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Fever of unknown origin can be a symptom of at least 200 diseases. Positron emission tomography-computed tomography, although highly informative, may not be readily available as an imaging tool. We present a clinical case of giant cell arteritis where computed tomography played a key role in arriving at a diagnosis. A 61-year-old woman presented to the hospital with a nocturnal fever up to 39.5°С, accompanied by chest and scapular pain, and substantial weight loss (10 kg over 3 months). Lymphoproliferative and infectious diseases were excluded. Baseline colonoscopy had revealed erosions in the colonic mucosa, leading to a preliminary diagnosis of ulcerative colitis, and subsequently, the patient was admitted to the gastroenterology department. Follow-up colonoscopy had excluded this diagnosis. Additional imaging via chest and abdominal computed tomography scan revealed wall thickening of aorta and its branches with subtle contrast enhancement. Conditions, such as tuberculous aortoarteritis and syphilitic aortitis, were excluded. The patient was diagnosed with giant cell arteritis involving brachiocephalic trunk, subclavian arteries, and celiac trunk. Prednisolone was administered with subsequent reduction in symptoms. Although computed tomography may not be regarded as the gold standard for the differential diagnosis of fever of unknown origin, this case underscores its valuable contribution in establishing a definitive diagnosis.

Background. To stratify the risk in patients with COVID-19, it is important to understand the parameters that predispose to a severe course. Following risk factors were described: age over 60 years, overweight, male gender, chronic diseases: hypertension, diabetes mellitus. Low liver density on computed tomography (CT) is also considered as a potential risk factor. Aim. To evaluation whether low liver density can be used as a predictor of severe COVID-19. Materials and methods. Retrospective single-center cohort study. Patients with COVID-19 treated in a hospital setting, who underwent two CT scans of the thoracic organs in dynamics, were included. The patients were divided into groups according to the severity of the course (groups of moderate course, severe course and lethal outcome). Relation of the investigated factors was estimated using regression analysis. Results. 99 patients were enrolled; 3 comparison groups were formed (moderate-severe course n=37, severe course n=52, lethal outcome n=8). All groups significantly differed in C-reactive protein levels. According to multivariate regression analysis, COVID-19 severity was influenced by the liver to spleen density ratio as measured by CT scan on admission [odds ratio 12.18 (95% confidence interval 1.6789.07); p=0.008]. Conclusion. Reduced liver density on CT scan in a patient with COVID-19 may be a predictor of severe course of novel coronavirus infection.

BACKGROUND: The use of telemedical technologies (TMT) is widespread in providing care to patients of various profiles. However, TMTs are hardly ever used in gastroenterology, despite the extensive digitalization of healthcare. Potential sites for the use of TMTs among gastroenterological patients were assessed. AIM: The study aimed to assess the effectiveness and benefits of TMTs in patients with digestive diseases. Patients with colorectal cancer (CRC): Screening and postoperative management. The TMT intervention increased the number of patients screened for CRC compared to standard face-to-face counseling. In addition, the quality of preparation for colonoscopy was higher in patients who interacted with the physician via TMTs compared to the control group. Most studies reported positive effects of TMTs on quality of life and physical activity in patients with CRC. However, the study by K. Beaver et al. showed that the incidence of CRC recurrence did not differ in the TMT and face-to-face groups. Patients with nonalcoholic fatty liver disease (NAFLD): Correction of lifestyle. When assessing the use of TMTs among NAFLD patients, a significant decrease in alanine aminotransferase and aspartate aminotransferase activity was found compared to that in face-to-face management. The results of the body mass index reduction are contradictory. The most pronounced tendency towards weight loss was observed with the telemedical follow-up of patients over a 6-month period. Patients with irritable bowel syndrome (IBS): Treatment and monitoring of symptoms. Two directions are distinguished in the treatment of IBS by ТМТs. The first is cognitive behavioral therapy (CBT). H. Everitt et al. showed clinically significant improvement in 72.8% of cases after 12 months of web-based CBT. The advantages of using telemedicine in the delivery of CBT include the geographical independence of the physician and the patient, personalization of treatment, and the possibility of ongoing support for the patient and his or her family. The second direction is the use of special diets, such as low-fermentable nutrient diets (FODMAP). Patients following the FODMAP diet supervised by the mobile app reduced symptom severity (odds ratio 55; 95% confidence interval 1198, p=0.01). Special mobile apps (IBS Constant Care) were used to monitor the condition of patients with IBS, which analyze input data and assess severity, providing information to both the patient and the physician. Patients with inflammatory bowel disease (IBD): Patient training and telemonitoring. The study by L. Pang et al. proved that the patients quality of life in the telemedicine intervention group was significantly higher (p=0.03). Another advantage of using TMTs is the provision of access to educational materials about IBD and the possibility of remote contact with the treating physician. The patients ability to obtain necessary information reduces the need for unplanned visits to medical facilities, thus reducing the cost of organizing medical care for patients with IBD. The degree of IBD activity and risk of recurrence and adherence to therapy did not differ significantly between the telemedicine intervention group and the standard face-to-face follow-up group. METHODS: A literature search relevant to the review was conducted in the PubMed database. The studies taken for assessment were those on the use of TMTs among patients with IBD, IBS, NAFLD, and CRC. TMTs were used to access educational information and dietary recommendations, provide information on lifestyle adjustments and physical activity, remind patients to take medicines, consult with physicians, and assess disease activity by completing online questionnaires. The various studies used text messaging, e-mail, mobile apps, websites, and videoconferencing apps as a means of communication. RESULTS: The use of telemedicine in the management of patients with digestive diseases showed high efficiency. TMTs contribute to: Improved quality of life in patients with digestive diseases. Increasing physical activity of patients with CRC and NAFLD. Improved quality of CRC screening. Maintaining remission of IBD and CRC as effectively as face-to-face monitoring. Moreover, the use of TMTs allows personalized treatment, ensures the ongoing support of the patient and his or her family by the medical staff, and provides patients with access to quality educational materials about the disease. CONCLUSIONS: Thus, the use of TMTs is promising in the treatment of digestive diseases and requires wider introduction into practice.

The article describes a rare diagnosis of monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL), due to its veiled by a number of so-called masks of enteropathies. A detailed analysis of all clinical, morphological and immunohistochemical data made it possible to establish the correct diagnosis. The revealed pathology is extremely rare in practice, even among specialists in hematology. The article demonstrates the main stages of both a complex diagnosis and an attempt at therapy for this aggressive form of intestinal lymphoma.

Inflammatory bowel diseases (IBDs) represent a group of nosologies including Crohns disease and ulcerative colitis. These diseases lead both to the deterioration of the patients physical condition and to a pronounced decrease in the quality of life. Currently, healthcare costs of managing patients with IBDs are steadily increasing and are commonly associated with the need for examinations and therapy with expensive drugs and unplanned expenses of healthcare resources for unscheduled consultations, emergency hospitalizations, and surgical interventions. Deterioration of patients condition may be associated with self-cancellation of therapy after normalization of the state of health. The use of telemedical technologies (TMTs) is promising for maintaining remission of IBDs, improving adherence to therapy, and reducing the frequency of unscheduled visits to the clinic and the cost of treating IBD complications (including surgery). The efficiency and benefits of TMTs in patients with IBDs were assessed in comparison with standard face-to-face follow-up. A literature search relevant to the review was conducted in the PubMed database. Papers were selected that assessed the efficiency of telemedical interventions among patients with IBDs as compared to the standard face-to-face follow-up group. The evaluation criteria included the degree of the disease activity, risks of IBD recurrence, quality of life of patients, adherence to therapy, healthcare costs, and frequency of visits to healthcare facilities. Telemedical interventions were conducted using the Internet, mobile applications, various telemedical platforms, SMS messages, and phone calls. The telemedical follow-up groups received access to educational materials and online consultations with a specialist upon request and completed questionnaires to assess disease activity, adherence to therapy, and quality of life. The degree of IBD activity and risk of recurrence and the level of adherence to therapy did not differ significantly between the telemedical intervention and standard face-to-face follow-up groups. The study by L. Pang et al. showed that the patients quality of life in the group of telemedical intervention was significantly higher (p=0.03) [8]. Another advantage of using TMTs is the provision of access to educational materials about IBDs and the possibility of remote contact with the treating physician. The patients ability to obtain necessary information reduces the need for unplanned visits to medical facilities and the cost of organizing medical care for patients with IBDs. The use of TMTs allows to monitor IBD activity as effectively as face-to-face follow-up, improve the patients quality of life with IBDs, and reduce costs for organizing care for patients with these diseases by decreasing the frequency of unscheduled visits to the doctor and conducting unnecessary additional examinations.

Crohns disease with localization in the upper gastrointestinal tract, terminal ileum, or colon is diagnosed based on visualization of the lesion area using endoscopic methods and histological examination. In cases of damage to the small intestine, when endoscopy methods are not informative enough and the use of videocapsular endoscopy has a number of contraindications, it is advised to use radiation diagnostic methods, such as multispiral computed tomography and/or magnetic resonance enterography, to make a diagnosis. We present a clinical case of ambiguous clinical manifestations of Crohns disease with small intestine and rectal involvement. Tomographic imaging was used to confirm the diagnosis. A 44-year-old patient presented with complaints of non-pronounced abdominal pain, dyspepsia. The lab panel showed indirect signs of malabsorption, an increase in fecal calprotectin. An endoscopic examination with histological verification revealed a picture of proctitis. After performing computed tomography and/or magnetic resonance enterography multiple lesions of the small intestine were revealed. This clinical case demonstrates an atypical clinical picture of Crohns disease with jejunal, iliac, and rectal lesions. The patient had no characteristic complaints; the results of endoscopic and morphological studies were not informative. Imaging by means of computed and magnetic resonance tomography has played a crucial role in the diagnosis and successful treatment.

Aim. To perform comparative analysis of visceral sensitivity index (VSI) of patients with previously diagnosed irritable bowel syndrome (IBS) and of patients with IBS symptoms after COVID-19 infection. Materials and methods. The study was carried out on the basis of University Clinical Hospital №1; 200 patients with COVID-19 infection were examined. Selection criteria were the recommendations of the Rome Consensus IV (2016). Fourteen patients met the criteria for IBS (Rome IV). Forty patients with a verified diagnosis of IBS before the COVID-19 pandemic (Group 2) were selected as a comparison group. The control group included 50 healthy respondents (group 3). Group 1 included 14 patients; Group 2 included 40 patients (54 patients in total): 37 women and 17 men. The control group included 50 patients: 23 men and 27 women. VSI was estimated in the studied groups. Results. No statistically significant difference of VSI index (p0.05) was revealed while comparing two studied groups (group 1 and group 2). In group 1 and group 2 the mean values of VSI were 24.575.47 and 33.982.55 respectively. Absence of significant differences allows to assume from the position of biopsychosocial model that the patients were initially predisposed to IBS development. Conclusion. A new coronavirus infection is one of the triggers for the development of IBS 6 months after COVID-19 infection.

The global epidemic of a new coronavirus infection caused by SARS-CoV-2 is a major threat to human health. In the clinical picture, along with acute respiratory distress syndrome, liver lesions are also noted. The following mechanisms are currently being considered: direct damaging effects of SARS-CoV-2, immuno-mediated inflammation, hypoxia, drug exposure, and reactivation of pre-existing liver disease. We studied 150 patients with COVID-pneumonia who are under inpatient treatment at the University Clinical Hospital No. 1 of Sechenov First Moscow State Medical University. Of these, the presence of SARS-CoV-2 RNA was confirmed by polymerase chain reaction in 84 (56.0%) patients. In 55 (36.7%) patients, an increase in serum aminotransferases was registered, mainly alanine aminotransferase max. up to 572 U/L and aspartate aminotransferase up to a max. of 232 U/L. The long-term consequences are unknown and require monitoring of these patients.