Ис­пользование пероксида водорода выдыхаемого воздуха для оценки эффективности терапии бронхиальной астмы

Exhaled hydrogen peroxide is a marker of airway inflammation. However, its utility for monitoring of asth­ma is still uncertain. The aim of this study was to assess the effect of short-acting β2-agonists and inhaled steroids on the hydrogen peroxide (H202) concentration in expired breath condensate in asthmatic patients. Fifteen patients with moderate atopic asthma were treated with salbutamol as required for 2 weeks followed 12-week treatment with budesonide (Pulmicort Turbuhaler, 400 meg daily). The exhaled H202 concentration as measured using a colorimetric assay (Gallati&Pracht, 1985). FEV1 was assessed using dry spirometer. Airway hyperresponsiveness was considered as a provocative concentration of inhaled histamine causing the 20%-fall in FEV1 (PD20).The H202 baseline level in the asthmatic patients (0.19±0.03 μ‎M) was elevated compared to healthy sub­jects (0.028±0.003, p<0.001). The exhaled H202 concentration did not change during the treatment with salbutamol but it was diminished by Pulmicort Turbuhaler. This was associated with significant improvement in clinical symptom score, FEV1 and PD20 in asthma patients.We conclude that the short-acting β2-agonists do not influence the H202 concentration in the exhaled air condensate of the asthma patients but the inhaled steroids decrease it. This may reflect different anti-inflam­matory activities of these medications.Целью настоящей работы явилось изучение влияния β2-агонистов и ингаляционных стероидов (ИГКС) на концентрацию пероксида водорода (Н2O2) в конденсате выдыхаемого воздуха (КВВ) у больных бронхиальной астмой (БА). Под наблюдением находилось 15 больных атопической БА средней тяжести течения, которые в течение 2 нед получали сальбутамол в режиме "по требованию", а затем в течение 12 нед получали будесонид (пульмикорт турбухалер в дозе 400 мкг/сут). Концентрацию Н2O2 в КВВ изучали спектрофотометрическим методом ("Gallati&Pracht”, 1985). Бронхиальную проходимость (ОФВ1) изучали методом спирометрии. Для оценки гиперреактивности бронхов (ПД20) использовали бронхопровокационный тест с гистамином.Уровень Н2O2 в процессе лечения сальбутамолом (0,19±0,03 мкМ) существенно не изменялся по сравнению с исходным (0,19±0,04 мкМ), а при назначении будесонида достоверно снижался (0,038±0,005). Изменение Н2O2 происходило параллельно с улучшением клинического состояния больных, увеличением ОФВ1 и снижением ПД20.Таким образом, β2-агонисты не влияют, а ИГКС снижают концентрацию Н2O2 в КВВ у больных БА, что, вероятно, отражает их различное влияние на активность воспалительного процесса. Это подтверждает возможность использования Н2O2 в качестве маркера воспаления в дыхательных путях у пациентов с астмой

К вопросу о возможных механизмах действия акупунктуры при лечении больных бронхиальной астмой

The acupuncture effect mechanisms (efficacy of a single procedure and a treatment course) have been thoroughly studied with due account of neirophysical, biochemical and energetic aspects. The study was based on an integral estimation assessment of patients’ conditions (contemporary European and classic Chinese estimates) for 60 patients with a mild course of bronchial asthma and 30 patients with the pre-asthma state treated with acupuncture monotherapy.Specific aspects of the homeostasis adaptive correction have been defined. This makes it possible to recommend the acupuncture not only for treatment but for the bronchial asthma prophylaxis.Механизмы действия акупунктуры (эффекты одной процедуры и курсового лечения) изучались комплексно (нейрофизиологические, биохимические, энергетические аспекты) на основе интегральной оценки состояния (современной европейской и классической китайской) у 60 больных с легким течением бронхиальной астмы и 30 больных с состоянием предастмы в процессе монотерапии акупунктурой. Уточнены особенности адаптивной коррекции гомеостаза, позволяющие рекомендовать акупунктуру не только для лечения, но и для профилактики бронхиальной астмы

Regional development gaps in Argentina: A multidimensional approach to identify the location of policy priorities

Spatial inequalities within Latin American countries have historically attracted the interest ofacademics, policy-makers, and international agencies. This article aims to provide amultidimensional diagnosis of provincial development gaps in Argentina, in order to identifythe location of policy priorities. Therefore, we built a large database, which covers sevendevelopment dimensions, and applied multivariate analysis techniques to overcome someanalytical limitations of previous studies. Results show the stability of provincial developmentgaps between 2003 and 2013 and some heterogeneity within geographic regions. Instead,cluster analysis offers a better classification of Argentine provinces according to theirdevelopment gaps, which can help the government to prioritize the places wheredevelopment policies are strategic.Fil: Niembro, Andrés Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; Argentina. Universidad Nacional de Río Negro; ArgentinaFil: Sarmiento, Jesica Isabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; Argentina. Universidad Nacional de Río Negro; Argentin

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Падения у коморбидных пациентов старческого возраста при сочетанном применении психотропных и кардиологических лекарственных средств

The article discusses aspects of drug-induced falls in elderly comorbid patients against the background of polypragmasy and also assesses the role of drug interactions that are highly dangerous according to the risk of falling. A drug audit of the obtained pharmacotherapy database was performed in patients with comorbid pathology older than 75 years, in order to identify fall-risk-increasing drugs, ranked according to the degree of risk of falling, their significant interactions and with using the traffic light classification. The data on the analysis of the contribution of psychotropic, cardiological drugs and their combination on the risk of developing a fall in the hospital in comorbid patients of old age against polypragmasy are presented. В статье рассмотрены аспекты лекарственно-индуцированных падений у коморбидных пациентов старческого возраста на фоне полипрагмазии, а также оценена роль сочетанного применения лекарственных средств, отнесенных к высокоопасным по риску падения. Проведен лекарственный аудит базы данных получаемой фармакотерапии у пациентов старше 75 лет с коморбидной патологией на предмет выявления лекарственных средств, отнесенных к высокоопасным по риску падения, ранжированных по степени этого риска согласно светофорной классификации, и их значимых взаимодействий. Представлены данные по анализу исследования вклада психотропных, кардиологических лекарственных средств и их сочетания на риск развития падения в стационаре у коморбидных пациентов старческого возраста на фоне полипрагмазии

Транспорт одновалентных катионов через мембрану эритроцитов и бронхолитическое и протективное действие ингаляции фуросемида при бронхиальной астме

The work was aimed to investigate the erythrocyte cation transport in patients with asthma with respect to bronchial hyperreactivity on anisosmotic solutions and its correction using inhaled furosemide. Rubidium uptake by and Na+ loss from erythrocytes incubated in Rb-Mg2+ solution were determined with flame emission using Perkin-Elmer АА 306 spectrophotometer. Bronchial hyperreactivity was studied using challenge tests with inhaled distilled water and hypertonic saline solution (3.6 %). In a day after the challenge test the patients inhaled 1 % solution of furosemide (60 mg, 4 ml) followed by the repeated bronchial challenge test which was performed twice at 30-min interval. The 10 to 15 % increase in erythrocyte Na+ concentration was found. Na+ -K+ pump activity in the erythrocytes increased by 34–38 %. Na+-K+-2Cl-co-transport in erythrocytes was 60-65 % higher than in healthy donors and was significantly higher in patients with bronchial hyperreactivity compared with that of patients without bronchi hyperreactivity. Inhaled furosemide inhalation was found to improve bronchial airflow parameters such as FEV1 and FEF50. The data obtained revealed alteration of erythrocyte cation transport in asthma patients as well as bronchodilating and protective effects of inhaled furosemide.Целью настоящей работы являлось исследование состояния катион-транспортирующих систем эритроцитов больных бронхиальной астмой (БА) с гиперреактивностью бронхов на анизосмотические растворы и возможности коррекции выявленных изменений с помощью ингаляции фуросемида. Для исследования транспорта ионов определяли скорость входа в эритроциты рубидия и скорость выхода натрия с помощью пламенно-эмиссионного анализа на атомно-абсорбционном спектрофотометре Perkin-Elmer АА 306. Бронхопровокационные пробы проводили с дистиллированной водой и гипертоническим раствором NaCl (3,6 %). На следующий день производили ингаляцию изоосмолярного 1%-ного раствора фуросемида (60 мг, 4 мл), после чего повторяли бронхопровокационные пробы. Обнаружено, что у больных БА на 10–15 % увеличивается содержание в эритроцитах натрия. Активность Na-K-насоса в эритроцитах больных БА повышена на 34–38 %. Активность Na-K-2Cl-котранспорта также увеличена по сравнению со здоровыми людьми на 60–65 %. Активность Na-K-2Cl котранспорта у больных БА с гиперреактивностью бронхов была достоверно выше по сравнению с больными БА без гиперреактивности бронхов на анизосмотические растворы. После ингаляции фуросемида отмечали улучшение бронхиальной проходимости, а по истечении 30 мин в среднем по группе обследованных наблюдали достоверное увеличение объема форсированного выдоха за 1-ю с (ОФВ1) и МОС50 по сравнению с исходными значениями. Полученные результаты свидетельствуют об изменении катион-транспортной функции эритроцитов больных БА и о бронхолитическом и протективном (защитном) действии ингаляции фуросемида

Falls in elderly patients with comorbidity, which were prescribed combined application of psychotropic and cardiovascular medicines

The article discusses aspects of drug-induced falls in elderly comorbid patients against the background of polypragmasy and also assesses the role of drug interactions that are highly dangerous according to the risk of falling. A drug audit of the obtained pharmacotherapy database was performed in patients with comorbid pathology older than 75 years, in order to identify fall-risk-increasing drugs, ranked according to the degree of risk of falling, their significant interactions and with using the traffic light classification. The data on the analysis of the contribution of psychotropic, cardiological drugs and their combination on the risk of developing a fall in the hospital in comorbid patients of old age against polypragmasy are presented