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This article provides a general overview of the pathway to become an intensivist in the United States of America (USA). It begins with a detailed description of the current structure of critical care training in the USA and the application process to fellowship training programs. There is then a presentation of the general structure of critical care units within the USA and how intensive care unit physicians fit into it. The article concludes with a discussion of how American critical care fits globally within international critical care societies.

Objective: The aim of this study is to evaluate the effectiveness of radiation safety training developed for nurses working in intensive care units (ICUs). Materials and Methods: This study was carried out on a total of 144 nurses working in the neonatal and pediatric ICUs of two different hospitals. The radiation safety training developed for the nurses of the ICU for the nurses in the training group (n=62) was given face-to-face in 7 sessions in groups of 8-10 people. The data were collected through the descriptive information form and the radiation safety information form, as well as the observations made by the researcher. Results: As a result of the observations, the development of protective behaviors against ionized radiation of the nurses in the training group increased significantly both compared to the control group and pre-training case (p

Objective: The purposes of our study were to determine the relationship between coronavirus disease (COVID) pneumonia and mortality and immunization status of patients and to present our first extracorporeal membrane oxygenation (ECMO) experiences by retrospectively evaluating pregnant women. Materials and Methods: The research was conducted by screening the files of 37 pregnant/postpartum COVID-2019 cases monitored and treated in the intensive care unit between March 1, 2020 and December 1, 2021. The patients’ ages, systemic comorbidities, vaccination details, and clinical and laboratory features were recorded and analyzed. The patients were divided into two groups as survivors (group 1; n=17) and exitus ones (group 2; n=20); and the results were compared statistically. Results: Of 37 patients, 17 (45.9%) survived (group 1) and 20 (54.1%) died (group 2) with a median of 31 gestational weeks and 9 days length of stay in the ICU. ICU admission time [which day of polymerase chain reaction (PCR)+] and cesarean time (which day of PCR+) were 8 days. Nine (24%) patients received ECMO and mechanical ventilation, with 6 (66.6%) exitus and 3 (33.3%) survivors who were discharged from the hospital without sequelae. Of 37 pregnant/postpartum patients, 36 were unvaccinated. Conclusion: Vaccination should be given priority in pregnant women, and ECMO may be effective in the recovery of oxygenation in pregnant COVID-19 patients.

Objective: This study was conducted to determine the opinions of nurses working in surgical intensive care units (S-ICU) about the participation of family members (FM) in the care of patients during the dying process. Materials and Methods: Ethical approval was obtained before starting the research. The study was conducted in descriptive type with 81 nurses working in the S-ICU of a training and research hospital between 15 March and 15 April 2022. The data were collected through the descriptive information form and the nurse's opinion determination form created by the researcher. STROBE checklist was used in reporting the research. A p

Objective: We postulated that adding tube resistance compensation (TRC) to pressure support ventilation (PSV) would have beneficial effects on metabolic parameters in patients scheduled for weaning. Here, the PSV and PSV+TRC were compared by measuring oxygen consumption (VO2), energy expenditure (EE), and carbon dioxide production (VCO2). Materials and Methods: This was a prospective, randomised, crossover study. Seventy-eight adult patients were randomised to receive either PSV or PSV+TRC. Group 1 consisted of patients that started with PSV initially and then switched to PSV+TRC, whereas Group 2 first received PSV+TRC and then switched to PSV. After 30 minutes of monitoring and stabilization, an indirect calorimeter was connected and metabolic parameters measurement was taken every 5 minutes for 30 minutes, and the last measurement values were recorded at the 30th minute. The patient was then switched to the second treatment mode, and the procedure was repeated. Results: TRC+PSV ventilation had no clinical effects on metabolic parameters compared with PSV (EE, 1746 vs. 1763, respectively; VO2, 255 vs. 260, respectively; VCO2, 206 vs. 208, respectively; all p > 0.05). Conclusion: Adding TRC to PSV did not cause any changes in gas exchange, haemodynamic variables, or metabolic parameters in patients for weaning.

Objective: In this retrospective and cross-sectional study, it was aimed to evaluate the efficacy of tocilizumab (TCZ) treatment in critical COVID-19 patients who were hospitalized in the intensive care unit (ICU) and developed cytokine storm. Materials and Methods: The study included 219 critically ill COVID-19 patients followed in the ICU and treated with TCZ. All patients received 2 doses of 400 mg/day TCZ treatment during their stay in the ICU. Clinical conditions, laboratory data, inotrope requirement and chest radiographs before and after TCZ treatment were compared. Mortality rates at the 7th day, 28th day and total mortality rates of the patients were recorded. Results: It was observed that there was a significant decrease in CRP values over time after TCZ treatment. There was a significant increase in leukocyte, lymphocyte, lactate, urea, creatinine, AST, D-dimer, LDH and PCT values. The 7-day mortality of the patients was 21%, the 28-day mortality was 64.8%, and the total mortality rate was 65.3%. Conclusion: It was determined that after TCZ treatment, only CRP levels, which are among the inflammatory parameters, decreased significantly in patients, and the mortality rates were still high with the increase in the values of kidney and liver function tests of the patients.

Objective: Myroides species are mostly low-grade opportunistic pathogens and infect immunocompromised patients. Reports of Myroides spp. increased from clinical samples due to unique developments in molecular microbiology. However, clinical importance of this microorganism in intensive care units’ patients is debated. We aimed to determine whether Myroides spp. strains isolated from urinary catheter cultures of patients in intensive care units are led to an infection or colonization by examining the risk factors of the patients between January 2018 and December 2022. Materials and Methods: In a university hospital, the patients who Myroides spp.isolated from urine cultures in intensive care units between January 2018 and December 2022 were included in the study. The method and reasons of taking urine samples, the presence of a urinary catheter, blood cultures samples in terms of urinary sepsis, the antimicrobial susceptibility of the isolates, and hospital stay were evaluated retrospectively. Also, control culture samples were taken after 24 and 72 hours by changing the urinary catheters of these patients. Results: Thirty-six patients were enrolled to the study. Urine cultures were taken for investigate the source of infection in 23 patients, and nine for control urinary culture and in three patients for macroscopic urine blurred and in one patient to detect colonization before urinary surgery. There was not any blood culture positivity found. All Myroides spp. isolated patients had urinary catheter. Average length of hospital stay was determined as 41.3 days (7-355). A total 34 of the 36 isolated Myroides spp. were pan-drug resistant. Antibacterial treatment was not initiated in any of the patients. Urinary catheters change after first isolation of Myroides spp. was recommended in all patients. After the patients’ urinary catheters were changed, Myroides spp. were not grown in the control culture samples taken 24 and 72 hours after. Conclusion: As a result of our study, Myroides spp. were isolated especially in patients with long hospital stays and urinary catheters. It was determined that the patients were controlled without treatment, only with urinary catheter replacement. We believe that this agent should be evaluated as having a very high rate of urinary colonization, and the urinary catheter should be changed first, urinary symptoms should be followed up, and unnecessary antimicrobial use should be avoided.

Objective: In the management of haemodynamically unstable patients, cardiac output (CO) measurement provides clinicians with important data on organ tissue perfusion. This measurement can be performed by pulse-induced contour cardiac output (PiCCO) using thermodilution method, which is a less invasive method, and ultrasonic cardiac output monitoring (USCOM), which is completely non-invasive. The aim of this study was to investigate the clinical relevance of CO and cardiac index measurements obtained by USCOM in patient’s with sepsis and septic shock by comparing them with the PiCCO technique, which has been used as a reference measurement method in recent years. Materials and Methods: In this prospective study, 36 patient’s with sepsis and septic shock ventilated with 8-10 mL/kg tidal volume without respiratory effort were included. Patient’s with arrhythmia, known heart failure or pulmonary embolism were excluded. Results: After averaging the PiCCO and USCOM measurements performed by different clinicians, the heart rate was found to be 3.23 L/min/m2 with PiCCO and 2.24 L/min/m2 with USCOM. When the two results were compared, the difference was statistically significant (p=0.01). Stroke volume variation was 15.80% with PiCCO and 52.89% with USCOM. When the two results were compared, the difference was statistically significant (p=0.01). Conclusion: There was no agreement between USCOM and PiCCO measurements in sepsis patient’s. In our opinion, more studies are needed for USCOM reliability.

Objective: The aims of this study was to investigate factors associated with intensive care unit (ICU) admission and prognosis following surgical treatment of gynaecological malignancy. Materials and Methods: This study was designed as a retrospective cohort analysis, which encompasses patients who were subjected to gynecologic oncological surgery and subsequently monitored in the ICU from December 1st, 2022, to December 1st, 2023. Results: Data of 57 patients who underwent gynaecological oncological surgery and were admitted to ICU during the study period were analysed. Median age was 61.47 years, median body mass index 27 kg/m2, American Society of Anaesthesiologists score 3±2.5. The most common indication for ICU admission was haemodynamic instability with 73.6% (n=42), followed by respiratory failure with 15.7% (n=9) and other reasons. Charlson comorbidity index, lactate and base deficit levels were higher and albumin values were lower in patients with ICU stay of 3 days or more (p=0.04, p=0.004, p=0.034, p=0.025). Only 2 patients (3.5%) developed mortality during the study period. Conclusion: The most common indication for ICU follow-up after elective gynaecological oncology surgery is hemodynamic instability with low ICU mortality and short length of stay in general.

Abstract Background End-stage renal disease (ESRD) poses a significant burden globally and in India. However, access to treatment remains limited due to resource and cost constraints. This study aimed to evaluate the health-related quality of life (HRQoL) and economic burden among haemodialysis patients. Methods A descriptive cross-sectional study using European Quality of life, EQ-5D-5L, to measure health-related quality of life across 5 domains, i.e. mobility, self-care, usual activities, pain/discomfort and anxiety/depression, was administered, across three settings—government dialysis centre, private dialysis centre and charity based dialysis centre. The health utility values were also calculated. Also, the costs incurred in dialysis were done. Results The mean (± SD) age of the participants was 55 (± 11) years, the majority of the participants were male (n = 61), 80% (n = 64) of the participants were employed before and 40% of them had lost a job, due to the morbidity of the disease. Upon analyzing the EQ-5D-5L data, it is inferred that all five domains were the same across all three setups. The direct cost incurred on the haemodialysis ranged from INR.600 to INR.3500 per month, and the indirect cost ranged fromINR.50 to INR. 3000, which is borne by the participants, in about 70% of the cases. Chief Minister Health Insurance Scheme was found to be extremely useful, wherein only 30% (n = 25) of the study participants (n=81) were insured beneficiaries. Conclusion HRQoL was moderately impaired, and treatment posed substantial financial hardship among hemodialysis patients. Expanding access to decentralized and community-based care models could help address the challenges of regular treatment and lost productivity.

Abstract Introduction Metabolic syndrome is a chronic disease associated with multiple comorbidities. Over the last few years, machine learning techniques have been used to predict metabolic syndrome. However, studies incorporating demographic, clinical, laboratory, dietary, and genetic factors to predict the incidence of metabolic syndrome in Koreans are limited. In the present study, we propose a genome-wide polygenic risk score for the prediction of metabolic syndrome, along with other factors, to improve the prediction accuracy of metabolic syndrome. Methods We developed 7 machine learning-based models and used Cox multivariable regression, deep neural network (DNN), support vector machine (SVM), stochastic gradient descent (SGD), random forest (RAF), Naïve Bayes (NBA) classifier, and AdaBoost (ADB) to predict the incidence of metabolic syndrome at year 14 using the dataset from the Korean Genome and Epidemiology Study (KoGES) Ansan and Ansung. Results Of the 5440 patients, 2,120 were considered to have new-onset metabolic syndrome. The AUC values of model, which included sex, age, alcohol intake, energy intake, marital status, education status, income status, smoking status, dried laver intake, and genome-wide polygenic risk score (gPRS) Z-score based on 344,447 SNPs (p-value

Abstract Background Achondroplasia and mandibulofacial dysostosis with microcephaly (MFDM) are rare monogenic, dominant disorders, caused by gain-of-function fibroblast growth factor receptor 3 (FGFR3) gene variants and loss-of-function elongation factor Tu GTP binding domain-containing 2 (EFTUD2) gene variants, respectively. The coexistence of two distinct Mendelian disorders in a single individual is uncommon and challenges the traditional paradigm of a single genetic disorder explaining a patient’s symptoms, opening new avenues for diagnosis and management. Case Presentation We present a case of a female patient initially diagnosed with achondroplasia due to a maternally inherited pathogenic FGFR3 variant. She was referred to our genetic department due to her unusually small head circumference and short stature, which were both significantly below the expected range for achondroplasia. Additional features included distinctive facial characteristics, significant speech delay, conductive hearing loss, and epilepsy. Given the complexity of her phenotype, she was recruited to the DDD (Deciphering Developmental Disorders) study and the 100,000 Genomes project for further investigation. Subsequent identification of a complex EFTUD2 intragenic rearrangement confirmed an additional diagnosis of mandibulofacial dysostosis with microcephaly (MFDM). Conclusion This report presents the first case of a dual molecular diagnosis of achondroplasia and mandibulofacial dysostosis with microcephaly in the same patient. This case underscores the complexity of genetic diagnoses and the potential for coexistence of multiple genetic syndromes in a single patient. This case expands our understanding of the molecular basis of dual Mendelian disorders and highlights the importance of considering the possibility of dual molecular diagnoses in patients with phenotypic features that are not fully accounted for by their primary diagnosis.

Abstract Distal hereditary motor neuropathies (dHMN) are a group of heterogeneous diseases and previous studies have reported that the compound heterozygous recessive MME variants cause dHMN. Our study found a novel homozygous MME variant and a reported compound heterozygous MME variant in two Chinese families, respectively. Next-generation sequencing and nerve conduction studies were performed for two probands. The probands in two families presented with the muscle weakness and wasting of both lower limbs and carried a c.2122 A > T (p.K708*) and c.1342 C > T&c.2071_2072delinsTT (p.R448*&p.A691L) variant, respectively. Prominently axonal impairment of motor nerves and slight involvement of sensory nerves were observed in nerve conduction study. Our study reported a “novel” nonsense mutation and a missense variant of autosomal recessive late-onset dHMN and reviewed reported MME variants associated with dHMN phenotype.

Abstract Background Pathogenic variants of MYH7, which encodes the beta-myosin heavy chain protein, are major causes of dilated and hypertrophic cardiomyopathy. Methods In this study, we used whole-genome sequencing data to identify MYH7 variants in 397 patients with various cardiomyopathy subtypes who were participating in the National Project of Bio Big Data pilot study in Korea. We also performed in silico analyses to predict the pathogenicity of the novel variants, comparing them to known pathogenic missense variants. Results We identified 27 MYH7 variants in 41 unrelated patients with cardiomyopathy, consisting of 20 previously known pathogenic/likely pathogenic variants, 2 variants of uncertain significance, and 5 novel variants. Notably, the pathogenic variants predominantly clustered within the myosin motor domain of MYH7. We confirmed that the novel identified variants could be pathogenic, as indicated by high prediction scores in the in silico analyses, including SIFT, Mutation Assessor, PROVEAN, PolyPhen-2, CADD, REVEL, MetaLR, MetaRNN, and MetaSVM. Furthermore, we assessed their damaging effects on protein dynamics and stability using DynaMut2 and Missense3D tools. Conclusions Overall, our study identified the distribution of MYH7 variants among patients with cardiomyopathy in Korea, offering new insights for improved diagnosis by enriching the data on the pathogenicity of novel variants using in silico tools and evaluating the function and structural stability of the MYH7 protein.

Introduction：Ischemia reperfusion injury (IRI) is detrimental to kidney transplants and may contribute to poor long-term outcomes of transplantation. Programmed cell death (PCD), a regulated cell death form triggered by IRI, is often indicative of an unfavorable prognosis following transplantation. However, given the intricate pathophysiology of IRI and the considerable variability in clinical conditions during kidney transplantation, the specific patterns of cell death within renal tissues remain ambiguous. Consequently, accurately predicting the outcomes for transplanted kidneys continues to be a formidable challenge. Methods：Eight Gene Expression Omnibus (GEO) datasets of biopsied transplanted kidney samples post IRI and 1548 PCD-related genes derived from 18 PCD patterns were collected in our study. Consensus clustering was performed to identify distinct IRI subtypes based on PCD features (IRI PCD subtypes). Differential enrichment analysis of cell death, metabolic signatures, and immune infiltration across these subtypes was evaluated. Three machine learning algorithms were used to identify PCD patterns related to prognosis. Genes associated with graft loss were screened for each PCD type. A predictive model for graft loss was constructed using 101 combinations of 10 machine learning algorithms. Results：Four IRI subtypes were identified: PCD-A, PCD-B, PCD-C, and PCD-D. PCD-A, characterized by high enrichment of multiple cell death patterns, significant metabolic paralysis, and immune infiltration, showed the poorest prognosis among the four subtypes. While PCD-D involved the least kind of cell death patterns with the features of extensive activation of metabolic pathways and the lowest immune infiltration, correlating with the best prognosis in the four subtypes. Using various machine learning algorithms, 10 cell death patterns and 42 PCD-related genes were identified positively correlated with graft loss. The predictive model demonstrated high sensitivity and specificity, with area under the curve (AUC) values for 0.5-, 1-, 2-, 3-, and 4-year graft survival at 0.888, 0.91, 0.926, 0.923, and 0.923, respectively. Conclusion：Our study explored the comprehensive features of PCD patterns in transplanted kidney samples post IRI. The prediction model shows great promise in forecasting graft loss and could aid in risk stratification in patients following kidney transplantation.

Acute pulmonary embolism (APE) is a life-threatening condition with a high mortality rate. The pathophysiology involves various complex processes. The systemic immune-inflammatory index (SII) is a well-known biomarker that reflects the intricate balance between pro-inflammatory and anti-inflammatory immune components. In this systematic review, we aim to determine the significance of SII as a potential biomarker for APE.

Accidental hypothermia (AH) presents a significant mortality risk, even in individuals with good health. Early recognition of the parameters associated with negative prognosis could save more lives.

In this study, we aimed to compare metabolic risk factors, lipid indices, healthy eating index, and physical activity among premenopausal, menopausal, and postmenopausal women.

Background: Metabolic-associated fatty liver disease and liver fibrosis are intimately linked to insulin resistance, type 2 diabetes, obesity, and metabolic syndrome. Transient elastography (TE) and point shear wave elastography (pSWE) were used to measure liver stiffness in patients who met the ultrasound criteria for steatotic liver diseases (SLD). This study compared two methods for estimating liver stiffness in patients with SLD, which in turn correlated with liver fibrosis. Method: Ultrasound B-mode imaging was used to identify SLD. In total, 250 MAFLD patients were recruited. Patient characteristics, laboratory investigations, and liver stiffness measurements using TE and pSWE were assessed on the same day.

Background: Polymyalgia rheumatica (PMR) is an inflammatory condition closely linked with giant cell arteritis, which is a large vessel vasculitis. To provide real-world evidence on PMR outcomes and their determinants, we conducted a longitudinal study focusing on symptom relief and acute phase reactant normalization.

The frequency of thyrotoxicosis may vary between countries and some laboratory test results may be used in etiology research. This study aimed to evaluate the prevalence of thyrotoxicosis diagnoses and laboratory test results.

Sepsis is one of the most common causes of death in patients admitted to intensive care units (ICUs). The development of sepsis is significantly influenced by genetic predisposition. In this study, we highlight a potential association between a variant of the fat mass and obesity-associated (FTO) gene and risk of sepsis in children and adolescents.

Research advances in the oncology treatment field have led to the widespread use of immunotherapy. The usage of immune checkpoint inhibitor (ICI) has improved the survival of cancer patients with metastases. This has also led to the rapidly expanding indications for ICI use. However, ICI usage may lead to toxicity, which may be immune-related, in different organ-specific targets. The immune-related adverse events (irAEs) of ICI may lead to increased morbidity, decreased quality of life, and early termination of ICI. The clinical manifestations of irAEs in the gastrointestinal system are variable, ranging from self-limited to life-threatening or fatal events. In this review article, we would like to focus on discussing ICI-induced colitis, which is one of the most common ICI irAEs in the gastrointestinal tract.

Background: Aldosterone synthase (CYP11B2) is crucial for aldosterone production, and variations in its gene may influence type 2 diabetes mellitus (T2DM) development. This study explores the link between two single nucleotide polymorphisms (SNPs) in the CYP11B2 gene - −344T/C and K173R and T2DM in the Moroccan population .

Eosinophilic Esophagitis is a widely-recognized immune-mediated esophagus disease with distinct clinical and histopathological features, exhibiting an increased global incidence. Therapeutic options encompass either dietary measures or pharmacological approaches, including proton pump inhibitors and topical corticosteroids. The use of monoclonal antibodies is currently under comprehensive evaluation, with a plethora of ongoing clinical trials designed to determine their clinical efficacy. The present case report demonstrates an exceptional case of refractory Eosinophilic Esophagitis, unresponsive to conventional treatment, achieving both clinical and histopathological remission subsequent to initiation of benralizumab treatment. Concurrently, our case underscores the necessity for continued research in the field of monoclonal antibodies for their use as a future treatment approach against Eosinophilic Esophagitis.

Objectives: Biomarker-based clinical practice is currently gaining ground and increasingly affects decision making. A variety of biomarkers have been studied through the years and some of them have already an established role in modern medicine, such as procalcitonin (PCT) which has been proposed to reduce antibiotic exposure. We purposed to systematically review all biomarkers examined for guiding the clinical practice in patients with pneumonia.

Background: Respiratory allergies mostly allergic rhinitis and asthma represent an important and increasing public health problem and one of the priorities for the European health systems. There is an increasing public concern regarding the persistence and severity of allergic diseases and many difficulties of health systems in providing prompt specialized medical assistance. Our study aims to highlight the main results of the Alliance 4Life project focused on the evaluation of the burden and management of respiratory allergies in primary care from Romania and comparative health-related data from four Central and Eastern European countries.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection represented a disruptive pathology that emerged in late 2019 with profound implications ranging from individual health to health systems and world economy. Our study aimed to evaluate clinical, biochemical and computerized tomography (CT) parameters values in determining the severity of pulmonary embolism (PE) associated with COVID-19.

Human immunodeficiency virus (HIV) is no longer considered a contraindication for kidney transplantation (KT). KT management in HIV patients is a complex process with challenges, such as drug interactions between immunosuppression and antiretroviral (ARV) therapy. In our country, no KT has been performed thus far in this category of patients.

Abstract Obesity is the one of the most important components of metabolic syndrome. Because obesity related hypertension accounts for two thirds of essential hypertension, managing obesity and metabolic syndrome is a crucial task in the management of hypertension. However, the current non-pharmacological therapies have limitations for achieving or maintaining ideal body weight. Recently, glucagon-like peptide-1 receptor agonists (GLP1-RAs) have demonstrated excellent weight control effects, accompanied by corresponding reductions in blood pressure. GLP1-RAs have shown cardiovascular and renal protective effects in cardiovascular outcome trials both in primary and secondary prevention. In this document, the Korean Society of Hypertension intends to remark the current clinical results of GLP1-RAs and recommend the government and health-policy makers to define obesity as a disease and to establish forward-looking policies for GLP1-RA treatment for obesity treatment, including active reimbursement policies.

Abstract As childhood obesity rates increase worldwide, the prevalence of obesity-related hypertension is also on the rise. Obesity has been identified as a significant risk factor for hypertension in this age group. National Health Surveys and meta-analyses show increasing trends in obesity and pediatric hypertension in obese children. The diagnosis of hypertension in children involves percentiles relative to age, sex, and height, unlike in adults, where absolute values are considered. Elevated blood pressure (BP) in childhood is consistently associated with cardiovascular disease in adulthood, emphasizing the need for early detection and intervention. The pathogenesis of hypertension in obesity involves multiple factors, including increased sympathetic nervous system activity, activation of the renin-angiotensin-aldosterone system (RAAS), and renal compression due to fat accumulation. Obesity disrupts normal RAAS suppression and contributes to impaired pressure natriuresis and sodium retention, which are critical factors in the development of hypertension. Risk factors for hypertension in obesity include degree, duration, and distribution of obesity, patient age, hormonal changes during puberty, high-sodium diet, sedentary lifestyle, and socioeconomic status. Treatment involves lifestyle changes, with weight loss being crucial to lowering BP. Medications such as angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers may be considered first, and surgical approaches may be an option for severe obesity, requiring tailored antihypertensive medications that consider individual pathophysiology to avoid exacerbating insulin resistance and dyslipidemia.

Abstract Background The triglyceride-glucose (TyG) index is a reliable marker of insulin resistance that is involved in the progression of hypertension. This study aimed to evaluate the association of the TyG index with the risk for major cardiovascular events (MACE) in young adult hypertension. Methods A total of 2,651 hypertensive patients aged 18–40 years were consecutively enrolled in this study. The TyG index was calculated as Ln [triglycerides × fasting plasma glucose/2]. The cutoff value for an elevated TyG index was determined to be 8.43 by receiver-operating characteristic curve analysis. The primary endpoint was MACE, which was a composite of all-cause death, non-fatal myocardial infarction, coronary revascularization, non-fatal stroke, and end-stage renal dysfunction. The secondary endpoints were individual MACE components. Results During the median follow-up time of 2.6 years, an elevated TyG index was associated with markedly increased risk of MACE (adjusted hazard ratio [HR] 3.440, P

The Prostate Imaging Reporting and Data System (PI-RADS) is an essential tool for standardizing the interpretation of multiparametric magnetic resonance imaging (mp-MRI) of the prostate for detecting prostate cancer. This article provides a comprehensive overview of the latest version, PI-RADS 2.1, with clear pictures to guide radiologists in its practical application for improved diagnostic accuracy. The article explores the key modifications, emphasizing the changes in scoring criteria and their impact on clinical decision-making. It discusses the importance of mp-MRI sequences, such as T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced imaging, and clarifies their significance in the PI-RADS 2.1 framework. The article highlights practical insights to help radiologists integrate this updated system into their day-to-day practice, promoting consistency and reliability in reporting.

Chronic liver disease (CLD) has been recently recognized as a major public health priority. Assessment of presence and degree of liver fibrosis is critical to the management of CLD and traditionally required a liver biopsy. However, biopsy has many limitations including the risk of complications and sampling error. Magnetic resonance elastography (MRE) has emerged as a noninvasive and highly accurate technique for evaluating liver fibrosis. In this comprehensive review, we will delve into the current uses and guidelines for the usage of MRE in CLD, highlighting its advantages and limitations.

Solid pseudopapillary tumor is a mixed solid and cystic neoplasm of the pancreas which occurs most commonly in females in second or third decade of life with few reported pediatric cases. It has a low malignancy potential with good prognosis after surgical resection.

The use of Prostate Imaging Reporting and Data System (PI-RADS) with multiparametric magnetic resonance imaging (MRI) has significantly improved the detection of clinically significant prostate cancer (csPCa), but there are certain challenges that the reader may face. This review provides an overview of the pitfalls associated with the PI-RADS system for multiparametric prostate MRI (mpMRI), with suggestions/pearls to help overcome these pitfalls.

Prostate cancer remains a significant global health concern, necessitating continuous research and innovation in treatment modalities. This review explores the currently employed techniques in radiation dose planning and tumor irradiation in the context of prostate cancer management. In addition, we delve into the nuances of expected posttreatment magnetic resonance imaging (MRI) appearances within the gland or in the prostate bed, postradiation tumor recurrence, and its mimics.

Diseases of the middle ear and the temporal bone pyramid remain one of the most common diseases in the structure of otorhinolaryngological pathologies, which have a significant impact on the quality of life of adults and children. Exudative processes, as well as their consequences, become one of the main causes of persistent hearing loss and are characterized by an asymptomatic course with a gradual evolution to chronic forms. It should be noted that in childhood the risk of impaired speech and intellectual development increases, leading to changes in the psycho-emotional status, social maladaptation of the child, and a decrease in the quality of life. Timely and complete diagnosis and high-quality follow-up takes a leading role in preventing the development of conductive hearing loss and other complicated pathologies of the temporal bone pyramid. Purpose of the study. To study the main predisposing factors, methods of radiological diagnosis and dynamic observation of patients, as well as some modern aspects of the treatment of the most common pathologies of the temporal bone pyramid. Methodology. We conducted an analytical review of open access sources from scientific databases such as Scopus, PubMed, Google Scholar, Web of Science, DisserCat, CyberLeninka. Key words used for the search: “chronic otitis media”, “cholesteatoma”, “mastoiditis”, “complications”, “magnetic resonance imaging”, “DWI”, “computed tomography”. Publications included in the literature review were full-text articles in English and Russian and dissertations in Russian. Exclusion criteria: brief reports, newspaper articles and personal communications. The search range was 5 years (2018-2023). A total of 108 sources were analyzed, of which 50 met the research objectives and inclusion criteria. Results and conclusions. In the diagnosis of temporal bone pathologies, the gold standard for diagnosis is computed tomography, but non-ionizing research techniques are increasingly used. Indications for the use of magnetic resonance imaging of the temporal bones are constantly expanding, and techniques for merging data with computed tomography data are being increasingly introduced. As a follow-up tool, magnetic resonance therapy is increasingly becoming a priority technique to reduce patient radiation exposure in the long term. In the treatment of complicated forms of diseases, endoscopic and laser correction techniques are used in foreign practice, helping to reduce the risk of recurrence and postoperative complications. Key words: chronic otitis media, cholesteatoma, magnetic resonance imaging, computed tomography, treatment

Aim: Blood pressure measurement is an integral part of clinical practice in patient care and treatment, as well as being of critical importance in the early diagnosis, treatment, and prevention of the complications of hypertension. This study was carried out to determine the effect of supine, semi-Fowler’s, and Fowler’s positions on the blood pressure values of patients hospitalized in surgical clinics. Material and methods: This quasi-experimental study was carried out with 112 preoperative surgical patients hospitalized in the surgical clinics of a training and research hospital. Using a bedside monitor, the patients' systolic and diastolic blood pressures were measured in the supine, Fowler’s, and semi-Fowler’s positions. The Pearson correlation coefficient, Mauchly's sphericity, ANOVA, and Bonferroni correction were used in the data analysis. Results: While systolic blood pressure values did not differ between the supine and semi-Fowler’s positions (F = .007, p = .934), there was a significant difference between the semi-Fowler’s and Fowler’s positions (F =5.534, p = .020). Diastolic blood pressure values differed significantly between the supine and semi-Fowler’s (F = 7.406, p = .008) and semi-Fowler’s and Fowler’s (F = 9.038, p = .003) positions. Conclusions: It is vital for nurses to establish procedures for blood pressure measurement and evaluation in the clinic and other team members and periodically revise the existing procedures.

Acute kidney injury (AKI) is a condition characterized by a sudden decline in kidney function, leading to accumulation of waste products and fluids in the body. It is a common and serious complication in patients with cardiovascular diseases, and it is associated with increased morbidity and mortality. Aim: In this study, we explore the relationship between cardiac issues and the development of AKI, as well as strategies for its prevention and management. The primary aim of this study is to examine the incidence and risk factors for the AKI in patients admitted to the cardiac intensive care unit/CICU), as well as the impact of AKI on patient outcomes. Methods: We conducted prospective observational single center study. 292 consecutive patients admitted to ICU after open heart surgery by sternotomy were included. Patients were monitored in ICU for frequency of AKI, perioperative risk factors, cardiac surgery-associated acute kidney injury (CSA-AKI) and their impact on patients’ outcome. Results: After admission to the intensive care unit, 33 patients (11.3%) developed CSA-AKI in the postoperative period. According to the analysis, male gender (p=0.03), decreased GFR (p=0.02) as well as high EuroSCORE II (p=0.013), hemoglobin level before surgery (p = 0.002) and the presence of diabetes and chronic kidney disease (p=0.03) were independent predictors of AKI after open-heart surgery. In patients who developed AKI, the duration of artificial lung ventilation was increased (21.3 vs 9.9 hours p = 0.001) and the duration of stay in the intensive care unit (4.3 vs. 1.9 days, P = 0.02). Conclusion: Patients often have AKI after heart surgery. EuroSCORE II, gender, diabetes, time of cardiopulmonary bypass and chronic kidney disease are independent predictors of AKI development. The appearance of AKI is due to an unfavorable outcome of events. The appearance of acute kidney injury is associated with adverse consequences.

Aim: Postoperative new-onset atrial fibrillation (POAF) after isolated coronary artery bypass graft surgery (CABG) is associated with adverse events. The Predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score is used to predict the bleeding risk after dual antiplatelet therapy and has been associated with arrhythmias in recent years. Therefore, the present study sought to investigate the association between the PRECISE-DAPT score and POAF after coronary artery bypass graft surgery. Materials and Methods: 350 patients who underwent CABG were retrospectively screened. After exclusion criteria, 135 patients were included in the study. A total of 135 patients who underwent on-pump CABG were divided into two groups: patients with POAF and those without POAF. The PRECISE-DAPT score was calculated for each patient, and intergroup comparisons of the calculated scores were performed. Results: POAF was detected in 66 patients out of 135. Patients with POAF had longer hospital stays. PRECISE-DAPT score was higher in the patients with POAF compared to the patients without POAF (p

Abstract Aim: Current research seeks to explore the correlation between early mobilisation in physical exercise and the functionality and life quality of patients post cardiac surgery. Methods: A cohort of 100 patients, aged between 18 and 65, comprising 52 men and 48 women, participated in a program of early physical performance commencing from the first day through the seventh day post - heart surgery. Outcome measures included the 6 Minute-Walk Test (6MWT), the Short Form-International Physical Activity Questionaire (SF-IPAQ), and the Short Form-36 (SF-36). Each assessment was administered on the seventh day following cardiac surgery. Results: Statistical analysis revealed a significant interrelation (p

In the present study, a systematic literature review was conducted to examine the prevalence of homo- and heterozygous forms of Familial hypercholesterolemia among different racial and ethnic groups. Familial hypercholesterolemia (FH) is an inherited disorder characterised by elevated blood levels of cholesterol and low-density lipoprotein (LDL), which increases the risk of cardiovascular disease. Databases PubMed, Web of Science, and Elsiever were searched and only peer-reviewed articles with a large number of contributors and sufficient prevalence and ethnicity data were included. Diagnosis of FH was based on genetic testing or clinical criteria. The results of the study indicate inadequate and untimely diagnosis of FH, resulting in inadequate treatment. To date, only 9% of countries have statistical data on the prevalence of FH in the general population. In order to develop effective prevention strategies for cardiovascular diseases associated with FH, further research is needed to obtain accurate epidemiological data, including the race and ethnicity of patients. This will allow optimisation of strategies to reduce the burden of preventable cardiovascular disease associated with FH.

Health, a holistic concept encompassing physical, mental, and social well-being, stands as a fundamental value in every individual's life. Despite its paramount importance, many scholars highlight the insufficient commitment to a healthy lifestyle among student populations, often attributed to the challenges associated with academic transitions and social adjustments. Understanding the factors influencing student health behaviors is crucial for promoting well-being and fostering healthy lifestyles. This study employed a cross-sectional, retrospective analysis using primary data. The survey covered socio-economic factors and aspects of a healthy lifestyle among students from various universities in the Karaganda region, including Medical, Technical, and Humanitarian universities. Multiple logistic regression analysis was conducted to identify determinants influencing students' health behaviors. Demographic analysis revealed that surveyed students were primarily urban-born, enrolled in medical university programs, and predominantly lived with parents or relatives. Most students reported financial capacity for medical care and rated their social standing favorably. A significant proportion exhibited a normal BMI, with a notable prevalence of chronic diseases. While emergency care utilization varied, general practitioner visits were common, albeit less frequent among students with chronic conditions. Factors influencing health behaviors included educational program enrollment, socio-economic status, residential circumstances, gender, age, vaccination status. Understanding the complex interplay of factors influencing student health behaviors is essential for designing effective health promotion programs within universities. This study provides valuable insights into the determinants of health behaviors among students, shedding light on areas for intervention and emphasizing the importance of fostering a healthy lifestyle for overall well-being and academic success.

BACKGROUND Migrants tend to have an increased risk of physical and mental ill health, but less access to health care services. Hence this study was conducted with the following objectives: to describe the health problems among Migrant construction workers in Chennai, to determine the quality of life of Migrant construction workers in Chennai and to assess the Health seeking behaviour of Migrant construction workers in Chennai METHODS This was a community based Cross-sectional study conducted in construction sites in Chennai. Interstate migrant construction laborers including men and women aged more than 18 years who are working in the construction sites for more than 1 year were included in the study. The study was conducted from March to April 2023. Sample size was calculated to be 400 and convenient sampling was used. Structured and pretested Validated Questionnaire was used for data collection. RESULT: The study showed that 13% had respiratory disease, 5.1% had acute febrile illness and 5.1 % had gastrointestinal disease. About 13% of the respondents went to nearby medical shop when they have any medical problems. About 41% of the repondents had poor QOL and quality of life was very poor in 5% of the respondents.

Aim: Shoulder diseases are believed to be associated with metabolic factors including diabetes and obesity. Our research aimed to determine how age-related comorbidities and rising body mass index (BMI) affected shoulder pain, disability, and joint range of motion (ROM). Methods: The study included 137 individuals aged 20–80 who sought treatment for chronic shoulder pain at the physical medicine and rehabilitation outpatient clinic and, they were recorded for their demographics, BMI, comorbidities, pain duration, dominant shoulder, affected shoulder, history of treatment, joint ROM, visual analogue scale pain score, and shoulder pain and disability index score. Results: The study found that the obese group had a high mean age (p=0.047) and substantially more common thyroid dysfunction (p=0.031). When individuals with and without diabetes mellitus (DM) were compared, it was observed that the DM group had significantly less ROM. Similarly, ROM was found to be considerably lower in the group with hypertension (HT) when a comparison was made for having or not having HT. In comparison of patients with or without hyperlipidemia (HL), the group with HL had significantly lower BMI compared to the group without HL (p=0.047). Upon comparing the groups with and without thyroid disease, it was discovered that the former had a considerably higher BMI (p=0.012). Conclusion: We found that the two most prevalent disorders associated with shoulder pain, DM and HT, have a particularly positive influence on joint range of motion. We also observed a connection between thyroid problems and BMI. In the management of shoulder discomfort, managing comorbidities and BMI are crucial.

Objectives: Evaluation of the Effectiveness of Developed Algorithms for Managing Pregnant Women and Assessing Severity Using the WHO ABCDE Approach During COVID-19 Among Practicing Physicians Material and methods: To evaluate the effectiveness of the algorithm for managing pregnant women and assessing severity using the WHO ABCDE approach during COVID-19, we analyzed 102 medical records of pregnant patients with COVID-19 who received treatment in infectious disease hospitals and perinatal centers in the city of Shymkent from January to April 2022. Results: Diagnostic errors were made in 22.5% of the sample before the training on the developed algorithms. Following the training sessions, the error rate decreased by 7.8%. Physicians identified errors in the following diagnoses: influenza - 10.8% (11 cases), acute intestinal infections - 4.9% (5 cases), acute cerebrovascular accident, measles, and atypical pneumonia - 1.9% (2 cases each), and Kawasaki disease - 0.9% (1 case). After the training, the incidence of the diagnosis of "Influenza" decreased by 4.9% and "Acute intestinal infections" by 3%. Our findings revealed that the percentage of diagnostic errors (underdiagnosis) significantly dropped from 41.2±6.9% (n=51) to 11.6%±4.9 (p

Osteoma is one of the rare benign bone tumors and often presented asymptomatic through which could be expanded to close tissues. The current article will present a case report of giant frontal sinus osteoma and successful surgical treatment. The described tumor's size is astounding and among one of the biggest currently reported. In a discussion section, we try to provide the helpful groundwork for this disease’s etiology and describe the surgical approach performed. The purpose of this study is to present the clinical symptoms, radiological findings, and surgical indications of a giant frontal sinus osteoma with an orbital cavity expansion and secondary VI cranial nerve palsy. Moreover, histological findings of the tumor in the forms of granulomatous inflammation and tumor-infiltrating lymphocytes with single multinucleated giant cells brought our attention to provide additional antibacterial treatment and perform an osteoplastic operation 6 months later.

This article analyzes a clinical case of vesicular toxicodermia caused by infection with the scabies mite Sarcoptes scabiei. The focus is on a female patient who, according to her medical history, noticed the development of intense itching and rashes on her hands and feet after using an antiseptic. Initial treatment provided no relief, and further investigations confirmed the presence of the scabies mite. The article emphasizes the importance of a comprehensive approach to diagnosing and treating such clinical cases, including careful monitoring for allergic reactions to antiseptics and other potential irritants. Special attention is given to the necessity of etiological therapy directly targeting the scabies pathogen, as well as symptomatic treatment to alleviate itching and inflammatory manifestations.

For a long time, the family of receptor tyrosine kinases, including epidermal growth factor receptor and insulin-like growth factor 1 receptor, was regarded as the main players stimulating cell proliferative signaling. Today, it is increasingly clear that many G protein-coupled receptors (GPCRs) are also involved in controlling the hallmarks of cancer by activating diverse intracellular signaling networks. GPCRs can therefore be considered as promising drug targets for fighting against diverse types of human malignancies. Although plant polyphenols, flavonoids, are well known for their diverse anticancer effects inhibiting the growth, proliferation, migration, and invasion of malignant cells, involvement of GPCRs in these activities has still remained largely unelucidated. Therefore, in this review article, the current knowledge about the role of GPCRs in anticancer action of structurally varied flavonoids is compiled, highlighting the ability of these natural polyphenols to modulate the expression levels of GPCRs but also suppress the action of endogenous ligands and downstream tumor-promoting events. These data show that targeting the respective GPCRs by specific flavonoids may open new perspectives in the therapeutic intervention in human malignancies.