TREATMENT OF HIRSCHSPRUNG DISEASE IN ADULTS

The article presents our own experience of treatment of Hirschsprung disease in adults

Left Atrial Thrombosis before Catheter Ablation or Cardioversion in Patients with Non-valvular Atrial Fibrillation or Atrial Flutter: what Risk Score is Most Informative?

Aim. To compare different scores in assessment of risk of left atrial or its appendage thrombosis (LAAT) in patients with non-valvular atrial fibrillation (AF) or atrial flutter (AFL) undergoing transesophageal echocardiography before catheter ablation (CA) or cardioversion (CV).Material and methods. In retrospective, single-center, case-control study medical records of 1994 patients with non-valvular AF or AF from the period 2014-2019, who underwent transesophageal echocardiography before CA or elective CV, were analyzed. LAAT was detected in 33 of them. For the control group, 167 patients without LAAT were randomly selected from this database. CHADS2, CHA2DS2-VASc, R2CHADS2, R-CHA2DS2-VASc, R2CHA2DS2-VASc, CHA2DS2-VASc-RAF, mCHA2DS2-VASc, CHA2DS2-VASc-AFR, ATRIA scores were evaluated and compared as potential predictors of LAAT.Results. Mean age of studied patients (n=200) was 60.3±10.9, 55% of them were males. Most of patients had non-valvular AF (87,5%) and were assessed before CA (84,0%). All risk scores were associated with LAAT and CHA2DS2-VASc-RAF score was most informative [AUC 0.84; 95% confidence interval (CI) 0.76-0.91]. According to multivariate analysis in a logistic regression model among studied risk scores CHA2DS2-VASc-RAF score was the single independent predictor of LAAT [odds ratio (OR) 1.37; 95% CI 1.21-1.55; p=0.004). OR of LAAT among patients with CHA2DS2-VASc-RAF >3 was 12.8 (95% CI 3.75-43.9; p<0.0001) with sensitivity, specificity, positive and negative predicting values 90.6%, 57.1%, 30.2% and 96.7% respectively Conclusion. In the studied group of patients with non-valvular AF or AFL, without severe structural heart disease and severe concomitant diseases CHADS2, CHA2DS2-VASc, R2CHADS2, R-CHA2DS2-VASc, R2CHA2DS2-VASc, CHA2DS2-VASc-RAF, mCHA2DS2-VASc, CHA2DS2-VASc-AFR, ATRIA scores were associated with LAAT. CHA2DS2-VASc-RAF score was the most informative. >˂0.0001) with sensitivity, specificity, positive and negative predicting values 90.6%, 57.1%, 30.2% and 96.7% respectively.Conclusion. In the studied group of patients with non-valvular AF or AFL, without severe structural heart disease and severe concomitant diseases CHADS2, CHA2DS2-VASc, R2CHADS2, R-CHA2DS2-VASc, R2CHA2DS2-VASc, CHA2DS2-VASc-RAF, mCHA2DS2-VASc, CHA2DS2-VASc-AFR, ATRIA scores were associated with LAAT. CHA2DS2-VASc-RAF score was the most informative

Тромбоз левого предсердия и/или его ушка при неклапанной фибрилляции предсердий: эхокардиографические и лабораторные факторы риска, возможности прогнозирования и коррекции

The review presents data on the feasibility of using laboratory findings to predict the presence of left atrium (LA) and/or left atrial appendage (LAA) thrombus in non-valvular atrial fibrillation (NvAF). It describes the relationship between the presence of a blood clot in the LA/LAA and a blood group, certain parameters of peripheral blood, blood brain natriuretic peptide levels, homocysteine, asymmetric D-methylarginine, uric acid and D-dimer.The authors presented data of studies to show a relationship between the presence of LA/LAA trombus and individual parameters obtained during transthoracic echocardiography: left ventricular mass index, left atrial volume index, LvEF/left atrial volume index ratio, E/e' ratio, peak systolic deformity of the left atrium.The capabilities of different scales in assessing the likelihood of the presence of LA/LAA thrombus in NvAF are evaluated. insufficient information capacity of the CHADS2 and CHA2DS2-vASc scales is demonstrated. The article described attempts to improve the scales by adding other risk factors (CHA2DS2-VASc-MS, CHA2DS2VASc-AFR, CHA2DS2VASc-RAF scales, as well as the possible role of additional consideration of blood brain natriuretic peptide levels). It is shown that it is feasible to add information on the duration of NvAF paroxysm and glomerular filtration rate to the CHA2DS2-VASc scale. in addition, consideration of the presence of metabolic syndrome may be beneficial. Overall, approaches with addition of information on the duration of NvAF paroxysm and glomerular filtration rate to the CHA2DS2-VASc scale proved to be most successful.The authors presented the shortcomings of accumulated evidence base regarding the relationship between the studied parameters and the presence of LA/LAA thrombus, including a small number of examined patients, usually a retrospective character of the study, a search of LA/LAA thrombus before the planned catheter ablation or electropulse therapy. As a result, it is not known to what extent the studied predictors and scales may be applied to a wider contingent of patients with NvAF. In addition, most studies have been performed on the Asian population and it is unclear whether their results can be extrapolated to other ethnic groups. It was shown that thrombi do not disappear under pressure of anticoagulant therapy in at least one-third of patients.В обзоре представлены данные о возможностях использования лабораторных показателей для прогнозирования наличия тромба в левом предсердии (ЛП) и/или его ушке (уЛП) при неклапанной фибрилляции предсердий (нФП). Охарактеризована связь с наличием тромба в ЛП/уЛП группы крови, отдельных показателей периферической крови, уровней в крови мозгового натрийуретического пептида, гомоцистеина, ассиметричного Д-метиларгинина, мочевой кислоты и Д-димера.Представлены данные исследований, продемонстрировавших связь с наличием тромба в ЛП/уЛП отдельных показателей, получаемых при трансторакальной эхокардиографии: индекса массы миокарда левого желудочка, индекса объема левого предсердия, отношения ФВЛЖ/индекс объема левого предсердия, отношения Е/e', пиковой систолической деформации левого предсердия.Охарактеризованы возможности различных шкал в оценке вероятности наличия тромбоза ЛП/уЛП при нФП. Продемонстрирована недостаточная информативность шкал CHADS2 и CHA2DS2-VASc и охарактеризованы попытки их улучшения за счет добавления других факторов риска (шкалы CHA2DS2-VASc-MS, CHA2DS2VASc-AFR, CHA2DS2VASc-RAF, а также возможная роль дополнительного учета концентрации мозгового натрийуретического пептида в крови). Показано, что перспективно добавление к шкале CHA2DS2-VASc информации о длительности пароксизма нФП и скорости клубочковой фильтрации. Кроме того, возможна польза от учета наличия метаболического синдрома. В целом наиболее успешными оказались подходы с добавлением к шкале CHA2DS2-VASc сведений о длительности пароксизма нФП и скорости клубочковой фильтрации.Представлены недостатки накопленной доказательной базы о связи изученных показателей с наличием тромба ЛП/уЛП, среди которых небольшое число обследованных больных, обычно ретроспективный характер изучения, поиск тромба в ЛП/ уЛП перед планируемой катетерной аблацией или электроимпульсной терапией. В итоге неизвестно, насколько применимы изученные предикторы и шкалы к более широкому контингенту больных с нФП. Коме того, большинство исследований выполнено на азиатской популяции и неясно, можно ли экстраполировать их результаты на другие этнические группы. Показано, что как минимум у трети больных тромбы не исчезают на фоне антикоагулянтной терапии

Unrecorded alcohol consumption in Russia: toxic denaturants and disinfectants pose additional risks

In 2005, 30% of all alcohol consumption in Russia was unrecorded. This paper describes the chemical composition of unrecorded and low cost alcohol, including a toxicological evaluation. Alcohol products (n=22) from both recorded and unrecorded sources were obtained from three Russian cities (Saratov, Lipetsk and Irkutsk) and were chemically analyzed. Unrecorded alcohols included homemade samogons, medicinal alcohols and surrogate alcohols. Analysis included alcoholic strength, levels of volatile compounds (methanol, acetaldehyde, higher alcohols), ethyl carbamate, diethyl phthalate (DEP) and polyhexamethyleneguanidine hydrochloride (PHMG). Single samples showed contamination with DEP (275–1269 mg/l) and PHMG (515 mg/l) above levels of toxicological concern. Our detailed chemical analysis of Russian alcohols showed that the composition of vodka, samogon and medicinal alcohols generally did not raise major public health concerns other than for ethanol. It was shown, however, that concentration levels of DEP and PHMG in some surrogate alcohols make these samples unfit for human consumption as even moderate drinking would exceed acceptable daily intakes

Drinking in transition: trends in alcohol consumption in Russia 1994-2004

BACKGROUND: Heavy alcohol consumption is widespread in Russia, but studying changes in drinking during the transition from Communism has been hampered previously by the lack of frequent data. This paper uses 1-2 yearly panel data, comparing consumption trends with the rapid concurrent changes in economic variables (notably around the "Rouble crisis", shortly preceding the 1998 survey round), and mortality. METHODS: Data were from 9 rounds (1994-2004) of the 38-centre Russia Longitudinal Monitoring Survey. Respondents aged over 18 were included (>7,000 per round). Trends were measured in alcohol frequency, quantity per occasion (by beverage type) and 2 measures of potentially hazardous consumption: (i) frequent, heavy spirit drinking (≥80 g per occasion of vodka or samogon and >weekly) (ii) consuming samogon (cheap home-distilled spirit). Trends in consumption, mean household income and national mortality rates (in the same and subsequent 2 years) were compared. Finally, in a subsample of individual male respondents present in both the 1996 and 1998 rounds (before and after the financial crash), determinants of changes in harmful consumption were studied using logistic regression. RESULTS: Frequent, heavy spirit drinking (>80 g each time, ≥weekly) was widespread amongst men (12-17%) throughout, especially in the middle aged and less educated; with the exception of a significant, temporary drop to 10% in 1998. From 1996-2000, samogon drinking more than doubled, from 6% to 16% of males; despite a decline, levels were significantly higher in 2004 than 1996 in both sexes. Amongst women, frequent heavy spirit drinking rose non-significantly to more than 1% during the study. Heavy frequent male drinking and mortality in the same year were correlated in lower educated males, but not in women. Individual logistic regression in a male subsample showed that between 1996 and1998, those who lost their employment were more likely to cease frequent, heavy drinking; however, men who commenced drinking samogon in 1998 were more likely to be rural residents, materially poor, very heavy drinkers or pessimistic about their finances. These changes were unexplained by losses to follow-up. CONCLUSIONS: Sudden economic decline in late 1990s Russia was associated with a sharp, temporary fall in heavy drinking, and a gradual and persistent increase in home distilled spirit consumption, with the latter more common amongst disadvantaged groups. The correlation between heavy drinking and national mortality in lower educated men is interesting, but the timing of RLMS surveys late in the calendar year, and the absence of any correlation between drinking and the subsequent year's mortality, makes these data hard to interpret. Potential study limitations include difficulty in measuring multiple beverages consumed per occasion, and not specifically recording "surrogate" (non-beverage) alcohols