Care Protocols Research Articles

Asociación entre hiperglucemia y complicaciones post-exodoncia en pacientes con Diabetes Mellitus tipo II: Scoping Review

Introduction: Diabetes mellitus (DM) is a prevalent chronic metabolic disorder worldwide, with Type II DM (T2DM) emerging as the most widespread variant. In Chile, approximately 11% of adults aged 20 to 79 suffer from this condition. Given its high prevalence, dental surgeons should be trained to evaluate risk factors, particularly the potential complications linked to tooth extraction in individuals with T2DM. Objetive: To describe the available scientific evidence on post-exodontia complications associated with hyperglycemia in patients with Type II diabetes mellitus. Materials and Methods: An exploratory systematic review was conducted following the PRISMA-ScR extension protocols using the databases PubMed, EBSCO, Scopus and the Cochrane Library. The search employed the following algorithms: ((“Diabetic patient complications” AND “Dental extractions”)), ((“Diabetes” AND “tooth extraction”)), ((“Glycemia” AND “Tooth extraction complications”), ((“Blood glucose” AND “Tooth extractions”), ((“Dental extraction sockets” AND “Diabetics”). Results: Out of a total of 973 articles, 25 were included for this review. Six relevance criteria were considered, revealing safety parameters for conducting extractions in patients with T2DM, with capillary blood glucose levels not exceeding 200 mg/dL for elective extractions and 240 mg/dL for emergency extractions. Conclusions: There is limited evidence correlating threshold values of hyperglycemia with post-extraction complications in patients with T2DM. Most authors agree that the primary concern is not T2DM itself, but hyperglycemia. Furthermore, there is minimal consistency in the recommended care protocols for these patients.

ERCP for common bile duct stones in the elderly: refining the procedure to improve outcomes.

Removal of common bile duct stones in patients with a previous cholecystectomy was one of the first indications for ERCP with biliary sphincterotomy. Thanks to a minimally invasive procedure, patients were prevented from having a new operation. Subsequently, as the technique proved to be successful, ERCP was extended to all patients with choledocholithiasis, regardless of whether or not they had gallbladder. Also contributing was the fact that, at least in the beginnings, surgical interventions on the bile duct with laparoscopic cholecystectomy were more difficult. Nowadays, many surgeons prefer to perform cholecystectomy with a bile duct clean of stones. In this issue of the Spanish Journal of Gastroenterology, Gardenyes et al. present a study on ERCP for common bile duct stones in elderly patients. The novelty of this study is not only to analyze the ERCP procedure, which we already knew has similar success and complication rates to younger patients, but also to focus on the long-term outcome, considering the frailty that frequently accompanies aging. The study concludes that older patients may benefit from enhanced care protocols to reduce medical adverse events and improve outcomes. For us gastroenterologists and endoscopists, another conclusion that can be drawn from this study is that we should not be satisfied that ERCP in older patients has the same success and complication rates as in younger patients, but rather we should strive to ensure that the results are even better.

Resin inlays as an aesthetic alternative to conventional restorations in posterior teeth. Case study

The systematized professional experience was developed from the analysis of a case treated based on resin inlays as an aesthetic alternative to conventional restorations in posterior teeth. The description of the design and care protocol prior to the attention of the ethics committee is of relevant importance. The objective was to expose the use of composite resin under indirect technique as an alternative to the structural involvement of posterior teeth in a patient treated at the postgraduate clinic of the San Gregorio University of Portoviejo, Manabí, Ecuador. Dies were used as a basis for making the inlays using the incremental technique. To obtain the model, the arch of the selected teeth was impressed with alginate, followed by casting in light silicone for the prepared portion of the tooth and in type III stone plaster for the rest. The cementation process in the oral cavity is carried out with dual resin cement. After analyzing the information collected, an encouraging conclusion is reached that supports the viability and predictability of composite resins indirectly in clinical settings. This, of course, provided that there is a deep knowledge of the advantages and limitations inherent to the various materials involved. Likewise, it is positioned as a reasonable alternative for cases of considerably affected teeth, which, in some instances, could have been considered for more extensive treatments, such as crowns, which involves the removal of remaining dental tissue that could possibly have been preserved

The use of a train-the-trainer model to educate non-dental healthcare professionals for oral care

Background: Associations between oral health and systemic conditions have been well established in recent literature. Improvements in oral hygiene have consistently shown to significantly reduce the incidence of respiratory infections, which has high morbidity and mortality rates in the frail elderly. However, the simple low-cost intervention of good oral care remains overlooked in healthcare institutions and nursing homes, due to limited awareness and knowledge. Previous efforts for oral care training of non-dental healthcare professionals have been largely sporadic, with little impact and reach to the medical fraternity. Purpose: To overcome these challenges, we utilized a train-the-trainer model, where seven senior nurses from the long-term stay wards of a public community hospital were educated on the importance of good oral health and trained to administer a comprehensive oral care protocol in patients requiring assistance. The Oral Health Education Programme (OHEP) consisted of a full-day workshop on Common Dental Conditions, Oral Health Assessment Technique (OHAT), and oral hygiene instruction for normal and assisted tooth brushing in independent and mechanically ventilated patients respectively. Results: Majority of the nurses felt that the training was effective and applicable to their work. The number of patients with chronic respiratory infections in the wards were reduced after commencement of OHEP. Conclusion: This interprofessional education collaboration using the train-the-trainer model provides a standardized curriculum, while allowing autonomy for the trainers to customize modules relevant to their respective institutions. This partnership model between medical nurses and oral health professionals allows for better sustainability of the programme.

Experience and expression of postnatal mothers practicing kangaroo mother care: A qualitative study.

Kangaroo Mother Care is a valuable technique recognized for its impact on bonding, breastfeeding, and thermoregulation in newborn infants, transcending considerations of weight, gestational age, or clinical condition. This study aimed to assess mothers' feelings and perceptions regarding the implementation of the Kangaroo Mother Care procedure. In this qualitative investigation, individual interviews were conducted with 25 postnatal mothers who had experienced Kangaroo Mother Care with their infants. While, 12 unique responses were acquired. These interviews served as a means to explore and document the mothers' perspectives on Kangaroo Mother Care. The analysis of field notes identified four themes and one subtheme, which were coded into categorical distinctions. A total of 25 postnatal mothers, along with their newborns participated in this study. The majority of postnatal mothers fall within the age range of 20-30 years (48%), followed by 30-40 years (40%), Regarding newborn, majority were full-term (64%), followed by premature (28%) The findings revealed several significant outcomes. Mothers reported a marked improvement in their perception of Kangaroo Mother Care, describing reduced pain, enhanced comfort, and an overall positive sentiment. Many expressed that practicing KMC was a novel and delightful experience, marking their first engagement in this procedure. Moreover, a majority expressed a willingness to continue Kangaroo Mother Care in the future, hoping for its continued implementation within hospital settings. This enthusiasm aligns with recognizing Kangaroo Mother Care as a priority in nursing mother care. In conclusion, the study underscores the potential benefits and positive impact of Kangaroo Mother Care on mother's experience. The findings advocate for the broad implementation of Kangaroo Mother Care as a valuable strategy in neonatal care, offering a holistic approach to improving the well-being of both mothers and newborns. These insights emphasize the importance of promoting and integrating Kangaroo Mother Care into neonatal care protocols, contributing to enhanced neonatal health and maternal satisfaction.

Protocolo assistencial de acolhimento em unidade de pronto atendimento no contexto da Covid-19 (2020-2021)

Abstract Qualitative action-research research aimed to describe the process of reorganizing the care flow of a UPA to face the COVID-19 pandemic, based on the implementation of care protocols. The collective problem was the organization of the care flow for people with the flu syndrome (FS). The study considered the action-research cycles proposed by Tripp (2005). In the planning phase, the flow of care for patients with FS was developed through the analysis of regulations, physical structure, and available resources. During implementation, intersectoral partnerships were established for physical adaptation, training of professionals, and resizing of the team. The planning and implementation process was described based on reports and data were collected from the unit's management equipment and the Municipal Health Department. The evaluation was carried out continuously, based on feedback from the literature and reflected practice. The reorganization of the unit with the implementation of protocols and division of flows showed positive points, such as participation and involvement of the team, review of processes, search for evidence, and intersectoral partnerships; and negative, such as the difficulty in separating FS patients within the physical structure of the UPA.

Immediate Unprotected Weightbearing vs 2 Weeks Nonweightbearing After Open Reduction Internal Fixation of Ankle Fractures.

Postoperative care protocols for ankle fracture surgery remain controversial with variability among care providers. This prospective controlled trial compared 12-week postoperative outcomes for immediate unprotected weightbearing (IMWB) vs nonweightbearing (NWB) for 2 weeks in a splint followed by weightbearing as tolerated (WBAT) in a boot after surgical fixation of selected low-energy ankle fractures without superior articular involvement. Eighty-seven patients undergoing surgical fixation of ankle fractures at a single level 1 trauma center were recruited according to specific criteria and enrolled by presentation date. The first 43 eligible patients were allocated to the control group, with NWB in a splint for 2 weeks followed by WBAT in a walker boot. The next 44 patients recruited were allocated to the IMWB group. The primary outcome was the Olerud-Molander score (OMAS). Secondary outcome measures included the Euroquol-5D (EQ5D) score and Work Productivity and Activity Impairment: Specific Health Problem (WPAI:SHP) scores, ankle range of motion (ROM), wound complications, time to return to work, radiograph measurements, and fracture reduction loss. In this perioperative-focused study, we collected data on patients until 12 weeks postoperation. The IMWB group had 5 superficial wound complications vs 1 in the control group. At 12 weeks, we found no difference in OMAS, EQ5D, WPAI:SHP scores, ROM, time to return to work, or radiographic measurements. In this short-term and relatively small prospective trial, we found more wound complications among patients treated with immediate unprotected weightbearing compared with patients treated with 2 weeks of NWB followed by protected weightbearing. Given the low incidence and small sample size, we do not know if these observed findings are generalizable. However, we also found no difference in functional outcomes at 12 weeks postoperation between these 2 groups. In light of that, we do not recommend IMWB after open reduction internal fixation of low-energy ankle fractures with plate and/or screw fixation. Level II, prospective controlled trial.

Perceptions of care-dependent older people in nursing homes about their oral health and oral care

Background: Oral health is associated with general health but often remains neglected in residential care settings. Integration of oral care into general care is necessary, but literature shows that appropriate oral care is hampered by multiple barriers. Among older people, attitudes towards oral health and oral care are poor, as they are often unaware of the importance of oral health. The lack of ability to perform their own oral care, due to ageing, is also a perceived barrier. This study is part of research on the implementation of the new Oral Health Section (OHS) in the interRAI assessment of general care needs of nursing home residents. The aim of the study is to identify older people’s experiences with their own oral health, with the oral care performed, their perception of the importance of oral care, as well as their meaning about the assessment of their oral health using. 
 Setting and participants: Care-dependent older people living in 3 Flemish nursing homes. 
 Methods: In-depth interviews were performed and the Oral Health-Related Quality of Life 14 (OHIP-14) instrument was completed. This validated instrument measures the degree of self-rated oral health and satisfaction with the oral health status. The OHS was also filled out, which assesses whether they need assistance with daily oral hygiene care (Oral Hygiene CAP) and whether they need to be referred to a dentist (Dentist CAP). Interviews were coded, validated and discussed by 2 researchers and analysed in the software Nvivo1.7.
 Results: A total of 22 care-dependent older people were interviewed. The mean age of the sample was 84.5 (± 8.2 SD) and 63.6% were female. A total of 11 participants (50%) had no teeth but wore dentures; the others still had their natural teeth. The mean score of the OHIP-14 was 3.9 (range 0-56), indicating good scores for oral health-related quality of life. All older people who still had their natural teeth found it important to keep them in the future. Most older people were satisfied with their own oral health (81.8%), although, according to the results of the CAPs, 86.4% of them scored poorly on the assessment of oral hygiene and 68.2% needed immediate referral to a dentist. This shows that older people tend to overestimate their own oral health and are often satisfied, despite having several oral health problems.
 Conclusions/implications: The study provided information about the perceptions and experiences of older people regarding their oral health and oral care. Learning about their experiences and perceptions can help to identify their wishes and needs, making it possible to improve daily oral care and proactively develop strategies to provide effective dental care for the future older population. Policy makers can use these results to foster the integration of oral care guidelines into care protocols within nursing homes, as well as support collaboration with dentists and dental hygienists within care facilities.

Veterinary management protocol for non-human primates: quarantine, anesthesia, and postoperative care for mastoidectomy at animal research institutions

Non-human primate (NHP) research faces challenges due to zoonosis risk and complex veterinary management yet lacks standardized guidelines for animal care. Therefore, we developed an advanced veterinary management protocol for NHP quarantine, anesthesia, and postoperative care. Three female 4 to 5-year-old cynomolgus monkeys were anesthetized and underwent various tests, including body weight, temperature, blood tests, urinalysis, microbiological monitoring, and physical and dental examinations. Ivermectin and medicated baths were administered to eradicate ectoparasites and endoparasites, and testing was repeated 30 days later. Following quarantine, we performed computed tomography and anesthesia maintenance for mastoidectomy. To relieve pain and maintain body weight, we administered tramadol intramuscularly 4 times/day for 3 days and meloxicam subcutaneously twice daily for 14 days. Feed replacements were provided. During the 33-day quarantine period, physical examinations revealed no abnormalities indicative of infectious diseases, and no specific clinical symptoms were observed. Through a preliminary test of anesthesia time, we selected ketamine 4 mg/kg + medetomidine 50 µg/kg for short experiments such as computed tomography, and ketamine 8 mg/kg + medetomidine 50 µg/kg for intubation. Ten days after mastoidectomy, NHPs consumed 100 kcal/kg and recovered their body weight. This study offers advanced veterinary management guideline for NHP research. Such protocols can lead to more standardized and ethical practices in NHP research, thereby enhancing the quality of studies on NHPs and the translation of findings to human health and disease.

IA model for the creation of automatic and personalized health literacy plans for home care services and protocol for its validation

Background: Health Literacy (HL) is considered a social determinant of health with a direct and significant impact on health-related quality of life, especially in groups of elderly, polymedicated or chronically ill persons. According to the WHO, HL implies achieving a level of knowledge, personal skills and confidence that allows the adoption of measures to improve health through a change in lifestyle. It is a concept that combines elements of health and education. HL is the result of health education. In fact, a poor understanding of health recommendations or instructions is related to poor disease self-management and limited use of preventive resources. Furthermore, a low level of HL translates into an increase in (a) avoidable hospitalizations, (b) healthcare costs and (c) mortality rates. Artificial intelligence (AI) can help create personalized HL plans for each patient automatically. Moreover, thanks to digital education platforms these plans can be delivered and monitored remotely and digitally, reducing the resource of professional hours. The application of AI in health literacy is especially interesting in home health services, where the resources of professionals are scarce and care falls mainly on the family and the patient him/herself.
 Aim: The aim of this study is to develop an IA model for the creation of automatic and personalized HL plans for home care settings that can be consumed by families through a digital tool. The protocol for validation of the HL plans created by the model is also presented.
 Method: At the beginning, (1) a comprehensive geriatric assessment is performed that identifies the needs and capabilities of the care ecosystem (patient-caregiver) in a model of comprehensive person-centered care in the home care setting. (2) After analysis of the data collected in the assessment using validated diagnostic algorithms the IA model automatically generates an individualized training itinerary HL plan adapted to each user profile. (3) Using nursing indicators defined in the NNN taxonomy (NANDA, NOC, NIC) we measure at the beginning and at the end of the HL plan: (a) the knowledge acquired; (b) the change in behavior/behavior and (c) objective results of the health status.
 Main Results: We present an AI model for automated and scalable HL plan creation for home care settings. This model has the potential to improve the HL of the 65+ population (chronicity, complexity, multi-pathology, dependency, frailty, pre-frailty or autonomy) and their informal caregiving ecosystem (non-professional caregivers) in the home setting, especially if long-term care is present. The learning programs created for the HL plan were carried out under a rigorous protocol based on criteria of accessibility and scientific evidence.
 Conclusions: Thanks to the protocol, it will be possible to validate the impact of the HL plans created by the IA model on both the patient and the caregiver. The IA model is currently in the process of validation but shows promising results in reducing the time spent on direct intervention by professionals and improving the population's accessibility to HL plans thanks to the IA model.

Integrated neighborhood teams in the chronic care project 'Leuven Cares' (Zorgzaam Leuven)

In the city of Leuven, ‘integrated neighborhood teams’, as the smallest building blocks of primary care networks, work together facilitated by ‘Leuven Cares’ and driven by population health management and clinical guidelines for the most common chronic diseases.
 Primary caregivers from different professional backgrounds and working in the same neighborhood cooperate to provide structured and coordinated care.
 The targeted patient groups are their shared most vulnerable population with complex needs.
 In 2018 Leuven Cares started founding neighborhood teams. Via a bottom up approach, primary care providers were stimulated to unite in neighborhood oriented networks. Frameworks and local actions for integrated care are elaborated by the neighborhood teams, who act on the level of the neighborhood, while individual teams at patient level do apply them. To start with, risk stratification based on queries in the electronic records helps the teams to indicate what population(s) to focus most on. Than agreements are made for disease management in patients with chronic diseases and care protocols for patients with increased care needs. Stratification helps to see parallelism and complementarity in existing interventions and actions. It also points out where gaps exist that are not covered with usual care. Proactive care, profound coordination of care for complex needs, care planning, empowerment of patients to control their own care process are items that are focused on in the local teams.
 More specific, those frameworks make sure that every patient has access to a care plan that is spoken trough and clear. Items of this care plan are medical follow up and coordination of care, medication coordination, healthy lifestyle, mental wellbeing, prevention etc…
 An individual care plan structures the fragmented care and supports communication between the individual caregivers. An even more important goal of this plan is the possibility for the individual patient to take control over his own care process. For people who are not capable to coordinate their own care, support can be given by the local network. One team member, with a specific focus takes on a coaching role in care coordination This team member can supervise the individual care process for those who cannot do it alone, or can even take over coordination if needed.
 General team processes are supported by the team coach, acting as an operational manager, who assists the team in focusing on the long-term vision, in the implementation of the framework, in gathering data of what happens in the local actions etc.
 
 This results in eight multidisciplinary primary care teams that are progressively engaged to provide integrated care to their shared, most vulnerable population. In these teams up to 60% of the primary caregivers are involved to support the needs of 4000 included patients (October 2022).
 Leuven has been our testing ground to develop these co-acting teams. The overall population of this city is already very divers. On the other hand, our model is not tested for smaller less divers cities, and more rural neighborhoods.
 Next steps are to find out whether our model is implacable for other environments. 
 
 
 
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Development and Implementation of an Integrated Pharmaceutical Care Program for patients with COPD in a Rehabilitation Hospital.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive disease associated with airflow limitation and prolonged respiratory problems. The treatment requires an interdisciplinary approach with a holistic view of the patient. A cornerstone of the treatment consists of inhalation therapy. Inhalation errors are abundant and medication adherence towards inhalation therapy is low. We aimed (1) to develop a standardized pharmaceutical care protocol for hospitalized patients with COPD and (2) to evaluate the effect and feasibility of protocol implementation.
 Methods: This study took place at the rehabilitation hospital Koningin Elisabeth Instituut (RH-KEI) in Oostduinkerke, Belgium from January 2021 to April 2022. The protocol was based on the PHARMACOP protocol, tailored to the specific setting using in-depth interviews with all HCPs involved in the pharmaceutical care of patients with COPD (physicians, pharmacists, pharmacy technicians, nurses, physiotherapists and an occupational therapist). The finalized protocol consisted of six additional patient contacts (3 evaluation moments, 2 educational moments and 1 evaluation moment two weeks after discharge), mainly between the hospital pharmacist and the patients. Consequently, from January 2022 to April 2022, adult patients with COPD were included to follow the complete protocol. Patient outcomes were evaluated using standardized questionnaires (i.e. mMRC, BMQ, CAT, EQ-D and EQ-VAS). The feasibility was assessed during a focus group discussion with all involved HCPs and a patient survey after discharge.
 Results: Before the start of the study, the hospital pharmacist in RH-KEI had no patient contact and there were no (recurrent) training sessions about inhaler use. The in-depth interviews elucidated that most involved health care providers (HCPs) had insufficient knowledge of the correct use of inhalers. This is however needed as 37% of included patients made at least one critical inhalation error at hospitalization. The adapted PHARMACOP protocol was tested in 13 patients, after which a significant improvement was noted in mMRC (p = 0.047), BMQ concerns (p = 0.011) and CAT score (p = 0.002). A trend towards improvement was noted in the EQ-5D and EQ-VAS score (resp. p = 0.065, p = 0.590). Finally, mean inhalation technique scores had significantly improved (p = 0.003). Transferring information to primary care HCPs seemed difficult as only a third of patients had handed over their discharge letter to their community pharmacist. The in-hospital HCPs concluded that the protocol was feasible for implementation with some adjustments, such as a more prominent role of the (hospital) pharmacist, the possibility to tailor the program to the patient and a set timing for interdisciplinary (patient) discussions. 
 Conclusion: An interdisciplinary pharmaceutical care program can improve outcomes in patients with COPD. Additional attention should be given to the inclusion of primary care HCPs to guarantee continuity of care concerning inhalation therapy for COPD management.

Platelet-Rich Plasma in Dermatology: New Insights on the Cellular Mechanism of Skin Repair and Regeneration.

The skin's recognised functions may undergo physiological alterations due to ageing, manifesting as varying degrees of facial wrinkles, diminished tautness, density, and volume. Additionally, these functions can be disrupted (patho)physiologically through various physical and chemical injuries, including surgical trauma, accidents, or chronic conditions like ulcers associated with diabetes mellitus, venous insufficiency, or obesity. Advancements in therapeutic interventions that boost the skin's innate regenerative abilities could significantly enhance patient care protocols. The application of Platelet-Rich Plasma (PRP) is widely recognized for its aesthetic and functional benefits to the skin. Yet, the endorsement of PRP's advantages often borders on the dogmatic, with its efficacy commonly ascribed solely to the activation of fibroblasts by the factors contained within platelet granules. PRP therapy is a cornerstone of regenerative medicine which involves the autologous delivery of conditioned plasma enriched by platelets. This is achieved by centrifugation, removing erythrocytes while retaining platelets and their granules. Despite its widespread use, the precise sequences of cellular activation, the specific cellular players, and the molecular machinery that drive PRP-facilitated healing are still enigmatic. There is still a paucity of definitive and robust studies elucidating these mechanisms. In recent years, telocytes (TCs)-a unique dermal cell population-have shown promising potential for tissue regeneration in various organs, including the dermis. TCs' participation in neo-angiogenesis, akin to that attributed to PRP, and their role in tissue remodelling and repair processes within the interstitia of several organs (including the dermis), offer intriguing insights. Their potential to contribute to, or possibly orchestrate, the skin regeneration process following PRP treatment has elicited considerable interest. Therefore, pursuing a comprehensive understanding of the cellular and molecular mechanisms at work, particularly those involving TCs, their temporal involvement in structural recovery following injury, and the interconnected biological events in skin wound healing and regeneration represents a compelling field of study.

The role of Helicobacter pylori infection in the development and course of allergic diseases in children with gastroesophageal reflux disease

Objective — to improve the prevention and treatment of esophageal lesions in children based on the study of Helicobacter pylori infection in pediatric patients with allergic diseases.
 Materials and methods. Examination involved 256 children aged 6 to 18 years, from them 118 children without allergic pathology were included in the control group. The diagnosis was verified according to the unified clinical protocols of primary and secondary medical care. H. pylori was determined with biopsy urease test or histologically. Video esophagogastroduodenoscopy with endoscopic determination of pH was used to assess the condition of mucosa of the upper gastrointestinal parts. The results were processed using the methods of non‑parametric statistics.
 Results. Helicobacter pylori infection occurred more often in children with atopic dermatitis (32%), less often and equally often (24%) at bronchial asthma and allergic rhinitis and in 16% of patients with a combination of allergic diseases. Only 2 (1.4%) patients had H. pylori‑associated chronic urticaria, which was related to the specificity of the hospital department. Helicobacter infection was observed more often in patients with allergic rhinitis and atopic dermatitis without atopic changes. When comparing the Helicobacter association in children with allergic diseases depending on age, a significant difference was established in the group of children aged 6—12 years with allergic rhinitis and mainly with atopy. Endoscopic changes in the esophageal mucosa and esophageal motility disorders in association with Helicobacter pylori more often diagnosed in patients with atopic dermatitis (10.3%), less often and equally often in patients with bronchial asthma and allergic rhinitis (7.7%), the lowest frequency of Helicobacter pylori infection was found in patients with combined allergic pathology (5.1%) and no association in patients with urticaria. Endoscopic signs of esophageal inflammation were more often detected in patients with atopic dermatitis who had Helicobacter pylori infection and esophageal motility disorders. Most often, inflammatory changes in esophageal mucosa were found in patients with allergies developed in the presence of motor disorders, the risk of their development increased in case of Helicobacter infection. It has not been proven that the presence of atopy affected the development of inflammation in the esophagus.
 Conclusions. Among allergic diseases, Helicobacter pylori infection was more often revealed in patients with atopic dermatitis (32%), allergic rhinitis (24%) and bronchial asthma (24%) without statistical significance. A significant difference in H. pylori contamination depending on age was found only in patients with allergic rhinitis (H. pylori was determined more often in elementary school age), in the rest of the patients and in the control group, no significant differences were found. Endoscopic lesions of the esophagus were more often detected in atopic dermatitis, in particular esophagitis (in 17.9%), it was Helicobacter‑associated in 10.3% of cases and was combined with moderate motor disorders in 10.3% of observations. Allergic rhinitis (15.4%) was also associated with Helicobacter pylori infection (7.7%) and was accompanied by motility disorders in 15.4% of cases. Motor disorders, which were registered both in patients with allergic diseases and in patients without allergies, played an important role in the esophagus inflammation and formation of gastroesophageal reflux disease.

Fast cycling culture of the annelid model Platynereis dumerilii.

Platynereis dumerilii, a marine annelid, is a model animal that has gained popularity in various fields such as developmental biology, biological rhythms, nervous system organization and physiology, behaviour, reproductive biology, and epigenetic regulation. The transparency of P. dumerilii tissues at all developmental stages makes it easy to perform live microscopic imaging of all cell types. In addition, the slow-evolving genome of P. dumerilii and its phylogenetic position as a representative of the vast branch of Lophotrochozoans add to its evolutionary significance. Although P. dumerilii is amenable to transgenesis and CRISPR-Cas9 knockouts, its relatively long and indefinite life cycle, as well as its semelparous reproduction have been hindrances to its adoption as a reverse genetics model. To overcome this limitation, an adapted culturing method has been developed allowing much faster life cycling, with median reproductive age at 13-14 weeks instead of 25-35 weeks using the traditional protocol. A low worm density in boxes and a strictly controlled feeding regime are important factors for the rapid growth and health of the worms. This culture method has several advantages, such as being much more compact, not requiring air bubbling or an artificial moonlight regime for synchronized sexual maturation and necessitating only limited water change. A full protocol for worm care and handling is provided.

OSTEOPONTIN AS EFFECTIVE PROGNOSTIC AND THERAPEUTIC MARKER OF BRONCHIAL ASTHMA IN CHILDREN

Bronchial asthma is one of the most common non-infectious diseases among children. According to the official statistics of the Ministry of Health of Ukraine, the number of cases among Ukrainian children is about 5.61 per 1000 children. In recent years, more and more attention of specialists has been devoted to the study of inflammatory mediators such as osteopontin.
 Purpose of the study is to improve the prevention and treatment of bronchial asthma in children based on assessing prognostic levels of osteopontin.
 Materials and methods: 96 children aged 6 to 18 were examined. The diagnosis was verified according to the unified clinical protocol of primary and secondary medical care "Bronchial asthma in children" (order of the Ministry of Health of Ukraine dated October 8, 2013 No. 868). Assessment of osteopontin was carried out during remission by ELISA among 80 patients with bronchial asthma, the control group consisted of 16 healthy children. The study was conducted in adherence to human rights in accordance with prevailing legislation in Ukraine and aligns with international ethical standards. The results were analyzed utilizing non-parametric statistical methods through Microsoft Excel and IBM SPSS Statistics.
 Results and discussion. Boys constituted the majority of the subjects studied, comprising 73%. In the main group, all patients were diagnosed with a mixed form of asthma, categorized by severity as follows: intermittent - 30% (40), mild persistent - 31% (29), moderate persistent - 26% (21), and severe - 13% (10). Upon analyzing osteopontin levels based on age, within the bronchial asthma group, values were nearly identical between early and late school-age children (27.6 ng/ml and 27.7 ng/ml, respectively). In contrast, the control group exhibited different patterns: higher values in early school-age children at 10.6 ng/ml and 8.9 ng/ml in the high school group. Notably, the significantly elevated level of osteopontin in the main group at 27.6 ng/ml compared to the control group at 9.8 ng/ml warrants attention, suggesting that osteopontin could serve as a marker for the inflammatory process.
 Conclusions: Physiologically, the level of osteopontin is higher in children of early school age. Osteopontin is a marker of inflammation in BA in children, which is probably higher in patients of the main group and its level has no age difference. The level of osteopontin is directly proportional to the severity of the disease and can serve as its prognostic criterion. The higher the level of osteopontin, the more powerful anti-inflammatory therapy the patient may need.

Renewed calls for abortion-related research in the post-Roe era.

Nearly 50 years after Roe versus Wade, the United States Supreme Court's decision in Dobbs versus Jackson Women's Health Organization unraveled the constitutional right to abortion, allowing individual states to severely restrict or ban the procedure. In response, leading medical, public health, and community organizations have renewed calls for research to elucidate and address the burgeoning social and medical consequences of new abortion restrictions. Abortion research not only includes studies that establish the safety, quality, and efficacy of evidence-based abortion care protocols, but also encompasses studies on the availability of abortion care, the consequences of being denied an abortion, and the legal and social burdens surrounding abortion. The urgency of these calls for new evidence underscores the importance of ensuring that research in this area is conducted in an ethical and respectful manner, cognizant of the social, political, and structural conditions that shape reproductive health inequities and impact each stage of research-from protocol design to dissemination of findings. Research ethics relates to the moral principles undergirding the design and execution of research projects, and concerns itself with the technicalities of ethical questions related to the research process, such as informed consent, power relations, and confidentiality. Critical insights and reflections from reproductive justice, community engagement, and applied ethics frameworks have bolstered existing research ethics scholarship and discourse by underscoring the importance of meaningful engagement with community stakeholders-bringing attention to overlapping structures of oppression, including racism, sexism, and ways that these structures are perpetuated in the research process.

Overview of the Association Between the Pathophysiology, Types, and Management of Sickle Cell Disease and Stroke.

Sickle cell disease (SCD) is a genetic blood disorder that affects hemoglobin and increases stroke risk, particularly in childhood. This review examines the pathophysiological association between SCD and stroke, the classification of stroke types, risk factors, diagnosis, management, prevention, and prognosis. A comprehensive literature search was conducted via PubMed, Scopus, and Cochrane databases. Relevant studies on SCD and stroke pathophysiology, classification, epidemiology, diagnosis, treatment, and prevention were identified. Sickle cell disease causes red blood cells to become rigid and sickle-shaped, obstructing blood vessels. Recurrent sickling alters cerebral blood flow and damages vessel walls, often leading to ischemic or hemorrhagic strokes (HS). These occur most frequently in childhood, with ischemic strokes (IS) being more common. Key risk factors include a prior transient ischemic attack (TIA), low hemoglobin, and a high leukocyte count. Neuroimaging is essential for diagnosis and determining stroke type. Primary prevention centers on blood transfusions and hydroxyurea for those at high risk. Acute treatment involves promptly restoring blood flow and managing complications. However, significant knowledge gaps remain regarding stroke mechanisms, optimizing screening protocols, and improving long-term outcomes. This review synthesizes current evidence on SCD and stroke to highlight opportunities for further research and standardizing care protocols across institutions. Ultimately, a holistic perspective is critical for mitigating the high risk of debilitating strokes in this vulnerable patient population.

Evaluation of a respiratory care protocol including less invasive surfactant administration in preterm infants.

Respiratory care protocol including less invasive śsurfactant administration (LISA) in ≤29 weeks' gestational age (GA) infants introduced in October 2018. Retrospective study of infants admitted on continuous positive airway pressure (CPAP) October 2018 to December 2021. Maternal and neonatal variables were compared between infants managed on CPAP with and without LISA. Infants who received LISA and subsequently required mechanical ventilation (MV) within 72 h of life (HOL) [LISA failure (LF)] were compared with those who required no MV [LISA success (LS)]. 249 infants were admitted on CPAP, 5 were intubated prior to LISA, 143 required LISA and 101 remained on CPAP without surfactant. Of those receiving LISA, 108 were LS and 35 were LF. Compared to LS, LF infants were of lower GA and birth weight, required higher fractional inspired oxygen (FiO2), and CPAP level at birth, admission, one HOL, and an hour after LISA. Moreover, LF infants had higher mortality and morbidity. Together GA ≤ 25 weeks' and FiO2 ≥ 0.3 an hour after LISA best predicted LF. Over 80% of infants admitted on CPAP avoided MV within 72 HOL. Early predictors of LF provide targets for future interventions to decrease need for MV in preterm infants. Less invasive surfactant administration (LISA) decreases the need for mechanical ventilation (MV) and improves outcomes. However, some infants require MV within 72 h of life (HOL) despite LISA (LISA failure). Over 80% of ≤29 weeks' gestational age (GA) infants can be successfully managed on CPAP with or without surfactant in the first 72 HOL. A combination of factors including ≤25 weeks' GA and fraction of inspired oxygen ≥0.3 an hour after LISA predict LISA failure. Evaluation of a noninvasive respiratory support strategy including LISA provides targets for intervention to decrease need for MV in preterm infants.

Prevalence and risk factors of exposure keratopathy among critically ill patients: A systematic review and meta-analysis.

To identify the incidence, prevalence and risk factors of exposure keratopathy (EK) among critically ill patients. Systematic review and meta-analysis, in accordance with the PRISMA 2020 Statement. The Cochrane Library, PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), China Knowledge Resource Integrated Database (CNKI), Chinese Biomedical Database (CBM), Weipu Database (VIP) and WanFang Database were systematically searched from inception to June 2022. Observational studies that reported EK among paediatric and adult critically ill patients were screened and included original articles based on the inclusion criteria. Two reviewers independently completed data extraction and quality assessments. Subgroup analysis investigated potential causes of heterogeneity. Of the 4508 studies identified, 23 studies involving 3519 subjects were included. The pooled prevalence of EK was 34.0%, and the pooled incidence rate of EK was 23.0%. Risk factors associated with EK in critically ill patients included lagophthalmos, chemosis, eye blinks <5 times per minute, mechanical ventilation, sedation, lower Glasgow Coma Scale (GCS) score and higher Acute Physiology and Chronic Health Evaluation (APACHE) II score. This review shows that EK rates are high in critically ill patients and are influenced by multiple factors. Medical staff should pay more attention to EK in critically ill patients, conduct professional evaluations and implement targeted eye care protocols to reduce its occurrence. This study shows the frequency of and multiple risk factors for EK in critically ill patients, which provides evidence-based guidance for nurses to evaluate the risk of EK in critically ill patients and take appropriate precautions to reduce the risk. The protocol was registered in PROSPERO (https://www.crd.york.ac.uk/prospero/) (CRD42022346964). No patient or public contribution.