Vascular abnormalities visualized by multislice computed tomography of the abdomen: accidental findings or immediate causes of pain syndrome? (topic review)

Abnormalities of the abdominal aorta branches may cause chronic mesenteric ischemia, progressive pathological changes of the internal organs in this setting, and chronic pain syndrome. The causes of chronic mesenteric ischemia may be divided into atherosclerotic and non-atherosclerotic. Atherosclerosis of the unpaired branches of the abdominal aorta involves stenosis or occlusion. Other causes include fibromuscular dysplasia, vasculitis (Takayasu, segmental mediolytic arteriopathy), and median arcuate ligament syndrome. These syndromes, the pathogenesis of some of which remains controversial, lead to nonspecific complaints such as abdominal pain, weight loss, and others. Digital subtraction angiography or duplex ultrasound may provide hemodynamic information in cases of vascular disease in this area. However, multislice spiral computed tomography is in many cases the first choice because it allows for a comprehensive assessment of the state of blood vessels and associated morphological changes of internal organs. Structural changes accompanying these syndromes can also occur in patients who are undergoing a medical examination for other reasons. However, these syndromes should not be diagnosed solely on the basis of imaging; instead, the findings should be compared with the clinical presentation, which implies collaboration of radiologists and clinicians.

West Nile fever in Volgograd Oblast: features of the epidemic process’s manifestations at the present stage

Objective: To study the regional features of the West Nile fever (WNF) epidemic process manifestations using the example of the territory with stable and long-term pathogen circulation (Volgograd Oblast).Materials and Methods: We used the data of the Reference Center for monitoring the WNF pathogen based on the Volgograd Research Anti-Plague Institute of Rospotrebnadzor over 1999–2021. The main method is a comprehensive epidemiological method.Results: The long-term changes in the WNF incidence in Volgograd Oblast is characterized by a cyclical nature with an interval of 1–8 years and a tendency to decrease. The maximum risk of infection occurs in August (58.8%), but there is an increase in the number of cases in September. The average duration of the epidemic season is 8.4 weeks. Case fatality rate is at the level of 4.3%; the prevalence of the number of deaths in the group of 70 years and older (75%), as well as among men (63.6%) has been established. The greatest contribution to the incidence rate is made by the age group of 60 years and older (37.7%). Features of the clinical presentation include the dominance of forms without damage to the central nervous system (91.1%) and moderate clinical course (72.3%). The prevalence of the urban population among the infected was noted (85.5%).Conclusion: A comparative analysis of the clinical and epidemiological WNF manifestations in Volgograd Oblast, territories with a stable circulation of the pathogen (Astrakhan and Rostov Oblasts) and, in overall, the Russian Federation, established differences in the duration of cyclical fluctuations in incidence, seasonality (Rostov Oblast), age structure of incidence (Astrakhan Oblast), distribution of cases by the severity of the clinical course, the site of the alleged infection and social status.

Comparison of the main parameters of 24-hour blood pressure monitoring in patients with hypertension and atherosclerotic lesions of the arteries of the lower extremities

Objective: To study the features of the parameters of 24-hour blood pressure monitoring (24h-BPM) in patients with hypertension and atherosclerosis of the arteries of the lower extremities (AALE).Materials and Methods: A total of 120 patients with hypertension were divided into 3 groups: Group I consisted of 46 patients with hypertension and clinically manifested AALE; Group II included 39 patients with hypertension and asymptomatic AALE; Group III included 35 patients with hypertension without AALE. Laboratory and instrumental studies were performed, including 24h-BPM and ultrasound triplex scanning (USTS) of the arteries of the lower extremities. Statistical analysis was performed using Microsoft Office Excel 16 (2015, Microsoft, USA), Statistica 10.0 (StatSoft, USA), IBM SPSS Statistica 26.0 (IBM, USA).Results: Higher values of systolic blood pressure (SBP) were revealed in Group I patients compared with Group III (P <0.05). Increased variability of daily average and daytime SBP were found in Group I patients (16 [13; 17] and 15.5 [12; 18] mm Hg), which significantly differed from those in Group III (P = 0.005). The patients of Group II showed higher values of diastolic blood pressure (DBP) compared with Group I (P <0.017). Higher values of pulse blood pressure (PBP) were found in Group I compared with Groups II and III (P = 0.001). In Group I, the normal type of 24-hour index of SBP was 2 times less common (P <0.017).Conclusions: The clinical manifestation of AALE is associated with higher SBP and PBP values, SBP variability and lower DBP values, which indicates a higher risk of cardiovascular complications.

Results of epizootic monitoring of natural foci of particularly dangerous infections common to humans and animals in Rostov Oblast

Objective: To analyze the results of epizootic monitoring of natural foci of particularly dangerous infections common to humans and animals in Rostov Oblast to establish their activity.Materials and Methods: The data of epizootic monitoring conducted by zoologists; the results of laboratory research of field material obtained in natural foci of infectious diseases. Descriptive, zoological, genetic, serological methods, and retrospective epidemiological analysis were used.Results: The results of the conducted epizootic monitoring showed the presence in Rostov Oblast of natural foci of particularly dangerous infectious diseases common to humans and animals. While the natural focus of the plague is in a depressed state and does not show activity, in the foci of tularemia, West Nile fever (WNF), Crimean hemorrhagic fever (CHF), ixodic tick-borne borreliosis (ITB), hemorrhagic fever with renal syndrome (HFRS), Q fever, Batai fever, California serogroups, Syndbis revealed the antigens of these pathogens in biological material obtained from small mammals and blood-sucking insects, which indicates the epizootic activity of these foci. In the natural foci of WNF, CHF, ITB, HFRS, cases of these disease among the population were recorded, which confirms the epidemic activity of these foci.Conclusion: The obtained results of epizootic monitoring over the period from 2008 to 2020 emphasize the relevance and necessity of continuing these studies in natural foci in Rostov Oblast.

Manifestation of electrocardiographic signs of the Brugadа syndrome in the setting of therapy with class Ic antiarrhythmic drug Ethacizine

The article presents a clinical case of a patient presenting with electrocardiographic signs of the Brugada syndrome in the setting of therapy with class Ic antiarrhythmic drug Ethacizine. The special feature of this case is a complete disappearance of ECG signs of the Brugada syndrome and the normalization of ECG after withdrawal of the drug. For a functional diagnostiсian, it is important to pay timely attention to the Brugada pattern on the ECG and consider such changes not only in connection with subepicardial ischemia and possible myocardial damage.

Autoimmune polyglandular syndrome type I. Features of clinical manifestations, difficulties in diagnosis and methods of correction

Autoimmune polyglandular syndrome (APG) type I is an orphan disease with autosomal recessive inheritance caused by mutations in the autoimmune regulator gene (AIRE); the disease onset typically occurs in childhood. The disease is characterized by a wide variety of clinical manifestations with a certain stage in the manifestation of individual symptoms. The rare occurrence of this pathology determines its late diagnosis, which can lead to the decompensated life-threatening conditions and an unfavorable outcome. Widely informing pediatric specialists will contribute to the development of a diagnostic algorithm for timely verifying the disease from the moment its first clinical manifestations appear, and will improve the quality and life expectancy of the patients.

The fetus gender value in the structure of obstetric pathology in pregnant women with gestational diabetes mellitus

Objective: To study the obstetric pathology and delivery outcomes in pregnant women with gestational diabetes depending on the sex of the fetus.Materials and Methods: A retrospective analysis of 2014 histories of pregnancy and childbirth of women with gestational diabetes (GD) over the period of 2018-2021, was carried out. Two groups were formed based on the sex of the fetus: Group 1 (1012 pregnant women) with male fetuses and Group 2 (1002 pregnant women) with female fetuses. For statistical analysis, the proportions (%) were compared using the Pearson’s χ2 (chi-square) test.Results: It was proved that the male sex of the fetus is a risk factor for the GD and concomitant obstetric complications (placental insufficiency, risk of preterm birth, fetal macrosomia). The prevalence of hypotonic bleeding, defects of the placenta, and placenta increta, and related cases of manual control of the uterine cavity and uterus extirpation in mothers of boys with GD was established. Also, in patients of this group, birth injuries consisting in a rupture of the posterior labial commissure were significantly more often registered as a result of childbirth with a large fetus, while cases of cervical rupture prevailed in women with female fetuses.Conclusions: The revealed dependence of the nature of obstetric complications and the course of labor on the sex of the fetus in pregnant women with GD warrant developing a monitoring system that takes into account the gender of the fetus.

Preterm and term rupture of the amniotic sac in the third trimester: outcomes for mother and child

Objective: To evaluate the characteristics of women in labor and pregnancy outcomes at different gestational periods with preterm prelabor rupture of membranes (PPROM) and preterm rupture of membranes (PROM) in the third trimester of pregnancy.Materials and Methods: The study included pregnant women in the third trimester, at the gestation period of 28-41.6 weeks of pregnancy, divided into groups of PROM and PPROM: 173 (80.8%) and 41 (19.2%) pregnant women, respectively.Results: It was found that PPROM is associated with a significantly lower gestational age, higher levels of C-reactive protein, and higher body temperature upon admission to the maternity hospital (P <0.05). Breech presentation and history of cesarean section were significantly associated with PPROM (P < 0.05), rather than PROM. The PPROM group had a significantly longer latency period compared to the PROM group, in which the latency period increased with a lower gestational age (28–31.6 weeks). A significantly higher rate of admission to the neonatal intensive care unit (NICU) was observed in the PPROM group compared to the PROM group. Also, at the gestational age of 28-31.6 weeks, a significantly higher rate of admission to the NICU was revealed compared to the gestational age of 32-36. 6 weeks (P < 0.05).Conclusions: The purpose of this retrospective study was to evaluate the characteristics of women in labor and pregnancy outcomes at different gestational periods with PPROM and PROM in the third trimester of pregnancy.

Changes in body composition depending on the rs1801282 PPARG polymorphism in patients with different variants of treatment of early carbohydrate metabolism disorders

Objective: To study the effect of the rs1801282 PPARG polymorphism on changes in the body composition of patients with early carbohydrate metabolism disorders in groups with different variants of treatment.Materials and Methods: The study involved 64 patients (8 men and 56 women) with early carbohydrate metabolism disorders. At baseline, all patients underwent genotyping for the rs1801282 PPARG polymorphism and body composition determination with bioelectrical impedance analysis (BIA). Then, the patients were divided into two groups depending on the type of therapy. The patients from Group 1 (40 subjects, mean age 45.2±15.4 years) kept a generally accepted diet with the exclusion of simple carbohydrates and limitation of complex carbohydrates and fats. The patients from Group 2 (24 subjects, mean age 51.2±14.5 years) took metformin in addition to the diet therapy. The effects of different types of treatment on body composition changes were assessed with follow-up BIA 3 months after the start of treatment.Results: Carriers of the mutant G allele of rs1801282 PPARG in the metformin and diet therapy group showed a significant increase in the content of body cell mass (1.28±0.51% vs 0.36±0.37%; P = 0.021) compared with CC homozygotes in the absence of differences in body weight changes (P > 0.05).Conclusions: The presence of the mutant allele G of rs1801282 PPARG promotes the increase in body cell mass in case of adding metformin to the diet therapy in patients with early carbohydrate metabolism disorders.

Biomarkers of the type of recurrent uterine myoma-associated growth

Objective: To assess the diagnostic value of biomarkers: microbiological, molecular and biological, immunological biomarkers, characteristic of various types of recurrent myoma-associated growth.Materials and Methods: Seventy women of reproductive age with recurrent uterine myoma and its combination with adenomyosis after conservative treatment in the Clinic of Kuban State Medical University were examined. Methods: microbiological examination, sonography, Doppler sonography, histology, immunohistochemistry, morphometry.Results: The type of recurrent myoma-associated growth was proved to be dependent on molecular and biological characteristics of tumors, the presence of infection and blood perfusion. It was indicated that women with recurrence of myoma-associated growth of a “false” type were characterized by high rates of infections (the presence of reproductive losses, chronic inflammatory diseases of the pelvic organs) and significant bacterial contamination of the genital tract biotopes. Blood perfusion features were identified for true and “false” types of recurrent myoma-associated growth based on Doppler sonography data, which were consistent with features of tumor vessel morphometry. Analysis of uterine myoma histological types and their vascularization features showed correlation of forms with a high proliferative potential of a tumor on a molecular and cellular level to moderate and high expression of steroid hormone receptors in combination with Ki67, a significant diameter of the lumen of the vessels with the highest VI and VFI values.Conclusions: A comprehensive study of women with uterine hyperplasia determines the possibility of prediction of pathogenetic variants of recurrent myoma-associated tissue growth and adequate choice of treatment options and rehabilitation course.