DYNAMICS OF FREQUENCY AND PECULIARITIES OF THE STRUCTURE OF CONGENITAL MALFORMATIONS IN SOUTH UKRAINE (MONITORING STUDY)

Background. In Ukraine, the unfavorable demographic situation makes monitoring of the birth rate of children with congenital malformations urgent issue to identify regional features of epidemiology and develop methods for prenatal diagnosis and prognosis. Objective. Objective of this study is to characterize the frequency dynamics, to identify structural features of congenital malformations of newborns in Kherson region over a 20-year period (2000-2019) and to compare the prevalence of various nosological forms of malformations in the region, in Ukraine and in European countries. Methods. Research methods: epidemiological, medical-statistical. Results. In Kherson region, the average frequency of congenital malformations over the past 20 years is: for newborns – 31.57±1.25‰; for live births – 31.38±1.11‰; for stillborns – 197.7±0.65 per 10,000. In the structure of defects, cardiovascular malformations are leading (31.77%), musculoskeletal malformations (25.14%), genital malformations (17.5%). Increased prevalence of developmental anomalies in the region is mainly associated with an increase in the frequency of model malformations recorded by EUROCAT (r=0.69, p<0.05). The increase in the total frequency of congenital malformations is caused by increased number of births of children with cardiovascular defects (by 4.67‰), genital defects (by 1.21‰), other congenital malformations (by 1.55‰), multiple malformations (by 0.37‰). Conclusion. Monitoring results showed an increase in congenital malformations incidence in Kherson region over a 20-year period by 7.94‰ possibly caused by population decline due to negative natural and mechanical growth. The prevalence of hereditary defects is at the same level. The frequency of some nosological forms significantly exceeds in the region compare to that in Ukraine and Europe: cardiovascular defects – in 1.5 times, genital malformations – in nearly 3 times, musculoskeletal defects – almost twice.

VITAMIN D AND UROLITHIASIS IN CHILDREN

Background. Urolithiasis is currently one of the topical issues of contemporary urology and medicine in general. This is primarily due to the high prevalence of urolithiasis; according to several population studies it ranges from 3.5 to 9.6%. At the same time, there is a steady increase in its incidence. Therefore, the matter of urolithiasis is one of the most urgent in present-day medicine. Objectives. The aim of the research was to study the content of a polymorphic genetic marker of the vitamin D receptor gene related to development and relapse of urolithiasis in children. Methods. The content of a polymorphic genetic marker of the vitamin D receptor gene related to development and relapse of urolithiasis in 100 children was investigated. Results. The results of the study prove that the vitamin D receptor gene assists in revealing disorders that promote urolithiasis development. Conclusion. Comparative analysis of the frequency of distribution of Fok1 genotypes of the vitamin D receptor gene polymorphism showed that statistical significance of the association (p=0.02) of f allele according to the dominant inheritance model (total Ff+ff genotypes) was established in the group of patients with urolithiasis compare to the corresponding indicator of the control group (63%).

SYSTEMATIC REVIEW ON THE PSYCHOMETRIC, RELIABILITY AND VALIDITY PROPERTIES OF TRANSLATED NEUROPATHIC PAIN SCREENING TOOLS (DN4, LANSS AND PDQ) 1 JANUARY 2005 – 19 JULY 2019

Background. Different neuropathic pain screening tools (DN4, LANSS and PDQ) have been developed, translated into several local languages, and validated. To determine the reliability of these tools and their ability to differentiate between diagnosing neuropathic pain quality from nociceptive pain, a systematic review was conducted to synchronize properties and suggest the reliability of the translated version of these neuropathic pain-screening tools. Objective. To conduct an evidence-based systematic review to assess the psychometric, reliability and validity of the translated version of DN4, LANSS and PDQ between January 2005 and 2019. Methods. Two independent reviewers adopted the use of online (Internet) search machine (Pubmed, Scopus and Web of science) to search for the relevant articles based on JBI (Joanna Briggs Institute) inclusion criteria. Data extracted from the articles were synthesis in tabular form. Results. Twenty-six articles were included from DN4 (n=11), LANSS (n=8) and PDQ (n=4) translated from English language to eight local languages. The sensitivity and specificity of the DN4 studies ranged from 75% to 98% and 37.3% to 96%, respectively. The internal reliability (α) of the translated version of the DN4 ranged from 0.55-0.862. The sensitivity and specificity of the LANSS studies ranged from 75% to 98% and 37.3% to 96%, respectively. The internal reliability (α) of the translated version of the LANSS ranged 0.67-0.96. The sensitivity and specificity of the PDQ studies ranged from 75% to 98% and 37.3% to 96%, respectively. The internal reliability (α) of the translated version of the PDQ ranged 0.81-0.86. Conclusions. All the translated instruments reviewed showed good internal consistency of the items, high sensitivity and Positive predictive value (PPV) but not to a suitable level compared with the original version. Therefore, these screening tools are suggested to be used in conjunction with the clinical testing for appropriate diagnosis of patients with neuropathic pain quality.

SIGNIFICANCE OF DETECTION OF FREE/TOTAL PSA RATIO AND OTHER BIOCHEMICAL PARAMETERS IN PATIENTS WITH BPH, CARCINOMA PROSTATE AND ITS CLINICOPATHOLOGIC CORRELATION

Background. Benign prostatic hyperplasia (BPH) can raise prostate-specific antigen (PSA) levels two to three times higher than the normal level. An increased PSA level does not indicate Prostate Cancer (PCa), but the higher the PSA level, the higher the chance of having PCa. Detection and treatment have been profoundly affected by the advent of Free/Total PSA ratio testing. Objectives. The aim of the study was to estimate free, total PSA levels and its ratio for serum levels of calcium, acid phosphatase and alkaline phosphatase in patients with BPH and PCa; to correlate clinical, biochemical and histopathological findings in the above patients. Methods. PSA levels were detected by Chemiluminescent assay; serum calcium – by Modified Arsenazo method; serum acid phosphatase – by Doumas et al method; and Alkaline phosphatase – by Lowry et al method. Results. Present study found high levels of total PSA in BPH and PCa. Levels of free PSA were high in BPH as compared to PCa rate. Free/Total PSA ratio is reduced considerably in PCa as compared to BPH. Serum acid phosphatase and alkaline phosphatase were considerably higher in PCa as compared to BPH. Serum calcium levels did not show significant difference in control and study groups. Conclusions. It was established that patients with PCa have a greater fraction of bound PSA and a lower percentage of free PSA than in those without PCa. Therefore, in clinical practice Free/Total PSA ratio helps clinicians to decide if a biopsy is necessary. Objectives: The study was carried out with the following objectives: to estimate free, total PSA levels and calculate Free/Total PSA ratio in patients with BPH and Carcinoma Prostate, to study the serum levels of calcium, acid phosphates, and alkaline phosphatase in patients with BPH and PCa. and to correlate clinical, biochemical and histopathological findings in the above patients. Methods. Free and total PSA levels were detected by Chemiluminescent assay; Serum Calcium was detected by Modified Arsenazo method. Serum acid phosphatase was detected by Doumas et al method and Alkaline phosphatase were detected by Lowry et al method Results: Present study found high levels of Total PSA in BPH and PCa. Levels of free PSA were high in BPH as compared to PCa ate. Free /Total PSA ratio is reduced considerably in PCa as compared to BPH. Serum acid phosphatase and alkaline phosphatase were slightly raised in PCa as compared to BPH. Serum calcium levels did not show a significant difference in control and study groups. Conclusion: We concluded that patients with PCa have a greater fraction of bound PSA and a lower percentage of free PSA than in men without PCa. There was a negative correlation found between the free/total PSA ratio and the histopathologic findings. The lower the ratio higher is the grade of malignancy. Therefore in clinical practice Free/Total PSA ratio helps clinicians to decide if a biopsy is necessary

ADULT-ONSET CYSTIC HYGROMA IN AXILLA: A RARE CASE REPORT FROM INDIA AND LITERATURE REVIEW

Background. Cystic hygroma (CH), occurs in 1/6000 live births and in 90% of cases develops in age less than 2 years old. They are mainly located in cervicofacial region. Adult-onset CH is very rare. Objective. The aim of this study is to review literature to discuss the clinical presentation, diagnosis, and treatment of CH in adults through a case report of unilocular CH in the axillary region in an adult male from India. Methods. A first case report of unilocular CH in axillary region in an adult male from India is being investigated. Results. Here we report a case of unilocular CH in the axillary region in a 49-year-old male with a 14x16x8 cm cystic swelling in left axilla with a history of aspiration failure. Contrast-enhanced MRI (CEMRI) showed well-defined thin walled, unilocular cystic lesion which appeared hyperintense on T2 & STIR and hypointense on T1W1 and showed thin peripheral rim of enhancement on post contrast images. The patient underwent surgical excision and the diagnosis of a pathological CH was established. His postoperative recovery was uneventful and had no evidence of recurrence. Conclusion. Due to rarity of adult-onset unilocular CH in axilla, its evaluation for prompt diagnosis and definitive treatment to prevent recurrence and complications is urgent. Furthermore, this is the first reported case from India which has been successfully managed at a peripheral hospital in Northeast-India and our report of this case contributes to the evidences supporting the role of CH in a differential diagnosis for masses in the adult axilla, especially in acute phase with no predisposing factors.

DISTRIBUTION AND QUANTITATIVE CHANGES OF MAST CELLS IN GUINEA PIGS LUNG IN OVALBUMIN-INDUCED ALLERGIC INFLAMMATION

Background. One of the most important cells in local immunity in lung are mast cells. They are involved in both innate and adaptive immune responses to inhaled allergens. The question of distribution of these both cell types in guinea pig lung in case of experimental allergic inflammation in most aspects remains open. Objective. The aim of this research is to study the distribution and quantitative changes of mast cells in lung of guinea pigs in ovalbumin-induced allergic inflammation. Methods. the lungs of 48 male guinea pigs have been studied using histological, morphometric and statistical methods in cases of experimental ovalbumin-induced allergic inflammation. The total number of mucosa related must cells and perivascular mast cells in guinea pig lungs were counted. Results. It has been established that mucosa related mast cells are normally more abundant in guinea pigs lung than perivascular ones. Maximum increase in a number of mucosa related mast cells was revealed in the early period of allergic inflammation, as evidenced by maximum increase coefficient of 1.4 in the 1st experimental group, compare to the control (P*/**<0.05). However, maximum increase in number of perivascular mast cells in 5 times was found during the late period of allergic inflammation in the 4th experimental group (P*/**<0.05). Conclusion. Experimental sensitization and challenge with ovalbumin leads to statistically significant increase in average number of both types of mast cells but predominantly the latter ones. It has been proved that cells dynamics is multidirectional.

INFLUENCE OF THICK EXTRACT FROM MAITAKE MUSHROOMS ON SIGNS OF INFLAMMATORY PROCESS IN EXPERIMENTAL TOXIC HEPATITIS

Background. The priority of the contemporary pharmaceutical industry is to create effective, safe and inexpensive drugs to ensure the highest quality of care and optimal use of available raw materials. Objective. The aim of our study was to investigate anti-inflammatory properties of the Maitake mushrooms thick extract in the experiment on rats with paracetamol(acetaminophen)-induced hepatitis. Methods. 60 white male rats, weighing 180-210 g, randomized into 10 groups of 6 animals in each, were used for the experiment. Paracetamol hepatitis was simulated by acetaminophen intragastric administering in a dose of 1250 mg/kg 1 time per day (for 2 days) as a suspension in 2% starch gel solution. Maitake mushrooms thick extract, which was administered intragastrically 2 hours before the administration of acetaminophen and daily after the lesion in a dose of 150 mg/kg of the animal’s body weight, was used for the toxic lesion correction. “Silibor” was selected as the comparison drug, which was administered according to the same scheme as the investigated extract in a dose of 20 mg/kg of the animal’s body weight. Euthanasia was conducted on the 3rd, 7th and 10th day of the experiment with sodium barbamyl. Liver homogenate and animal serum were used for the studies. The development of inflammatory processes was studied by the content of pro-inflammatory and anti-inflammatory cytokines, as well as C-reactive protein in the serum of rats with toxic hepatitis and after the application of Maitake mushroom extract and the comparison drug. Results. It was found that the introduction of acetaminophen to animals for the acute hepatitis simulation is accompanied by changes in the cytokine profile, i.e. an increase in the level of IL-6 and a decrease in the level of IL-4 in the serum of rats. Inflammatory development is evidenced by the content of C-reactive protein increase in the blood of the affected animals. The application of Maitake mushroom extract facilitated bringing the studied indicators almost to the level of intact control. Conclusions. Reduction of inflammation signs in rats with the simulated paracetamol hepatitis under the influence of Maitake mushrooms thick extract confirms its anti-inflammatory properties. Objective. The aim of our study was to investigate anti-inflammatory properties of the Maitake mushrooms thick extract in the experiment on rats with paracetamol(acetaminophen)-induced hepatitis. Methods. 60 white male rats, weighing 180-210 g, randomized into 10 groups of 6 animals each, were used for the experiment. Paracetamol hepatitis was simulated by acetaminophen intragastric administering in a dose of 1250 mg/kg 1 time per day (for 2 days) as a suspension in 2% starch gel solution. Maitake mushrooms thick extract, which was administered intragastrically 2 hours before the administration of acetaminophen and daily after the lesion in a dose of 150 mg/kg of the animal’s body weight, was used for the toxic lesion correction. "Silibor" was selected as the comparison drug, which was administered according to the same scheme like the investigated extract in a dose of 20 mg/kg of the animal’s body weight. Euthanasia was conducted on the 3rd, 7th and 10th day of the experiment with sodium barbamyl using. Liver homogenate and animal serum were used for the studies. The development of inflammatory processes was studied by the content of pro- and anti-inflammatory cytokines, as well as C-reactive protein in the serum of rats with toxic hepatitis and after the application of Maitake mushroom extract and the comparison drug. Results. It was found that the introduction of acetaminophen to animals for the acute hepatitis simulation is accompanied by changes in the cytokine profile, namely, an increase in the level of IL-6 and a decrease in the level of IL-4 in the serum of rats. The inflammatory process development is evidenced by the content of C-reactive protein increasing in the blood of affected animals. The application of Maitake mushroom extract helped to bring the studied indicators closer to the level of intact control. Conclusions. The application of the Maitake mushrooms thick extract as a corrective factor at the simulated paracetamol hepatitis confirms its anti-inflammatory properties. KEYWORDS: Maitake mushrooms, paracetamol, hepatitis, inflammatory processes, thick extract, anti-inflammatory properties.

CLINICAL OUTCOMES AND ADVERSE DRUG REACTIONS IN COVID-19 PATIENTS TREATED WITH HYDROXYCHLOROQUINE AND AZITHROMYCIN ALONE OR COMBINED

Background. Use of Hydroxychloroquine with or without Azithromycin is repurposed in SARS-CoV-2 in the absence of definitive treatment. Objective. To evaluate the association between the use of Hydroxychloroquine and Azithromycin when given alone or in combination on clinical outcomes and adverse drug reactions among lab confirmed SARS CoV-2 positive patients admitted in a COVID tertiary care hospital of a University Medical college. Methods. a retrospective observational comparative study was conducted. COVID-19 positive patients admitted in study hospital for management of COVID-19 were enrolled into the study. The patients were categorized into 4 treatment groups based on having received the following treatment during hospitalization: (A) Hydroxychloroquine with Azithromycin, (B) Hydroxychloroquine without Azithromycin (Hydroxychloroquine alone), (C) Azithromycin alone, and (D) Neither drug, defined as no receipt of either Hydroxychloroquine or Azithromycin in the record; other medications may have been dispensed. Results. 800 patients were enrolled. Mean±Standard deviation of duration of hospital stay (in days) for study Group A was 11.37±7.11, for Group B was 8.37±4.77, for Group C was 18.22 ± 5.69 and for Group D was 6.12±2.97. Mortality in Group A was 29.74%, Group B – 33.16%, Group C – 0% and in Group D – 1.32%. Conclusion. Among hospitalized patients with COVID-19 treatment, Group C was associated with good clinical outcome. However, the interpretation of these findings may be limited by the observational design.

RADIATION EXPOSURE IN ACCESSORY PATHWAY ABLATION PROCEDURES IN CARDIAC ELECTROPHYSIOLOGY: A RETROSPECTIVE ANALYSIS

Background. Radiofrequency catheter ablation (CA) has been the treatment of choice in patients with accessory pathway (AP)-mediated tachycardias. Most of these procedures are done under fluoroscopic guidance, leading to significant radiation exposure to the patient and the laboratory personnel. In this analysis, we have looked at the amount of radiation exposure in AP CA procedures performed without the support of a three-dimensional electroanatomic mapping system. We have analyzed changes in exposure indices over the study period and the impact of change in fluoroscopy frame rate (FFR). Objectives. The objectives of this study are to quantify radiation exposure in accessory pathway ablation procedures; to analyze the radiation exposure trend over time; and to evaluate the effect of fluoroscopy frame rate reduction on the radiation exposure indices in these procedures. Methods. All the AP ablation procedures performed at our institute from January 2016 to December 2019 were retrospectively analyzed. The collected data were age, sex, location of APs based on successful site of ablation on fluoroscopy, procedure time, fluoroscopy time, and dose-area product (DAP). Effective dose (ED) was estimated from DAP. The data of procedures performed before January 2018 (“pre” group) were compared with those of the procedures performed after that date (“post” group). Pre-group procedures were performed at an FFR of 7.5 frames per second (fps), and post-group procedures – at an FFR of 3.75 fps. Results. The total number of procedures included in the analysis was 635. The mean age of the patients was 39±14 years, and 401 of them (63%) were males. The most common location of the APs was left lateral (38%). Procedure time and radiation indices showed a significant decrease over the study period (p < 0.001). Post group procedures had significantly shorter procedure time and lower radiation exposure than pre group procedures. Conclusions. A decrease in the FFR was associated with a significant reduction in radiation exposure in AP ablation procedures

A CROSS SECTIONAL STUDY OF LIPID PROFILE IN NON-DIABETICS WITH STROKE IN URBAN CHITRADURGA

Background. The amount of evidence regarding the relation between serum lipids, lipoproteins and cerebrovascular accident is not adequate. The atherogenecity of diabetics and non-diabetics are different. Therefore, non-diabetic patients were included in the study. Objective. To study lipid abnormalities in non-diabetic stroke patients in our setup. Methods. The study was carried out at the Department of General Medicine, BMCH, Chitradurga, during the period from June 2020 to December 2020. The lipid profile and the fasting blood sugar rates of 50 stroke patients without diabetes were studied. Their serum samples were assessed for fasting blood glucose (FBG), total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL) and high-density lipoprotein cholesterol (HDL) by using standard biochemical methods. Results. The age distribution of the subjects was from 19 to 72 years with a mean age of patients 54.8±15.75 years. Among patients 31 (62%) were males and 19 (38%) were females. Among the study subjects 58% were hypertensive, 76% were smokers, 32% were alcoholics and 34% had family history of cerebrovascular accident. Among ischemic stroke group, the most common deranged value in the ischemic group was decreased HDL deranged in 54.1% of patients; the second most common deranged value – increased VLDL deranged in 40.5%. Among the hemorrhagic group the most common deranged value was also decreased HDL, which was deranged in 46.1% of patients and the second most common deranged value – increased total cholesterol, which was deranged in 53.8% patients. Conclusion. Lipid profile should be considered while predicting the risk of stroke.