Vol 81, No 10 (2009)

Aim: to study cardiac rhythm variability (CRV), to optimize pregnancy management tactics and to choose a delivery procedure. Subjects and methods. Ninety-six 19-to-37 year-old (mean age 28.3±9.4 years) women at 35-39 weeks gestational age were examined. All the women were diagnosed as having congenital or acquired (rheumatic) heart disease. Their hemodynamics and CRV were analyzed according to the type of hemodynamic overload, for which purpose three patient groups were formed: 1) volume overload; 2) pressure overload; and 3) combined overload. A control group comprised 40 healthy pregnant women. Before and 2-3 days after delivery, all the women underwent 24-hour Holter cardiac rhythm monitoring with the estimation of the temporary and spectral parameters of CRV. Results. In antepartum heart diseases accompanied by volume overload, there was a tendency for total CRV (SDNN 95.4 ± 15.8 msec versus 125.5 ± 17.8 msec in the controls) to decrease and for sympathetic activity to significantly increase (SDANN 65.7 ± 13.7 and 109.9 ± 14.7 msec, respectively; p < 0.05). When pressure overload (a moderate gradient) developed, the temporary parameters of total CRV, sympathetic and parasympathetic activities did not differ from those in the control group. Heart diseases attended by pressure overload and a high gradient were characterized by a significant reduction in total CRV (100.5 ± 24.6 msec; p < 0.05) as compared with those in patients having a moderate pressure gradient, with a declining trend for total spectrum power, Group 3 patients showed a reduction in all the indices reflecting the temporary and spectral characteristics, suggesting a considerable rise in sympathetic activity and a decrease in total autonomic spectrum power. Conclusion. Based on SRV studies, indications for prolonged pregnancy and spontaneous or, in some cases, surgical delivery can be assessed in pregnant women with heart diseases.

At present, about 250 million subjects suffer from type 2 diabetes (T2D) in the world. Scientists assume that this figure will amount to 380 million subjects by 2025. Macrovascular complications hold the lead in the structure of mortality in patients with T2D. Chronic hyperglycemia is known to be a cause of the development and progression of T2D. As for effective diabetes control, there is strong evidence suggesting that better glycemic control can considerably reduce a risk for both micro- and macroangiopathy. To what values glycosylated hemoglobin (HbA1c) should be reduced to prevent complications due to T2D, currently remains an urgent problem. Based on the largest studies dealing with this problem, recommendations have been formulated for different groups of patients: to achieve HbA1c levels of < 7% for all patients; < 6% for those at relatively low risk for hypoglycemia, and in the range from 7.5 to 8% for those at its high risk.

Aim. To evaluate the influence of age and body mass index (BMI) on fasting and postprandial (2 hours after glucose load) plasma glucose (FPG and PPG) levels in males and females. Subjects and methods. A screening for carbohydrate metabolic disturbances (by using an oral glucose tolerance test) was made in the stratified adult sample from two municipal districts of the Moscow Region. The data were statistically processed by the computer program SPSS 11.0. Results. The mean FPG level in normoglycemic subjects was 5.26 ± 0.43 mmol/l. There was a significant (p < 0.001) positive correlation between age and FPG: r = 0.11 in men and r = 0.17 in women. The mean PPG was 6.15 ± 1.35 mmol/l; in males it was significantly lower than that in females. There was a significant correlation between age and PPG: r = 0.30 in males and r = 0.13 in females. A weak, but statistically significant correlation was found between FPG and body mass index (BMI) in women: r = 0.02. There was no significant correlation between FPG and BMI in men. No significant correlation was found between PPG and BMI in both males and females. A lower PPG level was 2 times more frequently observed in men than that in women (37.70 and 17.57%, respectively). Conclusion. Fasting and postprandial (2 hours after glucose load) plasma glucose levels increase with age in subjects without carbohydrate metabolic disturbances. A predictable plasma glucose level increase depending on age is described by the cubic regression model equation.

Aim. To estimate a relationship between the intima-media thickness (TIM), cardiovascular risk (CVR) factors, and the level of C-reactive protein (CRP) in gouty patients. Subjects and methods. Eighty-nine patients at an interattack interval were examined. The patients' mean age was 46.0 ± 11.4 years; the duration of the disease was 5.2 (3.0; 8.9) years. The traditional CVR factors were analyzed. Carotid ultrasound scanning was performed to detect vascular atherosclerotic lesion. The serum CRP concentration was measured by a highly sensitive immunonefelometric assay. Results. According to the TIM, the patients were divided into 2 groups: 1) 37 patients with signs of carotid atherosclerotic lesion (TIM l 0.9 mm); 2) 52 patients with a TIM of less than 0.9 mm. The ages at the moment of examination and at the onset of the disease, the duration of the disease, as well as systolic blood pressure, and the risk of myocardial ischemia were greater in Group 1 than those in Group 2. In patients with atherosclerosis, the concentration of CRP was statistically significantly higher than that in patients without this condition. Conclusion. By complementing the classical CVR factors, CRP may be a predictor of cardiovaskular diseases and their complications in patients with gout at an interattack interval.

Aim. To evaluate the efficiency and safety of arthrofoon versus sublingual nimesulide in patients with degenerative disc disease (DDD) in two parallel groups. Subjects and methods. Fifty patients (males and females) aged 18-35 years who had acute and chronic low back pain (LBP) (visual analog scale (VAS), > 40 mm) associated with DDD were enrolled in the study. Therapeutic efficiency was evaluated from the intensity of pain (VAS), spinal function (Schober's test and Tomayer's test), the severity of disease (VAS), assessed by a physician and a patient, and the frequency of recurrent pain episodes. Results. The evaluation of the efficacy of arthrofoon showed a statistically significant positive change in pain (VAS), which corresponded to that in the indices of the pain syndrome during nimesulide administration. There was a statistically significant reduction in the frequency of recurrences in patients with chronic intermittent LBP treated with arthrofoon (p < 0.01). Arthrofoon used alone and in combination with paracetamol demonstrated a good safety profile. Conclusion. In DDD-associated LBP, the use of arthrofoon is effective and safe in young patients with both the acute (in combination with nonsteroidal anti-inflammatory drugs as a short course) and chronic (requiring long-term anti-inflammatory therapy) types of the disease.

The review considers the current theories of depression and its clinical manifestations, as well as the factors that determine the likelihood of depression. It presents information on cerebral structural and functional changes observed in depression. There are data on the tactics of antidepressive therapy as a whole and on the use of coaxil in particular.

Aim. To study the influence of long-term of vardenafil use on endothelial and erectile functions in patients with arteriogenic erectile dysfunction (ED) Subjects and methods. The study included 74 arteriogenic ED patients (mean age 57.4 ± 4.7 years). In addition to a comprehensive andrological examination, all the patients underwent the estimation of the endothelial function of cavernous arteries, the indicator of which is the percentage increase in the diameter of cavernous arteries. The patients were divided into 3 groups: 1) 24 patients receiving vardenafil on demand in a dose of 10 mg; 2) 26 patients taking the drug on demand in a dose of 20 mg; and 3) 24 patients regularly using the agent in a dose of 10 mg every other day. Endothelial and erective functions were re-estimated 1, 3, and 6 months after the initiation of vardenafil therapy and a month following its discontinuation. Results. Erectile function improvement was noted just a month after the initiation of vardenafil therapy and achieved the maximum values by month 6. The highest erectile function parameters were observed in Group 3. There was a significant endothelial function improvement only in Group 3; the peak effect was achieved by month 6 of treatment. Conclusion. The long-term use of vardenafil contributes to the improvement of both erectile and endothelial functions in patients with arteriogenic ED.