Clinical Observation of Peripartum Cardiomyopathy

Research relevance: the article presents the results after clinical observation of peripartum cardiomyopathy in a patient aged 30 years. Purpose of the study: to analyze the results of a clinical study conducted in the cardiology department of the Osh Medical United Clinical Hospital. Research methods: a differential diagnosis of acute myocarditis, idiopathic dilated cardiomyopathy and peripartum cardiomyopathy was carried out. Research results: taking into account the life history, laboratory and instrumental examination data, the diagnosis was peripartum cardiomyopathy. Conclusion: the treatment carried out gave a satisfactory clinical effect.

Presence of Malassezia Hyphae Is Correlated with Pathogenesis of Seborrheic Dermatitis

Our results support the proposal that the hyphal form of Malassezia could be one of the pathogenic factors that contribute to SD, which has been previously less well studied. This clinical observation paves the way for further investigations of the molecular mechanisms of Malassezia hyphal pathogenicity in SD.

Radiomics-Based Detection of Radionecrosis Using Harmonized Multiparametric MRI

In this study, a radiomics analysis was conducted to provide insights into the differentiation of radionecrosis and tumor progression in multiparametric MRI in the context of a multicentric clinical trial. First, the sensitivity of radiomic features to the unwanted variability caused by different protocol settings was assessed for each modality. Then, the ability of image normalization and ComBat-based harmonization to reduce the scanner-related variability was evaluated. Finally, the performances of several radiomic models dedicated to the classification of MRI examinations were measured. Our results showed that using radiomic models trained on harmonized data achieved better predictive performance for the investigated clinical outcome (balanced accuracy of 0.61 with the model based on raw data and 0.72 with ComBat harmonization). A comparison of several models based on information extracted from different MR modalities showed that the best classification accuracy was achieved with a model based on MR perfusion features in conjunction with clinical observation (balanced accuracy of 0.76 using LASSO feature selection and a Random Forest classifier). Although multimodality did not provide additional benefit in predictive power, the model based on T1-weighted MRI before injection provided an accuracy close to the performance achieved with perfusion.

In silico screening method for non-responders to cardiac resynchronization therapy in patients with heart failure: a pilot study

Background Cardiac resynchronization therapy (CRT) is an effective treatment option for patients with heart failure (HF) and left ventricular (LV) dyssynchrony. However, the problem of some patients not responding to CRT remains unresolved. This study aimed to propose a novel in silico method for CRT simulation. Methods Three-dimensional heart geometry was constructed from computed tomography images. The finite element method was used to elucidate the electric wave propagation in the heart. The electric excitation and mechanical contraction were coupled with vascular hemodynamics by the lumped parameter model. The model parameters for three-dimensional (3D) heart and vascular mechanics were estimated by matching computed variables with measured physiological parameters. CRT effects were simulated in a patient with HF and left bundle branch block (LBBB). LV end-diastolic (LVEDV) and end-systolic volumes (LVESV), LV ejection fraction (LVEF), and CRT responsiveness measured from the in silico simulation model were compared with those from clinical observation. A CRT responder was defined as absolute increase in LVEF ≥ 5% or relative increase in LVEF ≥ 15%. Results A 68-year-old female with nonischemic HF and LBBB was retrospectively included. The in silico CRT simulation modeling revealed that changes in LVEDV, LVESV, and LVEF by CRT were from 174 to 173 mL, 116 to 104 mL, and 33 to 40%, respectively. Absolute and relative ΔLVEF were 7% and 18%, respectively, signifying a CRT responder. In clinical observation, echocardiography showed that changes in LVEDV, LVESV, and LVEF by CRT were from 162 to 119 mL, 114 to 69 mL, and 29 to 42%, respectively. Absolute and relative ΔLVESV were 13% and 31%, respectively, also signifying a CRT responder. CRT responsiveness from the in silico CRT simulation model was concordant with that in the clinical observation. Conclusion This in silico CRT simulation method is a feasible technique to screen for CRT non-responders in patients with HF and LBBB.

Spontaneous drainage of the pseudocyst of the tail of the pancreas with the formation of a junction between the cyst and the stomach

The aim of the study was to evaluate the informative value of various diagnostic methods for spontaneous drainage of the pancreatic pseudocyst into the stomach.Materials and methods: based on the clinical observation of a patient who received complaints of pain in the epigastrium, an episode of melena, after suffering acute pancreatitis several years ago with the development of pancreatic necrosis with an outcome in the cyst of the tail of the pancreas, drainage of the omentum bag. The patient underwent a comprehensive laboratory and instrumental examination.Results: ultrasound, endoscopic examination, MSCT suspected a malignant process in the stomach with ulceration and germination into the pancreas. After performing endoscopic ultrasonography, it was possible to differentiate the layers of the formation and make the correct diagnosis, which was confirmed by subsequent MSCT with oral contrast.Conclusions: a spontaneously opened pancreatic pseudocyst in the lumen of the stomach is a rare and difficult to diagnose disease. An integrated approach, including endoscopic, ultrasound, X-ray, and laboratory methods of investigation when compared with the clinical picture, allows us to verify the formation of the pancreas.

Surgical treatment of retinal detachment with inferior break using combined gas-air tamponade with viscoelastic

Surgical treatment of rhegmatogenous retinal detachment with an inferior break remains a challenge for ophthalmic surgeons. When using silicone tamponade, complications can develop, such as increased intraocular pressure and emulsification of silicone. In recent years, tamponade of the vitreous cavity with a gas-air mixture has been actively used, however, not all patients can observe the forced position face down, and the tamponade itself is not long-term. Purpose. The authors proposed a method for the treatment of rhegmatogenous retinal detachment with an inferior break using a combined tamponade with a gas-air mixture and viscoelastic based on sodium hyaluronate. Material and methods. A clinical observation of a patient successfully operated on with the use of the specified combined tamponade is presented. A detailed description of a new surgical technique is presented, which allows achieving a higher anatomical and functional results. Conclusion. To confirm the effectiveness and safety of the proposed method, further studies on a group of patients are needed. Key words: rhegmatogenous retinal detachment, inferior break, gas-air tamponade, tamponade with viscoelastic, sodium hyalur onate

The use of Kollapan in the treatment of periodontal diseases

Relevance. Before starting the therapeutic treatment of various periodontal diseases, it should be clearly understood that a high-quality treatment is possible only with complex therapy, excluding local irritating adverse factors in the oral cavity, elimination of inflammatory processes in the periodontal tissues, as well as violations of its function. One of the main tasks of the treatment of periodontal diseases is the preservation of the dentition with a single functional system.Purpose – to assess the use of the drug Kollapan in tooth extraction and treatment of periodontitis.Materials and methods. The clinical observation group consisted of 40 patients aged 19 to 65 years. The gender ratio was 3 : 2 (60% men, 40% women). The largest percentage of patients (65%) came to the clinic with complex tooth extraction. The remaining 35% – with generalized periodontitis of moderate and mild severity.Results. Clinical observation showed that in the first group of patients, whose therapy included the use of Collapan, after a complex tooth extraction, physiological healing of the hole was observed, the disappearance of inflammation within 24–36 hours after the surgery

Clinical observation of a patient with hemangiomatosis involving skin, subcutaneous tissue, lung, stomach, intestinal, liver, kidney, spine

Aim. The work demonstrates a clinical case of an extremely rare pathology ‒ hemangiomatosis with damage to the skin, subcutaneous tissue, lungs, stomach, intestinal, liver, kidneys, and spine. Results. Patient L., born in 1994 with multiple hemangiomas. No heredity was observed for vascular tumors. In childhood, several large hemangiomas had to be surgically removed. She resorted to the Amur Regional Perinatal Center about her first pregnancy. There was a high risk of hemorrhagic complications due to damage to internal organs, primarily the lungs. Since there were multiple lesions of the vertebrae, it was decided not to use neuraxial methods of anesthesia. Total intravenous anesthesia and artificial ventilation of the lungs under the control of bronchoscopy were chosen by the method of anesthesia. Hemangiomatosis with lesions of internal organs was the indication for a Cesarean section. The operation took place without complications. The child was born healthy. Conclusion. In most cases, cosmetic defects are a significant problem of hemangiomatosis. However, in a number of situations, for example during pregnancy, there is a high risk of rupture of hemangiomas and the development of bleeding. In this case, the choice of the method of delivery and anesthesia depends on the location of the hemangiomas.

Assessing the Quality of Care at Primary Health Care Level in Two Pilot Regions of Albania

The quality of care (QoC) of primary health care (PHC) services in Albania faces challenges on multiple levels including governance, access, infrastructure and health care workers. In addition, there is a lack of trust in the latter. The Health for All Project (HAP) funded by the Swiss Agency for Development and Cooperation therefore aimed at enhancing the population's health by improving PHC services and implementing health promotion activities following a multi-strategic health system strengthening approach. The objective of this article is to compare QoC before and after the 4 years of project implementation. A cross-sectional study was implemented at 38 PHC facilities in urban and rural locations in the Diber and Fier regions of Albania in 2015 and in 2018. A survey measured the infrastructure of the different facilities, provider–patient interactions through clinical observation and patient satisfaction. During clinical observations, special attention was given to diabetes and hypertensive patients. Infrastructure scores improved from base- to endline with significant changes seen on national level and for rural facilities (p < 0.01). Facility infrastructure and overall cleanliness, hygiene and basic/essential medical equipment and supplies improved at endline, while for public accountability/transparency and guidelines and materials no significant change was observed. The overall clinical observation score increased at endline overall, in both areas and in rural and urban setting. However, infection prevention and control procedures and diabetes treatment still experienced relatively low levels of performance at endline. Patient satisfaction on PHC services is generally high and higher yet at endline. The changes observed in the 38 PHC facilities in two regions in Albania between 2015 and 2018 were overall positive with improvements seen at all three levels assessed, e.g., infrastructure, service provision and patient satisfaction. However, to gain overall improvements in the QoC and move toward a more efficient and sustainable health system requires continuous investments in infrastructure alongside interventions at the provider and user level.