Turkmen State Medical University

Abstract Malnutrition is associated with an increased risk of mortality in patients with chronic heart failure (CHF). However, the nutritional habits of frail patients with CHF and its relationship with the different severity of domains of senile asthenia has not been sufficiently studied. Aim: To evaluate the nutritional status according to CONUT score in patients with CHF depending on the domains of frailty syndrome. Materials and methods: A prospective study included 150 patients over 75 years (median age [IQR] 83.0 [77.8-87.0] years, 38% (n=57) men) admitted to a multidisciplinary hospital for CHF decompensation, who were assessed for the prevalence of HFA-ESC domains (2019) – clinical, psycho-cognitive, functional and social. Nutritional status was assessed according to the CONUT score. The combined endpoint was a combination of death from all causes and repeated hospitalizations for CHF within 1 year after discharge from the hospital. Results: 96.7% (n=145) of senile patients with CHF had at least one domain of senile asthenia, the presence of all four domains was observed in more than a third of patients. Disorders in the psycho-cognitive and social spheres were the most common – 88.7% (n=133) and 74.0% (n=111), respectively, and clinical and functional domains were less common in 64.0% (n=96) and 56.7% (n=85) of patients, respectively. The presence of all four domains of frailty syndrome increases the risk of combined events from the primary endpoint by 2.5 times (OR 2.5; 95% CI 1.1-5.7, p<0.05), hospital mortality by 14.7 times (OR 14.7; 95% CI 3.3-66.4, p<0.05). The median CONUT score increased with multiple frailty domains. – 2,5±1,6, 3,2±2,5, 3,7±2,7, 3,8±2,6 and 4.6±2.9 points for 0, 1, 2, 3 and 4 domains of frailty syndrome, respectively. The CONUT score correlated with the IL-6 level (r=0.510, p<0.001). With a CONUT score ≥2, senile patients with CHF had an increased chance of an unfavorable outcome both in the short term – hospital mortality increased by 5 times (OR 5.3, 95% CI 1.6–40.7, p<0.05), and within 12 months – death from CHF or repeated hospitalization for CHF within 1 year after discharge from the hospital increased almost by 4 times (OR 3.8, 95% CI 1.2-11.6, p<0.05). Conclusion: The worst indicators of nutritional status in patients with CHF are associated with a more frequent combination of several domains of frailty syndrome. Determination of nutritional status with the CONUT score in patients with CHF is a justified method for identifying a high-risk group of unfavorable outcomes.

Background: There is a lack of information concerning the peripheral blood leukocytes sensibility on the nerve fibers and brain tissue antigens and their participation in the central nervous system (CNS) functional activity and pathology development. There is relevance of research aimed at the elaboration of the new biological markers of brain damage and nervous system diseases. Their introduction to CNS pathology diagnosis and treatment would lead to the development of new diagnostic and therapeutic strategies. Methods: This investigation focused on the sensitivity of blood leukocytes to soluble nerve fiber and brain antigens in vitro among healthy children, as well as children with epilepsy and autism. Results: It has been shown that, in vitro , some antigens of the brain and nervous tissue modulate (both inhibit and stimulate) the migration of the peripheral blood leukocytes from the glass capillary in practically healthy children. Consequently, in children without visible neurological symptoms, peripheral blood contains leukocytes that are specifically sensitized to these antigens of the brain and nervous tissue. In this regard, children with epilepsy were examined. At the beginning of treatment, the patients leucocyte sensibility to antigens significantly exceeded the reference values. During specific treatment, the indices decreased, and with a stable effect of anticonvulsant therapy, they practically returned to normal. In contrast, in children with autism, leukocyte migration in the presence of antigens was sharply reduced, compared to healthy children and children with epilepsy. Conclusions: Significant fluctuations of the leucocytes response to the nervous system and brain antigens in vitro within a group of practically healthy children make us think about the presence of hidden neurological pathology in children. In addition, the obtained data, in our opinion, indicate the diagnostic value of changes in the degree of sensitization of blood leukocytes in CNS pathology. Int J Clin Pediatr. 2024;13(3):96-100 doi: https://doi.org/10.14740/ijcp546

ObjectivesAs unrecorded alcohol use contributes to a substantial burden of disease, this study characterises this phenomenon in newly independent states (NIS) of the former Soviet Union with regard to the sources of unrecorded alcohol, and the proportion of unrecorded of total alcohol consumption. We also investigate associated sociodemographic characteristics and drinking patterns.DesignCross-sectional data on overall and unrecorded alcohol use in the past 7 days from WHO STEPwise Approach to NCD Risk Factor Surveillance (STEPS) surveys. Descriptive statistics were calculated at the country level, hierarchical logistic and linear regression models were used to investigate sociodemographic characteristics and drinking patterns associated with using unrecorded alcohol.SettingNine NIS (Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkmenistan and Uzbekistan) in the years 2013–2017.ParticipantsNationally representative samples including a total of 36 259 participants.ResultsA total of 6251 participants (19.7%; 95% CI 7.9% to 31.5%) reported alcohol consumption in the past 7 days, 2185 of which (35.1%; 95% CI 8.2% to 62.0%) reported unrecorded alcohol consumption with pronounced differences between countries. The population-weighted average proportion of unrecorded consumption in nine NIS was 8.7% (95% CI 5.9% to 12.4%). The most common type of unrecorded alcohol was home-made spirits, followed by home-made beer and wine. Older (45–69 vs 25–44 years) and unemployed (vs employed) participants had higher odds of using unrecorded alcohol. More nuanced sociodemographic differences were observed for specific types of unrecorded alcohol.ConclusionsThis contribution is the first to highlight both, prevalence and composition of unrecorded alcohol consumption in nine NIS. The observed proportions and sources of unrecorded alcohol are discussed in light of local challenges in policy implementation, especially in regard to the newly formed Eurasian Economic Union (EAEU), as some but not all NIS are in the EAEU.

Setting: The first countrywide anti-tuberculosis (TB) drug resistance survey in Turkmenistan was carried out from August 2012 to February 2013. Objective: To investigate the levels and patterns of resistance to first-line anti-TB drugs among new and previously treated pulmonary TB cases and explore the risk factors for multidrug-resistant (MDR) TB. Design: Cross-sectional study with sampling of all 64 (100%) TB diagnostic units in the country. All consecutive patients meeting the specific criteria for survey eligibility were enrolled into the study during the data intake period. Sputum samples were transported to the National TB Reference Laboratory for bacteriological culture and drug susceptibility testing to first-line anti-TB drugs. Results: Of the 731 patients enrolled, 561 were newly-diagnosed and 170 previously treated TB patients. MDR-TB was found in 13.9% (95% CI: 11.1-17.0) among the new patients and 37.6% (95% CI: 30.3-45.4) among the previously treated patients. History of previous anti-TB treatment was a risk factor for MDR-TB (OR: 3.66; 95% CI: 2.45–5.46). None of the socio-behavioral and demographic factors explored were found associated with MDR-TB. Conclusion: This is the first countrywide survey of anti-TB drug resistance to ever conducted in Turkmenistan. It was implemented according to international standards and provides valuable information for the future planning of effective programmatic management of drug resistant TB in the country.