On the issue of critical arterial stenosis

Cardiovascular disease (CVD) is the leading cause of death worldwide. The main contribution to the structure of mortality from CVD is made by atherosclerosis. Indications for surgical treatment of patients with diseases caused by atherosclerotic lesions of the arteries are set taking into account the degree of their stenosis. Angiography has been considered the gold standard for screening patients with CVD for many years. Numerous studies carried out over the past several decades have revealed the weak side of this method in assessing the significance of borderline stenosis. Therefore, to analyze such changes, functional tests were introduced to clarify the indications for surgical intervention. Currently, criteria for the significance of stenosis of the iliac, renal and coronary arteries have been determined. The significance of stenosis of the arteries supplying the brain and intestines is still a matter of debate and requires further study.

Experience of using Rituximab in neurological practice (literature review and own observation)

Currently, due to the lack of specific etiotropic therapy, rituximab is widely used for the treatment of most autoimmune diseases of the central and peripheral nervous system. Rituximab is a chimeric monoclonal antibody with specificity for CD20, the antigen found on the surface of normal and malignant B-lymphocytes. It is used mainly in hematological practice. It is used off-label for the treatment of neurological diseases. The world literature describes the use of rituximab for the treatment of such pathologies as autoimmune encephalitis, neuromyelitis optica spectrum disorder, multiple sclerosis, primary angiitis of the central nervous system, immune-mediated inflammatory polyneuropathy, myasthenia gravis, refractory to basic immunosuppressive therapy. This article provides an overview of the world literature on the use of rituximab in neurological practice, describes our own experience of its use on the basis of the Department of Neurology № 1 of Pavlov University (Saint Petersburg, Russia).

Giant expanded perivascular spaces: literature review and description of a clinical case

The differentiation of giant perivascular spaces is the complicated task due to its rare occurrence and multiple differential series. Cystic neoplasms, parasitic cysts, and lacunar strokes are need to be excluded. Knowing and ability to recognize pathognomonic radiological features can help to prevent excessive diagnostics and make the correct diagnose quickly. The article presents a clinical case of a rare and difficulty diagnosing variant of giant perivascular spaces.

The influence of polymorphic variants rs2305619 и rs3816527 of the PTX3 gene on clinical profile and outcomes in patients with hypertrophic cardiomyopathy: results of a 11-years follow-up

The objective of this study was to determine the association of polymorphic variants rs2305619 and rs3816527 of the PTX3 gene with clinical profile and outcomes in hypertrophic cardiomyopathy (HCM) patients.Methods and materials. The study population consisted of 153 patients ≥18 years old with a confirmed diagnosis of HCM. The control group included 200 healthy donors. Duration of follow-up was 11 years (2008–2019 yrs.). The study design included a new model for determining variants of the clinical profile and outcomes of HCM. Polymorphic variants rs2305619 and rs3816527 of the PTX3 gene were genotyped by polymerase chain reaction.Results. The mortality rate in patients ≥18 years old with 1, 2 and 3 adverse pathways of HCM progression was significantly higher, compared with those without adverse pathways (р<0.001). A combination of chronic heart failure (CHF) with midrange and reduced LVEF (<49 %) with 1, 2 and 3 adverse pathways in HCM patients occurred more frequently, compared with those who had CHF with preserved LVEF (≥50 %) (odds ratio (OR) = 0.168, 95 % confidence interval (CI) =0.068–0.412, р<0.001). The genetic testing showed no significant differences in genotype and allele frequencies of polymorphic variants rs2305619 and rs3816527 of the PTX3 gene in patients with HCM and control groups. It was found a tendency for increase in GG genotype frequency (p<0.068) and significant increase in G allele frequency of rs2305619 of the PTX3 gene in HCM patients ≥18 years old and CHF with mid-range and reduced LVEF (<49 %) (A:G, OR=0.521, 95 % CI=0.301–0.902, p<0.019). HCM patients (age – 63 [58; 75] years) and type 2 diabetes mellitus demonstrated high prevalence in AG and GG genotypes (p<0.008) and G allele frequencies of rs2305619 of the PTX3 gene (A:G, OR =1.952, 95 % CI=1.076–3.542, p<0.026).Conclusions. HCM progression along 1 and more adverse pathways in patients ≥18 years old has been characterized with adverse outcome. G allele of rs2305619 of the PTX3 gene is associated with CHF with mid-range and reduced LVEF (<49 %) in HCM patients ≥18 years old. The associations of G allele and AG and GG genotypes of rs2305619 of the PTX3 gene with diabetes type 2 are observed in elderly HCM patients.

Parameters of the corpus callosum and thalamuses in mesocephalic women of the second period of mature age according to MRI data

Introduction. One of the most important parts of the brain from a morphofunctional point of view is the corpus callosum and the thalamus. Today, the problem of the lack of clear morphometric characteristics of these parts of the brain in mesocephalic women of the second period of mature age is obvious.The objective of the study was to establish the morphometric characteristics of the corpus callosum and thalamuses in mesocephalic women of the second period of mature age using the method of magnetic resonance imaging.Methods and materials. The results of morphometric examination of the corpus callosum and thalamuses of 37 women aged 36 to 54 years using magnetic resonance imaging were analyzed. We determined the length and height of the corpus callosum, knee thickness, cushion thickness, its depth (anterior, upper and posterior). The transverse, longitudinal, and vertical dimensions of the thalamuses were determined.Results. The morphometric characteristics of the corpus callosum is characterized by the predominance of the knee thickness over the thickness of the cushion (p<0.01). The parameter of the posterior depth of the corpus callosum prevails over the parameters of the upper and anterior depths of its occurrence (p<0.01). When comparing the parameters of the upper depth and the anterior depth of the corpus callosum, there is a tendency for the upper depth indicator to prevail (p>0.05). The regularity of the morphometric characteristics of the thalamuses is the tendency to the predominance of all parameters in the left hemisphere (p>0.05).Conclusions. The results of the comparative analysis of the morphological characteristics of the corpus callosum in the elderly and senile age supplement the knowledge of age-related anatomy and will be useful in the clinical practice of doctors of radiation diagnostics and magnetic resonance imaging offices.

Psycholinguistics Analysis of Schizophrenia Spectrum Disorders Patients’ Writing and Oral Speech (on the Example of the Autobiographical Texts)

Introduction. There are speech disorders as one of the psychopathology diagnostics criteria in ICD and DSM. However, the linguistic component is not enough studied, so the study topic is actual. The use of text analysis allows to apply psycholinguistics approach to the objectification of thinking disorders. The objective of the study was aimed to detect psycholinguistics features of oral and written speech in patients with schizophrenia.Methods and materials. Participants were 29 schizophrenia patients, 20 patients with personality disorder and 25 healthy participants. Methods: expert assessment, anamnestic assessment, experimental-psychological (tests of thinking, collect memories), linguistic analysis, statistical analysis.Results. Oral speech of patients with schizophrenia is complex and volume, the writing speech is «factual», lexically varied and low communicative. In oral and writing speech of patients with schizophrenia, there are three text types correlated with thinking disorders. Texts of patients with schizophrenia are less volume, simpler in structure, describe more facts than thoughts and feelings, unlike patients with personality disorder and healthy participants.Conclusion. Texts of patients with schizophrenia, personality disorder and healthy participants are different in formal linguistics characteristics. Such characteristics of the speech of patients suffering from schizophrenia as a lot of impersonal sentences describing object attribute, complexly organized speech, emphasis on describing emotions and oneself using the pronoun «I» allow to suppose that the patient has thinking disorders: thinking distortion by formal and latent ways of object attributions, thinking purposefulness disorder, thinking «versatility».

Lower limbs lengthening over the intramedullary nail versus lengthening by Ilizarov technique

Introduction. Lengthening over the nail (LON) combines the advantages of external and internal fixations.The objective was to compare the effectiveness of the application, to assess the structure and frequency of complications in patients treated with lengthening by Ilizarov technique and lengthening over the nail.Methods and materials. We analyzed 55 LON cases and 64 cases lengthening by Ilizarov technique. The duration of the external fixation period, complications and quality of the patient life were compared.Results. The external fixation period in LON group was 4 times less than in the Ilizarov technique group. There were 25 complications (45.5 %) in LON group and 54 complications (84.4 %) in the Ilizarov technique group. Femur lengthening was associated with a greater number of complications in both groups. Pin infections were 2.5 times less frequently in the femur LON group. Knee contractures were only in Ilizarov technique group (11.4 %). Ankle joint contracture was noted with the same frequency during tibial lengthening in both groups. Disorders of the consolidation were 2 times more often in the femur LON group and 5 times more often in the tibial lengthening with Ilizarov technique. Premature fusion was observed only in the LON group. There were 2 times less fractures of the half-pins and wires in the LON group.Conclusions. A reduction of external fixation period in LON group correlates with the 2-fold decrease of complications and an increase of the treatment comfort. LON is promising for wider clinical applications.

Severe complicated shigellosis case developed by young pregnant woman

No doubts that shigellosis severity directly depends on the spread of the gut specific lesion. There are some data published on the basis of autopsy records and pointing to shigella caused lesion spreading both to colon and ileum in adult cases especially in those older than 60 y.o. or with any immunosuppressive premorbid background. Obviously, the gut mucosa condition determines the local resistance potential and moreover it's shown that in shigellosis cases, the histologic pattern of gut mucosa depends on quantity and quality of neutrophils, extremely important to control the intensity of agent invasion. Viral infections with concomitant neutropenia are commonly considered as immune suppressive conditions. As to Herpes virus infection, it's well known as the large mucosa lesion disease that can subsequently lead to aggravation of any forthcoming acute bacterial infection. The paper suggests the description of shigellosis case confirmed with the use of PCR test (PCR kit Amplisens All-bacto-screen-FL Lab, Interlabservice) and developed by young woman with unfavorable premorbid condition. The disease course turned to be severe and complicated by the peritonitis development. The aggravating factors in the proposed case were likely such immune modulating concurrent conditions as Herpes virus infection and pregnancy. The clinical example demonstrates that young people can develop severe complicated shigellosis course given burdened premorbid background availability.

Factors associated with inappropriate reduced doses of non-vita-min K antagonist oral anticoagulants in patients with atrial fibrillation

The objective was to study the factors associated with inappropriate reduced doses of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with non-valvular atrial fibrillation (AF) in real outpatient practice.Methods and materials. 10663 case histories of patients hospitalized to the therapeutic clinic of the university for 5 years (2014 — 2018) were studied, 1307/10663 (12,3 %) case histories of patients with AF were selected. Factors associated with inappropriate low doses of anticoagulant therapy (ACT) with NOACs at prehospital treatment were studied.Results. NOACs received 57.7 % (384/665) of patients with AF at the outpatient stage: rivaroxaban — 180/384 (46.9 %) patients, dabigatran etexilate — 110/384 (28.6 %) patients, apixaban — 94/384 (24.5 %) patients. Inappropriate reduced doses of NOACs were revealed in 68/384 (17.7 %) patients: apixaban — 22/94 (23.4 %), dabigatran — 18/110 (16,4 %) and rivaroxaban — 28/180 (15.6 %) (p>0,05). Patients who received inappropriate reduced doses of NOACs as compared to those who received standard doses of NOACs had higher frequency of major bleedings in the past (7.4 and 1.0 %; p=0.014) and had higher risk of bleedings (HAS-BLED 1.7±1,1 and 1.2±1.0; p = 0.0002). Proportion of patients who had HAS-BLED≥3 in these groups were 19.1 % and 8.6 % (p=0.033). All patients who received inappropriate reduced doses of NOACs had modifiable risk factors of bleedings. 85.3 % of patients with AF who received inappropriate reduced doses of NOACs had high risk of stroke according to CHA2DS2-VASc scale.Conclusion. In real outpatient practice, NOACs were recommended to 57.7 % of patients with AF. 17.7 % of patients received NOACs s in inappropriate reduced doses. Frequency of major bleedings in the past and bleeding risk in AF patients with inappropriate reduced doses was higher than in patients with standard doses.