Results Of Clinical Examination Research Articles

СИНДРОМ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ ПРИ ФЕОХРОМОЦИТОМЕ И ГОРМОНАЛЬНО-НЕАКТИВНОЙ АДРЕНОКОРТИКАЛЬНОЙ АДЕНОМЕ НАДПОЧЕЧНИКА

Introduction. The syndrome of arterial hypertension (AH) can be in patients with functioning and non-functioning masses of the adrenal glands which requires a thorough examination to exclude secon¬dary AH of origin. Aim. Identification of clinical, laboratory and radiological features of the AH syndrome in pheochromocytoma (PCC) and adrenocortical adrenal adenoma (incidentaloma). Materials and methods. A retrospective analysis of the clinic, biochemical, hormonal, radiological methods of examination was carried out in 15 patients referred for surgical treatment with a diagnosis of pheochromocytoma. During the postoperative histological examination of the removed masses of the adrenal glands, the diagnosis of PCC was confirmed in 8 out of 15 patients, in 7 patients instead of PCC, adrenocortical adenoma of was diagnosed. Results. Comparative analysis of the results of clinical, laboratory and radiological examination of patients with PCC and non-functioning adrenocortical adenoma with arterial hypertension syndrome showed that arterial hypertension syndrome in PCC has the following features: a crisis course of hypertension with its characteristic symptoms (headache, tremor, profuse sweating, palpitations), passing without treatment with the development of severe weakness after the crisis. Patients with PCC, compared with patients with adrenocortical adenoma, had a lower body mass, high levels of metanephrine, and on computed tomography (CT), the tumors were larger with high contrast uptake in the unenhanced and delayed phases. The reasons for the overdiagnosis of PCC in patients with adrenocortical adenoma in the presence of hypertension were: underestimation of clinical manifestations and an increase in the level of normetanephrine in daily urine, as well as a slight increase in the unenhanced density of contrast uptake on CT in 2 of 7 patients.

Превентивна пластика порушень архітектоніки присінка рота

The aim of the study. Improving the effectiveness of сomplex treatment of patients with maxillomandibular anomalies and disorders of the architectonics of the vestibule of the mouth. Research methods. 30 people aged 12–15 years with maxillomandibular anomalies and disorders of the architectonics of the vestibule of the mouth and 15 people of the comparison group. All patients had buccal frenulum plastic surgery using our proposed method. Patients of group I (15 people) were prescribed chlorhexidine-denta, patients of group II (15 people) were prescribed chlorhexidine-denta and a preparation based on hyaluronic acid in the postoperative period. Scientific novelty. Clinical studies have shown that all patients have anomalies of buccal frenum fixationin the area of the canines and premolars. The results of cytomorphometric and rheographic studies indicated a deficiency of blood supply in these areas. We found that up to 12 years in children may increase the depth of the vestibule of the mouth. The results of clinical and laboratory examination showed the advantage of the proposed treatment plan. Long-term results indicate the formation of a normorthophic scar, the absence of recurrences and recessions of the gums in the area of projections of connective tissue strands, the normalization of clinical and laboratory parameters. The obtained data in the ІІ group significantly differ from those in the І group (p < 0.05). Conclusions. Surgical correction of disorders of the architectonics of the vestibule of the mouth is an important and necessary stage of complex treatment of patients with maxillomandibular anomalies and disorders of the architectonics of the vestibule of the mouth. We can achieve the desired therapeutic effect in the treatment of such patients and prevent relapses only by eliminating the etiological factor. The use of preparations based on hyaluronic acid in the postoperative period stimulates reparative processes in the operated area and contributes to the formation of a normotrophic scar. Plastics of buccal frenulums are prevention of abnormal position of premolars and gum recession in the area of canines and premolars. It is important for preventive dentistry. Key words: vestibule of the mouth, buccal frenum, hyaluronic acid, mucosal graft.

Оптимізація лікування гастроезофагеальної рефлюксної хвороби з супутнім ожирінням: нові підходи та перспективи

In recent decades, there has been a rapid increase in obesity among the working-age population. Excess weight is associated with an elevated risk of developing gastrointestinal pathology, including gastroesophageal reflux disease (GERD). The aim of this study was to investigate the effectiveness and rationale for the addition of tyrosine-2-alanylglycyl-phenylalanyl-leucyl-arginine diacetate (dalarin) to the standard GERD treatment regimen. Materials and Methods: A total of 110 study participants were divided into two groups: 40 patients with GERD without concomitant obesity and 70 patients with GERD and grade I obesity. One group received the standard treatment protocol, while the other group received dalarin as an additional medication. Disease progression was assessed after a three-week period using clinical, laboratory, and instrumental examinations. Results: The results of clinical, laboratory, and instrumental examinations provide evidence that combined treatment with the inclusion of dalarin surpasses the effectiveness of the standard treatment protocol in both the isolated GERD group and the GERD group with concomitant obesity.

OPTIMISING THE TREATMENT OF PATIENTS WITH ADVANCED OVARIAN CANCER: AN ANALYSIS OF PRELIMINARY RESULTS

Summary. Aim: to evaluate surgical complications, side effects of chemotherapy, 1- and 3-year survival in patients with advanced ovarian cancer against the background of the introduction of optimized personalized treatment. Object and methods: for this purpose, a comparative analysis of the results of clinical examination and treatment of 74 patients with primary serous ovarian adenocarcinoma of stages III–IV (FIGO 2015) who were treated at the University Clinic of Odesa National Medical University was conducted. Patients were divided into 2 groups: Group IA — patients with primary ovarian cancer who were treated with primary cytoreductive surgery (PDS) + adjuvant chemotherapy (ACT) — 43 patients; IB group — patients with primary ovarian cancer who were treated with neoadjuvant chemotherapy (NACT) + interval cytoreductive surgery (ICS) + adjuvant chemotherapy — 16 patients. Results: the absence of statistical difference in the median overall survival in groups IA (PDS + ACT) and IB (NACT + ICS + ACT) was shown to be explained by the complete volume of cytoreduction performed. There was a change in 3-year survival from 56.3 to 70.7% (χ2 = 0.951; p = 0.329) and an increase in 5-year survival from 12.5 to 60.9% (φ = 0.0012; p < 0.05). In group IB, the percentage of postoperative complications in patients and the average length of hospital stay after cytoreductive surgery were lower than in group IA, but the difference was statistically insignificant. When comparing the frequency of side effects of paclitaxel/carboplatin chemotherapy treatment in groups IA and IB, the values of χ2 = 36.441; p = 0.0195 were obtained. Thus, it was proved that in the IB group, the toxic effects of chemotherapy of 3–4 degrees of severity were significantly more common. Conclusions: there was no statistical difference when comparing the median overall survival and progression-free survival in the study groups. It has also been shown that primary cytoreductive surgery with macroscopically visible residual masses, especially in suboptimal and suboptimal volume (CC 2-3), leads to a significant decrease in survival rates in patients with ovarian cancer.

Extrahepatic manifestations of chronic hepatitis B at the Centre National Hospitalier et Universitaire Hubert Koutoukou Maga in Cotonou in 2017

Introduction: Extrahepatic manifestations (EEM) are frequently encountered in chronic viral hepatitis. The aim of this study was to determine the prevalence of MEH in chronic viral hepatitis B (CVH) and to identify factors associated with these manifestations. Materials and methods: This was a descriptive and analytical cross-sectional study conducted from May 15 to August 31, 2017. Data were collected prospectively on the basis of the results of clinical examinations and paraclinical examinations of patients with HVB who consulted us during this period. Results: A total of 121 patients with HVB were included. Of the 121 patients with HVB, MEH was found in 103 patients (85.1%). These MEH were clinical (MCEH) in 86 patients (71.1%), and biological (MBEH) in 57 patients (47.1%). The main MCEH were asthenia (58.7%), arthralgia (27.3%), dermatological manifestations (17%) and paresthesias (12.4%). Biological manifestations included renal impairment (33.8%) and thrombocytopenia (25.6%). None of the factors studied was associated with the presence of extrahepatic clinical manifestations of HVB. However, age and antiviral treatment were associated with the presence of renal involvement (p= 0.011). Conclusion: MEH was present in the majority of chronic HVB carriers, and was dominated by asthenia. However, no factor was associated with the presence of extrahepatic clinical manifestations; whereas age and antiviral treatment were associated with the existence of an extrahepatic biological manifestation.

The design and clinical application of a new appliance to treat impacted maxillary central incisors.

Maxillary central incisor impaction is one of the most common types of dental anomalies in children. Treatment of impacted central incisors is complicated and challenging given the position of the impacted central incisors, root development, and the complexity of the crown eruption direction. This study aimed to describe the use of a new multifunctional appliance for the treatment of impacted maxillary central incisors. This article reports the use of a novel appliance for the treatment of impacted maxillary central incisors. We describe the cases of two young patients with labial horizontally impacted maxillary central incisors. Both patients were treated using this novel appliance. Therapeutic effects were evaluated by comparing the pretreatment results, posttreatment cone-beam computed tomography images, and posttreatment clinical examination results. At the end of the treatment period using the novel appliance, the impacted central incisors had successfully been properly aligned in the dental arch, and the tooth roots had not resorbed. Both patients exhibited good dental alignment, with restored function and acceptable aesthetics. This article demonstrates that the new appliance was comfortable, convenient, safe, and effective in the treatment of impacted maxillary central incisors and that its clinical use should be promoted in the future.

Compensation pathways for venous drainage of the brain in superior sagittal sinus occlusion by parasagittal meningioma

This study aims to determine the existing pathways of collateral cerebral circulation in parasagittal meningiomas that cause superior sagittal sinus occlusion based on literature review and analysis of own clinical observations. Results of clinical and instrumental examination of 221 patients treated in Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov from 2000 to 2021 were subjected to retrospective and prospective analysis. Inclusion criteria were: patient age of 18+, parasagittal extracerebral tumor according to computed tomography/magnetic resonance imaging, histologically verified meningioma, superior sagittal sinus occlusion (type V-VI according to M.P. Sindou and J.E. Alvernia) according to selective cerebral angiography. This study is based on the analysis of examination of 43 patients who met the inclusion criteria. The selected patients were analyzed for demography (sex, age), brain computed tomography/magnetic resonance imaging before and after intravenous contrast enhancement, and computed tomography angiography and selective cerebral angiography data. Transformed venous drainage pathways were analyzed depending on the location of superior sagittal sinus occlusion by parasagittal meningioma: anterior, middle, or posterior third of the superior sagittal sinus. It was determined that preoperative diagnosis of parasagittal meningiomas that, based on brain computed tomography/magnetic resonance imaging, has signs of type V or VI superior sagittal sinus invasion according M.P. Sindou and J.E. Alvernia, must include selective cerebral angiography. Dynamic images of selective cerebral angiography in the venous phase allows to fully assess the established pathways of collateral blood flow and the blood flow direction. Information on collateral venous circulation in case of superior sagittal sinus occlusion by parasagittal meningioma is extremely important in a surgery planning. It helps avoiding iatrogenic damage to eloquent veins, which increases radical tumor removal with maintaining/improving a patient’s functional state in the early postoperative period and improving long-term treatment outcomes.

Artificial intelligence-based diagnosis of asbestosis: analysis of a database with applicants for asbestosis state aid

ObjectivesIn many countries, workers who developed asbestosis due to their occupation are eligible for government support. Based on the results of clinical examination, a team of pulmonologists determine the eligibility of patients to these programs. In this Dutch cohort study, we aim to demonstrate the potential role of an artificial intelligence (AI)-based system for automated, standardized, and cost-effective evaluation of applications for asbestosis patients.MethodsA dataset of n = 523 suspected asbestosis cases/applications from across the Netherlands was retrospectively collected. Each case/application was reviewed, and based on the criteria, a panel of three pulmonologists would determine eligibility for government support. An AI system is proposed, which uses thoracic CT images as input, and predicts the assessment of the clinical panel. Alongside imaging, we evaluated the added value of lung function parameters.ResultsThe proposed AI algorithm reached an AUC of 0.87 (p < 0.001) in the prediction of accepted versus rejected applications. Diffusion capacity (DLCO) also showed comparable predictive value (AUC = 0.85, p < 0.001), with little correlation between the two parameters (r-squared = 0.22, p < 0.001). The combination of the imaging AI score and DLCO achieved superior performance (AUC = 0.95, p < 0.001). Interobserver variability between pulmonologists on the panel was estimated at alpha = 0.65 (Krippendorff’s alpha).ConclusionWe developed an AI system to support the clinical decision-making process for the application to the government support for asbestosis. A multicenter prospective validation study is currently ongoing to examine the added value and reliability of this system alongside the clinic panel.Key Points• Artificial intelligence can detect imaging patterns of asbestosis in CT scans in a cohort of patients applying for state aid.• Combining the AI prediction with the diffusing lung function parameter reaches the highest diagnostic performance.• Specific cases with fibrosis but no asbestosis were correctly classified, suggesting robustness of the AI system, which is currently under prospective validation.

Extracranial Carotid Artery Aneurysms: 20-Year Experience of Surgical Management

Extracranial carotid artery aneurysm (ECAA) is a rare vascularpathology with reported incidence of 0.2-5.0% of all carotid artery surgical interventions. Most of ECAAs remain clinically asymptomatic, however, they can manifest in neurological symptoms as transient ischemic attack or stroke. The presence of a pulsating formation, swallowing disorders, signs of compression of cranial nerves may beindicative of the aneurysm growth, which is associated with higher risk of thromboembolic complications and less oftenwith rupture. Surgical treatment is a method of choice in symptomatic patients or in cases of the aneurysm growth and includes resection with arterial reconstruction, ligation of the artery or endovascular intervention.&#x0D; The aim. To improve the results of surgical treatment of ECAAs.&#x0D; Materials and methods. The results of clinical examination, laboratory, instrumental, intraoperative observations were analyzed in 39 patients (35 [89.7%] men and 4 [10.3%] women) with 44 ECAAs, who were admitted to the Vascular Surgery Department of Lviv Regional Clinical Hospital for the period from 2003 to 2022. To conϐirm the diagnosis of ECAA, preoperative instrumental examination included duplex ultrasonography and multispiral computed tomography angiography.&#x0D; Results. Etiological causes of ECAAs included: atherosclerosis (79.5%),ϐibromuscular dysplasia (7.7%), trauma (5.1%), previous operations in the neck region (5.1%) and infection (2.6%). The justiϐication of the choice of surgical tactics depended on the localization of aneurysm, concomitant carotid occlusive disease or pathological deviation of carotid arteries. Early results of surgical treatment were evaluated up to 30 days of the postoperative period. The postoperative complications included: transient ischemic attack in 1 (2.6%), ischemic stroke in 2 (5.1%), cranial nerve damages in 4 (10.3%), thrombosis of arterial reconstruction in 2 (5.1%), hematoma of postoperative wound in 4 (10.3%), infection of postoperative wound in 1 (2.6%) cases. Postoperative mortality was 2.6%.&#x0D; Conclusion. ECAA is a rare clinical disease that requires an active surgical approach to reduce the risk of ischemic stroke. Reconstructive surgery of ECAAs is a highly effective method of treatment that allows to achieve satisfactory results and prevent the development of severe complications.

Use of zero-gravity robotic-assisted locomotion simulator in rehabilitation of patients with spinal trauma sequelae

In 2013, the WHO reported that 250,000 to 500,000 people worldwide are affected by traumatic spinal cord injury every year (WHO, 2013). In Russia, it is estimated that over 250,000 people suffer from disabilities as a result of spinal cord injury. This number continues to increase due to an increase in injury rate, as well as improvement in survival rate of patients affected by acute and long-term periods of traumatic spinal cord injury (TSCI). This study aimed to justify the safe and effective use of a zero-gravity robotic-assisted trainer for locomotor therapy in complex rehabilitation of patients with TSCI, as well as to compare this therapeutic approach with conventional motor rehabilitation programs that use other robotic mechanotherapy techniques. Neurological and functional disorders were assessed in 30 TSCI patients based on clinical examination and electromyography (EMG) results. All patients were classified into an intervention group and a control group by sequential randomisation. Rehabilitation programs for the intervention and control groups were alike, except for robotic mechanotherapy. Significant positive dynamic changes in motor functions, measured according to the ASIA Impairment Scale (American Spinal Cord Injury Association; Marino et al., 2003) were noted in the intervention group, in which two patients moved up to a higher level. EMG data showed a significant difference between the groups in favour of the intervention group. In addition, there was a significant difference between the two groups in postural function improvement in a seated position. Rehabilitation of patients in the intervention group involved engaging the axial muscles, facilitating an increase in strength, and improving trunk muscle control. Both groups of patients showed a significant decline in spasticity, as well as changes in their functional status. The ability of patients to perform normal daily activities also showed improvement. Our findings show that zero-gravity robotic-assisted locomotor training is a safe and effective procedure in the complex rehabilitation of patients with TSCI. This technique improves motor skills, self-care, and postural function in TSCI patients. Furthermore, we found a significant correlation between neurological and functional changes, which is indicative that this new therapeutic modality focuses on a restorative concept. Further research with a power increment is warranted.

EFFICIENCY OF APPLICATION OF THE DRUG "HEPTRAL-VET" IN THE COMPLEX TREATMENT OF DOGS WITH ACUTE COURSE OF PYROPLASMOSIS

The article presents the results of clinical trials of the drug, the active substance of which is ademethionine 1,4-butanedisulfonate (ademethionine salt), on dogs with an acute course of piroplasmosis. The drug is one of hepatoprotectors designed to normalize the morpho-functional state of the liver and metabolic processes in the body. It should be noted that hepatoprotectors don’t affect the cause of the disease, but the pathogenesis. Ademethionine is a natural amino acid, which is present in all body tissues and fluids. It acts as a coenzyme and methyl group donor in transmethylation reactions, is a precursor in the formation of physiological sulfurated (thiol) compounds (cysteine, taurine, glutathione, coenzyme A, etc.) in transsulfurization reactions.&#x0D; Due to the restoration of the synthesis of glutathione, phosphatidylcholine and taurine, ademethionine provides antioxidant and detoxification effects, restores the structure of hepatocyte membranes and promotes the removal of toxic bile acids.&#x0D; According to the system of preclinical and clinical testing of veterinary medicinal products, which meets international requirements and is the main guarantee for the development of effective, safe and competitive drugs, we conducted clinical studies of the hepatoprotective drug "HEPTRAL-VET", manufactured by "BIOTESTLAB" LLC, the active ingredient of which is ademethionine 1,4-butanedisulfonate, on dogs with an acute piroplasmosis, in order to study its hepatoprotective and detoxifying action.&#x0D; According to the results of clinical examinations of dogs by doctors of veterinary clinics in Lviv and blood laboratory tests 8 animals were selected with signs of acute pyroplasmosis. After specific therapy, the animals were administered intravenously the drug "Heptral-vet" at a dose of 20 mg/kg body weight once a day for 3-6 days, depending on the clinical state of animals.&#x0D; Before the treatment of animals, a decrease in the concentration of hemoglobin, the number of erythrocytes and the value of hematocrit, an increase of ESR, in leucoformula – an increase in the number of rod-nuclear neutrophils and a decrease in the number of lymphocytes were revealed in their blood. From the biochemical indicators – a decrease in the concentration of total protein, an increase in the content of total bilirubin, and a significant increase in the activity of liver transaminases were established.&#x0D; On the 7th day after the treatment, hematological studies have established an increase in the concentration of hemoglobin, the number of erythrocytes, value of hematocrit, a decrease in ESR and the number of rod-nuclear neutrophils, compared to the initial values. At the same time, biochemical studies of blood serum established a tendency to increase the content of total protein and albumin, decrease the content of bilirubin against the background of normalization of enzyme activity. The increase in the content of urea and creatinine in the dog’s blood serum occurred within the physiological norm. Thus, during this period, we observed the recovery of the dogs' bodies after disease. According to the observations of treating doctors, the drug "HEPTRAL-VET" contributed to the faster recovery of dogs, the normalization of their physiological indicators, and was well tolerated by animals.

Innovative Technologies in Interpreting the Results of Traditional Clinical and Laboratory Examination of Patients with Nonspecific Inflammatory Lung Diseases and Purulent Inflammatory Diseases

Innovative Technologies in Interpreting the Results of Traditional Clinical and Laboratory Examination of Patients with Nonspecific Inflammatory Lung Diseases and Purulent Inflammatory Diseases

Atypical endoscopic finding of colocolic intussusception: case report and literature review

Adult-onset colonic intussusception is a rarely encountered condition that leads to large intestinal obstruction with time. Patients often present with a variety of symptoms that are non-specific making it challenging to arrive at a definitive diagnosis. This is worrying as diagnostic delay could lead to a significant increase in morbidity and mortality. We wish to present and describe a case of an atypical endoscopic finding of colocolic intussusception secondary to ascending colon cancer. Sixty-seven-year-old lady was referred for 1 month's duration of passing melenic stools with mucus followed by a week's complain of hematochezia. Clinical examination and other relevant blood results were unremarkable except for iron deficiency anemia. Initial colonoscopy revealed a large mass within the splenic flexure with inconclusive biopsies. A more detailed colonoscopy repeated the following day revealed a massive, black-to-yellowish lesion within the splenic flexure with no viable mucosa seen. Colonic bezoar was initially suspected, however various endoscopic retrieval methods proved futile. Switching to a slimmer diagnostic gastroscope, the colon was carefully negotiated until a large ulcer was found within the ascending colon, adjacent to the mass' origin. An emergency CT abdomen and subsequently extended right hemicolectomy performed revealed a colocolic intussusception with sealed perforation secondary to an ascending colonic mass acting as an intussusceptum. Histopathology evaluation confirmed an ascending colon adenocarcinoma (pT2N0M0) amidst a background of extensive ischemic changes. Endoscopic descriptions of colonic intussusception are unusual given their rarity. Furthermore, these lesions can mimic a colonic bezoar as a result of fecal accretion and this can ultimately lead to false diagnostic and therapeutic decisions. In such instances, clarification with a CT scan before management decision can potentially avert unnecessary endoscopic intervention and complications.

Analysis of Clinical Characteristics of Connective Tissue Disease-Associated Interstitial Lung Disease in 161 Patients: A Retrospective Study.

This study was conducted to retrospectively analyze the clinical characteristics of CTD-ILD patients to provide strategies for clinical management. This study collected and analyzed the clinical data and relevant examination results of 161 patients diagnosed with CTD-ILD between 01 January 2018 and 01 January 2021. A total of 161 CTD-ILD patients, 74.53% were females and 25.47% were males, 32.92% were elderly and 67.08% were non-elderly. The main clinical symptoms of CTD-ILD patients were cough (44.72%), decreased activity tolerance (40.37%). RA-ILD was the most common one in the non-elderly and the elderly CTD-ILD patients (48.15% and 50.94%, respectively). Compared with non-elderly, elderly patients with CTD-ILD had a longer duration of CTD (p=0.04). However, fatigue (p=0.005), activity tolerance (p=0.029), the incidence of pulmonary diffusion dysfunction (p=0.047), and systemic immunoinflammatory index (SII, p=0.014) (platelet × NLR) were all decreased. The standard deviation of red blood cell distribution width (RDW) (p=0.024) and immunoglobulin (IgA) (p=0.033) was significantly increased. The smoking index was significantly higher in men than in women with CTD-ILD (p=0.000), but symptoms of reduced activity tolerance were less pronounced than in women (p<0.05). Elderly CTD-ILD patients (p=0.003) and women from non-elderly patients were prone to lower hemoglobin (p=0.000). Among the elderly, the lymphocyte ratio was more significantly elevated in female CTD-ILD patients than in males (p=0.018). In contrast, neutrophil to lymphocyte ratio (NLR) and SII were lower in female (p=0.038) than in male CTD-ILD patients (p=0.043). CTD-ILD mainly affects non-elderly and women. Age may not be involved with decreased activity tolerance and increased lung function impairment in CTD-ILD patients. However, the elderly patients with CTD-ILD, especially the elderly female patients with low inflammation levels and high immune disorders, have a poor prognosis.

Analysis of Clinical and Biochemical Characteristics of Patients With Genetically Confirmed Familial Hypercholesterolemia in Russian North Western District Residents.

Aim To compare results of clinical, laboratory, and genetic examination of patients with familial hypercholesterolemia (FHC).Material and methods 112 patients aged 40.2±17.9 years (49 men) were examined. The gene of low-density lipoprotein receptor (LDLR) was analyzed and evaluated using the Dutch Lipid Clinic Network (DLCN) criterion of lipid score ≥6. The LDLR gene mutation was searched for using the conformational polymorphism analysis followed by sequencing of the DNA of isolated LDLR gene exons.Results Mean variables of the blood lipid profile were total cholesterol (C), 10.12±2.32 mmol/l, LDL-C, 7.72±2.3 mmol/l. Corneal arcus was observed in 15 % of patients, tendon xanthomas in 31.8 %, and xanthelasma palpebrarum in 5.3 %. The types of LDLR gene mutations included missense mutations (42.8 %), mutations causing a premature termination of protein synthesis (41.1 %), and frameshift mutations (16.1 %). In the presence of a mutation in exon 4, patients with IHD compared to patients with no IHD had significantly higher levels of total C (10.88±2.08 mmol/l vs. 8.74±1.57 mmol/l, respectively, р=0.001) and LDL-C (8.60±2.14 mmol/l vs. 6.62±1.79 mmol/l, respectively, р=0.005). Patients with IHD compared to patients with no IHD and a mutation in LDLR gene exon 9 had only a higher LDL-C level (8.96±1.53 mmol/l vs. 6.92±1.59 mmol/l, respectively, р=0.022). A differentiated comparison of IHD patients using a logistic regression depending on the identified type of LDLR gene mutation produced formulas for calculating the odds ratio of IHD and myocardial infarction (MI) with adjustments for the patient's age and baseline LDL.Conclusion The detection rate of the LDLR gene mutations was 42.8 % for missense mutations, 41.1 % for mutations causing a premature termination of protein synthesis, and 16.1 % for frameshift mutations. Blood lipid profiles did not differ between patients from different cities and with different types of LDLR gene mutations. Blood lipid profiles were different in IHD patients depending on the mutation type.

Пренатальне спостереження за розвитком доброякісної пухлини у плода: клінічний випадок

The article presents the results of monitoring the course and development of a benign tumor in the fetus - lymphangiomy, which is a rare pathology (up to 10% of benign neoplasms in children). These neoplasms are not caused by chromosomal abnormalities and, as a rule, are characterized by a favorable intrauterine and postnatal course, which depends on the size and location of the formation. The article describes a benign tumor of the lymphatic system of a congenital nature in the neck, presents the results of monitoring the course and development of the tumor in the fetus. The results of the study are based on general clinical data and ultrasound data. With antenatal diagnosis of large lymphangioma in the neck, operative delivery is indicated. Purpose - to present a clinical case of prenatal diagnosis of lymphangioma in the fetus, to describe the features of observation and clinical case history. Materials and methods. This clinical case is presented in a patient V., 31 years old, who had a second delivery, third pregnancy. Data from general clinical studies, ultrasound examination (ultrasound scanner Aloka 3500) were used. Results. According to the results of general clinical examinations, the patient's tests during pregnancy were within the normal range. According to the biochemical screening data of the first trimester, the pregnant woman is classified as a low-risk group. An ultrasound examination of the III trimester, at 32 weeks, revealed a mass in the axillary region of the fetus on the right (lymphangioma). Early diagnosis of fetal lymphangioma allows you to control the course of pregnancy, childbirth, and evaluate possible complications. Conclusions. The described clinical case of lymphangioma is an illustration of dynamic prenatal and postnatal observation and its ultrasonic interpretation. Early diagnosis of benign tumors of the lymphatic system of a congenital nature allows you to adequately control the course of pregnancy, childbirth, assess placental insufficiency and anticipate complications. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Хронические офтальмохламидийные инфекции

Eye lesions in the structure of chlamydia occupy one of the leading places, the proportion in adults ranges from 3 to 30 % of all cases of conjunctivitis. 130 patients with sluggish chronic conjunctivitis aged 19–50 years were examined, including 90 women and 40 men. The duration of the disease was from 3 months to 5 years. The traditional cytological method was used as the main diagnostic method to determine the etiological cause of chronic inflammation. According to the results of clinical and laboratory examination of patients with chronic conjunctivitis, chlamydial infection was detected in 9.2 % of cases with the presence of dry eye syndrome (DES) – in 6.2 %. Thus, it is necessary to improve the quality of timely diagnosis of acute chlamydial infection, without leading to a chronic form of the disease. The traditional cytological method remains quite informative for the diagnosis of conjunctival ophthalmochlamydia. Keywords: chronic conjunctivitis, chlamydial infection, conjunctival scraping, cytogram, Prowacheck – Halberstadter inclusions

Strategy for Procalcitonin-Controlled Antimicrobial Therapy in the COVID-19 Pandemic

The objective of this review is to optimize the use of antibiotic therapy for COVID-19 based on the published and our own data. The decision to prescribe antibiotic therapy in case of secondary bacterial pneumonia associated with SARS-CoV-2 should be based on a comprehensive assessment of the results of clinical, laboratory and instrumental examination including the elevated level of procalcitonin (more than 0,5 ng/ml).To achieve this objective, 48 publications were analyzed.

Current methods for microbiological diagnosis of acute central nervous system infections.

The incidence of infections affecting the central nervous system has increased in recent years, making neuroinfections a current global health problem. The central nervous system is quite well protected from the external and internal environments, although it is susceptible to infection by a wide variety of pathogens. The etiological diversity further complicates the management of such infections because it is important to identify correctly the specific cause in order to choose the most appropriate antimicrobial therapy. Diagnosis is made not only based on clinical and epidemiological data but also on the results of clinical laboratory and microbiological examination of cerebrospinal fluid. This article aims to review current microbiological methods in the diagnosis of acute central nervous system infections and help healthcare providers to recognize their advantages and limitations in order to manage their patients appropriately.

Relevance of the Scaphoid Shift Test for the Investigation of Scapholunate Ligament Injuries

Background: Although it is part of the common clinical examination of scapholunate ligament pathologies, there are only little data on the diagnostic value of the scaphoid shift test. The aim of this study was to evaluate the scaphoid shift test in a large cohort of patients. Materials and Methods: We retrospectively analysed 447 patients who underwent the scaphoid shift test and wrist arthroscopy because of various suspected injuries of the wrist, correlating the results of clinical examination with data obtained during the wrist arthroscopy. Sensitivity, specificity, and positive and negative predictive values were calculated and evaluated. Results: The sensitivity of the scaphoid shift test was low (0.50) when examining the whole cohort. In a subgroup of patients specifically referred for suspected scapholunate ligament injury, the sensitivity was higher (0.61), but the specificity was low (0.62). In detecting more serious lesions (Geissler 3 + 4), the scaphoid shift test demonstrated higher sensitivity (0.66). Conclusions: An isolated scaphoid shift test may only be of limited value in the diagnosis of scapholunate ligament lesions and should, therefore, be viewed as a useful tool for a preliminary assessment, but a negative test should not prevent the surgeon from indicating a more extensive diagnostic workup.