Specific Risk Groups Research Articles

Exosomal glypican-1 is elevated in pancreatic cancer precursors and can signal genetic predisposition in the absence of endoscopic ultrasound abnormalities.

BACKGROUNDIndividuals within specific risk groups for pancreatic ductal adenocarcinoma (PDAC) [mucinous cystic lesions (MCLs), hereditary risk (HR), and new-late onset diabetes mellitus (NLOD)] represent an opportunity for early cancer detection. Endoscopic ultrasound (EUS) is a premium image modality for PDAC screening and precursor lesion characterization. While no specific biomarker is currently clinically available for this purpose, glypican-1 (GPC1) is overexpressed in the circulating exosomes (crExos) of patients with PDAC compared with healthy subjects or those harboring benign pancreatic diseases.AIMTo evaluate the capacity of GPC1+ crExos to identify individuals at higher risk within these specific groups, all characterized by EUS. METHODSThis cross-sectional study with a prospective unicentric cohort included 88 subjects: 40 patients with MCL, 20 individuals with HR, and 20 patients with NLOD. A control group (CG) was submitted to EUS for other reasons than pancreatic pathology, with normal pancreas and absence of hereditary risk factors (n = 8). The inclusion period was between October 2016 and January 2019, and the study was approved by the Ethics Committee of Centro Hospitalar Universitário de São João, Porto, Portugal. All patients provided written informed consent. EUS and blood tests for quantification of GPC1+ crExos by flow cytometry and carbohydrate antigen 19-9 (CA 19-9) levels by ELISA were performed in all subjects. EUS-guided tissue acquisition was done whenever necessary. For statistical analysis, SPSS® 27.0 (IBM Corp., Armonk, NY, United States) version was used. All graphs were created using GraphPad Prism 7.00 (GraphPad Software, San Diego, CA, United States).RESULTSHalf of MCLs harbored worrisome features (WF) or high-risk stigmata (HRS). Pancreatic abnormalities were detected by EUS in 10.0% and 35.0% in HR and NLOD individuals, respectively, all considered non-malignant and “harmless.” Median levels of GPC1+ crExos were statistically different: MCL [99.4%, interquartile range (IQR): 94.9%-99.8%], HR (82.0%, IQR: 28.9%-98.2%), NLOD (12.6%, IQR: 5.2%-63.4%), and CG (16.2%, IQR: 6.6%-20.1%) (P < 0.0001). Median levels of CA 19-9 were within the normal range in all groups (standard clinical cut-off of 37 U/mL). Within HR, individuals with a positive history of cancer had higher median levels of GPC1+ crExos (97.9%; IQR: 61.7%-99.5%), compared to those without (59.7%; IQR: 26.3%-96.4%), despite no statistical significance (P = 0.21). Pancreatic cysts with WF/HRS were statistically associated with higher median levels of GPC1+ crExos (99.6%; IQR: 97.6%-99.8%) compared to those without (96.5%; IQR: 81.3%-99.5%) (P = 0.011), presenting an area under the receiver operating characteristic curve value of 0.723 (sensitivity 75.0% and specificity 67.7%, using a cut-off of 98.5%; P = 0.012).CONCLUSIONGPC1+ crExos may act as biomarker to support the diagnosis and stratification of PDAC precursor lesions, and in signaling individuals with genetic predisposition in the absence of EUS abnormalities.

The role of platelet microvesicles in the pathogenesis of preeclampsia

Among the diverse picture of preeclampsia, the hematological component, thrombocytopenia, attracts attention. Platelets are able to form microvesicles by budding the plasma membrane from the cell surface during apoptosis, stimulation, and also in a small amount in normal conditions. The membrane of these particles has a negative charge and contains phospholipids and an integral glycoprotein on the outer monolayer, due to which platelet microvesicles are involved in the process of blood coagulation and angiogenesis. Microvesicles are of platelet origin, they were first discovered in the middle of the last century in England when describing the phenomenon of plasma and serum coagulation in the absence of platelets in them. The number of platelet microvesicles dynamically changes during the formation of preeclampsia in pregnant women and in women with risk factors for the development of preeclampsia, which include obesity, arterial hypertension, diabetes mellitus, antiphospholipid syndrome. Exposure to these risk factors for preeclampsia before pregnancy leads to a change in the concentration of cells that produce microvesicles, which in turn can create conditions favorable for the development of preeclampsia during pregnancy. A special risk group are women with a history of preeclampsia. Taking into account the direct role of microvesicles in the processes of angiogenesis and blood coagulation, the study of these particles will allow a more detailed study of the pathophysiological aspects of the preeclampsia development, which will expand the possibilities for early prediction of this pathology and improvement of perinatal outcomes.

Recent research advances in identification and prevention of youth suicide risk.

The rate of youth suicidal behaviors has gradually increased over the last 15 years and continues to grow during the COVID-19 pandemic. This trend burdens mental health services and demands significant developments in risk detection and delivery of interventions to reduce the risk. In this article we outline significant advances and recent findings in youth suicide research that may facilitate strategies for identifying and preventing suicide risk among youth at risk in general and in specific risk groups. The rise in suicide and suicidal behaviors is most likely to affect young people of racial, ethnic, sexual, and gender identity minorities and those living in poverty or experiencing maltreatment. The suicide rate in children is rising and demands special attention. Proximal risk factors for suicidal behavior compared with suicidal ideation have been suggested to identify near-term suicidal risk. Effective and scalable prevention strategies were identified, and the role of new technologies in suicide prevention among youth is to be determined. To reach broader suicide prevention in youth and reduce the pressure on mental healthcare, public health approaches and improved service access for minority youth and those living in underserved areas of the world are needed.

Antisocial and Criminal Behaviors of Secondary School Students from the city of Chihuahua in Northern Mexico and Associated Risk Factors

Background: Since the school is a key setting during adolescence, it is crucial to detect deviant social behaviors of individuals in this environment to target corrective measures. Aim: To estimate the prevalence of antisocial and criminal behaviors of secondary school students in the city of Chihuahua, northern Mexico, and to explore associated factors. Methods: Cross-sectional survey with adolescents aged 13-16 years, randomly selected from public and private schools. The Mexican version of the validated antisocial and criminal behaviors questionnaire was applied to 430 students from 41 schools. Proportions and mean scores were computed. Results were stratified by individual and school characteristics. Logistic regression was used to identify factors associated with the probability of reporting at least one criminal behavior. Results: Eating when not allowed (67.5%) and arriving late to school (51.7%) were the most frequent antisocial behaviors, while spending money gambling (17.2%) and damaging objects or property in public spaces (15.5%) were the most frequent criminal behaviors. Men had a higher criminal mean score (1.35 vs. 0.89; p&lt;0.05), and 9th graders had higher mean than 7th and 8th graders for antisocial (7.05 vs. 5.39 and 4.97; p&lt;0.05) and criminal (1.44 vs. 0.98 and 0.94; p&lt;0.05) behaviors. Public schools had a lower antisocial mean than the private (5.52 vs. 6.61; p&lt;0.05). High-income private schools had the highest mean for antisocial behavior (7.44), followed by tele-secondaries (7.06); for criminal behavior, public technical (1.71) and tele-secondaries (2.31) had the highest means. The schools’ lowest academic performance was associated with lower means, especially for criminal behavior. Male sex, higher school grade, low school performance, having failed a year, reporting family problems, and performing specific free-time activities (e.g., hanging out with friends) were associated with a higher adjusted odds ratios of reporting at least one criminal behavior. Conclusion: The most frequent behaviors were quantified, and specific risk groups and factors were identified in order to design and implement preventive programs

The Multidisciplinary Guidelines for Diagnosis and Referral in Cerebral Visual Impairment.

IntroductionCerebral visual impairment (CVI) is an important cause of visual impairment in western countries. Perinatal hypoxic-ischemic damage is the most frequent cause of CVI but CVI can also be the result of a genetic disorder. The majority of children with CVI have cerebral palsy and/or developmental delay. Early diagnosis is crucial; however, there is a need for consensus on evidence based diagnostic tools and referral criteria. The aim of this study is to develop guidelines for diagnosis and referral in CVI according to the grade method.Patients and MethodsWe developed the guidelines according to the GRADE method 5 searches on CVI (children, developmental age ≤ 18 years) were performed in the databases Medline, Embase, and Psychinfo, each with a distinct topic.ResultsBased on evidence articles were selected on five topics: 1. Medical history and CVI-questionnaires 23 (out of 1,007). 2. Ophthalmological and orthoptic assessment 37 (out of 816). 3. Neuropsychological assessment 5 (out of 716). 4. Neuroradiological evaluation and magnetic resonance imaging (MRI) 9 (out of 723). 5. Genetic assessment 5 (out of 458).ConclusionIn medical history taking, prematurity low birth weight and APGAR (Appearance, Pulse, Grimace, Activity, Respiration) Scores (<5) are important. Different questionnaires are advised for children under the age of 3 years, older children and for specific risk groups (extremely preterm). In ophthalmological examination, eye movements, specially saccades, accommodation, crowding, contrast sensitivity and visual fields should be evaluated. OCT can show objective signs of trans-synaptic degeneration and abnormalities in fixation and saccades can be measured with eye tracking. Screening of visual perceptive functioning is recommended and can be directive for further assessment. MRI findings in CVI in Cerebral Palsy can be structured in five groups: Brain maldevelopment, white and gray matter lesions, postnatal lesions and a normal MRI. In children with CVI and periventricular leukomalacia, brain lesion severity correlates with visual function impairment. A differentiation can be made between cortical and subcortical damage and related visual function impairment. Additional assessments (neurological or genetic) can be necessary to complete the diagnosis of CVI and/or to reveal the etiology.

Lasers for benign prostatic hyperplasia (hybrid, blue diode, TFL, Moses). Which one to choose?

To present the evidence of latest developments of lasers for the surgical treatment of benign prostatic hyperplasia (BPH). We focused on recent advancements in Ho:YAG laser such as Moses technology, the Thulium Fiber Laser (TFL), the blue diode laser, and hybrid laser. Laser enucleation of prostate techniques using either Ho:YAG laser with the Moses technology and Moses 2.0, or TFL seem efficient and safe compared with the standard enucleation using Ho:YAG laser. Only in vitro studies evaluated the blue diode laser and hybrid laser (combination of a continuous wave TFL and blue diode laser). Blue diode laser showed intermediate incision depth and minimal coagulation depth compared with Ho:YAG laser and Super Pulse TFL. Hybrid laser showed deep incision depth and small coagulation area compared with Ho:YAG laser and continuous wave TFL. Surgical treatment of BPH using Moses technology, Moses 2.0, and TFL shows encouraging results comparable to the standard enucleation using Ho:YAG laser. Only in vitro data are currently available for blue diode laser and hybrid laser. Future well-designed studies comparing these technologies and evaluating them on specific risk groups of patients as well as the long-term durability of outcomes are needed.

Supporting Doctor's Decisions Based on Electronic Medical Documentation in Polish.

We describe new functionalities that have been added to an existing and widely used software solution in Polish public healthcare. The system automatically evaluates a number of medical scores. It provides epidemiologic monitoring concerning infectious diseases; classifies a particular patient to a specific risk group; and detects anomalies. Moreover, an analysis of a prescribed drug is performed.

Biomarker characterization in endometrial cancer in Italy: first survey data analysis.

SummaryObjectiveEndometrial carcinoma (EC) is the most common gynecological malignant disease in high income countries. The 2020 edition of the World Health Organization (WHO) Classification of Tumors of the Female Genital Tract underlines the important clinical implications of the new integrated histo-molecular classification system, in order to correctly define the specific prognostic risk group. This survey analysis will focus on the most commonly adopted immunohistochemical and molecular biomarkers used in daily clinical characterization of a diagnosed endometrial carcinoma in Italian labs.MethodsAn evaluation questionnaire was distributed to 41 Italian pathology laboratories. Normal habits in EC evaluation, especially regarding mismatch repair status (MMR) and microsatellite instability (MSI), were collected. A summary and a descriptive statistical analysis were used to show the current practice of each laboratory.ResultsThe analysis of MMR status by immunohistochemistry (IHC) is carried out on the majority of all EC samples. The most frequent strategy for the analysis of MMR status in EC is IHC of four proteins (PMS2, MSH6, MSH2, MLH1). MSI analysis by molecular method in endometrial cancer is rarer and more restricted to some circumstances. Hypermethylation of the MLH1 promoter by methylation-specific PCR and pyrosequencing was analyzed in case of negative expression of MLH1/PMS2. Also, the analysis of p53 in EC is performed in the majority of cases. POLE mutational profiling is adopted only in a limited number of laboratories. Fifty-five percent of Italian laboratories refer to national/international guidelines when analyzing biomarkers in EC (among those, 45% use the ESGO Guidelines, 18% ASCO-CAP, 18% AIOM, 14% WHO, 5% British Association of Gynaecological Pathologist, 5% ESMO, 5% NCCN).ConclusionsAdoption of guidelines and standardization of pre-analytical and analytical procedures are effective tools for adequate EC prognostic risk stratification and high quality standard of care.

Health care professionals' perspectives on shared decision making supported by personalised‐risk‐for‐recurrences‐calculations regarding surveillance after breast cancer

ObjectiveBreast cancer patients for whom less intensive surveillance is sufficient can be identified based on the risk for locoregional recurrences (LRRs). This study explores health care professionals' (HCPs) perspectives on less intensive surveillance, preferences for shared decision‐making (SDM) about surveillance and perspectives on the use of patients' estimated personal risk for LRRs in decision‐making about surveillance.MethodsWe conducted semi‐structured interviews with 21 HCPs providing follow‐up care for breast cancer patients in seven Dutch teaching hospitals (Santeon hospitals).ResultsHCPs were predominantly positive about less intensive surveillance for women with a low risk for recurrences. They mentioned important prerequisites such as clearly defined surveillance schedules based on risk categories, information provision and communication support for patients and HCPs. Most HCPs supported SDM about surveillance and were positive about using patients' estimated personal risk for LRRs. HCPs specified prerequisites such as clear visualisation and explanation of risk information, attention for fear of cancer recurrence (FCR) and defined surveillance schedules for specific risk groups.ConclusionMentioned prerequisites for less intensive surveillance need to be accounted for. Information needs and existing misconceptions need to be addressed. Outcome information regarding risks for LRRs and FCR can enrich the SDM process about surveillance.

Immunological Potency, Efficacy, and Tolerance of “Gam-COVID-Vac” Vaccine among Students: Prospective Study

Background. Students, as the most active and mobile part of population, often unite into educational and informal groups, move to other regions or countries, and present a specific risk group for the spread of new coronavirus infection. Thus, they require preventive vaccination. objective. The aim of the study is to study the immunological potency, tolerance, and efficacy of Gam-COVID-Vac vaccine among students of Krasnodar. Methods. 119 seronegative students (18-30 years old) were examined. SARS-CoV-2 IgG (ELISA method) was determined 1, 3, and 6 months after two completed rounds of vaccination. Post-vaccination adverse events and COVID-19 cases were evaluated in the study. Results. SARS-CoV-2 IgG level 1 month after vaccination ranged from 6.15 to 19.38 and was to 16.39 (AU/mL) ± 1,12. Immunological potency values ranged from 4.407 to 21.5 (AU/mL) (14.74 ± 2.93) 3 months after. IgG titers were in the range of 4.14 to 17.71 (AU/mL) (10.97 ± 4.69) 6 months after. Adverse events after vaccination were revealed in 34 respondents (28.6%). Among them, local (hyperemia, pain, edema) — 21 (17.6%): slight — 90.4%, major — 9.6%; general (fever, weakness, algor, headache, arthralgia, myalgia) — 13 (10.9%): slight — 69.2%, major — 30.8%. The increase in vaccination coverage in students from 30.3 to 79.1% reduced the COVID-19 morbidity from 3.81 to 1.57%. Conclusion. Gam-COVID-Vac vaccine induced stable humoral response, demonstrated sufficient safety, and reduced morbidity 2.4-fold.

Cribado e intervención breve en consumo de alcohol

Morbidity associated with alcohol consumption includes digestive, psychiatric, neurological, infectious disease, cancers of various types, cardiovascular disease, intentional injuries, unintentional injuries, social pathology, and family problems. The most recent evidence does not indicate that “moderate” consumption is beneficial to health. The most recent evidence indicates that “moderate” consumption is not beneficial to health. Therefore, the emphasis should be placed on avoiding risky drinking and advising patients that it would be in their best health interest to avoid alcohol or to drink alcohol at low-risk doses. The AUDIT-C is the most appropriate screening instrument. Cognitive-behavioural and motivational strategies form the basis of brief intervention. Positive information about the benefits of moderation and information about the dangers of alcohol intake should be given. In early stages of dependence, pharmacological treatment for detoxification, withdrawal and follow-up is considered. More serious cases require coordination with addiction services. In Spain, BI has proven effective and to reduce alcohol consumption by 100g/week. Community strategies are the appropriate policy framework to achieve the best results from brief intervention. They should aim to reduce the supply and availability for consumption by adopting legislative measures to limit both economic and physical accessibility. Furthermore, measures should be implemented to reduce the demand for alcohol through health education for specific risk groups.

Vertical program of screenings and check-ups in the Russian Federation: design, implementation and lessons learnt

BackgroundThe Russian Federation has introduced a vertical large-scale program of ‘dispensarization’ (Program) that includes health check-ups and screenings for the entire adult population. It is expected to improve the results of medical interventions and ensure health gains at a relatively low cost. The major research question: Does the design and implementation of the program meet the expectations?MethodsWe analyze regulatory acts and the literature on the design and the outcomes of the Program. Physicians’ surveys and interviews are conducted to understand the capacity of primary care providers to meet the requirements of the Program, as well as the link between the early identification of new illnesses and their follow-up management, administration of the program, the barriers to its successful implementation.ResultsThere is a substantial progress in the coverage of the population and increase in the number of identified illnesses. Some specific instruments of the Program implementation work well, others require more careful design and additional integrative and managerial activities. The capacity of primary care providers does not allow to provide high quality preventive services, as well as to ensure a continuum of preventive and curative work. The pattern of the Program administration facilitates its nation-wide implementation according to the unified rules, but makes it more difficult to account for the local conditions and limits the autonomy of professionals to choose specific population risk groups and a list of services. The interaction of providers in preventive activities is inadequate.ConclusionThe expectations of the Program are too high due to the inconsistencies in its design and implementation. The major lesson learnt is that the program like this should meet the capacity of primary care and be designed as a complex of interrelated activities to identify illnesses and provide their follow-up management.

Are older adults with hip fractures a specific risk group for vitamin B12 deficiency?

AbstractBackgroundHip fractures (HF) are a high‐impact geriatric syndrome. Vitamin B12 deficiency is an HF risk factor. There are few studies on prevalence of B12 deficiency in older adults with HF. The objectives are as follows: in older adults with HF, to describe/characterize plasma levels of vitamin B12 (PL‐B12); to verify presence/absence of a subgroup with borderline, near‐deficient PLB12; to describe HF incidence; and to analyse relationships between PL‐B12 and studied variables.MethodsCross‐sectional, observational study, analytical component. Complete Collection sample (01.08.2016–31.08.2018). Variables: PL‐B12, age, sex, HF location, time of year, in‐hospital stay length. Medians/percentiles, non‐parametric tests. PL‐B12 cut‐off points according to the WHO, proposing new cut‐off points to capture borderline values.ResultsA total of 580 subjects. HF incidence = 264/100 000 ≥ 65 years, 79% female, 72% extracapsular HF. Medians: age = 83 years; PL‐B12 = 349 pg/cc; hospitalization = 13 days. Significantly lower PL‐B12 in males (P = 0.023) and extracapsular fractures (P = 0.013). No significant differences between age groups, length of hospitalization, and season of the year. Thirty‐five per cent B12 deficiency (16% deficiency and 19% mild deficiency). By increasing cut‐off point for deficiency to 400 pg/cc, prevalence increased to 58%.ConclusionsHigh prevalence of vitamin B12 deficiency among older adults with HF, significantly higher in men and extracapsular HF. Twenty‐four per cent normal PL‐B12 according to WHO criteria, but with borderline, near‐deficient levels, at the time of HF. In older adults with HF, we recommend measuring PL‐B12 and raising the cut‐off level required to diagnose deficiency. We consider that older adults with HF are a specific risk group for vitamin B12 deficiency.

ANALYSIS OF THE GINGIVAL RECESSION PREVALENCE AMONG DENTAL PATIENTS CONSIDERING ASSOCIATED AGE-RELATED, IATROGENIC AND PATHOLOGICAL CHANGES OF DENTAL STATUS

Assessment of gingival recessions prevalence and explicitation of their distribution among studied samples of dental patients considering criteria of age, sex, severity of gingival apical migration and the facts of associated dental status changes can potentially help to identify specific risk groups. Implementation of preventive measure among such risk groups could potentially optimize the prognosis of future conservative or surgical treatment of gingival recessions.&#x0D; The objective of present study was to evaluate the prevalence of gingival recessions among dental patients, while also considering the associated age-related, iatrogenic and pathological changes of dental status. In order to assess the prevalence of gingival recessions among dental patients a study sample was formed out of the patients of the private dental clinic "Dentistry 3D Plus" (Cherkasy).&#x0D; Formation of study sample was provided by the method of block randomization according to the different age subgroups (18-19 years, 20-29 years, 3039 years, 40-49 years and 50-59 years). Each subgroup was set with 100 dental patients of the appropriate age. The diagnosis of recession was established due to the specific diagnostic criterion of marginal gingiva apical migration with exposure of the tooth root surface. The recession classification was performed according to the approach proposed by P.D. Miller’s. The depth of the recession was determined using a periodontal probe of CP 15 North Carolina design. Recessions were identified in 52 persons (52,0%) among 100 patients aged 18-19 years, in 68 persons (68,0%) among patients aged 20-29 years, in 95 persons (95,0%) among patients aged 30-39 years, in 96 persons (96,0%) among patients aged 40-49 years, and in 96 persons (96,0%) among patients aged 50-59 years. In general, the average prevalence of Miller’s class I recessions among all pathologies diagnosed within different age subgroups was 61,45±16,82%, prevalence of Miller’s class II recession reached 10,74±3,56%, prevalence of Miller’s class III recession was 21,71±10.80%, and prevalence of Miller’s class IV recession was 6,10±2.97%. Thus, Miller's class I and III recessions were the most prevalent, and the frequency of their diagnostics was statistically higher than class II (p &lt; 0,05) and class IV recessions (p &lt; 0,05). The average depth of recessions that met the diagnostic criteria for class I according to Miller was 2,31±1.35 mm, for Miller’s class II – 4,27±2,40 mm, for Miller’s class III – 6.31 ± 2.86 mm, for Miller’s class IV – 7,53±2,29 mm. Among all diagnosed recessions cases that were observed among patients of different age subgroups, 13,71±6,72% were associated with periodontitis pathology, 5,04±2,98% with overcrowding, 7,80±3,84% with signs of pathological attrition, 9,06±2,13% with non-carious cervical dental lesions, 7,85±1,60% with carious lesions of enamel and dentin, 7,97±1,83% with parafunctional activity and/or traumatic occlusion pattern, 7,85±4,26% with the fact of orthodontic intervention, 9,75±2,44% with existing problematic restorations, 8,16±1.62% with anomalies of teeth position, 7,72±0,74% with inadequate oral hygiene condition, 5,25±0,90% with bad habits that were identified during anamnesis collection, 5,28±2,60% with anomalies of mucous bundles attachment, while in 4,55±4,18% of the cases diagnosed recessions were not clinically associated with functional or structural dental status disorders.&#x0D; The results of study demonstrated a progressive increase in the number of recessions associated with periodontal disease (p &lt; 0,05), pathological attrition (p &lt; 0,05), non-carious dental lesions (p &lt;0.05) and problematic restorations (p &lt; 0,05 ) related to the parallel increase of patients’ average age, which according to the provided regression analysis was statistically significant during the comparison of such studied parameters among different age subgroups. Patients aged 30 years and older, male, and those with clinical signs of periodontitis, pathological attrition, non-carious and carious cervical lesions, poor oral hygiene, overcrowding of teeth, abnormalities of teeth position and abnormal attachment of mucous membranes could be categorized as those having potential risk for further recession development. Therefore, such patients require provision of timely comprehensive dental treatment to maintain the level of soft tissue coverage in the area of their own teeth and to correct changes in dental status associated with gingival recession development. Considering established relationship between the frequency of recession diagnostics among patients of different age subgroups and associated age-related, iatrogenic and pathological changes of dental status, it is advisable to determine how the latter may affect the prognosis of surgical treatment of gingival recessions with the use of flap displacement techniques and different soft tissue transplants for restoring soft tissue coverage of exposed root surfaces.

The risk of cardiac and cerebrovascular complications in patients with concomitant cardiovascular diseases who have had COVID-19

During the pandemic caused by the SARS-CoV-2 virus, patients with cardiovascular diseases (CVD), which are often found in the population, are a special risk group. Cardiovascular complications after COVID-19 can occur at diff erent periods of the disease. This research describes cardiovascular complications in patients after recovery.The aim of the study was to identify the incidence of new CVD and complications of existing cardiac pathology in patients who recovered from COVID-19.Material and methods. A retrospective, observational study including 370 patients was conducted. All patients underwent telephone consultations within 6 months after the infectious diseases hospital discharge. When new CVDs, complications or anabasis were identifi ed, follow-up visits were initiated.Results. Among 370 patients under the study, concomitant CVD was registered in 249 (67.29%) people, 121 (32.71%) patients had no case history of cardiovascular pathology. In patients with concomitant CVD during the fi rst 6 months after the infectious diseases hospital discharge, 25 (10.04%) new cardiovascular events were registered, which is signifi cantly more frequent than in patients without case history of CVD (n = 1; 0.83%). The number of events described above was more often observed in the fi rst 3 months after discharge, which is statistically signifi cant (p ˂ 0.05). BP destabilization was most often observed (n = 67; 27.2%) as anabasis, which may be associated with an increased level of anxiety in patients. It was also noted that new CVDs, as well as anabasis, developed because of the timely specialized cardiological medical care absence, which probably led to undesirable events due to inability to correct CVD risk factors in time.Conclusions. In patients with concomitant CVD, who have had COVID-19, in contrast to patients without case history of CVD, the risk of developing new cardiovascular events is signifi cantly higher. Patients with CVD deserve the closest attention during the fi rst 3 months after discharge from the infectious diseases hospital.

The importance of the nasopharyngeal mucosa protection for prevention of acute respiratory viral infections and influenza in children

ARVI is the most common children infection: children aged 0–5 years suffer, on average, 6–8 episodes of ARVI per year; and in the 1–2 years of visiting kindergarten the incidence rate is higher for 10–15% than in unorganized children, and at school the latter get sick more often. The incidence of ARVI is the highest in the period from September to April and it amounts about 87–91 thousand per 100 thousand in the population. The respiratory infectious disease protection of the organism is carried out in several stages and at various levels. It primarily depends on a mechanical barrier that prevents entering the virus agent into the organism – the mucous membrane of the nasal cavity, paranasal sinuses and nasopharynx. It can be achieved due to the peculiarities of its structure – respiratory epithelium, mucociliary transport, mucus properties and lymphoid organs associated with mucous membranes. If the pathogen nevertheless penetrates this barrier, then innate immunity starts protection activity, and after that the acquired immunity activates. Antiviral protection has differences due to the structure of the virus, it’s extremely small size, and the impossibility of reproduction outside the cells. The formed immune response persists even after elimination of the pathogen in the form of immune memory, which allows a faster and stronger reaction when the pathogen reappears. Children with primary immunodeficiency, genetic, oncological, hematological diseases, bronchial asthma, chronic ENT pathology are a special risk group in terms of the frequency and severity of ARVI and influenza. In this connection, the prevention of the incidence of ARVI and influenza is extremely important.

Mental health of the adult population in Germany during the COVID-19 pandemic. Rapid Review.

This rapid review examines how the mental health of adults in the general population in Germany changed during the COVID-19 pandemic. We conducted a systematic literature search and included 68 publications as of July 30 2021. The underlying studies were classified according to their suitability for representative statements for the general population and for estimating changes in mental health over time. In addition, the observation period and operationalisation of outcomes were considered.The first wave of infection and the summer plateau were mapped by 65% of the studies. Studies that were particularly suitable for representative statements due to their research design showed mixed results, which tend to indicate a largely resilient adult population with a proportion of vulnerable individuals. A predominantly negative development of mental health was described by results from more bias-prone study designs. Routine data analyses showed decreases in outpatient and especially inpatient care, increased use of a crisis service, mixed results for outpatient diagnoses, incapacity to work and mortality as well as indications of shifts in the spectrum of diagnoses. As the current evidence is ambiguous, generalised statements should be reflected in favour of a differentiated view. There is a need for research on the further course of the pandemic, specific risk groups and the prevalence of mental disorders.

Use of idarucizumab for emergency surgery in patients taking dabigatran

This article presents modern possibilities for the provision of emergency surgical care to patients with atrial fibrillation, who administered dabigatran etexilate. We describe two clinical situations, in which idarucizumab, a specific dabigatran antagonist, which is a monoclonal antibody fragment that binds dabigatran, was used to neutralize the anticoagulant effect of dabigatran etexilate before emergency surgery. In the first case, the patient developed acute gangrenous calculous cholecystitis, in the second a patient required an urgent epicystostomy. In both cases, the successful outcome of surgical interventions was due to the effective interactions of the team of specialists and adherence to the algorithm for providing emergency care to such patients, as well as the presence of idarucizumab in hospitals. The postoperative management of patients and the timely resumption of anticoagulant therapy to prevent thromboembolic complications is no less important. The presented clinical cases confirm the feasibility of using idarucizumab to provide emergency surgical care to patients on dabigatran etexilate, as well as the need to take into account the possible risk of emergency interventions when anticoagulant therapy is prescribed to patients with atrial fibrillation. This paper discusses special risk groups of patients in whom rapid reversal of anticoagulation is required due to altered hemostasis.We outline data of a prospective cohort study (RE-VERSE AD), which examined the efficacy and safety of idarucizumab in patients with uncontrolled bleeding and in patients requiring urgent surgery. We also present the RE-VECTO study data on the use of idarucizumab in real-life clinical practice.

Immunisation status of children and adolescents with a new diagnosis of inflammatory bowel disease

BackgroundPatients with Inflammatory Bowel Disease (IBD) are at increased risk of serious infections, including vaccine preventable diseases. Current evidence suggests uptake of additional recommended special risk vaccinations is low. Identification of IBD patients prior to commencing immunosuppressive therapy allows for optimisation of vaccination, including timely administration of live-attenuated and additional recommended vaccines, such as influenza and pneumococcal vaccines.MethodsPaediatric patients (0–18 years) seen at the tertiary Royal Children’s Hospital, Melbourne, Australia, with a recent diagnosis of IBD were referred by the Gastroenterology Unit to our Specialist Immunisation Clinic (SIC) for assessment and provision of routine and special risk vaccines. Data was collected via a standardised REDCap questionnaire completed in or post attendance at the SIC and included serology results where available.ResultsSixty-nine paediatric patients were recruited to the study between 2014 and 2017. Median age at IBD diagnosis was 11.25 years (IQR 4.64 years), with median time between diagnosis and SIC review of 0.88 years (IQR 2.84 years). At initial review 84.1% (58/69) of patients were up to date with vaccines on the Australian National Immunisation Program (NIP) schedule. Of those who were tested, serological evidence of immunity was demonstrated in 38.3% (23/60) of patients for Hepatitis B, 66.7% (36/54) for measles, 51.9% (28/54) for rubella and 41.9% (26/62) for Varicella Zoster Virus. Prior to SIC review 47.8% (33/69) had additional vaccinations and 92.8% (64/69) had vaccinations administered in the 12 months following SIC assessment. The Pneumococcal conjugate vaccine (76.8%, 53/69) was the most commonly administered vaccine after SIC review, followed by influenza vaccine (69.6%, 48/69). Within 12 months of SIC review 43.5% (30/69) of patients had completed the schedule and were up-to-date as recommended by the SIC.ConclusionsChildren with IBD and other special risk groups can benefit from early referral to a SIC team to ensure optimal administration of routine and additionally recommended vaccines, especially live and additional special risk vaccines. The value of optimising immunisations could also be applied to other special risk groups, including adult IBD cohorts, particularly those commencing newer biologic immunosuppressive medications.

The impact of clinical risk conditions on influenza and pneumonia diagnoses in England: a nationally representative retrospective cohort study, 2010-2019.

The impact of influenza and pneumonia on individuals in clinical risk groups in England has not previously been well characterized. Using nationally representative linked databases (Clinical Practice Research Database (CPRD), Hospital Episode Statistics (HES) and Office for National Statistics (ONS)), we conducted a retrospective cohort study among adults (≥ 18 years) during the 2010/2011-2019/2020 influenza seasons to estimate the incidence of influenza- and pneumonia-diagnosed medical events (general practitioner (GP) diagnoses, hospitalisations and deaths), stratified by age and risk conditions. The study population included a seasonal average of 7.2 million individuals; approximately 32% had ≥1 risk condition, 42% of whom received seasonal influenza vaccines. Medical event incidence rates increased with age, with ~1% of adults aged ≥75 years hospitalized for influenza/pneumonia annually. Among individuals with vs. without risk conditions, GP diagnoses occurred 2-5-fold more frequently and hospitalisations were 7-10-fold more common. Among those with obesity, respiratory, kidney or cardiovascular disorders, hospitalisation were 5-40-fold more common than in individuals with no risk conditions. Though these findings likely underestimate the full burden of influenza, they emphasize the concentration of disease burden in specific age and risk groups and support existing recommendations for influenza vaccination.