Science Center Research Articles

ДИФФЕРЕНЦИАЛЬНАЯ ДИАГНОСТИКА ПРИОБРЕТЕННОЙ АПЛАСТИЧЕСКОЙ АНЕМИИ У ДЕТЕЙ: АНАЛИЗ ДАННЫХ РЕГИСТРОВОГО ИССЛЕДОВАНИЯ

Acquired aplastic anemia (AA) is still the diagnosis of exclusion. The purpose of the research was to identify clinical and laboratory signs that do not correspond to acquired AA allowing to diagnose other diseases accompanied by cytopenia. Materials and methods used: Authors represent the results of diagnostic search in pediatric patients (0 to 18 y/o) with a suspected diagnosis of acquired AA who underwent remote diagnosis in the laboratories of the National Scientific and Practical Center for Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev (Moscow, Russia) as part of the Register Study in Sep. 1, 2017-May 1, 2022. Results: in retrospective analysis of 523 children records, 104 (20%) patients had other diagnoses. In 29 (27.9%) patients were diagnosed with inherited bone marrow failure syndromes (IBMFS), in 11 (10.6%) with myelodysplastic syndrome, in 11 (10.6%) with deficiency anemia, in 10 (9.6%) with congenital unspecified AA, in 7 (6.7%) with immune cytopenia, in 7 (6.7%) with inborn defects of immunity, in 6 (5.8%) with secondary AA, in 6 (5.8%) with acute leukemia, in 2 (1.9%) with paroxysmal nocturnal hemoglobinuria and in 15 (14.4%) cases with other unspecified diseases. Fanconi anemia (n=15/29 patients) was the most common disease in the IBMFS group; this group had also included: dyskeratosis congenita (n=9), Schwachman-Diamond syndrome (n=2), amegakaryocytic thrombocytopenia (n=2), Diamond-Blackfan anemia in combination with congenital neutropenia (n=1). Conclusion: differential diagnosis of acquired AA can be difficult though it is undoubtedly must-do for successful treatment. Verification of other alternative diseases, including genetically determined syndromes, contributes to the choice of optimal patient management tactics.

Novel Eyelid Supraorbital Pretemporal Approach to the Anterior Communicating Artery Complex: A Quantitative Cadaveric Comparative Study

Abstract Objectives Access to the anterior communicating artery (ACom) complex may be achieved via the modified orbito-zygomatic (mOZ) or eyelid supraorbital (ES) approaches. Further, the ES approach may improve cosmesis at the cost of decreased exposure and maneuverability. Thus, a novel eyelid supraorbital pretemporal (ESP) approach, a combination of the ES approach with a pretemporal dissection, may optimize the shortcomings of the ES approach. Design This is a cadaveric study. Setting Five ES, ESP, and mOZ approaches were performed on cadaveric heads and compared. Participants Cadaveric specimens were provided under the University of Oklahoma Health Science Center's Willed Body Program. Main Outcome Measures Quantitative measures of exposure, maneuverability, and angles of attack in horizontal and vertical planes were compared between approaches. Results The ESP approach was superior in terms of exposure and deep maneuverability when compared with the ES approach (p < 0.01). In addition, this approach demonstrated superior angles of attack in vertical (p < 0.01) and horizontal (p = 0.045) planes. When compared with the mOZ approach, the ESP approach provided significantly greater exposure to the contralateral A2 (p < 0.01) with a less favorable horizontal angle of attack (p < 0.01). The ESP provides exact exposure to complete the pretemporal osteotomy, offering a unique perspective on the ACom complex. Conclusion When accessing the ACom complex, the ESP approach yields superior exposure and maneuverability compared with the ES approach and is comparable to the mOZ approach, with unique advantages provided by the addition of pretemporal osteotomy and dissection.

Transitioning Towards a Virtual Falls Prevention Program for Frail Seniors: Learning from the Experiences of Older Adults During the COVID-19 Pandemic.

The literature to date is unable to clearly characterize the appropriateness of virtual care for falls prevention services from the patient perspective. In response to COVID-19, the Falls Prevention Program (FPP) at Sunnybrook Health Sciences Centre was modified to include virtual components. We set out to uncover the experiences of this unique older-adult patient population to inform FPP quality improvement and appropriate incorporation of technology post-pandemic. FPP patients during the COVID-19 pandemic (February 2020 - February 2022) and their primary caregivers met inclusion criteria. Out of 18 eligible patients, 10 consented to participate in 20-minute, semi-structured telephone interviews conducted and transcribed by the first author. Inductive coding followed by theme generation occurred through collaborative analysis. The participants (n=10) were 60% female, mean age 84 years (SD 5.8), 60% living alone, and 70% university educated. We generated three main themes: 1) First Steps First, revealed a common desire for physical and mental support and the perceived essentials of a successful FPP highlighting the importance of program length and individualized attention; 2) Overcoming Obstacles, highlighted participants' experiences overcoming barriers with technology in the context of an isolating pandemic; and 3) Advancing Care Post-Pandemic, elaborated on the appropriateness of virtual care and delved into the importance of program personalization. The interviewed older adults revealed agreement on the FPP's necessity and the importance of increasing program length, one-on-one interaction, and program flexibility for unique patient needs. Incorporating virtual assessment prior to in-person exercises was largely favoured and should be considered as an appropriate use of technology post-pandemic.

Đặc điểm lâm sàng và hiệu quả điều trị của liệu pháp oxy cao áp ở bệnh nhân chóng mặt ngoại biên

This paper presents “Clinical characteristics and therapeutic efficacy of hyperbaric oxygen therapy in patients with peripheral vertigo” to determine the clinical features of peripheral vertigo and its therapeutic efficacy. The study was carried out at Hyperbaric Oxygen Center (Southern Branch of Joint Vietnam-Russia Tropical Science and Technology Research Center) from October 2021 to December 2022, with 60 patients, divided into 2 groups. Group 1 consisted of 30 patients was treated with hyperbaric oxygen therapy (HBOT) and group 2 consisted of 30 patients was treated with HBOT and drugs (vestibular inhibitors, antiemetics and brain tonics). The results showed that: vertigo often occured when changing head position, vertigo accompanied by nausea, loss of balance. After the treatment, the group treated with HBOT and drugs, the patient's condition improved better, the level gradually increased with HBOT. In the group treated with HBOT and drugs, the mean score before treatment was 12.5 points, after 10 days of treatment was 4.37 points, after 20 days of treatment decreased to 0.63 points and after 30 days of treatment to 0.27 points. Particularly, in the group treated with HBOT, this rate was 12.33 points, respectively; 6.37 points; 2.1 points and 0.97 points (p < 0.05).

Investigation of the Resilience, Self-Efficacy, and Perceived Social Support of Gifted Students

Introduction: This research aimed to analyze the levels of psychological resilience in terms of different variables, self-efficacy, and perceived social support among gifted students, investigate the relationships between these variables, and examine the predictive power of self-efficacy and perceived social support on psychological resilience. Method: The study involved 232 gifted middle school students from six different Science and Art Centers in Turkey. Participants completed the Demographic Information Form, Child and Adolescence Resilience Scale, Self-Efficacy Scale for Children, and Social Support Evaluation Scale for Children and Adolescents. Findings: The findings revealed significant differences in psychological resilience scores based on gender, grade, and participation in social/sportive activities. Positive relationships were observed among psychological resilience, emotional self-efficacy, academic self-efficacy, social self-efficacy, total self-efficacy, perceived social support from family, peers, and teachers, and total perceived social support. Self-efficacy and perceived social support were identified as significant predictors of psychological resilience in gifted students. Discussion: Enhancing the levels of self-efficacy and perceived social support, as well as promoting participation in social/sportive activities, can contribute to the psychological resilience of gifted students. There is a positive relationship between self-efficacy, perceived social support, and psychological resilience in gifted students. As the levels of self-efficacy and perceived social support increase, the psychological resilience of gifted students also increases.

Predictors of endocrine immune-related adverse events (irAEs) in patients treated with immune checkpoint inhibitors (ICI) in routine clinical practice.

e14713 Background: Endocrine irAEs have been reported in association with various ICI and are characterized by their correlation with improved survival outcomes. A growing clinical comprehension of endocrine irAEs has facilitated the development of effective treatment strategies involving hormone replacement, which has been shown to enhance patients' quality of life. This study aims to evaluate outcomes in patients (pts) experiencing endocrine irAEs and identify predictive factors for their occurrence. Methods: This retrospective cohort study comprised 214 adult pts with solid malignant tumors who underwent ICI, either as monotherapy or in combination with other chemotherapeutic agents, at the SBIH Moscow Clinical Scientific and Practical Center named after A.S. Loginov of DHM. Results: Between June 2016 and January 2023, 214 pts were included in the study (46.3% female, 53.7% male). The median age was 62.6 years (range 32–91). At the data cut-off (1 February 2024) the median overall survival (OS) for the analyzed population was 34,5 months (95%CI 21,15-43,91). No significant difference in median OS was observed between pts with overall endocrine irAEs and those exhibiting specific manifestations, such as hypocortisolism and destructive diabetes mellitus. However, thyroid irAEs were associated with improved median OS: 27.5 months compared to 22.6 months in those without (p=0.037); RR=1.39 (95%CI 1.025-1.89; p=0.036). The grade of endocrine irAEs did not impact the survival benefit. A significant association was observed between age group and endocrine irAEs (Pearson’s χ2=9.92, p=0.019), with a left-skewed age distribution due to a higher proportion of participants aged 32–44 years among those developing endocrine irAEs. Pts with nodular goiter had a 2.91 times higher risk of developing thyroiditis (95%CI 1.03–8.25), although this did not reach statistical significance (p=0.067). Calcium channel blockers were associated with an increased risk of developing thyroid irAEs (RR=1.54, 95%CI 1.09–2.19; p=0.036). Antihistamine use was a robust predictor of hypothyroidism with a RR=1.68 (95%CI 1.05–2.7, p=0.04). Initial derived neutrophil-to-lymphocyte ratio (dNLR) ≥3 predict the development of endocrine irAEs (Pearson χ2=4.02; p=0.045) as well as dNLR>2.2 (Pearson χ2=4.22, p=0.04). Conclusions: Thyroid irAEs are correlated with improved OS. Predictors of endocrine irAEs may include young age (32-44 years), calcium channel blocker or antihistamine use, dNLR ≥3, or dNLR >2.2. Prospective trials are warranted to validate these findings.

Something to Chew on; Plate-Waste at an Ontario Veteran's Centre.

There is paucity of data assessing levels of food/beverage waste in long-term care (LTC) facilities, especially in Ontario. Observations in the Veteran's Centre (VC) at Sunnybrook Health Sciences Centre (Sunnybrook) indicated food/beverage waste may be high, potentially impacting sustainability efforts within our institution. Before proceeding with waste reduction efforts, we conducted a comprehensive 3-day waste-audit of food/beverage items provided to VC residents with the goal of understanding the extent of food/beverage waste at VC, items wasted, and any other factors that may inform future changes. Our results indicate that 28% of items served to residents were wasted. Lunch was the meal with greatest waste at 31% and waste of solid items was 12% higher than that of liquids. We observed a large variability in waste between residents and within each resident, with 15% of residents wasting >50% of items provided. This study provides a deeper insight into the magnitude of food/beverage waste in a LTC population and highlights the importance of considering individualized strategies to address waste to avoid negative impact on residents.

Experimental Study on Strength and Durability Parameters of Recycled Aggregate Concrete by Using Chemical and Mechanical Treatment

Abstract: Up to 150 million tons of construction and demolition (C&D) waste are produced annually in developing nations like India, making up 35–40% of the world's total C&D waste. According to the Centre for Science and Environment, India recycles just 1% (6500 tonnes) of its construction and demolition waste (C&D) per day. Recycled concrete aggregate is conserved by thermal and mechanical treatment of recycled coarse aggregate, while natural aggregate lessens the impact on landfills. Demolished concrete derbies are used as recycled concrete aggregate. The physical and mechanical properties of natural and recycled aggregate are studied in these experimental works by replacing natural aggregate (by weight) with 10%, 20%, 30%, and 40% recycled aggregate with M30 and M40 grade concrete. The results of compression and tensile strength are compared after 28 days.

Development of Arctic Tourism and Creative Industries as Drivers for the Transformation of Arctic Cities and Territories

Horizontal integration of regions is a process of cooperation and unification of efforts between different regions to achieve common goals and solve common problems. This process can manifest itself in various areas, including economics, science, culture, education and other areas. The goal of horizontal integration of regions based on research projects is to strengthen ties, increase the level of interaction and cooperation between different regions, which contributes to economic growth, the development of scientific and cultural exchanges, and an increase in the overall level of welfare and development. The article presents the experience of interaction between scientific teams of two universities - the Murmansk Arctic University and the Higher School of Economics National Research University - to study the influence of Arctic tourism and creative industries on the socio-economic development of the Arctic region. The results of the project have practical significance for the Murmansk region and can be scaled up to other regions of the Arctic territories of the Russian Federation, taking into account certain regional nuances.

Global Overview of the Application of the Braun-Blanquet Approach in Research

Environmental classifications are of paramount importance for assessing the impacts of land-use changes, for prioritizing conservation efforts, and for developing effective management strategies to mitigate the negative impacts of human activities. The aim of our research was to provide as complete an analysis as possible of the studies that have been carried out using the Braun-Blanquet approach. The global review of studies based on the Braun-Blanquet approach includes 1168 papers and was conducted using the PRISMA 2009 methodological recommendations, strict criteria for the selection/quality of papers, and modern methods of data analysis and visualization using VOSviewer software developed by Nees Jan van Eck and Ludo Waltman (Centre for Science and Technology Studies (CWTS) of Leiden University in the Netherlands) (version 1.6.18), which ensures a representative sample, minimization of subjective judgements, and reliability of conclusions. It was noted that the number of publications on Braun-Blanquet is growing exponentially. This is an indication of the scientific interest in this methodology and its continuous further development. Based on a detailed analysis of the keywords, the main research directions and challenges are identified. These include improving the conceptual and methodological foundations of the Braun-Blanquet approach; improvement in regional vegetation classifications, synthesizing them and producing a comprehensive classification for large areas as a basis for biodiversity conservation and sustainable land use; expansion of the geography; compilation and updating of databases of phytosociological data; management of dynamics and vegetation; discussion of the important problem of continuity and discreteness of vegetation in the context of ecological classifications; and vegetation mapping. The top 20 journals publishing the most cited articles were identified, as well as the top 20 most cited journals whose high citation rate is due to the large number of high-quality articles. The analysis of the bibliographic network of papers in dynamics has shown that the structure of relationships is not constant and has changed significantly. The analysis of the authors’ publication activity showed that the vast majority of researchers have a low publication activity and have published only one to three papers. A peculiarity also emerges: if all the most cited authors are concentrated in Eurasia, then most of the most actively published authors are outside Eurasia. The importance of the Braun-Blanquet approach for the study and classification of forest vegetation should be emphasized. In this case, the Braun-Blanquet approach is integrated into forest typologies, increasing their ecological validity and environmental relevance.

Psychotropic medications and mortality from cardiovascular disease and suicide for individuals with depression in Taiwan

BackgroundPolypharmacy for treatment of depression has been increasing in Taiwan. MethodsIndividuals having depressive disorders were identified in a national database for healthcare services and followed up for 5 years. The mean dosage of antidepressants, antipsychotics, mood stabilizers, and sedative-hypnotics was calculated; the associations between the exposure dosage to different psychotropic medications and patients’ overall death and death due to cardiovascular diseases (CVD) and suicide were examined. ResultsA total of 400,042 individuals with depressive disorders (63.8% women) were identified. Compared with those with no exposure to antidepressants, patients prescribed antidepressants had decreased mortality. Use of antipsychotics had a dose-related increase in overall mortality risk compared to no exposure group. Contrarily, depressed patients taking sedative-hypnotics had decreased overall and CVD mortality compared to no exposure group, with the most prominent decrease in CVD mortality of up to 54.9% for those in the moderate exposure group (hazard ratio: 0.451, 95% confidence interval: 0.405–0.503). A moderate or high dose of antidepressants or sedative-hypnotics was shown to be associated with a significantly increased mortality for suicide compared to those with no exposure. ConclusionsAntidepressant and sedative-hypnotic use was associated with decreased all-cause and CVD-related mortality and use of antipsychotics was associated with a dose-related increase in mortality risk. Future studies are needed to further clarify the involved mechanisms and benefits and risks should be carefully weighed when prescribing psychotropic medications in patients with depressive disorders.

RETRACTION: Comparative effectiveness of low-level laser therapy and transcutaneous electrical nerve stimulation in symptomatic Temporomandibular Disorders: A Randomised Control Trial.

Batra, S. Srivastava, A., Shivakumar, G. C., Marrapodi, M. M., Herford, A. S., Cicciù, M., Minervini, G. (2023) Comparative effectiveness of low-level laser therapy and transcutaneous electrical nerve stimulation in symptomatic Temporomandibular Disorders: A Randomised Control Trial. Journal of Oral Rehabilitation, 50: 1185-1193. https://doi.org/10.1111/joor.13555 The above article, published online on 05 July 2023 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor in Chief, Peter Svensson, and John Wiley and Sons Ltd. The retraction has been agreed following concerns raised by a third party about the ethical approval for the study described. The publisher contacted the authors, who provided a letter of ethical approval from People's College of Dental Sciences & Research Center, People's University, which did not match the ethical approval reported in the article. The authors reported that the study was initiated at Banaras Hindu University, but were not able to provide evidence of ethical approval from this institution. In addition, the authors did not provide an explanation for why the clinical trial was registered with Clinical Trial Registry-India retrospectively, which violates the journal's author guidelines that require authors to provide an explanation for retrospective registration of clinical trials. Following the investigation by the publisher, the journal has concluded this article did not follow the journal's requirements regarding ethical approval of clinical trials and registration of clinical trials, and so the journal must issue a retraction. Shivakumar, G. C. has stated that Marrapodi, M. M., Herford, A. S., Cicciù, M., and Minervini, G. were not involved in the investigation, data curation, conceptualization, methodology, or formal analysis of the clinical study. The authors disagree with this retraction.

Sociotechnical imaginaries in academic medicine strategic planning: a document analysis.

Purpose Along with other industries, healthcare is becoming increasingly digitized. Our study explores how the field of academic medicine is preparing for this digital future. Method Active strategic plans available in English were collected from faculties of medicine in Canada (n = 14), departments in medical schools (n = 17), academic health science centres (n = 23) and associated research institutes (n = 5). In total, 59 strategic plans were subjected to a practice-oriented form of document analysis, informed by the concept of sociotechnical imaginaries. Results On the one hand, digital health is discursively treated as a continuation of the academic medicine vision, with expansions of physician competencies and of research institutes contributions. These imaginaries do not necessarily disrupt the field of academic medicine as currently configured. On the other hand, there is a vision of digital health pursuing a robust sociotechnical future with transformative implications for how care is conducted, what forms of knowledge are prioritized, how patients and patienthood will be understood, and how data work will be distributed. This imaginary may destabilize existing distributions of knowledge and power. Conclusions Looking through the lens of sociotechnical imaginaries, this study illuminates strategic plans as framing desirable futures, directing attention towards specific ways of understanding problems of healthcare, and mobilizing the resources to knit together social and technical systems in ways that bring these visions to fruition. There are bound to be tensions as these sociotechnical imaginaries are translated into material realities. Many of those tensions and their attempted resolutions will have direct implications for the expectations of health professional graduates, the nature of clinical learning environments, and future relationships with patients. Sociology of digital health and science and technology studies can provide useful insights to guide leaders in academic medicine shaping these digital futures.

P.094 Incidence of pathologically confirmed primary malignant brain tumours in Newfoundland and Labrador: an eight-year review spanning 2015-2022

Background: Considering regional and temporal trends, we sought to explore the incidence of primary malignant brain tumours in Newfoundland and Labrador. Methods: We reviewed all primary, malignant brain tumour cases from 2015-2022 confirmed by St. John’s Health Sciences Centre pathology reports. Incidence rates were standardized using the 2011 Canadian standard population. Results: We included 362 cases. The average annual age-standardized incidence rate of primary, malignant brain tumours per 100,000 was 7.0 (95% CI: 6.3-7.7), lower than the national average (7.93; 95% CI: 7.78-8.08). The incidence of glioblastoma (5.1; 95% CI: 4.5-5.7) was significantly higher than the national average (4.05; 95% CI: 3.95-4.16). Temporal trends revealed that oligodendroglioma incidence spiked from 0.5 (95% CI: 0.2-0.7) in 2015-2019 to 1.5 (95% CI: 0.4-2.6) in 2020 before returning to baseline in 2022. Regional trends indicated a lower incidence of malignant tumours in Labrador-Grenfell (5.1; 95% CI: 2.5-7.6), compared to 6.9 (95% CI: 6.2-7.6) averaged elsewhere. Conclusions: Higher rates of glioblastoma in Newfoundland and Labrador could have a genetic or multi-factorial cause. The increased occurrence of oligodendroglioma during the COVID-19 pandemic necessitates broader investigation, potentially linked to delays in patient care during this period. Regional trends could suggest less access to care in rural populations and underestimated incidence.

P.092 Incidence of tissue-sampled brain metastases pre- and post-COVID-19 in Newfoundland and Labrador: an eight-year review

Background: Brain metastases indicate an advanced tumour stage for many cancers. We sought to investigate the incidence change of tissue-sampled brain metastases and its relation to staging challenges during the COVID-19 pandemic in Newfoundland and Labrador. Methods: We reviewed all brain metastasis cases from 2015-2022 requiring first-time tissue sampling according to pathology reports from the St. John’s Health Sciences Centre. Incidence rates were calculated using yearly population data by regional health authorities and standardized using the 2011 Canadian standard population. Results: We included 173 cases. The average annual age-standardized incidence rate of brain metastases requiring tissue sampling per 100,000 increased from 2.5 (95% CI: 2.0-3.1) pre-COVID-19 to 4.1 (95% CI: 3.3-5.0) post-COVID-19. Brain metastases from lung primaries accounted for 69% of this increase. While incidence declined to near-baseline in the Eastern provincial population by 2022 (3.3; 95% CI: 1.5-5.1), incidence rose into 2022 in the Western population (8.6; 95% CI: 3.9-13.2). Conclusions: These data suggest a delayed presentation of malignancies during the COVID-19 pandemic and underscore the importance of prioritized staging during times of strain on healthcare systems. Regional, temporal trends suggest regions distant from tertiary care centres could face challenges in resolving cases with delayed presentation post-COVID-19.

Bridging the gap in precision medicine: TranSYS training programme for next-generation scientists

IntroductionIn the evolving healthcare landscape, precision medicine's rise necessitates adaptable doctoral training. The European Union has recognized this and promotes the development of international, training-focused programmes called Innovative Training Networks (ITNs). In this article, we introduce TranSYS, an ITN focused on educating the next generation of precision medicine researchers. In an ambition to go beyond describing the consortium goals, our article explores two key aspects of ITNs: the training and collaboration.MethodsUsing self-report questionnaires, we evaluate the scientific, professional, and personal growth of ESRs over the duration of the ITN and investigate whether this can be linked to network activities.ResultsOur quantitative analysis approach reveals substantial improvements in scientific, professional, and social skills among young researchers facilitated by the engagement in this interdisciplinary network. We provide case studies underlining the advantages of collaborative environments, featuring innovative scientific exchange within TranSYS.DiscussionWhile challenging, ITNs foster positive growth in young researchers, yet exhibit weaknesses such as balancing stakeholder interests and partner commitment. We believe this study may benefit a variety of stakeholders, from prospective ITN creators to industry partners, to design better sustainable training networks going forward.

Catalysing virtual collaboration: The experience of the remote TIES working groups

AbstractDuring the COVID‐19 pandemic, the idea of collaboration and scientific exchange between members of the scientific community was enhanced by technology. Virtual meetings and work platforms have become common resources to continue generating research, partially replacing instances of joint in‐person work before, during or after a conference. The idea of teleworking played a fundamental role in remote collaboration groups within The International Statistical Society (TIES), a community of interdisciplinary scientists such as statisticians, mathematicians, meteorologists, and biologists, among others working on quantitative methods to enhance solutions to environmental problems. In 2021 the Society launched three working groups with the aim of improving networking across the Society's members and develop creative collaboration, while advancing statistical and computational methods motivated by real‐world driven applications in environmental research. Here, we provide insights from this virtual collaborative initiative.

#1440 Analysis of risk factors for the development of coronary events in patients with chronic kidney disease stage 5

Abstract Background and Aims To analyze the number and presence of certain risk factors for the development of coronary events in patients with chronic kidney disease receiving program hemodialysis. Method To achieve this goal, we first conducted an information search in electronic databases of articles: in English - in PubMed, the search depth was from 2010 to 2020, after which we selected the most common risk factors for the development of coronary events in the conditions of Uzbekistan (Table 1). The study and recruitment of patients took place in the department of nephrology and hemodialysis of the Republican Specialized Scientific and Practical Medical Center for Nephrology and Kidney Transplantation in 2023. The study involved 73 (42.95%) men and 97 (57.05%) women; the average age of the patients was 54.00 ± 13.72 years. The main causes of chronic renal failure in the structure of the overall morbidity of the prospective study were: diabetic nephropathy - 41% (69), chronic glomerulonephritis - 40% (68), chronic pyelonephritis - 12.9% (22). Results All 170 patients were assessed for risk factors for the development of coronary events according to Table 1. Based on the current literature, we selected 30 risk factors for the development of coronary events. The most common risk factors for the development of coronary events were, that is, 2/3: albumin, body mass index, calcium, cardiovascular diseases, clinical and ambulatory blood pressure, chronic heart failure, diastolic blood pressure, hemoglobin, left ventricular hypertrophy, mean arterial pressure, systolic blood pressure, diuretic (urea), years with hypertension. The least significant risk factors for the development of coronary events were, that is, 1/3: diabetes, diabetic nephropathy, dyslipidemia, coronary heart disease, left ventricular end-diastolic volume, metabolic syndrome, parathyroid hormone, peripheral vascular disease, phosphorus, potassium, pulse pressure, sodium (in plasma), sodium-potassium ratio, smoking, total cholesterol. Conclusion In 2/3 of the studied patients of the main group, the presence of 15 risk factors for the development of coronary events was noted, in 1/3 of the patients, 21 risk factors for the development of coronary events were identified. The above risk factors together increase the incidence of coronary events in patients with stage 5 CKD several times. Coronary events are the leading causes of death in all groups. The most common were: acute left ventricular failure and sudden cardiac death. And predictors of the risk factor for death for coronary events include: blood albumin levels, BMI, blood hemoglobin, LVH, SBP, DAS, CHF, blood calcium, years since hypertension.

#503 The influence of the degree of liver cell failure on the functional state of the kidneys in patients with liver cirrhosis

Abstract Background and Aims Studying the influence of the severity of liver cirrhosis on the functional ability of the kidneys in patients without concomitant diseases (without diabetes mellitus and hypertension). Method The study included 38 patients with liver cirrhosis who were treated in the gastroenterology department of the Republican Scientific and Practical Center for Therapy and Medical Rehabilitation in Tashkent. The average age of patients was 54 ± 3.4 (from 33 to 65). The examined patients were divided into two groups, depending on the degree of hepatic cellular failure (according to the Child-Pugh classification) and the development of ascitic syndrome. In group 1 Liver cirrhosis without ascites (P-P class A) the number of patients was 20. In group 2 Liver cirrhosis with ascites (P-P class B) the number of patients was 18. When examining patients, we used: Clinical blood test; blood chemistry; determination of electrolytes, creatinine; general urine analysis; glomerular filtration level; Functional renal reserve (defined as the increase in glomerular filtration expressed as a percentage after the administration of Dopamine at a dose of 2-3 μg/kg/min. To assess portal hypertension, all patients underwent ultrasound examination of the organs abdominal cavity and duplex scanning of portal system vessels. Results The examined patients were analyzed for the functional state of the kidneys and its relationship with the main parameters of portal hypertension and hepatic cell failure. Comparative characteristics of the main indicators of renal function significant differences in functional parameters were revealed depending on degree of hepatic cell failure. In the group of patients with cirrhosis with ascites, there was a significant decrease in renal GFR to 77.5 ± 1.4 ml/min, in contrast to the unchanged level of GFR in the group of patients with cirrhosis without ascites—99.3 ml/min. In patients with cirrhosis without ascites, the glomerular filtration rate increases by against the background of dopamine administration was 13.5 ± 4.7% (which corresponds to the norm), in contrast to patients in the second group, where the average Renal Functional Reserve was 8.4 ± 2.8%. Changes in renal function were also characterized by a decrease in Fractional Excretion of Sodium (FENa). The reduction in FENa in the group of patients with persistent ascites. During a detailed assessment of the RFR in patients of the first group, the RFR was below normal only in 2.6 ± 2.5%, while in the second group the number of patients with the decrease in the RFR was 69.7 ± 8.1%. Study of functional renal reserve in a group of patients with cirrhosis with ascites revealed unchanged this indicator in only 10 (30.3 ± 8%). U 19 (57.5 ± 8.6%) of patients in this group, the RFR was less than 10%, and in 12.2 ± 5.7% cases of RFR was below 5%, which indicated pronounced intraglomerular hypertension and the risk of developing resistant ascites. Conclusion The present study indicates that Renal Functional Reserve (RFR) in patients with liver cirrhosis reflects the speed of effective renal plasma flow. A decrease in FPR in Child-Pugh class A liver cirrhosis was detected in 2.6% of cases, with hepatic cell failure, Child-Pugh class B in 69.7%.

Health literacy of patients eligible for cochlear implants

Background Hearing loss is known to be an independent risk factor for inadequate health literacy. The objective of this study was to assess the level of health literacy among patients undergoing cochlear implantation to determine areas for improvement in delivery of patient information. Methods A cross-sectional survey was conducted at the otology-neurotology clinic at Sunnybrook Health Sciences Centre. Patients eligible for cochlear implantation completed two health literacy screening tools: The Short Test of Functional Health Literacy in Adults (S-TOFHLA) and Brief Health Literacy Screen (BHLS). Results Thirty seven patients were included (41% female, 59% male, mean age: 55 years). Most patients had adequate health literacy through BHLS (76%) and S-TOFHLA (98%) scoring. Over 80% of patients were not able to correctly recount all the operative risks associated with cochlear implant surgery and one third of patients did not correctly recount any risks associated with a cochlear implant surgery. Female sex was associated with higher scores (p=0.03) and low income (<$35,000) was associated with lower scores (p=0.05). Conclusion Patients eligible for cochlear implants have adequate health literacy, but most are not able to recount operative risks. Educational tools are required to improve patient retention, understand, and perioperative health information delivery.