Vascular endothelial growth factor as a marker of endothelial dysfunction in poly- and comorbidity: focus on hypertension, type 2 diabetes mellitus and subclinical hypothyroidism

Background. The goal of our study was to investigate the content and particularities of change of vascular endothelialgrowth factor-A (VEGF-A) levels as a marker of endothelial dysfunction (ED) in patients with hypertension(HT) with or without type 2 diabetes mellitus (T2DM) and with or without subclinical hypothyroidism (SH). Material and methods. Two hundred and eleven patients with hypertension stage II were divided into 3 groups:Group 1 — with HT (n = 55); Group 2 — with AH and T2DM (n = 97); Group 3 — with HT, T2DM and SH(n = 59). The patients in Group 3 were divided into 3 subgroups depending on TSH levels: 3a (n = 26) — TSH4.0–6.0 mIU/L; 3b (n = 20) — TSH 6.1–8.0 mIU/L; 3c (n = 13) — TSH 8.1–10.0 mIU/L. We evaluated lipids,carbohydrate metabolism, serum insulin concentration, insulin resistance index — HOMA, and the level ofVEGF-A in plasma. Results. The levels of VEGF-A in Group 2 was significantly lower vs. Group1 (323.94 ± 22.17 pg/mLand 413.15 ± 29.02 pg/mL, respectively (p < 0.05)). The patients in Group 3d had lower VEGF-A levels thanthe patients in Group 1, but higher than those in Group 2. Among Group 3 patients, the levels of VEGF-Awere the lowest in the 3a subgroup (375.91 ± 19.81 pg/mL), significantly different from 3b and 3c subgroups(p < 0.05), for which no differences were found (p > 0.05.). In the 3a subgroup VEGF-A levels were significantlyhigher than in Group 2 patients (p < 0.05). Conclusion. These data confirms the hypothesis of increasing ED in hypothyroidism even at the subclinical level

Effect of achieving blood pressure targets on the relative telomere length in hypertensive patients with and without type 2 diabetes mellitus

Background. The role of relative telomere length (RTL) as a marker of cardiovascular prognosis and quality controlof the disease course remains to be found out. The aim of the study was to determine the relationship betweenthe relative blood leukocyte telomere length (RLTL), relative buccal epithelium cell telomere length (RBTL) andachieving blood pressure targets (BPTs) in hypertensive (H) individuals with type 2 diabetes mellitus (T2DM) andwithout T2DM. Material and methods. In 156 patients with stage II hypertension (96 of them had T2DM), carbohydrate metabolismparameters and blood pressure levels were evaluated. RLTL and RBTL were determined by a real timequantitative PCR. Results. A combination of hypertension and T2DM was associated with significantly greater RLTL (p = 0.009) andRBTL (p = 0.001) compared with isolated hypertension. There was no convincing evidence of BPT influence onthe change in the RLTL in isolated hypertension. Achieving BP targets was associated with a paradoxical shorteningof RBTL. There was a significant shortening of RTL in hypertensive patients with T2DM when the BPTs were notreached. An analysis of variance revealed a significant influence of BPTs on the RBTL and RLTL. Conclusion. Patients with a comorbid course of hypertension and T2DM had more pronounced decrease in theRTL. Target levels of blood pressure have a more significant effect on the RLT than the glycemic control in patientswith concomitant T2DM. An additional determination of the RBTL enhances the diagnostic and prognostic powerwhen evaluating the effectiveness of correcting cardiovascular risk factors including blood pressure

Features of hemodynamic and metabolic disorders in obese patients with resistant hypertension

Background. The aim was to establish the features of hemodynamic and metabolic parameters in obese patients with true and pseudo-resistant arterial hypertension (AH). Material and methods. The study included 200 patients with uncontrolled AH and obesity. Patients were initially prescribed dual antihypertensive therapy. Those patients who did not reach target blood pressure (BP) levels after 3 months on dual therapy were additionally prescribed a third antihypertensive drug. Of the 98 patients who were assigned to triple therapy, 48 patients did not reach target BP (27 patients had pseudo-resistant and 21 patients had true resistant AH). These patients were additionally prescribed a fourth antihypertensive drug (spironolactone). The effectiveness of the treatment was evaluated 6 months after the start of antihypertensive therapy. Results. After 6 months of therapy, unlike patients without resistance, individuals with resistant AH had more pronounced cardiovascular remodeling and metabolic disorders, disbalance of oxidative stress-antioxidant protection, proinflammatory activity and higher activity of the renin-angiotensin-aldosterone system. Patients with true resistance differed from pseudo-resistant patients by having significantly lower body mass index (BMI); in the absence of differences in BP levels, cardiovascular remodeling, lipid and carbohydrate profiles, patients with true resistance had significantly higher levels of aldosterone, higher activity of oxidative stress system, lower levels of general antioxidant protection, higher adiponectin levels, and lower leptin level. Conclusions. Obese patients with true resistance differed from pseudo-resistant patients by having significantly lower BMI, higher aldosterone levels, more pronounced imbalance of the system of oxidative stress-antioxidant protection and less pronounced adipokine imbalance

Management of patients with infiltrative pulmonary darkening

The aim of this module is to provide the student with an opportunity to keeping patient in pulmonology clinic. Students should be able to describe and define: what is mean by the term fever of unknown origin, the basic mechanisms of fever of unknown origin. The student should have an understanding of the pathophysiology of these diseases and be able to develop a comprehensive differential diagnosis. The student will understand the appropriate diagnostic testing, the assessment, diagnosis and management the patient with fever of unknown origin

Module 3. Current practice of internal medicine. Contents module№ 1. Theme 9. Management of the patients with stable angina

Management of the patients with stable angina: introduction, Canadian Cardiovascular Society Angina Classes, main causes of decreased myocardial oxygen supply or increased myocardial oxygen demands, diagnosis, assessment, general measures and treatment

Hypertensive Heart Disease: A Narrative Review Series—Part 1: Pathophysiology and Microstructural Changes

Sustained hypertension causes structural, functional, and neurohumoral abnormalities in the heart, a disease commonly termed hypertensive heart disease (HHD). Modern concepts of HHD, including processes of remodeling leading to the development of various LVH patterns, HF patterns accompanied by micro- and macrovasculopathies, and heart rhythm and conduction disturbances, are missing in the available definitions, despite copious studies being devoted to the roles of myocardial and vascular fibrosis, and neurohumoral and sympathetic regulation, in HHD development and progression. No comprehensive and generally accepted universal definition and classification of HHD is available to date, implementing diagnostic criteria that incorporate all the possible changes and adaptions to the heart. The aim of this review series is to summarize the relevant literature and data, leading to a proposal of a definition and classification of HHD. This first article reviews the processes of initial myocardial remodeling, and myocardial and vascular fibrosis, occurring in HHD. We discuss important pathophysiological and microstructural changes, the different patterns of fibrosis, and the biomarkers and imaging used to detect fibrosis in HHD. Furthermore, we review the possible methods of targeting myocardial fibrosis in HHD, and highlight areas for further research

Age-associated features of oxidative stress as marker of vascular aging in comorbid course of hypertension and type 2 diabetes mellitus

Aim: To evaluate activity of oxidative stress (OS) as marker of vascular aging in different age groups of patients with combined course of arterial hypertension (HT) and type 2 diabetes mellitus (T2DM).Methods: 126 patients (average age 57.8 ± 6.2 years) with stage II HT and compensated T2DM were divided into 2 subgroups: 2a (n = 59) - aged 45-60 years; 2b (n = 97) - aged 61-75 years; 30 patients with isolated stage II HT (comparison group), 20 practically healthy individuals (control group). The activity of antioxidative [glutathione peroxidase, sulfhydryl groups (SH-groups)] and oxidative [malonic dialdehyde (MDA)], 8-hydroxy-2-deoxyguanosine (8-OH-dG) systems in blood serum, were studied.Results: A significant increase in MDA levels (P < 0.05) and SH-groups (P < 0.05) compared with healthy volunteers was observed. Patients in 2b group had lower MDA values than in 2a (6.25 ± 0.33 μmol/L, 7.07 ± 0.44 μmol/L, respectively, P > 0.05). In the 2b group, in comparison with 2a patients, a decrease in thiol status was observed (P > 0.05). The level of 8-OH-dG was increased in patients with HT and T2DM, but there was also an age-associated increase in the average 8-OH-dG in the 2b group.Conclusion: The age-associated changes in the OS in comorbid course of HT and T2DM did not have significant differences. Nevertheless, the presence of correlations between various indexes that are included in the concept of “vascular aging” and indicators of oxidant-antioxidant systems in different age groups allows us to make an assumption about the significant influence of the oxidative status on the status of vascular age, especially in the older age group persons

Management of patients with pleural effusion

The students should be able to describe clinical presentation, provide the diagnose, differentials and treatment of pleurisy The aim of this topic is to provide the student with an opportunity to: provide a basic overview of the pathophysiology, history, and the main causes of pleurisy; provide a diagnostic steps for the patients with suspected pleural effusion; provide a classification of transudates and exudates, asses the results of labs and images in different variants of pleural effusion, discuss the procedure of diagnostic and therapeutic thoracentesis(goals, indications, contraindication, techniqueof the procedure),discuss the treatment (medical and surgical care) of different types of pleurisy