Terapevticheskii arkhiv

Background. Cardiovascular diseases (CVD) and chronic obstructive pulmonary disease (COPD) are the two leading causes of death in the world. Studies show a close mutually aggravating relationship between arterial hypertension (AH) and COPD. Antihypertensive therapy in patients with AH and COPD has a number of features, aiming to reduce the risk of developing cardiovascular complications and mortality from CVD without worsening lung function.

Aim. To analyze the data of patients with AH and COPD included in the national registry to determine the burden of CVD risk factors, concomitant cardiovascular, cerebrovascular diseases and chronic kidney disease, obesity, diabetes mellitus, gout and characteristics of antihypertensive therapy.

Materials and methods. A comparative analysis of patients of the hypertension registry (conducted in outpatient clinics) was performed depending on the presence (n=3323) or absence (n=54073) of chronic obstructive pulmonary disease. Statistical analysis of the obtained data were performed using the R 4.3.3 statistical computing environment (R Foundation for Statistical Computing, Vienna, Austria).

Results. The prevalence of COPD in patients with hypertension was 5.8% (3323 cases). The presence of COPD in patients with hypertension, regardless of gender and age, was statistically significantly associated with higher odds of having coronary artery disease [odds ratio (OR) 2.21, 95% confidence interval (CI) 2.06–2.38; p<0.001], a history of myocardial infarction (OR 1.73, 95% CI 1.59–1.87; p<0.001), chronic heart failure (OR 1.95, 95% CI 1.82–2.1; p<0.001), a history of acute cerebrovascular accident (OR 1.25, 95% CI 1.07–1.46; p=0.004), transient ischemic attack (OR 2.9, 95% CI 2.31–3.59; p<0.001), atrial fibrillation (OR 1.68, 95% CI 1.45–1.93; p<0.001). Patients with hypertension and COPD more often received drugs from the group of angiotensin-II receptor antagonists than patients with hypertension without COPD (22.7% vs 17.7%). The prescription of drugs from the group of beta-blockers in patients with hypertension and COPD was lower by 4%. Cardiovascular risk factors, comorbidities such as diabetes mellitus, gout, obstructive sleep apnea in patients with hypertension and COPD are more common.

Conclusion. Patients with COPD and hypertension have a higher incidence of risk factors, CVD and comorbid pathologies. They require closer attention during examination and during the selection of antihypertensive therapy. In patients with hypertension and COPD, angiotensin-converting-enzyme inhibitors and beta-blockers are prescribed less frequently than in patients with hypertension without COPD due to possible side effects and contraindications.

Background. Dysregulation of apoptosis in diffuse B-large cell lymphoma (DLBCL) contributes to increased tumor proliferation, as well as the formation of resistance to treatment. One of the most relevant areas of molecular research is the study of the mechanisms of programmed cell death – apoptosis. The AIF (Apoptosis Inducing Factor) protein participates in the regulation of the caspase-independent pathway of cell death and is a potential predictor of the course of DLBCL.

Aim. To evaluate the prognostic value of AIF expression in DLBCL.

Materials and methods. A retrospective study included 100 patients with newly diagnosed DLBCL. All patients received standard 1st line therapy according to the R-CHOP scheme. Using histological, immunohistochemical studies of lymph nodes and/or other organs involved in the pathological process were performed. A morphometric calculation of the data was carried out with the determination of the percentage of AIF-expressing tumor cells. The threshold level of expression of these proteins was calculated using by the ROC analysis (57%). Based on the threshold, patients were divided into groups with high (above threshold) and low (subthreshold) protein levels. The calculation of overall (OS) and progression-free (PFS) survival was performed using the Kaplan–Meier method with graphical construction of the corresponding curves, the levels of factors were compared using the log-rank test criterion. The independent influence of factors on the course of DLBCL was determined using multivariate Cox regression analysis.

Results. The subthreshold level of AIF was associated with low rates of OS and PFS of patients (34.9 and 48.8%, respectively). As a result of multivariate Cox analysis, it was found that the AIF protein is an independent prognostic marker for the course of DLBCL.

Conclusion. The subthreshold value of AIF expression is associated with low OS and PFS in patients.

Aim. To evaluate the prognostic value of pulmonary ventilation disorders in the development of arrhythmia recurrence in patients with chronic obstructive pulmonary disease (COPD) and paroxysmal atrial fibrillation (AF).

Materials and methods. The study included 387 patients with COPD, who were divided into two groups: group 1 consisted of 54 (13.9%) patients with COPD and paroxysmal AF, who had AF paroxysm during hospitalization; group 2 (comparison group) – 333 (86.1%) patients with COPD without arrhythmia.

Results. Significantly more severe bronchial obstruction was found in group 1 patients than in group 2 patients. A one-factor regression analysis revealed that a decrease in forced exhalation volume in 1st second of less than 35% increased the risk of AF recurrence in patients with COPD by 2.49 times (odds ratio 0.401, 95% confidence interval 0.218–0.856; p=0.012). According to the results of bodyplethysmography, patients in group 1 showed a significant decrease in the diffusion capacity of the lungs for carbon monoxide, an increase in aerodynamic and specific bronchial resistance compared with group 2, a decrease in the diffusion capacity of the lungs of less than 8 ml/min/mm. Mercury increased the risk of AF paroxysm in COPD patients by 1.297 times (odds ratio 0.771, 95% confidence interval 0.53–0.92; p=0.013). To assess the risk of arrhythmia recurrence in patients with COPD and paroxysmal AF, we developed a mathematical model (sensitivity – 73.8%, specificity – 70.3%).

Conclusion. Decreased ventilation capacity of the lungs increases the risk of arrhythmia recurrence in patients with COPD and paroxysmal AF.

Nutrition and physical activity play a key role in the onset and progression of sarcopenic obesity (SO). Therefore, dietary interventions are essential in comprehensive programs to prevent and treat this condition. The classic approach to obesity diet therapy, which is to reduce the caloric value of the diet, is associated with a decrease in body weight due to both fat and fat-free components. In elderly patients with SO, a reduction in body weight impacts not only the muscle mass but also muscle function. A promising approach to diet therapy for this type of obesity is qualitative modification of the diet structure used for weight loss. The clinical role of specific components of diets, foods, and overall dietary patterns that are effective for CO treatment remains poorly understood. Sufficient intake of high-quality protein and branched-chain amino acids is known to stabilize and increase muscle mass, and recommended protein intakes in patients with SO of different ages continue to be discussed. It has been shown that in the elderly and senile age, the need for energy decreases; however, the need for protein increases. The role of ù-3 polyunsaturated fatty acids, vitamin D, calcium, and polyphenols in the treatment of SO may be due to their anti-inflammatory effect, as well as, possibly, activation of mitochondrial functions and regulation of myogenesis processes. Developing and using specialized foods containing proteins, branched-chain amino acids, and other key nutrients can improve the effectiveness of SO therapy. The review summarizes modern nutritional approaches to SO.

The particular focus of the modern scientific community and practical medicine is concentrated on patients with refractory arterial hypertension when appropriate lifestyle measures and treatment with optimal or best tolerated doses of 5 or more drugs with diuretic and mineralocorticoid receptor antagonist fail to lower office blood pressure to <140/90 mmHg. Inefficiency of recommended treatment methods requires new therapeutic approaches for these patients. The efficiency and mechanisms of extracorporeal treatment for blood pressure reduction in patients with malignant hypertension were first studied in the 1980s and 1990s. This clinical case study demonstrates the use of extracorporeal hemocorrection procedures as part of the complex treatment of patients with refractory arterial hypertension.

For a long time, the clinical lecture occupied a central place in teaching the course of faculty therapy and shaping the clinical thinking of future doctors. Since the time of Zakharyin and Botkin, the form and content of clinical lectures have undergone significant changes. The focus has gradually shifted from the analysis of the patient to the disease, which partly contradicts the principles of teaching in faculty clinics, laid down at their creation. The article traces these trends based on materials published in various periods of medical science development.