The Correlation of Collateral Circulation and Age during Acute Ischemic Heart Disease

Backgroundː Coronary collaterals (CC) are alternative sources of blood supply to myocardium jeopardized by Ischemia. Aim: To investigate the dependence and influence of collateral circulation on age during acute ischemic heart disease. Methods: Analysis shows that 673 patients were studied from the SamgoriMedi Clinic (Tbilisi, Georgia) aged 27– 94 years (64.7+11.48) with acute coronary syndromes. Basic medical data such as sex, age, cardiovascular risk factors, angina pectoris, revascularization history, echocardiography, and laboratory data were obtained from the patient’s medical records. CC vessels were graded according to the Rentrop grading system of 0 to 3. Resultsː The development index of collateral circulations visibly increases with age. Average age increases accordingly as follows: rentrop 0 - 62.85+12.01, rentrop 1 - 64.90+10.79, rentrop 2 - 66.84+10.49, and rentrop 3 - 69.04+9.68 (p<0.0001). There is positive significant correlation between the development of collateral circulation and age groups r=0.170**, p<0.001. The cases of female sex, hypertension, acute MI without ST elevation, CABG frequency (also EF% - 35-45%, <35%), and multiple vessel coronary lesion are noticed to increase with age, while the male sex and EF (ejection fraction) >45% cases decreases with age. Conclusion Collateral circulation shows significantly positive correlation with age and female sex. However, it should be mentioned that in elderly patients with a high ejection fraction and normal diastolic function, the development of collateral vessels is low

The Georgian Adolescent Health Survey: methodological and strategic issues

Summary.: Objectives: To conduct a national survey on adolescent health and lifestyles in Georgia and to thus set up a database on adolescent. Methods: A two-stage cluster sample of around 8000-10 000 in-school 15-18years adolescents are being reached through a random selection of classes in Georgia. The sample has been stratified by age, region, type of school and language. A self-administered questionnaire of 87 questions has been developed and translated into the four main languages used in Georgia. Results: Up to June 2004, the researchers have reached 511 classes (9306 pupils). In total, 8039 questionnaires have been considered valid. The main concerns encountered for this survey are linked with acceptance of the survey, cross-cultural issues, political and strategic problems as well as inadequate physical environmental support. Conclusion: Despite Georgia's unfavourable economical and political situation, it has been possible to run a national survey on the health of adolescents, according to the usual standards used in the field. This survey should allow for 1) the identification of priorities in the field of health care and health promotion 2) the monitoring of adolescent health in the futur

The Georgian version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR)

The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the Georgian language. The reading comprehension of the questionnaire was tested in 10 JIA parents and patients. Each participating centre was asked to collect demographic, clinical data and the JAMAR in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents. The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the 3 Likert assumptions, floor/ceiling effects, internal consistency, Cronbach\u2019s alpha, interscale correlations, test\u2013retest reliability, and construct validity (convergent and discriminant validity). A total of 100 JIA patients (26% systemic, 57% oligoarticular, 16% RF negative polyarthritis, and 1% RF positive polyarthritis) and 100 healthy children, were enrolled at two paediatric rheumatology centre. Notably, none of the enrolled JIA patients is affected with psoriatic arthritis or with enthesitis-related arthritis or with undifferentiated arthritis. The JAMAR components discriminated healthy subjects from JIA patients, except for the school-related problems variable. All JAMAR components revealed good psychometric performances. In conclusion, the Georgian version of the JAMAR is a valid tool for the assessment of children with JIA and is suitable for use both in routine clinical practice and clinical research

GENDER RELATED DIFFERENCES IN OUTCOMES FOLLOWING PERCUTANEOUS CORONARY INTERVENTIONS IN DIFFERENT AGE GROUPS OF PATIENTS WITH ST – ELEVATION ACUTE MYOCARDIAL INFARCTION

Background: Conflicting evidence exists in respect of gender differences in outcomes after Acute Coronary Syndromes (ACS). Aim: Evaluation of gender differences in outcomes after ST – elevation Acute Myocardial Infarction (STEMI) in different age groups of patients following percutaneous coronary interventions (PCI). Methods: We studied consecutive 292 female and consecutive 311 male STEMI patients who underwent PCI with stent implantation. Study individuals were divided into groups by the gender and age (<65, 65-75, >75 years). Patients with total ischemic time >4 hours were excluded from the study. In hospital, 45-day and one year outcomes (death from cardiovascular causes, repeated angiography and revascularization) were evaluated, as well as several factors which may influence disease outcomes. Results: Total death rate in hospital, during 45-days and one year period: in women - 0.168, 0.250, 0.438, in men - 0.161, 0.289, 0.408, differences were not significant (p> 0.05). In hospital death rate in study groups (age groups <65, 65-75,>75years): in women -0.112, 0.155, 0.257, in men -0.121, 0.176, 0.216. Forty five-day mortality rate in study groups: in women -0.135, 0.279, 0.338, in men- 0.226, 0.279, 0.471; one year mortality rate in study groups: in women -0.315, 0.419, 0.622, in men - 0.347, 0.419, 0.529. Differences are statistically significant in age group under 65 years (P<0.05). Age under 65 years is associated with lower probability of in hospital and 45 days mortality (OR -0.53, 95% CI 0.9 – 0.25, OR- 0.36, 95% CI 0.18-0.72) in females, as well as with one year mortality in females OR- 0.47 , 95%CI 0.28 -0.80 and 45 days mortality in males OR-0.35, 95%CI 0.59-0.99. Study showed significantly (P<0.005) higher rate of repeated angiography (0.154 vs 0.077) and revascularization (0.127 vs 0.026) in females as compared with men after STEMI following primary PCI with stent implantation, Conclusions: a) Mortality rates (in hospital, 45 days and one year) after STEMI in patients with ischemic time <4 hours who underwent PCI with stent implantation did not differ between genders; b) Women younger 65 years with STEMI after timely revascularization have better prognosis as compared with their male counterparts and females of other groups; c) Risk of one year repeated angiography and revascularization in one year is higher in female patients with STEMI following primary PCI with stent implantation

SPECIAL MECHANISM OF CONDUCTION TYPE INVERSION IN PLASTICALLY DEFORMED n-Si

The aim of research is studying the mechanism of n–p inversion of the conduction type of deformed silicon crystals in the course of their thermal treatment. Initially, almost non-dislocation zone-melted phosphorus-doped n-Si single crystals with electron concentration of 2×1014 cm–3 were studied. Uniaxial compression at temperature of 700 °С and pressure of 25 MPa increased the dislocation density to 108 cm–2. After long (within 30 min) cooling of the deformed crystals to room temperature, an n–p inversion of the conduction type occurred. The effect is explained by the formation of phosphorus–divacancy complexes PV2 in the defective atmosphere of dislocations, which are acceptor centers with energy level of Ev+0.34 eV. The found out n–p inversion mechanism differs from the standard one for plastically deformed n-type semiconductors with a diamond-like crystalline structure, which consists in the formation of acceptor centers along edge dislocations

The Procedure for Determining and Quality Assurance Program for the Calculation of Dose Coefficients Using DCAL Software

The development of a spallation neutron source with a mercury target may lead to the production of rare radionuclides. The dose coefficients for many of these radionuclides have not yet been published. A collaboration of universities and national labs has taken on the task of calculating dose coefficients for the rare radionuclides using the software package: DCAL. The working group developed a procedure for calculating dose coefficients and a quality assurance (QA) program to verify the calculations completed. The first portion of this QA program was to verify that each participating group could independently reproduce the dose coefficients for a known set of radionuclides. The second effort was to divide the group of radionuclides among the independent participants in a manner that assured that each radionuclide would be redundantly and independently calculated. The final aspect of this program was to resolve any discrepancies arising among the participants as a group of the whole. The output of the various software programs for six QA radionuclides, 144Nd, 201Au, 50V, 61Co, 41Ar, and 38S were compared among all members of the working group. Initially, a few differences in outputs were identified. This exercise identified weaknesses in the procedure, which have since been revised. After the revisions, dose coefficients were calculated and compared to published dose coefficients with good agreement. The present efforts involve generating dose coefficients for the rare radionuclides anticipated to be produced from the spallation neutron source should a mercury target be employed

An Interdatabase Comparison of Nuclear Decay and Structure Data Utilized in the Calculation of Dose Coefficients for Radionuclides Produced in a Spallation Neutron Source

Internal and external dose coefficient values have been calculated for 14 anthropogenic radionuclides which are not currently presented in Federal Guidance Reports Nos. 11, 12, and 13 or Publications 68 and 72 of the International Commission on Radiological Protection. Internal dose coefficient values are reported for inhalation and ingestion of 1 μm and 5 μm AMAD particulates along with the f1 values and absorption types for the adult worker. Internal dose coefficient values are also reported for inhalation and ingestion of 1 μm AMAD particulates as well as the f1 values and absorption types for members of the public. Additionally, external dose coefficient values for air submersion, exposure to contaminated ground surface, and exposure to soil contaminated to an infinite depth are also presented. Information obtained from this study will be used to support the siting and permitting of future accelerator-driven nuclear initiatives within the U.S. Department of Energy complex, including the Spallation Neutron Source (SNS) and Accelerator Production of Tritium (APT) Projects

Reformation of system of emergency medical help for injured persons on early hospital stage

Objective. To determine the key trend of reformation of the system of the emergent medical help to the injured persons on early hospital stage. Маterials and methods. The systemic analysis, including a bibliographical one, semantic and economic methods of investigation, as well as organization of the medical help delivery to the injured persons in USA. Results. The system of the emergency medical help delivery to the injured persons is based on the trauma centers net. Treatment of the injured persons, suffering severe trauma in the centers of trauma is by 40 - 60% more effective and by 50 - 60% more cost-effective, than in surgical/traumatological departments of the national Medical Health Service. The system of Emergency Medical Help for injured persons on early hospital stage in Ukraine demands organization of no less than 30 Centers of Trauma of the level І on the base of the University Regional Hospitals and in the cities with more than 1 million of inhabitants; approximately 200 the Level II Centers of Trauma on the base of multidisciplinary hospitals for intensive treatment of the second level and 300 the Level III trauma centers on the base of multidisciplinary hospitals for intensive treatment of the first level. Complete need for Ukraine constitutes 530 Centers of Trauma. Conclusion. The system for the Emergency Medical Help Delivery to the injured persons must be based on the net of the Trauma Centers of a certain level. The trauma centers organization needs some preliminary work to do: to study the traumatism indices, analysis of the regional need in medical help delivery and depicting of the National Trauma Registry. Trauma Centers in Ukraine is expedient to create on the base of the university regional hospitals, multidisciplinary hospitals of intensive therapy and hospitals of urgent medical help. Possibility of inclusion to the medical help delivery of such specialists, as a surgeon, anesthesiologist, traumatologist and neurosurgeon, constitutes an obligatory element of the trauma center organization. Financial support for the medical help delivery to the injured persons, suffering severe combined trauma, demands additional input of the nonbudget resources

Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries:results of an internet-based global point prevalence survey

Summary: Background: The Global Point Prevalence Survey (Global-PPS) established an international network of hospitals to measure antimicrobial prescribing and resistance worldwide. We aimed to assess antimicrobial prescribing and resistance in hospital inpatients. Methods: We used a standardised surveillance method to collect detailed data about antimicrobial prescribing and resistance from hospitals worldwide, which were grouped by UN region. The internet-based survey included all inpatients (adults, children, and neonates) receiving an antimicrobial who were on the ward at 0800 h on one specific day between January and September, 2015. Hospitals were classified as primary, secondary, tertiary (including infectious diseases hospitals), and paediatric hospitals. Five main ward types were defined: medical wards, surgical wards, intensive-care units, haematology oncology wards, and medical transplantation (bone marrow or solid transplants) wards. Data recorded included patient characteristics, antimicrobials received, diagnosis, therapeutic indication according to predefined lists, and markers of prescribing quality (eg, whether a stop or review date were recorded, and whether local prescribing guidelines existed and were adhered to). We report findings for adult inpatients. Findings: The Global-PPS for 2015 included adult data from 303 hospitals in 53 countries, including eight lower-middle-income and 17 upper-middle-income countries. 86 776 inpatients were admitted to 3315 adult wards, of whom 29 891 (34·4%) received at least one antimicrobial. 41 213 antimicrobial prescriptions were issued, of which 36 792 (89·3%) were antibacterial agents for systemic use. The top three antibiotics prescribed worldwide were penicillins with β-lactamase inhibitors, third-generation cephalosporins, and fluoroquinolones. Carbapenems were most frequently prescribed in Latin America and west and central Asia. Of patients who received at least one antimicrobial, 5926 (19·8%) received a targeted antibacterial treatment for systemic use, and 1769 (5·9%) received a treatment targeting at least one multidrug-resistant organism. The frequency of health-care-associated infections was highest in Latin America (1518 [11·9%]) and east and south Asia (5363 [10·1%]). Overall, the reason for treatment was recorded in 31 694 (76·9%) of antimicrobial prescriptions, and a stop or review date in 15 778 (38·3%). Local antibiotic guidelines were missing for 7050 (19·2%) of the 36 792 antibiotic prescriptions, and guideline compliance was 77·4%. Interpretation: The Global-PPS showed that worldwide surveillance can be accomplished with voluntary participation. It provided quantifiable measures to assess and compare the quantity and quality of antibiotic prescribing and resistance in hospital patients worldwide. These data will help to improve the quality of antibiotic prescribing through education and practice changes, particularly in low-income and middle-income countries that have no tools to monitor antibiotic prescribing in hospitals. Funding: bioMérieux