Clinical Status Of Patients Research Articles

Enterocele with Risk of Intestinal Incarceration: A Case Report

Purpose: To describe the diagnosis and management of enterocele with high risk of bowel ischemia in patients with pelvic organ prolapse. Methods: We describe the clinical case of an 81-year-old patient, hypertensive, obese, anticoagulated because of an atrial fibrillation and pelvic organ prolapse. Initially, conservative treatment was offered due to the high surgical risk, but sometime later the patient came to the emergency department with enterocele and risk of intestinal ischemia. Results: After placing the patient in the Trendelenburg position and applying ice to the perineum, the prolapse is reduced. Subsequently, urgent surgical intervention is performed with a total vaginal hysterectomy, anterior colporrhaphy, Ritcher's operation and colpoperineorrhaphy. This intervention solved the patient's clinical condition and also avoided the small bowel ischemia. Conclusion: The diagnosis of advanced enterocele with risk of intestinal obstruction is a very rare but potentially serious clinical case. The immediate recognition and management are very important because of the risk of vaginal rupture, intestinal necrosis, and also systemic infection.

The most common dermatological manifestations of inflammatory bowel diseases

Inflammatory bowel diseases are increasingly common problem in clinical practice. This condition is caused by both the growing morbidity and more accurate and widely available diagnostic methods, affecting the rising recognition. 
 It is worth remembering, that clinical presentation of inflammatory bowel disease is not limited to gastrointestinal tract. 
 Dermatological symptoms are an important part in the diagnosis of inflammatory bowel diseases, because they can occur as the first manifestation of the beginning of the disease process, as well as be a prognostic factor for the occurrence of exacerbations of the disease. This is an invaluable source of information on the patient's clinical condition, affecting the effectiveness of his treatment in the early stages of the disease, and allowing more efficient control of its course. 
 This has an enormous impact on the prognosis and comfort of patients' lives. In the following article, available medical studies on extraintestinal skin manifestations, clinical presentation and treatment options have been reviewed.

Predictors of In-hospital Outcomes in Hospitalized Patients With COPD Exacerbation

Background: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are associated with significant mortality. Objectives: The present study aimed to identify the risk factors that contribute to hospital outcomes of patients admitted with COPD exacerbation. Methods: This prospective cross-sectional study was performed on 74 patients hospitalized with COPD exacerbation. Pulse oximetry, complete blood count, high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT), and venous blood gas were taken under standard conditions. The clinical condition of patients was scored based on the COPD Assessment Test (CAT) and shortness of breath based on the standard, modified Medical Research Council (mMRC) questionnaire. The patients were divided into three groups based on in-hospital outcomes (i.e., favorable, unfavorable, and terrible or worse). One-way analysis of variance, chi-square test, logistic regression model, and odds ratio (OR) analysis were used to determine the most important factors associated with outcomes. A P-value less than 0.05 was considered statistically significant. Results: Out of 74 patients, 43 (58.1%) and 31 (41.9%) subjects were male and female, respectively. The patients’ mean age was 68.19 ± 10.62 years. The number (%) of patients in favorable, unfavorable, and worse outcome groups was 27 (36.48%), 30 (40.54%), and 17 (22.97%), respectively. As the CAT and mMRC score increased, the chance of terrible outcomes also increased (OR = 1.22, confidence interval (CI): 1.10 - 1.35). There was no significant correlation between worse outcomes and hs-CRP. The PCT was significantly higher in the group with worse outcomes than in the groups with favorable and unfavorable outcomes (P < 0.01). Conclusions: The COPD evaluation by the CAT and mMRC plays an important role in the in-hospital outcomes of hospitalized COPD patients with exacerbation. The serum level of PCT was also a determinant factor of prognosis in hospitalized patients with COPD exacerbation.

Percutaneous snare-retrieval of intracardiac thrombus under fluoroscopic and transesophageal echocardiography guidance: case report and systematic review.

Intracardiac foreign bodies (IFB) are rare clinical conditions. There are now several reports on the percutaneous retrieval of IFB under fluoroscopy. However, some IFB are not radiopaque, and retrieval requires combined fluoroscopic and ultrasound guidance. We report the case of a bedridden 23-year-old male patient with T-lymphoblastic lymphoma treated with long-term chemotherapy. Ultrasound examination diagnosed a huge thrombus in the right atrium near the opening of the inferior vena cava which affected the patency of his PICC line. Ten days of anticoagulant therapy did not modify the thrombus size. Open heart surgery was not feasible because of the patient clinical condition. Snare-capture of the non-opaque thrombus was done from the femoral vein under fluoroscopic and ultrasound guidance with excellent outcomes. We also present a systematic review of IFB. We found out that percutaneous removal of IFBs is a safe and effective procedure. The youngest patient who received percutaneous IFB retrieval was 10 days old and weighed only 800 g, while the oldest patient was 70 years old. Port catheters (43.5%) and PICC lines (42.3%) were the most commonly found IFBs. Snare catheters and forceps were the most commonly used instruments.

Smart Design of Sensor-Coated Surgical Sutures for Bacterial Infection Monitoring.

Virtually, all implantable medical devices are susceptible to infection. As the main healthcare issue concerning implantable devices is the elevated risk of infection, different strategies based on the coating or functionalization of biomedical devices with antiseptic agents or antibiotics are proposed. In this work, an alternative approach is presented, which consists of the functionalization of implantable medical devices with sensors capable of detecting infection at very early stages through continuous monitoring of the bacteria metabolism. This approach, which is implemented in surgical sutures as a representative case of implantable devices susceptible to bacteria colonization, is expected to minimize the risk of worsening the patient's clinical condition. More specifically, non-absorbable polypropylene/polyethylene (PP/PE) surgical sutures are functionalized with conducting polymers using a combination of low-pressure oxygen plasma, chemical oxidative polymerization, and anodic polymerization, to detect metabolites coming from bacteria respiration. Functionalized suture yarns are used for real-time monitoring of bacteria growth, demonstrating the potential of this strategy to fight against infections.

Multimodal monitoring: practical recommendations (dos and don'ts) in challenging situations and uncertainty.

With the advancements in modern medicine, new methods are being developed to monitor patients in the intensive care unit. Different modalities evaluate different aspects of the patient's physiology and clinical status. The complexity of these modalities often restricts their use to the realm of clinical research, thereby limiting their use in the real world. Understanding their salient features and their limitations can aid physicians in interpreting the concomitant information provided by multiple modalities to make informed decisions that may affect clinical care and outcomes. Here, we present a review of the commonly used methods in the neurological intensive care unit with practical recommendations for their use.

Functional status of pediatric patients with trauma and risk factors for mortality from a single center in China.

The influence of reduced functional status has become increasingly relevant because of the gradual decline in mortality rate over the recent years. Nonetheless, only a few studies investigating the functional status of patients with trauma at hospital discharge have been conducted. This study aimed to identify the risk factors influencing the mortality rate in pediatric trauma survivors at a pediatric intensive care unit and analyze their functional status using the Functional Status Scale (FSS). A retrospective analysis was conducted at Shengjing Hospital of China Medical University. Children admitted to the pediatric intensive care unit between January 2015 and January 2020 who met the trauma diagnostic criteria were included. The FSS score and the Injury Severity Score (ISS) were recorded upon admission and discharge, respectively. Clinical data were compared between the survival and non-survival groups to identify the risk factors for poor prognosis. The risk factors for mortality were identified using multivariate and univariate analyses. A total of 246 children {59.8%, male; median [interquartile range (IQR)] age: 3 [1-7] years} were diagnosed with trauma (including head trauma, chest trauma, abdominal trauma, and extremity trauma). Of these patients, 207 were discharged, 11 dropped out mid-treatment, and 39 died (hospital mortality rate, 15.9%). Upon admission, the median FSS and trauma scores were 14 (IQR, 11-18) and 22 (IQR, 14-33) points, respectively. At discharge, the FSS score was 8 (IQR, 6-10) points. The patient clinical status improved with a ΔFSS score of -4 (IQR, -7, 0) points. At hospital discharge, 119 (48.3%), 47 (19.1%), 27 (11.0%), 12 (4.8%), and 2 (0.9%) survivors had good, mildly abnormal, moderately abnormal, severely abnormal, and very severely abnormal function, respectively. Reduced functional status in patients was categorized as follows: motor, 46.4%; feeding, 26.1%; sensory, 23.2%; mental, 18.4%; and communication, 17.9%. In the univariate analysis, ISS >25 points, shock, respiratory failure, and coma were independently associated with the mortality rate. Multivariate analysis revealed that the ISS was an independent risk factor for mortality. The mortality rate of patients with trauma was high. ISS was an independent risk factor for mortality. Mildly reduced functional status remained at discharge and was reported in nearly half of the discharged patients. Motor and feeding functions were the most severely impacted domains.

Active surveillance for carbapenem resistant enterobacteriaceae (CRE) using stool cultures as a method to decrease CRE infections in the pediatric intensive care unit (PICU)

BackgroundThe incidence of Carbapenem Resistant Enterobacteriaceae (CRE) infections is increasing worldwide. Due to dearth of alternative antibiotics, prevention of infection transmission is a part of CRE infection management strategy. Early detection of CRE by active surveillance coupled with contact isolation is much more appropriate compared to contact isolation upon receipt of routine cultures dictated by the patient's clinical condition. ObjectivesTo determine whether active CRE surveillance will decrease CRE infection rates in the Pediatric Intensive Care Unit (PICU). MethodsRetrospective observational study done in the 10-bed PICU of a tertiary care teaching children's hospital from July 2013 to June 2015. Rectal swabs for CRE were sent from all PICU patients except stable post-operative patients. Contact isolation precautions were followed for rectal swab positive patients. CRE colonization and infection rates were calculated and compared. ResultsTotal of 1262 rectal swabs were sent from 1022 patients. CRE colonization rate was 19.5%. Post intervention, ICU acquired CRE colonization decreased by 36% and ICU acquired CRE infection rates decreased by 100%, both showed significant decrease (p ​< ​0.0001). ConclusionActive CRE surveillance and institution of contact isolation in appropriate situations is helpful in decreasing CRE colonization and infection rates in the PICU.

Cardiopulmonary rehabilitation programme improves physical health and quality of life in post-COVID syndrome

Many patients with previous COVID-19 infection suffer from prolonged symptoms after their recovery: cough, dyspnea, chest pain, shortness of breath, fatigue, anxiety or depression, regardless of milder or severe coronavirus infection. Review of the literature demonstrates underrepresented complex cardiopulmonary rehabilitation of patients with post-COVID syndrome. The aim of our quasi-experimental study was to evaluate the effectiveness of complex cardiopulmonary rehabilitation and to assess the quality of life, functional parameters before and after a 14-day specific cardiopulmonary rehabilitation and two months later. Sixty-eight patients participated in rehabilitation at Semmelweis University's Department of Pulmonology. Respiratory function: forced expiratory volume in 1 second (FEV1%pred), 6-minute walk test (6MWT), chest kinematics (CK), quality of life [EuroQol-5D (EQ-5D), Post-COVID-19 Functional Status (PCFS)] and Modified Medical Research Council (mMRC) dyspnea scale were measured at the beginning and end of the programme and two months after the rehabilitation. The 14-day rehabilitation programme resulted in significant improvement of 6MWT {492 [interquartile range (IQR), 435-547] vs. 523 (IQR, 477-580) m; P=0.031}, mMRC [1 (IQR, 0.25-1) vs. 0 (IQR, 0-1); P=0.003], EQ-VAS score [75 (IQR, 65-80) vs. 85 (IQR, 75-90); P=0.015], and PCFS [1 (IQR, 1-2) vs. 0.5 (IQR, 0-1); P=0.032]. Respiratory function and chest kinematics also improved, FEV1(%pred) [86 (IQR, 73-103) vs. 91 (IQR, 80-99); P=0.360], chest kinematics [3.5 (IQR, 2.75-4.25) vs. 4 (IQR, 1-5.25) cm; P=0.296], and breath-holding test (BHT) [33 (IQR, 23-44) vs. 41 (IQR, 28-58) s; P=0.041]. Complex cardiopulmonary rehabilitation improved workload, quality of life, respiratory function, complaints and clinical status of patients with post-COVID syndrome. Personalized complex pulmonary rehabilitation can be beneficial and recommended for patients suffer from post-COVID syndrome, who have good potential for recovery and are able to participate in the two weeks complex pulmonary rehabilitation.

PO-01-025 EPICARDIAL LEAD PERFORMANCE TRENDS IN PEDIATRICS AND CONGENITAL HEART DISEASE: WHAT STARTS UP, MUST COME DOWN

Small children and certain types of congenital heart disease (CHD) require epicardial CIED systems when pacing is indicated. Lead performance at implant is potentially affected by patient clinical status, as many of these systems are placed during other operation for CHD or in the post-operative period. Anatomical alterations and scarring from prior procedures may result in limited options and higher lead performance measurements are often accepted at implant. To assess evolution of epicardial lead performance in the acute post-implant period at mid-term follow-up. Retrospective single center study of children and adult congenital heart disease patients undergoing epicardial bipolar pacing lead and generator implantation between 1/2012-6/2022. Patients were censored in follow-up at the time of lead removal, patient death, or pacing polarity change to unipolar. There were 256 leads implanted in 128 pts (mean age 6.1 ± 9.8 years), including 201 (79%) leads implanted in patients with CHD and 138 (54%) implanted in the perioperative or immediate post-operative period (within 30 days). Implant sites were: 76 right atrial, 71 right ventricle, 39 left atrial and 70 left ventricle. Threshold for measurements were available at 6 weeks and 1 year for 160 (63%) and 138 (54%) respectively. The mean threshold at time of implant was 1.3 (range 0.1-6) V. Mean threshold change from implant to post op day 1 (POD1), 6 weeks and 1 year was: –0.34±0.78V (p=0.0001), –0.23 ±0.85V (p=0.003), and –0.2±0.9V (p=0.0026), respectively. At implant, 47 leads (18%) had a threshold ≥ 2 V, of which 42/47 (90%) decreased to <2 by POD1. Leads with higher threshold at implant had a mean decrease in threshold by POD1 of -1.33 V vs. -0.44 V for leads with an implant threshold of <2V (p<0.0001). For patients with an implant threshold of ≥2V, impedance >1000 ohms, CHD, perioperative or acute post-op status, and location of the lead did not significantly impact the odds of having a persistently higher threshold (≥2 V) on POD1. Epicardial pacing lead thresholds improve significantly in the immediate post-op period, even when initial measures could be considered unacceptably high and remain stable at one year post implant. Most leads with high implant thresholds improved to <2 by POD1. No factors effecting the likelihood of improvement were identified. While striving for low threshold at implant remains important, these data support a high likelihood that thresholds will optimize by POD 1.

Euthanasia in Africa: A scoping review of empirical evidence.

The core ethical perplexity is that physician-assisted suicide and euthanasia (PAS/E) contradicts the core value of medical practice which is about the duty of care to preserve life. While most arguments for and against euthanasia emerge from other continents, no African country legalizes or decriminalizes PAS/E. The essence of this scoping review is to collate evidence and scientific voices on euthanasia in Africa by synthesizing empirical articles on the subject in Africa. In this scoping review, a systematic search of five electronic research databases-PubMed, SCOPUS, CINHAL Complete, Allied and Complementary Medicine (AMED), and APA PsycInfo-was conducted to identify relevant articles conducted in Africa on euthanasia. After deduplication with the Rayyan software, the retrieved literature were screened for eligibility, and only eligible articles were included in the review. Relevant data from these articles were extracted and analyzed using narrative synthesis. Only 14 articles reporting empirical studies, conducted in Africa, and published in English, were included in the review after a rigorous screening process. The review shows a wide rejection of euthanasia, but there is not much resistance to passive euthanasia, that is, withholding/withdrawing life-saving medical care from a terminally ill patient, mostly due to advanced age of the patient and the incurability of the illness. Many factors, such as religion, profession, and age help in shaping the way an individual view and understand PAS/E. Professionals take the patient's clinical condition and sociocultural context into consideration when making decisions about end-of-life care. The sociocultural context did not favor PAS/E. Euthanasia will continue to be a subject of controversy and debate in Africa and elsewhere. The majority of Africans hold the duty of care and preservation of life as the hallmark of medical practice, which informs the wide rejection of PAS/E.

Characterization of Adenosine A2A receptors expression in hypercholesterolemia to understand the cardiovascular risk

Cardiovascular diseases (CVD) are the leading cause of mortality and morbidity worldwide. Hypercholesterolemia [elevated blood levels of total- and low-density lipoprotein-cholesterol (T-C and LDL-C)] is one of the main CVD risk factors and hypocholesterolemic treatments (statins, PCSK9 inhibitors, LDL-apheresis) are part of the daily patient care. During ischemia, hypoxia and inflammation, adenosine blood concentration increases and activates A2A adenosine receptors (A2AR, expressed by endothelial cells and lymphocytes), thus producing a protective effect via its vasodilatory and immunosuppressive functions. Alterations of A2A receptors expression and properties have been found in CVD patients. In a previous pilot study, we described a lower A2AR expression in peripheral blood mononuclear cells (PBMCs) of a small cohort of patients with heterozygous Familial hypercholesterolemia (HeFH), a severe genetic hyperlipidemia (Vairo et al., 2021). In this project, we would like to extend the characterization of A2AR expression in a larger cohort of patients with hypercholesterolemia (including heterozygous and homozygous FH and polygenic hypercholesterolemia) before and after hypocholesterolemic treatments and to understand whether 1) alterations of A2AR expression are broadly associated with hypercholesterolemia; 2) there is a correlation among A2AR expression, blood T-C and LDL-C levels and patient's clinical status; 3) all A2AR alterations may be rescued by hypocholesterolemic treatments. Hypercholesterolemic patients and healthy subjects are selected by age, gender and clinical status, including blood cholesterol levels (T-C > 240 mg/dL and/or LDL-C > 190 mg/dL). A2AR expression was explored in PBMCs by western blot and cytometry. We show on a small number of patients a decrease in A2A receptors expression compared with healthy subjects and an inverse correlation between A2AR expression and total- and LDL-cholesterol blood levels. Our results suggest that alterations of A2A receptors expression are associated with hypercholesterolemia and might help to better understand the high cardiovascular risk in hypercholesterolemia patients.

Extracellular vesicles: A promising therapy against SARS-CoV-2 infection

Extracellular vesicles: A promising therapy against SARS-CoV-2 infection

Retrieval analysis of the Essure® micro insert female sterilization implant: Methods for metal ion and microscopic analysis.

The Essure® Device is a female sterilization implant comprised of four alloys (Ni-Ti, 316L SS, Pt-Ir and Sn-Ag) and Dacron fibers. As part of the mandated 522 post-market surveillance study, implant retrieval and metal-ion analysis methods were developed separate from patient clinical data, to quantify trace metal ions found in tissue and to assess implant degradation present. Three segments of tissue (proximal implant, distal implant, and tissue distal from the implant) stored in neutral buffered formalin, were retrieved. Tissue was prepared for metal ion analysis using inductively coupled mass spectrometry (ICP-MS). Implant sections from four patients, were analyzed using digital optical microscopy (DOM), scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS). Image analysis showed Sn-Ag solder corroded and elevated Sn ion levels in tissue proximal to the solder compared to tissues more remote in all cases observed. The 316L SS exhibited signs of degradation with high surface concentrations of molybdenum and chromium and low iron compared to the parent alloy. Evidence of elevated iron, chromium and nickel within the tissues and storage solutions combined with precipitation of an iron-calcium-phosphorous material on some implants indicate evidence of SS corrosion. Ni-Ti, Pt-Ir and Dacron appear to have no major damage. This study includes preliminary results as part of the ongoing 522 study and therefore no final conclusions regarding the device or patient data can be drawn from this present study until the entire 522 study is complete. STATEMENT OF SIGNIFICANCE: The Essure Device is a female sterilization implant that was implanted into approximately 750,000 women. The device is composed of polyethylene terephthalate fibers and 4 metal alloys, 316L stainless steel, Nickel-Titanium, Tin-Silver and Platinum-Iridium. Following an increase in patient reported adverse events, the FDA required a 522-post market surveillance study. As part of this study, implants are retrieved from patients via salpingectomy or hysterectomy. This study focuses on the development of the implant retrieval methods following surgery, with focus on measuring local tissue metal ions, their distribution and assessing the degradation of the implant without correlation to patient clinical condition.

Propafenone-induced liver injury in an elderly patient with paroxysmal atrial fibrillation--a new case report and literature review

Antiarrhythmic drugs are used more and more often, which is related to the aging of the population and the growing number of arrhythmias, especially atrial fibrillation (AF). One of the drugs used in AF is propafenone, considered a relatively safe drug in people without heart disease. Nevertheless, it can cause severe damage to the liver if one ignores the subtle symptoms that indicate an incipient problem. We present the case of an 82-year-old woman diagnosed with paroxysmal AF who developed acute liver injury during treatment with propafenone. On the fifth day of her hospitalization, we observed nausea and vomiting after introducing regular treatment with propafenone. Similar symptoms occurred before hospitalization when propafenone was taken ad hoc in the event of an AF attack. They were treated as dyspeptics in a patient who underwent cholecystectomy. Laboratory tests showed high serum alanine transaminase, gamma-glutamyltranspeptidase, C-reactive protein, total bilirubin, and a slight increase in aspartate transaminase. Infection with hepatic viruses, alcohol abuse, other drugs toxicity, and intrahepatic cholangitis due to cholelithiasis were excluded as a cause of liver damage. With the discontinuation of propafenone, the patient's clinical condition and laboratory test results improved. Similar cases published in the literature are discussed in the paper. It also draws attention to the need to report adverse drug reactions to the appropriate authorities and discusses the reasons for under-reporting in Poland.

Effects of Reoperation Timing on Survival among Recurrent Glioblastoma Patients: A Retrospective Multicentric Descriptive Study.

Glioblastoma inevitably recurs, but no standard regimen has been established for treating this recurrent disease. Several reports claim that reoperative surgery can improve survival, but the effects of reoperation timing on survival have rarely been investigated. We, therefore, evaluated the relationship between reoperation timing and survival in recurrent GBM. A consecutive cohort of unselected patients (real-world data) from three neuro-oncology cancer centers was analyzed (a total of 109 patients). All patients underwent initial maximal safe resection followed by treatment according to the Stupp protocol. Those meeting the following criteria during progression were indicated for reoperation and were further analyzed in this study: (1) The tumor volume increased by >20-30% or a tumor was rediscovered after radiological disappearance; (2) The patient's clinical status was satisfactory (KS ≥ 70% and PS WHO ≤ gr. 2); (3) The tumor was localized without multifocality; (4) The minimum expected tumor volume reduction was above 80%. A univariate Cox regression analysis of postsurgical survival (PSS) revealed a statistically significant effect of reoperation on PSS from a threshold of 16 months after the first surgery. Cox regression models that stratified the Karnofsky score with age adjustment confirmed a statistically significant improvement in PSS for time-to-progression (TTP) thresholds of 22 and 24 months. The patient groups exhibiting the first recurrence at 22 and 24 months had better survival rates than those exhibiting earlier recurrences. For the 22-month group, the HR was 0.5 with a 95% CI of (0.27, 0.96) and a p-value of 0.036. For the 24-month group, the HR was 0.5 with a 95% CI of (0.25, 0.96) and a p-value of 0.039. Patients with the longest survival were also the best candidates for repeated surgery. Later recurrence of glioblastoma was associated with higher survival rates after reoperation.

The thrombus proteome in stroke reveals a key role of the innate immune system and new insights associated with its etiology, severity, and prognosis

BackgroundNowadays little is known about the molecular profile of the occluding thrombus of patients with ischemic stroke. ObjectivesTo analyze the proteomic profile of thrombi in patients who experienced an ischemic stroke in order to gain insights into disease pathogenesis. MethodsThrombi from an exploratory cohort of patients who experienced a stroke were obtained by thrombectomy and analyzed by sequential window acquisition of all theoretical spectra-mass spectrometry. Unsupervised k-means clustering analysis was performed to stratify patients who experienced a stroke. The proteomic profile was associated with both the neurological function (National Institute of Health Stroke Scale [NIHSS]) and the cerebral involvement (Alberta Stroke Program Early CT Score [ASPECTS]) prior to thrombectomy and the clinical status of patients at 3 months using the modified Rankin Scale. In an independent cohort of 210 patients who experienced a stroke, the potential role of neutrophils in stroke severity was interrogated. ResultsProteomic analysis identified 580 proteins in thrombi, which were stratified into 4 groups: hemostasis, proteasome and neurological diseases, structural proteins, and innate immune system and neutrophils. The thrombus proteome identified 3 clusters of patients with distinctive severity, prognosis, and etiology of the stroke. A protein signature clearly distinguished atherothrombotic and cardioembolic strokes. Several proteins were significantly correlated with the severity of the stroke (NIHSS and ASPECTS). Functional proteomic analysis highlighted the prominent role of neutrophils in stroke severity. This was in line with the association of neutrophil activation markers and count with NIHSS, ASPECTS, and the modified Rankin Scale score 90 days after the event. ConclusionThe use of sequential window acquisition of all theoretical spectra-mass spectrometry in thrombi from patients who experienced an ischemic stroke has provided new insights into pathways and players involved in its etiology, severity, and prognosis. The prominent role of the innate immune system identified might pave the way for the development of new biomarkers and therapeutic approaches in this disease.

CLINICAL, FUNCTIONAL AND IMMUNOLOGICAL CHARACTERISTICS OF SEVERE BRONCHIAL ASTHMA

Bronchial asthma is the most common and socially significant disease in humans. Among patients who cannot achieve control, a special group is patients with severe asthma. Objective: comprehensive assessment of clinical, functional, immunological features and pharmacotherapy of severe bronchial asthma in real clinical practice to optimize basic pathogenetic therapy. Materials and methods: 83 patients diagnosed with severe asthma were examined. Patients with severe asthma are divided into 2 groups: patients with and without fixed airway obstruction. Plasma concentrations of cytokines IL-4, IL-5, IL-9, IL-13, periostin, cathepsin S, TGF- were determined by solid-phase enzyme immunoassay. Immune status was investigated on the NAVIOS Flow Cytometer. Results: In both groups of severe bronchial asthma, we found a decrease in T helper and immunoregulatory index levels with simultaneous increases in cytotoxic T lymphocytes, natural T killers, naive T lymphocytes, activated T and B lymphocytes, and phagocytic index compared to controls. There were no differences in immune status between the groups and the resulting changes were independent of the presence or absence of fixed obstruction. In both study groups, we found an increase in cathepsin S and TGF- in plasma compared to control. We identified the most significant risk factors for the formation of fixed obstruction: taking SABA more than 4 inhalations per day (OR = 4.2) and FeNO concentration more than 20 ppb (OR = 6.0). There was a significant improvement in the clinical condition of patients with severe asthma with fixed obstruction while taking genetically engineered biological therapy for a year. Conclusion: To date, there is no unambiguous idea of the mechanisms of implementation of pathobiochemical reactions in the bronchial wall in severe asthma, which lead to the development of fixed airway obstruction. Severe asthma is variable and depends on the correct choice of management tactics.

Time Spent on Medical Round Activities, Distance Walked, and Time-Motion in the General Medicine Department at Hamad General Hospital in Qatar.

Background The daily morning round is a routine activity performed by medical teams. During the morning round, updates on the patient's clinical condition, new laboratory results, and other test results are reviewed and discussed between team members, the patient, and at times the family. Completing these tasks takes time. The design of the patient location differs between hospitals, and significant distance between patients can considerably affect round times. This study assesses physicians' time spent on clinical activities,the distance traveled, and the time they spend walking between patients during daily morning rounds to identify better reorganization methods to reduce wasted time. Methodology The survey was self-administered and had no intervention needing ethical approval. The research team's leader engaged two observers (a general practitioner from another department and a general internal medicine department case manager) to collect the data. The general practitioner was a medical graduate doctor, while the bed manager was not a medical college graduate. They observed 10 rounds over 10 non-consecutive days from July 1 to July 30, 2022. They recorded daily activities during the daily morning round, including time spent with patients, family conversations, bedside education, medication, social issues, and the time and distance required to move from patient to patient and from one location to location. The informal conversations about age, work history, and other small talk were recorded and converted into quantitative data. In each round, records were given to a statistician for rechecking. Subsequently, the records were imported into a Microsoft Excel spreadsheet for further statistical analysis. For continuous variables, the data were summarized as mean, median, and standard deviation. For categorical variables, the data were summarized as counts or proportions. Results On average, the duration of the daily morning round was 161.7 ± 17.3 minutes. The average number of patients seen by the general internal medicine round team was 14. The median patient encounter time per patient was 14 minutes (11-19 minutes), with an average of 12 minutes. An average of 8.6 employees participated in the 10-day rounds. The physician spent 41.2% of the time in direct contact with the patient during the morning round, 11.4% in maintaining electronic medical records, and 18.20% in bedside teaching.Additionally, 7.1% of the round time was spent because of interruptions by clinical and non-clinical staff other than team members or family members who were not in the room. Furthermore, a team member walked an average of 763 ± 54.5 m (667-872 m) per round, costing 35.7 minutes (22.1%) of the total round time. Conclusions The daily morning round time wassignificantly longer compared with the reported round times. Relocating patient beds to a common location reduced the rounding time by 22.30%. Disruption, teaching, and medical instruction must also be considered and shortened to reduce the morning round time.

Anxiety disorders in general medical practice – clinical picture, diagnosis, optimized approaches to therapy

Anxiety disorders are widespread in the population and in general medical practice and have a pronounced negative impact on the quality of life and functioning of patients. Currently, the prerequisites for the diagnosis and treatment of anxiety disorders outside the psychiatric network are accumulating by therapists, general practitioners and other non-psychiatric doctors. A review of the most significant factors contributing to a wider diagnosis and treatment of anxiety disorders in general medical practice is given. This review presents modern ideas about the pathogenesis of anxiety disorders, substantiates the modern idea of their multifactorial nature, the contribution of genetic and epigenetic, psychological and social factors, outlines the concepts of the neurobiological basis of pathological anxiety based on neuroimaging studies. In the future, information is provided on the general manifestations of anxiety disorders, the main clusters of anxiety, the systematics of anxiety disorders according to ICD-10. Modern ideas about the diagnosis of anxiety disorders using both scales and a clinical approach are given, a detailed review of currently available diagnostic scales validated for clinical practice is presented. The main approaches to conducting a clinical conversation are also presented, recommendations are given for the most successful collection of information about the clinical condition of patients. At the end of the review, information is given on existing approaches to psychopharmacotherapy and psychotherapy of anxiety disorders. Taking into account pharmacological and clinical studies, the place of drugs tofisopam (an atypical allosteric modulator of GABA receptors) and buspirone (a partial agonist of serotonin 1A receptors) in the treatment of anxiety disorders in general medical practice has been argued.