Создание монумента «Возрождение крымскотатарского народа» как культурное явление в жизни крымского общества

В статье автором охарактеризован градостроительный объект Монумент «Возрождение крымскотатарского народа» как культурное явление в жизни крымского общества, призванное внести вклад в процесс воспитания духовности и культуры в молодых людях.У статті автором охарактеризовано містобудівельний об’єкт Монумент «Відродження кримськотатарського народу» як культурне явище у житті кримського суспільства, що призвание донести внесок у процес виховання духовності та культури молоді.The author describes a monument „Rebirth of the Crimean Tatars” as a cultural phenomenon in the life of the Crimean society, which can contribute in the process of spiritual and cultural upbringing of young people

Relationship of neutrophil-to-lymphocyte ratio, in addition to C-reactive protein, with cardiovascular events in patients with type 2 diabetes

Aim: To quantify the relationship of neutrophil-to-lymphocyte ratio (NLR) with cardiovascular events and all-cause mortality in patients with type 2 diabetes (T2D), independent of C-reactive protein (CRP). Methods: Patients with T2D from the UCC-SMART-cohort were studied using multivariable-adjusted Cox regression. The relationship of NLR and CRP with vascular events (cerebrovascular events, myocardial infarction and vascular death) and all-cause mortality was quantified. Results: During 10,833 person-years, 232 vascular events and 302 deaths occurred in 1,239 patients with T2D. Risk of vascular events and all-cause mortality increased per standard deviation (SD) in NLR (hazard ratio (HR) 1.27; 95 % confidence interval (CI):1.11–1.46) and 1.15; 95 % CI:1.02–1.30) after adjustment for CRP. CRP was not associated with vascular events after adjustment for NLR, (HR per SD 1.03; 95 % CI: 0.90–1.19), but was associated with all-cause mortality (HR per SD 1.18; 95 % CI: 1.04–1.33). Notably, NLR was related to vascular events in patients with CRP < 2 mg/L (HR per unit 1.45; 95 % CI: 1.19–1.77). Conclusion: In patients with T2D, NLR is related to higher risk of CVD and all-cause mortality, independently from CRP. NLR is related to CVD even when CRP is low, indicating that NLR is a marker of CVD-risk in addition to CRP. Both NLR and CRP are independently related to all-cause mortality in T2D patients

Left Ventricular Diastolic Dysfunction across Levels of Kidney Function: A Cross-Sectional Study Based on Routine Clinical Practice Data

Left ventricular diastolic dysfunction (LVDD) commonly coexists with kidney dysfunction. In this study, we investigated the presence of abnormalities in echocardiography parameters indicative of LVDD across stages of kidney function. Methods: We selected patients who visited a university hospital and had a serum creatinine and echocardiography reported in their medical records. Participants were categorized based on their kidney function: normal (estimated glomerular filtration rate [eGFR] ≥ 90 mL/min/1.73 m2), mildly decreased (eGFR: 60–90), moderately decreased (eGFR: 30–60), and severely decreased (eGFR 95 g/m2 in women or >115 g/m2 in men (OR: 2.07 [95% CI: 1.27, 3.38]). The linear regression showed a significant inverse association between eGFR and echocardiography parameters, meaning that with worse kidney function, the parameters for LVDD worsened as well. Conclusions: Abnormal echocardiography parameters of LVDD were present even in patients with mildly decreased kidney function. As the kidney function worsened, there was a gradual increase in the risk of abnormal parameters of LVDD

Етнологія релігії – актуальна сфера українського релігієзнавства

Background: Inhaled long-acting beta-2-adrenoceptor agonists (LABA) are frequently used in patients suffering from asthma and chronic obstructive pulmonary disease (COPD). For evaluation of real-life data, drug consumption studies are needed but results might be widely influenced due to methodological differences in particular regarding inter-country comparisons. Objectives: This study aims to compare the LABA prescribing in the general population and specifically in patients suffering from asthma and/or COPD in five European countries. Methods: Crude and age- and sex-standardized (European 2008 reference population) annual period prevalence rates per 10,000 persons were calculated for the period 2002-2009 based on seven European electronic health record databases (Denmark, Germany, Spain, the Netherlands (2), and the United Kingdom (2)). Stratification by sex, age, and indication were performed for the annual period prevalence rates. Results: In all databases, we observed an increase in LABA prescriptions during the study period for the general population and for patients suffering from asthma and/or COPD. In 2008, the highest standardized period prevalence was observed in the Dutch Mondriaan-AHC and the Spanish BIFAP database (443.3 and 395.5 per 10,000 persons), and the lowest in the German Bavarian Claims and Dutch Mondriaan- NPRCD database (278.7 and 290.6 per 10,000 persons). Prevalence rates for LABA increased with age and were highest in patients over 70 years. Patients with a combined diagnosis of asthma and COPD had higher prevalence rates of LABA compared to patients with a single diagnosis of asthma or COPD. The proportion of patients with one inhaled LABA prescription only ranged from 14% (UK databases) to 35% (Spanish BIFAP database) in 2008 in the general population. Conclusions: By using a standardized protocol, we demonstrated inter- and intra-country differences in LABA prescriptions. A general increase of LABA prescriptions during the study period was observed in all databases

Care after pancreatic resection according to an algorithm for early detection and minimally invasive management of pancreatic fistula versus current practice (PORSCH-trial): design and rationale of a nationwide stepped-wedge cluster-randomized trial

BACKGROUND: Pancreatic resection is a major abdominal operation with 50% risk of postoperative complications. A common complication is pancreatic fistula, which may have severe clinical consequences such as postoperative bleeding, organ failure and death. The objective of this study is to investigate whether implementation of an algorithm for early detection and minimally invasive management of pancreatic fistula may improve outcomes after pancreatic resection. METHODS: This is a nationwide stepped-wedge, cluster-randomized, superiority trial, designed in adherence to the Consolidated Standards of Reporting Trials (CONSORT) guidelines. During a period of 22 months, all Dutch centers performing pancreatic surgery will cross over in a randomized order from current practice to best practice according to the algorithm. This evidence-based and consensus-based algorithm will provide da

Adult height, coronary heart disease and stroke: a multi-locus Mendelian randomization meta-analysis

BACKGROUND: We investigated causal effect of completed growth, measured by adult height, on coronary heart disease (CHD), stroke and cardiovascular traits, using instrumental variable (IV) Mendelian randomization meta-analysis. METHODS: We developed an allele score based on 69 single nucleotide polymorphisms (SNPs) associated with adult height, identified by the IBCCardioChip, and used it for IV analysis against cardiovascular risk factors and events in 21 studies and 60 028 participants. IV analysis on CHD was supplemented by summary data from 180 height-SNPs from the GIANT consortium and their corresponding CHD estimates derived from CARDIoGRAMplusC4D. RESULTS: IV estimates from IBCCardioChip and GIANT-CARDIoGRAMplusC4D showed that a 6.5-cm increase in height reduced the odds of CHD by 10% [odds ratios 0.90; 95% confidence intervals (CIs): 0.78 to 1.03 and 0.85 to 0.95, respectively],which agrees with the estimate from the Emerging Risk Factors Collaboration (hazard ratio 0.93; 95% CI: 0.91 to 0.94). IV analysis revealed no association with stroke (odds ratio 0.97; 95% CI: 0.79 to 1.19). IV analysis showed that a 6.5-cm increase in height resulted in lower levels of body mass index (P < 0.001), triglycerides (P < 0.001), non high-density (non-HDL) cholesterol (P < 0.001), C-reactive protein (P = 0.042), and systolic blood pressure (P = 0.064) and higher levels of forced expiratory volume in 1 s and forced vital capacity (P < 0.001 for both). CONCLUSIONS: Taller individuals have a lower risk of CHD with potential explanations being that taller people have a better lung function and lower levels of body mass index, cholesterol and blood pressure

Multiple database approach for study of associations between frequently used drugs and community-acquired pneumonia

Background: The association between communityacquired pneumonia (CAP) and commonly used drugs such as statins, ACE-inhibitors (ACE-I), and proton pump inhibitors (PPI) has been extensively studied in different settings and populations with often conflicting results. The origin of this heterogeneity is unknown and unravelling its nature is important for clinical interpretation of these pharmacoepidemiological (PE) results. Objectives: To explore sources of heterogeneity in the association between CAP and use of ACE-I, statins, and PPIs by using the same methods in a multi-database study in multiple settings. Methods: We used data from the TI PHARMA Mondriaan project providing access to various healthcare databases from hospitals, general practices (GP), and pharmacies. Ten different case-control sets in five different populations derived from both general practitioner (GP) and hospital data have been generated (2004-2010). Patients and controls were matched on age, gender, and index year. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for the associations between the three drug classes of interest and CAP. Crude associations were adjusted for comorbidity and drug use (semi-adjusted; common variables in all sets), and for all available confounders (fully adjusted). Results: In total, data of 38,742 cases and 118,019 controls have been studied. The mean age of the hospitalised patients was 63 years and 46-61 years for the GP patients. For statin use and pneumonia risk the semiadjusted OR varied from 0.82 to 1.38. A comparable range was observed for ACE-I and PPI use with ORs of 1.02-1.61 and 1.29-2.69, respectively. Overall, the associations were stronger for hospitalised CAP patients matched to population controls vs. GP CAP patients matched to population controls. Furthermore, prevalence of drug exposure was higher when assessed based on dispensing data vs. prescription data. Conclusions: Associations between statin, ACE-I, and PPI use and CAP risk were influenced by sampling population and data source and may explain the large heterogeneity observed between previous observational PE studies

Multiple database approach for study of associations between frequently used drugs and community-acquired pneumonia

Background: The association between communityacquired pneumonia (CAP) and commonly used drugs such as statins, ACE-inhibitors (ACE-I), and proton pump inhibitors (PPI) has been extensively studied in different settings and populations with often conflicting results. The origin of this heterogeneity is unknown and unravelling its nature is important for clinical interpretation of these pharmacoepidemiological (PE) results. Objectives: To explore sources of heterogeneity in the association between CAP and use of ACE-I, statins, and PPIs by using the same methods in a multi-database study in multiple settings. Methods: We used data from the TI PHARMA Mondriaan project providing access to various healthcare databases from hospitals, general practices (GP), and pharmacies. Ten different case-control sets in five different populations derived from both general practitioner (GP) and hospital data have been generated (2004-2010). Patients and controls were matched on age, gender, and index year. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for the associations between the three drug classes of interest and CAP. Crude associations were adjusted for comorbidity and drug use (semi-adjusted; common variables in all sets), and for all available confounders (fully adjusted). Results: In total, data of 38,742 cases and 118,019 controls have been studied. The mean age of the hospitalised patients was 63 years and 46-61 years for the GP patients. For statin use and pneumonia risk the semiadjusted OR varied from 0.82 to 1.38. A comparable range was observed for ACE-I and PPI use with ORs of 1.02-1.61 and 1.29-2.69, respectively. Overall, the associations were stronger for hospitalised CAP patients matched to population controls vs. GP CAP patients matched to population controls. Furthermore, prevalence of drug exposure was higher when assessed based on dispensing data vs. prescription data. Conclusions: Associations between statin, ACE-I, and PPI use and CAP risk were influenced by sampling population and data source and may explain the large heterogeneity observed between previous observational PE studies

The risk of acute myocardial infarction after discontinuation of antihypertensive agents

Background: Sudden discontinuation of some antihypertensive agents such as beta-blockers and centrally acting antihypertensive agents are associated with increased risk of acute coronary events. Objectives: The aim of this study was to assess the association between discontinuation of different antihypertensive agents and the risk of acute myocardial infarction (AMI). Methods: A nested case control study was performed in a cohort of antihypertensive drug users from the Utrecht Cardiovascular Pharmacogenetics (UCP) database. Within this cohort, patients who were hospitalized for first AMI were considered cases. Cases were matched (1 up to 4) to controls at the same AMI date (index date). Antihypertensive users were defined as current users if the index date fell within prescribed duration or as stoppers if this date fell outside the prescribed duration. According to recency of stopping, stoppers were divided into recent stoppers (≤90 days), intermediate-term stoppers (91-180 days), and longterm stoppers (>180 days). The study included only antihypertensive users who were specifically current users or stoppers of one antihypertensive agent. Logistic regression analysis was used to assess the association between the discontinuation of antihypertensive agents and the risk of AMI and to control for confounding. Results: We included 1245 cases and 4994 controls in our analysis. The risk of AMI was significantly increased with all stoppers of beta-blockers (adjusted OR: 1.54, 95%CI (1.25-1.90)), calcium channel blockers (CCBs) (adjusted OR: 2.25, 95%CI (1.53- 3.30)), and diuretics (adjusted OR: 1.76, 95%CI (1.24-2.48)) compared with current users. Moreover, the risk of AMI was significantly increased for longterm stoppers (beta-blockers, CCBs, angiotensinconverting enzyme inhibitors, and diuretics) and intermediate- term stoppers (beta-blockers and CCBs) versus current users. There was no difference in AMI risk between recent stoppers of antihypertensive agents versus current users. Conclusions: Discontinuation of antihypertensive agents increases the risk of AMI after more than 90 days of stopping. Adherence to antihypertensive agents plays an important role in reducing the risk of AMI in patients with hypertension

The impact of age and sex on the reporting of cough and angioedema with renin–angiotensin system inhibitors : a case/noncase study in VigiBase

The purpose of this study was to assess the impact of age and sex on the reporting of cough and angioedema related to renin–angiotensin system (RAS) inhibitors. A case/noncase study was performed in VigiBase. Two case groups were identified, reports of cough and reports of angioedema, and noncases were all reports of all other adverse events. Logistic regression analysis was used to assess the association between reporting of cough and angioedema with each class of RAS inhibitors stratified by age/sex and to control for confounding. The reporting of cough with angiotensin-converting enzyme (ACE) inhibitors was significantly higher in women than in men [adjusted reporting odds ratio (ROR): 44.0, 95% CI (43.2–44.8) for women vs. 29.2, 95% CI (28.5–29.9) for men]. There was no difference in reporting of cough linked to angiotensin receptor blockers (ARBs) and aliskiren between men and women. In contrast, the reporting of angioedema with ACE inhibitors and ARBs was significantly higher in men than in women, but for aliskiren, women had a significantly higher ROR than men [adjusted ROR: 5.20, 95% CI (4.18–6.46) for women vs. 3.04, 95% CI (2.30–4.02) for men]. The reporting of cough with ACE inhibitors was increased with age until reaching a plateau at middle adulthood (40–59 years) and the reporting of angioedema with ACE inhibitors was increased with age until elderly (60–79 years). Age had only a slight effect on the reporting of cough and angioedema with ARBs and aliskiren. Both age and sex have substantial effects on the reporting of cough and angioedema with RAS inhibitors and in particular ACE inhibitors. Further study is needed to determine whether these differences mainly express different adverse drug reaction risks in subgroups or also can be explained by factors influencing reporting