Analysis of the hospitalization time impact on hospital mortality from acute myocardial infarction

Diseases of the circulatory system and their most severe form – acute myocardial infarction (AMI) – is one of the most important problems of modern medicine due to the steady increase in morbidity, negative impact on quality of life, early disability of patients. 19.5 % of patients die from AMI, 50 % among which die 90-120 minutes after the first symptoms of the disease. The aim of the research was to analyse the impact of hospitalization on the mortality of patients with AMI and predict the risk of death in case of untimely hospitalization of this category of patients. Materials and methods. We have conducted a retrospective analysis of 876 medical records of patients diagnosed with AMI who were treated in the cardiology department of Kharkiv Regional Clinical Hospital in 2019. During the study, we have used retrospective, logical, medical and statistical methods. Odds ratios and a 95 % confidence interval were also calculated. Results and discussion. The research revealed the impact of hospitalization on the organization of medical care and hospital mortality of patients with AMI. It was found that the largest share of patients with AMI, both among the dead and those who left the hospital, were hospitalized in the period from 2 to 12 hours from the onset of the disease (49.6 % and 52.33 %, respectively), as well as in period after 24 hours – 28.00 % and 21.70 %, respectively. The largest share of patients with AMI, regardless of the time of hospitalization were persons older than 60 years. The results of the analysis showed that in the period up to 2 h from the onset of the disease, the share of hospitalized patients with more severe heart muscle damage (presence of Q wave) was 91.35 % against 8.65 % of patients with AMI without ST segment elevation. It should be noted that in almost 50 % of cases, patients with AMI without ST segment elevation were hospitalized after 24 h from the onset of the disease. At the same time, the largest share of deaths in this group of patients was observed in the hospital stay from 12 to 24 hours. According to the results of the research, risk factors for fatal outcome in AMI were identified, in particular male gender, the presence of an established ECG diagnosis of NSTEMI, conducting SKA in patients with AMI. It was also found that timely hospitalization of patients within the therapeutic window reduces the chances of hospital mortality by 52 %. Conclusions. The obtained data indicate a strong relationship between the time of hospitalization and the organization of medical care and hospital mortality of patients with AMI. It is reliably established that timely hospitalization of patients within the therapeutic window reduces the chances of hospital mortality by 52 %: HS is 0.483 (95 % CI 0.238 – 0.981), p=0.175

The use of selected neutrophil protein plasma concentrations in the diagnosis of Crohn's disease and ulcerative colitis : a preliminary report

Background: Difficulties in diagnosis of inflammatory bowel disease (IBD) motivate the search for new diagnostic tools, including laboratory tests. The aim of this study was to evaluate concentrations of the neutrophil (NEU) proteins leukocyte elastase (HLE-α1AT), lactoferrin and calprotectin as potential biomarkers used in the diagnosis and assessment of clinical activity of Crohn’s disease (CD) and ulcerative colitis (UC).Material/Methods: The study included 27 patients with CD, 33 patients with UC and 20 healthy controls. Plasma concentrations of calprotectin, lactoferrin and HLE-α1AT were measured using ELISA.Results: In patients with CD higher concentrations of HLE-α1AT (64.3±43.1 vs. 30.1±7.7 ng/l, P<0.001), calprotectin (151.6±97.8 vs. 69.9±22.1 ng/l, P<0.001) and lactoferrin (243.2±102.0 vs. 129.7±32.7 ng/l, P<0.001) than in the control group were found. In patients with UC higher plasma concentrations of HLE-α1AT (62.0±30.9 vs. 30.1±7.7 ng/l, P<0.001), calprotectin (149.6±72.3 vs. 69.9±22.1 ng/l, P<0.001) and lactoferrin (242.6±107.5 vs 129.7±32.7 ng/l, P<0.001) than in the control group were found. HLE-α1AT/NEU and lactoferrin/NEU ratios in patients with UC were significantly higher compared with patients with CD. Calprotectin (P=0.010) and lactoferrin (P=0.023) levels were higher in patients with the active compared with inactive phase of CD.Conclusions: The diagnostic characteristics of plasma granulocyte protein concentrations indicate the usefulness of these tests in the diagnosis of IBD. Higher HLE-α1AT and lactoferrin/NEU ratios in patients with UC than with CD may suggest the usefulness of these ratios in differential diagnostics. Plasma calprotectin and lactoferrin levels may be useful in CD activity assessment

Markers of antioxidant defense in patients with type 2 diabetes

Aims. Diabetes is considered a state of increased oxidative stress. This study evaluates blood concentrations of selected markers of antioxidant defense in patients with type 2 diabetes. Methods. The study included 80 type 2 diabetes patients and 79 apparently healthy controls. Measured markers included ferric reducing ability of plasma (FRAP), reduced glutathione (GSH), glutathione peroxidase (GPx), glutathione reductase (GR), γ-glutamyltransferase (GGT) and uric acid serum, and plasma and/or hemolysate levels. Results. FRAP, uric acid, CRP, and GGT levels were significantly higher in patients with diabetes. Plasma and hemolysate GR was significantly higher whereas GPx activity was significantly lower in patients with diabetes. There were no significant differences in antioxidant defense markers between patients with and without chronic diabetes complications. Fasting serum glucose correlated with plasma GPx, plasma and hemolysate GR, FRAP, and serum GGT, and HbA1c correlated with serum GGT. Only FRAP and serum uric acid were significantly higher in obese (BMI>30 kg/m2) patients with diabetes than in nonobese patients. Conclusions. Some components of antioxidant defense such as GR, uric acid, and GGT are increased in patients with type 2 diabetes. However, the whole system cannot compensate for an enhanced production of ROS as reflected by the trend toward decreased erythrocytes GSH

Carboxylated and undercarboxylated osteocalcin in metabolic complications of human obesity and prediabetes

Background Carboxylated osteocalcin (Gla‐OC) participates in bone remodeling, whereas the undercarboxylated form (Glu‐OC) takes part in energy metabolism. This study was undertaken to compare the blood levels of Glu‐OC and Gla‐OC in nonobese, healthy obese, and prediabetic volunteers and correlate it with the metabolic markers of insulin resistance and early markers of inflammation. Methods Nonobese (body mass index [BMI] <30 kg/m2 ; n = 34) and obese subjects (30 <BMI <40 kg/m2 ; n = 98), both sexes, aged 25 to 65 years, were divided into healthy control, normal weight subjects, healthy obese, and obese with biochemical markers of prediabetes. The subgroups with obesity and low or high Gla‐OC or Glu‐OC were also considered for statistical analysis. After 2 weeks of diet standardization, venous blood was sampled for the determination of Gla‐OC, Glu‐OC, lipid profile, parameters of inflammation (hsCRP, interleukin 6, sE‐selectin, sPECAM‐1, and monocyte chemoattractant protein 1), and adipokines (leptin, adiponectin, visfatin, and resistin). Results Gla‐OC in obese patients was significantly lower compared to nonobese ones (11.36 ± 0.39 vs 12.69 ± 0.90 ng/mL, P = .048) and weakly correlated with hsCRP (r = −0.18, P = .042), visfatin concentration (r = −0.19, P = .033), and BMI (r = −0.17, P = .047). Glu‐OC was negatively associated with fasting insulin levels (r = −0.18, P = .049) and reduced in prediabetic individuals compared with healthy obese volunteers (3.04 ± 0.28 vs 4.48 ± 0.57, P = .025). Conclusions Decreased blood concentration of Glu‐OC may be a selective early symptom of insulin resistance in obesity, whereas the decreased level of Gla‐OC seems to be associated with the appearance of early markers of low grade inflammation accompanying obesity

International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes.

peer reviewedThis International Consensus Classification and Nomenclature for the congenital bicuspid aortic valve condition recognizes 3 types of bicuspid valves: 1. The fused type (right-left cusp fusion, right-non-coronary cusp fusion and left-non-coronary cusp fusion phenotypes); 2. The 2-sinus type (latero-lateral and antero-posterior phenotypes); and 3. The partial-fusion (forme fruste) type. The presence of raphe and the symmetry of the fused type phenotypes are critical aspects to describe. The International Consensus also recognizes 3 types of bicuspid valve-associated aortopathy: 1. The ascending phenotype; 2. The root phenotype; and 3. Extended phenotypes

Summary: International Consensus Statement on Nomenclature and Classification of the Congenital Bicuspid Aortic Valve and Its Aortopathy, for Clinical, Surgical, Interventional and Research Purposes.

peer reviewedThis International evidence-based nomenclature and classification consensus on the congenital bicuspid aortic valve and its aortopathy recognizes 3 types of bicuspid aortic valve: 1. Fused type, with 3 phenotypes: right-left cusp fusion, right-non cusp fusion and left-non cusp fusion; 2. 2-sinus type with 2 phenotypes: Latero-lateral and antero-posterior; and 3. Partial-fusion or forme fruste. This consensus recognizes 3 bicuspid-aortopathy types: 1. Ascending phenotype; root phenotype; and 3. extended phenotypes

Експертна оцінка доцільності лікувально-діагностичних заходів при наданні екстреної допомоги хворим з гострим коронарним синдромом

It is known that it is possible to affect the extent of myocardial damage and, as a result, mortality only in the first hours of its development. Therapeutic tactics in ACS with elevation of the ST segment involves the restoration of coronary blood flow, the main method is the reperfusion of the coronary artery by systemic thrombolysis or PCI in a specialized hospital. The effectiveness of treatment is inversely related to the time spent. The aim of the study was to examine the opinion of specialists on the feasibility of implementing the items of the protocol of emergency medical care for patients with ACS at the place of call. Materials and methods. During the study the method of expert evaluations, which consisted of gathering information by interviewing experts and summarizing the individual opinions of experts into a general concept was used. The experts were 48 emergency physicians. The method of expert evaluation included the following stages: development of the questionnaire; survey of experts; summary of examination materials; calculation of statistical indicators; interpretation of the obtained results and formulation of conclusions. Results. In order to assess the actions of the emergency team, depending on the need to conduct them for diagnosis and emergency care for patients with ACS at the scene, we calculated the feasibility indexes for each item of the protocol. In the future, we divided the treatment and diagnostic measures for ACS with ST segment elevation according to the level of expediency at the scene into four groups (n): n1 – high level, n2 – sufficient level and n3 – low level and n4 – very low level. According to the results of the ranking, the scope of measures to be implemented by the head of the emergency team at the ACS with elevation of the ST segment on arrival on call, as well as measures that, according to interviewed experts, are not required at this stage and can be carried out during transportation of the patient to a specialized hospital. Conclusions. Based on the results of the calculation of feasibility indices and subsequent ranking of treatment and diagnostic measures for the relevant groups (n1, n2, n3, n4) from 37 items of the study, to assist patients with ACS with ST segment elevation at the scene, it is recommended to perform 16Известно, что повлиять на объем поражения миокарда, и, как следствие - смертность - возможно только в первые часы его развития. Терапевтическая тактика при ОКС с элевацией сегмента ST предусматривает восстановление коронарного кровотока, основным методом является реперфузия коронарной артерии путем системного тромболизиса или ЧКВ в условиях специализированного стационара. Эффективность лечения находится в обратной зависимости от затраченного времени. Целью исследования стало изучение мнения специалистов о целесообразности выполнения пунктов протокола экстренной медицинской помощи больным с ОКС на месте вызова. Материалы и методы. В исследовании был использован метод экспертных оценок, заключался в сборе информации путем опроса экспертов и возведении индивидуальных мнений экспертов в общую концепцию. Экспертами выступили 48 врачей по медицине неотложных состояний. Методика экспертной оценки включала следующие этапы: разработку анкеты; опрос экспертов; сведения материалов экспертизы; расчет статистических показателей; интерпретацию полученных результатов и формулирование выводов. Результаты. С целью оценки действий бригады Э(С)МП в зависимости от необходимости их проведения для диагностики и оказания экстренной помощи больным с ОКС на месте вызова нами были рассчитаны индексы целесообразности по каждому пункту протокола. В дальнейшем нами осуществлено распределение лечебно-диагностических мероприятий при ОКС с элевацией сегмента ST по уровню целесообразности проведения на месте происшествия на четыре группы (n): n1 - высокий уровень, n2 - достаточный уровень и n3 – низкий уровень и n4 – очень низкий уровень. По результатам ранжирования определен объем мероприятий, целесообразных к осуществлению руководителем бригады Э(С)МП при ОКС с элевацией сегмента ST при проезда на вызов, а также меры, которые, по мнению опрошенных экспертов, являются не обязательными для проведения на данном этапе и могут быть осуществлении во время транспортировки больного в специализированный стационар. Выводы. На основании результатов проведенного расчета индексов целесообразности и дальнейшего ранжирования лечебно-диагностических мероприятий на соответствующие группы (n1, n2, n3, n4) с 37 пунктов протокола, исследовались, для оказания помощи больным с ОКС с элевацией сегмента ST на месте происшествия рекомендуется выполнять 16Відомо, що вплинути на об’єм ураження міокарду, і, як наслідок – смертність – можливо лише у перші години його розвитку. Терапевтична тактика при ГКС з елевацією сегмента ST передбачає відновлення коронарного кровотоку, основним методом є реперфузія коронарної артерії шляхом системного тромболізису або черезшкірного коронарного втручання в умовах спеціалізованого стаціонару. Ефективність лікування знаходиться в зворотній залежності від витраченого часу. Метою дослідження стало вивчення думки спеціалістів щодо доцільності виконання пунктів протоколу екстреної медичної допомоги хворим з гострим коронарним синдромом на місці виклику. Матеріали і методи. У дослідженні був використаний метод експертних оцінок, що полягав у зборі інформації шляхом опитування експертів та зведенні індивідуальних думок експертів у загальну концепцію. Експертами були 48 лікарів з медицини невідкладних станів. Методика експертної оцінки включала наступні етапи: розробку анкети; опитування експертів; зведення матеріалів експертизи; розрахунок статистичних показників; інтерпретацію отриманих результатів та формулювання висновків. Результати дослідження. З метою оцінки дій бригади Е(Ш)МД в залежності від необхідності їх проведення для діагностики та надання екстреної допомоги хворим на ГКС на місці виклику були розраховані індекси доцільності за кожним пунктом протоколу. У подальшому здійснено розподіл лікувально-діагностичних заходів при ГКС з елевацією сегменту ST за рівнем доцільності проведення на місці події на чотири групи (n): n1 – високий рівень, n2 – достатній рівень та n3 – низький рівень та n4 – дуже низький рівень. За результатами ранжування визначено обсяг заходів, доцільних до здійснення керівником бригади Е(Ш)МД при ГКС з елевацією сегменту ST при доїзді на виклик, а також заходи, які, на думку опитаних експертів, є не обов’язковими для проведення на даному етапі та можуть бути здійсненні під час транспортування хворого до спеціалізованого стаціонару. Висновки. На підставі результатів проведеного розрахунку індексів доцільності та подальшого ранжування лікувально-діагностичних заходів на відповідні групи (n1, n2, n3, n4) із 37 пунктів протоколу, що досліджувались, для надання допомоги хворим з ГКС з елевацією сегменту ST на місці події рекомендовано виконувати 1