Nevin Manimala

Georgian Med News. 2021 Apr;(313):113-117.

ABSTRACT

The aim of the article is scientific conceptualization of the problem of mental derangement as a mandatory medical criterion of limited sanity according to criminal legislation by experience of Ukraine and some foreign countries and development of new approaches to such status assessment. Empirical study base of the problem consists of judgments of conviction taken from Unified State Register of Court Rulings of Ukraine and carried out on persons who commit crimes in the state of limited sanity from March 1st, 2014, till August 1st, 2020. Results of some foreign researchers’ studies of the problem in question have been used as well. A combination of general and special scientific methods (comparative method, system structural method, method of statistical analysis, method of legal phenomenon system analysis etc.) has been applied to reach the aim in view. In conclusion: medical criterion of limited sanity (“mental derangement”) used by lawmaker does not allow defining clearly types of illnesses, represent all possible types of psychiatric pathology and also causes complications in law enforcement practice. It has been proved that increase of quantity of people having mental derangements and quantity of crimes committed by such people shows that non-application of compulsory measures of medical care, correlational programs leads to repeated crimes commitment. Taking into account absence of duration of compulsory measures of medical care application, it has been suggested to stipulate this by Ukrainian legislation and to develop classification of mental derangements and criteria of their division into severe and non-severe.

PMID:34103441

Georgian Med News. 2021 Apr;(313):89-93.

ABSTRACT

Herpesvirus infections (HI) are the most common HIV-associated diseases. Due to the development of the HIV pandemic, the incidence of HI against the background of HIV infection is steadily increasing, and the implantation of HAART makes certain changes in the course of diseases of this category. The aim of the study was to compare clinical and immunological data in different forms of HI in HIV-positive patients and in patients with normal immune status. From March, 2019 to April 2021, 59 HIV-positive and 60 HIV-negative patients were included in the study. The study used clinical and laboratory methods: ELISA, PCR (HIV RNA, HSV-1, HSV-2, VZV, EBV, CMV, HHV-8), immunological studies (CD3 +, CD4 +, CD8 +, CD4 +/CD8 +, CD20 +). The data were statistically processed using the IBM SPSS Statistics statistical package. The clinical features of herpesvirus skin diseases associated with HIV is closely related to the immune status. The spectrum of clinical manifestations and the incidence of skin and mucous membrane diseases in HIV-infected people are influenced by the severity of immunodeficiency and the systemic use of antiretroviral drugs. The severity of manifestations correlates with the level of CD4 + cells: with a value below 349 cells/μl, an atypical course was observed, and with a value of less than 200 cells/μl, a generalized infectious process.

PMID:34103437

Georgian Med News. 2021 Apr;(313):66-71.

ABSTRACT

Musculoskeletal diseases significantly impair the quality of life and work limitation. Purpose: to determine specificities of work limitation dynamic amongst the patients with lower back and lower limbs musculoskeletal disorders grouped by their psychotypes within the outpatient physical therapy. The Work Limitations Questionnaire (WLQ) was used in the research. The study involved 55 patients who completed a course of physical therapy. The data obtained confirmed the impact of the type of attitude to the disease on all indicators of work limitations according to the WLQ, except for the “Physical Demands” scale. The study confirmed the existence of greater work limitations amongst the patients with irrational psychotypes. The biggest difference between the groups was observed on the “Time Management” scale. All questionnaire scales had significant improvements during physical therapy in both groups. The most significant changes were observed on the “Physical Demands” and “Time Management” scales. The largest difference between the groups was observed on the “Physical Demands” and “Mental-Interpersonal Demands” scales. After grouping the patients by the type of attitude to the disease, a number of significant differences in the indicators of work limitations were observed. Though being slightly better, dynamic indicators did not register any statistical advantages in group rational psychotypes during physical therapy. These results are important for working out an individualized physical therapy program according to the type of attitude to the disease, improving dynamic of work limitation indicators, and probably the quality of life.

PMID:34103433

Georgian Med News. 2021 Apr;(313):48-51.

ABSTRACT

The aim – to study the efficiency of correction of hard tooth tissues discoloration. The study was conducted on 135 patients with tooth discoloration. Clinical – complex examination of patients with determination of hard tooth tissues color (Vіta scale), indexes of individual oral hygiene, intensity and prevalence of gums inflammation for the study of efficiency of the applied medical and preventive complexes of correction of hard tooth tissues discoloration depending on a clinical situation; statistical – for determination of authenticity of differences of the results. Patients of O-1 group, who used abrasive bleaching toothpastes, during the initial examination, had a poor oral hygiene. In patients O-2 group, who used peroxide containing bleaching toothpastes, during examination of 420 teeth hard tooth tissues discoloration were noted in 187 (44.53%) patients teeth. Patients O-3 group, who used enzyme containing bleaching toothpastes, during the initial examination had hard tooth tissues discoloration in 198 (47.14%) tooth. The proposed algorithms for whitening with usage of oral hygiene facilities tested positive. However, obtained in the long-term observation results showed that the most pronounced bleaching effect with enzyme containing toothpaste. Studies had shown the most pronounced efficacy of enzyme containing whitening toothpaste in the complex treatment and prevention of correction of hard tooth tissues discoloration compared to other whitening toothpastes.

PMID:34103429

Georgian Med News. 2021 Apr;(313):41-44.

ABSTRACT

Otitis is a serious and noteworthy disease. Only timely and adequate treatment guarantees to cure it and prevent complications. The present study involved 250 patients, raining in age from 2 to 64 years. Patients’ data were anonymous and cannot be identified. 125 patients were diagnosed with middle purulent otitis, 20 with middle secretory otitis, 78 with external diffuse otitis, and 27 with external otitis media.The aim of the research was to determine the efficacyof antibiotic-contained ear drops in the treatment of acute otitis media, in combination with mono- or systemic antibiotics. The data were analyzed utilizing the descriptive statistics. The frequency distribution of variables was also determined and the results were presented in appropriate numeric values and percentages.

PMID:34103427

Georgian Med News. 2021 Apr;(313):12-20.

ABSTRACT

Objective – to study the character of possible postoperative complications and to define the reason and frequency of postoperative hemorrhage as a complication of partial nephrectomy. From January 2008 to December 2019 were performed 175 partial nephrectomy (PN) by a single surgeon in a high volume center. 41 operations were laparoscopic partial nephrectomy (LPN), 134 – open partial nephrectomy (OPN). In 152 cases kidney cancer was detected. Physical status, tumor volume, R.E.N.A.L. score, operative access, warm ischemia time (WIT), postoperative bleeding and its severity and treatment options were assessed in both groups of patients. Based on our study, R.E.N.A.L score may be a good tool in prognosis of a delay postoperative bleeding after nephron sparing surgery and this is statistically significant. On the other hand, single R.E.N.A.L score characteristics can’t be reliable predictors of a delay bleeding. It is possible that a lack of cases with a significant postoperative bleeding in current study (6 of 175 cases) have some statistical restrictions. From our point of view, for better prognosis of delay bleeding, aside from hephrometric system it is important to take into account a proximity of a segmental arteries to a resection border, presens of any type of a coagulopathy and a preoperative antithrombotic therapy, obesity. High R.E.N.A.L score index is connected with a risk of significant postoperative bleeding, but this type of bleeding is rare after any nephron sparing surgery. Postoperative selective angioembolization is a method of choice and, in most cases, effective to stop kidney bleeding and nephron preservation.

PMID:34103423

Hosp Pediatr. 2021 Jun 8:hpeds.2020-005298. doi: 10.1542/hpeds.2020-005298. Online ahead of print.

ABSTRACT

OBJECTIVES: Patients with autoimmune encephalitis (AE) often present with symptoms that are broadly characterized as psychiatric or behavioral, yet little attention is given to the precise symptomatology observed. We sought to more fully define the psychiatric symptoms observed in patients with anti-N-methyl-D-aspartate receptor (NMDAR), anti-glutamic-acid-decarboxylase 65 (GAD65), and anti-voltage-gated-potassium-channel complex (VGKC) antibody-mediated AE using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition nomenclature.

METHODS: We present a case series (n = 25) using a retrospective chart review of 225 patients evaluated for AE in a tertiary care academic medical center between 2014 and 2018. The included patients were ≤18 years old with anti-NMDAR AE (n = 13), anti-GAD65 AE (n = 7), or anti-VGKC AE (n = 5). The frequency of neuropsychiatric symptoms present at the onset of illness and time to diagnosis were compared across groups.

RESULTS: Psychiatric symptoms were seen in 92% of patients in our cohort. Depressive features (72%), personality change (64%), psychosis (48%), and catatonia (32%) were the most common psychiatric symptoms exhibited. On average, patients experienced impairment in ≥4 of 7 symptom domains. No patients had isolated psychiatric symptoms. The average times to diagnosis were 1.7, 15.5, and 12.4 months for anti-NMDAR AE, anti-GAD65 AE, and anti-VGKC AE, respectively (P < .001).

CONCLUSIONS: The psychiatric phenotype of AE in children is highly heterogenous. Involving psychiatry consultation services can be helpful in differentiating features of psychosis and catatonia, which may otherwise be misidentified. Patients presenting with psychiatric symptoms along with impairments in other domains should prompt a workup for AE, including testing for all known antineuronal antibodies.

PMID:34103402 | DOI:10.1542/hpeds.2020-005298

Stroke Vasc Neurol. 2021 Jun 8:svn-2020-000852. doi: 10.1136/svn-2020-000852. Online ahead of print.

ABSTRACT

BACKGROUND: For patients with stroke with large-vessel occlusion (LVO), study of factors predicting response to intravenous thrombolysis (IVT) would allow identifying subgroups with high expected gain, and those for whom it could be considered as futile, and even detrimental. From patients included in the Mechanical Thrombectomy After Intravenous Alteplase vs Alteplase Alone After Stroke trial, we investigated clinical-imaging factors associated with optimal response to IVT.

METHODS: We included patients receiving IVT alone. Excellent outcome was defined by a 3-month modified Rankin Scale (mRS) score ≤1. Clinical-imaging predictors were assessed on multivariate analysis after multiple imputations. The predictive performance of the model was assessed with the C-statistic.

RESULTS: Among 247 patients with LVO treated with IVT alone, 77 (31%) showed 3-month mRS ≤1. Predictors of 3-month mRS ≤1 were no medical history of hypertension (OR 2.43; 95% CI 1.74 to 3.38; p=0.007); no current smoking (OR 2.76; 95% CI 1.79 to 4.26; p=0.02); onset-to-IVT time (OR 0.47 per hour increase; 95% CI 0.23 to 0.78; p=0.003); diffusion-weighted imaging (DWI) volume (OR 0.78 per 10 mL increase; 95% CI 0.68 to 0.89; p=0.0004); presence of susceptibility vessel sign (SVS) (OR 7.89; 95% CI 1.65 to 37.78; p=0.01) and SVS length (OR 0.87 per mm increase; 95% CI 0.80 to 0.94; p=0.001). The prediction models showed a C-statistic=0.79 (95% CI 0.79 to 0.80).

CONCLUSIONS: In patients with stroke with anterior-circulation LVO treated with IVT alone, predictors of excellent outcome at 3 months were no medical history of hypertension or current smoking, reduced onset-to-IVT time, small DWI volume, presence of SVS and short SVS length. These predictive factors could help practitioners in decision-making for IVT implementation in reperfusion strategies, all the more for the drip and ship paradigm.

TRIAL REGISTRATION NUMBER: NCT01062698.

PMID:34103393 | DOI:10.1136/svn-2020-000852

J Immunother Cancer. 2021 Jun;9(6):e002718. doi: 10.1136/jitc-2021-002718.

ABSTRACT

BACKGROUND: Previous studies have suggested that inflammatory markers (neutrophil-to-lymphocyte ratio (NLR), lactate dehydrogenase (LDH) and fibrinogen) are prognostic biomarkers in patients with a variety of solid cancers, including those treated with immune checkpoint inhibitors (ICIs). We aimed to develop a model that predicts response and survival in patients with relapsed and/or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) treated with immunotherapy.

METHODS: Analysis of 100 consecutive patients with unresectable R/M HNSCC who were treated with ICI. Baseline and on-treatment (day 28) NLR, fibrinogen and LDH were calculated and correlated with response, progression-free survival (PFS) and overall survival (OS) using univariate and multivariate analyses. The optimal cut-off values were derived using maximally selected log-rank statistics.

RESULTS: Low baseline NLR and fibrinogen levels were associated with response. There was a statistically significant correlation between on-treatment NLR and fibrinogen and best overall response. On-treatment high NLR and raised fibrinogen were significantly associated with poorer outcome. In multivariate analysis, on-treatment NLR (≥4) and on-treatment fibrinogen (≥4 ng/mL) showed a significant negative correlation with OS and PFS. Using these cut-off points, we generated an on-treatment score for OS and PFS (0-2 points). The derived scoring system shows appropriate discrimination and suitability for OS (HR 2.4, 95% CI 1.7 to 3.4, p<0.0001, Harrell’s C 0.67) and PFS (HR 1.8, 95% CI 1.4 to 2.3, p<0.0001, Harrell’s C 0.68). In the absence of an external validation cohort, results of fivefold cross-validation of the score and evaluation of median OS and PFS on the Kaplan-Meier survival distribution between trained and test data exhibited appropriate accuracy and concordance of the model.

CONCLUSIONS: NLR and fibrinogen levels are simple, inexpensive and readily available biomarkers that could be incorporated into an on-treatment scoring system and used to help predict survival and response to ICI in patients with R/M HNSCC.

PMID:34103355 | DOI:10.1136/jitc-2021-002718

Science. 2021 Jun 8:eabe4832. doi: 10.1126/science.abe4832. Online ahead of print.

ABSTRACT

The COVID-19 pandemic has revealed the pronounced vulnerability of the elderly and chronically-ill to SARS-CoV-2-induced morbidity and mortality. Cellular senescence contributes to inflammation, multiple chronic diseases, and age-related dysfunction, but effects on responses to viral infection are unclear. Here, we demonstrate that senescent cells (SnC) become hyper-inflammatory in response to pathogen-associated molecular patterns (PAMPs), including SARS-CoV-2 Spike protein-1, increasing expression of viral entry proteins and reducing anti-viral gene expression in non-SnCs through a paracrine mechanism. Old mice acutely infected with pathogens that included a SARS-CoV-2-related mouse β-coronavirus experienced increased senescence and inflammation with nearly 100% mortality. Targeting SnCs using senolytic drugs before or after pathogen exposure significantly reduced mortality, cellular senescence, and inflammatory markers and increased anti-viral antibodies. Thus, reducing the SnC burden in diseased or aged individuals should enhance resilience and reduce mortality following viral infection, including SARS-CoV-2.

PMID:34103349 | DOI:10.1126/science.abe4832