Comorbid Pathology Research Articles

INFLUENCE OF ACCOMPANYING GASTRODUODENAL PATHOLOGY ON CLINICAL SYMPTOMS AND QUALITY OF LIFE OF PATIENTS WITH CHRONIC PANCREATITIS

SUMMARY. In spite of the considerable advance in the research of pancreatic pathology, clinical symptoms and syndromes, along with the life quality evaluation with the use of SF-36 and GSRS questionnaires of patients with chronic pancreatitis combined with comorbid pathology of gastroduodenal zone (GDZ) organs continues to be studied and substantiated insufficiently. The aim – to study the clinical symptoms and assess life quality using the SF-36 and GSRS questionnaires in the comorbidity of chronic pancreatitis with H. Pylori-associated chronic gastritis. Material and Methods. 30 outpatients with CP and 117 with CP in comorbidity with chronic gastritis (CG) associated with H. Pylori were examined. A combined assessment of clinical manifestations (symptoms/syndromes) of patients with CP and CP with H. Pylori-associated chronic gastritis was conducted. For the reliable assessment of life quality, groups of patients were compared: the control group, patients with CP and patients with comorbidity. The physical and psychological components were evaluated using the SF-36 questionnaire. Indicators of the life quality components of patients of both groups were also studied according to the scales of the GSRS questionnaire. Results. The clinical symptoms in the comorbidity of CP with accompanying gastroduodenal disorders had specific features compared to those in isolated CP: a smaller number of patients had a pain syndrome (93.3 % vs. 100.0 %); dyspepsia syndrome was found in all the patients with comorbid pathology (100.0 % vs. 86.7 %), a significantly larger number of such patients had nausea (63.3 % vs. 26.5 %), a feeling of heaviness (26.7 % vs. 18,8 %), diarrhea (33.3 % vs. 17.9 %), alternating diarrhea and constipation (26.7 % vs. 23.1 %), enteropancreatic and asthenoneurotic syndromes were detected with a slight advantage in patients with comorbidity – 72.6 % against 66.7 %, and 90.0 % against 83.8 %. It was found that the average total index of the physical component of patients with CP with comorbidity compared to that in the group of isolated CP according to the SF-36 questionnaire was found to be significantly lower: the difference between the values of the average total index of the physical component of life quality of the patients from the comparison groups was 10.42 points (11.2 %). Conclusion. It was established that the difference between the total indicators of the psychological component scales of the life quality according to the SF-36 questionnaire of the groups of patients with CP and patients with comorbidity is 9.71 (11.5 %), which proved that the psychological state of patients with CP with concomitant gastroduodenal changes was significantly worse. The total index of the GRSR scales in the group of patients with CP+GDC (gastroduodenal changes) is significantly higher than of the group with isolated CP – by 1.52 times, and this proved a significantly lower quality of life according to the state of gastroenterological syndromes of the GSRS questionnaire (р≤0.05).

QUALITY OF TREATMENT OF ARTERIAL HYPERTENSION IN COMBATANTS TAKING INTO ACCOUNT THE PRESENT COMORBID PATHOLOGY

Objective: Assessment of compliance of treatment of arterial hypertension (AH) in participants of modern armed conflicts with the requirements of evidence-based medicine, taking into account their comorbid pathology. Design and method: The design of the study was passive retrospective one-time (cross-sectional). The medical charts of inpatient patients of 213 male combatants, aged 27-59 years, average age 45.0 ± 6.8 years, who underwent treatment during 2018-2021, were analyzed by the method of random sampling. Results: It was established that all combatants with hypertension were prescribed antihypertensive drugs: angiotensin-converting enzyme inhibitors (54% of patients), calcium channel blockers (26%), angiotensin receptor blockers (25%) (that is, not all patients used angiotensin-converting enzyme inhibitors or angiotensin receptor blockers), beta blockers (24%) and diuretics (16%). In combatants suffering from hypertension with comorbid coronary heart disease (CHD), beta blockers were prescribed in 26%, calcium channel blockers in 28%, statins in only 45% of patients, without monitoring the achievement of target levels of low-density lipoprotein cholesterol density; antiplatelet therapy was prescribed for 70% of patients, which does not meet the requirements of modern medical and technological documents and needs correction. An insufficient prescription of antihypertensive drugs from the groups of beta blockers (26% of patients) and calcium channel blockers (28%) was established in military personnel with hypertension - participants in modern armed conflicts with comorbid coronary artery disease. Inadequate prescribing of statins (only in 45% of patients) and antiplatelet therapy (70%) to patients with hypertension with comorbid coronary heart disease and lack of strict control of low-density lipoprotein cholesterol levels were revealed. Conclusions: It is necessary to increase the awareness of military doctors about the need for cardiovascular risk stratification in all patients with hypertension and patients with hypertension with comorbid coronary heart disease of combatants, regarding modern requirements for the treatment of patients with hypertension with concomitant pathology, on issues of safety and feasibility of prescribing statins and antiplatelet therapy to combatants with hypertension and concomitant coronary heart disease to reduce the risk of developing cardiovascular complications and improve the prognosis with this comorbidity.

Effect of treatment on genetic predictors and quality of life in rheumatoid arthritis patients with type 2 diabetes, hypertension, and obesity

Background. Connective tissue disease, in particular rheumatoid arthritis (RA), is characterized by a progressive joint damage and polymorphism of extra-articular lesions that affect the patient’s quality of life. Although the widespread implementation of basic therapy through the use of disease-modifying antirheumatic drugs has a positive effect on social consequences, the experience gained shows the impossibility of achieving a stable remission of the disease or reducing the activity of autoimmune inflammation against the background of using these medicines in all patients for a number of reasons. One of these reasons is the presence of comorbid pathology, which requires a personalized approach to each person. The objective was to study the quality of life of patients with RA in combination with type 2 diabetes mellitus (T2DM), hypertension and obesity depending on the T-786C polymorphism of the endothelial nitric oxide synthase gene promoter. Materials and methods. A laboratory and instrumental examination involved 110 patients who were treated at the clinical base of the Department of Internal Medicine of Bukovinian State Medical University, Chernivtsi Regional Endocrinology Center, Chernivtsi Regional Clinical Hospital, and Reference Center for Molecular Genetic Research of the Ministry of Health of Ukraine. Results. When assessing the quality of life in the studied groups, a decrease in indicators on all scales was detected. Thus, in RA combined with hypertension and obesity, PF was 1.73 times lower, RP— 1.97 times, BP— 1.44 times, SF— 1.46 times, MH— 1.26 times , RE— 1.66 times, GH— 1.35 times (p<0.05) lower than in patients with isolated RA. Taking into account the T-786C polymorphism of the eNOS gene, it can be asserted that all indicators of quality of life were reduced in the carriers of the СС genotype, in contrast to the carriers of the T-allele: PF— by 2.06 (pTT<0.05) and 2.46 times (pTС<0.05); RP— by 2.0 (pTT<0.05) and 2.87 times (pTС<0.05); BP— by 1.86 (pTT<0.05) and 2.52 times (pTС<0.05); SF— by 1.55 and 2.07 times (рTС<0.05); MH— by 1.42 (pTT<0.05) and 1.53 times (pTС<0.05); RE— by 1.30 (pTT<0.05) and 1.54 times (pTС<0.05); VT— by 3.34 (pTT<0.05) and 3.72 times (pTС<0.05); GH— by 2.32 (pTT<0.05) and 2.38 times (pTС<0.05), respectively. Conclusions. When comparing the quality of life in the studied groups, it can be stated that the lowest indicators on all scales were in patients with RA combined with hypertension, obesity and T2DM and in carriers of the СС genotype of the analyzed gene, which reflected the worst physical condition and psychosocial status.

THE SPECIFICS OF POSTCOVID ATRIAL FIBRILLATION IN ELDERLY AND LATE-LIFE PATIENTS WITH ARTERIAL HYPERTENSION AND ISCHEMIC HEART DISEASE

Objective: To study the frequency and conditions for the emergence of atrial fibrillation paroxysms (AFP) in elderly and late-life patients in the postcovid period on the background of comorbid pathology. Design and method: 2 months after SARS-Cov-2-pneumonia, 124 people were examined, 66 of them (41 men and 25 women) aged 68±5.9 years (group 1) and 58 (33 men and 25 women) aged 81±4.3 years (group 2). According to computed tomography (CT) performed during SARS-CoV-2-pneumonia, in group 1, 12 patients (18.2%) had lung lesion volume < 25% (CT1); 34 patients (51.5%) 25-49% (CT2); 18 patients (27.3%) 50-74% (CT3); 2 patients (3%) > 75% (CT4). In group 2, 14 patients (24.1%) had CT1; 18 patients (31.1%) CT2; 21 patients (36.2%) CT3; 5 patients (8.6%) CT4. All patients had arterial hypertension (AH) and coronary heart disease (CHD) on the background of atherogenic dyslipidemia; 59 had type 2 diabetes mellitus (DM), 13 had chronic kidney disease (CKD). Holter monitoring (HM) was performed for all. The content of ferritin, D-dimer, and CRP in the blood plasma was measured for all. Results: According to the HM, in 13 of 66 (19.7%) group 1 patients, AFP were registered, of which 7 patients had 30-40 minutes seizures, 3 patients – about 2 minutes seizures. 3 patients were hospitalized, their sinus rhythm was restored by cardioversion. In 16 of 58 (27.6%) group 2 patients, HM revealed AFP, 2 of them were hospitalized due to the deterioration of their condition, the sinus rhythm was restored by cardioversion. In 7 patients, AFP did not exceed 30 minutes; in another 7 patients, AFP were short, no more than 2-3 minutes. Blood ferritin in group 1 was 175±66.2 ng/ml; in group 2 212±40.2 ng/ml (p = 0.012); D-dimer 501±50.3 ng/ml and 835±53.8 ng/ml, respectively (p = 0.0002); CRP 4.3±2.1 mg/l and 8±3.3 mg/l, respectively (p = 0.0009). Conclusions: 2 months after SARS-CoV-2-pneumonia with a large area of lung damage, elderly and late-life patients with a very high cardiovascular risk have signs of inflammation, and a tendency to increased thrombosis, which probably causes the AFP emergence.

PECULIARITIES OF THE COURSE OF ATRIAL FIBRILLATION IN PATIENTS WITH ARTERIAL HYPERTENSION AFTER A CORONAVIRUS INFECTION

Objective: Arterial hypertension is one of the most common comorbid pathologies in patients with atrial fibrillation (AF). The aim of our study was to evaluate blood pressure indicators as a predictor of the development of AF after experiencing a coronavirus infection (CI). Design and method: 187 patients (pts) aged 62,5±0,9 years (47% men, 53% women) were included in the study. The vast majority of pts (89%) had arterial hypertension (stage2 – 80%, stage3 – 9%). The first three groups formed 116 pts who had AF and underwent CI. The first group (G1) consisted of 36 pts who did not have AF before CI. The second group (G2) was represented by 25 pts in whom the transition of the paroxysmal form of AF into persistent, or persistent AF into its permanent form occurred. The third group (G3) consisted of 55 pts in whom the form of AF did not change. Two control groups were formed: K1 - 49 pts with AF who did not have a history of CI, and K2 - 22 pts with extrasystole who experienced CI, but who did not develop AF. Results: Arterial hypertension affected the possibility of developing and worsening the course of AF after CI in G2 pts compared with K1 pts (88,0% vs. 80,0%, p< 0,05), G1 compared with K2 patients. Concomitant hypertension was associated with an increase in the frequency and duration of AF paroxysms after COVID-19. Thus, G2, compared to G3, was characterized by more frequent detection of both 2nd degree hypertension (72% versus 65,5%; p<0,05) and 3rd degree hypertension (12% versus 3,6%, p<0.05). Conclusions: Arterial hypertension are predictors of the development of AF in patients after CI. The presence of AH significantly worsens the course of AF after CI, increasing the frequency of paroxysms of this arrhythmia and their duration.

EPIDEMIOLOGICAL FEATURES OF COMORBID PATHOLOGY IN COMBATANTS WITH ARTERIAL HYPERTENSION

Objective: Determination of the prevalence of comorbid pathology in patients with arterial hypertension (AH) participants in modern armed conflicts in order to implement timely preventive measures in order to prolong their health for military service. Design and method: By design, the research was a passive retrospective one-time (cross-sectional) study. The medical charts of inpatient patients of 213 male combatants, aged 27-59 years, average age 45.0 ± 6.8 years, who underwent treatment during 2018-2021, were analyzed by the method of random sampling. The examined patients were stratified according to the stage of hypertension: 126 patients with hypertension stage I and 87 patients with hypertension stage II. Results: The most common comorbid diseases with hypertension in combatants were diseases of the circulatory system (DCS, 60%), diseases of the endocrine system, nutritional disorders and metabolic disorders (DES, 82%), diseases of the nervous system (DNS, 65%), musculoskeletal diseases ulcer system and connective tissue (59%), diseases of digestive organs (52%), anxiety and depressive disorders (85% and 97% of patients, respectively). The association of an increase in the frequency of various concomitant diseases with the second stage of hypertension was determined - in stage II hypertension, compared with stage I hypertension, DCS was diagnosed more often (98% and 33%, respectively, p < 0.05), DEC (86% and 78%, respectively, p < 0.05), DNS (respectively 77% and 56%, p < 0.05). And diseases of the genitourinary system were more often diagnosed with stage I hypertension (43% and 22%, respectively, p < 0.05). The higher frequency of diagnosis of DCS in stage II hypertension is caused by coronary heart disease (97% and 25%, respectively, p < 0.05). Conclusions: The most common comorbid diseases in military personnel with hypertension who are participants in modern armed conflicts are DCS, DES, DNS, diseases of the musculoskeletal system and connective tissue, diseases of the digestive organs, anxiety and depressive disorders. In order to prolong the health for military personnel with hypertension and participants in modern armed conflicts, measures for the secondary prevention of DCS (primarily coronary heart disease), DES, DNS, anxiety and depressive disorders are expedient.

Characteristics of patients with chronic heart failure in different age groups

There are indications that the severity of clinical manifestations of chronic heart failure (CHF) is related to the age of patients, with older age groups characterized by a more severe course of CHF and more significant pathological changes in instrumental and laboratory parameters. In view of the above, the aim of the present study was to compare NT-proBNP level, other basic parameters of left ventricular myocardial contractility and the results of 6-min walk test, in CHF patients of different age. We investigated these parameters by dividing the total number of subjects into subgroups of young (18-44 years), middle-aged (45-59 years) and elderly (60-74 years) age according to WHO guidelines. There were 111 patients with CHF (82 men and 29 women) aged 20 to 74 years (mean age 60.4±1.25 years). The patients were divided into three subgroups: 1st - young age (21 patients), 2nd - middle age (37 patients) and 3rd - old age (53 patients). Echocardiographic examination, 6-minute walking test, determination of NT-proBNP level in blood plasma were used during the examination. The number of patients with decreased EF (<35%) was significantly lower among young patients, while those with preserved EF was significantly higher among elderly patients. There were more patients with signs of pulmonary hypertension (high systolic pulmonary artery pressure (SPAP)) among elderly patients. The average distance walked during a 6-minute walk was relatively shorter in elderly patients, as well as a greater number of patients with higher (III-IV functional classes (FC)). The number of patients with elevated blood NT-proBNP levels as well as mean NT-proBNP levels were also relatively higher in the older age groups. Thus, the clinical course of CHF is characterized by a more severe course in elderly patients, despite the prevalence of patients with preserved EF, which is confirmed by more frequent occurrence of FC III-IV, clinical-instrumental and laboratory parameters, and is associated, at least partly, with more frequent occurrence of comorbid pathology.

Prognostic significance of mucosal transformation factors in patients with Barrett’s esophagus

Relevance: PB is a dynamic state, regression and progression of the disease are possible in the same patient against the background of a long period of observation. Materials and methods. The study was conducted on the basis of the MMC BR in Moscow in the period from 2013 to 2023, both retrospectively and prospectively. The diagnosis of BE was established on the basis of the endoscopic picture (according to the Prague criteria) and the data of the morphological study of the biopsy material. As a result of the analysis, 122 patients were selected who were on inpatient and outpatient treatment, as well as dynamic observation. Examination of patients included: clinical data with an assessment of comorbid pathology, endoscopic examination with sampling of biopsy material, morphological, including immunohistochemical studies of biopsy material: determination of mutations in the P53, P63 genes and the nuclear proliferation marker Ki-67. The treatment was carried out in accordance with the clinical recommendations of the Russian Gastroenterological Association based on the developed algorithm and included conservative therapy for BE and identified comorbid pathology, as well as in groups of patients with low-grade dysplasia, endoscopic intraluminal treatment-argon plasma coagulation. Results. Analysis of the results made it possible to conclude that the applied algorithm was highly effective: high scores on the goal achievement scale were achieved in 88% of patients. Moreover, the greatest success was achieved in groups with low-grade dysplasia due to the use of personalized methods of treating patients with BE based on a deep clinical and morphological analysis, including, in addition to generally accepted, gender and age characteristics, assessment of comorbid pathology and the dynamics of P53, P63 and Ki-67 in determining the timing of dynamic follow-up of patients.

Arterial hypertension management in patients with confirmed coronary heart disease: how far are we from meeting prevention goals?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction International registry studies offer useful information on the state of the cardiovascular risk factor management. The SURF CHD (Survey of Risk Factors in Coronary Heart Disease) II study is a clinical audit of the recording and management of major cardiovascular (CV) risk factors in patients with established coronary heart disease (CHD). CV risk factors’ control varies by countries and is typically insufficient, according to the prior studies. Purpose This study aimed to assess adherence to European Society of Cardiology (ESC) recommendations for secondary prevention of cardiovascular diseases based on the measurement of blood pressure (BP) control and its therapeutic management in patients with confirmed CHD at different hospitals in one of the regions at high risk for cardiovascular disease. Methods Eight public and private health care centres of Azerbaijan participated in the SURF CHD II study between November 2019 and April 2022. A one-page standard questionnaire of the study was used to collect information electronically on demographics, diagnostic category, risk factors, physical and laboratory data, and prescribed medications from consecutive patients aged ≥18 years with established CHD during outpatient visits. Uncontrolled arterial hypertension (AH) is identified as follows: systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg. Results Data from 949 patients with CHD (the mean age 59.6±9.58 years; 27.3% female) were included in the study. Only 11.7% of participants were involved in a cardiac rehabilitation program. Previous history of AH was registered in 73,1% of participants, while uncontrolled SBP was detected in 59.6% of them. Regarding medications, 82.4% of patients were taking antihypertensive drugs: 52.2% were taking beta-blockers, 51.2% ACE inhibitors, 7.9% ARBs, and 31.7% calcium antagonists. Only 11.7% of participants were involved in a cardiac rehabilitation program. Conclusion The study results have shown that the implementation of the current ESC recommendations for CHD secondary prevention and in particular the control rate of BP is insufficient. Given the fact that patients are at very high risk with different comorbid pathologies, this is of great importance in the management of such patients. This should be taken into account by healthcare organizers when planning secondary prevention activities and public health protection measures, especially in the regions at high risk for cardiovascular disease.

PECULIARITIES OF THE TREATMENT APPROACH FOR HUMERAL DIAPHYSIS FRACTURES IN PATIENTS WITH COMORBIDITIES

Humeral diaphysis fractures are one of the frequent components of the low-energy trauma in people of different age and gender groups with comorbid pathology. Pathological autoimmune and trophic processes that disrupt the reparative capabilities of the body have a negative impact on the formation of connective tissue. The purpose of this study is to identify the peculiarities of the treatment for humeral diaphysis fractures in patients with comorbid pathology. Methods and Material. 42 patients with humeral diaphysis fractures, aged 18 to 88 years, have been involved in the study. All patients were diagnosed to have comorbid pathology affecting the regenerative processes of bone and connective tissues. Type 1 and Type 2 diabetes mellitus was diagnosed in 71.4% (30) and 28.6% (12) patients, respectively. In 28.8% (12) cases, erythrodermic psoriasis without psoriatic arthro- and enthesopathies was diagnosed. The treatment for humeral diaphysis fractures in all studied cases was carried out using the surgical techniques. Results and Discussion. 2 clinical groups of patients were distinguished depending on the applied method of osteosynthesis. The evaluation of the treatment outcomes was carried out according to a number of parameters, namely the presence of complications of combined genesis during the healing of postoperative wounds and prolongation of the repair phase for fracture consolidation and bone callus formation. Conclusions. The risk for postoperative complications among patients with injuries of the humeral diaphysis with underlying erythrodermic psoriasis and Type1 and Type 2 diabetes mellitus can be reduced by minimizing the surgical interventions and applying minimally invasive surgery.

The role of stress and sleep disorders in the development of cardiovascular complications in patients with arterial hypertension: what is important for an internist to know? A review

This publication discusses the mechanisms underlying the development of arterial hypertension on the background of stress, discusses the current problems of blood pressure control in patients with stress-induced sleep disorders, the clinical features of patients with hypersympathicotonia as the main mechanism for the development of arterial hypertension and blood pressure variability in patients with comorbid pathology, a diagnostic algorithm, as well as presenting current recommendations in the strategy for choosing the optimal antihypertensive therapy with the possibility of personalized choice in various clinical situations.

Treatment of patients with knee osteoarthritis with hyaluronate sodium (Revisk) in clinical practice

BACKGROUND: Osteoarthritis is a disease highly associated with a wide range of comorbidities, which leads to significant limitations of the therapeutic possibilities, in particular, the long-term use of non-steroidal anti-inflammatory drugs. Thus, develop algorithms for effective treatment of osteoarthritis aimed at reducing the need for anti-inflammatory therapy is of great importance.
 AIM: To evaluate the efficacy and safety of hyaluronic acid for the treatment of osteoarthritis in patients with comorbid pathology.
 MATERIALS AND METHODS: 30 patients aged 40 to 65 years with IIIII stages of knee osteoarthritis who received treatment with the hyaluronate sodium were examined according to the KellgrenLawrence scale. The course of treatment included standard intra-articular injections of Revisk (sterile sodium hyaluronate gel obtained by microbial fermentation) into the knee joints once a week, in a course of 3 injections. During the study non-steroidal anti-inflammatory drugs therapy was allowed at stable standard dosages. The effectiveness of treatment was assessed by changes in the WOMAC index, the Visual Analog scale pain scores for pain on movement, at rest, goniometry data, 30-meters walking test and stair climb test.
 RESULTS: A positive effect of treatment on all the parameters has been noted: significant improvement in clinical indicators of pain according to the visual analog scale, functional tests, and the WOMAC index scores. The positive dynamics of the estimated parameters during treatment started from the 7th day of therapy.
 CONCLUSIONS: The hyaluronate sodium (Revisk) can be used for treating patients with IIIII stages of knee osteoarthritis with moderate dysfunction of joints.

Depression in patients with cerebral microangiopathy

Cerebral microangiopathy (CMA) is one of the significant causes of depression in the elderly. Close associations of the risk of developing depression with white matter hyperintensity, the presence of lacunar infarcts, and other markers of vascular disease are shown. The available data suggest that various vascular mechanisms, in particular, involvement of small vessels of the brain, generalized microvascular and endothelial dysfunction, metabolic risk factors, – are risk factors for the development of depression. Pathogenetic mechanisms include cerebral hypoperfusion and immune dysregulation. Depression is also a common complication of coronavirus infection, occurring both in the acute and postCOVID periods. The same mechanisms as in vascular depression are involved in the pathogenesis of the development of post-COVID depressive disorders. Given the complexity of the mechanisms of development of depressive disorders in patients with CMA, the presence of severe comorbid vascular pathology, antidepressants with an optimal ratio of efficacy and safety should be preferred. Agomelatine (Valdoxan) is one of such drugs.

Cardiotrophin-1 as a prognostic biomarker of hypertension and a key regulator of cardiac glucose metabolism

Background. Hypertension, type 2 diabetes mellitus (T2DM), and obesity are among the most common diseases in the world, and their growth rates are of a pandemic nature. Since cardiovascular diseases still occupy a leading place in the structure of mortality, the study of biomarkers continues that can be key in the diagnosis of early signs of cardiovascular pathology. Such promising molecule is cardiotrophin-1 (CTF-1). CTF-1 is a protein with a molecular weight of 21.5 kDa, which belongs to the interleukin-6 (IL-6) family. The purpose of this study is to evaluate the circulating level of CTF-1 in comorbid patients with hypertension, and to conduct a comparative analysis of its serum concentration in the presence of various comorbidities. Materials and methods. One hundred and eleven patients with hypertension (men/women— 50/61) aged (54.37±1.18) years and 20 persons of the control group were examined. In the process of examination, they were divided into 4 groups depending on the presence of comorbid pathology: hypertension— group 1 (n=22); hypertension combined with obesity— group 2 (n=30); hypertension and T2DM— group 3 (n=31); hypertension, T2DM and obesity— group 4 (n=28). In all patients, body weight and height were measured, body mass index (BMI) was calculated, glycated hemoglobin (HbA1c) levels, lipid metabolism indicators were determined, systolic and diastolic blood pressure levels were measured. CTF-1 content in blood serum was determined by enzyme-linked immunosorbent assay. Results. A direct correlation of CTF-1 level with weight, BMI, HbA1c level, systolic and diastolic blood pressure was found (p < 0.001). The data obtained prove that CTF-1 can be a trigger for the occurrence of cardiovascular complications, since its level progressively increases with increasing severity of comorbid pathology, and its highest serum concentration is found in patients with hypertension, concomitant T2DM and obesity. The detected changes demonstrate the role of CTF-1, the adipose tissue hormone, in the development of comorbid pathology and make it possible to assert that CTF-1 is a potential biomarker of cardiovascular complications. Conclusions. The level of CTF-1 was significantly higher in patients with hypertension, T2DM, obesity compared to those with hypertension, hypertension and obesity, as well as compared to this indicator in the control group. The concentration of CTF-1 in blood serum positively correlates with the levels of systolic and diastolic blood pressure, body weight, BMI, total cholesterol and HbA1c level. The study of the relationship between the serum level of CTF-1 and metabolic and hormonal indicators in comorbid patients is a promising direction for further research.

Some aspects of the safety of Russian vaccines against COVID-19 in employees of medical organizations

Medical staff and teachers are at high risk of infection. In this connection, it seems relevant to study the effectiveness of the safety of preventive measures aimed at reducing the incidence. A separate issue of which is the results of vaccination of risk groups for infection with SARS-CоV2. The purpose of the study is to evaluate the frequency of registration of post-vaccination reactions of various vaccines against COVID-19 approved for use in Russia among medical staff and faculty of medical higher educational institutions (HEI). A cross-sectional, retrospective, cross-sectional online study was conducted between January and March 2022. The survey involved the teaching staff and medical workers of medical higher educational institutions (HEI) and their subordinate clinics (n = 6032). The majority of vaccinated employees of medical institutions and medical schools had a good tolerability of immunization.Serious adverse events were not registered. A higher incidence of PE and NE was observed in respondents after the first vaccination (p < 0.05). Most often, respondents reported an increase in body temperature (6.9–21.7 %), myalgia (5.5–21.2 %), general weakness (8.4–23.6 %), arthralgia (1.7–9.7 %), local reactions (0.8–16.7 %). In more than 85 % of cases, the above complaints were detected in the first 3 days from the moment of vaccination. A history of COVID-19 infection increased the risk of local and systemic adverse reactions. Gender characteristics of the post-vaccination reaction were revealed, manifested by more frequent registration of NE and PE in men under 35. An inverse relationship between the frequency of NE and PE with age was determined. The presence of comorbid pathology in two or more systems, regardless of age, increased the risk (OR) of various PE and NE from 1.047 to 1.539. The results can be used as an additional tool when planning a personalized approach to vaccinating healthcare workers against COVID-19.

Adult-Onset tethered cord Syndrome: Case series from a comprehensive interdisciplinary spine center

IntroductionDiagnosis, pathophysiology, and rationale for surgical intervention in adult-onset tethered cord syndrome (ATCS) remain controversial. In this population, comorbid degenerative spinal disease (DSD) and prior trauma may sometimes distract from radiologic evidence of TCS. MethodsWe retrospectively reviewed electronic medical records of consecutive patients (2011–2019) presenting with back pain, lower extremity neurological symptoms, and/or urinary or bowel symptoms, who had radiologic evidence of fatty filum terminale (FT) and/or low-lying conus (LLC) in the setting of degenerative spine disease, and who underwent surgical detethering of the spinal cord. Medical history, presenting symptoms, MRI reports, and postoperative outcome data were collected and summarized. FT specimens were analyzed using histology and transmission electron microscopy (TEM). Correlation of preoperative characteristics with outcome were assessed using multivariate logistic regression. ResultsForty-nine patients (mean age 47.9 ± 17.6 years) diagnosed with ATCS were included. Nineteen (38.8 %) had undergone prior spine surgery. From baseline to one-month post-op, the proportion of patients with neurologic symptoms decreased from 100 % to 77.8 % (p < 0.001), back pain from 87.8 % to 48.9 % (p < 0.001), urinary symptoms from 79.6 % to 26.7 % (p < 0.001), and bowel symptoms from 34.7 % to 6.7 % (p < 0.001). Differences remained significantly lower at three-months and 12-months postoperatively (p < 0.05). On MRI, LLC was seen in 75.5 % of patients, fatty FT in 8.2 %, and filum lipoma in 69.4 %. Evidence of DSD was observed in 87.7 % of patients, and prior trauma was reported by 32.7 %, neither of which was correlated with surgical outcome. Forty-six FT specimens were assessed for histology, and 26 for TEM. In addition to known neuronal components of the FT, the collagen ultrastructure revealed collagen corkscrewing and beading (57.7 %) and fibril swelling (57.7 %) on TEM. ConclusionsSurgical intervention resulted in symptom improvement including resolution of urinary incontinence for many patients diagnosed with ATCS, even in the presence of comorbid degenerative spine pathology.

Features of the Clinical Course and Quality of Life in a State with Chronic Pancreatitis and Gastroduodenal Changes

Despite the significant progress in the study of pancreatic gland (PG) pathology, the clinical symptoms and syndromes, as well as assessment of quality of life using the SF-36 and GSRS questionnaires in patients with chronic pancreatitis (CP) in combination with comorbid pathology of the organs of the gastroduodenal zone (GDZ) remain insufficiently studied and substantiated. The objective: to analyze the clinical symptoms and assessment of quality of life using the SF 36 and GSRS questionnaires in the comorbidity of chronic pancreatitis with H. pylori-associated chronic gastritis. Materials and methods. An examination and study of indicators of 30 outpatients with CP and 117 patients with CP in comorbidity with chronic gastritis (CG) associated with H. pylori was carried out. 87 (59.2%) men and 60 (40.8%) women from 19 to 76 years old (average age – 48.29±1.04 years) were the participants. The control group included 30 practically healthy persons, comparable in age and sex. The clinical manifestations of the participants of the study groups were analyzed. For a reliable assessment of the quality of life, groups of patients were compared: the control group, patients with CP and patients with comorbidities. The physical and psychological components were evaluated using the SF-36 questionnaire. Indicators of the quality of life components of patients according to the scales of the GSRS questionnaire were also studied. Results. Clinical symptomatology in the comorbidity of CP with concomitant gastroduodenal disorders had features compared to those in isolated CP. Painful, dyspeptic, enteropancreatic and asthenovegetative, anemic syndromes were more often detected in patients with CP and disorders of the gastrointestinal tract. It was found that the average total score of the physical component in patients with CP and comorbidity was significantly lower than that in the group of isolated CP according to the SF-36 questionnaire: the difference between the values of the average total score of the physical component of quality of life in patients of the comparison groups was 10.42 points (11.2%). Conclusions. The results of the study show that the difference between the total indicators of the scales of the psychological component of the quality of life according to the SF-36 questionnaire of the groups of patients with CP and patients with comorbidity is 9.71 (11.5%). This proves that the psychological state of patients with CP with accompanying gastroduodenal changes is significantly worse.

Effect of APOE ɛ4 genotype on age at onset and comorbid pathologies in multiple system atrophy (P8-11.004)

<h3>Objective:</h3> To elucidate the effect of apolipoprotein (APOE) ɛ4 genotype on age at onset and comorbid pathologies in multiple system atrophy (MSA). <h3>Background:</h3> APOE ɛ4 increases risk of Alzheimer’s disease (AD) and lowers age of onset of late-onset AD. In synucleinopathy, APOE ɛ4 has been reported to correlate with the severity of Lewy body pathology in Lewy body disease and to lower the age of onset of Parkinson’s disease. The association of APOE E4 with MSA is not well understood. <h3>Design/Methods:</h3> This study included 145 pathologically confirmed MSA patients (female 43%) in the Mayo Clinic Brain Bank. We reviewed the medical records to identify the age at onset at which motor or autonomic symptoms presented. MSA patients were divided into two groups: APOE ɛ4 carriers and non-carriers. We examined comorbid pathologies, including AD pathology, Lewy-related pathology, TDP-43 proteinopathy, argyrophilic grains, cerebral amyloid angiopathy (CAA), and aging-related tau astrogliopathy (ARTAG). We defined the presence of AD pathology based on the Braak neurofibrillary tangle stage and the Thal amyloid phase if both were equal or greater than 3. We compared the frequency of each pathology between APOE ɛ4 carriers and non-carriers. <h3>Results:</h3> Among 145 MSA patients, 26% (37/145) had APOE ɛ4 (female 41%) and 74% (108/145) had non-ɛ4 (female 44%). Age at onset was significantly younger in MSA with APOE ɛ4 than non-ɛ4 (P = 0.028, 56 ± 6 vs. 60 ± 10 years old). The frequency of CAA was significantly greater in MSA with APOE ɛ4 than non-ɛ4 (P = 0.0032, 43% vs. 18%); however, there was no significant difference in the frequency of AD pathology, Lewy-related pathology, TDP-43 proteinopathy, argyrophilic grains, and ARTAG. <h3>Conclusions:</h3> Our results indicate that APOE ɛ4 is associated with CAA in MSA, as well as lower age at onset, but not AD or Lewy-related pathologies. <b>Disclosure:</b> Dr. Sekiya has nothing to disclose. Dr. Koga has nothing to disclose. Dr. Ross has nothing to disclose. Dr. Dickson has nothing to disclose.

Seizure Rates Across Pathologically-Confirmed Dementia Subtypes (P3-6.005)

<h3>Objective:</h3> Taking advantage of a large autopsy series of uniformly pathologically-characterized persons with dementia (PWD), our goal was to determine the seizure occurrence rate for different types of pathologically confirmed dementia subtypes. <h3>Background:</h3> The incidence of seizures in PWD is higher than in persons without dementia. However, evidence of this is based on studies that included clinically-diagnosed all-cause dementia, pathologically-diagnosed Alzheimer’s Disease (AD), or clinically-diagnosed subtypes of dementia without pathological confirmation. <h3>Design/Methods:</h3> Retrospective review of clinical and autopsy records among all veterans who died while in a VA-based Special Dementia Care Unit and whose families consented to brain autopsy was conducted. <h3>Results:</h3> Of the 335 veterans, the majority (n = 327, 97.61%) were male with an average age of 78 years at death (SD=7.62). The average age at first reported symptom was 71 (SD=8.28). Overall, 57 (17%) veterans had evidence of new-onset seizures after the date of their dementia diagnosis and were thus considered to have dementia-related seizures. Of those with AD-only neuropathology (n=121), 26 (21.5%) had developed seizures and accounted for 45.6% of all the dementia-related seizure cases. In addition, most of the remaining cases of dementia-related seizures (n=26, 45.6%) showed evidence of AD pathology and in addition to another comorbid pathology. The remaining five (8.8%) were diagnosed with Frontotemporal Dementia and/or Traumatic Brain Injury. <h3>Conclusions:</h3> Dementia-related seizures are common and are associated with AD pathology. Even among pathologically mixed dementias, seizure prevalence was driven by AD pathology. Diagnosis of seizures in patients with dementia may reflect underlying AD pathology, regardless of clinical presentation. The development of dementia-related seizures should raise the possibility of underlying AD pathology and thus could have implications for treatment response. <b>Disclosure:</b> An immediate family member of Dr. Moo has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Taylor and Francis. Dr. Moo has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Smith Mirabella Blake. Dr. Moo has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Cambridge Medical Experts. The institution of Dr. Moo has received research support from VA HSR&amp;D. The institution of Dr. Moo has received research support from VA Office of Rural Health. Prof. Shirk has received personal compensation for serving as an employee of Hologic. The institution of Prof. Shirk has received research support from Alzheimer’s Association. The institution of Prof. Shirk has received research support from VA. The institution of Prof. Shirk has received research support from NIA. Dr. Baumann has nothing to disclose. Dr. Sullivan has nothing to disclose.

P117 Machine-learning derived characteristics associated with tapering TNF inhibitors in individuals with rheumatoid arthritis

Abstract Background/Aims Tapering of TNF inhibitor (TNFi) drugs may be considered in some patients to reduce risks and costs. Selecting appropriate patients is not always straightforward and may be influenced by age, sex, comorbidity and disease activity state. We sought to identify predictors for dose tapering in a real-world clinical setting. Algorithmic extraction, selection and analysis of relevant patient sub-cohorts could enable identification of relevant predictors associated with TNFi dose tapering. Methods Our institution has a Rheumatology Biologics database running prospectively for over 15 years. Our approach for patients with RA receiving TNFi has been to dose-taper by one third and then 50% if remission achieved (defined as DAS28&amp;lt;2.6 on two occasions more than 6 months apart with no corticosteroid use). Prescribing, disease activity scores and demographics were extracted using SQL along with comorbidity coding, pathology results and anthropometric data. Data were anonymised and analysed in Python 3.8 within our institutions’ Trusted Research Environment (TRE). Pandas, NumPy and StatsModels python packages were used for the analysis in Jupyter notebooks. 49 covariates were considered clinically relevant and included in the regression analysis. Recursive feature elimination (RFE) was performed using logistic regression (LR) with threshold p-value of 0.05. The primary outcome was tapering of TNFi, algorithmically identified by a temporal increase in dosing interval or decrease in dosage. To avoid multiple-drug confounding, only the most recent TNFi data was included for each patient. Results 663 patients with RA were initiated on TNFi between 5th November 2001 and March 2nd 2020. 491 (74.1%) were female with a mean age of 65.5 (SD ± 14.2) years. 261 (39.4%) received adalimumab, 209 (31.5%) etanercept, 74 (11.2%) infliximab, 82 (12.4%) certolizumab and 37 (5.6%) golimumab. Concurrent methotrexate (MTX) was seen in 34.5% (n = 22), either oral or subcutaneous. There was no change in the likelihood of tapering associated with depression, hypothyroidism, obesity, smoking or seropositivity for RF or anti-CCP. Those taking MTX were more likely to taper their biologics (OR 3.33, 95%CI 1.83-6.09, p = &amp;lt;.000), as were patients who were coded as having type 1 or 2 diabetes (7.4% n = 49, OR 3.23, 95%CI 1.32-8.25, p = 0.011), Higher DAS28 CRP score (OR 0.548, 95%CI 0.38-0.78, p = 0.001), and DAS 28 ESR score (OR 0.71, 95%CI 0.53-0.95, p = 0.021) significantly decreased chance of tapering. Conclusion Concurrent methotrexate use increases likelihood of subsequent tapering in patients with RA receiving TNFi. Unexpectedly, patients with diabetes were also more likely to taper, however due to low numbers of patients in this group and the width of confidence intervals this should be interpreted cautiously. As expected, patients with high disease activity scores were less likely to taper. This algorithm driven approach produced results largely in keeping with clinical intuition, however these methods may aid in future selection of tapering cohorts. Disclosure T. Phillips: None. M. Bhandari: None. M. Stammers: None. S. Fraser: None. M. George: None. S. Lin: None. M. Lwin: None. C. Holroyd: None. C. Edwards: Other; CE has received fees for advisory boards, speaker’s bureau, research support from Abbvie, Astra Zeneca, BMS Celltrion Chugai, Gilead, Galapagos, GSK, Janssen, Eli Lilly, Pfizer, Roche, Sandoz, Samsung.