Persistent Forms Research Articles

P114 SARS-CoV-2 infection in IBD: pandemic waves and predictors of severe or persistent COVID-19

BackgroundThis study aimed to compare the risk of COVID-19 in patients with IBD versus the general population, and to evaluate predictors of infection acquisition, progression to severe forms, and risk of developing persistent COVID-19. We also assess the differences between cases across the different COVID-19 pandemic waves in our target population.MethodsThis single-centre prospective, cohort study included consecutive IBD patients diagnosed of COVID-19 either by a positive polymerase chain reaction test and/or antigen test in nasopharyngeal swabs, or by anti-SARS-CoV-2 antibodies, and that they had a follow-up of at least 4 months. Using logistic regression, we evaluated cases versus IBD controls included in the IBD Unit database for predictors of COVID-19 acquisition. COVID-19 cases were distributed according to pandemic waves. Cox regression analysis was used for predictors of severe and persistent COVID-19.ResultsBy May 31, 2021, 160 out of 1911 IBD patients (8.3%) were diagnosed with COVID-19. IBD patients had a similar adjusted incidence of COVID-19 (OR 0.94; 95% CI 0.86–1.02; P=0.42), and a similar associated mortality ratio (OR 0.83; 95% CI 0.6–1.06; P=0.48), compared to the general population. In multivariable analysis, treatment with biologics was associated with a higher risk (OR 2.22, P<0.001), and treatment with salicylates with a lower risk (OR 0.71, P=0.048) of contracting COVID-19.(Table 1) 62 COVID-19 cases were diagnosed during the first wave of pandemic (until the end of June 2020), and 54 and 44 cases during the second and third waves (until the end of December 2020 and May 2021, respectively).(Figure 1) In multivariate analysis, first wave cases were associated with a higher risk of progression to severe forms of infection (OR 4.76, 95% CI 1.83–12.37, P=0.001), and development of persistent COVID-19 (OR 2.4, 95% CI 1.16–4.95, P=0.018). 29 patients (18.1%) required hospitalisation and were classified as severe COVID-19, which was associated in multivariable analysis with age>48 (HR 3.68, P=0.007), cases diagnosed in the first wave (HR 6.04, P<0.001), and comorbidities (evaluated with Duke Severity of Illness Checklist [DUSOI], P<0.001).(Table 2) During a median follow-up of 8.4 months, 68 patients (42.5%) were diagnosed with persistent COVID-19. Multivariable analysis identified UC (P=0.053), comorbidities (P=0.090), and being diagnosed during the first wave (P=0.011) as risk factors for persistent COVID-19.(Table 3) ConclusionIBD patients have a similar risk of COVID-19 and associated mortality as the general population. Cases diagnosed during the first wave of the pandemic had severe and persistent forms of COVID-19 more frequently. Age and comorbidity were the main risk factors for severe forms of the disease.

Polymerase chain reaction in diagnostics of latent and persistent forms of infectious cattle diseases

Polymerase chain reaction in diagnostics of latent and persistent forms of infectious cattle diseases

Nectin-2 Acts as a Viral Entry Mediated Molecule That Binds to Human Herpesvirus 6B Glycoprotein B

Human herpesvirus 6B (HHV-6B) is a T-lymphotropic virus and the etiological agent of exanthem subitum. HHV-6B is present in a latent or persistent form after primary infection and is produced in the salivary glands or transmitted to this organ. Infected individuals continue to secrete the virus in their saliva, which is thus considered a source for virus transmission. HHV-6B primarily propagates in T cells because its entry receptor, CD134, is mainly expressed by activated T cells. The virus then spreads to the host’s organs, including the salivary glands, nervous system, and liver. However, CD134 expression is not detected in these organs. Therefore, HHV-6B may be entering cells via a currently unidentified cell surface molecule, but the mechanisms for this have not yet been investigated. In this study, we investigated a CD134-independent virus entry mechanism in the parotid-derived cell line HSY. First, we confirmed viral infection in CD134-membrane unanchored HSY cells. We then determined that nectin cell adhesion molecule 2 (nectin-2) mediated virus entry and that HHV-6B-insensitive T-cells transduced with nectin-2 were transformed into virus-permissive cells. We also found that virus entry was significantly reduced in nectin-2 knockout parotid-derived cells. Furthermore, we showed that HHV-6B glycoprotein B (gB) interacted with the nectin-2 V-set domain. The results suggest that nectin-2 acts as an HHV-6B entry-mediated protein.

Analysis of the results of epizootic monitoring of viral diarrhea — a disease of mucous membranes in cattle in the Russian Federation according to the reporting of 4-vet for 2020

Relevance. The reproductive health of dairy cows is one of the top priorities in dairy farming. Viral diarrhea, a disease of mucous membranes in cattle, is one of the causes of impaired reproductive function on farms. The disease is widespread throughout the world and causes significant economic damage, which consists of a decrease in productivity, lack of offspring, impaired reproductive function of the broodstock, costs of treatment and specific prevention. The viral diarrhea virus has an immunosuppressive effect. Diagnosis is complicated by a “blurry” clinical picture due to the association of the virus with other respiratory-intestinal viruses and the addition of a secondary bacterial infection, as well as the presence of a persistent form of infection. The diagnosis requires the analysis of clinical and epizootic data, pathological changes and a combination of several methods of laboratory diagnostics. An important link in the prevention and recovery of herds is the conduct of epizootic monitoring and analysis of its results.Methodology. The assessment of the epizootic situation for viral diarrhea, a disease of mucous membranes in cattle in the Russian Federation for 2020, was carried out based on the results of the analysis of information obtained from annual reports provided by state veterinary laboratories in the FSBI CNMVL in the form of 4-vet (annual).Results. Based on the results of the epizootic monitoring, it can be concluded that the viral diarrhea virus is widely circulating in the livestock farms of the Russian Federation. In 2020, positive results were recorded in all federal districts of the Russian Federation (in 33 subjects), except for the Far Eastern Federal District. The most difficult epizootic situation is in the North Caucasus Federal District and the Central Federal District (38% and 29% of the total number of positive results, respectively).

Obstructed Hemivagina and Ipsilateral Renal Anomaly: Case Report

BACKGROUND: Hemivaginal obstruction syndrome and ipsilateral renal anomalies are known as Herlyn-Werner-Wunderlich syndrome (HWWs) or better known by the acronym obstructed hemivagina and ipsilateral renal anomaly (OHVIRA). It occurs as a result of complete failure of the Müllerian ducts to fuse and accounts for about 5% of Müllerian duct anomalies. Initial manifestations usually appear as a result of secretions accumulating within the hemivaginal obstruction. Patients with HWWs can come with complaints of lower abdominal pain, severe dysmenorrhea, pelvic or vaginal mass, abnormal vaginal discharge, acute urinary retention, fever, or vomiting. Therefore, careful diagnosis and appropriate management of this condition are desirable. The objective of the study was to report on the management of the obstruction due to HWWs. Patient was suspected hematocolpos with uterus didelphys from ultrasound and suggested right renal agenesis from BNO IVP. Diagnosis then confirmed by laparoscopy diagnostic. CASE REPORT: A 12-year-old patient was admitted to the gynecology ward of Dr. M. Djamil Central General Hospital from polyclinic with abdominal pain since 4 months before being admitted to the hospital. The pain gets worse every day before menstruation and decreases when given painkillers. CONCLUSION: OHVIRA syndrome is a triad characterized by hemivaginal obstruction and agenesis of the ipsilateral kidney (OHVIRA) and uterus in the delphys. Clinical symptoms in general are cyclic dysmenorrhea, palpable mass due to accumulation of menstrual flow, and severe pelvic pain which can later develop into a persistent form as a result of prolonged retention of menstrual secretions and obstructed hemivagina. Management options are surgical resection of the obstructed vaginal septum and drainage.

ОТДАЛЕННЫЕ РЕЗУЛЬТАТЫ МИНИИНВАЗИВНОЙ ЭПИКАРДИАЛЬНОЙ ВИДЕОАССИСТИРОВАННОЙ РАДИОЧАСТОТНОЙ ИЗОЛЯЦИИ ЛЕГОЧНЫХ ВЕН ПРИ ИЗОЛИРОВАННОЙ ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ

Aim. To analyze long-term results of the use of minimally invasive epicardial video-assisted radiofrequency ablation (RFA) of the pulmonary veins (PV) in patients with various forms of isolated atrial fibrillation (AF). Materials and methods. Since February 2011 to December 2014, 22 patients (male/female – 21/1) with paroxysmal / persistent / long-standing persistent idiopathic form of AF were operated on the basis of the Republican Scientific and Practical Center “Cardiology”, 7 (31.8%) / 9 (41%) / 6 (27.2%) cases respectively. Mean age was 48.33 ± 9.37 (31–66) years old. The average duration of the history of AF before the operation was 58.6 ± 32.5 months. RFA was performed through a bilateral mini-thoracotomy approach using video endoscopy with the application of bipolar irrigated Gemini X ablative clamp electrodes. All patients underwent bilateral antral RFA isolation of the PVs. In 100% of patients it was possible to achieve a conduction block from the PV collectors. Results. During the hospital period, there were not no lethal cases, conversions to sternotomy, and neurological complications. The long-term period was studied in 100% of patients, the average follow-up period was 7.4+0.5 years. The final rhythm was assessed using Holter monitoring in 3, 6, and 12 months after surgery, then annually. In 6 (28%) cases in patients with initial non-paroxysmal AF, endocardial RFA of the isthmus of the right atrium or PV orifices was performed at different times after surgery due to the presence of atrial flutter (4/19%) or AF (2/9.5%). Implantation of the pacemaker was required in 2 cases (9.0%). The ef fectiveness of bipolar antral RFA isolation of the PV using the Gemini X device, depending on the initial form of AF in the long-term period: paroxysmal – 100%, persistent – 66.7%, long-term persistent – 33.3%. Conclusion. Epicardial minimally invasive bipolar antral PV isolation is a highly effective treatment for paroxysmal AF. In non-paroxysmal forms of AF, it is necessary to expand isolation of arrhythmogenic zones in the atria.

Chronic non-bacterial osteomyelitis in children: Outcomes, quality of life.

Chronic non-bacterial osteomyelitis is a chronic sterile inflammatory bone condition. We aimed to describe patients' clinical and radiographic findings and to evaluate their response to therapy and their quality of life. This cross-sectional study included 18 patients from a single center in Turkey whose clinical, radiological features, and outcomes were reviewed retrospectively. The quality of the patients' lives after treatment was compared with healthy controls using the Pediatric Quality of Life Inventory 4.0. The median age of disease onset was 12 years (IQR 10-14 years) and 11 (61.1%) patients were male. The median follow-up duration was 15 months (IQR 12-22 months). The persistent form of chronic non-bacterial osteomyelitis was the most common pattern in 15 (83.3%) patients and a recurrent pattern was defined in three (16.7%) patients. The lesions were multifocal in all patients and 15 (83.3%) patients had symmetric distribution in whole-body magnetic resonance imaging. The most common sites of arthritis were the knee and sacroiliac joints. Methotrexate was used in 16 (88.9%) patients as first-line therapy. However, some patients were unresponsive to the first-line therapy and needed tumor necrosis factor-α inhibitors (55.6%) and bisphosphonates (16.7%). We observed remission in only four (22.2%) patients, and three (16.7%) patients were unresponsive. The patients had a significantly poorer quality of life than controls (P=0.005). Chronic non-bacterial osteomyelitis is an insidious disease that requires detailed analysis for diagnosis and whole-body magnetic resonance imaging is an effective tool for its diagnosis. Despite the advanced treatment, patients with chronic non-bacterial osteomyelitis have a poor quality of life.

FEATURES OF CLINICAL SYMPTOMS AND THE INFLUENCE OF RISK FACTORS ON THE OCCURRENCE OF BRONCHIAL ASTHMA IN CHILDREN OF LVIV REGION OF DIFFERENT AGES

Bronchial asthma (BA) is a common chronic pathology of the lower respiratory tract in children. The first manifestations of the disease can begin at any age, but the clinical features, of the course, are different in different periods of childhood. Manifestations and course of asthma may disappear or progress with age. Therefore, it is likely that there are differences in the pathophysiology, inflammatory response of the body and the features of the clinic of asthma in children of different ages, which affects the diagnosis and treatment. The aim of the study was to determine the features of clinical symptoms and the influence of risk factors for asthma on its occurrence in children of different ages.&#x0D; Materials and methods. We analyzed the anamnesis and clinical symptoms of 57 children aged 3 to 18 years, who were treated from September 2020 to June 2021 in the Lviv Regional Children's Clinical Hospital “OHMATDYT” and in the Lviv Municipal City Children's Clinical Hospital. The age groups did not differ statistically in the severity of asthma (P&gt; 0.05). Thus, in group 1 was 1 patient (9.09%) with mild form, 1 patient (9.09%) - moderate persistent form, 8 patients (72.73%) - with severe persistent form. Among patients of age group 2 was 1 patient (3.85%) with mild persistent form, 3 children (11.54%) - moderate and 21 children (80.77%) - with severe persistent form. In group 3 was 1 patient (5%) with a mild persistent form, 6 patients (30%) - moderate and 12 children (80%) - with a severe persistent form. The vast majority of patients were boys (84.21 ± 4.83%). All patients underwent general clinical examinations, spirometry, and allergy tests. We used the clinical-anamnestic method to perform the tasks of the work, which consisted in collecting a detailed somatic and genealogical anamnesis during the parents` questionnaire. Physical development of children was assessed using centile tables. Statistics were evaluated by calculating Student's t-test and Pearson's consistency test. Preschool children with asthma were more likely to experience shortness of breath during exercise and a wet low-yielding cough, and children of primary and secondary school age were more characterized by concomitant allergic rhinitis. Autumn was more unfavorable period for the exacerbation of clinical manifestations of asthma in children of Lviv region was period. We did not find correlation of birth weight on the timing of asthma. However, a burdensome obstetric history contributed to the early development of clinical manifestations of asthma. Preschool children were more likely to be exposed to nicotine during the antenatal period and had a shorter duration of breastfeeding, which may be a probable risk factor for asthma in preschool children. In 77% of children from different age groups were burdened with a history of allergies, with 66% of cases more pronounced in the maternal line. An analysis of physical development revealed that most preschool children were overweight.&#x0D; Conclusions. Asthma has features of clinical symptoms in children of different ages - shortness of breath during exercise and whooping cough are characteristic of preschool children, and concomitant chronic persistent rhinitis - for older age groups. Seasonal exacerbations are characteristic of asthma in children; in particular, the autumn period is more unfavorable, common for asthmatics in children of all ages among patients in Lviv region. Maternal smoking during pregnancy has a significant effect on the risk of developing asthma in children. Also, a burdened maternal allergy history and overweight child contributes to the development of asthma in children.

A Case Report on Schizophrenia with Autoimmune Encephalitis

Schizophrenia is a severe mental illness with a high death rate and significant societal implications. Curative treatments are not available due to a lack of understanding of its etiopathogenesis. The mild encephalitis hypothesis of schizophrenia, established primarily by Karl Bechter and Norbert Müller, is one of the new research hypotheses. According to this theory, a significant subset of schizophrenia patients suffers from a mild but persistent form of encephalitis caused by a variety of etiology ranging from viral infections to traumas to autoimmune illnesses. This inflammatory method is believed to occur in the start or during the course of the disease.&#x0D; The authors present case of a 65-year-old female got admitted in female psychiatric ward AVBR Hospital Sawangi Meghe, Wardha Maharashtra with chief complaint of forgetfulness, interest in environment decline, unable to communicate, poor performance at work, muttering to self, sleep disturbance, seeing people which are not seen other, fearfulness. all necessary investigation done, in mental status examination founded impairment in memory, disorientation cognitive function impairment, RBC count 3.82, WBC count 5300, Hb% 12, calcium 8.1, urea 26, creatinine 0.6, sodium 142, potassium 4.0. Alkaline phosphate 89. HIV, HBSAG non-reactive, A large number of white blood cells in the CSF An MRI that reveals evidence of brain inflammation. There was a slight increase in antinuclear antibody (1: 40 titer). Blood and CSF were positive for oligoclonal bands. The patient was received symptomatic treatment antianxiety, antipsychotic drug alleviates hallucinations and delusion. &#x0D; Disturbances of consciousness and orientation, catatonia, speech dysfunction, focal neurological signs, epileptic seizures/EEG abnormalities or autonomic dysfunction are warning signs in psychiatric patients which should always induce cerebrospinal fluid analysis with determination of antineuronal autoantibodies. Currently established immunotherapy strategies are summarised, taking into account international expert advice. Guided by clinical warning signs, our qualitative review enables rapid and reliable diagnosis of definite autoimmune encephalitis. This is of high relevance for the affected individuals, since early and sufficiently intense immunotherapy often leads to a good prognosis despite severe illness.

Active tolerance development in allergy to cow-based milk proteins

Food allergy is a potentially life-threatening condition without approved pathogenetic treatments other than eliminating the causal allergen and relief of acute allergic conditions. Immunoglobulin G-mediated form of food allergy remains a serious and growing problem worldwide. Its prevalence is steadily increasing and is a severe psychosocial and economic burden for patients and their families. Cow-based milk and products are important components of a childs diet, which are introduced at their first year of life, which can cause allergic reactions. The traditional management of children with cow-based milk allergy includes eliminating the dairy-free diet, and a significant number of patients form milk protein tolerance by the age of 5 years. However, with persistent forms of allergy to cow-based milk proteins, the need for active tactics of patient management to form tolerance arises. Oral immunotherapy is a promising approach to food allergy treatments based on a gradually increased allergen by analogy with standardized immunotherapy for respiratory allergens until reaching a maintenance dose. Each stage of oral immunotherapy should be considered as a personalized therapy.&#x0D; This review contains an analysis of available studies on the effectiveness of oral immunotherapy in the treatment of cow-based milk protein allergy.

The pathogenicity and virulence of Toxoplasma gondii

ABSTRACT Toxoplasma gondii is a parasitic protist infecting a wide group of warm-blooded animals, ranging from birds to humans. While this infection is usually asymptomatic in healthy individuals, it can also lead to severe ocular or neurological outcomes in immunocompromised individuals or in developing fetuses. This obligate intracellular parasite has the ability to infect a considerable range of nucleated cells and can propagate in the intermediate host. Yet, under the pressure of the immune system it transforms into an encysted persistent form residing primarily in the brain and muscle tissues. Encysted parasites, which are resistant to current medication, may reactivate and give rise to an acute infection. The clinical outcome of toxoplasmosis depends on a complex balance between the host immune response and parasite virulence factors. Susceptibility to the disease is thus determined by both parasite strains and host species. Recent advances on our understanding of host cell-parasite interactions and parasite virulence have brought new insights into the pathophysiology of T. gondii infection and are summarized here.

Application and validation of ukrainian-language modification of the ferrans and powers quality of life questionnaire for patients with heart rhythm distirancies in Ukraine

Introduction. Atrial flutter (AFl) and atrial fibrillation (AF) are ones of the most common arrhythmias, they constitute a significant proportion of cardiovascular events. Radiofrequency ablation (RFA) is the most common strategy of rhythm control in these patients, affects many endpoints, including quality of life. Existing validated questionnaires are not specific, need a lot of time as for patient during filling in, as for doctor during interpretation. In English resources Ferrans and Powers questionnaire has shown high sensitivity and specificity for patients with heart rhythm disturbances, which further uses in different patients’ cohorts. The aim of our work was to evaluate acceptability, reliability, legitimacy and sensitivity of the Ukrainian-language modification of the Ferrans and Powers questionnaire for patients with AFl and AF before and after RFA. Materials and methods. The original Ferrans and Powers questionnaire, which consists of 15 questions, was translated and adapted from English into Ukrainian. The survey was conducted among patients before the RFA procedure, in the acute postoperative period (3–5 days), 3 months and 12 months after the procedure. According to the results, the sum of points was calculated and classes were allocated: class 1 (significant decrease in quality of life) – 15–44 points, class 2 (moderate decrease in quality of life) – 45–74 points and class 3 (slight decrease, or high quality of life) – 75–90 points. Acceptability, reliability, legitimacy and sensitivity of the survey scale were assessed. Results. The study included 118 patients with a mean age of 58.98 ± 9.6, 49 women (41.5 %). The scale of the Ukrainian-language modification of the Ferrans and Powers questionnaire had a high internal sequence (logic), the average correlation between the points of the scale was 0.51; Cronbach’s alpha coefficient is 0.9. All the recommended criteria for constructing such scales were agreed, 15 points were combined into a single scale, in which 32 % of discrepancies with the original points were observed. By acceptability, the highest and lowest extremes of quality of life were below the recommended maximum of 20 %. Reliability was confirmed by compliance with the recommended criteria of internal density and reproducibility in repeated measurements. A high intrinsic density was demonstrated, confirming the design-related validity of the questionnaire. The sensitivity of the proposed scale was reflected in the increase in the quality of life of patients after all types of RFA procedures. The study proved the high acceptability, reliability, validity and sensitivity of the quality of life questionnaire of patients with cardiac arrhythmia in patients with paroxysmal, persistent and persistent forms of AFl and/or AF, as well as their observation in the stages after RFA. Conclusions. The Ukrainian-language modification of the Ferrans and Powers questionnaire has high levels of acceptability, reliability, legitimacy and sensitivity for patients with AFl and AF, which is a useful practical tool for the treatment and control of these patients.

Detection of Chlamydia Pneumoniae in Lung Tissues Derived from Lung Tumor-Bearing Iraqi Patients

Chlamydia pneumoniae is an intracellular gram-negative bacteria associated with lower and upper respiratory tract infections. Several studies, mostly achieved by serological assays, proposed a role for this bacteria in lung cancer risk. Therefore, this study aimed to evaluate the prevalence of Chlamydia pneuomoniae in fresh lung tissues of a sample of Iraqi patients with lung tumors, utilizing polymerase chain reaction (PCR) technique. . Chlamydia pneumoniae DNA was detected in 86.67% of samples. Besides, DNA sequencing of 16S rRNA gene revealed that our isolate is closely related to Chlamydia pneumoniae TW183 strain. It is concluded that Chlamydia pneumoniae is found in fresh lung tissues of patients, suggesting past infection, reinfection, or persistent form, which may play a role in the development or exacerbation of lung tumors. Our results confirm the high prevalence of this type of bacteria in Iraqi patients.

Molecular and Therapeutic Targets for Amyloid-beta Plaques in Alzheimer's Disease: A Review Study.

Alzheimer's disease (AD) is characterized by progressive loss of cognition and a gradual decrease in memory. Although AD is considered the most persistent form of dementia and a global concern, no complete cure or agents that can completely halt the progression of AD have been found. In the past years, significant progress has been made in understanding the cellular and molecular changes associated with AD, and numerous drug targets have been identified for the development of drugs for this disease. Amyloid-beta (Aβ) plaques and neurofibrillary tangles (NFT) are the major attributes of AD. Symptomatic relief is the only possible treatment available at present and a disease-modifying drug is of utmost importance. The development of drugs that can inhibit different targets responsible for the formation of plaques is a potential area in AD research. This review is not a complete list of all possible targets for AD but serves to highlight the targets related to Aβ pathology and pathways concerned with the formation of Aβ fragments. This shall serve as a prospect in the identification of Aβ plaque inhibitors and pave the strategies for newer drug treatments. Nevertheless, substantial research is done in this area but to bridle, the clinical difficulty remains a concern.

Prognostic value of pharmacotherapy in patients with atrial fibrillation after radiofrequency ablation

The aim of the work: to evaluate the prognostic effect of pharmacotherapy before and after radiofrequency ablation (RFA) in patients with atrial fibrillation (AF) on all-cause mortality, supraventricular arrhythmia recurrence and non-fatal cardiovascular events. Materials and methods. Patients with paroxysmal, persistent and long-term persistent forms of AF were examined before and after RFA – isolation of pulmonary veins. The primary endpoint was patient survival, secondary – a composite endpoint of freedom from recurrence and/or non-fatal cardiovascular events for 2 years of a follow-up. Frequency and doses of pharmacotherapy were evaluated. Standard statistical procedures were used for initial data evaluation. Results. 116 patients were consecutively enrolled in the study. In the long-term post-ablation, 23 patients (19.8 %) continued to take amiodarone, 2 patients (1.7 %) – propafenone for arrhythmic events, 38 patients (32.8 %) needed anticoagulants, and 37 patients (31.9 %) received beta-adrenoceptor blockers over the entire follow-up period. The use of RAAS inhibitors decreased from 81.0 % before the ablation to 56.0 % in the long-term period following RFA. Multifactorial logistic regression analysis showed that the prolonged (more than 3 months) anticoagulation (P = 0.032) after RFA was an independent predictor of patient survival in the two-year follow-up; doses of anticoagulants before the procedure, use and doses of beta-adrenoceptor blockers in the long-term post-ablation period were associated with the secondary endpoint. Conclusions. RFA for AF significantly reduced the frequency of medications use in the long-term postoperatively. Independent predictors of survival were the doses of anticoagulants more than 3 months after ablation, arrhythmia recurrence and non-fatal cardiovascular events – the doses of anticoagulants before the procedure, and the use and doses of beta-adrenoceptor blockers in the long-term period after RFA.

Mid-term outcomes of thoracoscopic and hybrid therapy of atrial fibrillation

Aim. To evaluate the efficacy and safety of thoracoscopic and hybrid techniques in patients with various forms of atrial fibrillation (AF).Methods. The results of thoracoscopic ablation of 87 patients with AF were analyzed: 27 (31%) with paroxysmal form, 15 (17%) - with persistent, 45 (52%) - with long-term persistent form at follow-up 18.6±6.7 months. “Box-Lesion” treatments and amputation of left atrial appendage (LAA) were performed in 69 (79.3%) patients, “Box Lesion” without LAA amputation in 12 (13.7%). When atrial tachycardia was recorded for more than 30 seconds after a 3-month “blind” period, patients underwent hybrid catheter intervention.Results. Freedom from atrial arrhythmias in the group of paroxysmal AF was achieved in 84% of patients (21 of 25), in the group of persistent form - in 60% of patients (9 of 15), in the group of long-term persistent form - in 78% (32 of 41) at a given observation period. In the structure of postoperative atrial tachycardia, AF recurrence was 5 (6.25%), typical atrial flutter (AFL) - 3 (3.75%), atypical AFL - 10 (12.5%). The mean LA volume index in patients with stable sinus rhythm was 64.6±11.3 ml/m2 versus 74.65±15.4 ml/m2 in the atrial tachycardia group (Student’s t-test 0.53, p = 0.6). These patients underwent a hybrid intervention. At a follow-up period of 15.9±10.9 months, a stable sinus rhythm was maintained in 15 (83.3%) patients. The overall rate of intra- and postoperative complications of thoracoscopic ablation was 5.7%.Conclusion. Thoracoscopic and hybrid approaches are effective methods for various forms of AF treatment.

Efficacy and safety of anticoagulant therapy in real clinical practice in patients with persistent atrial fibrillation after interventional treatment

Aim. To study the efficacy and safety of anticoagulant therapy in patients with persistent atrial fibrillation (AF) after interventional treatment during 36 months of follow-up.Material and methods. The study included 135 patients (78 men and 58 women) in the age from 31 to 80 years (mean age 61.0 [55; 66]) with persistent AF who underwent catheter treatment. All patients were treated in the arrhythmia department of the Research Institute of Cardiology (Tomsk National Research Medical Center from 01.01.2017 to 31.12.2017.Results. In patients with persistent AF, the effectiveness of catheter treatment was 60% after 12 months of follow-up (81 patients had no documented AF during this period) and 63.7 % (n=86) - after 24 and 36 months. No fatal outcomes, myocardial infarction, or ischemic stroke were observed within 12 months after catheter treatment in patients with an effective procedure. During 36 months of follow-up, the incidence of ischemic stroke on the background of receiving anticoagulant therapy and effective catheter treatment of persistent AF was significantly lower than in patients with unsuccessful ablation (1.16% and 10%, respectively), even though not all patients from the first group received prescribed medication.Conclusion. Successful radiofrequency procedure/cryo-ablation of AF persistent form significantly reduced the risk of ischemic stroke from 10% to 1.16% and almost eliminated the likelihood of other thromboembolic complications, while the invasive strategy did not increase the risk of large and small bleeding in this group of patients.

Predictors of atrial fibrillation recurrence after surgical ablation of long-standing persistent AF with concomitant coronary artery bypass grafting

Abstract Background A long-standing persistent form of atrial fibrillation (AF) in anamnesis, requiring surgical ablation together with coronary artery bypass surgery (CABG), significantly increases the risk of reccurence in the postoperative period. Before operation should consider the predictors of AF for long-term preservation of rhythm after surgery. Purpose To evaluate the predictors of AF recurrence on 3rd day and at discharge in patients after CABG with concomitant surgical ablation of long-standing persistent AF. Methods A prospective randomized single-center analysis was performed on patients with long-standing persistent AF, undergoing CABG with concomitant left atrial ablation (LAA) or biatrial ablation (BA) between 2016 and 2019. 116 patients were randomized into two groups: 58 in LAA+CABG, 58 in BA+CABG. The median age of the patients was 65 (IQR, 61 to 67.75) years in gr. BA and 62 (IQR, 58 to 66) in gr. LAA (Mann-Whitney U-test, p=0.050), 83% of men were in gr. BA (Fisher test, p&amp;gt;0.999). Predictors of AF development on day 3 were identified using multivariable logistic regression from the following baseline characteristics: myocardial infarction in anamnesis, time of artificial circulation, time of application of radiofrequency energy, the size of the left and right atrium, funcrional class of cardiac angina and heart failure, gender, age, acute cerebrovascular accident (CVA), additional intervention on the heart (operations for aortic aneurysm, mitral, aortic and tricuspid valves replacement), concomitant cardiovascular, respiratory, digestive and urogenital diseases. Results Using a multivariate model of logistic regression, the following significant predictors of arrhythmias on the 3rd day in gr. BA were included: additional intervention on the heart valves (OR 63.13, p=0.001); an increase in the functional class (FC) of chronic heart failure (CHF) NYHA by 1 (OR 40.06, p=0.018); a history of CVA (OR 9.13, p=0.026). The following significant predictors of AF reccurence on the 3rd day in gr.LAA were identified: an increase in the long axis of the right atrium by 1 cm (OR 3.05, p=0.006); an increase of the FC of cardiac angina by 1 (OR 7.11, p=0.011); in women (OR 7.14, p=0.017). In BA significant predictors of AF reccurence at discharge were: an increase in the long axis of the left atrium by 1 cm (OR4.86, p=0.015); reccurence of AF on the 3rd day (OR 17.45, p=0.005); 1 year increase in age (OR 1.24, p=0.023); the presence of diabetes (OR 47.67, p=0.002). In gr. LAA the predictors at discharge were: reccurence of AF on 3rd day (OR 38.35, p=0.001); a history of CVA increases the chances of arrhythmia (OR 210.83, p=0.032). Conclusion Number of clinical and functional characteristics of a patient may be predictors of AF. We examined the predictors of reccurence of AF after surgical ablation of long-standing persistent AF with concomitant CABG. Taking them into account when choosing the optimal strategy of treatment is important. Funding Acknowledgement Type of funding sources: None.

Clinical and Pathogenetic Assessment of Relationships Between the Dynamics of Body Weight Changes and Atrial Fibrillation in Patients with Primary Obesity

Aims.To evaluate the impact of body weight dynamics on the clinical course of atrial fibrillation in obese patients.Materials and methods. The study included 101 primary obese patients with paroxysmal or persistent atrial fibrillation. Study design: a retrospective, single-center, comparative study. Retrospectively аccording to the he body weight dynamics, patients were divided into 3 groups: those who increased their body weight by &gt;3 % (Group 1, n=40), maintained their initial body weight by ±2.9 % (Group 2, n=29), and reduced their initial body weight by &gt;3 % (Group 3, n=32). Follow-up examinations by a doctor were carried out at least once every 6 months for minimum 36 months. Change in AF type was determined by disease patterns and 7-day Holter monitoring results. The groups were comparable in gender (p=0,9267), age (p=0,3841), height (p=0,8900), and disease form (Paroxysmal atrial fibrillation /Persistent atrial fibrillation) (p=0,8826), the severity of symptoms on the European Heart Rhythm Association score of atrial fibrillations (p=0,8687) and systolic blood pressure at the beginning of the study (p=0,4500).Results. At the final control examination, the body weight of patients in Group 1 increased by an average of 11,4 [9,3; 13,1] kg (р &lt;0,001*), while weight loss in Group 3 averaged -6,2 [-8,4; -5,3] kg (p &lt;0,001*). The decrease in body weight of Group 2 patients was insignificant (p=0,5377) and amounted to -0,1 [-2,0; 1,3] kg. The progression of the disease from paroxysmal to persistent form was observed among 15 (37 %) patients in Group 1, 9 (31 %) patients — in Group 2, 2 (6 %) patients — in Group 3 (p=0,0079*). The regression of arrhythmia from persistent to paroxysmal form was not registered in group 1 (0 %), in group 2, the reverse development of the disease was noted in 1 patient (3 %) and in group 3 — in 6 patients (19 %) (p=0,0053*). There were no free from AF patients in Group 1 at the final follow-up, while 2 (7 %) patients were free from AF in Group 2 and 7 (22 %) — in Group 3 (р=0,0047*). In patients undergoing ablation, procedural success was determined after a 3-month blind period. The need for interventional procedures to restore the sinus rhythm and their multiplicity when comparing the groups did not differ significantly. However, in a pairwise comparison, the difference between groups 1 and 3 of participants was statistically significant (p=0,0079* and p=0,0374*, respectively). Conclusion. This study demonstrates the relationships between the dynamics of body weight and the clinical course of atrial fibrillation. The progression of obesity leads to the progression of the disease. Weight-loss management reverses the type and natural progression of AF, improves the prognosis and the course of disease, regardless of other significant risk factors, increases the anti-arrhythmic therapy effect and the effect of interventional treatment.

High Incidence of Asymptomatic Phase I IgG Seroconversion After an Acute Q Fever Episode: Implications for Chronic Q Fever Diagnosis.

The aim of this study was to describe the natural history of acute Q fever, including its clinical and serological evolution and progression to chronic Q fever. Observational cohort study (January 2011-September 2020) performed at Valme University Hospital (Seville, Spain). Inclusion criteria: (1) patients aged ≥18 years; (2) acute Q fever diagnosis, defined as suggestive symptoms in the presence of phase II immunoglobulin G (IgG) titer >1:256; (3) at least 6 months' follow-up after the acute Q fever episode. The incidence of seroconversion to a chronic Q fever serological pattern, defined as phase I IgG titers ≥1:1024 6 months after acute Q fever diagnosis, was assessed. During the study period, 117 patients were included. Thirty-four (29%) patients showed phase I IgG titers ≥1:1024 6 months after acute Q fever diagnosis. All patients with classic serological criteria for chronic Q fever diagnosis remained asymptomatic despite no specific treatment, with a median (quartile 1-quartile 3 [Q1-Q3]) follow-up of 26.5 (14-44) months in this subgroup. No cases of Q fever endocarditis nor other persistent focalized infection forms were observed during the study period. A significant proportion of acute Q fever patients develop classic serological criteria for chronic Q fever diagnosis in the absence of additional data of chronic Q fever. Consequently, phase I IgG cutoff titers >1:800 should not be used as a criterion to consider such a diagnosis. The incidence of persistent focalized infection forms after acute Q fever is extremely low and does not justify the use of prophylaxis strategies.