Efficacy and tolerability of felodipine based antihypertensive therapy in hospitalized patients with hypertension

Aim. To compare efficacy and tolerability of felodipine based antihypertensive therapy with those of standard hospital treatment of hypertension. Material. Inhospital patients were randomized 1:2 to standard antihypertensive therapy or to therapy which included felodipine (n=50 and 100, 36 and 35% men, mean age 66.0 +/- 8.4 and 64.3 +/- 8.1 years, initial blood pressure 162.4 +/- 9.3/99.3 +/- 6.4 and 163.2 +/- 10.3/98.2 +/- 6.5 mm Hg, respectively). Felodipine was used: (1) as first drug with subsequent addition of other drugs as required; (2) after cessation of previously ineffective therapy; (3) in cases of intolerance to previous therapy, (4) as supplementation to previously insufficiently effective therapy. Results. At discharge in felodipine group 6, 25, 29 and 40% of patients received mono- (felodipine 10 mg/day), 2, 3 and 4 component therapy, respectively. in standard treatment group all patients received combination therapy with 3 (48%) or 4 (52%) drugs. Felodipine group compared with group of standard therapy was characterized by less frequent correction of anti hypertensive therapy (0.8+/-0.6 and 2.2 +/- 0.9, p<0.05), smaller number of drugs used (3.03 +/- 0.95 and 3.52 +/- 0.5. p<0.01), more frequently achievement of target blood pressure level (88 and 64%. p=0.0075), less pronounced difference between morning and evening self-measured blood pressure. Conclusion. The use of felodipine in hospitalized patients with hypertension allowed achieving target blood pressure with fewer drugs. Felodipine was safe and well tolerated

Efficacy and tolerability of felodipine based antihypertensive therapy in hospitalized patients with hypertension

Aim. To compare efficacy and tolerability of felodipine based antihypertensive therapy with those of standard hospital treatment of hypertension. Material. Inhospital patients were randomized 1:2 to standard antihypertensive therapy or to therapy which included felodipine (n=50 and 100, 36 and 35% men, mean age 66.0 +/- 8.4 and 64.3 +/- 8.1 years, initial blood pressure 162.4 +/- 9.3/99.3 +/- 6.4 and 163.2 +/- 10.3/98.2 +/- 6.5 mm Hg, respectively). Felodipine was used: (1) as first drug with subsequent addition of other drugs as required; (2) after cessation of previously ineffective therapy; (3) in cases of intolerance to previous therapy, (4) as supplementation to previously insufficiently effective therapy. Results. At discharge in felodipine group 6, 25, 29 and 40% of patients received mono- (felodipine 10 mg/day), 2, 3 and 4 component therapy, respectively. in standard treatment group all patients received combination therapy with 3 (48%) or 4 (52%) drugs. Felodipine group compared with group of standard therapy was characterized by less frequent correction of anti hypertensive therapy (0.8+/-0.6 and 2.2 +/- 0.9, p<0.05), smaller number of drugs used (3.03 +/- 0.95 and 3.52 +/- 0.5. p<0.01), more frequently achievement of target blood pressure level (88 and 64%. p=0.0075), less pronounced difference between morning and evening self-measured blood pressure. Conclusion. The use of felodipine in hospitalized patients with hypertension allowed achieving target blood pressure with fewer drugs. Felodipine was safe and well tolerated

Инсульт у детей и подростков: актуальные проблемы догоспитальной диагностики

The article is devoted to the urgent problem of pediatrics and pediatric neurology, pre-hospital diagnosis of stroke in children. A review of domestic and foreign literature on the early diagnosis of stroke in children and adolescents, as well as epidemiological data on pediatric stroke, is presented. Particular attention is paid to the features of the symptoms of stroke and stroke-like conditions («stroke masks») in the pediatric population and the analysis of the main factors that influence errors in the early diagnosis of stroke in children and adolescents. Currently, in the diagnosis of ischemic stroke, its «masks» are found in 53.9 % of cases, with hemorrhagic stroke, in 36.3 %, and with transient ischemic attacks, in 9.8 % of cases. One of the most common diseases with which it is necessary to differentiate ischemic stroke in children is migraine. This problem is covered in academic writings that highlight the leading differential diagnostic criteria for migraine and stroke, and also represent a diagnostic algorithm. The clinical features of pediatric stroke, especially manifest symptoms, make it difficult to apply adult screening stroke scales in pediatrics. The article discusses the main scales for the early diagnosis of stroke in adults, and their potential application in pediatric practice. Currently accumulated experience in prehospital and early diagnosis of stroke in children determines the main directions of work to reduce the time of diagnosis of acute cerebrovascular accidents in children, followed by the introduction of reperfusion therapy in pediatric practice.Статья посвящена актуальной проблеме педиатрии и детской неврологии - догоспитальной диагностике инсульта у детей. Представлен обзор отечественной и зарубежной литературы, посвященной ранней диагностике острых нарушений мозгового кровообращения у детей и подростков, а также эпидемиологические данные по педиатрическому инсульту. Особое внимание уделено особенностям симптоматики инсульта и инсультоподобных состояний («масок инсульта») в педиатрической популяции, и анализу основных факторов, влияющих на ошибки в ранней диагностике инсульта у детей и подростков. В настоящее время при диагностике ишемического инсульта его «маски» встречаются в 53,9 % случаев, при геморрагическом инсульте - в 36,3 %, при транзиторных ишемических атаках - в 9,8 % случаев. Одно из наиболее частых заболеваний, с которым необходимо дифференцировать ишемический инсульт у детей - это мигрень. Этой проблеме посвящены работы, которые выделяют ведущие дифференциально-диагностические критерии мигрени и инсульта, а также представляют диагностический алгоритм. Клинические особенности педиатрического инсульта, особенно манифестных симптомов, затрудняют использование взрослых скрининговых инсультных шкал взрослых в педиатрии. В статье рассмотрены основные шкалы ранней диагностики инсульта у взрослых, их возможное применение в педиатрической практике. Накопленный в настоящее время опыт догоспитальной и ранней диагностики инсульта у детей определяет основные направления работы по сокращению времени постановки диагноза острого нарушения мозгового кровообращения у детей, с последующим внедрением в педиатрическую практику реперфузионной терапии

Pre-hospital diagnosis of stroke in children. An analysis of the work of the First aid station in Moscow and the primary pediatric stroke center [Dogospital'naya diagnostika insul'tov u detei. Analiz raboty sluzhby skoroi meditsinskoi pomoshchi Moskvy i pervichnogo tsentra po lecheniyu tserebrovaskulyarnoi patologii u detei i podrostkov]

OBJECTIVE: The article presents an analysis of pre-hospital diagnosis of stroke in children. MATERIAL AND METHODS: Pediatric Stroke Center of Morozov Children's City Clinical Hospital (Center) for the period from October 2018 to December 2019, 502 cases of hospitalization of children by the First aid Station to the Center with directing diagnoses of ischemic stroke (IS), haemorrhagic stroke (HS), transient ischemic attack (TIA), vertebrobasilar syndrome (VBS) were analysed. RESULTS AND CONCLUSION: TIA was the most prevalent diagnosis made by the First aid station, with the lowest rate of confirmation after further examination in the hospital (7.8%). The higher rates of confirmation were observed for VBS (31.5%), IS (11.2%) and HI (9.1%). The so-called «masks of stroke» were diagnosed in 84.3% cases of hospitalizations that was in line with earlier studies, which reported 50 to 93%. Based on the data on the frequency of symptoms, their combinations and specificity, a screening scale for pre-hospital diagnosis of stroke in children was suggested.ЦЕЛЬ ИССЛЕДОВАНИЯ: Анализ догоспитальной диагностики инсульта у детей. МАТЕРИАЛ И МЕТОДЫ: Центром по лечению цереброваскулярной патологии у детей и подростков на базе ГБУЗ «Морозовская ДГКБ ДЗМ» совместно с ГБУ «ССиНМП им. А.С. Пучкова» проведен анализ догоспитальной диагностики инсульта у детей. За период с октября 2018 г. по декабрь 2019 г. было проанализировано 503 случая госпитализации детей службой СМП в Центр с направляющими диагнозами ОНМК (АИИ, геморрагический инсульт (ГИ), транзиторная ишемическая атака (ТИА), синдром вертебрально-базилярной недостаточности (ВБН)). РЕЗУЛЬТАТЫ И ЗАКЛЮЧЕНИЕ: Самым распространенным диагнозом службы СМП при подозрении на цереброваскулярную патологию у детей являлась ТИА, имевшая самую низкую (7,8%) частоту подтверждения при дообследовании в стационаре. Чаще всего совпадали диагнозы СМП и Центра при ВБН (31,5%), АИИ — в 11,2% случаев, а ГИ — в 9,1%. В 84,3% случаев госпитализации у детей были диагностированы так называемые маски инсульта, что совпадало с данными ранее проводимых зарубежных исследований и составляло от 50 до 93% случаев. Самой частой «маской» инсульта в нашей работе была мигрень, встречавшаяся в 32,4% случаев от всех госпитализированных. На основании проведенного анализа, учитывая частоту встречаемости симптомов при АИИ, их сочетание и специфичность, Центром совместно с ГБУ «ССиНМП им. А.С. Пучкова» была предложена скрининговая шкала догоспитальной диагностики АИИ в детском возрасте для врачей и фельдшеров службы СМП

Epidemiological factors and routing features of patients with spontaneous nosebleeds

At the stage of emergency medical care (EMC) the nosebleeds (NB) not connected with trauma are considered spontaneous. Since previous works have studied the prevalence of NB only at the hospital stage, some issues of NB epidemiology need to be clarified Objective. To study the prevalence of spontaneous nosebleeds (NB) in the structure of emergency medical care in Moscow and to characterize the dynamics of the epidemiological process and the routing features of this patient based on the data obtained. Material and methods. A statistical analysis of the ambulance field teams’ work in the medical care provision to patients with NB was carried out. Exclusion criteria from the study: patients needed the emergency psychiatric care; patients with chronic renal failure accompanied by EMC teams for outpatient hemodialysis; pediatric patients; NB of traumatic genesis. The observation period was 6 years (2015—2020). One of the statistical analysis was singular spectral analysis (SSA). Results. For 6 years, the ambulance team made 24 160 701 calls to patients. Patients with spontaneous bleeding (SB) accounted for 1.1% (262 503), with NB — 0.3% (n=73 202). In the insurance company structure, the share of NB amounted to 27.9%. The proportion of medical evacuation of patients with NB is 30.5%, with other SB — 84.3%. Repeated calls of ambulance teams to patients with NB vary from 7% to 10.4% while the 6-year trend is characterized by a decrease of 0.9%. The proportion of patients with NB who required medical evacuation to multidisciplinary hospitals is decreasing by 5.4% annually. As a result of the SSA it was found that the dynamics of the prevalence of nosebleeds in the structure of EMC is characterized by constantly growing trend with a median annual increase by 12.5% [12; 14.5]. After studying the epidemiology dynamics of nosebleeds, the seasonal pattern was established. The increase in the number of nosebleeds in the winter (December and January months) and the decline — in the summer (July). The seasonal value extremes of Меmax =1432.5 [1182; 1698] and Меmin =672 [610; 720] people in the summer and winter seasons, respectively, were established. During the 6-year follow — up period an ever-increasing number of patients with nosebleeds was recorded at seasonal extremes: in winter by 89%, in summer — by 37.3%. Conclusion. Trend analysis and SSA can be the first step to identify the more complex mathematical patterns for medical data that are varying over time. © 2021, Media Sphera Publishing Group. All rights reserved