Clinical efficacy of a personalized exercise program in the rehabilitation of patients with atrial fibrillation after radiofrequency ablation

Aim. To study the clinical efficacy and safety of a personalized exercise program in the rehabilitation of patients with paroxysmal atrial fibrillation (AF) after primary pulmonary vein radiofrequency ablation (RFA).Material and methods. Patients (n=48) with paroxysmal AF who underwent RFA were randomized into two groups: main (n=24) — patients involved in the exercise program and received standard therapy; control (n=24) — patients received standard therapy. The program included exercise complexes with the calculation of energy consumption, step training and walking. The program lasted 6 months, while the follow-up period — 12 months. All patients in the study underwent a faceto-face learning interview.Results. After 6-month exercise program, bicycle ergometer test revealed an increase in duration (by 18,6%, p<0,001) and power (by 24,8%, p<0,01) of the load, while these changes were not revealed in the control group. The positive aftereffect of training on these parameters persisted even after the completion of program. Left atrial and left ventricular end-diastolic dimension remained stable in exercise program group and significantly increased in the control group. In contrast to the control group, the following parameters significantly decreased in trained patients after 6 months: body mass index by 2,8% (p<0,05), systolic blood pressure by 2,1% (p<0,05), heart rate by 12,1% (p<0,05), low-density lipoprotein cholesterol concentration by 18,8% (p<0,001), high-sensitivity C-reactive protein by 22,9% (p<0,05), N-terminal pro-brain natriuretic peptide by 28,2% ( p<0,05), aldosterone by 41,5% (p<0,001) and angiotensin II by 41,3%, p<0,05). In addition, in the exercise program group an increase in high-density lipoprotein cholesterol by 20,6% (p<0,05) and physical activity level by 23,8% (p=0,001) was revealed. At the same time, both groups showed a significant decrease in the concentration of fibrinogen and transforming growth factor-β1. After 6 months, in the exercise program group versus the control group, there was a decrease in the number of registered supraventricular premature beats (p<0,01), episodes of supraventricular tachyarrhythmia (p<0,05), including AF (p<0,05).Conclusion. Involvement of patients with AF after catheter RFA in a cardiac rehabilitation program based on moderate-intensity aerobic training improves exercise tolerance, cardiac function, corrects thrombogenic factors, and reduces the likelihood of arrhythmia recurrence, including AF

COMPARATIVE PHARMACOKINETICS AND EFFECT ON THE HEMODYNAMICS OF ORIGINAL AND GENERIC NEBIVOLOL IN HEALTHY VOLUNTEERS

Beta-blockers are an important part of modern pharmacotherapy in cardiology. The introduction of generics into clinical practice requires clear evidence of bioequivalence to the original drug.Aim. To study the pharmacokinetics and effect on hemodynamic parameters of the original and a generic nebivolol in healthy volunteers in the fasting state. Material and methods. 18 healthy volunteers were included into the randomized open study on cross-balanced design. They received single dose (5 mg) of two compared preparations of nebivolol under fasting condition. The concentration of unchanged nebivolol in blood plasma was determined by gas chromatography-tandem mass spectrometry. Calculation of pharmacokinetic parameters and assessment of the hemodynamic were performed.Results. The concentrations of nebivolol after the original and generic drugs intake did not differ significantly in any time point (AUC0-∞ 41.09±46.82 vs 47.16±66.58 ng•hr/mL and T1/2 30.84±10.78 vs 29.59±12.08 hours, respectively). Blood pressure reduction was slightly more pronounced when taking generic nebivolol, while the reduction in heart rate at 2 and 4 hours – after original nebivolol intake.Conclusion. A comparative pharmacokinetic study of the genetic nebivolol showed its bioequivalence to the original drug. The effect on hemodynamic parameters with single dose (5 mg) of generic and original nebivolol in healthy volunteers was comparable

Содержание тяжёлых металлов во льду нижнего течения реки Амур

For the first time, the content of heavy metals in the river ice in the lower Amur River has been analyzed, taking into account the stratigraphic heterogeneity of the ice structure in the river channel. According to the conditions of origin and duration of formation, the main varieties of ice were identified – layered frozen ice, naled-type (icing) ice, and hummocky ice. The most widespread in the Amur ice cover is ice consisting of layers forming hummocky-frozen, hummocky-naled and homogeneous frozen ice sequences. The aim of the study was to determine the content of heavy metals in different ice varieties and the possibility of using this data to assess river pollution during the winter period. The highest content of heavy metals was found in the naled ice, which is due to its formation on the ice surface contaminated during the winter. The minimum content was found in the layered frozen ice, which is formed throughout the winter due to accretion from below. In the layers of hummocked ice formed for several days during the autumn ice drift, metals have average content and uniform distribution within the entire thickness. Influence of Khabarovsk city in winter period is most noticeable by the content of metals in the frozen variety of Amur river ice near its right bank, where the city is located. High concentrations were noted for Pb and Zn, and less pronounced for Cu and Ni. Ice is more informative object than water under the ice, and its chemical composition can serve as an indicator of the ecological state of the river during the freezing period.Установлено содержание тяжёлых металлов в речных льдах различного происхождения в нижнем течении р. Амур в окрестностях г. Хабаровск. Ледяной покров реки представлен сочетаниями трёх разновидностей льда: намёрзшим, наледным и торосистым, которые различаются по условиям формирования, строению и распределению в них тяжёлых металлов. Повышенные содержания металлов во льду в зоне влияния города позволяют использовать их в качестве показателя экологического состояния реки во время ледостава

Влияние дыма лесных пожаров на течение болезней органов дыхания

In 1998 wood fire'in the Far East lasted from July to November and seized the territory of 2.1 rAillion of hectares. More than 1 million of residents have undergone td an influence of smoke from burning wood for long time. Though the mortality and morbidity from respiratory diseases did not increase in 1998, the authors revealed a number of quantitative changes in the course of principal respiratory diseases in the period of the smoke influence.Hospitalization of patients with pneumonia in Khabarovsk and Komsomolsk hospitals increased by 20-30%. This disease run more severe compared with the same period of 1997. Bilateral lung injury and dry cough were observed more often. A peculiar bronchopneumopathy with breathlessness, dry cough, crackles and wheezing on auscultation, bilateral bronchial wall thickening on chest radiography, absence of fever and intoxication, high efficacy of glucocorticosteroids and bronchodilators was noted in children aged 5-13 years.In 191 adult patients with lung obstructive disease the effect of traditional complex therapy was reliably worse assessed by the FEV1 dynamics. The increase of atmospheric CO concentration more than 3 mg/m3 was accompanied by an improvement of bronchial passability in asthmatic patients and its worsening in chronic obstructive bronchitis patients (p<0.05). This is thought to involve different obstruction mechanisms in these diseases.Лесные пожары на Дальнем Востоке в 1998 году продолжались с июля по ноябрь и охватили площадь до 2,1 млн га. Более 1 млн жителей региона длительное время подвергались воздействию продуктов горения леса. Несмотря на отсутствие роста заболеваемости и смертности от патологии органов дыхания в 1998 году, авторами выявлен ряд качественных изменений в течении основных заболеваний системы дыхания в период воздействия дыма.На 20-30% увеличилась госпитализация больных пневмонией в больницы г. Хабаровска и г. Комсомольска-на-Амуре. Заболевание носило более тяжелое течение, чем за тот же период 1997 года. Чаще отмечался двусторонний характер поражения легких и симптомы сухого кашля. У детей в возрасте 5-13 лет в период задымленности отмечено появление своеобразной бронхопневмопатии с симптомами одышки, сухого кашля, крепитацией и хрипами при аускультации, двусторонним усилением легочного рисунка на рентгенограмме, отсутствием лихорадки и интоксикации, высокой эффективностью лечения глюкокортикоидами и бронхолитиками.У 191 взрослого пациента с обструктивными заболеваниями легких в период задымленности отмечен достоверно более низкий эффект стандартной комплексной терапии по критерию ОФВ1. Повышение концентрации СО в атмосфере более 3 мг в 1 м3 сопровождалось улучшением бронхиальной проходимости у больных астмой и её снижением у пациентов с хроническим обструктивным бронхитом (р<0,05), что, вероятно, связано с различием механизмов обструкции при этих заболеваниях

Interventions to improve adherence to inhaled steroids for asthma.

BACKGROUND: Despite its proven efficacy in improving symptoms and reducing exacerbations, many patients with asthma are not fully adherent to their steroid inhaler. Suboptimal adherence leads to poorer clinical outcomes and increased health service utilisation, and has been identified as a contributing factor to a third of asthma deaths in the UK. Reasons for non-adherence vary, and a variety of interventions have been proposed to help people improve treatment adherence. OBJECTIVES: To assess the efficacy and safety of interventions intended to improve adherence to inhaled corticosteroids among people with asthma. SEARCH METHODS: We identified trials from the Cochrane Airways Trials Register, which contains studies identified through multiple electronic searches and handsearches of other sources. We also searched trial registries and reference lists of primary studies. We conducted the most recent searches on 18 November 2016. SELECTION CRITERIA: We included parallel and cluster randomised controlled trials of any duration conducted in any setting. We included studies reported as full-text articles, those published as abstracts only and unpublished data. We included trials of adults and children with asthma and a current prescription for an inhaled corticosteroid (ICS) (as monotherapy or in combination with a long-acting beta2-agonist (LABA)). Eligible trials compared an intervention primarily aimed at improving adherence to ICS versus usual care or an alternative intervention. DATA COLLECTION AND ANALYSIS: Two review authors screened the searches, extracted study characteristics and outcome data from included studies and assessed risk of bias. Primary outcomes were adherence to ICS, exacerbations requiring at least oral corticosteroids and asthma control. We graded results and presented evidence in 'Summary of findings' tables for each comparison.We analysed dichotomous data as odds ratios, and continuous data as mean differences or standardised mean differences, all using a random-effects model. We described skewed data narratively. We made no a priori assumptions about how trials would be categorised but conducted meta-analyses only if treatments, participants and the underlying clinical question were similar enough for pooling to make sense. MAIN RESULTS: We included 39 parallel randomised controlled trials (RCTs) involving adults and children with asthma, 28 of which (n = 16,303) contributed data to at least one meta-analysis. Follow-up ranged from two months to two years (median six months), and trials were conducted mainly in high-income countries. Most studies reported some measure of adherence to ICS and a variety of other outcomes such as quality of life and asthma control. Studies generally were at low or unclear risk of selection bias and at high risk of biases associated with blinding. We considered around half the studies to be at high risk for attrition bias and selective outcome reporting.We classified studies into four comparisons: adherence education versus control (20 studies); electronic trackers or reminders versus control (11 studies); simplified drug regimens versus usual drug regimens (four studies); and school-based directly observed therapy (three studies). Two studies are described separately.All pooled results for adherence education, electronic trackers or reminders and simplified regimens showed better adherence than controls. Analyses limited to studies using objective measures revealed that adherence education showed a benefit of 20 percentage points over control (95% confidence interval (CI) 7.52 to 32.74; five studies; low-quality evidence); electronic trackers or reminders led to better adherence of 19 percentage points (95% CI 14.47 to 25.26; six studies; moderate-quality evidence); and simplified regimens led to better adherence of 4 percentage points (95% CI 1.88 to 6.16; three studies; moderate-quality evidence). Our confidence in the evidence was reduced by risk of bias and inconsistency.Improvements in adherence were not consistently translated into observable benefit for clinical outcomes in our pooled analyses. None of the intervention types showed clear benefit for our primary clinical outcomes - exacerbations requiring an oral corticosteroid (OCS) (evidence of very low to low quality) and asthma control (evidence of low to moderate quality); nor for our secondary outcomes - unscheduled visits (evidence of very low to moderate quality) and quality of life (evidence of low to moderate quality). However, some individual studies reported observed benefits for OCS and use of healthcare services. Most school or work absence data were skewed and were difficult to interpret (evidence of low quality, when graded), and most studies did not specifically measure or report adverse events.Studies investigating the possible benefit of administering ICS at school did not measure adherence, exacerbations requiring OCS, asthma control or adverse events. One study showed fewer unscheduled visits, and another found no differences; data could not be combined. AUTHORS' CONCLUSIONS: Pooled results suggest that a variety of interventions can improve adherence. The clinical relevance of this improvement, highlighted by uncertain and inconsistent impact on clinical outcomes such as quality of life and asthma control, is less clear. We have low to moderate confidence in these findings owing to concerns about risk of bias and inconsistency. Future studies would benefit from predefining an evidence-based 'cut-off' for acceptable adherence and using objective adherence measures and validated tools and questionnaires. When possible, covert monitoring and some form of blinding or active control may help disentangle effects of the intervention from effects of inclusion in an adherence trial

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Improving Asthma Management: Patient–Pharmacist Partnership Program in Enhancing Therapy Adherence

Community pharmacist interventions can assist in improving adherence in patients with asthma. The objective of the study was to assess the feasibility of patient-centered counseling using the developed asthma-specific tools to identify barriers to adherence and identify their preliminary effect on adherence barrier score and asthma control. Adult patients with persistent asthma were invited to participate in a 3-month pre–post intervention study involving community pharmacist-provided patient-centered counseling. Bivariate analyses were conducted to determine whether there were changes in outcomes from the pre to post period. Of 36 recruited patients, 17 completed both pre and post surveys. At baseline, patients had a mean ACT score of 15.1 ± 3.5, with 94% having uncontrolled asthma, and an average of 4.2 ± 2.5 reported barriers. The following barriers were most common: not having an Asthma Action Plan (52.9%), use of inhaler more or less often than prescribed (47.1%) and forgetfulness (41.2%). The ACT score increased by 2.7 ± 5.4, which was not statistically significant; however, it might be clinically significant. Two barrier scores improved as a result of the intervention. Preliminary evidence on the feasibility of identifying and addressing patient-specific barriers to adherence delivered by pharmacists showed that it has the potential to resolve barriers and improve asthma outcomes