Risk For Development Of Disease Research Articles

A critical review of diagnostic and prognostic markers of chronic hepatitis B infection

Abstract A major worldwide health concern, chronic hepatitis B necessitates precise prognostic and diagnostic indicators for clinical guidance. This article highlights the clinical importance and current issues of the major markers used in both the detection and prognosis of chronic hepatitis B. An important indicator of an ongoing and persistent infection is the hepatitis B surface antigen. Hepatitis B virus DNA quantification monitoring aids in assessing viral load and hepatic cancer risk. While limited evidence of liver damage is provided by alanine aminotransferase levels, the hepatitis B core antibody verifies acute infection. Seroconversion to the hepatitis B e antibody is linked to a lower risk of disease development, and the hepatitis B e antigen status is a critical prognostic factor. Treatment choices are guided by a biopsy of the liver or minimally invasive liver fibrosis detection. Genotypes of the hepatitis B virus and host variables influence the prognosis by adding to the disease’s variability. Noninvasive techniques to evaluate the severity of the disease are provided by serum markers of fibrosis, such as the fibrosis score based on four criteria and the aspartate aminotransferase-to-platelet ratio index. The requirement for indicators that distinguish between distinct viral phases and increase specificity in evaluating liver damage is one of the challenges facing chronic hepatitis B research. Even though it is quite difficult to find reliable biomarkers for resistance especially when it comes to hepatocellular cancer risk estimation, there are advanced methods, which include imaging and omics that can help in improving the accuracy of the diagnostics and prognosis. Interventions early point that improve patient outcomes are made possible using diagnostics and prognostics as they are quite effective in managing the complicated landscape of chronic hepatitis B. Key in addressing these challenges today and improving the diagnostic and prognostic markers in the future, particularly those that would support the development of successful treatment plans for people living with chronic hepatitis B virus (HBV), are scientific research, technological advances and collaborations.

Bidirectional relationship between pancreatic cancer and diabetes mellitus: a comprehensive literature review

Pancreatic cancer (PC) is a fatal malignant disease. It is well known that the relationship between PC and type 2 diabetes mellitus (T2DM) is a complicated bidirectional relationship. The most important factors causing increased risks of pancreatic cancer are hyperglycemia, hyperinsulinemia, pancreatitis, and dyslipidemia. Genetics and the immune system also play an important role in the relationship between diabetes mellitus and pancreatic cancer. The primary contributors to this association involve insulin resistance and inflammatory processes within the tumor microenvironment. The combination of diabetes and obesity can contribute to PC by inducing hyperinsulinemia and influencing leptin and adiponectin levels. Given the heightened incidence of pancreatic cancer in diabetes patients compared to the general population, early screening for pancreatic cancer is recommended. Diabetes negatively impacts the survival of pancreatic cancer patients. Among patients receiving chemotherapy, it reduced their survival. The implementation of a healthy lifestyle, including weight management, serves as an initial preventive measure to mitigate the risk of disease development. The role of antidiabetic drugs on survival is controversial, however, metformin may have a positive impact, especially in the early stages of cancer, while insulin therapy increases the risk of PC.

A TELENURSING SERVICE'S IMPACT ON COVID-19 PATIENTS: LITERATURE REVIEW

Background: Pandemic Corona Virus Disease 2019 (COVID-19) is an infectious disease caused by SARS-COV2. COVID-19 has become a world pandemic that poses various risks throughout the world such as an increase in the number of patients and the risk of disease development in the world health system, especially nursing. The WHO reports that technology has a growing role in education and good work practice. Telenursing is well defined as the application of telecommunications and information technology to provide remote nursing practice. Purpose: This study aimed to examine the process of establishing a telenursing service for COVID-19. Methods: Three databases—PubMed, Google Scholar, and Research Gate—were used to find research publications. English-language keywords included in the literature search are telenursing OR tele-nursing and Covid-19, with the inclusion of works from 2019 to 2021. Results: Five studies that matched the inclusion criteria and the goals of this literature review were examined from a total of 936 research articles. Following the critical evaluation of five articles, a simplified thematic analysis was performed. This research review's main finding was that non-contact counseling services, instruction, and nursing care are important. Conclusion: Application of the telenursing program improved information technology and enabled the delivery of nursing care remotely. As an additional treatment option for patients with COVID-19, other remote self-care instruction techniques may be applied.

Oral Health and Older Adults: A Narrative Review.

Oral health's association with general health, morbidity, and mortality in older adults highlights its importance for healthy aging. Poor oral health is not an inevitable consequence of aging, and a proactive, multidisciplinary approach to early recognition and treatment of common pathologies increases the likelihood of maintaining good oral health. Some individuals may not have regular access to a dentist, and opportunities to improve oral health may be lost if health professionals fail to appreciate the importance of oral health on overall well-being and quality of life. The authors of this narrative review examined government websites, the American Dental Association Aging and Dental Health website, and the Healthy People 2030 oral objectives and identified xerostomia, edentulism, caries, periodontitis, and oral cancer as five key topics for the non-dental provider. These conditions are associated with nutritional deficiencies, poorer quality of life, increased risk of disease development and poorer outcomes for cardiovascular disease, diabetes, and other systemic conditions prevalent among older adults. It is important to note that there is a bi-directional dimension to oral health and chronic diseases, underscoring the value of a multidisciplinary approach to maintaining oral health in older adults.

ХАРАКТЕРИСТИКА КАРДИОВАСКУЛЯРНОГО РИСКА У БОЛЬНЫХ С ПСОРИАТИЧЕСКИМ АРТРИТОМ

Abstract. Introduction. Patients with psoriatic arthritis are exposed to a higher risk of developing cardiovascular complications. Development and progression of these disorders are based on a complex of closely interrelated factors, such as traditional cardiovascular risk factors, cardiovascular toxicity of some antirheumatic drugs, primarily non- steroidal anti-inflammatory drugs and glucocorticoids, and chronic autoimmune inflammation, which, according to many researchers, is the leading pathogenetic mechanism of atherosclerotic vascular lesions. The aim of the study was to assess the prevalence of traditional risk factors, the state of the blood lipid spectrum, and atherosclerotic remodeling of peripheral arteries in patients with psoriatic arthritis. Materials and Methods. We examined 84 patients (41 women and 43 men) aged 20 to 65 years. Arthritis was diagnosed based on the CASPAR criteria. Patients were assessed regarding traditional risk factors, such as hypertension, obesity, smoking, aggravated family history of CVD, diabetes, physical inactivity, and dyslipidemia; ten-year total coronary risk was calculated using the SCORE scale. To diagnose subclinical atherosclerosis, the patients underwent Doppler ultrasound of the carotid arteries with an assessment of the intima-media complex thickness. Results and Discussion. Assessment of disease development risk factors showed that all patients with psoriatic arthritis had from one to five risk factors. More common risk factors were smoking in 50 (59.5 %) patients, AO in 44 (52.4 %), dyslipidemia in 48 (57.1 %), and arterial hypertension. Patients with a long history of the disease have a higher prevalence of risk factors. According to the results of calculating the ten-year total coronary risk (SCORE scale), most patients were in the group of low (46.4 %) and moderate (38 %) risk. An association was found between the level of total coronary risk and arthritis activity in groups of patients with low and moderate risk. The average intima-media complex thickness of the common carotid artery in the group of patients with psoriatic arthritis was statistically significantly higher than in those in the control group (p=0.0361).Conclusions. An increased risk of cardiovascular complications was found in patients with psoriatic arthritis, while most patients have several risk factors in various proportions. According to the risk assessment on the SCORE scale, it was found to be statistically significant in the group of patients with psoriatic arthritis, which correlates with disease activity. The presence of subclinical atherosclerosis was detected in form of a statistically significant increase in the intima-media complex thickness of the carotid arteries. All the above indicates the current problem of psoriasis comorbidity, which dictates a personalized comprehensive approach to therapy for the selection of safe and adequate therapy for all diseases diagnosed in an individual patient.

The safety and efficacy of nonvitamin K antagonist oral anticoagulants in morbidly obese patients with atrial fibrillation: a meta-analysis

Background and aimAtrial fibrillation (AF) is the most frequently observed cardiac arrhythmia in clinical settings. Obesity can influence the efficacy of the treatment administered, which requires a larger dose and more time to accomplish therapeutic targets due to altered pathophysiology. Our study aimed to assess the overall efficacy and safety of nonvitamin K antagonist oral anticoagulants (NOACs) versus warfarin in AF patients with morbid obesity (BMI > 40 kg/m2 and/or weight > 120 kg) to prevent complications.MethodsWe conducted a literature search on PubMed, Web of Science, the Cochrane Library, and Scopus till October 2022 for articles addressing the efficacy and safety of NOACs versus warfarin for the treatment of AF in morbidly obese patients. We performed the meta-analysis with RevMan software version 5.4 and Open Meta Analyst. The main outcomes assessed were stroke, major bleeding, and minor bleeding after anticoagulation, as did the history of comorbidities and risk factors in morbidly obese patients. Quality assessment was performed using Cochrane’s ROB-2 tool and the Newcastle–Ottawa scale.ResultsRegarding major bleeding events, pooled data showed that patients taking NOACs had a significantly lower risk than patients taking warfarin (OR = 0.54, 95% CI: [0.41–0.70]; p < 0.00001). However, for minor bleeding, there was a nonsignificant effect of NOACs on reducing the risk of bleeding (OR = 0.72, 95% CI = 0.47–1.09; p = 0.12), which became highly significant in favor of NOACs after sensitivity analysis (OR = 0.55, 95% CI = 0.49–0.61]; p < 0.00001). There was a significant difference in the incidence of stroke between the NOAC group and the warfarin group (OR = 0.69, 95% CI = 0.60–0.80]; p < 0.00001). According to the results of the single-arm study analysis, the overall effect of all the outcomes was associated with a high risk of disease development in patients receiving NOACs.ConclusionOur meta-analysis showed a favorable effect of NOACs vs warfarin in morbidly obese patients. Some outcomes were not significantly different, which calls for future research to better assess their safety and efficacy in this particular weight group.Trial registrationThe study was registered with PROSPERO under registration number CRD42022362493 on October 2022.

Sugar Alcohol: A Comparison of Xylitol and Sorbitol in Food Application

Sugar is commonly used on a daily basis but, consuming excessive sugar can lead to various health issues such as diabetes, cardiovascular, and respiratory illnesses. As a result, the food industry has been manufacturing artificial sweeteners in order to reduce the risk of disease development. This research aims to compare the roles of xylitol and sorbitol based on their chemical value, as well as the benefits and drawbacks of their use in food applications. Sugar alcohols are mostly employed as thickeners and sweeteners and are additionally referred to as bulk sweeteners. Xylitol is typically found in fruits, vegetables, and hardwood trees. Furthermore, when compared to sucrose, xylitol includes similar tastes and sweeteners, though insulin is not required during metabolism. Additionally, it is used in healthcare products such as toothpaste and mouthwash due to its ability to prevent tooth decay. Similarly, sorbitol can be found in fruits and vegetables and is frequently employed as a sweetener, texture enhancer, and moisture maintainer. Nevertheless, xylitol and sorbitol may have their own set of advantages and disadvantages. It has been found that xylitol has a wide range of potential health benefits, including lower blood glucose and insulin response, and less sweetness intensity than sucrose. However, a drawback of ingesting xylitol is that it provides low-GI energy, making it unsuitable for people with low glucose levels, and it has a lower laxation threshold. Sorbitol also provides health benefits as it supplies calories and has a low glycemic index.

Precision nutrition in pediatric IBD: A position paper from the ESPGHAN special interest group for basic science and translational research, the IBD Porto group, and allied health professionals.

Stratified and precision nutrition refers to disease management or prevention of disease onset, based on dietary interventions tailored to a person's characteristics, biology, gut microbiome, and environmental exposures. Such treatment models may lead to more effective management of inflammatory bowel disease (IBD) and reduce risk of disease development. This societal position paper aimed to report advances made in stratified and precision nutritional therapy in IBD. Following a structured literature search, limited to human studies, we identified four relevant themes: (a) nutritional epidemiology for risk prediction of IBD development, (b) food-based dietary interventions in IBD, (c) exclusive enteral nutrition (EEN) for Crohn's disease (CD) management, and (d) pre- and probiotics for IBD management. There is scarce literature upon which we can make recommendations for precision or stratified dietary therapy for IBD, both for risk of disease development and disease management. Certain single-nucleotide polymorphisms related to polyunsaturated fatty acid (PUFA) metabolism may modify the effect dietary PUFA have in increasing the risk of IBD development. Non-colonic CD, mild-to-moderate CD, and high microbiota richness may predict success of EEN and may be used both for prediction of treatment continuation, but also for early cessation in nonresponders. There is currently insufficient evidence to make recommendations for precision or stratified dietary therapy for patients with established IBD. Despite the great interest in stratified and precision nutrition, we currently lack data to support conclusive recommendations. Replication of early findings by independent research groups and within structured clinical interventions is required.

A high fiber diet intervention during pregnancy: The SPROUT (Single goal in PRegnancy to optimize OUTcomes) protocol paper

BackgroundInterventions to prevent excessive gestational weight gain (GWG) have had a limited impact on maternal and infant outcomes. Dietary fiber is a nutrient with benefits that counters many of the metabolic and inflammatory changes that occur during pregnancy. We will determine if a high dietary fiber (HFib) intervention provides benefit to maternal and infant outcomes. Methods and designPregnant women will be enrolled in an 18-week intervention and randomized in groups of 6–10 women/group into the intervention or control group. Weekly lessons will include information on high-dietary fiber foods and behavior change strategies. Women in the intervention group will be given daily snacks high in dietary fiber (10–12 g/day) to facilitate increasing dietary fiber intake. The primary aim will assess between-group differences for the change in maternal weight, dietary fiber intake, dietary quality, and body composition during pregnancy and up to two months post-partum. The secondary aim will assess between-group differences for the change in maternal weight, dietary fiber intake, and dietary quality from two months to one year post-partum and infant body composition from birth to one-year-old. DiscussionEffective and simple intervention strategies to improve maternal and offspring outcomes are lacking. Changes during the perinatal period are related to the risk of disease development in the mother and offspring. However, it is unknown which changes can be successfully targeted to have a meaningful impact. We will test the effect of an intervention designed to counter many of the metabolic and inflammatory changes that occur during pregnancy. Ethics and disseminationThe University of Kansas Medical Center Institutional Review Board (IRB) approved the study protocol (STUDY00145397). The results of the trial will be disseminated at conferences and in peer reviewed publications. Trial registrationClinicalTrials.gov ID: NCT04868110

Association of Gene Polymorphisms with Breast Cancer Risk in the Kazakh Population.

The research aim is analyzing and identify reliable genetic markers of breast cancer risk in the Kazakh population. The databases were analyzed with the selection of polymorphisms associated with the development of breast cancer and further genotypic study of a group of women with a confirmed diagnosis of breast adenocarcinoma (group No. 1) and a group of relatively healthy women (group No. 2). The research presents the results of a study on the frequency of certain single-nucleotide polymorphisms in patients with breast cancer in the Republic of Kazakhstan. The frequency of single-nucleotide polymorphisms rs4646, rs1065852, rs4244285, rs67376798, rs6504950, rs2229774, rs1800056, rs16942, rs4987047 is statistically significant compared to the control group of patients. These polymorphisms in the Kazakh population have a direct association with an increased risk of breast cancer in women and may be used as cancer indicators during the genetic screening of patients with a complicated family history. Single-nucleotide polymorphisms such as rs55886062, rs3918290, rs12721655, rs4987117, rs2229774, rs11203289, rs137852576, rs11571833, rs80359062 and rs11571746 were found in more than 40. Zero percent of patients with breast cancer may be used as markers for detecting patients at increased risk of breast malignancy in the Kazakh population without a history of poor family history. The usage of the data obtained in a set of state programs for early screening of patients will improve the rates of early breast tumor detection, form groups of patients with a high risk of disease development and improve the quality and expectancy of life.

An analytical investigation of body parts more susceptible to aging and composition changes using statistical hypothesis testing

In recent years, age-related changes in body composition in the elderly are attracting attention. This is associated with a decline in physical functions and an increased risk of disease development. In general, age-related changes in body composition can be minimized with appropriate exercise. However, there are no studies that investigate body parts susceptibility to aging and changes in body composition of those parts. Therefore, devising exercise programs and advising daily life while taking these into account becomes difficult. This study aims to identify body parts that are more susceptible to aging and their body composition changes. The body composition was obtained with a Direct Segmental Multi-frequency Bioelectrical Impedance Analysis using InBody770 in 8 male elderly patients who had been shortly hospitalized. Statistical hypothesis testing was used to determine whether site-specific body composition changed significantly between hospital discharge and 1 year, 1 year and 2 years, and hospital discharge and 2 years. The results showed that Lean body mass, Total Body Water, Intracellular Water, Extracellular Water in the right arm; Lean body mass and Total Body Water in the left arm and trunk are more sensitive to aging.

Prognostic implications of family screening in Dilated and Arrhythmogenic Cardiomyopathies

Abstract Introduction Dilated cardiomyopathy (DCM) and arrhythmogenic left dominant cardiomyopathy (ALVC) are overlapping phenotypes of inherited cardiomyopathies characterized by left ventricular systolic dysfunction (LVSD), sharing the same genetic background. The risk of disease development in relatives is relevant and influenced by multiple factors. The purpose of familial screening (FS) is to early detect cardiac manifestations by ECG and echocardiogram every 2-5 years. Recent studies suggested a possible role of Holter-ECG and Global Longitudinal Strain (GLS) for disease prediction. However, these are not strongly recommended in the current FS guidelines. Moreover, it is unclear if FS represents a useful tool to prevent cardiac events in family members. Purpose Our study aims to 1) elucidate the role of genetic and environmental factors for cardiac disease development in relatives of probands affected by DCM/ALVC, 2) quantify the predictive role of FS for LVSD, and 3) assess the prognostic impact of FS on relatives. Methods Reasons for first medical contact, genetic data, baseline and follow-up (FU) clinical, ECG, echocardiogram, GLS, Holter-ECG data and outcomes were compiled. LVSD was defined as ejection fraction &amp;lt; 50%. Moreover, a primary outcome including all-cause death (D) and heart transplantation (HT) and an arrhythmic secondary outcome including sudden cardiac death (SCD) and major ventricular arrhythmias (MVA) were evaluated in affected relatives. Results A total of 385 relatives (85% with a proband affected by DCM) were enrolled. Among these, 223 (58%) were unaffected at baseline. During a median follow-up of 60 (IQR 30-110) months, 81 (36%) developed LVSD. Being carrier of pathogenic variants and having a family history of SCD were the main clinical factors significantly associated with LVSD development in the multivariable model, whereas environmental factors were not. Moreover, the GLS value at baseline was significantly lower in relatives developing LVSD compared to persistent unaffected relatives (-14.9 ±3.2 vs -19.8 ±3.2, p&amp;lt;0.001), and its value was an independent predictor of LVSD. Furthermore, in comparison to previously published predictive models which included age, ECG and echocardiographic abnormalities (C-index 0.64), adding Holter-ECG offers a better fit and increases the concordance by 20% (C-index 0.77). In conclusion, in the total population of 243 relatives (63%) with LVSD (at the baseline or at FU), cardiac events were less frequent among relatives detected by FS. Conclusions Genetic background plays a major role in the development of LVSD in relatives of DCM/ALVC probands. GLS and Holter-ECG could be useful tools to improve the efficiency of FS to predict LVSD, suggesting early FU visits. FS shows a significant prognostic protective impact in this study population.

ВЛИЯНИЕ ОДНОНУКЛЕОТИДНЫХ ПОЛИМОРФИЗМОВ ГЕНОВ IL1β, EDN1 И NOS3 НА ИНДИВИДУАЛЬНЫЙ ГЕНЕТИЧЕСКИЙ ПРОФИЛЬ ПАЦИЕНТОВ С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА В РЕСПУБЛИКЕ КРЫМ

Abstracts. Introduction. Coronary heart disease prevalence rate grows, which determines the importance of researchers’ inquiries aiming to improve the prevention, diagnosis, and treatment of this pathology. Aim. This study was aimed at identifying the associations of polymorphisms of genes interleukin 1-beta, endothelin-1, and endothelial nitric oxide synthase in patients with coronary heart disease. Materials and Methods. We studied polymorphic markers of endothelin-1 (rs5370), endothelial nitric oxide synthase (rs2070244), and interleukin 1-beta genes (rs1143634 and rs16944) in patients with ischemic heart disease (n=229) and in controls (n=56) by multiplex allele-specific polymerase chain reaction with electrophoretic detection. Odds ratio (OR) was used to state the association of genotypes with the disease; 95% confidence interval limits were calculated to assess the significance of OR. Results and Discussion. Analysis of the T-511C polymorphism in the interleukin 1-beta gene demonstrated a trend towards an increased risk of coronary heart disease associated with the TT genotype in the study group (Odds ratio=2.2, 95%. Confidence interval: 1.3-3.6). At the same time, the CC genotype can be associated with a protective effect (Odds Ratio=0.3, 95%. Confidence Interval: 0.2-0.6). When analyzing the C3953T polymorphism in the interleukin 1-beta gene, the TT genotype showed a significantly increased disease development risk within the pathology under study (Odds Ratio=6.4, 95%. Confidence Interval: 1.7-23.4). Analysis of the polymorphic marker C786T in the NOS3 gene showed a correlation between the TT genotype and susceptibility to coronary heart disease (Odds ratio=2.07, 95%. Confidence interval: 1.3-3.2), while the CC genotype showed a protective effect (Odds ratio=0.3, 95%. Confidence interval: 0.2-0.5). A similar result was obtained in an experiment with the Lys198Asn polymorphism in the endothelin-1 gene. TT genotype showed an association with the increased risk of coronary heart disease (Odds ratio=6.5, 95%. Confidence Interval: 3.4-12.4). Odds ratio analysis of the effect of heterozygotes showed no risk of coronary heart disease (Odds ratio=0.3, 95%. Confidence Interval: 0.1-0.5). Conclusions. This study allowed us to find an association between the polymorphic markers of genes endothelin-1 (rs5370), eNOS (rs2070244), and interleukin-1β (rs114634 and rs16944) and the coronary heart disease risk in the population, which may be useful for both stratification and selection of further therapeutic strategies.

Navigating the ALS Genetic Labyrinth: The Role of MAPT Haplotypes.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by wide clinical and biological heterogeneity, with a large proportion of ALS patients also exhibiting frontotemporal dementia (FTD) spectrum symptoms. This project aimed to characterize risk subtypes of the H1 haplotype within the MAPT (microtubule-associated protein tau) gene, according to their possible effect as a risk factor and as a modifying factor in relation to the age of disease onset. One hundred patients from Bulgaria with sporadic ALS were genotyped for the variants rs1467967, rs242557, rs1800547, rs3785883, rs2471738, and rs7521. Haploview 4.2 and SHEsisPlus were used to reconstruct haplotype frequencies using genotyping data from the 1000 Genomes project as controls. Genotype-phenotype correlation was investigated in the context of age of disease onset and risk of disease development. While the individual variants of the subtypes do not influence the age of onset of the disease, a correlation was found between the specific haplotype GGAGCA (H1b) and the risk of developing sALS, with results showing that individuals harboring this haplotype have a nearly two-fold increased risk of developing sALS compared to other H1 subtypes. The results from this study suggest that fine transcriptional regulation at the MAPT locus can influence the risk of ALS.

Patient and provider perception of home blood pressure monitoring kits

BackgroundPregnant patients of racial/ethnic minorities have higher preeclampsia rates. Home blood pressure monitoring (HBPM) has been investigated for disparity reduction. Smaller studies showed patients find HBPM to be a helpful intervention postpartum. Further investigation is needed to define the role of HPBM in an at-risk and diverse population antepartum. ObjectiveTo assess patient perception of HBPM among diverse patients at high risk of disease development. Study DesignProspective study conducted from April 2020-September 2021. HBPM kits were advertised and interested parties across the United States responded. Cuff Kits were then distributed to participating providers. Providers distributed the kits to patients meeting high-risk criteria for disease development, prioritizing those of racial/ethnic minorities. Surveys were distributed quarterly to providers and patients to assess HBPM perception. Results2910 Cuff Kits were distributed to patients at 179 sites in 14 states. Of those, 1160 were distributed to Black patients, 1045 to White patients, and 500 to Hispanic patients. 117 patients completed surveys, with most patients finding Cuff Kits “very valuable” or “valuable” (68.4% and 19.7%, respectively). Most providers (73.4%) felt the Cuff Kits influenced patient care. ConclusionsMost patients receiving Cuff Kits reported a beneficial impact on disease understanding and most belonged to racial/ethnic groups at higher risk of adverse outcomes. Providers found HBPM had a beneficial impact on care. Though more research is needed to illustrate the impact of HBPM on outcomes, this study suggests that among racial/ethnic minorities and those at the high risk, HBPM is a well-received intervention.

Association of angiotensin-converting enzyme (ACE) I/D variation with biochemical parameters and oxidative stress markers in systemic lupus erythematosus patients in west of Iran.

We aimed to study insertion/deletion (I/D) variation (rs4646994) of ACE gene in a group of SLE patients in west of Iran and its possible relationship with oxidative stress. Genotypes and allele frequencies related to ACE (I/D) variation were determined in 108 SLE patients and 110 gender and age-matched healthy controls using PCR. Neopterin, malondialdehyde (MDA), and serum lipid concentrations were determined by HPLC and enzyme assay respectively. The overall distribution of ACE I/D genotypes in SLE patients was different from that of the control group (P = 0.005). DD genotype compared to ID genotype increased the risk of SLE (OR = 2.57, 95% CI 1.4-4.8, P = 0.003). ID genotype compared to the II genotype decreased the risk of disease (OR = 0.45, 95% CI 0.2-0.99, p = 0.042). SLE patients with DD, ID, and II genotypes had lower paraoxonase (PON) activity and higher serum levels of MDA and neopterin versus control patients. We also detected a significant protective effect against SLE in presence of ACE I alleles and lack of angiotensin II receptor, type 1 (AGTR1) A1166C (NCBI reference SNP id: rs5186), C alleles in this study (OR = 0.31, 95% CI 0.14-0.68, P = 0.002). Carriers of the DD genotype of ACE gene with higher serum concentrations of neopterin and MDA, and lower PON activity had a high risk to develop SLE, while ID genotype decreased the risk of disease development by 2.22 times compared to II genotype.

The review of genetic screening services and common BRCA1/2 variants among South African breast cancer patients.

The South African genetic screening services for breast cancer comprise targeted and comprehensive tests that screen for the presence of genetic alterations. Clinically, these variants determine the risk of disease development as well as treatment approaches best suited for carriers. The current targeted tests screen for seven pathogenic sequence variants, which are mainly common among Whites, a population that constitutes 9.1% of South Africa. However, these tests are offered to all patients despite consistent negative results observed among Blacks, Indians, and Mixed ancestry (known as Coloreds in South Africa). Consequently, Blacks, White, and Colored patients who potentially carry other variants receive unbefitting treatment, resulting in poor clinical response, recurrence, and high mortality. This review aimed to identify the presence and incidence of pathogenic variants in BRCA1/2 previously reported in all South African populations. We selected literature using a scoping review approach, from which we included eight articles and two reports. Overall, we identified 59 BRCA1 and 60 BRCA2 pathogenic sequence variants from a cohort of 5709 patients and unknown patients from 90 families. The most reported variant was BRCA2 c.7943delG, which was common in White and Colored patients. None of the seven common variants was reported in either Blacks or Indians, which demonstrates the urgency to tailor genetic tests which are optimal for all South African patients and present a range of variants which could serve as diagnostic targets for Black, Indian, and Colored patients.

Feasibility and Clinical Utility of Prediction Models for Breast Cancer–Related Lymphedema Incorporating Racial Differences in Disease Incidence

Breast cancer-related lymphedema (BCRL) is a common complication of axillary lymph node dissection (ALND) but can also develop after sentinel lymph node biopsy (SLNB). Several models have been developed to predict the risk of disease development before and after surgery; however, these models have shortcomings that include the omission of race, inclusion of variables that are not readily available to patients, low sensitivity or specificity, and lack of risk assessment for patients treated with SLNB. To create simple and accurate prediction models for BCRL that can be used to estimate preoperative or postoperative risk. In this prognostic study, women with breast cancer who underwent ALND or SLNB from 1999 to 2020 at Memorial Sloan Kettering Cancer Center and the Mayo Clinic were included. Data were analyzed from September to December 2022. Diagnosis of lymphedema based on measurements. Two predictive models were formulated via logistic regression: a preoperative model (model 1) and a postoperative model (model 2). Model 1 was externally validated using a cohort of 34 438 patients with an International Classification of Diseases diagnosis of breast cancer. Of 1882 included patients, all were female, and the mean (SD) age was 55.6 (12.2) years; 80 patients (4.3%) were Asian, 190 (10.1%) were Black, 1558 (82.8%) were White, and 54 (2.9%) were another race (including American Indian and Alaska Native, other race, patient refused to disclose, or unknown). A total of 218 patients (11.6%) were diagnosed with BCRL at a mean (SD) follow-up of 3.9 (1.8) years. The BCRL rate was significantly higher among Black women (42 of 190 [22.1%]) compared with all other races (Asian, 10 of 80 [12.5%]; White, 158 of 1558 [10.1%]; other race, 8 of 54 [14.8%]; P < .001). Model 1 included age, weight, height, race, ALND/SLNB status, any radiation therapy, and any chemotherapy. Model 2 included age, weight, race, ALND/SLNB status, any chemotherapy, and patient-reported arm swelling. Accuracy was 73.0% for model 1 (sensitivity, 76.6%; specificity, 72.5%; area under the receiver operating characteristic curve [AUC], 0.78; 95% CI, 0.75-0.81) at a cutoff of 0.18, and accuracy was 81.1% for model 2 (sensitivity, 78.0%; specificity, 81.5%; AUC, 0.86; 95% CI, 0.83-0.88) at a cutoff of 0.10. Both models demonstrated high AUCs on external (model 1: 0.75; 95% CI, 0.74-0.76) or internal (model 2: 0.82; 95% CI, 0.79-0.85) validation. In this study, preoperative and postoperative prediction models for BCRL were highly accurate and clinically relevant tools comprised of accessible inputs and underscored the effects of racial differences on BCRL risk. The preoperative model identified high-risk patients who require close monitoring or preventative measures. The postoperative model can be used for screening of high-risk patients, thus decreasing the need for frequent clinic visits and arm volume measurements.

#4585 POST-TRANSPLANTATION LYMPHOPROLIFERATIVE DISORDER: COMPARISON OF RISK AND PROGNOSTIC FACTORS BETWEEN KIDNEY AND OTHER ORGAN TRANSPLANT RECIPIENTS

Abstract Background and Aims Post-transplantation lymphoproliferative disorder (PTLD) is a potentially fatal complication of transplantation, pathogenesis of which remains to be fully understood. In solid organ transplant recipients, the risk of disease development is associated with graft type and is lowest for kidney (KTR), intermediate for liver (LTR) and high for lung (LngTR) transplant recipients. The aim of this study was to investigate the factors contributing to the development and treatment outcomes of PTLD and compare their impact on the populations of KTRs, LTRs and LngTRs. Method In this retrospective cohort study we have included all KTRs, LTRs and LngTRs diagnosed with PTLD at four transplantation centers in Poland between 2002 and 2022. The following data were collected from the patients’ medical records: immunosuppression (IS), viral infections, PTLD type, treatment and outcomes. Mann-Whitney U-test was used to assess the differences in group composition, and univariate Cox regression was used to determine the impact of variables upon PTLD time of onset and patient survival. p-values below 0.05 were considered statistically significant. Results We identified 31 KTRs, 31 LTRs and 5 LngTRs who fulfilled the inclusion criteria. Among the patients of the transplantation center leading this study, PTLD was diagnosed in 22 (0.82%) out of 2699 KTRs and 29 (2.03%) out of 1386 LTRs. Two thirds of the patients were male, the median age at first transplantation was 39 years and the median age at PTLD diagnosis was 48 years. KTRs and LTRs significantly differed in IS treatment: more KTRs used steroids (GCS, p = 0.042) and cyclosporin (CsA, p = 0.001), more LTRs used tacrolimus (TAC, p&amp;lt;0.001) and anti-CD25 induction (p = 0.003). KTRs developed PTLD later than LTRs (141 months after transplantation vs 53 months, p = 0.004) and LngTRs (5 months after transplantation, p = 0.001). Monomorphic PTLD was the most frequent in KTRs (80.6%, p = 0.032). Initial IS treatment reduction was used in 91% of all patients. The groups did not significantly differ in the type of PTLD treatment. TAC had the opposite effect on PTLD time of onset in KTRs (HR = 2.92, 95%CI 1.35-6.34, p = 0.007) and LTRs (HR = 0.18, 95%CI 0.04-0.89, p = 0.036). At the end of the observation period 16.7% of KTRs, 51.6% of LTRs and 80% of LngTRs were alive. Complete remission was achieved in 48.4% of KTRs, 61.3% of LTRs and 80% of LngTRs. KTRs had the highest rate of loss to follow up at 41.4%. Patient survival was longer in patients who were treated with anti-CD20 monotherapy (HR = 0.28, 95%CI 0.08-0.96, p = 0.042) and surgery (HR = 0.33, 95%CI 0.12-0.91, p = 0.031). Conclusion KTRs develop PTLD significantly later than LTRs and LngTRs, and disease onset is associated with TAC use. Low KTR survival rate is related to the high rate of loss to follow up (e.g. loss of graft function and return to hemodialysis). Surgical treatment, used mainly in focal PTLD improves patients’ survival. The positive effect of anti-CD20 monotherapy on patients’ survival reflects the efficacy of current stratified treatment regimens for PTLD.

Relationship between the mechanisms of atherosclerosis and prostate cancer: literature review

Cardiovascular disease and cancer remain the leading causes of hospitalization and death worldwide. Prostate cancer (PC) is one of the most common malignant diseases in men. Epidemiological studies have shown that the majority of patients with PC die not from cancer but from cardiovascular diseases, particularly coronary heart disease. In recent years, several studies have examined the relationship between atherosclerosis and PC, suggesting a stronger relationship than previously thought. Processing characteristics of the development and progression of both diseases include dysregulation of cell proliferation, oxidative stress, genetic changes, and inflammation. Despite conflicting data on the role of high cholesterol levels in the development of PC over the past decade, numerous studies have confirmed its importance in PC development and progression; meanwhile, statins have confirmed their value in reducing the risk of disease development and progression. The presented data confirm the need for a thorough assessment of cardiovascular risk factors, the presence of concomitant cardiovascular diseases in patients with PC, and the use of methods for the prevention and treatment of diseases associated with atherosclerosis to reduce cardiovascular risk and inhibit PC progression.