Background. Achieving a high level of quality of life is one of the priorities in the treatment of chronic diseases. Focusing on the quality of life, it is possible to optimally adjust the treatment plan for patients, influencing the link that suffers most in this pathology. Hypothyroidism is mainly formed as a result of surgery on the thyroid gland, or autoimmune thyroiditis, and at the same time is one of the most common endocrine diseases, is of great social importance due to the potentially adverse effect on most organs and systems, resulting in a decrease in quality of life.The aim. To analyze the impact of primary hypothyroidism (postoperative hypothyroidism and autoimmune thyroiditis) on the quality of life of patients.Materials and methods. During the study, a clinical, laboratory and psychological study of 78 women with uncompensated primary hypothyroidism was carried out: 40 women aged 32–76 years with postoperative hypothyroidism (main group) and 38 women aged 36–60 years with autoimmune thyroiditis (comparison group). The quality of life was judged by the indicators of the MOS SF-36 questionnaire.Conclusion. In the examined patients with primary hypothyroidism, an association between an increase in TSH levels and a decrease in all indicators of the quality of life was revealed. First, indicators of physical functioning, general health, role and emotional functioning worsened. The dependence of indicators on the MOS SF-36 scales with the age of patients, the duration of hypothyroidism, and the level of TSH was revealed. The quality of life in patients with postoperative hypothyroidism was significantly reduced compared to patients who had hypothyroidism due to autoimmune thyroiditis.
Aim.In this research, we set out to study organic changes in the heart and blood vessels of obese men suffering from non-alcoholic fatty liver disease (NAFLD) combined with cardiac pathology in the metabolically unhealthy phenotype (MUHP). Another objective consisted in establishing a relationship between liver damage and the pathology of the heart and blood vessels.Materials and methods.A group of 112 men (male)aged 61.2±1.7 diagnosed with the ischemic heart disease (IHD) and stage 1–3 arterial hypertension (AH) were examined during the stationary treatment in the Republican Clinical Diagnostic Centre (Izhevsk, Russia). The patients were divided into 3 groups according to their body mass index (BMI): 29 men with a BMI under 25 kg/m2(I group); 43 overweight men a BMI over 25 of kg/m2(II group); 40 men with obesity and a BMI above 30 of kg/m2(III group). Laboratory and non-invasive instrumental examinations required for the diagnostics of NAFLD and IHD were carried out, including liver ultrasound and FibroScan elastometry. Other examinations included the measurement of the intra-abdominal adipose tissue (IAT) and epicardial adipose tissue (EAT) thickness, the calculation of the visceral adiposity index (VAI), the estimation of endothelial dysfunction indicators, as well as the assessment of the structural and functional parameters of the heart and blood vessels.Results.In obese patients with pronounced NAFLD signs, IAT, EAT and VAI indicators are shown to increase in direct correlation with the parameters of liver steatosis. A relationship is established between the most significant structural and functional indicators of the heart (myocardial mass index, volume of the left atrium), blood vessels (endotheliumdependent vasodilation, the size of the intima-media complex of the common carotid artery) and NAFLD. It is demonstrated that the correlation coefficients grow with the progression of fatty infiltration and liver fibrosis signs.Conclusions.The results of the study have revealeda connection between the NAFLD presence and the main markers of visceral fat depots (IAT, EAT, VAI), which is shown to increase the risk of cardio-vascular complications in such patients. NAFLD is accompanied by endothelial dysfunction and a change in the most significant parameters of cardiac and vascular remodelling. These parameters manifest the progression of pathological changes in the liver parenchyma, which increases the cardio-metabolic risk in patients with MUHP.
BackgroundRaynaud's phenomenon (RP) secondary to rheumatic diseases (RD) is associated with significant morbidity (e.g., ulcerations and gangrene).1 Three groups of specific drugs have been marketed for RP (prostanoids, ERAs and PDE-5 inhibitors).2ObjectivesTo evaluate the comparative efficacy and safety of two prostanoids (intravenous iloprost and alprostadil) in treatment of secondary RP.MethodsIn 2013 and 2014, all 25 inpatients at the regional clinic with secondary RP were treated with prostanoids [23 females; mean (SD) age 47.5 (10.2) yrs]. 20 (80%) pts had systemic sclerosis (SSc),3 by 1 (4%) – RA, SLE, dermatomyositis, cryoglobulinaemic vasculitis and overlap-syndrome. Duration of RD was 19.1±9.5 yrs, time since onset of RP 13.2±6.4 yrs. Limited cutaneous SSc (13 pts) manifestated with RP in 54%, diffuse SSc (7 pts) - in 57%. 80% of pts had activity of both RD and RP.6 pts was treated by intravenous iloprost 25 μg for 3–5 days every 3 months. 10 pts received intravenous alprostadil 20 μg for 10 days every 6 months. III group had alprostadil-switched-to-iloprost (due to alprostadil ineffectiveness; 7 pts) or iloprost-switched-to-alprostadil (due to iloprost side effects; 2 pts) therapy. There were no significant differences between three groups at baseline in Raynaud's Condition Score (RCS), SSc activity and Health Assessment Questionnaire Disability Index (HAQ-DI). All pts were treated with conventional synthetic DMARDs.ResultsAt baseline, the incidence of finger pallor and numbing was 80%, digital pain – 68%, fingertip clefts – 44%, digital tip ulcers – 40%, fingertip pitting scars – 16%. 56% of pts had constant RP symptoms and signs. Joint and muscle involvement had 76% of pts, pulmonary involvement – 68%, heart diseases – 56%.All treatments allowed reducing or stopping digital numbness and pain. About six-sevenths of pts with RP could be classified as good responders to iloprost and two-thirds – to alprostadil. Iloprost reduced the frequency of RP attacks by ∼1.2/day compared with alprostadil (p=0.024) and daily duration of RP attacks by ∼45.3 min in comparison (p=0.015). Treatment with iloprost showed significant benefit on RCS with ∼2.8 difference with alprostadil (p=0.032). After a 24-month follow-up all iloprost pts had healed up digital clefts and ulcers. A trend towards a decrease in HAQ-DI was seen in alprostadil groups, and significant HAQ-DI reduction – in iloprost. Treatment with iloprost was associated with a trend towards improvements in pulmonary hypertension and functions. Both prostanoids were well tolerated, except for incidents of tachycardia and hypotension in 2 iloprost pts.ConclusionsAlprostadil has significant but moderate efficacy in secondary RP. Iloprost is superior to alprostadil and might be recommended not only for severe RP but for preventing digital ulcers.ReferencesWigley FM. Clinical practice. Raynaud's phenomenon. N Engl J Med 2002;347:1001–1008.Kowal-Bielecka O, Landewé R, Avouac J, et al. EULAR recommendations for the treatment of systemic sclerosis: a report from the EU...
Aim. To assess the opportunities and advantages of the method of transillumination pulsooptometry and ultrasound visualization in differential diagnosis of benign and malignant mammary neoplasms. Materials and methods. The study material of 532 persons aged 30-50 years was analyzed. All patients underwent ultrasound diagnosis of the mammary gland, pulsooptometry according to Z.M. Sigal (1981), computed and magnetic resonance imaging, ductography, mammography. To varify the nature of growth, biopsy material was subjected to histological analysis. Results. Out of 532 patients examined, mammary cancer was revealed in 130 women, non-cancerous neoplasms of various etiology - in 402. Conclusions. In spite of all achievements in modern medicine and development of new diagnostic and treatment methods, US combined with transillumination pulsooptometry is most available and reliable.
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