Higher Total Risk Research Articles

Outcomes of Patients with Normal LDL-Cholesterol at Admission for Acute Coronary Syndromes: Lower Is Not Always Better.

There are few prospective data on the prognostic value of normal admission low-density lipoprotein cholesterol (LDL-C) in statin-naïve patients with acute coronary syndromes (ACS) who are treated with a preemptive invasive strategy. We aimed to analyze the proportion of patients with normal LDL-C at admission for ACS in our practice, and their characteristics and clinical outcomes in comparison to patients with high admission LDL-C. Two institutions' prospective registries of patients with confirmed ACS from Jan 2017 to Jan 2023 were used to identify 1579 statin-naïve patients with no history of prior coronary artery disease (CAD), and with available LDL-C admission results, relevant clinical and procedural data, and short- and long-term follow-up data. Normal LDL-C at admission was defined as lower than 2.6 mmol/L. All demographic, clinical, procedural, and follow-up data were compared between patients with normal LDL-C and patients with a high LDL-C level (≥2.6 mmol/L) at admission. There were 242 (15%) patients with normal LDL-C at admission. In comparison to patients with high LDL-cholesterol at admission, they were significantly older (median 67 vs. 62 years) with worse renal function, had significantly more cases of diabetes mellitus (DM) (26% vs. 17%), peripheral artery disease (PAD) (14% vs. 9%), chronic obstructive pulmonary disease (COPD) (8% vs. 2%), and psychological disorders requiring medical attention (19% vs. 10%). There were no significant differences in clinical type of ACS. Complexity of CAD estimated by coronary angiography was similar between the two groups (median Syntax score 12 for both groups). There were no significant differences in rates of complete revascularization (67% vs. 72%). Patients with normal LDL-C had significantly lower left ventricular ejection fraction (LVEF) at discharge (median LVEF 52% vs. 55%). Patients with normal LDL-C at admission had both significantly higher in-hospital mortality (5% vs. 2%, RR 2.07, 95% CI 1.08-3.96) and overall mortality during a median follow-up of 43 months (27% vs. 14%, RR 1.86, 95% CI 1.45-2.37). After adjusting for age, renal function, presence of diabetes mellitus, PAD, COPD, psychological disorders, BMI, and LVEF at discharge in a multivariate Cox regression analysis, normal LDL-C at admission remained significantly and independently associated with higher long-term mortality during follow-up (RR 1.48, 95% CI 1.05-2.09). A spontaneously normal LDL-C level at admission for ACS in statin-naïve patients was not rare and it was an independent risk factor for both substantially higher in-hospital mortality and mortality during long-term follow-up. Patients with normal LDL-C and otherwise high total cardiovascular risk scores should be detected early and treated with optimal medical therapy. However, additional research is needed to reveal all the missing pieces in their survival puzzle after ACS-beyond coronary anatomy, PCI optimization, numerical LDL-C levels, and statin therapy.

Spatial Distribution, Speciation, and Ecological Risk Assessment of Heavy Metals in Surface Sediments of Dongjiang Lake, Hunan Province

To understand the heavy metal pollution status of Dongjiang Lake, the contents and species of heavy metals in the surface sediments were investigated during September 2021, and the heavy metal pollution level and potential ecological risk were evaluated. The results showed that Cd, Pb, As, Cu, Zn, Ni, and Cr contents were in the range of 0.40-34.1, 14.8-1688, 6.99-1155, 6.89-280, 26.2-1739, 6.29-55.4, and 23.3-44.8 mg·kg-1, respectively, with extremely uneven spatial distributions. The highest contents of Cd, Pb, As, Zn, Cu, and Ni were found in the site adjacent to Yaogangxian tungsten ore. The proportion of metal species with bioavailability was high, in which Cd in acid-soluble species was 46.7%-71.5% and Pb in reducible species was 46.8%-67.0%. The bioavailable species of Cu, Zn, Ni, and Cr were 35%-68%, 42%-72%, 26%-51%, and 6%-30%, respectively, although they primarily existed in residual species. According to the geo-accumulation index (Igeo), there was a moderate or extreme pollution status of Cd in all sites, moderate or extreme pollution status of Pb in 90% of sites, and moderate pollution status of As, Cu, and Zn in 30% of sites. The ecological risk factor (Eri) of Cd showed high potential ecological risk in all sites with significantly high potential ecological risk in 80% of sites. Moreover, As and Pb had significantly high potential ecological risk, and Cu had moderate potential ecological risk in S7, which was adjacent to Yaogangxian tungsten ore. There was a high total potential ecological risk in all sites and significantly high potential ecological risk in 50% of sites. Therefore, the surface sediments of Dongjiang Lake were under the combined pollution of Cd, Pb, As, Zn, and Cu with high bioavailability and high total potential ecological risk.

Human health risks in Ferozepur District, Punjab, India due to potentially toxic elements in agricultural soils

In the present study, soil contamination by arsenic, cadmium, chromium, cobalt, copper, iron, lead, manganese, nickel, uranium and zinc; and associated human health risks were assessed at 30 agricultural sites in Ferozepur District, Punjab. Above 90% soil samples had high content of chloride, sodium and potassium. Cadmium, arsenic, zinc and lead in 100%, 76.67%, 76.67% and 66.67% samples exceeded their safe limits (mg/kg; 0.06, 20, 50 and 10, respectively). Individual/multi-elemental indices indicated high PTEs contamination in soils posing low to considerable ecological risk. Principal components PCI and PCII contributed 44.748% and 30.476% variance in data, respectively. PTEs in soils were classified in two categories using cluster analysis (I: Cd, U, Co, Pb, Ni, Cr, As, Cu, Zn and Mn; II: Fe), indicating both geogenic and anthropogenic origins. Health risks due to PTE exposure via dermal contact, inhalation and ingestion were also assessed. Children were found to be highly prone to non-cancer health risk (mean hazard index = 1.30) by As exposure, mainly via ingestion pathway. High total cancer risk was posed to residents via As (7.52E-05) and Cr (9.17E-06) exposure, primarily through ingestion. Bioremediation and efficient disposal of solid and liquid wastes may reduce soil contamination in the study area.

WHO Non-Lab-Based CVD Risk Assessment: A Reliable Measure in a North Indian Population.

Introduction:Timely, affordable, and sustained interventions reduce the risk of heart attack or Stroke in people with a high total risk of cardiovascular diseases (CVD). Risk prediction tools are available to estimate the cardiovascular risk using information on multiple variables. CVD risk charts prepared by the World Health Organization (WHO) has laboratory-based and non-laboratory-based charts with the latter meant for use in resource limited settings. We conducted a study to determine concordance between the laboratory- and non-laboratory risk charts and to estimate the prevalence of selected CVD risk factors in a rural Indian population.Methods:A community-based cross-sectional study was conducted in rural area of Ballabgarh in district Faridabad, Haryana. Sample of 1,018 participants aged 30–69 years was selected randomly from study area. Information on CVDs risk factors was obtained using WHO STEPS questionnaire, anthropometry and laboratory investigation. Risk distribution among the study participants was observed. Concordance between laboratory- and non-laboratory-based WHO CVD risk charts was determined using agreement analysis.Results:The mean age of the study participants was 43.9 (8.9) years and 55.6% participants were women. Among various CVD risk factors, hypertension (39.4%) was the major factor followed by overweight (34.1%) was found to be major factor, followed by current smoking (23.6%) and hypercholesterolemia (18.7%). The concordance between the two charts was 83.3% with kappa value of 0.64. Considering laboratory-based charts as the gold standard, the sensitivity and specificity of non-laboratory-based risk charts at 5% risk as cut-off was 86.5% and 90.3% respectively.Conclusion:The study shows a good agreement between the laboratory-based and non-laboratory-based risk charts. Thus non-laboratory-based risk charts are suitable for risk estimation of CVDs for use in resource limited settings like India.

Somatic Symptom Disorder among medical students in Umm Al-Qura University, Makkah Al-Mukarramah, Kingdom of Saudi Arabia

Background: A somatic symptom disorder (SSD) occurs when a person feels extreme, exaggerated anxiety about physical symptoms that results in major distress and/or problems of functioning. Objective: This study aims to screen somatic symptom disorder among medical students. Methods: This cross-sectional study was conducted on medical students during the academic year 2019/2020. 374 medical students were recruited for this study. Self administered questionnaire was used to collect the data including two sections; socio-demographic information and Somatic Symptom Scale-8 (SSS-8) questions. Results: Out of 374 students, 206 (55.1%) were males, 292 (78.1%) were from the clinical years (Years 4-6), 353 (94.4%) were singles, 71 (19.0%) were smokers, 83 (22.2%) had social stressors and 88 (23.5%) had educational problems. On considering only the high SSS-8 total risk scores, the prevalence of SSD is estimated to be 39% (20.3% had very high and 18.7% had high risk). Feeling tired or having low energy was the most prevalent symptom. Female students and students having social stressors and educational problems were more vulnerable to have SSD. Conclusions: There is high prevalence of SSD among our medical students. Accordingly, health education programs and frequent mentoring of the students are highly recommended. Key words: somatic, symptom, disorder, medical students

Systematic ESG exposure and stock returns: Evidence from the United States during the 1991–2019 period

AbstractUsing a sample of US stocks over the period 1991–2019, we test whether stocks with high exposure to a social index exhibit high returns. Using a univariate analysis, our in‐sample results show that stocks with high sensitivities to the MSCI KLD 400 Social Index underperform stocks with low sensitivities by an annual risk‐adjusted performance of 7.02%. The negative premium is also larger in the post‐crisis period of 2007–2019 and is equal to 10.25%. The out‐of‐sample results offer, however, only weak evidence of such a finding, with a risk‐adjusted performance difference of merely −0.84% over the full sample period and no significant differences between the pre‐crisis and post‐crisis periods. In the multivariate regression, we find evidence of a negative relationship between exposure to the social index and stock performance. Moreover, we find that stocks with high exposure to the social index display a low corporate social responsibility score, a high Tobin’s Q, high long‐term debt, a large size, high total risk, a high market beta, a high SMB coefficient, a low HML coefficient, and a small MOM coefficient.

Association between intestinal neoplasms and celiac disease: A review.

Celiac disease (CD) is a chronic immune-mediated intestinal disease with genetic susceptibility. It is characterized by inflammatory damage to the small intestine after ingestion of cereals and products containing gluten protein. In recent years, the global prevalence rate of CD has been approximately 1%, and is gradually increasing. CD patients adhere to a gluten-free diet (GFD) throughout their entire life. However, it is difficult to adhere strictly to a GFD. Untreated CD may be accompanied by gastrointestinal symptoms, such as diarrhea, abdominal pain, and extraintestinal symptoms caused by secondary malnutrition. Many studies have suggested that CD is associated with intestinal tumors such as enteropathy-associated T-cell lymphoma (EATL), small bowel cancer (SBC), and colorectal cancer. In this study, we reviewed related studies published in the literature to provide a reference for the prevention and treatment of intestinal tumors in patients with CD. Compared with the general population, CD patients had a high total risk of SBC and EATL, but not colorectal cancer. The protective effect of GFD on CD-related malignancies is controversial. Further studies are needed to confirm whether GFD treatment can reduce the risk of intestinal neoplasms in CD.

Condensation: A Retrospective Cohort Study to Investigate the Association Between Maternal Pre-pregnancy Obesity and Childhood Respiratory Disease.

We sought to explore whether maternal pre-pregnancy obesity is an independent risk factor for offspring respiratory morbidity during childhood. A population-based retrospective cohort analysis comparing childhood respiratory morbidity incidence in offspring to mothers with pre-pregnancy obesity (BMI≥ 30kg/m2) and those who had lower BMI was conducted. Respiratory diagnoses were pre-defined based on ICD-9 codes. The study population comprises of all deliveries that took place at the Soroka University Medical Center (SUMC), the sole tertiary hospital in the Negev (Southern Israel), between the years 1991-2014. A Kaplan-Meier survival curve was used for cumulative respiratory morbidity incidences over time and a Cox proportional hazards model was constructed to control for confounders. During the study period, 242,342 infants met the inclusion criteria; out of which 3290 were born to mothers with a diagnosis of pre-pregnancy obesity. Offspring to mothers with pre-pregnancy obesity had a significant higher risk for obstructive sleep apnea (OR 1.43, 95% CI 1.002-2.046) as well as a higher total risk for hospitalizations due to childhood respiratory morbidity (OR 1.21, 95% CI 1.041-1.398). The cumulative respiratory morbidity incidence over time was significantly higher in the maternal pre-pregnancy obesity group (p = 0.044). Controlling for maternal age, gestational diabetes mellitus, hypertensive disorders and gestational age, pre-pregnancy obesity remained an independent risk factor for offspring respiratory morbidity (adjusted HR = 1.175, 95% CI 1.018-1.357). Maternal pre-pregnancy obesity may create an environment leading to an increased risk for long-term offspring respiratory morbidity, and specifically obstructive sleep apnea.

Potentially toxic elements in river water and associated health risks in Ropar Wetland, India and its vicinity

In the present study, quality of surface water from five different locations on the banks of river Sutlej in Ropar wetland was determined by estimation of physico-chemical parameters; water quality indices; contents of arsenic, cadmium, cobalt, chromium, copper, iron, manganese, lead and zinc; determination of genotoxic potential of water samples using Allium cepa root chromosomal aberration assay and plasmid pBR322 DNA nicking assay; and assessment of associated possible human health risks for adults and children. River water was slightly alkaline, moderate to very hard, non-saline, genotoxic and unsuitable for both drinking and irrigation. Among 20 surface water samples analysed, contents of Cd, Cr, Cu, Fe, Mn and Pb in 11, 7, 3, 15, 14 and 13 samples exceeded the safe limits (mg/L) of 0.003, 0.05, 0.05, 0.30, 0.10 and 0.01, respectively. Ingestion of surface posed higher health risk than dermal contact, where Co was major contributor to mean hazard index (3.26–10.72 for adults and 4.22–13.87 for children). Hazard index for dermal contact in both age groups was < 1.00. Cr was found to be primarily responsible for high total cancer risk posed by both routes of exposure, i.e. ingestion (6.83E−04 to 2.03E−03 for adults and 7.58E−05 to 2.25E−04 for children) and dermal contact (5.15E−05 to 2.02E−04 for adults and 6.23E−06 to 2.44E−05 for children). Prolonged exposure to contaminated surface water may elevate the human health risk in the study area; therefore, pre-treatment of river water is necessary before its utilization by human population of the study area.

The role of nutritional factors in the formation of cardiovascular risk in patients with type 2 diabetes mellitus

Cardiovascular diseases are the most common complications of type 2 diabetes mellitus (T2DM) and remain the main cause of mortality in this category of patients. Currently, there is more and more data that confirm the influence of nutritional factors not only on the achievement of target values of metabolic parameters in diabetes, but also on predictors of cardiovascular risk, and also demonstrate their role as independent predictors. In this regard, the study of the role of nutritional factors in the formation of high cardiovascular risk in patients with T2DM is of high practical importance and relevance. The aim was to assess the role of nutritional factors in the formation of high total cardiovascular risk in patients with T2DM. Material and methods. An open clinical controlled prospective observation was carried out for one year in 110 patients with T2DM (87 women and 23 men, mean age 56.7±8.6 years). The average value of glycated hemoglobin (HbA1c) in the group was 8.95±2.09%, the av erage value of the body mass index was 32.3±6.2 kg/m2. All patients were assessed for traditional cardiovascular risk factors, markers of systemic inflammation and endothelial dysfunction, nutritional status was assessed by analyzing the frequency of consumption and a general semi-quantitative assessment of the intake of nutrients, food groups, and energy. During a one-year prospective follow-up, total cardiovascular endpoints were recorded and the effect of patient education on metabolic parameters, nutritional factors, and cardiovascular risk was assessed. Results. In patients with T2DM who had various clinical forms of cardiovascular diseases, the diet had an increased level of fats, which exceeded the intake in individuals without complications (p=0.013), and saturated fatty acids (SFA) (p=0.003). The risk of developing cardiovascular events in patients with T2DM increased by 5 times under excessive consumption of products containing SFA (meat, animal fats, sausages) (OR 5.34; CI 3.05-10.22, p=0.001). The decrease in body weight in the target range (by 7-10% during the year) was characterized by a decrease in the HbA1c by 11.9%, postprandial glycemia by 25.7%, total cholesterol by 20.4%, atherogenic coefficient by 25.0%, plasminogen activator inhibitor-1 by 8.5%, highly sensitive C-reactive protein by 27.4%, systolic blood pressure by 6.9%, and also was accompanied by significant decrease in unfavorable total cardiovascular events during the year (p=0.024). In addition, in the group of patients who underwent training, there was a decrease in the total amount of calories consumed (p=0.018), consumption of SFA (p=0.021) and mono- and disaccharides (p=0.001), an increase in dietary fiber in the diet (p=0.015). Conclusion. In the course of the study, an imbalance in the nutritional components of the diet in patients with T2DM was revealed. The significant role of alimentary factors in the formation of high cardiovascular risk has been demonstrated, as well as the effectiveness of therapeutic education of patients in terms of managing behavioral risk factors.

Shariah screening and corporate governance: The case of constituent stocks of Dow Jones US Indices

Shariah screening discards the firms that belong to impermissible business sectors (or sin industries) and follow capital structure with high debt and current assets. This study tests whether the firms passing Shariah screening have better (or worse) governance quality as compared to firms not subjected to Islamic screening. The screened firms may have lesser governance quality as they cannot use debt to discipline managers or achieve optimal capital structure. On the contrary, they may be better governed as these firms get higher presence of institutional investors and better analyst coverage. This paper provides comparison of governance quality of Shariah compliant (SC) firms in United States by using proprietary dataset of Dow Jones US Indices. The screened firms offer ground for a natural experiment as they pass negative ethical screening and meet financial criteria for the inclusion in the index. The findings suggest that the SC firms have lesser governance quality than Shariah Non-Compliant firms. The lower level of governance can be attributed to lower Size, lower Profitability, higher Dividend Payout, higher Total Risk and lower Free Cash Flow. Various robustness tests are performed to validate the findings and the results remained robust. These findings provide useful insights about the governance mechanism of SC firms that are emerging as an important alternative investment class in the last two decades.

Safety of hydroxychloroquine in COVID-19 and other diseases: a systematic review and meta-analysis of 53 randomized trials.

IntroductionMany concerns still exist regarding the safety of hydroxychloroquine (HCQ) in the treatment of Coronavirus Disease 2019 (COVID-19).ObjectivesThe purpose of this study was to evaluate the safety of HCQ in the treatment of COVID-19 and other diseases by performing a systematic review and meta-analysis.MethodsRandomized controlled trials (RCTs) reporting the safety of HCQ in PubMed, Embase, and Cochrane Library were retrieved starting from the establishment of the database till June 5, 2020. Literature screening, data extraction, and assessment of risk bias were performed independently by two reviewers.ResultsWe identified 53 eligible studies involving 5496 patients. The meta-analysis indicated that the risk of adverse effects (AEs) in the HCQ group was significantly increased compared with that in the control group (RD 0.05, 95%CI, 0.02 to 0.07, P = 0.0002), and the difference was also statistically significant in the COVID-19 subgroup (RD 0.15, 95%CI, 0.07 to 0.23, P = 0.0002) as well as in the subgroup for other diseases (RD 0.03, 95%CI, 0.01 to 0.04, P = 0.003).ConclusionsHCQ is associated with a high total risk of AEs compared with the placebo or no intervention in the overall population. Given the small number of COVID-19 participants included, we should be cautious regarding the conclusion stating that HCQ is linked with an increase incidence of AEs in patients with COVID-19, which we hope to confirm in the future through well-designed and larger sample size studies.Electronic supplementary materialThe online version of this article (10.1007/s00228-020-02962-5) contains supplementary material, which is available to authorized users.

New approaches to managing patients with high total risk (review of year 2019 recommendations)

Cardiovascular disease is the leading cause of death worldwide. The current recommendations of the European Society of Cardiology (ESC) – 2019 are based on the results of large multicenter clinical trials that have proven the effectiveness of more stringent approaches to the management of patients with high cardiovascular risk. New regimens of drug therapy, the definition of new target values for blood pressure, blood lipid levels and the correction of hyperglycemia, the prevention of thromboembolic complications, are aimed at reducing the risk of cardiovascular events and mortality from cardiovascular diseases. The article discusses recommendations of the European Society of Cardiology – 2019 on the management of patients with chronic coronary disease, with lipid metabolism disorders, and diabetes mellitus.

Assessment of methods used for 3-dimensional superimposition of craniofacial skeletal structures: a systematic review.

BackgroundSo far, several techniques have been recommended for the assessment of craniofacial changes through skeletal tissue superimposition, but the evidence that supports them remains unexplored. The purpose of the present study is to assess the available literature on skeletal-tissue superimpositions of serial craniofacial CT or CBCT images used to detect morphological changes.Materials and MethodsMedline (via Pubmed), EMBASE, Google Scholar, Cochrane Library, Open Grey and Grey Literature Report were searched (last search: 17.11.2019) using specific terms that fulfilled the requirements of each database in the context of the study aim. Hand searches were also performed. The outcomes of interest were the accuracy, precision, or agreement between skeletal-tissue superimposition techniques to assess changes in the morphology of craniofacial structures. Studies of any design with sample size ≥3 were assessed by two authors independently. The study protocol was registered in PROSPERO (ID: CRD42019143356).ResultsOut of 832 studies, fifteen met the eligibility criteria. From the 15 included studies, 12 have shown high total risk of bias, one low risk of bias, and two studies have shown unclear risk of bias. Thirteen out of the 15 studies showed high applicability concerns, two unclear and no study had low applicability concerns. There was high heterogeneity among studies regarding the type of participants, sample size, growth status, machines, acquisition parameters, superimposition techniques, assessment techniques and outcomes measured. Fourteen of them were performed on Cone Beam Computed Tomography (CBCT) and one on Computed Tomography (CT) derived 3D models. Most of the studies (eleven) used voxel-based registration, one landmark-based registration and three studies compared different registration techniques, which include the surface-based registration. Concerning the area of interest, nine studies focused on the anterior cranial base and certain facial structures, four on maxillary structures and four on mandibular structures. Non-growing participants were included in six studies, growing in eight, whereas one study had both.ConclusionMost of the available studies had methodological shortcomings and high applicability concerns. At the moment, certain voxel-based and surface-based superimpositions seem to work properly and to be superior to landmark-based superimposition. However, further research in the field is required to develop and properly validate these techniques on different samples, through high quality studies with low applicability concerns.

Оптимальная комбинация Лизиноприла и Амлодипина для лечения пациентов с артериальной гипертонией

Arterial hypertension (AH) remains one of the most common diseases in the world. Reducing cardiovascular risk of mortality from cardiovascular complications is a priority in the treatment of hypertension. Targets of hypertension therapy is to achieve SBP/DBP &lt;140/80 mm Hg. article, regardless of cardiovascular risk and comorbidity. The choice of antihypertensive therapy depends on blood pressure levels, the presence or absence of concomitant diseases, lesion of target organs. Effective and long-lasting control of AH proved by the use of combinations of antihypertensive drugs, including antagonists and ACE inhibitors. The purpose of the study. Evaluation of clinical efficacy and safety of fixed combination antihypertensive therapy using lisinopril combined with amlodipine in patients with hypertension. Material and methods. The study included 30 respondents from essential hypertension II-III degree (ESH/ESC, 2018) aged 35 to 75 years. Patients were treated with the schema a (lisinopril 10 mg, amlodipine 5 mg) and scheme b (lisinopril 20 mg, amlodipine 10 mg) fixed combination therapy with the drug VivaCor® once in the morning. The period of observation was 3 months. At the time of inclusion and at the end of the study all respondents was performed echocardiography, daily monitoring of blood pressure, evaluation of laboratory and instrumental methods of research. Results and discussion. The combination of lisinopril with amlodipine has a fairly high antihypertensive activity, provides a significant cardioprotective effect and is an integral part of antihypertensive therapy in the long-term strategy of administering patients with high hypertensive / very high total cardiovascular risk. Conclusions: 1. The use of a fixed combination of lisinopril and amlodipine in patients with hypertension instead of free or other two-component combinations leads to its target level within 3 months of therapy. 2. Taking a fixed combination of lisinopril and amlodipine is effective and safe. 3. Therapy using the combined drug VivaCor® in patients with high / very high risk of hypertension prevents further pathological remodeling of the heart. 4. The combination of amlodipine and lisinopril is metabolically neutral and well tolerated by patients. Keywords: arterial hypertension, lisinopril, amlodipine, VivaCor.

The effects of heart rate, adherence to antihypertensive pharmacotherapy and physical exercise on clinical course of first grade hypertension

Objective . To analyze the prognostic effects of metabolic and hemodynamic characteristics and adherence to treatment in patients with first grade arterial hypertension (HTN). Design and methods . We have examined twice (with interval 71,3 ± 10,5 months) 67 patients with first grade HTN. Baseline and final investigations included office blood pressure (BP) measurements, heart rate and body mass index calculation, ambulatory BP monitoring. In addition, at baseline we assessed the levels of total cholesterol, low and high density lipoproteins, triglycerides. vascular endothelial growth factor, glucose and insulin. We also performed glucose tolerance test. At follow-up, life style changes and adherence to treatment were assessed via structured questionnaires. Eleven patients with adverse outcomes composed a separate subgroup including 5 with HTN worsening, 2 with angina pectoris worsening, 3 with myocardial infarction, 1 case of sudden death. Results . Insulin levels at glucose tolerance test was higher in patients with adverse outcomes. At baseline, fasting and postprandial heart rate was greater than 80 bpm in 91 % of patients with first grade HTN who developed adverse outcomes and in 21 % in the rest of the group (p &lt; 0,001). Disease progression and complication development were registered only in patients with both high/very high cardiovascular risk and heart rate greater than 80 bpm. Only in patients with very high cardiovascular risk major cardiovascular events were detected. Low adherence to treatment significantly worsened prognosis: the majority (80 %) of patients with adverse outcomes took antihypertensive drugs irregularly; 60 % patients with adverse outcomes reduced level of physical activity. Increment in regular physical activity was found more frequently in patients with serum vascular endothelial growth factor &gt; 200 pg/ml. Conclusions . Heart rate greater than 80 bpm is associated with unfavorable prognostic effect in patients with first grade HTN and high/very high total cardiovascular risk. Disease progression and complication development are more frequent in patients with irregular therapy and/or those who reduced physical activity level.

Gender Differences in Risk Assessment Among Youth Adjudicated to Juvenile Correctional Facilities

The Indiana Department of Corrections (IDOC) uses the IYAS-RES, a risk assessment tool comprised of the following domains: juvenile justice history; family and living arrangements; peers and social support network; education and employment; pro-social skills; substance abuse, mental health, and personality; and values, beliefs, and attitudes. Using a sample of 3,144 juveniles adjudicated to Indiana juvenile correctional facilities, this study examines gender differences in the risk assessment instrument. Results of the study indicated that there were gender differences in all but one of the risk assessment domains (values, beliefs, and attitudes). This study also found that females had higher total risk assessment scores than males, especially for domains that more directly capture female-specific pathways to crime. Results from OLS regression, however, found that males were assessed at higher overall risk levels than females, net of controls. These findings suggest a need to utilize more gender responsive assessment instrument.

Concentrations of arsenic in freshwater, estuarine and mangrove clams from the Mekong and Red R. deltas

During 2017-2018 arsenic concentrations in soft tissues of economically important bivalves from the Mekong and the Red R. Deltas were estimated. Freshwater, estuarine and mangroves species in 10 genera from 11 sites were analyzed. Arsenic levels in both freshwater and estuarine clams were below the permissible limits for hazardous substances in fish and fishery products for recommendation of FAO. In the contrary, in mangrove clams Geloina increased levels of As were found. Target hazard quotients and target cancer risk of As was calculated. Arsenic concentrations in the tissues of the Geloina are estimated to pose a rather high total cancer risk to consumers.

Research institute for complex problems of hygiene and occupational diseases

Objective of the work:assessment and analysis of the risk to the health of the population of Novokuznetsk from the effects of atmospheric emissions from stationary sources of rail transport.Research methods:the volume of the maximum permissible emissions of the structural units of the OJSC “Russian Railways” in the city of Novokuznetsk was analyzed. The calculation of the maximum and average annual concentrations of toxic substances from each source for selected exposure points was made according to the “Methods for calculating the dispersion of emissions of harmful (polluting) substances into the atmospheric air” using the “ECO Center Standard” program. Health risks were calculated in accordance with the “Guidelines for the assessment of the public health risk when exposed to chemicals polluting the environment: “G 2.1.10.1920-04” and methodology A. P. Scherbo “Environment and health: approaches to risk assessment” were compared with acceptable values.Main results of the study:priority pollutants entering to the city’s atmosphere from stationary sources of OJSC “Russian Railways” and determining the risk of chronic intoxication are dioxide ferric, nitrogen dioxide, carbon oxide, hydrofluoride, sulfur dioxide. Soot as a carcinogen is not dangerous for public health. The highest total risk of chronic intoxication is observed in the area of the railway station. The greatest contribution to the formation of the risk of chronic intoxication is made by emissions from the sources of the wagon repair depot. The levels of immediate risks from exposure to all selected pollutants are zero. Determining of the levels of health risks taking into account the background concentrations of toxic substances revealed that the highest levels of immediate risks at all design points are observed from the influence of carbon oxide. The proposed activities aimed at reducing risk levels.Conclusion:stationary sources of the structural units of Russian Railways in Novokuznetsk contribute to air pollution in the city without having a significant impact on the health of the population.

P2644Coronary atherosclerotic burden and risk of major adverse cardiac events in hypertensive patients with erectile dysfunction

Abstract Purpose Aim of the study is to assess the prevalence of angiographically coronary artery disease (CAD) and the incidence of future cardiovascular (CV) events among hypertensive males with erectile dysfunction (ED) on the basis of calculated total CV risk at first presentation. Methods A total of 392 hypertensive ED patients without diabetes or known cardiovascular disease underwent a comprehensive evaluation for presence of target organ damage (TOD) and stratified into three total CV risk categories based on blood pressure (BP) category, CV risk factors, TOD and presence of chronic kidney disease. Total testosterone (TT) and peak systolic velocity (PSV) at penile arteries were measured as markers of ED severity and predictors of CV risk. All patients underwent exercise treadmill test and stress echocardiography to reveal myocardial ischemia. Men with positive one or both of the two tests were referred for coronary angiography in order to document CAD. Our primary outcome was a composite measure which included acute myocardial infarction (AMI), stroke, congestive heart failure, revascularization with either percutaneous coronary intervention or coronary artery bypass graft surgery. All patients were followed from cohort entry until major CV event, or end of study period (December 2018), whichever occurred first. Results The whole population was divided into high (n=176), intermediate (n=120) and low (n=96) total CV risk groups. The three groups had similar mean age (57 yrs). The prevalence of angiographically documented CAD was significantly higher among patients in the high risk group (n=32, 18%), compared to intermediate (n=15, 12.5%) and low risk (n=4, 4.1%) (overall P&lt;0.05). Furthermore, there was a progressive decrease in penile PSV and TT levels from low to moderate and high total CV risk (35 vs 31 vs 28 cm/s and 5.1 vs 4.3 vs 3.8 ng/ml, respectively, overall P&lt;0.001), indicating significant microvascular damage and androgen deficiency in men with a higher CV risk category. Interestingly, Kaplan-Meier analysis revealed a comparable incidence of major CV events in patients who were at high and intermediate total CV risk at entry (12.5% vs. 11%, respectively, log-rank =0.57) and a greater incidence of major CV events compared to that of low CV risk patients (3.2%), (log-rank P=0.004, for all comparisons) during a 9-year follow-up period (figure). CV events during a 9-year follow-up Conclusion The incidence of future CV events is considerably high among hypertensive ED patients with a intermediate total CV risk at first evaluation. Such patients may require a comprehensive evaluation to reveal occult CAD and they need an aggressive management of BP and concomitant risk factors to reduce their CV risk and improve their sexual life.