Chronic Pathologies Research Articles

English

Introduction: Addressing the health problems of prison inmates is a major challenge for public administrations, which are responsible for guaranteeing the necessary services to deal with them. It is therefore essential to know which are the chronic pathologies that affect them most frequently, what impact they have on the oral cavity and what type of treatments are required. The aim of this study is to shed further light on these questions. Material and method: Articles in PubMed on chronic and oral pathologies and treatment needs were reviewed. Results: The most prevalent chronic pathologies are heart disease, chronic respiratory disease, diabetes and cancer. Anxiety and depression are also highly prevalent among the prison population, along with the consumption of tobacco, alcohol and drugs of abuse. They are responsible for the appearance of caries and periodontal diseases, the treatment of which should be carried out in the prison environment. Conclusions: The level of dental care among the prison population is very low. Therefore, it is necessary to implement preventive and therapeutic measures among inmates to improve their oral health and, consequently, their general health.

Pathogenetic relationship of microbiome and metabolic disorders on the background of hypertension and gout: Potential targets of pharmacotherapy

Cardiometabolic diseases are one of the urgent problems of modern medicine. Currently, much attention is being paid to the study of the common pathogenesis of diabetes mellitus, gout and hypertension. One of the pharmacological targets is the correction of the intestinal microbiome and dysbiosis, as an integral link in the development of systemic inflammation and endotoxinemia, leading to the development of these pathologies. The article presents the results of scientific research devoted to the study of the effect of the intestinal microbiome on the development of cardiometabolic diseases. The main goal of the research is to find a rational pharmacological therapy of intestinal dysbiosis for the treatment of comorbid patients. It has been proved that, together with standard drug therapy, taking into account the pathogenetic features of the development of cardiometabolic diseases, it is advisable to use drugs that affect the intestinal microbiome. The main classical approach is the use of probiotic drugs containing live bacteria. The use of probiotics in combination with probiotic drugs to support the growth of intestinal normoflora has become a promising direction. However, this approach requires a long period of correction of the microflora, which prompted the idea of using postbiotics – signaling molecules – products of the vital activity of the microflora for a more targeted and rapid effect on pathological processes, both in the intestine and on the organ system as a whole. This approach promotes the beginning of the development of synbiotics, a complex of microorganisms, growth factors and metabolites that made it possible to more effectively influence on dysbiotic processes in various pathologies, including dyslipidemia and cardiovascular diseases. Correction of intestinal barrier permeability disorders will help prevent the development of systemic complications associated with chronic pathologies. The article also presents the author’s scheme of the pathogenesis of cardiometabolic diseases, based on the study of current scientific research.

Paracetamol and ibuprofen fixed-dose combination for the management of acute mild-to-moderate pain in children: strengthening and enhancing of result of Nominal Group Technique through Delphi consensus

BackgroundParacetamol and ibuprofen are the most commonly used drugs for pain treatment in children and their combination has shown improved analgesic effect compared to treatment with either drug alone. Current literature lacks specific guidelines regarding the settings in which this combination should be adopted.MethodsThe survey, conducted with Delphi methodology, involved 75 hospital and outpatient pediatricians with clinical experience in the management of pain in children. Pediatricians involved were asked to validate or not the results of the previous NominalGroup Tecnique (NGT) consensus and thus specify the optimal clinical settings in which the paracetamol/ibuprofen fixed-dose combination could be adopted.ResultsThe results confirm the importance of the fixed-dose paracetamol and ibuprofen combination for the control of mild-to-moderate acute pain in children. Particularly, this association seems to be appropriate in case of headache, earache, odontalgia and musculoskeletal pain, and in specific settings such as post-operative and post-procedural pain. The broadening of the panel brought to slight variations in clinical management practices between hospital and outpatient specialists. Nonetheless, overall consensus supports the notion that the fixed dose combination is more efficacious than monotherapies and it is well tolerated. Moreover, experts unanimously agree on the usefulness of the combination for caregivers, leading to improved adherence and effectiveness.ConclusionsBoth the NGT consensus and the broader Delphi consensus confirm the usefulness of the paracetamol-ibuprofen fixed-dose combination in pediatric pain. This is attributed to its superior effectiveness compared to monotherapies, a good tolerability profile, and improved compliance and ease of use. Some pain settings related to chronic, inflammatory and rheumatological pathologies remain to be investigated to evaluate the use of this combination.

The New Healthcare: AI-Driven Population Stratification, Proactive Medicine, and Predictive Analysis

Abstract Background The Covid-19 pandemic has highlighted structural and functional weakness of local health services. Italy carried out its reorganization with DM 77/2022, financed by Mission 6 PNRR of the CE. The model adopted aims to move from a reactive to proactive medicine, to be implemented close to the places where citizens live. The priority objective is to know data on the progress of chronic pathologies and non self-sufficiency using advanced digitalization tools. Methods 14 types of administrative data from 2022 to 2023, concerning 180000 (ISTAT data) people in the Lecce Social Health District (DSS Lecce), were analyzed with AI (Chat GPT). Results Thanks to algorithms, 6 categories of clinical complexity were identified. The analysis showed that the population assisted is 198696, for temporary presences, with the most represented age group being 50-55 years. Births decreased by 36% in 10 years (from 1681 to 1076), with 2197 deaths in 2023. 42,38% of the population (average age 38,58 years) did not use healthcare resources, while 57,62% (average age 54,19 years) required them. 48646 patients have cardiovascular disease, but only 10% with heart failure were actively monitored. 25047 have metabolic disease, 11195 are diabetics, 5929 have chronic respiratory diseases, 8167 chronic neurological diseases and 907 are cancer patients. Increasing age leads to polymorbidity and show signs of social, economic and health fragility. Conclusions the strategic objective of the Lecce DSS was management of chronicity according to specific care pathways, PDTA. Create healthcare teams capable of being case managers depending on the level of complexity (family doctors, nurses, etc). With the 2024 data there will be 3 consecutive years of analysis which will allow the development of predictive systems to identify population clusters at risk of increasing complexity and in need of proactive medical interventions, use of telemedicine with the support of a Territorial Operations Center. Key messages • AI-driven stratification supports personalized health plans to improve healthcare delivery, patient outcomes, and optimize resource allocation. • A new model of Population Health Management supported by Artificial Intelligence.

Inflammation: The Beauty or the Beast? Vitamins, Nutritional Supplements, Antioxidant Therapy, and Modulators of Inflammation as Therapeutic Interventions

The importance of inflammation in disease development is now well known not only for acute states but also for chronic pathologies [...]

Gingival inflammation and leukocyte-endothelium cell interactions in women with polycystic ovary syndrome.

Given the link between chronic inflammation and periodontal pathologies and increased cardiovascular risk, this study aims to investigate if gingivitis exacerbates the inflammatory response and subclinical atherosclerotic markers in women with polycystic ovary syndrome (PCOS). For this case-control study, women were assigned to three groups: two PCOS groups (with and without gingivitis) and a control group. Anthropometric and biochemical variables were determined, along with periodontal parameters (probing pocket depth [PPD], clinical attachment level [CAL], bleeding on probing [BOP], plaque index, calculus index, and tooth loss), systemic and neutrophil inflammatory markers (tumor necrosis factor alpha [TNFα], C-reactive protein [CRP], and c-Jun N-terminal kinase [JNK]), systemic oxidative stress mediators (myeloperoxidase [MPO] and glutathione), soluble cellular adhesion molecules, and neutrophil-endothelium cell interactions (rolling flux, velocity, and adhesion). Of 104 women recruited, 68 had PCOS, 24 of whom presented gingivitis, and 36 were controls. PCOS patients presented altered sexual hormone, lipid, and carbohydrate profiles. Levels of systemic inflammatory markers, MPO, and soluble platelet selectin (sP-selectin) were higher, and glutathione levels were lower in PCOS patients. BOP, plaque, and calculus index values were higher in PCOS patients with gingivitis. Neutrophils from PCOS patients showed increased JNK and decreased adhesion under flow conditions, with reduced rolling velocity and increased rolling flux and cellular adhesion, all of which were more pronounced in those with gingivitis. BOP was independently associated with rolling velocity, rolling flux, and cellular adhesion. Neutrophils of PCOS patients with gingivitis exhibit hyperactivity, promoting interaction with the endothelium and potentially contributing to atherosclerotic disease. Currently, there is a high prevalence of diseases that affect tooth-supporting tissues (periodontal diseases) and negatively influence the oral health and quality of life of the adult population. These pathologies lead to movement of the teeth and impairment of chewing function, eventually resulting in the loss of teeth. In recent years, the concept of periodontal medicine has arisen and consists of studying how periodontal diseases can influence our general inflammatory system and how systemic inflammatory pathologies can affect our oral health. In the present study, we evaluate a group of women with polycystic ovary syndrome (PCOS), a condition characterized by alterations of sex hormones and lipid profile and weight gain (body mass index). Our results show a high prevalence of gum inflammation among women with PCOS, which affects the interaction of their leukocytes and endothelial cells. The leukocytes of these women are hyper-responsive, presenting greater endothelial adhesion, lower flow velocity and enhanced rolling compared to those in a PCOS group without gum inflammation or controls. This study has generated a new line of research to analyze how neutrophils from patients with gingivitis exhibit hyperactivity, which promotes their interaction with the endothelium, thus contributing to the development of atherosclerotic disease.

Signature Proteins in Small Extracellular Vesicles of Granulocytes and CD4+ T-Cell Subpopulations Identified by Comparative Proteomic Analysis.

Several studies have described the proteomic profile of different immune cell types, but only a few have also analysed the content of their delivered small extracellular vesicles (sEVs). The aim of the present study was to compare the protein signature of sEVs delivered from granulocytes (i.e., neutrophils and eosinophils) and CD4+ T cells (i.e., TH1, TH2, and TH17) to identify potential biomarkers of the inflammatory profile in chronic inflammatory diseases. Qualitative (DDA) and quantitative (DIA-SWATH) analyses of in vitro-produced sEVs revealed proteome variations depending on the cell source. The main differences were found between granulocyte- and TH cell-derived sEVs, with a higher abundance of antimicrobial proteins (e.g., LCN2, LTF, MPO) in granulocyte-derived sEVs and an enrichment of ribosomal proteins (RPL and RPS proteins) in TH-derived sEVs. Additionally, we found differentially abundant proteins between neutrophil and eosinophil sEVs (e.g., ILF2, LTF, LCN2) and between sEVs from different TH subsets (e.g., ISG15, ITGA4, ITGB2, or NAMPT). A "proof-of-concept" assay was also performed, with TH2 biomarkers ITGA4 and ITGB2 displaying a differential abundance in sEVs from T2high and T2low asthma patients. Thus, our findings highlight the potential use of these sEVs as a source of biomarkers for diseases where the different immune cell subsets studied participate, particularly chronic inflammatory pathologies such as asthma or chronic obstructive pulmonary disease (COPD).

European Respiratory Society International Congress 2024: attendance of the Ukrainian delegation

ABSTRACT. From September 7 to 14, 2024, the Congress of the European Respiratory Society was held in Vienna (Austria) and for the third time it was organized in hybrid format. This event attracts participants from more than 160 countries from all continents and provides a scientific forum with a broad multidisciplinary program. Every year, the Ukrainian delegation takes part in the congress, where it highlights the results of the investigations of Ukrainian scientists and doctors. In 2024, 48 abstracts of reviews from Ukraine were selected for the congress. The structure of their topics reflected the current problems of national health care. The largest number of works (16) were devoted to chronic obstructive pulmonary disease and bronchial asthma, the most common conditions among chronic pathologies of the respiratory system. The next important topic of the Ukrainian delegation was tuberculosis (9 reports), as an epidemic of this disease has been registered in Ukraine since 1995 and continue now. The third important group of questions (8 presentations) related to today’s global problem – the consequences of the COVID-19 pandemic. Two oral presentations of the Ukrainian researchers on the topic of artificial intelligence and digital technologies were associated to the main theme of the congress “Humans and machines: getting the balance right”.

The nurse consultant in remote medical monitoring: an innovative, patient-centered approach

Telemedical monitoring of heart failure patients is revolutionizing the traditional approach to care, thanks to the crucial role played by nurse consultants. Based on two years' experience in a telemonitoring unit, where the practice model is outside the conventional nursing context, we aim to highlight this innovative method, which is helping to improve the care and benefits of patients with chronic pathologies. This patient-centered approach offers holistic, individualized care through personalized remote monitoring, fostering a relationship of trust and encouraging patient autonomy.

Treatment adherence and wellness, nutrition, and physicalactivity outcomes of diabetic patients with comorbiddepression during the 18-month follow-up of the TELE-DD study.

A good adherence to pharmacological treatment in chronic pathologies such as type 2 diabetes and clinical depression is essential to improve illness prognosis. The main goal of the TELE-DD study was to analyze the effectiveness of a telephone, psychoeducational, and individualized intervention carried out by nurses in patients with type 2 diabetes mellitus and comorbid clinical depression with prior nonadherence to pharmacological treatment. In this paper, we describe and analyze secondary outcomes of the trial intervention. A prospective cohort study was used to assess the effectiveness of a telephonic intervention (IG) in n = 191 participants with a similar control group (CG). Adherence to pharmacological treatment was assessed using the patient's self-perceived adherence questionnaire. In addition to clinical (HbAc1, HDL, LDL), physical (body mass index, blood pressure) and psychological measures (Patient Health Questionnaire-9 affective state), and psychosocial distress due to Diabetes Distress Scale Questionnaire at 3, 6, 12, and 18 months of follow-up were also analyzed. The proportion of "Total Adherents" in the IG was higher throughout the study. This was particularly true at month 18 of the intervention. Self-perceived adherence rates increased by 27.1% in the IG and by 1.1% in the CG. Results of clinical and physical measures were higher in the IG than in the CG at month 18 of the intervention. The interview based on positive reinforcement as well as individualized attention and flexibility in making telephone calls and dissemination of the intervention in the media closest to the patients were key to achieving good participation and collaboration as well as continuity in adherence to treatment and self-care.

Correlation Between Intraoperative Near-infrared Spectroscopy Values and Neurologic Outcomes in Patients Undergoing Total Aortic Arch Replacement Using the Frozen Elephant Trunk Technique

ObjectiveTo correlate intraoperative near-infrared-spectroscopy (NIRS) values to neurologic outcome in patients undergoing total aortic arch replacement using the frozen elephant trunk (FET) technique. DesignRetrospective, single centre registry study using a two-way repeated measures ANOVA. SettingBetween 11/2013 and 12/2023, 427 patients were treated for acute and chronic aortic pathologies using FET procedure. ParticipantsOne-hundred sixty-six patients who had complete NIRS data at all predefined timepoints were included and retrospectively divided into two groups: patients with stroke diagnosed by experienced radiologists and clinicians and patients without stroke after FET. MeasurementsBilateral NIRS values were recorded continuously and at seven critical timepoints in each patient a correlation was made between left- and right-sided NIRS values and stroke. Main Results23 patients (13.9%) were diagnosed with a stroke. There was a significantly higher in-hospital mortality in patients with stroke (21.7%) compared to patients without stroke (7.7%) (p = 0.037). Left sided regional cerebral oxygenation (rSO2) did not show any significant difference in patients with stroke versus patients without stroke (p = 0.550). There were differences detected in right sided rSO2 trends (p < 0.001) and the inter-hemisphere NIRS at the specified timepoints (p = 0.009). The interaction Time x Stroke, however, did not show any significant results in all our analyses (p > 0.05). ConclusionNIRS is a reliable tool to monitor intraoperative frontal lobe cerebral oxygen saturation. However, its use to predict postoperative stroke remains limited. Further refinements are needed to develop the technique to a prediction tool.

Multi-modal transcriptomic analysis reveals metabolic dysregulation and immune responses in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD), a progressive inflammatory condition of the airways, emerges from the complex interplay between genetic predisposition and environmental factors. Notably, its incidence is on the rise, particularly among the elderly demographic. Current research increasingly highlights cellular senescence as a key driver in chronic lung pathologies. Despite this, the detailed mechanisms linking COPD with senescent genomic alterations remain elusive. To address this gap, there is a pressing need for comprehensive bioinformatics methodologies that can elucidate the molecular intricacies of this link. This approach is crucial for advancing our understanding of COPD and its association with cellular aging processes. Utilizing a spectrum of advanced bioinformatics techniques, this research delved into the potential mechanisms linking COPD with aging-related genes, identifying four key genes (EP300, MTOR, NFE2L1, TXN) through machine learning and weighted gene co-expression network analysis (WGCNA) analyses. Subsequently, a precise diagnostic model leveraging an artificial neural network was developed. The study further employed single-cell analysis and molecular docking to investigate senescence-related cell types in COPD tissues, particularly focusing on the interactions between COPD and NFE2L1, thereby enhancing the understanding of COPD's molecular underpinnings. Leveraging artificial neural networks, we developed a robust classification model centered on four genes—EP300, MTOR, NFE2L1, TXN—exhibiting significant predictive capability for COPD and offering novel avenues for its early diagnosis. Furthermore, employing various single-cell analysis techniques, the study intricately unraveled the characteristics of senescence-related cell types in COPD tissues, enriching our understanding of the disease's cellular landscape. This research anticipates offering novel biomarkers and therapeutic targets for early COPD intervention, potentially alleviating the disease's impact on individuals and healthcare systems, and contributing to a reduction in global COPD-related mortality. These findings carry significant clinical and public health ramifications, bolstering the foundation for future research and clinical strategies in managing and understanding COPD.

Mortality from Acute and Chronic Diseases of the Circulatory System in the Period before and after the COVID-19 Pandemic in Moscow

Sudden death from acute forms of cardiovascular diseases, especially in working age, when it is physiologically clearly premature, is evidence of diseases not detected in time: the main task of cardiologists is to avoid the transition of chronic pathologies into an acute form, in which the condition can worsen at lightning speed. Acute and chronic forms of cardiovascular diseases require different clinical approaches. Thus, the division of pathologies into two blocks– acute and chronic conditions– has, in addition to academic, purely practical significance. In this context, the specifics of the metropolis, with its developed medical structure, both emergency and hospital, and outpatient, are extremely interesting. The present study is devoted to identifying differences in the dynamics of acute and chronic forms of circulatory diseases during stable and crisis periods in a metropolis. It demonstrated that the contribution of acute conditions to both mortality from coronary heart disease and CVB, as well as losses from diseases of the circulatory system in general, decreased significantly in the population of Moscow during the study period, which certainly indicates positive changes in mortality. Similar processes were observed in Russia, but in Moscow the proportion of acute conditions was lower than the national one.

Thrombospondins: Conserved mediators and modulators of metazoan extracellular matrix.

This review provides a personal overview of significant scientific developments in the thrombospondin field during the course of my career. Thrombospondins are multidomain, multimeric, calcium-binding extracellular glycoproteins with context-specific roles in tissue organisation. They act at cell surfaces and within ECM to regulate cell phenotype and signalling, differentiation and assembly of collagenous ECM, along with tissue-specific roles in cartilage, angiogenesis and synaptic function. More recently, intracellular, homeostatic roles have also been identified. Resolution of structures for the major domains of mammalian thrombospondins has facilitated major advances in understanding thrombospondin biology from molecule to tissue; for example, in illuminating molecular consequences of disease-causing coding mutations in human pseudoachrondroplasia. Although principally studied in vertebrates, thrombospondins are amongst the most ancient of animal ECM proteins, with many invertebrates encoding a single thrombospondin and the thrombospondin gene family of vertebrates originating through gene duplications. Moreover, thrombospondins form one branch of a thrombospondin superfamily that debuted at the origin of metazoans. The super-family includes additional sub-groups, present only in invertebrates, that differ in N-terminal domain organisation, share the distinctive TSP C-terminal region domain architecture and, to the limited extent studied to date, apparently contribute to tissue development and organisation. Finally, major lines of translational research are discussed, related to fibrosis; TSP1, TSP2 and inhibition of angiogenesis; and the alleviation of chronic cartilage tissue pathologies in pseudoachrondroplasia.

Microglial morphological/inflammatory phenotypes and endocannabinoid signaling in a preclinical model of periodontitis and depression

BackgroundDepression is a chronic psychiatric disease of multifactorial etiology, and its pathophysiology is not fully understood. Stress and other chronic inflammatory pathologies are shared risk factors for psychiatric diseases, and comorbidities are features of major depression. Epidemiological evidence suggests that periodontitis, as a source of low-grade chronic systemic inflammation, may be associated with depression, but the underlying mechanisms are not well understood.MethodsPeriodontitis (P) was induced in Wistar: Han rats through oral gavage with the pathogenic bacteria Porphyromonas gingivalis and Fusobacterium nucleatum for 12 weeks, followed by 3 weeks of chronic mild stress (CMS) to induce depressive-like behavior. The following four groups were established (n = 12 rats/group): periodontitis and CMS (P + CMS+), periodontitis without CMS, CMS without periodontitis, and control. The morphology and inflammatory phenotype of microglia in the frontal cortex (FC) were studied using immunofluorescence and bioinformatics tools. The endocannabinoid (EC) signaling and proteins related to synaptic plasticity were analyzed in FC samples using biochemical and immunohistochemical techniques.ResultsUltrastructural and fractal analyses of FC revealed a significant increase in the complexity and heterogeneity of Iba1 + parenchymal microglia in the combined experimental model (P + CMS+) and increased expression of the proinflammatory marker inducible nitric oxide synthase (iNOS), while there were no changes in the expression of cannabinoid receptor 2 (CB2). In the FC protein extracts of the P + CMS + animals, there was a decrease in the levels of the EC metabolic enzymes N-acyl phosphatidylethanolamine-specific phospholipase D (NAPE-PLD), diacylglycerol lipase (DAGL), and monoacylglycerol lipase (MAGL) compared to those in the controls, which extended to protein expression in neurons and in FC extracts of cannabinoid receptor 1 (CB1) and to the intracellular signaling molecules phosphatidylinositol-3-kinase (PI3K), protein kinase B (Akt) and extracellular signal-regulated kinase 1/2 (ERK1/2). The protein levels of brain-derived neurotrophic factor (BDNF) and synaptophysin were also lower in P + CMS + animals than in controls.ConclusionsThe combined effects on microglial morphology and inflammatory phenotype, the EC signaling, and proteins related to synaptic plasticity in P + CMS + animals may represent relevant mechanisms explaining the association between periodontitis and depression. These findings highlight potential therapeutic targets that warrant further investigation.Graphical

B cell targeting in IgA nephropathy.

The "multi-hit theory/4-hit theory" pathogenesis hypothesis is widely accepted and IgA nephropathy (IgAN) is understood to be a disease originating from Hit 1, galactose deficient IgA1 (GdIgA1). The chronic repetitive activation of the complement pathway (alternative and lectin pathways) and the subsequent inflammation results in progressive glomerular damage that spills over into increased intraglomerular pressure and other hemodynamic changes, increased urinary protein, glomerulosclerosis, and tubulointerstitial fibrosis. The basic pathophysiology of this disease is the progression of a mixture of such acute and chronic pathologies. Currently, a number of new drugs has emerged as promising agents, such as complement regulators, endothelin receptor antagonists, and SGLT2 inhibitors, which are associated with each pathological step after glomerular deposition of GdIgA1/immune complexes. On the other hand, the molecular mechanisms of GdIgA1 production are gradually being elucidated, and the development of several novel therapeutic agents targeting the responsible B cells and their international clinical trials are progressing. These agents that inhibit or control the production of the Hit1, GdIgA1, are highly expected as essential therapies for this disease. The large body of clinical and basic research findings to date strongly suggest that nephritogenic GdIgA1 is a polymeric IgA1 of mucosal origin. In addition, the B cells involved in its nephritogenic GdIgA1 production are mainly differentiated mature B cells such as plasma cells, which may migrate to the bone marrow as well as the mucosa. The innate immune system in the mucosa, especially Toll-like receptors (TLRs), is thought to be involved in their production. Among TLRs, TLT9 and TLR7, which recognize bacterial and viral unmethylated DNA and RNA, have been reported to be involved. The mucosal activation of these TLRs is associated with the production of APRIL (A Proliferation Inducing Ligand) and BAFF (B cell activating factor), which are TNF superfamily cytokines involved in B cell maturation, survival, and IgA class switching, and may also be involved in the production of nephritogenic GdIgA1. It is still inconclusive whether APRIL or BAFF is more closely involved in the production of nephritogenic GdIgA1. Phenotypes in transgenic animal models suggest BAFF involvement, however, a genome wide association study (GWAS) analysis of human IgAN has identified APRIL, not BAFF, as a candidate gene. Based on the above background, several international clinical trials are underway for drugs such as TLR regulators (hydroxychloroquine), anti-APRIL drugs, anti-BAFF drugs, APRIL/BAFF receptor (TACI) binding inhibitors, and cytoreductive drugs (proteasome inhibitors, anti-CD38 antibodies) to inhibit nephritogenic GdIgA1 production in responsible B cells. This session will provide an overview of the responsible B cells, their GdIgA1 production mechanism, and ongoing drugs.

Parcours de soins rénové, e-santé et maillage officinal : une réponse complexe à la pénurie de médecins

The number of doctors in France today is far too low to meet the growing demand for patient care. An ageing population, a growing number of chronic pathologies and inequalities in access to care across the country are just some of the issues to be considered. By optimizing the care pathway, and promoting interdisciplinarity; by integrating digital health developments, such as shared medical records, new digital tools and telehealth; and by relying on the territorial network of pharmacies, banking on the dispensing pharmacist as a local public health player, France is seeking to make its healthcare system more efficient in the regions, thereby making up for the shortage of doctors.

P158 EDUCATION AS A PARAMETER FOR MANAGEMENT IN HYPERTENSION

Objective: Despite advancements, hypertension and its associated factors remain the leading cause of global death with concerning increases. This study aimed to estimate whether the impact of mass education in adults and subsequently in adolescents and children in Tunja, Boyacá, Colombia S.A influenced their knowledge of these factors. Methods: Cross-sectional and prospective community study in individuals &gt; 18 years, with open invitation to various points of care collecting information with Framingham surveys, blood pressure measurement, anthropometric variables, educational level, history, associated factors, and cardiovascular diseases knowledge of causes (CDKC). Conducting four sessions: (1) December 2018, without prior educational intervention (PEI), (2) March 2019, PEI adults, (3) July 2019, PEI in adolescents and children‘s schools, (4) March 2024 long-term evaluation. PEI for adults included in-person lectures, media, and printed materials, for schools (13) lectures, printed materials, and educational video games. Results: 3,025 people were surveyed, with a mean age of 49.9 years (SD ± 14.3); men 46%. Of the total, 52% were sedentary, 47% overweight, and 8% obese, smoking 11%, alcohol consumption 31%, diabetes 7.3%, cholesterol 56.4%, hypertension 32.1%, and CDKC 37%. Comparatively among the records, hypertension: (1) 37.4%, (2) 32.1%, (3) 32.6%, (4) 26.6%. CDKC: (1) 22.1%, (2) 38.6%, (3) 43.4%, and (4) 47%, its correlation with other variables and other risk factors are part of another report. Conclusions: We highlight the positive impact of educational intervention more in schools, evidenced by the increase in knowledge from 22.1% to 43.4% (p&lt;0.001), and the decrease in hypertension from 37.4% to 32.6% (p&lt;0.001). This knowledge increased to 47% in the long-term evaluation, reflected in the lower prevalence of hypertension 26.6%. These two parameters were not as significant with education only in adults, where we usually direct our campaigns, forgetting adolescents and children as the family guiding axis to change the course not only of cardiovascular diseases but also of chronic pathologies.

Otomycosis: Epidemio-Clinical and Therapeutic Profile at the Fousseyni DAOU Hospital in Kayes, Mali

Introduction: Otomycosis is a relatively common pathology of the external ear canal, its prevalence is estimated to be 5 to 10% of all otitis externa [1,2, 3]. There are no data on otomycosis at the Kayes Hospital, hence the interest of this study. Methodology: This was a descriptive study with retrospective data collection that spanned the period from January 1, 2021 to December 31, 2023. All patients with clinically suspected otomycosis on otoscopy, otoendoscopy and/or confirmed on mycological examination and with usable medical records were included. Results: We recorded 1156 cases of otitis externa, including 384 cases of otomycosis, i.e. a frequency of 33.2%. Females were the most represented at 51.6% (n=198) with a sex ratio of 0.93. The mean age was 37 years with extremes of 7 and 77 years. The reasons for consultation were: otalgia 44.8% (n=172), pruritus 35.2% (n=135), otorrhea 20% (n=77). The main contributing factors were cleaning the ear with cotton swab, 57.8% (n=221), wearing a turban 26.3% (n=101), and using antibiotic and corticosteroid drops 9.6% (n=37). The otologic examination revealed whitish or blackish deposits, purulent otorrhea and inflammation of the external auditory canal. Mycological examination found yeasts 42.3% (n=122) and molds 57.2% (n=163). Treatment was based on topical antifungals and antibiotics in 69% (n=265) and the combination of antifungal and antihistamine in 31% (n=119). Conclusion: Otomycoses are benign, chronic infectious pathologies. Their occurrence is multifactorial. Cleaning with the cotton swab and wearing the turban were the main causes. Keywords: Otomycosis, Fousseyni DAOU Hospital in Kayes.

Anti-Inflammatory Role of the Klotho Protein and Relevance to Aging.

The α-Klotho protein (hereafter Klotho) is an obligate coreceptor for fibroblast growth factor 23 (FGF23). It is produced in the kidneys, brain and other sites. Klotho insufficiency causes hyperphosphatemia and other anomalies. Importantly, it is associated with chronic pathologies (often age-related) that have an inflammatory component. This includes atherosclerosis, diabetes and Alzheimer's disease. Its mode of action in these diseases is not well understood, but it inhibits or regulates multiple major pathways. Klotho has a membrane form and a soluble form (s-Klotho). Cytosolic Klotho is postulated but not well characterized. s-Klotho has endocrine properties that are incompletely elucidated. It binds to the FGF receptor 1c (FGFR1c) that is widely expressed (including endothelial cells). It also attaches to soluble FGF23, and FGF23/Klotho binds to FGFRs. Thus, s-Klotho might be a roaming FGF23 coreceptor, but it has other functions. Notably, Klotho (cell-bound or soluble) counteracts inflammation and appears to mitigate related aging (inflammaging). It inhibits NF-κB and the NLRP3 inflammasome. This inflammasome requires priming by NF-κB and produces active IL-1β, membrane pores and cell death (pyroptosis). In accord, Klotho countered inflammation and cell injury induced by toxins, damage-associated molecular patterns (DAMPs), cytokines, and reactive oxygen species (ROS). s-Klotho also blocks the TGF-β receptor and Wnt ligands, which lessens fibrotic disease. Low Klotho is associated with loss of muscle mass (sarcopenia), as occurs in aging and chronic diseases. s-Klotho counters the inhibitory effects of myostatin and TGF-β on muscle, reduces inflammation, and improves muscle repair following injury. The inhibition of TGF-β and other factors may also be protective in diabetic retinopathy and age-related macular degeneration (AMD). This review examines Klotho functions especially as related to inflammation and potential applications.