Prognostic Factors for Evolution of Non Alcoholic Fatty Liver Disease Patients Utilizing Poisson Regression and Continuous Time Markov Chains

In the present paper, the deleterious effects of obesity, type 2diabetes and insulin resistance, systolic and diastolic hypertension on the rate of progression of fibrosis in non-alcoholic fatty liver disease (NAFLD) patients are illustrated using a new approach utilizing the Poisson regression to model the transition rate matrix. The observed counts in the transition counts matrix are used as response variables and the covariates are the risk factors for fatty liver. Then the estimated counts from running the Poisson regression are used to estimate the transition rates using the continuous time Markov chains (CTMC) followed by exponentiation of the estimated rate matrix to obtain the transition probability matrix at specific time points. Using a hypothetical data of 150 participants followed up every year for a total of 28 years recording their demographic characteristics and their timeline of follow up are demonstrated. The findings revealed that insulin resistance expressed by MOMA-IR 2 has the most deleterious effects among other factors for increasing the rate of forward progression of patients from state 1 to state 2 as well as from state 2 to state 3 and from state 3 to state 4. The higher the level of HOMA-IR is, the more rapid the rate of progression is.

Prognostic Factors for Evolution of Non Alcoholic Fatty Liver Disease Patients Utilizing Poisson Regression and Continuous Time Markov Chains

In the present paper, the deleterious effects of obesity, type 2diabetes and insulin resistance, systolic and diastolic hypertension on the rate of progression of fibrosis in non-alcoholic fatty liver disease (NAFLD) patients are illustrated using a new approach utilizing the Poisson regression to model the transition rate matrix. The observed counts in the transition counts matrix are used as response variables and the covariates are the risk factors for fatty liver. Then the estimated counts from running the Poisson regression are used to estimate the transition rates using the continuous time Markov chains (CTMC) followed by exponentiation of the estimated rate matrix to obtain the transition probability matrix at specific time points. Using a hypothetical data of 150 participants followed up every year for a total of 28 years recording their demographic characteristics and their timeline of follow up are demonstrated. The findings revealed that insulin resistance expressed by MOMA-IR 2 has the most deleterious effects among other factors for increasing the rate of forward progression of patients from state 1 to state 2 as well as from state 2 to state 3 and from state 3 to state 4. The higher the level of HOMA-IR is, the more rapid the rate of progression is.

The Impact of Superficial Vessel Density on Glaucoma Progression according to the Stage of Glaucoma

Purpose: To investigate the clinical significance of vessel density (VD) on visual field (VF) progression regarding the severity of glaucoma. Methods: A total of 130 eyes were recruited in this retrospective and longitudinal study. Superficial and deep VDs in circumpapillary and macular regions were measured via ImageJ. The rate of VF progression was defined as the mean deviation (MD) slope (dB/year). Linear regression was used to verify factors affecting deterioration of VF. The eyes with lower superficial VD were further analyzed. Results: Fifty patients with early glaucoma (EG) (MD > −6 dB) and 52 patients with moderate-to-advanced glaucoma (MAG) (MD ≤ −6 dB) were included. A faster progression rate was found in MAG (p = 0.049). Superficial VD was noticeably related to the VF progression rate in total eyes and in MAG (Both Ps ≤ 0.007, respectively). With patients in the lower half of the superficial VD, the VD was significantly associated with the rate of progression (B, 0.049, p = 0.021). This association was independent of the baseline MD and OCT parameters. Conclusion: Decreased superficial VD might conversely affect the progression of glaucoma even in MAG, which suggests superficial VD could be used as a potential marker to foresee the disease progression even in progressed eyes.

The COVID-19 Assessment for Survival at Admission (CASA) Index: A 12 Months Observational Study

Objective: Coronavirus disease 2019 (COVID-19) is a disease with a high rate of progression to critical illness. However, the stratification of patients at risk of mortality is not well defined. In this study, we aimed to define a mortality risk index to allocate patients to the appropriate intensity of care.Methods: This is a 12 months observational longitudinal study designed to develop and validate a pragmatic mortality risk score to stratify COVID-19 patients aged ≥18 years and admitted to hospital between March 2020 and March 2021. Main outcome was in-hospital mortality.Results: 244 patients were included in the study (mortality rate 29.9%). The Covid-19 Assessment for Survival at Admission (CASA) index included seven variables readily available at admission: respiratory rate, troponin, albumin, CKD-EPI, white blood cell count, D-dimer, Pa02/Fi02. The CASA index showed high discrimination for mortality with an AUC of 0.91 (sensitivity 98.6%; specificity 69%) and a better performance compared to SOFA (AUC = 0.76), age (AUC = 0.76) and 4C mortality (AUC = 0.82). The cut-off identified (11.994) for CASA index showed a negative predictive value of 99.16% and a positive predictive value of 57.58%.Conclusions: A quick and readily available index has been identified to help clinicians stratify COVID-19 patients according to the appropriate intensity of care and minimize hospital admission to patients at high risk of mortality.

STUDY OF CLINICAL AND BIOCHEMICAL INDICATORS IN MUSCLE PATHOLOGY AMONG PATIENTS WITH HEMOPHILIA

Aim. Determine the state of the biochemical composition of blood in the midst and resolution of muscle hematomas in patients with hemophilia.Materials and methods. 118 patients with hemophilia were examined. These patients were inpatient treatment at the hemophilia center at the Republican Specialized Scientific and Practical Hematology Center of the Ministry of Health of the Republic of Uzbekistan. The control group consisted of 40 apparently healthy men of the same age. Results. Signs of massive hemorrhages in the tissue are an increase in the blood level of the activity of the cytoplasmic enzyme aspartate aminotransferase (54.1 ± 3.9 and 18 ± 4.1, respectively) and alanine aminotransferase (55.3 ± 5.2 and 27.3 ± 4.4, respectively). Depending on the severity of the breakdown of muscle fibers and the rate of progression of the complication, the increase in CPK activity in myopathies can be either sharp - 680.7 ± 14.2 IU / L (hemophilic tumor, tissue necrosis), or, conversely, insignificant 120.3 ± 11.1 IU / L (muscle tissue contracture or atrophy). Deficiency of serum iron (6.4 ± 1.1 μmol / L) was revealed in all groups of examined patients with hemophilia. There was a tendency to lower cholesterol content to 3.3 ± 0.2 mmol / L. The content of urea, as the end product of protein metabolism, was higher in hemophilia patients with a syndrome of necrotic changes in hematomas – in 4 patients (9.8 ± 2.2 mmol / l), which, in our opinion, is associated with an increase in the breakdown of hemoglobin and other proteins with massive hemolysis of erythrocytes in tissues. The study of trace elements in the blood serum revealed a deficiency of Mg²+ 1.6 times, Ca²+ 2.1 times.Conclision. In patients with hemophilia with hemorrhages in muscle tissue, there was a tendency to lower cholesterol and iron levels, and an increase in the amount of bilirubin. The “key” enzymes for the diagnosis and prognosis of complications can be a dynamic study of the activity of the levels of CPK (creatine phosphokinase) and ALT (alanine aminotransferase), AST (aspartate aminotransferase).

Progression of keratoconus in children and adolescents

AimsTo evaluate the rates of keratoconus progression and associated factors in eyes of children and adolescents.MethodsRetrospective, cohort study of individuals ≤18 years old at the time of keratoconus diagnosis and with at least 6 months of follow-up. Corneal tomography was performed using an Orbscan tomographer (Bausch & Lomb, Rochester, New York, USA) to determine whether progression occurred. Tomographic progression of keratoconus was defined as a change in any of the investigated parameters (keratometry values, KMAX, maximum anterior or posterior elevation, central pachymetry, thinnest pachymetry) beyond the limits of repeatability.Results148 eyes of 106 patients with a mean age of 15.2±2.5 years were studied over a mean follow-up period of 2.9±2.2 years. The overall rate of tomographic progression was 77.0% (114/148 eyes). Eyes that progressed had more advanced disease at presentation with higher anterior curvature (KMAX55.4±6.3 vs 52.2±5.4 dioptres; p<0.01), posterior elevation (108.2±40.9 vs 86.3±35.6 µm; p<0.01) and lower central pachymetry measurements (442.1±56.7 vs 454.4±47.5 µm; p=0.01). Age at presentation, gender, atopy, documented eye rubbing, ethnicity and duration of follow-up were not significantly associated with progression in the multivariate analyses. There was a higher rate of bilateral progression if at least one eye had severe keratoconus (73.9%) compared with no severe keratoconus in either eye (36.8%; p=0.03).ConclusionsA high rate of progression was identified in keratoconic eyes of children and adolescents. More advanced disease at initial presentation may increase the risk of further keratoconus progression.

The effect of various modifiers on the course of periodontitis

The purpose of the work is to establish the degree of influence of various modifiers on the course of chronic generalized periodontitis. We examined 83 periodontal patients. During the examination, in addition to the obligatory volume, data on somatic burden and dependence on smoking were included with the determination of the number of cigarettes smoked per day. Bleeding of the gums was determined in the area of all teeth. To determine the rate of progression of periodontitis on the basis of orthopantomogram data, an indirect indicator was calculated — the decrease in the alveolar bone in relation to the patient's age. It was established by the research that the modeling of periodontitis, with an identical hygienic state of the oral cavity of patients, is affected by concomitant somatic pathology, especially diabetes mellitus, making the course of periodontitis worse; and also a bad habit — smoking, which contributes to more pronounced vascular changes in the periodontium in patients with clinical manifestations of periodontitis. Recommendations are given to take into account the concomitant pathology of internal organs and the degree of dependence of patients on tobacco smoking when planning periodontal treatment, in order to correct these risk factors and motivate the patient to cooperate with a doctor.

Algorithm of diagnosis and treatment of patients with distal occlusion in the period of replacement bite

The purpose of the work is to establish the degree of influence of various modifiers on the course of chronic generalized periodontitis. We examined 83 periodontal patients. During the examination, in addition to the obligatory volume, data on somatic burden and dependence on smoking were included with the determination of the number of cigarettes smoked per day. Bleeding of the gums was determined in the area of all teeth. To determine the rate of progression of periodontitis on the basis of orthopantomogram data, an indirect indicator was calculated — the decrease in the alveolar bone in relation to the patient's age. It was established by the research that the modeling of periodontitis, with an identical hygienic state of the oral cavity of patients, is affected by concomitant somatic pathology, especially diabetes mellitus, making the course of periodontitis worse; and also a bad habit — smoking, which contributes to more pronounced vascular changes in the periodontium in patients with clinical manifestations of periodontitis. Recommendations are given to take into account the concomitant pathology of internal organs and the degree of dependence of patients on tobacco smoking when planning periodontal treatment, in order to correct these risk factors and motivate the patient to cooperate with a doctor.