Severe Chronic Disease Research Articles

Exploring the mechanism of Gentiana rigescens Franch. in the treatment of pulmonary fibrosis based on network pharmacology

Pulmonary fibrosis (PF) is a severe chronic interstitial lung disease with high mortality, and there is currently a lack of definite and effective treatment methods. Studies have found that gentiopicroside, a secoiridoid glycoside compound derived from plants of the Gentiana genus, can significantly improve pulmonary inflammation and fibrosis lesions in mice with pulmonary fibrosis. However, the mechanism of its anti-fibrotic effect is unclear. Therefore, in this study, we employed network pharmacology's virtual computer technology to investigate the potential mechanism underlying the anti-pulmonary fibrosis effect of Gentianae Radix et Rhizome (Longdan in Chinese, GRR). Our findings offer valuable theoretical insights and serve as a guiding reference for future experimental investigations. A total of 10 active compounds and 920 drug-target proteins were identified from the TCMSP database. The compound-target-pathway-disease network showed that GRR could potentially treat PF by regulating the MDM2, ERBB2 and VEGFA, signaling pathways through its key targets, including AKT1, TNF, and MAPK1. The protein‒protein interaction network revealed that these targets had strong interactions with each other, indicating a potential synergistic effect of GRR in treating PF. The GO and KEGG enrichment analyses further supported the potential anti-pulmonary fibrosis mechanisms of GRR, including regulating the inflammatory response, ECM-receptor interaction, and TGF-beta signaling pathways. Our study provides a systematic analysis of the potential anti-pulmonary fibrosis mechanisms of GRR based on network pharmacology. These findings could contribute to the development of novel treatments for PF and provide a basis for further experimental studies.

Podology issues: Optimization of onychomycosis therapy

Onychomycosis is an infectious disease of the nail apparatus, caused by pathogenic fungi, manifested in the form of changes in color, configuration of the nail plate, as well as inflammatory processes in the soft tissues adjacent to the nail. Classic therapy in the form of systemic antimycotics is not suitable for everyone (for example, elderly patients with severe liver disorders or concomitant chronic diseases); itraconazole and terbinafine are not combined with a large number of drugs. Therefore, the use of auxiliary non-drug treatment methods becomes extremely important. This article discusses the method of podological treatment of nail plates, proving its effectiveness and safety.

Unraveling the Mysteries of Cystic Fibrosis: Causes, Symptoms, and Treatment Strategies

In this work we present the most relevant and important data, so that the reader will be able to identify the disease "Cystic Fibrosis", regardless of the fact that in Mexico this disease is not common, thanks to the fact that in Mexico and in the world newborns are screened. In this way the rate of this disease in Mexico and the world was reduced. In Mexico, there are 350 new cases every year, said the General Director of the National Center for Gender Equity and Reproductive Health, Dr. Ricardo García Cavazos. Thanks to this data, the purpose of this work is to guide readers in the identification of this disease and in this way generate a positive and active influence in the identification of this disease. This disease is a disease that has its historical antecedents since the year 1595, when with the thought of a spell on a girl during her autopsy, the first clinical data that are characteristic of this disease were given. Being in the 70's where with the passage of time and as new knowledge came to what we know today. Cystic fibrosis is an inherited multisystem disorder of children and adults, it is the leading cause of severe chronic lung disease in children. Cystic fibrosis occurs most often in white populations in Northern Europe, North America and Australia/New Zealand and is inherited in an autosomal recessive manner.

A Narrative Review of Advancements in Understanding and Treating Varicose Veins.

Chronic venous disease, with varicose veins as its archetypal manifestation, stands as a pervasive and intricate health quandary, encompassing a vast array of contributing factors. Age, genetics, obesity, pregnancy, and prolonged immobility weave a complex tapestry, underscoring the omnipresence of this ailment. Its societal and economic footprint is undeniably formidable, as diverse classifications underscore its multifaceted character. The intricate interplay of chronic venous disease with diabetes mellitus and neuropathy compounds the challenge, fostering soaring healthcare expenditures and a palpable erosion of quality of life, particularly among women harboring cardiometabolic risk factors. Despite research shedding light on heightened susceptibility within certain demographics, the enigmatic determinants orchestrating the transition from mild to severe chronic venous disease continue to elude us. Varicose veins, marked by the presence of dilated and tortuous subcutaneous vessels, precipitate both physical discomfort and cosmetic concerns, frequently necessitating meticulous clinical evaluation coupled with ultrasound studies to secure a precise diagnosis. Treatment strategies are strategically crafted to ameliorate distressing symptoms, enhance aesthetic concerns, and forestall potential complications. Nevertheless, the prognostication of chronic venous disease remains ensconced in a degree of ambiguity, hinting at the vast terrain yet to be charted in this medical domain. The quest to fathom the intricacies of this condition uncovers an ever-evolving panorama where conservative interventions play an indispensable role in managing mild cases, while interventional procedures like endovenous laser ablation and sclerotherapy step onto the stage for patients grappling with severe symptoms, thus treading the fine line between efficacy and invasiveness. Moreover, a meticulous economic analysis underscores the cost-effectiveness of various therapeutic modalities, thereby bolstering the imperative of a patient-centered approach. As we navigate the labyrinthine complexities of chronic venous disease and varicose vein management, we are inexorably drawn to the pivotal role of customized treatment approaches, as well as the dynamic interplay between scientific progress, patient preferences, and therapeutic innovations in the relentless pursuit of optimized outcomes and an enhanced quality of life.

Hypercapnia increases ACE2 expression and pseudo-SARS-CoV-2 entry in bronchial epithelial cells by augmenting cellular cholesterol.

Patients with chronic lung disease, obesity, and other co-morbid conditions are at increased risk of severe illness and death when infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Hypercapnia, the elevation of CO2 in blood and tissue, commonly occurs in patients with severe acute and chronic lung disease, including those with pulmonary infections, and is also associated with high mortality risk. We previously reported that hypercapnia increases viral replication and mortality of influenza A virus infection in mice. We have also shown that culture in elevated CO2 upregulates expression of cholesterol synthesis genes in primary human bronchial epithelial cells. Interestingly, factors that increase the cholesterol content of lipid rafts and lipid droplets, platforms for viral entry and assembly, enhance SARS-CoV-2 infection. In the current study, we investigated the effects of hypercapnia on ACE2 expression and entry of SARS-CoV-2 pseudovirus (p-SARS-CoV-2) into airway epithelial cells. We found that hypercapnia increased ACE2 expression and p-SARS-CoV-2 uptake by airway epithelium in mice, and in cultured VERO and human bronchial epithelial cells. Hypercapnia also increased total cellular and lipid raft-associated cholesterol in epithelial cells. Moreover, reducing cholesterol synthesis with inhibitors of sterol regulatory element binding protein 2 (SREBP2) or statins, and depletion of cellular cholesterol, each blocked the hypercapnia-induced increases in ACE2 expression and p-SARS-CoV-2 entry into epithelial cells. Cigarette smoke extract (CSE) also increased ACE2 expression, p-SARS-CoV-2 entry and cholesterol accumulation in epithelial cells, an effect not additive to that of hypercapnia, but also inhibited by statins. These findings reveal a mechanism that may account, in part, for poor clinical outcomes of SARS-CoV-2 infection in patients with advanced lung disease and hypercapnia, and in those who smoke cigarettes. Further, our results suggest the possibility that cholesterol-lowering therapies may be of particular benefit in patients with hypercapnia when exposed to or infected with SARS-CoV-2.

Damage to the blood system after COVID-19 in family medicine practice

Coronavirus infection is an acute viral disease with airborne transmission [1]. One of the first descriptions was in 1975 in a patient suffering from acute rhinitis. The causative agents of the disease are a family of RNA-containing coronaviruses. Within the family, there are several groups of infectious agents that are dangerous to the human body: human coronavirus 229E, human coronavirus OS-43, and human intestinal coronaviruses. The pathogen is quite unstable in the environment, and its effects can be eliminated using disinfectants and exposure to high temperatures [2]. HIV infected patients, children, and patients with severe chronic diseases (diabetes mellitus, oncological processes) are mainly considered to be at risk for the incidence of atypical coronavirus pneumonia. After entering the upper respiratory tract, the coronavirus actively multiplies and epithelial cells are destroyed. If the immune system is poorly developed, the coronavirus can penetrate the alveoli, and the process of pathogen replication occurs in their cytoplasm. By exocytosis, the finished virions lie on the outer membrane of the cells, which activates the fusion of epithelial cells and accelerated syncytium formation.

Combination of Minimally Invasive Methods for the Treatment of Varicose Veins.

The aim of the study was to evaluate the efficacy and safety of the combination of minimally invasive methods for the treatment of incompetent great saphenous vein and perforating veins. Between December 2019 and October 2020, F-care radiofrequency ablation combined with ultrasound-guided foam sclerotherapy and residual perforator ligation and concomitant microphlebectomy were adopted for all eligible patients. The clinical symptoms scores, complications, and quality of life were recorded. 49 patients (64 limbs) with a mean age of 63.29 ± 10.14years, and 60.9%4 were male. The 1-year truncal closure rate was 63/64 (98.4%).1 A significant improvement in the Venous Disability Score, the Venous Segmental Disease Score, the Venous Clinical Severity Score and Chronic Venous Disease Quality of Life Questionnaire Score, at 12months after the combination of minimally invasive treatment, were observed in the study. One patient developed intermuscular vein thrombosis that was successfully managed with rivaroxaban. The combination of minimally invasive methods is a safe and effective method for the treatment of lower extremity varicose veins. Further large-scale, prospective, multi-center studies are needed to further verify the findings of this study.

A Case Report on Rasmussen Encephalopathy (RE)

Summary: Rasmussen's encephalitis (RE) is a rare and severe chronic inflammatory brain disease resulting in drug-resistant epilepsy and progressive hemispheric destruction with neurological deficit. ER is associated with deterioration of background EEG activity, progressive atrophy of the affected hemisphere on MRI and extensive PET hypometabolism over the affected hemisphere. We report the case of a 6-year-old girl who presented with pharmacoresistant epilepsy.
 Observation: A 6-year-old child with no particular medical history presented 6 months prior to admission with epilepsy resistant to all therapeutic classes (antiepileptic drugs). Clinical examination revealed left hemiparesis with facial involvement and constant left hemi-myoclonus.
 An EEG showed a pattern compatible with a continuous epileptic encephalopathy that could correlate with Rasmussen syndrome.
 Cerebral MRI Revealed: right cerebral hemiatrophy with secondary homolateral hippocampal sclero-atrophy, compatible with Rasmussen encephalitis.
 The patient received immunoglobulins and a corticosteroid bolus, but without improvement; she was therefore a candidate for surgical treatment.
 Rasmussen's encephalopathy is a rare and serious disease that can be responsible for paresis and cognitive decline. Its pathophysiology is still poorly defined, and it mainly affects children.

A Simple Step-by-Step Guide to Permanent Punctal Occlusion with the Ophthalmic Burr and Suture Technique.

The medical treatment of dry eye disease usually follows a step-wise approach to achieve clinical improvement, ranging from non-surgical interventions with intensive lubrication to permanent surgical punctal occlusion. While frequent lubrication is essential, the intense regime is often too burdensome and difficult to maintain at the required frequency. Punctal plugs are an invaluable alternative approach, but also have limitations, especially in conscious children, in whom inserting and re-inserting punctum plugs in clinic can be challenging. If a patient has permanent and severe dry eye disease and responded well to a trial of temporary punctal plugging, a permanent surgical solution should be considered next. Liu et al showed that a more successful, yet simple technique to achieve permanent occlusion is to combine de-epithelialising the punctum and ampulla with the immediate firm apposition of the de-epithelialised surface using a self-absorbable suture - with a success rate of 92% in a prospective study. This article demonstrates this technique step-by-step in an 8-year-old child with severe chronic dry eye disease following proton beam therapy for orbital rhabdomyosarcoma. She underwent this procedure with excellent results.

Antifibrotic Efficacy of a New Phytocomposition of Essential Phospholipids with Glycyrrhizic Acid, Ecdysterone, Lycopene and Proanthacyanidin in Experimental Severe Chronic Hepatitis Compared with Phosphogliv

Since the prevalence of acute and especially severe chronic liver diseases of various etiologies increases from year to year, this pathology is recognized as the main burden on health worldwide. Currently, it has been established that the use of drugs based on essential phospholipids and plant origin with antioxidant and hepatoprotective activity is very effective in the prevention and treatment of liver diseases. In this regard, we studied under experimental conditions the effect of phytocomposition of soy lecithin, glycyrrhizic acid, lycopene and ecdysterone (conditional name hepalipin) and proanthacyanidin (conditional name yantacin) isolated from the plant Alhagi pseudalhagi on cytolytic-cholestatic liver damage, as well as on the development of fibrosis. In this study, we evaluated the hepatoprotective and antifibrotic effects of a new combination called Hepatocin obtained in a 1:1 ratio (100 mg/kg of Hepalipin and 100 mg/kg of Yantacin). All the studies conducted were conducted on adult nonlinear rats, while the experimental animals were divided into a control group infected with heliotrin, a substance with hepatotoxic action, a group receiving hepatocin, and an intact group that was not infected with heliotrin at the same time. In the conducted studies, hepatocin significantly inhibited the development of cytolytic-cholestatic liver damage, helped to maintain the functions of the liver synthesizing protein and glycogen, and when administered to experimental animals against the background of a chronic disease developing as a result of damage by heliotrin, it has an antioxidant effect. In addition, the use of hepatocin for more than two months in chronic liver damage or early stage fibrosis led to the restoration of serum enzymes of experimental animals, as well as regulators of cytochrome P450 and b5 fibrogenesis in liver tissues, PCNA, PDGF-BB to levels almost close to the initial (intact) values. Thus, in experimental conditions of chronic severe hepatitis or early stage fibrosis, hepatocin showed statistically significant advantages over Phosphogliv in terms of the intensity of hepatoprotective or antifibrotic action.

The Effect of Pregnancy on Urinary Symptoms.

Background Urinary incontinence is a condition that causes social, medical, or hygienic problems. The increase in the incidence of stress incontinence, particularly with increasing parity, emphasizes the role of pregnancy on the etiology of incontinence and other urinary symptoms. This study aimed to estimate the effect of pregnancy on urinary incontinence and other urinary symptoms with history and urodynamic data. Methodology This study was conducted at Mustafa Kemal University, Medical Faculty, Obstetrics and Gynecology Department. A total of 72 pregnant primigravid women without any urinary problems were included in the study. Patients with severe chronic disease, neurological disorders, antepartum hemorrhage, multiple pregnancies, younger than 18, and those with physical and mental disabilities were excluded. All patients were initially evaluated in the first trimester and finally in the sixth week of the postpartum period. Demographic and obstetric data, including urological complaints and urodynamic findings, were recorded. Results There were significant increases in nocturia, frequency, dysuria, urgency, and stress urinary incontinence complaints in pregnant women. Urge incontinence was not significantly different after pregnancy. In the postpartum urodynamic studies, nine (12.5%) patients with stress urinary incontinence and six (8.3%) patients with detrusor instability were detected. There was no significant difference between cesarean section and vaginal delivery regarding incontinence. Conclusions According to the study findings, pregnant women who were continent before pregnancy could become incontinent after birth according to urodynamic data. However, long-term studies are needed to determine whether this incontinence is temporary. Additionally, according to our results, cesarean section should not be recommended over vaginal delivery only to prevent incontinence.

Persistent spontaneous pneumomediastinum in a dog with pulmonary fibrosis

AbstractA 5‐year‐old, 5.8‐kg, neutered, male, mix‐breed dog was presented to the emergency service of a university hospital for assessment of respiratory distress. Thoracic radiographs identified a moderate pneumomediastinum, mild cervical subcutaneous emphysema and moderate bilateral diffuse bronchial and unstructured interstitial pulmonary patterns. The dog had a 6‐week long history of progressive respiratory signs before presentation, culminating in acute respiratory embarrassment in the absence of a precipitating event. Three sets of radiographs were performed before presentation, which demonstrated a persistent pneumomediastinum and progressively severe pulmonary infiltrates. The dog was humanely euthanased after 24 hours of hospitalised care, with a diagnosis of interstitial pulmonary fibrosis made at postmortem examination. Spontaneous pneumomediastinum is usually an acute condition, which resolves within a few weeks of diagnosis and does not recur. Persistent spontaneous pneumomediastinum has been described in people previously, and is a rare potential sequela to severe chronic pulmonary disease in dogs.

Fuzzy ontology-based approach for liver fibrosis diagnosis

The domain of the digestive system is prone to severe chronic disease in the form of liver cirrhosis, which is currently a leading cause of mortality. This article presents a new intelligent system for predicting the severity of liver fibrosis in patients with chronic viral hepatitis C. The proposed system is based on the inference capabilities of fuzzy ontology and operates on semantic rule-based techniques. A fuzzy decision tree technique was employed to generate the ontology rule base using a dataset of real fibrosis cases from the Mansoura University Hospital, Egypt. These rules were then encoded into a set of fuzzy semantic rules using the fuzzy description logic format. To evaluate the system’s effectiveness, the proposed ontology was then tested on 47 chronic HCV cases, with an attempt made to see if this correctly diagnosed the patients’ conditions. The performance of the proposed system was compared with that of the now-standard Mamdani fuzzy inference system; while the latter achieved an accuracy of 95.7/%, the proposed fuzzy ontology-based system demonstrated higher performance, with 97.8% accuracy. Furthermore, the proposed system also supports semantic interoperability between clinical decision support systems and electronic health record ecosystems. The positive impacts of this system on the correct prediction of liver fibrosis severity thus suggest that it has the potential to assist medical professionals in diagnosing and treating this dangerous disease.

Analysis of the state and problems of pharmaceutical supply for patients with epidermolysis bullosa

Aim. To analyze medical technologies (MT) for the treatment of epidermolysis bullosa (EB) and their availability to patients and the healthcare system.
 Materials and methods. The study objects were scientific publications, normative legal acts, guidelines (protocols), statistical data, the Orphanet network, official data of the Ministry of Health and the State Enterprise “Medical Procurement of Ukraine”, marketing information. The methods of content analysis, structural and logical, comparison, generalization, marketing analysis were used.
 Results. Modern approaches to the classification of types of EB were studied; epidemiological indicators were analyzed; recommendations of clinical protocols were summarized. It has been found that currently there are no available specific MT in the world for the treatment of this severe chronic disease. International clinical guidelines recommend the use of medicines and medical products to relieve symptoms (wound care, reduce pain and itching), prevent secondary pathologies and improve the quality of life of patients with EB. The cost of treating EB depends on the severity of the disease and the patient’s age. The burden of the disease and the impact on the budget are assessed to be high. The state cannot provide 100 % of the need for the necessary medicines and medical products due to budget constraints. The analysis of the national legal framework for providing patients with rare (orphan) diseases, including EB, with the necessary medicines and medical products was carried out. It has been determined that only 9 INNs of the seven groups of medicines recommended by the protocol are included in the National List and can be purchased for budget funds. The annual need, nomenclature and volumes of purchases of drugs for the treatment of EB were studied. According to the State Enterprise “Medical Procurement of Ukraine” in 2023, for patients with EB it is planned to purchase eight groups of medical products for skin and wound care under 20 names in the amount of UAH 119.8 million.
 Conclusions. In order to improve approaches to the pharmaceutical provision of patients with EB, it is extremely important to use health technology assessment (HTA) to identify the most effective and economically feasible medicines and medical products.

Projecting the Potential Budget Impact Analysis of Paliperidone Palmitate in Egyptian Adult Patients with Schizophrenia.

Background: Schizophrenia is a serious mental disorder that has greater negative consequences on role functioning than many other severe chronic diseases. Objective: We evaluated the economic impact of long-acting injections of paliperidone palmitate (PP) vs daily oral antipsychotics to treat chronic schizophrenia from a societal perspective over a 2-year period. Methods: A static budget impact model was developed to compare PP with daily oral antipsychotics (risperidone, olanzapine, and aripiprazole) in the treatment of patients with chronic schizophrenia. Our study included treatments used during relapse and hospitalization, validated by an expert panel. The clinical parameters were extracted from the PRIDE trial. Direct medical costs and indirect costs were measured. The unit cost of drug acquisition for all medications was extracted from the public sector. One-way sensitivity analyses were conducted. Results: The target population in our model was estimated to be 142 incident patients. In the first year, the total drug costs in Egyptian pounds (EGP) for PP and oral antipsychotics were £2.7 million and £724 004, respectively, while the total medical costs for PP and oral antipsychotics were £3 million and £5.6 million, respectively. In the second year, the total drug costs for PP and oral antipsychotics were £2.7 million and £724 004, respectively, while the total medical costs for PP and oral antipsychotics were £3 million and £5 million, respectively. The total costs for PP (£11.6 million) over 2 years were less than those of oral antipsychotics without PP (£12.7 million). PP produced an estimated budget savings of £1 046 561 (budget savings per patient per year, £3667). In addition, PP resulted in the avoidance of 18 hospitalizations per year compared with the without-PP arm. Sensitivity analyses showed that the percent of hospitalizations for both oral antipsychotics and PP had the greatest impact on the results. Conclusion: The lower hospitalization rates associated with PP offset the increase in drug costs. PP may potentially be cost-saving compared with the standard of care in chronic schizophrenia in Egyptian representative healthcare settings. Policy makers may consider this approach to improve patient outcomes and budget sustainability.

Lsisi G, Ezzat M, Ramadan M. Projecting the Potential Budget Impact Analysis of Paliperidone Palmitate in Egyptian Adult Patients with Schizophrenia

Background: Schizophrenia is a serious mental disorder that has greater negative consequences on role functioning than many other severe chronic diseases. Objective: We evaluated the economic impact of long-acting injections of paliperidone palmitate (PP) vs daily oral antipsychotics to treat chronic schizophrenia from a societal perspective over a 2-year period. Methods: A static budget impact model was developed to compare PP with daily oral antipsychotics (risperidone, olanzapine, and aripiprazole) in the treatment of patients with chronic schizophrenia. Our study included treatments used during relapse and hospitalization, validated by an expert panel. The clinical parameters were extracted from the PRIDE trial. Direct medical costs and indirect costs were measured. The unit cost of drug acquisition for all medications was extracted from the public sector. One-way sensitivity analyses were conducted. Results: The target population in our model was estimated to be 142 incident patients. In the first year, the total drug costs in Egyptian pounds (EGP) for PP and oral antipsychotics were £2.7 million and £724 004, respectively, while the total medical costs for PP and oral antipsychotics were £3 million and £5.6 million, respectively. In the second year, the total drug costs for PP and oral antipsychotics were £2.7 million and £724 004, respectively, while the total medical costs for PP and oral antipsychotics were £3 million and £5 million, respectively. The total costs for PP (£11.6 million) over 2 years were less than those of oral antipsychotics without PP (£12.7 million). PP produced an estimated budget savings of £1 046 561 (budget savings per patient per year, £3667). In addition, PP resulted in the avoidance of 18 hospitalizations per year compared with the without-PP arm. Sensitivity analyses showed that the percent of hospitalizations for both oral antipsychotics and PP had the greatest impact on the results. Conclusion: The lower hospitalization rates associated with PP offset the increase in drug costs. PP may potentially be cost-saving compared with the standard of care in chronic schizophrenia in Egyptian representative healthcare settings. Policy makers may consider this approach to improve patient outcomes and budget sustainability.

Parental acceptability of vaccinating young children against influenza and COVID-19

IntroductionThe struggle against influenza, and more recently against Coronavirus Disease 2019 (COVID-19), relies mostly on protective measures and vaccines. In France, COVID-19 vaccination campaigns include children over 5 years of age, whereas the influenza vaccine is reserved for children and infants older than 6 months with severe chronic disease. The final decision to vaccinate ultimately rests with the parents. This study aimed to explore the opinions of parents regarding COVID-19 and influenza vaccinations, and which factors are likely to influence their decision in order to improve prevention approaches, and thus obtain better vaccination coverage among children. Methods and surveyIn this trans-sectional multicenter survey, self-administered questionnaires were sent to parents of children attending 14 childcare institutions over a period of 2 months, December 2021-February 2022. The questionnaire consisted of three sections: the first collected general, social and professional data, the second addressed perceived parental acceptability regarding influenza and COVID-19 vaccinations in healthy children, while the last section explored the main sources of information consulted by the parents regarding vaccinations. Subject’s characteristics were described using number and percentages, as they are all categorical variables. Description of answers regarding both influenza and COVID-19 sources of information data were performed. Characteristics of patients answers were described and compared according to intention of vaccine groups. ResultsAmong the 343 questionnaires collected, 41.7 % of respondents stated they were supportive of vaccination of their children against influenza and 37 % against COVID-19. Media (Internet, TV and radio) were the most cited sources of information. Incentive factors for both vaccination against influenza and COVID-19 were individual, and collective protection. Limiting factors were fear of side effect and Age of the child. Media was the sole source of information, concerning vaccination against influenza for 59 % non-graduates and 28 % of participants having a higher education level, and respectively 49 % and 19 % for vaccination against COVID-19. The acceptability rate was influenced by the level of education and the sources of information. Discussion and conclusionAbout 40 % of the parents were supportive of children’s vaccinations against COVID-19 and influenza respectively (37 % and 42 %) in order to protect the vulnerable people around them. The media influences the decision to vaccinate especially when the level of education is low.

Experience With Regional Anesthesia for Carotid Endarterectomy at the N.V. Sklifosovsky Research Institute for Emergency Medicine

Acute cerebrovascular accident is one of the major causes of death and disability of patients around the world. In 30-40% of cases, the cause of ischemic stroke is an extracranial lesion of the brachiocephalic vessels. Carotid endarterectomy is the main technique for preventing cerebrovascular accident in carotid artery stenosis. General anesthesia with endotracheal intubation has been the method of choice since the widespread introduction of this type of surgical intervention into clinical practice and in most centers remains so to this day. At the same time, many authors report, that the use of general anesthesia with endotracheal intubation has limitations in a number of patients, namely, in the presence of an embologenic plaque in the operated internal carotid artery, severe coronary artery disease, decompensated aortic and / or mitral stenosis, low ejection fraction, heart rhythm and conduction disorders, severe chronic diseases of the respiratory system, as well as patient refusal for general anesthesia.THE AIM of the study was to show the possibilities of using regional anesthesia for carotid endarterectomy in a high-risk patient.RESULTS The use of regional anesthesia allows surgeons to avoid instability or abrupt changes in hemodynamics in the intraoperative period. Indications for its use are also cases of critical contralateral stenosis of the internal carotid artery when it is necessary to carefully consider the advisability of installing an internal stent.CONCLUSION The use of regional anesthesia made it possible to successfully perform carotid endarterectomy without cardiovascular events, neurological deficit and postoperative complications in a patient with relative contraindications to general anesthesia.

Systemic lupus erythematosus and antiphospholipid syndrome: past, present, future

Immune-inflammatory (autoimmune and autoinflammatory) rheumatic diseases are widespread severe chronic inflammatory diseases and also "models" for studying the fundamental mechanisms of pathogenesis and approach to pharmacotherapy of other diseases associated with autoimmunity and/or autoinflammation. Uncontrolled inflammation leading to hypercoagulation forms the basis of "thromboinflammation", which is considered a universal pathogenetic mechanism of organ involvement in immune-inflammatory rheumatic diseases, as well as in COVID-19 and atherosclerotic vascular lesions (atherothrombosis). Thrombo-inflammatory mechanisms play a crucial role in systemic lupus erythematosus and antiphospholipid syndrome. Russian rheumatology, under the leadership of academician Valentina Alexandrovna Nasonova, greatly contributed to the research of these disorders. This article addresses the current view about the overlapping pathogenetic mechanisms of thrombosis in systemic lupus erythematosus and antiphospholipid syndrome, the relevance of these studies during the COVID-19 pandemic, and the prospects for antithrombotic and anti-inflammatory therapy.

Proton pump inhibitor treatment is associated with acute-on-chronic liver failure in patients with advanced cirrhosis.

Acute-on-chronic liver failure (ACLF) is a fatal complication of cirrhosis. Hence, identification of risk factors for ACLF is crucial. Previous studies have linked proton pump inhibitor (PPI) treatment to complications of cirrhosis, however, a possible effect of PPI treatment on the risk of ACLF has not been investigated yet. Therefore, the present study aimed to characterize the impact of PPI treatment on ACLF development. A total of 642 patients hospitalized due to complications of cirrhosis were retrospectively identified, and PPI treatment during an observation period of 3 years following the hospitalization was reviewed. Subsequently, 74 patients with newly initiated PPI treatment at the time of hospitalization (PPI group) were 1:1 propensity score matched to 74 patients who received no PPI treatment (no-PPI group). Primary end point was the development of ACLF during the observation period, and secondary endpoints were mortality and upper gastrointestinal bleeding. PPI and no-PPI groups had comparably severe chronic liver disease at baseline. Nevertheless, the cumulative incidence of ACLF in the presence of death as competing risk was markedly higher in the PPI group compared with the no-PPI group. ACLF-related deaths contributed significantly to a higher 3-year mortality in the PPI group. Uni and multivariable competing risk regression models confirmed that PPI treatment was an independent predictor of ACLF in the study collective (subdistribution HR: 1.892, 95% CI: 1.092-3.281, p = 0.023). The impact of PPI treatment on ACLF development was particularly strong in patients with a model for end-stage liver disease score >12. Upper gastrointestinal bleeding was slightly less frequent in the PPI group. The present results indicate that PPI treatment could be a risk factor for ACLF in patients with advanced cirrhosis.