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Atrial Flutter as the First Manifestation of Progressive Cardiac Conduction Disease in a Young Apparently Healthy Patient: А Case Report

Abstract

We reported a case of a twenty-one-year-old man with an atrial flutter as the first manifestation of progressive cardiac conduction disease. The patient was admitted to the cardiology department due to complaints of shortness of breath and a decrease in exercise tolerance, which had happened after physical exercises (running). During ambulatory ECG monitoring persistent AFL was observed with atrial rate 262-297 bpm and ventricular rate 26-136 bpm (average 56 bpm). AV conduction was very variable – 4:1-14:1. The results of ambulatory ECG monitoring during the whole period of recording indicated signs of atrioventricular conduction disturbances. After cardioversion sinus rhythm was restored additional rhythm and conduction disorders were revealed. Ambulatory ECG monitoring was performed two weeks after the initial one, and throughout this recording were registered sinus rhythm on the background of first-degree AV block; transient Mobitz I AV block; and type 2 second-degree sinoatrial block. Trans-esophageal electrophysiology study was performed. During pharmacological denervation of the heart, signs of slowing of the atrioventricular conduction and sinus node recovery time persisted. These changes along with right bundle branch block were regarded as a progressive cardiac conduction disease with an apparently hereditary cause.

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The Incidence of Depression and the Decrease of Quality of Life in Patients with Moderate-Severe Inflammatory Acne

Abstract

Objective: to know the prevalence of depression in patients with moderate-severe acne vulgaris.

Hypothesis: the incidence of depression increases in patients with moderate-severe acne vulgaris and will therefore decrease the quality of life.

Background: acne is a very frequent dermatosis in the outpatient clinic, it is not considered a life-threatening disease. It has been associated with negative emotional status. Also, suffering from it for a long time has been associated with depression, anxiety and frustration. The complications of acne in the psychosocial aspect are related to academic or vocational performance, self-esteem and adolescents’ quality of life.

Materials and Methods: the type of study was retrospective cross-sectional descriptive observational study. The sampling was carried out at the facilities of the Popular Autonomous University of the State of Puebla, taking into account any person within the institutional organisation within the range of 12-20 years of age, with a total of 50 participants. The Hamilton assessment scale of depression and the Cardiff Acne disability index were applied to all patients with dermatological diagnosis of moderate-severe vulgar acne in a period between February-October 2019. Results: a total of 50patients were analysed, of which 28 were women aged 12 to 20 years and 22 men (28 women and 13 men) and severe acne in 9 patients, all over 17 years of age and male. According to the degree of depression, 28% (n = 14) of the patients were obtained without some degree of depression; 60% (n = 30) with minor depression; 12% (n = 6) with moderate depression. Regarding the quality of life: 40% (n = 20) of the patients showed good quality of life, 46% (n = 23) regular quality of life and 14% (n = 7) showed poor quality of life.

Conclusion: orderly study of the psychic impact of acne and other skin diseases on people suffering them is recent and is carried out through questionnaires that try to measure the impact the diseases have on the patients’ quality of life.

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Methicillin-Resistant Staphylococcus Aureus in Community Settings: Spread of Drug Resistance and Uncontrollable Infections

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is a major multidrug-resistant bacterial pathogen. The evolution of MRSA is dynamic posing an ongoing threat to humans. The evolution of MRSA includes horizontal gene transfer, which is mediated by mobile genetic elements, plasmids, and bacteriophages, and also mutations. In this review, we clarify the recent trends in MRSA from the perspectives of drug-resistance transfer and uncontrollable infections, particularly those occurring in community settings. We first address the role of MRSA as a disseminator of multidrug resistance. We have studied the cell-to-cell transfer of drug resistance, in which transfer frequencies range from 10-3 to 10-8. The mechanisms of drug-resistance transfers include the self-transmission of large plasmids, the mobilization of small nonconjugative plasmids, the generalized transduction of phages, and the transfer of transposons with circular intermediates. We then discuss uncontrollable infections. Although several anti-MRSA agents have been developed, uncontrollable cases of MRSA infections are still reported. Examples include a case of uncontrollable sepsis arising from a community-associated MRSA (CA-MRSA) with the ST8/SCCmecIVl genotype, and a relapsing severe invasive infection of ST30/SCCmecIVc CA-MRSA in a student athlete. Some of these cases may be attributable to unique adhesins, superantigens, or cytolytic activities. The delayed diagnosis of highly adhesive and toxic infections in community settings may result in CA-MRSA diseases that are difficult to treat. Repeated relapse, persistent bacteremia, and infections of small-colony variants may occur. To treat MRSA infections in community settings, these unique features of MRSA must be considered to ensure that diagnostic delay is avoided.

Open access
Mobile Ultrasound Systems as a Modern Tool for the Doctor

Abstract

Miniaturisation of ultrasound equipment in the form of a tablet- or smartphone-sized scanner is the result of rapid development of modern medical technology. Availability of mobile ultrasound devices has changed our approach to diagnostics of many cardiovascular diseases. Mobile visualisation can be performed at the patient’s bedside and is simple in use. The information obtained from mobile visualisation, despite being incomplete, is of undoubtable value for rapid diagnosis which leads to early treatment onset. These devices possess unique characteristics: low cost, wide availability, safety, and precision. These characteristics make them usable in different clinical scenarios by operators of different specialties and expertise. Visualisation and interpretation of the images is done fast and provides useful diagnostic, prognostic and treatment data for each situation. This review devotes main attention to the regulation of application of mobile ultrasound devices, the notion of “focus cardiac ultrasound” and its differences from emergency and elective expert echocardiography protocols as well as limitations and numerous advantages related to usage of mobile ultrasound systems.

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Possible Deleterious Impact of Glyphosate and its Commercial Formulation in Reproductive Health of Fishes

Abstract

Glyphosate (GLY) is the active ingredient of Roundup® and it is the most utilized herbicide worldwide in the maintenance of conventional agricultural crops, and lawns in parks. A growing number of studies have associated environmental GLY to different pathologies such as obesity, diabetes, heart disease, Alzheimer’s disease, depression, and autism. Different fish species have been used for a long time as experimental biological models to measure the environmental impact of different substances. Therefore, the present study approached the possible association between the exposure to GLY / Roundup® and the ecotoxicological impact on fish reproductive health. With this goal, we performed a comprehensive analysis of the literature and its content by systematic review of international databases. Two independent electronic searches were performed on Medline / PubMed and Scielo for identifying relevant studies published in English up to September 2019. The application of inclusion / exclusion criteria settled the boundaries for this systematic review and after qualitative analysis of the data; we found evidences that suggest a link between the exposure to GLY / Roundup® with deleterious effects on reproductive health in eight different species of fish.

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Intrafamilial Infection of Helicobacter Pylori: Abnormal Gastric Epithelial Cells, Pedestal-Rich H. Pylori Adherence, and a Gene Mutation in a Child with Protein-Losing Gastroenteropathy

Abstract

Helicobacter pylori, one of the most prevalent human pathogens, colonizes the gastric mucosa and is associated with gastric diseases, such as gastritis and peptic ulcers, and is also a bacterial risk factor for gastric cancer. Cytotoxin-associated gene A (CagA) protein, a major virulence factor of H. pylori, is phosphorylated in cells at its Glu-Pro-IIe-Tyr-Ala (EPIYA) motif and is considered to trigger gastric cancer. CagA is classified into two forms, Western CagA with EPIYA-ABC and East Asian CagA with EPIYA-ABD, with the latter associated with a high risk of developing gastric cancer. CagA causes morphological transformation of cells, yielding the “hummingbird” phenotype in AGS cells and possibly membranous pedestals in the gastric epithelium, albeit rarely. H. pylori adherence to the gastric mucosa is not yet fully understood. Here, we describe an intrafamilial infection case of H. pylori, focusing on the gastric epithelium, H. pylori adherence, and a gene mutation in a child with protein-losing gastroenteropathy (characterized by excessive loss of plasma proteins into the gastrointestinal tract). H. pylori, which also infected family members (mother and father), was genetically a single clone with the virulence genes of an East Asian type. The patient’ gastric mucosa exhibited some unique features. Endoscopy revealed the presence of protein plugs on the mucosal surface, which were immunoelectrophoretically similar to serum proteins. Electron microscopy revealed abnormal gastric epithelial cells, totally covered with the secretions or possessing small swollen structures and irregular microvilli. The patient’s H. pylori infection was characterized by frequently occurring thick pedestals, formed along adherent H. pylori. The serum protein level returned to normal and the protein plugs disappeared after the successful eradication of H. pylori, albeit with lag periods for healing. He had a mutation in the OCRL1 gene, associated with Dent disease (asymptomatic proteinuria). Thus, in the patient’s gastric mucosa, we found the abnormal gastric epithelial cells, which may be caused by an OCRL1 mutation or H. pylori, and pedestal-rich H. pylori infection, possibly caused by a higher level of action of CagA in the abnormal epithelial cells. The data suggests a novel H. pylori virulence factor associated with “excessive plasma protein release”.

Open access
Preparation of Patients for Elective Percutaneous Coronary Intervention: Management of Risk Factors as an Approach to Increase in Intervention Efficacy

Abstract

The article is a topical literature review of the place of percutaneous coronary interventions in the structure of elective revascularisation procedures, preoperative preparation of patients with stable ischaemic heart disease before percutaneous coronary intervention, the prospects of the technique, taking into account the latest advances in intervention cardiology (intravascular methods for assessing the hemodynamic significance of stenosis, drug eluting stents). Modern data of the early and long-term results of percutaneous coronary intervention are presented, the predictable potentially modifiable risks of adverse events are described, and ways to correct them are discussed. The results of randomised studies comparing the effectiveness of different approaches for managing patients with stable coronary heart disease (medical therapy, percutaneous coronary intervention) are presented, and prospects for using new drugs to improve the early and late outcomes of endovascular revascularisation are discussed.

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Primary Aldosteronism Complicated by Hypokalemic Rhabdomyolysis. A Clinical Case

Abstract

Primary aldosteronism (PA) is one of the most common causes of secondary hypertension, which in less than half of cases is manifested by hypokalemia. In cases where hypokalemia becomes significant, it can lead to muscle weakness or even paralysis. Such patients are often unsuccessfully treated by neurologists or rheumatologists. In our clinical case a 61 year old patient had rapidly developing symptoms, which were interpreted by ambulance paramedics as an acute cerebrovascular accident. Since the patient was admitted to a multidisciplinary hospital, he was examined by doctors of different specialties, the diagnostic direction was set correctly and rhabdomyolysis was already detected at the initial stage. We excluded various causes of myopathy, which ultimately led us to the most likely cause of this condition - hypokalemia, and explained muscle symptoms. As a result, it helped us to identify the correct diagnosis - aldosteronism. The patient quickly recovered due to the prescribed therapy and felt good, and therefore refused surgical treatment (adrenalectomy), which, perhaps, would allow him to fully recover. Thus, a rare clinical case of differential diagnosis and successful drug treatment of PA with hypokalemia, which is manifested by rhabdomyolysis, is presented.

Open access
The Problem of Patients’ Adaptation to Full Removable Dentures

Abstract

One of the key modern orthopaedic dentistry problems related to rehabilitation of patients with complete edentulism is the process of their adaptation to artificial orthopaedic constructions. According to fundamental and modern scientific research, the biological factor, i.e. the complex of all reactions of the organism to the prosthesis including psychological reactions that is individual for each user, is the most important one.

Development of new conditioned-reflex connections and formation of cortical inhibition of active stimulus, that a full removable denture is, depends directly on the balance and dynamics of patient’s neural processes despite having several common characteristics including chronometric ones that can be revealed in the majority of patients of this category.

Furthermore, previous experience of full removable denture usage is of great importance, specifically its presence or absence and whether it was positive or negative etc., which in its entirety influences the degree and intensity of phases in patient’s adaptation to a new artificial construction.

In this connection, it is important to note the role of patients’ psychological preparation, their familiarisation with corresponding illustrative material, establishment of the psychological contact aimed to form positive but at the same time realistic view on the provided prosthetic care in terms of functional and aesthetic optimum restoration, which is an essential part of successful rehabilitation for this category of patients.

On the grounds of many years’ practical experience, a number of most frequent complaints and questions of patients provided with rehabilitation using full removable dentures which frequently accompany adaptation process and demand careful doctor’s attention while performing explanatory work has been developed. Thereafter, it is necessary to make a corresponding note in patient’s medical record with signature confirmation in order to prevent further conflicts associated with the process of adaptation to dentures and its peculiarities related to this specific patient.

Open access
Spontaneously Resolved Ventricular Fibrillation and Ventricular Tachycardia in Arrhythmic Variant of Acute Myocardial Infarction (Clinical Case)

Abstract

Different heart rhythm disorders occur in almost all patients with myocardial infarction (MI). Arrhythmias in setting of MI are caused by electrical instability of myocardium as a result of metabolic and microcirculatory disorders. However, the presence of even severe heart rhythms disorders does not provide a basis for diagnosis of arrhythmic MI. In arrhythmic variant of infarction heart rhythm disorders and associated symptoms should prevail in clinical presentation. Supra ventricular or ventricular paroxysmal tachycardia, less often atrial fibrillation or flutter, and high degree AV block are registered most commonly. Pain may be absent or slight. Loss of consciousness is possible, due to cerebral blood circulation disorder. Arrhythmic variant may be accompanied by acute heart failure or significant arterial hypotension, up to arrhythmogenic shock. This variant of MI often occurs in older people who have anamnesis of structural heart diseases. In MI patients, reduction of cerebral blood circulation due to tachyarrhythmia and hypotension can cause ischemic stroke.

Open access