ScienceRise: Medical Science

The influence of the Epstein-Barr virus on paraclinical indicators and cytokine levels in children with rotavirus gastroenteritis

2023-02-06T15:39:46+02:00

The aim. To identify the influence of the latent form of Epstein-Barr virus infection on the clinical picture, parameters of clinical blood analysis and cytokine response of children with rotavirus gastroenteritis.

Materials and methods. 56 children were examined. Of them, 33 children (group 1) had no background infection with herpesviruses, and 23 patients (group 2) suffered from rotavirus gastroenteritis against the background of Epstein-Barr virus (EBV) infection. The patients were comparable in terms of sex, age and disease severity. Differences at p <0.05 were considered statistically significant.

Results. The analysis of the obtained data showed that the latent form of EBV infection affects the clinical picture, indicators of clinical blood analysis and the reaction of serum cytokines of children with rotavirus gastroenteritis.

Сonclusions. A comparative analysis revealed that a latent form of herpesvirus infection in children with rotavirus gastroenteritis is associated with lower temperature reaction and a lower frequency of vomiting in the acute period of the disease against the background of longer persistence of fever, diarrhoea and catarrhal syndromes. On the part of the investigated laboratory indicators, the presence of EBV infection is characterized by a lower level of haemoglobin (р = 0,013) against a higher content of neutrophils (p = 0.002), eosinophils (p = 0.033) and monocytes (p < 0.001) in the acute period of RVI, and a significantly higher content of eosinophils (p = 0.001) and monocytes (p < 0.001) against the background of a lower level of the relative content of lymphocytes compared to patients of Group 1 in the period of early convalescence. Changes in the cytokine response in children with mixed infection are characterized by a significantly lower concentration of IL-1β at the onset of RVI and a higher content of IL-4 and TNF-α throughout the disease compared to children with mono-RVI

Sonoelastographic evaluation of salivary gland lesions with clinicopathological association

2023-03-14T10:11:29+02:00

Sonoelastography is a comparatively new and developing technology in the field of salivary gland imaging. Nevertheless, it has the potential to distinguish between various types of lesions by calculating the degree of strain-related deformation under the externally applied force. With this background, the present study was undertaken to evaluate the role of sonoelastography in characterising salivary gland lesions as benign or malignant.

The aim: To evaluate and characterize salivary Gland lesions on the Gray scale and Colour doppler ultrasonography and sonoelastography and to correlate these findings with the clinico-pathological diagnosis.

Methodology: This prospective cross-sectional study was conducted in the Department of Radiodiagnosis, Teerthanker Mahaveer Medical College & Research Centre, Moradabad (U.P.), from Aug 2021 to Nov 2022. All patients referred to the radiology department for imaging with clinical suspicion of having salivary gland lesions were enrolled in the study and evaluated on the SIEMENS ACUSON S3000 machine. Gray scale USG was done first to assess various morphological features of lesions, and then a Doppler assessment was done to determine vascularity within the lesion. Subsequently, real-time strain elastography (eSie touch) was performed to assess the tissue stiffness. The elastogram image of the detected lesions was evaluated using colour coding ranging from blue (soft) through green (intermediate/average hardness) and red (hard). After strain elastography, shear wave elastography of the lesion was also performed using Virtual Touch Quantification (VTQ) and Virtual Touch Imaging Quantification (VTIQ) software. The sonographic findings were correlated with histopathological diagnosis. The acquired data were subjected to statistical analysis using the software SPSS version 20. Sensitivity, specificity, PPV and NPV were calculated for conventional ultrasound techniques alone & in combination with elastography.

Results: Out of the 50 salivary gland lesions included in the study, 44 (88 %) were benign, whereas 6 (12 %) were malignant on cytology. The age of the study population ranged from 16 to 75 years, with a mean age of 38.82 years. Pleomorphic adenoma (60 %) was the most frequent lesion, followed by Warthin's tumour (28 %). The Conventional USG showed 66.67 %, sensitivity, 52.27 %, specificity, 16.00 %, PPV, 92.00 % NPV and 54.00 % accuracy in differentiating benign from malignant lesions while USG- Elastography combined showed higher diagnostic performance with 83.33 %, sensitivity, 79.55 %, specificity, 35.71 % PPV, 97.22 % NPV and 80.00 %, accuracy. The specific cut-off scores for the sonoelastography score, eSie touch, VTQ, and VTIQ were also determined to diagnose a lesion as malignant or benign, and the difference was found to be statistically significant.

Conclusions: Sonoelastography alone cannot be solely relied upon to distinguish between malignant & benign salivary gland abnormalities. However, it can be combined with conventional USG for better differentiation and characterization of these lesions

Prognosis of abnormal uterine bleeding in women of reproductive age with extragenital disorders

2023-03-15T19:13:53+02:00

The purpose of the study was to elaborate on a prognostic model for predicting the development of abnormal uterine bleeding in women of reproductive age with accompanying extragenital disorders based on mathematical methods.

Materials and methods. The study, which was in 2019-2022, involved 100 women of reproductive age with AUB and accompanying extragenital disorders under observation, who made up the main group. The control group comprised 50 women of reproductive age undergoing medical checkups. On the basis of 23 diagnostic indicators, the most informative ones were mathematically selected for the prognosis of AUB in women with extragenital abnormalities.

Results and their discussion. The prognosis of the risk of developing AUB in women of reproductive age with extragenital disorders was carried out on a double scale (0 – low probability, 1 – high probability). The search for diagnostically informative factors involved a set of 23 working indicators that were investigated in the examined patients using four levels of the risk scale. In order to solve this issue, the factors that have the greatest importance in the formation of the prognosis were selected using discriminant analysis methods, and a corresponding mathematical model was created. The classification functions made it possible to enter the practical plane and form rules for assessing the presence/absence of the risk of developing AUB in patients of reproductive age with extragenital disorders. The corresponding expressions are the following equations:

NP = BAS ART*75.57+FSH*2.96+prolac*0.02+estrad*0.02-40.78

PP = BAS ART*105.35+FSH*0.79+prolac*0.1+estrad*0.08-114.49,

where NP is a negative prognosis, PP is a positive prognosis.

If NP > PP, then the most likely prognosis is the absence of AUB in the patient; otherwise, if PP > NP – there is an increased risk of AUB.

Conclusion. Pulsation index in the basal arteries of the uterus, FSH, prolactin and estrogens are prognostically significant indicators for predicting the risk of abnormal uterine bleeding in patients of reproductive age with extragenital disorders. The above formula, obtained from the conducted discriminant analysis, makes it possible to predict bleeding in a specific patient

Study of consolidation chemotherapy after definitive chemoradiation in locally advanced carcinoma esophagus in a tertiary care hospital

2023-02-25T07:34:59+02:00

Concurrent chemoradiation (CCRT) is considered the standard of care in locally advanced and inoperable carcinoma oesophagus patients. However, the majority of these patients have residual disease after completion of CCRT, and there are no definitive treatment guidelines for the management of the residual disease. Reports on consolidation chemotherapy for patients with oesophagal cancer after definitive CCRT are rare and have shown mixed results.

The aim of this study was to see the effects of consolidation chemotherapy in patients of CCRT who had residual disease and were not surgical candidates and also monitor its side effects.

Material and methods: It was a prospective interventional protocol over 2 years where patients received 4 cycles of consolidation chemotherapy post-CCRT. These patients were followed after completion of chemotherapy for response, toxicity and survival.

Results: 45 patients were initially enrolled for the study, histopathologically proven carcinoma of the oesophagus, out of which 30 patients finally received the full course of treatment and were available for final assessment. After consolidation chemotherapy, 23 (76.7 %) patients had a complete response, 3 (10 %) had a partial response, and 4 (13.3 %) had stable disease. There was no progression of the disease during treatment. The overall treatment protocol was well tolerated by all the patients. There were no grade IV toxicities. On follow-up till the compilation of this data, 23 (76.6 %) of the patients were alive, and 7 (23.3 %) died (disease-related events). Out of these 7 patients, 4 patients had a local failure, and 3 patients developed distant metastasis in the form of brain and liver metastasis.

Conclusion: Consolidation chemotherapy after concurrent chemoradiation in locally advanced, inoperable carcinoma oesophagus is a well-tolerable protocol with high chances of complete response rates

Determining the risk of miscarriage in genetic forms of thrombophilia

2023-03-17T20:25:52+02:00

The aim: to study the distribution and influence of coagulation factor gene polymorphisms and endothelial dysfunction on the development of recurrent pregnancy loss.

Materials and methods: a prospective case-control study included 109 pregnant women in the 1st trimester with habitual miscarriage and 34 conditionally healthy pregnant women with an uncomplicated obstetrical anamnesis without risk factors for miscarriage. Genetic polymorphisms of coagulation and fibrinolysis factors (1691 G→A FVL, 20210 G→A prothrombin, 675 5G/4G PAI-1, 455 G→A fibrinogen β), as well as endothelial dysfunctions (192 Q→R PON-1, 677 C → T MTHFR) were investigated using allele-specific polymerase chain reaction.

Results: Pathological polymorphisms of the genes of the hemostasis system and endothelial dysfunction play a significant role in the development of miscarriage, namely such pathological genotypes as 1691 GA of factor V Leiden - increases the risk by 5.3 times (95 % CI 1.5-18.5), 20210 GA of prothrombin - by 26.47 times (1.6-445.7), 675 4G/4G PAI-1 - by 7, 5 times (1.7-33.79), -455AA fibrinogen β - 9.7 times (1.3-74.16), 677 CT MTHFR - 2.6 times (1.0-6.2), 677 TT MTHFR - 21.7 times (1.3-368.6). Multigenic forms of thrombophilia predominate in the majority of patients with miscarriage and account for 76.1 % (p<0.001, OR=12.31, 95 % CI 4.8-31.55). It was determined that the simultaneous presence of two pathological polymorphisms increases the risk of miscarriage by 3.88 times (OR 3.38; 95 % CI 1.26-9.97), and three ones - more than 2.5 times (OR 2.66; 95 % CI 1.02-7.19).

Conclusions: the course of pregnancy against the background of pathological polymorphisms of the genes of the hemostasis system and endothelial dysfunction significantly increases the risk of habitual miscarriage, which should be considered when planning a pregnancy in women with habitual miscarriage