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Knight, Robert. "The Austrian State Treaty and Beyond." Contemporary European History 10, no. 1 (March 2001): 123–42. http://dx.doi.org/10.1017/s0960777301001060.
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Gerald Stourzh, Um Einheit und Freiheit. Staatsvertrag, Neutralität und das Ende der Ost-West-Besetzung Österreichs 1945–1955 (4. völlig überarbeitete und wesentlich erweiterte Auflage), Studien zu Politik und Verwaltung 62 (Vienna/Cologne/Graz: Böhlau, 1998), 834 pp., ISBN 3-205-98383-1. Günter Bischof, Austria in the First Cold War, 1945–55. The Leverage of the Weak (Basingstoke/London: Macmillan/St. Martin's Press, 1999), 237 pp., ISBN 0-333-72547-6. Lothar Höbelt, Von der vierten Partei zur Dritten Kraft. Die Geschichte des VdU (Graz/Stuttgart: Leopold Stocker Verlag, 1999), 303 pp., ISBN 3-702-00866-7. Anton Pelinka, Austria. Out of the Shadow of the Past, Nations of the Modern World: Europe (Boulder/Oxford: Westview, 1998), 256 pp., ISBN 0-813-32918-3.
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Family, Leila, Su-Jau Yang, Zandra Klippel, Yanli Li, John H. Page, Roberto Rodriguez, and Chun Chao. "Risk of Febrile Neutropenia (FN) in Select Myelosuppressive Chemotherapy Regimens." Blood 126, no. 23 (December 3, 2015): 3257. http://dx.doi.org/10.1182/blood.v126.23.3257.3257.
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Abstract Introduction Febrile neutropenia (FN) is a serious adverse effect of myelosuppressive chemotherapy, which often results in hospitalization and chemotherapy dose modification. FN risk depends on patient characteristics and chemotherapy regimen risk. Understanding the FN risk associated with individual chemotherapy regimens can help guide the use of prophylactic granulocyte colony-stimulating factor (G-CSF) and patient monitoring. To this end, the NCCN has classified regimens into high (≥20%), intermediate (10%-20%), or low (<10%) FN risk based primarily on clinical trial data. However, even for the same regimen, the FN risk is often higher in clinical practice than in clinical trials. In this study, we assessed the FN risk associated with several regimens for which FN risk has not been determined or has shown substantial variability outside of a clinical trial setting, using data from Kaiser Permanente Southern California (KPSC), a large, community-based practice. Methods Included were patients diagnosed with incident non-Hodgkin's lymphoma (NHL), breast cancer (BC), or multiple myeloma (MM) between 2008 and 2013 at KPSC who initiated the following chemotherapy regimens: bendamustine ± rituximab for NHL; docetaxel, carboplatin, and trastuzumab (TCH) or docetaxel and cyclophosphamide (TC) for BC; or Q4W lenalidomide 25 mg/dexamethasone for MM. Bendamustine ± rituximab, TCH, and lenalidomide are not classified by NCCN; TC is classified as intermediate FN risk but has shown considerable variability of FN incidence when used in clinical practice. Data on cancer diagnosis, chemotherapy use, G-CSF use, neutrophil count, and infections were obtained from KPSC's electronic medical records to estimate the incidence proportions of FN and grade 3 and 4 neutropenia. FN was defined as (1) hospitalization with absolute neutrophil count (ANC) <1000/µL or (2) hospitalization with primary or secondary diagnosis codes of neutropenia (ICD-9 288.0x) and fever (ICD-9 780.6), diagnosis code for bacterial/fungal infection, or antibiotic use. Grade 3 neutropenia was defined as ANC ≥500/µL to <1000/µL; grade 4 neutropenia as ANC <500/µL. Patients who received prophylactic G-CSF within 5 days of chemotherapy initiation were excluded from analysis. Results Overall, 40 (12%) NHL patients; 149 (24%) and 340 (28%) BC patients who received TCH and TC, respectively; and 0 (0%) MM patients were excluded due to prophylactic G-CSF. Over the first 6 cycles of bendamustine (median 338.4 mg/m2) ± rituximab for NHL patients (n = 307), 7.2% experienced FN, 4.2% grade 3 neutropenia, and 17.6% grade 4 neutropenia. Over the first 6 cycles of TCH for BC patients (n = 462), 24.2% experienced FN, 10.6% grade 3 neutropenia, and 44.6% grade 4 neutropenia. Over the first 6 cycles of TC for BC patients (n = 859), 20.5% experienced FN, 9.5% grade 3 neutropenia, and 37.5% grade 4 neutropenia. Over the first 4 cycles of lenalidomide/dexamethasone for MM patients (n = 186), 3.8% experienced FN, 5.9% grade 3 neutropenia, and 18.3% grade 4 neutropenia (Table 1). Conclusions Using NCCN criteria, bendamustine ± rituximab for NHL and lenalidomide/dexamethasone for MM would be classified as low-FN-risk regimens (<10%). By contrast, BC regimens TCH and TC would be classified as high-FN-risk regimens (>20%) based on our data. These results could help inform prophylactic G-CSF use for the selected regimens in clinical practice. Table 1. Number and Incidence Proportion of Neutropenic Outcomes Overall and by Cycle Cancer: Regimen Cycle Patients n FN Events n (%) Grade 3 Neutropenia Events n (%) Grade 4 Neutropenia Events n (%) NHL: Bendamustine ± rituximab Overall 307 22 (7.2) 13 (4.2) 54 (17.6) 1 307 12 (3.9) 5 (1.6) 28 (9.1) 2 225 3 (1.3) 4 (1.8) 21 (9.3) 3 173 2 (1.2) 4 (2.3) 15 (8.7) 4 130 2 (1.5) 4 (3.1) 10 (7.7) 5 92 4 (4.4) 4 (4.4) 8 (8.7) 6 69 2 (2.9) 2 (2.9) 0 (0) BC: TCH Overall 462 112 (24.2) 49 (10.6) 206 (44.6) 1 462 70 (15.2) 39 (8.4) 138 (29.9) 2 326 13 (4.0) 15 (4.6) 42 (12.9) 3 282 17 (6.0) 9 (3.2) 39 (13.8) 4 247 6 (2.4) 8 (3.2) 31 (12.6) 5 199 4 (2.0) 6 (3.0) 25 (12.6) 6 169 8 (4.7) 3 (1.8) 12 (7.1) BC: TC Overall 859 176 (20.5) 82 (9.5) 322 (37.5) 1 859 126 (14.7) 51 (5.9) 266 (30.9) 2 649 21 (3.2) 42 (6.5) 82 (12.6) 3 571 19 (3.3) 23 (4.0) 62 (10.9) 4 511 14 (2.7) 22 (4.3) 45 (8.8) 5 94 1 (1.1) 3 (3.2) 9 (9.6) 6 84 2 (2.4) 1 (1.2) 2 (2.4) MM: Lenalidomide / dexamethasone Overall 186 7 (3.8) 11 (5.9) 34 (18.3) 1 186 2 (1.1) 8 (4.3) 17 (9.1) 2 101 3 (3.0) 5 (5.0) 14 (13.9) 3 63 2 (3.2) 2 (3.2) 8 (12.7) 4 37 0 (0) 0 (0) 4 (10.8) Disclosures Family: Amgen Inc.: Research Funding. Klippel:Amgen Inc.: Employment, Equity Ownership. Li:Amgen Inc.: Employment, Equity Ownership. Page:Amgen Inc.: Employment, Equity Ownership.
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Souza-Filho, José Jerônimo de, and Vinicius Ronzani Cerqueira. "Influência da densidade de estocagem no cultivo de juvenis de robalo-flecha mantidos em laboratório." Pesquisa Agropecuária Brasileira 38, no. 11 (November 2003): 1317–22. http://dx.doi.org/10.1590/s0100-204x2003001100010.
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O objetivo deste trabalho foi analisar a influência da densidade de estocagem no crescimento, conversão alimentar e sobrevivência de juvenis de robalo-flecha (Centropomus undecimalis). Os peixes foram coletados em ambiente natural e treinados a aceitar dietas artificiais. Os indivíduos, com comprimento total de 13±0,4 cm e peso de 23±0,3 g foram estocados em tanques circulares de fibra de vidro de 5 m³, com água do mar e aeração contínua, nas densidades de 3, 6 e 9 peixes/m³, por 180 dias. Os valores de amônia total (0 a 0,5 mg/L), temperatura da água (23,3 a 30,6ºC), salinidade (17 a 34 g/L), pH (7,8 a 8,4) e oxigênio dissolvido (4,8 a 6,9 mg/L) apresentaram padrão similar entre os tratamentos. A conversão alimentar (1,88, 2,06 e 2,31) e a sobrevivência (100%, 98,9% e 96,3%) foram significativamente melhores nos tratamentos com 3 e 6 peixes/m³. As médias finais de peso (110, 87 e 80 g) e comprimento total (20, 18,5 e 18 cm) apresentaram diferença significativa. A maior taxa de crescimento foi observada com 3 peixes/m³; entre as demais não houve diferença. Entretanto, a biomassa final (332, 511 e 703 g/m³) foi diretamente proporcional à densidade. A baixa densidade favorece o cultivo do robalo em relação ao crescimento, sobrevivência e conversão alimentar.
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Hanafi, Z., D. R. Corfield, S. E. Webber, and J. G. Widdicombe. "Tracheal blood flow and luminal clearance of 99mTc-DTPA in sheep." Journal of Applied Physiology 73, no. 4 (October 1, 1992): 1273–81. http://dx.doi.org/10.1152/jappl.1992.73.4.1273.
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Tracheal blood flow and 99mTc-labeled diethylenetriamine pentaacetic acid (DTPA) clearance were measured in the sheep trachea in vivo. The tracheal arteries were isolated and perfused. An isolated segment of tracheal lumen was filled with Krebs-Henseleit solution containing 99mTc-DTPA, and radioactivity was measured in blood from a catheterized tracheal vein. Infusions at constant pressure of methacholine (n = 5), albuterol (n = 6), and histamine (n = 5) increased arterial inflow [+250 +/- 73.0, +74.2 +/- 22.9, +68.9 +/- 39.2% (SE), respectively] and venous outflow (+49.5 +/- 13.8, +11.6 +/- 4.5, +6.2 +/- 13.9%) but decreased 99mTc-DTPA output (-36.8 +/- 8.4, -20.4 +/- 6.2, -58.1 +/- 11.7%) and concentration (-53.9 +/- 10.1, -27.3 +/- 7.5, -49.3 +/- 14.4%). Phenylephrine (n = 9) decreased arterial inflow (-49.4 +/- 10.0%) and venous outflow (-4.1 +/- 5.9%) but increased 99mTc-DTPA output (+74.6 +/- 44.2%) and concentration (+94.4 +/- 56.6%). When the tracheal arteries were initially perfused at constant flow and the flow rate was then changed, 50% increases in flow (n = 5) increased perfusion pressure (+35.9 +/- 2.2%) and venous outflow (+10.5 +/- 3.8%) but decreased 99mTc-DTPA output (-24.4 +/- 7.8%) and concentration (-30.4 +/- 8.8%). Decreases in flow of 50% (n = 3) and 100% (n = 10) decreased perfusion pressure (-34.2 +/- 4.2, -80.1 +/- 3.5%, respectively) and venous outflow (-11.0 +/- 4.8, -29.7 +/- 7.2%) but increased 99mTc-DTPA output (+45.9 +/- 27.5, +167.4 +/- 70.4%) and concentration (+64.7 +/- 26.7, +305.7 +/- 110.2%).(ABSTRACT TRUNCATED AT 250 WORDS)
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van der Schee, Cindy, Alex van Belkum, Lisette Zwijgers, Esther van der Brugge, Errol L. O'neill, Ad Luijendijk, Tineke van Rijsoort-Vos, Willem I. van der Meijden, Henri Verbrugh, and Hans J. F. Sluiters. "Improved Diagnosis of Trichomonas vaginalis Infection by PCR Using Vaginal Swabs and Urine Specimens Compared to Diagnosis by Wet Mount Microscopy, Culture, and Fluorescent Staining." Journal of Clinical Microbiology 37, no. 12 (1999): 4127–30. http://dx.doi.org/10.1128/jcm.37.12.4127-4130.1999.
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Four vaginal cotton swab specimens were obtained from each of 804 women visiting the outpatient sexually transmitted disease clinic of the Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands, for validation of various forms of Trichomonas vaginalis diagnostic procedures. One swab specimen was immediately examined by wet mount microscopy, a second swab was placed in Kupferberg's Trichosel medium for cultivation, and two swabs were placed in phosphate-buffered saline (PBS), pH 7.2. The resulting PBS suspension was used for direct staining with acridine orange and fluorescence microscopy, inoculation of modified Diamond's culture medium, and a PCR specific for T. vaginalis. A total of 70 samples positive in one or more of the tests were identified: 31 (3.8%) infections were detected by wet mount microscopy, and 36 (4.4%) were identified by acridine orange staining, as opposed to 40 (4.9%) and 46 (5.7%) positives in modified Diamond's and Trichosel media, respectively. PCR was positive for 61 (7.5%) samples. Secondly, from each of 200 women were obtained a urine sample and a vaginal cotton swab specimen, and 200 urine samples were obtained from men. For the women, 15 (7.4%) of the samples showed a positive result for either the wet mount (n = 1), Trichosel culture (n = 6), PCR on the vaginal swab sample (n = 10), or PCR on the urine specimen (n = 11). Four men (2%) were diagnosed with aT. vaginalis infection. Thus, PCR appears to be the method of choice for the detection of genital infections with T. vaginalis.
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Zebarth, B. J., J. W. Paul, and K. Chipperfield. "Nutrient losses to soil from field storage of solid poultry manure." Canadian Journal of Soil Science 79, no. 1 (February 1, 1999): 183–90. http://dx.doi.org/10.4141/s98-050.
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The study was done to quantify the effect of uncovered field storage of solid poultry manure in south coastal British Columbia on a site where solid Turkey manure was stored uncovered each fall and winter for approximately 6 yr. The soil was sampled to 370 cm depth in a transect with six sampling locations: two in the manure storage area, and two on either side of the manure storage area. The soil was analyzed for the concentrations of total organic C, total Kjeldahl N, ammonium, nitrate, K, P, Mg, and Na in addition to soil pH and electrical conductivity. The mass of nutrients to 370 cm depth was 39 700 and 330 kg NH4+–N ha−1, 500 and 480 kg NO3−–N ha−1, 36 400 and 1440 kg K ha−1, 12 100 and 2190 kg P ha−1, 3150 and 1140 kg Mg ha−1 and 9850 and 975 kg Na ha−1 for the manure storage and non-storage sampling locations, respectively. The depth weighted average soil pH was 8.4 and 4.7 and average soil electrical conductivity was 3.3 and 0.3 dS m−1 for the manure storage and non-storage sampling locations, respectively. The lack of an increase in soil nitrate concentration in the manure storage area was attributed to concentrations of free ammonia in soil solution toxic to nitrifying bacteria. The results highlight the high potential for nutrient loss from uncovered fall and winter field storage of poultry manure in south coastal British Columbia. Key words: Turkey manure, soluble C, soil ammonium, free ammonia, electrical conductivity
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Burtman, V. S., A. V. Dvorova, and S. G. Samygin. "Latitudes of the Eastern Ural microcontinent and Magnitogorsk island arc in the Paleozoic Ural Ocean." LITHOSPHERE (Russia) 20, no. 6 (December 29, 2020): 842–50. http://dx.doi.org/10.24930/1681-9004-2020-20-6-842-850.
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Research subject. Rocks of the Paleozoic Eastern Ural microcontinent and Magnitogorsk island arc occupy a significant part of the Southern Urals and some part of the Middle Urals. The Western Urals are composed of rocks of the ancient Baltic continent and overthrust oceanic rocks. In the Eastern Urals and Trans-Urals rocks of the accretion complexes, oceanic crust, island arcs, the Eastern Ural microcontinent and the Kazakhstan Paleozoic continent are widespread. Rocks are exposed in the Denisov tectonic zone. The Magnitogorsk simatic Island Arc originated in the Ural Ocean, near the Baltic continent, in the early Devonian, developing from the Emsian to the Famennian. A collision between the Magnitogorsk arc and the Baltic continent occurred in the Famennian century. In the pre-Carboniferous age, the Eastern Ural microcontinent was located in the Ural Ocean. In the Tournaisian period, the Eastern Ural microcontinent accreted with the Baltic continent. The Kazakhstan continental massif was located on the other side of the Ural Ocean. The volcanic belt above the subduction zone was active on the edge of the Kazakhstan continent in the Early–Middle Devonian and in the Early Carboniferous. A subduction under the Baltic and Kazakhstan continents consumed most of the crust of the Ural Ocean by the middle of the Bashkir century. As a result, the Baltic continent (together with the Eastern Ural microcontinent) came into contact with the Kazakhstan continent. The formation of folded orogen began in the Moscow century following the collision of sialic terrains.Materials and methods. The research was based on the relevant data obtained by several researchers in 2000–2018 on rock paleomagnetism. Results. The paleolatitudinal positions of the Eastern Ural microcontinent were determined, comprising 5.3 ± 7.4°) in the Middle Ordovician and 8.2 ± 7.2° in the Early–Middle Silurian. The respective paleolatitudinal positions for the Early–Middle Devonian comprised: the Ural margin of the Baltic paleocontinent (7.7 ± 3.7°), the Magnitogorsk island arc (3.2 ± 3.1°) and the Ural margin of the Kazakhstan paleocontinent (20.6 ± 3.8°).Conclusion. According to the analysed paleomagnetic data, in the Early–Middle Devonian, the distance between the latitudes of the margins of the Baltic and Kazakhstan continents was not less than 600 km provided they were in the same hemisphere, and more than 2,300 km provided they were in different hemispheres. The convergence of the terrains was associated with the subduction of the Ural Ocean crust before its closure, which occurred in the Tournaisian century.
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Journal, Baghdad Science. "The effect of Sunn bug Eurygaster intgriceps infection of wheat on the Capability of bread making." Baghdad Science Journal 7, no. 2 (June 6, 2010): 895–900. http://dx.doi.org/10.21123/bsj.7.2.895-900.
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The present study aims to identifying the effect of Eurygaster integriceps infection on the quality features of the local wheat varity IBA 99. The result revealed significant decrease in the percentage of protein of infected wheat at (4, 5)% compared to sound wheat values for the sound wheat were (10.9%) whereas those for the infected wheat were(9.0, 8.4 )% also the result revealed significant increased in the percentage of ash in the infected wheat flour. The result showed significant decrease in the percentage of wet and dry gluten in the infected wheat by sun bug at the rate of (2, 3, 4, 5)% compared to sound wheat value (27, 9% and 25, 23, 22, 22, 20%) for wet gluten and (8.2, 7.8, 7, 7.2, 6%) for dry glutin . The value of sedimentation of the infected wheat decreased as of the infection increased it reached 22 ml for sound wheat and (22, 20, 20, 17, 17,)ml for infected wheat at percentage (1, 2, 3, 4, 5)% respectively. The result of falling number test have also shown significant decreased as infection rate increased, it reached(330) for sound wheat and ( 322,307, 282, 260, 250)second for infected wheat at percentage (1, 2, 3, 4, 5)% respectively. There were no significant different between the specific volume value of product loaf of infected wheat flour by sunn bug at percentage (1, 2, 3)% but the different were significant in specific volum value of infected wheat flour at rate (4 and 5)% compared to sound wheat. The sensitive evaluation of bread referred to no significant differences of quality and baking properties for loaf of infected wheat flour at (1, 2, 3,%) compared to sound wheat but the loaf of infected wheat flour at 4 and 5 % have low quality and baking properties compared to the loaf of sound wheat.
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Kamenicky, Peter, Anne Blanchard, Michael Frank, Sylvie Salenave, Alexia Letierce, Michel Azizi, Marc Lombès, and Philippe Chanson. "Body Fluid Expansion in Acromegaly Is Related to Enhanced Epithelial Sodium Channel (ENaC) Activity." Journal of Clinical Endocrinology & Metabolism 96, no. 7 (July 1, 2011): 2127–35. http://dx.doi.org/10.1210/jc.2011-0078.
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Abstract Background: Soft-tissue swelling and increased extracellular volume, two features of acromegaly, are related to the antinatriuretic effects of excess GH/IGF-I, but the precise pathophysiological mechanism is unclear. Objective: Our objective was to determine the effect of the GH excess on renal and extrarenal epithelial sodium channel (ENaC) activity. Design and Setting: We conducted a prospective randomized open-label blinded-endpoint (PROBE) crossover study (www.ClinicalTrials.gov Identifier: NCT00531908) at a tertiary referral medical center and clinical investigation center. Intervention: Sixteen patients (five females, 11 males) with acromegaly were randomly assigned to receive 20 mg amiloride (an ENaC blocker) and 25 mg furosemide (a Na-K-2Cl cotransporter blocker) under a high-sodium diet to suppress endogenous renin and aldosterone. Measurements: Diuretic-induced changes in the urinary Na/K ratio (reflecting coupling between ENaC-mediated Na reabsorption and distal K secretion) and the intranasal amiloride-sensitive potential (reflecting extrarenal ENaC activity) were measured before and 6 months after (range, 1–12 months) treatment of acromegaly. Results: Serum IGF-I concentrations normalized in all the patients after treatment of acromegaly. Baseline plasma renin and aldosterone concentrations remained unchanged after treatment. Active acromegaly, compared with controlled disease, was associated with an enhanced response [median (interquartile range)] to amiloride [urinary Na/K, 13.9 (9.8–19.5) vs. 6.3 (4.3–8.4) mmol/mmol, P = 0.0003], a reduced response to furosemide [urinary Na/K, 5.2 (4.6–7.2) vs. 7.1 (5.4–8.8) mmol/mmol, P =0.0151], and an increased intranasal amiloride-sensitive potential [5.8 (11.9–3.8) vs. 4.2 (6.4–2.1) mV, P = 0.031], respectively. Conclusion: GH/IGF-I excess in humans is associated with enhanced renal and extrarenal ENaC activity that may contribute to soft-tissue swelling and volume expansion in acromegaly.
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Schils, Frédéric, Benedict Rilliet, and Michael Payer. "Implantation of an empty carbon fiber cage or a tricortical iliac crest autograft after cervical discectomy for single-level disc herniation: a prospective comparative study." Journal of Neurosurgery: Spine 4, no. 4 (April 2006): 292–99. http://dx.doi.org/10.3171/spi.2006.4.4.292.
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Object The authors conducted a study to evaluate and compare prospectively the implantation of either an empty carbon fiber composite frame cage (CFCFC) or an iliac crest autograft after anterior cervical discectomy (ACD) for cervical disc herniation with monoradiculopathy. Methods Thirty-six consecutive patients with one-level radiculopathy due to single-level cervical disc herniation were treated by ACD, and implantation of either an empty CFCFC (24 patients) or an iliac crest autograft (12 patients). Radiological and clinical assessments were performed preoperatively, immediately postoperatively; and at 3, 6, and 12 months postoperatively. Fusion, at the 12-month follow-up examination was demonstrated in 96% of the patients in the cage group and in 100% of those in the autograft group. The mean anterior intervertebral body height was 3.7 mm preoperatively and 3.9 mm at 12 months in the CFCFC, and 4.1 and 3.8 mm, respectively, in the autograft group. In cage-treated patients, neck pain, as measured using the visual analog scale (VAS) (Score 0 = minimum; 10 = maximum) decreased from 6.4 preoperatively to 2.0 at 12 months, and radicular pain, decreased from 8.4 preoperatively to 1.5 at 12 months. In the autograft group, neck pain changed from a mean preoperative VAS score of 7.2 to 2.5 at 12 months, and radicular pain decreased from a preoperative mean of 7.8 to 1.4 at 12 months. Analysis of the 12-Item Short Form Health Survey domains and the Oswestry Disability Index scores indicated a significant improvement in both the Physical and Mental Component Summary domains in both groups. Conclusions Implantation of an empty CFCFC or a tricortical iliac crest autograft after ACD are safe and reliable options for the treatment of cervical disc herniation causing one-sided radiculopathy. Both procedures produced equally satisfying clinical and radiological results, leading to a high fusion rate and maintaining intervertebral height. Implantation of an empty CFCFC has the advantages of avoiding any donor site morbidity and requiring a significantly shorter operative time.
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Ukaga, C. N., S. O. Sam-Wobo, R. H. Muhammed, H. O. Mogaji, O. A. Surakat, M. M. Suleiman, C. Egbuche, C. A. Ekwunife, and G. N. Wokem. "Low First Wave COVID-19 cases and health seeking behaviors across the six geopolitical zones of Nigeria." Nigerian Journal of Parasitology 42, no. 1 (April 14, 2021): 1–8. http://dx.doi.org/10.4314/njpar.v42i1.1.
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This study was carried out across the six geopolitical zones to assess knowledge and health seeking behaviors of Nigerians during the first wave of COVID-19 pandemic lockdown in order to understand the seemingly low cases of COVID-19 in Nigeria. Structured and pretested short questionnaires were employed to obtain information electronically and physically across the six geopolitical zones on socio-demographic characteristics of participants; the knowledge of participants on COVID-19 disease; availability and accessibility to testing and isolation centers in the communities, attitudes and health seeking behaviors. Atotal of 1023 respondents; 705 (68.9%) males and 318 (31.1%) females across the six geopolitical zones in Nigeria participated in this study with 477(46.6%) within the 26-45 years age category, and 6(0.6%) above 66 years. Atotal of 985(96.3%) had heard about COVID-19 at the time of survey while a total of 859(84.0%) of the respondents were aware of the presence of COVID-19 laboratory testing centers. Across the geopolitical zones, majority of the respondents 487(47.6%) claimed there are no routine testing for COVID-19 at their community level, while 303 (29.6%) affirmed otherwise and 216(21.1%) did not know if there were routine testing going on or not. On health seeking behaviors across the country, majority of the respondents 558(54.5%) affirmed they would visit the hospital as the first point of contact if the opportunitypresented itself, 244(23.9%) claimed they would call the NCDC toll line, 2(0.2%) said they would use prayers, while 1(0.1%) respectively claimed they would use home management strategies through visiting chemist stores and checking the internet for solutions. Findings from this study confirm that there is very high awareness of the COVID-19 disease across the country, and limited number of testing centers at the community level. The implications include the possibility of unreported COVID19 cases in the cities as well as in the communities.
Keywords: COVID-19, knowledge, health seeking behaviors, community level
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Pinzón Ardila, Omar. "Modelado de un Recuperador Dinámico de Tensión para el Mejoramiento de la Calidad de la Onda de Tensión." BISTUA REVISTA DE LA FACULTAD DE CIENCIAS BASICAS 14, no. 1 (May 4, 2016): 62. http://dx.doi.org/10.24054/01204211.v1.n1.2016.1938.
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Liu, Z., L. Lai, G. Im, M. Samuel, D. Wax, and R. S. Prather. "318EFFECT OF PIG FOLLICLE FLUID AND FETAL CALF SERUM ON PORCINE OOCYTE MATURATION AND SUBSEQUENT DEVELOPMENT AFTER ACTIVATION AND SOMATIC CELL NUCLEAR TRANSFER." Reproduction, Fertility and Development 16, no. 2 (2004): 278. http://dx.doi.org/10.1071/rdv16n1ab318.
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In vitro maturation of porcine oocytes is very important for understanding porcine somatic cell nuclear transfer (SCNT). In order to develop an in vitro maturation system that can provide more high quality oocytes, the effect of porcine follicle fluid (pFF) (gathered from 3–5-mm porcine follicles) and fetal calf serum (FCS: Sigma, St. Louis, MO, USA), as an important additional component of a chemically-defined medium was studied. Cumulus-oocyte complexes (COC) derived from follicles 3–5mm in diameter were cultured in three different media: a chemically-defined medium (CDM: TCM-199 with 0.1mgmL−1 cysteine, 10ngmL−1 EGF, 0.5μgmL−1 LH and 0.5μgmL−1 FSH); CDM with 10% pFF (CDM+p); and CDM with 10% FCS (CDM+F). After 42–44h of maturation, oocytes with a clear polar body were classified as matured oocytes. Matured oocytes stimulated by electric pulse (120v, 30μs, 2 pulse), or enucleated and fused with fibroblasts to construct SCNT embryos by using the same electrical parameters. All of these parthenogenetic and SCNT embryos were cultured in Porcine Zygote Medium-3. The blastocyst rate was assessed under a stereomicroscope on Day 6, and the number of nuclei in the blastocysts was counted under a fluorescent microscope after staining with 5μgmL−1 of Hoechst 33342. All data were subjected to a Generalized Linear Model Procedure (PROC-GLM) of Statistical Analysis System (SAS). The maturation rates of porcine oocytes in CDM and CDM+p were 53.2±3.8% (539/1050) and 69.7±3.8% (587/847), respectively;; in CDM and CDM+F, 61.1±3.1% (471/776) and 70.2±3.7% (577/844), respectively. Oocytes matured in CDM+p and CDM+F showed a higher (P<0.05) maturation rate than those in CDM. The percentages of parthenogenetic blastocysts of oocytes matured in CDM and CDM+p were 13.9±2.1% (35/250) and 20.2±5.3% (64/300), and the numbers of nuclei in these blastocysts were 25.8±2.3 and 25.8±1.4, respectively. The blastocyst rate from CDM- and CDM+F-matured oocytes were 20.1±2.0% (53/272) and 22.2±4.7%(71/298), and the numbers of nuclei in these blastocysts were 24.7±1.5 and 25.3±1.5, respectively. There were no significant (P>0.05) differences in the percentages of parthenogenetic blastocysts and nuclei numbers between CDM and CDM+p, or CDM and CDM+F. The percentages of blastocysts in SCNT embryos derived from CDM and CDM+p were 8.1±1.5% (14/192) and 12.3±1.9% (24/192), while the nuclei numbers in these blastocysts were 26.6±1.2 and 34.5±2.2, respectively. The percentages of blastocysts after SCNT from oocytes matured in CDM and CDM+F were 24.3±4.9% (35/139) and 27.1±5.5% (45/176), while the numbers of nuclei were 29.8±2.5 and 32.2±1.9, respectively. There were no significant (P>0.05) differences between CDM and CDM+p, or CDM and CDM+F in SCNT embryo blastocyst rate, but the SCNT embryos derived from CDM+p showed a higher (P<0.05) nuclear number. In conclusion, these results indicate that 10% pFF or FCS in CDM can promote a higher maturation rate of porcine oocytes. As recipient cytoplasm for SCNT, oocytes matured in CDM+p can support development of blastocysts that contain more nuclei than those matured in CDM alone. Supported in part by Food for the 21st Century and RR13438.
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Hunter, Ruth F., Aisling Gough, Jennifer M. Murray, Jianjun Tang, Sarah F. Brennan, Oliver J. Chrzanowski-Smith, Angela Carlin, et al. "A loyalty scheme to encourage physical activity in office workers: a cluster RCT." Public Health Research 7, no. 15 (August 2019): 1–114. http://dx.doi.org/10.3310/phr07150.
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Background Increasing physical activity in the workplace can provide physical and mental health benefits for employees and economic benefits for the employer through reduced absenteeism and increased productivity. However, there is limited evidence on effective behaviour change interventions in workplace settings that led to maintained physical activity. This study aimed to address this gap and contribute to the evidence base for effective and cost-effective workplace interventions. Objectives To determine the effectiveness and cost-effectiveness of the Physical Activity Loyalty scheme, a multicomponent intervention based on concepts similar to those that underpin a high-street loyalty card, which was aimed at encouraging habitual physical activity behaviour and maintaining increases in mean number of steps per day. Design A cluster randomised controlled trial with an embedded economic evaluation, behavioural economic experiments, mediation analyses and process evaluation. Setting Office-based employees from public sector organisations in Belfast and Lisburn city centres in Northern Ireland. Participants A total of 853 participants [mean age 43.6 years (standard deviation 9.6 years); 71% of participants were female] were randomly allocated by cluster to either the intervention group or the (waiting list) control group. Intervention The 6-month intervention consisted of financial incentives (retail vouchers), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of the workplaces allowed participants to monitor their accumulated minutes of physical activity. Main outcome measures The primary outcome was mean number of steps per day recorded using a sealed pedometer (Yamax Digiwalker CW-701; Yamax, Tasley, UK) worn on the waist for 7 consecutive days and at 6 and 12 months post intervention. Secondary outcomes included health, mental well-being, quality of life, work absenteeism and presenteeism, and the use of health-care resources. Results The mean number of steps per day were significantly lower for the intervention group than the control group [6990 mean number of steps per day (standard deviation 3078) vs. 7576 mean number of steps per day (standard deviation 3345), respectively], with an adjusted mean difference of –336 steps (95% confidence interval –612 to –60 steps; p = 0.02) at 6 months post baseline, but not significantly lower at 12 months post baseline. There was a small but significant enhancement of mental well-being in the intervention group (difference between groups for the Warwick–Edinburgh Mental Wellbeing Scale of 1.34 points, 95% confidence interval 0.48 to 2.20 points), but not for the other secondary outcomes. An economic evaluation suggested that, overall, the scheme was not cost-effective compared with no intervention. The intervention was £25.85 (95% confidence interval –£29.89 to £81.60) more costly per participant than no intervention and had no effect on quality-adjusted life-years (incremental quality-adjusted life-years –0.0000891, 95% confidence interval –0.008 to 0.008). Limitations Significant restructuring of participating organisations during the study resulted in lower than anticipated recruitment and retention rates. Technical issues affected intervention fidelity. Conclusions Overall, assignment to the intervention group resulted in a small but significant decline in the mean pedometer-measured steps per day at 6 months relative to baseline, compared with the waiting list control group. The Physical Activity Loyalty scheme was deemed not to be cost-effective compared with no intervention, primarily because no additional quality-adjusted life-years were gained through the intervention. Research to better understand the mechanisms of physical activity behaviour change maintenance will help the design of future interventions. Trial registration Current Controlled Trials ISRCTN17975376. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 15. See the NIHR Journals Library website for further project information.
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Schulman, Sam, Henry Eriksson, Ajay Kakkar, Clive Kearon, Sebastian M. Schellong, Patrick Mismetti, Martin Feuring, Stefan Hantel, Joerg Kreuzer, and Samuel Z. Goldhaber. "Influence of Age and Renal Function on Efficacy and Safety of Dabigatran Versus Warfarin for the Treatment of Acute Venous Thromboembolism: A Pooled Analysis of RE-COVER™ and RE-COVER™ II." Blood 124, no. 21 (December 6, 2014): 594. http://dx.doi.org/10.1182/blood.v124.21.594.594.
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Abstract Background: In the RE-COVER™ and RE-COVER™ II trials, dabigatran etexilate (DE) was as effective as warfarin (W) for prevention of recurrent venous thromboembolism (VTE) in patients with acute VTE, and was associated with a lower risk of bleeding. Objectives: Older patients and patients with renal impairment may be at greater risk of bleeding and/or VTE. In this post-hoc analysis of the pooled dataset from RE-COVER™ and RE-COVER™ II, we assessed rates of VTE recurrence and bleeding with DE and W in patients below and above 75 years according to renal function (normal, or mildly or moderately impaired). Methods: Patients with acute VTE, initially on parenteral anticoagulation, were randomized to either W (started in parallel; international normalized ratio range 2.0‒3.0) or DE 150 mg twice daily for 6 months. Primary efficacy outcome was recurrent, symptomatic VTE/VTE-related death from randomization to the end of the prespecified post-treatment follow-up. Safety outcomes included centrally adjudicated major bleeding events (MBEs), the composite of MBEs or clinically relevant non-major bleeding events (MBEs/CRBEs), and any bleeds from the start of the double-dummy period (treatment with oral DE or W alone) to the end of the 6-month period. Patients with creatinine clearance (CrCL) ≤ 30 mL/min (hence not meeting inclusion criteria) were excluded from this analysis. Results: In all patients aged < 75 years, recurrent VTE/VTE-related death occurred in 65/2241 (2.9%) and 52/2218 (2.3%) patients with DE and W, respectively. In the analysis by renal function, event rates for DE vs W in subgroups with CrCL ≥ 80 (normal), 50–< 80 (mild renal dysfunction), and 30–< 50 mL/min (moderate renal dysfunction), respectively, were 3.1% (57/1828) vs 2.5% (45/1780), 2.1% (8/381) vs 1.5% (6/403), and 0% (0/32) vs 2.9% (1/35). In all patients aged ≥ 75 years, recurrent VTE/VTE-related death occurred in 3/272 (1.1%) and 10/304 (3.3%) patients with DE and W, respectively. Event rates for DE vs W in the normal, mild and moderate renal dysfunction subgroups, respectively, were 3.1% (1/32) vs 5.2% (3/58), 1.3% (2/158) vs 1.9% (3/158), and 0% (0/82) vs 4.5% (4/88). For the safety endpoints, in all patients aged < 75 years, MBEs occurred in (DE vs W, respectively) 16/2169 (0.7%) vs 29/2146 (1.4%) patients, MBEs/CRBEs in 87/2169 (4.0%) vs 153/2146 (7.1%) patients, and any bleeding in 303/2169 (14.0%) vs 430/2146 (20.0%) patients. The table shows event rates by renal function; bleeding rates in this age group were numerically lower for DE than W across all categories of renal function, except for rates of MBEs in patients with moderate dysfunction (6.7% vs 6.5%). Among the older patient group, bleeding event rates for DE vs W were 8/252 (3.2%) vs 11/287 (3.8%) for MBEs, 21/252 (7.9%) vs 35/287 (12.2%) for MBEs/CRBEs, and 48/252 (18.3%) vs 68/287 (23.0%) for any bleeding. The table shows event rates by renal function; the incidences of bleeding were numerically lower for DE vs W across all categories of renal function in older patients, except for MBEs (5.3% vs 3.6%) and MBEs/CRBEs (11.8% vs 9.6%) in the subgroup with moderate renal dysfunction. TablePatientsMBEsPatients, n/N (%)MBEs/CRBEsPatients, n/N (%)Any bleedsPatients, n/N (%)Age(year)CrCL (mL/min)DEWDEWDEW< 7530‒< 502/30 (6.7)2/31 (6.5)3/30 (10.0)4/31 (12.9)6/30 (20.0)8/31 (25.8)50‒< 805/359 (1.4)10/387 (2.6)26/359 (7.2)43/387 (11.1)70/359 (19.5)90/387 (23.3)≥ 809/1780 (0.5)17/1728 (1.0)58/1780 (3.3)106/1728 (6.1)227/1780 (12.8)332/1728 (19.2)≥ 7530‒< 504/76 (5.3)3/83 (3.6)9/76 (11.8)8/83 (9.6)15/76 (19.7)21/83 (25.3)50‒< 804/145 (2.8)6/149 (4.0)10/145 (6.9)23/149 (15.4)27/145 (18.6)35/149 (23.5)≥ 800/31 (0.0)2/55 (3.6)1/31 (3.2)4/55 (7.3)4/31 (12.9 )10/55 (18.2) Conclusions: In DE-treated patients, no increase in VTE recurrence was apparent for older (≥ 75 years) vs younger (< 75 years) patients. Recurrent VTE rates decreased with declining renal function. Bleeding events increased with declining renal function in both age groups irrespective of treatment, but in most subgroups were numerically less frequent with DE than with W. Disclosures Schulman: Boehringer Ingelheim: Consultancy, Honoraria, Research Funding; Bayer HealthCare: Consultancy, Honoraria, Research Funding. Eriksson:Boehringer Ingelheim: Consultancy; BMS: Consultancy; Pfizer: Consultancy. Kakkar:Boehringer Ingelheim: Consultancy, Honoraria, Research Funding; Pfizer: Consultancy, Honoraria, Research Funding; BMS: Consultancy, Honoraria, Research Funding; Daiichi: Consultancy, Honoraria, Research Funding; Bayer: Consultancy, Honoraria, Research Funding; Sanofi: Consultancy, Honoraria, Research Funding; Eisai: Consultancy, Honoraria, Research Funding. Kearon:Bayer Healthcare: Consultancy; Boehringer Ingelheim (Canada): Consultancy. Schellong:Daiichi Sankyo: advisory boards, advisory boards Other, Honoraria; Bayer Healthcare: advisory boards, advisory boards Other, Consultancy, Honoraria; BMS/Pfizer: Honoraria; Boehringer Ingelheim: advisory boards Other, Consultancy, Honoraria. Feuring:Boehringer Ingelheim: Employment. Hantel:Boehringer Ingelheim: Employment. Kreuzer:Boehringer Ingelheim: Employment. Goldhaber:Boehringer Ingelheim: Consultancy; Daiichi: Consultancy, Research Funding; BMS: Consultancy, Research Funding; Janssen: Consultancy; Merck: Consultancy; Pfizer: Consultancy; Portola: Consultancy; Sanofi-Aventis: Consultancy.
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Leitch, Heather A., Hatoon Ezzat, Meaghan D. Rollins, Dominic H. C. Wong, Chantal S. Leger, Khaled M. Ramadan, Michael J. Barnett, and Linda M. Vickars. "Transfusion Dependence in Patients with Primary Myelofibrosis Has a Negative Impact on Survival Independent of Decreased Myelopoiesis." Blood 110, no. 11 (November 16, 2007): 4653. http://dx.doi.org/10.1182/blood.v110.11.4653.4653.
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Abstract Primary myelofibrosis (PMF) is a myeloproliferative disorder characterized by progressive bone marrow failure, extramedullary hematopoiesis and risk of progression to blast phase (BP). Many PMF patients (pts) require red blood cell (RBC) transfusions, risking iron overload (IOL)-related organ dysfunction. Pts with myelodysplastic syndrome and RBC transfusion dependence (TD) have worse overall survival (OS), which may be improved by iron chelation therapy (ICT). To assess the effect of TD and ICT on survival in PMF, we reviewed 30 pts seen from 1985 to 2007 with a marrow biopsy confirmed diagnosis. 21 pts were male and 9 female and median age at Dx was 66.5 (range 43–84) years (y). ECOG Performance Status; 0, n=13; 1, n=9; 2, n=7; 3, n=1. WBC count was <4.0 or >30x109/L at diagnosis in 5 pts, and hemoglobin (Hb) <100G/L in 14. Karyotype in 13 pts: normal, n=11; del (6)(q25), n=1; complex, n=1. Lille Prognostic Score was: 0, n=10; 1, n=11; 2, n=4. 20 pts were RBC-TD with total units (U) transfused: 1–20, n=6; 21–50, n=3; >50, n=11. Initial PMF treatment was: supportive care, n=21; low-dose chemotherapy, n=4; immunomodulatory, n=3; splenectomy, n=2. Clinical evidence of IOL, n=14 total: CHF, n=4; liver disease, n=3; endocrine, n=3; ferritin ≥1000 ug/L at Dx, n=6. Baseline features that differed between transfusion-independent (TI) and TD and between non-ICT-TD and ICT pts: total RBCU transfused (p=0.0001 and p=0.03) and evidence of IOL (p=0.003 and p=0.06), respectively. 5 pts received ICT for a median of 75.7 (range 2.9–117) months (mo); 4 received desferrioxamine (DFO) 0.5–3g by subcutaneous infusion 12 h/d, 5 d/wk and 2 received deferasirox (1 switched from DFO). At a median follow-up (FU) of 58.8 (0.1–243.7) mo, 2 non-ICT pts and 1 ICT pt progressed to PMF-BP; 2 received chemotherapy and all 3 died of progressive BP within weeks. Median OS for all pts, TI, TD and ICT pts was: 102.1 (14.4–243.7) mo; not reached at 204.9 mo; 60.8 (14.4–243.7) mo and 83.6 (60.8–202.9) mo and 5y OS was 67%; 100%; 55% and 66% respectively (p=0.014 for TD vs. TI). Factors significant for OS were: RBC-TD (p=0.014, hazard ratio [HR] 43.6, confidence intervals [CI] 41–46.2); increasing RBC transfusion requirement (TR; 2 fold change in RBCU/4wk; p=0.018, HR 5.0 [4.3–5.7]); Hb<100G/L (p=0.03, HR 3.8, [3.2–4.4]); total RBCU transfused (p=0.0001, HR 1.3 [1.0–1.6]). 12 TD pts (60%) died: cardiac, n=3; infection, n=3; bleeding, n=2 (1 ICT pt); PMF-BP, n=3; unknown, n=1. Initial/pre-ICT mean ± standard error (se) ferritin was 2337±1038ug/L in ICT pts and 506±466ug/L in non-ICT pts, and FU ferritin decreased in ICT pts to 1902±428ug/L (p=0.03) and was 824±445ug/L in non-ICT pts (p=NS). Initial and FU neutrophil counts (NC) in ICT pts were a mean ±se of 4.7±1.6 and 5.0±1.7 vs. 7.2±1.5 and 20.6±7.7 x109/L in non-ICT pts; platelet counts (PLTC) were 432±89; 527±208; 293±50; and 203±36 x109/L respectively and RBCU transfused/4 wk were 2.3±0.6; 3.3±0.8; 1.3±0.3; 1.8±0.4 (p=NS for all and for TI vs. TD NC and PLTC). In conclusion, 67% of pts with PMF developed RBC-transfusion dependence, which portended worse OS. However, there was no significant decrease in neutrophil or platelet counts or increase in RBC transfusion requirements. This suggests the effect of TD on OS was not from impaired myelopoiesis alone, and that there may be an impact of IOL secondary to TD on outcome. Prospective studies of ICT in PMF pts are warranted.
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Engert, Andreas, Heinz Haverkamp, Carsten Kobe, Jana Markova, Christoph Renner, Anthony D. Ho, Josée Zijlstra, et al. "Reduced Intensity of Chemotherapy and PET-Guided Radiotherapy in Patients with Advanced Stage Hodgkin Lymphoma: The GHSG HD15 Final Results." Blood 118, no. 21 (November 18, 2011): 589. http://dx.doi.org/10.1182/blood.v118.21.589.589.
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Abstract Abstract 589FN2 Purpose: Intensified chemotherapy with eight cycles of BEACOPPescalated in advanced stage Hodgkin lymphoma (HL) is highly effective but also associated with relevant treatment related toxicity. In addition, the need for radiotherapy in this setting is unclear. To reduce toxicity without losing efficacy the German Hodgkin Study Group thus conducted the prospective randomized clinical HD15 trial investigating two less intensive chemotherapy variants, followed by positron emission tomography (PET) guided radiotherapy. Methods: Between January 2003 and April 2008, 2182 patients with newly diagnosed, histology-proven HL aged 18–60 years were included. Patients in Ann-Arbor stage IIB with large mediastinal mass or extranodal lesions, or those in stage III or IV were randomly assigned to receive either eight cycles of BEACOPPescalated (8Besc), six cycles of BEACOPPescalated (6Besc), or eight cycles of BEACOPP14 (8B14). After completion of chemotherapy, patients in partial response (PR) with a persistent mass measuring 2.5 cm or more were assessed by PET. Only patients who were positive on centrally-reviewed PET scan received additional radiotherapy (RT) with 30Gy. The study was designed to show non-inferiority for the primary endpoint, freedom from treatment failure (FFTF). Other endpoints included overall survival, tumor response, side effects of treatment and progression-free survival (PFS) after PET. Results: The full analysis set comprised 2126 patients, 705 with 8Besc, 711 with 6Besc and 710 with 8B14. Baseline characteristics were balanced between groups with a median age of 33 years and 334 patients (15.7%) in stage II disease. 682 patients (32.1%) had an International Prognostic Score (IPS) of 0–1, 1115 (52.4%) of 2–3, and 329 (15.5%) of 4–7. Hematological toxicities occurred in 92.4% (8Besc), 91.7% (6Besc), and 79.7% (8B14) of cases. After a median follow-up of 48 months, there were 53 deaths (7.5%) in the 8Besc group, 33 (4.6%) in the 6Besc group and 37 (5.2%) in the 8B14 group. The higher number of deaths in the 8Besc group mainly resulted from acute toxicity of chemotherapy (15 vs. 6 vs. 6) and secondary neoplasms (13 vs. 5 vs. 8). There were 72 secondary cancers including 29 secondary acute myeloid leukemias and myelodysplastic syndroms, 19 (2.7%) after 8Besc, 2 (0.3%) after 6Besc and 8 (1.1%) after 8B14. Complete response (CR) was achieved in 90.1% of patients after 8Besc, in 94.2% after 6Besc and in 92.4% after 8B14 (p=0.01). FFTF at 5 years was 84.4% in the 8Besc group, 89.3% in the 6Besc group (97.5% confidence interval (CI) for difference 0.5% to 9.3%), and 85.4% in the 8B14 group (97.5 CI −3.7% to 5.8%), respectively (see figure). Accounting for planned interim analyses, both 97.5 repeated CIs for the hazard ratio excluded the non-inferiority margin of 1.51 (8Besc vs. 6Besc, 0.44 to 1.02; 8Besc vs. 8B14, 0.62 to 1.36). Overall survival at five years was 91.9%, 95.3%, and 94.5%, and was also better with 6Besc compared to 8Besc (97.5% CI 0.2% to 6.5%). PFS results were similar to FFTF. Per-protocol and subgroup analyses supported the primary analysis. PET scans performed after chemotherapy were centrally reviewed in 822 patients of whom 739 were in PR with residual mass ≥ 2.5 cm having no other exclusion criteria. 548 patients were PET-negative (74.2%) and 191 were PET-positive (25.8%). Importantly, PFS was comparable between patients in CR or those in PET-negative PR after chemotherapy with 4-year PFS rates of 92.6% and 92.1%, respectively. Only 11% of all patients in HD15 received additional RT as compared to 71% in the prior HD9 study. Conclusion: Six cycles of BEACOPPescalated followed by PET-guided RT are more effective and less toxic compared to 8 cycles in patients with advanced stage HL. In particular, critical toxicities observed with 8 cycles where reduced with 6 cycles of BEACOPPescalated. PET performed after chemotherapy can guide the need of additional RT in this setting and reduces the number of patients requiring RT. Disclosures: No relevant conflicts of interest to declare.
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Addasi, Alaa. "Hodgkin Lymphoma in Jordan; A Retrospective Analysis of 477 Cases in King Hussein Cancer Centre." Blood 118, no. 21 (November 18, 2011): 4862. http://dx.doi.org/10.1182/blood.v118.21.4862.4862.
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Abstract Abstract 4862 BACKGROUND Jordan is a small country with an estimated mid year population in 2008 of 5 850 000, 3015000 of whom are males and 2 835 000 are females (male: female ratio 1.06: 1). (Department of Statistics Jordan, 2008). About 12.7 % of the population is under 5 years old, and 37.3 % under 15 years old. 11%if the population are 15–19 year old, with a M:F ratio 1.06:1 as well) Only 3.3 % of the total population is above the age of 65 years old (sex ratio of 1.01 male per 1 female in this age group). According to the Jordan Cancer Registry Report for 2008, Lymphoma is the fourth most common Cancer in the country. A total of (4606 ) new cases of cancer were recorded among Jordanians in the year 2008, 333 (7.2%) of whom had a diagnosis of lymphoma.111 (2.4%) were diagnosed as Hodgkin's lymphoma (HL), and 222 (4.8%) as Non Hodgkin Lymphoma(NHL). OBJECTIVE In this study, we aim to characterize some of the clinico-pathological features of Hodgkin lymphoma in Jordan by analyzing the data available for patients referred to King Hussein Cancer Center over a seven year period. PATIENTS AND METHODS A retrospective analysis was conducted of adults (>18 years) lymphoma patients referred to KHCC, between 1/1/2003 and 31/12/2010. Clinical features and histological subtypes were prospectively established for all patients registered in the Lymphoma Service Database. Pathology review and original paraffin block were mandated for all patients. RESULTS Over the 8 year period of 2003–2010,1329 lymphoma patients were referred to KHCC and registered in the Lymphoma Service Database, of whom 477 (35.9%) were diagnosed with Hodgkin's lymphoma. Among this group all 477 patients were adults 18 years or older (100%), as children are treated in a different department. The median age was 35 years, (with an age range of 18–77), and 5% of patients were above the age of 60. 290 (61 %) of the patients were males, 187 (39%) were females, with a male to female (M:F) ratio of 1.55:1. 276 (57.8%) of the HL cases had a diagnosis of nodular sclerosis Hodgkin lymphoma (HDNS), making it the most common histological subtype. 120(25.2%) had mixed cellularity Hodgkin lymphoma (HDMC), 9 (1.9%) had lymphocyte-rich Hodgkin lymphoma (HDLR), and 6 (1.2%) had lymphocyte-depleted Hodgkin (HDLD). Nodular lymphocyte predominance Hodgkin lymphoma (NLPHD) cases were 33, and constituted 6.9% of the HL cohort. CONCLUSION Hodgkin lymphoma appears to constitute a bigger share of the lymphoma burden in Jordan, as opposed to Europe and the US. Clinico-pathological features, however, appear to be closer to those described in Western countries, with similar incidence of HDNS, and HDMC subtypes, but possibly with less incidence of HDLR and HDLD subtypes. Disclosures: No relevant conflicts of interest to declare.
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Kulkarni, Samar, Stephanie Michail, Charlotte Smith, Joanna Tomlins, John Murray, Michael Dennis, Jim Cavet, et al. "Retrospective Analysis of Seasonal Respiratory Viral Infections (SRVI) in Hematology, Lymphoma and Oncology Patients." Blood 128, no. 22 (December 2, 2016): 4608. http://dx.doi.org/10.1182/blood.v128.22.4608.4608.
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Abstract Introduction: Community acquired SRVI increase hospital referrals, hospitalization and ICU admissions resulting in high morbidity and mortality during winter season. As there are no defined preventative or treatment measures for most of the SRVI, there is increasing burden on health service resources during SRVI season. This analysis was carried out to evaluate the SRVI incidence, risk factors, impact on mortality and changes in incidence trends over 9 year period in immunocompromised cancer patients. Methods: 2906 cancer patients (haematology: n=1098, 37.8%, lymphoma: n=643, 22.1%, other cancers: n= 1156, 40.1%) treated from January 2006 to January 2015 who had respiratory virus PCR were evaluated. Patients with haematological cancers included ALL (n=137), AML (n=338), Myeloma (n=396), CLL (n=131) or other cancers (n=96) [median age: 50 yr., 5-87, Male: 692, Female: 406). Common solid tumour diagnosis included cancer of Breast (n=280, 24.0%), GI tract (n=207, 17.8%), Lung (n=190, 16.3%), Genitourinary (n=180, 15.5%) or other sites (n=299, 25.7%), [Males: 461, Females: 695; median age: 55 yr., range: 6-89]. Patients with haematological malignancies were younger than patients with other cancers (median age: 50 yr. vs. 55 yr., p<0.001). 804 patients (27.7%) had stem cell transplant. Incidence was compared to the seasonal incidence of SRVI reported by NHS England. All patients with respiratory symptoms who had viral PCR requested on throat and nose swab were included. A total of 10,025 samples were evaluated. Results: In patients with malignancy, the season for ParaFlu, Rhinovirus, Metapneumovirus and FluA lasted longer than in general population (average: 2 months, started early and ended later). Incidence of RSV (6.2%, 4.9%, 1.6%, p=0.001), Adenovirus (1.3%, 1.7%, 0.33%, p=0.004), Rhinovirus (16.6%, 19.9%, 8.5%, p=0.001) and ParaFlu (7.4%, 6.3%, 2.6%, p=0.057) was higher in hematology and lymphoma patients. Incidence of PCP was higher in oncology patients (15.1%, 7.2%, 9.6%, p=0.001). Incidence of PCP was higher with increasing age (5.8% age< 50, 12.2% age>50 yr., p=0.001). Rhinovirus (18.7% age<25 yr., 12.3% age >75 yr., p=0.001) and ParaFlu (8.1% age <25 yr. vs. 6.1% age >25 yr., p=0.02) was higher in younger patients. Stem cell transplant increased risk of RSV (6.8% vs. 3.5%, p=0.001), Adenovirus (1.7% vs. 0.6%, p=0.001) and ParaFlu (8.1% vs. 0.23%, p=0.001) but risk of PCP (7.7% vs. 11.8%, p=0.0001) was lower. Risk of positive PCR for any respiratory virus was higher with increasing age, hematological cancers, and use of stem cell transplant. Surprisingly, diagnosis of CLL and Myeloma did not increase SIRV risk. Thirty-day mortality was higher in patients who had SRVI (p=0.041). Mortality was higher in patients with solid tumours (p<0.0001), RSV infection (p<0.001), FluA (p0.02), PCP (p<0.001), non-SCT patients (p<0.0001) and older age. Except for increasing incidence of PCP in Oncology patients no annual variations in the incidence of specific pathogens was seen. Conclusion: This is one of the first reports that compares incidence of SRVI in patients with cancer to that in general population. The analysis of SRVI using PCR based diagnosis demonstrates that incidence of SRVI in cancer patients show different trends than in general population. SRVI season lasts longer and RSV, FluA and PCP contribute to 30-day mortality. Increasing PCP incidence in patients with solid tumours raises the questions about need to use of PCP prophylaxis in all these cases. Disclosures Somervaille: Novartis: Consultancy, Honoraria; Imago Biosciences: Consultancy. Bloor:Janssen: Honoraria, Speakers Bureau; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; GSK: Consultancy, Speakers Bureau; Gilead: Honoraria; Abbvie: Membership on an entity's Board of Directors or advisory committees.
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Magnus, Dan, Santosh Bhatta, and Julie Mytton. "432 Establishing injury surveillance in emergency departments in Nepal: epidemiology and burden of paediatric injuries." Emergency Medicine Journal 37, no. 12 (November 23, 2020): 825.2–827. http://dx.doi.org/10.1136/emj-2020-rcemabstracts.7.
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Aims/Objectives/BackgroundGlobally, injuries cause more than 5 million deaths annually. Children and young people are a particularly vulnerable group and injuries are the leading cause of death in people aged 5–24 years globally and a leading cause of disability.In most low and middle-income countries where the majority of global child injury burden occurs, systems for routinely collecting injury data are limited. There is a continuing need for better data on childhood injuries and for injury surveillance.The aim of our study was to introduce a hospital-based injury surveillance tool – the first of its kind in Nepal and explore its feasibility. We undertook prospective collection of data on all injuries/trauma presenting to 2 hospital emergency departments to describe the epidemiology of paediatric hospital injury presentations and associated risk factors.Methods/DesignA new injury surveillance system for use in emergency departments in Nepal was designed and used to collect data on patients presenting with injuries. Data were collected prospectively in two hospitals 24 h a day over 12 months (April 2019 - March 2020) by trained data collectors using tablet computers.Abstract 432 Table 1Socio-demographic profile and characteristics of injury among children attending emergency of hospitals in Makwanpur district, Nepal, April 2019 – March 2020 (N=2696)CharacteristicsFrequencyGender Male 1778 Female 918 Age groups 0–4 years 653 5–9 years 866 10–14 years 680 15–17 years 497 Median year (IRQ) 8 (5 – 13) Ethnicity/caste Janajati 1384 Brahmin/Chhetri 892 Dalit 148 Madhesi 146 Muslim 74 Others 50 Unknown 2 Place where injury occurred Home/Compound 1576 Highway/road/street 636 School 233 Recreational area 138 Workplace 76 Other 37 Activities at the time injury occurred Leisure/Play 1889 Travelling (other than to/from school/work) 296 Work 202 Travelling (to/from school/work) 184 Education 42 Organised sports 11 Other 52 Unknown 20 Intent of injury Unintentional 2560 Intentional (self-harm) 61 Intentional (assault) 75 Unintentional (n=2560) Fall 912 Animal or insect related 728 Road traffic injury 356 Injured by a blunt force 201 Stabbed, cut or pierced 176 Fire, burn or scald 65 Poisoning 52 Suffocation/choking 36 Electrocution 12 Drowning and submersion 7 Other 13 Unknown 2 Self-harm (n=61) Poisoning 38 Hanging, strangulation, suffocation 12 Stabbed, cut or pierced 6 Injured by blunt object 4 Other 1 Assault (n=75) Bodily force (physical violence) 43 Injured by blunt object 18 Stabbed, cut or pierced 8 Pushing from a high place 2 Poisoning 2 Sexual assault 1 Other 1 Nature of injury (one most severe) Cuts, bites or open wound 1378 Bruise or superficial injury 383 Fracture 299 Sprain, strain or dislocation 243 Internal injury 124 Head Injury/Concussion 83 Burns 67 Other 115 Unknown 2 Not recorded 2 Severity of injury No apparent injury 125 Minor 1645 Moderate 813 Severe 111 Not recorded 2 Disposition Discharged 2317 Admitted to hospital 164 Transferred to another hospital 179 Died 21 Leave Against Medical Advice (LAMA) 11 Unknown 2 Not recorded 2 Note:Not recorded = missing cases95% CI calculated using one proportion test and normal approximation method in Minitab.Abstract 432 Table 2Distribution of injuries by age-group, sex and mechanism of injury among children attending emergency of hospitals in Makwanpur district, Nepal, April 2019 – March 2020Age groups & Sex0 - 4 years5 - 9 years10–14 years15–17 yearsMaleFemaleTotalIntent & mechanismsn (%)n (%)n (%)n (%)n (%)n (%)n (%)Unintentional Fall 239 (26.2) 328 (36.0) 249 (27.3) 96 (10.5) 636 (69.7) 276 (30.3) 912 (100) Animal or insect related 175 (24.0) 260 (35.7) 190 (26.1) 103 (14.1) 470 (64.6) 258 (35.4) 728 (100) Road traffic injury 49 (13.8) 108 (30.3) 86 (24.2) 113 (31.7) 223 (62.6) 133 (37.4) 356 (100) Injured by a blunt force 54 (26.9) 74 (36.8) 49 (24.4) 24 (11.9) 150 (74.6) 51 (25.4) 201 (100) Stabbed, cut or pierced 20 (11.4) 56 (31.8) 49 (27.8) 51 (29.0) 127 (72.2) 49 (27.8) 176 (100) Fire, burn or scald 42 (64.6) 10 (15.4) 9 (13.8) 4 (6.2) 27 (41.5) 38 (58.5) 65 (100) Poisoning 33 (63.5) 6 (11.5) 5 (9.6) 8 (15.4) 26 (50.0) 26 (50.0) 52 (100) Suffocation/choking 24 (66.7) 5 (13.9) 2 (5.6) 5 (13.9) 20 (55.6) 16 (44.4) 36 (100) Electrocution 2 (15.7) 0 (0.0) 3 (25.0) 7 (58.3) 10 (83.3) 2 (16.7) 12 (100) Drowning and submersion 1 (14.3) 1 (14.3) 3 (42.9) 2 (28.6) 3 (42.9) 4 (57.1) 7 (100) Other 6 (46.2) 4 (30.8) 3 (23.1) 0 (0.0) 10 (76.9) 3 (23.1) 13 (100) Unknown 2 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (100) 2 (100) Total 647 (25.3) 852 (33.3) 648 (25.3) 413 (16.1) 1702 (66.5) 858 (33.5) 2560 (100) Self-harm Poisoning 0 (0.0) 0 (0.0) 6 (15.8) 32 (84.2) 7 (18.4) 31 (81.6) 38 (100) Hanging 0 (0.0) 0 (0.0) 3 (25.0) 9 (75.0) 4 (33.3) 8 (66.7) 12 (100) Stabbed, cut or pierced 0 (0.0) 0 (0.0) 2 (33.3) 4 (66.7) 1 (16.7) 5 (83.3) 6 (100) Injured by blunt object 0 (0.0) 2 (50.0) 2 (50.0) 0 (0.0) 4 (100) 0 (0.0) 4 (100) Other 0 (0.0) 0 (0.0) 0 (0.0) 1 (100) 1 (100) 0 (0.0) 1 (100) Total 0 (0.0) 2 (3.3) 13 (21.3) 46 (75.4) 17 (27.9) 44 (72.1) 61 (100) Assault Bodily force (physical violence) 3 (7.0) 1 (2.3) 11 (25.6) 28 (65.1) 37 (86.0) 6 (14.0) 43 (100) Injured by blunt object 2 (11.1) 8 (44.4) 4 (22.2) 4 (22.2) 13 (72.2) 5 (27.8) 18 (100) Stabbed, cut or pierced 1 (12.5) 0 (0.0) 2 (25.0) 5 (62.5) 7 (87.5) 1 (12.5) 8 (100) Pushing from a high place 0 (0.0) 1 (50.0) 1 (50.0) 0 (0.0) 1 (50.0) 1 (50.0) 2 (100) Poisoning 0 (0.0) 1 (50.0) 0 (0.0) 1 (50.0) 1 (50.0) 1 (50.0) 2 (100) Sexual assault 0 (0.0) 0 (0.0) 1 (100) 0 (0.0) 0 (0.0) 1 (100) 1 (100) Other 0 (0.0) 1 (100) 0 (0.0) 0 (0.0) 0 (0.0) 1 (100) 1 (100) Total 6 (8.0) 12 (16.0) 19 (25.3) 38 (50.7) 59 (78.7) 16 (21.3) 75 (100) Abstract 432 Table 3Association of injury location, nature and severity with age among children attending emergency of hospitals in Makwanpur district, Nepal, April 2019 – March 2020Age groups0 – 4 years5 – 9 years10–14 years15–17 yearsTotalChi-SquareInjury characteristicsn (%)n (%)n (%)n (%)n (%)P valueLocation of injury sustained Home/Compound 537 (34.1) 504 (32.0) 319 (20.2) 216 (13.7) 1576 (100) <0.001 Highway/road/street 85 (13.4) 196 (30.8) 190 (29.9) 165 (25.9) 636 (100) School 15 (6.4) 107 (45.9) 85 (36.5) 26 (11.2) 233 (100) Recreational area 9 (6.5) 44 (31.9) 55 (39.9) 30 (21.7) 138 (100) Workplace 1 (1.3) 4 (5.3) 19 (25.0) 52 (68.4) 76 (100) Other 6 (16.2) 11 (29.7) 12 (32.4) 8 (21.6) 37 (100) Total 653 (24.2) 866 (32.1) 680 (25.2) 497 (18.4) 2696 (100) Nature of injury Cuts, bites or open wound 328 (23.8) 506 (36.7) 314 (22.8) 230 (16.7) 1378 (100) <0.001 Bruise or superficial injury 81 (21.1) 99 (25.8) 118 (30.8) 85 (22.2) 383 (100) Fracture 48 (16.1) 101 (33.8) 112 (37.5) 38 (12.7) 299 (100) Sprain, strain or dislocation 48 (19.8) 78 (32.1) 72 (29.6) 45 (18.5) 243 (100) Internal injury 44 (35.5) 8 (6.5) 18 (14.5) 54 (43.5) 124 (100) Head Injury/Concussion 18 (21.7) 26 (31.3) 18 (21.7) 21 (25.3) 83 (100) Burns 42 (62.7) 9 (13.4) 10 (14.9) 6 (9.0) 67 (100) Other 41 (35.7) 38 (33.0) 18 (15.7) 18 (15.7) 115 (100) Unknown 2 (100) 0 (0.0) 0 (0.0) 0 (0.0) 2 (100) Total 652 (24.2) 865 (32.1) 680 (25.2) 497 (18.4) 2694 (100) Severity of injury No apparent injury 39 (31.2) 45 (36.0) 26 (20.8) 15 (12.0) 125 (100) <0.001 Minor 419 (25.5) 535 (32.5) 406 (24.7) 285 (17.3) 1645 (100) Moderate 171 (21.0) 262 (32.2) 225 (27.7) 155 (19.1) 813 (100) Severe 23 (20.7) 23 (20.7) 23 (20.7) 42 (37.8) 111 (100) Total 652 (24.2) 865 (32.1) 680 (25.2) 497 (18.4) 2694 (100) Abstract 432 Table 4Association of injury location, nature and severity with sex among children attending emergency of hospitals in Makwanpur district, Nepal, April 2019 – March 2020SexMaleFemaleTotalChi-SquareInjury characteristicsn (%)n (%)n (%)P valueLocation of injury sustained Home/Compound 979 (62.1) 597 (37.9) 1576 (100) <0.001 Highway/road/street 421 (66.2) 215 (33.8) 636 (100) School 176 (75.5) 57 (24.5) 233 (100) Recreational area 111 (80.4) 27 (19.6) 138 (100) Workplace 62 (81.6) 14 (18.4) 76 (100) Other 29 (78.4) 8 (21.6) 37 (100) Total 1778 (65.9) 918 (34.1) 2696 (100) Nature of injury Cuts, bites or open wound 959 (69.6) 419 (30.4) 1378 (100) <0.001 Bruise or superficial injury 246 (64.2) 137 (35.8) 383 (100) Fracture 200 (66.9) 99 (33.1) 299 (100) Sprain, strain or dislocation 154 (63.4) 89 (36.6) 243 (100) Internal injury 50 (40.3) 74 (59.7) 124 (100) Head Injury/Concussion 59 (71.1) 24 (28.9) 83 (100) Burns 27 (40.3) 40 (59.7) 67 (100) Other 79 (68.7) 36 (31.3) 115 (100) Unknown 2 (100) 0 (0.0) 2 (100) Total 1776 (65.9) 918 (34.1) 2694 (100) Severity of injury No apparent injury 81 (64.8) 44 (35.2) 125 (100) 0.048 Minor 1102 (67.0) 543 (33.0) 1645 (100) Moderate 533 (65.6) 280 (34.4) 813 (100) Severe 60 (54.1) 51 (45.9) 111 (100) Total 1776 (65.9) 918 (34.1) 2694 (100) Abstract 432 Table 5Distribution of injuries by outcome and mechanism of injury among children attending emergency of hospitals in Makwanpur district, Nepal, April 2019 – March 2020Outcome of injuryDischargedAdmittedTransferredDiedLAMAUnknownTotalIntent & mechanismsn (%)n (%)n (%)n (%)n (%)n (%)n (%)Unintentional Fall 787 (86.5) 65 (7.1) 53 (5.8) 0 (0.0) 4 (0.4) 1 (0.1) 910 (100) Animal/insect bite/sting 704 (96.7) 3 (0.4) 19 (2.6) 0 (0.0) 1 (0.1) 1 (0.1) 728 (100) Road traffic injury 260 (73.0) 47 (13.2) 44 (12.4) 5 (1.4) 0 (0.0) 0 (0.0) 356 (100) Injured by a blunt force 190 (94.5) 4 (2.0) 6 (3.0) 0 (0.0) 1 (0.5) 0 (0.0) 201 (100) Stabbed, cut or pierced 165 (93.8) 8 (4.5) 3 (1.7) 0 (0.0) 0 (0.0) 0 (0.0) 176 (100) Fire, burn or scald 52 (80.0) 12 (18.5) 1 (1.5) 0 (0.0) 0 (0.0) 0 (0.0) 65 (100) Poisoning 30 (57.7) 4 (7.7) 16 (30.8) 1 (1.9) 1 (1.9) 0 (0.0) 52 (100) Suffocation/choking/asphyxia 24 (66.7) 4 (11.1) 6 (16.7) 1 (2.8) 1 (2.8) 0 (0.0) 36 (100) Electrocution 7 (58.3) 2 (16.7) 2 (16.7) 1 (8.3) 0 (0.0) 0 (0.0) 12 (100) Drowning and submersion 4 (57.1) 0 (0.0) 0 (0.0) 3 (42.9) 0 (0.0) 0 (0.0) 7 (100) Other 12 (92.3) 1 (7.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 13 (100) Unknown 2 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (100) Total 2237 (87.5) 150 (5.9) 150 (5.9) 11 (0.4) 8 (0.3) 2 (0.1) 2558 (100) Self-harm Poisoning 5 (13.2) 8 (21.1) 23 (60.5) 0 (0.0) 2 (5.3) 0 (0.0) 38 (100) Hanging 1 (8.3) 0 (0.0) 1 (8.3) 10 (83.3) 0 (0.0) 0 (0.0) 12 (100) Stabbed, cut or pierced 6 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 6 (100) Injured by blunt object 4 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 4 (100) Other 1 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (100) Total 17 (27.9) 8 (13.1) 24 (39.3) 10 (16.4) 2 (3.3) 0 (0.0) 61 (100) Assault Bodily force (physical violence) 34 (79.1) 5 (11.6) 3 (7.0) 0 (0.0) 1 (2.3) 0 (0.0) 43 (100) Injured by blunt object 18 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 18 (100) Stabbed, cut or pierced 6 (75.0) 1 (12.5) 1 (12.5) 0 (0.0) 0 (0.0) 0 (0.0) 8 (100) Pushing from a high place 2 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (100) Poisoning 1 (50) 0 (0.0) 1 (50.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (100) Sexual assault 1 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (100) Other 1 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (100) Total 63 (84.0) 6 (8.0) 5 (6.7) 0 (0.0) 1 (1.3) 0 (0.0) 75 (100) Abstract 432 Figure 1Seasonal variation of injuries identified by the injury surveillance system over a year among children attending emergency of hospitals in Makwanpur district, Nepal, April 2019 – March 2020Results/ConclusionsThe total number of ED patients with injury in the study was 10,154.2,696 were patients aged <18 years. Most injuries in children were unintentional and over half of children presenting with injuries were <10 years of age. Falls, animal bites/stings and road traffic injuries accounted for nearly 75% of all injuries with some (drowning, poisonings and burns) under-represented. Over half of injuries were cuts, bites and open wounds. The next most common injury types were superficial injuries (14.2%); fractures (11.1%); sprains/dislocations (9.0%). Child mortality was 1%.This is the biggest prospective injury surveillance study in a low or middle country in recent years and supports the use of injury surveillance in Nepal for reducing child morbidity and mortality through improved data.CHILD PAPER: RESULTS SECTIONTotal number of ED patients: 33046Total number of ED patient with injury: 10154 (adult=7458 & children=2696)8.2% (n=2696) patients with injury were children aged <18 yearsHetauda hospital: 2274 (84.3%)Chure hill hospital: 422 (15.7%)
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Lazo-Langner, Alejandro, Jeff Hawell, Michael J. Kovacs, Philip S. Wells, Dimitrios Scarvelis, Melissa Anne Forgie, and Marc Rodger. "A Systematic Review and Meta-Analysis of Proportions of Thrombosis and Bleeding in Patients Receiving Venous Thromboembolism (VTE) Prophylaxis After Orthopedic Surgery (OS). An Update." Blood 114, no. 22 (November 20, 2009): 3125. http://dx.doi.org/10.1182/blood.v114.22.3125.3125.
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Abstract Abstract 3125 Poster Board III-62 VTE is the most frequent complication of OS and it can be prevented through anticoagulant prophylaxis. Numerous studies have evaluated different agents for this purpose and there are new agents currently under development or recently approved for this indication. We conducted a systematic review of randomized controlled trials (RCT) evaluating administration of anticoagulants for VTE prophylaxis in OS and performed a MA of proportions to estimate the overall incidence of major VTE (proximal VTE, pulmonary embolism (PE), or death from PE), total VTE (proximal and distal VTE, PE or death from PE), symptomatic VTE and major bleeding episodes (as defined by the International Society on Thrombosis and Hemostasis). We included RCT comparing currently approved anticoagulants (head-to-head or placebo-controlled) for VTE prophylaxis in OS (hip and knee arthroplasty and hip fracture surgery) using systematic evaluation of VTE (ultrasound or venography, pulmonary angiography, CT pulmonary angiography, or ventilation perfusion scan). Heterogeneity of proportions was evaluated using a chi2 test and pooled estimates of proportions were obtained using either a fixed or a random effects model in which the weights were estimated as proposed by Laird and Mosteller. We retrieved 74 studies including180 research arms and enrolling 71,012 patients. The total number of events and evaluable patients, percentage of events and 95% CI, and number of study arms included are shown in the table. We found differences in the percentage of VTE and bleeding events associated with the use of different anticoagulants for VTE prophylaxis after OS. Due to the nature of the analysis no effect measure can be estimated. These estimates might help to design future studies. Major VTE Total VTE Symptomatic VTE Major Bleeding Cases / Evaluable Pts. (N) Percentage (95% CI) Study arms (N) Cases / Evaluable Pts. (N) Percentage (95% CI) Study arms (N) Cases / Evaluable Pts. (N) Percentage (95% CI) Study arms (N) Cases / Evaluable Pts. (N) Percentage (95% CI) Study arms (N) All patients LMWH 993/23692 5.96 (5.81, 6.11) 72 4068/22610 20.29 (20.04, 20.55) 80 193/19431 1.32 (1.27, 1.37) 35 476/28725 1.98 (1.93, 2.02) 70 UFH 234/2407 13.39 (12.86, 13.93) 14 596/2537 22.54 (22, 23.08) 17 11/339 3.24 (3.06, 3.43) 4 70/2849 2.75 (2.61, 2.89) 16 Warfarin 269/5677 6.28 (6.09, 6.46) 12 1317/4203 31.05 (30.44, 31.66) 12 71/4146 1.95 (1.83, 2.08) 6 96/6751 1.78 (1.69, 1.87) 12 Fonda 96/3673 3.81 (3.53, 4.09) 7 223/3477 6.82 (6.57, 7.07) 6 69/6398 1.06 (1.01, 1.1) 8 121/6576 1.63 (1.55, 1.71) 9 Riva 50/5025 2.02 (1.86, 2.19) 8 242/4595 13.05 (12.16, 13.94) 8 29/6252 0.46 (0.45, 0.48) 6 31/6643 0.63 (0.59, 0.68) 8 Dabi 149/4091 3.64 (3.59, 3.69) 6 834/4051 22.96 (21.91, 24.01) 6 26/3664 0.71 (0.67, 0.75) 4 67/5419 1.21 (1.17, 1.26) 6 Placebo 193/710 24.26 (23.17, 25.34) 10 379/816 49.35 (48.08, 50.62) 11 19/198 12.02 (10.32, 13.72) 3 12/753 1.59 (1.5, 1.68) 7 Total 1984/45275 129 7659/42289 140 418/40428 66 873/57716 128 Total Hip Arthroplasty LMWH 653/15978 6 (5.85, 6.16) 50 1817/14480 15.58 (15.35, 15.82) 55 81/11552 0.7 (0.69, 0.72) 19 306/18010 1.97 (1.92, 2.02) 45 UFH 187/1739 14.3 (13.64, 14.96) 11 354/1836 20.13 (19.46, 20.8) 13 11/246 4.47 (4.21, 4.73) 3 52/1451 3.2 (3.01, 3.39) 11 Warfarin 77/2758 4.28 (4.08, 4.48) 6 265/1273 20.82 (20.59, 21.04) 6 32/1833 1.75 (1.69, 1.81) 2 47/2856 2.23 (2.09, 2.37) 5 Fonda 28/1799 2.96 (2.58, 3.33) 3 85/1695 5.01 (4.91, 5.12) 2 15/2255 0.67 (0.63, 0.7) 2 69/2349 2.94 (2.87, 3.01) 3 Riva 25/2938 2.21 (1.95, 2.46) 5 73/2749 9.72 (8.92, 10.53) 5 10/3468 0.29 (0.27, 0.31) 3 14/3795 0.49 (0.44, 0.54) 5 Dabi 72/1803 3.99 (3.88, 4.11) 2 124/1766 7.02 (6.77, 7.27) 2 21/2293 0.92 (0.91, 0.93) 2 38/2309 1.65 (1.58, 1.72) 2 Placebo 105/414 26.01 (24.76, 27.27) 7 174/418 45.43 (43.74, 47.13) 7 4/147 2.72 (2.46, 2.98) 2 3/388 0.77 (0.69, 0.86) 5 Total 1147/27429 84 2892/24217 90 174/21794 33 529/31158 76 Total Knee Arthroplasty LMWH 277/6916 4.45 (4.34, 4.55) 25 2062/7326 30.72 (30.37, 31.07) 32 83/4902 1.69 (1.66, 1.73) 11 89/7808 1.14 (1.12, 1.16) 26 UFH 42/638 6.58 (6.39, 6.78) 3 226/638 35.42 (35.05, 35.79) 3 0/93 NE 1 3/318 0.94 (0.84, 1.05) 2 Warfarin 192/2919 8.1 (7.88, 8.32) 9 1052/2930 39.36 (38.69, 40.02) 9 39/2056 1.9 (1.84, 1.96) 3 28/3407 0.82 (0.79, 0.85) 8 Fonda 23/452 9.3 (7.93, 10.67) 2 45/361 12.47 (12.12, 12.81) 1 3/517 0.58 (0.51, 0.65) 1 12/601 2 (1.88, 2.11) 2 Riva 25/2087 1.2 (1.15, 1.24) 3 169/1846 18.55 (16.47, 20.63) 3 19/2784 0.68 (0.65, 0.71) 3 17/2848 0.6 (0.57, 0.63) 3 Dabi 77/2288 3.37 (3.32, 3.41) 4 710/2285 30.98 (30.42, 31.55) 4 5/1371 0.36 (0.32, 0.41) 2 29/3110 0.93 (0.89, 0.98) 4 Placebo 88/296 27.12 (24.54, 29.7) 4 205/398 55.19 (53.53, 56.84) 5 15/51 29.41 (28.16, 30.66) 1 9/365 2.47 (2.31, 2.62) 4 Total 724/15596 50 4469/15784 57 164/11774 22 187/18457 49 LMWH Low molecular weight heparin, UFH unfractionated heparin, Riva Rivaroxaban, Dabi Dabigatran etexilate Disclosures Lazo-Langner: Boehringer Ingelheim: Honoraria. Rodger:Bayer: Research Funding; Leo Pharma: Research Funding; Pfizer: Research Funding; Boehringer Ingelheim: Membership on an entity's Board of Directors or advisory committees; Biomerieux: Research Funding; GTC Therapeutics: Research Funding.
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Kobyzeva, Daria, Larisa Shelikhova, Zhanna Shekhovtsova, Rimma Khismatullina, Maria Ilushina, Anna Loginova, Alexey Nechesnuyk, and Michael Maschan. "Total Body Irradiation Among Recipients of Tcrαβ /CD19- Depleted Grafts in a Cohort of Children with Hematologic Malignances: Single Center Experience." Blood 136, Supplement 1 (November 5, 2020): 2. http://dx.doi.org/10.1182/blood-2020-139282.
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Purpose: to analyze the radiation-induced organ-specific toxicity and survival outcomes in pediatric patients after hematopoietic stem cell transplantation (HSCT) with TCRαβ /CD19- depletion and myeloablative total body irradiation (TBI)-based conditioning regimen. Methods and Materials: We analyzed retrospectively a cohort of 197 patients (pts) with different hematological malignances. ALL - 150 pts: 1st CR - 40 pts; 2nd CR - 77; advanced - 33 pts; AML - 24 pts: active disease - 20 pts, 1st CR - 1 pt; 2nd CR - 3 pts; others (JMML, NHL etc.) - 23 pts. All the patients received allo-HSCT with TCRαβ /CD19- Depletion at Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology between 07/2014 and 04/2020. TBI (1200 cGy given twice daily in 6 fractions or once daily given in 4 fractions) was used as a part of HSCT conditioning regimens. The TBI technique included the irradiation of whole body using IMRT (TomoTherapy Helical System and IMRT Vmat on Elekta Linac) with following organ sparing: lungs, kidneys, lenses. The lung dose was prescribed as V8<40% (i.e the volume of each lung receiving 8 Gy, not to exceed 40%). The mean kidney dose was prescribed at < 8Gy. Forty-four patients received additional simultaneous integrated boost (SIB) up to 15 Gy or consecutive boost up to 18 Gy to different sites (bone marrow, etc.). Age of patients was from 3 to 21 y.o. (median - 10 y.o.). 26 pts were treated under anesthesia. Haploidentical HSCT was performed in 172 pts, allo-HSCT from matched unrelated donor was performed in 14 pts, from matched related donor - in 12 pts. We register acute toxicity (nausea/vomit/diarrhea, headache, veno-occlusive disease (VOD)) - during radiation therapy and 30 days after SCT, subacute toxicity - up to 100th day after SCT and late toxicity - at least 100 days after SCT according RTOG scale. Results: Follow-up period was from 0,3 to 7,2 years (median follow up period - 2 years). OS for all the patients was 66,7%±3,8%; EFS was 63,0%±3,6%; the transplant-related mortality rate was 8,9±2,1%. OS in patients with acute leukemia was 69,9±4,2% in ALL-group and 44,8±11,0% in AML-group (p=0,015). Mean survival time for patients with ALL was 4,3 years. EFS for pts with ALL was 66,7±4,1%; TRM = 8,4±2,3%. EFS for pts with AML was 43,1±10,3%; TRM = 16,3±7,5%. TRM in patients with 1st and 2nd CR was 5,5%±2,9%. TBI-related toxicity not significantly contribute to TRM, as most cases were infection-related. Acute toxicity during radiation therapy was registered among 100% of pts, in 97% of pts acute toxicity didn't exceed grade 1-2 according to RTOG scale. Among 3% of pts - grade 3 acute toxicity (nausea/vomiting/headache/diarrhea) was observed. We also registered VOD in 3 pts (all of them received SIB to bone marrow). Subacute toxicity was registered in 0.5% of patients (n=1) (interstitial pneumonia 3-4 stage according RTOG). Radiation-induced kidney toxicity was not registered. Conclusion: The developed TBI method included in conditioning regimen before allogenic SCT with TCRαβ /CD19-depletion in pediatric pts has tolerable organ-specific toxicity and predictable results of survival outcomes. Disclosures No relevant conflicts of interest to declare.
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Ding, Yan, Can-Lan Sun, Liton Francisco, Liang Li, Min Li, Brian Hahn, Jennifer Noe, et al. "Genetic Susceptibility to Therapy-Related Leukemia – Role of Expression Quantitative Trait Loci (eQTL)." Blood 118, no. 21 (November 18, 2011): 2438. http://dx.doi.org/10.1182/blood.v118.21.2438.2438.
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Abstract Abstract 2438 Therapy-related leukemia (t-MDS/AML) is a leading cause of non-relapse mortality in patients treated for cancers, such as Hodgkin lymphoma (HL) or non-Hodgkin lymphoma (NHL). Although the association between therapeutic exposures (alkylators, topoisomerase II inhibitors) and t-MDS/AML is clearly defined, inter-individual variability does exist, suggesting the role for genetic factors. Understanding the full spectrum of genetic susceptibility to t-MDS/AML should help identify those at highest risk, setting the stage for targeted surveillance and/or pharmacological intervention. Using a matched case-control design (clinical characteristics – Table 1), we previously identified an association between t-MDS/AML and GSTM1 deletion, demonstrated as differences in both genotype frequency and gene expression level, suggesting that drug-metabolizing enzymes contribute to individual susceptibility. In general, genotyping study analyzes germ line variant alleles that potentially affect function or production level of genes; while expression analysis investigates differences in transcription level resulting from germ line or somatic variations caused by genetic or epigenetic changes, or treatment exposures. In the previous study, after adjusting for treatment exposures, we had detected association of t-MDS/AML with GSTM1 deletion (P = 0.057), and significantly lower expression of GSTM1 (measured by 2 probesets on Affymetrix HG U133 Plus 2 Array) in cases compared with controls (p = 0.0058). Interestingly, several cases with at least one intact allele of GSTM1 expressed low levels of GSTM1; levels that were comparable to individuals who were homozygous for the null allele. Therefore we hypothesized that additional loci control expression levels of this gene and may also predict susceptibility to t-MDS/AML. These expression quantitative trait loci (eQTL) represent genomic regions for the control of quantitative variation in gene expression, typically through modulation of activity of cis-regulatory elements. To test this hypothesis, we identified one SNP, rs11101992, as a genetic marker to a cis-acting eQTL for GSTM1 in lymphoid cell lines (p = 1.6 × 10−10) based on data from a previous study (Dixon et al. Nat Genet 39, 1202–1207) and confirmed its effect in CD34+ peripheral blood stem cells from 32 subjects of Caucasian ancestry (p = 0.078). We then genotyped this SNP in the 49 pairs of matched cases/controls and identified a much stronger association of t-MDS/AML with this SNP (P = 0.0026). The association persisted after adjusting for GSTM1 deletion (P = 0.0076). This SNP was also correlated with expression level of other GSTM gene family members located within the same chromosomal region in lymphoid cell lines (p = 3.4 × 10−10 with GSTM2, p = 3.8 × 10−7 with GSTM3, and p = 4.1 × 10−7 with GSTM4), possibly due to cross hybridization among probe sets or co-expression control of these homologous genes. Our results suggest that additional germ line variation other than GSTM1 deletion regulates expression level of this or other members of the GSTM family and contributes to the risk of t-MDS/AML. We are currently evaluating genetic effect of individual GSTM genes to t-MDS/AML. To our knowledge, this is the first report of the role played by eQTL in defining the genetic susceptibility of t-MDS/AML and provides a novel strategy to uncover new risk loci for this lethal complication resulting from cancer treatment.Table 1:Clinical CharacteristicsCharacteristicsGenotyping StudyExpressionStudyCases (n=49)Controls (n=49)Cases (n=12)Controls (n=22)Primary Diagnosis (%) HL292400 NHL 7176100100Age at Primary Diagnosis (Median, Range)49.1 (13–73)47.9 (26–75)48.9 (26–67)48.2 (26–64)Race/ethnicity (%) Caucasians77.681.658.386.4 Hispanics18.414.333.39.1 African-Americans2.02.08.34.6 Asians/others2.02.00.00.0Gender (%) Male71595077 Female29415023Type of Treatment (%) Autologous HCT7145100100 Conventional295500Latency or follow-up from Primary Diagnosis (Year, Median, Range)4.9 (0.6–29)8.1 (2.4–30)3.6 (1.2–9.2)8.2 (4.8–21)Latency or Follow-up from aHCT (Year, Median, Range)3.1 (0.4–17)3.9 (0.6–10)2.8 (0.5–3.7)7.2 (0.5–8.4)Cytogenetic Abnormality (%) 5q- or 7q-5733 11q236.5NA25NA Others3025 Normal6.517Treatment Exposure Radiation (%)69658368 Alkylating Agent Score3 (1–6)3 (0–6)2 (1–4)3 (1–5) Topoisomerase II Inhibitor Score3 (0–4)3 (0–4)3 (2–4)3 (2–4) Disclosures: No relevant conflicts of interest to declare.
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Kahn, Susan R., Sam Schulman, Josée Martineau, John A. Stewart, Anne McLeod, Carla Strulovitch, Mark Blostein, et al. "Patterns of Management and Adherence to Venous Thromboembolism (VTE) Treatment Guidelines In a National Prospective Cohort Study of VTE Management In the Canadian Outpatient Setting: Recovery Study." Blood 116, no. 21 (November 19, 2010): 565. http://dx.doi.org/10.1182/blood.v116.21.565.565.
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Abstract Abstract 565 Introduction: Little is known about patterns and quality of venous thromboembolism (VTE) management in Canadian outpatient settings, including how closely clinicians adhere to evidence based treatment guidelines. Such information could help identify gaps in patient care requiring attention. Objectives: To obtain prospective, clinical practice-based data from Canadian outpatient settings on 1) management of VTE; 2) determinants of patterns of VTE management; 3) degree of adherence with ACCP 2008 VTE treatment guidelines; and 4) frequency of bleeding and recurrent VTE during follow-up. Methods: We performed a multi-centre prospective observational study to evaluate physician practice patterns and degree of adherence to ACCP consensus guidelines for VTE treatment. From 2007–2010, we enrolled 915 consecutive patients with objectively confirmed acute symptomatic VTE who received treatment with the low molecular weight heparin (LMWH) enoxaparin alone or with warfarin in the outpatient setting (mainly thrombosis clinics) in 12 Canadian centers. Patients attended an enrolment visit, where data on demographics, site(s) of VTE, VTE risk factors, bleeding risk factors, creatinine clearance and initial treatment were recorded. A follow-up visit occurred when anticoagulant treatment was stopped or at 6 months, whichever occurred first. Indicators of adherence to VTE treatment guidelines included: (1) having received any thromboprophylaxis for VTE associated with transient risk factors (recent medical admission, major surgery or leg immobilization); (2) use of LMWH monotherapy to treat cancer-associated VTE; (3) at least 5 days median duration of LMWH in patients treated with initial LMWH overlapped with warfarin; (4) at least 1 day overlap of LMWH and warfarin once INR was therapeutic. Recurrent VTE, bleeding and adverse events were recorded throughout study follow-up. Results: At the time of abstract submission, end of study data were available for 747 of 915 enrolled patients. Average age was 56 years, 54% were male and mean body mass index was 28.3 kg/m2. Index VTE was lower or upper extremity deep venous thrombosis (DVT) in 511 (68.4%) patients, pulmonary embolism (PE) with or without DVT in 218 (29.2%) patients, and unusual site DVT in 18 (2.4%) patients. VTE was associated with cancer in 70 (9.4%) patients, transient risk factors in 289 (38.7%) patients, hormonal risk factors in 55 (7.4%) patients and was deemed unprovoked in 331 (44.3%) patients. Overall, enoxaparin was prescribed at a dose/frequency of 1.5 mg/kg QD in 85.4% of patients, 1.0 mg/kg BID in 14.6% of patients and 1.0 mg/kg QD for one patient who had creatinine clearance <30ml/min. Among patients with VTE risk factors such as recent medical admission, recent surgery or paralysis, only 37.3% had been prescribed thromboprophylaxis. Among patients with cancer-related VTE (n=70), 61.4% were prescribed LMWH monotherapy, a majority received 1.5 mg/kg once daily, and 42.9% received such treatment for >3 months. Among patients treated with initial LMWH overlapped with warfarin (n= 667; 89.3%), median duration of LMWH was 8 days (IQR 6–10 days), median duration of warfarin was 182 days (IQR 115–190) and median overlap with LMWH once INR was therapeutic was 1 day (IQR 1–2 days). However, 48 (7.2%) patients received <5 days LMWH and 99 (15%) patients had overlap <1 day. During follow-up, 16 (2.1%) patients had recurrent VTE, at a median of 71 days follow-up; rate of recurrent VTE was highest (8.6%) and occurred earliest (median, 49 days) in cancer patients. Major bleeding events (primarily GI or GU) occurred in 10 (1.3%) patients at a median of 23 days; at the time of bleed, 2 patients were receiving LMWH alone, 3 patients, LMWH and warfarin, and 5 patients, warfarin alone. Conclusions: Our study provides useful information on clinical features of patients, management of VTE and rates of recurrence and bleeding in Canadian outpatients. Our results suggest that there are important gaps in (1) use of thromboprophylaxis to prevent VTE and (2) use of LMWH monotherapy to treat VTE in cancer patients. Conversely, in patients treated with combination LMWH/warfarin therapy, adherence to recommendations regarding minimum duration of LMWH and minimum overlap of LMWH and warfarin once INR was therapeutic was quite good. Disclosures: Kahn: Sigvaris: Research Funding; sanofi-aventis: Advisory Board, Research Funding; Boehringer Ingelheim:. Schulman:Sanofi Aventis: Honoraria.
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Ben Tekaya, A., B. D. Siwar, S. Bouden, O. Saidane, R. Tekaya, I. Mahmoud, and L. Abdelmoula. "AB0190 LIVER INVOLVEMENT IN RHEUMATOID ARTHRITIS." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 1119.2–1119. http://dx.doi.org/10.1136/annrheumdis-2021-eular.4179.
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Background:Rheumatoid arthritis (RA) can be associated to extra-articular manifestations and comorbidities, including hepatic disturbances. It can be related to an underlying viral, metabolic or immune disease, or to a medical treatment toxicity [1].Objectives:We aim to study liver involvement in a group of RA patients.Methods:We performed a cross sectional study in 249 RA patients responding to the ACR/EULAR 2010 criteria for RA diagnosis. Hepatic enzymes, B and C hepatitis viruses screening tests, abdominal ultrasonography, biliary tract MRIs, fibrotests and fibroscans if available were collected and analysed.Results:Two hundred and forty-nine patients were included with 83.8% of women. The mean age was 59±11.67 years. The mean age at diagnosis was 47±14.9 years with a mean disease evolution of 11±8.83 years.The mean disease activity (DAS28) was 4,66 with levels ranging from 0.12 to 7.78.Liver abnormalities were found in 68 patients (27.3%).Viral disease represented 32.3% of liver abnormalities and was found in 8.8% of the total number of patients. Positive anti-HBc antibodies with negative HBs antigen were found in 8.4% of the patients, no viral reactivation with conventional or biological disease-modifying anti-rheumatic drugs was noted.Besides, 4 of the 249 patients had positive HCV antibodies tests; one of them had a reactivation of a hepatitis C infection after treatment with leflunomide, one had a chronic C hepatitis with chronic liver disease, one had an old B and C hepatitis infection and the last one had an associated liver nodule for which an exploration was triggered. One patient had post hepatitis C cirrhosis associated with a hepatocellular carcinoma treated with surgery and an association of ledipasvir and sofosbuvir with a negative serology.Medical treatment toxicity was responsible for 25% of liver abnormalities. Paracetamol caused both hepatic cholestasis and cytolysis in 5 patients, and isolated cholestasis in 2 patients. NSAIDs caused both hepatic cholestasis and cytolysis in 2 patients, and isolated cholestasis in one patient. Methotrexate was responsible for isolated cholestasis in 2 patients, isolated hepatic cytolysis in one patient and both cholestasis and cytolysis in one patient. An interaction between methotrexate and fluconazole caused one case of hepatic cholestasis and cytolysis. Treatment of a latent tuberculosis with isoniazid and rifampicin was responsible for cholestasis in one patient.Immune hepatic disease was present in 3 patients: 2 patients had a primary biliary cholangitis that manifested with a cholestasis and one patient had an auto-immune hepatitis that manifested with cytolysis and cholestasis.The prevalence of hepatic steatosis was of 4.8%, assessed with ultrasonography or microscopic examination of a liver biopsy. Hepatic enzymes test was normal in 2%, showed isolated cholestasis in 2% and both cholestasis and hepatic cytolysis in 0.8% of the patients.One patient had a secondary hemochromatosis to multiple transfusions for sickle cell anaemia, causing cholestasis and cytolysis.No aetiology was found for hepatic cholestasis and/or cytolysis in 7.2% of patients.Conclusion:Liver involvement in RA is common and has different aspects. A careful monitoring of liver enzymes tests is crucial to detect hepatic disease and prevent its evolution to a chronic liver disease and cirrhosis. On the other hand, screening for viral hepatitis B and C is necessary to prevent an aggravation of a chronic infection and a reactivation of a latent one [2].References:[1]Sellami M, Saidane O, Mahmoud I, Tekaya AB, Tekaya R, Abdelmoula L. Etiological Features of Liver Involvement in Rheumatoid Arthritis. Curr Rheumatol Rev. 2020;16(4):332-6.[2]Karadağ Ö, Kaşifoğlu T, Özer B, Kaymakoğlu S, Kuş Y, İnanç M, et al. Viral hepatitis screening guideline before biological drug use in rheumatic patients. Eur J Rheumatol. mars 2016;3(1):25-8.Disclosure of Interests:None declared
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Imamaliyeva, Samira Z., Dunya M. Babanly, Vladimir P. Zlomanov, Mahammad B. Babanly, and Dilgam B. Taghiyev. "Thermodynamic Properties of Terbium Tellurides." Kondensirovannye sredy i mezhfaznye granitsy = Condensed Matter and Interphases 22, no. 4 (December 15, 2020): 453–59. http://dx.doi.org/10.17308/kcmf.2020.22/3116.
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The paper presents the results of a study of solid-phase equilibria in the Tb–Te system and the thermodynamic properties of terbium tellurides obtained by the methods of electromotive forces and X-ray diffraction analysis. Based on the experimental data, it was established that the TbTe, Tb2Te3, TbTe2 и TbTe3 compounds are formed in the system. For the investigations of the alloys from the two-phase regions TbTe3+Te, TbTe2+TbTe3, and Tb2Te3+TbTe2, the EMF of concentration cells relative to the TbTe electrode was measured. The EMF of concentration cells relative to the terbium electrode was measured for the TbTe+Tb2T3 region. The partial thermodynamic functions of TbTe and Tb in alloys were determined bycombining the EMF measurements of both types in the 300–450 K temperature range, based on which the standard thermodynamic functions of formation and standard entropies of the indicated terbium tellurides were calculated.
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Electrochimica Acta. 2016;222: 1770–1775.DOI: https://doi.org/10.1016/j.electacta.2016.11.07520. Morachevsky A. G., Voronin G. F., Geyderich V. A.,Kutsenok I. B. Elektrokhimicheskie metody issledovaniyav t e r m o d i n a m i k e m e t a l l i c h e s k i k h s y s t e m .[Electrochemical methods of investigation inhermodynamics of metal systems]. Moscow:Akademkniga Publ.; 2003. 334 p. Available at: https://elibrary.ru/item.asp?id=19603291 (In Russ.)21. Babanly M. B., Yusibov Y. A. Elektrokhimicheskiemetody v termodinamike neorganicheskikh sistem[Electrochemical methods in thermodynamics ofinorganic systems]. Baku: BSU Publ.; 2011. 306 p.22. Imamaliyeva S. Z., Mehdiyeva I. F., Taghiyev D. B.et al. Thermodynamic investigations of the erbiumtellurides by EMF method. Physics and Chemistry ofSolid State. 2020;21(2): 312–318. DOI: https://doi.org/10.15330/pcss.21.2.312-31823. Hasanova G. S., Aghazade A. I., Yusibov Yu. A.,Babanly M. B. Thermodynamic investigation of theBi2Se3-Bi2Te3 system by the EMF method. Kondensirovannyesredy i mezhfaznye granitsy = CondensedMatter and Interphases. 2020;22(3): 310–319. DOI:https://doi.org/10.17308/kcmf.2020.22/296124. Imamaliyeva S. Z., Babanly D. M., Gasanly T. M.,et al.: Thermodynamic properties of Tl9GdTe6 andTlGdTe2. Russian Journal of Physical Chemistry A.2018;92(11): 2111–2116. DOI: https://doi.org/10.1134/s003602441811015825. Mansimova S. H., Orujlu E. N., Sultanova S. G.,Babanly M. B. Thermodynamic properties of Pb6Sb6Se17.Kondensirovannye sredy i mezhfaznye granitsy =Condensed Matter and Interphases. 2017;19(4): 536–541. https://doi.org/10.17308/kcmf.2017.19/23426. Imamaliyeva S. Z., Gasanly T. M., MahmudovaM. A. Thermodynamic properties of GdTe compound.Physics. 2017;22: 19–21. Available at: http://physics.gov.az/Dom/2017/AJP_Fizika_04_2017_en.pdf27. Imamaliyeva S. Z., Musayeva S. S., Babanly D. M.,Jafarov Y. I., Tagiyev D. B., Babanly M. B. Determinationof the thermodynamic functions of bismuthchalcoiodides by EMF method with morpholiniumformate as electrolyte. Thermochim. Acta. 2019; 679:178319–17825. DOI: https://doi.org/10.1016/j.tca.2019.17831928. Baza dannykh termicheskikh konstant veshchestv.Elektronnaya versiya pod. red. V. S. Yungmana. 2006[Database of thermal constants of substances.Electronic version V. S. Yungman (ed.). 2006]. Availableat: http://www.chem.msu.ru/cgi-bin/tkv.pl?show=welcome.html/welcome.html
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Oldenburg, Johannes, Dimitrios Tsakiris, Cedric R. Hermans, RI Liesner, Kate Khair, Maria Gabriella Mazzucconi, Katharina N. Steinitz-Trost, Gerald Spotts, Armin J. Reininger, and Alessandro Gringeri. "Ahead Study: A 3 Year Follow-up of 522 Severe and Moderate Hemophilia a Patients." Blood 128, no. 22 (December 2, 2016): 3786. http://dx.doi.org/10.1182/blood.v128.22.3786.3786.
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Abstract Introduction: Long-term, real-world data on natural history of hemophilia A patients, safety and treatment outcome are still insufficient, particularly as far as the impact of bleeding on patient lives is concerned, as most of clinical trials and PASS studies are limited in study population size and length of follow-up, often no longer than 12 months. Methods: The AHEAD study is a non-interventional, prospective long-term cohort study including severe and moderate hemophilia A patients treated with ADVATE. Study endpoints include long-term joint health outcomes, annualized (joint) bleeding rates (ABR/AJBR), factor consumption, quality of life and safety data. Globally, AHEAD aims to evaluate data on approximately 1,000 patients, with a maximum follow-up period of up to 8 years. This interim data report includes 3 years of follow-up after study start. Results: The interim data report includes 522 patients from 21 countries (German study arm is not included in this analysis), for overall 1160 patient years. Of these, 334 completed year 1, 238 year 2 and 136 year 3 study visits. Median age at screening was 17 years (min-max: 0 - 78) and 57% of patients had severe HA (FVIII<1%); 78% were on prophylaxis, 21% were on demand (OD) and 1% on ITI treatment. The median ABRs in year 1, 2 and 3 were 1.2/1.2/1.9 respectively in patients on prophylaxis and 8.4/10.0/7.2, respectively in patients on OD. Median AJBRs were 0.9/0.9/1.0 in the prophylaxis group and 6.4/5.5/5.9 for patients on OD in the first three years of observation. Very similar data were reported taking only severe hemophilia A patients on prophylaxis into account (ABR: 1.9/1.7/2.5 and AJBR: 1.0/1.0/1.1) Overall, 56% of patients on prophylaxis and 32% of patients OD had an AJBR <1 in the first year, 54% and 33% in the second year and 52% and 22% in the third year. In the OD group about half of the patients had an AJBR ≥ 6, in the 3 years of follow up, while only 10% of patients in the prophylaxis group. Median annualized total dose in the prophylaxis group was consistently approximately 245,000IU while the FVIII consumption in the OD group was ranging from 26,000 to 47,000. Effectiveness of prophylaxis assessed by investigators was excellent/good in 93-96% of cases in the three years of observation. Functionality assessment using the hemophilia activity level (HAL) questionnaire showed a median summary score of 77.3-86.7 for patients on prophylaxis and 67.9-71.3 in patients OD over the 3 year follow up period. Differences of health related quality of life (HRQoL) as assessed by the SF-12 were found in the domain physical functioning (median score of 75-100 vs. 50-75 in patients on prophylaxis and OD, respectively) and role physical (median scores of 75 vs. 62.5-75 in patients on prophylaxis and OD, respectively). There were 7 treatment-related adverse events (AEs): 6 serious AEs (5 transient low titer inhibitors and 1 transient high titer inhibitor). The remaining non serious treatment-related adverse event was a mild allergic cutaneous reaction with rhinitis. All patients continued to receive ADVATE. Conclusion: Interim read-out of 3 year follow-up of patients enrolled in the AHEAD study show a clinically meaningful difference in ABR/AJBR, HAL, HRQoL of patients on prophylaxis or OD treatment. This study represents the largest cohort of hemophilia patients with the longest follow-up period. Disclosures Tsakiris: Baxalta, now part of Shire: Consultancy, Honoraria, Research Funding; Bayer Switzerland GmbH: Consultancy, Honoraria, Research Funding. Hermans:Baxalta, now part of Shire: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Investigator Clinical Studies. Liesner:Baxalta, now part of Shire: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Bayer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Octapharma: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Sobi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; BPL: Research Funding; Cangene: Research Funding; CSL Behring: Membership on an entity's Board of Directors or advisory committees. Khair:Pfizer: Research Funding; NovoNordisk: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Baxalta, now part of Shire: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Study Investigator, Research Funding; Octapharma: Consultancy, Equity Ownership, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Study Investigator, Patents & Royalties, Research Funding, Speakers Bureau; Sobi/Biogen: Research Funding. Mazzucconi:Baxalta, now part of Shire: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Bayer: Speakers Bureau; NovoNordisk: Speakers Bureau; Pfizer: Speakers Bureau; Roche: Membership on an entity's Board of Directors or advisory committees; Amgen: Speakers Bureau; Novartis: Speakers Bureau; Shire: Speakers Bureau. Steinitz-Trost:Baxalta, now part of Shire: Employment. Spotts:Shire: Employment. Reininger:Baxalta, now part of Shire: Employment, Equity Ownership. Gringeri:Shire: Employment, Equity Ownership.
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Coiffier, Bertrand, Evgenii Osmanov, Xiaonan Hong, Adriana Scheliga, Jiri Mayer, Fritz C. Offner, Simon A. Rule, et al. "A Phase 3 Trial Comparing Bortezomib Plus Rituximab with Rituximab Alone In Patients with Relapsed, Rituximab-Naive or -Sensitive, Follicular Lymphoma." Blood 116, no. 21 (November 19, 2010): 857. http://dx.doi.org/10.1182/blood.v116.21.857.857.
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Abstract Abstract 857 Background: Follicular lymphoma (FL) is an incurable B-cell non-Hodgkin's lymphoma (NHL) representing ∼20% of all NHL. Rituximab (R) is approved for the treatment of CD20+ relapsed/refractory FL, and single-agent bortezomib (Vc; VELCADE®) has shown activity in heavily pretreated patients. Vc and R show additive activity in preclinical models, and the combination was active and well tolerated in a phase 2 study. This randomized, open-label, multi-center, international, phase 3 clinical trial (LYM3001) compared the efficacy and safety of Vc plus R (Vc-R) vs R alone in patients with relapsed or refractory, R-naive or R-sensitive FL. Methods: Patients with grade 1/2 measurable FL who had relapsed/progressed following prior therapy (time to progression [TTP] ≥6 months if prior R-containing therapy), ECOG performance status ≤2, and no peripheral neuropathy grade ≥2 were randomized (1:1) to receive 5-week cycles of Vc-R (Vc 1.6 mg/m2, d 1, 8, 15, 22, cycles 1–5, plus R 375 mg/m2, d 1, 8, 15, 22 in cycle 1 and d 1 only in cycles 2–5) or R alone (administered according to the same schedule as for the Vc-R arm). In both groups, treatment was administered for five cycles or until progression or unacceptable treatment-related toxicity. Randomization was stratified by FLIPI score (0–1 vs 2 vs ≥3), prior R therapy (yes vs no), time since last dose of anti-FL therapy (≤1 vs >1 year), and region (US vs EU vs rest of world). Primary endpoint was progression-free survival (PFS); secondary endpoints included overall response rate (ORR), complete response (CR) rate, TTP, and safety/tolerability. Response and progression were assessed by independent radiology committee (IRC) using the modified International Workshop Response Criteria. Planned sample size was 670 patients to provide 90% power (α=0.05, 2-sided) to detect a 33% improvement in median PFS with Vc-R vs R (i.e. 13.3 vs 10 months). Results: Between April 2006 and August 2008, 676 patients (intent-to-treat [ITT] population) were enrolled from 164 centers in 29 countries across Europe, the Americas, and Asia. Baseline characteristics were well balanced between the two arms; median age was 57 years (range 21–84), 54% were female, 75% were Caucasian and 21% were Asian. The majority of patients (93%) had an ECOG performance status of 0 or 1, 51% and 48% had grade 1 and 2 FL, respectively, and 41%, 35%, and 23% had high, intermediate, and low FLIPI score, respectively; 83% had Ann Arbor Stage III or IV, and 38% had bone marrow involvement at baseline. 33% of patients had received 3 or more prior lines of therapy (range 1–6+); 44% had received prior R therapy. The most common prior regimens were CHOP (38%), CVP (25%), single-agent R (17%), R-CHOP (12%), and R-CVP (11%). At a median follow-up of 33.9 months, a total of 440 PFS events were observed by IRC in the ITT population, 212 in the Vc-R arm and 228 events in the R arm. Median PFS improved from 334 days (95% CI: 278, 365) with R alone to 389 days (95% CI: 351, 456) with Vc-R; the hazard ratio was 0.822 (95% CI: 0.681, 0.991). This improvement is statistically significant with a 2-sided P-value of 0.039. The ORR was 63% with Vc-R vs 49% with R (P<0.001), including 25% and 18% verified CR rates, respectively (P=0.035). The durable response rate (>6 months) was 50% with Vc-R vs 38% with R (P=0.002). The median time to subsequent antilymphoma treatment was significantly improved in the Vc-R vs R arm (700 vs 537 days, P=0.027). Median OS was not reached in either group. Patients received a median 25 weeks treatment in both the Vc-R and R groups (range 5–40 and 5–35 in the Vc-R and R groups, respectively). Adverse events (AEs) were reported for 95% of Vc-R and 78% of R patients. The most common AEs were diarrhea (52% Vc-R, 8% R), nausea (29% Vc-R, 7% R), and pyrexia (25% Vc-R, 10% R). Most AEs were grade 1 or 2. Grade ≥3 AEs were reported in 46% of Vc-R and 21% of R patients; the most common grade ≥3 AEs were neutropenia (11% vs 4%) and diarrhea (7% vs 0%). Peripheral sensory neuropathy was reported in 17% of patients in the Vc-R arm vs 1% in the R arm; 3% vs 0% grade ≥3. 18% and 11% of Vc-R and R patients, respectively, had serious AEs, only 4% and 1% of patients discontinued due to drug-related AEs, and there were 9 and 4 on-treatment deaths, respectively. Conclusion: The addition of weekly Vc to R therapy in patients with relapsed FL was associated with statistically significant improvements in PFS, response rate, and time to next antilymphoma treatment, with acceptable additional toxicity. Disclosures: Coiffier: Johnson & Johnson: Honoraria. Off Label Use: Discussion of Velcade in NHL subtypes other than mantle cell lymphoma is included. Mayer:Roche: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding. Rule:Johnson & Johnson: Consultancy, Speakers Bureau; Roche: Consultancy. Walewski:Roche: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen-Cilag: Investigators fee. Crump:Millennium Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees; Johnson & Johnson: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Roche: Consultancy. Shpilberg:Johnson & Johnson: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Hermann:Millennium Pharmaceuticals: Research Funding. Parasuraman:Millennium Pharmaceuticals: Employment, Equity Ownership. Zhu:Johnson & Johnson: Employment. Enny:Johnson & Johnson: Employment, Equity Ownership. Theocharous:Johnson & Johnson: Employment. van de Velde:Johnson & Johson: Employment, Equity Ownership. Elsayed:Johnson & Johnson: Employment, Equity Ownership.
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Almeida, Maria Tereza Carvalho, Fernanda Alves Maia, Maria das Mercês Borém Correa Machado, Filipe Alves Souza, Victor Bruno da Silva, Mateus Almeida de Carvalho, and João Felício Rodrigues Neto. "Desenvolvimento docente: avaliação de uma experiência em um curso de Medicina (Teacher development: evaluation of an experience in a Medical course)." Revista Eletrônica de Educação 13, no. 1 (January 5, 2019): 306. http://dx.doi.org/10.14244/198271992635.
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The objective of this study was to evaluate the actions offered in the Teacher Development Program from the perceptions of the teachers of the medical course of a public university that has been working with active teaching and learning methods since 2002. After each action of the program, an evaluation instrument was applied to the participants, and the answers were submitted to content analysis and then organized into three categories: infrastructure and logistics, the teaching-learning strategies and the developed content. Teachers highlight the importance of organization and planning of activities and the environment in which these actions are developed; they emphasize the importance of using teaching–learning strategies that allow greater re?ection on own practice and the integration of theory and practice. They point out that the themes proposed were timely and necessary, they recognize the importance of being in development, they talk about the motivation from the experiences lived. It is concluded that the Teacher Development is a process through which the teacher is in transformation, through a conscious and constant reflection of his own practice. This process can be promoted by institutional investments and by the regulatory mechanisms of institutions, constituted of an evaluation referenced in objective indicators, consistent with the goals to be achieved. In this sense, it is necessary to invest in permanent education, because long-term programs allow the development of the teacher´s and the institution´s needs.ResumoO objetivo deste estudo foi avaliar as ações oferecidas em um Programa de Desenvolvimento Docente a partir da percepção dos professores do curso de medicina de uma universidade pública que utiliza métodos ativos de ensino-aprendizagem desde 2002. Após cada ação do programa, um instrumento de avaliação foi aplicado aos participantes, e respostas foram submetidas à análise do conteúdo e em seguida foram organizadas em três categorias: infraestrutura e logística, estratégias de ensino-aprendizagem utilizadas, e conteúdo desenvolvido. Os professores destacam a importância da organização e planejamento das atividades e do ambiente em que essas ações se desenvolveram; Enfatizam a importância de utilizar estratégias de ensino-aprendizagem que possibilitem maior reflexão sobre a própria prática e a integração da teoria e a prática. Apontam que os temas propostos foram oportunos e necessários, reconhecem a importância de estarem em desenvolvimento, falam sobre a motivação a partir das experiências vivenciadas. Conclui-se que o Desenvolvimento Docente é um processo pelo qual o professor está em transformação, por meio de uma re?exão consciente e constante de sua própria prática. Esse processo pode ser promovido pelos investimentos institucionais e pelos mecanismos reguladores das instituições constituídos por uma avaliação referenciada em indicadores objetivos, coerentes com as metas a serem alcançadas. Nesse sentido, é necessário investir na educação permanente, pois os programas em longo prazo permitem trabalhar as necessidades do professor e da instituição.ResumenEl objetivo de este estudio fue evaluar las acciones ofrecidas en un Programa de Desarrollo Docente a partir de la percepción de los profesores del curso de medicina de una universidad pública que utiliza métodos activos de enseñanza - aprendizaje desde 2002. Después de cada acción del programa, un instrumento de evaluación se aplicó a los participantes, y las respuestas se sometieron al análisis del contenido y luego se organizaron en tres categorías: infraestructura y logística, estrategias de enseñanza - aprendizaje utilizadas, y contenido desarrollado. Los profesores destacan la importancia de la organización y planificación de las actividades y del ambiente en que esas acciones se desarrollaron; Enfatizan la importancia de utilizar estrategias de enseñanza - aprendizaje que posibiliten una mayor reflexión sobre la propia práctica y la integración de la teoría y la práctica. Se señalan que los temas propuestos fueron oportunos y necesarios, reconocen la importancia de estar en desarrollo, hablan sobre la motivación a partir de las experiencias vivenciadas. Se concluye que el Desarrollo Docente es un proceso por el cual el profesor está en transformación, por medio de una re?exión consciente y constante de su propia práctica. Este proceso puede ser promovido por las inversiones institucionales y por los mecanismos reguladores de las instituciones constituidos por una evaluación referenciada en indicadores objetivos, coherentes con las metas a ser alcanzadas. En este sentido, es necesario invertir en la educación permanente, pues los programas a largo plazo permiten trabajar las necesidades del profesor y de la institución.Keywords: Educational development, Medical education, Professional development, Qualitative research.Palavras-chave: Desenvolvimento e educação, Formação médica, Desenvolvimento profissional, Pesquisa qualitativa.Palabras claves: Desarrollo y educación, Formación médica, Desarrollo profesional, Investigación cualitativa.ReferencesABID, Kauser. Faculty development: a need in time for educators in healthcare. J Pak Med Assoc, v. 63, n. 4, p. 428-431, Apr., 2013.ALMEIDA, Maria Tereza Carvalho; BATISTA, Nildo Alves. Ser docente em métodos ativos de ensino-aprendizagem na formação do médico. Rev Bras Educ Med, v. 35, n. 4, p. 468-476, julho, 2011.ALMEIDA, Maria Tereza Carvalho; MAIA, Fernanda Alves; BATISTA, Nildo Alves. Gestão nas escolas médicas e sustentabilidade dos programas de desenvolvimento docente. 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Baraliakos, X., A. Deodhar, R. Ranza, S. Rednic, F. Ciccia, F. Ganz, T. Gao, et al. "POS0235 COMPARISON OF AXIAL AND PERIPHERAL MANIFESTATIONS IN PATIENTS WITH PSORIATIC ARTHRITIS AND ANKYLOSING SPONDYLITIS IN UPADACITINIB CLINICAL TRIALS." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 338–39. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2105.
Full textAbstract:
Background:Axial, peripheral, and other disease manifestations often overlap between psoriatic arthritis (PsA) and ankylosing spondylitis (AS). Upadacitinib (UPA) is an oral Janus kinase inhibitor under evaluation for the treatment of PsA and AS.Objectives:To describe and compare baseline characteristics and UPA efficacy across 4 subgroups of patients (pts) from clinical trials: active PsA (with/without axial involvement) and active AS (with/without peripheral involvement).Methods:Baseline characteristics and efficacy of UPA in reducing axial and peripheral signs and symptoms were assessed via an integrated analysis across the 4 pt subgroups from the SELECT-PsA 1,1 SELECT-PsA 2,2 and SELECT-AXIS3 studies. Analyses of baseline characteristics included pts in the UPA 15 mg once daily (QD), UPA 30 mg QD, and placebo (PBO) groups; efficacy analyses included pts in the UPA 15 mg QD group only. Axial involvement in PsA (axial PsA) was determined by investigator assessment. Peripheral involvement in AS was defined based on presence of tender or swollen joints (TJC68 >0 or SJC66 >0), or presence of enthesitis at baseline (Maastricht Ankylosing Spondylitis Enthesitis Score >0).Results:2102 pts (UPA 15 mg; UPA 30 mg; PBO) were evaluated across the 4 subgroups (PsA [with/without axial involvement]: 626/1289; AS [with/without peripheral involvement]: 135/52). 33% of pts with PsA had axial PsA; 72% of pts with AS had peripheral symptoms. Pts with axial PsA had higher peripheral joint (TJC68 and SJC66) and skin (psoriasis) burden than pts with AS with peripheral involvement (p<0.0001). Pts with AS with peripheral involvement had significantly greater overall pain (pt’s assessment of pain; p=0.0002) and back pain (BASDAI Q2; p<0.0001) scores, and higher total BASDAI (p=0.0076) and ASDAS (p=0.0351) scores than pts with axial PsA; physician’s global assessment of disease activity, and peripheral pain and tenderness (BASDAI Q3 and Q4) were numerically similar for these 2 subgroups (Table 1). The efficacy of UPA 15 mg (measured using ASDAS and BASDAI) was generally consistent across the 4 pt subgroups regardless of peripheral or axial involvement (Figure 1).Table 1.Baseline demographics, medical history, and disease characteristicsMean (SD), unless otherwise specifiedPsA with axial involvementn=626PsA without axial involvementn=1289AS with peripheral involvementn=135AS without peripheral involvementn=52p-value(PsA with axial involvement versus AS with peripheral involvement)Male, n (%)300 (47.9)583 (45.2)88 (65.2)44 (84.6)0.0003Age, years50.7 (12.6)52.0 (12.0)46.6 (12.7)42.2 (11.4)0.0008Body mass index, kg/m230.3 (7.1)30.7 (6.8)a26.7 (4.9)26.8 (5.2)*Duration of disease symptoms, years11.2 (9.3)b10.4 (9.5)a14.6 (10.9)14.0 (10.6)0.0009Duration of disease since diagnosis, years7.7 (8.0)7.3 (8.0)7.0 (9.2)6.8 (8.4)0.3738TJC6823.6 (16.4)20.6 (14.6)5.3 (8.2)0*SJC6611.9 (9.0)11.2 (8.2)1.5 (3.2)0*Psoriasis, n (%)616 (98.4)1269 (98.4)7 (5.2)0*Uveitis, n (%)1 (0.2)5 (0.4)3 (2.2)1 (1.9)0.0191Inflammatory bowel disease, n (%)10 (1.6)13 (1.0)2 (1.5)2 (3.8)1.0000PhGA6.7 (1.7)6.5 (1.7)6.7 (1.5)c6.9 (1.7)b0.6960Pain, VAS 0–106.3 (2.0)b6.1 (2.2)d6.9 (1.6)a6.8 (1.7)a0.0002ASDAS(CRP)3.4 (1.0)e3.1 (1.0)f3.5 (0.7)a3.7 (0.8)a0.0351BASDAI (Total score)6.0 (2.1)e5.5 (2.2)f6.4 (1.6)6.3 (1.8)a0.0076BASDAI Q2 (Back pain)6.1 (2.7)e4.8 (3.2)f7.2 (1.7)7.2 (1.6)a*BASDAI Q3 (Peripheral pain/ swelling)6.3 (2.4)e6.0 (2.6)f5.9 (2.4)5.5 (2.4)a0.0747BASDAI Q4 (Tenderness)5.8 (2.6)e5.6 (2.7)f6.1 (2.5)5.7 (2.4)a0.3196*p<0.0001Data missing for an=1, bn=3, cn=6, dn=11, en=4, fn=14Conclusion:Pts with PsA with axial involvement and pts with active AS showed some differences in baseline characteristics but similar improvements versus placebo with UPA 15 mg QD.References:[1]McInnes I, et al. Ann Rheum Dis 2020;79(Suppl 1):16–17; 2. Genovese MC, et al. Ann Rheum Dis 2020;79(Suppl 1):139; 3. van der Heijde D, et al. Lancet 2019;394:2108–17.Acknowledgements:AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and participated in the writing, review, and approval of the abstract. No honoraria or payments were made for authorship. Medical writing support was provided by Grant Thomas Kirkpatrick, MSc, of 2 the Nth (Cheshire, UK), and was funded by AbbVie.Disclosure of Interests:Xenofon Baraliakos Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, and UCB, Atul Deodhar Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, GSK, Janssen, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, GSK, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, and UCB, R Ranza Speakers bureau: AbbVie, Janssen, Novartis, and Pfizer, Consultant of: AbbVie, Janssen, Novartis, and Pfizer, Simona Rednic: None declared, francesco ciccia Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Novartis, Pfizer, UCB, and Werfen, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, MSD, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Celgene, Chugai, Pfizer, and UCB, Fabiana Ganz Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Tianming Gao Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Apinya Lertratanakul Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, In-Ho Song Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Andrew Ostor Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, Gilead, MSD, Novartis, Pfizer, and Roche, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, Gilead, MSD, Novartis, Pfizer, and Roche, Laura C Coates: None declared.
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Cruz, José Henrique de Araújo, Lindoaldo Xavier Sousa, Bruno Firmino de Oliveira, Francisco Patrício de Andrade Júnior, Maria Angélica Satyro Gomes Alves, and Abrahão Alves de Oliveira Filho. "Disfunção temporomandibular: revisão sistematizada." ARCHIVES OF HEALTH INVESTIGATION 9, no. 6 (October 10, 2020): 570–75. http://dx.doi.org/10.21270/archi.v9i6.3011.
Full textAbstract:
Introdução: Disfunção Temporomandibular (DTM) é o termo para designar um quadro de desorganização neuromuscular identificada pela presença de cefaleias crônicas, sons na articulação temporomandibular, restrições dos movimentos mandibulares, hiperestesia e dor nos músculos da mastigação, da cabeça e do pescoço. Objetivo: realizar uma revisão de literatura sobre a DTM. Material e Método: foi feita uma seleção de artigos científicos a partir das bases de dados LILACS e SCIELO utilizando os descritores “Articulação Temporomandibular”, “Transtornos da Articulação Temporomandibular” e “Dor Facial”, usando como critérios de inclusão trabalhos brasileiros e inglês publicados em português e inglês no período de 2000 a 2018. Dos 798 artigos encontrados e delimitados pelos critérios inclusivos, foram selecionados 56 artigos como amostra, que apresentaram a temática elencada para a pesquisa e que foram discutidos nas seguintes sessões: a) Conceitos e epidemiologia; b) Etiologia; c) Sintomatologia; d) Diagnóstico; e) Tratamento. Conclusão: as causas da DTM são multifatoriais e seu diagnóstico deve ser minucioso. Observa-se a importância da anamnese para coleta de dados sintomatológicos da doença e o estudo de cada caso para melhor adequar a técnica de tratamento a ser utilizada. Há a necessidade de avaliações clínicas multidisciplinares nos indivíduos identificados com DTM para que o tratamento seja otimizado, minimizando a morbidade e diminuindo os custos do tratamento.
Descritores: Articulação Temporomandibular; Transtornos da Articulação Temporomandibular; Dor Facial.
Referências
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Yakubu, Bashir Ishaku, Shua’ib Musa Hassan, and Sallau Osisiemo Asiribo. "AN ASSESSMENT OF SPATIAL VARIATION OF LAND SURFACE CHARACTERISTICS OF MINNA, NIGER STATE NIGERIA FOR SUSTAINABLE URBANIZATION USING GEOSPATIAL TECHNIQUES." Geosfera Indonesia 3, no. 2 (August 28, 2018): 27. http://dx.doi.org/10.19184/geosi.v3i2.7934.
Full textAbstract:
Rapid urbanization rates impact significantly on the nature of Land Cover patterns of the environment, which has been evident in the depletion of vegetal reserves and in general modifying the human climatic systems (Henderson, et al., 2017; Kumar, Masago, Mishra, & Fukushi, 2018; Luo and Lau, 2017). This study explores remote sensing classification technique and other auxiliary data to determine LULCC for a period of 50 years (1967-2016). The LULCC types identified were quantitatively evaluated using the change detection approach from results of maximum likelihood classification algorithm in GIS. Accuracy assessment results were evaluated and found to be between 56 to 98 percent of the LULC classification. The change detection analysis revealed change in the LULC types in Minna from 1976 to 2016. Built-up area increases from 74.82ha in 1976 to 116.58ha in 2016. Farmlands increased from 2.23 ha to 46.45ha and bared surface increases from 120.00ha to 161.31ha between 1976 to 2016 resulting to decline in vegetation, water body, and wetlands. The Decade of rapid urbanization was found to coincide with the period of increased Public Private Partnership Agreement (PPPA). Increase in farmlands was due to the adoption of urban agriculture which has influence on food security and the environmental sustainability. The observed increase in built up areas, farmlands and bare surfaces has substantially led to reduction in vegetation and water bodies. The oscillatory nature of water bodies LULCC which was not particularly consistent with the rates of urbanization also suggests that beyond the urbanization process, other factors may influence the LULCC of water bodies in urban settlements.
Keywords: Minna, Niger State, Remote Sensing, Land Surface Characteristics
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Bhandari, Sudhir, Ajit Singh Shaktawat, Bhoopendra Patel, Amitabh Dube, Shivankan Kakkar, Amit Tak, Jitendra Gupta, and Govind Rankawat. "The sequel to COVID-19: the antithesis to life." Journal of Ideas in Health 3, Special1 (October 1, 2020): 205–12. http://dx.doi.org/10.47108/jidhealth.vol3.issspecial1.69.
Full textAbstract:
The pandemic of COVID-19 has afflicted every individual and has initiated a cascade of directly or indirectly involved events in precipitating mental health issues. The human species is a wanderer and hunter-gatherer by nature, and physical social distancing and nationwide lockdown have confined an individual to physical isolation. The present review article was conceived to address psychosocial and other issues and their aetiology related to the current pandemic of COVID-19. The elderly age group has most suffered the wrath of SARS-CoV-2, and social isolation as a preventive measure may further induce mental health issues. Animal model studies have demonstrated an inappropriate interacting endogenous neurotransmitter milieu of dopamine, serotonin, glutamate, and opioids, induced by social isolation that could probably lead to observable phenomena of deviant psychosocial behavior. Conflicting and manipulated information related to COVID-19 on social media has also been recognized as a global threat. Psychological stress during the current pandemic in frontline health care workers, migrant workers, children, and adolescents is also a serious concern. Mental health issues in the current situation could also be induced by being quarantined, uncertainty in business, jobs, economy, hampered academic activities, increased screen time on social media, and domestic violence incidences. The gravity of mental health issues associated with the pandemic of COVID-19 should be identified at the earliest. Mental health organization dedicated to current and future pandemics should be established along with Government policies addressing psychological issues to prevent and treat mental health issues need to be developed.
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Dian saviqoh, Iis. "ANALISIS POLA HIDUP DAN DUKUNGAN KELUARGA PADA PASIEN DIABETES MELITUS TIPE 2 DI WILAYAH KERJA PUSKESMAS PAYUNG SEKAKI." HEALTH CARE : JURNAL KESEHATAN 10, no. 1 (June 30, 2021): 181–93. http://dx.doi.org/10.36763/healthcare.v10i1.116.
Full textAbstract:
ANALISIS POLA HIDUP DAN DUKUNGAN KELUARGA PADA PASIEN DIABETES MELITUS TIPE 2 DI WILAYAH KERJA PUSKESMAS PAYUNG SEKAKI
1Iis Dian Saviqoh, 2Yesi Hasneli, 3Nopriadi
1Fakultas Keperawatan Universitas Riau
Email : iisdians@gmail.com
2 Fakultas Keperawatan Universitas Riau
Email : yesi_zahra@yahoo.com
3 Fakultas Keperawatan Universitas Riau
Email : nopriadi_dhs@yahoo.com
ABSTRAK
Diabetes Melitus (DM)adalah penyakit metabolik dengan ciri kadar gula darah yang tinggi. DM tipe 2 paling sering diderita. Peyebabnya karena pola hidup yang tidak sehat, beberapa upaya untuk mengurangi faktor pemicu seperti mengatur pola makan, kontrol berat badan, berolahraga, pantau gula darah, diet yang terarah, gizi sehat dan seimbang. Selain itu, dukungan keluarga juga mempengaruhi kualitas hidup pasien DM. Tujuan penelitian ini untuk mengetahui gambaran pola hidup (pola makan, aktivitas fisik) dan dukungan keluarga pada penderita DM tipe 2. Metode penelitian ini menggunakan deskriptif analitik dengan rancangan cross sectional. Sampel penelitian ini 131 orang penderita yang diambil berdasarakan kriteria inklusi menggunakan purposive sampling. Hasil: Penderita terbanyak umur yaitu 56-65 tahun (36,6%) dan banyak diderita laki-laki yaitu (52,7%), responden yang mengalami komplikasi (91,6%) dan banyak diderita oleh laki-laki (99,9%) sedangkan jenis komplikasi yaitu kebas (nefrophaty perifer) (69,5%). pola hidup penderita menunjukkan pola hidup baik (81,7) dan dukungan keluarga menunjukkan dukungan keluarga baik (98,5). Kesimpulan: Pola hidup yang baik dapat juga dipengaruhi oleh dukungan keluarga yang baik sehingga membuat penderita semakin bersemangat untuk menerapkan pola sehat dalam kehidupan sehari-hari.
Kata Kunci:Diabetes Melitus, Pola Hidup, Dukungan Keluarga
ABSTRACT
Diabetes Mellitus (DM) is a metabolic disease characterized by high blood sugar levels. Type 2 DM is the most common. The reason is due to an unhealthy lifestyle, several attempts to reduce trigger factors such as regulating diet, weight control, exercising, monitoring blood sugar, directed diet, healthy and balanced nutrition. In addition, family support also affects the quality of life of DM patients. The purpose of this study was to describe the pattern of life (diet, physical activity) and family support in patients with type 2 diabetes. This research method used descriptive analytic with cross sectional design. The sample of this study was 131 patients who were taken based on the inclusion criteria using purposive sampling. Results: Most patients were aged 56-65 years (36.6%) and mostly suffered by men (52.7%), respondents who experienced complications (91.6%) and most suffered by men (99, 9%) while the type of complication is numbness (peripheral nephropathy) (69.5%). The patient's lifestyle showed a good lifestyle (81.7) and family support showed good family support (98.5). Conclusion: A good lifestyle can also be influenced by good family support so that it makes sufferers more enthusiastic to apply healthy patterns in daily life.
Keywords: Diabetes Mellitus, Lifestyle, Family Support
Referensi: 54 (2010-2020)
PENDAHULUAN
Diabetes Melitus (DM) merupakan sekelompok penyakit metabolik dengan ciri kadar gula darah yang tinggi (hiperglikemik) (Pramukamto et al., 2018). Tanda dan gejala yang umum sering dirasakan pada penderita dengan gula darah tinggi adalah banyak kencing (polyuria), mudah haus (polydipsia) dan mudah lapar (polyphagia). Bila ini dibiarkan dapat menimbulkan komplikasi baik secara akut maupun kroik, yaitu timbul beberapa bulan atau beberapa tahun sesudah mengidap DM. Komplikasi DM yang paling sering adalah hiperglikemia dan koma diabetik (Susilo & Wulandari, 2011).
Menurut Sutedjo (2016) Kematian penderita DM lebih banyak disebabkan oleh komplikasi daripada oleh penyakitnya sendiri sehingga, Diabetes melitus merupakan salah satu dari empat penyakit tidak menular prioritas yang menjadi target tindak lanjut oleh para pemimpin dunia. Jumlah kasus dan prevalensi diabetes terus meningkat selama beberapa dekade terakhir (WHO Global Report, 2016).
WHO (World Health Organitation) memprediksi kenaikan jumlah penyandang DM di dunia dari 463 juta pada tahun 2019 menjadi 700 juta juta pada tahun 2045 naik menjadi 51% (WHO, 2019). International Diabetes Federation (IDF) memprediksi adanya kenaikan jumlah penyandang DM di Indonesia dari 9,1 juta pada tahun 2014 menjadi 14,1 juta pada tahun 2035. Dengan angka tersebut Indonesia menempati peringkat ke-5 di dunia, atau naik dua peringkat dibandingkan data IDF tahun 2013 yang menempati peringkat ke-7 dunia ( PERKENI, 2015).
Berdasarkan Riset Kesehatan Dasar (Riskesdas, 2018) yang menunjukkan prevalensi diabetes melitus pada penduduk dewasa Indonesia sebesar 6,9% di tahun 2013, dan melonjak pesat ke angka 8,5% di tahun 2018. Diabetes melitus di Provinsi Riau berada di urutan 15 untuk penyakit tidak menular (PTM) dengan kenaikan 1,0 persen (2013) menjadi 1,9 persen (2018). Sedangkan pada tahun 2019 terjadi peningkatan pravelensi DM menjadi urutan ketiga dari 10 penyakit terbesar di Kota Pekanbaru setelah Hipertensi.
Data terbaru yang didapatkan dari Dinas Kota Pekanbaru 2019, distribusi kasus diabetes melitus di Puskesmas se-kota Pekanbaru berdasarkan tempat diabetes melitus Tipe 2 tertinggi terdapat di Puskesmas Payung Sekaki sebesar 207 penderita. Jumlah distribusi kunjungan di puskesmas payung sekaki dari bulan Agustus 2019 sampai Agustus 2020 sebesar 540 penderita diabetes melitus.
Secara umum Diabetes melitus dibagi menjadi tiga, yaitu tipe 1, 2 dan gestasional (terjadi saat kehamilan). DM tipe 1 dulu disebut Insulin Dependent Diabetes Melitus (IDDM), diabetes yang bergantung pada insulin. Faktor penyebabnya adalah virus atau reaksi auto-imun (rusaknnya sistem kekebalan tubuh) yang merusak sel-sel penghasil insulin, yaitu sel beta penghasil insulin pada pulau-pulau langerhans pankreas sehingga terjadi kekurangan insulin. Diabetes tipe ini biasanya mengenai anak-anak dan remaja. Sedangkan, DM tipe 2 disebut diabetes life style karena selain faktor keturunan, disebabkan oleh gaya hidup yang tidak sehat. Diabetes tipe 2 tidak bergantung insulin karena pankreas masih menghasilkan insulin tetapi insulin yang diproduksi, jumlahnya tidak mencukupi dan kerja insulin tidak efektif karena adanya hambatan pada insulin yang disebut resistensi insulin (Nurrahmani, 2015).
Sebenarnya resistensi insulin mendahului terjadinya penurunan produksi insulin. Selama resistensi insulin belum diperbaiki pankreas harus bekerja keras menghasilkan insulin sebanyak-banyaknya untuk dapat menggempur resistensi tersebut agar gula juga bisa masuk. Namun karena gejalanya minim, maka semakin lama pankreas tidak mampu memproduksi insulin. Faktor pemicu resistensi insulin adalah kegemukan, kurang bergerak, dan terlalu banyak makan dengan gizi yang tidak seimbang (Nurrahmani, 2015).
Upaya untuk mengurangi faktor pemicu tersebut diperlukan pencegahan seperti mengatur pola makan, kontrol berat badan, tidur cukup, berolahraga, pantau gula darah, manajemen stress, batasi komsumsi garam, berhenti kebiasaan merokok, diet yang terarah, gizi sehat dan seimbang (Susilo Y, Wulandari A. 2011).
Hal diatas sesuai dengan penelitian Dafriani (2017), di Poliklinik Penyakit Dalam RSUD dr. Rasidin Padang diketahui bahwa kejadian DM lebih tinggi pada responden dengan pola makan yang tidak baik yaitu 27 responden (51,9%) dibandingkan yang memiliki pola makan yang baik yaitu 12 responden (29,3%). Sedangkan, pada aktivitas fisik diketahui bahwa kejadian DM lebih tinggi pada responden dengan aktifitas fisik yang ringan yaitu 26 responden (53,1%) dibandingkan yang memiliki aktifitas fisik berat yaitu 13 responden (29,5%).
Selain itu, dukungan keluarga juga mempengaruhi kualitas hidup penderita DM tipe 2 ini sesuai dengan penelitian Retnowati et.al (2015) di Puskesmas Tanah Kalikedinding didapatkan bahwa mayoritas responden yang menyatakan puas terhadap kualitas hidupnya adalah responden yang memperoleh dukungan baik dari keluarga sebesar 85,2%.
Hasil survey awal di Puskemas Sidomulyo dari 5 penderita di dapatkan bahwa 2 penderita mengatakan dapat mengatur pola makan dan rutin berolahraga seperti jalan pagi bersama keluaga di sekitaran komplek perumahan, 1 penderita mengatakan tidak mampu mengatur pola makan karena karena istrinya selalu masak makanan kesukaannya tetapi selalu berolahraga di sore hari bersama anaknya, 2 penderita mengatakan tidak mampu mengatur pola makan dan jarang melakukan aktivitas fisik seperti jalan pagi ataupun sore hari.
Sehubungan hal di atas dapat diketahui bahwa pola hidup dan dukungan keluarga sangat berpengaruh terhadap kondisi fisik. Perubahan pola hidup dan dukungan keluarga dalam perilaku hidup sehat seperti pola makan yang tidak baik, kurang olahraga, serta kebiasaan-kebiasaan tidak sehat merupakan penyebab diabetes melitus. Usia subjek berada dalam rentang usia dewasa madya pada umumnya selalu mengikuti setiap adanya perubahan terutama perubahan mengenai pola hidup. Langkah tersebut dapat dimulai dengan menggali permasalahan penelitian tentang pola hidup penderita Diabetes Melitus tipe 2 dengan judul yaitu “Analisis pola hidup dan dukungan keluarga pada penderita DM tipe 2 di wilayah kerja puskesmas payung sekaki” yang mencangkup pola makan, aktivitas fisik seperti olahraga dan dukungan keluarga yang sangat membantu penderita untuk hidup sehat.
TUJUAN PENELITIAN
Untuk mengetahui gambaran pola hidup (pola makan, aktivitas fisik) dan dukungan keluarga pada penderita DM tipe 2.
MANFAAT PENELITIAN
Hasil penelitian ini dapat dijadikan sumber informasi dan pengembangan ilmu pengetahuan, khususnya pendidikan keperawatan mengenai analisis pola hidup dan dukungan keluarga pasien DM tipe 2.
METODE PENELITIAN
Jenis penelitian yang digunakan merupakan deskriptif analisis menggunakan cross sectional. Tempat penelitian dilakukan di Puskesmas Payung Sekaki Kota Pekanbaru pada tanggal 29 Januari-12Febaruari 2021. Populasi dalam penelitian ini adalah penderita Diabetes Melitus Tipe 2 di wilayah kerja Puskesmas Payung Sekaki Pekanbaru pada tanggal 1 Agustus 2019 sampai dengan 1 Agustus 2020 sebesar 205 penderita. Pengambilan sampel pada penelitian ini menggunakan tabel penentu sampel oleh Stepen Isaac Wiliam B. Michael dengan taraf kesalahan (significance level) sebesar 5%, maka jumlah sampel yang digunakan pada populasi 205 adalah 131 sampel.
Kriteria inklusi adalah karakteristik umum subyek penelitian dari suatu populasi target yang terjangkau dan diteliti (Nursalam, 2013). Kriteria inklusi dalam penelitian ini adalah:
Penderita DM Tipe II yang berada di Wilayah Kerja Puskesmas Payung Sekaki Pekanbaru dengan usia 40 tahun keatas.
Penderita yang bersedia menjadi subyek dan menandatangani informend consent.
Penderita yang tidak memiliki komplikasi.
Penderita yang memiliki komplikasi akut (jangka pendek) yaitu hiperglikemia, diabetik ketoasidosis (DKA) dan komplikasi kronik (jangka panjang) yaitu hipertensi, penyakit arteri koroner, stroke, retinopati diabetik, nefropati diabetik.
Kriteria ekslusi dalam penelitian ini adalah:
Penderita yang tidak menjawab kuisioner dengan lengkap.
HASIL PENELITIAN
Karateristik Responden
Tabel 1.
Distribusi karakteristik responden berdasarkan umur
Umur
Frekuensi (n)
Persentase (%)
36-45
25
19,1
46-55
29
22,1
56-65
48
36,6
>65
29
22,1
Total
131
100
Berdasarkan tabel diatas menunjukkan bahwa 131 responden yang diteliti, distribusi responden terbanyak umur yaitu 56-65 tahun sebanyak 48 orang responden (36,6%).
Tabel 2
Distribusi karakteristik responden berdasarkan jenis kelamin
Jenis Kelamin
Frekuensi (n)
Persentase (%)
a. Laki-laki
b. Perempuan
69
62
52,7
47,3
Total
131
100
Berdasarkan tabel diatas menunjuk bahwa 131 responden yang diteliti, distribusi responden terbanyak yaitu laki-laki sebanyak 69 responden (52,7%) sedangkan perempuan sebanyak 62 responden (47,3%).
Tabel 3
Distribusi karakteristik responden berdasarkan pendidikan
Pendidikan Terakhir
Frekuensi (n)
Persentase (%)
SD
17
13,0
SMP
16
12,2
SMA
49
37,4
SMK
4
3,1
D3
17
13,0
S1
26
19,8
S2
2
2
Total
131
100
Berdasarkan tabel diatas menunjukkan bahwa dari 131 responden yang diteliti pada karakteristik berdasarkan pendidikan paling tinggi adalah lulus SMA yaitu sebanyak 49 orang responden (37,4%).
Tabel 4
Distribusi frekuensi responden berdasarkan komplikasi DM
Komplikasi DM
Frekuensi (n)
Persentase (%)
Ya
120
91,6
Tidak
11
8,4
Total
131
100
Berdasarkan tabel diatas menunjukkan bahwa dari 131 responden yang diteliti pada karakteristik berdasarkan komplikasi DM paling tinggi adalah responden yang mengalami komplikasi yaitu 120 orang responden (91,6%).
Tabel 5
Distribusi frekuensi komplikasi yang diderita responden
Jenis Komplikasi
Frekuensi (n)
Persentase (%)
Tidak ada
11
8,4
Kebas
91
69,5
Hipertensi
20
15,3
Jantung
2
1,5
Post Stroke
1
8
Ginjal
1
8
Mata Kabur
5
3,8
Total
131
100
Berdasarkan tabel diatas menunjukkan bahwa dari 131 responden yang diteliti pada karakteristik berdaarkan jenis komplikasi DM paling tinggi adalah kebas (nefrophaty perifer) sebesar 91 orang responden (69,5%).
Tabel 6
Distribusi Komplikasi diabetes melitus berdasarkan jenis kelamin
Komplikasi
Jenis Kelamin
Laki-laki
Perempuan
Tidak ada
9
2
Kebas
45
46
Hipertensi
10
10
Jantung
2
0
Post stroke
0
1
Ginjal
1
0
Mata kabur
2
3
Frekuensi (n)
69
62
Persentase (%)
100
100
Berdasarkan tabel diatas menunjukkan bahwa dari 131 responden yang diteliti komplikasi DM banyak diderita laki-laki sebesar 69 (99,9%).
Tabel 7
Distribusi Pola Hidup pasien diabetes melitus tipe 2.
Pola hidup (pola makan, aktivitas fisik)
Frekuensi (n)
Persentase %
Baik
107
81,7
Buruk
24
18,3
Berdasarkan dari tabel diatas menunjukkan bahwa dari 131 responden yang diteliti pada pola hidup penderita menunjukkan pola hidup baik dengan jumlah 107 orang responden (81,7) sedangkan pola hidup buruk berjumlah 24 orang (18,3%).
Tabel 8
Distribusi dukungan keluarga pada pasien diabetes melitus tipe 2
Dukungan keluarga
Frekuensi (n)
Persentase %
Baik
129
98,5
Buruk
2
1,5
Berdasarkan dari tabel diatas menunjukkan bahwa dari 131 responden yang diteliti pada dukungan keluarga menunjukkan dukungan keluarga baik dengan 129 orang responden (98,5) sedangkan dukungan keluarga buruk dengan 2 responden (1,5).
Tabel 9
No
Item Pertanyaan
Kategori
F (n)
%
A
Sub Variabel : Metode
1
Saya menerapkan pola makan sehat dengan 3J: Jumlah kalori, jadwal makan, jenis makan
Tidak pernah
5
3,8
Jarang
42
32,1
Sering
73
55,7
Selalu
11
8,4
2
Saya makan dengan porsi cukup untuk mempertahankan berat badan ideal
Tidak pernah
41
31,3
Jarang
48
36,6
Sering
33
25,2
Selalu
9
6,9
3
Saya mengkonsumsinasi 2 ½ centong nasi setiap saya makan
Tidak pernah
73
55,7
Jarang
38
29,0
Sering
13
9,9
Selalu
7
5,3
4
Saya mengkonsumsi makanan yang banyak mengandung serat seperti buah dan sayur
Tidak pernah
3
2,3
Jarang
4
3,1
Sering
34
26,0
Selalu
90
68,7
5
Saya setiap hari mengkonsumsi makanan yang banyak mengandung protein. Seperti: telur dan daging
Tidak pernah
0
0
Jarang
8
6,1
Sering
104
79,4
Selalu
19
14,5
6
Saya membatasi makanan yag asin
Tidak pernah
3
2,3
Jarang
16
12,2
Sering
83
63,4
Selalu
29
22,1
7
Saya membatasi makanan yang banyak mengandunng lemak dan kolestrol tinggi. Seperti: santan, udang dan kepiting
Tidak pernah
3
2,3
Jarang
20
15,3
Sering
88
67,2
Selalu
20
15,3
8
Saya makan porsi cukup untuk mempertahankan gula darah
Tidak pernah
10
7,4
Jarang
62
47,3
Sering
51
38,9
Selalu
8
6,1
9
Saya olahraga 3-5 kali dalam seminggu
Tidak pernah
15
11,5
Jarang
71
54,2
Sering
28
21,4
Selalu
17
13,0
10
Saya melakukan jalan santai disekitaran komplek setiap pagi atau sore
Tidak pernah
9
6,9
Jarang
20
15,3
Sering
50
38,2
Selalu
52
39,7
11
Saya bersepedadi hari sabtu atau minggu
Tidak pernah
88
67,2
Jarang
25
19,1
Sering
12
9,2
Sering
6
4,6
12
Saya berenang di hari sabtu atau minggu
Tidak pernah
99
75,6
Jarang
18
13,7
Sering
11
8,4
Selalu
3
2,3
13
Saya olahraga waktu yang saya habiskan 30-60 menit
Tidak pernah
14
10,7
Jarang
56
42,7
Sering
49
37,4
Selalu
12
9,2
Tabel 10
No
Item Pertanyaan
Kategori
F (n)
%
A
Sub Pertanyaan
Dimensi Emosional
1
Keluarga mengerti saat saya mengalami masalah yang berhubungan dengan diabetes
Tidak pernah
0
0
Jarang
13
9,9
Sering
88
67,2
Selalu
30
22,9
2
Keluarga mendengarkan jika saya bercerita tentang diabetes
Tidak pernah
0
0
Jarang
13
9,9
Sering
91
69,5
Selalu
27
20,6
3
Keluarga memahami jika saya sedih dengan diabetes
Tidak pernah
0
0
Jarang
8
6,1
Sering
96
73,3
Selalu
27
20,6
4
Keluarga saya mengerti tentang bagaimana saya merasakan diabetes
Tidak pernah
0
0
Jarang
14
10,7
Sering
87
66,4
Selalu
30
22,9
Dimensi Penghargaan
5
Keluarga mengingatkan saya tentang keteraturan diet
Tidak pernah
1
0,8
Jarang
10
7,6
Sering
99
75,6
Selalu
21
16,0
6
Keluarga mengigatkan saya untuk memesan obat diabetes
Tidak pernah
12
9,2
Jarang
31
23,7
Sering
49
37,4
Selalu
39
29,8
Dimensi Instrumental
7
Keluarga mendukung usaha saya untuk olahraga
Tidak pernah
3
2,3
Jarang
38
29,0
Sering
43
32,8
Selalu
47
35,9
8
Keluarga membantu saya membayar pengobatan diabetes
Tidak pernah
0
0
Jarang
10
7,6
Sering
86
65,6
Selalu
35
26,7
Dimensi Informasi
9
Keluarga memberi informasi baru tentang diabetes
Tidak pernah
0
0
Jarang
32
24,4
Sering
68
51,9
Selalu
31
23,7
10
Keluarga memberi saran agar saya kontrol ke dokter
Tidak pernah
11
8,4
Jarang
58
44,3
Sering
62
47,3
Selalu
62
47,3
11
Keluarga memberi saran agar saya menkuti edukasi diabetes
Tidak pernah
1
0,8
Jarang
23
17,6
Sering
72
55,0
Selalu
35
26,7
12
Saya merasakan kemudahan mendapatkan informasi dari keluarga tentang diabetes
Tidak pernah
0
0
Jarang
25
19,1
Sering
74
56,5
Selalu
32
24,4
PEMBAHASAN
Karakteristik Responden
Umur
Penelitian yang telah dilakukan terhadap 131 responden didapatkan bahwa umur pasien diabetes melitus tipe 2 di Wilayah Kerja Puskesmas Payung Sekaki yaitu masa dewasa akhir (36-45 tahun) 25 orang responden (19,1%), masa lansia awal (46-55 tahun) 29 orang responden (22,1%), masa lansia akhir (56-65) 48 orang responden (36,6%), masa lansia akhir 56-65, dan masa manula (>65 tahun) 29 orang responden (22,1%). Menurut penelitian Kurniati dan Yanita (2016) Diabetes melitus (DM) merupakan penyakit kronis yang ditandai dengan hiperglikemia dan intoleransi glukosa yang terjadi karena kelenjar pankreas tidak dapat memproduksi insulin secara adekuat yang atau karena tubuh tidak dapat menggunakan insulin yang diproduksi secara efektif atau kedua-duanya. Faktor risiko yang tidak dapat diubah adalah faktor umur. Menurut Dalimartha & Adrian (2012) umur >45 berisiko untuk menderita diabetes melitus.
Jenis Kelamin
Penelitian yang telah dilakukan terhadap 131 responden didapatkan bahwa pasien diabetes melitus tipe 2 di Wilayah Kerja Puskesmas Payung Sekaki lebih banyak terjadi pada laki-laki sebanyak 69 orang responden (52,7%). Karakteristik ini tidak sesuai jika dibandingkan dengan data Riskesdas tahun 2018. Menurut data Riskesdas di Indonesia tahun 2018 penderita diabetes melitus banyak diderita oleh perempuan yaitu 1,8% sedangkan laki-laki sebesar 1,2%.
Pendidikan Terakhir
Penelitian yang telah dilakukan terhadap 131 responden didapatkan bahwa pasien diabetes melitus tipe 2 di Wilayah Kerja Puskesmas Payung Sekaki didapatkan bahwa riwayat pendidikan terakhir sebagian besar responden tamatan SMA yaitu sebanyak 49 orang responden (37,4%). Hal ini didukung dengan penelitian Arimbi, Lita dan Indra (2020) menyatakan bahwa terdapat pengaruh faktor risiko tingkat pendidikan terhadap risiko terkena penyakit diabetes melitus tipe II, dan yang memiliki peluang yang paling besar terhadap penyakit diabetes melitus adalah tingkat pendidikan SMA atau yang sederajat (76.7%).
Tingkat pendidikan seseorang memiliki pengaruh terhadap kejadian penyakit diabetes melitus tipe 2. Hal ini sesuai dengan penelitian Trisnadewi, Adiputra dan Mitayanti (2018) yang menyatakan rendahnya tingkat pendidikan dan pengetahuan merupakan salah satu penyebab tingginya angka kasus suatu penyakit. Pengetahuan bisa diperoleh melalui promosi kesehatan salah satunya pendidikan kesehatan.
Meskipun demikian tidak dipungkiri masih ada orang yang berpendidikan tinggi mengabaikan kesehatan dengan berbagai alasan yang menyebabkannya, salah satunya berhubungan dengan pekerjaan dimana dengan adanya kesibukan yang tinggi sehingga pola hidup yang tidak teratur atau tidak teraturnya pola makan meyebabkan gangguan kesehatan. Biasanya orang dengan kegiatan yang padat sering lupa utuk makan namun lebih banyak makan cemilan. Dengan adanya perubahan gaya hidup dan kebiasaan makan, konsumsi makanan yang energi dan tinggi lemak selain aktivitas fisik yang rendah, akan mengubah keseimbangan energi dengan disimpannya energi sebagai lemak simpanan yang jarang digunakan (Rahmasari & Wahyuni, 2019)
Komplikasi DM
Penelitian yang telah dilakukan terhadap 131 responden didapatkan bahwa pasien diabetes melitus tipe 2 di Wilayah Kerja Puskesmas Payung Sekaki lebih banyak komplikasi sebesar 120 orang responden (91,6%). Sedangkan, jenis komplikasi yang banyak diderita responden perempuan adalah neurophaty (kebas) sebesar 91 orang responden (69,5%). Hal ini sejalan dengan penelitian Suyanto dan Susanto (2016, dalam Booya, F., Bandarian, F., Larijani, B., Pajouhi, M., Noorei, M, dan Lotfi, 2005) Hasil ini sesuai dengan hasil penelitian terdahulu yang relevan yang menyatakan bahwa faktor resiko potensial neuropati diabetik lebih besar pada perempuan sebesar 78 % dibandingkan responden laki-laki 22 %.
Pola Hidup
Penelitian yang telah dilakukan terhadap 131 responden didapatkan bahwa pola hidup meliputi pola makan dan aktivitas fisik pada pasien diabetes melitus tipe 2 di Wilayah Kerja Puskesmas Payung Sekaki didapatkan pola hidup baik dengan jumlah 107 orang responden (81,7%). Hal ini tidak sesuai dengan penelitian Heriawan, Fathony dan Purnawati (2019) dari 60 responden sebagian besar responden dikategorikan memiliki pola makan sehat sejumlah 31 responden pola makan pada pasien diabetes melitus sebagian besar didapatkan memiliki pola makan tidak sehat dengan 19 responden.
Pada item 1, responden yang menerapkan pola makan sehat dengan 3J: jumlah kalori, jadwal makan, jenis makan yang menjawab sering sebanyak 73 orang responden (55,7%). Artinya kesadaran responden untuk menerapkan pola makan sehat dengan 3J cukup tinggi. Hal ini sesuai dengan wawancara peneliti dengan instalagi gizi di puskesmas dimana setiap hari sebelum dilakukan penyuluhan tentang diabetes minimal 1 kali seminggu.
Pada item 2, 3, dan 8 responden yang menerapkan makan dengan porsi cukup untuk mempertahankan berat badan ideal yang menjawab jarang sebanyak 48 orang responden (36,6%), yang mengkonsumsi 2 ½ centong nasi setiap saya makan yang menjawab tidak pernah 73 orang responden (55,7%) dan yang makan porsi cukup untuk mempertahankan gula darah yang menjawab jarang sebesar 62 orang responden (47,3%). Artinya responden merasa jika makan sedikit kurang dari 2 ½ itu membantu dalam menurunkan gula darah dan berat badan menjadi ideal. Padahal, porsi cukup disini adalah cukup dalam jumlah kalori agar responden tidak merasa lemas diakibatkan kenaikan gula darah yang tidak terkontrol karena jumlah kalori responden yang tidak mencukupi tubuh. Jumlah kalori yang tidak cukup dapat mengakibatkan rsponden merasa lapar dan berkeinginan untuk makan lagi tanpa melihat jadwal makan, jumlah makan, dan jenis makanan. Bila dibiarkan, secara tidak sadar pasien sudah mengkonsumsi makanan yang melebihi jumlah kalori perhari. Jumlah kalori yang dianjurkan adalah 25-30 kalori per kilogram berat badan ideal. Hal ini sesuai dengan penelitian Baequny, Harnarni dan Rumimper (2015) yaitu sebagian besar responden mempunyai pola makan tinggi kalori sebanyak 43 responden (57%) dan sebagian kecil mempunyai pola makan tidak tinggi kalori yaitu sebanyak 32 responden (43%). Faktor yang bisa mempengaruhi pola makan yang salah pada responden adalah tingkat pengetahuan yang kurang baik tentang perencanaan makanan bagi penderita DM.
Pada item 4, responden yang mengkonsumsi makanan yang banyak mengandung serat seperti buah dan sayur sebesar 90 responden (68,7%). Artinya kesadaran responden dalam mengkonsumsi serat seperti sayur dan buah sangat tinggi. Sayur dan buah yang dikonsumsi oleh penderita diabetes melitus mengandung serat yang dapat memperlambat proses perpidahan karbohidrat menjadi gula, sehingga peningkatan gula dalam darah meningkat secara perlahan, dan membantu mengontrol kadar gula darah dalam darah. Selain itu, serat dapat membuat kita merasa kenyang lebih lama, sehingga kita bisa makan lebih sedikit dan mencegah makan berlebihan. Hal ini tidak sesuai dengan penelitian Purnasari dan Maryato (2011) Pada penelitian ini diketahui asupan serat responden berkisar antara 15,7 gram sampai dengan 27,4 gram, dengan rata-rata asupan serat sebesar 21,57 gram. Sebanyak 77,1% responden mempunyai tingkat asupan serat <25 gr/hari. Pada penderita diabetes dianjurkan untuk mengkonsumsi serat sebanyak 25-35 gr/hari, terutama serat larut air. Berdasarkan data recall diketahui asupan serat responden hanya sedikit. Asupan serat yang kurang pada sampel terkait dengan pola kebiasaan makan yang mengkonsumsi sayuran dalam jumlah sedikit dibandingkan konsumsi karbohidratnya dan jarang menkonsumsi buah, padahal kandungan serat banyak terdapat pada sayur dan buah, hal ini dapat disebabkan karena kurangnya pengetahuan akan manfaat serat bagi kesehatan. Dari data recall hanya 22,9% responden yang memiliki asupan serat sesuai dengan yang dianjurkan pada penderita diabetes yaitu 25-35 gr/hari.
Pada item 5, responden yang setiap hari mengkonsumsi makanan yang banyak mengandung protein. Seperti: telur dan daging sebesar 104 orang responden (79,4%). Protein dapat mengurangi kenaikan gula darah karena protein bersifat mengenyangkan dan lambat di cerna di dalam tubuh sehingga kalori tubuh pada pasien dm dapat terkontrol. Hal ini tidak sesuai dengan Idris, Jafar dan Indriasari (2014) hasil penelitian pada pasien diabetes melitus tipe 2 diketahui bahwa sebesar 69,6% pasien dengan konsumsi protein kurang sebagian besar yaitu 81,2% memiliki kadar gula darah tidak terkontrol dibandingkan pasien yang memiliki kadar gula darah terkontrol 18,8%. Hasil uji pearson chi square menunjukkan bahwa tidak ada hubungan bermakna antara asupan protein dengan kadar gula darah pasien diabetes mellitus tipe 2.. Tidak adanya hubungan yang bermakna tingkat asupan protein dengan kontrol kadar gula darah dikarenakan fungsi utama protein adalah untuk pertumbuhan dan mengganti sel-sel yang rusak. Protein akan digunakan sebagai sumber energi apabila ketersediaan energi dari sumber lain yaitu karbohidrat dan lemak tidak mencukupi melalui proses glikoneogenesis.
Pada item 6 yang membatasi makanan asin yang menjawab sering sebesar 83 orang responden (63,4%) dan item 7 yang membatasi makanan yang banyak mengandunng lemak dan kolestrol tinggi. Seperti: santan, udang dan kepiting yang menjawab sering sebesar 88 orang responden (67,2%). Responden memiliki kesadaran tinggi dalam membatasi makanan yang banyak mengandung garam, lemak dan kolestrol tinggi. Banyak responden mengatakan bahwa makanan asin, lemak dan kolestrol tinggi dapat memperberat penyakit diabetes melitus yang diderita sehingga mereka selalu berusaha menjaga asupan yang dikonsumsi. Dari penyuluhan yang di dapat mereka mengatakan bahwa makanan yang asin akan menyebabkan hipertensi dan jika hipertensi tidak dapat di kontrol maka akan meyebabkan stroke. Sedangkan untuk lemak dan kolestrol tinggi, mereka lebih suka menjaga karena umur mereka rentan dengan penyakit stroke. Hal ini sesuai dengan penelitian Zainudin dan Yunawati (2012) Asupan garam yang berlebihan terus-menerus dapat memicu tekanan darah tinggi. Ginjal akan mengeluarkan kelebihan tersebut melalui urin. Apabila fungsi ginjal tidak optimal, kelebihan natrium tidak dapat dibuang dan menumpuk di dalam darah. Volume cairan tubuh akan meningkat dan membuat jantung dan pembuluh darah bekerja lebih keras untuk memompa darah dan mengalirkannya ke seluruh tubuh. Tekanan darah pun akan meningkat, inilah yang terjadi pada hipertensi. Selama konsumsi garam tidak berlebihan dan sesuai kebutuhan, kondisi pembuluh darah akan baik, ginjal pun akan berfungsi baik, serta proses kimiawi dan faal tubuh tetap berjalan normal tidak ada gangguan. Asupan lemak berfungsi sebagai sumber pembangun jika sesuai dengan kebutuhan asupan lemak yang di butuhkan tetapi asupan lemak akan menjadi masalah ketika asupan lemak yang masuk berlebih dari asupan lemak yang dibutuhkan. Konsumsi pangan sumber lemak yang tinggi terutama lemak jenuh membuat kolesterol low density lipoprotein (LDL) meningkat yang lama-kelamaan akan tertimbun dalam tubuh dan dapat membentuk plak di pembuluh darah. Plak tersebut akan menyumbat pembuluh darah sehingga mempengaruhi peningkatan tekanan darah. Membatasi konsumsi lemak dilakukan agar kadar kolesterol darah tidak terlalu tinggi. Kadar kolesterol darah yang tinggi dapat mengakibatkan terjadinya endapan kolesterol dalam dinding pembuluh darah. Apalabila dibiarkan maka akan menyumbat pembuluh nadi dan mengganggu sistem peredaran darah yang dapat memperberat kerja jantung dan secara tidak langsung memperparah tekanan darah
Pada item 9, 10 dan 13 responden olahraga 3-5 kali dalam seminggu yang menjawab jarang 71 orang responden (54,2%), responden yang melakukan jalan santai disekitaran komplek setiap pagi atau sore yang menjawab selalu 52 orang responden (39,7%), dan waktu yang dihabiskan responden untuk olahraga adalah 30-60 menit yang menjawab jarang 56 orang responden (42,7%). Di musim pandemi seperti sekarang olahraga sangat di anjurkan dengan mematuhi protokol kesehatan. Kesadaran responden tentang pentingnya olahraga dengan berjalan santai di sekitaran komplek rumah merupakan aktivitas fisik sedang. Banyak manfaat yang didapatkan ketika melakukan jalan santai dengan waktu 30-60 menit yaitu ketika tubuh beraktivitas makan glukosa dalam tubuh akan diubah menjadi energi. Hal ini sesuai dengan WHO (2018) Pada kasus diabetes tipe 2 aktivitas fisik sangat membantu dalam penyerapan glukosa darah kedalam otot. Pada saat otot berkontraksi permeabilitas membran terhadap glukosa meningkat. Sehingga saat otot berkontaksi akan bertindak seperti insulin. Maka dari itu saat beraktivitas fisik, resistensi insulin berkurang.
Dukungan Keluarga
Penelitian yang telah dilakukan terhadap 131 responden didapatkan bahwa dukungan keluarga pada pasien diabetes melitus tipe 2 di Wilayah Kerja Puskesmas Payung Sekaki dukungan keluarga baik dengan jumlah 129 orang responden (98,5%). Penelitian ini didukung dengan penelitian Isfandiari dan Wardani (2014) yaitu responden yang mendapatkan dukungan keluarga melakukan pengendalian kadar gula darah kurang baik sebesar 23,5% (8 responden) dan melakukan pengendalian kadar gula darah dengan baik sebesar 32,4% (11 responden).
Hal ini sejalan dengan penelitian Nuraisyah, Kusnanto dan Rahayujati (2017) yaitu adanya hubungan dukungan keluarga dengan kualitas hidup pasien DM II (p-value: 0,00). Untuk hasil analisis diperoleh bahwa adanya hubungan dukungan keluarga yang ditinjau dari empat dimensi yaitu dimensi emosional (p-value: 0,00), dimensi penghargaan (p-value: 0,00), dan dimensi instrumental (p-value: 0,00). Sementara untuk hasil nilai analisis diperoleh bahwa adanya hubungan variabel komplikasi dengan kualitas hidup pasien DM II (p-value: 0,02).
Item 1,2,3 dan 4 merupakan dukungan emosional. Rata-rata responden menjawab sering mendapatkan dukungan emosional yang baik. Dengan jawaban tersebut maka keluarga bagi responden sangat dibutuhkan ketika responden mengalami kesulitan tentang diabetes yang dideritanya. Ketika seorang keluarga yang menderita diabetes sangat butuh tempat untuk bercerita, hal pertama yang akan dilakukan responden adalah bercerita dengan keluarga. Sedangkan respon keluarga yang menunjukkan rasa empati akan membuat responden semakin nyaman bercerita dan terasa lega setelah bercerita. Ini sangat membantu responden yang berkeinginan untuk sembuh ataupun untuk mempertahankan gula darah tetap terkontrol sehingga tidak menimbulkan komplikasi yang tidak diinginkan.
Pada item 5 dan 6 merupakan dimensi penghargaan. Rata-rata responden menjawab sering pada item tersebut. Dengan jawaban tersebut, penghargaan yang diterima responden berupa dorongan agar tetap mempertahan kadar gula darah tetap normal dengan mengingatkan responden untuk tetap memesan obat diabetes dan menjaga keteraturan waktu diet. Hal ini dapat membuat responden sangat diperhatikan dan dihargai oleh keluarga sehingga mampu menambah semangat responden agar tetap menjaga kadar gula darah tetap normal dan menghindari komplikasi yang ditimbulkan oleh diabetes melitus.
Pada item 7 dan 8 merupakan dimensi instrumental. Rata-rata responden menjawab selalu untuk item 7 dan sering untuk item 8. Dengan jawaban tersebut, dukungan keluarga berupa dimensi instrumental yaitu mengembalikan energi atau stamina dan semangat yang menurun serta memberi rasa perhatian dan kepedulian terhadap responden yang menderita diabetes melitus yang sedang berusaha untuk tetap menjaga dan mengontrol agar gula darahnya tetap normal.
Pada item 9,10,11 dan 12 merupakan dimensi informasi. Rata-rata jawaban responden pada ke empat item tersebut adalah sering. Ini menunjukan bahwa keluarga mampu memberikan informasi yang baik untuk responden sehingga menekan stressor yang muncul akibat penyakit yang diderita. Sehingga responden mampu untuk mengolah informasi yang didapat agar diabetes yang diderita tidak dapat menimbulkan komplikasi dan tetap menjaga gula darah tetap normal.
PENUTUPAN
Kesimpulan
Hasil penelitian menunjukkan bahwa karakteristik umur responden yang menderita diabetes melitus tipe 2 terjadi pada usia lansia akhir yaitu 56-65 tahun dan diabetes melitus tipe 2 banyak diderita oleh laki-laki sebanyak 69 orang responden. Rata- rata riwayat pendidikan terakhir responden sebagian besar adalah tamatan SMA sebanyak 49 orang responden. pasien diabetes melitus tipe 2 di Wilayah Kerja Puskesmas Payung Sekaki lebih banyak mnderita komplikasi sebesar 120 orang responden. Sedangkan, jenis komplikasi yang banyak diderita responden perempuan adalah neurophaty (kebas) sebesar 91 orang responden.
Hasil Penelitian menunjukkan bahwa pola hidup meliputi pola makan dan aktivitas fisik pada pasien diabetes melitus tipe 2 di Wilayah Kerja Puskesmas Payung Sekaki didapatkan pola hidup baik dengan jumlah 107 orang responden (81,7%). Sedangkan, dukungan keluarga pada pasien diabetes melitus tipe 2 di Wilayah Kerja Puskesmas Payung Sekaki dukungan keluarga baik dengan jumlah 129 orang responden (98,5%).
Ini berarti pola hidup yang baik dapat juga dipengaruhi oleh dukungan keluarga yang baik sehingga membuat penderita semakin bersemangat untuk menerapkan pola sehat dalam kehidupan sehari-hari.
Saran
Bagi Mahasiswa hasil penelitian ini dapat menjadi masukan, media pembelajaran dan referensi tambahan bagi profesi keperawatan dalam melakukan pengkajian pada pasien DM tipe 2 baik dari segi pola makan, aktivitas fisik dan dukungan keluarga.
Bagi peneliti selanjutnya hasil penelitian ini diharapkan menjadi referensi untuk peneliti selanjutnya dan bahan perbandingan dan bahan pertimbangan untuk lebih memperdalam penelitian selanjutnya dengan desain berbeda.
Bagi puskesmas hasil penelitian ini diharapkan menjadi masukan bagi puskesmas untuk melakukan penyuluhan tentang diabetes melitus minimal 2 kali bulan sekali khusus pada pasien diabetes melitus agar pasien yang belum sempat mendengarkan penyuluhan sebelum dilakukan pelayanan bisa mendengarkan kembali informasi terbaru seputar diabetes melitus.
Iis Dian Saviqoh, Mahasiswa Program Studi Ilmu Keperawatan Universitas Riau, Indonesia
Yesi Hasneli, Dosen Program Studi Ilmu Keperawatan Universitas Riau, Indonesia
Nopriadi, Dosen Program Studi Ilmu Keperawatan Universitas Riau, Indonesia
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Ostrovsky, Yu P., L. V. Rachok, I. A. Grebenyuk, E. K. Kurlyanskaya, A. V. Valentyukevich, O. G. Chernookiy, L. G. Shestakova, V. S. Khudnitskaya, T. A. Dubovik, and M. G. Kolyadko. "Heart Transplantation in Belarus." Transplantation and artificial organs, December 16, 2020, 61–78. http://dx.doi.org/10.30702/transpaorg/05_20.0112/060-077/002.
Full textAbstract:
Objective. To evaluate the effectiveness of the treatment of patients with end-stage heart failure.Materials and methods. In total for the period from 2009 to 2019, 3038 potential recipients of donor heart were examined, of which 22% were put on a waiting list of transplantation. Orthotopic heart transplantation was performed in 326 patients, which accounted for 40% of the total number of patients on the waiting list for a ten-year period.Results and discussion. During the period from 2009 to 2019, orthotopic heart transplantation in Belarus on the basis of the Scientific-Practical Center «Cardiology» was performed for 326 patients with terminal heart failure. The preference was given to the biatrial technique (89%), only 30 patients were operated on using the bicaval technique (11%). The duration of artificial blood circulation was 250 + 24 min. The patient’s stay after heart transplantation in the intensive care unit and reanimation was 9 + 3 days, while the duration of artificial respiration was 10 + 6 hours on average. The hospital period averaged 23 + 6 days. The average for 10 years the hospital mortality rate was 8.4%, and in the period from 2016 to 2019 did not exceed 7.2%. The dynamics of survival rates are presented graphically in the diagram.Findings. Currently, the achievements of transplantology have allowed us to achieve some success in the struggle for the lives of patients, which a few decades ago, medicine could only dream of. Today, the team of cardiac surgeons and cardiologists is faced with the task of finding methods to ensure the longest life expectancy of the donor organ by reducing the risk of various complications, as well as developing new technologies that will maximize the life expectancy of patients with terminal heart failure in anticipation of an optimal donor heart.
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Adekunle, Lola, Rebecca Chen, Lily Morrison, Meghan Halley, Victor Eng, Yogi Hendlin, Mackenzie R. Wehner, Mary-Margaret Chren, and Eleni Linos. "Association between financial links to indoor tanning industry and conclusions of published studies on indoor tanning: systematic review." BMJ, February 4, 2020, m7. http://dx.doi.org/10.1136/bmj.m7.
Full textAbstract:
Abstract Objective To assess whether an association exists between financial links to the indoor tanning industry and conclusions of indoor tanning literature. Design Systematic review. Data sources PubMed, Embase, and Web of Science, up to 15 February 2019. Study selection criteria Articles discussing indoor tanning and health were eligible for inclusion, with no article type restrictions (original research, systematic reviews, review articles, case reports, editorials, commentaries, and letters were all eligible). Basic science studies, articles describing only indoor tanning prevalence, non-English articles, and articles without full text available were excluded. Results 691 articles were included in analysis, including empiric articles (eg, original articles or systematic reviews) (357/691; 51.7%) and non-empiric articles letters (eg, commentaries, letters, or editorials) (334/691; 48.3%). Overall, 7.2% (50/691) of articles had financial links to the indoor tanning industry; 10.7% (74/691) articles favored indoor tanning, 3.9% (27/691) were neutral, and 85.4% (590/691) were critical of indoor tanning. Among the articles without industry funding, 4.4% (27/620) favored indoor tanning, 3.5% (22/620) were neutral, and 92.1% (571/620) were critical of indoor tanning. Among the articles with financial links to the indoor tanning industry, 78% (39/50) favored indoor tanning, 10% (5/50) were neutral, and 12% (6/50) were critical of indoor tanning. Support from the indoor tanning industry was significantly associated with favoring indoor tanning (risk ratio 14.3, 95% confidence interval 10.0 to 20.4). Conclusions Although most articles in the indoor tanning literature are independent of industry funding, articles with financial links to the indoor tanning industry are more likely to favor indoor tanning. Public health practitioners and researchers need to be aware of and account for industry funding when interpreting the evidence related to indoor tanning. Systematic review registration PROSPERO CRD42019123617.
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Quinaglia, T. Q., T. Ferreira De Souza, F. Bianchini Cardoso, L. M. Silva, C. Toledo, T. Neilan, L. Antunes-Correa, M. J. Herold, and O. R. Coelho-Filho. "P2596Right ventricular function after anthracycline therapy: specificities of myocardial necrosis markers." European Heart Journal 40, Supplement_1 (October 1, 2019). http://dx.doi.org/10.1093/eurheartj/ehz748.0921.
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Abstract Background Anthracycline therapy may induce left ventricle (LV) dysfunction. However, few studies investigated how it may affect the right ventricle (RV). Purpose The goal of this study was to assess RV systolic function and biomarkers that may predict early dysfunction in breast cancer patients treated with anthracyclines. Methods Twenty-seven women with breast cancer (51.8±8.9 years), underwent CMR prior, and up to 3-times after doxorubicin with matching measurements of biomarkers: high-sensitive troponin T (TnT), creatinine-kinase MB isoenzyme (CK-MB) and C reactive protein (CRP). Results Before anthracyclines, all subjects had normal LVEF (69.4±3.6%) and RVEF (55.1±9%) and LV and RV EF correlated significantly (ρ=0.42; p=0.031). At 351–700 days after anthracycline, LVEF and LV mass index declined to 58±6% (P<0.001) and 36±6 g/m2 (P<0.001) (table). RVEF also decreased, reaching 46±8% at 231,4 days after (P<0.001), but lost the correlation with LVEF seen at baseline (r=0.22; P=0.068). RVEF showed strong negative association with serum CK-MB (r=−0.4, p=0.004) and no significant correlation with TnT (r=−0.18, p=0.28) or CRP (r=0.03, p=0.932) (figure). In patients with a peak TnT of >10 pg/ml the change of RVEF overtime was significant (Regression Splines coefficients for RVEF: 1.0, p=0.731–peak TnT ≤10pg/ml; 2.51, p<0.001–peak TnT >10 pg/ml). LVEF was not associated with CK-MB (p=ns). Baseline and Follow-Up CMR Findings Median days after anthracycline Pre-DOX (79,146] (146,231] (231,350] (350,700] N 27 16 19 14 16 LVEF, % 69.4±3.6 61.1±7.6† 55.99±5.0† 53.8±8.4† 57.5±6.1† LVEDV index, ml/m2 60.2±9.9 64.3±9.6 66.7±17.7 * 56.9±18.5 59.2±12.6 LVESV index, ml/m2 18.3±4.0 24.7±7.3# 29.0±7.3† 26.2±9.7† 25.3±8.2† LV mass index, g/m2 51.4±8.0 45.3±3.8† 43.2±4.9† 39.9±5.4† 36.0±6.1† RVEF, % 55.1±9.4 51±8.1 48±8.5 46±8.5 50±7.4 RVEDV index, ml/m2 45.07±6.6 46.5±11.31 47.35±9.16 41.14±9.7 46.16±7.3 RVESV index, ml/m2 20.45±5.4 22.31±5.8 24.77±6.6 21.96±6.4 22.24±4.7 Data are presented as mean ± SD. LV: left ventricle; RV: right ventricle; EF: ejection fraction; EDV: end diastolic volume; ESV: end systolic volume (average±SD). *Significantly different from Pre-DOX level (p<0.05 from linear mixed effects model). #Significantly different from Pre-DOX level (p<0.01 from linear mixed effects model). †Significantly different from Pre-DOX level (p<0.001 from linear mixed effects model). RVEF and correlate variables Conclusions RVEF reduction does not follow LVEF changes after anthracyclines and CK-MB may be a more specific biomarker to assess RV dysfunction. A higher peak cTnT could predict a greater change in RVEF during follow-up.
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Kologrivova, I., MA Shtatolkina, TE Suslova, VV Ryabov, OA Koshelskaya, and OA Trubacheva. "Decreased nuclear translocation of FoxP3 transcription factor in patients with ST-segment elevation myocardial infarction." European Heart Journal. Acute Cardiovascular Care 10, Supplement_1 (April 1, 2021). http://dx.doi.org/10.1093/ehjacc/zuab020.055.
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Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Ministry of Science and Higher Education of Russian Federation T regulatory lymphocytes (Treg) participate in resolution of inflammation and are essential in post-infarct myocardial healing. The crucial mediator of Treg activity is transcription factor FoxP3. Nuclear localization of FoxP3 is an obligatory requirement for anti-inflammatory properties of the cells. FoxP3 is also expressed in conventional T-lymphocytes at the stage of their activation. Data on functional state of FoxP3 in chronic and acute coronary syndromes are absent. Purpose Our aim was to comparatively evaluate the level of FoxP3 nuclear translocation in subpopulations of FoxP3+ T-lymphocytes in patients with chronic and acute coronary syndromes. Methods We have recruited 14 patients with chronic coronary syndrome (CCS) (8 males; 6 females; 63.2 ± 9.0 y.o.) and 5 patients with acute anterior ST-segment elevation myocardial infarction (STEMI) (4 males; 1 female; 61.4 ± 11.2 y.o.). Reperfusion of the infarct-related artery (IRA) has been achieved in all STEMI patients (the mean time of recanalization constituted 5 hours), and coronary angioplasty and IRA stenting were performed. Health status was evaluated and functional class of chronic heart failure was assessed according to the 6-minute walk test. Peripheral blood mononuclear cells were isolated from heparinized blood of CCS patients and STEMI patients during the first day after the event. Frequency of T regulatory and T conventional lymphocytes and degree of FoxP3 nuclear translocation in them were evaluated by imaging flow cytometry. Results Numbers of T regulatory lymphocytes in STEMI patients were lower than in patients with CCS, while numbers of T conventional lymphocytes were higher. However these differences did not reach the level of statistical significance: 7.2 (6.2; 8.4)% vs. 6.7 (3.8; 7.0)% of T regulatory lymphocytes (p = 0.298) and 1.6 (1.3; 1.8)% vs. 2.1 (1.0; 2.8)% of T conventional cells (p = 0.754), in CCS and in STEMI patients, respectively. Meanwhile, STEMI patients displayed significantly lower nuclear translocation of FoxP3 in lymphocytes compared to CCS patients: 74.8 (64.9; 92.9)% vs. 98.2 (96.8; 98.7)% in T regulatory cells (p = 0.026) and 58.7 (33.9; 67.7)% vs. 88.3 (73.1; 96.9)% in T conventional lymphocytes (p = 0.034). Conclusions Our study is the first one to comparatively describe the FoxP3 nuclear translocation in patients with chronic coronary syndrome and STEMI. We showed that STEMI is primarily associated with the decrease of nuclear localization of FoxP3 rather than with changes in numbers of FoxP3+ T-lymphocytes in peripheral blood. The revealed phenomenon demonstrates that alterations of the balance between the suppressive and inflammatory activities of T-lymphocytes are observed already in the early inflammatory phase of STEMI, long before their expected clonal expansion.
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Gizatulina, T., A. V. Pavlov, L. U. Martyanova, G. V. Kolunin, I. V. Shorochova, V. E. Kharats, and N. Y. Khorkova. "P5651Association of left atrial fibrosis extent with left ventricular geometric remodeling and diastolic dysfunction in patients with paroxysmal atrial fibrillation." European Heart Journal 40, Supplement_1 (October 1, 2019). http://dx.doi.org/10.1093/eurheartj/ehz746.0594.
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Abstract Introduction Whether left atrial fibrosis (LAf) in patients with atrial fibrillation (AF) is a consequence of left ventricular (LV) diastolic dysfunction or primary atrial pathology continues to be a debatable issue. Electroanatomical mapping (EAM) allows to image and to define LAf as a substrate of AF. Purpose To study the relationship of LAf extent with LV diastolic function and geometric remodeling in patients (pts) with paroxysmal AF. Methods 56 pts with paroxysmal AF (mean age 57.1±8.4 years, 31 males), undergone catheter ablation, were enrolled in the study, including 30 pts with arterial hypertension (AH), 15 – with coronary artery disease (CAD) and AH. Comprehensive transthoracic echocardiography was carried out in all pts to assess chamber volumes, systolic and LV diastolic functions and geometry patterns according to Recommendations of ASE and EACVI. Before ablation, EAM was performed in sinus rhythm. The bipolar low voltage areas of LAf were identified with the cut-off <0.5 mV. For the LAf quantification following indicators were calculated: total square of LAf (Sf, cm2) and LAf degree, estimated as an analog of the UTAH staging system, by selection of UTAH I: <5% fibrosis; II: 5–19%; III: 20–35% and IV: >35%. Results All patients had preserved systolic LV function. To assess the influence of LV geometry on LAf extent all pts were distributed in accordance to LV geometry patterns (p): normal geometry (pI) – 27 pts, concentric remodeling (pII) – 13, eccentric hypertrophy (pIII) – 10, concentric hypertrophy (pIV) – 6. Pts with pIII were older than pI pts: 60.8±6.4 vs 53.9±10.4 (p=0.048). All pts with pIII and pIV had AH. From 11 pts without AH, 10 had pI of LV geometry. PIII was revealed more often in CAD pts compared to those without CAD: 29.2 vs 10.5% (p=0.04). PIII pts had bigger LA volume compared to pI pts (74.3±22.5 vs 58.8±19.4 ml, p=0.019) and pII pts (61.9±14.9, p=0.05), but LA volume of pIII pts didn't differ from pIV pts (71.9±14.5, p=0.78). PIII pts had more extent Sf than pI pts (28.32±8.9 vs 13.4±6.5, p=0.05), while Sf of pII (17.3±8.7, p=0.495) and pIV pts (16.4±9.5, p=0.699) didn't differ significantly from Sf of pI pts. As for the degree of LAf, UTAH I was absent in pts with pIII and UTAH IV was revealed in 40% of these pts, while in pts with pI UTAH I was in 26% and UTAH IV - in 14.8% (p=0.049). However, Sf and UTAH degree did not depend on age, CAD and heart failure presence. As for diastolic dysfunction, in pIII and pIV pts e∼septal and e∼lateral were lower compared to pI pts: 6.3±1.9, 5.5±2.4 vs 8.5±2.2 (p<0.01) and 8.2±2.7, 8.0±3.8 vs 11.3±2.9 (p<0.01), respectively, while E/e∼ in pIII pts didn't differ from pI pts (8.0±1.6 vs 7.2±1.6, p=0.17), but in pIV was more than in pI pts (10.4±2.8, p=0.003). Conclusion LAf extent in paroxysmal AF is associated more with such LV geometry pattern as eccentric hypertrophy, than with diastolic disorders, which accompany both eccentric and concentric hypertrophy.
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"Buchbesprechungen." Zeitschrift für Historische Forschung 47, no. 1 (January 1, 2020): 79–182. http://dx.doi.org/10.3790/zhf.47.1.79.
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Zucht-, Arbeits- und Strafhäuser in Graz (1700 - 1850) (Mitteilungen des Instituts für Österreichische Geschichtsforschung. Ergänzungsband, 63; Forschungen zur geschichtlichen Landeskunde der Steiermark, 83), Wien / Köln / Weimar 2019, Böhlau, 556 S. / Abb., € 85,00. (Simon Karstens, Trier) Oldach, Robert, Stadt und Festung Stralsund. Die schwedische Militärpräsenz in Schwedisch-Pommern 1721 - 1807 (Quellen und Studien aus den Landesarchiven Mecklenburg-Vorpommerns, 20), Köln / Weimar / Wien 2018, Böhlau, 518 S. / Abb., € 60,00. (Michael Busch, Rostock) Koller, Ekaterina E., Religiöse Grenzgänger im östlichen Europa. Glaubensenthusiasten um die Prophetin Ekaterina Tatarinova und den Pseudomessias Jakob Frank im Vergleich (1750 - 1850) (Lebenswelten osteuropäischer Juden, 17), Wien / Köln / Weimar 2019, Böhlau, 352 S., € 60,00. (Agnieszka Pufelska, Lüneburg) Häberlein, Mark / Holger Zaunstöck (Hrsg.), Halle als Zentrum der Mehrsprachigkeit im langen 18. Jahrhundert (Hallesche Forschungen, 47), Halle a. d. S. 2017, Verlag der Franckeschen Stiftungen, VI u. 265 S. / Abb., € 56,00. (Martin Gierl, Göttingen) Geffarth, Renko / Markus Meumann / Holger Zaunstöck (Hrsg.), Kampf um die Aufklärung? Institutionelle Konkurrenzen und intellektuelle Vielfalt im Halle des 18. Jahrhunderts, Halle a. d. S. 2018, Mitteldeutscher Verlag, 334 S., € 50,00. (Martin Gierl, Göttingen) Giro d’Italia. Die Reiseberichte des bayerischen Kurprinzen Karl Albrecht (1715/16). Eine historisch-kritische Edition, hrsg. v. Andrea Zedler / Jörg Zedler (Beihefte zum Archiv für Kulturgeschichte, 90), Wien / Köln / Weimar 2019, Böhlau, 694 S. / Abb., € 90,00. (Michael Maurer, Jena) Backerra, Charlotte, Wien und London, 1727 - 1735. Internationale Beziehungen im frühen 18. Jahrhundert (Veröffentlichungen des Instituts für europäische Geschichte Mainz, 253), Göttingen 2018, Vandenhoeck & Ruprecht, 474 S., € 80,00. (Michael Schaich, London) Gottesdienst im Bamberger Dom zwischen Barock und Aufklärung. Die Handschrift des Ordinarius L des Subkustos Johann Graff von 1730 als Edition mit Kommentar, hrsg. v. Franz Kohlschein / Werner Zeißner unter Mitarbeit v. Walter Milutzki (Studien zur Bamberger Bistumsgeschichte, 9), Petersberg 2018, Imhoff, 687 S. / Abb., € 79,00. (Tillmann Lohse, Berlin / Leipzig) Warnke, Marcus, Logistik und friderizianische Kriegsführung. Eine Studie zur Verteilung, Mobilisierung und Wirkungsmächtigkeit militärisch relevanter Ressourcen im Siebenjährigen Krieg am Beispiel des Jahres 1757 (Quellen und Forschungen zur Brandenburgischen und Preußischen Geschichte, 50), Berlin 2018, Duncker & Humblot, 696 S. / Abb., € 139,90. (Tilman Stieve, Aachen) Frey, Linda / Marsha Frey, The Culture of French Revolutionary Diplomacy. In the Face of Europe (Studies in Diplomacy and International Relations), Cham 2018, Palgrave Macmillan, XI u. 300 S., € 149,79. (Christine Vogel, Vechta) Wagner, Johann Conrad, „Meine Erfahrungen in dem gegenwärtigen Kriege“. Tagebuch des Feldzugs mit Herzog Carl August von Weimar, hrsg. v. Edith Zehm (Schriften der Goethe-Gesellschaft, 78), Göttingen 2018, Wallstein, 552 S. / Abb. / Faltkarte, € 59,00. (Michael Kaiser, Köln / Bonn) Zamoyski, Adam, Napoleon. Ein Leben. Aus dem Englischen übers. v. Ruth Keen / Erhard Stölting, München 2018, Beck, 863 S. / Abb., € 29,95. (Hans-Ulrich Thamer, Münster)
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Chavdarov, Anatoliy V. "Special Issue No. – 10, June, 2020 Journal > Special Issue > Special Issue No. – 10, June, 2020 > Page 5 “Quantative Methods in Modern Science” organized by Academic Paper Ltd, Russia MORPHOLOGICAL AND ANATOMICAL FEATURES OF THE GENUS GAGEA SALISB., GROWING IN THE EAST KAZAKHSTAN REGION Authors: Zhamal T. Igissinova,Almash A. Kitapbayeva,Anargul S. Sharipkhanova,Alexander L. Vorobyev,Svetlana F. Kolosova,Zhanat K. Idrisheva, DOI: https://doi.org/10.26782/jmcms.spl.10/2020.06.00041 Abstract: Due to ecological preferences among species of the genus GageaSalisb, many plants are qualified as rare and/or endangered. Therefore, the problem of rational use of natural resources, in particular protection of early spring plant species is very important. However, literary sources analysis only reveals data on the biology of species of this genus. The present research,conducted in the spring of 2017-2019, focuses on anatomical and morphological features of two Altai species: Gagealutea and Gagea minima; these features were studied, clarified and confirmed by drawings and photographs. The anatomical structure of the stem and leaf blade was studied in detail. The obtained research results will prove useful for studies of medicinal raw materials and honey plants. The aforementioned species are similar in morphological features, yet G. minima issmaller in size, and its shoots appear earlier than those of other species Keywords: Flora,gageas,Altai species,vegetative organs., Refference: I. Atlas of areas and resources of medicinal plants of Kazakhstan.Almaty, 2008. II. Baitenov M.S. Flora of Kazakhstan.Almaty: Ġylym, 2001. III. DanilevichV. G. ThegenusGageaSalisb. of WesternTienShan. PhD Thesis, St. Petersburg,1996. IV. EgeubaevaR.A., GemedzhievaN.G. The current state of stocks of medicinal plants in some mountain ecosystems of Kazakhstan.Proceedings of the international scientific conference ‘”Results and prospects for the development of botanical science in Kazakhstan’, 2002. V. Kotukhov Yu.A. New species of the genus Gagea (Liliaceae) from Southern Altai. Bot. Journal.1989;74(11). VI. KotukhovYu.A. ListofvascularplantsofKazakhstanAltai. Botan. Researches ofSiberiaandKazakhstan.2005;11. VII. KotukhovYu. The current state of populations of rare and endangered plants in Eastern Kazakhstan. Almaty: AST, 2009. VIII. Kotukhov Yu.A., DanilovaA.N., AnufrievaO.A. Synopsisoftheonions (AlliumL.) oftheKazakhstanAltai, Sauro-ManrakandtheZaisandepression. BotanicalstudiesofSiberiaandKazakhstan. 2011;17: 3-33. IX. Kotukhov, Yu.A., Baytulin, I.O. Rareandendangered, endemicandrelictelementsofthefloraofKazakhstanAltai. MaterialsoftheIntern. scientific-practical. conf. ‘Sustainablemanagementofprotectedareas’.Almaty: Ridder, 2010. X. Krasnoborov I.M. et al. The determinant of plants of the Republic of Altai. Novosibirsk: SB RAS, 2012. XI. Levichev I.G. On the species status of Gagea Rubicunda. Botanical Journal.1997;6:71-76. XII. Levichev I.G. A new species of the genus Gagea (Liliaceae). Botanical Journal. 2000;7: 186-189. XIII. Levichev I.G., Jangb Chang-gee, Seung Hwan Ohc, Lazkovd G.A.A new species of genus GageaSalisb.(Liliaceae) from Kyrgyz Republic (Western Tian Shan, Chatkal Range, Sary-Chelek Nature Reserve). Journal of Asia-Pacific Biodiversity.2019; 12: 341-343. XIV. Peterson A., Levichev I.G., Peterson J. Systematics of Gagea and Lloydia (Liliaceae) and infrageneric classification of Gagea based on molecular and morphological data. Molecular Phylogenetics and Evolution.2008; 46. XV. Peruzzi L., Peterson A., Tison J.-M., Peterson J. Phylogenetic relationships of GageaSalisb.(Liliaceae) in Italy, inferred from molecular and morphological data matrices. Plant Systematics and Evolution; 2008: 276. XVI. Rib R.D. Honey plants of Kazakhstan. Advertising Digest, 2013. XVII. Scherbakova L.I., Shirshikova N.A. Flora of medicinal plants in the vicinity of Ust-Kamenogorsk. Collection of materials of the scientific-practical conference ‘Unity of Education, Science and Innovation’. Ust-Kamenogorsk: EKSU, 2011. XVIII. syganovA.P. PrimrosesofEastKazakhstan. Ust-Kamenogorsk: EKSU, 2001. XIX. Tsyganov A.P. Flora and vegetation of the South Altai Tarbagatay. Berlin: LAP LAMBERT,2014. XX. Utyasheva, T.R., Berezovikov, N.N., Zinchenko, Yu.K. ProceedingsoftheMarkakolskStateNatureReserve. Ust-Kamenogorsk, 2009. XXI. Xinqi C, Turland NJ. Gagea. Flora of China.2000;24: 117-121. XXII. Zarrei M., Zarre S., Wilkin P., Rix E.M. Systematic revision of the genus GageaSalisb. (Liliaceae) in Iran.BotJourn Linn Soc.2007;154. XXIII. Zarrei M., Wilkin P., Ingroille M.J., Chase M.W. A revised infrageneric classification for GageaSalisb. (Tulipeae; Liliaceae): insights from DNA sequence and morphological data.Phytotaxa.2011:5. View | Download INFLUENCE OF SUCCESSION CROPPING ON ECONOMIC EFFICIENCY OF NO-TILL CROP ROTATIONS Authors: Victor K. Dridiger,Roman S. Stukalov,Rasul G. Gadzhiumarov,Anastasiya A. Voropaeva,Viktoriay A. Kolomytseva, DOI: https://doi.org/10.26782/jmcms.spl.10/2020.06.00042 Abstract: This study was aimed at examining the influence of succession cropping on the economic efficiency of no-till field crop rotations on the black earth in the zone of unstable moistening of the Stavropol krai. A long-term stationary experiment was conducted to examine for the purpose nine field crop rotation patterns different in the number of fields (four to six), set of crops, and their succession in crop rotation. The respective shares of legumes, oilseeds, and cereals in the cropping pattern were 17 to 33, 17 to 40, and 50 to 67 %. It has been established that in case of no-till field crop cultivation the economic efficiency of plant production depends on the set of crops and their succession in rotation. The most economically efficient type of crop rotation is the soya-winter wheat-peas-winter wheat-sunflower-corn six-field rotation with two fields of legumes: in this rotation 1 ha of crop rotation area yields 3 850 grain units per ha at a grain unit prime cost of 5.46 roubles; the plant production output return and profitability were 20,888 roubles per ha and 113 %, respectively. The high production profitabilities provided by the soya-winter wheat-sunflower four-field and the soya-winter-wheat-sunflower-corn-winter wheat five-field crop rotation are 108.7 and 106.2 %, respectively. The inclusion of winter wheat in crop rotation for two years in a row reduces the second winter wheat crop yield by 80 to 100 %, which means a certain reduction in the grain unit harvesting rate to 3.48-3.57 thousands per ha of rotation area and cuts the production profitability down to 84.4-92.3 %. This is why, no-till cropping should not include winter wheat for a second time Keywords: No-till technology,crop rotation,predecessor,yield,return,profitability, Refference: I Badakhova G. Kh. and Knutas A. V., Stavropol Krai: Modern Climate Conditions [Stavropol’skiykray: sovremennyyeklimaticheskiyeusloviya]. Stavropol: SUE Krai Communication Networks, 2007. II Cherkasov G. N. and Akimenko A. S. Scientific Basis of Modernization of Crop Rotations and Formation of Their Systems according to the Specializations of Farms in the Central Chernozem Region [Osnovy moderniz atsiisevooborotoviformirovaniyaikh sistem v sootvetstvii so spetsi-alizatsiyeykhozyaystvTsentral’nogoChernozem’ya]. Zemledelie. 2017; 4: 3-5. III Decree 330 of July 6, 2017 the Ministry of Agriculture of Russia “On Approving Coefficients of Converting to Agricultural Crops to Grain Units [Ob utverzhdeniikoeffitsiyentovperevoda v zernovyyee dinitsysel’s kokhozyaystvennykhkul’tur]. IV Dridiger V. K., About Methods of Research of No-Till Technology [O metodikeissledovaniytekhnologii No-till]//Achievements of Science and Technology of AIC (Dostizheniyanaukiitekhniki APK). 2016; 30 (4): 30-32. V Dridiger V. K. and Gadzhiumarov R. G. Growth, Development, and Productivity of Soya Beans Cultivated On No-Till Technology in the Zone of Unstable Moistening of Stavropol Region [Rost, razvitiyeiproduktivnost’ soiprivozdelyvaniipotekhnologii No-till v zone ne-ustoychivog ouvlazhneniyaStavropol’skogokraya]//Oil Crops RTBVNIIMK (Maslichnyyekul’turyNTBVNIIMK). 2018; 3 (175): 52–57. VI Dridiger V. K., Godunova E. I., Eroshenko F. V., Stukalov R. S., Gadzhiumarov, R. G., Effekt of No-till Technology on erosion resistance, the population of earthworms and humus content in soil (Vliyaniyetekhnologii No-till naprotivoerozionnuyuustoychivost’, populyatsiyudozhdevykhcherveyisoderzhaniyegumusa v pochve)//Research Journal of Pharmaceutical, Biological and Chemical Sciences. 2018; 9 (2): 766-770. VII Karabutov A. P., Solovichenko V. D., Nikitin V. V. et al., Reproduction of Soil Fertility, Productivity and Energy Efficiency of Crop Rotations [Vosproizvodstvoplodorodiyapochv, produktivnost’ ienergeticheskayaeffektivnost’ sevooborotov]. Zemledelie. 2019; 2: 3-7. VIII Kulintsev V. V., Dridiger V. K., Godunova E. I., Kovtun V. I., Zhukova M. P., Effekt of No-till Technology on The Available Moisture Content and Soil Density in The Crop Rotation [Vliyaniyetekhnologii No-till nasoderzhaniyedostupnoyvlagiiplotnost’ pochvy v sevoob-orote]// Research Journal of Pharmaceutical, Biological and Chemical Sciences. 2017; 8 (6): 795-99. IX Kulintsev V. V., Godunova E. I., Zhelnakova L. I. et al., Next-Gen Agriculture System for Stavropol Krai: Monograph [SistemazemledeliyanovogopokoleniyaStavropol’skogokraya: Monogtafiya]. Stavropol: AGRUS Publishers, Stavropol State Agrarian University, 2013. X Lessiter Frank, 29 reasons why many growers are harvesting higher no-till yields in their fields than some university scientists find in research plots//No-till Farmer. 2015; 44 (2): 8. XI Rodionova O. A. Reproduction and Exchange-Distributive Relations in Farming Entities [Vosproizvodstvoiobmenno-raspredelitel’nyyeotnosheniya v sel’skokhozyaystvennykhorganizatsiyakh]//Economy, Labour, and Control in Agriculture (Ekonomika, trud, upravleniye v sel’skomkhozyaystve). 2010; 1 (2): 24-27. XII Sandu I. S., Svobodin V. A., Nechaev V. I., Kosolapova M. V., and Fedorenko V. F., Agricultural Production Efficiency: Recommended Practices [Effektivnost’ sel’skokhozyaystvennogoproizvodstva (metodicheskiyerekomendatsii)]. Moscow: Rosinforagrotech, 2013. XIII Sotchenko V. S. Modern Corn Cultivation Technologies [Sovremennayatekhnologiyavozdelyvaniya]. Moscow: Rosagrokhim, 2009. View | Download DEVELOPMENT AND TESTING OF AUTONOMOUS PORTABLE SEISMOMETER DESIGNED FOR USE AT ULTRALOW TEMPERATURES IN ARCTIC ENVIRONMENT Authors: Mikhail A. Abaturov,Yuriy V. Sirotinskiy, DOI: https://doi.org/10.26782/jmcms.spl.10/2020.06.00043 Abstract: This paper is concerned with solving one of the issues of the general problem of designing geophysical equipment for the natural climatic environment of the Arctic. The relevance of the topic has to do with an increased global interest in this region. The paper is aimed at considering the basic principles of developing and the procedure of testing seismic instruments for use at ultralow climatic temperatures. In this paper the indicated issue is considered through the example of a seismic module designed for petroleum and gas exploration by passive seismoacoustic methods. The seismic module is a direct-burial portable unit of around 5 kg in weight, designed to continuously measure and record microseismic triaxial orthogonal (ZNE) noise in a range from 0.1 to 45 Hz during several days in autonomous mode. The functional chart of designing the seismic module was considered, and concrete conclusions were made for choosing the necessary components to meet the ultralow-temperature operational requirements. The conclusions made served for developing appropriate seismic module. In this case, the components and tools used included a SAFT MP 176065 xc low-temperature lithium cell, industrial-spec electronic component parts, a Zhaofeng Geophysical ZF-4.5 Chinese primary electrodynamic seismic sensor, housing seal parts made of frost-resistant silicone materials, and finely dispersed silica gel used as water-retaining sorbent to avoid condensation in the housing. The paper also describes a procedure of low-temperature collation tests at the lab using a New Brunswick Scientific freezing plant. The test results proved the operability of the developed equipment at ultralow temperatures down to -55°C. In addition, tests were conducted at low microseismic noises in the actual Arctic environment. The possibility to detect signals in a range from 1 to 10 Hz at the level close to the NLNM limit (the Peterson model) has been confirmed, which allows monitoring and exploring petroleum and gas deposits by passive methods. As revealed by this study, the suggested approaches are efficient in developing high-precision mobile seismic instruments for use at ultralow climatic temperatures. The solution of the considered instrumentation and methodical issues is of great practical significance as a constituent of the generic problem of Arctic exploration. Keywords: Seismic instrumentation,microseismic monitoring,Peterson model,geological exploration,temperature ratings,cooling test, Refference: I. AD797: Ultralow Distortion, Ultralow Noise Op Amp, Analog Devices, Inc., Data Sheet (Rev. K). Analog Devices, Inc. URL: https://www.analog.com/media/en/technical-documentation/data-sheets/AD797.pdf(Date of access September 2, 2019). II. Agafonov, V. M., Egorov, I. V., and Shabalina, A. S. Operating Principles and Technical Characteristics of a Small-Sized Molecular–Electronic Seismic Sensor with Negative Feedback [Printsipyraboty I tekhnicheskiyekharakteristikimalogabaritnogomolekulyarno-elektronnogoseysmodatchika s otritsatel’noyobratnoysvyaz’yu]. SeysmicheskiyePribory (Seismic Instruments). 2014; 50 (1): 1–8. DOI: 10.3103/S0747923914010022. III. Antonovskaya, G., Konechnaya, Ya.,Kremenetskaya, E., Asming, V., Kvaema, T., Schweitzer, J., Ringdal, F. Enhanced Earthquake Monitoring in the European Arctic. Polar Science. 2015; 1 (9): 158-167. IV. Anthony, R. E., Aster, R. C., Wiens, D., Nyblade, Andr., Anandakrishnan, Sr., Huerta, Audr., Winberry, J. P., Wilson, T., and Rowe, Ch. The Seismic Noise Environment of Antarctica. Seismological Research Letters. 2015; 86(1): 89-100. DOI: 10.1785/0220150005 V. Brincker, R., Lago, T. L., Andersen, P., and Ventura, C. Improving the Classical Geophone Sensor Element by Digital Correction. In Conference Proceedings: IMAC-XXIII: A Conference & Exposition on Structural Dynamics Society for Experimental Mechanics, 2005. URL: https://www.researchgate.net/publication/242452637_Improving_the_Classical_Geophone_Sensor_Element_by_Digital_Correction(Date of access September 2, 2019). VI. Bylaw 164 of the State Committee for Construction of the Russian Federation “On adopting amendments to SNiP 31-01-99 “Construction climatology”. URL: https://base.garant.ru/2322381/(Date of access September 2, 2019). VII. Chao Xu, Junbo Wang, Deyong Chen, Jian Chen, Bowen Liu, Wenjie Qi, XichenZheng, Hua Wei, Guoqing Zhang. The Electrochemical Seismometer Based on a Novel Designed.Sensing Electrode for Undersea Exploration. 20th International Conference on Solid-State Sensors, Actuators and Microsystems &Eurosensors XXXIII (TRANSDUCERS &EUROSENSORS XXXIII). IEEE, 2019. DOI: 10.1109/TRANSDUCERS.2019.8808450. VIII. Chebotareva, I. Ya. New algorithms of emission tomography for passive seismic monitoring of a producing hydrocarbon deposit: Part I. Algorithms of processing and numerical simulation [Novyye algoritmyemissionnoyto mografiidlyapassivnogoseysmicheskogomonitoringarazrabatyvayemykhmestorozhdeniyuglevodorodov. Chast’ I: Algoritmyobrabotki I chislennoyemodelirovaniye]. FizikaZemli. 2010; 46(3):187-98. DOI: 10.1134/S106935131003002X IX. Danilov, A. V. and Konechnaya, Ya. V. Analytical comparison of seismic instruments for stationary surveys in the Arctic [Sravnitel’nyyanalizseysmicheskoyapparaturydlyastatsionarnykhnablyudeniy v Arktike]. DSYS. URL: https://dsys.ru/upload/id254_docPDF_FranzJosefLand.pdf(Date of access September 2, 2019). X. Dew point temperature calculator. Maple Tech. International LLC. URL: https://www.calculator.net/dew-point-calculator.html?airtemperature=20&airtemperatureunit=celsius&humidity=0.34&dewpoint=&dewpointunit=celsius&x=51&y=14(Date of access September 2, 2019). XI. Frolov, A. S. Matching of wave fields recorded by different geophysical receivers [Soglasovaniyevolnovykhpoley, poluchennykh s primeneniyemrazlichnoyregistriruyushcheyapparatury]. Abstracts IX International scientific and technical conference competition of young specialists “Geophysics-2013”. Saint-Petersburg: Gubkin University, 2013. URL: https://www.gubkin.ru/faculty/geology_and_geophysics/chairs_and_departments/exploration_geophysics_and_computers_systems/files/2013_SPb_Frolov.pdf. (Date of access September 2, 2019). XII. Gibbons, S. J., Asming, V., Fedorov, A., Fyen, J., Kero, J., Kozlovskaya, E., Kværna, T., Liszka, L., Näsholm, S.P., Raita, T., Roth, M., Tiira, T., Vinogradov, Yu. The European Arctic: A laboratory for seismoacoustic studies. Seism. Res. Letters. 2015; 86 (3): 917–928. XIII. GOST 8.395-80. State system for ensuring the uniformity of measurements. Reference conditions of measurements while calibrating. General requirements [Gosudarstvennayasistemaobespecheniyaedinstvaizmereniy. Normal’nyyeusloviyaizmereniypripoverke. Obshchiyetrebovaniya]. Moscow: Standartinform, 2008. URL: http://gostrf.com/normadata/1/4294821/4294821960.pdf (Date of access September 2, 2019). XIV. Guralp 6TD. Operators’ Guide. Document Number: MAN-T60-0002, Issue J: April, 2017. Guralp Systems Limited. URL: https://www.guralp.com/documents/MAN-T60-0002.pdf (Date of access September 2, 2019). XV. Inshakova, A. S., Barykina, E. S., and Kozlov, V. V. Role of silica gel in adsorption air drying [Rol’ silikagelya v adsorbtsionnoyosushkevozdukha]. AlleyaNauki (Alley of Science). 2017; 15. URL: https://www.alley- science.ru/domains_data/files/November2017/ROL%20SILIKAGELYa%20V%20ADSORBCIONNOY%20OSUShKE%20VOZDUHA.pdf(Date of access September 2, 2019). XVI. Ioffe, D. and Pozdnyakov, P. Searching for Hidden Reserves of Modern Microchip Circuits. Part I [Poiskskrytykhrezervovsovremennykhmikroskhem. Chast’ I].Komponenty I tekhnologii (Components and Technologies). 2015; 4: 144-46. XVII. Jiang Xu, Xi Wang, Ningyi Yuan, Jianning Ding, Si Qin, Joselito M. Razal, Xuehang Wang, ShanhaiGe, Gogotsi, Yu. Extending the low temperature operational limit of Li-ion battery to −80 °C. Energy Storage Materials (IF0). Published 2019-04-27. DOI: 10.1016/j.ensm.2019.04.033. XVIII. Kouznetsov, O. L., Lyasch, Y. F., Chirkin, I. A., Rizanov, E. G., LeRoy, S. D., Koligaev, S. O. Long-term monitoring of microseismic emissions: Earth tides, fracture distribution, and fluid content. SEG, APPG Interpretation. 2016: 4 (2): T191–T204. XIX. Laverov, N. P., Bogoyavlenskiy, V. I., Bogoyavlenskiy, I. V. Fundamental Aspects of Rational Management of the Petroleum and Gas Resources of the Arctic and the Russian Continental Shelf: Strategy, Prospects, and Problems [Fundamental’nyyeaspektyratsional’nogoosvoyeniyaresursovneftiigazaArktiki I shel’faRossii: strategiya, perspektivyi problem].Arktika: ekologiya I ekonomika [Arctic: Ecology and Economy]. 2016; 2 (22): 4-13. XX. Lee, P. Low Noise Amplifier Selection Guide for Optimal Noise Performance, Analog Devices, Inc., AN-940 Application Note. Analog Devices, Inc. URL: https://www.analog.com/media/en/technical-documentation/application-notes/AN-940.pdf(Date of access September 2, 2019). XXI. Markatis, N., Polychronopoulou, K., Tselentis, Ak. Passive seismic tomography: A passive concept actively evolving. First Break. 2012; 30 (7): 83-90. XXII. Matveev, I. V. and Matveeva, N. V. Portable seismic recorder “SEISAR-5” with very low energy consumption for autonomous work in harsh climatic conditions [Portativnyyseysmicheskiyregistrator «Seysar-5» s ochen’ nizkimenergopotrebleniyemdlyaavtonomnoyraboty v slozhnykhklimatic heskikhusloviyakh]. Nauka I tekhnologicheskierazrabotki (Science and Technological Developments). 2017; 96 (3): 33-40. [Special Issue “Applied Geophysics: New Developments and Results. Part 1. Seismology and Seismic Exploration]. DOI: 10.21455/std2017.3-3. XXIII. Mishra, R. The Temperature Ratings of Electronic Parts.Electronics Cooling magazine. URL: http://www.electronics-cooling.com/2004/02/the-temperature-ratings-of-electronic-parts(Date of access September 2, 2019). XXIV. Moore, Sue E.; Stabeno, Phyllis J.; Van Pelt, Thomas I. The Synthesis of Arctic Research (SOAR) project. 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URL: http://fciarctic.ru/index.php?page=ckpg (Date of access September 2, 2019). XXXV. Sobisevich, A. L.,Presnov, D. A.,Agafonov, V. M.,Sobisevich, L. E. Autonomous geohydroacoustic ice buoy of new generation [Vmorazhivayemyyavtonomnyygeogidroakusticheskiy buy novogopokoleniya]. Nauka I tekhnologicheskierazrabotki (Science and Technological Developments). 2018; 97 (1): 25–34. [Special issue “Precise Geophysical Monitoring of Natural Hazards. Part 1. Instruments andTechnologies”]. DOI: 10.21455/ std2018.1-3. XXXVI. Zhukov, Y. V. Issues of resistance and reliability of electronic equipment products to the exposure factors [Voprosystoykosti i nadezhnostiizdeliyradioelektronnoytekhniki k vneshnimvozdeystvuyushchimfaktoram]. Provintsial’nyyenauchnyyezapiski (The journal Provincial scientific proceedings). 2019; 1 (9): 118-124. View | Download COMPARATIVE ANALYSIS OF RESULTS OF TREATMENT OF PATIENTS WITH FOOT PATHOLOGY WHO UNDERWENT WEIL OPEN OSTEOTOMY BY CLASSICAL METHOD AND WITHOUT STEOSYNTHESIS Authors: Yuriy V. Lartsev,Dmitrii A. Rasputin,Sergey D. Zuev-Ratnikov,Pavel V.Ryzhov,Dmitry S. Kudashev,Anton A. Bogdanov, DOI: https://doi.org/10.26782/jmcms.spl.10/2020.06.00044 Abstract: The article considers the problem of surgical correction of the second metatarsal bone length. The article analyzes the results of treatment of patients with excess length of the second metatarsal bones that underwent osteotomy with and without osteosynthesis. The results of treatment of patients who underwent metatarsal shortening due to classical Weil-osteotomy with and without osteosynthesis were analyzed. The first group consisted of 34 patients. They underwent classical Weil osteotomy. The second group included 44 patients in whomosteotomy of the second metatarsal bone were not by the screw. When studying the results of the treatment in the immediate postoperative period, weeks 6, 12, slightly better results were observed in patients of the first group, while one year after surgical treatment the results in both groups were comparable. One year after surgical treatment, there were 2.9% (1 patient) of unsatisfactory results in the first group and 4.5% (2 patients) in the second group. Considering the comparability of the results of treatment in remote postoperative period, the choice of concrete method remains with the operating surgeon. Keywords: Flat feet,hallux valgus,corrective osteotomy,metatarsal bones, Refference: I. A novel modification of the Stainsby procedure: surgical technique and clinical outcome [Text] / E. Concannon, R. MacNiocaill, R. Flavin [et al.] // Foot Ankle Surg. – 2014. – Dec., Vol. 20(4). – P. 262–267. II. Accurate determination of relative metatarsal protrusion with a small intermetatarsal angle: a novel simplified method [Text] / L. Osher, M.M. Blazer, S. Buck [et al.] // J. Foot Ankle Surg. – 2014. – Sep.-Oct., Vol. 53(5). – P. 548–556. III. Argerakis, N.G. The radiographic effects of the scarf bunionectomy on rearfoot alignment [Text] / N.G. Argerakis, L.Jr. Weil, L.S. Sr. Weil // Foot Ankle Spec. – 2015. – Apr., Vol. 8(2). – P. 89–94. IV. Bauer, T. Percutaneous forefoot surgery [Text] / T. Bauer // Orthop. Traumatol. Surg. Res. – 2014. – Feb., Vol. 100(1 Suppl.). – P. S191–S204. V. Biomechanical Evaluation of Custom Foot Orthoses for Hallux Valgus Deformity [Text] // J. Foot Ankle Surg. – 2015. – Sep.-Oct., Vol.54(5). – P. 852–855. VI. Chopra, S. Characterization of gait in female patients with moderate to severe hallux valgus deformity [Text] / S. Chopra, K. Moerenhout, X. Crevoisier // Clin. Biomech. (Bristol, Avon). – 2015. – Jul., Vol. 30(6). – P. 629–635. VII. Computer assisted planning and custom-made surgical guide for malunited pronation deformity after first metatarsophalangeal joint arthrodesis in rheumatoid arthritis: a case report [Text] / M. Hirao, S. Ikemoto, H. Tsuboi [et al.] // Comput. Aided Surg. – 2014. – Vol. 19(1-3). – P. 13–19. VIII. Correlation between static radiographic measurements and intersegmental angular measurements during gait using a multisegment foot model [Text] / D.Y. Lee, S.G. Seo, E.J. Kim [et al.] // Foot Ankle Int. – 2015. – Jan., Vol.36(1). – P. 1–10. IX. Correlative study between length of first metatarsal and transfer metatarsalgia after osteotomy of first metatarsal [Text]: [Article in Chinese] / F.Q. Zhang, B.Y. Pei, S.T. Wei [et al.] // Zhonghua Yi XueZaZhi. – 2013. – Nov. 19, Vol. 93(43). – P. 3441–3444. X. Dave, M.H. Forefoot Deformity in Rheumatoid Arthritis: A Comparison of Shod and Unshod Populations [Text] / M.H. Dave, L.W. Mason, K. Hariharan // Foot Ankle Spec. – 2015. – Oct., Vol. 8(5). – P. 378–383. XI. Does arthrodesis of the first metatarsophalangeal joint correct the intermetatarsal M1M2 angle? Analysis of a continuous series of 208 arthrodeses fixed with plates [Text] / F. Dalat, F. Cottalorda, M.H. Fessy [et al.] // Orthop. Traumatol. Surg. Res. – 2015. – Oct., Vol. 101(6). – P. 709–714. XII. Dynamic plantar pressure distribution after percutaneous hallux valgus correction using the Reverdin-Isham osteotomy [Text]: [Article in Spanish] / G. Rodríguez-Reyes, E. López-Gavito, A.I. Pérez-Sanpablo [et al.] // Rev. Invest. Clin. – 2014. – Jul., Vol. 66, Suppl. 1. – P. S79-S84. XIII. Efficacy of Bilateral Simultaneous Hallux Valgus Correction Compared to Unilateral [Text] / A.V. Boychenko, L.N. Solomin, S.G. Parfeyev [et al.] // Foot Ankle Int. – 2015. – Nov., Vol. 36(11). – P. 1339–1343. XIV. Endolog technique for correction of hallux valgus: a prospective study of 30 patients with 4-year follow-up [Text] / C. Biz, M. Corradin, I. Petretta [et al.] // J. OrthopSurg Res. – 2015. – Jul. 2, № 10. – P. 102. XV. First metatarsal proximal opening wedge osteotomy for correction of hallux valgus deformity: comparison of straight versus oblique osteotomy [Text] / S.H. Han, E.H. Park, J. Jo [et al.] // Yonsei Med. J. – 2015. – May, Vol. 56(3). – P. 744–752. XVI. Long-term outcome of joint-preserving surgery by combination metatarsal osteotomies for shortening for forefoot deformity in patients with rheumatoid arthritis [Text] / H. Niki, T. Hirano, Y. Akiyama [et al.] // Mod. Rheumatol. – 2015. – Sep., Vol. 25(5). – P. 683–638. XVII. Maceira, E. Transfer metatarsalgia post hallux valgus surgery [Text] / E. Maceira, M. Monteagudo // Foot Ankle Clin. – 2014. – Jun., Vol. 19(2). – P.285–307. XVIII. Nielson, D.L. Absorbable fixation in forefoot surgery: a viable alternative to metallic hardware [Text] / D.L. Nielson, N.J. Young, C.M. Zelen // Clin. Podiatr. Med. Surg. – 2013. – Jul., Vol. 30(3). – P. 283–293 XIX. Patient’s satisfaction after outpatient forefoot surgery: Study of 619 cases [Text] / A. Mouton, V. Le Strat, D. Medevielle [et al.] // Orthop. Traumatol. Surg. Res. – 2015. – Oct., Vol. 101(6 Suppl.). – P. S217–S220. XX. Preference of surgical procedure for the forefoot deformity in the rheumatoid arthritis patients–A prospective, randomized, internal controlled study [Text] / M. Tada, T. Koike, T. Okano [et al.] // Mod. Rheumatol. – 2015. – May., Vol. 25(3). – P.362–366. XXI. Redfern, D. Percutaneous Surgery of the Forefoot [Text] / D. Redfern, J. Vernois, B.P. Legré // Clin. Podiatr. Med. Surg. – 2015. – Jul., Vol. 32(3). – P. 291–332. XXII. Singh, D. Bullous pemphigoid after bilateral forefoot surgery [Text] / D. Singh, A. Swann // Foot Ankle Spec. – 2015. – Feb., Vol. 8(1). – P. 68–72. XXIII. Treatment of moderate hallux valgus by percutaneous, extra-articular reverse-L Chevron (PERC) osteotomy [Text] / J. Lucas y Hernandez, P. Golanó, S. Roshan-Zamir [et al.] // Bone Joint J. – 2016. – Mar., Vol. 98-B(3). – P. 365–373. XXIV. Weil, L.Jr. Scarf osteotomy for correction of hallux abducto valgus deformity [Text] / L.Jr. Weil, M. Bowen // Clin. Podiatr. Med. Surg. – 2014. – Apr., Vol.31(2). – P. 233–246. View | Download QUANTITATIVE ULTRASONOGRAPHY OF THE STOMACH AND SMALL INTESTINE IN HEALTHYDOGS Authors: Roman A. Tcygansky,Irina I. Nekrasova,Angelina N. Shulunova,Alexander I.Sidelnikov, DOI: https://doi.org/10.26782/jmcms.spl.10/2020.06.00045 Abstract: Purpose.To determine the quantitative echogenicity indicators (and their ratio) of the layers of stomach and small intestine wall in healthy dogs. Methods. A prospective 3-year study of 86 healthy dogs (aged 1-7 yrs) of different breeds and of both sexes. Echo homogeneity and echogenicity of the stomach and intestines wall were determined by the method of Silina, T.L., et al. (2010) in absolute values of average brightness levels of ultrasound image pixels using the 8-bit scale with 256 shades of gray. Results. Quantitative echogenicity indicators of the stomach and the small intestine wall in dogs were determined. Based on the numerical values characterizing echogenicity distribution in each layer of a separate structure of the digestive system, the coefficient of gastric echogenicity is determined as 1:2.4:1.1 (mucosa/submucosa/muscle layers, respectively), the coefficient of duodenum and jejunum echogenicity is determined as 1:3.5:2 and that of ileum is 1:1.8:1. Clinical significance. The echogenicity coefficient of the wall of the digestive system allows an objective assessment of the stomach and intestines wall and can serve as the basis for a quantitative assessment of echogenicity changes for various pathologies of the digestive system Keywords: Ultrasound (US),echogenicity,echogenicity coefficient,digestive system,dogs,stomach,intestines, Refference: I. Agut, A. Ultrasound examination of the small intestine in small animals // Veterinary focus. 2009.Vol. 19. No. 1. P. 20-29. II. Bull. 4.RF patent 2398513, IPC51A61B8 / 00 A61B8 / 14 (2006.01) A method for determining the homoechogeneity and the degree of echogenicity of an ultrasound image / T. Silina, S. S. Golubkov. – No. 2008149311/14; declared 12/16/2008; publ. 09/10/2010 III. Choi, M., Seo, M., Jung, J., Lee, K., Yoon, J., Chang, D., Park, RD. Evaluation of canine gastric motility with ultrasonography // J. of Veterinary Medical Science. – 2002. Vol. 64. – № 1. – P. 17-21. IV. Delaney, F., O’Brien, R.T., Waller, K.Ultrasound evaluation of small bowel thickness compared to weight in normal dogs // Veterinary Radiology and Ultrasound. 2003 Vol. 44, № 5. Р 577-580. V. Diana, A., Specchi, S., Toaldo, M.B., Chiocchetti, R., Laghi, A., Cipone, M. Contrast-enhanced ultrasonography of the small bowel in healthy cats // Veterinary Radiology and Ultrasound. – 2011. – Vol. 52, № 5. – Р. 555-559. VI. Garcia, D.A.A., Froes, T.R. Errors in abdominal ultrasonography in dogs and cats // J. of Small Animal Practice. – 2012. Vol. 53. – № 9. – P. 514-519. VII. Garcia, D.A.A., Froes, T.R. Importance of fasting in preparing dogs for abdominal ultrasound examination of specific organs // J. of Small Animal Practice. – 2014. Vol. 55. – № 12. – P. 630-634. VIII. Gaschen, L., Granger, L.A., Oubre, O., Shannon, D., Kearney, M., Gaschen, F. The effects of food intake and its fat composition on intestinal echogenicity in healthy dogs // Veterinary Radiology and Ultrasound. 2016. Vol. 57. № 5. P. 546-550 IX. Gaschen, L., Kircher, P., Stussi, A., Allenspach, K., Gaschen, F., Doherr, M., Grone, A. Comparison of ultrasonographic findings with clinical activity index (CIBDAI) and diagnosis in dogs with chronic enteropathies // Veterinary radiology and ultrasound. – 2008. – Vol. 49. – № 1. – Р. 56-64. X. Gil, E.M.U. Garcia, D.A.A. Froes, T.R. In utero development of the fetal intestine: Sonographic evaluation and correlation with gestational age and fetal maturity in dogs // Theriogenology. 2015. Vol. 84, №5. Р. 681-686. XI. Gladwin, N.E. Penninck, D.G., Webster, C.R.L. Ultrasonographic evaluation of the thickness of the wall layers in the intestinal tract of dogs // American Journal of Veterinary Research. 2014. Vol. 75, №4. Р. 349-353. XII. Gory, G., Rault, D.N., Gatel, L, Dally, C., Belli, P., Couturier, L., Cauvin, E. Ultrasonographic characteristics of the abdominal esophagus and cardia in dogs // Veterinary Radiology and Ultrasound. 2014. Vol. 55, № 5. P. 552-560. XIII. Günther, C.S. Lautenschläger, I.E., Scholz, V.B. Assessment of the inter- and intraobserver variability for sonographical measurement of intestinal wall thickness in dogs without gastrointestinal diseases | [Inter-und Intraobserver-Variabilitätbei der sonographischenBestimmung der Darmwanddicke von HundenohnegastrointestinaleErkrankungen] // Tierarztliche Praxis Ausgabe K: Kleintiere – Heimtiere. 2014. Vol. 42 №2. Р. 71-78. XIV. Hanazono, K., Fukumoto, S., Hirayama, K., Takashima, K., Yamane, Y., Natsuhori, M., Kadosawa, T., Uchide, T. Predicting Metastatic Potential of gastrointestinal stromal tumors in dog by ultrasonography // J. of Veterinary Medical Science. – 2012. Vol. 74. – № 11. – P. 1477-1482. XV. Heng, H.G., Lim, Ch.K., Miller, M.A., Broman, M.M.Prevalence and significance of an ultrasonographic colonic muscularishyperechoic band paralleling the serosal layer in dogs // Veterinary Radiology and Ultrasound. 2015. Vol. 56 № 6. P. 666-669. XVI. Ivančić, M., Mai, W. Qualitative and quantitative comparison of renal vs. hepatic ultrasonographic intensity in healthy dogs // Veterinary Radiology and Ultrasound. 2008. Vol. 49. № 4. Р. 368-373. XVII. Lamb, C.R., Mantis, P. Ultrasonographic features of intestinal intussusception in 10 dogs // J. of Small Animal Practice. – 2008. Vol. 39. – № 9. – P. 437-441. XVIII. Le Roux, A. B., Granger, L.A., Wakamatsu, N, Kearney, M.T., Gaschen, L.Ex vivo correlation of ultrasonographic small intestinal wall layering with histology in dogs // Veterinary Radiology and Ultrasound.2016. Vol. 57. № 5. P. 534-545. XIX. Nielsen, T. High-frequency ultrasound of Peyer’s patches in the small intestine of young cats / T. Nielsen [et al.] // Journal of Feline Medicine and Surgery. – 2015. – Vol. 18, № 4. – Р. 303-309. XX. PenninckD.G. Gastrointestinal tract. In Nyland T.G., Mattoon J.S. (eds): Small Animal Diagnostic Ultrasound. Philadelphia: WB Saunders. 2002, 2nd ed. Р. 207-230. XXI. PenninckD.G. Gastrointestinal tract. In: PenninckD.G.,d´Anjou M.A. Atlas of Small Animal Ultrasonography. Blackwell Publishing, Iowa. 2008. Р. 281-318. XXII. Penninck, D.G., Nyland, T.G., Kerr, L.Y., Fisher, P.E. Ultrasonographic evaluation of gastrointestinal diseases in small animals // Veterinary Radiology. 1990. Vol. 31. №3. P. 134-141. XXIII. Penninck, D.G.,Webster, C.R.L.,Keating, J.H. The sonographic appearance of intestinal mucosal fibrosis in cats // Veterinary Radiology and Ultrasound. – 2010. – Vol. 51, № 4. – Р. 458-461. XXIV. Pollard, R.E.,Johnson, E.G., Pesavento, P.A., Baker, T.W., Cannon, A.B., Kass, P.H., Marks, S.L. Effects of corn oil administered orally on conspicuity of ultrasonographic small intestinal lesions in dogs with lymphangiectasia // Veterinary Radiology and Ultrasound. 2013. Vol. 54. № 4. P. 390-397. XXV. Rault, D.N., Besso, J.G., Boulouha, L., Begon, D., Ruel, Y. Significance of a common extended mucosal interface observed in transverse small intestine sonograms // Veterinary Radiology and Ultrasound. 2004. Vol. 45. №2. Р. 177-179. XXVI. Sutherland-Smith, J., Penninck, D.G., Keating, J.H., Webster, C.R.L. Ultrasonographic intestinal hyperechoic mucosal striations in dogs are associated with lacteal dilation // Veterinary Radiology and Ultrasound. – 2007. Vol. 48. – № 1. – P. 51-57. View | Download EVALUATION OF ADAPTIVE POTENTIAL IN MEDICAL STUDENTS IN THE CONTEXT OF SEASONAL DYNAMICS Authors: Larisa A. Merdenova,Elena A. Takoeva,Marina I. Nartikoeva,Victoria A. Belyayeva,Fatima S. Datieva,Larisa R. Datieva, DOI: https://doi.org/10.26782/jmcms.spl.10/2020.06.00046 Abstract: The aim of this work was to assess the functional reserves of the body to quantify individual health; adaptation, psychophysiological characteristics of the health quality of medical students in different seasons of the year. When studying the temporal organization of physiological functions, the rhythm parameters of physiological functions were determined, followed by processing the results using the Cosinor Analysis program, which reveals rhythms with an unknown period for unequal observations, evaluates 5 parameters of sinusoidal rhythms (mesor, amplitude, acrophase, period, reliability). The essence of desynchronization is the mismatch of circadian rhythms among themselves or destruction of the rhythms architectonics (instability of acrophases or their disappearance). Desynchronization with respect to the rhythmic structure of the body is of a disregulatory nature, most pronounced in pathological desynchronization. High neurotism, increased anxiety reinforces the tendency to internal desynchronization, which increases with stress. During examination stress, students experience a decrease in the stability of the temporary organization of the biosystem and the tension of adaptive mechanisms develops, which affects attention, mental performance and the quality of adaptation to the educational process. Time is shortened and the amplitude of the “initial minute” decreases, personal and situational anxiety develops, and the level of psychophysiological adaptation decreases. The results of the work are priority because they can be used in assessing quality and level of health. Keywords: Desynchronosis,biorhythms,psycho-emotional stress,mesor,acrophase,amplitude,individual minute, Refference: I. Arendt, J., Middleton, B. Human seasonal and circadian studies in Antarctica (Halley, 75_S) – General and Comparative Endocrinology. 2017: 250-259. (http://dx.doi.org/10.1016/j.ygcen.2017.05.010). II. BalandinYu.P. A brief methodological guide on the use of the agro-industrial complex “Health Sources” / Yu.P. Balandin, V.S. Generalov, V.F. Shishlov. Ryazan, 2007. III. Buslovskaya L.K. Adaptation reactions in students at exam stress/ L.K. Buslovskaya, Yu.P. Ryzhkova. Scientific bulletin of Belgorod State University. Series: Natural Sciences. 2011;17(21):46-52. IV. Chutko L. S. Sindromjemocionalnogovygoranija – Klinicheskie I psihologicheskieaspekty./ L.S Chutko. Moscow: MEDpress-inform, 2013. V. Eroshina K., Paul Wilkinson, Martin Mackey. The role of environmental and social factors in the occurrence of diseases of the respiratory tract in children of primary school age in Moscow. Medicine. 2013:57-71. VI. Fagrell B. “Microcirculation of the Skin”. The physiology and pharmacology of the microcirculation. 2013:423. VII. Gurova O.A. Change in blood microcirculation in students throughout the day. New research. 2013; 2 (35):66-71. VIII. Khetagurova L.G. – Stress/Ed. L.G. Khetagurov. Vladikavkaz: Project-Press Publishing House, 2010. IX. Khetagurova L.G., Urumova L.T. et al. Stress (chronomedical aspects). International Journal of Experimental Education 2010; 12: 30-31. X. Khetagurova L.G., Salbiev K.D., Belyaev S.D., Datieva F.S., Kataeva M.R., Tagaeva I.R. Chronopathology (experimental and clinical aspects/ Ed. L.G. Khetagurov, K.D. Salbiev, S.D.Belyaev, F.S. Datiev, M.R. Kataev, I.R. Tagaev. Moscow: Science, 2004. XI. KlassinaS.Ya. Self-regulatory reactions in the microvasculature of the nail bed of fingers in person with psycho-emotional stress. Bulletin of new medical technologies, 2013; 2 (XX):408-412. XII. Kovtun O.P., Anufrieva E.V., Polushina L.G. Gender-age characteristics of the component composition of the body in overweight and obese schoolchildren. Medical Science and Education of the Urals. 2019; 3:139-145. XIII. Kuchieva M.B., Chaplygina E.V., Vartanova O.T., Aksenova O.A., Evtushenko A.V., Nor-Arevyan K.A., Elizarova E.S., Efremova E.N. A comparative analysis of the constitutional features of various generations of healthy young men and women in the Rostov Region. Modern problems of science and education. 2017; 5:50-59. XIV. Mathias Adamsson1, ThorbjörnLaike, Takeshi Morita – Annual variation in daily light expo-sure and circadian change of melatonin and cortisol consent rations at a northern latitude with large seasonal differences in photoperiod length – Journal of Physiological Anthropology. 2017; 36: 6 – 15. XV. Merdenova L.A., Tagaeva I.R., Takoeva E.A. Features of the study of biological rhythms in children. The results of fundamental and applied research in the field of natural and technical sciences. Materials of the International Scientific and Practical Conference. Belgorod, 2017, pp. 119-123. XVI. Ogarysheva N.V. The dynamics of mental performance as a criterion for adapting to the teaching load. Bulletin of the Samara Scientific Center of the Russian Academy of Sciences. 2014;16:5 (1): S.636-638. XVII. Pekmezovi T. Gene-environment interaction: A genetic-epidemiological approach. Journal of Medical Biochemistry. 2010;29:131-134. XVIII. Rapoport S.I., Chibisov S.M. Chronobiology and chronomedicine: history and prospects/Ed. S.M. Chibisov, S.I. Rapoport ,, M.L. Blagonravova. Chronobiology and Chronomedicine: Peoples’ Friendship University of Russia (RUDN) Press. Moscow, 2018. XIX. Roustit M., Cracowski J.L. “Non-invasive assessment of skin microvascular function in humans: an insight into methods” – Microcirculation 2012; 19 (1): 47-64. XX. Rud V.O., FisunYu.O. – References of the circadian desinchronosis in students. Ukrainian Bulletin of Psychoneurology. 2010; 18(2) (63): 74-77. XXI. Takoeva Z. A., Medoeva N. O., Berezova D. T., Merdenova L. A. et al. Long-term analysis of the results of chronomonitoring of the health of the population of North Ossetia; Vladikavkaz Medical and Biological Bulletin. 2011; 12(12,19): 32-38. XXII. Urumova L.T., Tagaeva I.R., Takoeva E.A., Datieva L.R. – The study of some health indicators of medical students in different periods of the year. Health and education in the XXI century. 2016; 18(4): 94-97. XXIII. Westman J. – Complex diseases. In: Medical genetics for the modern clinician. USA: Lippincott Williams & Wilkins, 2006. XXIV. Yadrischenskaya T.V. Circadian biorhythms of students and their importance in educational activities. Problems of higher education. Pacific State University Press. 2016; 2:176-178. View | Download TRIADIC COMPARATIVE ANALYSIS Authors: Stanislav A.Kudzh,Victor Ya. Tsvetkov, DOI: https://doi.org/10.26782/jmcms.spl.10/2020.06.00047 Abstract: The present study of comparison methods based on the triadic model introduces the following concepts: the relation of comparability and the relation of comparison, and object comparison and attributive comparison. The difference between active and passive qualitative comparison is shown, two triadic models of passive and active comparison and models for comparing two and three objects are described. Triadic comparison models are proposed as an alternative to dyadic comparison models. Comparison allows finding the common and the different; this approach is proposed for the analysis of the nomothetic and ideographic method of obtaining knowledge. The nomothetic method identifies and evaluates the general, while the ideographic method searches for unique in parameters and in combinations of parameters. Triadic comparison is used in systems and methods of argumentation, as well as in the analysis of consistency/inconsistency. Keywords: Comparative analysis,dyad,triad,triadic model,comparability relation,object comparison,attributive comparison,nomothetic method,ideographic method, Refference: I. AltafS., Aslam.M.Paired comparison analysis of the van Baarenmodel using Bayesian approach with noninformativeprior.Pakistan Journal of Statistics and Operation Research 8(2) (2012) 259{270. II. AmooreJ. 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