INTRODUCTION. According to the WHO, tuberculosis remains one of the 10 leading causes of death in the world. Certain features of the pathogen, peculiarities of treatment regimens and some individual characteristics of patients create barriers to the effective treatment of the disease. MATERIALS AND METHODS. Retrospective analysis of literary sources - recommendations, scientific articles and statistical data. RESULTS. A review of the literature data showed features of the pathogen, patient-related problems and possible omissions in treatment regimens, that may be the cause of treatment effectiveness lack and a risk factor for the emergence of drug resistance in M. tuberculosis. Insufficient efficacy of treatment was described in patients with low adherence to treatment with oral anti-TB drugs, the presence of comorbidities, with a low level of intestinal permeability of oral medications and in patients with severe forms of tuberculosis. All these patients had a high mortality rate when treated within standard regimens using oral medications. CONCLUSIONS. To solve the problems of low TB treatment efficiency in these categories of patients, the necessary measures are aimed at maximizing the elimination of causes listed in the article in order to optimize treatment regimens in accordance with the patient’s characteristics and needs, taking into account the peculiarities of mycobacteria.
Львівський національний медичний університет імені Данила Галицького, кафедра внутрішньої медицини № 2, Україна olga_korolyuk@ukr.netГіпертригліцеридемію виявляють у 74% пацієнтів з метаболічним синдромом. Не зважаючи на появу нових доказів про її незалежний вплив на ризик серцево-судинних ускладнень та смертність, вона розглядається як фактор резидуального ризику після холестерину ліпопротеїнів низької щільності (ХС ЛПНЩ). Для з'ясування особливостей клінічних проявів, метаболічних порушень та довгострокових серцево-судинних ускладнень у хворих на ішемічну хворобу серця з метаболічним синдромом обстежено 107 пацієнтів. За рівнем тригліцеридів крові <1,7 та ≥1,7 ммоль/л учасників поділено на групу 1 (n=58, 28 чоловіків, 21 жінка) та групу 2 (n=58, по 29 чоловіків та жінок). У хворих групи 1 частіше виникала фібриляція передсердь (24,5% vs. 10,3%, р=0,07) та дилатація камер серця з появою регургітації на атріовентрикулярних клапанах (59,2% vs. 32,7%, р=0,007). У пацієнтів з гіпертригліцеридемією виявлено вищі рівні Log (тригліцериди / холестерин ліпопротеїнів високої щільності) і продукту акумуляції ліпідів (р<0,0001), інсуліну і Спептиду натще (р<0,003), глікемії в усіх точках орального глюкозотолерантного тесту (р<0,02) та індексу HOMA (р<0,002), але нижчі індекси Matsuda і deFronzo (р<0,005), а також вищу частоту стеатозу печінки (81% vs. 55%, р=0,01) та патології жовчного міхура (55,2% vs. 34,7%, р=0,051). У 55,2% жінок групи 2 проведено гістероваріектомію (vs. 34,7% у групі 1, р=0,018). За 40 місяців зафіксовано 27 нових випадків діабету (23,8% у групі 1 та 41,5% у групі 2, кумулятивні частки виживання 72,8% і 35,4% відповідно, р=0,039). Не зважаючи на тривалий прийом аторвастатину у дозах 20-40 мг, за 50 місяців спостереження документовано 53 госпіталізації з приводу гострого коронарного синдрому, серцевої недостатності чи порушення ритму, з них 3 фатальні (у 30,6% пацієнтів групи 1 та 65,5% групи 2, кумулятивні частки виживання 69,0% та 30,7% відповідно, р=0,0002), причому у групі 2 навіть в осіб із вмістом ХС ЛПНЩ <1,8 ммоль/л. Ключові слова: тригліцериди крові, ішемічна хвороба серця, діабет, серцево-судинні ускладнення.Зв'язок роботи з науковими програмами, планами, темами. Дана робота є фрагментом НДР кафедри внутрішньої медицини № 2 ЛНМУ ім. Данила Галицького «Метаболічні предиктори перебігу хвороб внутрішніх органів на фоні ожиріння та їх прогностичне значення», № держ. реєстрації 0107U001050.Вступ. У нормі сироватковий рівень тригліцеридів (ТГ) натще складає ≤1,69 ммоль/л. Рівні в межах 1,7-2,25 / 2,26-11,29 / 11,3-22,57 / ≥22,58 ммоль/л вважаються відповідно м'якою / помірною / тяжкою та дуже тяжкою гіпертригліцеридемією (ГТЕ). Ризик серцево-судинних захворювань (РССЗ) при помірній ГТЕ більш виражений, ніж при тяжкій [1]. Разом зі зниженням рівня холестерину ліпопротеїнів високої щільності (ХС ЛПВЩ), ГТЕ часто входить у кластер метаболічного синдрому (МС), хоча і не є його обов'язковим компонентом. З-поміж усіх критеріїв МС, частота ГТЕ складає 74%, посідаючи друге місце після артеріальної гіпертенз...
The aim: To estimate the dynamics of echocardiographic parameters in patients with CAD within 5 years after revascularization. Material and methods: 50 persons (males/females 39/11; mean age 59.9±9.3 years; STEMI 76%, non-STEMI 24%) were divided into two groups: n=38 after PCI with stenting (PCIwS); n=12 after CABG. Observation included regular echocardiography with LV myocardial mass (LVMM) and geometry estimation. Results: Groups were comparable by age, co-morbidity, BP, heart rate and BMI. Significantly severe baseline LV hypertrophy (LVH) and left atrial enlargement (LAE) in group 2 explained by spread coronary atherosclerosis. Later progressive LAE (4.37±0.22 cm, P0-60<0.05) in group 1, and aortic/LV dilatation (+0.4/+1.0 cm, respectively, both P0-60<0.05) in group 2 developed. In two years LVMM index increased by 13.4/17.5% in groups 1/2, respectively. Normal geometry and concentric remodeling completely disappeared in 3/1.5 years after PCIwS/CABG, respectively. Conclusions: Within the 1st year after revascularization, patients with CABG had more severe LVH. In 5 years after PCIwS the ratio between concentric/eccentric LVH was 2:1, whereas after CABG – 1:2.
Background Low-density lipoprotein cholesterol (LDL-C) is the main target for cardiovascular risk reduction. Statins remain the first-line therapy, however whether long-term statin use is safe and sufficient for achieving the new LDL-C goal (<1.4 mmol/l instead of <1.8 mmol/l) among patients at very high risk (VHR), especially those with multiple metabolic risk factors, remain uncertain. The purpose of our research was to estimate LDL-C lowering effect and occurrence of cardiovascular events (CVE) in ambulatory VHR patients who received atorvastatin for 5 years. Methods 107 patients (57 males and 50 females, mean (SD) age in years 59.8 (11.0) and 65.3 (8.5), respectively) with documented coronary artery disease who used atorvastatin at daily doses of 20 mg (n=40, baseline LDL-C 2.39 (0.53) mmol/l) or 40 mg (n=67, baseline LDL-C 4.05 (0.94) mmol/l) were included. The initial assessment included anthropometry, measuring of HbA1c and lipid profile (standard kits Human, Germany, LDL-C was calculated using the Friedewald's equation), and oral glucose tolerance test. During observation once annually patients were interviewing about prior hospitalizations due acute myocardial infarction, decompensated heart failure or stroke with further screening for type 2 diabetes mellitus (T2DM). Survival was analysed by Kaplan-Meier's method, using Cox's F-test; Fisher's exact test or Mann-Whitney U-test were used to compare independent samples; Wilcoxon matched pairs test was used for comparison of dependent samples. Results All participants had elevated baseline LDL-C, arterial hypertension and overweight or obesity (BMI ≥30 kg/m2 in 57%); 63.5% had prediabetes, 22.4% had first-detected T2DM, 54.2% had serum triglycerides >1.7 mmol/l, and 62.6% had low serum HDL-C adjusted to gender. Although in the end of observation, LDL-C levels in both atorvastatin regimens were significantly lower comparing to baseline (1.64 (0.20) and 2.20 (0.50) mmol/l, respectively, both P<0.0001), only 40% of patients who used 20 mg of atorvastatin and 49.3% of those who used 40 mg reached LDL-C target <1.8 mmol/l. Only 1.9% of participants reached LDL-C target <1.4 mmol/l. During observation, CVE were documented in 34 patients (n=9 (23.1%) vs n=25 (36.8%) in those who used 20 mg and 40 mg of atorvastatin, resp., P=0.072). This difference was significant when compared patients who achieved and did not achieved LDL-C target <1.8 mmol/l (14.3% vs 46.6%, resp., cumulative proportions surviving (CPS) 85.7% vs 53.5%, P=0.0001). Besides, during observation 29 new cases of T2DM were detected, (n=7 (22.6%) vs n=22 (42.3%) in those who used 20 mg and 40 mg of atorvastatin, resp., CPS 77.4% vs 57.0%, P=0.036). Conclusion After 5-year of atorvastatin use, less than 50% of metabolically compromised VHR patients had achieved LDL-C targets <1.8 mmol/l. Therapy was associated with dose-dependent risk of T2DM. To avoid statin dose escalation, combination therapy might be considered. Funding Acknowledgement Type of funding source: None
Aim — to determine the changes in carbohydrate metabolism in case of intact gallbladder(GB) and its disorders including the condition after cholecystectomy in patients with coronary heart disease (CHD). Materials and methods. Examinations involved 71 inpatients (52.11 % males, 47.89 % females, median age 65 years) with various forms of CHD (acute coronary syndrome, acute myocardial infarction, postinfarction cardiosclerosis), who were treated in cardiological and infarctional wards. All patients were divided into groups depending on the sonographically determined GB status: the 1st group (n = 30) with intact GB, 2ndgroup (n = 24) with inflections, sludge or signs of chronic cholecystitis, the 3rd group (n = 7) withcholelithiasis and calculous cholecystitis, the 4th(n = 10) with the history of cholecystectomy. Thegroupswereage- and nosology-matching. Apart from routine investigations, 20 parameters of glucose metabolism were determined: oral glucosetolerance test (OGTT) with the estimation of glucose, insulin and C-peptide levels at baseline (0’) and on 30, 60 and 120 minutes after taking of 75 g of glucose; glycated hemoglobin(НbА1c) levels; increasing areas under curves in the early and late phases for glucose (iAUCG 0-30’, 30-120’) and insulin (iAUCI 0-30’, 30-120’); seevral indexes (HOMA-IR, Quicki, Matsuda, Shuster, DeFronzo). Results. It has been established that GB disorders were accompanied by the significantly less frequent normal glucose metabolism (6.4 % vs 26.7 %) and higher diabetes incidence (19.4 % vs 3.3 %, both p < 0.05) compared to the intact GB. GB condition did not affect the liver insulin sensitivity, the peripheral tissues’ insulin sensitivity, liver clearance of insulin, C-peptide level, as well as the early or late insulin secretion phase, although it was significantly associated with glycemia levels, glycated hemoglobin and the ratio between insulin secretion and the tissue sensitivity. The worst condition of carbohydrate metabolism was observed in case of sludge, GB deformations and signs of chronic cholecystitis: these changes were accompanied by significantly higher glycemia at all points (0’, 30’, 60’, 120’), bigger area under curve for glucose in the late phase (30—120’), higher glycated hemoglobin and lower DeFronzo index. The condition after cholecystectomy was associated with a lower level of glycated hemoglobin, although during the first hour after glucose loading levels of glycemia exceeded the values of people with intact GB. Conclusion. The gallbladder condition affects carbohydrate metabolism, and its pathological changes are associated with a deterioration of carbohydrate balance.
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