Vol 91, No 1 (2019)


Clinical features of arterial hypertension in men and women (according to the National Registry of Arterial Hypertension)

Chazova I.E., Aksenova A.V., Oschepkova E.V.


Modern clinical guidelines for the diagnosis and treatment of arterial hypertension (AH) do not provide different treatment strategies separately for men and women. The analysis of gender differences in cardiovascular complications and features of AH therapy contributes to the development of an individualized approach to diagnosis and treatment of hypertension. The purpose of this study is to study the effect of sex on the features of therapy of arterial hypertension and the development of cardiovascular complications. Materials and methods. Data from the register of AH from outpatient hospital and cardiology departments of hospitals of 22 regions of the Russian Federation were analyzed. Data of medical documents of 33 564 patients with AH [(36.2%) men and 21 423 (63.8%) women] were entered into the on-line computer program and were analyzed using the statistical software package STATISTICA 10. Results. Cardiovascular and cerebrovascular diseases are more often diagnosed in men: peripheral artery disease, coronary heart disease, acute coronary syndrome, congestive heart failure, ischemic stroke, dissecting aortic aneurysm. The beginning of development cardiovascular disease in men with elevated blood pressure is already observed at age of 25-44 years, which indicates the need for preventive measures already in adolescence and closer monitoring of treatment at a young age. Conclusion. The study confirmed the role of the male sex as a risk factor for the development of cardiovascular disease in hypertensive men and women with comparable figures of blood pressure in. Identified gender features must be considered when diagnosing patients with AH.
Terapevticheskii arkhiv. 2019;91(1):4-12
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Effect of stress at work on the risk of cardiovascular diseases among the population of 25-64 years in Russia/Siberia (WHO program “MONICA-psychosocial”)

Gafarov V.V., Gromova E.A., Panov D.O., Gagulin I.V., Gafarova A.V.


The aim of the study was to determine the impact of stress on work on the risk of cardiovascular disease over a 16-year period in an open population of 25-64 years in Russia/Siberia. Materials and methods. A random representative sample of the population of both sexes of 25-64 years old in Novosibirsk in 1994 (men: n=657, 44.3±0.4 years, response - 82.1%, women: n=689, 45.4±0.4 years, response - 72.5%). The screening survey program included: registration of socio-demographic data, determination of stress at work (Karazek scale). The period of prospective follow-up of participants was 16 years. The study identified the following "end points": the first cases of myocardial infarction (MI), stroke. Results. A high level of stress at work was in 29.5% of men and 31.6% of women, the average level in 48.9% of men and 50.7% of women (χ2=2.574, υ=2, p=0.276). The risk of developing MI for a 16-year period, among people experiencing stressful situations at work, was: in men, HR=3.592, and women HR=3.218 (95% CI 1.146-9.042); stroke risk - among men, HR=2.603 (95% CI 1.06-4.153) in women HR=1.956 (95% CI 1.008-3.795). In multivariate analysis, in men with stress at work, the risk of MI among men was HR=1.15 (95% CI 0.6-2.2), among women - HR=2.543 (95% CI 1.88-7.351); risk of stroke, was in men, HR=3.8 (95% CI 1.6-8.8), in women - HR=1.95 (95% CI 0.984-3.887). The risk of stroke was higher among single, divorced and widowed men, HR=4.2 (95% CI 1.5-13.2), and in women with secondary or primary education, HR=3 (95% CI 0.852-11.039). Conclusion. It was established that a high level of stress at work is not gender-specific; the risk of developing MI over a 16-year period is higher in women than in men, stroke in men; the risk of myocardial infarction and stroke in both sexes is affected by the social gradient.
Terapevticheskii arkhiv. 2019;91(1):13-18
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Working time costs of doctors-therapists of divisionals on a patient

Liutsko V.V., Son I.M., Ivanova M.A., Dezhurny L.I., Kudrina V.G.


The aim of this article is to establish a weighted average costs of the workflow of the doctor-the therapist of the district, providing primary health care to the population in the outpatient setting to determine the costs when you visit one patient. Materials and methods. Held fotohronometra working process research 39 physicians in the 17th precinct pilot areas from all Federal districts. Within fotohronometra research conducted 6474 measurement. Results and discussions. The average time a physician of the district while visiting a patient in a medical organization made up of 15.30±2.0 min, while visiting at home - 32.5±2.0 min the Largest proportion of the working time of the doctor-the therapist of the district while visiting a patient in the outpatient setting is necessary to work with medical records (47.31%). On core activities while visiting a patient in the practitioner, the district spends to 45.54% of the time. For other activities - 7.15%. Conclusion. As a result fotohronometra research workflow of doctors-therapists of district, providing primary health care in outpatient settings, set the average time a physician of the district while visiting one patient (15.30±2.0 min), while visiting at home (32.5±2.0 min).
Terapevticheskii arkhiv. 2019;91(1):19-23
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Pulmonary arterial hypertension in Russia: six-year observation analysis of the National Registry

Chazova I.E., Arkhipova O.A., Martynyuk T.V.


Aim. Assess the prevalence, clinical course, current therapy, and mortality in patients with pulmonary arterial hypertension (PAH) in the National Registry. Materials and methods. In the prospective study we included patients over 18 years of age with diagnosed PAH [idiopathic PAH (IPAH); Drug - and Toxin-Induced Pulmonary Hypertension; inherited PAH; PAH associated with congenital heart disease (PAH-CHD); PAH associated with systemic connective tissue disease (PAH-CTD); PAH associated with HIV infection (PAH-HIV); with portal pulmonary hypertension (portoPAH)]. The observation was carried out in 15 expert centers of Russia from 01.01.2012 to 31.12.2017. Results. Our registry included 470 patients with PAH: IPAH - 41.5%, PAH-CHD - 36%, PAH-CTD - 19.5%, inherited PAH - 0.4%, portoPAH - 1.9%, PAH-HIV - 0.4%, Drug - and Toxin-Induced PAH - 0.4%. The prevalence among women was 84%. The mean age at the time of patient enrollment in the registry for the overall group of PAH was 42.7±15.3 years. The distance in the 6-minute walking test was 361.3±129.3 m. Among all patients with PAH, 65% had functional class (FC) III/IV at the time of diagnosis, among IPAH - 62%. 69.9% received PAH-specific therapy, of which 62.1% - monotherapy, 32.7% - dual combination therapy, and 5.2% triple therapy. Sildenafil is the most commonly prescribed drug in the regimen of monotherapy. 31.6% of patients were treated with bosentan, 6.4% - riociguat, 3.4% - ambrisentan, 2.1% - macitentan and 2.0% iloprost. Survival of patients with PAH was 98.9% at 1 year of follow-up, 94.1% at 3 years and 86.0% at 5 years. Conclusion. The registry data indirectly indicates the need to increase efforts aimed at improving the diagnosis of systemic connective tissue diseases in adults, as well as congenital heart defects in children for timely surgical treatment. In recent years, PAH-specific drugs of the new generation have been introduced into clinical practice, but currently in Russia there are no parenteral prostanoids, which are recommended for the most severe patients.
Terapevticheskii arkhiv. 2019;91(1):25-31
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Prognostic role of ST2 in patients with chronic heart failure of ischemic etiology and carbohydrate metabolism disorders

Grakova E.V., Kopeva K.V., Teplyakov A.T., Ogurkova O.N., Garganeeva A.A., Garmaeva O.V.


Aim. To study the role of soluble ST2 (sST2) in patients with coronary artery disease (CAD) and chronic heart failure (CHF) associated with carbohydrate metabolism disorders (impaired glucose tolerance (IGT) and type 2 diabetes mellitus (DM) in risk stratification of adverse cardiovascular events (ACE) for 12 months of follow-up. Materials and methods. We enrolled 118 patients with CAD and CHF I-III FC (NYHA) with the ejection fraction of left ventricular of 60 [46; 64] % aged 62.5 [57; 68] years. Serum sST2 levels were measured by enzyme immunoassay. Results. Depending on the presence of carbohydrate metabolism disorders (CMD), the patients were divided into 3 groups: group 1 (n=65) included patients without CDM, group 2 (n=30) included with IGT, and group 3 (n=23) included with type 2 DM. Serum levels of sST2 in patients with CMD were significantly (p=0.011) higher than in patients without CMD, but in subgroups of patients with IGT and type 2 DM, the concentrations of sST2 did not differ. In group 1 sST2 levels were 30.51 [26.38; 37.06] ng/ml, and in group 2 and 3 - 37.97 [33.18; 47.48] and 41.45 [35.27; 50.37] ng/ml, respectively. There were statistically significant differences in the rate of adverse ACE in relation to sST2 levels: in spite of CMD, in subgroups with biomarker overexpression adverse CCC occurred more often (p<0.01). According to the ROC analysis, the sST2 level of 33.14 ng/ml with the sensitivity of 73.3% and the specificity of 75.0% can be considered as a marker of ACE development within 12 months of follow-up (AUC=0.77, 95% CI 0.59-0.89, p=0.002). Conclusion. In patients with CHF of ischemic etiology, the prognostic significance of sST2 are established as a biomarker of ACE development. In patients with CDM, sST2 levels are significantly higher than in those without CDM that is associated with a higher rate of ACE within 12 months of follow-up.
Terapevticheskii arkhiv. 2019;91(1):32-37
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Clinically significant food preferences of patients with atrial fibrillation: a nosological and regional peculiarities

Skirdenko J.P., Nikolaev N.A.


The aim of the investigation was to study the peculiarities of food consumption in patients with atrial fibrillation, capable of influencing the anticoagulant therapy with warfarin, in comparison with healthy volunteers and taking into account geographical specifics. Materials and methods. In an open cohort study, 196 respondents (88 men, 108 women) evaluated food preferences using a questionnaire survey. The quantitative evaluation of adherence to lifestyle modification was studied by QAA-25. Statistical data processing was performed by parametric (Student's t-test) and nonparametric (Wald-Wolfowitz, Kolmogorov-Smirnov, Pearson) analysis methods. Results. There were no statistically significant differences in food rations between the studied categories of respondents, both increasing [37.0±19.5 points versus 37.3±17.98 points; Wald-Wolfowitz (Z), p=0.16] and reducing the activity of warfarin [62.2±26.3 points versus 63.4±23.8 points; Wald-Wolfowitz (Z), p=0.95]. The absence of differences remained in the evaluation, taking into account regional characteristics of nutrition. The respondents were taking warfarin, there is no relationship between the level of commitment to the modification of lifestyle and diet modification. Conclusion: it is shown that medical recommendations aimed at correcting the eating behavior of respondents taking warfarin are not effective, which can be an independent risk factor for complications of both warfarin therapy and the underlying disease.
Terapevticheskii arkhiv. 2019;91(1):38-42
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Comorbidity and polymorbidity of the patient with chronic obstructive pulmonary disease and cardiovascular diseases

Grigoryeva N.Y., Maiorova M.V., Korolyova M.E., Samolyuk M.O.


Aim: the study of comorbid status and characteristics of clinical course of ischemic heart disease (IHD) in patients with chronic obstructive pulmonary disease (COPD). Materials and methods. We conducted a retrospective analysis of case histories of 958 IHD patients aged 32 to 93 years (mean age of 60.8±10.2 years), including men - 525 (54.8%), women - 433 (45.2%) who were treated in the cardiology Department of city clinical hospital №5 of Nizhny Novgorod. Related COPD was diagnosed in 251 patients (26.3%). We compared two groups patients: with IHD and COPD, and the second - persons suffering from only IHD (without COPD). Results. Myocardial infarction was transferred by 62.2% of patients in Group 1, which is 16.3% more than in Group 2 (p<0.05). Arterial hypertension in patients with COPD was 13.6% more frequent than in patients without COPD (p<0.05), and 6.4% more often (p<0.05), with comorbid pathology there was a chronic and paroxysmal forms of atrial fibrillation. In patients with IHD in combination with COPD it is 21.5% more often (p<0.05) than in IHD without COPD, there was shortness of breath and 32.1% more often (p<0.05) of the heartbeat. In patients with IHD with COPD, a higher level of was C-reactive protein detected (p<0.05) and more pronounced violations of the lipid profile (p<0.05). Conclusion. COPD makes a significant contribution to the development of the cardiovascular continuum, modifying its course. A modern patient with COPD is a high-risk patient with severe cardiovascular comorbidity and various polymorbidity.
Terapevticheskii arkhiv. 2019;91(1):43-47
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Levels of depression and life exhaustion in the open population of the middle urbanized Siberian city: gender differences

Akimova E.V., Akimov M.J., Gakova E.I., Kayumova M.M., Gafarov V.V., Kuznetsov V.A.


The aim of the study was to determine the levels of depression and life exhaustion in men and women of the open urban population in the age range. Materials and methods. A single-stage epidemiological study was conducted among people of both sexes aged 25-64 in Tyumen. A representative sample was formed from the electoral lists of citizens by the method of "random numbers" - 2000 men and women with a response among men 85.0%, among women - 70.3%. The study of depression was conducted according to the algorithms of the program of the world health organization "MONICA-psychosocial". Results. The prevalence of depression in the Tyumen population and in the age and sex groups showed a predominance of the average level over the high, in the age categories 25-34 and 35-44 years - significantly higher prevalence of high levels of depression in women. The higher prevalence of the average level of men and women IN the open population was determined to be relatively high. The average level of LIFE significantly prevails in women in the older age categories and in the population as a whole, the high level of LIFE - at the age of 25-34 years in women and at the age of 55-64 years in men. Conclusion. Therefore, in the open population of the middle-urbanized Siberian city there is a need to form an integrated approach to the prevention of non-infectious diseases, especially cardiovascular diseases, as it is established that prevention programs lead to a reduction in the burden of depression and, and effective approaches to the prevention of psycho-emotional States at the level of individual communities include school-oriented programs to teach positive thinking among the population, starting from a young age.
Terapevticheskii arkhiv. 2019;91(1):48-52
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Endothelial dysfunction a significant marker of adverse clinical outcome in patients with atrial fibrillation after cardioembolic stroke

Zolotovskaya I.A., Davydkin I.L.


Aim. To study the prognostic significance of endothelial dysfunction (ED) markers in the development of adverse clinical outcome (death) in patients with atrial fibrillation (AF) within a year after cardioembolic stroke. Materials and methods. 260 patients with newly diagnosed (nAF), paroxysmal, persistent and permanent forms of AF who underwent stroke were included. Duration of observation-12 months. V1 - the beginning of the study: V2 - 180 (±5) days and V3 - 360 (±5) evaluated the level of von Willebrand factor (fW), antithrombin III (AT III) and plasminogen. Results and discussion. During the year of follow-up, patients with AF who underwent and had a high mortality rate. During the whole period 38 (14.6%) patients died, 15 (23.0%) - in the group with nAF, 6 (9.2%) - in the group with paroxysmal AF, 7 (10.8%) - in the group with persistent AF and 10 (15.4%) - in the group with permanent AF. After a year of follow-up, the level of fW in patients with nAF was higher than in patients of all groups, and statistically significant in patients with paroxysmal and persistent forms of AF. At III was important in the group of patients with nAF and with a constant form of AF, in the same groups there was no statistically significant increase in a year of follow-up. It was found that in survivors with nAF at III (73.54±8.67%) higher (p=0.002) compared with the dead (65.77±6.01%). In the group of patients with paroxysmal AF in survivors of III (77.75±10.15%) higher (p=0.031) compared with the dead (69.25±5.80%). In patients with persistent AF, the survivors of III (76.57±9.09%) were higher (p=0.002) compared to the dead (65.60±2.21%). Taking into account the results of the analysis of the dynamics of ed markers, it can be assumed that AT III is the most accurate prognostic marker for the studied cohort of patients. Conclusion. Detection and correction of ED in AF in patients within a year after stroke can optimize the tactics of management of patients and improve the prognosis of the diseas.
Terapevticheskii arkhiv. 2019;91(1):53-59
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Functional state of the small airways in patients with bronchial asthma associated with obesity

Mineeva E.E., Antonyuk M.V., Yurenko A.V., Gvozdenko T.A.


Aim. To assess the functional status of the small Airways in patients with bronchial asthma associated with obesity, by body plethysmography. Materials and methods. 65 patients with bronchial asthma of mild severity, partially controlled course, including 30 patients with normal body weight and 35 patients with obesity of I degree were examined. Control group-30 healthy volunteers. Examined forced vital capacity (FVC), forced expiratory volume in first second (FEV1) ratio of FEV1 to FVC (FEV1/FVC), maximum volumetric exhalation rate after 25.50 and 75% FVC (MEF75, MEF50, MEF25), average flow velocity in the exhalation interval 25-75% of FVC (MMEF25-75). Method bodyplethysmography was evaluated in bronchial resistance, functional residual capacity (FRC), residual volume of the lungs (RV), total lung capacity (TLC), the percentage of RV/TLC. Results. Patients with bronchial asthma with obesity showed a reduction of indicators of bronchial obstruction: FEV1 of 14% (p=0.02), FEV1/FVC by 14% (p=0.001), MEF75 30% (p=0.001), MEF50 by 35% (p=0.001), MEF25 by 44% (p=0.003), MMEF25-75 by 38% (p=0.001). The increase of bronchial resistance on inhalation in 2 times (p=0.001), on exhalation in 3.3 times (p=0.003) was found, which is typical for generalized bronchial obstruction at the proximal level. An increase in RV by 24% (p=0.03), TLC - by 9% (p=0.03), RV/TLC - by 18% (p=0.03), indicating the presence of "air traps" and dysfunction of the small respiratory tract. Conclusion. In patients with asthma of mild severity associated with obesity, both the central bronchis and the distal lung are affected, which are manifested by generalized bronchial obstruction, the formation of "air traps" and dysfunction of the small respiratory tract.
Terapevticheskii arkhiv. 2019;91(1):61-63
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Relationships of arterial hypertension and reduced renal function in a population 25-45 years

Kovalkova N.A., Ragino Y.I., Scherbakova L.V., Hudyakova A.D., Denisova D.V., Voevoda M.I.


Aim. To study relationships of reduced renal function with hypertension and other cardiometabolic risk factors in persons aged 25-45 years. Materials and methods. A cross-sectional population study of one of the typical district of Novosibirsk (Russia) was performed during 2013-2016 years. The study included 468 men and 606 women aged 25-45 years. Blood pressure (BP), waist circumference (WC), blood lipids, glucose, creatinine were measured. Glomerular filtration rate (GFR) was calculated with the formula CKD-EPI. Hypertension was registered if blood pressure (BP) was ≥140/90 mm Hg, reduced kidney function - at GFR<90 ml/min/1.73 cm2. Results. Prevalence of hypertension among men was 28%, among women - 9%. The proportion of people with GFR<90 ml/min/1.73 cm2 among men was 9.8%, among women - 34%. Among all examined people GFRs <60 ml/min/1.73 cm2 was revealed in 0.3% only. The association of hypertension with reduced renal function was determined only in men. Based on results of multivariate linear regression analysis, a significant negative association of GFR with age was determined, there was no association of GFR with systolic BP (SBP) in either men or women. In men, inverse relationships of GFR with low-density lipoprotein cholesterol (LDL-С), triglycerides (TG), direct - with WC were determined. Significant inverse association of GFR with diastolic BP (DBP) was revealed only after exception of TG from the regression model. In women, GFR's inverse relationship with LDL-С and DBP was observed, and the direct - with WC. In stepwise analysis the validity of all associations was confirmed after exception of the association of GFR with WC in men. Conclusions. In a population of 25-45 years a reduced GFR was associated with increased DBP; levels of LDL-С, TG showed negative association with GFR; in men increased TG levels were more important in reducing GFR than elevated DBP.
Terapevticheskii arkhiv. 2019;91(1):64-70
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Interrelation of cardiovascular risk factors with high albuminury among patients with arterial hypertension living in Mountain Shoriya

Mulerova T.A., Filimonov E.S., Maksimov S.A., Maksimov V.N., Voevoda M.I., Ogarkov M.Y.


Aim: to evaluate the association of a complex of cardiovascular risk factors and genetic markers with the development of high albuminuria among patients with arterial hypertension in the population of Mountain Shoriya, taking into account ethnicity. Materials and methods. A clinical epidemiological study of a compactly residing population in remote areas of Mountain Shoria was carried out. 1409 people were examined [901 people - representatives of the indigenous nationality (Shorians), 508 people - representatives of non-indigenous nationality (90% of them are Caucasians)]. Hypertension was diagnosed according to the National Guidelines of the Russian Society of Cardiology/the Russian Medical Society on Arterial Hypertension (2010). All patients underwent clinical, laboratory and instrumental investigation. To study the state of the kidneys, the concentration (the presence of elevated levels) of albumin (albuminuria) in the morning portion of urine by an immunoturbidimetric method was analyzed. Polymorphisms of genes ACE (I/D, rs4340), АGT (c.803T>C, rs699), AGTR1 (А1166С, rs5186), ADRB1 (с.145A>G, Ser49Gly, rs1801252), ADRA2B (I/D, rs28365031), MTHFR (c.677С>Т, Ala222Val, rs1801133) and NOS3 (VNTR, 4b/4a) were tested using PCR. Results. In the group of shors with arterial hypertension, high albuminuria was associated with polymorphisms of the ACE genes (OR=2.05), ADRA2B (OR=6.00), elevated triglyceride level (OR=2.86), decreased index of cholesterol of high density lipoproteins (OR=5.57) and increased index of low density lipoproteins (OR=2.49); in the new population - with polymorphisms of the AGTR1 genes (OR=8.66), ADRA2B (OR=6.53), MTHFR (OR=7.16), obesity (OR=2.72), and abdominal obesity (OR=3.14). Conclusion. The primary predictors determining the development of high albuminuria among patients with arterial hypertension in both ethnic groups were genetic ones. In addition to them, non-genetic risk factors also contributed to the development of this organ damage to the kidneys: age and lipid metabolism disorders in representatives of indigenous nationality; age and abdominal obesity in the examined patients non-indigenous nationality.
Terapevticheskii arkhiv. 2019;91(1):71-77
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Chronic obstructive pulmonary disease patients electronic register analysis: the effectiveness of patient’s dynamic follow up and evaluation of treatment program

Mishlanov V.J., Shubin I.V., Bekker K.N., Katkova A.V., Koshurnikova E.P.


In the last few years new informatics methods were implemented in medicine and allowed to create big data including individual clinical markers of every patient. It is suggested that clinical electronic patient’s register analysis will present accurate information about different treatment programs effectiveness, including those whose effectiveness is not still proved today. The aim of the study. To estimate the effectiveness of clinical patients register implementation as well as to analyze different treatment and prophylactic programs on chronic obstructive pulmonary disease (COPD) patients’ structure. Materials and methods. The COPD patient’s register consists of 4257 cases. Spirometrical data were evaluated. Dynamic follow was performed on 567 COPD patients. Bronchodilator’s therapy was estimated as well as combined inhaled corticosteroid/ long acting β2-agonist medications and vaccination against pneumococcal infection. Results. Computer program “Electronic polyclinic” proposed by the authors of this article is effective in precision of diagnostic decision making in cohort study, dynamic follow up after clinical symptoms, evaluation of instrumental and laboratory results, prophylactics and treatment effectiveness, “clinical patients registers” automatic formation using syndrome or nosological principle, checking the COPD patients in the group of those with bronchial obstruction. Conclusion. Positive effects of long-acting bronchodilator treatment on COPD exacerbation decreasing and more expressed effect of inhaled corticosteroid/ long acting β2-agonists were confirmed. More interesting result was influence of vaccination against pneumococcal infection PCV13 (polyvalent conjugated vaccine) on exacerbation frequency and dyspnea severity.
Terapevticheskii arkhiv. 2019;91(1):78-83
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Differential radiological diagnosis of tuberculous sacroiliitis and bone involvement in Gaucher disease: a clinical case

Soloveva A.A., Ponomarev R.V., Lukina K.A., Mamonov V.E., Khomenko V.A., Kostina I.E., Yatsyk G.A., Lukina E.A.


Differential diagnosis of bone involvement in patients with Gaucher disease can be challenging. Other diseases with similar radiological signs should be ruled out. Here we present a clinical case of tuberculous sacroiliitis in the patient with type I Gaucher disease. Advanced radiological methods of examination are described. Our case report proves the necessity of an individual approach to the management of such cohort of patients.
Terapevticheskii arkhiv. 2019;91(1):84-88
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Autoimmune liver disease (primary biliary cholangitis/autoimmune hepatitis-overlap) associated with sarcoidosis (clinical cases and literature review)

Burnevich E.S., Popova E.N., Ponomarev A.B., Nekrasova T.P., Lebedeva M.V., Filatova A.L., Shchanitcyna E.M., Ponomareva L.A., Beketov V.D., Bondarenko I.B., Tanashchuk E.L., Nikulkina E.N., Moiseev S.V.


Clinical features of overlap autoimmune hepatitis/primary biliary cholangitis and morphological-proved sarcoid lesions (lungs, lymph nodes, skin) were performed. Data of long-term clinical observation presented in comparison with the results of laboratory datas, instrumental and morphological studies of liver tissue, lungs, skin. The modern aspects of pathogenesis of association autoimmune and granulomatous diseases arediscussed on the example of clinical cases of combination of cholestatic variants of autoimmune hepatitis and generalized sarcoidosis.
Terapevticheskii arkhiv. 2019;91(1):89-94
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Pentoxifylline and nephroprotection: effects on renal dysfunction and cardiovascular risks

Murkamilov I.T., Aitbaev K.A., Fomin V.V., Murkamilova Z.A., Bayzhigitova A.A.


Generalized data on nephroprotective efficacy of pentoxifylline in chronic kidney disease (CKD) are presented. The potential of this drug in treating people suffering from CKD and cardiovascular diseases (CVD) with a high risk of developing the terminal stage of renal dysfunction is considered. Antiproteinuric, antifibrotic and anti-inflammatory effects of pentoxifylline significantly reduce the risk of progression of CKD and joining of CVD in the future. Efficacy in preventing the onset of the uremic stage of CKD, safety andapplicability at all stages of renal dysfunction development make pentoxifylline a very appealing drug not only for nephrologists but also for physicians.
Terapevticheskii arkhiv. 2019;91(1):95-100
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Protective measures of patients with cardiovascular diseases from exposure to heat waves: medicated and non-medicated

Smirnova M.D., Svirida O.N., Ageev F.T.


In conditions of climate warming with an increase in heat waves associated with an increase in cardiovascular morbidity and mortality, the particular interest is the effect of cardiovascular drugs on adaptation to high temperatures. The review reflects the results of European and domestic studies on the safety of therapy during long and short heat waves. Recommendations for the correction of therapy during this period are given. Self-control of blood pressure (SCAD) is a mandatory component of the therapy of arterial hypertension during heat waves. With the development of clinically significant hypotension, a reduction in the dose of antihypertensive drugs is necessary. It is recommended to start with a dose reduction and/or withdrawal of diuretics and nitrates. Not recommended the complete abolition of antihypertensive therapy because of the risk of hypertensive crises, characteristic of abnormal heat, as well as due to the increase in blood pressure when the weather changes and the temperature drops. With increasing blood pressure during heat waves, it is recommended to give preference to calcium channel antagonists, angiotensin converting enzyme inhibitors (ACE inhibitors) and selective beta-blockers. It is necessary to inform patients about the additional protective effect of statins in order to increase adherence to therapy. Patients taking diuretics require individual daily monitoring of fluid intake and body weight. An overview of recommendations on sanogenic behavior during heat waves is given. Details are considered rules for the use of air conditioning, methods of diagnosis of dehydration and drinking mode
Terapevticheskii arkhiv. 2019;91(1):101-107
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Safety of nonsteroidal anti-inflammatory drugs in patients with cardiovascular risk

Naumov A.V., Tkacheva O.N., Khovasova N.O.


The review presents current information on the role of NSAIDs in the development of cardiovascular disasters. The development of non-desirable cardiovascular effects and an increase in cardiovascular risk with the administration of NSAIDs, most experts assess in terms of the antagonistic effect on the platelet-vascular homeostasis of metabolites of COX-thromboxane A2 and prostaglandin I2 (prostacyclin). All the presented reviews confirming an increase in the risk of MI complications in the administration of NSAIDs, indicate the class-specificity of this undesirable effect, not homogeneous for different representatives of the group. Important clinical aspects of prescribing NSAIDs for patients with low and moderate cardiovascular risk are the clinical features of the patient and the individual set of risk factors for CVD. Such pharmacokinetic characteristics of NSAIDs as a short half-life, a high degree of binding to blood plasma albumins are indicative of greater safety of NSAIDs, but the final decision must be made based on the accumulated data of clinical trials and meta-analyzes.
Terapevticheskii arkhiv. 2019;91(1):108-113
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Significance of L-carnitine in internal medicine

Sizova Z.M., Shikh E.V., Makhova A.A.


The review presents the results of a number of experimental and clinical studies proving the prospects of using L-carnitine in the clinic of internal diseases. Due to the antioxidant and antihypoxant properties, the additional use of L-carnitine in addition to the main etiopathogenetic therapy is prescribed by cardiologists, nephrologists, neurologists, gerontologists. Experimental studies we conducted earlier showed no effect of L-carnitine on the activity of the P450 CYP 3A4 system, which reduces the likelihood of drug-drug interaction at the level of metabolism of drugs metabolized by P450 3A4. When using L-carnitine as part of complex pharmacotherapy, the drug has an increased safety profile in comorbid patients taking L-carnitine.
Terapevticheskii arkhiv. 2019;91(1):114-120
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Iatrogenia in internist practice

Dvoretsky L.I.


The article presents the history of the issue, the concept of iatrogenia, possible negative consequences of the interaction of the doctor and the patient in modern conditions. The main forms of iatrogenic (psychogenic, hospital, iatrogenic diagnostic procedures, medicinal, etc.) are given. An important place is occupied by implantation of iatrogenic (patients with artificial heart valves, cardio-implanted electronic devices, coronary stents, articular endoprostheses). The most vulnerable to the development of iatrogenic are elderly and senile patients. The interdisciplinarity of the iatrogenic problem and its educational significance for therapists, general practitioners, clinical pharmacologists, pathologists.
Terapevticheskii arkhiv. 2019;91(1):121-128
pages 121-128 views

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