6th Month Research Articles

Multi-omics analysis reveals alterations of breastmilk metabolites and proteins in Hong Kong lactating mothers.

The nutritional contents of breastmilk (BM) directly participate in neonatal metabolism via breastfeeding. Currently, there is limited research on BM metabolites and proteins compositions, and their alterations during the long lactation period in Hong Kong mothers. In this study, liquid chromatography-mass spectrometry-based metabolomics, lipidomics and proteomics studies were applied to compare the compositions in BM of Hong Kong lactating mothers at the 2nd, 6th, and 12th months after delivery. Distinct metabolomics and lipidomics signatures in 6th month versus 2nd month and 12th month versus 2nd month were observed, and a total of 19 differential metabolites and 105 lipids were identified. Metabolomics study showed the significant alterations in key pathways involved in biotin metabolism, amino acid, and fatty acid-associated metabolisms. Lipidomics analysis indicated the accumulation of triglyceride and ceramide during the lactation period. The remodeling of glycerophospholipids was also observed during 12-month period. Moreover, 28 differentially expressed proteins were identified and mainly associated with GO functions and KEGG pathways of ribosome and complement and coagulation cascades, which were validated by network analysis. Our research contributes to the understanding of the BM compositions and differences during the long lactation period in postpartum women of Hong Kong.

Efficacy and predictors of response to somatostatin analogues in patients with ectopic ACTH syndrome

Aim. To study the immediate efficacy, tolerability and predictors of response to prolonged-acting somatostatin analogues (SSAs) in patients with ectopic ACTH syndrome (EAS). Materials and methods. A multicenter, observational study with a retrospective analysis. The effectiveness of treatment was evaluated every 12–24 weeks by the activity of hypercortisolism, clinical symptoms of the disease, control of tumor growth. Patients were conditionally divided into “responders” and “non-responders” at time points of 6, 12 and 24 months. Radiological efficacy was performed according to the RECIST 1.1. Statistical data processing was carried out by using IBM SPSS Statistics 23. Results. The study included 46 patients (26 women, 20 men). The median follow-up period was 71 months [32; 122]. Localized tumor process (T1-3N0M0) – in 19 (41.3%) patients, locally widespread (T1-3N1M0, T4N0-1M0) – in 15 (32.6%), generalized (T1-4N0-1M1) – in 12 (26.1%) cases. Surgical treatment was performed in 33 (71.7%) patients. SSAs were the first-line therapy for all 46 patients. The average duration of SSAs use was 34 months (Me 27.5 [13.8; 41]). Dose escalation was required in 39.4% cases, the period before the first dose escalation was on average 9 months. 13 (48.1%) patients achieved drug-induced remission of the disease. Normalization of cortisol in 24hUFC or its decrease ≥50% from the baseline level by the 6th month of treatment was achieved in 46.4%, by the 12th month – in 61.9%, “eluding” from the effect of therapy was observed in 3 patients. Objective response was evaluated in 30 patients. There was no complete response to the treatment. In 4 (13.3%) cases – a partial response, in 15 (50%) – disease stabilization, in 11 (36.7%) – disease progression. The best therapeutic efficacy of SSAs is associated with bronchial NET (HR 0.078, 95% CI 0.010–0.633; p=0.017), and resistance to treatment is associated with negative expression of SSTR5 (HR 6.532, 95% CI 1.019–41.878; p=0.048). Conclusion. SSAs are the drugs of choice for the first-line treatment of patients with EAS, allowing for long-term effective control of hypercortisolism and tumor progression in more than 60% of patients. Significant factors determining the response to SSAs after 6 months of treatment are expression status of SSTR5 and NET localization.

The effect of single-layer and double-layer graft usage in tympanoplasty on hearing and graft success.

In this study, we investigated whether the use of double layer graft (DLG) in tympanoplasty would increase grafting success rates (GSR) and whether increased graft thickness would negatively affect hearing. The study group consisted of patients with DLG and the control group consisted of patients with single layer graft (SLG). The results of 195 patients in terms of hearing achievement and 211 patients in terms of GSR were compared. Hearing and GSR were analyzed in 103 DLG and 108 SLG patients. Postoperative 6th month air conduction pure tone averages were 25.34 (±14.99) dB in DLG group and 20.50 (±8.82) dB in SLG group. These values were statistically significantly higher in the DLG group (p=0.005). Postoperative air bone gap was 11.40 (±8.61) dB in DLG and 12.95 (±10.88) dB in SLG and there was no statistically significant difference in hearing gain between the groups. GSR was 99/103 (96.1%) in the DLG group and 103/108 (95.4%) in the SLG group with no difference between the groups (p=0.679) CONCLUSION: We concluded that DLG is not superior to SLG in terms of both hearing and GSR, and may even be disadvantageous in terms of hearing, and this should be taken into consideration in patient selection.

Effects of robotic surgery experience on open radical prostatectomy results: single centre & single surgeon experience

This study aimed to evaluate the effect of robotic surgery experience on open radical prostatectomy (ORP) outcomes. We retrospectively reviewed 100 patients who underwent an ORP for clinically localised prostate cancer (PCa) performed by the same experienced surgeon. The groups included the last 50 patients before (Group 1) and the first 50 patients after (Group 2) robotic surgery experience. A detailed history, peroperative, and oncological data were recorded. Continence status and erectile functions were evaluated before surgery and at 1, 3, 6, and 12 months postoperatively by daily pad count and an International Index of Erectile Function (IIEF) short form and were compared between groups. The demographics and preoperative data were similar. The preoperative and postoperative Gleason score was higher in Group 2 (p = 0.001, 0.033; respectively). The operation time (200 vs. 115 min), estimated blood loss (400 vs. 200 ml), peroperative transfusion rate (46% vs. 8%), drain removal time (4 vs. 3 days), hospital stay (5 vs. 4 days), and urethral catheter removal time (21 vs. 14 days) were significantly lower in Group 2 (p < 0.001). The continence rate was significantly higher in Group 2 in the first month (p = 0.027), but no significant difference was found at 3, 6, and 12 months. Erectile functions (mean IIEF: 9.47 vs. 11.18 at 12th month, p = 0.220) showed no significant difference between the groups in the first year after surgery. In addition to ergonomic benefits, robotic surgery provides a significant surgical procedure experience due to its great visualisation. The most important advantages that robotic surgery adds to our ORP experience were improved early continence; less bleeding and a decreased need for transfusions; and a shorter operation time, hospital stay, and urethral catheter removal time.

Effect of thyroid peroxidase antibody titers trajectories during pregnancy and postpartum on postpartum thyroid dysfunction.

To identify risk factors contributing to the development of postpartum hypothyroidism in women newly diagnosed with subclinical hypothyroidism (SCH) during the first trimester of pregnancy (T1). Additionally, this study aimed to explore the impact of thyroid peroxidase antibody (TPOAb) titers trajectories throughout pregnancy and postpartum. Thyroid hormone levels and thyroid autoantibody titers were collected from T1 to the 12th month postpartum. Logistic regression analysis was employed to identify independent risk factors for hypothyroidism at the 12th month postpartum and to develop a prediction model. Model performance was assessed through discrimination, calibration, and clinical applicability, with internal validation using the bootstrap resampling method. Growth Mixture Modeling was applied to delineate the trajectory of TPOAb titers during pregnancy and postpartum, and logistic regression analysis was conducted to investigate the influence of these trajectories on the occurrence of postpartum hypothyroidism. At the 12th month postpartum, hypothyroidism was either newly diagnosed or persisted in 76 of 209 cases (36.36%). Several significant risk factors for postpartum hypothyroidism were identified, including multiparity, positive TPOAb in T1, positive TPOAb and thyroglobulin antibody in T1, serum thyroid-stimulating hormone levels at SCH diagnosis in T1, and the final dose of levothyroxine in the third trimester. A prediction model was constructed and presented with a nomogram. Furthermore, a higher trajectory of serum TPOAb titer during pregnancy and postpartum emerged as a predictive factor for hypothyroidism at the 12th month postpartum. Women with elevated TPOAb titers during pregnancy and postpartum necessitate ongoing and vigilant monitoring of thyroid function, even after childbirth.

Comparison of outcome of lambda plate versus double plate fixation in AO Type C fractures of distal humerus in adults.

Objective: To compare the outcome of lambda plate versus double plate fixation in AO Type C fractures of the distal humerus in adults regarding bone union, range of motion and MEP score. Study Design: Randomized Clinical Trial. Setting: Sheikh Zayed Hospital, Lahore. Period: 1-01-2020 to 31-12-2020. Methods: After fitting in the inclusion criteria, 50 patients were signed up, 25 in each group. In group A, patients underwent surgery by using a lambda plate. In group B, patients underwent surgery by using a double plate. All this procedure was done by a researcher under the supervision of a supervisor. On follow up on each visit, patients were re-evaluated for MEP score. If MEP scores&gt;75, then excellent to the good outcome was noted. Meanwhile, range of motion and bone union on x-rays was also evaluated. Results: In this study, the average age of the patients was 37.46±11.34 years; 32(64%). patients were male, while 18(36%). patients were females. After the 6th month, the excellent to good MEP score was noted in 23 patients (92%) of the double plate group versus the excellent to good MEP was found in 24 patients (96%) of lambda plate group, p-value=&gt;0.999. After the sixth month, in the double plate group, the delayed union was noted in two patients (8%) of double plate group while in one patient (4%) of lambda plate group, p-value=0.261. Conclusion: This study concluded that in the management of fractures of distal humerus in adults, both lambda plate and double plate fixation are equally effective.

Evolution of the medium-term functional outcomes of holmium laser prostate enucleation (HoLEP).

The boom in surgery for benign prostatic hyperplasia using Holmium laser enucleation (HoLEP) has reduced length of hospitalization, catheterization duration and the risk of bleeding, with comparable results to the old gold standard. The aim of this study is to evaluate the evolution of medium-term functional results after HoLEP. Retrospective monocentric observational study in patients who underwent HoLEP surgery from 2014 to 2019. We analyzed our post-operative functional results (scores USP, IPSS, QdV and Qmax) at short and medium term. The results were compared to preoperative data. At last consultation was performed at least one year after the procedure. A total of 338 patients underwent HoLEP surgery during this period. The mean follow-up time at the last consultation was 3.5 years. At the last consultation, the USP was 0.5 for the dysuria score (a 2.7-point improvement) (p<0.001), 1.6 points for the overactive bladder score (a 3.9-point improvement) (p<0.001), 0.5 for the stress urinary incontinence score (a 0.1-point improvement) (p=0.67). Among the patients, 2% had severe urinary incontinence (Stress urinary incontinence USP ≥ 7). The average IPSS at the last consultation was 3.7, an improvement of 16 points compared with the pre-operative score (p<0.001), and the average QoL was 1, a improvement of 4.3 (p<0.001). Surgical treatment of benign prostatic hyperplasia using HoLEP appears to be an efficient technique at medium term with a 2% rate of severe stress urinary incontinence. Overactive bladder is corrected from the 6th month postoperatively.

Optimal frailty assessment tool for elderly patients with heart failure based on outcome prediction: protocol for a multicentre prospective cohort study

IntroductionFrailty significantly influences the prognosis of elderly patients diagnosed with heart failure. The assessment of frailty is a critical initial step in the management of these patients, as a systematic...

Investigation of surfactant apoproteins and Brucella sp. antigens in the lungs of aborted bovine fetuses and neonatal calves delivered weak

The main objectives of this study were to investigate surfactant apoprotein expression (SP) and to detect Brucella sp. antigens in the lungs of aborted bovine fetuses and neonatal calves delivered weak. The Avidin-Biotin-Peroxidase Complex (ABC) and the indirect immunofluorescence (IF) techniques were applied, using antibodies to the lung surfactant apoproteins (SP-A, SP-B, SP-C) and Brucella sp. antigens. Hyperplasia of type II cells was also assessed by evaluating Thyroid Transcription Factor-1 (TTF-1), Proliferating Cell Nuclear Antigen (PCNA), and Cytokeratin Pan Type I/II (CK-P) markers. The study materials were the lungs of 46 aborted bovine fetuses and 20 neonatal calves delivered weak. Brucella sp.-positive fetal lungs displayed bronchopneumonia in 24 cases. The lungs of the weak-delivered neonates which were positive for Brucella sp. also showed pneumonia. Bacterial culture detected positivity in 11 of 46 fetuses and two neonates. IHC for Brucella sp. antigens found positivity in 22 of 46 fetuses and four neonates. Thus, our research revealed that the IHC technique using anti-Brucella sp. antibodies was useful for detecting Brucella sp. in autolytic and culture-negative fetuses. The study also found that surfactant synthesis begins close to the 7th month of gestation in bovine fetuses. Immunolabeling to SPs occurred in the cytoplasm of both type II and Clara cells, along with SP-C only in type II pneumocytes. The IF yielded dense labeling for Brucella sp. antigens, SP-B, and CK-P, respectively, in the phagocytic cells and epithelium of the airways. Also, pneumonia in newborn calves indicates an intrauterine infection by Brucella sp.

Prevalence of postpartum depression and its association with diabetes mellitus among mothers in public health facilities in Mbarara, Southwestern Uganda

ABSTRACT Postpartum Depression (PPD) is a major health challenge with potentially devastating maternal and physical health outcomes. Development of diabetes mellitus has been hypothesized as one of the potential adverse effects of PPD among mothers in the postpartum period, but this association has not been adequately studied especially in low resource settings. This study aimed at determining prevalence of postpartum depression and its association with diabetes mellitus among mothers in Mbarara District, southwestern Uganda. We conducted a facility based cross-sectional study of 309 mothers between 6th week to 6th month after childbirth. Using proportionate stratified consecutive sampling, mothers were enrolled from postnatal clinics of two health facilities, Mbarara Regional Referral Hospital and Bwizibwera Health center IV. PPD was diagnosed using the Mini-International Neuropsychiatric Interview (MINI 7.0.2) for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Diabetes mellitus was diagnosed by measuring Hemoglobin A1c (HbA1c). Logistic regression was used to determine the association of PPD and diabetes mellitus among mothers. The study established that PPD prevalence of PPD among mothers of 6th weeks to 6th months postpartum period in Mbarara was 40.5% (95% CI: 35.1–45.1%) and it was statistically significantly associated with diabetes mellitus in mothers between 6 weeks and 6 months postpartum. The prevalence of diabetes mellitus among mothers with PPD was 28% compared to 13.6% among mothers without PPD. Mothers with PPD had 3 times higher odds of being newly diagnosed with diabetes as compared to those without PPD (aOR = 3.0, 95% CI: 1.62–5.74, p = 0.001). Mothers with PPD between 6 weeks and 6 months postpartum are more likely to have diabetes mellitus as compared to those without PPD. Well-designed prospective analytical studies are needed to conclude on the risk of diabetes mellitus in relation to PPD. Early screening of PPD may be considered in postpartum mothers.

Analysis of the Implementation of Traffic Management at the Johor Roundabout Jalan Karya Wisata-Medan Johor

Johor Roundabout is located on Jalan Karyawisata kec, Medan Johor, or more precisely right in front of the entrance to the J-City complex. This roundabout was just built in the 12th month of 2023. The existence of this roundabout has a detrimental impact on the speed of vehicles passing through the roundabout. The aim of this thesis is to analyze the performance of roundabouts using the MKJI1997 method. This survey was carried out by conducting research for 7 days, where each day I conducted a survey for 12 hours, namely from 07:00 to 19:00. After carrying out the survey, it was also found that the peak hour occurred on Monday at 17:00-18:00 where it was obtained that the total inflow was 7854 PCU/hour with the composition of Light Vehicles (LV) 3127 Pc/hour, Heavy Vehicles (HV) 322 PCU/hour and , motorbike (MC) 2189Smp/hour, and the results also obtained for the degree of saturation, namely 1.094, which means that the level of service for the roundabout is at F (i.e. traffic flow conditions are relatively low).

In-situ formation of molybdenum disulfide nanoparticle and its catalytic performance in heavy oil long-term aquathermolysis

Heavy oil is an important unconventional petroleum resource due to its abundant reserve, but the reduction of viscosity is a prerequisite for its effective exploitation. Researchers are trying to develop heavy oil catalytic aquathermolysis technologies for their merit of irreversible viscosity reduction through in-situ upgrading. The key point of catalytic aquathermolysis is the in-situ formation of high active catalytic phase. In this study, we have demonstrated that the precursor (NH4)2MoS4 was fully decomposed into MoS2 nanoparticles at relatively low temperature of 200°C after 90 minutes. The decomposition of (NH4)2MoS4 in aquathermolysis was significantly different from its decomposition process under hydrogen and vacuum atmospheres. The laboratory experimental results showed that the heavy oil viscosity reduction rate was above 85 % with the action of in- situ formed MoS2 nanoparticles after aquathermolysis. The sulfur content of heavy oil and asphaltene, asphaltenes and aromatics contents of heavy oil were decreased significantly, indicating that the cracking and ring opening reactions did take place. In the oilfield experiment, the precursor (NH4)2MoS4 was injected into the reservoir along with steam. After one-time injection, the catalytic effect could be sustained for at least four months. The maximum viscosity reduction rate was as high as 90 % during the first week, and still around 70 % in the 4th month. The molecular structural analysis of the produced heavy oil proved that the asphaltenes has been effectively cracked during the in-situ catalytic aquathermolysis. Both the laboratory and oilfield experimental results demonstrated that (NH4)2MoS4 precursor could form MoS2 nanoparticle and effectively catalyze the upgrading reactions of heavy oil. We hope that this study will provide a new catalyst development strategy for the catalytic aquathermolysis exploitation technology of heavy oil.

Associations between prenatal alcohol exposure and early education outcomes: a matched controls study using the born in Bradford dataset.

Prenatal alcohol exposure (PAE) is associated with cognitive, behavioural, and developmental impairments throughout the lifespan of affected individuals, but there is limited evidence on how early this impact can be identified through routinely collected childhood data. This paper explores the relationship between PAE and the Early Years Foundation Stage Profile (EYFSP), a statutory teacher-based summative assessment of early development in relation to learning goals. This analysis uses the Born in Bradford dataset, a UK based cohort (n = 13,959; full dataset), which collected self-reported PAE from 11,905 mothers, with 19.8% reporting drinking alcohol at some point during pregnancy. Coarsened exact matching was conducted to examine relationships between patterns of PAE and children achieving a 'Good Level of Development' on the EYFSP, a binary variable assessed at 4-5 years of age, controlling for known confounders, including deprivation, mother's education, exposure to other teratogenic substances, and child's age at assessment. Additionally, we examined EYFSP sub-scores to identify specific developmental deficits associated with PAE.The key finding is a statistically significant association between PAE at a level of consuming 5 or more units of alcohol (equivalent to 50 ml or 40 g of pure alcohol) at least once per week from the 4th month of pregnancy onwards and lower EYFSP scores when accounting for established confounding variables. These findings highlight that the detrimental impact of alcohol during pregnancy can be identified using statutory educational assessments. This has implications internationally for prevention work, policy, and commissioning of support services for people impacted by PAE.

The effect of breakfast skipping and sleep disorders on glycemic control, cardiovascular risk, and weight loss in type 2 diabetes

Background & AimsMeal timing is an emerging branch of science that investigates the influence of eating patterns on the circadian rhythm and overall health. There are still discrepancies in the literature as to whether late distribution of food intake and sleep disorders could impact biochemical, anthropometric, and cardiovascular markers. The objectives of this study were firstly observe skipping breakfast and sleep disorders over 12 months. Secondarily, analyze the individual influence of these findings on changes biochemical, anthropometric, and cardiovascular markers during the same period. MethodsThis descriptive study is part of a tertiary analysis in a recently published study. This research recruited 84 participants with Type 2 Diabetes (T2D) who were divided: Control-40 participants received only medical care; Intervention-44 participants received the same medical care along with nutritional assessment. Consultations occurred quarterly over 12th months, and a follow-up was conducted after 3 months. For influence analysis, non-normal variables were compared using Mann-Whitney, while normal variables were compared using unpaired t-tests. In all instances, α = 0.05 and P < 0.05 were adopted. ResultsAnalysis revealed a high percentage of patients in both groups who skipped breakfast, slept less than 6 hours, and experienced nighttime awakenings during the 1st visit. By the 12th month, there was deterioration in all data in the control group and significant improvement in the intervention group. Those with sleep disturbances also had lower HDL-cholesterol (HDL-C) values (p=0.0054). For the other analyzes no significant differences were found. ConclusionParticipants who skipped breakfast and had more nocturnal awakenings possibly had worse glycemic and weight control, but this difference was not statistically significant and only trends were observed. Sleep disorders could affect HDL-C levels. However, the influence analysis does not establish a causal relationship and more clinical trials are needed to analyze this topic on T2D.

Early assessment of responsive neurostimulation for drug-resistant epilepsy in China: A multicenter, self-controlled study.

To evaluate the efficacy and safety of the first cohort of people in China treated with a responsive neurostimulation system (EpilcureTM, GenLight MedTech, Hangzhou, China) for focal drug-resistant epilepsy in this study. This multicenter, before-and-after self-controlled study was conducted across 8 centers from March 2022 to June 2023, involving patients with drug-resistant epilepsy who were undergoing responsive neurostimulation (RNS). The study was based on an ongoing multi-center, single-blind, randomized controlled study. Efficacy was assessed through metrics including median seizure count, seizure frequency reduction (SFR), and response rate. Multivariate linear regression was conducted to explore the relationships of basic clinical factors and intracranial electrophysiological characteristics with SFR. The postoperative quality of life, cognitive function, depression, and anxiety were evaluated as well. The follow-up period for the 19 participants was 10.7±3.4months. Seizure counts decreased significantly 6months after device activation, with median SFR of 48% at the 6th month (M6) and 58% at M12 (P<0.05). The average response rate after 13months of treatment was 42%, with 21% (n=4) of the participants achieving seizure freedom. Patients who have previously undergone resective surgery appear to achieve better therapeutic outcomes at M11, M12 and M13 (β<0, P<0.05). No statistically significant differences were observed in patients' scores of quality of life, cognition, depression and anxiety following stimulation when compared to baseline measurements. No serious adverse events related to the devices were observed. The preliminary findings suggest that EpilcureTM exhibits promising therapeutic potential in reducing the frequency of epileptic seizures. However, to further validate its efficacy, larger-scale randomized controlled trials are required. Chinese Clinical Trial Registry (No. ChiCTR2200055247).

Tocilizumab for the management of corticosteroid-resistant GO combined with OMG: a case series

PurposeTo highlight the safety and efficacy of tocilizumab (TCZ) in Graves’ ophthalmopathy (GO) combined with ocular myasthenia gravis (OMG) patients refractory to steroids and cholinesterase inhibitor (CEI).MethodsThis was retrospective case series. We reviewed the health records of patients with GO combined with OMG, ten of whom were refractory to corticosteroids and CEI treatment and received intravenous injection of TCZ. Ten patients were treated with four injections of TCZ (intravenously, 8 mg per kilogram of body weight, once a month). We analyzed the efficacy and safety of TCZ treatment for this subset of patients with GO and OMG.ResultsThe main outcomes including quality of life questionnaire in Graves’ orbitopathy (GO-QoL) score, Clinical Activity Score (CAS), Myasthenia Gravis Activities of Daily Living profile (MG-ADL) score, proptosis, diplopia and ptosis were assessed at 3 time points: “Baseline” (before the TCZ injection), “4th month” (after fourth time TCZ injection), “Follow up” (Last follow-up). Comparing parameters at 4th month vs. at baseline, all indicators improved at 4th month including GO-QoL score of visual functioning subscale (82.29 ± 13.71 vs. 35.98 ± 20.66, P < 0.001), GO-QoL score of the appearance subscale (80 ± 8.75 vs. 40.63 ± 17.95, P < 0.001), CAS (1.3 ± 0.46 vs. 4.5 ± 0.81, P < 0.001), MG-ADL (2.5 ± 1.56 vs. 5.11 ± 1.14, P < 0.001). Furthermore, proptosis decreased from 19.73 ± 2.84 to 17.93 ± 2.26 mm at 4th month (P < 0.0001). Diplopia and ptosis were also resolved at 4th month. After following up for a minimum of 11 months, the patients had no signs of relapse. In addition, we observed that all analyzed patients exhibited no significant drug reactions following the administration of TCZ.ConclusionTocilizumab maybe a useful therapeutic option in refractory GO coexisting with OMG. However, considering the limitation of a retrospective study, short follow up period and small sample size of this study, randomized controlled studies are needed to validate our results.

Is Automated Insulin Delivery System Therapy Safe and Effectıve in Children Under 7 Years Old?

This study aims to evaluate the off-label use of the MiniMed™ 780G system in children under seven years old, as clinical outcomes in this age group are less established despite the improvements in glycemic control seen with MiniMed™ 780G therapy. Children under seven years old with type 1 diabetes (T1D) using MiniMed™ 780G pump therapy were retrospectively compared with children of similar age and gender using MiniMed™ 640G insulin pump therapy and multiple-dose insulin (MDI) therapy with continuous glucose monitoring systems (CGMs). CGM metrics, total daily insulin dose (TDI), and HbA1c levels were evaluated retrospectively at baseline and at the 3rd, 6th, and 12th months. At the initiation of MiniMed™ 780G therapy, the mean age was 5,25±1,22 years (range: 2,8-6,8 years), and the mean TDI was 10,12±4,34 U/day (range: 4,5-17 U/day). The glucose management indicator (GMI) and HbA1c remained lower in the MiniMed™ 780G group at the 3rd, 6th, and 12th months compared to baseline (p=0,009 and p<0,001, respectively). In the MiniMed™ 780G group, Time Above Range (TAR) was significantly lower at the 3rd, 6th, and 12th months (p=0,018, 0,017, and 0,04, respectively), and Time in Range (TIR) was higher at the 3rd and 12th months (p=0,026 and 0,019, respectively). The coefficient of variation (CV) and HbA1c were lower at the 12th month (p=0,008 and 0,015, respectively) compared to the other groups. No instances of ketoacidosis or severe hypoglycemic events were observed in any of the children during the follow-up period. The absence of significantly higher levels of hypoglycemia compared to other groups at any time point, along with a significant decrease in TAR across all time points, a significant increase in TIR at the 3rd and 12th months, and a significant decrease in HbA1c and CV, indicates that the MiniMed™ 780G system is both safe and effective for children under seven years old.

An integrated approach in the treatment of a patient with chronic destructive pulmonary tuberculosis with extensively drug-resistant pathogen

A clinical example demonstrating the need for a comprehensive approach in the treatment of patients with chronic tuberculosis and extensively drug-resistant pathogen is presented. The patient repeatedly had relapses of a specific process, despite ongoing anti-tuberculosis therapy for several years. During this period, drug resistance to the new anti-tuberculosis drug bedaquiline was formed, which significantly reduces the possibility of selecting adequate anti-tuberculosis therapy. In addition, the patient has a widespread tuberculous process of the trachea and bronchi, accompanied by massive bacterial excretion. Against the background of the complex treatment, by the 6th month of treatment, it was possible to achieve pronounced positive dynamics, however, a massive fibrous cavity remained in the right lung. Given the low functional parameters limiting the use of resection surgery, the patient was able to undergo collapsosurgical treatment in the form of extrapleural pneumonitis

Left Ventricular Ultrasound Diastolic Parameters in Postmenopausal Breast Cancer Patients Treated with Adjuvant Anthracycline and Trastuzumab

Background: Breast cancer remains the leading cause of cancer-related deaths among women of all ages. As age increases, so does the risk of both cancer and cardiovascular diseases, heightening the likelihood of short-term and long-term cardiovascular side effects. Therefore, strategies for early diagnosis and prevention of cardiotoxicity are crucial. he optimal use of conventional echocardiographic parameters is important, especially given the limited access to advanced echocardiography in developing countries. Aims: To evaluate changes in left ventricular (LV) ultrasound parameters, including diastolic parameters, in postmenopausal women with breast cancer (BC), as a high-risk group receiving anthracycline-trastuzumab-containing regimens. Study Design: A prospective 24-month single-center study. Place and Duration of Study: From December 2019 to March 2024 at the ultrasound laboratory of Tbilisi State University Medical Center, Tbilisi, Georgia Methodology: Seventy-four postmenopausal patients with primary BC receiving anthracycline or anthracycline-trastuzumab were assessed for LV systolic and diastolic parameters before the anticancer therapy and at six subsequent visits. Cardio-protection was administered to high-risk patients preventively and to others when cardiotoxicity developed. Multiple regression was used to estimate relationships between various independent and dependent variables. Cardiotoxicity was assessed using survival analysis tools (Kaplan-Meier curves and Cox proportional model). Results: The two-year CTRCD survival rate was 63.5%. During the 2-year follow-up, the mean E/e' increased across the entire cohort, but remained within the normal range. E/e' &gt;15 was noted only in CTRCD patients at 6th month mark (4.1%, n=3, P=.056) within the high-risk group, peaking at 9th month (10.8%, n=8, P&lt; .00). Multiple regression indicated a significant association of IVRT baseline value with late cardiotoxicity (adj. beta-coefficient= 0.32; t = 2.73, P=.008) and DT baseline value with early cardiotoxicity (adj. beta-coefficient = -0.25; t = -3.31, P=0.002). GLS demonstrated predictive value from the first month in 13.5% of the cohort and in 34.5% of patients with CTRCD (P&lt; .00). Conclusion: Our 2-year longitudinal prospective study of anthracycline–trastuzumab-containing regimens in postmenopausal women with early BC revealed that: 1) Predictive association of E/e' with cardiotoxicity was not detected. 2) A reliable association with late cardiotoxicity (T7) from the diastolic parameters was revealed only by IVRT baseline value 3) A reliable association with early cardiotoxicity (T4) from diastolic parameters was revealed only by DT baseline. 4)GLS is superior to E/e' in its prognostic value and diagnostic ability of cardiotoxicity .

Potential influence of interleukin-6 -174G/C gene polymorphism on kidney graft function and tacrolimus dose requirements: five-year follow-up

1. Introduction The study aimed to investigate the influence of interleukin (IL)-6 -174 G/C gene polymorphism on graft function (defined as estimated glomerular filtration rate, eGFR), as well as on the tacrolimus (Tac) pharmacokinetics during the five years after kidney transplantation. 2. Methods The study included 115 Caucasian kidney transplant recipients on Tac-based immunosuppression. The patients were followed between 6 and 60 post-transplantation months. Interleukin-6 and CYP3A5 genotyping were performed. 3. Results Patients carrying the IL-6 -174GG genotype had lower eGFR values compared to the patients with the IL-6 -174GC and −174CC genotypes at the 12th, 48th and 60th post-transplantation months. The linear regression analysis indicated that eGFR at the 6th post-transplantation month and IL-6 -174 G/C polymorphism are independent predictors of eGFR values in the late post-transplantation period. The IL-6 -174GG genotype carriers had lower dose-adjusted trough concentration (C0/D) of Tac compared to the IL-6 C allele carriers during the entire observation period (except at the 24th month), while this effect was independent of the CYP3A5 genotype within three years post-transplantation. 4. Conclusion Interleukin-6 genotyping could be an additional tool to categorise patients towards the risk of graft deterioration in the long-term post-transplantation period. The IL-6 genotyping could be supportive in genotype-guided dosing of Tac.