Trophic Skin Changes Research Articles

038. Association Between High Body Mass Index and Smoker in Shopkeepers with Chronic Venous Insufficiency in Sederhana Market Bandung

Background: Chronic venous insufficiency (CVI) is a condition that encompasses several pathological changes such as lower extremity edema, skin trophic changes, and discomfort than secondary to venous hypertension. It is estimated that 73% of women and 56% of men are affected by CVI. Shopkeepers are the jobs that have a high risk of becoming a risk factor for CVI such as high BMI > 25 (body mass index) and smokers. The study aims to know the association between high BMI and smoker in shopkeepers with CVI in the Sederhana Market, Bandung. Methods: The cross-sectional study was conducted on shopkeepers in the Sederhana Market from March to September 2023. Data from shopkeepers that met the inclusion criteria was collected through history taking, physical examination, and filling out the research questionnaire. Results: Among 48 shopkeepers in Sederhana Market, 37 had CVI (79.2%), with a demographic of 73% male and 27% female, and the mean age of the patients was 44.9 (30-59) years. The average sitting time during trading was 15.1 (10-20) hours, and the average standing time during trading was 5.3 (2-13) hours. The association between high BMI and smoker with CVI in shopkeepers was carried out, and it was found that there was a association between high BMI (p = 0.0006), and smokers (p = 0.0023) with CVI among the shopkeepers. Conclusion: There are association between high BMI and smoker in shopkeepers with CVI in the Sederhana Market, Bandung.

VENOTONICS IN MODERN CLINICAL PRACTICE

Chronic venous diseases (CVD) are an extremely common pathology of the circulatory system. An important component of the treatment of CVD is the use of pharmaceuticals. Their tasks include reducing the specific symptoms of the disease, enhancing the effects of other methods of treating CVD, preventing further development and complications of the disease. The main means of pharmacotherapy of CVD are called venotonics or phlebotonics. The most studied and most commonly used form of venotonics are flavonoids, which reduce the permeability of capillaries, thereby having a beneficial effect on the vessels of the microcirculatory bed. The main indications for taking venotonics are specific symptoms of CVD: a feeling of heaviness, varying degrees of discomfort, pain, itching in the lower extremities, chronic swelling and trophic skin changes. This determines the active use of venoactive drugs in the treatment of various forms of CVD. Most clinical studies show that venotonics have decongestant, anti-inflammatory, antioxidant properties, and also maintain the tone of the venous wall. The main effect of venotonics is their ability to affect the state of blood vessels both at the macrocirculatory level and at the microcirculatory level. The wide effect of venotonics confirms the effectiveness of their use in modern clinical practice in the treatment of various forms of CVD.

Effectiveness of herbal drug Terminalia Arjuna in chronic venous insufficiency - A prospective observational study

IntroductionChronic venous insufficiency (CVI) manifests in various clinical presentations ranging from asymptomatic but cosmetic problems to severe symptoms, such as lower limb edema, skin trophic changes, and ulceration. CVI substantially affects the quality of life and work productivity of the patients. Ayurveda, an ancient traditional medicine in India, evaluates the various pathological stages of CVI with a wide range of pathological conditions such as Siragranthi (venous abnormalities), Raktavaritavāta (disorders of vāta occluded by rakta ∼ blood), ApanaVaigunya (vitiated apānavāyu), Arsha (hemorrhoids), VataRakta (rheumatism due to rakta), Kushtha (integumentary disease) and Dushta Vrana (putrefied wound) depending upon the presentations of the patient. Ayurvedic texts mention Terminalia arjuna as a potential herb for treating various conditions related to the circulatory system. The drug is an effective anti-inflammatory, anti-oxidant, and anti-hypertensive and has a definite role in improving cardiovascular hemodynamics and wound healing. These attributes suggest that the potential of Terminalia arjuna needs to be explored as a promising venoactive drug. MethodsThis prospective observational study included 25 patients (31 limbs) with CVI who were treated with Tab Terminalia arjuna (Bark extract of Terminalia arjuna in a dose of 500 mg, given twice a day) and were observed on two visits on day 30 and day 90. Follow-up was carried out for three months to evaluate post-treatment complications or adverse effects. The clinical outcome assessment was done using Venous Clinical Severity Score (VCSS), and clinical grading was performed using clinical classification (C0 – C6) of CEAP (Clinical–Etiology–Anatomy–Pathophysiology) classification. ResultsThe median VCSS score (of both limbs) during the third visit was comparatively lower than the first, with a statistically significant improvement at 0.05 level. Further, there was a substantial positive improvement in the clinical classification of CEAP among the patients in pre and post treatment phase. ConclusionThe prospective observational study shows that Tab Terminalia arjuna is safe and effective in CVI, reducing the symptoms like pain, edema, inflammation, pigmentation, induration and also expediting ulcer healing.

Features of Benzodiazepine Poisoning in the Elderly and Senile Patients

AIM OF THE STUDY To study benzodiazepine poisoning in geriatric patients compared to patients of working age.MATERIAL AND METHODS We examined 82 patients with benzodiazepine poisoning, hospitalized in the Department of Acute Poisoning and Somatopsychiatric Disorders of the N.V. Sklifosovsky Research Institute for Emergency Medicine in 2020–2021, which were divided into age categories: young (18–44 years old), middle (45–59 years old) and older (over 60 years old) age. The presence of benzodiazepines in urine was confirmed by immunochromatographic analysis and gas chromatography–mass spectrometry (GC-MS). The concentration of phenazepam in the blood and urine was determined in 45 patients by GC-MS. Statistical processing of the material was performed using the IBM program SPSS Statistics 27.0. The median (Me), 25th and 75th percentiles were determined. The comparison of quantitative data was performed using non-parametric criteria, the level of significance was taken as p<0.05.RESULTS It was found that acute phenazepam poisoning prevailed in all age groups (90% of patients). Among young and middle-aged patients, moderate and deep stunning (GCS score 12–14) prevailed, and in older people moderate and severe poisoning prevailed (GCS score 3–12), with no statistically significant differences in blood concentrations of phenazepam between the groups. In patients of the older age group with benzodiazepine poisoning, compared to people of working age, the development of respiratory failure was statistically significantly more frequent — 13.8-fold, pneumonia — 12.6-fold, vein thrombosis of the lower extremities — 7.8-fold, trophic skin changes — 29-fold. The duration of treatment in older patients with benzodiazepine poisoning was 3.5-fold higher than in young and middle-aged patients, mortality in the older age group was 41%.CONCLUSION The course of acute poisoning with benzodiazepines, including phenazepam, in the elderly and senile age differs in comparison with persons of working age with a high incidence of complications and adverse outcomes.

Narrative Review of the Pathogenesis of Stasis Dermatitis: An Inflammatory Skin Manifestation of Venous Hypertension.

Stasis dermatitis (SD), also known as venous dermatitis, is a form of inflammatory dermatitis of the lower extremities that typically occurs in older individuals and represents a cutaneous manifestation of venous hypertension. Venous hypertension (also known as sustained ambulatory venous pressure) is most often due to retrograde blood flow, which occurs due to calf muscle pump failure. This failure is most commonly secondary to incompetent venous valves, valve destruction, or obstruction of the venous system. Many of the common symptoms associated with SD are caused by inflammatory processes. This review summarizes the pathogenesis and key role of inflammation in SD by reviewing inflammatory biomarkers associated with SD. The literature was selected though a high-level PubMed search focusing on keywords relating to inflammation associated with SD. Venous reflux at the lower extremities causes venous hypertension, which leads to chronic venous insufficiency. High venous pressure due to venous hypertension promotes the local accumulation and extravasation of inflammatory cells across the vascular endothelium. Leukocyte trapping in the microcirculation and perivascular space is associated with trophic skin changes. Cell adhesion molecules are linked with the perpetuated influx of activated leukocytes into inflammatory sites. Here, inflammatory cells may influence the remodeling of the extracellular matrix by inducing the secretion of proteinases such as matrix metalloproteinases (MMPs). The increased expression of MMPs is associated with the formation of venous leg ulcers and lesions. Phosphodiesterase4 activity has also been shown to be elevated in individuals with inflammatory dermatoses compared to healthy individuals. Because inflammation is a key driver of the signs and symptoms of SD, several of the highlighted biomarkers of inflammation represent potential opportunities to target and interrupt molecular pathways of cutaneous inflammation and, therefore, remediate the signs and symptoms of SD. Understanding the pathogenesis of SD may help clinicians identify drivers of inflammation to use as potential targets for the development of new treatment options.

Clinical Presentation and Associated Factors of Lower Limb Chronic Venous Insufficiency at a Tertiary Hospital in Uganda: A Cross-Sectional Study

Background: Lower limb chronic venous insufficiency (CVI) is a common disorder associated with sequelae of changes that lead to varicose veins and skin trophic changes. There is limited data on potential associated factors from representative studies yet its burden and impact on the quality of life is quite significant. We evaluated the clinical presentation and associated factors of lower limb CVI among patients at Mulago National Referral Hospital (MNRH). Methods: We conducted a cross-sectional study of 104 consecutive participants with CVI aged ≥ 18 years attending the outpatient clinics of MNRH. Limbs of participants with history of surgery pertaining to CVI were excluded. We recorded information on demographics, relevant medical history, symptoms, lifestyle and clinical presentation. We described CVI using the clinical and anatomical components of the clinical-etiologic-anatomical and pathophysiologic (CEAP) scale. Data was analyzed at both bivariate and multivariate levels using Stata version 14.1 Results: Altogether, 104 participants were enrolled with a male: female ratio of 2:1, age range of 18 to 85 years and median age of 43 years. The commonest venous symptoms included; venous pain (96.2%), sensation of swelling (93.3%) and heaviness (79.8%). Of the 146 affected limbs, CEAP clinical class included; C0:59.6%, C1:40.4%, C2:80.8%, C3:88.5%, C4:73.1%, C5:30.8%, C6:51.9%. The anatomical class identified superficial veins in 138 (90.5%), deep veins in 46 (29.7%) and perforator veins in 122 (79.7%) affected limbs. Men had significantly higher proportions of skin trophic changes 88.7% vs 63.6% (p=0.003) while females had significantly higher proportions of venous symptoms compared to men 57.6% vs 32.4% (p=0.015). All participants with a smoking history had skin changes. Obese and overweight patients had higher proportions for venous symptoms 13 (54.2%) and 14(50%) respectively as compared to those who had a normal BMI 14(28.6%). Conclusions: Most participants are symptomatic with advanced disease, young and predominantly male. Males had 4.5 times higher odds of having skin changes as compared to females. Although some associated factors such as age, gender are immutable, others can be modified, such as physical activity, cigarette smoking.

Impact of type 2 diabetes mellitus on hemodynamic and morphology of foot arteries: A duplex ultrasound evaluation

BackgroundType-2 Diabetes Mellitus (T2DM) is a significant health condition that is becoming more prevalent worldwide. Uncontrolled diabetes can lead to various complications, including peripheral artery disease (PAD). Duplex ultrasonography is critical to identify the stage of the disease and the patient's suitability for treatment procedures.Purpose: to assess Doppler blood flow parameters and morphologic alterations of dorsalis pedis artery (DPA) and posterior tibial artery (PTA) in T2DM. Materials and methodsA cross-sectional single-center study was conducted in Khartoum State. One hundred adult diabetic patients with average ankle-brachial index and reasonable glycemic control were selected randomly and enrolled in the study. Their age ranged from 27 to 86 years. A Duplex ultrasound examination was performed using a high-frequency ultrasound probe to assess the Doppler indices, arterial diameters, and wall thickness of the DPA and PTA. The data were analyzed using SPSS program version 23. ResultsIncreased duration of type-2 diabetes cause a significant increase in arterial wall thickness and pulsatility index (PI) of the DPA and PTA; (p-value < 0.05). The PI values decreased significantly in diabetic patients with trophic skin foot changes (p-value < 0.001), while the blood resistive index (RI) increased significantly in these patients (p-values < 0.01). Despite the reasonable glycemic control, a positive linear relationship was found between glycosylated hemoglobin (HA1c) levels and RI values of both DPA and PTA (R2 = 0.642). ConclusionThe study concluded that in type 2 diabetes with reasonable glycemic control, the arterial wall thickness of DPA and PTA increased as the duration of diabetes increased. The PI values of DPA and right PTA increased significantly with the increased time of the disease. The RI increased, and PI decreased in a subgroup with trophic skin changes. There is a positive linear relationship between glycosylated hemoglobin (HA1c) levels and RI values of both DPA and PTA.

Modern concept about trophic venous ulcers

Venous trophic ulcer is a common complication of chronic venous diseases that have a negative impact on the quality of life and result negative socio-economic consequences. There are three main theories of development of venous trophic ulcers. The criterion is visible trophic changes of skin (CEAP class C4). If correction of etiological factor of ulcer is impossible, local management is preferred. There are various wound coverings which can be used for the treatment of trophic ulcers. However, data on their effectiveness are sometimes unavailable. Therefore, it is necessary to systematize knowledge about modern measures and methods of exposure to trophic ulcers. The authors also discuss current understanding of pathophysiology, symptoms and diagnosis of venous trophic ulcers.

The efficacy of new neuronal growth factor in the healing of the sciatic nerves in rabbits.

Regeneration of nervous tissue is unpredictable and an ideal growth factor to influence the healing of the injured nerves is not available. A recent study in rats had shown that a new neuronal growth factor (NNGF) was effective in the early healing of the sciatic nerves. The aim of this experimental study is to test the efficacy of NNGF in the healing of iatrogenic division of the sciatic nerves in a larger animal (rabbits). White New Zealand 20 male rabbits of 6 months of age were divided into two groups. Intramuscular ketamine and xylazine were used to anesthetize the animals. The sciatic nerves were divided using scalpel blade 15 and 10/0 Vicryl was used to repair the divided neural tissue. In the study group, 10 mg/kg body weight of NNGF was instilled on the top of the divided nerves and the wound was closed. At 4 weeks, the operated limbs were observed for any trophic skin changes. Nerve conduction studies were carried out using train-of-four-Watch SX, Organon (Ireland) Ltd., and Ireland. The rabbits were put to death humanely and the sciatic nerves were removed and delivered to the pathologist in 2% formalin. The pathologists were blinded about the two groups. Electromyographic study done at 4 weeks showed in the untreated group; the mean twitches 1-T4 was 0.45 ± 0.31% and in the treated group, the average was 77.912 ± 5% (P > 0.001). Microscopic anatomy in the treated group revealed prominent healing by regeneration was evidenced by showing growth of its proximal segments into an empty endoneurial tube which was not seen in the control group. In the control group, the nerves showed no histological element of healing by regeneration. NNGF proves that in a larger animal at 4 weeks profoundly influenced early regeneration of experimentally created divisions of myelinated nerve tissue.

ЗНАЧЕНИЕ ГОНАРТРОЗА В РАЗВИТИИ ВАРИКОЗНОЙ БОЛЕЗНИ НИЖНИХ КОНЕЧНОСТЕЙ

Objective: To evaluate the role of arthritis of the knee joint in the development and progression of varicose veins of the lower extremities. Methods: An observational cross-sectional cohort study was conducted on 180 patients. There were 56 (31.1%) males and 124 (68.9%) females with VVs of the lower extremities. The VVs' clinical features were studied according to the presence or absence of knee osteoarthritis. The study group (SG) included 88 patients with KOA in combination with VVs. The control group (CG) comprised 92 people suffering from VVs and not having a degenerative joint disease of the knee. Both groups of patients were comparable in terms of basic demographic parameters, disease duration and body mass index. Results: In the SG, oedema and skin trophic changes of the lower limbs (lipodermatosclerosis, eczema) were observed in 39 and 21 cases, respectively. The number amounts to 68.2%, which was 33.4% more compared to the percentage of the CG cases (34.8%, n=32). In the presence of KOA, a varicose transformation of both saphenous veins and their tributaries was more often noted in 36 (40.9%) cases, whereas in CG patients, VVs development occurred only in 6 (6.5%) cases. On the contrary, an isolated varicose transformation of the great saphenous vein (GSV) and its tributaries was more common among CG compared to SG patients, at 93.5% and 55.7%, respectively. Among the examined cohort, the incidence of isolated disease of the small saphenous vein (SSV) and insufficiency of its ostial valve had no significant difference between SG and CG patients and occurred in 3.4% and 6.5% of cases, respectively. In SG patients, concurrent incompetence of the ostial valves of the GSV and SSV (n=39; 44.3%) and insufficiency of leg perforating veins (n=60; 68.2%) were more often noted. In the CG, perforator reflux and incompetence of the communicating veins were present only in 6 (6.5%) and 32 (34.8%) patients, respectively. The mean GSV ostial diameter in SG and CG patients was significantly different and amounted to 12.1±1.4 mm and 8.2±0.9 mm, respectively. Varicose dilatation of the superficial veins of both lower extremities was most often noted in the SG than in CG, 90.9% and 39.1% of the patients, respectively. There was a direct correlation between the KOA stage and such factors as VVs class (r=0.58; p&lt;0.001), the laterality of lower limbs involvement (r=0.63; p&lt;0.001) and disease recurrence (r= 0.59; p&lt;0.001). Conclusion: Degenerative joint disease of the knee, in which the locomotor function of the limb is impaired, can act as one of the risk factors for the development or progression of varicose transformation of the superficial veins of the lower extremities. Therefore, further research is needed to study the lower limb biomechanics in patients with VV, with and without KOA. Keywords: Varicose veins, knee osteoarthritis, venous hypertension, ostial valve incompetence.

Early results of application of the system of mechanochemical obliteration of varicose veins for the treatment of varicose veins

Introduction . The basis of varicose veins is reflux in the great saphenous veins, and at present one of the basic principles of treating varicose veins is to eliminate reflux. Thermal obliteration is the gold standard, but non-thermal non-tumescent methods have several advantages. Target . Evaluation of the safety and effectiveness of mechanochemical obliteration in patients with venous insufficiency using the Flebogrif catheter. Materials and methods . The study included 8 women and 2 men over 18 years of age with reflux along the GSV with a target vein diameter of no more than 12 mm. The average age of the patients was 43.8 ± 11.5 years. Stage C2 (varicose saphenous veins) was detected in six patients (60%), stage C3 (edema) in 3 patients (30%), stage C4a (trophic changes of skin and subcutaneous tissues, hyperpigmentation and/or varicose eczema) in one patient (10%). Results. After the procedure, complete occlusion of the target segments of the varicose vein was achieved in 100 percent of cases (10 patients) at all study periods (up to 2 months). Palpation in the projection of the target vein was painless in all patients. The ultrasound imaging showed complete occlusion of the target vein and the absence of complete or segmented recanalization in all patients during all postoperative examinations. No adverse events or complications were reported. Conclusions . Mechanochemical obliteration is a reliable way to eliminate vertical reflux. The main advantages for the patient are speed, painlessness, beauty and outpatient procedures. A big plus for the doctor, in addition to the speed of the intervention and patient satisfaction, is the absence of the need for complex technical devices (thermogenerators), as well as the absence of the need for tumescent anesthesia, which makes the procedure more comfortable for the patient.

Prolonged intravenous infusion therapy of lidocaine in treatment of chronic venous insufficiency in C6 and C6R stage

Chronic venous disease (CEAP stage C2 - C3) is found in approximately 25% of the population, and trophic skin changes, including leg ulcers (C4 - C6), up to 5%.The aim of the work was to develop an effective dose and concentration of lidocaine and the optimal method of its administration for the treatment of chronic venous disease in the stage of active trophic wounds and accelerate the healing process.Materials and methods. The results of treatment of 97 patients with chronic venous insufficiency in stage C6 and C6r were evaluated, which were divided into two clinical groups: retrospective (n= 50) in which classical surgical treatment was performed (Coquette veins ligation, Narat phlebectomy) and prospective (n=47) in which classical surgical intervention (crossectomy + Bebcock and / or Narat phlebectomy) was used in combination with the prolonged intravenous infusion therapy of lidocaine.Research results and their discussion. In the period of 3-6 months, complete healing of trophic wounds was observed in the prospective group. At the same time, in 25.53% of patients in this group complete healing was observed up to 7 days. Whereas, in patients of the retrospective group, this was observed between 6-9 months. In addition, the rate of decrease in the area of trophic wound for the first month in the prospective group was 23.72% higher than in the retrospective group (р˂0.05). We did not observe a recurrence of a trophic wound in the follow-up period up to 1 year in the prospective group.

ADVISABILITY OF USING CILOSTAZOL IN PATIENTS WITH CHRONIC LIMB-THREATENING ISCHEMIA

The article presents the results of surgical and conservative treatment of patients with chronic limb-threatening ischemia (CLTI) of the lower extremities due to steno-occlusive atherosclerotic arterial lesions. The definite role of cilostazol in creating favorable conditions for the healing of trophic wounds is shown.&#x0D; Aim: to improve the results of surgical treatment of patients with CLTI, with use of surgical and conservative methods of treatment, in particular the use of the Cilostazol (Plestazol).&#x0D; Materials and methods. The research included 60 people aged 53 to 82 years with CLTI. All patients had trophic skin changes on the lower extremities (IV grade according to Fontaine classification; 5, 6 category according to Rutherford classification). The operations were performed by the open method (aorto-bifemoral bypass grafting / prosthetics, femoral-popliteal / distal bypass grafting) and X-ray endovascular method (percutaneous balloon angioplasty of the arteries of the lower extremities and stenting of the arteries). The examined patients were divided into 2 groups statistically and clinically comparable (in the main group, open operations were performed in 12 patients, endovascular interventions in 18 patients). In the comparison group - 17 patients were operated openly, endovascular – 13 patients).&#x0D; The research evaluated the microflora sown from wounds on the foot, the size of the skin defect, the rate of healing of which was assessed in the dynamics (reduction of wound area), the rate of body and changes in white blood, antibacterial drugs were prescribed according to sensitivity. During microbiological examination and culture of wounds of the lower extremities, it was found that the most common flora were gram-positive staphylococci (S. aureus, S. epidermidis). E. coli, Pr. mirabilis, Ps were also sown as accompanying flora. The area of necrosis was determined using a transparent film with a grid of squares of 1 mm². Wounds were treated topically with antiseptic and antimicrobial drugs according to the stages of the wound process without the use of hardware treatments.&#x0D; The drug was prescribed as an additional antiplatelet therapy and as a vasodilator to assess the effectiveness of cilostazol in the main group. In the comparison group, patients received antiplatelet therapy.&#x0D; Research results. A homogeneous category of patients with chronic limb-threatening ischemia, who underwent revascularization, demonstrate different rates of healing of the initial trophic ulcers and the appearance of fresh granulation tissue. The fresh granulation tissue after treatment of wounds on the foot, including after performed necrectomy in patients in the main group appeared in 6-11 days (9.7 ± 2.83, confidence interval 8.69-10.71), while the time of appearance of the newly formed granulation tissue in the comparison group was 9-16 days. The total time of wound healing in the main group averaged 70 (73.1 ± 2.05) days, in the comparison group this figure was 90 (89 ± 2.63) days.&#x0D; All patients who received the drug Cilostazol had a faster rate of healing of necrosis, which is explained, among other things, by the pro-angioproliferative properties of the drug.&#x0D; Conclusions. The use of surgical and conservative methods of treatment in particular use of cilostazol (plestazol) in patients with chronic limb-threatening ischemia, can shorten the healing time of wounds.

Диагностика и тактика ведения пациенток с гиперандрогенией в раннем репродуктивном возрасте

Hyperandrogenism is characterized by the presence of clinical symptoms and / or biochemical parameters of high androgen levels. Dermopathy and particularly acne and hirsutism are regarded as the main clinical markers of hyperandrogenism. Cosmetic problems associated with hyperandrogenism are often the reason for young woman to seek medical attention. Body hair growth in atypical areas, acne and trophic skin changes have a significant effect on the emotional state, provoke a sense of imperfection and loss of attractiveness, and reduce the quality of life. Concomitant menstrual disorders (up to 50–75%) complicate the patient’s state and determine an increased risk of gynecological disorders in the future. The causes of hyperandrogenism in early reproductive age can be varied: from more common physiological hyperandrogenism in adolescence, idiopathic hyperandrogenism, polycystic ovary syndrome (PCOS) and the atypical form of congenital adrenal hyperplasia to less common hyperthecosis, acromegaly, hyperprolactinemia, hypothyroidism, Cushing’s disease, and androgen-secreting tumors. The diagnostic search should begin with assessing complaints and clinical symptoms, and a complete physical examination. To confirm biochemical hyperandrogenism, total and free testosterone, and free androgen index are evaluated. Additional methods of examination are used to clarify the diagnosis. Treatment is prescribed in accordance with the established diagnosis. Androgen-secreting tumors require surgical intervention. Other causes of hyperandrogenism are usually treated with medication. According to current recommendations, combined oral contraceptives are the first-line therapy for the most common conditions accompanied by hyperandrogenism (hirsutism, acne vulgaris, PCOS) in early reproductive age. A clinical solution may be a combined administration of microdoses of ethinylestradiol (20 μg) and drospirenone (3 mg), progestagen with antiandrogenic property in the mode 24 + 4 (for instance: Dimia). This article presents clinical cases of diagnosis and management tactics for patients of early reproductive age with hyperandrogenism. Conclusion. The differential diagnosis of physiological and pathological conditions accompanied by hyperandrogenism is one of the current challenges for obstetrician-gynecologist. A properly developed algorithm of examination, interpretation of its results, therapy and prevention of complications are of great importance. Key words: acne, alopecia acreata, congenital adrenal hyperplasia, hyperandrogenism, hirsutism, girls, drospirenone, combined oral contraceptives, contraception, adolescents, early reproductive age, polycystic ovary syndrome, ethinylestradiol

Management and treatment outcomes of patients undergoing endovenous ablation are significantly different between Intersocietal Accreditation Commission-accredited and nonaccredited vein centers

ObjectiveThe Intersocietal Accreditation Commission of vein centers was instituted in 2014, yet data regarding impact of accreditation on patients undergoing superficial vein interventions are lacking. This study was undertaken to identify differences in patient outcomes and utilization index as a measure of appropriate use in accredited compared with nonaccredited centers. MethodsThis study was performed with a matched control design using prospectively collected data from two major U.S.-based venous registries: the Society for Vascular Surgery Vascular Quality Initiative Varicose Vein Registry and the American Vein & Lymphatic Society PRO Venous Registry. ResultsA total of 39,001 patients treated between 2015 and 2018 in 192 centers were included in the study. The Vascular Quality Initiative Varicose Vein Registry provided information on 19,810 (50.8%) patients, and the American Vein & Lymphatic Society PRO Venous Registry provided information on 19,191 (49.2%) patients. Accredited centers were significantly more likely to treat patients with advanced venous disease as characterized by trophic skin changes (C4-C6, 38.1% vs 25.2%; P < .001). Percentage of patients treated 2 standard deviations above the Medicare-reported mean (3.4 utilization index) was significantly higher among patients treated at nonaccredited centers (3.3% vs 0.1%; P < .001). Venous Clinical Severity Score of those who were assessed between 1 month and 1 year after ablation decreased by 4.98 ± 4.01 in nonaccredited centers compared with 5.61 ± 3.64 in accredited centers (P < .001). Complications were low in both cohorts (nonaccredited centers, 71 [0.4%]; accredited centers, 17 [0.1%]; P < .001). One-year clinical follow-up was higher in nonaccredited centers (76.4% vs 31.5%; P < .001). ConclusionsVenous registries are a powerful tool for capturing and identifying significant variations in procedure utilization and complications in low-risk procedures. Intersocietal Accreditation Commission accreditation was associated with reduced use of endovenous therapies, slightly lower complication rates, lower 1-year follow up, and greater improvement in Venous Clinical Severity Score.

Динамика состояния кожи нижних конечностей у пациентов с хронической венозной недостаточностью на фоне применения негормонального противовоспалительного и увлажняющего средства на основе нафталанской нефти

Background: chronic venous insufficiency with venous hypertension results in skin trophic changes as well as the proliferation and keratinization of epidermal cells that leads to multiple microinjuries. These microinjuries are a portal of entry for secondary infections. A group of medicines, skin protectors, aims to normalize these processes. Medications that improve skin regeneration and also demonstrate anti-inflammatory and antibacterial effects are of particular interest. Aim: to assess the effect of 3% naphthalan cream Losterin on the skin of the lower extremities in patients with chronic venous insufficiency. Patients and Methods: 15 patients (5 men and 10 women, mean age 67.27±1.03 years) were examined. All participants applied Losterin® on the right tibial and foot skin while the left lower limb was the control. Optical coherence tomography (OCT) of symmetrical tibial and foot skin areas was performed before and after one week of the treatment to evaluate its efficacy. The brightness, height, and border sharpness of skin layers as well as blood vessels were assessed. Results: all patients reported on the improvement of dryness, itching, desquamation, and skin elasticity after the topical treatment versus no-treatment. OCT performed after one week of the treatment with Losterin demonstrated less edema, lower height and brightness of the 1st and 2nd optical layers thus illustrating reduced hyperkeratosis. Additionally, reduced stratum corneum thickness was revealed after the topical treatment. Conclusions: Losterin allows for higher efficacy of the complex treatment for chronic venous insufficiency by reducing the risk of skin microinjuries, regenerating the hydrolipid mantle of the skin, and improving physiological desquamation. Moreover, subjective perceptions are fully in line with OCT findings. KEYWORDS: Losterin, skin protectors, optical coherence tomography, trophic ulcers, venous hypertension. FOR CITATION: Petrova K.S., Nemirova S.V., Islamov R.A., Karpenko A.A. Dynamics of skin lesions of the lower leg in patients with chronic venous insufficiency after the applications of a non-hormonal anti-inflammatory moisturizer based on naphthalan oil. Russian Medical Inquiry. 2020;4(10):632–636. DOI: 10.32364/2587-6821-2020-4-10-632-636.

Evaluation and Management of Chronic Venous Disease Using the Foundation of CEAP.

Venous disease is common. Depending on the population studied, the prevalence may be as high as 80%. Significant chronic venous disease with venous ulcers or trophic skin changes is reported to affect 1-10% of the population. A systematic assessment of the clinical findings associated with chronic venous disease will facilitate appropriate imaging. Based on imaging and assessment, patients with reflux or obstruction can be recommended proper medical and endovascular or surgical management. Many types of endovascular management are available to treat reflux and eliminate varicose veins and tributaries. More recently adopted non-thermal non-tumescent techniques have been shown to be comparable with more widely performed laser or radiofrequency ablation techniques. A thorough clinical assessment, appropriate duplex ultrasound imaging, and use of advanced imaging when needed will allow clinicians to optimize therapy for patients with chronic venous disease based on the etiology, anatomy involved, and the pathophysiology.

Fingertip amputations treated with occlusive dressings

The aim of this study was to analyze a series of patients who suffered a distal finger amputation and who were treated with occlusive dressings. A retrospective study was done of 19 patients from a single hospital. At the review, an independent examiner evaluated the time required for wound healing, the number of occlusive dressings used, fingertip trophic skin changes, epicritic sensitivity using the Weber two-point discrimination (2PD) test, sensitivity based on the monofilament test, complications, the presence of dysesthesia or cold intolerance, and the QuickDASH score. The mean follow-up was 12.6 months (6–25). A mean of 3.2 occlusive dressings (3–5) were used per patient, and the mean healing time was 4.3 weeks (4–5). The skin texture, fingertips and nail bed were good or excellent in 18 cases. The 2PD test was good or normal in 16 cases. Eighteen patients were satisfied or very satisfied with the outcome. The mean QuickDASH score was 5.53 (0–20.45). In the literature, the recovery of tactile sensation is good after use of occlusive dressings (2PD of 2.5 to 4.0mm). The mean sensitivity reported in various studies is better than that observed after use of a skin flap. While the sample size in our study was small, the functional outcome and appearance were good. Thus we prefer using occlusive dressings in Zone 1 and 2 fingertip amputations, and flaps in zones 3 and 4 to ensure better fingertip viability and sensation.

The Spa Resort, an ideal place for patient education. Examples in Venous and Lymphatic disorders”

The health of patients with chronic diseases cannot be improved substantially on the long run by the treatment of their lesions or even of their disease alone. They need in addition a patient-based approach, involving their ability to participate in the management of their disease. Therapeutic education falls within the scope of patient-based treatment approach. Its purpose is to help the patient with chronic disease to achieve the changes in lifestyle and health related behaviors required by his health condition and to cope with the everyday limitations he encounters. This is carried out through structured programs involving both group workshops and faceto-face interviews conducted by specially trained health professionals, aiming at improving his knowledge, skills and motivation. Although at first restricted to diabetes mellitus and asthma, the field of therapeutic education of the patient now widened to almost any chronic disease, and spa resorts have proven to provide a suitable setting for the development of such therapeutic education programs, because of the large number of patients present at the same site with the same disease, the motivation and availability of the patient during his stay in the Spa resort, but also to a positive interaction between the physical experience of the balneotherapeutic sessions and the education process. In France, balneology is a popular treatment for patients with chronic venous and lymphatic insufficiencies with close to 100 000 patients treated each year. With the logistic help of the Francaise pour la Recherche Thermale, we were able to develop the Veinothermes program dedicated to patients with advanced venous insufficiency (with skin trophic changes) and the 'Thermœdeme program for patients with lymphedema. Both programs were accredited by the French public health system, and we were able to show their ability to improve the patients' health related behaviors and compliance to their treatment at 3 and 9 months, with parallel improvement of their quality of life. In the case of venous insufficiency, a randomized controlled trial evaluation the combination of balneology and therapeutic education showed a long-lasting (12 months), large and significant improvement of patients symptoms, quality of life and health status. Another RCT is presently starting regarding lymphedema. The presentation will summarize the data of these four studies. Works supported by grants from the Association Francaise pour la Recherche Thermale.

Acquired Ulcero-Mutilating Bilateral Acro-Osteopathy (Bureau-Barrière Syndrome).

We present a 35-year-old male patient with Bureau-Barrière syndrome. Bureau-Barrière syndrome is an ulcero-mutilating acropathy almost invariably associated with excessive alcohol intake. It presents with a triad of trophic skin changes with recurrent ulcerations, bone lesions and nerve damage. The clinical presentation includes chronic painless plantar ulcerations with periulcerous hyperkeratosis, hyperhidrosis, livedoid skin colour, nail dystrophy, widening and infiltration of the toes and common interdigital mycoses. Other non-specific skin changes related to the alcohol consumption are commonly observed as well. The condition affects mainly middle-aged men suffering from alcoholism. Often a bilateral location at the lower limb of male alcoholics has been described, as in our patient. Successful treatment of the Bureau-Barrière syndrome requires an interdisciplinary approach. Cessation of alcohol intake and smoking is of paramount importance.