Clinical Hospital Center Research Articles

The COVID – 19 pandemic influence on hospitalizations for ambulatory care-sensitive condition

Abstract Aim To explore whether the COVID-19 pandemic influenced hospitalizations for ambulatory care-sensitive conditions (ACSCs) during the COVID-19 pandemic in Split-Dalmatia County, Croatia. Methods We employed a cross-sectional comparative study using two different time periods, the prepandemic (March 2019 to February 2020) and the pandemic (March 2020 to February 2021) to explore possibilities of COVID-19 pandemic influence on hospitalizations for ambulatory care-sensitive conditions (ACSCs) during the COVID-19 pandemic in Split-Dalmatia County. The research used data from the national information system on hospitalizations from the Clinical Hospital Center Split, University Hospital Split. The ACSCs was classified in the categories of vaccine preventable, chronic and acute disease. The indicators were statistically analysed. The z-score test for two population proportions is used. Results During prepandemic (March 2019 to February 2020) there were 48,289 hospitalizations, in the pandemic period (March 2020 to February 2021) there were 37,999 hospitalizations. The ACSCs hospitalizations made 6.4% in the prepandemic and 7.1% in the pandemic period. In the pandemic there was a significantly higher ACSCs hospitalizations compared to the prepandemic (z =-3.9348; p = 0.00008; p < 0), which was supported by a significant increase regarding ACSCs hospitalizations in the category of acute diseases, among women (z=-3.6614; p = 0.00026; p < 0 .05), in age groups 0-19 years (z=-4.0492; p < 0.00001; p < 0.05) and 20-64 years (z= -3.8818; p = 0 .0001; p < 0.05). Conclusions The results of the study show that the COVID-19 pandemic contributed to the total number of hospitalizations as well as the hospitalization of the ACSC. One of the reasons for these changes was certainly the changed organization of the work of the entire health system due to the COVID-19 pandemic. Key messages • The results of the study show that the COVID-19 pandemic contributed to the total number of hospitalizations as well as the hospitalization of the ACSC. • One of the reasons for these changes was certainly the changed organization of the work of the entire health system due to the COVID-19 pandemic.

Vaccination against SARS-CoV-2 of adult allergic patients – experience from the Clinical Hospital Center Rijeka

Vaccination against SARS-CoV-2 of adult allergic patients – experience from the Clinical Hospital Center Rijeka

Postpartum Blood Loss in COVID-19 Patients-Propensity Score Matched Analysis.

The aim of this study was to compare the estimated blood loss and the frequency of obstetric hemorrhage among pregnant women with and without COVID-19 infection. The study was carried out in the Department of Obstetrics and Gynecology, at the Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Poland. From 15 May 2020 to 26 April 2021, a total of 224 parturients with COVID-19 infection were admitted for labor. The control group consisted of 300 randomly recruited pre-pandemic deliveries that took place between 15 May 2019 and 26 April 2020 at the Department. The primary outcome was the presence of postpartum hemorrhage, defined as an estimated blood loss of ≥500 mL within 24 h after birth or the need to transfuse 2 or more units of packed red blood cells (pRBCs). Secondary outcomes were the difference between hemoglobin and hematocrit levels at 24 h postpartum, the number of pRBCs units transfused, and the need for transperitoneal drainage. After applying the propensity-score-matching procedure for postpartum bleeding risk factors, 325 eligible patients were included in the final analysis, divided into 203 COVID-19 positive and 122 COVID-19 negative prepandemic deliveries. SARS-CoV-2 infected patients were characterized by a longer activated partial thromboplastin time (APTT), a reduced prothrombin time (PT), and lower platelet count at initial presentation. COVID-19 deliveries were found to be associated with a higher frequency of postpartum hemorrhage, an increased estimated blood loss, the more frequent use of peritoneal drainage, and more pRBCs units transfused. During the pandemic, an increased risk of postpartum hemorrhage posed another threat to SARS-CoV-2 infected pregnant women. It is essential to be aware of this when approaching COVID-19 delivery and to implement efficient preventative methods.

Prediction of depression among patients with cardiovascular disease scheduled cardiac surgery using an AI-empowered pipeline

Abstract Introduction Several studies have demonstrated, that one in three patients with cardiovascular disease (CVD) suffers from depression, and depression increases the likelihood for cardiac morbidity and mortality in the CVD population by 2–3-fold, independently of traditional risk factors or gender. Purpose The aim of this work is to predict depression in patients with CVD. Methods The clinical study was conducted in the cardiac surgical intensive care unit of The Central Clinical Hospital, the Medical University of Lodz in Poland, among patients scheduled for elective coronary artery bypass graft surgery (CABG). 224 patients signed an informed consent form, met the inclusion criteria and were enrolled in the study. All the patients had chronic coronary syndromes. The inclusion criteria were: consecutive adult patients scheduled for CABG surgery or CABG surgery with cardiac valve repair or replacement (CVR). The study population was examined by a psychiatrist the day prior to the scheduled operation, a diagnosis of major depressive disorder (MDD) was established on the basis of DSM-5 criteria. A data curation pipeline was applied to automatically remove outliers and duplicated fields in the input dataset. An AI-empowered pipeline was developed to classify patients at higher risk for depression. Random downsampling with replacement was applied to deal with the increased class imbalance by taking into consideration two confound factors, namely the Mini Mental State Examination and Hemoglobin concentration <10mg/dl. The downsampling process was repeated K times. In each iteration, three bagging and boosting ML schemas were utilized for the classification task including the AdaBoost (adaptive boosting), Random Forests and Extreme Gradient boosting trees (XGBoost). To this end, a nested cross-validation process was applied for hyperparameter optimization and model validation, where: (i) a 3-fold cross-validation process was first applied to seek for the optimal set of hyperparameters based on the grid search approach by tuning core parameters, including the learning rate, number of estimators, and max depth, among others, and (ii) a stratified 5-fold cross-validation process was subsequently used to evaluate the performance of the best model from the previous stage by computing the classification accuracy, sensitivity, specificity, and area under the ROC curve (AUC). The performance evaluation results were averaged across the 5 folds and across the downsampling iterations. Shappley additive explanation analysis was finally applied to provide explainable risk factors for depression. Results sRAGE was significantly correlated with depression (r=0.32, p=0.038). The Random forests classifier presented the highest performance to predict depression (Accuracy: 0.71, Sensitivity: 0.71, Specificity: 0.75 and AUC: 0.74). Conclusions Depression can be predicted with 71% accuracy at patients with CVD and elevated sRAGE values. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): HORIZON2020

Loss of Expression of Antiangiogenic Protein FKBPL in Endometrioid Endometrial Carcinoma: Implications for Clinical Practice.

Background and Objectives: FK506 binding protein like (FKBPL) is a member of the immunophilin family, with anti-angiogenic effects capable of inhibiting the migration of endothelial cells and blood vessel formation. Its role as an inhibitor of tumor growth and angiogenesis has previously been shown in studies with breast and ovarian cancer. The role of FKBPL in angiogenesis, growth, and carcinogenesis of endometrioid endometrial carcinoma (EEC) is still largely unknown. The aim of this study was to examine the expression of FKBPL in EEC and benign endometrial hyperplasia (BEH) and its correlation with the expression of vascular endothelial factor-A (VEGF-A) and estrogen receptor alpha (ERα). Materials and Methods: Specimens from 89 patients with EEC and 40 patients with BEH, as well as histological, clinical, and demographic data, were obtained from the Clinical Hospital Centre Zemun, Belgrade, Serbia over a 10-year period (2010–2020). Immunohistochemical staining of the tissue was performed for FKBPL, VEGF-A, and ERα. Slides were analyzed blind by two pathologists, who measured the intensity of FKBPL and VEGF-A expression and used the Allred score to determine the level of ERα expression. Results: Immunohistochemical analysis showed moderate to high intensity of FKBPL expression in 97.5% (n = 39) of samples of BEH, and low or no expression in 93.3% (n = 83) of cases of EEC. FKBPL staining showed a high positive predictive value (98.8%) and a high negative predictive value for malignant diagnosis (86.7%). The difference in FKBPL expression between EEC and BEH was statistically significant (p < 0.001), showing a decrease in intensity and loss of expression in malignant tissues of the endometrium. FKBPL expression was positively correlated with ERα expression (intensity, percentage and high Allred score values) and negatively correlated with the expression of VEGF-A (p < 0.05 for all). Conclusions: FKBPL protein expression demonstrated a significant decrease in FKBPL in EEC in comparison to BEH tissue, with a high predictive value for malignancy. FKBPL might be emerging as a significant protein with antiangiogenic and antineoplastic effects, showing great promise for the diagnostic and therapeutic applications of its therapeutic derivatives in gynecological oncology.

Differential diagnostics of incomplete Vogt-Koyanagi-Harada syndrome (clinical case)

Introduction. According to literature sources, choroidal detachment is considered mainly as a complication of surgical treatment. At the same time, bilateral choroidal detachments in combination with retinal detachment are extremely rare. Spontaneous bilateral detachments are mentioned even less frequently. Purpose: To describe and analyze a clinical case of spontaneous bilateral subtotal detachment of choroid, to differentiate the diagnosis. Materials and methods. A 62-year-old patient was urgently hospitalized to the neurological department of Bor Central Clinical Hospital with complaints of severe headache accompanied by repeated vomiting. The computer tomography of brain, B-scanning, optical coherence tomogram were performed. There were ultrasonic results on the next day after the hospitalization: bilateral subtotal detachment of choroid, IOP = 10-11 mm Hg. Results. At the release: A slight local flat choroidal detachment was observed, OD profile of the retina was without pathology, partial detachment of the hyaloid membrane and vitreous body, OS retinal profile was a serous detachment of the neuroepithelium in the macular region. The decreased vision in both eyes was observed at the control examination two months later. The cystic macular edema of both eyes and progression cataract were diagnosed.

SARS-CoV-2 Spike and Nucleocapsid Antibody Response in Vaccinated Croatian Healthcare Workers and Infected Hospitalized Patients: A Single Center Cohort Study.

Studies assessing the dynamics and duration of antibody responses following SARS-CoV-2 infection or vaccination are an invaluable tool for vaccination schedule planning, assessment of risk groups and management of pandemics. In this study, we developed and employed ELISA assays to analyze the humoral responses to Nucleocapsid and Spike proteins in vaccinated health-care workers (HCW) and critically ill COVID-19 patients. Sera of more than 1000 HCWs and critically ill patients from the Clinical Hospital Center Rijeka were tested across a one-year period, encompassing the spread of major SARS-CoV-2 variants of concern (VOCs). We observed 97% of seroconversion in HCW cohort as well as sustained anti-Spike antibody response in vaccinees for more than 6 months. In contrast, the infection-induced anti-Nucleocapsid response was waning significantly in a six-month period. Furthermore, a substantial decrease in vaccinees’ anti-Spike antibodies binding to Spike protein of Omicron VOC was also observed. Critically ill COVID-19 patients had higher levels of anti-Spike and anti-Nucleocapsid antibodies compared to HCWs. No significant differences in anti-Spike and anti-Nucleocapsid antibody levels between the critically ill COVID-19 patients that were on non-invasive oxygen supplementation and those on invasive ventilation support were observed. However, stronger anti-Spike, but not anti-Nucleocapsid, antibody response correlated with a better disease outcome in the cohort of patients on invasive ventilation support. Altogether, our results contribute to the growing pool of data on humoral responses to SARS-CoV-2 infection and vaccination.

Presentation, diagnosis and treatment of giant cell arteritis

Objective: To present patients with giant cell arteritis (GCA) in our centre over a 10 year period in order to confirm current understanding of giant cell arteritis (GCA) and observe any possible specifities in our cohort. Patients and Methods: In this retrospective study all patients diagnosed with GCA in the Clinical Hospital Centre Rijeka from 1 Jan 2011 to 31 Dec 2021 were included. Data were collected on disease presentation and diagnostic workup at the initial exam, and treatment. Results: A total of 51 patients were included in the study, of which 72.55% patients were female, and 72.55% were over 70. Of 50 patients with available data in medical documentation, 8 (16.00%) had systemic disease (S-GCA), while the rest had cranial disease (C-GCA). Headache, considered also a pathognomonic sign, was the most common initial symptom (88.00% in whole cohort, or 97.62% if S-GCA is excluded). Of 49 patients, all had increased erthyrocyte sedimentation rate. Temporal artery biopsy was positive in 12/16 patients with C-GCA, while temporal artery ultrasound was positive in 12/16 patients. Biopsy or ultrasound was not performed in 18 patients, of which 8 were patients with S-GCA, and data were not available for one patient. No patients had both a biopsy and ultrasound performed. All patients were treated with glucocorticoids, 9.80% were also treated with methotrexate, 7.84% with toclizumab, and one with both methotrexate and azathioprine. Conclusion: These results are comparable to other centres in Croatia and at least one centre abroad.

Compliance of patients with cardiovascular diseases to optimal drug therapy

Introduction. An important principle of improving cardiovascular care is to increase the compliance of patients to optimal drug therapy. Purpose. To identify compliance in patients with cardiovascular diseases to optimal drug therapy. Materials and methods. Direct continuous questioning of patients with cardiovascular diseases (n = 1,018) was carried out using a modified Morisky D. questionnaire (1986). The survey was carried out by cardiovascular surgeons (n = 3) of the Central Clinical Hospital "Russian Railways Medicine". The degree of adherence of patients to the implementation of the recommendations of doctors at the stage of the initial interview and in 6 and 24 months was compared (p &lt; 0.05). Results. At the stage of the first consultation low compliance of patients to antihypertensive therapy (23.8%); high compliance to dual antiplatelet therapy was established in patients after endovascular arterials stenting (99%), anticoagulant therapy in patients with atrial fibrillation (86%) and hypoglycemic therapy in patients with diabetes (98%). After follow-up for six months, including the provision of endovascular and surgical care, compliance to optimal drug therapy in patients of all groups increased up to 99.9% (p &lt; 0.05). After follow-up for 24 months, the compliance degree to antihypertensive and anticoagulant therapy slightly decreased to 93.8 and 97.5%, respectively (p &gt; 0.05). Limitations. To assess compliance to the recommendations of doctors, the results of outpatient follow-up of one thousand eighteen patients with cardiovascular diseases over two years were analyzed, which is a sufficient reference sample. Conclusion. Compared with the initial consultation of patients, their compliance to optimal drug therapy increased during the 12 months of follow-up. Clinical management in the treatment-and-prophylactic process optimizes control over the effectiveness of the implementation of medical prescriptions, including self-control by patients of hemodynamic and other indicators. The formation of trusting relationships in the “doctor-patient” system is the most important principle of the continuity compliance of clinical management of the process of improving public health.

Anatomical Variations of the Median Nerve: A Cadaveric Study.

Objectives: Variations in the morphological anatomy of the median nerve such as formation, distribution, and communication have been well documented. All these variations should be taken into account when practicing any surgical approach for the treatment of injuries affecting the median nerve. Furthermore, they are of the utmost importance for interpretation of the clinical presentation. Methods: The objective of this investigation was to determine the anatomical variations in the formation of the median nerve in cadavers at the Forensic Pathology department in Central Clinical Hospital of the Academy of Sciences of the Russian Federation between January 2022 and April 2022. A descriptive, cross-sectional, and prospective information source study was conducted on 42 anatomical bodies (corpses) and 84 brachial plexuses. Results: After analyzing the results obtained in this investigation, we concluded that the median nerve presented variation in its formation in 22.6% of the investigated cases. These variations were more common in males (81.8%) than females (18.2%). The anatomical variation was unilateral in 7.1% and bilateral in 19% of all anatomical bodies examined. Conclusions: The median nerve presented a great number of variations in its formation in roughly 23% of the anatomical bodies, with male being the predominant gender. Furthermore, the most frequent region of formation was the axillary region (92.9%). For clinicians, it is important to remember these variations during surgical procedures in this area and during brachial plexus block.

Assessment of Rheumatoid Hand Function as a Characteristic Feature of Rheumatoid Arthritis in Patients Treated with Methotrexate or Methotrexate with Biological Agents with or without Deformation of Hands.

The hand is an excellent work tool that provides the functional ability to mechanical work. The hand is affected in rheumatoid arthritis (RA) patients, it is a significant problem in the functional sphere as a result of deformities, the grasping function limitation and muscle strength. The aim of the study was the assessment of grip strength, endurance and manipulation abilities of rheumatoid hands with or without deformities treated with methotrexate (MTX) or MTX plus biologics (MTX+BIO). The study involved 80 RA women, (40 received MTX+BIO, 40 MTX), treated at the Rheumatology Department of the Central Clinical Hospital of Interior Affairs in Warsaw. VASpain, DAS28, SDAI, HAQ, HAQ hands, estimation of hand grip strength, endurance, and manipulation ability were analyzed. In group MTX+BIO, values of DAS28 (3.7±1.3 vs. 4.3±1.2, p=0.019), HAQ (0.72 ± 0.57 vs. 1.08± 0.87, p=0.011) and HAQ-hand (0.85±0.65 vs. 1.19±0.68, p=0.024) were statistically lower than in MTX group. Hand deformations were recorded in 35 (43.7%) cases, 16 (40%) in MTX group, 19 (47.5%) in MTX+BIO. Comparison of grip strength, endurance, and manipulation ability showed better results in MTX+BIO group with deformities (significance level from 0.013 to 0.046) than in MTX group. Relative differences in hand function in MTX + BIO group ranged from 10.8% (maximal power grip strength) to 127.6% (minimal hand endurance), after disease duration adjustment - from 28.2% (maximal power grip strength) to 148.4% (minimal hand endurance). Measuring grip strength, hand endurance, manipulation abilities are useful in RA patients with hand deformities.

Preterm Births: Obstetric Features and Neonatal Outcomes at University Hospital Mostar

Background: The aim of this study was to determine and analyze the frequency and obstetric features of preterm birth and neonatal outcomes of infants born before 37 completed weeks of pregnancy. Methods: The retrospective study included 470 premature births. The following data on preterm births were collected from hospital records and analyzed: gestational age, type of preterm birth, multiple pregnancy and maternal parity. The parameters of preterm infants were: Apgar score, intrauterine growth restriction (IUGR), perinatal asphyxia, respiratory distress syndrome (RDS), sepsis, necrotizing enterocolitis, intracranial hemorrhage, neonatal convulsions, hypoglycemia, blood transfusion, the need for surfactant, the need for mechanical ventilation, the length of stay in an Intensive Care Unit and early and late neonatal mortality.Main findings: The frequency of preterm births was 6.48%. The most common type of premature birth was spontaneous premature birth. Most complications occurred in neonates with a gestational age of 28-34 weeks. The most common respiratory complication was RDS (8.1%). Early neonatal mortality was 1.49% and late neonatal mortality was 0.85%.Principal conclusion: Neonatal outcomes of premature infants are directly proportional to their gestational age. The neonatal mortality rate of premature infants at Clinical Hospital Center Mostar (CHC) Mostar is comparable to other developing countries.Key words: preterm birth, gestational age neonatal outcome, perinatal care, neonatal mortality

Impact of Immediate and Delayed Breast Reconstruction on Quality of Life of Breast Cancer Patients.

A mastectomy affects the psychological, social, and sexual well-being of patients. Research has confirmed that breast reconstruction is important for improving the quality of life in patients with breast cancer. The aim of this study was to assess the quality of life of patients who underwent a mastectomy followed by immediate or delayed breast reconstruction. This prospective study was conducted from January 2018 to March 2020 at the Clinical Hospital Center Osijek, using the health questionnaire SF-36. The study included 79 patients. The results of the study showed that patients who underwent a mastectomy had the lowest scores in the domain of restriction due to physical difficulties, 18.8 (6.3–31.3), in physical functioning and limitation due to emotional difficulties, 16.7 (8.3–33.3), in mental health. In immediate breast reconstruction, patients rated better physical health (p < 0.001), while patients who underwent delayed breast reconstruction rated their mental health worse (p < 0.001) as measured by the SF-36 questionnaire. Conclusion: The results of this study show that patients without breast reconstruction rated their quality of life worse than patients who underwent immediate and delayed breast reconstruction after mastectomy. There is no difference in the quality of life between patients who underwent immediate and delayed breast reconstruction after mastectomy.

Hypermagnesemia and hyperphosphatemia are highly prevalent in patients with COVID-19 and increase the risk of death

ObjectivesNonrespiratory manifestations of COVID-19 include endocrine disorders, among which are calcium-magnesium-phosphate homeostasis abnormalities, which seem to influence the disease severity and patient outcome. The aim of this study was to evaluate the prevalence and impact of calcium-magnesium-phosphate and vitamin D3 disorders on survival in patients hospitalized for COVID-19 depending on the severity of the disease and kidney function. Design or methodsThe study was conducted between April 2020 and May 2021 at Central Clinical Hospital in Warsaw, Poland. A total of 146 patients who had tested concentration of at least one of the studied elements, estimated glomerular filtration ratio, creatinine levels, and blood saturation, and were diagnosed with COVID-19 disease were included in the analysis. ResultsWe found that hypermagnesemia was common and associated with a 1.5-fold increased risk of death in the whole cohort. Hyperphosphatemia also increased the risk of death, exactly 2.4-fold. Furthermore, we found a statistically significant association between increased mortality in the whole cohort and hypovitaminosis D3 (P <0.05). Serum creatinine concentration and estimated glomerular filtration ratio significantly correlated with serum magnesium and phosphate levels. ConclusionHypermagnesemia, hyperphosphatemia, and hypovitaminosis D but not hypocalcemia influence the mortality of patients with COVID-19. These parameters should be monitored routinely in this group of patients, especially in those with decreased kidney function.

X-ray-endovascular interventions in the treatment of patients with liver metastases of colorectal cancer after the termination of systemic chemotherapy

Background: At present, the problem of treating common forms of colorectal cancer does not lose its relevance due to the increase in its incidence. Systemic chemotherapy is the main line of treatment for patients with unresectable liver metastases. However, a significant problem of modern oncology is the further treatment tactics for patients with chemoresistant metastases. Aims: to improve the treatment results for patients with chemoresistant liver metastases of colorectal cancer. Method: 36 patients with unresectable liver metastases of colorectal cancer were treated at the Granov Russian Research Center of Radiology and Surgical Technologies and the RZD-Medicine Central Clinical Hospital. For all the patients, systemic chemotherapy was considered unreasonable due to the development of chemoresistance or a high degree of toxicity. The patients underwent regional chemotherapy chemoinfusion and/or chemoembolization of the hepatic artery. Results: The treatment evaluation was performed using the RECIST 1.1 scale. After 6 months, a partial response was reached in 1 patient (2.8%), stabilization was observed in 29 (80.5%) patients, and 6 patients (16.7%) had the disease progression. In 2 (5.6%) cases, a lethal outcome was observed against the background of the systemic progression of the oncological disease. One year later, stabilization of the malignant process was detected in 21 (58.3%) cases, progression was detected in 15 (41.7%) cases. A one-year survival of patients was 83.3%, the overall survival 22 months. Conclusion: The use of interventional radiology methods has shown its effectiveness in patients with unresectable chemoresistant liver metastases of colorectal cancer.

The experience of the decision-making algorithm of primary healthcare for the elderly patients with cardiovascular diseases

Highlights. The basis for improving the quality of medical care is the arrangement of algorithms for clinical processes. The choice of a clinical and organizational solution for cardiovascular diseases in groups of older age patients at the stage of primary healthcare is a complex medical and economic task that requires maintaining the balance of efficiency, safety and quality of life in the "patient – risks – survival – economic efficiency" system. The development of an algorithm for making clinical and organizational decisions concerning cardiovascular diseases in elderly patients to improve the effectiveness of primary healthcare is an urgent health issue.Aim. To develop and evaluate the effectiveness of the algorithm for making clinical and organizational decisions at the primary healthcare stage for elder patients with cardiovascular diseases.Methods. The bases for the study were conducted in 2016–2020 at the Vascular Surgery Department of Peoples Friendship University of Russia and the Central Clinical Hospital “RZD-Medicine”. The object of the study was the patients with cardiovascular diseases (n = 422), mean age 76.11±7.2 years old. The subject of the study was cardiovascular surgeons (n = 4) experienced in surgical and endovascular technology. The algorithm was based on the content analysis of scientific publications (n = 27), clinical practice, the organizational and technological algorithm of PHC (primary healthcare) developed by Abramov A.Yu. and the colleagues in 2020 and the recommendations for the care of the elderly people with polymorbidity developed by the American Geriatric Society (2012). The medical, social and clinical effectiveness as well as the economic results of inpatient treatment were evaluated. The periods before and after the implementation of the algorithm in 2016–2017 and 2018–2020 were compared. Content analysis, analytical, statistical, mathematical, comparative, and expert research methods were applied.Results. The developed PHC (primary healthcare) algorithm contributed to the high level of accessibility of endovascular care (100%). Cardiovascular surgeons positively assessed the possibility of providing surgical care in 100% of cases and patient adherence to surgical treatment (99.5%). In 2016–2017 and 2018–2020 the surgical activity of the vascular surgery department significantly increased from 7 to 98.9%, the average bed-day decreased from 9.5 to 6.8 days and the postoperative bed-day from 7.2 to 4.12 days, the frequency of repeated hospitalizations in the hospital decreased during the year from 3.1±0.2 to 1.6±0.4 times, the incidence of primary acute myocardial infarction from 12 to 0% and relapses of critical ischemia of the lower extremities from 36 to 2%. The average cost of direct medical costs for the treatment of one patient during the year in the main and control groups did not differ significantly, 4 086$ (USA) и 3 887$ (USA), respectively.Conclusion. The PHC development and experience algorithm indicates the increase in the medical, social and clinical effectiveness of medical care for cardiovascular diseases in patients of older age groups and helps to reduce the direct costs of inpatient care.

Condition of membranes of erythrocytes of peripheral blood of elderly people with chronic tiredness and low level of tolerance to physical load

Purpose: The aim of the work is to study the osmotic stability and morpho-functional features of peripheral blood erythrocytes of patients with chronic fatigue syndrome depending on the level of exercise tolerance and associated risk factors. groups of factors that may be the cause, so the development of measures to eliminate them is an urgent problem today, which requires the development of effective ways to correct chronic fatigue syndrome. It is known that the peripheral part of erythron actively responds to changes that occur in the whole body after the action of various factors, including those factors that lead to chronic fatigue syndrome.&#x0D; Material and methods of research. The examination was performed on the basis of the Department of Vascular Neurology of the Central Clinical Hospital of Ivano-Frankivsk. The study involved 30 patients aged 55-65 years (mean age 60.6 + 1.2 years), who were divided into 3 groups: 1 gr. included 10 patients with chronic fatigue syndrome and a high level of exercise tolerance. The 2nd group included 10 patients with chronic fatigue syndrome and the average level of exercise tolerance, the composition of 3 gr. included 10 patients with chronic fatigue syndrome associated cardiovascular pathology (angina pectoris, hypertension) and low exercise tolerance (3 gr.).&#x0D; Results. It is established that chronic fatigue syndrome proceeds in 3 phases and has natural stages of development which are characterized by three groups of etiological factors and the corresponding levels of teletransitivity to physical activity, each of which corresponds to a certain erythrocyte profile and level of osmotic stability of erythrocytes which are offered to use as prognostic and diagnostic characteristics. chronic fatigue syndrome.&#x0D; Conclusions. The study of the quantitative composition of peripheral blood erythrocytes and hemoglobin, as well as their ratio (color index) in patients with chronic fatigue syndrome on the background of low levels of exercise tolerance revealed a decrease in erythrocytes and hemoglobin by 42% and 25%, respectively, indicating the presence of anemic hypoxia. 2. In conditions of chronic fatigue there is a decrease in osmotic resistance of erythrocytes, as evidenced by a decrease in the number of osmotically stable erythrocytes with a gradual decrease in the concentration of NaCl solution (3.0%; 0.5%; 0.46%; 0.3%). 3. In chronic fatigue there is a deterioration of membranes in peripheral blood erythrocytes, as evidenced by a decrease in their osmotic stability and an increase in the number of irreversibly altered forms of РВЕ, as well as a decrease in peripheral blood erythrocytes, which is closely correlated with decreased tolerance to exercise.

Obstructive Sleep Apnea and Cardiovascular Risk: The Role of Dyslipidemia, Inflammation, and Obesity.

Introduction: The present study aimed to establish the role of lipid abnormalities and inflammatory markers for developing cardiovascular risk, as well as to address the importance of obesity as a common comorbidity in patients with obstructive sleep apnea (OSA). Methods: The study was conducted as a prospective cohort study including 120 patients with newly diagnosed OSA between 2019 and 2020, at University Clinical Hospital Center “Bezanijska kosa”, Belgrade, Serbia. The diagnosis was established by polysomnography. In all patients, sociodemographic data, respiratory, lipid, and inflammatory parameters were collected and complete echocardiographic study and 24-h blood pressure monitoring were performed. Results: The mean patient age was 55.7 ± 13.8 years. Study population was mostly male (70.0%) and obese (56.7%). At least 30 apneas or hypopneas per hour were present in 39.0% of patients. A strong positive correlation was found between OSA severity and BMI (r = 0.562, p < 0.001), both associated with lipid, inflammatory and respiratory parameters, and cardiovascular profile of patients with OSA (p < 0.05 for all). Echocardiographic study and 24-h blood pressure monitoring parameters were in turn correlated with lipid and inflammatory markers (p < 0.05 for all). Conclusion: The results of this study support the important role of dyslipidemia and inflammation, as well as coexistence of obesity in the pathogenesis of numerous conditions linked with an increased risk of cardiovascular morbidity and mortality in patients with OSA.

An analysis of the vitamin D overtesting in a tertiary healthcare centre.

IntroductionVitamin D testing is excessively used in clinical practice, despite of the clinical guidelines statements against population screening for vitamin D deficiency. This study aimed to assess an annual number of performed 25-hydroxy vitamin D (25(OH)D) tests that were unsupported by the national guidelines for prevention, detection and therapy of vitamin D deficiency in adults and to calculate associated financial burden for the publicly funded healthcare.Materials and methodsA representative sample of requested 25(OH)D tests in 2018 (N = 474) was formed after selection and randomisation of data set (N = 5298) collected from the laboratory information system database of the Clinical Department for Laboratory Diagnostics, the Clinical Hospital Centre Rijeka. Records were classified in two groups depending on associated medical condition(s) according to the national guidelines. An annual cost of the total and group specific vitamin D testing was calculated on the base of a single test price reimbursed by the Croatian Healthcare Insurance Fund (CHIF).ResultsMedical conditions with high-risk for vitamin D deficiency were detected in 43% (206/474) of vitamin D requests (group 1). Conditions not associated with vitamin D deficiency were detected in 57% (268/474) requests (group 2). A total cost of 25(OH)D testing for the CHIF was 58,729.50 EUR (25,523.79 EUR in the group 1 and 33,205.71 EUR in the group 2).ConclusionsMore than half of all 25(OH)D tests performed in the clinical laboratory represent avoidable cost for the public healthcare. Prevention of population screening by vitamin D testing is needed.

Resolution of the Working Meeting of Experts in “Dermatology”: Possibilities of systemic therapy of atopic dermatitis with selective immunosuppressants

On February 19, 2022, a working meeting of experts on the problem of atopic dermatitis was held in Moscow under the chairmanship of the Director of the State Scientific Center for Dermatovenereology and Cosmetology of the Ministry of Health of Russia, Doctor of Medical Sciences, Professor, Corresponding Member of the Russian Academy of Sciences A.A. Kubanov. Also in attendance was the Academician of the Russian Academy of Sciences, Chief Freelance Childrens Specialist in Preventive Medicine, Head of the Research Institute of Pediatrics and Childrens Health of the Central Clinical Hospital of the Russian Academy of Sciences of the Ministry of Science, and Higher Education of the Russian Federation, Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Sciences, L.S. Namazova-Baranova, and also the Deputy Director for Clinical Work ― Chief Physician of the Federal State Budgetary Institution SSC Institute of Immunology FMBA of Russia Doctor of Medical Sciences, Professor N.I. Ilyina.&#x0D; The meeting raised germane issues of providing medical care, reducing the burden of the disease, and improving the quality of life of patients with atopic dermatitis. New possibilities and principles of systemic therapy in patients with moderate and severe atopic dermatitis were discussed. We analyzed data on a new representative of the small molecule class the selective Janus kinase 1 inhibitor, upadacitinib, which was registered in the Russian Federation in June 2021. This analysis aimed to determine its place in atopic dermatitis therapy algorithms and the possibility of the impact of its use as a therapy on the quality of life of patients in relation to the burden of diseases.&#x0D; The article has been published in several journals simultaneously with permission from authors and publishers. The parallel publication is available here: Capabilities of atopic dermatitis systemic therapy with selective immunosuppressors: resolution of the experts workshop of dermatology profile. Pediatric pharmacology. 2022;19(2):209211. DOI: https://doi.org/10.15690/pf.v19i2.2424