Morbid Conditions Research Articles

Trauma, poisoning and envenomation caused by fish in Brazil: a review

Injuries caused by traumatic, poisonous and venomous animal are relatively common in the medical practice of many regions, especially in tropical countries, such as Brazil. These include morbid events caused by a wide variety of fish. Although they are generally of low severity, restricted to local manifestations of the place where the venom/poison comes into contact with the skin or mucosa, these illnesses can evolve to more severe conditions which, in rarer cases, can lead to death. The potential severity in some cases, along with the recent increase in the number of notifications, in different areas of the country, demonstrate the need for a better understanding of these events. Based on these considerations, the present article aims to review the literature on the main characteristics of trauma, poisoning and envenomation by fish in Brazil, with emphasis on the causative animals and on the pathophysiological, clinical and therapeutic aspects of these morbid conditions

Estimation of the Prevalence of Uncorrected Refractive Error and Other Ocular Morbid Conditions in School Children of Industrial Area in a Non-metro City in India

PurposeThis study aims to estimate the prevalence of uncorrected refractive error and ocular morbid conditions in school-going children of the Pimpri Chinchwad Municipal Corporation (PCMC) industrial belt.MethodsOcular examination was done in a well-equipped mobile clinic on school premises in the presence of a school teacher using visual acuity (VA) charts, autorefractometer, retinoscope, and handheld slit lamp. For the age group of 5-6 years, Lea symbols and HOTV charts were used, and for the age group of >7 years, Snellen’s chart was used. A detailed anterior segment examination was done to see lid position, the presence of any lid swelling, conjunctival congestion, conjunctival xerosis, corneal opacity, and lens opacity, and findings of previous eye surgery were noted. Spectacle correction was given to these students if they were found to have a significant refractive error.Children requiring intervention other than refractive correction were referred to a tertiary hospital.ResultsA total of 3,054 school children were examined. Most were between the age group of 11-15 years (2,448 (80.2%)), with a mean age of 12.45 ± 2.022 years; 1,470 (48.1%) were male children. A total of 368 (12.04%) children had uncorrected refractive error. Myopia was seen in 204 (6.68%) children, hypermetropia in 16 (0.52%) children, and astigmatism in 148 (4.85%) children. On classification, simple myopic astigmatism (SMA) was found in 73 (2.39%) children, compound myopic astigmatism (CMA) in 38 (1.24%) children, simple hypermetropic astigmatism (SHA) in 13 (0.34%) children, and compound hypermetropic astigmatism (CHA) in 16 (0.52%) children. Moreover, 121 children had ocular morbid conditions. Ocular morbidity with decreased vision was seen in 52 (1.7%) children with preexisting refractive error and 12 (0.39%) with amblyopia, and strabismus was seen in eight (0.26%) children. Five (0.16%) children had lens disorder, and five (0.16%) had no improvement with glasses despite normal anterior segment.ConclusionThere was a high prevalence of uncorrected refractive error. Early detection of uncorrected refractive error and ocular morbidity will improve overall performance in school-going children.

Lifestyle behaviours predicting major cardiovascular diseases mortality in a practically extinct cohort of middle-aged men followed-up for 61 years

To study lifetime relationships of three major lifestyle behaviours with cardiovascular mortality in a cohort of middle-aged men that reached practical extinction. In the Italian Areas of the Seven Countries Study of Cardiovascular Diseases (SCS), 1712 men were enrolled and examined in 1960, and behavioural habits were measured: smoking habits, physical activity and diet each divided into three classes. Follow-up for mortality was extended for 61 years. Three groups of major cardiovascular diseases (CVD) were used for analysis, coronary heart disease (CHD), STROKE and other Heart Diseases of Uncertain Aetiology (HDUE). Kaplan–Meier curves, death rates in classes of behaviours and Cox proportional hazard models were computed, the last ones adjusted for other major risk factors. In 61 years of follow-up, 1708 men died and 727 were cases of CVD as defined above. Clear separation of classes in Kaplan–Meier survival curves were seen only for physical activity and diet in CHD, and physical activity for STROKE. Cox proportional hazard ratios (HR, adjusted for age, blood pressure and serum cholesterol) showed the significant protective effect on CHD of Mediterranean diet (HR = 0.72), vigorous physical activity (0.55), never smoking (0.73); on STROKE of vigorous physical activity (0.67); on HDUE of never smoking (0.57). Combination of three healthy versus three unhealthy behaviours was associated for CHD to a lower mortality of 39%. This comparison was not coherent for STROKE and HDUE. Lifetime healthy behaviours are clearly beneficial versus CHD mortality but not necessarily for mortality from HDUE and STROKE that probably represent different morbid conditions.

Aqueous Humor Cytokine Response in the Contralateral Eye after First-Eye Cataract Surgery in Patients with Primary Angle-Closure Glaucoma, High Myopia or Type 2 Diabetes Mellitus.

Bilateral sequential cataract surgery within a short period is becoming more prevalent because of the efficiency and safety of modern cataract surgery. It has been reported that the first surgical eye might affect the contralateral eye. This study investigated the cytokines involved in the immunopathogenesis of pre-existing ocular or systemic conditions, as well as the inflammatory biomarkers in response to topical stimuli, by analyzing the cytokine profile of aqueous humor (AH) from cataract patients without these morbidities as control and with type 2 diabetes mellitus (DM), primary angle-closure glaucoma (PACG) or high myopia (HM) in each eye at the beginning of first (defined as baseline) and second eye cataract surgery. Forty patients were recruited in this cohort study (10/group). Bilateral sequential cataract surgeries were conducted at intervals of 12.08 ± 1.2 days. Aqueous humor samples (100-200 μL/eye) were separately collected from 40 first-eyes and 40 second-eyes at the beginning of the cataract surgeries. Twenty-seven selected cytokines were detected with Luminex-multiplex immunoassay. The concentrations of cytokines in the aqueous humor and their association with pre-existing ocular or systemic conditions were analyzed and compared between and within the groups. Before first-eye surgery (baseline), the levels of interleukin (IL)-1ra, IL-13 and tumor necrosis factor (TNF)-alpha were significantly increased in PACG compared with controls. The levels of IL-13 were increased while that of IL-15 were decreased in HM. Compared with controls, 11 cytokines were significantly increased in DM. In the AH of the contralateral eye after first-eye cataract surgery, basic fibroblast growth factor (bFGF) was significantly more abundant in PACG and HM, while the levels of monocyte chemoattractant protein-1 (MCP-1) and interferon gamma-induced protein 10 (IP-10) were decreased in PACG. We also identified 6 significantly upregulated cytokines in DM compared with controls. Compared with baseline, there was an overlap of 5 altered cytokines in the AH of contralateral eyes after first-eye surgery between the four groups. Some were exclusively altered in each subgroup, with 1 in the control group, 4 cytokines in the PACG and HM groups, and none in the DM group. From the initial profile, it is observed that patients with pre-existing ocular or systemic conditions have some degree of inflammation in their eyes before surgery and in the contralateral eye after the first eye cataract surgery, which could be peculiar of the morbid conditions of the patients. Inflammation was more detectable in patients with type 2 DM before surgery. PACG and HM patients showed stronger intraocular inflammatory reactions to topical stimuli compared with controls and DM patients. Our data suggest that ophthalmologists should pay closer attention to inflammatory responses, especially in cataract patients with pre-existing conditions, although the clinical significance of these changes following surgery remains to be further investigated.

A COMPARATIVE STUDY OF STAPLERS VERSUS HAND SEWN ANASTOMOSIS IN INTESTINAL SURGERIES

INTRODUCTION: Intestinal anastomosis is a surgical procedure to establish communication between two separated portions of the intestine. This procedure restores intestinal continuity after removal of a pathological condition affecting the bowel. Intestinal anastomosis can be performed by a hand-sewn technique using absorbable or non-absorbable sutures, mechanical stapling devices. Sutured anastomosis (hand-sewn technique) is the commonly used method. The newer stapling devices for intestinal anastomosis has provided an alternative option to perform rapid anastomosis.1 Various studies have contradictory results in terms of duration of procedure, post operative recovery and anastomotic leak. There are insufcient evidence to demonstrate superiority of either technique and more studies are needed to demonstrate the superiority of either technique. AIM MATERIAL AND METHODS:: To study and compare the effectiveness of staplers vs hand sewn anastomosis in Intestinal surgeries. A comparative observational study Consists of patients presenting with need of bowel resection and anastomosis inclusion criteria at Apollo Hospital Gandhinagar, Gujarat. The patients who are admitted for elective as well as emergency resection & anastomosis of small and large intestines for various illnesses are selected after thorough clinical examination and investigations to conrm the diagnosis co- morbid conditions. Details were recorded in the proforma prepared. : 62.5% complications in comorbid subjects and 37.5% complications in non comorbid subjects.RESULTS The mean of anastomotic time for hand sewn group was 27.8 minutes whereas for the stapler group it was 9.0 minutes mins .With respect to return of bowel sounds, mean time was 46.32 hours in the hand sewn group and 35 hours in the stapler group Mean day of hospitalization was 8.16 days in hand sewn and 7.8 days in stapler technique. mean time taken for resumption of oral feeds the was 66.96 hours in hand sewn group and was 59.52 hours in stapler group .hand sewn group had total ve complications(20%), whereas stapler group had three complications(12%) Both the groups did not have any mortality. The mean cost of hand sewn anastomosis is 717.4 Rs which is signicantly less than mean cost of stapled anastomosis which is 33,754 Rs. : Stapler anastomosis signicantly reduces operative time and time taken for return of normal bowel sounds.CONCLUSION Because of the shortened total operating time in the stapled anastomosis .There is increased risk of overall complications in patients having co- morbidities in both hand sewn and stapled anastomosis. Mechanical staplers are far more costly than suture materials. Stapling technique can be used safely and effectively

Pattern of Self-medication and Associated Factors: A Study in Islamabad, Pakistan

The main objective was to identify the pattern of self-medication (use of medicinal products without prescription) and it’s associated socio-demographic factors (income, geographical area, gender, education level, e.t.c.) A cross-sectional study was carried out on a sample of 40 participants. Multi-stage sampling technique was used and sample was selected from 5 sectors and 5 sub-areas of the city. Univariate analysis was conducted for descriptive statistics. Two bivariate regression models were used. Self-medication and it’s relation to COVID-19 was also analysed. Most common symptoms for which self-medication was practised included headaches and migraines (27.27%) Results were analysed through SPSS version 26. Prevalence of self-medication behaviours in Islamabad was estimated to be 70%. Knowledge, perceptions and attitudes related to self-medication were also analysed. People who reported self-medication behaviours often receive information through internet and social media. Self medication rate is more prevalent in women, persons who are married, and in people with existing co- morbid conditions.

WORKPLACE EXPOSURE MONITORING AND MORBIDITYPATTERN OF WORKERS EMPLOYED IN HIGHWAY TOLL PLAZA

At the toll plaza, vehicle operation, including acceleration and deceleration, emit more pollutants and takes longer to cross the area, with the highest level of pollution being generated during this period. As a result, the workers are exposed to numerous sorts of pollution for an extended periodof time throughout their workday. In the present study, we monitored probable contaminants inside the toll plaza in order to assess the morbidity conditions of these individuals as a result of chronic exposures at the workplace. Personal measurements of particulate matter (PM), total volatile organic carbons (VOCs) and carbon monoxide (CO), and polyaromatic hydrocarbons (PAHs)-particulate phase were considered to determine exposure. The mean work shift dustconcentration of PM2.5 and PM10 readings were within the permissible level of Indian standards (PM2.5 60 μg/m3 and PM10 100 μg/m3) but exceed the WHO recommended guideline (PM2.5 15 μg/m3and PM10 45 μg/m3). The maximum CO concentration was 2.65 ppm, while the lowest was 0.31ppm.Lesser aerodynamic particulate matter of PM1 and PM4 and gases, which were monitored, have norecognised standards. H2S concentrations ranged from 0.06 to 2.00 ppm, while VOC concentrations ranged from 0.08 to 0.41ppm. Total PAHs were found in the range of 2.10-24.81 μg/m3 and Benzo [] Pyrene (BaP) was identified in the range of 2.10-7.60 g μg/m3 in each sample. Headache (66 %), back pain (60.4 %), coughing (54.7 %), hair fall (41.5%), tearing (32.2 %), itching eyes (32.2 %), joint pain (28.3 %), congestion in the nose (17%), sore throat (%), and neck pain (15.1 %) were the mostcommon health problems reported by toll plaza workers.

Effects of Opioid Sparing Analgesia for Surgical Procedure of Laparoscopic Pyloromyotomy in Order to Enhance Recovery and Better Surgical Outcomes

Aim: To determine the analgesic efficacy in early post operative period with out respiratory depression and to determine surgical outcome for patients under laparoscopic pyloromyotomy.
 Methodology: This study was done at Pediatric surgery operating theatre and Post anesthesia care unit (PACU). Peoples University of Medical and Health Sciences for women (PUMHSW) Nawabshah during the period of 2010-2022. Total 103 cases were observed with n=68 male and n=35 females. Ethical approval was obtained from PUMHSW ethical review board and written informed consent was taken from subjects’ parents or guardians. Infants of both sexes with 2-4.5 kg weight, age 3-8 weeks and diagnosed cases of infantile hypertrophic pyloric stenosis (IHPS) patients confirm by ultrasound were included in this study. Patients with the age of more than 2 months, with significant co morbid conditions, required an additional procedure during the operation, and those subjects possess a contraindication to the laparoscopic approach in the opinion of either the surgeon or the anesthesiologist were excluded from this study. Postoperative pain was measured by using the Neonatal Infant Pain Scale (NIPS) at 30,60,90,120 mins after completion of surgery.
 Results: In current study 103 patients were participated with male (n=68) to female (35) ratio 1.94:1 with mean age 34.94±7.31 days. Mean weight of the patients were studied 3.08±0.59 kg. Laparoscopic surgical procedure are less painful and patients can be managed by non opioid analgesic combination of intravenous acetaminophen with local anesthetic infiltration to achieved adequate pain relief and avoidance of delayed recovery, postoperative respiratory depression.
 Conclusion: Laparoscopic pyloromyotomy is safe and effective technique without postoperative respiratory depression and apneic episodes and better surgical outcome especially when opioid sparing multimodal analgesia is given.

A Comparison of 7 Oncology External Control Arm Case Studies: Critiques From Regulatory and Health Technology Assessment Agencies

ObjectivesThe development of accelerated approval programs for high morbidity and unmet need conditions has driven the use of single-arm studies in drug development. Regulatory and health technology assessment (HTA) agencies are recognizing that high-quality external control arms (ECAs), built using real-world data, can reduce uncertainties arising from single-arm studies. This review compared 7 case studies of regulatory and HTA agencies’ evaluations of oncology ECAs. MethodsFood and Drug Administration multidisciplinary reviews for oncology submissions from 2014 to 2021 were screened to identify 7 cases (2 blinatumomab indications, avelumab, and erdafitinib, entrectinib, trastuzumab deruxtecan, and idecabtagene vicleucel) with ECAs to support efficacy claims. Regulatory (Food and Drug Administration, European Medicines Agency, Health Canada) and HTA (pan-Canadian Oncology Drug Review, National Institute for Health and Care Excellence, Federal Joint Committee, Haute Autorité de Santé, and Pharmaceutical Benefits Advisory Committee) submissions for these cases were reviewed. The decision makers’ ECA critiques and the level of influence on the decision were analyzed and categorized. ResultsAcross case studies, selection bias and confounding were the most common ECA critiques. Nevertheless, agreement in critiques between and among regulators and HTA bodies was low. ECA influence on agencies’ decisions also varied. ConclusionsEvaluating the same ECA evidence, agencies focused on methodologic issues (ie, selection bias and confounding), but were often not aligned on their critiques. Further research is needed to fully characterize how agencies evaluate ECAs. This study is a first step in critically evaluating agencies’ critiques of ECAs and highlights the need for future guidance development around ECA design and generation.

Preschool eye screening: A study in South India

To assess the prevalence of ocular disorders and visual disability in preschool children in Southern India and to know if preschool eye screening by ophthalmologist or ophthalmic officer is essential to be made mandatary program. This is apreschool based prospective cross sectional study which was adopted in 47 Anganwadi (preschool), which came under one Taluk in Karnataka Total of 1283 children were screened and examined by ophthalmologist and ophthalmic officer at general hospital, over a period of 2 months. All the children were divided into 2 groups, 0-3yrs and 3-6 years, who underwent a detailed eye examination. Children aged 3-6 yrs were also examined for refractive disorders. The pattern of refractive errors and ocular disorders etc. were studied by cross-sectional descriptive analysis of data and statistical analysis for age and gender. Among 1283 children examined, 757 were 0-3 yrs and 526 were 3-6 yrs, out of which 66 (5.2%) children with ocular disorders were detected. The commonest eye disorder in children of 3-6 yrs group was refractive error 24 (4.6%) commonest being myopia 11(2%). No statistically significant differences in the distribution of ocular disorders by age or gender were detected. Screening of preschool children by an Ophthalmologist or an Ophthalmic officer detects ocular disorders and makes timely intervention possible and also prevents the development of permanent visual disability and thus prevents socioeconomic urden. A large-scale community-based preschool eye screening program in India identifies morbid eye conditions early, that are amenable to cure and prompt rehabilitation.

Prospective observational study of surgical site infections in clean and clean contaminated surgeries in a tertiary care hospital

Introduction: Surgical Site Infections [SSIs] have plagued surgeons since time immemorial. Infection is encountered by all the surgeons; by nature of their craft, they invariably impair the first line of host defences, the cutaneous or the mucosal barrier. The entrance of microbes into the host tissues is the initial requirement for infection. Materials and Methods: This was a prospective observational study conducted at tertiary care teaching hospital over a period of two years from May 2019 to April 2021 with the approval of the hospital ethics committee. Universal sampling was employed for the study duration. List of surgeries was received from operation theatre on daily basis. From this list only clean and clean contaminated surgeries were selected. Data regarding demographic details, type of surgery performed, whether emergency or planned surgery, the duration of surgery, surgical antibiotic prophylaxis given, duration of preoperative stay, presence of co morbid conditions and the duration of post op stay was collected. Results: Total 2382 clean and clean contaminated surgeries were included in the study. Out of these 98 patients developed SSI. The incidence of SSI was 2.05%. There were 1298 (54.50%) male patients, out of which 18 (0.69%) developed SSI.

The impact of a health systems strengthening initiative on child morbidity: The case of the Ghana Essential Health Interventions Program in rural northern Ghana.

BackgroundImproving child and maternal health remains a core objective of global health priorities, extending from the millennium development goal (MDG) era to the current focus on the Sustainable Development Goals (SGDs). This paper analyses the childhood morbidity effects of the Ghana Essential Heath Interventions Program (GEHIP), a community-based health systems strengthening in rural northern Ghana. GEHIP was a five-year embedded implementation science plausibility trial that implemented a set of health systems strengthening strategies and tested the proposition that their combined effect at the district, subdistrict and community levels could foster effective community engagement and thereby improve maternal and child health outcomes.MethodsA two stage random sample survey of reproductive-aged women residing in treatment and comparison districts at the GEHIP baseline and end line was used for Heckman Difference-in-differences (DiD) regression models for estimating the incremental effect of GEHIP exposure on three child morbidity conditions (diarrhea, fever and cough), as recalled by maternal respondents in the course of survey interviews.ResultsAfter controlling for child age and gender, maternal age, education, marital status, health insurance status, religion, ethnicity, occupation and household wealth index, regression results show that GEHIP had a statistically significant 45% reduction in fever (OR = 0.55, CI = 0.31–0.98) and 47% reduction in cough (OR = 0.53, CI = 0.30–0.94), over and above temporal reductions that prevailed in study districts. Although not significant, GEHIP also had 38% reduction in the incidence of diarrhea.ConclusionPrevious research has shown that GEHIP had a pronounced positive effect with a reduction in mortality. Our results show that household location in GEHIP districts also led to a significant reduction in morbidity due to cough and fever among under-five children. This association is a likely outcome of GEHIP’s impact on the accessibility of primary health care services. Results lend further support to the growing body of evidence that strengthening health systems in rural Africa through the provision of community-based strategies enhances prospects for achieving the United Nations child health SDGs.

P360 HYPERTENSION DURING PREGNANCY

Abstract Pregnancy is a physiological condition and a delicate period too; that’s why it’s essential to support the woman. It is important to contact the specialists in Gynecology and rely on other specialists to deal with any morbid conditions that arise during gestation. In this regard, heart disease is the main cause of maternal morbidity and mortality in pregnancy. The surveillance of women with cardio–vascular disease must therefore be guided by the so–called “pregnancy heart team”. In particular, arterial hypertension affects 5 to 10% of pregnant women. The cardiovascular risk is continuously increasing. What are the reasons of this? First of all, the increase of the age of the future mothers. Furthermore, the fact that women, like the general population, are increasingly obese, hypertensive and diabetic. Cardiovascular diseases do not represent an absolute contraindication to pregnancy, except in a few cases, in particular, in severe pulmonary hypertension. However, it is essential to follow the patients according to personalized protocols with close collaboration between gynecologist and cardiologist. Our hospital references for the southern area of the province of Modena; in agreement with our gynecologist we saw the opportunity to collaborate even more closely and start a way dedicated to pregnant women. In 2021, about 30 women between 20 and 40 years old were sent to our attention, with predominantly arterial hypertension or notable symptoms. Patients were referred to us and underwent evaluation. We performed 50% EKG and examination, 50% transthoracic echocardiogram, 60% blood pressure Holter, 10% 24 hour Holter EKG. Seventy percent of the patients came from African race and the remaining from Caucasian. There was also a link with the socio–cultural level of the patients, in most cases they were overweight. In the meantime, hygienic–sanitary therapy and, if not sufficient, medical therapy has always been set up. The drug we preferred was Methyldopa under close monitoring for the comforting data from the technical data sheet on its use. To date, there have been no adverse events or complications reported to us. Further studies are needed to evaluate the effectiveness of interventions to reduce both the risk of recurrence of hypertension in future pregnancies and that of long–term cardiovascular complications.

Jarcho-Levin syndrome in Pakistan: a case report and review of 321 cases on the principles of diagnosis and management

BackgroundJarcho-Levin syndrome (JLS) is a genetic condition that constitutes specific vertebral anomalies combined with coastal or thoracic anomalies due to specific gene mutations. Although the condition is associated typically to Puerto-Ricans, we describe the novel case of JLS in a Pakistani family that presented with respiratory distress secondary to the condition.Case presentationThe case is a full-term girl that had a webbed neck with an undefined chest deformity. Radiology showed kyphoscoliosis and a crablike chest. Early identification of these high morbidity conditions is key to allow for optimal treatment and improved outcomes.ConclusionsWe have provided a brief breakdown of the management principles of the condition and more than 80 years after the first case of Jarcho-Levin syndrome was reported, we present the diagnostic criterion for JLS.

The Use of Artificial Intelligence Algorithms in the Diagnosis of Urinary Tract Infections-A Literature Review.

Urinary tract infections (UTIs) are among the most common infections occurring across all age groups. UTIs are a well-known cause of acute morbidity and chronic medical conditions. The current diagnostic methods of UTIs remain sub-optimal. The development of better diagnostic tools for UTIs is essential for improving treatment and reducing morbidity. Artificial intelligence (AI) is defined as the science of computers where they have the ability to perform tasks commonly associated with intelligent beings. The objective of this study was to analyze current views regarding attempts to apply artificial intelligence techniques in everyday practice, as well as find promising methods to diagnose urinary tract infections in the most efficient ways. We included six research works comparing various AI models to predict UTI. The literature examined here confirms the relevance of AI models in UTI diagnosis, while it has not yet been established which model is preferable for infection prediction in adult patients. AI models achieve a high performance in retrospective studies, but further studies are required.

The Von Willebrand factor-ADAMTS-13 axis: a two-faced Janus in bleeding and thrombosis

Von Willebrand factor (VWF), a blood multimeric protein with a very high molecular weight, plays a crucial role in the primary hemostasis, the physiological process characterized by the adhesion of blood platelets to the injured vessel wall. Hydrodynamic forces are responsible for the VWF multimers conformational transitions from a globular to a stretched linear conformation. These characteristics render this protein a valuable object to be investigated by mechanochemistry, the biophysical chemistry branch that studies the effects of shear forces on protein conformation. This review will focus on the structural elements of the VWF molecule involved in the biochemical response to shear forces. The stretched VWF conformation favors the interaction with the platelet GpIb and at the same time with ADAMTS-13, the zinc-protease that cleaves VWF in the A2 domain, limiting its prothrombotic capacity. It is important to consider the level or the function of VWF or ADAMTS-13 always in relation each other, keeping in mind that in many thrombotic forms of microangiopathies the reduction of the ratio between the ADAMTS-13 activity and the VWF level (lower than 0.5) can be a valuable parameter to predict a real thrombotic risk. Hence, a significant increase in VWF level alone, even without any reduction of ADAMTS-13 concentration, would still be responsible for a significant reduction of the ADAMTS-13/VWF ratio, which ultimately could reflect or predict a prothrombotic risk. Future studies will have to validate the concept whether ADAMTS-13/VWF ratio could a valuable and reliable biomarker to predict or confirm the presence of thrombotic risk in several morbid conditions.

ASSESSMENT OF DEFICIENCY OF NEUROSURGICAL OPERATIONS IN THE PERIOD OF COVID-19 PANDEMIC

Abstract. The proceeding pandemic of COVID-19 makes strong indirect impact on human health, limiting volumes of the planned surgical help to millions of patients worldwide. Is known of influence of a pandemic on volumes of surgical interventions very little. In article the short overview of influence of a pandemic COVID-19 for work of neurosurgical offices in territorial subjects of the Russian Federation is provided. COVID-19 pandemic significantly changed structure of bed fund of the country due to sharp increase in quantity of infectious beds from 57.5 thousand beds in 2015 to 210.1 thousand beds in 2020. Besides, for treatment of patients with COVID-19 in 2020 63.4 thousand specialized beds were in addition developed in 69 territorial subjects of the Russian Federation, most of all in the Moscow region – 8424 beds and in Moscow – 8117 beds. Also, as a part of intensive care units 14408 beds for an intensive care of the patients affected with a new coronavirus infection were allocated. Thus, all 259.1 thousand beds, or 25.1% of total capacities of bed fund of the round-the-clock hospitals of the country, a part of which it was reorientated, were used for treatment of the patients infected with COVID-19 in 2020 in Russia. In 2020 because of a pandemic in Russia the total deficiency of volumes of neurosurgical operations was 23.6 thousand interventions, including 4.1 thousand operations at an injury of the head and 3.2 thousand operations on removal of tumors of a brain which belong to urgent and urgent interventions. The action plan in force majeure is necessary for surgical services for ensuring availability of the surgical help in the current phase of development of a pandemic. The post-pandemic phase will demand recovery of work of surgical services and accumulation of their potential taking into account priority of delivery of health care and the collected unsatisfied need of the population for surgical treatment of diseases of a nervous system and also other morbid conditions.

Opportunities for correction of individual links of the pathogenesis of allergic rhinitis and bronchial asthma with assessment of the quality of life of patients

Introduction. One of the antileukotriene drugs for the treatment of bronchial asthma and allergic rhinitis with and without polyposis is montelukast. The presented article presents the results of the analysis of the effectiveness, safety and impact on the quality of life of patients, the use of the singular, in various forms of allergic rhinitis and associated comorbid conditions.Aim of the study. To assess the impact on the quality of life of patients, the effectiveness and safety of the use of montelukast in the complex therapy of patients with allergic rhinitis and comorbid diseases.Materials and methods.A simple, blind, randomized, controlled clinical trial involved 97 patients divided into 4 groups: patients with moderate allergic rhinitis; allergic rhinitis of moderate severity and bronchial asthma; severe allergic rhinitis and bronchial asthma; severe allergic rhinitis, bronchial asthma and polypous rhinosinusitis. In parallel with the comparison of drug tolerability, safety and clinical symptoms (rhinorrhea, nasal congestion, itching, sneezing, bronchopulmonary manifestations), the quality of life was assessed using a special SNOT-22 questionnaire.Results. The use of the antileukotriene drug montelukast in the complex therapy of allergic rhinitis and related comorbid conditions significantly improved the clinical symptoms and quality of life of patients over the entire period of treatment in all groups. There was an increase in the suppression of leukotriene-mediated effects when using montelukast, more in the group of people with allergic rhinitis and bronchial asthma, such as symptoms of the allergic triad, mucus hypersecretion, bronchospasm, eosinophilia, increased vascular permeability, etc.Conclusion. In the treatment of patients with allergic rhinitis and morbid conditions, Singular has demonstrated an inhibitory effect on cysteinyl leukotrienes, high bioavailability, good tolerability and safety.

Health Condition of Internal Migrants in India: A Review

The surge in the number of internal migrants in India from 315 million in 2001 to 454 million in 2011 indicates that an average of about 14 million people migrate every year. With this ever-increasing rate of migration within the country, the act of providing effective healthcare services to all remains a challenge. Based on a systematic review of literature, the present study assesses the health condition of internal migrants in India, with emphasis on understanding the health status of and health care access to women migrants in their place of destination. Findings from the review delineated several health problems and morbid conditions, such as the threat of infectious diseases, work-related illness, sexually transmitted infections (STI) and psychological disorders. In the case of women migrants, critical health issues associated with pregnancy and maternal health, prevalence of anaemia, risk of STI, spousal abuse and harassment in the workplace were indicated. This review paper identifies lack of social security and health care coverage for the migrants as crucial concerns; and therefore demonstrates the need to have all-inclusive urban health care policies to ensure general health and well-being for migrants, along with better work and living conditions in the destination region.

Exploring clues for wide variations in COVID-19 fatality rates among countries

COVID-19 flu has been the worst pandemic on earth in more than a century and has thus far claimed more than six million lives worldwide. As of 19th March 2022, there were 57 major countries where one million or more COVID-19cases were registered, and the deaths reported therein constituted 92.3% of the total deaths worldwide. The high mortality rate is associated with comorbid conditions of the infected. Obesity, diabetes, cardiovascular diseases, high blood pressure, chronic obstructive pulmonary diseases, tuberculosis, and a higher percentage of the aged population (more than 65y) were identified as major morbidity conditions among others. Mycobacterium sensitized healthy people were found to resist the disease more efficiently. Prior vaccination with human influenza virus vaccines had considerable protective effects against catching or manifesting severity in COVID-19 flu. Timely vaccination with an approved vaccine against SARS-CoV-2 was considered immensely protective from the disease. All countries should therefore adopt policy measures that ensure adequate vaccination among their population.