Journal articles - Saratov Medical Journal
All articles: 107
Perimortem and postmortem caesarean section: a systematic review
Scientific article
Rationale: Perimortem caesarean section (PMCS) is an emergency procedure performed in pregnant women over 20 weeks of gestation with cardiac arrest, in order to save the mother and the foetus, or only one of them. The objective of the review was to present clinical traits and evaluate survival of mothers and newborns as well as the complications following PMCS. Materials and methods: A systematic review between March and May 2021 was performed using the PRISMA method with the terms "perimortem caesarean section" "postmortem caesarean section", "maternal cardiac arrest", "perimortem caesarean section "AND "case report" "postmortem caesarean section" AND "case report". Results: 23 papers from 12 countries with 39 cases were counted. Of the total sample, 17.94% of the mothers survived and of these, 42.85% had neurological complications. Of 39 newborns counted, 69.23% survived, 28.20% died and in 2.56% the information was missing. 30.76% of the cases followed the five-minute rule and 56.41% required 6 or more minutes, 12.82% did not specify time. Conclusion: The results of this analysis demonstrated higher mortality in women who had a cardiac arrest during pregnancy related to the neonates who survived. The possibility of performing PMCS should neither be ruled out even if the established five-minute time frame has passed, nor should time be invested in verifying foetal viability.
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Polymorphisms of hemostasis and folate cycle genes as predictors of COVID-19 severity
Scientific article
Objective: to identify the frequency of single nucleotide polymorphisms (SNPs) of hemostasis and folate cycle genes in patients with stable coronary artery disease (CAD) depending on the severity of COVID-19 in the acute period. Materials and methods. Our study included 416 patients with CAD who had COVID-19 more than 12 weeks ago with documented severity course. All patients were distributed among two groups. Group 1 included patients with mild severity (n=203), while Group 2 comprised patients with moderate severity (n=213) of COVID-19. All study subjects were examined for polymorphisms of hemostasis and folate cycle genes. We performed an assessment of the following genetic variants: 20210 G>A of the F2 gene, 1691 G>A of the F5 gene, 807 C>T of the ITGA2 gene, 10976 G>A of the F7 gene, 1298A>C of the MTHFR gene, 66 A>G of the MTRR gene, 2756 A>G of the MTR gene, 677 C>T of the MTHFR gene, 455 G>A of the FGB gene, 103 G>T of the F13A1 gene, 675 5G>4G of the SERPINE1 (PAI-1) gene, and 1565 T>C of the ITGB3 gene. These polymorphisms are likely to contribute to a more severe course of COVID-19 in patients with CAD. Results. Predisposing factors for the development of a more severe course of COVID-19 among patients with CAD may be the presence of heterozygous polymorphism (455 G>A) of the FGB gene and 1565 T>C polymorphism (CC genotype) of the ITGB3 gene. Contrariwise, the 807 C>T polymorphism (CC genotype) of the ITGA2 gene in the analyzed sample was associated with a mild course of COVID-19. Conclusion. SNPs 455 G>A of the FGB gene and 1565 T>C (rs5918) of the ITGB3 gene are potential markers for identifying and predicting a more severe course of COVID-19 in patients with CAD
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Objective: assessment of the anatomical and topographical parameters of the wound channel formed in the course of the posterolateral musculofascial approach with the purpose of identifying the possibility of its clinical use in decompressive and stabilizing surgical interventions. Materials and Methods: a posterolateral musculofascial approach to the lumbar spine was modeled using material from 20 male and female cadavers 54 – 76 years of age (median 67.5 years) who died from diseases not associated with the pathology of the spine. The study examined wound length, depth, wound depth index, and wound access zone, as well as the angle of intersection of the wound edges with the surface of surgical instruments. Results: the mean length of the surgical wound when performing the lateral musculofascial approach was 149.75±6.35 mm. The mean depth of the wound was 116.75±8.85 mm. The mean value of the surgical wound depth index with interfascial approach was 77.96±5.04. The mean area of the intervertebral disc available for removal was 71.2±2.8%. The length of the aperture in the annulus fibrosus was on average 15.8±0.78 mm. The mean angle of the intersection of the wound edge by the trajectory of transpedicular screw implantation was 3.15±1.25°. Conclusion:the assessment of the anatomical and topographical parameters of the wound channel formed during the posterolateral musculofascial approach allowed concluding that such surgical approach could be used to improve the functional outcomes of decompressive and stabilizing interventions on the lumbar spine.
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Scientific article
Objective: to assess the readiness of patients for online communication with a healthcare worker and the demand for medical care in a remote format. Materials and Methods. We interviewed 507 patients using the original questionnaire, which allowed obtaining data on the respondents’ experience in using online communication with a doctor, their readiness for digital health care instead of office visits, and the impact of Internet resources on the patient’s trust in the recommendations given by the attending physician. Results. We established that 30.6±2.1% of patients used online communication with their doctor, while 40.5±2.2% would like to have this opportunity. We observed a difference in readiness for digital communication between groups of respondents interested in pediatricians (parents of children attending city children’s polyclinics) and groups of central district hospital patients and multidisciplinary city hospital patients (p<0.001). The effect of age on the patient’s readiness for online communication has been confirmed. The most in demand in the remote format were referral services (for laboratory tests and hospitalization), especially in the group of parents of children attending city children’s polyclinics. The study of the patient’s behavior in relation to the search for a second opinion on the Internet showed that the majority of the respondents did not intend to double-check their doctor’s prescriptions, and the absolute majority of respondents (82.8±1.7%) trusted more their attending physician than Internet sources. Conclusion. The results of the study indicate the readiness of the population to implement digital communication and transfer part of medical care to the digital sphere. The most in-demand services were those for issuing referrals for hospitalization and to specialists, as well as for tests and pharmaceutical prescriptions that the patient receives on an ongoing basis.
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Objective: to identify the relationship between the results of in silico and in vivo studies of hypoglycemic, hypolipidemic, and hepatoprotective properties expressed by a new 1,4-dihydropyridine derivative with the laboratory code AZ-383. Material and Methods. Virtual biological screening of the AZ-383 compound was conducted using SwissTargetPrediction online tool. The identified biotargets were promising for pharmacological correction of multiple metabolic disorders, which was confirmed in an in vivo experiment conducted on male Wistar rats: the levels of glucose, total cholesterol, triglycerides, alanine aminotransferase, aspartate aminotransferase, and total bilirubin in the blood were examined; the microarchitecture of the rat liver was assessed after pharmacological correction (using the AZ-383 compound) of the modeled metabolic disorders. Results. The presence of hypoglycemic, hypolipidemic and hepatoprotective properties in the compound AZ-383, along with its favorable effect on body weight, was revealed. The glucose level reached values of 7.9±0.4 mmol/L. The body weight of rats after the use of AZ-383 was 378±12 g. Under the influence of AZ-383, we observed an increase in the number of hepatocytes by 17.8%, a reduction in the size of hepatocytes by 7%, and a decrease in the area of the cytoplasm and nuclei of hepatocytes by 5.2% and 18.7%, respectively, vs. the control group of animals. Conclusion. Our in vivo experimental study confirmed the presence of hypoglycemic, hypolipidemic and hepatoprotective properties in the AZ-383 compound, which corresponds to the biotargets determined in silico for this 1,4-dihydropyridine derivative.
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Republican Arthrology Center and its contribution to the development of orthopedic rheumatology
Scientific article
The article provides information on the organization and functioning achievements of the Republican Arthrology Center (RAC), which has become the first specialized clinic in the Russian Soviet Federative Socialist Republic (RSFSR) that provided arthrological assistance to the population. The result of the organizational and methodological efforts of the RAC employees was the development of a network of rheumatology rooms in almost all territories of the country, along with the organization of the orthopedic rheumatology service and its separation from the cardiovascular rheumatology service. In the RAC, scientific developments were successfully carried out on the problems of arthroplasty of large joints, surgical and conservative treatment of patients with rheumatoid arthritis, osteoarthritis of large joints, prevention of contractures of the knee joint. Saratov Research Institute of Traumatology and Orthopedics (SRITO) hip joint endoprosthesis, a collapsible endoprosthesis and other constructions that have received wide recognition were created at the RAC. In the absence of international experience in creating an orthopedic rheumatology service network, the RAC was, on one hand, a pioneering phenomenon in world health care, and on the other hand, a natural consequence of the power vertical centralization in the USSR. At the same time, it should be emphasized that the need to create the RAC in the Russian Federation was caused by the growth in morbidity of rheumatic diseases, along with population aging and the prospects of orthopedic rheumatology associated, first of all, with the active introduction of total joint replacement with artificial structures in developed countries of the world. Over three decades of its existence, the RAC has been an organizational, methodological, medical, scientific and consulting center providing an orthopedic care to patients with diseases and injuries of large joints throughout the Russian Federation.
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Objective: to conduct a comparative analysis of the accuracy of intraocular lens (IOL) selection in patients with an eye length of less than 22.0 mm using the Barrett Universal II, Kane, and Hoffer Q formulas, as well as via artificial intelligence (AI). Materials and Methods. We analyzed the outcomes of 88 phacoemulsification cataract surgeries with monofocal IOL implantation. Preoperative biometry and IOL calculations were performed on an IOL Master 700 (Zeiss, Germany). The accuracy of IOL selection was also determined via the LensCalc software based on AI (DecisionTreeClassifier). Results. The axial length of the eyes in patients ranged from 19.8 to 22.0 mm. The prediction of achieving the target refraction was most accurate when using the Barrett Universal II formula rather than Hoffer Q (Z=2.12; p=0.034). The mean error in achieving the target refraction when using the Barrett Universal II formula did not differ from the Kane formula (p>0.05). Using AI, we established that higher accuracy in the IOL power calculation was achieved when using the Barrett Universal II formula. Conclusion. Based on a comparative analysis of the study results and an assessment of the accuracy of IOL selection using AI, we established that the Barrett Universal II formula (4th generation) was more accurate in determining the optical power of the IOL in short eyes than the Hoffer Q formula (3rd generation). Our calculation results based on using the Barrett Universal II formula, unlike the Hoffer Q formula, were similar (p>0.05) to those calculated using the Kane formula (5th generation), which, according to the results of the majority of published studies, is currently the most accurate formula for IOL selection.
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Skin autofluorescence as a factor of adverse prognosis in patients with peripheral atherosclerosis
Scientific article
Objective: to determine the prognostic value of skin autofluorescence (SAF) as a factor of cardiovascular complications and mortality. Materials and Methods. Our prospective study included 122 patients with peripheral arterial disease (PAD): atherosclerotic stenosis of the brachiocephalic trunk was detected in 95 patient (77.9%), while chronic arterial insufficiency (CAI) of the lower limbs was found in 47 study participants (38.5%). SAF was measured by an original device developed by the authors. Clinical, anthropometric and biochemicalparameters, along with instrumental parameters of the heart and blood vessels, were studied via ultrasound examination. The prospective part of the study (follow-up) was carried out for up to 1,043 (on average, 736) days. Results.The SAF parameter correlated directly and significantly with scores on the scale of clinical prognostic signs, CAIof the lower limbs, and history of surgeries on the leg arteries. In the course of the follow-up period, there were seven deaths and at least one hospitalization for cardiovascular reasons in 42 patients. The most common were hospitalizations due to conservative treatment of CAI, the need for coronary artery bypass grafting, and coronary stenting. Using the logistic regression method, we determined that the incidence of hospitalization or mortality was associated with SAF values, plasma glucosecontent, and the presence of chronic heart failure above functional class 1. The sensitivity and specificity of the model were 71% and 68%, respectively. Conclusion.The SAF parameter can be used as an integral independent predictor in patients with multifocal atherosclerosis.
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Stress-strain properties of aponeurotic suture in anterior abdominal wall after a midline laparotomy
Scientific article
Objective: method development for preventing postoperative ventral hernias based on experimental assessment of the stress-strain properties of aponeurosis in various types of a midline laparotomy. Materials and methods. We evaluated 42 fascia muscular aponeurotic complexes of the anterior abdominal wall. Based on the technique for dissecting the aponeurosis and its suturing, the complexes were divided into two groups (each containing 21 samples): Group 1 with a bypass of the umbilical ring on the left, and Group 2 with umbilical ring dissection. Results. Fascia aponeurotic complexes dissected and sutured through the umbilical ring (Group 2) had, on the average, higher values of mechanical characteristics. E.g., mean values of tensile stress (S), tensile stress at a maximum load (Smax), Young’s modulus (E), aponeurotic tensile strain (D), aponeurotic tensile strain at a maximum load (Dmax), and maximum load level (Load) were higher in Group 2 by 35.4; 39.8; 14.9; 34.6; 30.2 and 40.2 (%), respectively. Conclusion. We conducted the development, experimental application and evaluation of a novel method for preventing postoperative ventral hernias after a midline laparotomy based on the assessment of the stress-strain properties of aponeurosis.
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Studying implants with different coating types in an in vivo experiment
Scientific article
Objective: to evaluate the safety and osseointegration properties of experimental implant specimens with different types of coatings in an in vivo experiment in rats. Materials and Methods. A morphological study was performed on 60 laboratory sexually mature rats. The study materials were implant specimens from four groups with different types of VT6 titanium alloy coatings. Results. Biological compatibility of all implant specimens was confirmed. In the uncoated implant group, no significant bone formation was observed, and implant stability remained low by Month 2 (2.9±1.1 pts on the implant stability scale). Chitosan-coated implants exhibited low stability (1.8±0.1 pts by Week 2), but significant stimulation of osteogenesis was observed. In the antibacterial coating group, good integration and minimal implant mobility were noted (3.4±0.3 pts after one), and the antibacterial coating was preserved for two weeks. Conclusion: Hydroxyapatite and chitosan coatings contributed to quicker osseointegration via stimulating angiogenesis, stromal collagen synthesis, and bone formation, while maintaining full biocompatibility and rapid biodegradation. The antibacterial coating ensured rapid relief of inflammation in the postoperative wound area.
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Surgical treatment outcomes of resistant diabetic macular edema
Scientific article
Objective: to analyze the effect of surgical intervention in resistant diabetic macular edema (DME) on morphological and functional parameters of the retina according to optical coherence tomography (OCT) and microperimetry data. Materials and methods. Our study included 75 patients diagnosed with resistant DME: Group 1 (25 patients, 25 eyes) treated with intravitreal injection of anti-VEGF drugs; Group 2 (26 patients, 26 eyes) undergoing vitrectomy (VE) with internal limiting membrane peeling; Group 3 (24 patients, 24 eyes) undergoing VE with internal limiting membrane peeling and submacular injection of balanced salt solution (BSS). Results. After 1 wk., the foveal thickness in Group 3 decreased by 1.3 times (p=0.043) compared with Group 1 and 1.2-fold (p=0.044) compared with Group 2; after 1 mo.: by 1.5 times (p=0.041) and 1.2-fold (p=0.044); after 6 mos.: by 1.2 times (p=0.042) in Group 2 and 1.4-fold (p=0.042) in Group 3 against Group 1; after 12 mos.: by 1.3 times in Group 3 (p=0.043) against Group 1. When analyzing the best corrected visual acuity (BCVA) after 6 mos., the functional results in patients of Groups 2 and 3 improved by 1.8 times (p=0.038) and 1.9 times (p=0.039), respectively against Group 1. Light sensitivity 1 wk. after surgery was 1.4 times higher in Group 2 (p=0.042) and 1.5 times higher in Group 3 (p=0.041) than in Group 1. Conclusion. In the treatment of DME, vitreoretinal surgery plays an important role in changing retinal parameters, contributing to a decrease in thickness in the early stages, an increase in light sensitivity, and an increase in BCVA.
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Objective: to compare the levels of systemic inflammation biomarkers between groups of patients with paroxysmal and persistent atrial fibrillation (AF). Materials and methods. The study included 232 patients with AF who underwent primary pulmonary vein ablation. The mean age was 62 (54; 67) years. Patients were distributed between two groups: with paroxysmal AF and with persistent AF. Results. The analysis of the levels of inflammatory markers did not reveal statistically significant differences between the groups: 0.8 (0.6; 1.1) vs. 0.9 (0.7; 1.1), p=0.077 for the systemic inflammation response index; 361 (276; 509) vs. 373 (294; 551), p=0.505 for the systemic-immune inflammation index; 170 (122; 255) vs. 197 (139; 259), p=0.150 for the aggregate index of systemic inflammation; 1.6 (1.3; 2.2) vs. 1.8 (1.3; 2.3), p=0.428 for the neutrophil-to-lymphocyte ratio; 122 (86; 132) vs. 107 (91; 130), p=0.576, for the platelet-to-lymphocyte ratio; and 0.228 (0.177; 0.291) vs. 0.241 (0.200; 0.301); p=0.262 for the monocyte-to-lymphocyte ratio. No differences were found after statistical correction for baseline clinical characteristics. According to the ROC analysis, no statistically significant threshold values of the levels of the studied markers were found for each type of AF. Conclusion. We revealed no differences in the levels of systemic inflammation biomarkers between patients with paroxysmal and persistent types of AF. Currently, data on the existence of an association between the levels of systemic inflammation biomarkers and various types of AF are contradictory, and further research in this area is required.
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Objective: to evaluate total testosterone level in men with type 2 diabetes mellitus (DM) and varying degrees of carbohydrate metabolic compensation. Materials and Methods. The continuous cross-sectional non-interventional screening study included 100 men 45 [43; 48] years of age with newly diagnosed type 2 DM. The study continued from February through May of 2021. The level of glycated hemoglobin (HbA1c) and total blood testosterone were determined. Group comparisons were performed via Mann–Whitney U test, Kruskal–Wallis test and Fisher’s exact test. The differences were assumed statistically significant at p<0.05. Results. When comparing patients with different HbA1c content, we discovered that in patients with HbA1c from less than 6.5 to 9.9%, total testosterone levels as well as testosterone deficiency prevalence did not differ statistically significantly. At HbA1c -12%, the prevalence of testosterone deficiency increased statistically significantly (p<0.001), and testosterone levels decreased (p<0.001). Comparison of patient groups with HbA1c levels from less than 6.5 to 9.9% and from 10 to 11.9% did not yield statistically significant differences in the testosterone deficiency prevalence and testosterone content. However, there was a trend towards worse parameter values in the latter group, especially because patients with HbA1c levels from less than 6.5 to 9.9% were older. Conclusion. Total testosterone levels in type 2 DM patients are associated with carbohydrate metabolic compensation. Negative impact on testosterone production was detected in patients with HbA1c content of ≥10%.
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Objective: to identify the nature of proliferation and apoptosis process disorders in the gingival epithelium in postmenopausal women with varying degrees of bone mineralization for early diagnosis and optimization of combination therapy. Materials and Methods. We examined 80 women aged 55–60 years with chronic generalized periodontitis (CGP) and reduced bone mineral density (BMD). All patients underwent a standard dental examination, including an index assessment of periodontal tissues. BMD was quantified via a densitometric analysis of the bone tissue condition. The investigation of periodontal epithelial cell renewal was performed using immunohistochemical studies. Results. We discovered that in postmenopausal patients with CGP and BMD disorders, there was a reduction in the proliferation of gingival epithelial cells with activation of their apoptosis (Iapt=0.73±0.03%, Iki-67=11.77±0.27%) vs. the patients with intact periodontium (Iapt 0.29±0.04%, Iki-67=9.88±0.09%), p=0.04. Conclusion. We discovered that CGP in postmenopausal women occurs with enlarged activity of apoptosis of gingival epithelial cells against the background of their reduced proliferation. The activity of inflammatory destructive processes in periodontal tissues is higher in patients with osteopenia vs. those without BMD impairment.
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Objective: to identify the relationship between microcirculatory changes in the general blood flow and periodontium in pregnant women. Materials and Methods. The study involved 98 pregnant women who were examined for microcirculatory changes in the fourth finger of the left hand and periodontium. The control group consisted of 30 nonpregnant women. Laser Doppler flowmetry was carried out in two stages. At stage 1, vasomotor activity of vessels was studied, while at stage 2, the contribution of high- and low-frequency oscillations to the overall modulation of blood flow was examined. A correlation analysis of microcirculatory changes in the general blood flow and periodontium was performed. Results. Pregnant women exhibited a reduction in vasomotor activity of vessels and a deterioration in the local blood flow rate. The coefficient of variation was 1.6 times smaller than in the control group (p=0.03). The percentages of the contribution of pulse and respiration waveforms were 7.6 (p=0.03) and 1.5 times (p=0.03) higher than in the control group, in the modulation spectrum of which the amplitude of myogenic genesis prevailed. We revealed a functional relationship between the local blood flow rate in the oral cavity microvessels and the vasomotor activity of the fourth finger of the left hand (Pearson correlation coefficient: 1.0). Conclusion. The revealed relationship confirms the homogeneity of changes in microcirculatory disorder both in periodontium and in the general blood flow in the entire body. This fact must be taken into account when managing pregnant women by a dentist and a gynecologist.
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Objective: to substantiate the feasibility and safety of a new surgical treatment method for patients with impression fractures and deformities of the posterolateral proximal tibial epiphysis from a topographic and anatomical standpoint. Materials and Methods. The study was conducted on 11 unfixed lower limb specimens obtained from six deceased individuals aged 52 to 64 years. The experiment was performed in two series. In the first series, the proposed surgery was simulated on three specimens, followed by dissection to assess the risk of damage to anatomical structures. In the second series, horizontal cuts with epoxy plastination (according to the method by D.A. Starchik) were made on eight specimens after the operation, and morphometry was performed. Results. In the first series of experiments, the technique of the proposed treatment method was tested, and nonexistent risk of damage to important neurovascular structures was confirmed. In the second series, the shortest distances from the fixation screw to the neurovascular structures were determined. The popliteal vein, popliteal artery, tibial nerve, and common peroneal nerve were located at a distance of 20.1–24.8 mm, 16.2–23.2 mm, 17.8–24.5 mm, and 13.2–24.1 mm, correspondingly. Conclusion. The effective technique of the proposed method was experimentally developed. The anatomical safety of the intervention was confirmed: the tibial nerve and popliteal vessels were located outside the risk area. The identified risk of injury to the common peroneal nerve during fibular head mobilization is minimized by correct execution of the technique.
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Background. The formation and development of industrial model for social processes and systems in the early twentieth century brought to life a novel form of organizing scientific activity via establishing research institutions. Objective. This study aimed to investigate the gaps in the history of traumatology institutions in the early years of the Soviet State. Materials and methods. We carried out a comprehensive analysis to retrieve the data from both State and institutional archives, as well as from the literature sources. The narrative analysis was chosen as the method of data interpretation. Most archive documents are made available to the scientific community for the first time. Our study covered the period of time from 1917 to 1930. Over 500 sources were analyzed. Results. We established that the first five traumatology institutions were founded in the following sequence: Saratov Traumatology Institute in 1919, Rostov Traumatology Institute in 1920; Astrakhan, Moscow Oblast, and Voronezh Traumatology Institutes in 1921. The concept of research institution was mainly designed to achieve the systematic augmentation of scientific knowledge and form a new employee type called a professional scientist. Conclusion. Discovering the history of establishing first traumatology institutions that provided healthcare services and conducted independent scientific studies led us to defining a new, previously unexplored institutionalization stage of Russian traumatology and orthopedics. In the early years of the Soviet State, research institutions facilitated the development and implementation of efficient medical technologies into healthcare practice.
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Ultrasonography screening of carotid arteries in asymptomatic patients
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Objective: to identify the most important predictors of carotid artery stenosis in ambulatory patients of Saratov and Saratov Oblast, using multivariate analysis, and to specify an ideal patient for ultrasonographic screening. Materials and methods. In 2014-2018, field consultations and ultrasonographic examinations were performed for asymptomatic patients with suspected carotid artery disease at outpatient clinics of Saratov and Saratov Oblast. Such patients were referred for screening by neurologists and general practitioners. The study encompassed 470 medical charts. The multivariate regression analysis was performed to identify independent predictors of carotid artery stenosis of 50 per cent or more. Results. Carotid artery stenosis of ≥30% was detected in 24.5% (i.e., 115 of 470) of study participants; of ≥50% in 10.2% (48 of 470) patients, and of ≥70% stenosis in 2.9% (14/470) of participants. The multivariate analysis revealed that the odds of finding stenosis of ≥50% in patients, selected by neurologists and general practitioners for ultrasonographic screening, were significantly higher in the presence of the following factors: age exceeding 72, male gender, acute cerebrovascular event in anamnesis > 6 months ago, atherosclerosis of leg arteries, and episodes of speech impairment. We developed the point scale for risk assessment. A point scale for risk assessment has been created. In the absence of prognostic factors, the absolute risk of detecting stenosis ≥50% was just 3%, with 1 point it was 16%, and with 4 points it amounted to >50%. Conclusion. Our analysis enabled us to specify the most significant predictors of carotid artery stenosis in patients observed at outpatient clinics of Saratov and Saratov Oblast, and to obtain a patient model helping to optimize optimize selection for ultrasonographic examination.
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Use of linezolid and bedaquiline in patients with pulmonary tuberculosis in the postoperative period
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Objective: to assess the effectiveness of chemotherapy regimens for multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) with the inclusion of linezolid (Lzd) and bedaquiline (Bq) in patients who underwent a surgery for pulmonary TB. Materials and Methods. A non-randomized continuous single-center retrospective clinical trial based on 154 patients who were operated for drug-resistant pulmonary TB at the National Medical Research Center for Phthisiology and Infectious Diseases, Moscow, Russia, from 2018 through 2023. A comparative analysis of the effectiveness of chemotherapy regimens (depending on the inclusion of new anti-tuberculosis drugs [ATDs]) was performed. Results. The proportions of adverse effects of ATDs in both study groups without taking into account the use of Lzd and Bq were similar: in 24.1% (n=21/87) of cases in Group 1 and in 25.4% (n=17/67) of patients in Group 2. The inclusion of Lzd and Bq in the postoperative chemotherapy regimen (Group 1) significantly reduced the duration of the treatment course to 38.5±2.1 weeks vs. 44.6±2.2 weeks in Group 2. Thus, the favorable outcome occurred 6.1 weeks earlier with the inclusion of Lzd and Bq (p=0.041). Adverse effects of ATDs were observed in 24.1% of patients treated with Lzd and Bq. Conclusion. The inclusion of Lzd and Bq in the MDR-TB and XDR-TB chemotherapy regimens makes it possible to reduce the total duration of the treatment course until a favorable outcome is observed.
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Objective: to assess the informativity of using the cytological rapid method for examining sentinel lymph nodes in patients breast cancer. Materials and Methods. Our included 46 patients 30-85 years of age with verified breast cancer. On the day before the surgery, approximately 150-200 MBq of the 99mTc-NanoTop radiopharmaceutical were injected peritumorally into the parenchyma of the affected mammary gland. After 1.5-2 hours, lymphoscintigraphy was performed, followed by SPECT/CT. The latter helped visualizing sentinel lymph nodes. The next day after the administration of the radiopharmaceutical, during surgery, sentinel lymph nodes were identified using a gamma detector. Further on, the surgeon removed the lymph node(s) and sent it/them for the examination by the cytological rapid method. To assess the informativity of this method, we compared its results the gold standard of morphological diagnostics: histological examination of postoperative material. Results. The cytological rapid method revealed the presence of metastases in sentinel lymph nodes in 12 patients, which substantially influenced their further treatment tactics. We therefore conformed that this method is not inferior to the histological examination of the tumor. The sensitivity and specificity of the cytological rapid method are 100%. When comparing the results of cytological rapid method and planned histological examination, we revealed no discrepancies in diagnoses based on the state of the lymph nodes. Conclusion. Cytological rapid method is an informative method for sentinel lymph node detection in breast cancer patients.
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