Open Access Macedonian Journal of Medical Sciences

A Monograph on Anatomy and Variants of Hepatic Resectional Surgery

Danilo Coco — 2024-09-15

BACKGROUND: The liver anatomy appears to be very complex due to the enormous number of vascular and biliary branches as well as the fact that the underlying pathology frequently distorts the anatomy. To prevent damage during surgical or invasive procedures, it is advised to be aware of the arteries’ typical structure and variations. Hepatic surgeons, general surgeons, transplant surgeons, interventional radiologists, and other medical specialists who treat liver problems must have this knowledge.

MATERIALS AND METHODS: We have retrospectively evaluated the PubMed databases, Embase, and the Cochrane Library by applying various combinations of subject-related terms. The search terms identified with the medical subject heading were “Anatomy, right hepatectomy, resection, variants.” The databases were used to collect the literature published since 1991.

RESULTS: Results delineated that 91.6% of patients had a single right hepatic vein, 81% shared a trunk with their middle hepatic vein (MHV) and left hepatic vein (LHV), and 19% had separate MHV and LHV drainage into the inferior vena cava. Overall prevalences of the abnormal hepatic artery, abnormal right hepatic artery (aRHA), abnormal left hepatic artery (aLHA), and combined aRHA/aLHA were found to be 27.41%, 15.63%, 16.32%, and 4.53%, respectively. The most common variation (type 2) is the so-called “portal vein (PV) trifurcation,” in which the main PV divides into the left PV, the right anterior PV, and the right posterior PV. The right posterior sectoral duct joins the left hepatic duct with a supraportal course, the right posterior sectoral duct joins the right anterior sectoral duct with an infraportal course, the trifurcation variation of the biliary tree, retroportal course, and the left lateral segmental ducts caudal to the umbilical portion of the PV are examples of variant biliary anatomy encountered in PV variations. Duplication of the common bile duct is a very uncommon congenital biliary system defect.

CONCLUSION: It is very crucial for surgeon to have abreast knowledge of the tributaries, their anatomy, and variations to limit blood loss and operative morbidities.

Perceptions of Patients and Professionals about the Path of a Patient with Periodontal Disease through the Health-care System

Karmen Erjavec — 2024-09-15

BACKGROUND: Periodontal disease or periodontitis is one of the most common chronic diseases worldwide. Examining the pathways of patients with periodontitis through the health-care system enables a more comprehensive approach to treatment and support that improves social inclusion and quality of life.

AIM: The aim of the study was to explore and understand the perceptions of people with periodontitis and key experts in the field regarding the treatment pathways and the key information, actors, structures, activities, processes, and factors that contribute to improving the treatment of patients with periodontitis.

MATERIAL AND METHODS: We used a qualitative research design with in-depth interviews to gather comprehensive data on individuals’ perspectives and experiences related to periodontitis. A total of 12 patient interviews and 12 expert interviews were conducted.

RESULTS: Most interviewees only contacted a dentist when periodontitis symptoms such as gum swelling and tooth mobility became severe. This delayed response is attributed to limited health literacy and a lack of familiarity with basic oral health. Physicians often miss these symptoms or hesitate to treat them due to uncertainty, limited knowledge, or systemic pressures. Improvements in health care call for enhanced symptom recognition, patient education, and interprofessional collaboration to tackle these challenges efficiently.

CONCLUSION: The study underscores the need for improved health literacy and interprofessional collaboration in health care, highlighting that delayed treatment of periodontitis due to lack of symptom recognition and limited oral health knowledge necessitates more effective patient education and health-care provider training.

Intermittent Exotropia and Overminus Lens Therapy in Macedonia

Antonela Ljubic — 2024-09-15

AIM: Intermittent exotropia (IXT) is the most common form of exodeviations. The aim of our study was to investigate the outcome after overminus lens therapy in children and young adults with IXT.

METHODS: Fifty-three children and young adults with IXT, aged 3–33 years, from Macedonia, underwent slit-lamp examination, ocular motility, and refraction. For assessing near control in children and young adults with IXT, we used an office-based Mayo Scale.

RESULTS: Most of the patients had Mayo score 1 (30.2%) and Mayo score 2 (26.4%). A Mayo score of 3 was presented in 18.9% of the patients, and Mayo score of 0 in 15.1%. A Mayo score of 4 was presented in 5.7%, and Mayo scored only in 3.8% of the IXT patients. After prescribing overminus glasses, 43.4% of the IXT patients showed better outcomes with better punctum proximum convergence and/or, better stereoacuity, and/or smaller near angle of deviation (in pdp). 52.8% same motility and sensory outcome was observed, whereas only in 3.8% worse findings were reported.

CONCLUSIONS: Our study group was with a mean age over 5 (10.2 years) and we used lower overminus therapy (add. −0.75 D). The following studies of overminus lens therapy on IXT children and young adults over 5 years of age, should confirm our findings of a high percentage of improvement in terms of Mayo near control assessment.

Potential use of Oncostatin M in Critically ill Patients with acute Kidney Injury

Amin Soliman — 2024-09-15

BACKGROUND: Acute kidney injury (AKI) is one of the most common complications affecting patients admitted to intensive care unit (ICU) worldwide. In response to injury, both kidneys and liver secrete acute phase reactants as a mechanism of protection. Oncostatin M (OSM) is a member of the interleukin-6 family of cytokines which was found to be elevated during renal injury as in diabetic nephropathy, glomerulonephritis, and obstructive nephropathy.

AIM: The study aimed to assess the role of OSM as an early biomarker of AKI in critically ill patients.

PATIENTS AND METHODS: We conducted a prospective case–control study that included 202 patients admitted to ICU within Kasr El-Aini University hospitals during the period between January 2022 and August 2022. Eligible patients were divided into two groups according to the occurrence of AKI, and Oncostatin was assessed in the sera of the included patients.

RESULTS: Our findings showed that the AKI group had statistically significant lower OSM levels compared to the control group, especially among those patients who had poor clinical outcomes and non-survivors. We also found that OSM is a good predictive tool for the prediction of mortality among patients admitted to ICU with sepsis complicated with AKI (Area under the curve = 0.673, 95% confidence interval: 0.532–0.814) with a sensitivity of 83.8% and specificity of 61.4%.

CONCLUSION: OSM plays an important role among critically ill patients who are admitted to the ICU with sepsis, it can significantly predict AKI development and subsequent mortality.

The Low Back Pain - Looking For a Physiotherapeutic Approach

Lence Nikolovska — 2024-09-15

BACKGROUND: Low back pain (LBP) is one of the most common neurological complaints. It affects young people but has a slow progression even at a later age. LBP is a condition with a rich clinical picture – pain, severely limited range of motion in the spinal column (especially in the area of the L4-L5 segment) and sacro-iliac joints, difficulty walking. Physiotherapy has an essential role in maintaining the general condition and improving the quality of life for this contingent of patients.

AIM: The aim of the present study is to create and approve a physiotherapy methodology for pain reduction in patients diagnosed by a neurologist – radiculitis of the lumbo-sacral plexus.

METHODS: 20 clinically proven patients divided into two groups were included in the study. After signing informed consent declarations and assessment of anthropometric data (age, height, and weight), the subjects were evaluated with neurological tests such as Lasegue test and dolorimetry. Results were also reported on the Barthel index scale.

RESULTS: The dynamics of dolorimetry results, quality of life, and mobility in the spine area (especially the lumbar segment) were monitored in the two studied groups, with the results in the experimental group demonstrating better values (p < 0.0001).

CONCLUSION: There is no unified system for pain reduction in patients with LBP. As a result of applied physiotherapy, including modern techniques for myofascial massage, a faster increase in joint mobility in the area of the spine and sacroiliac joints, an improvement in muscle strength and, above all, a reduction in pain symptoms were found.

The Influence of Experimental Chronic Antenatal and Acute Postnatal Hypoxia on the Morphological State of the Liver Stromal Component

Alla B. Zotova — 2024-09-15

BACKGROUND: At present, the asymptomatic course of liver pathology in early childhood remains an urgent problem.

AIMS: The objective of the study was the detection of morphological features of the stromal component of the liver of rats, which were at different stages of postnatal ontogenesis and were exposed to chronic antenatal and acute postnatal hypoxia (APH).

MATERIALS AND METHODS: The study material was rat liver tissue of the control group, the APH group, and the chronic antenatal hypoxia (CAH) group.

RESULTS: From day 1 to day 35, CAH leads to an increase and growth of the stromal component in the liver of offsprings due to the development of sclerotic changes caused by activation of collagen formation with a predominance of mature collagen Type I over immature collagen Type III on day 1 and day 14 of the experiment and predominance of collagen Type III over collagen Type I on day 35 of the experiment, increasing the expression of fibronectin. Starting from day 14, APH leads to the development of sclerotic changes in this organ which increase to day 35, less pronounced compared to the detected sclerotic changes in CAH, and manifest in increased expression of fibronectin, activation of collagen formation with a predominance of collagen Type I over collagen Type III on days 14 and 35 of the experiment.

CONCLUSION: CAH from day 1 and APH from day 14 of postnatal life lead to the development of sclerotic changes in the liver of offsprings, which are more pronounced in cases of simulation of CAH and increase with age.

Electrodiagnostic Findings of Median Nerve Motor and Sensory Conduction in Neurological Asymptomatic Newly Diagnosed Patients with Hypothyroidism

Ilija Zdravkov — 2024-09-15

BACKGROUND: The influence/impact of thyroid hormones on peripheral nervous system has still not been thoroughly/substantially studied/examined. Neurographic studies, which measure motor and sensory nerve conduction along with F-wave, have an important role in diagnosing diseases of the peripheral nerves since electrophysiological sings of neuropathy can be detected even in subclinical state/cases.

AIM: The aims of this study were to assess the neurophysiological parameters of the median nerve by electrodiagnostic measurements using electromyoneurogaphy (EMNG) in the region of radiocarpal joint in patients with newly diagnosed and medically untreated primary hypothyroidism who had no symptoms and signs of peripheral nerve damage/injury/lesion. Furthermore, it was our aim to make an insight of the possible early detection of the latent damage of peripheral nervous system in untreated hypothyroidism.

MATERIAL AND METHODS: This was a prospective clinical study that comprised 78 subjects/patients according to inclusion criteria, divided into two groups: one with primary hypothyroidism and the other group involving euthyroid subjects. Thyroid status was examined in each subject; anthropometric parameters were analyzed, and electromyoneurographic imaging (EMNG) of hand median nerve was realized.

RESULTS: Of the total number of 78 subjects included in the study, 58 (74.36%) had hypothyroidism and 20 were euthyroid subjects (25.64%). The calculated mean levels of thyroid status parameters in hypothyroid patients, TSH, aTPO and FT4, were 6.19±1.85 mIU/L, 872.22±296.66 U/mL and 0.78±0.11 ng/dL, respectively. In euthyroid patients, the mean levels of TSH, aTPO and FT4 were 0.27±0.08 mIU/L, 31.2071±5.65 U/mL and 1.31±0.25 ng/dL, respectively. Statistically significant differences were obtained between hypothyroid and euthyroid subjects regarding: age (p=0.0147, r=0.3239), body weight (p=0.0441, r= -0.531), body mass index (p=0.0050, r= -0.301), WHO classification for BMI (p=0.0032, r= -0.250), TSH (p<0.0001, r=-0.309), aTPO (p<0.0001, r=0.5554) and FT4 (p<0.0001, r= -0.317). In the group of 58 hypothyroid subjects, 38 (65.52%) were women and 20 (34.48%) were men. A strong correlation and significant statistical difference were registered in EMNG pathological findings in patients with pathologic BMI and with mild predilection for the sensory part of the median nerve. Of the 58 hypothyroid patients, EMNG pathologic findings were present in 18 that, in terms of their features, indicated a distal lesion of the median nerve. These 18 subjects had an increased body mass index (30.83±5.65 kg/m2).

CONCLUSIONS: Discovery, definition and explanation of etiopathogenic nodes in peripheral nervous system diseases will require extensive and multidisciplinary strategies in the next decades. These complex conditions, in our opinion, will claim a steady/a step-by-step/ approach to the problems, as well as consistency and symmetry in the design and methodology of the research procedures.

Transthyretin-related Familial Amyloid Polyneuropathy: A Case Report

Sara Nikolova — 2024-09-15

BACKGROUND: Hereditary amyloidosis transthyretin is an autosomal dominant disease caused by heterozygous mutations in the transthyretin gene. The disease is characterized by amyloid deposits in various organs, primarily in the peripheral nerves and the myocardium.

CASE PRESENTATION: A 53-year-old female patient with the onset of symptoms 2 years earlier, presented with fatigue, difficulty walking, progressive muscle weakness, tingling in the hands and feet, blood pressure variations, weight loss, and constipation. There was no positive family history of familial amyloid polyneuropathy (FAP). Electromyography revealed sensorimotor axonal neuropathy; electrophoresis of cerebrospinal fluid was of transudative type, without immune activity in the central nervous system, while echocardiography detects hypertrophic myocardium and interventricular septum.

CONCLUSION: All patients who show symptoms of peripheral neuropathy with predominant signs of autonomic nervous system damage and hypertrophic cardiomyopathy should be referred for genetic testing for FAP.

Syphilitic Roseola in Human Immunodeficiency Virus-infected Homosexual: A Case Report

Elvira Bernadetta — 2024-09-15

BACKGROUND: Roseola syphilitica is one of the main manifestations of secondary syphilis. Syphilis is a sexually transmitted disease caused by Treponema pallidum. Syphilis and human immunodeficiency virus (HIV) infection can occur simultaneously and complicate the progression of the disease. HIV-syphilis coinfection is often cited as the main cause behind the increasing prevalence of syphilis among men who have sex with men (MSM).

CASE PRESENTATION: A 21-year-old man with HIV infection came with complaints of reddish spots on the face, genitalia, and palms of hands and feet that had appeared 3 weeks prior without itching or pain. The patient had a history of self-limiting red spots on his genitals 3 months prior. T. pallidum hemagglutination assay and veneral disease research laboratory serological examination showed titers of 1/10240 and 1/128. The patient was diagnosed with secondary syphilis and was given a single dose intramuscular injection of benzathine penicillin G 2.4 million units. Syphilis is often found together with HIV infection. The clinical picture of syphilis varies greatly, depending on the stage. In HIV patients, the clinical manifestations of syphilis are similar to non-HIV patients but the lesions are more aggressive. Serological tests are accurate and reliable for diagnosis and monitoring patient’s response to treatment. Until now, penicillin is still effective for treating syphilis but further physical and serological examinations are still needed for up to 24 months.

CONCLUSION: HIV infection in MSM is the most important factor causing syphilis. The diagnosis is made based on physical examination and blood serology. There is no difference in syphilis therapy between HIV patients and those who do not have HIV.

Analysis of Antibiotic Treatment and Microbiological Findings and Its Implication on Outcome in Patients with Parapneumonic Effusions

Sanja Petrusevska-Marinkovic — 2024-09-15

BACKGROUND: Parapneumonic effusion (PPE), as a complication of community-acquired pneumonia, sometimes progresses into complicated PPE (CPPE) and empyema, thus becoming a significant clinical problem. There is a lack of guidelines for antibiotic therapy and reports on local microbiological status and resistance of microorganisms.

AIM: Тhe paper is focused on the analysis of antibiotic therapy and microbiological findings that are affecting patient outcomes and length of treatment.

METHODS: We analyzed 94 patients, 50 with uncomplicated PPE (UCPPE) and 44 with CPPEs.

RESULTS: More patients (59.57%) were male, average age 53.82 ± 17.5 years. Alcoholism was the most common comorbidity in patients with CPPE registered in 25% of patients. A positive pleural punctate culture was present in 31.82% of patients with CPPE. Peptostreptococcus was most often isolated in 28.57%. Blood culture was positive in 12.76% of patients. Most of the patients were treated with combined therapy that also covered anerobes (64.89%). Statistical differences existed in terms of days of hospital treatment with a longer hospital stay for patients with CPPE (p < 0.0001). The average time of hospital treatment in patients with UCPPE was 15 days, and in patients with CPPE, it was 21 days.

CONCLUSION: As soon as a pleural infection is noted, patients should receive antibiotic therapy, which should be based on pleural fluid culture. Anerobic coverage is required. In this way, the development of CPPE and empyema will be prevented, and thus, mortality and long hospital stays will be reduced.

Musculoskeletal Disorders at Work among Slovenian Physiotherapists: Prevalence and Risk Factors

Nataša Koprivnik — 2024-09-15

BACKGROUND: Musculoskeletal disorders at work (MSDWs) remain the most common health problem in the European Union, particularly in Slovenia, where the prevalence of MSDWs is slightly above the European average. Despite the extensive literature on MSDWs in the health sector, there is little research on physiotherapists (PTs), especially in Europe. Our previous study showed a high prevalence of MSDWs among PTs, with the lower back, neck, and shoulder being the most affected.

AIM: The aim of this study was to investigate the prevalence of MSDWs among Slovenian PTs, ergonomic factors, and the association between MSDWs and demographics and MSDWs and ergonomic risk factors.

METHODS: The survey covered Slovenian PTs working in different health-care settings, using a non-randomized snowball sample. 198 PTs participated, after excluding 22 incomplete questionnaires, 176 PTs remained in the final sample. Data were collected through questionnaires covering demographics, ergonomic risk factors, and the incidence of pain and discomfort in the body.

RESULTS: The lifetime prevalence of MSDWs among 176 FTs was 97.7%. The most affected body regions were the neck (79.5%), upper back (59.2%) and lower back (51.7%). The 1-year prevalence of MSDWs was 94.9%, with the highest prevalence in the upper back (69.3%), neck (66.5%) and lower back (64.3%). The study identified a weak negative association between the prevalence of MSDWs and factors such as age, working life, and job satisfaction across various body regions.

CONCLUSIONS: The results of the survey confirm a high prevalence of MSDWs among Slovenian PTs, which is comparable to European surveys. Key risk factors include ergonomic load and demographic variables. These data highlight the need to improve working conditions and ergonomic measures in physiotherapy practice. The study contributes to a better understanding of MSDWs among PTs in Slovenia and provides a basis for further research and interventions to reduce the risk of MSDWs.

The Hemostatic Effect of T-Hemocel in Neurosurgery Case

Andi Asadul Islam — 2024-09-15

BACKGROUND: Decompressive craniectomy (DC) is a neurosurgical procedure associated with significant blood loss. Effective hemostatic agents can minimize blood loss and improve surgical outcomes. T- Hemocel, a hemostatic agent composed of oxidized regenerated cellulose, is increasingly used in neurosurgery, but its efficacy in DC requires further investigation.

AIM: This study aimed to evaluate the hemostatic efficacy of T-Hemocel in patients undergoing DC.

METHODS: A retrospective chart review was conducted on ten (10) patients who underwent DC at our institution between July 2019 and August 2019. Data on patient demographics, time to hemostasis, and surgical complications were collected. Due to the limited sample size, a control group receiving a different hemostatic agent was not included.

RESULTS: All ten patients who received T-Hemocel during DC achieved hemostasis within 10 min of administration. No surgical bleeding incidents were reported. This retrospective analysis suggests that T-Hemocel may be a viable hemostatic option in DC, with all patients achieving hemostasis within 10 min. However, the small sample size limits the generalizability of these findings.

CONCLUSION: Future studies with larger sample sizes and potentially including a control group are warranted to confirm these observations and explore the efficacy of T-Hemocel in a broader range of neurosurgical procedures.

Assessing Knowledge of Older Adults’ Caregivers about Goals, Mission, and Values of Home Health Care at KAMC in Riyadh

Amjad S. Al-Seraya — 2024-09-15

BACKGROUND: Older adults suffer from several underlying diseases and conditions. Furthermore, their physical and mental health gradually deteriorated over time which made this population need care from others. Homecare healthcare is the direct provision of clinical services and/or medical supplies to patients in their homes. Caregivers play a critical role in providing efficient care for elders and they can be family members or hired professionals.

AIM: The study aimed to assess the awareness of older adults’ caregivers about the goals, mission, and values of home health care (HHC) at King Abdulaziz Medical City (KAMC) in Riyadh and the factors affecting their knowledge level.

METHODS: This cross-sectional descriptive research was conducted on all caregivers of older adults at the HHC department at KAMC, Riyadh between the periods from December 15, 2023, to April 15, 2023. The study was conducted using a standardized self-administered questionnaire that involved three parts. Analysis of data was carried out by SPSS software version 24.

RESULTS: A number of 302 participants were enrolled; 58.3% were males and 36.4% were daughters of the patients. There were 92.4%, 87.7%, and 78.1% knew about the goals, mission, and values of HHC, respectively. There 75.2% and 85.8% knew about the services and focus of HHC. The mean ± SD of knowledge score was 12.75 ± 4.05. Significant correlations were found between the mean score of knowledge and nationality (p = 0.02) and the relation of the participant to the patient (p = 0.007).

CONCLUSION: Caregivers of older adults exhibited good knowledge regarding the goals, mission, and values of HHC. Furthermore, there was general good knowledge, but with few gaps. Nationality and relation to the patient were the only significant factors associated with knowledge.

Revision Surgery due to Patient Dissatisfaction with Remaining Valgus leg Alignment after Kinematically Aligned Total Knee Arthroplasty: A Case Report

Erika Jerele — 2024-09-15

BACKGROUND: The kinematic alignment (KA) technique aims to achieve true resurfacing of the knee joint and recreate prearthritic anatomy while preserving soft tissues. However, it remains uncertain whether all prearthritic anatomies are biomechanically equivalent and if KA is suitable for cases with extreme anatomical variations.

CASE PRESENTATION: The case of a 75-year-old female patient with a moderate valgus deformity who underwent kinematically aligned total knee arthroplasty (TKA) was reported. The patient required early revision surgery due to persistent pain in the medial collateral ligament area and dissatisfaction with the postoperative leg alignment.

CONCLUSION: There is a paucity of studies addressing the outcomes of kinematically aligned TKA in patients with valgus knees. Concerns persist regarding the suitability of unrestricted KA for all anatomical variations, particularly extreme ones. This case underscores the importance of considering restricted KA as a potentially safer alternative. In addition, patient perception of limb alignment and appearance significantly impacts the success of total knee arthroplasty, particularly in cases with valgus deformities.

Internet Addiction among Egyptian Teens during COVID-19 Pandemic

Ayman F. Armaneous — 2024-09-15

BACKGROUND: Teens’ lifestyles have changed significantly during and after COVID-19 epidemic and they have started engaging in risky health behaviors like using smartphone more frequently. Everyone is compelled to use their smartphone more frequently than usual to access daily necessities during the COVID-19 pandemic lockdown.

AIM: We aimed to evaluate the problem of internet addiction and the increasing use of smartphone among teenage Egyptian youth during COVID-19 pandemic.

METHODS: Online surveys were sent to Egyptian teens (12–18 years old) in several governorates in June 2020, and they were completed by 154 youths over the course of one month. Different teenagers were required to respond to and share in this poll, and versions in both English and Arabic were used. At the outset of the questionnaire, the question about consent was viewed as mandatory. The extent of Internet use was evaluated using Young’s Internet Addiction Test (IAT). The survey was divided into four sections and created with the goals of understanding the modes (frequency, patterns, and goals) of internet use, the negative effects, linked parental behaviors, as well as the eventual occurrence and severity of addiction. The same data from the time before the epidemic was also looked into and analyzed. Version 23 of IBM SPSS Statistics was used for the analysis. The p-value threshold for significance was established at 0.05.

RESULTS: The mean age of the teens was 14.38 ± 2.87 years and equal gender frequency (males of 50.6% and females of 49.4%. About 79.9% of them live in urban environment, 18.8% suffered from family problems and 40.9% were in the secondary educational level. Increased physical inactivity of participants was noticed after COVID-19 among participants (55.8%). About 87.7% of them used smartphone for online access (87.7%). Half of the subjects (50%) spent 1–3 h online before COVID, while more than half of them (59.1%) spent more than 6 hours online after COVID, with a statistically significant difference. Mean IAT was 61.91 ± 16.77 after COVID versus 45.26 ± 12.45 before COVID. The prevalence of internet addiction was increased from 67.5% before COVID-19 to 77.9% after COVID-19 infection. IAT score was normal, mild, moderate, and severe in 5.8%, 16.2%, 65.6%, and 12.3% after COVID-19, respectively, compared to normal, mild, moderate, and severe IAT score in 26.6%, 5.8%, 61.0%, and 6.5% before COVID, respectively, with significant differences between them before and after COVID (p < 0.000). Increasing mother’s and father’s educational, increasing time spent online, decreasing duration of sleep, and lower the number of days of exercise for more than 30 min/week were associated with higher IAT score.

CONCLUSIONS: During the COVID-19 pandemic, internet addiction was extremely common among teenagers (77.9%). The amount of time spent online, the length of sleep, and the number of days that a person exercises for more than 30 min/week were all predictors of addiction.

Anti-Inflammatory And Immunomodulating Activity of the 1(10) Β-Epoxy-5,7α,6β(Н)-Guai-3(4),11(13)-Dien-6,12-Olide

Ainyr Maratovna Zhumakaeva — 2024-09-15

BACKGROUND: The article discusses the results of studies of the anti-inflammatory and immunomodulatory activity of the sesquiterpene lactone 1(10)β-epoxy-5,7α,6β(Н)-guai-3(4),11(13)-diene-6,12-olide (hereinafter referred to as epoxyguaianolide).

AIM: The article discusses the results of studies of the anti-inflammatory and immunomodulatory activity of the sesquiterpene lactone 1(10)β-epoxy-5,7α,6β(Н)-guai-3(4),11(13)-diene-6,12-olide.

MATERIALS AND METHODS: A non-steroidal anti-inflammatory drug diclofenac sodium at a dose of 25 mg/kg (ampoules, 2 mL each, manufactured by Germany) was used as a reference drug in models of acute aseptic inflammation and cotton ball granuloma. On the model of cyclophosphamide immunosuppression, the immunomodulator levamisole at a dose of 3 mg/kg, was used as a reference drug. The immunomodulating effect of the test samples was studied on outbred adult male rats and outbred mice. We calculated the arithmetic mean, the mean square error of the arithmetic mean, the significance of the difference between the mean Рt according to the student’s t-test (TTEST), and the significance of the difference in Pf variances according to the Fisher f-test.

RESULTS: The results of the experiments indicate the presence of a pronounced immunomodulatory activity in epoxyguaianolide. When interacting with cells of the immune system, epoxyguaianolide activated the studied parameters in animals with immunosuppression, whereas in intact animals, it did not affect the above parameters. On the model of cyclophosphamide immunosuppression, it was found that epoxyguaianolide has a pronounced immunomodulatory effect, manifested in an increase in the number of T-lymphocytes and a subpopulation of theophylline-resistant T-lymphocytes, an increase in the number of theophylline-sensitive T- and B-lymphocytes, activation of phagocytosis processes, and increased cell migration. This action of epoxyguaianolide eliminates the minimal possibility of hyperactivation of the immune system, which is an important condition for its use as an immunotropic agent.

CONCLUSIONS: The conducted experiments made it possible to recommend epoxyguaianolide for clinical trials as an immunomodulating agent in the treatment of chronic inflammatory diseases accompanied by secondary immunodeficiencies.