Incidence of tuberculosis of bones and joints in Sumy region

Bones and joints, among other extrapulmonary organs, are most often affected by tuberculosis. The clinical picture is often «hidden», the diagnosis of the disease is delayed for a long time with all the negative consequences. Objective — to study the trend in the incidence of tuberculosis of the bone and joint localization of the Sumy region residents in recent years and draw the attention of general practitioners to the urgent problem of today. Materials and methods. We analyzed the incidence of tuberculosis of bones and joints of the Sumy region residents during 2007—2019. During this period, 200 patients with osteoarticular tuberculosis registered in the region. Results and discussion. Over the past 13 years, the number of patients with tuberculosis of the bone and joint localization averaged 2.5 % of all newly detected processes. Tuberculosis of the spine (spondylitis) occurred in 119 (59.5 %) patients, specific inflammation of the hip joint in 49 (24.5 %), knee — in 11 (5.5 %), ankle — in 6 (3.0 %). Tuberculosis of other bones and joints was found in 15 (7.5 %) patients, 60 (50.4 %) patients with tuberculous spondylitis were recognized as disabled for the first time. Of these, the group I was found in 19 (31.7 %), II — in 25 (41.7 %), III — in 16 (26.6 %). Conclusions. In recent years, there has been an increase in the proportion of patients with CST among all newly diagnosed patients in the Sumy region. The spine is most often affected by tuberculosis of the bones and joints (59.5 %). At the same time, a significant lesion (3—4 vertebrae) was recorded in 23 (19.3 %) persons, five and more vertebrae — in 19 (16.0 %) patients. Patients with tuberculous spondylitis in 50.4 % of cases permanently lost their ability to work. Most patients of groups I and II of disability and a significant number of patients of group III require surgical intervention; without its implementation, there are irreversible changes in the vertebrae, which lead to increased medical, biological, and social disability.

THE PECULIARITIES OF THE DATA OF INSTRUMENTAL EXAMINATIONS OF WOMEN AFFECTED BY UTERINE FIBROIDS WITH CONCOMITANT HEPATOBILIARY DISEASES

Nowadays, women’s reproductive health is a topical issue of obstetrics and gynecology, therefore, great importance is attributed to timely diagnosis and prevention of diseases that influence fertility. The topicality of the issue of uterine hyperplasia, in particular, uterine fibroids, is accounted for by the social significance of the disease. Its incidence rate is constantly growing and makes up from 30 to 50% in women older than 35 years and, according to the data of autopsy, - up to 80%. No doubt, the peculiarities of development and progression of hyperplasia are determined by the reserve potential of various systems and organs, including the hepatobiliary system.The aim of research is to analyze the results of instrumental examinations of the functional capacity of hepatocytes in women affected by uterine fibroids and functional disorders of the hepatobiliary system. Research materials and methods. To accomplish the set objective, we used the following contemporary instrumental examination methods: ultrasonography and rheovasohepatography as well as a clinical and paraclinical analysis of caserecords of 150 women aged between 35 and 45 and affected by uterine fibroids, who were treated at the gynecological department of the Regional Perinatal Centre.Research results. As the research result show, uterine fibroids and the related hormonal disorders often go together with functional and morphological lesion of hepatocytes. Patients affected by uterine fibroids have preconditions for the development of functional disorders of hepatocytes as they present significant disorders of hepatic hemodynamics, decreased blood supply of the liver, as a result of pre- and postcapillary resistance.Conclusions. There is a close connection between uterine fibroids with concomitant hepatobiliary disorders and the severity of hormonal disorders, and the significant lesion of hepatocytes may be irreversible. Thisrequires pathogenetic correction by introducing drugs with hepatoprotective and antioxidant effects.

Abstract 16856: Mathematical Modeling of Blood Flow to Evaluate the Hemodynamic Significance of Peripheral Vascular Lesions

Introduction: Evaluating the severity of lesions in peripheral arteries is challenging. Image-based blood flow modeling from peripheral computed tomographic angiography (pCTA) may provide a non-invasive method to determine the hemodynamic significance of lesions. The objective of this study was to evaluate the diagnostic performance of a trans-lesion pressure drop computed from pCTA-based blood flow modeling in the peripheral arteries. Methods: Ten patients undergoing digital subtraction angiography (DSA) and pCTA were included. The peripheral arteries were divided into 8 segments per extremity and stenosis severity was visually graded by DSA as non-stenosed (grade 0), mild (grade I), moderate (grade II), severe (grade III), occluded (grade IV) or non-evaluable. A functionally significant lesion was defined as grade III or IV by DSA. Independent from the DSA review, a resting pressure gradient (rPG) and exercise PG (ExPG) for each segment was calculated from pCTA-based blood flow modeling (Figure), and a functionally significant lesion was defined as having an rPG > 5 mm Hg or an ExPG > 20 mm Hg. Results: Mean age was 52±16 years, 4 patients (40%) were male, 8 patients (80%) presented with critical limb ischemia, mean ankle brachial index was 0.60±0.29 and 66 arterial segments were available for both assessment methods. Twenty-two segments had functionally significant lesions by DSA. For rPG, sensitivity was 80%, specificity was 85% and accuracy was 79% with DSA as the standard; for ExPG, sensitivity was 84%, specificity was 89% and accuracy was 88%. Conclusions: Use of a resting pressure gradient > 5 mm Hg and an exercise pressure gradient > 20 mm Hg measured by peripheral computed tomography-based blood flow modeling accurately identifies functionally significant stenosis in patients with advanced peripheral vascular disease. These results support a prospective imaging trial to further validate this novel approach.

Association of epicardial fat thickness assessed by echocardiography with the severity of coronary artery disease

Introduction : Epicardial fat thickness (EFT) can reflect risk of cardiovascular disease particularly coronary artery disease (CAD). The aim of this study was to investigate the association of EFT assessed by echocardiography and presence as well as severity of CAD. Methods: Two hundred and twenty consecutive patients who candidate for coronary angiography because of possible CAD were studied. EFT was evaluated in standard parasternal long axis (PlAX) and parasternal short axis (PSAX) view from 3 cardiac cycles at the end of systole and diastole. The severity of CAD was defined in two ways: (1) SYNTAX score, (2) number of vessels with significant lesion. Results: PLAX (EFTS ) (EFT in systole) and PLAX (EFTd ) (EFT in diastole) were significantly higher in patients with CAD in comparison with patients without CAD (P = 0.046, P = 0.041 respectively). There was a significant correlation between PLAX (EFTS ) (P = 0.05), PLAX (EFTd ) (P = 0.04) and SYNTAX score. There was no statistically significant relationship between EFT and number of diseased vessel (P > 0.05). Multivariate analysis was done for adjusting the effects of confounding factors and it showed that EFT (OR: 10.53, P = 0.004) was significantly correlated severe CAD as assessed by the SYNTAX score. Conclusion: EFT assessed by transthoracic echocardiography was higher significantly in patients with CAD than in normal patients. EFT as an easily available and cost-effective echocardiographic feature might be useful to predict complexity of CAD.

Cardiac Imaging—Physiologic Assessment of Coronary Artery Lesion

Thirty percent of angiographically significant coronary lesions may be functionally significant. Physiological assessment is essential to treat intermediate coronary lesions before taking the decision for percutaneous intervention. Even when coronary artery bypass is planned as treatment modality in triple-vessel coronary artery disease, the SYNTEX II trial has shown that functionally significant lesion treatment by bypass grafts improves the outcome of these patients. In this article, possible ways of estimating the physiologic assessment of coronary lesion, and the advantages and disadvantages of methods of estimating the physiologic assessment of coronary lesions is discussed.

Successful PCI of Anomalous Left Circumflex Coronary Artery Arising from Right Coronary Sinus – A Case Report

Coronary artery anomalies occur in 1.3-5.6% of patients undergoing coronary arteriography. An anomalous origin of LCX from right coronary sinus is the most common congenital variant. It is usually considered “benign” since it is not known to predispose individuals to sudden cardiac death. Such vessels are particularly predisposed to atherosclerotic disease in their proximal portion, due to the acute angulation of its origin from the aorta and its posterior retro aortic course. We present a case of 55 years old female admitted with acute coronary syndrome. Coronary angiogram showed the anomalous origin of the left circumflex artery from right coronary sinus. This artery had a significant lesion which was successfully stented with a drug-eluting stent.

Thoracic Radiography Characteristics of Drug Sensitive Tuberculosis and Multi Drug Resistant Tuberculosis: A Study of Indonesian National Tuberculosis Prevalence Survey

Background: Tuberculosis (TB) remains a burden globally, including Indonesia. The primary objective of this study is to reveal the chest radiography characteristic of drug-sensitive TB (DS-TB) and multi-drug resistant TB (MDR-TB) in the Indonesian national tuberculosis prevalence survey 2013–2014. The secondary objective is to explore the correlation and incidence rate of chest radiography lesion of DS-TB and MDR-TB cases. Methods: This is a cross-sectional retrospective analytical studies with national and regional coverage. Samples were selected by stratified multi-stage clustering sampling technique in a population aged ≥15 years old. The diagnosis of TB was based on culture and GeneXpert tests. Results: There were 147 DS-TB and 11 MDR-TB patients that were analyzed in this study. The nodule is the only type of lesions that distinguish MDR-TB and DS-TB. In multivariate analysis of DS-TB, there were 3 significant chest radiography lesions, i.e infiltrate, cavity and consolidation with odd-ratio (OR) of 14, 13, and 3, respectively. In MDR-TB, the only significant lesion is a nodule, with OR of 19. Conclusion: Nodule is the only type of lesions that distinguish MDR-TB and DS-TB. Infiltrate, cavity and consolidation were the types of chest radiography lesions on DS-TB, meanwhile, a nodule was the only significant lesion for MDR-TB.

Multicenter prospective evaluation of the express view reading mode for small-bowel capsule endoscopy studies

Background Reducing the reading time of capsule endoscopy films is of high priority for gastroenterologists. We report a prospective multicenter evaluation of an “express view” reading mode (Intromedic capsule system). Methods Eighty-three patients with obscure gastrointestinal bleeding were prospectively included in 10 centers. All patients underwent small-bowel capsule endoscopy (Intromedic, Seoul, Republic of Korea). Films were read in standard mode, then a second reading was performed in express view mode at a second center. For each lesion, the precise location, nature, and relevance were collected. A consensus reading and review were done by three experts, and considered to be the gold standard. Results The mean reading time of capsule films was 39.7 minutes (11 – 180 minutes) and 19.7 minutes (4 – 40 minutes) by standard and express view mode, respectively (P < 1 × 10 – 4). The consensus review identified a significant lesion in 44/83 patients (53.0 %). Standard reading and express view reading had a 93.3 % and 82.2 % sensitivity, respectively (NS). Consensus review identified 70 significant images from which standard reading and express view reading detected 58 (82.9 %) and 55 (78.6 %), respectively. The informatics algorithm detected 66/70 images (94.3 %) thus missing four small-bowel angiodysplasia. Conclusion The express view algorithm allows an important shortening of Intromedic capsule film reading time with a high sensitivity.

A Comparative Preliminary Study on CT Contrast Attenuation Gradient Versus Invasive FFR in Patients with Unstable Angina

Theaimof this preliminary study was to assess the effectiveness of transluminal contrast attenuation gradient (TAG) determined by computed tomographic angiography (CTA), for the evaluation of the functional significance of coronary artery stenoses in patients with acute coronary syndromes produced by vulnerable coronary plaques, and to demonstrate the correlation between this new parameter and the vulnerability markers of the culprit lesions.Material and methods:This is a preliminary pilot study on 10 patients with acute coronary syndromes – unstable angina type, who underwent CTA for the assessment of coronary lesions, followed by invasive angiography and the determination of fractional flow reserve (FFR) prior to a revascularization procedure. Patients were divided into 2 groups, according to their FFR values: Group 1 consisted of 6 patients with an FFR value <0.8 (functionally significant lesion), and Group 2 consisted of 4 patients who presented an FFR value >0.8 (functionally non-significant lesion).Results:FFR values were 0.64 ± 0.07, 95% CI: 0.5–0.7 in Group 1, and 0.86 ± 0.05, 95% CI: 0.7–0.9 in Group 2. Plaques associated with an FFR<0.8 presented a higher amount of plaque volume (192.7 ± 199.7 mm3 vs. 42.1 ± 27.3 mm3, p = 0.1), necrotic core (66.7 ± 72.9 mm3 vs. 10.0 ± 9.3 mm3, p = 0.1), and fibro-fatty tissue (29.7 ± 37.4 mm3 vs. 6.2 ± 3.8 mm3, p = 0.2). At the same time, TAG significantly correlated with the presence of a functionally significant lesion. Coronary lesions associated with low FFR presented significantly higher values of TAG along the plaque as compared with lesions with FFR values >0.8 (TAG values 22.1 ± 5.8 HU vs. 11.7 ± 2.5 HU, p = 0.01). Linear regression identified a significant correlation between TAG and FFR values as a measure of functional significance of the lesion (r = 0.7, p = 0.01).Conclusions:Contrast attenuation gradient along the culprit lesion, determined by CTA, correlates with the FFR values and with CT markers of plaque vulnerability, indicating that the presence of vulnerability features inside a coronary plaque could increase the functional significance of a coronary lesion.

SYNTAX Score in Patients with High Computed Tomography Coronary Calcium Score

Objectives: To study the conventional coronary angiogram ( CA) findings in patients with high coronary calcium on multidetector computed tomogram. Materials and Methods: Fifty patients with coronary calcium high enough in its extent and location to interfere with the interpretation of a contrast-filled coronary artery for a significant lesion were studied with conventional CA. Framingham risk score (FRS), computed tomography (CT) coronary calcium score (CCS), and SYNTAX score (SS) from the CA were calculated by separate investigators who were blinded to other scores. Effectively, 250 coronary arteries (left main, left anterior descending, left circumflex, and right coronary artery and posterior descending artery in each subject) with calcium scores were studied for lesions on CA. Results: Thirty-five subjects had high FRS, 10 had intermediate FRS, and 5 had low FRS. Eight subjects of 25 (32%) with CCS between 350 and 1000 had no significant coronary artery disease (CAD). Overall, the CCS and the SS had a strong agreement with each other (r = 0.68, P < 0.01) that persisted in those with very high scores >1000 (r = 0.55, P < 0.01, n = 30), but only a nonsignificant weak correlation with scores between 350 and 1000 (r = 0.1, P = 0.62, n = 20). Individual vessel calcium scores correlated strongly for the presence of any lesion (r = 0.52, P < 0.01) in the same artery but only weakly for a significant lesion (r = 0.29, P = 0.05). Conclusion: High CT CCS in this cohort of intermediate to high (Framingham score) risk patients correlated strongly with the subject's global burden of the CAD as derived by the SS, more so for subjects with very high scores. Similarly, CCS correlated strongly with the presence of any lesion but only weakly for a significant stenosis; also, about one-third of patients with CCS between 350 and 1000 may not have significant disease on conventional CA.