Twenty-four-hour profile of peripheral and central blood pressure in young patients with high-normal blood pressure and hypertension

Aim. To evaluate indicators of daily monitoring of peripheral and central blood pressure in young patients with high-normal blood pressure (HNBP) and essential hypertension (HTN).Material and methods. One hundred twelve patients with HNBP or untreated hypertension aged 25-44 years were included. General clinical investigations were performed. An office blood pressure (BP) were assessed using an automatic BP monitor OMRON M2 Basic. Twenty-four-hour ambulotary BP monitoring (ABPM) on the brachial artery and aorta was carried out for 24 hours using the BpLAB system (OOO Petr Telegin) with an integrated Vasotens system. Depending on BP, patients were divided into groups: with HNBP and hypertension. Statistical processing and comparative analysis of the obtained data were carried out.Results. HNBP group consisted of 47 patients, while the HTN group consisted of 65 patients. The mean age of patients was 34,7±3,2 years. The parameters of daytime and nighttime peripheral BP had significant differences between the HNBP and HTN groups. Aortic BP monitoring revealed following differences: in patients with HTN, central BP values during the day and at night reflected higher values compared to patients from the HNBP group. The number of dippers for peripheral systolic blood pressure (SBP) was more by a quarter (p=0,038) in the HNBP group than in the HTN group. There were no differences in the reduction of diastolic blood pressure (DBP). The reduction in aortic SBP between the groups of HNBP and HTN were comparable. Among hypertensive patients, DBP dippers on the aorta were 20% higher (p=0,04) than in the HNBP group. According to the augmentation and the amplification index reduced to heart rate, there were no significant differences between the groups.Conclusion. Intergroup and intragroup differences were revealed depending on the types of 24-hour profile depending on peripheral and central BP. Reference values and predictive value of central BP require further research

COMPARATIVE EFFICACY OF LONG-TERM ANTIHYPERTENSIVE MONOTHERAPY IN PATIENTS WITH ARTERIAL HYPERTENSION AT THE WORK PLACE

Aim. To compare effects of 12-month monotherapy with nebivolol, enalapril and indapamide on blood pressure (BP), left ventricular hypertrophy and quality of life in the locomotive engineers and their assistants with stress-associated hypertension at the work place (HTwp).Material and methods. 96 locomotive engineers (20- 53 y.o) and their assistants with HTwp were observed. The patients were randomized to receive nebivolol (1 group), enalapril (2 group) or indapamide (3 group). 24-hour BP monitoring, echocardiography and quality of life interview with SF–36 questionnaire were performed at the start and after 12 months of the treatment.Results. Long-term therapy lead to achievement of target BP level, improved quality of life and reduced in left ventricular hypertrophy in patients with HTwp. Nebivolol reduced systolic “BP load” more significantly than indapamide did, exerted favorable influence on circadian BP rhythm and reduced heart rate. Monotherapy with nebivolol showed benefits in effect on quality of life.Conclusion. Nebivolol has some advantages in comparison with indapamide and enalapril in antihypertensive therapy of patients with stress-associated HT

Recurrent left atrial rhabdomyosarcoma: a case report

Cardiac tumors are rare, and their diagnosis is a clinical problem associated with significant heterogeneity of pathology. The purpose of this publication is to report a rare known disease and analyze the problem for the purpose of medical education. In a case report, the following characteristic signs of a heart tumor were demonstrated: rapid progression of heart failure symptoms, systemic manifestations (anemia, severe weakness). The results of transthoracic and transesophageal echocardiography made it possible to interpret the intracardiac mass as a tumor recurrence. Histological examination confirmed the diagnosis of left atrial rhabdomyosarcoma. A specific of this case is the tumor recurrence 2 years after surgery

ELECTRICAL INSTABILITY OF MYOCARDIUM IN YOUNG MEN WITH ARTERIAL HYPERTENSION AND OCCUPATIONAL STRESS

Aim. To evaluate prevalence of electrical instability of the heart in persons with stressogenic professions by a complex evaluation of the parameters of clinical and functional methods of investigation.Material and methods. Totally 154 men included with AH of I-II stages; first group consisted of 78 motormen and their assistants having stressogenic profession, second grup consisted of 76 persons with minimal psychoemotional tension. A clinical and functional investigation was performed.Results. In 1st group "possible existence" of delayed atrial and ventricular potentials was twice and three times (resp.) more prevalent comparing to the 2nd (with p=0,0001 and p=0,0002, resp.). A rigid circadian index in the 1st group was 1,7 times more prevalent (Х2=10,5; p<0,001). In those having AH with concomitant chronic gastritis and gastric or duodenal ulcer disease the circadian rigidity was 1,6 times more prevalent (x2 =5,9; p<0,05) in the 1st group. In first stage AH the shift of vagosympathetic balance to sympathic type is more common for the 1st group than for the 2nd.Conclusion. In young men with AH and occupational stress comparing to men with low — stress profession the signs of electrical instabilty are more common

The first TIPS surgery performed in the Udmurt Republic in a young patient with secondary biliary cirrhosis

Treatment of patients with iatrogenic injuries of the biliary tract is the most difficult and important section in hepatobiliary surgery. When analyzing the causes, it was found that in 70–94 % of cases this type of injury is observed during cholecystectomy. We present a rare clinical case of the development of secondary biliary cirrhosis due to iatrogenic trauma of the biliary tract. This injury caused long-term suffering for the patient due to the further development of complications of cirrhosis, specifically of portal hypertension. The latter caused repeated recurrent profuse bleeding from varicose veins of the esophagus. The use of a minimally invasive transjugular intrahepatic portosystemic shunt procedure for the first time in the Udmurt Republic was of particular relevance in solving this problem. This procedure has become a key one in solving the abovementioned problems and will become the preventive measure for the cirrhosis progression in the future. It is also important to focus on prophylactic measures aimed at preventing iatrogenic injuries of the biliary tract, as this problem can cause irreversible complications. Prevention should include adequate examination and visualization of the bile ducts and gallbladder before surgery, their careful mobilization, compliance with the rules of operation with electrosurgical instruments, as well as the use of additional minimally invasive techniques such as choledoscopy, cholangiography and intraoperative ultrasound. Besides that, all manipulations should be carried out under strict control and clear visualization of instruments and anatomical structures of organs. The article provides a detailed description of the technique of transjugular intrahepatic portosystemic shunt surgery, as well as presents X-ray images obtained during this operation

Computer analysis of regulation of hepatocarcinoma marker genes hypermethylated by HCV proteins

Hepatitis C virus (HCV) is a risk factor that leads to hepatocellular carcinoma (HCC) development. Epigenetic changes are known to play an important role in the molecular genetic mechanisms of virus-induced oncogenesis. Aber rant DNA methylation is a mediator of epigenetic changes that are closely associated with the HCC pathogenesis and considered a biomarker for its early diagnosis. The ANDSystem software package was used to reconstruct and evaluate the statistical significance of the pathways HCV could potentially use to regulate 32 hypermethylated genes in HCC, including both oncosuppressor and protumorigenic ones identified by genome-wide analysis of DNA methylation. The reconstructed pathways included those affecting protein-protein interactions (PPI), gene expression, protein activity, stability, and transport regulations, the expression regulation pathways being statistically significant. It has been shown that 8 out of 10 HCV proteins were involved in these pathways, the HCV NS3 protein being implicated in the largest number of regulatory pathways. NS3 was associated with the regulation of 5 tumor-suppressor genes, which may be the evidence of its central role in HCC pathogenesis. Analysis of the reconstructed pathways has demonstrated that following the transcription factor inhibition caused by binding to viral proteins, the expression of a number of oncosuppressors (WT1, MGMT, SOCS1, P53) was suppressed, while the expression of others (RASF1, RUNX3, WIF1, DAPK1) was activated. Thus, the performed gene-network reconstruction has shown that HCV proteins can influence not only the methylation status of oncosuppressor genes, but also their transcriptional regulation. The results obtained can be used in the search for pharmacological targets to develop new drugs against HCV-induced HCC

Acute myocardial damage in new coronavirus infection (COVID-19)

Introduction. Acute respiratory distress syndrome (ARDS) and cardiovascular events, acute myocardial injury being the most frequent of the latter, are among the leading causes of death in COVID-19 patients. The lack of consensus on acute myocardial injury pathogenesis mechanisms, the patients management, treatment an rehabilitation logistics, the anticoagulant treatment in identified SARS-CoV-2 or suspected COVID-19 patients setting indicates the need to assess, analyze and summarize the available data on the issue.Введение. Острый респираторный дистресс-синдром и сердечно-сосудистые осложнения, наиболее частым из которых является острое повреждение миокарда (ОПМ), занимают ключевое место в структуре причин смерти больных с новой коронавирусной инфекцией. Отсутствие единого мнения о механизмах развития острого поражения миокарда, обоснованной тактики ведения пациентов с ОПМ, применении антикоагулянтной терапии у лиц с идентифицированным SARS-CoV-2 или подозрением на COVID-19 отражают необходимость поиска, анализа и обобщения имеющихся литературных данных по данной проблем

Atrial fibrillation and gastrooesophageal reflux disease: association mechanisms, treatment approaches

The article is devoted to assessing the relationship of atrial fibrillation (AF) and gastroesophageal reflux disease (GERD). We studied possible anatomical correlations, common risk factors and mechanisms of AF development in patients with gastroesophageal reflux. We demonstrated the problems of the treatment of such patients, since a number of studies have proved the possibility of using proton pump inhibitors in the treatment of AF. In other cases the arrhythmogenic effect of these drugs was obtained. Treatment of AF by catheter ablation most commonly worsens the course of GORD and can lead to the development of fatal complications. Large-scale prospective researches are needed for further detailed study of AF and GERD associations, as well as tactics for management of these patients

Adverse Reactions of the Cardiovascular System when Taking Nonsteroidal Anti-inflammatory Drugs and Ways to Reduce Them

The most important issue of modern pharmacotherapy is not only efficacy, but also the safety of medicines. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is one of the main methods of treating acute and chronic pain in a wide range of diseases and pathological conditions. However, the prescription of this group of drugs requires consideration of the potential risks of complications, including from the side of the cardiovascular system. The purpose of the review was to assess the adverse reactions of the cardiovascular system when taking NSAIDs and approaches to their reduction. The article presents data on the mutual potential impact of cardiovascular diseases and musculoskeletal system, presents the results of large-scale studies of Russian and foreign authors and meta-analyzes of the NSAIDs effect on blood pressure profile, development of myocardial infarction, stroke and heart failure. The possible pathogenetic mechanisms of the side effects of NSAIDs are reviewed; the complexity of managing comorbid patients is demonstrated; it is shown that symptomatic treatment of pain and inflammatory syndrome should be carried out considering a personalized approach to the patient and rational choice of drugs.Before the NSAIDs prescription, it is necessary to consider all cardiovascular risk factors with the determination of the total risk of cardiovascular complications. In patients with a very high cardiovascular risk, the use of any NSAIDs should be avoided; with high and moderate risk, the use of NSAIDs with the most favorable cardiovascular safety profile is possible. If the patient belongs to the category of low total coronary risk, the doctor can choose any NSAIDs

Target organ damage in stress-induced arterial hypertension

Aim. То investigate the features of target organ damage in patients with stress-induced arterial hypertension (AH).Material and methods. The study included 329 men, aged 29—55 years, with Stage I-II AH. Group I consisted of 197 individuals with workplace AH (WAH), Group II — of 132 patients with essential AH (AH); mean age was 41,3±1,4 and 42,5±1,5 years, respectively. All participants underwent Doppler echocardiography and brachiocephalic (BC) duplex scanning.Results. Left ventricular hypertrophy (LVH) was diagnosed in 38,1 % and 28,1 % of the patients from Groups I and II, respectively. Concentric LVH (CLVH) prevalence was 12,3 % higher in WAH individuals than in AH patients (χ2=7,9; p=0,05). Type I diastolic dysfunction (DD) was registered in 87,3 % and 62,1 % of the patients from Groups I and II, respectively. DD prevalence was 25,2 % higher in WAH subjects than in AH participants (χ2=28,5; p=0,001). In Groups land II, increased thickness of common carotid artery wall was observed in 47,2 % and 34,1 %, respectively; its prevalence was 13,1 % higher in WAH patients comparing to people with AH.Conclusion. In WAH and AH patients, DD and LVH were the most typical manifestations of TV damage. DD was more prevalent in WAH than in AH. LVH prevalence was similar in both groups, but CLVH was more typical for WAH than for AH. The same tendency was observed for BC atherosclerosis