Gastrointestinal Bleeding in Antithrombotic Therapy in Patients with Coronary Heart Disease: Risk Factors, Pathogenesis and Treatment

Aim. Description of risk factors, pathogenesis and treatment strategies of gastrointestinal bleeding (GIB) in the course of antithrombotic therapy in patients with coronary heart disease (CHD).Key points. Risk factors of GIB during antithrombotic therapy in CHD patients include: GIB, gastric and/or duodenal ulcer in the history, reflux esophagitis, presence of H. pylori, inflammatory bowel disease, diverticula, haemorrhoids, angiodysplasia, gastrointestinal neoplasia, age above 65 years, concomitant treatment with non-steroidal anti-inflammatory drugs (NSAIDs), glomerular filtration rate <50 mL/min, high doses of direct oral anticoagulants (DOACs) ≥3 in HAS-BLED score. Pathogenesis of GIB in the course of antithrombotic therapy is associated with systemic hypocoagulation and local damaging effects of these drugs. Strategies of GIB treatment during DOAC therapy in patients with CHD are determined by severity of bleeding and threat to life. Aside to standard conservative measures, endoscopic or surgical haemostasis requires usage of antidotes to suppress effects of DOACs and other specific drugs in severe cases.Conclusion. GIB associated with antithrombotic therapy in CHD patients poses a serious medical problem of growing importance with wider application of anticoagulant drugs. Antithrombotic therapy requires accurate decision making, risk assessment, careful monitoring of the patient’s condition and timely diagnosis of gastrointestinal disorders following good rationale in GIB prevention

STUDY OF THE PROPERTIES OF THE MIXED WATER/SALT HOUSE DUST MITE ALLERGEN AIMING TO DESIGN ITS SUBLINGUAL FORM

Сurrent allergen-specific immunotherapy (AIT) is the most pathogenetically justified method of the IgE-dependent treatment of allergic diseases. Subcutaneous (SCIT) and sublingual (SLIT) AIT are currently used in wide clinical practice. Sublingual immunotherapy is characterized by the convenience of use, decreased incidence of systemic and local side effects, and proven clinical efficacy. However, sublingual form of home dust mite allergen for AIT is not yet produced in Russia. Previously, the technology for sublingual form of D. farinae (Der f) mites allergen was developed in our laboratory, and this extract was shown to be non-toxic and free of any significant side effects. We obtained a sublingual form of mixed D. pteronyssinus (Der р)/D. farina mites allergen for sublingually allergen-specific immunotherapy. We studied physico-chemical and immunobiological properties of the Der р and Der f mites phenol-free water-salt mixed extract (WWSME). WWSME was studied after sterilizing filtration. WWSME was analyzed by electrophoresis in polyacrylamide gel in the presence of dodecyl-sodium sulfate and reverse-phase high-performance liquid chromatography. ELISA was performed with polyclonal rabbit serum, obtained by sensitization of animals with recombinant Der f1 and Der f2 allergens. ELISA shows positive reaction of WWSME with IgG-antibodies of rabbits. We studied acute and chronic toxicity of received mixed allergen in laboratory animals. Pathomorphological studies have shown that WWSME has no detectable toxicity and does not cause local irritation in the animals. The WWSME product contains native proteins, retains immunogenic properties, is non-toxic and does not cause significant side effects. This extract can be used as the basis for designing a sublingual form of dust mite mixed allergen, which is especially promising for pediatric applications

Specific risk factors for cerebrovascular disorders in patients with chronic kidney disease in the pre-dialysis period

Cerebral vascular disorders are one of the leading causes of disability and mortality in patients with chronic kidney disease (CKD). The article presents the currently available data on risk factors (RF) for the development of cerebrovascular disorders in pre-dialysis patients with CKD. Two groups of RF are identified: traditional and non-traditional (specific). Traditional RF, which include arterial hypertension, diabetes mellitus and hypercholesterolemia, independently affect the cerebral vascular bed and get worse against the background of CKD. Specific RF is associated with features of the CKD pathogenesis. It includes increased blood levels of homocysteine, β2-microglobulin, impaired calcium-phosphorus metabolism, accumulation of uremic toxins and toxins of intestinal bacteria, anemia and other factors. In the present review, special attention is paid to specific RF and pathogenetic mechanisms of the development of cerebrovascular disorders in predialysis patients with CKD. Timely detection of cerebral risk factors may lead to the improvement of early diagnosis and prevention of cerebral vascular disorders, optimization of therapy for patients with CKD

EFFECT OF LISINOPRIL ON 24-HOUR BLOOD PRESSURE AND ARTERIAL STIFFNESS IN PATIENTS WITH ARTERIAL HYPERTENSION AND RHEUMATOID ARTHRITIS

Aim. To study effect of 24-week treatment with lisinopril on blood pressure (BP) and arterial stiffness in patients with arterial hypertension (HT) and rheumatoid arthritis (RA).Material and methods. Twenty patients with essential HT grade  1-2 and RA (mean age 60.2±7.9 years) were treated with lisinoprilin 24 weeks in open controlled study. Office blood pressure (BP) was 147.2±9.4/87.5±8.6 mm Hg; 24-h mean  BP – 141.8±9.3/82.2±9.6 mm Hg; HT duration was 14.5±9.4 years, and RA duration – 12.3±2.6 years. A high incidence of traditional cardiovascular risk factors was identified: 95% of patients had dyslipidaemia, 45% – obesity, 35% – impaired glucose tolerance. Atherosclerosis of carotid arteries with stenosis less than 25% was diagnosed in 65% of patients. Most patients had a positive rheumatoid factor and cyclic citrullinated peptide antibodies, as well as moderate RA activity and III-IV radiologic stage of RA. All patients received methotrexate as the basic anti-inflammatory drug, 12 (60%) patients – selective cyclooxygenase-2 inhibitors, 6 (30%) patients took corticosteroids equivalent to prednisolone 7.5±5.5 mg per day. Mean  dose  of lisinopril was 12.2±9.8 mg/day. Office BP measurements, 24-hour ambulatory BP monitoring (ABPM), and  arterial stiffness evaluation were  performed initially and  at the end of the study. Arterial stiffness was assessed by cardio-ankle vascular index on the right (R-CAVI) and on the left (L-CAVI).Results. After 24-week therapy with lisinopril office systolic and diastolic BP significantly decreased by 16.0±7.2/11.6±9.1 mm Hg (p<0.0001) and 11.6±9.1 mm Hg (p<0.0001), respectively. The target BP was achieved in 16 (83%) patients. According to the ABPM 24-week therapy with lisino pril led to a significant (p<0.002) decrease in BP for all referable periods: by 12.4±9.1/7.6±3.9 mm Hg within 24 hours;  by 13.4±10.1/8.0±6.1 mm Hg for daytime; by 10.1±9.3/7.3±6.3 mm Hg for night-time. After lisinopril treatment, R-CAVI decreased from 8.9±1.7 to 8.4±1.6 relative units (p=0.011), L-CAVI decreased from 8.9±1.6 to 8.4±1.5 relative units (p=0.003).Conclusion. In patients with combination of HT and RA, 24-week therapy with lisinopril had a significant antihypertensive effect and improved the elastic properties of the vessels

Salicaceae-Feeding Leaf-Mining Insects in Siberia: Distribution, Trophic Specialization, and Pest Status

International audienceThis paper provides an overview of the leaf-mining insect community feeding on willows (Salix spp.) and poplars (Populus spp.) in Siberia. According to published data and our own observations, 50 leaf-mining insect species (i.e., 24 species of Lepidoptera, 15 Coleoptera, 6 Diptera, and 5 Hymenoptera) feed on those two plant genera in Siberia. Using an integrative approach combining field work, morphological and DNA barcoding analyses, we identified 32 leaf-mining insect species from 14 regions across Siberia (i.e. 64% of all leaf-mining species known on Salicaceae in this part of Russia). Among them, 26 species most often found in parks and botanical gardens, represented new faunistic records for several poorly explored regions of Siberia. We have more than doubled the list of Salicaceae-feeding leaf-mining insects in Tomsk oblast, Altai krai, and the Republic of Tuva, and for the first time provided data on leaf-miners for the Khanty-Mansi Autonomous Okrug. The micromoth Phyllocnistis gracilistylella (Gracillariidae), recently described from Japan, was found on a new host plant (Salix caprea) in the south of Krasnoyarsk krai, is new for Russia. Eight leafmining insect species (i.e., five gracillariids: Phyllocnistis labyrinthella, Ph. unipunctella, Phyllonorycter apparella, Ph. sagitella, and Ph. populifoliella; two beetles: Zeugophora scutellaris and Isochnus sequensi; and one sawfly: Heterarthrus ochropoda) can outbreak on poplars, most often in urban plantations, botanical gardens, and plant nurseries in Siberia, and can also affect natural stands. Forty-five species of 50 leaf-mining insects known to feed on willow and poplar in Siberia also occur in Central and Eastern Europe. The remaining five species (Phyllocnistis gracilistylella, Phyllonorycter sibirica, Heterarthrus fasciatus, Tachyerges dauricus, and Isochnus arcticus) are recorded in Asia only. Species richness of the family Gracillariidae, the most diverse on Salicaceae in Siberia, displays 80% similarity to that in the European part of Russia and 71% to the Russian Far East. We discuss the faunal similarity of these regions and highlight the importance of applying an integrative approach combining ecological, morphological analyses, and DNA barcoding to explore and characterize the insect fauna of poorly studied regions of Asian part of Russia