RESEARCHPlease cite this paper as: Ospanov O, Ospanova K, Kadyrova I. Neuron-specific enolase level in patients with metabolic syndrome and its value forecasting acute stroke. AMJ 2018;11(3):186-194. ABSTRACT BackgroundPatients with metabolic syndrome are at a greater risk of experiencing a cerebrovascular event. Several studies show that patients with metabolic syndrome have asymptomatic ischemic brain injury. In this case, there is a need for rapid determination of asymptomatic brain lesions and prediction of acute stroke. AimsThe aim of the study was to determine the neuron-specific enolase (NSE) serum level in patients with metabolic syndrome and the value of this level for forecasting acute stroke. MethodsThe study used the following information to determine metabolic syndrome: waist circumference, total cholesterol, triglycerides, high-density lipoprotein cholesterol, blood pressure, and blood glucose. Doppler sonography mapping of the brachiocephalic trunk was held to determine the percentage of the carotid artery stenosis. To determine asymptomatic ischemic brain injury, the NSE serum marker was measured. Statistical processing of the measurements was performed using the H test and the Mann-Whitney test. The possible link between MS and NSE were determined by logistic regression analysis. Mathematical modeling was performed using logistic regression. ResultsThere are statistically significant differences in NSE concentrations in groups with metabolic syndrome and ischemic stroke patients. This assertion is confirmed by logistic regression analysis, which revealed the existence of a relationship between metabolic syndrome and increased concentration of NSE. ConclusionPatients with metabolic syndrome have an increased concentration of NSE. This indicates the presence of asymptomatic ischemic neuronal damage. A prognostic model for determining the probability that patients with metabolic syndrome will have an acute stroke was developed.
Among the new professions, the introduction of which is in demand in the modern health system, is the profession of a bariatric and metabolic surgeon. Bariatric and metabolic surgery is a cost-effective field of medicine, with a relatively short payback period, and its development is of high social importance. Considering the positive impact on the life expectancy and quality of life of patients, the use of laparoscopic mini-gastric bypass surgery, as a more effective and reliable, as well as relatively safe method of bariatric and metabolic surgery, is an attractive investment area. The development of bariatric and metabolic surgery is of particular relevance in preventing the negative consequences of obesity for human health, in particular, in the combination of type 2 diabetes mellitus with morbid obesity. All this determines the high relevance of the development of such a new field of surgery as bariatric and metabolic surgery in the health system of the Republic of Kazakhstan and the training of bariatric and metabolic surgeons within the framework of specialization programs for medical specialists of the surgical profile.
Aim: Classification of hiatal hernias should include the main parameters for intraoperative selection of the surgical treatment method. Abbreviated descriptions of hiatal hernias, such as HH I-IV are not complete and need further development. Methods: We have perfected a classification of hiatal hernias and used it in clinical practice to classify hernias in 75 patients who underwent surgical treatment. Four recognized types of hiatal hernias (HH) were used. Type I (sliding) hernias have the gastroesophageal (GE) junction above the level of the diaphragmatic hiatus. Type II (rolling) hernias have a normally positioned GE junction, but a portion of the fundus is above the hiatus. Type III hernias have displacement of the GE junction and fundus above the hiatus and type IV hernias are characterized by the presence of other viscera within the hernia sac. The width (W) defect between the right and left diaphragmatic crura is the most important size measurement that determines the difficulty of successfully repairing the hiatal hernia, with W1 < 3 cm; W2, 3-5 cm; W3, 5-8 cm; and W4 > 8 cm. The length (L) of the hernia defect was defined as the vertical distance in cm between the high and low point of hiatal orifice with L1 < 5 cm; L2, 5-8 cm; and L3 ≥ 8 cm. Measurement of the GEJ position was done immediately after hiatal opening to evaluate the grade of short esophagus (SE), with SE0, no shortening; SE1, shortening by ≤ 4 cm; and SE2, shortening by > 4 cm. We considered that hiatal hernia recurrence (R) after previous repair should be included in the classification with R0, no recurrence and R (n), the number of previous hernia repairs.Results: Our perfected classification was in the format: HH I-IV; W1-4; L1-3; SE 0-2; R 0-n. According to our data, the parameters of hiatal hernia were formulated in most cases (49/75) as HH I; W 2; L 2; SE 0; R 0, which represented the prevalence of patients with sliding hernia with secondary width and length of the esophageal orifice, without shortening esophagus or recurrence.Conclusions: Our classification allows abbreviated description of the main intraoperative parameters of hiatal hernia, which facilitates the choice of the surgical treatment method.
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