Vol 88, No 1 (2016)

Editorial
Recent trends in and new data on the epidemiology and prevention of non-communicable diseases
Boytsov S.A.
Abstract
Mortality from non-communicable diseases (NCDs) in the country varies considerably among its regions and social strata of the population. The main reason for providing inadequate conditions for a healthy lifestyle is that the state and municipal authorities and employers pay insufficient attention to the role of socioeconomic risk factors for NCDs. Only an analysis of the reasons for changing mortality rates allows the correct course of actions to reduce mortality to be chosen and a national plan for the control of NCDs to be worked out. The important mechanisms for improving the prevention of NCDs are to make better cardiovascular risk stratification systems, to introduce telemonitoring the status of the patients followed up, and to interface the prophylactic medical examination of elderly patients with a geriatric service. The design of long-acting drugs is a promising way to increase the patients’ motivation to control blood pressure and blood cholesterol levels.
Terapevticheskii arkhiv. 2016;88(1):4-10
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A rank-order method for the integrated assessment of trends in all-cause and cardiovascular mortality rates in the subjects of the Russian Federation in 2006—2012
Artamonova G.V., Maksimov S.A., Tabakaev M.V., Barbarash L.S.
Abstract
Aim. To rank the subjects of the Russian Federation by the trend direction in all-cause and cardiovascular mortality (including mortality from coronary heart disease and cerebrovascular diseases) as a whole and at able-bodied age. Subjects and methods. The investigation used mortality rates from to the 2006 and 2012 data available in the Federal State Statistics Service on 81 subjects of the Russian Federation. According to mortality rates, each region was assigned a rank in 2006 and 2012. Trends in rank changes in the Russian Federation’s regions were analyzed. A cluster analysis was used to group the subjects of the Russian Federation by trends in rank changes. Results. The cluster analysis of rank changes from 2006 to 2012 could combine the Russian Federation’s regions into 10 groups showing the similar trends in all-cause and circulatory disease mortality rates. Overall, the results of the ranking and further clusterization of the regions of the Russian Federation correspond to the trends in all-cause and cardiovascular mortality rates according to the data of other Russian investigations, by qualitatively complementing them. Conclusion. The trend rank-order method permits a comprehensive comparative analysis of changes in all-cause and cardiovascular mortality in the subjects of the Russian Federation both as a whole and at able-bodied age, which provides qualitatively new information complementing the universally accepted approaches to studying the population’s mortality.
Terapevticheskii arkhiv. 2016;88(1):11-16
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The stages of development of cardiovascular diseases and the evolution of their pattern in the veterans of the Great Patriotic War (according to the 1946-2015 records of the Saint Petersburg War Veterans Hospital)
Kabanov M.Y., Shvartsman Z.D., Ageenko E.M., Zaitsev Y.E., Semenova I.L.
Abstract
Aim. To determine the stages of development of cardiovascular diseases and the evolution of their pattern in the veterans of the Great Patriotic War during 70 postwar years. Subjects and methods. The investigation used the 1946-2014 annual reports on the hospital’s work; analysis of the pattern of therapeutic and cardiovascular diseases over time; the results of laboratory and functional tests in 148 patients who developed in-hospital myocardial infarction (cardiospecific enzymes, electrocardiography, echocardiography (EchoCG), and, if clinically indicated, coronary angiography) and in 112 cardiopulmonary patients who were detected to have a chronic multimorbid heart phenomenon (EchoCG, radiological examination, blood gas tests, and statistical processing of the findings). Results. The postwar evolution of therapeutic and cardiovascular diseases was ascertained to consist of 5 stages, each of which averaged about 15 years. At the same time, the nosological entities typical of the subsequent stage developed in the pattern of those at the preceding stage and gradually became predominant. The form of in-hospital myocardial infarction, as well as the chronic multimorbid heart phenomenon in the presence of comorbidity (chronic obstructive pulmonary disease and hypertensive disease) at Stage IV was described. Conclusion. With allowance made for the stages of development of therapeutic diseases and evolution of its pattern in the veterans of the Great Patriotic War, the clinical departments of the hospital, its laboratory and functional diagnosis departments have been reorganized for 70 postwar years in order to render adequate specialized medical care to the patients.
Terapevticheskii arkhiv. 2016;88(1):17-22
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Results of endovascular revascularization in elderly patients with ST-segment elevation myocardial infarction in multivessel disease in relation to the degree of coronary atherosclerosis
Tarasov R.S., Kochergina A.M., Ganyukov V.I., Barbarash O.L.
Abstract
Aim. To investigate the impact of the degree of coronary atherosclerosis evaluated by the SYNTAX scale on the early and late results of endovascular revascularization in elderly and middle-aged patients with ST-segment elevation myocardial infarction (STEMI). Subjects and methods. The investigation enrolled 327 consecutively admitted patients with STEMI and multivessel coronary bed disease, who had received revascularization within the first 12 hours after disease onset via primary percutaneous coronary interventions (PCI). The clinical, demographic, and angiographic characteristics of the patients, as well as the specific features of chosen revascularization strategies and treatment outcomes were compared in two groups of 103 elderly patients (≥65 years of age) and 224 middle-aged patients (≤64 years) in relation to the severity of coronary bed lesion according to the SYNTAX scale. Results. By and large, severe coronary atherosclerosis (≥23 SYNTAX scores) was related to reduced left ventricular ejection fraction and clinical manifestations of acute heart failure in all the analyzed patients regardless of their age and this was most markedly associated with the risk factors of cardiovascular events in the elderly patients. The elderly patients with severe coronary atherosclerosis (≥23 SYNTAX scores) were noted to have the lowest frequency of successful PCIs and higher 30-day mortality rates after primary PCI. Conclusion. The SYNTAX scale is of high prognostic value in the patients with STEMI, by determining the results of endovascular revascularization in elderly and middle-aged patients. The elderly patients with STEMI and severe coronary atherosclerosis are at very high risk for poor outcome within 30 days of follow-up after primary CPI, which necessitates a search for optimal revascularization strategies for this category of patients.
Terapevticheskii arkhiv. 2016;88(1):23-28
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Impact of the dosing of basic drugs on the risk of rehospitalization in patients with chronic heart failure
Arutyunov A.G., Dragunov D.O., Arutyunov G.P., Sokolova A.V.
Abstract
Aim. To investigate the impact of doses of the drugs, which have been achieved during adjustment and account for less or more than 50% of the maximal therapeutic ones on the risk of rehospitalization. Subjects and methods. The data of the Pavlov Register were used to assess the treatment of patients with chronic heart failure. To assess the risk of rehospitalization in relation of the dose of a drug, all the doses were represented in percentage terms depending on the maximum therapeutic one. Results. The risk of hospitalization during 6 months in the patients receiving angiotensin-converting enzyme inhibitors at a dose of 25% or less of the therapeutic one was 21.18% (odds ratio (OR), 1.41; 95% confidence interval (CI), 1.13—1.76), that at doses of 50 and 100% of the therapeutic one was 16% (OR, 0.71; 95% CI, 0.56—0.88) and 34% (OR, 0.51; 95% CI, 0.43—0.60), respectively. The risk of rehospitalization in the patients taking β-blockers at doses of 25, 50, and 100% of the therapeutic one was 26% (OR, 1.05; 95% CI, 0.94—1.17), 23% (OR, 0.902; 95% CI, 0.75—1.07), and 6.25% (OR, 0.19; 95% CI, 0.07—0.56), respectively. The combined analysis of the dose and use frequency of diuretics showed that the highest risk of rehospitalization turned was noted in the patients using a single dose of 100 mg of furosemide (4.2% of cases) once weekly and was as high as 39% (OR, 0.45; 95% CI, 1.04—1.98). Conclusion. The risk of rehospitalization is largely determined by the dosing factor in outpatient settings. Increasing the doses during adjustment reduces the risk of rehospitalization.
Terapevticheskii arkhiv. 2016;88(1):29-34
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A change in adrenal responsiveness in sotalol-treated patients with paroxysmal atrial fibrillation depending on autonomic nervous system tone
Borisova E.V., Afanasyev S.A., Rebrova T.Y., Kisteneva I.V., Batalov R.E., Popov S.V.
Abstract
Aim. To evaluate the efficacy of sotalol depending on the magnitude of changes in adrenal responsiveness and autonomic nervous system tone in patients with paroxysmal atrial fibrillation (AF). Subjects and methods. Twenty-six patients with paroxysmal AF in the presence of coronary heart disease (CHD) and hypertension were examined. Sinus rhythm variability and sympathicotonic and vagotonic disorders were studied in patients with paroxysmal AF before and during sotalol treatment. A commercial Beta-ARM-Agat kit was used to estimate the adrenal responsiveness of erythrocyte membranes (β-APM), which can judge the body’s individual sensitivity to β-adrenoblockers. Results. Sotalol used in the average therapeutic doses of 160-240 mg did not reduce ejection fraction or increase atrioventricular conduction up to abnormal values. In patients with borderline and mild hypertension, the drug lowered blood pressure statistically significantly (p=0.01) and was well tolerated. The drug increased the sensitivity of β-adrenoblockers in patients with adrenergic AF. Conclusion. The effect of sotalol on the autonomic nervous system manifested in the higher power of a high-frequency spectral component of heart rate variability than in that of a low-frequency one. Long-term sotalol administration significantly reduced β-APM, increasing the sensitivity of adrenoceptors.
Terapevticheskii arkhiv. 2016;88(1):35-39
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Features of polymorbidity in cardiac and gastroenterologic patients from a therapeutic clinic
Nikolaev Y.A., Sevostyanova E.V., Mitrofanov I.M., Polyakov V.Y., Dolgova N.A.
Abstract
Aim. To examine the incidence of polymorbidity (PM) and changes in its rates in 2003 to 2011 in cardiac and gastroenterologic patients living in the Novosibirsk Region and the Republic of Sakha (Yakutia) in accordance with gender, occupation, and residence. Subjects and methods. The dynamics of PM rates was analyzed in 13 496 patients who had been examined and treated at the Cardiology and Gastroenterology Departments, Therapeutic Clinic, Research Institute of Experimental and Clinical Medicine (Novosibirsk), 2003—2011. The study used an archival research method and a statistical analysis of all nosological entities, groups, and classes in ICD-10, regardless of whether the diagnosis was primary or concurrent. Results. There was an increase in PM rates among the therapeutic clinic’s patients of regardless of their gender and occupation. There were gender differences in the incidence of PM: its higher rates were noted in the women than those in the men among both the residents of the Novosibirsk Region and those of the Republic of Sakha (Yakutia). More significantly higher PM rates were registered in the male inhabitants of the Novosibirsk Region. There were also regional differences in the incidence of PM: its rates proved to be higher in the patients in the Republic of Sakha (Yakutia) than in those in the Novosibirsk Region in 2003—2007. At the same time, the growth rates for PM were more marked in the patients in the Novosibirsk region than in those in the Republic of Sakha (Yakutia); these differences levelled off in subsequent years. Conclusion. The findings indicate a pronounced increase in the incidence of PM in cardiac and gastroentorologic patients and determine a need to keep in mind the influence of gender, social, and regional factors on its development in order to create and improve a primary and secondary prevention, diagnosis and treatment system.
Terapevticheskii arkhiv. 2016;88(1):40-45
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Results of circulatory disease detection during prophylactic medical examination of the adult population: the first two years’ experience
Kalinina A.M., Ipatov P.V., Kushunina D.V., Egorov V.A., Drozdova L.Y., Boytsov S.A.
Abstract
Aim. To estimate circulatory diseases (CD) detection rates during prophylactic medical examination of the adult population and to define their association with mortality rates and the spread of risk factors. Materials and methods. The results of the 2013—2014 prophylactic medical examinations for CD in the adult population of the Russian Federation as a whole and its subjects were comparatively analyzed using the data of statistical reports and official medical statistics on morbidity and mortality in the adult population. Results. The data of official statistical reports on the results of prophylactic medical examinations in 2013 (19.4 million) and 2014 (22.2 million) were analyzed. In 2013 and 2014, there were 85.9 and 82.7 CD cases per 1000 examinees, respectively. These years were marked by the detection of 50.0 and 46.2 hypertensive patients, 17.1 and 16.1 coronary heart disease (CHD) cases, and 11.5 and 11.2 cerebrovascular diseases (CVD) ones, respectively. In 2013 and 2014, most CD cases were caused by hypertension (58.4 and 57%, respectively). The proportion of CHD was 19.9 and 19.4% and that of CVD was 13.4 and 13.6%, respectively. Conclusion. The analysis carried out could provide evidence for the importance of continuous monitoring of prophylactic medical examination at the level of each specific healthcare facility for primary health care to improve its quality and completeness of diagnostic examination. The found interregional differences in the detection rate of CD call for detailed analysis and determination of their causes, which will ensure the preventive direction of a medical examination that is inextricably entwined with further active follow-up measures for patients having the identified diseases and a risk for their development.
Terapevticheskii arkhiv. 2016;88(1):46-52
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The role and place of high-dose immunosuppressive therapy and autologous transplantation of hematopoietic stem cells for autoimmune diseases
Makarov S.V., Rossiev V.A., Mishchenko O.V., Kozlov V.A., Semagina O.V., Alexandrova I.Y., Grishina G.V., Minaev Y.L.
Abstract
Aim. To determine the possible boundaries of high-dose immunosuppressive therapy and autologous hematopoietic stem cell transplantation (HDIT-autoHSCT) for autoimmune diseases (AUDs), such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and multiple sclerosis (MS). Subjects and methods. A long-term trial was conducted at one center to evaluate the efficiency and safety of HDIT-autoHSCT in patients with AUDs. The previous standard therapy was noted to be resistant or lowly effective. The age of 10 patients with systemic connective tissue diseases was 27.6±2.8 years; the pre-HDIT-autoHSCT disease duration was 5.9±1.3 years; the median posttransplantation follow-up was 39.3 months. The age of 49 patients with MS reached 34.9±1.33 years; the pretransplantation disease duration was 8.4±0.69 years; the median post-HDIT-autoHSCT follow-up was 42 months. The efficiency of transplantation was evaluated on the basis of clinical findings, by using scales, laboratory tests, and magnetic resonance imaging. Pretransplantation conditioning was carried out according to the protocols: a) BEAM + antilymphocyte globulin (ALG); b) fludarabine + melphalan + ALG. No fatal outcomes due to a transplant procedure were observed. Results. Overall 5-year survival after transplantation was 80% for systemic connective tissue diseases and 95% for MS; 5-year progression-free survival rates were 30% in the RA and SLE groups and 45% in the MS group. HDIT-autoHSCT turned out safe and reduced the activity of the process and further disease progression for a long period of time, as confirmed by regression of clinical symptoms and/or status stabilization in 9 patients with SLE or RA and in all patients with MS. Conclusion. The favorable factors associated with the results of transplantation are age younger than 35 years in collagenoses with their short-term duration and moderate signs; age younger than 40 years in MS with a disease duration of less than 10 years and expanded disability status scale scores of not more than 6.5. Of importance are functional system scores, duration of first remission, and an index of disease progression in different types of MS.
Terapevticheskii arkhiv. 2016;88(1):53-59
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Results of malignancy detection during prophylactic medical examinations in 2013—2014
Aleksandrova L.M., Starinsky V.V., Kalinina A.M., Kaprin A.D., Boytsov S.A.
Abstract
Aim. To analyze the efficiency of prophylactic medical examination for malignancies that considerably contributes to adult mortality. Materials and methods. The data of the national health statistics (Form 131/o, 7, 35) were used to make an expert analytical assessment of the results of prophylactic medical examinations for cancer in certain adult population groups in Russia in 2013—2014. Results. Medical examinations covered 20.5 and 22.5 million people in 2013 and 2014, respectively. The proportion of 21-36-, 39-60-, and over 60-year olds was 36, 42, and 22%, respectively. All the age groups showed a preponderance of women with their larger proportion in the older age groups (55, 58, and 64%, respectively). In 2013 and 2014 there were 27,173 and 34,638 detected patients with malignances, including 17,095 (62.9%) and 20,944 (60.5%) women and 10,078 (37.1%) and 13,694 (39.5%) men, respectively. In these years, the breast (28 and 30.5%), prostate (13.9 and 18.5%), rectum (6.5 and 7.5%), stomach (6.3% and 7.8%), lung (6.1 and 7.3%) ranked fifth in cancer sites. There was a 17.6% increase in the detection rate of malignancy among the first identified patients during prophylactic medical examinations and and a 10.2% increase among all actively detected patients in 2014 versus 2013. The older age groups exhibited a rise in cancer detection rates, the most significant (11.8%) increase being in the women older than 60 years of age. Conclusion. The malignancy detection rates were noted to be on the rise, although there are defects in organizing prophylactic medical examination, ensuring the complete scope of necessary investigations, and interpreting the findings. The measures methodically supported a by regional cancer may provide a guide to solving these problems. At the same time, efforts are needed to actively attract citizens in the participation in prophylactic medical examination and in the development of behavioral attitudes associated with the higher responsibility for maintaining personal and public health.
Terapevticheskii arkhiv. 2016;88(1):60-66
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Influence of smoking cessation on the microcirculatory bed in apparently healthy young people
Sirotin B.Z., Korneeva N.V.
Abstract
Aim. To study the influence of smoking cessation on the microcirculatory bed (MCB) in 33 healthy young people. Subjects and methods. The investigation enrolled 33 healthy young people (male/female (M/F) ratio, 20:13; mean age, 21.6±0.5 years) who had quit smoking 1 month to 10 years (mean age 2.5±0.5 years) before. Comparable groups consisted of 15 smokers (M/F ratio, 5:10; mean age, 21.5±0.8 years) and 18 nonsmokers (M/F ratio, 6:12; mean age, 21±0.3 years). Computer-assisted video-biomicroscopy of the bulbar conjunctiva was carried out. When assessing the results, attention was focused on microvessel diameter changes in the patients who had quit smoking compared to the smokers and nonsmokers. Results. As compared to the smokers, those who had quit smoking showed a significant increase in the mean diameters of arterioles (13.01±0.41 and 18.33±0.65 µm; р<0.001) and capillaries (9.2±0.23 and 9.89±0.19 µm; р<0.05). The number of functioning capillaries per mm2 of the conjunctival surface did not differ from that in the nonsmokers (8.01±0.21 and 8.25±0.44; р>0.05). Thus, the rarefication phenomenon reflecting the influence of smoking on the MCB vessels at a young age undergoes rapidly regression. There are increases in the diameter of arterioles and the number of functioning capillaries just in the first months of smoking cessation (р<0.01). Conclusion. The considerably increased diameters of arterioles and capillaries and the larger number of functioning capillaries per mm2 of the conjunctival surface suggest that smoking cessation at a young age have a positive impact on MCB vessels.
Terapevticheskii arkhiv. 2016;88(1):67-69
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The incidence of respiratory symptoms and their associations with serum cotinine levels as a marker of tobacco smoking in 25-45-year-old Novosibirsk dwellers
Kovalkova N.A., Denisova D.V., Polonskaya Y.V., Kashtanova E.V.
Abstract
Aim. To study the incidence of respiratory symptoms and to reveal their associations with serum cotinine levels (SCL) in 25—45-year-old Novosibirsk dwellers. Subjects and methods. The WHO respiratory symptom questionnaire and the ECRHS screening questionnaire were used for a population-based survey conducted in Novosibirsk to identify respiratory symptoms; 545 people replied to the questions available in the questionnaires. SCL was determined by enzyme immunoassay on a random subsample of 182 examinees. Results. The incidence of respiratory symptoms was determined among the 25—45-year-old Novosibirsk dwellers: cough (27.7%), more than 3-month cough per year (22%), sputum discharge (25%), forced respiration/wheezing in the past year (22.6%), suffocation fits in the past year (5.3%), and cough/forced respiration/stertor bouts by breathing cold air (14.9%) or contacting animals, plants, or chemical agents (16.5%). There was a significant positive correlation between SCL and the presence of cough, more than 3-month cough per year, sputum discharge, forced respiration/wheezing in the past year (compared to the examinees who did not report these symptoms). The median SCL proved to be significantly higher in the people who complained of cough, more than 3-month cough per year, sputum discharge, and forced respiration/wheezing in the past year (compared to the examinees who did not report these symptoms). The people who had a SCL of more than 3 ng/ml were ascertained to be at higher risk of cough, more than 3-month cough per year, sputum discharge, and forced respiration/wheezing in the past year than those who had a SCL of less than 3 ng/ml. Conclusion. The incidence of respiratory symptoms was determined among the 25-45-year-old Novosibirsk dwellers; SCL was found to be associated with the symptoms characteristic of bronchial obstructive diseases; the expediency of using the SCL threshold of 3 ng/ml as a marker of tobacco smoking was confirmed.
Terapevticheskii arkhiv. 2016;88(1):70-74
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Typical management practice in outpatients with type 2 diabetes mellitus in cities, towns, and villages
Sapozhnikova I.E., Tarlovskaya E.I., Avksentyeva M.V.
Abstract
Aim. To analyze one-year typical management practice in outpatients with type 2 diabetes mellitus (T2DM) in cities, towns, and villages. Subjects and methods. 438 records of T2DM outpatients regularly visiting their physicians during 2009 were retrospectively analyzed. Group 1 included 221 outpatients from 7 polyclinics of the Kirov Regional Center; Group 2 consisted of 227 patients from 36 districts of the Kirov Region. VEN-, ABC-, and frequency analyses were made; the costs of drug therapy and hospitalization for the included patients were calculated. Results. The investigation revealed the low efficiency of sugar-lowering therapy (SLT), insufficient glycated hemoglobin testing rates (15% in Group 2 during a year), inadequate correction of SLT. During one year the number of patients with fixed target office blood pressure levels in Group 1 increased from 16.6 to 34.1% (р<0.001) and that in Group 2 was statistically significantly unchanged (21.6% vs 25.1%; p=0.05). In Group 2, the use frequency of statins was lower (20.3% by the end of the year versus 49.3% in Group 1; р<0.001); the examination quality was worse; the drugs with unproven efficacy, the cost of which was higher than that of statins/disaggregants, were used more often. In Groups 1 and 2, there were 50 (23.7%) and 95 (41.9%) patients who were more commonly hospitalized for T2DM-related causes; Group 2 patients had a higher rate of hospitalizations and longer inpatient treatment. Conclusion. The worse outpatient care quality in the towns and villages was followed by increases in a need for inpatient treatment and in direct drug (2.36-fold) and non-drug direct and indirect (2.77-fold) costs.
Terapevticheskii arkhiv. 2016;88(1):75-81
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Associations of lipoproteins with bone mass in postmenopausal women
Skripnikova I.A., Abirova E.S., Alyasova P.A., Alikhanova N.A., Khudyakov M.B., Vygodin V.A.
Abstract
Aim. To study an association between blood lipid composition and bone mass in Russian postmenopausal women. Subjects and methods. The cross-sectional study included 373 postmenopausal women aged 45—80 years who were examined to diagnose osteoporosis in outpatient settings. Height, body weight, and waist and hip circumferences (WC and HC) were measured before densitometry. Quetelet’s index was calculated as a ratio of weight (kg) to height (m2). The concentration of lipids and apolipoproteins (apo) AІ and B were measured by enzyme immunoassay. Bone mineral density (BMD) in the spine and proximal femur (PF) was estimated by dual-energy X-ray absorptiometry. Results. According to bone mass, the patients were divided into three groups: 1) osteoporosis (OP); 2) osteopenia; 3) normal BMD. The levels of total cholesterol and high-density lipoprotein (HDL) cholesterol were significantly higher in the postmenopausal women with OP than in those with normal bone mass. There was a negative correlation of cholesterol and HDL cholesterol levels with lumbar spine BMD and that of HDL levels with BMD in the femoral neck (FN) and entire PF. The level of lipoprotein (a) (LPa) was significantly lower in the group of patients with OP and positively correlated with BMD in FN and entire PF. After adjustment for age, the duration of menopause, Quetelet’s index, and WC/HC association remained only between LPa and FN BMD. Conclusion. Multivariate regression analysis failed to confirm a trend towards decreased BMD and increased HDL cholesterol. This suggests that the association of HDL cholesterol with bone mass is apparently mediated by other factors and, above all, with age, postmenopausal hormonal status and body weight.
Terapevticheskii arkhiv. 2016;88(1):82-88
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Experience in treating portal thromboses in patients with chronic myeloproliferative diseases
Melikyan A.L., Sukhanova G.A., Vakhrusheva M.V., Subortseva I.N., Orel E.B.
Abstract
Patients with myeloproliferative diseases (MPD) are noted to be at high risk for portal thromboses. This problem gives rise to disability if it is untimely treated or resistant to therapy. The paper gives the experience of the Outpatient Department of the Hematology Research Center, Ministry of Health of the Russian Federation, in using antithrombin III in MPD patients (3 patients with primary myelofibrosis, 3 with essential thrombocythemia) and acute and subacute portal vein thromboses resistant to therapy with direct anticoagulants. In all 5 cases, the use of antithrombin III in combination with low-molecular-weight heparin showed a positive clinical effect as rapid relief of pain syndrome and comparatively early (3-week to 1.5—2-month) recanalization of thrombosed vessels. Three clinical cases are described in detail.
Terapevticheskii arkhiv. 2016;88(1):89-95
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Prevention of complications of colonic diverticular disease in outpatient practice
Levchenko S.V., Komissarenko I.A., Lazebnik L.B.
Abstract
The literature review gives an update on the frequency and risk factors of complications of colonic diverticular disease, the results of recent investigations, which suggest the success and safety of outpatient treatment for uncomplicated acute diverticulitis. It evaluates the efficacy of pharmacological agents from different groups in preventing complications of colonic diverticular disease.
Terapevticheskii arkhiv. 2016;88(1):96-100
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