Anterior Abdominal Wall Pain

Aim: to present modern approaches to the differential diagnosis and treatment of anterior abdominal wall pain.Key points. Pain in the anterior abdominal wall is a common reason for visiting a gastroenterologist and is often misinterpreted. Signs that distinguish it from visceral and parietal pain include local character, a positive Carnett sign and the effectiveness of local anesthetic injection. Among the main causes, it is necessary to highlight diseases that are not accompanied by a palpable mass in the anterior abdominal wall (anterior cutaneous nerve entrapment syndrome, ilioinguinal nerve syndrome, slipping rib syndrome, radiculopathy and myofascial pain syndrome). Another group of causes of pain in the anterior abdominal wall is represented by diseases in which areas of infiltration (tumors, endometriosis, infections) or hernial protrusions are determined, in which radiation methods play an important role in diagnosis.Conclusion. Knowledge of pathognomonic clinical and instrumental signs is the basis for differential diagnosis and choice of treatment strategy for pathology of the anterior abdominal wall

Prognostic Models of Primary Sclerosing Cholangitis

Aim: to study the significance of prognostic scales in a target group of patients with primary sclerosing cholangitis (PSC) living in the Chelyabinsk region.Materials and methods. The study included 21 patients with a confirmed diagnosis of primary sclerosing cholangitis (PSC) and a disease duration of at least two years. The primary endpoint studied was death. The MELD, Mayo Risk Score, Amsterdam-Oxford PSC Score, PREsTo score, and UK-PSC Score scales were calculated based on the medical records. Statistical processing was carried out using the SPSS Statistics v.22 application.Results. A retrospective assessment of the risk of mortality using the MELD, Mayo Risk Score and Amsterdam-Oxford PSC Score did not reveal a statistically significant difference between deceased and surviving patients. The UK-PSC Score scale showed the highest predictive value (p = 0.046).Conclusion. The new predictive model UK-PSC Score showed advantages in predicting death in PSC patients compared to other scales

Esophageal Lichen Planus as a Cause of Dysphagia: Literature Review and Clinical Observation

Aim: to analyze the literature data, and to raise awareness of doctors of various specialties about the methods of diagnosis and treatment of esophageal lichen planus (ELP).Key points. In a 67-year-old female patient with complaints of difficulty swallowing solid food and weight loss, esophagogastroduodenoscopy revealed subcompensated stenosis of the middle third of the esophagus and signs of fibrinous esophagitis. Based on the characteristics of the endoscopic picture and the detection of apoptotic Ciwatt bodies in esophageal biopsies, a diagnosis of ELP was established. Treatment with glucocorticosteroids led to relief of symptoms and positive endoscopic dynamics. ELP is rare and the least studied, data on this disease in the literature are presented mainly in the form of clinical observations and analysis of series of cases. Typical clinical manifestations include dysphagia and odynophagia. Despite the low prevalence, ELP can be associated with serious complications: stenosis and esophageal squamous cell carcinoma. Endoscopic examination reveals characteristic signs in the esophagus: swelling, thickening and increased vulnerability of the mucosa, often with fibrin, formation of membranes and strictures. The histological picture is represented by epithelial dyskeratosis with exfoliation, lichenoid lymphocytic infiltration. The most specific histological sign is the presence of apoptotic Civatte bodies. Recommendations for the treatment of ELP are limited to the results of a series of clinical observations and include the prescription of systemic corticosteroids. The issue of supportive therapy is the least studied.Conclusion. Analysis of the literature data and the clinical case demonstrate that lichen planus of the esophagus is one of the rare causes of dysphagia. Characteristic endoscopic and histological signs are key for the diagnosis. The management of patients with esophageal lichen planus is insufficiently defined and today includes taking of glucocorticosteroids, endoscopic dilation of stricture and dynamic endoscopic observation, given the high risk of squamous cell carcinoma in this category of patients

Heterotopic Gastric Mucosa in Cervical Oesophagus: Clinical Observations

Aim. Description of the endoscopic and clinical traits of heterotopic gastric mucosa (HGM) observed in cervical oesophagus.Key points. HGM in proximal oesophagus can be asymptomatic or have various clinical manifestations. A 40-yo female patient consulted a gastroenterologist with complaints of cough and globus sensation. For several years she was visiting an otorhinolaryngologist and psychotherapist, with therapy ineffective. Esophagogastroduodenoscopy (EGDS) at the last visit revealed several foci of HGM in cervical oesophagus of 1.2 x 0.8 cm maximal size. The patient was prescribed a combined prokinetic — proton pump inhibitor therapy, which relieved the symptoms. EGDS in a 21-yo patient without active complaints revealed a 2 cm-wide HGM of 4/5 cervical oesophageal lining with acidproducing zones.Conclusion. Two different scenarios of cervical oesophageal HGM are described, the first one manifested with laryngopharyngeal reflux, and the second devoid of clinical manifestations despite a large heterotopic site

The FINDRISC scale as a risk assessment tool for liver fibrosis in patients with nonalcoholic fatty liver disease

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world, which includes changes from hepatic steatosis and nonalcoholic steatohepatitis to fibrosis and cirrhosis. Attempts to find noninvasive markers of liver fibrosis have led to a variety of scales, diagnostic algorithms, and imaging techniques. Individual studies have analyzed the relationship between the FINDRISC scale and hepatic steatosis and concluded that this questionnaire can be used as part of population screening to identify individuals at risk for hepatic steatosis. However, our review of the literature did not reveal any clinical studies on the use and effectiveness of the FINDRISC in liver fibrosis screening.AIM: To evaluate diagnostic value of FINDRISC for liver fibrosis detection.MATERIALS AND METHODS: The study enrolled patients aged 40–60 years from unorganized outpatient population. The sample of patients was formed randomly according to the inclusion and noninclusion criteria. All patients were assessed with standard anthropometric parameters. The FINDRISC questionnaire was used. All patients underwent transabdominal ultrasound examination of the liver and transient liver elastometry. The degree of steatosis was evaluated using Hamaguchi ultrasound scale. RESULTS: The study included 100 patients. An increased risk of type 2 DM (≥7 points) was detected in 68% of patients using the FINDRISC scale. Liver steatosis was diagnosed in 41% of patients. Median values of hepatic elastic modulus by transient elastometry were 4.50 (4.00; 5.25) kPa. At the same time, liver elasticity modulus values ≥5.9 kPa were registered in 11 (11.0%) patients. When analyzing the array of sensitivity and specificity values using the ROC-curve, it was found that for the FINDRISC scale the maximum LR+ and the minimum LRvalues were observed when the number of points on the indicated scale exceeded 10. At this cutoff, the FINDRISC scale had a sensitivity of 81.8% and specificity of 61.8% for detecting liver fibrosis (liver modulus of elasticity ≥5.9 kPa). The scale was of good diagnostic value (AUC 0.699; 95% CI 0.530–0.815).CONCLUSION: In an unorganized sample of patients aged 40–60 years the FINDRISC can serve as a diagnostic tool for liver fibrosis and steatosis. Sum of FINDRISC scores >10 allowed to diagnose liver fibrosis (liver elastic modulus ≥5.9kPa) with sensitivity 81.8% and specificity 61.8%. The probability of absence of hepatic fibrosis with FINDRISC scale values <10 was 96.5%

Mycophenolate Mofetil and Clostridium difficile-associated Colitis

Aim. A clinical observation of colitis conditioned by mycophenolate mofetil intake and concomitant Clostridium difficile-associated disease.Key points. Mycophenolate mofetil (MMF) is an active immunosuppressant with side effects affecting gastrointestinal tract (GIT). A 37-yo male patient with type 1 diabetes mellitus was admitted at a gastroenterology unit with clinical signs of diarrhoea with haematochezia. A history of diabetic nephropathy and related-donor pre-dialysis kidney transplantation in 2012, since when MMF intake was 2000 mg daily. Catarrhal ulcerative colitis in colonoscopy, C. difficile toxins in pathogen stool panel. Ulcerative, ischaemic colitises and the graft-versus-host disease were ruled out in examination. A positive clinical and endoscopic trend was observed upon MMF withdrawn and start of vancomycin.Conclusion. The case presented illustrates the clinical picture and diagnostic algorithm in MMF-associated colitis. The case-distinctive is association with C. difficile infection

Diagnostic Algorithm for Joint Pain in Patients with Inflammatory Bowel Disorders

Aim. An algorithm development for joint pain differential diagnosis in patients with inflammatory bowel disorders (IBD) and its validation in clinical practice.Materials and methods. A total of 349 IBD patients hospitalised for gastroenterological complaints at the Chelyabinsk Regional Clinical Hospital during 2017–2020 have been examined.Results. Upon survey, 97 (27.8%) IBD patients complained of joint pain. Ulcerative colitis (UC) predominated (79 patients; 81.4%), Crohn’s disease (CD) had a 18.6% incidence. In survey, 27% UC and 32.1% CD patients reported joint pain (p = 0.26). Among IBD patients, 52.6% had mechanical, and 47.4% — inflammatory pain. The inflammatory back pain (IBP) rate in survey cohort was 23.7%. Use of a diagnostic algorithm allowed concomitant rheumatic disease detection in 7 (7.2%) patients from the IBD–joint pain cohort: 2 patients were diagnosed with psoriatic spondyloarthritis, 2 — rheumatoid arthritis, 1 — gout and 2 — with ankylosing spondylitis. IBD-associated arthritis was diagnosed in 41 (42.3%) cases, osteoarthritis — in 38 (39.2%) IBD patients with joint pain, arthralgia with no objective inflammation, impaired joint function or lesions in X-ray and/or ultrasound — in 13 (13.4%) patients.Conclusion. Joint pain complaints are common in IBD patients and require a multispecialty rheumatologists-involving approach to proceed with differential diagnosis and opting for treatment tactics. A clinically verified algorithm coupled with laboratory tests and instrumental imaging facilitates diagnosis and optimal therapy selection in IBD patients with complaints of joint pain

Profile of antiphospholipid antibodies and complement system in COVID-19 patients of different severity

COVID-19, a severe acute respiratory syndrome caused by SARS-CoV-2, may predispose to thrombotic events, especially when combined with antiphospholipid antibodies (aPL). However, there are limited data on prevalence and antigenic specificity of aPL in COVID-19. Complement activation is assumed to play an important role in pathogenesis of COVID-19-associated coagulopathy. During the SARS-CoV-2 pandemic, it is necessary to identify important biomarkers for predicting severe course of COVID-19 and risk of thrombotic complications. Our objective was to evaluate the aPL profile, quantitative content and activity of complement and its components in COVID-19 patients graded by severity in the course of time. IgM and IgG antibodies to cardiolipin (CL), phosphatidylserine (PS), β2-glycoprotein-I (β2-GP-I), prothrombin (PT), annexin V (An V), as well as C1q complement component, content of its C3 and C4 components and total complement activity were determined in blood serum using ELISA approach. 141 patients with COVID-19 were included in the study. Group 1 consisted of 39 patients with mild form, group 2 (65 patients) presented with moderate form, and group 3 included 37 patients with severe form of COVID-19. Blood samples were obtained on day 3-7 of the disease (1st point) and after 14-28 days (2nd point). The results were as follows: aPL were detected in 29.1% of the total COVID-19 cohort, frequency of aPL detection by the severity grade did not differ (33.3%, 24.6% and 32.4%). In 8.5% of the patients, aPL were detected only at the 1st time point; in 14.2%, only at the 2nd point; and in 6.4% of the cases, at the both time points. Antibodies to PT (16.3%) and An V (11.3%) were revealed more frequently. The detection frequency of antibodies to PT was significantly higher than antibodies to CL and PS (7.1%), β2-GP-I (7.8%). The prevalence of aPL in groups 1 and 3 did not differ. At the 1st point in group 3, increased levels of C4 (89.2%) and C3 (24.3%) in blood, and a decrease in complement activity (35.1%) were more often observed than in group 1. At the 2nd time point in group 3, a decrease in complement activity was often detected (59.5%). The C3 levels exceeding 720 μg/ml were found to predict a 2.6-fold increased risk of severe COVID-19, and this risk became 3.3 times higher at C4 levels of > 740 μg/ml. The antibodies to PT and An V are often detected in COVID-19 patients, along with low prevalence of antibodies to CL and β2-GP-I. These antibodies can be involved in pathogenesis of COVID-19-associated coagulopathy, being detectable at the late stage of the disease, and they may trigger APS in predisposed patients and reconvalescents. Although presence of aPL antibodies is not associated with COVID-19 severity, their persistence over the period of convalescence may be an additional risk factor for thromboembolic complications. The COVID-19 patients are characterized by activation of the complement system, which increases in severe cases, and manifests with increased or decreased levels of C3 complement component, increased levels of C4 component in blood, and a decreased total complement activity. Quantitative determination of C3 and C4 complement components over the period of COVID-19 progression is of prognostic value, with respect to severity of the disease

Research of hemodynamic in visceral branches of the abdominal aorta in patients with nonalcoholic fatty liver disease

Aim. Rate particular regional hemodynamics in unpaired visceral branches of the abdominal aorta in patients with nonalcoholic fatty liver disease (NAFLD), depending on the severity of liver fibrosis, established by circumstantial laboratory markers. Materials and Methods. The study included 53 patients of both sexes, older than 50 years. The first group consisted of 17 people with NAFLD and liver fibrosis, established by Forns - index and the value of more than 6.9. The second group included 36 people with the value Forns - index less than 6.9. The examination included the study of clinical and anamnestic parameters, evaluation of laboratory parameters, instrumental examination of the gastrointestinal tract. Biochemical parameters of the study completed hyperlipidemia. All patients underwent transabdominal duplex scanning unpaired visceral branches of the abdominal aorta, will allow to estimate blood flow velocity parameters and calculate the shear rate. Results. Patients in both groups were matched for age and sex. When analyzing the structure of comorbid diseases of the digestive tract in patients with hepatic fibrosis in NAFLD, the most frequently detected Chronic Biliary pancreatitis. The study of lipid metabolism, showed significantly lower cholesterol levels in patients with NAFLD and Forns index of more than 6.9, with a peak performance speed of blood flow and shear rate in the splenic artery were significantly lower in this group of patients. Conclusion. Patients with nonalcoholic fatty liver disease and hepatic fibrosis, established by indirect laboratory markers (Forns-index) did not differ in age and gender composition and comorbid diseases from patients without liver fibrosis. The low shear rate in the splenic artery in patients with hepatic fibrosis steatosis suggests developing a violation of local splanchnic hemodynamics in the pool against the backdrop of liver fibrosis and can then be used as one of the proxy indicators that reflect morphological changes in the liver.Цель. Оценить особенности региональной гемодинамики в непарных висцеральных ветвях брюшной аорты у пациентов с неалкогольной жировой болезнью печени (НАЖБП) в зависимости от выраженности фиброза печени. Материалы и методы. В исследование включены 53 пациента обоего пола старше 50 лет. Первую группу составляли 17 человек с НАЖБП и фиброзом печени, установленным по Forns - индексу и значением более 6,9. Во вторую группу вошли 36 человек со значением Forns - индекс менее 6,9. Обследование включало изучение клинико-анамнестических параметров, оценку лабораторных показателей, инструментальное исследование желудочно-кишечного тракта. Биохимическое исследование дополнено изучением параметров липидемии. Всем пациентам выполнено трансабдоминальное дуплексное сканирование непарных висцеральных ветвей брюшной аорты, позволившее оценить скоростные параметры кровотока и рассчитать скорости сдвига. Результаты. Больные обеих групп были сопоставимы по полу и возрасту. При анализе структуры коморбидной патологии пищеварительного тракта у пациентов, страдающих фиброзом печени на фоне НАЖБП, наиболее часто выявлялся хронический билиарнозависимый панкреатит. Исследование липидного обмена, выявило достоверно более низкий уровень холестерина у пациентов с НАЖБП и индексом Forns более 6,9. При этом показатели пиковой скорости кровотока и скорость сдвига в селезеночной артерии были достоверно ниже у данной группы пациентов. Выводы. Пациенты с неалкогольной жировой болезнью печени и фиброзом печени, установленным по косвенному лабораторному маркеру (Forns-индекс), не отличались по возрастно-гендерному составу и коморбидным заболеваниям от пациентов без фиброза печени. Низкая скорость сдвига в селезеночной артерии у пациентов с фиброзом печени на фоне жирового гепатоза свидетельствует о развивающемся нарушении локальной гемодинамики в спланхническом бассейне на фоне фиброза печени и может в дальнейшем использоваться как один из косвенных показателей, отражающих морфологические изменения в печени

Effect of COVID-19 vaccination on the immune status and autoantibody profile in women of reproductive age

In the context of the COVID-19 pandemic, scientific interest is growing in studying the impact of the proposed vaccination on women’s reproductive health. As is known, alterations in the state of the immune system and activation of an autoimmune response can lead to reproductive failure in women and potential complications of subsequent pregnancy. Objective: to evaluate the effect of the “Gam-COVID-Vac” on the immune status parameters, the relationship of their changes and the specific immune response to vaccination with the dynamics of the level of autoantibodies in women of reproductive age.The prospective study included 120 women who were vaccinated against COVID-19 with the “Gam-COVIDVac”. The criteria for inclusion in the study were: the age from 18 to 49 years, the absence of COVID-19 in the anamnesis, a negative result of a study on SARS-CoV-2 by PCR and negative results of tests for antibodies of classes G and M to SARS-CoV-2 before vaccination, the absence of pregnancy and serious somatic diseases. The patients were examined twice: immediately before vaccination and 90-100 days after the introduction of the 1st component of the vaccine. The level of IgG antibodies to SARS-CoV-2 after vaccination was assessed using ELISA. Before and after vaccination, the levels of antiphospholipid, anti-nuclear, organ-specific and antihormonal autoantibodies were determined, peripheral blood lymphocytes were immunophenotyped to determine the main subpopulations (CD3, CD4, CD8, CD19, CD5, CD16, CD56), as well as the expression of activation markers of lymphocytes (HLA-DR, CD25, CD147) using monoclonal antibodies.The effectiveness and safety of the combined vector vaccine against COVID-19 were high. Specific IgG antibodies to SARS-CoV-2 were produced in 98.3% of vaccinated women, no serious adverse reactions were observed. After vaccination, there was an increase in the level of some autoantibodies within the reference ranges, only IgM antibodies to phosphatidylethanolamine (PE) and IgG antibodies to DNA increased above the reference values. However, this increase was transient. After vaccination, the following changes in the parameters of the immunogram were observed: an increase in the content of cells with CD3+CD25+, CD19+ phenotype in peripheral blood and a decrease in the content of cells with CD56+CD16+ phenotype within the reference ranges, a decrease in CD147+/CD3+. Weak correlations were noted between these changes in immunogram parameters and the levels of some autoantibodies. The specific antiviral immune response to vaccination did not correlate with the autoimmune response.Vaccination with “Gam-COVID-Vac” is effective and safe and does not lead to disorders in the immune system. The observed increase in the level of autoantibodies to PE and DNA is transient. Changes in the parameters of the immune status within the reference ranges may be due to vaccination and the development of a specific antiviral immune response