Assessment of Nutritive Status in Patients with Symptoms of Heart Failure

Aim of the research. To study the parameters of nutritional status of patients with acute and chronic coronary syndromes and symptoms of heart failure in conjunction with clinical, anthropometric, laboratory parameters, structural and functional characteristics of the heart. Materials and methods. A cross-sectional study of 106 patients with acute and chronic coronary syndromes and symptoms of heart failure. All subjects underwent an integrated assessment of the nutritional status (anthropometric, caliperometric (caliper metric) indicators, CONUT scale (lymphocytes, total cholesterol, albumin), hormonal indicators (N-terminal brain natriuretic propeptide), structural changes in the myocardium using echocardiography, exercise tolerance by 6-minute walk test. Results. Nutritional deficiency, according to CONUT scale, was found in 81.1 % of cases (86 patients). In the group of patients with the presence of malnutrition, there were significantly high level of fibrinogen and N-terminal brain natriuretic propeptide. The interpretation of changes in body composition showed a significant upward trend in the prognostic index of hypotrophy and a decrease in lean body mass as heart failure progresses. The dependence of nutritive insufficiency on the CONUT scale with laboratory parameters (creatinine, fibrinogen, brain natriuretic propeptide), structural and functional characteristics of the heart (diastolic and systolic dimensions of the left ventricle, ejection fraction, left ventricular myocardial mass index), a functional indicator of tolerance to the physical load (6-minute walk test) was determined. Conclusion. An integrated analysis of nutritional status indicators of patients with heart failure revealed an increase of malnutrition signs with an increase of the severity of HF. Pathological effects of nutritional deficiency are associated with impaired left ventricular systolic function, reduced exercise tolerance

Ассоциация злокачественных новообразований и нарушения трофологического статуса у пациентов паллиативного профиля

Malnutrition is one of the most common disorders observed in patients who are being treated for various diseases. In cancer patients with a palliative profile, compared with patients without malignant neoplasms, anemia, lymphopenia, decreased glomerular filtration rate were significantly more often detected, and a tendency to lower albumin levels was revealed. There was a significant decrease in PNI, BMI, shoulder circumference, thickness of the skin‑fat fold of the scapula and shoulder, and a tendency to reduce lean body weight in patients with palliative malignancies. The logistic regression analysis revealed the relationship between the presence of a malignant tumor in palliative patients and the presence of trophic status disorders: PNI (β = –0.37, p = 0.021), weight (β = –0.41, p = 0.001), BMI (β = –0.36, p = 0.001), shoulder circumference (β =–0.65, p = 0.001), thickness of the scapular skin‑fat fold (β = –0.66, p = 0.001).Недостаточное питание относится к одним из наиболее распространенных нарушений, отмечающихся у пациентов, находящихся на лечении по поводу различных заболеваний. У онкологических пациентов паллиативного профиля в сравнении с пациентами без злокачественных новообразований достоверно чаще выявлялась анемия, лимфопения, снижение скорости клубочковой фильтрации, выявлена тенденция к более низкому уровню альбумина. Выявлено достоверное снижение показателя PNI (прогностический нутритивный индекс), индекса массы тела (ИМТ), окружности плеча, толщины кожно-жировой складки лопатки и плеча, тенденцию к снижению общей массы тела у пациентов со злокачественными новообразованиями паллиативного профиля. Проведение логистического регрессионного анализа выявило взаимосвязь между наличием злокачественной опухоли у пациентов паллиативного профиля и наличием нарушений трофологического статуса: PNI (β = –0,37, р = 0,021), вес (β = –0,41, р = 0,001), ИМТ (β = –0,36, р = 0,001), окружность плеча (β =–0,65, р = 0,001), толщина кожно-жировой складки лопатки (β =–0,66, р = 0,001)

Functional disorders of the gastrointestinal tract in correlation with anxiety and neurotization

Our cross-sectional study included 75 people (students of medical university), whose average age was 21.4 ± 0.7 years (M + s). They comprised 57 women and 18 men. To characterize the severity of the course of functional diseases of the digestive tract, the Questionnaire '7x7' was used. The psychodiagnostic toolset included: an integrative anxiety test; a scale for psychological express-diagnosis of the level of neurotization. The psychological characteristics of the examined subjects with functional disorders of gastrointestinal tract were characterized by the prevalence of the general level of personal anxiety and its subscales (emotional discomfort and asthenic component), as well as by the significant prevalence of the proportion of people in the lowered1 category of neurotization. The revealed correlations between functional disorders of the gastrointestinal tract and subscales of personal anxiety can be useful in planning prevention programs, a complex (bi-disciplinary) therapy and rehabilitation of functional gastrointestinal disorders.В одномоментное исследование включено 75 человек (студентов медицинского ВУЗа), средний возраст которых составил 21,4+0,7 лет (M+s). Из них - 57 женщин и 18 мужчин. Для характеристики тяжести течения функциональных заболеваний ЖКТ применялся Опросник «7x7». Психодиагностический инструментарий включал: интегративный тест тревожности; шкалу для психологической экспресс-диагностики уровня невротизации. Психологические особенности обследованных с функциональными расстройствами желудочно - кишечного тракта характеризовались преобладанием общего уровня личностной тревожности и её субшкал (эмоциональный дискомфорт и астенический компонент), а также значимым превалированием доли лиц в категории «пониженного уровня» невротизации. Выявленные корреляции между функциональными расстройствами желудочно - кишечного тракта и субшкалами личностной тревожности могут оказаться полезными при планировании программ профилактики, комплексной (бидисциплинарной) терапии и реабилитации функциональных гастроинтестинальных расстройств

Stress cardiomyopathy in pregnancy (clinical observation)

Nowadays increases the number of described cases of non-ischemic cardiomyopathy with different clinical situations, including acute emotional distress that reaches catastrophic degree. This article presents an observation of my own practice development of 'broken heart syndrome' during pregnancy as a result of the loss of a loved one. The nature, prevalence and prognosis of the syndrome takotsubo need further study because the question about the mechanisms of this pathology remains open. The novelty and interest of domestic researchers confirms the relevance of the discussion of the topic for adequate treatment of patients during pregnancy and the postpartum period.В настоящее время увеличивается количество описанных случаев неишемической кардиомиопатии при различных клинических ситуациях, включая острый эмоциональный стресс, достигающий степени катастрофического. В данной статье представлено наблюдение из собственной практики развития «синдрома разбитого сердца» при беременности в результате потери близкого человека. Природа, распространенность и прогноз синдрома такоцубо нуждаются в дальнейшем изучении, т.к. вопрос о механизмах данной патологии остается открытым. Новизна и повышенный интерес отечественных исследователей подтверждает актуальность обсуждения заявленной темы для формирования адекватной тактики ведения пациентов во время беременности и послеродовом периоде

GENDER SPECIFICS OF STRUCTURAL AND FUNCTIONAL PARAMETERS OF VESSELS IN RELATION TO PSYCHOEMOTIONAL FACTORS IN ALMOST HEALTHY INDIVIDUALS

Aim. To study gender specifics of structural and functional parameters of brachiocephal arteries with the relation to psychoemotional factors in almost healthy individuals.Material and Methods. Overall 107 almost healthy economically active individuals included from organized population (46 male, 61 female), with the average age 43,4±10,8 y. All participants underwent psychological testing that included questionnaires: Spolberger-Khanin test, depression evaluation scale by the Center for Epidemiological Studies, visualanalogue scale (modified Dembo-Rubinstein), the social frustration level, social adaptation test by Holmes-Rey, ultrasound scanning of brachiocephal arteries with evaluation of local rigidity parameters.Results. There were significant gender differences found for the vessel wall structural and functional parameters. Average values of systolic and diastolic diameters, total common carotid artery wall thickness were higher in males, but the rigidity index - in women. Prevalence of personal anxiety and clinically significant stress estimates by the Holmes-Rey scale was significantly higher in women, 75% and 36%, resp. In both groups the association of psycho-emotional factors and vessel parameters was found. But for men there was independent relation of reactive and personal anxiety with the thickness of “intima-media” and in women – correlation of depression and vessel wall compliance.Conclusion. The results direct to the need for further research of novel methods for complex primary prophylaxy of stress-induced remodeling of vessels with the connection to psychoemotional and gender specifics