Aim.To determine the severity of chronic kidney disease (CKD) in patients after acute coronary syndrome (ACS).Material and methods.The study was conducted in Semey (Semipalatinsk), East Kazakhstan region. The case histories of patients with ACS who were admitted to the University Hospital of the State Medical University (Semey State Medical University) of the East Kazakhstan Region for 1 year were studied. A total of 659 case histories were analyzed, of which 263 were patients with myocardial infarction (MI), and 396 were patients with unstable angina (UA). The diagnostic criteria for CKD were: proteinuria, levels of creatinine, glomerular filtration rate (GFR) <60 ml/min/1,73 m2. CKD stage was determined by the parameters of GFR.Results.The average proteinuria in patients with MI (Me=0,033) were higher than in patients with UA (Me=0,00), U=39564,5, Z=-5,579 p=0,000. The average values of creatinine in patients with MI were 10,26 mmol/l higher than in patients with UA (t=3,333, df=657, p=0,001). The mean GFR values in patients with MI were lower by 4,69 L/min/1,73 m2 than in patients with UA (t=-3,794, df=657, p=0,000. The highest percentage of CKD in patients with ACS were in stage 2-3, the second stage of CKD was more often diagnosed in patients with UA.Conclusion.The results of study allowed us to characterize the severity of CKD in patients undergoing ACS. We consider that widespread introduction of international and national clinical guidelines on the diagnosis, treatment and prevention of CKD in patients undergoing ACS is needed.
BACKGROUND: The prevalence of hemophilia B in the global population is approximately 1:60,000. Undifferentiated systemic mesenchymal dysplasia (uSMD) is diagnosed rather frequently, about 1:5, according to Russian authors; no data on uSMD prevalence in other countries are available. The combination of hemophilia and uSMD has grouped under the term hematomesenchymal dysplasia (HMD). This combination significantly worsens the clinical picture, prognosis, and quality of life of the patient. AIM: In this article, we present a rare clinical case of a child with a combination of hemophilia B and HMD. CASE REPORT: A clinical case of a male patient, 5 years old with hemophilia B, severe form combined with HMD, complicated by hemothorax, abscessed pulmonary lobe hematoma has presented. The presence of HMD and the above complications had an unfavorable effect on the severity of the clinical picture and the abnormal response to treatment. The main diagnostic procedures were the assessment of the phenotypic signs of HMD in combination with laboratory and instrumental examination methods such as ultrasound, computed tomography (CT) scan, and echocardiography. Vital treatment is factor IX replacement therapy and supportive one. CONCLUSION: This clinical example highlights the importance of clinical alertness to hereditary coagulopathies, which often lead to life threatening, sometimes disabling complications that significantly reduce the quality of life of children with hemophilia. Consequently, full-scale epidemiological studies of the prevalence of HMD in the population are an urgent task for the near future.
Фармакоэпидемиологический мониторинг использования антидепрессантов у больных с тревожно-депрессивным синдромом в клинике внутренних болезней Н.В. Иванова, Б.Б. Фишман, Г.И. Шварцман, Л.А. Фоменко, А.А. Абдулин, М.С. Казымов, И.В.Самсонова, М.А Результаты. Больные страдали артериальной гипертонией (28%), ИБС (20%), сердечной недостаточностью (14%), цереброваскулярной патологией и патологией периферической нервной системы (18%), гастродуоденальной патологией (20%). Амитриптилин занимал первое место (49%) среди антидепрессантов в назначениях врачей. Затем по популярности следовали пароксетин (22%) и тианептин (12%). Частота использования других антидепрессантов не превышала 5%. Отмечены различия в использовании антидепрессантов у врачей различных специальностей. Заключение. Необходим дифференцированный подход к назначению антидепрессантов. Селективные ингибиторы обратного захвата серотонина имеют преимущество для лечения тревожно-депрессивных расстройств в клинике внутренних болезней, связанное с их хорошей переносимостью. Тем не менее, остаются клинические ситуации, при которых могут применяться трициклические антидепрессанты. Ключевые слова: коморбидность, тревожно-депрессивные расстройства, психофармакотерапия, антидепрессанты. All patients suffered from different internal diseases and were treated with antidepressants because of anxious and depressive concomitant disorders. Results. Arterial hypertension observed in 28% of patients, ischemic heart disease -in 20%, heart failure -in 14%, cerebrovascular and peripheral nervous system diseases -in 18% and gastroduodenal diseases -in 20% of patients. Amitriptyline took the first place (49%) among antidepressant prescriptions. Next antidepressants according to prescription popularity were paroxetine (22%) and tianeptine (12%). Rate of other antidepressant prescriptions were not higher than 5%. There were differences in antidepressant prescriptions between physicians of different specialties. Conclusion. Reasonable approaches should be used to choose antidepressants. Selective serotonin reuptake inhibitors have benefit for the therapy of concomitant anxious and depressive disorders due to their good tolerability. Nevertheless tricyclic antidepressants are essential in some clinical situations.
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