STATENESS OF POSTSOVIET TERRITORIAL POLITIES

Abstract: All post-soviet states face stateness problems, that is why it’s important to reveal their preconditions. The article distinguishes the main factors of state formation in the post-USSR states determining the similarities and differences in the governance problems, the effectiveness of state institutions and rational use of resources. The similarities are explained through the specific nature of post-imperial transition with problems of state and nation-building on top. The differences are determined by the following factors: inclusion into international structures, the number of competing internal and external centers and the degree of tension between centers and cultural-ethnic, regional and economic peripheries, the institutional legacies, the traditions of statehood, resource presence and the degree of political regime consolidation

Kosovo: Secession as a Nation-building Project

The article focuses on stateаnd nation-building in the partially recognized Republic of Kosovo. The main research question is whether it is possible to build effective state institutions within non-consolidated borders after a “remedial secession” relying on the support of international actors. The article identifies the factors that determine this possibility. They are tradition of independent political being and power organization; peculiarities of sociocultural and ethnic composition; goals and strategies of the external actors and their compliance with needs of the internal actors and the population; level of new institutions’ applicability. The authors conclude that the tradition of power organization, non-consolidated borders (including socio-cultural borders), contradictions between different international organizations and between them and internal actors hamper the process of state-building in Kosovo to a great extent. The evidence is the lack of visible improvements reflected by indicators of the economic and institutional development. Furthermore, weak integration of Serbian minority, especially in the North Kosovo, remains a major challenge to nation-building within existing borders

Methotrexate in the combination therapy of juvenile idiopathic arthritis

The paper discusses whether biological agents (BAs) may be used as monotherapy. The combination of different BAs and methotrexate (MTX) allows a good result in patients with juvenile idiopathic arthritis refractory to standard antirheumatic therapy. The efficiency of this therapy meets the ACRpedi50 criteria in 80–90% of patients; one third of patients can achieve the inactive stage of the disease. When BAs are administered, the frequency of use of nonsteroidal anti-inflammatory drugs and glucocorticoids is reduced. In only 15% of patients, MTX can be discontinued during the first year of therapy with BA, significantly more frequently with tocilizumab

Uveitis associated with juvenile idiopathic arthritis

Rheumatoid uveitis is a serious problem in rheumatology and ophthalmology due to the peculiarities of the disease – an undistinguished beginning, chronic course and a high incidence of disabling complications. The article analyzes various data on the development and nature of uveitis in children with juvenile idiopathic arthritis. The authors describe the analysis of the results of various studies of this disease. They consider the features and results of treatment of children with rheumatoid uveitis using genetically engineered biological drugs

Evaluation of effectiveness and safety of Etanercept in children with Juvenile psoriatic arthritis

Introduction. Juvenile psoriatic arthritis is a chronic inflammatory disease accounting for 3-10% of all juvenile arthritis. Genetically engineered biological medications, particularly Etanercept, proved to be effective and safe in the adult patients with psoriatic arthritis; however, there are only a few studies on the use of Etanercept in children with juvenile psoriatic arthritis.Objective. To evaluate the effectiveness and safety of Etanercept in children with juvenile psoriatic arthritis.Children characteristics and research methods. This open, single-center, prospective, observational clinical study with observation period from 2012 to 2019 included 18 patients (2-13-year-old; mean age 7,58±3,7 years; boys/girls 2:1, average illness duration 3 [1,4-6,6] years with juvenile psoriatic arthritis; the patients received etanercept (0,8 mg/kg/week) in combination with methotrexate (10-15 mg/m2/week). The effectiveness was evaluated at the 6, 12 and 18th month. To assess the improvement in articular manifestations the authors applied the criteria of the American Association of Rheumatologists for pediatric patients (ACRpedi), to estimate the skin manifestations they used the BSA and PASI scores.Results. In the test group by month 6 of study ACRpediNoResp/30/50/70/90/100 was 5,56/94,4/55,56/5,56/0/0%, by month 12 - 0/94,4/88,9/61,1/11,1/5,56%, by month 18 - 0/77,8/77,8/72,2/33,3/11,1% accordingly. Clinical and laboratory remission was recorded in 33,3% of cases. Drug-induced remission was 33,3%. The PASI score by months 6, 12, and 18 was 1,6 [0,6-4,6], 0,35 [0,1-1,05]; 0,1 [0-0,5], BSA - 4,9 [1,0-7,0], 1,5 [0,75-3,15] and 0,7[0,5-1,0] % respectively. 21,4% ofpatients demonstrated pharmacological remission of psoriasis. Drug-induced remission of psoriasis was 21,4%. There were no clinically significant adverse events during the study.Conclusion. Thus, etanercept in combination with methotrexate has demonstrated its effectiveness against arthritis and psoriasis in children with juvenile psoriatic arthritis

Presentation, management, and outcomes of older compared to younger adults with hospital-acquired bloodstream infections in the intensive care unit: a multicenter cohort study

Purpose: Older adults admitted to the intensive care unit (ICU) usually have fair baseline functional capacity, yet their age and frailty may compromise their management. We compared the characteristics and management of older (≥ 75 years) versus younger adults hospitalized in ICU with hospital-acquired bloodstream infection (HA-BSI). Methods: Nested cohort study within the EUROBACT-2 database, a multinational prospective cohort study including adults (≥ 18 years) hospitalized in the ICU during 2019-2021. We compared older versus younger adults in terms of infection characteristics (clinical signs and symptoms, source, and microbiological data), management (imaging, source control, antimicrobial therapy), and outcomes (28-day mortality and hospital discharge). Results: Among 2111 individuals hospitalized in 219 ICUs with HA-BSI, 563 (27%) were ≥ 75 years old. Compared to younger patients, these individuals had higher comorbidity score and lower functional capacity; presented more often with a pulmonary, urinary, or unknown HA-BSI source; and had lower heart rate, blood pressure and temperature at presentation. Pathogens and resistance rates were similar in both groups. Differences in management included mainly lower rates of effective source control achievement among aged individuals. Older adults also had significantly higher day-28 mortality (50% versus 34%, p < 0.001), and lower rates of discharge from hospital (12% versus 20%, p < 0.001) by this time. Conclusions: Older adults with HA-BSI hospitalized in ICU have different baseline characteristics and source of infection compared to younger patients. Management of older adults differs mainly by lower probability to achieve source control. This should be targeted to improve outcomes among older ICU patients

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Purpose In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes

The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections

Purpose: The primary objective of this study was to evaluate the associations between centre/country-based factors and two important process and outcome indicators in patients with hospital-acquired bloodstream infections (HABSI). Methods: We used data on HABSI from the prospective EUROBACT-2 study to evaluate the associations between centre/country factors on a process or an outcome indicator: adequacy of antimicrobial therapy within the first 24 h or 28-day mortality, respectively. Mixed logistical models with clustering by centre identified factors associated with both indicators. Results: Two thousand two hundred nine patients from two hundred one intensive care units (ICUs) were included in forty-seven countries. Overall, 51% (n = 1128) of patients received an adequate antimicrobial therapy and the 28-day mortality was 38% (n = 839). The availability of therapeutic drug monitoring (TDM) for aminoglycosides everyday [odds ratio (OR) 1.48, 95% confidence interval (CI) 1.03-2.14] or within a few hours (OR 1.79, 95% CI 1.34-2.38), surveillance cultures for multidrug-resistant organism carriage performed weekly (OR 1.45, 95% CI 1.09-1.93), and increasing Human Development Index (HDI) values were associated with adequate antimicrobial therapy. The presence of intermediate care beds (OR 0.63, 95% CI 0.47-0.84), TDM for aminoglycoside available everyday (OR 0.66, 95% CI 0.44-1.00) or within a few hours (OR 0.51, 95% CI 0.37-0.70), 24/7 consultation of clinical pharmacists (OR 0.67, 95% CI 0.47-0.95), percentage of vancomycin-resistant enterococci (VRE) between 10% and 25% in the ICU (OR 1.67, 95% CI 1.00-2.80), and decreasing HDI values were associated with 28-day mortality. Conclusion: Centre/country factors should be targeted for future interventions to improve management strategies and outcome of HABSI in ICU patients