РазноеКлиническая и прогностическая значимость бендопноэ у больных пожилого возраста, наблюдающихся в амбулаторных условиях Ларина В. Н., Головко М. Г., Захарова М. И., Богуш Н. Л., Порядин Г. В. ФГБОУ ВО "Российский национальный исследовательский медицинский университет имени Н. И. Пирогова" Минздрава России. Москва, Россия Цель. Оценка клинической и прогностической значимости одышки при наклоне туловища вперед у больных пожилого возраста, наблюдающихся в амбулаторных условиях. Материал и методы. В открытое, проспективное нерандомизированное исследование были включены 55 амбулаторных пациентов в возрасте ≥60 лет с хронической сердечной недостаточностью (ХСН) II-IV функционального класса (NYHA) вследствие ишемической болезни сердца или артериальной гипертонии, индексом массы тела (ИМТ) <30 кг/м 2 . Проводили общепринятый осмотр, оценку лабораторных параметров, эхокардиографическое исследование. Результаты. Одышка при наклоне туловища вперед выявлена у 45% пациентов. Бендопноэ ассоциировалось с инфарктом миокарда в анамнезе (р<0,001), отношение шансов (ОШ) 11,5, 95% доверительный интервал (ДИ) 2,7-47,8, аневризмой левого желудочка (р=0,005, ОШ 9,4, 95% ДИ 1,7-54,5), увеличенным конечносистолическим размером (р=0,003, ОШ 18,4, 95% ДИ 2,69-12,5), низкой фракцией выброса (р<0,001, ОШ 19,2, 95% ДИ 4,46-8,23), госпитализациями (р=0,004, ОШ 2,6, 95% ДИ 1,4-4,9). Заключение. Одышку при наклоне туловища вперед имели 45% пациентов ≥60 лет с ИМТ <30,0 кг/м 2 , которая не зависела от ИМТ, и тесно ассоциировалась с тяжестью клинического состояния, эхокардиографическими параметрами и госпитализациями. Полученные результаты позволяют рассматривать этот симптом в качестве маркера тяжести клинического состояния и выраженного застоя у амбулаторных пациентов старшего возраста с хронической сердечной недостаточностью без сопутствующего ожирения. Ключевые слова: одышка, бендопноэ, хроническая сердечная недостаточность, пожилые пациенты.Конфликт интересов: не заявлен.
Acute viral respiratory infections can increase the risk of progression of a pre-existing condition, including a cardiovascular pathology. Life-threatening complications of Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) necessitate research into the cardiovascular effects of COVID-19 crucial for developing adequate treatment strategy for infected patients, especially those of advanced age. This article reviews the literature on the clinical and functional characteristics of patients with COVID-19, including those with poor outcomes. The article looks at the pathophysiological processes occurring in the cardiovascular system in the setting of SARS-CoV-2 infection, risk factors and death predictors. It also discusses continuation of therapy with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in patients with COVID-19.
Statistical analysis Categorical variables were presented as the number and percentage of patients, and continuous variables as mean (SD) or median (IQR, Q1-Q3) as appropriate. Differences in clinical characteristics at baseline with regard to bendopnea were compared using the χ 2 test for categorical variables and the t test or the nonparametric Mann-Whitney test for continuous variables. Normality was assessed using the Kolmogorov-Smirnov test. Multivariate logistic regression was used to evaluate the odds ratio (OR) and its 95% CI. Bendopnea was a dependent variable. Left ventricular end-systolic dimension, BMI, waist circumference were continuous variables; low left ventricular ejection fraction (<40%), HF decompensation were dichotomized variables. A 2-tailed P value of less than 0.05 was deemed significant. The statistical analyses were performed using the SPSS software, version 22.0 (IBM Corporation, Armonk, New York, United States). Results and discussion Bendopnea was present in 35 patients (41.6%). All patients with bendopnea
The article discusses modern approaches to screening for dyslipidemia and its control, target levels of low-density lipoproteins (LDL), initiation of lipid-lowering therapy depending on the total risk on the Systematic Coronary Risk Evaluation (SCORE) scale, considering the effects of age, gender, smoking, blood pressure, lipid levels, which are of crucial importance for selecting preventive and therapeutic strategies in patients with several risk factors. Different types of therapy for dyslipidemia are discussed as of monotherapy with statins and, in combination with ezetimibe, inhibitors of the enzyme proprotein convertase subtilisin-kexin type 9 (PCSK9). New lipid-lowering drugs are highlighted: bempedoic acid and inclisiran, a synthetic small interfering RNA (siRNA) conjugated with a hydrocarbon of three-antennary N-acetylgalactosamine, which activates the natural RNA interference mechanism to cleave the mRNA of the PCSK9 enzyme and prevent its translation into a protein molecule. This increases the number of receptors for LDL and reducing their amount in the blood. We present our results of assessing the use of lipid-lowering therapy and achievement of the target LDL value in very high-risk patients. Innovative biotechnological drugs based on human monoclonal antibodies or antisense oligonucleodins create additional opportunities for improving the treatment of statin-resistant forms of dyslipidemia in patients with a very high cardiovascular risk. The article aims to increase the level of knowledge about modern approaches to lipid-lowering therapy of general practitioners, cardiologists of the primary care settings and will be of interest to other specialists.
Aim. Assessment of the frequency of reaching the target level of blood pressure (BP) and the factors affecting it in outpatients with arterial hypertension (AH). Materials and methods. An open, one-stage, comparative study involving 64 patients with hypertension and 47 without hypertension at the age of 40 to 59 years. All patients underwent physical examination, assessment of cardiovascular risk (CVR), 24-hour blood pressure monitoring (ABPM), echocardiography (ECHOCG), color duplex scanning of brachiocephalic arteries. Results. Patients with hypertension and comparison groups were comparable in age, sex, smoking, history of myocardial infarction. 1st degree of hypertension was present in 26.6%, 2nd in 40.6%, 3rd in 12.5% of patients. Obesity was detected in 24.3% of patients and all patients with obesity had AH. The SCORE score in individuals with hypertension was 4.94.5; in the comparison group, 2.32.6 (p0.001). Non-stenosing atherosclerosis was present in 54.8% and 88%, p=0.020, and atherosclerotic plaque in the vascular lumen was present in 45.3% and 12% of patients with and without hypertension, respectively (p0.001). 68.8% were constantly treated, and the target BP was reached in 31.3% of patients with hypertension. Male gender (OR 1.68; 95% CI 1.6828.49; p=0.007), obesity (OR 4.78; 95% CI 1.1420.29; p=0.033), concomitant pathology (OR 3.09; 95% CI 1.029.37; p=0.046) were negative, and dyslipidemia (OR 0.10; 95% CI 0.010.84; p=0.033) was positive, affecting the achievement of the target level of blood pressure. Conclusion. The target level of blood pressure was achieved in 31.3% of outpatients with hypertension, mainly in women. Among patients who did not reach the target level of blood pressure, men, individuals with high SSR and obesity predominated. Concomitant pathology and obesity are negative, and dyslipidemia was positively associated with the achievement of the target level of blood pressure, which must be taken into account when developing measures for prevention and treatment.
Острые вирусные инфекции дыхательных путей могут увеличить вероятность прогрессирования имеющейся сопутствующей патологии, в том числе сердечно-сосудистого происхождения. Появление жизнеугрожающих осложнений на фоне коронавируса 2 (severe acute respiratory syndrome coronavirus 2, или SARS-CoV-2), вызывающего коронавирусную болезнь 2019 (Coronavirus disease 2019, или COVID-19), обусловливает необходимость изучения кардиоваскулярных эффектов COVID-19 с целью оказания рациональной медицинской помощи пациентам, особенно старшего возраста. В статье представлен обзор литературных данных, посвященных анализу клинико-функциональных особенностей пациентов с COVID-19, в том числе имевших неблагоприятный прогноз. Уделено внимание патофизиологическим особенностям, происходящим на фоне инфекционного процесса в сердечно-сосудистой системе, факторам риска и предикторам летальности при COVID-19. Обсуждается вопрос о возможности продолжения приема ингибиторов ангиотензин-превращающего фермента или антагонистов рецепторов ангиотензина II большинством пациентов с сердечно-сосудистыми заболеваниями и COVID-19.
The article presents the experience of teaching the discipline «outpatient therapy» in a remote format at the department of outpatient therapy of the medical faculty of the Russian National Research Medical University. N.I. Pirogov during the COVID-19 pandemic. The contribution of the department to the training of personnel for primary health care, the principles of organizing the pedagogical process in the epidemic period for interacting with students and monitoring the knowledge gained are presented. The importance of an automated educational system in the process of distance learning is discussed, which significantly accelerated and facilitated the work of the faculty of the department. The role of the «trigger mechanism» of distance learning for the intensification of the work of the department’s employees in the creation of educational, methodological, control and measuring materials and self-improvement for close interaction with technical innovations is noted. The remote type of work with students is possible, but it is not perfect - no «analogue» of the generally accepted training at the university can replace the «live communication» of the teacher with the student.
The article provides a detailed analysis of the educational complex in the discipline "Outpatient therapy", which is taught at the relevant departments of RNIMU named after N.I. Pirogov and the department of the same name VSMU named after N.N. Burdenko. Both of these universities are part of the East European NOMK, which was created to implement the Strategy for the Development of Medical Science in the Russian Federation for the period until 2025. The fundamental difference between the educational process in the two universities is the different distribution of the hourly load across semesters and the methodological approach to studying the discipline. Various approaches to teaching discipline in universities are aimed at achieving a common goal - the training of medical personnel focused on achievement of a common goal - the training of medical personnel oriented to the professional standard “Physician-general practitioner (district general practitioner)” and the provision of primary health care. The experience accumulated by the staff of the departments allows us to fully approach the training of specialists and, quite justifiably, to begin interaction between structures for the exchange of this experience.
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