Clinical State Of Patients Research Articles

Clinical Practice Guideline: The Diagnosis and Treatment of Osteoporosis.

Osteoporosis is a common disease that affects approximately 6 million people in Germany alone. Osteoporotic fractures impair the quality of life and may make independent living impossible. Recommendations on the diagnosis and treatment of osteoporosis are indispensable for the effective care of this large group of patients. For a thorough updating of the German clinical practice guideline (an evidence-based guideline with recommendations for clinical practice) on osteoporosis, a comprehensive, systematic search for relevant publications was carried out, including guidelines from other countries. The retrieved literature was assessed with standardized (Oxford) criteria, and clinically relevant key questions were answered according to the PICO scheme ("population, intervention, comparison, outcomes"). The assessment of clinical risk factors for osteoporosis is the basis of osteoporosis diagnostics, which should be carried out quickly after a fracture. If risk factors are present in a postmenopausal woman or a man aged 50 or above, bone densitometry testing with dual-energy x-ray absorptiometry (DXA) is recommended. The further diagnostic evaluation should proceed in stepwise fashion depending on the clinical symptoms, the fracture status, and the degree of bone density reduction. Pharmacotherapy should be adapted to the fracture risk. Osteoanabolic treatment is recommended with high priority if the patient is judged to have a very high risk of fracture (10% or more in the next three years). The further course and duration of treatment should be determined individually, depending on the evolution of the patient's clinical state. Prerequisites for the optimal treatment of patients with osteoporosis include a correct diagnosis and interdisciplinary and interprofessional collaboration to determine and provide the proper treatment. 71% of persons with osteoporosis in Germany are still untreated, and this gap must be closed.

Effects of a 4‐Month Supervised Aerobic‐Strength Training on Cognitive Functions and Clinical State of Patients with Parkinson’s Disease

Effects of a 4‐Month Supervised Aerobic‐Strength Training on Cognitive Functions and Clinical State of Patients with Parkinson’s Disease

Final conclusions of the own investigations of combined antihypertensive treatment on clinical state in patients with arterial hypertension without and with diabetes mellitus: use of own materials in education in nation. and Engl. languages at pre- and po

General practice – family medicine department. Object of investigation – patients with confirmed diagnosis of arterial hypertension without and with diabetes mellitus of second type, which were under observation at the primary medical care centers. 
 The aim of the investigation was the study of efficiency of the combined (calcium channel blocker – amlodipin besilat and angiotensin II receptor antagonist – valsartan) antihypertensive treatment in patients with arterial hypertension combined with diabetes mellitus from the start of the treatment in the practice of primary care physician.
 Methods of the investigation included physical examination, general clinical, instrumental and laboratory methods, monitoring of side effects.
 As a result it was found, that combined antihypertensive treatment (amlodipin and valsartan) is effective and safe in patients with arterial hypertension and diabetes mellitus of 2 type, which helps to reach the target level of arterial pressure in 72 % of patients and can be recommended from the beginning of the treatment in the practice of family physician. Maximal effect of the treatment in patients with arterial hypertension of II-III degree and diabetes mellitus of 2 type was observed only at 12th week of treatment. At combined antihypertensive treatment (amlodipin and valsartan) they observed tendency to the reduction of left ventricle hypertrophy. Despite the rate and percentage of the reaching of target arterial pressure were lower in the group of patients, which have diabetes mellitus of 2 type, it is necessary to recommend more active modification of the way of life in the named group of patients. It was found reduction of heart and vascular risks in the group of patients with arterial hypertension II–III degree with diabetes mellitus 2 type. This makes the basis for more active modification of life style and using from the start of the treatment combined antihypertensive therapy immediately. Consider all found results using from the start of the treatment combined antihypertensive therapy immediately by the primary care physician is proved for patients with arterial hypertension combined with diabetes mellitus.
 Accumulated materials (including theoretical reviews, demonstrative poster reports etc.) are used at training of interns in speciality «general practice – family medicine», during practical classes for higher courses education in national and English languages

Early Allogeneic Transplantation Favorably Influences the Outcome of Pediatric Acute Myeloid Leukemia—A Retrospective Study in a Single Center Over 2 Decades

Transplantation advancements offer the potential for improving the prognosis of patients with acute myeloid leukemia (AML). Controversies surrounding indications and timing persist. We focused on identifying prognostic factors and exploring the advantages of early transplantation. We studied 102 pediatric patients with AML (February 1999-August 2022), using Cox regression to analyze survival and hematopoietic cell transplantation (HCT) outcomes and Kaplan-Meier curves to assess HCT timing's impact on prognosis. "Treatment in First Complete Remission [CR1]: Chemotherapy" showed increased risk in multivariate and univariate Cox regression analyses, whereas "HCT during the study period" displayed divergent outcomes. Focusing on transplanted patients, "Treatment in CR1: Chemotherapy" still correlated with higher mortality risk. These findings emphasize the pivotal role of the treatment strategy adopted in CR1 on overall survival rather than HCT alone. Donor cytomegalovirus (CMV) positivity is also related to reduced mortality risk. Kaplan-Meier analysis supported superior 5-year survival rates with "HCT" compared with "chemotherapy" in CR1. In the 3-arm analysis, "HCT in CR1" demonstrated better 5-year overall survival (OS) and 5-year disease-free survival (DFS) compared with "Never HCT," whereas "HCT in CR2" had the least favorable prognosis (5-year OS: 79.2% vs 57.1% vs 50%, P = .056; 5-year DFS: 73.6% vs 55.2% vs 0%, P = .000). Our study highlights the benefits of transplantation during CR1 on prognosis. However, when contemplating CR1 transplantation recommendations, evaluation of various factors, such as the patient's clinical state, relapse risk, transplant-related mortality, CMV status, and other pertinent considerations, is vital. Comprehensive case discussions with patients and families are demanded in optimizing treatment.

Searching for New Biomarkers to Assess COVID-19 Patients: A Pilot Study.

During the initial diagnosis of urgent medical conditions, which include acute infectious diseases, it is important to assess the severity of the patient's clinical state as quickly as possible. Unlike individual biochemical or physiological indicators, derived indices make it possible to better characterize a complex syndrome as a set of symptoms, and therefore quickly take a set of adequate measures. Recently, we reported on novel diagnostic indices containing butyrylcholinesterase (BChE) activity, which is decreased in COVID-19 patients. Also, in these patients, the secretion of von Willebrand factor (vWF) increases, which leads to thrombosis in the microvascular bed. The objective of this study was the determination of the concentration and activity of vWF in patients with COVID-19, and the search for new diagnostic indices. One of the main objectives was to compare the prognostic values of some individual and newly derived indices. Patients with COVID-19 were retrospectively divided into two groups: survivors (n = 77) and deceased (n = 24). According to clinical symptoms and computed tomography (CT) results, the course of disease was predominantly moderate in severity. The first blood sample (first point) was taken upon admission to the hospital, the second sample (second point)-within 4-6 days after admission. Along with the standard spectrum of biochemical indicators, BChE activity (BChEa or BChEb for acetylthiocholin or butyrylthiocholin, respectively), malondialdehyde (MDA), and vWF analysis (its antigen level, AGFW, and its activity, ActWF) were determined and new diagnostic indices were derived. The pooled sensitivity, specificity, and area under the receiver operating curve (AUC), as well as Likelihood ratio (LR) and Odds ratio (OR) were calculated. The level of vWF antigen in the deceased group was 1.5-fold higher than the level in the group of survivors. Indices that include vWF antigen levels are superior to indices using vWF activity. It was found that the index [Urea] × [AGWF] × 1000/(BChEb × [ALB]) had the best discriminatory power to predict COVID-19 mortality (AUC = 0.91 [0.83, 1.00], p < 0.0001; OR = 72.0 [7.5, 689], p = 0.0002). In addition, [Urea] × 1000/(BChEb × [ALB]) was a good predictor of mortality (AUC = 0.95 [0.89, 1.00], p < 0.0001; OR = 31.5 [3.4, 293], p = 0.0024). The index [Urea] × [AGWF] × 1000/(BChEb × [ALB]) was the best predictor of mortality associated with COVID-19 infection, followed by [Urea] × 1000/(BChEb × [ALB]). After validation in a subsequent cohort, these two indices could be recommended for diagnostic laboratories.

Prognostic value of the Walch classification for patients before and after shoulder arthroplasty performed for osteoarthritis with an intact rotator cuff

The Walch classification is commonly utilized by surgeons when determining the treatment of osteoarthritis (OA). However, its utility in prognosticating patient clinical state before and after TSA remains unproven. We assessed the prognostic value of the modified Walch glenoid classification on preoperative clinical state and postoperative clinical and radiographic outcomes in total shoulder arthroplasty (TSA). A prospectively-collected, multi-center database for a single-platform TSA system was queried for patients with rotator cuff-intact OA and minimum 2 year follow-up after anatomic and reverse TSA (aTSA, rTSA). Differences in patient-reported outcome scores (PROMS) [SST, ASES, SPADI, VAS Pain, Shoulder Function score], combined patient-reported and clinical-input scores (Constant, UCLA, SAS), active range of motion (ROM) values (forward elevation [FE], abduction, external rotation [ER], internal rotation [IR], and radiographic outcomes (humeral and glenoid radiolucency line rates, scapula notching rate) were stratified and compared by glenoid deformity type per the Walch classification for aTSA and rTSA cohorts. Comparisons were performed to assess the ability of the Walch classification to predict the preop, postop, and improved state after TSA. 1,008 TSAs were analyzed including 576 aTSA and 432 rTSA. Comparison of outcomes between Walch glenoid types resulted in 15 pairwise comparisons of 12 clinical outcome metrics, yielding 180 total Walch glenoid pairwise comparisons for each clinical state (preoperative, postoperative, improvement). Of the 180 possible pairwise Walch glenoid type / metric comparisons studied for aTSA and rTSA cohorts, <6% and < 2% significantly differed in aTSA and rTSA cohorts, respectively. Significant differences based on Walch type were seen after adjustment for multiple pairwise comparisons in the aTSA cohort for FE and ER preoperatively, the Constant score postoperatively, and for abduction, FE, ER, Constant score, and SAS score for pre- to postoperative improvement. In the rTSA cohort, significant differences were only seen in abduction and Constant score both postoperatively and for pre- to postoperative improvement. There were no statistically significant differences in humeral lucency rate, glenoid lucency rate (aTSA), scapular notching rate (rTSA), complication rates, or revision rates between Walch glenoid types after TSA. Although useful for describing degenerative changes to the glenohumeral joint, we demonstrate a weak association between preoperative glenoid morphology according to the Walch classification and clinical state when evaluating patients undergoing TSA for rotator cuff-intact OA. Alternative glenoid classification systems or predictive models should be considered to provide more precise prognoses for patients undergoing TSA for rotator cuff-intact OA.

Green alternatives in treatment of liver diseases: the challenges of traditional medicine and green nanomedicine.

Liver diseases have become a global problem with approximately 2 million deaths per year. The high increase in the mortality rate of these diseases is mostly related to the limitations in the understanding of the evolutionary clinical cases of liver diseases, the low delivery of drugs in the liver, the non-specific administration of drugs and the side effects generated at the systemic level by conventional therapeutic agents. Today it's common knowledge that phytochemicals have a high curative potential, even in the prevention and/or reversibility of liver disorders; however, even using these green molecules, researchers continue to deal whit the same challenges implemented with conventional therapeutic agents, which limits the pharmacological potential of these friendly molecules. The latest advances in nanotechnology have proven that the use of nanocarriers as a delivery system for green active ingredients, as well as conventional ones, increases the pharmacological potential, due to their physicochemical characteristics (size, Zeta potential, etc. ) moldable depending on the therapeutic objective; in addition, it should be noted that in recent years, nanoparticles have been developed for the specific delivery of drugs towards a specific target (stellar cells, hepatocytes, Kupffer cells), depending on the patient's clinical state of the disease.

Dual Antibody Treatment for Simultaneous Acute Cellular Rejection and Antibody-Mediated Rejection After Liver Transplantation: A Case Report

Antibody-mediated rejection (AMR) after liver transplantation is uncommon but sometimes has a grave prognosis. We herein describe a 40-year-old man who developed simultaneous acute cellular rejection and acute AMR due to de novo donor-specific anti-human leukocyte antigen antibodies after living donor liver transplantation. He underwent living donor liver transplantation with his brother-in-law as the donor. Hepatic function deteriorated on postoperative day 6, and a liver biopsy revealed histologic findings of typical acute cellular rejection. However, steroid pulse therapy and thymoglobulin did not produce a clinical response, and his liver function dramatically deteriorated on postoperative day 13 (aspartate aminotransferase, 2787 IU/L; total bilirubin, 14.1 mg/dL). We diagnosed acute AMR based on positive immunohistochemical staining for C4d in portal areas and added plasma exchange and high-dose intravenous immunoglobulin after rituximab. The patient's clinical state improved and ultimately resolved. To our knowledge, this is the first report of dual antibody treatment for simultaneous acute cellular rejection and acute AMR induced by de novo donor-specific anti-human leukocyte antigen antibodies. Despite his fulminant clinical course, we successfully rescued the recipient with immediate anti-humoral therapy. The rapid treatment decision and adequate understanding of the mechanisms of anti-humoral therapy were crucial to overcoming acute AMR in this case.

Predictive biosignature of major depressive disorder derived from physiological measurements of outpatients using machine learning

Major Depressive Disorder (MDD) has heterogeneous manifestations, leading to difficulties in predicting the evolution of the disease and in patient's follow-up. We aimed to develop a machine learning algorithm that identifies a biosignature to provide a clinical score of depressive symptoms using individual physiological data. We performed a prospective, multicenter clinical trial where outpatients diagnosed with MDD were enrolled and wore a passive monitoring device constantly for 6 months. A total of 101 physiological measures related to physical activity, heart rate, heart rate variability, breathing rate, and sleep were acquired. For each patient, the algorithm was trained on daily physiological features over the first 3 months as well as corresponding standardized clinical evaluations performed at baseline and months 1, 2 and 3. The ability of the algorithm to predict the patient's clinical state was tested using the data from the remaining 3 months. The algorithm was composed of 3 interconnected steps: label detrending, feature selection, and a regression predicting the detrended labels from the selected features. Across our cohort, the algorithm predicted the daily mood status with 86% accuracy, outperforming the baseline prediction using MADRS alone. These findings suggest the existence of a predictive biosignature of depressive symptoms with at least 62 physiological features involved for each patient. Predicting clinical states through an objective biosignature could lead to a new categorization of MDD phenotypes.

Association of Subthalamic Beta Frequency Sub-bands to Symptom Severity in Patients with Parkinson’s Disease: A Systematic Review (P5-11.014)

<h3>Objective:</h3> To synthesize existing literature regarding the association of beta sub-band local field potential (LFP) characteristics to clinical ratings of motor symptoms in patients with Parkinson’s disease (PD). <h3>Background:</h3> Beta (13–30 Hz) frequency measures have been found to be associated with motor dysfunction in patients with PD undergoing deep brain stimulation (DBS). Low-beta may be more responsive to medication states and express stronger association to motor dysfunction in PD compared to High-beta. However, a consensus on beta sub-band relationships to clinical state has yet to be determined. <h3>Design/Methods:</h3> A systematic search of existing literature was completed using EMBASE. Articles which collected subthalamic nucleus (STN) LFPs using macroelectrodes in patients with PD, analyzed low- (13–20 Hz) and high-beta (21–35 Hz) bands, collected UPDRS-III measures, and reported correlational strength or predictive capacity of LFPs to UPDRS-III scores. Articles were screened by title and abstract prior to undergoing full-text review for inclusion and data extraction. <h3>Results:</h3> The initial search yielded 233 articles. After screening and full-text review, 10 articles, with a total of 300 patients, were included. Beta measures included power spectral density, peak characteristics, and burst characteristics. Eight (80%) articles found low-beta and six (60%) found high-beta to be significantly correlated with, or predictive of, UPDRS-III scores or response to therapy. Four (40%) articles found both low- and high-beta to be associated with, or predictive of, UPDRS-III sub-scores or response to therapy. However, only one of the four found that high-beta had a stronger association to symptom severity compared to low-beta. <h3>Conclusions:</h3> This systematic review suggests that low-beta measures represent a biomarker of Parkinsonian symptom severity in patients with STN-DBS to a greater capacity than high-beta measures. Interestingly, these associations were found across multiple LFP measures, suggesting multiple analytical approaches using LFP signals can still yield clinically meaningful biomarkers of patient clinical state. <b>Disclosure:</b> Rebekah Summers has received personal compensation for serving as an employee of Medtronic. Rebekah Summers has received research support from National Institute of Health. Dr. Morelli has received personal compensation for serving as an employee of Medtronic.

Organization of patient transfer from conventional hospital to hospitalization at home

The organization of patient transfer from conventional hospital to hospitalization at home (HAH) is not well known. Our study aims to describe this organization by identifying the key professionals of the pathways and the incentives and obstacles to the continuity of care. Patient transfer from conventional hospital to HAH is a period of strong tension between all health care professionals and the organization of discharge is not sufficiently anticipated by hospital prescribers. The description of the patient clinical state is not always shared between the conventional hospital and the HAH professionals mainly when they do not work together. An HAH physician can be of support. Finally, the HAH nurse has a main role at the interface of the hospital department, the patient, and the home care professionals with an important activity of coordination of interventions. Patient transfer from conventional hospital to HAH should be anticipated by hospital professionals upon entrance and common needs assessment tools would allow a better security of the pathways.

The Covid-19 Antibody Titer of Convalescence Plasma Repeated Donors at Red Cross Indonesia of Tulungagung Regency

Convalescent plasma is plasma that is already present in the body and includes anti-SARS-CoV-2 antibodies. This plasma includes antibodies that may kill viral particles, thereby preventing virus entrance into cells. This neutralizing procedure has an effect on the improvement of a patient's clinical state after receiving convalescent plasma treatment. The possibility of this convalescent plasma therapy as a treatment for individuals infected with SARS-CoV-2 has been evaluated, and clinical trials are still ongoing. The aim of this study is to determine the antibody titer of the donor. The research was a descriptive study. Total sample was 25 repeated male donors. The data of their IgM and IgG levels was obtained from Management Information System at Red Cross Indonesia Of Tulungagung Regency. Data was presented as table. The mean IgG level of repeated convalescent plasma donors is higher than the mean IgM level. The mean IgM level of repeated convalescent plasma donors is often constant. The mean IgG level of convalescent plasma donors increased through the fifth donor and then declined from the sixth to the ninth donor. The mean result of IgM and IgG has decreased by a higher proportion than it has increased.

The Potency of Oral L-Arginine Suplementation Based on Chitosan-Coated Gold Nanoparticles (c-AuNPs) as Preeclampsia Prevention in Pregnant Women

Preeclampsia is a multi-systemic hypertensive disorder in pregnant women after two weeks of gestation and can cause complications in about 6-10% of all pregnancies. The incidence of preeclampsia in Indonesia is 128,273/year or about 5.3%. However, the handling of preeclampsia in Indonesia is still not optimal. This disease is difficult to detect and often appears suddenly, so prevention efforts need to be taken as an essential step in reducing morbidity and mortality due to this disease. Previous studies have shown that L-Arginine exhibits potential properties in preventing preeclampsia. This literature review aims to determine the potential for oral L-Arginine supplementation to prevent preeclampsia in pregnant women. Search for literature using search engines such as Google Scholar, Science Direct, ResearchGate, and NCBI. Inclusion and exclusion criteria are used to eliminate unrelated journals so 38 journals are obtained. L-Arginine has great potential as a preventive supplementation of preeclampsia by increasing the vascular NO synthesis where NO deficiency in pregnant women can induce changes in the uteroplacental structure. Supplementation of the dietary L-Arginine at a low dose of 3 g/day for three to four weeks is required in early pregnancy. The use of chitosan-coated gold nanoparticles (c-AuNPs) as encapsulation on a protein increases the bioavailability of oral supplementation and improves the patient's clinical state. Further research regarding the effectiveness of L-Arginine supplementation orally with c-AuNPs and the optimal dosage as a preeclampsia preventive supplement is needed.

D-34 | Trends of Endomyocardial Biopsy and Predictors of In-hospital Outcomes: National In-Patient Database Analysis from 2006 to 2017

BackgroundEndomyocardial biopsy (EMB) has limited indications based on expert consensus in new-onset fulminant heart failure, restrictive cardiomyopathies, and post-cardiac transplant. While generally considered a low-risk procedure, this depends on the patient's clinical state, the operator's experience, and cardiac pathologyexpertise. We sought to evaluate the temporal trend in EMB rates and inpatient outcomes.MethodsWe conducted a weighted analysis on EMB recipients (identified by ICD-9 and ICD-10-PCS codes) during their index hospitalization. We performed a trend analysis using the Cochran–Armitage test. We calculated adjusted odds ratios (aOR) to identify factors associated with inpatient mortality. A p-value < 0.05 was determined as statistically significant.ResultsWe found 64181 adult patients admitted for EMB between 2006 - 2017. The majority were 40 to 59 years old(41.8%), identified as white (62.8%), and male (68.7%). Inpatient mortality was 3.2% and the annual trend of EMB and its inpatient mortality remained stable over time. Coagulopathy aOR 3.18 (95% CI 2.61 – 3.87), electrolyte disturbances aOR 3.07 (95% CI 2.54 – 3.72), peripheral vascular disease aOR 3.08 (95% CI 2.31 – 4.10) and CHF aOR 2.28 (95% CI 1.80 – 2.87) increased the odds of inpatient mortality. The rate of iatrogenic cardiac tamponade (1.7%) and pneumothorax (1.2%) also remained stable.ConclusionsDisclosuresK. Quelal Nothing to disclose. A. Vij Nothing to disclose. BackgroundEndomyocardial biopsy (EMB) has limited indications based on expert consensus in new-onset fulminant heart failure, restrictive cardiomyopathies, and post-cardiac transplant. While generally considered a low-risk procedure, this depends on the patient's clinical state, the operator's experience, and cardiac pathologyexpertise. We sought to evaluate the temporal trend in EMB rates and inpatient outcomes. Endomyocardial biopsy (EMB) has limited indications based on expert consensus in new-onset fulminant heart failure, restrictive cardiomyopathies, and post-cardiac transplant. While generally considered a low-risk procedure, this depends on the patient's clinical state, the operator's experience, and cardiac pathologyexpertise. We sought to evaluate the temporal trend in EMB rates and inpatient outcomes. MethodsWe conducted a weighted analysis on EMB recipients (identified by ICD-9 and ICD-10-PCS codes) during their index hospitalization. We performed a trend analysis using the Cochran–Armitage test. We calculated adjusted odds ratios (aOR) to identify factors associated with inpatient mortality. A p-value < 0.05 was determined as statistically significant. We conducted a weighted analysis on EMB recipients (identified by ICD-9 and ICD-10-PCS codes) during their index hospitalization. We performed a trend analysis using the Cochran–Armitage test. We calculated adjusted odds ratios (aOR) to identify factors associated with inpatient mortality. A p-value < 0.05 was determined as statistically significant. ResultsWe found 64181 adult patients admitted for EMB between 2006 - 2017. The majority were 40 to 59 years old(41.8%), identified as white (62.8%), and male (68.7%). Inpatient mortality was 3.2% and the annual trend of EMB and its inpatient mortality remained stable over time. Coagulopathy aOR 3.18 (95% CI 2.61 – 3.87), electrolyte disturbances aOR 3.07 (95% CI 2.54 – 3.72), peripheral vascular disease aOR 3.08 (95% CI 2.31 – 4.10) and CHF aOR 2.28 (95% CI 1.80 – 2.87) increased the odds of inpatient mortality. The rate of iatrogenic cardiac tamponade (1.7%) and pneumothorax (1.2%) also remained stable. We found 64181 adult patients admitted for EMB between 2006 - 2017. The majority were 40 to 59 years old(41.8%), identified as white (62.8%), and male (68.7%). Inpatient mortality was 3.2% and the annual trend of EMB and its inpatient mortality remained stable over time. Coagulopathy aOR 3.18 (95% CI 2.61 – 3.87), electrolyte disturbances aOR 3.07 (95% CI 2.54 – 3.72), peripheral vascular disease aOR 3.08 (95% CI 2.31 – 4.10) and CHF aOR 2.28 (95% CI 1.80 – 2.87) increased the odds of inpatient mortality. The rate of iatrogenic cardiac tamponade (1.7%) and pneumothorax (1.2%) also remained stable. Conclusions DisclosuresK. Quelal Nothing to disclose. A. Vij Nothing to disclose. K. Quelal Nothing to disclose. A. Vij Nothing to disclose.

Innate and acquired immunity indices in assessing the clinical severity of patients with childhood schizophrenia

The results of previous studies suggest pathogenetic role of immune system in the development of schizophrenia. Examination of adolescent and young adult schizophrenic patients showed that the activity/ level of distinct parameters of innate and acquired immunity correlates with acuity and severity of pathological process in the brain. Presumably, evaluation of immune system characteristics in patients with childhood schizophrenia, concerning severity of their clinical symptoms, along with potential therapeutic aspect, may be the basis for early diagnosis of these conditions, and monitoring and prognosis of the further progression of the disease. The objective of our study was to compare clinical and immunological indices in children with schizophrenia to analyze the possibility of using these parameters for determination of the degree of activity of the pathological process. Sixty-two patients (39 boys and 23 girls) from 4 to 17 years of age with childhood schizophrenia were examined. Psychopathological and psychometric methods (PANSS and CGI-S scales) were used to assess mental state of the patients. Immunological parameters were determined in blood serum taken by fingerprick. Activity of leukocyte elastase (LE) and a1-proteinase inhibitor (a1-PI) was determined by spectrophotometric method. To determine the level of autoantibodies to S-100B and MBP, we used enzyme immunoassay. The study revealed activation of innate (by activity of LE and a1-PI) and acquired (by the level of autoantibodies to S-100B and MBP neuroantigens) immunity markers in blood serum of children with schizophrenia. Correlation analysis showed the significant positive correlation between complex evaluation of activation level of the immune system and severity of the patients’ state on the CGI-S scale (r = 0.64, p &lt; 0.0001), as well as severity of negative symptoms according to the PANSS scale (r = 0.34, p = 0.0077). The revealed correlations suggest an opportunity for using immunological parameters (LE and a1-PI activity, and antibodies to neuroantigens), as the additional laboratory criteria for the assessment of clinical state in patients with childhood schizophrenia.

Acute vital signs changes are underrepresented by a conventional electronic health record when compared with automatically acquired data in a single-center tertiary pediatric cardiac intensive care unit.

We sought to evaluate the fidelity with which the patient's clinical state is represented by the electronic health record (EHR) flow sheet vital signs data compared to a commercially available automated data aggregation platform in a pediatric cardiac intensive care unit (CICU). This is a retrospective observational study of heart rate (HR), systolic blood pressure (SBP), respiratory rate (RR), and pulse oximetry (SpO2) data archived in a conventional EHR and an automated data platform for 857 pediatric patients admitted postoperatively to a tertiary pediatric CICU. Automated data captured for 72h after admission were analyzed for significant HR, SBP, RR, and SpO2 deviations from baseline (events). Missed events were identified when the EHR failed to reflect the events reflected in the automated platform. Analysis of 132054622 data entries, including 264966 (0.2%) EHR entries and 131789656 (99.8%) automated entries, identified 15839 HR events, 5851 SBP events, 9648 RR events, and 2768 SpO2 events lasting 3-60min; these events were missing in the EHR 48%, 58%, 50%, and 54% of the time, respectively. Subanalysis identified 329 physiologically implausible events (eg, likely operator or device error), of which 104 (32%) were nonetheless documented in the EHR. In this single-center retrospective study of CICU patients, EHR vital sign documentation was incomplete compared to an automated data aggregation platform. Significant events were underrepresented by the conventional EHR, regardless of event duration. Enrichment of the EHR with automated data aggregation capabilities may improve representation of patient condition.

MyomiRs in cultured muscle cells from patients with idiopathic inflammatory myopathy are modulated by disease but not by 6-month exercise training.

Idiopathic inflammatory myopathies/IIM are associated with changes in muscle-specific microRNA/miR. Exercise improves muscle function and metabolism in parallel with changes in miR expression. We investigated the effects of disease and exercise on miRs in differentiated muscle cells/myotubes from IIM patients and controls. Samples of m. vastus lateralis were obtained by needle biopsy from IIM patients before/after 6-month training and from matched sedentary healthy controls. Muscle cell cultures were established and exposed to saturated fatty acid during differentiation. MiR-133a,-133b,-206,-1 and their target genes (qPCR), fat oxidation (FOx), lipids (chromatography) and mitochondrial oxidative phosphorylation (OxPHOS) complexes (immunoblotting) were measured. Interrelations between in vitro miRs and metabolism of myotubes as well as clinical parameters and disease activity/MITAX were explored. Levels of miRs were higher in myotubes derived from IIM patients compared to healthy controls (up to 3.5-fold, p<0.05). Neither 6-month training (IIM patients) nor in vitro palmitate treatment modulated myomiRs in myotubes. However, miR-133a,-133b, and miR-1 correlated negatively with FOx (p<0.01), triacylglycerols (p<0.05) and OxPHOS complex-V (p<0.05) and positively with OxPHOS complex-I (p<0.05) in myotubes. MiR-133a and miR-133b in myotubes were related to disease activity and fasting glycaemia in vivo (both p<0.05). Upregulation of microRNAs involved in myogenesis and regeneration in muscle cells derived from IIM patients indicates activation of compensatory epigenetic mechanisms, potentially aimed to counteract disease progression. Relationships of microRNAs with in vitro metabolic profile of muscle cells as well as with clinical parameters support the role of muscle-specific microRNAs in modulating muscle metabolism and clinical state of patients.

Critical Point-of-care Ultrasound Diagnosis of Fournier's Gangrene: A Case Report.

IntroductionFournier’s gangrene is a severe, necrotizing, and potentially fatal, soft tissue infection of the perineum that can be difficult to diagnose clinically. Point-of-care ultrasound (POCUS) has established a critical role in emergency medicine as a quick diagnostic tool due to its safety, accuracy, and cost effectiveness.Case ReportWe present a case in which POCUS was used to rapidly confirm diagnosis in an unstable, severely septic patient presenting to the emergency department with Fournier’s gangrene.ConclusionPoint-of-care ultrasound can be used to make the diagnosis of Fournier’s gangrene in critical patients when other diagnostic modalities are not feasible due to a patient’s clinical state.

Комбінована терапія ішемічної хвороби серця Армадіном і Тризипіном — ще один варіант або унікальна можливість?

Актуальність. У статті подані матеріали дослідження «КОМЕТА» з вивчення ефективності комбінації препаратів Армадін і Тризипін, ін’єкційної та таблетованої форм, вітчизняного виробника ТОВ НВФ «Мікрохім» у комплексному лікуванні хворих на ішемічну хворобу серця (ІХС) з високим кардіоваскулярним ризиком (ВКР) в умовах денного стаціонару кардіологічного профілю та амбулаторії, дана інтегральна оцінка обґрунтованості застосування розробленої схеми лікування протягом місяця і при тривалому спостереженні. Матеріали та методи. У дослідження включено 30 хворих на ІХС з ВКР, які отримували стандартну терапію відповідно до рекомендації ESC. Додатково призначали в/в краплинні інфузії Армадіну (200 мг на 100,0 фізрозчину), Тризипіну (1000 мг в/в у трубку в розведенні 1 : 2 на фізіологічному розчині), Армадін-лонг 300 мг, 1 табл. ввечері — протягом двох тижнів, потім протягом чотирьох тижнів Тризипін-лонг 1000 мг вранці, Армадін-лонг 300 мг по 1 табл. вранці і ввечері. Конт­роль ефективності призначеного комплексу здійснювався за динамікою клінічного статусу, показників тредміл-тесту (т/тесту), проби з 6-хвилинною ходьбою, ехокардіо­скопії, холтерівського моніторування ЕКГ (ХМЕКГ) за стандартними методиками; самооцінку якості життя проводили за класичним опитувальником із використанням анкети MOS 36-Item Short-Form Health Survey (SF-36). Результати. Встановлена позитивна динаміка в клінічному стані хворих, переважання статистично достовірних показників об’єктивних досліджень: т/тесту — приріст показника толерантності до фізичного навантаження на 3,4 МЕТ, збільшення пройденої дистанції при виконанні проби з 6-хвилинною ходьбою і переходом 33,3% хворих в категорію осіб з більш легким функціональним класом захворювання, зниження кількості передсердних і шлуночкових екстрасистол при ХМЕКГ і, що найбільш важливо, усунення коротких пароксизмів шлуночкової тахікардії. Анкетування хворих на предмет динаміки оцінки якості життя показало позитивний результат за основними критеріями опитувальника: рольове функціонування, обумовлене фізичним і емоційним станом, покращилося вдвічі (відповідно до і після — 50 і 100, 33 і 67). Висновки. Комплексне лікування препаратами Армадін і Тризипін (ін’єкційна, таблетована форми) є успішною технологією терапії і реабілітації хворих на ІХС з ВКР. Доцільні подальші багаторічні спостереження при довгостроковому використанні методики в перманентному режимі. Комбінація препаратів Армадін і Тризипін вітчизняного виробника ТОВ НВФ «Мікрохім» перспективна в плані активного вивчення в складі комплексної терапії хворих на ІХС та впровадження в широку медичну практику з метою підвищення терапевтичної ефективності в складі комплексної терапії хворих на ІХС.

Alzheimer's disease and type 2 diabetes mellitus: similarities in pathomechanisms lead to therapeutic opportunities.

Type 2 diabetes mellitus is a metabolic disease the development of which depends on both environmental and genetic factors. The rapid increase in the number of cases observed in recent decades has been associated with the lifestyle predominant in the West, characterised by a high-calorie diet rich in carbohydrates and saturated fatty acids as well as little physical activity and chronic stress. Another disease with growing morbidity is Alzheimer's disease, a neurodegenerative disorder characterised by progressive dementia. The results of numerous studies indicate many similarities between these two diseases in terms of their pathomechanisms, especially changes in the activity of enzymatic pathways, accumulation of peptides with altered structure, and chronic inflammation. Amyloid β, hyperphosphorylated tau protein, amylin, and apolipoprotein J are involved in both pathologies. The reasons for their excessive accumulation are not fully understood, but cellular metabolism disorders associated with insulin resistance and diabetes mellitus may play a key role in this process. It is highly probable that the changes observed at cellular level, which translate into the clinical state of patients, are caused by many abnormalities common to both diseases. The discovery of pathophysiological similarities has resulted in attempts to use antidiabetic drugs in Alzheimer's disease therapy. While animal studies have revealed the potential benefits of oral antidiabetic drugs, studies on humans have not provided clear data regarding their effectiveness. Most clinical trial results are promising, but there have also been studies that have shown no significant, or even adverse, effects of these drugs on Alzheimer's disease course. Undoubtedly, further research is needed to better understand the mechanisms by which the medications used in diabetes treatment affect the nervous system, and further clinical trials to compare the effectiveness of this therapy in patients presenting different clinical conditions at different stages of Alzheimer's disease.