Occurrence Of Syndromes Research Articles

Endoscopic Management of Efferent Loop Syndrome and Its Complications: Lessons Learnt

Both afferent and efferent loop syndromes are rare complications that can develop post-gastro-jejunostomy. Although the incidence of afferent loop syndrome is ~0.3% to 1%, efferent loop syndrome is extremely rare with only limited case reports. We report a case of malignant efferent loop obstruction which was successfully managed by an endoscopic luminal self-expanding metal stent. This led to an unusual complication of obstructive jaundice with cholangitis secondary to a mechanical afferent loop syndrome requiring an additional endoscopic luminal stenting of the afferent loop. Endoscopic management of afferent or efferent loop syndromes is technically challenging and a consecutive occurrence of the dual-loop syndromes should be expected by the interventional endoscopist.

Investigating the patterns of air pollution exposure on major cardiovascular events by cluster analysis. Insights from the EP-PARTICLES study on a Polish smog cohort

Abstract Introduction Exposure to air pollution (AP) is a modifiable risk factor for cardiovascular diseases. Aim To analyse the short-term effects of AP on the occurrence of acute coronary syndromes (ACS). Methods The EP-PARTICLES study consists of a retrospective nationwide cohort of Eastern Poland residents (N= 8,077,671). The area is characterized by a specific type of pollution - Polish smog, featuring high concentrations of particulate matter (PM), benzo(a)pyrenes (BaP) and favourable atmospheric conditions of formation. Medical data were collected from the National Health Fund and the Central Statistical Office. The records included sex and age and the causes of hospitalization. The analysis utilized air quality modeling data from the GEM-AQ system, which allowed to provide daily pollution concentration at the level of each LAU (ie. local administrative units, at municipality level), throughout the observation period. We estimated LAU specific associations of AP concentration using quasi-Poisson generalized additive models. We controlled our models for long-term trends and weather conditions. In the second stage, we pooled LAU-specific estimates with a random-effects meta-analysis. The results are presented as % risk ratio (RR), and 95% confidence intervals (95% CIs) for the two-day moving average of AP concentration on the present day and the day after exposure (ie. LAG0-1). Cluster analysis was performed on LAU levels from 19 variables using the k-mens clustering using the Ward minimum variance method. The set of variables included demographic, ecological, socioeconomic, environmental conditions. Results Over the years 2011-20, we noted 2,141,213 hospitalizations due to CVD, including 139,697 ACS cases (45.2% STEMI). The main triggers for ACS were PM2.5 (RRLAG0-1 1.04 95%CI 1.028-1.053), BaP (RRLAG0-1 1.021 95%CI 1.01-1.032). We identified three distinct clusters: Cluster 1 was characterized by high population density and GPD per capita and highest prevalence of atrial fibrillation. Cluster 2 (40% of the entire population) exhibited significantly high variability, characterized by low population density and GPD per capita, the highest prevalence of heart failure, people drinking alcohol and smoking tobacco. Cluster 3 (7% of the entire population) was in the middle but showed the highest prevalence of hypertension, diabetes and renal failure. Cluster 2 inhabited areas with low concentrations of PMs and BaP and demonstrated increased vulnerability to the effects of PM2.5 and BaP from 3% to 5.2% (P<0.001). For details see Figure 1. Conclusions PM and BaP are important factors associated with the occurrence of MACE. AP exposure should be considered in CVD prevention models. Cluster classification helps in risk stratification and prognosis. Adverse effects of AP can be mitigated by attention to improving socio-economic status and hazardous habits.Associations between AP exposure and ACS

Comparison of Diagnostic Parameters of Acute Coronary Syndromes in Patients with and without Cancer: A Multifactorial Analysis.

The simultaneous occurrence of cancer and acute coronary syndromes (ACSs) presents a complex clinical challenge. This study clarifies variances in diagnostic parameters among ACS patients with and without concurrent cancer. This retrospective study included 320 individuals diagnosed with ACS, stratified equally into two cohorts-one with cancer and the other cancer-free. We evaluated risk factors, symptom profiles, coronary angiography results, echocardiographic evaluations, and laboratory diagnostics. Statistical analysis was performed using Student's t-test, the Mann-Whitney U test, and the chi-square test. Cancer patients were older (mean age 71.03 vs. 65.13 years, p < 0.001) and had a higher prevalence of chronic kidney disease (33.1% vs. 15.0%, p < 0.001) but a lower prevalence of hyperlipidemia (59.7% vs. 82.5%, p < 0.001). Chest pain was less frequent in cancer patients (72.5% vs. 90%, p < 0.001), while hypotension was more common (41.9% vs. 28.8%, p = 0.022). NSTEMI was more common in cancer patients (41.9% vs. 30.6%, p = 0.048), while STEMI was less common (20.6% vs. 45.3%, p < 0.001). RCA and LAD involvement were less frequent in cancer patients (RCA: 18.1% vs. 30.0%, p = 0.018; LAD: 18.8% vs. 30.0%, p = 0.026). This study demonstrates differences in the clinical presentation of ACS between patients with and without cancer. Cancer patients were less likely to present with chest pain and more likely to experience hypotension. Additionally, they had a higher prevalence of chronic kidney disease and they were less likely to have hyperlipidemia. These findings highlight the need for a careful approach to diagnosing ACS in oncology patients, considering their distinct symptomatology.

Incidence of hand-foot syndrome with protein kinase inhibitors in advanced hepatocellular carcinoma patients who received atezolizumab-bevacizumab combination.

Treatment of advanced HepatoCellular Carcinoma (HCC) is based on first-line (L1) combination of atezolizumab and high-dose (HD) bevacizumab while second-line (L2) refers one antiangiogenic protein kinase inhibitors (aaPKI). This prolonged antiangiogenic pressure let us to observe an increasing occurrence of Hand-Foot Syndromes (HFS) in patients receiving aaPKI after HD bevacizumab combination. This study reports observations and discussions about the evidence and hypothesis that could be made. Patients who received the L1 combination from September 1st 2020 to December 31st 2022 to identify L2 aaPKI. Demographic, biological, oncological data and occurrence of HFS were collected. In addition were collected the number of L1 combination cycles, type of aaPKI, and delay between last L1 cycle and L2 initiation. This study had a purely exploratory purpose, so no statistical analysis was planned. 17 patients received an aaPKI after the L1 HD bevacizumab combination with a median time of 26 days from last L1 cycle to L2 start. Five patients experienced HFS including grade 3 (n = 2) with sorafenib and cabozantinib. The HFS occurred with a median delay of 23 days (IQR: 21-28) from aaPKI start. Three patients experienced aaPKI-related dose-limiting toxicity. Proportion of patients experienced HFS in our cohort did not differ from pivotal trials data and the sample size do not allow to conclude. Hypotheses include timing of aaPKI start in HCC treatment, vascular toxicity at aaPKI start after HD bevacizumab discontinuation instead combination, patient-related outcome for a better understanding of these aaPKI-related HFS post HD bevacizumab.

Cardiovascular events after invasive pneumococcal disease: a retrospective cohort study

ObjectivesThis study aims to understand the magnitude of and mechanisms underlying the development of cardiovascular events (CVEs) in patients with invasive pneumococcal disease (IPD). We aimed to identify factors that contribute to the occurrence of CVEs within 1 year after admission and discuss implications for patient care. MethodsA multicentered cohort study included adult patients from four Dutch hospitals who had a positive blood culture for Streptococcus pneumoniae and any type of clinical manifestation between 2012 and 2020. Disease characteristics and microbiological data were systematically collected from electronic patient files. The main outcome measures were the occurrence of stroke and acute coronary syndromes (ACS). ResultsOf 914 eligible patients, 4.2% experienced a CVE within 1 year after admission for IPD. ACS mainly occurred in the first 2 weeks, whereas stroke developed throughout follow-up. Although ACS was positively associated with disease severity, the sole independent predictor was alcohol abuse (odds ratio [OR] 3.840, 95% confidence interval [CI] 1.108-13.303). Although stroke occurred in 6.3% of meningitis cases, the best clinical predictor of stroke was a body temperature >39.5 °C at admission (OR 3.117 [1.154-8.423]). In the adult IPD population aged <70 years, pneumococcal serotypes were the primary predictors of ACS (7F; OR 15.733 [1.812-136.632]) and stroke (22F; OR 7.320 [1.193-44.903]). ConclusionsAdverse CVEs were not uncommon after IPD diagnosis and deserve attention, especially in the high-risk groups we identified in our study population. Whether specific serotypes play a role in the development of CVE requires substantiation in further research.

Features of the course of hydrocephalus in children after removal of a tumor of the posterior cranial fossa in the near and long term

The article presents the results of a study of the dynamics of the development of persistent hydrocephalus in children after surgical removal of a tumor of the posterior cranial fossa in the early and late postoperative period. The analysis of the incidence of neuropsychological syndromes: cerebellar cognitive-affective syndrome and cerebellar mutism syndrome in children of this group was carried out. Retrospective analysis included 30 patients under 18 years of age with a diagnosis tumor of the posterior cranial fossa complicated by occlusive hydrocephalus. All patients were operated on in the conditions of the Department of Neurosurgery for Children No. 7 of the Almazov National Medical Research Centre. As a result of the study, the risk groups for maintaining hydrocephalus after removal of the tumor of the posterior cranial fossa were determined, and the frequency of occurrence of neuropsychological syndromes in the postoperative period was determined.

Fifteen-Year Clinical Outcomes After Sirolimus-Eluting Stent Implantation.

Clinical outcomes after percutaneous coronary intervention have improved with the use of drug-eluting stents, but data beyond 10 years are limited. The purpose of this study was to evaluate the clinical outcomes of patients undergoing sirolimus-eluting stent implantation with follow-up beyond 10 years and to determine the impact of clinical and angiographic characteristics on long-term prognosis.Methods and Results: The clinical outcomes of 885 patients who had undergone sirolimus-eluting stent implantation at a single institution were retrospectively reviewed. Primary endpoints included in the analysis were clinically driven target lesion revascularization (cTLR) and target lesion revascularization (TLR). Univariate and multivariate nominal logistic regression was used for data analysis. The incidence rates of cTLR and TLR beyond 10 years after sirolimus-eluting stent implantation were 16.4% and 36.8%, respectively, with cTLR tending to decrease beyond 10 years. Acute coronary syndrome was a predominant trigger for cTLR. Age, statin use, and stent restenosis emerged as predictors of cTLR within 10 years, but no significant predictors other than age were identified beyond 10 years. Events continue to occur beyond 10 years after sirolimus-eluting stent implantation, with a trend toward an increase in acute coronary syndromes. It is important to be vigilant about the occurrence of acute coronary syndromes during long-term follow-up.

The Characteristics of White Dot Syndromes Following SARS-COV-2 Infection: A Systematic Review.

To review all studies reporting the occurrence of white dot syndromes (WDSs) following SARS-COV-2 infection. On May 12, 2023, we registered our protocol on PROSPERO [registration number: CRD42023426012]. Five different databases including PubMed, Scopus, Web of Science, Google Scholar, and Science Direct were searched up to May 2023. We included all studies that reported the symptoms of WDSs following SARS-COV-2 infection. The data was extracted using a uniform Excel extraction sheet. All statistical tests were conducted with a 95% confidence interval and a 5% error margin. A p-value of less than 0.05 was considered statistically significant. The publication bias of included studies was assessed using JBI Critical Appraisal Checklist for Case Reports and IHE Quality Appraisal Checklist for Case Series studies. This review included thirty-two studies involving forty-eight patients. Acute macular neuroretinopathy was the most common disease (70.8%) followed by multiple evanescent white dot syndrome (14.6%) with 58.3% of WDS after their first SARS-COV-2 infection, and paracentral acute middle maculopathy (4.1%). They were mostly unilateral (56.2%). The presenting symptoms were blurred vision (70.8%), visual field disturbance (68.7%), and photopsia (20.8%). About 35.4% of the patients improved by their treatment and future complications were persistent scotoma (4.2%) and macular edema (2.1%). White dot syndromes are very rare entities. Our findings suggest a possible association between white dot syndrome onset and SARS-COV-2 infection. We recommend ophthalmologists should be aware of this suggested association to deliver better management and patients' care.

Prevalence of geriatric syndromes and associated factors in Iranian older adults with type 2 diabetes: A population-based correlational study

Background &amp; Aim: Geriatric syndromes are known as a major obstacle in the treatment and care of older adults with diabetes. This study aimed to determine the prevalence of geriatric syndromes and associated factors in community-dwelling older adults with diabetes in the south of Tehran, Iran, in 2022.&#x0D; Methods &amp; Materials: A population-based correlational study was conducted among 392 older adults with diabetes, covered by selected health centers in the south of Tehran, Iran, using the multistage sampling method. Persian forms of geriatric assessment tools were used, including Mini-Mental State Examination, Activities of Daily Living, Instrumental Activities of Daily Living, Mini Nutritional Assessment, and Geriatric Depression Scale. The obtained data were analyzed by descriptive and chi-square test in SPSS-26.&#x0D; Results: The mean age of the participants was 69.5±6 years (63% female, 37% male). About 54.6% of the older adults with diabetes studied had three or more Geriatric syndromes. Polypharmacy was the most prevalent geriatric syndrome (76.5%). The number of geriatric syndromes had a significant association with female gender (p&lt;0.001), lower education (p&lt;0.001), loss of the spouse (p= 0.004), and lower-income (p=0.019). Also, with the increase in the number of diabetes comorbidities, the occurrence of all geriatric syndromes increased significantly (p&lt;0.001).&#x0D; Conclusion: The prevalence of geriatric syndromes in older adults with diabetes in the south of Tehran is very high and warning. Due to the increasing population of older adults in Iran, policymakers and healthcare providers should take appropriate actions to confront the issue with a comprehensive understanding of the present condition.

Prevalence of geriatric syndromes among older outpatients with dementia

AbstractBackgroundThe occurrence of geriatric syndromes in people with dementia may result in worsening of independence and autonomy.MethodA cross‐sectional study was conducted on outpatients with dementia aged ≥ 60 years old. Dementia was diagnosed by neuropsychiatrists following DSM‐5 criteria.. The geriatric syndromes includes nutritional status (Mini Nutritional Assessment Scale‐Short Form), polypharmacy, comorbidities, alcohol use, symptom of depression (Quality of Life in Alzheimer Disease), physical functional (Barthel Index, Instrumental Activities of Daily Living), lower body strength (30 seconds stand chair test), high risk of fall (Time Up and Go test ≥ 13.5 seconds), hearing loss (Whisper test), low visual acuity (Snellen test) and poor quality sleep (The Pittsburg Sleep Quality Index).ResultA total of 87 participants was recruited in the study (mean age: 76.8±1.2 years; female: 65.5%). The median number of geriatrics syndrome per participant was 5 (IQR = 2). The most common geriatric syndromes were loss of independence (96.6% impariment in ≥1 IADL task score), reduced lower body strength (86.2%), risk of malnutrition (78.2%), low speed (74.7%) and risk of falls (67.8%). The prevalence of alcohol use, risk of malnutrition, loss of independence and reduced lower body strength were consistently increase linearly with the severity of dementia.ConclusionThe presence and co‐incidence of geriatric syndromes is common among outpatients with dementia. This finding could have important clinical implications in the clinical work‐up and service delivery in Vietnam. We have begun to think about how we can develop our primary to provide comprehensive, multidisciplinary approaches to screening, recognition, and treatment of people with dementia

Метаболічні порушення, спричинені гострим панкреатитом, та їх корекція за допомогою ентерального харчування пацієнтів

The occurrence of hypermetabolism and hypercatabolism syndromes in patients with acute pancreatitis is associated with the release of pro-inflammatory cytokines, which leads to an increase in energy consumption and basic metabolism, which depend on both the severity of the course and the duration of the disease. The aim of our work was to investigate the state of the problem of nutritional support for patients with acute pancreatitis at the current stage. The degree of nutritional status disorders in patients with acute pancreatitis varies depending on the etiological factors and severity of the disease and requires a differentiated approach to their correction. With the development of hypermetabolic syndrome, energy consumption can increase by 77-158%. Nutritional support is an important component of acute pancreatitis therapy, the goal of which is to ensure adequate caloric intake, modulate the response to oxidative stress, and counteract catabolic effects during the course of the disease. Restoration of intestinal absorption in patients with severe acute pancreatitis occurs on average 48 h after the start of complex conservative therapy, which is the optimal time to start enteral nutrition. Nasogastric nutritional support in patients with severe acute pancreatitis is safe and leads to a 25.8% reduction in the incidence of local infectious complications, length of hospital stay by 16 days and deaths by 21.4% in comparison with parenteral nutrition. The use of antiflatulents as part of a mixture for enteral nutrition allows to improve the laboratory indicators of blood serum, to reduce the frequency of intestinal complications by 21.5%. Nutritional support should be started with nasogastric administration of food mixture, and in case of complications (intolerance, aspiration, etc.), nasojejunal administration. Parenteral nutrition should be used if enteral nutrition is impossible or not tolerated.

CCTA characteristics of vulnerable plaques preceding acute coronary syndromes-a comparative analysis between STE- and NSTE-ACS

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by the University of Medicine, Pharmacy, Science and Technology „George Emil Palade“ of Târgu Mureș Research Grant number 510/13/17.01.2022. Background CCTA adverse plaque features, that illustrate increased vulnerability, have been established as significant predictors for adverse events in patients with coronary artery disease. Decades of research have benchmarked the implication of vulnerable plaques (VP) in the occurrence of acute coronary syndromes (ACS). Still, there is little information concerning the interrelation between VP features and the subsequent type of ACS. Aim We sought to identify specific characteristics of future culprit vulnerable plaques, in a comparative analysis between the type of ACS they trigger, in patients undergoing CCTA and plaque analysis for stable chest pain. Material and Methods We conducted a prospective analysis, with a 3 year follow-up, on 50 subjects who underwent CCTA evaluation for stable chest pain. Coronary plaques were analyzed at baseline, for lesions that presented moderate stenosis, with at least one vulnerability marker (LAP, PR, NRS, SCs), which became culprit lesions during follow-up. Patients were initially divided into 2 groups (gr.1 – with STE-ACS, n=13) gr.2 – patients with NSTE-ACS, n=37). The secondary analysis divided the population in 3 groups gr.1-patients with UA (n=28); gr.2- with STEMI (n=13); gr.2 –with NSTEMI (n=9). Results The time to the occurrence of an ACS was higher for STE-ACS compared to NSTE-ACS (169.9±177.4, p&amp;lt;0.001), which was similar when comparing NSTEMI vs. UA vs. STEMI (p = 0.0001). The lowest degree of stenosis was present for VP that had triggered NSTEMI (p = 0.03). Evaluation of plaque composition revealed that the STE-ACS group presented higher non-calcified (171.6±63 vs. 130.6±80.1 mm3 p = 0.04) and lipid rich (19.9±16.7 vs. 11.42±10.5 mm3, p = 0.04) volumes, with no other differences regarding plaque composition and morphology. Plaques that had triggered STEMI during follow-up, presented highest non-calcified (p = 0.01) and lipid rich (p = 0.01) volumes. The greatest number of plaques with over 2 vulnerability markers per lesions were found in NSTEMI precursor lesions compared to UA and STEMI (77.8% vs. 53.8% ±25%, p = 0.01). Conclusions Compared to NSTE-ACS triggering lesions, vulnerable plaques that precede STEMI-ACS present a more lipid rich, non-calcified phenotype. NSTEMI precursor lesions are heterogeneous, with a low calcium volume and increased number of vulnerability markers, while VPs triggering unstable angina are calcified, with a low lipid rich volume and spotty calcifications.

Spontaneous Coronary Artery Dissection Postpartum and Recurrence during Menopause: Hormonal Involvement in Acute Coronary Syndromes

In this case report, we present a case of a 38-year-old woman with no cardiac history and no risk factors who was admitted to the hospital with a spontaneous coronary artery dissection (SCAD) after pregnancy. Twelve years later, she suffered a recurrent SCAD during her menopause. SCAD is a rare occurrence of acute coronary syndromes and recurrence is even more rare. SCAD seems to occur predominantly in females and seems to be related to hormone levels. At first presentation, the patient was 38 years old and 4 weeks postpartum. She presented with chest pain. Electrocardiogram (ECG) showed loss of r-amplitude but no ST-segment deviation. Troponins were elevated and showed significant rise and fall. She was treated with dual anti-platelet strategy and underwent coronary angiography (CAG) which showed a type 1 dissection of the distal circumflex artery. The lesion was treated conservatively. Second presentation was 12 years later, in which she again presented with chest pain this time during menopause. ECG showed marginal changes and the troponins were again elevated. She underwent CAG again which showed a new SCAD (Type 2 B) in the second marginal obtuse artery. The old SCAD lesion was healed. Renal angiography was preformed which showed an renal bead pattern typical for fibromuscular dysplasia. Again, she was treated conservatively. This case is the first case report of a patient suffering from a recurrent SCAD in a different coronary artery, both events probably related to hormonal changes, that is, postpartum and during menopause. This may emphasize careful examination of chest pain in menopause patients with a history of earlier SCAD.

Discussion of Acute Deficiency Syndrome Theory and its Clinical Application

Discussion of Acute Deficiency Syndrome Theory and its Clinical Application

Central Bradypnea and Ataxic Breathing in Myotonic Dystrophy Type 1 - A Clinical Case Report.

The occurrence of obstructive and central sleep apnea syndromes, ventilator pump failure and reduced hypercapnic ventilatory drive in myotonic dystrophy type 1 (DM1) is well established, and there are indications for an impairment of the hypoxic ventilator drive, too. Yet, it is still unknown, to which extent the respiratory rhythm is affected by DM1, thus if a central bradypnea, cluster breathing or ataxic ("Biot's") breathing can occur. Additionally, the causes of the impairment of the central respiratory drive in DM1 are not known. We present the case of a tracheotomized female patient with DM 1 with central bradypnea and ataxic breathing. A 57-year-old woman with DM1 was admitted to our Neurointensive Care Unit (NICU) due to refractory tracheobronchial retention of secretions resulting from aspiration of saliva. Due to a combination of chronic hypercapnic respiratory failure, severe central bradypnea with a minimal breathing frequency of 3 per minute and ataxic breathing a pressure-controlled home ventilation was initiated. In our patient central bradypnea and ataxic breathing possibly were respiratory sequale of DM1, that may have been caused by pontine white matter lesions affecting the pontine respiratory nuclei. From a clinical viewpoint, polygraphy is a suitable tool to objectify disorders of the respiratory rhythm in DM1 even in tracheotomized patients. Clinical studies combining respiratory diagnostics as polygraphy, transcutaneous capnometry and blood gas analysis with brain magnetic resonance imaging (MRI) are required to better understand disorders of respiratory regulation in DM1, and to identify their anatomical correlates.

The Novel Role of Noncoding RNAs in Modulating Platelet Function: Implications in Activation and Aggregation.

It is currently believed that plaque complication, with the consequent superimposed thrombosis, is a key factor in the clinical occurrence of acute coronary syndromes (ACSs). Platelets are major players in this process. Despite the considerable progress made by the new antithrombotic strategies (P2Y12 receptor inhibitors, new oral anticoagulants, thrombin direct inhibitors, etc.) in terms of a reduction in major cardiovascular events, a significant number of patients with previous ACSs treated with these drugs continue to experience events, indicating that the mechanisms of platelet remain largely unknown. In the last decade, our knowledge of platelet pathophysiology has improved. It has been reported that, in response to physiological and pathological stimuli, platelet activation is accompanied by de novo protein synthesis, through a rapid and particularly well-regulated translation of resident mRNAs of megakaryocytic derivation. Although the platelets are anucleate, they indeed contain an important fraction of mRNAs that can be quickly used for protein synthesis following their activation. A better understanding of the pathophysiology of platelet activation and the interaction with the main cellular components of the vascular wall will open up new perspectives in the treatment of the majority of thrombotic disorders, such as ACSs, stroke, and peripheral artery diseases before and after the acute event. In the present review, we will discuss the novel role of noncoding RNAs in modulating platelet function, highlighting the possible implications in activation and aggregation.

Influence of premorbid psychosocial stressors on chronic localized pain syndromes clinical characteristics (observational study)

Introduction. It is now recognized that stress plays an important role in the occurrence and exacerbation of chronic pain syndromes. Stress has a modulatory effect on the structures of the nervous system depending on the nature, duration and intensity of the stressor which is reflected in the clinical characteristics of pain.Aim. To study the features of the clinical characteristics of chronic localized pain syndromes depending on the presence of psychosocial stressors at the onset of pain.Materials and methods. The study included 118 patients with chronic localized pain syndromes 38 men (32.2%) and 80 women (67.8%) aged 19 to 66 years (mean age 41 ± 11 years). Depending on the presence of premorbid psychosocial stressors at the onset of pain patients were divided into two groups group I (main), group II (control). The research methods included a general clinical assessment of the pain syndrome characteristics, an assessment of the emotional state, psychosocial indicators and quality of life using special scales and tests. Statistical analysis was carried out using the StatTech v. 2.6.1.Results. Patients of group I experience more than 4-6 episodes of exacerbations per year, the duration of pain is from 8 to 28 days, affecting an average of 4 (3; 6) localizations, using more descriptors (p &lt; 0.001, p = 0.013, p = 0.014, p=0.017, p=0.002 resp.), more likely to suffer from headaches and cervicalgia (p = 0.004 and p &lt; 0.001 resp.), use on average 4 (2; 5) drug group for pain relief (p = 0.004). Among patients with premorbid psychosocial stressors the proportion of women is 6.5 times higher (p &lt; 0.001). A significantly greater number of patients with sleep disorders and anxiety were identified in group I (p &lt; 0.001, p = 0.009 respectively), the total score in assessing fatigue was 24 (19; 39) points which corresponds to moderate fatigue (p = 0.009). The average stress score on the Holmes-Rahe scale was 80 (53; 102) (p &lt; 0.001), the main stressful events are work-related problems. Direct statistically significant relationships between the level of stress and the characteristics of the pain syndrome were established the number of pain localizations, the intensity of pain, the number of descriptors (p &lt; 0.001, p &lt; 0.001, p &lt; 0.001). The life quality index was 2 (2; 4) scores according to the EQ-5D-3L questionnaire which indicates a decrease in the quality of life (p &lt; 0.001) in group I. It was noted that the chances of stress onset of pain in an active lifestyle are 3.4 times lower (p = 0.012).Conclusion. Premorbid psychosocial stressors are markers of the severity of chronic pain and affective distress. At the same time premorbid psychosocial stressors can be considered a modifiable factor. If it is assessed and recognized in time, the development of chronic pain and associated affective distress can be eliminated and potentially prevented.

Prevalence of neuropsychiatric disorders in internally displaced persons with dementia during wartime in Ukraine

IntroductionDuring the second wave of Russia-Ukraine war, around 8 million were internally displaced. Negative mental health impact of the war cannot be underestimate. Among internally displaced persons (IDPs), particularly vulnerable category is people with neurocognitive deficits. Stress associated with displacement may cause a change not only in cognitive functions, but also affect the onset or evaluation of behavioral and psychological symptoms.Objectivesto study the prevalence of neuropsychiatric disorders in hospitalized patients with dementia, who were internally displaced and to compare with general population frequency.Methods64 IDPs with dementia (moderate and severe neurocognitive deficits) who were examined during March-September 2022. Cases of newly arrived persons were taken into account, after 1 to 30 days had passed since their relocation. The diagnosis was verified based on the ICD-10 criteria (F00-F01). The degree of neurocognitive deficit was determined using the MMSE and MoCA tests. Affective pathology was studied using the HAM-D, HAM-A, PHQ-9, AES scales. Psychotic symptoms and behavioral disorders were studied based on clinical examination and medical records. The study was conducted in Lviv Regional Psychiatric Hospital.Resultsamong the examined patients, 60 (94% of all examined) had neuropsychiatric disorders. Among this sample, neuropsychiatric symptoms (an isolated symptom or a combination of two or more symptoms) occurred with the following frequency: apathy 16 (26.7%), anxiety49 (81.7%), depressive symptoms 32 (53.3%), agitation and aggression 41 (68.3%), hallucinatory symptoms 8 (13.3%), delusional disorders 34 (56.7%), wandering and disorientation 18 (30%), refusal of food and medicine 12 (20%)Image:ConclusionsIn this study the frequency of occurrence of certain neuropsychiatric syndromes among IDPs with dementia differed from the studied average frequency of occurrence of the same symptomatology among the general population. In particular, anxiety symptoms among IDPs with dementia occurred 42% more often than on average among patients with dementia in the general population (with a frequency of 81% vs 39%), agitation and aggression - 28% more often (68% vs 40%), and delusions - 16% more often (57% vs 31%). At the same time, symptoms such as apathy (by 19%) and refusal to eat (by 14%) were observed less often among IDPs with dementia than among dementia patients from the general populationDisclosure of InterestNone Declared

Intra-uterine diazepam exposure decreases the number of catecholaminergic and serotoninergic neurons of neonate rats

Benzodiazepines, such as diazepam (DZP), are used to treat anxiety disorders, and are prescribed to pregnant woman for therapeutic purposes. Concerns regarding their consequences on postnatal development rise as they cross the placenta and interact with the embryo. Occurrence of malformation and behavioral syndromes have been reported for different ages, but little is known about their effects on the brain after exposure during intrauterine life. Thus, we sought to evaluate the effects of intrauterine exposure to DZP on the number of brainstem’s catecholaminergic and serotonergic neurons, implicated in respiratory control, in male and female rats on postnatal (P) day 12–13, using immunofluorescence labeling for tyrosine–hydroxylase (TH) and serotonin (5–HT). We observed a reduction in the number of catecholaminergic neurons for males and females. Special attention is given to the reduction in the density of neurons in the A6 region, involved in ventilatory responses to CO2. Interestingly, only males showed a reduction in the number of serotonergic neurons, while females were not affected. These findings suggest that in utero exposure to DZP results in deleterious neuroanatomical effects on P12–13 rats and raises a note of concern for women clinicians to make more informed choices about the use of anxiolytic treatments during gestation.

Abstract 15552: Optimal Virtual Monoenergetic Settings in Spectral Ct With a Dual Layer Detector: Breakthrough in Achieving Best Contrast Between Non Calcified and Calcified Plaques and Lumen in Coronary Arteries

Introduction: Non calcified plaque (NCP) in coronary arteries on CT is correlated with occurrence of acute coronary syndromes and coronary artery calcification (CAC) may occasionally be co-existed. CAC induces a blooming artifact, which magnifies the calcification versus its actual size. The CT values of NCP and CAC are influenced by tube kilovoltage (kV). Recent spectral CT with a dual-layer detector can generate CT images at any kiloelectron voltage (keV) (range: 40-200) after ordinary acquisition using virtual monoenergetic settings (VMS). Hypothesis: Using a new spectral CT, we can determine the optimal VMS settings for achieving best contrast between NCP, CAC and the lumen in coronary arteries. Methods: We performed enhanced 128 slice Spectral CT 7500 scans using a dual-layer detector in 42 patients with NCP and CAC on CT (tube voltage: 120 kV). After scanning, VMS images at various keV values were created from the spectral-based images. We measured the mean CT values of NCP and CAC, lumen in left main artery (LMA), and fat tissue around coronary arteries within a 1.0 mm2 circle in the axial images at each keV in early phase with a contrast. Results: Lower keV values were linked to only slightly increased mean CT values of NCP, but markedly increased mean CT values of CAC. The CT values of the lumen in the LMA were markedly increased. Conversely, the CT values of fat tissue were slightly decreased. The greatest differences in mean CT values between NCP and the LMA were observed at 40 keV. However, considering blooming artifact of CAC at 40 keV, the optimal keV for achieving the best contrast between the CT values of NCP and the lumen in the LMA was influenced by age, male sex. Conclusions: The NCP in coronary arteries, CAC, lumen of the LMA, and fat tissue exhibit unique characteristics. When conventional CT rather than spectral CT is used to evaluate the occurrence of NCP, it is necessary to determine the optimal tube voltage based on the age and male sex of the patient, CAC, and lumen of the LMA.