The agreement of experts of the Eurasian Association of Therapists (EAT) discusses pathogenesis and treatment of COVID-19. Modern data on the characteristics of cardiovascular, kidney, respiratory damage in SARS-infected CoV-2 are presented. The tactics of managing patients initially having cardiovascular diseases, diabetes mellitus, chronic obstructive pulmonary disease, bronchial asthma, chronic kidney disease are discussed in detail. The article presents data on drug interaction of drugs.
The aim of the study is to identify the relationships between the functional state of vascular endothelium and regional cerebral blood flow in people of working age with moderate to severe obstructive sleep apnea syndrome. A transverse prospective observational study was conducted. It included 24 patients. Among them were 16 patients of working age with moderate to severe obstructive sleep apnea syndrome who were included in the main study group and 8 patients without sleep disorders in the control group according to polysomnography. The levels of biochemical markers of endothelial dysfunction, the indicators of endothelium-dependent vasodilation of the brachial artery were determined. Single-photon emission computed tomography of the brain was performed using 99mTc-hexamethylpropyleneaminoxime. In the patients of working age with moderate to severe obstructive sleep apnea syndrome, significantly lower average group values of the serum nitric oxide level of 11.7 (6.25‒18.30) μmol/l were detected versus 34.4 (25.33‒41.70) μmol/l in the control group, p < 0.01), as well as higher homocysteine concentrations of 19.4 (15.13‒23.76) μmol/l versus 11.6 (6.40‒ 14.71) μmol/l in the control group, p < 0.05, sP-selectin 176 (142.0‒189.0) ng/ml versus 122 (113.3‒168.5) ng/ml in the control group, p < 0.05, and sE β-selectin 78 (69.0‒121.0) ng/ml versus 52 (43.1‒73.3) ng/ml in the control group, p < 0.05. The data on the correlation of the level of neurohumoral markers of endothelial dysfunction of sP-selectin (p < 0.01) and sE-selectin (p < 0.05) with the degree of impaired regional cerebral blood flow were obtained. A direct relationship was found between the markers of endothelium-dependent vasodilation and regional cerebral blood flow in the frontal segments (p < 0.05), the temporal segment on the right (p < 0.05).
The aim of the study was to investigate the features of clinically suspected myocarditis complicated by the left ventricular systolic dysfunction development. 93 patients with clinically suspected myocarditis were examined. The average age was 36.63 ± 1.15 years. In 43.01 % of patients the disease was accompanied by a decrease in left ventricular systolic function. In the group of patients with left ventricular systolic dysfunction in comparison with those with preserved left ventricular ejection fraction, a significantly lower proportion of men (75 % versus 81 %, respectively, χ2 = 9.3, p < 0,01) and a higher average group age (40.7 ± 1.87 versus 33.6 ± 1.3 years, respectively, p < 0,01) were revealed. The course of the disease in patients with left ventricular systolic dysfunction was characterized by a more frequent development of rhythm disturbances (65 % versus 43.3 %, respectively, χ2 = 4.3, p < 0,05) and a higher heart rate at admission (94.5 (75‒100) and 85 (70‒89) beats per minute, respectively, p = 0.006). The structural and functional state of the heart according to echocardiography in patients with a reduced left ventricular ejection fraction versus comparison group was characterized by larger heart chambers sizes, more pronounced violations of local left ventricular contractility, more frequent involvement of the right ventricle in the pathological process (56.3 % versus 22.2 %, respectively, χ2 = 6.4, p < 0,05). The relationships between the left ventricular ejection fraction Весці Нацыянальнай акадэміі навук Беларусі. Серыя медыцынскіх навук. 2020. Т. 17, № 4. C. 452–460 453 and the patient’s age (r = ‒0.36), the value of the heart rate at admission (r = ‒0.32), the severity of heart failure at admission, the degree of impaired local contractility of the left ventricle, the degree of right ventricular function (TAPSE, r = 0.58), the severity of myocardial fibrosis according to cardiovascular magnetic resonance imaging (r = ‒0.32) were revealed.
The aim of the study is assess the dynamics of laboratory and instrumental parameters (these are cardiovascular risk factors) in patients with chronic kidney disease in the preoperative period and after renal transplantation.A single-center prospective cohort study included 43 kidney transplant recipients. Clinical examination, laboratory and instrumental studies were carried out in the preoperative period, in six months and in five years after transplantation. Laboratory tests included a complete blood count, coagulation, biochemical blood test and enzyme-linked immunosorbent assays. The dynamics of structural and functional heart parameters was studied by echocardiography in the preoperative period and in five years.It was found that the blood pressure, pulse rate, and hypotension episodes decreased after renal transplantation. Hyperaldosterone in the preoperative period was more common than after transplantation. It was observed that the blood level of total cholesterol, triglycerides, interleukin-6, tumor necrosis factor-α, and C-reactive protein decreased in the postoperative period. The hyperglycemia incidence significantly decreased by the end of the observation period. It was detected that the NT-proBNP level increased in all recipients in the preoperative period and decreased to normal values in 37.2 % (n = 16) recipients in the postoperative period. The number of red blood cells and the hemoglobin concentration increased and the hyperethropoietinemia incidence decreased in the postoperative period. The glomerular filtration rate was lower in six months after transplantation than in five years.
The condition of gastric mucosa was assessed in relatives of patients with gastric cancer (RPGC). The study included 108 RPGC (main group) and 102 patients with no family history of gastric cancer who were screened for dyspepsia. All study participants were subjected to clinical examination, questioning and esophagogastroduodenoscopy (EGDS) with a biopsy, in which the gastric mucosa state was assessed according to the modified Sydney system, the OLGA and OLGIM systems, and the definition of Helicobacter pylori (H. pylori) infection. It was established that the prevalence of H. pylori infection in the main group was 58.3 % (95 % CI 48.8–67.7), in the control group – 56.0 % (95 % CI 46.1–65.6). At RPGC, atrophy of any localization (46.3 % (95 % CI 39.4–53.2) versus 26.5 % (95 % CI 20.4–32.6), respectively, was found more often than in the control group, respectively, p = 0.002), antral atrophic gastritis (41.6 % (95 % CI 34.8–48.4) versus 26.5 % (95 % CI 20.4–32.6), respectively, p = 0.020), and isolated atrophy in the stomach body (4.6 % (95 % CI 1.7–7.4) versus 0 % ( p = 0.03). In RPGC, atrophy developed at a younger age (48.0 years (95 % CI 44.0–52.0) versus 53.0 years in the control group (95 % CI 48.3–57.8) p = 0.000). There were no significant differences between the groups in the incidence of metaplasia and dysplasia. The following risk factors for development of atrophy were identified in the factor analysis: age over 6f0 years (odd ratio (OR) 53.0; 95 % CI 12.2–390.1; p < 0.001), age over 40 years (OR 4.0; 95 % CI 2.0–8.2; p < 0.001), heredity burdened by gastric cancer (OR 2.7; 95 % CI 1.4–5.7; p = 0.006) and the use of strong alcoholic beverages (OR 5.5; 95 % CI 1.6–21.6; p = 0.009). The frequency of the atrophy development of the gastric mucosa is increased in RPGC, and atrophic gastritis develops at a younger age in comparison with individuals without a burdened hereditary history. In addition to the hereditary factor, the risk of atrophy is associated with age and alcohol use.
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