Purpose of the study: to present a description of the clinical observation of chronic aspiration bronchiolitis in a patient with a large diverticulum of the upper esophagus and gastroesophageal refl ux disease (GERD).Materials and methods: a brief review of the literature on the modern concept of extraesophageal respiratory manifestations of GERD, the features of the course of upper esophageal diverticula, clinical and radiological symptoms of chronic aspiration bronchiolitis is presented. In the above clinical case, chronic aspiration bronchiolitis was a manifestation of gastroesophageal pathology.Results: The development of fi brosing interstitial lung disease in a patient with a large upper esophageal diverticulum and GERD is presented.Conclusion: the problems of differential diagnosis of respiratory symptoms in esophageal pathology are shown. The authors hope that the described observation will increase the attention of doctors regarding comorbid fi brosing interstitial lung diseases in esophageal pathology; the need for timely detection of a progressive fi brotic phenotype and determination of indications for antifi brotic therapy.
Objective: to clarify the clinical and diagnostic features of arterial hypertension in patients with mild and moderate forms of COVID-19, taking into account the elapsed time. Material and methods. We examined 116 patients aged 44-60 years who were admitted to the hospital with uncontrolled stage 2 arterial hypertension, 96 of them had mild and moderate COVID-19. The patients were divided into two groups: the first group up to 12 weeks after suffering COVID-19 and the second group after 12 weeks. The examination included echocardiography and ambulatory blood pressure (BP) monitoring. Results. In post-COVID-19 patients, the ratio of daytime to nighttime systolic BP was statistically significantly lower than in disease-free patients (p <0,001, p1 =0,015). There was a decrease in the daily BP index in the group 1 and group 2 (11.6±0.8% and 12.2±1.2%, respectively, p=0,001). Among patients after COVID-19, non-dippers were detected, more often in group 1 (9 people (17.6%) versus 2 people (4.4%) (x2=4.18, p=0.042). Conclusion. Arterial hypertension in patients who underwent mild and moderate COVID-19 was characterized by an insufficient decrease in systolic blood pressure at night, the presence of non-dippers with positive dynamics after 12 weeks from the onset of the infectious process.
Aim. Аnalysis of the efficacy and safety of complex therapy including fixed-dose combinations of long-acting bronchodilators (FCLB) in comorbid patients with an exacerbation of chronic obstructive pulmonary disease (COPD) of the spirometry grades III – IV and hypertension.Methods. A total of 232 patients with an exacerbation of COPD of the spirometry grades III – IV were examined. 174 (75%) patients were diagnosed with the third grade (GOLD III), 58 (25%) – with the fourth spirometry grade (GOLD IV). In the GOLD III group, a moderate exacerbation was diagnosed in 22 (12.6%), severe — in 152 (87.4%). In the GOLD IV group, a moderate exacerbation was diagnosed in 5 (8.5%), severe — in 53 (91.5%), respectively. The patients were divided into 4 groups. Group 1 included 50 patients with an exacerbation of COPD of the spirometry grades III – IV without hypertension; Group 2 – 56 patients with an exacerbation of COPD and concomitant hypertension; Group 3 – 64 patients with an exacerbation of COPD without hypertension, who received FCLB in addition to standard therapy from the 3rd day of hospitalization; Group 4 – 62 patients with an exacerbation of COPD of the spirometry grades III – IV and concomitant hypertension who received FCLB in addition to standard therapy from the 3rd day of hospitalization. The examination included clinical and instrumental methods: the changes in the clinical signs and symptoms, the dyspnea index (according to the mМRS scale), the saturation of hemoglobin with oxygen (SaO2), spirometry, heart rate variability, the frequency and nature of arrhythmias, and systolic and diastolic blood pressure (BP).Results. A sympathicotonic disorder of the autonomic balance was revealed in patients with exacerbation of COPD of the spirometry grades III – IV. This tendency intensified in the patients with concomitant hypertension, which indicated an additional negative effect of comorbid hypertension on the studied parameters. Aggravation of sympathicotonia could be a trigger for an increase in ectopic rhythm disturbances, including high-grade ventricular extrasystoles. In the groups with concomitant hypertension, rhythm disturbances were more frequent (p < 0.05). The inclusion of FCLB in the complex therapy of exacerbation of COPD of the spirometry grades III – IV made it possible to improve the condition of patients significantly: to reduce the dyspnea index on the mМRS scale, increase SaО2 and FEV1 (p < 0.05), achieve clinical improvement in COPD faster and shorten the hospitalization period. As a result of the rapid and effective relief of exacerbation of COPD, the influence of pathogenic factors on the cardiovascular system in the examined patients decreased. The addition of FCLB to the treatment COPD with and without comorbid hypertension did not have a negative effect on heart rate variability, did not aggravate rhythm disturbances, and did not destabilize the BP.Conclusion. The positive clinical effects of the inclusion of FCLB in the complex therapy of exacerbation of COPD of the spirometry grades III – IV in patients with comorbid hypertension led to a decrease in shortness of breath, an improvement in respiratory functions, a decrease in tissue hypoxia and eliminated possible adverse events of this group of drugs.
; 2 ГУЗ «Областной клинический кардиологический диспансер», Саратов В настоящее время коморбидность выделена в качестве самостоятельного клинического направления. Влияние коморбидной патологии на клинику, диагностику, лечение и прогноз каждого из заболеваний многогранно. Терапия коморбидных пациентов с сердечно-сосудистой патологией и ХОБЛ-серьезная проблема современной медицины. В обзорной статье представлены данные о коморбидности сердечнососудистой, легочной патологии, о наличии общих факторов риска, о сложностях в подборе адекватной терапии. Перечислены показания к реваскуляризации при ОКС, ХИБС, приведены результаты контролируемых сравнительных исследований по эффективности и безопасности различных методов лечения ХИБС. Обращает внимание отсутствие клинических рекомендаций по ведению пациентов с сочетанной патологией. Принятые в настоящее время стандарты и клинические протоколы ведения больных ограничены рамками специализации экспертов и не ориентированы на пациента в реальной клинической практике. Предложено создание регистров с включением пациентов со сходными коморбидными состояниями, близкими потребностями к исходам заболевания. Создание регистров и проведение наблюдательных программ могут быть выполнены в отечественных крупных медицинских центрах. Результаты масштабного изучения клинической рутинной практики ведения пациентов с коморбидной патологией позволят решить реально существующие клинические задачи практического здравоохранения. Полученные результаты могут стать основой для создания соответствующих клинических рекомендаций по ведению пациентов с коморбидной патологией. Ключевые слова: коморбидность, реваскуляризация миокарда, ИБС, ХОБЛ, регистр.
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