A Balance of Interests: the Concordance of Copyright Law and Moral Rights in the Worldwide Economy

LECTURE IN INTERNAL MEDICINE PROPAEDEUTIC

Liver Cirrhosis

NOTES FOR PRACTICAL LESSONS IN INTERNAL MEDICINE FOR STUDENTS OF IV COURSE OF MEDICAL SCHOOL V.N.KARAZIN KHARKOV NATIONAL UNIVERSITY FOR 2ND SEMESTER 2015-2016 STUDY YEA

Chronic Hepatitis

NOTES FOR PRACTICAL LESSONS IN INTERNAL MEDICINE FOR STUDENTS OF IV COURSE OF MEDICAL SCHOOL V.N.KARAZIN KHARKOV NATIONAL UNIVERSITY FOR 2ND SEMESTER 2015-2016 STUDY YEA

DAILY BLOOD PRESSURE PROFILES IN PATIENTS WITH ARTERIAL HYPERTENSION: IS IT ENOUGH TO USE SYSTOLIC BLOOD PRESSURE ONLY

The systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP) daily profiles incidence was studied in 53 patients with arterial hypertension. A significant difference in the frequency of occurrence of different types of SBP, DBP and PP daily profile was revealed. In the structure of SBP daily profile «nondipper» and «dipper» types were dominated, DBP - «dipper» and «overdipper» types, PP - «night-picker» type. The conclusion about the need to evaluate not only the SBP circadian pattern, but DBP and PP also to improve the quality of arterial hypertension diagnosis, prognosis and treatment was made

QTC INTERVAL DURATION CLASS AND DRUG THERAPY OF PATIENCE IN A FIRST YEAR AFTER PACEMAKER IMPLANTATION

49 patients (28 female, 21 male) with implanted DDD/DDDR, VVI/VVIR and CRT pacemakers are investigated. Purpose frequency and dose rate of anticoagulants, antiplatelet agents, direct thrombin inhibitors, cardiac glycosides, amiodarone; ivabradine, diuretics, aldosterone antagonists, beta-adrenergic blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), statins were evaluated before, in acute postoperative period (3–5 days), 6 months and 1 year after pacemaker implantation. Patients were divided into classes 1 (normal QTc (320–440 ms)) – 24 (49 %) patients) and 2 (long QTc (> 440 msec)) – 25 (51 %) patients) of QTc interval duration. To process the data using standard statistical procedures using Microsoft Excel. It was more often prescriptions of new anticoagulants, beta-adrenergic blockers, ARBs, statins to patients in the first year after pacemaker implantation. QTc interval duration lengthening was associated with a greater purpose frequency and doses of amiodarone, diuretics, beta-adrenergic blockers, ACE inhibitors, ARBs and statins. Patients with implanted pacemaker need individualized drug therapy according to QTc interval duration, in particular, enhancing antiischemic, antihypertensive, antiarrhythmic therapy and therapy of chronic heart failure in patients with QTc interval duration lengthening

THE PROPORTION OF PATIENTS WITH HYPERTENSION IN THE GROUPS OF TERMS PROLONGED QTc INTERVALS PER DAY DATA OF AMBULATORY ECG MONITORING IN DEPENDENCE FROM CLINICAL SIGNS

The study of the proportion of patients in 82 patients with hypertension in groups of different periods of prolonged QTc per day was performed based on the data of the AM of the ECG, depending on the clinical signs. Depending on the duration of prolonged QTc per day, the patients were assigned to one of three groups: group 1 – the term extended by day of the interval QTc from 0 to 33.3 %, group 2 – from 33.4 to 66.6 %, group 3 – from 66.6 to 100 %. The proportion of patients with hypertension was determined in the groups of the prolonged QTc interval depending on age, sex, weight of patients, type of circadian heart rate index, stage, degree and prescription of EH, presence of coronary heart disease, FC and stage of CHF and diabetes mellitus. According to the AM ECG, an prolonged QTc interval occurs in each patient with hypertension, with an increase of 0 to 33.3 % per day, it is detected in 76 %, from 33.4 to 66.6 % – in 16 % and with 66.7 to 100 % – in 8 % of patients. The existence of a prolonged QTc interval in each patient indicates that in its analysis it is necessary to base on the data of the AM of the ECG taking into account, except for the elongation and lengthening for a day

Iodine deficiency disorder (IDD) of the thyroid gland & Thyrotoxicosis

Notes for the Practical lesson in Internal Medicin

Management of patient with portal hypertension. Management of patient with ascites

STUDY MATERIALS FOR SELF-PREPARATION FOR VI COURSE STUDENT

INFLUENCE OF THE TOTAL POWER OF THE HEART RATE VARIABILITY SPECTRUM ON THE SPECTRAL PARAMETERS DISTRIBUTION IN PATIENTS WITH ARTERIAL HYPERTENSION IN A PACED BREATHING TEST

To determine the effect of the total power (TP) of the heart rate variability (HRV) spectrum on the distribution of high, low and very low frequency waves, 40 patients with arterial hypertension (AH) at the age of 58 ± 9 years were divided into 5 groups according to the degree of TP decrease in the initial stage of the test: 1st – more than 3000 ms2; 2nd – 3000–2000 ms2; 3rd – 2000-1000 ms2; 4th – 1000–500 ms2; 5th – less than 500 ms2. To assess HRV parameters in each group, 3 stages of the paced breathing test with a double (light and sound) metronome were evaluated; the hardware and software complex «Cardiolab» («HAI-Medica») was used. The distribution of the parameters was estimated taking into account the median, 25 and 75 quartiles. To estimate the differences between the statistical samples, the nonparametric Mann-Whitney U-test was used, as well as the Craskell–Wallis criterion. Statistically significant differences were considered between the data at a value of p < 0.05. It was found that the greater is the degree of TP reduction, the more significant is the autonomic imbalance, as well as the decrease in the influence of paced breathing on the regulation of the heart rhythm; at TP values below 1000 ms2 not only the parasympathetic component decrease is observed, but also the transition from sympathicotonia to the neurohumoral factors prevalence

DINAMICS OF BLOOD PRESSURE AND HEART RATE VARIABILITY PARAMETERS DURING BIOFEEDBACK IN LOOP OF HEART RATE VARIABILITY AND PACED BREATHING IN PATIENTS WITH DIFFICULT-TO-CONTROL ARTERIAL HYPERTENSION ON THE BACKGROUND OF DRUG

60 patients with difficult-to-control arterial hypertension (DTCAH) were examined (average age is 59.0 ± 9.4 years). The changes in blood pressure (BP) and parameters of heart rate variability (HRV) during biofeedback sessions (BFB) in loop of paced breathing (PB) in patients with DTCAH on the background of standard drug therapy were assessed. It has been established that the systematic sessions of BFB in loop of PB in patients with DTCAH allow to increase the total power of the HRV spectrum, VLF and HF, and also improve control of BP. BFB in loop of PB can be recommended as an adjunctive method to the standard drug therapy for patients with DTCAH