Smoking Abuse Research Articles

Drug Abuse and Mental Illness in Erigavo Mental Hostiptal, Erigavo, Somalia

Mental illness is an international health crisis that puts the lives of over three hundred million people (Four percent of the world’s population) at risk. The study was conducted at the Erigavo Mental Hospital in Somaliland and its main focus was the bond between substance abuse and mental illness. The research was to check the influence of the different drugs, screen mental health problems, and draw a link between drugs and mental illness. The sources of the quantitative data were a total of 27 employees and managers. This study is cross-sectional. We employed the measure of the magnitude and direction of a linear relationship between two variables with the Pearson correlation coefficient. The outcomes that were acquired show that there was use and particularly abuse of khat, substance smoking, and alcohol consumption, the score means of which were quite high. The investigation results, however, imply that through drug use and other forms of alcohol drug abuse, one of them counter various mental health problems. Furthermore, the addicted people demonstrated the tendency to use force in their attempt to solve the conflicts and to experience the highest degree of tension, with the mean score of the former giving 4.11 while the standard deviation of the latter giving 1.086, thus this shows the mental impact of drug use on the inhabitants of Erigavo. The main result of the study was the strong, positive relationship between drug addiction and mental illness, which became evident through an r - value of 0.509 and a p - value of 0.559. It means that those people who are involved in drug misuse are the ones who are likely to have mental health disorders. Based on the findings of the study, we suggest a combination of measures to recover drug addiction and mental illness. This consists in strengthening prevention. The study that lays the groundwork for suggestions, involves an approach that is holistic in nature. The main ideas of preventing drug usage, psychological health care, enhancing mental health services, and working towards certified professionals are key integrated activities of the whole concept. The hospital, thus, will be in a better position to eliminate the two major disease components namely; drug abuse and mental ailment. Thus, in this way, with the help of the new treatment approaches, a hospital provides and their patients who are quite likely to recover and lead healthy.

The psychometric properties of students’ attitudes, coping strategies, and psychological symptoms

<span lang="EN-US">This study examined the psychometric elements of psychological symptoms, attitudes and coping strategies and the impact of COVID-19 on learning among the university students in Malaysia. The design employed in this study was survey method, that centered on convenience sampling method. A total of 489 students from eight undergraduate program of year 1 to year 4 participated in the study. They enrolled in various disciplines ranging from chemical and food science, medicine, engineering, psychology, communication to religious studies program. Data was analyzed using exploratory factor analysis (EFA) with all items being grouped within the study’s constructs, which subsequently, were tested using the establishment of measurement model of confirmatory factor analysis. The instrumentation for this study was adapted from Weiner’s Attribution Theory, Expectations and Values Theory. Comparatively, in measuring the students’ coping strategic approach, items were adopted from Greenaway. Additionally, the Counseling Center Assessment of Psychological Symptoms (CCAPS-62) scale was adapted to measure the eight constructs namely anxiety, social anxiety, academic distress, eating anxiety distress, family distress, hostility, and smoking abuse. The Cronbach’s alpha values for all three constructs have indicated the accepted values. Findings revealed that the loading factors for the attitude, coping strategies and psychological constructs are at the accepted values and acceptable composite reliability values. Findings also indicate that the measurement model for the construct attitude, coping strategies and psychological have loading estimates that are statistically significant.</span>

Spontaneous Pneumothorax Secondary to Bullous Lung Emphysema Positive for Cannabinoids upon Toxicological Examination.

Cannabis can be related to respiratory diseases, but the relationship between smoking marijuana and the development of a pneumothorax has scarcely been investigated. We aimed to analyze, in patients with a history of cannabis smoking abuse submitted to lung apicectomy for a primary spontaneous pneumothorax (PSP), the correlation between the presence of cannabinoids in the resected lung and the detection of bullous emphysema within the same tissue. Patients undergoing lung apicectomy for a PSP were prospectively enrolled, and the correlation between the presence of cannabinoids in the resected lung tissue and histological finding of bullous emphysema was investigated with Fisher's exact test. There were 21 male patients, with a median age of 27 years. The cannabinoids found by the toxicological examination in surgical specimens were mainly delta-9-tetrahydrocannabinol (THC), cannabinol (CBN), and cannabidiol (CBD). In 14/21 patients, cannabinoids were detected in the resected lung tissue, and bullous emphysema was present in 13/14 of these (93%), while bullous emphysema was found in only 1/7 (14%) of the remaining patients who were negative for cannabinoids in the lung tissue, and the difference was found to be statistically significant (p < 0.0009). Our study demonstrated the presence of bullous emphysema in most cannabinoid-positive patients and its absence in most of those who were cannabinoid-negative, supporting the correlation between cannabinoids in the lung tissue and bullous emphysema with the development of a "secondary" spontaneous pneumothorax.

(250) Male Physicians as Patients: Is Fertility an Issue?

Abstract Introduction Physicians may be subjected to grueling work hours, sleep deprivation, and a stressful work environment during their prime reproductive years. While attention to fertility among female physicians has garnered interest in recent years, little is known about the fertility of their male colleagues. Objective In this study we sought to compare semen parameters of male physicians presenting for a fertility evaluation compared to their non-physician counterparts. Methods Upon IRB approval, a retrospective review of all hospital employed individuals (or their partners) who underwent a semen analysis between 2013-2019 was performed. Post-vasectomy semen analysis patients were excluded. Baseline patient demographics including age, comorbidities, occupation, and BMI were recorded. Normal semen parameters were defined by the World Health Organization 2010 criteria. A comparison analysis of semen analysis parameters, baseline characteristics, and comorbidities was conducted with a significant p-value defined as &amp;lt;0.05. Results Of the 169 physicians and 438 non-physicians identified, physicians were more likely to have a lower BMI (median 25.8 vs. 28.0, p&amp;lt;0.0001) when compared to their non-physician counterparts. Physicians were less likely to have ADHD, depression, obstructive sleep apnea, malignancy, alcohol abuse, and history of smoking (p&amp;lt;0.05). Physicians had better semen parameters including pH, concentration, motility, volume, and morphology (p&amp;lt;0.05), with a greater sperm concentration (68.4 vs. 52.2 million/mL, p&amp;lt;0.0001) and higher total motile sperm count (125 vs. 86.4 million, p&amp;lt;0.0001) compared to non-physicians. However, male physicians were more likely to be older at time of semen analysis (33.8 versus 32.7 years, p&amp;lt;0.05), more likely to utilize assisted reproductive technology (IVF and IUI, p=0.0277), have older female partners (p=0.0053), and have older female partners at time of delivery (p=0.0124). Conclusions In this study we report, for the first time, semen parameters of physicians compared to non-physicians. Physicians had a significantly higher total motile sperm count and sperm concentration; however, they were older at time of semen analysis, more likely to utilize ART, and more likely to have older female partners. While physicians may be healthier, this may indicate increased difficulty achieving pregnancy. Patient care is directly impacted by the health and safety provided to their physicians. As the paradigm in the medical field shifts from caring only for our patients to caring for ourselves, fertility amongst male physicians warrants further investigation. Disclosure No

Prevalence of COVID-19 outcomes in patients referred to opioid agonist treatment centers.

Background: Coronavirus disease (COVID-19) is a mild to severe infectious respiratory illness caused by the SARS-CoV-2 virus. Based on the numerous pieces of evidence regarding the role of opioids in immune function, viral replication, and virus-mediated pathology, we decided to assess the incidence and severity of COVID-19 outcomes in people undergoing opioid maintenance treatment. Methods: This is a prospective, descriptive, multi-center study that included 452 patients undergoing maintenance treatment in opioid agonist treatment (OAT) clinics in different cities of Iran. Demographic information, underlying disease, history of maintenance treatment, type of drug used, history of addiction, smoking, and the kind of substance abused, were recorded. A physician evaluated the COVID-19 symptoms, and the severity of the disease was defined based on the number of observed symptoms. Results: The results have not shown any significant difference in the severity of COVID-19 symptoms in different nationalities, gender, and treatment groups. Furthermore, the history of drug abuse, including time and type of abuse and smoking, has not indicated any significant association with the occurrence of symptoms. Only the severity of COVID-19 in the mentioned cities (first and second follow-up: p < 0.001) and individuals with a history of underlying disease (first follow-up: p = 0.020; second follow-up: p = 0.043) were significantly different. Conclusion: Our results have demonstrated that the severity of symptoms in people with the underlying disease was significantly higher than in others. But there is no association between sex, race, treatment groups, and abuse history with the severity of COVID-19 symptoms in methadone maintenance treatment (MMT) patients.

Cross-Addiction Risk Profile Associations with COVID-19 Anxiety: a Preliminary Exploratory Study.

“Cross-addiction” involves a person substituting one form of addictive behaviour for another. Indeed, cross-additive presentations have been frequently described (e.g. from drugs to alcohol, gambling to sex), and risk profiles have been assumed. Nevertheless, there has been a dearth of evidence considering the occurrence of cross-addiction risk profiles in the community. This research is imperative for informing effective prevention/intervention policies, especially under anxiety-provoking conditions, such as the current coronavirus pandemic. To address this need, a cross-sectional exploratory research design was utilized, with quantitative survey data obtained from 968 respondents (18–64; Mage = 29.5 years, SD = 9.36), who completed an online survey regarding a range of addictive behaviours (i.e. abuse of alcohol, drug, smoking, online gaming, shopping, internet, exercise, online gambling, sex, and social media) and their anxiety about the coronavirus. Latent class/profiling analyses were implemented to (a) explore profiles of cross-addiction risk, (b) describe the characteristics and the proportions of these profiles, and (c) identify their differential associations with the pandemic precipitated anxiety. Findings revealed two distinct profiles/types, the “cross-addiction low risk” (57.4%) and the “cross-addiction high risk” (42.6%). Those in the latter scored consistently higher across all behaviours assessed, were more likely to suffer from concurrent addictive problems, and reported significantly higher levels of pandemic-related anxiety. Implications for prevention, assessment, and treatment and future research are discussed.

Comparison of demographic, socioeconomic, and lifestyle determinants in infertile and fertile males and females from two big cities of Punjab

BACKGROUND: Infertility is an apparent failure of a couple to conceive. The demographic, socioeconomic, and lifestyle determinants in infertility and its related factors should be seen more realistically. Regional variations in the causes of infertility need a completely comprehensive approach that helps to dive deeper into the root cause of the disease and manage it holistically. MATERIALS AND METHODS: A study on selected risk factors of infertility among 100 infertile couples and 200 fertile males, females attending tertiary health-care centers and in vitro fertilization centers from two big cities of Punjab was conducted. The data were collected using semi-structured pro forma questionnaire. The data collected included the anthropometric measurements, demographic profile, lifestyle variables impacting infertility, and socioeconomic attributes. Data were analyzed to look out for risk factors and their association using the odds ratio. RESULTS: The findings of the study revealed that nonvegetarian diet, more tea and alcohol usage, smoking abuse, and duration of mobile phone usage were seen more in infertile couples which was statistically significant in relation to fertile participants. Occupation, physical activity, sleep, socioeconomic variables, and education status did not show any statistical significance when compared between the two groups. Interestingly, statistical significance was seen in the obese class II category only in infertile males in comparison to fertile males. CONCLUSION: An all-inclusive perspective is needed for the diagnosis, treatment, and management of infertility. Health-care professionals need to dive into aspects of infertility treatment other than medical interventions to provide an integrated treatment regimen for couples facing infertility.

Lifestyle choices following head and neck cancer treatment: A qualitative study.

The benefits of a healthy lifestyle in reducing risk of cancer and chronic disease are well-documented. Many individuals who have had head and neck cancer (HNC) report complex social situations with a history of poor dietary habits, smoking and alcohol abuse. Survivorship can be a strong motivator to make positive lifestyle changes, reducing risk of cancer recurrence and ill-health. Research investigating whether HNC survivors adopt healthy lifestyle recommendations is lacking. To explore the health-related practices of post-treatment HNC patients, seeking to identify barriers and motivators to following recommended health guidelines. Tape-recorded interviews were conducted with 20 HNC survivors, and comparisons made to Department of Health recommendations. 80% of participants made lifestyle changes following HNC treatment. The most prevalent changes were to diet and alcohol intake. Key motivators were reducing cancer risk and ill-health; barriers included lack of motivation, support and misinformation. Treatment side-effects presented both motivators and barriers. There was widespread recognition of the "5 a day" message, and harm caused by smoking. Other public health recommendations were less well-known; 98% were unaware of current alcohol guidelines, physical activity was overestimated, and only one participant took vitamin D. In this study HNC survivors were highly motivated to make healthy lifestyle changes. Further work is required to increase awareness of Government guidelines, as health messages are not always reaching the public or are misinterpreted.

Increased length of stay following total joint arthroplasty based on insurance type.

Increased length of stay after total joint arthroplasty has been shown to be a risk factor for peri-operative complications. The purpose of this study was to determine if Medicaid insurance would be a risk factor for increased length of stay after total joint arthroplasty. We retrospectively reviewed a single surgeon's practice of 428 total hip and total knee arthroplasties who had insurance status of Medicaid, Medicare, Private or none. After exclusion criteria there were 400 patients. Patients with insurance status of Medicaid, Medicare or Private were then compared based on length of stay ≤ 2days and length of stay > 2days and then further analyzed using demographic, operative data, and total length of stay. Medicaid patients had an increased length of stay compared to patients with Medicare or Private insurance [1.98days versus 1.73days, p = .037, 95% confidence intervals (1.78-2.18) and (1.61-1.85), respectively]. The greatest predictor of a less than two-night stay post-operatively was private insurance status (p = 0.001). Medicaid patients had a higher incidence of prescribed narcotic use pre-operatively (p = 0.013). Although not significant, a trend was noted in the Medicaid population with higher incidence of smoking (p = 0.094) and illicit drug abuse (p = 0.099) pre-operatively in this sample subset. Patients with Medicaid insurance undergoing total joint arthroplasty have increased length of stay compared to patients with Medicare or Private insurance and have higher incidence of pre-operative narcotic use.

498 Oxidative stress and left ventricular performance in patients according to different glycometabolic phenotypes

Abstract Recent studies demonstrated that in normoglucose-tolerant subjects (NGT), 1-h post load plasma glucose value ≥155 mg/dL, during OGTT, identifies a worse cardio-metabolic risk profile with increased risk for Type 2 Diabetes Mellitus (T2DM). T2DM patients present increased oxidative stress, due to high blood glucose levels, which plays a central role in the development of CV events. The aim of our study was to evaluate the correlation between oxidative stress and subclinical myocardial damage, assessed with speckle tracking echocardiography, in NGT patients with 1-h post load ≥155 mg/dL vs. NGT &amp;lt; 155 subjects, impaired glucose tolerance (IGT) and T2DM patients. We enrolled 100 Caucasian patients (61 M, 39 W, mean age 61.4 ± 10.7) afferent to CATAMERI study. Main exclusion criteria were CV complications, history of malignant or chronic respiratory disease, alcohol, drug influencing glucose metabolism or smoking abuse. All subjects underwent clinical and laboratory evaluation, OGTT and HOMA-IR. The serum values of the markers of oxidative stress (8-isoprostane and NOX-2) were assessed with ELISA sandwich. Statistical analysis was performed with ANOVA test, linear correlation analysis and stepwise multivariate linear regression model. According to OGTT results, subjects were divided into 4 groups: NGT &amp;lt; 155 (n = 30), NGT ≥ 155 (n = 24), IGT (n = 28), T2DM (n = 18). Serum levels of 8-isoprostane and NOX-2 were significantly increased (P &amp;lt; 0.0001) in NGT ≥ 155 compared to NGT &amp;lt; 155 group, but similar with IGT, indicating an increase in oxidative stress with the worsening of the metabolic status. The left global systolic function, evaluated as myocardial deformation and global longitudinal strain (GLS), appeared progressively lower proceeding from the NGT &amp;lt; 155 group to the T2DM group (P &amp;lt; 0.0001). Moreover, for similar values of ejection fraction (EF), NGT ≥ 155 subjects presented reduced GLS compared to NGT &amp;lt; 155 (P = 0.001), but similar to IGT patients. The linear correlation analysis showed that endo/epi ratio was significantly and inversely correlated with 1 h post load glycaemia (r = −0.632, P &amp;lt; 0.0001), NOX-2 (r = −0.638, P &amp;lt; 0.0001), 8-isoprostane (r = −0.508, P &amp;lt; 0.0001); GLS was inversely correlated with 1 h post load glycaemia (r = −0.734, P &amp;lt; 0.0001) and directly and significantly correlated with 8-isoprostane (r = 0.564, P &amp;lt; 0.0001), NOX-2 (r = 0.625, P &amp;lt; 0.0001). From stepwise multivariate linear regression model, NOX-2 resulted the major predictor of endo/epi ratio, justifying 40.7% of its variation. 1-h post load glycaemia was the second predictor of endo/epi ratio justifying another 9.2% of its variation. Similarly 1-h post load glycaemia was the strongest predictor of the GLS, explaining 53.9% of its variation. Our study demonstrated that NGT ≥ 155 subjects present functional alterations of myocardial contractile fibres, compared to NGT &amp;lt; 155 subjects, but similar to IGT, and these alterations are correlated with oxidative stress. Moreover, GLS is able to identify early alterations in the contractility of subendocardial longitudinal fibres long before the alteration of EF. This data have a central role in ongoing research on the association between hyperglycaemia at 1-h post load and CV risk.

P027 CHRONIC MESH INFECTION AFTER TRANSVERSUS ABDOMINIS RELEASE FOR A MULTIRECURRENT COMPLEX VENTRAL HERNIA IN HIGH RISK PATIENT: CRITICAL ISSUES OF A LONG LASTING MANAGEMENT

Abstract Aim to point out the critical issues of the management of a challenging case of complex ventral hernia (CVH) in high risk patient Material and methods A 58-year-old female was referred to our Institution with a history of alcohol and smoking abuse, COPD and class I obesity. Four years before she underwent liver transplantation. In the next two years she had 2 VH repairs with polypropilene (PP) meshes. The postoperative course was complicated by a deep surgical site infection (SSI) and dehiscence. The wound resulted in a large R2 M3-L2 CWH with distorted anatomy. The patient experienced VH incarcerations and bowel obstructions. Clinical examination revealed no signs of infection and the CT scan showed partial loss of substance of the abdominal wall. Results The patient underwent posterior component separation with transversus abdominis release (PCS-TAR) and large PVDF mesh on top of a biosynthetic mesh implantation. The postoperative course was complicated after 14 days by a SSI causing a large wound dehiscence with underlying mesh exposure. The patient was readmitted and negative pressure wound therapy (NPWT) with topical wound solution instillation was initiated. After 1 month was followed up as an out-patient to continue traditional NPWT and removal of former PP remnants. NPWT was interrupted after 6 months and no signs of infection nor VH recurrence were recorded at 1 year. Conclusions the indication to PCS-TAR for such comorbid patient should be carefully evaluated. The use of a biosyntetic mesh could be debatable. The conservative management of a chronic infection could be the first-line option in case of macroporous mesh implantations.

DENYING TOTAL HIP ARTHROPLASTY IN SMOKERS, PATIENTS WITH ALCOHOL ABUSE OR IN PATIENTS WITH HUMAN IMMUNODEFICIENCY VIRUSES. WHY?

Nowadays total hip arthroplasty (THA) is one of the most successful surgical procedures in the world and the number of procedures performed is growing every year. However, its success largely depends on the absence of postoperative complications. Among the risk factors affecting the occurrence of postoperative complications are smoking, alcohol abuse, drug abuse, human immunodeficiency viruses (HIV), obesity, anemia, diabetes mellitus, malnutrition, rheumatoid arthritis, cardiovascular diseases, renal failure and dialysis, depression and anxiety. In the presented manuscript, such factors as HIV, smoking and alcohol abuse were considered. In smokers, bone regeneration slows down due to impaired bone metabolism and a slowdown in vascular recovery. Alcohol abuse affects human immunity, inhibiting T-helper cells, and also causing blood coagulation disorders. Alcohol abuse increases the risk of hospital complications, surgery related complications and general medical complications. Smoking can increase the risk of septiccomplications (lower respiratory tract infection, sepsis, urinary tract infection), myocardial infarction, risk of aseptic loosening of implants. Mortality was also higher in smokers compared to nonsmokers. HIV increases bone fragility, debilitation, rate of cardiovascular diseases and decreases the number of CD4+ cells in the blood, which directly affects the risk of periprosthetic joint infections and revision. All three factors increase the patient's lengthof stay in the hospital after THA. Currently, recommendations have been developed for preventive measures that need to be taken to reduce the risk of postoperative complications by performing primary THA. According to the recommendations, quitting smoking and drinking alcohol 4 weeks before THA will significantly reduce the risk of postoperative complications. For HIV-positive patients, antiretroviral therapy and subsequent assessing the viral load arerequired prior to THA. Preoperative care in this category of patients, undergoing primary THA, can reduce the risk of complications.

Diagnosis dan Penatalaksanaan Karsinoma Tonsil

AbstractTonsilar carcinoma is the most common squamous cell carcinoma of the tonsils that presents as ulcerated lesions on a necrotic basis. These tumors often appear at an advanced stage and often metastasize to the lymph nodes. In recent years, head and neck malignancies due to HPV infection have increased. Other causes of carcinoma of the tonsils are smoking and alcohol abuse. The overall incidence of tonsillar carcinoma increase in the younger population, and this may be associated with an increase of human papilloma virus infection. Tonsil carcinoma varies in clinical history. In the early stages, tonsilar carcinoma are asymptomatic, but at an advanced stages patients might have complaint of a persistent sore throat, unilateral otalgia, or a sensation of mass in the throat, bleeding from the mouth, fetor oris with trismus as a sign of a local invasion. The diagnosis of tonsilar carcinoma made based on history, physical examination, clinical symptoms, and supporting examinations such as of CT scan, MRI and tumor tissue biopsy. Management of tonsilar carcinoma for stage I-II and stage III (T1-2, N1) are local and regional radiotherapy to achieve a good effect. Radiotherapy is the main treatment modality in early-stage of tonsillar carcinoma. concomitant chemotherapy and radiation therapy are the standard treatment for advanced tonsillar carcinoma currently. chemotherapy can be given before radiotherapy or as neoadjuvant, given after radiotherapy or as adjuvant, or given concurrently with radiotherapy.

Prevalence of substance abuse and its associated factors among medical students: a cross-sectional study

Background: Substance abuse by medical students poses a significant risk not only on their personal life but also on their professional life by putting their patients at risk. Our study aims to find out the prevalence of substance abuse and factors associated with it among medical students. Methods: A descriptive, online-questionnaire based, cross-sectional study was carried out at Gandaki Medical College, a medical school in Gandaki Province of Nepal. Whole sampling technique was used. SPSS-25.0 software was used for statistical analysis. Descriptive statistics were used for analyzing demographic and substance abuse related variables. Chi square and Fishers exact test was used to find out if any differences existed in substance abuse by demographic characteristics. Results: Among 420 eligible participants, 219 participated in the survey (response rate: 52.2%). Alcohol was the most commonly used substance with overall lifetime prevalence of 58% followed by cigarette smoking and illegal drug abuse at 21.9% and 13.7%, respectively. The abuse of substances was significantly higher (p&lt;0.05) in males, who were offered substances by friends, and amongst study participants who worked with an intoxicated colleague. The most common reason for substance abuse was “For pleasure, curiosity or to go along with friends” (23%, n=18). Major and minor dysfunction due to alcohol abuse was reported by 8(3.7%) and 33(15.1%) participants, while the same dysfunctions due to drug abuse were reported by 1(0.5%) and 14(6.4%) participants, respectively. Conclusions: The prevalence of substance abuse was high among medical students and was found to be associated with male gender, if offer of substances were made by friends, and amongst those who worked with an intoxicated colleague. This problem of substance abuse among medical students should be addressed timely as failing to do so might have serious consequences on the healthcare system of the country.

Continuous flow left ventricular assist devices do not worsen endothelial function in subjects with chronic heart failure: a pilot study.

AimsTo evaluate endothelial function in subjects with left ventricular assist devices (LVADs), comparing them with subjects with chronic heart failure with reduced ejection fraction on the list for heart transplant (HT) and with HT patients with a normal systolic cardiac function to identify any differences.MethodsWe enrolled 28 subjects with LVAD, 55 subjects with HT, and 42 subjects with heart failure on the transplant list. The subjects underwent a general physical examination, assessment of laboratory blood parameters, and assessment of endothelial function through flow‐mediated dilation (FMD) of brachial artery.ResultsThe three groups were homogeneous as regards age, gender, smoke abuse, C‐reactive protein (CRP) and FMD parameters (P = ns). In LVAD group percentage of FMD change showed an inverse correlation with CRP (rho: −0.5, P: 0.003), a well‐known marker of inflammation and tissue damage.ConclusionsContinuous flow related to LVAD seems to not worsen endothelial function. Endothelial function was not affected by cardiovascular risk factors (hypertension, hypercholesterolaemia, diabetes, obesity, and tobacco habit), by the functional status expressed by New York Heart Association class, by the left ventricular systolic function and by the presence or absence of ischaemic heart disease in all the populations analysed. CRP was the only factor able to influence percentage of FMD change in patient with LVAD, reinforcing the hypothesis that inflammation is the main determinant of endothelial function.

Weekly chemotherapy as first line treatment in frail head and neck cancer patients in the immunotherapy era

ObjectiveFirst-line therapy for metastatic squamous cell carcinoma of the head and neck (R/M HNSCC) has been revolutionized by the introduction of anti-checkpoint monoclonal antibodies, which have shown a significant improvement in overall survival (OS) gaining approval in a first line setting. Efficacy and safety of first-line weekly chemotherapy, compared to 3-weeks treatment, was retrospectively evaluated in a frail patient population with R/M HNSCC with the aim to evaluate its role as part of a personalized first-line approach.MethodsA total of 124 patients with locally incurable R/M HNSCC receiving weekly (21) or three-weekly (103) chemotherapy plus cetuximab in a first line setting from December 2010 to September 2020 were retrospectively reviewed. Treatment outcomes in terms of objective response rate (ORR), progression-free survival (PFS), overall survival (OS) and toxicities were analysed.ResultsPatients in the three-week subgroup were ECOG PS 0 (39) and 1 (64) while patients in weekly group (21) were all PS 2. No significant differences were reported in terms of age, sex, smoking and previous alcohol abuse considering the two distinct subgroups. Moreover, no statistically significant difference was found in PFS and OS between the two treatment subgroups. The response rate was 35% (36 patients) and 34% (7 patients) in three-week and weekly treatment group, respectively. Seventy patients (68%) in the three-week group experienced chemotherapy-related toxicities, predominantly G3. In the weekly group a predominantly low-grade toxicity was found in a lower number of patients (52%).ConclusionThe weekly schedule appears to be an active and safe strategy in frail patients with R/M HNSCC. Based on these data, a weekly schedule could be considered as a first line treatment in all frail patients excluded from pembrolizumab treatment and a study on the combination of weekly chemotherapy and immunotherapy should be performed.

Dynamics of the prevalence of modifiable cardiovascular risk factors in the European part of the Russian Federation

Objective: to estimate the prevalence in the dynamic of physical inactivity, overweight and obesity, smoking and alcohol abuse in a representative sample of the European part of the Russian Federation. Materials and methods: the population of eight subjects of the European part of Russia was randomized in 2002. The resulting sample was examined by local doctors. The resulting sample included 19,503 respondents who were examined by local doctors in 2002 and 2017. Results: from 2002 to 2017 the prevalence of smoking has decreased from 23,1 to 20,5% (р &lt; 0,001) (47,9 – 42,6% (р &lt; 0,001) among men and 4,8 – 4,5% (р = 0,323 among women)). The smoking index among men has decreased from 18,8 to 17,8 (р = 0,024) and from women increased from 7,7 to 10,6, р &lt; 0,001. The prevalence of alcohol abuse has decreased from 32,2 to 22,3% (р &lt; 0,001) (51,6 – 39,0% (р &lt; 0,001) among men and 17,4 – 10,1% (р &lt; 0,001) among women). Average dose of ethanol, among drinkers has changed from 84,0 ± 94,4 ml to 75,4 ± 75,5 ml (р &lt; 0,001) (120,6 ± 111,9 – 97,7 ± 85,2 (р &lt; 0,001) among men and 44,7 ± 45,3 – 46,0 ± 46,3 (р &lt; 0,001) among women). Percentage of respondents who are overweight or obese has increased from 46,9 to 60,0% (р &lt; 0,001) (41,6 – 58,2% (р &lt; 0,001) among men and 50,9 – 31,3% (р &lt; 0,001) among women). Although the prevalence of inactivity has decreased from 83,2 to 81,0% (р &lt; 0,001) (79,8 – 78,4% р = 0,045 among men and 85,7 – 83,0% (р &lt; 0,001) among women), the proportion of people without physical activity has increased from 71,5 to 74,0% (р &lt; 0,001), because the proportion of people with low physical activity has decreased. Conclusion: the prevalence of bad habits in Russia is decreasing, but the proportion of people who have inactivity, overweight and obesity is increasing. These facts will not significantly reduce cardiovascular morbidity and mortality in Russsia, and require optimization of population prevention programs that will reduce the prevalence of inactivity, overweight and obesity in society.

EXPERIENCE OF ALPHA - LIPOIC ACID IN THE TREATMENT OF PSORIASIS IN PATIENTS WITH BAD HABITS

The prevalence of psoriasis poses a considerable public health burden and requires the elaboration of new treatment approaches. Despite the high prevalence and incidence of the disease and large amounts of reports on this problem, there has not been established an integral vision on the pathogenesis of this dermatosis. Risk factors for psoriasis can be divided into two groups, first of all, external and internal ones. Special attention is paid to smoking and alcohol consumption. The aim of our study was to determine the role of alpha - lipoic acid as a component of the complex therapy for psoriatic patients with alcohol and smoking abuse. The study has demonstrated that alpha-lipoic acid increases the reserves of intracellular glutathione, prevents the damage of mitochondria during lipid peroxidation. This enables to restore the balance of redox processes in hepatocytes and reduces the damaging effects of toxic substances. The effectiveness of the psoriasis therapy including alpha-lipoic acid was evaluated by comparing the biochemical blood parameters of the patients who took the therapy with alpha-lipoic acid (I group) and who did not (II group). The obtained results show the patients of the I group the have indicators of total cholesterol improved by 73.7%, the indicators of total and direct bilirubin improved by 25.7% and 32.4%; infiltration and erythema has considerably diminished by 92.9% of the patients that is 2.3 times higher compared with patients of the II group (control). We consider that this study has supported higher therapeutic efficacy of the proposed method of complex therapy for psoriatic patients of the I group that includes the addition of 600 mg of alpha-lipoic acid as a single dose taken in 30 minutes before the first meal for a month.

MO819RISK FACTORS FOR COVID-19 MORTALITY IN HEMODIALYSIS PATIENTS

Background and AimsThe global pandemic with SARS-CoV-2 virus and Covid-19 threatened hemodialysis patients as vulnerable category with high risk for fatal outcome. The aim of the study was to determine the prevalence and risk factors for mortality in hemodialysis (HD) patients with confirmed Covid-19.MethodThis study was retrospective, multicentric, and included all HD patients with positive PCR test for SARS-CoV-2 during the period of 10 months from March 1 – December 31/2020. The outcome of patients with positive PCR test for SARS CoV-2 was evaluated. The following clinical parameters were compared in two groups of patients (the deceased and alive): age, sex, hemodialysis vintage, type of vascular access, BMI, Hemoglobin, WBC, Platelets, CRP, LDH, D-dimer, s-albumin, radiological findings, smoking abuse, therapy with ACE and ARBs, presence of symptoms and comorbidities: hypertension (HTA), diabetes mellitus (DM), coronary artery disease (CAD), chronic pulmonary disease (CPD), dyslipidemia, atrial fibrillation (AFF), malignancy, treatment in hospital and intensive care unit (ICU) with oxygen support and mechanical ventilation, and anticoagulant therapy. Statistical analysis was performed by SPSS, continued variables with ANOVA and categorical variables with Pearson Chi- square test and logistic regression.ResultsOf total 631 hemodialysis patients during the period of 10 months 162 patients (113 M and 49 F) or 25,67% were with positive PCR test for SARS-CoV-2, they have had mean age 62,47±13,14 years and HD vintage 71,93±68,01 months. During the observed period 38 patients with Covid-19 (25 M and 13 F) deceased, that represents mortality of 23,45%, 8 patients deceased at home and 30 patients in hospital. The mortality in patients with age range 18-49 years was 8%, with 50-59 years 18,9%, with 60-69 years 22,2%, with 70-79 years 31,2% and in patients with ≥ 80 years was 50%. Clinical parameters showed that the deceased patients compared with alive patients have had statistically significant higher age (67,7±10,57 vs 60,85±13,46 years; p=0.004), biochemical findings WBC (9,13±4,07 vs 6,45±3,0; p<0.001), LDH (394±4,07 vs 294±143; p=0.032), D-dimer (3699±4,07 vs 2025±2628; p=0.041), lower s-albumin (25,03±4,0 vs 34,57±6,89; p<0.001), and less hospital days (9,87±12,15 vs 16,24±14,31; p=0.04). Regarding comorbidities the mortality in the deceased patients was significantly higher in patients with chronic pulmonary disease (CPD) in comparison to patients without CPD (56,3% vs 19,9%; p=0.001), and in patients with malignancy in comparison to patients without malignancy (57,1% vs 21,9%; p=0.032). The mortality in hospitalized patients was significantly higher in comparison to treated patients at home (25,8% vs 10,5%; p<0.001) and was significantly higher in patients treated in ICU in comparison to patients treated at hospital (40,7% vs 25%; p<0.001). By logistic regression model it was determined that presence of chronic pulmonary disease (HR=6,178; p=0.008), ICU treatment (HR=5,311; p=0.01) and malignancy (HR=16,766; p=0.01) were the most predictive risk factors for mortality.ConclusionOur study showed that mortality is high in HD patients with Covid-19 and amounts 23,45%, which is in accordance with other larger studies of ERACODA and ERA-EDTA registry regarding mortality of hemodialysis patients with Covid-19 (25% vs 20%). The mortality in HD patients with Covid-19 was associated with advanced age, high level of WBC, LDH and D-dimer, and low level of s-albumin. In contrast to general population, no association with gender, diabetes and cardiovascular disease, but significant association of mortality with presence of chronic pulmonary disease, malignancy, hospital and ICU treatment was found.

Unique collateral providing flow for an occluded iliac artery.

We present a 63-year-old female patient with a past medical history significant for previous smoking abuse, hypertension, and chronic pulmonary obstructive disease referred for worsening claudication. She had quit smoking 2 years prior and has had progressively worsening left lower extremity claudication with one to two blocks over the past 6 months. Her surgical history is significant for a cholecystectomy, c-section, and hysterectomy. On physical examination she had no palpable left femoral pulse and weak posterior tibial and dorsalis pedis pulses on doppler.