Case History Research Articles

Analysis of the occurrence of germline mutations BRCA1\2, PALB2, CHEK2, NBN in patients with pancreatic malignancies. Single-center cohort non-randomized retrospective study

Objective. To analyze the frequency of carriage of BRCA1\2, PALB2, CHEK2, NBN mutations in patients with malignant neoplasms of pancreas. Materials and methods. The single-center cohort non-randomized retrospective study is based on the data of 82 patients who were examined and treated in Russian Research Center of Radiology and Surgical Technologies named after academician A.M. Granov from 2020 to 2022. Patients with confirmed ductal adenocarcinoma of pancreas were included into the study group. Screening of mutations in exons 2,10, 18, 19 of BRCA1 gene and exon 11 of BRCA2 gene was performed in these patients. In addition, oncological family histories were studied. Results. Analysis of medical documentation data showed that 18 (22 %) patients with pancreatic cancer had a hereditary oncological history. In this cohort of patients, 5 (28 %) had relatives with pancreatic cancer, 9 (50 %) had a family history of ovarian cancer, 2 (11 %) female relatives of patients in the study group were diagnosed with breast cancer before the age of 50, also 2 (11 %) patients had a history of more than 2 relatives who suffered from breast cancer and / or prostate cancer. When evaluating the results of revealing the mutations in the entire study group (82 patients), BRCA1 (c.5266dupC) was revealed in 8 patients (9.7 %), PALB-2 (c.1592delT) – in 2 patients (2.4 %), mutations CHEK2, NBN and BRCA2 were not diagnosed in any patient. 5 (6 %) patients who were BRCA1 mutation carriers and one patient with an established PALB2 mutation, according to the analysis of case histories, had no oncological history. None of the patients in the study group was a carrier of the BRCA2, CHEK2 and NBN mutations. Conclusions. Some patients with pancreatic cancer are carriers of germline mutations. Considering our data on the trend of association between germline mutations and pancreatic cancer, we can make an assumption about the prospect of using this indicator as one of the markers for early detection of pancreatic cancer not only in patients with hereditary risk factors for neoplasia, but also in patients without cancer anamnesis. To obtain the results, further observation of patients in the study group and randomized multicenter studies are required.

Cerebral venous thrombosis and deep medullary vein thrombosis: Padua experience over the last two decades.

Cerebral venous thrombosis (CVT) is a cerebrovascular disorder that accounts for 20% of perinatal strokes. CVT incidence ranges from 0.67 to 1.12 per 100,000 newborns, while the incidence of "deep medullary vein thrombosis" (DMVT), a subtype of CVT, cannot be accurately estimated. This study aims to analyze the case history of CVT in the neonatal period, with a specific focus on DMVT. Newborns diagnosed with CVT, with or without DMVT, between January 2002 and April 2023, were collected using the Italian Registry of Infantile Thrombosis (RITI). Cerebral MRIs were reviewed by an expert neuroradiologist following a standardized protocol. Forty-two newborns with CVT were identified, of which 27/42 (64%) had CVT, and the remaining 15/42 (36%) had DMVT (isolated DMVT in 9/15). Symptom onset occurred in the first week of life (median 8days, IQR 4-14) with a male prevalence of 59%. The most common risk factors for CVT were complicated delivery (38%), prematurity (40%), congenital heart diseases (48%), and infections (40%). Seizures were the predominant presenting symptom in 52% of all cases. Hemorrhagic infarction was higher in cases with isolated DMVT (77%) compared to patients with CVT without DMVT (p = 0.013). Antithrombotic treatment was initiated in 36% of patients. Neurological impairment was observed in 48% of cases at discharge, while 18 out of 31 infants (58%) presented one or more neurological deficits at long term follow up. Conclusion:DMVT occurs in over a third of neonates with CVT. Multicentric studies are essential to establish standardized protocols for therapy, neuroimaging, and follow-up in these patients.

Healthy Placemaking in the Public Space in Sana'a City: A Case Study (The Main Square of Qaa Al-Olfi)

The public space with its components (streets and public parks) occupied an important place in the history of urban design and community health, as they are the determinants and resilient elements of health within cities. Modern concepts and design methods have been developed in response to urban health pandemics, including the creation of a healthy placemaking that achieves the health of the population within the urban context; Due to the lack of applications by principles healthy placemaking in streets and public parks in Sanaa, it has negatively impacted the daily health activities of residents, The research problem is that Sanaa's streets and public parks do not have any urban design to promote the health of Yemenis in the face of the pandemics; he study object is to create guided design models for the streets and public park in the study area, which simulate the applications of healthy placemaking to help planners provide solutions to face the spread of diseases and pandemics in urban areas, The importance of this research comes in the form of the first Yemeni urban study that deals exclusively with the issue of healthy placemaking in the streets and public parks during of urban health pandemics. The research followed the descriptive inductive approach in studying the theoretical concepts and the practical approach in creating design models the applications of the health placemaking during health pandemics on the study area.

Objects of the Mind: using film to explore the entangled histories of media and mental health

This article presents the findings of an Arts and Humanities Research Council (AHRC) project, Objects of the Mind: engaging publics in the material cultures of media and mental health (AH/W002140/1), which was co-investigated by academics at the University of East Anglia and the University of Manchester and curators from across the Science Museum Group (SMG). Through this co-investigation we sought to tap into public interest in the SMG object collections and the accessibility of popular films (supplied by partners StudioCanal) to engage new audiences for our research on the interactions of psychiatry and cinema. From the museum perspective, we sought to use this research to ask new questions and tell new stories about the SMG objects, and to foster cross-collection dialogue between medicine (Science Museum) and media (National Science and Media Museum) collections. We discuss a range of events, activities and outputs we delivered towards these aims, but focus particularly on three new films we produced that (re)combined museum objects, feature film clips and expert interviews to tell new, enhanced or entangled stories about and across the collections. We will use these three short films to demonstrate three dialogues the project fostered: between museum collections; between histories; and between academic disciplines.

Changes in Emergency Department Utilization in Vulnerable Populations After COVID-19 Shelter-in-Place Orders.

This study aims to compare emergency department (ED) utilization and admission rates for patients with a history of mental health (MH) disorders, substance use disorders (SUDs), and social determinants of health (SDOH) before and after implementing COVID-19shelter-in-place (SIP) orders. This was a retrospective, multicenter study leveraging electronic medical record (EMR) data from 20 EDs across a large Midwest integrated healthcare system from 5/2/2019 to 12/31/2019 (pre-SIP) and from 5/2/2020 to 12/31/2020 (post-SIP). Diagnoses were documented in the patient's medical records. Poisson and logistic regression models were used to evaluate ED utilization and admission rate changes. A total of 871,020 ED encounters from 487,028 unique patients were captured. Overall, 2,572 (0.53%) patients had a documented Z code for SDOH. Patients with previously diagnosed MH disorders or SUDs were more likely to seek ED care after the SIP orders were implemented (risk ratio (RR): 1.20, 95% confidence interval (CI): 1.18-1.22, p<0.001), as were patients with SDOH (RR: 2.37, 95% CI: 2.19-2.55, p<0.001). Patients with both previously diagnosed MHdisorders or SUDs and a documented SDOH had even higher ED utilization (RR: 3.31, 95% CI: 2.83-3.88, p<0.001) than those with either condition alone. Patients with MHdisorders and SUDs (OR: 0.89, 95% CI: 0.86-0.92, p<0.001) or SDOH (OR: 0.67, 95% CI: 0.54-0.83, p<0.001) were less likely to be admitted post-SIP orders, while patients with a history of diseases of physiologic systems were more likely to be admitted. Vulnerable populations with a history of MH disorders,SUDs, and SDOH experienced increased ED utilization but a lower rate of hospital admissions after the implementation of SIP orders. The findings highlight the importance of addressing these needs to mitigate the impact of public health crises on these populations.

DYNAMICS OF CORONAVIRUS INFECTION COVID-19 AND SOCIAL CHARACTERISTICS OF PATIENTS WITH TUBERCULOSIS AND HIV-ASSOCIATED TUBERCULOSIS

The aim of the research. Assessment of the influence of social factors on the course and outcome of a new coronavirus infection COVID-19 in patients with tuberculosis and HIV-associated tuberculosis.Materials and methods. A retrospective analysis of 103 case histories of patients in 2 study groups: HIVassociated TB/COVID-19 (n=45) and TB/COVID-19 (n=58) is presented.Results. The mean age of patients with a combination of HIV-associated tuberculosis and COVID-19 infection (42,8 ± 7,2 years) is significantly lower than patients with tuberculosis and COVID-19 infection (51,3 ± 13 years). Bad habits, including drug addiction (62,2% and 3,4% in the groups, respectively) and alcoholism (93,3% and 67,2% in the groups, respectively) were associated with HIV infection. Hepatitis C (77,8% and 15,5% in the groups, respectively), refusal of further inpatient treatment (84,4% and 25,9% in the groups, respectively), stay in correctional labor institutions (ITU) (53,3% and 27,6% in the groups, respectively) were significantly more common in HIV-infected patients. Such social factors as disability, lack of work, place of residence, degree of education, living with or without relatives, marital status, housing characteristics did not affect the dynamics and outcome of the disease in general. The form and phase of the course of tuberculosis were associated with HIV infection. Type 2 diabetes mellitus was associated with the absence of HIV infection (0% and 17.2% in the groups, respectively). The severity of the course of COVID-19, the outcome of the disease at the end of inpatient treatment did not depend on the presence of HIV infection.Conclusion. No direct relationship between HIV infection and social factors associated with it with the severity of tuberculosis and the new coronavirus infection COVID-19 has been established.

New light on an old syndrome: Role of Api g 7 in mugwort pollen–related celery allergy

BackgroundCelery root is known to cause severe allergic reactions in patients sensitized to mugwort pollen. ObjectiveTo study clinically well-characterized patients with celery allergy by IgE testing with a comprehensive panel of celery allergens to disentangle the molecular basis of the “celery-mugwort-syndrome”. MethodsPatients with suspected food allergy to celery underwent a standardized interview. Main inclusion criteria were a positive food challenge with celery or an unambiguous case history of severe anaphylaxis. IgE to celery allergens (rApi g 1.01, rApi g 1.02, rApi g 2, rApi g 4, nApi g 5, rApi g 6, rApi g 7), and to mugwort allergens (rArt v 1, rArt v 3, rArt v 4) were determined by ImmunoCAP. IgE levels ≥ 0.35kUA/L were regarded positive. ResultsSeventy-nine patients with allergy to celery were included. Thirty patients suffered from mild oral or rhino-conjunctival symptoms and 49 from systemic reactions. Sixty-eight % had IgE to celery extract, 80% to birch pollen and 77% to mugwort pollen. A combination of Api g 1.01, 1.02, 4, 5, and 7 increased diagnostic sensitivity for celery allergy to 92%. The LTPs Api g 2 and Api g 6 were not relevant in our celery allergic population. IgE to Api g 7, detected in 52% of patients, correlated closely (r=0.86) to Art v 1 from mugwort pollen. Eleven out of 12 patients with monosensitization to Api g 7 were IgE negative to celery extract. The odds ratio for developing a severe anaphylactic reaction rather than only mild oral symptoms was about 6 times greater (odds ratio 5.87; 95% CI 1.08-32.0, p=0.0410) for Api g 7 sensitized versus Api g 7 non-sensitized subjects. ConclusionThere is an urgent need for routine diagnostic tests to assess sensitization to Api g 7 not only to increase test sensitivity, but also to identify celery allergic patients at risk of a severe allergic reaction to celery.

Sir William Osler (1849-1919) and neurology in his time.

Sir William Osler, physician in Montreal, in Pennsylvania, at Johns Hopkins and in England, promoted clinical medicine and its interpretation through clinical and pathological observation. He was a keen bibliophile and medical historian. He taught at the bedside and wrote a textbook that was a standard work in his time and for several decades after he died. As a generalist he practised the emerging speciality of neurology and knew many of the early clinicians in that field. The neurology of his time and his contributions to the subject are explored here.

THE CHALLENGING SCENARIO OF DYSPNEA IN THE ELDERLY: DUE MORE TO CONGESTION OR INFLAMMATION?

Abstract Introduction Elderly patients hospitalized due to acute heart failure often have a concomitant acute lung disease. Establishing the role of each disease in a clinical picture of acute cardiopulmonary syndrome can be challenging. A common thread of these diseases is inflammation; a hyperinflammatory response determines more serious symptoms and a worse prognosis. Purpose We evaluated the effectiveness of a treatment with dexamethasone in patients with acute cardiopulmonary syndrome and strong inflammatory response. Materials and Methods We evaluated 302 consecutive HFPEF (heart failure with preserved ejection fraction) patients ≥80 years of age, with concomitant symptoms attributable to acute bronchitis, pneumonia, or COPD exacerbation, hospitalized due to worsening dyspnoea, with an NT–proBNP ≥3,000 pg/ml, and a finding X–ray of lung congestion with or without a consolidation. Reactive C Protein (CRP) was measured. Patients with SARS–CoV–2, indication to corticosteroids for other clinical conditions or need for mechanical ventilation were excluded. The 112 patients with CRP&amp;gt;20 mg/dl were randomized into 2 groups: 56 patients were treated open–label with dexamethasone at a dose of 8 mg iv/day for a maximun of ten days, in addition to the usual therapies, while the same number of patients were treated with the usual therapy. In both groups antibiotics were administered based on procalcitonin guided protocl. Clinical recovery time, length of hospitalization, in–hospital mortality, need for a new hospitalization and mortality at one month were evaluated. Results The mean age of patients was 89±5 years in the dexamethasone group and 88±5 in the usual therapy group. The results are shown in Table 1. Patients treated with dexamethasone experienced a faster clinical recovery and a shorter length of hospitalization. No significant differences were found regarding either in–hospital mortality or need for rehospitalization and mortality at 30 days. Notably, PCT guided treatment led to an average reduction in duration of antibiotic therapy from 8 to 5 days. Conclusions Very elderly patients with acute cardiopulmonary syndrome and hyperinflammatory state have a favorable response to dexamethasone therapy added to the usual therapy in terms of clinical improvement and length of hospitalization. Our case history is small to evaluate a possible improvement in mortality. These findings need to be consolidated from double–blind randomized controlled trials.

Thrivers and Survivors during Study Abroad: The Individual Cases of Japanese Learners of English

Whilst study abroad (SA) periods hold much promise for foreign language development, increasing research suggests sojourners’ experiences are unique, and language development does not always follow a linear trajectory. For some learners, SA has little impact on their language performance despite the affordances of L2 immersion (the Survivors). Other learners maximise the potential of SA, and this has a positive impact on their language development (the Thrivers). This paper examines the selected cases of four Japanese learners of English and their request language performance during a 10-month SA in the UK. Changes in pragmatic knowledge (based on appropriateness ratings) were documented at three equidistant time points. Language contact profile data also provided quantitative insights into the learners’ extracurricular language use and qualitative personal reflections. The selected cases illustrate two learners surviving the SA experience, showing minimal change in their request performance. The other two learners thrived during SA, showing accelerated performance in terms of lexical variation at the production level. This paper reports on the case histories of these learners to better understand these unique experiences and pragmatic discrepancies. Suggestions for how learners might be more pragmatically successful during SA are also offered.

Retrospective evaluation of the effectiveness and safety of UVB-311 in atopic dermatitis

BACKGROUND: Atopic dermatitis is a widespread skin disease based on immune and genetic mechanisms of chronic inflammation formation. The disease most often develops in early childhood, has a frequent recurrent course, age-related clinical features. In this regard, the disease is characterized by a wide variety of treatment methods, the effectiveness of which varies and is a highly debated topic at the present time. AIM: to retrospectively evaluate the efficacy and safety of standard local and systemic therapy of atopic dermatitis in combination with UVB 311 nm. MATERIALS AND METHODS: 100 case histories of patients with atopic dermatitis of varying severity who were in the clinic of skin and venereal diseases in the period from 2022 to 2023 were analyzed. Of these, 50 patients received combined systemic and topical therapy with UVB 311 nm (the first group), and 50 patients received only standard topical and systemic therapy (the second group). Systemic and topical therapy of atopic dermatitis included, according to clinical recommendations, corticosteroids, calcineurin inhibitors, antihistamines. RESULTS: As a result of combined therapy with UVB 311 nm, patients showed a decrease in the SCORAD index by 1.7 times after 1 month of therapy, by 8 times after 2 months, and by 30 times after 6 months. In the second group, the SCORAD index decreased 1.2 times after 1 month from the start of therapy (p=0.0004), 3 times after 2 months (p=0.0001), 20 times after 6 months (p=0.003). Side effects in the first group were detected only in 5 (10%) patients: 2 (4%) patients had skin burning, 2 (4%) had skin itching, 1 (2%) patient had photodermatitis in the form of erythema of the skin. These adverse reactions were of a short-term nature and quickly passed if the recommendations were followed without canceling the procedures. CONCLUSION: UVB 311 nm therapy for atopic dermatitis has a higher therapeutic effect, is well tolerated, has minimal early side effects, and leads to clinical remission faster than standard systemic and local therapy.

Implementation of Internet of Things for Condition-Based Maintenance in Elevator Systems: An Analytical Case Study

The aim of this paper is to show how IOT technology can allow highly distributed elevator equipment servicing by using remote-monitoring technology to ease a move from tradi- tional corrective maintenance (CM) and time-based maintenance (TBM) to more prophetic, condition-based maintenance (CBM) in evidence to accomplish different advantages.The Literature review can indicate that CBM has merit over conventional CM and TBM from a theoretical outlook, but it turns on constant monitoring enhancement via advanced IOT technology. A detailed case history was implement to bring practical proof that IOT allows elevator adamant to attain CBM.Through, a theoretical context, the CBM of elevators put together exper- tise.The venture lies in data collection, data analysis and decision making in real-world context of business. The key outcome of this research recommends that in the case of elevators the IOT can be commercialized and would improve the welfare and accuracy of equipment. It might, so, be understandable from technological, process and economic aspect. Our long term physical world case study reveal an actual way of building the CBM of elevators worldwide. Incorporating Internet of things and other modern technology will improve the safety and authenticity of elevator equipment,longer service life, minimize disruption or difficulty and business interference as a result of equipment downtime and to eliminate major repairs, thus result in low maintenance cost. A key contribution in this study stand in the empiric confirmation of the advantages and difficulties of CBM through Internet of things comparative to conventional CM and TBM in the instance of elevators. The writer had faith that this study is well timed and will be worth to company working on the same research or business strategies.These are form on condition based maintenance, IOT, Time-based maintenance and Corrective maintenance.

Geotechnical correlation field-informed and data-driven prediction of spatially varying geotechnical properties

Geotechnical measurements are often limited, leading to the use of interpolation techniques for interpreting spatial variations in geotechnical properties from sparse geo-data. Traditional geostatistical methods suffer from significant computational complexity. On the other hand, data-driven approaches often lack integration with geotechnical domain knowledge, potentially oversimplifying or complicating predictions related to the spatial variability of geotechnical properties. This study introduces a novel framework that combines geotechnical knowledge with data-driven methods to model inherent soil spatial variability incorporating Geotechnical Correlation Field (GCF) that reflects domain knowledge. The GCF, influenced by Autocorrelation Function (ACF) types and Scale of Fluctuation (SOF), provides a flexible basis for accurately representing spatially varying geotechnical properties. Using a large synthetic database comprising known ACF types and SOFs, we constructed a series of specialized neural networks. These networks identify random field parameters at different sites based on sparse data, and the estimated parameters can be directly used to calculate GCFs for a given site. The performance of the proposed method is validated using a set of synthetic data and a real case history in New Zealand. The results demonstrate the model can accurately predict random field parameters for irregularly spaced geo-data, even with limited information. Significantly, the GCFs offer improved physical interpretations and enhance the performance of subsurface modeling. The computational complexity of this method is independent of the number of soil cells, making it highly efficient and scalable.

Liquefaction ground deformations and cascading coastal flood hazard in the 2023 Kahramanmaraş earthquake sequence

The 2023 Kahramanmaraş earthquake sequence produced extensive liquefaction-induced ground deformations and ongoing flooding along the shoreline of the Mediterranean port city of İskenderun, Türkiye. This study compiles field observations and analyses from cross-disciplinary perspectives to investigate whether earthquake-induced liquefaction was a significant factor for increasing the flood hazard in İskenderun. Geotechnical reconnaissance observations following the earthquakes included seaward lateral spreading, settlement beneath buildings, and failures of coastal infrastructure. Three presented lateral spreading case histories indicate consistent ground deformation patterns with areas of reclaimed land. Persistent scatterer interferometry (PSI) measurements from synthetic aperture radar (SAR) imagery identify a noticeably greater rate of pre- and post-earthquake subsidence within the İskenderun coastal and urban areas relative to the surrounding regions. The PSI measurements also indicate subsidence rates accelerated following the earthquakes and were typically highest near the observed liquefaction manifestations. These evaluations suggest that while the liquefaction of coastal reclaimed fill caused significant ground deformations in the shoreline area, ongoing subsidence of İskenderun and other factors likely also exacerbated the flood hazard. Insights from this work suggest the importance of evaluating multi-hazard liquefaction and flood consequences for enhancing the resilience of coastal cities.

Liquefaction at two petrochemical facilities during the February 6, 2023, Kahramanmaras-Turkiye earthquake sequence

Two petrochemical facilities, located in the Dortyol district of Hatay metropolitan city along the Mediterranean coastline in Turkiye were shaken by the February 6, 2023, M7.8 Pazarcik and M7.6 Ekinözü-Elbistan earthquakes in Kahramanmaraş. This study investigates their seismic performances from a seismic soil liquefaction engineering perspective, addressing several key aspects: the i) identification of surface manifestations of seismic soil liquefaction, including soil ejecta, ground deformations, and displacements, ii) examination of subsurface soil characteristics, iii) evaluations of soil liquefaction susceptibility and triggering, iv) analyses of post-liquefaction ground settlements, lateral deformations, and displacements, and v) comparisons of these observed outcomes with predicted results. The assessment results indicated that liquefaction triggering evaluations, based on the SPT- and CPT-based semi-empirical methods of Cetin et al. (2018) and Moss et al. (2006), respectively, were consistent with observed field manifestations of liquefaction or their absence. However, estimated settlements obtained from the liquefaction-induced volumetric settlement procedures of Tokimatsu and Seed (1984), Shamoto et al. (1998) and Cetin et al. (2009), underestimated field settlements. This underestimation was partially explained by the additional contribution of lateral spreading deformations to field settlements, which were not considered due to one-dimensional nature of these volumetric settlement assessments. Additionally, semi-empirical correlations of Hamada et al. (1986) and Youd et al. (2002) consistently overestimated observed lateral displacements. The discrepancies in settlement and lateral spreading displacements are believed to stem from the presence of liquefaction susceptible fine-grained and/or gravelly units, which may have higher residual shear strengths and/or produce higher volumetric strains than typical clean sand layers in case history sites used for developing these semi-empirical methods. The documented field performances and assessment results are hoped to contribute to further developing and refining/calibrating increasingly accurate and reliable empirical and/or analytical methods for assessing hazards related to liquefaction triggering, and liquefaction-induced ground deformations and displacements.

Dynamic stress analysis of rock joints under railway loading

The proper estimation of stresses generated by the passage of a train is fundamentally important to the serviceability and longevity of railways, and yet very limited knowledge is available where the track substructure is built on a jointed rock mass. The present study introduces an analytical solution for estimating the ground stresses arising from moving wheel loads, causing a change in the three-dimensional stress state in the track formation, in relation to the stress variation with depth and along the longitudinal track section – that is, the direction of train passage. Based on 21 case histories, an array of field measurements and numerical simulations covering a wide range of freight tonnage, train speeds and different formation conditions were considered to validate the proposed analytical solution. The proposed methodology (analytical solution) was then applied to a jointed rock subgrade to determine the normal and shear stresses acting along a specific discontinuity plane. The main analytical outcome demonstrates that the orthogonal vertical and shear stresses present different and phase-shifted history plots for homogeneous ground conditions with principal stresses rotation. However, conversely for a jointed subgrade, the normal and shear stresses along the discontinuity have the same history plot pattern and are in phase. As a practical guide, the results from this study would help to define which cyclic loads should be applied in laboratory tests to simulate realistic traffic patterns of trains travelling over a jointed rock subgrade.

СОВРЕМЕННАЯ ТАКТИКА ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ БОЛЬНЫХ С ВАРИКОЗНОЙ БОЛЕЗНЬЮ НИЖНИХ КОНЕЧНОСТЕЙ

Varicose veins are a very popular disease. It is observed in 10–15% of men and 20–35% of women and is often accompanied by long-term incapacity and subsequent disability of the patient. That’s why it’s not surprising that endovenosus laser ablation therapy (EVLT) is replacing surgery as the main treatment for varicose veins. Currently, laser radiation with wavelengths in the λ range from 0.45 to 2 is used for EVLT. A positive treatment result was achieved at all wavelengths that were used. The resulting differences in clinical applications in terms of pain levels, complications, and postoperative healing were rates largely subjective, leading to controversy regarding the choice of the most effective method. This was facilitated by the evolution of interpretations of the processes occurring during EVLT, which, from the authors’ point of view, is useful for their understanding. Endovasal methods have been proven to be cost-effective and safe and can be performed under local anesthesia on an outpatient basis. To date, this technique has become quite widespread in vascular surgery. This paper provides a review of the literature on the prevalence and pathophysiology of varicose veins of the lower extremities, the achievements of endovasal methods of treating varicose veins of the lower extremities, and studied modern methods of surgical correction of varicose veins. We analyzed and described the main issues related to endovenous techniques for obliterating varicose veins. Conducted on 20 case histories of patients with venous insufficiency of the lower extremities, operated on at the CHU “KB “RZD-Medicine” named after. N.A. Semashko” comparative analysis of modern surgical methods for the treatment of varicose veins of the lower extremities. The operation was performed on one lower limb in 18 patients, and on two lower limbs in 2 people. All patients underwent endovasal laser coagulation (EVLC) in combination with miniphlebectomy. The disadvantages and advantages of the modern surgical method of treating venous insufficiency of the lower extremities (EVL) have been identified.

What predicts response to sertraline for people with depression in primary care? a secondary data analysis of moderators in the PANDA trial.

Antidepressants are a first-line treatment for depression, yet many patients do not respond. There is a need to understand which patients have greater treatment response but there is little research on patient characteristics that moderate the effectiveness of antidepressants. This study examined potential moderators of response to antidepressant treatment. The PANDA trial investigated the clinical effectiveness of sertraline (n = 326) compared with placebo (n = 329) in primary care patients with depressive symptoms. We investigated 11 potential moderators of treatment effect (age, employment, suicidal ideation, marital status, financial difficulty, education, social support, family history of depression, life events, health and past antidepressant use). Using multiple linear regression, we investigated the appropriate interaction term for each of these potential moderators with treatment as allocated. Family history of depression was the only variable with weak evidence of effect modification (p-value for interaction = 0.048), such that those with no family history of depression may have greater benefit from antidepressant treatment. We found no evidence of effect modification (p-value for interactions≥0.29) by any of the other ten variables. Evidence for treatment moderators was extremely limited, supporting an approach of continuing discuss antidepressant treatment with all patients presenting with moderate to severe depressive symptoms.

Exploring Risk Factors for Adverse Reactions in Children with an Acute Psychotic Episode Using the Global Trigger Tool: Does Age Matter?

Aim: To establish significant risk factors for the development of adverse drug effects (ADEs) in children and adolescents with an acute psychotic episode taking antipsychotics. Materials and Methods: The research team randomly selected 15 patient records each month for 3 years (2016-2018). Overall, 450 patient records were included (223 boys and 227 girls, mean age was 14.52 ± 2.21 years). Adverse effects were identified using the standard algorithm of the Global Trigger Tool method. A "trigger" is an indication that an adverse reaction is likely to occur, e.g., an antihistamine prescription on a prescribing list. When a trigger was detected, the case history was studied in further detail to confirm the occurrence of ADEs. We divided patients into two groups: the "children" group (under 12 years old) and the "adolescents" group (13 years and older). Data were analyzed using the statistical package IBM SPSS Statistics 23.0. Results: Of the 450 patient records, 402 (89.3%) had at least one trigger detected. In total, 126 case histories contained evidence of ADE (28%). The total number of ADEs per 1000 patient days was 5.39 and the number of ADEs per 100 admissions was 32.0. Among adolescents, two or more triggers per patient were significantly more frequently identified (61.3% vs. 44.6%; p = 0.001). ADEs were rare in "Children" compared with "Adolescents" (13.8% vs. 30.4%; p = 0.006). The logistic regression analysis confirmed high predictive role of "Adolescence" (odds ratio [OR] = 2.58; 95% confidence interval [CI] 1.22-5.4; p = 0.013), "Polypharmacy" (OR = 1.96; 95% CI 1.23-3.1; p = 0.004), and "First-life hospitalization" (OR = 2.17; 95% CI 1.34-3.48; p = 0.001) for ADE fact in patient records. Conclusion: We found that significant risk factors for ADEs to antipsychotics in patients with acute psychotic episode were adolescence (13 years and older), polypharmacy, and first-life hospitalization. The fact that children (i.e., younger than 13 years of age) are less likely to experience ADEs was not associated with high-risk drugs or higher doses in our study.

Ulcerative stomatitis associated with yellow bristle grass in New Zealand dairy cows

ABSTRACT Case history A line of 25 cull cows were all found to have ulcerative lesions of the tongue at post-mortem inspection in a New Zealand slaughter plant. A further 9 of 10 cows inspected at the farm of origin had similar oral lesions. There were no other clinical signs or indicators of ill-health observed at ante-mortem inspection in the abattoir or on the farm. The cows had been fed baleage for 3 weeks prior to slaughter, made from pasture in paddocks heavily contaminated with yellow bristle grass (Setaria pumila). Clinical findings There was extensive and deep transverse linear ulceration in the lingual fossa immediately rostral to the torus linguae. At histological examination, full-thickness ulceration of the stratified squamous epithelium was observed with a bed of disorganised collagenous tissue and extensive mixed inflammatory infiltrate extending into the sub-epithelial connective tissue and skeletal muscle. Barbed plant fragments were embedded in both the superficial and deeper areas of inflammation. Detailed examination of the baleage also found that yellow bristle grass seedheads were present. Diagnosis Based on the presence of barbed plant material in the tongue and yellow bristle grass seeds in the baleage, a diagnosis of ulcerative stomatitis associated with yellow bristle grass was made. Clinical relevance Clinicians should be aware of the potential for hay or baleage contaminated with yellow bristle grass to cause oral lesions in cattle.