Drug-Induced Atrial Fibrillation / Atrial Flutter

Drug-induced atrial fibrillation / flutter (DIAF) is a serious and potentially life-threatening complication of pharmacotherapy. Purpose of the work: systematization and analysis of scientific literature data on drugs, the use of which can cause the development of DIAF, as well as on epidemiology, pathophysiological mechanisms, risk factors, clinical picture, diagnosis and differential diagnosis, treatment and prevention of DIAF. Analysis of the literature has shown that many groups of drugs can cause the development of DIAF, with a greater frequency while taking anticancer drugs, drugs for the treatment of the cardiovascular, bronchopulmonary and central nervous systems. The mechanisms and main risk factors for the development of DIAF have not been finally established and are known only for certain drugs, therefore, this section requires further study. The main symptoms of DIAF are due to the severity of tachycardia and their influence on the parameters of central hemodynamics. For diagnosis, it is necessary to conduct an electrocardiogram (ECG) and Holter monitoring of an ECG and echocardiography. Differential diagnosis should be made with AF, which may be caused by other causes, as well as other rhythm and conduction disturbances. Successful treatment of DIAF is based on the principle of rapid recognition and immediate discontinuation of drugs (if possible), the use of which potentially caused the development of adverse drug reactions (ADR). The choice of management strategy: heart rate control or rhythm control, as well as the method of achievement (medication or non-medication), depends on the specific clinical situation. For the prevention of DIAF, it is necessary to instruct patients about possible symptoms and recommend self-monitoring of the pulse. It is important for practitioners to be wary of the risk of DIAF due to the variety of drugs that can potentially cause this ADR.

Porous Ceramic Sternal Prosthesis Implantation in a 13-Year-Old Patient Presenting with Metastatic Ewing's Sarcoma

Ewing's sarcoma is the second most frequent primary malignant bone tumor in adolescents and young adults. Locations on the thoracic wall represent up to 20% of primary and secondary locations. We present the case of a 13-year-old patient treated with the use of a radiolucency porous bioceramic prosthesis as a sternal replacement for a wide tumor resection in an oncologic context. Focal radiation therapy was not possible due to the high risk of severe myocardial injuries caused by the sternal location of the tumor. The sternum CERAMIL® (I.CERAM, Limoges, France), in porous alumina (Al2O3) has already been implanted into adults in sternal replacement during its invasion by a tumor or its infectious destruction. There were no complication concerning the surgery. The last follow-up at 2 years postoperatively reveals a satisfactory clinical situation with any functional thoracic complaint and nor any functional respiratory symptoms. The porous alumina sternal prosthesis offers a reliable alternative for sternal replacement indications for children in an oncologic context.

Efficacy of the R(+)-enantiomer of alpha-lipoic acid in clinical practice

The article presents current data from the scientific medical literature on the effective use of the R(+)-enantiomer of α-lipoic acid in various pathological conditions. The authors analyze the literature data on the comparative assessment of the activity of racemic and dextrorotatory forms of thioctic (alpha-lipoic) acid in low back pain, the effect of the R(+)-enantiomer in combination with hyperbaric oxygen therapy on the production of interleukin-6, tumor necrosis factor α and vascular endothelial growth factor in the healing of chronic ulcers of the lower extremities, as well as the use of R-α-lipoic acid in patients with mild to moderate carpal tunnel syndrome. It should be noted that recently around the world there is a tendency to gradual transition from the course treatment of diabetic neuropathy towards long-term and continuous use of pathogenetic therapies in order to maintain their positive effects. Alpha-lipoic acid is widely used in neurological practice, as evidenced by our data. Also, α-lipoic acid is actively used in gastroenterology in the treatment of chronic liver diseases. Currently, the action of α-lipoic acid is being actively studied in terms of the prevention and treatment of atherosclerosis. Based on the analyzed data, the authors concluded that it is the R(+)-enantiomer of α-lipoic acid that has a positive biological effect, and treatment with it should be carried out almost constantly, taking breaks in its intake. The duration of R-α-lipoic acid use depends on the specific clinical situation, and given the current personalized approach to treatment, as shown by the analysis of modern medical sources, people with diabetes in a state of decompensation of carbohydrate metabolism should be prescribed it for 6 months continuously with a break of 2 months and repeated courses.

Forensic Toxicological and Medico-Legal Evaluation in a Case of Incongruous Drug Administration in Terminal Cancer Patients

Background: In most cases, palliative care is prescribed to adults diagnosed with cancer. The definition of the most suitable therapy for an effective sedation in terminal cancer patients still represents one of the most challenging goals in medical practice. Due to their poor health, the correct dosing of drugs used for deep palliative sedation in terminal cancer patients, often already on polypharmacological therapy, can be extremely complicated, also considering possible drug-to-drug interactions that could lead to an increased risk of overdose and/or incongruous administration with fatal outcomes. The case of a terminal cancer patient is presented, focusing on the “adequacy” of administered therapy. Materials and Methods: A young male, affected by Ewing sarcoma, attending a palliative care at his own home, died soon after midazolam administration. Toxicological and histological analyses were performed on body fluids and organ fragments. Results and Discussion: Morphological reliefs evidenced a neoplastic mass, composed of lobulated tissue with a lardy, pinkish-gray consistency, extending from the pleural surface to the lung parenchyma, also present at the sacrum region (S1–S5), at the anterior mediastinum level, occupying the entire left pleural cavity, and infiltrating the ipsilateral lung. Metastatic lesions diffused to rachis and lumbar structures. The brain presented edema and congestion. Toxicological analyses evidenced blood midazolam concentrations in the range of 0.931–1.690 µg/mL, while morphine was between 0.266 and 0.909 µg/mL. Death was attributed to cardiorespiratory depression because of a synergic action between morphine and midazolam. The pharmacological interaction between midazolam and morphine is discussed considering the clinical situation of the patient. The opportunity to proceed with midazolam administration is discussed starting from guidelines recommendation. Finally, professional liability outlines are highlighted.

Analog and digital modeling of sound and impaired periodontal supporting tissues during mechanical testing

Periodontitis is one of the most common conditions affecting oral health among adults, posing a great challenge for both patients and also for dentists aiming to treat this disease. In severe stages such deterioration of the supporting tissues, namely the periodontal ligaments and the bone, can occur, which will affect the biomechanical behavior and therefore the longevity and survival of the affected teeth. In order to be able to plan both periodontal and subsequent restorative treatment properly, valid modelling of the current clinical situation is advised. The aim of the present article is to comprehensively discuss possible analog and digital modeling methods of periodontally affected teeth and the periodontal structures surrounding them. Modelling possibilities can serve later as the basis of mechanical load, digital finite element studies, and also aid clinical treatment planning.

USE OF "INTRAFEN" IN MILD TO MODERATE COVID-19

Повышение температуры тела человека-это своеобразная реакция на воздействие какого-либо агента и/или возбудителя, попавшего в организм человека. При каких-либо инфекционных заболеваниях в организме человека повышается температура тела человека. Также в настоящее время повышение температуры тела при распространенной коронавирусной инфекции является одним из симптомов заболевания. Цель: в нашей статье мы хотели бы рассмотреть клиническую ситуацию с больными COVID-19 и отметить, что был проведен ряд наблюдений и анализов для оценки эффективности и безопасности применения препарата «Интрафен» с целью снятия повышенной температуры, что дает положительный эффект лекарственного средства. Материалы и методы: рекомендовать пациентам с симптомами заболевания короновирусной инфекцией легкой и средней тяжести, С целью снижения повышенной температуры тела, противовоспалительного и улучшения общего состояния пациента, что мы достигнем положительного результата путем введения препарата интрафен в Вену. Результат: на основании анамнезных данных, полученных от больного, результатов клинических, лабораторных, инструментальных исследований выявлено эффективное действие препарата интрафен. Вывод: пациентам легкой и средней тяжести, перенесшим короновирусную инфекцию, можно увидеть, что введение препарата интрафен в Вену эффективно влияет на кратковременное снижение повышенной температуры тела, противовоспалительное действие, улучшение общего состояния больного. An increase in a person's body temperature is a self-contained response to the action of some agent and/or pathogen that has entered the body. With any infectious diseases in the human body, a person's body temperature increases. In addition, with the current coronavirus infection, an increase in body temperature is one of the symptoms of the disease. Purpose: in our article, we would like to consider the clinical situation of patients with COVID-19 and draw attention to the fact that a number of observations and analyses were carried out to assess the effectiveness and safety of using the drug "Intrafen" in order to relieve elevated fever. Materials and methods: in order to reduce elevated body temperature, anti-inflammatory and improve the general condition of the patient, to suggest that we will achieve a positive result by injecting the drug intrafen into the vein in patients with mild to moderate severity with symptoms of coronavirus infection disease. Result: based on Anamnesis data obtained from the patient, the results of Clinical, Laboratory, and instrumental studies, the effective effect of intrafen was determined. Conclusion: by injecting the drug intrafen into the vein in patients of mild and moderate severity who have had a Coronavirus infection, it can be seen that it has an effective effect on the short-term reduction of elevated body temperature, anti-inflammatory effect, improvement of the general condition of the patient.

Management of Oroantral Fistulae and Communications: Our Recommendations for Routine Practice

Oroantral communication (OAC) is one of the main complications of extracting antral or sinus teeth. OAC is a gap between the maxillary sinus and the oral cavity. When left untreated, it causes maxillary sinusitis and dramatically impairs the patient’s quality of life. Numerous surgical treatment techniques have been described, from mucosal techniques to using bone substitutes or very conservative alternative means. Many cases of recurrence after treatment have been reported, and the choice of the method adapted to the clinical situation remains challenging. Therefore, it is necessary to establish a correct diagnosis and choose the surgical technique best adapted to the case. This work is aimed at reviewing several techniques for the treatment of OAC and at describing our recommendations for use in daily practice for each of them through four clinical cases.

Anxiety disorders in clinical practice - a modern view on the problem of therapy

Clinically significant anxiety occurs in 5-7% of the general population and in 25% or more of patients seen by general practitioners. The lifetime incidence of anxiety disorders can be over 30%. Anxiety in adolescence and young adulthood often later develops into depression. The line between a “normal” response to a threat and a pathological anxiety disorder is often very blurred and there may be a continuum from personal distress to mental disorder. The real clinical situation is that most people with anxiety do not have their diagnosis. Only about a quarter (27.6%) of people who meet DSM-V, criteria for anxiety disorder receive treatment. The aim of the study was to optimize the treatment of anxiety disorders using the drug Mexidol®, taking into account modern data of epidemiology and neurobiology. Material and methods. This review is based on relevant publications obtained through selective searches in PubMed from 2010 to 2020 (58 references). The search was conducted for the following words: anxiety disorders, terminology, Mexidol®. The presence of at least one of these keywords served as a criterion for inclusion in this review. Results and discussion. Recently, there have been changes in the classification of anxiety disorders terminology. In ICD-10, disorders that were previously defined as neuroses are now located systemically in the headings F40 - F42: panic disorder, agoraphobia, social phobia; specific isolated phobias; general anxiety disorder, obsessive thoughts, compulsive actions and others. Estimates are widely spread across countries, with the highest prevalence in low-income countries (5.0%), lower in middle-income countries (2.8%), and lowest in high-income countries (1.6%). Mixed anxiety-depressive disorders are also one of the manifestations of chronic cerebral ischemia (CCI). In order to optimize treatment and to consider development of psychosomatic pathology in patients with anxiety disorders, Mexidol® is widely used. It has a vegetotropic, anti-stress, anxiolytic and other effects. Mexidol® creates a mechanism for biological desensitization of recurring neurotic, anxious experiences, stabilizes the parameters of the neuropsychiatric status. Conclusions. Our clinical and research experience shows that the management of patients with anxiety disorders can be optimized with the use of Mexidol®. Against the background of sequential drug therapy in most studies, a regression of affective disorders was noted (a decrease in the severity of anxiety, depressive manifestations, and asthenic syndrome). Keywords: anxiety disorders, terminology features, Mexidol®.

COMPUTER TECHNOLOGIES FOR DETERMINING INDEX ASSESSMENT OF THE DESTRUCTION OF DENTAL HARD TISSUES

The aim of the study was to compare the obtained data of hard dental tissues destruction indices with the corresponding indications for the choice of the method of treatment by means of mathematical analysis. Materials & methods. 120 patients aged 20 to 55 were examined and 358 teeth hard tissue defects were identified in them. The data of indices was obtained and compared with the indications for orthopedic treatment according two indices in the same clinical situation. Results. The study showed that the indices had different meanings and different indications for treatment in the same situations. Such discrepancies in indications for treatment indicate the subjective data of one of the indices, which does not take into account the depth of destruction and the volume of the remaining natural tissue of the teeth. Comparison of these indices showed different figures in the same clinical situation, identifying corresponding incorrect indications for the choice of the design of the first investigated index, as well as more accurate data of the proposed index. Conclusion. The index assessment of hard dental tissues destruction serves as the main guideline for the dentist when choosing a method for tooth restoration, and can be calculated using photographs, scans and computer software.

Demographic, Clinical and Radiological Features of Healthcare Workers and Two Index Cases That Were Infected with COVID-19 (SARS-Cov-2)

To evaluate the index cases leading to the transmission of healthcare workers (HCWs) in Rize/Turkey Recep Tayyip Erdogan University Faculty of Medicine Education and Research Hospital with COVID-19 infection and the clinical features of infected HCWs. The first two COVID-19 test positive patients treated at Rize/Turkey between 10.03.2020 and 12.04.2020 and HCWs those who examined these two patients whose COVID-19 PCR test results were positive were included in this study. In Rize/Turkey, the first and second cases of positive COVID-19 which was recorded on 13.03.2020 on 25.03.2020, 27 HCWs (female, 63%, n = 17 and male, 37%, n = 10 and the mean age was 33.2 ± 6.9 years) who contacted during the treatment of these cases and became COVID-19 positive were examined. The median of symptom duration (days) of the HCWs was 5 days (range: 0–17 days). Fever, 55.6% (n = 15); malaise, 44.4% (n = 12); cough, 40.7% (n = 11); sore throat, 33.3% (n = 9); myalgia, 33.3% (n = 9); dyspnea, 14.8% (n = 4); diarrhea, 22.2% (n = 6); vomiting, 14.8% (n = 4); anosmia, 18.5% (n = 5); ageusia, 22.2% (n = 6) and headache, 37% (n = 10) of the cases. The rates of headache in female HCWs infected with COVID-19 were found to be significantly higher compared to men (52.9%). None of them had severe clinical situation requiring intensive care follow-up or acute respiratory distress syndrome (ARDS). Laboratory measurements of HCWs were carried out at the first when they had symptoms and when they recovered, and results were compared accordingly. The thorax computerized tomography (CT) findings of HCWs were normal in 74.1% (n = 20) of total. HCWs were initially affected by the COVID-19 pandemic. Early measures provided by the Health authorities, access to diagnosis and treatment, and the young age average in HCWs prevented severe outcomes such as severe clinical course and mortality at the beginning of the outbreak.