7 research outputs found
Multifocal atherosclerosis: focus on the prevention of ischemic events
In patients with atherosclerotic lesions of two or more systems or multifocal atherosclerosis (MFA), the risks of ischemic events are extremely high. MFA leads not only to cardiovascular outcomes, but also to a decrease in the patientβs quality of life, life expectancy, and in most cases to disability. The prevalence of this pathology and the importance of preventing adverse outcomes are often underestimated. This literature review examines the problem of MFA in the context of key studies on the prevalence, course of multivessel disease and the reduction of the risk of cardiovascular events in this group of patients, with an emphasis on antiplatelet and anticoagulant therapy
Π‘ΡΠ°Π²Π½ΠΈΡΠ΅Π»ΡΠ½Π°Ρ ΠΎΡΠ΅Π½ΠΊΠ° Π²Π»ΠΈΡΠ½ΠΈΡ ΡΠΈΠ½ΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΈΡ Π±Π°Π·ΠΈΡΠ½ΡΡ ΠΏΡΠΎΡΠΈΠ²ΠΎΠ²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΡΡ ΠΈ Π³Π΅Π½Π½ΠΎ-ΠΈΠ½ΠΆΠ΅Π½Π΅ΡΠ½ΡΡ Π±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ² Π½Π° ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅, ΡΠΊΠΎΡΠΎΡΡΡ ΡΠ°Π·Π²ΠΈΡΠΈΡ Π΄Π΅ΡΡΡΡΠΊΡΠΈΠ²Π½ΡΡ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ ΠΈ ΠΊΠ°ΡΠ΅ΡΡΠ²ΠΎ ΠΆΠΈΠ·Π½ΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ ΡΠ΅Π²ΠΌΠ°ΡΠΎΠΈΠ΄Π½ΡΠΌ Π°ΡΡΡΠΈΡΠΎΠΌ
There are few studies of the efficiency of therapy with disease-modifying antirheumatic drugs (DMARDs) and biological agents (BAs) in patients with early rheumatoid arthritis (eRA) as part of a treat-to-target strategy.Objective: to investigate the effects of DMARDs and BAs used in combination with methotrexate (MTX) on clinical course, quality of life (QoL), and the evolution of articular erosions and synovitis in patients with RA.Patients and methods. The investigation enrolled 151 patients with eRA. At the first stage, the patients received DMARDs. At the second stage, 101 patients with persistent moderate and high disease activity were prescribed MTX at a dose of 25 mg/week or 20 mg/week in combination with infliximab (INF), or 20 mg/week in combination with rituximab (RTX). At the third stage, 20patients with persistent high disease activity were switched to tocilizumab (TCZ) therapy.Results and discussion. At 12 months of DMARD therapy, a clinical remission was more often achieved in the MTX group. The use of INF or RTX significantly improved QoL in the patients. That of TCZ as a second- and third-line drug led to a significant decrease in DAS28-CRP. Conclusion. There were no statistically significant differences between the INF and RTMgroups with respect to the time course of changes in CRP, ESR, circulating immune complexes, and the indicators of X-ray progression, which confirms the possibility of switching from a first-line BA to its subsequent lines with an increasing clinical disease activity. TCZ can be a second- and third-line drug when the effect of therapy with other BAs escapes.ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π±Π°Π·ΠΈΡΠ½ΡΠΌΠΈ ΠΏΡΠΎΡΠΈΠ²ΠΎΠ²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΡΠΌΠΈ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ°ΠΌΠΈ (ΠΠΠΠ), Π° ΡΠ°ΠΊΠΆΠ΅ Π³Π΅Π½Π½ΠΎ-ΠΈΠ½ΠΆΠ΅Π½Π΅ΡΠ½ΡΠΌΠΈ Π±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ°ΠΌΠΈ (ΠΠΠΠ) Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΠ°Π½Π½ΠΈΠΌ ΡΠ΅Π²ΠΌΠ°ΡΠΎΠΈΠ΄Π½ΡΠΌ Π°ΡΡΡΠΈΡΠΎΠΌ (ΡΠ Π) Π² ΡΠ°ΠΌΠΊΠ°Ρ
ΡΡΡΠ°ΡΠ΅Π³ΠΈΠΈ Β«ΠΠ΅ΡΠ΅Π½ΠΈΠ΅ Π΄ΠΎ Π΄ΠΎΡΡΠΈΠΆΠ΅Π½ΠΈΡ ΡΠ΅Π»ΠΈΒ» Π½Π΅ΠΌΠ½ΠΎΠ³ΠΎΡΠΈΡΠ»Π΅Π½Π½Ρ.Π¦Π΅Π»Ρ Π½Π°ΡΡΠΎΡΡΠ΅ΠΉ ΡΠ°Π±ΠΎΡΡ β ΠΈΠ·ΡΡΠΈΡΡ Π²Π»ΠΈΡΠ½ΠΈΠ΅ ΠΠΠΠ ΠΈ ΠΠΠΠ Π² ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΠΈ Ρ ΠΌΠ΅ΡΠΎΡΡΠ΅ΠΊΡΠ°ΡΠΎΠΌ (ΠΠ’) Π½Π° ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅, ΠΊΠ°ΡΠ΅ΡΡΠ²ΠΎ ΠΆΠΈΠ·Π½ΠΈ (ΠΠ) ΠΈ ΡΠ²ΠΎΠ»ΡΡΠΈΡ ΡΡΡΡΠ°Π²Π½ΡΡ
ΡΡΠΎΠ·ΠΈΠΉ ΠΈ ΡΠΈΠ½ΠΎΠ²ΠΈΡΠ° Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
Π Π.ΠΠ°ΡΠΈΠ΅Π½ΡΡ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠ΅Π½ 151 Π±ΠΎΠ»ΡΠ½ΠΎΠΉ ΡΠ Π. ΠΠ° ΠΏΠ΅ΡΠ²ΠΎΠΌ ΡΡΠ°ΠΏΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ ΠΏΠΎΠ»ΡΡΠ°Π»ΠΈ ΠΠΠΠ. ΠΠ° Π²ΡΠΎΡΠΎΠΌ ΡΡΠ°ΠΏΠ΅ 101 ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Ρ ΡΠΎΡ
ΡΠ°Π½ΡΡΡΠ΅ΠΉΡΡ ΡΠΌΠ΅ΡΠ΅Π½Π½ΠΎΠΉ ΠΈ Π²ΡΡΠΎΠΊΠΎΠΉ ΡΡΠ΅ΠΏΠ΅Π½ΡΡ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π±ΡΠ» Π½Π°Π·Π½Π°ΡΠ΅Π½ ΠΠ’ 25 ΠΌΠ³/Π½Π΅Π΄, Π»ΠΈΠ±ΠΎ 20 ΠΌΠ³/Π½Π΅Π΄ Π² ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΠΈ Ρ ΠΈΠ½ΡΠ»ΠΈΠΊΡΠΈΠΌΠ°Π±ΠΎΠΌ (ΠΠΠ€), Π»ΠΈΠ±ΠΎ 20 ΠΌΠ³/Π½Π΅Π΄ Π² ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΠΈ Ρ ΡΠΈΡΡΠΊΡΠΈΠΌΠ°Π±ΠΎΠΌ (Π Π’Π). ΠΠ° ΡΡΠ΅ΡΡΠ΅ΠΌ ΡΡΠ°ΠΏΠ΅ 20 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΠΎΡ
ΡΠ°Π½ΡΡΡΠ΅ΠΉΡΡ Π²ΡΡΠΎΠΊΠΎΠΉ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΡΡ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ Π±ΡΠ»ΠΈ ΠΏΠ΅ΡΠ΅Π²Π΅Π΄Π΅Π½Ρ Π½Π° ΡΠ΅ΡΠ°ΠΏΠΈΡ ΡΠΎΡΠΈΠ»ΠΈΠ·ΡΠΌΠ°Π±ΠΎΠΌ (Π’Π¦Π).Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΈ ΠΎΠ±ΡΡΠΆΠ΄Π΅Π½ΠΈΠ΅. Π12 ΠΌΠ΅Ρ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΠΠΠ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠ°Ρ ΡΠ΅ΠΌΠΈΡΡΠΈΡ ΡΠ°ΡΠ΅ Π΄ΠΎΡΡΠΈΠ³Π°Π»Π°ΡΡ Π² Π³ΡΡΠΏΠΏΠ΅ ΠΠ’. ΠΠ°Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ ΠΠΠ€ ΠΈΠ»ΠΈ Π Π’Π ΠΏΡΠΈΠ²ΠΎΠ΄ΠΈΠ»ΠΎ ΠΊ Π·Π½Π°ΡΠΈΠΌΠΎΠΌΡ ΡΠ»ΡΡΡΠ΅Π½ΠΈΡ ΠΠ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ². ΠΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ Π’Π¦Π ΠΊΠ°ΠΊ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ° Π²ΡΠΎΡΠΎΠΉ ΠΈ ΡΡΠ΅ΡΡΠ΅ΠΉ Π»ΠΈΠ½ΠΈΠΈ ΡΠΏΠΎΡΠΎΠ±ΡΡΠ²ΠΎΠ²Π°Π»ΠΎ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎΠΌΡ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΡ DAS28 Π‘Π Π.ΠΡΠ²ΠΎΠ΄Ρ. ΠΠ΅ΠΆΠ΄Ρ Π³ΡΡΠΏΠΏΠ°ΠΌΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ
, ΠΏΠΎΠ»ΡΡΠ°Π²ΡΠΈΡ
ΡΠ΅ΡΠ°ΠΏΠΈΡ ΠΠΠ€ ΠΈ Π Π’Π, Π½Π΅ Π²ΡΡΠ²Π»Π΅Π½ΠΎ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΡΡ
ΡΠ°Π·Π»ΠΈΡΠΈΠΉ Π² Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΠ΅ Π‘Π Π, Π‘ΠΠ, ΡΠΈΡΠΊΡΠ»ΠΈΡΡΡΡΠΈΡ
ΠΈΠΌΠΌΡΠ½Π½ΡΡ
ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠΎΠ² ΠΈ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ, ΡΡΠΎ ΠΏΠΎΠ΄ΡΠ²Π΅ΡΠΆΠ΄Π°Π΅Ρ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ Β«ΠΏΠ΅ΡΠ΅ΠΊΠ»ΡΡΠ΅Π½ΠΈΡΒ» Ρ ΠΏΠ΅ΡΠ²ΠΎΠ³ΠΎ ΠΠΠΠ Π½Π° ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΡ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΡΠΈΡ
Π»ΠΈΠ½ΠΈΠΉ ΠΏΡΠΈ Π½Π°ΡΠ°ΡΡΠ°Π½ΠΈΠΈ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ. Π’Π¦Π ΠΌΠΎΠΆΠ΅Ρ Π±ΡΡΡ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠΌ Π²ΡΠΎΡΠΎΠΉ ΠΈ ΡΡΠ΅ΡΡΠ΅ΠΉ Π»ΠΈΠ½ΠΈΠΈ ΠΏΡΠΈ ΡΡΠΊΠΎΠ»ΡΠ·Π°Π½ΠΈΠΈ ΡΡΡΠ΅ΠΊΡΠ° ΠΎΡ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π΄ΡΡΠ³ΠΈΠΌΠΈ ΠΠΠΠ
Rehabilitation after COVID-19. Resolution of the International Expert Council of the Eurasian Association of Therapists and the Russian Society of Cardiology
By the middle of 2021, the official global number of coronavirus disease 2019 (COVID-19) patients was close to 230 million, but the number accounting for asymptomatic patients was much higher. Consequences and rehabilitation after COVID-19 are of particular interest and raise many controversial and unresolved issues. On May 18, 2021, the Eurasian Association of Therapists organized an international panel of experts to analyze challenges associated with the post-COVID-19 period. This panel aimed to develop approaches to identify gaps in the discussed issues. This interdisciplinary team of leading experts reviewed the current literature and presented their data to formulate practical guidance on management of patients after COVID-19. The panel of experts also presented recommendations on how to implement the gained knowledge into health care practices
Clinical features of post-COVID-19 period. Results of the international register βDynamic analysis of comorbidities in SARS-CoV-2 survivors (AKTIV SARS-CoV-2)β. Data from 6-month follow-up
Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 β 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period
Comparative evaluation of the effects of synthetic disease-modifying antirheumatic drugs and biological agents on clinical course, the rate of development of destructive changes, and quality of life in patients with rheumatoid arthritis
There are few studies of the efficiency of therapy with disease-modifying antirheumatic drugs (DMARDs) and biological agents (BAs) in patients with early rheumatoid arthritis (eRA) as part of a treat-to-target strategy.Objective: to investigate the effects of DMARDs and BAs used in combination with methotrexate (MTX) on clinical course, quality of life (QoL), and the evolution of articular erosions and synovitis in patients with RA.Patients and methods. The investigation enrolled 151 patients with eRA. At the first stage, the patients received DMARDs. At the second stage, 101 patients with persistent moderate and high disease activity were prescribed MTX at a dose of 25 mg/week or 20 mg/week in combination with infliximab (INF), or 20 mg/week in combination with rituximab (RTX). At the third stage, 20patients with persistent high disease activity were switched to tocilizumab (TCZ) therapy.Results and discussion. At 12 months of DMARD therapy, a clinical remission was more often achieved in the MTX group. The use of INF or RTX significantly improved QoL in the patients. That of TCZ as a second- and third-line drug led to a significant decrease in DAS28-CRP. Conclusion. There were no statistically significant differences between the INF and RTMgroups with respect to the time course of changes in CRP, ESR, circulating immune complexes, and the indicators of X-ray progression, which confirms the possibility of switching from a first-line BA to its subsequent lines with an increasing clinical disease activity. TCZ can be a second- and third-line drug when the effect of therapy with other BAs escapes
Clinical features of post-COVID period. Results of an International Register "Dynamics Analysis of Comorbidities in SARS-CoV-2 Survivors (ACTIV SARS-CoV-2)" (12-month follow-up)
Aim. To investigate on post-COVID period in patients of the Eurasian region.Material and methods. A total of 9364 consecutively hospitalized patients were included in ACTIV registry. Enrollment of patients began on June 29, 2020, and was completed on March 30, 2021, corresponding to the first and second waves of the pandemic. Demographic, clinical, and laboratory data, computed tomography (CT) results, information about inhospital clinical course and complications of COVID-19 during hospitalization were extracted from electronic health records using a standardized data collection form. The design included follow-up telephone interviews with a standard questionnaire at 3, 6, and 12 months to examine the course of post-COVID period.Results. According to ACTIV register, 63% of patients after COVID-19 had new adverse symptoms or exacerbations of the existing symptoms lasting for up to 1 year. After hospital discharge, 79,8% of patients sought unscheduled medical attention in the first 3 months, 79,1% at 4-6 months, and 64,8% at 7-12 months. Readmission rate was 11,8% in the first 3 months, 10,9% at 4-6 months, and 10,1% at 7-12 months. The most common reasons for unscheduled treatment in the first 3 months were uncontrolled hypertension, decompensated type 2 diabetes, destabilization of coronary artery disease, gastrointestinal disease, AF episodes, exacerbation of asthma and chronic obstructive pulmonary disease, decompensated heart failure (HF). The 12-month mortality of COVID-19 survivors after the discharge was 3,08%. Multivariate analysis showed that independent risk factors for fatal outcome were age (direct correlation), the levels of hemoglobin (inverse correlation), oxygen saturation (inverse correlation), and aspartate aminotransferase (direct correlation), as well as class III-IV HF, prior stroke, cancer, inhospital acute kidney injury. Based on these identified risk factors, a nomogram was constructed to determine the 3-month mortality risk after discharge.Conclusion. Analysis of ACTIV register showed that end of the acute phase of COVID-19 does not imply a complete recovery
Lipid profile in hospitalized patients with COVID-19 depending on the outcome of its acute phase: data from the international registry "Dynamics analysis of comorbidities in SARS-CoV-2 infection survivors"
Aim. To study the lipid profile in hospitalized patients with coronavirus disease 2019 (COVID-19) depending on the outcome of its acute phase according to the AKTIV international registry.Material and methods. The AKTIV registry included men and women over 18 years of age with a diagnosis of COVID-19, who were treated in a hospital. A total of 9364 patients were included in the registry, of which 623 patients were analyzed for levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglycerides on days 1-2 of hospitalization. The level of high-density lipoprotein cholesterol (HDL-C) was calculated using the Friedewald equation.Results. We found that a decrease in LDL-C level was significantly associated with an unfavorable prognosis for hospitalized patients with COVID-19. This pattern persisted in both univariate and multivariate analyses. LDL-C levels in the final multivariate model had a significant relationship with the prognosis (an increase in the death risk by 1,7 times with a decrease per 1 mmol/l). In addition, we found that the survival of patients with an indicator level of <2,45 mmol/l is significantly worse than in patients with an LDL-C level β₯2,45 mmol/l. All patients with high LDL-C ((β₯4,9 mmol/l) survived, while among patients with low LDL-C (<2,45 mmol/l. All patients with high LDL-C ((β₯4,9 mmol/l) survived, while among patients with low LDL-C (<1,4 mmol/l), mortality was 13,04%, which was significantly higher than in patients with LDL-C β₯1,4 mmol/l (6,32%, p=0,047).Conclusion. A decrease in LDL-C in the acute period is significantly associated with an unfavorable prognosis for hospitalized patients with COVID-19. Determination of LDL-C can be included in the examination program for patients with COVID-19. However, the predictive value of this parameter requires further study in prospective clinical studies