Georgian medical news最新文献

Clinical practice guidelines aim to facilitate early diagnosis, implement early treatment and minimise gaps in care regardless of physician expertise or level of seniority. Consensus guidelines must be adapted to meet local and regional differences allowing for optimum benefit with what is available in terms of diagnostics and treatments. Childhood and adolescent obesity are no exception to this. In this survey we aim to understand practice variation and gaps to better advocate for a regional and local care plan for obesity care in the young.

Methods: A questionnaire was conducted between July 2024 and August 2024, aimed at healthcare professionals of all medical specialties. It consisted of 104 questions.

Results: Family medicine consultants treat most obese youth in Jordan. Several gaps were identified in the assessment and care of patients, including but not limited to psychosocial effects of obesity and efficient multidisciplinary teamwork.

Conclusion: Clear consensus guidelines are necessary to tackle childhood and adolescent obesity in Jordan.

Linear scleroderma of head and face (LSH) in children is a severe disorder, that results in hemiatrophy of skin, subcutaneuse tissue, bones with functional disabilities, neurologic disorders and uveal involvement. The aim of the research was to establish uveal involvement in children with hemifacial scleroderma. Materials and methods: A retrospective analysis was done in a group of 110 children with hemifacial scleroderma. A comprehensive clinical, laboratory and instrumental examination was performed, including MRI of the brain, EEG, and an ophthalmologist's examination, which included visometry, biomicroscopy, and ophthalmoscopy. Results: 10 cases of uveal involvement were detected (9% of 110 pt). 9 patients had anterior segment inflammation (iridocyclitis), in 2 iridocyclitis was combined with retinal changes (in 1- peripheral focal chorioretinitis, in 1- iridocyclitis and central focal chorioretinitis). In one case, iridocyclitis was combined with optic neuropathy. In 3 children uveitis appeared at the disease debute, in the others 3-10 years later. Uveal inflammation in all cases was on the side of scleroderma skin involvement. In 3 children uveitis was bilateral. Seizures and concomittant foci in white matter of the brain were detected in 2 children with uveitis. 90% of the group had positive antinuclear factor. Persistent decrease in visual acuity developed in 3 patients. Соnclusion: Patients with LSH must undergo routine eye examination using basic ophthalmological techniques (visometry, biomicroscopy, ophthalmoscopy) every 6 months and highly necessary in case of relapse of scleroderma We assume that patients with UI in LSH must be defined as patients with JSS and treated intensively with systemicglucocorticoids, cytostatics and even biologics in case of resistance.

A high level of hemoglobin and hematocrit is one of the most important laboratory indicators of polycythemia vera (PV). Nevertheless, in some cases, these indicators may be normal or below the norm. This form of the disease is called latent or masked PV (LPV). It has been found that thrombohemorrhagic complications (THC) are more common in LPV patients than in classic PV (CPV) patients. The relationship between JAK2 gene mutation allele burden, thrombocytosis, leukocytosis level and the occurrence of thrombosis during LPV was analysed in different studies. The results some of them were conflicted. It is also possible that this situation occurs due to the delay in diagnosis and treatment of patients with LPV.

Aim: investigate the laboratory and clinical features of the latent form of PV.

Materials and methods: An analysis of PV patients registered in 2019-2020 was conducted. Out of them patients with LPV were distinguished. During diagnosis of the disease, general blood analysis, trepanobiopsy and histological examination of bone marrow, molecular genetic examination of peripheral blood and bone marrow were performed. All numerical indicators obtained in the course of the research were statistically analyzed taking according to the modern recommendations. Indicators in the groups were arranged in the order of variation, and the average indicator, standard error of this indicator, confidence interval for the 95% confidence level (CI-confidence interval) were calculated for each order. For comparing the groups, the integrity criterion p was taken into account. Calculations were performed using ONE-WAY-ANOVA calculation software.

Results: We study 101 patients. Out of them 36 patients with latent polycythemia were identified. The clinical and laboratory parameters of patients with LPV and CPV were compared. In latent PV the complaints of patients were less intense; the size of the spleen was smaller; thrombotic complications were more often; hemoglobin, hematocrit, erythrocytes count was lower; the number of platelets was higher; leukocytes count and JAK2М617F gene allel burden were not statistically different. The most part of LPV patients, in contrast to CPV patients, was in a high-risk group of THC.

Conclusion: According to the obtained results, it can be concluded that timely and correct diagnosis of LPV is very important. Despite the fact that disease passes in a latent, masked form, THC are more likely to occur. This can be attributed to the high platelet count in the blood and the lack of timely treatment of the disease.

In recent years, the prevalence of thoracic aortic aneurysm has increased, and in most cases this pathological condition is diagnosed accidentally. The aim of the current study was to determine the relationship of clinical, laboratory and morphological data with the presence of aorta wall dissection in patients with thoracic aortic aneurysm to reveal factors associated with aorta dissection.

Materials and methods: The following data of 109 patients mean aged of 53 years with thoracic aortic aneurysm (43 patients with aortic dissection) were analyzed: presence/absence of arterial hypertension, indicators of general blood analysis and blood biochemistry, immunomorphological characteristics of the expression of Von Willebrand factor.

Results: Statistically significant differences were found between the incidence of arterial hypertension with respect to the presence or absence of aortic dissection (p=0.002), the relationship between the content of lymphocytes (p=0.021), segmented neutrophils (p=0.001) and the presence of Von Willebrand factor in the medial layer of the aorta, i.e., the prevalence of vasa vasorum (p=0.018), with aortic dissection. The average expression area of Willebrand factor in the medial layer of the aorta during dissection was 3.6 (1.5)%, and in patients without aortic dissection - 0.8 (0.3)%.

Conclusion: The results of the study indicate that aortic dissection in patients with thoracic aortic aneurysm is associated with high blood pressure and is accompanied by the development of an inflammatory reaction.

The present study meticulously delineates the biochemical alterations in serine protease activity and various life variables in patients with kidney failure compared to a control group. By evaluating 160 samples, comprising 80 from individuals with renal failure and 80 from healthy controls, the researchers observed a significant elevation in serine protease activity among kidney failure patients (274.38 ± 1.55 U/L) relative to the control group (173.78 ±1.49 U/L). Beyond serine protease, other enzymes such as lactate dehydrogenase, basal phosphatase, myeloperoxidase, peroxidase, and aspartate aminotransferase also showed heightened activities in renal failure patients; alanine aminotransferase similarly exhibited a notable increase. Conversely, catalase and arylesterase activities were markedly reduced in these patients compared to controls. The mineral profile revealed substantial decrements in calcium, iron, copper concentrations alongside potassium levels in kidney failure sufferers while showing pronounced increments in phosphate, zinc, and sodium concentrations. Furthermore, protein profiles indicated a stark decrease in total protein, albumin levels along with triglycerides and various cholesterol forms except for high-density lipoprotein cholesterol which increased significantly alongside urea, creatinine and glucose levels; globulin and uric acid also saw considerable elevations when contrasted with the control group's data. These comprehensive findings underscore the profound metabolic disruptions inherent to kidney failure while providing pivotal insights into enzyme activities and mineral imbalances associated with this condition.

Background and objectives: This research is considered the first of its kind in Kirkuk City to study the activity of lecithin cholesterol acyl transferase (LCAT), the levels of apolipoprotein A-1 (Apo A-1), and Fatty acid binding protein-4 (FABP4) and some biochemical variables in T2DM patients who uncontrolled the disease (glycated hemoglobin (HbA1C)˃8%) and compared with patients who controlled the disease (HbA1C˂7%) and healthy controls (HbA1C≤5.5%), and find the correlation among them.

Methods: This research included 184 persons [128 patients (70 uncontrolled DM and 58 controlled DM + 56 healthy patients] aged (40-80) years from both sexes. The current study is divided into three groups: uncontrolled DM patients (G1) and controlled DM patients (G2) are compared to healthy controls (G3). Activity of LCAT, concentration of Apo A1, FABP4, insulin, fasting serum glucose (FSG), lipid profile and HbAc1% were evaluated and -correlated.

Results: The study found a significant rise in in HbAc1(%), FSG, TG, Cholesterol, LDL, VLDL, and FABP4 levels in uncontrolled diabetic patients (G1) compared to controlled diabetes (G2) and healthy controls (G3). At the same time, there are no significant (P value =0.2) differences between controlled DM patients (G2) and controlled healthy groups (G3). The study found no significant differences in insulin level among DM patients (G1), controlled DM patients (G2), and healthy controls (G3) (P = 0.2) while the LCAT activity, the concentration of HDL and ApoA1showed significant decreased (P=0.01) among G1, G2, compared to G3.

Background and objectives: This prospective study was conducted at the University Hospital NAO "MUS" (Semey Medical University, Non-Profit Joint-Stock Company (NCJSC) of Semey, Kazakhstan. The objective of our investigation was to delineate potential risk factors associated with coagulopathy among patients presenting with mechanical jaundice.

Materials and methods: One hundred eighty-six patients who underwent surgical procedures between October 2020 and September 2022 in Semey, located in East Kazakhstan, were included in this study. Logistic regression analysis was employed to explore independent associations between non-coagulopathy and its respective correlates.

Results: The gender distribution among participants was as follows: 68 men (36.6%) and 118 women (63.4%), with an average age of 62.2 years (95% confidence interval: 52-72.4). Coagulopathy was observed in 87.9% of patients (N=163). Nine risk factors associated with the development of coagulopathy were included in the binary logistic regression model: nationality (p=0.005), local residence (p=0.01), obesity (p=0.0001), hemoglobin concentration (p=0.003), platelet count (p=0.008), total bilirubin level (p=0.031), alanine aminotransferase (p=0.001), soluble fibrin-monomer complexes (p=0.034), and international normalized ratio (INR) (p=0.005).

Conclusions: The majority of patients developed coagulopathy, and key sources of its occurrence were identified. Surgeons need to pay closer attention to patients of Kazakh ethnicity with obesity, as well as to those with mild anemia, elevated levels of platelet count, soluble fibrin-monomer complexes, alanine aminotransferase, and international normalized ratio, as they are more likely to develop coagulopathy. Additionally, patients with moderate or severe jaundice are also more prone to the development of coagulopathy.

Median sternotomy has been the conventional approach for correction of atrial septal defect despite poor cosmetic results at times. Right anterior minithoracotomy was, therefore, assessed as an alternative procedure with a better cosmetic outcome.

Material and methods: from April 2008 through February 2017 102 patients underwent correction of atrial septal defect with the use of normothermic perfusion on a beating heart through right anterior minithoracotomy involving a short incision through the fourth intercostals space and the direct cannulation. The 75 were female and 27 male end the averaging age 19,2±2,0 years. The corrected defects included atrial septal defect type II, atrial septal defect with short aortic edge, atrial septal defect with short inferior edge, atrial septal defect with short superior edge, sinus venosus superior type atrial septal defect and sinus venosus inferior type atrial septal defect. The length of the skin incision varied from 4 to 10 cm, depending on the age of the patient.

Results: There was no operative or late mortality or major morbidity. The mean cardiopulmonary bypass time was 19±4 minutes, the duration of mechanical ventilation after surgery in patients was 2,4±0,9 hours. Cosmetic result was very satisfactory in all patients.

Conclusions: The right anterior minithoracotomy incision is a safe and effective alternative to a median sternotomy for correction of atrial septal defect. Cosmetic results are highly satisfactory.

Objective: Explore the effectiveness of ultrasound-guided percutaneous catheter drainage (PCD) combined with somatostatin in the treatment of severe pancreatitis (SAP) patients.

Methods: A retrospective study method was adopted to select 95 patients with SAP who were treated in our hospital from January 2018 to June 2022 for clinical research. Among them, 48 patients received routine treatment+somatostatin (control group), and other 47 patients received ultrasound guided PCD treatment on the basis of the control group (research group). The differences in the peripheral white blood cells (WBC), procalcitonin (PCT), interleukin-6 (IL-6), and Tumor Necrosis Factor- α(TNF- α), prostacyclin I2 (PGI2), plasma thromboxane 2 (TXA2), blood amylase, serum albumin (ALB), acute physiological function and chronic health score (APACHE II), sequential organ failure score (SOFA), and clinical efficacy were compared. The ICU treatment time, hospital stay, and incidence of complications were also recorded for the two groups of patients.

Results: Before treatment, there was no statistically significant difference in APACHE II score and SOFA score between the research group and the control group (P>0.05); The APACHE II scores of the research group after 14 days of treatment and 28 days of treatment were lower than those of the control group. The SOFA scores of the research group after 28 days of treatment were lower than those of the control group, and the differences were statistically significant (P<0.05); Before treatment, there was no statistically significant difference in WBC, PCT, IL-6, TNF-α, PGI2, TXA2, blood amylase, and ALB levels between the research group and control group (P>0.05); PCT, IL-6, TNF-α, TXA2 and blood amylase levels in the research group after 28 days of treatment were lower than that in the control group, and the differences were statistically significant (P<0.05); The ICU treatment time and hospitalization time of the research group were lower than those of the control group, and the differences were statistically significant (P<0.05); After 28 days of treatment, clinical efficacy evaluation was conducted, and the overall efficacy of the research group patients was better than that of the control group, with statistically significant differences (P<0.05); The complication rate of the research group was 27.66%, and that of the control group was 47.92%, which was significantly lower in the research group than in the control group (P<0.05).

Conclusion: Ultrasound guided PCD combined with somatostatin treatment for SAP patients can more effectively alleviate the degree of inflammatory response, effectively alleviate the severity of the patient's condition, reduce the occurrence of related complications, and improve clinical treatment effectiveness.

The prevalence of deaths from cervical cancer (CC) in the word was around 350.000 in the last 5 years, indicating the need to analyze the potential causality and current management approaches. This study aimed to evaluate the level of knowledge regarding CC, including its risk factors, signs and symptoms and early detection methods, as well as the awareness and attitude of participants toward the screening tests.

Methods: This cross-sectional study was conducted between August and October of 2023 in a representative sample of 18-59 years old Armenian women. Data were generated using structured interviews with self-administered questionnaire and adopted from similar studies and translated into Armenian.

Results: Majority of the survey respondents demonstrated moderate awareness about the risk factors, signs and symptoms of the condition. The poorest knowledge regarding the preventive colposcopy screening method of CC was observed. Comparison of demographic characteristics of participants and their awareness regarding the inquired topics revealed evident relationship between the disease rate and studied variables. A strong relationship was observed between the awareness of CC risk factors and CC symptoms of the disease and age groups, residency, number of children, insurance and employment status, level of education and level of income.

Conclusion: The short period of the survey and a fast track of data analysis with independent variables has revealed the region-specific current rates for the assessed variables and their relationship. The study added more facts to the existing body of knowledge about the implementation strategies and limitations of CC screening programs.