Proposal for a Unitary Anatomo-Clinical and Radiological Classification of Third Mobile Window Abnormalities

Introduction: An increased number of otic capsule dehiscence (OCD) variants relying on the third window pathomechanism have been reported lately. Therefore, a characterization of the anatomical structures involved and an accurate radiological description of the third window (TW) interface location have become essential for improving the diagnosis and appropriate therapeutic modalities. The purpose of this article is to propose a classification based on clinical, anatomical, and radiological data of third mobile window abnormalities (TMWA) and to discuss the alleged pathomechanism in lesser-known clinical variants.Materials and Methods: The imaging records of 259 patients who underwent, over the last 6 years, a high-resolution CT (HRCT) of the petrosal bone for conductive hearing loss were analyzed retrospectively. Patients with degenerative, traumatic, or chronic infectious petrosal bone pathology were excluded. As cases with a clinical presentation similar to those of a TW syndrome have recently been described in the literature but without these being confirmed radiologically, we thought it necessary to be integrated in a separated branch of this classification as “CT - TMWA.” The same goes for certain intralabyrinthine pathologies also recently reported in the literature, which mimic to some extent the symptoms of a TW pathology. Therefore, we suggest to call them intralabyrinthine TW-like abnormalities.Results: Temporal bone HRCT and, in some cases, 3T MRI of 97 patients presenting symptomatic or pauci-symptomatic, single or multiple, unilateral or bilateral OCD were used to develop this classification. According to the topography and anatomical structures involved at the site of the interface of the TW, a third-type classification of OCD is proposed.Conclusions: A classification reuniting all types of TMWA as the one proposed in this article would allow for a better systematization and understanding of this complex pathology and possibly paves the way for innovative therapeutic approaches. To encompass all clinical and radiological variants of TMWA reported in the literature so far, TMWAs have been conventionally divided into two major subgroups: Extralabyrinthine (or “true” OCD with three subtypes) and Intralabyrinthine (in which an additional mobile window-like mechanism is highly suspected) or TMWA-like subtype. Along these subgroups, clinical forms of OCD with multiple localization (multiple OCD) and those that, despite the fact that they have obvious characteristics of OCD have a negative CT scan (or CT – TMWA), were also included.

The experience of successful use of melatonin, L‑arginine and L‑carnitine in treatment post-COVID‑19 pain syndromes in persons with cystic transformation of the pineal gland

As an introduction, the article presents a small review of the literature devoted to the problem of clinical variants of postovoid syndrome and, in particular, headaches and back pain. There are 6 cases with various headaches and 1 case with back pain in patients with cystic transformation of the pineal gland after a verified COVID-19 infection. All patients were diagnosed with melatonin, L‑arginine and L‑carnitine deficiency before treatment. After the replacement therapy, the pain syndrome was stopped in all patients within 10 days, and a month after the start of treatment, the indicators of melatonin, L‑arginine and l‑carnitine returned to the reference values of the norm.

Nephrological Aspects of Metabolic Syndrome in Patients with Chronic Kidney Disease on Peritoneal Dialysis with Different Clinical Variants of Coronary Heart Disease

The purpose of the study was to identify the components of the metabolic syndrome most characteristic of different clinical variants of ischemic heart disease in patients with chronic kidney disease on peritoneal dialysis. Materials and methods. 114 patients took part in the study. The average duration of peritoneal dialysis therapy was 53 months. Clinical variants of ischemic heart disease were determined by angina attacks, by painless myocardial ischemia detected by ECG-load cycle ergometer test, by increasing phenomena of ischemic dilated cardiomyopathy (diastolic dysfunction, calcification and atheromatosis of aorta and heart valves) by echocardiographic study in dynamics and by the previous myocardial infarction episodes. All patients were accordingly divided into 5 clinical groups, one of which was patients with no evidence of coronary heart disease (comparison group). The data were processed using the SPSS 19.0 for Windows statistical software package. Results and discussion. Considering different components of metabolic syndrome: body weight, arterial hypertension, dyslipidemia, the highest body mass index in patients on peritoneal dialysis was found in the group of patients suffering from ischemic dilated cardiomyopathy. High-density lipoproteins were lowest in the group of patients who underwent myocardial infarction. Hypertriglyceridemia was most pronounced in the group of patients with painless myocardial ischaemia. Low-density lipoproteins were highest in the group of patients with stable angina pectoris. Mean arterial pressure was highest in the group of patients with stable angina and in the group of patients with painless myocardial ischaemia. Conclusion. The highest number of patients with metabolic syndrome was found in the groups of patients with non-painful myocardial ischemia and ischemic dilated cardiomyopathy (67% and 51% respectively). In the group of patients with non-painful myocardial ischaemia (high acute coronary risk group), metabolic syndrome was diagnosed by four features: visceral obesity, raised blood sugar, arterial hypertension, raised very low density of lipoproteins and triglycerides. In the group of patients with ICDMP (group of patients with severe diastolic heart failure), metabolic syndrome was diagnosed by three features: visceral obesity, elevated blood sugar and low density lipoproteins. Thus, a vector for further research may be to investigate the effect of complexly corrected components of the metabolic syndrome on the occurrence of acute coronary risks or progression of chronic heart failure in patients with chronic kidney disease on peritoneal dialysis

Clinical variants of esophageal stenosis caused by infectious esophagitis in children

Infectious esophagitis (IE) is commonly seen in immunocompromised patients. IE may be the first symptom of immunodeficiency state, also can be complication of immunosuppressive therapy in patients with hematological and oncological diseases. Severe complication of IE is esophageal stenosis. Patient management tactics continue to be discussed. A purpose of our publication is to demonstrate our experience in the management of patients with infectious esophageal stenosis. The etiology, features of the clinical and endoscopic picture, as well as the effectiveness of drug therapy and endoscopic methods of treatment have been analyzed. The study was approved by the Independent Ethics Committee and the Scientific Council of the D. Rogachev NMRCPHOI. In each case, parents gave their consent to the use of their child’s data, including photographs, for research purposes and in publications.

Finding at dermatologist’s appointment: linear porokeratosis

The article deals with the epidemiology, pathomorphological picture, trigger factors of development, clinical manifestations and forms, diagnosis, and peculiarities of treatment of linear porokeratosis. A clinical case is presented.Purpose of the article. To consider the clinical manifestations and peculiarities of the course of porokeratosis, paying special attention to linear porokeratosis and its management tactics.Material and methods. The article presents a clinical case of linear porokeratosis. The analysis of medical records was carried out. The forms of porokeratosis, clinical manifestations, peculiarities of diagnosis and approaches to the treatment of porokeratosis in modern conditions are considered.Results. This clinical case demonstrates the difficulty of making a diagnosis of linear porokeratosis. The diagnosis was made based on the results of histological examination of biopsy material. A tactic for the management of the patient was developed.Conclusions. Porokeratosis is a rare skin disease with a wide range of clinical variants, which is important for clinicians to know in order to make a correct diagnosis and avoid errors in diagnosis. The clinical manifestations of the disease are varied, with localized, disseminated, and rash forms.

Hyperekplexiа. Clinical observation

The differential diagnosis of paroxysmal conditions, as well as disorders of muscle tone (hypertension) in the neonatal period and in young children is quite complicated. Various states of the nervous system in newborns are transient and permanent, optimal and suboptimal, normal and pathological. Among them, we can mention non-epileptic paroxysmal states of early childhood. In some cases, non-epileptic paroxysmal states of early childhood is accompanied by motor disorders, manifested by an excessive increase in limb tone in newborns. This pathological condition of muscle tone in the English-language literature is referred to by the term stiffness baby (the syndrome of a rigid or fettered baby). Neonatal pathological muscle hypertonicity, unlike physiological hypertonicity of muscles of a newborn, is a rather rare condition. The article presents literature data and a description of the clinical observation of a patient with hyperekplexia. Hyperekplexia is a rare paroxysmal movement disorder in young children. The main clinical variants of the disease, methods of diagnosis and correction, the main mutations associated with this condition are considered. The article describes the own clinical observation of an early-age patient with hyperekplexia, its clinical picture, features of paroxysmal states and therapy, neuroimaging data, electroencephalographic phenomena recorded in the patient and genetic testing that confirmed the diagnosis of non-epileptic paroxysmal disorders. The child has a mutation in the ATAD1 gene associated with type 4 Hyperekplexia (618011).

Post-covid syndrome in children

Multisystem inflammatory syndrome in children associated with COVID-19 is a new disease, information first appeared in April 2020. There were reported cases of hospitalized children with unusual symptoms, manifested primarily by fever and multisystem inflammation from the pediatricians in the UK and other countries during the coronavirus infection pandemic (COVID-19). Some of these children were in critical condition with symptoms of shock and multiple organ failure, and some children had manifestations similar to Kawasaki disease. Despite the fact that COVID-19 in children is relatively easy, some of the «convalescents» after 2–6 weeks develop symptoms largely identical to the manifestations of severe forms of new coronavirus infection in adults. The report presents own clinical cases of multisystem inflammatory syndrome that developed in children after acute form of a new coronavirus infection. The authors discuss the possible clinical variants of the syndrome, its origin and outcomes.

Psychosomatic disorders (distress, depression, anxiety, somatization) in young patients who have had COVID-19

AIM: The mission is to assess possible psychosomatic disorders (in particular, stress as a nervous breakdown, an acute temporal phase of a specific disorder, which is manifested primarily by signs of depression and neurosis) in young patients who have had COVID-19, in the course of rehabilitation, to improve medical and psychological support after their discharge from the hospital. MATERIALS AND METHODS: 60 convalescents who have had COVID-19 and had practically been healthy before (men aged 19.87 1.64 years) were examined. The main clinical variants and manifestations of COVID-19 in our study were inapparent infection (II) in 19 cases (31.67%), acute respiratory viral infection (ARVI) in 21 cases (35.0%), pneumonia without respiratory failure (P) in 20 cases (33.33%). These are clinical variants and manifestations of mild-to-moderate of COVID-19 severity. The diagnosis of all clinical variants and manifestations of COVID-19, the patients examination, treatment and discharge from the hospital were carried out in accordance with regulatory documents. The patients were examined 68 month after discharge from the hospital. Psychometric examination of these individuals to separate their clinical manifestations of distress and somatization and manifestations of depression and anxiety was carried out according to the questionnaire The Four-Dimensional Symptom Questionnaire, 4DSQ), developed in 1996 by the Dutch specialists B. Terluin. This questionnaire was translation into Russian and adapted by A.B. Smulevich et al. [2014]. Voluntary informed consent was obtained from each of the patients before their participating the study. RESULTS: Indicators of distress, anxiety, somatization after all the clinical variants and manifestations of COVID-19 have a moderately increased level, which indicates a serious illness that has been suffered, in some cases with an unfavorable outcome. The strongly increased level of depression in our study is probably due to the presence of astheno-neurotic syndrome due to the previous COVID-19 disease. The data on the correlation between the scales of methods indicate the direction of possible psychoprophylactic work with convalescents. CONCLUSIONS: The results of the study showed that young patients without concomitant diseases who have had COVID-19, even with a mild and low-symptom course, may develop psychosomatic consequences such as distress, anxiety, somatization and some others. The reasons, duration, potential risk factors for their development require further study, however, timely developed preventive and therapeutic and diagnostic measures, taking into account the individual characteristics of the patient, can have a positive effect.