Anamnestic Characteristics Research Articles

Bone fractures in children with celiac disease: analysis of clinical and anthropometric measurements and bone metabolism markers

Introduction. Abnormal bone remodelling process is one of the clinical manifestations of celiac disease, which increases the risk of developing osteopenia conditions, including bone fractures. The median age for the first fracture is similar in celiac disease and in the general population, but the incidence is higher in patients with celiac disease.Aim. To compare clinical and anamnestic characteristics, anthropometric measurements and laboratory test results in celiac children and adolescents with and without bone fractures.Materials and methods. A total of 151 children aged 1-17 years were included in the study. Patients were divided into two groups: those who had fractures in their lifetime - 21 (13.9%) children and those who had no fractures - 130 (86.1%) children. Results. The frequency of fractures among the patients included in the study was 13.9%, while among children with vitamin D deficiency fractures were reported 2.7 times more often than among children with its optimal level (p = 0.019).Vitamin D deficiency was detected in 20 (95.2%) children with fractures, and levels of 30 ng/ml or higher were found in 1 (4.8%) child. In the group of patients without fractures, the 25(OH)D optimal level was observed in 43 (33.1%) cases.It was found that patients with fractures had a significantly lower osteocalcin level than children without fractures - 26.9 (15.6; 32.9) ng/ml (p < 0.001), and children with fractures had C-terminal telopeptide level 1.9 times higher than the group of children without fractures (p = 0.01). The median PTH concentration in children with fractures was 34.6 (19.6; 54.7) pg/ml, whereas in children without fractures it was 24.2 (17.1; 39.5) pg/ml (p = 0.1).Conclusion. Due to elevated PTH level and severe vitamin D deficiency, a predominance of osteoresorption over osteosynthesis was observed in children with celiac disease and fractures of tubular bones. It is important to maintain a 25(OH)D optimal level and monitor biochemical markers of bone metabolism in patients with celiac disease to assess the processes of bone formation and resorption.

Factors affecting treatment adherence in working-age patients with myocardial infarction

Aim of the study was to analyze the factors affecting treatment adherence in working-age patients with myocardial infarction (MI). Material and methods. During hospitalization, data of 150 patients with MI were collected using medical records and questionnaires. Social treatment readiness was assessed using the S.V. Davydov method with the calculation of treatment adherence (TA) score. After 6 months, the vital status, frequency and causes of hospitalizations, intake of the main groups of drugs, achievement of cardiovascular health target, frequency of regular medical check-up and the type of specialist conducting it were analyzed. In conclusion, the factors affecting the TA score were identified, as well as factors related to the achievement of cardiovascular health targets. Results. 6 months after MI, 4 (2.7 %) patients died due to cardiovascular diseases, 24 (16 %) were hospitalized. The inpatient TA score was 5 (4; 8) (median (lower quartile; upper quartile)), in 79 (52.6 %) patients it was low. The adherence of the surviving patients to treatment after six months was high: 142 (97.3 %) were taking disaggregants, 138 (94.5 %) were taking beta-blockers and reninangiotensin-aldosterone system inhibitors, 139 (95.2 %) were taking statins. However, only 56 (69.1 %) patients achieved target levels of low-density lipoproteins (LDL); 118 (80.8 %) patients achieved target levels of blood pressure, 95 (65.1 %) patients achieved target levels of heart rate (HR) at rest. Only about half (56.8 %) of patients with MI had regular medical check-ups, and only 38.5 % visited cardiologist. Patients who did not achieve target levels of LDL and HR had lower baseline TA score (p = 0.038 and p = 0.029, respectively), they showed up to fewer regular medical checkups after MI (p < 0.001). In patients who did not achieve target HR, the indicator of willingness to pay for treatment was low (p = 0.041), and regular medical check-ups were 4.2 more likely to be performed by a paramedic (p = 0.021). High-score TA was associated with the patient`s lack of propensity for social isolation, high social awareness, trust in the therapeutic treatment, willingness to pay for treatment, high sociability, dyslipidemia in history, the absence of passive smoking during the year, undergoing stage 2 of stroke recovery, working at the time of MI or the late age at onset of alcohol consumption. Low TA score was associated with the patient being the resident in the city, Q-wave MI, and a long-term smoking. Conclusions. Among the factors affecting treatment adherence in working-age patients with MI, certain indicators such as medical and social treatment readiness throughout hospitalization, and social, economic and clinical anamnestic characteristics are highlighted. The identification these factors should be implemented in real clinical practice to improve secondary prevention and outpatient follow-up.

Measurement of leptin and soluble leptin receptor levels in patients with endometrial hyperplastic processes

Objective. To measure leptin and soluble leptin receptor levels in patients with endometrial hyperplastic processes.Materials and methods. 90 patients were included in the study, 70 with hyperplastic endometrial processes made up the main group, 20 with morphologically normal endometrium were included in the comparison group. The concentration of leptin and the soluble leptin receptor in the blood serum was measured by the method of enzyme immunoassay, the clinical and anamnestic characteristics of the disease were studied Results. There were no significant differences between the groups when comparing serum leptin levels: in the study group, the hormone level was 6,01 (3,64;7,50) ng/ml, in the comparison group — 6,44 (3,55;10,11) ng/ml (z = 0,61, p = 0,54). The level of soluble leptin receptor was significantly lower in patients in the main group and was 8531 (5697; 15895) ng/ml, and 16181 (10696; 20251) ng/ml in the comparison group (z = 2.614, p = 0.008).Conclusion. Patients with endometrial hyperplastic processes are characterized by a decreased level of the soluble leptin receptor, whereas a leptin level has no significant differences compared to those in patients without endometrial pathology. The identified condition causes a defect in the signal transmission from the leptin receptor and a decrease in the hormone transport, leading to a disruption of the biological action of leptin. The established level of soluble leptin receptor < 14769 pg/ml, in combination with ultrasound examination, will increase the efficiency of diagnostic measures to detect endometrial hyperplastic processes.

CLINICAL AND PROGNOSTIC FEATURES OF ELDERLY PATIENTS WITH UNSTABLE ANGINA PECTORIS UNDERGOING CONSERVATIVE TREATMENT DEPENDING ON LEFT VENTRICULAR EJECTION FRACTION

Highlights High cardiovascular morbidity and mortality in the Russian Federation and in Kuzbass is mainly due to high number of elderly and senile patients; it simply reflects the current demographic situation in the country. Elderly and senile patients with acute coronary syndrome (ACS) account for 50% of hospitalized patients. In real clinical practice, a significant number of elderly patients with ACS receive conservative treatment, whereas the prognosis in this cohort is determined by the development of recurrent coronary events and the progression of heart failure. Due to small number of patients older than 75-80 years included in randomized clinical trials, there are certain gaps in the management of elderly patients with ACS and heart failure. Obviously, elderly patients require a special approach to patient management, taking into account the complexity of clinical and anamnestic factors affecting the prognosis. AbstractAim. To study clinical and prognostic features of elderly patients with unstable angina pectoris undergoing conservative treatment depending on left ventricular ejection fraction (LVEF).Methods. 130 elderly patients, with mean age of 82 (77; 89) years, hospitalized for unstable angina with a GRACE score of less than 140 to a vascular center in Kemerovo were included in the study. During hospitalization, standard laboratory and instrumental studies were performed, except coronary angiography. The quality of life was assessed using the EQ-5D 3L questionnaire. After 12 months, patient compliance with treatment recommendations, primary and secondary endpoints, and quality of life were analyzed.Results. All patients were diagnosed with heart failure, 50 (38.5%) patients presented with LV EF less than 40% (the group I), 80 (61.5%) patients presented with LV EF more than 40% (the group II). The groups were comparable in gender, age, presence of multifocal of atherosclerotic disease, prevalence of aortic stenosis, arrhythmias and comorbidities. Women predominated in both groups, and arterial hypertension was noted in all patients. In the group I, a history of myocardial infarction, coronary revascularization, and NYHA FC III were more common (p<0.05). The level of quality of life at discharge was low in both groups: 34.8 (29; 42) and 39.4 (34; 46) points, respectively (p>0.05). Almost all patients were on triple neurohumoral blockade (beta-blockers, renin-angiotensin-aldosterone system inhibitors and mineralocorticoid receptor antagonists) for heart failure and dual antiplatelet therapy. One year later, 85.2% of patients in the group I and 90% of patients in the group II were taking all prescribed medication at low or medium therapeutic doses (without the need for drug titration). The overall mortality in the groups was 46% and 37.5%; cardiovascular deaths accounted for 32% and 30%, respectively (p>0.05). There were no differences in the frequency of endpoints (hospitalization, stroke, acute coronary syndrome, coronary revascularization) between the groups. The level of quality of life remained low in both groups.Conclusion. In patients over 75 years hospitalized for unstable angina, main clinical and anamnestic characteristics, annual prognosis and quality of life do not depend on LV EF, whereas the need for coronary revascularization during the 1 year remains high.

Acute kidney injury is a risk factor for in-hospital mortality in patients with acute cardiovascular pathology and concomitant COVID-19

Abstract Funding Acknowledgements Type of funding sources: None. Although respiratory failure and hypoxemia are the main manifestations of COVID-19, many patients also experience worsening kidney function. Hemodynamic disorders in patients with acute cardiovascular pathology can also worsen renal function. The aim of this study was to assess kidney function and its significance for the development of in-hospital complications in patients who were hospitalized with acute cardiovascular pathology and had a co-infection with COVID-19. 139 pts with acute cardiovascular pathology who were diagnosed with COVID-19 were examined. 69 (49.6%) pts had ACS (47 pts with AMI), 33 (23.7%) pts - hypertensive urgency, 24 (17.3%) pts - ADHF, 9 (6.5%) pts - tachysystolic paroxysm of atrial fibrillation, 2 (1.4%) pts - acute pulmonary embolism, and 2 (1.4%) pts - syncope. The average age was 67.9±12.7 y.o., 70 (50.4%) pts were male. Concomitant arterial hypertension was found in 87.1%, DM – 20.9%, CHF - 30.9%, COPD – 9.4% of pts, history of AMI – 20.1% and ischemic stroke – 9.4% of pts. The initial creatinine level was 110.7±66.1 μmol/l, eGFR CKD-EPI - 63.3±20.3 ml/min/1.73m2 (eGFR<60 ml/min/1 ,73m2 – 46.0% of patients). Patients with eGFR<60 ml/min/1.73m2 were older, more often female, often had a history of AF, had a lower level of hemoglobin and blood pressure at admission, a greater number of complications (need for NIV, inotropic therapy) and higher in-hospital mortality (25.0% vs. 5.3%, p=0.002). Acute kidney injury, which was evaluated according to KDIGO criteria (creatinine level increase ≥ 26.5 μmol/l within 48 hours or ≥ 1.5 times within 7 days) was observed in 21 (15.4%) patients (12.0% in patients with eGFR≥60 ml/min/1.73m2 and 18.8% with eGFR<60 ml/min/1.73m2, p<0.05). These patients did not significantly differ from patients without AKI in terms of basic clinical and anamnestic characteristics, but had a lower spO2 level at admission (86.9±11.2% vs. 93.4±5.0%, p=0.016). Patients with AKI had a significantly higher number of in-hospital complications: acute hypoxic delirium (47.6% vs. 8.7%, p=0.003), VTE (14.3% vs. 0.9%, p=0.070), death from of all causes (47.6% vs. 7.0%, p=0.002) and more often required organ support therapy: non-invasive/invasive lung ventilation (52.4% vs. 11.3%, p<0.001), inotropic therapy (57, 1% versus 5.2%, p<0.001). The simplified criterion of AKI (increase of creatinine level ≥ 26.5 μmol/l in comparison with the value at admission at any time during the hospital period) also made it possible to distinguish the category of patients at high risk of hospital complications and death (37.9% vs. 8.2% , p=0.004). Acute kidney injury is a powerful risk factor for in-hospital complications and mortality in patients with acute cardiovascular pathology and concomitant COVID-19 infection.

Emergency Medical Services Response: Outcomes of Non-Transported Patients

Introduction:As a part of a primary intervention, Emergency Medical Services (EMS) may leave a patient at the scene. This decision is made in partnership with the dispatching center. The prognosis of these patients is often unknown. The aim of our study was to assess the outcomes of non-transported EMS patients.Method:It was a descriptive, prospective study conducted over a two-year-period. We included all alive non-transported EMS patients from the site of intervention after a primary mission of the EMS team based on a medical decision. The prognosis was assessed by unexpected events (UE) defined by death, second EMS call, urgent consultation or hospitalization/surgery within seven days. We considered two groups: a group with UME (UME+) and a group with good evolution (UE-).Results:We included 97 patients. The average age was 56±19 years. Seventeen patients (17,5%) had no medical histories. Hypoglycemia was observed in 43% of patients. Thirty-four patients (35%) had an UE. These UEs were distributed as the following: ten consulted a private doctor, ten consulted their family physician, seven called the EMS, three visited the emergency department and four died. There were no significant differences in demographic, anamnestic characteristics between two groups. Psychiatric pathology was more common in the UE- group(28% vs. 9%; p=0.0037). Intravenous injections were more common in the UE+ group (64% vs 39% ; p=0,019). Among the four deaths, three were unexpected.Conclusion:One-third of non-transported EMS patients had UE. Unexpected death was rare (one patient). Setting-up a system for these patients including scores and algorithms, and a post-EMS compulsory visit in collaboration with family physicians could be beneficial.

Clinical case of severe COVID-19 in a child with morbid obesity

The pandemic of coronavirus infection is characterized by a low percentage of complications and severe forms in sick children compared to the adult population. However, there have been described cases of severe clinical course of COVID-19 in children with comorbidities among which is obesity. The aim of this study was to analyze the severe course of a new coronavirus infection paralleled with morbid obesity in a pediatric patient. Materials and methods. All accompanying patient medical documentation was examined. Results and discussion. From the anamnesis of life it is known that the patient was long time complained of intensively increased body weight, on which she repeatedly underwent examinations. In 2018, hypothalamic pubertal syndrome was diagnosed for the first time, for which the patient received hypoglycemic and antihypertensive drugs, hepatoprotectors on an ongoing basis. In the epidemiological anamnesis, the intrafamilial COVID-19 contact with mother was established. The main disease began acutely with a rise in body temperature up to 3939.5C, cough and weakness. During the first week of illness, the patient did not seek medical help and receive self-treatment, but the positive effect was not achieved. Saturation measurement showed low oxygen level (SpO2 71%). In this regard, the patient underwent chest computed tomography, which revealed a bilateral interstitial polysegmental lung lesion with signs of consolidation. After emergency hospitalization, the patient was prescribed empiric antibiotic therapy, anti-inflammatory and antithrombotic treatment, as well as respiratory support. A positive PCR result of a throat and nasal swab for SARS-CoV-2 was obtained in the hospital. Due to a poor response to therapy, the patient was transferred to a respiratory hospital. At the time of hospitalization, the condition was considered severe due to severe respiratory failure and premorbidity. The range of treatments included oxygenotherapy, antibacterial and anticoagulation therapy, as well as surfactant and the nucleoside analogue Remdesivir. During treatment, the clinical picture gained a positive trend, and after 6 days of hospitalization the patient no longer needed respiratory support. According to the results of repeated computed tomography, bilateral interstitial polysegmental pneumonia was diagnosed with damage to the lung tissue up to 95%. The patient remained stable and showed no signs of respiratory failure during the following days of hospitalization. On the 20th day of ilness, the patient was discharged from hospital with full clinical recovery. Conclusion. This clinical case demonstrates the role of premorbid background in aggravating the clinical picture of a new coronavirus infection in a child. Careful study of anamnestic characteristics is necessary in patients of any age, even with an uncomplicated disease course.

Outcomes of coronary artery bypass grafting and percutaneous coronary intervention in high-risk non-ST-segment elevation acute coronary syndromes

Highlights. Despite high hospital mortality after coronary bypass grafting in patients with high-risk non–STsegment elevation acute coronary syndrome, surgical myocardial revascularization remains a preferable treatment modality since percutaneous coronary intervention in these patients is associated with high perioperative complications due to severely calcified coronary lesions.Background. The optimal revascularization strategy in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) remains the subject of many years of controversy. Coronary artery bypass grafting (CABG) improves the long-term prognosis through complete revascularization, however, percutaneous coronary intervention (PCI), due to its availability and low invasiveness, suggests an improvement in hospital outcomes.Aim. To compare hospital outcomes of CABG and PCI performed within 24 hours in high-risk NSTE-ACS patients.Methods. In the present study, the first group included 30 NSTE-ACS patients who underwent CABG in the first 24 hours (the CABG group), whereas 30 NSTE-ACS patients who underwent PCI were included in the second group (the PCI group).Results. The mean age was 64,4±7,3 years, it was comparable in both groups. The main clinical and anamnestic characteristics of patient in both groups were comparable as well. The severity of coronary atherosclerosis according to the Syntax score was 25,6±9,2 in the CABG group, and 21,7±5,7 in the PCI group (p = 0,054). After revascularization, the residual Syntax score did not differ between the groups (p = 0,42), indicating complete revascularization. Hospital mortality was relatively high in the CABG group (13,3%), while no such cases were noted in the PCI group. Most of the patients with adverse outcomes had a critical lesion of the left main coronary artery and a complicated postoperative course.Conclusion. The results of this study demonstrate promising outcome of CABG in patients with severe multivessel coronary disease at high risk of adverse events.

Reported COVID-19 vaccines side effects among Algerian athletes: a comparison between inactivated virus, adenoviral vector, and mRNA COVID-19 vaccines

ABSTRACT Objectives Many types of COVID19 vaccines are administered globally, yet there is not much evidence regarding their side effects among athletes. This study evaluated the selfreported postvaccination side effects of inactivated virus, adenoviral vector, and mRNA COVID19 vaccines among Algerian athletes. Methods A cross-sectional survey-based study was carried out in Algeria between March 01 and 4 April 2022. The study used a validated questionnaire with twenty-five multiple-choice items covering the participants’ anamnestic characteristics, post-vaccination side effects (their onset and duration), post-vaccination medical care, and risk factors. Results A total of 273 athletes completed the survey. Overall, (54.6%) of the athletes reported at least one local side effect, while (46.9%) reported at least one systemic side effect. These side effects were more prevalent among the adenoviral vector group compared to the inactivated virus and mRNA groups. The most common local side effect was injection site pain (29.9%), while Fever (30.8%) was the most prevalent systemic side effect. The age group of 31–40 years, allergy, previous infection with COVID-19, and the first dose of vaccines were associated with an increased risk of side effects for all groups of COVID-19 vaccines. Logistic regression analysis further revealed that compared to males, the incidence of reported side effects was significantly higher in females (odd ratio (OR) = 1.16; P = 0.015*) only for the adenoviral vector vaccine group. In addition, a significantly higher percentage of athletes group of high dynamic/moderate static or high dynamic /high static components suffered from post-vaccination side effects compared to the group of athletes with high dynamic/low static components (OR = 14.68 and 14.71; P < 0.001, respectively). Conclusions The adenoviral vector vaccines have the highest rate of side effects, followed by the inactivated virus and mRNA COVID-19 vaccines. COVID‑19 vaccines were well-tolerated among Algerian athletes and there were no reports of serious side effects. Nevertheless, further long-term follow-up study with a larger sample size of athletes (from different types and sports categories) is warranted to establish the long-term safety of the COVID-19 vaccine.

Nutritional Health Knowledge and Literacy among Pregnant Women in the Czech Republic: Analytical Cross-Sectional Study.

Adequate nutrition and the nutritional status of pregnant women are critical for the health of both the mother and the developing foetus. Research has shown a significant impact of nutrition on the child's health and the future risk of developing chronic noncommunicable diseases (NCDs), such as obesity, diabetes, hypertension, and cardiovascular disease. There is currently no data on the level of nutritional knowledge of Czech pregnant women. This survey aimed to evaluate their level of nutritional knowledge and literacy. An analytical cross-sectional study was conducted in two healthcare facilities in Prague and Pilsen between April and June 2022. An anonymous self-administered paper-form questionnaire for assessing the level of nutritional knowledge (40 items) and the Likert scale for assessing nutrition literacy (5 items) were used. A total number of 401 women completed the questionnaire. An individual's nutritional knowledge score was calculated and compared with demographic and anamnestic characteristics using statistical methods. The results showed that only 5% of women achieved an overall nutritional score of 80% or more. University education (p < 0.001), living in the capital city (p < 0.001), experiencing first pregnancy (p = 0.041), having normal weight and being overweight (p = 0.024), and having NCDs (p = 0.044) were statistically significantly associated with a higher nutritional knowledge score. The lowest knowledge scores were found in the areas of optimal energy intake, optimal weight gain, and the role of micronutrients in diet during pregnancy. In conclusion, the study shows limited nutrition knowledge of Czech pregnant women in some areas of nutrition. Increasing nutritional knowledge and nutrition literacy in Czech pregnant women is crucial for supporting their optimal course of pregnancy and the future health of their offspring.

Profile of a patient with stable coronary artery disease and impaired muscle status

Aim. To determine the clinical profile of a patient with stable coronary artery disease (CAD) and impaired muscle status.Material and methods. The study included 387 patients with stable CAD who had indications for open myocardial revascularization. Quantification of muscle tissue was carried out using computed tomography. Comparative analysis of clinical and anamnestic characteristics of groups of patients with sarcopenia (n=152) and those with normal muscle status (n=235) was performed.Results. Signs of sarcopenia were found in 39,3% of patients with stable CAD. In the group of sarcopenia and the group with normal muscle status, there was a predominance of males — 86,2 and 64,7% (p=0,01), the presence of hypercholesterolemia — 51,3 and 31,1% (p=0,02), type 2 diabetes — 21,1 and 28,1% (p=0,06), multivessel CAD — 25,6 and 17,8% of cases (p=0,018), respectively. In sarcopenia, a 4 times longer history of diabetes was noted (p=0,01) and a 2,3 times longer duration of CAD (p=0,03). The prevalence of obesity in sarcopenia was 3,4 times less (p=0,003). Correlation analysis showed the relationship of muscle status with age (r=-0,674; p=0,002), duration of CAD history (r=-0,582; p=0,001) and diabetes (r=-0,748; p&lt;0,001).Conclusion. The clinical and anamnestic profile of a patient with stable CAD and sarcopenia is characterized by an association of decreased muscle mass with male sex, hypercholesterolemia, multivessel coronary CAD, a long-term history of type 2 diabetes and angina.

Пилинг внутренней пограничной мембраны сетчатки в хирургическом лечении диабетического макулярного отека (2 клинических случая)

Relevance. Vitreoretinal surgery (VRS) for diabetic macular edema (DME) is the treatment of choice when combined with vitreomacular interface (VMI) anomalies. Peeling of the inner limiting membrane (ILM) of the retina in such patients is a controversial procedure. Purpose. To clinically approve new method of ILM peeling in patients with DME in combination with VMI. Material and methods. The article presents a comparative analysis of two clinical cases. The patients had similar clinical and anamnestic characteristics. In both cases, patients underwent VRS for DME with a large intraretinal cyst in the fovea in combination with epimacular fibrosis (EMF). The operation was combined with intervention for cataract (phacoemulsification with implantation of an elastic intraocular lens). Only the stages of ILM peeling were different: in the first case, the technology with the preservation of the ILM fragment in the fovea was used, in the second, a complete peeling of the ILM was performed. Results. In the course of dynamic observation for 6 months after the operation, observation, examination and, if necessary, additional treatment were carried out. Based on the results of observation and evaluation of the functional and anatomical parameters of the retina within 6 months, an improvement was noted in 1st patient and stabilization in 2nd patient. In the case of 2nd patient, a lamellar macular rupture formed at a period of 3 months, which can be regarded as a complication of the complete ILM peeling technique. Conclusion. Peeling of the ILM with preservation of the fragment in the fovea showed better functional and anatomical results compared to the complete removal of the ILM. Morphofunctional results of this method are to be investigated on the representative patient sample. Key words: diabetes mellitus, diabetic retinopathy, diabetic macular edema, vitrectomy, ILM-peeling, optical coherence tomography

Implantable cardioverter-defibrillators for primary and secondary prevention of sudden cardiac death in clinical practice: analysis of the clinical and anamnestic characteristics of patients according to the Kuzbass registry

Aim. To study clinical and anamnestic data of patients with implantable cardioverterdefibrillators (ICD) for primary or secondary prevention of sudden cardiac death (SCD) based on the data from the Kuzbass ICD registry.Methods. Retrospective analysis of demographic, clinical and anamnestic data from the “Kuzbass Registry of Patients with Implanted Cardioverter-Defibrillator”, which includes 286 patients admitted at the Kuzbass Cardiology Center in 2015–2019, was carried out.Results. The age of patients included in the registry was 59 (53; 66) years, 239 (83.6%) were men; all patients were diagnosed with heart failure. ICD for primary prevention of SCD was prescribed in 171 (63.6%) patients (group 1) and for secondary prevention in 98 (36.4%) patients (group 2). The groups were comparable in age, sex, main nosology (coronary artery disease), left ventricular ejection fraction (31.4 (26; 35) and 30 (10; 68)%, p = 0.389). Compared with the group 2, the group 1 had fewer working patients, higher incidence of heart defects, severe heart failure, higher incidence of paroxysmal supraventricular tachycardia (68.7% versus 44.8%, p = 0.001), and higher rates of revascularization (48, 9% and 31.7%, respectively, p = 0.006). Before ICD implantation for heart failure, 210 (73.4%) patients were receiving renin angiotensin aldosterone system inhibitors, 259 (90.6%) – beta-blockers, 167 (58.4%) – mineralocorticoid receptor antagonists. There were no differences in prescribed treatment between the groups. Only 137 (47.9%) patients, 86 (47.3%) patients in the group 1 and 51 (49.0%) patients in the group 2 received triple neurohormonal blockade. Remote monitoring was used only within the framework of research programs.Conclusion. The primary cohort of patients with ICD is the primary SCD prevention group. Regardless of the type of SCD prevention, the underlying disease is coronary artery disease. Current guidelines for optimal drug therapy and myocardial revascularization are not always followed prior to ICD implantation. The creation of registries of patients with ICD is an effective way to identify existing problems in ICD patient selection and to optimize follow-up and treatment.

Relative leukocyte telomere length in patients with chronic alcohol addiction depending on clinical and anamnestic characteristics

Relative leukocyte telomere length in patients with chronic alcohol addiction depending on clinical and anamnestic characteristics

Результаты клинической апробации специализированного продукта диетического лечебного питания «Бифинилан» для детей старше семи лет, больных фенилкетонурией

Objective. To evaluate the efficacy, safety, and tolerability of a specialized food product for dietary therapeutic nutrition “Bifinilan” in children over 7 years of age with phenylketonuria. Patients and methods. An open-label prospective study was conducted in outpatient clinical settings. It included 17 children with phenylketonuria aged between 8 and 15 years (12 girls and 5 boys), who received a specialized product “Bifinilan” for 30 ± 2 days. Clinical and anamnestic characteristics, blood phenylalanine levels determined by the fluorescent method were assessed at the beginning and at the end of the study. Results. During the study, blood phenylalanine levels decreased significantly and were within the reference range (median before the study was 9.11 mg/dL, at the end of the study – 6.17 mg/dL, p &lt; 0.05). At the same time, in children with initially elevated phenylalanine level, it decreased to an acceptable range, and in children with a normal phenylalanine level, it remained within the same range. Patients, their parents, and physicians were completely satisfied with the use of the product, which was well tolerated and the transition to which was not followed by an adaptation period. Conclusion. The efficacy, safety, and good tolerability of a specialized food product for dietary therapeutic nutrition “Bifinilan” in children over 7 years of age with phenylketonuria was demonstrated. Key words: children, specialized food product for dietary therapeutic nutrition, phenylalanine, phenylketonuria

Оценка клинико-анамнестических характеристик тяжести течения ковидной пневмонии в разные сроки беременности и развития риска досрочного родоразрешения

Aim: To evaluate the influence of clinical and anamnestic factors on the severity of the course and early delivery in pregnant women with covid pneumonia. Study design: Retrospective cohort single-center study. Materials and methods. The study included 81 pregnant women with covid pneumonia at a gestational age of 22.0–41.3 weeks. Depending on the severity of the condition, the women were divided into three groups: the 1st group included 13 patients who did not require respiratory support, the 2nd group included 52 pregnant women who received non-invasive respiratory support, the 3rd group included 16 patients who required invasive respiratory support. On the first day after hospitalization, clinical and anamnestic indicators, clinical manifestations of viral pneumonia, data from laboratory and instrumental studies of patients were analyzed. Computed tomography (CT) of the chest organs was prescribed to pregnant women after a consultation on the need for this study. An assessment of anthropometric data and the condition of children at birth was performed. Results. Women of all groups were comparable in clinical and anamnestic characteristics. A higher risk of invasive respiratory support was determined in patients with the onset of the disease at gestational age ≤ 207 (187–233) days (p &lt; 0.001), with an increase in body temperature during illness ≥ 38.6 (38.0–39.0) °C (p = 0.009), saturation in atmospheric air ≤ 90.0 (87.0–93.0)% (p &lt; 0.001). With this combination of parameters, a higher probability of changes in the structure of the lungs according to chest CT data was revealed: ≥ 77.5 (68.2–90.0)% (p &lt; 0.001). Pregnant women with ferritin levels ≥ 125.0 (84.4–268.9) ng/ml had a higher risk of severe viral pneumonia and preterm delivery (p = 0.001). Compared with women in other groups, patients with invasive respiratory support had a shorter delivery time (≤ 210.0 (203.5–238.5) days) (p &lt; 0.001) and a higher chance of preterm birth (odds ratio = 7.07 (95% confidence interval — 1.44; 69.02)). Children of patients with severe viral pneumonia received a statistically significantly worse Apgar score at 1 and 5 minutes of life (p &lt; 0.001), and also had lower weight and body length at birth compared to newborns at 1 and 2 groups (p &lt; 0.001). Conclusion. The study revealed the most informative factors of severity and early delivery in pregnant patients with viral pneumonia caused by a new coronavirus infection. These predictors are important to consider during outpatient monitoring of pregnant patients with coronavirus pneumonia in order to make a timely decision on hospitalization. Keywords: pregnancy, coronavirus infection, covid pneumonia, early delivery.

CLINICAL-ANAMNESTIC CHARACTERISTICS OF NONSPECIFIC VAGINITIS IN WOMEN IN DIFFERENT AGE GROUPS

The purpose of the study was to study the clinical and anamnestic characteristics of women with specific vaginitis in different age groups from different angles. Materials and research methods. The research was carried out at the Research Institute of Obstetrics and Gynecology. The study included 120 women of reproductive age who were diagnosed with nonspecific vaginitis. Examination of women was carried out according to the generally accepted scheme: anamnesis, including complaints of patients, general clinical and gynecological examinations, laboratory, instrumental, bacteriological studies, the calculation was carried out by a mathematical method. The largest part of all patients was aged 18-30 years, i.e. reproductive age. Results and its discussion. The frequency of menstrual irregularities in women included in the study with nonspecific vaginitis was high. When studying pregnancy-related indicators in women with nonspecific vaginitis, it was found that the frequency of primary and secondary infertility, as well as miscarriage in these women, is quite high. The structure of extragenital diseases in women with nonspecific vaginitis was different. Although various pathologies (of the urinary system, respiratory organs, gastrointestinal tract, nervous system) occurred with different frequencies, the rates were quite high.

Prediction of the development of fetal growth retardation in pregnant women with chronic arterial hypertension

During intrauterine life a fetus with growth restriction does hemodynamic, metabolic and hormonal adjustments to cope with the adverse uterine environment, and these changes can become permanent and irreversible. Despite the progress in the knowledge of delayed fetal development, the biomarkers are able to identify this pathology at an early stage and stratify its severity, both before and after childbirth, are still not determined. The objective: to evaluate the prognostic value of the angiogenesis marker level, hormonal profile and Doppler examination for fetal growth restriction (FGR) in pregnant women with chronic arterial hypertension (CAH).Materials and methods. A prospective examination of 61 pregnant women with CAH 1-2 degrees was conducted, which included an analysis of the clinical and anamnestic characteristics and the study of the pregnancy course in the first trimester (11-12 weeks). To determine the level of risk factors for the FGR development the examined pregnant women were divided into groups: women with CAH with FGR (n=10), and pregnant women with CAH without FGR (n=51).Human chorionic gonadotropin (CHG), progesterone (PG) and estradiol (E) were determined in blood serum. Angiogenesis markers – placental growth factor (P1GF) as a pro-angiogenic factor and soluble fms-like tyrosine kinase (sFlt-1) as an anti-angiogenic factor were studied, the ratio of sFlt-1/PLGF (coefficient K) was calculated. All patients had Doppler examination of vascular blood flow in the left and right uterine arteries (pulsation index – PI, resistance index – RI and systolic-diastolic ratio – SDR). The ultrasound examination was done with the ultrasound machine “Mylab Six System”. Statistical analysis was performed using program Statistica® for Windows 13.0. A single-factor logistic regression analysis and a method of building logistics regression, which was evaluated by means of receive operating characteristic curve (ROC-curve) according to the area under the curve (AUC) were used to determine the prognostic level of markers, the 95 % confidence interval was calculated. Results. In the first trimester of pregnancy in women with CAH the PLGF level was &lt; 8.2 pg/ml (sensitivity – 80.0 %, specificity – 60.78 %), area under the ROC curve (AUC) – 0.697 (95 % CI: 0.566–0.808; p =0.0128), which indicate an increased risk of FGR development. The growth of sFl-1 &gt; 1802.59 ng/ml (sensitivity – 70.0 %, specificity – 64.71 %), area under the ROC-curve (AUC) 0.678 (95 % CI: 0.547–0.792; p=0.05) increase the risk of FGR development. The coefficient K in 11-12 weeks of pregnancy was ≥ 95.36 units (sensitivity – 100.0 %, specificity – 43.14 %), area under ROC-curve (AUC) – 0.735 (95 % CI: 0.607–0.840; p=0.0128), which indicate an increase the risk of FGR development. PG/PlGF ratio is 7.21 (sensitivity – 70.0 %, specificity – 70.59 %) and area under the ROC-curve (AUC) 0.702 (95 % CI: 0.571–0.812; p = 0.0118) also indicate the increase the risk of FGR development, as well as the value of the ratio of E/PLGF &gt; 138.53 (sensitivity – 100.0 %, specificity – 35.29 %) and area under the ROC-curve (AUC) 0.640 (95 % CI: 0.507– 0,759). Doppler results in pregnant women with CAH, in the presence of risk factors for FGR development, demonstrate that the CDR was not likely to differ in all groups of patients: 3.62±0.09 units in the persons with CAH and FGR (n=10) and 3.71±0.05 units in the pregnant women with CAG without FGR (n=51) in the right uterine artery; 3.63 ± 0.09 units and 3.71 ± 0.05 units in the left uterine artery, respectively (p&lt;0.05 for all values). However, if PI in the right uterine artery is more than 1.84 units and more than 1.82 units in the left uterine artery, the FGR will further develop. Conclusions. According to the results of the study, it was found that pregnant women with CAH 1-2th degrees with FGR development in the future, in the first trimester of gestation (11-12 weeks) have a decrease PlGF level, sFlt-1and the coefficient K increase. These indicators in the 11–12 weeks of pregnancy were: PlGF ≤ 8.2 pg/ml, sFlt-1 &gt; 1802.59 ng/ml, coefficient K ≥ 95.36 units, and PG/PlGF &gt; 7.21 units, E/PlGF &gt; 138.53 units and CHG/PlGF ≥ 30.14 units.In the pregnant women with CAG, in whom FGR risk will subsequently determine, the significant changes in the CDR and RI at 11-12 weeks of pregnancy are not established, but with an increase of PI more than 1.84 units in the right uterine artery and more than 1.82 units in the left uterine artery FGR will further develop.

Monkeypox Knowledge and Vaccine Hesitancy of Czech Healthcare Workers: A Health Belief Model (HBM)-Based Study.

The recent human monkeypox virus (HMPXV) outbreak in non-endemic countries that started in May 2022 has raised concerns among public health authorities worldwide. Healthcare workers (HCWs) play a decisive role during epidemics in transmitting accurate information to the public and motivating them to pursue protective behaviours, including immunisation. A cross-sectional survey-based study was conducted in the Czech Republic in September 2022 to evaluate HMPXV-related knowledge and vaccination perceptions among HCWs. The study utilised a digital self-administered questionnaire (SAQ) to collect data from the target population. The proposed SAQ inquired about participants' sociodemographic and anamnestic characteristics, perceived knowledge of HMPXV, factual knowledge, and vaccination perceptions according to the health belief model (HBM). A total of 341 participants were included in this study; most of them were females (88.9%), allied HCWs (89.4%), heterosexuals (87.1%), married (61.9%), and vaccinated against COVID-19 (91.2%). Only 8.8% of the participants agreed to receive vaccination against HMPXV; 44.9% rejected it, while 46.3% were hesitant. While digital news portals (47.5%) and social media (25.8%) were among the most utilised sources of information about HMPXV, the scientific journals (5.6%), ECDC (5%), and the U.S. CDC (1.5%) were the least common sources. The participants demonstrated suboptimal levels of factual knowledge, especially regarding HMPXV vaccines (1.5 ± 1.2 (0-4)) and treatments (0.9 ± 0.9 (0-4)). Additionally, several misconceptions were detectable among the participants, regarding topics such as the availability of effective vaccines and antivirals against HMPXV, the risk of vertical transmission, and homosexual stigmatisation. The HBM indicated that the cues to action and perceived susceptibility were the most important constructs to predict HMPXV vaccine acceptance. the findings of this study call upon public health practitioners and health policymakers in the Czech Republic to act accordingly in order to determine the drivers of vaccine hesitancy among Czech HCWs. Dedicated educational campaigns should aim to counter the HCWs' misconceptions around HMPXV, and future studies should aim to explore the prevalence and drivers of HMPXV vaccine hesitancy among the general population.

Clinical and Anamnestic Characteristics, Cardiovascular Pharmacotherapy and Long-term Outcomes in Multimorbid Patients after COVID-19

Aim. To study the clinical and anamnestic characteristics, pharmacotherapy of cardiovascular diseases (CVD) and long-term outcomes in post-COVID-19 patients with cardiovascular multimorbidity (CVMM), enrolled in the prospective hospital registry.Material and methods. In patients with confirmed COVID-19 included in the TARGET-VIP registry, the CVMM criterion was the presence of two or more CVDs: arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF), atrial fibrillation (AF). There were 163 patients in the CVMM group and 382 – in the group without CVD. The information was obtained initially from hospital history sheet, and afterwards – from a telephone survey of patients after 30-60 days, 6 and 12 months, from electronic databases. The follow-up period was 13.0±1.5 months.Results. The age of post-COVID patients with CVMM was 73.7±9.6 years, without CVD – 49.4±12.4 years (p&lt;0.001), the proportion of men was 53.9% and 58.4% (p=0.34). In the group with CVMM the majority of patients had AH (92.3-93.3%), CHD (90.4-91.4%), and minority – CHF (42.7-46.0%) and AF (42.9-43.4%). The combination of 3-4 CVDs prevailed (58.9-60.3%). The proportion of cases of chronic non-cardiac pathologies was higher in the CVMM group (80.9%) compared to the group without CVD (36.7%; p&lt;0.001). The frequency of proper cardiovascular pharmacotherapy during the follow-up period decreased from 56.8% to 51.3% (p for trend = 0.18). The frequency of anticoagulant therapy in AF decreased significantly: from 89.1% at the discharge from the hospital to 56.4% after 30-60 days (p=0.001), 57.1% and 53.6% after 6 and 12 months of monitoring (p for a trend &lt;0.001). There were no other significant changes in the frequency of other kinds of the proper cardiovascular pharmacotherapy (p&gt;0.05). There were higher rate of all-cause mortality among patients with CMMM (12.9% vs 2.9%, p&lt;0.001) as well as rates of hospitalization (34.7% and 9.9%, p&lt;0.001) and non-fatal myocardial infarction (MI) – 2.5% vs 0.5% (p=0.048). The proportion of new cases of CVD in the groups with CVMM and without CVD was 5.5% and 3.7% (p=0.33). The incidence of acute respiratory viral infection (ARVI)/influenza was higher in the group without CVD – 28.3% vs 19.0% (p=0.02). The proportion of cases of recurrent COVID-19 in groups with CVMM and without CVD was 3.7 % and 1.8% (p=0.19).Conclusion. Post COVID-19 patients with CVMM were older and had the bigger number of chronic non-cardiac diseases than patients without CVD. The quality of cardiovascular pharmacotherapy in patients with CVMM was insufficient at the discharge from the hospital with following non-significant decrease during 12 months of follow-up. The frequency of anticoagulant therapy in AF decreased by 1.6 times after 30-60 days and by 1.7 times during the year of follow-up. The proportion of new cases of CVD was 5.5% and 3.7% with no significant differences between compared groups. The rate of all-cause mortality, hospitalizations and non-fatal MI was significantly higher in patients with CVMM, but the frequency of ARVI/influenza was significantly higher in patients without CVD. Recurrent COVID-19 was registered in 3.7% and 1.8% of cases, there were no significant differences between compared groups.