Preventive Measures In Patients Research Articles

A Modified Transformer Network for Seizure Detection Using EEG Signals.

Seizures have a serious impact on the physical function and daily life of epileptic patients. The automated detection of seizures can assist clinicians in taking preventive measures for patients during the diagnosis process. The combination of deep learning (DL) model with convolutional neural network (CNN) and transformer network can effectively extract both local and global features, resulting in improved seizure detection performance. In this study, an enhanced transformer network named Inresformer is proposed for seizure detection, which is combined with Inception and Residual network extracting different scale features of electroencephalography (EEG) signals to enrich the feature representation. In addition, the improved transformer network replaces the existing Feedforward layers with two half-step Feedforward layers to enhance the nonlinear representation of the model. The proposed architecture utilizes discrete wavelet transform (DWT) to decompose the original EEG signals, and the three sub-bands are selected for signal reconstruction. Then, the Co-MixUp method is adopted to solve the problem of data imbalance, and the processed signals are sent to the Inresformer network for seizure information capture and recognition. Finally, discriminant fusion is performed on the results of three-scale EEG sub-signals to achieve final seizure recognition. The proposed network achieves the best accuracy of 100% on Bonn dataset and the average accuracy of 98.03%, sensitivity of 95.65%, and specificity of 98.57% on the long-term CHB-MIT dataset. Compared to the existing DL networks, the proposed method holds significant potential for clinical research and diagnosis applications with competitive performance.

The unavoidable pressure injury/ulcer: a review of skin failure in critically ill patients.

Due to an ageing population and prolonged lifespan, pressure injury (PI) incidence is increasing. Patients with a PI typically endure longer hospital stays, which create a significant burden on healthcare resources and costs. With appropriate preventive interventions, most PIs can be avoided; however, skin failure may become inevitable in particular instances. These are classified as unavoidable PIs. Patients in a critical condition are exposed to a unique set of therapies, medications and bodily states. Oftentimes, these instances decrease tissue tolerance, which may promote PI formation. Patients who are critically ill, especially those with extended stays in the intensive care unit, are susceptible to skin failure due to: prolonged immobility; mechanical ventilation; acute respiratory distress syndrome; COVID-19; sepsis; multiorgan system dysfunction; vasopressor use; and treatment with extracorporeal membrane oxygenation. Poor perfusion leading to skin breakdown results from the compounding factors of circulatory collapse, build-up of metabolites, compromised lymphatic drainage, patient comorbidities, and ischaemia via capillary blockage in patients who are critically ill. In addition, similar physiology is present during end-of-life multisystem organ failure, which creates unavoidable skin deterioration. The aim of this review is to provide an overview of circumstances which decrease tissue tolerance and ultimately lead to PI development, despite adequate preventive measures in patients who are critically ill.

Anastomotic tension "Bridging": a risk factor for anastomotic leakage following low anterior resection.

Excessive tension at the anastomosis contributes to anastomotic leakage (AL) in low anterior resection (LAR). However, the specific tension has not been measured. We assessed whether "Bridging," characterized by the proximal colon resembling a suspension bridge above the pelvic floor, is a significant risk factor for AL following LAR for rectal cancer. This retrospective study reviewed the medical records and laparoscopic videos of 102 patients who underwent laparoscopic LAR using the double stapling technique at Yachiyo Hospital between January 2014 and December 2023. Patients were classified based on whether they had Bridging (tight or sagging) or were in a Resting state of the proximal colon, and the association between Bridging and AL was examined. AL occurred in 31.3% of the Tight Bridging group, 20% of the Sagging Bridging group, and 2.2% of the Resting group (P = 0.002). The incidence of AL was significantly higher in patients with Bridging than in those without (23.2% vs. 2.2%, P = 0.003). Multivariate analysis revealed that Bridging is an independent risk factor for AL (odds ratio = 6.97; 95% confidence interval: 1.45-33.6; P = 0.016). The presence of Bridging is a significant risk factor for AL following LAR for rectal cancer, suggesting the need for implementing preventive measures in patients with this condition.

Study protocol for the development and validation of a questionnaire evaluating predisposition to immunosuppressant medication non-adherence of kidney pre-transplant patients. The KATITA project.

Non-adherence to immunosuppressive medication after kidney transplant is an important cause of graft rejection and loss. Approaches to minimization of non-adherence have focused on the identification of episodes of medication non-adherence, but by then irreparable harm to the graft may already have occurred, and a more effective approach would be to adopt preventive measures in patients who may have difficulty in adhering to medication. The aim of this study protocol is to develop and validate a clinical questionnaire for assessing, in kidney transplant candidate patients in the pre-transplant setting, the predisposition to non-adherence to immunosuppressive medication. In this multicenter, prospective study, a pilot questionnaire in Brazilian Portuguese language, composed of Likert-scaled statements expressing patients' beliefs, behaviors and barriers regarding medication taking will be assembled from a literature review, from focus groups, and an expert panel. The pilot questionnaire will be administered to a minimum of 300 patients in kidney transplant waiting lists and exploratory factor analysis will be used for development of the definitive questionnaire. A random subsample of a minimum of 60 patients will have the scale re-administered after one month for evaluation of test-retest reliability. A multicenter, external validation study will include 364 kidney transplant candidates who will be evaluated immediately before surgery and at months 3, 6 and 12 post-transplant for assessment of concurrent validity, by comparison with two scales that assess medication non-adherence, and for determination of predictive validity using a triangulation method for assessment of medication non-adherence. Structural validity will be assessed with confirmatory factor analysis using structural equation modeling. Cross-cultural generalizability and validity will be assessed by a multicenter study, in which a translation of the scale to another language will be administered to kidney transplant candidate patients from a different culture, with a subsample being selected for test-retest. This study will be conducted in Spain with a Spanish translation of the scale.

The Efficacy of Aprepitant in Preventing Post-bariatric Surgery Nausea and Vomiting: Evidence from Clinical Trials.

This study aims to evaluate the effectiveness of aprepitant in preventing postoperative nausea and vomiting (PONV) following metabolic bariatric surgery (MBS). Clinical trials meeting the inclusion criteria were identified through searches of PubMed, Embase, and the Cochrane Library databases, as well as clinical trials registered at clinicaltrials. gov. These trials compared aprepitant with the control or placebo groups among patients who underwent MBS. Meta-analysis was performed using StataSE 17.0 software to calculate the pooled risk ratio (RR) and its 95% confidence interval (CI) to assess the effectiveness of aprepitant in preventing PONV following MBS. A total of five articles comprising six studies including 929 patients undergoing MBS were included. Meta-analysis revealed a significant reduction in the incidence of PONV among patients receiving aprepitant (pooled RR = 0.51, 95% CI: 0.38-0.68, P < 0.05). Subgroup analysis indicated that aprepitant effectively reduced PONV incidence at 0, 6, and 12h postoperatively in patients with MBS, but did not decrease PONV occurrence at 24 and 48h postoperatively. Aprepitant demonstrated significant clinical efficacy in preventing PONV following MBS, effectively reducing patient discomfort, and improving postoperative recovery. Therefore, aprepitant should be considered a preventive measure in patients undergoing MBS to enhance patient satisfaction and recovery rates. Additionally, to maintain an effective drug concentration, aprepitant should be administered within the first 24h postoperatively. CRD 42024528154.

Якість життя: бюджетний баласт чи державотворча необхідність

The aim of the study is to determine the risks, challenges and threats caused by the genetic liability, environmental conditions and living environment, to establish the importance of their impact on the quality of life in Ukraine, to develop a methodological approach to their assessment and to develop a set of measures within the context of the spatial regeneration of the national socio-economic system under conditions of the military aggression of the Russian Federation and in the postwar period. The research is based on information from open sources, expert opinions, data of the State Statistics Service of Ukraine and the data base of the World Health Organization, on results presented in medical, demographic and economic monographic studies and the materials included in sample surveys. Systemic approach and analysis methods, sociological, genetic population, statistical, comparative analysis, generalizations and expert evaluations were utilized. It has been recognized that factors such as genetic burden and environmental conditions and the environment of life have increased the impact on the quality of life of the population of Ukraine, the effect of which has determined the requirements for societal, demographic, organizational-economic, medical-social and socio-political response to threatening events. Awareness of demographic determinism, general laws and modern economic trends in the formation of the quality of life in the country in the conditions of military aggression of the Russian Federation allowed: a) to form a complex of medical and genetic, social, public and state mechanisms and measures to ensure it; b) specify the negative factors of the spatial evolution of the socio-economic system, which determined the need to take into account the medical and genetic reserves and opportunities and develop measures to eliminate the destructive influence of environmental conditions and living environment in the course of solving the demographic and socio-economic problems of the state; c) propose a medical-genetic concept of quality of life and living environment, the implementation of which will enable the generation of a healthy heritage (physical and psychological), will allow to form potential and build up reserves for improving the quality of life. Taking into account resource limitations and the presence of threats and risks in the internal environment, medical genetic counseling and testing, the creation of satisfactory environmental conditions along with a living environment become necessary levers in the recovery of Ukraine. The constitution and importance of the impact of quality of life factors for Ukraine have been updated: heredity (32.0 %); environmental conditions and living environment (32.0 %); nature of the life and lifestyle of the individual (26.0 %); quality of medical care and socio-economic factors (10.0 %). Systemic conditions for the regeneration of the demographic and economic situation, improvement of the quality of life and well-being to proceed with the development of a healthy society have been formulated. A model for assessing the quality of life has been developed, enhancing the methodological approach in assessing the economic equivalent of the value of living, which also involves calculatiing the economic profit of the state from the preserved working capacity of a person as a result of successful treatment / prevention of a genetic anomaly. This becomes the basis for: substantiating the economic effectiveness of medical and genetic care and other treatment and preventive measures for patients with genetic pathologies; rationalization of pension payments; development of a new social policy. The practical significance of the results becomes the basis to improve: the national model of medical and genetic monitoring; a set of preventative measures within the population; analysis of aggressive environmental conditions and living environment; cost of living estimates; systems for managing loss risk factors.

Increased Risk of Fragility Fractures in Patients with Primary Biliary Cholangitis

Abstract Large-scale studies on the risk of fragility fractures in patients with primary biliary cholangitis (PBC) are limited due to low incidence. We aimed to investigate whether PBC is associated with fragility fractures using real-world nationwide data. The Korean National Health Insurance Service claims data from 2007 to 2020 were analyzed in this population-based cohort study. Patients with PBC (n = 4951) were matched with controls (n = 19 793) using a 1:4 ratio based on age, sex, and follow-up duration. The primary outcome was fragility fracture, which comprised fractures of the vertebra, hip, distal radius, and proximal humerus. The incidence rates (IRs) and hazard ratios (HRs) were determined to assess the impact of PBC on fragility fractures. During the median follow-up period of 5.37 years, 524 patients in the PBC group had fragility fractures (IR, 18.59/1000 person-years [PYs]). After adjusting for covariates, PBC increased the risk of fragility fractures by 1.63-fold (95% confidence interval, 1.20–2.22; P = 0.002). The vertebra and hip were particularly susceptible to fracture in patients with PBC, with adjusted HRs of 1.77 and 2.23, respectively. In the subgroup analysis, the risk of fragility fracture was 2.53-fold higher in men and 1.59-fold higher in women with PBC than that in the respective matched control groups. Considering the morbidity and mortality related to fragility fractures, increasing awareness of fragility fracture risk and implementing appropriate preventive measures in patients with PBC are imperative.

Hygiene and Care Protocols for Implant-supported Dental Prostheses in Patients with Diabetes

Background: Prophylactic dental procedures following implant placement are critical to the long-term success of implants and are also dependent on the patient maintaining effective home care. Purpose: Evaluation of the effectiveness of preventive measures in patients with diabetes during long periods after prosthetic treatment with implants. Materials and methods: The study included 62 patients with diabetes with edentulism using 146 dental implants. Patients underwent constant monitoring, including regular occupational hygiene during follow-up examinations. Their frequency was set individually from 2 to 4 times A clinical index including Bleeding on Probing (BOP), Probing Depth (PD), and Marginal Bone Loss (MBL). Results: In patients included in the preventive protocol after 12 months, the mean BOP was 1.4 ± 0.15, and PPD was 2.46 ± 0.42. After 12 months in patients mean MBL was 0.72 ± 0.6 mm, after 3 years MBL was 1.24 ± 0.25 mm. For patients who were excluded from preventive services after 12 months, the mean BOP 1.9 ± 0.25, and the mean PPD was 3.56 ± 0.28). After 12 months in patients mean MBL was 0.87 ± 0.7 mm, after 3 years MBL was 1.52 ± 0.32 mm (p &gt; 05). Compared to persons enrolled in the preventive protocol, those in the group without services were more likely to develop peri-implantitis (42.4% vs. 12,6%). The survival rate of implants after 3 years was 98.4%. The survival rate of implants in those patients who were excluded from preventive services after 3 years was 95.4%. Conclusion: For patients with diabetes, regular medical examinations, accompanied by professional oral hygiene procedures, prevent the development of negative reactions of the soft tissues surrounding the implant.

Knowledge about the Risk of Cardiovascular Disease among Adults with Type 2 Diabetes in Taif City, Saudi Arabia: A Cross sectional study

Background: Diabetes patients are significantly more likely to develop cardiovascular diseases (CVDs). Lack of understanding about the disease’s risk for CVDs would increase morbidity and mortality. Objectives: The purpose of this study was to ascertain the level of awareness among persons with type 2 diabetes in Taif, Saudi Arabia, regarding their risk of CVDs. Methods: A cross-sectional study was carried out on 300 type 2 diabetic patients through an online survey. Results: The mean knowledge of risk of cardiovascular disease among adults in Taif was 15.4 ± 5.4. 26% of the participants had an age range from 50-59 years and 57.1% were females. Most of the participants had an age at diabetes diagnosis more than 30 years and 41.7% had a duration of disease less than 5 years. Regarding knowledge of participants it was reported that, a family history of heart disease 55.8%, old age 66%, smoking 79.5%, high blood pressure 76.9% and bad cholesterol (LDL) 74.4% at higher risk for developing heart disease. 64.4% knew\ they should keep their blood pressure under control and 80.1% knew regular exercise can reduce their risk of developing heart disease. There was a positive relationship between participants education level and knowledge. Conclusion: This study found that adults with type 2 diabetes in Taif have a high level of knowledge about the risk of cardiovascular disease. Education and preventive measures for patients about CVD risk factors and diabetes management can improve health and reduce the risk of CVD. Keywords: knowledge, risk, CVD, DM, adults, Taif

Daily Antiplatelets Other Than Aspirin Reduce Liver Cancer Risk but Increase Intracranial Hemorrhage Risk in Cirrhotic Patients.

Aspirin, known to reduce the risk of liver cancer, has been proposed as a preventive measure for patients with chronic hepatitis and cirrhosis. However, concerns regarding aspirin's potential to cause gastrointestinal (GI) mucosal injury and bleeding have emerged. Several antiplatelets other than aspirin (APOA) that pose a smaller risk of GI bleeding than aspirin have been proposed as potential aspirin substitutes. This study investigated whether APOAs were effective at reducing the risk of hepatocellular carcinoma (HCC). Additionally, we evaluated the safety of APOAs, specifically regarding their potential to increase the risk of GI bleeding, in a nationwide cirrhosis cohort. For the period January 1, 2000, to December 31, 2017, we identified 686 993 patients with cirrhosis from a national database. A control group was established using 1:2 propensity score matching on the basis of sex, age, comorbidities, and medication use. Daily use of APOAs was significantly associated with lower incidences of HCC (aHR 0.67; 95% CI, 0.60-0.73; P < 0.001) and showed no significant increase in GI bleeding risk (aHR 1.04; 95% CI, 0.93-1.15; P = 0.533) compared to nonuse of APOAs. However, the risks of intracranial hemorrhage (aHR, 1.41; 95% CI, 1.18 to 1.69; P < 0.001) and overall mortality (aHR, 2.03; 95% CI, 1.95 to 2.10; P < 0.001) were higher in the APOA user group. Our results suggest that although daily use of APOAs other than aspirin may decrease the HCC risk of patients with cirrhosis, it may also increase their risks of intracranial hemorrhage and overall mortality. Therefore, the use of APOAs as an alternative to aspirin for HCC prevention in patients with cirrhosis requires careful consideration.

Analysis of the quantitative composition of the dental biofilm depending on the state of the hard dental tissues

The microflora of the oral cavity affects not only the development and course of the pathology of the hard dental tissues but also the effectiveness of its treatment and prevention. Therefore, it is equally important for a dentist to determine the species composition of microorganisms and their quantitative characteristics. The aim of the work was to study the quantitative composition of the planktonic form of the dental biofilm of the vestibular surface of the cervical teeth in young patients; its analysis in patients with a wedge-shaped defect, cervical caries and clinically intact teeth. A microbiological study of the dental biofilm of intact premolars of 33 caries-resistant patients (average age [23.90±5.34] years) was conducted. All patients were divided into three groups depending on the condition of the hard dental tissues. The dental biofilm removed from the lesion was additionally examined in patients with wedge-shaped defects. Microorganisms were identified by morphological, tinctorial and biochemical characteristics. A quantitative study of the population level was carried out by counting colony-forming units (CFU) in one gram of biomaterial which was expressed as a decimal logarithm (lg CFU/g). An imbalance between representatives of pathological and normal microflora was determined. Patients with cervical caries had a significantly higher chance of having Str. mutans and Lactobacterium in the dental biofilm, and a lower chance Str. γ-haemolyticus (p&lt;0.05). It confirms the role of Str. mutans and Lactobacterium in the etiology of cervical dental caries. There were no significant differences between the quantitative composition of the dental biofilm of patients of different groups that is probably related to the study of its planktonic component, the criteria for forming groups and the high level of caries resistance of the examined enamel. The obtained results can be useful in prescribing treatment and preventive measures for patients with cervical pathology of the teeth as well as in evaluating their effectiveness. In our opinion, it will contribute to a significant reduction in its prevalence and intensity among young people. Keywords: microorganisms, оral cavity, wedge-shaped defect, cervical caries.

THE CHALLENGE OF KIDNEY DAMAGE DURING INTERVENTIONAL CARDIOLOGY PROCEDURES

Introduction: Contrast nephropat(CN) is a frequent cause of acute renal failure (ARF). The diagnosis is based on an elevation of serum creatinine of 0.5 mg/dl (= 44.2 µmol/l) and/or ? 25% of baseline creatinine. In 90% of patients developing AKI on PC, it classically occurs between 24 and 72 hours after the examination. Diuresis is generally preserved, proteinuria is minimal, and urine sediment shows only granular cylinders and few cells. The differential diagnosis is that of ARF caused by cholesterol emboli from invasive procedures in the suprarenal aorta. In the short term, AKI following coronary angiography is associated with procedural complications, a longer hospital stay (8.1 days versus 4.7 days p &lt; 0.001), and higher one-year mortality (12.1% versus 3.7%). Patients at risk of developing PC-related nephropathy, particularly those with chronic renal failure or concomitant hypovolemia, have the need for extrarenal purification in some cases, in addition to the risk of cardiovascular mortality. This makes contrast media nephropathy a serious event for which clinicians must be prepared. Objective:the aim of this work was to determine the incidence of NIPC in patients undergoing primary angioplasty and/or coronary angiography procedures and generate hypotheses about risk factors. Materials and methods In collaboration with the cardiology department, we conducted a longitudinal descriptive study between January 2019 and January 2021. It included a cohort of 180 patients undergoing emergency or cold angiocoronary angiography for diagnostic or therapeutic purposes. Clinical and biological follow-up was 3 months for all patients. Patients with a blood test including creatininelevels before the examination and creatinine levels at 3 days, 15 days, 1 month, and 3 months after the procedure were included. Those who had undergone PCI for anexamination other than coronary Results Characteristics of the overall population All patients hadnormal creatinine levels and were predominantly male (70.0%) with an average age of 60.8 years. Of these patients, 20.6% had diabetes, 18.2% hypertension and 6.4% heart failure (HF). The rate of IR was 20.8%. Descriptive study Comparison of patient characteristics with and without NCI: The multivariate logistic regression study demonstrated that diabetes mellitus (Odds Ratio (OR)=2.26 95% confidence interval (CI95%): 1.29-3.98, p=0.005), a left ventricular ejection fraction (LVEF) &lt; 45% (OR=2. 03 IC95% :1.22-3.39, p=0.007) and a quantity of iodinated contrast medium (ICP) &gt; 90ml (1.72 IC95%:.of iodinated contrast medium (ICP) &gt; 90ml (1.72 IC95%: 0.99-2.99, p=0.05) were predictive of the occurrence of NCI. It should be noted that age was linked to creatinine clearance, and it was through a reduction in renal function that advanced age was responsible for a higher incidence of CIN. Furthermore, the search for correlations between these five independent factors 2 by 2 showed a significant relationship between diabetes and reduced renal function in the co-presence of these two factors, their effects are reciprocally potentiated and are responsible for an increased risk. Preventive measures showed? their efficacý only in the diabetic group, where prior hydration with saline significantly reduced the incidence of CIN: 16% versus 50% in diabetics who did not receive saline infusion Conclusion: Despite current management, this pathology affects the cardiovascular prognosis of patients, even though normalization of renal function is usually achieved within a month of exploration. In addition to identifying factors predictive of NIPC with a view to implementing appropriate preventive measures in patients at risk, we stress the importance of ensuring a good hemodynamic state intra-procedurally27.

Shared decision making for anticoagulation reduces anxiety and improves adherence in patients with atrial fibrillation

BackgroundTreatment with oral anticoagulants (OACs) could prevent stroke in atrial fibrillation (AF), but side effects developed due to OACs may cause patients anxiety during decision making. This study aimed to investigate whether shared decision making (SDM) reduces anxiety and improves adherence to stroke prevention measures in patients with AF.MethodsA one-group pretest–posttest design using a questionnaire survey was applied at the outpatient cardiology clinic between July 2019 until September 2020. A Patient Decision Aid (PDA) tool was used for the completion of the questionnaire survey after health education and counseling. Ten questions were included for patients’ recognition of SDM, and a 5-point scoring method was used, where “very much” was scored as 5 points, and “totally not” was scored as 1 point.ResultsFifty-two patients with AF were enrolled. In terms of patients’ recognition of SDM, points of more than 4.17 out of 5 were noted, indicating recognition above the level of “very much.” The patients’ anxiety scores before SDM were 3.56 (1.2), with a decrease of 0.64 points (p < 0.001) to 2.92 (1.3) after SDM. After SDM, the number of patients who decided to take OAC increased from 76.9% to 88.5%, and the 15.4% answering “unclear” decreased to 1.9% (p = 0.006). The patients’ anxiety levels after SDM were associated with gender (p = 0.025).ConclusionsThe approach using SDM enhanced our understanding of the pros and cons of OAC treatment and, in patients with AF, decreased anxiety about therapeutic decisions and increased willingness to accept treatment options.

Extended genetic analysis and tumor characteristics in over 4600 women with suspected hereditary breast and ovarian cancer

BackgroundGenetic screening for pathogenic variants (PVs) in cancer predisposition genes can affect treatment strategies, risk prediction and preventive measures for patients and families. For decades, hereditary breast and ovarian cancer (HBOC) has been attributed to PVs in the genes BRCA1 and BRCA2, and more recently other rare alleles have been firmly established as associated with a high or moderate increased risk of developing breast and/or ovarian cancer. Here, we assess the genetic variation and tumor characteristics in a large cohort of women with suspected HBOC in a clinical oncogenetic setting.MethodsWomen with suspected HBOC referred from all oncogenetic clinics in Sweden over a six-year inclusion period were screened for PVs in 13 clinically relevant genes. The genetic outcome was compared with tumor characteristics and other clinical data collected from national cancer registries and hospital records.ResultsIn 4622 women with breast and/or ovarian cancer the overall diagnostic yield (the proportion of women carrying at least one PV) was 16.6%. BRCA1/2 PVs were found in 8.9% of women (BRCA1 5.95% and BRCA2 2.94%) and PVs in the other breast and ovarian cancer predisposition genes in 8.2%: ATM (1.58%), BARD1 (0.45%), BRIP1 (0.43%), CDH1 (0.11%), CHEK2 (3.46%), PALB2 (0.84%), PTEN (0.02%), RAD51C (0.54%), RAD51D (0.15%), STK11 (0) and TP53 (0.56%). Thus, inclusion of the 11 genes in addition to BRCA1/2 increased diagnostic yield by 7.7%. The yield was, as expected, significantly higher in certain subgroups such as younger patients, medullary breast cancer, higher Nottingham Histologic Grade, ER-negative breast cancer, triple-negative breast cancer and high grade serous ovarian cancer. Age and tumor subtype distributions differed substantially depending on genetic finding.ConclusionsThis study contributes to understanding the clinical and genetic landscape of breast and ovarian cancer susceptibility. Extending clinical genetic screening from BRCA1 and BRCA2 to 13 established cancer predisposition genes almost doubles the diagnostic yield, which has implications for genetic counseling and clinical guidelines. The very low yield in the syndrome genes CDH1, PTEN and STK11 questions the usefulness of including these genes on routine gene panels.

Telemedicine for Optimizing Secondary Prevention in Coronary Artery Bypass Grafting Patients during COVID-19 Pandemic.

(1) Background: The COVID-19 pandemic has introduced a major disruption to the delivery of secondary prevention measures in patients with established atherosclerotic cardiovascular disease (CVD). It required a rapid and widespread adoption of new medical services, including the use of telemedicine. This study aimed to examine the impact of COVID-19 on secondary prevention in patients with coronary artery bypass grafting (CABG) and to evaluate the effectiveness of the telemedicine application for the implementation of lifestyle change measures, remote monitoring, and treatment regimen adjustment; (2) Methods: This prospective study on 194 CABG patients evaluated three consecutive years between 2019 and 2022 in the pre-pandemic period by face-to-face visits and during the pandemic by teleconsultations or hybrid follow-up. Variables of interest were compared between four periods: pre-pandemic-pre-P (1 March 2019-29 February 2020), lockdown-Lock (1 March-31 August 2020), restrictive-pandemic-Restr-P (1 September 2020-28 February 2021), and relaxed-pandemic-Rel-P (1 March 2021-1 March 2022). (3) Results: The average values of the lipidogram, blood sugar, and uric acid increased during Lock and Restr-P, but, through the use of teleprevention, they returned to the pre-pandemic level or even below this level. The exception was blood sugar, which remained high in Rel-P. The number of newly diagnosed patients with diabetes also increased, with most of them having moderate forms of COVID. During Lock and Res-P, the percentage of obese, smoking, or hypertensive patients increased, but, through the use of teleprevention, we managed to reduce it, although it remained slightly higher than the pre-pandemic level. Physical activity decreased in the first year of the pandemic, but, in Rel-P, CABG patients became more active than before the pandemic (4) Conclusions: The use of telemedicine for cardiovascular secondary prevention allowed us to not only continue seeing CABG patients but, also, to adjust their medication and to expand cardiovascular preventive counseling and testing with favorable results, especially during the second year of the pandemic.

Perioperative acute kidney injury in surgical treatment of renal cancer: pathogenesis, therapy of early and late complications

The development of acute renal injury is due to a number of factors both on the part of the patient (age, concomitant pathology, objective status) and the oncological process (stage of the disease, localization, volume of surgical intervention, access, etc.). Acute renal injury in patients with kidney cancer after surgical treatment may be accompanied by the development of early (hyperhydration, electrolyte balance disorders, hyperkalemia, acid‑base condition disorders, uremic intoxication) and late chronic kidney disease complications. The incidence of these complications increases with an increase in the volume of kidney resection, as a result of which it is important to take into account risk factors, timely diagnosis of the degree of kidney damage and medical measures aimed at restoring kidney function. Currently, the possibility of using various molecules as early markers of kidney damage, which help not only assess the presence of kidney damage, but also localize it, is being studied. For example, albumin, serum cystatin C, alpha 1‑microglobulin, P2‑microglobulin – markers of glomerular damage, NGAL, KIM‑1; L‑FABP, urine cystatin‑C, IL‑18 – reflect damage to the proximal tubule, GST, NGAL – distal tubule, calibindin D28 ‑ characterizes damage to the collecting duct, osteopontin, NHE‑3 – are associated with damage to the loop of Henle. Measures of a curative and preventive nature (infusion therapy, anti‑ischemic protection, modulation of ferroptosis, renal replacement therapy), as well as dynamic monitoring of the main biomarkers of renal damage are aimed at preventing the persistence of the pathological process with a possible outcome into chronic kidney disease, which is especially undesirable in patients with single kidney cancer. The main directions of medical and preventive measures in patients with acute kidney injury should be considered: 1) the fastest possible elimination or minimization of the effect of tumor tissue; 2) control and correction of life‑threatening complications of renal dysfunction (hyperhydration, electrolyte balance disorders (hyperkalemia), acid‑base state, uremic intoxication). Methods of anti‑ischemic protection include a number of surgical techniques aimed at 1) minimizing ischemia time, 2) reducing the intensity of volatile metabolic processes in the kidney, 3) training renal parenchyma for hypoxic conditions (receiving ischemic preconditioning).Duration of renal ischemia represents an important modifiable factor affecting early and distant renal function in surgically exposed patients. The article analyzes modern scientific data on the problem of postoperative acute kidney injury in renal cancer surgery.

Оцінка показників якості життя в дітей шкільного віку, хворих на артеріальну гіпертензію та ожиріння

The steady increase in the prevalence of obesity, arterial hypertension (Н) and their comorbidity among children and adults requires additional scientific research to identify the features of the combined course of these diseases and possible ways to improve treatment and preventive measures in patients of different age groups. Purpose - to analyze indicators of the quality of life (QL) in school-aged children with H and obesity. Materials and methods. 95 children aged 9-18 were examined. The examinees were divided into 4 groups: the Group 1 - children with normal blood pressure and normal body weight (BW); the Group 2 - patients with H and normal BW; the Group 3 - with normal blood pressure and obesity; the Group 4 - children with Hand obesity. QL was determined for all children using the Ukrainian version of the Pediatric Quality of Life Inventory 4.0 questionnaire. The frequency of certain complaints and some peculiarities of children’s lives in the study groups were also determined using a questionnaire developed by us. Statistical processing of the obtained results was carried out using MedStat v 5.2 (Y.E. Lyakh, V.G. Guryanov) and EZR v 1.35 (Saitama Medical Centre, Jichi Medical University, Saitama Japan 2017) programs. Results and conclusions. QL indicators in patients with obesity and H are lower (p&lt;0.05) than in the group of healthy children. The lowest indicators of the QL are observed in the Group 4, which were significantly lower (p&lt;0.005) compared to the same indicators in the Groups 2 and 3. Patients with H had significantly more frequent (p&lt;0.05) complaints of headache and dizziness compared with the Group 1. Patients with obesity had more (p&lt;0.05) complaints of heart palpitations during minor physical exertion compared to healthy children. In patients of the Group 4, complaints of headache, dizziness, palpitations during minor physical exertion were more common compared to the Group 1 (p&lt;0.05), and dizziness was more common than in the Group 3 (p&lt;0.05). According to survey data, 44.7% of obese children estimated their body weight as normal and did not consider it appropriate to change their lifestyle. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

THE PROBLEM OF HALITOSIS WHEN USING REMOVABLE DENTURES (CLINICAL CASE)

Recently, more and more publications are appeared in the literature in relation to the occurrence of the problem of bad breath, which are based on the basis of scientific researches.&#x0D; Halitosis, or fetor oris chronic bad breath, according to one of the researchers in this field, belongs to the category of "social disability". Since, for a certain group of the population, halitosis is the reason for limited communication with people suffering from this disease.&#x0D; The purpose of our work is to highlight a clinical case of chronic halitosis in a patient who uses partial removable prostheses made of acrylates.&#x0D; Patient M., born in 1952, complained of chronic, unpleasant mouth odor, which is observed every day and cannot be eliminated with the help of toothpaste and a brush.&#x0D; From the anamnesis of the patient M., it became known that the patient has been using partially removable plate prostheses for about a year. The patient notes that the unpleasant smell from the oral cavity bothered her even before the manufacture of removable prostheses. However, since using them, halitosis has increased. According to the patient’s words, she takes care of the prostheses regularly, but sometimes, during night sleep, they remain in the oral cavity.&#x0D; Treatment of halitosis in patient M. was carried out in two directions. Firstly, it is motivation and training in proper oral hygiene, selection of hygienic care products, demonstration of the technique of cleaning lingual plaque, application of antiseptic rinses and mouth fresheners. Secondly, it is a careful individual selection of structural materials, proper care of the prosthesis and its timely replacement during the using.&#x0D; Remote results of the examination of the oral cavity of patient M. and determination of the IR index by the method of S. Ulitovskyi confirmed the absence of the slightest smell at a close distance and confirmed the correctness of the selected treatment.&#x0D; Conclusion. The clinical case of chronic halitosis in a patient who uses removable prostheses shows the need for diagnosis, treatment and the use of preventive measures in patients suffering from this pathological condition.

Digital preventive measures for arterial hypertension (DiPaH) - a mixed-methods study protocol for health services research.

Digital health measures promise to further improve the quality of cardiovascular care but have not yet been widely implemented in routine care. The research project Digital preventive measures for arterial hypertension (DiPaH) will systematically identify structural and individual factors in different stakeholders that influence the use of digital preventive measures in patients with arterial hypertension in Germany. Special focus is given to remote and sparsely populated areas, the age-specific impact, as well as influence of digital health literacy. The DiPaH project is an exploratory cross-sectional study with a mixed-methods design, in which written surveys and interviews with patients and physicians will be conducted. In addition, secondary data from a health insurance company will be analyzed. In module 1, individuals from the database of the health insurance company with confirmed arterial hypertension will be interviewed (1,600 questionnaires, 30 interviews). Module 2 includes users of digital prevention offers and apps (400 questionnaires, 40 interviews) and in module 3, family physicians and cardiologists will be interviewed (400 questionnaires, 40 interviews). In a final module, the overall results will be analyzed and recommendations for interventions in clinical care will be derived. The DiPaH project will contribute to a patient-oriented and demand-based improvement of arterial hypertension prevention services in health care. Challenges and barriers will be analyzed and the respective target groups identified based on their prevention needs and social characteristics to enable a patient-centered implementation of digital prevention of arterial hypertension and cardiovascular services in general, and finally to improve cardiovascular outcomes. https://drks.de/search/de/trial/DRKS00029761, identifier DRKS00029761.

ДИНАМИКА СМЕРТНОСТИ ОТ ИНФАРКТА МИОКАРДА В РОССИЙСКОЙ ФЕДЕРАЦИИ, СЕВЕРО-ЗАПАДНОМ ФЕДЕРАЛЬНОМ ОКРУГЕ И КАЛИНИНГРАДСКОЙ ОБЛАСТИ ЗА 10-ЛЕТНИЙ ПЕРИОД, С 2012 ПО 2021 Г.Г.

Significance. Among cardiovascular diseases, myocardial infarction is the most frequent cause of death in the majority of regions of the Russian Federation. Regional peculiarities of the cardiovascular condition development and clinical course have high impact on many aspects of its diagnosis and treatment. The purpose of the study: to determine patterns of mortality from myocardial infarction in the Russian Federation, the Northwestern Federal District and the Kaliningrad region in the period from 2012 to 2021. Material and methods. Mortality rates from myocardial infraction in the regions of the Northwestern Federal District over a 10-year period (2012 -2021) were analyzed and calculated based on data of the Unified Interdepartmental Information and Statistical System of the Russian Federation. Data calculations and graphical analysis were performed using the Microsoft Excel package of application programs. Results. The study has undertaken a comparative analysis of statistical indicators of myocardial infarction mortality in Russia as a whole and in the regions of the Northwestern Federal District, including the Kaliningrad region. Over ten years, from 2012 to 2021, the Russian Federation saw a stable reduction in the myocardial infarction mortality rates from 47.1 cases per 100 000 population in 2012 to 38.27 cases per 100 000 population in 2021. On average, mortality from myocardial infarction in the Northwestern Federal District is higher than in Russia as a whole during the period under study, there was a steady decline from 57.6 in 2012 to 42.48 per 100 000 population in 2021. Among the Northwestern Federal District regions, the highest mortality rate was registered in the Pskov region: on average, 58.32 per 100 000 population and in St. Petersburg: on average, 54.64 per 100 000 population over 10 years, while the lowest one - in the Kaliningrad region: on average, 25.38 per 100 000 population. In the Kaliningrad region, as well as in the whole Russian Federation, there is an increase in mortality from myocardial infarction registered in 2021, which is probably due to the COVID-19 epidemic. Conclusion. Since a high incidence of cardiovascular diseases and high mortality from myocardial infarction are mainly due to a low patient awareness, it is necessary to implement regional programs aimed at increasing public awareness of risk factors and symptoms of cardiovascular diseases, as well as long-term follow-up programs for acute coronary syndrome survivors. Scope of application. Comparative aspects of statistical indicators of mortality from myocardial infarction reflect effectiveness of primary and secondary prevention measures in patients with coronary atherosclerosis carried out in regional health care institutions and will contribute to better planning and implementation of regional programs aimed at reducing mortality from cardiovascular complications