The impact of medical and psychological counseling with the use of remote technologies on the profile of the main risk factors for cardiovascular disease

Introduction: The development of new preventive approaches using medical and psychological counseling and distance technologies may contribute to better control of risk factors for cardiovascular disease (RF CVD). Aim: Evaluating the effectiveness of medical and psychological counseling using remote technologies for control and correction of the main RF CVD. Materials and methods: The study included 140 patients, average age was 53 ± 17 years (54% were men) who were included in the group of medical and psychological counseling using remote technologies (experimental group, n = 70) or in the group of standard care (control group, n = 70). At the beginning and end of the study, patients from both groups filled in specially created questionnaires. Patients of the experimental group received regular remote medical and psychological counseling by phone; information materials via internet messengers; SMS reminders. In 12 months, the severity of RF CVD in two groups was compared. Results: Medical and psychological counseling with the use of remote technologies during 12 months led to significant improvement in RF CVD: achievement of target blood pressure (p <0.01), physical activity (p <0.01), consumption of 400 g per day of vegetables and fruits (p <0.01), decrease in body mass index (p <0.001) and waist circumference (p <0.01), decrease in cholesterol level (p <0.01), in a subgroup of smoking patients - reducing the number of cigarettes smoked per day. There were no statistically significant differences in blood glucose and volume of consumed alcoholic beverages between groups. Conclusions: Medical and psychological counseling of patients with cardiovascular diseases using remote technologies (telephone calls, internet messengers, SMS reminders) can be an effective tool for monitoring and correcting various RF CVD.Введение: разработка новых профилактических подходов с использованием медико-психологического консультирования и дистанционных технологий может способствовать лучшему контролю факторов риска сердечно-сосудистых заболеваний (ФР ССЗ). Цель исследования: оценка эффективности медицинского и психологического консультирования с применением дистанционных технологий для контроля и коррекции основных ФР ССЗ по сравнению со стандартным наблюдением. Материалы и методы: Исследование включило 140 пациентов, средний возраст которых составил 53 ± 17 лет (из них мужчин 54%), которые были включены в группу медико-психологического консультирования с использованием дистанционных технологий (экспериментальная группа, n = 70) или в группу стандартного наблюдения в общемедицинской сети (контрольная группа, n = 70). Пациентами обеих групп в начале и в конце исследования были заполнены специально созданные опросники. Пациентам экспериментальной группы проведено регулярное дистанционное медико-психологическое консультирование по телефону; пересылка информационных материалов посредством интернет-мессенджеров, смс-напоминаний. Через 12 месяцев была сопоставлена степень выраженности ФР ССЗ в двух группах. результаты: Медико-психологическое консультирование с применением дистанционных технологий в течение 12 месяцев привело к достоверному улучшению профиля ФР ССЗ: достижению целевых уровней артериального давления (p<0,01), физической активности (p<0,01), увеличение доли пациентов, употребляющих 400 г. в день овощей и фруктов (р<0,01), снижению индекса массы тела (р<0,001) и уменьшению окружности талии (р<0,01), снижению уровня холестерина (р<0,01), в подгруппе курящих пациентов – уменьшению количества выкуриваемых в день сигарет. Между группами через 12 месяцев наблюдения не было статистически значимых различий по уровню глюкозы крови и объему употребляемых алкогольных напитков. Выводы: Медицинское и психологическое консультирование пациентов с сердечно-сосудистыми заболеваниями с использованием дистанционных технологий (телефонные звонки, смс-сообщения, интернет-мессенджеры) может быть эффективным инструментом контроля и коррекции различных ФР ССЗ

The cost-effectiveness of procalcitonin for guiding antibiotic prescribing in individuals hospitalized with COVID-19: part of the PEACH study

Background Many hospitals introduced procalcitonin (PCT) testing to help diagnose bacterial coinfection in individuals with COVID-19, and guide antibiotic decision-making during the COVID-19 pandemic in the UK. Objectives Evaluating cost-effectiveness of using PCT to guide antibiotic decisions in individuals hospitalized with COVID-19, as part of a wider research programme. Methods Retrospective individual-level data on patients hospitalized with COVID-19 were collected from 11 NHS acute hospital Trusts and Health Boards from England and Wales, which varied in their use of baseline PCT testing during the first COVID-19 pandemic wave. A matched analysis (part of a wider analysis reported elsewhere) created groups of patients whose PCT was/was not tested at baseline. A model was created with combined decision tree/Markov phases, parameterized with quality-of-life/unit cost estimates from the literature, and used to estimate costs and quality-adjusted life years (QALYs). Cost-effectiveness was judged at a £20 000/QALY threshold. Uncertainty was characterized using bootstrapping. Results People who had baseline PCT testing had shorter general ward/ICU stays and spent less time on antibiotics, though with overlap between the groups’ 95% CIs. Those with baseline PCT testing accrued more QALYs (8.76 versus 8.62) and lower costs (£9830 versus £10 700). The point estimate was baseline PCT testing being dominant over no baseline testing, though with uncertainty: the probability of cost-effectiveness was 0.579 with a 1 year horizon and 0.872 with a lifetime horizon. Conclusions Using PCT to guide antibiotic therapy in individuals hospitalized with COVID-19 is more likely to be cost-effective than not, albeit with uncertainty

Clinical and ultrasound features of non-specific aorto-arteriitis and aortic arch branch syndrome

Aim. With duplex scanning method, to compare clinical symptoms of non-specific aorto-arteriitis (NAA) to aortic arch pathology registered. Material and methods. In total, 32 women with NAA were examined. Twenty-four patients underwent duplex scanning of aortic arch branches, carotid intima-media thickness measurement (high-definition ultrasound method; Vivid 7 device, GE, USA). All participants underwent clinical and neurological examination, with inflammation activity assessment. Results. Isolated pathology of aortic arch branches (Type I NAA) was observed in 6 (25%) out of 24 patients; Type III NAA (pathology of aortic arch branches, thoraco-abdominal aorta, and its visceral branches) - in 16 (66,7%); Type IV NAA (pulmonary artery pathology, regardless of any other lesion location) - in 2 (8,3%). Arterial hypertension (AH) was diagnosed in 18 (75%) out of 24 participants. In Type I NAA, AH clinical course was milder than in Type III and IV NAA. Functional neurological and emotional-affective disturbances were typical for NAA. Common carotid artery pathology was registered in 19 (79,2%) patients, and cerebral blood flow pathology - in 2 (8,3%) out of 24 participants. Conclusion. In NAA patients, brachiocephalic artery and common carotid artery pathology prevalence is relatively high. At the same time, strokes and transient ischemic attacks are rare

Traditional smoking e-smoking among medical students and students-athletes-popularity and motivation

Smoking, medical students, students-athlete

State of the art for diagnosis and treatment of orthostatic hypotension

This paper presents state of the art of the problem of diagnosis and treatment of orthostatic hypotension (OH). It focuses on the developed algorithms for diagnostics of classical orthostatic hypotension (COH), initial orthostatic hypotension (IOH) and delayed orthostatic hypotension (DOH). It describes the necessary methods for the differential diagnosis of the OH causes. Comparative analysis of the European Society of Cardiology and American College of Cardiology/American Heart Association/Society of Cardiac Rhythm was performed. The treatment options for different groups of patients with orthostatic hypotension are described

Candesartan effectiveness in essential arterial hypertension and renal arterial hypertension

Aim. To study candesartan effectiveness and tolerability in essential arterial hypertension (ГАН) and AH associated with chronic renal disease.Material and methods. This 12-week open, controlled study included 14 patients (mean age 43,4±16 years) with diagnosed ГАН (n=9) or secondary AH of renal etiology (n=5). At baseline and after 12 weeks of candesartan therapy, office blood pressure (BP) measurement, 24-hour BP monitoring (BPM), vectorcardiography and decar-tography measurements of plasma renin activity, aldosterone, potassium levels and microalbuminuria (MAU) were performed.Results. Target BP level &lt;140/90 mm Hg was achieved in 6 out of 14 patients (42,8 %). Additional hydrochlorothiazide (HCT) therapy increased antihypertensive effect of candesartan. On average, MAU reduced from 63,5±16,8 to 31,7±24,4 mg/d (p&lt;0,0001).Conclusion. Candesartan therapy, especially combined with HCT, was effective in patients with mild to moderate AH, providing organo-protection. It could be recommended not only in ГАН, but also in symptomatic AH associated with chronic renal disease

Safety and efficacy of endovascular patent foramen ovale closure: the first results of a Russian multicenter study

Patent foramen ovale (PFO) is detectable in more than 25% of the adult population and is generally clinically insignificant. However, it can be a cause of paradoxical embolism in some cases. Randomized trials indicate that endovascular PFO closure in patients with a history of cryptogenic stroke is an effective method for the secondary prevention of catastrophic brain damage.Objective: to study the safety and efficiency of endovascular PFO closure in young patients with a history of cryptogenic stroke.Patients and methods. Sixty-two patients, including (22 males and 40 females) women, underwent percutaneous PFO closure in May 2018 to March 2020. The patients' mean age was 37.4±7.6 years. The inclusion criteria were a prior cryptogenic ischemic stroke lasting less than 12 months and PFO with a high risk for paradoxical embolism (PFO concurrent with atrial septal aneurysm or hypermobility; PFO, ≥2 mm size; the presence of the Chiari network and/or the Eustachian valve).Results and discussion. The technical success of the operation was achieved in all cases. In 50 (80.6%) patients, the right chamber of the heart was completely isolated from the left one in the first 3 months. During the first year, the atria were also completely isolated in 10 (16.1%) patients. A left-to-right shunt persisted in 2 (3.2%) patents 12 months later. Two patients were found to have main procedural complications: one had perioperative atrial fibrillation and the other had pseudoaneurysm formation at the puncture site.Conclusion. Endovascular PFO closure is a safe and effective operation for the secondary prevention of recurrent ischemic stroke. In our study, blood shunting through the PFO was stopped in 96.6% of patients at less than 6 months after surgery, which suggests that there is a rapid and effective reduction in the risk of paradoxical embolism

Straightforward Preparation of Telechelic H-bonding Polymers From Difunctional Trithiocarbonates and Supramolecular Block Copolymers Thereof

International audienceWe report an original strategy toward the straightforward preparation of precisely defined telechelic H-bonding polymers and the generation of supramolecular block copolymers thereof. Making use of an alpha,omega-functionalized symmetrical trithiocarbonate bearing thymine groups at both chain ends, a series of heterocomplementary H-bonding polymers were effortlessly generated by RAFT polymerization in a one step process. The resulting telechelic macromolecules selectively interacted with heterocomplementary alpha-DAP-functionalized chains to afford supramolecular block copolymers in solution and in bulk. These self-assemblies were evidenced by (1)H NMR and rheological measurements. As a consequence of these associations, whereas non functional homopolymer blends tended to microphase separate as observed by AFM analysis, H-bonding homopolymer blends exhibited homogeneous microstructures in accord with the formation of supramolecular block copolymers promoting the stabilization of the interface between the polymers