The study included 62 patients with uncomplicated primary and secondary infectious endocarditis admitted to S.P. Botkin city hospital from 2011 to 2014. The emphasis is laid on diagnostic significance of dynamic measurements of the levels of C-reactive protein, tumour necrosis factor, and highly sensitive troponin-1 for the evaluation of activity of the infectious/toxic process, severity of the disease, and detection of complications. The study revealed the relationship of the enhanced level of troponin-1 with changes of inflammation markers, morphofunctional characteristics of myocardium, and circulatory failure. Morphologicl study demonstrated inflammatory and dystrophic changes in myocardium, focal and diffuse cardiofibrosis suggesting development ofnon-coronarogenic myocardial lesions that play an important role in the progress of cardiac failure associated with infectious endocarditis.
The peculiarities of primary and secondary infective endocarditis (IE) were studied in 62 patients with primary and secondary IE, uncomplicated and complicated disease treated in S. P. Botkin city clinical hospital including analysis of dynamics of tumor necrosis factor α (TNF α), interleukin-6 (IL-6), vascular endothelial growth factor (VEGF) within 3 weeks after the onset of antibiotic therapy. A rise in TNF α and IL-6 levels was shown to correlate with the severity of the disease and the development of infectious-toxic syndrome. Most patients had an increased level of VEGF, a mediator involved in the regulation of inflammation. It was shown that combination of high TNF-α and IL-6 levels with the initially low or gradually increasing VEGF levelsuggests the unfavourable prognosis characteristic of the most heavily diseased anddeceased patients.
Клинико-лабораторные аспекты хронической сердечной недостаточности у больных метаболическим синдромом Хроническая сердечная недостаточность (ХСН) является важнейшей медицинской и социальной проблемой. Рост заболеваемости обусловлен как увеличением продолжительности жизни населения, так и влиянием факторов риска, способствующих развитию и нарастанию недостаточности кровообращения. Сочетание нескольких атерогенных факторов (абдоминального ожирения, инсулинорезистентности, артериальной гипертензии, гипергликемии, дислипидемии), объединенных понятием «метаболический синдром» (МС), обусловливает более быстрое развитие ХСН. Материал и методы. Обследованы 74 больных ХСН II-III функционального класса, включая 37 (50%) пациентов с признаками МС. Оценивались возрастная структура, клиническое течение, данные лабораторных и инструментальных исследований. Специальная программа включала определение концентрации лептина, аполипопротеинов А1 (апоА1) и B (апоВ), С-реактивного белка (СРБ) высокочувствительным методом. Проведено эхокардиографическое исследование с определением морфофункциональных показателей миокарда, определена толщина эпикардиального жира. Результаты и обсуждение. Показано, что у пациентов с МС ХСН характеризуется более ранним развитием и тяжелым течением. Эхокардиографические исследования выявили значительное увеличение размеров камер сердца, толщины миокарда левого и правого желудочков, легочную гипертензию. Морфофункциональные изменения по ряду параметров превысили таковые у больных ХСН в отсутствие МС. Зафиксировано значительное повышение уровня лептина, являющегося маркером ожирения, фиброза и воспаления. Показатели лептина и СРБ у больных МС достоверно превысили уровни в группе больных ХСН. Отмечался дисбаланс аполипопротеинов с тенденцией к снижению апоА1 и увеличению апоВ в группе больных ХСН и МС. Установлены корреляционные связи уровня лептина, СРБ, аполипопротеинов с массой миокарда левого желудочка, толщиной эпикардиального жира, фракцией выброса. Заключение. Данные исследования свидетельствуют о важной роли воспалительных и дисметаболических процессов в развитии и прогрессировании ХСН у пациентов с МС.
In recent years, the system of postgraduate education in medicine faces new challenges and the need for improvement. At the same time, it is necessary to search for a reasonable combination of various types of education in order to preserve and improve the professional knowledge of doctors.Aim. To demonstrate and assess the importance of combining distance learning technologies with traditional teaching methods.Material and methods. The paper analyzes the educational process at the Department of Therapy of the I.M. Sechenov First Moscow State Medical University in the period from 2020 to July 2022. The data are based on the results of the annual report of the department, a survey of students, and communication with students using electronic telecommunication technologies (forum, chat, e-mail). Data were analyzed using SPSS Statistics 23.0 software.Results. Department of Therapy of the I. M. Sechenov First Moscow State Medical University has been training doctors for a long time in advanced training programs using traditional and distance learning. In 2020, in connection with the pandemic of a coronavirus disease 2019 (COVID-19), distance learning technologies have been actively developed. Online lectures and video seminars have become an important component of advanced training programs, in which 252 students were trained in 2020, and 376 people from different cities of Russia during 2021 and the first half of 2022.In the first year of the pandemic, two short-term programs were created dedicated to epidemiology, clinic, diagnosis and treatment of patients with COVID-19. They were conducted using online seminars, which made it possible to train 4156 doctors from more than 29 regions of Russia. Most of the listeners noted the high professional level of the programs, the importance of using computer technology in addition to traditional methods.Conclusion. In the modern world, in order to maintain the required level of professional competence of a doctor, combination of traditional educational activities with distance learning should be used.
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