56 research outputs found

    Nonspecific aortoarteritis as a Cause of Aortic Dissection in a Middle Aged Man

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    Nonspecific aortoarteritis (Takayasu's disease) is a systemic inflammatory disease characterized by granulomatous lesions of the aorta and its large branches. The article describes the clinical manifestations, methods of diagnosis and treatment of this pathology. It also describes a clinical observation that illustrates the delayed diagnosis of the disease in a 47-year-old man, where Takayasu arteritis with lesions of the root, ascending aorta, both common carotid arteries, thoracic and abdominal aorta (type V according to the angiographic classification proposed by Moriwaki R.) manifested a syncopal state, just a few days before the development of a life – threatening complication-aortic dissection of type I according to the DeBakey classification. From a clinical point of view, it is important that Takayasu's disease does not always develop in young people, women, and Asian origin, and, unfortunately, it is often very late to diagnose, although the effectiveness of therapy, including surgical correction of this disease, is entirely determined by the timeliness of its diagnosis

    Outpatient Practice of Lipid-Lowering Therapy Prescription (According to the ARGO-3 Study)

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    Aim. To study the frequency of prescriptions of various types of lipid-lowering therapy and their effectiveness in outpatient clinical practice based on the results of a questionnaire of primary care physicians.Material and methods. The study was performed in 2022 in 75 constituent entities of the Russian Federation with the participation of 1117 doctors working in outpatient clinics. Most of the doctors had work experience of 10-20 years or more. Doctors of polyclinics (therapists and cardiologists, etc.) before the start of the study received instructions, questionnaires for filling out, developed by the National Atherosclerosis Society. The frequency of prescriptions by primary care physicians of various types of lipid-lowering therapy and their effectiveness in terms of the frequency of achieving target levels of low-density lipoprotein cholesterol (LDL-C) was studied based on the results of a questionnaire.Results. Monotherapy with statins was prescribed in 55.2% of cases, free combination of rosuvastatin with ezetimibe – in 17.2%, single pill combination of rosuvastatin with ezetimibe – in 23.2%, combination therapy with PCSK9 inhibitors – in 4.1% of cases. Target levels of LDL-C ˂ 1.8 mmol/l and ˂ 1.4 mmol/l were achieved with statin monotherapy in 42.6% and 28.2% of cases, respectively, free combination of rosuvastatin with ezetimibe – in 61.7% and 39 .5%, a fixed combination of rosuvastatin with ezetimibe – in 67.8% and 48.5%, combination therapy with PCSK9 inhibitors – in 96.8% and 92.8% of cases.Conclusion. The single pill combination of rosuvastatin with ezetimibe is more effective in achieving target levels of LDL-C compared with statin monotherapy and therapy with free combination of statin with ezetimibe. Despite the fact that the target values of LDL-C when prescribing a combination with PCSK9 inhibitors were achieved in 96.8% and 92.8% of cases, they were used quite rarely at the outpatient stage of treatment in the Russian Federation

    LIPID-LOWERING THERAPY IN OUTPATIENT PRACTICE (ACCORDING TO THE ARGO-2 STUDY)

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    Aim. To study the features of lipid-lowering therapy with rosuvastatin in high and very high cardiovascular risk patients in real outpatient practice.Material and methods. Patients ≥30 years, visited internists or cardiologists of district outpatient clinics in the period from October 2013 to July 2014 were included into the study. Each patient fill in questionnaire. Determination of total cholesterol (TC) level was performed without special preparation of the patient using a portable photometric blood analyzer. Doctors prescribed rosuvastatin therapy when indicated, in accordance with the Guidelines, choosing the dose on their own. Repeated TC level was determined after 1 month.Results. TC level was initially determined in 10547 patients. Rosuvastatin treatment was recommended for all patients. Repeated TC level determination was performed in 7897 patients in an average after 33 days. Baseline TC level in them was 6.37±0.89 mmol/l, and after 1 month while taking rosuvastatin – 4.89±0.81 mmol/l (p<0.001). The change of TC level was -22% (p<0.001). The average prescribed dose of rosuvastatin was 11.88±5.1 mg per day. The most often (62.8%) rosuvastatin was prescribed in a dose of 10 mg per day, in 27.3% of patients – 20 mg per day, in 9.2% – 5 mg per day, and only 0.5% of patients took it in the maximal dose.Conclusion. In real clinical practice, rosuvastatin for treatment of patients with high or very high cardiovascular risk is often prescribed in moderate doses and rarely in the maximum dose despite the proven lipid-lowering effect

    CLINICAL GUIDELINES FOR FAMILIAL HYPERCHOLESTEROLEMIA

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    These guidelines represent all current aspects of etiology, diagnosis, and treatment of the clinical and statistical group of familial hypercholesterolemia in both adults and children in accordance with the requirements of the Ministry of Health of Russia

    Влияние препарата «Кумазид» на функциональное состояние внутренних органов крыс

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    An investigation of Kumazid medication influence on functional condition of experimental animal main organs and and systems, that were subjected to intragastric injection during three monthes, was made. It was determined that the Kumasid medication dosed 1—100 mkg/kg administrated to rats intragastically during three monthes doesn’t change internal conditions of lab animals.Проведено исследование влияния препарата «Кумазид» на функциональное состояние основных органов и систем при длительном (3-месячном) внутрижелудочном введении препарата экспериментальным животным. Установлено, что препарат «Кумазид» при 3-месячном курсе внутрижелудочного введения крысам в дозах 1-100 мкг/кг массы тела не оказывает достоверных изменений состояния внутренних органов лабораторных животных

    Тактика хирургического лечения пациентов с инфарктом мозжечка

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    The aim of the study is to specify tactics of surgical treatment of cerebellar infarction (CI).Material and methods. The results of treatment of 80 patients with CI were studied. According to the clinical course of stroke, the patients were divided into 2 groups. The group of malicious cerebellar infarction included 55 patients (69%) (Group I), the group cerebellar infarction with benign course included 25 patients (31%) (Group II). Patients of Group I were divided into subgroups, in one of them surgical treatment was performed (surgical subgroup), and in the another one, only conservative (conservative subgroup) treatment was performed. In the surgical subgroup, 16 patients underwent isolated ventriculostomy, 5 - posterior fossa decompression (PFD), 18 - combination of ventriculostomy and PFD. The criteria of efficacy of surgery were recovery of consciousness and/or IV ventricle and the quadrigeminal cistern configurations. Results of treatment were assessed according to the Glasgow Outcome Scale.Results. Malicious cerebellar infarctions occurred more frequently in patients with volume of ischemia exceeding 20 cm3 in the first day of the disease. The threshold value of mass effect, which may cause further a malocious cerebellar infarction, in the first day of the disease was score 3 according to the M. Jauss scale. In group of patients with malicious cerebellar infarction, surgical treatment reduced the mortality rate of occlusion and dislocation syndrome by 35.8%. The most effective type of intervention was a combination of decompressive trepanation of the posterior cranial fossa and external ventricular drainage. Combined ventriculostomy and PFD were 34 % more effective than just ventriculostomy, and 38 % more effective than just PFD.Conclusion. Patients with cerebellar infarction of more than 20 cm3 and signs of a mass effect in the posterior cranial fossa score 3 or higher according to M. Jauss scale, are prone to developing a malicious course of the disease. After the development of clinical manifestations of occlusive and dislocation syndrome, they need surgical treatment.In the surgical treatment of malignant cerebellar infarction, ventriculostomy with PFD are advisable, as each operation separately does not always provide a necessary effect in decompensation of dislocation syndrome.Цель исследования материал и методы. Исследованы результаты лечения 80 пациентов с ИМ. По характеру клинического течения ИМ пациенты были распределены на две группы. В группу злокачественного течения ИМ вошли 55 пациентов (69%) (группа I), в группу доброкачественного течения ИМ - 25 пациентов (31%) (группа II). Пациенты I группы были дополнительно разделены на подгруппы, в которых проводили хирургическое (хирургическая подгруппа) и только консервативное (консервативная подгруппа) лечение. В хирургической подгруппе 16 пациентов перенесли ликворошунтирующие операции (ЛО), 5 - декомпрессивную трепанацию задней черепной ямки (ДКТ ЗЧЯ), 18 - ЛО в сочетании с ДКТ ЗЧЯ. Критериями эффективности хирургического лечения считали восстановление сознания до ясного и/или восстановление конфигурации IV желудочка и четверохолмной цистерны. Результаты лечения оценивали по шкале исходов Глазго.Результаты. Злокачественное течение ИМ чаще возникало у пациентов с объемом ишемии, превышающим 20 см3 в 1-е сут заболевания. Пороговое значение масс-эффекта в первые сутки заболевания по шкале М. Jouss, которое может в последующем вызвать злокачественный ИМ, составило 3 балла. У больных со злокачественным ИМ хирургическое лечение позволило снизить летальность от окклюзионно-дислокационного синдрома (ОДС) на 35,8%. Эффективность хирургического лечения среди больных, которым выполнили ДКТ ЗЧЯ совместно с ЛО, была выше на 34% по сравнению с ЛО и на 38% по сравнению с результатами больных с изолированной ДКТ ЗЧЯ.Заключение. Пациенты с ИМ объемом более 20 см3, сопровождающимся масс-эффектом в ЗЧЯ 3 балла и более по шкале М. Jouss, склонны к развитию злокачественного течения заболевания. При развитии клинической картины ОДС им показано хирургическое лечение.При хирургическом лечении злокачественного ИМ целесообразно выполнять совместно с вентрикулостомией ДКТ ЗЧЯ, так как каждая операция по отдельности не исключает дальнейшего прогрессирования ОДС

    Improved functionalization of oleic acid-coated iron oxide nanoparticles for biomedical applications

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    Superparamagnetic iron oxide nanoparticles can providemultiple benefits for biomedical applications in aqueous environments such asmagnetic separation or magnetic resonance imaging. To increase the colloidal stability and allow subsequent reactions, the introduction of hydrophilic functional groups onto the particles’ surface is essential. During this process, the original coating is exchanged by preferably covalently bonded ligands such as trialkoxysilanes. The duration of the silane exchange reaction, which commonly takes more than 24 h, is an important drawback for this approach. In this paper, we present a novel method, which introduces ultrasonication as an energy source to dramatically accelerate this process, resulting in high-quality waterdispersible nanoparticles around 10 nmin size. To prove the generic character, different functional groups were introduced on the surface including polyethylene glycol chains, carboxylic acid, amine, and thiol groups. Their colloidal stability in various aqueous buffer solutions as well as human plasma and serum was investigated to allow implementation in biomedical and sensing applications.status: publishe

    New perspectives in improving prognosis after myocardial infarction

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    The results of large, epidemiologic studies and clinical trials, e.g., GISSI-Prevenzione, demonstrate that highly purified omega-3 polyunsaturated fatty acids should be included into secondary prevention among myocardial infarction patients. Their positive clinical effects include: all-cause mortality reduction by 21%, mostly due to sudden death risk reduction by 45%
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