bluuebunny/crossref_metadata_2025 huggingface dataset:
The Increased Levels of Faecal Calprotectin in Children With Active Enthesitis Related Arthritis and Mri Signs of Sacroiliitis: the Results of A Single Centre Cross-Sectional Study in Juvenile Idiopathic Arthritis Patients
Authors: Lamot Lovro , Miler Marijana , Vukojevic Rudolf , Vidovic Mandica , Lamot Mirta , Trutin Ivana , Gabaj Nora Nikolac , Harjacek Miroslav
Published: August 2020

Background: Enthesitis related arthritis (ErA) is a specific subtype of juvenile idiopathic arthritis (JIA) which is often regarded as an undifferentiated form of juvenile spondyloarthritis (jSpA). Beside the arthritis of the peripheral joints, the crucial features of jSpA include enthesitis and/or arthritis of axial joints. Moreover, in adult onset spondyloarthritis gut is increasingly recognized as origin and/or target of inflammation, while the incidence of gut involvement in ErA patients is still largely unknown. The aim of this study was to assess the fCAL concentration, a surrogate marker of gut inflammation, in patients with various subtypes of JIA and non-inflammatory musculoskeletal conditions and to assess the correlation with various demographic, clinical, laboratory, imaging and treatment characteristics.Methods: This was a cross-sectional study involving 71 patients with various forms of JIA and other noninflammatory musculoskeletal diseases (NI-MSD). Along with detailed clinical and laboratory examination, fCAL and magnetic resonance imaging (MRI) of sacroiliac joints, thoracic and lumbar spine was routinely performed in all ErA patients, as well as in other patients who complained of abdominal and/or back pain, respectively. In all JIA patients, disease activity was measured using the juvenile arthritis (JADAS) or spondyloarthritis (jSpADA) disease activity score. Results: The median concentration of fCAL was highest in ErA subgroup (33.2 mg/kg, p=0.043), with a significant difference between patients with inactive and active disease (20.0 mg/kg vs 57.4 mg/kg, p=0.01), as well as between those with or without MRI signs of SIJ inflammation (22.6 mg/kg vs 54.3 mg/kg, p=0.048). In all patients, the fCAL concentration did not significantly differ among those receiving and not receiving NSAIDs (23 mg/kg vs 20 mg/kg, p=0.18), although weak correlation was found with the duration of the use (r=0.25, p=0.03).Conclusion: The (subclinical) gut inflammation might not be present only in adults with SpA, but also in children with undifferentiated forms of the jSpA, especially with active disease and/or MRI signs of SI inflammation.
Histochemical Analysis of Lacrimal Concretions in the Patients using Rebamipide Ophthalmic Suspension
Authors: Yamashita Ken , hiraoka miki , Sugita Shintaro , Yotsuyanagi Takatoshi
Published: August 2020

Backgroud: Concretions of the lacrimal drainage system can cause dacryocystitis. In the present study, our patient developed dacryocystisis with lacrimal concretions of a white soft mass. Rebamipide ophthalmic suspension had been applied for treatment of dry eye. To evaluate the pathogenic mechanism of the case, histological and chemical studies were performed.Case presentation: Our case was woman in her seventies. She had a medical history of rheumatoid arthritis. She was referred to our hospital for dacryocystitis after showing a poor response to treatment with antibiotic agents. A head computed tomography (CT) scan showed ductal high-density deposits along the lacrimal sacs. During dacryocystotomy, the hypertrophy of the lacrimal sacs was found replete with pus and cottage cheese-like white substances. The extracts were surgically removed and histological and chemical analysis was performed. The histological examination showed granulation tissues and acellular amorphous material with crystal-like structures. Positive staining by Alcian blue and Kossa was found in crystal-like legions. The extract obtained from the concretions showed the same fluorescence band and UV absorption spectrum in thin layer chromatography (TLC) and spectrometry, respectively, as rebamipide.Conclusion: Our findings suggest that the obstruction by lacrimal concretions containing rebamipide resulted in dacryocystitis in this case. In addition, it is speculated that in patients who have impaired tear secretion, refractory dacryocystitis may be evoked following the accumulation of rebamipide in the lacrimal sacs.
KIMIE: New Human Breast Milk Pasteurizer-Fully Automated, User Friendly, Cost-Effective Device for Universal Application
Authors: Waghmare Sudhir , Kharche Akshay , Kalane Shilpa , Haridas Vishakha , Patwardhan Sampada , Devaskar Uday
Published: August 2020

Natural mother’s breast milk (MBM) is the best food for all newborns especially the preterm. However, when natural MBM is not available or insufficient donor breast milk (DBM) is the second-best option. Sterifeed or HSC human milk pasteurizers have been commonly used for several decades. While these devices have served the purpose, they are relatively large, expensive, require special electrical and water connections, need a large amount of water which is not recycled and an ongoing supply of disposable plastic bottles. In addition, the use of these machines requires special training. Here we describe the development of a compact, automated, user-friendly human breast milk pasteurizer (HBMP) named Kimie capable of pasteurizing small volumes of DBM. This device does not require special water plumbing, recycles water, is inexpensive and does not require FDA approval.
Compostos bioativos e produção de biodiesel via saponificação direta da microalga Scenedesmus quadricauda (Turpin) Brébisson, 1835 (Chlorophyta: Scenedesmaceae)
Authors: Pereira Elizandra Ribeiro de Lima , Calixto Clediana Dantas , Medeiros Marcos Barros de , Araújo Vilma Barbosa da Silva , Morais Virgínia Maria Magliano , Sassi Cristiane Francisca da Costa , Fernandes Hélder Formiga , Sassi Roberto , Athayde-Filho Petrônio Filgueira de
Published: August 2020

O uso da biomassa de microalgas na produção de biocombustíveis e extração de compostos bioativos é uma área de pesquisa que tem recebido muita atenção nos últimos anos. Objetivou-se com esse estudo realizar a extração do óleo e produção de biodiesel via saponificação direta a partir da microalga Scenedesmus quadricauda (Turpin) Brébisson, 1835 (Chlorophyta: Scenedesmaceae) e posterior identificação dos compostos bioativos presentes na fração insaponificável do processo. O cultivo de S. quadricauda foi realizado num raceway (13.000 L) usando extrato de biocomposto hortifrutis enriquecido com nitrato e fosfato como meio de cultura. Foram utilizados dois métodos para extração dos ésteres metílicos de ácidos graxos (Saponificação e transesterificação). Os ácidos graxos foram extraídos utilizando hexano. O material proveniente da esterificação dos ácidos graxos obtidos via saponificação e hidrólise foi submetido a etapas de lavagem com água destilada para remoção de resquícios de solvente e catalisador. A amostra resultante foi rotaevaporada e o biodiesel obtido. Análises foram realizadas na fração insaponificável identificando a presença de compostos bioativos (carotenoides) em grande quantidade (4.050 µg/g) como rota biotecnológica de aproveitamento de biomassa residual do processo de extração e produção do biodiesel. A fração insaponificável obtida no presente estudo apresentou alto índice de antioxidantes sendo eficiente na constituição de aditivos em biodiesel na adição de 1,25% ampliando a capacidade oxidativa do biocombustível. O biodiesel obtido via saponificação não apresenta viabilidade para sua utilização puro em motores devido a sua alta viscosidade e índice de oxidação pouco estabilizado, no entanto, apresenta viabilidade para sua inserção em blendas de biocombustível.
El derecho de acceso a la justicia de los pueblos indígenas: estándares del Sistema Interamericano de Derechos Humanos
Authors: Bucetto María Sol
Published: August 2020

La obligación de suministrar recursos judiciales a las víctimas de violaciones a los derechos humanos se encuentra dentro de la obligación general a cargo de los Estados de garantizar el libre y pleno ejercicio de los derechos reconocidos por la Convención Americana de Derechos Humanos a toda persona que se encuentre sujeta a su jurisdicción. Sin embargo, la situación de vulnerabilidad en que se encuentran las comunidades indígenas y la organización y funcionamiento de las instituciones del Estado pueden resultar condicionantes a la hora de acceder a la justicia. Ante esta problemática, la Corte Interamericana ha establecido estándares específicos, que despliegan la obligación del Estado de respetar los derechos indígenas y lo instan a adoptar una serie de medidas para superar dichas limitaciones, en pos del reconocimiento del derecho a la identidad cultural y la determinación del origen étnico como un criterio prohibido de discriminación.
Aspectos penales del Derecho Ambiental y su vinculación con los Derechos del Consumidor: el caso de los residuos peligrosos
Authors: Yapur María Fernanda , Tambussi Carlos Eduardo
Published: August 2020

La relación de consumo no se limita a la contratación de bienes y servicios. Comprende también el estudio de los procesos productivos, los insumos utilizados, la producción ambientalmente adecuada y el tratamiento de los desechos. De esa manera, los conceptos de consumo y desarrollo sustentable como valores componentes de derechos humanos fundamentales se complementan mutuamente, como principios que jurídicamente postulan las condiciones para una mejor calidad de vida en el marco de un compromiso respecto de las generaciones futuras relacionado con la conservación del ambiente. Las normas penales respecto a los residuos peligrosos resguardan el ambiente, la salud y la seguridad de los consumidores, contemplando sanciones para determinadas conductas de los proveedores. Un estudio de su contenido, alcance, interpretación y definición de los bienes jurídicos protegidos en el caso del derecho argentino, donde el consumo sustentable es un principio constitucional  y legislativo de observación obligatoria por parte de los operadores e intérpretes jurídicos, convierte al derecho penal ambiental en un factor más de protección de los derechos del consumidor.
Una Nueva Visión del Mundo: la Ecología Profunda y su incipiente recepción en el Derecho Nacional e Internacional. (Cuarta Parte). Jurisprudencia Nacional
Authors: Martínez Adriana Norma , Porcelli Adriana Margarita
Published: August 2020

El presente trabajo forma parte de un proyecto de investigación que tiene por objeto el desarrollo de las diferentes posturas filosóficas, éticas y científicas que consideran a la naturaleza y a todos los seres vivientes como poblaciones o entidades con vida propia rescatando su valor intrínseco y en consecuencia, dan fundamento a concepciones jurídicas que los categorizan como sujeto de derechos y el análisis de las escasas legislaciones y casos jurisprudenciales nacionales e internacionales que la han receptado. Dada la extensión y profundidad de la temática, la misma se expone en varias partes y el presente artículo constituye la cuarta y última parte consistente en el análisis y sistematización de los casos jurisprudencial procedentes de las más altas Cortes Nacionales.
“Régimen subsidiado de salud frente al seguro regular, en la continuidad de cobertura en periodo de carencia”
Authors: Gutarra Perochena Nicolaz
Published: August 2020

La presente investigación se sustenta en una problemática relacionada a los regímenes de financiamiento en salud de la Ley Marco de Aseguramiento Universal en Salud, básicamente en la prohibición que dicha norma respecto a la duplicidad de afiliación a más de un regímenes de financiamiento, en el presente caso es el Régimen Subsidiado (SIS) frente al Régimen contributivo, a través del seguro regular (Essalud), situación que se torna compleja cuando el afiliado a este último seguro se encuentra en periodo de carencia y se vio interrumpida su atención médica y/o programación quirúrgica. Esta investigación fue realizada dentro de un enfoque cualitativo, su tipo de investigación es básica, diseño no experimental, método inductivo, tiene como muestra a 5 especialistas en seguridad social en salud, utiliza como instrumento a las entrevistas realizadasa los especialistas. Dentro del desarrollo se recogió como antecedentes internacionales a otras investigaciones del país de Colombia por la similitud de sus regímenes en salud con nuestro sistema peruano. Se llegó a la conclusión que se requiere la modificación de los Artículos 78 y 80 del Reglamento de la Ley Marco de Aseguramiento Universal en Salud.
La familia ensamblada y su inclusión en el Derecho Sucesorio Agrario: problemática juridical
Authors: Lamas Bertrán Gretcher , Londres Osorio Mary Dennis , Ramírez Thomas Dayamis
Published: August 2020

El presente artículo pretende reconocer la plenitud del goce de los derechos sucesorios de la familia ensamblada en materia agraria, pues no es secreto alguno que existen evidencias de vacíos e insuficiencias en los ordenamientos jurídicos tanto latinoamericanos como europeos vinculados a la familia, así como a la investigación en cuanto a la relación de esta institución con el Derecho Agrario en materia sucesoria. En nuestro país, rige una normativa familiar que se circunscribe estrictamente a la familia nuclear, excluyendo nuevos modelos familiares que constituyen una realidad latente en nuestra sociedad y que se encuentran completamente desprotegidos en materia normativa, tal es el caso de la familia ensamblada o reconstituida. Es por ello, que con el presente trabajo se pretende buscar vías de solución a fin de que el ordenamiento jurídico cubano brinde una protección eficaz a los miembros de estas familias, a fin de lograr un equilibrio entre la materia sucesoria agraria y el progreso social que ha presentado en los últimos años la institución familiar.
La Constitución de la Ciudad Autónoma de Buenos Aires. Su análisis a 25 años de la reforma constitucional argentina de 1994
Authors: López Alfonsín Marcelo Alberto
Published: August 2020

El trabajo analiza los distintos institutos que forman parte de la Constitución de la Ciudad Autónoma de Buenos Aires de 1996. Ésta fue sancionada en ejercicio del poder constituyente originario por una Convención ad hoc que deliberó como consecuencia del nuevo estatus jurídico-político de la Ciudad otorgado por la reforma constitucional nacional argentina de 1994, con la particularidad que su autonomía debe convivir con la condición de Buenos Aires como capital de la República. Se analizan los derechos fundamentales reconocidos y las políticas especiales que en la materia debe seguir el Estado porteño. También el juego institucional entre los distintos poderes –ejecutivo, legislativo y judicial- y los órganos de control, en el marco de un Estado Constitucional de Derecho. Por último, se realiza un balance de la autonomía porteña, que en opinión del autor es una asignatura pendiente a más de 25 años de la reforma constitucional argentina de 1994.
Una nueva perspectiva escenográfica teatral de la sala de audiencia penal
Authors: Momethiano Santiago Javier Ysrael , Ojeda Paravicino Yeniffer Stefani , Ramos García Fernando
Published: August 2020

El juzgamiento es la etapa del proceso penal que está constituida por un conjunto de debates expositivos orales, sobre la base de la investigación preparatoria,  que se lleva a cabo en la sala de audiencias, cuyo espacio se enriquecerá desde una visión escenografía teatral sujeta a la evolución de los sistemas procesales penales para una mejor solución del caso penal por el juzgador unipersonal o colegiado en el juicio oral.
Proposição De Uma Estrutura De Plano De Negócio Para Uma Empreendedora Do Ramo De Beleza Da Fronteira Sant’ana Do Livramento/Rs - Brasil E Rivera - Uruguai
Authors: Caliari Leonardo , Araujo Fernanda , Da Silva Madrid Rosemeri , Ailton da Rosa Cerqueira-Adão Sebastião
Published: August 2020

O presente estudo tem o objetivo geral de elaborar uma estrutura de plano de negócio para uma microempresa do ramo de beleza localizada na fronteira Sant’Ana do Livramento (BR) - Rivera (UY). Trata-se de uma pesquisa qualitativa, sendo os dados coletados por meio de entrevistas semiestruturadas e observações e inseridos em um software específico para elaboração de plano de negócio. Como resultado da pesquisa, foi possível edificar uma estrutura de plano de negócio que possibilitou um pré-diagnóstico da empresa, a qual possui seus processos de gestão com várias deficiências, especialmente, quanto à gestão financeira. No fim, a estrutura de plano de negócio foi entregue à empreendedora como sugestão para aplicação no seu negócio e, consequentemente, a sua adoção como ferramenta de desenvolvimento.
Implementasi Total Quality Managemen di SMPIT Abu Bakar Yogyakarta dan Implikasinya Terhadap Prestasi Sekolah
Authors: Fuadi Akhsanul
Published: August 2020

Implementation of Total Quality Management is absolutely necessary to be implemented in school to increase schools achievement . Total Quality Management is implemented by SMPIT Abu Bakar Yogyakarta as a strategy to increase a progressive achievements at the SMPIT Abu Bakar Yogyakarta. This management is implemented to every aspects to realize the progressive achievements and never stop.
The results of the implementation of the "Total Quality Management" strategy at SMPIT Abu Bakar Yogyakarta proved to be able to improve the achievements and quality of education at SMPIT Abu Bakar Yogyakarta. Based on the data starting from the 2010/2011 school year, Abu Bakar SMPIT won more than 200 championships by the students from the regency level to the national level. There was even one international event (ASEAN). There were 10 championships won by teachers from the regency level to the National level. For institutions, the school received an award as a school with national level integrity, a national family education model school, a superior quality model school at the provincial level, a champion of an environmentally friendly school for boarding program
Connected Mental Health: Systematic Mapping Study (Preprint)
Authors: Drissi Nidal , Ouhbi Sofia , Janati Idrissi Mohammed Abdou , Fernandez-Luque Luis , Ghogho Mounir
Published: August 2020

BACKGROUND

Although mental health issues constitute an increasing global burden affecting a large number of people, the mental health care industry is still facing several care delivery barriers such as stigma, education, and cost. Connected mental health (CMH), which refers to the use of information and communication technologies in mental health care, can assist in overcoming these barriers.

OBJECTIVE

The aim of this systematic mapping study is to provide an overview and a structured understanding of CMH literature available in the Scopus database.

METHODS

A total of 289 selected publications were analyzed based on 8 classification criteria: publication year, publication source, research type, contribution type, empirical type, mental health issues, targeted cohort groups, and countries where the empirically evaluated studies were conducted.

RESULTS

The results showed that there was an increasing interest in CMH publications; journals were the main publication channels of the selected papers; exploratory research was the dominant research type; advantages and challenges of the use of technology for mental health care were the most investigated subjects; most of the selected studies had not been evaluated empirically; depression and anxiety were the most addressed mental disorders; young people were the most targeted cohort groups in the selected publications; and Australia, followed by the United States, was the country where most empirically evaluated studies were conducted.

CONCLUSIONS

CMH is a promising research field to present novel approaches to assist in the management, treatment, and diagnosis of mental health issues that can help overcome existing mental health care delivery barriers. Future research should be shifted toward providing evidence-based studies to examine the effectiveness of CMH solutions and identify related issues.
Designing a Serious Game (Above Water) for Stigma Reduction Surrounding Mental Health: Semistructured Interview Study With Expert Participants (Preprint)
Authors: Wehbe Rina R , Whaley Colin , Eskandari Yasaman , Suarez Ally , Nacke Lennart E , Hammer Jessica , Lank Edward
Published: August 2020

BACKGROUND

Although in many contexts unsuccessful games targeting learning, social interaction, or behavioral change have few downsides, when covering a sensitive domain such as mental health (MH), care must be taken to avoid harm and stigmatization of people who live with MH conditions. As a result, evaluation of the game to identify benefits and risks is crucial in understanding the game’s success; however, assessment of these apps is often compared with the nongame control condition, resulting in findings specifically regarding entertainment value and user preferences. Research exploring the design process, integrating field experts, and guidelines for designing a successful serious game for sensitive topics is limited.

OBJECTIVE

The aim of this study is to understand which elements of game design can guide a designer when designing a game for sensitive topics.

METHODS

To carefully probe the design space of serious games for MH, we present Above Water (AbW), a game targeting the reduction of stigma surrounding MH, now in its second iteration. The game, AbW, serves as a consistent research probe to solicit expert feedback. Experts were recruited from a range of topic domains related to MH and wellness, game design, and user experience.

RESULTS

By using this deployment as a research probe, this study demonstrates how to synthesize gained insights from multiple expert perspectives and create actionable guidelines for successful design of serious games targeting sensitive topics.

CONCLUSIONS

Our work contributes to a better understanding of how to design specialized games to address sensitive topics. We present a set of guidelines for designing games for sensitive subjects, and for each guideline, we present an example of how to apply the finding to the sample game (AbW). Furthermore, we demonstrate the generalizability to other sensitive topics by providing an additional example of a game that could be designed with the presented guidelines.
Virtual Consultations and the Role of Technology During the COVID-19 Pandemic for People With Type 2 Diabetes: The UK Perspective (Preprint)
Authors: Quinn Lauren M , Davies Melanie J , Hadjiconstantinou Michelle
Published: August 2020

UNSTRUCTURED

The coronavirus disease (COVID-19) pandemic has presented unique challenges for people with diabetes, in addition to their high-risk stratification for infection. Supporting people with diabetes to self-care has been critical to reduce their risk of severe infection. This global pandemic has presented an opportunity to digitalize diabetes care and rapidly implement virtual diabetes clinics, with the aim of optimizing diabetes management and well-being, while keeping patients safe. We performed a rapid review of the literature to evaluate the feasibility and effectiveness of virtual clinics in diabetes care before and during the COVID-19 pandemic and have combined these findings with our own reflections in practice. We identified examples demonstrating safety and feasibility of virtual diabetes clinics, which aligns with our own clinical experience during the pandemic. The advantages of virtual clinics include reduced treatment burden, improved therapeutic alliances, societal and psychological benefits, and in our experience, innovative solutions to overcome the challenges presented by the transition from in-person to virtual care. We have provided three infographics to illustrate lessons learned and key recommendations, including steps to establish a virtual diabetes clinic, a checklist guide for health care professionals conducting virtual clinics, and a patient guide for making the most out of the virtual clinic. It is important to continue adapting to this pandemic and to make technology a sustainable option for the future of diabetes care.
Digital Health Strategies for Cervical Cancer Control in Low- and Middle-Income Countries: Systematic Review of Current Implementations and Gaps in Research (Preprint)
Authors: Rossman Andrea H , Reid Hadley W , Pieters Michelle M , Mizelle Cecelia , von Isenburg Megan , Ramanujam Nimmi , Huchko Megan J , Vasudevan Lavanya
Published: August 2020

BACKGROUND

Nearly 90% of deaths due to cervical cancer occur in low- and middle-income countries (LMICs). In recent years, many digital health strategies have been implemented in LMICs to ameliorate patient-, provider-, and health system–level challenges in cervical cancer control. However, there are limited efforts to systematically review the effectiveness and current landscape of digital health strategies for cervical cancer control in LMICs.

OBJECTIVE

We aim to conduct a systematic review of digital health strategies for cervical cancer control in LMICs to assess their effectiveness, describe the range of strategies used, and summarize challenges in their implementation.

METHODS

A systematic search was conducted to identify publications describing digital health strategies for cervical cancer control in LMICs from 5 academic databases and Google Scholar. The review excluded digital strategies associated with improving vaccination coverage against human papillomavirus. Titles and abstracts were screened, and full texts were reviewed for eligibility. A structured data extraction template was used to summarize the information from the included studies. The risk of bias and data reporting guidelines for mobile health were assessed for each study. A meta-analysis of effectiveness was planned along with a narrative review of digital health strategies, implementation challenges, and opportunities for future research.

RESULTS

In the 27 included studies, interventions for cervical cancer control focused on secondary prevention (ie, screening and treatment of precancerous lesions) and digital health strategies to facilitate patient education, digital cervicography, health worker training, and data quality. Most of the included studies were conducted in sub-Saharan Africa, with fewer studies in other LMIC settings in Asia or South America. A low risk of bias was found in 2 studies, and a moderate risk of bias was found in 4 studies, while the remaining 21 studies had a high risk of bias. A meta-analysis of effectiveness was not conducted because of insufficient studies with robust study designs and matched outcomes or interventions.

CONCLUSIONS

Current evidence on the effectiveness of digital health strategies for cervical cancer control is limited and, in most cases, is associated with a high risk of bias. Further studies are recommended to expand the investigation of digital health strategies for cervical cancer using robust study designs, explore other LMIC settings with a high burden of cervical cancer (eg, South America), and test a greater diversity of digital strategies.
Integration of Motor Learning Principles Into Virtual Reality Interventions for Individuals With Cerebral Palsy: Systematic Review (Preprint)
Authors: Demers Marika , Fung Karen , Subramanian Sandeep K , Lemay Martin , Robert Maxime T
Published: August 2020

BACKGROUND

Increasing evidence supports the use of virtual reality systems to improve upper limb motor functions in individuals with cerebral palsy. While virtual reality offers the possibility to include key components to promote motor learning, it remains unclear if and how motor learning principles are incorporated into the development of rehabilitation interventions using virtual reality.

OBJECTIVE

The objective of this study was to determine the extent to which motor learning principles are integrated into virtual reality interventions targeting upper limb function in individuals with cerebral palsy.

METHODS

A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was performed in 10 databases using a combination of keywords related to cerebral palsy, virtual reality, video games, and rehabilitation. Studies were divided into 2 categories: commercial video game platforms and devices and custom virtual reality systems. Study quality was assessed using the modified Downs and Black checklist.

RESULTS

The initial search yielded 1497 publications. A total of 26 studies from 30 publications were included, with most studies classified as “fair” according to the modified Downs and Black checklist. The majority of studies provided enhanced feedback and variable practice and used functionally relevant and motivating virtual tasks. The dosage varied greatly (total training time ranged from 300 to 3360 minutes), with only 6 studies reporting the number of movement repetitions per session. The difficulty progression and the assessment of skills retention and transfer were poorly incorporated, especially for the commercial video games.

CONCLUSIONS

Motor learning principles should be better integrated into the development of future virtual reality systems for optimal upper limb motor recovery in individuals with cerebral palsy.

CLINICALTRIAL

PROSPERO International Prospective Register of Systematic Reviews CRD42020151982; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020151982
Impact of Social Media on Health-Related Outcomes Among Older Adults in Singapore: Qualitative Study (Preprint)
Authors: Han Madeline , Tan Xin Yi , Lee Rachael , Lee Jeong Kyu , Mahendran Rathi
Published: August 2020

BACKGROUND

The worldwide spread of digitalization has led to the harnessing of technology to improve health outcomes. Paying attention to older adults’ social needs via social media is one way to promote healthy aging. Although 56% of older adults are smartphone users, little is known about their use patterns of social media.

OBJECTIVE

This exploratory study aims to determine the experiences of social media apps’ use among older adults in Singapore and understand their perceptions of its impact on health-related outcomes.

METHODS

This study used a qualitative research design with an interpretative approach. Using maximum variation purposive sampling, normal aging older adults (N=16) who were aged between 60 and 80 years and experienced in the use of internet-enabled technology were recruited from an existing community study. Semistructured, in-depth interviews were conducted. Employing a thematic analysis, interviews were transcribed verbatim and analyzed for codes inductively.

RESULTS

The following themes and subthemes were identified as key moderators of older adults’ experiences on social media apps: (1) personal attitudes: participants were encouraged to use social media due to the increased accessibility, which enabled the ease of contact, but perceptions that the quality of interactions was compromised and its associated risks reduced their use; and (2) social influences: the desire to bond with co-users and the availability of support increased use. In addition, use of social media apps was perceived to positively impact health through its ability to keep older adults cognitively engaged, improve health communication, and increase social connectedness. However, opinions remained mixed on older adults’ vulnerability to social media addiction.

CONCLUSIONS

Personal and social contexts determine older adults’ social media use. This study’s findings provide practical insights into how social media can be deployed to improve health-related outcomes in older adults.

CLINICALTRIAL
Carbohydrate metabolism disorders at Cushing disease onset
Authors: Pertseva N.O. , Chursinova T.V.
Published: August 2020

Atypical forms of endogenous hypercorticism, which are manifested in non-specific symptoms such as arterial hypertension, diabetes mellitus, obesity, are increasingly common in clinical practice to date. Considering that patients with hypercorticism have high risk of cardiovascular mortality, timely diagnosis is important. The clinical case was presented when Cushing disease manifested itself in the development of diabetes mellitus, arterial hypertension, rapid weight gain and no skin symptoms. Timely surgical treatment led to a complete regression of diabetes mellitus, normalization of blood pressure and weight of the patient.
Clinical features and risk factors of diabetes-associated osteoarthritis
Authors: Orlenko V.L. , Tronko М.D. , Yelizarova O.T.
Published: August 2020

Background. At present, data regarding the role of va­rious risk factors for the development of joint damage in patients with diabetes mellitus (DM) are extremely controversial. Particularly many questions remain regarding the clinical manifestations of this complication, since the development of diabetic arthropathies is a complex and multifaceted process that depends on the type of DM. The purpose of our study was to investigate the clinical features of diabetic arthropathy and to identify plausible risk factors for joint damage in patients with type 1 and 2 DM. Mate­rials and methods. Five hundred and fifty-six patients were divided into groups according to the type of DM, the presence and severity of diabetic arthropathy. Diagnosis of arthropathies was performed ­using the radiographic method and ultrasound of the joints. Results. In the group of patients with type 1 DM, arthropathy was diagnosed in 185 (74.5 %) cases, and in type 2 DM, joint lesions were detected in 241 (78.2 %) individuals. It was found that in the vast majority of patients with DM of both types, arthropathy was localized in the joints of the upper extremities. Most often, small distal or proximal joints of the hand and one of the large joints were involved in the pathological process. Oligoarthritis is characteristic of patients with type 1 DM, whereas polyarthritis is more common in patients with type 2 DM (t = 4.88, p ≤ 0.001). It was found that the risk of developing arthropathy in patients with type 1 DM increases significantly after 35 years, with body mass index (BMI) greater than 25.0 kg/m2, HbA1c levels higher than 8.0 %, and DM duration over 28 years. In patients with type 2 DM, the likelihood of developing arthropathy is increased in patients aged 61 years and older, with HbA1c levels greater than 8.2 %, BMI of 27.9 kg/m2 and above and the duration of diabetes more than 14 years. Conclusions. Preventive measures for diabetic arthropathy should be based on the maintenance of target HbA1c levels of less than 8 % for patients with type 1 DM and 8.2 % for people with type 2 DM, and BMI not higher than 25.0 kg/m2 for individuals with type 1 DM and 27.8 kg/m2 for those with type 2 DM.
Carney complex manifested itself in pituitary somatotropinoma and Cushing syndrome: a clinical case and current understanding of the problem
Authors: Cherenko S.M. , Cherenko M.S. , Martsinik E.M.
Published: August 2020

Background. Carney complex (CC) is a rare genetic disorder, which causes numeral neoplastic lesions of endocrine organs, skin, uterus, heart, and others. It is the first in Ukraine detailed description of a clinical case of CC with analysis of modern literature. The purpose was to discuss the variety of CC appearance and relevant directions of diagnosis, treatment and follow-up within the framework of a clinical case and literature review. Materials and methods. Well investigated and illustrated case of CC in a young woman was studied. Results of surgical treatment of somatotropinoma and primary pigmented nodular adrenocortical disease (PPNAD) were presented. Unilateral adrenalectomy has led to the persistent elimination of hypercortisolemia and confirmed the clinical diagnosis. Authors supplement a clinical case with detailed study of modern literature. Results. Patient underwent successful surgical treatment of pituitary somatotropinoma and PPNAD. During the first 10 months after unilateral adrenalectomy, moderate adrenal insufficiency still persisted. Due to the correct diagnosis of CC (despite the absence of molecular confirmation of this genetic disease), cardiac myxoma, uterine fibroid and thyroid nodules have been revealed. It will be the points of further investigations at follow-up. Conclusions. Even if genetic testing is unavailable, clinical suspicion could induce the investigation of possible CC. Unilateral adrenalectomy for PPNAD as a component of CC may be sufficient initial treatment option for Cushing syndrome.
Отражает ли название «диффузный токсический зоб» структурное состояние щитовидной железы при этой нозологии?
Authors: Buldyhina Yu.V.
Published: August 2020

Актуальность. Диффузный токсический зоб (ДТЗ) (болезнь Грейвса) является аутоиммунным заболеванием щитовидной железы (ЩЖ), распространенность которого неуклонно возрастает в структуре тиреоидной патологии, и составляет около 80 % всех причин гипертиреоза. Целью нашей работы было исследование структурного состояния ЩЖ у больных ДТЗ. Материалы и методы. Изучали цитологическую структуру узловых образований при ДТЗ (болезни Грейвса). Исследование проводилось в клинике ГУ «Институт эндокринологии и обмена веществ им. В.П. Комиссаренко НАМН Украины» и в Киевском городском центре эндокринной хирургии. Всего обследованы 310 пациентов с ДТЗ: 285 (91,94 %) женщин и 25 (8,06 %) мужчин, возраст которых варьировал от 19 до 70 лет (в среднем составил 41,25 ± 1,19 года). Длительность заболевания на момент начала обследования колебалась от одного месяца до 15 лет (в среднем 25,09 ± 2,76 месяца). Для определения объема и структуры ЩЖ проводились пальпаторное и ультразвуковое исследование, а также тонкоигольная аспирацинная пункционная биопсия с цитологическим исследованием пунктата и компъютерная томо­графия (КТ) органов шеи. Для установления/подтверждения диагноза осуществлялось гормональное обследование (определение в крови уровней тиреотропного гормона, свободного тироксина, свободного трийодтиронина, а также антител к рецептору тиреотропного гормона). Результаты. Доля больных с диффузным зобом без узловых образований в ЩЖ составляла 78,39 %, количество пациентов без увеличения объема ЩЖ — 2,58 %, с узловыми образованиями — 19,03 %. Среди пациентов с узловыми образованиями преобладали больные с доброкачественными аденоматозными (54,24 %) и коллоидными узлами (25,42 %). Папиллярная карцинома диагностирована у двух больных ДТЗ (3,39 %). КТ органов шеи и средостения позволила установить, что при относительно небольших размерах диффузного зоба (18,00 ± 2,78 см3) существует вероятность наличия значительной ретротрахеальной части ЩЖ. Выводы. Применение термина «болезнь Грейвса» для определения данной патологии является более целесо­образным, поскольку облегчает формулировку полного диагноза и коммуникацию с западными коллегами.
Повышение эффективности лечения пациентов с метаболическим синдромом путем применения комплекса селена и витаминов Оксилик
Authors: Pashkovska N.V. , Abramova N.O.
Published: August 2020

Актуальность. Метаболический синдром (МС) поражает примерно четверть населения планеты и сопровождается абдоминальным ожирением и инсулинорезистентностью, которые являются факторами дислипидемии, артериальной гипертензии и гипергликемии. Синдром нетирео­идной патологии развивается у 75 % госпитализированных пациентов и сопровождается периферическим гипотиреозом из-за подавления периферической конверсии тиреоидных гормонов. Так как около 80 % гормонов щитовидной железы производится в периферических органах и они регулируют почти все процессы в организме, патологические изменения, которые сопровождают нетиреоидную патологию, можно считать существенными и требующими коррекции. Однако эффективность сложных витаминных комплексов в сочетании с селеном при лечении МС остается неизвестной. Цель исследования: изучить эффективность лечения нарушений углеводного, липидного обмена, эндотелиальной функции, антиоксидантной системы, тиреоидного гомеостаза у больных с МС путем применения комплекса Оксилик. Материалы и методы. Нами исследована эффективность назначения комплекса селена и витаминов Оксилик по одной капсуле в течение одного месяца с целью влияния на звенья МС. Для подтверждения эффективности предлагаемого способа лечения нами обследовано и пролечено 65 пациентов с МС: 30 больных МС (первая группа), получавших Оксилик в течение одного месяца на фоне базисного лечения антигипертензивными и сахароснижающими препаратами, и 35 человек с МС (вторая группа), получавших только базисную терапию. Результаты. Дополнительное назначение комплекса Оксилик пациентам с МС по одной капсуле в течение одного месяца приводит к достоверному улучшению чувствительности рецепторов к инсулину, что отражается в снижении индекса HOMA-IR, показателей функционального состояния эндотелия (снижение продукции сосудистого эндотелиального фактора роста и десквамации эндотелиоцитов) и липидного обмена (снижение общего холестерина, рост липопротеинов высокой плотности и снижение коэффициента атерогенности), снижении титра уровня свободного тироксина (свТ4), возрастании свободного трийодтиронина (свТ3) и соотношения свТ3/свТ4, что свидетельствует об улучшении периферической конверсии тиреоидных гормонов путем повышения периферического дейодирования Т4 в более активный Т3. Выводы. Комплекс селена и витаминов Оксилик можно рекомендовать для больных с метаболическим синдромом.
Аутоиммунный полигландулярный синдром: сахарный диабет 1-го типа, тиреоидит Хашимото, системная красная волчанка, ревматоидный артрит и целиакия
Authors: Xhardo E. , Agaçi F.
Published: August 2020

Аутоиммунитет подразумевает патологический сбой иммунной системы организма, направленный против собственных тканей, что вызывает большое количество заболеваний. Различные аутоиммунные расстройства связаны между собой, но редко можно наблюдать несколько аутоиммунных заболеваний у одного пациента. Аутоиммунный полигландулярный синдром (АПС) — это состояние, характеризующееся тремя или более аутоиммунными нарушениями у одного человека. Семейные, иммунологические и инфекционные факторы вовлечены в патогенез АПС. Авторы описывают клинический случай одновременного наличия пяти аутоиммунных заболеваний у 33-летней женщины, а именно: сахарного диабета 1-го типа, аутоиммунного гипотиреоза, системной красной волчанки, ревматоидного артрита и целиакии, что обусловило окончательный диагноз: аутоиммунный полигландулярный синдром 3-го типа с целиакией. Пациенты с одним аутоиммунным расстройством имеют повышенный на 25 % риск развития других аутоиммунных нарушений. В этом случае клиницисты подчеркивают необходимость постоянного наблюдения за развитием новых аутоиммунных заболеваний у предрасположенных к ним пациентов. Возможность возникновения трех или более аутоиммунных нарушений у одного пациента не может быть случайностью и свидетельствует о патогенетической связи между каждым из них. Наличие одного аутоиммунного заболевания уже настораживает относительно появления другого. Возникновение аутоиммунных полигландулярных симптомов свидетельствует о необходимости постоянного наблюдения за развитием новых аутоиммунных заболеваний у предрасположенных к ним пациентов. Ранняя идентификация отдельного случая АПС необходима для снижения заболеваемости и смертности, связанных с АПС. Описанный клинический случай представляет интерес вследствие редкой ассоциации сразу 5 аутоиммунных расстройств. Эти заболевания у одного пациента позволяют диагностировать аутоиммунный полигландулярный синдром 3-го типа с целиакией. Более того, данный случай АПС подчеркивает важность надлежащего клинического наблюдения за пациентами с одним аутоиммунным расстройством, поскольку они имеют больший риск развития другого аутоиммунного заболевания.
Влияние соблюдения безглютеновой диеты на дефицит витаминов и микроэлементов у больных целиакией
Authors: Civan Hasret Ayyildiz
Published: August 2020

Актуальность. Целиакия — хроническое заболевание иммунного генеза, характеризующееся задержкой роста и мальабсорбцией, связанной с повреждением слизистой оболочки и воспалением тонкой кишки у генетически предрасположенных людей в результате воздействия глютена. При лечении целиакии достигается клиническое, гистологическое и серологическое улучшение состояния путем соблюдения безглютеновой диеты. Цель исследования: оценить уровень витаминов и микроэлементов у больных целиакией при соблюдении безглютеновой диеты. Материалы и методы. Под наблюдением находились 77 пациентов с диагнозом «целиакия», выявленным ретроспективно. Все случаи были подтверждены гистологически по классификации Marsh, все пациенты обследованы на фоне соблюдения безглютеновой диеты. Демографические особенности, возраст начала заболевания, результаты клинического обследования, антропометрические показатели и лабораторные результаты сравнивали в группах больных, которые придерживались диеты, и при ее отсутствии. Результаты. В исследование были включены 77 больных (48 женщин и 29 мужчин) с целиакией, средний возраст которых составил 9,81 ± 4,73 года. В основном у пациентов обнаружены гистологически по классификации Marsh типы 3a (n = 22) и 3b (n = 20). Результаты серологического скрининга показали, что в 40,3 % случаев (n = 31) больные соблюдали безглютеновую диету, тогда как в 59,7 % (n = 46) — не соблюдали. У больных этой группы отмечались достоверно более низкие показатели содержания витамина В12, витамина D, фолатов, цинка и селена по сравнению с группой больных, которые соблюдали соответствующую диету (p = 0,000; 0,000; 0,000; 0,000 и 0,031 соответственно). Кроме того, был обнаружен достоверно более высокий средний уровень общего IgA в сыворотке крови в группе больных без соблюдения диеты по сравнению с группой больных, которые соблюдали безглютеновую диету (p = 0,027). Выводы. Установлена высокая эффективность безглютеновой диеты для коррекции недостаточности и дефицита витаминов и микроэлементов. Необходимо детально информировать пациентов с целиакией и их семьи о неуклонном пожизненном соблюдении безглютеновой диеты, хотя соблюдение такого питания создает немало социальных и практических трудностей.
Частота асимптоматической гиперурикемии среди взрослых больных сахарным диабетом 1-го и 2-го типа
Authors: Cherniaieva A.A.
Published: August 2020

Цель исследования — изучить частоту асимптоматической гиперурикемии у больных сахарным диабетом (СД) 1-го и 2-го типа в украинской популяции на примере жителей г. Харькова и области. Материалы и методы. Обследованы 316 больных СД: 81 больной СД 1-го типа (группа 1), 150 больных СД 2-го типа (группа 2) и 85 больных СД 2-го типа с абсолютной инсулинозависимостью (группа 3). Оценку состояния пуринового обмена проводили путем определения концентрации мочевой кислоты в сыворотке крови и моче. Уровни мочевой кислоты определяли колориметрическим методом с помощью набора реагентов «СпайнЛаб, UricasePOD» (Украина). Для оценки влияния возраста больного, возраста больного на момент манифестации заболевания, продолжительности заболевания и индекса массы тела группы обследуемых были разделены на две подгруппы (А и Б соответственно) с учетом уровня урикемии и урикурии. Подгруппу 1А составили 60 больных СД 1-го типа без гиперурикемии (ГУ) и/или гиперурикурии (ГУУ), подгруппу 1Б — 21 больной с ГУ и/или ГУУ, подгруппу 2А — 76 больных без ГУ и/или ГУУ, подгруппу 2Б — 74 больных с ГУ и/или ГУУ, подгруппу 3А — 57 больных без ГУ и/или ГУУ, подгруппу 3Б — 28 больных с ГУ и/или ГУУ. Результаты. Частота нарушений пуринового обмена среди взрослых больных СД 1-го и 2-го типа составляет 38,9 %. Самая высокая частота нарушений пуринового обмена наблюдается у больных СД 2-го типа (49,3 %). Возраст больного при проведении исследования и на момент манифестации СД, продолжительность заболевания и индекс массы тела не являются определяющими факторами, влияющими на формирование нарушений пуринового обмена у больных СД 1-го и 2-го типа; возрастной фактор и продолжительность заболевания являются факторами риска нарушений пуринового обмена у больных СД 2-го типа с абсолютной инсулинозависимостью. Выводы. Асимптоматическая гиперурикемия диагностирована у 27,8 % обследованных больных сахарным диабетом. Частота асимптоматической гиперурикемии значительно выше у больных сахарным диабетом 2-го типа, чем у больных сахарным диабетом 1-го типа (3,48 и 24,4 % соответственно); абсолютная инсулинозависимость у больных сахарным диабетом 2-го типа не влияет на частоту асимптоматической гиперурикемии.