Patient Histories Research Articles

Effectiveness of eradication therapy for Hp infection of residents of Perm and the Perm region

Purpose: to evaluate the effectiveness of eradication therapy for Hp infection in Perm and the Perm region. Materials and methods: a retrospective analysis of 88 case histories of patients who underwent eradication of Hp infection was carried out at the Perm Medical Center (GASTROCENTER). Primary infection with H. pylori was confirmed by: serological blood test or determination of Hp antigen in feces, rapid urease test, and C13 urease breath test. Hp eradication therapy regimens, depending on the source of prescription, included standard triple therapy with the addition of bismuth preparations for a period of 14 days (main group) or 7-10-day triple therapy (control group). Results and discussion: the main indications for Hp eradication were: chronic gastritis and gastroesophageal reflux disease. In the main group, all patients received Hp eradication therapy with the inclusion of: esomeprazole (emanera) 40 mg, amoxicillin 1000 mg, clarithromycin (fromilid) 50 mg and bismuth tripotassium dicitrate (ulcavis) 240 mg twice a day for 14 days. The control group included patients who received Hp eradication schemes with various proton pump inhibitors, amoxicillin and clarithromycin or metronidazole or levofloxacin or even rifaximin for 7 or 10 days. Adverse events: abdominal pain and diarrhea occurred in both groups. Patients of the main group complained about bitterness in the mouth, where all patients received clarithromycin. Approximately the same small number of patients complained of nausea. With a differentiated assessment by groups, in the main group, Hp eradication was highly effective and reached 93%, while in the control group it was significantly lower and did not exceed 48% (p=0,00087) Conclusions: modern detection of Hp infection and its eradication is an effective approach to the prevention of atrophic gastritis, gastric cancer and peptic ulcer of the stomach and duodenum. The “gold” standard for diagnosing Hp infection is the 13C-urease breath test. For residents of Perm and the Perm Territory, it is recommended to use Hp eradication with the appointment of a 14-day regimen with the inclusion of esomeprazole (Emaner), clarithromycin (Fromilide), amoxicillin and bismuth tripotassium dicitrate (Ulkavis) as the first line of therapy.

Aspects of the development of hypothyroid cardiomyopathy associated with chronic systemic inflammation

Background. Cardiovascular manifestations are rated first among the symptoms of hypothyroidism. Since the highest prevalence of both coronary heart disease (CHD) and hypothyroidism is observed in the age group over 50 years old, the problem of combination of these nosologies in older people is increasing. Aim of the study is to investigate the structural and functional state of the left ventricular myocardium in hypothyroidism and CHD associated with chronic systemic inflammation. Materials and methods. To reach the objectives of the study, a randomized controlled clinical trial has been conducted in parallel groups of patients with hypothyroidism, CHD and combination of both. To form the main group, a screening analysis of 556 medical histories of patients with hypothyroidism and CHD during the period of 2006–2015 has been made, which were selected for further study. Results. It has been found that myocardial hypertrophy develops in all groups of patients, a decrease in thyroid function leads to remodeling of the left ventricular myocardium with the development of eccentric hypertrophy and the progression of systolic heart failure in comorbidity. A direct correlation between reduced ejection fraction and elevated interleukin-8 level has been detected. Evaluation of the state of chronic systemic inflammation revealed a significant increase in the level of interleukin-8 in patients with coronary heart disease associated with hypothyroidism (7.66 ± 2.18 pg/ml; p < 0.05). This indicate that the persistence of pro-inflammatory state in patients with combined pathology is a negative prognostic factor for the development of cardiovascular complications. Conclusion. During echocardioscopy of patients with hypothyroidism, the impaired central hemodynamics can be determined by the indicators of the diastolic and systolic heart function. In patients with isolated hypothyroidism and in combination with coronary heart disease, thickening of the left ventricular myocardial walls is noted, which proves the specificity of changes in the heart geometry that leads to the development of eccentric hypertrophy. This can be considered as the marker of a “hypothyroid” heart whose severity can determine the severity of hypothyroidism. Activation of chronic systemic inflammation is more pronounced in conditions of comorbidity, with a negative prognostic effect on the state of the cardiovascular system.

Co-Expression of Multiple PAX Genes in Renal Cell Carcinoma (RCC) and Correlation of High PAX Expression with Favorable Clinical Outcome in RCC Patients.

Renal cell carcinoma (RCC) is the most common form of kidney cancer, consisting of multiple distinct subtypes. RCC has the highest mortality rate amongst the urogenital cancers, with kidney renal clear cell carcinoma (KIRC), kidney renal papillary cell carcinoma (KIRP), and kidney chromophobe carcinoma (KICH) being the most common subtypes. The Paired-box (PAX) gene family encodes transcription factors, which orchestrate multiple processes in cell lineage determination during embryonic development and organogenesis. Several PAX genes have been shown to be expressed in RCC following its onset and progression. Here, we performed real-time quantitative polymerase chain reaction (RT-qPCR) analysis on a series of human RCC cell lines, revealing significant co-expression of PAX2, PAX6, and PAX8. Knockdown of PAX2 or PAX8 mRNA expression using RNA interference (RNAi) in the A498 RCC cell line resulted in inhibition of cell proliferation, which aligns with our previous research, although no reduction in cell proliferation was observed using a PAX2 small interfering RNA (siRNA). We downloaded publicly available RNA-sequencing data and clinical histories of RCC patients from The Cancer Genome Atlas (TCGA) database. Based on the expression levels of PAX2, PAX6, and PAX8, RCC patients were categorized into two PAX expression subtypes, PAXClusterA and PAXClusterB, exhibiting significant differences in clinical characteristics. We found that the PAXClusterA expression subgroup was associated with favorable clinical outcomes and better overall survival. These findings provide novel insights into the association between PAX gene expression levels and clinical outcomes in RCC patients, potentially contributing to improved treatment strategies for RCC.

EMPIRIC ANTIBIOTIC THERAPY OF ACUTE INFLAMMATORY PROCESSES OF THE FACE AND NECK IN CHILDREN AT THE OUTPATIENT STAGE, BASED ON THE RESULTS OF BACTERIOLOGICAL MONITORING OF THE DEPARTMENT OF MAXILLOFACIAL SURGERY.

Based on the analysis of bacteriological cultures of the wound discharge according to archival data of the case histories of patients with acute inflammatory processes of the face and neck on the basis of the Department of Maxillofacial Surgery of the Voronezh Regional Children's Clinical Hospital No. 2, data were obtained on microbiological pathogens and their sensitivity to various antibacterial drugs. Monitoring was carried out and the pathogen was classified in the main inflammatory processes of the face and neck in children from 1 to 15 years old. Based on the results obtained, we have developed and proposed schemes for empirical antibiotic therapy for use by pediatric dentists and pediatricians on an outpatient basis. The most relevant for outpatient applications are oral antibiotics with high bioavailability and efficacy against etiological pathogens.

Acute (profuse) hemorrhoidal bleeding

Objective. Hemorrhoids is one of the most common diseases in adult coloproctological practice, the main manifestation of which is bleeding of different degree of activity and complexity. The aim of the study was to analyze the results of diagnostics and treatment of patients with different stages of hemorrhoids for 3 years. Materials and methods. The results of diagnostics and treatment of patients with different stages of hemorrhoids treated in the coloproctological unit for 3 years (20192021) were analyzed. Results. The article considers the hemorrhoidal bleeding and the possibility of classification to optimize treatment; an algorithm used for rendering medical care to this group of patients is presented. The case histories of patients with hemorrhoids, treated at the First Republican Clinical Hospital of Udmurt Republic, were analyzed. Conclusions. Patients with profuse hemorrhoidal bleeding need hospitalization to the resuscitation unit, immediate identification and treatment of hemorrhagic shock. The offered protocol (algorithm) of managing patients permitted to work in a team, improve the quality of rendering medical care to patients with profuse hemorrhoidal bleeding and avoid lethal outcomes.

Clinical and Epidemiological Characteristics of Scarlet Fever in Russia

Relevance. In recent decades, large outbreaks of scarlet fever have been reported in European and Asian countries. Severe forms of the infection have become more frequent and the number of complications has also increased.Aim. To assess the incidence of scarlet fever in the Russian Federation using the official statistical sources, to identify the clinical features of scarlet fever among adults.Materials and methods. Analysis of the level and dynamics of the long-term incidence of scarlet fever in the entire population and among different age groups in Russia from 1890 to 2021 was performed based on the data of annual statistical forms. A clinical and epidemiological descriptive retrospective census study was conducted using data from the case histories of patients diagnosed with “scarlet fever” in The Infectious Disease Clinical Hospital No. 2 Moscow Healthcare Department from 2010 to 2022.Results. Three major cycles (40-50 years) can be distinguished in the long term with regard to incidence. In 1986, the rise in incidence was noted after 30 years since the previous one and it was less intensive. In the first cycle, rates increased gradually over almost 10 years beginning from 1891. In subsequent years, the incidence remained high (220-280 per 100,000), decreasing markedly to 50-60 per 100,000 population only by 1917-1918. The second cycle, from 1918 to 1942, was characterized by increasing rates (up to 462 per 100,000 population). In the third cycle (1946 - 1981), incidence rate reached a peak by 1955 (531.8 per 100,000 population), and started to gradually decrease afterwards. There were cycles lasting 3–6 years in in this period The fourth cycle (1982-1991) was not so large. In recent years (2007–2021), the incidence decreased 7.3 times (from 45.4 to 6.2 per 100 thousand). The average incidence rate during this period was 29.8 per 100 thousand. In 2022, the incidence of streptococcal infection increased 2.8 times (including scarlet fever – 3 times). The incidence increases were observed in the group 0-14 years and 14 and older (from 298,2 to 34,1 and from1,6 to 0,1respectively). As in the previous years (fourth cycle), children aged 3-6 years were the main contributors to the incidence of scarlet fever (the average incidence rate – 452,1 per 100,000). The average age of patients admitted to the hospital was 24 years (18–45 years). There was an increase in the average age of patients since 2017. During the study period, the number of hospitalized adults with scarlet fever decreased by half. In most cases (98.56%) the patients had a moderate condition at admission and only 3 had a severe condition (1.44%). The most common comorbid diagnoses were ENT-organs infections (9%), urinary tract infections (3.35%) and Wolf-Parkinson-White syndrome (2.87%). Scarlet fever had a complicated course of infection in 19 patients (9.09%). In the treatment were used cephalosporin (52.63%) and penicillin (41.63%).Conclusions. This study demonstrated a stable downward trend in the incidence of scarlet fever in the population of the Russian Federation in recent years until 2021. In 2022, the incidence increased 3 times (18.7 per 100 thousand). The number of hospitalizations among adults with scarlet fever and the number of patients with complications have decreased. The average age of patients by 5 years have increased. The treatment was carried out in accordance with clinical recommendations and the antibiotic resistance of the pathogen.

CHANGES IN MARKERS OF NEURO-IMMUNE DISINTEGRATION IN THE SUB-ACUTE PHASE OF ISCHEMIC STROKE

Background. The increase in the prevalence of CVZ gives reasons to consider the problem of combating stroke as a priority area of treatment and prevention work of medical workers all over the world.
 Aim: assessment of the role of changes in markers of neuroimmune disintegration in the acute phase of ischemic stroke.
 Material and methods. The study was conducted on the basis of the clinical units of the Medical Institute of the Black Sea National University named after Peter Mohyla (Mykolaiv, Odesa) in 2020-2022. At the first stage, a retrospective analysis of 150 disease histories of patients who underwent II and were undergoing rehabilitation at the "Expert Health" medical center was carried out. At the second, prospective stage, 28 patients who had II in the subacute period were examined with an in-depth immunological examination. An analysis of the dynamics of leukogram indicators, CRP, procalcitonin and other markers of inflammation was carried out. At the prospective stage, the blood content of pro-inflammatory cytokines (TNF, IL1, IL2, Il6) and anti-inflammatory cytokines (IL4, IL10) was additionally determined. Statistical processing was carried out by methods of dispersion and correlation analysis using Statistica 14.0 software (TIBCO, USA).
 Results. According to the retrospective analysis, the severity of changes in leukogram and CRP content correlated with the severity of II (r=0.11-0.29). With an average NIHSS score of 10.8±0.9, the content of lymphocytes in the peripheral pool averaged 17.3±0.4%, while the total content of leukocytes was 9.4±0.2 G/l. 76 (50.7%) patients had records in their medical records regarding the assessment of the CRP level, which averaged 7.7±0.9 mg/l. In 72.7% of patients, manifestations of atherosclerosis of brachiocephalic vessels were determined, including in 31.3% - signs of critical stenosis of the carotid arteries. When comparing the levels of CRP and the severity of the atherosclerotic process, a positive correlation of average strength was found (r=0.31).
 It is shown that in the subacute period at the stage of rehabilitation, the leukogram normalizes, the manifestations of the systemic inflammatory response decrease. At the same time, there are signs of stress on neuroimmune regulatory mechanisms and the need to monitor inflammatory biomarkers both in the acute and subacute stages of stroke.
 Conclusions. The expressiveness of changes in leukogram and CRP content correlates with the severity of II, and high levels of CRP are a predictor of an adverse clinical outcome. When comparing the levels of CRP and the severity of the atherosclerotic process, a positive correlation of average strength was found (r=0.31). With an ischemic stroke, neuroimmune regulatory mechanisms are stressed in the subacute stage of the disease. It is advisable to monitor inflammatory biomarkers both in the acute and subacute stages of stroke.

Методи лікування кіст щелеп у дітей. Ретроспективний аналіз

Odontogenic cysts of the jaws are one of the most common tumour-like neoplasms of the maxillofacial region in children. Today, there are various methods of treating cysts, but in childhood, the problem of choosing a treatment method is relevant and at the same time difficult, as some authors prefer cystectomy, while others prefer cystotomy. Purpose - to analyze the methods of treatment and management of jaw cysts in children depending on the type of cyst. Materials and methods. A retrospective analysis of 286 case histories of patients with jaw cysts aged 4 to 17 years was performed. The case histories were analysed according to the developed examination chart. Results. A retrospective analysis of 286 case histories of children with jaw cysts was performed. The age of the children ranged from 4 to 18 years. Radicular dentoalveolar cysts were diagnosed in 35% (n=100) of cases, radicular cysts - in 36% (n=104), follicular cysts - in 15% (n=43), suppurative cysts - in 5% (n=14), residual cysts - in 5% (n=14), primary bone cysts - in 3% (n=7), polycystic cysts - in 2% (n=4). Cystotomy was performed in the vast majority of cases - 58% (n=166), cystectomy - in 42% (n=120). Tamponade was performed in 63% (n=181) of cases, and in 37% (n=105) it was not performed. Conclusions. Radicular cysts are the most common odontogenic cysts of the jaws. Cystotomy and cystectomy are variable methods of cyst treatment. The most common method of treating cysts in children is cystotomy. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Quantifying Healthy Aging in Older Veterans Using Computational Audio Analysis.

Researchers are increasingly interested in better methods for assessing the pace of aging in older adults, including vocal analysis. The present study sought to determine whether paralinguistic vocal attributes improve estimates of the age and risk of mortality in older adults. To measure vocal age, we curated interviews provided by male U.S. World War II Veterans in the Library of Congress collection. We used diarization to identify speakers and measure vocal features and matched recording data to mortality information. Veterans (N = 2 447) were randomly split into testing (n = 1 467) and validation (n = 980) subsets to generate estimations of vocal age and years of life remaining. Results were replicated to examine out-of-sample utility using Korean War Veterans (N = 352). World War II Veterans' average age was 86.08 at the time of recording and 91.28 at the time of death. Overall, 7.4% were prisoners of war, 43.3% were Army Veterans, and 29.3% were drafted. Vocal age estimates (mean absolute error = 3.255) were within 5 years of chronological age, 78.5% of the time. With chronological age held constant, older vocal age estimation was correlated with shorter life expectancy (aHR = 1.10; 95% confidence interval: 1.06-1.15; p < .001), even when adjusting for age at vocal assessment. Computational analyses reduced estimation error by 71.94% (approximately 8 years) and produced vocal age estimates that were correlated with both age and predicted time until death when age was held constant. Paralinguistic analyses augment other assessments for individuals when oral patient histories are recorded.

Rational Therapeutic Approaches for the Management of Congestive Cardiac Failure

Background: Heart failure is a serious and progressive condition where the heart's ventricle fails to pump sufficient blood to the body's tissues. Flaws in the rationality of medication use, particularly with narrow therapeutic index drugs like digoxin, have been observed. These include multiple drug-drug interactions, polypharmacy, and therapeutic duplication. Pharmacists play a crucial role in minimizing medication errors through dose adjustments, patient counseling, and ensuring proper administration. Aims and Objectives: The objective of this project was to assess the appropriateness of recommended pharmacotherapies and their implementation in a clinical setting, focusing on drug-drug interactions, polypharmacy, contraindications, and untreated conditions. Study Design: For this study, a specialized questionnaire-based approach was used to gather data on congestive heart failure (CHF) patients. The collected information included patient demographics (name, gender, and age), chief complaints, co-morbidities, past medical and medication history, biochemical tests, diagnosis, social history, allergies, family history, and past surgeries. Materials and Methods: From a collection of 20 patient histories, it was observed that the majority of cases involved congestive heart failure (43.57%), followed by left ventricular dysfunction (30.35%), myocardial infarction (17.23%), and atrial fibrillation (8.71%) as the primary causes of hospitalization. Among the patients, co-morbidities such as diabetes mellitus (31.71%) and hypertension (25.23%) were prevalent. The collected data was regularly examined and analyzed. Results were evaluated based on ±SD (Standard). Results and Conclusion: In this study, 60 drugs were identified as contraindicated for patients, and some drugs required monitoring due to their profiles. Among the identified drug-related errors, 56.66% were attributed to drug interactions, often resulting from the simultaneous prescription of two interacting drugs. The incidence of polypharmacy was found to be 8.88%. Narrow therapeutic index drugs accounted for 5.55% of the medications, which were not adequately monitored. The analysis revealed that 33.35% and 25.80% of patients had diabetes and hypertension, respectively, in addition to heart failure. Heart failure was most commonly observed in individuals aged 51-60 years. The study highlighted several irrationalities in prescription practices, including inadequate dose adjustment for patients with chronic renal failure, polypharmacy, drug duplication, adverse drug reactions, cost-related issues, unavailability of therapeutic alternatives, and lack of monitoring for narrow therapeutic index medications.

The effect of neoadjuvant treatment on postoperative morbidity in upper rectal cancer

Background. The need of neoadjuvant treatment for upper rectal cancer remains the object of discussion, which makes further study of this topic important.Аim. To estimate the postoperative complications rate depending on the type of neoajuvant treatment.Materials and methods. A retrospective cohort multicenter study, that analyzed data of medical records of patients with upper rectal cancer from the archive of N.N. Blokhin Cancer Research Center of the ministry of Health of Russia, Ryzhikh national medical Research Center of Coloproctology of the ministry of Health of Russia and Stavropol Regional Clinical Oncology Center for 2007–2020. Patients were devided into 3 groups: the group of radiotherapy (5*5 gy), the group of neoadjuvant chemotherapy (4 courses of XELOX before surgery) and the group of surgery. The main endpoint was the study of anastomotic leak rate. Also we estimated the postoperative complications rate III–Iv degree (Clavien– Dindo), the sphincter-preserving surgery rate, the stoma creation rate, the postoperative mortality.Results. we included 110 patients in radiotherapy group, 188 patients in neoadjuvant chemotherapy group, 103 patients in surgery group. Study groups were comparable by sex, ASA status and histological grade. Postoperative grade III– Iv complications (in all cases were associated with anastomotic leak) developed in 8 (6.8 %) patients in neoadjuvant chemotherapy group versus 11 (10.0 %) patients in radiotherapy group (p = 0.379) and 12 (11.7 %) patients in surgery group (p = 0.208). There weren»t any significant differences in this parameter between the radiotherapy and the surgery group (p = 0.698). R0-resection was performed in 117 (99.2 %) patients in neoadjuvant chemotherapy group versus 107 (97.3 %) patients in radiotherapy group (p = 0.280) and 103 patients (100 %) in surgery group (p = 0.349). Radiotherapy and surgery groups didn’t differ significantly in R0-resection rate (p = 0.091). 1 patient (0.84 %) in neoadjuvant chemotherapy died before surgery, in other groups there weren’t any lethal outcomes (p = 0.283). Only the male sex, had a statistically significant effect on the anastomotic leak rate (risk ratio (HR) 2.875; 95 % confidence interval (CI) 1.24–6.63; p = 0.003).Conclusions. A study of these case histories of patients with cancer of the upper ampullary rectum, conducted by us, showed that neoadjuvant treatment didn»t affect the postoperative complications rate.

Methods of early diagnosis and pharmacological prevention of pancreatitis after endoscopic papillosphincterotomy

Introduction. The most frequent complication of endoscopic papillosphincterotomy (EPST) is acute pancreatitis. This complication is supposed to be based on mechanical, chemical, hydrostatic, enzymatic and thermal impact on pancreatic ducts and parenchyma. According to different literature data, the incidence of post-EPST pancreatitis (PEP) varies from 30 to 40 %, and the mortality rate is 2–10 %.The aim of the investigation was to expand information about peculiarities of early diagnostics and prevention of post-EST pancreatitis at the present stage.Materials and methods. To reach the set goal we analyzed 559 case histories of patients with diagnosed cholelithiasis, 319 of them underwent EPST.Results. During the study it was found out, that elevated neutrophils/lymphocytes ratio over 4,96 (p = 0,001), high LDH level over 250 IU/ml (p = 0,01), as well as Creactive to albumin index over 0,180 (p = 0,001) are reliable markers of early diagnosis. Also, indirect diagnostic markers of PEEP are biochemical signs of cholestasis and cytolysis of hepatocytes, as well as hyperglycemia combined with glucosuria. We consider the inclusion of intraoperative injections of papillotomy wound margins with Epinephrine in combination with subsequent Somatostatin administration in combination with rectal Diclofenac and intravenous hydration with Reamberin to be the most effective strategy for PEP prevention.Conclusions. Thus, we can conclude that despite the ongoing research and the search for effective algorithms for the prevention and early diagnosis of PEP, their data often contradict each other or simply do not confirm their effectiveness. The problem of prevention and diagnosis of PEP remains complex and requires further study. There are discrepancies, sometimes significant ones, in the current literature, which provides grounds for the development and research of new methods of early diagnosis and prevention.

IoT-based patient monitoring system for predicting heart disease using deep learning

Motivation: Chronic diseases include diabetes, cancer, heart disease (HD), and chronic respiratory diseases are the main causes of mortality globally. It is quite challenging to identify heart diseases when the symptoms or characteristics vary. In the contemporary digital environment, the healthcare sector produces a considerable volume of patient data. For doctors, manually processing these created data becomes exceedingly challenging. The Internet of Things is handling the generated data quite well. It provides continuous communication between individuals and devices, and its fusion with the Cloud enhances the quality of life. Materials and Methods: Deep learning, a branch of machine learning, has the transformational ability to rapidly and reliably analyse massive amounts of data, produce insightful conclusions, and effectively resolve complex problems. Massive volumes of data were collected by the IoT, and because of deep-learning algorithms, it is now possible to identify and diagnose diseases. The suggested approach collects information from IoT devices, and electronic medical evidence connected to patient histories that are stored in the cloud are sent to predictive analytics. Results and Conclusion: The Long Short Term Memory (LSTM) and Recurrent Neural Network based smart healthcare system for monitoring and precisely forecasting heart diseases obtains an accuracy of 99.99%, which is substantially superior to the current smart heart disease prediction systems such as traditional methods.

Risk factors of local recurrence and distant metastasis and manifestations of toxicity during chemoradiation treatment of cervical cancer patients

Relevance. Cervical cancer remains one of the most common malignancies in women worldwide, despite declining mortality rates due to large-scale screening programs and increased use of the human papillomavirus vaccine in Western countries. Although chemoradiotherapy has been recognized as the standard therapy for patients with locally advanced carcinoma, one-third of patients experience recurrence, and the effect of its treatment is far from satisfactory. In addition, factors affecting prognosis for patients with cervical cancer remain controversial. In connection with the above, research devoted to the analysis of the long-term clinical consequences of cervical cancer treatment and the search for prognostic factors remains extremely relevant.&#x0D; The purpose of the work is to determine the risk factors of local and distant metastasis and manifestations of toxicity during chemoradiation treatment of cervical cancer patients.&#x0D; Materials and methods. Paper case histories of non-operated patients with locally disseminated сervical cancer (stages 2B–4А) who underwent special treatment in the clinic of the institute in the period 1999–2020 were selected from the archive of the State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine» for inclusion in the electronic database. The selection criterion was either a follow-up period of more than 1 year, or a tracked recurrence of the disease within a period of up to 1 year. The end of observation was considered either the death of the patient, or the appearance of oncological consequences of the disease, or withdrawal from observation for unknown reasons (censored observations). The WizWhy package of the Data Mining category was used to conduct the research and propose hypotheses, followed by hypothesis testing by non-parametric statistical methods using the STATISTICA and SPSS general-purpose software package. Non-parametric methods were used – Pearson’s chi-squared test and the Mann–Whitney U-test.&#x0D; Results and discussion. A number of parameters and factors that have predictive properties regarding the risk of the appearance of oncological consequences of treatment in the future have been identified. The main immediate and remote consequences of chemoradiation treatment of patients and remote somatic consequences of combined treatment were analyzed.&#x0D; Conclusions. Catamnetic data of «processed» case histories, provided they are processed by appropriate mathematical methods, are a potential source for obtaining new non-obvious knowledge. In particular, the correct analytical approach to the processing of formalized medical history data made it possible to find a number of risk factors for local and distant metastasis and manifestations of toxicity during chemoradiation treatment of non-operated patients with locally disseminated cervical cancer, which creates the basis for the development of proposals for adjusting antitumor therapy and individualized patient support.

#4274 CLINICAL FEATURES AND OUTCOMES OF COVID-19-ASSOCIATED ACUTE KIDNEY INJURY REQUIRING DIALYSIS: EXPERIENCE FROM THE FIRST COVID-19 HOSPITAL IN SERBIA

Abstract Background and Aims The new coronavirus disease (COVID-19) pandemic faced the healthcare sector worldwide with an unprecedented challenge. Although respiratory failure is the main feature of the disease, renal involvement is also common, particularly in critically ill patients, and often requires urgent dialysis treatment. This study aimed to analyse clinical features and risk factors for poor outcomes in patients with COVID-19-associated acute kidney injury (AKI) requiring dialysis. Method All 98 patients included in this retrospective observational study were treated in the first hospital in Serbia transformed to exclusively admit COVID-19 patients at the onset of the epidemic. Data were collected from clinical charts and patient histories for the period between March 19, 2020, and March 19, 2022, and analysed with SPSS software, version 22 (IBM Corporation, New York, USA). Results Out of 6,540 non-pregnant adult patients hospitalized for COVID-19 (1,955 in the intensive care unit) in the observed period, 98 (85.7% male, age range 25-89 years) developed dialysis-requiring AKI. A total of 312 hemodialyses (HD) treatments were performed (3.18±2.39, range 1-12, per patient), mostly intermittent HD (85.7% of patients) pertaining to technical resources. The majority of patients (90.8%) had at least one comorbidity – hypertension (38.8%), diabetes (28.6%), cardiovascular disease (11.2%), cerebrovascular disease (3.1%), chronic respiratory disease (7.1%), malignancy (6.1%), or autoimmune disease (1.0%). Most patients (90.8%) required mechanical ventilation. Only 8 (8.2%) were vaccinated. Nearly half (49.0%) of the patients had bilateral pneumonia and 2.0% had ARDS at presentation, with an average CT severity score of 14.05±6.72 (range 1-25) at presentation. Time to AKI presentation was 8.96±5.14 days (range 2-25). The overall mortality rate was 91.8%. Surviving patients had significantly more HD procedures performed (5.00±2.39 vs 3.02±2.34; P = .024) and significantly lower procalcitonin level (1.89±0.16 ng/mL vs 6.14±9.57 ng/mL; P = .015) at presentation. Fatal outcome was significantly more common in individuals requiring mechanical ventilation (p&amp;lt;0.001). Other demographic (age, sex, smoking habit), clinical (comorbidities, vaccination status, radiographic finding, CT severity score, time to AKI onset, type of dialysis) and laboratory parameters (WBC, neutrophil/lymphocyte ratio, CK, LDH, urea, creatinine, CRP, IL-6, D-dimer, ferritin) were not significantly associated with adverse outcome. Multiple logistic regression showed that fewer HD procedures were significantly associated with a higher mortality rate (OR 0.77, 95% CI 0.60-0.99, P = .039). Conclusion Patients who develop dialysis-requiring AKI in the setting of COVID-19 have an extremely high mortality rate. Higher procalcitonin, the need for mechanical ventilation and a lower number of HD procedures are significantly associated with fatal outcomes in this population.

#4153 OUTCOMES OF COVID-19 INFECTION AMONG MAINTENANCE HEMODIALYSIS PATIENTS – EXPERIENCE FROM THE FIRST COVID-19 HOSPITAL IN SERBIA

Abstract Background and Aims Patients on maintenance hemodialysis (HD) might be particularly vulnerable to severe COVID-19 due to their older age and numerous comorbidities. Furthermore, their specific treatment regimen substantially exposes them to the risk of infection. The abrupt onset of the novel coronavirus disease (COVID-19) pandemic required prompt action and immediate reorganization of healthcare services while maintaining the necessary standard of treatment for chronic patients. In this study, we aimed to analyze clinical features and risk factors for poor outcomes in maintenance HD patients with COVID-19. Method We analyzed data for 226 maintenance HD patients (67.7% male, age range 25 – 90 years, time on dialysis 6 – 278 months) who contracted COVID-19 in their original dialysis units and were therefore transferred for further HD treatment to the first hospital in Serbia transformed to exclusively admit COVID-19 patients at the onset of the epidemic. According to the local protocol, all patients were hospitalized while being dialyzed. Data were collected from clinical charts and patient histories for the period between March 19, 2020, and March 19, 2022, and analysed with SPSS software, version 22 (IBM Corporation, New York, USA). Results A total of 1384 HD treatments were performed in 226 patients (6.12±4.50, range 1 – 34 per patient). Most patients (98.7%) had at least one comorbidity: hypertension (68.1%), diabetes (26.1%), cardiovascular disease (16.4%), cerebrovascular disease (7.5%), malignancy (9.3%), chronic respiratory disease (4.0%) or autoimmune disease (1.8%). The average number of comorbidities was 1.9±1.0 (range 0 – 4). Only 2.2% of all patients were vaccinated. Most patients (78.0%) had bilateral pneumonia upon admission, 15.3% had normal pulmonary X-ray, 5.1% had unilateral pneumonia and 1.7% had ARDS. 34% of the patients required mechanical ventilation. Fifty-seven patients (25.2%) received corticosteroid therapy, 5.3% were treated with chloroquine, 2.7% received antiviral therapy and 1.8% were administered IL6 antagonist. The overall mortality rate was 39.4%. Patients who died were significantly older (67.6±12.4 vs 63.2±12.7; p = 0.012), more often had cardiovascular disease (p = 0.046) and bilateral pneumonia (p&amp;lt;0.001), had worse CT severity score (13.0±5.1 vs 9.2±5.0; p&amp;lt;0.001) and required invasive mechanical ventilation (p&amp;lt;0.001) and had fewer HD treatments performed during hospitalization (5.1±4.8 vs 6.8±4.2; p = 0.007). They also had significantly higher white blood cells count (8.3±5.3 vs 5.6±2.9; p&amp;lt;0.001), serum urea (24.9±12.0 vs 21.1±8.4 mmol/L; p = 0.01), LDH (119.8±95.5 vs 63.9±72.9 IU/L; p&amp;lt;0.001), CRP (157.8±239.1 vs 61.1±94.8 mg/dL; p = 0.008), IL-6 (14.9±36.0 vs 2.8±7.3 pg/mL; p = 0.004), and Ddimer (372.3±294.1 vs 240.7±101.5 ng/mL; p&amp;lt;0.001). Multiple logistic regression showed a significant association between mortality and older age (OR 1.11, 95% CI 1.04-1.18, p = 0.001), need for mechanical ventilation (OR 43.1, 95% CI 9.5-198.6; p&amp;lt;0.001), higher CT severity score (OR 1.16, 95% CI 1.07 – 1.25; p&amp;lt;0.001), fewer HD procedures performed (OR 0.80, 95% CI 0.69-0.93; p = 0.003), and higher D-dimer levels (OR 1.00, 95% CI 1.00 - 1.01; p = 0.012). Conclusion Maintenance HD patients are considered a high-risk population for contracting COVID-19 and developing a severe form of the disease. Older age, higher CT severity score

RISK ASSESSMENT OF HOSPITAL STRAINS FORMATION AND OCCURRENCE OF HEALTH CARE-ASSOCIATED INFECTIONS AMONG PATIENTS OF A MULTIDISCIPLINARY MEDICAL ORGANIZATION

Aim. Risk assessment of the introduction of resistant strains of microorganisms and the formation of their hospital forms in the Clinics of the Irkutsk State Medical University (Clinics of the ISMU) Materials and methods. To analyze how the level of resistance of microbial strains isolated from patients effect the form of the disease the case histories of patients of the Clinic of the State Medical University for 2022 (n=123) were used. Bacteriological study of microbial contamination of air and environmental objects in the Clinics of the State Medical University in 2022 using swabs and aspiration method (n = 4523). Result. When comparing acute and chronic forms of diseases among groups of patients with highly resistant and low resistant strains of microorganisms, a statistically significant difference was found χ2 = 6.2 p&lt;0.012. In 2022, in the structural subdivisions of the ISMU Clinics, positive results of washings from environmental objects were recorded in only 0.3% (95% CI 0.14 - 0.46) of studies. In the treatment room of the ENT department of the Clinic of the State Medical University in November 2022, during routine microbiological monitoring, S. aureus, which is resistant to benzylpenicillin, was isolated once. Microbiological study of biomaterial from patients of the ENT department who were hospitalized in the same period showed the presence of S. aureus which has identical resistance to antibiotics in one patient. The maximum level of resistance was registered in S. epidermidis, isolated from the biomaterial from the patient of the otorhinolaryngological department, and amounted to 88.9%. Conclusion. Chronic forms of diseases are associated with the presence of highly resistant strains of microorganisms in a patient. Given the constant circulation of resistant pathogens among patients, there is a risk of introduction and formation of hospital clones of microorganisms in medical organizations.

Caracterización del estadio renal e identificación de comorbilidades asociadas a enfermedad renal crónica en Antioquia, 2019-2021

Objective: To characterize renal stages and identify comorbidities associated with chronic kidney disease in a population over 50 years old. Materials and methods: We used a descriptive, cross-sectional study based on bivariate analysis with description of quantitative and qualitative variables, in 88 clinical histories of patients from the renal unit of two health institutions in Antioquia. Results: it was found that 80, 6% of patients presented anemia with a decreased hemoglobin (mean 9.56 g/dL); the most frequent comorbidities were: hypertension in 81.8% of the participants, diabetes 45.5%, dyslipidemia 29.5%, smoking 20.5% and obesity 12.5%. Stage 5 was the most common in the target population. Conclusion: In the study population the most common comorbidities were presented with the following frequency: hypertension 65.09%, diabetes 30.09%, chronic renal disease predominated in those up of 60 years of age on stage 5, which was the prevalent. Normocytic normochromic anemia was evidenced in most patients.

Mycobacterium avium Complex Infections: Detailed Phenotypic and Functional Immunological Work-Up Is Required despite Genetic Analyses

Introduction: Cervical scrofulous lymphadenitis due to Mycobacterium avium complex (MAC) in immunocompetent adults is a rare disease. The presence of MAC infections demands meticulous clinical evaluation of patients along with detailed phenotypic and functional evaluation of their immune system including next-generation sequencing (NGS) analyses of target genes. Methods: Exact clinical histories of the index patients both suffering from retromandibular/cervical scrofulous lymphadenitis were obtained along with phenotypic and functional immunological evaluations of leukocyte populations followed by targeted NGS-based sequencing of candidate genes. Results: Immunological investigations showed normal serum immunoglobulin and complement levels, but lymphopenia, which was caused by significantly reduced CD3+CD4+CD45RO+ memory T-cell and CD19+ B-cell numbers. Despite normal T-cell proliferation to a number of accessory cell-dependent and -independent stimuli, the PBMC of both patients elaborated clearly reduced levels of a number of cytokines, including IFN-γ, IL-10, IL-12p70, IL-1α, IL-1β, and TNF-α upon TCR-dependent T-cell stimulation with CD3-coated beads but also superantigens. The IFN-γ production deficiency was confirmed for CD3+CD4+ helper and CD4+CD8+ cytotoxic T cells on the single-cell level by multiparametric flow cytometry irrespective of whether PMA/ionomycin-stimulated whole blood cells or gradient-purified PBMC was analyzed. In the female patient L1, targeted NGS-based sequencing revealed a homozygous c.110T>C mutation in the interferon-γ receptor type 1 (IFNGR1) leading to significantly reduced receptor expression on both CD14+ monocytes and CD3+ T cells. Patient S2 presented with normal IFNGR1 expression on CD14+ monocytes but significantly reduced IFNGR1 expression on CD3+ T cells, despite the absence of detectable homozygous mutations in the IFNGR1 itself or disease-related target genes. Exogenous addition of increasing doses of IFN-γ resulted in proper upregulation of high-affinity FcγRI (CD64) on monocytes from patient S2, whereas monocytes from patient L1 showed only partial induction of CD64 expression after incubation with high doses of IFN-γ. Conclusion: A detailed phenotypic and functional immunological examination is urgently required to determine the cause of a clinically relevant immunodeficiency, despite detailed genetic analyses.

Disease prognosis using machine learning algorithms based on new clinical dataset

Today, artificial intelligence-based solutions are produced to facilitate human life in almost every field. The healthcare sector is one of the sectors which took advantage of these solutions. Due to reasons such as the world’s ever-expanding population, ongoing epidemics, and the emergence of new disease types, it is becoming increasingly difficult for a patient to benefit from health services quickly and to make an accurate diagnosis. At this juncture, artificial intelligence reduces the patient density in hospitals, enables patients to access accurate information, and allows medical students to practice by seeing new cases. In this study, a new and reliable dataset was created with disease information obtained from various sources under the supervision of a specialist medical doctor. Then, new patient histories were added to the dataset used in the previous study, the experiments were repeated with the same algorithms, and the accuracy score comparison was presented. The created dataset includes 2006 unique patient histories, 358 symptoms, and 141 diseases and we think it will be a valuable dataset for researchers who make developments using machine learning in the field of healthcare. Various machine learning algorithms have been used in the training process to predict diseases belonging to different branches of medicine, such as diabetes, bronchial asthma, and covid. Besides, Support Vector Machine, Naive Bayes, K-Nearest Neighbors, Multilayer Perceptron, Decision Tree, and Random Forest algorithms, we also studied popular boosting algorithms such as XGBoost and LightGBM. All algorithms were validated with cross-validation and performance comparisons were made with different performance metrics such as accuracy, precision, recall, and f1-score. It is also the first study to achieve an accuracy score of 99.33% with a dataset that involves a greater number of diseases than the datasets used in the studies examined.