Standard Clinical Examination Research Articles

Effect of ranolazine on cardiac remodeling and pulmonary artery pressure in patients with acute pulmonary embolism

Background. The development of right ventricular (RV) dysfunction is the most significant predictor of in-hospital mortality and one of the most important factors affecting the short- and long-term prognosis of pulmonary embolism (PE). Therefore, the development of treatment regimens aimed at inhibiting the progression of RV dysfunction and the fastest possible restoration of its function, as well as preventing the development and progression of pulmonary hypertension, is an important area of reducing mortality in acute PE. One of the most promising drugs that can theoretically reduce both RV and pulmonary damage is ranolazine. The purpose of the study was to evaluate the feasibility and efficacy of prescribing ranolazine to patients with PE, focusing on its impact on echocardiographic parameters. Materials and methods. The study included 70 patients diagnosed with acute PE verified bу CT pulmonary artery angiogram performed on the first 1–2 days and after 8–10 days of treatment. Patients were divided into two groups: group 1 consisted of 29 people who received ranolazine at a dose of 500 mg twice daily starting from day 1–2 of standard treatment, for 1 month; group 2 included 49 patients who did not receive ranolazine. All patients underwent a standard general clinical examination with an assessment of risk factors for PE and early death according to the 2019 European Society of Cardiology guidelines, with subsequent statistical processing of the data. Results. When analyzing the dynamics of indicators in the groups, a statistically significant decrease was found in the size of the right atrium (p = 0.0009), RV (p = 0.046), mean pulmonary artery pressure (mPAP) (p = 0.027), pulmonary artery systolic pressure (sPAP) (p = 0.00004) in the group 1. In the group without ranolazine, there also was a decrease in the size of the right atrium (p = 0.002), mPAP (p = 0.009), and sPAP (p = 0.03), but with no effect on the size of the RV. When comparing the difference in parameters on day 1 and 8–10, i.e., the shift of the parameters during treatment, a statistically significant decrease in sPAP was obtained in the ranolazine group compared to the group without its use (p = 0.03). Conclusions. Adding ranolazine to standard therapy for pulmonary embolism reduces right ventricular and atrial remodeling, as well as pulmonary artery pressure.

COMPARING THE EFFICACY OF 35% TRICHLOROACETIC ACID (TCA) PEEL WITH TOPICAL 0.1% ADAPALENE GEL IN THE TREATMENT OF COMEDONAL ACNE

Comedonal acne is a common dermatological condition characterized by open and closed comedones. Treatment modalities, including chemical peels and topical retinoids, have managed comedonal acne. Aim and Objective: This study aimed to compare the efficacy of 35% trichloroacetic acid (TCA) peel with topical 0.1% adapalene gel in treating comedonal acne. Methodology: A randomized controlled trial (RCT) was conducted at the Sheikh Zayed Hospital, Rahim Yar Khan. A total of 80 patients with comedonal acne were recruited and randomly assigned to two treatment groups: Group A received 35% TCA peel, while Group B received topical 0.1% adapalene gel. The primary outcome measures included changes in comedonal lesion count and severity, assessed using standardized clinical photographs and dermatological examinations. Secondary outcomes comprised patient-reported improvement, adverse events, and treatment tolerability. Results: The mean age of participants was 25.4 ± 4.6 years, with a female predominance (65%). At baseline, both groups exhibited similar comedonal lesion counts and severity scores. Following treatment, a significant reduction in comedonal lesions was observed in both groups (p < 0.001). However, the reduction in comedonal lesion count was more significant in the 35% TCA peel group than the adapalene gel group (mean decrease of 80% vs. 60%, respectively). Additionally, patients in the TCA peel group reported higher satisfaction rates and fewer adverse events than the adapalene gel group. Conclusion: Our study suggests that 35% TCA peel is more effective than topical 0.1% adapalene gel in reducing comedonal acne lesions and improving patient satisfaction. TCA peel may represent a promising treatment option for patients with comedonal acne, offering superior efficacy and tolerability compared to topical retinoids.

TIC HYPERKINESIS IN FIRST-YEAR STUDENTS AGED 17-19

The clinical picture of tics and hyperkinesis manifested by involuntary movements and/or sounds is relevant primarily due to its impact on the quality of life and social adaptation of people, especially during their studies and early careers. To analyze tics in young people, we examined 80 people (37 women (46.3%) and 43 men (53.7%)), first-year students of a medical university aged 17 to 19 years without complaints and clear anamnestic indications of tic hyperkinesis during the routine educational process. Along with the standard clinical and neurological examination, we assessed hyperkinesis during 32 academic lectures lasting 90 minutes once a week for 2 semesters. Tics and hyperkinesis were detected in 38.7% of men and women aged 17-19 without complaints and clear anamnestic indications of tic hyperkinesis during the routine educational process (men - 64.5%, women - 35.5%). The most common tics were facial tics (35.1%), oculomotor disorders (21%) and smirking (15%). Sexual dimorphism of tics in first-year students aged 17-19 during the routine educational process was revealed in the predominance of motor tics and chronic tic disorders in men, and simple and complex vocal tics in women.

Long-term pharmacotherapy in patients with uterine myoma: assessment of effectiveness

BACKGROUND: Uterine myoma is one of the most prevalent gynecological diseases. Data concerning the effects of the medicinal agents used in patients with uterine leyomyomas, are both scientifically and practically important. AIM: This study aims to assess the clinical, laboratory, and instrumental effectiveness of 5-year use of micronized oral contraceptive containing estrogen and progestogen, intrauterine levonorgestrel-releasing system and progesterone receptor modulator in patients with uterine myoma. MATERIAL AND METHODS: Patients aged from 21 to 40 years old were assigned to 3 arms in accordance with the treatment regimen. Group 1 included 42 women with myomas ≤2 cm in diameter. These patients received combined oral contraceptive pills containing ethinylestradiol 20 mcg and desogestrel 150 mg according to the conventional contraceptive regimen, i.e. one pill daily, 21-day courses with following 7-day pauses. Group 2 included 34 women with uterine myoma and concomitant uterine endometriosis. In this group, the intrauterine devices containing levonorgestrel were inserted. Group 3 included 33 patients treated with the progesterone receptor modulator in order to reduce the diameter of uterine myomas. They received oral mifepristone at a dose of 50 mg daily for three months, followed by a 3-month pause and subsequent 3-month course of treatment. During the year, two cycles that included 3-month treatment course and 3-month treatment-free period, were repeated. All patients underwent standard clinical, laboratory and instrumental gynecological examination. Statistical processing was performed in the basis of Statistica 12.0 software. RESULTS: In Group 1, 80.9% of patients exhibited unchanged mean diameters of uterine myomas all over the course of treatment with contraceptive drugs, 16.7% of patients demonstrated growth of myoma (by 15%), while in 2.4% of patients myoma reduction (by 5%) was observed. In Group 2, the increase in the diameter of leiomyoma ranged from 20 to 30 percent was observed following the insertion of intrauterine levonorgestrel-releasing system in 58.8 percent of patients. In contrast, 35.3 percent of patients exhibited no change in myoma size, while a decrease by 15 percent was observed in only 5.9 percent of patients. In Group 3, 10 intermittent 3-month courses of mifepristone (50 mg) resulted in the reduction of uterine myoma by 40%–50% of the baseline diameter in 97.0% of patients. In general, the study drugs demonstrated beneficial effects and safety in patients with leiomyoma. CONCLUSION: The long-term use of low-dose oral contraceptives generally leads in the stabilization of the size of uterine myomas, while intrauterine levonergestrel-releasing system prevents their intensive growth. Nevertheless, the use of a drug belonging to the progesterone receptor modulator class, has proven to be the most effective approach to reducing the size of myomas.

Results of a three-year observation of the course of non-radiological axial spondyloarthritis

Identification of the non-radiological stage of axial spondyloarthritis (nr-axSpA) has contributed to the improvement of diagnostics and the expansion of therapeutic approaches in the early stages of the disease. However, there is still an unmet need for effective treatment of patients with active nr-axSpA.Objective: to evaluate the dynamics of nr-axSpA in patients in the Kaliningrad region and to identify additional factors influencing the radiological progression of the disease.Material and methods. A total of 68 patients with nr-axSpA were examined at baseline and during 3 year follow-up, most of them were women (62%). The median age of the participants was 27.5 [23.0; 33.3] years. The duration of diagnosis was 1 [1; 2] years. HLA-B27 antigen positivity was present in 40% of cases. Patients at baseline and during follow-up underwent a standard clinical and laboratory examination, pelvic radiography and magnetic resonance imaging of the sacroiliac joints. In addition, cytokine levels (visfatin, PPM1A, MIF, serum calprotectin) and the concentration of IgCD74 antibodies were determined.Results and discussion. After 3 years of follow-up, the diagnosis still met the criteria for nr-axSpA in 30 (44.1%) of the 68 patients, in 16 (23.5%) it transformed into radiographic axSpA (r-axSpA), in 7 (10.3%) – to axial psoriatic arthritis, in 13 (19.1%) the clinical picture no longer met the criteria for nr-axSpA, 2 (3%) patients dropped out of the study. When analyzing the values of visfatin, PPM1A, MIF and serum calprotectin, no differences were found between nr-axSpA and r-axSpA, while the average concentrations of IgCD74 antibodies were slightly higher in patients with nr-axSpA (7.4 and 5.0 ng/ml respectively). It was shown that the probability of radiological progression from nr-axSpA to r-axSpA increased 3.308-fold with a one-unit increase in the ASDAS (Ankylosing Spondylitis Disease Activity Score) index.Conclusion. The median duration of nr-axSpA diagnostics in the Kaliningrad region was 1 year. In terms of dynamics, after 3 years of observation, 44.1% of patients still met the criteria for nr-axSpA, and radiological progression to r-axSpA was observed in 23.5% of cases. High values of the ASDAS index and its increase by 1 unit increased the speed of radiological progression of nr-axSpA by 3.308 times. The difficulties in the early diagnosis of axSpA in practice necessitate the establishment of reference centers to obtain expert opinions on issues of differential diagnosis and treatment choices in patients with nr-axSpA and ankylosing spondylitis.

Prospective validation of a virtual post-operative clinic in vitreoretinal surgery.

To evaluate the clinical efficacy and safety of asynchronous virtual post-operative assessments following vitreoretinal surgery and procedures compared to traditional face-to-face assessments in a high-volume tertiary eye centre. Prospective comparative clinical series study of patients who had undergone vitreoretinal surgery or post-laser retinopexy. Patients received both virtual and face-to-face assessments. The virtual assessment included clinical questions, visual acuity measurement, and virtual retinal imaging using ultra-wide field (UWF) imaging and macular optical coherence tomography (OCT). Face-to-face assessments involved standard clinical examinations. We included 142 patients undergoing a variety of vitreoretinal procedures. We showed comparable results between virtual and face-to-face assessments in both, post-operative and post-laser treatments. UWF imaging with macular OCT demonstrated potential for effective virtual post-operative assessment. The virtual assessment has a sensitivity of 91% and specificity of 100% for detecting retinal detachments with 100% specificity and 100% sensitivity for detecting new retinal tears or insufficient laser treatment. The implementation of asynchronous virtual post-operative assessments following a variety of vitreoretinal procedures is a promising alternative to traditional face-to-face assessments. Virtual assessments using UWF imaging and macular OCT showed high sensitivity and specificity. Virtual post-operative clinics offer the potential to improve patient access and decrease the clinical burden, especially with the continuing evolution of telemedicine technologies and imaging modalities.

CILP-2 expression in the intervertebral discs of patients with lumbar radiculopathy

BackgroundIntervertebral disc (IVD) degeneration (IVDD) is one of the main causes of low back pain. One of the most important features of IVDD is the loss of extracellular matrix (ECM) with its structural components. Cartilage intermediate layer proteins (CILPs), minor glycoproteins residing in ECM, have been found to be increased in IVD as degeneration and aging progresses. The aim of the present study was to evaluate the expression of CILP-2 in the IVD of patients with lumbar radiculopathy.MethodsThe IVD samples were collected from 25 patients during spinal surgery (interlaminectomy, herniated disc removal). The control IVD samples were obtained from nine patients who underwent lateral corpectomies in the thoracic region. CILP-2 expression was detected by immunohistochemistry. The patients were divided into two groups – aged under or over 50 years. A standardized clinical examination with assessment of radicular signs and deficits was performed. Subjective disability and pain were assessed using the visual analogue scale and Oswestry Disability Index (ODI). The pre-operative MRI was graded for the degree of IVD degeneration by Pfirrmann grading system. IVD samples obtained during operations were subjected to the standardized histopathological analysis applying modified Boos classification. The data were analysed by t-test, Mann-Whitney U-test, and Spearman correlation test.ResultsBoth histopathology scores and Pfirrmann grades did not differ between patients’ groups. Also, no correlations were found between histopathology and Pfirrmann grades, neither were any differences seen when correlating both grades to ODI, back pain or leg pain scores. CILP-2 staining was noted in all studied samples, notably strong staining was seen around large cell clusters. However, no differences in CILP-2 staining were seen between the age groups of patients. No correlations were found between CILP-2 staining and Pfirrmann grades. Grading of CILP-2 immunostaining in nine control patient samples resulted in significantly lower values. The difference is statistically significant (P = 0.002) compared to CILP-2 staining scores of all 25 patients’ samples.ConclusionIn this study, we detected increased CILP-2 expression in the human IVD as compared to the control group patients. CILP-2 can be a possible IVDD marker; however, as knowledge about the role of CILP-2 is limited, further studies are required.

Indicators of the cytokine profile and standard immunogram in the controlled and uncontrolled course of bronchial asthma in children

Bronchial asthma in children is a multifactorial disease, but it is based on atopic inflammation, which is the focus of the main methods of research and therapy of this pathology. However, if we evaluate not only the fact of the appearance of bronchial asthma in a particular patient, but also consider its course in more detail, and especially the possibility of achieving control over the disease, then indicators of not only atopic inflammation, but also local inflammation in general, acquire great influence, which is one of the reasons for the continuing high percentage of uncontrolled and partially controlled course bronchial asthma in children. The purpose of this work is to identify changes in cytokine status indicators and immunograms – markers of the risk of uncontrolled bronchial asthma. 167 patients with bronchial asthma were examined, who, based on a standard clinical and instrumental examination, according to the criteria of clinical recommendations, were divided into two groups – controlled (70 people) and partially controlled and uncontrolled (97 children). All of them had their cytokines and IgA, IgM, IgG, IgE levels determined, in blood serum by ELISA, subpopulations of lymphocytes by flow cytometry, indicators of neutrophilic phagocytosis by light microscopy. In the group with uncontrolled asthma, the following significant differences were noted: a decrease in the level of IL-7, IL-9 and an increase in IL-8, there is also a higher level of B lymphocytes, IgE and IgM, and a lower level of IgA, similar changes, but less pronounced, were previously detected in other studies when comparing patients with bronchial asthma and conditionally healthy, as well as mild and severe course diseases. There were no significant differences in the other studied indicators. It is noteworthy that the greater influence on the control of the disease in bronchial asthma is not exerted by atopic cytokines responsible for the very fact of atopic inflammation, but by cytokines of general inflammation, such as IL-7, IL-8, IL-9, regulating the severity of inflammation in general, the role of IL-8 as a cytokine of granulocyte chemotaxis regulating local inflammation is especially interesting.

Spinal Cord Blood Perfusion Deficit is Associated with Clinical Impairment after Spinal Cord Injury.

Spinal cord injury (SCI) results in intramedullary microvasculature disruption and blood perfusion deficit at and remote from the injury site. However, the relationship between remote vascular impairment and functional recovery remains understudied. We characterized perfusion impairment invivo, rostral to the injury, using magnetic resonance imaging (MRI), and investigated its association with lesion extent and impairment following SCI. Twenty-one patients with chronic cervical SCI and 39 healthy controls (HC) underwent a high-resolution MRI protocol, including intravoxel incoherent motion (IVIM) and T2*-weighted MRI covering C1-C3 cervical levels, as well as T2-weighted MRI to determine lesion volumes. IVIM matrices (i.e., blood volume fraction, velocity, flow indices, and diffusion) and cord structural characteristics were calculated to assess perfusion changes and cervical cord atrophy, respectively. Patients with SCI additionally underwent a standard clinical examination protocol to assess functional impairment. Correlation analysis was used to investigate associations between IVIM parameters with lesion volume and sensorimotor dysfunction. Cervical cord white and gray matter were atrophied (27.60% and 21.10%, p < 0.0001, respectively) above the cervical cord injury, accompanied by a lower blood volume fraction (-22.05%, p < 0.001) and a higher blood velocity-related index (+38.72%, p < 0.0001) in patients with SCI compared with HC. Crucially, gray matter remote perfusion deficit correlated with larger lesion volumes and clinical impairment. This study shows clinically eloquent perfusion deficit rostral to a SCI, its magnitude driven by injury severity. These findings indicate trauma-induced widespread microvascular alterations beyond the injury site. Perfusion MRI matrices in the spinal cord hold promise as biomarkers for monitoring treatment effects and dynamic changes in microvasculature integrity following SCI.

Difficult-to-treat psoriatic arthritis. Data from the All-Russian registry of patients with psoriatic arthritis

Objective: to characterize patients with difficult-to-treat (D2T) psoriatic arthritis (PsA) and to assess risk factors for its development.Material and methods. The study included 263 PsA patients treated with biologic disease- modifying antirheumatic drugs (bDMARDs) or targeted synthetic DMARDs (tsDMARDs) and followed up for ≥2 years in the All-Russian Registry of PsA Patients. All patients underwent a standard clinical and laboratory examination, and concomitant diseases were recorded. PsA activity was assessed using DAPSA index and minimal disease activity criteria.Results and discussion. 152 (57.8%) patients who received 1 bDMARD/tsDMARD for 2 years achieved remission/low disease activity (LDA) according to DAPSA and were categorized as having non-D2T PsA. Other 111 (42.2%) patients switched ≥2 bDMARDs/tsDMARDs within 2 years, 71 (27%) of them achieved remission/LDS, and 40 (15.2%) patients who continued to have high or moderate PsA activity met the D2T criteria. A comparative analysis of 40 patients (20 men and 20 women) with D2T PsA and 152 patients (78 men and 74 women) with PsA who did not fulfil the D2T criteria was performed. It was found that patients with D2T PsA had a significantly longer duration of PsA (p=0.017), more frequent polyarthritis (p=0.014), dactylitis (p=0.004), enthesitis (p=0.001), BSA &gt;10% (p=0.008), onycholysis (p=0.001), HAQ &gt;0.5 (p=0.039), depression (p=0.007) and elevated blood uric acid levels (p=0.023).Conclusion. In real-life clinical practice, the D2T variant of PsA is reported in 15% of cases. Treatment-resistant PsA patients are characterized by a longer duration of PsA, more widespread severe psoriasis with onycholysis and are more likely to have polyarthritis, dactylitis, enthesitis and functional disorders at the time of bDMARD prescription, as well as concomitant diseases, especially depression and hyperuricaemia.

Medical education during the COVID-19 pandemic: An online-only course can achieve good to medium psychomotor skill level of basic head and neck examination

Background/ObjectivesNew teaching methods are warranted to meet the demand for increased flexibility in medical education while making optimal use of the limited resources of educators. The COVID-19 pandemic forced universities to resort to online-only teaching, even for training of psychomotor skills. The objectives of this study were: (I) to investigate the performance of students without previous experience in ear, nose and throat (ENT) examination after completing an asynchronous online teaching course in an objective standardized clinical examination (OSCE) and (II) to evaluate the degree of over- and underestimation of their abilities. MethodsThe study was designed as a prospective, single-institution medical education cohort study. Medical students (n = 54; 3rd/4th year, no previous head and neck examination skills) completed a comprehensive online training for basic head and neck examination skills 1–14 days before undergoing an OSCE on 5 different examination items (cervical lymph node examination, oral/oropharyngeal examination, otoscopy, Weber/Rinne hearing test, anterior rhinoscopy). Expert-evaluated theoretical knowledge and practical abilities were measured using Likert scales (1 = high proficiency to 5 = low proficiency). Participants self-evaluated their own skills before and after the OSCE (5-point Likert scales). ResultsStudents achieved an overall good to medium skill level in basic head and neck examination after online training. Increased psychomotor complexity of tasks contributed to worse performance. Expert evaluation of practical skills was better in male participants and those who rated their preparation as thorough. Low/no misjudgment (discrepancy between self- and expert-evaluation) was observed in most participants, while high discrepancy levels (strong misjudgment) were mainly attributable to the students’ underestimation of their own abilities. ConclusionsOnline training of head and neck examination skills is a cost- and resource-efficient introduction to skill training and was inevitable during the pandemic. However, it cannot replace practical hands-on training, especially in tasks with high psychomotor requirements. Refresher-courses could compensate for cancelled skill training during the pandemic.

WP1.6 - Intraoperative fascial traction for the treatment of large hernias - results of a multicentre study

Abstract Background The incidence of incisional hernias after median laparotomy is about 20%. Intraoperative fascial traction (IFT) is a new technique for treatment of large hernias. Materials and methods In this study data from five hospitals using IFT between 12/2020 and 9/2023 was analysed. In all cases the Fasciotens®Hernia System was applied. When fascia closure was not possible, transversus abdominis release (TAR) was performed. All patients underwent a standardized clinical and ultrasound examination during follow-up. Quality of life was assessed using the HerQLes questionnaire. Results A total of 96 patients were included in the study (HH-62, DA-11, SB-10, D-9, L-4). The age was 59.9±14.1 years, 41% were female, BMI was 31.0±7.3kg/m², hernia width was 15.7±5.1cm. 88.5% underwent pretreatment with botulinum toxin (BTX). A TAR was performed in 28.1% cases. Bridging was necessary in 5.2%. Length of stay was 8.3 days. In the postoperative course, 39/96 (40.6%) patients experienced a complication: 20.8% seroma, 9.4% wound infection, 4.2% haematoma, 2.1% intestinal injury, 1.0% wound dehiscence, 3.1% pneumonia and 2.1% urinary tract infection. No patient died. The incidence of wound infections was higher in patients with additional TAR (11.1% vs. 8.7%). During the mean follow-up of 15.7±12.6 months 2 hernias at the border of the mesh were recognized. The HerQLes summary score was 64.5. Conclusion This multicentre study shows a low incidence of wound infection and recurrences using IFT. The fascia closure rate is high when combining IFT with BTX pretreatment. Further randomised studies of IFT should follow to support these data.

The influence of rehabilitation on the quality of life after radical treatment of endometrial cancer and atypical endometrial hyperplasia

Background. Gynecological cancers in women are a widespread type of oncology. Among them, endometrial cancer (EC) is often highlighted as one of the most common diseases in this group. The analysis of publications showed insufficient effectiveness of rehabilitation in patients with EC and recurrent atypical endometrial hyperplasia (rAEH).Objective: to compare the state of patients with rAEH or EC after hysterectomy with bilateral salpingo-oophorectomy, depending on the recovery tactics.Material and methods. The study included 119 patients diagnosed with rAEH (n=58) or stage IA EC (n=61) after hysterectomy with bilateral salpingo-oophorectomy. The group of women with rAEH was divided into two subgroups: 1A (“active” rehabilitation, n=27) and 1B (“passive” rehabilitation, n=31); two subgroups were also formed from the cohort of EC patients: 2A (“active” rehabilitation, n=29) and 2B (“passive” rehabilitation, n=32). “Active’ rehabilitation included a comprehensive, personalized program, “passive” one was based on standard rehabilitation protocols. Apart from standard clinical examination of patients, their quality of life (QoL), physical condition as well as the levels of cytokines and other biochemical blood parameters were assessed.Results. An analysis of the overall picture showed a high incidence of rAEH or EC in women aged 40–49 years. Comorbid pathologies, low QoL level and a number of significant changes in laboratory parameters were often observed. Regardless of the approach to rehabilitation, the patients' health improved over the course of 12 months. “Active” rehabilitation significantly improved psychological well-being, sexual function, overall QoL and a number of other objective health indicators of patients with rAEH or EC compared to standard rehabilitation course.Conclusion. The overall picture of rAEH or EC patients was presented, the main factors that reduce QoL in women with these diseases were identified. A system of integral QoL assessment in patients with rAEH or stage IA EC was developed including subjective and objective parameters obtained during general clinical examination, laboratory tests and analysis of questionnairing results, which should be used to adequately monitor the state of patients after surgery and the effectiveness of rehabilitation. The advantage of comprehensive rehabilitation over standard protocols in terms of efficiency and speed of recovery was shown.

Median nerve lesions in pediatric displaced supracondylar humerus fracture: A prospective neurological, electrodiagnostic and ultrasound characterization.

Supracondylar humerus fractures (SCHFs) are the most common elbow fractures in children. Traumatic median nerve injury and isolated lesions of its pure forearm motor branch, anterior interosseus nerve (AIN), have both been independently reported as complications of displaced SCHFs. Our main objectives were to characterize the neurological syndrome to distinguish median nerve from AIN lesions and to determine the prognosis of median nerve lesions after displaced SCHFs. Ten children were prospectively followed for an average of 11.6 months. Patients received a standardized clinical examination and high-resolution ultrasound of the median nerve every 1-3 months starting 1-2 months after trauma. Electrodiagnostic studies were performed within the first 4 months and after complete clinical recovery. All children shared a clinical syndrome with predominant but not exclusive affection of AIN innervated muscles. High-resolution ultrasound uniformly excluded persistent nerve entrapment and neurotmesis requiring revision surgery but visualized post-traumatic median nerve neuroma at the fracture site in all patients. Electrodiagnostic studies showed axonal motor and sensory median nerve neuropathy. All children achieved complete functional recovery under conservative management. Motor recovery required up to 11 months and differed between involved muscles. It was shown that neurological deficits of the median nerve in displaced SCHFs exceeded an isolated AIN lesion. Notably, detailed neurological follow-up examinations and sonographic exclusion of persistent nerve compression were able to guide conservative therapy in affected children. Under these conditions the prognosis of median nerve lesions was excellent despite severe initial deficits, development of neuroma and axonal injury.

"Amr Sign": A Case-Control Study Evaluating the Diagnostic Value of a New Clinical Sign in the Diagnosis of Acute Appendicitis.

Introduction Acute appendicitis, a prevalent cause of acute abdominal pain and a common indication for emergency surgery, presents a diagnostic challenge due to its diverse clinical presentation and variability in appendix location and symptoms. Traditional diagnostic approaches, including physical examination, clinical scoring systems, and imaging techniques, have limitations. This study introduces the "Amr sign," a new diagnostic indicator characterized by sudden reflex hyperextension of the neck upon palpation of the right iliac fossa, which is hypothesized to reflect local peritoneal irritation from an inflamed appendix. Methods We conducted a prospective observational study at Alwakra Hospital from November 2016 to January 2019 that included 195 patients aged 15 years and older with right iliac fossa pain and an Alvarado score of four or more. The "Amr sign" was evaluated alongside standard clinical examination and imaging results. Diagnostic accuracy was assessed via histopathological confirmation, which is the gold standard. Results The "Amr sign" had a sensitivity of 68.6% and a specificity of 67.3%. The positive predictive value (PPV) was 89%, whereas the negative predictive value (NPV) was 45%. Receiver operating characteristic (ROC) analysis revealed an area under the curve (AUC) of 0.679 for the "Amr sign" compared with 0.622 for the other imaging modalities, suggesting comparable diagnostic performance. The "Amr sign" demonstrated a higher likelihood ratio of a positive test (2.3) and a lower likelihood ratio of a negative test (0.46). Conclusion The "Amr sign" is a promising diagnostic tool for acute appendicitis, offering a simple, reliable, and quick test that can be performed by less experienced physicians. While its sensitivity and specificity are moderate, its high PPV suggests that it is particularly useful in confirming appendicitis. Further research and validation are needed to fully establish its role in clinical practice.

Comparative assessment of venous congestion severity and hospitalization outcomes in patients with acute decompensated heart failure with preserved ejection fraction

Aim. To characterize the potental of additional paraclinical research methods (ultrasound, determination of body composition) for assessing the congestion severity in patients with acute decompensated heart failure with preserved ejection fraction (ADHFpEF) in the intensive care unit.Material and methods. We examined 82 patients with ADHFpEF aged from 50 to 85 years, who were hospitalized in the intensive care unit of the Veresaev City Clinical Hospital (Moscow). All patients underwent a standard clinical and laboratory examination, including determination of NT-proBNP, as well as echocardiography, chest radiography, bioimpedance analysis, Venous Excess Ultrasound (VExUS), lung ultrasound. Depending on the congestion degree visualized by VExUS, patients were divided into three groups.Results. The median levels of NT-proBNP, E/A and E/e', number of B-lines in one lung segment, ECW and TBW, and the diuretics' dose used in the hospital in pa tients with ADHFpEF and severe congestion were significantly higher. Signs of congestion obtained as a result of X-ray examination did not differ significantly between groups. In-hospital death was associated with higher values of NT-proBNP, E/A ratio, IVC diameter, number of B-lines in one lung segment, ECW and TBW. The odds of death in patients with VExUS Grade 3 increased 20,9 times compared to Grade 1 (95% CI: 1,125-387,688).Conclusion. Higher levels of NT-proBNP, the dose of diuretics used in the hospital, and ECW and TBW were associated with congestion severity. The severity of congestion assessed by VExUS and ECW/TBW are positively associated with inhospital mortality

New-Onset Chronic Musculoskeletal Pain Following COVID-19 Infection Fulfils the Fibromyalgia Clinical Syndrome Criteria: A Preliminary Study.

New-onset chronic musculoskeletal (MSK) pain (>3 months duration) is a common symptom of post-COVID-19 syndrome (PCS). This study aimed to characterise new-onset chronic MSK pain in patients with PCS and its overlap with Fibromyalgia Syndrome (FMS). We enrolled patients with new-onset chronic MSK pain post-COVID-19 and assessed the nature of the pain and associated symptoms using the C19-YRS (Yorkshire Rehabilitation Scale). The FMS assessment was conducted as part of a standard clinical examination using the American College of Rheumatology (ACR) 2010 criteria: (1) Widespread Pain Index (WPI) ≥ 7 and symptoms severity (SS) score ≥ 5, or WPI between 3 and 6 and SS score ≥ 9, (2) symptoms consistent for at least 3 months, and (3) no alternative diagnosis. Of the eighteen patients (average age 49.6 (SD 11.8) years; BMI 31.7 (SD 8.6)), twelve were female. The average symptom duration was 27.9 (SD 6.97) months post-infection. Thirteen patients (72.2%) met the FMS criteria, with an average WPI score of 8.8 and an average SS score of 8.2, indicating a high level of pain and significant quality of life impacts. These findings support the hypothesis that FMS may develop as a long-term sequela of a viral infection, underscoring the need for further research into post-viral long-term conditions.

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

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

Broncho-obstructive syndrome and the enzymes of cellular energy metabolism after coronavirus infection

Broncho-obstructive syndrome (BOS) after coronavirus infection is characterized by long-term, dry and painful cough which is hard for treatment, significantly reducing the quality of life of the patients. The goal of the study: to investigate the specific features of clinical manifestations of BOS diagnosed for the first time in patients belonging to different age groups in post-COVID-19 period and to estimate the degree of mitochondrial dysfunction by the imbalance of the enzymes of cellular energy metabolism. Materials and methods. 298 patients with BOS (age 18–78) were observed continuously for 2 years. Standard clinical, biochemical and functional examination was carried out, Saint George`s Respiratory Questionnaire (SGRQ) was used. Mitochondrial dysfunction was determined by the ratio of levels of two enzymes, lactate dehydrogenase (LDH) and succinate dehydrogenase (SDH), in peripheral blood lymphocytes. Statistical data processing was performed in STATISTICA 10.1 program package. Results. The duration and severity of BOS manifestations increased with age, they were the most prominent in the age group older than 60 y/o. Bronchial asthma was diagnosed for the first time in 85 patients, most of them belonging to the group 18–25 y/o. In all the patients with BOS, the SGRQ coeffitient was above 50, and comorbidity was established in 82.4% of the patients. The longest duration of BOS (49.4±3.5 days) was established in the group older than 60 y/o (n = 86). LDH/SDH ratio decreased from 6 to 4.8–5.2 a.u. in all the age groups. Such changes should be taken into account in the patients from young age groups. Conclusion. The revealed low values of LDH/SDH ratio have not been shown in the available literature earlier. These values demonstrate the development of secondary mitochondrial dysfunction in post-COVID-19 period in both younger and older age groups, particularly, in patients with more severe progression of BOS. Estimation of this parameter would allow to revealthe personified characteristics for each patients, which is important for quantifying the efficacy and duration of the required antioxidant therapy.

Clinical profile and associated comorbidities of cerebral palsy in children visiting Orotta National Referral Hospital, Eritrea: a cross-sectional study

BackgroundCerebral Palsy (CP) is one of the most common physical disabilities in children. This study aimed to explore the clinical spectrum of CP at Orotta National Referral and Teaching Hospital, including CP subtypes, gross motor function, patterns of associated comorbidities, and possible risk factors in children aged 2 to 12 years.MethodsA hospital-based cross-sectional study was conducted from January to April 2022 in 153 children with suspected motor symptoms. The Surveillance of CP in Europe (SCPE) decision tree was used as an inclusion criteria guideline and the evaluation of the participants was done using a standardized questionnaire and clinical examination. Descriptive statistics, chi-square test, and logistic regression were employed to statistically analyze the data.ResultsEighty-four children who fulfilled the clinical criteria were included in the study. The median age was 5-years [IQR: 3.8] with an equal distribution of males and females. Quadriplegic CP was the most common subtype (51.2%) followed by unilateral (hemiplegic) CP (22.6%), and dyskinetic CP (14.3%). Most children had severe gross motor impairment GMFCS level IV-V and females were almost three times more likely to have GMFCS level IV/V than males (AOR: 2.70; CI: 1.08–6.72; p-value = 0.033.) More than half (52.4%) of the neonates either did not cry within five minutes and/or needed breathing resuscitation, 55.3% had to be admitted to the NICU with a median of 5 days’ hospital stay. Between the first week of birth and the first year of life, 28.6% had trouble feeding, 26.2% had an infection, 10.7% had difficulty breathing, 20.2% had seizures and 6% had jaundice. Feeding problems (64.3%), speech problems of some sort (91.7%), and epilepsy (46.4%) were the most commonly associated comorbidities with CP.ConclusionsThe clinical profile of the CP patients was found to be dominated by the spastic subtype and moderate to severe disability. Since perinatal risk factors were found to be dominant, strengthening maternal and child healthcare systems is recommended to minimize incidents of preventable risk factors and the burden of the disability.