Volume 15 (2022): Issue 2 (December 2022)

Multiple sclerosis (MS) is a chronic autoimmune demyelinating disease of the central nervous system (CNS) with unclear and multifactorial etiology, variable clinical symptoms with different severity, and treatment with limited efficacy. Authors conclude that the immune system has a role in pathogenesis, and many modern therapies target the immune system. Among clinicians, it is accepted that not every patient will progress in the same way, and there is high variability between clinical courses of MS in different patients.

Modern therapies have shown to reduce new lesions and clinical relapses but lack effectiveness at halting underlying neurodegeneration at lesions, the localized inflammation on a small scale, chronic demyelination, and axonal and neuronal damage. Dietary metabolites have far-reaching and systemic effects. It has been suggested that diet can play an essential role in helping to modify immune system function to promote regulation as opposed to inflammation. Polyunsaturated fatty acids decrease inflammation through conversion into anti-inflammatory prostaglandins E1 and E2, which affect cytokine production, leukocyte migration, and other immune system components. The Mediterranean style diet is a diet low in saturated fats, high in polyunsaturated and monounsaturated fats, rich in fruits and vegetables, and low in processed foods (low salt content). Eating a Mediterranean-style diet can help reduce fatigue (as reported by patients) and change the clinical course favorably.

Acquired enterocutaneous fistulas are a considerable problem of abdominal surgery. In most cases, they result from surgical intervention. There are different classifications based on different signs and factors. We aimed to summarize the management principles for patients with acquired enterocutaneous fistulas. Critical evaluation of the data available from existing studies. The therapeutic regimen includes nutritional support, sepsis control, skin care, and, possibly, surgical treatment. Surgical interventions are considered in high-output small bowel fistulas. The treatment is continuous and requires a multidisciplinary approach.

The pandemic caused by COVID-19 infection almost two years ago is associated with many unknown multi-organ damages, including the endocrine system. Based on the fact that endocrine gland tissues express ACE-2 and TMPRSS2, it has been suggested that they may be directly attacked by the virus and cause toxic effects on them directly or indirectly by an autoimmune mechanism. Hypothalamic-pituitary-adrenal axis hormones are crucial for the course and progression of the disease and modulate the magnitude of the immune response and adaptation to stress. The aim of the present review is to summarize the state of the art in the COVID-19 and endocrine problems in its clinical and pathophysiological part and to answer the question of to what extent patients with COVID-19 have a higher risk of adverse outcomes.

Gastric cancer is the fifth most common and third leading cause of cancer death worldwide. Patients with chronic atrophic gastritis (CAG) and intestinal metaplasia (IM) are at increased risk of developing gastric cancer (GC). It is common for CAG to precede IM, but the etiology of the two conditions is not always the same. Different scoring systems are used to assess HAG, MI, and GC risk, making it difficult to interpret results from investigations and management of these conditions.

Gastroenteropancreatic neuroendocrine tumors are a heterogeneous group of tumors. There are several classification systems, and all of them have been validated.The article aims to summarize the existing classification systems of gastroenteropancreatic neuroendocrine tumors.A critical evaluation was based on the data available from existing studies.The classification of the European neuroendocrine tumor society is the one with the clinical benefits.The lack of unified classification systems creates incomplete epidemiologic data, leading to confusion among pathologists and clinicians.

Transanal total mesorectal excision (TaTME) is a trending and promising surgical procedure to treat rectal cancer with oncologically oriented precision. Complication rates are promising after the learning curve is passed. A prospective study on the first 12 consecutive TaTME patients was done. The primary aim was the intraoperative and the early and late postoperative complications rate. Оne persisting failure as an intraoperative complication was reported: two anastomotic leaks and a ventral hernia as postoperative complications. TaTME is safe in terms of intra- and postoperative complications.

The study compared early post-surgical complications between two groups of patients with pancreatoduodenal resection for pancreatic head carcinoma: patients with pancreatic-gastric anastomosis with mixed drainage and controls with pancreatic jejunal anastomosis with external drainage. The present study was a cohort study. The patient group was selected prospectively, and the control group – retrospectively. Patients were randomized by sex, age, primary tumor location, pancreatic parenchyma density, clinical symptoms, tumor–node–metastasis (TNM), and grade (G). We used the IBM SPSS Statistics software with the following tests: Fisher’s exact test, Pearson’s chi-squared test, Mann–Whitney U test. The optimized reconstruction approach with mixed drainage reduced early complications: early mortality - by 2.5%, overall morbidity - by 7.5%; pancreatic-digestive anastomosis insufficiency - by 2.5%; intra-abdominal bleeding - by 2.5%; intra-abdominal infection - by 2.5%; gastroparesis - by 5.0%; wound infection - by 2.5%; biliary leakage -by 2.5%. There were no cases of clinically significant pancreatic fistula. The control group was associated with an average of 9-fold higher relative risk of early complications. The passage was restored between the 4th and 7th day. Patients had a shorter average hospital stay (11 days) compared to controls (22 days). Digestive anastomoses reconstruction on a single loop and mixed intraluminal drainage through a modified nasogastric tube led to a 7-fold reduction in early post-surgical complications and a 2-fold shorter hospital stay.

Using CT in patients with stable angina can help diagnose obstructive and non-obstructive coronary heart disease and improve the prognosis of patients. Purpose of this study was to compare the diagnostic accuracy of CT in patients with stable angina to conventional invasive angiography. A retrospective study of 142 consecutive patients with stable angina from 2005 to 2014 was conducted. All patients underwent CT coronary angiography and subsequent conventional angiography. Patients without significant stenosis but with typical anginal symptoms and over three risk factors for coronary heart disease, such as after PCI and ACB, and patients with CT evidence of significant coronary atherosclerosis were also included in this study. A contingency table was used to calculate sensitivity and specificity. The value of the cap was 0.610. The sensitivity of the methodology was 93% (CI 89% - 98%), the specificity 57% (CI 89% - 98%), the positive predictive value was 88%, and the negative predictive value was 73%. The high sensitivity, negative and positive predictive hundredth of CTA compared to conventional angiography suggest that this methodology is of great diagnostic value and opportunities to influence the clinical behavior and improve the prognosis.

Chronic renal failure (CRF) syndrome significantly alters patients’ quality of life. Anaemia, hypertension, and cardiovascular diseases are common complications of CRF. The study aimed to determine the incidence of arterial hypertension (AH), anaemia, and left ventricular hypertrophy (LVH) in patients with CRF and to analyze the relationship between them. The study included 212 patients with CRF, treated at the Clinic of Nephrology and Dialysis at the University Hospital “Dr. G. Stranski,” Pleven, during 2008-2020. The AH accounted for 88.2% of the patients with CRF. The incidence of AH is comparable to that in patients in the predialysis period – 88.6% and among patients on dialysis – 87.9%. LVH was diagnosed in 94.3% of patients with CRF. The incidence of LVH in the predialysis period was 94.3%, and among dialysis patients -94.4%. The incidence of LVH among hypertensive and normotensive patients was comparable. The incidence of anaemia among patients with CRF was 86.3%. Anaemia was present in 94.4% of the patients on dialysis and in 78.1% of the patients in the predialysis period. The difference was significant (p <0.05). There was no correlation between anaemia and AH, nor between AH and LVH. A significant dependence of LVH on the duration of chronic renal failure and dialysis treatment was established.

We investigated the effect of the administration of probiotics (PB) for the prevention of neonatal jaundice (NJ) in 315 full-term newborns (NBs). We grouped them according to the type and duration of PB intake: A – 5 days L. rhamnosus; B – 5 days L. reteri; C – 5 days B. animalis; D – 30 days L. rhamnosus; E – 30 days L. reuteri, F – 30 days B. animalis; G – without PB. Bilirubin (BR) was measured from 1st to 5th, on 14th, and on 28th day. The incidence of pathologic NJ in groups A&D, B&E, C&F, and G was 37, 36, 29, and 44%, respectively. During first five days, the lowest BR levels were found in Group C, the highest in Group G. BR levels on 14th and 28th days were not significantly different between groups A and D, B and E, C and F. The lowest levels of BR on the same days were found in group F and the highest in group E. The prophylactic use of L. rhamnosus, L. reuteri and B. animalis in full-term NBs significantly reduced the incidence and continuance of NJ. Duration of taking PB significantly affects the development of NJ. The most pronounced effect was when B. animalis was added.

Abnormalities in mineral and bone metabolism are a risk factor for increased cardiovascular and all-cause mortality and bone fractures in patients with chronic kidney disease stage 5D (CKD 5D). This single-center study aimed to investigate the age-related features of mineral and bone disorders in patients with CKD 5D on haemodialysis treatment and analyse the therapy provided. The biochemical parameters of mineral and bone metabolism and the ongoing therapy were studied in 90 patients undergoing hemodialysis treatment, of whom 44 (48.9%) were aged <65 years and 46 (51.1%) were aged ≥65 years. Serum phosphate, 25(OH) vit.D, parathyroid hormone, and serum albumin were significantly lower in patients aged ≥65 years compared with patients aged <65 years. There was a significant negative correlation between these parameters and age. We found no significant differences in therapy between the two age groups. A significant proportion of the patients aged ≥65 years had serum calcium and parathyroid hormone values below the lower desirable limit, while most of those aged <65 years had hyperphosphatemia and parathyroid hormone ≥600 pg/ml. Mineral and bone metabolism in CKD stage 5D patients on hemodialysis showed age-dependent patterns. Knowing them is crucial for optimal treatment.

The study aimed to investigate the relationship between the professional environment and hypersensitivity reactions to various contact allergens, the features of the clinical course, and the type of allergic contact dermatitis (ACD) in 35 hairdressers. The analysis was based on data on length of professional experience, localization of rashes, clinical diagnosis and allergens, and the cause of positive reactions in patch testing. Skin changes most often affect the hands, palms, face, and neck. The frequency of ACD diagnosed was 46%, followed by dyshidrotic eczema (DE) - 34%. The highest percentage of contact dermatitis (68%) was seen in the upper extremities, followed by dermatitis of the face and hands (26%). Of the patients investigated, 34% had a history of illness up to 3 years. A negative correlation was found between professional experience and “hand eczema” (p=0.005). Patch tests showed that the most frequent positive reactions were to Nickel (II) sulfate hexahydrate (Nickel, 15 times) and p-Phenylenediamine (PPD, 14 times). These contact allergens are directly correlated with hand eczema. We compared the results with those published in the literature.

Uterine fibroids are the most common benign uterine tumours in women of reproductive age. They can present with different symptoms, including menorrhagia, cramping lower abdominal pain, bloating, urinary/bowel symptoms, spotting, and infertility. Management could be medical and surgical. Other options include uterine artery embolization and non-invasive treatment with high-intensity focused ultrasound (HIFU). We present a case of a 32-year-old woman with menorrhagia and severe pelvic pain. Ultrasound examination revealed an intramural myoma measuring 93x98x87 mm. The patient signed informed consent for HIFU ablation of the fibroid. Three months after the procedure, an MRI scan showed the fibroid had shrunk to 75% of its original size with dimensions 32x35x29. After six months, she became pregnant and gave birth to a healthy infant at 38-weeks gestation with caesarean section, at which point the fibroid measured 2 cm. HIFU is an alternative to surgical therapies and is highly beneficial in women wishing for future pregnancies. Preserving the option for future pregnancies in patients with uterine fibroids is only one of its benefits and might be the key solution for these women. HIFU treatment of uterine fibroids is an innovative approach. It should be encouraged: it is widely adopted in similar cases where it has positively impacted the treatment of uterine fibroids.

With over one million newly diagnosed cases in 2018, gastric cancer remains the fifth most common malignancy worldwide. Early detection of the disease is challenging as most patients are asymptomatic. The lack of screening programs leads to detection at an advanced stage and worsens the prognosis. Using biomarkers or endoscopic methods for early diagnosis would reduce the mortality from gastric cancer. We present a case of total extended (TEG) in advanced gastric cancer and a literature review of indications and complications of this treatment.