Adverse Factors Research Articles

Molecular Mechanisms Associated with Plant Tolerance upon Abiotic Stress

The important processes of plants are influenced by adverse environmental factors, which can have a negative impact on their growth and development. The last decade has seen an increase in the impact of abiotic stress on plants due to climate changes. The impact of abiotic stress on plants and their defense mechanisms is presented in the Special Issue “Molecular Mechanisms Associated with Plant Tolerance upon Abiotic Stress”. The studies enhance our understanding of how abiotic factors affect plants and their defense mechanisms.

Clinicopathological risk factors for prognosis and therapeutic response of primary central nervous system lymphoma in China: a single-center retrospective analysis of 118 cases.

To investigate the prognostic significance of clinicopathological factors in patients with primary central nervous system lymphoma (PCNSL) in a single center. Patients newly diagnosed with PCNSL at our center were recruited between January 2019 and March 2023. Baseline demographic and clinicopathological data were collected retrospectively. The Kaplan-Meier method and Cox regression analysis were performed for survival analyses. A total of 118 patients were enrolled. The median age was 64 (IQR, 54-68). The median progression-free survival (PFS) and overall survival (OS) were 12.70 (95%CI, 9.73-23.30) months and 36.87 (95%CI, 25.57-NR) months, respectively. KPS < 70 and ECOG ≥ 3 were significantly associated with worse PFS and OS. High International Extranodal Lymphoma Study Group (IELSG) score (IELSG 4-5) and high-risk Memorial Sloan-Kettering Cancer Center (MSKCC) score were also adverse factors for PFS and OS. BTK inhibitors (BTKi) therapy (HR 0.39, 95% CI, 0.18-0.86, p = 0.020) and consolidation therapy (HR 0.19, 95% CI, 0.06-0.64, p = 0.007) were confirmed as independent favorable factors for OS. A high NK lymphocyte proportion was associated with worse OS (p = 0.008). Patients in the high NK lymphocyte group experienced a higher rate of primary tumor resistance (57.14%) than the low NK lymphocyte group (33.33%). KPS < 70, ECOG ≥ 3, IELSG 4-5, and high-risk MSKCC score are adverse factors for PFS and OS. Importantly, BTKi therapy and consolidation therapy are independent favorable factors for OS. Peripheral lymphocyte immunophenotyping could be a potential predictive indicator for prognosis and therapeutic response in PCNSL.

A CsWRKY48 Gene from Tea Plants Intercropped with Chinese Chestnut Plays an Important Role in Resistance to Biotic and Abiotic Stresses

Tea plant (Camellia sinensis) is an important horticultural crop. The quality and productivity of tea plants is always threatened by various adverse environmental factors. Numerous studies have shown that intercropping tea plants with other plants can greatly improve the quality of their products. The intercropping system of Chinese chestnut (Castanea mollissima) and tea plants is an agricultural planting model in which the two species are grown on the same piece of land following a specific spacing and cultivation method. Based on a comparative transcriptome analysis between Chinese chestnut tea intercropped plantations and a pure tea plantation, it was found that the expression levels of the WRKY genes were significantly upregulated under the intercropping pattern. In this study, we cloned a candidate gene, CsWRKY48, and verified its functions in tobacco (Nicotiana tabacum) via heterologous transformation. The contents of protective enzyme activities and osmoregulatory substances were significantly increased, and the trichomes length and density were improved in the transgenic tobacco lines. This phenotype offered an enhanced resistance to both low temperatures and aphids for transgenic lines overexpressing CsWRKY48. Further analysis indicated that the CsWRKY48 transcription factor might interact with other regulators, such as CBF, ERF, MYC, and MYB, to enhance the resistance of tea plants to biotic and abiotic stresses. These findings not only confirm the elevated resistance of tea plants under intercropping, but also indicate a potential regulatory network mediated by the WRKY transcription factor.

Exploring the silent epidemic: investigating the hidden burden of normal weight obesity in type 2 Diabetes Mellitus in India - a cross-sectional study

ObjectiveThis study aimed to determine the prevalence of Normal Weight Obesity (NWO) and evaluate its association with cardiometabolic risk factors among patients with Type 2 Diabetes Mellitus (T2DM) in Gujarat, India.MethodsThis cross-sectional study included 432 adults with T2DM attending a Non-Communicable Disease clinic. Anthropometric measurements, body composition analysis using bioelectrical impedance, and clinical parameters were assessed. NWO was defined as normal BMI (18.5–24.9 kg/m²) with high body fat percentage (≥ 25% for men, ≥ 32% for women). Cardiometabolic risk factors, including blood glucose, blood pressure, and lipid profile, were evaluated. Statistical analyses included descriptive statistics, correlation analysis, and multivariate logistic regression.ResultsThe prevalence of NWO was 33% among the study population. Significant discordance was observed between BMI classification and body fat percentage, with 91% of males and 51.8% of females with normal BMI having obese levels of body fat. Individuals with NWO demonstrated higher cardiometabolic risk profiles compared to non-obese counterparts, including elevated random blood glucose levels (290 ± 110 mg/dL vs. 180 ± 80 mg/dL, p < 0.001), higher systolic (148.8 ± 25.4 mmHg vs. 122.5 ± 19.5 mmHg, p < 0.001) and diastolic blood pressure (98.5 ± 55.6 mmHg vs. 78.6 ± 36.6 mmHg, p < 0.001), and increased prevalence of hypertension (61% vs. 15%, p < 0.001). A moderate positive correlation was found between body fat percentage and random blood sugar levels (r = 0.504, p < 0.001). Multivariate analysis identified age, duration of diabetes, blood glucose levels, and blood pressure as independent factors associated with NWO.ConclusionThe high prevalence of NWO and its significant association with adverse cardiometabolic risk factors in T2DM patients underscores the limitations of using BMI alone for obesity assessment. These findings highlight the need for incorporating body composition analysis in routine clinical practice to improve risk stratification and management strategies in T2DM patients, particularly in the Asian Indian population.

A systematic review of longitudinal risk and protective factors for loneliness in youth.

To effectively tackle loneliness in youth, prevention and intervention strategies should be based on solid evidence regarding risk and protective factors in this age group. This systematic literature review identifies and narratively synthesizes longitudinal studies of risk and protective factors for loneliness in children and adolescents aged below 25 years. A systematic literature search was conducted in October 2023 using PsycINFO and MEDLINE, resulting in n = 398 articles, with n = 105 articles meeting the inclusion criteria. The examined factors included demographic (e.g., gender), socioeconomic (e.g., income sufficiency), social (e.g., peer acceptance), mental health (e.g., depression), physical health (e.g., disabilities), health behavior (e.g., sport participation), and psychological factors (e.g., shyness). Additionally, adverse childhood experiences (e.g., child maltreatment) and environmental factors (e.g., neighborhood characteristics) were investigated.Despite the wide range of potential risk and protective factors examined, relatively few studies provided strong evidence for a prospective association with loneliness. Risk factors that were consistently identified across multiple longitudinal studies included low peer acceptance and peer victimization, depression, social anxiety, internalizing symptoms, low self-esteem, shyness, and neuroticism. Additional replication is required to evaluate factors that have shown significant associations with loneliness in only a limited number of longitudinal studies (e.g., aggression).

Elemental composition of sputum, immune status, and features of pharyngeal microbiota in workers of the anode department of a copper smelter

The development of bronchial and pulmonary pathology depends on characteristics of the aerosols and individual resistance of the body, largely determined by the immune system, to their exposure. Mucous membranes of a healthy person are colonized by saprophytic bacteria or normal microbiota. Yet, changes in the composition and properties of the microbial landscape induced by adverse environmental factors increase the risk of inflammation and contribute to changes in the reactivity of the immune system. The study aims to establish the immune status, microbiota of the pharyngeal mucosa, and the elemental composition of sputum, given its cellular composition, in workers of the anode department of a copper smelter. We tested sputum culture and elemental composition, established clinical and immunological status, and analyzed pharyngeal microbiota in 28 workers of the anode department of a copper smelter. Based on the results of testing, the subjects were divided into two groups with (1) and without (2) leukocytosis (&gt;10 cells in the field of view) detected in sputum. We found no acute or chronic diseases of the bronchi and lungs in the examined workers. In group 1, we observed shifts in the immune response manifested by a decrease in the number of immunocompetent cells, activation of neutrophil phagocytosis, formation of reactive oxygen species in neutrophils, and displacement of normal microbiota of the oropharyngeal mucosa by opportunistic microorganisms (in 100% versus 35%, p&lt;0.05). The elemental composition of sputum was noted for a higher frequency of iron and lead detection and increased concentrations of barium, lead, iron, arsenic, molybdenum, antimony, vanadium, and cadmium. We established a significant effect of metals contained in sputum on cellular, humoral, and local immunity. The inflammatory bronchopulmonary response to toxic aerosol exposure is accompanied by changes in the cellular and phagocytic links of immunity, as well as in the microbial landscape on the mucous membrane of the upper respiratory tract characterized by displacement of normal biota by opportunistic microorganisms. Limitations. This study has certain limitations associated with the small sample size and the lack of opportunity to compare metal concentrations found in sputum with reference levels. Ethics. The study was approved by the Local Ethics Committee of the Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers (extract from the minutes of the meeting No. 8 dated 12/26/2016).

Exploring the role of bridging nodes linking adverse childhood experiences and psychological risk factors in suicidal ideation among MSM

This study investigates the interplay between distal adverse childhood experiences (ACEs) and proximal psychological risk factors in predicting suicidal ideation among men who have sex with men (MSM) using network analysis. A total of 1138 MSM completed self-reported questionnaires on demographics, ACEs, depression, anxiety, interpersonal needs, and suicidal ideation. We employed Gaussian graphical models to perform a network analysis that mapped the relationships between ACEs and proximal psychological variables and identified bridge nodes. Additionally, suicidal ideation was incorporated to reevaluate the network and explore the association between the identified bridge nodes and suicidal ideation. The results show that approximately 88.3% of participants reported experiencing ACEs, with an average occurrence of 3.4 types of ACEs. Suicidal ideation was reported by 31.3% of participants. Key bridging nodes in the psychosocial network included perceived burdensomeness, thwarted belongingness, feeling tired/having little energy, and excessive worrying. Perceived burdensomeness exhibited the strongest correlation with suicidal ideation, followed by thwarted belongingness. Moreover, neglect is strongly associated with suicidal ideation. Our findings suggest that ACEs are associated with suicidal ideation and may be linked to specific proximal psychological factors that correlate with and potentially exacerbate suicidal ideation. These findings provide support to the Interpersonal Theory of Suicide, which suggests that perceived burdensomeness and thwarted belongingness are vital psychological factors in the onset of suicidal ideation. Addressing and intervening in these bridging nodes could help reduce the influence of ACEs on suicide ideation within the MSM community.

A higher incidence of cardiovascular complications in hyperthyroid patients with Graves’ disease in comparison to hyperthyroid patients with subacute thyroiditis

Background: Hyperthyroidism, as well as systemic inflammation, are associated with a higher incidence and complications of cardiovascular disease. Both in Graves’ disease and subacute thyroiditis, patients are hyperthyroid. However, in Graves’ disease, there is an autoimmune process in the thyroid, and in subacute thyroiditis, hyperthyroidism is accompanied by systemic inflammation. It is not known if the rate of cardiovascular complications is higher in the course of Graves’ disease or subacute thyroiditis.. Methods: We performed a retrospective study of all hyperthyroid patients newly diagnosed with Graves’ disease or subacute thyroiditis between January 1st 2018 and December 31st 2021 at the Department of Nuclear Medicine, University Medical Centre Ljubljana. Cardiovascular complications in the period 3 months before or after diagnosis were registered. Values are expressed as mean (SD).. Results: The sample analysis included 1028 patients (247 with subacute thyroiditis, 781 with Graves’ disease). The two groups did not significantly differ by sex, age, and body mass index. A cardiovascular complication was registered in 78 patients; the incidence was significantly higher in Graves’ disease than in subacute thyroiditis (74 vs. 4, p&lt;0.001). Compared to patients with subacute thyroiditis, patients with Graves’ disease had significantly lower TSH: 0.010 (0.006) vs. 0.024 (0.044) mIU/L (p&lt;0.001), higher free T4: 44.1 (26.6) vs. 37.0 (14.7) pmol/L (p&lt;0.001), higher incidence of diabetes: 4.3 vs. 0.4% (p=0.001), arterial hypertension: 12.2 vs. 5.7% (p=0.004) and smoking: 26.7 vs. 8.7% (p&lt;0.001). In a logistic regression model, a significantly higher likelihood for cardiovascular complications was found in Graves’ disease vs. subacute thyroiditis (odds ratio 5.82, p=0.001), in patients with arterial hypertension (odds ratio 2.83, p=0.002), and in those with higher body mass index (odds ratio 0.92, p=0.043).. Conclusion: We report a higher incidence of cardiovascular complications in hyperthyroid patients with Graves’ disease in comparison to hyperthyroid patients with subacute thyroiditis. Patients with Graves’ disease were more severely hyperthyroid and had more adverse cardiovascular risk factors.

Ways to improve the system of prevention and treatment of environmental diseases

International experience, as well as many Russian research works, prove the necessity to concentrate efforts of healthcare professionals and researchers on development of healthcare technologies for diagnosis, prevention and treatment (including health resort treatment and rehabilitation) of so-called environmental diseases caused by unhealthy environments and adverse environmental factors (physical, chemical, biological, social ones). This paper proposes the integration of research areas in environmental medicine into profiles of various research specialties (Occupational Medicine, Ecology, etc.). It is also proposed to transform the healthcare specialty of Doctor of Occupational Medicine into Doctor of Environmental Medicine. Finding ways to improve the system of prevention and treatment of environmental diseases, discussing the issues of further integration of environmental medicine, public health, ecology, occupational medicine, restorative medicine and other biomedical, preventive and clinical disciplines may improve the diagnosis and treatment of human diseases caused by adverse effects of environmental factors, as well as contribute to the development of preventive strategies. The methods of epidemiologic (including prenosologic) diagnostics based on the assessment of functional reserves of the body should play a key role in scientific research with the implementation of its results in the practice of health professionals of various profiles, including environmental occupational pathologists, in order to improve clinical diagnostics and develop personalized treatment and rehabilitation programs for patients exposed to adverse environmental factors.

Pt(IV) Prodrug Photoactivation: A Promising Strategy for Cancer Therapy.

Platinum (II) drugs, including cisplatin, carboplatin, and oxaliplatin, have achieved significant clinical success in cancer treatment. However, their clinical application has been greatly hindered by various adverse factors, such as non-specific activation and drug resistance. Compared with Pt(II) drugs, the axial ligands within Pt(IV) compounds can improve the pharmacokinetic properties, selectivity, and biological activity, implementing alternative cytotoxic mechanisms beyond DNA cross-linking and partially overcoming drug resistance. The controlled conversion of Pt(IV) prodrugs into Pt(II) agents at the tumor site has been extensively explored internationally. In this review, Pt(IV) prodrug modification strategies are first summarized, and the development of the predominant external and internal photosensitizers is listed. Finally, three representative photoreduction mechanisms and strategies for developing corresponding Pt(IV) prodrugs are discussed. This work provides constructive instruction for the subsequent molecular design of Pt(IV) prodrugs.

Phenological multivariance of Betula pendula Roth in an anthropogenically transformed environment

Abstract The article presents the results of long-term biomonitoring based on the phenology of the arboreal species Betula pendula of the city of Yoshkar-Ola, Russia. The phenological multivariance of B. pendula was studied for the first time at different stages of the ontogenesis of the generative period, in the gradient of atmospheric air pollution by industrial and automotive toxicants. The rhythm of seasonal development of B. pendula depends on both individual and age characteristics, as well as on the influence of conditions of a specific urban microclimate and environmental pollution. Middle-aged generative individuals of B. pendula are characterized by earlier periods of the onset of phenophases, rapid leaf unfolding, prolonged flowering, yellowing of leaves and, in general, the growing season, compared with young and old generative trees. The asynchrony of seasonal development is characteristic mainly for trees located in the zone of medium pollution. Under conditions of a specific microclimate and air pollution, heterogeneity within ontogenetic groups B. pendula increases. The adaptation of B. pendula individuals to adverse weather factors and urban conditions is determined by the diversity of phenorhythmogroups in the generative period of ontogenesis.

The Impact of adverse histopathological factors and genetic markers with tumour sidedness on outcome of Standardized Surgical Management of Colon Cancer: A Single Centre Experience

The Impact of adverse histopathological factors and genetic markers with tumour sidedness on outcome of Standardized Surgical Management of Colon Cancer: A Single Centre Experience

Designing a regional clinical service for people with early-onset type 2 diabetes in England.

To design a regional clinical service for people with early-onset type 2 diabetes (EOT2D) in Leicester, Leicestershire and Rutland (England). A literature search was undertaken to identify important considerations. A working group of key stakeholders was formed to design a triage system and service pathway. Electronic medical records (EMRs) were searched (15th November 2023) to assess feasibility of the pathway and adapt accordingly. A literature search identified important considerations: High risk of complications; large proportion from minority ethnic and socioeconomically deprived backgrounds; significant psychological burden; stigma and other social challenges; and misclassification and miscoding. Novel clinical risk criteria were developed, implementable in EMRs, to match intervention-intensity to clinical need. Specialist clinics were planned, one for people at the highest-clinical risk, another for women with adverse perinatal risk factors. A healthcare professional training package was developed to increase awareness of the unmet clinical needs of people with EOT2D and to upskill in provision of holistic care. Subsequent EMR searches supported the need for our service. Due to the large numbers with HbA1c ≥86mmol/mol (10.0%; n=299; 10.8% of total), these people were prioritised for clinic access. We opted for specialist nurse/educator support to practices with clustering of patients and to financially incentivise referrals from primary care into services. We showcase a service specifically for people with EOT2D based on the literature, a broad range of stakeholder involvement and utilising a locally-sourced data-driven approach. We further discuss areas for development and recommendations based on the challenges we encountered.

Assessing Efficiency of Preferential Treatment from Resident Position

The article deals with the research analyzing adverse factors influencing the efficiency of preferential treatment functioning in the Far-East Federal Area. To build a complex assessment of factors hindering the development of business and affecting the demand for preferential treatment on the part of investors a survey of effective residents of preferential treatment zones was conducted. The author came to practical conclusions, which can be used for further upgrading of statutory enactments necessary to establish and regulate preferential treatment in the Far-East Federal Area. The research is based on statistic data of the Ministry on Developing the Far East and the Arctic and the limited company ‘The Corporation of Developing the Far East and the Arctic’. The findings of the research can be used by federal authorities of the Russian Federation, bodies of power in entities of the Russian Federation and controlling companies in order to improve investment climate on the territory of the Far-East Federal Area.

Dynamics of measurable residual disease for risk stratification and guiding allogeneic transplant in acute myeloid leukaemia patients with myelodysplasia-related mutations in first remission.

Accurate classification and risk prediction are critical for therapeutic decision-making in patients with acute myeloid leukaemia (AML). Myelodysplasia-related (MR) gene mutations are classified as adverse genetic factors by the European LeukaemiaNet-2022 guidelines. However, their prognostic value in de novo AML remains controversial. This study retrospectively analysed 188 patients with de novo AML-MR, stratifying them into four subgroups based on dynamic measurable residual disease (MRD) after induction, one or two courses of consolidation chemotherapy. The median follow-up was 36.8 months (4.6-73.7). Patients with persistent or recurrent MRD positivity after the second consolidation had the poorest 3-year relapse-free survival (RFS), overall survival (OS) and cumulative incidence of relapse compared to the other groups (p < 0.001). Multivariable analysis identified this high-risk group as an independent risk factor for both RFS and OS. We observed significant heterogeneity of OS benefit from allogeneic stem cell transplantation (allo-SCT) by MRD-risk groups, with substantial OS advantage for patients in subgroup D (3-year OS: allo-SCT 70.0% vs. 18.2% without, p < 0.001) but no benefit for others (p = 0.047 for interaction). This study underscores the importance of dynamic MRD in refining risk stratification and identifying de novo AML patients with MR mutations who would benefit from allo-SCT during the first complete remission.

Early life events may be the first steps on the multistep path to amyotrophic lateral sclerosis

A combination of multiple genetic and environmental factors appear to be required to trigger the onset of amyotrophic lateral sclerosis (ALS). Early life environmental exposures have been reported to be risk factors for a variety of adult-onset diseases, so we used data from an online international ALS case–control questionnaire to estimate whether any of these could be risk factors for the clinical onset of ALS. Responses were obtained from 1,049 people aged 40 years or more, 568 with ALS and 481 controls. People with ALS were more likely to have been born and lived longer in a country area than in a city area, to have younger parents, and to have lower educational attainment and fewer years of education. No ALS-control differences were found in sibling numbers, birth order, adult height, birth weight, parent smoking, Cesarean delivery, or age of starting smoking. In conclusion, early life events and conditions may be part of a group of polyenvironmental risk factors that act together with polygenetic variants to trigger the onset of ALS. Reducing exposure to adverse environmental factors in early life could help to lower the risk of later developing ALS.

Trauma, Resilience, and Treatment Outcomes in a Pediatric MOUD Clinic

Background: In this study, we explored the relationship between adverse childhood experiences and childhood protective factors (i.e., resilience) with outpatient treatment outcomes among youths receiving buprenorphine-based medication for opioid use disorder over a six-month period. Methods: An observational study was conducted among 42 participants utilizing the modified Adverse Childhood Experience Questionnaire and the Southern Kennebec Healthy Start Resilience survey. Treatment outcomes included the end of treatment, buprenorphine-based medication treatment nonadherence, and opioid relapse. Cox proportional hazard models were fit for all treatment outcomes. Results: Reported adverse childhood experiences were high compared with the national average and demonstrated a significant inverse association with time to buprenorphine treatment nonadherence. Total resilience score was not significantly associated with any treatment outcome. Analysis of potential confounders and other covariates likewise demonstrated no relationship. Conclusions: Higher reported adverse childhood experience scores were associated with greater hazard of buprenorphine-based medication nonadherence. This finding underscores the need for ACE screening and trauma-informed care in this population.

Mendelian randomization analysis to explore the relationship between cathepsins and malignant ovarian tumors.

Cysteine cathepsins are a family of lysosomal proteases that are often overexpressed in several human malignancies and haves been linked to cellular genomic alterations, disturbances in genomic stability, and the onset and spread of cancer. Recent studies have shown alterations in cysteine cathepsins in malignant ovarian tumors. However, it remains unclear whether there is a causal relationship between ovarian cancer, and its subtypes, and the cathepsin family. This study utilized two-sample Mendelian randomization (MR) analysis to examine this potential causal relationship. Genetic instruments derived from publicly available genetic summary data were used for the analyses. For MR analysis, the inverse-variance weighted method, weighted median method, and MR-Egger regression were employed. Multivariate MR analysis was performed concurrently. Univariate MR analysis indicated a strong correlation between decreased incidence of low-grade serous ovarian cancer and elevated levels of cathepsin L2 (odds ratio = 0.803, 95% confidence interval = 0.685-0.942, P = .007), whereas clear cell ovarian cancer showed a strong correlation with elevated levels of cathepsin H (odds ratio = 1.149, 95% confidence interval = 1.036-1.274, P = .008). Multivariate analysis, adjusted for 9 different cathepsins as covariates, confirmed the genetic relationships between cathepsin L2 and low-grade serous ovarian cancer and between cathepsin H and clear cell ovarian cancer. Our results suggest a causal relationship between cathepsins and ovarian malignancy and its subtypes. Cathepsin L2 has a protective effect on low-grade serous ovarian cancer, whereas cathepsin H is an adverse risk factor for clear cell ovarian cancer.

Analysis of influential factors of stent-related adverse events after percutaneous coronary intervention more than twice: a single-center retrospective study

We aimed to assess the factors affecting patient outcomes in multiple stent placements over a 10-year period. The single-center study included 1,200 patients who had multiple stents implanted at least twice or more. Participants were divided into the adverse outcomes as endpoints (n = 204 [17%]) and control groups. Univariate and multivariate analyses of stent-related adverse events risk during 10 years and logistic regression analysis of the adverse outcomes risk factors were performed. Univariate analysis revealed the impact of acute coronary syndrome (ACS), diabetes mellitus, hypertriglyceridemia, cumulative lesions in the left anterior descending (LAD) and left circumflex (LCX) arteries, number of stents in the LAD, LCX, and right coronary artery (RCA), presence of multiple coronary artery lesions, total number of stents used, and intervals between the first and second and between the fourth and fifth implantations. For secondary stent implantation, significant factors in univariate analysis included the number of LAD and LCX lesions, stents in LAD, LCX, and RCA, extent of coronary lesions, ACS, hypertension, diabetes, and total stent count. Many factors affect the outcomes in this patient group over time. Reducing the need for frequent percutaneous coronary intervention and considering the number of stents implanted are essential to improving outcomes.

DIAGNOSTIC CRITERIA AND RISK FACTORS FOR PULMONARY FIBROSIS IN PEDIATRIC PATIENTS WITH BRONCHIAL ASTHMA

The diagnosis of pulmonary fi brosis represents a signifi cant and urgent concern, particularly within the context of pediatric practice. A review of the scientifi c literature reveals that pulmonary fi brosis can be a complication of bronchial asthma in pediatric patients. Among pediatric patients, there is currently a trend towards a steady increase in the prevalence of allergic diseases, in particular bronchial asthma. An additional crucial area of investigation is the advanced study of asthma predictors, which include children with a history of extreme prematurity. Concurrently, prematurity and low birth weight represent risk factors for the onset of bronchopulmonary dysplasia. A substantial body of evidence from clinical trials of uncontrolled asthmasubstantiates the necessity for further investigation into the infl uence of additional adverse environmental factors, including electronic smoking. Despite the growing importance of diagnosing pulmonary fi brosis in adult patients in recent years, many questions remain regarding the relevance of this issue in pediatric patients.