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Vol 15, No 3 (2023)
- Year: 2023
- Articles: 9
- URL: https://journals.eco-vector.com/vszgmu/issue/view/7872
Reviews
Percutaneous coronary intervention in patients admitted with acute coronary syndrome within 6 months after COVID-19 (retrospective single-center study)
Abstract
BACKGROUND: Assessing clinical manifestations in patients during the period of destabilization of the course of coronary artery disease after COVID-19 coronavirus infection remains a clinical problem. Identifying features of coronary artery lesions in such patients will help to prevent the development of complications and may influence the tactics of active dynamic monitoring.
AIM: To evaluate the structure of coronary artery lesions and clinical manifestations in patients with acute coronary syndrome that developed within 6 months after COVID-19 new coronavirus infection.
MATERIALS AND METHODS: A comparative analysis of the results of coronary artery stenting in 157 patients admitted with acute coronary syndrome has been carried out. The 1st group included 69 patients who had COVID-19 (vaccinated — 24.6%) during the 6 months preceding acute coronary syndrome; in the 2nd — 88 patients without a history of COVID-19 (vaccinated — 42%). All the patients had drug-eluting stents implanted in the infarct-related artery. Long-term results have been observed in 151 (96.2%) patients.
RESULTS: Before the development of acute coronary syndrome, dispnoe was more often observed in patients of the 1st group (36; 52%) than in patients of the 2nd group (13; 14.8%). There were no focal neurological symptoms in the patients of both groups. Dizziness more often preceded acute coronary syndrome in the patients of the 1st group (26; 38.2%) compared to the control group (5; 5.7%). Decreased motivation and fatigue were detected in 27 (67.5%) patients in the 1st group, which was more common than in the 2nd group (13; 32.5%). Acute coronary syndrome with ST elevation was treated in 47 % and 38.6% of the patients in the 1st groups and the 2nd, respectively. The development of acute coronary syndrome with ST segment elevation with previous clinical manifestations of post-covid syndrome in the 1st group was observed in 95.8%, whereas in the absence of post-covid syndrome in 53.3%. The mean value of LVEF in patients who had COVID-19 was 55.9 ± 14%, which was significantly lower than in the patients in the control group (63.2 ± 5.5%; р < 0.001). During the course of coronavirus infection in the patients in the first group, lung damage of degrees I–II according to CT scan data was observed in 76.8% of the patients and in 23.2% of degrees III–IV. The frequency of lesions of the circumflex branch in the 1st group was 15.9%, in the 2nd — 11.4% (р = 0.403); of the right coronary artery — 33.3%, and 22.7% (р = 0.41); of the diagonal branch — 5.8%, and 3.4% (р = 0.47); of the left main coronary artery — 5.8%, and 6.8% (р = 0.79), of the left anterior descending branch — 52.2%, and 35.2% (р = 0.033), respectively. The incidence of vasospastic angina in the 1st group was 53.6%, in the 2nd — 15.9% (р < 0.0001). ST segment elevation in lead AVR as a manifestation of subendocardial ischemia was registered in the 1st group — 40.6%, the 2nd — 11.4% (р < 0.0001). All the patients had drug-eluting stents implanted in the infarct-related artery. Overall survival (in-hospital and long-term) was 100% for the first group and 100 % for the second one.
CONCLUSIONS: In the structure of coronary arteries lesions after COVID-19 new coronavirus infection in patients with acute coronary syndrome, damage to the anterior interventricular artery dominates (52.2%). The likelihood of having a left anterior descending lesion during the development of acute coronary syndrome with ST segment elevation in patients who have had COVID-19 is 1.5 times higher. The structure of clinical manifestations after COVID-19 in patients before the development of acute coronary syndrome is dominated by shortness of breath (52 %) and decreased motivation and fatigue (67.5 %).
5-11
Chronic atrophic gastritis: focus on diagnosis
Abstract
Currently, chronic atrophic gastritis is a risk factor for the development of gastric cancer. Data on the prevalence of chronic atrophic gastritis in Russia and the world are limited. Among the adult population of St. Petersburg aged 21 to 81 years, the prevalence of histologically verified chronic atrophic gastritis is 5.3%. Moreover, the chances of developing chronic atrophic gastritis in people over the age of 60 years compared to the group of 45–59 years are 2.5 times higher (95% confidence interval 1.5–4.1).
Morphological verification of the Operative Link for Gastritis Assessment diagnosis is not carried out in clinical practice in most cases. However, this method remains the most reliable method for timely verification of chronic atrophic gastritis, including chronic atrophic gastritis of mixed origin (autoimmune gastritis and Helicobacter pylori-associated gastritis), especially in the case of a seronegative variant of autoimmune gastritis.
Also, in addition to the heterogeneity of epidemiological data on chronic atrophic gastritis, there is disagreement about how to confirm its etiology as well as about the correlation of serological markers of atrophy and histological stage.
13-24
Original research
New method for determining volume of intraoperative blood loss during burn treatment surgery
Abstract
BACKGROUND: Nowadays, there are numerous ways to assess the volume and minimize intraoperative blood loss; however, their effectiveness is subjective. To compare the effectiveness of blood-saving techniques, it is necessary to create new more reliable methods for determining intraoperative blood loss.
AIM: To develop a new technique for determining intraoperative blood loss in the surgical treatment of burn victims.
MATERIALS AND METHODS: In the course of the study, we have developed and proposed our own, original method for determining the volume of intraoperative blood loss, taking into account the indicators of hemoglobin and hematocrit as well as a differentiated calculation of the volume of circulating blood. This technique has been tested on 82 victims with deep burns of the II–III degree (International Classification of Diseases 10th Revision), who were admitted to the department of thermal lesions in the period from April 2021 to December 2021. The data obtained have been processed in the Microsoft Excel 2007 program as well as by generally accepted methods of nonparametric statistics.
RESULTS: The methods currently available have a large variability of results when performing the same intervention. The developed technique shows a stable relationship between the volume of blood loss and the area of the excised scab.
CONCLUSIONS: The data obtained allow to conclude that the new method for determining blood loss in burn victims appears to be a simple and effective method. The new technique will allow to find the most effective methods of minimizing blood loss during surgical necrectomies, which will reduce the need for additional hemotransfusions and promote earlier rehabilitation of burn treatment.
25-32
Studying zonulin levels in patients with inflammatory bowel disease and peripheral arthritis
Abstract
BACKGROUND: Currently, disruption of the barrier function of the intestinal mucosa is considered one of the key mechanisms in the pathogenesis of extraintestinal manifestations of inflammatory bowel diseases, especially damage to the musculoskeletal system.
AIM: To study the relationship between the level of zonulin in blood serum and the parameters of the immune status in patients with inflammatory bowel diseases in combination with peripheral arthritis.
MATERIALS AND METHODS: 97 patients with ulcerative colitis and Crohn’s disease have been examined, with peripheral arthritis verified in 47 patients; the control group included 50 patients without peripheral arthritis. Zonulin, tumor necrosis factor α, interleukin-1β, -10, -17A, -23 were determined in blood serum using standard kits for direct enzyme immunoassay.
RESULTS: Patients with peripheral arthritis were younger with an earlier onset of inflammatory bowel diseases (p < 0.001). When assessing the concentration of serum zonulin in the patients with and without arthritis, no significant differences have been found. In the patients with peripheral arthritis, zonulin concentration directly correlated with the level of interleukin-17A (r = 0.323; p = 0.039), interleukin-23 (r = 0.321; p = 0.041).
CONCLUSIONS: According to the data obtained, the use of zonulin as a marker of peripheral arthritis in inflammatory bowel diseases is not recommended. Nevertheless, the correlation of zonulin and the concentrations of interleukin-17А and -23 demonstrates its role in the regulation of mucosal immunity in the development of extraintestinal manifestations of inflammatory bowel diseases.
33-40
Dynamics of the prevalence of Helicobacter pylori infection from 2015 to 2023
Abstract
BACKGROUND: The global prevalence of Helicobacter pylori infection has decreased from 58.2% (1980–1990) to 43.1% (2011–2022). To develop clinical recommendations for prevention diseases associated with Helicobacter pylori, it is important to assess changes in Helicobacter pylori infection in the world and in the Russian Federation, in particular.
AIM: To assess the dynamics of Helicobacter pylori infection among patients in St. Petersburg, who undergone 13С-urease breath test in the period from 2015 to 2023.
MATERIALS AND METHODS: All the patients have been included in the descriptive study to conduct 13C-urease breath test. If the Delta Over Baseline was less than 2.5‰, the test was considered negative. The value of this indicator of more than 2.5‰ indicated infection with Helicobacter pylori. The database for subsequent statistical analysis included age, gender, the facts of prior eradicative therapy, test results, including degree of infection.
RESULTS: Helicobacter pylori was detected in 32.7% (16,642; 95% confidence interval 32.3–33.1%) of the patients. Of the 50,884 study participants, 83.6% (42,543; 95% confidence interval 83.3–83.9%) of the patients had not received eradication therapy in the past (primary “naive” patients), 16.4% (8341; 95% confidence interval 16.1–16.7%) had undergone eradication therapy in the past therapy (treated “recurrent” patients). The average infection rate among primary patients was 36.1% (15,358; 95% confidence interval 35.6–36.6%), among recurrent patients — 15.4% (1284; 95% confidence interval 14.6–16.2%). From 2015 to 2017, a decrease in Helicobacter pylori infection was detected in “naive” and “recurrent” patients in all the groups by 14.8 and 21.1%, respectively, and from 2020 to 2023 — by 3.6 and 6.2%, respectively. The majority of both primary and recurrent patients showed a very high (IV) degree of infection — 73.0 and 66.5%, respectively.
CONCLUSIONS: The study demonstrated significant reduction of Helicobacter pylori infection from 2015 to 2017 indicating that information from doctors about the importance of diagnosing and treating Helicobacter pylori infection is a priority task. The new coronavirus infection also had an impact on the incidence of the infection; however, it is still unclear what the negative consequences of the active use of antibacterial agents in patients with COVID-19 are, first of all, potential impact on Helicobacter pylori resistance to key antibacterial drugs.
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Dynamics of clinical manifestations and cytokine levels in patients with rheumatoid arthritis associated with upadacitinib therapy
Abstract
BACKGROUND: Recently, it has become evident that despite extensive data obtained from randomised placebo-controlled trials, which are still the golden standard for assessing the efficacy and safety of therapy, there are still some fundamentally important questions regarding the optimal management of patients with rheumatoid arthritis. In this regard, it is extremely relevant to assess the results of therapy in real clinical practice. Currently, much attention is paid to the study of the level of proinflammatory cytokines, both as markers of inflammatory activity of rheumatoid arthritis and monitoring the prognosis of anti-inflammatory therapy efficacy. In Russia, there are no works devoted to the study of cytokine concentration dynamics in patients with rheumatoid arthritis on the background upadacitinib therapy, which proves the relevance of the following study.
AIM: To investigate the dynamics of clinical and laboratory values of inflammatory activity of the disease and cytokines in patients with rheumatoid arthritis associated with upadacitinib therapy.
MATERIALS AND METHODS: We examined 10 patients with a reliable diagnosis of rheumatoid arthritis: patients’ age was 46.30 ± 10.20 years and disease duration was 12.00 (3.00–21.00) years. All the patients had moderate to high disease activity: Disease Activity Score-28 with erythrocyte sedimentation rate 5.48 (4.50–5.80), Clinical Disease Activity Index 28.00 (19.50–32.00) and Simple Disease Activity Index 29.18 (19.51–33.05). All the patients included in the study were treated with upadacitinib at a dose of 15 mg once a day against the background of the therapy with methotrexate, leflunomide, non-steroidal anti-inflammatory drugs and glucocorticoids. Observation was carried out before treatment and after 3, 6 months of therapy. Serum levels of 15 cytokines: interleukin-1β, -4, -6, -10, -17A, -17F, -21, -22, -23, -25, -31, -33, tumor necrosis factor-alpha, interferon gamma, soluble СD40 ligand were studied using multiplex xMAP technology.
RESULTS: After 3 and 6 months of upadacitinib therapy, there was a significant decrease in Disease Activity Score-28 with erythrocyte sedimentation rate 3.78 (2.53–4.20) and 3.5 (2.00–3.68), Clinical Disease Activity Index 12.00 (5.00–17.34) and 9.0 (3.00–11.00), Simple Disease Activity Index 12.38 (5.02–17.00) and 9.61 (3.06–11.60), erythrocyte sedimentation rate 19.0 (11.0–26.0), 7.0 (4.0–18.0), CRP 0.56 (0.50–1.99), 0.71 (0.51–1.1). The values of erythrocyte sedimentation rate decreased after 3 months of treatment (baseline 21.0 (15.0–25.0) mm/hour, after 3 months 14,0 (11,0–17,0) mm/hour. After 6 months of upadacitinib therapy, there was a significant decrease in interleukin-10 (p < 0.05) and interleukin-33 (p < 0.01) levels compared to baseline. On the contrary, the level of interleukin-25 increased by the 6th month of treatment (p < 0.01).
CONCLUSIONS: The results of the study indicate the effectiveness of upadacitinib in rheumatoid arthritis, and also provide grounds for further study of the pathogenetic mechanisms of cytokine-dependent inflammation in this disease.
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Assessment of the physical development of children with and without high thrombogenic risk factors in the Health Center for Children
Abstract
BACKGROUND: Up to 65% diseases associated with pathological thrombus have been described; more than 100 thrombogenic risk factors leading to vascular accidents have been studied. It is known that physical development is an important indicator of health in children. The relationship between the presence of thrombogenic risk factors in various disorders of physical development in children has been studied.
AIM: To determine the relationship between physical development disorders in children and the presence of thrombogenic risk factors.
MATERIALS AND METHODS: The study included 396 children aged 14–18 years, who underwent physical growth assessment using the sigma deviation method and genetic testing to determine polymorphisms of folate cycle genes and polymorphisms of thrombophilia genes. Statistical processing was carried out using the application package Statistica 10.0 (StatSoft, Inc., USA).
RESULTS: The analysis of anthropometric indicators in children showed that in the group of the patients with thrombogenic risk factors, height and body weight values with average physical disharmonious development due to excess weight were statistically significantly higher than age-reference indicators.
CONCLUSIONS: Based on the results of the study, it has been shown that disharmony in physical development in children with high thrombogenic risk factors may be one of the risk factors for the development of thrombotic conditions.
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Pulmonary artery thrombosis. Clinical aspects and the possibility of prognosis
Abstract
BACKGROUND: Recently, there has been a growing interest to the pulmonary artery thrombosis due to the collected data on pathogenesis of this complication and the awareness about developing diagnostic and therapeutic strategy distinctive from those in pulmonary embolism.
AIM: To estimate the pulmonary artery thrombosis clinical presentation, its electrocardiographic and echocardiographic signs and the possibility of applying venous thromboembolism risk assessment scores and diagnostic scoring systems in the cohort of deceased patients with verified pulmonary artery thrombosis.
MATERIALS AND METHODS: A retrospective study based on the medical records analysis of two groups of deceased patients has been carried out. The first group included 80 patients with pulmonary artery thrombosis and the second one included 42 patients with pulmonary embolism. All the patients’ diagnoses were confirmed by the results of sectional and histological studies. 61 patient with COVID-19 and 19 non-COVID urgent patients with different pathologies were included in pulmonary artery thrombosis group. All 42 patients in pulmonary embolism group had verified venous thrombosis or heart chambers thrombi. Clinical presentation peculiarities, the electrocardiographic and echocardiographic reports as well as the possibility of application of Caprini, IMPROVE VTE, Padua, Wells and Geneva scoring systems were analyzed.
RESULTS: None of the 80 pulmonary artery thrombosis patients had hemoptysis, unexpected dyspnoea, sudden strong cough, chest pain, or syncopea. Electrocardiographic changes indicative of right ventricular strain were found in 52.5% in the pulmonary artery thrombosis group and in 57.1% in the pulmonary embolism group. Inversion of T waves, complete and incomplete right bundle branch block were recorded in 14.6% and in 12.5%, in 36.3% and in 47.5% in the pulmonary artery thrombosis group and in the pulmonary embolism group, respectively, without statistical significance between two groups. Echocardiographic findings of right ventricular overload and/or dysfunction were present in 5 out of 10 patients with pulmonary artery thrombosis and in 5 out of 9 patients with pulmonary embolism. The correlation between Caprini, IMPROVE VTE and Padua scores and the incidence of pulmonary artery thrombosis was as strong as with the incidence of pulmonary embolism. On the contrary, Wells and Geneva clinical prediction scores failed to determine the probability of pulmonary artery thrombosis.
CONCLUSIONS: Pulmonary artery thrombosis occurs without obvious clinical manifestations typical for pulmonary embolism. Electrocardiography and echocardiography reveal right ventricular overload in pulmonary artery thrombosis and in pulmonary embolism with equal frequency. Patients with high risk of pulmonary artery thrombosis can be identified by using the Caprini, IMPROVE VTE, Padua Prediction scores.
75-84
Case report
Clinical case of fulminant course of atypical hemolytic-uremic syndrome
Abstract
This clinical observation describes a case of a fulminant course of an atypical hemolytic-uremic syndrome. The initial stage of the course of the disease is of particular interest, which was not accompanied by typical manifestations of atypical hemolytic-uremic syndrome according to the type of acquired autoimmune hemolytic anemia. Thus, revealing this clinical observation may help in the diagnosis of atypical hemolytic-uremic syndrome with atypical initial manifestations and avoid errors, delays and adverse outcomes of this disease.
85-90
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор). Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 71733 от 08.12.2017.