The Effect of Angiotensin Receptor and Neprilysin Inhibitors on Quality of Life in Patients with Heart Failure with Reduced Ejection Fraction and Functional Mitral Regurgitation

Aim. To compare the change in quality of life indicators and the main clinical and instrumental parameters in patients with chronic heart failure (CHF) and functional mitral regurgitation (FMR) under the influence of sacubitril/valsartan compared with valsartan in an outpatient practice.Material and Methods. The study included 90 patients with chronic FMR, who were observed for 12 months. They received sacubitril/valsartan or valsartan. Efficiency criteria were: the difference between groups in scores according to the Kansas questionnaire for patients with cardiomyopathy; MR degree parameters (change in effective regurgitation orifice area, vena contracta width, MR volume and MR fraction); indicators of the severity of myocardial remodeling (left ventricular EF; the level of N-terminal brain natriuretic propeptide), exercise tolerance based on a 6-minute walk test, a change in the functional class of heart failure according to NYHA.Results. In a treatment efficacy analysis, the Kansas City Cardiomyopathy Questionnaire–Overall Summary Score improved by 22.1 points in the sacubitril/valsartan group and by 4.5 points in the valsartan group (p<0.001). EF, exercise tolerance, and the number of patients transitioning from NYHA functional class III to II increased in the sacubitril/valsartan group (p<0.05). Also, in this group, the effective area of the regurgitation opening, the width of the vena contracta, the volume of regurgitation, the fraction of regurgitation, and the level of N-terminal brain natriuretic propeptide (p<0.05) decreased more pronouncedly (p<0.05).Conclusion. Compared with valsartan, treatment with sacubitril/valsartan leads to a significant improvement in the quality of life in patients with FMR and HF with reduced EF, which is largely associated with a change in NT-proBNP, echocardiographic characteristics of the severity of MR and the degree of myocardial remodeling

Лекарственно-индуцированные поражения легких противоопухолевыми препаратами: распространенность, некоторые препараты и механизмы их воздействия. Часть 2

The article analyzes 49 publications on adverse drug reactions occurring during therapy with antitumor drugs. It presents data on pneumotoxicity and its clinical manifestations for such anticancer drugs as bleomycin, busulfan, cyclophosphamide, chlorambucil, methotrexate, nitrosourea derivatives, and taxanes, while the mechanisms of lung injury are not entirely clear and require further research. The prevention of drug-induced lung injury requires raising awareness among practicing physicians of different specialties, primarily general practitioners, rheumatologists, clinical immunologists, pulmonologists, phthisiologists, and oncologists due to non-specific manifestations of drug-induced lung injury and the use of antitumor drugs for other diseases apart from cancer.Проанализировано 49 источников литературы о нежелательных лекарственных реакциях, возникающих при терапии противоопухолевыми препаратами. Представлены данные о пневмотоксичности и ее клинических проявлениях для таких противоопухолевых препаратов, как блеомицин, бусульфан, циклофосфамид, хлорамбуцил, метотрексат, производные нитрозомочевины, таксаны, при этом механизмы развития поражения легких не совсем ясны, что требует дальнейших исследований. Для профилактики лекарственно-индуцированного поражения легких необходима информированность практикующих врачей разных специальностей, прежде всего терапевтов, ревматологов, клинических иммунологов, пульмонологов, фтизиатров, онкологов, ввиду неспецифичности симптомов лекарственно-индуцированного поражения легких и применения противоопухолевых лекарственных средств не только при развитии онкологических заболеваний

О различиях в стандартизации лекарственных препаратов на основе экстрактов хондроитина сульфата

Objective: a comparative analysis of 6 different chondroprotectors for injection, containing chondroitin sulfate (CS) based on natural extracts.Material and methods. Five samples were studied for each CS extract. The preparations were compared on the basis of profiles of trace element composition, sulfur content, chromatographic analysis and test for total protein. In each sample, the concentration of 72 elements was determined, then averaging was performed and the variances of the content of each element were calculated. To assess the content of the protein fraction, a modified Lowry method with bicincholic acid was used. Chromatographic profiles of the studied CS extracts were measured to estimate the molecular weight distribution.Results. The studied samples differ significantly from each other in the total and individual content of sulfur, toxic and conditionally toxic microelements. According to the analysis of sulfur and trace elements, a cluster of more standardized CS extracts was identified. It was shown that the assessments of the pharmaceutical quality of the studied extracts made by the elemental profile, correspond to the assessments of the quality by the degree of proteins elimination and by the molecular weight characteristics of CS extracts. In particular, the highest total content of toxic elements was found for CS-6 (14.87±1.81 μg/l) and CS-2 (9.20±1.12 μg/l), and the lowest – for CS-4 (1.46±0.23 μg/l), CS-3 (1.92±0.33 μg/l) and CS-1 (2.98±0.25 μg/l). The highest content of protein impurities was also found in CS-6 (9.62 mg/ml) and CS-2 (6.64 mg/ml), and the lowest – in CS-1 (2.87 mg/ml). At the same time, the highest amount of sulfur was found CS-1 (6400 mg/kg) and much less – for CS-2 (370 mg/kg) and CS-6 (100 mg/kg). Significant amounts of the high-molecular fraction of CS (1–40 kDa) were found only in CS-1, and only trace amounts of high-molecular CS forms were present in CS-2 and CS-6.Conclusion. The highest content of cholesterol and sulfur and, at the same time, the lowest content of toxic microelements and proteins were distinguished by the extract obtained from the trachea of a bovine.Цель: сравнительный анализ 6 различных хондропротекторов для инъекционного введения, содержащих хондроитина сульфат (ХС).Материал и методы. Для каждого экстракта ХС изучено по 5 образцов. Сравнение препаратов проведено на основании профилей микроэлементного состава, содержания серы, хроматографического анализа и теста на общий белок. В каждом образце определяли концентрацию 72 элементов, затем проводили усреднение и рассчитывали дисперсии содержания каждого из элементов. Для оценки содержания белковой фракции применяли модифицированный метод Лоури с бицинхолиновой кислотой. Хроматографические профили исследованных экстрактов ХС измеряли для оценки распределения молекулярной массы.Результаты. Исследованные образцы существенно отличаются друг от друга по суммарному и индивидуальному содержанию серы, токсичных и условно-токсичных микроэлементов. По оценкам анализа на серу и микроэлементы выделен кластер более стандартизированных экстрактов ХС. Показано, что оценки фармацевтического качества исследованных экстрактов, выполненные по элементному профилю, соответствуют оценкам качества по степени очистки от белков и молекулярно-весовым характеристикам экстрактов. В частности, наибольшее суммарное содержание токсичных элементов было найдено для экстрактов ХС-6 (14,87±1,81 мкг/л) и ХС-2 (9,20±1,12 мкг/л), а наименьшие – для ХС-4 (1,46±0,23 мкг/л), ХС-3 (1,92±0,33 мкг/л) и ХС-1 (2,98±0,25 мкг/л). Наибольшее содержание белковых примесей также найдено в экстрактах ХС-6 (9,62 мг/мл) и ХС-2 (6,64 мг/мл), а наименьшее – в ХС-1 (2,87 мг/мл). В то же время наибольшее количество серы выявлено для экстракта ХС-1 (6400 мг/кг) и гораздо меньшее – для ХС-2 (370 мг/кг) и ХС-6 (100 мг/кг). Значительные количества высокомолекулярной фракции ХС (1–40 кДа) были установлены только в экстракте ХС-1, а в экстрактах ХС-2 и ХС-6 присутствовали лишь следовые количества высокомолекулярных форм ХС.Заключение. Наибольшим содержанием ХС и серы (и в то же время наименьшим содержанием токсичных микроэлементов и белков) отличался экстракт, полученный из трахеи быка

Prognostic significance of vascular endothelial cell growth factors -A, -C and -D in breast cancer and their relationship with angio- and lymphangiogenesis

Vascular endothelial cell growth factors (VEGF)-A, -C and -D have potent angio and lymphangiogenic functions in experimental models, although their role in the progression of human breast cancer is unclear. The aims of the current study were to examine the relationship between the expression of the aforementioned growth factors with the angio and lymphangiogenic characteristics of breast cancer, and to assess their suitability as potential prognostic factors. Paraffin-embedded sections of 177 primary invasive breast cancer, with complete clinical follow-up information for 10 years, were stained for VEGF-A, -C, -D, podoplanin and CD34 using standard immunohistochemical approaches. The expression of the growth factors was correlated with clinicopathological criteria and patients' survival. Lymph vessel density (LVD) and microvessel density (MVD) were assessed and correlated with expression of the growth factors. Vascular endothelial cell growth factor-A, -C and -D were highly expressed in 40, 37 and 42% of specimens, respectively. High expression of VEGF-A and - C, but not of -D, was associated with a higher LVD (P=0.013 and P=0.014, respectively), a higher MVD (P<0.001 and P=0.002, respectively), the presence of lymph node metastasis (P<0.001 and P<0.001, respectively), distant metastasis (P=0.010 and P=0.008, respectively) and a shorter Overall Survival (P=0.029 and 0.028, respectively). In conclusion, breast cancers that express high levels of VEGF-A and -C are characterised by a poor prognosis, likely through the induction of angio and lymphangiogenesis. Examination of expression of VEGF-A and -C in breast cancer may be beneficial in the identification of a subset of tumours that have a higher probability of recurrence and metastatic spread

Atrial Septal Aneurysm in Adult Patients of Therapeutic Hospital

Aim. To study detection of atrial septal aneurysm (ASA) by transthoracic echocardiography in patients of the older age group of the therapeutic hospital, as well as combinations with other structural disorders of the heart and blood vessels, as well as other signs of congenital connective tissue dysplasia (CCTD) of other localization.Material and methods. Identification of ASA as well as other signs of CCTD was performed in patients ≥40 years hospitalized due to exacerbation of therapeutic diseases (n=1119), which had transthoracic echocardiography.Results. ASA was found in 1.34% of patients (n=15). Undifferentiated connective tissue dysplasia was diagnosed in 14 (93.3%) ASA patients. Prolapse of mitral (60%), tricuspid (33.3%) or both atrio-ventricular valves of the heart (6.7%), patent foramen ovale (33.3%), rudimentary Eustachian valve (6.7%), additional ventricle chords (13.3%), Valsalva sinus dilation (6.7%) was found in ASA patients. 14 (93.3%) patients had electrocardiography signs of cardiac rhythm and conduction disorders. Chronic venous insufficiency (100%), disorders of the musculoskeletal system (100%), hiatal hernia (40%), anterior abdominal wall hernia (46.7%), nephroptosis (46.7%), kidney cysts (33.3%) intestinal diverticula and dolichosigma (26.7%), bronchiectasis (6.7%) were also found.Conclusion. ASA was found in 1.34% of patients in a therapeutic hospital ≥40 years. Clinically significant and prognostically unfavorable CCTDs were not found in ASA patients in this study. However, physicians should consider the possibility of the presence of other abnormalities of the heart and large vessels, as well as other systems and organs that can lead to fatal events, in these patients

Use of inosine pranobex in frequently ill children

The follow-up group of «frequently ill children» is formed on the basis of criteria formulated by domestic pediatricians A.A. Baranov and V.Yu. Al’bitskiy, due to the high relevance of medical, social and economic problems caused by the increased morbidity in this category of patients especially with acute respiratory infections, with likely development of severe complications or the manifestation of chronic respiratory diseases. In general, the state of the immune system in frequently ill children is characterized by decreased local immunity and increased stress of systemic immunity, and the features of the functional immunity activity in this category of patients determine the various possibilities to affect immunity during the prevention and treatment of acute respiratory infections. This article discusses the features of the functional activity of the immune system in frequently ill children, as well as the possibilities of drug management of its disorders and the benefits of using inosine pranobex to prevent and treat respiratory infections in this category of patients. According to the international classification of drugs maintained by the World Health Organization, the drug belongs to the groups of immunomodulators (L) and antimicrobial antiviral drugs (J) for systemic use. It is proved that inosine pranobex effectively increases cellular and humoral immunity, and reduces non-specifically the viral replication capacity. During clinical trials, the drug proved to be a highly effective and safe component of the complex treatment of acute respiratory infections in frequently ill children. The use of inosine pranobex reduces the duration and intensity of symptoms of infectious respiratory tract diseases. The drug can be recommended for children with concomitant chronic respiratory tract diseases

Cigarette smoking could increase prevalence of carotid arterial plaque in obese male healthy collegiate students

Obesity is a known risk factor for several diseases and also negatively affects physical functioning. It is identified that obesity is an independent risk factor for cardiovascular (CV) disease. However, only few studies have investigated the association of different anthropometric measures with carotid plaque. We in this study aimed to investigate, compare and find the correlation between four measures in normal and obese adults: Anthropometric, Blood Analysis, Smoking habit and presence of Carotid Arterial Plaque. We included 44 healthy young collegiate students aged 20-25 years and were divided into two based on their body mass index: normal weight (n=15) and obese (n=29). Anthropometric measurements such as body weight, body mass index (BMI), waist / hip ratio (WHR), body fat percentage (BFP) and visceral fat area (VFA) and from the collected venous blood, total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol and glucose were measured. Presence of carotid arterial plaque [CAP] was identified by ultrasonography. Plaque presence was defined as e”1 plaque in any of the carotid arteries. Data were analyzed using independent t-test. Pearson’s correlation coefficient was used to find the correlations between the measured parameters. After adjustment for age and sex between the groups, there was strong evidence of significant difference between groups for anthropometric measures [Weight, BMI, WHR, BFP and VFA] and also for serum HDL, LDL and triglycerides levels (p 0.05). CAP was found in 69% of obese subjects and a strong correlation was found between smoking and presence of carotid plaque. A smoker is 1.84 times subjected to plaque occurrence than non-smoker among obese participants. In this study we found high prevalence of CAP among the obese adults. Occurrence of CAP was significantly increased among the smokers’ ones. Thus, evaluation of obese patients with this anthropometric, lipid profile and cigarette smoking could help the individuals to identify the risk of higher residual cardiovascular incidence. © 201