Both groups of children underwent a rapid step test, which has immediately confirmed the diagnosis, while the results of the microbiological culture came after 2-3 days.It is noteworthy to mention that all children of the sample, have been treated in my paediatric practice. Conclusion The comparative study confirmed that the rapid strep test is accurate in 97% of the examined cases. Namely, the parallel analyses consisting of rapid strep test and microbiological swabs in 269 children out of 380, have shown identical results.Therefore, a rapid strep test is ought to be done by every doctor, in order to come up with a prompt diagnosis and therapy, prevent diseases, as well as promoting rational use of antibiotics.
Liver fibrosis is a progressive pathological process that develops in chronic liver disease. This pathology can lead to cirrhosis. Liver biopsy remains the gold standard for evaluation of liver fibrosis, currently, though, non-invasive diagnostic methods are being actively introduced into clinical practice. Unlike liver biopsies, most non-invasive instrumental techniques are easy to perform, accessible, and repeatable, making them more convenient for evaluating dynamic fibrotic change. The review summarizes the main principles of non-invasive instrumental techinques for assessment of liver fibrosis severity, which have been studied and put into practice in recent years. The most widely used techniques in clinical practice are based on principles of elastography — it indirectly determines the organ tissue density. The techniques are characterized by different sensitivity and specificity in the diagnosis of fibrosis. The main issues arise when differentiating the disease stages. For some techniques, the limitation of use is ascites, excessive subcutaneous fat, whereas the main limiting factor for others is the high cost of the procedure. Meanwhile, there is every reason to believe that non-invasive techniques can take the main place in the diagnosis of liver fibrosis and replace biopsy in the foreseeable future. KEYWORDS: liver fibrosis, chronic liver diseases, non-invasive diagnostic techniques, elastography, liver biopsy, magnetic resonance imaging, ultrasound. FOR CITATION: Kulebina E.A., Surkov A.N., Usoltseva O.V. Non-invasive diagnostics of liver fibrosis: recent data on the possibilities of instrumental techniques. Russian Medical Review. 2020;4(5):297–301. DOI: 10.32364/2587-6821-2020-4-5-297-301.
Long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHAD) is a hereditary disease referred to the group of disorders of mitochondrial β-oxidation of fatty acids with autosomal recessive inheritance. The main symptoms include hypoglycemia, hepatic steatosis, cardiomyopathy, cardiac arrhythmias, progressive muscle hypotension. We present a case of successful diagnosis and treatment of a long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHAD) with the use of 100% medium chain triglycerides’ oil product. The importance of the possibly earliest verification of the diagnosis and initiation of diet therapy using medium-chain triglyceride oils is emphasized, which allows to reduce the disease manifestations and determines the need to include diseases of mitochondrial fatty acids β-oxidation into the neonatal screening program.
It is assumed that serum concentrations of type I, III, IV collagen (Col I, Col III, Col IV) and hyaluronic acid (HA) can provide informative evidence for the diagnosis of liver fibrosis (LF) using non-invasive procedures, however, there is insufficient data on the subject in paediatrics. Objectives: to study characteristics of changes in concentrations of Col I, Col III, Col IV and HA in blood serum in accordance with the stages of liver fibrosis in children. Materials and methods of research: a prospective study was carried out, which included 80 patients aged 5 to 17 years with chronic liver diseases of various etiologies, who underwent marginal resection of liver tissue under laparoscopic control, then a morphological study of the obtained biopsy was performed with determination of the stage of fibrosis on the METAVIR scale and the content of Col I, Col III, Col IV and HA in blood serum by the method of enzyme immunoassay. Results: the assessment of the content of K-I in the blood serum allows differentiating the stage F1 and F3 from F4 (p=0,025, p=0,006), Col IV – F1 from F2 (p=0,011), F3 (p=0,002) and F4 (p<0,001), HA – F1 from F3 (p=0,041), and also F4 from F1 (p<0,001), F2 (p<0,001) and F3 (p<0,001). There were no statistically significant differences in the content of Col III at different stages of LF (p=0,061). Statistically significant correlations of the histological stage of LF with changes in serological levels of Col I (ρ=–0,267, p=0,023), Col IV (ρ=0,409, p<0,001), and HA (ρ=0,575, p<0,001), and also the relationship between the concentrations of Col IV and HA (ρ=0,265, p=0,023). Conclusions: the correlations found in the histological phase of LF with changes in serological levels of Col I, Col IV and HA lead to the conclusion that fibrosis direct biomarkers are of diagnostic importance in determining the stage of LF, which is of great importance for practical medicine, especially in pediatrics.
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