Morbidity In Population Research Articles

Precision Medicine for COVID-19 Based on the Inflammatory Response

Background The threat due to the global pandemic of the coronavirus disease 2019 (COVID-19) demands a search for effective treatments to combat the severity of the infections and their associated morbidity and mortality in vulnerable populations. One of the medications with putative antiviral, anti-inflammatory, and immunomodulatory effects is fluvoxamine, a selective serotonin reuptake inhibitor and σ-1 receptor agonist. A few studies have reported doses of 100–300 mg/day to be effective. Aim This retrospective study evaluates the outcomes of an individually tailored dosing strategy for fluvoxamine, based on measurements of inflammatory status, in treating COVID-19-positive individuals in India. Methods This study included patients with severe acute respiratory syndrome coronavirus 2 infection visiting the outpatient department of a super speciality hospital in India from February to July 2021. Fluvoxamine was initiated at 50 mg or 100 mg twice daily based on their individual C-reactive protein (CRP) and D-dimer status. By day five, patients with rising or static levels of CRP and D-dimer were up-titrated. Results In a population of 104 individuals infected with COVID-19, 10 required up-titration of dose, and 94 patients did not need up-titration. Overall, there was very low mortality (N = 1) and hospitalization rate (8.7%). Those individuals who required an up-titration on day five had significantly elevated CRP and D-dimer levels compared to those who were maintained at the initial dose of 50 mg twice daily. In such patients, up-titration of the dose on day 5 appeared to offer better treatment benefits and outcomes. In our study population, there was only one mortality during the course of COVID-19. Conclusions Given the individual variability in the host immune response to severe acute respiratory syndrome coronavirus 2 infection, tailoring the dose of a drug such as fluvoxamine based on the inflammatory status of the individual may be beneficial. Individually tailored dosing could combat disease progression while reducing side effects.

Epidemiology of Paediatric Fractures at Koshi Hospital, A Tertiary Center in Eastern Nepal

Introduction: Paediatric trauma is a leading cause of disability, hospitalization and may lead to mortality in pediatric population. Incidence and nature of fracture varies according to region, culture, seasonal variations and age. Children are more prone to have injury at play grounds, due to fall from height and also due to road traffic accident due to unmanaged traffic and lack of road safety measures. Identification of specific high-risk injury patterns may lead to improved care and outcome. This study aims to find out the epidemiological profile of paediatric injuries presenting to a tertiary care hospital in eastern Nepal. Objective: To study the common fractures and their management in the paediatric age group at Koshi hospital. Methodology: This was a hospital based retrospective cross-sectional study done among 424 paediatric patients at Koshi hospital from January 2021 to December 2021.Ethical clearance was taken from Nepal health research council . Data collection was done from the outpatient (OPD), emergency and the operation room records and was compiled in Microsoft excel 2007. Results: A total of 424 paediatric fractures were taken into study over the duration of one year. Out of which 288 were male (67.92%) and 136(32.08%) were female. Playground injuries were the most common cause of paediatric fractures (49.76%) followed by fall from height (27.35%) and road traffic accident (12.26%). Distal radius and ulna fracture was found to be most common (30.89%). Conclusion: Distal radius and ulna is the commonly fractured bone followed by supracondylar fractures of the humerus. Most of the paediatric fractures can be managed conservatively. Supervised play in the grounds, at home and at schools are important because paediatric injuries most of the times can be prevented to decrease the morbidity and mortality in the paediatric population. Proper knowledge and awareness of the traffic rules and zebra crossings should be implemented with local community participation and cooperation.

Is There an Optimal Time Window of Placement of Intracranial Pressure (ICP) Monitor for Elderly Patients With Severe Traumatic Brain Injury? An 11-Year Institutional Cohort Study With Restricted Cubic Spline Analysis.

Severe traumatic brain injury (sTBI) is a prominent contributor to both morbidity and mortality in the elderly population. The monitoring of intracranial pressure (ICP) is crucial in the management of sTBI patients. Nevertheless, the appropriate timing for the placement of ICP monitor in elderly sTBI patients remains uncertain. To determine the optimal timing for the placement of ICP monitor in elderly sTBI patients, in this retrospective cohort study, we collected data from elderly patients (> 65 years) who suffered sTBI and received ICP monitors at Tangdu Hospital, The Fourth Military Medical University, between January 2011 and December 2021. To examine the relationship between the time of ICP monitor placement and in-hospital mortality, we conducted a multi-variate-adjusted restricted cubic spline (RCS) analysis. Additionally, logistic regression analysis was applied to further analyze the influencing factors contributing to early or late ICP monitor placements. A total of 283 eligible elderly TBI patients were included in the current analysis. The in-hospital mortality rate was 73 out of 283 (26%). The RCS analysis demonstrated an inverted U-shaped curve in the relationship between the timing of ICP monitor placement and in-hospital mortality. For the elderly sTBI patient cohort, 6 h was identified as the crucial moment for the treatment strategy. In addition, the protective time window for ICP placement was less than 4.92 h for the GCS 3-5 group, and less than 8.26 h for the GCS 6-8 group. However, the clinical benefit of ICP placement decreased gradually over time. The relationship between ICP placement and in-hospital mortality was non-linear, exhibiting an inverted U-shaped curve in elderly patients with sTBI. For elderly patients with sTBI, early (≤ 6 h) ICP placement was associated with reduced in-hospital mortality. The clinical benefit of ICP placement decreased beyond the optimal time window.

Intelligent Data Processing Methods for Studying the Influence of the Environment on the Morbidity of the Population in Moscow

Purpose of the study. The purpose of the study is to confirm or refute the environmental determinism of the occurrence of socially significant diseases among the population of Moscow based on the analysis of data on environmental and health indexes in the context of municipal units of the city.Materials and methods. The article analyzes Russian and foreign bibliography on the research problem. Based on collected and processed open data on environmental indexes and population morbidity in various districts of Moscow, various types of analysis were carried out to identify the relationship between these data. To classify socially significant diseases based on environmental indexes of the place of residence, machine learning models were designed. The mathematical basis of machine learning methods is the k-nearest neighbors’ method, multilayer perceptron, and gradient boosting. To create the models, the Jupyter Notebook software tool, which supports the Python programming language, was used.Results. Correlation and regression analysis showed that there is a statistically significant correlation between some selected environmental indexes and the occurrence of socially significant diseases. This result indicates a possible relationship, which is one of the main conclusions of this paper. A web interface has been developed to automate the analysis of new data using constructed machine learning models used to conduct regression analysis to create a binary logistic model (prediction based on collected data of people with socially significant diseases) and a multiclass classification models (prediction based on collected data, which it is the disease that can be detected in a person). The machine learning models used were analyzed and the best model for classifying socially significant diseases was determined.Conclusion. As a result of the study, it was possible to collect comprehensive information about various environmental indexes and the presence or absence of various objects that have an impact on the environment. These data were used not only in machine learning models, but also to form an objective assessment of the environmental situation of municipal units of Moscow city. Since automatic updating of the rating for dynamic data was implemented, this result can be used by ordinary users who do not have sufficient qualifications in ecology and medicine for independent analysis of the ecological state of areas. We believe that such research will certainly lead to effective practical solutions in this area.

Imaging approach to ingested foreign bodies in the neck.

Foreign body ingestion is a common clinical occurrenceworldwide, with high morbidity in the pediatric population and in adult patients with intentional attempts. Coins and button battery ingestions are more common among children. Bone impaction and swallowed dentures are usually seen in older adults. While most ingested foreign bodies pass through the gastrointestinal tract spontaneously with no complications, some require endoscopic and/or surgical intervention. Complications such as pharyngoesophageal ulceration, perforation, stricture, and deep neck infection can develop without timely diagnosis and management. The purpose of this article is to familiarize radiologists with the imaging approach to assess for characteristics and impacted locations of ingested foreign bodies in the neck.

Trends in clinical workload in UK primary care 2005-2019: a retrospective cohort study.

Substantial increases in UK consulting rates, mean consultation duration, and clinical workload were observed between 2007 and 2014. To the authors' knowledge, no analysis of more recent trends in clinical workload has been published to date. This study updates and builds on previous research, identifying underlying changes in population morbidity levels affecting demand for primary health care. To describe the changes in clinical workload in UK primary care since 2005. Retrospective cohort study using GP primary care electronic health records data from 824 UK general practices. Over 500 million anonymised electronic health records were obtained from IQVIA Medical Research Data to examine consulting rates with GPs and practice nurses together with the duration of these consultations to determine total patient-level workload per person-year. Age-standardised mean GP direct (face-to-face and telephone) consulting rates fell steadily by 2.0% a year from 2014 to 2019. Between 2005 and 2019 mean GP direct consulting rates fell by 5.8% overall whereas mean workload per person-year increased by 25.8%, owing in part to a 36.9% increase in mean consultation duration. Indirect GP workload almost tripled over the 15 years, contributing to a 48.3% increase in overall clinical workload per person-year. The proportion of the study population with ≥3 serious chronic conditions increased from 9.7% to 16.1%, accounting for over a third of total clinical workload in 2019. Findings show sustained increases in consulting rates, consultation duration, and clinical workload until 2014. From 2015, however, rising demand for health care and a larger administrative workload have led to capacity constraints as the system nears saturation.

Assessment of subclinical left ventricular systolic and diastolic dysfunction in patients with type 2 diabetes mellitus under follow-up at Tikur Anbessa specialized hospital, Ethiopia: a case-control study

BackgroundIndividuals with diabetes mellitus are at increased risk of cardiovascular diseases, which in turn are the most common cause of morbidity and mortality in the diabetic population. A peculiar feature of cardiovascular diseases in this population is that they can have significant cardiac disease while remaining asymptomatic. There is a paucity of data regarding subclinical cardiac imaging features among diabetic adults in Africa, particularly in Ethiopia. This study was conducted to compare the magnitude and spectrum of left ventricular systolic and diastolic dysfunction among asymptomatic type 2 diabetic adults versus a normotensive, non-diabetic control group and to evaluate the determinants of left ventricular diastolic and systolic dysfunction.MethodsThis was a case-control study conducted at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia. A standard transthoracic echocardiography was done for all study participants with type 2 diabetes mellitus and their normotensive and non-diabetic controls. Structured questionnaires were used to collect demographic and clinical characteristics and laboratory test results. Statistical analysis was done using the SPSS 25.0 software. The data was summarized using descriptive statistics. Bivariate and multivariate analysis was performed to determine the association between variables and echocardiographic parameters. The strength of statistical association was measured by adjusted odds ratios and 95% confidence intervals, with significant differences taken at p < 0.05.ResultsWe analyzed age- and sex-matched 100 participants in the study (diabetic) group and 200 individuals in the control group. Left ventricular systolic and diastolic dysfunction were significantly more prevalent among diabetic adults than their sex and age matched controls. Among diabetic individuals, ages of 60 years and above, dyslipidemia, use of Metformin and Glibenclamide, high serum triglyceride level, presence of neuropathy and use of statins correlated significantly with the presence of left ventricular diastolic dysfunction. Chronic kidney disease and neuropathy were determinants of left ventricular systolic dysfunction.ConclusionLeft ventricular systolic and diastolic dysfunction were significantly more prevalent among diabetic patients than their sex- and age-matched controls in our study. We recommend early screening for subclinical left ventricular dysfunction, especially in the elderly and in those with chronic kidney disease, dyslipidemia, and microvascular complications such as neuropathy.

The Effects of Pulmonary Risk Factors and Combination Thoracic Osseous Fractures on Mortality and Outcomes of Surgical Stabilization of Rib Fractures.

Rib fixation for traumatic rib fractures is advocated to decrease morbidity and mortality in select patient populations. We intended to investigate the effect of combination osseous thoracic injuries on mortality with the hypothesis that combination injuries will worsen overall mortality and that SSRF will improve outcomes in combination injuries and in high-risk patients. Patients with rib fractures were identified from the Trauma Quality Improvement Project registry from 2019. Patients were then divided into rib fracture(s) alone or in combination with sternal, thoracic vertebra, or scapula fracture. Patients were also categorized into those with COPD and smokers. Patients with AIS >3 outside of thorax were excluded. Patients were subcategorized into those who had rib fixation verse nonoperative management for all subgroups. Analysis was performed to evaluate the efficacy of rib fixation. A total of 111,066 patients were included for analysis. The overall mortality was 1.4%. Patients with COPD had over double the mortality risk, with an overall mortality of 3.4%. Combination injuries did not appear to increase mortality. SSRF did not decrease mortality; however, the number of patients in this group was too small to complete statistical analysis. The overall complication rate was 0.43%. There was a trend towards an increase in extrapulmonary complications in the group that underwent surgical fixation. Mortality from rib fractures with concomitant osseous thoracic fracture appears to be low. However, mortality is increased in patients with COPD regardless of rib fracture pattern. The number of patients who underwent SSRF was too small to make a statistical comparison.

What to do with foundation therapies for heart failure for patients with end-stage kidney disease on haemodialysis.

There is a significant burden of cardiovascular disease morbidity and mortality in the end-stage kidney disease population, driven by traditional and non-traditional risk factors. Despite its prevalence, heart failure is difficult to diagnose in the dialysis population due to overlapping clinical presentations, limitations of investigations, and the impact on the cardiorenal axis. 'Foundation therapies' are the key medications which improve patient outcomes in heart failure with reduced ejection fraction and include beta-blockers, renin-angiotensin-aldosterone system inhibitors and sodium-glucose cotransporter-2 inhibitors. They are underutilised in the dialysis population due to the exclusion of chronic kidney disease patients from major trials and legitimate clinical concerns e.g. hyperkalaemia, intradialytic hypotension and residual kidney function preservation. A coordinated cardiorenal multidisciplinary approach can guide appropriate diagnostic considerations (biomarkers interpretation, imaging, addressing unique complications of kidney disease), optimise dialysis management (prescription length, frequency and ultrafiltration targets) and when at euvolaemia facilitate the stepwise introduction of appropriate foundation therapies.

IJCM_50A: Mortality trends in Indian prisons and its associated risk factors: a time trend analysis from 2017-2021

Background: The environmental health status of jail populations poses a significant public health threat for prisoners and the general population. The environment of jails provides a suitable foundation concerning morbidity and mortality of the general population due to the concentrated potential source of infectious diseases, difficult access to treatment for chronic health conditions, interruption in the continuity of care for serious behavioural health conditions, as well as on-going issues for the prevention and treatment of substance abuse disorders. Prisoners should receive a healthcare provision equivalent to people living in the community. Those rights, if fulfilled, will contribute to the process of social rehabilitation and will facilitate further reintegration into society on release. Objective: To analyze the mortality trends in Indian prisons from 2017-2021 and determine associated risk factors. Methodology: The various mortality statistics and associated risk factors were retrieved from the Prison Statistics of India report published annually by the National Crime Records Bureau, Ministry of Home Affairs. A literature search was also done in electronic databases like -PubMed, Google Scholar, and other platforms using keywords- mortality in prisons, prison health, and death in Indian jails. Results: The obtained estimates identified an ascending trend in mortality in Indian prisons due to cardiovascular diseases, lung diseases, and suicide, accompanied by a rising trend in mental illnesses. Overcrowding, inadequate manpower for healthcare facilities, and poor budget allocation for prison health are some notable causes of rising mortality. Conclusion: The study’s findings revealed that prisoners, despite being a vulnerable section of the population, are deprived of adequate medical facilities due to restrictions imposed by law. Therefore, reducing overcrowding, recruiting adequate manpower for healthcare facilities and adequate budget allocation for prison health shall play an instrumental role in reducing the trend of mental illnesses and mortality in Indian prisons.

The experience of traumatic events, psychological distress, and social support: links to COVID-19 vaccine hesitancy and trends with age in a group of older Australians

BackgroundVaccination is important to reduce disease-associated morbidity and mortality in an ageing global population. While older adults are more likely than younger adults to accept vaccines, some remain hesitant. We sought to understand how traumatic events, psychological distress and social support contribute to older adults’ intention to receive a COVID-19 vaccine and whether these experiences change with age.MethodsWe analysed survey data collected as part of the Sax Institute’s 45 and Up Study in a population of Australian adults aged 60 years and over. Data were derived from the COVID Insights study; a series of supplementary surveys about how participants experienced the COVID-19 pandemic.ResultsHigher intention to receive a COVID-19 vaccine was associated with greater social support (adjusted odds ratio (aOR):1.08; 95%CI:1.06–1.11; p <.001) while lower intention was associated with personally experiencing a serious illness, injury or assault in the last 12 months (aOR:0.79; 95% CI:0.64–0.98; p =.03). Social support and the experience of traumatic events increased significantly with age, while psychological distress decreased.ConclusionsThere may be factors beyond disease-associated risks that play a role in vaccine acceptance with age. Older Australians on the younger end of the age spectrum may have specific needs to address their hesitancy that may be overlooked.

ANALYSIS OF MORPHOLOGICAL GASTRIC CANCER TYPES

Malignant neoplasms occupy the leading places in the structure of morbidity and mortality of the world's population. Stomach cancer is one of the five most common cancer types in Russia in terms of morbidity and is among the top three in terms of mortality from malignant neoplasms. The aim of the study is to study the morphological gastric cancer types depending on the stage, localization of the tumor process in the stomach and the age of the patient. Materials and methods. A retrospective analysis of data on 412 stomach cancer patients for 2022–2023, examined on the basis of the AI "Republican Clinical Oncology Dispensary" under the Health Ministry of Chuvashia, among whom there were 256 (62.1%) men and 156 (37.9%) women, was carried out. The average age of the patients was 65.6±12 years. All cases have morphological verification. Research results. The most frequently diagnosed morphological types of gastric cancer were identified: adenocarcinoma not otherwise specified (57.3%), colloid cancer (17.2%), less often – gastrointestinal stromal tumor (6.7%) squamous cell non-keratinizing carcinoma (4.1%). The remaining tumor types in gastric cancer were verified less frequently (0.2–3.0%). It was found that the most common morphological types of gastric cancer were detected in most cases in the elderly (over 60 years old) and males. Depending on the tumor localization in the stomach departments, it was verified: if the body of the stomach is affected, almost all types of stomach cancer are observed (the same with affection to the antrum), such types as tubular, micropapillary, neuroendocrine, scyrrhous and mixed were not found in the cardiac department of the stomach. In subtotal and total affection of all stomach parts, the morphological types of gastric cancer corresponded in most cases to not otherwise specified adenocarcinoma and colloid carcinoma. Such morphological type of gastric cancer as not otherwise specified adenocarcinoma which made up the bulk of all types of malignant gastric cancers, was mainly (in 52.1%) detected at stages III and IV of the disease and only in 16.9% of patients – at the early I stage of the disease. Other morphological types of gastric cancer identified in the late stages of the tumor process included colloid carcinoma, non-keratinizing squamous cell carcinoma and carcinoma simplex. Conclusions. The analysis of morphological gastric cancer types the predominance of adenocarcinomas and colloid cancer, identified more often in the late stages of the tumor process. The predominant localization of various morphological types of gastric cancer with body damage was established. The most common morphological types of gastric cancer are found in the elderly, more often in men.

Skin graft on a collagen and elastin matrix fixed with negative pressure in a complicated pediatric dog bite: case report

Animal bites represent a significant source of morbidity in the pediatric population, with dogs being the primary cause. Highlighting the need for innovative solutions to effectively tackle the issue and enhance both functional and aesthetic outcomes. Dog bites, marked by a heightened morbidity rate, present an inherent infection risk owing to the considerable bacterial load present in saliva. The fundamental approach to treatment revolves around preventing infection through meticulous washing, debridement, and the timely implementation of early primary closure. We detail the management of a pediatric patient with a dog bite on the pelvic limb, resulting in a challenging-to-manage wound. This case was successfully treated with a skin graft on a bed of collagen matrix, secured with negative pressure therapy. The choice of the appropriate technique for reconstructing skin defects depends on their depth and size. Consequently, combining these three techniques yielded a favorable functional and aesthetic outcome for the patient. This case report emphasizes the relevance of employing different techniques in managing complicated dog bites.

Under 5 pneumonia a forgotten pandemic: an insight into risk factors predicting outcome of severe pneumonia in children aged 2 months to 5 years of age

Background: Pneumonia is the leading cause of morbidity and mortality in the pediatric population. In developing countries like India, multiple sociodemographic and environmental factors influence the outcome of severe pneumonia so this study explores these risk factors with aim of finding ways to improve the outcome. Methods: It is a prospective observational study conducted over a period of 12 months on 2 months to 5 years, children with severe pneumonia admitted in ward and PICU of tertiary medical care institute. A total of 100 patients were enrolled in the given study after meeting the inclusion criteria. Predesigned proforma was used to record sociodemographic details, patient history, detailed examination findings and laboratory reports. Outcome in terms of mortality and morbidity was noted. Data analyzed using appropriate statistical tests, p values &lt;0.05 accepted as statistically significant. Results: The severe pneumonia was more common in the age group of 2 months to 1 year of age (59%) and in males (60%). Malnutrition and leukocytosis was statistically significant. 53 subjects were exclusively breastfed. Type of family, mother &amp; father’s education status, mother’s employment status, tobacco exposure and contact with tuberculosis were not found statistically significant in the given study. 21 participants required PICU and 10 patients required mechanical ventilation. 92 patients were discharged, while 2 patients expired. Conclusions: Pneumonia is an important preventable and treatable cause of under 5 mortalities. In developing countries like India an awareness and proper management of risk factors like malnutrition, low birth weight, immunization status can improve the outcome.

Prevalence and features of SARS-CoV-2 infection in prisons in Tuscany.

Prisons can be a reservoir for infectious diseases, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), due to the very intimate nature of the living spaces and the large number of people forced to share them. To investigate the SARS-CoV-2 epidemiology in prisons, this study evaluated the infection incidence rate in prisoners who underwent nasopharyngeal swabs. This is an observational cohort study. Data collection included information on prisoners who underwent nasopharyngeal swab testing for SARS-CoV-2 and the results. Nasopharyngeal swab tests for SARS-CoV-2 were performed between 15 February 2021 and 31 May 2021 for prisoners with symptoms and all new arrivals to the facility. Another section included information on the diagnosis of the disease according to the International Classification of Diseases, Ninth Revision, and Clinical Modification. Up until the 31 May 2021, 79.2% of the prisoner cohort (n = 1744) agreed to a nasopharyngeal swab test (n = 1381). Of these, 1288 were negative (93.3%) and 85 were positive (6.2%). A significant association [relative risk (RR)] was found only for the risk of SARS-CoV-2 infection among foreigners compared to Italians [RR = 2.4, 95% confidence interval (CI): 1.2-4.8]. A positive association with SARS-CoV-2 infection was also found for inmates with at least one nervous system disorder (RR = 4, 95%CI: 1.8-9.1). The SARS-CoV-2 incidence rate among prisoners is significantly lower than in the general population in Tuscany (standardized incidence ratio 0.7, 95%CI: 0.6-0.9). In the prisoner cohort, screening and rapid access to health care for the immigrant population were critical to limiting virus transmission and subsequent morbidity and mortality in this vulnerable population.

High HbA1C and Glycemic Control as Diabetic Nephropathy Etiology

Background: Type 2 Diabetes Mellitus (T2DM) is a metabolic disorder characterized by insulin resistance, leading to microangiopathic complications such as diabetic nephropathy (DN). DN involves changes in the kidney's glomeruli, leading to albuminuria and potentially progressing to end-stage renal disease (ESRD). Hyperglycemia, a hallmark of diabetes, contributes to long-term organ damage, making DM a significant global health concern. Methods: This study included 48 participants aged 30 to 65 years, divided into diabetic patients and controls. Blood samples were collected for analysis of urea, creatinine, and HbA1c levels. Results: The HbA1c levels in the patient group (8.57 ± 1.75) exhibited a statistically significant increase (P≤0.05) compared to the control group (5.28 ±0.78). However, there was no significant difference in urea levels between patients (45.88 ± 37.91) and controls (33.02 ± 18.87) (P≤0.05). Similarly, there was no significant variance in creatinine levels between patients (1.37±1.78) and controls (1.06±1.55) (P≤0.05). Elevated HbA1c levels might be a cause of disease severity and complexity in diabetes, emphasizing the need for comprehensive glycemic control. Conclusion: Regular monitoring of HbA1c levels is crucial for early detection and management of DN in diabetic patients. Increased microalbuminuria correlates with elevated HbA1c levels, highlighting the importance of glycemic control in preventing kidney function impairment. This study demonstrated the significance of comprehensive glycemic management strategies in mitigating DN progression and reducing morbidity in diabetic populations.

On the content of toxic elements in meadow grasses of rural areas of Khangalassky district

The importance of studying the microelement composition of soils and vegetation in the Northern territories is due to the role of microelements in soil formation under cryolithozone conditions, and secondly, the influence of the microelement background of plants on the physiological functions of animals and humans. At the same time, heavy metals deserve special attention as they pose a threat to all living organisms due to their ability to accumulate. The article presents data on the content of heavy metals in the aboveground parts of meadow grasses growing under cryolithozone conditions - in the Khangalassky district, located in the Central Yakut biogeochemical province. Atomic absorption spectral analysis showed that the content of heavy metals - cadmium and lead - in the aboveground parts of the studied plants varied significantly depending on the place of collection, but did not exceed the maximum permissible concentrations. The concentration of zinc in some of the herbal collection points exceeded the maximum permissible concentrations. The need to study the content of heavy metals in plants is due to the fact that they are the primary link in the movement of toxic elements along the trophic chain into the human body. Lead and cadmium accumulate in parenchymal organs, are carcinogenic and affect the morbidity and mortality of the northern population.

PREVALENCE AND STRUCTURE OF DENTO-MAXILLOFACIAL ANOMALIES IN CHILDREN

The high level of dental morbidity in the children's population of Ukraine remains one of the urgent problems of modern dentistry. Dental health is largely characterized by the correctness of the structure of the mandibular system, its proper functioning and balance, and its condition is one of the preventive and quite clearly fixed indicators of health/ ill health of the human body in general. The pathology of the maxillofacial system affects not only the state of health, but also the quality of life of the patient, his emotional and social well-being.&#x0D; In this context, information on the prevalence of dentomandibular abnormalities and the overall need for orthodontic treatment is essential to provide objective information to health care stakeholders in order to make an adequate allocation of health care resources based on objective epidemiological data. In addition, dento-mandibular anomalies, which are not detected and not eliminated in childhood, in the process of growth and development of the facial skeleton over time acquire more severe forms, which become more pronounced and are less amenable to treatment. Therefore, the analysis of the prevalence and severity of ASD in children is an important stage in the process of planning preventive and therapeutic measures.&#x0D; Data from literary sources indicate a high prevalence of dento-maxillofacial anomalies among children in different age periods and depending on the characteristics of the area of residence. In particular, the results of the examination of children aged eight months to seventeen years, residents of different regions of Ukraine, given in scientific works of recent years, indicate a high prevalence of dento-jaw anomalies (41%77.9%).&#x0D; The high prevalence of dento-mandibular anomalies indicates the need for timely diagnosis at the early stages of the development of orthodontic pathology, which will contribute to timely treatment, which will subsequently be able to ensure the normal development of the child's dento-mandibular system and improve the quality of life.

De Novo Metabolic Syndrome 1 Year after Liver Transplantation and Its Association with Mid- and Long-Term Morbidity and Mortality in Liver Recipients.

Background: Metabolic syndrome (MS) constitutes an important source of cardiovascular- and cancer-related morbidity and mortality in the general population. Limited information is available on whether these findings can be directly extrapolated to liver recipients. This study aimed to investigate the impact of post-transplant MS present 1 year after liver transplantation on survival rates, risk of major cardiovascular events (CVEs), and de novo malignancies. Methods: Adult deceased-liver-donor recipients who underwent transplantation in our centre between 2010 and 2019 and reached at least 1 year of post-transplantation follow-up were eligible. Results: Of 259 enrolled patients, 20% developed post-transplant MS 1 year after the procedure. The presence of post-transplant MS at 1 year did not affect all-cause mortality (p = 0.144) and risk of de novo malignancies (p = 0.198) in liver recipients. However, it was associated with an overall and time-dependent increase in the risk of major CVEs (p < 0.001). MASH aetiology of liver disease, pre-existing major CVEs, and development of de novo malignancy were independent predictors of all-cause mortality in liver recipients. Conclusions: New onset MS exerts a wide-ranging effect on the post-transplant prognosis of liver recipients. Obtaining optimal control over all modifiable metabolic risk factors is central to improving long-term outcomes in this population.

STUDY OF ACUTE BACTERIAL MENINGITIS IN CHILDREN BY GRAM STAIN, CULTURE AND ANTIGEN DETECTION

Objective: Acute Bacterial Meningitis (ABM) is associated with a high mortality rate and morbidity in paediatric population despite recent advances in diagnostic methods, antimicrobial and supportive treatments and monitoring. This study is therefore undertaken to aid in rapid diagnosis of ABM by latex agglutination test (LAT) and to comparatively evaluate Gram stain, Culture and LAT in the diagnosis of ABM along with antibiotic susceptibility pattern of the isolates. We undertake this study in children with symptoms of meningitis to isolate and identify the pathogens in CSF and blood and to determine their antibiotic susceptibility pattern. We will compare and evaluate the three methods Gram stain, culture and Antigen detection.&#x0D; Methods: A hospital-based prospective study conducted at Government General Hospital, Kakinada during December 2018–August 2020. A total of 50 clinically suspected cases of bacterial meningitis in the paediatric age group were taken. The CSF sample was collected and subjected to Gram stain, culture and antigen detection tests using PASTOREX TMMENINGITIS kit.&#x0D; Results: Out of 50 samples collected, 15 cases were declared as laboratory confirmed cases as per WHO criteria. Gram stain was positive in 6 cases. CSF culture could identify 8 cases of ABM. CSF LAT was positive in 12 cases. Group B Streptococcus was the most common etiological agent in neonates, while S. pneumoniae in children. The isolates were 100% sensitive to cefoperazone, cefuroxime, cefepime and gentamicin.&#x0D; Conclusion: Although Gram stain is simple and CSF culture is the gold standard, LAT has an advantage over Gram stain in terms of species identification. It was found to be more sensitive, rapid, easy to perform and could identify fastidious organisms like S. pneumoniae, N. meningitidis and Group B Streptococcus.