A plea for an extension of the anatomical nomenclature: Organ systems

This article is the third part of a series aimed at correcting and extending the anatomical nomenclature. Communication in clinical medicine as well as in medical education is extensively composed of anatomical, histological, and embryological terms. Thus, to avoid any confusion, it is essential to have a concise, exact, perfect and correct anatomical nomenclature. The Terminologia Anatomica (TA) was published 20 years ago and during this period several revisions have been made. Nevertheless, some important anatomical structures are still not included in the nomenclature. Here we list a collection of 156 defined and explained technical terms related to the anatomical structures of the human body focusing on the digestive, respiratory, urinary and genital systems. These terms are set for discussion to be added into the new version of the TA

Improving outpatient care in chronic heart failure

Despite advances in pharma and high-technology medicine, the rate of burdensome hospital admissions and mortality in patients with chronic heart failure (CHF) remains high. Over half of all admission-entailing decompensations have been repeatedly shown to emerge from non-compliance with outpatient prescriptions. Poor adherence to medication and non-medication treatment can only be broken by improving the patient’s awareness of the disease and his closer monitoring by healthcare professionals. The power of clinical and laboratory illness monitoring in line with the recommended quality criteria of medical aid in heart failure (HF) is strongly limited today by time resources available in outpatient and midwifery clinics. Meanwhile, an international and certain domestic experience has been built up to run CHF outpatient centres with involvement of specially-trained nursing and senior medical staff. Analytic evidence on such centres suggests a reduction in mortality and hospitalisation rate among the visiting patients. To combat existing drawbacks of CHF outpatient care, the National Medical Research Center of Cardiology in alliance with the Specialist Society of Heart Failure have developed the nurses’ guidelines for CHF rooms and are launching a medical staff training programme to manage CHF rooms, registry and data analysis. Furthermore, a procedure has been developed for patient routing to regional CHF outpatient cabinets that is being actively deployed in the Tyumen Region

The impact of visual functions on athletes’ results and methods of their improvements

Regardless of the sport, maintaining and improvement of visual functions in athletes act an important role in achieving personal records.In this article, the interrelationships between sports results and the state of visual functions were determined, as well as devices and methods were analyzed, thanks to which it is possible to improve functions of the visual analyzer

The influence of Losartanum and Amlodipinum fixed combination use on cardiovascular complications risk factors seasonal variability in patients with arterial hypertension

Rationale: The influence of drugs on adaptation to high temperatures and seasonal variability of cardiovascular disease factors is one of the most important issues of treatment raised during re-cent heat waves. The safety of calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs) use during heat waves is quite controversial. Aim: To assess the seasonal variability of hemodynamic parameters, vessel wall stiffness, lipid, carbohydrate and electrolyte metabolism in patients with arterial hypertension (AH) and to as-sess safety and effectiveness of fixed combination of Losartanum and Amlodipinum (Lortenza® KRKA) use according to one-year follow-up results. Materials and methods. The study included 26 patients with stage 1 and 2 AH aged from 42 to 81 years. Office blood pressure measurement, electrocardiography, volumetric sphygmography (pulse-wave velocity, cardio-ankle vascular index), serum chemistry, blood osmolarity tests were performed. Visual Analog Scale (VAS), Heat Questionnaries and self-control diaries were also assessed. The baseline visit took place in spring of 2016, the first visit - in May-June 2016, the second - during the heat wave, the third - in September-October 2016, the fourth - in January-February 2017, and the fifth - in April-May 2017. Results. The treatment resulted in systolic and diastolic blood pressure decrease (р=0.000) to target value which persisted during the follow-up period. According to the self-control diaries 81% of patients did really control BP. During the heat wave only 58% of patients succeeded in BP control, in autumn - 63%, in winter and spring - 81% and 86%, respectively. By the third visit the heart rate decreased on -6.0 (-11.1; -2.8) beats per minute, p=0.007. The decrease in pulse-wave velocity from 15.2±3.4 m/s to 13.6±2.7 m/s, p=0.01 and CAVI on -2.1 (-2.9; -0.65), p=0.01 was observed on the third visit. Decrease in uric acid level (

Prognostic value of subclinical atherosclerosis in patients with a SCORE risk <5%: data from a 10-year follow-up

Aim. To evaluate the contribution of subclinical atherosclerosis to the stratification of patients with a SCORE risk of cardiovascular events (CVEs) &lt;5% based on a 10-year follow-up.Material and methods. The study included 379 patients with SCORE risk of CVEs &lt;5% (82 men, 297 women). In 2009, all patients underwent clinical examination, carotid artery (CA) ultrasound with the detection of plaques, total CA occlusion, intima-media thickness (IMT) of the common carotid artery (CCA). The plaque number was determined as the total number of all plaques in 6 following segments: both CCAs, both CCA bifurcations and both internal carotid arteries. The total stenosis was calculated as the sum of stenoses in 6 CA segments in %. In 2019, a telephone survey of patients was conducted with a questionnaire assessing the following CVEs: all-cause death, cardiovascular death, myocardial infarction (MI), stroke, myocardial revascularization, cardiovascular hospitalizations, and composite endpoint.Results. The initial patients’ age ranged from 35 to 67 years (51,1±7,5 years). Plaques from 20% to 50% were detected in 303 participants (79,94%). Over the past 10 years, there have been 5 cardiovascular deaths (1,3%), 7 MIs (1,8%), 5 cases of unstable angina (1,3%), 12 cases of myocardial revascularization (3,2%), 15 strokes (4,0%), 51 cardiovascular hospitalizations (13,5%). The proportion of patients with registered endpoints (CVE+) was 22,4% (n=85). The groups of patients with and without CVEs differed in the level of systolic blood pressure (BP) and blood triglycerides, and did not differ in the level of diastolic BP, lipid profile, glucose, heart rate, smoking status, sex, and age. In the CVE+ group, there were higher values of CCA IMT (0,65 (0,64; 0,70) mm vs 0,62 (0,62; 0,66) mm, p&lt;0,05), total CA stenosis (102,5 (88,1; 120,8)% vs 80 (72,5; 88,1)%, p=0,01), and the CA plaque amount (4,0 (2,8; 3,9) vs 3,0 (2,6; 3,1), p=0,01), respectively. Total CA stenosis was an independent predictor of CVEs when adjusted for sex, age, systolic and diastolic BP (β=0,149; p&lt;0,05), but not for lipid profile. A ROC-analysis revealed a cut-off point for total CA stenosis of 82,5% (AUC=0,598, 95% confidence interval 0,5243-0,673, p&lt;0,05).Conclusion. The total CA stenosis has shown itself to be an independent predictor of CVEs in patients with a SCORE risk &lt;5%

Кардиомиопатия и множественный артериальный тромбоз у пациента с тахиформой фибрилляции предсердий, перенесшего COVID-19 тяжелого течения

We present a case of cardiomyopathy with a reduced left ventricular ejection fraction of up to 18%, multivessel arterial thrombosis in a patient who had undergone severe COVID-19 3.5 months earlier. The cardiopathy was initially considered as an outcome of SARSCoV2-induced myocarditis, but MRI with delayed gadolinium contrast revealed no fibrosis or evidence of active myocarditis. A detailed collection of the medical history showed that the duration of tachyform atrial fibrillation exceeded the 4 months indicated in the medical records. Oligosymptomatic manifestation of arrhythmia occurred 8 months earlier, the patient did not consult a physician due to epidemic conditions. Coronary angiography revealed subtotal stenosis of the anterior descending artery. Most probably, the cardiopathy was arrhythmogenic and ischemic. After achieving normosystole and coronary stenting, the left ventricular ejection fraction was 25-27%. At the first hospitalization 4 months ago, left atrial auricular thrombus was detected. After COVID-19 the patient received inadequately low dose of apixaban 5 mg per day. Three weeks after COVID-19, the patient was diagnosed with infarction of the right kidney, wall thrombosis in the abdominal aorta, thrombosis of the superficial femoral, deep femoral, popliteal, anterior tibial arteries on the left, right popliteal artery; thrombotic complications could have developed both in situ and as a result of cardioembolism. Administration of dabigatran 300 mg per day and aspirin helped to dissolve the thrombus in the left atrial auricle, improve the course of intermittent claudication, and avoid recurrent thrombotic complications. COVID-19 could contribute to the progression of atherosclerosis, more malignant course of atrial fibrillation, development of thrombosis, but coronavirus infection is not the only cause of severe disease in a patient. СOVID-19 can not only be the cause of direct lesions of the heart and vessels, but also have an indirect negative effect - to delay the detection of cardiac pathology and be the cause of its hypodiagnosis under the mask of “postcovid”.Представлен случай кардиомиопатии со снижением фракции выброса левого желудочка до 18%, многососудистым артериальным тромбозом у пациента, перенесшего COVID-19 тяжелого течения 3,5 мес. назад. Изначально кардиопатия расценивалась как исход миокардита, вызванного SARS-CoV2, однако МРТ с отсроченным контрастированием гадолинием не выявила ни фиброза, ни признаков активного миокардита. Подробный сбор анамнеза показал, что давность тахиформы фибрилляции предсердий превышает 4 мес., указанные в медицинской документации. Малосимптомная манифестация аритмии произошла на 8 мес. раньше, пациент не обращался к врачу в связи с эпидобстановкой. По данным коронароангиографии был выявлен субтотальный стеноз передней нисходящей артерии. Наиболее вероятно, кардиопатия носит аритмогенный и ишемический характер. После достижения нормосистолии и коронарного стентирования фракция выброса левого желудочка составила 25–27%. При первой госпитализации 4 мес. назад выявлен тромб ушка левого предсердия. После COVID-19 пациент получал неадекватно низкую дозу апиксабана 5 мг в сутки. Через 3 нед. после COVID-19 у пациента был выявлен инфаркт правой почки, пристеночные тромбы в брюшной аорте, тромбоз поверхностной бедренной, глубокой бедренной, подколенной, передней большеберцовой артерий слева, подколенной артерии справа; тромботические осложнения могли развиться как in situ, так и быть следствием кардиоэмболии. Назначение дабигатрана 300 мг в сутки и аспирина позволило добиться растворения тромба в ушке левого предсердия, улучшения течения перемежающейся хромоты, избежать повторных тромботических осложнений. COVID-19 мог способствовать прогрессированию атеросклероза, более злокачественному течению фибрилляции предсердий, развитию тромбозов, однако коронавирусная инфекция не является единственной причиной тяжелого заболевания у пациента. СOVID-19 не только может быть причиной прямого поражения сердца и сосудов, но и оказывать косвенное негативное влияние – отдалять выявление кардиальной патологии и быть причиной ее гиподиагностики под маской «постковида»

A plea for an extension of the anatomical nomenclature: The locomotor system

Anatomical nomenclature is the main tool of communication in morphology, anatomy and other medical disciplines as well as in medical education, and thus needs to be exact, flawless, elaborate and correct. The Terminologia Anatomica (TA) is a thorough and extensive list of anatomical terms and their definitions, and the current standard for human anatomical terminology. Although several revisions to the TA have been made in the last 20 years, some important anatomical structures are still not included. This article is aimed at correcting and extending the anatomical nomenclature described in the TA. We gathered and presented a list of anatomical terms, with their definitions and explanations, to provoke a discussion about correcting and extending the TA. Our list comprises of 96 terms related to the locomotor system of the human body, i.e., the bones, joints, muscles and related structures

Treatment of patients with high cardiovascular risk: a modern view on combined therapy

Introduction. Lack of efficacy of treatment with several medications in patients with arterial hypertension (AH) and high cardiovascular disease (CVD) risk is often explained by low compliance to treatment. Using combined therapy (CT) is one of the ways to increase compliance. Objective. To evaluate the influence of CT consisting of amlodipine, lisinopril and rosuvastatin on arterial elastance and serum fibrosis marker levels in patients with high CVD risk. Materials and methods. The study included 66 patients (mean age 66.5 years, 5% male, 95% female) with atherosclerosis of the brachiocephalic arteries. Serum levels of cholesterol and low density lipoprotein (LDL); brachial and central blood pressure (BP); brachial-ankle and carotid-femoral pulse wave velocity (baPWV and cfPWV, respectively); and augmentation index (AI) were determined initially and after 6 months of CT. Results. Against the background of CT statistically significant reduction of levels of LDL from 4.1 (3.6; 4.7) to 2.2 (1.8; 2.5) mmol/L (p<0.01); systolic and diastolic brachial BP from 127 (116; 144) to 122 (115; 132) mm Hg (p<0.01) and from 79 (72; 89) to 75 (70; 83) mm Hg (p<0.01), respectively; systolic and diastolic central BP from 125 (112; 139) to 120 (110; 124) mm Hg (p<0.01) and from 80 (75; 87) to 76 (70; 81) mm Hg (p<0.01), respectively; baPWV from 13.6 (12.5; 15.9) to 12.9 (11.8; 14.2) m/s (p<0.01); cfPWV from 11 (9; 12.2) to 9,4 (8.4; 10.2) m/s (p<0.01); and AI from 31 (25; 35) to 26 (21; 32) (p<0,05) was observed. Conclusion. CT consisting of amlodipine, lisinopril and rosuvastatin resulted in BP and LDL target level achievement and arterial stiffness reduction in patients with AH and high CVD risk. Further research is also necessary to more thoroughly assess efficacy of CT