Fungal urinary tract infection in outpatient practice: approaches to diagnosis and treatment

Introduction. In recent years, the role of fungal infection in inpatient and outpatient patients has been increasing. At the same time, there are currently no recommendations on the duration of treatment of outpatient patients with fungal urinary tract infection (UTI). Aim of the study. Optimization of methods of diagnosis and treatment of outpatient patients with fungal UTI.Materials and methods. To detect fungi in urine, the E. Koneman et al. (1997) method was improved. 56 patients with fungal UTI were examined. The efficacy of fluconazole in the treatment of fungal UTI was studied in 53 patients.Results. Candida albicans was detected in 37% of cases of fungal UTI in outpatient patients. Risk factors for fungal UTI in outpatient patients include: antibacterial therapy, infravesical obstruction, type 2 diabetes mellitus and the presence of urinary drainage. The microbiological efficacy of fluconazole therapy for 7, 10 and 14 days was 83.0%, 94.3% and 96.2%, respectively. The growth of fungi in the urine a month after treatment was absent in 86.7% of patients. In outpatient patients with fungal UTI without type 2 diabetes mellitus, the efficacy of fluconazole at a dose of 150 mg per day for 7 days was 94.9%. In patients with type 2 diabetes mellitus after 7 days of therapy, the efficacy was 50.0%.Conclusions. The most common causative agent of fungal UTI in outpatient patients is Candida albicans. To detect fungi in urine, samples should be seeded on selective media, while increasing the seeding volume to 0.1 ml and extending the incubation time to 96 hours. Fluconazole is a highly effective treatment for fungal UTI at a dose of 150 mg per day for 7 days, however, in patients with diabetes mellitus, therapy should last at least 10 days.

Assessment of the vitamin d levels effect on the course of the first trimester of pregnancy

Introduction. The course of physiological pregnancy is provided by many complementary factors. Thus, a deficiency in one of the links of the metabolic network contributes to the development of an imbalance in the work of the whole organism, which ensures the growth and development of the embryo from the first days of gestation. It has been proven that vitamin D can act as an immune regulator during implantation, providing a protective effect in whole period of pregnancy.Aim. The aim of this study is assessed the features of the course of pregnancy in patients with different levels of vitamin D in the blood in the first trimester.Materials and methods. A prospective multicenter randomized study was conducted in the North-West region of the Russian Federation among 88 pregnant women in the first trimester of gestation (up to 13 weeks). All patients were divided into 3 groups depending on the initial level of vitamin D (group 1–14 women with a 25(OH)D < 10 ng/ml, group 2–62 pregnant women from 10 to 30ng/ml, group 3–12 pregnant women with a vitamin D content > 30 ng/ml).Results. In group 1.86% of patients with severe vitamin D deficiency were diagnosed with threatened miscarriage, which is significantly higher than in group 3 (85.7% and 33.3%, χ2 = 7.490, p = 0.007). At the same time, retrochorial hematoma in group 1 occurred 3.5 times more often than in group 3 (57.1% and 16.67%, respectively, χ2 = 4.473, p = 0.035). Subsequently, every 4th woman from the group with vitamin D deficiency gave birth earlier than expected, which was not observed among patients from group 3 (25%, 0%, χ2 = 1.231, p = 0.268).Conclusion. Prescribing cholecalciferol vitamin replacement therapy as part of complex preserving therapy for threatening miscarriage, followed by monitoring its blood level and deviating from normal parameters, contributing to a favorable course of pregnancy and improving perinatal outcomes.

Triggers and markers of skin aging in women with menopausal syndrome

Introduction. External manifestations of aging, and especially skin aging are the most important for modern women.Aim. The aim of our study was to identify a set of adverse factors that effect on the skin of women in menopausal transition (MP) and in postmenopause (PM), and to identify markers of skin aging in this category of women.Materials and methods. The study included 36 women in MP and PM suffering from MS. At the first stage, anamnesis was collected, anthropometric data and severity of MS were evaluated, and the hormonal profile of patients was determined. At the second stage, computer mapping of the skin was performed using the digital video camera Aramo SG with the skin XPpro program. Statistic analysis was performed using the SPSS v13.0 program. Spearman’s analysis was used to determine the relationship between anthropometric, clinical and anamnestic data and the measurements of skin condition of women in MP and PM. Results. According to the obtained data, the main triggers of skin aging of women in MP and PM are: the presence of metabolic disorders (obesity, metabolic syndrome), decrease of estradiol and progesterone levels in blood serum as well as increase of prolactin level and rhythm disturbance of melatonin secretion. Markers of skin aging in women with menopausal syndrome are decreased moisture, increased oiliness in T-zone, increased of skin pigmentation and enlarged pore size.Conclusions. The obtained data are useful for management involuting skin changes of women in PM and MP suffering from MS. The data justifies the relevancy to normalization not only the estradiol level, but other sex steroids, melatonin, as well as correction of metabolic endocrine processes, and treatment of MS.

Caudal epidural blockades for chronic pain in the lower back in working age

Introduction. Chronic back pain syndrome, which significantly restricts a person’s daily activity, can cause the formation of depressive states and is a significantly more difficult task for treatment compared to acute pain.Aim. To evaluate the efficacy and safety of caudal epidural catheterization (CEC) and local therapy with anesthetics and glucocorticoids for chronic nonspecific discogenic and chronic radicular low back pain (LBP) in young and middle-aged patients.Materials and methods. 42 patients aged from 29 to 59 years, who in the neurosurgical department of the Vologda City Hospital No. 1 in 2017–2019 underwent an operation to install a caudal epidural catheter and prolonged injection therapy of local anesthetics and glucocorticosteroids for chronic nonspecific discogenic and chronic radicular LBP.Results. There were no purulent-septic complications, hematomas of the spinal canal. In the group of patients with radicular syndrome the average values of LBP according to VAS were as follows: before CEC – 78.5 mm; 5 days after CEC – 24.1 mm; 6 months after CEC – 19.6 mm; after 12 months – 17.9 mm. In the group of patients with nonspecific discogenic LBP the average pain estimates for VAS were as follows: before CEC – 78.1 mm; 5 days after CEC – 21.7 mm; 6 months after CEC – 20.9 mm; after 12 months – 23.4 mm.Сonclusion. Our experience indicates a high long-term efficacy and safety of treatment with caudal epidural catheterization and local prolonged therapy with anesthetics and glucocorticoids for chronic radicular and chronic nonspecific discogenic pain in the lower back in young and middle-aged patients selected on the basis of a special system of criteria.

Assessment of the temporomandibular joint condition using two-dimensional ultrasound scanning and doppler ultrasonography methods in patients with chronic inflammatory periodontal diseases

Introduction. Currently, dentists are increasingly detecting changes in the temporomandibular joint in patients with chronic inflammatory periodontal disease.Aim of the study. To carry out a comprehensive dynamic assessment of the temporomandibular joint (TMJ) condition and the registration of regional blood flow using two-dimensional ultrasound scanning to improve the efficiency of diagnostics of inflammatory periodontal diseases.Materials and methods. The study included 2 groups of patients: group 1 (control) consisted of 20 volunteers aged 20–25; Group 2 consisted of 52 people aged 25–45 years with moderate chronic periodontitis. For TMJ ultrasound and Doppler ultrasound, a portable ultrasound scanner LogicScan 128 with an HL-10 linear ultrasound transducer with an operating frequency of 5 to 12 MHz was used.Results and discussion. During ultrasound examination of the temporomandibular joint and measuring the size of the joint space in patients with moderate chronic periodontitis in a state of relative physiological rest, the following values were obtained: in the anterior region – 2.3 ± 0.5 mm; in the upper section – 1.6 ± 0.6 mm; in the posterior section – 1.8 ± 0.3 mm. We also measured the area of the temporomandibular joint disc in various positions. According to ultrasound data, an increase in the size of the joint space from 12.2 to 16.1% and an increase in the area of the articular disc by 17.1 to 36.7% were found in patients with chronic periodontitis. When assessing the trajectory of the articular track, motion delay and joint wedging are determined. In addition, in the color Doppler mapping (CDM) mode, the speed and index indicators of Doppler ultrasonography of the external carotid and temporal arteries were calculated.Conclusions. Modern diagnostic methods of ultrasound and Doppler mapping, assessing the hemodynamics and functional state of the TMJ, allow early diagnosis of changes in order to prevent the development of TMJ disorders in patients with chronic inflammatory periodontal diseases.

Pregnancy and childbirth in women from among the indigenous minorities of the north in the context of urbanization

Data on the health status of the population of the indigenous small-numbered peoples of the North of Khanty and Mansi, who migrated to the city and changed the traditional nomadic way of life, are few and not systematized.The aim of the study was to study the course of pregnancy and childbirth among the indigenous peoples of the north who migrated and live in the city of Khanty-Mansiysk, Khanty-Mansiysk Autonomous Okrug-Yugra. An increase in the frequency of gynecological diseases was revealed: menstrual irregularities (in 38.5%), inflammatory diseases of the cervix (in 42.3%) and inflammatory diseases of the uterus (in 19.2%). Half of the observed women had gastritis (50%), cholecystitis (51.9%), every fourth cystitis (23.1%), anemia was diagnosed in every third in 30.8%. Pregnancy in women of the study cohort was often complicated by early toxicosis, anemia, gestational diabetes mellitus, threatening premature birth. Childbirth in pregnant women from among the indigenous small peoples of the north living in the city was complicated by anomalies in labor, indications for emergency operative delivery. This requires further study of the health status of the indigenous peoples of the north and the development of a health improvement program.Materials and methods. The course of pregnancy, childbirth and the postpartum period was retrospectively analyzed in 168 women selected by the continuous sampling method. Women from the Khanty and Mansi KMNS living in the village of Berezovo, in the camps and in Khanty-Mansiysk were examined. Statistical processing was performed in the software package SPSS, Statistica 8.0, as well as using the Microsoft Excel analysis package.Results. The results of the study showed that the least number of deviations in the state of health were among women from the number of KMNS living in the village and in the camps and leading a traditional nomadic lifestyle. The course of pregnancy rarely had complications and 100% of women ended in spontaneous labor on time.Conclusion. The urbanization of women from among the indigenous small-numbered peoples of the north has an adverse effect on the state of somatic and reproductive health, characterized by a high frequency of gynecological diseases, pregnancy complications, labor anomalies and operative delivery.

Prediction of the transsphenoidal endoscopic adenomectomy results in patients with cushing’s disease

Introduction. Transsphenoidal adenomectomy (TSA) is the method of choice in the treatment of Cushing’s disease (CD), but remission of hypercorticism cannot be achieved in all patients. The search for predictors of CD remission after TSA remains to be an important challenge in the endocrinology today.Aim. To study the preoperative and postoperative data of patients with CD to identify the predictors of hypercorticism remission after TSA.Materials and methods. 101 patients with confirmed CD after TSA were included. One year after operation all patients were examined for the presence of hypercorticism remission and divided into two groups: with CD remission and its absence. In both groups’ preoperative pituitary magnetic resonance imaging (MRI) data, the results of preoperative high dose dexamethasone suppression test (HDDST) and the results of serum cortisol collected in the morning 2–3 days after surgery were compared.Results. One year after TSA, CD remission was confirmed in 63 patients (62.4%), whereas in 38 patients (37.6%) hypercortisolism persisted. Favorable predictors of CD remission were: the adenoma size > 3 mm without the invasive growth according to pituitary MRI (specificity 82.4%, sensitivity 82.8%), serum cortisol suppression ≥ 74% in preoperative HDDST (specificity 81.5%, sensitivity 86.3%), morning serum cortisol level in 2–3 days after surgery ≤ 388 nmol/l (specificity 79.3%, sensitivity 97.4%).Conclusions. Pituitary MRI data, the results of preoperative HDDST and morning serum cortisol in the 2–3 days after surgery can be used as predictors of CD remission.

Histomorphological view of the cornea investigated by laser confocal microscopy in keratoplasty

Introduction. Corneal transplantation is the most successful and commonly performed allotransplantation procedure as compared with other organs and tissues. Over 100,000 corneal transplantations are performed worldwide every year.Purpose. This study investigated whether in vivo confocal microscopy (IVCM) can aid in the diagnosis of a graft rejection reaction by detecting changes in cellular structures and density of immune cells after penetrating keratoplasty.Materials and methods. The study included thirty-four eyes of 34 patients who underwent penetrating keratoplasty (7 eyes with corneal graft rejection, 27 without rejection). The average age of patients is 51.1 ± 13.6 years (from 23 to 76 years). The follow-up period ranged from 12 to 36 months (24.5 ± 4.84 months). Follow-up was performed at 1, 3, 6, 12 months and annually after PKP. To study the morphology of the cornea all patients underwent IVCM to assess the basal epithelium, subbasal layer, stroma and endothelium. Immune cells were identified and evaluated for the shape, length of the processes and their density.Results. Patients with corneal graft rejection demonstrated significant accumulation of corneal dendritic-like immune cells compared to patients with non-rejected grafts. In addition, the cells acquired a more mature morphology (grade 2–3). The density of dendritic cells (DC) was 809.17 ± 342.19 (p < 0.001). A positive correlation was found between DC density and graft rejection (p < 0.001). As well the patients showed signs of endothelial failure with low endothelial cell density and pleomorphism, increased light scattering and hyperreflectivity of the stroma.Conclusions. In a complex of diagnostic measures, confocal microscopy may provide a valuable clinical adjunctive tool in diagnosis and management of early corneal graft rejection.

Role of zoledronic acid in treatment of osteoporosis and prevention of fractures

Introduction. One of the causes of primary disability and high mortality, among patients with osteoporosis, are fractures that occur with minimal trauma, as a rule, it is a fall from the height of one’s own height. The final link in the chain of preventive measures to reduce the frequency of osteoporosis and fractures on its background is the introduction of pharmacological correction of bone deficiency into the practical activity of an orthopedic traumatologist. Currently, there are several drugs that can change the disturbed metabolism. For example, the use of zoledronic acid significantly reduces the risk of fractures.Aim: to study the effect of zoledronic acid on bone mineral density in patients with osteoporosis complicated by a fracture of proximal end of the femur.Materials and methods. In a prospective cohort study, 14 patients received zoledronic acid for 2 years.Results. When comparing BMD L2-L4, it was revealed that a year after the start of treatment, its increase relative to the baseline value was 4.6%, but was statistically insignificant (0.86 ± 0.078 g/cm2 versus 0.90 ± 0.08 g/cm2, p > 0.05). After 2 years of treatment, the BMD of this segment increased, relative to the baseline values, by 12% and the differences became statistically significant (0.86 ± 0.078 g/cm2 compared to 0.97 ± 0.076 g/cm2, p < 0.05). The increase in BMD for the second year of treatment by 6% was statistically significantly different from the increase for the first year of treatment (0.90 ± 0.08 g/cm2 compared to 0.97 ± 0.076 g/cm2, p < 0.05).A comparative analysis of the basic units of the IPC hip after 1 and 2 years of treatment did not reveal significant differences: 0.7075 ± 0.046 g/cm2 compared to 0.7079 ± 0.034 g/cm2 and 0.70751 ± 0.046 g/cm2 compared to 0.6630 ± 0.97 g/cm2, p > 0.05. In any case, for 2 years not marked new vertebral body fractures. Only one patient had a fracture of the radius in the distal third. The quality of life, after 2 years, significantly improved on the scale of “habitual daily activities” (p = 0.007), decreased indicators on the scale of “anxiety” and “depression” (p > 0.05).Discussion. The study confirmed that even in the presence of pronounced bone loss, pharmacological correction of impaired remodeling reduces the risk of new fractures and improves the quality of life.Conclusion. Pharmacotherapy with zoledronic acid, in our study, confirmed its effectiveness in the treatment of osteoporosis.

Evaluation of biomarkers in the studies of keloid tissue after laser therapy

In this paper, we discuss what biomarkers to choose if there is a need to describe the results of laser therapy targeting keloid skin. We elevate the known cytomarkers (Krt14, Lgals7, Krt5, Dcn, Lum, Igfbp5, Cd31, Vwf, Stambpl1, Uqcrb, Cd3 and Acta2), biomarkers of the inflammatory response (Cd45/Ptprc, Adgre1, Ly6g, Il1b, Il4, Il13, Il22, Cxcl2 и Ccl17), as well as the proteins of extracellular matrix (type I and III collagens; precursors of COL5A1 and COLA1A; FTL, COL3A1, PGLS, CNN2, ANXA2, TPSAB1, COL12A1, precursors of APCS and ALB), and their encoding genes (FGF7, BAX, CCND1, MMP3, MMP9, CXCL1, -2, -5, -6 and -12; IL8, S100A7 and IL1A), those expression and co-location may potentially change the appearance and internal structure of damaged skin. We also describe how to choose biomarkers using the results genomic studies and their limitations. Moreover, we provide examples of how different groups of gene and protein biomarkers are used in experimental biology and clinical practice. According to the previously published data, well-known biomarkers verified on animal models, depend on their biological effects, let to characterize structural changes and changes in the composition of cells represented at the site of damage before and after the treatment. In addition, the published experimental and clinical data provide an opportunity to analyze the efficiency of new experimental approaches and compare them to each other.