Pub Date : 2023-11-12DOI: 10.30629/0023-2149-2023-101-9-10-449-453
V. B. Tskhai, P. A. Shesternya
Planning and managing pregnancy in the context of an existing rheumatic disease is a serious problem widely discussed in the medical community. Behcet’s syndrome (Behcet’s disease) is one of the least studied diseases in this context. Data on the mutual influence of vasculitis and pregnancy on the course and outcomes are contradictory. There is an obvious need for interdisciplinary support of pregnancy by an obstetrician-gynecologist and a rheumatologist to minimize the risk of losses and complications in this complex clinical situation. This review presents data published over the past two decades on the use of genetically engineered biological drugs in rheumatology.
{"title":"Behcet's syndrome and pregnancy","authors":"V. B. Tskhai, P. A. Shesternya","doi":"10.30629/0023-2149-2023-101-9-10-449-453","DOIUrl":"https://doi.org/10.30629/0023-2149-2023-101-9-10-449-453","url":null,"abstract":"Planning and managing pregnancy in the context of an existing rheumatic disease is a serious problem widely discussed in the medical community. Behcet’s syndrome (Behcet’s disease) is one of the least studied diseases in this context. Data on the mutual influence of vasculitis and pregnancy on the course and outcomes are contradictory. There is an obvious need for interdisciplinary support of pregnancy by an obstetrician-gynecologist and a rheumatologist to minimize the risk of losses and complications in this complex clinical situation. This review presents data published over the past two decades on the use of genetically engineered biological drugs in rheumatology.","PeriodicalId":17856,"journal":{"name":"Klinicheskaia meditsina","volume":"36 29","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135038518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-12DOI: 10.30629/0023-2149-2023-101-9-10-441-448
V. E. Milyukov, V. A. Bryukhanov, С. С. Nguyen
Cardioembolic stroke, like other types of acute cerebrovascular disorders, is a global priority medical and social problem. This review analyzes the role of anatomical factors, which, along with other factors of thrombus formation in the heart chambers, may represent an important and yet insufficiently studied link in the pathogenesis of this disease.
{"title":"Anatomical factors of intracavitary thrombus formation in the pathogenesis of cardioembolic stroke","authors":"V. E. Milyukov, V. A. Bryukhanov, С. С. Nguyen","doi":"10.30629/0023-2149-2023-101-9-10-441-448","DOIUrl":"https://doi.org/10.30629/0023-2149-2023-101-9-10-441-448","url":null,"abstract":"Cardioembolic stroke, like other types of acute cerebrovascular disorders, is a global priority medical and social problem. This review analyzes the role of anatomical factors, which, along with other factors of thrombus formation in the heart chambers, may represent an important and yet insufficiently studied link in the pathogenesis of this disease.","PeriodicalId":17856,"journal":{"name":"Klinicheskaia meditsina","volume":"36 28","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135038519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-23DOI: 10.30629/0023-2149-2023-101-7-8-413-415
A. T. Kortieva, V. S. Krushelnitskiy, S. A. Gabriel, V. Yu. Dynko, A. Ya. Guchetl, R. M. Tlekhurаy
Ectopic varices are any pathologically dilated collaterals in diff erent areas of the gastrointestinal tract, developing as a result of portal hypertension. When localized in the digestive system, varicose veins can be the cause of approximately 5% of cases of bleeding, with a high (up to 40%) fatality rate due to the diffi culty in diagnosing and treating them. The aim of this study is to present a rare clinical observation of recurrent gastrointestinal bleeding from varicose veins of the small intestine. Materials and methods: this article presents a clinical case of recurrent bleeding from ectopic varicose veins of the small intestine in a 65-year-old female patient. The patient was admitted to our hospital with complaints of tarry stools and weakness. She had undergone esophagogastroduodenoscopy (EGD) and colonoscopy (CS) at her place of residence, but no pathology was detected. She was referred to the surgical department of the State Budgetary Healthcare Institution “City Clinical Hospital No. 2” to determine the treatment strategy. In the conditions of the City Clinical Hospital No. 2 in Krasnodar, comprehensive endoscopic diagnostics of the digestive system were performed on the patient, including EGD, CS, video capsule endoscopy (VCE), and balloon-assisted enteroscopy (BAE). Results : erosions of the prepyloric part of the stomach were detected during EGD. Data indicating bleeding from the upper parts of the digestive system were found during colonoscopy. After appropriate preparation, video capsule endoscopy (VCE) was performed on the patient, which revealed signs of ongoing bleeding. Balloonassisted enteroscopy (BAE) was performed on the patient under endotracheal anesthesia in the operating room. Multiple bluish varicose veins, protruding into the lumen up to a distance of 4–5 mm, were visualized throughout the examined length of the small intestine (80 cm from the Treitz ligament). The patient underwent surgical intervention — resection of the aff ected segment of the small intestine. Conclusions : the presented modern methods of small bowel examination — capsule endoscopy and balloon-assisted enteroscopy — provide the opportunity for highly informative endoscopic examination, which signifi cantly aff ects the timeliness of diagnosis and early detection of small bowel diseases.
{"title":"Varicose veins of the jejunum as a rare source of recurrent bleeding","authors":"A. T. Kortieva, V. S. Krushelnitskiy, S. A. Gabriel, V. Yu. Dynko, A. Ya. Guchetl, R. M. Tlekhurаy","doi":"10.30629/0023-2149-2023-101-7-8-413-415","DOIUrl":"https://doi.org/10.30629/0023-2149-2023-101-7-8-413-415","url":null,"abstract":"Ectopic varices are any pathologically dilated collaterals in diff erent areas of the gastrointestinal tract, developing as a result of portal hypertension. When localized in the digestive system, varicose veins can be the cause of approximately 5% of cases of bleeding, with a high (up to 40%) fatality rate due to the diffi culty in diagnosing and treating them. The aim of this study is to present a rare clinical observation of recurrent gastrointestinal bleeding from varicose veins of the small intestine. Materials and methods: this article presents a clinical case of recurrent bleeding from ectopic varicose veins of the small intestine in a 65-year-old female patient. The patient was admitted to our hospital with complaints of tarry stools and weakness. She had undergone esophagogastroduodenoscopy (EGD) and colonoscopy (CS) at her place of residence, but no pathology was detected. She was referred to the surgical department of the State Budgetary Healthcare Institution “City Clinical Hospital No. 2” to determine the treatment strategy. In the conditions of the City Clinical Hospital No. 2 in Krasnodar, comprehensive endoscopic diagnostics of the digestive system were performed on the patient, including EGD, CS, video capsule endoscopy (VCE), and balloon-assisted enteroscopy (BAE). Results : erosions of the prepyloric part of the stomach were detected during EGD. Data indicating bleeding from the upper parts of the digestive system were found during colonoscopy. After appropriate preparation, video capsule endoscopy (VCE) was performed on the patient, which revealed signs of ongoing bleeding. Balloonassisted enteroscopy (BAE) was performed on the patient under endotracheal anesthesia in the operating room. Multiple bluish varicose veins, protruding into the lumen up to a distance of 4–5 mm, were visualized throughout the examined length of the small intestine (80 cm from the Treitz ligament). The patient underwent surgical intervention — resection of the aff ected segment of the small intestine. Conclusions : the presented modern methods of small bowel examination — capsule endoscopy and balloon-assisted enteroscopy — provide the opportunity for highly informative endoscopic examination, which signifi cantly aff ects the timeliness of diagnosis and early detection of small bowel diseases.","PeriodicalId":17856,"journal":{"name":"Klinicheskaia meditsina","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135966449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-22DOI: 10.30629/0023-2149-2023-101-7-8-368-375
S. A. Aliyev, E. S. Aliyev
The article is dedicated to the current problem of pyoseptic surgery, presenting an analytical review of the systematic literature that covers one of the rare forms of necrotizing fasciitis — Fournier’s gangrene. From the perspective of an evolutionary approach, the historical milestones in the formation of scientifi c views on the essence and etiopathogenesis of the disease, its epidemiology, classifi cation, clinical presentation, diagnosis, and treatment are presented. In the context of the defi nition, it is declared that in the modern understanding, “Fournier’s gangrene” implies a particular (specifi c) model of critical conditions in surgery, which is characterized by progressive purulent-necrotic lesions and putrefactive decomposition of fascial and soft tissue structures of the external genitalia, manifesting with systemic endotoxemia, septic shock, and high mortality rates. It is postulated that the intravascular invasion of causative microfl ora is at the basis of the pathogenetic mechanism of Fournier’s gangrene development, resulting in disseminated thrombosis of the microcirculatory bed of the superfi cial fascia of the scrotum. In accordance with the principles of evidence-based medicine, modern methods of diagnosis and treatment are outlined. It is shown that urgent surgical intervention in the format of “aggressive surgery,” with the main component being “manual elimination” of necrotic and non-viable tissues achieved through programmed (staged) sanitation necrectomy, is a priority in the treatment of patients with Fournier’s gangrene. Issues of adjuvant therapy using methods such as laser sanitation, vacuum wound therapy, and hyperbaric oxygenation are discussed. Based on a multifactorial analysis of data from contemporary literature, it is declared that a crucial condition that signifi cantly infl uences treatment outcomes and disease prognosis is a multidisciplinary approach to solving diagnostic and therapeutic tasks involving doctors from related specialties (surgeons, coloproctologists, urologists, dermatologists, intensivists, radiologists, bacteriologists).
{"title":"Fournier's gangrene аs a multidisciplinary problem of purulent septic surgery","authors":"S. A. Aliyev, E. S. Aliyev","doi":"10.30629/0023-2149-2023-101-7-8-368-375","DOIUrl":"https://doi.org/10.30629/0023-2149-2023-101-7-8-368-375","url":null,"abstract":"The article is dedicated to the current problem of pyoseptic surgery, presenting an analytical review of the systematic literature that covers one of the rare forms of necrotizing fasciitis — Fournier’s gangrene. From the perspective of an evolutionary approach, the historical milestones in the formation of scientifi c views on the essence and etiopathogenesis of the disease, its epidemiology, classifi cation, clinical presentation, diagnosis, and treatment are presented. In the context of the defi nition, it is declared that in the modern understanding, “Fournier’s gangrene” implies a particular (specifi c) model of critical conditions in surgery, which is characterized by progressive purulent-necrotic lesions and putrefactive decomposition of fascial and soft tissue structures of the external genitalia, manifesting with systemic endotoxemia, septic shock, and high mortality rates. It is postulated that the intravascular invasion of causative microfl ora is at the basis of the pathogenetic mechanism of Fournier’s gangrene development, resulting in disseminated thrombosis of the microcirculatory bed of the superfi cial fascia of the scrotum. In accordance with the principles of evidence-based medicine, modern methods of diagnosis and treatment are outlined. It is shown that urgent surgical intervention in the format of “aggressive surgery,” with the main component being “manual elimination” of necrotic and non-viable tissues achieved through programmed (staged) sanitation necrectomy, is a priority in the treatment of patients with Fournier’s gangrene. Issues of adjuvant therapy using methods such as laser sanitation, vacuum wound therapy, and hyperbaric oxygenation are discussed. Based on a multifactorial analysis of data from contemporary literature, it is declared that a crucial condition that signifi cantly infl uences treatment outcomes and disease prognosis is a multidisciplinary approach to solving diagnostic and therapeutic tasks involving doctors from related specialties (surgeons, coloproctologists, urologists, dermatologists, intensivists, radiologists, bacteriologists).","PeriodicalId":17856,"journal":{"name":"Klinicheskaia meditsina","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136098848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-22DOI: 10.30629/0023-2149-2023-101-7-8-404-409
A. A. Sheptulin, O. A. Storonova, P. V. Pavlov, A. S. Tertychny, D. D. Protsenko, X. V. Feoktistova
The article discusses the controversial terminology of biliary refl ux gastritis and the factors predisposing to its occurrence. Pathogenesis of this disease includes 2 main components: disorders of motility of the stomach and duodenum, leading to duodeno-gastric refl ux, and direct damaging eff ect of hydrophobic bile acids and lysolecithin on the protective barrier of the stomach mucosa. Clinical picture of biliary refl ux gastritis is nonspecifi c and most often corresponds to dyspepsia syndrome. Esophagogastroduodenoscopy with biopsy and subsequent histological examination, 24-hour pH-metry of the stomach, monitoring of bilirubin level in gastric contents are used in diagnostics of this disease. Treatment of biliary refl ux gastritis includes prescription of ursodeoxycholic acid, prokinetics, antacids, proton pump inhibitors, cytoprotectors. Given the insuffi cient study and controversial coverage of many aspects of biliary refl ux gastritis, this problem requires further research.
{"title":"Biliary refl ux gastritis: features of pathogenesis, diagnostics and treatment","authors":"A. A. Sheptulin, O. A. Storonova, P. V. Pavlov, A. S. Tertychny, D. D. Protsenko, X. V. Feoktistova","doi":"10.30629/0023-2149-2023-101-7-8-404-409","DOIUrl":"https://doi.org/10.30629/0023-2149-2023-101-7-8-404-409","url":null,"abstract":"The article discusses the controversial terminology of biliary refl ux gastritis and the factors predisposing to its occurrence. Pathogenesis of this disease includes 2 main components: disorders of motility of the stomach and duodenum, leading to duodeno-gastric refl ux, and direct damaging eff ect of hydrophobic bile acids and lysolecithin on the protective barrier of the stomach mucosa. Clinical picture of biliary refl ux gastritis is nonspecifi c and most often corresponds to dyspepsia syndrome. Esophagogastroduodenoscopy with biopsy and subsequent histological examination, 24-hour pH-metry of the stomach, monitoring of bilirubin level in gastric contents are used in diagnostics of this disease. Treatment of biliary refl ux gastritis includes prescription of ursodeoxycholic acid, prokinetics, antacids, proton pump inhibitors, cytoprotectors. Given the insuffi cient study and controversial coverage of many aspects of biliary refl ux gastritis, this problem requires further research.","PeriodicalId":17856,"journal":{"name":"Klinicheskaia meditsina","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136098850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-22DOI: 10.30629/0023-2149-2023-101-7-8-395-403
I. V. Samorodskaya, I. V. Klyuchnikov
The level of mortality from ischemic heart disease (IHD) is infl uenced by a signifi cant number of factors. Objective . Assessment of the dynamics and variability of standardized mortality rates (SMR) from chronic IHD and acute forms of ischemic heart disease (AIHD) in the regions of the Russian Federation (RF) in 2013–2021. Material and methods . Data from Rosstat for 2013–2021 on the average annual population and number of deaths in one-year age groups in 82 regions of the RF based on the “Brief Nomenclature of Causes of Death of Rosstat” (BNCDR). SMRs were calculated based on the European standard per 100,000 population. Results . From 2013 to 2019, most regions showed an unstable trend towards a decrease in SMRs from chronic IHD, myocardial infarction (MI), and other AIHD (ICD codes — I20.0, I20.1–9), and an increase in SMRs in 2020 and 2021. The greatest decrease in SMRs was registered for other AIHD (40.2 ± 37.9 in 2013 and 20.5 ± 26.8 in 2021 per 100,000 of population). The coeffi cient of variation between regional SMRs for other AIHD was 120%, for MI — 45%, and for chronic IHD — 37%. Statistically signifi cant diff erences between 2021 and 2013 were found for SMRs from chronic IHD (225.3 ± 76.5 and 207.4 ± 76.9), other AIHD, but not for MI (38.2 ± 18.1 and 30.7 ± 14). Overall, the SMRs from all forms of IHD in 2021 exceeded the indicators of 2013 in 19 regions. The variability and dynamics of regional SMRs from diff erent forms of IHD may be due to both the possibilities and quality of preventive and therapeutic measures, as well as diff erent approaches to determining the cause of death. Conclusions . Most regions show unstable dynamics towards a decrease in SMRs from diff erent forms of IHD, and the obtained results require clarifi cation of the criteria for IHD as the underlying cause of death.
{"title":"Dynamics of mortality rates from chronic and acute coronary heart disease in the regions of the Russian Federation in 2013–2021","authors":"I. V. Samorodskaya, I. V. Klyuchnikov","doi":"10.30629/0023-2149-2023-101-7-8-395-403","DOIUrl":"https://doi.org/10.30629/0023-2149-2023-101-7-8-395-403","url":null,"abstract":"The level of mortality from ischemic heart disease (IHD) is infl uenced by a signifi cant number of factors. Objective . Assessment of the dynamics and variability of standardized mortality rates (SMR) from chronic IHD and acute forms of ischemic heart disease (AIHD) in the regions of the Russian Federation (RF) in 2013–2021. Material and methods . Data from Rosstat for 2013–2021 on the average annual population and number of deaths in one-year age groups in 82 regions of the RF based on the “Brief Nomenclature of Causes of Death of Rosstat” (BNCDR). SMRs were calculated based on the European standard per 100,000 population. Results . From 2013 to 2019, most regions showed an unstable trend towards a decrease in SMRs from chronic IHD, myocardial infarction (MI), and other AIHD (ICD codes — I20.0, I20.1–9), and an increase in SMRs in 2020 and 2021. The greatest decrease in SMRs was registered for other AIHD (40.2 ± 37.9 in 2013 and 20.5 ± 26.8 in 2021 per 100,000 of population). The coeffi cient of variation between regional SMRs for other AIHD was 120%, for MI — 45%, and for chronic IHD — 37%. Statistically signifi cant diff erences between 2021 and 2013 were found for SMRs from chronic IHD (225.3 ± 76.5 and 207.4 ± 76.9), other AIHD, but not for MI (38.2 ± 18.1 and 30.7 ± 14). Overall, the SMRs from all forms of IHD in 2021 exceeded the indicators of 2013 in 19 regions. The variability and dynamics of regional SMRs from diff erent forms of IHD may be due to both the possibilities and quality of preventive and therapeutic measures, as well as diff erent approaches to determining the cause of death. Conclusions . Most regions show unstable dynamics towards a decrease in SMRs from diff erent forms of IHD, and the obtained results require clarifi cation of the criteria for IHD as the underlying cause of death.","PeriodicalId":17856,"journal":{"name":"Klinicheskaia meditsina","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136099295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-22DOI: 10.30629/0023-2149-2023-101-7-8-425-428
M. Sh. Knopov
The article presents the life and creative path of a prominent Russian surgeon, a talented organizer of military fi eld surgery, a well-known public figure, an excellent clinician, a wonderful teacher, Honored Scientist of the RSFSR, professor, Major General of the medical service Vladimir Semyonovich Levit.
{"title":"Levit is a prominent scientist and a talented surgeon (on the 140th anniversary of his birth)","authors":"M. Sh. Knopov","doi":"10.30629/0023-2149-2023-101-7-8-425-428","DOIUrl":"https://doi.org/10.30629/0023-2149-2023-101-7-8-425-428","url":null,"abstract":"The article presents the life and creative path of a prominent Russian surgeon, a talented organizer of military fi eld surgery, a well-known public figure, an excellent clinician, a wonderful teacher, Honored Scientist of the RSFSR, professor, Major General of the medical service Vladimir Semyonovich Levit.","PeriodicalId":17856,"journal":{"name":"Klinicheskaia meditsina","volume":"337 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136098847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-22DOI: 10.30629/0023-2149-2023-101-7-8-429-432
V. B. Simonenko, M. Sh. Knopov
Тhe article presents brief characteristics of military fi eld surgeons — representatives of the S.P. Fedorov school, who during the Great Patriotic War were chief surgeons of the fronts and fleets
{"title":"Contribution of S.P. Fedorov's school to the Russian military fi eld surgery","authors":"V. B. Simonenko, M. Sh. Knopov","doi":"10.30629/0023-2149-2023-101-7-8-429-432","DOIUrl":"https://doi.org/10.30629/0023-2149-2023-101-7-8-429-432","url":null,"abstract":"Тhe article presents brief characteristics of military fi eld surgeons — representatives of the S.P. Fedorov school, who during the Great Patriotic War were chief surgeons of the fronts and fleets","PeriodicalId":17856,"journal":{"name":"Klinicheskaia meditsina","volume":"90 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136098849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-22DOI: 10.30629/0023-2149-2023-101-7-8-381-386
E. A. Shirokov
Diseases associated with atherosclerosis occupy a leading place among the causes of death in most countries of the world. Antiplatelet therapy is one of the most eff ective and promising methods of stroke prevention. Long-term use of platelet antiplatelet agents of various pharmaceutical groups in high-risk patients has become a daily clinical practice. As a result of the practical application of modern drug strategies, the life expectancy of stroke survivors is increasing. The average age of patients with cardiovascular pathology is increasing. The majority of patients receiving antiplatelet agents are over 70 years old. The number of patients continuously receiving antiplatelet agents for 10 years or more is already hundreds of thousands. In recent years, clinical guidelines have expanded the indications for the appointment of platelet antiplatelet agents of diff erent pharmaceutical groups. In neurology, clopidogrel, ticagrelor, cilostazol are allowed. However, the choice of the optimal treatment regimen in patients with cerebrovascular pathology often causes diffi culty for doctors. Standard treatment regimens for patients at high risk of stroke are based on the use of acetylsalicylic acid preparations. In some cases, patients receive a combination of antiplatelet agents: aspirin and dipyridamole. The author analyzes the results of 30 years of acetylsalicylic acid use in a patient with a high risk of thrombosis and bleeding. During this period, the patient suff ers a transient ischemic attack, ischemic stroke, hemorrhoidal bleeding and intracranial hemorrhage. The article discusses optimal solutions in choosing an antithrombotic strategy in patients with high risk of stroke on a clinical example. Based on the analysis of current clinical recommendations and scientifi c research, the article formulates the principles of long-term antiplatelet therapy for patients of older age groups with the need for long-term treatment. The main directions of diff erentiated antithrombotic therapy have been determined depending on the suspected pathogenetic subtype of ischemic stroke, the risk of bleeding, age and the expected duration of treatment.
{"title":"Long-term antiplatelet therapy in patients with high risk of stroke","authors":"E. A. Shirokov","doi":"10.30629/0023-2149-2023-101-7-8-381-386","DOIUrl":"https://doi.org/10.30629/0023-2149-2023-101-7-8-381-386","url":null,"abstract":"Diseases associated with atherosclerosis occupy a leading place among the causes of death in most countries of the world. Antiplatelet therapy is one of the most eff ective and promising methods of stroke prevention. Long-term use of platelet antiplatelet agents of various pharmaceutical groups in high-risk patients has become a daily clinical practice. As a result of the practical application of modern drug strategies, the life expectancy of stroke survivors is increasing. The average age of patients with cardiovascular pathology is increasing. The majority of patients receiving antiplatelet agents are over 70 years old. The number of patients continuously receiving antiplatelet agents for 10 years or more is already hundreds of thousands. In recent years, clinical guidelines have expanded the indications for the appointment of platelet antiplatelet agents of diff erent pharmaceutical groups. In neurology, clopidogrel, ticagrelor, cilostazol are allowed. However, the choice of the optimal treatment regimen in patients with cerebrovascular pathology often causes diffi culty for doctors. Standard treatment regimens for patients at high risk of stroke are based on the use of acetylsalicylic acid preparations. In some cases, patients receive a combination of antiplatelet agents: aspirin and dipyridamole. The author analyzes the results of 30 years of acetylsalicylic acid use in a patient with a high risk of thrombosis and bleeding. During this period, the patient suff ers a transient ischemic attack, ischemic stroke, hemorrhoidal bleeding and intracranial hemorrhage. The article discusses optimal solutions in choosing an antithrombotic strategy in patients with high risk of stroke on a clinical example. Based on the analysis of current clinical recommendations and scientifi c research, the article formulates the principles of long-term antiplatelet therapy for patients of older age groups with the need for long-term treatment. The main directions of diff erentiated antithrombotic therapy have been determined depending on the suspected pathogenetic subtype of ischemic stroke, the risk of bleeding, age and the expected duration of treatment.","PeriodicalId":17856,"journal":{"name":"Klinicheskaia meditsina","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136099106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-22DOI: 10.30629/0023-2149-2023-101-7-8-387-394
A. A. Gurkina, N. I. Stuklov, N. D. Kislyj, R. R. Gimadiev, A. A. Strel’nikov
If chronic heart failure (CHF) is accompanied by anemic syndrome and iron defi ciency (ID) tolerance to treatment develops, the eff ectiveness of drugs that form the basis of CHF treatment decreases, and the prognosis worsens. Aim . To evaluate the possibilities of using iron preparations with hepcidin-independent absorption mechanism depending on the characteristics of iron metabolism, erythropoiesis and the level of infl ammation in patients with CHF and anemia. Material and methods. The study included 68 patients diagnosed with CHF to describe the characteristics of anemia (General group). Further, 56 patients who signed consent to the study were divided into two groups: 30 patients (Treatment Group) with standard CHF therapy and iron preparations, and 26 (Comparison Group) with standard CHF therapy only. Sucrosomial iron (SI) was used 60 mg per day orally for three months. Results . Variants of anemia in CHF: absolute ID (AID) — 43%, functional ID (FID) — 19%, anemia without ID — 38%. In the treatment group, an increase in hemoglobin (Hb, p < 0.002), hematocrit (Ht, p < 0.001), mean corpuscular volume (MCV, p < 0.002) and serum ferritin (SF, p < 0.05), in the Сomparison group only Ht, p < 0.01, and the greatest increase in Hb was detected in patients with SF < 30 μmol/l (p < 0.002). Conclusion . Anemia in CHF corresponds to the signs of anemia of chronic disease (ACD) with J, while J was detected in 62% of patients. The use of SI signifi cantly increases erythrocyte counts and SF/
如果慢性心力衰竭(CHF)伴有贫血综合征，并且对治疗产生了铁缺乏症(ID)耐受性，那么作为治疗CHF基础的药物的有效性就会降低，预后也会恶化。的目标。根据CHF合并贫血患者的铁代谢、红细胞生成和炎症水平的特点，评估使用具有hepcidin非依赖性吸收机制的铁制剂的可能性。材料和方法。该研究纳入68例诊断为CHF的患者，以描述贫血的特征(普通组)。此外，56名签署同意研究的患者被分为两组:30名患者(治疗组)接受标准CHF治疗和铁制剂，26名患者(对照组)仅接受标准CHF治疗。上体铁(SI)每天口服60毫克，持续3个月。结果。CHF贫血的变体:绝对ID (AID) - 43%，功能性ID (FID) - 19%，无ID贫血- 38%。治疗组血红蛋白(Hb, p <0.002)，红细胞压积(Ht, p <0.001)，平均红细胞体积(MCV, p <0.002)和血清铁蛋白(SF, p <0.05)， Сomparison组只有Ht, p <0.01, SF <患者Hb升高幅度最大;30 μmol/l (p <0.002)。结论。CHF的贫血对应于慢性疾病贫血(ACD)伴J的体征，而在62%的患者中检测到J。使用SI可显著增加红细胞计数和SF/
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