Comparison of microflora isolated from peripheral blood and valvular structures of the heart in patients with infective endocarditis

Background. Infective endocarditis (IE) is defined as an infection of a native or prosthetic heart valve, endocardial surface, or permanent cardiac apparatus. Currently, the determination of microorganisms that induce a disease or are involved in the process of pathogenesis by PCR is one of the most modern and rapid tests.The aim. To determine and to compare the spectrum of infectious pathogens in homogenate samples of native heart valves and blood of patients with IE.Materials and methods. Twenty patients with confirmed IE diagnose were examined, admitted for hospitalization at the Research Institute for Complex Issues of Cardiovascular Diseases (Kemerovo, Russia) in 2019. The range of tests used in the study was aimed at detecting such microorganisms as Streptococcus pyogenes, Streptococcus agalactiae, Enterobacter spp., Klebsiella spp., Staphylococcus spp., Streptococcus spp., Bacteroides fragilis, Bacteroides vulgatus, Bacteroides thetaiotaomicron, and Bacteroides ovatus.Results. The study found that 19 samples of heart valves were characterized by the presence of microorganisms from the genus Streptococcus spp., wherein Streptococcus agalactiae was found in two patients. Staphylococcus spp. Were found in 16 samples of valve homogenate. Detection of other pathogens revealed only two cases of Enterobacter spp., Klebsiella spp. When analyzing blood samples from patients with IE, not a single infectious agent was identified. The study revealed a statistically significant difference (p < 0.001) between the incidence of Staphylococcus spp. in samples of valve homogenate and peripheral blood of patients with IE. There was also a statistically significant difference (p < 0.001) for Streptococcus spp. both in samples of valve homogenate and peripheral blood from patients with IE.Conclusion. Molecular genetic research using PCR technologies has low efficiency in detecting the pathogen in the circulating bloodstream, as well as in blood culture. However, the study of homogenized biopsy specimens of the heart valve structures removed during surgery may allow correcting antimicrobial tactics in the early postoperative period of prosthetics

Концепция синдромальных диагнозов остеоартрита и боль в спине как причина неэффективности медикаментозной терапии

Osteoarthritis is considered a peripheral joint disease and is often ignored when discussing the prevalence and treatment of back pain. Traditionally, clinical guidelines from various countries are devoted to the treatment of nonspecific back pain (lower back pain), although this diagnosis is syndromic and is absent in ICD-10. Therefore, in real clinical practice, such diagnoses as osteochondrosis and dorsopathy simultaneously exist. The treatment strategies for back pain do not take into account chronic inflammation directly related to pro-inflammatory cytokines and oxidative stress, which makes drug therapy ineffective. It is advisable from the first days of therapy to choose parenteral forms from the group of symptomatic slow-acting drugs containing chondroitin sulfate (Chondroguard®), which will accelerate the onset of the analgesic effect and increase the effectiveness of pathogenetic therapy.Остеоартрит рассматривается как заболевание периферических суставов и часто игнорируется при обсуждении распространенности и терапии боли в спине. Традиционно клинические рекомендации различных стран посвящены лечению неспецифической боли в спине (боли в нижней части спины, БНС), хотя диагноз БНС синдромальный и отсутствует в МКБ-10, поэтому в реальной клинической практике наблюдается одномоментное существование таких диагнозов, как остеохондроз и дорсопатия. Современные стратегии терапии боли в спине не учитывают хроническое воспаление, которое напрямую связано с провоспалительными цитокинами и окислительным стрессом, что снижает эффективность медикаментозного лечения. Целесообразным выбором лекарственных средств является использование с первых дней терапии парентеральных форм препаратов из группы симптоматических медленнодействующих средств хондроитина сульфата (Хондрогард®), что позволяет ускорить наступление обезболивающего эффекта и повысить эффективность патогенетической терапии

SCLERODERMA SYSTEMATICA WITH INTERSTITIAL LUNG LESION: COMPARATIVE CLINICAL CHARACTERISTICSWITH PATIENTS WITHOUT LUNG LESION

Objective. To compare disease history data and clinical and laboratory parameters in patients with scleroderma systematica (SDS) with high-resolution computed tomography (HRCT)-verified interstitial lung lesion (ILL) versus those without lung involvement. Subjects and methods. An examination was made in 138 patients with SDS who had been consecutively admitted in 2006-2008, female/male ratio, 124 : 14; limited : diffuse : mixed forms, 78 : 40 : 20; mean age, 47±13 years; median disease duration, 6 (2.5 11) years. The history data (occupational hazards, smoking, respiratory diseases) and clinical manifestations of SDS and laboratory data were studied. The diagnosis of ILL was established on the basis of chest HRCT. Results. According to HRCT data, the signs of varying ILL were found in 82% of the patients with SDS. The duration of SDS was similar in the patients with and without lung involvement; but the latter were younger at the time of disease onset. There were no significant differences between the groups compared in history data, clinical forms of SDS, the frequency of involvement of visceral organs and systems. Crepitation was heard only in the patients with ILL. The frequency of respiratory manifestations increased with a larger number of the involved lung segments. The prevalence of ILL was found to be positively correlated with age at the onset of SDS (r=0.29;

Tenascin-C as a cardiovascular marker

Novel biological markers, such as fibrosis marker galectin-3, peptide hormone adrenomedullin, soluble ST2, chemokine CX3CL1, surrogate marker of vasopressin, and others, are every year one step closer to being introduced into health practice. Over the past decades, significant progress has been made in the study of cardiovascular biomarkers. A key moment was the introduction of deter mining the concentration of natriuretic peptides used as markers for the diagnostic and prognostic evaluation of patients with heart failure. Currently, in order to search for novel markers for early diagnosis and risk stratification, studies have been conducted on the analysis of promising inflammatory marker tenascin-C (TNC) in cardiovascular patients. Data have been obtained that allow us to consider TNC as a tool for risk stratification and assessment of cardiovascular disease prognosis. The combination of TNC with other biological markers, in particular brain natriuretic peptide, may improve prognostic power. Nevertheless, serial testing to assess the prognosis and effectiveness of ongoing treatment, including in the conditions of a multimarker model, requires further research

Gamma-glutamyl transpeptidase is a promising biological marker of heart failure

Introduction. Currently, the search and study of new biological markers that can help early diagnosis of heart failure, serve as a laboratory tool for assessing the effectiveness of therapy, be a predictive marker of possible adverse clinical outcomes and a significant criterion for risk stratification is very relevant. While cardiospecific markers, including natriuretic peptides, their precursors, and highly sensitive troponins, are widely used in clinical practice, the need to use other markers does not have sufficient evidence. aspect of a biological marker of heart failure.Gamma-glutamyl transpeptidase is an enzyme localized on the outer side of cell membranes and involved in the metabolism of glutathione and cysteine. This enzyme is a dimeric glycoprotein (68 kDa), consisting of 2 subunits – a large and a small (46 and 22 kDa). Gamma-glutamyl transpeptidase is encoded by a multigene family consisting of at least 7 different genes located on chromosome 22; however, only 1 of these genes is involved in the formation of a functional enzyme. Gamma-glutamyl transpeptidase was found in all cells except erythrocytes. There is a significant variability in enzyme activity, which is especially high in tissues with a secretory and absorptive function, such as the kidneys, biliary tract, intestines, and epididymis.Purpose of the review is to present an overview of current publications devoted to the study of γ-glutamyl transpeptidase in the aspect of a biological marker of heart failure.Materials and methods. The analysis of literature sources (foreign and domestic articles) was carried out in the databases: PubMed, RSCI, MedLine, Google Scholar, Science Direct. The search was performed according to the following keywords: biological markers, heart failure, γ-glutamyl transpeptidase, biological markers, heart failure, γ-glutamyl transpeptidase.Results. In addition to its clinical use as a test for liver disease, biliary tract disease, and alcohol abuse, γ-glutamyl transpeptidase is of great interest because of its association with cardiovascular disease, diabetes, metabolic syndrome, and cancer. In the literature available to us, we found a small number of works devoted to the study of γ-glutamyl transpeptidase in patients with heart failure. In the review, we have presented data from experimental and clinical studies indicating a clear link between γ-glutamyl transpeptidase and heart failure. The pathogenetic mechanism of the possible relationship between γ-glutamyl transpeptidase and heart failure is not completely clear. The localization of this enzyme in tissues with a transport function has led to the assumption that it is involved in the transport of amino acids through the γ-glutamyl cycle.Conclusion. Further deeper understanding of the structure and function of the enzyme is needed, as well as future clinical studies to determine the diagnostic, prognostic and possibly therapeutic significance of this biological marker

The era of Belousov Yuri: continuing the tradition. To the 80th birthday

The article is dedicated to the outstanding scientist, doctor, teacher, public figure, corresponding member of the Russian Academy of Sciences, professor, doctor of medical sciences Belousov Yuri, who would have turned 80 on September 23, 2022. The presented materials make it possible to recall the main milestones in the biography of this remarkable person. The article is based on materials collected by relatives, friends, colleagues and students of Yuri Belousov

STUDY OF THE EFFICIENCY AND SAFETY OF MYCOPHENOLATE MOFETIL THERAPY IN PATIENTSWITH SYSTEMIC SCLERODERMA

Interstitial lung disease (ILD) is one of the major causes of death in systemic scleroderma (SSD). Treatment of these patients remains difficult and controversial. Mycophenolate mofetil (MPM) has been in vitro shown to inhibit overproduction of type I collagen and hence may be effective against SSD. Objective: to study the efficiency and safety of MPM therapy in patients with SSD and clinically relevant ILD in an open-label prospective study. Subjects and methods. Ten patients with SSD (7 and 3 with its diffuse and limited forms, respectively) and ILD were given MPM in combination with glucocorticoids (mean daily dose was 10+4 mg). The mean MPM therapy duration was 11.4+1.3 months. The Rodnan total skin thickness score, flexion index, forced vital capacity (FVC), diffusing capacity of the lung for carbon monoxide (DLCO), and European Scleroderma Study Group (EScSG) activity index were estimated and a 6-minute walk test (6MWT) was carried out before and after MPM therapy. Results. After therapy, the whole group showed a significant reduction in skin scores from 12.9+9.8 to 5.6+3.2 (p=0.036) and EScSG from 3.9+1.4 to 2.25+1.03 (p=0.015) and an increase in exercise tolerance from 446+155 to 535+78 m (p=0.03) as evidenced by 6MWT. The degree of flexion contractures decreased from 15+21 to 3.7+11.3 mm (p>0.05). FVC (77.8+18.7% versus 73.8+11.3%) and DLCO (45+14.4% versus 42+16.4%) were significantly unchanged. A 10% or more clinically significant fall was noted in FVC and DLCO in 3 and 1 patients, respectively. In the remaining patients, the lung functional test results remained stable. MPM tolerability was satisfactory. All the patients completed their course of treatment. Conclusion. Stabilization of lung function with higher exercise tolerance and significantly reduced skin density allow therapy with MPM in combination with low-dose glucocorticoids to be regarded as an effective and well-tolerated treatment in patients with ILD in the presence of SS

Hypotensive therapy of arterial hypertension in chronic limb ischemia and acute thrombotic occlusion

The aim of the investigation was to evaluate the efficacy and safety of the treatment of arterial hypertension syndrome in patients with peripheral arterial disease of the lower and upper extremities and to analyze the efficiency of the effect of operative revascularization of the limb arteries on the course of arterial hypertension.Цель исследования – оценить эффективность и безопасность лечения синдрома артериальной гипертензии у больных с заболеваниями периферических артерий нижних и верхних конечностей и проанализировать эффективность воздействия оперативной реваскуляризации артерий конечностей на характер течения артериальной гипертензии

Resistance to antihypertensive therapy in hypertensive patients. The value of the renal and hemodynamic factors

In order to assess the significance of renal, renovascular lesions and dysfunctions in the development and progression of severe and resistant to combination antihypertensive therapy (GRA), arterial hypertension (AH) in 286 patients with primary hypertension of 1-3 degrees of severity, including 105 patients from the II century, and Article III. with signs of RAG. Use the classification AG European medical societies ES HI ESC 2013 (6). In 87 patients diagnosed with hypertension 1 severity, age from 27 to 65 years, on average 49,5 ± 1,4 years, 36 men, women - 51.2 patients with hypertension severity was 82, the age from 34 to 68 years, on average 58,4 ± 3,0 years, 38 men and women - 44; AH 3 tbsp. -117 people, 49 men, women - 68, age from 42 to 72 years, on average 58,3 ± 3,8 years. Target values of blood pressure (120/80 mm Hg or less) achieved on such antihypertensive therapy in 87 patients with I st. and 29 with hypertension II degree. - They were 1 study group - PN). Partial normalization of blood pressure - a level not higher than 140/90 mm Hg It was in 65 patients (53 with hypertension II degree, and 12 with Stage III AH.) - Group 2 - CHN. In 105 patients (with Stage II St.- 34 and 83 с Stage III AH. Failed to achieve a sustainable normalization of blood pressure, even when using a 3-4 component complex antihypertensive therapy on the results of blood pressure measurements over 6-8 office hours reached 180 GARDEN and (or) diastolic blood pressure of 110 mm Hg .st. - Group 3 patients - resistant AG (RAG). Resistance for hypertension was considered in cases with SBP above 180 mmHg. Art., Dad - above 110 mm Hg. St., in the absence of normalization on the background of a complex, three-component antihypertensive therapy and the worsening of concomitant coronary, cerebrovascular and renal failure, as well as the progression of visual impairment. We performed a comprehensive study of the function and structure of the MBC, which included urine and urinary sediment analysis by Nechiporenko on Zimnitsky, renal excretion and endogenous creatinine clearance. Diagnostics included dynamic renal scintigraphy, static renal scintigraphy, ultrasound of the kidneys and of the MBC, according to testimony - excretory urography, computed tomography of the adrenal glands, aortography and renal angiography. Found that patients with resistant ongoing combination antihypertensive therapy is different from the patients with stable disease rate of violations absorptive-excretory function - secretion and excretion of one or both kidneys, without significantly reducing function azotovyvedeniya. Renal artery stenosis is 4-5 times more frequently detected in patients with stable and malignant primary hypertension than in patients with labile its passage, and all vascular lesions, including pathology of the infrarenal aorta and the renal vein, almost 2 times more often. A number of forms of congenital and acquired diseases of the renal arteries and veins (7 species) were detected only in patients with resistant hypertension. Identification of the mechanisms of renal and renovascular hypertension severe allow some patients to increase the effectiveness of antihypertensive drug therapy or to achieve complete control of blood pressure.С целью оценки значимости почечных, вазоренальных поражений и дисфункций в развитии и прогрессировании тяжелой и резистентной к комбинированной гипотензивной терапии (РАГ) артериальной гипертензии (АГ) у 286 больных с первичной АГ 1 -3 степени тяжести, в том числе у 105 больных II ст. и III ст. с признаками РАГ. Использовали классификацию АГ европейских медицинских обществ ЕОГ/ЕОК, 2013 [6]. У 87 больных диагностировали АГ 1 степени тяжести, возраст от 27 до 65 лет, в среднем 49,5+1,4 года, мужчин 36, женщин - 5 1 . Больных с АГ 2 степени тяжести было 82 .возраст от 34 до 68 лет, в среднем 58,4+ 3,0 года, мужчин 38 и женщин - 44; с АГ 3 ст. -1 1 7 человек, мужчин 49, женщин - 68,возраст от 42 до 72 лет, в среднем 58,3+3,8 года. Целевых значений уровня АД (120/80 мм рт.ст. и ниже) удалось достичь на такой гипотензивной терапии у 87 больных I ст. и у 29 с АГ II ст. - они составили 1 группу исследования - ПН). Частичная нормализация АД - с уровнем не выше 140/90 мм рт.ст. была у 65 больных ( у 53 с АГ II ст. и у 12 с АГ III ст.) - 2 группа - ЧН. У 105 больных (с АГ II ст.- 34 и у 83 с АГ III ст. не удалось добиться устойчивой нормализации АД, даже при использовании 3-4 компонентной комплексной гипотензивной терапии уровень АД по результатам 6-8 офисных измерений за сутки достигал САД 180 и (или) ДАД 110мм рт .ст.- 3 группа больных - резистентной АГ (РАГ). Резистентным течение АГ считали в случаях с уровнем сАД выше 180 мм рт. ст., дАД - выше 110 мм рт. ст., при отсутствии нормализации на фоне проводимой комплексной, трехкомпонентной гипотензивной терапии и ухудшении течения сопутствующей коронарной, цереброваскулярной и почечной недостаточности, а также при прогрессировании нарушений зрения. Выполняли комплексное исследование функции и структуры органов МВС, которое включало исследование мочи и мочевого осадка, анализ по Нечипоренко, по Зимницкому, почечное выведение и клиренс эндогенного креатинина. Инструментальная диагностика включала динамическую сцинтиграфию почек, статическую сцинтиграфию почек, ультразвуковое исследование почек и органов МВС, по показаниям - экскреторную урографию, компьютерную томографию надпочечников, аортографию и ангиографию сосудов почек. Установили, что больных с резистентных к проводимой комбинированной гипотензивной терапией, отличала от больных со стабильным течением заболевания частота нарушений поглотительно-выделительной функции - секреции и экскреции одной или двух почек, без существенного снижения функции азотовыведения. Стенозы почечных артерий в 4-5 раз чаще выявлялись у больных со стабильной и злокачественной первичной гипертензией, чем у больных с лабильным ее течением, а все сосудистые поражения, включая патологию инфраренального отдела аорты и почечных вен, почти в 2 раза чаще. Целый ряд форм врожденной и приобретенной патологии почечных артерий и вен (7 видов) выявлялись только у больных с резистентной гипертензией. Идентификация вазоренальных и нефрогенных механизмов тяжелой артериальной гипертензии позволяла у части больных повысить эффективность медикаментозной гипотензивной терапии или добиться полного контроля АД