Марфаноидная внешност ь как фактор риска фибрилляции предсердий у пациенто в с о стеопорозом

Objective: to investigate the relationship between some signs of hereditary connective tissue disorders (HCTDs) as a Marfanoid appearance (MA) and the risk of atrial fibrillation (AF) in female patients with osteoporosis (OP).Subjects and methods. In 2014–2015, the investigation enrolled consecutively 104 women aged 58 to 70 years (mean age, 64.7±3.8 years) who had a verified diagnosis of primary OP and a body mass index of ≤25.0 kg/m2. The entries in the outpatient medical records and in the automated information system «Polyclinic» were retrospectively analyzed to divide the patients into 2 groups according to the sign of the documented diagnosis of AF. A study group consisted of 53 women (mean age, 65.6±5.2 years) with AF and OP; a control group included 38 patients (mean age, 64.9±4.7 years) with OP without AF; a control group comprised 38 patients (mean age, 65.1±3.9 years) without OP and AF. Anthropometric and phenotypical parameters and cardiovascular visceral signs were analyzed; the levels of transforming growth factor-β1 (TGFβ1) and interleukin (IL) 1β and 6 in the serum and those of deoxypyridinoline (DPD) in the urine were measured.Results. Analysis of the phenotypical signs of HCTDs in the patients with OP has shown that those with OP and AF have external signs of dysmorphogenesis and meet the criteria of MA. Statistically significant correlations were found between the frequency of MA signs and the magnitude of all cardiac morphometric parameters and the visceral signs of HCTDs in the study group. The serum levels of IL-1β, IL-6, and TGFβ1 in these patients were significantly higher than in the comparison and control groups. There was also a high correlation between the signs of MA and the content of DPD in the study group.Conclusion. The patients with OP and AF was found to have a statistically significant correlation of the phenotypical signs of dysmorphogenesis with the frequency of visceral signs of HCTD, the morphofunctional parameters of the heart, and the high concentration of cytokines and DPD. It may be suggested that there exists a genetically determined mechanism of connective tissue dysembryogenesis in OP, which is associated with the risk of AF.Цель исследования – изучение связи между отдельными признаками наследственных нарушений соединительной ткани (ННСТ) в виде марфаноидной внешности (МВ) и риском развития фибрилляции предсердий (ФП) у пациенток с остеопорозом (ОП).Материал и методы. В 2014–2015 гг. в исследование последовательно включены 104 женщины с верифицированным диагнозом первичного ОП в возрасте от 58 до 70 лет (средний возраст – 64,7±3,8 года) с индексом массы тела І25,0 кг/м2. Проведен ретроспективный анализ записей в медицинской карте амбулаторного больного, а также в автоматизированной информационной системе «Поликлиника» с целью разделения пациенток на две группы по признаку документально подтвержденного диагноза ФП. Основную группу составили 53 женщины с ФП и ОП (средний возраст – 65,6±5,2 года); группу сравнения – 51 женщина с ОП без ФП (64,9±4,7 года); группу контроля – 38 пациенток без ОП и ФП (65,1±3,9 года). Проанализированы антропометрические, фенотипические показатели, сердечно-сосудистые висцеральные признаки, определено содержание трансформирующего фактора роста β1 (TGFβ1), интерлейкина (ИЛ) 1β и 6 в сыворотке крови и дезоксипиридинолина (ДПИД) в моче.Результаты. Анализ фенотипических признаков ННСТ у больных ОП показал, что пациентки с ОП и ФП имеют внешние признаки дизморфогенеза и отвечают критериям МВ. Выявлены статистически значимые корреляционные связи между частотой признаков МВ и выраженностью всех морфометрических показателей сердца и висцеральными признаками ННСТ у пациенток основной группы. Содержание в сыворотке крови ИЛ1β, ИЛ6, TGFβ1 у этих пациенток было достоверно выше, чем у лиц групп сравнения и контроля. Также отмечена высокая корреляция между признаками МВ и содержанием ДПИД у пациенток основной группы.Заключение. У пациенток с ОП и ФП выявлена статистически значимая корреляция фенотипических признаков дизморфогенеза с частотой висцеральных признаков ННСТ, морфофункциональными показателями сердца, а также с высокой концентрацией цитокинов и ДПИД. Можно предположить, что при ОП имеется генетически детерминированный механизм дизэмбриогенеза соединительной ткани, сопряженный с риском развития ФП

Risks of unfavourable clinical outcomes in patients with first diagnosed stroke-associated atrial fibrillation

© 2018, Pharmainfo Publications. All rights reserved. Background—Atrial fibrillation (AF) is the most common arrhythmia often associated with cardioembolic stroke. Hypothesis—We investigated cases of AF first diagnosed (fdAF) in the acute phase of stroke.This type of AF might be common, and might suggest poor prognosis for patients. Methods— Following screening (n=1291) 661 patients with AF and a history of stroke were enrolled in this open-label, prospective study; patient average age was 68.0 years. Results—A high level of co-morbidity was observed: hypertension (in 100% of patients), ischemic heart disease (in 61.4% of patients), diabetes mellitus (in 52.3% of patients), and chronic kidney disease (in 32.1% of patients). In 154 (23.3%) patients AF was first diagnosed at the onset of cardioembolic stroke. The HAS-BLED score, age, hypertension and ischemic heart disease rates among these patients were comparable with the rest of the group; however, the percentage of patients with chronic kidney disease, diabetes mellitus or myocardial infarction was significantly higher. The highest one-year death rate was seen in patients with fdAF (death reported in 46 [29.9%] patients). The age of patients with fdAF who died was significantly higher, and their neurological disorders were more severe. Conclusions—The results show a high rate of fdAF and its poor prognosis in patients with cardioembolic stroke. Thus, the term “first diagnosed stroke-associated atrial fibrillation” seems relevant. The described condition has a negative predictive value, and is also associated with high co-morbidity burden in patients with fdAF

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

Rehabilitation after COVID-19. Resolution of the International Expert Council of the Eurasian Association of Therapists and the Russian Society of Cardiology

By the middle of 2021, the official global number of coronavirus disease 2019 (COVID-19) patients was close to 230 million, but the number accounting for asymptomatic patients was much higher. Consequences and rehabilitation after COVID-19 are of particular interest and raise many controversial and unresolved issues. On May 18, 2021, the Eurasian Association of Therapists organized an international panel of experts to analyze challenges associated with the post-COVID-19 period. This panel aimed to develop approaches to identify gaps in the discussed issues. This interdisciplinary team of leading experts reviewed the current literature and presented their data to formulate practical guidance on management of patients after COVID-19. The panel of experts also presented recommendations on how to implement the gained knowledge into health care practices

Marfanoid appearance as a risk factor for atrial fibrillation in patients with osteoporosis

Objective: to investigate the relationship between some signs of hereditary connective tissue disorders (HCTDs) as a Marfanoid appearance (MA) and the risk of atrial fibrillation (AF) in female patients with osteoporosis (OP).Subjects and methods. In 2014–2015, the investigation enrolled consecutively 104 women aged 58 to 70 years (mean age, 64.7±3.8 years) who had a verified diagnosis of primary OP and a body mass index of ≤25.0 kg/m2. The entries in the outpatient medical records and in the automated information system «Polyclinic» were retrospectively analyzed to divide the patients into 2 groups according to the sign of the documented diagnosis of AF. A study group consisted of 53 women (mean age, 65.6±5.2 years) with AF and OP; a control group included 38 patients (mean age, 64.9±4.7 years) with OP without AF; a control group comprised 38 patients (mean age, 65.1±3.9 years) without OP and AF. Anthropometric and phenotypical parameters and cardiovascular visceral signs were analyzed; the levels of transforming growth factor-β1 (TGFβ1) and interleukin (IL) 1β and 6 in the serum and those of deoxypyridinoline (DPD) in the urine were measured.Results. Analysis of the phenotypical signs of HCTDs in the patients with OP has shown that those with OP and AF have external signs of dysmorphogenesis and meet the criteria of MA. Statistically significant correlations were found between the frequency of MA signs and the magnitude of all cardiac morphometric parameters and the visceral signs of HCTDs in the study group. The serum levels of IL-1β, IL-6, and TGFβ1 in these patients were significantly higher than in the comparison and control groups. There was also a high correlation between the signs of MA and the content of DPD in the study group.Conclusion. The patients with OP and AF was found to have a statistically significant correlation of the phenotypical signs of dysmorphogenesis with the frequency of visceral signs of HCTD, the morphofunctional parameters of the heart, and the high concentration of cytokines and DPD. It may be suggested that there exists a genetically determined mechanism of connective tissue dysembryogenesis in OP, which is associated with the risk of AF

Clinico-pharmacological aspects of choice and safety of NSAIDs in patients with cerebrovascular disease against a background of rheumatoid arthritis

The retrospective study evaluated the risk of using non-steroidal antiinflammatory drugs (NSAIDs) for the treatment of back pain in patients with cerebrovascular disease against a background of rheumatoid arthritis. Acute cardio-and cerebrovascular events were reported in 9.7% of subjects treated with NSAIDs. Adverse effects during treatment were associated with diclofenac and nimesulide. Overall risks were low in the group treated with etoricoxib, allowing for all patients to undergo scheduled courses of NSAID therapy, including upon follow-up visits

THE OPPORTUNITIES FOR RISK REDUCTION OF RECURRENT STROKE IN ATRIAL FIBRILLATION

Aim. To study adherence to guidelines of patients’ management in atrial fibrillation (AF) in the spotlight of recurrent stroke risk reduction.Material and methods. Totally 350 patients (227 women, 123 men) included with AF of non-valvular etiology, with anamnesis of cardioembolic stroke (CES) in carotid pool. Patients were selected into 3 groups according to the parameters of NIHSS stroke severity. A complex clinical and instrumental study was performed at the baseline, in 3, 6 months and 1 year of follow-up, including hemostasis assessment.Results. In 28% AF was found first time during the stroke acute phase; in 109 (31,1%) patients — paroxysmal AF. Before the inclusion anticoagulants took 23 patients (6,9%), 8 (2,4%) took NOAC. The highest part of persons with the high risk of bleeding by HAS-BLED was marked in the III group — 27 cases (34,6%). In 3 month 6 patients died (1,7%): mean age 74,3±1,34 y., NOAC received only 2 patients. In 3 months in the group of the diseased (n=51) taking apixaban, a significant (pp<0,05) improvement marked, of the clotting parameters: decrease of fibrinogen level, stabilization of APTT.Conclusion. Conduction of further follow-up would define relevant markers of clotting pathology, making to forecast an adverse outcome in early rehabilitation period in AF, having CES and high comorbidity index

POSSIBILITIES OF PHARMACOLOGICAL CORRECTION OF STRUCTURAL AND FUNCTIONAL ALTERATIONS OF MICROCIRCULATION IN TERMS OF ENDOTHELIAL DYSFUNCTION IN COMORBID PATIENTS SUFFERED STROKE EVENT

Aim of the study – reveal clinical efficacy of naftidrofuryl in the aspect of correcting structural and functional changes of microcirculation (MC) in relation to the influence of the endothelial dysfunction (ED) parameters in comorbid patients suffered stroke event.Materials and methods. The study included 95 patients suffered ischemic type of stroke in the carotid bassin. An average age of patients was 69.0 ± 5.3 years, stroke duration was 73.5 ± 8.4 days. Patients were randomized in 2 groups by using blind method of envelopes. The mentioned groups matched on the main clinical and demographic characteristics. Patients from the 1st group (primary group, n = 47) were treated with naftidrofuryl (Duzofarm) at the daily dose of 300 mg, 2 patients (comparison group, n = 48) received basic therapy only. 50 people without an acute cerebrovascular accident in history were allocated as a control group (group 3). The following blood biochemical parameters were assessed: glucose, creatinine, total cholesterol, high density lipoprotein; triglycerides; markers of endothelial dysfunction: von Willebrand factor (VWF), tissue plasminogen activator inhibitor-1 (PAI 1), antithrombin III (AT III) and plasminogen. MC was studied by the method of laser doppler flowmetry. The duration of the observation period was 6 months, and 4 visits were performed during this period.Results. Initial task of group formation within the study protocol has been solved by us in a full range. Patients from Group 1 that received naftidrofuryl noted statistically significant differences after 3 and 6 months of follow-up observation. These differences reflected improvement in perfusion index, coefficient of variation, as well as endothelial, neurogenic and myogenic regulation of microvasculature, increase in perfusion oxygen saturation index in the microcirculation. We have found that an index of relative perfusion oxygen saturation in microvascular blood (Sm) being the main indicator that reflects oxygen saturation of microcirculation has significantly correlated with ejection fraction, PAI1, AT III, and plasminogen levels in group 1 patients in 3 and 6 months. We have also found significant correlation with ED when comparing parameters that express endothelial, neurogenic and myogenic regulation of microvessels. These data clearly demonstrated an association between improving of MC parameters and ED parameters in Group 1 patients.Conclusion. Possibility of correction of MC alterations leading to the worsening of ischemia and ED progression is one of the most promising directions in the treatment of stroke patients. Aim of the drug therapy is to prevent ED progression, reduced vascular tone and restore an adequate level of tissue hemoperfusion