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Here is a case of a Pulmonary AVM in a female presenting with sudden onset of dizziness and vomiting most likely secondary to a paradoxical emboli causing an ischemic stroke of the cerebellum.

BACKGROUND: The study aimed to identify the patterns of adaptive and behavioral strategies in different population groups, also to evaluate their association with the infection prevention strategies and the distress during the COVID-19 pandemic. METHODS: The data were obtained from the on-line survey of 1958 respondents (mean age 31±12 years) from March 30, 2020 to April 5, 2020. 578 respondents reported a history of affective disorders; 884 respondents - a history of somatic disease. The level of anxiety distress was evaluated with the Psychological Stress Measure (PSM-25). The analysis of variance was used for statistics. p

A 66-year-old male was found unresponsive and diagnosed with acute carbon monoxide poisoning, with pathognomonic findings on radiological imaging. During his first day's the patient underwent acute neurological deterioration; however, this was followed 2 weeks later with a subsequent improvement to near baseline. The improvement back to baseline was short-lived, and the patient quickly worsened and underwent neurological decompensation. These findings were consistent with delayed post hypoxic leukoencephalopathy, serious sequelae of carbon monoxide poisoning. This case report shows the importance of recognition of carbon monoxide toxicity and aims to improve accurate diagnosis of the sequelae that may follow using computed tomography and magnetic resonance imaging sequences, magnetic resonance spectroscopy in order to prevent or ameliorate further neurological decline.

Summary Background Etrolizumab is a gut-targeted, anti-β7 integrin, monoclonal antibody. In an earlier phase 2 induction study, etrolizumab significantly improved clinical remission compared with placebo in patients with moderately to severely active ulcerative colitis. We aimed to evaluate the efficacy and safety of etrolizumab in patients with moderately to severely active ulcerative colitis who had been previously treated with anti-tumour necrosis factor (TNF) agents. Methods HICKORY was a multicentre, phase 3, double-blind, placebo-controlled study in adult (18–80 years) patients with moderately to severely active ulcerative colitis (Mayo Clinic total score [MCS] of 6–12 with an endoscopic subscore of ≥2, a rectal bleeding subscore of ≥1, and a stool frequency subscore of ≥1) previously treated with TNF inhibitors. Patients were recruited from 184 treatment centres across 24 countries in North America, South America, Europe, Asia, Oceania, and the Middle East. Patients needed to have an established diagnosis of ulcerative colitis for at least 3 months, corroborated by both clinical and endoscopic evidence, and evidence of disease extending at least 20 cm from the anal verge. In cohort 1, patients received open-label etrolizumab 105 mg every 4 weeks for a 14-week induction period. In cohort 2, patients were randomly assigned (4:1) to receive subcutaneous etrolizumab 105 mg or placebo every 4 weeks for the 14-week induction phase. Patients in either cohort achieving clinical response to etrolizumab induction were eligible for the maintenance phase, in which they were randomly assigned (1:1) to receive subcutaneous etrolizumab 105 mg or placebo every 4 weeks through to week 66. Randomisation was stratified by baseline concomitant treatment with corticosteroids, concomitant treatment with immunosuppressants (induction randomisation only), baseline disease activity, week 14 MCS remission status (maintenance randomisation only), and induction cohort (maintenance randomisation only). All patients and study site personnel were masked to treatment assignment. Primary endpoints were remission (Mayo Clinic total score [MCS] ≤2, with individual subscores of ≤1 and a rectal bleeding subscore of 0) at week 14, and remission at week 66 among patients with a clinical response (MCS with ≥3-point decrease and ≥30% reduction from baseline, plus ≥1 point decrease in rectal bleeding subscore or absolute rectal bleeding score of 0 or 1) at week 14. Efficacy was analysed using a modified intent-to-treat population. Safety analyses included all patients who received at least one dose of study drug during the induction phase. This study is registered at ClinicalTrials.gov , NCT02100696 . Findings HICKORY was conducted from May 21, 2014, to April 16, 2020, during which time 1081 patients were screened, and 609 deemed eligible for inclusion. 130 patients were included in cohort 1. In cohort 2,479 patients were randomly assigned to the induction phase (etrolizumab n=384, placebo n=95). 232 patients were randomly assigned to the maintenance phase (etrolizumab to etrolizumab n=117, etrolizumab to placebo n=115). At week 14, 71 (18·5%) of 384 patients in the etrolizumab group and six (6·3%) of 95 patients in the placebo group achieved the primary induction endpoint of remission (p=0·0033). No significant difference between etrolizumab and placebo was observed for the primary maintenance endpoint of remission at week 66 among patients with a clinical response at week 14 (27 [24·1%] of 112 vs 23 [20·2%] of 114; p=0·50). Four patients in the etrolizumab group reported treatment-related adverse events leading to treatment discontinuation. The proportion of patients reporting at least adverse event was similar between treatment groups for induction (etrolizumab 253 [66%] of 384; placebo 63 [66%] of 95) and maintenance (etrolizumab to etrolizumab 98 [88%] of 112; etrolizumab to placebo 97 [85%] of 114). The most common adverse event in both groups was ulcerative colitis flare. Most adverse events were mild or moderate. During induction, the most common serious adverse event was ulcerative colitis flare (etrolizumab ten [3%] of 384; placebo: two [2%] of 95). During maintenance, the most common serious adverse event in the etrolizumab to etrolizumab group was appendicitis (two [2%] of 112) and the most common serious adverse events in the etrolizumab to placebo group were ulcerative colitis flare (two [2%] of 114) and anaemia (two [2%] of 114). Interpretation HICKORY demonstrated that a significantly higher proportion of patients with moderately to severely active ulcerative colitis who had been previously treated with anti-TNF agent were able to achieve remission at week 14 when treated with etrolizumab compared with placebo; however, there was no significant difference between groups in remission at week 66 among patients with a clinical response at week 14. Funding F Hoffmann-La Roche.

The high prevalence and variability of neurological and psychiatric symptoms in systemic lupus erythematosus has become the basis for emphasizing the special neuropsychiatric form of the disorder. Affective disorders (pathological changes in mood and anxiety) are the second most common neuropsychiatric manifestations in patients with systemic lupus erythematosus. However, the current nomenclature primarily focuses on the general clinical manifestations of affective disorders in neuropsychiatric form systemic lupus erythematosus, without evaluating the problems of their etiopathogenesis. Thereby, the aim of this review is the integration of information on the pathological mechanisms of depression and anxiety in patients with systemic lupus erythematosus. The available data on the biological aspects of the anxiety and depression in systemic lupus erythematosus indicate that the complex pathological models may be the best approach for studying, diagnosing, and treating comorbid pathology. The latter can be based on expanding the existing clinical categories, supplementing them with data on pathological mechanisms specific to particular sub-cohorts of patients. Such an approach can provide the specific and most effective preventive, diagnostic and therapeutic measures for each category of patients.

Schizophrenia is considered a multifactorial disease, where one of the pathogenetic links is oxidative stress; however, the results of studies are often contradictory, largely due to significant heterogeneity among study methods. The present study was undertaken to compare the levels of oxidative stress markers in the peripheral blood of patients with a first episode of schizophrenia (FES) and in healthy volunteers (HV). The study included 50 patients with FES and 37 HV. Blood samples were collected for spectrophotometric assessment of reduced glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA), aldehyde-2,4-dinitrophenylhydrazone (ADNPH), and ketone-2,4-dinitrophenylhydrazone (KDNPH) in blood plasma. Results showed that in patients with FES compared with HV, a significant decrease in CAT activity and an increase in oxidative modification of proteins (OMP) were found. In both groups, a significant increase in the level of MDA with age was revealed. In patients, the GSH plasma level was inversely proportional to the ADNPH level, and SOD activity was directly proportional to the KDNPH level. In volunteers there was no such correlation; however, there was a direct correlation between CAT activity and the levels of OMP and MDA. In both groups, a moderate direct correlation between peroxidation products was observed. The results confirm that a redox imbalance (a deficiency of antioxidants, in particular CAT, and excess OMP) may be a pathogenetic link in schizophrenia, which is manifested already at an early stage of the disease.

‘Mammographic density’ (MD) is a concept that has entered medical practice since 2017. as a marker of breast cancer risk factor (BC) according to the international classifiation of NCCN. The term reflcts the degree of severity of benign diffuse breast dysplasia in women of post-reproductive age. MD is determined by the ratio of stromal, epithelial, and adipose tissue. According to the literature, in young women, high MD limits the possibilities of X-ray mammography, reducing its effectiveness in oncomammoscreening, leading to the detection of advanced forms of breast cancer. Post-reproductive women with high MD are more likely to develop breast cancer than those with low MD. In this regard, MD is of particular interest for studying its role in oncogenesis. Recent molecular genetic studies of the differences between high and low MD explain the main biological reasons why post-reproductive women with dense breast structure are at a higher risk of developing breast cancer. The aim is to identify the factors that inflence the relationship of MD with the risk of developing breast cancer based on a comparative analysis of molecular genetic studies and radiological manifestations of MD of different severity and to identify the factors that contribute to the formation of MD variants.

For correct and reliable experimental in vivo assessment of antistress effect of various bioactive substances, appropriate biomodels reproducing stress and organism response to stress in laboratory animals should be chosen. We chose treadmill test for simulating exhaustive physical load and forced immobilization accompanied by disorders of physiological and psychological condition. Verification of the models used indicates their wide applicability for testing certain biological manifestations under reproduced stress exposure.

Background Children who experience traumatic physical injuries are at risk of developing acute stress disorder and posttraumatic stress disorder (PTSD). Early identification and treatment of these high-risk children can lead to improved mental health outcomes in this population. Objective This study assesses the feasibility of a study protocol that compares 3 screening tools for identifying patients at a high risk of later development of acute stress disorder or PTSD among pediatric trauma patients. Methods This pilot study compared 3 questionnaires used as screening tools for predictors of later development of PTSD in a convenience sample of pediatric trauma patients aged 7-17 years. Patients were randomized to one of 3 screening tools. Families were contacted at 30, 60, and 90-120 days postinjury to complete the Child Report of Post-Traumatic Symptoms questionnaire. The sensitivity and negative predictive value of the screening tools were compared for the diagnosis of PTSD defined using the Child Report of Post-Traumatic Symptoms questionnaire. Results Of the 263 patients identified for possible enrollment, 52 patients met full inclusion criteria and agreed to participate. Only 29 (55.7%) patients completed at least one follow-up questionnaire. The prevalence of acute stress disorder and PTSD in our population was 41% (95% CI [24, 61]) and 31% (95% CI [15, 51]), respectively. Conclusions In this pilot study, we sought to determine the utility of the 3 commonly used screening instruments for measuring traumatic stress symptoms in pediatric trauma patients to predict the diagnosis of acute stress disorder or PTSD. Limitations include the use of the Child Report of Post-Traumatic Symptoms screening tool as the gold standard for calculating test characteristics and lack of 24/7 enrollment capabilities. As such, a significant portion of patients were discharged prior to our teams' engagement for enrollment.

PURPOSE: Aerobic (AE) and resistance (RE) exercise elicit unique adaptations in skeletal muscle. The purpose here was to compare the post-exercise response of mTOR signaling and select autophagy markers in skeletal muscle to acute AE and RE. METHODS: In a randomized, cross-over design, six untrained men (27 ± 3 years) completed acute AE (40 min cycling, 70% HRmax) and RE (8 sets, 10 repetitions, 65% 1RM). Muscle biopsies were taken at baseline, and at 1 h and 4 h following each exercise. Western blot analyses were performed to examine total and phosphorylated protein levels. Upstream regulator analyses of skeletal muscle transcriptomics were performed to discern the predicted activation states of mTOR and FOXO3. RESULTS: Compared to AE, acute RE resulted in greater phosphorylation (P < 0.05) of mTOR(Ser2448) at 4 h, S6K1(Thr389) at 1 h, and 4E- B P1(Thr37/46) during the post-exercise period. However, both AE and RE increased m TOR(Ser2448) and S 6K1(Thr389) phosphorylation at 4 h (P < 0.05). Upstream regulator analyses revealed the activation state of mTOR was increased for both AE (z score, 2.617) and RE (z score, 2.789). No changes in LC3BI protein were observed following AE or RE (P > 0.05), however, LC3BII protein was decreased after both AE and RE at 1 h and 4 h (P < 0.05). p62 protein content was also decreased at 4 h following AE and RE (P < 0.05). CONCLUSION: Both acute AE and RE stimulate mTOR signaling and similarly impact select markers of autophagy. These findings indicate the early adaptive response of untrained human skeletal muscle to divergent exercise modes is not likely mediated through large differences in mTOR signaling or autophagy.

The article reflects the most important areas of work and the contribution of scientists of the Department of Economics and Finance of the JSC “VNIIZHT” (now the scientific center “Economics of Complex Projects and Tariff Formation”) in the development of economic science in railway transport since the foundation of the department in 1944 to the present.Theoretical foundations for measuring the economic efficiency of capital investments and new technology in the national economy were created by the head of the department academician T. S. Khachaturov, and then adapted to the conditions of railway transport by the head of the department Dr. Tech. Sci., prof. A. E. Gibshman, head of the sector Dr. Econ. Sci., prof. N. N. Barkov and their followers. Issues of management accounting, analysis, planning of operating costs, calculating the cost of transportation, calculating the unit costs of measuring transport work are central to the research of the department. Under the scientific guidance of Dr. Econ. Sci., prof. A. P. Abramov in this area of research in the department has developed a large scientific school. In the development of scientific areas for economic incentives and increasing labor productivity and financial management, a great contribution was made by Dr. Econ. Sci., prof. M. M. Tolkacheva. Traditional scientific direction for the department of economics is the improvement of pricing for freight and passenger transportation, and other activities. Theoretical research and practical development since the beginning of the 70s of the last century were conducted under the leadership of Dr. Econ. Sci. A. V. Kreinin, and later — the head of the department Dr. Econ. Sci. L. A. Mazo. Since the mid-80s under the direction of Dr. Econ. Sci., prof. O. F. Miroshnichenko, the issues of the economy of passenger transportation stand out in a separate scientific direction, covering high-speed traffic, costs, marketing, tariffs, reforming the passenger complex.At present, the staff of the research center continues to conduct research in the most important areas of the economy of railway transport, which contribute to the increase in the efficiency and competitiveness of Russian Railways in the transport services market.

Clinical workflows in oncology depend on predictive and prognostic biomarkers. However, the growing number of complex biomarkers contributes to costly and delayed decision-making in routine oncology care and treatment. As cancer is expected to rank as the leading cause of death and the single most important barrier to increasing life expectancy in the 21st century, there is a major emphasis on precision medicine, particularly individualisation of treatment through better prediction of patient outcome. Over the past few years, both surgical and pathology specialties have suffered cutbacks and a low uptake of pathology specialists means a solution is required to enable high-throughput screening and personalised treatment in this area to alleviate bottlenecks. Digital imaging in pathology has undergone an exponential period of growth. Deep-learning (DL) platforms for hematoxylin and eosin (H&E) image analysis, with preliminary artificial intelligence (AI)-based grading capabilities of specimens, can evaluate image characteristics which may not be visually apparent to a pathologist and offer new possibilities for better modelling of disease appearance and possibly improve the prediction of disease stage and patient outcome. Although digital pathology and AI are still emerging areas, they are the critical components for advancing personalised medicine. Integration of transcriptomic analysis, clinical information and AI-based image analysis is yet an uncultivated field by which healthcare professionals can make improved treatment decisions in cancer. This short review describes the potential application of integrative AI in offering better detection, quantification, classification, prognosis and prediction of breast and prostate cancer and also highlights the utilisation of machine learning systems in biomarker evaluation.

Ulcerative colitis is a form of inflammatory bowel disease that is characterized by acute and chronic inflammation. The aim of this work was to evaluate the efficacy of hydroethanolic extract of Maesa lanceolata leaves on acetic acid-induced colitis in rats. Colitis was induced by rectal administration of 1 mL of acetic acid (4%) in 25 male rats except the normal control group which received distilled water after 18 h of fasting followed by Ketamine (50 mg/kg)/Valium (10 mg/kg) anesthesia. Five hours later, the normal control and the negative control received distilled water, the positive control received prednisolone (5 mg/kg) and the three test groups received extract at 100, 200 and 400 mg/kg bw for eight days. During treatment, rectal temperature, the number and quality of the stools, and changes in body weight were assessed. At the end of the treatment, the animals were sacrificed, blood, colon, liver and spleen were collected for evaluation of hematological, inflammatory, antioxidant and histological parameters. Rectal temperature and the number of diarrheal, mucus and bloody stools were significantly reduced (P

Introduction Immune checkpoint inhibitors (ICPI) have improved progression-free survival in several solid tumors. Side effects are related to overstimulation of the immune system. Thyroid dysfunction (TD) is the most common endocrine immune-related adverse event of ICPI. Objective To describe the clinical presentation and the course of TD in cancer patients treated with ICPI referred to an endocrinology outpatient clinic. Material and methods This was a descriptive, retrospective and multicenter study of patients with TD associated with ICPI in six Spanish hospitals. Results 120 patients (50.8% women), mean age 60 ± 12 years were included. The initial TD was hypothyroidism in 49% of patients and hyperthyroidism in 51%, with an average of 76 (41–140) and 43 (26–82) days respectively between the onset of ICPI and the analytical alteration. Significantly, the earlier the first analytical determination was, the greater the prevalence of hyperthyroidism. A turnover was observed in 80% of subjects during follow-up, mostly from hyperthyroidism to hypothyroidism. Twenty-one percent received double ICPI therapy. The most frequent form of presentation in monotherapy was hypothyroidism (57%), and in double therapy it was hyperthyroidism (77%) (p = 0.002). Patients under double therapy showed thyroid alterations earlier than those in the monotherapy group (p = 0.001). After a follow-up of 205 (112–360) days, half of the patients continued under levothyroxine treatment. Conclusions Hypothyroidism and hyperthyroidism present in a similar proportion in cancer patients undergoing ICPI therapy. Our results suggest that transitory hyperthyroidism may not be detected in a relevant number of cases. In addition, TD in double therapy presents earlier. This should be taken into account in the follow-up protocols of these patients.

130 p.-4 fig.-23 tab.-Appendix A-D (118-129), The European Commission asked EFSA to update its 2011 risk assessment on hexabromocyclododecanes (HBCDDs) in food. HBCDDs, predominantly mixtures of the stereoisomers a-, b- and c-HBCDD, were widely used additive flame retardants. Concern has been raised because of the occurrence of HBCDDs in the environment, food and in humans. Main targets for toxicity are neurodevelopment, the liver, thyroid hormone homeostasis and the reproductive and immune systems. The CONTAM Panel concluded that the neurodevelopmental effects on behaviour in mice can be considered the critical effects. Based on effects on spontaneous behaviour in mice, the Panel identified a lowest observed adverse effect level (LOAEL) of 0.9 mg/kg body weight (bw) as the Reference Point, corresponding to a body burden of 0.75 mg/kg bw. The chronic intake that would lead to the same body burden in humans was calculated to be 2.35 lg/kg bw per day. The derivation of a health-based guidance value (HBGV) was not considered appropriate. Instead, the margin of exposure (MOE) approach was applied to assess possible health concerns. Over 6,000 analytical results for HBCDDs in food were used to estimate the exposure across dietary surveys and age groups of the European population. The most important contributors to the chronic dietary LB exposure to HBCDDs were fish meat, eggs, livestock meat and poultry. The CONTAM Panel concluded that the resulting MOE values support the conclusion that current dietary exposure to HBCDDs across European countries does not raise a health concern.An exception is breastfed infants with high milk consumption, for which the lowest MOE values may raise a health concern.

Introduction. Amidst a steady increase in hyperplastic processes in uterus and mammary glands, numerous studies have shown that women with dyshormonal pathology of mammary glands had a range of gynecological diseases: external or internal endometriosis, hyperplastic processes of the endometrium and myometrium, polyps, polycystic ovary syndrome (PCOS), etc.Objective. To assess the mammary gland condition in premenopausal women with endometrial hyperplasia during indole-3-car-binol (I3C) therapy.Materials and methods. A total of 42 premenopausal patients aged 45-52 years (48.54 ± 1.83) were enrolled in an open-label prospective study. All patients received I3C 400 mg a day for 12 months. The examination included clinical laboratory, ultrasound imaging and mammographic examination of the mammary glands, cytologic examination of a nipple discharge. The examinations were carried out at the baseline, 6 and 12 months after starting treatment. The study findings were evaluated using descriptive statistics. Differences were considered significant at p Results and discussion. All patients were diagnosed as having mastalgia before starting treatment. Mammary gland ultrasound imaging showed that the frequency of BI-RADS 2 was 9.5 times higher than that of BI-RADS 1 (90.5% and 9.5%, respectively, p Conclusion. Indole-3-carbinol therapy can be assessed as the treatment having an influence on the general components of pathogenesis of endometrial hyperplasia and benign hyperplastic processes in mammary glands. It is advisable to consider the use of indole-3-carbinol combined with antioxidant resveratrol in clinical practice.

Objective. To analyze the relationship between the affective disorders in the form of anxiety and depression and the development of pancreatic cancer and stomach cancer. Today, there is an interest to the relationship between changes in the emotional sphere of patients with malignant neoplasms (MNO) of the pancreas at the early stages of the disease, when there are no other clinically significant symptoms, which allow suspecting the disease at an early stage. Materials and methods. A questionnaire survey was carried out in 63 patients with histologically verified cancer of the pancreas and stomach, who were treated at the FGBU RNTSRKhT named after Acad. A.M. Granov in the period from 2018 to 2020. The survey was conducted using the questionnaire of the European Organization for Research and Treatment of Cancer (EORTC-QLQ-C30 Russian version) and the Hospital Anxiety and Depression Scale (HADS), Russian version. Statistical processing of treatment results was carried out using regression analysis and Mann-Whitney test with the SPSS statistical software package (Statistika 13.0). The probability of error p 0.05 was considered sufficient to conclude that the differences in the data obtained were statistically significant. Results. In a comparative assessment of the indicators of affective disorders in pancreatic cancer patients, there were noted more pronounced affective disorders, such as feeling of depression, feeling of irritation, anxiety and tension, the values of which, according to the results of the analysis of questionnaires, were 1.00 1, 1, 00 1.00 1 and 2.00 1, respectively. In patients with gastric cancer, the values of these affective disorders, according to the survey results, were less pronounced and amounted to 3.00 1.00 1.00, 3.00 1.00, 3.00 1, respectively (p = 0.000). Conclusions. Severe affective disorders, such as anxiety and depression, in patients with pancreatic cancer should be regarded as a factor of the early manifestation of the disease. Further study of this connection can create a theoretical basis for the development of specialized screening programs to identify patients in the risk groups for the development of pancreatic cancer.

We aimed to determine the impact of steroid use in COVID-19 in-hospital mortality, in a retrospective cohort study of the SEMICOVID19 database of admitted patients with SARS-CoV-2 laboratory-confirmed pneumonia from 131 Spanish hospitals. Patients treated with corticosteroids were compared to patients not treated with corticosteroids, and adjusted using a propensity-score for steroid treatment. From March–July 2020, 5.262 (35.26%) were treated with corticosteroids and 9.659 (64.73%) were not. In-hospital mortality overall was 20.50%, it was higher in patients treated with corticosteroids than in controls (28.5% versus 16.2%, OR 2.068 [95% confidence interval, 1.908 to 2.242], p = 0.0001), however, when adjusting by occurrence of ARDS, mortality was significantly lower in the steroid group (43.4% versus 57.6%, OR 0.564 [95% confidence interval, 0.503 to 0.633], p = 0.0001). Moreover, the greater the respiratory failure, the greater the impact on mortality of the steroid treatment. When adjusting these results including the propensity score as a covariate, in-hospital mortality remained significantly lower in the steroid group (OR 0.774 [0.660 to 0.907], p = 0.002). Steroid treatment reduced mortality by 24% relative to no steroid treatment (RRR 0.24). These results support the use of glucocorticoids in COVID-19 in this subgroup of patients.

Background Since the declaration of the pandemic, humanitarian medicine has been discontinued. Until now, there have been no general recommendations on how humanitarian surgical missions should be organized. Methods Based on our experience in the field of humanitarian surgical missions to Sub-Saharan Africa, a panel of recommendations in times of COVID-19 was developed. The fields under study were as follows: (1) Planning of a multidisciplinary project; (2) Organization of the infrastructure; (3) Screening, management and treatment of SARS-COV-2; (4) Diagnostic tests for SARS-COV-2; (5) Surgical priorization and (6) Context of patients during health-care assistance. We applied a risk bias measurement to obtain a consensus among humanitarian health-care providers with experience in this field. Results A total of 94.36% of agreement were reached for the approval of the recommendations. Emergency surgery must be a priority, and elective surgery adapted. For emergency surgery, we established a priority level 1a (

Background Transcatheter aortic valve replacement (TAVR) has become quite common. Atrioventricular conduction defects remain a frequent complication resulting with permanent pacemaker (PPM) implantation. Past studies showed conflicting results regarding PPM effect on mortality. Objective The purpose of this study was to assess the influence of PPM implantation on mid- and long-term mortality in a large cohort of patients who underwent TAVR. Methods Patients undergoing TAVR between 2009 and 2019 were categorized into groups: no PPM implanted (no-PPM), PPM implanted before the procedure (pre-PPM), and PPM implanted postprocedure (post-PPM). All-cause mortality up to 6 years was compared. Subanalyses were performed according to pacing burden. Proportion of patients who had decreased left ventricular ejection fraction within 1 year of the procedure after TAVR was also recorded. Results A total of 1489 patients were followed. Unadjusted mortality was similar for patients regardless of PPM status within 12 months (P > .187), yet within 72 months, mortality was similar for the post-PPM (P = .257) and higher for pre-PPM (hazard ratio 1.53; P = .002) groups. Analysis adjusted by clinical characteristics did not show any independent long- or mid-term survival effects of PPM (P > .563). Analysis according to pacing burden showed no significant mortality difference (P > .8). Analysis of post-PPM patients with “high” or “near constant” (>40%) pacing burden vs no-PPM patients showed similar mortality for both mid- and long-term mortality (P = .055 and P = .513). Left ventricular ejection fraction decrease within 1 year was more common in both PPM groups, with a higher proportion with higher pacing burden (P Conclusion This cohort of consecutive patients undergoing TAVR showed that postprocedure PPM was not associated with increased long-term mortality. This conclusion was not altered by ventricular pacing burden.

Diagnostic efficiency of breast cancer screening remains one of the most important issues in oncology and radiology. Artificial intelligence technologies are widely used in clinical medicine to effectively solve a number of technological and diagnostic problems. The aim. To develop segmentation neural network model for breast plain radiographs analysis with subsequent study of its clinical effectiveness. Materials and methods. The artificial intelligence-based system was developed to analyze X-ray mammography, аnd included a segmentation neural network with the U-Net architecture, a classification neural architecture ResNet50 with outputting the result using gradient boosting. 15486 X-ray cases were used for training, estimation of diagnostic accuracy and validation of the developed segmental model. All cases were labeled in specially developed software environment LabelCMAITech. The segmentation accuracy was determined by Intersection over Union (IoU) similarity coefficient, the probability of malignancy was calculated using the binary classification metrics. Results. The developed system is represented by a segmentation model based on neural network architecture. The model allows, with high accuracy of 0.8176 and higher, at threshold values on the output neurons of the network of 0.1 and 0.15, to localize X-ray findings that have diagnostic value for determining the likelihood of the presence of breast cancer signs in an X-ray mammographic study — focus, architecture distortion, local asymmetry, calcifications. When comparing the results of machine segmentation and marking of images by a radiologist, it was found that the model is not inferior to the doctor in the accuracy of determining the formations, extra-focal calcifications and intraglandular lymph nodes. Conclusion. The results of this study allow considering the model as an intelligent assistant to a radiologist in the analysis of screening mammographic cases.

The present study is a qualitative study with ethnographic techniques that aimed to comprehend the healthcare experiences of deaf persons considering their family, healthcare professionals, and interpreter perspectives. The study included twenty-six deaf persons. The information was collected using semi-structured interviews and focus groups consisting of 5 patients per session (mean) that inquired about experiences and relationships between deaf persons and healthcare professionals. The study identified communication constraints between patients and professionals, preventing the establishment of interpersonal relationships, which limited the development of adequate healthcare. Therefore, it is recommended that the deaf person access an interpreter during healthcare processes to facilitate communication in healthcare services.

The goal. To show the variety of manifestations of non-palpablebreast cancer, which create difficulties in diagnostics and thechoice of treatment tactics, to focus on the need to accelerate theintroduction of the latest organ-saving treatment and diagnostictechnologies and prevention into the system of mammary cancerscreening. The main provisions. The epidemiology of cancer, riskfactors, positive trends in mammary cancer screening in Russia arepresented. A description is given of the diversity of X-ray sonographic and molecular biological manifestations of non-palpable breastcancer based on the results of the analysis of a complex clinicalX-ray sonographic pathomorphological and molecular geneticexamination of 1,212 patients with clinically latent breast diseases,including 708 patients with non-palpable cancer of various molecular subtypes, manifested by a variety of options – a nodulargrowth (40.1%), an accumulation of microcalcifications (17.5%), asite of local heavy rearrangement of the structure (31.2%), canceraccompanied by pathological secretion (6.6%), X-ray negativecancer (4.6%). When distributed by stages, 70.3% had T1N0M0, 25%had TisN0M0 and microinvasive cancer. For differential diagnosis,high-tech radiological techniques were used – 3D X-ray and ultrasound tomosynthesis. Effective preoperative diagnostics allowed foradequate organ-saving treatment, including oncoplastic surgery,high-power radiation therapy and modern targeted drug treatment,timely rehabilitation and prevention. Conclusion. Non-palpablebreast cancer has many faces. Knowledge of the variants of itsmanifestations and the use of modern diagnostic methods arenecessary for mammary cancer screening, which creates thepreconditions for adequate timely organ-saving treatment thatpreserves the life of patients and its quality.

We report the clinical presentation and risk factors for survival in 175 patients with myeloproliferative neoplasms (MPN) and COVID-19, diagnosed between February and June 2020. After a median follow-up of 50 days, mortality was higher than in the general population and reached 48% in myelofibrosis (MF). Univariate analysis, showed a significant relationship between death and age, male gender, decreased lymphocyte counts, need for respiratory support, comorbidities and diagnosis of MF, while no association with essential thrombocythemia (ET), polycythemia vera (PV), and prefibrotic-PMF (pre-PMF) was found. Regarding MPN-directed therapy ongoing at the time of COVID-19 diagnosis, Ruxolitinib (Ruxo) was significantly more frequent in patients who died in comparison with survivors (p=0.006). Conversely, multivariable analysis found no effect of Ruxo alone on mortality, but highlighted an increased risk of death in the 11 out of 45 patients who discontinued treatment. These findings were also confirmed in a propensity score matching analysis. In conclusion, we found a high risk of mortality during COVID-19 infection among MPN patients, especially in MF patients and/or discontinuing Ruxo at COVID-19 diagnosis. These findings call for deeper investigation on the role of Ruxo treatment and its interruption, in affecting mortality in MPN patients with COVID-19.

—A range of foreign studies have shown that, in schizophrenia, hyperhomocysteinemia occurs more frequently than in the general population. Hyperhomocysteinemia may be an integrated marker of folate metabolism disorders (as a result of vitamin deficiency and/or genetic predisposition) or involved in the pathogenesis of the disease through several possible molecular mechanisms. In Russia, similar studies have not been conducted. In addition, there are conflicting results of studies on genetic factors involved in folate and homocysteine metabolism in schizophrenia. The aim of this study was to evaluate an association of serum homocysteine, folate, and cobalamin levels with schizophrenia in the Central part of Russia (Nizhny Novgorod region). For this purpose, 50 patients with schizophrenia and 36 healthy volunteers were randomly selected. The levels of homocysteine, folates and cobalamin (B12) were measured in blood serum. The concentration of homocysteine was measured using the Сobas analyzer (Roche Diagnostics) with an enzymatic assay. The content of folate and vitamin B12 was determined by chemiluminescent microparticle immunoassay (Architect, Abbott lab. S.A). It was found that the level of homocysteine was significantly higher in the patients than in the control group (p = 0.0041), and folate levels were significantly lower (p = 0.0072). The level of homocysteine in the patients had a weak negative statistically significant correlation with both folate level (ρ = –0.38; p = 0.0063) and with B12 level (ρ = –0.36; p = 0.0082). Homocysteine level was significantly higher in men than in women in the entire studied population (Z = –2.1068, p = 0.0351), as well as in subgroups of patients (Z = –2.11; p = 0.035) and healthy controls (z = 3.4; p = 0.00067). The data suggest the need for further investigation of hyperhomocysteinemia and other biochemical markers of folate metabolism disorders in schizophrenia in the Russian population and the development of ways to correct them to optimize the treatment of this mental disorder.

Personalized medicine means the selection of therapy for patients, taking into account the assessment of genetic risk factors for side effects. A number of studies show that folate metabolism disorders, including single nucleotide polymorphisms (SNPs) in the genes of folate-metabolizing enzymes, are more frequently detected in schizophrenic patients than in the general population. The role of SNPs of the key folate cycle enzymes in developing the extrapyramidal side effects of antipsychotics has not yet been studied, although there is evidence of their association with other movement disorders.Objective: to analyze the association between the carriage of SNP alleles of MTHFR 677C>T, MTR 2756A>G, and MTRR 66A>G and the severity of extrapyramidal side effects of antipsychotics in patients with schizophrenia.Patients and methods. The investigation included 61 patients with schizophrenia (according to the criteria for ICD-10 Code F20). All the patients took antipsychotics for at least 7 hospital days were examined using real-time polymerase chain reaction (PCR) with allele-specific primers, followed by detection for the carriage of SNP alleles of MTHFR 677C>T, MTR 2756A>G, and MTRR 66A>G. The standardized Simpson–Angus scale (SAS) was used to evaluate the severity of extrapyramidal symptoms; the PCR test results were unknown during their examination.Results and discussion. In the patients carrying a low-functional 677 T allele in the gene of the key folate cycle enzyme MTHFR, the severity of extrapyramidal side effects of antipsychotics was statistically significantly higher than in the carriers of the wild-type genotype: 13.27±5.10 versus 9.84±6.03 SAS scores, respectively (t=-2.40; p=0.020). In addition, the carriage of the wild allele A of SNP in the MTRR 66A>G gene (F=3.83; p=0.0283; pcorr.=0.043) is associated with the severity of extrapyramidal symptoms. There was a direct moderate correlation of the number of risk alleles at two loci with the total SAS score (r=0.51; p=0.00017).Conclusion. The polymorphic allele of MTHFR 677T and the wild allele of MTRR 66A can be regarded as risk alleles for the development of extrapyramidal side effects of antipsychotics.

Langerhans cell histiocytosis (LCH) is a rare disease with hitherto unknown etiology and pathogenesis. It is extremely rare for clinicians to encounter histiocytic lesions of the central nervous system (CNS); the proportion of cases of which is only 1–4% of all polysystemic and multifocal bone lesions. The paper describes a clinical case of fixation amnesia in a female patient with focal brain lesions in LCH. It depicts the most characteristic clinical features and presents an algorithm for the diagnosis of histiocytic brain lesion. The results of the experimental psychological examination of the patient are considered in detail and the clinical presentations of fixation amnesia are described. There are neuroimaging data showing the lesions in the hypothalamic-pituitary region and temporal bone, which involve the auditory structures. The clinical findings have led to the conclusion that both the clinical and neuroimaging patterns of histiocytic lesions in the CNS are non-specific, which complicates the diagnostic search in LCH. For correct diagnosis and timely treatment, it is necessary to perform a biopsy of the pathological focus, followed by histological and immunohistochemical examination of the material.

101 p.-5 fig.-16 tab., The European Commission asked EFSA to update its previous Opinion on nickel in food and drinking water, taking into account new occurrence data, the updated benchmark dose (BMD) Guidance and newly available scientific information. More than 47,000 analytical results on the occurrence of nickel were used for calculating chronic and acute dietary exposure. An increased incidence of post‐implantation loss in rats was identified as the critical effect for the risk characterisation of chronic oral exposure and a BMDL10 of 1.3 mg Ni/kg body weight (bw) per day was selected as the reference point for the establishment of a tolerable daily intake (TDI) of 13 μg/kg bw. Eczematous flare‐up reactions in the skin elicited in nickel‐sensitised humans, a condition known as systemic contact dermatitis, was identified as the critical effect for the risk characterisation of acute oral exposure. A BMDL could not be derived, and therefore, the lowest‐observed‐adverse‐effect‐level of 4.3 μg Ni/kg bw was selected as the reference point. The margin of exposure (MOE) approach was applied and an MOE of 30 or higher was considered as being indicative of a low health concern. The mean lower bound (LB)/upper bound (UB) chronic dietary exposure was below or at the level of the TDI. The 95th percentile LB/UB chronic dietary exposure was below the TDI in adolescents and in all adult age groups, but generally exceeded the TDI in toddlers and in other children, as well as in infants in some surveys. This may raise a health concern in these young age groups. The MOE values for the mean UB acute dietary exposure and for the 95th percentile UB raises a health concern for nickel‐sensitised individuals. The MOE values for an acute scenario regarding consumption of a glass of water on an empty stomach do not raise a health concern., The Panel wishes to thank the following for the support provided to this scientific output: Elena Rovesti. The Panel wishes to acknowledge all European competent institutions,Member State bodies and other organisations that provided data for this scientific output.

220 p.-4 fig.-37 tab.-15 fig. compl.-16 tab. compl.-2 tab. append., The European Commission asked EFSA for a scientific opinion on the risks for animal and human health related to the presence of chlorinated paraffins in feed and food. The data for experimental animals were reviewed and the CONTAM Panel identified the liver, kidney and thyroid as the target organs for the SCCP and MCCP mixtures tested in repeated dose toxicity studies. Decreased pup survival and subcutaneous haematoma/haemorrhage were also identified as critical effects for an MCCP mixture. For the LCCP mixtures tested, the liver was identified as the target organ. The Panel selected as reference points a BMDL10 of 2.3 mg/kg bw per day for increased incidence of nephritis in male rats, and of 36 mg/kg bw per day for increased relative kidney weights in male and female rats for SCCPs and MCCPs, respectively. For LCCPs, a reference point relevant for humans could not be identified. Due to the limitations in the toxicokinetic and toxicological database, the Panel concluded that derivation of a health-based guidance value was not appropriate. Only limited data on the occurrence of SCCPs and MCCPs in some fish species were submitted to EFSA. No data were submitted for LCCPs. Thus, a robust exposure assessment and consequently a complete risk characterisation could not be performed. A preliminary risk characterisation based only on the consumption of fish was performed, and the calculated margins of exposure suggested no health concern for this limited scenario. The Panel noted that dietary exposure will be higher due to the contribution of CPs from other foods. The Panel was not able to identify reference points for farm animals, horses and companion animals. No occurrence data for feed were submitted to EFSA.Therefore, no risk characterisation could be performed for any of these animal species., The Panel wishes to thank the hearing expert: Kerstin Krätschmer and EFSA staff member: Kelly Niermans for the support provided to this scientific output. The CONTAM Panel acknowledges all European competent institutions and other stakeholders that provided occurrence data in food and human milk and data on the toxicity of CPs, and supported the data collection for the Comprehensive European Food Consumption Database.

150 p.-15 fig.-37 tab., The European Commission asked EFSA to update their 2006 opinion on ochratoxin A (OTA) in food. OTA is produced by fungi of the genus Aspergillus and Penicillium and found as a contaminant in various foods. OTA causes kidney toxicity in different animal species and kidney tumours in rodents. OTA is genotoxic both in vitro and in vivo; however, the mechanisms of genotoxicity are unclear. Direct and indirect genotoxic and non-genotoxic modes of action might each contribute to tumour formation. Since recent studies have raised uncertainty regarding the mode of action for kidney carcinogenicity, it is inappropriate to establish a health-based guidance value (HBGV) and a margin of exposure (MOE) approach was applied. For the characterisation of non-neoplastic effects, a BMDL10 of 4.73 lg/kg body weight (bw) per day was calculated from kidney lesions observed in pigs. For characterisation of neoplastic effects, a BMDL10 of 14.5 lg/kg bw per day was calculated from kidney tumours seen in rats. The estimation of chronic dietary exposure resulted in mean and 95th percentile levels ranging from 0.6 to 17.8 and from 2.4 to 51.7 ng/kg bw per day, respectively. Median OTA exposures in breastfed infants ranged from 1.7 to 2.6 ng/kg bw per day, 95th percentile exposures from 5.6 to 8.5 ng/kg bw per day in average/high breast milk consuming infants, respectively. Comparison of exposures with the BMDL10 based on the non-neoplastic endpoint resulted in MOEs of more than 200 in most consumer groups, indicating a low health concern with the exception of MOEs for high consumers in the younger age groups, indicating a possible health concern. When compared with the BMDL10 based on the neoplastic endpoint, MOEs were lower than 10,000 for almost all exposure scenarios, including breastfed infants. This would indicate a possible health concern if genotoxicity is direct. Uncertainty in this assessment is high and risk may be overestimated.

Pancreatic cancer is the 12th most common malignant neoplasm and the 7th most common cancer related death worldwide. Early diagnosis of pancreatic cancer is complicated, since the disease proceeds for a long time without pronounced clinical symptoms, and the identification and screening of the so-called risk groups of patients is difficult, since the etiology of pancreatic cancer is currently a matter of scientific debate. Early diagnosis of pancreatic cancer can be based on the anamnestic analysis of the psychoemotional status of patients. Back in the early 20th century, based on an analysis of the results of a survey of patients with pancreatic cancer, researchers described a triad of affective signs, including depression, anxiety and a sense of impending death, which worried patients in the early stages of development of the disease. According to literature, the psychiatric symptoms of pancreatic cancer can appear 43 months before the somatic symptoms and occur in more than 50 % of patients. To date, there are a number of concepts in the literature that point to a significant contribution of affective disorders to the development of pancreatic cancer. The aim of this review is to analyze the literature data on the relationship between affective disorders and the development of pancreatic cancer.

The rate of detection of breast cancer by MRI, while other methods of radiological diagnosis are not sufficiently informative, ranges from 5.2 to 26.3 per cent. Suspicious breast tumors of category BI-RADS 4, 5 show morphological image-guided biopsy verification, in particular MRI with contrast. Purpose. To show the possibilities and features of carrying out MRI-guided vacuum breast biopsy, including after aesthetic breast augmentation. Material and methods. A comprehensive X-ray, ultrasound and MRI examination of 54 women aged between 28 and 70 years with different breast tumors was conducted. Of these, five were detected only by breast MRI with contrast, and were morphologically verified by MRI-guided vacuum aspiration biopsy. Results. 14 of the 54 patients with breast mass were diagnosed with breast cancer and 26 were diagnosed with benign diseases. The effectiveness of comprehensive examination and low-invasive high-tech MRI-guided procedures in early refined screening for breast cancer, including after aesthetic breast augmentation, has been demonstrated. MRI-guided vacuum-assisted breast biopsy is a fast, safe and accurate diagnostic method of morphological verification of suspicious breast tumors that do not have X-ray and ultrasound.

The aim of this study was to investigate the effect of a probiotic in preventing infections after third molar surgery. Thirty-eight patients were consecutively enrolled to a double-blind randomised placebo-controlled trial. Patients were asked to take one tablet two times a day containing a mixture of Levilactobacillus brevis CECT7480 (KABP-052) and Lactoplantibacillus plantarum CECT7481 (KABP-051) or placebo for the first post-intervention week. The primary outcome was the postoperative infection rate. Secondary outcomes included swelling, eating difficulties and postoperative pain recorded by the patient using a visual analogue scale (VAS) during the first postoperative week. No statistically significant difference in the infection rate between the groups was found; with only three cases of infections reported (one in the probiotic group and two in the placebo group) on the first week. Compared to placebo, treatment with the probiotic showed a significantly higher reduction in pain and eating difficulties scores at 5, 6 and 7 days post-surgery. Swelling values were not significantly different between the groups at any time point. The findings of this pilot study justify a larger study to clarify the possible role of these bacterial strains on the post-operative pain management following third molar surgery.

espanolLa anemia ferropenica (AF) es el trastorno carencial mas frecuente y supone, en los paises en desarrollo, el 2-28% de la poblacion. Constituye una de las consultas mas frecuentes en la practica clinica. En Espana, la prevalencia es mayor en mujeres menores de 50 anos (14,8%) y en la poblacion menor de 3 anos (4,3-5,7%). Para la evaluacion de un paciente con ferropenia, lo mas importante es identificar y tratar la causa subyacente. Dentro de las opciones de tratamiento existen compuestos orales que son una opcion segura, barata y eficaz y las formulaciones intravenosas estan indicadas para el tratamiento de la AF cuando los preparados orales no son adecuados o es clinicamente necesario un aporte rapido del mismo. EnglishIron deficiency anemia (IDA) is the most frequent nutritional disorder and can be found in 2–28% of the population in developing countries. It is one of the most frequent causes for consultation in clinical practice. In Spain, its prevalence is greater in women under 50 years of age (14.8%) and in those under 3 years of age (4.3–5.7%). In the evaluation of a patient with iron deficiency, the most important aspect is to identify and treat the underlying cause. Treatment options include oral compounds, which are a safe, economical, and effective option. Intravenous formulas are indicated for treatment of IDA when oral preparations are not adequate or when rapid supplementation is clinically necessary.

espanolLas anemias carenciales, en especial la anemia por deficit de hierro, representan un problema global de salud y es una de las consultas mas frecuentes en la practica clinica diaria. El hierro, la vitamina B12 y el acido folico intervienen en muchos procesos fisiologicos, por lo que su deficit conlleva otras complicaciones ademas de la anemia. Es importante conocer las herramientas de las que disponemos para su diagnostico, asi como su etiologia para establecer un tratamiento optimo. Sin embargo, la anemia de trastorno cronico es la mas frecuente en pacientes hospitalizados o con patologia cronica. Su etiologia es mas compleja, ya que suelen ser pacientes ancianos en los que, ademas de posibles deficits nutricionales, tambien hay que tener en cuenta la insuficiencia renal cronica, los procesos inflamatorios o infecciosos y las neoplasias. Su manejo a veces es multidisciplinar y depende de su magnitud, de las posibles causas y de las comorbilidades del paciente. EnglishNutritional anemias, especially iron deficiency anemias, are a global health problem and one of the most frequent causes for consultation in daily clinical practice. Iron, vitamin B12, and folic acid intervene in many physiological processes and as such, a deficiency in them entails other complications in addition to anemia. It is important to know the tools we have available for diagnosis as well as the etiology in order to establish optimal treatment. However, anemia of chronic disease is the most frequent anemia found in hospitalized patients or those with chronic pathologies. Its etiology is more complex, as it tends to occur in elderly patients in which, in addition to possible nutritional deficits, we also have to take into account chronic kidney disease, inflammatory or infectious processes, and neoplasms. Its management is sometimes multidisciplinary and depends on the magnitude and possible causes of the anemia and the patient's comorbidities.

El artículo muestra los resultados y conclusiones de una investigación de la Corporación Universitaria Minuto de Dios Antioquia Chocó Colombia en el 2018, en instituciones de educación superior, ubicadas en el Valle de Aburrá, Medellín, Colombia, estudio en el cual se observó la aplicación de la lúdica como estrategia de enseñanza, el rol de los docentes con el uso del software educativo y la aplicación de juegos gerenciales, programas informáticos didácticos apoyados en las TIC, una nueva propuesta, para la formación de competencias del campo profesional. La metodología se orientó a un enfoque cuantitativo de tipo inductivo. Para la discusión de los resultados, los hallazgos se cruzaron entre sí y luego, se trianguló esta información con los conceptos de los autores convocados. Se llegó a la conclusión que, la parte actitudinal y las competencias de los docentes, la dotación de software y las estrategias lúdicas, son factores que influyen positivamente la formación y aprendizaje de los estudiantes. Todo esto conlleva, a ofrecer al mercado laboral un profesional bien capacitado y apto para un mejor desempeño en el nicho de acción.

GOAL The aim of this study was to assess the efficacy of probiotic i3.1 in improving lactose intolerance symptoms compared with placebo after 8 weeks of treatment. BACKGROUND Probiotics are promising strategies to prevent and improve lactose intolerance symptoms, but previous studies have provided conflicting results. MATERIALS AND METHODS This randomized, prospective, placebo-controlled study was conducted at the Hospital Juarez de Mexico. We recruited adult patients with lactose intolerance confirmed by a lactose hydrogen breath test (LHBT) ≥20 parts per million (ppm) and a lactose intolerance symptom score ≥6 both upon lactose challenge. We compared the change from baseline in the scores of a validated symptom questionnaire and the LHBT after 8 weeks of probiotic or placebo treatment. RESULTS We included 48 patients: 33 receiving the probiotic and 15 receiving placebo (2:1 randomization). Demographic characteristics were homogeneous between groups. The reduction in total symptom score after a lactose challenge was significantly higher in the probiotic group versus the placebo group (-5.11 vs. -1.00; P

Resumo Com base nos pressupostos teóricos de Norbert Elias, objetivou-se compreender as figurações da equoterapia no Rio Grande do Sul no período demarcado entre 1970 e 2000. Para tanto, o corpus documental da pesquisa foi composto por documentos oficiais, jornais e revistas. A partir do conceito de figuração, a documentação analisada evidenciou elementos técnico-científicos, acoplados às áreas da saúde, educação e equitação, provenientes do hipismo e compartilhados na prática da equoterapia. As inter-relações estabelecidas entre essas áreas possibilitaram que tal prática congregasse atributos e representações emanadas do cenário hípico. Assim, constituíram-se outras figurações no campo da equoterapia, envolvendo relações entre entidades que congregavam militares e civis. Abstract Based on the theoretical assumptions of Norbert Elias, we sought to understand the figurations of equine-assisted therapy in Rio Grande do Sul from 1970 to 2000. To this end, the research corpus consisted of official documents, newspapers and magazines. Based on the concept of figuration, the documentation analyzed demonstrated technical-scientific elements linked to the fields of healthcare, education and horseback riding, coming from equestrianism and shared in the practice of equine-assisted therapy. The interrelations established between these different areas allowed the practice to take on attributes and representations emanating from the equestrian world. Thus, other figurations were developed in the field of equine-assisted therapy involving relationships between military and civil entities.

Background: The hydrographic network of the basins of the department of Quindio, located in Colombia, South America, suffers from pollution due to industries such as tanneries, mining, food processing, among others. Goals: Represent a hydrographic network of a basin employing a graph and study its most representative measures of centrality; as a case study, we considered the hydrologic network of the basins of the department of Quindio. Methods: The theory of networks and the analysis of centrality measures such as degree distribution, PageRank, and eccentricity; also, topological measures such as density and assortativity. Results: The study provided a different approach to research on the properties of river networks. The grade distribution shows a network with input grades of one, two, and three, while the output grade is only one or zero, consistent with a typical mountain basin. Measurements such as density and assortativity showed a low-density network with no defined connection patterns. The centrality of PageRank and eccentricity highlighted the leading causes and the most important rivers according to the way the hydrographic network is connected. Conclusions: The study concluded that by using network theory, we obtained a global vision of the network, understanding its structure and allowing us to visualize which areas of the network are vulnerable. PageRank’s centrality allowed us to identify well-monitored nodes in the network and those that need care; this same distribution highlighted zones in the network that are more prone to contamination. Finally, the eccentricity determined the center of the network (sector of “La Maria”) as one of the network’s most vulnerable areas.

Background. Although severe pneumonia and respiratory compromise have remained the predominant complications of coronavirus disease 19, we are now learning this virus is much more varied in its presentation. In particular, there are increasingly reported cases of thromboembolic events occurring in infected patients. Case Report. In this report, we present two patients, both under the age of 40 with known risk factors for venous thromboembolism, who presented with respiratory distress. Both patients were diagnosed with SARS-CoV-2 pneumonia and pulmonary embolism requiring management with anticoagulation. Both patients were discharged after a short course in the hospital. Conclusion. The discussion of a hypercoagulable state induced by coronavirus disease 19 has been well documented; however, the exact mechanisms remain unknown. We suspect that a prothrombotic inflammatory response provoked by coronavirus disease could be the culprit, acting as an additive effect on middle-aged patients with known risk factors for venous thromboembolism. We recommend clinicians closely monitor those with known risk factors for pulmonary embolism.

Introduction: The falls are associated with morbidity and mortality in the elderly. Numerous of functional mobility clinical tests have been created to identify older adults with potential for risk of falls. Objective: The purpose of this systematic review was to determine the predictive validity of functional mobility tests to predict the risk of falls in community-dwelling elderly. Method: Articles in English were searching in MEDLINE, SCOPUS and CINAHL. We found 18,520 documents and, after applying the inclusion and exclusion criteria, 11 articles were part of the final analysis. All articles analyzed included subjects over 60 years old. Results: The results showed that the TUG Test has good discriminative validity for elderly non-institutionalized, but it does not provide an adequate predictive validity. The TUG Test may not be enough as a unique basic screening tool to detect the risk of elderlies´ falling. Conclusion: It is suggested that the TUG Test should be used in combination with other predictors of falling risk tools or should it be reconfigured for the different levels of elderly physical active functionality.

One of the many negative consequences of the COVID-19 pandemic is the “secondary epidemic” of negative psychological effectsThe aim of the study was to identify socio-psychological factors associated with adaptive behavior in the population.Materials and methods: an on-line survey of 1957 Russian-speaking respondents over 18 years old was performed from 30.03.2020 to 05.04.2020. The level of anxiety distress was verified with the psychological stress scale (PSM-25). Dispersion analyses were used (pResults: Increased levels of psychological stress were associated with self-isolation (SE=0.13), social distanc- ing (SE=0.14) and antiseptic usage (SE=0.11). The scores of psychological stress were higher in individuals who search the media for coronavirus news more than once or twice a day (SE=0.11). At the same time, the fre- quency of requests for information about COVID-19 was not linearly associated to the individuals fears for their own lives. The concerns about the availability of protective equipment were specifically associated to compliance with self-isolation measures (SE=0.1). The combination of concerns about the contagiousness of the virus and the unavailability of medication for daily intake were associated with the principles of social distance (SE=0.12 and SE=0.11 respectively). Moreover, concerns about the lack of specific treatment for COVID-19, the danger to one’s own life, the contagiousness of the virus and the lack of protective equipment were associated with the protective behaviours related to hand hygiene (SE=0.12, SE=0.12, SE=0.11, SE=0.11 respectively). Wearing a mask was characterized by the same anxiety patterns as hand hygiene, but their association was inverse (respectively SE=0.13, SE=0.12, SE=0.14, SE=0.15). The most common type of anxious experience—fear for the health of relatives—was not specifically associated with certain types of behavior and accompanied each of its variants.Conclusion: Psychological reactions of the population to the COVID-19 pandemic are specifically associated with adaptive behavior in the dynamics of anti-epidemic measures.

Aim. Assessment if the interrelation of the levels of selenium, parameters of heart rate variability (HRV), biochemical and rheological characteristics of blood in patients with Q-myocardial infarction (Q-MI) taking standard medicinal therapy and dietary correction with organic selenium in different stages of the disease. Materials and Methods. An open comparative clinical study was conducted with involvement of 90 patients (the average age 58.31.4, of them 71 men and 19 women) diagnosed with acute coronary syndrome with elevation of Q-segment with outcome into Q-MI. The patients were divided to two comparable groups: control group that received standard therapy, and the main group that additionally received dietary product enriched with organic selenium. In acute, subacute and cicatrization stages, the dynamic series of RR intervals were recorded and mathematically analyzed on Varicard 2.51 complex, some biochemical parameters of blood, selenium status, rheological properties of blood were assessed. Results. In the stage of hospital treatment, reduction of the heart rate (from 68.81.7 to 64.01.3 beat/min; p0.05) was recorded in the main group. The initial level of SDNN in both groups was within the critical range (25.01.3 msec), and stress index (SI) several time exceeded the norm (1356.2390.6 conv.un.); by the end of the observation both parameters did not achieve normal values in both groups. The coefficient of variation (CV) stayed below normal values throughout the whole treatment period, although in the dynamics it showed some tendency to growth. The spectrum power of the curve enveloping the dynamic series of RR intervals (HF) almost twice increased in the control group (р0.05). Correlation analysis of the interrelation of biochemical parameters of blood, coagulogram and selenium of blood serum with different parameters of mathematical analysis of the heart rhythm revealed interrelations of different levels and direction. Conclusion. Use of dietary product rich in selenium having a positive effect on the trophotropic functions of an organism, in complex with standard therapy, reduces tension of adaptation mechanisms and enhances adaptation potential of an organism that improves the prognosis and reduces risks.