The COVID-19 pandemic determined the necessity for prompt diagnostics and optimal routing of patients, followed by rehabilitation and secondary prevention, as domestic tourism intensifies. The epidemic increased the importance of digital systems for the tourism service market. Digitalization took leading positions in the tourism industry and made market participants adapt to these changes for optimizing their activities and increasing revenues. Further development of tourism in Russia, giving the ongoing pandemic, would require digital technologies such as multilanguage informational services overcoming language barriers, digital tourist cards, mobile apps introducing cultural and national landmarks online, web services for preparing tourist routes. Judging from scientific and practical experience, we can expect that medical, social, physical and psychological rehabilitation supervised by medical personnel will improve body functioning including heart, lungs, central nervous system as well as restore patients’ quality of life in general.
BackgroundAccording to recent national and EULAR recommendation cardiovascular risk (CVR) in pts with RA should be evaluated using modified SCORE system. But a lot of investigations and real clinical data demonstrate that this system commonly down-estimates CVR in RA pts.ObjectivesAim of our study was to compare standard CVR assessment and additional CVR evaluation on the basis of specific disease-associated risk factors (RF) and CV system investigations in long standing RA.Methods118 pts (96 female, 22 male) aged from 34 to 74 years old (mean age 55.91±5.21) with long standing RA (duration >5 years) were observed. In all pts CVR was stratified according to modified SCORE. We have analysed pts medical cards and standard examination data to determine clinical features of RA and associated conditions to verify severity of CVR. In term to reveal asymptomatic CV disease pts had undergone additional investigations (echocardiography, Dopplerography of carotid arteries, ECG-monitoring).ResultsConventional CVRF were registered in 110 (93.22%) pts. Age>45 (male),>50 (female) was in 85 (72.03%) pts, BMI>25 kg/m2; in 10.17%, elevated cholesterol level and/or dyslipidemia in 41.52%, AH with target organ damage was detected in 45.76%, T2DM in 11.8%, CKD 3 stage in 10.17%, history of MI was in 2 (1.69%) pts. According to modified SCORE for RA very high, high, moderate and low CVR was detected in 17.80%, 47.46%, 18.64%, 16.10% cases respectively. High activity of RA was diagnosed in 61.02%, and erosive arthritis in 84.75% pts. Inadequate disease-modifying treatment was qualified in15.26% cases. Majority of pts (59.32%) received systemic glucocorticoids (GC) in daily doses from 2 to 12 mg of methylprednizolon, among these pts 14 (11.86%) have been taken GC in moderate and high dose for a long period. On the basis of instrumental data asymptomatic atherosclerosis of aorta and/or aortic valve and/or carotid arteries was detected in 44 pts (37.29%). Silent ischemia was revealed in 3 pts (2.54%). High disease activity and long term systemic GC treatment were associated with significantly high CV events in observed pts (p<0.05). Using obtained results we reassessed CVR in studied cohort. Revised data of CVR stratification suggest that 49 (41.53%) pts were in VH-CVR, 41 (34.75%) – in H-CVR, 16 (13.56%) in M-CVR and only 12 (10.17%) in L-CVR. The difference in pt ratio for CVR stratification was significant in accordance with χ2; criterion.ConclusionsObtained data suggest that modified SCORE is not absolutely reliable tool for precise CVR stratification in long standing RA. Additional investigations to define asymptomatic atherosclerosis and coronary artery disease are required in term to prevent CV complications especially in pts with high active erosive RA treated with systemic GC.Disclosure of InterestNone declared
Background As a low grade systemic inflammation plays an important role in the pathogenesis of atherosclerosis-associated diseases and diabetes mellitus (DM) there is an interest in the relevance of circulating markers of immune inflammation to clinical manifestation of cardiovascular disease (CVD), especially in the setting of DM. Purpose Purpose of our investigation was to assess the predictive value of numerous immune markers (pro-inflammatory cytokines, anti-connective tissue antibodies) in relation with circulating markers of endothelial dysfunction (ED) in persons with documented ischemic heart disease (IHD), DM, and asymptomatic atherosclerosis (AA). Methods 393 persons (147 pts with IHD, 126 pts with T2DM, 120 pts with AA) were observed during 3-year period. The baseline levels of pro-inflammatory cytokines (IL1β, IL6, TNF-α), antibodies against connective tissue components (collagen – antiC-ab, hyaluronic acid – antiHA-ab, chondroitin sulfate antiCS-ab), soluble markers of ED: von Willebrand factor (vWf), endothelin 1 (ET-1), endogenous NO synthase (eNOs) were evaluated by ELISA. The incidence and severity of cardiovascular events (CVE) in the relation with baseline levels of measured markers were evaluated by cluster analysis in 4 cohorts formed according to presence of AA, current IHD and T2DM (AA, IHD, T2DM, IHD+T2DM). From 2 to 4 clusters were separated depending on the incidence and severity of CVE. Results We have defined that in AA the numerous of circulating markers: ET-1, IL-1β, TNFα, antiC-ab, antiCS-ab was associated with clinically significant CVE. In IHD the most severe clinical manifestations were documented in cluster, characterized by increased ET1, vWf, IL6, antiC-ab levels and decreased eNOs, In T2DM without evidenced IHD CVE were associated with next profile: ET1, eNOs, IL-6, antiC-ab, and antiHA-ab. In combination of IHD with T2DM the worst cluster was presented with raised levels of vWf, TNF-α, IL-6, antiC-ab, anti-HA and CRP as well as decreased eNOs. Conclusions Circulating markers of ED and immune-mediated inflammation reflect the clinical manifestation of IHD in high-risk persons with AA and T2DM. Cluster analysis has demonstrated the relationship between specific baseline profile of investigated biomarkers and clinical significant CVE. Obtained data broads our understanding regarding the inflammatory mechanism of atherosclerosis and also suggest a set of circulating markers as predictors of adverse cardiovascular events.
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