplasia, lymphocytic reactions to insect bites, etc. The diagnosis of pseudolymphoma is based on anamnesis data (the presence of a provoking factor, with the exception of idiopathic pseudolymphomas), clinical picture (a single papule, less often a plaque localized in open areas of the upper half of the body ― the face: cheeks, nose, earlobes; scalp, upper extremities, chest), results histological, immunophenotypic studies, and with persistent persistence of rashes ― on the results of molecular biological studies.
 The similarity of clinical and pathomorphological signs of pseudolymph with malignant lymphoproliferative processes creates significant diagnostic difficulties and requires a thorough examination with the involvement of pathologists and oncologists. Diagnostic difficulties are often the cause of erroneous or late detection of skin lymphoma, which negatively affects the prognosis of the disease. Treatment tactics are determined by the morphological variant of lymphoid infiltration, as well as the presence and nature of the provoking factor. The majority of idiopathic psvdolymph is successfully treated with systemic glucocorticosteroids, however, in the case of resistance to systemic glucocorticoids, recommendations on treatment tactics have not yet been developed. Prolonged, often recurrent course, as well as the possibility of transformation of the process into malignant lymphoma of the skin, requires long-term clinical observation of patients.
 The case presented in the article confirms that the crucial importance for the successful diagnosis of pseudolymphoma lies in the analysis of anamnesis data, clinical picture, histological and immunohistochemical studies.

Case of acute recurrent myocardial infarction in a child

Information on the essential aspects of prevalence, etiology and pathogenesis of coronary heart disease, which is the leading cause of death in the world, is given in this article. It is emphasized that the incidence of ischemic coronary events is the result of a complex sequence of pathogenetic links, which involves the formation of atherosclerotic lesions and destabilization as the primary provoking factor. Purpose - the attraction of the medical community attention to the problem of ischemic heart disease in children. A clinical case of recurrent myocardial infarction in a child who was examined and treated at the MNPE «Ivano-Frankivsk Regional Children’s Clinical Hospital of the Ivano-Frankivsk Regional Council», is described here. The key points of the patient’s complaints, anamnesis of life and this disease are described, the data of the objective condition at the hospitalization and during dynamic observation of the child, which showed the signs of left ventricular overload, coronary blood flow disorder, dilatation of the left heart ventricles, decreased left ventricular contractility. The data of the main indices of laboratory and instrumental methods of research, including X-ray diagnostic methods, performed not only on the basis of the department, but also in the Scientific-Practical Medical Center of Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine (Kyiv). The treatment of this clinical case in the child is described in this article. The data of dynamic observation are given. The discussion and conclusions emphasize the problem of coronary insufficiency in pediatrics, which requires clinical understanding, the choice of the correct diagnostic algorithm and qualified medical care. The study was performed in accordance with the principles of the Declaration of Helsinki. Informed consent of the child’s parents was obtained for the research conduction. No conflict of interests was declared by the authors.

A Case of Successful Medical Treatment of Ventricular Tachycardia in a Patient With Ischemic Heart Disease and Heart Failure

The pathogenetic mechanisms of arrhythmias, including high-grade ventricular arrhythmias (including non-sustained ventricular tachycardia), in patients with coronary heart disease may be different. Therefore, the characteristics of ventricular arrhythmias must be considered based on the totality of data, taking into account all the available features. The importance of a personalized approach to the management of a patient with coronary heart disease who had extensive myocardial infarction 18.5 years ago, followed by mammary coronary artery bypass grafting, aneurysmectomy and the development of heart failure with a low ejection fraction, in whom ventricular arrhythmias occurred against the background of a stable course of coronary disease , but after emotional stress, is reflected in this work. An extended examination, as well as a detailed study of the nature of ventricular arrhythmias, made it possible to determine the main provoking factor and select an individualized pathogenetic treatment with a good antiarrhythmic result that persists for several years of observation. Conducting mental tests and psychological questioning can be recommended for patients with coronary heart disease and chronic heart failure as an additional examination to assess the contribution of the psycho-emotional factor to arrhythmogenesis after excluding the ischemic and sympathetic nature of ventricular ectopia. It is incorrect to consider that all ventricular arrhythmias in patients with coronary heart disease are ischemic in nature, and in some clinical situations this statement is even erroneous.

Sex-Related Differences in Patients Characteristics, Risk Factors, and Symptomatology in Older Adults with Pulmonary Embolism: Findings from the SERIOUS-PE Study.

Sex-specific factors are implicated in pulmonary embolism (PE) presentation in young patients, as indicated by increased risk in pregnancy. Whether sex differences exist in PE presentation, comorbidities, and symptomatology in older adults, the age group in which most PEs occur, remains unknown. We identified older adults (aged ≥65 years) with PE in a large international PE registry replete with information about relevant clinical characteristics (RIETE registry, 2001-2021). To provide national data from the United States, we assessed sex differences in clinical characteristics and risk factors of Medicare beneficiaries with PE (2001-2019). The majority of older adults with PE in RIETE (19,294/33,462, 57.7%) and in the Medicare database (551,492/948,823, 58.7%) were women. Compared with men, women with PE less frequently had atherosclerotic diseases, lung disease, cancer, or unprovoked PE, but more frequently had varicose veins, depression, prolonged immobility, or history of hormonal therapy (p < 0.001 for all). Women less often presented with chest pain (37.3 vs. 40.6%) or hemoptysis (2.4 vs. 5.6%) but more often with dyspnea (84.6 vs. 80.9%) (p < 0.001 for all). Measures of clot burden, PE risk stratification, and use of imaging modalities were comparable between women and men. PE is more common in elderly women than in men. Cancer and cardiovascular disease are more common in men, whereas transient provoking factors including trauma, immobility, or hormone therapy are more common in elderly women with PE. Whether such differences correlate with disparities in treatment or differences in short- or long-term clinical outcomes warrants further investigation.