Provoking Factor Research Articles

Recent insights into the management of treatment-resistant pediatric atopic dermatitis.

Atopic dermatitis (AD) is a prevalent protracted inflammatory skin condition that affects approximately 12% of children globally. Topical remedies, such as pharmacologic and nonpharmacologic management, and off-label systemic medicines, have traditionally been used to treat pediatric AD patients. To minimize comorbidities, sleep disturbances, pruritus, and signs of inflammation and improve the patient’s quality of life, it is vital to optimize severe AD management in pediatric patients. Treatment resistance can be caused by a variety of circumstances, including deficient obedience or inappropriate medicine usage, a shortage of adequate pharmaceuticals, hypersensitivity reciprocation to local application of therapeutics, cutaneous infections, and other infuriating ecological provoking factors. If these elements are eliminated, a skin biopsy is required to exclude other AD-like cutaneous disorders. New regimens that target peculiar avenues with improved proficiency and promise minimal adverse events have resulted from recent developments and understanding of the etiology of AD. Although the condition of most patients improves quickly with this treatment, some do not respond well. In this review, the author discusses the management of treatment-resistant atopic dermatitis, with an emphasis on the pediatric population.

Pulmonary embolism and deep vein thrombosis—comorbidities and temporary provoking factors in a register‐based study of 1.48 million people

BackgroundKnowledge on differences in patients who present with deep vein thrombosis (DVT) and those with pulmonary embolism (PE) is incomplete. ObjectiveTo determine comorbidities and temporary provoking factors in patients with a first‐time PE or DVT. MethodsThis was a nationwide Swedish registry‐based, retrospective, case‐control study including 298 172 patients with first‐time venous thromboembolism (VTE) and 1 185 079 controls matched for age, sex, and county of residence, free of VTE at the time of matching. ResultsPatients with PE were older than those with DVT (mean age, 69 vs 66 years) and included slightly more women (PE, 53.4% vs DVT, 52.1%). After multivariable adjustment for comorbidities (within 7 years) and temporary provoking factors (within 3 months), heart failure (PE: adjusted odds ratio [aOR], 2.64 [99% confidence interval [CI], 2.55‐2.73]; DVT: aOR, 1.66 [99% CI, 1.60‐1.72]), ischemic heart disease (PE: aOR, 1.51 [99% CI, 1.47‐1.56]; DVT: aOR, 1.01 [99% CI, 0.98‐1.04]), and chronic obstructive pulmonary disease (PE: aOR, 2.51 [99% CI, 2.40‐2.63]; DVT, 1.54 [99% CI, 1.47‐1.62]) were among diseases that showed higher odds ratios in patients with PE than in those with DVT, compared with controls. Comorbidities registered within 6 months were associated with higher aORs than those within 7 years. The highest population attributable risks for PE were for cancer (13.0%) and heart failure (11.7%). ConclusionCardiopulmonary diseases, particularly with recent onset, imply a higher risk for PE, whereas orthopedic surgery and lower‐extremity fractures carry a higher risk of DVT.

Circulatory EVs as a predictor of chronic urticarial activity.

Background: Chronic urticaria (CU) is a common and complex disorder that occurs without any identifiable provoking factor. The mechanisms underlying CU pathogenesis are still not fully understood. The autoimmune theory of IgG autoantibodies to IgE/high-affinity receptor of IgE on mast cells and mast cell activation and autoallergy (IgE-mediated disease) might contribute to CU pathogenesis. Extracellular vesicles (EVs) are membranous vesicles released from apoptotic or activated cells of different types. In this study, we aimed to investigate circulating EVs as potential biomarkers in patients with CU compared with that in healthy controls. Methods: We studied 15 patients with CU and 16 healthy controls. Circulatory EVs (plasma) were characterized by the presence of externalized phosphatidylserine (annexin V staining). An unpaired t-test was used, and P < 0.05 was considered statistically significant. Results: We did not find significant differences in the total number of EVs in patients with CU. A significant decrease in the levels of T-cells (CD3) and endothelial cells (CD146) (P < 0.05) in these patients than in controls was found. No significant differences were observed between patients with CU and healthy controls in terms of platelets, macrophages, PECAM-1, B cells, and tissue factors. Conclusion: Endothelial cells have been shown to contribute to the pathogenesis of CU and are also targeted by mediators released by mast cells and other cellular infiltrates. We identified that circulatory endothelial and T-cell EVs might play an important role in CU pathogenesis. In addition, our study highlights the importance of EVs as future therapeutic targets to be investigated.

Secondary thrombosis prevention practice patterns in pediatrics: Results of an international survey

BackgroundPediatric venous thromboembolism (VTE) rates continue to increase. Although most children present with transient provoking factors, some have persistent prothrombotic risks beyond the initial treatment period warranting secondary anticoagulation. Current pediatric VTE guidelines provide limited recommendations in this regard. ObjectivesOur primary objective was to identify key influences on pediatric thrombosis physicians’ decisions to initiate secondary anticoagulation. MethodsWe targeted pediatric hematologists/oncologists internationally using Duration of Therapy for Thrombosis in Children, Children’s Hospital Acquired Thrombosis consortium, and Venous Thromboembolism Network US pediatric subgroup membership rosters, who self‐identified as primary outpatient thrombosis providers. Of 124 total surveys distributed, 61 complete surveys were evaluable. We defined secondary anticoagulation as anticoagulant use beyond the initial treatment period, on a daily basis (extended) or limited to periods of superimposed clinical risk factors (episodic). ResultsPediatric thrombosis physicians surveyed indicated that they prescribe secondary anticoagulation in <25% of children despite persistent risks. Among those who indicated use of secondary anticoagulation, the preferred modality was extended anticoagulation in children with a history of recurrent unprovoked VTE (98%), chronic central venous catheter (74%), and potent thrombophilia (73%). Episodic anticoagulation was preferred in children with a history of mild thrombophilia (54%). Respondents were more likely to prescribe secondary anticoagulation for adolescents as opposed to children <12 years old. ConclusionsAmong pediatric thrombosis physicians surveyed, they perceived the prevalence of persistent prothrombotic risks to be high in children who have completed a course of anticoagulation for provoked VTE; however, estimated use of secondary anticoagulation was low. Studies involving real‐world data are needed to further evaluate use of secondary anticoagulation in this setting.

The Connection Between Opioid Withdrawal and Takotsubo Cardiomyopathy: Case Reports of ‘Opioid Octopus Heart’

Introduction Takotsubo Cardiomyopathy (TCM) is an incompletely understood diagnosis. The leading hypothesis of its pathogenesis is that a hyperadrenergic state leads to cardiotoxicity, which is supported by case findings. Withdrawal from opioids is one potential etiology of an excessive adrenergic response and, therefore, may precipitate TCM. Case Presentations Here, we present 2 cases of TCM in patients who chronically used opioids, both at the same institution within 1 month of each other. The first patient is a 68-year-old man who presented with a chronic obstructive pulmonary disease exacerbation and did not disclose his long-standing opioid use disorder. One day after admission, he was found to be in opioid withdrawal and, soon after, developed TCM. He was originally treated for non-ST elevation myocardial infarction and opioid withdrawal but decompensated. He was sent to the intensive care unit (ICU) to receive pressors and fluid resuscitation. He soon recovered and his cardiac function returned to baseline. The second patient is a 33-year-old woman with opioid use disorder taking methadone who presented with lower extremity weakness, edema, and pain. She was diagnosed with infective endocarditis. While awaiting surgery and receiving antibiotics, she developed respiratory failure and was upgraded to the ICU. There was a lapse in her opioid treatment, and she subsequently developed TCM. She was treated with pressors and fluids in the ICU, and eventually recovered with reduced cardiac function at the time of discharge. Conclusions While clinical evidence indicated opioid withdrawal as the likely provoking factor for development of TCM in the first case, the second patient’s symptoms from other clinical complications confounded the cause of her TCM. Twelve similar cases have been reported in the literature, suggesting that opioid withdrawal may be associated with development of TCM. Further quantitative research is required to establish this relationship. Our findings contribute to the theoretical pathophysiology of TCM and offer important considerations for clinical management of opioid withdrawal.

Search for associations between polymorphic variants of human acid chitinase gene and bronchial asthma in children of Novosibirsk

High prevalence of bronchial asthma among the population (about 300 million people all over the world) provides rationale for the search for candidate genes of disease. Human acidic chitinase (CHIA (AMCase)), encoded by theCHIAgene, is involved in the degradation of chitin, a component of the fungal cell wall and arthropod exoskeleton, which, if present in food or house dust, is a provoking factor for the bronchial asthma (BA) development. Functionally significant mutations in theCHIAgene may apparently increase the risk of susceptibility to BA.Aim.The aim of the study was to assess the associations of single nucleotide polymorphisms (SNPs) rs12033184 and rs3806448 in theCHIAgene with bronchial asthma in children in Novosibirsk.Material and Methods. The study was organized as case-control. A total of 537 blood samples were used. SNPs were determined by real-time PCR. The associations of polymorphic variants with the disease were assessed by the odds ratio.Results.No associations of rs12033184 and rs3806448 with BA were found.Conclusion.The role of acidic chitinase gene in the development of BA in residents of Novosibirsk was found to be less significant than in the Indian population where it was previously shown to be associated with the disease.

Concomitant pulmonary embolism and renal infarction associated with COVID-19 infection

The incidence of thromboembolic events has increased in COVID-19 patients. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is recognized as a provoking factor for acute pulmonary embolism. Concomitant arterial embolism should be kept in mind in cases with pulmonary embolism and COVID-19. Renal infarction should be suspected in a COVID-19 patients presenting with an unexpected symptom such as abdominal pain. In addition, thrombophilia screening should be considered in patients with thrombosis involving multiple organs without the existence of any risk factors.

The Prevalence of Dental Anxiety among Dental Patients in Qassim Region

Objective : This study aimed to assess the prevalence of dental anxiety among patients visiting dental clinics in the Al-Qassim region of Saudi Arabia. Methods: The 377 participants were selected from three major cities in the Al-Qassim region - Buridah, Onizah, and Alrass. A self-administered questionnaire based on the Modified Dental Anxiety Scale (MDAS) was used to gather the responses of the participants. The questionnaires were handed to respondents during their regular visits to dental clinics . Results: The findings of the study revealed that 19% of the sample population suffer from severe dental anxiety. The analysis showed that feelings associated with anesthetic injection are the most-anxiety provoking factor while the next day visit is the least anxiety-provoking item. The findings also found female patients are more anxious than their male counterparts and the difference between means of both genders is statistically significant. The study also noted that young age is associated with a high prevalence of dental anxiety. Conclusion: The patients who come to visit dental clinics located in the Al-Qassim region feel dental anxiety. The prevalence is higher among females than male patients. Moreover, young patients demonstrated a higher prevalence of dental anxiety than patients of mature ages. Keywords: Dental anxiety, Modified Dental Anxiety Scale, MDAS, Al-Qassim

The Prevalence of Dental Anxiety among Dental Patients in Qassim Region

Objective: This study aimed to assess the prevalence of dental anxiety among patients visiting dental clinics in Al-Qassim region of Kingdom of Saudi Arabia.&#x0D; Methods: The 377 participants were selected from three major cities of Al-Qassim region - Buridah, Onizah, and Alrass. A self-administered questionnaire based on Modified Dental Anxiety Scale (MDAS) was used to gather the responses of the participants. The questionnaires were handed to respondents during their regular visits to the dental clinics.&#x0D; Results: The findings of the study revealed that 18% of the sample population suffer from severe dental anxiety. The analysis showed that feelings associated with anesthetic injection are the most-anxiety provoking factor while the next day visit is the least anxiety-provoking item. The findings show that female participants (M = 3.1, p = .001) significantly manifest more dental anxiety than their male counterparts (M = 2.8, p = .001). The younger participants demonstrate higher dental anxiety than other age groups.&#x0D; Conclusion: The dental anxiety exists in the sample population. Gender and age are associated with varying MDAS scores.

Clinical profile of seizure disorder in hospitalized patients in tertiary care center - A prospective cross-sectional study

Background: Knowledge regarding people affected with epilepsy is essential for accurate planning and management of patients. This study was conducted to study clinical profile of seizure disorder in the patients hospitalized in a tertiary care hospital of Tamil Nadu. Aims and Objectives: To study clinical profile of seizure disorder in patients hospitalized in Coimbatore government medical college hospital. Materials and Methods: This study was a single center hospital based cross-sectional study of the clinical profile of seizure disorder in hospitalized patients at tertiary care center of Tamil Nadu, Neurology department the 2 years from 2018 to 2020. All the patients presenting with complaints of seizures were included in this study. Results: This study included a total of 321 patients with epilepsy. Their ages ranged between 10 and 100 years. 180 of the study population were males and 141 were female patients. 30% of patients had new onset seizures. Fever precipitated seizure in 16% of the subjects. Excitation, sleep deprivation, fever, watching television, and head trauma showed a strong association with generalized epilepsy. The majority of the patients had generalized tonic-clonic seizure, followed by focal neurological deficit. 98% of patients responded to treatment and they did not had recurrent episodes of seizure. Conclusion: The sample size of our cohorts is relatively small. It is possible that some prognosis factors may be missed due to the small sample size. Further studies with a larger sample cohort are required. Uneducated and low socioeconomic make people vulnerable to seizures because of lack of awareness, poor compliance to medicines, not detection of seizure provoking factor, repeated exposure to seizure provoking factor, prevalence of alcoholism, and thus lowering seizure threshold. There is a treatment gap still because of epilepsy and appropriate usage of resources will help to reduce this treatment gap and decreases epilepsy associated morbidity and mortality.

Incidence of Sars-COV-2 Infection in Sickle Cell Patients Presenting with a Painful Crisis, a 12 Month Prospective Cohort Study

Background:Sickle cell disease (SCD) is frequently complicated by painful vaso-occlusive crises (VOCs) often resulting in healthcare utilization including hospital admission. A vaso-occlusive crisis (VOC) can be induced by multiple factors including infection, exposure to cold, physical exercise, dehydration and stress. Given the current SARS-CoV-2 pandemic, we hypothesized that SARS-CoV-2 (even without symptoms of upper airway infection) might play a major causal role in VOC. However, our data suggests that COVID-19 is not a frequent provoking factor for clinical VOCs during the pandemic.Methods:In order to test this hypothesis, consecutive SCD patients presenting to the emergency department in our centre with symptoms compatible with VOC between March 16 th 2020 and March 16 th 2021, were tested for SARS-CoV-2 by real-time polymerase chain reaction (RT-PCR) of nasopharyngeal swabs irrespective of respiratory symptoms. Given the limited sensitivity of the RT-PCR in SARS-CoV-2 high incidence groups, low-dose non-contrast chest CT-scans were initially performed in addition to the RT-PCR.In addition, data comprised of temperature, oxygen saturation and laboratory results, was collected through chart review, from the visit at the emergency department. Presentations of SCD patients with a proven prior SARS-CoV-2 infection were excluded.Results:In total 122 VOCs in 70 adult SCD patients, presenting to the emergency department between March 16 th 2020 and March 16 th 2021, were evaluated. (Figure 1) Five presentations in two individual patients were excluded due to a prior RT-PCR proven SARS-CoV-2 infection. Furthermore, 13 presentations in six patients were excluded due to non-protocol adherence (not obtaining a RT-PCR at presentation). In total 104 episodes of VOC in 62 patients with SCD were prospectively analyzed on SARS-CoV-2 by RT-PCR irrespective of respiratory symptoms. In 104 consecutive presentations, five presentations tested positive on SARS-CoV-2 (4.8%). Only one of these five patients presented with respiratory symptoms in addition to the symptoms of a VOC and one patient was diagnosed with acute chest syndrome (ACS). Five of the 99 presentations of patients with a negative SARS-CoV-2 PCR, presented with respiratory symptoms. In this group, seven patients developed an ACS during admission. From March 16 th till May 31 st 2020, routine CT-scans were performed, in 23 out of 27 presentations with a VOC at the emergency department in addition to the RT-PCR in order to increase the diagnostic accuracy. In 19 of these presentations, that were tested negative for SARS-COV-2, no CT-abnormalities suggestive for COVID-19 were found. One of four CT-scans performed in patients with a positive RT-PCR, showed abnormalities that were not specific for COVID-19.Conclusion:In conclusion, we found a low incidence of SARS-CoV-2 infections in our cohort of consecutive SCD patients presenting with VOCs in 12 months during the COVID-19 pandemic. This suggests that COVID-19 is not a frequent provoking factor for clinical VOCs during the pandemic and may even be considered a coincidental finding given the low incidence and the fact that only one of the five patients with a positive RT-PCR presented with pulmonary symptoms. [Display omitted] DisclosuresNur: Celgene: Speakers Bureau; Roche: Speakers Bureau; Novartis: Research Funding, Speakers Bureau.

Extended-Duration Low-Intensity Apixaban to Prevent Recurrence in Patients with Provoked Venous Thromboembolism and Enduring Risk Factors: Rationale and Design of the HI-PRO Trial.

Patients with acute venous thromboembolism (VTE) in the setting of transient provoking factors are typically treated with short-term anticoagulation. However, the risk of recurrence may be increased in the presence of enduring risk factors. In such patients, the optimal duration of treatment remains uncertain. HI-PRO is a single-center, double-blind randomized trial. Patients with deep vein thrombosis (DVT) or pulmonary embolism (PE) following a major provoking factor, including major surgery or major trauma, who completed at least 3 months of standard-dose therapeutic anticoagulation and have at least one enduring risk factor (such as obesity or heart failure) will be considered for inclusion. Patients will be randomized to apixaban 2.5 mg twice daily or placebo for 12 months. The primary efficacy outcome will be symptomatic recurrent VTE-a composite of DVT and/or PE at 12 months after randomization. Secondary efficacy outcomes include a composite of death due to cardiovascular causes, nonfatal myocardial infarction, stroke or systemic embolism, major adverse limb events, or coronary or peripheral ischemia requiring revascularization at 12 months, and individual components of these outcomes. The primary safety outcome is major bleeding according to the International Society on Thrombosis and Haemostasis definition. The study plans to enroll 600 patients (300 per arm) to have 80% power for detecting a 75% relative risk reduction in the primary outcome. Active recruitment began in March 2021. HI-PRO will provide clinically meaningful data on whether patients with provoked VTE and enduring risk factors have fewer adverse clinical outcomes if prescribed low-intensity extended-duration anticoagulation.

Evaluation and Management of First-Time Seizure in Adults.

First seizures are often perceived as devastating events by patients and their families due to the fear of having a life-long disease. One in 10 people experiences one or more seizures during their lifetime, while 1 in 26 people develops epilepsy. Acute symptomatic seizures are often related to a provoking factor or an acute brain insult and typically do not recur. Careful history and clinical examination should guide clinicians' management plans. Electroencephalography and brain imaging, preferably with epilepsy-specific magnetic resonance imaging, may help characterize both etiology and risk of seizure recurrence. Antiepileptic drugs should be initiated in patients with newly diagnosed epilepsy. In patients without an epilepsy diagnosis, the decision to prescribe drugs depends on individual risk factors for seizure recurrence and possible complications from seizures, which should be discussed with the patient. Counseling about driving and lifestyle modifications should be provided early, often at the first seizure encounter.

Clinical and anamnestic characteristics and results of allergological testing in children with bronchial asthma and allergic rhinitis in case of allergy to house dust mites

House dust mites (HDM) are a common cause of allergies, however, it is not always easy to suspect a mite allergy from a patient's history. &#x0D; Objective: to determine clinical characteristics of patients, tactics for demonstrating the role of HDM sensitization in pediatric patients with allergic rhinitis (AR) and bronchial asthma (BA) with domestic sensitization. &#x0D; Materials and methods. The study included 420 patients, 256 boys, 164 girls, aged 5 to 17,9 years (mean 8,44 ± 3,06 years), with AR (100%) and AR in combination with BA (41,9%). The prick test on the forearm skin with water-soluble extracts was carried out and evaluated according to the standard method. The test was considered positive with a maximum wheal diameter of ≥3 mm 15 minutes after applying the prick. &#x0D; Results. Among patients with HDM sensitization (n=268), sensitization to both mites was detected in 218 cases (81,3%), and in 139 cases (51,9%) polysensitization to HDM allergens, house dust and epidermal allergens (cat, dog) was found. Patients noted persistent symptoms of nasal congestion, and rhinorrhea; the provoking factor was not determined by history in 46% of cases. In 69,8% of cases (97 children), it was impossible to isolate the leading allergen according to the history, since patients had contact with cats, dogs, dust, and polysensitization according to the prick tests. Nasal provocation test (NPT) with HDM allergens was performed in 92 children. Positive NPT was obtained in 83 cases (90,2%), negative in 9 cases (9,8%). &#x0D; Conclusions. With HDM sensitization, often (46%) the provoking factor is not determined by history. Monotonous symptoms are characteristic with the absence of obvious relationships with allergens, the location and activities of the child. In terms of frequency, the leading variant is sensitization to both mites D.pteronyssinus, D.farinae (81,3%), and polysensitization to HDM, house dust and cat and dog allergens (51,9%). NPT allows in 90% of cases to show the causal role of HDM allergens in polysensitized patients with insufficiently convincing anamnesis data.

A randomized, double-blind study on efficacy and safety of sepranolone in premenstrual dysphoric disorder

Women with premenstrual dysphoric disorder (PMDD) experience mood symptoms related to the increase in progesterone and the neuroactive steroid allopregnanolone. Our hypothesis is that allopregnanolone is the symptom provoking factor. The rationale for the present study was to treat PMDD patients with the GABAA receptor modulating steroid antagonist, sepranolone (isoallopregnanolone). Patients (n = 206) with PMDD from 12 European centers were randomized in a parallel double-blind study and treated with placebo, sepranolone 10 mg and 16 mg. Patients administered sepranolone subcutaneously every 48 h during the 14 premenstrual days of three consecutive menstrual cycles. After obtaining informed consent, the PMDD diagnosis was confirmed according to DSM-5 and verified with two menstrual cycles of daily symptom ratings using the Daily Record of Severity of Problems (DRSP) scale in an eDiary. Inclusion and exclusion criteria stipulated that the women should be essentially healthy, not pregnant, have no ongoing psychiatric disorder or take interfering medications, and have regular menstrual cycles. The study’s primary endpoint was the Total symptom score (Sum21, the score for all 21 symptom questions in the DRSP). In the prespecified statistical analysis the average score of the 5 worst premenstrual days in treatment cycles 2 and 3 were subtracted from the corresponding average score in the two diagnostic cycles. The treatment effects were tested using analysis of variance in a hierarchal order starting with the combined active sepranolone treatments vs. placebo. The prespecified analysis of Sum21 showed a large treatment effect of all three treatments but no statistically significant difference to placebo. However, the ratings of distress showed a significant treatment effect of sepranolone compared to placebo (p = 0.037) and the ratings of impairment showed a trend to greater treatment effect of sepranolone compared to placebo. Many women with PMDD had symptoms during a longer period than the late luteal phase. It has previously been shown that 9 premenstrual days may be more representative for comparison of PMDD symptom periods than the 5 worst premenstrual days. A post hoc analysis was undertaken in the per protocol population investigating the treatment effect during 9 premenstrual days in the third treatment cycle. The Sum21 results of this analysis showed that the sepranolone 10 mg was significantly better than placebo (p = 0.008). Similar significant treatment effects were found for the impairment and distress scores. A significantly larger number of individuals experienced no or minimal symptoms (Sum21 <42 points) with the 10 mg sepranolone treatment compared to placebo (p = 0.020). The results indicate that there is an attenuating effect by sepranolone on symptoms, impairment, and distress in women with PMDD especially by the 10 mg dosage. Sepranolone was well tolerated, and no safety concerns were identified.

Фитотерапия и лечение цистита: современные тенденции

Лечение инфекций нижних мочевых путей, в частности цистита, остается актуальной проблемой современности. Широкая распространенность заболевания, формирование резистентных штаммов этиологических микроорганизмов, изменение микробиоты, ограниченный арсенал противомикробных мероприятий обусловливают ежегодную смену рекомендаций по рациональному лечению цистита. Последние рекомендации Европейской ассоциации урологов (2019) значительно ограничивают применение антибиотиков, в частности фторхинолонов, среди которых при отсутствии внутриклеточных возбудителей, на наш взгляд, цефалоспорины 3-го поколения в трехдневном режиме остаются приоритетными. Национальный опыт свидетельствует о широком успешном применении уроантисептиков группы современных нитрофурантоинов, резистентность к которым документируется у очень ограниченного количества людей с циститом. Учитывая то, что цистит встречается в основном у женщин, считаем целесообразным рекомендовать как препарат первой линии нифуратель, который имеет широкий спектр действия и одновременно эффективен при специфическом и неспецифическом вульвовагините и бактериальном вагинозе, нередко являющемся провоцирующим фактором цистита, для приема в течение 5–7 дней. Среди альтернативных безрецептурных препаратов, которые успешно формируют доказательную базу, следует отметить фитониринговый препарат. Для поддержания функции и снижения риска обострений воспалительных заболеваний мочеполовой системы применяются диетические добавки, содержащие проантоцианидин А 36 мг и метилтиониния хлорид, назначаемые на 10 дней. Эти соединения наряду с нифурателем также успешно используют для приема профилактической редуцированной дозы однократно на ночь в течение одного — шести месяцев.

Hereditage and socially stress load in the pathogenesis of recurrent depressive disorders

The paper presents the results of a comprehensive clinical-genealogical, clinical-anamnestic and psychodiagnostic examination of patients with recurrent depression. The features, structure and role of heredity factors and social stress factors in the formation of recurrent depression have been investigated. The presence of a significant family accumulation of depressive disorders in the pedigrees was revealed in patients with recurrent depressive disorders, predominantly in the mother’s line. It was found that an important provoking factor in the development of depressive disorders is the presence of factors of mental traumatization, mainly social and psychological. It has been proved that a significant role in the pathogenesis of depression belongs not to the number of stressful events, but to the level of their stressfulness. The results obtained show that the formation of depressive disorders is determined by the presence of a combined effect of clinical and genealogical, social and environmental and socio-psychological factors.

Oropharyngeal Dysphagia with Aspiration as a Provoking Factor for COPD Exacerbation

The most common provoking factors for chronic Obstructive Pulmonary Disease (COPD) exacerbation include viral and bacterial tracheobronchitis, pneumonia, and exposure to environmental irritants and air pollution. In many patients with COPD exacerbation, the underlying cause cannot be identified. In general, patients with COPD exacerbation get admitted to the hospital and treated with antibiotics, glucocorticoids and inhaled bronchodilators. Oropharyngeal dysphagia is an under-recognized provoking factor for COPD exacerbation. Patients with advanced COPD often have impaired coordination of respiration and deglutition which can lead to aspiration of liquids, food particles, and saliva into the airways. Aspiration events can lead to exacerbation of symptoms and cause further decline in lung function. We described a 69-year-old male with a history of COPD who presented with progressive dyspnea, productive cough and hypoxia which required intubation and mechanical ventilation. The patient underwent a bronchoscopy for airway inspection which showed pieces of meat in the right main bronchus which were removed. Reportedly, the patient was having difficulty swallowing solid food prior to admission to the hospital.

Evaluation of Thrombotic Risk in Thyroid Cancer

Introduction: Current guidelines from the International Society of Thrombosis and Hemostasis recommend limited screenings for deep vein thrombosis (DVT) or pulmonary embolism (PE) with no identifiable precipitating factor (termed unprovoked). There is paucity of data with regards to thyroid cancer screening in the setting of an unprovoked VTE. Studies from Europe have shown an association between VTE and thyroid cancer; however, these studies do not account for differences in iodine availability, thus the need for studies in the United States. Understanding the risk of thyroid cancer as a provocative factor in developing a deep venous thrombosis (DVT) or pulmonary embolism (PE) may be able to facilitate case detection of disease and prevent future morbidity and mortality from thyroid cancer and/or VTE. Objectives: The primary objective of this study is to understand the risk of developing VTE in the setting of thyroid cancer. Methods: In this retrospective chart review study, we reviewed electronic medical records of patients with a history of DVT or PE between ages 18-99, presenting to all outpatient clinics at a single academic medical center in New Jersey between October 1, 2015, and Dec 31, 2018. We screened for coexistent cancer history among this group, and from this sample we further isolated cases of thyroid cancer. Results: 345 patients were found to have a history of VTE. 187 were female (54%) and 113 (29%) had a history of malignancy. The most common cancers were breast (19%), colorectal (9%), leukemia (9%), prostate (8%), and lymphoma (8%). Thyroid cancer accounted for 2% of all discovered cases. Conclusion: In this retrospective analysis, 2% of all patients with VTE and cancer carried a diagnosis of thyroid cancer. Although this suggests a relatively low risk, given the medical burden of a venous thromboembolism and the comparable proportion of thyroid cancer in all new cancer cases, thyroid cancer should be considered a provoking factor in unprovoked VTE.

Sex-specific differences in the presentation, clinical course, and quality of life of patients with acute venous thromboembolism according to baseline risk factors. Insights from the PREFER in VTE

IntroductionSex and the presence of specific provoking risk factors, along with age, influence the presentation and prognosis of venous thromboembolism (VTE). We investigated the presentation, course and quality of life in women and men with acute VTE classified according to their VTE provoking factors. MethodsPREFER in VTE is an international, non-interventional registry of patients with a first episode of acute symptomatic VTE. Baseline provoking factors were classified as follows: major transient, minor transient, active cancer, and none identifiable. The primary outcome was recurrent VTE. Quality of life and treatment satisfaction were secondary outcomes. ResultsOf 3,455 patients with acute VTE, 1,623 (47%) were women. The mean age at the time of VTE was 61 (SD 18) in women, 60 (SD 15) in men. The distribution of provoking risk factors was similar between sexes, despite a tendency for higher frequency of minor and major transient risk factors in women, and cancer or unprovoked VTE in men. At 12-month follow-up, VTE recurrence was reported in 74 (6.5%) women and 80 (6.4%) men (absolute risk difference -0.1%, 95% CI -1.9%; +2.1%). In patients with unprovoked VTE, the VTE recurrence rate was 38/612 (6.2%) in women and 53/798 (6.6%) in men (absolute risk difference -0.4, 95% CI -3.0; +2.1%). Multivariable Cox regressions confirmed the absence of sex differences. Quality of life and treatment satisfaction scores one year after VTE were lower in women than in men irrespective of the provoking risk factors (p<0.001 for both scores). ConclusionsDespite differences in the provoking risk factors for VTE, women and men had a similar rate VTE recurrence at one year. After acute VTE, women had lower quality of life and treatment satisfaction scores.