Clinic Of University Hospital Research Articles

Can Galectin-3 Be Used as a Predictor of Obstructive Sleep Apnea Severity: Insights from High-Volume Patient Single Center

Background/Objectives: Obstructive sleep apnea (OSA) is a condition characterized by intermittent airway obstructions, leading to reduced oxygen levels and increased sympathetic nervous system activity. OSA can cause a range of health problems, including an increased risk of cardiovascular diseases and mortality. Galectin-3, a member of the galectin family, plays a significant role in inflammation and fibrosis, and studies show that it is elevated in various conditions, including heart and lung diseases. The aim of this study was to determine whether galectin-3 levels are related to the severity of sleep apnea. Methods: A total of 191 participants from the University Clinical Hospital Center Bezanijska Kosa, Belgrade, Serbia, between January 2023 and May 2024, were included in the analyses. All patients were hospitalized under suspicion of OSA, and they all underwent a polysomnography test. Various demographic, respiratory, laboratory, and clinical parameters were obtained. Correlations between numerical variables and galectin-3 were assessed by the Pearson or Spearman correlation coefficients. Univariate and multivariate linear regression models were used to assess the predictors of galectin-3 values. In all analyses, the significance level was set at 0.05. Results: The mean age of the study participants was 56.2 years, mostly male (68.9%). Of the comorbidities, two-thirds of patients had hypertension (66.1%), 46.8% had hyperlipoproteinemia, and 21.1% had diabetes mellitus. Patients who had an AHI of more than fifteen events per hour more often had higher values of galectin-3. OSA severity had a significant positive correlation with galectin-3 (p = 0.014). In multivariate linear regression analysis, significant independent predictors of higher galectin-3 values were older age, presence of coronary disease, hypoventilation syndrome, higher BMI, NTproBNP, lactate, creatinine, lower LDL, and lower FEV1 (p < 0.05). Conclusions: The present study demonstrated that galectin-3 is linked to the severity of OSA and plays a crucial role in inflammation induced by intermittent hypoxia in OSA. Further screening and interventions targeting galectin-3 could aid in preventing inflammatory diseases related to sleep disturbances.

Interactive 3D visualisation technique used in pulmonary rehabilitation in chronic obstructive pulmonary disease: A randomised controlled study evaluating quality of life, compliance and use of health care.

A pulmonary rehabilitation (PR) programme, including exercise training, education, and behaviour change, is highly recommended in treatment guidelines for chronic obstructive pulmonary disease (COPD). A new PR educational material for PR using an interactive three-dimensional (3D) visualisation technique was developed. There is little known regarding using 3D in this setting. The aim was to evaluate, within a PR programme setting, differences between outcomes of education through interactive 3D compared with education by means of 2D visualisation in patients with COPD regarding health-related quality of life (HRQL), physical capacity, exercise self-efficacy, compliance to exercise training, compliance to medication, and the use of health care and to describe learning styles. Patients were cluster randomised to PR at the University Hospital clinic, including exercise training, for 10 weeks with education by 3D (n = 27) or education by traditional 2D technique (n = 17). At follow-ups, HRQL, physical capacity, self-efficacy, handgrip strength, compliance to exercise training, compliance to medication and health care utilisation were assessed. No significant differences were observed in HRQL in relation to COPD between the groups after 10 weeks. Differences were found in handgrip strength at baseline and at 10 weeks (p < 0.01). The 3D group had improved scores in HRQL assessed with the Leicester Cough Questionnaire (LCQ-S) psychological domain (p = 0.022). In the 2D group, the LCQ-S social domain (p = 0.028), psychological domain (p = 0.021) and the St George's Respiratory Questionnaire total (p = 0.050) were increased. The most common learning mode and learning style in both groups was reflective observation and divergent style. An interactive education in 3D technique used in a PR programme for patients with COPD yielded no significant differences compared to conventional techniques. Three-dimensional techniques can be used in PR for COPD as an alternative to conventional techniques. ClinicalTrials.gov (identifier:NCT02802618).

Prognostic Impacts of Depression and Inflammatory Factors in Pancreatic Cancer Patients.

This study explores the potential connections between clinical depression, inflammation, and cancer progression in pancreatic cancer patients. Conducted from May 2021 to May 2023 at the National Cheng Kung University Hospital Clinical Data Warehouse, this prospective study involved 279 pancreatic cancer patients. The nine-item self-reported Patient Health Questionnaire (PHQ-9) was used to assess depressive symptoms. The study focused on the correlation between clinically significant depression (PHQ-9 scores >10), levels of inflammatory factors, and patient survival rates. At the time of diagnosis, 34.0% of the patients exhibited clinically significant depression. Analysis using Fixed Effects in Generalized Linear Mixed Models (GLMM) revealed a notable link between log-transformed C-reactive protein (ln CRP) levels with occurrence of depression (odds ratio [OR] = 1.274, p = .010). Furthermore, a univariate Cox proportional hazard model with time-varying covariates indicated a correlation between clinically significant depression and decreased overall survival (hazard ratio [HR] = 6.245, p < .001). A multivariate Cox model also showed significant associations of both ln CRP levels (HR = 1.966, p = .030) and clinically significant depression (HR = 3.611, p = .028) with survival outcomes. The findings highlight a complex interplay between inflammation, depression, and survival in pancreatic cancer patients. However, the study is limited by the lack of control over all potential confounders, such as chronic conditions, which could independently influence both depression and inflammatory biomarkers.

P-1595. Short Interval Repeat Testing with a Multiplex Pneumonia Panel is Low Yield- A Case for Diagnostic Stewardship

Abstract Background Multiplex molecular panels have emerged as a tool for the rapid identification of potential pathogens and resistance markers for multiple syndromes including pneumonia. The BioFire® FilmArray® Pneumonia panel (PPP) is a multiplex molecular test that can rapidly detect 33 targets (including bacteria, viruses, and some common resistance genes) from respiratory samples. The role of this test in patient care is evolving and the role of repeat testing is not well described.Figure 1:Results of Repeat Pneumonia Pathogen Panel within 48 Hours Methods We conducted a retrospective chart review of all PPPs conducted at the Emory University Hospital Clinical Microbiology Lab which supports seven academic-affiliated hospitals during the period 3/13/2023-3/14/2024. Patients with a PPP test result within 48 or 168 hours of a previous test result were identified and reviewed for interval changes in the detected targets.Figure 2:Results of Repeat Pneumonia Pathogen Panel within 168 Hours Results There were 2307 PPPs resulted during the study period with a numerical trend of increasing use over time. For the study period, 73 (3.2%) of tests were repeats within 48 hours and 206 (8.9%) were repeats within 168 hours of a previous PPP test. For tests repeated within 48 hours (Figure 1), 46/73 (63.0%) returned the exact same results as the initial test, 7/73 (9.6%) detected fewer pathogens, 18/73 (24.7%) detected at least one additional pathogen. 6/18 (33.3%) of tests detecting a new pathogen detected a common respiratory virus. For tests repeated within 168 hours (Figure 2), 123/206 (59.7%) returned the exact same results, 35/206 (17.0%) detected fewer pathogens, and 45/206 (22.3%) detected at least one additional pathogen. Conclusion Repeat testing with the PPP was common during the study period and almost nine percent of the annual testing volume was repeat testing within one week of a previous result. Short interval repeat testing with the PPP typically returns a result with no additional potential pathogens detected and thus may be unlikely to affect clinical management. Ordering restrictions that include a “lockout period” may be a valid diagnostic stewardship approach to improve the use of this test. Disclosures Eli Wilber, MD, Elsevier: Advisor/Consultant|Roche Diagnostics: Advisor/Consultant

P1358 Microbiome differences in ulcerative colitis patients and healthy controls during the COVID-19 outbreak regarding dietary preferences, supplement, probiotic and antibiotic consumption history

Abstract Background There has been much interest in the possible benefits of microbiome-modulating interventions, such as probiotics, prebiotics, antibiotics in ulcerative colitis. Microbiota plays an important role in host health and is perturbed by several factors including antibiotics and diseases like coronavirus disease 2019 (COVID-19). Methods From June 2021 to June 2022 79 ulcerative colitis (UC) outpatients from Riga East Clinical University Hospital and 78 healthy controls were included in a Cross-sectional study. All patients were divided into groups according to medically proven data about COVID-19 status (COVID-19pos vs. COVID-19neg) within the last 6 months. Information about diet, vitamin, probiotic, and antibiotic intake and faecal samples were collected. MetaPhlAn v.2.6.0 tool was used for taxonomically classifying the gut microbiome shotgun-metagenome data. In further analysis gut microbiome (mostly bacteria phyla) and related data were analysed with SPSS 20.0. Results Overall, 157 participants were included in the study: 79 patients with ulcerative colitis and 78 healthy controls. In the UC group were 35(44.3%) female and 44(55.7%) males, in controls 63(80.8%) female and 15(19.2%) male, p&amp;lt;0.001.The most followed diets were lactose-free diet (8(10.5%) vs.3(3.90%), p=0.2) and gluten-free diet (4(5.19%) vs 6 (7.79%),p=0.7). Controls were more in low carb diet (3 (3.80%) vs.7(8.97%),p=0.2). Vegetarians were more in controls (1(1.27%) vs. 6(7.69%), p=0.06). There were no statistically significant differences regarding sweet consumption and gut microbiome in both groups. In the UC group fewer vitamin C users (8(10.1%) vs. 20(25.6%), p=0.02, vitamin D users 26(32.9%) vs.44(56.4%), p=0.005,vitamin B 4(5.06%) vs. 15(19.2%),p=0.01. In the UC group vitamin C users had less Euryarchaeota (M=0.0;SD=0.1 vs. M=1.0;SD=2.2,p&amp;lt;0.001) and fewer Proteobacteria (M=1.4;SD=1.3 vs. M=4.1;SD=7.8,p=0.11) than non-users. No Euryarchaeota were found in UC using vitamin B (M=0.0; SD+0.0 vs. M=0.9;SD=2.1,p&amp;lt;0.001). No statistical significance was found regarding use of antibiotics in both groups. Probiotics were used less frequently in the UC group at the time of the interview (13(16.5%) vs. 22(28.2%),p=0.1) and during the last month (13(16.5%) vs. 22(28.2%),p=0.1), no statistically significant differences were found in their gut microbiota. There were no statistically significant differences regarding the use of vitamin D and gut microbiome. Conclusion The most followed diets were lactose-free and gluten-free diets. There were no differences regarding sweet and vitamin D consumption and gut microbiome. In the UC group vitamin C users had less Euryarchaeota and less Proteobacteria than no users. There were no Euryarchaeota found in UC who were using vitamin B.

P1332 Differences in gut microbiome regarding education level, occupation and income level during COVID-19

Abstract Background Psychological and physical stress can worsen symptoms and contribute to flare-ups in ulcerative colitis (UC) patients. The education level, occupation and income level may affect ulcerative colitis patients during stressful periods such as COVID-19 outbreak. Methods In 12 months time (June 2021 to June 2022) 79 ulcerative colitis (UC) outpatients from Riga East Clinical University Hospital and 78 healthy controls were included in a Cross-sectional study. All patients were divided into groups according to medically proven data about COVID-19 status (COVID-19pos vs. COVID-19neg) within the last 6 months. Information about education, occupation, income level, stress, and faecal samples was collected. For taxonomical classifying of the gut microbiome shotgun-metagenome data, MetaPhlAn v.2.6.0 tool was used. Stress levels were evaluated by subjective self-assessment reporting high stress in the last month. In further analysis gut microbiome (mostly bacteria phyla) and related data were analysed with SPSS 20.0. Results In the UC group were 35(44.3%) female and 44(55.7%) males, in controls 63 (80.8%) female and 15(19.2%) male,p&amp;lt;0.001. UC group had fewer COVID-19 cases (16(20.5%) vs. 48(61.5%),p&amp;lt;0.001) and were sick for a shorter time (M=2.85;SD=7.10 vs. M=5.68;SD=5.22,p=0.005). UC group with COVID-19 symptoms had less Verrucomicrobia (M=0.1; SD=0.3 vs.M=0.8; SD=2.0,p=0.012). In both groups was equally high stress in the last month; no statistically significant changes were found. UC group was more worried about contracting COVID-19 than controls 29(38.7%)vs.9(11.5%),p&amp;lt;0.001. Evaluating occupation, respondents were in service (56(70.9%)UC vs.72(92.3%) controls,p=0.001). Evaluating education level, 38(48.1%) UC patients had a high school education level vs. 6(7.69%) in the control group p&amp;lt;0.001. Less respondents had a university and above university education level (37(46.8%) in the UC colitis group vs. 72(92.3%) in the control group&amp;lt;0.001. Regarding income level, fewer participants in the UC group considered their income as high 12(15.2%) vs.38(48.7%),p&amp;lt;0.001. UC group respondents considered their income as average 56(70.9%) more often than control 32(41.0%),p&amp;lt;0.001. Conclusion UC patients had COVID-19 less frequently and suffered from COVID-19 shorter time than healthy controls. Both groups underwent high stress in the last month before the interview. UC patients were worried more about contracting COVID-19 than controls. UC group had a high school education and considered their income as average. There were no differences regarding stress levels and gut microbiota in UC and healthy controls. Those in the UC group who had COVID-19 symptoms had less Verrucomicrobia.

P1331 Differences in gut microbiome comparing lifestyle habits between ulcerative colitis patients and healthy controls during COVID-19

Abstract Background Tobacco smoking and alcohol consumption are leading causes of the global burden of disease and are major contributors to premature mortality. The risk factors like cigarette smoking, and diet preferences have been identified responsible for ulcerative colitis patient’s microbiome alteration. Methods In 12-month time (June 2021 to June 2021) 79 ulcerative colitis (UC) outpatients from Riga East Clinical University Hospital and 78 healthy controls were included in a Cross-sectional study. All patients were divided into groups according to medically proven data about COVID-19 status (COVID-19 pos vs. COVID-19 neg) within the last 6 months. Information about smoking, alcohol intake and sports activities, as well as faecal samples, were collected. For taxonomical classifying of the gut microbiome shotgun-metagenome data, MetaPhlAn v.2.6.0 tool was used. In further analysis gut microbiome (mostly bacteria phyla) and related data were analysed with SPSS 20.0. Results Of 157 participants, 79 patients with ulcerative colitis and 78 healthy controls. In the UC group were 35 (44.3%) females and 44 (55.7%) males, in controls 63 (80.8%) females and 15 (19.2%) males, p&amp;lt;0.001 with a slight age difference in the UC group 38.3 (8.53) vs. 44.4 (12.8),p=0.001.People in the UC group were slightly taller (169 (8.08) vs. 174 (9.60), p=0.003) and weighed more (69.3 (13.0) vs. 75.5 (14.7), p=0.006). More smokers were reported in the UC group (17 (21.5%) vs. 6 (7.69%) in the control group, p=0.026. UC group respondents admitted smoking cessation in the past more than controls (48 (60.8%) vs.30 (38.5%), p=0.008),median pack years 9.89 (12.7) vs. 2.85 (4.87),p&amp;lt;0.001). In the UC group, smokers had less Euryarchaeota than no smokers (M=0.3;SD=0.7 vs. M=1.0;SD=2.3, p=0.029). Also, there were no statistically significant differences regarding overall alcohol use and gut microbiome. Sports activities were less frequent in the UC group (35 (44.3%) vs. 57 (73.1%), p&amp;lt;0.001). The most common sports activities were gym (10 (12.7%) vs. 21 (27.3%), p=0.037), stretching and yoga (8 (10.1%) vs. 18 (23.1%), p=0.04) and running (11(14.1%) vs. 13 (16.7%),p=0.8). Cycling was equally frequent in both groups 9 (11.5%), p&amp;gt;0.05. There were no statistically significant differences between activity in sports and gut microbiota, though, cyclers had less Verrucomicrobia (M=0.58; SD=1.02 vs. M=1.46; SD=4.07, p=0.04). Conclusion More smokers were found in UC group. There were no differences regarding overall alcohol use and gut microbiome. There were no differences between sports and gut microbiota, except cyclers had less Verrucomicrobia.

The Role OF 3D echocardiography in prediction of pulmonary vascular resistance and its reversibility in simple congenital heart disease with secondary pulmonary hypertension.

Pulmonary hypertension is a progressive and often fatal disease that frequently presents with the non-specific symptom of dyspnea on exertion. To determine non-Invasive Predictors of Pulmonary vascular resistance severity and reversibility in simple Congenital Heart Disease Patients Using 3D Echocardiography. This was a Prospective cohort study conducted on 40 patients selected from attendees of Cardiology clinics of Ain Shams University Hospitals over a period of 2 years. There was a statistically significant positive correlation between PVR and its reversibility and right ventricular parameters (EDV/ESV/SVI), tricuspid valvular parameters (Coaptation height/Tenting volume/Annulus perimeter/Major axis/Minor axis) measured by 3D echocardiography (P < 0.05). On the other hand, no statistically significant correlation was found between PVR or its reversibility and ejection fraction, and annulus area (P < 0.05). All echocardiographic parameters are either excellent or good predictors for reversibility of PVR except for EF, FAC, and S'. We conclude that EDV, ESV, SVI, CoH, tenting volume, and annulus perimeter were the most important variables to predict the PVR and found that all echocardiographic parameters were either excellent or good predictors for reversibility of PVR except for EF, FAC, and S'.

Nutritional Profiles and Factors Associated with the Intake of Certain Food Types in Patients Undergoing Maxillofacial Prosthetic Rehabilitation: A Cross-Sectional Study.

Background: Malnutrition is a significant concern for head and neck cancer (HNC) patients, as treatment often impairs mastication, causes dysphagia, and alters taste and smell, leading to reduced food intake and a diminished quality of life. Thus, this study aims to compare nutritional intake in HNC survivors using maxillofacial prostheses (MFPs) to healthy reference values and identify the factors influencing their dietary intake. Methods: The study included 56 patients treated for HNC undergoing rehabilitation with comfortable definitive dentures for over a month at the Maxillofacial Prosthetics Clinic of Tokyo Medical and Dental University Hospital. Data were gathered on the demographics, clinical characteristics, malnutrition risk using a malnutrition universal screening tool, dietary intake consistency via a functional oral intake scale, swallowing difficulties with eating assessment tool-10, and nutrient intake through a Brief-type Self-administered Dietary History Questionnaire. Patients' nutrient intakes were compared to the reference values from the BDHQ ad hoc computer algorithm based on the 2015 National Health and Nutrition Survey in Japan. Factors such as maximum mouth opening and the number of functional teeth were also assessed together with the aforementioned factors. Results: There were significant differences between the patient values and reference values, with lower intakes of total dietary fiber, carbohydrates, and β-carotene, while higher intakes of calcium, fats, and certain vitamins were noted in the patients. Food intake consistency, swallowing difficulties, and mouth opening significantly influenced green vegetable intake, whereas sex and the number of functional teeth impacted cereal intake. Conclusions: The HNC survivors were rehabilitated with MFP; however, their nutritional intake differed from that of healthy subjects. The significance of swallowing rehabilitation, appropriate food preparation, exercises to enhance mouth opening, and the preservation of functional teeth has been emphasized as critical factors influencing diet in head and neck cancer (HNC) survivors. Additionally, the importance of a multidisciplinary approach to nutritional care for these individuals is underscored.

Detecting freezing of gait: A comprehensive toolkit for enhanced Parkinson's assessment.

Detecting Freezing of Gait (FOG) poses challenges, with the subjective 6-item FOG Questionnaire relying solely on patient perception. We aim to create a holistic FOG Detection Toolkit combining subjective and objective elements (descriptions, images, and videos) to improve FOG detection precision. Development of the FOG Detection Toolkit involved a detailed cover sheet on FOG and its triggers, along with video exemplars and a 4-item FOG-specific self-assessment questionnaire, all rigorously validated. The toolkit was administered to 100 eligible consecutive Parkinson's disease (PD) patients at a PD referral clinic in a major public university hospital in Thailand. The FOG Detection Toolkit results are based on the total score from a 4-item FOG-specific self-assessment questionnaire (range: 0-16). Freezers were identified by scores ≥6. The cover sheet, images, and videos displayed robust content validity and inter-rater reliability. The 4-item questionnaire exhibited high sensitivity (98%) and specificity (100%), with a substantial Area Under the Curve (AUC) of 0.990 and satisfactory construct validity (r=0.68; p=0.01). Users reported positive pragmatic (1.75) and hedonic (1.34) experiences. Patients with FOG scored significantly higher on the Toolkit and demonstrated distinct gait parameters (p<0.001). The FOG Detection Toolkit showcases strong diagnostic performance, adequate construct validity, and positive user experience, facilitating accurate FOG detection. Its utility extends outside clinical environments, promising broader applicability for FOG management.

Patent Ductus Arteriosus Stenting via Percutaneous Common Carotid Artery Access for Ductus Dependent Pulmonary Blood Flow in Newborns and Infants: Experience in Latvia

Background: Newborn patients with cyanotic congenital heart diseases with ductus-dependent pulmonary blood flow require neonatal repair, or palliation with a secure source of pulmonary blood flow, up to definitive surgical correction or palliation of the malformation. There is growing experience of percutaneous patent ductus arteriosus stenting to maintain the ductal flow. Patients in need of PDA stenting are newborns or small infants and recent data suggests that a weight of &lt;4 kg increases the risk of thrombosis from femoral arterial catheterisation. Carotid access for newborn cardiac catheterisation avoids femoral arterial injury and improves the catheter course for certain transvasal procedures.The aim of this study was to report the Riga Children’s Clinical University Hospital`s (CCUH) 7 year experience of patent ductus arteriosus stenting using the percutaneous transcarotidal approach in newborn babies and small infants with ductus-dependent critical heart diseases.Methods: A retrospective review of all newborn and small infants who underwent transcatheter arterial duct stenting through the percutaneous carotid artery approach at the CCUH in Riga, Latvia between the years 2013 and 2020.Results: In total, 8 patients underwent PDA stenting using the transcarotid approach between the years 2013 and 2020 in CCUH. The approach in all cases was chosen based on the anatomical features seen on echocardiography. In two cases, early restenting was necessary, while other patients had no procedure-associated complications. In the long term follow-up of 4 patients in two cases, dopplerography of the accessed common carotid artery showed stenotic changes up to 50%.Conclusions: PDA stenting using the transcarotid approach is currently considered a relatively safe method and does not have a greater risk of developing postprocedural complications compared to the transfemoral approach. Transcarotidal PDA stenting in neonates and small infants with ductus-dependent critical congenital heart disease is possible in small volume paediatric cardiac surgery centre to stabilise the patient prior to definitive surgery or palliation of complex CHD. The vascular access should be chosen depending on the anatomical features of the patient and the competency of the cardiac interventionalist. From our experience, long-term changes in the affected common carotid artery may develop in a substantial number of cases, they may not be clinically significant in midterm follow-up period but have to be reevaluated. However, further randomised studies are necessary with large cohorts and longer follow-up period.

AN ALTERNATIVE TO THE GOLD STANDARD IN THE SURGICAL TREATMENT OF ACHALASIA CARDIA

The purpose of this study is to compare the results of treatment for achalasia cardia by Heller myotomy and peroral endoscopic myotomy. Subjects and methods. To conduct a comparative assessment of the results of treatment of patients with achalasia cardia by Heller myotomy and Dor fundoplication and peroral endoscopic myotomy, we analyzed the results of treatment of 65 (100.0%) patients who received the treatment at the Multidisciplinary Surgical Department of the National Medical Center «University Clinic» of the Zaporizhzhya State Medical and Pharmaceutical University and Zaporizhzhia Regional Clinical Hospital for 2019–2023. The postoperative observation period was one year. The postoperative follow-up period lasted one year. For a comparative assessment of treatment outcomes, all 65 patients (100.0%) were divided into two groups: group A consisted of 30 patients (46.2%) who underwent surgical treatment using the laparoscopic Heller myotomy with Dor fundoplication technique; group B included 35 patients (53.8%) treated using the peroral endoscopic myotomy (POEM) method. Results. Analysis of treatment outcomes for achalasia cardia based on the Eckardt scale demonstrated significant effectiveness in both groups. In the Heller myotomy group, the score decreased from 7.6 ± 1.1 before surgery to 3.3 ± 0.4 after surgery (p &lt; 0.0001, U = 466.0). Similarly, in the peroral endoscopic myotomy (POEM) group, the score decreased from 7.8 ± 0.7 before surgery to 3.0 ± 0.4 after surgery (p &lt; 0.0001, U = 492.0). These results indicate the equivalent effectiveness of both methods (p = 0.8032, U = 785.0). In the Heller myotomy group, recurrences were observed in 2 patients (6.7%), while in the POEM group, 2 cases (5.7%) of reflux esophagitis were detected post-treatment. However, these results were not statistically significant in either case (p = 0.1944, U = 495.0 and p = 0.6979, U = 490.0, respectively). Conclusion Oral endoscopic myotomy is a modern and minimally traumatic method of treating achalasia cardia, which can compete with Heller cardiomyotomy and can be considered as an effective alternative.

Photodynamic therapy in treatment of Lichen Planus – a literature review

Europäische Wissenschaftliche Gesellschaft Home About the Journal Peer Review Editorial Board For Authors Reviewer Recognition Archive Contact Impressum EWG e.V. Elektronische Zeitschriftbibliotek Logo Bielefeld Academic Search Engine Logo Erfolgreich durch internationale Zusammenarbeit DERMATOLOGY Cite as: Archiv EuroMedica. 2024. 14; 6. DOI 10.35630/2024/14/6.612 Received 18 September 2024; Accepted 13 December 2024; Published 16 December 2024 Photodynamic therapy in treatment of Lichen Planus – a literature review Piotr Janik1 email orcid id logo, Dominika Opala2 orcid id logo, Piotr Zatyka3 orcid id logo, Adam Słomczyński3 orcid id logo, Agata Pawłowska2 orcid id logo, Michał Rabenda2 orcid id logo, Dobromiła Osuch2 orcid id logo 1Wolski Hospital named after Dr. Anna Gostyńska Warsaw, Poland 2Jan Mikulicz-Radecki University Clinical Hospital, Wroclaw Poland 3University Clinical Centre of the Medical University of Warsaw, Poland download article (pdf) piotr.janik@protonmail.com ABSTRACT Introduction: Photodynamic therapy (PDT) is a recognized method in treating various conditions in dermatology, oncology, and gynecology. PDT involves introducing a substance called a photosensitizer into the patient's body, which accumulates in specific, targeted tissues. These tissues are then exposed to a light of a wavelength absorbed by the photosensitizer, leading to the release of cell-damaging factors from the photosensitizer within the targeted cells. Due to its effectiveness and good tolerance, PDT is used in treating both benign and malignant neoplasms, inflammatory diseases and autoimmune skin disorders. Objective: This study aims to analyze the literature on the application of PDT on treating lesions in oral lichen planus (OLP). Materials and Methods: A literature review was conducted using the PubMed database with the following keywords: ‘lichen planus’, ‘oral lichen planus’, ‘photodynamic therapy’, ‘LP’, ‘OLP’, ‘PDT’, applying filters 'clinical trial' and 'randomized clinical trial'. Conclusions: Photodynamic therapy is a promising method for treating oral mucosal lesions in LP. Clinical studies show comparable efficacy to topically applied steroids, with minimal reported adverse effects.

The effect of nursing care during pregnancy termination on women’s prenatal grief, depression, anxiety, stress and coping levels: A randomized controlled study

ABSTRACT The termination of pregnancy is considered an emotionally devastating experience. Early intervention and counseling are essential to prevent adverse complications following pregnancy loss. This study aimed to determine the effect of nursing care based on Swanson’s Theory of Caring on women’s prenatal grief, depression, anxiety, stress, and coping levels during pregnancy termination. The training and counseling program, based on Swanson’s Theory of Caring, included hospital care, a mobile application, and telephone follow-ups. We conducted this prospective randomized controlled experimental study in the gynecology and obstetrics clinic of a tertiary university hospital in Türkiye between September 2021 and May 2022. The study sample consisted of 50 women (intervention group: 25, control group: 25) whose pregnancy was terminated in the second trimester. The women were assigned to groups according to a randomization list created by a statistician. Data collection tools included a Personal Information Form, the Perinatal Grief Scale, the Depression, Anxiety, and Stress Scale, the Coping and Adaptation Process Scale, and the Numerical Rating Scale. We collected the data during hospitalization, between the 6th and 8thweeks after discharge, and at the 12thweek. We performed a chi-square test, a paired samples t-test, and an independent samples t-test on the IBM Statistical Package for the Social Sciences Statistics 26. The intervention group had lower mean perinatal grief (54.76 ± 19.49), depression (2.56 ± 2.39), anxiety (2.08 ± 2.10), and stress (3.52 ± 1.78) scores and higher mean coping and adjustment scores (140.48 ± 11.47) than the control group(p < .05). The intervention group also had a lower perception of labor pain, shorter discharge time, and a higher level of readiness for a new pregnancy (p < .05). The program that we applied in the study was effective in managing the pregnancy termination and post-discharge period in the population we studied.

Assessment of IL-8, RANTES, MIG, MCP-1, IP-10, and IL-12p70 and Their Association with Anxiety and Quality of Life in Patients with Chronic Kidney Disease or After Kidney Transplantation.

Anxiety is a subjective feeling of fear in response to stressful or threatening situations. Chronic diseases (such as chronic kidney disease) or the state after kidney transplantation are such situations and they may result in a decreased quality of life. The main aim of this research was to evaluate if the proteins IL-8, RANTES, MIG, MCP-1, IP-10, and IL-12p70 could be indicators of higher levels of anxiety or decreased quality of life in chronically ill women. The assessment was conducted using the STAI and SF-36 questionnaires and with the measurement of listed proteins from the patient's blood sample. The study group consisted of 107 women-101 patients from the Nephrological Clinic and 6 from the Dialysis Center. Both of the facilities are part of University Clinical Hospital No. 2 in Szczecin. Statistical analysis was performed using JASP software (JASP 0.18.3 version). Anxiety levels and quality of life correlations between STAI and SF-36 scores and individual variables were assessed. Logistic regression models were performed for both questionnaire outcomes: SF-36 and STAI. Lower quality of life was found in the group with a higher IL-8 concentration compared to the group of women with a lower IL-8 concentration. A positive weak correlation was found between a decreased quality of life and IL-8 and RANTES. A higher RANTES level increases the odds of a lower quality of life. This study shows that special care should be provided for chronically ill women (especially with CKD or after KTx) with a higher RANTES or IL-8 concentration. They would highly benefit from close monitoring of their mental health.

Clinical-Epidemiological Profile of Patients With Chronic Obstructive Pulmonary Disease Treated at the Pneumology Outpatient Clinic of a Brazilian University Hospital.

Background Chronic obstructive pulmonary disease (COPD) is asignificant illness that affects many Brazilians. It is a complex and extremely prevalent disease, and thus, understanding the clinical-epidemiological profile of the patients afflicted with this disease is of utmost importance for the adequate management of these patients by multidisciplinary teams. Objective The aim of the study was to describe the clinical and epidemiological profile of COPD patients in a specialized outpatient clinic. Methods This was a cross-sectional study. The sample comprised 198 patients who attended a specialized outpatient clinic in 2018. All variables were collected from the patients' medical records. Results The mean age of the patients was 69.56 ± 8.98 years (CI 95%: 68.30 - 70.82). Of the 198 patients, 115 (58.1%) were male, while 83 (41.9%) were female. Of all patients, 158 (79.8%) were active smokers or former smokers. The mean value for the forced expiratory volume in the first second (FEV1) was 53.35% ± 21.22 of the expected value (CI 95%: 49.76 - 56.94). The mean number of comorbidities presented by the patients was 2.51 ± 1.81 (CI 95%: 2.25 - 2.76) and the average number of drugs the patients were taking for COPD was 2.83 ± 1.24 drugs (IC95%: 2.66 - 3.01). Conclusion This study reveals a complex population, with moderate to severe COPD and a high burden of comorbidities. Thereby, it becomes clear that pulmonologists must consider the COPD patient as a whole due to the high prevalence of factors that can worsen the prognosis in this population.

A biopsychosocial approach towards understanding disparities in exercise participation between Hispanic and non-Hispanic White patients living with knee osteoarthritis.

Engaging in regular exercise is essential for managing knee osteoarthritis (KOA) symptoms. Despite the established findings, sustained exercise adoption remains a challenge for KOA patients, with notable disparities among Hispanic patients, warranting a need to identify determinants that explain the racial discrepancy in exercise participation. The purpose of this study was to employ a biopsychosocial model to identify determinants of exercise participation and highlight racial disparities. Patients (n=163) from a university hospital clinic were medically examined to be considered eligible for the study based on radiographs. Eligible participants completed validated survey measures that assessed exercise participation over the past two weeks, along with measures from biological, psychological and social domains to predict future intention exercise. Structural equation modelling tested hypothesized the paths. Past exercise behavior predicted attitudes, self-efficacy, and future exercise intentions. Pain catastrophizing correlated with exercise participation, but the competing effects of physician and (personal) social support on exercise nullified the significance of pain catastrophizing to exercise participation. Significant ethnicity comparisons found non-Hispanic white patients to have higher education, income, lower BMI, stronger scores on attitudes and self-efficacy, and greater exercise participation time. Non-significant effects between the two ethnicities include intention, physician support, and social support. Designing an intervention that helps foster support from the patient's physician and proximal friends/family members can play a vital role in exercise participation for both ethnicities. Additional focus on developing attitudes and self-efficacy among Hispanics can address some disparities. Further notes on promoting exercise equity using a biopsychosocial approach are provided.

COMPARATIVE ANALYSIS OF ADVERSE EFFECTS FOLLOWING BOOSTER DOSE BY DIFFERENT mRNA COVID 19 VACCINES AFTER TWO DOSES OF ADENOVIRAL VACCINATION IN HEALTH CARE WORKERS

Objective: This study explores the adverse effects to different messenger RNA (mRNA) vaccines (BNT162b2/Pfizer or mRNA-1273/Moderna) in health-care workers (HCWs) who received a third (booster) dose and were previously vaccinated twice with the adenoviral vector vaccine (ChAdOx1-S/Astra Zeneca). Materials and methods: The data were collected based on surveys of 175 HCWs at the University Clinical Hospital (UCH) Mostar from October 2021 to March 2022. The participants filled out the initial general survey form immediately before the booster vaccination and a second survey form regarding adverse effects after the vaccination. Based on the administered vaccines, HCWs were divided into two groups – Pfizer and Moderna. Data organisation and statistical analysis were performed using Microsoft Excel and SPSS statistical software. Results: Out of 175 participants, 132 (75.4%) had mild adverse effects post-vaccination, while no severe adverse effects were recorded. Adverse effects overall were significantly more frequent in participants vaccinated with the Moderna vaccine compared to the Pfizer vaccine (82.7%, P &lt; 0.001) and were significantly more prevalent in women (82.5%, P = 0.031). Specifically, shoulder pain, chills, shivering, and fever were more frequently reported by participants vaccinated with the Moderna vaccine. Conclusions: Both mRNA vaccines were considered safe to use, while the use of the Pfizer vaccine as a booster dose in a heterologous vaccination approach might have a lower incidence of adverse effects. Thus, the wide range of available vaccines is favourable during pandemic, and their dosages should be reconsidered primarily according to their immunological effectiveness in the future. Keywords: COVID-19, COVID 19 Vaccines, booster vaccination, adverse effects, health-care workers.

CLINICAL AND LABORATORY CHARACTERISTICS OF PATIENTS WITH MYASTHENIA GRAVIS: AN EXPERIENCE FROM UNIVERSITY CLINICAL HOSPITAL MOSTAR

Introduction: Myasthenia gravis (MG) is an important health problemthat affects significant number of patients. Proper understanding of the disease characteristics is important for adequate therapeutic approach. Aim: The aim of our study was to determine clinical and laboratory characteristics of patients with MG that were cured at the University Clinical Hospital Mostar. Subjects and methods: Data from the University Hospital Mostar Registry were used. In our study, we included all patients with MG (n=39), over the age of 18, regardless of gender, who regularly visit outpatient clinic. We analyzed following parameters: age, gender, clinical presentation, antibodies (AChR, MuSK), associated comorbidities, therapy, disease history, thymus pathology and applied treatment. Results: MG occurred more often in female patients (58%). In female patients, MG occurred mostly at the age range from 30-70 years, compared to male patients where MG mostly occurred at the age range from 50-90 years. Generalized form of MG was present in 74.36% of patients, and 25.64% had the ocular form. Anti-AChR antibodies were positive in 78.38%, anti-MuSK in 5.41% and 16.22% of patients were seronegative. The prostigmine test was positive in 97.37% and negative in 2.63% of patients. Among the initial symptoms, the most patients had ptosis and fatigue, while dysarthria, dysphagia, and diplopia were less common signs. Conclusion: Based on our study we can conclude that MG mostly affects older female population. The most of the patients had positive Anti-AChR antibodies and positive prostigmine test. Keywords: myasthenia gravis, anti AChR, anti MuSK, pyridostigmine, corticosteroids

INCIDENCE OF PULMONARY THROMBOEMBOLISM IN PATIENTS SUBJECTED TO COMPUTERIZED TOMOGRAPHY AND PULMONARY ANGIOGRAPHY AT THE UNIVERSITY CLINICAL HOSPITAL MOSTAR

Introduction: Pulmonary embolism is a serious medical problem with high mortality if not recognized in time. CT pulmonary angiography is a key method for diagnosing pulmonary embolism in patients with nonspecific symptoms such as shortness of breath, chest pain, and elevated D-dimer values. Objective: To determine the incidence of pulmonary embolism in patients undergoing CT pulmonary angiography at the University Clinical Hospital Mostar. Subjects and methods: A retrospective study included 300 patients with suspected pulmonary embolism who underwent CT pulmonary angiography. Technical imaging parameters included a low-dose protocol with intravenous iodine contrast. The results were analyzed by descriptive statistics, with an assessment of the frequency of pulmonary embolism, thrombus localization and incidental findings. Results: Pulmonary embolism was diagnosed in 27% of patients, with the most frequent involvement of the lobar arteries (43%). Massive emboli were recorded in 33% of cases. The average age of the respondents was 64 years, with an almost equal gender distribution. Elevated D-dimers were not sufficient to confirm the diagnosis in most patients. Incidental findings included pleural effusions, pneumonia, and tumors. Conclusion: CT pulmonary angiography is necessary for accurate diagnosis of pulmonary embolism, especially in patients with nonspecific symptoms. The results highlight the need to combine clinical and imaging methods, as well as adapt diagnostic protocols to reduce radiation exposure and optimize treatment outcomes. In the local context, these guidelines can improve diagnosis and treatment.