Resected Intestine Syndrome: Term Defining the Strategy for Nutritional Deficiency Management

Study Objective: to develop nutritional deficiency management approaches in patients with resected intestine syndrome. Study Design: observational study. Materials and Methods. We examined and treated 239 patients (143 women, mean age: 49.4 ± 6.5 years old; 96 men, mean age: 52.1 ± 15.6 years old) who underwent intestine resection to a various extent and level caused by various conditions. Small intestine was resected in 96 patients; a combined resection of small intestine and right half of large intestine was performed in 97 patients; and right hemicolectomy/colectomy was indicated in 46 cases. At least one month after surgery all patients underwent a screening to identify the nutrition risk as per the Screening of Nutritional Risk 2002 questionnaire. Study Results. It was found out that nutritional support was needed in 85.7% of cases, including 51% and 34.7% of cases with moderate and high risk of nutritional disorders, respectively. Various extent and levels of intestine resections are characterised by similar types of nutritional deficiency, most often it was a mixed type with signs on dehydration and protein-calorie deficiency. Following the results of a comprehensive nutritional deficiency assessment in our patients and taking into account the level and extent of intestine resection, as well as its causes and concomitant pathology, we propose a new term “resected intestine syndrome” and classification. Additional examinations using the proposed classification allowed adjusting the conventional nutritional therapy and modifying management. Conclusion. Data consolidation resulted in the need to introduce a new term “resected intestine syndrome” and to develop a classification which allows using differentiated correction of this condition and to make any forecasts. The term “resected intestine syndrome” we propose and a new classification of nutritional deficiency can help in identifying the potential risk as well as patients requiring nutritional correction and follow-up. Keywords: nutritional deficiency, resected intestine syndrome, therapy.

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Assessment of the Balance and Dizziness Objectification in Patients with Vestibular Bilous Headache

Doctor Ru ◽

10.31550/1727-2378-2021-20-9-17-20 ◽

2021 ◽

Vol 20 (9) ◽

pp. 17-20

Author(s):

E.M. Illarionova ◽

◽

N.P. Gribova ◽

◽

Keyword(s):

Visual Stimulation ◽

Control Group ◽

Frequency Spectra ◽

Study Objective ◽

Study Materials ◽

Study Results ◽

Pressure Centre ◽

Group 2 ◽

International Headache Classification ◽

Primary Frequency

Study Objective: To study the balance in patients with vestibular bilious headache (BH) and possible use of a special comprehensive stabilometrical program for dizziness objectification in them. Study Design: open comparative study. Materials and Methods. The study included 188 patients. Group 1 were 94 patients with confirmed BH (according to the International Headache Classification). Group 2 were 94 patients with common migraine. The stabilometrical control group included 94 healthy subjects. The balance and dizziness objectification were assessed using a special comprehensive method comprising a set of stabilometrical tests. Study Results. The most marked changes in stabilometrical parameters were recorded in patients with BH. Primary frequency spectra of these patients were in a range of 0.3 Hz and above 2 Hz, showing the dysfunction of the postural system and vestibular component in particular. The rate of pressure centre deviation and statokinesigram area were increased in the patients from group 2 vs controls; however, statistically significant differences were noted only in opticokinetic test, sensory and vestibular, and closed-eye tandem results. Comparison of the two clinical groups demonstrates significant differences in basic stabilometrical parameters of all challenge tests. Visual control exclusion as well as substandard visual stimulation had significant impact on changes in the analysed parameters. Conclusion. The use of special stabilometrical tests (opticokinetic stimulation, sensory and vestibular and tandem tests) described in this article allows assessing the balance, quantifying vestibular dysfunction in patients with BH, and objectifying dizziness. Keywords: dizziness, balance, vestibular migraine, computer-aided stabilometry.

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Analysis of Risk Factors and Perinatal Mortality Structure in Pregnant Patients with Diabetes Mellitus

Doctor Ru ◽

10.31550/1727-2378-2021-20-6-46-52 ◽

2021 ◽

Vol 20 (6) ◽

pp. 46-52

Author(s):

R.V. Kapustin ◽

◽

E.V. Kopteeva ◽

E.N. Alexeenkova ◽

E.M. Tsybuk ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Perinatal Mortality ◽

Perinatal Death ◽

Mode Of Delivery ◽

Overweight And Obesity ◽

Study Objective ◽

Study Materials ◽

Study Results ◽

Patients With Diabetes

Study Objective: To analyse risk factors and perinatal mortality structure in patients with various types of diabetes mellitus (DM) over the last 30 years in specialised settings. Study Design: retrospective single-site cohort study. Materials and Methods. We have studied 42 medical records containing cases of perinatal death of foetus or newborn in 1988–2018 in patients with DM1 (n = 20), DM2 (n = 10), gestational DM (n = 12). Study Results. The most common complication in pregnancy was preeclampsia combined with chronic placental insufficiency (47.6%). The most common risk factors of perinatal death were inadequate glycemic control in 1st trimester (69.0%), absence of preconception preparations (66.7%), preconception overweight and obesity (42.8%), and chronic arterial hypertension (28.6%). There were 38.1% antenatal deaths, 16.7% intranatal deaths, and 45.2% cases of postnatal mortality. The major causes of perinatal foetal mortality in 26.2% cases were placental disorders, 16.7% were associated with foetus growth retardation, diabetic fetopathy and respiratory distress syndrome. Conclusion. DM during pregnancy was associated with a higher risk of perinatal death. Timely preconception preparation, BMI normalization and a consolidated approach to term and mode of delivery can reduce the risk of perinatal mortality in women with various types of DM. Keywords: diabetes mellitus, gestational diabetes mellitus, perinatal mortality, stillbirth, obesity, preeclampsia

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Visual Object Agnosia in Acute Ischemic Stroke: A First Neuroimaging Biomarker

Doctor Ru ◽

10.31550/1727-2378-2021-20-9-6-10 ◽

2021 ◽

Vol 20 (9) ◽

pp. 6-10

Author(s):

G.V. Tikhomirov ◽

◽

V.N. Grigorieva ◽

A.S. Surkova ◽

◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Visual Object ◽

Visual Agnosia ◽

Study Objective ◽

Study Materials ◽

Stroke Study ◽

Study Results ◽

Potential Use ◽

Ct And Mri

Study Objective: To demonstrate the potential use of peripheral sulcus occipitotemporalis involvement as a first neuroimaging biomarker of visual object agnosia in acute ischemic stroke. Study Design: Retrospective study. Materials and Methods. We have examined 76 patients (52 males, 24 females) in peracute or acute hemisphetic (supratentorial) ischemic stroke. The age of participants was 66.5 ± 6.7 years. The examination involved neurological, neuropsychologic, neuroimaging and eye checks. Any disturbances of the visual object gnosis were diagnosed with the Object Decision test from the Birmingham Object Recognition Battery. According to brain CT and MRI results, all patients underwent assessment of their sulcus occipitotemporalis involvement. Study Results. Stroke-related visual object agnosia was diagnosed in 7 (9.2%) patients. Statistically significant correlation between foci localisation in the sulcus occipitotemporalis and visual object agnosia development (χ2 = 64.2; р < 0.001) has been demonstrated. The sensitivity of sulcus occipitotemporalis involvement as a biomarker of visual object agnosia in acute ischemic stroke was 85.7%, while the specificity was 100%. Conclusion. Sulcus occipitotemporalis involvement in acute ischemic stroke can be used as a neuroimaging biomarker of visual object agnosia. Keywords: visual agnosia, object agnosia, ischemic stroke, neuroimaging, sulcus occipitotemporalis.

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Pathogenesis of Implantation Incompetence of Endometrium in Endometriosis-Associated Infertility

Doctor Ru ◽

10.31550/1727-2378-2021-20-6-57-61 ◽

2021 ◽

Vol 20 (6) ◽

pp. 57-61

Author(s):

L.M. Mikhaleva ◽

◽

M.R. Orazov ◽

S.V. Volkova ◽

M.B. Khamoshina ◽

...

Keyword(s):

Reproductive Function ◽

Biopsy Material ◽

Aberrant Expression ◽

Study Objective ◽

Study Materials ◽

Keywords Endometriosis ◽

Study Results ◽

Endometrium Receptivity ◽

Endometrium Biopsy ◽

Fertile Women

Study Objective: To expand the idea of the pathogenesis of implantation incompetence of endometrium in women with endometriosis-associated infertility. Study Design: open perspective comparative study. Materials and Methods. The study enrolled 78 women. The study group included 32 patients with endometriosis genitalis externa (EGE) and infertility; the comparison group included 33 patients with EGE who used their reproductive function not more than 3 years before the study and who were not diagnosed with infertility; the group of morphological control made 13 fertile women without EGE. The subject of the study was endometrium biopsy material obtained on day 5–7 of menstruation, following the peak blood concentration of luteinizing hormone during the expected implantation window. Study Results. When patients with endometriosis-associated infertility were compared to fertile women with EGE, we noted increased expression of GATA2 — 1.6-fold, GATA6 — 1.7-fold, SF-1 — 1.5-fold and reduced HOXA10 expression by 2.9 times (p < 0.05 in all cases) in stroma of infertile women. When patients with endometriosis-associated infertility were compared to fertile women without EGE, we recorded statistically significant (р < 0.05) increase in expression of GATA2 in stroma (2.5-fold) and glands (2.2-fold), GATA6 and SF-1 in stroma (2-fold in both cases), and reduced HOXA10 expression both in stroma (3.6-fold) and glands (2.8-fold). Conclusion. Pathogenesis of implantation incompetence of endometrium in endometriosis-associated infertility is caused by impaired endometrium receptivity because of aberrant expression of transcription factor affecting local hormonal balance. Keywords: endometriosis-associated infertility, implantation incompetence of endometrium

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The Relationship of Rates and Causes of Stillbirth to Obstetric Facility Level

Doctor Ru ◽

10.31550/1727-2378-2020-19-8-55-61-65 ◽

2020 ◽

Vol 19 (8) ◽

pp. 61-65

Author(s):

M.Ya. Kamilova ◽

◽

P.A. Dzhonmakhmadova ◽

F.R. Ishan-Khodzhaeva ◽

◽

...

Keyword(s):

Fetal Death ◽

Labor And Delivery ◽

Study Objective ◽

Study Materials ◽

Perinatal Audit ◽

Study Results ◽

Level 3 ◽

Facility Level ◽

Relationship Of ◽

Level 2

Study Objective: To compare the rates and causes of stillbirth in level 2 and 3 obstetric institutions. Study Design: This was a retrospective group study. Materials and Methods: Statistical data and labor and delivery histories of women who experienced stillbirth and were admitted to obstetric facilities (two level 2 facilities and one level 3 facility) between January and June 2019 were reviewed. Retrospective analysis was done of their labor and delivery histories, and the cases of stillbirth were clinically analyzed, using the ReCoDe classification. Study Results: The frequency of stillbirth was higher in the level 3 hospital. Irrespective of the level of hospital, mortality in the antenatal period dominated (four out of six cases in the level 2 facilities and 104 out of 129 in the level 3 facility); it was more often due to congenital malformations in the level 2 facilities and to intrauterine growth restriction (IUGR) or placental insufficiency in the level 3 facility. In the level 3 hospital, the most common causes of intranatal fetal death included maternal (pre-eclampsia and extragenital diseases) and fetal (IUGR) disorders that developed before labor. The risk factors for stillbirth were inadequate quality of medical services and factors related to the woman or family, such as late registration for prenatal care, non-compliance with doctors’ recommendations, etc. Conclusion: The actual causes, as established in this study, of negligence leading to stillbirth demonstrate that there is potential for reducing perinatal mortality. Keywords: stillbirth, antenatal and intranatal fetal death, ReCoDe classification, causes of stillbirth, perinatal audit.

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Disorders of the Cervix and Characteristics of Colposcopy in Pregnant Women

Doctor Ru ◽

10.31550/1727-2378-2020-19-8-32-39 ◽

2020 ◽

Vol 19 (8) ◽

pp. 32-39

Author(s):

T.N. Bebneva ◽

◽

G.B. Dikke ◽

◽

...

Keyword(s):

Human Papillomavirus ◽

Pregnant Women ◽

Pap Smear ◽

Open Label ◽

Study Objective ◽

Group Iii ◽

Study Materials ◽

Group I ◽

Hpv Status ◽

Study Results

Study Objective: To determine the frequency of disorders of the cervix and identify characteristics of colposcopy specific to pregnant women infected with the human papillomavirus (HPV). Study Design: This was an open-label, non-interventional, comparative, cohort clinical study. Materials and Methods: Three hundred and thirty pregnant women participated in the study. They were divided into four groups: Group I (n = 73) was made up of women without any disorders of the cervix and with a negative test for human papillomavirus (HPV); Group II (n = 75) consisted of women with disorders of the cervix who did not have HPV; Group III (n = 96) comprised those who did not have disorders of the cervix, but had HPV; and Group IV (n = 86) consisted of patients with disorders of the cervix and HPV. Examinations performed included HPV testing with serotyping, cervical cytology (Pap smear), and colposcopy. Study Results: HPV was detected in 55.2% of the patients (182/330), 44.5% of whom (81/182) had types 16/18 HPV. The prevalence of grades I and II disorders of the cervix (mild and moderate) in women who had HPV as well as disorders of the cervix was 17.5% (15/86) according to colposcopy data and 9.3% (8/86) detected by cytology (р = 0.06). The total frequency of these disorders, irrespective of HPV status, was 9.3% (15/161) and 5.6% (9/161), respectively (р = 0.29). Interpretation of the colposcopy data in pregnant women was difficult in some cases due to changes in the cervix, which explains the 3.7% discrepancy between colposcopy and cytology in detecting disorders of the cervix. Conclusion: HPV screening may be done first in pregnant women, followed by cytology in HPV-positive patients. Colposcopy may be reserved for women with high-grade squamous intraepithelial lesions to exclude invasive cancer. Keywords: pregnancy, human papillomavirus, disorders of the cervix, risk factors, colposcopy.

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Neuro-Orthopedic Criteria of Dorsopathy in Pregnant Women

Doctor Ru ◽

10.31550/1727-2378-2021-20-5-43-48 ◽

2021 ◽

Vol 20 (5) ◽

pp. 43-48

Author(s):

E.V. Radzinskaya ◽

◽

I.V. Damulin ◽

◽

Keyword(s):

Pregnant Women ◽

Pelvic Ring ◽

Pubic Symphysis ◽

Study Group ◽

Study Objective ◽

Study Materials ◽

Lower Back ◽

Study Results ◽

Atlantooccipital Joint ◽

The Right

Study Objective: To improve the diagnostic and therapeutic efficiency of dorsopathy in pregnant women by introducing a neuro-orthopedic examination algorithm. Study Design: prospective cohort study. Materials and Methods. The study enrolled 171 pregnant women: 87 dorsopathy patients (study group) and 84 healty women (controls). Inclusion criteria in both groups were progressive single uterine pregnancy, while the inclusion criterion for the study group was lower back pain (LBP) or pelvic ring pain (PRP). Neuro-orthopedic examination complied with the Russian clinical recommendations. Study Results. Neuro-orthopedic criteria to differentiate between pregnant women with or without dorsopathy were lower craniosacral rhythm (7.37 ± 1.53 vs. 8.14 ± 1.46 cycle/min, р = 0.002); sacral counternutation (odds ratio (OR) = 2.66); somatic dysfunctions (SD) in the lower and/or middle third of the right shank, right knee, Th11 NSRL, right clavicle, atlantooccipital joint, cuniform bone (left torsion), dura mater. SD in the right hip and pubic symphysis was included into gestation-associated changes which were unrelated to dorsopathy (LBP and PRP). A probability of LBP and PRP during pregnancy is higher in right sacroiliac joint SD (OR = 13.28; 95% CI: 1.69-104.59). Conclusion. It is reasonable to use osteopathic methods in dorsopathy (LBP and PRP) during pregnancy. Neuro-orthopedic differential diagnosis of lower back and pelvic ring pain reduces the risk of unjustified therapy to prolong pregnancy. Keywords: dorsalgia, somatic dysfunction, pregnancy, neuro-orthopedic examination.

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Impaired Expression of Estrogen and Progesteron Receptors During the Implantation Window in Eutopic Endometrium of Infertile Women Associated with Endometriosis Genitalis Externa

Doctor Ru ◽

10.31550/1727-2378-2021-20-6-53-56 ◽

2021 ◽

Vol 20 (6) ◽

pp. 53-56

Author(s):

V.E. Radzinsky ◽

◽

M.R. Orazov ◽

L.M. Mikhaleva ◽

S.V. Volkova ◽

...

Keyword(s):

Clinical Manifestations ◽

Eutopic Endometrium ◽

Study Objective ◽

Infertile Women ◽

Implantation Window ◽

Study Materials ◽

Keywords Endometriosis ◽

Study Results ◽

Endometrium Receptivity ◽

Fertile Women

Study Objective: To study impaired expression of estrogen (ER) and progesteron (PR) receptor isoforms during the implantation window in eutopic endometrium of infertile women associated with endometriosis genitalis externa (EGE). Study Design: open perspective comparative study. Materials and Methods. The study included 32 patients with endometriosis-associated infertility and implantation failures within the scope of assisted reproductive technology programme (study group), and 33 fertile women with EGE rAFS (stages I to IV) (comparison group). We performed morphological and immunohistochemical examination of endometrium biopsy samples (pipelle biopsy) during an expected implantation window. Study Results. Eutopic endometrium of women with EGE and infertility during the implantation window demonstrated statistically higher (р < 0.05) expression of ERα (19-fold), ERβ (2.3-fold) in stroma and PR-B in glands (1.7-folds) as compared to fertile women win EGE with lower PR-A expression in stroma (2.5-fold). Conclusion. The morphofunctional condition of endometrium and its receptive properties during the implantation window in women with endometriosis-associated infertility reflect the nature of ER (α and β) and PR (А and В) isoforms expression, the abnormalities underlying the endometrium receptivity disorders, with clinical manifestations being absent pregnancy. Keywords: endometriosis-associated infertility; implantation window; endometrium receptivity

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Clinical Features of Psoriatic Arthritis in Children

Doctor Ru ◽

10.31550/1727-2378-2020-19-10-22-26 ◽

2020 ◽

Vol 19 (10) ◽

pp. 22-26

Author(s):

S.N. Chebysheva ◽

◽

N.A. Geppe ◽

E.S. Zholobova ◽

K.V. Aleksanyan ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Plaque Psoriasis ◽

Disease Onset ◽

Clinical Manifestations ◽

Joint Involvement ◽

Skin Involvement ◽

Study Objective ◽

Study Materials ◽

Study Results ◽

Medical University

Study Objective: to present literature review of clinical parameters and course of psoriatic arthritis (PsA) in children, and results of PsA patients examination in University Clinical Children Hospital of I.M. Sechenov First Moscow State Medical University. Study Design: open prospective study. Materials and Methods. We analysed medical records of 83 children with PsA aged 3 to 17 years who were examined and managed in University Clinical Children Hospital of I.M. Sechenov First Moscow State Medical University in 1989 – 2019. Study Results. Confirmed PsA was diagnosed in 59 (71%) children, suspected PsA — in 24 (29%) children; 44 (53%) children got ill before they were 6.5 years old. In 24 (29%) patients, disease started with skin involvement; in 59 (71%) patients, articular syndrome was the first manifestation of disease. In the group of patients with confirmed psoriasis, the most common was plaque psoriasis: it was diagnosed in 45 (76.3%) out of 59 children; guttate psoriasis was found in 8 (13.5%) children, isolated nail plaque psoriasis — in 3 (5.1%) patients, and palm and foot psoriasis — in 3 (5.1%) children. Psoriasis of the scalp was diagnosed in 23 (39%) subjects. In 8 (13.5%) patients, skin syndrome was associated with mild infiltration and scant desquamation. 18 (21.7%) out of 83 children had skin involvement together with nail bed involvement. Psoriasic onychodystrophy was diagnosed in 19 (23%) children (onycholysis, “oil patches” on fingers and toes); 15 (18.1%) children had “thimble syndrome”. On disease onset, 68.7% of children had oligoarticular, sometimes asymmetric articular syndrome; 18.1% had symmetric rheumatoid-like disease, 13.2% — psoriasic spondylitis. After 5 years of follow-up, articular syndrome transformed: 41.2% of patients had symmetric rheumatoid-like disease, 24.1% — asymmetric oligoarthritis, 24.1% — spondylarthritis with peripheral joint involvement, and 10.8% — arthritis mutilans. Most commonly PsA affected knee, talocrural joints, small hand joints – 41%, 31.3%, 29%, respectively. Conclusion. Clinical manifestations of PsA varied a lot. Our patients did not have a second peak. Almost one third of children had skin changes prior to arthritis development. Onset of disease was associated with asymmetric oligoarthritis prevalence. Later, articular syndrome changed, and symmetric rheumatoid-like disease prevailed. Keywords: children, psoriatic arthritis, psoriasis, juvenile idiopathic arthritis, Vancouver diagnostic criteria.

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Interleukin Profile in Children with Acute Bronchiolitis (Raw Data)

Doctor Ru ◽

10.31550/1727-2378-2021-20-10-12-17 ◽

2021 ◽

Vol 20 (10) ◽

pp. 12-17

Author(s):

A.B. Malakhov ◽

◽

A.E. Angel ◽

P.V. Berezhanskiy ◽

V.I. Elagina ◽

...

Keyword(s):

Respiratory Distress ◽

Pathological Process ◽

Cytokine Profile ◽

Acute Bronchiolitis ◽

Study Objective ◽

Course Of Disease ◽

Study Materials ◽

Study Results ◽

History Of ◽

Profile Changes

Study Objective: To find out the cytokine profile in blood serum of children with acute bronchiolitis. Study Design: Comparative study. Materials and Methods. We examined 52 patients aged 1 to 12 months who were hospitalised to Pulmonary Department with acute bronchiolitis and respiratory distress of various severity. All children had interleukins (IL) 4, 6, and 18 in their blood measured. Study Results. Patients demonstrated some trends in changes in their cytokine profile changes depending on respiratory distress severity. We have found direct correlations between high IL-18 levels and respiratory distress (r = 0.86), and between a history of allergies and high IL-4 levels (r = 0.78). Patients with rhinovirus had higher IL-6 values at any respiratory distress severity vs children with rhinosyncytial viral infection, who had higher IL-18 level. Conclusion. Acute bronchiolitis is characterised by a clear pattern of interleukin expression depending on presence of confounding factors impacting the course of disease and respiratory distress severity. Patients with bronchiolitis had marked changes in their cytokine profile depending on respiratory distress severity: increased IL-18 concentration and reduced IL-4 levels. Such changes in interleukin concentrations can be used as markers in forecasting the course of pathological process. Keywords: bronchiolitis, interleukins, respiratory distress.

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