The purpose — to determine the effect of patient’s compliance level on the appointment of personalized non-drug treatment of non-alcoholic fatty liver disease (NAFLD). Material and methods. 208 patients with excess body mass were examined, 177 patients with excess fat mass (according to the bioimpedance analyses) were included into the study. The patients (n = 93) were divided into groups according to their compliance level: Group 1 (n = 31, 33.3%) — low level; Group 2 (n = 38, 40.9%) — average level; Group 3 (n = 24, 25.8%) — high level of compliance. The period of observation was 3 months. The treatment program was selected depending on the compliance and physical activity levels. The control group (n = 84) included patients without personalized treatment. The unified diagnostic algorithm applied to all patients included biochemical blood test parameters, quantitative ultrasound steatometry within the combined elastography and dual-energy X-ray absorptiometry in the «Whole body» mode. Results. Groups of patients were formed according to the NAFLD stage: hepatic steatosis (n = 23, 24.7%), steatohepatitis with liver fibrosis F0-F1 (n = 41, 44.1%), steatohepatitis with liver fibrosis F2-F3 (n = 27, 29%), liver cirrhosis F4 (n = 2, 2.2%). The connection was revealed between the NAFLD stage decrease in the direction “fibrosis ^ steatohepatitis ^ steatosis” (with a fat mass index decrease) and the compliance level, which served as the basis for the non-drug treatment tactics. Conclusion. A preliminary assessment of the patient’s compliance for the NAFLD non-drug treatment is effective for the progressing along the disease stages of reduction of clinical and morphological manifestations. Quantitative ultrasound steatometry with dual¬energy X-ray absorptiometry in the ««Whole body» mode can be used in patients refusing liver biopsy.
Objective. To evaluate the effectiveness of the ultrasound steatometry technique in patients with non-alcoholic fatty liver disease. Materials and methods. 68 patients aged 19–62 years (median age 40.5 years) were examined, 30 men (44.1%) and 38 women (55.9%), who underwent a single diagnostic algorithm of 7 (8) stages: questioning, clinical examination, noninvasive bioimpedance, biochemical blood test, liver ultrasound in B-mode, determination of hepatorenal index, ultrasound steatometry, liver biopsy. Results. In 4 patients (5.88%), a remote clinical picture of the metabolic syndrome, fatty liver infiltration was diagnosed. Signs of steatohepatitis were present in 19 (27.9%) patients, signs of cirrhosis — in 2 (2.9%). The sensitivity and specificity were 60.3% and 72.6%, respectively, for the B-mode, 44.3% and 51.9%, respectively, for the ultrasound measurement of the hepatorenal index, 90.6% and 92.2%, respectively, for ultrasonic steatometry. Conclusion. Ultrasound steatometry is an informative method for screening of patients with non-alcoholic fatty liver disease. Correlation (r) of the ultrasound diagnosis of steatosis with biopsy at the stage S0 corresponds to 0.81, at the stage S1 — to 0.68, at the stage S2 — to 0.74, at the stage S3 — to 0.88, that indicates a high information value of this method.
Objective. To demonstrate the capabilities of a comprehensive instrumental multimodal differential diagnosis of viral pneumonia in the context of the COVID-19 pandemic.Material and methods. A clinical case of a patient with complicated viral pneumonia and a detailed description of the clinical picture, laboratory information, instrumental research data using minimally invasive interventions, followed by cytological and bacteriological examination, is presented.Results. While the patient was in the hospital, a comprehensive study was performed with a targeted assessment of the state of the chest organs and using minimally invasive diagnostic methods. The signs of bilateral pneumonia (probably of viral etiology, possibly corresponding to COVID-19 infection) revealed by ultrasound and MDCT of the chest organs were the basis for patient’s hospitalization.Conclusion. The multimodal instrumental approach allows to obtain a more complete picture of the pathological process in patients with viral pneumonia in a short time and minimizing radiation and determine the further tactical position in the treatment of this category of patients.
Introduction. The article presents an overview of novel complex algorithm based on methods of ultrasound steatometry, combined elastography and dual-energy X-ray absorbtiometry in “Whole body” mode in diagnostic and monitoring of metabolically associated fatty liver disease.The purpose of the study: to assess the possibility of quantitative ultrasound steatometry using in the detection and monitoring of metabolically associated fatty liver disease.Material and methods. 157 patients were examined. The main group consisted of 47 patients with liver steatosis; 45 patients with steatohepatitis and clinically insignificant liver fibrosis (F0-F1); 32 patients with steatohepatitis and clinically significant liver fibrosis (F2-F3); 33 patients with focal hepatic steatosis. We used complex algorithm based on methods of questionnaires, laboratory tests, ultrasound steatometry, combined elastography and dual-energy x-ray absorbtiometry in “Whole body” mode, liver biopsy. to determine the severity of steatosis, a scale was used: S0 – no steatosis; 2.9 dB/cm.Results and conclusion. It is possible to use quantitative ultrasound steatometry for metabolically associated fatty liver disease, as a reference method both for the initial detection of the disease and for monitoring non-drug treatment (sensitivity 90.7%, specificity 92.4%). The optimal complex for the diagnosis and monitoring of non-drug treatment of metabolically associated fatty liver disease includes an assessment of the level of compliance, the use of quantitative ultrasound steatometry and dual-energy X-ray absorptiometry in the «Whole body» mode (sensitivity 92.8%, specificity 92.3%).
Objective. To evaluate the diagnostic efficacy of the contrast-enhanced ultrasound examination of kidneys in patients with chronic pyelonephritis with a dose of injected contrast agent – 1.0 ml. Materials and methods. In 2020, 20 patients with chronic pyelonephritis were examined on the basis of the Fundamental research laboratory “Diagnostic Researches and Minimally Invasive Technologies”, Smolensk State Medical University. All patients underwent ultrasound examination Doppler mapping mode of the kidneys and the. Also, all patients underwent contrast-enhanced ultrasound examination of the kidneys for the diagnosis of angionephrosclerosis. Results. Using the improved technique in patients of group 2 compared with patients in group 1, the quality of the images obtained was preserved. In patients of group 1 with chronic pyelonephritis, the quantitative indicators correspond to the initial manifestations of angionephrosclerosis. Conclusion. Thus, the improved CEUS technique with the use of 1.0 ml of contrast agent showed good possibilities in the diagnosis of angionephrosclerosis in patients with chronic pyelonephritis.
Relevance. Currently, metabolic syndrome (MS) occurs in 20–30% of the population. The main age of patients is 20–65 years. The study of this syndrome is genetically determined, which indicates that insulin resistance is genetically determined. The obtained facts allowed us to consider MS as the principle of primary prevention of type 2 diabetes and its complications. MTS affects such vital organs as kidneys, pancreas, etc. Since the topic of the development of CKD in patients with metabolic syndrome is acute, a qualitative diagnosis of this complication is necessary. To date, such a method is non-ionizing contrast-enhanced ultrasound, which is not nephrotoxic and hepatotoxic and can be used in patients with reduced renal function.Objective. Evaluation of the effectiveness of the multimodal approach in the algorithm of instrumental diagnostics of examination of patients with metabolic syndrome on the background of type 2 diabetes mellitus.Materials and methods. A study of patients with metabolic syndrome (n = 240) was conducted in 2020–2022. When collecting and analyzing clinical and laboratory data, (n = 67) had metabolically associated fatty liver disease: 22 of them were women (32.8%), 45 men (67.2%), average age 51.0 ± 4.2. All patients were examined according to a single diagnostic algorithm, which included four stages. Stage 1. Examination of patients by specialists, including clinical and laboratory data, with the resolution of the conclusion (n = 67). Stage 2. Ultrasound of the liver with quantitative ultrasound steatometry with determination of the level of the attenuation coeffcient of the ultrasonic wave (n = 67). Stage 3. Conducting dualenergy X-ray absorptiometry (DXA) in the ‘Whole body’ mode (with an assessment of the percentage of adipose tissue, abdominal obesity index) (n = 67). Stage 4. Conducting multiparametric ultrasound of the kidneys in B-mode and colour Doppler mapping (CDC) mode in patients with CKD, followed by contrast-enhanced ultrasound (n = 14). The criteria for inclusion in the study are age over 18 years, metabolic syndrome.Conclusions. 1. The algorithm of examination of patients with metabolically associated fatty liver disease may include extended ultrasound examination of the kidneys, including contrast-enhanced ultrasound examination of the kidneys as a safe and effective method of assessing chronic kidney disease. 2. Two-energy X-ray absorptiometry in the ‘Whole body’ mode is a highly sensitive method in determining and monitoring the components of the metabolic syndrome. 3. A multimodal instrumental study of patients with metabolic syndrome and type 2 diabetes mellitus makes it possible to identify possible complications at an early stage.
The aim of the work was to evaluate the possibility of replacing liver biopsy with other methods of examination in patients with metabolically associated fatty liver disease. All patients were examined according to a single diagnostic algorithm consisting of four stages: physical, laboratory, instrumental (using non-invasive bioimpedansometry, multiparametric ultrasound examination, dual-energy X-ray absorptiometry in the "Whole body" mode, computer and magnetic resonance imaging), histological (evaluation of liver micropreparations on the SAF scale). the patients were divided into three groups, taking into account the results of histological examination of biopsies on the SAF scale: group 1 – patients with hepatic steatosis without signs of inflammation, fibrosis (n = 56, 53.9%); group 2 – patients with steatohepatitis and clinically insignificant hepatic fibrosis F0-F1 (n = 30, 28.8%); group 3 – patients with steatohepatitis and clinically significant liver fibrosis F2-F3 (n = 16, 15.4%). the correlation of findings obtained by the histological examination of liver biopsies and the data of ultrasound quantitative liver steatometry is high – r = 0.95 (for liver steatosis S1), r = 0.84 (for liver steatosis S2), r = 0.91 (for liver steatosis S3); ultrasonic shear wave elastography – r = 0.84 (for clinically insignificant liver fibrosis F0-F1), r = 0.88 (for clinically significant liver fibrosis F2-F3). the data obtained using dual-energy X-ray absorptiometry in the "Whole Body" mode quantitatively reflect the state of the patient's metabolic status, they can be evaluated in dynamics due to low radiation load. Thus, the diagnostic complex consisting of assessing the level of hepatic transaminases, multiparametric ultrasound examination and dual-energy X-ray absorptiometry in the "Whole body" mode is optimal to examine the patients who have contraindications to liver biopsy or completely refuse to pass this study. in case of the patient's consent, absence of contraindications, as well as in the presence of a number of diffuse liver diseases, histological examination is recommended to identify and to assess in detail the dystrophic, inflammatory, sclerotic, regenerative processes.
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