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КОРЕКЦІЯ ІНФУЗІЙНОЇ ТЕРАПІЇ ПРИ ГОСТРОМУ АЛКОГОЛЬНОМУ ПАНКРЕАТИТІ
Full text linkAbstract. Acute alcoholic pancreatitis (AAP) represents a significant cause of hospitalizations in surgical departments, with severe cases leading to multi-organ failure and high mortality rates, up to 30%. Effective management of AAP requires accurate patient condition assessment, which directly influences treatment strategies, including fluid resuscitation, pain relief, nutritional support, and antibiotic use. A key factor in AAP outcomes is the development of hypovolemia, caused by fluid loss into the peritoneal and retroperitoneal spaces, exacerbating systemic and local hypoperfusion, tissue ischemia, and pancreatic necrosis. Proper fluid therapy is essential to prevent both hypovolemia-related complications and fluid overload, which may lead to pleural effusion, cerebral edema, and cardiovascular dysfunction. Current guidelines for fluid therapy in AAP focus on maintaining specific physiological parameters such as mean arterial pressure, heart rate, central venous pressure, urine output, and hematocrit levels. However, the use of non-invasive methods like bioimpedance analysis, which measures tissue resistance to determine fluid distribution, may offer more precise insights into the patient's fluid status, enabling better management of infusion therapy.
The aim to optimize fluid management in patients with moderate to severe AAP and reduce infectious complications through the use of bioimpedance analysis.
Materials and methods. A total of 110 patients were enrolled, including 101 men and 9 women. The patients were divided into two groups: one treated with standard fluid therapy using Ringer's lactate solution and the other receiving Sterofundin ISO solution, with infusion volumes adjusted according to bioimpedance measurements. Laboratory tests, including procalcitonin levels and the Limulus amebocyte lysate (LAL) test, were used to monitor inflammatory markers and endotoxin levels, while bioimpedance measurements were conducted on days 1, 3, 5, 8, 11, and 14 to dynamically assess fluid balance.
The results showed that patients treated with Sterofundin ISO and bioimpedance-guided fluid management experienced a significant reduction in extracellular fluid volume deviations and infectious complications compared to those receiving standard treatment. In the second group, the incidence of infectious complications in patients with moderate AAP decreased from 35.9% to 21.62%, and in severe cases, from 81.3% to 44.45%..
Key words: acute alcoholic pancreatitis, LAL-test, bioimpedance measurement, infusion, infectious complicationsАнотація
Гострий алкогольний панкреатит (ГАП) є однією із основних причин госпіталізацій у хірургічні відділення, причому тяжкі випадки призводять до поліорганної недостатності та високої смертності (до 30%). Ефективне лікування ГАП вимагає точної оцінки стану пацієнта, що безпосередньо впливає на стратегії лікування, включаючи регідратацію, знеболення, та застосування антибіотиків. Ключовим фактором у патогенезі ГАП є розвиток гіповолемії, викликаної втратою рідини, що посилює системну та локальну гіпоперфузію, ішемію тканин та панкреатичний некроз. Адекватна інфузійна терапія необхідна для запобігання ускладнень, пов'язаних з гіповолемією та перевантаженням рідиною, що може призвести до плеврального випоту, набряку мозку та поліорганної недостатності. Сучасні рекомендації щодо рідинної терапії при ГАП зосереджені на підтримці певних фізіологічних параметрів, таких як середній артеріальний тиск, частота серцевих скорочень, центральний венозний тиск, діурез та рівень гематокриту. Однак використання неінвазивних методів, таких як біоімпедансометрія, що вимірює опір тканин для визначення розподілу рідини, може надати більш точні дані про склад організму пацієнта, що дозволяє краще корегувати терапію.
Метою дослідження є оптимізація рідинної інфузії у пацієнтів із ГАП середнього та важкого перебігу, а також зменшення інфекційних ускладнень за допомогою біоімпедансометрії
Матеріали та методи. У дослідження включено 110 пацієнтів, серед яких 101 чоловік та 9 жінок. Пацієнтів було розподілено на дві групи: перша група отримувала стандартизоване лікування відповідно до міжнародних протоколів, друга група отримувала інфузію розчином Стерофундин ISO, об'єм інфузії регулювався відповідно до результатів біоімпедансометрії. Лабораторні аналізи, включаючи рівні прокальцитоніну та ЛАЛ-тест, використовувалися для моніторингу запальних маркерів та рівнів ендотоксину, тоді як біоімпедансометрія проводилися у 1, 3, 5, 8, 11 та 14 доби стаціонарного лікування.
Результати показали, що пацієнти, які лікувалися Стерофундин ISO та біоімпеданс-керованою рідинною терапією, мали значне зниження відхилень позаклітинного об'єму рідини та інфекційних ускладнень порівняно з тими, хто отримував стандартне лікування. У даних пацієнтів частота інфекційних ускладнень із помірним ГАП зменшилася з 35,9% до 21,62%, а у тяжких випадках - з 81,3% до 44,45%.
Ключові слова: гострий алкогольний панкреатит, ЛАЛ-тест, біоімпедансометрія, інфузія, інфекційні ускладнення
Prevalence of Isolated Idiopathic Teres Minor Atrophy: A Retrospective Study
Full text linkIntroduction. Isolated idiopathic teres minor atrophy is a relatively understudied condition characterized by selective atrophy of the teres minor muscle without any identifiable underlying pathology.
This study aimed to determine the prevalence of isolated idiopathic teres minor atrophy.
Methods. Data were collected retrospectively by examining magnetic resonance imaging scans of the right and left shoulders of individuals aged 18 years or older performed at the Medical Centre of Majmaah University, Al Majma’ah, Saudi Arabia, between February 2019 and October 2022. Teres minor atrophy was classified using the original Goutallier classification system to assess fatty infiltration. In addition, demographics, including age, gender, and nationality, were collected. Associated imaging-based factors, such as teres minor and deltoid muscle edema, rotator cuff muscle tears, and injuries to the labrum and quadrilateral space, were also documented.
Results. Among the 2, 194 patients studied, 59 (2.7%) were diagnosed with isolated idiopathic teres minor atrophy, aged 27 to 75 years. Females comprised 59.3% of the affected individuals, and the majority of cases were Saudi nationals (81.4%). The right side was affected in 61% of cases. Nearly half of the affected individuals (50.9%) were classified as grade 2, while 25.4% were classified as grade 4. Patients with grade 3 and grade 4 isolated idiopathic teres minor atrophy were significantly older than those with grade 2 (58.29 ± 7.12 and 57.93 ± 12.34 versus 49.96 ± 11.72, respectively (p=0.029). No statistically significant associations were found between the demographic characteristics of individuals (age and gender) and the pattern of teres minor fatty involvement.
Conclusions. The incidence of isolated idiopathic teres minor atrophy was found to be 2.7%. Age was the main statistically significant factor associated with isolated idiopathic teres minor atrophy and the grade of teres minor atrophy. Other evaluated factors, including gender and the pattern of involvement, did not demonstrate any statistically significant associations
Indicators of Mineral Metabolism in the Oral Fluid in Patients with Gastroesophageal Reflux Disease
Full text linkDisruption of the digestive system in the gastrointestinal tract, namely in gastroesophageal reflux disease, leads to the development of pathological processes in the oral cavity, changing the homeostasis of the viscoelastic gel layer of the esophageal mucosa. Thus, it has been proven that there are reflex connections between the receptor apparatus of the esophageal mucosa and the efferent nerve fibers of the salivary glands, which can be disrupted in GERD. Therefore, saliva is involved in providing effective protection of the esophagus. As a result, the content of mineral components changes significantly: in particular, the level of calcium and enzyme composition.
Aim to study the indicators of mineral metabolism: the content of calcium, alkaline, and acid phosphatases in mixed saliva in patients with gastroesophageal reflux disease.
Methods 60 patients of various ages who underwent inpatient treatment at the IFNMU University Clinic were examined, where pH-metry was performed to determine acidity. The main group consisted of patients diagnosed with GERD, with decreased and increased acidity. The content of indicators of mineral metabolism in saliva was determined as follows: calcium (Ca) - photometric method with arsenase -111; acid phosphatase (AC) was determined by the Hillman method, alkaline phosphatase (AL) by hydrolysis of p-nitrophenyl phosphate at pH -10.4, release of p-nitrophenol and phosphate. The norm of indicators of mineral metabolism was established on 30 practically healthy volunteers. Statistical processing of data was carried out using the Microsoft Excel program by calculating the arithmetic mean.
Conclusions thus, the results obtained indicate that in GERD there is a violation of mineral metabolism in the oral fluid. The oral fluid is the first to come into contact with the reflux agent. This leads to a violation of saliva neutralization, so the study of saliva mineral composition can be considered as an early diagnostic marker for gastroesophageal reflux disease
Age-Adjusted D-Dimer Cutoff in Ruling Out Pulmonary Embolism among Saudi Arabians in Riyadh Province
Full text linkObjective. The study aimed to investigate the effectiveness of an age-adjusted D-dimer (AADD) cutoff in ruling out pulmonary embolism (PE) among the Saudi population, addressing the lack of data on AADD utility in this demographic.
Methods. This single-centre retrospective cohort study conducted at Department of Medicine, King Abdulaziz Medical City in Riyadh, Saudi Arabia, between 2010 and 2018 analysed the data from patients suspected of PE who underwent computed tomography pulmonary angiography (CTPA). Age-adjusted D-dimer (AADD) levels were calculated for patients over 50 years of age [(age×10) µg/L], and AADD cutoffs were compared for diagnostic accuracy.
Results. Among 277 subjects meeting inclusion criteria, a significant association between D-dimer levels and PE presence was observed. The AADD criteria showed a specificity of 94.7% and a sensitivity of 25%, with a Youden index of 0.2. The high negative predictive value of 90.62% supported the use of AADD in confirming the absence of PE in patients.
Conclusions. Based on the study findings, the AADD cutoff [(age×10) µg/L] can be efficiently and safely used as an exclusionary tool for patients over 50 years of age suspected of having PE. This study supports the clinical utility of AADD, particularly in older Saudi patient populations
Evaluating OSPE as a Formative Assessment Tool for Medical Students
Full text linkIntroduction. Objective structured practical examination (OSPE) is a globally recognized and widely implemented assessment method used for evaluating students in practical examinations. It requires examinees to complete various tasks within a set time frame, each assessed against predetermined criteria designed to measure practical skills and attitudes.
This study aimed to assess the effectiveness of the OSPE as a tool for internal assessment in the subject of Anatomy for first-year MBBS students, comparing its performance against the traditional practical examination (TPE) method.
Methods. In this prospective study, an OSPE tool specific to Anatomy was developed and validated for face and content to ensure that the OSPE stations were standardized and well-constructed. The part-leaving test covered the Thorax and Brain chapters using both the TPE and OSPE methods. A Bland-Altman plot was employed to assess the agreement between the quantitative assessments of both methods. Additionally, a 5-point Likert scale was utilized to gauge the perceptions of both students and faculty members regarding the assessment methods.
Results. The analysis revealed a significant difference between the scores obtained from OSPE and TPE. The intraclass correlation coefficients for reliability between TPE and OSPE were 0.81 for the Thorax chapter and 0.84 for the Brain chapter. Additionally, the Bland-Altman plots illustrating the scores from both assessment methods indicated low bias and no definite pattern. While no significant outliers were identified for the Brain part, the Thorax part exhibited outliers at a rate of 6.43%, suggesting the presence of low-impact erratic variables. The Chi-square test for student perceptions yielded significant results for the entire questionnaire. In contrast, faculty perceptions showed significant results for all questions except for two.
Conclusions. Due to the high intraclass correlation coefficients between TPE and OSPE and the absence of bias, systematic errors, and erratic variables, OSPE is a promising assessment tool. Students perceived that OSPE decreased the chances of failure and that the questions asked in OSPE were more relevant compared to the traditional method. Faculty members also noted that OSPE provided reasonably high transparency and decreased subjective bias compared to TPE. Considering these factors, it can be concluded that OSPE is a viable potential tool to replace TSE
ВИКОРИСТАННЯ ГІПОКСИЧНОЇ ТЕРАПІЇ ДЛЯ ЛІКУВАННЯ ЕПІЛЕПСІЇ
No full textEpilepsy is one of the most common and dangerous diseases in the world. The complexity of the etiology of this disease leads, in many cases, to the ineffectiveness of treatment protocols. The presence of a hypoxic factor in the pathogenesis of epilepsy as a leading factor in brain cell damage has allowed scientists to propose preventive hypoxic preconditioning of patients with epilepsy as an additional approach.
The aim of stady is to substantiate the feasibility of using hypoxytherapy to alleviate the condition of patients with epilepsy.
Materials and methods. We searched PubMed, Clinical Key Elsevier, and Google Scholar databases and analyzed scientific publications covering the problem of hypoxia use in the treatment of epileptic patients.
Results. Hypoxic preconditioning activates transcription factors, particularly hypoxia-inducible factor-1 (HIF-1), which triggers a cascade of adaptive responses that help protect the body from the subsequent action of a more powerful stressor of the same or different nature. Hypoxia therapy for epileptic patients reduces the frequency, duration, and severity of epileptic seizures due to the over-adaptation of brain cells to hypoxic conditions that accompany the initiation and development of epileptic states. However, the presence of a hypoxic component in the etiology of epilepsy makes the use of hypoxia therapy problematic given the danger of provoking epileptic states in patients with hypoxic cycles. However, the significant differences between therapeutic and pathological oxygen concentrations in the gas-air mixture for therapeutic breathing allow us to recommend this method as safe for treating patients with epilepsy.
Conclusions. Hypoxic therapy is a practical, evidence-based approach to the treatment of epileptic patients, provided that therapeutic regimens are strictly followed and patients are monitored.Анотація. Епілепсія - одне з найпоширеніших і найнебезпечніших захворювань у світі. Складність етіології цього захворювання призводить у багатьох випадках до неефективності протоколів лікування. Наявність гіпоксичного фактору в патогенезі епілепсії як провідного чинника ушкодження клітин головного мозку дозволила вченим запропонувати превентивну гіпоксичну прекондицію пацієнтів з епілепсією як додатковий підхід. Мета роботи - обґрунтувати доцільність застосування гіпокситерапії для полегшення стану хворих на епілепсію.Матеріали та методи. Проведено пошук у базах даних PubMed, Clinical Key Elsevier, Google Scholar та проаналізовано наукові публікації, що висвітлюють проблему застосування гіпоксії в лікуванні хворих на епілепсію.
Результати. Гіпоксичне прекондиціювання активує фактори транскрипції, зокрема гіпоксія-індукований фактор-1 (HIF-1), що запускає каскад адаптивних реакцій, які допомагають захистити організм від подальшої дії більш потужного стресора тієї ж або іншої природи. Гіпокситерапія хворих на епілепсію зменшує частоту, тривалість і тяжкість епілептичних нападів за рахунок надмірної адаптації клітин мозку до гіпоксичних умов, які супроводжують ініціацію і розвиток епілептичних станів. Однак наявність гіпоксичного компонента в етіології епілепсії робить застосування гіпоксичної терапії проблематичним з огляду на небезпеку провокування епілептичних станів у пацієнтів з гіпоксичними циклами. Однак значні відмінності між терапевтичною та патологічною концентраціями кисню в газоповітряній суміші для лікувального дихання дозволяють рекомендувати цей метод як безпечний для лікування хворих на епілепсію.Висновки. Гіпоксична терапія є практичним, доказовим підходом до лікування хворих на епілепсію за умови суворого дотримання терапевтичних схем та моніторингу стану пацієнтів
The Relationship Between Smile Type, Dental Composition, and Personality Traits in Young Adults
Full text linkIntroduction. This study investigates the complex interplay between dental compositions, smile styles, and personality traits in young adults seeking oral and dental care, guided by the Visagism paradigm.
Methods. A total of 150 young adult volunteers aged 18-35 years participated in the study. The participants completed a questionnaire designed to assess personality traits. A survey containing various personality characteristics was administered to determine the participants’ fundamental personality traits, with respondents encouraged to indicate the traits they most closely identified with honestly. Based on the survey responses, individuals were categorized into one of four main personality groups: melancholic/sensitive, sanguine/dynamic, choleric/strong, and phlegmatic/peaceful. Subsequently, a careful clinical examination was conducted to assess each patient’s tooth form, smile style, and the visibility of teeth and gums at different smile stages (stages III and IV). Statistical analysis was then conducted.
Results. Oval tooth forms (36%) and the commissure (Mona Lisa) smile style (72.5%) were most frequently observed, aligning with previous research. Notably, women exhibited a higher prevalence of a melancholic temperament. However, the study found no significant relationship between self-reported personality traits and dental compositions or smile styles.
Conclusions. The study did not confirm a significant association between personality traits and smile styles or dental forms. While the findings align with existing research, they highlight the complexity of the Visagism paradigm, emphasizing the need for further investigations into the relationship between temperament and dental aesthetics
Severe Hyponatremia Uncovering Secondary Adrenal Insufficiency: A Case Report
Full text linkIntroduction. Sodium is a crucial extracellular electrolyte for neuromuscular function, acid-base balance, cellular processes, and osmolarity regulation via transmembrane transport. Sodium deficiency, or hyponatremia, causes plasma hypoosmolarity, leading to water movement into tissues, cellular overhydration, and edema, especially within the brain. This study aimed to determine the cause of severe hyponatremia in a 65-year-old patient.
Case Report. A 65-year-old patient was admitted to the emergency department of “Pius Brînzeu” County Emergency Clinical Hospital, Timișoara, Romania, presenting with severe general deterioration, asthenia, headache, vertigo, nausea, vomiting, and epigastric pain. Laboratory tests conducted at the emergency department confirmed the presence of severe hyponatremia. The patient was transferred to the Internal Medicine Clinic, where immediate treatment for hyponatremia was initiated. Subsequent biological and imaging investigations revealed adrenal insufficiency as the underlying cause of severe hyponatremia.
Conclusions. Severe hyponatremia is a potentially life-threatening condition, with adrenal insufficiency as a significant underlying cause. Often overlooked due to subtle electrolyte disturbances, accurate diagnosis of secondary adrenal insufficiency is essential, as it requires lifelong hormonal replacement therapy. In such cases, targeted hydrocortisone therapy is vital for restoring hormonal balance, thus ensuring therapeutic efficacy and improving long-term patient outcomes
Dermatoglyphic Phenotype in Patients with Cardiovascular Disease
Full text linkIntroduction. Since the predisposition to develop cardiovascular disease is genetically determined, it can be assumed that there are phenotypic features (in particular, dermatoglyphic) that allow predicting the predisposition to develop acute myocardial infarction (MI).
The aim of the study was to determine the dermatoglyphic phenotype in patients with myocardial infarction.
Materials and methods. The object of the study was dermatoglyphs of distal phalanges of the fingers obtained from 60 male subjects (30 patients with myocardial infarction and 30 healthy men without cardiovascular pathology as a control group). The dermatoglyphic method and the method of statistical analysis were used.
Results. It was found that patients with MI had a higher frequency of curl patterns, but a lower frequency of ulnar and radial loops and arc patterns compared to the control group. The value of the comb count in patients with MI was lower than in the control group (p>0.05). The total comb count of the palmar fields a-b, c-d was higher, and the fields b-c were lower in patients with MI than in the control group. The mean value of the angle Аtd on both hands was higher in patients with MI than in the control group. Palm patterns and folds showed no significant differences between the groups.
Conclusions
The results of this study can be used to standardize the dermatoglyphic pattern of the Ukrainian population and identify individuals prone to MI
Analysis of Artifacts and Errors on Intraoral Phosphor Plate Radiographs: A Retrospective Study
Full text linkIntroduction. The advantages of phosphor plates (PPs), including their flexibility, thinness, and wireless connectivity, have contributed to their widespread use in dentistry alongside the advancement of digital radiography techniques. Continuous use of PPs and certain errors may lead to artifacts on the images. This retrospective study aimed to determine the frequency and types of intraoral PP artifacts.
Methods. This study was conducted on 814 intraoral PP radiographs, including periapical and bitewing images. The errors and artifacts were classified into 4 main categories: technical errors, plate-related artifacts, scanner-induced artifacts, and ambient light artifacts.
Results. A total of 656 periapical and 158 bitewing radiographs were examined. The most observed artifacts on the radiographs were plate-related artifacts, followed by technical errors (n=542, n=461, respectively). Within the category of plate-related artifacts, the most common artifacts were cracks or scratches (n=418, 77.1%), while within the category of technical errors, these were cone-cut errors (n=188, 40.7%). Parallel or zigzag radiopaque lines were the most common scanner-induced artifacts (n=313, 98.7%) and fading was the most common ambient light artefact (n=93, 49.2%). On more than half of the PPs, more than one artifact group was observed.
Conclusions. Cone-cut, cracks/scratches, parallel zigzag radiopaque lines, and fading were common PP artifacts and errors in this study. The analysis revealed that over half of the PPs exhibited appearance of more than one artifact group. The high frequency of artifacts poses a risk of incorrect and incomplete diagnoses in radiographs, emphasizing the crucial importance of understanding the causes and developing effective prevention strategies for artifacts to enhance the reliability of diagnostic imaging and ensure the accuracy of patient assessments