Vol 96, No 1 (2024)

Cover Page

Full Issue

Editorial

Possibilities for improving hospital and remote forecasts for unstable angina

Boytsov S.A., Provatorov S.I.

Abstract

Unstable angina (UA) is a type of acute coronary syndrome (ACS) without ischemic myocardial damage. The main criterion for the diagnosis of UA in ACS is the absence of changes in the concentration of cardiac troponin in the patient’s blood. When the volume of myocardial damage is small, it may be difficult to detect myocardial infarction in a patient using low-sensitivity tests for determining of cardiac troponin in the blood. This issue may lead to overdiagnosis of UA in patients with non-STE ACS. Optimal drug therapy and revascularization of the coronary arteries significantly reduce the risk of death and the development of myocardial infarction both in the hospital and in the long-term period in patients with UA. Outpatient follow-up and provision of free of charge medications to patients may reduce long-term mortality after an episode of UA.

Terapevticheskii arkhiv. 2024;96(1):5-10
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Original articles

The effect of taking antibacterial therapy on the outpatient stage and outcomes of community-acquired pneumonia in Tomsk hospitals

Vinokurova D.A., Kulikov E.S., Kobyakova O.S., Starovoytova E.A., Deev I.A., Fedosenko S.V., Chernogoryuk G.E., Chernysheva E.A., Yarovoy N.D.

Abstract

Background. Community-acquired pneumonia (CAP) remains one of the most common diseases requiring urgent hospitalization, with a significant part of patients already receiving antibiotics before admission to the hospital.

Aim. To assess the relationship between outpatient antibacterial therapy and in-hospital mortality and the severity of the CAP.

Materials and methods. The retrospective study included the data of adult patients with CAP who were hospitalized in Tomsk from January 1 to December 31, 2017.

Results. Among 1412 patients, 22.2% received antibiotics before admission to the hospital, the proportion of deaths in this group was significantly lower – 3.8% compared with 10.6% among patients without antibiotic therapy (p<0.001). Subjects who received antibiotics on outpatient basis were less likely to require being in the intensive care unit and administering vasopressors, in contrast to patients without prior antibiotic therapy: 5.1 and 10.6% (p=0.003); 7.1 and 4.7% (p=0.018) respectively. In patients with severe CAP on a scale IDSA/ATS, only 11.8% of cases were detected with antibiotics before hospitalization, while in mild CAP the frequency of administration was 16.6% (p<0.001).

Conclusion. Ambulatory antibacterial therapy had a positive effect on the subsequent course and outcomes of CAP in a hospital setting. Patients had a predominantly mild course of the disease, needing for vasopressors, and being in the intensive care unit, but was not consistent with the need for invasive mechanical ventilation.

Terapevticheskii arkhiv. 2024;96(1):11-16
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Clinical features of coronary artery disease and 5-year survival of patients after myocardial infarction against the background of depressive disorders

Nonka T.G., Lebedeva E.V., Repin A.N.

Abstract

Aim. To assess the features of the clinical picture of coronary artery disease (CAD) and the prognosis of patients with myocardial infarction with depressive disorder (DD).

Materials and methods. We examined 101 patients with stable CAD who had myocardial infarction more than six months ago: 67 CAD patients with depression (Group 1) and 34 CAD patients without depression (Group 2). The clinical picture of CAD was assessed by complaints, angina self-monitoring diaries, and exercise tests. The presence and severity of DD was determined using psychometric scales: BDI (Beck Depression Scale), HADS (Hospital Anxiety and Depression Scale) and the opinion of a psychiatrist. Five-year survival information was obtained through telephone interviews with patients and their relatives.

Results. In patients with CAD and DD in comparison with patients without DD self-monitoring diaries revealed more frequent angina attacks: 9 [6; 12] vs 6 [4; 7] per week (p=0.0001), the greater need for sublingual nitrates: 2 [0; 9] pills vs 0 [0; 4] pills (p=0.0001). DD significantly reduced exercise tolerance: 370 [250; 450] meters vs 435 [350; 500] meters using the six-minute walk test (p=0.04), according to the results of bicycle ergometry – 50 [25; 75] W vs 75 [50; 75] W (p=0.03). After 5 years of follow-up patients with comorbidities (CAD and DD) had a greater number of deaths: 13 (19.4%) vs 2 (5.9%), respectively, survived – 54 (80.6%) vs 32 (94.1%) (Gehan–Wilcoxon test, p=0.04).

Conclusion. The comorbidity CAD and DD leads to a worsening of the clinical course of CAD and prognosis, which actualizes the need for verification of the diagnosis of DD and timely prescription of antidepressant therapy.

Terapevticheskii arkhiv. 2024;96(1):17-21
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Inflammation and myocardial fibrosis: is there a relation with left bundle branch block

Rimskaya E.M., Stukalova O.V., Aparina O.P., Mironova N.A., Kuznetsova T.V., Chumachenko P.V., Golitsyn S.P.

Abstract

Aim. To assess myocardial changes during left bundle branch block (LBBB) in patients with dilated cardiomyopathy (DCM) and in structurally normal hearts.

Materials and methods. Seventy three patients with clinic-instrumental signs of DCM, were divided into 2 groups with LBBB (group 1; n=41) and without LBBB (group 2; n=32). Moreover, 15 patients with LBBB with no signs of structural heart diseases (group 3) and 10 healthy subjects were included in the study. Fibrosis assessment and the inflammation detection was performed by cardiovascular magnetic resonance (CMR). The inflammation in 15 patients from group 1 and 16 patients from group 2 was confirmed by endomyocardial biopsy (EMB). Moreover, the level of transforming growing factor β1was assessed in serum of all patients and healthy subjects (TGF-β1).

Results. The diffuse inflammatory process was defined in 46.7% cases of group 1 according to EMB data. The frequency of inflammation detection in groups 1 and 2 was comparable in EMB analyses (p=0,64) and CMR analyses (12,2% positive cases in group 1 vs 50% in group 2; p=0,18). The frequency of focal left ventricular fibrosis and intramural scar in the interventricular septum (“stria”) was also comparable in groups 1 and 2: 16 (39%) positive cases with focal fibrosis in group 1 versus 17 (53%) cases in group 2; p=0,35 and 6 (14,6%) cases with intramural scar in group 1 versus 7 (22%) in group 2; p=0,12. Patients from group 3 demonstrated no late gadolinium enhancement on CMR images but increased TGF-β1 level in the serum.

Conclusion. Focal myocardial fibrosis is not related to the LBBB. Patients with idiopathic LBBB are characterized by increased TGF-β1 level with no myocardial fibrosis. Diffuse inflammation in LBBB-DCM patients may contribute to the progression of systolic dysfunction but is not the reason for LBBB formation.

Terapevticheskii arkhiv. 2024;96(1):22-28
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Dynamics of hospital mortality in COVID-19 pandemia

Gareeva D.F., Lakman I.A., Agapitov A.A., Sadikova L.F., Davtian P.A., Kayumova V.L., Nurtdinova G.M., Badykova E.A., Kurbanov M.S., Idigov I.R., Fiedler L., Motloch L., Dieplinger А., Timiryanova V.M., Zagudullin N.S.

Abstract

Background. During the pandemic of coronavirus infection (COVID-19) caused by a virus SARS-CoV-2 there has been significant variability in symptoms of the disease over time, severity of the course and in particular hospital mortality. Several SARS-CoV-2 variants have been identified such as Alpha, Delta, Omicron and others.

Aim. To investigate the hospital mortality in patients with different strain variants during the period from April 2020 to April 2022. All included patients had moderate to severe COVID-19-associated pneumonia requiring hospitalization.

Materials and methods. In this retrospective, conclusive, non-randomized, non-controlled study 4854 clinical records of hospitalized patients with Alpha (n=2400, April – December 2020), Delta (n=1722, 2021) and Omicron (n=627, January – April 2022) variants were investigated.

Results. Hospital mortality is 6% in Alpha variant patients (6%), 5.7% in Delta and significantly lower in Omicron (1.5%; p<0,001). Cardiovascular disease (arterial hypertension, coronary heart disease, chronic heart failure), diabetes mellitus and chronic kidney disease were risk factors for death in Alpha and Delta, but not in Omicron. There was also a significant decrease in the duration of hospitalization with strains Delta [7 days (5; 9)] and Omicron [7 (5; 11)] compared with Alpha [11 (9; 13); p<0,001], and differences in factors the risk of mortality between the tested COVID variants.

Conclusion. Thus, differences in mortality and risk factors for death between COVID-19 variants could be shown in our cohort.

Terapevticheskii arkhiv. 2024;96(1):29-35
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The effectiveness of hardware CPAP therapy in heart failure with preserved left ventricular ejection fraction and obstructive sleep apnea syndrome

Yakovlev A.V., Efremov I.A., Yakovlevа N.F., Shilov S.N., Ryabikov A.N., Teplyakov A.T., Grakova E.V., Kopeva K.V., Shirokikh I.V.

Abstract

Aim. To evaluate the effectiveness of hardware Continuous Positive Airway Pressure therapy (CPAP therapy) and its likely predictors in patients with heart failure with preserved ejection fraction (HFpEF) associated with obstructive sleep apnea syndrome (OSAS).

Materials and methods. The study involved 207 men with HFpEF and OSAS (apnea/hypopnea index >15 per hour) who did not initially have ischemic disease and other structural heart pathology. At inclusion in the study, polysomnography and echocardiography were performed with an assessment of diastolic function and global longitudinal deformation of the left ventricular myocardium, as well as a 6-minute walk test (6MWT) and the level of the brain natriuretic peptide precursor (NT-proBNP) in the blood was determined. 80 patients received hardware CPAP the rapy, 127 patients made up the control group. After 12 months, 6MWT was repeated, NT-proBNP was determined, and clinical outcomes were assessed retrospectively.

Results. The CPAP group had 16% fewer hospitalizations (p=0.011 [95% confidence interval – CI 4.29]) and showed a trend towards an increase in the 6MWT distance (p=0.065). To assess the likely predictors of the effectiveness of CPAP therapy, a subgroup of “responders” was identified, characterized by an increase in the distance according to the 6MWT, a decrease in the level of NT-proBNP, and the absence of adverse clinical events during the observation period. There were significant differences between responders and non-responders in apnea/hypopnea index (p=0.01 [95% CI -10.6; -2.5]), global longitudinal deformation of the left ventricular myocardium (p=0.05 [95% CI -4.7; 0]), diastolic function E/A (p=0.02 [95% CI -0.1; 0]).

Conclusion. CPAP therapy improves clinical outcomes and functional status in patients with OSAS-associated HFpEF. The predictive model built using the identified efficacy predictors can be used to develop a personalized treatment algorithm for this cohort of patients.

Terapevticheskii arkhiv. 2024;96(1):36-41
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Relationships of doctors and patients of the infection hospital during the 1st and 2nd waves of the COVID-19 pandemic

Romanova T.E., Abaeva O.P., Prisyazhnaya N.V., Romanov S.V., Berdutin V.A.

Abstract

Aim. To conduct a comparative analysis of the relationship between doctors and patients in a regional infectious diseases hospital to combat the complications of COVID-19 during the 1st and 2nd waves of the pandemic.

Materials and methods. The basis of the study was the infectious diseases hospital deployed in the City Clinical Hospital No. 5 in Nizhny Novgorod. The hospital treated patients with complications of coronavirus infection with concomitant therapeutic or surgical pathology. The study was conducted taking into account the principles of robust management through questioning, on issues related to the social characteristics of patients and their subjective assessments of relationships with medical personnel. The scope of the study was 129 people.

Results. The study did not reveal any changes in the relationship between medical workers and patients; both in the 1st and in the 2nd wave of the pandemic, they were built on mutual respect and empathy: medical workers do their best to support patients, the latter, in turn, understand the difficulties of staff work in an infectious diseases hospital and feel gratitude. The established facts are convincing proof of the high level of readiness of medical organizations and their employees to work in extreme conditions associated with a tense epidemic situation.

Conclusion. Thus, the results of this study indicate the formation in the 1st wave of the pandemic of a model of relationships built on the principles of mutual trust, support and avoidance of conflicts between doctors and patients of the regional infectious diseases hospital and the preservation of this model during the 2nd wave of the pandemic.

Terapevticheskii arkhiv. 2024;96(1):42-44
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Combination therapy for productive cough in acute respiratory viral infection (ARVI) and acute bronchitis in real clinical practice

Leshchenko I.V., Esaulova N.A.

Abstract

Aim. To evaluate effectiveness and safety of combination drug containing ambroxol, guaifenesin and levosalbutamol (Ascoril LS), oral solution, in comparison with monocomponent drugs in the treatment of productive cough in adult patients with acute respiratory viral infection (ARVI) and acute bronchitis.

Materials and methods. Open randomized study included patients with clinical symptoms of ARVI and acute bronchitis, having productive cough with difficulty in sputum discharge. 160 patients were randomized into 4 groups that received the study drug or comparison drugs (ambroxol, acetylcysteine, Rengalin) 3 times a day for 20 days. After 5, 10, 15 and 20 days of treatment, the doctor assessed subjective complaints and effectiveness of therapy. The primary endpoint was the proportion of patients with high and very high efficacy, recovery from work, and clinically significant cardiovascular events.

Results. Satisfaction with clinical effect of therapy with Ascoril LS was noted by 96% of patients, tolerability and ease of administration by 99%. 97% of patients are satisfied with price/quality ratio. The overall percentage of satisfaction with treatment Ascoril LS was 99%. Tolerability of therapy was assessed by all patients as good, without the development of significant adverse events. During therapy for productive cough, a significant decrease in cough was noted in Ascoril LS group already on the 5th day of therapy (57%) and subsequently at all follow-up visits. Restoration of working capacity of patients in Ascoril LS group due to complete regression of productive cough was established in 50% of patients on the 5th day of treatment. On days 10 and 15, 75% and 90% of patients, respectively, were able to begin work due to complete relief of cough, which is significantly more compared to other treatment groups. It is important that in all cases Ascoril LS was prescribed at the very beginning of the disease, which made it possible to achieve the described results

Conclusion. The effectiveness of a new combination drug containing ambroxol, guaifenesin and levosalbutamol for the treatment of productive cough in adult patients with ARVI and acute bronchitis exceeds the effectiveness of monocomponent therapy with comparator drugs. The safety profiles of the study drug and comparison drugs were comparable, including in patients with cardiovascular risk.

Terapevticheskii arkhiv. 2024;96(1):46-52
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Clinical notes

Vaping use-associated lung injury in a teenager. Case report

Ozerskaia I.V., Malakhov A.B., Sedova A.Y., Denisova V.D., Barinova V.A., Grebeneva I.V.

Abstract

In the last 10–15 years, especially among young people, there has been an increase in the prevalence of vaping, which partially replaces the smoking of conventional cigarettes. The chemicals in vape liquids can provoke the development of non-infectious inflammatory pneumonitis. Symptoms of the disease usually appear within a few months after the start of smoking electronic cigarettes. Vape-associated lung disease is a clinical diagnosis and is established after the exclusion of other respiratory diseases. The article describes a clinical case of vape-associated lung injury in a 17-year-old teenager.

Terapevticheskii arkhiv. 2024;96(1):53-57
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Reviews

Therapies of chronic thromboembolic pulmonary hypertension: A review

Vasiltseva O.Y., Edemskiy A.G., Zeinalov D.F., Kliver E.N., Ussov W.Y., Grankin D.S., Sirota D.A., Chernyavskiy A.M.

Abstract

The article addresses therapies for chronic thromboembolic pulmonary hypertension (CTEPH). The main challenges of patient management at various stages of diagnosis and treatment and the prevalence and pathogenesis of CTEPH are described. Immediate and long-term outcomes after treatment are evaluated. The study aims to present current therapies for CTEPH.

Terapevticheskii arkhiv. 2024;96(1):58-62
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Pharmacogenetics of dipeptidyl peptidase-4 inhibitors in the treatment of type 2 diabetes mellitus: A review

Samoilova I.G., Vaizova O.E., Stankova A.E., Matveeva M.V., Podchinenova D.V., Kudlay D.A., Borozinets A.A., Filippova T.A., Grishkevich I.R., Partala A.V., Gerasimova D.A.

Abstract

The review addresses publications on genetic polymorphisms that potentially impact the effectiveness of therapy with hypoglycemic drugs of the dipeptidyl peptidase-4 inhibitor group. The literature was searched in the PubMed database from 2017 to 2023. Polymorphisms of several genes (GLP1R, TCF7L2, DPP-4, KCNQ1, KCNJ11, PNPLA3, PRKD1) are associated with the pharmacokinetic values and efficacy of dipeptidyl peptidase-4 inhibitors, which may be promising for personalizing the treatment of patients with type 2 diabetes mellitus.

Terapevticheskii arkhiv. 2024;96(1):63-67
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Consensuns

Efficacy, safety and prospects of using a combination of native type II collagen, methylsulfonylmethane, boswellic acids, vitamin C and vitamin D3 in knee osteoarthritis: a resolution of the Expert panel

Mazurov V.I., Alekseeva L.I., Belyaeva I.B., Belenkiy I.G., Burulev A.L., Gaydukova I.Z., Zonova E.V., Kalyuzhin O.V., Nesmeyanova O.B., Otteva E.N., Trofimov E.A.

Abstract

A meeting of the Expert Council on September 9, 2023 considered the last challenges in the treatment of osteoarthritis (OA) including OA in comorbid patients. Leading experts in rheumatology, traumatology and other relevant disciplines participated in the meeting. The key goal of Expert Council was the discussion of potential application of a combination of undenatured (native) type II collagen, methylsulfonylmethane, boswellic acids, vitamins C and D (Artneo complex) as a part of complex OA therapy. The experts concluded that Artneo for stage I–III knee OA patients is not just non-inferior in comparison with a combination of chondroitin sulfate and glucosamine hydrochloride but excels it in the decrease of magnetic resonance imaging synovitis markers and dynamics of Lequesne index for knee osteoarthritis severity. The proven efficacy and the favorable safety profile of 6-months Artneo course deserve the attention of medical community and the active implementation of Artneo complex into ambulatory practice, first of all, for the treatment of patients with mild or moderate synovitis and/or burdened with comorbidities.

Terapevticheskii arkhiv. 2024;96(1):68-74
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History of medicine

History of the study of infective endocarditis in Russia

Karaulova J.L., Kotova E.O., Pisaryuk A.S., Povalyaev N.M., Kobalava Z.D.

Abstract

The history of the study of infective endocarditis in Russia is described in the article.

Terapevticheskii arkhiv. 2024;96(1):75-79
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