ВЫЯВЛЕНИЕ БЕЗБОЛЕВОЙ ИШЕМИИ МИОКАРДА ПРИ РАЗВИТИИ РЕСТЕНОЗА У БОЛЬНОГО ПОСЛЕ ЧРЕСКОЖНОГО КОРОНАРНОГО ВМЕШАТЕЛЬСТВА

Restenosis is a complication of percutaneous coronary interventions which results in the destabilization of coronary heart disease. Presents a clinical case of detection of restenosis using stress Echocardiography one year after percutaneous coronary intervention.Рестеноз является одним из осложнений чрескожного коронарного вмешательства, приводящим к дестабилизации ишемической болезни сердца. Представлен клинический пример выявления рестеноза с помощью стресс-ЭхоКГ через год после чрескожного коронарного вмешательства.

Transcatheter transfemoral aortic valve replacement in a patient with acromegaly and severe left ventricular myocardial hypertrophy. Case report

Main causes of secondary hypertrophic cardiomyopathy include acromegalic cardiomyopathy. Heart damage in patients with the acromegaly is mediated both by the direct action of growth hormone and insulin-like growth factor-1, and increased deposition of collagen and lymphomononuclear cells in the myocardium, which leads to architectural changes, disturbances in fluid and electrolyte balance, severe left ventricular myocardial hypertrophy, diastolic and systolic left ventricular dysfunction and chronic heart failure. This article presents the world's first described observation demonstrating the possibility of successful transfemoral aortic valve repair to a comorbid patient with severe aortic stenosis according to the potential risks caused by the active form of the acromegaly

Satisfaction with the educational process: the students’ opinion

Results of questioning of students of pediatric faculty on satisfaction with quality of educational process are presented in article. Individual questionnaire of students of a third year of pediatric faculty upon termination of studying of disciplines “Propaedeutics of children’s diseases” and “Bases of formation of health of the children” realized within the main educational program in “Pediatrics” is conducted. Results of questioning have shown that in general the students of a third year studying in “Pediatrics” are satisfied with the organization and quality of educational process at department of faculty pediatrics and propaedeutics of children’s diseases.В статье представлены результаты анкетирования студентов педиатрического факультета по удовлетворенности качеством образовательного процесса. Проведен индивидуальный анкетный опрос студентов третьего курса педиатрического факультета по окончании изучения дисциплин «Пропедевтика детских болезней» и «Основы формирования здоровья детей», реализуемых в рамках основной образовательной программы по специальности «Педиатрия». Результаты анкетирования показали, что в целом студенты третьего курса, обучающиеся по специальности «Педиатрия», удовлетворены организацией и качеством учебного процесса на кафедре факультетской педиатрии и пропедевтики детских болезней

Pharmacoepidemiological treatment analysis of the chronic obstructive pulmonary disease and bronchial asthma at the inpatients department

The article presents analysis of the drug utilization review study of patients with chronic obstructive pulmonary disease and bronchial asthma at the inpatients department. As a result of the conducted pharmacoepidemiological comparative analysis consumption tendencies in the most significant pharmacotherapeutic groups have been established. The received results allow to confirm indirectly the efficiency of standardization strategy in public health care

Regional pharmacotherapy features of a bronchial asthma and chronic obstructive pulmonary disease

In article region features of pharmacotherapy patients with a bronchial asthma and chronic obstructive pulmonary disease in out-patient and stationary departments are presented. The received results were revealed by new data about quality of pharmacotherapy and to estimate efficiency of medical aid

CLINICAL OUTCOMES OF PERCUTANEOUS CORONARY INTERVENTION WITH DRUG ELUTING STENT IN STABLE ANGINA PATIENTS

Aim. To evaluate the occurence of cardiovascular events (CVE) and influence of lipid parameters on it, as other clinical and instrumental factors of coronary heart disease (CHD) patients during 5 years after selective percutaneous coronary intervention (PCI) with drug eluting stenting (DES).Material and methods. In the study, 574 patients included, with stable angina (81% males, mean age 60,3 y. o.), hospitalized to the FSBI RCSPC of MHRF for selective PCI with implantation of DES. Patients were prescribed the therapy according to stable angina guidelines, including statins. The analysis was done, of various clinical and instrumental and laboratory parameters for evaluation of prognostic significance. The endpoints were assessed: lethal cases from cardiovascular, as from all causes, non-fatal myocardial infarction (MI), non-fatal stroke, repeated coronary revascularization, that happened after discharge.Results. During the entire follow-up (average 53,5 months), CVE were registered in 24% cases. Totally, died 29 patients (5,1%), of those 4 (0,7%) — from non-cardiac causes, and repeat revascularization was done in 84 (14,6%) patients, non-fatal MI and stroke developed in 17 (3,0%) and 8 (1,3%), respectively. The risk factors were defined, that are related with the rate of fatal outcomes: smoking, brachiocephalic atherosclerosis, stroke in anamnesis, significant lesion of circumflex artery (CA) and its branches. Non-fatal stroke developed more oftenly in patients with higher body mass index (BMI) (32,2±2,56 versus 28,15±4,22, p=0,0164). Non-fatal MI more oftenly registered in patients with higher number and length of implanted stents (p=0,0018 and p<0,0001, resp.). By the end of follow-up, there were 66,2% patients on statins treatment. Target low density lipoproteides cholesterol (LDL-C) level (<1,8 mM/L) was found in 8,7%, median LDL-C level was 2,8 mM/L. There were no significant differences in LDL-C between those taking statins and discontinued,during 5 years. There was no significant relation of lipid profile values with CVE as well. The number of fatal cases was higher in the group of patients with lower baseline high density lipoproteide cholesterol. Conclusion. Adverse events were found in about quarter of patients. Most of patients did not reach the target LDL-C. There was no significant relation in baseline LDL-C and its level in 5 years, with the occurence of MI, stroke, repeat revascularizations, all cause deaths. This can be explained by the absence of significant differences in LDL-C levels in patients continuing and discontinued statins during the follow-up, and is related to the use of insufficient statins dosages and low adherence to statin treatment

PERCUTANEOUS INTERVENTION IN STABLE ANGINA: WHAT ISSUES DO WE SOLVE?

In the article, a role of percutaneous intervention discussed in stable ischemic disease of the heart, and an evolution presented of the perspectives on its influence on prognosis and clinical presentation of the disease. The results provided, of recent trials, including the ORBITA. According to current clinical guidelines, endovascular treatment does improve prognosis in patients with the left coronary artery stem lesion and proximal left descending artery lesion, as in a significant area of damaged myocardium involved in temporary ischemia. Percutaneous coronary intervention should be done in patients with continued clinical presentation of angina and nonsatisfactory life quality regardless the optimal medication treatment

EVALUATION OF THE PREVALENCE OF CARDIOVASCULAR EVENTS AND MORTALITY IN STABLE CORONARY HEART DISEASE PATIENTS DEPENDING ON BASELINE CORONARY COLLATERAL BLOOD FLOW (FIVE YEAR FOLLOW-UP)

Aim. To evaluate the prevalence of cardiovascular events and death depending on baseline coronary collateral blood flow (CBF) in five year follow-up of stable coronary heart disease (CHD) patients.Material and methods. To the study, 579 stable CHD patients included, who during scheduled coronary angiography (CAG) were diagnosed with at least one stenosis in one coronary artery (diameter no less than 1,5 mm), narrowing its lumen by ≥50%. CBF was assessed by Rentrop modified method. In 5 years post index CAG, the cardiovascular events were counted (relapse or worsening of functional class of angina, non-fatal myocardial infarction, coronary bypass surgery, acute stroke) and mortality.Results. In multifactorial analysis (Cox regression) the association revealed of the good CBF with lower cardiovascular mortality (HR 0,5; р=0,02) and all-cause mortality (HR 0,5; р=0,004). In multifactorial analysis (logistic regression) there was association of good CBF with lower rate of relapse/worsening of angina in long term period — (OR 0,36, p=0,002). There was no relation found for CBF condition and non-fatal myocardial infarction, percutaneous coronary intervention.Conclusion. By the data from five year follow-up, good CBF correlates with less cardiovascular and all-cause mortality and with the frequency of relapse/worsening of the FC of angina pectoris in chronic CHD patients, including those underwent revascularization, regardless of the severity of disease, coronary flow lesion and other factors associated with cardiovascular complications