Effectiveness Of Therapy In Patients Research Articles

The role of ecology in the region of residence of patients with epidermolysis bullosa and during the experiment

BACKGROUND: A person is constantly influenced by the environment, which determines his state of health. Animal testing is used to determine the danger of certain chemical agents of inanimate nature. To extrapolate the experimental result to humans, the body of patients with the dystrophic form of epidermolysis bullosa, which has a low threshold of resistance to aggressive stimuli, is preferable. AIM: To study the impact of anthropogenic physicochemical factors on the skin of white mice, as well as environmental ecology on the population of patients with the dystrophic form of congenital epidermolysis bullosa. MATERIALS AND METHODS: Scientific research is both observational and interventional. The observational part of the study included patients suffering from dystrophic form of epidermolysis bullosa. There are white mice in the interventional part. RESULTS: Seeding with agrochemicals causes skin eczema, periorbital dermatitis, finger mutation and contracture, claw deformity and chronic itching in white mice. The possibility and criteria for extrapolating the results of the experiment to patients suffering from dystrophic form of epidermolysis bullosa have been established. These criteria include: itching of the skin, mutation and pseudosyndactyly of the fingers. The effect on the body of patients with dystrophic form of epidermolysis bullosa with toxic agents was carried out by the living environment. It has been established that in order to achieve the positive effect of complex therapy, in addition to highly qualified medical care, an environmentally safe living environment is necessary. Traveling and living in conditions that do not pose an environmental danger to humans helps to reduce the severity of the disease and improve their quality of life. CONCLUSION: The ecology of the living environment determines the effectiveness of therapy in patients with dystrophic form of epidermolysis bullosa, as well as the timing of manifestation and severity of the disease. A healthy environment contributes to the epithelization of ulcerative elements and the disappearance of itching.

Direct comparative study of anti-IgE and anti-IL4Rα therapy effectiveness in patients with severe allergic and mixed bronchial asthma

Introduction. There is insufficiency of direct comparative studies of genetically engineered biological drugs (GEBD) for severe bronchial asthma (SA) treatment in scientific databases.Aim. To compare omalizumab and dupilumab effectiveness in patients with allergic and mixed SA in real clinical practice.Materials and methods. The direct comparative study included SA patients with an allergic component from regional registry of Sverdlovsk region. The data of patients with allergic (n = 68) and mixed (n = 27) SA treated with omalizumab (n = 62) and dupilumab (n = 33) were analyzed. Therapy effectiveness was determined for 12 months in general group No. 1, allergic asthma group No. 2 and mixed asthma group No. 3 according to the following indicators: asthma control level (ACT), proportion of patients with uncontrolled asthma, need for systemic glucocorticosteroids (SGCS) and short‐acting beta agonists (SABA), basic therapy volume, asthma exacerbations number, emergency calls and hospitalizations, forced expiratory volume in the first second (FEV ), assessment of life quality (AQLQ and SNOT-22). Control evaluation visits were conducted before therapy start, after 4 and 12 months of biologics taking.Results. In general, during the 12 months of targeted therapy in patients receiving omalizumab statistically significant positive dynamics was observed in 12 of the 13 evaluated indicators; in patients receiving dupilumab – in 9 indicators. When analyzing such indicators as, ACT, taking SGCS, exacerbations of SA, FEV , statistically significant positive dynamics was revealed for all 4 indicators in patients receiving omalizumab in group No. 2 and in patients receiving dupilumab in group No. 3.Conclusions. Patients with allergic component of SA respond equally well to therapy with omalizumab and dupilumab. At the same time, a tendency towards the advantage of omalizumab in patients with allergic asthma, and dupilumab in patients with a mixed phenotype of the disease was revealed.

Assessment of lytic therapy effect in patients with intermediate-high risk pulmonary embolism for prevention of chronic thromboembolic pulmonary hypertension: A randomized, double-blind trial.

This study aims to compare the effectiveness of thrombolytic therapy and anticoagulation in preventing chronic thromboembolic pulmonary hypertension (CTEPH). A total of 60 patients with intermediate-high risk pulmonary embolism (PE) were randomly assigned to receive either thrombolytic therapy (n = 30) or anticoagulation (n = 30). Echocardiographic assessments demonstrated no significant differences between the two treatment approaches in terms of right ventricular size (RVS) (on discharge in thrombolytic group: 31.17 ± 3.43 vs. anticoagulant group: 32.73 ± 5.27, p = 0.912), tricuspid annular plane systolic excursion (TAPSE) (on discharge in thrombolytic group: 17.66 ± 2.39 vs. anticoagulant group: 16.73 ± 2.93, p = 0.290), and systolic pulmonary artery pressure (SPAP) (on discharge in thrombolytic group: 32.93 ± 9.73 vs. anticoagulant group: 34.46 ± 9.30, p = 0.840). However, significant changes were observed in all assessed parameters within each treatment group (p < 0.001). The 6-month follow-up showed no significant difference between the two groups in terms of CTEPH incidence (p = 0.781) or functional class of the patients (p = 0.135). Based on the findings of this study, neither thrombolytic therapy nor anticoagulation demonstrated superiority over the other in reducing adverse outcomes associated with intermediate-high risk PE, including right ventricular size, SPAP, TAPSE, or CTEPH.

Absolute monocyte counts could predict disease activity and secondary loss of response of patients with Crohn's disease treated with anti-TNF-α drug.

Assessing Crohn's disease (CD) activity is critical for monitoring disease progression. In CD, monocytes could release TNF-α. Thus, it is extremely important to study its role in the disease activity and loss of response to anti-TNF-α biologics. In this study, we collected CD patients treated with biologics from January 2017 to May 2022. Indicators associated with disease activity were evaluated by Spearman correlation analysis and Mann-Whitney U test. Specifically, logistic analyses were used to explore the predictors of primary nonresponse (PNR) and secondary loss of response (SLOR) within 1 year of anti-TNF-α agents. In addition, a nomogram was developed for therapeutic effect prediction. 283 patients with CD were identified. Disease activity group, defined as CDAI equal to or greater than 150, had significant elevated absolute monocyte counts than disease remission group based on CDAI score (p = 0.019, Z = -2.354). Logistic analyses showed that absolute monocyte counts could be an independent predictor of 1-year SLOR of anti-TNF-α agents in CD patients (p = 0.013). A nomogram established based on gender, absolute monocyte counts, and hemoglobin could predict SLOR within 1 year of anti-TNF-α agents reliably. The results of this study support the utility of absolute monocyte counts detecting disease activity and anti-TNF-α therapy effect in patients with CD.

Neurofeedback treatment for Attention Deficit Hyperactivity Disorder in adults

IntroductionAttention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent neurodevelopment disorders in the world. Clinical guidelines for ADHD recommend multimodal treatment approaches, with current evidence suggesting that medication, including methylphenidate and various amphetamine formulations, in conjunction with psychosocial treatment are most effective in the short-term and long term. Over the last decade, an increasing number of studies investigating non-pharmacological treatments have been published, such as cognitive therapy, Neurofeedback (NF), Transcranial direct current stimulation with the aim of treating ADHD patients.ObjectivesWe comprehensively reviewed literature searching for studies on the effectiveness and specificity of NF for the treatment of ADHD. The aim of this review is to understand if there is scientific evidence in using of electroencephalogram (EEG)-Neurofeedback for treating patients with ADHD.Methods We did a non systemathic review using pubmed and google schoolar databases in order to analyze the influence and effects of therapy in patients diagnosed with ADHD and under treatment based on EEG Neurofeedback. We analyzed 18 systhematic reviews and metha-analysis and 2 case control studies.Results Accourding to the systhematic reviews results showed positive and significant effects in the visual memory, attention and visual recognition (spatial working memory). EEG also showed improvement in upper alpha activity in a resting state (open-eyed) measured from the occipital area, which similarly indicated improvement in the cognitive domain (attention). Compared to non-active control treatments, NF appears to have more durable treatment effects, for at least 6 months following treatment.Conclusions In conclusion, it is possible to affirm that a neuromodulating effect of the therapy positively influences cognitive processes, mood, and anxiety levels in patients with ADHD and is associated with significant long-term reduction in symptoms. Though limitations exist regarding conclusions about the specific effects of NF, the review documents improvements in school, social, and family environments. However, future efforts should focus on implementing standard neurofeedback protocols, ensuring learning, and optimizing clinically relevant transfer and more studies are needed for a properly powered comparison of follow-up effects between NF and active treatments and to further control for non-specific effects.Disclosure of InterestNone Declared

Outcomes of critically ill patients with liver failure who require mechanical ventilation: A retrospective, single-center study.

Critically ill patients with liver failure have high mortality. Besides the management of organ-specific complications, liver transplantation constitutes a definitive treatment. However, clinicians may hesitate to introduce mechanical ventilation for patients on liver transplantation waitlists because of poor prognosis. This study investigated the outcomes of intensive care and ventilation support therapy effects in patients with liver failure. This single-center study retrospectively enrolled 32 consecutive patients with liver failure who were admitted to the intensive care unit from January 2014 to December 2020. The medical records were reviewed and analyzed retrospectively for Acute Physiologic and Chronic Health Evaluation (APACHE)-II. The model for end-stage liver disease scores, 90-day mortality, and survival was assessed using the Kaplan-Meier method. The average patient age was 45.5 ± 20.1 years, and 53% of patients were women. On intensive care unit admission, APACHE-II and model for end-stage liver disease scores were 20 and 28, respectively. Among 13 patients considered for liver transplantation, 4 received transplants. Thirteen patients (40.6%) were intubated and mechanically ventilated in the intensive care unit. The 90-day mortality rate of patients with and without mechanical ventilation in the intensive care unit (13, 61.5% vs. 19, 47.4%, p = 0.4905) was similar. APACHE-II score >21 was an independent predictor of mechanical ventilation requirement in patients with liver failure during intensive care unit stay. Although critically ill patients with liver failure are at risk of multiorgan failure with poor outcomes, mechanical ventilation did not negatively affect the 90-day mortality or performance rates of liver transplantation. Clinicians should consider mechanical ventilation-based life support in critically ill patients with liver failure who are awaiting liver transplantation.

Variant Allele Frequency Analysis of Circulating Tumor DNA as a Promising Tool in Assessing the Effectiveness of Treatment in Non-Small Cell Lung Carcinoma Patients.

Despite the different possible paths of treatment, lung cancer remains one of the leading causes of death in oncological patients. New tools guiding the therapeutic process are under scientific investigation, and one of the promising indicators of the effectiveness of therapy in patients with NSCLC is variant allele frequency (VAF) analysis. VAF is a metric characterized as the measurement of the specific variant allele proportion within a genomic locus, and it can be determined using methods based on NGS or PCR. It can be assessed using not only tissue samples but also ctDNA (circulating tumor DNA) isolated from liquid biopsy. The non-invasive characteristic of liquid biopsy enables a more frequent collection of material and increases the potential of VAF analysis in monitoring therapy. Several studies have been performed on patients with NSCLC to evaluate the possibility of VAF usage. The research carried out so far demonstrates that the evaluation of VAF dynamics may be useful in monitoring tumor progression, remission, and recurrence during or after treatment. Moreover, the use of VAF analysis appears to be beneficial in making treatment decisions. However, several issues require better understanding and standardization before VAF testing can be implemented in clinical practice. In this review, we discuss the difficulties in the application of ctDNA VAF analysis in clinical routine, discussing the diagnostic and methodological challenges in VAF measurement in liquid biopsy. We highlight the possible applications of VAF-based measurements that are under consideration in clinical trials in the monitoring of personalized treatments for patients with NSCLC.

Treatment of chronic viral hepatitis c in perm Krai

Objective. To analyze the effectiveness of etiotropic antiviral therapy with direct antiviral drugs against chronic viral hepatitis C in the adult population of the Perm Krai.&#x0D; Materials and methods. In the regional register of Perm Krai, 20095 patients with chronic viral hepatitis C were registered. In 2019–2021, antiviral therapy with direct antiviral drugs, registered in the Russian Federation, and included in the list of vital and essential medicines for medical use was prescribed to 282 patients with chronic hepatitis C. There were 137 men (48.6 %), 145 (51.4 %) – women. The age of the patients ranged from 26 to 82 years, the duration of the disease – from 3 to 25 years.&#x0D; Results. All the therapy regimes we used showed 100 % effectiveness in the population of patients suffering from chronic hepatitis C associated with mild liver fibrosis regardless of genotype, whereas in the population of patients with grade 3 fibrosis or liver cirrhosis, 100 % effectiveness was achieved only after the use of sofosbuvir-containing schemes. The pangenotypic schemes resulted in 100 % achievement of a stable virological response among patients with genotype 1 regardless of the stage of liver fibrosis and previous therapy experience. In the treatment of patients infected with genotype 3 of hepatitis C virus with severe fibrosis, the effectiveness of 100 % was noted after the use of sofosbuvir-containing regimes.&#x0D; Conclusions. Among the adult population of Perm Krai, the overall effectiveness of therapy in patients with chronic hepatitis C, who used direct antiviral drugs, was 97.8 %.

Assessment of the state of autonomic dysfunction in patients with tuberculosis of the respiratory system and in combination with HIV infection in modern conditions

The autonomic nervous system (ANS) is an important part of the human nervous system responsible for regulating internal organs and maintaining the internal environment of the body. Adequate functioning of the ANS supports homeostasis is the internal stability of the body and regulates many functions in it, such as cardiac activity, breathing, etc. TB-related stress and inflammation affect have influence at the balance of sympathetic and parasympathetic activity. Affecting the work of the peripheral nervous system, it becomes possible to influence at the system of homeostasis of the body through its regulatory systems. Improving the diagnostics of autonomic dysfunction and identifying its dysfunction will provide an integrated individualized approach to treatment and will make a significant contribution to increasing the effectiveness of therapy for patients with tuberculosis.Aim. Diagnosis of the state of the autonomic nervous system by its main indicators using available informative methods for assessing its functional state in patients with respiratory tuberculosis, including in combination with HIV infection at the beginning of treatment and detecting the level of its damage for further correction with the prescription of pathogenetic therapy.Materials and methods. The functional state of the autonomic nervous system has been investigated in 260 people. In the study, 2 groups were formed: a control group (CG) of 70 healthy persons and a monitoring group (MG) of 190 newly diagnosed patients with tuberculosis. There are 3 subgroups in MG. The 1 subgroup included 65 patients with pulmonary tuberculosis, in whom the function of ANS was studied by conventional examination methods, and in 64 patients with tuberculosis 2 subgroups and 61 patients with tuberculosis in combination with HIV infection 3 subgroups using Varikard 2.51. Calculations were carried out in the program SPSS Statistics v. 23.Results and discussion. Comparison of the frequency of autonomic dysfunction in patients with MG, subgroup 1 with that in the CG according to questionnaires No. 1 (χ2=36.346; p&lt;0.001) and No. 2 (χ2=50.885; p&lt;0.001), HR per minute (χ2=31.989; p&lt;0.001), Kerdo index (χ2=30.008; p&lt;0.001), cold sample (χ2=36.549; p&lt;0.001) revealed high reliability of differences and indicated the predominance of sympathicotension, which was determined 7 times more often in patients. At the beginning of treatment, in patients with concomitant HIV infection was detected a more pronounced dysfunction of ANS with a predominance of its sympathetic link, which was found 9.3 times more often than in healthy persons and 2.3 times more often than in patients without HIV infection. Comparing the frequency of PARS in the «normal zone» in the CG and in the 2 subgroup of MG (t1=5.01; p1&lt;0,001; t2=3,69; p2&gt;0.001), in CG and in MG subgroup 3 (t1=3.61; p1&lt;0.001; t2=3.61; p2&lt;0.001) high significant differences were identified, indicating a significant predominance of regulatory process disorders in patients with tuberculosis and especially when combined with HIV infection.Conclusion. The revealed disorders in the work of ANS patients with tuberculosis and in combination with HIV infection are associated with intoxication and asthenovegetative syndrome. Monitoring of heart rate variability can be used in medical research, as well as in clinical practice to assess the state of the autonomic nervous system in patients with tuberculosis and when combined with HIV infection, determine the application point for the effects of pathogenetic therapy in order to improve the results and effectiveness of the treatment.

Assessing Treatment Efficacy and Determinants of Outcome in Isoniazid Mono-resistant Tuberculosis Patients: A Prospective Observational Study in Gujarat

Introduction: There is a high number of isoniazid-resistant tuberculosis (TB) in India; estimates imply that over 25% of TB patients there are isoniazid-resistant. Hence, the study aimed to evaluate the effectiveness of therapy for patients with isoniazid-mono-resistant TB and the negative effects of the H-mono-resistant TB Regime. Materials and Methods: It was a hospital-based prospective observational study from September 2021 to August 2022. Hence, 100 patients diagnosed with isoniazid mono-resistance TB enrolled in this study. After obtaining the prior informed consent of all patients willing to approve the collection and publication of their data, including extensive clinical history and radiological, microbiological, and biochemical investigations, this study included all diagnosed cases of isoniazid mono-resistant TB. A descriptive statistical analysis was done for continuous and categorical variables. Differences in characteristics between participants were tested with logistic regression and cross-tabulation. P &lt;0.05 was considered significant. Results: Among 100 patients participated, their mean age was 50.8 ± 3.2 years. About 72 (72%) participants have successful treatment outcomes (cure). Only about 25 (25%) patients had minor adverse drug reactions. Body mass index (16.6 [3.6–74]), substance addiction history (9.5 [3.3–26.9]), previous history of TB (9 [3.3–24.0]), type of lesion (5.3 [1.6–17]), and extent of the lesion (2.6 [1.03–6.07]) in chest X-ray were associated statistically with the treatment outcome. Conclusion: The findings suggest that the H-mono-resistance regime is generally well-tolerated, with only a small percentage of patients experiencing nonserious adverse drug reactions, and the overall successful treatment outcome in H-mono patients was 72%. The study also highlights the importance of monitoring drug resistance patterns, particularly for levofloxacin and moxifloxacin, and the need for effective treatment regimens for isoniazid mono-resistant pulmonary TB.

Biochemical markers assessing rate of reparative processes in patients with infiltrative pulmonary tuberculosis

Theeffectiveness of chemotherapy for infiltrative pulmonary tuberculosis (ITL) is determined by proper timing and adequacy of treatment. The speed of reparative changes in the pulmonary parenchyma is associated with the effectiveness of therapy. Different classes of proteinases are involved in extracellular matrix remodeling. The aim of the study was to evaluate a potential of using the markers of proteinase/inhibitors axis for predicting effectiveness of therapy in patients with ITL due to varying resistance ofMycobacterium tuberculosisto anti-tuberculosis drugs (PTP).Materials and methods.A retrospective study included 60 and 55 ITL patients with the drug sensitive (DS) and drug resistance (DR) Mtb strains, respectively. Patients were divided into two groups according to therapy effectiveness. The levels of blood serum matrix metalloproteinase MMP-1, MMP-3, MMP-8, MMP-9 and their TIMP-1 inhibitor, neutrophil elastase (NE), alpha-2 macroplobulin (MG) and proteinase inhibitor (PI) were determined. Statistica 10.0 and R software packages were used.Results. According to the model of discriminant analysis, the pattern of host inflammatory response in ITL was accounted for not only by varying pathogen resistance, but also by the different size of lung damage. Patients with a limited and widespread process with the DS of the pathogen strains were assigned to group I and II, and DR — to group III and IV group, respectively. The decisive in the speed of tissue repair was the number of neutrophils bearing various levels of proteinase MMP-8, MMP-9 (I group) or TIMP-1 and PI inhibitors (II group). Only combining biochemical data with the those on radiation methods are possible for prognosis in a group of patients with DR (III and IV).Conclusions.Combinations of the markers of the proteinase/inhibitors axis are informative in assessing a rate of reparative changes in ITL and differ not only depending on the pathogen DS strains, but also from the size of destructed pulmonary parenchyma. Differences in parameter combinations are accounted for by history of a specific disease.

Changes in Therapy Are Not Associated With Increased Remission in Patients With Crohn's Disease of the Pouch.

There is a paucity of data on the real-world effectiveness of therapies in patients with Crohn's disease of the pouch. This was a prospective multicenter study evaluating the primary outcome of remission at 12 months of therapy for Crohn's disease of the pouch. One hundred thirty-four patients were enrolled. Among the 77 patients with symptoms at baseline, 35 (46.7%) achieved remission at 12 months. Of them, 12 (34.3%) changed therapy. There was no significant association between therapy patterns and remission status. Approximately 50% with symptoms at enrollment achieved clinical remission at 12 months, most of whom did so without a change in therapy.

Optimising Insulin Injection Techniques to Improve Diabetes Outcomes.

The effectiveness of therapy in patients with diabetes depends on the correct use of the insulin injection technique. However, despite many established recommendations and evidence that an effective insulin injection technique is essential to improve glycaemic control and minimise the risk associated with diabetes, there is still a need to identify impediments to the insulin injection technique among patients and create awareness among patients and healthcare professionals about the importance of the optimisation of insulin injection techniques. This review focuses on the recent advancements in delivery devices, insulin injection technique teaching methods, monitoring, and complication management and highlights regional best practices and recommendations for optimising injection techniques to improve diabetes outcomes.

Modern view on rosacea: Topical issues of epidemiology, pathogenesis and therapy. Literature review

Rosacea is a multifactorial dermatological disease that is widespread throughout the world, initially manifested as a cosmetic defect, and in the absence of systemic and topical therapy leads to a change in the structure and functions of the facial skin.&#x0D; Patients with rosacea often seek medical attention, as these aesthetic problems impair their quality of life and contribute to the development of social and psychological problems. Chronic stress is often the cause of the development of social maladaptation, which occurs because of a constant feeling of self-doubt, own inferiority, and anxiety. Anxiety and chronic depression can cause even minor manifestations of rosacea, as it is localized on the skin of the face. Dermatosis often manifests itself in women older than 30 years, under the influence of multiple trigger factors, has a chronic relapsing course.&#x0D; Understanding the pathophysiology and the use of combined therapies can improve the effectiveness of therapy in patients with rosacea, achieve and prolong clinical remission, identify trigger factors and possible prevention. This explains the need to study rosacea not as an independent dermatosis, but as a sign of more significant disorders that can lead not only to social and aesthetic problems, but also affect the general health of the patient.

Rationale for the use of dexpanthenol drugs as part of the external therapy of dermatoses in children and adults

Impaired skin barrier plays a major role in the development of many skin diseases and conditions such as dry skin, sensitive skin, atopic dermatitis, contact dermatitis, etc. The topical therapy aims at not only suppressing the inflammatory response in the skin, but also at regenerating the destroyed protective epidermal lipid barrier in atopic dermatitis patients. Dexpanthenol was produced by synthesis in the middle of the last century and is a derivative of pantothenic acid. Topical dexpanthenol is well absorbed through the skin, where it is converted into pantothenic acid, a component of coenzyme A, and thus participates in the regulation of the synthesis of fatty acids and sphingolipids, components of the stratum corneum. Therefore, pantothenic acid is essential for the normal functioning of the epithelium. Topical dexpanthenol improves skin hydration due to its hygroscopic properties and ability to retain moisture. The hydrating effect is interrelated with its capacity to regenerate the epidermal barrier of the skin. Dexpanthenol also enhances the differentiation of corneocytes and lipid synthesis, stimulating the regeneration of the epidermis. Numerous studies show that the efficacy of dexpanthenol is comparable to the efficacy of glucocorticosteroids by a weak degree of activity. Dexpanthenol is the active ingredient of Pantoderm, which is available as cream and ointment. Pantoderm ointment and cream contain 5% dexpanthenol. The article presents its own clinical reports of the treatment of patients with atopic dermatitis and administration of the combination therapy. It may be concluded that the use of topical glucocorticosteroids combined with dexpanthenol can increase the effectiveness of therapy in patients with atopic dermatitis.

COVID-19 И ОЖИРЕНИЕ У ДЕТЕЙ, ИЛИ К ЧЕМУ ПРИВОДИТ ДИСТАНЦИОННОЕ ОБУЧЕНИЕ

The epidemiological situation in the country in recent years has led to an increase in the prevalence of childhood obesity, which was facilitated by quarantine measures, school closures and, as a result, restriction of children's access to healthy school meals, reduced control, and inactivity. And the Union of Pediatricians of Russia confirms the factors proven by world medical practice about the relationship between overweight and covid-19: adipose tissue contributes to better penetration of the coronavirus and increases the duration of virus persistence by 42%; obese people are more likely to have other chronic diseases, which, in turn, increase the risk of severe COVID-19. Therefore, the purpose of our work was to assess the mutual influence of COVID-19 and obesity in children, to optimize the “pron-position” method for patients with COVID-19 and overweight. We conducted preventive examinations of 366 students of the Lyceum of Philosophy and Planetary Humanism before and after quarantine measures and analyzed the medical histories of 54 children diagnosed with a New Coronavirus infection who were hospitalized in the infectious department of the Samara Regional Children's Infectious Hospital. As a result of our research, we observe a tendency for the growth of overweight children and a decrease in the level of health in the children's population of the Samara region, which directly indicates the need to introduce new preventive measures for children of the Samara region that can popularize a healthy lifestyle among students. And the product we developed made it possible to improve well-being and enhance the effectiveness of therapy in patients diagnosed with COVID-19, including overweight patients.

#4146 LIMITATIONS AND UNCERTAINTIES OF ASSESSING AND MANAGING OLDER PATIENTS WITH ANCA ASSOCIATED VASCULITIS

Abstract Background and Aims ANCA associated vasculitis (AAV) has a peak incidence in 65 -74 yr olds. As a result, it affects an ageing population who are vulnerable to co-morbidities, polypharmacy and frailty. Due to the high burden of morbidity and mortality in these patients, it is increasingly recognised that individualised management is needed. Whilst current immunotherapies are effective, there remains caution in treating older patients due to the potential risks. Yet despite AAV being a condition that predominantly affects older people, few studies have looked specifically at the benefit of treating AAV in such age groups, or at frailty assessments tools to guide treatment. Method We aimed to evaluate treatment outcomes in older AAV patients, as well as frailty assessment tools to aid prognostication and management. A cohort study evaluating outcomes of induction immunosuppression in patients ≥75yrs was constructed from 2 centres, with subsequent meta-analysis of published data [1]. In addition, studies identifying frail patients, who may be at risk of adverse outcomes, were carried out using the quantitative tools; Hospital Frailty Risk Score (HFRS) [2] and the Clinical Frailty Scale (CFS). Primary outcomes were mortality and end stage kidney disease (ESKD). The HFRS was calculated using hospital coding data from any hospital admissions between a patient's AAV diagnosis to 2yr follow up. Patients were categorized into low, intermediate and high HFRS groups. CFS scores at presentation were documented prospectively and then repeated a minimum of 6 weeks from diagnosis. A CFS score of ≥5 was used to categorise frailty. Differences in the scores were assessed and compared to clinical outcomes. Results Retrospective analysis of our AAV cohort aged ≥75 yrs demonstrated that induction immunosuppression was associated with a significant reduction in the 2yr mortality risk [HR 0.29 (95% CI 0.09–0.93)]. Following systematic review, with a study population of 290 patients, the pooled HR by meta-analysis confirmed a significant reduction in the risk of death with induction treatment [HR 0.31 (95% CI 0.16 - 0.57)]. Treated patients had a lower rate of ESKD, but this was not statistically significant [HR 0.71 (95% CI 0.15 – 3.35)]. Looking separately at frailty assessments, mortality and ESKD were assessed according to HFRS and CFS. Thirty-four patients with AAV aged ≥75 yrs were assessed using HFRS and categorised into the low (n = 18), intermediate (n = 13) and high (n = 3) HFRS groups. All patients in the high HFRS groups had ≥1 episodes of hospitalization after diagnosis of AAV. However, there was no difference in mortality or duration of hospitalisation between the 3 categories. Forty-one patients with AAV aged ≥65yrs were assessed using the CFS. The median CFS at diagnosis and follow-up was 4. There was no significant interval change in CFS (P = 0.16) suggesting that patients did not become frailer. Instead, there was a tendency towards improved frailty scores at reassessment (n = 17, 43%), with some patients going from a CFS of 6 (moderately frail) to 3 (managing well). There was no significant difference in ESKD between those categorised as frail and non-frail (P = 1.0), although crude mortality was higher among those initially categorised as frail (P = 0.03). Conclusion Our research shows that older patients with AAV benefit from standard remission-induction therapy and those treated had favourable mortality outcomes compared to those who were not. Furthermore, frailty assessment tools do not correlate clearly with clinical outcomes. Whilst there is evidence to support the use of HFRS and CFS in a many diseases, its utility in determining frailty and potential susceptibility to adverse effects of therapy in patients with multifaceted, autoimmune inflammatory disease remains limited. Patients may present ‘frail’ as a result of significant disease burden, which has the potential to improve with appropriate treatment. We suggest that age alone and frailty at assessment should not be a limiting factor when considering treatment and prospective studies of this population are needed.

The results of therapy in patients with high-risk neuroblastoma: the experience of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology

Treatment of patients with high-risk neuroblastoma (NB) is a complex challenge, and it is based on response to certain elements of therapy. The development and introduction of new treatment approaches, such as GD2-targeted immunotherapy (IT), leads to improved survival in this cohort of patients. The aim of the study was to retrospectively assess the effectiveness of therapy in patients with high-risk NB before the introduction of IT into clinical practice. We retrospectively analyzed the data of 151 NB patients stratified into a high-risk group who had received treatment in accordance with the modified NB2004 protocol of the German Society for Pediatric Oncology and Hematology (GPOH) at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology from 01.2012 to 12.2017. This study was approved by the Independent Ethics Committee and the Academic Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology. All the study subjects (or their legal representatives) signed a voluntary informed consent form indicating their agreement to treatment and use of their data for research purposes. Overall survival (OS), event-free survival (EFS), and risk factors were analyzed in the patients with high-risk NB including those who had completed multimodal therapy with autologous hematopoietic stem cell transplantation and post-consolidation therapy with isotretinoin and had achieved a satisfactory response to induction therapy (complete response (CR), very good partial response (VGPR), partial response (PR)) (population of special interest). The main unfavorable prognostic clinical and molecular genetic factors affecting survival in the high-risk NB patients were older age, MYCN gene amplification, and stage 4 of the disease. The use of the modified GPOH NB2004 protocol resulted in a satisfactory response (CR/VGPR/PR) to the induction therapy in most patients: 124/151 (82.1 %). Surgery (other than primary tumor biopsy) led to improved survival, with no statistical difference between macroscopic radical surgery and macroscopic residual tumor. At the same time, radiation therapy (RT), as the second element of local control, had a significant impact on EFS in the group of the patients with stage 4 disease: the 3-year EFS was 39.4 % (95 % confidence interval (CI) 23.1–55.4) in the patients with RT versus 25.7 % (95 % CI 17.5–34.7) in the patients without RT (p = 0.0295). The introduction of a new high-dose TreoMel chemotherapy regimen did not result in worse survival rates but led to a decrease in transplant-related toxicity. The 5-year OS and 5-year EFS were 49.4 % (95 % CI 40.9–57.3 %) and 33.3 % (95 % CI 25.9–40.9) respectively for all the study subjects, and 81.6 % (95 % CI 70.3–88.9) and 55.1 % (95 % CI 43.1–65.5) respectively for the patients from the population of special interest. The analysis of the results of therapy in the high-risk NB patients who had received treatment at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, yielded results comparable to those of the original GPOH NB2004 protocol. The patients with CR/VGPR/PR to the induction therapy who had completed the protocol treatment with autologous hematopoietic stem cell transplantation and isotretinoin post-consolidation therapy demonstrated higher 5-year EFS rates. However, there remains a need to develop more effective treatment regimens for high-risk NB.

Improving the Provision of Medical Care to Patients With Stroke Using JCI Standards. First Results

AIM OF THE STUDY To compare the dynamics of thrombolytic therapy effectiveness in patients with stroke after the reorganization of medical care using JCI standards.MATERIAL AND METHODS In 2022, a new system for routing patients with stroke at the level of the emergency department was introduced in the Emergency Care Hospital; and 976 patients with the diagnosis of brain infarction were treated. The analysis of the results was carried out by comparing the mortality rates from ischemic stroke, the number of thrombolytic therapies and procedures of mechanical methods of revascularization, as well as the indicators “Door-CT”, “DoorNeedle”, “Door-Opening” for 2021 and 10 months of 2022.RESULTS After the introduction of the new routing system for patients with stroke at the emergency department level, there appeared the first positive results. Thus, the mortality rate from brain infarction in 10 months of 2022 decreased by 5.6% compared to 2021. The number of thrombolytic therapies performed increased by 5.2%, and mechanical revascularization procedures by 1.62% over the same period, while the “Door-CT” indicator decreased by 27 minutes, “DoorNeedle” by 22 minutes, “Door-Opening” by 31.6 minutes.CONCLUSIONS The immediate results of the introduction of the new patient routing system at the level of the emergency department have proved successful, primarily due to the significant reduction in the mortality rate of patients with cerebral infarction by 5.6%. However, the process requires further investigation and has application points for further improvement.

How we monitor the therapy effectiveness in patients with chronic myeloid leukemia - A Single center experience

Chronic myeloid leukemia (CML) is a hematological disorder characterized by increased proliferation of the granulocytic cell lineage. We diagnose CML by presence of the breakpoint cluster region-abelson (BCR-ABL1) oncogene using the quantitative real-time polymerase chain reaction (QRT-PCR). This method provides an accurate and unambiguous follow-up of the treatment response to tyrosine kinase inhibitors (TKIs). This study aimed to determine the molecular response to the first and second generation of TKIs in first and second line of treatment using the QRT-PCR method. We conducted a retrospective study on 48 CML patients treated with the first and second generation of TKIs in first and second-line treatment. Treatment responses have been followed-up every 3 months using the QRT-PCR method. Patients were divided into three groups according to molecular responses to the first line of TKIs. Results obtained in this study showed that the first group of patients did not achieve major molecular response (MMR) in the first 18 months of TKI treatment. The second and third group of patients achieved MMR and deep molecular response (DMR) in the first 18 months of TKI treatment. These results indicate that patients with MMR and DMR in the first 18 months of TKIs treatment had a favourable clinical course of the disease. Inadequate molecular responses to the first line of TKIs can be improved with in increase of the dose of TKIs or by switching to other TKIs. Continuous and timely molecular monitoring of TKI’s response in CML patients provides a careful observation of the disease's course and a proper treatment approach.