Specific Risk Categories Research Articles

High low-density lipoprotein cholesterol levels in people with HIV by individual cardiovascular risk: A retrospective observational study

BackgroundPeople with HIV (PWH) are at increased risk of atherosclerotic cardiovascular disease (ASCVD). Lowering low-density lipoprotein cholesterol (LDL-C) is central of cardiovascular disease prevention. The aim of this study was to assess the prevalence, treatment, and control of high LDL-C levels as assessed on the basis of the ASCVD risk profiles indicated by European Society of Cardiology (ESC) guidelines of a cohort of PWH in order to evaluate the state of LDL-C management in current clinical practice. MethodsWe retrospectively assessed the prevalence, treatment, and control of high LDL-C levels in a cohort of PWH aged ≥40 years who accessed our HIV outpatient clinic between 1 March 2022 and 31 March 2023. Their 10-year ASCVD risk was calculated on the basis of their age and co-morbidities as recommended by guidelines. High LDL-C levels were defined as those above the “step two” target of their specific ASCVD risk category. ResultsAmong the 1404 assessed PWH, who were prevalently male (74.5 %) and Caucasian (85.6 %), and had a median age of 56 years (interquartile range [IQR] 49–61), 295 (21 %) were at very high risk (VHR), 634 (45.2 %) at high-risk (HR), and 348 (24.8 %) not at HR. The overall median LDL-C level was 116 mg/dL (IQR 96–141). Five hundred and sixteen (37 %) were undergoing lipid lowering treatment (LLT), and 650 (46.3 %) failed to achieve any step of their target LDL-C levels. ConclusionsDespite the high prevalence of PWH at VHR/HR for ASCVD, LDL-C levels were poorly controlled and LLT was greatly under used.

Exploring the accuracy of tooth loss prediction between a clinical periodontal prognostic system and a machine learning prognostic model.

The aim of this analysis was to compare a clinical periodontal prognostic system and a developed and externally validated artificial intelligence (AI)-based model for the prediction of tooth loss in periodontitis patients under supportive periodontal care (SPC) for 10 years. Clinical and radiographic parameters were analysed to assign tooth prognosis with a tooth prognostic system (TPS) by two calibrated examiners from different clinical centres (London and Pittsburgh). The prediction model was developed on the London dataset. A logistic regression model (LR) and a neural network model (NN) were developed to analyse the data. These models were externally validated on the Pittsburgh dataset. The primary outcome was 10-year tooth loss in teeth assigned with 'unfavourable' prognosis. A total of 1626 teeth in 69 patients were included in the London cohort (development cohort), while 2792 teeth in 116 patients were included in the Pittsburgh cohort (external validated dataset). While the TPS in the validation cohort exhibited high specificity (99.96%), moderate positive predictive value (PPV = 50.0%) and very low sensitivity (0.85%), the AI-based model showed moderate specificity (NN = 52.26%, LR = 67.59%), high sensitivity (NN = 98.29%, LR = 91.45%), and high PPV (NN = 89.1%, LR = 88.6%). AI-based models showed comparable results with the clinical prediction model, with a better performance in specific prognostic risk categories, confirming AI prediction model as a promising tool for the prediction of tooth loss.

Discretionary tone in reward-based crowdfunding: Do project owners talk their way to success?

This study examines the relationship between abnormal tone and project performance of reward-based crowdfunding (RBC) using the Kickstarter data from 2009 to 2020. We document a negative relationship between abnormal tone and the success of a project in the RBC campaign section, while a positive impact in the Risks and Challenges section. This outcome remains robust to a variety of sensitivity tests and after accounting for potential endogeneity concerns. Cross-sectional analyses reveal that the effect of abnormal tone in RBC on project success is contingent on project quality and legal jurisdiction. Further investigation of the concurrent effect of abnormal tone in the two sections shows that an increase in the discretionary tone, given that it is overly optimistic, has a negative effect on funding performance. Last, based on a machine learning Sent-Latent Dirichlet Allocation model, we explore up to 70 specific risk categories embedded in Kickstarter projects, and we find that eight of them are strongly and negatively associated with project success. Our paper provides valuable insights into the significance of disclosure and sheds light on the ongoing and increased regulations on crowdfunding platforms.

Is the T2MR Candida Panel a suitable alternative to the SeptiFast for the rapid diagnosis of candidemia in routine clinical practice?

ObjectivesThe diagnosis of invasive Candida infection remains challenging because of tests with slow turnaround times or mediocre performance. T2magnetic resonance imaging is a new diagnostic tool. We investigated the diagnostic accuracy of the T2Candida panel (T2) in comparison with blood culture (BC) and the SeptiFast (SF) for the detection of five different Candida species among high-risk intensive care unit patients with suspected candidemia. MethodsWe analysed blood samples collected from patients with suspected candidemia (177 samples from 138 patients) from August 2018 to April 2020. Blood samples were collected and analysed concurrently by BC, SF, and T2Candida. Subsequently, based on clinical and microbiological findings, patient samples were assigned to specific risk categories (proven, probable, and no candidemia). ResultsTwenty-two samples from 17 patients were classified as proven candidemia, and 15 samples from 14 patients were classified as probable candidemia. A sensitivity of 68.2% (95% CI, 45–86%) was observed for the BC and the SF, and a sensitivity of 63.6% (95% CI, 41–83%) was observed for the T2 when only cases with proven candidemia were evaluated. For proven and probable candidemia, the sensitivity was 40.5% (95% CI, 23–58%) for BC, 81.1% (95% CI, 65–92%) for SF, and 73.0% (95% CI, 56–86%) for T2. DiscussionThe diagnostic performance of SF and T2 was similar. For samples with proven/probable candidemia, SF and T2 had a higher sensitivity compared to BC. Used in conjunction with other diagnostic methods, T2 can replace the no longer available SF for the diagnosis of candidemia, enabling the timely initiation of targeted antifungal therapy.

The algorithms for drawing up annual plans of inspections performed by Rospotrebnadzor’s regional organizations within the framework of risk-based model

The existing model of control and surveillance activities is based on a procedure that involves assigning activities performed by juridical persons or private entrepreneurs and (or) production facilities used by them in these activities into a specific risk category or a specific hazard class (category). The goal of the present work was to develop and improve algorithms for drawing up annual plans of inspections performed by Rospotrebnadzor’s territorial organizations within the framework of the risk-based model. For the first time, we have formulated conceptual and mathematical statement of the problem of planning control and surveillance activities performed by Rospotrebnadzor. This allowed us, among other things, to consider history of violations (integrity of a given subject) over a specific period and availability of objects for inspections. The latter is described with several parameters that include both regional peculiarities (a distance between objects, quality of road networks) and “complexity” of checking a particular object. When analyzing the mathematical statement, we identified certain model parameters that had the greatest influence on a solution to the problem, that is, the most sensitive parameters that should be regulated with special care if we want to make control and surveillance activities more effective. We have created planning algorithms with preset parameter values (scenario forecasting programs) and tested them at the regional level. We have developed three criteria for comparing these algorithms: coverage of a number of subjects that are to be inspected; coverage of a number of objects that are to be inspected; coverage by the total risk. The testing results indicate that the combined algorithm has higher coverage rates since in this case not all objects are inspected when a given subject is being checked. Consequently, this allows reducing overall labor costs required to perform an inspection. The suggested approaches give an opportunity to achieve more effective distribution and use of resources allocated by Rospotrebnadzor for scheduled inspections.

Алгоритмы формирования ежегодных планов проведения проверок территориальными органами и организациями Роспотребнадзора в рамках риск-ориентированной модели

The existing model of control and surveillance activities is based on a procedure that involves assigning activities performed by juridical persons or private entrepreneurs and (or) production facilities used by them in these activities into a specific risk category or a specific hazard class (category). The goal of the present work was to develop and improve algorithms for drawing up annual plans of inspections performed by Rospotrebnadzor’s territorial organizations within the framework of the risk-based model. For the first time, we have formulated conceptual and mathematical statement of the problem of planning control and surveillance activities performed by Rospotrebnadzor. This allowed us, among other things, to consider history of violations (integrity of a given subject) over a specific period and availability of objects for inspections. The latter is described with several parameters that include both regional peculiarities (a distance between objects, quality of road networks) and “complexity” of checking a particular object. When analyzing the mathematical statement, we identified certain model parameters that had the greatest influence on a solution to the problem, that is, the most sensitive parameters that should be regulated with special care if we want to make control and surveillance activities more effective. We have created planning algorithms with preset parameter values (scenario forecasting programs) and tested them at the regional level. We have developed three criteria for comparing these algorithms: coverage of a number of subjects that are to be inspected; coverage of a number of objects that are to be inspected; coverage by the total risk. The testing results indicate that the combined algorithm has higher coverage rates since in this case not all objects are inspected when a given subject is being checked. Consequently, this allows reducing overall labor costs required to perform an inspection. The suggested approaches give an opportunity to achieve more effective distribution and use of resources allocated by Rospotrebnadzor for scheduled inspections.

Automated assessment reveals that the extinction risk of reptiles is widely underestimated across space and phylogeny.

The Red List of Threatened Species, published by the International Union for Conservation of Nature (IUCN), is a crucial tool for conservation decision-making. However, despite substantial effort, numerous species remain unassessed or have insufficient data available to be assigned a Red List extinction risk category. Moreover, the Red Listing process is subject to various sources of uncertainty and bias. The development of robust automated assessment methods could serve as an efficient and highly useful tool to accelerate the assessment process and offer provisional assessments. Here, we aimed to (1) present a machine learning–based automated extinction risk assessment method that can be used on less known species; (2) offer provisional assessments for all reptiles—the only major tetrapod group without a comprehensive Red List assessment; and (3) evaluate potential effects of human decision biases on the outcome of assessments. We use the method presented here to assess 4,369 reptile species that are currently unassessed or classified as Data Deficient by the IUCN. The models used in our predictions were 90% accurate in classifying species as threatened/nonthreatened, and 84% accurate in predicting specific extinction risk categories. Unassessed and Data Deficient reptiles were considerably more likely to be threatened than assessed species, adding to mounting evidence that these species warrant more conservation attention. The overall proportion of threatened species greatly increased when we included our provisional assessments. Assessor identities strongly affected prediction outcomes, suggesting that assessor effects need to be carefully considered in extinction risk assessments. Regions and taxa we identified as likely to be more threatened should be given increased attention in new assessments and conservation planning. Lastly, the method we present here can be easily implemented to help bridge the assessment gap for other less known taxa.

Trends in vaccination coverage against influenza in the pediatric population: an Italian overview

Abstract Background Influenza is a major public health issue for its epidemiological, clinical and economic impact. Children are a relevant age group for the diffusion of the infection in the community as they shed the virus in greater amounts and for longer periods of time than adults of any age. Vaccination is the best strategy to fight the disease. In Italy, until last year, influenza vaccination for the pediatric population was offered free only to children in specific risk categories, while in the last season its was extended also to all subjects from 6 months to 6 years old. The purpose of this work is to analyze the trend of vaccination coverage among children in the last decade in Italy. Methods We retrieved vaccination coverage data by the Italian Ministry of Health relating to influenza vaccination in the age groups 0-2, 2-4, 5-8 and 9-14 in the years 2010-2020 and analysed trends in and between regions. Results A preliminary analysis shows that vaccination coverage in the age groups considered ranged from a minimum of 1.1% to a maximum of 4.5%. The highest average percentage reached was recorded in the season 2010-11 (3.8%), while the lowest in the 2015-16 (1.5%). The highest average values (12,9%; 10,5%) were found in Puglia and Toscana, while the lowest (0.3%) in Friuli Venezia Giulia. From 2010 to 2015 there was a progressive decline in vaccination coverage, while in the following years there was a slight increase, up to the year 2019-2020, in which the average percentage value was 3%. Further results are expected for next summer, when 2020-21 data will be available. Conclusions Our analysis shows that in the Italian regions influenza vaccination coverage in children is variable but still extremely low. Childhood vaccination could provide an opportunity to decrease the burden of disease in this age group but may also help to protect the population at risk of serious complications, such as the elderly, due to the social role children play in the spread of this virus. Key messages Influenza vaccination in children is a major public health issue. Additional efforts are needed to make vaccination available for children and improve the stakeholders’ awareness on this topic.

Climatic Variables Differentially Influence Neotropical Plant Species of Conservation Concern

ABSTRACT Knowing how and to what extent environmental parameters affect threatened species facilitates the understanding of their specific microhabitat requirements. In this study, we examined the response patterns of four threatened tropical plant species to variations in temperature, precipitation, and physiographic variables, and analyzed the relative contributions of environmental variables to the observed distributions of the species. The studied species are Bursera coyucensis, Cryosophila argentea, Guatteria anomala, and Vatairea lundellii and are cataloged into specific risk categories in the Mexican Official Standard NOM-059-SEMARNAT. Our findings suggest differences in ranges of temperature and precipitation (for example, C. argentea exhibited narrower ranges compared to G. anomala and V. lundellii in precipitation) and similarity in ranges of slope across species distributions. We also found that most species distributions respond non-linearly to variations in environmental variables. These results contribute to defining the environmental spaces of these species. The partial and combined effects of climatic variables, and the range of environmental distributions reported here, have intrinsic implications for the adaptation capacity, plasticity, and survival of these species to environmental variation. This information could be useful to promote conservation activities such as the creation of microhabitats with optimal environmental preferences through sustainable silviculture.

Revised DIPSS-Plus: A Composite Clinical, Cytogenetic and Molecular Prognostic System for Primary Myelofibrosis

Background:The dynamic international prognostic scoring system (DIPSS)-plus currently offers the most comprehensive risk assessment tool in primary myelofibrosis (PMF) (JCO 2011;29:392). More recently, DIPSS-plus-independent genetic determinants of prognosis have been described; type 1/like CALR mutations predicted superior (Blood 2014;124:2465) and ASXL1 / SRSF2 mutations and very high risk (VHR) karyotype inferior survival (Leukemia 2013;27:1861; Blood 2011;118: 4595) . The objective of the current study was to enhance the prognostic value of DIPSS-plus, by incorporating genetic information.Methods:Learning and validation cohorts were recruited from the Mayo Clinic and University of Florence, respectively. Diagnosis was according to WHO criteria (Blood 2016;127:2391). The study required availability of complete information on DIPSS-plus, type 1/like CALR, ASXL1 and SRSF2 mutations and karyotype. Previously published methods were used for mutation analyses and determination of CALR variants (Blood 2014;124:2465; Leukemia 2013;27:1861) . VHR karyotype included monosomal, inv(3), i(17q) and -7/7q-. Survival was calculated from date of first referral for the Mayo cohort and date of diagnosis for the Florence cohort; patients receiving stem cell transplant were censored at the time of transplantation.Results: Mayo Clinic cohort (n=465)•Presenting clinical and genetic features and clinical course465 Mayo Clinic patients (median age 63 years; 64% males) served as the learning cohort; DIPSS-plus risk distribution at presentation was 32% high, 37% intermediate-2, 18% intermediate-1 and 13% low. Driver mutations included JAK2 in 54%, type 1/like CALR 23%, type 2/like CALR 4%, MPL 7% and triple-negative 12%. ASXL1 and SRSF2 mutational frequencies were 38% and 15%, respectively. Ten patients displayed VHR karyotype. During median follow-up of 4.6 years, 330 (71%) deaths, 55 (12%) leukemic transformations, and 30 (6.5%) transplants were documented. •Survival analysis and development of the “revised DIPSS-plus”Multivariable analysis confirmed independent prognostic contribution from DIPSS-plus, type 1/like CALR, ASXL1 / SRSF2 mutations and VHR karyotype; HRs (95% CI) were 8.4 (5.1-14.1) for DIPSS-plus high, 3.8 (2.3-6.3) intermediate-2, 2.3 (1.3-4.0) intermediate-1, 2.0 (1.5-2.8) for absence of type 1/like CALR, 1.7 (1.4-2.1) for presence of ASXL1 or SRSF2 mutation, and 1.9 (1.1-3.1) for VHR karyotype.HR-weighted scores were then assigned to absence of type 1/like CALR (1 point), presence of ASXL1 / SRSF2 mutation (1 point), presence of VHR karyotype (1 point) and DIPSS-plus intermediate-1 (1 point), intermediate-2 (2 points) and high (4 points) risk categories. Subsequent adverse point summation resulted in four new “revised DIPSS-plus (RDIPSS-plus)” risk categories: low (0-1 points; n=74; 16%); intermediate-1 (2-3 points; n=168; 36%), intermediate-2 (4-5 points; n=136; 29%) and high (6-7 points; n=87; 19%); the respective median survivals were 20, 6.3, 3.8 and 1.9 years (p<0.0001; Figure). RDIPSS-plus was also effective in predicting leukemic transformation; HRs (95% CI) were 19.3 (6.1-61.0), 5.8 (1.9-18.2) and 3.5 (1.2-10.6), for RDIPSS-plus high, intermediate-2, and intermediate-1 risk categories, respectively. •Risk group distributions in “RDIPSS-plus” vs “DIPSS-plus”All 87 patients in the “RDIPSS-plus” high risk group belonged to DIPSS-plus high risk category. Among 136 intermediate-2 risk patients in the “RDIPSS-plus” model, 60 belonged to DIPSS-plus high and 76 DIPSS-plus intermediate-2; among 168 patients in the “RDIPSS-plus” intermediate-1 risk group, 98 belonged to DIPSS-plus intermediate-2, 60 intermediate-1 and 10 low risk; among 74 patients in the “RDIPSS-plus” low risk group, 25 belonged to DIPSS-plus intermediate-1 and 49 low risk groups.Results: Florence cohort (n=347)The aforementioned observations were validated in an external cohort of 347 patients from the University of Florence (details to follow at time of presentation).Conclusions:“ RDIPSS-plus ” incorporates clinical, cytogenetic and molecular information, in order to provide a comprehensive prognostic tool for facilitating treatment decision-making in PMF. RDIPSS-plus was most effective in extracting patients with better than expected outcome, from specific DIPSS-plus risk categories. [Display omitted] DisclosuresVannucchi:Novartis: Honoraria, Speakers Bureau; Shire: Speakers Bureau.

Методические подходы к оценке категорий профессионального риска, обусловленного различными видами нарушений здоровья работников, связанными с комплексом факторов рабочей среды и трудового процесса

If we want to assess occupational risks predetermined by various health disorders among workers related to occupational factors and labor process factors, we need to examine whether additional methods can be applied here; these methods should allow not only quantitative determination of occupational risk but also its adequate categorizing. A procedure for risk assessment based on fuzzy sets analysis can be considered and applied for the matter. Suggested methodical approaches to occupational risk assessment based on this procedure involve step-by-step accomplishment of the following stages: determining fuzzy figures corresponding to preset occupational risk levels; preparing initial data (numeric characteristics of occupational risk) for calculations; probabilistic assessment whether a numeric characteristic of occupational risk belongs to fuzzy numbers; and estimated probability of belonging of occupational risk numeric characteristic. A basic instrument for implementing the procedure is determining a membership function for a trapezoid fuzzy number that estimates whether determined risk assessments belong to a specific risk category. We suggested a scale for assessing occupational risk levels, starting from negligible (0–1∙10-4) to extremely high (3∙10-1–1) and corresponding boundaries of trapezoid fuzzy interval (four figures that define a trapezoid number). The procedure was tested in a situation when occupational diseases (sensorineural hearing loss), work-related diseases (arterial hypertension), and their combinations were revealed under exposure to noise equal to 85 dBA; the tests allowed establishing that membership functions were equal to 1 for all risk levels determined as per results obtained via epidemiologic research.

Methodical approaches to assessing categories of occupational risk predetermined by various health disorders among workers related to occupational and labor process factors

If we want to assess occupational risks predetermined by various health disorders among workers related to occupational factors and labor process factors, we need to examine whether additional methods can be applied here; these methods should allow not only quantitative determination of occupational risk but also its adequate categorizing. A procedure for risk assessment based on fuzzy sets analysis can be considered and applied for the matter. Suggested methodical approaches to occupational risk assessment based on this procedure involve step-by-step accomplishment of the following stages: determining fuzzy figures corresponding to preset occupational risk levels; preparing initial data (numeric characteristics of occupational risk) for calculations; probabilistic assessment whether a numeric characteristic of occupational risk belongs to fuzzy numbers; and estimated probability of belonging of occupational risk numeric characteristic. A basic instrument for implementing the procedure is determining a membership function for a trapezoid fuzzy number that estimates whether determined risk assessments belong to a specific risk category. We suggested a scale for assessing occupational risk levels, starting from negligible (0–1∙10-4) to extremely high (3∙10-1–1) and corresponding boundaries of trapezoid fuzzy interval (four figures that define a trapezoid number). The procedure was tested in a situation when occupational diseases (sensorineural hearing loss), work-related diseases (arterial hypertension), and their combinations were revealed under exposure to noise equal to 85 dBA; the tests allowed establishing that membership functions were equal to 1 for all risk levels determined as per results obtained via epidemiologic research

Significance of Marker Chromosome on the Outcome of Allogeneic Hematopoietic Stem Cell Transplantation for AML

Significance of Marker Chromosome on the Outcome of Allogeneic Hematopoietic Stem Cell Transplantation for AML

Clinical Characteristics and Treatment Patterns By Risk Stratification in Patients with Essential Thrombocythemia: An Analysis of the MOST Study

Clinical Characteristics and Treatment Patterns By Risk Stratification in Patients with Essential Thrombocythemia: An Analysis of the MOST Study

Can the 2019 AHA/ACC Cardiovascular Guidelines Be Improved?

The 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease for treatment of atherosclerosis in asymptomatic individuals is an advance over previously published recommendations. However, since all guidelines are based on a limited quantity of published studies and result from a consensus of experts in different fields of medicine, omissions and errors are inevitable. The present manuscript identifies four areas in these 2019 AHA/ACC guidelines that alternative approaches or changes would result in improved outcomes and reductions in atherosclerotic events. First, the goal for the reduction in the prevalence of cardiovascular disease should be total (100%) eradication of the disease. This is a feasible goal as the facilities and resources to accomplish this task are currently available. Second, guidelines should acknowledge that atherosclerosis is a reversible disease as has previously been documented by multiple studies. If reversible, then under the appropriate clinical circumstances, it is preventable. Third, the goal for LDL cholesterol reduction should be <50 mg/dl, if eradication of atherosclerosis is to be achieved. This goal is achievable and safe as suggested by published studies. Fourth, widespread use of the coronary artery calcium scan needs to be recommended so that early atherosclerosis can be reversed before a major cardiovascular event occurs. Treating all individuals at a specific risk category without regard for the presence of disease results in poor adherence to therapy and unnecessary side effects. Consideration of these four issues would improve the AHA/ACC guidelines and result in better patient care.

Модель отнесения объектов защиты к определённой категории риска в области пожарной безопасности

Introduction. A mathematical model is presented for assigning protection objects to certain risk categories in the field of fire safety. The model is based on the concepts of the probability of adverse effects of fires causing harm (damage) of various extent and severity to the life or health of citizens, and the acceptable risk of harm (damage) from fires. Goals and objectives. The purpose of the study is to develop the procedure for assigning protection objects to a certain category of risk of harm (damage) based on estimates of the probability of fires with the corresponding severity consequences, to determine the acceptable level of risk of harm (damage) due to the fires, to calculate and develop numerical values of criteria for assigning objects of protection to the appropriate risk categories. Methods. The boundaries of the intervals corresponding to certain risk categories are determined by dividing the logarithmic scale of severity of adverse effects of fires into equal segments. Classification methods are used to assign objects of protection to a specific risk category. Results and discussion. Based on the level of severity of potential negative consequences of a fire, risk categories were determined for groups of protection objects that are homogeneous by type of economic activity and by functional fire hazard classes. The risk category for each individual object of protection is proposed to be determined using the so-called index of "identification of a controlled person" within a group of objects that are homogeneous by type of economic activity and class of functional fire hazard. Depending on the risk category, the periodicity of planned control and supervision measures in relation to the specific object of protection under consideration is determined, taking into account its socio-economic characteristics and the state of compliance with fire safety requirements by the controlled person. Conclusions. To develop criteria for classifying protection objects that are homogeneous in terms of economic activity and functional fire hazard classes, the probability of negative consequences of fires, that are causing harm (damage) of various extent and severity to the life or health of citizens, and the acceptable risk of causing harm (damage) as a result of fires, is used. The risk category for each individual object of protection is determined taking into account socio-economic characteristics of the object that affect the level of ensuring its fire safety, as well as the criteriaof integrity of the subordinate person that characterize the probability of non-compliance with mandatory fire safety requirements at the object of protection. Calculations are made and numerical values of criteria for assigning protection objects that are homogeneous in terms of economic activity and functional fire hazard classes to a certain category of risk are proposed. Key words: object of protection, probability of fire, acceptable level of risk, risk category, dangerous factor of fire, death and injury of people.

Drug-Induced Intracranial Hypertension: A Systematic Review and Critical Assessment of Drug-Induced Causes.

Idiopathic intracranial hypertension (IIH) is a condition with increased intracranial pressure of unknown etiology. Its presenting symptoms include persistent headache, pulsatile tinnitus, and visual obscuration. It tends to occur in obese women of childbearing age, and its greatest risk is irreversible loss of vision. Some of the commonly used medications in dermatology, especially those for acne vulgaris, have been associated with IIH. However, the creation of specific risk categories for drugs as a guide for clinicians has never been performed. The aim of this study was to critically assess all published cases of IIH and identify high-risk drugs associated with drug-induced intracranial hypertension (DIIH), to assist dermatologists and other physicians with patient education and monitoring of symptoms of secondary intracranial hypertension. MEDLINE, EMBASE, and Cochrane Review Databases were searched for all cases of IIH thought to be drug-related between January 1900 and June 2019. A total of 5117 articles were identified, and 235 articles were found to be relevant. All cases were assessed to satisfy the modified Dandy criteria for diagnosis of IIH, and the likelihood of each case being a 'definite' adverse drug reaction (ADR) was determined using the Koh algorithm for ADR. An association category (from weakly associated [Category I] to strongly associated [Category V]) was assigned based on the number of cases meeting these two criteria. There were 259 verifiable cases of DIIH. Vitamin A derivatives, tetracycline-class antibiotics, recombinant growth hormone, and lithium were found to be most strongly associated with DIIH (Categories IV and V). Corticosteroids were moderately associated with DIIH (Category III). Drugs that were weakly associated with DIIH (Categories I and II) include cyclosporine, progestin-only contraceptives, combined oral contraceptives, second- and third-generation fluoroquinolones, sulfenazone, gonadotropin-releasing hormones and luteinizing hormone-releasing hormone agonist, nalidixic acid, amiodarone, stanozolol, danazol, divalproic acid, sulfasalazine, ketoconazole, and ustekinumab. We suggest using the term 'drug-induced intracranial hypertension' (DIIH) and propose a set of diagnostic criteria for DIIH. Our review attempts to identify DIIH-associated drugs based on a strict diagnostic and drug-causality algorithm, then stratify them into appropriate risks categories. This may ultimately assist physicians in counselling patients about the risk of DIIH when prescribing medications and recognizing this uncommon yet sight-threatening condition.

De Novo Myelodysplastic Syndromes in Patients 20-50 Years Old Characterized By Frequent Mutations in TP53 and Transcription-Related Genes

De Novo Myelodysplastic Syndromes in Patients 20-50 Years Old Characterized By Frequent Mutations in TP53 and Transcription-Related Genes

PDB68 ASSESSMENT OF RISK FOR DEVELOPMENT OF TYPE 2 DIABETES IN THE GREEK POPULATION

To assess the risk for type 2 diabetes development in the adult Greek population and the factors associated with blood sugar levels. A short self-completed questionnaire was developed, based on existing related research tools. The study was conducted in pharmacies all around the country in 2018, the distribution of which is representative of the total population. Participants were asked to anonymously answer close-end questions regarding age, sex, weight, height, waist circumference, physical activity, use of hypertension medication, diet, history of high blood sugar and diabetes family history. The diabetes risk score was calculated with the use of a formula and correspond to specific risk categories (low, slightly increased, moderately increased, high and very high). Also, an additional blood sugar measurement was performed on the participants of the study on the spot. In total, 13,634 questionnaires were completed in 701 pharmacies. Women represent a higher proportion of the sample (57.9%) compared to men (42.1%), while 70.5% of the total sample was older than 45 years. Overall, 40.6% of the sample was in moderately or higher risk of developing type 2 diabetes, with no significant differences observed between men and women. Furthermore, 12,013 blood sugar tests were performed. Mean blood sugar of the sample was estimated at 104.73 mg/dL, and higher in men, older people, those with higher and it was positively associated with diabetes risk score for both sexes. Both for men and women, blood sugar level was associated with age, BMI, waist circumference, physical activity, diet and family history of diabetes. The results of the study indicate that the Greek population faces a significant risk of developing type 2 diabetes. Since diabetes is a preventable disease, pharmacies could play an important role in timely identifying people in high diabetes risk and direct them to proper primary healthcare.

The Risk of Long-Term Financing of Public Investments

The risk of financing of public investments is a phenomenon that accompanies development processes in a permanent manner. Investments in the public sector are generally characterized by relatively long implementation cycles and involve significant capital expenditure and the necessity of often parallel running a large number of investment projects. In the processes of this type of investment a specific risk category of financing of this type of investment is quite often taken into account, given that such projects are financed mainly from budgetary resources: the state budget and self-government budgets. Economic practice indicates an importance of the proper selection of the method of the financing of new investments and taking into account new funds from various sources. This situation is often the result of a shortage of budgetary resources from which public investments could be financed. There may be difficulties in financing investments resulting from the emergence of a risk of budgetary deficit and the public debt. This risk may have a negative impact on investment decisions and may adversely affect the future course of ongoing investment projects. The purpose of the paper is to undertake studies on the conditions of financing investments from the point of view of the possibility of budget deficit and public debt and the impact of changes in the financial situation on the overall level of risk of public investment. The text is an invitation to undertake a broader discussion on financing public investments in conditions of limited public financial resources.