Possibilities of bioimpedance method of investigation of elderly patients with chronic heart failure

Introduction. Diagnostics of congestive events in chronic heart failure (CHF) in elderly people is increasingly relevant due to the general aging of the population, which determines the search for new research methods. The aim is to evaluate the diagnostic capabilities of bioimpedance method in determining the severity of congestion in elderly patients with CHF. Materials and methods. 86 elderly patients with CHF of different clinical stages were examined, 36.0% of them were burdened with varicose vein disease of the lower limbs. Total body water content was assessed by active impedance at 50 kHz, extracellular fluid content — at 5 kHz. Results. Active resistance at 50 kHz in patients with CHF II B was 473.92±29.39, with CHF II A - 569.24±58.97, with CHF I — 601.33±24.64 ohms, respectively, at 5 kHz — 555.52±27.44, 633.50±51.32 and 722.50±15.85 ohms respectively. No total and/or extracellular fluid retention was detected in CHF II A without lower limb varicosity, and in 10 (58.8%) patients — in cases of its presence. Retention of total and/or extracellular fluid was detected in 74.4% of CHF stage II B patients, and 48.3% of them had varicose vein disease of the lower limbs. Discussion. Patients with CHF stage II B have the highest amount of total and extracellular fluid in the body compared to patients with CHF stage II A and CHF stage I, but the method is insensitive for diagnosis of fluid retention in the small circle of the circulation and differential diagnosis of the genesis of edema in varicose vein disease of the lower limbs. Conclusion. Bioimpedance imaging can be used for additional diagnostics of CHF in elderly patients in order to estimate the amount of total/extracellular fluid in the body to build personalized treatment and prevention programs.

Chronic thromboembolic pulmonary hypertension in an obese patient with type 2 diabetes mellitus

Metabolic disorders represent a serious medical and social problem and are risk factors for the development of thromboembolic complications. Disturbances of both carbohydrate and fat metabolism contribute to an increase in blood viscosity, creating prothrombotic conditions, which are not always objectively assessed even by specialists. In addition, multiple comorbid conditions usually significantly complicate the prognosis. The article presents a clinical case of recurrent thrombosis of the right atrium and the orifices of the superior and inferior vena cava in a 39-year-old patient with type 2 diabetes mellitus, obesity, arterial hypertension, and varicose vein disease.

HISTORICAL AND MODERN ASPECTS OF TREATMENT OF LOWER LIMB VARICOSE VEIN DISEASE (THE LITERATURE REVIEW)

In developed countries, lower limb varicose vein (LLVV) is determined in 25% of the adult population. The high prevalence of varicose vein disease and the likelihood of severe complications developments determine the socio- economic importance of fi nding the eff ective methods of treatment this pathology. Age, height, female gender, overweight and heredity are well known traditional risk factors. The pathogenesis of LLVV is a complex and multifactorial process.The aff ected of endothelial cells is the main pathogenetic link in the LLVV development, that leads to a violation of their antithrombogenic properties. In the future, other membranes of the vein wall are involved in the pathological process. The development of LLVV is associated with a violation of the venous valves and their damage as well. The main method for diagnostic LLVV is ultrasound CT angiogram, that allows you to simultaneously visualize the researched vessel, determine the direction of blood fl ow and its parameters, its individual anatomical features. There are conservative and surgical methods of LLVV treatment. The fi rst attempts of the conservative management for this disease were wrapping the aff ected leg, as evidenced by the rock paintings that had been found in the Sahara Desert. The current analogue is the compression therapy, which plays a major role in the conservative management of venous diseases. Before the conservative method of treatment of LLVV the drug therapy is used as well. The use of various herbs for the management of blood vessels was common in ancient India. Currently, there is the wide range of modern pleotropic drugs. Aulus Cornelius Celsus removed varicose veins with a tiny hook, which is an extremely early version of a varicose vein treatment performed today. In the following centuries, the methods of surgical treatment of this disease were constantly have been improved. Nowadays, the most frequently used methods of varicose vein obliteration are based on endovasal thermal damage of the venous wall, that leads to the occlusive fi brosis and transformation of the vein into a connective tissue cord. The main advantages of these interventions are minimal trauma, speedy rehabilitation, and good cosmetic result.

Study of the Clinical Profile of Varicose Vein Disease

Introduction: Varicose veins are part of the spectrum of chronic venous diseases and include dilated, tortuous veins of lower limbs, spider telangiectasia and reticular veins. Varicose vein disease is a very common problem of the western world and mostly their patients come for treatment because of cosmetic reasons. Indian scenario is different as mostly patients from lower socioeconomic strata of the society come for complications like ulceration, dermatitis etc. of varicose veins come for treatment. This problem sometimes results in chronic absenteeism from work, economic losses and change of occupation in many individuals. Methods: This observational study was carried out from 1st January 2017 to 30th June 2018 in Sri Aurobindo Medical College and Postgraduate Institute, Indore. Clinical profile of 52 patients of varicose vein disease was studied. All the patients were thoroughly examined and the pertaining data recorded. This data was tabulated and compared with the available literature on this subject. Results: Fifty two cases of varicose vein disease were studied. The commonest age group affected with the disease was between 41 to 50 years. Male patients were more and comprised of 84.6% of total number. Sapheno femoral junction valve was incompetent in 73.1 % cases as compared to saphenopopliteal junction[34.6%].Obesity was an important factor in causation of varicose vein disease. Flush ligation at SFJ with stripping was the commonest surgical procedure carried out our center. Conclusion: It is found that varicose vein disease with its associated sequelae brings the patient for treatment in our scenario. Long saphenous vein is the commonly affected part of the superficial venous system because of incompetency of the valve at SFJ. Although various etiological factors can be attributed to varicose vein disease but occupation and obesity remain the main factors. Accurate assessment of problem and adequate surgery will prevent recurrence. Key words: Varicose veins, venous ulcers, recurrent varicose veins.

Complete Nucleotide Sequence, Genome Organization, and Comparative Genomic Analyses of Citrus Yellow-Vein Associated Virus (CYVaV)

Citrus yellow-vein disease (CYVD) was first reported in California in 1957. We now report that CYVD is associated with a virus-like agent, provisionally named citrus yellow-vein associated virus (CYVaV). The CYVaV RNA genome has 2,692 nucleotides and codes for two discernable open reading frames (ORFs). ORF1 encodes a protein of 190 amino acid (aa) whereas ORF2 is presumably generated by a −1 ribosomal frameshifting event just upstream of the ORF1 termination signal. The frameshift product (717 aa) encodes the RNA-dependent RNA polymerase (RdRp). Phylogenetic analyses suggest that CYVaV is closely related to unclassified virus-like RNAs in the family Tombusviridae. Bio-indexing and RNA-seq experiments indicate that CYVaV can induce yellow vein symptoms independently of known citrus viruses or viroids.

Radiofrequency ablation of varicose veins: experience at a tertiary hospital

Background and objectives: Radiofrequency ablation (RFA) is a recent modality of treatment of the affected varicose vein. In the present study, the outcome of great saphenous varicose vein disease treated by radiofrequency ablation technique was analyzed. Methods: Patients with varicosities of the lower limb affecting mainly the great saphenous vein were (GSV) included. The procedures were carried out under spinal anesthesia. The target varicose vein was accessed by Seldinger technique and the RFA catheter advanced 2 to 3 cm below sapheno-femoral junction under ultrasonography (USG) guidance. A tumescent anesthetic infiltration was given in a solution of normal saline and sodium bicarbonate before the vein being ablated. Results: The success rate of RFA was 97.5 % (39 out of 40). One patient showed episodic recanalisation of vein at one year duplex colour scan. Though the complications related to procedure were negligible, one patient developed endovenous heat induced thrombosis (EHIT) and non-fatal pulmonary thromboembolism (PTE) which was managed adequately. Conclusion: Endovenous RFA is a useful treatment modality for varicose vein disease primarily due to great saphenous insufficiency with marked symptomatic improvement and least recurrence. Although the complications are minimal, EHIT is a potential and serious complication of heat ablation. Ibrahim Med. Coll. J. 2021; 15(1): 37-40

OUTCOMES OF SURGICAL TREATMENT FOR PULMONARY EMBOLISM FOLLOWING PHLEBOLOGIC INTERVENTIONS

The aim of the study was to analyze the outcomes of surgical treatment for pulmonary embolism in the group of patients previously operated on for varicose vein disease of the lower extremities.

HEMODYNAMIC DISORDERS IN VARICOSE VEIN DISEASE

Aim. Duplex ultrasound scanning (DUS) is a routine diagnostic procedure in patients with varicose vein disease. DUS mostly evaluates the qualitative (anatomical) parameters of the disease. Still, it is difficult to assess the microcirculatory parameters in trophic disorders based only on the anatomy, therefore assessment of quantitative blood flow parameters is needed. Our aim was to determine the potentials of conventional DUS in assessment of the hemodynamic disorders in patients with varicose disease. Materials and Methods. The study included 583 patients with varicose disease, 348 of which had trophic alterations. The patients were divided into 4 groups according to the CEAP clinical classes. Standard Valsalva and Siegel tests were performed during DUS. The following parameters were assessed in the superficial and deep veins: diameter of veins, antegrade blood flow velocity, retrograde blood flow velocity, reflux time; in the perforator veins (PV) – diameter, maximum velocity and average velocity of reflux. Peripheral resistance index (RI) in the arteries accompanying the PV was also analyzed. Results. A statistically significant difference in the diameter of the GSV was obtained between classes C2 and C3, C3 and C4, but not between class C5, 6 and class C4. Similar findings were observed in the assessment of diameter of the PVs and the velocity of retrograde blood flow through them. A gradual increase in these parameters could be seen with the progression of the disease, but a statistically significant difference was obtained only between classes C2 and C3 for the diameter of the PV and the peak velocity of retrograde blood flow. As for the average blood flow velocity, a statistically significant difference was obtained between classes C2 and C3, C3 and C4. Arteries in the perforator bundles demonstrated low RI which may be attributed to the presence of an arteriolo-venular bypass. Statistically significant differences were obtained for CEAP classes C2 and C3. Conclusions. Ultrasound duplex scanning of the study with use of Superb Micro-Vascular Imaging mode is an effective method in assessing the quantitative and microcirculatory parameters of hemodynamic disorders in patients with varicose vein disease of the lower extremities. Trophic ulcers in varicose vein disease are not an obligatory component of the disease, but only its complication.