Background In contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity. Methods and results CLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure. Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest. Conclusion In patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes. ClinicalTrials identifier ISRCTN43070564
Aim. To estimate the prevalence of non-acloholic fatty liver disease in patients with chronic hepatitis B, and the association of non-acloholic fatty liver disease with the biochemical, virological and metabolic faсtors. Methods. 53 patients with chronic hepatitis B observed in the regional hospital of infective diseases, Stavropol, at 2008-2012, were included. Patients were distributed to 2 groups according to the results of liver biopsies: group I - patients with hepatosteatosis (5%) and group II - no signs of steatosis (≤5%). Anthropometric, histological, biochemical, virological, and metabolic determinants were compared. Results. Of 53 patients, 18 (34%) liver biopsies had signs of steatosis. Patients with steatosis (group I), compared with group II, were older (43±13 vs 34.5±10.9 years, р=0.015), had higher body mass index (30±5.3 vs 22.9±4.3 kg/m 2, р=0.015), higher level of triglycerides (1.6±0.8 vs 1.06±0.7 mmol/l, р=0.014), higher level of cholesterol (5.6±0.7 vs 4.97±0.9 mmol/l, р=0.012), and higher serum insulin (13±7.9 vs 8.2±3 mkME/l, р=0.002) and leptin levels (16.2±15.6 vs 6.5±5.2 ng/ml, р=0.001). The values of HOMA (Homeostasis Model Assessment) and QUICKI (quantitative insulin sensitivity check index) indices corresponded to insulin resistance (НОМА 2.9±1.8 and 1.9±0.8, р=0.007; QUICKI 0.33±0.02 and 0.35±0.03, р=0.014). There were no differences in histological activity scores by Knodell and fibrosis scores by METAVIR scale between the groups. No reliable differences in virological parameters (viral load and HBeAg status) were obtained. Conclusion. Non-alcoholic fatty liver disease is observed in one-third of patients with hepatitis B and is associated with host metabolic factors, which correspond to the parameters of metabolic syndrome.
Purpose of the study. To study lipid metabolism in chronic hepatitis C and to assess its impact on the formation of insulin resistance, steatosis and progression of liver fibrosis.Materials and methods. The study included 205 patients with chronic hepatitis C (CHC). Conducts research, depending on the genotype C, viral load and body mass index (BMI) of the patients.Results. CHC patients revealed a combined hyperlipoproteinemia on the background of op-pression synthesis of apolipoproteins A1 and B. Formation of hepatic steatosis was associated with HCV genotype 3 virus-induced viral load at ≥ 6 log10 IU/ml and metabolic in VL < 6 log10 IU/ml. In patients with chronic hepatitis C genotype 1, high viral load leads to inhibition of protein synthesis conveyor ApoA1 and increased synthesis of cholesterol, accompanied by abdominal obesity and the formation of insulin resistance. CHC patients with BMI < 25 kg/m2 viral load ≥ 6 log10 ME/ml was associated with dyslipidemia IV type on D. Fredriskson (1970), hyperglycemia, insulin resistance and diabetes. The advanced stage of liver fi brosis (F ≥ 3 on a scale METAVIR) and non-response to treatment were associated with a decrease in HDL cholesterol below normal. With an increase in viral load > 5 log10 ME/ml signifi cantly increased the risk of lipid and carbohydrate metabolism.
1ФГБОУ ВО «Ставропольский государственный медицинский университет» Минздрава России, Ставрополь, Россия; 2 ООО «Лихвинские воды», Тульская область, пос. Рождествено, Россия; 3 ФГБУН Институт химической физики им. Н.Н. Семенова РАН, Ул. Косыгина 4, Москва РФ, 119991; 4 ФГБУН Институт химической физики им. Н.Н. Семенова РАН, Ул. Косыгина 4, Москва РФ, 119991 К развитию респираторных инфекций предрасполагает снижение иммунитета (в том числе местного), и в частности, секреторного иммуноглобулина А (sIgA), поэтому оптимальным лечением является комплексное воздействие как на вирусы, так и на иммунную систему. Одним из таких препаратов является спрей «Панавир Инлайт», обладающий активностью в отношении различных ДНК-и РНК-содержащих вирусов. Цель исследования -изучить клиническую эффективность спрея «Панавир Инлайт» при комплексном лечении гриппа и ОРВИ у взрослых пациентов инфекционного стационара. Материал и методы. В клиническом исследовании сезона 2017-2018 гг. принимали участие 66 больных гриппом и ОРВИ в возрасте от 18 до 56 лет, не получавших противовирусную терапию до госпитализации. Пациенты были рандомизированы на две группы по 33 человека. Больные из группы А получали стандартную противовирусную терапию и спрей «Панавир Инлайт» 2-5 раз в день. Пациенты группы В получали монотерапию противовирусными препаратами. Помимо традиционных методов обследования, определяли уровень sIgA в слюне до начала комплексной терапии и по окончании применения противовирусной терапии. Результаты. Использование спрея «Панавир Инлайт» увеличивало шансы купирования катаральных проявлений: боли в горле (ОШ 41,1; 95% ДИ 4,5-379,6), першения в горле (ОШ 23,8; 95% ДИ 5,6-100,8) и гиперемии ротоглотки (ОШ 19,6; 95% ДИ 2,3-164,1). Показатели sIgA до лечения не отличались в обеих группах (р>0,05). В группе А после комплексной терапии отмечали повышение sIgA (р<0,001). В группе В на фоне монотерапии противовирусными препаратами sIgA, напротив, снижался (р<0,001) и был ниже показателей в группе А после лечения (р<0,001). Средняя продолжительность госпитализации в группе А составляла 10,2±1,2 сут, в группе В -11,8±1,1 сут (р<0,01). Заключение. Учитывая эффективность и безопасность целесообразно включение спрея «Панавир Инлайт» в комплексную терапию ОРВИ и гриппа у взрослых.The decrease in immunity (including local immunity), and in secretory immunoglobulin (sIgA) in particular, predisposes to respiratory infections, so the best treatment is to exert complex effects on both viruses and the immune system. One of such agents is Panavir Inlight spray that has activity against various DNA-or RNA-containing viruses. Objective -to investigate the clinical efficacy of Panavir Insight spray in the combination treatment of influenza and acute respiratory viral infections (ARVI) in the adult patients of an infectious disease hospital. Subject and methods. The clinical trial during the 2017-2018 season covered 66 patients aged 18 to 56 years with influenza and ARVI who did not receive antiviral therapy prior to hospitalization. The patients were randomize...
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