Results Of Clinical Examination Research Articles

Features of immune status in patients with pulmonary tuberculosis after the COVID-19

BACKGROUND. Identification of immunological changes in patients with pulmonary tuberculosis after coronavirus infection will contribute to the prediction of its course and correction of therapeutic protocols. OBJECTIVE. The aim of the work is to determine the nature of immuno-mediated disorders caused by coronavirus disease (COVID-19) in patients with pulmonary sensitive tuberculosis (STB). MATERIALS AND METHODS. The results of a comprehensive immunological clinical and laboratory examination with subsequent computer processing of the data of 72 patients with STB of the lungs were analyzed. RESULTS. In the immune system of patients with pulmonary STB after COVID-19 the multidirectional changes are manifested by: a lower degree of increase of the blood leukocytes number (mainly due to a decrease in the absolute lymphocytes number), activation of the immune T-cells with an increase in the percent number and functional activity of pan-T-cells and T-helpers, an increase in the functional activity of T-suppressors, natural killers and killer T-cells (with the absolute and percent decrease of the latter), a higher level of the absolute and relative number of double positive (CD4+8+) cells and the functional activity of B-cells. A decrease in the level of IgA and an increase in the concentration of IgG with an decrease in the level of the medium and small circulating immune complexes, depression of the phagocytes link of immunity by reducing phagocyte number of phagocytes are observed in the blood of the patients with pulmonary STB after COVID-19. CONCLUSIONS. In the patients with pulmonary tuberculosis after COVID-19, the immune response is complex, with the crossing of immune reactions of pulmonary tuberculosis and post-COVID changes in immunity: on the one hand, previous COVID-19 promote compensatory activation of immune cells – T- and B-lymphocytes, natural killers; on the other hand, it causes suppression of antibacterial protection of mucous membranes (due to a decrease in the blood level of IgA) and reduces the body’s resistance (due to suppression of the phagocytes link of immunity).

Prevalence of cervical dysplastic lesions in cervical smears from Baghdad city: a single centre study

Objective: To assess the association of demographic and clinical features of patients with clinicopathological markers in cases of abnormal Pap smear. Method: The retrospective study was conducted from July 2020 to June 2021 at Al-Elwiya Maternity Teaching Hospital, Baghdad, Iraq, and comprised data from January 2019 to June 2020 of women who underwent Pap-smear. Data was retrieved for patients' age, marital status, smoking status, clinical symptoms at presentation, findings of clinical and cytological examinations, as well as follow-up or human papillomavirus testing data where applicable. Data was analysed using SPSS 26. Results: Of the 560 women with mean age 40.42±10.211 years, 26(4.6%) were attending the hospital for routine check-ups/screening, and 12(2.1%) for follow-up screening with previous abnormal Pap-tests, while the rest had been referred for medical consultation. The most common diagnosis was negative for intraepithelial lesion or malignancy 403(72%) Cervical epithelial abnormalities were seen in 136(24.3%) cases, and, of them, 12(8.8%) returned for follow-up. Epithelial abnormalities had a significant association with age, clinical presentation, and clinical examination results (p<0.05), while it had a non-significant relation with marital and smoking statuses (p>0.05). Conclusion: The majority of subjects were referred cases, with routine cervical screening being <5%. Increasing public awareness about the importance of cervical screening and follow-up is essential. Key Words: Papanicolaou, Uterine Cervical, Papillomavirus Viruses, Demography, Smoking

Efficacy of Picosecond Laser in Clinical, Histopathology, and Immunohistochemistry Examination in Indonesian Wrinkled Skin.

Introduction: The elderly population wants to improve skin function and maintain a youthful appearance without wrinkles. Laser is one of the highly developed and widely used therapeutic modalities of skin aging by stimulating dermal collagen formation. Picosecond laser therapy is performed on skin with wrinkles to determine the mechanism of wrinkle improvement with a picosecond laser through an increasing in tissue inhibitor of metalloproteinases 1 (TIMP-1), and a decrease in matrix metalloproteinase-1 (MMP-1), which was confirmed by collagen density. Methods: The study was started from March 2021 to July 2021 at URJ Dr. Soetomo Hospital Surabaya and Surabaya Skin Centre. Twenty patients meeting the inclusion criteria of being 36-55 years of age and having a wrinkle in the forearm were enrolled by random sampling. Each sample data was recorded, the average TIMP-1, MMP-1, collagen density, and clinical wrinkles were calculated, and the laser was performed by using a picosecond 755 nm laser. Results: All patients showed a moderate pre-test wrinkle scale. The figure for TIMP-1 and MMP-1 after therapy was higher. The MMP-1/TIMP-1 ratio in wrinkles treated by using a picosecond laser was lower but insignificant than before. The picture of collagen density indicates that collagen density after laser therapy was higher than before. Conclusion: The result of clinical examination, histopathology, and immunohistochemistry in this research explained that a picosecond 755 nm laser with DLA is an effective therapy for wrinkles in Indonesian patients without any adverse effects.

Characteristics and Risk Factors of Infections among Patients with Autoimmune Bullous Diseases: A Retrospective Single-Center Study in China

Abstract Background: Since infections can lead to adverse outcomes in autoimmune bullous diseases (AIBD), this study aimed to analyze infection characteristics in AIBD, predict infection risk factors and provide probable suggestions to infection prevention, which will spot a light on early discovery and prevention of infections in AIBD patients. Methods: This is a retrospective study of the medical records of inpatients diagnosed with AIBD at the Department of Infectious Diseases and Dermatology, Huashan Hospital from January 2017 to December 2021. We collected patients’ clinical manifestations and laboratory examination results. Risk factors for infections were evaluated using multivariate logistic regression. Results: A total of 263 AIBD patients were included in the study. The overall incidence of infection was 42.2% (111/263). Pemphigus had a higher infection rate (74/142, 52.1%) than bullous pemphigoid (37/121, 30.6%). Among the patients with infections, 49.5% (55/111) had bacterial infections, 13.5% (15/111) had fungal infections, 2.7% (3/111) had virus infections, and 34.2% (38/111) had mixed infections. Staphylococcus aureus and Candida were the most common pathogens in localized infections, while Cryptococcus and Candida were predominant in systemic infections. In the multivariate logistic model, pemphigus (odds ratio [OR] = 2.56, 95% confidence interval [CI] 1.41–4.63), hypoalbuminemia (OR = 3.78, 95% CI 1.68–8.50), and systemic glucocorticoid treatment (OR = 4.67, 95% CI 2.51–8.68) were independent risk factors for infection. Bullous pemphigoid (OR = 3.99, 95% CI 1.03–15.45), high-dose (average > 24 mg/day) compared to low-dose (average ≤ 6 mg/day) and medium-dose (average 6–24 mg/day) systemic glucocorticoid treatment (OR = 19.31, 95% CI 3.32–112.28, and OR = 5.71, 95% CI 1.37–23.79) were associated with increased risk factors of systemic infection. A methylprednisolone dose averaging 14 mg/day over the past three months has a 75.0% positive predictive value (PPV) for infections in AIBD patients. Conclusions: The incidence of infection in AIBD patients is high, with a broad spectrum of pathogens and infection locations. AIBD patients undergoing systemic glucocorticoid treatment, especially those receiving high doses in the previous three months, should be cautious about infection.

Bilateral internal carotid artery agenesis coexisting with bovine aortic arch: case report and literature review.

This case study aims to elucidate the rare occurrence of bilateral internal carotid artery agenesis combined with a bovine aortic arch. The main objectives are to explore the incidence, embryological origins, clinical manifestations, and associated anomalies of this unique vascular condition. The study involves a detailed investigation of a 55-year-old male with a history of recurrent transient ischemic attacks (TIAs) using MRI and CT scan. The patient's medical history, clinical examination, and imaging results were systematically analyzed to provide a thorough understanding of the anatomical variations. The main findings include the rare coexistence of bilateral ICA agenesis and a bovine aortic arch, making this the 39th documented occurrence of bilateral ICA agenesis and the first recorded instance of its association with a bovine aortic arch. Also, the study highlighted the demographic characteristics, clinical presentations, and associated anomalies observed in the 38 documented cases of bilateral internal carotid artery agenesis. This case report contributes valuable insights into the rarity of bilateral internal carotid artery agenesis and its unprecedented association with a bovine aortic arch. The findings emphasize the importance of heightened anatomical awareness in clinical practice, particularly. Recognizing and understanding such variations is crucial for accurate diagnosis, appropriate management, and improved patient outcomes. Further research in this area is warranted to deepen our understanding of these complex vascular anomalies.

Markers of early post-stroke cognitive impairment

Aim. To identify significant indicators of cognitive dysfunction based on discriminant analysis and to assess the influence of the course, nature and localization of ischemic stroke on the cognitive status of the patient.Materials and methods. We examined 290 patients diagnosed with ischemic stroke in the carotid artery area. Depending on presence of cognitive dysfunction according to the Montreal Cognitive Assessment Scale (MoSA) patients were divided into 2 groups: 240 patients with cognitive decline (≤25 point by MoCA) and 50 patients without it. In order to verify the markers, anamnestic characteristics were assessed, cognitive-functional indicators (according to the scales of the National Institutes of Health, MoCA, Bartel, Rankin, IQCODE questionnaire, additional scales to assess praxis, semantic aphasia, perception and executive function), data of neuroimaging studies. For statistical analysis machine learning algorithms and Python with its libraries (Pandas and SciPy) were implied.Results. The main neuropsychological indicators for patients with early post-stroke cognitive impairment were decline in the areas of perception, executive function, memory and semantic information processing, affective disturbances and physical fatigue. Relevant indicators identified during estimation of the instrumental and clinical examination results were severity of IS, left frontal and right parietal localisations of ischemia focus, presence of cortical atrophy and leukoaraiosis.Conclusion. Based on multi-factor analysis of clinical and paraclinical parameters using machine learning algorithms, the main markers of cognitive decline of early post-stroke impairments were identified. This will allow us to optimise the choice of neurocognitive rehabilitation strategies and to personalise the approach in the further management of the stroke patient.

Correlation of Player and Imaging Characteristics With Severity and Missed Time in National Football League Professional Athletes With Hamstring Strain Injury: A Retrospective Review

Background: Hamstring strain injuries (HSIs) are prevalent in US National Football League (NFL) players, but there is a paucity of information regarding imaging characteristics, injury severity, and player factors associated with time missed and risk of recurrent injury. Purpose: To describe player, football activity, clinical, and imaging characteristics of NFL players with HSIs, as well as determine player characteristics, clinical examination results, and magnetic resonance imaging (MRI) findings associated with injury occurrence, severity, and missed time. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective cohort of NFL players with acute HSI (n = 180) during the 2018-2019 season was identified. Injury data were collected prospectively through a league-wide electronic health record system. Three musculoskeletal radiologists graded MRI muscle injury parameters using the British Athletics Muscle Injury Classification (BAMIC) system. Player, football, clinical, and imaging characteristics were correlated with HSI incidence and severity and with missed time from sport. Results: Of the 1098 HSIs identified during the 2018-2019 season, 416 (37.9%) were randomly sampled, and 180 (43.3%) had diagnostic imaging available. Game activity, preseason period, and wide receiver and defensive secondary positions disproportionately contributed to HSI. The biceps femoris was the most commonly injured muscle (n = 132, 73.3%), followed by the semimembranosus (n = 24, 13.3%) and semitendinosus (n = 17, 9.4%) muscles. The most common injury site was the distal third of the biceps femoris and semitendinosus muscles (n = 60, 45.5% and n = 10, 58.8%, respectively) and central part of the semimembranosus muscle (n = 17, 70.8%). Nearly half of the injuries (n = 83, 46.1%) were BAMIC grade 2; 25.6% (n = 46), grade 3; and 17.8% (n = 32), grade 4. MRI showed sciatic nerve abnormality in 30.6% (n = 55) of all HSIs and 81.3% (n = 26) of complete tendon injuries. BAMIC grade correlated with both median days and games missed. Combined biceps femoris and semitendinosus injuries resulted in the highest median days missed (27 days). Conclusion: Among NFL players with acute HSIs, the most common injury was a moderate-severity injury of the distal biceps femoris. BAMIC grade was associated with missed time.

Management of Multiple Fractures of the Parasymphysis and Angle of the Mandible

Introduction: Mandibular fracture is a fracture that often occurs in maxillofacial trauma. Fracture locations most often occur in the parasymphysis region and combined angle- parasymphysis fractures. Multiple mandibular fractures usually cause facial asymmetry and are challenging to reduce. Fracture treatment must be carried out immediately to restore function and aesthetics. This case report aims to discuss managing multiple mandibular fractures in the angulus and parasymphysis regions of the mandible. Case report: A 13-year-old male patient came to the emergency room at Hasan Sadikin Hospital with bleeding from the mouth caused by a two-wheeled traffic accident. Clinical and radiographic examination results revealed a fracture of the right para symphysis and left mandibular angle. The procedure carried out is Open Reduction Internal Fixation (ORIF). Discussion: Mandibular fractures often occur, and the leading cause is usually caused by driving accidents. Clinical examination and radiographs are needed so appropriate treatment can be carried out. In this case, treatment involves open reduction internal fixation (ORIF) extra and intra-oral approaches. Installation of 2 mini plates each in the symphysis region and angle of the mandible. Conclusion: Treatment for multiple fractures that occurred in the maxillofacial area, in this case, was internal fixation with open reduction (ORIF). The results of the treatment showed facial symmetry and normal chewing function. Keywords: Trauma, mandibular fracture, angulus, para symphysis, ORIF

Clinical and genetic analysis of a patient with Neuronal intranuclear inclusion body disease characterized by cortical enhancement in the posterior brain region

To explore the clinical, imaging, and genetic characteristics of an adult patient with sporadic Neuronal intranuclear inclusion disease (NIID). A patient who had visited the First People's Hospital of Chenzhou on August 6, 2023 was selected as the study subject. Results of clinical examination, neuroimaging, and genetic testing were retrospectively analyzed along with a literature review. The number of GGC trinucleotide repeats in the 5'-untranslated region of the NOTCH2NLC gene was determined by GC-PCR. The patient had presented with episodic encephalopathy, with enhanced magnetic resonance imaging showing enhancement features of the posterior cerebral cortex during the period of acute episode. Genetic testing revealed an increased number of GGC repeats (n = 97) in the 5'- untranslated region of the NOTCH2NLC gene, which confirmed the diagnosis of NIID. Clinical attention should be paid to the enhanced MRI findings of patients with adult-onset NIID, for whom posterior cortical enhancement may be characteristic manifestation during the acute phase of encephalopathy-like episode.

Effectiveness of microsurgical palatal tonsillectomy in patients with oropharyngeal cancer and metastases of squamous cell carcinoma into the cervical lymph nodes without identified primary lesion

Introduction. Metastasis without an identified primary lesion is an unresolved and complex problem in clinical oncology. The issue of the necessity of primary lesion identification remains controversial. According to some studies, detection of the primary tumor potentially reduces the dose of radiation therapy and therefore prevents development of toxic reactions that reduce the quality of life of the patient, and in some cases completely eliminates the need for adjuvant therapy. Widespread development and application of robotic, microsurgical, and laser transoral techniques make it possible to verify latent oropharyngeal cancer. The detection of overexpression of p16 protein in metastatic affected lymph nodes may indicate the association of this pathology with human papillomavirus.Aim. To investigate the efficacy of microsurgical palatal tonsillectomy (using a surgical microscope) in diagnosis and treatment of occult oropharyngeal cancer in patients with cervical lymph node metastases of undetected primary site, determine the frequency of expression of the surrogate marker of human papillomavirus – protein p16.Materials and methods. The study was based on the results of diagnosing 82 patients with cervical lymph node metastases of undetected primary site. The inclusion criteria were morphologically verified cervical lymph node metastases of squamous cell carcinoma, absence of a primary tumour after a standard clinical examination. 10 patients underwent palatal tonsillectomy using a surgical microscope and cervical lymph node dissection based on the results of clinical examination and instrumental diagnostics.Results. The use of microsurgical palatal tonsillectomy in patients with metastases of squamous cell carcinoma in the cervical lymph nodes without identified primary lesion allowed to diagnose cancer of the palatine tonsil in 12.1 % of cases, cancer of this location associated with human papilloma virus in 70 % of cases.Conclusion. Microsurgical palatal tonsillectomy using a surgical microscope allowed us to not only verify occult palatine tonsil cancer, but also to establish accurate diagnosis and stage of the disease with subsequent determination of the scope of adjuvant therapy.

Clinical features of anti-neurofascin-155 antibody positive autoimmune nodopathy in 6 children

Objective: To analyze the clinical features of anti-neurofascin-155 (NF155) antibody positive autoimmune nodopathy in children. Methods: This was a case series study. A total of 6 children who were diagnosed accurately as anti-NF155 antibody positive autoimmune nodopathy by cell immunofluorescence assay at the Children's Hospital of Fudan University from January 2020 to December 2023 were collected. This study retrospectively analyzed 6 pediatric children's clinical manifestations, laboratory and electrophysiological examination results, and treatment outcomes. Results: Among 6 children with anti-NF155 antibody positive autoimmune nodopathy, there were 4 boys and 2 girls. The onset age of 6 children ranged from 3 years and 8 months to 12 years. All 6 children had extremity weakness (more severe in the distal and the lower extremities than in the upper extremities), 5 children had sensory deficits such as numbness or pain in the extremities, 4 children had tremors and ataxia, 3 children had cranial nerve involvement. Among the 6 children, 4 children had protein-cell separation in cerebrospinal fluid examinations. Among the 6 children, 1 child had central nervous system demyelination, the brain magnetic resonance imaging showed multiple abnormal signals in the bilateral cerebral hemispheres. Four children showed motor and sensory nerve damage in electrophysiological examination, and 2 children only showed motor nerve damage. Three children showed myelin and axonal damage, and 3 children only showed axonal damage. Among the 6 children, 5 children were treated with intravenous immunoglobulin and steroids. Among them, 2 children underwent plasma exchange due to poor efficacy, and subsequently, rituximab was added. There was 1 child changed the treatment with olfatomumab since the symptoms did not significantly improve after using rituximab. After treatment for 4-15 months, 2 children had no clinical symptoms, 1 child had improvement in clinical symptoms, 2 children had no significant improvement in clinical symptoms, and 1 child who did not receive the immunotherapy had no significant change in clinical symptoms. Conclusions: Anti-NF155 antibody positive autoimmune nodopathy in children presents with varying degrees of clinical manifestations. It is mainly characterized by extremity weakness, numbness and pain, often accompanied bytremorsand ataxia. Some pediatric patients may also have central nervous system demyelination. Cerebrospinal fluid and electrophysiological examination are important auxiliary examination methods. If steroid therapy is not effective, plasma exchange and rituximab treatment should be used as soon as possible.

Oral health management in children with severe congenital neutropenia with periodontitis: Case report.

Severe congenital neutropenia (SCN) is a rare and heterogeneous genetic disease. By describing the diagnosis and treatment of a child with SCN and periodontitis, this case provides a reference for the oral health management of a child with SCN and periodontitis. We describe a boy with clinical manifestations of oral bleeding, neutropenia, recurrent fever, and other recurrent infections. The absolute neutrophil count (ANC) was <0.50 × 109/L most of the time. Morphological examination of bone marrow cells showed active granulocyte hyperplasia and dysmaturation. According to the clinical manifestations, hematological examination and gene detection results, the child was diagnosed as SCN with chronic periodontitis. Periodontal treatment was performed after informed consent was obtained from the child guardian. These included supragingival and subgingival cleaning, hydrogen peroxide and saline irrigation, placement of iodoglycerin in the gingival sulcus, and oral hygiene instruction. Hematopoietic stem cell transplantation (HSCT) was performed later. One month after initial periodontal treatment, oral hygiene was well maintained and gingival swelling had subsided. Probing depth (PD) index on periodontal probing and bleeding was significantly reduced. However, there was no significant change in blood routine and other indicators before and after periodontal treatment. Once SCN is diagnosed, individualized treatment plans can be developed according to the characteristics of the disease and its impact on oral health, which can effectively control the interaction between SCN and periodontal disease and reduce the occurrence of serious infection.

Study on the risk factors of coal workers' pneumoconiosis and the mechanism of pyroptosis in peripheral blood

Objective: To explore the risk factors of coal workers' pneumoconiosis, reveal the molecular mechanism of pyroptosis in peripheral blood of coal workers' pneumoconiosis patients, and provide new strategies and potential diagnostic biomarkers for the treatment of the disease. Methods: From January 1, 2020 to December 31, 2022, workers with suspected occupational diseases who were diagnosed with coal workers' pneumoconiosis in the Third People's Hospital of Xinjiang Uygur Autonomous Region were included in the study, including 77 patients with coal workers' pneumoconiosis stage Ⅰ, 10 patients with stage Ⅱ, 6 patients with stage Ⅲ, and 49 workers with dust-free lung disease as the control group. General information of the subjects was collected, blood samples were collected for routine blood and blood biochemical results, and plasma levels of interleukin (IL) -1β and IL-18 were measured. Combined with the results of clinical examination, multi-factor ordered logistic regression analysis was carried out to evaluate the influencing factors of coal workers' pneumoconiosis. At the same time, the expression of pyroptosis related proteins in blood cells was detected to reveal the molecular mechanism of coal workers' pneumoconiosis. Results: All 142 subjects were male, with an average age of (51.65±6.31) years old and an average working age of (15.94±9.38) years. There were significant differences in smoking age (F=4.95, P=0.003) and lunch break distribution (H=8.84, P=0.031) among all groups. The hemoglobin content of stage Ⅰ patients was higher than that of stage Ⅱ patients, and the neutrophil percentage of stage Ⅲ patients was higher than that of the other 3 groups (P<0.05). The levels of total bilirubin and indirect bilirubin in stage Ⅰ patients were higher than those in control group, while the erythrocyte sedimentation rate in stage Ⅱ patients was higher than that in the other 3 groups (P<0.05). The levels of IL-18 and IL-1β in stage Ⅲ of coal workers' pneumoconiosis were higher than those in the other 3 groups (P<0.05). Multiple logistic regression analysis showed that smoking age (OR=1.03, 95%CI: 1.00-1.06) and IL-1β level (OR=4.61, 95%CI: 1.59-13.32) were independent risk factors for coal workers' pneumoconiosis (P<0.05). Compared with the control group, the expression levels of nucleotide-binding of oligomeric domain-like receptor protein 3 (NLRP3), Caspase-1, GSDMD, Caspase-4 and other proteins in stage Ⅲ of coal workers' pneumoconiosis were significantly increased (P<0.05) . Conclusion: Smoking age is a risk factor for coal workers' pneumoconiosis, IL-1β may be a potential biomarker for the diagnosis of coal workers' pneumoconiosis, and pyroptosis may play a role in the development of peripheral inflammation of coal workers' pneumoconiosis.

How effective is our current follow-up for patients with hypopharyngeal carcinoma?

The study aimed to evaluate the diagnostic efficacy of routine follow-up in detecting recurrent disease in hypopharyngeal carcinoma. Data from 76 patients with a total of 620 follow-up visits, 367 radiological studies, and 126 panendoscopies were retrospectively assessed regarding the diagnosis of recurrent disease based on the results of (I) radiological studies, (II) clinical examinations, and (III) clinical symptoms. All locally relapsed patients became symptomatic, and new onset of dysphagia (p < 0.001) was the most frequent complaint. The sensitivity for detecting local recurrences was 100% for both patients' symptom assessments and clinical examinations. The highest overall accuracy was found for clinical examinations (93.4%), followed by symptom assessments (80.5%), and radiological studies (73.8%). The risk of false positive radiological reports and subsequent panendoscopies was 2.2 times higher after previous radiotherapy (32.0% vs. 14.6%; p < 0.001). Symptom assessments and clinical examinations are highly efficient for detection of local failures.

Effects of Venoactive Drug Therapy and Ovarian Vein Interventions on Vasoactive Neuropeptide and Cytokine Levels in Patients with Pelvic Venous Disorders

To study and compare the effects of venoactive drug (VAD) therapy and ovarian vein embolization or resection (OVE or OVR, accordingly) on the levels of vasoactive peptides and cytokines in patients with pelvic venous disorders (PeVDs). The study included 70 consecutive female patients with PeVD symptoms, such as chronic pelvic pain (CPP), dyspareunia, dysuria, and vulvar varicosities. Based on the results of clinical examination and duplex ultrasound of the pelvic veins, the patients were allocated to the VAD therapy (n=38) or OVE/OVR (n=32). Additionally, the enzyme-linked immunosorbent assay tests were performed to determine levels of calcitonin gene-related peptide (CGRP), substance P (SP), interleukins 6 and 8 (IL-6, IL-8) and monocyte chemotactic protein-1 (MCP-1) after a 2-month course of VAD therapy and at 3months after OVE/OVR. The VAD therapy was associated with a significant decrease in CPP in 84% of patients with PeVD and isolated lesions of the parametrial veins (PVs) and uterine veins (UVs). VAD had no significant effect on the pelvic venous reflux. No changes in the CGRP, SP, IL-6, IL-8, and MCP-1 levels were detected after treatment. At 3months after OVE or OVR, all patients with PeVD and combined lesions of the ovarian veins (OVs), PVs and UVs reported almost complete relief of CPP. Along with elimination of reflux in ovarian veins, the disappearance of reflux in PVs and UVs was noted. A decrease in the CGRP and SP levels was observed (0.7±0.1ng/mL and 0.12±0.02ng/mL before treatment; 0.5±0.12ng/mL and 0.09±0.06ng/mL after treatment, respectively; all P<0.05). No changes in cytokine levels were revealed. Treatment with VAD is associated with the CPP relief, but has no significant effect on the CGRP, SP, IL-6, IL-8, and MCP-1 levels. OVE/OVR results in the CPP relief, elimination of the pelvic venous reflux and a significant decrease in the CGRP and SP levels, but does not change cytokine levels.

TG/HDL-C Ratio for Predicting Insulin Resistance in Obese Children from Beijing, China.

International studies have found that the blood triglycerides to highdensity lipoproteins (TG/HDL-C) ratio predicted insulin resistance in children with overweight and obesity. However, there is a lack of such reports on children from China. The objective of this study is to explore the ability of the TG/HDL-C ratio as a blood biomarker for insulin resistance (IR) in obese children in Beijing. We evaluated 262 children with obesity from our paediatric outpatient clinic in a cross-sectional study. Detailed medical histories of all children were ascertained, as were clinical examination and laboratory test results, including blood lipids, fasting glucose, insulin, and glycated haemoglobin. We divided them into age groups of 6-9 and 10-13.5 years and then into IR and non-IR groups based on the homeostatic model assessment for IR (HOMA-IR). Analysis was accomplished with SPSS software (version 22.0). The TG/HDL-C ratio was higher in children with IR in the 6-9 and 10-13.5-year age groups (p < 0.001). Univariate and multivariate analyses displayed that the TG/HDL-C ratio and HOMA-IR were correlated in the 6-9 and 10-13.5-year-old groups (p < 0.05). In the 6-9-yearold group, IR identified by a TG/HDL-C ratio ≥ 0.645 had a sensitivity, specificity, and an area under the curve (AUC) of 79.1%, 60.9%, and 0.734, respectively. In the 10-13.5-year-old group, IR identified by a TG/HDL-C ratio ≥ 0.725 had a sensitivity, specificity, and an AUC of 79.4%, 62.9%, and 0.724, respectively. We showed the application of the TG/HDL-C ratio to predict insulin resistance in obese children in Beijing with different diagnostic thresholds based on age (6-9-year-old group with TG/HDL-C ≥ 0.645; 10-13.5-year-old group with TG/HDL-C ≥ 0.725), which were lower compared with the diagnostic threshold for insulin resistance in children reported in other countries.

RISK FACTORS AND PROGNOSTIC MODELS OF DIABETIC RETINOPATHY AND OPPORTUNITIES OF PRECISION MEDICINE (analytical review)

Background. One of the priority directions of modern medicine development is prognostication, the purpose of which is to increase the accuracy and reliability of forecasts of outcomes related to diseases. In diabetes mellitus (DM), the task of precision medicine is to adapt diagnostic and treatment methods to subgroups of the population with similar characteristics in order to achieve maximum effectiveness. Currently, most forecasting methods are too narrowly focused on the blood glucose level, which makes the wide implementation of precision medicine approaches promising. Aim: to determine risk factors, existing prognostic models and possibilities of precision medicine to improve the effectiveness of diagnosis and treatment of diabetic retinopathy (DR). Materials and methods. The search for sources of Ukrainian and foreign literature for the analytical review was conducted keywords using the open medical scientific database PubMed (USA). At the first stage, 470 sources were selected, of which 46 were selected for this article. Results. It was established that the progression of DR in the initial stages is a consistent, significant and independent predictor of proliferative DR. The condition of the retina reflects the influence of the systemic environment and, in turn, has prognostic value for cardiovascular, renal and other complications. Most of the new biomarkers have yet to be tested in clinical practice, which requires additional studies to predict DR and clinical outcomes of its treatment. Most models include age, sex, ethnicity, and lifestyle variables as predictors: smoking, medical history, glycated hemoglobin, and DM duration. Increasing age of patients, DM duration and concomitant arterial hypertension are independent predictors of microvascular complications. We collected a database including 359 patients (359 eyes) with type 2 diabetes with DR of varying severity, the results of clinical, ophthalmological and laboratory examinations. Models for predicting progression and effectiveness of individualized treatment are being developed.

A RARE RETROPERITONEAL SOFT TISSUE NEOPLASM IN A 27-YEAR-OLD FEMALE: A CLINICAL CASE

Relevance: Myopericytoma is a soft tissue tumor characterized by the proliferation of myopericytes. The tumor originates from myoid cells localized in the skin and soft tissues. Usually, this tumor is benign, but in rare cases, it can be malignant. Myopericytoma is a rare neoplasm, so specific data on its prevalence around the world are limited. The article presents a clinical case of retroperitoneal myopericytoma and a review of the cases described in the literature to analyze the epidemiology and clinical characteristics. Accurate data on the global prevalence of myopericytoma are not available due to the rarity of the disease and the difficulties of diagnosis. Thus, the study of myopericytoma has significant relevance, as it contributes to a better understanding and management of this rare soft tissue tumor and improves patients’ quality of life. The study aimed to describe a clinical case of retroperitoneal soft tissue myopericytoma in a 27-year-old patient. Methods: The authors present a clinical case of retroperitoneal soft tissue myopericytoma. The descriptions of the other 50 clinical cases of myopericytoma were found in the PubMed, Cochrane Library, eLibrary, CyberLeninka, and Google Scholar electronic databases, including the results of clinical examination, computed tomography (CT) and magnetic resonance imaging (MRI), and histopathological examination of biopsy material. Results: A 27-year-old girl went to the clinic complaining of pressure pains in the lower abdomen. A formation in the retroperitoneal space was revealed after a comprehensive examination, including CT and MRI. Further, soft tissue biopsies of the retroperitoneal space were performed, and the diagnosis of myopericytoma was confirmed. The patient was successfully surgically removed from the tumor. Conclusion: Myopericytomas, although classified as benign tumors, pose a serious problem due to their tendency to relapse. Despite their slow growth, they can reach significant sizes and grow into surrounding structures and organs. Consequently, the experience and skill of surgeons play an important role in the vastness of surgical intervention for radical tumor removal, which is important for the patient’s prognosis and quality of life. Radical surgical treatment for myopericytoma is especially important because it allows the complete removal of the neoplasm and minimizes the risk of recurrence, thereby improving long-term results and reducing the need for additional therapeutic interventions.

Endodontic Management of Mandibular Second Molar with Middle Distal Canal

Mandibular second molar is often associated with variations in root canal morphology. Despite the intricate association, the occurrence of middle distal canal in endodontic literature is limited, with an incidence of 0.2% to 3%. Therefore, this study presents a case report describing a clinical situation in mandibular second molar that shows four canals, opening into different apical foramens. A 30-year-old male patient came to the Rumah Sakit Gigi dan Mulut of Universitas Sumatera Utara with the main complaint of intermittent pain in the lower right tooth persisting for two days. The results of clinical examination of the lower right second molar labeled as #47, showed a temporary filling, while radiography indicated widened periodontal ligament space and termination of lamina dura. After receiving informed consent, root canal therapy was carried out, and a direct resin composite onlay was selected for final restoration. To locate and treat hidden and unusual anatomy, dentists are often required to possess a comprehensive understanding of internal dental anatomy and use modern instruments, such as the dental operating microscope and ultrasonic tips. In certain clinical, direct resin composite onlay restorations can represent a valid alternative to traditional indirect restorations. In conclusion, this study shows that a comprehensive understanding of the potential variances in the internal anatomy of human teeth is essential to achieving successful outcomes in endodontic therapy.

A Clinical Case of Timely Diagnosis and Successful Treatment of Budd-Chiari Syndrome With Fulminant Cytolysis in the Setting of a First-time Diagnosed Myeloproliferative Disease.

The article presents a clinical case of peculiarities of clinical manifestations, diagnostic and therapeutic approaches of undiagnosed chronic myeloproliferative disease, on the background of which Budd-Chiari syndrome (BCS) developed. The results of clinical course, examination, and treatment of a patient with BCS as a manifestation of the hidden course of primary myelofibrosis with the presence of somatic mutation (V617F) in Janus-tyrosine kinase-2 (JAK2) gene in myeloid cells are presented. Standard clinical and laboratory examinations, and cytomorphologic and histologic examination of bone marrow were used. The diagnosis of BCS was confirmed by ultrasound (US) Doppler examination of the portal system vessels. Symptomatic therapy resulted in insignificant positive results. The analysis of this clinical case showed that the development of BCS was due to a chronic myeloproliferative disease that was not diagnosed before the development of thrombosis. Hepatic vein thrombosis was accompanied by the development of fulminant cytolytic syndrome. Along with symptomatic therapy, patient K., female, 32 years old, underwent transjugular intrahepatic portosystemic shunting 1 month after the first symptoms of BCS appeared, which contributed to a significant clinical effect. Seven years after the installation of 4 transjugular intrahepatic portosystemic shunts, the patient's condition remains satisfactory. The uniqueness of this clinical case lies in the presence of 2 serious diseases at the same time: myeloproliferative pathology (primary myelofibrosis) JAK2-positive variant and BCS. Timely diagnosis of both hematological diseases and their complication in the form of hepatic vein thrombosis with fulminant cytolytic syndrome allowed timely prescription of adequate treatment with a good clinical response.