The experience of sibutramine administration in patients with obesity and controlled arterial hypertension

BACKGROUND: Obesity is a metabolic disorder that becomes epidemic. Visceral adiposity increases the risk of arterial hypertension, diabetes mellitus and other comorbidities. According to this, the main aim of obesity treatment is not only a weight loss but also a decrease of the risk of comorbidities. AIMS: to assess the efficiency and safety of sibutramine in patients with obesity and arterial hypertension, to evaluate the drug influence on epicardial fat thickness. MATERIALS AND METHODS: 57 patients aged 35-60 with obesity and arterial hypertension were included in the study. All patients at the beginning and after 7 months of follow-up underwent complex examination including anthropometric measurement, ECG, office and ambulatory blood pressure measurement, echocardiography. Patients with controlled arterial hypertension were included. During the first month of follow-up patients were given general weight loss recommendations. Then sibutramine was added. Control visits to assess efficiency and safety of drug treatment were held after 1 and 6 months of follow-up. RESULTS: Women predominated among the study participants. Visceral adiposity was approved by anthropometric measurements among all patients. Most patients had impaired left ventricle geometry: concentric remodeling or hypertrophy. During the first month of follow-up the weight loss was mild: 2 kg (less than 2%) in average. Sibutramine for 1 month the weight loss increased: 3.7 kg (more than 2%) in average. After 6 months of drug administration the weight loss of patients consisted 8.6 kg (6.2%) in average. According to echocardiography results indexed mass of LV myocardium decreased in all patients more significantly in women. Also in this group of patients significant decrease of epicardial fat thickness was revealed. Adverse events of sibutramine were revealed in 26.3% of patients. The most frequent were constipation (12.3%) and dry mouth (10.6%). The severity of symptoms persisted for 1 month and then decreased, additional therapy was not required. CONCLUSIONS: Sibutramine treatment of obesity promotes effective weight loss, influences the adipose tissue distribution, decreases the progress of associated comorbidities. Sibutramine is an effective and safe drug that can be used in patients with visceral adiposity and controlled arterial hypertension

Subclinical markers of liver damage in patients with arterial hypertension and obesity

Aim. To investigate the possibility of preclinical detection of liver damage in patients with hypertension and obesity. Materials and methods. The study included 168 patients with hypertension aged 30 to 60 years. All patients underwent general clinical and laboratory-instrumental examination, including ultrasound of the abdominal organs with Doppler assessment of blood flow and determination of markers such as ALT, AST, TG, lipid profile indicators at inclusion, after a month, three months and nine months. Results. Depending on the presence of obesity, all patients with hypertension were divided into two groups. Obese patients had a statistically significant increase in office blood pressure, FSI, the ratio of TG and LDL-C to HDL-C, a more significant higher average levels of glucose, TG and ALT levels, as well as impaired hepatic blood flow according to ultrasound. Conclusion. Indicators of FSI, ALT/AST ratio, ratio of TG and LDL-С to HDL-C as well as assessment of hepatic blood flow indicators can be used for early diagnosis of nonalcoholic fatty liver disease, as they predict liver steatosis

Prevalence of chronic HCV infection in patients with type 2 diabetes mellitus in Russia

BACKGROUND: The poor outcomes of chronic hepatitis C (CHC) and type 2 diabetes determine the socio-economic significance of the combined pathology since they lead to premature death. The proportion of patients with type 2 diabetes with markers of viral hepatitis (VH) in the Russian Federation is not known, which does not allow us to estimate the burden for the state of this medical problem.OBJECTIVE: Assessment of the prevalence of concomitant pathology, HCV infection and type 2 diabetes, as well as the proportion of severe liver damage in its structure, according to the analysis of the primary medical records of four Moscow hospitals.MATERIALS AND METHODS: A retrospective analysis of the medical records of patients with HCV infection and diabetes mellitus, who admitted at different periods to four hospitals in Moscow, was carried out, as well as a total examination for the presence of anti-HCV in the blood of all patients with diabetes who were admitted within a certain period to the endocrinology department of a multidisciplinary hospital. Additionally, to determine the proportion of patients with liver cirrhosis (LC), an additional examination of patients with this combined pathology was carried out in accordance with the standards for the diagnosis of hepatitis C.RESULTS: In total, according to data from 4 hospitals in Moscow, over a certain period, 2% (105/5298) of diabetes patients with anti-HCV in their blood were identified. Sex ratio for men: women = 54 (51%): 51 (49%). Patients aged 50–69 years prevailed — 70% (74/105). Seroprevalence of HCV in cohorts of patients with type 2 diabetes according to the analysis in 3 health facilities: 0.9% (20/2196), 1.9% (8/432), 1.9% (28/1500). A significant drawback was revealed that did not allow assessing the true seroprevalence of HCV: not all patients were hospitalized with the results of a VH test, and not all of them were assigned an examination for VH markers if it was not performed before hospitalization. The proportion of type 2 diabetes patients with anti-HCV in the blood according to the results of total screening (3.7%; 16/432) became comparable to the proportion of type 2 diabetes patients among patients with CHC admitted to an infectious hospital (4.2%; 49 / 1170). The proportion of patients with LC according to the analysis of the medical records of the infectious hospital is 65% (32/49), in the group of endocrinological patients with additional examination it is 18% (13/71).CONCLUSION: For the first time in the Russian Federation, data were obtained on the prevalence of HCV infection in combination with type 2 diabetes. The results of the study indicate the need to develop effective screening programs to detect active HCV infection in the group of patients with diabetes, as well as patients among them with severe hepatic fibrosis for the timely conduct of highly effective antiviral therapy, which will prevent poor outcomes in a separate perspective

Long-Term Monitoring of Liver Fibrosis and Steatosis in Patients with Chronic Hepatitis C after Achieving a Sustained Virologic Response to Antiviral Therapy

Aim: to analyze the dynamics of fibrosis and steatosis of the liver according to fibroelastometry in patients with chronic hep-atitis C (CHC) after ≥ 6 months from transient elastometry (TE) achieving a sustained virologic response (SVR) to antiviral therapy.Materials and methods. At baseline, a prospective observational study included 628 CHC patients with known stage of liver fibrosis (F) before AVT, some of whom were phased out due to non-compliance with the inclusion criteria. The final analysis included 297 patients who had transient elastometry (TE) data with CAP™ technology on the severity of liver fibrosis (± steatosis) before treatment and after ≥ 6 months after reaching SVR (67 % – interferonfree regimens of therapy). Median follow-up from the moment SVR was confirmed was 3 years [2; 6].Results. At the end of the study, the average age of patients was 49 ± 12 years, of which 53 % were men. In the long-term period after reaching SVR, regression of liver fibrosis was diagnosed in 80 % of cases (including in patients with cirrhosis), and the progression of fibrosis was in 3 % of patient. At the same time, regression of liver steatosis was detected only in 31 % of the patient, worsening of the results was in 23 % (26 % of them had the appearance of steatosis (S) of the liver of 1–3 degrees in persons with no fatty liver before the start of AVT). In the group of patients with liver steatosis, the proportion of men was significantly higher (p = 0.004). Clinically significant stages of fibrosis F3–F4 were significantly more often recorded in patients with hepatic steatosis, both before treatment (46 % S1–S3 and 22 % S0, p < 0.001) and after ≥ 6 months after reaching SVR (19 % S1–S3 and 9 % S0, p = 0.023).Conclusion. In patients with chronic hepatitis C with SVR achieved in the long term, despite a significant regression of liver fibrosis, a high prevalence of hepatic steatosis remains. The data obtained indicate the feasibility of routine diagnosis of both fibrosis and steatosis of the liver in the management of patients with chronic HCV infection before and after successful antiviral therapy

MODERN DEVELOPMENT OF MEDICAL UNIVERSITY

Очевидна необходимость системного реформирования образовательного процесса в медицинских вузах РФ. Оно начато в рамках приоритетных национальных проектов. Одним из победителей конкурса вузов, внедряющих инновационные образовательные программы, стал Московский государственный медико-стоматологический университет (МГМСУ). В 2007 г. МГМСУ был начат экспериментальный проект, в рамках которого проделана следующая работа: повышение квалификации сотрудников, модернизация аудиторного фонда, закупка современного диагностического и обучающего оборудования, разработка нового оборудования, создание принципиально новых учебно-исследовательских, научных и клинических центров, создание принципиально новых учебников, учебных пособий и программ, а также коренная модернизация существующих. Это позволило принципиально уже сегодня продемонстрировать изменения в систему высшего медицинского образованияThe need for a systematic reformation of the educational process in the Russian medical universities is considered obvious. This reform has been started as part of the high-priority national projects. One of the winners of the competition between the universities implementing innovative educational programs is the Moscow State University of Medicine and Dentistry (MSUMD). In 2007 MSUMD started an experimental project which involves following activities: employee training, refurbishment of lecturing facilities, acquiring modern diagnostic and training equipment, development of innovative equipment, creation of fundamentally new academic and exploratory, scientific and clinical centers, creation of fundamentally new textbooks, manuals and programs, as well as radical update of the existing ones. This allowed MSUMD to already now show some fundamental changes in the system higher medical education

Методы исследования дислокационной структуры полупроводниковых монокристаллов группы AIIIBV

The development pace of advanced electronics raises the demand for semiconductor single crystals and strengthens the requirements to their structural perfection. Dislocation density and distribution pattern are most important parameters of semiconductor single crystals which determine their performance as integrated circuit components. Therefore studies of the mechanisms of dislocation nucleation, slip and distribution are among the most important tasks which make researchers face the choice of suitable analytical methods. This work is an overview of advanced methods of studying and evaluating dislocation density in single crystals. Brief insight has been given on the main advantages and drawbacks of the methods overviewed and experimental data have been presented. The selective etching method (optical light microscopy) has become the most widely used one and in its conventional setup is quite efficient in the identification of scrap defects and in dislocation density evaluation by number of etch pits per vision area. Since the introduction of digital light microscopy and the related transfer from image analysis to pixel intensity matrices and measurement automation, it has become possible to implement quantitative characterization for the entire cross-section of single crystal wafers and analyze structural imperfection distribution pattern. X-ray diffraction is conventionally used for determination of crystallographic orientation but it also allows evaluating dislocation density by rocking curve broadening in double-crystal setup. Secondary electron scanning electron microscopy and atomic force microscopy allow differentiating etch patterns by origin and studying their geometry in detail. Transmission electron microscopy and induced current method allow obtaining micrographs of discrete dislocations but require labor-consuming preparation of experimental specimens. X-ray topography allows measuring bulky samples and also has high resolution but is hardly suitable for industry-wide application due to the high power consumption of measurements.Digital image processing broadens the applicability range of basic dislocation structure analytical methods in materials science and increases the authenticity of experimental results.Темпы развития современной электроники помимо повышения спроса на полупроводниковые монокристаллы приводят к возрастанию требований по их структурному совершенству. Плотность дислокаций и характер их распределения являются важнейшими характеристиками полупроводниковых монокристаллов, определяющими дальнейшую эффективность их применения в качестве элементов интегральных систем. В связи с этим изучение механизмом возникновения, скольжения и распределения дислокаций — одна из актуальных задач, которая ставит ученных перед выбором метода исследования. В данной работе приведен обзор современных методик исследования и подсчета плотности дислокаций в монокристаллах. Дан краткий анализ основных преимуществ и недостатков каждого метода, а также приведены экспериментальные результаты. Метод избирательного травления (световой оптической микроскопии) получил наибольшее распространения и в своем классическом варианте является очень эффективным при решении задач обнаружения дефектов, приводящих к браку, и оценки плотности дислокаций по числу ямок травления, пересчитанных на площадь поля зрения. С использованием цифровой световой микроскопии, за счет перехода от анализа изображений к матрице значений интенсивности отдельного пикселя и автоматизации процесса измерений, становится возможным количественный анализ по всему поперечному сечению монокристаллической пластины и анализ характера распределения структурных несовершенств. Метод рентгеновской дифракции традиционно используется для определения кристаллографической ориентации, но также позволяет оценить величину плотности дислокаций по уширению кривой качания в случае двухкристальной геометрии. Методы растровой электронной микроскопии во вторичных электронах и атомно-силовой микроскопии позволяют дифференцировать фигуры травления по природе их возникновения и детально изучить их геометрию.Просвечивающая электронная микроскопия и метод наведенных токов позволяют получать микрофотографию отдельных дислокаций, но требуют трудоемкой предварительной подготовки экспериментальных образцов. Рентгеновская топография дает возможность работать с массивными образцами и также обладает высокой разрешающей способностью, но в связи с высокой энергоемкостью процесса измерений слабо применима в условиях производства.Цифровая обработка изображений позволяет расширить спектр возможностей основных материаловедческих методов исследования дислокационной структуры и повысить объективность получаемых результатов

СОВРЕМЕННЫЕ ПОДХОДЫ К КОМПЛЕКСНОМУ ЛЕЧЕНИЮ БИЛИАРНОГО ПАНКРЕОНЕКРОЗА

ABSTRACT. The paper reviews the treatment outcomes of 176 patients with biliary pancreatonecrosis. The history of pancreatonecrosis was identified in 82% of patients; in the remaining 18%, pancreatonecrosis was diagnosed after acute pancreatitis manifestations. Cholecystolithiasis was revealed in 82% of patients, cholecysto-choledocholithiasis was in 16%, and choledocholithiasis in 2%. A piecemeal pancreatonecrosis was found in 58% of patients, a large-focal one in 22%, subtotal or total in 20%. The combination of minimally invasive procedures on the biliary tract in the pancreatico-duodenal zone with the efficient detoxification and hepatoprotective therapies allowed mortality reduction from 28% to 18%. РЕЗЮМЕ. Проанализированы результаты лечения 176 пациентов с билиарным панкреонекрозом. В анамнезе панкреонекроз был выявлен у 82% больных, у остальных 18% он диагностирован после манифестации острого панкреатита. Холецистолитиаз выявлен у 82%, холецисто-холедохолити- аз — у 16%, холедохолитиаз — у 2%. Мелкоочаговый панкреонекроз наблюдался у 58% больных, крупноочаговый — у 22%, субтотальный или тотальный — у 20%. При сочетании малоинвазивных вмешательств на билиарном тракте панкреатодуоденальной зоны и эффективной детоксикационной, гепатопротекторной терапии удается снизить летальность с 28 до 18%

Индивидуальный и стандартный режимы химиотерапии у больных с впервые выявленным туберкулезом, сочетанным с ВИЧ-инфекцией, с позиций доказательной медицины в Российской Федерации

Summary. This was the first randomized clinical trial to compare efficacy of individual (fenazid, rifampicin / rifabutin, pyrasinamid, ethambutol, amikacin, levofloxacin) and standard chemotherapeutic regimens as active treatment in civil and penitentiary anti-TB settings. The trial involved 240 patients with newly diagnosed pulmonary tuberculosis and stage III to IV HIV infection; 27.5–39.1 % of them had primary multidrug resistance of Mycobacterium tuberculosis. The optimal effective and safe regimen has been firstly established to be the individual regimen using fenazid and levofloxacin including their combination with antiretroviral drugs. Such regimen provided M. tuberculosis elimination from sputum in 82.5–92.5 % of cases and healing of cavitary lesions in 62.5–77.5 % of cases after 3 months of therapy both in patients with blood CD4+ lymphocyte count 500 to 200 cells / mm3 and those with blood CD4+ lymphocyte count < 200 cells / mm3. Adverse events were observed in 7.5 to 25 % of the patients and did not required change in the chemotherapeutic regimen.Резюме. Впервые проведено рандомизированное клиническое исследование и изучена сравнительная эффективность индивидуального (IIБ – феназид, рифампицин / рифабутин, пиразинамид, этамбутол, амикацин и левофлоксацин) и стандартного (I) режимов химиотерапии (ХТ) в интенсивной фазе лечения в гражданских и пенитенциарных противотуберкулезных учреждениях у 240 больных с впервые выявленным туберкулезом легких, сочетанным с ВИЧ-инфекцией III и IV стадии, и наличием первичной множественной лекарственной устойчивости в 27,5–39,1 % случаев. Впервые обосновано и доказано, что наиболее оптимальным, эффективным и безопасным является индивидуальный (IIБ) режим ХТ с использованием феназида и левофлоксацина, в т. ч. в сочетании с антиретровирусными препаратами, что позволяет в течение 3 мес. интенсивной фазы лечения как у больных с количеством CD4+-лимфоцитов в периферической крови 500–200 кл. / мкл, так и < 200 кл. / мкл добиться прекращения бактериовыделения в 82,5–92,5 % случаев, а закрытия каверн – в 62,5–77,5 % случав. При этом побочные реакции, которые отмечались у 7,5–25 % пациентов, купировались применением патогенетических лекарственных средств без изменения применяемого режима ХТ

Clinical Practice Guidelines of the Russian Society for the Study of the Liver, the Russian Gastroenterological Association, the National Scientific Society of Infectious Disease Specialists for the Diagnosis and Treatment of Chronic Hepatitis C

Аim: diagnosis and treatment algorithms in the clinical recommendations intended for general practitioners, gastroenterologists, infectious disease specialists, hepatologists on the of chronic hepatitis C are presented.Summary. Chronic viral hepatitis C is a socially significant infection, the incidence of which in the Russian Federation remains significantly high. Over the past 10 years, great progress has been made in the treatment of hepatitis C — direct acting antiviral drugs have appeared. The spectrum of their effectiveness allows to achieve a sustained virological response in more than 90 % of cases, even in groups that were not previously considered even as candidates for therapy or were difficult to treat — patients receiving renal replacement therapy, after liver transplantation (or other organs), at the stage of decompensated liver cirrhosis, HIV co-infected, etc. Interferons are excluded from the recommendations due to their low effectiveness and a wide range of adverse events. The indications for the treatment have been expanded, namely, the fact of confirmation of viral replication. The terms of dispensary observation of patients without cirrhosis of the liver have been reduced (up to 12 weeks after the end of therapy). Also, these recommendations present approaches to active screening of hepatitis in risk groups, preventive and rehabilitation measures after the end of treatment.Conclusion. Great success has been achieved in the treatment of chronic hepatitis C. In most cases, eradication of viral HCV infection is a real task even in patients at the stage of cirrhosis of the liver, with impaired renal function, HIV co-infection, after solid organs transplantation

Генетический анализ вируса гриппа А / Н1N1 "пандемический" в условиях эпидемии

Genetic analysis of pandemic influenza A / H1N1 virus during epidemia.Генетический анализ вируса гриппа А / Н1N1 "пандемический" в условиях эпидемии