scholarly journals A new principle for the diagnosis morphea in the onset of the disease

2021 ◽  
Vol 24 (3) ◽  
pp. 263-274
Author(s):  
Denis V. Zaslavsky ◽  
Akmal A. Sidikov ◽  
Lyubov V. Garyutkina ◽  
Grigoriy B. Pyagai ◽  
Muyassar D. Alaeva ◽  
...  

BACKGROUND: Because of the low specificity morphea clinical manifestations in early stages, the differential diagnosis is difficult. AIMS: The purpose of the research is to propose a new diagnostic method for early stages of localized scleroderma. MATERIALS AND METHODS: During 20112020, 77 patients with clinical manifestations of morphea and 127 controls were examined and included in the study at the LenOblCenter. All participants were conducted a transcutaneous oximetry with the TCM-400 Radiometer apparatus. The tissue oxygen perfusion (tcpO2) level from 40 to 50 mm Hg was considered as a reversible decrease, from 30 to 40 mm hg was a borderline decline and the value below 30 mm hg was critical. The following diagnostic skin biopsy was conducted in all 77 patients RESULTS: Skin biopsy allowed to form 4 research groups: 40 patients with morphea, 12 patients with granuloma annulare, 15 patients with small plaque parapsoriasis and 10 individuals with large plaque parapsoriasis. 7 (17.5%) patients with morphea had normal tcpO2 values, 9 (22.5%) patients had significant decrease of tcpO2, 24 patients (60%) showed a reversible decrease of tcpO2. 3/12 (25%) patients with granuloma annulare and 1 patient (10%) with large plaque parapsoriasis had minor oxygen level decrease. Measurement on the healthy skin showed tcpO2 decrease in patients with comorbidities ― 3/77 (3.9%) in research group and 28/127 (22%) in controls. CONCLUSIONS: Transcutaneous oximetry is a new perspective direction in the diagnostic algorithm of the morphea based on the pathogenesis and morphological features of the disease.

2020 ◽  
Vol 23 (4) ◽  
pp. 227-237
Author(s):  
Denis V. Zaslavsky ◽  
A. A. Sidikov ◽  
L. V. Garyutkina ◽  
A. I. Sadykov ◽  
I. N. Chuprov ◽  
...  

BACKGROUND:Recently there has been an increase in the number of patients with scleroderma. AIM:This study aimed to investigate the pathogenesis and course and present the immunopathogenesis of localized scleroderma (LS) or morphea. MATERIALS AND METHODS:From 2010 to 2019, a prospective study of 77 patients with LS was conducted on the basis of the Leningrad regional center for specialized types of medical care. Based on histological examination, LS diagnosis was verified in 40 of 77 patients. Patients with LS (n = 40) were included in the first research group and were then divided into two subgroups based on the limitation period for the first symptoms of the disease: in subgroup I (n = 20), the disease manifested no later than 1.7 months before clinic visit; in subgroup II (n = 20), the limitation period was 1.5 years. RESULTS:Patients of both subgroups (n = 40) underwent immunohistochemical (IL-2, IL-4, CD4, CD8, vimentin, Toll-like receptor TLR7) tissue analysis and immunological blood tests to determine autoantibodies. To improve the differential diagnosis of LS, a comparative assessment of clinical manifestations and histological signs was performed in patients with LS (n = 40) and patients with clinically similar dermatoses (n = 37): annular granuloma (n = 12, 7 women and 5 men, average age 44 12 years), small plaque (n = 15, 6 women and 9 men, average age 42 4 years), and large plaque (n = 10, 5 women and 5 men, average age 59 8 years) parapsoriasis. According to the results of the histological examination, inflammatory changes are dominant in patients with LS manifestation period of 1.7 months from the onset of the disease, while fibrotic changes are apparent in patients with a manifestation period of 1.5 years. The expressions of CD4, CD8, IL-2, and TLR7 were more pronounced in subgroup 1, while those of IL-4, CD4, and vimentin were high in subgroup 2. No autoantibodies were detected in the blood of patients with LS. The results allow us to divide the pathogenesis of LS into two phases: inflammatory and fibrotic. Immune dysregulation and fibrosis occur simultaneously, but with phase dependant predominance. CONCLUSIONS:In the future, a detailed understanding of the pathogenesis of LS will help improve diagnostic and therapeutic algorithms and reduce the frequency of relapse and complications.


2017 ◽  
Author(s):  
Kristine Phillips

Scleroderma spectrum diseases are a heterogeneous group of disorders that are distinguished by abnormalities of the connective tissue in the skin and, in some cases, other organs. Each disorder may be characterized by the extent of cutaneous and internal involvement, as well as histopathologic features of skin biopsy. Scleroderma spectrum diseases include systemic scleroderma, localized scleroderma, and eosinophilic fasciitis. This chapter reviews the classification, epidemiology, etiology, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, outcome measures, management, and clinical course of scleroderma as well as the definition and classification, etiology/genetics, differential diagnosis, and treatment of localized scleroderma. Also discussed are the definition and classification, epidemiology, etiology/genetics/pathogenesis, diagnosis, differential diagnosis, and treatment of eosinophilic fasciitis. Tables review the classification of—and antinuclear antibodies in—scleroderma as well as the key assessments and interventions in scleroderma management. Figures illustrate the disease's presentation and clinical manifestations, including several images of scleroderma of the hands; face, palmar, and buccal telangiectasias in a patient with scleroderma; a radiograph demonstrating calcinosis of the elbow; Raynaud’s phenomenon; high-resolution computed tomographic images of diffuse cutaneous scleroderma, scleroderma and severe pulmonary hypertension, and limited cutaneous scleroderma; plus an esophagram demonstrating hypomotility. This review contains 11 highly rendered figures, 3 tables, and 72 references.


2018 ◽  
Vol 17 (3) ◽  
pp. 46
Author(s):  
I. V. Khamaganova ◽  
M. V. Novoseltsev ◽  
E. V. Lebedeva

Author(s):  
Ehsan Shahverdi ◽  
Mehdi Shahriari ◽  
Soonia Zare ◽  
Mohammad Saeid Rahimine- jad ◽  
Fatemeh Hosseinpour Soleimani ◽  
...  

Background: Acute lymphoblastic leukemia (ALL) is one of the blood cancers responsible for 80% of children’s leukemia and is also the most common malignancy in patients aged under 14 years (frequency of 23% among all types of cancers). Regarding the importance of identifying clinical symptoms to diagnose the disease in the early stages, this study is conducted to investigate the symptoms at diagnosis in ALL children. Methods: In this retrospective cohort study, 350 patients aged under 14, referring to four hospitals of Shiraz University of Medical Sciences as reference hospitals in Southern Iran, participated between 2013 and 2019. Their information was collected using patients’ records, and the data were analyzed using SPSS version16. Results: Based on the findings of this study, the first clinical manifestations of the disease happened suddenly and acute, occurring within a few days to a maximum of 6 weeks before diagnosis. Fever (70%) and hepatomegaly (60%) were the most common signs and symptoms in patients. However, a significant percentage of ALL patients referred with non-specific symptoms. Conclusion:The results of this study indicate the importance of recognizing common and unusual signs and symptoms based on a complete and thorough history taking and accurate physical examination as well as rare symptoms that may be ignored or misdiagnosed by physicians. The knowledge of common signs and symptoms results in early diagnosis of the disease in early stages.


2021 ◽  
Vol 19 (2) ◽  
pp. 141-146
Author(s):  
Yu. Yu. Liashko ◽  

Psoriatic arthritis is a heterogeneous disease characterized by the involvement of the axial skeleton and peripheral joints and / or entheses in the pathological process. The problems of diagnosing early psoriatic arthritis are not limited to the heterogeneity of clinical manifestations of the disease. Unlike rheumatoid arthritis, there are no biomarkers for the detection of early psoriatic arthritis, and therefore verification of the diagnosis depends on the identification of specific clinical signs. Finally, the absence of psoriasis in the presence of typical clinical signs of arthritis does not permit to confirm the diagnosis in the early stages. Considering numerous difficulties of clinical and laboratory diagnostics of psoriatic arthritis, great attention is paid to non-invasive instrumental methods for diagnosing the disease at early stages. The article provides up-to-date information on the potentials of ultrasound techniques in the diagnosis of early psoriatic arthritis.


2020 ◽  
Vol 96 (1) ◽  
pp. 45-51
Author(s):  
Arfenya E. Karamova ◽  
Lyudmila F. Znamenskaya ◽  
Vadim V. Chikin ◽  
Viktoria A. Mihina ◽  
Maria A. Nefedova

Purpose. To present a clinical case of IgG/IgA pemphigus in a 32-year-old woman. Material and methods. Clinical and laboratory examinations were performed to diagnose the disease: cytological examination of an impression smear from the bottom of the erosion, histological examination of a skin biopsy sample from the lesion, immunofluorescent examination of a biopsy sample of visually accessible unaffected skin. Results. Clinical manifestations of the disease were similar to Duhring's dermatitis herpetiformis, morphological ones to pemphigus vulgaris, but immunofluorescent examination of the skin biopsy sample in equal measure revealed deposits of both IgG and IgA in the epidermis, which allowed to determine a diagnosis of IgG/IgA pemphigus. Dapsone therapy at a dose of 100 mg per day led to a significant improvement in the patient's condition. Conclusion. Diagnosis of bullous dermatoses requires immunofluorescent examination of a biopsy sample of visually accessible unaffected skin. Dapsone was an effective medication for the patient with IgG/IgA pemphigus.


2019 ◽  
pp. 20-24
Author(s):  
P. I. Tkachenko ◽  
M. O. Cholovskyi ◽  
O. B. Dolenko ◽  
S. O. Belokon ◽  
Y. V. Popelo

Neuroblastoma in newborns is a fairly rare disease and affects 6-8 children per million children. It can be combined with congenital defects, has a tendency to metastasize and to spontaneous maturation in ganglioneuritis, which can simulate various diseases and significantly complicate its diagnosis. This publication provides clinical observations of a newborn baby with a neuroblastoma located in the maxillofacial area. Attention is drawn to the difficulties encountered in establishing a clinical diagnosis, to address questions about this, it is recommended that modern, highly informative methods of examination be more widely involved in examining such children, preferably in the early stages of the disease. Against the background of an unceasing increase in the number of malignant neoplasms of the maxillofacial area among the Ukrainian population, directly among the residents of the Poltava region, this figure is 2.3% of the total number of newly diagnosed malignant formations. Asymptomatic course and "erosion" of clinical manifestations of tumors at their initial stages of development, the untimely treatment of patients with specialized assistance against the background of inadequate awareness among citizens and healthcare professionals in this section of medicine and their lack of oncological anxiety leads to the fact that a significant proportion of patients falls on treatment with abandoned forms. In particular, according to the statistical reporting of the Poltava regional oncologic dispensary at stages III and IV, the malignant process in the tissues 41.6%, of which 54% is cancer of the oral mucosa, from 28%, where the cancer of the tongue is in 10% of cases of lung cancer and 8% diagnosed salivary gland cancer. It is rather unfortunate, but in 55% of the observations, the cause of late treatment is organizational and methodological disturbances: not enough complete examination of patients, to the hospital stage (underestimation of clinical data, X-ray changes, incorrect interpretation of the results of additional methods of examination), insufficient prophylactic work among the general population or a sequence of its planning, poor quality preventive examinations, delayed patients in the grass-roots of medical institutions. In spite of the fact that a significant proportion of organs and tissues of maxillofacial area are available for objective and application of additional methods of examination, about 40% of patients have launched forms of malignant processes due to the faults of doctors [2, 3, 5, 8]. In nursery practice, the situation does not look better, since in Ukraine, 3.5% of cases of malignant tumors are diagnosed annually in Ukraine. Unfortunately, in periodicals there are isolated data on primary and metastatic lesions of maxillofacial area in children, although the recognition and treatment of oncosomatic diseases in them in the early stages of development to date present considerable difficulties due to the large variety of clinical manifestations of tumors, age-specific features, dependence of diagnosis malignant neoplasms from the dynamics of growth, localization, local and general changes [6,7]. Therefore, in our opinion, the number of diagnostic errors in children's practice is greater than in adults. The problem is of general medical significance also because, due to topographic and anatomical features of the structures of the head and neck, any pathology of maxillofacial localization is the subject of participation of doctors in various related specialties. Thus, the given clinical case indicates the possibility of a malignant effect of tissues and organs of a child already during the period of fetal development, which greatly complicates the diagnostic procedure and should alert doctors of all specialties.


2021 ◽  
Vol 1 (1) ◽  
pp. 101-107
Author(s):  
Feifei Su ◽  
Shoufeng Yang ◽  
Liang Hong ◽  
Yao Sun ◽  
Yue Qu

Objective: This retrospective, two-center study aimed to provide solid clinical evidence to support the viral attenuation theory after passages of SARS-CoV-2 during the early stages of the pandemic. Methods: Clinical characteristics and outcomes of 150 COVID-19 patients hospitalized in Wenzhou, China between January and April 2020 were compared. These patients had similar demographic characteristics. Infections of 77 patients who visited Wuhan within 14 days before symptom onset were categorized as imported cases and that of the remaining 73 patients who had no recent travel history were categorized as locally transmitted cases. Results: COVID-19 cases in Wenzhou appeared to be mostly mild at the early stages of the pandemic. There were no differences in clinical manifestations, laboratory testing results, and radiographic presentation between imported and locally transmitted cases in Wenzhou, except that a higher proportion of lymphopenia was found in the imported case group. Assessment of infection severity showed that severe conditions were observed in 10.7% of the patients, with the imported case group having a significantly higher rate (15.6%) than the locally transmitted case group (5.5%, x2 = 4.016, p = 0.045). Conclusion: Although, the clinical manifestations of locally acquired infections were indistinguishable from those imported from Wuhan, they were less likely to develop into severe medical conditions, suggesting the possibility of virulence attenuation after viral passages during the early stages of the pandemic.


2020 ◽  
Vol 16 (24) ◽  
pp. 68-76
Author(s):  
N.V. Bakulina ◽  
◽  
A.S. Nekrasova ◽  
A.Ya. Gudkova ◽  
E.L. Latariya ◽  
...  

This review is devoted to the current state of the problem of diagnosis of systemic amyloidosis at the outpatient stage and in a multidisciplinary hospital. The article summarizes the existing information about the variants of the clinical course and provides current methods of verification of this disease. In systemic amyloidosis, the involvement of different systems and organs in the pathological process, the variety of clinical manifestations and nonspecific complaints of the patient in the early stages of this disease often lead to untimely establishment of the correct diagnosis and late initiation of treatment, worsening the prognosis and posing a significant threat to the life of the patient. Early diagnosis of systemic amyloidosis allows the patient to start treatment on time and increases the chances of success


Cells ◽  
2019 ◽  
Vol 8 (9) ◽  
pp. 1059 ◽  
Author(s):  
Chiara A. Elia ◽  
Matteo Tamborini ◽  
Marco Rasile ◽  
Genni Desiato ◽  
Sara Marchetti ◽  
...  

Bone marrow Mesenchymal Stem Cells (BM-MSCs), due to their strong protective and anti-inflammatory abilities, have been widely investigated in the context of several diseases for their possible therapeutic role, based on the release of a highly proactive secretome composed of soluble factors and Extracellular Vesicles (EVs). BM-MSC-EVs, in particular, convey many of the beneficial features of parental cells, including direct and indirect β-amyloid degrading-activities, immunoregulatory and neurotrophic abilities. Therefore, EVs represent an extremely attractive tool for therapeutic purposes in neurodegenerative diseases, including Alzheimer’s disease (AD). We examined the therapeutic potential of BM-MSC-EVs injected intracerebrally into the neocortex of APPswe/PS1dE9 AD mice at 3 and 5 months of age, a time window in which the cognitive behavioral phenotype is not yet detectable or has just started to appear. We demonstrate that BM-MSC-EVs are effective at reducing the Aβ plaque burden and the amount of dystrophic neurites in both the cortex and hippocampus. The presence of Neprilysin on BM-MSC-EVs, opens the possibility of a direct β-amyloid degrading action. Our results indicate a potential role for BM-MSC-EVs already in the early stages of AD, suggesting the possibility of intervening before overt clinical manifestations.


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