The article presents a clinical case of a 49-year-old man with a long history of alcohol abuse, type 2 diabetes mellitus and hypertension, who was hospitalized with symptoms of acute heart failure. Coronary angioventriculography excluded significant atherosclerotic lesions of the coronary arteries, revealed apical ballooning of the left ventricle (LV), and suspected takotsubo syndrome (TS). Subsequent examination revealed hyperglycemia, increased troponin I levels, decreased global contractility of the LV myocardium, and signs of obstructive hypertrophic cardiomyopathy (HCM). During inpatient treatment, including infusion therapy, beta-blockers and glucose monitoring, the patient's condition improved. Subsequent studies conducted at the outpatient stage confirmed the presence of HCM with a dynamic decrease in the degree of LV outflow tract obstruction, indicating a complex interaction between ST, HCM and withdrawal syndrome against the background of alcohol dependence. This case emphasizes the importance of differential diagnosis and an integrated approach to the treatment of patients with multiple comorbidities.
Vitamin D plays a central role in calcium regulation and oral health, yet deficiency remains widespread in many regions, including North Africa, despite abundant sunlight. Limited data are available regarding vitamin D status among dental patients in Libya. This study aimed to assess serum vitamin D and calcium levels among patients attending a dental clinic in Sabratha City, Libya, and to examine differences by age, gender, and vitamin D category. A descriptive analytical cross-sectional design was implemented from September to November, during which serum 25-hydroxyvitamin D and calcium were measured, and demographic data were recorded. Data were analyzed using IBM SPSS Statistics version 21, applying descriptive statistics, independent-samples t-tests, and one-way ANOVA with significance set at p < 0.05. Participants ranged in age from 6 to 50 years, with a mean of 20.83 ± 11.22 years. Serum vitamin D levels showed considerable variation, ranging from 3 to 53.8 ng/mL, with a mean of 22.51 ± 10.67 ng/mL; deficiency was identified in 47.2% of patients, insufficiency in 30.6%, and sufficiency in 22.2%. Serum calcium concentrations ranged from 8.3 to 10.1 mg/dL, with a mean of 9.11 ± 0.43 mg/dL. No statistically significant differences in vitamin D or calcium were found between males and females, between age groups, or across vitamin D categories. In conclusion, a notable proportion of dental clinic attendees had low vitamin D levels, whereas serum calcium levels remained within normal limits across all groups. These findings provide useful baseline biochemical information for this population and highlight the broad presence of suboptimal vitamin D levels in the region
Poor water solubility, which negatively influences the bioavailability of oral medications, is typical for the vast majority of molecules (up to 70
Introduction. Poly-L-lactic acid (PLLA) has a multifactorial effect on skin aging. It stimulates extracellular matrix components synthesis. High-molecular weight hyaluronic acid (HA) offers the advantage of maintaining optimal skin hydration and inhibiting matrix metalloproteinases. The combination of these agents appears to be promising, as evidenced by the synergistic effect observed in their actions. Aim. To evaluate the efficacy and safety of a hybrid one session treatment with PLLA and high-molecular weight HA for skin rejuvenation using both ultrasound (US) and histological diagnosis. Materials and methods. Reconstituted PLLA was injected to a depth of 3–4 mm into the anterior abdominal wall in six healthy females. Intradermal injections of HA were conducted to a depth of 2–3 mm. The efficacy of the injection treatments was assessed after 24 hours and 6 weeks based on visual assessment, photography, US, and histologic examination. Results. Six weeks after the treatment, the clinical signs included skin thickening and visual smoothing of the skin relief. Ultrasound results demonstrated zones of varying acoustic density, indicative of a gradual increase in connective tissue density. Areas of hyperechogenic density indicated structural reorganization and an increase in the number of connective tissue components. Histological examination of biopsy specimens confirmed active connective tissue restructuring. A comparison with the pre-treatment histology confirmed the formation of a denser network of collagen fibers at the level of dermis and subcutaneous adipose tissue. Conclusions. The developed hybrid protocol was characterized by a favorable clinical efficacy and safety profile. These results were confirmed by histology and US, and were characterized by structural reorganization of connective tissue, with an accumulation of collagen fibers in the dermis and subcutaneous fat.
Aim . To study the characteristics of the atrial fibrillation (AF) cryoballoon ablation (CBA) procedure and features of patient’s management in real clinical practice in Russia. Methods . “Prospective Atrial Fibrillation Cryoablation Registry” is an observational prospective national multicenter study. It was conducted from 01.2017 to 12.2019 in centers of Russian Federation. The registry included patients over the age of 18 who were agreed to participate this study and had indications for CBA of AF. The study protocol did not provide for significant restrictions on inclusion criteria, procedure technique and postoperative follow-up. The data was collected prior to the CBA of AF, during hospitalization for CBA and on the 12-month follow-up. Results . Participating centers enroll 980 patients according to inclusion criteria. CBA of AF was performed in 976 (99.6%) (mean age 59.7±9.2 years, 545 (55.8%) men) primary procedure - 840 (86.1%), re-ablation - 136 (13.9%). Parox- ysmal AF occurred in 828 (84.8%) patients and persistent AF (mean time of persistence 4.4±3.7 months) - in 145 (15.1%) patients. The average procedure time was 108.1±33.3 minutes and mean fluoroscopy time was 24.9±13.6 min. Most of the procedures were performed under general anesthesia. Complications after AF CBA occurred in 53 (5.4%) patients. The most common complication was paresis of the phrenic nerve - 20 (37.7%) cases which were associated with lower temperatures of CBA application of the right pulmonary veins (τ=0.08; p<0.05). The features of antiarrhythmic and anticoagulant therapy were evaluated. A group of patients without adequate anticoagulant therapy in the postoperative period was identified. Due to COVID-19 restrictions only 374 (38.3%) patients completed 12-month follow-up. The recurrence of arrhythmia was occurred in 85 (22.7%) patients. Multivariate regression analysis revealed the following predictors of arrhythmia recurrence: the first procedure (OR 3.96; p=0.023), male sex (OR 1.77; p=0.014), duration of the procedure (min) (OR 1.01; p=0.007). Conclusion . CBA is an effective and relatively safe procedure for the treatment of paroxysmal and persistent AF. Data from real clinical practice show a low proportion of serious complications of AF CBA. Data on the dynamics of drug therapy, including anticoagulant and antiarrhythmic therapy, were obtained. The attention of specialists performing AF catheter ablation and patient monitoring is required, since errors in patient management have been identified.
