Pub Date : 2022-10-21DOI: 10.18786/2072-0505-2022-50-036
E. Grigoryev, A. Ponasenko, A. Tsepokina, A. Ivkin, R. Kornelyuk
Aim: To assess the level of microRNA expression in the serum of patients who had undergone cardiac surgery depending on the postoperative complications (presence or absence of multiorgan failure, MOF). Materials and methods: The study group included 87 patients who had undergone heart surgery with cardiopulmonary bypass. The patients without postoperative complications comprised group 1 (n = 51), whereas those with postoperative MOF were in group 2 (n = 36). In all patients, blood samples were collected at two time points: before surgery and at 36 to 48 hours after surgery. The following miRNAs were chosen for the study: hsa-miR-486-5p (478128_miR), hsa-miR-191-5p (477952_miR), hsa-miR-192-5p (478262_miR), hsa-miR-146a-5p (478399_miR), hsa-miR-26a-5p (477995_miR), hsa-miR-30d-5p (478606_miR), hsa-miR-23a-3p (478532_miR), and hsa-miR-320a-5p (481049_miR). Polymerase chain reaction results were normalized to hsa-miR-16-5p (4427975). Results: Up-regulating miRNAs. Compared to baseline, there was a significant postoperative increase in miR-486-5p microRNA expression (group 1, 41.83 [19.86; 74.6] vs 940 [434.7; 1212.0]; group 2, 72.55 [21.37; 100.2] vs 492.4 [201.2; 998.0]; both p 0.001). An increase in the of microRNA miR-192-5p expression in the postoperative period was found both in the no-MOF group (from 0.39 [0.16; 1.07] at baseline to 5.96 [3.74; 10.35] after surgery, p = 0.002), and in the MOF group (from 1.74 [0.45; 3.35] at baseline to 17.16 [4.70; 24.96] after surgery, p = 0.003), with a statistically higher level of expression in group 2 (p = 0.028). Similar changes over time were observed for miR-30d-5p expression: group 1, 1.61 [0.47; 4.36] at baseline vs 5.03 [2.93; 6.56] after surgery (p = 0.002), group 2, 0.89 [0.32; 4.27] at baseline and 6.63 [3.92; 12.82] after surgery, respectively (p = 0.0045). Down-regulating miRNAs. The miR-191-5 and miR-146a-5p families demonstrated a significant increase in group 1 after surgery (3.85 [1.64; 5.6] vs 7.7 [5.48; 9.68], p = 0.021; and 18.1 [6.52; 19.9] vs 37.27 [29.13; 47.07], p = 0.016, respectively) and a significant postoperative decrease in group 2 (3.67 [2.60; 7.61] vs 1.66 [0.52; 2.36], p = 0.023; and 14.75 [12.79; 21.77] vs 5.96 [2.8; 8.2], p = 0.034, respectively), with between-group difference in the postoperative expression levels being also significant. As regards to miR-26a-5p и miR-23a-3p families, there was a similar trend: the group with uncomplicated postoperative course was had virtually no changes over time in their expression (the increase was non-significant), whereas the MOF group had lower postoperative values for this microRNA family. The between-group differences after surgery were significant for miR-26a-5p (group 1, 6.79 [3.38; 8.46], group 2, 0.26 [0.18; 1.9], p = 0.037) and for miR-23a-3p (14.14 [11.92; 26.63] and 2.0 [1.02; 4.18], respectively, p 0.001). Conclusion: When comparing microRNA expression before surgery, we did not find any significant differences betwe
目的:评估心脏手术患者血清中microRNA的表达水平与术后并发症(是否存在多器官衰竭，MOF)的关系。材料与方法:研究组纳入87例行心脏手术合并体外循环的患者。无术后并发症患者为1组(n = 51)，有术后MOF患者为2组(n = 36)。所有患者在手术前和手术后36 - 48小时两个时间点采集血样。选择以下mirna进行研究:hsa-miR-486-5p (478128_miR)， hsa-miR-191-5p (477952_miR)， hsa-miR-192-5p (478262_miR)， hsa-miR-146a-5p (478399_miR)， hsa-miR-26a-5p (477995_miR)， hsa-miR-30d-5p (478606_miR)， hsa-miR-23a-3p (478532_miR)和hsa-miR-320a-5p (481049_miR)。聚合酶链反应结果归一化为hsa-miR-16-5p(4427975)。结果:miRNAs上调。与基线相比，术后miR-486-5p microRNA表达显著升高(第1组，41.83 [19.86;74.6] vs 940 [434.7;1212.0);第2组，72.55 [21.37;100.2] vs 492.4 [2010.2;998.0);p均为0.001)。术后无mof组均发现microRNA miR-192-5p表达升高(从0.39 [0.16;1.07]基线至5.96 [3.74;10.35]术后，p = 0.002)， MOF组从1.74 [0.45;3.35]基线至17.16 [4.70];24.96]术后，p = 0.003)，且2组表达水平更高(p = 0.028)。随着时间的推移，miR-30d-5p的表达也发生了类似的变化:第1组，1.61 [0.47;4.36]基线vs 5.03 [2.93;6.56]术后(p = 0.002)， 2组0.89 [0.32];4.27]基线和6.63 [3.92;12.82]术后，差异有统计学意义(p = 0.0045)。显示microrna。术后1组miR-191-5和miR-146a-5p家族显著升高(3.85 [1.64;5.6 vs 7.7 [5.48;9.68]， p = 0.021;18.1 [6.52;19.9] vs 37.27 [29.13;47.07]， p = 0.016)，组2术后明显下降(3.67 [2.60;7.61] vs . 1.66 [0.52;2.36]， p = 0.023;14.75 [12.79;21.77] vs 5.96 [2.8;8.2]， p = 0.034)，术后表达水平组间差异也有统计学意义。至于miR-26a-5p, miR-23a-3p家族，也有类似的趋势:术后病程不复杂的组其表达几乎没有随时间的变化(增加不显著)，而MOF组该microRNA家族的术后值较低。术后miR-26a-5p组间差异有统计学意义(1组，6.79 [3.38;8.46]，第二组，0.26 [0.18;1.9]， p = 0.037)， miR-23a-3p (14.14 [11.92;26.63]和2.0 [1.02;4.18]， p 0.001)。结论:术前microRNA表达比较，MOF组与非MOF组无明显差异。术后对无mof组的microRNA表达的评估显示，负责上调(miR-486-5p、miR-192-5p、miR-30d-5p)和下调(miR-191-5p、miR-146a-5p)的microRNA表达均有所增加。在复杂的术后过程和MOF组中，随着时间的推移，上调的microrna的变化特征是表达增加(miR-486-5p, miR-192-5p, miR-30d-5p)，而下调的microrna (miR-191-5p, miR-146a-5p)的表达明显降低，这与无MOF组和基线值不同。
{"title":"The level of microRNA expression in cardiac surgery patients depends on postoperative multiorgan failure","authors":"E. Grigoryev, A. Ponasenko, A. Tsepokina, A. Ivkin, R. Kornelyuk","doi":"10.18786/2072-0505-2022-50-036","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-036","url":null,"abstract":"Aim: To assess the level of microRNA expression in the serum of patients who had undergone cardiac surgery depending on the postoperative complications (presence or absence of multiorgan failure, MOF). \u0000Materials and methods: The study group included 87 patients who had undergone heart surgery with cardiopulmonary bypass. The patients without postoperative complications comprised group 1 (n = 51), whereas those with postoperative MOF were in group 2 (n = 36). In all patients, blood samples were collected at two time points: before surgery and at 36 to 48 hours after surgery. The following miRNAs were chosen for the study: hsa-miR-486-5p (478128_miR), hsa-miR-191-5p (477952_miR), hsa-miR-192-5p (478262_miR), hsa-miR-146a-5p (478399_miR), hsa-miR-26a-5p (477995_miR), hsa-miR-30d-5p (478606_miR), hsa-miR-23a-3p (478532_miR), and hsa-miR-320a-5p (481049_miR). Polymerase chain reaction results were normalized to hsa-miR-16-5p (4427975). \u0000Results: Up-regulating miRNAs. Compared to baseline, there was a significant postoperative increase in miR-486-5p microRNA expression (group 1, 41.83 [19.86; 74.6] vs 940 [434.7; 1212.0]; group 2, 72.55 [21.37; 100.2] vs 492.4 [201.2; 998.0]; both p 0.001). An increase in the of microRNA miR-192-5p expression in the postoperative period was found both in the no-MOF group (from 0.39 [0.16; 1.07] at baseline to 5.96 [3.74; 10.35] after surgery, p = 0.002), and in the MOF group (from 1.74 [0.45; 3.35] at baseline to 17.16 [4.70; 24.96] after surgery, p = 0.003), with a statistically higher level of expression in group 2 (p = 0.028). Similar changes over time were observed for miR-30d-5p expression: group 1, 1.61 [0.47; 4.36] at baseline vs 5.03 [2.93; 6.56] after surgery (p = 0.002), group 2, 0.89 [0.32; 4.27] at baseline and 6.63 [3.92; 12.82] after surgery, respectively (p = 0.0045). \u0000Down-regulating miRNAs. The miR-191-5 and miR-146a-5p families demonstrated a significant increase in group 1 after surgery (3.85 [1.64; 5.6] vs 7.7 [5.48; 9.68], p = 0.021; and 18.1 [6.52; 19.9] vs 37.27 [29.13; 47.07], p = 0.016, respectively) and a significant postoperative decrease in group 2 (3.67 [2.60; 7.61] vs 1.66 [0.52; 2.36], p = 0.023; and 14.75 [12.79; 21.77] vs 5.96 [2.8; 8.2], p = 0.034, respectively), with between-group difference in the postoperative expression levels being also significant. As regards to miR-26a-5p и miR-23a-3p families, there was a similar trend: the group with uncomplicated postoperative course was had virtually no changes over time in their expression (the increase was non-significant), whereas the MOF group had lower postoperative values for this microRNA family. The between-group differences after surgery were significant for miR-26a-5p (group 1, 6.79 [3.38; 8.46], group 2, 0.26 [0.18; 1.9], p = 0.037) and for miR-23a-3p (14.14 [11.92; 26.63] and 2.0 [1.02; 4.18], respectively, p 0.001). \u0000Conclusion: When comparing microRNA expression before surgery, we did not find any significant differences betwe","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83814604","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}
Pub Date : 2022-10-19DOI: 10.18786/2072-0505-2022-50-034
R. Akhramovich, S. P. Semitko, A. V. Azarov, A. I. Analeev, Ilya S. Melnichenko, I. E. Chernysheva, Andrey A. Tretyakov, David G. Iosseliani
Background: Primary percutaneous coronary interventions (PCI) in acute coronary syndrome (ACS) with transradial access (TRA) are associated with the risk of local complications, such as occlusion of the radial artery (ORA), hematomas, pseudoaneurysms, and arteriovenous fistulas. Aim: To perform comparative assessment of clinical efficacy and safety of the TRA and dorsopalmar (modified distal) radial access (DpRA) for primary percutaneous coronary intervention in in-patients with ACS. Materials and methods: This was a randomized, dynamic, single-center, prospective study in two parallel groups. The patients were randomized in a 1:1 ratio into two groups with different types of the radiation access: TRA (n = 100) or DpRA (n = 100). TRA was made at the distal third of the forearm and DpRA on the dorsal palm surface. After the access zone was evaluated by angiography, the pressure bandage was placed on the zone for 6 hours for hemostasis. The comfort of hemostasis was assessed by the Gaston-Johansson 10-point verbal-descriptive pain rating scale. On the 57th day after PCI, all patients were examined with palpation and ultrasound assessment of the access artery. Results: The number of attempts, average duration of the radial artery puncture, duration of the fluoroscopy procedure, and the conversion rate did not depend on the access type. The scoring of the subjective hemostasis comfort showed a significant advantage of DpRA over TRA (6.4 [4; 10] in the TRA group vs 1.7 [0; 6] in the DpRA group, p 0.001). The rate of EASY III hematomas was 15 (15%) in the TRA group vs 3 (3%) in the DpRA group (p = 0.004). There were no EASY IVV hematomas, occlusion of the radial artery of the forearm, pseudoaneurysms and arteriovenous fistulas in the DpRA group. The diameter of the forearm radial artery was significantly larger than the diameter on the dorsal palm surface in the patients of both groups, regardless of the type of access chosen (2.75 0.32 mm and 2.38 0.36 mm in the TRA group, p 0.001; 2.84 0.38 mm and 2.45 0.36 mm in the DpRA group, p 0.001). In the patients with access conversion in both groups, the diameter of the radial artery at both levels was less than the average one. Conclusion: DpRA for PCI in ACS patients is a safe alternative to conventional radiation access. Ultrasound examination of the radial artery diameter in its distal and forearm parts before PCI could reduce the conversion rate.
背景:急性冠状动脉综合征(ACS)经桡动脉通路(TRA)的初步经皮冠状动脉介入治疗(PCI)与局部并发症的风险相关，如桡动脉闭塞(ORA)、血肿、假性动脉瘤和动静脉瘘。目的:比较评价经皮动脉介入治疗与经皮动脉介入治疗(经皮动脉介入治疗)的临床疗效和安全性。材料和方法:这是一项随机、动态、单中心、前瞻性研究，在两个平行组中进行。将患者按1:1的比例随机分为两组，分别采用不同类型的放射通路:TRA (n = 100)或DpRA (n = 100)。在前臂远端三分之一处进行TRA，在手掌背表面进行dpa。血管造影评估通路区后，在通路区放置压力绷带止血6小时。止血舒适度采用加斯顿-约翰逊10分言语描述性疼痛评定量表进行评估。PCI术后第57天，所有患者均行导管触诊及超声检查。结果:桡动脉穿刺次数、平均穿刺时间、透视时间和转换率与通道类型无关。主观止血舒适度评分显示dpa明显优于TRA(6.4分)[4;10] TRA组vs . 1.7 [0;[6] dpa组，p < 0.001)。TRA组EASY III型血肿发生率为15例(15%)，而dpa组为3例(3%)(p = 0.004)。dpa组无EASY IVV血肿、前臂桡动脉闭塞、假性动脉瘤、动静脉瘘。两组患者前臂桡动脉直径均显著大于手掌背表面直径，与选择的通路类型无关(TRA组为2.75 0.32 mm, 2.38 0.36 mm, p 0.001;dpa组分别为2.84 0.38 mm和2.45 0.36 mm, p < 0.001)。两组通路转换患者，两段桡动脉直径均小于平均值。结论:急性冠脉综合征患者行PCI的dpa治疗是一种安全的替代方法。PCI前超声检查桡动脉远端及前臂桡动脉内径可降低转换率。
{"title":"Comparative analysis of the dorsopalmar (modified distal) and transradial access in primary percutaneous coronary interventions in patients with acute coronary syndrome","authors":"R. Akhramovich, S. P. Semitko, A. V. Azarov, A. I. Analeev, Ilya S. Melnichenko, I. E. Chernysheva, Andrey A. Tretyakov, David G. Iosseliani","doi":"10.18786/2072-0505-2022-50-034","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-034","url":null,"abstract":"Background: Primary percutaneous coronary interventions (PCI) in acute coronary syndrome (ACS) with transradial access (TRA) are associated with the risk of local complications, such as occlusion of the radial artery (ORA), hematomas, pseudoaneurysms, and arteriovenous fistulas. \u0000Aim: To perform comparative assessment of clinical efficacy and safety of the TRA and dorsopalmar (modified distal) radial access (DpRA) for primary percutaneous coronary intervention in in-patients with ACS. \u0000Materials and methods: This was a randomized, dynamic, single-center, prospective study in two parallel groups. The patients were randomized in a 1:1 ratio into two groups with different types of the radiation access: TRA (n = 100) or DpRA (n = 100). TRA was made at the distal third of the forearm and DpRA on the dorsal palm surface. After the access zone was evaluated by angiography, the pressure bandage was placed on the zone for 6 hours for hemostasis. The comfort of hemostasis was assessed by the Gaston-Johansson 10-point verbal-descriptive pain rating scale. On the 57th day after PCI, all patients were examined with palpation and ultrasound assessment of the access artery. \u0000Results: The number of attempts, average duration of the radial artery puncture, duration of the fluoroscopy procedure, and the conversion rate did not depend on the access type. The scoring of the subjective hemostasis comfort showed a significant advantage of DpRA over TRA (6.4 [4; 10] in the TRA group vs 1.7 [0; 6] in the DpRA group, p 0.001). The rate of EASY III hematomas was 15 (15%) in the TRA group vs 3 (3%) in the DpRA group (p = 0.004). There were no EASY IVV hematomas, occlusion of the radial artery of the forearm, pseudoaneurysms and arteriovenous fistulas in the DpRA group. The diameter of the forearm radial artery was significantly larger than the diameter on the dorsal palm surface in the patients of both groups, regardless of the type of access chosen (2.75 0.32 mm and 2.38 0.36 mm in the TRA group, p 0.001; 2.84 0.38 mm and 2.45 0.36 mm in the DpRA group, p 0.001). In the patients with access conversion in both groups, the diameter of the radial artery at both levels was less than the average one. \u0000Conclusion: DpRA for PCI in ACS patients is a safe alternative to conventional radiation access. Ultrasound examination of the radial artery diameter in its distal and forearm parts before PCI could reduce the conversion rate.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73259432","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}
Pub Date : 2022-10-19DOI: 10.18786/2072-0505-2022-50-035
E. V. Vlasova, E. G. Akramova, B. Sharafutdinov, Rinat S. Mirvaliev
Background: The involvement of the right ventricular (RV) myocardium in inferior acute myocardial infarction (AMI) increases the risk of complication and death rates, which makes it important to timely identify this type of myocardial infarction. Aim: To assess the value of functional, biochemical, coronary angiographic and ultrasound parameters in the patients in their productive age with inferior AMI, in order to identify the RV injury before and after percutaneous coronary intervention (PCI). Materials and methods: This cohort prospective study included 141 patients with inferior AMI and ST elevation (26 women aged up to 60 years and 115 men aged up to 65 years), admitted to the emergency of the Medical Unit of Kazan (Volga region) Federal University from 2019 to 2021. The patients past history, clinical, biochemical and ultrasound data were obtained on admission and at discharge from the hospital. The two-dimensional speckle tracking echocardiography was performed at days 5 to 7 after PCI. The results are given as median values and 25% and 75% quartiles (Ме [Q1; Q3]). Results: According to electrocardiographic signs, 41.8% (n = 59) patients with inferior AMI comprised the group with the RV injury. There were no differences in the myocardial injury biomarker levels between the groups on admission (р = 0.31 and p = 0.786, respectively). The coronary angiography showed that the index artery was the right coronary artery in 100% (n = 59) cases with the RV injury and in 67.1% (n = 55, р 0.001) of the cases without the RV injury. Proximal involvement was 2.7 more common in biventricular infarction, than in the isolated inferior one (р = 0.013). During PCI, the RV involvement significantly increased the risk of complications (in 28 (47.5%) and 18 (22.0%) of the cases, respectively, р 0.001), among them being the need in a temporary pacemaker placement (8 (13.6%) and 2 (2.4%) patients, р = 0.027). Echocardiography showed worse parameters of global and local contractility of both ventricles in the group with the RV involvement in the inferior AMI. The left ventricular (LV) ejection fraction decreased from 55% [51; 57] to 52% [47; 56] (р = 0.005); global RV deformity from -15.2% [-18.5; -13.4] to -12.3% [-15.6; -10.6] (р 0.001); total number of segments with local contractility abnormalities increased from 2 [1; 3] to 5 [3; 6] (р 0.001). Conclusion: The study has confirmed that the involvement of RV into inferior LV AMI in the patients of productive age should be verified by abnormalities of electrocardiographic, biochemical, coronary angiographic and ultrasound parameters. To document the RV injury before PCI, ST elevation in additional right chest leads (V3RV4R) was most informative, whereas after PCI, it was the finding of abnormal local contractility of basal and medial inferior RV segments by two-dimensional echocardiography and decreased longitudinal RV deformation by speckle tracking.
{"title":"Biochemical, coronary angiographic and echocardiographic parameters in inferior acute myocardial infarction with right ventricle injury","authors":"E. V. Vlasova, E. G. Akramova, B. Sharafutdinov, Rinat S. Mirvaliev","doi":"10.18786/2072-0505-2022-50-035","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-035","url":null,"abstract":"Background: The involvement of the right ventricular (RV) myocardium in inferior acute myocardial infarction (AMI) increases the risk of complication and death rates, which makes it important to timely identify this type of myocardial infarction. \u0000Aim: To assess the value of functional, biochemical, coronary angiographic and ultrasound parameters in the patients in their productive age with inferior AMI, in order to identify the RV injury before and after percutaneous coronary intervention (PCI). \u0000Materials and methods: This cohort prospective study included 141 patients with inferior AMI and ST elevation (26 women aged up to 60 years and 115 men aged up to 65 years), admitted to the emergency of the Medical Unit of Kazan (Volga region) Federal University from 2019 to 2021. The patients past history, clinical, biochemical and ultrasound data were obtained on admission and at discharge from the hospital. The two-dimensional speckle tracking echocardiography was performed at days 5 to 7 after PCI. The results are given as median values and 25% and 75% quartiles (Ме [Q1; Q3]). \u0000Results: According to electrocardiographic signs, 41.8% (n = 59) patients with inferior AMI comprised the group with the RV injury. There were no differences in the myocardial injury biomarker levels between the groups on admission (р = 0.31 and p = 0.786, respectively). The coronary angiography showed that the index artery was the right coronary artery in 100% (n = 59) cases with the RV injury and in 67.1% (n = 55, р 0.001) of the cases without the RV injury. Proximal involvement was 2.7 more common in biventricular infarction, than in the isolated inferior one (р = 0.013). During PCI, the RV involvement significantly increased the risk of complications (in 28 (47.5%) and 18 (22.0%) of the cases, respectively, р 0.001), among them being the need in a temporary pacemaker placement (8 (13.6%) and 2 (2.4%) patients, р = 0.027). Echocardiography showed worse parameters of global and local contractility of both ventricles in the group with the RV involvement in the inferior AMI. The left ventricular (LV) ejection fraction decreased from 55% [51; 57] to 52% [47; 56] (р = 0.005); global RV deformity from -15.2% [-18.5; -13.4] to -12.3% [-15.6; -10.6] (р 0.001); total number of segments with local contractility abnormalities increased from 2 [1; 3] to 5 [3; 6] (р 0.001). \u0000Conclusion: The study has confirmed that the involvement of RV into inferior LV AMI in the patients of productive age should be verified by abnormalities of electrocardiographic, biochemical, coronary angiographic and ultrasound parameters. To document the RV injury before PCI, ST elevation in additional right chest leads (V3RV4R) was most informative, whereas after PCI, it was the finding of abnormal local contractility of basal and medial inferior RV segments by two-dimensional echocardiography and decreased longitudinal RV deformation by speckle tracking.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75496303","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}
Pub Date : 2022-10-07DOI: 10.18786/2072-0505-2022-50-033
E. Zvezdkina, A. Kedrova, D. Lebedev, D. N. Panchenkov, Y. Stepanova
Background: Magnetic resonance imaging (MRI) is used for the staging and assessment of treatment results of female pelvic tumors. The inclusion of transarterial chemoembolization (TACE) with drug-saturated microspheres into the treatment regimen puts a question to the radiologist: what TACE characteristics should be taken into account for the correct interpretation of the treatment results? Aim: To determine the main MRI parameters that characterize the results of TACE in the treatment of women with primary and recurrent pelvic tumors. Materials and methods: We performed a retrospective observational study of 80 patients with primary tumors (group 1) and 20 patients with recurrent tumors (group 2) of the small pelvis, complicated by tumor bleeding, who underwent 121 TACE procedures from 01.09.2015 to 01.12.2021 and were followed up to May 31, 2022. The study inclusion criteria were as follows: compliance with the approved protocol and time points for pelvic MRI. TACE results were evaluated according to RECIST 1.1. Results: In 100% of the cases in the groups 1 and 2, bleeding was controlled within 24 hours. In group 1, partial response was achieved in 48% (n = 38), complete response in 15% (n = 12), stabilization in 37% (n = 30), without any progression in all patients. In group 2, partial response was achieved in 27% (n = 5), complete response in 11% (n = 2), stabilization in 62% (n = 13), without any progression, as well. When comparing the mass volumes, recurrent tumors were significantly more responsive to TACE. The type of tumor growth was infiltrative (n = 25), expansive (n = 55), and mixed (n = 20). No significant differences in volume changes depending on the type of tumor growth were found. Eight women had undergone non-targeted ovarian embolization related to the type of blood supply. There were no cases of non-targeted embolization of the abdominal organs and the bladder, even with existing abnormal collateral vasculature. Conclusion: According to this data, the results of TACE for primary and recurrent pelvic tumors are characterized with the following MRI parameters: 1) hemostatic and cytostatic effects of TACE are manifested independently of each other; 2) tumor volume reflects changes after TACE to a greater extent than changes in linear dimensions; 3) there are cases of non-targeted ovarian embolization.
{"title":"Specific characteristics of the magnetic resonance imaging for transarterial chemoembolization with drug-saturated microspheres in oncogynecology","authors":"E. Zvezdkina, A. Kedrova, D. Lebedev, D. N. Panchenkov, Y. Stepanova","doi":"10.18786/2072-0505-2022-50-033","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-033","url":null,"abstract":"Background: Magnetic resonance imaging (MRI) is used for the staging and assessment of treatment results of female pelvic tumors. The inclusion of transarterial chemoembolization (TACE) with drug-saturated microspheres into the treatment regimen puts a question to the radiologist: what TACE characteristics should be taken into account for the correct interpretation of the treatment results? \u0000Aim: To determine the main MRI parameters that characterize the results of TACE in the treatment of women with primary and recurrent pelvic tumors. \u0000Materials and methods: We performed a retrospective observational study of 80 patients with primary tumors (group 1) and 20 patients with recurrent tumors (group 2) of the small pelvis, complicated by tumor bleeding, who underwent 121 TACE procedures from 01.09.2015 to 01.12.2021 and were followed up to May 31, 2022. The study inclusion criteria were as follows: compliance with the approved protocol and time points for pelvic MRI. TACE results were evaluated according to RECIST 1.1. \u0000Results: In 100% of the cases in the groups 1 and 2, bleeding was controlled within 24 hours. In group 1, partial response was achieved in 48% (n = 38), complete response in 15% (n = 12), stabilization in 37% (n = 30), without any progression in all patients. In group 2, partial response was achieved in 27% (n = 5), complete response in 11% (n = 2), stabilization in 62% (n = 13), without any progression, as well. When comparing the mass volumes, recurrent tumors were significantly more responsive to TACE. The type of tumor growth was infiltrative (n = 25), expansive (n = 55), and mixed (n = 20). No significant differences in volume changes depending on the type of tumor growth were found. Eight women had undergone non-targeted ovarian embolization related to the type of blood supply. There were no cases of non-targeted embolization of the abdominal organs and the bladder, even with existing abnormal collateral vasculature. \u0000Conclusion: According to this data, the results of TACE for primary and recurrent pelvic tumors are characterized with the following MRI parameters: 1) hemostatic and cytostatic effects of TACE are manifested independently of each other; 2) tumor volume reflects changes after TACE to a greater extent than changes in linear dimensions; 3) there are cases of non-targeted ovarian embolization.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82115724","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}
Pub Date : 2022-10-03DOI: 10.18786/2072-0505-2022-50-032
A. Khlebnikova
Background: Inverse psoriasis that is characterized by skinfold rash is seen in 12 to 36% of European patients with psoriasis. Isolated involvement of skinfolds can mimic a number of dermatoses with similar location. The differential diagnosis is increasingly frequently based on non-invasive methods, including dermatoscopy. Taking into account the warm and wet milieu of skinfolds, facilitating secondary infection, topical antibacterials and antiseptics are recommended for treatment, along with topical glucocorticosteroids and vitamin D3 analogues. Materials and methods: We have analyzed the results of assessment and treatment of 15 patients with psoriasis of major skinfolds that were admitted to the in-patient department of dermatology. All patients underwent dermatoscopy at 20 magnification. The patients were treated with desensitizing agents, hepatic protectors, and group B vitamins. Topical treatments applied in the rash areas included a combination topical agent containing mometasone furoate (0.5 mg), gentamicin sulfate (1 mg), econazole nitrate (10 mg), and dexpanthenol (50 mg). The treatment was considered effective if the M-PASI decreased at least by 75%; the results were assessed after 7 and 14 days of treatment. Results: In all cases, dermatoscopy of the vulgar psoriasis lesions showed vermilion or red to rosy background with evenly distributed dotted vessels and white scales diffusely located all over the visualized surface. The skinfold lesions were characterized by rosy or red background with evenly distributed dotted vessels, white scales located either as isolated groups, or at the periphery of the visualized areas; some plaques had local erosions, and in one case, hemorrhages. Morphological assessment of the biopsy samples in all patients with isolated skinfold lesions (n = 5) confirmed the diagnosis of psoriasis. Treatment-induced improvement was seen at day 2 to 3, and at day 14, there was a decrease of M-PASI by 90% in 6 (40%) patients and resolution of the lesions in 9 (60%). There were no treatment-associated adverse events or reactions. Conclusion: Dermatoscopy has proved to be a useful tool for non-invasive diagnostics of inverse psoriasis. At low magnification ( 20), its main sign was an even distribution of dotted vessels throughout the visualized area. In a number of cases, the dermatoscopic symptoms additionally included white scales grouped as isolated foci. The addition of the combination topical agent (mometasone furoate, gentamicin sulfate, econazole nitrate, and dexpanthenol) to the standard systemic therapy facilitated almost full resolution of skinfold psoriatic lesions.
{"title":"Inverse psoriasis: the diagnostic value of dermatoscopic assessment and the experience of treatment with a combination topical agent (a clinical series)","authors":"A. Khlebnikova","doi":"10.18786/2072-0505-2022-50-032","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-032","url":null,"abstract":"Background: Inverse psoriasis that is characterized by skinfold rash is seen in 12 to 36% of European patients with psoriasis. Isolated involvement of skinfolds can mimic a number of dermatoses with similar location. The differential diagnosis is increasingly frequently based on non-invasive methods, including dermatoscopy. Taking into account the warm and wet milieu of skinfolds, facilitating secondary infection, topical antibacterials and antiseptics are recommended for treatment, along with topical glucocorticosteroids and vitamin D3 analogues. \u0000Materials and methods: We have analyzed the results of assessment and treatment of 15 patients with psoriasis of major skinfolds that were admitted to the in-patient department of dermatology. All patients underwent dermatoscopy at 20 magnification. The patients were treated with desensitizing agents, hepatic protectors, and group B vitamins. Topical treatments applied in the rash areas included a combination topical agent containing mometasone furoate (0.5 mg), gentamicin sulfate (1 mg), econazole nitrate (10 mg), and dexpanthenol (50 mg). The treatment was considered effective if the M-PASI decreased at least by 75%; the results were assessed after 7 and 14 days of treatment. \u0000Results: In all cases, dermatoscopy of the vulgar psoriasis lesions showed vermilion or red to rosy background with evenly distributed dotted vessels and white scales diffusely located all over the visualized surface. The skinfold lesions were characterized by rosy or red background with evenly distributed dotted vessels, white scales located either as isolated groups, or at the periphery of the visualized areas; some plaques had local erosions, and in one case, hemorrhages. Morphological assessment of the biopsy samples in all patients with isolated skinfold lesions (n = 5) confirmed the diagnosis of psoriasis. Treatment-induced improvement was seen at day 2 to 3, and at day 14, there was a decrease of M-PASI by 90% in 6 (40%) patients and resolution of the lesions in 9 (60%). There were no treatment-associated adverse events or reactions. \u0000Conclusion: Dermatoscopy has proved to be a useful tool for non-invasive diagnostics of inverse psoriasis. At low magnification ( 20), its main sign was an even distribution of dotted vessels throughout the visualized area. In a number of cases, the dermatoscopic symptoms additionally included white scales grouped as isolated foci. The addition of the combination topical agent (mometasone furoate, gentamicin sulfate, econazole nitrate, and dexpanthenol) to the standard systemic therapy facilitated almost full resolution of skinfold psoriatic lesions.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89135223","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}
Pub Date : 2022-09-17DOI: 10.18786/2072-0505-2022-50-029
V. Kovalev, E. Bril, M. Semenov, Yury A. Seliverstov, L. Lepsveridze
Background: Freezing of gait (FOG) in Parkinson's disease (PD) and progressive supranuclear palsy (PSP) exert a significant adverse impact on the patients quality of life, the degree of their disability, and the risk of falls. A specific characteristic of FOG is a poor response to medical treatment. According to the data of open-label clinical trials and clinical case series published in the last decade, spinal cord stimulation (SCS) can be considered as one of the methods to improve this type of movement disorders. Materials and methods: We present a clinical series of patients with PD and PSP, who underwent implantation of a chronic epidural SCS system at the mid-thoracic level to correct FOG. The efficacy of surgical treatment was assessed at 2 and 5 months with the following scales and questionnaires: part III Unified Parkinson's Disease Rating Scale of Movement Disorder Society (MDS-UPDRS), Freezing of Gait Questionnaire (FOG-Q), Activity-Specific Balance Confidence Scale (ABC), Parkinson's Disease Quality of Life Questionnaire-8 (PDQ-8), Time up and Go Test (TUG), 10 Meter Walk Test. The patients were asked to report possible adverse reactions after the procedure. Results: The results of a 5-month follow-up were obtained from 4 patients (2 with PD and 2 with PSP). There were no adverse events associated with SCS. Оnly one patient with PD experienced a decrease in the severity of motor symptoms according to the MDS-UPDRS part III scale. An increase in the speed of 10 meters' walking distance and TUG test performance was observed in 3 patients. All patients reported an improvement in the quality of life (according to the PDQ-8 questionnaire) and confidence in maintaining balance (according to the ABC questionnaire) by month 2 after surgery. However, at month 5, a negative trend was noted again. Conclusion: The SCS method was safe in all 4 clinical cases described. There was a positive effect of SCS on the improvement of FOG and postural balance in PD and PSP. However, the duration of the therapeutic effect may vary.
背景:帕金森病(PD)和进行性核上性麻痹(PSP)患者的步态冻结(FOG)对患者的生活质量、残疾程度和跌倒风险有显著的不利影响。FOG的一个特殊特征是对药物治疗反应差。根据近十年来发表的开放标签临床试验数据和临床病例系列，脊髓刺激(SCS)可以被认为是改善这类运动障碍的方法之一。材料和方法:我们报道了一系列PD和PSP患者，他们在胸椎中段植入了慢性硬膜外SCS系统来纠正FOG。2个月和5个月时采用以下量表和问卷评估手术治疗的效果:第三部分运动障碍学会帕金森病统一评定量表(MDS-UPDRS)、步态冻结问卷(FOG-Q)、活动特异性平衡信心量表(ABC)、帕金森病生活质量问卷-8 (PDQ-8)、Time up and Go测试(TUG)、10米步行测试。患者被要求报告手术后可能出现的不良反应。结果:4例患者(PD 2例，PSP 2例)随访5个月。没有与SCS相关的不良事件。Оnly根据MDS-UPDRS第三部分量表，一名PD患者的运动症状严重程度有所下降。3例患者10米步行速度和TUG测试成绩均有明显提高。术后2个月，所有患者的生活质量(根据PDQ-8问卷)和维持平衡的信心(根据ABC问卷)均有改善。然而，在第5个月，再次出现了消极趋势。结论:本组所述4例临床病例，SCS法均安全。SCS对PD和PSP的FOG和姿势平衡的改善有积极作用。然而，治疗效果的持续时间可能会有所不同。
{"title":"Spinal cord stimulation for freezing of gait in Parkinson's disease and progressive supranuclear palsy: a case series","authors":"V. Kovalev, E. Bril, M. Semenov, Yury A. Seliverstov, L. Lepsveridze","doi":"10.18786/2072-0505-2022-50-029","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-029","url":null,"abstract":"Background: Freezing of gait (FOG) in Parkinson's disease (PD) and progressive supranuclear palsy (PSP) exert a significant adverse impact on the patients quality of life, the degree of their disability, and the risk of falls. A specific characteristic of FOG is a poor response to medical treatment. According to the data of open-label clinical trials and clinical case series published in the last decade, spinal cord stimulation (SCS) can be considered as one of the methods to improve this type of movement disorders. \u0000Materials and methods: We present a clinical series of patients with PD and PSP, who underwent implantation of a chronic epidural SCS system at the mid-thoracic level to correct FOG. The efficacy of surgical treatment was assessed at 2 and 5 months with the following scales and questionnaires: part III Unified Parkinson's Disease Rating Scale of Movement Disorder Society (MDS-UPDRS), Freezing of Gait Questionnaire (FOG-Q), Activity-Specific Balance Confidence Scale (ABC), Parkinson's Disease Quality of Life Questionnaire-8 (PDQ-8), Time up and Go Test (TUG), 10 Meter Walk Test. The patients were asked to report possible adverse reactions after the procedure. \u0000Results: The results of a 5-month follow-up were obtained from 4 patients (2 with PD and 2 with PSP). There were no adverse events associated with SCS. Оnly one patient with PD experienced a decrease in the severity of motor symptoms according to the MDS-UPDRS part III scale. An increase in the speed of 10 meters' walking distance and TUG test performance was observed in 3 patients. All patients reported an improvement in the quality of life (according to the PDQ-8 questionnaire) and confidence in maintaining balance (according to the ABC questionnaire) by month 2 after surgery. However, at month 5, a negative trend was noted again. \u0000Conclusion: The SCS method was safe in all 4 clinical cases described. There was a positive effect of SCS on the improvement of FOG and postural balance in PD and PSP. However, the duration of the therapeutic effect may vary.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78284352","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}
Pub Date : 2022-09-16DOI: 10.18786/2072-0505-2022-50-027
G. Galstyan
Rationale: Basal insulin glargine 300 U/mL (Gla-300) is a second-generation basal insulin analogue that has comparable efficacy and lower variability compared to the first generation long-acting insulin analogue glargine 100 U/mL. Aim: To assess the effectiveness and safety of Gla-300 in insulin-nave type 2 diabetic patients in the real world practice in Russia. Materials and methods: ATOS (NCT03703869) was a 12-month, prospective observational international multicenter study. The study included 4422 adults ( 18 years) with uncontrolled type 2 diabetes (HbA1c 7 and 11%) with 1 oral anti-hyperglycemic drug and for whom the treating physician had decided to add Gla-300. We performed a post-hoc sub-analysis of the study participants recruited in Russia. Results: The Russian study group included 1493 patients receiving Gla-300. At 6 months, 25.9% of the patients achieved their predefined individualized HbA1c target and 53.3% achieved their HbA1c target at month 12. Their mean ( SD) HbA1c level decreased from 9.3 0.9% at baseline to 7.6 0.7% and 7.2 0.7 at months 6 and 12. The incidence of hypoglycemia was generally low; overall, severe hypoglycemia was reported only in 0.07% and 0.13% of the patients at 6 and 12 months. The baseline average daily dose of Gla-300 was 13.2 4.9 Units; it to 23.6 9.1 and 26.0 9.8 Units at months 6 and 12. Conclusion: In the real world setting, initiation of insulin Gla-300 in type 2 diabetic patients who had been out of their target glucose range with oral hypoglycemic agents is associated with improved glycemic control and low risk of hypoglycemia.
{"title":"ATOS study: effectiveness and safety of insulin glargine 300 U/mL in the real world clinical practice in insulin-naïve type 2 diabetic patients in the Russian Federation","authors":"G. Galstyan","doi":"10.18786/2072-0505-2022-50-027","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-027","url":null,"abstract":"Rationale: Basal insulin glargine 300 U/mL (Gla-300) is a second-generation basal insulin analogue that has comparable efficacy and lower variability compared to the first generation long-acting insulin analogue glargine 100 U/mL. \u0000Aim: To assess the effectiveness and safety of Gla-300 in insulin-nave type 2 diabetic patients in the real world practice in Russia. \u0000Materials and methods: ATOS (NCT03703869) was a 12-month, prospective observational international multicenter study. The study included 4422 adults ( 18 years) with uncontrolled type 2 diabetes (HbA1c 7 and 11%) with 1 oral anti-hyperglycemic drug and for whom the treating physician had decided to add Gla-300. We performed a post-hoc sub-analysis of the study participants recruited in Russia. \u0000Results: The Russian study group included 1493 patients receiving Gla-300. At 6 months, 25.9% of the patients achieved their predefined individualized HbA1c target and 53.3% achieved their HbA1c target at month 12. Their mean ( SD) HbA1c level decreased from 9.3 0.9% at baseline to 7.6 0.7% and 7.2 0.7 at months 6 and 12. The incidence of hypoglycemia was generally low; overall, severe hypoglycemia was reported only in 0.07% and 0.13% of the patients at 6 and 12 months. The baseline average daily dose of Gla-300 was 13.2 4.9 Units; it to 23.6 9.1 and 26.0 9.8 Units at months 6 and 12. \u0000Conclusion: In the real world setting, initiation of insulin Gla-300 in type 2 diabetic patients who had been out of their target glucose range with oral hypoglycemic agents is associated with improved glycemic control and low risk of hypoglycemia.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89175891","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}
Pub Date : 2022-09-16DOI: 10.18786/2072-0505-2022-50-028
O. Georginova, Polina N. Astashkevich, T. N. Krasnova
Uric acid is an independent risk factor for socially important diseases, such as chronic heart failure and chronic kidney disease. The review summarizes current data on the impact of nutrition as a presumably modifiable factor into the development of hyperuricemia and gout. The authors describe biochemical mechanisms underlying hyperuricemia and present data on the influence of excessive intake of fructose, purines, and various alcohol-containing drinks on the risk of gout. Favorable impact of vitamin C supplements, coffee, cherry juice, some chemical elements (magnesium, zinc, and copper) on uric acid levels has been shown, as well as the impact of intake of low fat dairy products, polyphenols, food fibers, and omega-3 polyunsaturated fatty acids on the incidence of hyperuricemia. The information presented in the review can be used in clinical practice for preparation of an individualized nutritional plan aimed at normalization of uric acid levels. This would minimize the use of agents affecting the synthesis of uric acid and slow down the progression of chronic heart failure and chronic kidney disease.
{"title":"Modifiable nutritional factors in hyperuricemia and gout","authors":"O. Georginova, Polina N. Astashkevich, T. N. Krasnova","doi":"10.18786/2072-0505-2022-50-028","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-028","url":null,"abstract":"Uric acid is an independent risk factor for socially important diseases, such as chronic heart failure and chronic kidney disease. The review summarizes current data on the impact of nutrition as a presumably modifiable factor into the development of hyperuricemia and gout. The authors describe biochemical mechanisms underlying hyperuricemia and present data on the influence of excessive intake of fructose, purines, and various alcohol-containing drinks on the risk of gout. Favorable impact of vitamin C supplements, coffee, cherry juice, some chemical elements (magnesium, zinc, and copper) on uric acid levels has been shown, as well as the impact of intake of low fat dairy products, polyphenols, food fibers, and omega-3 polyunsaturated fatty acids on the incidence of hyperuricemia. The information presented in the review can be used in clinical practice for preparation of an individualized nutritional plan aimed at normalization of uric acid levels. This would minimize the use of agents affecting the synthesis of uric acid and slow down the progression of chronic heart failure and chronic kidney disease.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89408024","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}
Pub Date : 2022-09-06DOI: 10.18786/2072-0505-2022-50-026
E. F. Akhmedova, A. V. Galyavin, A. Zotov
In Russia, amebiasis is sporadically registered mainly in the southern regions. An endemic area is the Republic of Dagestan. We describe a clinical case, which illustrates challenges in the diagnosis of amebial colitis related to low awareness of physicians of parasitic diseases in non-endemic regions. A 38-year old female patient living in Moscow was initially misdiagnosed with Crohn's disease. Erosive and ulcerative colonic lesions found at colonoscopy were interpreted by a gastroenterologist as symptoms of an inflammatory bowel disease. No differential diagnosis with infections and parasitic diseases was performed. Long (2 years) persistence of symptoms despite treatment with 5-aminosalicylic agents for suspected Crohn's disease, absence of any significant laboratory abnormalities and no history of travelling to Asian countries were the reason for subsequent additional diagnostic work-up. After the patient was finally diagnosed with intestinal amebiasis, she was treated with metronidazole with some positive effect of decreased abdominal bloating and bowel growling. At the control colonoscopy, there was a positive trend seen in colonic mucosa, with healing of ulcers without any scarring. No protozoan cysts were any more found in her feces. According to the recommendations, the patient is regularly seen by a specialist in infectious diseases and a gastroenterologist. Expansion of amebiasis outside endemic regions points to the necessity to perform a wider diagnostic work-up in cases of mucosal lesions found at colonoscopy.
{"title":"Challenging diagnosis of amebiasis in a non-endemic region: a clinical case","authors":"E. F. Akhmedova, A. V. Galyavin, A. Zotov","doi":"10.18786/2072-0505-2022-50-026","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-026","url":null,"abstract":"In Russia, amebiasis is sporadically registered mainly in the southern regions. An endemic area is the Republic of Dagestan. We describe a clinical case, which illustrates challenges in the diagnosis of amebial colitis related to low awareness of physicians of parasitic diseases in non-endemic regions. A 38-year old female patient living in Moscow was initially misdiagnosed with Crohn's disease. Erosive and ulcerative colonic lesions found at colonoscopy were interpreted by a gastroenterologist as symptoms of an inflammatory bowel disease. No differential diagnosis with infections and parasitic diseases was performed. Long (2 years) persistence of symptoms despite treatment with 5-aminosalicylic agents for suspected Crohn's disease, absence of any significant laboratory abnormalities and no history of travelling to Asian countries were the reason for subsequent additional diagnostic work-up. After the patient was finally diagnosed with intestinal amebiasis, she was treated with metronidazole with some positive effect of decreased abdominal bloating and bowel growling. At the control colonoscopy, there was a positive trend seen in colonic mucosa, with healing of ulcers without any scarring. No protozoan cysts were any more found in her feces. According to the recommendations, the patient is regularly seen by a specialist in infectious diseases and a gastroenterologist. Expansion of amebiasis outside endemic regions points to the necessity to perform a wider diagnostic work-up in cases of mucosal lesions found at colonoscopy.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77306810","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}
Pub Date : 2022-09-06DOI: 10.18786/2072-0505-2022-50-025
L. D. Sadretdinova, K. Gantseva, Ilmira I. Galina, A. Tyurin
Aim: To analyze prevalence and type of symptomatic gastrointestinal involvement during symptomatic COVID-19 (up to 412 weeks after the disease) and post-COVID-19 syndrome (more than 12 weeks from the disease onset). Materials and methods: We retrospectively analyzed the data from 785 in-patients with the diagnosis of COVID-19, who were treated in the infectious disease hospital from May to December 2020. At the first phase of the study we analyzed how frequently they were referred for out-patient care by a gastroenterology specialist after they were discharged from the hospital (all 785 patient medical files). At the 2nd study phase we performed phone calls to 247 patients, that were discharged from the infectious disease hospital, during which a specially designed questionnaire was filled with items on their comorbidities, general and specific complaints, as well as the standardized Gastrointestinal Symptom Rating Scale (GSRS). Results: Within 2 years after their discharge from the infectious disease hospital, 88 patients asked for specialized gastroenterological care on an out-patient basis. The most common diagnoses were pancreatic diseases (33%), gastric disorders (31%), intestinal disorders (25%), liver and biliary disorders (11%). At referral, the most common complaints were dyspeptic: nausea, bitter taste in the mouth, heartburn, bloating (25%), abdominal pains of various location (17%) and stool abnormalities, such as diarrhea and constipation (11%). Among patients who participated in the phone survey (N = 247), symptomatic COVID-19 was observed in 90 (11.46%) cases, with predominant complaints being loss of taste, loss of smell, and fever. Post-COVID-19 syndrome was identified in 157 (20%) cases, with their main complaints being weakness, shortness of breath and joint pain. Stool abnormalities and abdominal pain occurred during symptomatic COVID-19 and in the post-COVID-19 period with the same frequency (9% and 10%, respectively). According to the GSRS results, the post-COVID-19 dyspeptic syndrome was characterized by prevailing complaints of heartburn (24%), upper abdominal pain and discomfort (20%), and bloating (15%). Conclusion: In the patients with a history of COVID-19, along with respiratory syndromes, gastrointestinal symptoms are seen, with their types being variable at various period of the coronavirus infection. In the early COVID-19, these are stool abnormalities and abdominal pain, and during the post-COVID-19 syndrome, nausea, bitter taste in the mouth, heartburn and bloating are more common.
{"title":"The duration of gastrointestinal symptom persistence at various periods of coronavirus infection","authors":"L. D. Sadretdinova, K. Gantseva, Ilmira I. Galina, A. Tyurin","doi":"10.18786/2072-0505-2022-50-025","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-025","url":null,"abstract":"Aim: To analyze prevalence and type of symptomatic gastrointestinal involvement during symptomatic COVID-19 (up to 412 weeks after the disease) and post-COVID-19 syndrome (more than 12 weeks from the disease onset). \u0000Materials and methods: We retrospectively analyzed the data from 785 in-patients with the diagnosis of COVID-19, who were treated in the infectious disease hospital from May to December 2020. At the first phase of the study we analyzed how frequently they were referred for out-patient care by a gastroenterology specialist after they were discharged from the hospital (all 785 patient medical files). At the 2nd study phase we performed phone calls to 247 patients, that were discharged from the infectious disease hospital, during which a specially designed questionnaire was filled with items on their comorbidities, general and specific complaints, as well as the standardized Gastrointestinal Symptom Rating Scale (GSRS). \u0000Results: Within 2 years after their discharge from the infectious disease hospital, 88 patients asked for specialized gastroenterological care on an out-patient basis. The most common diagnoses were pancreatic diseases (33%), gastric disorders (31%), intestinal disorders (25%), liver and biliary disorders (11%). At referral, the most common complaints were dyspeptic: nausea, bitter taste in the mouth, heartburn, bloating (25%), abdominal pains of various location (17%) and stool abnormalities, such as diarrhea and constipation (11%). \u0000Among patients who participated in the phone survey (N = 247), symptomatic COVID-19 was observed in 90 (11.46%) cases, with predominant complaints being loss of taste, loss of smell, and fever. Post-COVID-19 syndrome was identified in 157 (20%) cases, with their main complaints being weakness, shortness of breath and joint pain. Stool abnormalities and abdominal pain occurred during symptomatic COVID-19 and in the post-COVID-19 period with the same frequency (9% and 10%, respectively). According to the GSRS results, the post-COVID-19 dyspeptic syndrome was characterized by prevailing complaints of heartburn (24%), upper abdominal pain and discomfort (20%), and bloating (15%). \u0000Conclusion: In the patients with a history of COVID-19, along with respiratory syndromes, gastrointestinal symptoms are seen, with their types being variable at various period of the coronavirus infection. In the early COVID-19, these are stool abnormalities and abdominal pain, and during the post-COVID-19 syndrome, nausea, bitter taste in the mouth, heartburn and bloating are more common.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81066644","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}
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