History Of Disease Research Articles

Low triiodothyronine syndrome as a factor of an unfavorable course of heart failure in patients with ischemic heart disease and COVID-19 history

Objective — to establish the association of low triiodothyronine syndrome (LT3S) with the risk of an unfavorable course of heart failure (HF) in patients with ischemic heart disease who have had COVID‑19, taking into account some clinical, pharmacogenetic, and biomarker indicators. Materials and methods. The study included 352 patients with ischemic origin of HF arising in individuals with ischemic heart disease. Of these, 128 (36.4%) patients had a history of COVID‑19 with lung involvement, and 224 (63.6%) without lung involvement. The patients were followed up for 24 months to study the impact of the presence of LT3S, levels of tumor necrosis factor α (TNF‑α), interleukin‑6 (IL‑6), and polymorphisms of the β‑adrenergic receptor system genes on the course of HF, taking into account the frequency of hospitalizations due to HF decompensation. Results. The frequency of recurrent hospitalizations of HF patients without lung involvement in COVID‑19 was 20.6%, while in patients with lung involvement — 45.3% (χ2=24.505; p=0.0001). There is a tendency to the increase in the frequency of recurrent hospitalizations in HF patients with established LT3S compared to those without this syndrome (31.7% vs. 22.9%, χ2=3.326; p=0.068). It was found that the risk of LT3S increased in homozygous carriers of CC polymorphism at the Ser275 site of the G‑protein β3 subunit gene: the odds ratio (OR) was 1.75 (95% confidence interval (CI) 0.99—3.07; p=0.054). The risk of increasing concentration of TNF‑α and IL‑6 in HF patients was higher in homozygous carriers of CC polymorphism at the Ser275 site of the G‑protein β3 subunit gene: OR=4.55 (95% CI 1.27—16.34); p=0.028) and OR=5.86 (95% CI 1.81—19.00; p=0.003). The risk of recurrent hospitalizations in HF patients with lung involvement in COVID‑19 was associated with the heterozygous C/T polymorphism at the Ser275 site of the G‑protein β3 subunit gene (OR=4.36 (95% CI 1.85—10.27; p=0.022). Conclusions. In patients with ischemic HF low T3 blood serum level can be a predictor of unfavorable prognosis. LT3S in such patients is associated with more severe course of COVID­­19. The inducer of LT3S development may be proinflammatory cytokines that affect the conversion of T4 to T3. The risk of LT3S development in patients with IHD and COVID­­19 history is associated with b­­adrenoreceptor system gene polymorphism. Measuring T3 level in blood serum is a simple instrument for the risk stratification in patients with severe form of COVID­­19 on the background of HF syndrome.

Epidemiological, diagnostic and medical-social aspects of latent syphilis

Objective — to study epidemiological, clinical and medical-social aspects of latent syphilis in Ukraine over the past 40 years. Materials and methods. Data of patients with latent syphilis that were examined and treated in the clinic of skin and venereal diseases of the SE «Dnipro State Medical University of the Ministry of Health of Ukraine». In our study we used the results of epidemiological (retrospective study of outpatient charts and medical histories of patients) and clinical research methods as well as serological blood tests. Results and discussion. We studied the medical-social and epidemiological features of latent syphilis in 1147 patients for the period from 1980 to 2000 and for the period from 2000 to 2024 — in 1670 patients.The diagnosis of latent syphilis was established on the basis of clinical, anamnestic and serological examination of patients using the generally accepted criteria for verification of syphilis (ICD-X). Particular attention was paid to anamnestic and clinical data on concomitant pathology, previous diseases, and confrontation data. A therapist, neurologist, ophthalmologist, otolaryngologist, specialists in instrumental diagnostic methods, and radiologist were involved in the detailed analysis and assessment of intercurrent diseases. All patients were also examined for urogenital infections (gonorrhea, trichomoniasis, chlamydia, mycoureaplasmosis, bacterial vaginosis, urogenital candidiasis, genital herpes, papillomavirus infection).We conducted an analysis of archival disease histories for the period 1980—2000 (1147 patients with latent syphilis) allowed us to draw the following conclusions: latent syphilis was diagnosed in 78.9 %, late latent in 12.8 % of patients and unspecified latent in 8.3 % of patients.During the period 2000—2024 (1670 medical histories were analyzed), the diagnosis of latent syphilis was established in 78.2 % of patients, late latent in 16.7 % and unspecified latent in 5.1 %.Thus, the above data over the past 44 years indicate a significant increase (by 16.3 %) in the proportion of latent syphilis. Conclusions. Over the past 40 years, the proportion of latent syphilis has increased by almost 20 %. The number of patients with latent syphilis living in cities has increased from 70 to 86 %.The features of the modern course of latent syphilis include the fact that 80 % of female patients have concomitant sexually transmitted infections, and 42 % of male patients suffer from alcoholism and drug addiction. Among patients, both men and women, 80 % did not have a family, more than 70 % of patients performed unskilled work. The average age of patients decreased by 10 years from 36 to 26 years, that is, latent syphilis conditionally «became younger». A significant increase in the frequency of concomitant diseases among patients with latent syphilis has been established over the past 44 years. In particular, if in previous decades (1980—2000) patients with latent syphilis were most often diagnosed with various cardiovascular pathologies, then in recent decades (2000—2024) in addition to this pathology, there has been an increase in diseases of the gastrointestinal tract, ENT organs, as well as tuberculosis, viral hepatitis, and HIV infection.Among the most significant reasons for the increase in the proportion of patients with latent syphilis are the uncontrolled use of antibiotics.

ANALYSIS OF ANAMNESTIC DATA AND CLINICAL AND LABORATORY CRITERIA FOR FOOD INTOLERANCE IN PRETERM INFANTS TAKING INTO ACCOUNT THE SEVERITY OF PERINATAL PATHOLOGY

Every year, up to 10% of the total number of children in the world are born before term. Preterm birth is considered to be one of the main factors in the increase of neonatal morbidity and mortality. The morphological and functional immaturity of the body at premature birth is one of the factors in the development of severe metabolic disorders. The negative effect of intrauterine hypoxia causes a violation of the functional state of organ systems, causes the development of multiple organ failure after birth For the timely detection of these disorders, justification of the necessary preventive and therapeutic measures, the issues of improving diagnostic measures in children in the neonatal period, in order to prevent the development of gastrointestinal pathology in the future are discussed. The aim of the study. To analyze the anamnestic data and clinical and laboratory criteria for disorders of the functional state of the gastrointestinal system in premature infants, considering the severity of the course of perinatal pathology. Materials and methods of the study. The main group of the study consisted of 149 premature infants of gestational age 32-33/6 weeks: subgroup A - newborns with severe forms of perinatal pathology (67 children), subgroup B - children with clinical signs of moderate perinatal pathology (82 children). The comparison group consisted of 50 conditionally healthy children with gestational age of 34-36/6 weeks. Inclusion criteria: gestational age at birth 32-33/6 weeks, manifestations of digestive system dysfunction with the consent of the child's parents. The complex of laboratory methods included the study of the level of albumin, α-1-antitrypsin, fecal elastase-1, PMN-elastase and calprotectin in coprofiltrate. The studies were conducted in accordance with the provisions of GCP (1996), the Convention of the Council of Europe on Human Rights and Biomedicine (1997), the Declaration of Helsinki of the World Medical Association for the Ethical Principles of Scientific Medical Research Involving Human Subjects (1964-2008), the Order of the Ministry of Health of Ukraine No.690 dated 23.09.2009 (as amended by the Order of the Ministry of Health of Ukraine No.523 dated 12.07.2012). Approval of the Bioethics Committee of the Bukovinian State Medical University (Protocol No. 2 dated 9.02.2015). Statistical processing of the study results was performed using the software "STATISTICA" (StatSoft Inc., USA, version 10). Comparison of quantitative indicators with normal distribution was performed using Student's t-test (p<0.05; p<0.001). Qualitative differences between the comparison groups were evaluated using MedCalc software (Statistical Software Package for Biomedical Research, 2023, Version 16.1). The study was performed as part of the research work of the Department of Pediatrics, Neonatology and Perinatal Medicine of the Bukovinian State Medical University (Chernivtsi, Ukraine). Results of the study. The risk of developing food tolerance disorders in IPV depends on a complex of factors, namely, a burdened maternal history of gastroenterological diseases and the implementation of adverse factors during pregnancy and childbirth. Assessment of the newborn's somatic status should be comprehensive, with special attention to clinical and paraclinical criteria for gastrointestinal dysfunction. The clinical signs of combined gastrointestinal disorders are: increase in liver size beyond the physiological norm (100.0%) or hepatolithiasis (52.24%), jaundice (86.57%), edema (80.6%), endotoxemia syndrome (71.64%), intestinal flatulence (73.13%) and hemorrhagic manifestations (56.27%), including bleeding from the gastrointestinal tract (43.68%). The laboratory criteria confirming the presence of severe forms of food intolerance are an increase in the level of calprotectin > 390.15 µg/g, albumin > 37.25 µg/g, α-1-antitrypsin > 452.67 µg/g with a decrease in the level of PMN elastase < 95.49 ng/g in the newborn coprofiltrate. Conclusions. The significant risk of disorders of the functional state of the digestive system in conditions of perinatal hypoxia in critical conditions of the newborn period in premature infants requires special attention of practitioners to clarify the characteristics of the somatic history, the course of pregnancy and childbirth of the mother, as well as the nature of postnatal adaptation of the newborn. Such an approach will allow to identify newborns with increased risk of developing gastrointestinal disorders in the acute period of neonatal diseases, as well as long-term consequences, with due regard to the peculiarities of the formation of long-term adaptation processes.

Effective combination of corticosteroid and cyclosporine A for immunoglobulin A nephropathy with membranoproliferative glomerulonephritis features: a case report.

Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis worldwide with heterogeneous histopathological phenotypes. Although IgAN with membranoproliferative glomerulonephritis (MPGN)-like features has been reported in children and adults, treatment strategies for this rare IgAN subtype have not been established. Here, we present the case of a 56-year-old man with no history of kidney disease who initially presented with nephrotic syndrome. Renal biopsy revealed MPGN-like features with a negative serological workup for secondary causes. Immunofluorescent staining was predominantly positive for IgA in the glomerular mesangial and capillary walls. Galactose-deficient IgA1 staining showed a distribution pattern similar to IgA staining. Electron microscopy revealed disorganized structural deposits in the mesangial and subendothelial regions. Based on clinical and histopathological findings, the patient was diagnosed with primary IgAN. The nephrotic syndrome resolved completely after six months of combined corticosteroids and cyclosporine A (CsA) therapy. Although corticosteroids and CsA were tapered off, hematuria and proteinuria remained in complete remission for years of follow-up. This case demonstrates the importance of recognizing IgAN with MPGN-like features as a histopathological subtype that may benefit from intensive immunosuppressive therapy.

Association of Biopsy-proven Nonalcoholic Fatty Liver Disease with Obesity and Apolipoproteins.

Insulin resistance is considered the most important key mechanism in the development of nonalcoholic fatty liver disease (NAFLD). Some studies have reported that hyperinsulinemia decreases the hepatic secretion of apolipoprotein (Apo) B. Chronic hyperinsulinemia in NAFLD may be responsible for the accumulation of triglycerides in hepatocytes. We aimed to investigate whether apolipoproteins are related to histological findings in patients with biopsy-proven NAFLD. We also aimed to evaluate the effects of obesity on apolipoproteins and the pathogenesis of NAFLD. In this cross-sectional study, 91 patients with biopsy-proven NAFLD were included. The control group consisted of 39 healthy subjects who had no history of liver disease or alcohol consumption and were matched for age, gender and smoking. Apoliprotein A1 and Apo B were measured via an immunoturbidimetric method with commercially available OSR6142 Apo A1 and OSR6143 Apo B immunoassay kits on an Olympus AU2700 analyzer. Age, gender, and smoking distribution were similar among nonalcoholic steatohepatitis patients, simple steatosis patients, and controls. The differences in the mean Apo A1 and Apo B levels and the Apo B/A1 ratio among non-alcoholic steatosis, simple steatosis, and control subjects did not reach statistical significance. In addition, patients with obese NAFLD had higher steatosis scores than patients with nonobese NAFLD (p<0.05). Apo A1 and B levels and the B/A1 ratio were not associated with histopathological findings in patients with NAFLD. Fibrosis and ApoB1/A were found to be independent risk factors for metabolic associated fatty liver disease. In addition, obesity increases the grade of hepatic steatosis but does not cause lobular inflammation, ballooning or fibrosis.

Assessment of myocardial infarctions knowledge, attitudes and beliefs among adults living in Riyadh Saudi Arabia – insights from cross-sectional study

Globally, the prevalence of coronary artery disease (CAD) is increasing, accounting for a third of all deaths worldwide including myocardial infarctions (MIs) which represent the most severe clinical manifestation of CAD and are among the most dangerous coronary events. Therefore, this study aims to assess the knowledge of symptoms and risk factors of MIs, as well as attitudes and beliefs regarding MIs and confidence in recognizing CAD symptoms in Riyadh, Saudi Arabia. A cross-sectional study was conducted among individuals living in Riyadh, Saudi Arabia between November 2023 and April 2024 to assess their knowledge and beliefs about CAD and MIs. Data collection was done using convenience sampling with pretested and validated questionnaire. Furthermore, recruiting more sample was achieved by distributing the questionnaires using the snowball technique. ANOVA and Student’s t-test were used to determine the association between variables, with a p-value of < 0.05 considered statistically significant. Among respondents, approximately 65.5% were male, 27.3%, fell between the ages of 26 and 30 and 59.1% held a master’s degree. In terms of marital status, the majority, 76.2%, were married. The majority (90%) stated that jaw pain was a symptom of a heart attack, followed by chest pain/pressure (85.9%), weakness/fatigue (85.8%), palpitations/rapid heart rate, and chest discomfort (83.4%). Most respondents (91.6%) were aware that smoking and obesity could increase the risk of MIs, while 85.3% believed that a family history of coronary heart disease could affect the risk of MIs. Additionally, 92.3% said they would seek medical care if they experienced chest pain within 15 min. The respondents’ gender (p = 0.001), age (p = 0.004), education (p = 0.001), and marital status (p = 0.004) were significantly associated with levels of knowledge of MI. The findings showed that half of the study population had good knowledge and were well-informed about jaw and chest pain as the main symptoms of MI. Despite understanding the clinical potential of MI, the majority expressed low confidence in their ability to identify heart attack symptoms and recommended health education about the illness to provide prompt assistance.

Results of one-year follow-up of patients with severe myocarditis associated with COVID-19 on glucocorticoid therapy

The aim of the study – to investigate the effectiveness and safety of glucocorticoid therapy in patients with severe myocarditis associated with COVID-19.Materials and methods. The results are based on data obtained from 72 patients with severe acute myocarditis (AM) and heart failure (HF) with reduced left ventricular ejection fraction (LVEF ≤ 40 %). Patients were divided into two groups: the group 1 included 34 patients with AM, who had a documented history of coronavirus disease ≤ 3 months before the onset of clinical symptoms of AM; the group 2 consisted of 38 patients with AM, who had no history of coronavirus disease. All patients received optimal therapy for heart failure during all period of follow-up and immunosuppressive therapy with glucocorticoids (GKs) within first 6 months from the onset of AM. Patients underwent for echocardiography with speckle tracking and cardiac magnetic resonance (CMR). The studies were conducted three times: in the first month from the onset of clinical symptoms of myocarditis, after 6 months, and after 12 months of observation.Results and discussion. After 6 months of follow-up, improvements in the structural and functional state of the heart were observed in both groups, with group 1 showing greater increases in LVEF and LGSS by 13.1 % and 22.2 %, respectively (p&lt;0.05). Additionally, group 1 exhibited a reduction in the number of LV segments affected by inflammatory changes and the total number of damaged segments by 28.4 % and 18.3 %, respectively, compared to group 2 (p&lt;0.05–0.001). After 12 months results of CMR demonstrated significantly less myocardial damage in group 1 compared to group 2: the total number of LV segments affected by inflammation and/or fibrosis was 39.0 % lower (p&lt;0.001). The most common complications of GKs therapy after 6 months were obesity (13.88 %) and leukocytosis (12.50 %), while hypokalemia occurred in 6.94 % of cases. Complications such as arterial hypertension, hyperglycemia, functional hypercortisolism, and myalgia were recorded in 4.16 % of cases. After 12 months, a significant reduction or complete resolution of GC-associated complications was observed in most patients: only 7 cases (9.72 %) of pathology associated with GC therapy were recorded.Conclusions. In patients with acute severe myocarditis with a history of coronavirus disease, glucocorticoid therapy demonstrated greater efficacy in improving the structural and functional state of the heart after 6 months of follow-up compared to patients without a history of COVID-19. The use of glucocorticoids in patients with severe myocarditis was associated with the development of complications in more than a half of patients within the first 6 months of follow-up, while after 12 months, there was a significant reduction in their frequency or their complete regression. During the 12-month observation period, none of the patients developed diseases or pathological conditions associated with glucocorticoid use that required inpatient treatment.

Oligometastatic Disease Is Not an Absolute Contraindication to Pelvic Exenteration in Selected Patients With Locally Recurrent Rectal Cancer.

The treatment of locally recurrent rectal cancer has evolved dramatically in recent decades. As the boundaries of exenterative surgery continue to be pushed, one of the unanswered and controversial questions is the role of radical salvage surgery for locally recurrent rectal cancer in the setting of oligometastatic disease. To investigate the impact of synchronous or previously treated distant metastases on survival following pelvic exenteration for locally recurrent rectal cancer. Retrospective analysis of a prospectively maintained database. A high-volume specialist exenteration center. Consecutive adult patients undergoing pelvic exenteration with curative intent for locally recurrent rectal cancer between 1994 and 2023. Overall survival from time of pelvic exenteration. Of the 300 patients included, 193 (64%) were male and the median age was 62 years (range, 29-86). Median time from primary rectal cancer surgery to pelvic exenteration was 35 months (range, 4-191). In total, 56 patients (19%) had a history of metastatic disease; of which 42 (14%) had previously treated metastases and 18 patients (6%) had synchronous metastatic disease (including 4 patients with both synchronous and previously treated metastases). Five-year and median overall survival was 41% and 45 months, respectively. There was a trend toward poorer 5-year overall survival in patients with a history of metastatic disease compared to those without (25% vs 45%); however, this did not reach statistical significance (p = 0.110), possibly due to lack of statistical power. Five-year overall survival was 27%, 25% and 45% for patients with synchronous metastases, previously treated metastases, and no history of metastases, respectively (p = 0.260). Findings may not be applicable beyond highly selected patients treated at specialized exenteration centers. Long-term survival is achievable in highly selected patients with locally recurrent rectal cancer and synchronous or previously treated distant metastases. Therefore, oligometastatic disease should not be considered an absolute contraindication to exenterative surgery. See Video Abstract.

Sex-Based Differences of Thoracic Endovascular Aortic Repair for Stanford Type B Aortic Dissections.

There is a paucity of data on sex-based differences in outcomes after thoracic endovascular aortic repair (TEVAR) performed for Stanford type B aortic dissections (TBAD). Examining the predictive role of sex could shape future clinical guidelines for TEVAR. Thus, this study aims to evaluate the association between sex and postoperative outcomes after TEVAR performed for TBAD. This is a retrospective cohort study utilizing the Vascular Quality Initiative (VQI) from 2011-2024. We included all patients undergoing TEVAR for TBAD with entry tear zones > zone 0. Patients who presented with rupture, had a history of connective tissue disease and underwent conversion to open repair were excluded. Primary outcomes were 30-day mortality, postoperative stroke, myocardial infarction (MI), spinal cord ischemia (SCI), aorta-related reintervention and access-related reintervention. The secondary outcome was freedom from all-cause mortality (ACM) at 1 year. A total of 5,117 patients underwent TEVAR for TBAD, of which 1,553 (30.3%) were women. Female patients were more likely to have a smaller aortic diameter compared to male patients (42.8 ± 11.5 vs 45.8 ± 14.3; P<0.001). After adjusting for potential confounders, there were no significant differences in 30-day mortality, stroke, MI, SCI and aorta-related reintervention between male and female patients. However, female patients were significantly more likely to undergo postoperative access-related reintervention (aOR=2.4 [95% CI: 1.1-5.0]; P=0.023) compared to male patients. Freedom from ACM at 1 year was similar between males and females (aHR=1 [95% CI: 0.8-1.2]; P=0.955). In this study using large, real-world data, female patients undergoing TEVAR for TBAD showed an increased risk of postoperative access-related reintervention, possibly due to smaller access vessel diameter. Development of devices that better fit female anatomy may help mitigate these risks in the future.

The IL-23R and Its Genetic Variants: A Hitherto Unforeseen Bridge Between the Immune System and Cancer Development.

IL-23R (interleukin-23 receptor), found on the surface of several immune cells, plays a key role in the immune system. Indeed, this process is not limited to the inflammatory response but also plays a role in the adaptive immune response. The binding between IL-23R and its specific ligand, the interleukin 23, initiates a number of specific signals by modulating both properties and behavior of immune cells. In particular, it is critical for the regulation of T helper 17 cells (Th17). Th17s are a subset of T cells involved in autoimmune and inflammatory diseases, as well as in cancer. The clinical relevance of IL-23R is underscored by its association with an elevated susceptibility or diminished vulnerability to a spectrum of diseases, including psoriasis, ankylosing spondylitis, and inflammatory bowel disease (IBD). Evidence has emerged that suggests it may also serve to predict both tumor progression and therapeutic responsiveness. It is noteworthy that the IL-23/IL-23R pathway is emerging as a promising therapeutic target. A number of biologic drugs, such as monoclonal antibodies, are currently developing with the aim of blocking this interaction, thus reducing inflammation. This represents a significant advancement in the field of medicine, offering new hope for pursuing more effective and personalized treatments. Recent studies have also investigated the role of such a pathway in autoimmune diseases, and its potential impact on infections as well as in carcinogenesis. The aim of this review is to focus on the role of IL-23R in immune genetics and its potential for modulating the natural history of neoplastic disease.

BIOMEDICAL RISK FACTORS FOR THE DEVELOPMENT OF PREECLAMPSIA OF VARYING SEVERITY IN PREGNANT WOMEN

The aim of this study was to identify biomedical risk factors for the development of preeclampsia of varying severity in the group of examined pregnant women. Material and methods. 70 women whose pregnancy was complicated by the development of preeclampsia were under observation. The first group included 46 (65.7%) patients with moderate preeclampsia; the second group included 24 (34.2%) women with severe preeclampsia. The diagnosis was established on the basis of the patient's complaints, clinical examination, somatic, obstetric and gynecological anamnesis, analysis of the course of the present pregnancy, ultrasound fetometry and Dopplerometry findings. The patients who participated in the study had an assessment of clinical and anamnestic parameters, somatic status, obstetric and gynecological anamnesis. Data from 45 pregnant women with an unencumbered obstetric and gynecological history and a physiologically occurring pregnancy were used as control values. Results. The prognostic risk factors for the development of moderate and severe preeclampsia were analyzed based on the calculation of relative risk indicators (RR) and 95% confidence interval (95% CI). In the group of pregnant women with both severe and moderate preeclampsia, strong prognostic risk factors were: place of residence in the regions, extragenital pathology in the anamnesis, gynecological diseases in the anamnesis, the number of pregnancies in the anamnesis, birth parity, and arterial hypertension. The early identification of risk factors for moderate and severe preeclampsia enables timely preventive measures, thereby improving patient outcomes and prognosis. Conclusion. The analysis revealed that preeclampsia was more prevalent among pregnant women with a history of various extragenital diseases, a complicated obstetric and gynecological history, and concomitant hypertension.

Treatment Options for Nosocomial Ventriculitis/Meningitis: A Case Report and Review of the Literature

Ventriculo-meningitis or nosocomial meningitis/ventriculitis is a severe nosocomial infection that is associated with devastating neurological sequelae. The cerebrospinal fluid isolates associated with the infection can be Gram-positive or -negative, while the Enterococcus spp. is rarely identified. We report a case of a 68-year-old woman with a past medical history of insulin-dependent diabetes mellitus, hypertension, and coronary artery disease. She was admitted to the intensive care unit following a scheduled sphenoid wing meningioma resection. Her course was complicated with left middle cerebral artery pseudoaneurysm and hemispheric hemorrhage, and an arterial stent and external ventricular drainage catheter were placed. Neurological evaluation showed a minimal conscious state. She presented high fever on the 35th intensive care unit day. Cerebrospinal fluid was sampled and the external ventricular catheter was removed. Enterococcus faecalis was isolated from the culture specimen. The patient received targeted treatment with an ampicillin plus ceftriaxone combination, and a follow-up culture confirmed the pathogen’s eradication. Although she was considered cured, she had a prolonged intensive care unit stay and finally died in the ward two months after the completion of treatment. This case highlights the first reported use of this combination in a severe, non-endocarditis, invasive enterococcal infection, while the review discusses treatment options for nosocomial ventriculitis/meningitis.

CYTOLOGICAL CHARACTERISTICS OF THE WOUND HEALING PROCESS IN PATIENTS WITH CORONARY HEART DISEASE AT DIFFERENT STAGES OF THE POSTOPERATIVE PERIOD IN ODONTOGENIC PHLEGMON OF MAXILLOFACIAL LOCALIZATION

Odontogenic phlegmon of maxillofacial localisation is one of the most common diseases in the practice of a dental surgeon. The presence of comorbidities, such as coronary heart disease, can negatively impact the course of the underlying condition, complicate diagnosis and treatment, and delay patient recovery. This highlights the need to explore and improve treatment methods for odontogenic phlegmon in patients with coronary heart disease. The aim of this study was to examine the dynamics of regenerative processes in the wound at different stages of the postoperative period after using both classical and novel treatment methods for odontogenic phlegmon of maxillofacial localization in patients with coronary artery disease. Subjects and methods. The study included 80 patients with this pathology, divided into 4 groups. In the first group, quercetin was added to standard therapy, in the second group, quercetin and mexazol were used, and the third group received standard treatment. Patients in these three groups had a history of coronary heart disease. The fourth group (control) had only the underlying disease without comorbidities. Cytological examination was performed using the "surface biopsy" method. The material was collected on days 1, 3, 5, 7, and 9 of the postoperative period and stained using the Romanowsky-Giemsa method. Subsequently, histological specimens were examined. Results. On day 1, the main cellular elements across all groups were erythrocytes. By day 3, lymphocytes and single holonuclear cells were observed in the first group; precollagen fibers appeared in the second group; the third group showed a significant number of polymorphonuclear leukocytes; and the fourth group mainly had holonuclear cells. By day 5, the first group showed progressive development of regenerative processes, while the second group entered the final phase of regeneration. In the third and fourth groups, gradual development of the regenerative process was observed. On day 7, the first group showed signs of the final stage of wound healing, and the second group had completed this process. The third and fourth groups showed signs of the regenerative stage at this point. On day 9, no signs of inflammation were present in the third and fourth groups. Conclusion. The use of quercetin combined with intravenous mexazol injections as part of conservative therapy accelerates regenerative processes in the postoperative period and shortens the duration of the inflammatory reaction.

Radiocarbon Dating of Gallstones for Timeline of Formation, Dormancy Analysis, and Correlation with Chemical/Microbial Composition: A Pilot Study on Gallstone Geobiology.

India has a high incidence of gallstones, which can cause chronic inflammation and increase the risk of gallbladder cancer. Understanding the age and composition of gallstones can provide insights into their formation and growth. This study used ¹⁴C dating, FTIR, and metagenome analysis to explore the natural history, deposition rate, and microbial/chemical composition of gallstones. In this pilot study three cholesterol gallstones were chosen with different tissue histopathologies (normal, metaplasia, and dysplasia) and respective layers were analyzed for 14C bomb pulse dating and FTIR for age and chemical composition respectively. The core of each gallstone was subjected to scanning electron microscopy and further to 16S rRNA sequencing for microbial analysis. The 14C data indicated that the largest stone with dysplastic epithelium formed over a period of six years, while stones with metaplasia and normal pathology took 13 and 12 years, to develop, respectively. Further, the largest stone was dormant for 6 years before subject experienced acute pain, while other two stones laid dormant for 7 and 18 years. FTIR analysis revealed that all the three gallstones were primarily composed of cholesterol. Additionally, calcium oxalate, calcium carbonate, and calcium bilirubinate were present in stones with underlying dysplasia. The 16S rRNA analysis showed an increased abundance of Corynebacterium sp. in stones associated with metaplasia and dysplasia. Moreover, pathogenic species of Klebsiella and E. coli were abundant in calcium oxalate-rich gallstones with underlying dysplasia. Overall, the pilot study established the feasibility of 14C bomb pulse in evaluating the timeline of gallstone formation and combining with FTIR/metagenome analysis helps in understanding the natural history of gallstone associated disease.

Morphological studies of labyrinthine tissue in patients affected with Meniere's disease and vestibular schwannoma following labyrinthectomy.

Meniere's disease (MD) is a disabling disease of the inner ear, having a substantial effect on a patient's quality of life. While various postulations regarding its aetiology exists, due to the difficulty with accessing inner ear tissue, there have been limited histological studies in patients with active MD. Tissue was collected during labyrinthectomy from 8 patients with intractable MD who had failed medical therapy (22 samples), and 9 patients undergoing translabyrinthine resection of vestibular schwannoma (19 samples). 20 additional samples were obtained from 2 cadavers without a history of inner ear disease. Samples were assessed with routine histology and a panel of immunohistochemical markers to assess any differences between the groups. No MD samples demonstrated significant inflammatory infiltrate, evidence of denervation of the sensory epithelium, fibrosis, or thickening of blood vessel wall stroma. Novel findings included confirmation that no lymphatic channels of usual type were present and that the subepithelial stromal cells are strongly positive for S100, suggesting possible perineurial origin. There were no consistent differences in expression of Claudin or Aquaporin between the MD and VS patient samples. This is one of the largest comparative histological study utilising operative samples from inner ear of living donors with active intractable MD and control patients with VS. There were no significant morphological differences between the two groups, suggesting that the aetiology lies elsewhere within the vestibular system. Examination of endolymphatic sac tissue is therefore a priority for future work.

Maternal Allergic Disease Phenotype and Infant Birth Season Influence the Human Milk Microbiome.

Early infancy is a critical period for immune development. In addition to being the primary food source during early infancy, human milk also provides multiple bioactive components that shape the infant gut microbiome and immune system and provides a constant source of exposure to maternal microbiota. Given the potential interplay between allergic diseases and the human microbiome, this study aimed to characterise the milk microbiome of allergic mothers. Full-length 16S rRNA gene sequencing was performed on milk samples collected at 3 and 6 months postpartum from 196 women with allergic disease. Multivariate linear mixed models were constructed to identify the maternal, infant, and environmental determinants of the milk microbiome. Human milk microbiome composition and beta diversity varied over time (PERMANOVA R2 = 0.011, p = 0.011). The season of infant birth emerged as the strongest determinant of the microbiome community structure (PERMANOVA R2 = 0.014, p = 0.011) with impacts on five of the most abundant taxa. The milk microbiome also varied according to the type of maternal allergic disease (allergic rhinitis, asthma, atopic dermatitis, and food allergy). Additionally, infant formula exposure reduced the relative abundance of several typical oral taxa in milk. In conclusion, the milk microbiome of allergic mothers was strongly shaped by the season of infant birth, maternal allergic disease phenotype, and infant feeding mode. Maternal allergic disease history and infant season of birth should therefore be considered in future studies of infant and maternal microbiota. Trial Registration: ClinicalTrials.gov identifier: ACTRN12606000281594.

Optimizing Travel Insurance Purchase Detection using Predictive Models

What traveler features should be considered when designing airline travel insurance policies, and can predictive modeling enhance the accuracy of purchase predictions? Motivated by the increased need to safeguard investments due to frequent flight interruptions and cancellations during the COVID-19 pandemic and its travel restrictions, we investigate the uptake of flight travel insurance using predictive models. This study applies various machine learning techniques to a dataset consisting of 1,987 travelers, examining whether they purchased travel insurance (a binary classification problem). Performance metrics such as misclassification rate, precision, recall, F-score, and the area under the receiver operating characteristic curve (AUC) are used to assess model effectiveness. The models were optimized using cross-validation on the training data. Among the models tested, eXtreme Gradient Boosting Machine (XGBoost) achieved the highest accuracy rate of 86%, along with the best AUC, precision, recall, and specificity, indicating a 98% accuracy in predicting who will purchase travel insurance. Other robust models, such as ensemble methods and neural networks, also demonstrated strong performance, with similar AUC and precision scores. Features such as annual income, age, travel history, and education history were found to be the most significant predictors, while chronic disease history had little impact. Parsimonious predictive models, using only the most important variables, yielded better performance. Our findings highlight the critical role of predictive accuracy in helping insurers mitigate the financial risk due to travel interruptions.

Association of Severity of Coronary Artery Disease With Traditional Risk Factors, Clinical Characteristics and Carotid Plaque Burden in Patients With Acute Coronary Syndrome.

To study the associations between risk factors, clinical characteristics, severity of brachiocephalic artery (BCA) atherosclerosis and severity of coronary artery (CA) disease in patients with acute coronary syndrome (ACS). The study included patients with any type of ACS and obstructive coronary artery disease confirmed by coronary angiography. A quantitative analysis of coronary angiography data was performed with an assessment of the number of CAs with significant stenosis and calculation of the SYNTAX score. The major clinical and laboratory parameters that are risk factors for atherosclerosis and/or affect the cardiovascular prognosis were assessed; for patients with ACS without ST segment elevation (NSTE-ACS), the risk score was calculated by the GRACE scale. The BCA ultrasound examination was performed with a quantitative analysis of atherosclerotic burden. The study included 312 patients aged 64 [56, 72] years; the proportion of men was 69.2%. The frequency of lesions of 1, 2 and 3 coronary arteries was 34.6, 35.3, and 30.1%, respectively; the SYNTAX score was 14 [9, 21]. According to the results of univariate analysis, the number of stenotic CAs and the SYNTAX score were associated with age, smoking history, history of ischemic heart disease, diabetes mellitus (DM), the presence of non-stenotic CA lesions, the GRACE score in NSTE-ACS, and the Charlson comorbidity index. An inverse correlation was found for the level of physical activity and a slightly weaker one for the glomerular filtration rate and high-density lipoprotein cholesterol (HDL-C). In multivariate models, the only independent predictors of the number of stenotic CAs were HDL-C (odds ratio, OR 0.37, 95% confidence interval, CI 0.17-0.81; p=0.012) and the smoking history (OR 1.30, 95% CI 1.12-1.52; p=0.001), a coefficient of determination of the model R2 of 18%, SYNTAX score with a history of myocardial infarction (ß=6.40, 95% CI 3.22-9.58; p&lt;0.001), insulin-dependent DM (ß=9.44, 95% CI 3.50-15.38; p=0.002), GRACE score for NSTE-ACS (ß=0.06, 95% CI 0.01-0.11; p&lt;0.014), and a coefficient of determination of the model R2=20%. Patients with ACS show significant, independent associations of the severity of coronary atherosclerosis with HDL-C, smoking duration, history of myocardial infarction, insulin-dependent diabetes, and the GRACE score in NSTE-ACS. Variability in the severity of CA lesions is only to a small extent determined by risk factors, clinical characteristics, and the severity of concomitant carotid atherosclerosis.

Preliminary Evidence That Shared Genetic Influences Underlie Comorbidity Between Self-Reported Eating and Internalizing Disorders and Gastrointestinal Disease in Adult Women and Men.

Accumulating research suggests both eating disorders (EDs) and internalizing disorders (e.g., anxiety, depression) are associated with gastrointestinal disease (e.g., irritable bowel syndrome, inflammatory bowel disease). However, the mechanisms underlying comorbidity with gastrointestinal disease-and whether they may differ for eating and internalizing disorders-remain poorly understood. Addressing these gaps is a critical first step to refining etiologic models of comorbidity and identifying potential targets for intervention. Participants included female and male twins ages 18-65 from the population-based MSU Twin Registry (N = 5883). Lifetime history of EDs, internalizing disorders, and gastrointestinal disease was assessed via questionnaire. We first examined whether EDs and internalizing disorders were independently associated with gastrointestinal disease phenotypically. We then used trivariate Cholesky decomposition twin models to investigate whether EDs and internalizing disorders were related to gastrointestinal disease through overlapping or distinct genetic/environmental pathways. Eating (OR = 2.54, p = 0.009) and internalizing (OR = 2.14, p < 0.001) disorders were independently associated with gastrointestinal disease. Conclusions were unchanged after adjusting for important covariates (e.g., body mass index, age) and did not significantly differ across sex. Twin models suggested genetic influences shared by all three conditions explained their co-occurrence, with 31% of the variance in EDs and 12% of the variance in gastrointestinal disease attributable to genetic influences shared with internalizing disorders. Shared genetic mechanisms may contribute to comorbidity between EDs, internalizing disorders, and gastrointestinal disease. Identifying overlapping molecular pathways could potentially lead to novel interventions that simultaneously address all three conditions.

The relationship between body mass index changes and mortality in geriatric peritoneal dialysis patients: a case-control study.

The prevalence of chronic kidney disease (CKD) is increasing, reflecting the rising incidence of chronic diseases. With the continuous growth of the global geriatric population, a significant portion of individuals with CKD consists of those aged over 65. Regardless of the chosen treatment method, protein-energy loss in patients undergoing renal replacement therapy (RRT) has been associated with elevated morbidity and mortality rates. This is a retrospective, single-center study of incident adult PD patients on peritoneal dialysis (PD) from 1998 to 2022. We aimed to compare the survival outcomes of geriatric patients on PD with changing BMI measurements. In the geriatric patient group exhibiting a reduced BMI after dialysis initiation, BMI significantly and negatively influenced survival (p = 0.01). The negative effect of BMI on survival was independent of known risk factors such as diabetes mellitus, a history of cardiovascular disease, gender, residual renal function, and history of hemodialysis before peritoneal dialysis (HD before PD) (p = 0.04). Although BMI is easy and extensively measured, it is not considered the perfect monitoring parameter for dialysis patients. However, regular follow-up of BMI, especially in geriatric cases, can be a guiding tool for estimating patients' prognoses.