CLINICAL AND MORPHOLOGICAL PARRALLELS IN THE COURSE OF RESPIRATORY SARCOIDOSIS

Sarcoidosis is a systemic disease characterized by the development of chronic immune inflammation and formation of granulomas. It is important to know clinical, morphological and immunologic variants of the course of this disease in order to investigate the pathomorphologic parameters of the granuloma.Of late negative trends have been observed in the changes of sarcoidosis pathomorphology. Due to the above it is important to investigate predictors for the course of this disease, including specific parameters of granulematous inflammatory process in various clinical variants not only from the point of view of diagnostics but further management tactics for those suffering from this disease

Клинико-иммунологическая характеристика больных клещевым энцефалитом в острый период в Томской области

Results of complex research of features of clinical and immunological profiles tick-borne encephalitis during the sharp period in Tomsk Region are resulted in the article. Last years redistribution of a parity of clinical displays of the sharp period in favor of prevalence of feverish forms of disease and a tendency to increase in cases of long circulation of an antigene of a virus tick-borne encephalitis is marked. One of the important reasons of such effect is decrease in immunological reactance of an organism with development of cytokine’s disbalance and expression infringement receptors of cytokines with lymphocytic cages.Представлены результаты комплексного исследования особенностей клинического и иммунологического профилей клещевого вирусного энцефалита в острый период в Томской области. В последние годы отмечаются перераспределение соотношения клинических проявлений острого периода в пользу преобладания лихорадочных форм заболевания и тенденция к увеличению случаев длительной циркуляции антигена вируса клещевого энцефалита. Одной из важных причин такого эффекта является снижение иммунологической реактивности организма с развитием цитокинового дисбаланса и нарушение экспрессии цитокинов рецепторов лимфоцитарными клетками

Клинико-функциональные особенности течения саркоидоза органов дыхания в реальной практике

As a rule, heart damage in patients with sarcoidosis of respiratory organs (SOD) is not diagnosed in time, so a very important and urgent task is to identify common heart rhythm and conduction disorders.The aim of the study was to investigate the main clinical manifestations of sarcoidosis in SOD, depending on the peculiarities of the disease course and to compare the frequency and severity of pulmonary and extrapulmonary manifestations of sarcoidosis, including myocardial lesions and electrocardiographic (ECG) signs of heart rhythm disorders.Methods. In the period 2006– 2016, the pilot open prospective uncontrolled study conducted at the Pulmonology Department of the Regional State Autonomous Healthcare Institution "Tomsk Regional Clinical Hospital" included patients (n = 84) aged 20–67 years with the diagnosis of SOD. Patients were divided into 2 clinical groups: the 1st comprised 45 (53.5%) patients with a favorable course of sarcoidosis, the second one included 39 (46.4%) patients with an unfavorable course of the disease. A full range of studies was carried out, including the analysis of medical history and clinical and epidemiological data, instrumental methods (including ECG and Holter ECG monitoring (HM), pathomorphological study of lung biopsy samples.Results. According to the data of frequency analysis of occurrence of pulmonary and extrapulmonary clinical manifestations in ODS, it was shown that the leading clinical manifestations, most frequently occurring in patients of both groups, included asthenia syndrome (72.6%), bronchial syndrome (66.7%) and fever syndrome (33%). In 33% of cases, clinical manifestations of myocardial damage were detected. In 41 (51.2%) patients in both groups, changes on ECG were recorded at rest. Regardless of the course of the disease, in 23.5% of patients of both clinical groups, according to the results of the HM ECG, rhythm and conduction disturbances were found – a combination of ventricular arrhythmias and conduction disorders (ventricular extrasystole and right His bundle branch block of various degrees) and a combination of supraventricular arrhythmias and conduction disturbances (supraventricular extrasystole and right His bundle branch block of various degrees).Conclusion. Thus, regardless of the severity of the disease course, SOD patients are concerned about complaints from both respiratory system and extrapulmonary manifestations, including cardiac complaints, as well as heart rhythm and conduction disorders (according to the results of ECG and HM ECG), the frequency of which, according to the comparative analysis, has not significantly changed in both clinical groups, which indicates the non-specific character of clinical manifestations. Как правило, поражение сердца у больных саркоидозом органов дыхания (СОД) своевременно не диагностируется, поэтому весьма важной и актуальной задачей является обнаружение часто встречающихся нарушений сердечного ритма и проводимости.Целью исследования явились изучение основных клинических проявлений при СОД в зависимости от особенностей течения заболевания и сравнительная оценка частоты и тяжести легочных и внелегочных проявлений саркоидоза, включая поражения миокарда и электрокардиографические (ЭКГ) признаки нарушений сердечного ритма.Материалы и методы. В период 2006–2016 гг. в пилотное открытое проспективное неконтролируемое исследование, проведенное в отделении пульмонологии на базе Областного государственного автономного учреждения здравоохранения «Томская областная клиническая больница», были включены пациенты (n = 84) в возрасте 20– 67 лет с диагнозом СОД. Больные были распределены на 2 клинические группы: 1-ю составили 45 (53,5 %) пациентов с благоприятным течением саркоидоза, 2-ю – 39 (46,4 %) больных с неблагоприятным течением заболевания. Проведен полный спектр исследований, включая анализ анамнестических и клинико-эпидемиологических данных, инструментальные методы (включая ЭКГ и холтеровское мониторирование (ХМ) ЭКГ), патоморфологическое исследование биоптатов легких.Результаты. По данным частотного анализа встречаемости легочных и внелегочных клинических проявлений при СОД показано, что ведущими клиническими проявлениями, встречающимися наиболее часто у пациентов обеих групп, являлись синдромы астении (72,6 %), бронхитический синдром (66,7 %), синдром лихорадки (33 %). В 33 % случаев выявлены клинические проявления поражения миокарда. У 41 (51,2 %) пациента в обеих группах в состоянии покоя зафиксированы изменения на ЭКГ. Независимо от течения заболевания, у 23,5 % больных обеих клинических групп по результатам ХМ ЭКГ обнаружены нарушения ритма и проводимости – сочетание желудочковых аритмий и нарушений проводимости (желудочковая экстрасистолия и блокада правой ножки пучка Гиса разной степени) и сочетание наджелудочковых аритмий и нарушений проводимости (суправентрикулярная экстрасистолия и блокада правой ножки пучка Гиса разной степени).Заключение. Таким образом, независимо от тяжести течения заболевания, больных СОД беспокоят жалобы как со стороны дыхательной системы, так и внелегочные проявления, включая кардиальные, а также нарушения ритма сердца и проводимости (по результатам ЭКГ и ХМ ЭКГ), частота встречаемости которых, по результатам сравнительного анализа, в обеих клинических группах достоверно не изменялась, что свидетельствует о неспецифичности клинических проявлений.

Клещевой вирусный энцефалит в Томской области за последние 10 лет

In the given work had been lead the analysis of epidemiological data TBE for 1999—2009 on Tomsk area. The information on quantity imparted against tick-borne encephalitis, about results of research of pincers and blood at the persons who have addressed on points prevention of tick-borne encephalitis and about quantity of the diseased tick-borne encephalitis is presented. Analysis of a complex of preventive actions is spent. The reasons of formation of the long maintenance of a virus tick-borne encephalitis in blood are shown.Представлен анализ итогов эпидемических сезонов по клещевому энцефалиту 1999—2009 гг. по Томской области. Дана информация о количестве привитых против клещевого энцефалита, о результатах исследования клещей и крови у лиц, обратившихся на пункты серопрофилактики, и о количестве заболевших клещевым энцефалитом. Проведен разбор комплекса профилактических мероприятий. Показаны причины формирования длительного антигеноносительства вируса клещевого энцефалита

Modern potential of thrombotic complication prevention among patients with acute coronary syndrome without ST segment elevation in real clinical practice (Part I)

Aim. To compare therapeutic and diagnostic measures, as well as the incidence of cardiovascular events (CVE), during hospitalization, one-year and five-year follow-up period among the patients with acute coronary syndrome without ST segment elevation (non-STE ACS), who were urgently hospitalized to a therapy department of a large multi-field hospital, or to a specialised cardiology department. This comparison was aimed at identifying the methods for further medical service optimization. Material and methods. This retrospective, historical cohort study included 350 consecutive medical histories of non-STE ACS patients, urgently hospitalized to the urgent cardiology department (Research Institute of Cardiology, Siberian Branch, Russian Academy of Medical Sciences), and 370 medical histories of the patients hospitalized to the therapy department (City Hospital No. 1). Results. In the therapy department, non-STE ACS patients received fewer diagnostic and therapeutic procedures than in the cardiology department, due to limited resources. The risk levels at in- and out-patient treatment stages were not assessed adequately, which resulted in a higher incidence of adverse outcomes throughout the follow-up period. Original clopidogrel was administered to 6 % and 0 % of the cardiology and therapy department patients, respectively. Since there is no statistically significant difference in hard outcomes between original and generic clopidogrel (Zyllt), the latter could be recommended to ACS patients. Conclusion. Non-STE ACS patients with high risk should be referred to specialised cardiology hospitals, where invasive diagnostic and treatment (percutaneous coronary intervention) could be performed. High effectiveness and good safety profile should improve Zyllt treatment compliance in most patients after ACS and/or revascularization

RISKS AND BENEFITS OF REPERFUSION STRATEGIES IN ACUTE MYOCARDIAL INFARCTION WITH ST SEGMENT ELEVATION

The review discusses various reperfusion strategies in patients with acute myocardial infarction with ST segment elevation (STEMI), based on the evidence from international clinical trials. The modern views on real-world invasive and conservative strategies of STEMI management in European countries are presented. The key factor for patients’ survival is the timing, not the method of reperfusion. The strategy of primary percutaneous coronary intervention (PCI) may fail to reduce mortality, if the door-to-balloon time is over 60 minutes, compared to immediate thrombolytic therapy (TLT). PCI is more effective than TLT only if the time difference (door-to-balloon vs. door-to-needle) is under 2 hours. The choice of reperfusion method should be based on the patient’s risk level. Primary PCI has limitations, since this method is not widely accessible, requires specially trained staff and special equipment. Early TLT is an acceptable standard method in STEMI management, highly applicable for the Russian clinical practice. However, in patients already treated with TLT, pharmaco-invasive strategy could be the method of choice. The description of thrombolytic drugs is focussed on the agents of II and III generations – alteplase (Actilyse®) and tenecteplase (Metalyse®), respectively. Before the introduction of Metalyse®, continuous infusion of Actilyse® was regarded as the gold standard of pharmacological reperfusion therapy. Recently, it has been shown that single-bolus Metalyse® therapy is as effective as continuous Actilyse® infusion, but with better safety profile. Pre-hospital TLT with single-bolus Metalyse® therapy (5-10 seconds) provides a unique clinical opportunity for early STEMI management and maximal myocardial rescue

Optimising the treatment of patients with acute coronary syndrome without ST segment elevation

Aim. To investigate the effects of unfractionated heparin (UFH) and its combination with warfarin on clinical course and plasma hemostasis in patients with acute coronary syndrome (ACS) without ST segment elevation.Material and methods. This prospective, open, randomized study included 174 ACS individuals without ST elevation. Group I (n=100) received UFH intravenously; Group II (n=74) received UFH and warfarin. Additionally, all participants were administered cardiomagnil (300 mg at admission, then 75 mg/d). Standard anti-anginal treatment was also performed. During 150 days after the randomization, the incidence of severe coronary complications and plasma hemostasis were investigated.Results. In patients receiving UFH, a statistically significant decrease in antithrombin (AT) III concentration was observed 1 day after the randomization. UFH reduces the AT III pool, which increases the risk of recurrent angina during and after heparin therapy. In UFH group, a significant increase in soluble fibrin-monomer complex (SFMC) concentration was registered at Day 8. In UFH + warfarin group, no SFMC increase was observed at Day 8, and the adverse coronary event incidence was statistically lower from Day 15 to Day 150, since warfarin prevented the “rebound” effect (thrombosis reactivation).Conclusion. Warfarin prevented the “rebound” effect after the end of heparin treatment (recurrent angina, plasma hemostasis activation, and increased SFMC levels at Day 8)

EVALUATION OF MENTAL STATUS AND ITS CORRECTION AGOMELATINE IN PATIENTS WITH ACUTE CORONARY SYNDROME

Continuous sampling method using aquestionnaireHospitalAnxiety and Depression Scale (GSHTD) held survey 250 patients with acute coronary syndrome (ACS) admitted to the emergency Department of cardiologyInstituteofCardiology, SB of RAMS. Of these, 85 people (34%) were detected symptoms of anxiety and depression in 165 people (66%), anxiety and depressive symptoms were found. In a pilot randomized prospective comparative study included 46 people. Against the background of the basic treatment of ACS, 23 patients received an additional agomelatine. Results of the study are showed an improvement in mental status and quality of lif