Development Of Adverse Outcomes Research Articles

Rurality and outcomes in prostate cancer: role of socioeconomic status and educational attainment

Abstract Background/Introduction Patients diagnosed with prostate cancer (PC) have a higher cardiovascular disease (CVD) prevalence and mortality risk. Rurality have been associated with up to 33% higher CVD risk and 44% higher all-cause mortality risk in patients with PC. Purpose Analyze the impact of rurality (from both patient and provider perspectives) on the development of adverse outcomes after a PC diagnosis according to socioeconomic and educational status. Methods We included men aged ≥66 with a new primary PC diagnosis (defined as ICD-10 = C61) from 2009-2017 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. The primary outcomes were CVD (comprising heart failure, atrial fibrillation, acute myocardial infarction, peripheral artery disease, and ischemic stroke), PC-specific mortality (PCsm), cardiovascular disease mortality (CVDm), and all-cause mortality. Patients living in areas with a population of <2,500 or <20,000, not adjacent to a metropolitan area, were considered to have a positive rural status. The provider status (metropolitan vs. non-metropolitan) was defined according to the 2013 National Center for Health Statistics' Urban-Rural Classification Scheme for Counties. Low socioeconomic status (SES) was defined according to Yost Index quintiles. Low educational status was defined according to percentiles of people >25 years old with less than a high school diploma. Multivariable Fine-Gray models, accounting for competing mortality/type of mortality, and Cox regression models were applied. Results We included 75,221 patients with PC (Picture 1), of which 1,828 were from rural areas and 362 were from rural areas with providers from non-metropolitan areas. Among patients from rural areas under the care of non-metropolitan providers, 82.6% had low SES (Yost Index ≤ 2). In this subgroup, patients from rural areas with non-metropolitan providers had 30% higher CVD risk (sHR 1.30; 95% CI 1.04-1.62) and 44% higher all-cause mortality risk (sHR 1.44; 95% CI 1.14-1.83; Picture 2) when compared to patients with low SES from urban or rural areas with providers from metropolitan areas. Additionally, within patients from rural areas with non-metropolitan providers, the median % of people with only high school diploma was 38.3 (IQR 36.2-40.9). Among those with low educational status (≤41% of high school county-rate), patients from rural areas with non-metropolitan providers had a 35% higher associated CVD risk (sHR 1.35; 95% CI 1.06-1.71), 54% higher associated CVDm risk (sHR 1.54; 95% CI 1.01-2.36), and a 32% higher associated all-cause mortality risk (sHR 1.32; 95% CI 1.04-1.66). Conclusion Patients with PC from rural areas with non-metropolitan providers have higher rates of low SES and low educational status and suffer from up to 54% higher associated risks of adverse outcomes, emphasizing the role of multiple domains of the Social Determinants of Health in health outcomes.

36 The long-term consequences of short-course systemic corticosteroid therapy for childhood acute asthma exacerbations

Abstract Background Paediatric emergency department (ED) asthma guidelines recommend the administration of short-course systemic corticosteroids (SCS) for moderate to severe asthma exacerbations. The potential adverse implications of frequent, short-course SCS in children are poorly characterized. Objectives To determine the risk of adverse outcomes in children with asthma who receive multiple short-courses of SCS for asthma exacerbation management. Design/Methods In this population-based, retrospective cohort study, we identified children aged 1-16 years with an ED asthma presentation/hospitalization between October 1, 2017, and February 28, 2020. We divided participants into an SCS-exposed and unexposed cohort. A minimum washout period of 3 years was applied to exclude any SCS use before the index date. During a 24-month follow-up period, we captured cumulative short-courses of SCS for acute asthma management and the primary outcome, development of steroid-associated complications. We excluded participants with steroid-treated comorbidities, non-asthma-related SCS exposure and development of adverse outcome(s) before the index visit. We compared baseline characteristics between cohorts using descriptive statistics. A Prentice-Williams-Peterson model was used to determine the risk of adverse outcomes amongst children receiving SCS for asthma management with results expressed as adjusted hazard ratios (HR) and 95% Wald confidence intervals (CI). Results We identified 1468 participants with an asthma ED visit who received ≥1 SCS course for acute management and 541 participants who did not receive SCS during our study window, after applying inclusion/exclusion criteria. Baseline demographics were balanced between cohorts aside from age at index, which was significantly younger (4.31 ± 3.71 vs 7.64 ± 4.21 p<0.001) in the SCS-exposed cohort. Overall, the risk of developing a recurrent SCS-associated adverse outcome was not increased in the SCS-exposed cohort (HR = 0.95, 95% CI: 0.74-1.23, p=0.7). However, when the number of SCS courses was considered, a significant risk of recurrent SCS-associated outcomes emerged, especially for those receiving 4+ SCS courses (HR = 2.30, 95% CI: 0.92-5.80). This potential dose-response effect was negated when patients who were likely on medium to high dose maintenance inhaled corticosteroids, were removed in a sensitivity analysis (HR = 1.38, 95% CI: 0.35-5.39). Conclusion At a tertiary care Canadian paediatric hospital, children and adolescents receiving short-course SCS for asthma exacerbation management overall do not demonstrate an increased risk of developing complications after two years follow-up. However, complication risk may be increased among those receiving 4+ cumulative SCS courses.

Sex-difference of multifactorial intervention on cardiovascular and mortality risk in DKD: post-hoc analysis of a randomised clinical trial

ObjectiveWomen with type 2 diabetes experience higher cardiovascular and mortality risk than men possibly because of a sub-optimal cardio-protective treatment. We evaluated whether an intensive multifactorial therapy (MT) produces similar protective effect on development of adverse outcomes in women and men.Research design and methodsNephropathy in Diabetes type 2 study is an open-label cluster randomized trial comparing the effect of Usual Care (UC) or MT of main cardiovascular risk factors (blood pressure < 130/80 mmHg, HbA1c < 7%, LDL < 100 mg/dL, and total cholesterol < 175 mg/dL) on cardiovascular and mortality risk in patients with type 2 diabetes. In this post-hoc analysis, we stratified patients by sex to compare the occurrence of MACEs (primary endpoint) and all-cause death (secondary endpoint) between women (104 MT and 105 UC) and men (103 MT and 83 UC).ResultsAchievement of therapeutic goals was similar by sex, with 44% and 47% of women and men in MT achieving at least 3 targets vs. 16% and 20% of women and men in UC. During a median follow-up of 13.0 years, we recorded 262 MACE (48.5% in women) and 189 deaths (53.6% in women). Compared to the UC group, the risk of MACE in the MT group was reduced by 52% in women and by 44% in men (P = 0.11). Conversely, the reduction in mortality risk by MT was greater in women (44% versus 12%, P = 0.019).ConclusionsMT similarly reduces the risk of MACEs in either sex. This therapeutic approach is associated with a survival advantage in women as compared with men and it may represent an important rationale to motivate physicians in overcoming their therapeutic inertia often encountered in female patients as well as to encourage patients of both sexes at improving their adherence to multidrug therapy.

Association of Neoadjuvant Chemotherapy With Postoperative Outcomes in Immediate Prepectoral Prosthetic Breast Reconstruction.

Neoadjuvant chemotherapy (NACT) followed by total mastectomy and immediate reconstruction has become an important strategy in the treatment of breast cancer. Although the safety of subpectoral implant-based breast reconstruction with NACT has been extensively evaluated, the safety in prepectoral reconstruction has not been clearly elucidated. We aimed to evaluate the association of NACT with immediate prepectoral breast reconstruction outcomes. A retrospective review of patients who underwent total mastectomy and immediate implant-based prepectoral breast reconstruction between May and December 2021 was conducted. Patients were categorized into 2 groups: those receiving NACT and those not receiving it. Postoperative complication rates were compared between the 2 groups. The independent association between NACT and the complication profiles was evaluated. Propensity score matching was also conducted. We analyzed 343 cases, including 85 who received NACT treatment and 258 who did not. Compared with the non-NACT group, the NACT group was younger, had a higher body mass index, and a higher rate of adjuvant radiotherapy. There were no differences in the rates of overall complications or type of complication between the 2 groups. In the multivariable logistic analyses, NACT did not show a significant association with the development of adverse outcomes. Similar results were observed in propensity score matching analyses. Our results suggest that receiving NACT may not have a significant detrimental effect on the postoperative outcomes of immediate prepectoral prosthetic reconstructions. Conducting prepectoral implant-based reconstruction in the setting of NACT might be safe and provide acceptable outcomes.

Liquid respiratory desaturation. The first experience of application on large biological objects

Introduction. This article is a continuation of the publication of the experimental studies results of prevention of acute decompression sickness (aDCS) in laboratory animals by the method of liquid respiratory desaturation (LRDS). LRDS is a method of preventing decompression disorders by the excretion of metabolically indifferent gases (in particular nitrogen) from the body during spontaneous respiration with liquid or artificial liquid lung ventilation (ALLV), by dissolved gas concentration gradient "from tissues to respiratory fluid". The method allows to provide rapid desaturation of the body from metabolically indifferent gases in the process of liquid respiration before and/or during decompression, thereby creating conditions for application of ultra-fast decompression profiles without the risk of decompression disorders.&#x0D; The aim of the study was to confirm the possibility of LRDS being a method of DCS prevention on large laboratory animals (minipigs).&#x0D; Materials and methods. The studies were performed on Wiessenau minipigs (n=8) — male and female, aged 4–5.5 months and weighing 7.1–11.2 kg. Animals of the control (n=4) and experimental (n=4) groups were subjected by compression by keeping in an air environment under high pressure (absolute 0.5 MPa for 60 minutes) to saturate tissues with indifferent gas (nitrogen). After compression experimental group was exposed to 30-minute ALLV with a liquid (perfluorodecalin) saturated with an oxygen under normobaric conditions. Air environment pressure during procedure of artificial lung ventilation was kept at 0.5 MPa. Decompression of the control and experimental groups was carried out in non-stop manner for 80 and 40 seconds respectively. The investigation of severity of clinical manifestations of DCS (changes in hemodynamic and respiratory parameters) including ultrasonic examination of gas bubbles in the heart and large vessels of the liver and as well as survival of animals in groups and pathoanatomical changes was performed.&#x0D; Results of the study. Clinical manifestations, ultrasonic scanning of the heart and venous vessels of the liver, as well as morphological examination data indicated the development of severe acute post-decompression disorders (PDD) in animals of the control group, which caused deaths in 100% of cases. Meanwhile all animals in experimental group survived and their state was stable. According to ultrasonic examination, the presence of small number of gas bubbles in the right-side heart chambers and liver's venous vessels being noted, but they disappeared after several hours. Deviations of the respiration's parameters function from background values (shortness of breath of a mixed type with the participation of auxiliary muscles, etc.) observed from the 2nd to the 4th day after ALLV, as well as compensatory reactions from the cardiovascular system (heart rate variability and instability of hemodynamic parameters) were caused by ALLV.&#x0D; Conclusions. Compressed air exposure 0.5 MPa for 60 minutes followed by 80 seconds of non-stop decompression allows to provoke the severe acute PDD minipigs model, manifested by pronounced intravascular gas formation, the development of acute respiratory and cardiovascular insufficiency causing the development of adverse outcomes.&#x0D; The ultrasound method of visual assessment of intravascular gas formation severity, adapted for minipigs, together with the dynamics of changes in the indicators of respiratory and cardiovascular systems makes possible to assess not only state of animal under anesthesia, but also the effectiveness of PDD prevention measures.&#x0D; The usage of ALLV with PFC liquid completely saturated with 100% oxygen under normobaric conditions makes possible partial removal of indifferent gas (nitrogen) dissolved in tissues of experimental animals during exposition in a compressed air environment before decompression and thereby carry out the prevention of DCS by LRDS method. It makes possible to implement successfully ultra-fast decompression profiles, incompatible with life in the control group.&#x0D; The state of animals from experimental group after LRDS is characterized by lung impairment caused by ALLV in hyperbaric conditions accompanied by temporary changes of external respiration function and compensatory reactions of cardiovascular system, observed during first 4 days.&#x0D; Ethics. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. The Clinical Study Protocol was approved by local Ethics Committee of The Federal State Budgetary Scientific Institution «Izmerov Research Institute of Occupational Health».

Vaccination of children against coronavirus infection caused by SARS-CoV-2

The novel coronavirus infection (COVID-19) is currently a widespread disease in all countries of the world. The adult population is predominantly involved in the epidemic process. In children, the disease proceeds, as a rule, in asymptomatic, mild and moderate forms. However, severe forms of the disease with the development of adverse outcomes are possible. Severe forms of infection are more likely to develop in children under the age of 1 year and older than 12 years. The risk group for a non-smooth course and adverse outcomes are children with concomitant diseases: genetic, neurological, metabolic disorders, congenital heart defects, obesity, diabetes mellitus, bronchial asthma and other chronic lung diseases, sickle cell anemia, oncopathology, immunodeficiency states. At present, various types of vaccines are used for specific prevention in the world: based on M-RNA technologies, vectorial, inactivated. These vaccines are effective and safe in reducing the burden of disease in eligible adolescents. Despite the emergence of new strains of circulating viruses, vaccines continue to be effective in preventing severe infections, hospitalization and death.

Rate pressure product as a novel predictor of long-term adverse outcomes in patients after percutaneous coronary intervention: a retrospective cohort study

ObjectivesPrevious studies have suggested that heart rate and blood pressure play important roles in the development of adverse outcomes in patients with coronary artery disease (CAD) who underwent percutaneous coronary...

The sCD14-ST predictive value in the development of adverse outcomes in operated colorectal cancer patients (diagnostic study).

For the period 2020-2021, 90 operated CRC patients were examined. Patients were divided into two groups: 1 - 50 patients operated on for CRC without acute bowel obstruction (ABO); 2 - 40 patients operated on for tumor ABO caused by CRC. To determine sCD14-ST by the ELISA (enzyme-linked immunosorbent assay) method, venous blood was taken 1h before surgery and 72h after it (third day). sCD14-ST levels were higher in CRC patients with ABO, organ dysfunction, and dead patients. If the sCD14-ST level on the third day after surgery is greater than 520pg/ml, the risk of a fatal outcome is 12.3 times higher than at its lower level [odds ratio (OR): 12.3, 95% CI: 2.34-64.20]. With the increase in the sCD14-ST level on the third day after surgery from baseline or its decrease by no more than 8.8pg/ml, the risk of organ dysfunctions is 6.5 times higher than with its greater decline (OR: 6.5, 95% CI: 1.66-25.83). This study has demonstrated that in CRC patients, sCD14-ST can be used as a predictive criterion for the development of organ dysfunction and death. Significantly worse results and prognosis were observed in the patients with higher levels of sCD14-ST on the third day after surgery.

The role of viral hepatitis B and C in the development of adverse outcomes in patients after tuberculosis

Despite the study of the epidemiology of tuberculosis and its co-infection over the past decades, a number of questions remain, including those related to the impact of co-infection on survival depending on the chosen tuberculosis treatment regimen, the likelihood of adverse outcomes in the form of gastrointestinal bleeding and cirrhosis of the liver and their relationship with the therapy of the underlying disease. The purpose of the study: to evaluate the survival of patients with tuberculosis who have co-infection (viral hepatitis B and C) and receive multicomponent chemotherapy. Materials and Methods: The study included all patients who received treatment for active tuberculosis and had viral hepatitis B and/or C from 01/01/2004 to 12/31/2020. A total of 1687 patients were included. Twenty-two patients were lost to follow-up, and attempts to ascertain their clinical status were unsuccessful. Vital status was assessed in all patients. The mean duration of follow-up was 10.5±3.0 years. Median follow-up was 11.3 years (95% confidence interval (CI) 8.2-14.3). The average age of the cohort was 53.3±7.7 years. The study assessed survival and all-cause mortality annually. Results: The frequency of chronic hepatitis B in the group of patients with active tuberculosis was 3.8%, hepatitis C - 14.8%, hepatitis B and C - 0.5% of cases. Such an incidence of viral hepatitis is associated with a high frequency of illicit drug users (62.4%). It should be noted that the frequency of hepatitis treatment was low and amounted to 8.7%. When assessing the contribution of hepatitis B and C to the mortality of patients with active tuberculosis, it was found that hepatitis is not a predictor of death in patients. At the same time, patients who did not receive hepatitis therapy had a higher risk of death (unadjusted odds ratio (OR) - 1.28, 95% CI 1.04-1.65). The adjusted OR for hepatitis B was - 1.87 95% CI 0.67-1.52, C - 1.24 95% CI 0.90-2.18, B and C - 1.72 95% CI 0.99-2.02. Conclusion: The presence of chronic viral hepatitis B and/or C in patients with active tuberculosis did not affect mortality from all causes and regardless of the type of virus during a long period of observation. Patients who did not receive treatment for viral hepatitis and who had a history of tuberculosis had a higher risk of death from all causes (OR 1.28, 95% CI 1.04-1.65).

The role of increased serum creatinine level in adverse outcomes of endovascular revascularisation in patients with acute coronary syndrome

Ischemic kidney damage as part of acute coronary syn-drome (ACS) largely contributes to the development of un-favorable outcomes not only of the underlying disease, but also of endovascular procedures, aggravating the patient’s condition and prognosis. This study is aimed at assessing the long-term results of coronary stenting for ACS in pa-tients with a sharp increase in serum creatinine levels wit-hin 48 hours after the intervention. Purpose: to evaluate the relationship between an increase in serum creatinine levels after coronary stenting of an infarct-related artery and the development of adverse outcomes in the long term. Materials and methods: 51 patients with ACS took part in the study. Serum creatinine was assessed before and wit hin 48 hours after coronary stenting. Subsequent-ly, after 3–6 months, patients underwent repeat coronary angiography to assess the patency of the coronary bed. Results: based on repeated coronary angiography, we identified the development of angiographic restenosis in those patients who demonstrated a significant increase in serum creatinine levels within 48 hours after stent implan-tation. In the group of patients without restenosis, creati-nine values before and after revascularization were com-parable. Conclusion: we noted that kidney damage due to acute coronary syndrome in combination with the intro-duction of a large volume of contrast agent can contribute to the development of unfavorable outcomes of coronary sten ting in the long term, namely, in-stent restenosis

Categorical principal component analysis to characterize patients at Intensive Care Unit admission

Abstract Background Healthcare-associated infections (HAIs) are the most frequent complications in healthcare settings, with a major impact on adverse outcomes. Here, we aimed to identify the relationships between patients’ characteristics admitted to Intensive Care Units (ICUs). Methods We used data of patients included in the “Italian Nosocomial Infections Surveillance in Intensive Care Units” (SPIN-UTI) project, who stayed in ICU for more than 2 days. Using Categorical principal component analysis (CATPCA) two components of risk were assessed. Values of variance accounted for (VAF) &amp;gt;0.3 were accepted as the significant effect of a variable on each component. A Chronbach’s alpha &amp;gt;0.7 was accepted as a measure of the internal consistency of the model. Results A total of 22402 admissions (62% female) were included. The average age was 65.7 years (SD = 16.6). Our model explains 35.3% of the total variability, with a Cronbach's alpha value of 0.847. The visual examination of component loading plot allows to evaluate the correlation between the quantified variables and each of the two components. In particular, the first component is explained by the presence of intubation (VAF=0.826), central venous catheter (VAF=0.749), and urinary catheter (VAF=0.727), patient’s origin (VAF=0.584), antibiotic treatment (VAF=0.479), non-surgical treatment for acute coronary disease (VAF=0.375), type of admission (VAF=0.509), surgical intervention (VAF=0.419). In the second component, the variables with the greatest contribution were the SAPS II (VAF=0.660), age (VAF=0.583), type of admission (VAF=0.531), surgical intervention (VAF=0.522). Thus, the first component would represent the exposure to invasive devices and medical procedures, and the second component the severity of patients. Conclusions Our results proposed the usefulness of CATPCA to identify factors involved in the development of adverse outcomes, highlighting the role of exposure to invasive devices and severity of patients. Key messages • There are several relationships between patients clinical and personal characteristics. • CATPCA represents a useful approach for the analytical exploitation of healthcare data.

Preterm birth: the impact of risk factors on pregnancy outcomes

BACKGROUND: Despite the achievements of modern obstetrics and neonatology, the problem of preterm birth remains one of the most pressing.&#x0D; AIM: The aim of this study was to evaluate the influence of risk factors on the outcome of threatened preterm birth.&#x0D; MATERIALS AND METHODS: This prospective cohort study included the analysis of clinical and anamnestic data of 130 patients delivered at various gestational ages. The main group comprised 68 women with preterm delivery, with the control group consisting of 62 women with timely delivery.&#x0D; RESULTS: The outcome of preterm birth is adversely affected by overweight in the group of modifiable risk factors, by history of premature birth in the immediate family in the group of non-modifiable risk factors, and by a previous COVID-19, anemia and autonomic nervous system disorders in the group of potentially modifiable risk factors. The most reliable prognostic marker for the development of preterm labor was the shortening of the cervical length of less than 2.5 cm according to ultrasound.&#x0D; CONCLUSIONS: The formation of risk groups based on the analysis of clinical, anamnestic, medical, and social data, as well as somatic and gynecological diseases can help avoid the development of adverse outcomes of preterm birth.

MO428: Fibrosis Markers, But Not Circulating Autotaxin (ATX) or Lysophosphatidic Acid (LPA) Associate With Disease Progression in Diabetic Kidney Disease (DKD)

Abstract BACKGROUND AND AIMS Diabetic kidney disease (DKD) remains the most common cause of the end-stage renal disease (ESRD) worldwide. Kidney fibrosis predicts functional decline and ESRD in many, but not all patients [1]. Autotaxin (ATX) is the enzyme converting lysophosphatidylcholine to Lysophosphatidic acid (LPA), which is a key factor in the development of fibrosis and inflammation. Preclinical studies have shown that inhibition of ATX may be beneficial in DKD [2, 3]. In this study, we assessed the relationship between systemic/circulating ATX, LPA and fibrosis markers of collagen type III degradation (C3M), type VI formation (PRO-C6) and connective tissue growth factor (CTGF) with kidney disease stage in a retrospective DKD cohort. METHOD We measured ATX, LPA 18:2, LPA 20:4, pPRO-C6 and pCTGF in plasma, and uPRO-C6, uC3M in urine in 203 patients (including DKD and control) at recruitment and at a follow-up (FU) visit (n = 108). After adjusting for missingness, skewness, highly correlated confounders and excluding patients on dialysis, the cohort resulted in n = 155 patients at baseline, n = 53 at FU and n = 144 for the time to adverse outcome. To assess the relationship between the markers of interest with CKD stage and estimated glomerular filtration rate (eGFR), Bayes ordinal logistic regression and linear regression were applied, respectively. A random forest (RF) algorithm was used also to predict both outcomes and identify the most relevant predictors. Cox regression analysis was used to assess the relationship between the markers at baseline and time to adverse outcomes, defined as a decline in eGFR &amp;gt;30% or death. A sensitivity analysis including relevant confounding covariates was applied to all regression models. Benjamini &amp; Hochberg adjustment was used to account for multiplicity. RESULTS pPRO-C6 and uC3M levels showed consistently significant associations with CKD stage (Figure 1a-b) also after adjusting for confounding variables both at baseline and FU. Higher CKD stages or lower eGFR values were associated with higher pPRO-C6 and lower uC3M levels. RF (10-fold cross-validated mean AUC = 0.75) also selected these markers as the most relevant predictors for CKD stage (Figure 1c). Similar results were obtained when using eGFR. During a median follow-up time of 4.00 years, 14.58% of the patients had an adverse outcome. Both baseline pPRO-C6 [hazard ratio (HR) 2.68 (95% confidence interval, CI 1.47–4.88, P -adjusted &amp;lt; 0.05 per 2-fold ng/mL increase] (Figure 2) and uPRO-C6 levels [HR 1.43 (1.08–1.89, P -adjusted&amp;lt; 0.05) per 2-fold ng/mmol increase] were significantly associated with development of adverse outcomes, whereas only a trend was found for uC3M level [HR 0.50 (0.27–0.91, P -adjusted&amp;lt; 0.06) per 2-fold µg/mmol increase]. After adjusting for confounders, none of the markers showed a significant association with time to adverse outcome. CONCLUSION pPRO-C6 and uC3M showed consistent associations with CKD stage and pPRO-C6, uPRO-C6 and uC3M (trend) also an association with the risk of adverse outcomes, which is in alignment with previous studies [4]. In contrast, no associations were observed for circulating ATX or LPAs. However, results should be interpreted carefully due to the relatively low number of patients in this cohort and missing histology to verify fibrosis or local ATX/LPA action.

Теоретичні аспекти формування концепції лікування переломів кісток, що утворюють підтаранний суглоб

The causes of unfavorable outcomes of treatment of fractures of the bones of the posterior part of the foot have a direct connection with the fundamental moments of the use of therapeutic tactics. The issues of therapeutic tactics and the choice of optimal surgical interventions in the system of treatment of fractures of bones forming a fractured joint remain insufficiently studied and poorly covered in the specialized literature, and their significance is underestimated. The regularities of the formation of factors that worsen the results of treatment of fractures of the talus and calcaneus are not systematized, and measures to prevent them are proposed mainly at the empirical level. The frequency of complications remains relatively high, and the ways to reduce it are not well defined, since they are due to the use of traditional techniques. Insufficiently studied issues of identifying risk factors for the development of adverse outcomes limit the possibilities of timely correction of therapeutic tactics. The wrong choice of treatment tactics explains the errors caused by the insufficient qualifications of medical staff and the development of complications that can lead to an unfavorable outcome of treatment in general. The variety of factors affecting the outcome of treatment also raises questions for the development and implementation of a single pathogenetically based system of preventive measures, which allows taking into account the effect of these factors and their possible mutual influence. The low efficiency of traditional approaches to the treatment of fractures of the bones of the posterior part of the foot emphasizes the expediency of searching for new ways of reposition and stable fixation of the bones forming the subtalar joint in the case of various types of injuries. Taking into account the above, measures to prevent the consequences of rammed damage will be effective only if they are comprehensively developed within a single conceptual model, which consists of two levels: organizational, diagnostic and technological. Each of these levels includes similar mechanisms aimed at eliminating the influence of factors contributing to the negative outcome of treatment. Before planning surgery and choosing the method of osteosynthesis, a systematic analysis of the factors affecting the results should be carried out in accordance with the nature of the fracture. Conclusion. The proposed conceptual model shows a natural objective relationship between the levels, so the solution of emerging problems is actually of direct scientific interest. The levels differ only in the content of the phenomena studied and the mechanisms of influence on the treatment process. Work on the improvement of these levels is at this stage the most realistic and practically significant subject of scientific research in traumatology and orthopedics, which can lead to a significant improvement in the anatomical and functional results of the treatment of foot injuries. The performed analytical study and the proposed conceptual model expand the understanding of the process of preventing adverse consequences and the choice of tactics in the treatment of bone injuries that form the subtalar joint

Features of the course of coronavirus infection in patients with diabetes mellitus

Diabetesmellitus, overweight and the age of a patient over 65 years old are identified by clinicians as themain factors that can complicate the course of the coronavirus infection and increase the likelihood of fatal outcome. Although in the general human population mortality from coronavirus fluctuateswithin 3–5 %, sometimes very significantly differing in individual countries, this level can reach 15–25 % among patientswith diabetes, especially for those receiving insulin therapy. Diabetes mellitus as a concomitant disease in COVID-19 is considered one of the most significant risk factors for the development of adverse outcomes due to a more severe course of infection in conditions of hyperglycemia and other aggravating factors.

Prognosis of adverse outcomes in patients with ST-elevation myocardial infarction and acute ischemic kidney injury

Abstract Background The category of patients with ST-segment elevation myocardial infarction (STEMI) remains in the focus of attention of cardiologists across the globe due to the high rates of hospital and long-term mortality. Acute ischemic kidney injury represents one of the most serious complications of STEMI, due to its highly negative impact on the disease prognosis. Therefore, it is critical for a clinician to identify STEMI and acute ischemic kidney injury patients who are at high risk of developing adverse outcomes. Purpose To identify key prognostic markers of adverse outcomes in patients with STEMI and acute ischemic kidney injury. Methods The study included 173 patients (ages 37–75), who were admitted to the intensive care unit with STEMI. Two groups of patients were identified based on their renal function: a group with STEMI and acute ischemic kidney injury (main group, n=111) and a group with STEMI and normal renal function (comparison group, n=62). Acute ischemic kidney injury diagnosis was confirmed on the basis of KDIGO (2012) recommendations - when patients with MI were hospitalized with creatinine level increased by up to ≥1.5 times as compared to baseline creatinine level before hospital admission. A critical condition for confirming the diagnosis was absence of chronic kidney disease and urinary tract disorders in patients' medical history. To identify risk factors of adverse outcomes, multivariate logistic regression analysis was used. Results Regression analysis was performed in order to build a predictive model for the development of adverse outcomes (death from cardiovascular causes, recurrent MI, unstable angina within 12 months). The analysis was based on the results of clinical, laboratory and instrumental evaluations of the focus patients. The derived prognostic model included the following features: age, level of the N-terminal fragment of brain natriuretic peptide (NT-pro-BNP), C-reactive protein level, creatinine level and local contractility index. A mathematical model for predicting the likelihood of adverse outcomes was developed on the basis of regression analysis data. ROC analysis including building of a ROC curve was conducted in order to test the quality of the model; the AUC was 0,996. The resulting model achieved 90,6% sensitivity, 100% specificity and 97,1% positive predictive value. Conclusion The following prognostic markers of adverse outcomes development in patients with STEMI and acute ischemic kidney injury were identified as most critical: age, NT-pro-BNP level, C-reactive protein level, creatinine level and local contractility index based on echocardiography results. The mathematical model for predicting the likelihood of adverse outcomes, developed as a result of the study, will become a powerful clinical tool for improving the survival rate in patients with STEMI and acute ischemic kidney injury. Funding Acknowledgement Type of funding sources: None.

English

BACKGROUND Multiple micronutrient deficiencies commonly coexist in pregnancy and may play a role in the pathogenesis of many high-risk events in pregnancy. Mineral estimation during the first and second trimester may help in the identification of high-risk pregnancies predisposed to pre-eclampsia, preterm birth or low birth weight. Body mass index (BMI) is an independent risk factor influencing the serum levels of micronutrients like iron, calcium, phosphorous and magnesium. The purpose of this study was to compare the serum levels of iron, magnesium, calcium and phosphorus during first &amp; second trimesters of pregnancy and their correlation with body mass index and adverse pregnancy outcomes. METHODS This was a longitudinal descriptive study, done over a period of twelve months, from April 2017 to March 2018. 94 low risk pregnant women were selected in the first trimester, and they were followed up for the entire duration of pregnancy. 2 ml of blood is collected at first and second trimester and analysed for the serum levels of iron (µg/dl), magnesium (mg/dl), calcium (mg/dl) and inorganic phosphorus (mg/dl). Mean values of these elements were noted and BMI was measured. Patients were followed up to observe the pregnancy outcome, especially development of hypertension, preterm birth and low birth weight. The data were subjected to suitable statistical analyses. P value less than 0.05 is considered as statistically significant. RESULTS Mean values of Ca, Mg, inorganic P and Fe were 9.3 mg/dl ± 0.52, 1.79 mg/dl ± 0.28, 3.59 mg/dl ± 0.54 and 83.7 µg/dl ± 25.36 respectively in first trimester and 8.9 mg/dl ± 0.47, 1.62 mg/dl ± 0.16, 3.17 mg/dl ± 0.44 and 76.17 µg/dl ± 21. 69 respectively in the second trimester. Hypocalcaemia was noted in 12.7 % and 38.3 % in the first and second trimester respectively. Hypomagnesaemia was seen in 51.1 % and 80.9 % in the first and second trimester respectively. Hypophosphatemia was seen in 3.2 % and 14.8 % in the first and second trimester respectively. These findings were statistically significant. There was no significant change in the iron levels in the present study. 19.1 % were underweight. 56.4 % had normal BMI. 19.2 % were overweight. 5.3 % were obese. CONCLUSIONS There is no correlation between serum values of trace elements and the BMI of study subjects. Even though significant hypocalcaemia, hypophosphatemia and hypomagnesaemia was noted in second trimester compared to first, there was no predisposition to the development of adverse outcomes like pre-eclampsia, preterm birth or low birth weight. This may be the effect of dietary and pharmacological supplementation during pregnancy. KEYWORDS Micronutrients, Pregnancy Complications, Calcium, Phosphorus, Magnesium, Iron

Surgical Apgar score as a complication predictor in gastrointestinal oncologic surgery

Introduction and aimsSurgical resection of gastrointestinal (GI) cancer is the cornerstone of curative treatment but entails considerable morbidity. The surgical Apgar score (SAS) is a practical and objective instrument that provides immediate feedback. The aim of the present study was to evaluate the performance of the SAS for predicting complications at 30 days in patients with primary GI cancer that underwent curative surgery. Materials and methodsA prospective observational study was conducted that included 50 patients classified into a low SAS (≤ 4) group or a high SAS (≥ 5) group. Complications were defined as any event classified as a Clavien-Dindo grade II to V event. Bivariate and multivariate analyses were performed through the Cox regression and a p<0.05 was considered significant. ResultsOverall postoperative morbidity was 50.0%, with no mortality. Eighty-six percent of cases were catalogued as having an ASA≥3. Eighty-eight percent had a high SAS, of whom 45.5% presented with a complication, whereas 12.0% had a low SAS and a complication rate of 83.3%. In the multivariate analysis, the BMI (OR: 3.351, 95% CI: 1.218-9.217, P=.019), SAS (OR: 0.266, 95% CI: 0.077-0.922, P=.037), surgery duration (OR: 3.170, 95% CI: 1.092-9.198, P=.034), and ephedrine use (OR: 0.356, 95% CI: 0.144-0.880, P=.025) were significantly associated with the development of adverse outcomes. ConclusionsSAS was shown to be an independent predictive factor of postoperative morbidity at 30 days in the surgical management of GI cancer and appears to offer a reliable sub-stratification in a high-risk population with an ASA≥3.

Primary care physician services and the frequency of comorbidities in patients with acute myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background The management of patients with multiple comorbidities represents a significant burden on healthcare each year. Despite requiring regular medical care to treat chronic conditions, a large number of these patients may not receive proper care. Significant disparities have been identified in patients with multiple comorbidities and those who experience acute coronary syndrome or acute myocardial infarction (AMI). Only limited data exists to identify the impact of comorbidities and utilization of primary care physician (PCP) services on the development of adverse outcomes, such as AMI. Purpose The primary objective was to analyze how PCP services utilization can be associated with comorbidities in patients who experienced an AMI. Methods This study was based on retrospective data analysis which included 250 patients admitted to the Hartford Hospital Emergency Department (ED) for an AMI. Out of these, 27 patients were excluded due to missing documentation. Collected data included age, gender, medications and recorded comorbidities, such as hypertension, hyperlipidemia, diabetes mellitus (DM), chronic kidney disease (CKD) and previous arrhythmia. Each patient was assessed regarding utilization of PCP services. Statistical analysis was performed in order to identify differences between patients with documented PCP services and those without by using the Chi-square test. Results The records allowed for identification of documented PCP services for 172 out of 223 (77.1%) patients. The most common comorbidities were hypertension and hyperlipidemia: in 165 (74.0%) and 157 (70.4%) cases respectively. The most frequent comorbidity was hypertension: 137 out of 172 (79.7%) in pts with PCP vs 28 out of 51 (54.9%) without PCP, and significantly more often in patients with PCP, p&amp;lt; 0.001. Hyperlipidemia was the second most frequent comorbidity: in 130 out of 172 (75.6%) vs 27 out of 51 (52.9%) accordingly, and also significantly more often (p&amp;lt; 0.002) in patients with PCP services. The number of comorbidities ranged from 0-5, including 32 (14.3%) patients without comorbidities: 16 (9.3%) with a PCP and 16 (31.4%) without PCP services. The majority of patients - 108 (48.5% of 223), had 2-3 documented comorbidities: 89 (51.8%) had two and 19 (34.6%) had three. The remaining 40 (17.9%) patients had 4-5 comorbidities: 37 (21.5%) of them with a PCP and 3 (10.3%) without, with a significant difference (p &amp;lt; 0.001) found for patients with a higher number of comorbidities who utilized PCP services. Conclusions Our study shows that the majority of patients who presented with an AMI had one or more comorbidities. Furthermore, patients who did not utilize PCP services had fewer identified comorbidities. This suggests that there may be a significant number of patients who experienced AMI with undiagnosed comorbidities due to not having access to PCP services.

EPIDEMIOLOGICAL ASPECTS AND CLINICAL RESULTS OF ORTHODONTIC TREATMENT OF CHILDREN FROM 7 TO 12 YEARS OLD

Currently, the global dental community notes a natural increase in dentoalveolar anomalies (DAA) in the occlusal bite, depending on many objective factors and subjective preconditions. However, the result of their treatment is not always effective, leading to the development of adverse outcomes and unpredictable complications in the permanent dentition. The aim of our study was to optimize the choice of temporary orthodontic constructions for the treatment of DAA in children from 7 to 12 years of age on the basis of retrospective analysis of medical records. Materials and methods of research: retrospective, analytical, statistical. In order to obtain scientifically comparable indices we used methodological principles of ranging the studied materials (043-1/u medical record of an orthodontic patient) by age period, gender features, dentoalveolar anomalies and temporary orthodontic constructions. As a result of the study, we found no tendency toward a decrease in the incidence of DAA, and negative dynamics of structural and clinical manifestations depending on age and gender identity. It has been established that MAC is combined with such disorders of child's vital functions as chewing, swallowing, speech, breathing. It was found that the frequency of DAA is 80.6%, and the prevalence of DAA in children aged 7-12 years increased from 27.6% to 42%. According to the conducted survey of 1439 children of this age category, distal occlusion takes the leading role among pathologies of DAA, followed by deep incisal occlusion and abnormalities of teeth position. Most often removable orthodontic appliances are used for their correction. Fixed orthodontic appliances are the most effective in the treatment of transversal anomalies, vertical incisal occlusion and combined anomalies. The presented materials show that the high prevalence of DAA and the need for treatment of the subjects confirms the need for further study of this problem to improve the effectiveness of treatment of dental anomalies in patients aged 7-12 years.