Volume 35 (2022): Edizione 3 (September 2022)

This comes about because of a lack of predicted biomarkers in the risk analysis of CVD events in chronic kidney disease (CKD) patients. The present study aimed to determine the clinical utility of independent, predictable biomarkers such as serum creatinine, estimated Glomerular Filtration Rate (eGFR), high sensitive C-Reactive protein (hsCRP), fibrinogen and lipid profile as early predictors of CVD in CKD at stage III/IV.

Methods. This is a case-control study that includes a sample size of 100 patients of cases and 100 patients of controls who were recruited from November 2020 to April 2021, from the Nephrology department of the Visakhapatnam tertiary care teaching hospital, and present with chronic kidney disease – stage III/IV. The subjects’ general conditions (age, gender, height, weight, systolic blood pressure, diastolic blood pressure, and smoking history); underlying diseases (coronary heart disease and diabetes mellitus) were recorded. Fasting venous blood samples were collected under aseptic conditions from the study group after taking informed consent. The measurement of serum creatinine was performed by modification of kinetic Jaffe reaction. The Cockcroft-Gault equation was used to calculate eGFR in both cases and controls. CRP testing was done with a Cobas C311 analyzer, using immunoturbidimetric assay. The Fibroquant kit from Tulip was employed to measure fibrinogen levels in blood samples, and enzymatic methods were applied for lipid profile analysis.

Results. In this study, higher mean values of hsCRP (34.28 mg/dl), increased serum creatinine levels (2.876 mg/dl), reduced eGFR (28.37 mls/min), high levels of serum fibrinogen (291.6 mg/dl), and cholesterol (214.5 mg/dl), HDL (28.34 mg/dl), TG (162.1 mg/dl), VLDL (32.41 mg/dl) and LDL (153.77 mg/dl) were found to be independent predictors of assessment of CV events in patients with CKD stages III and IV as determined by Chi-square test.

Conclusion. A prompt and accurate assessment of cardiovascular risk in CKD patients would enable more aggressive and focused treatment of the individuals who are most in need of preventive interventions to decrease incident rates.

There are many treatment modalities for COVID-19 – with varied outcome. Therefore, authors designed this study to assess prescribing patterns and the clinical outcome for hospitalized patients with severe and critical COVID-19 so as to determine the most effective approach.

Authors conducted a retrospective observational study on 346 adult patients with either severe or critical COVID-19, who were admitted to public hospitals in Al-Najaf city, Iraq from June to September 2020. Patients’ information, medications and outcomes were collected from their medical records in the registered office of the hospital.

A total of 346 patients were enrolled, with a majority of patients being adults above 35 years old and male (70.2%). Most patients (81%) received corticosteroid as dexamethasone, and about 45% of all patients were given convalescent plasma therapy, while a few patients were prescribed antiviral favipiravir (23%) and lopinavir/ritonavir (19%). As supportive care medications, anticoagulant such as enoxaparin was administered to most of the patients (93%) and more than half of all patients received the broad-spectrum antibiotic, meropenem.

The majority of the patients recovered and were discharged alive (66%), however, the in- hospital mortality rate was 26%. Interestingly, patients treated with enoxaparin alone or in combination with hydroxychloroquine were associated with better outcome.

The prescribing pattern of COVID-19 specific medications and supportive care is aligned with guideline recommendations and associated with a beneficial therapeutic outcome.

Medical literature is an important source of drug safety information relevant for signal detection, safety profile analysis and risk-benefit assessment. The main goal of our study was to assess the utility of domestic medical literature as a source of drug safety information. All safety information identified for active substances published between 1.01.2018-31.12.2019 in domestic medical journals published in Poland were analyzed. Four thousand seven hundred eighty-nine drug safety information was reported for 500 active substances. Two thousand and forty-four submissions dealing with drug safety (48.28%) were identified in the 10 journals from the list of analyzed journals (3 of these were identified in the 2019 JCR and 5 of these were indexed in the main scientific databases and 9 of these had an affiliation to scientific society). There was a correlation between journal impact factor and scientific database indexation with the number of published individual literature reports and type of safety information. Journals publishing in Polish constituted source for about 40% of all safety information published in the examined period. Journals indexed in Medline were the source of about 37% of all safety information while 42% was published in Embase. Local medical literature is a source of valuable safety information but the list of journals for monitoring should be carefully selected with particular attention to journals with impact factor.

Atrial fibrillation (AF) is the most common supraventricular arrhythmia. Despite significant advances in its treatment, it still remains one of the leading causes of cardiovascular morbidity and mortality. In the last two decades, pulmonary vein isolation (PVI) was developed as the most effective treatment option. The reported effectiveness of a single ablation procedure ranges from 40% to 69% with single, and up to 88% with repeated procedures, with acceptable safety profile. The PubMed database was searched, using terms including ‘atrial fibrillation ablation’, ‘pulmonary vein isolation’, ‘computed tomography’, ‘pulmonary vein anatomy’ and ‘ovality index’. Papers were reviewed for relevance and scientific merit. Different imaging techniques are used for pre-procedural assessment of left atrial (LA) anatomy, of which computed tomography (CT) is the most common. It allows assessing pulmonary vein (PV) anatomy, the LA wall thickness in different regions and the left atrial appendage (LAA) anatomy, together with excluding the presence of intracardiac thrombi. Pre-procedural PVs imaging is important regardless of the selected ablation technique, however, cryoballoon (CB) ablation seems to be particularly anatomy-dependent. Additionally, CT also permits assessment of several PVs characteristics (geometry, dimensions, angulations, the ostium area, orientation and ovality index (OI), which are essential for the patients’ qualification and designing the strategy of AF ablation. In this paper, we have reviewed the role of CT imaging in patients undergoing ablation procedure due to recurrent/symptomatic atrial fibrillation. Moreover, we discussed the relevant literature.

Pediatric tuberculosis is a health problem of special significance because it is a marker for current transmission of tuberculosis in society. The research aimed at analyzing the peculiarities of detection and course of pediatric extrapulmonary tuberculosis (EPTB) taking into account the profile of drug resistance. A retrospective study of medical charts of children with EPTB (n = 47; 1^st group) and pulmonary tuberculosis (PTB) (n = 49; 2^nd group) aged 0-15 for 2013-2020 has been conducted. 2 subgroups with EPTB were identified separately: resistant (EPRTB) (n = 23) and sensitive (EPSTB) (n = 24). Results and discussion. The frequency of EPTB was 9.8%. Tuberculosis of peripheral LN (40.5%), CNS (27.7%), bones and joints (23.4%) was significantly more often diagnosed, than other lesions. Almost half of children with EPTB had a miliary distribution. In 44.7% of children with EPTB contact with a patient with tuberculosis was not established. EPRTB was significantly more common among children under 1 and up to 3 years of age than EPSTB. The resistance to combination of HR (73.6%) was found more often than to HRES (10.5%), HRS, H and Z (5.3% each; p<0.01). In 73.9% of children with EPRTB was detected when seeking medical care, in 13.0% the time to diagnosing lasted 6 months. Among children with EPRTB, gradual course was more frequent and in 47.8% intoxication syndrome was dominating. 78.3% of children with EPRTB were not vaccinated. Conclusion. The above indicates the need to intensify preventive measures against tuberculosis among children, especially at risk groups, make monitoring of contacts and their treatment.

Nematodes are invertebrates that inhabit the water and soil environment. Numerous nematodes are parasites of plants, animals and humans, especially children. Among the parasitic diseases of the gastrointestinal tract, diseases caused by nematodes are very common: eneterobiasis, ascariasis, and toxocarosis. From February 2022, we observe an intensive migration of people from Ukraine to the European Union countries: mainly to Poland (4.5 million) and to a lesser extent to Slovakia, Hungary and Romania. They are mostly women with children. In places where they find shelter, they try to provide children with the best possible conditions for their development. Hence the authors’ interest in hygienic conditions in the playgrounds of the European Union countries bordering Ukraine.

The aim of the study was to examine samples from selected playgrounds in Romania, Hungary, Slovakia and Poland for eggs of nematodes Ascaris lumbricoides, Toxocara sp., and Trichuris trichiura.

Twenty samples of sand and soil obtained from 4 playgrounds in Craiova (Romania), Miskolc (Hungary), Košice (Slovakia) and Lublin (Poland). In order to detect the presence of Toxocara canis/cati, Ascaris lumbricoides and Trichiuris trichiura eggs, a modified flotation method was used. No eggs of parasites were found in the examined sand samples. The pilot study suggests that refugees can safely play in the playgrounds in Romania, Hungary, Slovakia and Poland.

Children need to play outdoors. It is a natural tendency for young children to put everything in their mouths. Hygienic condition of playgrounds is important for maintaining their health. Companion animals (dogs and cats) as well as wild animals can transmit parasites that cause zoonoses in humans. Such infections often affects children playing in sandpits and playgrounds. Sand samples taken from specific locations (sandboxes, playgrounds) can be tested for the presence of parasite eggs specific to humans and animals (Ascaris, Toxocara, Trichuris). They cause ascariasis, toxocarosis, trichurosis. Invasive eggs of the parasites due to the very thick, multi-layered egg shells are very resistant to the influence of climatic factors and to chemicals present in the environment. The only way to get rid of parasite eggs from locations where they endanger human health is to remove the top layer of sand or soil or completely replace the sand. However, this is a laborious and costly procedure.

The aim of the project was to examine samples from selected playgrounds in Lublin (Polnad) in terms of the presence of Ascaris, Toxocara, and Trichuris eggs.

Thirty five samples of sand and soil obtained from 7 playgrounds in Lublin were obtained in May 2022 and tested for the presence of Ascaris, Toxocara, and Trichuris eggs with flotation method. In none of the examined samples the parasite eggs were found. The tested playgrounds in Lublin are hygienic and safe from eggs of Ascaris, Toxocara, and Trichuris.

Blood transfusion is a well-established treatment for anaemia. Herein, blood and its components are transfused to replenish circulating blood volume, maintain the oxygen capacity of the blood and normalise the function of the coagulation system. Anaemia treatment by blood transfusions is a great challenge, especially with reference to paediatric patients. Blood is irreplaceable in a life-threatening situation, but it has its own side effects, just like all applied pharmacological products. Hence, it is extremely important to carefully select donors and utilise blood components according to the patient’s individual needs. Children represent a group that requires specific criteria to be met, mainly because of the fact that their physiological and haematological systems differ from those of adults. The most common types of anaemia seen in children are deficiency anaemias such as iron-deficiency anaemia, while less common are vitamin B12 deficiency anaemia or folate deficiency anaemia. Secondary anaemia is also relatively frequent in chronic diseases, among others, immunological or infectious, as well as renal, liver, endocrine and neoplastic diseases. Anaemia due to blood loss is also included in this group. Furthermore, some anaemias, such as aplastic anaemia (due to impaired erythrocyte production) and haemolytic anaemia (due to excessive destruction of red blood cells) may be congenital or acquired. Before deciding to implement blood therapy, the patient’s clinical condition or the different haematological, biochemical and immunological parameters at different stages of life should be considered. Since each transfusion may result in a variety of post-transfusion reactions, immunisation or transmission of infectious diseases, the decision to transfuse blood or blood components should be taken only when the patient cannot be treated effectively by any other means and the expected benefits of the transfusion outweigh the risks associated with possible complications. Considering the recipients’ low blood volume, low metabolic efficiency, higher haematocrit levels than in adults and immature immune system, products for these patients should be prepared in a special way. These components must ensure minimal risk of metabolic and haemostatic disorders. The collection of these products, as well as their preparation, storage and transfusion, should be carried out in accordance with current legislation.

The placenta is considered the first interface between mother and fetus, and a normal placenta is essential for pregnancy without complications. IUGR is considered the most common condition recognized in complicated pregnancy and accounts for 26% or more of stillbirth. The current study aims to explore the presence of IUGR and placental angiogenesis by investigating the expression of VEGF and eNOS in both placenta of IUGR of CMV-infected mother and placenta of normal mother in relation to awareness of CMV in Iraqi women.

The expressions of VEGF and e NOS was studied using the avidin-biotin-peroxidase technique, while awareness was studied using 10-minute surveys in Al-Karkh directorate (Baghdad) to investigate their knowledge of CMV infection in relation to the level of education and economic status.

The expression of angiogenic factors (VEGF, eNOS) was significant in syncitiotrophoblasts, smooth muscle cells and corionic villous stromal cells, and was significant in unaware, low-educated women with low income. Increased expression of angiogenic factors of IUGR babies may be a result of unawareness of CMV infection, which leads to dysregulation of angiogenic factors, and, subsequently, to inadequate placental vascularization.

The work is aimed at producing fast disintegrating diclofenac potassium tablets to relieve pain and tenderness by applying a quality-by-design approach. Diclofenac potassium (DP) is of BCS class II and has issues of minimal oral bioavailability. This can be overcome by complexing DP with β-cyclodextrin (β-CD) and sodium starch glycolate (SSG). The attempt was to optimize DP tablets by applying central composite design (CCD). Nine different DP tablet formulations were created and assessed for physicochemical constraints, disintegration time and drug dissolution at the end of 30 min. The separate and mutual consequences of β-CD and SSG on the disintegration time of DP tablets are highly significant (P<0.01). The DP tablets made with β-CD in 150 mg disintegrated rapidly within 39±2 sec, and gave very rapid drug dissolution (96.35±2.36%) at the end of 30 min. These DP tablets (F-8) contain β-CD (150 mg) and SSG at 32.07 mg. The intermittent levels of β-CD and higher levels of SSG gave good dissolution of DP tablets. The polynomial equation linking the response, i.e. disintegration time in sec (Y₁) and the levels of β-CD (A) and SSG (B) based on the pragmatic results, is Y₁=45-3.14277A- 2.46599B-1.25AB+1.75A2-0.5B². In contrast, the DP release at the end of 30 min was expressed as Y₂ = 88.57 + 4.09333A + 3.27837B + 1.2525AB - 2A² + 0.8875B². The study concludes that SSG decreases the disintegration time with its concentration and β-CD concentration ingresses the drug release from the formulation.