Long-term Monitoring Of Patients Research Articles

КРУПНАЯ ФИБРОМА ЛЕВОГО ЖЕЛУДОЧКА СЕРДЦА У РЕБЕНКА

Introduction. Fibroma is considered as benign solitary tumor, which is the second most common among primary heart tumors in children. It rarely starts to regresses, contributes to the formation of hemodynamic disorders and congestive heart failure, as well as life-threatening arrhythmias, and also can lead to the development of sudden death. Aim. Informing physicians about a rare cardiac fibroma in children on the example of a clinical case. Material and methods. Describing a clinical case of patient K., 7 months old, who was referred to the cardiac surgery department for a planned operation to remove a left ventricular mass, which was diagnosed prenatally at 32 weeks. Results and discussion. A dynamic observation was carried out, during which, according to echocardiography and magnetic resonance imaging, an increase in the tumor from 35x25 mm to 70x35 mm and the formation of mitral stenosis were noted. The average pressure gradient in the mitral valve increased from 2 to 11 mm Hg there was a limitation of the mobility of its valves. A partial resection of the tumor was performed. Morphological and immunohistochemical studies confirmed the diagnosis of fibroma. The postoperative period proceeded well. Conclusion. Cardiac fibromas in children, regardless to the clinical course of the disease, require long-term monitoring of patients with an electrocardiological study, echocardiography and magnetic resonance imaging method, and if there is a threat of complications, surgical removal of the tumor.

Hemostatic Profile and Serological Response of Patients with Immune Thrombotic Thrombocytopenic Purpura after Receiving BNT162b2 Vaccine: A Prospective Study.

Coronavirus disease is a clinical challenge for patients with autoimmune conditions. Patients affected by immune thrombotic thrombocytopenic purpura (iTTP) are particularly vulnerable to SARS-CoV-2 infection. Protecting these patients with vaccination is therefore mandatory, although concerns may exist on a possible increased thrombotic risk or risk of disease relapse after vaccine exposure. So far, there is no information on serological response and hemostatic activation in iTTP patients after SARS-CoV-2 vaccination. In this study, in April 2021, we enrolled iTTP patients in clinical remission and on regular outpatient follow-up to receive the first and second dose BNT162b2 vaccine as a part of a prospective trial aimed at monitoring for 6 months after vaccination the occurrence of subclinical laboratory signs of clotting activation, as well as overt thrombotic complications or disease relapse. The seroconversion response was monitored in parallel. The results were compared with those of control non-iTTP subjects. A moderate decrease of ADAMTS-13 activity was recorded at 3 and 6 months in five patients with normal values at baseline, while an ADAMTS-13 relapse occurred at 6 months in one patient. Abnormalities in the endothelium activation biomarkers postvaccination were observed in iTTP patients compared with controls. The immunological response to vaccine was overall positive. No clinical iTTP relapses or thrombotic events manifested in the 6 month-follow-up after vaccination. The results of this study are in favor of efficacy and safety of mRNA vaccines in patients with iTTP, and highlight the importance of long-term monitoring of iTTP patients.

Echocardiographic Findings in Asymptomatic Mediastinal Lymphoma Survivors Years after Treatment Termination.

Patients treated due to mediastinal lymphomas are at risk of cardiovascular complications, as they receive chemotherapy, usually containing anthracyclines, often combined with thoracic radiotherapy. The aim of this prospective study was to assess early asymptomatic cardiac dysfunction using resting and dobutamine stress echocardiography (DSE) at least 3 years after the end of mediastinal lymphoma treatment. Two groups of patients were compared: those treated with chemoradiotherapy and those exclusively treated with chemotherapy. Left ventricular contractile reserve (LVCR) during DSE was assessed using changes in LV ejection fraction (LVEF), LV global longitudinal strain (LV GLS), and a novel parameter-Force, which is the ratio of the systolic blood pressure to the LV end-systolic volume. The study included 60 patients examined at a median of 89 months after the end of treatment. Resting echocardiography showed normal LVEF of 58.9 ± 9.6%, borderline LV GLS of -17.7 ± 3%, decreased mean stroke volume (SV) of 51.4 ± 17 mL, and indexed SV of 27.3 ± 8 mL/m2, and the right ventricular free wall longitudinal strain (LS) was impaired in some patients but not in all. There were no significant differences between the groups, with the exception of arterial hypertension, which was more common in the chemotherapy group (32% vs. 62.5%, p = 0.04). In resting echocardiography, only LV posterior wall LS differed significantly and was impaired in patients treated with chemotherapy (-19.1 ± 3.1% vs. -16.5 ± 5.1%, p = 0.04). DSE, performed in 21 patients after a median of 166 months from the end of cancer treatment, detected new contractility disorders in 1 patient (4.8%) and decreased LVCR in the majority of patients when determined using changes in LVEF or LV GLS, and in all patients when assessed with changes in Force. Conclusions: Most asymptomatic mediastinal lymphoma survivors showed preserved ventricular function on resting echocardiography. However, all of them showed impaired LV contractile reserve on DSE, as assessed with a simple parameter-Force. This may indicate subtle LV dysfunction and confirms the need for long-term monitoring of patients with potentially cardiotoxic cancer treatment.

Characterization of oral bacterial and fungal microbiome in recovered COVID-19 patients

COVID-19 has emerged as a global pandemic, challenging the world’s economic and health systems. Human oral microbiota comprises the second largest microbial community after the gut microbiota and is closely related to respiratory tract infections; however, oral microbiomes of patients who have recovered from COVID-19 have not yet been thoroughly studied. Herein, we compared the oral bacterial and fungal microbiota after clearance of SARS-CoV-2 in 23 COVID-19 recovered patients to those of 29 healthy individuals. Our results showed that both bacterial and fungal diversity were nearly normalized in recovered patients. The relative abundance of some specific bacteria and fungi, primarily opportunistic pathogens, decreased in recovered patients (RPs), while the abundance of butyrate-producing organisms increased in these patients. Moreover, these differences were still present for some organisms at 12 months after recovery, indicating the need for long-term monitoring of COVID-19 patients after virus clearance.

Prognostic biomarkers of progressive pulmonary fibrosis in patients with interstitial lung diseases

A high proportion of patients with various interstitial lung diseases (ILD) develop progressive pulmonary fibrosis (PLF) associated with a deterioration in the quality of life, a decrease in functional status and early mortality. PLF is diagnosed in patients with ILD of known or unknown etiology other than idiopathic pulmonary fibrosis (ILF), who have radiological signs of pulmonary fibrosis, and at least two of the three criteria for progression, including clinical, functional and radiological indicators that have arisen over the past year in the absence of alternative causes of deterioration. Subtypes of ILD that are at risk of developing a progressive fibrosing phenotype include ILD associated with connective tissue diseases, such as rheumatoid arthritis and systemic scleroderma; sarcoidosis; hypersensitive pneumonitis, occupational lung diseases. In 2022, new criteria for the diagnosis of PLF appeared. The existing evidence of common pathogenesis mechanisms leading to progressive pulmonary fibrosis suggests the presence of uniform biomarkers of disease activity for a wide range of diseases. Pulmonary fibrosis is initiated by microinjuries of the alveolar epithelium of various etiologies, in the future its progression includes similar pathophysiological mechanisms, which suggests the presence of uniform biomarkers of disease activity for a wide range of diseases. Biomarkers can help not only identify patients at risk of progression, but also allow monitoring the early response to treatment. Biomarker research to date has identified a number of molecular markers that predict the presence of the disease, prognosis and/or response to treatment. The creation of national and international registries allows for long-term monitoring of patients with PLF, to answer questions about the long-term effectiveness of treatment. To date, a number of molecular factors that claim to be predictors are being discussed, allowing to verify the diagnosis, determine the prognosis and response to therapy.

РОЛЬ СУБЪЕКТИВНЫХ И ОБЪЕКТИВНЫХ КРИТЕРИЕВ В ОЦЕНКЕ СОСТОЯНИЯ БОЛЬНЫХ БРОНХООБСТРУКТИВНЫМИ ЗАБОЛЕВАНИЯМИ В УСЛОВИЯХ УДАЛЕННОГО МОНИТОРИНГА

Introduction. Wearable or home electronic devices with the function of transmitting information at a distance are used for the purpose of remote dynamic monitoring of the condition of patients. Aim. To determine the effectiveness of the use of "new" criteria for assessing the health status of patients with broncho-obstructive diseases in order to monitor remotely. Material and methods. 28 patients with broncho-obstructive diseases who were admitted for inpatient treatment were examined. Most of them had comorbidities, mainly cardiovascular pathology. A general clinical examination and special research methods were performed: an interactive survey using the respiratory module of the Electronic Polyclinic program, remote monitoring of vital signs using a smart watch and a mobile application for recording and transmitting information, a 6-minute walk test with simultaneous recording of vital signs with using a smart watch, a questionnaire and a scale for assessing the usability of the System usability scale system. The analysis of the results was performed by using the Statistica 13.0 software package. Results and discussion. Interactive survey corresponded to the severity of dyspnea according to the mMRC and Borg scales. The 6-minute walk test showed a significant limitation of physical activity and an increase in heart rate. The deep sleep phase has been limited. The CRP index averaged 7.78±8.48 µg/l. More than 85% of patients expressed their willingness to continue observation. The results of the correlation analysis demonstrated a direct relationship with the patient's physical activity assessment and the results of the 6-minute walk test, and an inverse relationship with the 6-minute walk test result and the patients' age, severity of respiratory failure and CRP concentration. The duration of deep sleep is inversely correlated with the SpO2 value. Our studies made it possible to compare the obtained data with the results of traditional methods of examining a patient, to confirm the position that the physical activity of a patient with broncho-obstructive disease is connected with indicators of the function of external respiration, and also that the total duration of sleep of COPD patients mainly consists of light sleep with a decrease in the duration of deep sleep. An inverse relationship was found with the duration of deep sleep and the concentration of CRP and the value of SpO2. The described monitoring system allows you to timely adjust the treatment regimen, reduce the number of hospitalizations, the risk of exacerbation or death.Conclusion. Additional instrumental control of vital parameters increases the efficiency of the system of long-term remote monitoring of patients with broncho-obstructive diseases. the indicators represent the severity of the symptoms of the disease and the degree of violations of the indicators of the function of external respiration.

Propuesta de seguimiento tras cirugía protésica de cadera primaria: Revisión sistemática de la literatura.

Total hip replacement is probably the most successful surgical technique within orthopedic surgery, despite this it is foreseeable that some patients will require revision of their implant over time. These facts make it necessary to adopt a cost-effective model for long-term clinical monitoring and control of patients and their implants. Generally, the clinical reviews carried out tend to have an annual frequency, which seems to constitute an unnecessary action due to its low effectiveness in detecting cases that require an action derived from their visit (around 0.6%) and a significant financial burden. We carried out a systematic review of the last ten years around: "hip arthroplasty follow up recommendations" and "total hip replacement recommendations for follow-up", with a proposal for follow-up planning.

Electrodermal activity and heart rate variability for detection of peripheral abnormalities in type 2 diabetes: A review.

Modern medicine exhibits an upward trend towards non-invasive methods for early detection of disease and long-term monitoring of patients' health. Diabetes mellitus and its complications are a promising area for implementation of new medical diagnostic devices. One of the most serious complications of diabetes is diabetic foot ulcer. The main causes responsible for diabetic foot ulcer are ischemia caused by peripheral artery disease and diabetic neuropathy caused by polyol pathway-induced oxidative stress. Autonomic neuropathy impairs function of sweat glands, which can be measured by electrodermal activity. On the other hand, autonomic neuropathy leads to changes in heart rate variability, which is used to assess autonomic regulation of the sinoatrial node. Both methods are enough sensitive to detect pathological changes caused by autonomic neuropathy and are promising screening methods for early diagnosis of diabetic neuropathy, which could prevent the onset of diabetic ulcer.

МУЛЬТИМОДАЛЬНАЯ ДИАГНОСТИКА У ПАЦИЕНТОВ С КОМПОНЕНТАМИ МЕТАБОЛИЧЕСКОГО СИНДРОМА, ПЕРЕНЕСШИХ ИНТЕРСТИЦИАЛЬНУЮ ПНЕВМОНИЮ, АССОЦИИРОВАННУЮ С COVID-19

Introduction. Coronavirus infectious disease caused by SARS-CoV-2 characterized by vast clinical variability. Extrapulmonary complications associated with endothelial damage, thrombosis and impaired regulation of immune responses provide unfavorable impact on the outcome of the disease and rehabilitation opportunities. Also, infection inflict damage to the gastrointestinal tract, hepatobiliary system. A key - roles to avoid aforementioned conditions are proper diagnosis and treatment plan, which should be make as soon as possible among the patients with elements of metabolic syndrome. The aim of the study - analyze the possibilities of multimodal diagnostics in patients with elements of the metabolic syndrome who get infected by SARS-CoV-2. Material and methods. In 41 patients with positive SARS-CoV-2, according to a nasopharyngeal smear study, the elements of the metabolic syndrome such as an increase in body mass index, serum triglycerides, and blood pressure were determined. Dynamic ultrasound of the abdominal cavity organs, CT scan of the chest in the near and distant periods were performed. Results and discussion. In the period 2020 - 2021. in patients with elements of the metabolic syndrome who have suffered of interstitial pneumonia caused by COVID-19, the predominant patterns was diffuse mosaic changes in lung tissue lesions with the spread of changes in lung parenchyma to more than one segment were identified. In a comparative aspect, dynamic multimodal diagnostics of abdominal organs was performed, confirming extrapulmonary complications from the liver: hepatosplenomegaly (p ≤ 0.01), changes of hemodynamics in hepatic vessels in patients with MS (p ≤ 0.05), increased stiffness and formation of liver parenchyma fibrosis in almost 15% (F2- F3). Conclusion. Study confirm the need for careful and long-term monitoring of patients, who are a in group of risk to develop metabolic syndrome with multimodal noninvasive ultrasound control of the condition of target organs.

Legionnaires' Disease in China Caused by Legionella pneumophila Corby.

Legionella pneumophila is an intracellular pathogen causing pneumonia in humans. In February 2022, Legionnaires' disease caused by L. pneumophila strain Corby in a patient with lung adenocarcinoma was identified for the first time in China. This paper includes the case report and phenotypic and genomic analysis of the Corby (ICDC) strain. Its biological characteristics were evaluated by antibiotic sensitivity testing and cytology experiments, and genomic analysis was performed to understand its genetic evolution. The patient's clinical manifestations included cough, fever, pulmonary infiltration, and significantly decreased activity endurance. After empirical antimicrobial therapy, infection indicators decreased. The Corby (ICDC) strain was susceptible to nine antibiotics and exhibited strong intracellular proliferation ability. A phylogenetic tree showed that the Corby (ICDC) strain was closely related to the Corby strain, but under the pressure of a complex environment, its genome had undergone more rearrangement and inversion. The type IF CRISPR-Cas system was identified in its genome, and spacer analysis indicated that it had been invaded by several foreign plasmids, bacteria, and viruses during evolution. Legionnaires' disease caused by L. pneumophila strain Corby may be ignored in China, and it is urgent to improve long-term monitoring and investigation of aquatic environments and patients with respiratory infections to prevent a large-scale outbreak of Legionnaires' disease.

Incidence and prognostic significance of malignant arrhythmias during (repetitive) Holter electrocardiograms in patients with pulmonary hypertension.

In patients with pulmonary hypertension (PH), increased pulmonary vascular resistance (PVR) may lead to increased right ventricular afterload and cardiac remodelling, potentially providing the substrate for ventricular arrhythmias. Studies dealing with long term monitoring of patients with PH are rare. The present study evaluated the incidence and the types of arrhythmias retrospectively recorded by Holter ECG in patients with newly detected PH during a long-term Holter ECG follow-up. Moreover, their impact on patient survival was evaluated. Medical records were screened for demographic data, aetiology of PH, incidence of coronary heart disease, level of brain natriuretic peptide (BNP), results from Holter ECG monitoring, 6-minute walk test distance, echocardiographic data and hemodynamic data derived from right heart catheterization. Two subgroups were analyzed: 1. patients (n = 65) with PH (group 1 + 4) and derivation of at least 1 Holter ECG within 12 months from initial detection of PH and 2. patients (all PH etiologies, n = 59) with 3 follow-up Holter ECGs. The frequency and complexity of premature ventricular contractions (PVC) was classified into "lower" and "higher" (=non sustained ventricular tachycardia, nsVT) burden. Holter ECG revealed sinus rhythm (SR) in most of the patients (n = 60). Incidence of atrial fibrillation (AFib) was low (n = 4). Patients with premature atrial contractions (PAC) tend to have a shorter period of survival (p = 0.098), PVC were not correlated with significant survival differences. During follow-up PAC and PVC were common in all PH groups. Holter ECG revealed non sustained ventricular tachycardia in 19/59 patients [(32.2%); n = 6 during first Holter-ECG, n = 13 during second/third Holter-ECG]. In all patients suffering from nsVT during follow-up previous Holter ECG revealed multiform/repetitive PVC. PVC burden was not linked to differences in systolic pulmonary arterial pressure, right atrial pressure, brain natriuretic peptide and results of six-minute walk test. Patients with PAC tend to have a shortened survival. None of the evaluated parameters (BNP, TAPSE, sPAP) was correlated with the development of arrhythmias. Patients with multiform/repetitive PVC seem to be at risk for ventricular arrhythmias.

The role of matrix metalloproteinases in pathogenesis, diagnostics, and treatment of human prostate cancer

Abstract The prostate gland is highly susceptible to oncogenic transformation, many times more than other sex tissues, such as seminal vesicles. In fact, prostate cancer (PCa) will be diagnosed in one in seven lifetime patients, making PCa the subject of intense research aimed at clarifying its biology and providing adequate treatment. PCa is the fourth most common cancer in the world in terms of the overall population and the second most common cancer for the male population. It is postulated that the development of PCa may be influenced by dietary factors, physical and sexual activity, androgens, obesity, and inflammation, but their role in the development of prostate cancer still remains unclear. Extracellular matrix metalloproteinases (MMPs) and tissue metalloproteinase inhibitors (TIMPs) play an important role in many physiological and pathological processes, including proliferation, migration, invasion, cell differentiation, participation in inflammatory processes and angiogenesis. Numerous studies point to a direct relationship between MMPs and both local tumor invasion and the formation of distant metastases. High activity of MMPs is observed in solid tumors of various origins, which positively correlates with a poor overall survival rate. Although biochemical diagnostic markers of PCa are currently available, from the point of view of clinical practice, it seems particularly important to develop new and more sensitive markers allowing for early diagnosis and long-term monitoring of patients after PCa treatment, and the assessment of MMP activity in urine and serum of patients are potential factors that could play such a role.

"Guiding lights" for the diagnosis of chronic thromboembolic pulmonary hypertension in the flow of patients with pulmonary embolism

On December 13, 2021, an expert council was held to determine the position of experts of different specialties regarding the reasons for the low level of diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) in real clinical practice in a pandemic of a new coronavirus infection and possible ways to improve detection in patients with pulmonary embolism (PE) ) in history. The reasons for the low level of diagnosis of CTEPH are the insufficient level of knowledge of specialists, especially primary care physicians; lack of clear regulatory documents and expert centers for the management of this category of patients. Primary diagnosis of CTEPH in a pandemic can be strengthened through the widespread use of telemedicine for consultations of primary care physicians with specialists from expert centers; to maximize the role of echocardiography and computed tomography (CT) as differential diagnostic tools for dyspnea, in particular in patients with COVID-19. To increase the detection rate of CTEPH, diagnostic vigilance is required in patients with risk factors and episodes of venous thromboembolism. To improve the screening of CTEPH, it is necessary to create an algorithm for monitoring patients who have had PE; provide educational activities, including through the media; create materials for patients with accessible information. The regulatory documents should designate the circle of responsible specialists who will be engaged in long-term monitoring of patients with PE. Educational programs are needed for primary care physicians, cardiologists, and other physicians who come into the field of view of patients with CTEPH; introduction of a program to create expert centers for monitoring and managing patients with the possibility of performing ventilation-perfusion lung scintigraphy, cardiopulmonary stress test, CT, right heart catheterization. It seems important to build cooperation with the Ministry of Health of Russia in order to create special protocols, procedures for managing patients with PE and CTEPH.

Long-term results of 10 years of observation of cured cases of pulmonary tuberculosis

Aim of the study: Conduct long-term monitoring of recovered patients with pulmonary TB and study the frequency of relapses of pulmonary TB and factors contributing to their development in the Republic of Tajikistan. Material and research methods: Of the total number of patients with pulmonary TB, 820 people in 2010-2011 after successful treatment, were transferred for further dispensary observation to PHC facilities, whose health status we monitored for 10 years (including 2020). Of the 820 patients, we were able to track the health status for 10 years in 622 patients (320 men and 302 women, age groups 19-44 years old - 330 people and 45-69 years old - 292 people). The rest - for various reasons were lost from further dispensary observation. All patients in PHC facilities annually during the period of dispensary observation underwent clinical, instrumental, laboratory, and X-ray examinations to exclude the recurrence of TB. Data for each patient were tracked using the National TB Registry OpenMRS data. Research results: The elimination of preventive anti-relapse measures in people with residual post-tuberculosis changes in the lungs led to an increase in the number of relapses of the disease. The analysis of the conducted studies shows that the incidence of relapses of pulmonary TB does not depend on the regions and the severity of TB burden, they often develop with insufficient follow-up after the end of treatment and inadequate preventive measures in dispensaries patients. The study of the reasons for the development of relapses makes it possible to timely identify a group of patients who need anti-relapse measures and prolongation of dispensary observation. Conclusion: Thus, the results of this observation revealed the occurrence of relapses within 10 years in 19.3% of cases. A retrospective analysis of the initial forms of the disease showed that relapses of pulmonary tuberculosis occurred more often in patients who had had fibrous-cavernous pulmonary tuberculosis, than in patients who had disseminated pulmonary TB, and less often after suffering infiltrative pulmonary TB. Relapses of the disease occurred more often in men aged 19-44 years. The results obtained indicate the development of relapses of pulmonary tuberculosis has a statistically significant dependence on the form of the initial disease, the presence of RPTCL, comorbid diseases such as HIV, diabetes mellitus, COPD, and the regularity of taking anti-TB drugs. At the same time, it turned out that the social status of all patients with relapses corresponds to the level of poverty, which should also be taken into account.

IoT architecture for continuous long term monitoring: Parkinson’s Disease case study

In recent years, technological advancements and the strengthening of the Internet of Things concepts have led to significant improvements in the technology infrastructures for remote monitoring. This includes telemedicine which is the ensemble of technologies and tools involved in medical services, from consultations, to diagnosis, prescriptions, treatment and patient monitoring, all done remotely via an Internet connection.Developing a telemedicine framework capable of monitoring patients over a continuous long-term monitoring window may encounter various issues related to the battery life of the device or the accuracy of the retrieved data. Moreover, it is crucial to develop an IoT architecture that is adaptable to various scenarios and the ongoing changes of the application scenario under analysis.In this work, we present an IoT architecture for continuous long-term monitoring of patients. Furthermore, as a real scenario case study, we adapt our IoT architecture for Parkinson’s Disease management, building up the PDRMA (Parkinson’s disease remote monitoring architecture). Performance analysis for optimal operation with respect to temperature and daily battery life is conducted. Finally, a multi-parameter app for the continuous monitoring of Parkinson’s patients is presented.

Avascular necrosis as a part of post-COVID syndrome. Case reports

Coronavirus disease 2019 (COVID-19) can manifest with a wide range of extrapulmonary symptoms and have longterm consequences (so-called post-covid syndrome (PCS) or “long COVID-19”). Manifestations of PCS show a wide clinical spectrum and include cardiac, pulmonary, neurological, gastrointestinal, dermatological, mental symptoms, vascular thrombosis and avascular necrosis (AVN) of the bones.We present our own observations of the development of bone’s AVN in 3 patients who underwent COVID-19 with bilateral lung disease, in whom after 4–6 months the first signs of AVN were noted and characterized by a progressive multifocal lesion, which was accompanied by an increase of C-reactive protein concentration.The pathogenetic mechanisms of AVN development in the framework of PCS are discussed. The importance of conservative and surgical methods in the treatment of the disease are considered. Since the development of AVN of various localizations with a long latent period is possible after COVID-19, long-term monitoring of patients is required. Further study of the problem of PCS in general and AVN in particular is required.

Kinesiotaping in cerebral palsy rehabilitation

BACKGROUND: Cerebral palsy is a disease caused by a perinatal lesion of the central nervous system (CNS) characterized by a violation of static and dynamic functions. The combination of speech, motor, and mental disorders indicate the need for a comprehensive approach to disease treatment. Numerous studies have been devoted to functional disorder restoration and orthopedic correction in children with cerebral palsy. Among the publications devoted to the rehabilitation of children with cerebral palsy, there are no works with the leading role of kinesiotaping. This work is related to the need to revise the method application in cerebral palsy, considering the laws of regulatory activity of the CNS and the pathological disease physiology.
 AIM: This study aimed to demonstrate a highly effective approach to kinesiotaping application from the physiology point of view and the laws of pathological regulatory dependence of the CNS in cerebral palsy.
 MATERIALS AND METHODS: We have observed 157 patients diagnosed with: Spastic diplegia (Little's disease), double hemiplegia, hemiparetic form of cerebral palsy, hyperkinetic form of cerebral palsy; atonic-astatic form of cerebral palsy (classification according to K.A. Semenova)". We used a clinical neurological and orthopedic examination with an assessment of motor development according to the scale of ontogenetic development, standard scales and tests for assessing the state of the muscles. Taping courses were conducted as a rehabilitation method.
 RESULTS: The study results revealed numerous improvements in the clinical picture of cerebral palsy in completely different disease forms and the pathology severity. Some regularities of the method application have been developed and formulated at the Department of Rehabilitation, Sports Medicine, and Physical Culture of the Pirogov Russian National Research Medical University (Moscow) since 2011 and its effectiveness has been confirmed by interested specialists in improving the effectiveness of rehabilitation programs for cerebral palsy.
 CONCLUSION: The kinesiotaping technique has a pronounced effect on many acts of physiological activity that are not related to the motor activity of the CNS. The taping method results have a long-lasting effect, fixed by changes in the work of the CNS over a subsequent long period (at least 36 months). From our point of view, teaching kinesiotaping to parents of children with cerebral palsy ensures the continuity of the rehabilitation treatment process, as well as the possibility of long-term dynamic monitoring of patients to assess the effectiveness of the method.

Evaluation and Long-term Monitoring of Patients with MODY, and Description of Novel Mutations

Evaluation and Long-term Monitoring of Patients with MODY, and Description of Novel Mutations

First vs second wave of COVID-19 pandemic in patients with obsessive compulsive disorder: A multicentre report from tertiary clinics in Northern Italy

IntroductionAmong patients with mental illness, those with obsessive compulsive disorder (OCD) showed a significant clinical worsening by the COVID-19 pandemic. The effects of the COVID-19 pandemic on OCD have been shown to worsen symptoms severity, with serious clinical consequences. However, the persistence of COVID-19 pandemic in OCD patients has been poorly investigated. The purpose of the present study was to assess the impact of the second wave of the COVID-19 pandemic in a sample of OCD patients and to compare the results with those obtained during the first wave on the same OCD sample. Methods116 OCD outpatients attending three OCD tertiary clinics in Northern Italy and previously included in a report on the impact of COVID-19, were followed-up in order to investigate sociodemographic and clinical features. Appropriate statistical analyses for categorical and continuous variables were conducted. ResultsThe 43 OCD patients with a clinical worsening (OW) reported a significant development of new obsessions/compulsions and the recurrence of past OC symptoms, higher rates of psychiatric comorbidities and sleep disturbances compared to patients without symptom worsening. Moreover, an increase in avoidance behaviors, suicidal ideation, Internet checking for reassurance, and job difficulties emerged in OW patients. Also, lower rates of pharmacological stability, and higher rates of therapy adjustment were observed. In terms of sex differences, males showed higher rates of past obsessions occurrence, while females showed a rise in Internet checking behaviors. When comparing OW patients between the first and the second wave, the latter showed significantly higher rates of past obsession occurrence and lower rates of pharmacological stability. Moreover, patients with OW showed a significantly older age during the second wave. ConclusionThe persistence of the COVID-19 pandemic showed a globally impaired clinical picture in the analyzed OCD sample. A further worsening between the two waves timepoints emerged, mainly involving older patients with OCD. The concordance between our results and those existing in literature highlights the importance of an accurate long-term monitoring of OCD patients in light of COVID-19 pandemic persistence.

Artificial intelligence augments detection accuracy of cardiac insertable cardiac monitors: Results from a pilot prospective observational study

BackgroundInsertable cardiac monitors (ICMs) are indicated for long-term monitoring of patients with unexplained syncope or who are at risk for cardiac arrhythmias. The volume of ICM-transmitted information may result in long data review times to identify true and clinically relevant arrhythmias.ObjectiveThe purpose of this study was to evaluate whether artificial intelligence (AI) may improve ICM detection accuracy.MethodsWe performed a retrospective analysis of consecutive patients implanted with the Confirm RxTM ICM (Abbott) and followed in a prospective observational study. This device continuously monitors subcutaneous electrocardiograms (SECGs) and transmits to clinicians information about detected arrhythmias and patient-activated symptomatic episodes. All SECGs were classified by expert electrophysiologists and by the WillemTM AI algorithm (IDOVEN).ResultsDuring mean follow-up of 23 months, of 20 ICM patients (mean age 68 ± 12 years; 50% women), 19 had 2261 SECGs recordings associated with cardiac arrhythmia detections or patient symptoms. True arrhythmias occurred in 11 patients: asystoles in 2, bradycardias in 3, ventricular tachycardias in 4, and atrial tachyarrhythmias (atrial tachycardia/atrial fibrillation [AT/AF]) in 10; with 6 patients having >1 arrhythmia type. AI algorithm overall accuracy for arrhythmia classification was 95.4%, with 97.19% sensitivity, 94.52% specificity, 89.74% positive predictive value, and 98.55% negative predictive value. Application of AI would have reduced the number of false-positive results by 98.0% overall: 94.0% for AT/AF, 87.5% for ventricular tachycardia, 99.5% for bradycardia, and 98.8% for asystole.ConclusionApplication of AI to ICM-detected episodes is associated with high classification accuracy and may significantly reduce health care staff workload by triaging ICM data.