Increasing Availability of the International Normalized Ratio Control in Russia

Background: Warfarin is still, in some cases, the only medication to prevent thromboembolic complications. Warfarin intake imposes regular INR monitoring, which can be performed domiciliary. Currently, in the Russian market, there are two models of automatic portable blood coagulometers: CoaguChek XS (Germany) and qLabs ElectroMeter (China). The main problem of portable coagulometers is their high cost and high cost of operation, which the majority of patients cannot afford. To explore the demand for development of a Russian coagulometer with a more affordable price, a questionnaire survey was carried out among the patients who needed this device. Methods and Results: We surveyed 70 patients taking Warfarin, with 5 years duration paroxysmal, persistent/or stable AF of nonvalvular etiology, having >2 CHADS-VASc score for thrombembolia risk assessment and <3 HAS-BLED score for hemorrhage risk assessment. According to the survey results, 7 (10%) patients had portable coagulometers, including 3 persons with CoaguChek XS and 4 persons with Micropoint qLabs ElectroMeter. Among these patients, there were 4 persons who continued regular INR monitoring domiciliary, while 3 patients had financial difficulties in getting testing strips. At the same time, 14 (20%) patients were not aware of the possibility of domiciliary INR monitoring. As it turned out, those patients who received regular INR monitoring domiciliary with a portable coagulometer, or at their local polyclinics, had neither ischemic strokes nor hemorrhages within a period of five years. Conclusion: It is critical to develop and manufacture a domestic equivalent of a portable coagulometer and testing strips for household use at a more affordable price

THE INITIAL STAGE OF TESTING THE DEVELOPED APPARATUS TO DETERMINE THE INTERNATIONAL NORMALIZED RATIO

Протромбиновое время (ПТВ) – это лабораторный показатель, позволяющий оценить внешний путь свертывания крови (активность факторов I, II, V, VII и X). Для стандартизации результатов теста ПТВ введен показатель МНО. МНО = (ПТВ пациента/ПТВ 100%)МИЧ. Набирает популярность контроль МНО с помощью портативных коагулометров. На российском рынке представлены: CoaguChek XS, qLabs Electrometer. Главная проблема − их высокая стоимость и дороговизна в эксплуатации. Российские ученые давно задались вопросом импортозамещения. Однако, в литературе нет информации о тестировании разработок. При разработке экспериментальной модели для измерения МНО и ПТВ, мы руководствовались результатами литературного поиска по наукометрическим базам данных Elibrary, Scopus, PubMed и WoS с учетом предполагаемой стоимости разрабатываемой модели.Цель исследования. Провести начальный этап тестирования экспериментальной модели с сопоставлением полученных результатов с данными сертифицированной лаборатории.Материал и методы. Обследовано 70 пациентов (26 мужчин и 44 женщины), принимающих «Варфарин». Материал для измерения экспериментальной моделью – капиллярная кровь. В качестве тест-системы применяли тест-полоску qLabs® PT-INR Test Strip.Результаты. Разница ПТВ тестируемой модели и результатов сертифицированной лаборатории ± 1–2 секунды. ПТВ Протромбин-калибратора 13 сек. Протромбиновое отношение Протромбин-калибратора 1,0. Пациент №1. ПТВ на тестируемом аппарате 34 сек. МИЧ тробопластина на тест-полоске 1,0. МНО = (34 сек /13 сек × 1,0)1,0 = 2,62. Результат сертифицированной лаборатории: ПТВ 36 сек, МНО 2,86. Пациент №2. ПТВ на тестируемом аппарате 31 сек. МНО = (31 сек/13 сек × 1,0)1,0 = 2,38. Результаты сертифицированной лаборатории: ПТВ 32 сек, МНО 2,48.Вывод. Согласно представленным результатам, полученным в ходе тестирования разработанной портативной модели у пациентов, находящихся на варфаринотерапии, получены сопоставимые результаты ПТВ и МНО сертифицированной лабораторией.Prothrombin time (PTT) is a laboratory indicator that allows to evaluate the external pathway of blood coagulation (activity of factors I, II, V, VII and X). An INR indicator was introduced to standardize the results of the PTV test. INR = (patient’s PTT/PTT norm) ISI. The control of the INR is gaining popularity with the help of portable coagulometers. On the russian market are CoaguChek XS, qLabs Electrometer. The main problem is their high cost and high cost of operation. Russian scientists have long wondered about import substitution. However, in the literature there is no information on testing development. When developing an experimental model for measuring INR and PTV, we were guided by the results of the literary search in the scientometric databases Elibrary, Scopus, PubMed and WoS, taking into account the estimated cost of the developed model.Background. To conduct the initial stage of testing an experimental model with a comparison of the results obtained with the data of a certified laboratory.Materials and methods. We examined 70 patients (26 men and 44 women) taking «Warfarin». The material for measuring the experimental model was capillary blood. We used the qLabs® PT-INR Test Strip as a test system.Results. We obtained the Difference of the PTT of the tested model and the results of the certified laboratory ± 1–2 seconds. PTT prothrombin calibrator was 13 sec. Prothrombin ratio prothrombin calibrator was 1.0. Patient №1. PTT on the tested device 34 seconds. ISI troboplastin on test strip was 1.0. INR = (34 sec / 13 sec × 1.0)1.0 = 2.62. The result of a certified laboratory: PTT 36 sec, INA 2.86. Patient №2. PTT on the tested device 31 sec. INR = (31 sec / 13 sec × 1.0)1.0= 2.38. The results of the certified laboratory: PTT 32 sec, INR 2.48.Conclusions. According to the presented results obtained during testing of the developed portable model in patients on warfarin therapy, comparable results of PTT and INA were obtained with a certified laboratory

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Effect of lead and cadmium ions upon the pupariation and morphological changes in Calliphora vicina (Diptera, Calliphoridae)

Modelling the influence of different concentrations of lead and cadmium ions upon a laboratory culture of insects has not been adequately studied. In our research, we assessed the influence of cadmium and lead nitrates at different concentrations (10-2-10-9 М) upon the development of larvae, pupae and imagines of Calliphora vicina Robineau-Desvoidy, 1830 (Diptera: Calliphoridae). We found an acceleration in the development of larvae and an increase in mass of puparia when lead ions were added to the food of the larvae, and decrease in the mass of puparia when cadmium ions were added. We registered nanism and malformation of the fly imagines in experiments with lead and cadmium in the food substrate. We observed that under the influence of the studied heavy metal ions there was a reduced motor activity of the fly larvae at all stages of development, a delay in formation of puparia and a delay in the emergence of imagines in comparison with the control group

The Impact of Cameraria ohridella (Lepidoptera, Gracillariidae) on the State of Aesculus hippocastanum Photosynthetic Apparatus in the Urban Environment

The paper presents the results on resistance of Aesculus hippocastanum Linnaeus, 1753 trees to Cameraria ohridella Deschka &amp; Dimi&#263;, 1986 (Lepidoptera, Gracillariidae) impact under conditions of a modern urban environment on the example of Dnipro city as the largest industrial city in Ukraine. Field experiments were conducted in all park areas of the city, which allowed covering the full gradient of the existing urban environment and considered the different degrees of the tree settlement by the invasive insect species. The research of the impact of C.&nbsp;ohridella caterpillars&rsquo; vital activity on the photosynthetic apparatus state was carried out by applying a chlorophyll fluorescence induction technique. Diagnosis of photosynthetic dysfunction of fresh Ae.&nbsp;hippocastanum leaves was conducted using a portable &ldquo;Floratest&rdquo; fluorometer manufactured in Ukraine. Interpretation of the obtained Kautsky curves showed that significant changes in their critical parameters associated with the degree of leaf damage by C.&nbsp;ohridella caterpillars were not detected. The influence of tree growth site conditions on the following 4 main indicators of chlorophyll fluorescence induction was established: the initial value of fluorescence induction after irradiation; the value of &ldquo;plateau&rdquo; fluorescence induction; the maximum value of fluorescence induction; the stationary value of fluorescence induction after light adaptation of the plant leaf. It was found that the efficiency coefficients of photochemical processes in Ae. hippocastanum trees growing in low terrain levels differed significantly, which can probably be interpreted as their response to the specific characteristics of the urban environment

The Impact of <i>Cameraria ohridella</i> (Lepidoptera, Gracillariidae) on the State of <i>Aesculus hippocastanum</i> Photosynthetic Apparatus in the Urban Environment

The paper presents the results on resistance of Aesculus hippocastanum Linnaeus, 1753 trees to Cameraria ohridella Deschka & Dimić, 1986 (Lepidoptera, Gracillariidae) impact under conditions of a modern urban environment on the example of Dnipro city as the largest industrial city in Ukraine. Field experiments were conducted in all park areas of the city, which allowed covering the full gradient of the existing urban environment and considered the different degrees of the tree settlement by the invasive insect species. The research of the impact of C. ohridella caterpillars’ vital activity on the photosynthetic apparatus state was carried out by applying a chlorophyll fluorescence induction technique. Diagnosis of photosynthetic dysfunction of fresh Ae. hippocastanum leaves was conducted using a portable “Floratest” fluorometer manufactured in Ukraine. Interpretation of the obtained Kautsky curves showed that significant changes in their critical parameters associated with the degree of leaf damage by C. ohridella caterpillars were not detected. The influence of tree growth site conditions on the following 4 main indicators of chlorophyll fluorescence induction was established: the initial value of fluorescence induction after irradiation; the value of “plateau” fluorescence induction; the maximum value of fluorescence induction; the stationary value of fluorescence induction after light adaptation of the plant leaf. It was found that the efficiency coefficients of photochemical processes in Ae. hippocastanum trees growing in low terrain levels differed significantly, which can probably be interpreted as their response to the specific characteristics of the urban environment

The immunologic effects of maraviroc intensification in treated HIV-infected individuals with incomplete CD4+ T-cell recovery: a randomized trial

Item does not contain fulltextThe CCR5 inhibitor maraviroc has been hypothesized to decrease T-cell activation in HIV-infected individuals, but its independent immunologic effects have not been established in a placebo-controlled trial. We randomized 45 HIV-infected subjects with CD4 counts <350 cells per mm(3) and plasma HIV RNA levels <48 copies per mL on antiretroviral therapy (ART) to add maraviroc vs placebo to their regimen for 24 weeks followed by 12 weeks on ART alone. Compared with placebo-treated subjects, maraviroc-treated subjects unexpectedly experienced a greater median increase in % CD38+HLA-DR+ peripheral blood CD8+ T cells at week 24 (+2.2% vs -0.7%, P = .014), and less of a decline in activated CD4+ T cells (P < .001). The % CD38+HLA-DR+ CD4+ and CD8+ T cells increased nearly twofold in rectal tissue (both P < .001), and plasma CC chemokine receptor type 5 (CCR5) ligand (macrophage-inflammatory protein 1beta) levels increased 2.4-fold during maraviroc intensification (P < .001). During maraviroc intensification, plasma lipopolysaccharide declined, whereas sCD14 levels and neutrophils tended to increase in blood and rectal tissue. Although the mechanisms explaining these findings remain unclear, CCR5 ligand-mediated activation of T cells, macrophages, and neutrophils via alternative chemokine receptors should be explored. These results may have relevance for trials of maraviroc for HIV preexposure prophylaxis and graft-versus-host disease. This trial was registered at www.clinicaltrials.gov as #NCT00735072