The Influence of Multivessel Bypass Surgery on the Onset of Atrial Fibrillation in Elderly Patients

Aim. To study the factors associated with the development of postoperative atrial fibrillation (POAF) with single- or two- or more vascular bypass grafting in elderly patients with coronary heart disease.Methods. The study included 454 patients with coronary artery disease who underwent CABG. Patients were divided into 4 groups: 1 group – with single-vessel bypass, 2 group – with 2-vessels, 3 group – with 3-vessels and 4 group with 4-vessels bypass. During the observation period postoperative atrial fibrillation (POAF) occurred in 7.5% of patients in group 1, 18.4% in group 2, 17.5% in group 3 and 19.2% of patients in group 4. Since there were no significant differences in the incidence of POAF in patients with 2-4-vessels bypass grafting, these groups were combined for further analysis. 2 groups are allocated: Group I comprised patients with single-vessel bypass graft (79 patients, 76.0% of males, the average age of 65.0 [63.0;68.0] years), Group II – with 2-4-vessels bypass grafts (357 patients, 78.4% of males, the median age of 67.5 [64.5;69.0] years).Results. POAF occurred in 7.5% of patients in group I and in 18.4% of patients in group II (p=0.03) on the median 4.9 [1.2;8.7] day after coronary artery bypass graft. The multivariate regression analysis showed that indicators, associated with POAF development in patients undergoing CABG were the following: aortic cross-clamping time >36 min (odds ratio [OR)]1.4; 95% confidence interval (CI) 1.1-2.8; p=0.030), time of ischemia >19 min (OR 1.7; 95% CI 1.2-3.3; p=0.020), age >65 years (OR 1.8; 95% CI 1,1-4,1; p=0.010), left atrium diameter >39 mm (OR 2.9; 95% CI 1.5-5.4; p=0.005), left ventricular ejection fraction <51% (OR 1.9; 95% CI 1.2-3.0; p=0.04).Conclusion. In our study, atrial fibrillation in the early postoperative period was more common in patients undergoing multivessel coronary bypass surgery. Indicators, significantly associated with POAF in patients undergoing Coronary artery bypass graft were aortic cross-clamping time >36 minutes, time of ischemia >19 minutes, age >65 years, left atrium diameter >39 mm and left ventricular ejection fraction <51%

Omega-3 polyunsaturated fatty acids in the prevention of postoperative atrial fibrillation in open heart surgery: a systematic review and meta-analysis

Aim. To evaluate the literature data on the efficacy of omega-3 polyunsaturated fatty acids (PUFAs) in the prevention of postoperative atrial fibrillation (POAF) in elective cardiac surgery, including onor off-pump coronary artery bypass grafting and/or valve replacement and/or repair.Material and methods. The search for studies was carried out using the PubMed database and Google Scholar from 2005 to January 31, 2022. From the initially identified search results, 19 articles were analyzed. The design of articles corresponded to randomized clinical trials. Omega-3 PUFAs was selected as an interventional effect. The studies were to include, as an end point, the assessment of new POAF cases in the early period after open heart surgery.Results. The meta-analysis included 15 studies with 3980 patients, of which 1992 (50,0%) patients took omega-3 PUFAs. POAF occurred in 587 (29,5%) patients receiving omega-3 PUFAs and 679 (34,2%) patients on standard therapy (hazard ratio, 0,8, 0,68-0,93, p=0,004). There is a variation in effect size for POAF patients in the presented randomized clinical trials relative to the axis of the central trend and heterogeneity of studies with a significant number of patients included (I2=51%, p=0,01).Conclusion. Our systematic review and meta-analysis showed the effectiveness of omega-3 PUFAs in the prevention of POAF during open heart surgery

GENETIC POLYMORPHISMS OF CYTOCHROME P450 2C9, VITAMIN K EPOXIDE-REDUCTASE SUBUNIT 1 AND WARFARIN DOSING IN PATIENTS WITH PERMANENT ATRIAL FIBRILLATION

Aim - to assess the influence of genetic polymorphisms of CYP2C9 and VKORC1 on warfarin dosing in patients with permanent form of atrial fibrillation. Methods. The study included examination of 100 patients with coronary heart disease and permanent form of atrial fibrillation; mean age 60.5±5.8 years. Conclusion. In patients with permanent form of atrial fibrillation, genotypes CYP2C9*1/*3, TT and GG genotypes of VKORC1 are associated with low warfarin dose, compared to other genotypes. Genotype CYP2C9*1/*3 increases the risk of bleeding complication during warfarin therapy

Оптимальне керування нормальними режимами ЕЕС з врахуванням чутливості втрат потужності і технічного стану регулюючих пристроїв

Досліджено існуючі математичні методи визначення чутливості втрат потужності до зміни навантаження в вузлах. Запропоновано при оптимальному керуванні нормальними режимами (НР) електроенергетичних систем (ЕЕС) на етапі формування керуючих впливів враховувати чутливість втрат потужності в вітках до зміни навантаження в вузлах та технічний стан регулюючих пристроїв. Вдосконалено математичну модель коефіцієнту якості функціонування трансформаторів з регуляторами під навантаженням (РПН).The existing mathematical methods for determining power losses sensitivity to a change in the nodes. An optimal control in normal mode (HP) electric power systems (EPS) at the stage of control actions take into account the sensitivity of the power losses in branches to a change in the condition of sites and control devices. Improved mathematical model coefficient as function transformers with regulators under load (RPN)

Omega-3 Polyunsaturated Fatty Acids: the Role in Prevention of Atrial Fibrillation in Patients with Coronary Artery Disease after Coronary Artery Bypass Graft Surgery

Aim. To estimate the role of omega-3 polyunsaturated fatty acids (PUFAs) administration in atrial fibrillation (AF) prevention after planned coronary artery bypass graft (CABG) surgery.Material and Methods. Studied were 306 patients divided into two groups: patients of group I didn’t receive PUFAs (158 patients, 82.7% males) and patients of group II received PUFAs (148 patients, 89.3% males). PUFAs were prescribed in daily dose 2000 mg 5 days before surgery and in daily dose 1000 mg in postoperative period during 21 days.Results. Postoperative AF (POAF) occurred in 29.7% patients in group I and in 16.9% patients in group II (р=0.009). We found that after CABG in patients of the I group median IL-6 level was 39.3% higher (p=0.001), interleukin-10 – 20.2% higher (p=0.01), superoxide dismutase – 78.9% higher (р<0.001), malondialdehyde – 33.8% higher (p=0.03), docosahexaenoic acid – 31.8% lower (p=0.01) and omega-3 index – 43.4%    lower (p=0.04) than in patients of the II group.According to multivariate regression analysis we found significant association between the factors of inflammation, oxidative stress and the risk POAF development.Conclusions. In patients who took PUFAs, we found less activation of inflammation, oxidative stress, the increasing of docosahexaenoic acid and omega-3 index accompanied by the decreasing of POAF development rates up to 12.8%

METHOD OF GRAVITATIONAL THERAPY IN TREATMENT OF GASTROINTESTINAL TRACT DISORDERS

Aim - to increase the efficiency of treatment of patients with gastrointestinal tract disorders by including the method of gravitational therapy into the treatment complex. Methods. The method of gravitational therapy was used to achieve beneficial impact on the diseases of the gastrointestinal tract. Results. The paper presents the relevance of the treatment of gastrointestinal tract diseases and the search for new treatment options that have fewer side effects and reduce the cost of treatment. It also explores the influence of gravitational therapy on diseases of the gastrointestinal tract, and further introduction of this method in the treatment regimens. It specifies the importance of complementing medical treatment of gastrointestinal tract diseases with the physiotherapy methods. We present indications for diseases of the digestive system and contraindications for gravitational therapy. Conclusion.Positive influence of gravitational therapy in cases of gastrointestinal tract disorders was revealed

Розробка та дослідження структури системи автоматичного керування нормальними режимами електроенергетичних систем

Досліджено функції і структуру сучасних систем автоматичного керування режимами електроенергетичних систем. Запропоновані шляхи вдосконалення структурної схеми системи автоматичного керування режимами електроенергетичних систем за рахунок використання програмного комплексу SD Builder і введення додаткових блоків, зокрема блоку розрахунку планового значення технічних втрат потужності і блоку визначення коефіцієнту якості функціонування регулюючих пристроїв.Investigated functions and structure of power systems modern automatic control. Proposed ways to improve the structural scheme of the automatic control by modes of power systems through the use of software SD Builder and the introduction of additional units, including the calculation of technical power losses planned and functioning quality coefficient of regulating devices

INFLUENCE OF INTERMITTENT PNEUMATIC COMPRESSION ON ARTERIAL BED

Aim - to estimate the influence of intermittent pneumatic compression on arterial bed. Material and methods. The paper presents a literature review concerning the use of pneumatic compression in patients with peripheral artery disease. Results. Possibilities of pneumatic compression for prophylaxis and treatment of chronic ischemia in patients with peripheral artery disease are under discussion. Conclusion. The rapid growth of investigators’ interest in nonmedical methods of influence on arterial bed, and also the search for new and efficient methods and regimens highlight the significance of medical pneumatic compression. Currently, there is limited literature available about customization of pneumatic compression in accordance with nosology and individual indicators of blood circulation in lower extremities. As mentioned above, the most relevant and perspective direction is investigation of complex key indicators of arterial biomechanics with possibilities of the regimen correction, i.e. with implementation of feedback mechanism

Lipid profile of patients with arterial hypertension who underwent COVID-19: possibilities of drug therapy/ LEADER

Aim. To study the dynamics of the lipid profile of hypertensive patients with dyslipidemia who underwent COVID-19.Material and methods. Hypertensive patients with dyslipidemia who underwent COVID-19 [n=126; 58 men and 68 women; median age 60 (56.0; 65.5) years] examined. Patients were included into two groups: group 1 (n=64) received a single pill combination of lisinopril + amlodipine + rosuvastatin; 2 groups (n=62) continued the previous drug treatment. Clinical, demographic, office blood pressure (BP), total cholesterol (TC), low density lipoprotein cholesterol (LDL-c), high density lipoprotein cholesterol, triglycerides, C-reactive protein (CRP) levels were assessed in all patients in 3 visits within 24 weeks.Results. The groups did not differ in prior antihypertensive therapy (except for more frequent use of angiotensin II receptor blockers in group 2, p<0.05), lipid profile and blood pressure parameters at study entry. A decrease in systolic (by 9.5%) and diastolic blood pressure (by 12.1%) after 24 weeks was found in group 1 compared with 4.29% and 5.56%, respectively, in group 2 (p<0.05). A decrease in the level of total cholesterol by 14.5% and LDL-c by 31.4% after 24 weeks was found in group 1 compared with 11.2% and 9.7%, respectively, in group 2 (p<0.05). The level of CRP during the observation period decreased by 53.7% in group 1 versus 43.4% in patients of group 2 (p<0.05).Conclusion. The single pill combination of lisinopril/amlodipine/rosuvastatin in hypertensive patients with dyslipidemia who underwent COVID-19 led to an improvement in lipid profile and blood pressure control

Диагностика туберкулеза легких в условиях пульмонологического отделения стационара

A clinical case of 23-year old female with pulmonary tuberculosis is described in this article. The patient was admitted to a hospital with preliminary diagnosis of community-acquired pneumonia and negative TB test. Differential diagnosis of pulmonary tuberculosis and community-acquired pneumonia is often difficult and could be more difficult in patients with co-existing specific (Mycobacterium tuberculosis) and non-specific infection in the lungs.Дифференциальная диагностика туберкулеза легких (ТЛ) и пневмонии является сложной проблемой на этапе первичного обследования пациента в терапевтической практике. Представлен клинический случай диагностики ТЛ у 23-летней женщины при поступлении в стационар терапевтического профиля с диагнозом внебольничная пневмония при наличии отрицательных специфических тестов на ТЛ. Диагностика также может быть затруднена при наличии сочетанной специфической (микобактерии туберкулеза) и неспецифической инфекции в зоне воспалительного поражения легких