Frequency of C > T polymorphism in fourth chromosome and levels of crp in patients with atrial

Introduction. Atrial fibrillation is a heart rhythm disorder, characterized by rapid and uncoordinated atrial activation which is the most common arrhythmia in clinical practice. Atrial fibrillation is observed in 1.5 - 2% of the general population and its incidence increases with age reaching more than 8-15% by 80 years of age. Atrial fibrillation is traditionally considered as a non genetic disorder. The cause of atrial fibrillation in 10-20% of cases is unknown and it is diagnosed as idiopathic

Participation of women of the Antanta countries in the first world war their role in the development of medicine (on example of UK, Russia and Serbia)

The article considers the issue of the participation of the women of the Entente countries in the First World War. Countries such as the British Empire, the Russian Empire, and Serbia are taken as an example. The conclusion is drawn about the contribution of women of these countries to the Entente Victory in the war and the development of medicine and nursing in this period.В статье рассмотрен вопрос об участии женщин странАнтанты в первой мировой войне. В качестве примера взяты такие страны как Британская империя, Российская империя и Сербия. Сделан вывод о вкладе женщин этих стран в Победу Антанты в войне и развитии медицины и сестринского дела в данный период

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Communicating to Oppress and Liberate, Reproduce and Transform: A Study of Food Insecurity as a Material-Discursive System

This study seeks to investigate food insecurity and food assistance in the United States. Specifically, this dissertation expands the interdisciplinary literature on food insecurity and addresses recent calls in the communicative study of hunger to uncover the deeper communicative dynamics of hunger and conceptualizing food insecurity in new ways, so that there is a more nuanced understanding of how communication constructs food insecurity. To address such calls, I propose a guiding theoretical idea that I name food insecurity as a material-discursive system, or a dynamic configuration of subsystems including organizations, individuals, materialities, internal/external structures, institutions, policies, human activities. Theoretically, this study is also guided by structuration theory and liberation perspectives/lenses, an umbrella concept for an interdisciplinary set of ideas about scholarship targeting social marginalization. I situate this research in a mid-sized town in the northwestern part of Indiana, United States. I took a qualitative approach and collected (a) two-year observations of activity in a local church food pantry, (b) one-on-one interviews with people in food insecurity and food pantry volunteers in this town, (c) material artifact data in the form of transcribed video footage of the online C-SPAN archives regarding the U.S. food stamp policy, and (d) reflective journal notes. Through such data collection methods, the dissertation aims to understand how communication reproduces and transforms the food insecurity system, as well as how communication manifests in oppressive and liberating ways for the system stakeholders. Since this study conceptualizes food insecurity as a system, it also aims to understand the structural dynamics of the system so that it can clarify how communication reproduces and transforms the system, oppresses and liberates in the system. Communication reproduces the food insecurity system in three ways: by mediating the implementation of system rules, by supporting system adaptation and management, and by confirming and replicating system assumptions. Simultaneously, when system stakeholders interact in the system, they transform the system as their interactions result in selective compliance with system rules or a full digression from system expectations. Through their discourses, system stakeholders try to transform the system by strategically challenging system logics. Furthermore, the study shows that communication in the food insecurity system can have oppressive impacts for food insecurity stakeholders when it promotes alienation, marginalization of stakeholder voices, and uneven distribution of system resources. However, communication can be liberating to system stakeholders as it can be a tool to promoting community, shaping solutions to food insecurity, and fostering reflexivity that recovers system stakeholders’ tarnished images. The results also suggest that a number of external and internal structures shape the food insecurity system, and many of these structures operate in the system in communicative ways. The dissertation has theoretical contributions for the study of food insecurity more generally and as a communication phenomenon. The dissertation also contributes to practice in the arena of food assistance and community interventions addressing poverty.

Frequency of C > T polymorphism in fourth chromosome and levels of crp in patients with atrial

Introduction. Atrial fibrillation is a heart rhythm disorder, characterized by rapid and uncoordinated atrial activation which is the most common arrhythmia in clinical practice. Atrial fibrillation is observed in 1.5 - 2% of the general population and its incidence increases with age reaching more than 8-15% by 80 years of age. Atrial fibrillation is traditionally considered as a non genetic disorder. The cause of atrial fibrillation in 10-20% of cases is unknown and it is diagnosed as idiopathic