Results Of Clinical Examination Research Articles

Frequency of HER-2 NEU Receptor Positivity and its Relationship with Estrogen Progesterone Receptors in Patients of Breast CA

Background: Carcinoma breast is the commonest malignancy of females all over the world and second leading cause of death due to cancer among females. In Pakistan it is more common at a young age contrary to the West where it is more common in old age (after 60 years). The objectives of this cross sectional study were to determine the frequency of HER-2/neu receptor over-expression and its association with some of the features of breast cancer like patient age, ER/PR status, tumour size, histological grade and axillary lymph node involvement. Methods: This study was conducted at Surgery ward unit 2, Fatima Memorial Hospital, Lahore, from June 2015 December 2015. Study included all patients with breast cancer admitted in Surgery unit 2 of FMH, Lahore for Modified Radical Mastectomy (MRM). The resected specimens were sent to histopathologist for immunohistochemical (IHC) studies (HER-2/neu receptor and ER/PR) and detailed histopathological analysis including tumour subtype, size, histological grade and involvement of axillary lymph nodes. Patients refusing HER-2/neu receptor immunohistochemistry were excluded from the study. Name, age, sex, other relevant data, detailed history and clinical examination findings and results of investigation were recorded. Data was analyzed with SPSS version 10. Results: This study included 50 patients of breast cancer having modified radical mastectomy (MRM). Age distribution ranged from 45-61 years with a Mean±SD of age 52.2±4.3 years. 30 out of 50 patients (62.5%) were >52 years, while 20 patients out of 50 (40%) were ≤40 years of age. The HER-2/neu receptor status was found positive in 30 patients (60%) and negative in 20 patients (40%) of the total cases While, it was significantly associated with tumour size (p<0.05) and negative ER/PR status (p<0.05). Conclusion: Due to high prognostic significance and frequency in Pakistani females with breast cancer, HER-2/neu receptor should be checked in all patients with breast cancer so that the positive cases should have herceptin therapy and benefit from anthracycline based chemotherapeutic agents which can improve survival in these patients. Keywords: Breast carcinoma, HER-2/neu, ER/PR

Клинический случай трансформации плоской лейкоплакии в веррукозную после перенесенной новой коронавирусной инфекции (COVID-19)

The authors describe a clinical case of the transformation of flat leukoplakia into verrucous form in a patient after a new coronavirus infection. The results of clinical and histological examination are presented. The ineffectiveness of conservative treatment suggests the need for surgical treatment. Strict observation and monitoring of patients with verrucous leukoplakia should be mandatory even after surgical treatment, since they have a high recurrence rate and malignant transformation.

Preserving reproductive health before the first pregnancy

Research objective: to evaluate the effectiveness of drugs based on decamethoxine for the treatment of inflammatory diseases of genital organs in adolescent girls entering reproductive age.Materials and methods. The study included 96 patients aged 17–19 years who lived an irregular sexual life. The diagnosis of vulvovaginal infection was verified based on clinical and laboratory data. All patients with vulvovaginal infection received Decasan solution 50–100 ml three times a day in the form of irrigation of the external genitalia for the daytime sanitation and Gynodek vaginal gel 5 ml once at night for 7 days, which provided a night exposure of the antiseptic component and created an environment for the restoration of vaginal lactoflora. The effectiveness of treatment was assessed by the results of clinical and bacteriological examination before and after treatment. The criteria for the effectiveness of treatment were complete clinical and bacterial sanitation.Results. According to the results of the microbiological study, all patients were divided into 3 groups: group I consisted of 36 patients with nonspecific vulvovaginitis, group II – 28 adolescent girls with vulvovaginal candidiasis, group III – 32 patients with mixed bacterial-candidiasis infection.The clinical efficacy of therapy was 95.8%: in group I – 94.4%, in group II – 96.4%, in group III – 96.9%. Bacteriological examination, carried out 2 weeks after the end of the course of treatment, confirmed the effectiveness of therapy in 94.4% of adolescent girls with nonspecific vulvovaginitis, in 89.3% with vulvovaginal candidiasis and in 87.5% with mixed bacterial-candidiasis infection.Conclusions. Topical treatment of inflammatory genital diseases in adolescent girls entering reproductive age is effective, safe and can be considered the therapy of choice. Therapy with drugs based on decamethoxine (Decasan and Gynodek) is highly effective in mono- and mixed vulvovaginal infections, which contributes to the preservation of the reproductive health of adolescent girls at the stage of entering reproductive age.

AB0858 Clinical characteristics of patients with spondyloarthritis with COVID-19 in anamnesis in the Republic of Tatarstan

BackgroundThe management of patients with spondyloarthritis (SpA) during the period of the novel coronavirus infection (NCI) pandemic is a significant problem due to insufficient evidence base.ObjectivesTo study the features of the course NCI and its influence on the course of SpA.MethodsFrom March 2020 to January 2022, 55 patients with SpA who underwent NCI (with a confirmed result of SarsCoV2 PCR and / or using X-ray computed tomography (CT) of the lungs): ankylosing spondylitis (AS) 37 people, with psoriatic arthritis (PsA) 18 people. Of these 32 (58.2%) were men, 23 (41.8%) - women, the average age of patients was 49 [37.5; 57.5] years. The duration of SpA at the time of NCI was 11 [7; 16] years. SpA activity before NCI was low in 15 (34.8%) patients, moderate in 25 (58.1%), and high in 3 (6.9%) patients. The results of clinical and laboratory examinations were evaluated during the NCI and after 1, 3, 6 months.ResultsSymptoms of NCI in patients with SpA were comparable in frequency and severity to the course of infection in the population. 47.3% had a mild course of NCI, and 52.7% of those observed had a moderate course, which is comparable with the general population data. Lung involvement was detected in 29 (52.7%) patients. The outcome of COVID-19 in all patients is recovery. Analysis of the course of SpA showed an increase in activity 1 and 3 months after NCI: BASDAI from baseline to COVID-19 4.3±1.57 to 4.9±1.7 points after 3 months, similar to ASDAS_CRP from 2.6±1, 2 to 3.7±0.2, BASFI from 3.0±1.9 to 3.8±1.8. A positive correlation was found between the severity of NCI and the BASFI index after 3 months (0.870). Analysis of the course of PsA showed an increase in activity 1 and 3 months after NCI: DAS28 from the baseline 2.78±0.98 to 4.15±1.16 points after 3 months. Of the total number of recoveries, 72.2% of patients showed an increase in activity due to clinical and laboratory parameters.78.1% of patients noted the presence of post-COVID symptoms after NCI, 56.3% had a combination of more than 3 different symptoms. Most often there was an increase/appearance of pain in the joints - in 78.1%: significant - in 61.8%, insignificant - in 16.3% of respondents. Strengthening/appearance of muscle pain and/or headache and/or dysautonomia occurred in 72.7%. This can be assessed as an exacerbation of the underlying disease, or, conversely, the appearance of arthralgia and myalgia could have an impact on the increase in AS and PsA activity indices. The second most frequent were a decrease in the quality of life (QOL) and working capacity in 69.0% of patients: significant in 36.3% of patients, insignificant in 32.7%.The appearance/intensification of shortness of breath and a decrease in exercise tolerance were noted by 60% of the respondents. Among them, 34.5% of patients with moderate severity, 25.4% - with mild NCI. Appearance/intensification of chest pain and/or palpitations was noted by 16.3% of patientsConclusionThe prevalence and course of the NCI in patients with SpA did not differ from that in the population. However, coronavirus infection has led to increased pain and an increase in AS activity, long-term persistence of post-COVID manifestations in the form of musculoskeletal pain and asthenic symptoms in the form of a decrease in the quality of life. At the same time, specific respiratory symptoms occurred in a third of patients and were not associated with the severity of the NCI.Disclosure of InterestsNone declared

AB1179 CLINICAL CHARACTERISTICS OF PATIENTS WITH RHEUMATOID ARTHRITIS WHO UNDERWENT COVID-19 IN THE REPUBLIC OF TATARSTAN

BackgroundThe management of patients with rheumatoid arthritis (RA) and novel coronavirus infection (NCI) is a significant problem due to the insufficient evidence base on this topic.ObjectivesTo study the features of the transferred NCI in patients with RA and its influence on the course of RA.MethodsFrom March 2020 to January 2022, 105 patients with RA who underwent NCI with a confirmed SarsCoV2 PCR result and/or X-ray computed tomography (CT) of the lungs were followed up. The age of the patients was 62 [55; 68] years, among them females - 84.7% (89 patients). The duration of RA at the time of NCI was 11 [6.5; 17.5] years. RA activity before NCI was low in 14 (13.3%) patients, moderate in 70 (66.6%), and high in 21 (20%) patients. The results of clinical and laboratory examinations were evaluated during the COVID-19, 1 and 3 months after it.ResultsThe symptoms of NCI in patients with RA were comparable in frequency and severity to the course of infection in the population. 30 (28.6%) patients had a mild course of COVID-19, 74 (70.5%) had a moderate course, and 1 had a severe course. Bilateral polysegmental pneumonia was detected in 75 (71.4%) patients.The outcome of COVID-19 in all patients is recovery. Analysis of the course of RA showed a significant increase in activity 1 and 3 months after NCI: DAS28 from baseline to COVID-19 3.59±1.13 to 4.87±1.27 points after 3 months, respectively. Of the total number of recovered patients, 38.0% of patients showed an increase in activity due to clinical and laboratory parameters.90.4% of patients noted the persistence or appearance of symptoms after undergoing NCI after 3 months, 45.7% had a combination of more than 3 different symptoms. The most common manifestations of asthenia in the form of a decrease in the quality of life (QOL) and working capacity.in 90.4% of patients: significant in 58.0% of people, insignificant in 32.4% of people. There was no significant correlation between RA activity and NCI severity. The second most frequent was the increase/appearance of pain in the joints - in 86.6% of respondents: significant in 72.3%, insignificant - 14.2%. Strengthening/appearance of muscle pain and/or headache and/or dysautonomia occurred in 44.7%. Appearance/intensification of shortness of breath and a decrease in exercise tolerance were noted by 36.1% of respondents: significant in 19.0% of people, insignificant in 17.1% of people. Among them, 64.8% (24) people with moderate severity, 35.2% (13) people with asymptomatic or mild NCI. Appearance/intensification of chest pain and/or palpitations was noted by 44.7% of people.ConclusionThe prevalence and course of COVID-19 in patients with RA did not differ from that in the general population. However, coronavirus infection has led to an increase in pain and an increase in RA activity, a long-term persistence of post-COVID manifestations in the form of musculoskeletal pain and asthenic symptoms with a deterioration in the quality of life. There was no significant correlation between RA activity and NCI severity. At the same time, specific respiratory symptoms occurred only in a third of patients.Disclosure of InterestsNone declared

Prevalence of adenomyosis in women undergoing hysterectomy for abnormal uterine bleeding, pelvic pain or uterine prolapse – A retrospective cohort study

BackgroundAdenomyosis can cause symptoms like dysmenorrhea, dyspareunia, pelvic pain and bleeding disorders and is related to subfertility and obstetrical complications. The disease is probably underestimated and underdiagnosed because of difficulties in reliable clinical examination and imaging results. The age-related prevalence of adenomyosis still remains unclear. In this retrospective analysis we describe the rate of adenomyosis in two independent cohorts of patients undergoing hysterectomy for benign diseases (2011–2013 and 2015–2018) and its correlation to presurgical symptoms respectively indications for hysterectomy. Materials and methodsAll surgeries have been performed in the same department of minimally invasive gynecological surgery by a total of two experienced surgeons following a surgical internal standard for the indication bleeding disorder, dysmenorrhea. We analyzed the overall rate of patients with adenomyosis in both cohorts and related the histological presence of adenomyosis to presurgical symptoms. We also analyzed a subgroup of postmenopausal patients with uterine prolapse. ResultsIn 307 patients we detected 42.0% of cases with histologically proven adenomyosis. In the group of patients with bleeding disorders and dysmenorrhea as indication for surgery we found the highest rate of adenomyosis (59.3%, cohort 1). 81,1% patients with adenomyosis (cohort 1) reported symptoms. In the subgroup of 42 postmenopausal patients, we found 23.8% of cases with adenomyosis. ConclusionOur data shows that a positive anamnesis regarding the symptoms bleeding disorders and dysmenorrhea is suspicious for adenomyosis. In hysterectomy specimen adenomyosis can be found in more than 40%. The role of adenomyosis-related symptoms requires further investigation, especially in adolescent and postmenopausal patients.

Diagnosis of Ectopic Intrathyroidal Parathyroid Adenoma with Nodular Goiter by 18F Fluorocholine: A Case Report.

The occurrence of ectopic intrathyroidal parathyroid adenoma (EPTA) is very rare, which causes some difficulties in diagnosis and complicates treatment. In addition, the occurrence of EPTA with nodular goiter (NG) is rare, which makes diagnosis difficult and requires the assistance of clinical evidence, imaging data, and cytological examination results. Therefore, we present a patient with a final diagnosis of ETPA with NG.

Long-Term Outcome of Horses Undergoing Unilateral Mandibular Condylectomy and Meniscectomy for Temporomandibular Joint Disease.

BackgroundThere are no reports describing the long-term outcome of sport horses undergoing unilateral mandibular condylectomy with meniscectomy (UMC) for treatment for severe temporomandibular joint (TMJ) disease (TMD). Whether horses undergoing UMC require a specialized diet, can return to riding with a bit, or return to intended function after surgery is unknown.ObjectiveTo determine the long-term outcome of horses undergoing UMC for treatment of severe TMD.Study DesignA multi-institutional, retrospective study.MethodsMedical records obtained from seven equine referral hospitals of horses with severe TMD that underwent UMC were reviewed. Details regarding the presenting complaints, results of clinical examination, findings of diagnostic imaging, surgical technique, and outcome (including long-term follow-up with an owner questionnaire) were recorded.ResultsEleven horses fit the inclusion criteria. Three had severe idiopathic osteoarthritis, and eight had confirmed septic osteoarthritis of the TMJ. The most common post-operative complications were drainage and peri-incisional swelling (n = 5). One horse developed a hematoma at the surgical site because the facial artery was inadvertently transected during the approach, causing the condylectomy to be postponed. All horses were discharged alive from the hospital, and 10 returned to their previous or intended use. All had complete resolution of clinical signs of TMD. One mare was retired from athletic use due to her genetic value as a broodmare. One horse was euthanized 2 years after UMC due to progressively worsening of clinical signs of temporohyoid osteoarthropathy (THO), which were not present before surgery. When available, owner satisfaction of the results of the procedure was excellent.Main LimitationsSample size; multiple institutions; owner bias.ConclusionsUnilateral mandibular condylectomy should not be considered a salvage procedure. Horses treated for severe TMD by UMC can return to their previous or intended level of athletic performance and do not require a specialized diet.

Serum protein electrophoresis in Dirofilaria immitis naturally infected dogs: Latest news and a systematic literature review

According to the main Guidelines on canine heartworm disease (HWD) by the American and European Societies (i.e., AHS, ESDA, and ESCCAP), a correct diagnosis of Dirofilaria immitis infection should include the detection of circulating microfilariae in the whole blood and the adult antigens in serum or plasma sample. So far, scant data are available on laboratory abnormalities in dogs affected by HWD, although techniques including serum protein electrophoresis (SPEP) have proved to be useful for the diagnosis and monitoring of other vector-borne diseases, such as the canine leishmaniosis. Therefore, this study aims to evaluate the SPEP pattern in dogs naturally infected by D. immitis. Furthermore, a systematic review of the literature on this topic was carried out. Medical records from heartworm-positive dogs, of any sex, age, and breed and with available clinical examination and laboratory test results (i.e., complete blood count, serum biochemical profile, and SPEP) were retrospectively collected. If available, laboratory results obtained from dogs after treatment for HWD were also evaluated. When compared with the reference intervals, out of 30 dogs infected by D. immitis and enrolled, 63.3% (n = 19) had a lower percentage of albumin, and 80.0% (n = 24) had higher percentages of beta globulins, with beta-2, and especially beta-3 globulins the most frequently altered fractions. In terms of absolute values (g/dL), the proportion of dogs with hypoalbuminemia, and increased total globulin, alpha, beta- and gamma globulins were 4/30 (13.3%), 6/30 (20.0%), 2/30 (6.7%), 16/30 (53.3%) and 8/30 (26.7%), respectively. For 7 dogs, SPEP results evaluated three and six months after treatment with doxycycline (10 mg/kg BID for 4 weeks) were available. In these dogs a significant post-treatment increase in the percentage of albumin, alpha-2 globulin, and albumin/globulins ratio was observed, as well as a significant decrease both in the percentage and in the absolute value of total-, beta-, and beta-3 globulins. The systematic review of literature databases yielded a total of three studies that were considered eligible and included in the qualitative synthesis. This study provides novel information on SPEP alterations in dogs naturally infected by D. immitis. The evaluation of serum proteins and their electrophoretic pattern may represent an important diagnostic tool for a prompt and accurate diagnosis (e.g., differentiating infections in dogs sharing similar clinical signs and endemic in the same geographical area) and monitoring of HWD.

Can ultrasound help to overcome uncertainty in clinical joint assessment in juvenile idiopathic arthritis?

Assessment of active synovitis is crucial for the management of juvenile idiopathic arthritis (JIA). We aimed to investigate the correlation of musculoskeletal ultrasound (MSUS) and clinical examination results and relate them to arthritis relapse rate. JIA patients with questionable presence of active arthritis (Q-joints) and controls (JIA and healthy children) were recruited. MSUS of Q-joints, active joints and their inactive counterparts was performed at study entry. Standard disease activity parameters were prospectively recorded. Of 481 joints of 138 JIA patients, 99 joints (20.6%) of 58 patients had one or more Q-joints with 54/99 (54.5%) having MSUS features of active disease. Clinically inactive joints had lower proportion of MSUS synovitis (78/253, 30.8%) while MSUS activity was present in 114/129 (88.4%) of clinically active joints and in 2/105 (1.9%) joints of 36 healthy controls. Within the 15-month follow-up 23/99 (22%) Q-joints and 31/253 (12%) clinically inactive joints relapsed. Joints with subclinical synovitis relapsed more frequently than MSUS inactive ones (p<0.001). The relapse rate was higher in MSUS-active Q-joints (19/23, 82%) than in clinically inactive ones (16/31, 52%) with MSUS synovial hypertrophy as the main relapse predictor in multivariate analysis. Ankle and knee joints relapsed most frequently. Acknowledgement of joints with questionable synovitis may contribute to the assessment of disease activity in JIA. Presence of MSUS synovitis carries a clinically meaningful risk of disease recurrence in these joints. In clinical practice, our findings encourage timely MSUS assessment of the joints in question, especially in patients without any other features of active disease.

CHARACTERISTICS OF MICRO-BIOCOENOTIC DISORDERS IN YOUNG CHILDREN WITH DIFFERENT CLINICAL FORMS OF BRONCHITIS

Introduction. Non-specific respiratory diseases, in particular, various clinical forms of bronchitis in young children and adolescents, are remaining not only a scientific problem, but also have medical and social impact. The aim of this work is to clarify the differential diagnostic criteria for different forms of bronchitis in children based on a comprehensive assessment of the results of bacteriological, clinical-radiological and bronchological examinations of patients. Materials and methods. The results of clinical observation and examination of 50 children with recurrent (35) and obstructive (15) bronchitis aged from 4 months to 3 years old are presented. According to age, all patients were divided into two groups. The first group consisted of children aged from 4 months to 1 year old (10), the second group included children aged from 1 to 3 years old (40). Smears taken from the mucous membrane of the anterior pharynx served as material for bacteriological examination. X-ray and bronchological examinations were conducted according to the indications, taking into account the severity and course of the disease. Conclusion. Our data indicate that the frequency of microbial sensitization in children with recurrent bronchitis is higher than in children with obstructive form of bronchitis that is obviously a favourable background for the development of infectiousallergic bronchial asthma. For patients with obstructive bronchitis, the state of bacterial polysensitization is more typical. Conducted studies indicate the feasibility of a comprehensive approach and evaluation of various clinical forms of bronchitis in young children, taking into account bacteriological, clinical-radiological and bronchological data that help to clarify the mechanisms of pathogenesis of this pathology and the use of rational methods of therapy.

Effects of medical history and clinical factors on serum lipase activity and ultrasonographic evidence of pancreatitis: Analysis of 234 dogs

BackgroundLipase measurements and ultrasonographic (US) evidence of pancreatitis correlate poorly.ObjectivesIdentify explanations for discrepant lipase and pancreatic US results.AnimalsTwo hundred and thirty‐four dogs with gastrointestinal signs.MethodsA retrospective study was conducted, in which lipase activity and US were performed within 30 hours. Medical history, clinical examination results, lipase activity, and US results were recorded.ResultsLipase and US results were weakly correlated (r s = .25, P < .001). At both evaluated time cut‐offs, median lipase activities were significantly higher with shorter durations of clinical signs before presentation (≤2 days, 334 U/L; >2 days, 118 U/L; P = .03; ≤7 days, 334 U/L; >7 days, 99 U/L; P = .004), but US was not significantly more frequently positive. For both cut‐offs (>216/≤216 U/L, >355/≤355 U/L; reference range, 24‐108 U/L), median disease duration was significantly shorter (3 vs 4 days) with higher lipases. Previous pancreatitis episodes were significantly associated with an US diagnosis of pancreatitis (P = .04), but median lipase activities were not significantly higher (386 U/L vs 153 U/L; P = .06) in these dogs. Pancreatic US was significantly more often positive when the request contained “suspicion of pancreatitis” (P < .001) or “increased lipase” (P = .01). Only changes in pancreatic morphology, echogenicity, and peripancreatic mesentery were significantly associated with a positive US diagnosis, and also had significantly higher lipase activities.Conclusions and Clinical ImportanceDuration of clinical signs before presentation differently affects laboratory and US evidence of pancreatitis. Previous pancreatitis episodes and information given to radiologists influence US results. These findings can be helpful for future studies on pancreatitis in dogs.

Development and early diagnosis of critical illness myopathy in COVID-19 associated acute respiratory distress syndrome.

BackgroundThe COVID‐19 pandemic has greatly increased the incidence and clinical importance of critical illness myopathy (CIM), because it is one of the most common complications of modern intensive care medicine. Current diagnostic criteria only allow diagnosis of CIM at an advanced stage, so that patients are at risk of being overlooked, especially in early stages. To determine the frequency of CIM and to assess a recently proposed tool for early diagnosis, we have followed a cohort of COVID‐19 patients with acute respiratory distress syndrome and compared the time course of muscle excitability measurements with the definite diagnosis of CIM.MethodsAdult COVID‐19 patients admitted to the Intensive Care Unit of the University Hospital Bern, Switzerland requiring mechanical ventilation were recruited and examined on Days 1, 2, 5, and 10 post‐intubation. Clinical examination, muscle excitability measurements, medication record, and laboratory analyses were performed on all study visits, and additionally nerve conduction studies, electromyography and muscle biopsy on Day 10. Muscle excitability data were compared with a cohort of 31 age‐matched healthy subjects. Diagnosis of definite CIM was made according to the current guidelines and was based on patient history, results of clinical and electrophysiological examinations as well as muscle biopsy.ResultsComplete data were available in 31 out of 44 recruited patients (mean [SD] age, 62.4 [9.8] years). Of these, 17 (55%) developed CIM. Muscle excitability measurements on Day 10 discriminated between patients who developed CIM and those who did not, with a diagnostic precision of 90% (AUC 0.908; 95% CI 0.799–1.000; sensitivity 1.000; specificity 0.714). On Days 1 and 2, muscle excitability parameters also discriminated between the two groups with 73% (AUC 0.734; 95% CI 0.550–0.919; sensitivity 0.562; specificity 0.857) and 82% (AUC 0.820; CI 0.652–0.903; sensitivity 0.750; specificity 0.923) diagnostic precision, respectively. All critically ill COVID‐19 patients showed signs of muscle membrane depolarization compared with healthy subjects, but in patients who developed CIM muscle membrane depolarization on Days 1, 2 and 10 was more pronounced than in patients who did not develop CIM.ConclusionsThis study reports a 55% prevalence of definite CIM in critically ill COVID‐19 patients. Furthermore, the results confirm that muscle excitability measurements may serve as an alternative method for CIM diagnosis and support its use as a tool for early diagnosis and monitoring the development of CIM.

Порушення функції печінки в дітей раннього віку з позагоспітальною пневмонією: роль маркерів інфекційно-запального процесу

Today, pneumonia remains the leading cause of infant mortality and morbidity worldwide. Pneumonia increases inflammatory processes, accompanied by the activation of inflammatory mediators, and can provoke significant metabolic disorders in the body. Purpose - to determine liver dysfunction in young children with community-acquired pneumonia based on the study of markers of infectious-inflammatory process. Materials and methods. The results of clinical and laboratory examination of 338 children aged 1 month to 3 years with community-acquired pneumonia were analyzed. The children were hospitalized in the Infectious Diseases Boxed Department for Young Children of the Vinnytsia Regional Children’s Clinical Hospital. Verification of the diagnosis was made using the recommendations of the British Thoracic Society. All patients had pneumonia of varying severity, depending on which they were divided into two groups: group I - 129 children who were diagnosed with community-acquired pneumonia of moderate severity; group II - 209 patients with severe pneumonia. Comparison group - 40 healthy children. Results. Markers of infectious-inflammatory process were studied to determine the levels of pro-inflammatory cytokines - interleukin (IL-1, IL-6) and proteins of the acute phase of inflammation - C-reactive protein (CRP) and fibrinogen in the serum of young children with outpatients. Aminotransferase hyperenzymemia is closely correlated with the activity of the infectious-inflammatory process, which indicates a positive correlation between the level of IL-1 and ALT (rxy=+0.047) and AST (rxy=+0.111). At the same time, there is a negative correlation between the levels of IL-1, CRP and the activity of aminotransferases in blood plasma. Conclusions. It was found that the course of community-acquired pneumonia is accompanied by an increase in the serum of children with concentrations of IL-1 and IL-6 in parallel with the severity of the disease. The synthesis of pro-inflammatory cytokines stimulates the production of acute CRP, but reduces the concentration of fibrinogen in the blood of sick children. The identified links between the content of the studied cytokines at the systemic level and multidirectional changes in the acute phase of inflammation indicate a violation of the liver, where proteins are synthesized. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: cytokines, C-reactive protein, fibrinogen, alanine aminotransferase, aspartate aminotransferase, liver, community-acquired pneumonia, children, early age.

Challenges in preoperative diagnosis of glossopharyngeal nerve schwannoma: own findings analysis

Medical history, disease onset, clinical symptoms, and results of neuroimaging of 14 glossopharyngeal schwannoma patients, who were exa­mined and treated in the Subtentorial Neurooncology Department of the State Institution, Romodanov Institute of Neurosurgery of the NAMS of Ukraine (8 patients) and the Neurosurgery Department No. 2 of the Municipal Enterprise, Mechnikov Dnipropetrovsk Regional Clinical Hospital of Dnipropetrovsk Regional Council (6 patients) in 2018 to 2021 have been analyzed in details. The study inclusion criteria were as follows: patient’s age over 18, pre­sence of unilateral primary glossopharyngeal nerve schwannoma. Our study showed that most of clinical signs and symptoms of the glossopharyngeal nerve schwannoma are associated with otolaryngological disorders (such as hearing loss, tinnitus, hoarseness, or dizziness) or cerebellar disorders (such as ataxia, nystagmus, or dizziness). Neuroimaging cerebellopontine angle tumors diagnosis must include brain computed tomography (with mandatory assessment of the state of jugular foramen and internal auditory canal) and IV contrast brain magnetic resonance tomography and inclusion of high-resolution sequences, gradient echo (3D CISS, DRIVE, TRUFFI, B-FFE) with the aim of better visualization and differentiation of various cerebellopontine angle cranial nerves. The study demonstrates the com­plexity of a reliable preoperative diagnosis when using standard diagnostic tools. Preoperative jugular foramen and cerebellopontine angle tumors diagnosis should be based on a systematic approach and include a comparison of results of comprehensive clinical and instrumental examination and neuroimaging studies.

Dynamic detection of HER2 of circulating tumor cells in patients with gastric carcinoma and its clinical application.

The aim of the present study was to construct and characterize human epidermal growth factor receptor2 (HER2) lipid magnetic ball (H‑LMB) for separating circulating tumor cells (CTCs) in patients with gastric carcinoma (GC) and to compare the result of separated CTC counts with that of next‑generation sequencing (NGS) for single‑gene analysis to verify the consistency for evaluating the association between the detection results and the progress of clinical treatment, so as to facilitate early diagnosis and dynamic monitoring of GC. A lipid magnetic ball (LMB), coated with Fe3O4 nanoparticles, was synthesized by microemulsion technique and an anti‑HER2 antibody was conjugated to the surface of LMB to form H‑LMB, followed by the characterization of the prepared H‑LMB. The detection of capture efficiency of LMBs in GC cells was tested by MTT and expression of HER2 mRNA was determined by reverse transcription‑quantitative PCR. The positive detection rate of HER2 was verified by HER2‑fluorescence insitu hybridization (FISH) test on the separated CTCs from GC. Further verification was performed based on the consistency between the result of separated CTCs and that of single‑gene NGS assay of HER2, associated with the determination of clinical consistency. The constructed H‑LMB exhibited good stability and specificity. The mutation rate of HER2 by the FISH test was 14% in the blood samples of 50patients with GC and was 14% by NGS assay. The mutation rate of HER2 was 12% in H‑LMB and the positive detection rate was 85.7% compared with the results of the FISH test, indicating consistency with the clinical diagnosis and pathological examination results. In conclusion, the anti‑HER2 antibody‑modified LMB can separate CTCs with HER2 abnormal expression, which exhibits an application potential in GC diagnosis and treatment and is of great clinical significance for the diagnosis and evaluation of its therapeutic effect on GC.

Effectiveness of vitex agnus castus extract in the treatment of primary dysmenorrhea

Background. Primary dysmenorrhea (PD) is one of the most common types of gynecological pathology and is observed in 31–52% of young women, in 10% of them the pain is so intense that leads to disability. In the pathogenesis of PD consider a representative of eicosanoids— thromboxane A2 with a pronounced vasoconstrictor effect. The article presents the results of clinical and hormonal examination of women with PD and developed on this basis a method of treatment. The purpose was to develop and evaluate the effectiveness of treatment of PD, taking into account the multicomponent pathogenesis of the disease. Materials and methods. There were 60 women observation, randomly divided into two groups: 30 women with PD (main group) and 30healthy women (control group). PD was diagnosed on the basis of patients’ complaints of painful menstruation and related symptoms, excluding organic gynecological pathology and diseases of the internal organs in consultation with a physician and endocrinologist. Treatment of patients with PD was performed with a combined drug, which includes a standardized extract of Vitex agnus castus L., indole-3-carbinol, 3,3-diindolyl-methane, passionflower extract, California escholzia extract. Results. As a result of treatment in patients with PD significantly reduced the intensity of pain, and 60% completely disappeared pain, all disappeared fear of waiting for the next menstruation, significantly reduced the manifestations of autonomic vascular (from 17% of patients to 3%), autonomic (from 10% of patients to 0%), metabolic and endocrine (from 13% of patients to 0%) disorders and disorders of the emotional and mental sphere (from 23% of patients to 7%), no patient had a combination of symptoms. Conclusions. Given the safety, high therapeutic efficacy, the drug based on Vitex agnus castus extract can be recommended for the treatment of young patients with PD lasting at least 3 months.

Cystic adenomatous lung malformation of type II in the newborn, problems of early diagnosis

Introduction. Cystic adenomatous malformation (CAM) is a congenital lung malformation resulting from abnormal morphogenesis of lung branching at different stages and in different parts of the tracheobronchial tree, with formation of cysts. The incidence of CAM is one case per 8,300-35,000 live births. The modern classification distinguishes four types of CAM. The aim of the work was to analyze the features of the course of the disease and radiological signs that can help the doctor to suspect the presence of congenital lung malformations in the newborn in the early stages of manifestation, justify additional diagnostic methods, and timely choose an appropriate treatment tactic. Material and methods. The article presents the clinical observation of a newborn infant with type II CAM and concomitant disease «early neonatal sepsis». Medical documents are used, where the results of clinical examination, instrumental (X-ray, ultrasound, CT) and laboratory methods of investigation are presented. Data of histological examination of biomaterial obtained intraoperatively are presented. Results. An analysis of the clinical and radiological dynamics is given. Based on the examination, congenital malformations were detected, and surgical treatment was performed. The child was discharged from the hospital on the 35th day of life in a satisfactory condition. A detailed analysis of diagnostic limitations at each stage of the child's life was conducted. Discussion. Diagnosis of CAM in the early stages was difficult not only because of the nature of the malformation, but also because of the clinic of sepsis, which was the leading one in the first days of life. The morphology of the malformation leads to problems with its prenatal diagnosis and the lack of a clear radiological and ultrasound picture in the postnatal period. Conclusion. In any case of recurrent air leak syndrome, differential diagnosis of congenital pulmonary malformations and the use of CT or MRI for accurate imaging seems reasonable.

Parent-provided photographs as an outcome measure for childhood chalazia

To determine whether smartphone photographs of children's eyelids are reliable for diagnosing the presence of chalazia. In this prospective cross-sectional study, 60 participants, 7 months to 16.5 years of age, at four sites were enrolled; all participants had a chalazion measuring at least 2 mm on at least one eyelid based on an in-person clinical examination by a pediatric eye care professional. Smartphone photographs taken by the parent during the office visit were uploaded to the study website. A masked reader assessed each photograph for the presence or absence of chalazia; results were compared with the gold standard clinical examination results. Sensitivity and specificity for the presence of chalazion by eyelid were calculated. Photographs were available for 240 eyelids; 85 had at least one chalazion and 155 were without a chalazion based on clinical examination. The masked reader correctly classified 68 of 85 eyelids with at least one chalazion and 151 of 155 eyelids without chalazia for a sensitivity of 80% (95% CI, 72%-86%) and a specificity of 97% (95% CI, 94%-99%). Sensitivity improved to 89% for chalazia 5 mm or larger and 94% when superficially located within the eyelid. Parental smartphone photographs appear to be useful in assessing chalazia in children as an alternative to in-office follow-up examinations. These photographs may be a valuable outcome measure in future clinical trials of chalazia treatment, especially when assessing larger lesions.

Hypoxic-ischemic brain injuries in cardiosurgical patients (rationale of causal connections)

Summary. The presented article substantiates the materials on causation in the most common variants of hypoxic-ischemic brain lesions in cardiac surgery patients. The study showed that the functional changes assumed by the patient's brain (under the conditions of heart surgery using the resources of artificial circulation), reflects the state of the structural patterns of the whole organism. The aim of the study – to analyze the clinical and anamnestic materials on pathogenetic prototypes of hypoxic-ischemic lesions that occur in patients as a result of cardiac surgery. Materials and Methods. The materials were the results of anamnestic profile clinical examinations and observations of patients (n = 118) who were on routine hospitalization in the profile department of the State Institution "Heart Institute of the Ministry of Health of Ukraine" in Kyiv. The study used a thematic map of the patient, developed and processed by the author. Its content was related to clinical prototypes associated with the leading symptoms of the disease and contributed to the understanding of the pathogenetic mechanisms of the latter. Results. The complex research, scientific-theoretical, methodological, and patent-licensing information on the specialty has shown that embolism is considered to be a priority mechanism for the development of hypoxic-ischemic lesions. Another important factor in the pathogenesis of hypoxic-ischemic disorders is hypoperfusion. One of the reasons for the development of stroke during cardiac surgery, especially in the surgical treatment of aortic pathology, is hypoperfusion due to instability of central hemodynamics. The next level of influence on systemic processes of development of hypoxic-ischemic defeats of the brain of cardiac surgery patients is the systemic inflammatory response. According to some researchers, CNS damage after cardiac surgery is largely due to side effects associated with the use of artificial circulation. An important point associated with the occurrence of hypoxic-ischemic changes in the brain is called general anesthesia. The technique of total intravenous and/or inhalation anesthesia does not provide adequate protection of CNS structures from intraoperative pain. Conclusions. Analysis of clinical and anamnestic materials on pathogenetic prototypes of hypoxic-ischemic lesions that occur in patients as a result of cardiac surgery, shows the presence of a complex of pathogenetic components, among which the leading role is played by: embolism; hypoperfusion; systemic inflammatory response with changes in hemostasis and the use of an arsenal of general anesthesia