Predictive indicators of an unfavorable prognosis for the restoration of laryngeal functions in unilateral lesions of the recurrent laryngeal nerve in thyroid surgery

Recurrent laryngeal nerve (RLN) damage in thyroid surgery is a very dangerous complication. An otolaryngologist, especially at pri­mary care institutions,should administer conservative or surgical treatment in a timely manner and depending on the type of nerve damage (transient, permanent), i. e., to analyze possible prognosis of the disease. Only few studies to predict disease developmentin RLN have been performed. One of the most modern and informative methods is laryngeal electromyography using needle electrodes, but despite the sufficient number of patients with this pathology, in most medical institutions in Ukraine it is not performed, given the technical difficulties of implementation, invasiveness and difficulty in interpreting the results of this method.Aim — to analyze the laryngoscopic signs of paresis and paralysis of the larynx in thyroid surgery and to identify the most significant from them, which together can serve as prognostic criteria of the lack of recovery of laryngeal mobility (paralysis).Materials and methods. A single-site prospective study was conducted in the years 2018—2021 that involved 164 patients with postoperative laryngeal movement disorders, who were divided into two groups: subjects with laryngeal paralysis (n = 33) and patients with laryngeal paresis (n = 131). All patients underwent phoniatric examination. The following signs have been identified: general signs, including age, number of operations, scope of surgical intervention, and 18 laryngoscopicsigns, each of them had two to seven grades. For the convenience, the grades were coded with numbers and, if possible, arranged in ascending order of severity. The obtained results were processed with Fisher angular transformation.Results. Among 18 laryngoscopic and general signs, 10main (predictors) were identified, that affect the absence or presence of laryngeal paralysis. They included:elements of mobility of the paralyzed vocal cords (VC) (absent), flotation of the «paralyzed» VC (insignificant and pronounced), mobility of the arytenoid cartilage (absent), closure of the VC (complete non-closure), synchronicity of oscillations VC (absence of movement of the paralyzed VC), restriction of the movement of the «paralyzed» VC (absent (the GE is motionless), level of the VC in the vertical plane (not on the same level), the tension of the median edge of the VC (incurvate), patient’s age > 45 years, the position of the «paralyzed» VC (median and intermedian). The mathematical analysis showed that none of the isolated laryngoscopic signs can be used as an independent criterion in assessing the predictions of the laryngeal mobilityrestoration.Conclusions. Prognostic laryngoscopic signs of recurrent laryngeal nerve damage in the thyroid surgery allow to create a prognostic model of recovery or lack of recovery of laryngeal motility, which is important for the appointment of timely adequate treatment.

Representation of Jombang as “a santri city”: landscape linguistic study

This study examines the representation of Jombang district as a santri city. The purpose of this study is to describe the extent to which the representation of the mention of Jombang district as a santri city is examined from the use of language in public spaces that can reflect these nicknames. The data in this study are forty forms of language use on billboards, shop names, road signs, and general signs on other roads that can reflect the designation of Jombang district as a santri city. This is a qualitative descriptive research. The theory used is the basic theory from Landry and Bourhis (1997) which focuses on the study of landscape linguistics which refers to information functions and symbolic functions. The results showed that there were five ways of representing Jombang as a santri city, namely (1) representation through naming shops, buildings, and community groups using Arabic which was written using Latin letters, (2) representation through naming streets, alleys, and institutions using names. family or the founder of the Islamic boarding school, (3) representation through the provision of special information for the boarding school students, (4) representation through the promotion of Islamic boarding school-based schools, and (5) representation through other objects. The methods of representation are divided into six categories of language signs in public spaces, namely in the category of road signs, advertising or promotional signs, warning signs, building names, information signs, and objects. There were also factors that influenced the presence of language signs in public spaces that represented Jombang as a santri city, namely (1) being close to the boarding school area, (2) following trend which is done by other subjects around the boarding school, (3) the need for the existence of an institution, and (4) information facilities for the general public.

REFUSAL OF THE SUBJECTIVE RIGHT TO THE INVIOLABILITY OF HOME IN A CRIMINAL PROCEDURE (THEORETICAL AND LEGAL ASPECT)

The article discusses consent to the conduct of investigative actions in a home as a refusal of an authorized person from his subjective right to the inviolability of the home, as well as the peculiarities of the procedural procedure for conducting investigative actions in a home in the presence of a refusal of the subjective right to its inviolability. The legal significance of consent to the entry of strangers into the home is that it is a waiver of the right to the inviolability of the home and is one of the legal facts that allow the official conducting the investigative action to interfere with the right of this person. Proceeding from the general signs of a waiver of the right, the authors argue that the inviolability of the home is a subjective right that can be waived, they determine the persons whose waiver of the right to the inviolability of the home has legal significance. By renouncing his right to the inviolability of his home, a person turns out to be from the powers that make up the content of this right. The authors come to the conclusion that the constitutional and legal nature of the principle of the inviolability of the home makes it necessary to ascertain the opinion of all residents on the performance of any investigative actions in the home, with the exception of a search and seizure, the basis for the production of which is exclusively a judicial decision. The article also analyzes the procedure for giving up the right to the inviolability of the home by giving consent.

Empirical study of suicide intentions of adolescents

The article analyzes the features of suicidal ideation of adolescents. The phenomenon of suicide as a human behavior aimed at intentional self-harm with a fatal end, self-destruction is considered. The general signs of suicidal intent are analyzed: verbal signs (notification of one's intention to others); behavioral signs (significant changes in behavior: larger indifference on their appearance, disruption of the attention process, missing school, avoidance of communication with peers); situational signs (betraying their legacy, cowardice or excessive aggression, clash with important people, disruption of relationship). As a result of empirical research, it was found that the studied adolescents are characterized by a mostly low level of anxiety, which is an indicator of the stability of the emotional state and lack of anxiety; low and medium level of frustration, and adolescents are confident, responsible, resistant to failure, are not afraid of difficulties; adolescents have an average rate of aggression, which is characterized by coming into student’s conflicts, to prove their point, using elements of aggression to assert themselves and maintain their status in the peer group; the average indicator of rigidity testifies to their stability in the actions provoked by unforeseen events; found that some adolescents clearly expressed the dominance of emotions over intellectual control in assessing the situation, readiness to respond to a traumatic situation rather emotionally than logically, existing social pessimism as a negative concept of the world, also, they are characterized by demonstrativeness (demonstration of suicidal intentions) of the willingness to attract public attention of others to themselves, their problems, to achieve compassion and awareness. It is concluded that it is necessary to develop a system of socio-psychological measures to reduce suicidal ideation among adolescents.

COMPLEX X-RAY DIAGNOSTICS OF THE VERTEBRO-NEUROLOGICAL SYNDROMES IN PATIENTS WITH DYSTROPHIC DISEASES OF THE LUMBAR SPINE

Traditional X-ray methods identify general signs of a dystrophic process in 82.2% of cases but they do not provide suffi cient information about the nature of a pathological process, lesion prevalence and localization, a level and a degree of compression of neurological and vascular elements of the vertebral canal. Specifi city of X-ray imaging in the identifi cation of a dystrophic process nature is just 47.8%. X-ray imaging and T1-,T2-weighted MRI are enough for examining patients with discogenic changes of the vertebral segments; their combined results are highly effective (99.4%). Spiral CT and MRI are complementary methods for the examination of patients with dystrophic diseases of the lumbar spine; when used together their eff ectiveness reaches 95.4%. The comparative assessment of sensitivity, specifi city and accuracy of modern methods of X-ray diagnostics, development of an algorithm of the examination of patients with dystrophic diseases of the lumbar spine were performed on the basis of the study results.

A Single Arm Clinical Trial to Assess the Combined Effectiveness of Anubhuta Kashaya and Kaishora Guggulu in the Management of Chronic Kidney Disease (CKD)

CKD encompasses a spectrum of pathophysiologic processes associated with abnormal kidney function and a progressive decline in the glomerular filtration rate (GFR). Elimination of Malas from the body is also an inductive of good health. There are totally three Malas explained by the Samhitas namely Purisha, Mutra & Sweda. In Chronic Kidney Disease (CKD) where there is a less formation of Mutra, the Karma of Mutra is removing Kleda (waste products) from the body. So, the Kleda which resides in the body causes Pratiloma gati of Vata leading to different variety of diseases which involves Dusti of Rakta. Therefore, use of Mutrala & Raktashodhaka Dravyas may be helpful in the subjects of CKD. There is no availability of direct description of CKD in Ayurvedic science, except Vrukka roga Adhikara of Bhaishajya Ratnavali. So, we studied the disease with Ayurvedic concepts on the basis of general signs and symptoms. Here 28 subjects diagnosed with Chronic Kidney Disease (CKD) fulfilling the inclusion criteria were selected incidentally for study. For each subject of CKD Amapachana and Koshtashodhana was done with Hareetakyadi churna, Anubhuta Kashaya and Kaishora Guggulu are administered as Shamanoushadhi. With this intervention, we are able to give mild to moderate improvement in subjective and objective parameters. During the study improvement of subjective parameters are well appreciated than the objective parameters. The objective of the study is to establish the combined effectiveness of Anubhuta Kashaya and Kaishora guggulu in the management of Chronic Kidney Disease.

DE NOVO AUTOIMMUNE HEPATITIS AFTER LIVER TRANSPLANTATION IN CHILDREN. REVIEW

De novo autoimmune hepatitis (AIH) is a clinical disease similar to AIH that develops in liver transplant recipients with diseases other than AIH. Timely recognition of this disease makes it possible to avoid graft rejection and liver re-transplantation (LT), liver fibrosis, and can ensure a long life expectancy, given the effectiveness of more active immunosuppression with the use of corticosteroids and azathioprine, as in the treatment of idiopathic AIH. The de novo prefix was added to distinguish this condition from primary autoimmune hepatitis prior to transplant, but the diagnostic algorithm adopted generally accepted diagnostic criteria for autoimmune hepatitis. In fact, de novo autoimmune hepatitis is characterized by typical necroinflammation of the liver, rich in plasma cells, increased serum gammaglobulin levels, and the appearance of inorganic specific autoantibodies. However, the general signs of autoimmune hepatitis de novo, apparently, cannot be associated with an unambiguous pathophysiological pathway, since they can develop in patients undergoing liver transplantation due to different etiologies. The literature review presents such aspects as the prevalence of this case, the influence of the HLA phenotype on the manifestation and outcome of the disease, diagnosis and treatment. Objective. To conduct a literary meta-analysis of scientific publications on the development of De novo Autoimmune hepatitis after liver transplantation in children. Materials and methods. The authors selected scientific bases for the search such as: Web of science, Cyberleninka, UpToDate, Pubmed and Cochrane, Google Scholar. Results. A meta-analysis of scientific articles in English and Russian was carried out for the selected keywords. The causes of development were not infectious or surgical complications. Liver biopsy revealed histological changes typical of acute or chronic ovulation. High levels of transaminases, hypergammaglobulinemia, positivity to autoantibodies – ANA, AMA, SMA, anti-LKM-1. De novo AIH patients did not respond to conventional anti-rejection therapy, but responded only to classical AIH therapy.

Unusual increase in the incidence of unilateral Optic Neuritis: Case presentation

Optic neuritis presents as an acute or subacute inflammatory episode. Objective: Describe the clinical-epidemiological characteristics in 7 cases with unilateral optic neuritis and evaluate the therapeutic results obtained. Material and method: A series of cases with a diagnosis of unilateral optic neuritis who attended the Neurophthalmology consultation at the Hermanos Ameijeiras Hospital in Havana, Cuba, from August 6 to November 16, 2018, from Havana and Matanzas, were studied. An unusual increase in the incidence of NO was recorded in the period analyzed. Results: An unusual increase in the incidence of unilateral optic neuritis was recorded. The average age was 33.5 years. All reported unilateral painless visual loss. Four patients reported general signs and symptoms suggestive of having suffered a respiratory disease of viral origin, between 7 and 15 days before optic neuritis. In the examination carried out, great impairment of visual acuity (≤0.05) and colors (0/21) was found. The centro-caecal scotoma was the most frequent campimetric defect. Optical Coherence Tomography (OCT) in the affected eye showed increased neuroretinal thickness, decreased nerve fiber layer, and ganglion cell damage. Treatment was with intravenous methylprednisolone and B vitamins. Conclusions: An unusual increase in patients with unilateral optic neuritis was observed. The OCT revealed damage to the structures at the level of the retina and the optic nerve. The therapeutic effectiveness was conditioned by the time of evolution of the neuritis.

Unusual increase in the incidence of unilateral Optic Neuritis: Case presentation

Optic neuritis presents as an acute or subacute inflammatory episode. Objective: Describe the clinical-epidemiological characteristics in 7 cases with unilateral optic neuritis and evaluate the therapeutic results obtained. Material and method: A series of cases with a diagnosis of unilateral optic neuritis who attended the Neurophthalmology consultation at the Hermanos Ameijeiras Hospital in Havana, Cuba, from August 6 to November 16, 2018, from Havana and Matanzas, were studied. An unusual increase in the incidence of NO was recorded in the period analyzed. Results: An unusual increase in the incidence of unilateral optic neuritis was recorded. The average age was 33.5 years. All reported unilateral painless visual loss. Four patients reported general signs and symptoms suggestive of having suffered a respiratory disease of viral origin, between 7 and 15 days before optic neuritis. In the examination carried out, great impairment of visual acuity (≤0.05) and colors (0/21) was found. The centro-caecal scotoma was the most frequent campimetric defect. Optical Coherence Tomography (OCT) in the affected eye showed increased neuroretinal thickness, decreased nerve fiber layer, and ganglion cell damage. Treatment was with intravenous methylprednisolone and B vitamins. Conclusions: An unusual increase in patients with unilateral optic neuritis was observed. The OCT revealed damage to the structures at the level of the retina and the optic nerve. The therapeutic effectiveness was conditioned by the time of evolution of the neuritis.

Pediatric Idiopathic Intracranial Hypertension Post-measles Vaccine: A Case Report

Idiopathic intracranial hypertension is characterized by an increase in intracranial pressure with no significant structural cause. The diagnostic criteria include general signs and symptoms of generalized increased intracranial pressure or papilledema, increased Cerebrospinal Fluid (CSF) pressure (>250 mm H2 O), and normal brain imaging. It usually occurs in adults but rarely can be seen in children. We report a 7-year-old child with a manifestation of increased intracranial tension after the measles vaccine, associated with bilateral sixth nerve palsy and bilateral facial palsy with lower motor neuron features. Normal magnetic resonance imaging and CSF results were normal, except for an increase in CSF pressure. The symptoms began to be resolved after lumbar puncture with the complete resolution of symptoms after one and half months. We add also acetazolamide at the proper dose to reduce intracranial pressure from the first day of diagnosis.