ScienceRise: Medical Science

Gut microbiota modulation by postbiotics in patients with coronary artery disease and atrial fibrillation

Iryna Melnychuk — 2024-03-30

The aim: is to improve gut microbiota composition by the long-term postbiotics (glycine and propionic acid) supplementation in patients with coronary artery disease (CAD) and atrial fibrillation (AF).

Materials and methods: 40 patients were divided into 3 groups: first (CAD) – 14 patients with CAD but without arrhythmias; second (CAD+AF) – 18 patients with CAD and AF paroxysm; and the control group – 8 patients without CAD and arrhythmias. 16 patients from the II group received basic therapy, according to the latest ESC guidelines, and postbiotic supplementation: rebamipide (2-(4-chlorobenzoylamino)-3-[2(1H))-quinolon-4-yl] propionic acid) by 100 mg 3 times a day and glycine by 100 mg 3 times a day during 6 months. 16-S rRNA sequencing checked gut microbiota composition.

Results: The II group patients had a significant rise in Pseudomonadota (by taxonomic analysis), Actinobacter Spp. and a decrease in Blautia Spp., Bacteroides Thetaiotaomicron compared with the I group, P<0.05. Long-term postbiotics supplementation for patients with coronary artery disease and atrial fibrillation leads to a significant decrease in Firmicutes/ Bacteroides ratio, P<0.05; a significant rise in Verrucomicrobiota and a decrease in Firmicutes, P<0.05; a significant increase in Lactobacillus spp., Akkermansia muciniphila, Blautia spp., Prevotella spp. and a decrease in Streptococcus spp. and Methanosphaera stadmanae, P<0.05. A significantly lower F/B ratio was found in the patients with long-term postbiotics supplementation in comparison with placebo group patients, P<0.05. A significant increase in Actinomycetota was found in the patients with long-term postbiotics supplementation compared to placebo group patients, P<0.05. A significant increase in probiotic species (Akkermansia muciniphila, Blautia spp., Eubacterium Rectale, and Prevotella spp.) and a decrease in species, associated with cardiometabolic disorders (Streptococcus spp.) was found in the patients with long term postbiotics supplementation in comparison with placebo group patients, P<0.05.

Conclusion: Long-term postbiotics supplementation for patients with coronary artery disease and atrial fibrillation leads to positive gut microbiota modulation

Assessment of the implantation window and embryonic factor impact to the treatment of recurrent implantation failure (RIF). A prospective study

Oleksandra Kozyra — 2024-03-30

The aim: to study of the prognostic value of endometrial receptivity and preimplantation genetic diagnosis of embryos, and their influence on the effectiveness of in vitro fertilization (IVF) programs. We also evaluate the importance of this factor in comparison with other potential causes of infertility.

Materials and methods: This prospective cohort study included 123 infertile women who underwent in vitro fertilization (IVF) treatment. 93 patients had repeated unsuccessful implantation attempts and were divided into three groups: group 1 - patients who were treated using genetically untested embryos according to a standard fixed stimulation protocol, group 2 - patients who were treated using euploid embryos after preimplantation genetic screening according to standard fixed protocol; group 3 - patients who underwent treatment using euploid embryos after pre-implantation genetic screening and determination of the implantation window with subsequent modification of the stimulation protocol, according to the endometrial examination result. 30 patients had a first attempt at IVF, which was carried out using genetically untested embryos, according to a standard fixed protocol, and made up the control group (CG).

Determination of the window of implantation was carried out by triple aspiration biopsy of the endometrium during the luteal phase of the menstrual cycle since the endometrium is most susceptible to implantation during this period. Samples were analyzed using scanning electron microscopy. Based on the results obtained, the endometrial preparation protocol was individualized for the next attempt. preimplantation genetic testing (PGT) of embryos was carried out by the next generation (NGS) method.

Statistical analysis was performed using IBM SPSS V25.0 for Windows software.

Results: According to the obtained results, patient characteristics, screening rates, IVF cycle characteristics, and the number, quality, and stage of transferred embryos were compared between groups. The rate of clinical pregnancy was 46.7 % among patients of group 1.70 % among patients of group 2, 82.8 % among patients of group 3 and 50.0 % of the control group and statistically significantly different between groups (χ²=10.955, p= 0.012). The rate of live birth was 43.3 % among patients of group 1, 53.3 % among patients of group 2, 72.4 % among patients of group 3 and 43.3 % - of the control group, however, it did not differ statistically significantly between groups (χ²=6,639, р=0,084)

Conclusions: The unique window of implantation and the embryonic factor are among the main reasons for multiple failed implantation attempts. Personalization of the endometrial preparation protocol and preimplantation embryo diagnosis are effective methods to improve IVF outcomes

Acute pain syndromes in injuries to the nerves and plexuses of the limbs

Olga Dubenko — 2024-03-30

Injuries of peripheral nerves and plexuses cause serious disorders in the affected limbs. Unfortunately, the frequency of nerve injuries and limb plexuses is steadily increasing in our country, due to hostilities, which emphasizes the extreme relevance of this pathology.

The aim of the review is to consider the current data on pathophysiological mechanisms, clinical manifestations, and treatment of acute pain syndromes in patients with injuries of peripheral nerves and limb plexuses.

Materials and methods. Scientific databases PubMed, Google Scholar, Scopus, Cochrane Library, as well as the materials of the International Association for the study of pain were used to search for sources of research information. The main studies were found in Pubmed, Google Scholar and materials of the International Association for the study of pain and made up 191 sources of information, 150 of which were excluded from the review due to insufficient data on pathophysiological mechanisms, clinical manifestations, and treatment of pain syndromes in patients with damage to the nerves and plexuses of the limbs, thus 41 sources of information formed the basis of the review.

Results: Brachial plexus and peripheral nerve injuries can be associated with any combination of nociceptive, neuropathic, phantom limb pain, and even complex regional pain syndromes. Acute neuropathic pain is an under-recognized condition, often difficult to treat and can progress to persistent pain and disability. Neuropathic pain develops because the main damage affects the somatosensory system. It is caused by peripheral nerve damage and associated changes in the central nervous system. The first line of pharmacological treatment for neuropathic pain according to current guidelines is anticonvulsant drugs that affect neuronal calcium channels, as well as tri- and tetracyclic antidepressants and selective serotonin/norepinephrine reuptake inhibitors.

Conclusions: At the current stage, progress has been made in understanding the mechanisms of development of the pathological condition and in the development of therapeutic approaches, however, the chronicity of pain syndrome in patients with damage to the nerves and plexuses of the limbs is still high, which requires further research to develop complex pathogenetic therapy and better understanding of the mechanisms pain in this category of patients

Body mass index, lipid profile, and endothelial dysfunction gene polymorphism in women with early-onset and late-onset preeclampsia

Tetiana Loskutova — 2024-03-30

The aim: to investigate and analyze clinical parameters, laboratory biomarkers of lipid metabolism and endothelial dysfunction gene polymorphisms in early-onset and late-onset preeclampsia and to identify potential risk factor(s) for the development of early-onset preeclampsia.

Materials and methods: a prospective case-control study included 133 women in the second half of pregnancy, including 46 with early-onset (EOP) and 87 with late-onset preeclampsia (LOP) and 34 conditionally healthy pregnant women with an uncomplicated obstetric history and no risk factors for preeclampsia. Concentrations of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides in blood plasma were determined. Genetic polymorphisms of endothelial dysfunction (192 Q→R PON-1, 677 C→ T MTHFR) were studied using allele-specific polymerase chain reaction.

Results: Early-onset preeclampsia is associated with an increased relative risk: preterm delivery by 2.08 times (95 % CI 1.48-2.93), operative delivery by 2.2 times (95 % CI 1.46-3.33), early operative delivery by 2.9 times (95 % CI 1.5-5.5), fetal distress during delivery by 3.78 times (95 % CI 1.2-11.9), a low score on the Apgar scale on the 1st minute, less than 6 points, by 2.59 times (95 % CI 1.84-3.66), on the 5th minute – 5.04 times (95 % CI 1.41-18.11), Grade III prematurity – 13.24 times (95 % CI 3.14-55.78) compared to women with late-onset preeclampsia. The study found that overweight was more often observed in patients with EOP (34.8 %) than in those with normal pregnancy (15.9 %) (p=0.02; OR=2.8; 95 % CI 1.03-7.7), obesity (BMI > 30 kg/m2) was more often recorded in those with LOP (33.33 %) than in the control group (3 (6.8 %)) (p=0.02; OR=6.8; 95 % CI 1.9-23.9). Patients in both groups with preeclampsia showed signs of dyslipidemia, but its significance in the development of early-onset or late-onset preeclampsia has not been separately proven. The study found that the number of carriers of MTHFR 677 TT in the group with EOP prevailed over the indicator of C group where there were no carriers of the pathological homozygote 677TT (p<0.05, OR= 20.73 95 % CI 1.16-371.28), and the T allele in the EOP group occurs 1.78 times more often than in the LOP group (p<0.05, OR=2.22; 95 % CI 1.26-3.88) and 2.43 times more often than in the C group (P<0.05, or= 3.15; 95 % CI 1.54-6.45).

Conclusions: Factors of early onset of PE include pre-pregnancy, overweight, first pregnancy, a history of preeclampsia, and carrier of the 677T allele of the MTHFR gene

Analysis of exhaled breath condensate in patients with asthma and recurrent wheezing

Viktoriia Kolisnyk — 2024-03-30

Wheezing is the most common clinical symptom of bronchial obstructive syndrome. The functions of pulmonary surfactant (PS) depend directly on the level of total phospholipids (TP). This can be used to assess the integrity of the cell membrane structure.

Objective. To determine the level of total phospholipids and calcium in exhaled breath condensate in young children with recurrent wheezing and asthma.

Materials and methods. The study included 77 patients divided into 3 groups. Group 1 included 30 patients (20 girls and 10 boys) with no more than 2 episodes of recurrent wheezing in their lifetime; Group 2 -10 patients (6 boys and 4 girls) with more than 3 episodes of recurrent wheezing, and 37 patients (15 girls, 22 boys) with asthma. The control group consisted of 20 conditionally healthy children (11 girls, 9 boys). All patients were aged from 3 months to 6 years. The determination of phospholipid levels and calcium (Ca) in the exhaled breath condensate was performed in dynamics - during the period of clinical manifestations and remission.

Results. The level of phospholipids in the exhaled breath condensate was the highest in patients of all groups at the stage of clinical manifestations compared with the period of remission, while its lowest level was noted in the control group. During the peak of the disease, the level of Ca in the exhaled breath condensate was significantly lower compared to the period of remission. The control group had the highest level.

Conclusions. The exhaled breath condensate's high level of phospholipids in the first days of the disease confirms cell damage in the presence of inflammation. Additionally, the exhaled breath condensate's Ca level is lowest during this period, possibly indicating its involvement in cell damage

Analysis of the frequency of cervical pathology manifestation in permanent teeth of different groups

Zoriana Masna — 2024-03-30

Cervical tooth lesions today belong to the most common dental pathologies characterized by a pronounced tendency to increase.

The aim of our study was to determine the frequency of various types of cervical pathology in formed permanent teeth.

Material and methods. The randomized group of examined patients included 200 middle-aged individuals (100 males and 100 females). The examination included collecting anamnestic data and examining the oral cavity and teeth to identify cervical caries and non-carious lesions of cervical localization.

Results. Various types of cervical tooth pathology were found in 45 % of the total number of examined patients. The highest percentage among cervical lesions belongs to cervical caries (28.5 %). The frequency of cervical erosions is 16 %, and wedge-shaped defects - 13.5 %. Cervical caries and erosions are more often detected in males, while wedge-shaped defects are more common in females. In females, isolated cervical caries are most frequently manifested (36 %), and isolated wedge-shaped defects and erosions are less frequent (16 % and 17 % respectively). The least frequent manifestation in females is the combined lesion of teeth with wedge-shaped defects and erosions (5 %). In males, isolated cervical caries is most frequently detected (42 %), isolated erosions are nearly twice less common (23 %), and isolated wedge-shaped defects (8 %) and combined lesions of teeth with wedge-shaped defects and erosions (4 %) are the least frequent. All types of cervical pathology most often affect premolars, less often incisors, and least often molars.

Conclusions. 45 % of middle-aged individuals seeking dental care have cervical tooth lesions, with the highest percentage being cervical caries. Cervical caries and erosions are more common in males, while wedge-shaped defects are more common in females. All types of cervical pathology most often affect premolars and, least often, molars

Sacrococcygeal pilonidal cyst with the disease onset as an anterior perianal abscess: a clinical case

Dmytro Dubenko — 2024-03-30

The aim. To analyze the clinical case of surgical treatment of a patient with a pilonidal cyst (PC) of the sacrococcygeal area, which manifested as an anterior perianal abscess, and to justify the need for an in-depth differential and diagnostic search in patients with corresponding clinical manifestations of perianal pathology.

Description of a clinical case. The article describes a clinical case of successful treatment of a 24-year-old patient with a pilonidal cyst of the sacrococcygeal area and a purulent secondary fistula that mimicked a perianal abscess with an incomplete external fistula of the rectum. Data are given on the step-by-step performance of the diagnostic process and the choice of optimal surgical treatment tactics.

Results and discussion. The described clinical case is interesting for specialists and its detailed coverage due to: a) the presented atypical course of PC; b) selected diagnostic tactics; c) the selected method of operative treatment of the patient. The points mentioned above are described in detail in the section, with coverage and visualization of possible alternative options for the patient's diagnosis and the use of various tactics for surgical treatment.

Conclusions. Conducting an extended differential diagnostic search using additional instrumental imaging methods is justified in patients with pilonidal disease with an atypical or blurred course. Performing a complete perioperative set of examinations allows for choosing the correct surgical tactics for treating such patients. The use of a full-fledged invasive examination of the perianal area using methods of regional or general anesthesia is reasonably justified in case of suspicion of insufficient informativeness of clinical-instrumental, laboratory, and imaging methods of examination

Episode of renal dysfunction in a child with eating disorder: a case report

Ievgeniia Burlaka — 2024-03-30

Among the various organ dysfunctions seriously affected by eating disorders (EDs) is kidney damage. The kidneys are vital organs responsible for several essential functions, including the balance of the body's acid-base and mineral metabolism, the removal and excretion of substances, and the regulation of blood volume and pressure.

Eating disorders are a widespread and clinically relevant class of multiorgan disorders that occur mainly in adolescence. EDs often have serious clinical manifestations, which are determined by electrolyte imbalance, endocrine and mental disorders, renal failure, and other disorders. Common eating disorders discussed in the literature and frequently encountered in clinical practice are anorexia nervosa and bulimia nervosa. Anorexia nervosa is a type of abnormal eating behaviour that involves the consumption of very little food and may include intentional vomiting or the misuse of laxatives or diuretics.

Kidneys perform a number of vital functions to maintain homeostasis in our body. One of the main functions of the kidneys is blood filtration and the removal of metabolic products. This allows you to maintain the optimal level of fluid and electrolytes and remove toxins. Restriction of fluid intake and abuse of diuretics can cause a decrease in blood flow to the kidneys and further renal failure. The result of the latter is the development of serious violations of vital functions. Low dietary protein intake in people following a restricted diet (restrictive anorexia) leads to a decrease in glomerular filtration rate (GFR) and renal plasma flow. Treatment of acute kidney injury on the background of volume deficit due to fluid loss involves its termination and hydration orally or with the help of intravenous infusions of physiological solution depending on the severity of volume deficit and kidney damage, which was observed and described in this clinical case.

Aim. To analyze the peculiarities of kidney injury in a child with an eating disorder.

Materials and Methods. A detailed analysis of the case history of a pediatric patient diagnosed with eating disorder complicated with an acute episode of renal dysfunction was done. Basic anamnestic, clinical, laboratory, and instrumental data were analyzed and given in the paper. A graphic presentation is done with PowerPoint.

Results. We describe a 14-year-old female patient diagnosed with ED and acute kidney injury (AKI) leading to intensive care unit interventions.

Conclusions. AKIs can result from a number of conditions that are common among anorexics and include dehydration, high blood pressure, toxins, inadequate nutrition and possibly altered electrolytes. Serum creatinine, blood urea nitrogen (BUN), glomerular filtration rate (GFR), and electrolytes are among the kidney function markers that need to be monitored in the early stages of AKI linked to anorexia. The right medical care, which includes normalizing blood pressure and adequate hydration, leads to the patient's recovery. Further follow-ups on kidney function in such patients are of high importance