[Blood pressure telemonitoring and remote counseling in uncontrolled hypertension].

Telehealth is a useful adjunct in hypertension (HTN) management. Despite obvious short-term clinical benefit, long-term social impact and cost-effectiveness have not been fully investigated. AIM: Predictive modeling of long-term clinical and social outcomes and the cost-effectiveness analysis of blood pressure (BP) telemonitoring and remote counseling (BPTM) in patients with HTN. MATERIALS AND METHODS: A Markov cohort-based (1000 patients in each study arm) model was developed and adopted a 10-year time horizon with 12-month time cycles. Cost and outcome data collected from the three-month study of 240 patients (160 in BPTM group and 80 controls, 48 y.o.). All patients started at a non-complicated HTN well state with a certain possibility of disease progression in a number of health states over a discrete time period. BPTM was compared with usual care in terms of 10-year healthcare costs, quality adjusted life years (QALY) using a Ministry of Health of Russian Federation perspective. RESULTS: In the long-term run when compared with usual care BPTM was more effective in terms mortality (67 versus 91 patients lost and 9.6 versus 9.71 life years gained) and costs (cost of illness 102 508 000 RUR versus 145 237 700 RUR). Taking quality of life measures into account, the effect of BPTM was also more pronounced (8.31 versus 7.82 QALYs gained). The resultant incremental cost-utility ratio for BPTM was 275 178.98 RUR/1 QALY gained/1 patient (134 837.70 RUR/0.49 QALY/1 patient). CONCLUSION: According to the results of predictive modeling, implementation of BPTM into clinical practice is likely lead to reduced cardiovascular morbidity and mortality in a cost-effective way.

[Assessment of the clinical efficacy of telemonitoring and distant counseling in patients with uncontrolled hypertension].

The aim of the study was to investigate the mathematical correlation of the clinical efficacy of blood pressure telemonitoring and distant counseling (BPTM) in patients in uncontrolled hypertension (HTN). Telehealth tools are widely used in HTN management. However clinical efficacy of such interventions assessed mainly in groups investigated without its populational and attributable impact. Materials and methods. The total of 240 patients were included, then randomized in 2:1 manner to BPTM group (n=160, median age 47 y.o.) and control group (n=80, median age 49 y.o). The user - friendly and secure telehealth software was provided with mobile application (patients) and desktop (doctors) platforms which allowed storage and analysis of self-BP monitoring data and remote consultations. A three - month surveillance was designed with mandatory baseline and final face - to - face visits with the assessment of office systolic BP (oSBP). Mathematical evaluation was based on target SBP rates achieved in comparator groups and included the absolute efficacies (AE), the attributable efficacy (AtE), the relative efficacy (RE) and the population attributable efficacy (PAtE). Results. BPTM group characterized by larger decrease in SBP level compared with controls (-16.8±2.9 mm Hg versus -7.9±3.9 mm Hg; p.

Biophysical characterization of glycodendrimers as nano-carriers for HIV peptides.

This paper examines the formation and stability of nano-complexes that could provide a new therapeutic approach against HIV-1 infection. Poly(propylene imine) glycodendrimers decorated with 2(nd) generation cationic carbosilane dendrons were generated and their use in polyplex formation checked. Owing to their positively-charged terminal amino groups the hybrid glycodendrimers can bind anionic peptides. It was shown that they form nano-complexes with the HIV-derived peptides P24, Gp160 and Nef. Complexes 130-190 nm in size were formed in molar ratios (dendrimer/ peptide) of (3-4):1. These were sufficiently stable over time and at different pHs. The results obtained suggest that the hybrid dendrimers studied can be considered as alternative carriers for delivering HIV peptides to dendritic cells.

Glycodendrimers as new tools in the search for effective anti-HIV DC-based immunotherapies.

Dendritic cells (DC), which play a major role in development of cell-mediated immunity, represent opportunities to develop novel anti-HIV vaccines. Dendrimers have been proposed as new carriers to ameliorate DC antigen loading and in this way, we have determined the potential use of maltose decorated neutrally and positively charged G4 glycodendrimers. Thus, immunostimulatory properties of these glycodendrimers on human DC were evaluated in the context of HIV infection. We have demonstrated that DC treated with glycodendrimers were fully functional with respect to viability, maturation and HIV-derived antigens uptake. Nevertheless, iDC and mDC phenotypes as well as mDC functions such as migration ability and cytokines profile production were changed. Our results showed the potential carrier properties of glycodendrimers to activate the immune system by the way of DC stimulation. This is the first study for exploring the use of maltose-functionalized dendrimers-peptides complexes as a potential DC-based vaccine candidate. FROM THE CLINICAL EDITOR: In this paper, maltose-functionalized dendrimer-peptide complexes are demonstrated to activate the immune system by way of dendritic cell (DC) stimulation. DC vaccination using this methodology may be applicable to a variety of conditions, including infections and potentially cancer.

Mechanism of neuroprotection of melatonin against beta-amyloid neurotoxicity.

The main component of senile plaques in Alzheimer's disease (AD), aggregated amyloid beta peptide (ßA), is neurotoxic and implicated in AD pathology. Melatonin is a hormone secreted from the pineal gland, levels of which are decreased in aging, particularly in AD subjects. This hormone is known to possess neuroprotective properties against ßA toxicity in vivo, but the mechanism of protection remains controversial. In cultures of mixed neurones and astrocytes, we find that melatonin is protective against neuronal and astrocytic death induced by aggregated full length ßA 1-40 and the fragments ßA 25-40 and ßA 1-28. Melatonin had no effect on the process of fibrillation of ßA and did not alter ßA-induced calcium signalling in astrocytes, but did significantly reduce the rate of ßA-induced reactive oxygen species production and also protected astrocytes against the mitochondrial depolarisation. Thus, scavenging of reactive oxygen species by melatonin appears to be the primary effect of melatonin in protecting neurones and astrocytes against ßA toxicity.

[Adrenal hemorrhage in a newborn with factor V Leiden--a clinical case].

Neonatal adrenal hemorrhage is frequently associated with birth trauma, perinatal asphyxia, septicemia, coagulation defects and thromboembolism. We report a case of bilateral adrenal hemorrhage in newborn baby with perinatal asphyxia. Ultrasound findings of subacute adrenal hemorrhage draw attention to its presumable antenatal genesis. DNA analysis for thrombophilic mutations identifies factor V Leiden.

[Prevention of anemia of prematurity].

Anemia of prematurity is seen in infants of less than 32 weeks' gestation. This anemia is due to low erythropoietin level and endogenous insufficiency of iron and vitamins. Administering of recombinant human erythropoietin, iron and vitamins in time is logic prevention alternative. The aim of our study is to examine the frequency of late haemotransfusions as an indicator of this prevention. We have investigated 181 children, who were born before the 32nd gestational week and who were distributed in two groups: group A (with prevention) and group B (without prevention). We found no significant difference in the frequency of the late transfusions between the two groups, but the results of the prevention in the most mature infants were better than those of the infants who were born before the 30th gestational week.

[Active screening for genetic pathology in newborns. I. Registration of congenital abnormalities]. / Aktiven skrining za genetichna patologiia sred novorodeni. I. Registratsiia na vrodeni anomalii.

Active screening for genetic pathology over a period of 12 years (1990-2001) involved examination of 29,629 newborns at the Clinic of Obstetrics and Gynaecology. Congenital anomalies were detected in 1244 cases (live-, stillbirths and terminated pregnancies) which gives an average incidence rate of 42.0 per 1000 among the studied population. Congenital cardiac anomalies and CA of the central nervous system were the most common types of isolated CA. They provided frequencies of 7.76 per 1000 and 6.85 per 1000 cases respectively. The incidence of the neural tube defects (NTD), particularly, varied throughout the years (t = 2.69; p < 0.01) but stated high--on average 2.12 per 1000 with the highest rate of 3.89 per 1000 in 1993. A reduction in the incidence of NTD is possible with a recommendation of periconceptional folic acid supplementation. Registration of CA is a strategy for identifying families at risk to give births of child with CA. This approach enabled us to provide more accurate genetic counselling and prenatal diagnosis for genetic pathology. Active screening of newborn population is likely to be an effective and necessary service.

[Congenital anomalies among live-birth infants and their place in the structure of neonatal mortality--the Higher Medical Institute, Pleven (1993-97)]. / Vrodeni anomalii sred zhivorodenite i miastoto im v strukturata na neonatalnata smurtnost--VMI, Pleven (l993-97).

The aim of the study was to determine the frequency of the congenital anomalies (CA) among the live-born (LB), the structure of the neonatal mortality (NM) and the impact of congenital anomalies on it. Congenital anomalies were found in 171 (2.71%) of 11,902 infants born and hospitalized at the Clinics of Neonatology--Pleven between 1993 and 1997. 171 (14.4% o) of all LB died in 28 day after delivery. Noninfectious lung pathology and CA were responsible for respectively 28.7% and 27.5% of these deaths and were the main causes of NM. Multiple congenital anomalies and CA of cardio-vascular system were the most frequent CA that caused these deaths. The major part of the CA with genetic basis (64%) emphasizes the importance of the registration of CA and the genetic counselling for declining the NM rate.

[The sensitivity, specificity and prognostic values of peripheral secretions in the neonatal intensive unit]. / Chuvstvitelnost, spetsifichnost i prognostichni stoinosti na periferni sekreti v neonatologichnoto intenzivno otdelenie.

We analyzed cultures (body surface and blood) from 125 infants-64 of them with proved neonatal bacterial sepsis. Isolates from cultures of material from the ear canal, nasopharynx, stomach, endotracheal tube were compared to those recovered from blood. The optimum sensitivity, specificity, and positive predictive values of surface cultures were 40%, 70.6% and 66.7% respectively. We conclude that surface cultures are of limited in predicting the etiology of sepsis in neonates.