Clinic Of University Hospital Research Articles

Comparative study of orbital volumes according to multispiral computed tomography data

BACKGROUND: It is believed that accurate reconstruction of the correct anatomy of the orbital bony walls, restoration of symmetry and volume are necessary for a favorable functional prognosis and elimination of an aesthetic defect. The main problem when estimating orbital volume is its complex anatomy. Scientists use various methods to determine orbital volume, and in reviews comparing various methods for calculating orbital volumes, there is no data on which orbital volumetric method is the most accurate, since each of them has both advantages and disadvantages. AIM: The aim of this study is the analysis and the comparison of orbital volumes according to multispiral computed tomography data of healthy patients without bone-traumatic changes of orbital walls. MATERIALS AND METHODS: To measure the volume of orbits, 50 random patients were selected who were examined in the radiology department No. 2 of the University Clinical Hospital No. 1 of the Sechenov University from 2023 to 2024 and who underwent multispiral computed tomography of the facial skeleton for indications unrelated to orbital conditions. Computed tomography data from 25 women and 25 men of different ages (from 18 to 85 years old) were analyzed. A total of 8 groups were formed depending on gender and age: group 1 — women 18–25 years old, group 2 — men 18–25 years old, group 3 — women 26–35 years old, group 4 — men 26–35 years old, group 5 — women 36–50 years old, group 6 — men 36–50 years old, group 7 — women 51 and older, group 8 — men 51 and older. Multispiral computed tomography of the facial skeleton was performed using the Aquilion One 640 CT scanner (Japan) with 0.5 slice thickness in bone and soft tissue windows, to be able to calculate orbital volumes at the workstation, all bone contours of the orbits were marked on each axial slice, starting from the upper wall to the bottom of the orbit with a representation of the orbital volumes in ml. RESULTS: The difference in the volumes of the right and left orbits of 0.5 ml or more was detected in 5 women out of 25 cases, among men the difference was present in 12 cases out of 25; a difference in volumes of more than 1 ml was noted in 1 woman and 2 men; a difference of more than 1.5 ml was not observed in any study group. The orbital asymmetry coefficient in women ranged from 0 ml to 1.21 ml, in men — from 0.08 ml to 1.19 ml, in women, the average volume of both orbits is less than in men. It was also detected that the volume of orbits increases with age, both in men and women. CONCLUSIONS: Considering that the majority of patients had differences in orbital volumes of up to 1.0 ml, we agree with studies that indicate the possibility of using a healthy contralateral orbit as a guideline when planning reconstructive surgery. However, for planning surgical treatment, it is recommended to use manual contouring, as this allows the most accurate reproducibility of the bone boundaries of the orbit, although it requires more time than semi- and automatic segmentation. Also, the advantages of the used method for calculating the volumes of orbits in this study include reproducibility on any workstation from different manufacturers, since the method is carried out on a standard tomograph workstation and does not require any additional software.

P-432 The association of early pregnancy loss and thrombophilia

Abstract Study question Is there a correlation between thrombophilia and the occurrence of pregnancy loss? Summary answer No statistically significant association is observed between thrombophilia and the live births. What is known already The understanding of recurrent pregnancy loss is a subject of controversy, encompassing both its causes and potential treatments and there is currently no consensus regarding the criteria for examining patients experiencing pregnancy loss, the specific tests to be conducted, or the appropriate treatment approaches. The connection between hereditary thrombophilia and pregnancy loss remains unclear. Study design, size, duration Within the timeframe of 01/12/2020 to 01/06/2022, pregnancy loss clinic of a tertiary university hospital received a total of 296 patients who had experienced at least one pregnancy loss. Following examination, these patients were encouraged to return to clinic if they became pregnant again. Among them, 192 patients did become pregnant and sought further care. These patients received treatment based on pregnancy loss clinic’s management algorithm, and their subsequent pregnancies were closely monitored. Participants/materials, setting, methods This prospective study involved 192 patients who, after undergoing examination, experienced subsequent pregnancies. These patients were categorized into two groups based on their obstetric outcomes: live birth and pregnancy loss. The primary focus of the study was to compare hereditary and acquired thrombophilia between these two groups. Additionally, secondary outcomes included a comparison of obstetric history, genetics, uterine anomalies, and results from biochemical and hormonal examinations between the two groups. Main results and the role of chance 150 of 192 patients achieved live birth (78.13%). The prevalence of hereditary thrombophilia mutations showed no significant differences between the two groups. Specifically, in the pregnancy loss group, the FV Leiden mutation rate was 12.5%, compared to 13.7% in the live birth group (p = 0.836). The Prothrombin gene mutation was observed in 7.5% of the pregnancy loss group and 7.25% of the live birth group (p = 1.000). Additionally, the PAI 4G/5G polymorphism was present in 60% of the pregnancy loss group and 52% of the live birth group (p = 0.347), the MTHFR/C677T polymorphism was detected in 62.5% of the pregnancy loss group and 56.5% of the live birth group (p = 0.500), and the MTHFR/1298C polymorphism was identified in 62.5% of the pregnancy loss group and 60.1% of the live birth group (p = 0.788). While antithrombin III levels were comparable between the two groups (p = 0.53), a noteworthy decline in antithrombin III levels was observed with an increasing history of losses: 110.2 for one loss, 106.0 for two losses, and 100.2 for three or more losses (p = 0.033). The homocysteine level was found to be 10.85 μM (range: 6.60-24.80 μM) in the pregnancy loss group and 9.40 μM (range: 4.90-37.00 μM) in the live birth group (p = 0.023). Limitations, reasons for caution A limitation of our study is its single-center nature. Additionally, we did not include a healthy control group with no history of pregnancy loss, preventing a direct comparison between the pregnancy loss group and a group unaffected by such experiences. Wider implications of the findings Our study provides valuable insights into questioning the live birth expectations of women who have experienced pregnancy loss and underscores the significance of thrombophilia in the context of pregnancy loss. Trial registration number not applicable

Relationship between Serum Zinc Level and Retinopathy in Type 2 Diabetic Patients

Abstract Background Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia caused by insulin resistance (IR) or impaired insulin production. Diabetic retinopathy (DR) is a common microvascular disorder which occurs in type 2 diabetes mellitus (T2DM) patients due to chronic hyperglycemia. Previous studies reported that serum zinc (Zn) was associated with certain diabetic microvascular complications. Objective To evaluate relation between serum zinc level and diabetic retinopathy in patients with type 2 diabetes mellitus. Subjects and Methods The current study included 60 subjects with their ages ranging from 18- 60, selected from diabetes and ophthalmology outpatient clinics of Ain Shams University Hospitals for 7 months in a period from July 2022 to January 2023 with matched age and sex . fasting and post prandial blood glucose, hemoglobin A1c (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP),serum creatnine, LDL, HDL, TG,TC and serum zinc levels were measured among groups. Results The study shows statistically significant difference between DM type II subgroups regarding duration of disease (yrs) being higher in DM II with retinopathy 12.5 (10.5 – 16.5) than DM II without retinopathy 9 (6 – 12) with p < 0.001. serum Zn levels were significantly lower in the DR group than the controls and diabetic without retinopathy.in whole DM type II group, there was statistically significant negative correlation found between zinc level and duration of diabetes, HbA1c, LDL, TC, FBS, 2PP and serum creatinine level, while in DM II without retinopathy there was statistically significant negative correlation found between zinc level and duration of diabetes, LDL, TC and FBS and also in DM type II retinopathy there was statistically significant negative correlation found between zinc level and duration of diabetes, HbA1c, FBS, 2PP and serum cretainine level .There is no statistically significant difference found between control group and DM type II group regarding weight, height and BMI of the studied patients with p-value = 0.108, 0.198 and 0.343; respectively. There is no statistically significant difference found between control group and DM type II group regarding systolic and diastolic blood pressure of the studied patients with p- value = 0.554 and 0.405; respectively. Conclusion Our study suggested that lower serum zinc level in T2D patients was related to higher prevalence of diabetic microvascular complications. Patients with lower serum zinc level were more likely to have a longer duration of diabetes, poorer glucose control, and worse β-cell function. Older age, higher HbA1c level, and the prevalence of DN were risk factors related to the lower serum zinc level.

P-351 Reproductive outcomes in a cohort of lymphoma patients

Abstract Study question What are the reproductive outcomes in women with malignant lymphoma Hodgkins (HD) and non-Hodgkins (NH) from a single, experienced center? Summary answer 74 children were born to 43 women (28 with HD, 15 with NH) giving a live birth rate (LBR) of 81% and 72%, respectively. What is known already The risk of premature ovarian insufficiency (POI) after HD and NH is related to female age, type and dose of gonadotoxic treatment. Where ABVD regimens in HD patients and CHOEP regimens in most young NH patients, rarely results in POI and reduced fertility, treatment with BEACOPP or BEAM and stem cell transplantation seems to be associated with a much higher risk of ovarian failure. However, studies are heterogeneous and there is still a need for studies with structural follow up on repeated measurements of ovarian function markers in relation to clinical outcomes. Study design, size, duration This cohort study was conducted as a single center study at the fertility clinic in a large public Danish university hospital. Data was collected retrospectively from medical records from 1999 to 2020 and prospectively from 2020 to 2023. We included all female patients with HD (n = 63) and NH (n = 32), who were referred to our clinic for fertility preservation between 1999 and 2022. End of follow up was December 31st, 2023. Participants/materials, setting, methods Age at referral ranged from 14 to 33 years. Information about diagnoses, gonadotoxic treatment, gynecologic (including endocrine parameters) and obstetric history was retrieved from medical records. Permission to obtain retrospective data from 1999 to 2020 was given by the Danish Patient Safety Authorities (jrn 3-3013-2790/1) and prospective data collection was given by informed consent from the patients from 2020 and onwards. Main results and the role of chance 33% of patients with HD had ABVD only, and the remaining BEACOPP or other high-dose alkylating regimens. 72% of patients with NH had CHOEP, and the rest other high-dose alkylating regimens. 78/95 women had fertility preservation. Of these, 95% had ovarian tissue cryopreservation (OTC), 5% had IVF with vitrification of oocytes or embryos. Following chemotherapy 33 women (52%) with HD and 18 (56%) with NH became pregnant. Of these, 28 women with HD had 51 deliveries, and 15 with NH had 23 deliveries. The LBR was 0,81 for HD and 0,72 for NH. For HD patients, 54% of the deliveries were achieved by women who had ABVD compared to about 40% after other high-dose alkylating regimens. For NH patients, 73% of deliveries were achieved by women who had CHOEP compared to 13% after other high-dose alkylating regimens. Most pregnancies were conceived spontaneously. A total of 15/74 women had ovarian tissue transplantation (OTT). Of these, 7 women with HD became pregnant resulting in 4 deliveries, and 4 women with NH became pregnant resulting in 2 deliveries giving an overall pregnancy rate of 73% in this group of women and a LBR of 40%. Limitations, reasons for caution This study is based on information from medical records in public Danish hospitals, containing information on all deliveries. Pregnancies and deliveries outside of Denmark might therefore not be included. Furthermore, for some women the follow-up period was only one year, which could underestimate the fertility in this group of patients. Wider implications of the findings This study shows a reassuringly high rate of spontaneous pregnancies in female survivors of malignant lymphomas. Only 20% of the women have so far used their tissue stored before chemotherapy. Current results might question whether we overtreat our lymphoma patients by offering OTC to the majority Trial registration number not applicable

Lipocalin-2 Level in Patients with Polycystic Ovary Syndrome: Association with Insulin Resistance and Metformin Therapy

Abstract Background PCOS appears to be associated with an increased risk of metabolic aberrations, including insulin resistance and hyperinsulinemia, type 2 diabetes mellitus, dyslipidemia, and cardiovascular disease throughout womens’ lifespan. Aim of the Work The aim of this study is to: Assess the association of Lipocalin-2 with polycystic ovary syndrome in a sample of the Egyptian female. Study the effect of metformin therapy on Lipocalin-2 level in female patients with polycystic ovary syndrome Patients and Methods Our study was conducted on 52 females. Their age ranged between 17-43 years old. They were collected from the outpatient obstetrics and gynaecology clinics of Ain Shams University Hospitals, assess the association of Lipocalin-2 with polycystic ovary syndrome in a sample of Egyptian females and its association with insulin resistance. It was conducted from June 2018 to March 2019. The study was explained to all patients and control subjects, and written consent was obtained before starting the study. Results Serum lipocalin-2 levels did not differ between patients with PCOS and BMI-matched healthy controls (P-value 0.193). In the present study, there was no significant difference between the 2 studied groups as regard HOMA-IR (p = 0.375). Metformin therapy for 3 months in patients with PCOS in the present study, resulted in significant reduction in lipocalin-2 level (p- value<0.01), (mean 54.2±15.3 ng/ml before metformin therapy vs 42.9±14.2 ng/ml after metformin therapy). In our study metformin therapy in PCOS group resulted in significant reduction in weight, BMI, waist circumference and HOMA-IR. Furthermore, linear regression analysis for the parameters affecting lipocalin level in our study, showed that BMI was the only significant confounder affecting lipocalin level. So the reduction in lipocalin level following metformin therapy in PCOS group in our study may be due to weight reduction perse. Conclusion In conclusion, our results show that PCOS per se is not associated with elevated serum lipocalin-2 levels. Weight loss induces a significant reduction in serum lipocalin-2 levels in overweight/obese patients with PCOS. Treatment with metformin of patients with PCOS also induces a reduction in serum lipocalin-2 levels.

BURNOUT SYNDROME OF NURSES/TECHNICIANS IN THE COVID-19 PANDEMIC AT UNIVERSITY CLINICAL HOSPITAL MOSTAR

Introduction: Burnout syndrome results from chronic stress at work combined with ineffective coping with stress. Medical workers belong to the occupations with the highest percentages of burnout syndrome, which has been further increased by the crisis caused by the COVID-19 pandemic. Objective: To identify the symptoms and risk factors for the development of burnout syndrome in nurses/technicians during the COVID-19 pandemic. Subjects and methods: A prospective study was conducted with a survey for symptoms and risk factors for the development of burnout syndrome among nurses/technicians of the University Clinical Hospital (UCH) Mostar in the COVID wards, during the COVID-19 pandemic, in July and August of 2021. A survey questionnaire specially created for this research was used, and data analysis was performed in the program SPSS. Results: All nurses and technicians felt exhaustion while working in the COVID wards, they were worried about infecting their family members, and the vast majority had severe headaches and were irritable. Most of the respondents had demanding working hours, were overloaded with work and insufficiently informed about this new disease. However, most nurses/technicians did not show serious symptoms such as anxiety, concentration problems, high blood pressure, emotional exhaustion, depression, or suicidal thoughts. Almost everyone experienced a sense of belonging to the team and good mutual communication. Conclusion: The research indicates a significant risk of burnout syndrome among nurses and technicians while working with COVID-19 patients. Therefore, it is very important to recognize the development of this syndrome in time, and to develop a strategy for prevention, treatment, and rehabilitation of these persons. Keywords:nurses/technicians, burnout syndrome, COVID-19, healthcare system

#2859 Clinical and morphological characteristics of biopsy-proven kidney graft rejection in Latvia

Abstract Background and Aims Kidney transplantation is a treatment for many patients with end stage renal disease leading to increased quality of life. In last decades results in kidney transplantation have been improving, but allograft rejection remains an important clinical problem. Graft biopsy remains the gold standard to assess the cause of kidney transplant status. This study aimed to determine clinical and histopathological characteristics, treatment and short-term outcomes of biopsy-proved kidney graft rejection in Latvia. Method In this retrospective observational study all kidney allograft biopsies performed in Pauls Stradins Clinical University Hospital from January 2014 till December 2022 was reviewed. Biopsies with rejection, ≥7 glomeruli, patients ≥18 years old were included. Acute rejection was diagnosed according to clinical, laboratory and biopsy-proven acute rejection (BPAR) histological criteria. BPAR was classified and subdivided using Banff criteria. All recipients universally received either depleting or non-depleting induction therapy. Most of the patient (82%) for maintenance immunosuppression (MI) received triple therapy with calcineurin inhibitor, mycophenolate mofetil, and prednisone, others—in different combinations with above and mammalian target of rapamycin (mTOR), azathioprine. Graft function was evaluated according to glomerular filtration rate (GFR), calculated with the CKD-EPI Creatinine, 2021 equation. Treatment strategies, laboratory data at the time of biopsy and after 1 year follow-up were analysed. Repeated-control biopsies after receiving therapy were excluded. Data were analysed using descriptive statistics and T-test. Results From all 523 biopsies, further included and analysed were 153 (total 146 patients). 58% were males, average patient age was 45.5 years. Most 84% of the grafts were from deceased, 8%—living donors. Mean time from transplantation to biopsy was 32 months. Acute antibody-mediated rejection (AAMR) was diagnosed in 41% cases, chronic-active antibody mediated (CAAMR)—25%, followed by mixed 16%, acute cellular (ACR) 10% and borderline 8% rejection. Besides augmented MI for almost all patients, pulse steroids (GCS) were the most commonly 70% administered treatment, followed by plasma exchange 59% (PEX), rituximab (RTX) 50%, immunoglobulins (IG) 24% and anti-thymocyte globulin (ATG) 10% in different, mostly non-homogenous combinations. Non adherence, advanced fibrotic changes in biopsy and serious comorbidities were the main reasons patients did not receive specific treatment besides intensified MI. The most favourable outcomes were in ACR where mean allograft GFR increased +20.7 ml/min after one year, compared to the worst outcome CAAMR group where GFR decreased −4.7 ml/min (p = 0.03). In ACR group 92% graft function stayed the same or improved, moreover 54% graft function increased ≥20% from baseline; similarly in mixed and AAMR group GFR increase ≥20% were for 45% and 48%, compared to CAAMR where it was only for 6% of patient. Furthermore, the CAAMR group was with the most patients (48%) who returned to dialysis or died. In AAMR and mixed rejection groups mean GFR changes were close +13.4 ml/min and +12.9 ml/min (p = 0.95). There were no statistically significant associations between treatment outcomes in PEX+RTX+GCS vs PEX+RTX+GCS+IG in the AAMR group (p = 0.382). Overall, 3.9% of patients died. Conclusion Overall BPAR prevalence between kidney graft biopsies was high (29%). Antibody mediated rejection was diagnosed most often with least favourable short-term outcomes in CAAMR group. Despite various improvements in immunosuppression, CAAMR remains a serious cause of transplant dysfunction or loss.

Risk factors and surgical outcomes of diabetic foot in patients with diabetes at larribere clinic in oran university hospital

Risk factors and surgical outcomes of diabetic foot in patients with diabetes at larribere clinic in oran university hospital

Patient profile of asymptomatic primary hyperparathyroidism (APHPT) at tertiary care riga east clinical university hospital

Patient profile of asymptomatic primary hyperparathyroidism (APHPT) at tertiary care riga east clinical university hospital

Comparison of admissions for diabetic ketoacidosis in patients with autoimmune diabetes and type 2 diabetes in the san cecilio clinic university hospital

Comparison of admissions for diabetic ketoacidosis in patients with autoimmune diabetes and type 2 diabetes in the san cecilio clinic university hospital

Non-invasive thermal measurements during newborn’s therapeutic hypothermia and processing of their results

This paper focuses on the heat transfer processes occurring during the treatment of neonates suffering from hypoxic-ischemic. This is a type of brain dysfunction (brain injury) that happens (mainly during delivery) when the brain experiences a decrease in blood flow (because of abnormal blood circulation) and in consequence, a decrease in oxygen. It frequently results in an increase in brain temperature to the danger level and hypoxia in some other organs. Treatment requires a specialized cooling device to decrease the temperature of the neonate’s body and particularly the brain temperature. One of the cooling methods is so-called “selective brain cooling”, which consists of direct cooling of the head by a cooling cap. In this work results of non-invasive measurements for 11 patients suffering from hypoxic-ischemic encephalopathy and treated at the University Clinical Hospital in Opole, Poland. Collected data were processed in a novel way to formulate a whole series of cumulative energy balances for all patients. It is found that cumulative balancing allows one to determine the metabolic heat rate and results in a more stable history of the therapy than balancing step by step.

Efficiency assessment of follow-up methodology of patients with knee replacement to predict post-surgical functionality: a protocol for randomised control PROKnee trial

IntroductionEven when total knee arthroplasty (TKA) is an extended treatment, most patients experience a suboptimal evolution after TKA. The objectives of this study are the following: (1) to determine the...

The relationship between infection parameters and urine volume in acute kidney injury

Aim: Acute kidney injury (AKI) is a clinical syndrome that can cause disturbances in fluid-electrolyte and acid-base balance, resulting in the accumulation of nitrogen and uremic toxins along with the loss of kidney functions within hours or days. In this study, it was aimed to retrospectively examine patients with acute kidney injury to determine whether there is a relationship between infection parameters and urine volume. Materials and Methods: The study included a total of 144 patients with (n=74) and without infection (n=70) out of 294 patients with AKI who received treatment between 1 January 2020 and 31 December 2021 in the nephrology clinic of a tertiary university hospital. Results: The mean age was 66.4±15.7 (range:19-95) in patients with infection and 63.8±15.2 (range:36- 93) in non-infected patients. 51.4% (n=38) of those with infection and 52.9% (n=37) of those without infection were women. There was no difference between the individuals with and without infection in terms of age and gender (p>0.05). Infection was present in 51.4% (n=74) of the patients included in the study. Urinary tract (31.3%) and respiratory tract infections (13.2%) were the most common in those with infection. A moderate negative correlation was observed between admission CRP and discharge creatinine level in patients with infection. There was no correlation between PCT and sedimentation rate, urine volume and admission/discharge creatinine level. Moderate positive correlations were found between admission/discharge PCT and admission/discharge urine volume in patients without infection. In addition, moderate negative correlations were found between admission/discharge sedimentation rate and admission urine volume. Conclusions: No correlation was found between PCT and sediment (incoming/exit) and outflow urine volume in patients with infection.

Cross-sectional analysis of a cohort of people over 65 years of age living with HIV

IntroductionThis study aims to describe and analyze the characteristics of aged people who are living with HIV (APHIV) and evaluate their association on the comorbidities they currently have. MethodsCross-sectional analysis of APHIV under active follow-up at the Infectious Diseases Unit of the University Clinical Hospital of Santiago de Compostela. Demographic and clinical data were analyzed, along with their association with the development of comorbidities in this population. A correlation and multiple linear regression analysis were performed for this purpose. ResultsEighty-five APHIV, 65 males and 20 females, with an average age of 69 years (IQR 8) and a duration of living with HIV of 17 years (SD 7), were studied. 41% of them had their initial diagnosis with AIDS. The most common comorbidities are hypertension and dyslipidemia in 55% and 52%, respectively. 40% of APHIV take at least 5 medications. 35% have received more than 5 lines of antiretroviral treatment. At the time of analysis, all APHIV have an undetectable viral load. No significant association was observed between the number of comorbidities and various characteristics of APHIV; however, a weak correlation was noted among age, the cumulative number of antiretroviral treatments received throughout their lives, and the number of comorbidities. ConclusionsThis analysis highlights the substantial burden of comorbidities and polypharmacy experienced by APHIV. Further studies are needed to better understand the characteristics and variables influencing their development.

Correlation Between Blood Lactate and Salivary Biomarkers During Exercise in Women with Hypothyroidism Treated With L-Thyroxine

Background: Hypothyroidism reduces circulating levels of thyroid hormones metabolic enzymatic activities, and the skeletal muscle's work capacity and lactatemia increase during exertion. Objectives: To analyze salivary biomarkers and blood lactate obtained in exercise stages through exhaustion and investigate their correlation. Methods: Eight females attended the University Clinical Hospital who showed a condition of subclinical hypothyroidism. Before they began replacing with L-thyroxine, they were submitted to an ergometric test to check their tolerance to effort. Eight weeks after treatment, all volunteers were again submitted to lab and ergometric tests. Saliva and blood were collected to determine total protein, nitric oxide, IgA, lactate, and lipid profile. Results: The present study identified a correlation (0.8), so the behavior of the blood lactate could explain the behavior of the salivary of total proteins by 74.22% (R2 = 0.7422). Lactate production was minimized when women underwent L-thyroxine treatment in the first six stages of exercise. Still, total salivary proteins increased for pharmacotherapy between stages 1 and 8. While salivary nitric oxide had a percentage variation between pre- and post-exercise times of 96% before the start of treatment when the same exercise was performed after eight weeks of treatment with L-Thyroxine, this variation was 150%. Conclusion: The measurement of STP is an essential marker of stress, and it is highly correlated with the most used blood marker, lactate. Regarding treatment with L-Thyroxine in women with subclinical hypothyroidism, after eight weeks of this therapy, it was possible to observe a reduction in blood lactate production after the incremental load test on a cycle ergometer, accompanied by a reduction in the concentration of SA. SNO and SIgA tended to increase in women undergoing treatment, and this treatment should be considered in subsequent studies as causing a different effect on these markers.

Role of Fetal Cardiac ECHO and Fetal Cardiac MRI in Prediction of Post Natal Hemodynamic Maladaptation in Fetuses of Diabetic Mothers

Background: Maternal diabetes mellitus (DM) is defined as a degree of glucose intolerance with recognition during pregnancy (pregestational or gestational, type 1 or type 2), and it is estimated to be 15% in pregnant females in 2019. The current study aimed to study the role of fetal echocardiography and fetal cardiac magnetic resonance imaging (MRI) in anticipation and diagnosis of hemodynamic maladaptation changes in fetuses of diabetic mothers as predictors for (closure of Patent ductus arteriosus (PDA), persistent pulmonary hypertension and diastolic dysfunction) which were confirmed with post-natal echocardiographic and clinical assessment. Methods: This study was an observational follow-up study that included 80 pregnant diabetic females who were following in the specialized clinics of Ain Shams University Hospitals during the period starting from August 2020 till December 2022. Results: Diabetes affected left ventricle (LV) diastolic function and global cardiac function but did not affect LV systolic function (p-value=0.000). Interventricular septum (IVS) thickness had a significant positive correlation with LV- Myocardial performance index (MPI) and indices of DM such as HbA1c. Diastolic dysfunction was the most affected cardiac parameter in infants of diabetic mothers (p-value=0.002). The hemoglobin A1c (HbA1c) was the most significant predictor for IVS thickness in diabetic mothers' fetuses, especially with a long duration of DM (p-value=0.012). Conclusion: Fetal echocardiography in diabetic mothers is essential and the gold standard modality not only for diagnosing structural abnormalities but also for evaluating the cardiac function of the fetuses. Fetal cardiac MRI could be considered a complementary imaging modality that uses no ionizing radiation, good tissue contrast, and a larger field of view.

Lung Diffusion Capacity in Patients With Bilateral COVID-19 Pneumonia: A Three-Month Follow-Up Study.

The aim of this study was to determine the short-term consequences of coronavirus disease 2019 (COVID-19) infection on pulmonary diffusion in patients with severe (but not critical)andmoderately severe COVID-19 pneumonia during three months after COVID-19 infection. A prospective study included 81 patients with an RT-PCR-test confirmed diagnosis of COVID-19 infection treated in the COVID Department of Lung Diseases of University Clinical Hospital Mostar. Inclusion criteria were≥18-year-old patients, COVID-19 infection confirmed using real-time RT-PCR, radiologically confirmed bilateral COVID-19 pneumonia, and diffusion capacity of the lungs for carbon monoxide (DLCO) one and three months after COVID-19 infection. The pulmonary function was tested using the MasterScreen Body Jaeger (Jaeger Corporation, Omaha, USA) and MasterScreen PFT Jaeger (Jaeger Corporation, Omaha, USA) according to American Thoracic Society guidelines one and three months after COVID-19 infection. Forced vital capacity significantly increased three months after COVID-19 infection compared to the first-month control (p<0.0005). Also, a statistically significant increase in the FEV1 value (p<0.0005), FEV1%FVC ratio (p<0.005), DLCO/SB (p<0.0005), DLCO/VA value (p<0.0005),and total lung capacity (TLC) (p<0.0005) was observed in all patients. Our study showed that recovery of DLCO/VA and spirometry parameters was complete after three months, while DLCO/SB was below normal values even after three months. Therefore, one month after the COVID-19 infection patients had partial recovery of lung function, while a significant recovery of lung function was observed three months after the COVID-19 infection.

The Importance of Nonpharmacological Applications in the Management of Infections Caused by Stenotrophomonas maltophilia in Pediatric Patients: A Single-Center Experience

Abstract Objective This study aimed to contribute to the literature by evaluating the clinical characteristics of children with Stenotrophomonas maltophilia infection, predisposing factors, and implementation of additional measures for disease control, with the goal of improving survival and reducing mortality in pediatric patients. Methods Clinical data and microbiological test results of patients with S. maltophilia growth in cultures of samples from any biological site and clinical symptoms of systemic infection referred to the pediatric clinic of a tertiary university hospital between January 2021 and August 2023 were reviewed. Results The study included 40 patients with a median age of 2.5 years (range 1–16 years). Medical devices were present in 26 patients (65%). Polymicrobial growth occurred in 16 patients (40%). Prior to the detection of S. maltophilia infection, 35 patients (87.5%) received broad-spectrum antimicrobial therapy. Death occurred in 11 patients (27.5%). In 2022, there were 23 cases of S. maltophilia infection, with the highest number occurring in March 2022 (9 cases per month). After that date, various nonpharmacological measures were implemented for all patients with confirmed infection, including strict contact isolation in single-occupancy, high-efficiency particulate air-filtered rooms. Conclusion There were multiple risk factors for increased mortality in our study population. Despite these unfavorable factors, the mortality rate was low. Disease control was achieved through nonpharmacological interventions implemented alongside antimicrobial therapy, resulting in effective prevention of potential outbreaks. Implementation of nonpharmacological interventions alongside medical treatment can reduce mortality and improve survival in pediatric patients with S. maltophilia infection.

Analysis of the expression of the Serpina1 gene in SARS-CoV-2 infection: study of a new biomarker

IntroductionThe SERPINA1 gene encodes the protein Alpha-1 Antitrypsin (AAT1). Possible imbalances between the concentrations of proteases and antiproteases (AAT1) can lead to the development of serious pulmonary and extrapulmonary pathologies. In this work we study the importance of this possible imbalance in patients with COVID-19. ObjectivesTo correlate the severity of the symptoms of SARS-COV-2 infection with the AAT1 concentrations at diagnosis of the disease. MethodsAn observational, prospective, cross-sectional, non-interventional, analytical study was carried out where 181 cases with COVID-19 admitted to the “Lozano Blesa” University Clinical Hospital of Zaragoza were selected. The concentration of AAT1 was studied in all of them and this was correlated with the clinical aspects and biochemical parameters at hospital admission. Results141 cases corresponded to patients with severe COVID and 40 patients with mild COVID. AAT1 levels were positively correlated with the days of hospitalization, severity, C-Reactive Protein, ferritin, admission to Intensive Care, and death, and presented a negative correlation with the number of lymphocytes/mm3. AAT1 concentrations higher than 237.5 mg/dL allowed the patient to be classified as “severe” (S72%; E78%) and 311.5 mg/dL were associated with the risk of admission to Intensive Care or Exitus (S67%; E79%). ConclusionsLevels of the SERPINA1 gene expression product, AAT1, correlate with the severity of COVID-19 patients at diagnosis of the disease, being useful as a prognostic biomarker.

Effect of air sterilizers in an outpatient clinic at a tertiary university hospital.

After the COVID-19 outbreak, interest in airborne virus infections has increased. We considered ways to reduce the risk of infection to other people by inactivating the virus before it is inhaled into the heating, ventilation, and air conditioning (HVAC) systems. We installed a recently developed air sterilizer in the newly remodeled outpatient clinic of a tertiary university hospital and confirmed its effectiveness. After remodeling the ENT outpatient clinic at Chonnam National University Hospital, 15 KOKKOS air sterilizers (Bentech Frontier Co., Ltd., Gwangju, Korea) were installed. Total culturable microorganisms (TCMs) and volatile organic compounds (VOCs) were measured in five separate inspection areas three days before installation, 2 weeks after installation, and 4 weeks after installation. After measurement of TCMs, improvement in air quality occurred 2 weeks after air sterilizer instatement at all timepoints except inspection area 5, and further improvement was achieved after 4 weeks (p < 0.05). After assessment of VOCs, improvement occurred 4 weeks after air sterilizer connection at all points (p < 0.05). KOKKOS air sterilizers are effective in improving air quality in an outpatient clinic at a tertiary university hospital.