Diastolic dysfunction in late postmenopausal patients with undifferentiated connective tissue disease and hypertension

Aim. To assess myocardial diastolic function (DF) in late postmenopausal women with undifferentiated connective tissue disease (UCTD) and hypertension (HTN).Material and methods. This cross-sectional study included 135 postmenopausal women, the median age of which was 68 years (65÷70,5 years). The anamnesis was collected using a standardized questionnaire. Verification of UCTD was carried out according to clinical guidelines. All patients underwent standard transthoracic echocardiography. The assessment of left ventricular (LV) DF was carried out according to the transmitral flow. LV diastolic dysfunction (DD) was classified into three types: rigid, pseudonormal, and restrictive. Statistical processing was carried out in the STATISTICA 13.0 environment. The measure of data averaging is the median, the measure of dispersion is 25%÷75%. The significance of differences was assessed using the Mann-Whitney test. Differences were considered significant at p˂0,05.Results. Group 1 — 20 (14,8%) patients with verified UCTD and HTN, group 2 — 88 (65,2%) patients with HTN without UCTD, control group — 23 (30%) patients without HTN and UCTD. There were no differences in age, duration of postmenopause and body mass index between the groups. In the first group, a significant decrease in the ratio of peak early to late diastolic LV filling velocity was revealed (p˂0,01). A significant increase in left ventricular end-systolic wall stress revealed in group 1. In 108 (100%) patients, LVDD was detected; among the patients of the control group, DD was not detected. In 8 (40%) patients in group 1, a pseudo-normal type of DD was detected, while in 12 out of 20 patients (60%) — rigid type of DD. When assessing DF in patients of group 2, a significant decrease was found in the ratio of peak early to late diastolic LV filling velocity, a significant increase in LV end-diastolic wall stress and end-diastolic pressure. In 2 out of 3 (57,80%) patients of group 2, DD of the rigid type was detected, while pseudonormal type — in 32,2% of patients in this group. Group 2 patients had a significant decrease in the early diastolic mitral annular velocity (p˂0,01).Conclusion. The analysis of myocardial echocardiographic characteristics indicates a significant contribution of HTN-associated UCTD to the development of LVDD in postmenopausal women

Geometry and function of the left ventricle in patients with postmenopausal osteoporosis

The purpose of the study is to identify the structure and function peculiarities of the left ventricle in postmenopausal patients with different bone mineral density.Цель исследования – выявление особенностей строения и функции левого желудочка у пациенток постменопаузального периода с различной минеральной плотностью костной ткани

Polymorbidity and Polypragmasia in High and Very High Cardiovascular Risk Patients

Aim. Assessment of the level and structure of polymorbidity, features of pharmacotherapy therapy in patients of different age groups, belonging to the category of high and extremely high cardiovascular risk, observed in outpatient clinics.Material and methods. The single-stage study included 282 patients of high and very high cardiovascular risk who were divided into three groups: (1) age 45-59 years, (2) 60-74 years, (3) ≥75 years. The structure of polymorbidity and features of pharmacotherapy in different age groups patients were evaluated. The frequency of polypragmasia was determined, and treatment adequacy in patients over 65 years of age was analyzed using the STOPP / START criteria and the Beers criteria of 2019.Results. High and very high cardiovascular risk patients have been found to be highly polymorbid, polimorbidity level increasing with age. Thus, among elderly patients, ischemic heart disease, chronic heart failure (CHF) were more often detected, as well as a high frequency of concomitant and background conditions, especially bone and joint system involvement (osteoarthritis, rheumatoid arthritis). Polypragmasia (administration of ≥5 drugs) was detected in 150 patients (53.2%) and was more common among elderly patients. According to Beers criteria, there were 48 cases of inadequate medication prescribing in 46 (28.0%) elderly patients. According to 80 STOPP criteria, 75 cases of prescribing potentially non-recommended drugs to 55 patients (32.1%) were detected. According to 34 START criteria, 116 cases of non-prescribing of necessary drugs to 52 (30.4%) elderly patients were found. When assessing the frequency of prognosis modifying medication prescribing, patients with CHF in 107 (63.0%) cases received angiotensin converting enzyme inhibitors, and in 42 cases (24.5%) angiotensin II receptor antagonists had been prescribed.  Thus,  87.5%  CHF patients were receiving renin-angiotensin-aldosterone system blockers. Statins were administered in 225 (79.8%) cases, antiplatelet agents were prescribed in 157 (67.9%) cases, and 23 persons (9.9%) were on oral anticoagulants for atrial fibrillation.Conclusion. In the structure of the studied cohort most of the high and very high cardiovascular risk outpatients were polimorbid, elderly and senile. Polypragmasia has been detected in more than half of elderly outpatients (53%), irrational medication was found in 28% to 30% elderly patients. Most patients with CHF were on statins, antithrombotic therapy, and renin-angiotensin-aldosterone system blockers

Justification of additional criteria for comorbid state: tuberculosis and diabetes mellitus

The article presents the results of a one-time study on the assessment of the severity of diabetes in patients with tuberculosis.В статье представлены результаты одномоментного исследования, посвященного оценке тяжести течения сахарного диабета у пациентов, страдающих туберкулезом

Analysis of the reasons of the hospitalization in the cardiological stationary in the practice of the clinicist

Analysis of the structure of the causes of cardiac patients being hospitalized is a relevant topic, the article contains a detailed discussion. Hospitalization is an important medico-social problem, both in terms of features of the course of diseases and treatment, as well as economic reasons. In this research the most frequent reasons of patients being hospitalized in cardiology of the Ekaterinburg’s clinical city hospital are studied. Comparison of the obtained data with statistical data in the Russian population was carried out. It was revealed, that the greatest number of hospitalized belonged to the senior age group, had a high level of a comorbidity. Chronic heart failure has a significant share in the structure of the causes for nosological diseases. In contrast to the literature data, in the studied sample, patient compliance was at a high level, which allows us to conclude that the greatest number of hospitalizations in the sample we studied is related to the nature of the disease at elderly patients with a cardiological profile with multiple accompanying pathology.В статье затронута актуальная тема анализа структуры причин госпитализаций пациентов кардиологического профиля. Госпитализация является важной медико-социальной проблемой, как с точки зрения особенностей течения заболеваний и лечения, так и экономических причин. В данном исследовании изучены наиболее частые причины госпитализации пациентов в кардиологическое отделение городской клинической больницы г. Екатеринбурга. Проведено сравнение полученных данных со статистическими данными в Российской популяции. Выявлено, что наибольшее количество госпитализированных относились к старшей возрастной группе, имели высокий уровень коморбидности. Значительную долю в структуре нозологических причин занимала ХСН. В отличие от литературных данных, в исследованной выборке комплаентность больных оказалась на достаточно высоком уровне, что позволяет сделать вывод о том, что наибольшее количество госпитализаций в исследованной нами выборке связано с именно с характером течения заболевания у пожилых пациентов кардиологического профиля с множественной сопутствующей патологией

The role of the body mass decrease in dyslipidemia correction in patients with cardiovascular diseases and type 2 diabetes

The interaction of obesity and dyslipidemia as two significant risk factors leads to an accelerated course of atherosclerosis and its complications. For patients with cardiovascular diseases, secondary prophylaxis is necessary, as the total cardiovascular risk is increasing. This research work is devoted to the study of the weight loss influence on the lipid spectrum of high and very high cardiovascular risk patients receiving high-grade drug therapy for cardiovascular diseases. The study included 130 patients (30 men and 100 women, mean age 68.3 ± 7.3) with excess weight or obesity, type 2 diabetes mellitus and cardiovascular diseases. It was revealed that the body mass index has decreased for more than 10% from the initial level and it was accompanied by the decrease in the level of triglycerides, p = 0.05, in combination with an increase in the level of high density lipoproteins, p = 0.03. The reduction in body mass may additionally improve the lipid profile of the patients receiving effective therapy.Взаимовлияние ожирения и дислипидемии (ДЛП) как двух значимых факторов кардиоваскулярного риска (КВР) приводит к ускоренному течению атеросклероза и его осложнений. У пациентов с сердечно-сосудистыми заболеваниями (ССЗ) и сахарным диабетом 2 типа (СД 2 типа) вторичная профилактика имеет крайне высокое значение, поскольку у данной категории больных суммарный КВР имеет нарастающий характер. Исследовано влияние снижения массы тела (МТ) на липидный спектр пациентов высокого и очень высокого КВР, получающих полноценную медикаментозную терапию ССЗ. В исследование было включено 130 пациентов (30 мужчин и 100 женщин, средний возраст 68,3±7,3) с избыточной МТ или ожирением, СД 2 типа и ССЗ. Выявлено, что уменьшение индекса массы тела (ИМТ) более 10% от исходного уровня сопровождалось снижением уровня триглицеридов (ТГ), p=0,05, в сочетании с повышением уровня липопротеинов высокой плотности (ЛПВП), p=0,03. Снижение МТ у пациентов, получающих эффективную терапию, может дополнительно улучшить состояние липидного профиля

International clinical trials as an option to improve the quality of medical education and care

The USMU Faculty of General Medicine and Faculty of Pediatrics 6th year students Google mediated anonymous voluntary survey results are discussed. The survey was dedicated to assessing the awareness and attitude of graduate students on international randomized clinical trials (RCT) conducted by the University employees. Also issues of personal motivation and readiness of graduates to participate in the discussed type of professional medical activity after graduation is evaluated. 70% graduate students suggest that the participation of University teachers in RCT improves the quality of medical education.В статье рассмотрены результаты анонимного добровольного анкетирования с помощью гугл-опросника студентов 6 курса лечебно-профилактического и педиатрического факультетов УГМУ, посвященного оценке информированности студентов выпускного курса специалитета о международных клинических исследованиях (КИ), проводимых сотрудниками вуза, мотивации и готовности выпускников заниматься обсуждаемым видом профессиональной медицинской деятельности после окончания вуза. 70% обучающихся по программам специалитета считают, что участие преподавателей университета в РКИ повышает качество медицинского образования

The role of the body mass decrease in dyslipidemia correction in patients with cardiovascular diseases and type 2 diabetes

The interaction of obesity and dyslipidemia as two significant risk factors leads to an accelerated course of atherosclerosis and its complications. For patients with cardiovascular diseases, secondary prophylaxis is necessary, as the total cardiovascular risk is increasing. This research work is devoted to the study of the weight loss influence on the lipid spectrum of high and very high cardiovascular risk patients receiving high-grade drug therapy for cardiovascular diseases. The study included 130 patients (30 men and 100 women, mean age 68.3 ± 7.3) with excess weight or obesity, type 2 diabetes mellitus and cardiovascular diseases. It was revealed that the body mass index has decreased for more than 10% from the initial level and it was accompanied by the decrease in the level of triglycerides, p = 0.05, in combination with an increase in the level of high density lipoproteins, p = 0.03. The reduction in body mass may additionally improve the lipid profile of the patients receiving effective therapy.Взаимовлияние ожирения и дислипидемии (ДЛП) как двух значимых факторов кардиоваскулярного риска (КВР) приводит к ускоренному течению атеросклероза и его осложнений. У пациентов с сердечно-сосудистыми заболеваниями (ССЗ) и сахарным диабетом 2 типа (СД 2 типа) вторичная профилактика имеет крайне высокое значение, поскольку у данной категории больных суммарный КВР имеет нарастающий характер. Исследовано влияние снижения массы тела (МТ) на липидный спектр пациентов высокого и очень высокого КВР, получающих полноценную медикаментозную терапию ССЗ. В исследование было включено 130 пациентов (30 мужчин и 100 женщин, средний возраст 68,3±7,3) с избыточной МТ или ожирением, СД 2 типа и ССЗ. Выявлено, что уменьшение индекса массы тела (ИМТ) более 10% от исходного уровня сопровождалось снижением уровня триглицеридов (ТГ), p=0,05, в сочетании с повышением уровня липопротеинов высокой плотности (ЛПВП), p=0,03. Снижение МТ у пациентов, получающих эффективную терапию, может дополнительно улучшить состояние липидного профиля

Quality of the graduate’s knowledge: "examination view"

Assessment of students' knowledge in interviews with teachers is an integral part of any exam. However, it inevitably has a partially subjective coloring. The article presents the results of a retrospective analysis of the results of the completion of the State Final Attestation by the 6th year students of the treatment and prevention faculty of the Ural State Medical University in 2017. The results of the assessment of knowledge by independent teachers at various stages of the state exam are analyzed. The patterns of interrelations between the obtained estimates are revealed. Highlighted issues that should pay attention to the training of studentsОценка знаний студентов при собеседовании с преподавателями является неотъемлемой частью любого экзамена. Однако, она неизбежно имеет частично субъективную окраску. В статье представлены результаты ретроспективного анализа результатов сдачи Государственной Итоговой Аттестации студентами 6 курса лечебно–профилактического факультета Уральского государственного медицинского университета в 2017 году. Проанализированы результаты оценки знаний независимыми преподавателями на различных этапах государственного экзамена. Выявлены закономерности взаимосвязей между полученными оценками. Выделены вопросы, на которые следует обратить внимание в обучении студенто

Vitamin D3 and magnesium deficiency in women with connective tissue dysplasia in the postmenopausal period

The article presents the results of a cross-sectional study on the frequency of detection of connective tissue dysplasia in postmenopausal women, the relationship between the frequency of detection, bone mineral density, serum cholecalciferol and clinical and laboratory signs of magnesium deficiency.В статье представлены результаты кросс-секционного исследования, посвященного оценке частоты выявления НДСТ у женщин, находящихся в постменопаузе, наличия связи между частотой их выявления, минеральной плотностью костной ткани, сывороточным уровнем холекальциферола и клиническими и лабораторными признаками дефицита магния