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It was to explore the clinical efficacy and safety of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) targeted drugs combined with hyaluronic acid-gadolinium sesquioxide-nanoparticles (HA-Gd2O3-NPs) in non-small cell lung cancer (NSCLC). In this study, 70 patients with stage IV EGFR mutant NSCLC diagnosed in the First Affiliated Hospital of Jinzhou Medical University were selected. They were randomly divided into the combined group (35 cases) and the control group (35 cases). HA-Gd2O3-NPs were prepared by hydrothermal polymerization, and combined with EGFR-TKI in the clinical treatment of NSCLC. The results showed that HA-Gd2O3-NPs were spherical with a uniform particle size of about 124 nm. The NSCLC survival rate of the combined group was 37.2 ± 5.3% under 6 Gy X-ray irradiation, and that of the control group was 98.4 ± 12.6% under 6 Gy X-ray irradiation. The total effective rate of the control group (20%) was significantly lower than that of the study group (42.86%) (P

Polyneuropathies are diseases of the peripheral nervous system with lesions of motor, sensory or autonomic fibers which are encountered by attending physicians of almost all specialties in outpatient and clinical settings. To date, more than 100 different causes of polyneuropathies have been identified. Metabolic and toxic polyneuropathies are the most common in the group of secondary polyneuropathies. Diabetic, alcoholic, uremic, and drug-induced polyneuropathies take the leading place among these diseases. The main forms of diabetic polyneuropathy are presented. The main clinical form is distal symmetrical polyneuropathy. Clinical symptoms depend on the type of fibers involved in the pathological process - thin or thick. There is an assessment scale in points to determine the severity of diabetic polyneuropathy, which helps in clarifying the diagnosis and prognosis of the disease. The next most frequent among metabolic polyneuropathies is uremic polyneuropathy as the most frequent complication in patients suffering from chronic renal insufficiency. Risk factors of uremic polyneuropathy development, clinical picture, the course of the disease are described. Within the framework of toxic polyneuropathies, the main place is given to alcoholic polyneuropathies, chemotherapy-induced, and drug-induced. For each of these categories, clinical forms and pathophysiology of development are described. For all polyneuropathies, the main diagnostic aspects are presented. The main therapeutic approaches are shown. A separate place is given to the use of alpha-lipoic acid.

Most of the existing ubiquitous clinic recommendation (UCR) systems adopt linear mechanisms to aggregate the attribute-level performances of a clinic to evaluate the overall performance. However, such linear mechanisms may not be able to explain the choices of all patients. To solve this problem, the modified mixed binary nonlinear programming (MMBNLP)–feedforward neural network (FNN) approach is proposed in this study. In the proposed methodology, first, the existing MBNLP model is modified to improve the successful recommendation rate using a linear recommendation mechanism. Subsequently, an FNN is constructed to fit the relationship between the attribute-level performances of a clinic and its overall performance, thereby providing possible ways to further enhance the recommendation performance. The results of a regional experiment showed that the MMBNLP–FNN approach improved the successful recommendation rate by 30%.

Aim. To compare risk factors, features of COVID-19 course and outcomes in pregnant women during epidemic increase in incidence in 2020 and 2021. Materials and methods. The study included 163 pregnant women with laboratory-confirmed SARS-CoV-2 infection within May December 2020 (1st2nd waves of the epidemic) and 158 pregnant women who had new coronavirus infection within May August 2021 (3rd wave of the epidemic). Patients in all groups were comparable in age (1835 years), social status, parity, body mass index, and had no known risk factors for COVID-19. Results. Iron deficiency anemia, smoking, belonging to the Buryat ethnic group were recognized as persistent risk factors for COVID-19 in pregnant women. Over the 1st year of the pandemic, in pregnant women, the following clinical manifestations of novel coronavirus infection were commonly seen: anosmia (87.7%), somnolence (68.7%), shortness of breath even with a mild lung damage (68.1%). In the 3rd wave of the 2nd year of the pandemic, the leading signs and symptoms were cough (70.3% vs 38.7%, p0.001), runny nose (46.2% vs 3.7%, p0001), sore throat (367% vs 37%, p0.001); an increase in body temperature above 38C (19.6% vs 7,4%, p=0.006), pneumonia detected by computed tomography (61.4% vs 21.4%; p0.001). There was a significant increase in the incidence of severe lung lesions (with computed tomography 34: 17.7% vs 4.9%; p0.001) and admissions to intensive care units (11.4% vs 6.4%; p= 0041). There was a need for invasive mechanical ventilation (1.89% vs 0%; p=0.118). There was 1 death (0.63% vs 0%; p= 0.492), which was associated with the fulminant course of COVID-19. Conclusion. Persistent COVID-19 confounders in pregnant women who have no known risk factors in the third trimester of gestation are iron deficiency anemia, smoking, and belonging to the Buryat ethnic group. The clinical course of SARS-CoV-2 infection has changed and became more unfavorable: symptoms of acute respiratory disease (cough, runny nose, sore throat) began to prevail, the rate and severity of pneumonia and rate of mortality increased.

The relevance of pneumonia remains at the forefront and has recently attracted the attention of not only the entire medical community, but also all political and economic institutions of most countries of the planet. This nosology continues to be in the center of attention, identifying one of the key causes in the frequency of mortality of the population. The presented article accumulates the most up-to-date theses regarding viral pneumonia on the basis of a review of a large number of scientific literature, domestic and foreign studies. Although the term “viral pneumonia” has been used in medical practice for more than a century, nevertheless, there is no final diagnostic algorithm and an established final concept. The article reflects special historical medical and philosophical aspects in the study of pneumonia from the time of Hippocrates to the present. The epidemiological features, etiology, and also the terminological base of viral pneumonia are updated, thereby the concept of viral pneumonia in medical categories is fixed. A promising classification of viral pneumonia according to ICD-XI is presented. Attention is drawn to the autopsy morphological characteristics of the bronchopulmonary organ complex in viral pneumonia, post-mortem descriptions are given with links to authoritative research sources. The main modern diagnostic capabilities of the scientific medical community in the detection of pneumonia are described, the issues of the formation of new diagnostic algorithms are reflected. The clinical picture of viral pneumonia is described in detail, the clinical concept of the phase course of the disease based on pathomorphological data is presented for the first time. The main modern groups of drugs for etiotropic and pathogenetic treatment of the disease are considered. The conclusion reflects the main problematic postulates and prospects for further study of the disease.

BACKGROUND Neonatal hepatic portal venous gas (HPVG) is associated with a high risk of necrotizing enterocolitis (NEC) and was previously believed to be associated with an increased risk of surgery. CASE SUMMARY A 3-day-old full-term male infant was admitted to the pediatrics department after presenting with “low blood glucose for 10 min”. Hypoglycemia was corrected by intravenous glucose administration and oral breast milk. On the 3rd d after admission, an ultrasound examination showed gas accumulation in the hepatic portal vein; this increased on the next day. Abdominal vertical radiograph showed intestinal pneumatosis. Routine blood examination showed that the total number of white blood cells was normal, but neutrophilia was related to age. There was a significant increase in C-reactive protein (CRP). The child was diagnosed with neonatal NEC (early-stage). With nil per os, rehydration, parenteral nutritional support, and anti-infection treatment with no sodium, his hepatic portal vein pneumatosis resolved. In addition, routine blood examination and CRP examination showed significant improvement and his symptoms resolved. The patient was given timely refeeding and gradually transitioned to full milk feeding and was subsequently discharged. Follow-up examination after discharge showed that the general condition of the patient was stable. CONCLUSION The presence of HPVG in neonates indicates early NEC. Early active anti-infective treatment is effective in treating NEC, minimizes the risk of severe NEC, and reduces the need for surgery. The findings of this study imply that early examination of the liver by ultrasound in a sick neonate can help with the early diagnosis of conditions such as NEC.

Randall S Porter,1 Kathleen Holt,2 Rajeev S Ramchandran3 1Pediatric Ophthalmology and Ocular Genetics Service, University of Rochester Flaum Eye Institute, Rochester, NY, USA; 2University of Rochester Clinical & Translational Science Institute, Rochester, NY, USA; 3Retina and Vitreous Service, University of Rochester Flaum Eye Institute, Rochester, NY, USACorrespondence: Randall S PorterFlaum Eye Institute, Box 659, 601 Elmwood Ave, Rochester, NY, 14642, USATel +1 585 275-7039Fax +1 585 275-2352Email Randall_Porter@urmc.rochester.eduPurpose: The full utility of general health Patient-Reported Outcomes Measurement Information System® (PROMIS) surveys in the eye care setting has not been previously demonstrated. This report demonstrates the feasibility of implementing PROMIS in an eye care clinic.Patients and Methods: Over 2 months, general health and functioning PROMIS surveys were offered to all patients in an optometric clinic in Rochester, NY. Demographic and clinical variables were recorded along with percent completion and time to completion of the survey.Results: Across 651 patients, 258 chose to attempt PROMIS. Patients with low visual acuity were less likely to attempt the survey (p=0.049), and younger patients were more likely to complete the survey (p=0.025); no other patient characteristics were found to differ between those who did and did not participate in, nor complete, PROMIS. A total of 193 patients completed the survey (74.8%) in a mean time of 6.36 minutes (range = [1.43, 51.92] minutes; standard deviation = 5.62 minutes). Time to completion did not vary significantly across any groups.Conclusion: Our relatively high completion rate among those who attempted PROMIS indicates that PROMIS surveys are feasible to implement in an optometry clinic. While most patients completed the survey in little time, the large range of time to completion may indicate that some patients had difficulty completing the survey. Furthermore, the significant difference in visual acuity between those who participated in the survey and those who did not highlights the need to address the way PROMIS is delivered in order to foster greater inclusion.Keywords: patient-reported outcome, PRO, ophthalmology, optometry, clinic

Background To analyze and evaluate EGFR, KRAS, and PIK3CA gene mutation rates and clinical distribution in patients with different types of lung cancer Method A total of 221 lung cancer patients treated in our hospital between January 2016 and June 2019 were enrolled. Tissue and whole blood samples were collected and analyzed to determine the mutation status of EGFR, KRAS, and PIK3CA genes. The gene exon mutation rates were determined. Relevant clinical data, such as age, gender, tumor sample type, treatment method, pathologic type, and lung cancer stage were recorded and statistically analyzed. Results The EGFR gene mutation rates in exons E18-E21 were 2.3%, 17.6%, 3.6%, and 20.4%, respectively. E18, E19, and E20 mutations were commonly detected in adenosquamous carcinoma, and E21 mutations were commonly detected in adenocarcinoma. Mutations in exons E18-E21 were frequently detected in patients with lung cancer stages IA, IB, IIA, or IIB, respectively. The KRAS gene mutation rate in lung cancer patients in exon E2 was higher in whole blood and tissue samples than other exon mutations, while the KRAS gene mutation rate in exons E2 and E3 was significantly higher in patients with lung cancer stages IIB and IA, respectively. PIK3CA gene mutations in exons E9 and E20 occurred in patients < 60 years of age. Exon E9-positive mutations were more common in men or patients with squamous cell carcinoma, while exon E20-positive mutations were more common in females. Conclusion The EGFR, KRAS, and PIK3CA gene exon mutation rates differ and were shown to be correlated with different clinical indicators, which have significance in clinical treatment.

Objective:Bleeding is one of the most important problems in humans. Absence, deficiency or dysfunctions of protein factors in the coagulation system can cause prolonged bleeding, morbidity or mortality. Although factor VIII, factor IX and von Willebrand factor deficiencies are the most common, deficiencies in all other factors exist, called rare factor deficiencies. This study aimed to present the clinical presentations, laboratory findings, treatments, and surgical interventions in patients with rare factor deficiencies other than factor VII followed up in our clinic.Materials and Methods:Patients who were diagnosed with rare factor deficiency other than factor VII in the department of pediatric hematology and oncology between July 1997 and June 2020 were included in this study. Patients’ demographic characteristics, clinical presentations, family history, prothrombin time, activated partial thromboplastin time and factor levels, treatments and surgical interventions were recorded retrospectively from patients’ files.Results:Nineteen patients were included in the study, of which 7 (37%) had factor X deficiency, 5 (25%) had factor XI, 3 (16%) had factor V+VIII, 2 (10%) had factor V and 1 (5%) had factor I and XIII deficiencies. Parents of 12 patients had consanguinity marriages. All patients with factor X deficiency had bleeding episodes, and three of them were under prophylaxis with prothrombin complex concentrate. Other patients were under on-demand treatment. In total, 19 surgical interventions (11 minor; 8 major) were performed.Conclusion:Rare bleeding disorders are very uncommon and heterogeneous, with variable associations between coagulation factor activity and bleeding phenotype. A multidisciplinary and expertise team (haematologists, nurses, gynaecologists, obstetricians, orthopaedist, etc.) is necessary for the treatment and regular followup of patients with rare bleeding disorders.

Aim. To compare clinical features, drug therapy and outcomes in patients with non-obstructive and obstructive coronary artery infarction.Material and methods. The study included 206 patients with a diagnosis of myocardial infraction (MI). According to the results of coronarography, patients were divided into two groups: 103 patients (group 1; MINOCA) did not have obstructive involvement coronary arterial (CA): in 67 (65%) of cases, there is no data for atherosclerotic coronary bed lesion, another 36 (35%) – have CA stenosis up to 50%. 103 patients (group 2) with MI and obstructive CA (MIOCA). The patients of the second group in 100% of cases underwent endoprosthesis of CA, the affection of which caused infraction. The second group was selected by the copy method comparatively to the first group. The analysis of clinical peculiarities, medication and outcomes was made in these groups of patients, in particular.Results and conclusions. The clinical “portrait” of patients with MI in nonobstructive and obstructive CA involvement did not differ significantly. Higher serum level of total cholesterol (5.6 [4.4;6.2] vs 5.1 [4.4;5.8] mmol/l р=0.04) and cholesterol of low-density lipoproteins (2.9 [2.2;3.5] vs 2.5 [2.1;2.9] mmol/l р=0,01), troponin [2.8 [0.7;15.0] vs 1.2 [0.1;7.7] ng/ml р=0.02) were identified in blood tests of MIOCA patients in the comparison with MINOCA group. Antero-lateral (р=0.02) and unspecified localization of MI (р=0.03) was more frequent in the MINOCA group. The differences in therapeutic approach were manifested in the more frequent prescription of double antiplatelet therapy: (99.0% vs 80.6% р< 0.01) in MIOCA patients. In the MINOCA group а more frequent prescription of dihydropyridine calcium channel blocking agents was registered (23.3% vs 2.9% р0.05), annual mortality (5.1% against 7.8%; p>0.05), and combined endpoint (6.8% against 10.7%; p>0.05).Conclusion. Despite the similarity of the clinical presentations of MI with obstructive and nonobstructive CA involvement in real clinical practice, there are differences in the pharmacotherapeutic approach in the management of these groups of patients. MINOCA is characterized by an unfavorable outcomes similar to MIOCA.

Introduction. Chickenpox is one of the most common infectious diseases in childhood. It is considered a benign disease, but both children and adults can lead to the development of serious complications.Purpose: to study the epidemiological and clinical features of chickenpox in children aged 0–17 years, hospitalized in the Krai government-owned publicy funded health care institution “City clinical hospital No. 11, Barnaul”, for the period 2008–2018.Materials and methods. The materials of the study were data from statistical reporting forms No. 2 of the Federal state statistical observation “Information on infectious and parasitic diseases” in Barnaul for 2008–2018, and medical archive documentation of the children’s infectious diseases Department of the Krai government-owned publicy funded health care institution “City clinical hospital No. 11, Barnaul” for the same period. Data processing was performed using calculation of intensive and extensive indicators, calculation of the arithmetic mean (X) and standard error of the average (m). Calculations were made using the STATISTICA-10 program.Results. The incidence of chickenpox is consistently high, and children aged 3 to 6 years dominated the structure of hospitalized patients with the diagnosis of «chickenpox». All patients were not vaccinated against this infection. Patients developed complications due to the layering of secondary bacterial flora. Summary. Chickenpox is an infectious disease that can be severe, especially in patients with a heavy premorbid background. There is a tendency to” grow up” the infection, which emphasizes the need to discuss specific prevention of the disease.

Modern agriculture and plant breeding must continuously meet the high and increasingly growing requirements of consumers and recipients. In this context, one of the conditions for effective management of any farm is access to quick and efficient diagnostics of plant pathogens, the result of which, together with the assessment of experts, provide breeders with tools to effectively reduce the occurrence of plant diseases. This paper presents information about biodiversity and spectrum of endophytic and phytopathogenic bacterial species identified in plant samples delivered to the Plant Disease Clinic in 2013–2019. During the tests, using the Biolog Gen III system, the species affiliation of the majority of detected bacterial strains found in plant tissues as an endophyte and not causing disease symptoms on plants was determined. These data were compiled and compared with the number of found identifications for a given species and data on the pathogenicity of bacterial species towards plants. In this way, valuable information for the scientific community was obtained about the species composition of the bacterial microbiome of the crop plants studied by us, which were confronted with available literature data. In the study, special attention was paid to tomato, which is the plant most often supplied for testing in the Plant Disease Clinic due to its economic importance.

Introduction The ubiquitously expressed nonhistone nuclear protein high‐mobility group box protein 1 (HMGB1) has different functions related to posttranslational modifications and cellular localization. In the nucleus, HMGB1 modulates gene transcription, replication and DNA repair as well as determines chromosomal architecture. When the post‐transcriptional modified HMGB1 is released into the extracellular space, it triggers several physiological and pathological responses and initiates innate immunity through interacting with its reciprocal receptors (i.e., TLR4/2 and RAGE). The effect of HMGB1‐mediated inflammatory activation on different systems has received increasing attention. HMGB1 is now considered to be an alarmin and participates in multiple inflammation‐related diseases. In addition, HMGB1 also affects the occurrence and progression of tumors. However, most studies involving HMGB1 have been focused on adults or mature animals. Due to differences in disease characteristics between children and adults, it is necessary to clarify the role of HMGB1 in pediatric diseases. Methods and Results Through systematic database retrieval, this review aimed to first elaborate the characteristics of HMGB1 under physiological and pathological conditions and then discuss the clinical significance of HMGB1 in the pediatric diseases according to different systems. Conclusions HMGB1 plays an important role in a variety of pediatric diseases and may be used as a diagnostic biomarker and therapeutic target for new strategies for the prevention and treatment of pediatric diseases.

Proteins and peptides have become a significant therapeutic modality for various diseases because of their high potency and specificity. However, the inherent properties of these drugs, such as large molecular weight, poor stability, and conformational flexibility, make them difficult to be formulated and delivered. Injection is the primary route for clinical administration of protein and peptide drugs, which usually leads to poor patient's compliance. As a portable, minimally invasive device, microneedles (MNs) can overcome the skin barrier and generate reversible microchannels for effective macromolecule permeation. In this review, we highlighted the recent advances in MNs-mediated transdermal delivery of protein and peptide drugs. Emphasis was given to the latest development in representative MNs design and fabrication. We also summarize the current application status of MNs-mediated transdermal protein and peptide delivery, especially in the field of infectious disease, diabetes, cancer, and other disease therapy. Finally, the current status of clinical translation and a perspective on future development are also provided., Graphical abstract Proteins and peptides have become a significant therapeutic modality for various diseases, and microneedles provide a great prospect for the transdermal delivery of proteins and peptides.Image 1

Corneal dystrophies represent a group of progressive, genetically transmitted disorders with variable pathological, histological, and clinical manifestations. Recent ophthalmological examination techniques and genetic investigation methods have brought benefits in the deepening of these conditions. However, many aspects remain unknown, so the results of treatments are unsatisfactory. The aim of this article was to recall the clinical, genetic, histological and treatment types of these conditions.

Background Foot health problems are common in the general population, and particularly so in people with rheumatic and musculoskeletal disorders (RMD). Several clinical guidelines state that people with RMDs should have access to foot health services, although service capacity is often limited. The current COVID-19 pandemic has increased the need for alternative ways to provide patient care. The aim of this clinical audit was to review a newly implemented telephone follow-up appointment service conducted within the Rheumatology Podiatry Department in Leeds, UK. Methods Fifty-eight patients attending the Rheumatology Podiatry Department at Leeds Teaching Hospitals NHS Trust were contacted by telephone approximately 6–8 weeks following initial intervention. During the telephone consultation, all patients were asked pre-defined questions relating to their symptoms, intervention efficacy, the need for further appointments and their preference for the type of consultation. To assess the cost of the telephone consultation the number of attempts needed in order to make successful contact, the duration of the call and the number of telephone follow-up appointments completed in a working day were also recorded. Results Twenty-five patients (43%) were successfully contacted within the 6–8 weeks stipulated time frame and were included in the analysis. Of the 25 contacted, twelve (48%) patients were successfully contacted on the first attempt. Ten (40%) were successfully contacted on the second attempt. The remaining three patients (12%) required 3 or more attempts to make successful contact. Telephone consultations were estimated not to last longer than 10 min, including notes screening and documentation. Eleven patients (44%) reported an improvement in their symptoms, thirteen (52%) reported no change and one patient (4%) reported their symptoms to be worse. Conclusion Telephone follow-up consultations may be a potentially cost-effective alternative to face-to-face appointments when implemented in a Rheumatology Podiatry Department, and provide an alternative way of providing care, especially when capacity for face-to-face contact is limited. The potential cost saving and efficiency benefits of this service are likely to be enhanced when telephone consultations are pre-arranged with patients.

Premature ovarian insufficiency (POI) is a life-changing diagnosis, with profound physical and psychological consequences. Objective. To determine the prevalence, clinical features and hormone characteristics of women with premature ovarian failure of different age group. Materials and methods . During the study we examined 1200 women, aged 18–45 years. Of all examined women, 17 patients with clinical and hormonal signs of POI under the age of 40 were identified. All participants signed an informed consent and underwent general clinical, instrumental and hormonal examination. Statistical analysis was performed using the Statistica 10.0. Results . The prevalence of POI among women of reproductive age was 1.4 % (1200/17). The most common clinical signs: a feeling of «heat», increased sweating and dryness in the vagina. Hot flashes were more often during the manifestation of the disease (50 %). An increase in FSH concentration was noted (26.14 ± 33.4 mIU/mL). The concentrations of thyroid hormone and prolactin were slightly higher in women aged 30–35 years, compared with older patients in the group of women at the onset of the disease in women from 35 to 40. Prolactin levels in women under 35 years old were 431.86 ± 357.82 and 387.13 ± 207.54 mU/L in the patients aged 35–40 years, accordingly (p > 0.05) Conclusion . It was established that the frequency of POF in Eastern Siberia does not differ from the frequency of occurrence of this disease in the world. The progression of clinical manifestations of hypoestrogenism occurs gradually. Hot flashes were the earliest menopausal complaints. In women aged 30–35 years, POI is accompanied by a relatively higher activity of prolactinergic and thyrotropic pituitary functions.

Background. In this article, we present a study that tries to characterize the patient with rectal cancer who addresses the Brașov County Emergency Clinical Hospital (SCJUBv). Aim. The aim of the study is to characterize from an epidemiological and clinical point of view the population group with rectal cancer that addresses the Brașov County Emergency Clinical Hospital, most of them being from Brașov County. We created a profile of the patient with rectal cancer in this area, outlining some risk factors. Material and methods. We conducted a prospective study of patients with rectal cancer hospitalized and operated in SCJUBv between 01.01.2013 and 31.12.2018. They were analyzed according to: age, sex, presence of associated diseases, symptoms at admission, presence of distant metastases, type of surgical treatment applied, local extension and histological type of the tumor. Results. The studied group includes 79 patients hospitalized and operated at the Brașov County Emergency Clinical Hospital. Of these, 49 were men and 30 were women. The average age of the group is 67.76 years. Patients in the study group had multiple associated conditions. The first five places are occupied by the following diseases: hypertensive disorder, ischemic heart disease, anemia, dyslipidemia, type II diabetes. At hospital admission, the patients showed the following symptoms: rectorrhagia, intestinal transit disorders, weight loss, pain in the lower abdomen, perineal pain, loss of appetite, nausea and vomiting. Preoperative imaging examinations (ultrasound, CT) revealed secondary determinations located in the intra-abdominal lymph nodes, hepatic and pulmonary. Rectal amputation was performed in 67 cases and anterior rectal resection with anastomosis in 12 of the cases. The analysis of the histopathological examination bulletins allowed the quantification of the local extension of the tumor. Conclusions. Based on this epidemiological and clinical study, we can draw the "robot portrait" of the patient with rectal cancer hospitalized in SCJU Brașov: is a 67-68 year old male, also presenting cardiovascular diseases with doctor appointment for rectal bleeding and intestinal transit disorders. Surgery will be performed with an amputation of the rectum. The histopathological diagnosis will be G2 adenocarcinoma in most cases

Highlights • Virtual clinics improved adherence to the BOAST COVID-19 guidelines. • An early consultant opinion reduces face to face clinic appointments, rationing resources, improving efficiency and clinical safety. • Virtually assessing the 26 patients who were incorrectly initially seen face-to face would have saved 22 appointments and 13 Xray attendances. • Triaging all patients through virtual clinic improved compliance to the BOAST COVID-19 guidelines to 99%., COVID-19 has had profound management implications for orthopaedic management due to balancing patient outcomes with clinical safety and limited resources. The BOAST guidelines on outpatient orthopaedic fracture management took a pragmatic approach. At Great Western Hospital, Swindon, a closed loop audit was performed looking at a selection of these guidelines, to assess if our initial changes were sufficient and what could be improved. Method: An audit was designed around fracture immobilisation, type of initial fracture clinic assessment, default virtual follow up clinic and late imaging. Interventions were implemented and re-audited. Results: Initially 223 patients were identified over 4 weeks. Of these, 100% had removable casts and 99% did not have late imaging. 96% of patients were initially assessed virtually or had initial orthopaedic approval to be seen in face to face clinic. 97% had virtual follow up or had documented reasons why not. The 26 patients who were initially seen face to face were put through a simulated virtual fracture clinic. 22 appointments and 13 Xray attendances could have been avoided. We implemented a change of requiring all patients to be assessed at consultant level before having a face to face appointment. The re-audit showed over 99% achievement in all areas. Conclusion: Virtual fracture clinics, both triaging new patients and follow-up clinics have dramatically changed our outpatient management, helping the most appropriate patients to be seen face to face. Despite their limitations, they have been well tolerated by patients and improved patient safety and treatment.

The study objective is to investigate clinical features of obsessive autoerotic behavior in men and to develop a complex of therapeutic interventions. Materials and methods Comparison and analysis of psychopathic characteristics of 60 patients were performed. The group 1 included 28 patients with schizoid personality disorder, the group 2 included 14 patients with obsessive compulsive disorder, the group 3 included 18patients with schizotypal disorder. Results. Presence of obsessive autoerotic behavior and its clinical and psychopathological features are considered an important criterion of mental pathology diagnosis. A program of effective therapy and rehabilitation for these disorders is proposed: in patients with schizoid personality disorder — serotoninergic antidepressants and low doses of antipsychotics; in patients with obsessive compulsive disorder — anxiolytics (for several subsequent weeks), selective serotonin reuptake inhibitors and low doses of antipsychotics; in patients with schizotypal disorder — atypical antipsychotics predominantly in combination with selective serotonin reuptake inhibitors. Social rehabilitation of patients is also necessary for all groups. It is directed towards learning social skills of appropriate interactions with the partner considering their needs, capabilities, personal preferences both in intimate relations and everyday life. Conclusion. Features of obsessive autoerotic behavior (pretentiousness, preferring these sexual activities to real sexual contacts with an available partner, persistent character et al.) can serve as a criterion for diagnosis of mental pathology and basis for therapy selection. In selection of medications, clinical manifestations of mental disorders are considered.

COVID-19 has had an unprecedented effect on healthcare with certain services being altered to minimise face-to-face contact. This aim of this project was to explore opinions on routine telephone consultations and whether they could be implemented as COVID pressures change. We randomly selected 100 patients who had a telephone consultation instead of their normal urological follow-up and posted them a questionnaire. We also compared the number of consultations and non-attendances with the pre-COVID era. Seventy percent of patients replied to the questionnaire, and 79% wanted to continue with telephone appointments. Eighty-two percent felt that despite COVID-19, their urological care was unaffected. Generally, the reason that telephone appointments were unacceptable for patients was a preference for face-to-face interaction. The majority expressed a lack of enthusiasm for potential video consultations with only 43% interested in this. Over 95% of patients who required investigations still had these tests performed. There was a reduction in patients who 'did not attend (DNAs)' from 7.5% prior to COVID-19 to 3% during the peak of the pandemic. This study has demonstrated our patients' satisfaction and acceptance of remote consultation and its efficiency in reducing missed appointments during the pandemic. It is now an option our patients can now choose as their mode of follow-up.

Background With among the lowest urologist per population ratios in Europe, the demand for urology specialist review in Ireland far exceeds supply. Lower urinary tract symptoms (LUTS) account for a significant number of referrals. The traditional paradigm of every patient being reviewed in a consultant-led clinic is unsustainable. New models of care with nurse-led clinics represent an opportunity to optimise limited resources. Methods Existing long-waiting male LUTS referrals were triaged to a specialist nurse-led LUTS clinic. After urology CNS assessment, charts were reviewed by a consultant urologist and a plan formulated. Relevant data were prospectively collected and analysed. Results Fifty-eight new male patients with LUTS were seen over a 6-month period with an average waiting time of 15.8 months. Patients were assessed with uroflowmetry, IPSS and DRE. Mean age was 64, IPSS 14.5, Qmax 18.3 ml/s and PVR 89 ml. Thirty patients (52%) were discharged directly with lifestyle modification and medical therapy. Twenty-eight patients (48%) required one or more further investigations and subsequent review; 11 had flexible cystoscopy, 4 had urodynamics, 5 had prostate MRI, and 2 patients were listed for surgery (TURP and circumcision). The remaining 10 patients were for review post trial of lifestyle modifications and/or medical treatment. After review/investigations, 4 more patients were discharged. A total of 32 patients (55%) were discharged or listed for surgery after initial assessment. This total increased to 62% after a second review/investigations. Conclusion Introduction of a CNS-led LUTS clinic has significantly reduced the number of patients requiring follow-up in general urology clinics, representing a quality improvement in service provision. Supplementary Information The online version contains supplementary material available at 10.1007/s11845-020-02428-8.

Purpose. Rhinovirus infection has in the past been perceived as a disease capable of causing mild respiratory symptoms in most cases in children. Modern clinical and epidemiological studies have shown that rhinovirus infection in adults and children and has a moderate and severe course. The aim of this study was to conduct a clinical and laboratory analysis of cases of rhinovirus infection in adult hospitalized patients and evaluate the etiological role of rinoviruses in the epidemic season of 2017/18.Materials and methods. 1013 case histories of patients admitted to the hospital with a diagnosis of SARS were studied. These patients were taken nasopharyngeal swabs were investigated by PCR for the detection of respiratory pathogens. A positive result was obtained with rhinovirus infection of 51 patients.Results. Of the examined patients, 41,6% had influenza, 45,8% had no viruses and 12,6% had other viral infections, of which 40% were due to rhinovirus infection. Among them, young patients prevailed: the median age for men was 31,0 years, for women-27,5 years. The disease occurred in a moderate form – 78,8%, severe course was observed in 5,3% of patients and was accompanied by infectious and toxic shock. Most often the disease occurred with complications acute bronchitis – 22,1%, pneumonia joined in 15,7% of cases.Conclusion. rhinovirus infection ranks first (40%) among non-influenza causes of viral respiratory tract infection in the examined patients. It was registered mainly in young people. In most cases, it proceeded in a moderate form and had a complicated course, including pneumonia.

Objective : to establish the clinical and epidemiological features of acute intestinal infections (AII) in children in the Astrakhan region, depending on the etiological factor, age, season of the year. Materials and methods : a retrospective analysis of the incidence of acute intestinal infections in children in the Astrakhan region for 2019 and 3335 case histories of patients diagnosed with acute intestinal infections, under the age of 17 years, who were treated at the Regional Infectious Clinical Hospital, Astrakhan, during 2019. Research results : Acute intestinal infections of established etiology in children in the Astrakhan region is 35%. Among acute intestinal infections caused by established pathogens, the viral etiology of the disease occurred in 22%, bacterial in 78% of patients. The etiological structure of аcute intestinal infections in children has changed due to an increase in the number of intestinal infections caused by opportunistic bacteria. In the age structure of patients with acute intestinal infections caused by opportunistic bacteria, children of the first year of life dominated (69%). Refined viral diarrhea in 86% of patients proceeded with a topical diagnosis of enteritis, gastroenteritis, bacterial diarrhea proceeded on the type of enterocolitis and colitis in 91% of patients.

The study of the genetic polymorphism rs231775 (+ 49A > G) and rs5742909 (+ 3 18С > Т) of the CTLA-4 gene in 100 children with chronic HBV infection revealed associations only with the carriage of the + 49A/ G polymorphic variant. Moreover, the carriage of the G allele in the homozygous mutant + 49GG position suggested the development of pronounced forms with a progressive course and a high probability of the outcome of the disease in cirrhosis. The established gender differences — the boys' high expression of the minor G-allele of the CTLA-4 gene, especially in the homozygous mutant variation + 49GG — proves the phenomenon of a high incidence of hepatotropic viral infection in boys. Therefore, the carriage of mutant variation + 49GG can be considered among the HOST factors for predicting adverse outcomes of chronic HBV infection in children.

Background: Waiting time is an important factor affecting the satisfaction of outpatients and also one of the indicators for assessing the level of access to health care services as well as service quality. Objectives: The aim of this study was to evaluate the waiting time and satisfaction in outpatients referring to Imam Hossein polyclinic, Zanjan in 2017 using patient flow analysis (PFA). Methods: The present research is a descriptive-analytical study. A total of 392 outpatients were selected using a convenience sampling method. Data were collected using a timing checklist and Patient Satisfaction Questionnaire (PSQ) and analyzed using structural equation analysis and analysis of variance through LISREL 8.5, MINITAB 17.2, SPSS 24, and STATISTICA 12 software. Results: According to the obtained data, the longest average waiting time was in the radiology clinic (27±11 minutes), and the shortest was in the pharmacy (5±3 minutes). Also, the average duration of the examination was 9±9 minutes. The mean patient satisfaction was 3.38 out of 5 (average degree of satisfaction). The results showed that waiting time was inversely related to patient satisfaction and examination time was directly related to satisfaction, and waiting time in the laboratory and admission had the greatest effect on reducing patient satisfaction. Also, the patientchr('39')s waiting time to receive services and the duration of the doctorchr('39')s visit were at an acceptable level and patientschr('39') satisfaction with the waiting time was at a moderate level. Conclusion: Since the radiology clinic was one of the bottlenecks of outpatient facilities in this polyclinic, measures to reduce waiting time and increase patient satisfaction are recommended.

Primary dentists at the era of the National Health Insurance are only paid IDR2,000 each patient. The Capitation funds can not cover the cost of services that must be spent. The payment system must be improved because it is related to the quality of service. The aims of this study to analyze the management and utilization of dental capitation funds including the bottlenecks and to generate solutions in the implementation of JKN. This research was descriptive with qualitative approach. The informants of the study were 16 (sixteen) dentists as an independent practitioners and pratama clinics in Palembang and Lubuklinggau with highest and lowest capitation coverage. Data were analyzed by data reduction, data presentation, conclusion drawing and verification. The result showed that t here was a disparity in capitation fund income received by dentists both as an independent practitioners and pratama clinic. Not all dentists get the ideal number of participants 1: 10,000. Dentists with low capitation norms have difficulty to set their operational funds. The budget for operational cost is bigger than services cost. Revenues compared to capitation funds are still lacking. Most capitation funds for primary dentists are insufficient and still rely on fee for service patients. The government should set dental capitation norm and regulation for National Health Insurance era. Key words : dentist, capitation, clinic, utilization, regulation

Introduction The parent study was a survey in 28 headache centers (6 countries) which identified five potential root causes for long waiting lists that limit patient access to specialist care. Here we performed an extension of the parent study to increase the panel of centers contacted, the representativeness of the analysis, and the statistical validity of the results, and to explore the role of dedicated headache clinics, triage, and specialized nurses. Methods We conducted a 19-question survey using a sample of 239 headache centers (16 countries). The five-area framework identified in the parent study was confirmed and further developed by describing treatment center archetypes according to their setting (general neurology versus dedicated clinic) and resources available within the center (number of healthcare professional [HCPs] full-time-equivalent positions). Results In total, 474 HCPs were interviewed across 16 countries. The proportion of patients with chronic migraine and episodic migraine varied across centers and countries. There was limited access to specialized centers in this enlarged sample; with global average waiting list of 3.7 months for the first visit and 2.5 months for the follow-up visit. Long waiting lists for headache patient care is a major issue in several countries, with the waiting lists for new patient visits extending up to 14 months. The presence of a dedicated nurse was correlated positively with the use of triage for prioritization of patient access (correlation coefficient: 0.85) and completing migraine diary (0.71). Conclusion This study confirmed differences across treatment center archetypes in terms of patients, waiting lists, level of delegation to nurse, and patient education and compliance, and provides support for the potential benefit of dedicated clinical settings for headache patients. The survey highlighted the potential role of nurses in patient education and waiting list prioritization, consequently benefiting headache centers.

In Japan, rotavirus (RV) vaccines have already been introduced but not used for universal vaccination as of 2018. Therefore, we identified cases of severe rotavirus gastroenteritis (RVGE) in children younger than three years of age and investigated the occurrence of infection before and after the introduction of RV vaccines. An ecological study through prospective surveillance was conducted in four pediatric clinics in Shibata City, Niigata Prefecture, Japan, during the 2011 to 2018 RVGE epidemic seasons. We divided the study period into three eras: pre-vaccine introduction era (2011), low-mid coverage transitional era (2012 to 2014, RV vaccine coverage rate: 32.9–56.5%), and high coverage plateau era (2015 to 2018, 67.7–81.7%). In this study, the incidence rate of severe RVGE was significantly lower in the plateau era than in the pre-vaccine introduction and transitional eras. Furthermore, the hospitalization rate due to RVGE in Shibata City was lower in the plateau era than in the pre-vaccination introduction and transitional eras. The number of hospitalizations due to RVGE in subjects who required or did not require intravenous rehydration at the pediatric clinics significantly decreased with the increase in vaccine coverage rates by more than 70% in the plateau era.

Information technology integration is expected to be able to accommodate the ease and improvement in supporting database platforms through intranet and internet infrastructure. Integration is intended to blend desktop and web database systems. Medical Checkup Purwokerto is a designated place to facilitate the checkup health of the official PJTKI Banyumas Disnaker BNP2TKI. The current system, which is a check-up application, is carried out by prospective Indonesian Workers or Medical checkup units, covering many processes including registration, health checks, types, results, payments and reports. There was a buildup of operational activities Clinical work on a daily basis, by the administrator of the medical record so that management aimed at developing a web-based clinical information system includes the scope of the processed database components, access authorization, and security. The method used is the software development life cycle (SDLC) with the Evolutionary Prototype Model. Results, patient data can be integrated as a whole process flow with a client-server network architecture

Background Fibromyalgia (FM) is a common disorder in general population and it causes an increased patient load in hospitals and specialty clinics. FM attendance will be high in clinics dealing with neuropathic pain and other pain syndromes. Though prevalence of FM has been studied in community and pain clinics in other countries, it has not so far been studied in India. So, a study is relevant and hence it was planned in neurology clinic of a teaching government hospital. At present, they are treated mainly by nonsteroidal anti-inflammatory drugs (NSAIDs) which are public health hazard. Methods Using 2016 revision of 2010/2011 American College of Rheumatology criteria of FM, patients were screened in neurology OPD. Proportion and clinical profile were noted. Study was continued for 6 months till the sample size was met. Results A total of 2,300 patients were screened. Two hundred and ninety-eight FM patients were identified among them. Proportion was 12.96%. Delayed diagnosis of more than a year occurred in 55%. Only 29.2% were treated, but none was offered cognitive behavioral therapy (CBT) before. NSAIDs for pain were given for 51.01%. Conclusion Proportion of FM detected is considerable. Affection of homemakers and manual laborers, delayed diagnosis, coexisting comorbid illness, and treatment of pain with NSAIDs are causes of concern. Clinicians should be sensitized to clinical profile and criteria of FM. Patients should be diagnosed and treated by CBT at the earliest and NSAIDs should be avoided as far as possible.

At present, it is difficult to carry out differential diagnosis between schizophrenia, schizoaffective disorder (SAD) and affective disorders (AD), which is caused by a similarity of the clinical features of psychosis exacerbation. A promising direction of improving the quality of differential diagnosis is the study of nosospecific pathopersonological transformations (PpT). Studying of these changes and identifying their clinical differences from the pathopersonology of schizophrenia and AD will allow differential diagnosis with a high level of confidence. The aim of the study was to develop an algorithm for the diagnostic differentiation of SAD and other endogenous psychoses with episodic course (schizophrenia and AD) based on the analysis of clinical-psychopathological, medical- psychological and clinical-ethological features of remission. Contingents and methods. 312 patients were examined at the Municipal Non-Commercial Enterprise “Regional Clinical Institution for Provision of Psychiatric Care” of Zaporizhzhia Regional Council, including 102 patients suffering from AD, 102 persons with SAD and 108 patients diagnosed with “Schizophrenia. Paranoid type. Episodical course”. The main methods of the study were clinical-psychopathological, psychodiagnostical, pathopsychological, clinical-anamnestical, clinical-ethological, as well as medical-statistical analysis. Results. The study developed an algorithm for the diagnostic differentiation of SAD and other endogenous psychoses with episodic course (schizophrenia and AD) based on the analysis of clinical-psychopathological, medical-psychological and clinical-ethological features of remissions / intermissions. The algorithm involves the sequential use of 2 tables (differentiation for the pair of SAD – schizophrenia and SAD – AD), which included features, sorted by decreasing total informative index. Conclusions. The results obtained can be used in the differential diagnosis of endogenous psychosis with the determination of nosological affiliation of the clinical case to the SAD and for use of individually required medico-rehabilitative interventions.

Factor VII deficiency is one of the hereditary coagulation disorders that has autosomal reccessive inheritance and is observed relatively frequently (1/500 000). It is clinically heterogeneous, and may be asymptomatic or lead to life-threatening bleeding. Thus, there is no correlation between FVII activity and clinical findings. Plasma-derived and recombinant FVII concentrates are currently used for treatment. In countries where access to these products is lacking, fresh frozen plasma and prothrombin complex concentrates are also used, though they contain low amounts of factor FVII. In this study, we present the clinical properties, treatments, and surgical interventions used in patients followed up in our clinic with a diagnosis of factor FVII deficiency.Patients who were diagnosed as FVII deficiency in Division of Pediatric Hematology and Oncology between July 1997 and July 2018, were included in the study. The patients' demographic characteristics, symptoms at presentation, PT, aPTT, and FVII values, types of bleeding, and treatments and surgical interventions used, were recorded. The bleedings observed in the patients were classified by severity as asymptomatic, minor, and major.A total of 18 patients (7 girls and 11 boys) with a mean age of 9.64±9.63 years were included in the study. The mean follow-up time was found as 78.06±54.4 months. When the bleedings were classified clinically, no bleeding was observed in eight patients (44.4%). The factor FVII level was found as10% in three of these eight asymptomatic patients and above 20% in the others. Minor bleeding was observed in nine patients (50%) and major bleeding was observed in one patient. When the patients were classified as asymptomatic and symptomatic, there was no significant difference between the two groups in terms of FVII level (p=0.57). A total of 21 surgical interventions were performed in 14 (78%) of 18 patients who were being followed up.FVII deficiency has a very wide spectrum both clinically and in terms of approach to surgical interventions. Therefore, patients with factor FVII deficiency should be followed up and treated by comprehensive care centers with close collaboration of multiple disciplines.Faktör VII eksikliği otozomal çekinik kalıtılan ve nispeten sık görülen (1/500 000) kalıtsal pıhtılaşma bozukluklarındandır. Klinik olarak heterojendir, asemptomatik seyredebildiği gibi yaşamsal kanamalara da yol açabilmektedir. Nitekim FVII aktivitesi ile klinik bulguların arasında korelasyon bulunmamaktadır. Tedavisinde, plazma kaynaklı ve rekombinan FVII konsantreleri kullanılırsa da, bunlara erişimin olmadığı ülkelerde düşük miktarda FVII içermelerine rağmen taze donmuş plazma ve protrombin kompleks konsantreleri de kullanılmaktadır. Bu çalışmada, kliniğimizde izlenen FVII eksikliği tanısı almış hastaların klinik özellikleri, tedavileri ve uygulanan cerrahi girişimler sunulmaktadır.İstanbul Üniversitesi Onkoloji Enstitüsü, Çocuk Hematolojisi ve Onkolojisi Bilim Dalı’nda Temmuz 1997- Temmuz 2018 tarihleri arasında FVII eksikliği tanısı alan hastalar çalışmaya alındı. Hastaların demografik özellikleri, başvuru yakınmaları, PT, aPTT ve FVII değerleri, kanama tipi, tedavileri ve uygulanan cerrahi girişimler kaydedildi. Hastalarda görülen kanamalar ağırlıklarına göre asemptomatik, minör ve majör olarak sınıflandırıldı.Ortalama tanı yaşları 9,64±9,63 olan 7’si kız 11’i erkek toplam 18 hasta çalışmaya alındı. Hastaların ortalama izlem süresi 78,06±54,4 ay idi. Kanamalar klinik olarak sınıflandırıldığında; sekiz hastada (%44.4) herhangi bir kanama gözlenmezken, asemptomatik seyreden sekiz hastanın üçünde FVII düzeyi10, diğerlerinde %20’nin üzerinde idi. Dokuz (%50) hastada minör kanama, ve bir hastada major kanama kaydedildi. Hastalar asemptomatik ve semptomatik olarak sınıflandırıldığında iki grup arasında FVII düzeyi açısından anlamlı farklılık yoktu (p=0,57). İzlenen 18 hastanın 14’üne (%78) toplam 21 cerrahi girişim uygulandı.FVII eksikliği gerek klinik olarak gerekse cerrahi girişimlere yaklaşım olarak çok geniş bir yelpazede yer almaktadır. Bu nedenle, FVII eksikliği tanısı almış hastaların, uzmanlaşmış bir kanama bozukluğu merkezi ve birden çok bilim dalı ile yakın işbirliği içinde izlem ve tedavi edilmesi gerekmektedir.

The article discusses one of the leading problems of modern angioneurology - chronic cerebral ischemia. The main etiological factors playing a significant role in the development of chronic cerebral ischemia, among which atherosclerosis, hypertension, myocardial diseases, diabetes mellitus, etc. play a major role. The main clinical manifestations of this disease are described. The emphasis is on the fact that the main nucleus of the clinical picture of chronic cerebral ischemia is cognitive impairment, which in most cases determines the severity of patients. The development of cognitive impairment is associated with focal or diffuse brain lesions, resulting in the impairment of one or more cognitive functions. Vascular cognitive deficits are the result of acute or chronic cerebrovascular processes. The main causes and mechanisms of vascular cognitive impairment development are presented. It is shown that depending on the mechanism and the cause, the rate of cognitive impairment development may vary. The clinical picture of cognitive impairments developing as a result of the lesion of small brain vessels is described. The peculiarities of vascular cognitive disorders occurring against the background of cerebral hypoperfusion are described. The modern criteria of diagnosis are given. The main diagnostic methods are listed. The main approaches in treatment of patients with chronic cerebral ischemia depending on the disease stage are described. In-depth attention is given to neuroprotection with a more detailed description of the mechanisms of action and clinical efficacy of drugs with active substances - citicoline and ethylmethylhydroxypyridine succinate.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are currently actively used in real clinical practice and everyday life with a wide range of pathological conditions and diseases, and are part of the medicinal arsenal of doctors of various specialties. Along with high pharmacotherapeutic efficacy according to the main indications, a whole range of various complications is associated with the use of NSAIDs. Of particular relevance is the negative specific effect of NSAIDs on the mucous membrane of the gastrointestinal tract. The problem of NSAID gastropathy is widely discussed in the literature, which is largely due to the possibilities of its prevention and treatment using proton pump inhibitors. For a long time, much less attention was paid to the issues of NSAID-dependent bowel damage, which may be associated with less instrumental diagnostic capabilities of these lesions and the lack of effective means for their prevention and treatment. The review presented addresses the pathogenesis, clinical features and diagnosis of NSAID enteropathy. Proton pump inhibitors effectively prevent the development of dyspepsia, erosion and ulcers, as well as gastrointestinal bleeding when taking NSAIDs at the level of the upper gastrointestinal tract, but they are ineffective in preventing and treating NSAID enteropathy. A new approach is the use of rebamipide, which has proven its clinical effectiveness in the prevention of NSAID-mediated Lesions in the upper and Lower gastrointestinal tract. Currently, rebamipid is included in the recommendations of the leading specialized communities in Russia and is recommended not only for the prevention and treatment of NSAIDs induced gastrointestinal lesions, but also as part of the complex therapy of peptic ulcer and anti-heLicobacter therapy. The review reviewed studies showing the efficacy and safety of rebamipide for the treatment and prevention of NSAID enteropathy.

The aim of the work is to study the development of non-alcoholic fatty liver disease (NAFLD) accompanied by changes in the clinical course and general transformation of diagnostic and therapeutic approaches to a patient with comorbid conditions. Materials and methods. A retrospective and prospective analysis of the specialized literature and research on NAFLD associated with comorbid clinical conditions was carried out. Results. The review of the scientific literature provides data on the development of NAFLD associated with comorbidity, the results of clinical studies, as well as own observations. The main causes and risk factors, pathogenesis, prevalence and course of NAFLD, which is a hepatic manifestation of metabolic syndrome, are discussed. The criteria for NAFLD diagnosis, diagnostic capabilities of various invasive and non-invasive methods, and modern approaches to the management of patients are presented. It has been shown that modern NAFLD treatment should take into account all existing risk factors including lifestyle modification, implications for metabolic syndrome components, hepatoprotective therapy, and correction of the intestinal microbiota. Conclusions. NAFLD in modern conditions is one of the most common diseases among the Ukrainian population in the overall structure of the internal organ pathology. Insufficient information on the features of NAFLD comorbid course limits the possibilities of diagnosis and treatment for this category of patients. Thus, the history of the development, progression and treatment of NAFLD comorbid course is constantly being improved.

Amaç: Bu çalışmanın amacı; hastanemizde istenen iç hastalıkları konsültasyonlarının retrospektif olarak incelenmesi ve konsültas-yon istemlerindeki eksikliklerin saptanmasıdır. Materyal ve Metot: 01.09.2017 – 31.10.2017 tarihleri arasında acil servis ve diğer yatan hasta kliniklerinden istenen iç hastalıkları konsültasyonları kayıtlar üzerinden retrospektif olarak incelendi. Hastaların demografik verileri ve konsültasyon istem metinleri kaydedildi. Dört soru ile konsültasyon metinleri yeterlilik açısından değerlendirildi ve puanlandı.Bulgular: 2 aylık sürede toplam 416 konsültasyon cevaplanmıştı. 172 acil servis, 244 diğer servislerdi. Yaş ortalaması acil servis için 62,7, diğer servisler için ise 61,8 idi. Nefroloji her iki grupta da en sık konsültasyon istenen iç hastalıkları yan dalı idi. Konsültasyonların %68 gibi büyük bir çoğunluğu ilk 1 saat içeris-inde sonuçlandırılmıştı. Hastaların %53,5’i için yatış kararı verild-iği görüldü. Her iki grupta da değerlendirme puanlarına bakıldığın-da konsültasyon istem metinlerinin yetersiz olduğu görüldü.Sonuç: Konsültasyon istem metinleri genel olarak yetersiz olup ilgili hekimleri yeterli olarak bilgilendirmemektedir. Danışılan hasta hakkında yeterli bilgi sahibi olmayan konsültan hekimin hasta hakkında doğru karar vermesi zorlaşmaktadır. Bu sebeple konsültasyon istem metinlerinin düzeltilmesi çok önemlidir., Objective: The aim of this study is; retrospectively examining the required internal medicine consultations in our hospital and deter-mining the deficiencies in the consultation requests.Materials and Meyhods: Between 01.09.2017 and 31.10.2017, the internal medicine consultations requested from emergency services and other inpatient clinics were retrospectively reviewed. Demographic data of the patients and the request for consultation were recorded. In four questions, the consultation texts were eva-luated and scored for proficiency.Results: A total of 416 consultations were answered within 2 months. 172 emergency services, 244 other services. The mean age was 62,7 for the emergency services and 61,8 for the other services. Nephrology was the most frequently consulted internal medicine in both groups. A large majority of 68% of the consulta-tions were concluded in the first 1 hour. 53.5% of the patients were admitted to hospital. When the evaluation scores were evalua-ted in both groups, it was seen that the request for consultation was insufficient.Conclusion: Consultation documents are generally inadequate and do not adequately inform physicians. It is difficult for the consul-tant who does not have enough information about the patient to make a correct decision about the patient. For this reason, it is very important to develop consultation request texts.

Environmental change, climate warming, population density increase, high migration activity of the population and other factors provoke the emergence and spread of new infections around the world. The emergence in December 2019 of diseases caused by the new coronavirus («coronavirus disease 2019») has already gone down in history as an emergency of international importance. It is known that the most common clinical manifestation of a new infection is pneumonia, and also in a significant part of patients — respiratory distress syndrome. Our article provides a brief analytical review of these temporary guidelines Ministry of Health of the Russian Federation «Prevention, Diagnosis and Treatment of a New Coronavirus Infection (COVID-19)», version 3 (03.03.20) and other published sources. The team of authors expresses the hope that these data will be useful to doctors in providing medical care to patients with a new coronary virus infection, as well as to teachers in preparing students and residents. Source: Ministry of Health of the Russian Federation. Temporary guidelines «Prevention, diagnosis and treatment of new coronavirus infection (COVID-19)», version 4 (27.03.20). Available on: https://static-3.rosminzdrav.ru/system/attachments/attaches/000/049/881/original/COVID19_recomend_v4.pdf

The intersection between cardiovascular disease and cancer care is relevant to patients with cancer across the health care system. Cancer and cardiovascular disease are the leading causes of death in the United States ([1][1]). In the United States, 48% of adults have cardiovascular disease ([2][2

Aim. Clinical, epidemic and laboratory characterisation of ixodic tick-borne borreliosis in order to improve the early diagnosis of the disease and the timely etiotropic therapy.Materials and methods. The medical histories of 257 patients with ixodic tick-borne borreliosis treated in the regional infectious diseases hospital in Krasnodar from 2004 to 2018 were analysed. The data of the epidemiological history, the clinical manifestations of the disease, the results of laboratory and instrumental studies, as well as the principles of therapy were analysed.Results. The incidence of ixodic tick-borne borreliosis in the Krasnodar Krai is characterised by spring-summer seasonality, the predominance among women over 45, and urban residents. The disease has an acute course (85.9%), occurs mainly in the erythema form with little pronounced symptoms of intoxication, a typical ring-shaped erythema, which large dimensions remain longer in women. During the non-erythemic form of the disease, the development of serous meningitis and encephalomeningitis with impaired cerebral blood fl ow as well as the changes in corticocortical relationships were observed. During the sub-acute course, radiculopathy and polyneuropathy, as well as diffuse changes of the myocardium with conduction disturbance and the development of atrioventricular block, arthralgia and arthritis/arthrosis were registered. The increase in LDH, CPK and transaminase was observed for all forms of the disease.Conclusion. In connection with the formation of a natural ixodic tick-borne borreliosis focus on the territory of the Krasnodar Krai, it is necessary to exclude this disease in patients with the signs of fever, weakness, and erythema at the site of tick suction. The tendency of ixodic tickborne borreliosis to the long course with the development of multiorgan pathology causes the need for follow-up observation of recovered patients both by an infectious disease specialist and narrow specialists (a neurologist, rheumatologist or cardiologist).

Infection by Rhodococcus equi is considered one of the major health concerns for foals worldwide. In order to better understand the disease’s clinical and pathological features, we studied twenty cases of natural infection by R. equi in foals. These cases are characterized according to their clinical and pathological findings and immunohistochemical aspects. Necropsy, histologic examination, bacterial culture, R. equi and Pneumocystis spp. immunohistochemistry were performed. The foals had a mean age of 60 days and presented respiratory signs (11/20), hyperthermia (10/20), articular swelling (6/20), prostration (4/20), locomotor impairment (3/20) and diarrhea (3/20), among others. The main lesions were of pyogranulomatous pneumonia, seen in 19 foals, accompanied or not by pyogranulomatous lymphadenitis (10/20) and pyogranulomatous and ulcerative enterocolitis (5/20). Pyogranulomatous osteomyelitis was seen in 3 foals, one of which did not have pulmonary involvement. There was lymphoplasmacytic (4/20), lymphoplasmacytic and neutrophilic (1/20) or pyogranulomatous arthritis (1/20), affecting multiple or singular joints. Immunohistochemistry revealed to be a valuable tool for the detection of R. equi, confirming the diagnosis in all cases. Furthermore, pulmonary immunostaining for Pneumocystis spp. demonstrates that a coinfection with R. equi and this fungal agent is a common event in foals, seen in 13 cases. RESUMO: Infecção por Rhodococcus equi é considerado um dos maiores problemas sanitários para potros em todo o mundo. Para melhor compreender a apresentação clínica e patológica da enfermidade, foram avaliados vinte casos de infecção natural por R. equi em potros. Os casos são caracterizados de acordo com seus achados clínicos e patológicos e aspectos imuno-histoquímicos. Foram realizados exames de necropsia, histologia, bacteriologia e imuno-histoquímica para R. equi e Pneumocystis spp. Os potros tinham idade media de 60 dias e apresentaram sinais respiratórios (11/20), hipertermia (10/20), aumento de volume articular (6/20), prostração (4/20), distúrbios locomotores (3/20) e diarreia (3/20), entre outros. As lesões mais importantes eram pneumonia piogranulomatosa, vista em 19 potros, acompanhada ou não por linfadenite piogranulomatosa (10/20) e enterocolite ulcerativa (5/20). Osteomielite piogranulomatosa foi constatada em três potros, um dos quais não apresentava envolvimento pulmonar. Artrites afetando uma ou múltiplas articulações eram caracterizadas por infiltrado linfoplasmocítico (4/20), linfoplasmocítico e neutrofílico (1/20) e piogranulomatoso (1/20). A imuno-histoquímica demonstrou ser uma ferramenta valiosa na detecção de R. equi, permitindo confirmar o diagnóstico em todos os casos avaliados. Além disso, a imuno-histoquímica para Pneumocystis spp. demonstra que a coinfecção por R. equi e o agente fúngico é um evento frequente em potros, constatado em 13 casos.

Biomarkers as biological signposts of cancer have become an essential component of oncology drug development. The importance of biomarkers in oncology has grown substantially due to the advent of targeted anti-cancer therapies, which are directed against a specific biological target that tumor cells rely on for their growth. In clinical cancer trials, biomarkers are used for the selection of patients most likely to benefit from a certain (personalized) treatment. Biomarkers can also facilitate the early detection of treatment outcome, which may provide essential guidance for treatment modification or discontinuation. For these reasons, the interest in the use of biomarkers in cancer trials has grown considerably over the past 60 years. Many challenges are encountered in the development of reliable and robust methods used for the measurement of biomarkers. Firstly, biomarkers need to be detected in patient material such as body fluids and tissue that contain a complex mixture (the matrix) of similar endogenous molecules. Secondly, endogenous compounds may affect the stability of a biomarker, or the biomarker is susceptible to post-translational modification. Thirdly, obtaining biomarker-free matrices for the method development is often impossible. Lastly, sometimes a pure and certified biomarker is not available to serve as reference standard. The level of purification of these reference standards may vary considerably between manufacturers, resulting in high lot-to-lot variation of 76% in a European Bioanalysis Forum case study. In this thesis, we focus on the development and validation of diagnostic and pharmacodynamic biomarker methods for the support of (pre)clinical cancer studies. Diagnostic biomarkers provide essential insight into the patient’s disease condition, for instance whether metastases are present. In contrast, pharmacodynamic biomarkers are used to establish whether a cancer drug is hitting its pharmacological target and thereby help to guide the clinical decision making about drug dose and optimal administration schedule. In regard to the importance of biomarkers, laboratory methods for their measurement need to be extensively validated to ensure that the used methods are specific, accurate, precise, and robust. We found, however, that only 13% of the pharmacodynamic biomarker methods used in clinical cancer trials for the past 7 years were fully validated. The majority of biomarker methods used in clinical trials have only partly been validated, which may explain why these methods not always perform as expected in the clinic. It may also be an important factor in the relatively low approval rate of 27% for new cancer drugs in 2018. This lack of validation for clinical cancer biomarker methods may be explained by the absence of international guidelines for their validation. However, since 2018 recommendations for the validation of biomarker methods have existed from the Food and Drug administration. Here, we demonstrate the development of seven cancer biomarker methods, and show that full validation of these biomarker methods is possible. These biomarker methods were designed for high sensitivity and precision to further enhance their clinical usefulness. We successfully applied these fully validated biomarker methods in (pre) clinical cancer studies. The clinical chemistry laboratory of our hospital, Antoni van Leeuwenhoek, has implemented our biomarker method for the detection of epithelial circulating tumor cells as a standard diagnostic tool for the diagnosis of leptomeningeal metastases.

International audience; The conifers, from the latin meaning "cone carrier," include about 650 species distributed in seven families. They are found all over the world, and the most known conifers are the cypresses, the junipers, the yews, the larches, the firs, or the pines. The most allergenic pollen is emitted by the Cupressaceae/Taxaceae family with mainly five different genera: Cupressus, Hesperocyparis, Juniperus, Cryptomeria, and Chamaecyparis. The symptomatic period starts in November and ends in April. In Mediterranean areas, Cupressus sempervirens is the most common pollinating species. Five main cypress allergens have been thoroughly described. Depending on the geographic area and the studied population, the prevalence of cypress allergy in the general population ranges from 0.6% to 3%, and 9-65% of outpatients consulting an allergist are sensitized to cypress pollen. This prevalence is increasing likely to be due to the modifications of the environment. Rhinitis is the most prevalent clinical symptom, while conjunctivitis is the most disabling. Clear-cut improvements of the quality of life are observed upon an effective and safe specific immunotherapy. Associations with food allergy based on molecular allergen crossreactivities were described resulting in sometimes severe symptoms. Pollens from Pinaceae family, especially pines or firs, although abundant, do not demonstrate a significant clinical impact.

BackgroundThe severities of human adenovirus (HAdV) infection are diverse in different areas of Tibet, China, where a large altitude span emerges. Serious consequences may be caused by medical staff if the clinical stages and immunological conditions of patients in high-altitude areas are misjudged. However, the clinical symptoms, immunological characteristics, and environmental factors of HAdV infection patients at different altitude areas have not been well described.MethodsIn this retrospective, multicenter cohort study, we analyzed the data of patients who were confirmed HAdV infection by PCR tests in the General Hospital of Tibet Military Command or CDC (the Center for Disease Control and Prevention) of Tibet Military Command from January 1, 2019, to December 31, 2020. Demographic, clinical, laboratory, radiological, and epidemiological data were collected from medical records system and compared among different altitude areas. The inflammatory cytokines as well as the subsets of monocytes and regulatory T cells of patients were also obtained and analyzed in this study.ResultsSix hundred eighty-six patients had been identified by laboratory-confirmed HAdV infection, including the low-altitude group (n = 62), medium-altitude group (n = 206), high-altitude group (n = 230), and ultra-high-altitude group (n = 188). Referring to the environmental factors regression analysis, altitude and relative humidity were tightly associated with the number of infected patients (P < 0.01). A higher incidence rate of general pneumonia (45.7%) or severe pneumonia (8.0%) occurred in the ultra-high-altitude group (P < 0.05). The incubation period, serial interval, course of the disease, and PCR-positive duration were prolonged to various extents compared with the low-altitude group (P < 0.05). Different from those in low-altitude areas, the levels of IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, G-CSF, GM-CSF, IFN-γ, IP-10, MCP-1, TNF-α, TNF-β, and VEGF in the plasma of the ultra-high-altitude group were increased (P < 0.05), while the proportion of non-classical monocytes and regulatory T cells was decreased (P < 0.05).ConclusionsThe findings of this research indicated that patients with HAdV infection in high-altitude areas had severe clinical symptoms and a prolonged course of disease. During clinical works, much more attention should be paid to observe the changes in their immunological conditions. Quarantine of patients in high-altitude areas should be appropriately extended to block virus shedding.

The quality of provider-interaction determines client satisfaction and decision to seek health care. This research aimed to determine the women clients’ perception of their quality of interaction with the health care providers in a government reproductive health clinic in one of the municipalities in northern Philippines. Respondents consisted of 30 pregnant women who had visited the clinic for prenatal health care check-up were interviewed. A structured questionnaire and a semi-structured guided for probing served as the study’s research instruments. Women perceived the health care providers to possess good communication skills, and had displayed behavior that showed a regard for them. However, the provider-interaction was considered to be unilinear, with the provider perceived to have dominated the interface, The women also perceived only a somewhat evident show of sympathy/empathy. Hostile words were heard frequently. Creation of a two-way interaction with respect for their clients must be considered by the health care providers. Policies must also be formulated to improve the quality of provider-client interaction inside reproductive health clinics.

Aim. To identify confounding factors, features of the clinical course and outcomes of COVID-19 in pregnant and non-pregnant patients of early reproductive age who have no known risk factors and premorbid background. Materials and methods. The study included 163 pregnant women in the third trimester of gestation, 100 non-pregnant women with laboratory-confirmed SARS-CoV-2 infection and 100 pregnant women who did not get sick. Patients of all groups were comparable in age (18–35 years), social status, parity, body mass index, had no known risk factors for COVID-19; those who got sick were treated simultaneously. Results. Statistically significant associations were revealed between COVID-19 infection in the pregnant and iron deficiency anemia, vegetovascular dystonia, belonging to the Buryat ethnicity, and smoking. Pregnant women with COVID-19 were more likely to have no symptoms (23.3% vs 5%; p

Nanoparticles are used in the clinic to treat cancer, resolve mineral deficiencies, image tissues, and facilitate vaccination. As a modular technology, nanoparticles combine diagnostic agents or therapeutics (e.g., elements, small molecules, biologics), synthetic materials (e.g., polymers), and biological molecules (e.g., antibodies, peptides, lipids). Leveraging these parameters, nanoparticles can be designed and tuned to navigate biological microenvironments, negotiate biological barriers, and deliver therapeutics or diagnostic agents to specific cells and tissues in the body. Recently, with the Emergency Use Authorization of the COVID‐19 lipid nanoparticle vaccines, the advantages and potential of nanoparticles as a delivery vehicle have been displayed at the forefront of biotechnology. Here, we provide a 5‐year status update on our original “Nanoparticles in the Clinic” review (also a 2‐year update on our second “Nanoparticles in the Clinic” review) by discussing recent nanoparticle delivery system approvals, highlighting new clinical trials, and providing an update on the previously highlighted clinical trials.

The aim is to determine the epidemiological and cytogenetic profile (Philadelphia chromosome: Ph1) and the bcr-abl gene in patients with chronic myeloid leukemia (CML) and to assess the therapeutic response of patients to hydroxy-urea and Imatinib treatment. From January 1, 2010 to December 30, 2020, an observational study for diagnostic and analytical purposes was carried out in 54 cases of CML at the National Reference University Hospital (CHU-RN) of N’Djamena. All selected patients presented with splenomegaly on physical examination. Significant differences were observed between the proportion of housewives (31.48%) and civil servants (3.70%), emaciated patients (27.84%) and those with fever (3.70%) with the probabilities of 0.001 and 0.001 respectively. Hyperleukocytosis ranged from 100,000-149,000 GB / mm3(42.30%) and the platelet count ranged from 20,000 / mm3to 611,000 / mm3. Polymorphic and massive myeloma was 30-80% of cases, a medullary karyotype with 33.33% Ph1 + chromosome and 66.66% Ph1-, 33.33% bcr-abl transcript and 33.33% transcribed b3 a2 respectively. The treatment regimens were: Hydroxy-Urea (HU) + prednisolone (60%), and Imatinib + prednisolone (40%). Partial hematological remission was obtained in 40% of cases. CML is a condition that occurs at all ages and especially in men in our region. The continuation of this study at the national level will allow the public authorities to achieve national prevalence and to organize effective prevention and early management.

Background and aim: In this study, we aimed to perform a comprehensive analysis of patients with acute hepatic flares observed during the course of chronic hepatitis B infection in order to provide early diagnosis, management, and best characterization of this unique group of hepatitis B patients. Patients and methods: The study was designed in a retrospective and prospective manner. Chronic hepatitis B patients with acute hepatic flares, admitted to the Department of Gastroenterology and Hepatology were enrolled in the study. Demographic, clinical, biochemical, and virological findings were recorded via pre-prepared forms. Results: The study was conducted on 125 patients. The mean age was 34.08 +/- 12.68 and the male to female ratio was determined as 2.28. Over 117 patients (93.6%) had at least one symptom. The most common symptoms and signs were fatigue (81.6%), anorexia (64%), jaundice (60%), and nausea (52%). Anti-HBc immunoglobulin M (IgM) antibody was detected in 24 patients (19.2%) and serum hepatitis B virus (HBV) deoxyribonucleic acid (DNA) was positive in 107 (85.6%) patients. The most common cause of exacerbations was spontaneous hepatic flares (80.8%). Conclusion: According to the results of this single-center study, acute hepatic exacerbations are more common in young men. The disease usually presents with non-specific symptoms and jaundice is the most common finding. As a sign of intensive inflammation and hepatocellular injury, serum ferritin levels seem to be high. Serum HBV DNA and anti-HBc IgM positivity with elevated alpha-fetoprotein (AFP) levels are presenting features of acute hepatic exacerbations.