Introduction. All thrombotic microangiopathy (TMA) variants in obstetric practice have a diverse clinical presentation and can manifest as various system and organ damage, which often makes it difficult or interfere with the diagnostic assessment, thus slowing down initiation of the necessary therapy.Aim. To study the clinical presentations of various TMA variants in obstetric practice.Materials and methods. A total of 313 pregnant women were enrolled in the study, of which atypical hemolytic uremic syndrome (aHUS) was diagnosed in 71 women, “HELLP syndrome” in 124 women, and “PE” with varied severity in 70 women. A group of patients with more rare causes of TMA was also identified: TTP and sepsis in 13 patients, and 35 patients without signs of TMA were included in the control group. We assessed and compared the main clinical, laboratory and instrumental findings.Results. The study identified damage to various systems and organs in various TMA types in obstetric practice. The damage to kidneys, liver, nervous system, visual organs was observed in patients with aHUS, HELLP syndrome, TTP, septic TMA and PE, while the damage to skin, cardiovascular system and lungs was detected in patients from all groups except for PE. Small and large vessel thrombotic complications were detected in patients from the former three groups. The patients with aHUS showed the maximum multisystemic presentation severity.Conclusions. The thrombotic microangiopathy in obstetrics is generalized in nature, and various symptoms of organ dysfunction require a multidisciplinary approach to such patients.
Аннотация. При индивидуальной траектории обучения важно уметь объективно оценивать результаты учащихся, выделяя их персональные достижения. Для этого традиционная балльно-рейтинговая система, основанная на усреднении получаемых оценок, явно не годится.Традиционно балльно-рейтинговая система удобна для распределения учащихся в группы успеваемости (удовлетворительно, хорошо, отлично). Однако это нивелирует их индивидуальные способности, в процессе обучения не видна траектория развития обучающегося. Способности к обучению скрываются от будущего работодателя.Создается психологическая ситуация, когда процесс обучения становится не наблюдаемым, что не позволяет управлять им ни педагогам, ни самим учащимся. Такое явление известно в теории управления как техническими, так и административными, экономическими и социально-психологическими системами.Для реализации индивидуальной траектории обучения наряду с традиционными технологиями линейного оценивания предлагается использовать информационную технологию нелинейного оценивания, основанную на статистической теории принятия решений и нелинейной фильтрации оценок, полученных учащимися в процессе обучения.Основным преимуществом нелинейного оценивания является значительное снятие вырождения, присущее линейному оцениванию. Это позволяет различать комбинации стандартных оценок, а не только значения их сумм и, тем более, средних значений. Важность невырожденности состоит в том, что при увеличении количества заданий для повышения точности оценивания возрастает и количество комбинаций стандартных оценок, приводящих к одним и тем же суммарным значениям. Предлагаемое нелинейное оценивание решает эту задачу.
Background. Anti-angiogenic anticancer drugs that block the vascular endothelial growth factor signaling pathway can cause renal damage. Assessment of the risk of nephrotoxicity allows developing optimal treatment approaches and ensuring the relative safety of therapy. Aim. To assess early clinical and laboratory manifestations and risk factors for nephrotoxicity of antiangiogenic drugs. Materials and methods. The study included 50 patients who received antiangiogenic drugs in different regimens of chemotherapy. Demographic factors, body mass index, blood pressure levels, type of antiangiogenic drug, and concomitant therapy were assessed. Before treatment and over a period of 8 weeks, the levels of hemoglobin, number of platelets and schistocytes, D-dimer levels, serum lactate dehydrogenase (LDH) levels, as well as daily proteinuria and serum creatinine and eGFRCKD-EPI were assessed. Linear regression analysis was performed to assess risk factors for nephrotoxicity and arterial hypertension (AH). Results. The median age of patients was 46 [3457] years, 22 (44%) men and 28 (56%) women. AH developed in 52%, a decrease in eGFR in 42%, along with a decrease in hemoglobin levels and an increase in LDH levels at 2 weeks of therapy. The numbers of schistocytes and platelets significantly decreased by 8 weeks of therapy. Risk factors for impaired renal function during treatment with antiangiogenic drugs were an initial decrease in GFR less than 80 ml/min/1.73 m2, an increase in D-dimer levels, and a decrease in hemoglobin levels by 8 weeks of treatment. The risk factors for AH during therapy were the initial decrease in eGFR less than 80 ml/min/1.73 m2 and no prophylactic anticoagulant therapy. Conclusion. Early signs of nephrotoxicity of antiangiogenic anticancer drugs were a decrease in eGFR and AH. The independent risk factors for nephrotoxicity were the initial decrease in eGFR, an increase in D-dimer levels, and a decrease in hemoglobin levels at 8 weeks of treatment, while the prophylactic use of anticoagulant therapy reduced this risk in our study.
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