In multivariate analysis, Group 3, but not Groups 2 and 4, had an increased risk of poor 3- and 12-month functional outcome (adjusted OR 2.59, 95% CI 1.64-4.07, P < 0.01 and OR 3.97, 95% CI 2.32-6.76, P < 0.01, respectively) compared with Group 1.
 
  Different trajectories of post-stroke DS are related to different outcomes. Patients who only have later DS also have the worst prognosis.
 Different trajectories of post-stroke DS are related to different outcomes. Patients who only have later DS also have the worst prognosis.The Government of the Republic of Armenia (RA) strives to ensure the measures to achieve good ecological status for Armenian surface water bodies.  https://www.selleckchem.com/products/Metformin-hydrochloride(Glucophage).html  However, the main goal remains unaccomplished, as the hydro-biological monitoring tools are not properly developed. Thus, the current work aims at contributing to the establishment of principles and a relevant and cost-effective biological monitoring tool for the RA aquatic ecosystems, through the development of a simplified multimetric index (MMI). Since the adoption of the decree N° 927-N from 11 Jun 2011, the baseline studies have been initiated in the six river basin management areas established in the RA. The current work is summing up the results for the Arpa River system in order to test the methodology. In particular, it is testing the possibility to develop MMI based on the use of Rapid Biological Assessment protocol accepted in our monitoring system. Also, the work represents the approach of bottom-up biotic validation of reference sites established in the recent hydro-biologic monitoring system. Due to the proposed validation procedure, further use of one of the established reference sites in the case study object has been rejected. Considering well-established approaches for MMI development in EU member states, four variations of MMI were developed for a particular river system, and the combination of Ntaxa-%EPT-Abundance(ind/m2)-BMWP-ASPT-FBI-Nfamily metrics has been proposed as the main one. However, further development of a river typology and the establishment of joint reference conditions in the Caucasus region have concluded as a priority.
  All rheumatic autoimmune diseases are associated with arthritis of the hands, whereby it is possible to differentiate between typical and atypical arthritis patterns, which arekey for diagnosis. Rheumatoid arthritis is commonly associated with synovitis of the hands. While patients with disease duration of less than 2years were previously considered to have early disease, unfavorable prognosis with delayed initiation of therapy has reduced this time frame to 3months after symptom onset.
 
  The aim is to provide radiologists with asystematic description of the clinical aspects of rheumatoid arthritis in order to better understand this entity so that they can confidently recognize arthritis patterns in the hands at an early stage.
 
  Narrative review based on the current literature on the subject from radiological and rheumatological point of view.
 
  Synovitis of the hands is a common manifestation in rheumatoid arthritis. Knowledge of the epidemiology, prevalence, incidence, pathogenesis, genetics, etiology, biology and immunology, serology, histology, clinical presentation, the classification and diagnostic criteria, and therapy is essential for the radiologist to better understand the image-based morphologic changes associated with this complex disease and thereby gain greater confidence in the diagnosis of early stages.
 
  For the diagnosis of rheumatoid arthritis, the radiologist must be familiar with basic clinical knowledge to confidently analyze the patterns present in arthritis of the hands at initial diagnosis and during the course of the disease, which are essential for therapy decisions.
 For the diagnosis of rheumatoid arthritis, the radiologist must be familiar with basic clinical knowledge to confidently analyze the patterns present in arthritis of the hands at initial diagnosis and during the course of the disease, which are essential for therapy decisions.
  Rheumatoid arthritis can cause joint destruction, especially joints of the hands. Diagnosed at an early stage, which often includes imaging methods, can minimize structural joint damage and resulting disabilities as well as avoid systemic manifestations such as cardiovascular damage through rapid and continuous so-called targeted treatment approaches.
 
  The aim of this work is the systematic description and report of imaging findings in rheumatoid arthritis as the most common autoimmunologic rheumatologic disease, which is characterized by a typical pattern of synovitis of the hands.
 
  Narrative review based on the current literature on the subject from the radiological and rheumatological point of view.
 
  Inflammation of the hands represents the most frequently affected area of the body in rheumatoid arthritis. Taking into consideration the topology and typical synovitis patterns of the hands, differences between early and late stages are described. Knowledge regarding image-based morphological changes associated with this complex disease, especially in the hands, is important in the differential diagnosis, especially in early stages of the disease.
 
  For the diagnosis of rheumatoid arthritis of the hands, the radiologist must be familiar with basic knowledge of arthritis in the hands to confidently analyze the typical patterns present in the diagnostic imaging at initial diagnosis and during the course of the disease, which serve as aguide for therapy decisions.
 For the diagnosis of rheumatoid arthritis of the hands, the radiologist must be familiar with basic knowledge of arthritis in the hands to confidently analyze the typical patterns present in the diagnostic imaging at initial diagnosis and during the course of the disease, which serve as a guide for therapy decisions.Immune thrombozytopenia (ITP) is a rare acquired thrombocytopenia occurring in 2 to 4 persons per 100,000 per year. ITP is defined as a platelet count less than 100 G/l in patients in whom other causes of thrombocytopenia have been ruled out. Severe bleeding is rare but may constitute a life-threatening condition. Therapeutic options include platelet transfusions, glucocorticoids and intravenous immune globuline (IVIG). Emergency splenectomy has to be considered in otherwise untreatable bleeding. We present the case of a 65-year-old patient with chronic refractory ITP and finally fatal bleeding.