Concomitant Chronic Diseases Research Articles

Relationship between nutrition and chronic low back pain. Review

Low back pain is a common and complex condition that significantly affects people’s daily functioning, ability to work, quality of life and places a significant burden on the healthcare system. Chronic low back pain is pain that persists for more than 12 weeks and is caused by mechanical, psychological and social factors. The main risk factors for chronic low back pain include a sedentary lifestyle, overweight and obesity, high stress levels, smoking, sleep disturbances, concomitant chronic diseases and poor diet. The World Health Organisation emphasises the importance of nutrition as part of a healthy lifestyle and an important preventive aspect of chronic non-communicable diseases. The relationship between nutrition and health is complex and multicomponent, involving direct and indirect mechanisms of influence. In recent years, a significant number of publications have appeared in the literature on the relationship between nutrition and low back pain. The purpose of this review was to analyse and systematise the knowledge on the mechanisms of the relationship between nutrition and chronic low back pain. An unhealthy diet is the main cause of underweight or overweight, which has an indirect effect on the development of chronic low back pain. Diets with anti-inflammatory properties can reduce inflammation, normalize weight, and have a positive effect on the course of chronic low back pain. The review found that the main mechanisms of interaction between nutrition and chronic pain are the pro-inflammatory properties of foods, underweight, overweight and obesity, and macro and micronutrient deficiencies. There is a need to develop nutritional strategies for patients with chronic low back pain as one of the key areas of a multidisciplinary approach to solving this problem.

Cardiovascular Health Status in US Adults With Chronic Diseases: National Health and Nutrition Examination Survey (NHANES), 2013-2018.

Cardiovascular health (CVH) assessment may have important benefits for adults with chronic diseases to prevent incident cardiovascular disease and additional chronic conditions. Few studies have compared CVH in adults with chronic diseases and healthy adults without chronic disease using the American Heart Association's (AHA's) Life's Essential 8 (LE8) metrics. We used National Health and Nutrition Examination Survey data from 2013 to 2018 to identify the presence of 16 chronic diseases by participant self-report of diagnosis. We included adults aged 20 to 79 years. CVH was defined by AHA's LE8 metrics. Overall mean LE8 (range 0-100, higher = better CVH) and individual LE8 metric scores were calculated according to disease status for all participants and stratified by self-identified sex, race, and ethnicity. There were 12 296 adults (51% women; mean age, 46 years) representing >186 million noninstitutionalized US adults. Significantly, and often substantially, lower CVH scores were noted for adults with chronic disease (14 of 16 diseases studied) versus unaffected adults, including all subtypes of cardiovascular disease, lung diseases, chronic kidney disease, liver conditions, cancer, arthritis, cognitive decline, and depression. For example, mean overall LE8 score was 14.0 points lower in those with versus without chronic obstructive pulmonary disease (51.0 versus 65.0, P<0.0001). Men and Black adults consistently had lower LE8 scores. CVH is significantly poorer in adults with many chronic diseases compared with unaffected adults. These data suggest the utility of the LE8 score to identify groups for targeted optimization of CVH to enhance primary and secondary prevention efforts for cardiovascular disease and potentially for concomitant chronic diseases of aging.

Changes in clinical condition and quality of life of patients with involutional changes of facial skin and metabolic syndrome after the course of treatment with therapeutic physical factors

BACKGROUND: The presence of concomitant chronic non-infectious diseases, which significantly increase in probability and severity with age, contributes to the intensity of external manifestations of involutional processes. This is absolutely true for the metabolic syndrome, which is confirmed to be associated with involutional changes in the skin and soft tissues of the face through systemic mechanisms of comorbidity, determining mutual additive influences. AIM: The aim of the study was to evaluate the clinical efficacy of the combined use of transcranial magnetic field therapy, oxygen bar therapy, and laser phoresis of hyaluronic acid for the treatment of involutional skin changes in patients with metabolic syndrome. MATERIALS AND METHODS: Using a simple randomization technique, patients with involutional skin changes associated with metabolic syndrome (n=120) were divided into 4 groups of 30 subjects each. Subjects in group 1 (control group) received only laser phoresis of hyaluronic acid; subjects in group 2 (comparator group 1) received one course of transcranial magnetic therapy; subjects in group 3 (comparator group 2) received one course of oxygen bar therapy; subjects in group 4 (experimental group) received one course of combined treatment (laser phoresis of hyaluronic acid + transcranial magnetic therapy + oxygen bar therapy). Results were evaluated based on changes in the severity of key clinical and functional signs of age-related skin changes. In addition, the quality of life of the patients was evaluated using the Dermatologic Index, and the overall aesthetic improvement was evaluated using the Global Aesthetic Improvement Scale (GAIS). RESULTS: The comorbidity of chronoaging with metabolic syndrome is associated with subjectively more severe major clinical manifestations of facial skin aging and indicative changes in its morphological and functional parameters. A comparative analysis of the effectiveness of using different monotherapy regimens showed the most significant regression of clinical manifestations with the laser phoresis of hyaluronic acid. The total subjective score of major clinical manifestations of age-related skin changes decreased by 39.8% on a visual analog scale (VAS), and the quality of life increased by 61.7%. The GAIS score was 2.48. Visual analog scale scores were largely consistent with changes in objective skin parameters. In the transcranial magnetic therapy and oxygen bar therapy groups, the effect was weaker and almost equal. The highest efficacy was reported in the experimental group: regression of clinical manifestations of skin chronoaging and restoration of objective dermal parameters were reliable and exceeded the level of the control group after the treatment. CONCLUSION: The combined treatment shows a significant increase in clinical efficacy due to the pathogenetic effect on the metabolic syndrome. Sinergy of therapeutic physical factors is achieved by different modalities, sites of treatment, and mechanisms of biological potential.

The use of physiotherapy methods in the complex treatment of patients with chronic laryngitis

Purpose of the study. Issues of voice quality and health as the main means of communication are becoming increasingly relevant. The increase in the incidence of chronic laryngitis among patients of different age groups is due to a significant list of etiological factors, including deteriorating environmental conditions, exposure to bad habits, a significant increase in stress levels and the presence of chronic concomitant diseases. In this aspect, it is important to take into account the increasing load on the vocal apparatus, as well as the increasing requirements for voice quality in modern society. Materials and methods. The purpose of this study was to increase the effectiveness of complex conservative treatment of patients with chronic laryngitis as a result of exposure to low-intensity laser radiation on the larynx area. 52 patients with voice disorders were examined and treated and were divided into two groups. The results. In group 1, 24 patients received complex treatment, which included a course of drug inhalations, phonopedagogical correction, and compliance with the voice regime. In group 2, consisting of 28 patients, a similar complex conservative treatment was supplemented with laser therapy for the larynx area. When conducting a comparative analysis of the results of therapy, based on an assessment of the dynamics of patient complaints, data from a videolaryngostroboscopic study and acoustic analysis of the voice, a more pronounced improvement in the clinical and functional state of the larynx was found in patients of the 2nd group. Conclusion. Consequently, the use of low-intensity laser therapy on the larynx area as part of complex conservative treatment of chronic laryngitis helps to achieve a significantly predominant clinical result and improve the quality of life of patients with chronic pathology of the vocal apparatus.

From NAFLD to MAFLD and MASLD: a tale of alcohol, stigma and metabolic dysfunction

Liver steatosis is a frequent finding in clinical practice and it is estimated to affect 30% of the general adult population worldwide. It became one of the leading causes of end-stage liver disease and hepatocellular carcinoma. From its first description, a diagnosis of nonalcoholic fatty liver disease (NAFLD) required the exclusion of excessive alcohol consumption and concomitant chronic liver diseases of different origins, making it a diagnosis of exclusion. In recent years, the need to stress the strict association between liver steatosis and metabolic dysfunction (i.e., insulin resistance, overweight/obesity, type 2 diabetes, and metabolic syndrome), as well as the desire to define a condition in a positive rather than negative way, led to new definitions and new diagnostic criteria. Metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed by Eslam et al. in 2020. More recently, a Delphi consensus endorsed by several international hepatologic societies proposed a new terminology [metabolic dysfunction-associated steatotic liver disease (MASLD)] and a new set of diagnostic criteria. The MAFLD and MASLD definitions have a good degree of concordance. They mainly differ in the number of metabolic derangements needed to define “metabolic dysfunction” in normal-weight individuals and in alcohol consumption. Indeed, while MAFLD does not exclude patients with significant alcohol consumption, the recent Delphi consensus included the metabolic dysfunction and alcohol-related liver disease (MetALD) disease entity, a condition in which steatosis, metabolic dysfunction, and moderate alcohol intake coexist. In the present narrative review, we underline the strengths and possible limitations of each definition and summarize available evidence from epidemiologic studies evaluating the clinical usefulness of each set of diagnostic criteria.

Efficacy of combined lumbar plexus and parasacral sciatic nerve block in elderly patients undergoing hip fracture surgery: a retrospective analysis

Aims: Hip fractures are a major cause of morbidity and mortality in the elderly population. Anesthesia management significantly affects outcomes in elderly patients. In recent years, peripheral nerve blocks acquired importance, especially in patients where subarachnoid blocks are contraindicated or in patients with severe pulmonary or cardiac diseases. This study aimed to retrospectively evaluate the efficacy of combined lumbar plexus block and parasacral sciatic nerve block in geriatric populations. Methods: Data from patients over 70 years of age (ASA III) who underwent surgery for hip fracture and received combined lumbar plexus and parasacral sciatic nerve blocks between 2014 and 2024 were retrospectively analyzed. The efficacy of anesthesia, the need for intraoperative rescue anesthesia, and hemodynamic parameters were evaluated. Results: The mean age of the 98 patients included in the study was 79.81 ± 8.94 years. Most patients had concomitant chronic diseases. A total of 19 (19.94%) patients were administered Fentanyl 50 mcg and Propofol 0.5 mg/kg for pain at the beginning of surgery, and none of the patients who received sedoanalgesia experienced severe respiratory distress or low oxygen saturation. Anesthesia and analgesia were effectively administered, and the need for intraoperative rescue anesthesia was low. Hemodynamic parameters remained stable. Conclusion: Combined lumbar plexus and parasacral sciatic nerve block is an effective anesthetic method for hip surgery in elderly patients with comorbidities. This method reduces the need for general anesthesia, provides comprehensive analgesia, and maintains hemodynamic stability.

Effect of multimorbidity on depressive status in older Chinese adults: evidence from the China Health and Retirement Longitudinal Study (CHARLS)

ObjectiveThis study aims to further explore the relevant influencing factors of depression and explore the correlation between multimorbidity coexistence and depression to find the goals and methods of early intervention...

Evaluation of Tracheostomy Patients in Our Pediatric Intensive Care Unit: A Single-Center Study.

A tracheostomy is a surgical procedure that can be performed on critically ill patients of all ages in intensive care units as indicated, and its use has been increasing in recent years.The most common indications are prolonged mechanical ventilation and upper airway obstruction. This study aimed to examine the indications for tracheostomy, assess the outcomes of patients who underwent the procedure, and identify the factors affecting these outcomes. Material and method: A retrospective analysis of patients who underwent tracheostomy between 2013 and 2019 at Dicle University Faculty of Medicine Hospital Paediatric Intensive Care Unit (PICU). The patients' age, gender, distribution by age, primary diagnosis at admission to the intensive care unit, indication for tracheostomy, presence of additional disease, type of respiratory support before and after tracheostomy, development of complications (perioperative/postoperative), decannulation status, mortality, and discharge status were recorded. Results:A total of 61 patients were enrolled into the study.The average age of the patients was 81.72 months (SD = 17.5), with the youngest being eight months old and the oldest being 203 months old.Of the 61 patients included in the study, 32 (52%) were male and 29 (48%) were female. The majority of patients (32 patients) were in the preschool age group (25-84 months). The primary diagnosis of 27 patients (44.3%) who underwent tracheostomy was neuromuscular diseases, and the most common indication for tracheostomy was prolonged intubation (24 patients, 39.3%). Concomitant chronic diseases were present in 54 patients (88.5%). Patients received mechanical ventilation support for an average of 47.34 days before tracheostomy. Early tracheostomy (0-21 days after initiation of mechanical ventilation) was performed on 14 patients, and late tracheostomy (21 days and later) was performed on 47 patients. Complications developed in nine patients (14.8%) in the perioperative period and in 19 patients (31.1%) in the postoperative period, while no complications developed in 39 patients (63.9%). Six patients (9.8%) were decannulated. Furthermore, 28 patients (45.9%) died.No tracheostomy-related mortality was documented. Despite most patients being of preschool age, having prolonged intubation prior to tracheostomy, and having accompanying chronic illnesses, tracheostomy remains a frequently used procedure in paediatric intensive care units due to its low complication rates, making it an essential intervention that facilitates discharge from paediatric intensive care.

Leveraging Computed Tomography Imaging to Detect Chronic Obstructive Pulmonary Disease and Concomitant Chronic Diseases.

Leveraging Computed Tomography Imaging to Detect Chronic Obstructive Pulmonary Disease and Concomitant Chronic Diseases.

Blood infection of Capnocytophaga canimorsus etiology following a dog bite: case report and review of the available literature.

We present the case of a 71-year-old man who developed sepsis caused by Capnocytophaga canimorsus as a result of being bitten by his own dog. Positive blood cultures were obtained, but due to difficulties in determining the bacterial species, the patient was treated empirically with ceftriaxone and levofloxacin. After using the recommended empirical therapy, the patient's condition improved. Capnocytophaga canimorsus is difficult to identify, among others, due to its long growth time and specific development conditions (capnophiles). These Gram-negative bacilli cause a number of diseases in humans, ranging from infections of the skin and subcutaneous tissue, through peritonitis, to sepsis. The portal of infection with these bacteria is most often a wound caused by an animal bite. Additional risk factors that increase the risk of developing a severe infection and even death include older age, concomitant chronic diseases, and immunosuppression.

How Immunonutritional Markers Are Associated with Age, Sex, Body Mass Index and the Most Common Chronic Diseases in the Hospitalized Geriatric Population-A Cross Sectional Study.

this study included 1190 hospitalized geriatric patients. The criteria to participate were ability to communicate, given consent and C-reactive protein (CRP) lower than 6 mg/dL. the mean age of the study population was 81.7 ± 7.6 years. NLR (neutrophil-to-lymphocyte ratio), LMR (lymphocyte-to-monocyte ratio), MWR (monocyte-to-white blood cell ratio), SII (systemic immune-inflammation index), PNI (prognostic nutritional index) and CAR (C-reactive protein-to-albumin ratio) were related to age. NLR and MWR were higher, while LMR, PLR (platelet-to-lymphocyte ratio and SII were lower in men. All markers were related to BMI. NLR, LMR, LCR (lymphocyte-to-CRP ratio), MWR, PNI and CAR were related to several concomitant chronic diseases. In multivariate analyses, age and BMI were selected as independent predictors of all studied immunonutritional markers. Atrial fibrillation, diabetes mellitus and dementia appear most often in the models. PNI presented the most consistent statistical association with age, BMI and concomitant chronic diseases. this study reveals the pivotal role of aging and BMI in inflammatory marker levels and the association of immunonutritional markers with different chronic diseases. Atrial fibrillation seems to have the most dominant connection to the immunonutritional markers.

Assessment of Skin Autofluorescence and Its Association with Glycated Hemoglobin, Cardiovascular Risk Markers, and Concomitant Chronic Diseases in Children with Type 1 Diabetes.

A total of 348 children with T1D aged 3-18 years and 85 age- and gender-matched control subjects were enrolled. sAF was quantified using an AGE Reader (Diagnoptics BV, The Netherlands). The analysis covered HbA1c, blood lipid, and C-reactive protein (CRP) levels, ambulatory blood pressure monitoring records, and body composition parameters. The associations between variables and sAF were assessed using the Mann-Whitney U test and Spearman correlation. We observed significantly higher sAF values in the T1D group compared to the control (1.40 [1.27-1.53] vs. 1.20 [1.07-1.30, AU]; p = 0.004), consistent across all tested age groups. In the T1D group, sAF was positively correlated with current HbA1c, mean of historical HbA1c values, and T1D duration (r values, respectively: 0.27, 0.22, 0.14, all p < 0.01). Percentage of body fat was positively correlated with sAF (r = 0.120; p = 0.044). No significant correlations were found between sAF and lipid fractions, Z-score of BMI, parameters from 24 h ambulatory blood pressure monitoring, or the amount of albumin excreted in urine. sAF was positively correlated with CRP (r = 0.17, p < 0.05). sAF was significantly higher in patients with concomitant celiac disease (1.53 [1.43-1.63] vs. 1.40 [1.27-1.53, AU], p = 0.001). Among young T1D patients with relatively brief diabetes duration, sAF effectively mirrors prior glycemic control, as presented by historical average HbA1c. However, associations with conventional CV risk markers are not evident. The higher sAF values in patients with celiac disease warrant further exploration.

Integrated self-management support provided by primary care nurses to persons with chronic diseases and common mental disorders: a qualitative study

BackgroundMore and more people suffer from concomitant chronic physical diseases and common mental disorders, calling for integrated self-management support in primary care. However, self-management support of chronic physical diseases and common mental disorders is not clearly operationalized by guidelines and is still conducted in silos by primary care nurses, especially in favour of chronic diseases. This study aims to better understand primary care nurses’ experience of integrated self-management support for people with physical chronic diseases and common mental disorders.MethodsAn interpretive descriptive qualitative approach was conducted with 23 primary care nurses from family medicine groups in Quebec (Canada). They were selected through purposive and snowball sampling methods to participate in an individual interview. Data were analysed using an iterative inductive and deductive analysis (Rainbow Model of Integrated Care and the Practical Reviews in Self-Management Support (PRISMS) taxonomy).ResultsNurses’ experience of integrated self-management support for people with CD and CMD was structured around: (1) elements of the approach; (2) clinical integration through prevention and health promotion; and (3) operationalization of integrated self-management support. Several elements deemed essential to integrated self-management support were identified. Nurses offered integrated self-management support through prevention of risk factors and promotion of a healthy lifestyle for physical chronic diseases and common mental disorders. Nurses’ self-management support activities included education, action plans, monitoring, and many practical, psychological, and social support strategies. A model of integrated self-management support for primary care nursing is proposed to better understand its clinical integration.ConclusionThis study presents clinical integration of self-management support and activities for people with physical chronic diseases and common mental disorders in primary care settings. Understanding integrated self-management support will help implement future interventions.

A Study of the Association between Primary Oral Pathologies (Dental Caries and Periodontal Diseases) Using Synchrotron Molecular FTIR Spectroscopy in View of the Patient's Personalized Clinical Picture (Demographics and Anamnesis).

In this exploratory study, we searched for associations between the two most common diseases of the oral cavity-dental caries and periodontal diseases-taking into account additional factors, such as personalized clinical pictures (the individual risk factors of the patient), based on the method of a multivariate data analysis of the molecular changes in the composition of human gingival crevicular fluid (GCF). For this purpose, a set of synchrotron Fourier-transform infrared spectroscopy (FTIR) spectra of gingival crevicular fluid samples from patients with different demographics, levels of dental caries development and periodontal diseases, and the presence/absence of concomitant chronic diseases were obtained and analyzed. Using a set of techniques (v-, F-, Chi-square tests; a principal component analysis (PCA); and the hierarchical clustering of principal components (HCPCs)) implemented in the R package FactoMineR allowed us to assess the relationship between the principal components (PCs) and characteristics of the respondents. By identifying the features (vibrational modes in the FTIR spectra) that contribute most to the differentiation of the spectral dataset, and by taking into account the interrelationships between the patients' characteristics, we were able to match specific biological markers (specific molecular groups) to the two factors of interest-two types of oral pathologies. The results obtained show that the observed changes in the quantitative and qualitative composition of the modes in the infrared (IR) spectra of the GCF samples from patients with different dental caries developments and periodontal diseases present confirm the difficulty of identifying patient-specific spectral information. At the same time, different periodontal pathologies are more closely associated with other characteristics of the patients than the level of their caries development. The multivariate analysis performed on the spectral dataset indicates the need to take into account not only the co-occurrence of oral diseases, but also some other factors. The lack of this consideration (typical in lots of studies in this area) may lead to misinterpretations and consequently to a loss of data when searching for biological markers of certain oral diseases.

Impact of comorbidity on surgical management of breast cancer in elderly patients.

e12596 Background: More than half of breast cancers are diagnosed above the age of 60 years, a quarter of which diagnosed with invasive breast cancer among those over 75 years of age. Treatment of breast cancer (BC) at this age remains a complex problem. Elderly patients often have various comorbidities that impose increased risks of complications with antitumor treatment. This leads to both excessive and insufficient treatment of BC. In patients over 75 years of age, an individual approach to treatment is recommended, taking into account their general health and life expectancy, the risk of death from breast cancer compared to other causes, as well as the advantages and disadvantages of treatment methods. Objective: To evaluate the influence of comorbidity on the risks of complications (early and delay) after surgical treatment in elderly and senile patients (pts). Methods: A retrospective analysis of the results of breast cancer treatment in 292 pts over 75 years of age, who underwent surgical treatment at the first stage in SBIH Moscow Clinical Scientific and Practical Center named after A.S. Loginov of DHM from 2016 to 2019. The initial stages of breast cancer (I and IIA) were diagnosed in 257 (88.0%) pts, 35 pts (12.0%) has IIB and IIIA clinical stages. Radical mastectomy was performed in 171 (58.6%) cases, breast-conserving surgery was performed in the remaining 121 (41.4%). Forty-six (15.8%) patients had diabetes mellitus, 121 (41.4%) had cardiovascular disease, 36 (12.3%) had heart rhythm disorders, 38 (13.0%) had chronic cerebral ischemia, and the risk of grade 3 and 4 cardiovascular complications was found in 251 (86.0%) cases. Results: In the early postoperative period severe complications occurred in 1 (1.7%) patient (acute coronary syndrome) leading to death. No local recurrences were detected. The overall 3-year survival rate was 86.3% and the recurrence-free survival rate was 89.7%. In 10 (3.4%) cases, death was due to progression of RRMS, 30 (10.3%) patients died from other causes (acute cardiovascular failure, stroke, COVID-19). Conclusions: Comorbid conditions in elderly patients after surgery did not affect the development of complications in the early postoperative period. Preliminary preoperative preparation of elderly patients (correction and selection of drug therapy for concomitant chronic diseases) reduces the risk of early postoperative complications.

Peculiarities of clabsi in oncologic hospitals

Currently, healthcare-associated infections (HAIs) are one of the most dangerous complications for hospitalized patients. The economic damage caused by HCAI in the Russian Federation annually is about 15 billion rubles; in addition, HCAI occupy the tenth place among the causes of mortality of the population. Catheter-associated bloodstream infection holds the leading place in the structure of ISMP morbidity. The concept of CVC-AIC (catheter-associated bloodstream infections or CLABSI), in turn, is included in CAIC. Purpose of the study. To analyze the current literature data of domestic and foreign authors for the years 2012-2022 concerning CAIC in patients of oncologic hospitals with CVCs, including subcutaneous central venous port catheters. Material and Methods. A review of 38 literature sources for the last 10 years was performed, including current information on catheter-associated bloodstream infections, measures to prevent them, and modern treatment approaches. Results. The studies have shown that the combination of drug resistance in microorganisms and immunity reduction in cancer patients, which occurs against the background of chemotherapy, makes them a risk group for the development of CAICs and episodes of their recurrence. Ensuring epidemiological safety of bloodstream catheterization in such patients is an important step in the prevention of CAIC. This is one of the priority tasks of oncoepidemiology today. Conclusion. The leading role in the occurrence of catheter-associated bleeding plays the term of catheterization and the condition of the patient, his age, stage of cancer development and concomitant chronic diseases. One of the most vulnerable risk groups are cancer patients from hemoblastosis chemotherapy and bone marrow and hematopoietic stem cell transplantation units. This may be due to the use of immunosuppressant drugs to suppress graft rejection, which significantly reduce patients' immunity. According to the results of studies, infection with drug-resistant Gram-negative microorganisms, including multidrug-resistant ones, is prevalent in cancer patients with CAIC. When using povidone iodine, there is a tendency to decrease the incidence of CAIC, but the use of chlorhexidine alcohol solution showed better results. A direct correlation was observed between the use of surgically implanted intravascular devices for long-term function and a lower incidence of CAIC, particularly in pediatric oncology.

Treatment of blunt thoracic trauma in a Level 1 Trauma Center

Blunt chest trauma has a significant high morbidity and mortality rate. In general, the treatment is conservative; in the case of hemothorax, pneumothorax, and hemopneumothorax chest tube drainage is often required. Immediate surgery is indicated in massive bleeding, tracheal and oesophageal injuries, and pericardial tamponade. Elective surgery should be performed in the case of retained hematoma, unresolved pneumothorax and flail chest. The first prioritized procedure is video-assisted thoracoscopy. The aim of this study is to analyze the treatment options and therapeutic results in reviewing 8,108 patients afflicted with blunt thoracic trauma. In over a three-year period 7,853 patients’ data were analyzed. Altogether 1,624 (20.68%) patients suffered severe injuries, such as sternal or rib fracture(s), pleural or lung injuries. In this group, a simple rib fracture (1-3) was diagnosed in 1,466 (90.27%), unilateral serial rib fracture (≥4) in 84 (5.17%), bilateral rib fracture in 16 (0.99%) and flail chest in 47 (2.89%) patients. In 11 (0.68%) cases, only parenchymal injuries without rib fracture were found. Altogether, 190 (11.70%) patients were afflicted with pneumothorax, hemothorax, or both, and only 86 (45.26%) of these cases required chest tube drainage. One immediate thoracotomy was needed to staunch massive bleeding and elective video-assisted thoracoscopy was performed in 6 cases. Lung contusion was diagnosed in 57 (3.51%) patients. The most frequent complication was pneumonia with a rate of 0.19% (15 patients). Empyema (3 patients), unresolved pneumothorax (1 patient), and retained hematoma (4 patients) occurred in 0.04%, 0.01% and 0.05% of the cases, respectively. Altogether, 13 (0.17%) patients succumbed at a mean age of 63.54±21.92 years. Three of these cases (23.08%) experienced multiple trauma and 12 (92.31%) suffered from concomitant chronic diseases. Patients with blunt chest trauma rarely required immediate operation. Overall, in the case of unresolved pneumothorax and retained hematoma, surgery is indicated, in which these cases video-assisted thoracoscopy is the first and primary option.

RV in COPD - The complicated matters of the heart - Correlation of ECHO and biomarker with COPD severity and outcome.

Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of cardiovascular involvement, which is among the leading causes of morbidity and mortality worldwide. Echocardiography (ECHO) could be a reliable, non-invasive tool for predicting the risk of cardiovascular modalities in patients with COPD. Combining the ECHO parameters with highly selective cardiac troponin could predict the severity and outcome of patients with COPD. This prospective observational study was conducted at a tertiary care hospital in South India. All patients who met the criteria were included. Patients with other concomitant chronic lung diseases were excluded. An echocardiographic examination was performed, and blood samples for hs-Tnt were taken on admission for patients admitted with COPD. Categorical variables were analyzed using Pearson's Chi-square test, and the T-test was used to compare the means. One-way analysis of variance (ANOVA) followed by the Bonferroni multiple comparison tests was done to compare different echo parameters concerning COPD severity. The mean tricuspid annulus plane systolic excursion (TAPSE) and right ventricle (RV) fraction area change (FAC) values were lower with the increase in the disease severity (P < 0.001). There was a significant increase in the mean systolic pressures in the right atrium and ventricle in patients with severe COPD (P < 0.001). The mean hs-TnT values were significantly higher in patients with severe COPD (18.86 ± 18.12) and correlated well with the increase in the severity of the disease (P < 0.001). Changes in the echo parameters, such as mean TAPSE and RV FAC values, negatively correlated with COPD severity. There was an increase in systolic pressure in both atria and ventricles with the progression of COPD. Troponin helped predict mortality during hospitalization. Comprehensive echocardiographic parameters, such as TAPSE and RV FAC, help assess the disease's severity, predict mortality, and evaluate whether the proper ventricular function is reliable. Troponin is a valuable adjunct that is an independent and strong predictor of overall mortality in patients with COPD.

Coping strategies in patients with schizophrenia and concomitant chronic cardiovascular diseases

In the context of modern socio-economic conditions, coping strategies reflecting adaptive capacity to stress are realized through the environment and personally determined mechanisms of behavior (coping mechanisms). Due to the high lability of disease processes and social vulnerability in general, schizophrenia patients are more subject to stress. Cardiovascular diseases, often observed in patients with schizophrenia, contribute to the progression of their social disintegration and decrease the level of adaptive skills. The aim of the study was to establish coping strategies in schizophrenia patients with concomitant cardiovascular diseases. 70 patients diagnosed with paranoid schizophrenia, who were on inpatient treatment in psychiatric departments № 1 and № 5 of the State Institution «Lugansk Republican Clinical Psychoneurological Hospital» of the Lugansk People»s Republic, participated in the study. All subjects of the study were divided into two study groups: group 1 — schizophrenia patients without cardiovascular pathology (n=40) and group 2 — patients with schizophrenia and cardiovascular pathology (n=30). The mean age of the patients was 46.5±5.9 years, with 27 (38.6 %) men and 43 (61.4 %) women. Clinical, psychopathological, catamnestic, psychometric, and statistical research methods were used. The study revealed that the greatest number of patients had a non-constructive coping mechanism for dealing with stressful conditions, with a small number of patients with a constructive type. When comparing the percentages of patients with and without cardiovascular disease, it was found that patients with cardiovascular pathology were superior in positive coping strategies. These studies confirm the significance of cardiovascular diseases in schizophrenia patients in the processes of maladaptation in changing life conditions.

Possible causes of morbidity and adverse outcomes of COVID-19 in vaccinated elderly patients

A prospective randomized observational study was conducted in cohorts of vaccinated and unvaccinated patients hospitalized in one of the Moscow hospitals and diagnozed with COVID-19 in the period from 06.23.2021 to 01.05.2022.The purpose of the study was to identify the epidemiological features of COVID-19 in vaccinated people and to present scientifically based data on the need for vaccination and its importance in stopping the epidemic process.Materials and Methods. The samples were studied in comparison for a number of indicators: age, clinical condition at admission, the presence and number of concomitant systemic chronic diseases as well as disease outcomes.Results. It was proven that the risk of COVID-19 morbidity in vaccinated people decreased by 1.5 times, mortality by 1.5 times, and hospitalization due to the severity of the condition by 3.1 times. The mortality risk among vaccinated patients shifted to older age (76.9 years), while among unvaccinated patients, the mortality risk was higher for older people (73.7 years), which indicates an increase in life expectancy of vaccinated people.