Modern approaches to treatment of patients with biliary sludge: how to choose optimal scheme?

Currently, biliary sludge (BS) is considered as a pathological process associated with an increase in the lithogenicity of bile and according to the modern classification of gallstone disease referred to the prestone stage of the disease. In the mechanism of BS formation, the main role belongs to four factors: glut of bile with cholesterol, formation of crystallization nucleus, dysfunction of the gallbladder (contraction, absorption, secretion), violation of the enterohepatic circulation of bile acids. Clinical manifestations in BS are most often associated with concomitant functional disorders of the biliary tract and chronic bacterial duodenitis with duodenal hypertension. The main directions in the treatment of BS are reduced to the restoration of the normal rheological properties of bile, the normalization of the motor function of the biliary system and the duodenum, the correction of the intestinal microbiome. The article discusses effective treatment regimens for BS depending on its morphological features and clinical course with the use of ursodeoxycholic acid or hofitol. The mechanism of Chophytol action (Mayoly Spindler, France) at BS is presented. The additional use of Meteospasmyl in the presence of intestinal antiseptic indications contributes to the rapid resolution of clinical manifestations in this pathology.

Download Full-text

Change of Intestinal Microbiome in Patients with Coronavirus Infection

Ukraïnsʹkij žurnal medicini bìologìï ta sportu ◽

10.26693/jmbs06.05.022 ◽

2021 ◽

Vol 6 (5) ◽

pp. 22-27

Author(s):

M. M. Mishina ◽

◽

O. V. Kotsar ◽

Pochernina M. H. ◽

O. V. Kochnieva ◽

...

Keyword(s):

Bacterial Translocation ◽

Intestinal Barrier ◽

Multiple Organ ◽

Infection Process ◽

The Body ◽

Intestinal Microbiome ◽

Intestinal Lumen ◽

Treatment Regimens ◽

Analysis And Synthesis ◽

Coronavirus Infection

The purpose of the study was to analyze modern literature on the problems of dysbiosis in patients with COVID-19, to study the main mechanisms of systemic interaction between the intestine and lungs, as well as changes in the microbiota that occur under the influence of coronavirus infection. Materials and methods. A comprehensive selection of research methods was used for the work: systematization of the material, the method of generalization, methods of analysis and synthesis. Scientific works in the field of microbiology, epidemiology and infectious diseases were studied. Literature data for the last 2 years (2019-2021) were considered. The results of bacteriological studies from patients with COVID infection were described. The data obtained were processed using information-analytical and statistical-analytical methods. Results and discussion. As a result of this work, a complex of connections between intestine and lungs, which is called the "intestinal-lung axis", was considered. It is known that the interaction between these two biotopes occurs with the participation of microflora and its metabolites. Dysfunction of the intestinal barrier is accompanied by bacterial translocation. Bacteria from the intestinal lumen enter the liver through the portal vein system. The lymphatic pathway of bacterial translocation from the intestine to the lungs is also possible, which causes multiple organ failure syndrome in coronavirus infection. The COVID-19 virus is able to reduce the number of ACE2 receptors in the gastrointestinal tract, which leads to an imbalance in the intestines. At the same time, the infection process in the lungs promotes the growth of bacteria of the Enterobacteriacae family in the intestine, which also leads to dysbiotic disorders. The use of probiotics is an effective tool in the complex treatment of this infection, which facilitates the general condition of patients. In the course of treatment, it is important not only to eliminate the virus from the body, but also to restore normal intestinal microbiota after an infection. Conclusion. Thus, the use of probiotic drugs for the treatment of patients with coronavirus infection can significantly reduce the risk of developing dysbiosis and improve the condition of patients. A perspective direction is the development of new treatment regimens for dysbiotic conditions using probiotics, eubiotics, synbiotics and postbiotics to prevent the development of severe complications in COVID infection

Download Full-text

Golimumab in the treatment of extra-skeletal manifestations of ankylosing spondylitis

Modern Rheumatology Journal ◽

10.14412/1996-7012-2019-4-110-115 ◽

2019 ◽

Vol 13 (4) ◽

pp. 110-115

Author(s):

A. B. Demina

Keyword(s):

Ankylosing Spondylitis ◽

Observational Studies ◽

Clinical Manifestations ◽

Large Sample Size ◽

Efficacy And Safety ◽

High Efficacy ◽

Treatment Regimens ◽

Insufficient Response ◽

Inflammatory Changes

Extra-skeletal manifestations (EMs) of ankylosing spondylitis (AS) can occur and proceed in parallel with inflammatory changes in the joints and spine and often dominate in the clinical picture of AS, determining its high activity and significantly worsening the quality of life in patients. In a number of cases, EMs are characterized by an insufficient response to standard anti-inflammatory therapy for back pain, arthritis, and enthesitis; and there is a need to prescribe another class of drugs.The review highlights the results of studies evaluating the efficacy of golimumab (GLM) in treating EMs in patients with AS: uveitis (GO-EASY Study) and ulcerative colitis (UC) (PURSUIT-SC, PURSUIT-M studies). Analysis of these studies have shown the high efficacy and safety of GLM in reducing the clinical manifestations of AS and in preventing the exacerbations of uveitis and UC. However, despite the successes achieved in treating AS and its EMs, there are many unresolved issues, including those related to the elaboration of optimal treatment regimens, which required longer observational studies with a large sample size.

Download Full-text

Hepatic involvement in sarcoidosis

Terapevticheskii arkhiv ◽

10.26442/00403660.2019.04.000179 ◽

2019 ◽

Vol 91 (4) ◽

pp. 4-12

Author(s):

V V Fomin ◽

M Yu Brovko ◽

M V Kalashnikov ◽

V I Sholomova ◽

T P Rozina ◽

...

Keyword(s):

Clinical Manifestations ◽

Normal Liver ◽

Liver Function Tests ◽

Pathological Process ◽

Unknown Etiology ◽

Primary Biliary Cholangitis ◽

Treatment Protocols ◽

Hepatic Involvement ◽

Wide Range ◽

Hepatic Sarcoidosis

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Liver is frequently involved in the pathological process. Wide range of clinical manifestations can be seen: from asymptomatic lesion with normal liver function tests to cirrhosis with portal hypertension. Biopsy plays the key role in diagnosis of the hepatic sarcoidosis. It is essential for morphological diagnosis to exclude other causes of granulomatous liver disease, most often - primary biliary cholangitis. Nowadays there are no standard treatment protocols for patients with hepatic sarcoidosis.

Download Full-text

Structural composition and clinical features of dermatological patients with keratinocytic skin tumors

Problems in oncology ◽

10.37469/0507-3758-2021-67-1-91-96 ◽

2021 ◽

Vol 67 (1) ◽

pp. 91-96

Author(s):

Rustem Khasanov ◽

Elena Faizullina ◽

Irina Khismatulina ◽

Azat Murtazin

Keyword(s):

Skin Cancer ◽

Medical Care ◽

Clinical Features ◽

Basal Cell ◽

Clinical Manifestations ◽

Pathological Process ◽

Skin Tumors ◽

Long Period ◽

Nasal Region ◽

Common Malignancy

Basal cell skin cancer (BCС) is the most common malignancy that is found in dermatological practice. The purpose of the study: to determine the structure of clinical manifestations of BCС in ambulant dermatological patients. The study was conducted from 2015 to 2017 in a private clinic in Kazan, which has a license to provide medical care in the specialties "dermatovenerology" and "surgery". We studied the results of examination of 2730 patients with skin tumors available in outpatient cards. 101 patients with histologically verified BCС were examined, including 29% of men (n=29) and 71% of women (n=72), the average age was 59.7±14.9 years (median – 61.5 years). The percentage of patients with BCС among patients with all skin malignancies at the dermatological reception was 95.3% (n=101). Most often, patients aged 60-74 years suffered from BCС: women – in 21.0% (n=21) and men – in 16.0% (n=16), respectively. The proportion of women aged 45-59 years was significantly higher – 20.0%, than the proportion of men – 9.0% (p<0.05). Men were significantly more likely to see a dermatologist – 55.0% in less than a year from the onset of the disease, than women – 21.4% (p<0.01). The proportion of women (44.6%) who noted the appearance of a tumor over a long period (≥5 years) was significantly less than the proportion of men 15.0% (p<0.05). The most common variant of BCС was the nodular form n=77 (76.2%), in which the primary elements of 80.5% were identified by dermatologists as single 5-10 mm papules. The oculo-fronto-nasal region was involved in the pathological process in 47.5% (n=48) of cases, which is significantly more frequent than in other localisations (p<0.05). Dermatoscopy improved the visualization of the atypical vascular network.

Download Full-text

Infections due to Mycobacterium leprae and Nontuberculous Mycobacteria

10.2310/im.1239 ◽

2011 ◽

Author(s):

Michael K Leonard Jr ◽

Henry M Blumberg ◽

Carlos Franco-Paredes

Keyword(s):

Nontuberculous Mycobacteria ◽

Clinical Manifestations ◽

Mycobacterium Leprae ◽

Lepromatous Leprosy ◽

Molecular Diagnostic ◽

Diagnostic Tools ◽

Human Pathogens ◽

Mycobacterial Infections ◽

Rapidly Growing Mycobacteria ◽

Treatment Regimens

Mycobacterium leprae infection (i.e., leprosy) is a disease that has been recognized—and often misunderstood—since ancient times. The emergence of HIV/AIDS and the development of newer culture methodologies and molecular diagnostic tools have brought about increased interest in the epidemiology, diagnosis, and treatment of human infections from nontuberculous mycobacteria (NTM). More than 140 species of NTM have been identified; approximately 50 of these may be pathogenic for humans, causing a broad spectrum of disease. This chapter covers both M. leprae and selected NTM organisms, including M. avium complex; M. kansasii; M. marinum; and rapidly growing mycobacteria such as M. chelonae, M. fortuitum, and M. abscessus. The section on leprosy encompasses subsections on diagnosis, clinical manifestations and classification, laboratory studies, treatment, and leprosy reactions. Treatments for nontuberculous mycobacteria infections are also covered. Figures include a natural history of leprosy, tuberculoid leprosy, lepromatous leprosy, and various forms of borderline leprosy, as well as type 1 and type 2 leprosy reaction. Tables include the Ridley-Jopling classification of leprosy, recommendations for treatment of leprosy, clinical characteristics and treatment of leprosy, major clinical syndromes associated with nontuberculous mycobacterial infections, diagnosing nontuberculous mycobacterial lung disease, a listing of slow and rapidly growing mycobacteria that are human pathogens, plus treatment regimens for selected nontuberculous mycobacterial infections in adults. This review contains 59 references.

Download Full-text

Gender Differences in the Pathogenesis and Outcome of Lupus and of Lupus Nephritis

Clinical and Developmental Immunology ◽

10.1155/2012/604892 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 61

Author(s):

Julie Schwartzman-Morris ◽

Chaim Putterman

Keyword(s):

Immune Responses ◽

Lupus Erythematosus ◽

Severe Disease ◽

Clinical Manifestations ◽

Male Gender ◽

Gender Disparities ◽

Systemic Lupus ◽

Hematological Indices ◽

Treatment Regimens ◽

Tailored Treatment

Systemic Lupus Erythematosus (SLE) typically affects females at far greater rates than males; however male SLE patients often have more severe disease than females. The gender disparities have been reported in clinical manifestations and in serological and hematological indices as well. In particular, SLE complicated with nephritis is more frequent in men than women, and several groups identified male gender as a risk factor for progression to renal failure. The specific differences in pathogenesis amongst genders have yet to be conclusively defined, though genetic, hormonal, and immune responses have been analyzed thus far. Further research is warranted to further elucidate these differences and permit the development of gender-tailored treatment regimens.

Download Full-text

Bowel Symptoms

10.1093/med/9780190204709.003.0003 ◽

2017 ◽

Author(s):

Kimberly Chow ◽

Lauren Koranteng

Keyword(s):

Bowel Obstruction ◽

Clinical Manifestations ◽

Advanced Practice ◽

Comorbid Disease ◽

Medication Treatment ◽

Global Issues ◽

Treatment Regimens ◽

Bowel Symptoms ◽

Life Threatening

Constipation, diarrhea, and bowel obstruction are three common and distressing symptoms in palliative care patients. These symptoms rarely occur without other clinical manifestations of disease, and their management must be considered in light of comorbid disease. Constipation, diarrhea, and bowel obstruction affect a person’s quality of life, eligibility for certain therapies, and may even be life-threatening. This chapter discusses the advanced practice registered nurse (APRN)’s role in the assessment, prevention, and management of these common bowel symptoms. as well as the global issues surrounding management. The causes and pharmacological treatment of these three bowel symptoms are discussed and detailed medication treatment regimens are presented in tabular form.

Download Full-text

Spontaneous psoas abscess: presenting with phlegmasia cerulea dolens

Annals of The Royal College of Surgeons of England ◽

10.1308/003588411x13010648053243 ◽

2011 ◽

Vol 93 (4) ◽

pp. e15-e16 ◽

Cited By ~ 5

Author(s):

Jagwinder Dhaliwal ◽

Ajanta Jayatunga

Keyword(s):

Lower Extremity ◽

Complete Resolution ◽

Early Recognition ◽

Psoas Abscess ◽

Pathological Condition ◽

Clinical Manifestations ◽

Pathological Process ◽

Successful Outcome ◽

Life Threatening ◽

Phlegmasia Cerulea Dolens

Phlegmasia cerulea dolens (PCD) is a limb-threatening venous disorder involving massive proximal venous thrombosis. The clinical manifestations are of oedema, cyanosis and pain of lower extremity. Patients presenting with PCD have an underlying pathological condition that predisposes to the thrombotic process. We report a diabetic patient who presented with PCD and septicaemia due to a spontaneous psoas abscess. Anticoagulation with heparin and treatment of the underlying psoas abscess led to complete resolution of symptoms. An understanding of the underlying pathological process responsible is vital to early recognition and successful outcome in this rare limb- and life-threatening venous disorder.

Download Full-text

X-linked lymphoproliferative disease due to SAP/SH2D1A deficiency: a multicenter study on the manifestations, management and outcome of the disease

Blood ◽

10.1182/blood-2010-06-284935 ◽

2011 ◽

Vol 117 (1) ◽

pp. 53-62 ◽

Cited By ~ 187

Author(s):

Claire Booth ◽

Kimberly C. Gilmour ◽

Paul Veys ◽

Andrew R. Gennery ◽

Mary A. Slatter ◽

...

Keyword(s):

Clinical Manifestations ◽

Treatment Strategies ◽

Lymphoproliferative Disease ◽

Outcome Data ◽

Epstein Barr Virus Infection ◽

Cell Transplant ◽

Hematopoietic Stem ◽

Treatment Regimens ◽

Barr Virus ◽

Epstein Barr

Abstract X-linked lymphoproliferative disease (XLP1) is a rare immunodeficiency characterized by severe immune dysregulation and caused by mutations in the SH2D1A/SAP gene. Clinical manifestations are varied and include hemophagocytic lymphohistiocytosis (HLH), lymphoma and dysgammaglobulinemia, often triggered by Epstein-Barr virus infection. Historical data published before improved treatment regimens shows very poor outcome. We describe a large cohort of 91 genetically defined XLP1 patients collected from centers worldwide and report characteristics and outcome data for 43 patients receiving hematopoietic stem cell transplant (HSCT) and 48 untransplanted patients. The advent of better treatment strategies for HLH and malignancy has greatly reduced mortality for these patients, but HLH still remains the most severe feature of XLP1. Survival after allogeneic HSCT is 81.4% with good immune reconstitution in the large majority of patients and little evidence of posttransplant lymphoproliferative disease. However, survival falls to 50% in patients with HLH as a feature of disease. Untransplanted patients have an overall survival of 62.5% with the majority on immunoglobulin replacement therapy, but the outcome for those untransplanted after HLH is extremely poor (18.8%). HSCT should be undertaken in all patients with HLH, because outcome without transplant is extremely poor. The outcome of HSCT for other manifestations of XLP1 is very good, and if HSCT is not undertaken immediately, patients must be monitored closely for evidence of disease progression.

Download Full-text

SOME ASPECTS OF THE EATIOLOGY OF PARODONTUS DISEASES. (LITERATURE REVIEW)

Ukrainian Dental Almanac ◽

10.31718/2409-0255.2.2018.13 ◽

2018 ◽

pp. 54-59

Author(s):

N.N. Saveleva ◽

I.I. Sokolova ◽

S.I. German ◽

T.V. Tomilina

Keyword(s):

Gastrointestinal Tract ◽

Periodontal Disease ◽

Structural Damage ◽

Inflammatory Diseases ◽

Periodontal Diseases ◽

Clinical Manifestations ◽

Pathological Process ◽

Chronic Obstructive ◽

Internal Organs ◽

Periodontal Tissues

The review of the scientific literature is devoted to the topical issues of studying the etiology of periodontal diseases, which are one of the most common and complex pathologies of the maxillofacial region. Analysis of recent studies proves a stable relationship between the development of periodontal diseases and disorders in the immune system, the neurohumoral system, metabolic disorders, genetic predisposition, and so on. The article presents the data obtained in the course of studying the literature on the role of disorders in the functioning of individual organs (gastrointestinal tract, liver, lungs, heart, and urinary system) in the development of chronic periodontal diseases. The article notes that the anatomical and physiological proximity of the periodontal and digestive tract tissues, the generality of innervation and humoral regulation create prerequisites for the involvement of periodontal disease in the pathological process in diseases of the gastrointestinal tract. One of the main etiological factors in the development of inflammatory diseases of the gastrointestinal tract and periodontium is Helicobacter pylori, which is found in the loci of the oral cavity: in the oral and gingival fluid, on the mucous membrane of the tongue and cheeks, and in the periodontal pockets. It is pointed out that the liver also occupies a special place in the development of periodontal diseases, which is explained by the performance of its significant functions for the human body: regulatory, metabolic, antitoxic and other. There is evidence that the pathology of periodontal disease plays a leading role in the structure of dental diseases in patients with chronic obstructive pulmonary diseases, which is clinically manifested by symptoms of generalized periodontitis of the І-ІІ degrees of development and its complications - partial or complete secondary adentia, and with tooth preservation - defects in dental series and violations of occlusion, function, aesthetics. Scientists suggest a general biological mechanism for the development of generalized periodontitis and cardiovascular diseases, linking the development of periodontal diseases in patients with cardiovascular pathology with microcirculatory disorders. The dependence of the severity of inflammatory changes in the periodontal tissues on the disturbances of salt metabolism in urolithiasis is proved. The data obtained indicate that diseases of the internal organs contribute to the structural damage of periodontal tissues and they are a risk factor for periodontal diseases, which necessitate the presence of not only theoretical knowledge and practical skills in dentistry, but also their awareness of the features and clinical manifestations of somatic pathology. An urgent and justified step in the treatment of periodontal diseases is also the involvement in the process of rendering complex dental care to internist doctors capable of quickly and qualitatively assessment the condition of the internal organs and the basic systems of the patient's body.

Download Full-text