Stage C3 Research Articles

P-561. Long-Acting Cabotegravir and Rilpivirine in HIV Individuals Over 60 years: a Real-World Study (RELATIVITY Cohort)

Abstract Background The switching strategy to long-acting cabotegravir and rilpivirine (CAB+RPV) has emerged as a standard approach for people living with HIV (PLWH), offering high efficacy, safety, and convenience rates. Nevertheless, there is a scarcity of data regarding older PLWH, an important and growing population with physiological differences and arising comorbidities. Methods We conducted a multicenter, non-controlled, retrospective study on HIV virologically suppressed individuals who switched to long-acting CAB+RPV. We evaluated demographic and clinical factors associated with this switch in individuals over 60 years of age. Results The study included 154 individuals from 27 hospitals in Spain, representing 12.8% of the Relativity cohort, which comprised 1204 individuals. The median age was 63 years (range: 61 to 68), with 77.9% being men. 89.5% were Spaniards, followed by South Americans (6.5%). HIV transmission ocurred via HSH in 42.6% of cases and heterosexual in 27.7%. Comorbidities were present in 70.1% of individuals, with 17.5% having three and 3.9% having four. The most prevalent comorbidities were dyslipidemia (45.5%), high blood pressure (32.5%), and osteoporosis (19.5%). The HIV infection median time was 22 years (range: 13 to 31), the antiretroviral therapy median time was 18 years (range: 11 to 24), and the median time of viral suppression was 12 years (range: 8 to 17). 24.5% were in CDC stage C3. The nadir CD4+ cell count was 240 (range: 111 to 374) cells/mm³, and 5.8% had previous virological failure with resistance mutations in 100% (NRTI, PIs or both). ART before switching included DTG/3TC (31.8%), DTG/RPV (28.6%), BIC/FTC/TAF (16.2%), DRV/c/FTC/TAF (5.2%), and EFV/FTC/TDF (1.9%). The main reasons for switching were patient request (43.5%), improvement in quality of life (35.7%), and simplification (23.4%). The efficacy rate at week 28 was 100%, with no discontinuations. Conclusion In a real-life setting, switching to long-acting CAB+RPV proves to be a viable option for individuals over 60 years old, with long-standing HIV infection and a high burden of baseline comorbidities, demonstrating sustained virological control over the initial 28 weeks of this treatment. Therefore, it should also be offered to older patients, even if they have multiple treated comorbidities. Disclosures All Authors: No reported disclosures

Cytomegalovirus retinitis in a patient with human immunodeficiency virus: A clinical case study

Aims/Purpose: To present a clinical case of cytomegalovirus (CMV) retinitis in a patient with newly diagnosed HIV, highlighting the characteristic retinal appearance and treatment outcomes.Methods: A 52‐year‐old male with no significant medical history presented with weight loss and persistent diarrhea. Initial evaluation revealed HIV infection at AIDS stage C3, with a high viral load (2,330,000 copies/mL) and severe immunosuppression (CD4 count = 10 cells/μL). Additional findings included pancolitis, atypical pulmonary infiltrates, and pancytopenia. Ophthalmologic examination was conducted due to reported visual disturbances.Results: Ophthalmologic assessment revealed a visual acuity of 1.0 in both eyes and intraocular pressure of 10 mmHg. Fundoscopy and ultra‐wide field retinography identified lesions resembling a "cheese and tomato pizza" in the right eye, characterized by granular white‐yellow and white‐gray paravascular infiltrates, retinal opacification, and associated hemorrhages. Optical coherence tomography (OCT) showed foveal integrity but significant vitreous cellularity in the right eye and optic nerve edema.The patient was treated with Valganciclovir 900 mg every 12 hours for CMV, alongside a combination antiretroviral therapy (ART) regimen of Bictegravir, Emtricitabine, and Tenofovir, plus Atovaquone due to cotrimoxazole intolerance. Follow‐up examinations indicated a gradual improvement in retinal lesions, with the right eye showing residual peripheral nasal lesions and the left eye remaining clear.Conclusions: This case underscores the importance of early diagnosis and prompt initiation of antiviral and antiretroviral therapies in managing advanced opportunistic infections in HIV/AIDS patients. The "cheese and tomato pizza" analogy aids in the visual identification of CMV retinitis. Continuous monitoring and timely intervention are crucial for preserving vision and improving patient outcomes.References Basic and Clinical Science Course, Retina. American Academy of Ophthalmology. 2021 Diaz Llopis M. AIDS in Ophthalmology. Lecture 1996 Spanish Society of Ophthalmology (SEO)

Imaging characteristics of lower limb venous insufficiency on doppler ultrasonic

Introduction: Chronic lower limb venous insufficiency is becoming common worldwide. The location and distribution of venous insufficiency correlates with clinical features and contributes to determining treatment strategy. Methods: Descriptive cross-sectional study, performed at Dong Nai General Hospital from May 2023 to May 2024. The research subjects were cases of venous insufficiency diagnosed with Doppler ultrasound. The reflux patterns of great saphenous vein insufficiency are classified into 4 types as follows: type 1, reflux in both the ankle and saphenofemoral junction; type 2, ankle reflux, preserved saphenofemoral junction; type 3, reflux at the saphenofemoral junction, preserved ankle area; type 4, total great saphenous vein reflux Results: There were 130 patients participating in the study. Average age is 59 ± 11 years, female/male ratio = 2.2. The rate of great saphenous, lesser saphenous, and deep vein insufficiency is 91.0, 15.8 and 15.0%, respectively. The majority of patients are in stage C2 with 37.6%. The most common locations for great saphenous vein reflux are mid-thigh, above the knee and below the knee (>70%). 96.7% of cases have reflux in the middle of the thigh and/or below the knee. The rates of reflux types 1, 2, 3, and 4 of the great saphenous vein are 34.2; 24.3; 23.7 and 17.8%. CEAP 4 has the highest incidence in types 3 and 4 and the lowest in type 1. VCSS scores in types 1 and 2 are significantly smaller than those in types 3 and 4. Conclusion: Great saphenous vein insufficiency is most common in patients with venous insufficiency. Terminal valve regurgitation (types 3 and 4) is associated with clinical severity. Checking for reflux at the mid-thigh and below-the-knee locations may increase the likelihood of detecting great saphenous vein insufficiency.

Conditional survival and the prognostic value of serum carcinoembryonic antigen level in oldest old with colorectal cancer

BackgroundTo evaluate the clinical value of serum CEA levels and their implications on the diagnostic value of the conventional TNM staging system in the oldest-old patients with colorectal cancer (CRC).MethodsThe recruited subjects were colorectal cancer patients aged 85 and older. The cutoff value for normal CEA level is 5 ng/mL. Patients with elevated CEA levels were categorized as stage C1, and those with normal CEA levels as stage C0. A number of Cox proportional hazard regression models were established to evaluate the prognosis of different prognostic factors with hazard ratios (HRs) and 95% confidence intervals (CIs). The Kaplan–Meier method was utilized to display the disparate prognostic impact of multiple clinicopathological factors with the log-rank test.ResultsA total of 17,359 oldest-old patients diagnosed with CRC were recruited from the SEER database. The conditional survival of oldest-old patients with CRC was dismal with a 1-year conditional survival of only 11%, 18%, and 30% for patients surviving 1, 3, and 5 years, respectively. Patients with stage C1 exhibited a 48.5% increased risk of CRC-specific mortality compared with stage C0 (HR = 1.485, 95%CI = 1.393–1.583, using stage C0 patients as the reference, P < 0.001). All the stage C0 patients indicated lower HRs relative to the corresponding stage C1 patients.ConclusionsDismal conditional survival of oldest-old patients with CRC should be given additional consideration. C stage influences the prognosis of oldest-old patients with CRC.

Prevalence of chronic kidney disease in patients with type 2 diabetes admitted to multidisciplinary hospitals: results of a prospective observational multicenter study (CREDO)

AIM: To assess the prevalence of chronic kidney disease (CKD), clinical and demographic characteristics and therapy profile in patients with type 2 diabetes admitted to multidisciplinary hospitals. CREDO (Cardio-REnal Diabetic cOmplications) trial was initiated for this purpose.MATERIALS AND METHODS: in a prospective observational multicenter study for the period from August 2022 to April 2023, data from 445 patients with type 2 diabetes hospitalized in multidisciplinary hospitals of the Moscow Department of Health were analyzed. The data was collected on a single visit. The design of the study did not involve any interventions in routine clinical practice, including the choice of a diagnostic or treatment method.RESULTS. The study included 445 patients with the main inclusion criteria — type 2 diabetes, age over 50 years, duration of diabetes more than 3 years. The prevalence of CKD was 90%, while in 43% the diagnosis of CKD was confirmed, in 43% it was detected for the first time, and in 7% the disease progressed. Patients with stage C2 and C3 (a and b), as well as with levels of A1 and A2 albuminuria, were most often identified. The percentage of patients in whom the albuminuria was not performed remained high — 46.2%. The highest incidence of CKD was observed in patients with inadequate glycemic control, having an HbA1c level of ≥9%. In the group with newly diagnosed CKD, sodium-glucose co-transporter-2 inhibitor (iSGLT-2) was received by 31.1% of patients, glucagon-like peptide-1 receptor agonists (GLP-1 RA) — 7.9% of patients. In the group with confirmed CKD — 30.7% and 9.4%, respectively.CONCLUSION: it has been shown that patients over the age of 50 with type 2 diabetes with a disease duration of more than 3 years are at a high risk of developing CKD — 90%. The results obtained convincingly confirm the possibility of detecting CKD and initiating nephroprotective therapy at the hospital stage.

#1530 Studying parenteral nutrition in patients with dialysis stage chronic kidney disease

Abstract Background and Aims Hemodialysis is associated with high rates of morbidity and mortality, as well as poor quality of life. Changes in nutritional status and loss of protein and energy are important indicators of these risks. Maintaining optimal nutritional status in hemodialysis patients is an important but sometimes overlooked aspect of treatment. In some cases, intradialytic parenteral nutrition is possible, but lack of knowledge about the practical aspects of administration is rarely discussed. The purpose of our study was to study the age-related characteristics of the nutritional status in patients with CKD of the dialysis stages who are on parenteral nutrition. Method The study included 40 patients with stage C5 CKD. Glomerular filtration rate (eGFR) was estimated using the CKD-EPI formula (2011) [11]. Anthropometric data were studied: height, weight, body mass index (BMI), mid-thigh circumference and mid-upper arm circumference, as well as laboratory data: urea, creatinine, electrolytes, albumin, total protein, hemoglobin. All patients underwent instrumental research methods: ECG, EchoCG. The patients were divided into 2 groups – with and without PEM. Statistical data processing was carried out according to standard methods using a computer program package. Results Total body water (TBW) (P = 0.026) and triceps skinfold thickness (P &amp;lt; 0.05) were higher in the hemodialysis group. BMI and other anthropometric parameters showed no significant differences between the two groups. Total caloric intake (P &amp;lt; 0.05) and total cholesterol (P &amp;lt; 0.05) were higher in patients with PEM. Intake of other nutrients, including proteins, lipids, microelements and vitamins, did not show significant differences between the two groups. Only 24% of patients were malnourished. Triglyceride levels were higher in non-malnourished patients, but HDL levels were higher in malnourished patients. Some anthropometric indicators were significantly higher in patients not suffering from PEM. It is worth noting that malnourished patients consumed more calories and nutrients, including proteins, plant lipids, animal lipids and carbohydrates. Conclusion Compared with malnutrition patients and non-malnutrition patients, several anthropometric parameters, including subiliac skinfold thickness and MAC, were significantly lower in the malnutrition group. These values can be measured using simple methods and are used as a useful method for assessing malnutrition. Interestingly, patients with malnutrition and lower BMI albumin actually consumed more calories and nutrients from food. This means that malnutrition in dialysis patients is not simply caused by low food intake.

Histoplasmosis in patients living with HIV in Europe: review of literature.

Histoplasma capsulatum (var. capsulatum Hcc and duboisii Hcd), is a dimorphic fungus that causes histoplasmosis. It usually affects people coming from endemic areas, causing a variety of clinical manifestations up to progressive disseminated histoplasmosis (PDH), especially among people living with HIV (PLWH). We conducted a systematic review to assess histoplasmosis burden of PLWH in Europe. The review follows PRISMA guidelines, with protocol registered in PROSPERO (CRD42023429779). Seventy-eight articles were selected, including 109 patients (32 women). On overall, median age was 37 years. Forty-six patients were Americans, 39 Africans, 17 Europeans, 5 Asians, in 2 cases nationality was not specified. Cases were mainly diagnosed in Italy (28.4%), France (17.3%) and Spain (17.4%), with a north-south gradient. Six cases lacked epidemiologic links with endemic areas. Concerning CDC HIV staging at diagnosis, the information was available for 60 PLWH (55%) and all subjects were at stage C3 except for two subjects at stage B3. PDH was the AIDS-presenting illness in 39 patients. Most patients had a PDH (80.7%); other common extrapulmonary forms were isolated cutaneous histoplasmosis (7.3%), or lymphatic localization (2.7%). In 30 cases, the diagnosis was made by analyzing only one sample. For the remaining 79 cases, multiple samples were collected from each patient. Regarding the biological sample more frequently used for the diagnosis of histoplasmosis, bronchoalveolar lavage sample was taken from 39 patients, and tested positive in 51.3% of cases; 36 patients underwent a skin biopsy which was positive in 86.1% of cases and 28 patients performed bone-marrow biopsy, which led to the diagnosis of histoplasmosis in 92.9% of cases. The identification of Histoplasma capsulatum was available in 97 PLWH through examination of different samples: Hcc and Hcd were identified in 89 and 8 PLWH, respectively. Concerning therapies, 67.9% were treated with liposomal amphotericin B, 18.3% with itraconazole, 10 died pre-treatment. The overall mortality rate was 23.6%. Non-survivors exhibited more frequently gastrointestinal symptoms (p = 0.017), while cutaneous signs correlated with better survival (p = 0.05). Untreated patients faced higher mortality (p < 0.001). Histoplasmosis should be considered amongst opportunistic infection in PLWH, even in Europe, especially if patients originate from or have travelled to endemic areas. Systematic review registration: The registration number is CRD42023429779.

The role of compression therapy after endovenous laser ablation (EVLA) - review.

&lt;b&gt;&lt;br&gt;Introduction:&lt;/b&gt; Chronic venous disease (CVD) is a rising problem in western countries. There are several stages of CVD that can be treated with different ways. One of the methods of treating varicosity, C2 stage of CVD, is still developing endovenous laser ablation (EVLA). This method is popular due to its short operation time, less bleeding, quick recovery and no surgical scars. The compression therapy in form of compression stockings has been widely used as a conservative treatment of early stage CVD and it&apos;s also used after EVLA. However there are no strong recommendations towards using compression therapy after this kind of surgery.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Aim and Method:&lt;/b&gt; This paper is aimed to review existing knowledge about compression therapy benefits and its recommended time period after EVLA. Search engines used in review: Pubmed and Cochrane.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Results:&lt;/b&gt; Studies focusing on the compression therapy after EVLA of varicose veins have questioned the prolonged use of compression therapy as it brings no additional benefits and might be difficult for patients to adhere. The existing studies recommended the time period no greater than 1-2 weeks. There are no significant changes in reoccurrence rate and return to normal activities between compression and non-compression group. It is proven that compression therapy significantly reduces the postoperative pain and consumption of analgesics.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Discussion:&lt;/b&gt; Compression therapy seems as a safe option for low pain management. There is a need for further research involving the impact of the compression therapy after EVLA, especially in group of low energy delivered settings as the results of treatment are promising.&lt;/br&gt.

The inflammatory response-related robust machine learning signature in endometrial cancer: Based on multi-cohort studies.

Uterine corpus endometrial carcinoma (UCEC) is a prevalent form of cancer in women, affecting the inner lining of the uterus. Inflammation plays a crucial role in the progression and prognosis of cancer, making it important to identify inflammatory response-related subtypes in UCEC for targeted therapy and personalized medicine. This study discovered significant variation in immune response within UCEC tumors based on molecular subtypes of inflammatory response-related genes. Subtype A showed a more favorable prognosis and better response to immunotherapies like anti-CTLA4 and anti-PDCD1 therapy. Functional analysis revealed subtype-specific differences in immune response, with subtype A exhibiting higher expression of genes related to cytokine signaling pathways, NK cell-mediated cytotoxicity pathways and inflammatory processes. Subtype A also showed increased sensitivity to three chemotherapeutic agents. A 12-gene inflammatory response-related signature was found to have prognostic value for 1, 2 and 3year survival in UCEC patients. Additionally, a validated machine learning-based signature demonstrated significant differences in clinical traits between low-risk and high-risk cohorts. Elevated risk scores were associated with higher pathological grading, older age, advanced stage and immune subtype C2. Low-risk groups had higher infiltration of immune cell types such as CD8 + T cells and activated CD4 + cells. However, the abundance of cytotoxic immune cells decreased with increasing risk scores. Finally, PCR was applied to test the different expression in P2PX4. P2RX4 knockdown inhibited the proliferation and proliferation of the endometrial carcinoma Ishikawa cell line. In conclusion, this developed signature can serve as a clinical prediction index and reveal distinct immune expression patterns. Ultimately, this study has the potential to enhance targeted therapy and personalized medicine for UCEC patients.

Chronic diarrhea in a pediatric patient with HIV

Despite advances in antiretroviral therapy (ART), diarrhea remains a common problem with HIV infection and contributes to reduced quality of life and survival in HIV-infected patientes. Diarrhea is estimated to occur in approximately 90 % of HIV/AIDS patients in developing countries and between 30 % and 60 % in developed countries. Opportunistic pathogens that cause diarrhea in HIV-infected persons include protozoa, fungi, viroses, and bacteria. Several species of protozoa belonging to Cryptosporidium, Microsporidia and Isospora, are among the most common causative pathogens responsible for significant morbility and mortality in HIV patients. The case of a pediatric patient with chronic diarrhea with HIV stage C3 in irregular treatment with antiretrovirals Abacavir, Lamivudine, Lopinavir/Ritonavir admitted to the Institute of Tropical Medicine in which Isospora belli was isolated in coproparasitological for which she received treatment is presented below with Trimetropim-Sulfamethoxazole in addition to Griseofulvin for tinea capitis and Ivermectin and Permethrin 5 % lotion for scabies. Diarrhea can cause significant morbility in HIV-positive patients and can be due to a multitude of etiologies, from infectious pathogens to malignancy to drugs. Diarrhea is also an independent predictor of reduced quality of life and, in the case of advanced HIV disease, increased mortality.

ОЦЕНКА РАСПРОСТРАНЕННОСТИ И СТРУКТУРЫ ХРОНИЧЕСКОЙ БОЛЕЗНИ ПОЧЕК ПРИ САХАРНОМ ДИАБЕТЕ

The incidence of diabetes mellitus has more than doubled over the past ten years. The prevalence of chronic kidney disease is comparable to the prevalence of diabetes mellitus. Chronic kidney disease occurs in diabetes mellitus in 20-40% of cases. The aim of the study was to analyze the prevalence and structure of chronic kidney disease in diabetes mellitus according to the diabetes registry «Polyclinic № 4», Saransk. According to the diabetes registry data, the structure and prevalence of chronic kidney disease in patients with type 1 and type 2 diabetes mellitus, anthropometric indicators, the duration of diabetes mellitus and chronic kidney disease, and indicators of metabolic control of diabetes were analyzed. In the present study, the prevalence of chronic kidney disease was 17% in type 1 diabetes mellitus and 19% in type 2 diabetes mellitus. At the same time, in both types of diabetes mellitus, chronic kidney disease of stage C2 (50% in type 1 and 52% in type 2) and C3 stage (39% in type 2 and 28% in type 1) predominated. type of diabetes). Glycosylated hemoglobin was within the target range in 78% of type 1 diabetic patients and in 83% of type 2 diabetic patients. In patients with diabetes mellitus and chronic kidney disease, it is necessary to intensify hypoglycemic therapy, achieving target indicators of carbohydrate metabolism. The only indicator of the lipid spectrum, which is presented in the registry, was total cholesterol, it is necessary to study the full lipid spectrum.

A randomized controlled trial of standard vs customized graduated elastic compression stockings in patients with chronic venous disease

ObjectiveThis study aimed to compare the efficacy of customized graduated elastic compression stockings (c-GECSs) based on lower leg parameter models with standard GECSs (s-GECSs) in patients with chronic venous disease (CVD). MethodsIn this randomized, single-blind, controlled trial, 79 patients with stage C2 or C3 CVD were assigned to one of two groups: c-GECSs or s-GECSs. The primary outcome was change to Venous Insufficiency Epidemiological and Economic Study Quality of Life (VEINES-QOL) scores at months 1, 3, and 6 as compared with baseline. Secondary outcomes included compliance with wearing ECSs, interface pressure at the smallest circumference of the ankle (point B) and the largest circumference of the calf (point C), and calf volume (CV). ResultsThere were 13 pairs of s-GECS and 2 pairs of c-GECS that showed pressure values higher than the standard at either point B or C. The c-GECSs were significantly superior to s-GECSs in terms of score improvement at all three time points (month 1, 8.47 [95% confidence interval (CI), 7.47-9.45] vs 5.89 [95% CI, 5.00-6.78]; month 3, 9.60 [95% CI, 8.47-10.72] vs 6.72 [95% CI, 5.62-7.83]; month 6, 7.09 [95% CI, 5.93-8.24] vs 3.92 [95% CI, 2.67-5.18]; P < .0001). Besides, at month 1, the mean daily use time of the c-GECS and s-GECS groups was 10.7 and 9.5 hours, respectively (P < .05). Correlation analysis indicated a negative relationship between local high pressure and daily duration in the s-GECS group (rpb = –0.388; n = 38; P < .05). Variances in pressure were greater in the s-GECSs group. The c-GECSs showed advantage in maintaining pressure. Both c-GECSs and s-GECSs effectively reduced CV (mL), with no significant differences between groups (month 1, 90.0 [95% CI, 71.4-108.5] vs 85.0 [95% CI, 65.6-104.2]; month 3, 93.8 [95% CI, 69.7-117.8] vs 85.9 [95% CI, 65.5-106.2]; month 6, 70.8 [95% CI, 46.5-95.2]) vs 60.8 [95% CI, 44.1-77.5]). ConclusionsThe c-GECSs based on individual leg parameter models significantly improved VEINES-QOL scores and provided stable and enduring pressure as compared with s-GECSs for patients with stage C2 or C3 CVD. Although both c-GECSs and s-GECSs effectively reduced CV, the superior fit and comfort of c-GECSs improved patient compliance. Hence, c-GECSs are a viable alternative for patients who have difficulty tolerating s-GECSs.

ПЕРСОНИФИЦИРОВАННЫЙ ПОДХОД К ОЦЕНКЕ РИСКА РАЗВИТИЯ ПОВТОРНЫХ СЕРДЕЧНО-СОСУДИСТЫХ СОБЫТИЙ И ХРОНИЧЕСКОЙ БОЛЕЗНИ ПОЧЕК У ПАЦИЕНТОВ С ИНФАРКТОМ МИОКАРДА И ОСТРЫМ ПОВРЕЖДЕНИЕМ ПОЧЕК

Introduction: AKI (acute kidney injury) is a common comorbid condition in patients with AMI (acute myocardial infarction), complicating its course and treatment. In the future, the prognosis of these patients after discharge from the hospital, as well as the incidence of recurrent cardiovascular events (CVS) and chronic kidney disease (CKD) are not known. The purpose of the study: to study the predictors of the development of recurrent cardiovascular events (CVS) in patients with myocardial infarction (MI) with acute kidney injury (AKI). Develop a calculator - a risk meter for repeated CCC. Materials and methods: the study was performed in the Altai Regional Cardiological Dispensary. 193 patients with MI and PCI (percutaneous coronary intervention) were included, divided into 2 groups: the first - 123 patients aged 62.8±1.1 years with MI and AKI, the second - 70 patients without AKI, age 61.3± 1.6 years. Upon admission and before discharge, the level of the KIM-1 molecule (Kidney Injury Molecule-1) and IL-18 (interleukin-18) was studied by ELISA in the urine. All patients underwent coronary angiography using low-osmolar contrast. One year after discharge, the frequency of development of repeated CCC was assessed. Statistical calculations were carried out using statistical packages STATISTICA 12.0. The level of statistical significance was taken equal to 0.05. Results. The level of KIM-1 (at admission) in the first group was statistically higher than in the second: 1998.9±147.6 versus 1289.8±126.1 pg/ml p=0.001, and IL-18 in the AKI group exceeded the corresponding parameter of the group without AKI: 179.0±12.9 versus 114.9±11.5 pg/ml p=0.007, respectively. A year later, it was found that the frequency of recurrent cardiovascular events was higher in the group with AMI and AKI: unstable angina was diagnosed in 26 (21.1%) patients in the group with AKI and 5 (7.1%) patients without AKI in history, p=0.010; 19 (15.4%) and 2 (2.8%) patients, p=0.006, 20 (16.2%) and 3 (4.2%), p=0.013 patients, respectively, had repeated myocardial infarction and progression of CHF in a year . Progression of renal dysfunction during the year was observed 5 times more often in patients with MI and AKI: CKD C2 was diagnosed in 49 (39.8%) patients of the first group and 16 (22.8%) of the second, p = 0.01; CKD C3a and C3b stages - in 34 (27.6%), p˂0.001 and 19 (15.4%) patients, p=0.002, respectively, CKD stage C4 was detected in 4 (3.2%) patients of the group with AMI and AKI in the early postinfarction period. As a result of constructing a multifactorial logistic regression model, predictors were identified that have a multiplicative effect on the development of recurrent CV events: BMI over 25 kg/m2 increases the risk of recurrent CV events by 0.91 [0.83; 0.99] times, p=0.028, history of prior MI in 3.32 [1.24; 9.86] times, p=0.022. Increase in CRP by 1.01 [1; 1.03] times, p=0.045, troponin I, 0.97 [0.94;1] times, p=0.037, and IMT-1, 1 [1;1] times, p=0.030. On the development of CKD: an increase in age is associated with an increase in the chances of developing CKD by 1.18 [1.1; 1.29], p ˂0.001; troponin I by 0.96 times [0.92; 1], p=0.030; systolic blood pressure in 1.03 [1; 1.07] times, p = 0.029. A calculator has been developed for risk stratification of the development of recurrent CV events and an algorithm for managing this category of patients after discharge from the hospital. Conclusions: thus, the identified predictors make it possible to calculate the risk of developing recurrent CV events and CKD using the developed calculator and allocate these patients to a separate group for personalized observation, taking appropriate measures of secondary prevention.

New insights into the Barents Sea Calanus glacialis population dynamics and distribution

Arctic copepods are major grazers and vital food for planktivores in polar ecosystems but challenging to observe due to remoteness and seasonal sea ice coverage. Models offer higher spatio-temporal resolution, and individual-based models (IBMs) are useful since they incorporate individual variability which characterizes most copepod populations. Here, we present an IBM of the Arctic copepod Calanus glacialis, a key secondary producer in polar regions of the Barents Sea. The model is coupled to a three-dimensional physical-biological model, and an IBM for the Atlantic congener C. finmarchicus. We use the model to fill seasonal “gaps” between discontinuous spatio-temporal sampling for studying the spatial and seasonal population dynamics. Our simulations suggest that, across the Atlantic and Arctic domains of this ecosystem, total population egg production peaks in July, and copepodid 3 is the main overwintering stage descending to deeper overwintering depths between July and September. Total population biomass peaks at 5 times higher carbon mass than the seasonal minimums and is driven by the seasonal build-up of biomass in stages C4, C5 and adults. Ocean currents spreads the population over a large area, though with a clear spatial separation between C. glacialis and C. finmarchicus in the northern and southern Barents Sea, respectively. There is a mixture between 1- and 2-years life cycles in the model population, and those who require two diapause phases to reach maturity have spent a larger part of their life north of 77°N, where temperatures are colder and the growth season shorter than further south. A remaining question is where the source population of C. glacialis in this ecosystem resides, and whether the population relies on local survival and reproduction or continuous supply from a source population outside the Barents Sea.

High Physical Activity Volume Is Associated With an Increase in the Calibre of the Lower Limb Veins Without Impact on Functional Discomfort: the VARISPORT Study

The relationship between physical activity and lower limb veins is complex. If a sedentary lifestyle is considered to be negative on lower limb veins, specific information on physical activity varicose vein volume is sparse, especially the effect of high physical activity volume. The main objective of the VARISPORT study was to evaluate lower limb veins (clinically, morphologically, and haemodynamically) and chronic venous disease symptoms in subjects exposed to high physical activity volume compared with a group of non-exposed subjects. A cross sectional study compared a group of high exercise training volume volunteers (more than eight hours of uninterrupted vigorous intensity physical activity per week for more than six months: high physical activity volume group, HPAV group) with a volunteer control group matched for age, sex, and body mass index. Clinical examination was performed to determine the Clinical, Etiological, Anatomical, Pathophysiological (CEAP) classification of each subject and the Carpentier score was used to assess symptoms related to possible chronic venous disease. Duplex ultrasonography was used to assess vein diameters and reflux in the deep and superficial veins. One hundred and nineteen subjects were included in each group. The lower limb veins (deep and superficial) were significantly more dilated in the HPAV group. More reflux was found in the great saphenous veins and non-saphenous veins in the HPAV group. High physical activity volume was associated with a higher frequency of visible varicose veins (stage C2 of the CEAP classification), odds ratio 3.37 (95% confidence interval 1.66 - 7.25) without impact on functional discomfort (44 subjects with a Carpentier score ≥ 1 in each group). The VARISPORT study reported an increase in the calibre of the lower limb veins without impact on functional discomfort. Further studies are needed to determine whether these athletic veins are truly pathological varicose veins or simply an adaptation to high physical activity volumes.

Management of chemotherapy adversity through Ayurveda: An experience

Abstract Cancer is a leading cause of death worldwide, accounting for nearly 10 million deaths in 2020. Chemotherapy is the largely accepted treatment protocol for cancer, but it comes with an increased risk of infections and side effects. Ayurveda can be a promising adjunct therapy to minimize the adverse effects of chemoradiotherapy. A 65-year-old female who was a known case of double-vessel block suddenly developed severe abdominal pain and was treated symptomatically by a general physician. Her weight loss was consistent with multiple episodes of abdominal pain for a year after which she was diagnosed to have moderately differentiated adenocarcinoma of the cecum. The patient was managed with exploratory laparotomy (with right hemicolectomy with ileal transverse colon end-to-end anastomosis). The histopathology study reported it as a Modified Astler–Coller stage C2. Consequently, six cycles of Folfox (chemotherapy) were advised by the oncologist. Before starting the chemotherapy, Ayurveda treatment was started to combat the expected side effects of chemotherapy. The treatment protocol included Dhanyaka phanta, Suvarnamalini vasanta, Madiphala rasayana, and Guduchyadi ksheerapaka. The patient had no additional complaints during the chemotherapy and all the hematological parameters were within normal limits. The patient reported weight gain after completion of the chemotherapy. Expected side effects (hair loss, mouth sores, anorexia, diarrhea, and vomiting) were not reported during the treatment. Known side effects of chemotherapy like infection, easy bruising, bleeding, or fatigue were also not reported; therefore, the present study concludes that the side effects of chemotherapy may be controlled by Ayurveda adjunct therapy.

Glass Cups with Fire-Rounded Rims in the Cherniakhiv Culture: a Problem of Origin

In the article a research devoted to the problem of origin of hemispherical glass cups with fire-rounded rims discovered within the Cherniakhiv culture area is presented. These finds may be compared to a certain extent to Western European vessels of Eggers 199, 202, 205-206 types or the so-called Bodenrippenschale and Faßschale (after G. Rau) as well as cups of Werbkowice and Weklice types according to T. Stawiarska. Although, the Cherniakhiv artefacts are quite diverse in terms of their ornamental design, they are very similar referring to their morphology as well as finishing and decoration techniques. This fact, besides their identical chronological position and the same distribution pattern allow considering the mentioned items as a single glassware group and assuming their common origin. The conducted investigation demonstrates that at the end of the late Roman time (stage C3) the Cherniakhiv glass cups with fire-rounded rims were an original typological group of vessels, which had no synchronous analogues outside their distribution area. Although, the products that are similar to them in the technological point of view, occurred earlier in European Barbaricum, Roman provinces and antique centres of the Northern Black Sea region as well as at the end of the late Roman time in the Crimea. Taking into account the typological uniqueness and chronology of the Cherniakhiv finds as well as the absence of similar glassware among the products of synchronous glass-making centres of the neighbouring Roman provinces, it can be assumed that the most likely place of their origin was the Komariv workshop. The glass cups with fire-rounded rims are considered one of the items produced in this workshop. The artefacts that have close parallels among Cherniakhiv cups are also known here. It is worth noting, that the geochemical composition of some Cherniakhiv items finds close analogues between raw material and glassworking waste from Komariv, which is further evidence in favour of this hypothesis. The Roman origin of the Cherniakhiv cups, due to their morphological difference and chronological asynchrony with technologically similar products of the Roman glass-working centers, seems unlikely to us. Nevertheless, despite certain morphological differences, some early types of Western and Northern European artefacts, as well as Roman provincial glassware could serve as prototypes for the Cherniakhiv finds.

Personalization of Anticoagulant Therapy with Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Chronic Kidney Disease Based on Pharmacogenetic Testing

Background. Polymorphic variants of the genes encoding these isoenzymes and carrier proteins involved in the pharmacokinetics of direct oral anticoagulants (DOAC) may alter their function and, therefore, hypothetically may increase the risk of bleeding associated with the use of DOAC. Aims to study the possible relationship between the presence of polymorphic variants of ABCB1 (rs2032582, rs1045642, rs1128503), CYP3A5 (rs776746) and CYP3A4 (rs35599367) genes on the residual equilibrium concentration (Cmin,ss /D) of apixaban, CYP3A isoenzyme activity and bleeding development in patients with AF and CKD C3C4 stages. Methods. The study included 142 patients with AF combined with chronic CKD stages C3 and C4, receiving apixaban therapy, aged 58 to 99 years (median age 84 years). Pharmacogenetic, pharmacokinetic testing and assessment of CYP3A isoenzyme group activity were performed. Results. Plasma concentration of apixaban depended on the stage of CKD: a higher level of Cmin,ss /D was observed in patients with CKD stage C4 compared to patients with CKD stage C3a and with CKD stage C3b. When studying the effect of rs1045642 (C3435T) polymorphism of ABCB1 gene on apixaban pharmacokinetics, it was found that carriers of homozygous TT genotype had lower median apixaban concentration in blood compared to carriers of CC and TC genotypes (p = 0.027 and 0.034 respectively). For rs2032582 polymorphism of ABCB1 gene, we recorded that patients with GG genotype had higher Cmin,ss /D level of apixaban compared to GT genotype carriers (p = 0.037). CYP3A metabolic activity was statistically significantly lower (p = 0.036) in the group with a history of bleeding compared with that in patients in the group without a history of bleeding (0.8 (0.5; 1.3) and 1.2 (0.7; 2.1); p = 0.036). CYP3A metabolic activity did not differ between patients with different CYP3A5 (rs776746) and CYP3A4 (rs35599367) polymorphism genotypes. For the rs1045642 polymorphic variant, there were fewer carriers of the heterozygous TC genotype (16 (45.7%) patients) among patients with bleeding during the follow-up period compared to patients with no bleeding (43 (53.1%) patients; p = 0.024). Conclusions. The results of the study indicate the presence of an association between genome-wide changes (polymorphic variants of the ABCB1 (rs1045642) and CYP3A5 (rs776746) gene and the presence of apixaban-associated bleeding in patients with AF and CKD stages 34. Mechanisms of such an association require further study.

Construction Safety Risks of Metro Tunnels Constructed by the Mining Method in Wuhan City, China: A Structural Equation Model-Fuzzy Cognitive Map Hybrid Method

A hybrid method based on the structural equation model (SEM) and a fuzzy cognitive map (FCM) was developed to study the influences of the construction safety risks (CSR) of metro tunnels constructed by the mining method on the project risk (PR). An SEM was used to identify and verify the correlations between the CSR and PR. An FCM was developed adopting the verified standardized causality and path coefficient in the SEM. On this basis, predictive reasoning and diagnostic reasoning were performed in the framework of an FCM to simulate the CSR and PR. The feasibility of the developed method was validated based on the construction project of a metro tunnel in Wuhan City, China. The results show that (1) the cause concept node C2 (tunnel excavation) shows the strongest positive correlation with the target concept node CT (PR). According to their risks, the construction stages are ranked in descending order as C2 (tunnel excavation), C1 (advanced support), C6 (auxiliary measures), C4 (structure waterproofing), C3 (primary support), and C5 (secondary lining). (2) The target concept node CT is most sensitive to changes in the cause concept nodes C2 and C1. (3) Close attention should be paid to key risks, such as X9 (over-excavation and under-excavation) and X8 (unreasonable determination of excavation footage and sequence) in stage C2. Originality and significance: (1) A hybrid method that can simulate the dynamic interaction between the CSR and PR is proposed. (2) A new perspective for the dynamic evaluation of a PR is provided. (3) The method can be used as a decision-making tool for controlling the PR.

Analysis of parents’ awareness on the chronic kidney disease in children

Introduction. Informing the population about chronic kidney disease is an important factor for preventing or combating the disease, and maintaining the health of the younger generation.&#x0D; Objective: to study the level of awareness of parents about chronic kidney disease. &#x0D; Methods. In a specially designed form, an anonymous survey of 112 parents of children treated at the department regarding chronic kidney disease was conducted. Statistical processing of the obtained results was carried out.&#x0D; Results. In most children (91.6%), the diagnosis of chronic kidney disease was established at the stage C3–C5 in the hospital. Moreover, in 100% of cases, this diagnosis was a “random finding”; 75.9% of respondents showed lack of information about the disease and its treatment, and the level of awareness is directly related to the stage of the disease. Moreover, as a result of insufficient information, the parents admitted to fail to comply with the terms of visiting the child, a nephrologist (22.9%), the recommendations to limit the diet of protein (19.3%) and potassium (36.2%), fluid volume (61.5%). At the same time, the parents believed the cause of the progression of chronic kidney disease in the child to be the lack of follow-up (43.7%), late diagnosis (33.7%), improper treatment (13.3%), and the late beginning of the treatment (9.6%). &#x0D; Conclusion. The work proved a low degree of awareness about chronic kidney disease, which contributes to the late diagnosis of the disease and low adherence to treatment. This problem requires improving methods and forms of informing the population, including expanding the capacity of outpatient care (preventive examinations, health education in nephrology schools).