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Objectives: Hypertension is a leading cause of death and disease burden followed by dyslipidemia. Their asymptomatic nature leads to low adherence and persistence to treatments. A systematic literature review (SLR) investigated the impact of single-pill-combinations (SPC) compared to free-equivalent combination (FEC) on adherence, persistence, clinical outcomes, healthcare resource utilization (HCRU), and patient-reported outcomes, in patients with hypertension, dyslipidemia, or both. Methods: MEDLINE, MEDLINE-IN-PROCESS, Embase, and Cochrane were searched from inception until 11 May 2021, for studies comparing SPC against FEC in patients with hypertension and/or dyslipidemia. Patient characteristics, study design, therapies, measures of adherence or persistence, clinical outcomes, and follow-up were extracted. Results: Among 52 studies identified in the SLR, 27 (n = 346,030 patients) were included in the meta-analysis. SPCs were associated with significantly improved adherence compared with FEC, as assessed through medication-possession-ratio ≥80% (odds ratio (OR) 0.42, p < 0.01) and proportion of days covered ≥80% (OR 0.45, p < 0.01). SPC also improved persistence (OR 0.44, p < 0.01) and systolic blood pressure (SBP) reduction (mean difference −1.50, p < 0.01) compared with the FEC. Conclusions: SPC use resulted in significantly improved adherence, persistence, and SBP levels compared with FEC in patients with hypertension. The findings support SPC use in reducing the burden of hypertension and dyslipidemia. Plain Language Summary: High blood pressure is a leading cause of death and disease burden followed by high lipid levels in the blood. Due to the silent nature of the diseases, patients can fall short of optimal medical treatment adherence and persistence, leading to poor outcomes and disease complications. Simplification of the treatment regimen can be achieved using SPC therapies. The study was conducted to look for published studies that compared the use of SPC with FEC in patients with high blood pressure, high lipid levels in the blood, or both. The researchers were able to find 52 already published studies, of which, 27 studies reported adherence, persistence, and SBP reduction which were included in the data analysis. Researchers found SPCs to be associated with much greater improved adherence and persistence and a higher reduction in SBP when compared with FEC in high blood pressure patients. These findings support SPC use in reducing the burden of high blood pressure and high lipid levels in the blood. [ABSTRACT FROM AUTHOR]

Discrimination as a phenomenon has an adverse effect on society and produces prejudice and negative views about a certain situation, which makes diversity seem more like a problem than a strength. The primary objective of this research project is to evaluate (a) the relationship between a respondent’s ancestry and discrimination categories, and (b) the association between discrimination based on gender, age and nationality with health and happiness. The main results stem from descriptive statistical operations and regression analysis of the tenth round of European Social Survey (ESS) data regarding the Republic of North Macedonia, Montenegro and Serbia. Our analysis shows that happiness is more stable and predictive measure when it comes to social indicators analysis. Health is also impacted more by other social and environmental indicators, such as genetic predisposition, pollution, hospital conditions, doctors’ qualifications, and stress. Roma are the most vulnerable category among all categories of discrimination in the three countries under investigation. [ABSTRACT FROM AUTHOR]

We present a two-step physical method for the fabrication of composite nanoparticle-based nanostructures. The proposed method is based on the pulsed laser deposition (PLD) technique performed sequentially in vacuum and in air. As a first step, thin-alloyed films of iron with noble metal were deposited by PLD in vacuum. The films were prepared by ablation of a mosaic target formed by equal iron and gold sectors. As a second step, the as-prepared alloyed films were ablated in air at atmospheric pressure as the laser beam scanned their surface. Two sets of experiments were performed in the second step, namely, by applying nanosecond (ns) and picosecond (ps) laser pulses for ablation. The structure, microstructure, morphology, and optical properties of the samples obtained were studied with respect to the laser ablation regime applied. The implementation of the ablation process in open air resulted in the formation of nanoparticle and/or nanoparticle aggregates in the plasma plume regardless of the ablation regime applied. These nanoparticles and/or nanoaggregates deposited on the substrate formed a complex porous structure. It was found that ablating FeAu films in air by ns pulses resulted in the fabrication of alloyed nanoparticles, while ablation by ps laser pulses results in separation of the metals in the alloy and further oxidation of Fe. In the latter case, the as-deposited structures also contain core–shell type nanoparticles, with the shell consisting of Fe-oxide phase. The obtained structures, regardless of the ablation regime applied, demonstrate a red-shifted plasmon resonance with respect to the plasmon resonance of pure Au nanoparticles. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is a relatively new method of inguinal hernia surgical repair that, at theory, provides a good view of the inguinal anatomy and sac contents and, as a laparoscopic procedure, is considered less invasive and with fewer complications compared to total extraperitoneal (TEP) inguinal hernia repair. Purpose: This study aims to assess the short-term outcome of laparoscopic transabdominal preperitoneal inguinal hernia (TAPP) repair. Material and methods: The retrospective clinical data for 138 patients with unilateral and bilateral hernia, operated in the Department of General, Visceral, and Emergency Surgery of the University Emergency Medicine Hospital 'N. Pirogov' from 01 January 2022, to 01 January 2023, were included. The risk profile of the patients, the intraoperative and postoperative complications, the duration of hospital stay, the frequency, and the type of analgesics used were analyzed. Results: Forty-one women (29.7%) were included; men comprised 97 (70.29%) of the cohort. Of the selected group, 63 (45.7%) patients had indirect inguinal hernias, 34 (24.6%), and 25 (18.1%) were diagnosed with direct inguinal hernia and accreta inguinal hernia, respectively. A history of repeatedly occurring hernias was found in 16 patients (11.6%). The average hospital stay was 32 hours (or 1.3 days) and ranged from 24 hours (1 day) to 48 hours (2 days). Complications occurred in 11 (7.97%) patients. The need for analgesics and anti-inflammatory agents was reliably reduced compared to the patients undergoing conventional surgical treatment of inguinal hernia. The patients were followed for three months post-discharge for the occurrence of surgical morbidity associated with the TAPP hernia repair. None of the patients used an antimicrobial agent, as indicated by a possible complicating bacterial infection. Rehabilitation was started within the first 12 hours after the operation, thus contributing to a significantly shorter hospital stay compared to patients undergoing conventional surgical repair of an inguinal hernia. Conclusion: Our results demonstrate that TAPP inguinal hernia repair is a safe procedure with reduced postoperative pain. It has fewer complications, with no significantly longer operative time and a shorter overall hospital stay [ABSTRACT FROM AUTHOR]

Anxiety conditions and disorders are common in the general population, and patients suffering from them often seek the services of emergency departments. Anxiety is a psychopathological symptom that accompanies not only psychiatric conditions, but a wide range of somatic diseases, and a combination of both. The biochemical and pathophysiological mechanisms of psychosomatic interrelationship and comorbidity are complex and multi-layered. Thus, diagnosing the root cause of anxiety is a clinical challenge. Early, and on time, recognition of an anxiety disorder helps to avoid unnecessary investigations, ensures correct treatment and saves hospital resources. Careful use of medications, psychoeducation and referral to a specialist improves patient outcome with this potentially debilitating disease. In this article, the authors aim to present in a synthesized form the main epidemiological data on the prevalence of anxiety symptoms and disorders, anatomical localization and biochemical mechanisms and relationships in the pathogenesis of anxiety symptoms, as well as to derive the main guidelines for recognizing and differentiating clinicopathological constellations in somatic conditions in emergency medical practice. Materials and methods. Existing published studies from an international database, related to the subject of the article, have been thoroughly studied. Results. Anxiety symptoms, in particular panic attacks and disorders, are widespread in primary care and occupy a significant part of the work process, especially at times of peak loads, natural disasters and situations of mass traumatism. Conclusions. Timely training and good preparation for recognition and adequate assessment of anxiety conditions in primary and emergency medical care significantly shorten the therapeutic route of patients. They receive competent help on time, and the cost of their treatment is significantly reduced. Discussion. Modern medical science, including psychiatric, offers advanced drug and non-drug methods for the treatment and prevention of anxiety conditions and disorders. [ABSTRACT FROM AUTHOR]

We aimed to summarize evidence on the effect of poor medication adherence on clinical outcomes and health resource utilization (HRU) among patients with hypertension and/or dyslipidemia. A systematic review of studies reporting clinical outcomes and HRU for patients by status of adherence to antihypertensives and/or lipid-lowering medications was searched using Embase, MEDLINE, and MEDLINE In-Process and supplemented by manual searches of conference abstracts. In total, 45 studies were included, with most being retrospective observational studies (n = 36). Patients with poor adherence to antihypertensives and lipid-lowering medications compared with those with good adherence showed less reduction of blood pressure (BP) and low-density lipoprotein cholesterol (LDL-c) after 6–12 months follow-up (∆ systolic BP: 1.2 vs. −4.5 mmHg; ∆LDL-c: −14.0 to −18.9 vs. −34.1 to −42.0 mg/dL). Poor adherence was also significantly associated with a higher risk of cardiovascular events (HR: 1.1–1.9) and mortality (HR: 1.4–1.8) in patients with hypertension and dyslipidemia and increased HRU (i.e. outpatient visits, risk of cardiovascular-related and all-cause hospitalization, annual inpatient days, total health-care costs). Poor adherence is associated with poor clinical outcomes and increased HRU, highlighting the need to enhance medication adherence in patients with hypertension and/or dyslipidemia. High blood pressure is a leading cause of death and disease burden followed by high lipid levels in blood. Due to the silent nature of the diseases, patients can fall short of optimal medicinal treatment adherence and persistence, leading to poor outcomes and disease complications. The effectiveness of medicinal interventions depends on the appropriate medication-taking behavior of patients as lower adherence can lead to poor treatment benefits. Research was conducted to look for published studies that assessed the effect of lower medication adherence on clinical outcomes and health resource use among patients with high blood pressure, high lipid levels in blood, or both. Researchers were able to find 45 already published studies, from which 32 evaluated the use of blood pressure lowering medications and 7 evaluated the use of lipid-lowering medications, while 6 included patients treated with both types of medications. Refill of pharmacy prescription records was the most common method of assessing treatment adherence. Researchers found that patients with lower adherence to these medications compared with those with good adherence showed less decrease in blood pressure levels and less improvement in blood lipid levels after 6–12 months of follow-up. Patients who had lower adherence also had higher rates of cardiovascular events and deaths and increased usage of health services including visits to outpatient clinics, getting admitted to hospitals, and a longer stay of hospitalizations, leading to a higher overall healthcare cost. These findings suggest lower adherence is associated with poor clinical outcomes and increased health-care resource usage, highlighting the need to improve medication adherence in patients with high blood pressure and high lipid levels in blood. [ABSTRACT FROM AUTHOR]

The applications of Raman spectroscopy have been limited by the presence of the fluorescence emitted by some samples. This interference can be depressed by shifting the excitation source used in Raman spectroscopy to the high‐energetic ultraviolet (UV) or deep ultraviolet (DUV) ranges. Plasmon resonance of aluminum (Al) nanostructures can play an important role in surface‐enhanced Raman spectroscopy (SERS) of fluorescence samples. Al active nanostructures have been produced for the first time on the aluminum nitride (AlN) substrates by nanosecond (ns) laser pulses or on fused silica by direct picosecond (ps) laser deposition. The efficiency of the Al active nanostructures produced on AlN for 355 nm SERS was simulated using the finite difference time domain (FDTD) method. The ability of using the Al active nanostructures has been proven for the first time to study rhodamine 6G (R6G) and methylene blue (MB) as probe fluorescing molecules for 355 nm SERS. The SERS spectra at different conditions have also been achieved. [ABSTRACT FROM AUTHOR]

Background and objectives: Multiple reforms aimed at improving the Chinese population's health have been introduced in recent years, including several designed to improve access to innovative drugs. We sought to review current factors affecting access to innovative drugs in China and to anticipate future trends. Methods: Targeted reviews of published literature and statistics on the Chinese healthcare system, medical insurance and reimbursement processes were conducted, as well as interviews with five Chinese experts involved in the reimbursement of innovative drugs. Results: Drug reimbursement in China is becoming increasingly centralized due to the removal of provincial pathways, the establishment of the National Healthcare Security Administration and the implementation of the National Reimbursement Drug List (NRDL), which is now the main route for drug reimbursement in China. There is also an increasing number of other channels via which patients may access innovative treatments, including various types of commercial insurance and special access. Health technology assessment (HTA) and health economic evidence are becoming pivotal elements of the NRDL decision-making process. Alongside the optimization of HTA decision making, innovative risk-sharing agreements are anticipated to be increasingly leveraged in the future to optimize access to highly specialized technologies and encourage innovation while safeguarding limited healthcare funds. Conclusions: Drug public reimbursement in China continues to align more closely with approaches widely used in Europe in terms of HTA, health economics and pricing. Centralization of decision-making processes for public reimbursement of innovative drugs allows consistency in assessment and access, which optimizes the improvement of the Chinese population's health. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to identify risk factors associated with the development of pulmonary arterial hypertension (PAH) in patients with systemic lupus erythematosus (SLE). Methods: We conducted a systematic literature review of studies focusing on adult patients classified as having SLE‐related PAH by searching the electronic databases Embase, Medline, Medline in‐progress, Wanfang, China National Knowledge Infrastructure, Ichushi Web, Kmbase, and KoreaMed. Based on the findings, we conducted a Delphi survey to build expert consensus on issues related to screening for PAH in patients with SLE and on the importance and feasibility of measuring the identified factors in clinical practice. Results: We included 21 eligible studies for data synthesis. Sixteen factors were associated with an increased risk of SLE‐PAH: pericardial effusion, serositis, longer duration of SLE, arthritis, acute and subacute cutaneous lupus, scleroderma pattern on nailfold capillaroscopy, diffusion capacity of carbon monoxide in the lungs (DLCO) <70% predicted, interstitial lung disease, thrombocytopenia, and seven serological factors. Six factors were associated with a decreased risk of SLE‐PAH: malar/acute rash, hematologic disorder, renal disorder, higher Systemic Lupus Erythematosus Disease Activity Index score, and two serological factors. Among these, there were six risk factors on which the panelists reached strong or general consensus (peak tricuspid regurgitation velocity on echocardiography >2.8 m/s, pericardial effusion, DLCO <70% predicted, scleroderma pattern on nailfold capillaroscopy, brain natriuretic peptide >50 ng/l, and N‐terminal pro–brain natriuretic peptide >300 ng/l). The Delphi panel confirmed the need for a screening tool to identify patients with SLE at high risk of developing PAH and provided consensus on the importance and/or practicality of measuring the identified factors. Conclusion: The risk factors we identified could be used in a screening algorithm to identify patients with SLE with a high risk of developing PAH to facilitate early diagnosis, which could improve prognosis and management of these patients. [ABSTRACT FROM AUTHOR]

Purpose: The study aims to assess the current outcomes and complications of laparoscopic ventral hernia repair using intraperitoneal onlay mesh with defect closure (IPOM PLUS) technique by use of dual-sided synthetic mesh. Material and methods: Retrospectively clinical data for 27 patients with umbilical, paraumbilical, incisional, ventral, and primary hernia, operated in the Department of General, Visceral and Emergency Surgery “Pirogov” from 01.06.2022 to 01.06. 2022 was analyzed. The diagnosis was based on history, physical examination(mainly), ultrasound, and CT. Of the hospitalized, women were 16 (59.26%) men 11 (40.74%). Results: Of the selected group, 13 patients had umbilical defects, 3 with an epigastric hernia, 7 with a paraumbilical hernia, and 4 with incisional defects. Adhesiolysis was needed in 18 cases, while others were performed straight with hernia closure. The operating time varied between 49 and 127 minutes (average 57.4 minutes). The hospital stay ranged from 1 day to 4 days (average 1.7 days). We had noticed complications in three of the cases (11.11%). Conclusion: IPOM PLUS repair is safe, practicable, and advantageous over a standard IPOM or open repair as reported in the literature. Accordingly, we prefer this approach with the closure of the fascial defect first while repairing ventral abdominal wall hernias. [ABSTRACT FROM AUTHOR]

Introduction: Acute cholecystitis is the second most common non-obstetric surgical disease during pregnancy. There have been several trials comparing operative and non-operative management in the past. Purpose: To present a clinical case from our practice and to compare clinical management with worldwide standards. Materials and methods: A 42-year-old patient in the 20th gestational week presented to our department with complaints of pain in the epigastrium and RUQ, as well as a single incidence of vomiting, during the last two days. Results: We operated 15 h after admission and did a standard laparoscopy. The patient was discharged on the 4th postoperative day. Conclusion: A review of the available literature shows the prevalence of early laparoscopic cholecystectomy, while non-operative management has proven to have higher complication rates. Laparoscopic surgery in pregnancy has proven to be safe for both mother and fetus. In our case, the patient was operated on within the first 24 hours of admission. We did not observe any complications during her stay and follow-up. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) is still a major medical concern. Patients who have recovered from the infection from COVID-19 face the ordeal of post-covid syndrome. In these patients, there is a decrease in physical abilities, in particular musculoskeletal complications and post-traumatic stress, depression and chronic fatigue, which impair their quality of life. This necessitates long-term rehabilitation, which supports recovery after hospitalization. Treatment through movement is part of the rehabilitation measures contributing to the functional recovery of patients with post-covid syndrome. To study how the functional capabilities of these patients improve and how their quality of life is affected, we created a set of physical exercises to be performed at home for 6 months. At baseline and at the end of the study, patients completed the SF-36 quality of life questionnaire. The aim of the study was to track the changes in the quality of life of patients with post-covid syndrome by influencing their functional state. Our study found a decline in the quality of life of the examined patients. After the application of the kinesitherapy program, the functional status of the patients improved, their functional independence was optimized, which contributed to the improvement of the quality of life of the post-covid patients syndrome. [ABSTRACT FROM AUTHOR]

Acquired (adaptive) immunity is a major factor determining effective immune response against a few infectious diseases. The immune response during recovery from COVID-19 is complex, involving both cellular and humoral adaptive immunity. The purpose of the study is to determine the intensity and effectiveness of the immune response at the end of the second year after discharge from the hospital in patients who have suffered from moderate and severe forms of coronavirus infection. A study among 2683 patients who suffered from moderately severe and severe coronavirus SARS-CoV2 infection with recorded complications which have not received a vaccine against SARS-nCoV-2 was performed. In the studied group of patients there were no deaths. In the whole cohort, the share of underlying prehospital comorbidity was also analyzed. The immune response induced because of moderate and severe infection with COVID-19 could serve as source of protection from recurrent severe infection for patents of different ages with various comorbidities. [ABSTRACT FROM AUTHOR]