Nevin Manimala

ESC Heart Fail. 2021 Jun 22. doi: 10.1002/ehf2.13476. Online ahead of print.

ABSTRACT

AIMS: Heart failure (HF) is common in both men and women, yet disease pathophysiology, presentation, and progression differ between sexes. Studies addressing whether biomarkers predict new onset HF sex-specifically are scarce. This study therefore aims to test the sex-specificity of 252 protein biomarkers for new-onset HF.

METHODS AND RESULTS: A matched case-control design in patients selected from cohorts within the HOMAGE consortium was used. Cases (new-onset HF, n = 562) and controls (n = 780) were matched for cohort (PREDICTOR, HEALTH-ABC, & PROSPER), follow-up time (defined as time from entry to incident HF), and age. Incident HF was defined as first hospitalization for HF. Targeted plasma proteins (n = 252) were measured using Proximity Extension Assay technology from O-link. To look for sex differences for new onset HF, we adjusted for cohort, age, and baseline clinical parameters. At baseline, women had a biomarker profile reflecting activated metabolism and immune responses. However, none of the biomarkers had a significant interaction with sex in predicting new onset HF, but four biomarkers had a trend towards sex-specificity (P < 0.013). E-selectin and interleukin 1 receptor antagonist were more female-specific, whereas IL17A and CHIT1 tended to be male sex-specific for incident HF.

CONCLUSIONS: The majority of biomarkers associated with incident HF did not significantly differ between women and men, despite clear differences in biomarkers at baseline.

PMID:34156155 | DOI:10.1002/ehf2.13476

J Magn Reson Imaging. 2021 Jun 21. doi: 10.1002/jmri.27792. Online ahead of print.

ABSTRACT

BACKGROUND: Fetal growth restriction (FGR) is associated with a high fetal brain volume/liver volume (FBV/FLV) ratio. Ultrasound may not always be reliable, which has prompted further investigation of MRI techniques.

PURPOSE: To determine the relationship between FBV/FLV ratio, as measured by MRI, and gestational age (GA) in normal fetuses and those with FGR.

STUDY TYPE: Retrospective.

POPULATION: One hundred and forty seven singleton pregnancies including 105 appropriate-for-gestational age (AGA) fetuses and 42 FGR fetuses.

FIELD STRENGTH/SEQUENCE: Three-dimensional fast imaging employing steady-state acquisition at 1.5 T.

ASSESSMENT: The FBV and FLV were measured by three radiologists. The inter- and intraobserver agreements, the correlation between FBV/FLV ratio, and advancing GA were evaluated; the diagnostic value of FBV/FLV ratio was evaluated and compared with head circumference/abdominal circumference (HC/AC) ratio measured by ultrasound.

STATISTICAL TESTS: Intraclass correlation coefficient (ICC) was used to determine inter- and intraobserver agreements. Regression analysis was used to assess the correlation between FBV/FLV ratio and advancing GA. The diagnostic value of the FBV/FLV ratio was examined by the area under the receiver operating characteristic (ROC) curve.

RESULTS: The inter- and intraobserver agreements were excellent with an interobserver ICC of 0.984 and intra-observer ICCs of 0.989, 0.994, and 0.995. The FBV/FLV ratio in AGA fetuses decreased significantly with advancing GA (Pearson correlation coefficient = -0.844). The FBV/FLV ratio in FGR fetuses was significantly higher than that in AGA fetuses. To identify fetuses at high risk for FGR using the FBV/FLV ratio, the area under the ROC curve was 0.978, with an optimal cut-off value of 4.10. The sensitivity of FBV/FLV ratio in identifying FGR was significantly higher than that of HC/AC ratio (0.929 vs. 0.529).

DATA CONCLUSION: An inverse correlation exists between FBV/FLV ratio and advancing GA in normal fetuses. A high FBV/FLV ratio may be used to ascertain fetuses at high risk for FGR.

LEVEL OF EVIDENCE: 3 Technical Efficacy Stage: 3.

PMID:34156128 | DOI:10.1002/jmri.27792

Rev Esp Salud Publica. 2021 Jun 22;95:e202106086.

ABSTRACT

OBJECTIVE: The increasing complexity of clinical trial protocols and the very nature of investigational drugs increase the likelihood of prescribing errors and require comprehensive control and monitoring of treatments. The aim of this study was to measure and analyze the potential risks of prescribing errors in investigational drugs.

METHODS: A prospective, descriptive, and observational study was carried out in a third-level hospital in Madrid, for one month in 2017. Manual prescribing errors (EP) in investigational drugs and potential risks of harm to the patient were analyzed. A descriptive statistical analysis was performed, including the absolute and relative frequency for the variables.

RESULTS: A total of 254 medical orders corresponding to 327 lines of treatment and 274 different drugs were reviewed, of which 83% were categorized as “high-risk”. Results showed 217 (85.4%) EP within the identification of the medical order and 1,045 (319,6%) in the treatment. The risk level of harm to the patient was high for all EP in patient identification and moderate for all EP in the clinical trial identification. The lines of treatment showed an especially high-risk potential for EP in dosage (25%) and frequency (41%).

CONCLUSIONS: The high rate of EP found, along with the high-risk potential these entail, reflects the need for improving the security process when prescribing investigational drugs in our field.

PMID:34156039

Wiad Lek. 2021;74(4):1019-1023.

ABSTRACT

OBJECTIVE: The aim: Was to study the dynamics of the incidence of diphtheria in the Transcarpathian region of Ukraine.

PATIENTS AND METHODS: Materials and methods: A retrospective analysis of the data of the state statistical reporting of the Transcarpathian region on the incidence of diphtheria, the carriage of infection, vaccination coverage and the severity of diphtheria immunity was carried out.

CONCLUSION: Conclusions: Low coverage of the population with vaccination against diphtheria, registration of an outbreak of diphtheria among international students of the region, and other regions of Ukraine in conditions of increased population migration, are alarming prognostic signs of the possible development of another significant epidemic rise of diphtheria morbidity in Transcarpathia.

PMID:34156023

Wiad Lek. 2021;74(4):998-1002.

ABSTRACT

OBJECTIVE: The aim: To analyze and calculate CVR in patients with T2DM and concomitant obesity.

PATIENTS AND METHODS: Materials and methods: The selection of patients was carried out based on the Uzhhorod District Clinical Hospital, in the period from November 2016 to January 2020. All patients were divided into 3 groups: 1 (n=93) with T2DM and concomitant obesity, 2 (n=87) with T2DM, 3 (n=39) with obesity. The treatment period lasted 1 year and included dosed exercise for at least 30 minutes per day and dietary recommendations. Patients in groups 1 and 2 received metformin 850 mg twice daily in combination with dapagliflozin 10 mg once daily. CVR was determined at the time of enrollment and after 1 year of treatment using: American College of Cardiology / American Heart Association Guideline on the Assessment of Cardiovascular Risk (2013) (ASCVD Risk) and Framingham Risk Score (FRS).

RESULTS: Results: The data obtained as a result of the study revealed the highest CVR in patients of group 1, in contrast to group 2 and 3 (p<0.05). After 1 year of complex treatment, CVR indicators were statistically significantly reduced in all experimental groups (p<0.05).

CONCLUSION: Conclusions: Determining CVR parameters and exposure to them within 10 years can remove unwanted cardiovascular complications.

PMID:34156019

Wiad Lek. 2021;74(4):992-997.

ABSTRACT

OBJECTIVE: The aim: Study of the dynamics of morphological rearrangement of bone under conditions of immediate occlusive functional load and the effect of splinting of implants with temporary orthopedic structures with the analysis of the coefficient of stability of implants during immediate implantation in the experiment.

PATIENTS AND METHODS: Materials and methods: A series of experiments was performed on 6 male Duroc pigs at the age of 6 months and weighing 40-60 kg. In the course of recent advances, the following methods have been used: the clinical protocol of immediate – implantation of time-consuming clothes, the definition of COEFICIENT, morphometry and light microscopy of the slides, statistical analysis.

RESULTS: Results: By morphometric examination after 3 months the BIC in the series with splinting was 1.68 times higher compared to 1 month. studies, in a series of experiments without splinting – 1.9 times, after 3 months. the difference between implantation experiments with splinting components and without splinting is 1.6 times. During the functional study of the resonant – frequency analyzer, there is an increase in the ISQ in the second and third months after surgery, but this figure is higher in the study using the splint component.

CONCLUSION: Conclusions: Stagnation of the shingle component in the case of intrinsic intraoperative functional juvenile implantation accelerates the dynamics of osteointegration, so that high indicators of the efficiency of the implant stability can be achieved.

PMID:34156018

Wiad Lek. 2021;74(4):973-976.

ABSTRACT

OBJECTIVE: The aim: To study the effect of arterial hypertension on the course of chronic obstructive pulmonary disease in patients with comorbid pathology.

PATIENTS AND METHODS: Materials and methods: The prospective study included 61 patients with COPD: 32 stable male patients with COPD with comorbid arterial hypertension of stage II 1-3 degrees and 29 stable outpatients of men with COPD of clinical groups A-D with impaired respiratory function II-IV according to GOLD. All patients, in accordance with the goals and objectives of the study, were divided into 2 groups: group I consisted of men with isolated COPD, middle age – 56.0 (8.5) years, average duration of the disease – 16.2 (1.3) years, Group II consisted of male patients with COPD and arterial hypertension (AH), middle age – 59.5 (7.5). The patients underwent a general clinical examination, which included an assessment of complaints, anamnestic data, and a physical examination. The severity of COPD was determined on the basis of the frequency of exacerbations during the year, assessment of dyspnea using the mMRS scale, spirographic data. Statistical materials were processed using the STATISTICA 10.0 program.

RESULTS: Results: In group I, 20 patients (69%) complained of dyspnea during exercise, in group II – 25 patients (78%) (p = 0.4), 28 patients (96.5%) complained of cough with vague sputum. group and 30 patients in group II (93.8%) (p = 0.09). When assessing the number of exacerbations over the past year, it was determined that patients with isolated COPD had an average of 1.0 (1.0; 2.0) exacerbations, and patients with COPD and AH – 2.0 (1.0; 3.0 ) (p = 0.06). According to the CAT questionnaire, the following data were obtained: in group I – 9.0 (8.0; 11.0) points, and in group II – 17.5 (10.0; 20.0) points (p = 0.02). When conducting spirographic studies, a statistically significant more expressive bronchial obstruction was found in patients with COPD and comorbid hypertension.

CONCLUSION: Conclusions: The presence of comorbid arterial hypertension leads to the intermittent effect of diseases: according to the results of mMRC and SAT test, ailments for COPD were examined, they have a more severe course of underlying seizure in the presence of concomitant arterial hypertension. Clinical manifestations in patients with COPD and H are more severe compared to clinical manifestations in patients without aggravated diseases of the cardiovascular system. Concomitant arterial hypertension enhances the manifestations of bronchial obstruction, in the same way as with patients with isolated COPD.

PMID:34156014

Wiad Lek. 2021;74(4):957-760.

ABSTRACT

OBJECTIVE: The aim: To evaluate the efficiency of the proposed therapy, which included recommendations for nutrition, physical activity and treatment with rosuvastatin, omega-3 PUFA and ursodeoxycholic acid, on the indicators of the lipid profile in patients with NAFLD and prediabetes.

PATIENTS AND METHODS: Materials and methods: 78 patients with impaired glucose tolerance were examined. According to the inclusion and exclusion criteria, 55 patients with prediabetes and concomitant NAFLD were included in the study. All patients underwent a comprehensive clinical examination, which included anthropometric data collection, objective examination, and venous blood sampling for laboratory tests.

RESULTS: Results: The data obtained after 12 months of proposed treatment revealed a statistically significant improvement of indicators lipid profile in patients with prediabetes and NAFLD. Moreover, no significant difference between mean values of HDLC, LDLC, TG and atherogenic coefficient of almost healthy individuals and the corresponding indicators of treated patients detected.

CONCLUSION: Conclusions: therapy which included recommendations for nutrition, physical activity and treatment with rosuvastatin, omega-3 PUFA and ursodeoxycholic acid significantly improved lipid metabolism in patients with prediabetes and NAFLD.

PMID:34156011

Wiad Lek. 2021;74(4):954-956.

ABSTRACT

OBJECTIVE: The aim: Is to determine the features of hemodynamics and the character of structural and functional changes in the prostate gland in middle-aged infertile males in the conditions of chronic hepatitis.

PATIENTS AND METHODS: Materials and methods: We studied the features of hemodynamics and structural and functional state of the prostate gland in middle-aged males who had suffered from chronic hepatitis with the help of ultrasound scanning, Color-Doppler sonography, and histology, morphology, and statistics.

RESULTS: Results: It was detected that in 3-5 years after chronic viral hepatitis in middle-aged males (the first period), the volume of the prostate gland increases to (27.1±1.2) cm3, and its mass to (28.0±1.7) g compared to the control. Blood flow rates in the prostate gland: arterial blood flow velocity, blood flow diastolic velocity, volumetric blood flow are significantly lower than the control ones. Glandular zone surface decreases to 53% and connective tissue increases to 43%. Epithelium in the secretory area of the gland is compressed.

CONCLUSION: Conclusions: 1.According to the data of ultrasound diagnostics and Color-Doppler sonography, the volume of the prostate gland increases to (27.1±1.8) cm3 and its mass to (28.0±1.7) g at chronic viral hepatitis, compared to the control (21.3±1.5) cm3 and (24.7±1.3) g (р<0.05). Atrophic changes in the prostate gland are manifested with the decreased height of the columnar epithelium of the gland and overgrowth of connective tissue in the stroma of the organ. 2.Angioechometric indices of arterial blood circulation in central and peripheral zone of the prostate decreases to (7.26±0.46) cm/sec and (7.80±0.32) cm/sec respectively compared to the control (18.30±3.10) cm/sec and (17.70±2.90) cm/sec. Venous blood flow rates decrease to (2.45±0.21) cm/sec and (2.60±0.16) cm/sec compared to (5.54±0.8) cm/sec and (5.36±0.03) cm/sec (р<0.05).

PMID:34156010

Wiad Lek. 2021;74(4):940-947.

ABSTRACT

OBJECTIVE: The aim: To carry out a statistical analysis of physical and reproductive health characteristics in women after ineffective reattempts of using assisted reproductive technologies and identify significant medical and social factors contributing to the development of chronic endometritis.

PATIENTS AND METHODS: Materials and methods: We carried out a statistical analysis involving 177 outpatient medical records: group 1 includes 127 women aged under 45 with two or more ineffective attempts of in vitro fertilization; group 2 comprised 50 healthy women without reproductive disorders. The complete physical exam included past history, clinical and gynecologic examination, lab techniques and medical imaging according to outpatient medical records obtained during the follow-up care in Isida-IVF Medical Center LLC. Chronic endometritis was recognized by means of histologic examination of endometrium, with the samples obtained by an endometrial pipelle biopsy on day 4-9 of the menstrual cycle.

RESULTS: Results: The prevalence of pelvic inflammatory disease in patients of group 1 comprised 47.2%, endometritis – 41.7%; p1.2 <0.01. The prevalence of acute endometritis among patients of group 1 comprised 6.3%; p1.2 >0.05 and was associated with an infection after abortion. In group 1, sexually transmitted infections were reported in 67.7% of patients, p1.2> 0.05, bacterial vaginosis was registered 1.5 times more often – 28.4%; p1.2 <0.05. In group 1, single induced abortion was reported in 15.0%, while 2 times it took place in 15.7% (p1.2 <0.05). Laparoscopies were previously performed in 59.8% of women, laparotomies – in 62.2%, while in 25.4% of women these interventions were reperformed. Unilateral salpingectomy, due to ectopic pregnancy, was performed in 25.4% of women, bilateral – in 12.7%. Fallopian tube removal, due to sactosalpinx, was performed in 25.4% of women, unilateral salpingectomy took place in 3.9% of cases. The most significant risk factors of chronic endometritis in groups studied are acute postabortal endometritis, RR (relative risk) = 1.439, p = 0.029 and postoperative peritonitis provoked by the complications of appendectomy, RR = 1.430, p = 0.084. We detected none of significant effects of pelvic inflammatory disease on the development of chronic endometritis (RR = 45.132, Confidence interval (CI) (6.151-331.167), p = 0.001). The analysis of reproductive failures, as a risk factor of chronic endometritis in women of group 1, showed a significant relative risk: with the past history of premature birth, RR = 1.44, p = 0.039, in case of reattempts of induced abortions, RR = 1.5, p<0.001, Spontaneous miscarriage RR = 1.572, p = 0.001. A higher relative risk of developing chronic endometritis was observed during pregnancy – RR = 1.597, p = 0.001.

CONCLUSION: Conclusions: Statistical analysis of women’s reproductive health after ineffective reattempts of using ART revealed that the high rate of fetal interventions, low rate of alternative and safe abortion methods are registered in these women, as well as the nonavailability of any system of health measures after reproductive failures. A significant increase in miscarriage at early stages takes place, as well as the absence of a tendency for preterm labor to decrease in the rate. Maintaining women’s reproductive health is a considerable medical and social issue, whose resolving depends on joint efforts of governmental and public entities, healthcare agencies and the population responsibility for own health. Designing and adopting the program of preconception care and planning for pregnancy in women after ineffective reattempts of using ART, with chronic endometritis as a primary disease, should be the top priority area of a health care system.

PMID:34156008