Somatic Pathology Research Articles

CHARACTERISTICS OF THE AMINO ACID PROFILE OF BLOOD PLASMA IN PSORIASIS

Introduction. Psoriasis is an autoimmune disease that affects the skin, has a number of systemic manifestations and is associated with the devel-opment of a number of somatic pathologies. It is known that one of the systemic features of psoriasis is changes in the blood plasma amino acid pool, but the pathogenetic significance of this fact has not yet been determined. The purpose of this work was to study the amino acid profile of blood plasma in psoriasis and its relationship with biochemical markers of lipid and purine metabolism. Materials and methods. The study group included 45 patients with psoriasis vulgaris. The comparison group included 46 donors of the Chelyabinsk Regional Blood Transfusion Station. The concentrations of 20 proteinogenic amino acids, as well as ornithine and citrulline, were determined. Results. Recorded changes demonstrating the rearrangement of relationships between the concentrations of circulating amino acids in psoriasis; cor-relations of amino acid levels with a number of clinical diagnostic biochemical markers in the group of patients with psoriasis were determined. A sig-nificant increase in the levels of cysteine, phenylalanine and leucine was found in psoriasis compared with the corresponding indicators of the compar-ison group. Cysteine concentrations positively correlated with uric acid levels. Elevated levels of cysteine and leucine have been associated with disor-ders of purine and lipid metabolism. Conclusions. The data obtained indicate changes in the amino acid profile in psoriasis, some of which may be associated with the development of comorbid metabolic pathologies.

Corrections for geographical differences in photoperiod in time-series analysis

This article presents the results of the development of the corrections for geographical differences and photoperiodism in time-series analyses of physiological and demographic indicators.
 the models were created using the results of the studies of biological rhythms obtained using the software developed by the author using wavelet analysis and photoperiodic stability of the chronotype during adaptation to the conditions of the North, shift work in healthy individuals as well as in subjects with somatic or mental pathology. We also assessed long-term demographic rhythms of the population living in different regions of Russia.
 For standardization and ranking of interseasonal, inter-regional studies (physiology of movements and shift work) in chronophysiological format, we propose the use of the calculated "photoperiodic latitudinal coefficient". To improve the accuracy of the models, we propose the use of the "signal- noise coefficient" in the interpretation of the results, an assessment of the "degree of polyrhythmicity" and the "rhythm instability index" in the presence of "inserted" or "quantized" rhythms.

Structural and functional state of postinfarction myocardium and vascular endothelial growth factor: is there a connection?

Purpose of the study. To reveal the relationship between the serum concentration of vascular endothelial growth factor and the structural and functional state of the myocardium in patients in the post-infarction period at the stage of rehabilitation.Materials and methods. We examined 94 patients at the outpatient stage of rehabilitation after ad hoc stenting 6 weeks after myocardial infarction, 10 healthy volunteers without somatic pathology. All participants in the study underwent standard transthoracic echocardiography with assessment of thickness of epicardial fat, assessment of the concentration of vascular endothelial growth factor (VEGF) in peripheral blood by ELISA.Results and discussion. VEGF values above the median values were associated with lower left ventricular ejection fraction and left ventricular fraction shortening, which indirectly may indicate a more pronounced expression of VEGF in patients with left ventricular systolic dysfunction. Assessing the parameters of LV diastolic dysfunction in groups with different levels of VEGF, no significant differences were found in patients after myocardial infarction. Correlation relationships between the content of VEGF and the thickness of epicardial adipose tissue were not found either among patients or in the control group.Conclusions. Elevated VEGF values in patients with coronary artery disease at the 6th week of rehabilitation were accompanied by left ventricle systolic dysfunction, in contrast to diastolic dysfunction. There was no direct correlation between the thickness of epicardial fat and the concentration of VEGF in the blood serum in patients with coronary artery disease.

NSAID-esophagitis: how to break the vicious circles of pathogenesis? Clinical case

The article presents a complex clinical case of drug‑induced erosive esophagitis grade C with the formation of Schatzki ring in patient S., 85 years old. A feature of the case under consideration is the long‑term persistence of both esophageal (dysphagia, odynophagia) and extraesophageal (thoracalgia) complaints, which required an extensive differential diagnosis to rule out the cardiac genesis of the pain syndrome. The diagnostic search was complicated by the patient’s advanced age, the presence of serious accompanying somatic pathology, moderate cognitive decline, contradictory data from X‑ray examination and computer tomography, and the patient’s categorical refusal to perform a biopsy, which made histological confirmation of the presumptive diagnosis impossible. Empirical appointment of pantoprazole (Nolpaza) made it possible to level the phenomenon of odynophagia and improve the condition of the esophageal mucosa, but long‑term use of Nolpaza in high doses was required for restoration of erosive‑destructive changes in the damaged esophagus and stomach.
 Moreover, the literature review is presented, which reveals modern ideas about the mechanisms of Schatzki ring, the features of management and treatment of patients with dysphagia and Schatzki ring according to the guidelines of authoritative international organizations — the World Gastroenterology Organization, the American College of Gastroenterology. The key provisions of the specified organizations, which regulate the doctor’s actions in the management of patients with Schatzki ring, are given. The advantages of prescribing pantoprazole (Nolpaza) are described, taking into account the peculiarities of its mechanism of action, bioequivalence to the original pantoprazole, CYP450‑unassociated hepatic metabolism, the absence of significant drug interactions, serious adverse events, the possibility of its administration to elderly and senile patients without dose correction, the expediency and safety of the long‑term intake.

КЛИНИКО-АНАМНЕСТИЧЕСКИЕ ДАННЫЕ БЕРЕМЕННЫХ С РАЗНЫМ ТЕЧЕНИЕМ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ

Pregnant women infected with SARS-CoV-2 are considered as a risk group for the development of severe complications and an unfavorable outcome of a new coronavirus infection. At the same time, various non-gestational factors may be an additional unfavorable background that determines the course of this disease in pregnant women. The purpose of the study was to evaluate the clinical and anamnestic data of pregnant women with different course of a new coronavirus infection. Material and research methods. A retrospective analysis of the history and comorbidity data of 360 pregnant women infected with SARS-CoV-2 was carried out. The features of the reproductive history and ex-tragenital pathology of pregnant women with different course of Coronavirus Disease 2019 (COVID-19) were revealed. The standard collection of anamnesis and clinical examination was carried out, which is required to fill in the medical records of an outpatient and inpatient patient. Statistical pro-cessing of the obtained results was carried out using Microsoft Excel 2010 and Statistica (version 6.0). Research results. It has been established that among pregnant women with a severe course of this dis-ease, patients who use nicotine-containing products and have such concomitant somatic pathologies as diabetes mellitus, obesity, hypothyroidism, iron deficiency anemia, chronic arterial hypertension and varicose veins are significantly more common. Unfavorable factors of the reproductive history in-clude: abortion, non-developing pregnancy, preeclampsia. Conclusion. To predict the course of a new coronavirus disease in the gestational period, it is necessary to take into account the listed clinical and anamnestic data of the patient.

Analysis of the quality of osseointegration of dental implants by using the Periotest M device

The main criterion for assessing the engraftment of dental implants is their high-quality osseointegration [1]. Unreasonable loads exerted on a dental implant integrated into the bone tissue lead to its premature rejection. Adequate osseointegration of dental implants is also influenced by their shape, size, quality of their installation, adherence to the operating protocol, as well as the start date of subsequent prosthetics [2]. A qualitative method for determining the stability of an installed dental implant is the method of periotestmetry. In the absence of general somatic pathologies and disorders in the structure of the dental system, stable osseointegration of dental implants, periotestometry data (averaged values for 16 strokes) are in the range from -8 to 0 units. The aim of the study was to analyze the osseointegration of installed dental intraosseous-on bone implants by performing periotestmetry. Materials and methods: The study group consisted of 116 patients who received 167 dental implants. At 1, 2, 4 months, half a year, a periotestmetric study was conducted using the Periotest M apparatus. Results and discussion: The analysis of the parameters obtained in the course of the study revealed the dependence of the periotestmetric data and the quality of osteontegration of intraosseous-extraosseous dental implants. Conclusion: The study of the indicators of periotestmetric data for intraosseous-bone dental implants made it possible to qualitatively predict the results of orthopedic treatment, and also made it possible to assess the degree of osseointegration of the installed dental implants.

Neurogenic voiding dysfunction in children: challenges of wartime

Neurogenic voiding dysfunction (NVD) is the result of the functional inability of the urinary bladder associated with neural dysregulation mechanisms at different levels. During the period when a child grows and thrives, the most important body systems develop. So, the influence of any traumatic events on children has very severe and delayed negative consequences. Post-traumatic stress disorder (PTSD) not only disrupts the psychological state of the child but also provokes a number of pathologies, leading to the progression of already existing problems, especially those associated with a neurovegetative imbalance. Elucidation of the causes and mechanisms of NVD development, which arose against the background of PTSD, gains ground in wartime.
 NVD in children is often combined with psychobehavioral (attention deficit and hyperactivity disorders, dissociative episodes, increased anxiety, insomnia, night terrors, eating disorders) and somatic (pathology of the digestive, cardiovascular, endocrine systems, infectious diseases, etc.) problems that are exacerbated by PTSD.
 Close anatomic-functional and neurovegetative interaction of the pelvic organs determines the development of concomitant colonic dysfunction, which very often accompanies NVD. Unfortunately, because of the great variety of clinical manifestations of bladder and bowel dysfunction, the combined pathology is often overlooked, and diagnosed late, which negatively affects the child's quality of life and psychological state.
 Attention to the combined dysfunction of the bladder and bowel, timely diagnosis and proper correction with the use of pathogenetic-directed therapy, adequate nutrition, and long-term psycho-rehabilitation measures are necessary measures in the effective management of children in wartime.

Endophthalmitis risk factors associates with phacoemulsification (Literature review)

The most frequent sources of microbial flora inside the eye are the ocular surface, foci of para-ocular infection of the patient. In vitreous samples from eyes with endophthalmitis microorganisms are revealed that are the saprophytic flora of the ocular surface. It is mainly represented by staphylococci, from which epidermal staphylococcus prevails quantitatively. Immunodeficiency states, diabetes mellitus, terminal liver and kidney diseases increase the risk of endophthalmitis development. Eradication of opportunistic pathogenic flora in the source loci, sanation of para-ocular infection, correction of somatic pathology by profile specialists is more relevant for endophthalmitis prevention. The problem of growing antibiotic resistance should also be considered. Thus, when selecting patients for surgery, one should be guided by the data on antibiotic resistance of the identified flora, pay attention to the presence of para-ocular infection and the systemic somatic status of the patient. This will provide a better vector for the development of recommendations for optimal prophylaxis.

Dynamics of index scores after complex treatment of periodontal diseases in persons with general somatic pathology

The purpose of the study was to evaluate the effectiveness of the developed schemes of complex treatment and prevention of periodontal tissue diseases in patients with general somatic pathology according to the dynamics of periodontal and hygienic indices. Treatment was carried out in 134 patients with inflammatory and dystrophic-inflammatory diseases of the perio­dontium against the background of somatic pathologies: two developed schemes of complex treatment of periodontal diseases were used, taking into account the values of the CPITN index. All patients were divided into 2 groups: the main (73 (54.48 %) patients), whose treatment was carried out using the schemes developed by us, and the comparative (61 (45.52 %) patients), in whom the treatment of periodontal pathology was carried out according to generally accepted schemes. The dynamics of the values of PMA, OHI-S indices and the vacuum test of gingival capillary resistance were evaluated according to the method of Kulazhenko V.I. before the treatment of periodontal diseases, 3, 6 and 12 months after it. After 12 months of follow-up, the values of the PMA index remained significantly lower compared to the values before treatment, and the state of oral hygiene remained satisfactory in patients of both groups. In the examined main group, an increase in the time of formation of hematomas on the gums ((62.14±0.38) seconds) was observed by 1.15 times compared to the data before treatment, but in the patients of the comparison group, this indicator was lower than the initial data. Тhe patients of the main group showed an improvement in all index scores, while in the comparison group, the values of these indices were below the initial values. Treatment of periodontal disease with values of the CPITN index ≤ 2 and > 2 points against the background of general somatic pathology, with the use of schemes developed by us, contributed to the elimination of inflammation, improvement of oral hygiene and normalization of hemodynamics in the periodontal tissues, which was confirmed by the positive dynamics of index scores in the near and distant periods of observation. Keywords: treatment of periodontal diseases, somatic pathology, index assessment of periodontal status.

Impact of medication correction of labor weakness on obstetrical complications and newborn status

Objectives: To analyze the impact of medical correction of labor weakness with oxytocin on obstetric and newborn complications.Materials and methods. 100 cases of childbirth with weakness of labor activity and medical correction with oxytocin (main group) and 50 cases of childbirth without weakness of labor activity (control group) were analyzed. The analysis included pregnancy and childbirth histories of mothers aged 20–32 years with a gestation period of 37– 41 weeks with uncomplicated pregnancies, without significant somatic and obstetric-gynecological pathology, who gave birth in the Perinatal Center of Kyiv during the last 3 years.Depending on the method of delivery, the women of the main group were divided into 3 subgroups: Iа – natural vaginal, spontaneous delivery (n = 60), Ib – operative vaginal delivery using a vacuum extractor (n = 22), Іc – delivery by cesarean section (n = 18).The following factors were studied in each group: assessment of newborns status according to the Apgar scale at the 1st and 5th minutes, pH level of the umbilical cord blood, frequency of fetal distress based on cardiotocography (Fischer score < 6 points), duration of labor induction, color of the amniotic fluid.Results. The average duration of labor was the largest in the subgroup of spontaneous vaginal deliveries, the smallest in the subgroup of cesarean section. In subgroup Ib in 14 (63.6%) cases indications for the vacuum extractor were signs of fetal distress and only in 8 (36.4%) cases – weakness of labor activity.In subgroup Ia compared to subgroup Ic, there was a longer average duration of labor and higher percentage of deliveries with meconium-stained waters (28.3%), higher frequency of neonatal acidemia (16.7%) and the birth of children with an Apgar score at the 5th minute ≤ 6 points (8.4%). In subgroup Ic compared to subgroup Ia, there was a higher value of cases of Fischer score < 6 points (50%), the duration of labor reinforcement for more than 4 hours (44.5%), more cases of asphyxia (44.5%), and the birth of children with an Apgar score at the 1st minute ≤ 6 points (38.9%). Indications for caesarean section in subgroup Ic in 50% of cases were signs of fetal distress, in 38.9% – weakness of labor activity which was not associated with medication, in 11.1% – a clinically narrow pelvis.In all groups there was a relationship between the duration of labor induction and the condition of the newborn (the frequency of asphyxia of newborns was higher when the infusion of oxytocin lasted more than 4 hours).In subgroup Ib fetal distress was the indication for urgent delivery in 63.6% of cases, and in subgroup Iс it was 50%. This indicates signs of a mediated negative effect of exogenous oxytocin on the fetus during childbirth. The newborns condition, according to the studied criteria, was worse in the groups with labor reinforcement compared to the control group, regardless of the method of delivery.Conclusions. The use of oxytocin during childbirth can have a negative effect on the fetus, which increases the frequency of operative vaginal deliveries and cesarean sections and, as a result, is a risk factor for complications in the postpartum period. There is a correlation between duration of oxytocin injection and condition of the newborn.

Hormonal predictors of circulatory diseases in liquidators of Chernobyl accident consequences

Relevance. Diseases of the circulatory system occupy a leading place in the structure of somatic pathology of liquidators. Obesity, signs of asthenization, vegetal vascular disorders, which were detected in numerous studies, suggest the presence of hypogonadism in this category of victims. Sex hormone deficiency is considered an important link in the formation of non-communicable diseases, which determined the relevance of the study.The goal. To carry out a retrospective assessment of the change in the hormonal indicators of the endocrine axis of hypophysis-sex hormones and to assess the effect of partial androgen deficiency on the formation of circulatory diseases in the dynamics of the examination in the liquidators of the consequences of the Chernobyl accident.Materials and methods. Hormonal indicators of the pituitary-gonadal endocrine axis were investigated by immunochemical analysis in 1065 men involved in the aftermath of the Chernobyl accident in 1986–1987, combined into groups depending on the period of examination from 1994 to 2019 and in control groups. The average age of patients entering the Chernobyl zone was 33.6 (0.8) years.Results. Seven years after the accident, liquidators in 13.1 % cases show a shortage of sex hormones, by 33 years of follow-up, the proportion of such patients increases by 4.6 times. Sex hormone deficiency 7 years after the accident was revealed in men of relatively young age, the correlation of testosterone levels with the concentration of gonadotropins and prolactin has not been established. The increase in prolactin in the liquidators of the consequences of the Chernobyl accident, reliable in relation to the control group, remains for 12 years after the accident. 30–33 years after the accident, participants in the elimination of the consequences of the Chernobyl accident have significant age-related changes in hormonal indicators, among which the main is partial androgen deficiency.Conclusions. The persistent imbalance of hormones of the pituitary-gonadal endocrine axis at the time of 1994–1998 contributed to the clinical manifestation of circulatory diseases in liquidators – middle-aged men, clinical symptoms, on the other hand, aggravated diverse shifts in the functioning of this endocrine axis of regulation. In the later period of observation by 30–33 years after the accident, a decrease in androgen levels was accompanied by a steady increase in circulatory diseases in liquidators.

Intraoperative neurophysiological monitoring in surgery of lumbar spinal stenosis

Background. Lumbar spinal stenosis is a pathological constriction of the central spinal canal, lateral pocket or intervertebral foramen. The complication rate of lumbar spinal stenosis surgery ranges from 10 to 24 %. In order to reduce the number of intraoperative and early postoperative complications accompanied by the development of neurological deficit, various techniques of intraoperative neurophysiological monitoring are used.Aim. Study of informativity of the use of intraoperative neurophysiological monitoring during surgical treatment of degenerative lumbar spinal stenosis based on the experience of the neurosurgical department of the Republican Clinical Hospital (Yoshkar‑Ola, Mari El Republic).Materials and methods. Thus, 69 decompressive‑stabilizing surgical interventions for degenerative lumbar spinal stenosis at the L3–L5 level, performed with intraoperative neurophysiological monitoring (free‑run electromyography, transcranial motor evoked potentials, somatosensory evoked potentials, triggered electromyography were included in the retrospective study).Results. During intraoperative neurophysiological monitoring transcranial motor evoked potentials from the legs was registered in all cases. Normal somatosensory evoked potentials were recorded in most cases, in 12 cases (17.4 %) baseline somatosensory evoked potentials were not registered due to preoperative neurological deficits and the presence of concomitant somatic pathology. 308 inserted pedicular screws were examined using the triggered electromyography. Muscle responses were registered in 31 (45 %) operations, 45 (14 %) screws. True negatives were registered with 29 (64.4 %), true positives were registered with 12 (26.7 %), and false positives were registered with 4 (8.9 %) screws. In the postoperative period no increase in motor and sensory neurological deficits was observed in all patients; no neurological signs of screw malpositioning were revealed.Conclusion. The use of multimodal intraoperative neurophysiological monitoring during surgical treatment of lumbar spinal stenosis reduces the risk of postoperative neurological complications.

Моніторинг стану здоров’я дітей з коарктацією аорти в післяопераційному періоді

Purpose - to improve the observation of children after surgical treatment of the aortic coarctation. Materials and methods. A retrospective analysis of 87 case histories of patients with aortic coarctation in the preoperative period was performed; 44 patients underwent daily blood pressure monitoring, nitric oxide levels in 61 children were determined in the postoperative period; histological examination of 15 coarctated aortic sites was performed; quality of life was assessed in 56 patients with aortic coarctation after surgical treatment. Results. According to daily blood pressure monitoring, an inadequate increase in blood pressure during physical and mental activity was obtained; a violation of the circadian rhythm of blood pressure with insufficient decrease in systolic and diastolic or excessive decrease in diastolic pressure was detected. The results of the assessment of blood pressure variability revealed a significant difference in the standard deviation of the mean daily diastolic blood pressure (62.5 (55; 75)), daily diastolic blood pressure (72.5 (57; 78.5)), and an increase in the circadian systolic blood pressure index (16 (11.5; 17)). The level of nitric oxide in the blood of a group of patients with arterial hypertension was 4.18±0.86 μmol/l (M±SD - mean ± standard deviation). in the control group - 5.51±0.69 μmol/l. Thus, a significant decrease in nitric oxide in the group with arterial hypertension was established (t=-5.45; p<0.001). It was also diagnosed that in the group of patients with stable arterial hypertension, the level of nitric oxide was 3.74±0.79 μmol/l, and in the subgroup of patients with labile hypertension - 4.44±0.80 μmol/l, the subgroups in the content of nitric oxide significantly differed from each other (t=2.91; p<0.01), as well as from the values of the control group: with stable arterial hypertension (t=-6.72; p<0.001) and labile arterial hypertension (t=-4.41; p<0.001). The dependence of the level of nitric oxide in serum on the time of the postoperative period and the type of arterial hypertension was established. The histological features of area of narrowing in the form of foci of necrosis of cells and fibers, areas of hypo- and anelastosis, the presence of newly formed vessels of capillary type were identified and studied. The main factors in reducing the quality of life of patients with coarctation of the aorta in the postoperative period are the presence of arterial hypertension, restriction of physical activity, parents’ оverprotection. Conclusions. Based on the data obtained, an individual observation card of a patient with aortic coarctation was created. A set of clinical, instrumental and laboratory signs that may be a leading role in the occurrence and course of arterial hypertension in children (concomitant cardiovascular and somatic pathologies, initial level of systolic and diastolic blood pressure, level of the final product of nitric oxide in serum, structural features of the aortic wall) has been determined. An original method of examination of patients with aortic coarctation in the postoperative period was proposed. 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 all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Роль проблем пренатального периода в развитии ретинопатии недоношенных. Часть 2

Purpose. Identification of prenatal factors influencing on the retinopathy of prematurity (ROP) development and severity of its course. Material and methods. A retrospective analysis of 90 case histories of premature patients was carried out. There were 3 groups of clinical trials: children without ROP development (30 children), children with ROP development with severe course of type I, requiring surgical treatment (30 children) and children with type II ROP that ended in spontaneous regression (30 children). Results. The detection of cervical ectopia in the mother can potentially be used as a risk factor for predicting the development of ROP and its severe course during screening. The presence of miscarriages in the mother’s obstetric history is associated with a high risk of ROP requiring surgical treatment. Maternal history of medical abortion does not significantly affect the risk of developing ROP in a premature newborn. The presence in the anamnesis of a mother of an undeveloped (missed) pregnancy is a risk factor for the development of ROP and its severe course in a premature baby. Threatened abortion in the 1st trimester and its treatment with progesterone analogues are associated with a reduced risk of developing ROP and a decrease in its severity. The development of preeclampsia is not associated with a high risk of developing and severe ROP. Somatic pathology, maternal hypertension and a history of hepatitis do not affect the development of ROP. Conclusion. The presence of an ectopic cervix in the mother, miscarriages and undeveloped pregnancy in an obstetric history are prenatal risk factors for retinopathy of prematurity. Key words: prenatal risk factors, retinopathy of prematurity, premature baby, cervical ectopia, miscarriage, missed pregnancy, preeclampsia

Glaucoma in pregnant women: features of treatment

This review provides information on the features, incidence, pathogenetic mechanism, possibilities of conservative, laser and surgical treatment of glaucoma in pregnant women. The purpose of this literature review is to study the features of managing patients with glaucoma during pregnancy. Glaucoma is a large group of eye diseases characterized by a gradual development of visual impairments and atrophy of the optic nerve. The pathology is most common among the population over 40 years old, but due to the advancement of reproductive technologies, the availability of diagnostic methods, as well as high clinical awareness, the frequency of ophthalmologists managing glaucoma in pregnant women increases. Elevated intraocular pressure in pregnant women is becoming more common and, therefore, is an urgent problem. There is a trend towards an increase in the number of pregnant women who experienced elevated intraocular pressure for the first time. Previously identified pathology in childhood or secondary glaucoma due to previous ophthalmic diseases or severe somatic pathology is a special category of patients. Such patients are encountered regularly and require close supervision by both an ophthalmologist and a gynecologist. The evidence base for antiglaucoma drugs is small; there are clinical experiments on animals, which results do not always carry over to humans, and retrospective studies. The doctor's arsenal presently includes a number of drugs that have possible side effects for the fetus, as well as laser and surgical treatment. There is no standard treatment, so each case should be considered individually with an understanding of the physiology, mechanism of action of the drugs and their possible effects. Therefore, glaucoma during pregnancy and lactation is a serious medical problem, and its solution depends on interdisciplinary medical approach.

<i>Stenotrophomonas maltophilia</i> Infection in Trauma and Orthopedic Patients: Clinical Experience and Review

Background. Stenotrophomonas maltophilia (S. maltophilia) is a gram-negative non-fermenting bacillus and is a rare pathogen of orthopedic infection. Due to the relatively low virulence of S. maltophilia, many clinicians are still faced with the question of whether this bacterial species is simply a colonizing agent or the true cause of infection.
 Aim of the study to raise the awareness of practitioners about S. maltophilia as a rare pathogen of orthopedic infection.
 Methods. A retrospective analysis was performed concerning the frequency of S. maltophilia isolation from patients treated at the Vreden Center for periprosthetic infection and/or osteomyelitis from January 1, 2009 to October 31, 2022. The literature search by keywords was carried out in the PubMed/MEDLINE, Scopus, eLIBRARY, and Cyberleninka databases. The search retrieved 587 articles published in Russian or English over the period from 2012 to November 2022.
 Results. During the study period, 9 cases of orthopedic monoinfection with S. maltophilia were identified in 9 patients aged 36 to 83 years. At the time of admission, no leukocytosis was detected in patients, and only 2 of 9 patients had elevated C-reactive protein level. S. maltophilia is naturally resistant to many broad-spectrum antibiotics. Co-trimoxazole is considered the drug of choice for the treatment of S. maltophilia infection. The limited choice of drugs for targeted therapy, the presence of multiple determinants of antibiotic resistance, the existence of microbial associations and patient risks including implantation, chronic nature of infection, elderly age, as well as the presence of significant concomitant somatic pathology can lead to the ineffectiveness of the ongoing treatment of infections caused by S. maltophilia. Our experience shows that in the case of sensitivity of S. maltophilia strain to co-trimoxazole it is possible to prescribe this drug for a long course as monotherapy, provided that the radical surgical treatment of the focus is performed.

Placenta previa: risk factors, maternal and perinatal outcomes

Introduction. Placenta previa (PP), especially invasive forms (placenta accreta spectrum PAS), is one of the leading causes of maternal and perinatal morbidity and mortality. The aim of the study is to study the features of the anamnesis, pregnancy and childbirth outcomes for the mother and fetus with placenta previa, and to identify the main risk factors for this pathology. Materials and methods. Retrospective cohort study by continuous sampling method: Group 1 – 64 patients with PP, 2 – 30 women with normal childbirth. The anamnesis of women and pregnancy outcomes were studied. Statistical calculations: Mann-Whitney criteria, χ2 Pearson, odds ratio indicator (OSH). Results. The probability of PP increases in a woman's history with cesarean section in anamnesis (OR 20.53 (7.2–58.53), p < 0.001), premature birth (OR 4.29 (1.45–12.68), p = 0.04), abortion (OR 3.77 (2.32– 6.12), p = 0.004), including induced (OR 14.16 (4.95–40.53), p = 0.001) and spontaneous (OR 3.65 (2.01–6.62), p = 0.02), as well as somatic diseases (OR 6.17 (3.8–10.02), p < 0.001), especially the presence of anemia (OR 19.84 (6.95–56.61), p < 0.001), gastrointestinal diseases (OR 13.18 (4.6–37.75), p = 0.002), overweight/obesity (OR 6.23 (2.14–18.14), p = 0.015), varicose veins (OR 5.37 (1.84–15.72), p = 0.005). The threat of miscarriage (p = 0.012), placental disorders (p = 0.012), anemia (p = 0.026), genital infection (p = 0.023) were recorded more often in women with placenta previa. All women with PP were delivered by operation caesarean section, often prematurely (45.3 %; p < 0.001), urgently (45.3 %, p < 0.001) because of bleeding (37.5 %, p < 0.001). The expansion of the volume of surgery was required in 37.5 % of cases, hemotransfusion – 50.0 %. Morphofunctional indicators of children from mothers with PP were significantly lower, and the frequency of asphyxia, respiratory distress syndrome, аrtificial lung ventilation was higher than in the control group. Discussion. PP and PASS are potentially dangerous pathologies for the life and health of women and children, which is confirmed by the results of this study. However, problems of diagnosis of this pathology were revealed at the outpatient stage. In addition to the well-known risk factors for abnormal placentation, associations of PP with a low socio-economic status of a woman and a number of somatic nosologies, such as obesity, anemia, gastrointestinal tract diseases, varicose veins, the influence of which is probably indirect. The association of abnormal placentation with excessive use of gestogens during pregnancy cannot be ruled out. Conclusions. The risk factors for PP were the presence of a history of cesarean section, abortions, premature birth, low socio-economic status, somatic pathology (overweight / obesity, anemia, gastrointestinal diseases, varicose veins). PP is associated with a high frequency of the threat of miscarriage, placental disorders, genital infection, premature birth, cesarean section operations, bleeding, decreased morphofunctional indicators of newborns, perinatal morbidity and mortality

ANALYSIS OF THE COURSE OF PREGNANCY, CHILDBIRTH AND THE STATUS OF NEWBORNS BORN BY DISPLACED WOMEN

Aim of the study: to analyse the effect of involuntary migration on the course of pregnancy, labour and delivery, and neonatal outcomes in pregnant women in the third generation. Materials and methods. This paper presents an analysis of a prospective study of the course of pregnancy, childbirth, and the condition of new-born infants born by displaced Azerbaijani women. A prospective analysis was made in the course of puberty and the state of reproductive health in 54 refugee women of early reproductive age, who were divided into two groups, aged 18-25 and 26-35 years. Results. A study conducted among third generation women revealed pronounced negative trends in both somatic and reproductive health among refugee women in this group. Their average age ranged from 18 to 35. Most of the patients, 37 (68.5%), were born with a birth weight of less than 3000g. The mean age of parents at the time of girl's birth was 25.4±2.26 years for mothers, 26.9±5.29 years for fathers, i.e., in the immediate post-stress period. The subjects are characterized by menstrual cycle dysfunction (63%-29.5%). Hypermenorrhoea occurs in 46% of the subjects, primary amenorrhoea in 8.2%, and secondary amenorrhoea in 3.3%. There is also a high percentage of inflammatory diseases of the female genital organs (93.4%). A high percentage of somatic pathologies is found in the female patients: iron deficiency anaemia - 77.8%, gastrointestinal diseases - 48.1%, thyroid diseases - 9.3%, urinary diseases - 22.5%, helminthiasis - 16.7%, etc. Sexually transmitted infections were diagnosed in chronic form in 14 patients. The rate of placental insufficiency of grade 1a and 1b was diagnosed in 29%-16%, and delayed foetal development of grade 1 and 2 in 12%-8% respectively. Asphyxia (27%), newborn hypotrophy (7.5%), prematurity (18%) is characteristic of the newborns of this group of patients. Conclusion. Analysis of the results of a comprehensive study of the health of pregnant refugee women has shown that even in the third generation the stress associated with forced migration of the older generation and adverse socio-medical problems are reflected in the formation and functioning of the reproductive age of the younger generation.

Therapeutic efficacy and safety of the use of the homeopathic preparation during teething in children

Introduction. The variability of the dentition terms is caused by numerous factors: the age and health of the parents, the parity, etc. Children may experience discomfort, which may be relieved by various pharmacological and non-pharmacological methods. Aim. To study the effect of factors on the temporary teeth eruption in children, the severity of discomfort symptoms and the therapeutic efficacy of a homeopathic medicine during the period of dentition.Materials and methods. The study included patients aged 4 months to 2 years. All children were divided into two groups. Group I included 97 apparently healthy children, Group II included 318 children with verified somatic pathology, who had residual effects of the perinatal hypoxic nervous system injury.Results and discussion. The analyses of correlation relationship between the dentition terms and medical and biological factors during pregnancy and childbirth in children showed the pronounced relationships: in group I – between the 53rd tooth eruption timing and the age of the mother, the mother’s disease during pregnancy, the threat of miscarriage (r = 0.98, p < 0.05); in group II – a high correlation coefficient between the 65th tooth eruption timing and acute infections suffered by the mother during pregnancy (r = 0.76; p < 0.05). Symptoms associated with teething were observed in 61% of children in group I and 72% (p < 0.05) in group II. Given the low awareness of parents about the homeopathic medicine (8.5%), we gave a talk and suggested using a homeopathic medicine during the next tooth eruption in a child.Conclusions. The temporary teeth eruption timetable is influenced by the course of the antenatal period, the mother’s age and the residual effects of the perinatal hypoxic nervous system injury. The homeopathic medicine is indicated to relieve symptoms of discomfort during the dentition period in the first year of life.

EXPERIENCE OF PHARMACOGENETIC TESTING IN THE TREATMENT OF ANTIPSYCHOTICS

IntroductionOne of the promising methods for optimizing treatment in order to achieve high-quality remissions is a personalized approach to prescribing therapy in the form of pharmacogenetic testing, the feasibility of which has already been substantiated and proven in a number of clinical guidelines. By the beginning of 2022, several influential regulatory and expert organizations recommend considering the results of genetic testing when prescribing therapy. Thus, personalization of antipsychotic therapy is being introduced in the world practice.ObjectivesTo establish the significance of pharmacogenetic markers that determine the efficacy and safety of antipsychotic therapy in patients with schizophrenia in clinical practice.MethodsThe study included 264 patients (141 men, 123 women; 27.3 ± 4.5 years) from among the first hospitalized in a psychiatric hospital in the period 2018-2020, meeting the inclusion criteria (psychosis within the schizophrenia spectrum disorders; consent to participate in research). Non-inclusion criteria - signs of organic brain damage; alcohol or substance abuse; somatic pathology in the stage of decompensation). The examination took place in three stages - in the first days of hospitalization at the peak of the acute condition and during the formation of remission - after 6 and 12 months. Genetic analysis was performed using high-density biochips from Illumina CoreExome Bead (Illumina Inc, USA). During the follow-up observation, some patients dropped out due to refusal to undergo examination, change of diagnosis or change of place of residence. After 6 and 12 months, it was possible to trace the dynamics of the state of 91 patients (50 men, 41 women; 24.9 ± 4.6 years).ResultsBased on the follow-up results, two types of schizophrenia dynamics were identified - with a relatively favorable and unfavorable course. The formation of a relatively stable remission corresponding to the criteria proposed by the working group was noted in 47 patients (51.6%), carriers of gene polymorphisms: DRD2 rs1799732 (del); COMT rs4680(GG); BDNF rs6265 (CC); ANKK1 rs1800497 (GG); MC4R rs489693 (AA); ABCB1 rs1045642 and ABCC1 rs212090 (GG). An unfavorable course with the ineffectiveness of antipsychotics was found in 48.4% of cases in patients with DRD2 rs1799732 (G/del) carriers; COMT rs4680(AA); BDNF rs6265 (TT); ANKK1 rs1800497 (AA); MC4R rs489693 (GG); ABCB1 rs1045642 and ABCC1 rs212090 (AA).ConclusionsAfter analyzing the results of genetic testing and clinical and dynamic characteristics of the course of schizophrenia, we can talk about the relationship between the establishment of high-quality remission in the presence of polymorphisms in the genotype, whose role has been proven in terms of the effectiveness and safety of antipsychotics.Disclosure of InterestNone Declared