Increased Hospitalization Rates Research Articles

THE USE OF ANTIBIOTICS IN FOOD ANIMALS – A THREAT TO HUMAN HEALTH

Background: Antibiotics are widely used in food animals to prevent disease, promote growth and maintain productivity. Modern animal production practices involve regular use of antimicrobials, but abusive use can lead to harmful consequences. The aim of this review was to provide comprehensive information regarding the risk of regular application of antibiotics in food animals, the potential consequences and impact on human health, and options for the prevention of antibiotic resistance in the food chain. Review Results: Although organizations such as WHO, UN, and EU have taken steps to reduce and limit the use of antibiotics in animals, these are proving insufficient in developing countries. In many countries, the antibiotics used in animals appear to exceed that in humans. The abuse in food animals promotes the development of antibiotic-resistant bacteria and resistance genes that can be transmitted to humans through food consumption and direct contact with animal food or environment mechanisms. This can lead to human infections with antibiotic-resistant bacteria, causing treatment failure and, therefore, more severe and longer-lasting illnesses, increased hospitalization rates, more deaths and higher costs to society. Furthermore, as food animals and animal-derived foods are traded globally, they contribute to antibiotic resistance in countries far from where the problem originates. Conclusion: Overcoming the problem of antibiotic resistance requires a multidisciplinary approach with effective action coordination and information exchange between the agricultural, food, veterinary and health sectors. Through international cooperation, efforts should focus on reducing unnecessary antibiotics use and reducing the spread of antibiotic-resistant bacteria, but national-level action on antibiotic resistance and food safety is also essential.

Health-related quality of life and its predictors among hypertensive patients on follow up at public hospitals in Addis Ababa, Ethiopia: application of Tobit regression model

BackgroundHealth-related quality of life and its associated factors among hypertensive patients living in Ethiopia are not well studied. Therefore, this study aims to assess the level of health-related quality of life and its associated factors in hypertensive patients on follow-up in Public Hospitals in Addis Ababa, Ethiopia.MethodsA facility-based cross-sectional study was conducted among 339 hypertensive patients on follow-up at Yekatit 12 &Zewditu Hospitals. Data were collected through face-to-face interviews using Euro Quality of Life Groups 5 Dimensions 5 Levels (EQ-5D-5L) in combination with Euro Quality of Life Groups Visual Analog Scale (EQ-VAS). A multivariable Tobit regression model was employed to assess the association between EQ-5D-5L index, EQ-VAS, and potential predicting factors.ResultsThe median index value and EQ-VAS Scales score was 0.86 (IQR = 0.74, 0.94) and 69 (IQR = 55, 80) respectively.The proportion of participants reporting anxiety/depression and pain/discomfort problems was highest, while the fewest patients reported problems in the self-care dimension. Older, rural residents, low income, higher stages of hypertension, increased use of antihypertensive medications, and patients with an increased hospitalization rate scored lower on health-related quality of life than others.ConclusionHealth-related quality of life among hypertensive patients attending public health hospitals in Addis Ababa is unacceptably poor. Emphasis should be given to patients with higher stages of hypertension, increased use of antihypertensive medications, and an increased hospitalization rate giving due focus to older, rural residents, and low-income patients to promote their health-related quality of life.

The Interplay of Comorbidities in Chronic Heart Failure: Challenges and Solutions.

Chronic heart failure (HF) is frequently associated with various comorbidities. These comorbid conditions, such as anemia, diabetes mellitus, renal insufficiency, and sleep apnea, can significantly impact the prognosis of patients with HF. This review aims to synthesize current evidence on the prevalence, impact, and management of comorbidities in patients with chronic HF. A comprehensive review was conducted, with a rigorous selection process. Out of an initial pool of 59,030 articles identified across various research modalities, 134 articles were chosen for inclusion. The selection spanned various research methods, from randomized controlled trials to observational studies. Comorbidities are highly prevalent in patients with HF and contribute to increased hospitalization rates and mortality. Despite advances in therapies for HF with reduced ejection fraction, options for treating HF with preserved ejection fraction remain sparse. Existing treatment protocols often lack standardization, reflecting a limited understanding of the intricate relationships between HF and associated comorbidities. There is a pressing need for a multidisciplinary, tailored approach to manage HF and its intricate comorbidities. This review underscores the importance of ongoing research efforts to devise targeted treatment strategies for HF patients with various comorbid conditions.

Iron supplementation in patients with chronic inflammatory bowel disease: recommendations for a practical approach

Iron deficiency is the predominant cause of anemia. Iron deficiency anemia plays a major role, especially in patients with inflammatory bowel disease (IBD), and is the most common extraintestinal manifestation and IBD-associated systemic complication. The presence of anemia leads to a reduction in quality of life in patients with IBD associated with limitations in physical, emotional, and cognitive function. In addition, it is associated with an increased hospitalization rate. For this reason, iron supplementation is of particular importance. Oral and intravenous iron supplements are used to treat iron deficiency. Due to the lack of absorption and gastrointestinal side effects of oral substitution, intravenous supplementation is becoming increasingly important. However, there are still certain concerns about intravenous administration.With the help of this review, we want to address the topic of iron substitution in patients with IBD, summarize current guideline recommendations, and provide a practical approach.

Grouped mixtures of air pollutants and seasonal temperature anomalies and cardiovascular hospitalizations among U.S. Residents

BackgroundAir pollution is a recognized risk factor for cardiovascular disease (CVD). Temperature is also linked to CVD, with a primary focus on acute effects. Despite the close relationship between air pollution and temperature, their health effects are often examined separately, potentially overlooking their synergistic effects. Moreover, fewer studies have performed mixture analysis for multiple co-exposures, essential for adjusting confounding effects among them and assessing both cumulative and individual effects. MethodsWe obtained hospitalization records for residents of 14 U.S. states, spanning 2000–2016, from the Health Cost and Utilization Project State Inpatient Databases. We used a grouped weighted quantile sum regression, a novel approach for mixture analysis, to simultaneously evaluate cumulative and individual associations of annual exposures to four grouped mixtures: air pollutants (elemental carbon, ammonium, nitrate, organic carbon, sulfate, nitrogen dioxide, ozone), differences between summer and winter temperature means and their long-term averages during the entire study period (i.e., summer and winter temperature mean anomalies), differences between summer and winter temperature standard deviations (SD) and their long-term averages during the entire study period (i.e., summer and winter temperature SD anomalies), and interaction terms between air pollutants and summer and winter temperature mean anomalies. The outcomes are hospitalization rates for four prevalent CVD subtypes: ischemic heart disease, cerebrovascular disease, heart failure, and arrhythmia. ResultsChronic exposure to air pollutant mixtures was associated with increased hospitalization rates for all CVD subtypes, with heart failure being the most susceptible subtype. Sulfate, nitrate, nitrogen dioxide, and organic carbon posed the highest risks. Mixtures of the interaction terms between air pollutants and temperature mean anomalies were associated with increased hospitalization rates for all CVD subtypes. ConclusionsOur findings identified critical pollutants for targeted emission controls and suggested that abnormal temperature changes chronically affected cardiovascular health by interacting with air pollution, not directly.

Isolated Transverse Process Fractures: Should We Offer Lumbar Corset or Not?

Background The aim of this study is to emphasize the need to be careful in terms of internal organ injuries in patients with isolated transverse process fracture (ITPF), and to investigate the effectiveness of corset use in controlling acute pain. Methods This is a retrospective study including 72 patients with only transverse process fractures secondary to trauma, who were admitted to the Emergency Department of Sakarya University Research and Training Hospital between January 2020 and October 2022. The radiological diagnoses were collected from spinal vertebral computed tomography images. Twelve patients were excluded from the study due to exclusion criteria. Sixty patients with ITPF were included in the comparison group. All patients were divided into two groups. The groupwith no lumbar corset (LC) included those who were discharged with analgesic and muscle relaxant treatment without a brace (n = 33). The LC+ group (n = 27) included those who received rigid lumbosacral orthosis in addition to analgesic and muscle relaxant treatment. Pain levels of all cases in both groups were evaluated with Visual Analog Scale scores on the day of trauma, the first week, the first month, and the sixth month. Results A total of 25 cases had one ITPF, 25 had two, 17 had three, and five patients had four or more ITPFs. The hospitalization rate was the highest among patients with four or more ITPFs (40%). Although the hospitalization rates according to the number of ITPFs were not statistically significant (p = 0.528), there was a clinical significance regarding increasing hospitalization rates with the increasing number of ITPFs. The hospitalization rates were 12%, 16%, 17.6%, and 40% in patients with one, two, three, and four or more ITPFs, respectively. Conclusion ITPFs should be treated conservatively. Concomitant organ injuries must be ruled out before treatment. Medical treatment without a lumbar corset could be used as a cost-effective choice.

A hub and spoke model to supply the Sicilian neurorehabilitation demand: effects on hospitalization rates and patient mobility.

Cerebrovascular diseases in Sicily have led to high mortality and healthcare challenges, with a notable gap between healthcare demand and supply. The mobility of patients seeking care, both within and outside Sicily, has economic and organizational impacts on the healthcare system. The Hub and Spoke model implemented by the IRCCS Centro Neurolesi "Bonino-Pulejo" of Messina aims to distribute advanced neurorehabilitation services throughout Sicily, potentially reducing health mobility and improving service accessibility. The evaluation was based on calculating hospitalization rates, examining patient mobility across Sicilian provinces, and assessing the financial implications of neurorehabilitation admissions. Data from 2016 to 2018, covering the period before and after the implementation of the Hub and Spoke network, were analyzed to understand the changes brought about by this model. The analysis revealed a significant increase in hospitalization rates for neurorehabilitation in the Sicilian provinces where spokes were established. This increase coincided with a marked decrease in interregional health mobility, indicating that patients were able to receive high-quality care closer to their residences. Furthermore, there was a decrease in both intra-regional and inter-regional escape rates in provinces within the Hub and Spoke network, demonstrating the network's efficacy in improving accessibility and quality of healthcare services. The implementation of the Hub and Spoke network substantially improved neurorehabilitation healthcare in Sicily, enhancing both accessibility and quality of care for patients. The network's establishment led to a more efficient utilization of healthcare resources and balanced distribution of services. These advancements are vital steps toward equitable and effective healthcare delivery in Sicily.

One disaster two traumas: Being under rubble and burn injuries in the 2023 Maraş, Turkey earthquakes

IntroductionOn February 6, 2023, two separate destructive earthquakes with magnitudes of 7.7 and 7.5 occurred in Kahramanmaraş, Türkiye. More than 50,000 people lost their lives, and over 100,000 were reported injured. In this study, patients referred to hospitals with burn diagnosis and management of burn wounds following the disaster were evaluated. Material and methodsInformation on burn injury admissions related to the earthquake was collected from all burn facilities in the country within 15 days after the earthquake. The patients' demographics, being under rubble, rescue times, burn causes, grafting procedures, and deaths were recorded. ResultsFollowing the earthquake, burn victims were transferred to the 13 Burn Treatment Centers located in 10 provinces. A total of 191 patients were burned. Among the burn patients, 101 (52.9%) were rescued from the rubble 2–60 h after the earthquake. Eight patients who were hospitalized at the burn centers died. Scalding and flame burns were the most common etiologies. Burned total body surface area, concomitant crush injury, hospitalization, and mortality was higher among the patients trapped under rubble (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). Victims who stayed longer time under the rubble required significantly more grafting procedures (p < 0.001). ConclusionIn a literature review, it was observed that there are a limited number of publications reporting earthquake-related burns. In the February, 6 Türkiye earthquake, flame burns were seen due to small fires that occurred in collapsed buildings during the earthquake. And also contact burns and hot liquid burns were seen in earthquake victims trapped under rubble. Bursting hot water pipes, overturned stoves, contact with hot central heating radiators, and heated construction irons caused scalding and contact burns. It is believed that prolonged entrapment may cause delays in burn treatment or lead to deeper burns due to prolonged contact with the burning agent, increasing hospitalization rates. This earthquake once again drew attention to burn injuries that could occur during and after earthquakes, including those that may occur under rubble.

Burden of chickenpox complications in Poland, 2006 to 2021: A comprehensive registry-based study.

BackgroundChickenpox, a vaccine-preventable disease caused by the varicella zoster virus, generally presents with mild symptoms but can cause complications necessitating hospitalisation. In Poland, since 2009, vaccination has been obligatory for children up to 12 years of age who are particularly vulnerable to infection and for children in their vicinity.AimTo examine the burden of chickenpox complications and the trends of hospitalisation arising from these complications over time in the Polish population.MethodsData spanning 2006-21 were sourced from the Polish Infectious Diseases Surveillance System, the Nationwide General Hospital Morbidity Study and the Statistics Poland death registry. Standardised and age-specific incidence rates, hospital discharge rates and number of deaths because of chickenpox were calculated. Moreover, the joinpoint regression model was used to analyse trends of annual hospital discharge rates.ResultsOver the analysed timeframe, 25,804 hospitalisations and 52 deaths attributable to chickenpox complications were documented, and 1.0% of chickenpox cases required hospitalisation because of chickenpox. Age-standardised hospitalisation rates varied between 2.3 and 9.6 per 100,000 population. The analysis revealed no statistically significant trend in overall hospital discharge rates from chickenpox complications. However, a notable increase in hospitalisation rates was observed in children aged 0-4 and among inhabitants of rural areas, with annual percentage changes of 4.9% and 3.4% respectively.ConclusionsOur findings suggest that the implementation of a universal chickenpox immunisation programme, supported by health education, should be considered to reduce the number of hospitalisations and nearly eliminate deaths because of chickenpox.

Genetic risk for hospitalization of African American patients with severe mental illness reveals HLA loci.

Mood disorders such as major depressive and bipolar disorders, along with posttraumatic stress disorder (PTSD), schizophrenia (SCZ), and other psychotic disorders, constitute serious mental illnesses (SMI) and often lead to inpatient psychiatric care for adults. Risk factors associated with increased hospitalization rate in SMI (H-SMI) are largely unknown but likely involve a combination of genetic, environmental, and socio-behavioral factors. We performed a genome-wide association study in an African American cohort to identify possible genes associated with hospitalization due to SMI (H-SMI). Patients hospitalized for psychiatric disorders (H-SMI; n=690) were compared with demographically matched controls (n=4467). Quality control and imputation of genome-wide data were performed following the Psychiatric Genetic Consortium (PGC)-PTSD guidelines. Imputation of the Human Leukocyte Antigen (HLA) locus was performed using the HIBAG package. Genome-wide association analysis revealed a genome-wide significant association at 6p22.1 locus in the ubiquitin D (UBD/FAT10) gene (rs362514, p=9.43x10-9) and around the HLA locus. Heritability of H-SMI (14.6%) was comparable to other psychiatric disorders (4% to 45%). We observed a nominally significant association with 2 HLA alleles: HLA-A*23:01 (OR=1.04, p=2.3x10-3) and HLA-C*06:02 (OR=1.04, p=1.5x10-3). Two other genes (VSP13D and TSPAN9), possibly associated with immune response, were found to be associated with H-SMI using gene-based analyses. We observed a strong association between H-SMI and a locus that has been consistently and strongly associated with SCZ in multiple studies (6p21.32-p22.1), possibly indicating an involvement of the immune system and the immune response in the development of severe transdiagnostic SMI.

The impact of cancer metastases on COVID-19 outcomes: ACOVID-19 and Cancer Consortium registry-based retrospective cohort study.

COVID-19 can have a particularly detrimental effect on patients with cancer, but no studies to date have examined if the presence, or site, of metastatic cancer is related to COVID-19 outcomes. Using the COVID-19 and Cancer Consortium (CCC19) registry, the authors identified 10,065 patients with COVID-19 and cancer (2325 with and 7740 without metastasis at the time of COVID-19 diagnosis). The primary ordinal outcome was COVID-19 severity: not hospitalized, hospitalized but did not receive supplemental O2, hospitalized and received supplemental O2, admitted to an intensive care unit, received mechanical ventilation, or died from any cause. The authors used ordinal logistic regression models to compare COVID-19 severity by presence and specific site of metastatic cancer. They used logistic regression models to assess 30-day all-cause mortality. Compared to patients without metastasis, patients with metastases have increased hospitalization rates (59% vs. 49%) and higher 30day mortality (18% vs. 9%). Patients with metastasis to bone, lung, liver, lymph nodes, and brain have significantly higher COVID-19 severity (adjusted odds ratios [ORs], 1.38, 1.59, 1.38, 1.00, and 2.21) compared to patients without metastases at those sites. Patients with metastasis to the lung have significantly higher odds of 30-day mortality (adjusted OR, 1.53; 95% confidence interval, 1.17-2.00) when adjusting for COVID-19 severity. Patients with metastatic cancer, especially with metastasis to the brain, are more likely to have severe outcomes after COVID-19 whereas patients with metastasis to the lung, compared to patients with cancer metastasis to other sites, have the highest 30-day mortality after COVID-19.

Etiology, Clinical Approach, and Therapeutic Consequences of Hyponatremia

A perturbation in the water balance rather than any change in salt content is the main cause of hyponatremia, the most frequent electrolyte abnormality, defined as a serum sodium concentration &lt;135 mEq/L. Hyponatremia may be divided between mild (Na &gt; 120 mEq/L) or severe (Na &lt; 120 mEq/L) hyponatremia, and is most frequently observed in elderly ICU hospitalized patients. Based on tonicity, hyponatremia may be hypotonic (a decreased concentration of the solute), isotonic, and hypertonic (falsely low sodium). According to the volume of extracellular fluid (ECF), hyponatremia is further divided among hypovolemic, euvolemic, or hypervolemic hyponatremia. Finally, hyponatremia may develop rapidly as acute (&lt;48 h), usually with severe symptoms, or slowly as chronic hyponatremia, usually being asymptomatic or with mild symptoms. Acute severe hyponatremia presents with severe CNS problems, increased hospitalization rates, and mortality. The treatment with 3% sodium chloride and a 100 mL IV bolus based on severity and persistence of symptoms needs careful monitoring. A non-severe hyponatremia may be treated with oral urea. In asymptomatic mild hyponatremia, an adequate solute intake with an initial fluid restriction of 500 mL/d adjusted according to the serum sodium levels is preferred. Vaptans could be considered in patients with high ADH activity regardless of whether they are euvolemic or hypervolemic. In general, the treatment of hyponatremia should be based on the underlying cause, the duration and degree of hyponatremia, the observed symptoms, and volume status of patient.

Cerebrovascular Disease Hospitalization Rates in End-Stage Kidney Disease Patients with Kidney Transplant and Peripheral Vascular Disease: Analysis Using the National Inpatient Sample (2005-2019).

Individuals with end-stage kidney disease (ESKD) face higher cerebrovascular risk. Yet, the impact of peripheral vascular disease (PVD) and kidney transplantation (KTx) on hospitalization rates for cerebral infarction and hemorrhage remains underexplored. Analyzing 2,713,194 ESKD hospitalizations (2005-2019) using the National Inpatient Sample, we investigated hospitalization rates for ischemic and hemorrhagic cerebrovascular diseases concerning ESKD, PVD, KTx, or their combinations. Patients hospitalized with cerebral infarction due to thrombosis/embolism/occlusion (CITO) or artery occlusion resulting in cerebral ischemia (AOSI) had higher rates of comorbid ESKD and PVD (4.17% and 7.29%, respectively) versus non-CITO or AOSI hospitalizations (2.34%, p < 0.001; 2.29%, p < 0.001). Conversely, patients hospitalized with nontraumatic intracranial hemorrhage (NIH) had significantly lower rates of ESKD and PVD (1.64%) compared to non-NIH hospitalizations (2.34%, p < 0.001). Furthermore, hospitalizations for CITO or AOSI exhibited higher rates of KTx and PVD (0.17%, 0.09%, respectively) compared to non-CITO or AOSI hospitalizations (0.05%, p = 0.033; 0.05%, p = 0.002). Patients hospitalized with NIH showed similar rates of KTx and PVD (0.04%) versus non-NIH hospitalizations (0.05%, p = 0.34). This nationwide analysis reveals that PVD in ESKD patients is associated with increased hospitalization rates with cerebral ischemic events and reduced NIH events. Among KTx recipients, PVD correlated with increased hospitalizations for ischemic events, without affecting NIH. This highlights management concerns for patients with KTx and PVD.

P459 The prevalence and characteristics of inflammatory bowel disease-related ocular involvement in children

Abstract Background Ocular manifestations (OM) in patients with inflammatory bowel disease (IBD) are uncommon, particularly in children. We aimed to explore the prevalence, characteristics and risk factors of IBD associated OM in a large epidemiologic cohort-based study. Methods A cross-sectional study was performed using the Maccabi Healthcare Services (MHS) database. The eligible population included all patients diagnosed with IBD as children (&amp;lt;18 years) between January 2005 and July 2023. An additional analysis was conducted on patients diagnosed with ocular disease during childhood (&amp;lt;18 years) and IBD during childhood or adulthood. Results Out of 2,567 children with IBD (males 55%, Crohn’s disease 64%), 78 (3%) were diagnosed with OM at any time during disease course. In 54 patients (69%), the OM occurred after IBD diagnosis with a median time of 2.6 (0.47-7) years between the two events, whereas in 24 patients (31%) OM preceded IBD diagnosis with a median time of 2.1 (0.6-5.7) years. OM was significantly associated with Crohn’s disease, compared with ulcerative colitis (78.2% vs. 63.6% in the entire cohort; p=0.03). The presence of OM was associated with increased usage of systemic corticosteroids (p&amp;lt;0.001), biologic agents (p=0.04) and longer duration since IBD diagnosis (p=0.04). There were 55 patients with OM during childhood who were ever diagnosed with IBD. In this population OM was also associated with increased usage of systemic corticosteroids (p&amp;lt;0.001) and increased hospitalization rate per year (p=0.048). The annual prevalence of OM increased gradually from 10/1000 patients in 2005 to 22/1000 patients in 2022 (p=0.55). Conclusion Ocular involvement in children with IBD is rare and more common in patients with Crohn’s disease with a stable prevalence rate. It is associated with a longer duration of disease, greater usage of systemic corticosteroids and biologic agents and with a higher rate of hospitalizations, potentially representing a more severe disease course.

Hospitalizations and Mortality From Myasthenia Gravis: Trends From 2 US National Datasets

Myasthenia gravis (MG) is a rare neuromuscular disorder where IgG antibodies damage the communication between nerves and muscles, leading to muscle weakness that can be severe and have a significant impact on patients' lives. MG exacerbations include myasthenic crisis with respiratory failure, the most serious manifestation of MG. Recent studies have found MG prevalence increasing, especially in older patients. This study examined trends in hospital admissions and in-hospital mortality for adult patients with MG and readmissions and postdischarge mortality in older (65 years or older) adults with MG. Data from the Nationwide Inpatient Sample (NIS), an all-payer national database of hospital discharges, were used to characterize trends in hospitalizations and in-hospital mortality related to MG exacerbations and MG crisis among adult patients aged 18 years or older. The Medicare Limited Data Set, a deidentified, longitudinal research database with demographic, enrollment, and claims data was used to assess hospitalizations, length of stay (LOS), readmissions, and 30-day postdischarge mortality among fee-for-service Medicare beneficiaries aged 65 years or older. The study period was 2010-2019. Multinomial logit models and Poisson regression were used to test for significance of trends. Hospitalization rates for 19,715 unique adult patients and 56,822 admissions increased from 2010 to 2019 at an average annualized rate of 4.9% (MG noncrisis: 4.4%; MG crisis: 6.8%; all p < 0.001). Readmission rates were approximately 20% in each study year for both crisis and noncrisis hospitalizations; the in-hospital mortality rate averaged 1.8%. Among patients aged 65 years or older, annualized increases in hospitalizations were estimated at 5.2%, 4.2%, and 7.7% for all, noncrisis, and crisis hospitalizations, respectively (all p < 0.001). The average LOS was stable over the study period, ranging from 11.3 to 13.1 days, but was consistently longer for MG crisis admissions. Mortality among patients aged 65 years or older was higher compared with that in all patients, averaging 5.0% across each of the study years. Increasing hospitalization rates suggest a growing burden associated with MG, especially among older adults. While readmission and mortality rates have remained stable, the increasing hospitalization rates indicate that the raw numbers of readmissions-and deaths-are also increasing. Mortality rates are considerably higher in older patients hospitalized with MG.

Association between low selenoprotein P concentrations and anaemia in hospitalized heart failure patients.

Heart failure (HF) patients with anaemia tend to have a worse outcome, with increased hospitalization rates, decreased exercise tolerance, and higher mortality compared to those without anaemia. Limited research exists on the association between selenium deficiency and anaemia specifically in HF patients, despite previous findings of a correlation in different populations. The BIOSTAT-CHF study demonstrated that higher selenium levels in HF patients were associated to a lower risk of anaemia and iron deficiency. This study investigates the relationship between selenoprotein P (SELENOP) concentrations, a major contributor and functional biomarker of selenium transport, and anaemia, Hb levels, and iron status in hospitalized HF patients. SELENOP was analysed in 320 hospitalized HF subjects, with complete data available for 310 subjects. The relationships between continuous SELENOP concentrations and 1) Hb concentrations, 2) anaemia (Hb<115g/L (women), <130g/L (men)), and 3) iron status (as measured by transferrin receptor 1 (TfR1) which increases in iron deficiency) were evaluated using multivariable logistic and linear regression models. Additionally, SELENOP concentrations in the lowest quartile were related to anaemia, haemoglobin, and iron state in multivariable logistic and linear models. The mean age of the study population was 75.0±11.6years, and 30% were women. Anaemia was present in 133 subjects (42.9%). SELENOP concentrations were positively correlated with haemoglobin concentrations (0.238; P<0.001) and negatively with TfR1 concentrations (-0.238, P<0.001). In multivariable regression models, higher SELENOP concentrations were associated with higher Hb concentrations (B=3.23; P=0.002) and lower TfR1 concentrations (B=-0.20; P<0.001). Furthermore, SELENOP deficiency was associated with lower Hb concentrations (B=-7.64: P=0.001), higher TfR1 concentrations (B=0.31; P=0.003), and higher odds of anaemia in HF patients (odds ratio 2.17; 95% confidence interval 1.23-3.82; P=0.008). In hospitalized heart failure patients, lower concentrations of SELENOP were associated with higher prevalence of anaemia.

Evaluating the efficiency of medical care for children with diabetes mellitus in different regions of Ukraine over the past 20 years (2002–2021) of peacetime

Background. The growing number of children with diabetes creates a global economic problem, including a financial burden on the country’s health care system and economic stress for families of children with diabetes. The purpose was to assess the effectiveness of medical care for children with diabetes in different regions of Ukraine over the last 20 years (2002–2021) of peacetime. Material and methods. The article presents the results of statistical evaluation and epidemiological analysis of data from the Center for Medical Statistics of the Ministry of Health of Ukraine on the rates of disability, hospitalization, and inpatient care among the pediatric population in 2002–2021. Statistical processing of the results was carried out using MS Excel, XLSTAT-Pro. Results. During 2002–2021, an increase in the rate of primary disability due to diabetes mellitus was highest among adolescents — by 4.1 times and lowest among primary schoolchildren — by 3.4 times; among children 0–6 years old, it increased by 3.6 times. The proportion of children with disabilities due to diabetes as of 2017 is 12 % among the age group of 0–6 years, and 25 % in adolescents (15–17 years). In 2013–2021, the hospitalization rate among children with diabetes increased from 1.27 to 1.35 per 1,000 of the relevant population, and the average length of hospital stay decreased by 19 %. The rate of mortality due to diabetes complications among hospitalized children varies and does not have a specific trend (in 2021, it was 0.02 per 100 in-patients). Conclusions. The analysis of the efficiency of medical care for children with diabetes during 2002–2021 in the context of increasing prevalence and incidence of diabetes showed stable trends towards a huge increase in the level of primary and general disability, a slight increase in hospitalization rates, and a decrease in the average length of hospital stay. These results call for a detailed study of the causes, control, and revision of protocol documents for the management of such patients.

Iron deficiency in heart failure with preserved ejection fraction: rationale and design of the FAIR-HFpEF trial

Background: Iron deficiency is highly prevalent in patients with heart failure and has well established diagnostic criteria. Its occurrence is associated with reduced quality of life, exercise capacity and increased hospitalization rates and mortality. The clinical efficacy of treating iron deficiency has not been tested in patients with heart failure with preserved ejection fraction (HFpEF). Methods: The FAIRHFpEF trial aims to enroll patients with HFpEF, reduced exercise capacity and iron deficiency (defined as serum ferritin &lt;100 ng/mL or serum ferritin 100299 ng/mL with transferrin saturation &lt;20%). Patients will be treated in a multicenter, doubleblind, randomized clinical trial with intravenous ferric carboxymaltose (FCM) at doses aimed to replenish iron stores vs. placebo. The primary endpoint is the difference in exercise capacity from baseline to week 24 as assessed by the 6minute walk test. Secondary endpoints include healthrelated quality of life assessments such as the Kansas City Cardiomyopathy Questionnaire, the European Quality of Life5 Dimensions questionnaire and global function tests. Conclusions: The FAIRHFpEF trial is designed to investigate the effect of intravenous iron repletion in iron deficient patients with HFpEF using FCM.

Iron deficiency in heart failure with preserved ejection fraction: rationale and design of the FAIR-HFpEF trial

Background: Iron deficiency is highly prevalent in patients with heart failure and has well established diagnostic criteria. Its occurrence is associated with reduced quality of life, exercise capacity and increased hospitalization rates and mortality. The clinical efficacy of treating iron deficiency has not been tested in patients with heart failure with preserved ejection fraction (HFpEF). Methods: The FAIRHFpEF trial aims to enroll patients with HFpEF, reduced exercise capacity and iron deficiency (defined as serum ferritin &lt;100 ng/mL or serum ferritin 100299 ng/mL with transferrin saturation &lt;20%). Patients will be treated in a multicenter, doubleblind, randomized clinical trial with intravenous ferric carboxymaltose (FCM) at doses aimed to replenish iron stores vs. placebo. The primary endpoint is the difference in exercise capacity from baseline to week 24 as assessed by the 6minute walk test. Secondary endpoints include healthrelated quality of life assessments such as the Kansas City Cardiomyopathy Questionnaire, the European Quality of Life5 Dimensions questionnaire and global function tests. Conclusions: The FAIRHFpEF trial is designed to investigate the effect of intravenous iron repletion in iron deficient patients with HFpEF using FCM.

Iron deficiency in heart failure with preserved ejection fraction: rationale and design of the FAIR-HFpEF trial

Background: Iron deficiency is highly prevalent in patients with heart failure and has well established diagnostic criteria. Its occurrence is associated with reduced quality of life, exercise capacity and increased hospitalization rates and mortality. The clinical efficacy of treating iron deficiency has not been tested in patients with heart failure with preserved ejection fraction (HFpEF). Methods: The FAIRHFpEF trial aims to enroll patients with HFpEF, reduced exercise capacity and iron deficiency (defined as serum ferritin &lt;100 ng/mL or serum ferritin 100299 ng/mL with transferrin saturation &lt;20%). Patients will be treated in a multicenter, doubleblind, randomized clinical trial with intravenous ferric carboxymaltose (FCM) at doses aimed to replenish iron stores vs. placebo. The primary endpoint is the difference in exercise capacity from baseline to week 24 as assessed by the 6minute walk test. Secondary endpoints include healthrelated quality of life assessments such as the Kansas City Cardiomyopathy Questionnaire, the European Quality of Life5 Dimensions questionnaire and global function tests. Conclusions: The FAIRHFpEF trial is designed to investigate the effect of intravenous iron repletion in iron deficient patients with HFpEF using FCM.