Almanac of Clinical Medicine最新文献

{"title":"Comparison of in-hospital and long-term mortality and assessment of their predictors in patients with myocardial infarction and unstable angina","authors":"A. Shchinova, A. Potekhina, Y. Dolgusheva, Yuliya E. Efremova, A. Osokina, A. Filatova, E. V. Sorokin, I. I. Shestova, S. I. Provatorov","doi":"10.18786/2072-0505-2023-51-013","DOIUrl":"https://doi.org/10.18786/2072-0505-2023-51-013","url":null,"abstract":"Background: The extent of myocardial damage largely determines both in-hospital and long-term mortality in patients with acute coronary syndrome. According to the literature, the in-hospital and long-term mortality rates in patients with unstable angina (UA) are lower than those in the patients with myocardial infarction (MI). \u0000Aim: To evaluate the in-hospital and long-term mortality rates and their predictors in patients undergoing in-patient treatment for acute coronary syndrome (MI and UA) in the regional cardiovascular center with the service territory of 1 million persons. \u0000Materials and methods: This retrospective registry study enrolled 1130 patients (715 [63.3%] men, 415 [36.7%] women) who were treated for UA and MI in the regional cardiovascular center in 2019. Based on the discharge diagnosis, the patients were divided into two groups: patients with MI (n = 766) and those with an UA episode (n = 364). The in-hospital and delayed mortality rates, as well as their predictors, were analyzed in both groups. The mean duration of the follow-up was 17.8 3.6 months. \u0000Results: The in-hospital mortality in patients with confirmed MI was 11.1% (85 patients) versus 0.27% (1 patient) in the UA patients (p 0.001). The independent predictors of in-hospital mortality in MI patients were a decreased left ventricular ejection fraction (LV EF) (odds ratio (OR) 0.9021, 95% confidence interval (CI) 0.82090.9914, p = 0.0324), chronic kidney disease C3a and above (OR 9.3205, 95% CI 2.670632.5283, p = 0.0005), and the extension of coronary involvement at coronary angiography (OR 1.3526, 95% CI 1.06670.0127, p = 0.0127). The long-term mortality in MI patients was 10.4% (72 patients) with no significant difference from that in UA patients (9.9%, 36 patients, p = 0.76). The independent predictors of long-term mortality after MI were older age (OR 1.12, 95% CI 1.011.22, p = 0.0052), chronic kidney disease C3a and above (OR 2.3375, 95% CI 1.13924.7963, p = 0.0206), decreased EF (OR 0.8895, 95% CI 0.730.99, p = 0.0364), atrial fibrillation on admission (OR 3.1462, 95% CI 1.35107.3268, p = 0.0079), and diabetes mellitus (OR 2.3163, 95% CI 1.25524.2744, p = 0.0072). In the UA patients, the predictors of the long-term mortality were a decrease in LV EF (OR 0.9139, 95% CI 0.86830.9619, p = 0.0006) and in blood hemoglobin level (OR 0.9729, 95% CI 0.95440.9917, p = 0.0050). \u0000Conclusion: The in-hospital mortality in UA patients is lower than that in MI patients, with comparable long-term mortality. This indicates the need of active follow-up of the patients with past UA, irrespective of the endovascular assessment and intervention.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"294 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73525638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of molnupiravir in adult outpatients with COVID-19","authors":"N. Pshenichnaya, K. Omarova, L. Balykova, K. Zaslavskaya, D. N. Zemskov, A. V. Taganov, P. A. Belyy, A. Gorelov, D. Pushkar","doi":"10.18786/2072-0505-2023-51-014","DOIUrl":"https://doi.org/10.18786/2072-0505-2023-51-014","url":null,"abstract":"Background: One of the basic principles for the treatment of COVID-19 patients is the early initiation of etiotropic therapy. The evidence base for assessment of the efficacy and safety of antivirals for COVID-19 continues to expand with new clinical trials. One of the promising etiotropic medications is molnupiravir. \u0000Aim: To evaluate the efficacy and safety of molnupiravir (Esperavir) in outpatients with COVID-19. \u0000Materials and methods: This randomized comparative open-label clinical study was conducted from December 1, 2021 to March 11, 2022 in 12 research centers in the Russian Federation. The study involved 240 outpatients with mild and moderate COVID-19. The mean age of patients was 43.5 years; 70,0% (168/240) of the patients had comorbidities, mainly obesity grade II and arterial hypertension. The outpatients were treated with molnupiravir (Esperavir, PROMOMED RUS LLC, Russia) in 4 capsules 200 mg twice daily (every 12 hours), with the single dose being 800 mg and the daily dose 1600 mg. Duration of treatment was 5 days. The patients were followed up for 28 days. The patients in the standard treatment group (n = 120) received antiviral therapy recommended for outpatients by the provisional guidelines effective at the time of the study. Pathogenetic and symptomatic therapy in both groups was comparable. \u0000Results: The results of the clinical study in 240 outpatients with mild or moderate COVID-19 showed that molnupiravir at a dose of 800 mg twice daily for 5 days significantly reduced (by 4-hold at days 1415 of the follow-up) the risk of disease progression to more severe course, compared with the standard therapy group (2.5% (3/120) and 10.0% (12/120) of patients; p = 0.0149.) By days 67 of the follow-up, the virus had been eliminated in 71.67% of the patients treated with the study drug and only in 58.3% (70/120) of the patients in the standard therapy group. Complete clinical recovery at days 67 was achieved in 19.2% (23/120) of the patients in the molnupiravir group, compared to 5.8% (7/120) in the standard therapy group. Compared to the standard therapy, treatment with molnupiravir also significantly reduced the frequency and severity of the disease symptoms, such as cough and change in odor or taste perception over the last 24 hours, already at 67 days after the start of treatment. Molnupiravir treatment was well tolerated, most adverse events were mild. There were no cases of drug withdrawal or dose modification of the study drug due to adverse events. \u0000Conclusion: The results of the clinical study of antiviral agent molnupiravir (Esperavir) have proven its benefits over standard therapy in outpatients with mild and moderate COVID-19 in terms of the disease worsening risk reduction and hospitalization, the rate of viral elimination, the changes in symptoms severity over time, improvement of the patients general status and clinical condition and reduction of COVID-19 complications both in patients without and with risk factors for sev","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73048034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of Reed-Berezovsky-Sternberg cells in lymphatic nodes in classic Hodgkin's lymphoma by flow cytometry: a clinical case series","authors":"F. М. Abbasbeyli, A. Fedenko, Pervin A. Zeynalova, Тatyana Y. Mushkarina, A. Melnikova, L. Grivtsova","doi":"10.18786/2072-0505-2023-51-015","DOIUrl":"https://doi.org/10.18786/2072-0505-2023-51-015","url":null,"abstract":"Despite their B cell origin, Reed-Berezovsky-Sternberg tumor cells (RBS) in classic Hodgkin's lymphoma (cHL) demonstrate an absolutely unique phenotype. Immunohistochemistry of RBS cells is positive for CD15 antigen in most of cases, CD30, PAX-5; they do not express the T cell antigen CD3, В cell CD19, and in most cases are negative for the B cell antigen CD20, as well as for common leukocyte antigen CD45. Taking into account such unequivocal immunophenotype, RBS cells can be identified by multiparameter flow cytometry. Thus, J.R. Fromm et al. (2006, 2014) have convincingly shown the possibility to identify RBS cells in a puncture and/or biopsy sample of lymphatic nodes in cHL and were of the fair opinion that such rather simple and reproducible technique as flow cytometry could be an additional diagnostic instrument in cHL. \u0000We have tested the technique proposed by J.R. Fromm et al. for the assessment of lymphatic node involvement in cHL and used 8 to 10-parameter flow cytometry for detection RBS cells in cHL in 8 biopsy samples of a lymphatic node, and confirmed the feasibility to identify RBS cells by high performance flow cytometry. We also performed morphological and immunohistochemical assessment of the biopsy samples of lymphatic nodes from patients with suspected cHL. The study included clinical cases with immunohistochemically confirmed cHL (n = 8), and the control samples were from those with other diagnoses than Hodgkin's lymphoma. In all cases of cHL we found RBS cells. In future we plan to analyze larger case samples by flow cytometry.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83497409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative computed tomography perfusion navigation for maximal resection of high grade gliomas: a prospective non-randomized trial","authors":"R. Talybov, T. N. Trofimova, V. Mochalov, I. V. Shvetsov, V. V. Spasennikov","doi":"10.18786/2072-0505-2023-51-012","DOIUrl":"https://doi.org/10.18786/2072-0505-2023-51-012","url":null,"abstract":"Background: The main purpose of surgery for glioblastoma is to ensure the maximally possible cytoreduction. Computed tomography perfusion imaging has non-invasive tools for assessment of tumor blood flow and allows for visualization of the tumor borders and its most malignant zones. \u0000Aim: To evaluate the efficacy of intraoperative computed tomography perfusion navigation (ICTPN) during surgery for high grade gliomas. \u0000Materials and methods: This prospective non-randomized study included 142 patients (76 men and 66 women) with morphologically verified diagnosis of glioblastoma or diffuse astrocytoma grade 4 (World Health Organization 2021 criteria), who had surgery from 2016 to 2022. The ICTPN-based procedures were performed in 94 patients, with 55 with gross total and 39 with subtotal tumor resection. The control group included 48 patients with non-ICTPN-based surgical procedures. All patients were treated with standard adjuvant chemoradiation therapy. The efficacy of surgery was assessed every 3 months. The study endpoint was any tumor progression. The duration of the follow-up was 15 months. Baseline and contrast-enhanced preoperative imaging and postoperative follow-up assessments were performed with a 3T magnetic resonance imaging scanner (General Electric Discovery W750). ICTPN was done with a 32 slice computed tomography scanner (Toshiba Aquilion LB). \u0000Results: In the totally resected ICTPN group, the mean duration of the relapse-free period was 13.05 months; the relapse-free survival at 6 and 12 months was 92 and 55%, respectively (p 0.001). These results were significantly better than those in the subtotally resected ICTPN patients (8.98 months, 66 and 9%, respectively; log rank test for Kaplan-Meier curves, p 0.001) and in non-ICTPN patients (5.81 months, 23 and 0%, respectively, log rank test, p 0.001). \u0000Conclusion: ICTPN enables a more objective assessment of the tumor borders and the extent of its resection, as well as relapse-free survival benefits for the patients.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79483573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemorrhage into a somatotropinoma аs a first reason for examination of a patient with previously undiagnosed acromegaly and papillary thyroid cancer","authors":"G. Nurullina, Igor N. Pushkarev, E. Pigarova, N. V. Latkina, G. I. Akhmadullina","doi":"10.18786/2072-0505-2023-51-011","DOIUrl":"https://doi.org/10.18786/2072-0505-2023-51-011","url":null,"abstract":"Pituitary apoplexy is a rare acute condition that can be caused by hemorrhage into the pituitary adenoma or its infarction. This is accompanied by severe headache, nausea, vomiting, photophobia, visual and oculomotor disorders, loss of consciousness, and can also lead to a decrease in the production of a number of hormones by the pituitary gland, i.e. hypopituitarism. We present a clinical case of a 42-year female patient with previously undiagnosed acromegaly and papillary thyroid cancer. The reason for the examination was clinical symptoms of pituitary apoplexy. Right hemithyroidectomy with central and lateral lymphadenectomy was performed for her papillary thyroid cancer, followed by radioactive iodine therapy due to an increased risk of cancer progression. Hemorrhage into the pituitary adenoma in this patient has led to panhypopituitarism and remission of acromegaly. Insulin-like growth factor 1 and growth hormone levels during oral glucose tolerance test were within the reference values, which made the diagnosis of acromegaly challenging.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74680484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive impairment and its treatment in patients with multiple sclerosis","authors":"A. Zabirova, I. Bakulin, A. Poydasheva, M. Zakharova, N. Suponeva","doi":"10.18786/2072-0505-2023-51-009","DOIUrl":"https://doi.org/10.18786/2072-0505-2023-51-009","url":null,"abstract":"Cognitive impairment (CI) is a relatively common manifestation of multiple sclerosis (MS), which can occur with any type of the disease course and activity. The largest CI prevalence and severity are observed in progressive MS. In relapsing-remitting MS the most prominent deterioration of cognitive functions is seen during relapses; however, in some patients it can continue also throughout remission. In a small number of patients CI can be the most significant symptom of the disease; in addition, it sometimes can be the only clinical feature of the relapse. Despite this, in clinical practice CI remains out of the focus of attention, and is not evaluated when assessing the disease severity and/or activity, while CI is not included into EDSS. Nonetheless, a number of specialized neuropsychological tests and batteries has been developed recently, which can be used for both screening and detailed assessment of CI in MS, as well as for assessment of its changes over time. \u0000CI has a negative impact on MS patients' quality of life, their social interactions, daily and occupational activities. The influence of disease-modifying agents on CI has been poorly investigated; however, there is evidence that they can reduce the degree of CI. The optimal choice of pathogenetic treatment in patients with CI remains understudied. There is no convincing evidence of the effectiveness of symptomatic pharmacological treatment of CI in MS, and cognitive rehabilitation is the only approach with confirmed effectiveness. Considering the limitations of this technique (its availability, quite a big number of sessions), there is a need to search for other methods to increase its efficacy, including non-invasive neuromodulation (in particular, transcranial direct current stimulation or transcranial magnetic stimulation). This article is focused on a brief review of the main diagnostic methods of CI in MS, its pathogenetic and symptomatic treatment, and cognitive rehabilitation techniques, as well as on the results of the studies on non-invasive neuromodulation.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88591702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left ventricular diastolic function in adult patients with an atrial septal defect and its age-dependent changes over time after transcatheter closure of the defect","authors":"I. Kovalchuk, I. R. Rafaeli, V. A. Kryukov, A. Rogatova, A. V. Azarov, S. A. Kurnosov, D. G. Ioseliani","doi":"10.18786/2072-0505-2023-51-008","DOIUrl":"https://doi.org/10.18786/2072-0505-2023-51-008","url":null,"abstract":"Background: There are no echocardiographic (echoCG) criteria to predict whether adult patients with an atrial septal defect (ASD) will develop post-procedural left ventricular (LV) failure after the defect closure. \u0000Aim: To evaluate the LV diastolic function before and after the intervention in ASD patients depending on their age and, based on this, to identify potential echoCG risk factors for the development of acute heart failure immediately after the ASD closure. \u0000Materials and methods: This retrospective study included 69 patients with the mean age of 44.2 14.5 years and 57 (82.6%) being women. The patients were divided into 2 age groups: group 1 included 39 (56.5%) patients aged 18 to 49 years (mean SD, 35.4 9.4 years) and group 2, 30 (43.5%) patients aged 50 to 74 years (mean SD, 60.1 6.1 years). The characteristics of the ASD, heart chambers and LV diastolic function were assessed with transthoracic and transesophageal echoCG. The indexed indicators of the left atrial (LA) and LV volumes were measured before the intervention and in the postoperative period and compared. LV diastolic function was assessed by the e lateral (determined by tissue Doppler imaging, TDI) and E/e ratio (reference values 10 cm/s and 8, respectively). \u0000Results: The indexed LA volume at baseline in the second group was slightly higher than in the first one (27.6 9.8 ml/m2 and 25.4 7.1 ml/m2; p = 0.311), whereas there was no between-group difference in the baseline indexed LV volume parameters (41.8 7.9 ml/m2 and 42.4 8.6 ml/m2, respectively; p = 0.768). Immediately after the closure of the ASD, LV diastolic function deteriorated. In the patients below 50 years of age, this difference was non-significant, despite significant changes in the E/e values (from 7.6 3.6 to 9.9 4.1; p = 0.012). In the second age group, this parameter increased significantly (from 9.2 5.7 to 13.1 4.3, respectively; p = 0.005). The TDI index (e lateral) decreased in both groups: in the group 1, from 11.9 2.5 to 9.1 2.2 (p 0.001) and in the group 2, from 9.3 3.6 to 7.9 1.6 (p = 0.061). Two patients of the elderly group, in whom sings of LV failure were identified immediately after the defect closure, by echoCG showed the lowest TDI values (е lateral) (7.8 and 8.0 cm/sec before closure and 6.4 and 7.0 cm/sec thereafter), as well as the highest values E/e before closure (13.4 and 13.1, respectively). In the long-term (12.5 6.5 months on average), the E/e index decreased in both age groups, compared to that in the early postoperative period, approaching the preoperative parameters (group 50 years of age: 7.6 3.6 9.9 4.1 8.7 4.8, group 50 years of age, 9.2 5.7 13.1 4.3 10.8 5.6). The TDI e indicators also shifted close to their initial values, increasing from 9.1 2.2 to 11.6 1.9 in the group 50 years of age and from 7.9 1.6 to 8.9 2.8 in the group 50 years of age. In the long-term, the LA volume index in both groups was unchanged, compared to its baseline values. The indexed LV end diastolic volum","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"370 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74549460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bile acid dysmetabolism in inflammatory bowel diseases","authors":"D. Kuznetsova, S. Lapin, I. Gubonina","doi":"10.18786/2072-0505-2023-51-007","DOIUrl":"https://doi.org/10.18786/2072-0505-2023-51-007","url":null,"abstract":"Aim: To summarize the state-of-the-art data on the molecular mechanisms of bile acid (BA) synthesis and absorption, their impaired absorption and receptor-dependent signaling, as well as on the effects of the gut microbiota on BA metabolism in inflammatory bowel diseases (IBD). \u0000Key messages: BA malabsorption is one of the relevant mechanisms in the development of diarrhea in IBD. It may occur due to various disorders of the ileum, such as terminal ileitis, ileocolitis or ileocecal resection in Crohn's disease and ileoanal reservoir in ulcerative colitis. Molecular mechanisms of BA malabsorption in IBD are related to a defect in the BA uptake by the apical sodium dependent bile acid transporter (ASBT), as well as to a decrease in the expression of pregnane X receptor (PXR) and farnesoid X receptor (FXR), whose activation by glucocorticoids results in an increase in the BA reabsorption in the ileum and a decrease in hologenic diarrhea. The metabolic profile of luminal BA in IBD is characterized by an increased content of conjugated and 3-OH-sulfated BA and reduced levels of secondary BA. The decrease in the relative abundance of the Lachnospiraceae and Oscillospiraceae spp. in IBD patients leads to a decrease in the efficiency of microbial biotransformation of BA. Changes in the BA metabolic profile in IBD affect the gut microbiota, and impaired interaction with the FXR, PXR, G protein-coupled bile acid receptor (GPBAR1), retinoid-related orphan receptors (RORs) and vitamin D receptor (VDR) results in a pro-inflammatory response and increased intestinal permeability, bacterial translocation, and IBD progression. BA metabolism in IBD-associated primary sclerosing cholangitis (PSC-IBD) is characterized by a significant decrease in the luminal BA pool, and the microbiota composition is remarkable for an increase in the relative abundance of Fusobacterium and Ruminococcus spp., and a decrease in Veillonella, Dorea, Blautia, Lachnospira and Roseburia. \u0000Conclusion: Disordered synergistic interplay of BA with intestinal microbiota results in disruption of the ligand-receptor interaction and BA metabolic transformation, which contributes to the activation of the immune system, formation of a vicious circle of chronic inflammation and IBD progression. Further studies into mutual influence of the gut microbiota, BA metabolism and receptor signaling may promote the development of new methods for the diagnosis and treatment of IBD.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75758469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the neutrophil-leukocyte index in patients with cardiac disorders and new coronavirus infection","authors":"R. Litvinenko, R. T. Velibekov, S. V. Gaiduk, K. Zhdanov, Darya P. Narolskaya","doi":"10.18786/2072-0505-2023-51-006","DOIUrl":"https://doi.org/10.18786/2072-0505-2023-51-006","url":null,"abstract":"Background: The neutrophil-leukocyte index (NLI) is an independent predictor of an unfavorable outcome in stable ischemic heart disease, as well as of mortality in patients with acute coronary syndromes and uncontrolled heart failure. A number of studies have shown the informative value of NLI for the prediction of severe course of COVID-19. NLI variability in COVID-19 with comorbid baseline physical diseases and cardiovascular disorders in particular, has not been studied. \u0000Aim: To evaluate the clinical value of NLI in hospitalized patients with COVID-19 depending on their concomitant cardiac disorders. \u0000Materials and methods: In this retrospective quantitative study we have analyzed the data from medical files of the patients with the diagnosis of new coronavirus infection confirmed by polymerase chain reaction, treated in a specialized in-patient department of infectious diseases in 2020 to 2022. Previously diagnosed cardiac disorders were defined as any past history of these disorders. The results of instrumental and laboratory work-up were assessed before treatment. \u0000Results: The analysis included 226 patients with median age of 50.0 (Q1Q3: 42.063.0) years, with 81.4% (n = 184) of them being men. Ninety four (41.6%) patients had no previously diagnosed cardiovascular disorders. Arterial hypertension by the time of admittance was present in 132 (58.4%), ischemic heart disease, in 77 (34.1%), atherosclerotic and/or post-infarct cardiosclerosis, in 82 (36.3%), and chronic heart failure, in 77 (34.1%) of the patients. \u0000In the total study group (n = 226) the median NLI was 2.6 (1.574.47). The larger was the volume of the lung involvement (assessed by computed tomography at admittance), the higher was NLI (p = 0.009, Kruskal-Wallis test). There was an association between the NLI value and the degree of respiratory failure (p 0.001, Kruskal-Wallis test). Median NLI in the patients with cardiac disorders (irrespective of their nosology) was significantly higher than that in the patients without any history of cardiovascular problems: 3.30 (2.095.42) versus 1.95 (1.423.62) (p 0.001, Mann-Whitney U-test). We found significant difference in the NLI values for each type of cardiac disorders, compared to that in the patients without history of cardiovascular disorders, including for the patients with arterial hypertension (p 0.001, Kruskal-Wallis test), ischemic heart disease (p 0.001, Mann-Whitney U-test), atherosclerotic cardiosclerosis (p = 0.001, Mann-Whitney U-test), and chronic heart failure (p = 0.040, Kruskal-Wallis test). \u0000Conclusion: We have confirmed the contribution of cardiovascular disorders to the course of COVID-19 and the clinical value of NLI as a convenient laboratory marker of the severity of infectious disease.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91060060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The results of surgery for giant aneurysms of the middle cerebral arteries: a retrospective study","authors":"Yu V Pilipenko, S. Eliava, A. Konovalov, F. Grebenev, B. Barchunov","doi":"10.18786/2072-0505-2023-51-005","DOIUrl":"https://doi.org/10.18786/2072-0505-2023-51-005","url":null,"abstract":"Background: Surgical treatment of middle cerebral artery (MCA) giant aneurysms is a challenging task. The information on its current principles is rather limited, with the publications based on isolated case reports and small series. \u0000Aim: To identify the types of procedures and evaluate the results of surgery in patients with giant MCA aneurysms. \u0000Materials and methods: We retrospectively analyzed the data on 55 patients who had undergone surgery for MCA giant aneurysms in the Burdenko Neurosurgery Center from 2010 to 2021. Thereafter 52 patients were followed up for 6 to 120 months (for 53.1 33.7 months on average). \u0000Results: The giant MCA aneurysms were located at the M1 segment bifurcation in 33 (60%) patients, within the M1 segment, in 11 (20%), M2 in 7 (12.7%), and M3 and M4 in 4 (7.3%) patients. There were 32 (58.2%) saccular and 23 (41.8%) fusiform aneurysms. Surgical interventions for MCA giant aneurysms included their neck clipping (50.9%, n = 28), clipping with formation of the arterial lumen (3.6%, n = 2), bypass procedures (34.5%, n = 19), wrapping (3.6%, n = 2), and endovascular procedures (7.3%, n = 4). Perioperative worsening of the neurologic status (The Modified Rankin Scale, mRS) was observed in 50.9% (n = 28) of the patients, and the death rate was 1.8% (n = 1). The complete closure of giant aneurysms was achieved in 78.2% (n = 43) of the cases. The long-term outcome was favorable in 76.9% of the patients (40 from 52 available for the follow up). \u0000Conclusion: Microsurgical clipping and bypass types of surgery were the most common surgical procedures for the treatment of MCA giant aneurysms. These procedures are technically complex and are associated with a relatively high number of complications. The main directions of future studies could be in the search for new and more precise diagnostic assessment of the collateral circulation in the cortical MCA branches, improvement of the algorithm for the bypass selection, as well as an investigation of the long-term results of endovascular and combined treatments. A thorough long-term postoperative patient follow-up and the possibility of high quality control angiography are of major importance.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74595411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}