International Recommendations Research Articles

Pregnancy outcomes among women with inflammatory bowel disease: A UK tertiary centre experience.

Optimal management of inflammatory bowel disease (IBD) in pregnancy is associated with better pregnancy outcomes. We describe management of IBD during pregnancy and maternal and fetal outcomes of patients from a tertiary UK IBD centre. This is a retrospective observational cohort study of all pregnancies occurring between 2015 and 2021 in a large tertiary IBD centre in the UK. IBD activity and management prior to, during and after pregnancy were recorded along with pregnancy and neonatal outcomes. Associations between IBD-focused interventions and any adverse pregnancy outcomes, as well as the association between IBD severity and treatments and adverse maternofetal outcomes were assessed. Pregnancies in 130 women with IBD were included for analysis. The mean maternal age at delivery was 30.5 (± 4.7) years. At conception, 73 women (56.2%) were in clinical remission and 24 (18.4%) were treated with a biologic agent. Active disease during pregnancy, measured by physician global assessment, was less frequent in women who were in clinical remission at conception, compared to those not in remission at conception (16/73 21.9% vs. 39/49 79.6%; data insufficient for eight women). Active IBD at conception was associated with pre-term birth (p = 0.04). Maternal corticosteroid use in any trimester was associated with low birth weight (T1 p = 0.02; T2 p = 0.005; T3 p = 0.007). Active disease (p = 0.008) and steroid use in the third trimester (p = 0.05) were both associated with neonatal infections up to sixmonths after birth. Women in clinical remission at the time of conception have favorable outcomes, consistent with prospective observational studies. Our observations emphasize the importance of high quality IBD care for women pre and post-partum in line with international recommendations.

The role of unsaturated fatty acids in depression treatment - international clinical guidelines and recommendation of psychiatric associations

The role of unsaturated fatty acids in depression treatment - international clinical guidelines and recommendation of psychiatric associations

Is per capita fish consumption in Latin America aligned with international recommendations for a healthy diet?

The World Health Organization (WHO) is urging Latin American countries to prioritize the prevention of chronic noncommunicable diseases. Diet is a crucial factor in determining one’s health, and healthy eating recommendations emphasize the consumption of fish at least twice a week due to its protein, vitamin, mineral, and essential fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). This review was designed to compare the status of fish consumption as a source of EPA and DHA fatty acids in some Latin American countries (namely Brazil, Chile, Colombia, and Ecuador), and comparisons with international recommendations within a healthy diet could contribute to the WHO’s call for a focus on preventing the aforementioned diseases in the region. A comprehensive literature search was conducted from January to October 2022 using PubMed, Scopus, EBSCO, and government compendia. Keywords included “fish,” “consumption,” “fatty acids,” “nutrients,” and “Latin America;” and “fish,” “chronic non-communicable diseases,” “all-cause mortality,” “obesity,” “cancer,” “neurodegenerative diseases,” “metabolic diseases,” “diabetes,” “polycystic ovary syndrome,” and “metabolic syndrome.” In countries such as Chile, Brazil, and Colombia, per capita fish consumption falls below WHO’s recommended levels, and the most commonly eaten species do not contain sufficient polyunsaturated fatty acids to provide an optimal intake of EPA and DHA. It is therefore recommended that each country review its dietary guidelines and fish recommendations based on the most commonly consumed species to ensure that their populations obtain the recommended intake of EPA and DHA fatty acids and thus the benefits related to the prevention of chronic noncommunicable diseases.

Value of troponin and NT-proBNP to screen for cardiac amyloidosis after carpal tunnel syndrome surgery

BackgroundEarly diagnosis of cardiac amyloidosis (CA) is crucial due to the promising effect of disease-modifying treatment. This calls for screening strategies to identify CA patients with so-called “red flags”, such as carpal tunnel syndrome (CTS). ObjectivesThis study aims to assess Troponin-T (TnT) and N-terminal pro-B-type natriuretic peptide (NT-ProBNP) as predictors for CA in patients with a history of surgery for bilateral carpal tunnel syndrome, a population suitable for systematic screening. MethodsSubjects with a history of surgery for bilateral CTS 5–15 years prior, identified using national registries were investigated for CA as per international recommendations. Sensitivity, specificity, positive and negative predictive values were assessed, and receiver operating curves were generated using logistic regression. ResultsAmong the 250 participants, 12 were diagnosed with CA, all with wild-type transthyretin amyloidosis. Elevated TnT levels (≥13 ng/L) were found in all CA patients and 25.6% (±2.8) of non-CA patients. The negative predictive value (NPV) of TnT <13 ng/L was 100%. For NT-ProBNP the NPV was 99.1% when age dependent cutoff levels were used. A combination of both biomarkers yielded an NPV of 99.1% and sensitivity of 99.7%. Early disease (Mayo or NAC stage 1) was found in 83% of identified patients with CA. ConclusionThis study demonstrates the utility of TnT and NT-ProBNP as negative predictors to exclude CA in a screening population with a history of surgery for CTS.

Prophylactic phenylephrine infusion versus treatment with vasopressor bolus as needed during non-urgent cesarean delivery and neonatal acidemia: a retrospective cohort study (2016–2021)

IntroductionProphylactic vasopressor administration reduces spinal hypotension during cesarean delivery, however the effects of vasopressor administration on neonatal acidemia remain uncertain. We examined the occurrence of neonatal acidemia in the setting of non-urgent cesarean delivery and compared outcomes between cases receiving prophylactic phenylephrine infusion versus cases treated with boluses of phenylephrine. MethodsRetrospective cohort study with ethical approval, comparing non-urgent cesarean delivery cases performed under spinal anesthesia (2016 to 2021), receiving either prophylactic phenylephrine infusion or boluses as needed.Data were collected from anesthesia and labor ward electronic medical records. Records with missing pH or missing blood pressure data were excluded. The independent variable was prophylactic phenylephrine administration, a strategy implemented following international recommendations in 2018. The main outcome was neonatal acidemia, defined as umbilical artery pH < 7.1. The secondary outcome was maternal hypotension, defined as at least one systolic blood pressure (SBP) measurement below 100 mmHg or below 80% baseline. ResultsA total of 4392 patients were included in the final analysis; 1318 (30.0%) received prophylactic phenylephrine infusion. Neonatal acidemia (umbilical artery pH < 7.1) occurred in 28 (2.1%) cases receiving prophylactic phenylephrine versus 50 (1.6%) treated with boluses as needed (p = 0.188). Prophylactic phenylephrine infusion was not associated with occurrence of neonatal acidemia (aOR 0.83; 95% CI 0.52 to 1.33, p = 0.435). Prophylactic phenylephrine infusion was associated with a reduced spinal hypotension rate when defined as SBP < 100 mmHg (OR 0.47; 95% CI 0.37 to 0.57; p < 0.001), with similar results when hypotension was defined as a drop below 80% or 90% of baseline SBP. ConclusionIn this pragmatic study, prophylactic phenylephrine infusion was associated with a reduction in maternal spinal hypotension, but not reduced neonatal acidemia.

One Health Priorities: Advancing Veterinary Public Health in Latin America and the Caribbean.

One Health (OH) is an integrative approach to human, animal, and environmental health and can be used as a comprehensive indicator for comparative purposes. Although an OH index has been proposed for comparing cities, states, and countries, to date, no practical study has compared countries using this approach. Accordingly, this study aimed to assess OH initiatives using a survey with a veterinary public health focus. The questionnaire contained 104 quantitative questions and was sent to representatives of governmental institutions of 32 countries in the Americas. After exclusion criteria were considered, a total of 35 questionnaires from 17 countries were analyzed, with country names remaining undisclosed during the statistical analyses to protect potentially sensitive information. Principal component analysis (PCA) of health parameters in Latin America and the Caribbean (LAC) as a function of country perception (self-vector) showed that food safety was ranked higher than public policies (p = 0.009), and that both (p = 0.003) were ranked higher than institutional routines related to zoonosis programs. National policies in accordance with international standards, regulations, recommendations, and guidelines was considered the standout topic for public policy, with higher-ranking topics including standard. Meanwhile, challenging topics included tools, preparedness, governance, and research. Food safety showed both strengths and challenges in the coordination of its activities with other sectors. Food safety communication was scored as a strength, while foodborne diseases prevention was ranked as a challenge. Institutional routines for zoonosis maintained both strong and challenging topics in the execution and implementation of attributions and daily routine. Thus, the survey showed that topics such as access to and compliance with international guidelines and intercountry integration were ranked higher than in-country articulation, particularly among food safety, zoonoses, and environmental institutions.

Development and psychometric validation of a patient safety assessment tool in German Radiation Oncology: the PaSaGeRO Study protocol

IntroductionEnsuring patient safety in radiation oncology is crucial for delivering high-quality healthcare. Patient safety indicators (PSIs) provide a mechanism for identifying, quantifying and evaluating risks and the effectiveness of safety...

Quality-of-care standards in adult type 3 intestinal failure caused by benign disease: A European society of clinical nutrition and metabolism (ESPEN) position paper

BackgroundOutcomes related to chronic intestinal failure (CIF) vary significantly within and between countries. While there are extensive European Society of Clinical Nutrition and Metabolism (ESPEN) guidelines on the delivery of optimal care in CIF, there are no international consensus recommendations on the structure or resources required, nor on the process and appropriate outcome measures for delivering such quality care in CIF. AimThe aim of this position paper is therefore to devise ESPEN-endorsed, internationally agreed quality of care standards, covering the resources, systems and standards that centres should aim for in order to deliver optimal CIF care. MethodsMembers of the Home Artificial Nutrition-CIF Special Interest Group of ESPEN proposed an initial set of quality-of-care standards which was submitted to voting amongst clinicians from international CIF centres using a modified Delphi process, with participants rating each proposed statement as ‘essential’, ‘recommended’ or ‘not required’. Any statement receiving 80% of more ‘not required’ responses was excluded. ResultsAll 30 proposed standards relating to the structure, 18 relating to the process and 16 to the outcome measures of CIF care were deemed to be essential or recommended in more than 80% of respondents. ConclusionThis is the first paper to determine and describe internationally-agreed quality of care standards in CIF, which are now aimed at forming the basis for all CIF teams to develop and monitor their service, while also informing policymakers and payers on the infrastructure required for the optimal approach to multi-disciplinary team CIF care delivery. The recording of standardised outcomes should also allow internal and external benchmarking of care delivery within and between CIF centres.

Glycaemia and ischaemia-reperfusion brain injury in patients with ischaemic stroke treated with mechanical thrombectomy (GLIAS-MT): an observational, unicentric, prospective study protocol

IntroductionPoststroke hyperglycaemia is an independent risk factor for poorer outcomes in patients treated with mechanical thrombectomy (MT) and is associated with a lower probability of functional recovery and higher mortality...

Biological variation of methylmalonic acid in urine in spanish population

Background-AimMethylmalonic acid (MMA) is currently the best biomarker of functional vitamin B12 deficiency. However, for a correct interpretation of the patient’s results it is necessary to know its biological variation (BV).No BV data are available for urine MMA values, as measured by mass spectrometry. Hence, the aim of this study was to estimate the within- and between-person coefficients of variation (CVw, CVg) for MMA in a healthy population, and the associated index of individuality (II), as well as to define quality specifications based on BV and the reference change value (RCV). MethodsRandom urine samples from 34 healthy volunteers were collected over four consecutive weeks. Samples were stored at –80 °C until analysis in a single analytical run. MMA excretion was quantified by tandem liquid chromatography coupled to mass spectrometry (HPLC-MS/MS). Results were normalized to urine creatinine.The coefficients of variation were estimated by CV-ANOVA. Confidence intervals (95 %) were calculated. Quality specifications were defined according to international recommendations. ResultsA total of 128 samples were included. The coefficients of variation were CVw = 35.7 % (26.1–45.3) and CVg = 67.7 % (58.3–77.0). The associated II was 0.5 and the RCV was 88.1 %. ConclusionConsidering the II obtained, MMA in urine has high individuality, therefore, RCV is better to evaluate serial clinical results. Our results will contribute to a better clinical interpretation of this biomarker and will represent a great aid when defining analytical performance specifications for this magnitude.

White and wholewheat bread consumption and the risk of exposure to acrylamide and 5-hydroxymethylfurfural

This study used a green validated method to evaluate the risk of exposure of individuals of different ages to acrylamide (AA) and 5-hydroxymethylfurfural (5-HMF) by consuming white and wholewheat bread. Recoveries of AA and 5-HMF were 100.7% and 100.1%, respectively, while uncertainty was 2.3% and 6.2%. Levels of AA ranged from 617.22 to 3151.8 μg/kg while levels of 5-HMF ranged from 180.5 to 648.2 μg/kg. Female adolescents were almost 2-fold exposed to AA when they consumed 100% wholewheat bread (2.93 μg/kg bw/day) by comparison with white bread (1.72 μg/kg bw/day). Estimated daily exposure to AA was 1.5-fold higher than international recommendations. These findings raise concern for health risks associated with exposure to processing contaminant as the result of bread consumption, especially made from whole grains. Since development of those compounds is inevitable during breadmaking, it is crucial to standardize processing conditions and recipes to mitigate it.

Ozone therapy in musculoskeletal medicine: a comprehensive review

Musculoskeletal disorders encompass a wide range of conditions that impact the bones, joints, muscles, and connective tissues within the body. Despite the ongoing debate on toxicity and administration, ozone demonstrated promise in managing several musculoskeletal disorders, modulating pain and inflammation. A literature search was conducted. The research design, methods, findings, and conclusions of the studies were then examined to evaluate the physiological effects, clinical application, controversies, and safety of the application of ozone in musculoskeletal medicine. Ozone application demonstrates considerable therapeutic applications in the management of musculoskeletal disorders, including fractures, osteoarthritis, and chronic pain syndromes. Despite these advantages, studies have raised concerns regarding its potential toxicity and emphasized the importance of adhering to stringent administration protocols to ensure safety. Additionally, heterogeneities in patient reactions and hazards from oxidizing agents were observed. Given its anti-inflammatory and analgesic qualities, ozone therapy holds potential in the management of several musculoskeletal disorders. Additional high-quality research with long follow-up is required to refine indications, efficacy and safety profile. Finally, for wider clinical acceptability and utilization, the development of international recommendations is essential.

Extraskeletal Ewing sarcoma of the extremities and trunk: a retrospective analysis of a mono-institutional series.

Introduction Extra-skeletal Ewing sarcoma is a rare malignant tumor, and current international recommendations indicate systemic and local treatment like bone Ewing sarcoma; to the best of our knowledge, very few studies tried to explore the clinical and genetic characteristics of this tumor and the most appropriate treatment strategy remains uncertain. Methods We reviewed 35 extra-skeletal Ewing sarcoma (EEwS) cases enrolled at Rizzoli Orthopedic Institute in Bologna, Italy between 1988-2022. We performed RNA sequencing in 18 Ewing sarcoma cases, including 12 bone Ewing sarcomas (BEwS) and 6 EEwS. We analyzed overall survival (OS), local relapse-free survival (LRFS), and metastasis-free survival (MFS) and the risk factors associated to survival. Results Unsupervised Hierarchical clustering showed no differences in the transcriptional profile between EEwS and BEwS. Five-year OS was 67% (95%CI 47-80), 5-year LRFS was 61% (95% CI 43-75), and 5-year MFS was 55% (95% CI 38-70). Recurrent tumors, larger than 8 cm, and elevated LDH serum value resulted to be a negative prognostic factor. Conclusions The founding of a genetic profile indistinguishable between EEwS and BEwS, confirms the view that includes the two subgroups in the same tumor entity and supports the use of a single therapeutic approach for Ewing sarcoma independently from the site of origin. Statistical evaluation showed that size bigger than 8cm, elevated LDH, and recurrent tumors had a worse prognosis, suggesting a risk-stratification method for identifying patients for specific therapy treatment. However, larger, multicentre, prospective trials are called for to validate our findings.

Circular Economy Principles in the Regulatory Oversight of the Management of By- Products – Case Study: Tin Slag 2

The tin processing industry generates abundant slag, as a by-product, that contains radioactive substances from uranium and thorium decay series radionuclides. The increase in tin production will be proportional to the rise in tin slag. The Circular economy is a concept that aims to minimize the extraction of primary resources, keep resources as long as possible, increase added value, or limit the final disposal of waste. The concept of reuse, recycling, or reprocessing is part of the concept. This paper aims to identify aspects of the existing regulations in Indonesia that support circular economy principles in the management of by-products, such as tin slag 2. The methodology used in this paper is a literature study of regulations, international recommendations, and related research. Based on the measurements of tin slag 2 samples originating from Bangka Belitung Province, the main chemical constituents based on XRF analysis are SiO2, CaO, MgO, Fe2O3, and TiO2. The activity concentration of a tin slag 2 sample showed a value that exceeded the criterion of 1 Bq/gram for the radionuclides in the uranium and thorium decay series. From a material perspective, tin slag 2 can be reused or recycled for specific purposes. Various studies have proven the performance of tin slag 2 as a partial substitution of fine aggregate or cement in manufacturing mortar or concrete. The identification shows that several existing regulations in Indonesia explicitly and implicitly regulate the provisions of the circular economy concept. According to the Ministry of Environment and Forestry regulations, by-products with activity concentrations of less than 1 Bq/gram can be used as raw material, raw material substitution, energy source substitution, and other uses. Meanwhile, the by-products with activity concentrations of more than 1 Bq/gram are challenging as the provisions of by-products with a value of more than 1 Bq/gram are regulated in BAPETEN Regulation No. 16 of 2013 (currently in the revision stage). BAPETEN Regulation No. 16 of 2013 explains that by-products can be utilized for certain activities. However, the regulation must explain the terms and criteria for reusing by-products. Provisions of by-product processing, as stipulated in GR No. 52 of 2022, are limited to extracting nuclear minerals such as uranium and thorium. So, the meaning of processing in GR No. 52 of 2022 and provisions for reuse previously contained in BAPETEN Regulation No. 16 of 2013 have different meanings. Keywords: circular economy, by-product, tin, slag 2, radioactive substances, nuclear minerals

The effect of hygienic material use during menstruation on the prevalence of RTIs symptoms among women in India

Background: Every month, healthy adolescent girls and pre-menopausal adult women are impacted by the crucial topic of menstrual hygiene. Menstrual hygiene management is essential to women’s reproductive health. Menstrual product consumption, poor cleaning techniques, and material reuse are examples of suboptimal menstrual health and hygiene. So, the current study was planned to assess the impact of hygienic material use during menstruation on the prevalence of RTIs among women in India. Methods: A cross-sectional, comparative community-based study was conducted in urban and rural areas of Bangalore, India. Study was conducted from December 2023 to March 2024. All female patients in reproductive age group attending RHTC and UHTC OPD were included. Interview method was used to collect data from consented participants on socio demographic details, products used for menstrual hygiene and symptoms suggestive of RTI in last 6 months were collected. Results: A community-based study was conducted in rural and urban field practice area of a medical college in Bangalore. A total of 258 participants attending UHTC and RHTC centres were included from each area. The proportion of participants with RTI symptoms were 62.2%. In current study 20.3% participants reported lower abdominal pain and 18.6% of participants had pain during micturition in past 6 months. Conclusions: Our study’s findings show a direct link between subpar MHM procedures and RTI symptoms. Our results confirm international recommendations for a dual focus on providing suitable absorbent materials and making sure that ambient conditions allow associated hygiene, such as washing, safety, and dignity for women.

Which government policies to create sustainable food systems have the potential to simultaneously address undernutrition, obesity and environmental sustainability?

IntroductionA transformation of food systems is urgently needed, given their contribution to three ongoing and interlinked global health pandemics: (1) undernutrition and food insecurity, (2) obesity and non-communicable diseases (NCDs), and (3) climate change and biodiversity loss. As policymakers make decisions that shape food systems, this study aimed to identify and prioritise policies with double- or triple-duty potential to achieve healthier and more environmentally sustainable food systems.MethodsThis study undertook a 4-step methodological approach, including (i) a compilation of international policy recommendations, (ii) an online survey, (iii) four regional workshops with international experts and (iv) a ranking for prioritisation. Policies were identified and prioritised based on their double- or triple-duty potential, synergies and trade-offs. Using participatory and transdisciplinary approaches, policies were identified to have double- or triple-duty potential if they were deemed effective in tackling two or three of the primary outcomes of interest: (1) undernutrition, (2) obesity/NCDs and (3) environmental degradation.ResultsThe desk review identified 291 recommendations for governments, which were merged and classified into 46 initially proposed policies. Based on the results from the online survey, 61% of those policies were perceived to have double- or triple-duty potential. During the workshops, 4 potential synergies and 31 trade-offs of these policies were identified. The final list of 44 proposed policies for healthier and more environmentally sustainable food systems created was divided into two main policy domains: ‘food supply chains’ and ‘food environments’. The outcome with the most trade-offs identified was ‘undernutrition’, followed by ‘environmental sustainability’, and ‘obesity/NCDs’. Of the top five expert-ranked food supply chain policies, two were perceived to have triple-duty potential: (a) incentives for crop diversification; (b) support for start-ups, and small- and medium-sized enterprises. For food environments, three of the top five ranked policies had perceived triple-duty potential: (a) affordability of healthier and more sustainable diets; (b) subsidies for healthier and more sustainable foods; (c) restrictions on children's exposure to marketing through all media.ConclusionThis study identified and prioritised a comprehensive list of double- and triple-duty government policies for creating healthier and more environmentally sustainable food systems. As some proposed policies may have trade-offs across outcomes, they should be carefully contextualised, designed, implemented and monitored.

Implementation of a Microbiological Surveillance Protocol in a Portuguese Tertiary Care Academic Endoscopy Unit

Introduction: International societies recommend microbiological surveillance of endoscopes to reduce the incidence of endoscope-associated infections, particularly for duodenoscopes. However, surveillance protocols are not internationally standardized, both regarding sample collection, processing, and culture. This study aims to provide a framework protocol encompassing the experience of a tertiary large volume endoscopy center and the microbiology laboratory for collecting and culturing of endoscope samples for microbiological surveillance. Methods: A sample collection and processing protocol was designed as a result of a cooperation between the Endoscopy Center of the Gastroenterology Department and the Microbiology Laboratory of the Department of Clinical Pathology. This protocol reflects international recommendations in this topic and the human and technological resources of the involved departments. Results: The established protocol for collecting samples varies according to the type and model of endoscope. The specimens are collected as sterile saline liquid samples, as well as swabs (with and without transport media). Together with the collection of samples from the endoscope, samples from the final rinse water as well as the water bottle are also collected. For duodenoscopes and curvilinear echoendoscopes, we perform microbiological surveillance every 3 months; for gastroscopes and colonoscopes, at least, once a year; and for specific endoscopes, such as the pediatric or dual-channel therapeutic endoscopes, enteroscopes, or radial echoendoscopes, every 6 months. Conclusion: Endoscopy units should have detailed protocols for microbiological surveillance of endoscopes. These protocols should be drawn up by a multidisciplinary team that includes endoscopy nurses, gastroenterologists, microbiologists, and the antimicrobial stewardship team, following international recommendations, adapted to each institution resources.

Axial spondyloarthritis—current aspects

Axial spondyloarthritis (axSpA) is a frequent inflammatory rheumatic disease mainly affecting the axial skeleton causing inflammatory back pain. If chronic inflammation persists new bone formation may occur possibly leading to irreversible spinal stiffness. The disease has a strong genetic background with HLA-B27 as the major factor. For diagnostic purposes, imaging is of critical importance—especially conventional radiography and magnetic resonance imaging (MRI). While the former has advantages in the detection of bony changes such as the syndesmophytes, MRI is used to detect axial inflammation but also erosions in the sacroiliac joint. Treatment follows the treat-to-target strategy starting with non-steroidal anti-inflammatory drugs (NSAIDs) in the first line, and later, if high disease activity persists, therapy with biologic disease modifying anti-rheumatic drugs (bDMARDs) is according to international recommendations indicated. For the treatment of axSpA, important targets such as tumor necrosis factor alpha (TNFα) and interleukin (IL)-17 have been identified, and several of their inhibitors (i) including some biosimilars for the former have been approved. Recently, also inhibition of Janus kinases was shown to be efficacious. There is evidence that long term inhibition of inflammation with TNFi can reduce bone formation.

A detection and defense security system design for nuclear waste storage against stealth terrorists attack

Abstract The physical protection system (PPS) is one of the main systems used in nuclear facilities to protect these facilities from terrorist attacks, the possibility of bombing, sabotage, and theft. Installation of a security system for nuclear waste stores from the outside is necessary and very important for early detection and physiological deterrence greater than the internal security system. From this perspective, this work provides a solution for the protection of nuclear waste stores, which means detection and defense systems. This paper introduces an advanced security system and proposes a design for a detection and defense security system for nuclear waste storage against stealth terrorist attacks. The security system that is being suggested will have smart camera surveillance system, electric chock system, intense flashlight barrier, high-intensity sound barriers, and dual-side infrared rays. Three consecutive processes – detection, deterrence, and defense – will be operated around the building of the waste storage. The concept may be implemented by establishing an early detection system to detect any intrusion by terrorist attackers through a protected area surrounded by storage. The following step is deterring the attackers from completing their mission by installing advanced deterrence system and putting delay components along the path of their attack on the waste storage to complicate the mission. Then the defense system is operating to stop terrorist progress. Finally, the work make an evaluation process of the overall security system which has been designed by using EASI program to verify the accepted level of physical protection, maintain the validity and updates of security system components, and follow procedures, rules and requirements of the nuclear regulatory authority at the national level and meet the international IAEA concept and recommendations.

Contemporary algorithms for diagnosing obstructive coronary artery disease in real clinical practice

Background. Despite the high evidence level of the currently existing international recommendations on stable coronary heart disease (CHD) and chronic coronary syndrome, their implementation in domestic clinical practice is insufficient.The aim of the work. To analyze the choice of diagnostic tactics (non-invasive and invasive) in patients with suspected obstructive coronary heart disease in real clinical practice.Methods. The study included outpatients with suspected obstructive CHD, in whom the pre-test probability (PTP) of obstructive CHD was determined; if PTP = 5–15 %, clinical probability was assessed based on CHD risk factors. Based on the results of coronary angiography, the following groups were identified: group I – obstructive lesion of the coronary arteries (≥ 70 %) (n = 50); group II – non-obstructive lesion of the coronary arteries (&lt; 70 %) (n = 32); group III – intact coronary arteries (n = 40). Results. According to the results of coronary angiography, the frequency of detection of obstructive lesion of the coronary arteries was 42 % (in patients without past medical history of myocardial infarction – 31 %). Before performing coronary angiography, non-invasive tests were performed in 2.5 % of cases. Pain in the chest was represented by typical angina in 74 % of patients, with no difference in frequency in all groups. PTP values were statistically significantly higher in the group with obstructive CHD (median – 32 %), however, in the other two groups, PTP values corresponded to a high risk of obstructive CHD (median – 27 % and 21 %, respectively). PTP was an independent predictor for obstructive CHD and subsequent myocardial revascularization.Conclusion. In the cohort of outpatients with suspected coronary heart disease we examined during invasive coronary angiography, the frequency of obstructive lesion of the coronary arteries remains low. Non-invasive tests were performed in isolated cases, while PTP was an independent predictor for obstructive CHD and subsequent myocardial revascularization. To increase the frequency of detection of obstructive coronary heart disease, we should adhere to the diagnostic algorithms of the European Society of Cardiology and make wider use of non-invasive imaging tests.