Mast cell activation syndrome: Myths and realities

Background: Mast cells (MCs) have been implicated in a spectrum of allergic, immunologic, and infectious inflammatory conditions that involve different organ systems. MC activation can occur through several different surface receptors other than the well known IgE mediated pathway. Methods: We use two representative case reports from our practice to summarize what is currently known about MCAS disorders (reality) so that the clinician can more easily differentiate these conditions from other complex unexplained conditions that are being associated with MC activation (myth). Results: Many complex MC-related conditions, such as clonal MC diseases, have been well characterized but other MC-related disorders, such as MC activation syndrome (MCAS) and idiopathic anaphylaxis, still remain poorly defined. The current consensus recommendations for a diagnosis of MCAS require clinical symptoms of anaphylaxis that correlate with elevation of a MC activation biomarker(s), which improves with H1-antihistamines. Conclusion: Clinical symptoms of MCAS can overlap with other conditions, including neurogenic disorders, e.g., dysautonomia, which necessitate the importance for the clinician to render an accurate diagnosis so that appropriate treatment is provided.

CURRENT STATE OF THE PROBLEM OF DRAINAGE FOR NEUROGENIC BLADDER

Данный литературный обзор посвящен одной из актуальных проблем современной урологии - нейрогенной дисфункции мочевыводящих путей. Нейрогенная дисфункция нижних мочевыводящих путей является одной из важнейших проблем современной урологии, что обусловлено ее высокой распространенностью, частотой вторичных осложнений со стороны мочевыделительной системы и социально-экономической значимостью. Распространенность нейрогенного мочевого пузыря среди пациентов, перенесших острое нарушение мозгового кровообращения, варьирует от 15 % до 94 % и зависит от времени, прошедшего с момента сосудистого события. В статье представлены патофизиологические механизмы, лежащие в основе данной патологии, подробно рассмотрены современные методы дренирования нижних мочевыводящих путей, их преимущества и недостатки. К современным способам дренирования при нейрогенных расстройствах нижних мочевыводящих путей относят периодическую (интермиттирующую) катетеризацию, постоянную катетеризацию и надлобковую цистостомию. Анализ доступной литературы указывает на то, что частота осложнений, ассоциированных как с нейрогенной дисфункцией мочевого пузыря, так и с используемыми способами дренирования, продолжает оставаться достаточно высокой. Таким образом, проблема профилактики катетер-ассоциированных осложнений и улучшения качества жизни данной категории больных на сегодняшний день продолжает оставаться актуальной и требует проведения дальнейших исследований в данной области This literature review is devoted to one of the most pressing problems of modern urology - neurogenic urinary tract dysfunction. Neurogenic dysfunction of the lower urinary tract is one of the most important problems of modern urology, due to its high prevalence, frequency of secondary complications from the urinary system, and socio-economic significance. The prevalence of neurogenic bladder among patients who have experienced acute cerebrovascular accident varies from 15 % to 94 % and depends on the time elapsed since the vascular event. The article presents the pathophysiological mechanisms underlying this pathology, discusses in detail modern methods of drainage of the lower urinary tract, their advantages and disadvantages. Modern methods of drainage for neurogenic disorders of the lower urinary tract include periodic (intermittent) catheterization, permanent catheterization, and suprapubic cystostomy. Analysis of the available literature indicates that the frequency of complications associated with both neurogenic bladder dysfunction and the drainage methods used continues to be quite high. Thus, the problem of preventing catheter-associated complications and improving the quality of life of this category of patients continues to be relevant today and requires further research in this area

Features of phosphorus-calcium metabolism in children with neurogenic disorders of urination

THE AIM: To study the characteristics of phosphorus-calcium metabolism in patients with neurogenic disorders of urination, taking into account the severity of the manifestations of connective tissue dysplasia. PATIENTS AND METHODS. The study included 90 children, including 60 children with neuro-muscular dysfunction of the bladder (NMDB) and 30 children with enuresis from the age of 5 to 15 years. The diagnosis was established based on a comprehensive examination and according to industry standards. Connective tissue dysplasia was diagnosed in children with the detection of 6 or more small external or visceral manifestations involving 3 or more organs from different systems. Assessment of the severity (severity) of connective tissue dysplasia was carried out according to the point system proposed by T.I. Kadurina et al. Each group was divided into subgroups depending on the severity of the manifestations of connective tissue dysplasia. The determination of the level of calcium and phosphorus in the blood and urine, as well as the calculation of the calcium-creatinine coefficient followed by a comparison of the results in these groups and subgroups. To assess the significance of differences, the Mann-Whitney test was calculated, p <0.05 was considered significant. RESULTS. he level of calcium and phosphorus in the urine was slightly higher in children with enuresis, especially in the morning portion of urine, where the concentration of calcium was 26% higher than in patients with NMDB. At the same time, the value of calcium /creatinine coefficient was significantly higher in the group of patients with enuresis and was 2 times higher than the normative indicators, which indicates the importance of hypercalciuria in the development of enuresis. СONCLUSION. According to the obtained data, the severity of calciuria, determined by the value of the calcium-creatinine coefficient, is significantly higher in patients with enuresis than with NMDB.