Vol 88, No 1 (2016)

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.

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.

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.

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.

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.

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.

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.

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.