The Predictive Value of Serum Aldosterone Level for Coronary Artery Calcium Score in Patients with Chronic Kidney Disease: A Single-center Study.

Patients with chronic kidney disease (CKD) have high cardiovascular risk (CVR), which is often underestimated by conventional tools. The coronary artery calcium score (CACS) significantly improves CVR stratification by conventional tools, but it is often not available in low-resources settings. Aldosterone may be a cheaper alternative to CACS for CVR assessment in CKD patients. The aim was to assess the ability of serum aldosterone level to predict CACS in patients with CKD in comparison to standard predictors. This single-center study included 57 patients aged 40 to 67 years with CKD (estimated glomerular filtration rate [eGFR] ≥45 ml/min) and arterial hypertension. Serum aldosterone, sex, age, body mass index, blood pressure, total cholesterol, eGFR, and proteinuria were used for prediction of CACS>0 Agatston units (AU) and CACS>100 AU. The area under the curve (AUC) with 95% confidence intervals (CI) and the mean Brier scores were examined for predictors of CACS. Aldosterone predicted a CACS>100 AU (AUC = 0.72, 95% CI: 0.56-0.88), but not a CACS>0 AU. Age predicted a CACS>100 AU (AUC = 0.80, 95% CI: 0.67-0.93) and a CACS>0 AU (AUC = 0.75, 95% CI: 0.62-0.89). The addition of aldosterone to age for prediction of a CACS>100 AU improved the mean Brier score, compared to the model with age alone, from 0.16 to 0.14, but not the AUC (0.83, 95% CI: 0.70-0.95). Aldosterone was a significant predictor of a CACS>100 AU in patients with CKD, but aldosterone was not a better predictor than age alone.

Gastric cancer epidemiology from 2009 to 2019 in Dnipro Region, Ukraine.

BACKGROUND: Gastric cancer (GC) is in top-five the most frequent cancers in Ukrainian males and is the third cause of death among patients with cancer. GC keeps its leading position in cancer ranks despite the decline in incidence and mortality over the last 50 years. Local epidemiological information will help in better targeting medical and public health interventions. PATIENTS AND METHODS: The data about 8438 patients with newly diagnosed GC between 2009 and 2019 was obtained from Dnipro Cancer Registry. RESULTS: Incidence decreased from 24.5 to 22.6, mortality decreased from 21.4 to 15.7 (per 100000), death rate increased from 0.64 to 1.04 between 2009 and 2019. Over 11 years of observation incidence was 23.4, mortality was 19.4, death rate was 0.721. Standardised incidence ratio was 1.42, standardised mortality rate was 1.67; age-standardised incidence was 25.5, age-standardised mortality was 21.2 (European standard). Median (95% confidence interval (95% CI)) survival of the patients was 172 (165-178) days. One-year survival rate fluctuated between 27% and 34%. Male sex and older age were associated with higher risk of death (hazard ratio (95% CI) - 1.08 (1.03-1.13) vs females and 1.15 (1.12-1.17) per 10-years increase of age, respectively). CONCLUSIONS: The study describes the trends in epidemiology of gastric cancer in Dnipro region, Ukraine, between 2009 and 2019. The need for the national prevention strategy of GC in Ukraine was identified.

Types of morbidity presenting in frontline-bordering regions of Ukraine: the experience of deploying additional mobile medical units.

INTRODUCTION: On 24 February 2022, the full-scale military invasion of Russia into Ukraine has started, creating one of the largest humanitarian crises in Europe since the World War II. As of 27 July 2022 (by the time when the most of Russian advances have already occurred), more than 900 healthcare facilities in Ukraine were damaged and 127 hospitals were destroyed completely. METHODS: Mobile medical units (MMU) were deployed in the frontline-bordering areas. An MMU included a family doctor, a nurse, a social worker and a driver, and aimed to provide medical help in remote areas. 18 260 patients who received medical help in MMUs in Dnipro (Dnipro city) and Zaporizhia (Zaporizhia city and Shyroke village) oblasts from July until October 2022 were included in the study. The patients were subdivided by month of visit, area of residence and area of MMU operation. Patients' sex, age, date of visit and diagnosis were analysed. Comparison between groups was performed using analysis of variance and Pearson's χ2 tests. RESULTS: Majority of patients were females (57.4%), people aged 60+ years (42.8%) and internally displaced persons (IDPs) (54.8%). The proportion of IDPs increased from 47.4% to 62.8% over the period of study (p<0.01). The most common cause of visit to doctors was cardiovascular diseases (17.9%). The frequency of non-respiratory infections remained stable over the period of study. CONCLUSIONS: In the frontline-bordering areas of Ukraine, females, people older than 60 years and IDPs more frequently sought medical help in MMUs. Causes of morbidity in the studied population were similar to the causes of morbidity before the beginning of full-scale military invasion. Maintaining continuous access to healthcare services may be beneficial for the patient outcomes, especially in terms of cardiovascular disease.