Modern approach to the diagnosis and treatment of thrombocytopenia

2021 ◽  
pp. 28-34
Author(s):  
Marina Leonidovna Kochieva
Keyword(s):  
Blood Test ◽  
Healthy Adult ◽  
Clinical Manifestations ◽  
Antithyroid Drugs ◽  
Modern Approach ◽  
Somatic Diseases ◽  
Immunodeficiency States ◽  
Test Treatment ◽  
Main Clinical Manifestation ◽  
Platelet Formation

Normally, the number of platelets in a healthy adult is in the range of 150-320 x 10⁹. A condition in which their number falls below 150x10⁹ is called thrombocytopenia. It can be both associated with a violation of the process of platelet formation in the bone marrow (in particular, with aplastic anemia, hemoblastosis, thrombocytopenic purpura), and be a concomitant pathology, for example, be a consequence of drug treatment of a number of somatic diseases. In the pathogenesis of thrombocytopenia, three main directions are distinguished: a decrease in platelet production, an acceleration of their decay and a violation of the distribution of the platelet pool with their sequestration in the spleen. Most often, drug thrombocytopenia develops against the background of the use of cytostatics, chloramphenicol, antithyroid drugs, NSAIDs. The decrease in the number of platelets can also be influenced by the regular use of alcohol, some infectious diseases, and immunodeficiency states. The main clinical manifestation of thrombocytopenia is hemorrhagic syndrome, proceeding as petechial rashes or ecchymosis, however, in some cases, clinical manifestations may be absent, and then the diagnosis is made on the basis of a clinical blood test. Treatment of thrombocytopenia is carried out taking into account the etiological factor that caused it.

scholarly journals Antineutrophil Cytoplasmic Antibodies in Patients Treated With Methimazole

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A922-A922
Author(s):  
Pedro Weslley Rosario ◽  
Gabriela Costa Andrade ◽  
Flavia Coimbra Pontes Maia
Keyword(s):  
High Frequency ◽  
Clinical Manifestations ◽  
Severe Adverse Event ◽  
The Other ◽  
Antineutrophil Cytoplasmic Antibodies ◽  
Antithyroid Drugs ◽  
Anca Associated Vasculitis ◽  
Asymptomatic Patients ◽  
Antibodies Detection

Abstract Introduction: Antithyroid drugs (ATDs) are widely used for the treatment of hyperthyroidism. Most side effects of these medications are mild and emerge within the first months of treatment. In contrast, antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis is a severe adverse event whose occurrence increases with increasing time of treatment. Vasculitis is more frequently associated with propylthiouracil than with methimazole, but the latter has also been related to the occurrence of ANCA and even to clinically manifest vasculitis. Many patients develop ANCA during treatment with methimazole but do not exhibit signs/symptoms of vasculitis. Objective: We previously reported a relatively high frequency (20%) of ANCA in patients exposed to methimazole but none of them exhibited clinical manifestations of vasculitis on that occasion. We continued to follow up these patients with ANCA and report here their evolution after 2 years. Methods: Seventeen patients exposed to methimazole were followed for 2 years after antibodies detection (ANCA). Results: Eight patients had ANCA but had not used methimazole for at least 6 months. During the following 24 months, continuing without ATD, none of the patients developed clinically apparent vasculitis. In the last assessment, five patients no longer had ANCA, while these antibodies persisted in three. Nine patients had ANCA and had been on methimazole for at least 6 months. The medication was not immediately discontinued in these patients when the antibodies were detected. After this detection, treatment with methimazole was continued in these patients for more 3 months (n = 1), 6 months (n = 2), 9 months (n = 1), 12 months (n = 2), 18 months (n = 2), and 24 months (n = 1). During the 2 years of follow-up after the detection of ANCA, none of the 9 patients developed signs/symptoms of vasculitis. In the last assessment, ANCA were negative in two patients who had received methimazole for more 3 and 6 months and who were therefore without receiving the drug for 21 and 18 months, respectively. The other 7 patients remained ANCA positive. Conclusion: Although vasculitis is necessarily associated with the presence of ANCA, the inverse frequency is undefined and appears to be low. Thus, measurement of ANCA would not be recommended in asymptomatic patients during methimazole treatment and immediate discontinuation of this drug, if these antibodies are detected eventually, may not be required. Reference: Antineutrophil cytoplasmic antibodies in patients treated with methimazole: a prospective Brazilian study. Andrade GC, Maia FCP, Mourão GF, Rosario PW, Calsolari MR. Braz J Otorhinolaryngol. 2019; 85:636-41.

scholarly journals Clinical Manifestations of Periodontal Tissue Diseases in Patients with Rheumatoid Arthritis Who Live in Anthropogenically Loaded Areas

2020 ◽  
Vol 27 (3) ◽  
pp. E2020310
Author(s):  
Khristina Kovalyshyn ◽  
Mykola Rozhko
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Manifestations ◽  
Environmentally Friendly ◽  
Severe Form ◽  
Control Group ◽  
Periodontal Tissues ◽  
Group I ◽  
Periodontal Index ◽  
Somatic Diseases ◽  
Degree Of Severity

The objective of the study is to clinically assess the condition of periodontal tissues in patients with rheumatoid arthritis, living in anthropogenically loaded and environmentally friendly areas and in people with generalized periodontitis without concomitant somatic diseases. Materials and methods. There were examined 137 patients, including 82 patients with generalized periodontitis of the I degree (subgroups A) and the II degree (subgroups B) with rheumatoid arthritis, living in anthropogenically loaded areas (group I), environmentally friendly areas (group II) and without concomitant somatic diseases living in environmentally friendly areas (group III). Control group – included 18 healthy people. Periodontal tissues were evaluated according to the indices: Greene-Vermillion, PMA, periodontal index offered by Russel and the depth of periodontal pockets.  Results. Women (80%) dominated in each group, patients with generalized periodontitis of the II degree of severity dominated, too.  The highest depth of periodontal pockets was 5.02±0.11 mm in the IB subgroup and differed significantly from this figure in the IIB subgroup 1.07-fold (pIB-IIB<0.05) and from that in the IIIB subgroup 1.2-fold (pIB-IIIB<0.001). The value of the Greene-Vermilion index in patients with GP of the I degree of development in all subgroups A corresponded to “unsatisfactory”. In patients with GP of the II degree of development, the state of hygiene corresponded to “bad” in subgroups IB, IIB and was 3.04±0.11 points (pIB-IIB˂0.01, pIB-IIIB˂0.001, pIB-K˂0.001); 2,63 ± 0.07 points (pIIB-IB˂0.01, pIIB-IIIB˂0.001, pIIB-K˂0.001), in ІІІB – “unsatisfactory”. According to the indicators of the PMA index in patients with GP of the I degree of severity, we’ve found the average severity degree of gingivitis (within the range of 43.25±2.02 – 48.06±1.46%) and severe degree of gingivitis in patients with the GP of the II degree >50 %. The highest indicator of periodontal index was found in the IB subgroup – 6.16±0.10 points (pIB-IIB˂0.01, pIB-IIIB˂0.001, pIB-K˂0.001), which indicated a severe form of periodontitis. Conclusion. Most often, GP in patients with RA was diagnosed in women, most of whom were patients with GP of the II degree (most in group I – 69.04%). The highest depth of periodontal pockets was 5.02±0.11 mm in the IB subgroup. The performed clinical and index assessment of periodontal tissues in patients of three groups indicates a more severe course of GP of the I and II degree in patients with rheumatoid arthritis living in anthropogenically loaded areas (IA, IB subgroups).

scholarly journals Characteristics of CoVID-19 in children: the first experience in the hospital of st. Petersburg

2020 ◽  
Vol 12 (3) ◽  
pp. 56-63 ◽  
Author(s):  
E. A. Dondurey ◽  
L. N. Isankina ◽  
O. I. Afanasyeva ◽  
A. V. Titeva ◽  
T. V. Vishnevskaya ◽  
...  
Keyword(s):  
Blood Test ◽  
Clinical Laboratory ◽  
Clinical Symptoms ◽  
Intensive Therapy ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Total Mortality ◽  
Upper Respiratory Tract ◽  
Epidemiological Features ◽  
Upper Respiratory

Objective: to identify the clinical, laboratory and epidemiological features of the new coronavirus (CV) infection in the provision of specialized medical care to children in the megalopolis of the Russian Federation. Methods: 674 cases of hospitalization of patients from birth to 17 years old inclusive with confirmed COVID-19 in the period from March 26 to June 26, 2020 in a children’s multidisciplinary hospital in St. Petersburg. Diagnostics of SARS-COV-2 in upper respiratory tract (URT) smears was carried out by PCR (a set of reagents for detecting RNA of coronavirus 2019-nCoV by PCR with hybridization-fluorescence detection “Vector-PCRRV-2019-nCoV-RG”). Patients underwent 4 (3; 5) repeated examinations depending on the diagnosis of the referral, as well as the duration of the convalescent virus carriage. The analysis of the severity of the course of the disease, the main clinical manifestations and their relationship with the development of pneumonia, as well as the epidemiological features of COVID-19 in children. The duration of inpatient treatment, outcomes and the need for intensive care are described. Changes in a number of laboratory parameters on analyzers made in the USA were assessed: a clinical blood test on a hematological one - Coulter UniCel (Beckman Coulter), a biochemical blood test on a biochemical one - Uni Cel DxC (Beckman Coulter), a coagulogram on a hemostasis analyzer (Instrumentation Laboratory). Results: Overall, there was a favorable course of COVID-19 in children. Intensive therapy was required only in 3.6% of cases with a total mortality rate of 0.15%, Kawasakilike syndrome was recorded in 0.3% of cases. In 1/3 of patients, prolonged viral shedding from the upper respiratory tract was detected. In children, intrafamilial infection from adults was in the lead; schoolchildren accounted for half of all hospitalizations. A distinctive feature of the new infection was mild clinical symptoms with fever and catarrhal symptoms up to 4/5 of cases, gastrointestinal symptoms - in every third patient. There were no significant differences in the severity of the disease by age. Pneumonia, diagnosed in ¾ cases by computed tomography, complicated the course in 13.1% of cases. The defeat of the lungs was accompanied by fever and dry cough, and in a more severe course: desaturation, chest pains, a feeling of insufficiency of inspiration. The age peaks of the incidence of pneumonia were revealed: at 4, 9, 12 years old and at the age of 17 years, the maximum (in 1/3 of cases). Laboratory changes were insignificant and quickly reversible. Conclusion: the course of COVID-19 in children in the megalopolis of Russia is comparable with foreign information. However, taking into account the experience of “Spanish ‘flu”, it is possible that in pediatric practice the number of severe forms and unfavorable outcomes may change in the near future, especially due to the difficulty of diagnosing Kawasaki-like syndrome and the need for a multidisciplinary approach to the treatment of such patients. Currently, the most vulnerable to the new CV are children with severe oncological, neurological and cardiovascular pathology, who have a rapid decompensation of the underlying disease against the background of COVID-19.

scholarly journals Considerations for Thyroidectomy as Treatment for Graves Disease

2019 ◽  
Vol 12 ◽  
pp. 117955141984452 ◽  
Author(s):  
Mary Smithson ◽  
Ammar Asban ◽  
Jason Miller ◽  
Herbert Chen
Keyword(s):  
Clinical Manifestations ◽  
Endocrine System ◽  
Thyroid Stimulating Hormone ◽  
Clinical State ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Replacement Rate ◽  
Free T4 ◽  
Organ Systems ◽  
Toxic Multinodular Goiter

Hyperthyroidism is a clinical state that results from abnormally elevated thyroid hormones. Thyroid gland affects many organ systems; therefore, patients usually present with multiple clinical manifestations that involve many organ systems such as the nervous, cardiovascular, muscular, and endocrine system as well as skin manifestations. Hyperthyroidism is most commonly caused by Graves disease, which is caused by autoantibodies to the thyrotropin receptor (TRAb). Other causes of hyperthyroidism include toxic multinodular goiter, toxic single adenoma, and thyroiditis. Diagnosis of hyperthyroidism can be established by measurement of thyroid-stimulating hormone (TSH), which will be suppressed with either elevated free T4 and/or T3 (overt hyperthyroidism) or normal free T3 and T4 (subclinical hyperthyroidism). Hyperthyroidism can be treated with antithyroid drugs (ATDs), radioactive iodine (RAI), or thyroidectomy. ATDs have a higher replacement rate when compared with RAI or thyroidectomy. Recent evidence has shown that thyroidectomy is a very effective, safe treatment modality for hyperthyroidism and can be performed as an outpatient procedure. This review article provides some of the most recent evidence on diagnosing and treating patients with hyperthyroidism.

Dynamics of hematological parameters in patients with asymptomatic and mild course of COVID19 infection

2021 ◽  
pp. 25-30
Author(s):  
R. R. Ismagilov ◽  
F. S. Bilalov ◽  
Yu. A. Ahmadullina ◽  
M. N. Sitdikova ◽  
A. Zh. Gilmanov
Keyword(s):  
Flow Cytometry ◽  
Blood Cells ◽  
Blood Test ◽  
Hematological Parameters ◽  
White Blood Cells ◽  
Clinical Manifestations ◽  
Reference Intervals ◽  
Mild Degree ◽  
Hematological Changes ◽  
Degree Of Severity

We studied changes in the parameters of the general (clinical) blood test in dynamics in outpatient patients with an asymptomatic course and a mild degree of severity of COVID-19. The study involved 67 patients. 30 men and 37 women were examined, their average age was 35 years. All the interviewed patients did not take specific antiviral drugs. Clinical manifestations were evaluated at the time of the survey on the 1st and 7th day from the day of receiving a positive PCR result. The parameters of the general (clinical) blood test were determined by flow cytometry in the CBC + 5Diff mode on a Unicel® DxH 800 hematological analyzer (Beckman Coulter, USA) in dynamics on the 1st and 7th days of observation. The features of clinical manifestations in patients with an asymptomatic course and mild severity coincided with the data of other authors. Hematological changes were mainly characterized by changes in the number of white blood cells and their subpopulations. On the 7th day of observation, there was a significant tendency to increase the number of white blood cells, lymphocytes, eosinophils, neutrophils and platelets within the reference intervals.

scholarly journals Frequently ill children: has everything been resolved?

2018 ◽  
pp. 206-214
Author(s):  
A. L. Zaplatnkikov ◽  
A. A. Girina ◽  
E. Е. Lokshina ◽  
I. V. Lepiseva ◽  
I. D. Maikova ◽  
...  
Keyword(s):  
Respiratory Diseases ◽  
Respiratory Infections ◽  
Functional Gastrointestinal Disorders ◽  
Clinical Manifestations ◽  
Allergic Diseases ◽  
Respiratory Morbidity ◽  
Recurrent Respiratory Infections ◽  
Detailed Assessment ◽  
High Level ◽  
Immunodeficiency States

The article presents an analysis of causes of recurrent respiratory infections in children. The special attention is drawn to the need for improvement of the epidemiological, anamnestic, social and other data to clarify the causes and provoking factors for increased respiratory morbidity. It has been shown that allergic diseases, immunodeficiency states, persistent herpetic infections, functional gastrointestinal disorders, etc. are often hidden.under the mask of “frequently ill children”. This determines the importance of a detailed assessment of clinical manifestations of each episode of the disease and the correct interpretation of examination results for the timely diagnosis specification. It was proposed to move from targeting the “frequently ill children” group to nosological verification, which have a high level of respiratory morbidity. It has been proved that early arriving at a diagnosis makes it possible to timely prescribe etiopathogenetic therapy, which significantly increases the effectiveness of treatment. The article presents an analysis of clinical studies of the effectiveness and safety of OM-85 immunomodulator of bacterial origin in children with recurrent respiratory diseases.

scholarly journals Nosological Dilemma and Clinical Polymorphism of the Catatonia Phenomenon

Psychiatry ◽  
2020 ◽  
Vol 18 (2) ◽  
pp. 61-70
Author(s):  
P. O. Borisova
Keyword(s):  
Clinical Features ◽  
Affective Disorders ◽  
Selection Criteria ◽  
Scientific Literature ◽  
Clinical Manifestations ◽  
Underlying Disease ◽  
Cochrane Library ◽  
Distinctive Features ◽  
Somatic Diseases

Objective: to provide the description of researchers’ views evolution and provide the review of modern scientific literature on nosological affiliation and clinical features of catatonia. Material and methods: Scopus, PubMed, Cochrane Library, eLIBRARY databases were searched for literature (44 000 papers) using the keyword ‘catatonia‘. Based on the selection criteria, the search has been found the clinical cases, cohort and random studies, dedicated to psychopathologic description of catatonia, accompanied by affective disorders, autism and hysteria. 50 papers issued between 2000 and 2020 were selected for the analysis. Conclusions: catatonia, traditionally treated as a symptom of schizophrenia, currently is predominantly interpreted as a “transnosological syndrome”, which accompanies various (both mental and somatic) diseases. The clinical manifestations of catatonia in affective disorders, autism and hysteria have their own distinctive features, also the presence of catatonic symptoms is associated with a greater severity of the underlying disease, low quality of remissions, which explains why the experts are wary of the endogenic factors.

scholarly journals Hereditary angioedema: approaches to diagnosis and treatment, analysis of a clinical family case

2021 ◽  
pp. 34-40
Author(s):  
O. V. Skorohodkina ◽  
A. V. Luntsov ◽  
A. A. Vasileva ◽  
O. A. Bareycheva
Keyword(s):  
Hereditary Angioedema ◽  
High Efficiency ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Therapeutic Interventions ◽  
Laboratory Research ◽  
Modern Approach ◽  
Adequate Treatment ◽  
Pathogenetic Therapy ◽  
Modern Classification

Hereditary angioedema belongs to the group of rare, orphan, genetically determined defects that represent a significant medical and social problem due to the pronounced impact on the quality of life and potential mortality, as well as the emerging difficulties associated with timely diagnosis and the appointment of adequate treatment. The article presents data on the modern classification of hereditary angioedema, clinical manifestations of the disease, approaches to diagnosis verification and treatment principles. Therapy of hereditary angioedema is determined by the need for effective relief of acute attacks of the disease, prevention of edema before medical interventions, and, if indicated, long-term prophylaxis. The article discusses a differentiated approach to the treatment of hereditary angioedema, characterizes various options for therapeutic interventions. In a clinical case, the history of several generations of a family with manifestations of hereditary angioedema is described. A modern approach to the diagnosis of the disease based on detailed history, clinical symptoms, and laboratory research results has been demonstrated. The analysis of the effectiveness of treatment was carried out and the high efficiency of pathogenetic therapy of hereditary angioedema with human C1-esterase inhibitor was shown. 

scholarly journals EXPERIMENTAL MODELS OF THE HYPOTHYROIDISM

2021 ◽  
Vol 29 (1) ◽  
pp. 69-76
Author(s):  
Aleksey M. Chaulin ◽  
Julia V. Grigorieva ◽  
Galina N. Suvorova
Keyword(s):  
Thyroid Hormones ◽  
Genetic Model ◽  
Clinical Manifestations ◽  
Experimental Models ◽  
Laboratory Animals ◽  
Antithyroid Drugs ◽  
Diagnostic Strategies ◽  
Functional Changes ◽  
Advantages And Disadvantages ◽  
Holistic Understanding

Hypothyroidism is a systemic chronic disease that occurs as a result of a deficiency of thyroid hormones (thyroid hormones): triiodothyronine and tetraiodothyronine (thyroxine). Targets of thyroid hormones are almost all organs and tissues of the human body, which explains the variety of clinical manifestations that occur when these hormones are deficient. Recently, basic research through the use of experimental models has become more relevant and allowed us to obtain a number of new morphological and functional changes that occur in hypothyroidism. This review discusses the main experimental models of hypothyroidism: surgical, radioactive, dietary, anti-thyroid administration and genetics’ model. The main principle of the surgical model of hypothyroidism is to remove the thyroid gland. The radioactive model is based on the introduction of a radioactive isotope of iodine to laboratory animals. The dietary model is based on the use of a special diet with a limited amount of iodine. The drug model is based on the introduction of antithyroid drugs - methylimidazole and propylthiouracil. The principle of the genetic model consists in special genetic manipulations with the genome of laboratory animals. The advantages and disadvantages of each model are discussed. The use of sophisticated equipment has brought specialists closer to a more complete and holistic understanding of the morphological and functional manifestations of hypothyroidism. Researching of experimental models is an important tool in relation to the studying of the mechanisms underlying hypothyroidism and, as a result, in improving prevention and treatment-diagnostic strategies.

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