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Aim: to assess adaptive hemostasis changes in multiple dichorionic pregnancy after in vitro fertilization (IVF). Materials and Methods. A prospective observational randomized controlled trial was conducted by examining 58 and 46 pregnant women with multiple dichorionic diamniotic twins resulting from applying assisted reproductive technologies (ART) and spontaneous delivery (comparison group), respectively. Hemostasis parameters were studied as follows: activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen, antithrombin, protein C, protein S, functions of protein С (РrоС Global test), D-dimer, platelet aggregation with adenosine-5-diphosphate (ADP), ristocetin, and collagen. Results. A high coagulation potential was revealed, more prominent after using ART (p < 0.05). Fibrinogen level gradually increased while gestation age increased, whereas APTT, PT and TT level decreased. In the group with natural conception, fibrinogen increased by 22 % in the second trimester, reaching 4.5 g/L (95 % CI = 4,2–4,8) and by 6 % in the third trimester, reaching 4.8 g/L (95 % CI = 4,3–5,4), whereas in the IVF group – by 26 %, reaching 5.3 g/L (95 % CI = 4,7–5,6) and by 21 %, reaching (6.5 g/L; 95 % CI = 5,2–6,8) in relevant trimester of pregnancy, respectively. Antithrombin level was lower in IVF patients – 76.8 % (95 % CI = 72.6 – 81.0) in the second trimester, reaching 70.6 % (95 % CI = 64.8–76.4) in the third trimester (p < 0.001). Protein C level did not differ significantly between groups and was low within the reference range. The aggregatogram demonstrated a high platelet hemostatic potential in IVF patients (p < 0.05) as early as in the first trimester: ADP-induced aggregation – 68.3 % (95 % CI = 62.9–73.7), ristocetin-induced aggregation – 53.1 % (95 % = CI 48.7–58.5), collagen-induced aggregation – 58.4 % (95 % CI = 52.1–64.7). In the third trimester, both platelet aggregation and functional activity (ADP-induced aggregation – 64.5 % [95 % CI = 59.3–69.7], ristocetin-induced aggregation – 68.4 % [95 % CI = 63.2–73.6], collagen-induced aggregation – 50.7 % [95 % CI = 44.3–57.1]; p < 0.05) and D-dimer level persistently increased, also more prominently in the IVF group (1.60 ± 0.46 ng/ml; p < 0.05). Conclusion. Gestational adaptation in induced multiple pregnancies is at high risk of breach in compensatory mechanisms and requires monitoring for timely detection of decompensation signs and their correction to prolong pregnancy till optimal delivery time frame.

Anna Basok,1 Elvira Romanjuk,1 Boris Rogachev,1 Yosef Shmuel Haviv,1 Ruth Shaco Halevy,2 Marina Vorobiov1 1Nephrology Department, Ben Gurion University Medical Center, Beer Sheva, Israel; 2Pathology Department, Ben Gurion University Medical Center, Beer Sheva, IsraelCorrespondence: Anna Basok, Nephrology Department, Ben Gurion University Medical Center, Uchmanit 13, Beer-Sheva, 8485283, Israel, Email basok@bgu.ac.ilAbstract: We described an extraordinary case of invasive aspergillosis (IA) after commercial kidney transplantation. Massive infestation by angiotrophic fungi with morphological features of Aspergillus caused fungal arteritis of renal blood vessels with detachment of the kidney graft from the iliac artery with ipsilateral leg ischemia, necessitating graft removal and recurrent vascular surgery to restore the blood supply to the leg. A literature review comprising various features of invasive aspergillosis and ethical aspects of commercial kidney transplantations is elucidated in this paper.Keywords: invasive aspergillosis, IA, transplant tourism, TT, galactomannan

Background and purpose: Testosterone is an essential sex hormone in maintaining masculine characteristics, which is prescribed for male hypogonadism as testosterone replacement treatment (TRT). Herein, we investigated long-standing controversies about the association between TRT and major adverse cardiovascular events (MACEs), based on real world adverse event (AE) reports, registered in the Food and Drug Administration Adverse Event Reporting System (FAERS).Methods: Publicly available FAERS data from 1 January 2004 to 31 December 2022 were retrieved from the Food and Drug Administration (FDA) website. The data mining protocol including the reporting odds ratio (ROR) and the Bayesian confidence propagation neural network (BCPNN) was applied to analyze overreporting caused by risk factors and MACEs, including TRT, morbidities, and ages. The ROR and the BCPNN were also applied to investigate the annually developing trend of pharmacovigilance (PV) signals in the real world, retrospectively.Results: A total of 3,057 cases referring to MACEs, with a median age of 57 years old (yo), were identified from 28,921 cases of testosterone users. MACEs related to PV signals have emerged since 2014, including cardiac death, non-fatal myocardial infarction, and non-fatal stroke. Myocardial infarction (MI) (ROR: 9.46; IC025: 3.08), acute myocardial infarction (AMI) (ROR: 16.20; IC025: 3.72), ischemic cardiomyopathy (ROR: 11.63; IC025: 2.20), and cardiomyopathy (ROR: 5.98; IC025: 1.96) were the most significant signals generated, and weaker signals included cardiac failure acute (ROR: 4.01; IC025: 0.71), cardiac arrest (ROR: 1.88; IC025: 0.56), and ventricular fibrillation (VF) (ROR: 2.38; IC025: 0.38). The time-to-onset (TTO) of MACEs was calculated with a median of 246 days for AMI.Conclusion: For myocardial infarction and cardiomyopathy, TRT statistically tended to increase the risk of MACEs, while for cardiac arrhythmia, cardiac failure, and stroke, TRT demonstrated beneficial effects among the population with morbidities, such as testosterone deficiency (TD), diabetes mellitus (DM), and hypertension. MACEs were rare but led to serious outcomes including significant increase in death and disability. Since 2018, and before 2014, reports referring to TRT associated with MACEs were relatively scarce, which indicated that there might be a considerable number of cases that went unrecorded, due to neglection. Health workers and testosterone users might pay more attention to testosterone-induced MACEs.

Inflammation plays a role in the pathogenesis of COPD by interfering with the protease/antiprotease and oxidant/antioxidant balance. There is no adequate data about the relationship between oxidative stress biomarkers and FEV1 values in stable COPD patients. Prospective cohort study, designed in tertiary care chest disease hospitals' outpatient clinic. COPD patients were approved informed consent were included in the study. The total antioxidant status (TAS,), total oxidant status (TOS), total thiol (TT), native thiol (NT), IL1 IL6, and TNFα levels were measured. The mean age of 33 COPD patients who joined the study was 61±9,32 years, while their average body mass index (BMI) was 27±4,31 kg/m2. There was no statistically significant difference between the groups in terms of age, gender, weight, smoking status and comorbidities. According to the results of the analysis, there was a statistically significant difference in TOS, TAS, oxidative stress index (OSI), TT, NT, DIS, IL-1β, IL-6, and TNFα between the control and COPD patient groups (p [Med-Science 2022; 11(2.000): 770-74]

Study Objective is to evaluate prevalence of hepatitis A, B, C, E, and TT virus infection markers in highly qualified sportsmen. Study Design: multicenter open single-site clinical study.Materials and Methods: 100 blood serum samples of sportsmen (game, complex coordination, technical, etc.) were studied. Biological material (blood serum) was obtained from 54 men and 46 women aged 16 to 45 years during an in-depth medical examination. All sportsmen filled out a questionnaire, including demographic data, description of the sport, information about infection risk factors, information about the presence of acute viral hepatitis and vaccination. Anti-HAV IgG, HBsAg, anti-HBcore, anti-HCV, anti-HEV IgG, anti-HEV IgM were determined in the blood serum by enzyme immunoassay; using polymerase chain reaction — DNA Anelloviridae (TTV, TTMDV, TTMV). Study Results: Anti-HAV IgG was detected in 57/66 (86,4%) sportsmen, women (91,2%) predominated, among them a third were engaged in synchronized swimming. 7/57 (12,3%) of the examined had indications of vaccination against hepatitis A. The frequency of anti-HEV IgG did not exceed 3% (2/66). anti-HEV IgM were not detected in any case. Also, none of the examined sportsmen in the blood serum was not determined HBsAg. However, anti-HBcore (marker of latent HBV infection) was detected in 13% (13/100) of the samples. The detection rate of anti-HCV was low, combined with the presence of anti-HBcore was 2% (2/100). In addition, DNA TTV, TTMDV and TTMV, respectively, were found in serum samples from 66/100 (86%), 79/100 (79%), 71/100 of sportsmen. Conclusion: The high frequency of hepatitis virus markers was found (HAV — 74,1%, TTV/TTMDV /TTMV — 71-86%), HBV — 13%, HEV — 3%, HCV — 2%). All patients denied a history of acute viral hepatitis. Vaccination against hepatitis A and B is a modern strategy that prevents infection and the development of acute viral hepatitis. Its mandatory holding should become part of the targeted preparation of sportsmen to achieve the highest sports results.

Cellulitis is a bacterial infection of the deeper layers of the skin, namely, the dermis and the subcutaneous tissue. The most common organisms involved in causing cellulitis are group A β-hemolytic streptococci and Staphylococcus organisms. Rare causes include Pseudomonas aeruginosa in case of puncture wounds, anaerobes, Eikenella, Viridans streptococci in human bites. Cellulitis is mainly a clinical diagnosis but blood counts and ESR can be done to confirm its occurrence. Risk factors for cellulitis include breaks in the skin which allows an entry point for the bacteria, other risk factors include immune deficient states such as HIV/leukemia, conditions that affect the vascular system, and skin conditions such as eczema and psoriasis. Vaccination is an extremely rare cause of cellulitis with no cases of cellulitis reported since 1998 due to complication of vaccination. In our case, patients presented signs and symptoms of cellulitis 2 days after receiving the tetanus prophylaxis vaccine. He was treated with broad-spectrum antibiotics after admission and discharged once the condition settled.

Abstract Background Traditional coagulation tests are included in emergency guidelines for management of patients on direct oral anticoagulants (DOACs) who experience acute bleeding or require surgery. We determined the ability of traditional coagulation tests and fast whole blood thromboelastography (ROTEM®) to screen for anticoagulation activity of dabigatran and rivaroxaban as low as 30 ng/mL. Methods One hundred eighty-four citrated blood samples (75 dabigatran, 109 rivaroxaban) were collected from patients with non-valvular atrial fibrillation (NVAF), to perform screening tests from different manufacturers, (diluted, D) PT, aPTT, TT and ROTEM®. The activity of DOACs was quantitatively determined by clot detection assays: Hemoclot DTT and DiXaI test (Biophen), on CS2100 (Siemens). The clotting time (CT) of INTEM and EXTEM ROTEM® (Werfen) were used as test parameters. Results Dabigatran, ≥ 30 ng/mL, was accurately detected by five coagulation tests: APTT Actin FSL (93%), PT Neoplastin (93%), APTT Cephascreen, Thromboclotin, and Thrombin (all 100%), but not by PT Innovin (49%). CT-EXTEM (91%) was sufficiently sensitive, but not CT-INTEM (52%). APTT Cephascreen and Thrombin showed good linearity (R2 = 0.71,R2 = 0.72). For the other tests linearity was moderate to poor. Rivaroxaban was accurately detected by PT Neoplastin (98%) and less so by APTT Cephascreen (85%). In addition, rivaroxaban was also accurately detected by CT-INTEM (96%). PT Neoplastin showed good linearity (R2 = 0.81), all other tests had moderate to poor linearity. Conclusion In patients with NVAF, the ability of routine coagulation tests to detect the presence of significant levels of DOACs is test and reagent dependent. CT-INTEM and CT-EXTEM may be fast whole blood alternatives. Trial registration The Institutional Review Board of the MUMC approved this study (December 2011, project number 114069).

Aim. Study clinical outcomes in patients with, chronic hepatitis C depending on genotype of hepatitis C virus (HCV) and IL28B gene polymorphism. Materials and methods. 592 individuals were examined, 75 of those had HCV RNAgenotypes determined by PCR. Genotyping of single nucleotide polymorphisms (SNP) - rs 12979860 (C/T) and rs8099917 (T/G) in IL28B gene was carried out by real-time PCR. Results. HCV RNA was detected in 72 examined residents of Yakutia. HCV lb genotype was determined in 74.2% of cases, 3a - in 11.4%, la and 2 - 5.7% each. Frequency of polymorph variant rsl2979860 CC was 72.2%, CT - 27.8%, rs8099917 TT - 61.1%, TG - 23.2%. Conclusion. Combination of HCV lb with polymorphic variants of IL28B gene rs.l.2979860 CC and rs8099917 CT showed a less aggressive course of the disease. On the other hand, HCV infection of individuals with genotype 3a and polymorphism rsl2979860 CC or rs809917 TT of IL28B gene showed a more severe clinical presentation. The presence of polymorph variants rs8099917 T/G and rs 12979860 C/T showed more severe clinical outcomes of HCV infection (viral load up to 19035212 copies, cirrhosis with ascite, hepatocarcinoma).

Artykuł jest próbą zwrócenia uwagi na zagadnienia właściwości technicznych przy eksploatacji podstawowych typów sieci elektroenergetycznych stosowanych na statkach. Celem jest porównanie ich pracy przy powszechnie występujących uszkodzeniach.

El desarrollo de las TIC favoreció la aparición del Teletrabajo (TT) a mediados del siglo pasado, pero actualmente, tan sólo el 13,2% de las empresas españolas lo fomentan. Las diferencias culturales, sociales, y las dificultades para homogeneizar la información disponible, hacen que resulte un desafío unificar criterios para su desarrollo. Esta revisión bibliográfica pretende mostrar el marco global del TT en España, factores de riesgo, repercusión, beneficios y perjuicios, detallar las condiciones y medidas de seguridad laboral que deberían acompañar el proceso. Para obtener los artículos se ha realizado una búsqueda bibliográfica en las principales bases de datos biomédicas. Efectos beneficiosos evidenciados serían el alto nivel de autonomía, elevada satisfacción laboral, mejor relación con el supervisor, disminución de la tasa de abandono del trabajo y del conflicto familiar. Otras publicaciones indican que reforzando los recursos personales, mejora el compromiso y la eficacia de los trabajadores. Se destaca la escasa existencia de descriptores específicos DeCS-MeSH para TT, incluidos en las bases de datos bibliográficas que utilizan estos tesauros como motor de búsqueda, Medline, Cochrane Library e IBECS, lo que dificulta la recuperación de información. El desconocimiento general sobre esta modalidad de trabajo, la cultura organizacional, el sistema de control y supervisión laborales basadas en la desconfianza, no facilitan la implantación del TT en España al ritmo en el que se impone en otros países de nuestro entorno como Reino Unido, Alemania y Francia, por lo que se hace necesario un cambio de mentalidad colectiva para integrar el TT como alternativa laboral en el marco de la sociedad actual en la que nos desenvolvemos.

Two flavonoids, rutin and hesperidin, were investigated in vitro for anticoagulant activity through coagulation tests: activated partial thromboplastin time (aPTT), prothrombin time (PT) and thrombin time (TT). Only an ethanolic solution of rutin at the concentration of 830 µM prolonged aPTT, while TT and PT were unaffected. In order to evaluate whether the prolongation of aPTT was due to the decrease of coagulation factors, the experiment with deficient plasma was performed, showing the effects on factors VIII and IX. Since pharmacological activity of flavonoids is believed to increase when they are coordinated with metal ions, complexes of these flavonoids with Al(III) and Cu(II) ions were also tested. The results showed that complexes significantly prolonged aPTT and had no effects on PT and TT. Assay with deficient plasma (plasma having the investigated factor at less then 1%) revealed that complexes could bind to the coagulation factors, what may lead to a non-specific inhibition and aPTT prolongation. An effort was made to correlate stability of complexes with their anticoagulant properties.

Introduction: Poor access and utilization of antenatal and other health services continue to contribute to high maternal mortality rate along with other socioeconomic factors. Improving utilization of maternal health care services is a global challenge for the health system in low and middle income countries. Material and Methods: It was a community based descriptive cross-sectional study which was undertaken from August 2010 to July 2011 in 4 villages of Paithan taluka, of Aurangabad district. Respondent women who had less than 1 year child and should be resident of particular area for previous 2 years or more at the time of interview were included in the study. Simple random sampling was used for selection of villages. Results: In present study only 40.8% respondent women had their first antenatal visit in 1st trimester. Majority of the women 90.3% had institutional delivery. Out of 8(3.9%) deliveries assisted by untrained person in 4(1.9%) deliveries umbilical cord cut with unsterile instrument and of these 4(1.9%) deliveries in 2(1.0%) untrained person applied cow dung to umbilical stump. Conclusions: Awareness regarding three or more antenatal visits and registration of pregnancy in first trimester should be emphasized through health education campaign. In present study though negligible percentage of hazardous practice of application cow dung to the umbilical stump was observed. It should be averted through health education and promotion of institutional deliveries.

In this study, we aimed at characterizing the structure and the anticoagulant activity of a polysaccharide fraction (AGP33) isolated from the gonads of Haliotis discus hannai Ino. AGP33 was extracted by enzymatic hydrolysis and purified by ion-exchange and gel-filtration chromatography. The backbone fraction of AGP33 (BAGP33), which appeared to contain of mannose, glucose and galactose, was prepared by partial acid hydrolysis. According to methylation and nuclear magnetic resonance (NMR) spectroscopy, the backbone of AGP33 was identified as mainly consisting of 1→3-linked, 1→4-linked, and 1→6-linked monosaccharides. AGP33 is a sulfated polysaccharide with sulfates occur at 3-O- and 4-O-positions. It prolonged thromboplastin time (APTT), thrombin time (TT) and prothrombin time (PT) compared to a saline control solution in a dosage-dependent manner. AGP33 exhibited an extension (p < 0.01) of APTT compared to the saline group at concentrations higher than 5 μg/mL. AGP33 exhibited higher anticoagulant activity than its desulfated product (AGP33-des) and BAGP33. The results showed that polysaccharide with higher molecular weight and sulfate content demonstrated greater anticoagulant activity.

Le Lettere Pastorali, come risulta gia dal titolo, contengono un certo numero delie istruzioni che riguardano la vita delle comunita ecclesiastiche a Efeso e sull'isola di Creta. Tra questi indizi troviamo anche quelli che riguardano il comportamento verso le autorita civili (l Tm 2,2; Tt 3,1). Queste devono essere rispettate ma sotto la condizione di compiere il loro dovere, cioe garantiscono la convivenza pacifica di tutti i cittadini. La chiesa primitiva fu consapevole del funzionamento delle istituzioni dello stato, tra questi la schiavitu (cf. Tt 2,9-10; 1 Tm 6, 1-2). In testi soprannominati non abbiamo trovato l'accentazione di quel fatto, ma soltanto le indicazioni per i cristiani che anche nello stato di schiavitu devono annunziare al mondoGesu Cristo. Un altro tema che riguarda il potere e il comportamento nel raduno dei cristiani. Per questa volta si tratta del potere d'insegnare. Dall'analisi di 1 Tm 2,11-14 risulta che ił comportamento della donna che ascolta, impara e poi parla, e "un atteggiamento tipico" del discepolo. Invece il comportamento del uomo che insegna e guida la comunita, e ''un atteggiamento tipico" del maestro. Tutto questo ha un collegamento stretto con Unico Sovrano ( cf. 1 Tm 6, 15-16) e con il Suo regno (2 Tm 4,2.18) che raggiungera la pienezza la fine dei tempi.