V. A. Kachnov, V. V. Tyrenko, E. S. Bratilova, A. V. Koltsov
Anemia and iron deficiency are common in cardiovascular diseases. The most studied issue is iron deficiency and anemia in patients with heart failure, for whom clear clinical guidelines have been developed. Atrial fibrillation is the most common supraventricular tachyarrhythmia and is characterized by a growing prevalence worldwide. At the same time, iron deficiency anemia is one of the most common diseases in the world, and iron deficiency is the cause of up to 80% of anemia in the adult population. The mutual influence of these two nosological units is currently insufficiently studied. In this regard, the study of the mutual effects of iron deficiency, iron deficiency anemia and atrial fibrillation and the justification of the need for drug correction of iron deficiency in patients with atrial fibrillation is an extremely actual problem. The pathophysiological mechanisms of the effect of iron deficiency on the possibility of atrial fibrillation are quite multifaceted. Among these mechanisms can be distinguished: the effect of iron deficiency on the mitochondrial level, on the cardiomyocyte, on heart function and on the organismal level. At the same time, atrial fibrillation can contribute to the development of iron deficiency. The comorbid course of iron deficiency and atrial fibrillation potentiates the clinical manifestations of each other and reduces the quality of life. The effect of correction of anemia and iron deficiency in patients with atrial fibrillation is currently insufficiently studied to formulate practical recommendations. However, it can be assumed that the treatment of iron deficiency in atrial fibrillation will lead to a reduction in symptoms, an improvement in the quality of life and a decrease in the frequency of hospitalizations.
{"title":"Iron deficiency, anemia and atrial fibrillation","authors":"V. A. Kachnov, V. V. Tyrenko, E. S. Bratilova, A. V. Koltsov","doi":"10.21518/ms2024-001","DOIUrl":"https://doi.org/10.21518/ms2024-001","url":null,"abstract":"Anemia and iron deficiency are common in cardiovascular diseases. The most studied issue is iron deficiency and anemia in patients with heart failure, for whom clear clinical guidelines have been developed. Atrial fibrillation is the most common supraventricular tachyarrhythmia and is characterized by a growing prevalence worldwide. At the same time, iron deficiency anemia is one of the most common diseases in the world, and iron deficiency is the cause of up to 80% of anemia in the adult population. The mutual influence of these two nosological units is currently insufficiently studied. In this regard, the study of the mutual effects of iron deficiency, iron deficiency anemia and atrial fibrillation and the justification of the need for drug correction of iron deficiency in patients with atrial fibrillation is an extremely actual problem. The pathophysiological mechanisms of the effect of iron deficiency on the possibility of atrial fibrillation are quite multifaceted. Among these mechanisms can be distinguished: the effect of iron deficiency on the mitochondrial level, on the cardiomyocyte, on heart function and on the organismal level. At the same time, atrial fibrillation can contribute to the development of iron deficiency. The comorbid course of iron deficiency and atrial fibrillation potentiates the clinical manifestations of each other and reduces the quality of life. The effect of correction of anemia and iron deficiency in patients with atrial fibrillation is currently insufficiently studied to formulate practical recommendations. However, it can be assumed that the treatment of iron deficiency in atrial fibrillation will lead to a reduction in symptoms, an improvement in the quality of life and a decrease in the frequency of hospitalizations. ","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"48 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141122037","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}
N. Semigolovskii, I. S. Simutis, D. S. Salygina, M. S. Danilov, A. Svetlikov, S. N. Semigolovskii
The actuality of the problem of pulmonary embolism is due to the widespread occurrence of this complication with unpredictable consequences, including hemodynamic instability, arterial hypotension, shock, disability and sudden death. Pulmonary embolism is now considered in developed countries as the most common cause of preventable inhospital death and maternal mortality. Thrombolytic therapy is used for intermediate and high-risk pulmonary embolism with hemodynamic instability of the patient, however, there is also ongoing discussion about the possibilities of its implementation in normotensive patients under certain conditions. Currently, streptokinase, urokinase and alteplase (Actilize and Revelise in Russia) are used for thrombolytic therapy of pulmonary embolism. Indications for use in pulmonary embolism have been expanded recently for the already wellknown domestic thrombolytic non-immunogenic staphylokinase (Fortelizin®), which has proven itself in patients with acute myocardial infarction and acute ischemic stroke. A clinical case of delayed (on the 4th day of hospitalization) use of Fortelisin with a positive effect in a 49-year-old normotensive anemized patient with syncope in the PE debut with non-occlusive thrombosis of the posterior tibial veins without flotation of blood clots is presented. The features of Fortelizin, which favorably distinguish it from other thrombolytic agents, are: the highest fibrin selectivity; the possibility of bolus administration of a fixed dosage, independent of the patient’s body weight; safety of repeated administration; high rate of onset of effect; prevention of a significant decrease in blood fibrinogen levels, which reduces the risk of bleeding. Thus, the use of the domestic thrombolytic recombinant non-immunogenic staphylokinase drug Fortelizin, taking into account the data of the conducted studies and the described case, seems to be a successful example of import substitution in medicine.
{"title":"Experience in the use of non-immunogenic recombinant staphylokinase in the treatment of massive pulmonary embolism","authors":"N. Semigolovskii, I. S. Simutis, D. S. Salygina, M. S. Danilov, A. Svetlikov, S. N. Semigolovskii","doi":"10.21518/ms2024-164","DOIUrl":"https://doi.org/10.21518/ms2024-164","url":null,"abstract":"The actuality of the problem of pulmonary embolism is due to the widespread occurrence of this complication with unpredictable consequences, including hemodynamic instability, arterial hypotension, shock, disability and sudden death. Pulmonary embolism is now considered in developed countries as the most common cause of preventable inhospital death and maternal mortality. Thrombolytic therapy is used for intermediate and high-risk pulmonary embolism with hemodynamic instability of the patient, however, there is also ongoing discussion about the possibilities of its implementation in normotensive patients under certain conditions. Currently, streptokinase, urokinase and alteplase (Actilize and Revelise in Russia) are used for thrombolytic therapy of pulmonary embolism. Indications for use in pulmonary embolism have been expanded recently for the already wellknown domestic thrombolytic non-immunogenic staphylokinase (Fortelizin®), which has proven itself in patients with acute myocardial infarction and acute ischemic stroke. A clinical case of delayed (on the 4th day of hospitalization) use of Fortelisin with a positive effect in a 49-year-old normotensive anemized patient with syncope in the PE debut with non-occlusive thrombosis of the posterior tibial veins without flotation of blood clots is presented. The features of Fortelizin, which favorably distinguish it from other thrombolytic agents, are: the highest fibrin selectivity; the possibility of bolus administration of a fixed dosage, independent of the patient’s body weight; safety of repeated administration; high rate of onset of effect; prevention of a significant decrease in blood fibrinogen levels, which reduces the risk of bleeding. Thus, the use of the domestic thrombolytic recombinant non-immunogenic staphylokinase drug Fortelizin, taking into account the data of the conducted studies and the described case, seems to be a successful example of import substitution in medicine.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141122281","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}
I. Arustamyan, V. E. Pavlov, Y. Polushin, S. Karpishchenko, O. Stancheva, G. Efimenko
Introduction. Endoscopic rhinosinus surgery stands out for its reduced complications and marked symptomatic improvement compared to open surgical approaches. However, local bleeding challenges may compromise the efficacy of minimally invasive procedures. Exploring terlipressin’s application in endoscopic rhinosinus surgery is a promising avenue, given its mechanism of action and successful use in obstetric and other medical practices.Aim. This study aimed to assess terlipressin’s efficacy in reducing intraoperative bleeding during endoscopic rhinosinus surgical interventions under general anesthesia.Materials and methods. A prospective randomized cohort study included 170 cases of endoscopic rhinosinus surgical interventions. The BT group (n = 89) received no terlipressin, while the T group (n = 81) had 200 mcg of terlipressin during surgery. Bleeding intensity was assessed on a 6-point scale. Heart rate, blood pressure, perfusion index, and bleeding intensity were recorded at 10th, 30th, and 60th minute into the operation (study points). Bleeding intensity ≥2 points was considered significant. Results. In the T group, mean BP was significantly higher at all study points than in the BT group. Perfusion index values in the terlipressin group were significantly lower throughout. ROC analysis highlighted perfusion index’s prognostic value at 30th and 60th minutes for predicting significant bleeding. Threshold perfusion index values associated with increased bleeding probability were 4.520 at 30th minutes and 5.040 at 60th minute. Multifactorial analysis linked intraoperative terlipressin administration to a lower likelihood of significant intraoperative bleeding.Conclusion. Intravenous terlipressin (200 mcg) effectively reduces intraoperative bleeding intensity without lowering arterial pressure during endoscopic rhinosinus surgical interventions under general anesthesia.
{"title":"Terlipressin using for intraoperative bleeding reduction during endoscopic rhinosinus surgery","authors":"I. Arustamyan, V. E. Pavlov, Y. Polushin, S. Karpishchenko, O. Stancheva, G. Efimenko","doi":"10.21518/ms2024-097","DOIUrl":"https://doi.org/10.21518/ms2024-097","url":null,"abstract":"Introduction. Endoscopic rhinosinus surgery stands out for its reduced complications and marked symptomatic improvement compared to open surgical approaches. However, local bleeding challenges may compromise the efficacy of minimally invasive procedures. Exploring terlipressin’s application in endoscopic rhinosinus surgery is a promising avenue, given its mechanism of action and successful use in obstetric and other medical practices.Aim. This study aimed to assess terlipressin’s efficacy in reducing intraoperative bleeding during endoscopic rhinosinus surgical interventions under general anesthesia.Materials and methods. A prospective randomized cohort study included 170 cases of endoscopic rhinosinus surgical interventions. The BT group (n = 89) received no terlipressin, while the T group (n = 81) had 200 mcg of terlipressin during surgery. Bleeding intensity was assessed on a 6-point scale. Heart rate, blood pressure, perfusion index, and bleeding intensity were recorded at 10th, 30th, and 60th minute into the operation (study points). Bleeding intensity ≥2 points was considered significant. Results. In the T group, mean BP was significantly higher at all study points than in the BT group. Perfusion index values in the terlipressin group were significantly lower throughout. ROC analysis highlighted perfusion index’s prognostic value at 30th and 60th minutes for predicting significant bleeding. Threshold perfusion index values associated with increased bleeding probability were 4.520 at 30th minutes and 5.040 at 60th minute. Multifactorial analysis linked intraoperative terlipressin administration to a lower likelihood of significant intraoperative bleeding.Conclusion. Intravenous terlipressin (200 mcg) effectively reduces intraoperative bleeding intensity without lowering arterial pressure during endoscopic rhinosinus surgical interventions under general anesthesia.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"37 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141122247","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}
The phenomenon of a patent foramen ovale in patients with pulmonary embolism increases the risk of ischemic stroke. The clinical significance of this phenomenon should be taken into account to determine the diagnostic algorithm, management tactics and choice of secondary prevention. The prognosis of a patient with pulmonary embolism depends not only on the likelihood of recurrent pulmonary embolism, the formation of chronic pulmonary hypertension, but is also associated with an increased risk of ischemic stroke through the mechanism of paradoxical embolism due to the presence of a patent foramen ovale. A venous thrombus migrates through the patent foramen ovale as a result of the operation of an intracardiac right-left shunt. The purpose of the scientific review is to raise awareness of the problem of ischemic stroke in patients with pulmonary embolism. The results of studies and registries are presented, which reflect that the presence of patent foramen ovale increases the risk of developing ischemic stroke in patients with pulmonary embolism. Ischemic stroke can occur within 2–22 days after the onset of a pulmonary embolism clinic, and the risk of ischemic stroke remains within a year. Non-invasive transcranial dopplerography is recommended for diagnosis at the first stage of identification of the right-to-left shunt and is highly sensitive method (95–98%). Transesophageal echocardiography should be considered for the second stage of diagnosis. Thrombolytic therapy or surgical thrombectomy improves the prognosis for this category of patients. Тhrombolytic therapy may be given for up to 14 days in patients with pulmonary embolism. The use of thrombolytic therapy in the development of ischemic stroke becomes a possible option to improve the prognosis patients. The choice strategy for secondary prevention is important because patients have an increased risk of relapse.
{"title":"Clinical significance of a patent foramen ovale in patients with pulmonary embolism","authors":"A. V. Pavlova","doi":"10.21518/ms2024-012","DOIUrl":"https://doi.org/10.21518/ms2024-012","url":null,"abstract":"The phenomenon of a patent foramen ovale in patients with pulmonary embolism increases the risk of ischemic stroke. The clinical significance of this phenomenon should be taken into account to determine the diagnostic algorithm, management tactics and choice of secondary prevention. The prognosis of a patient with pulmonary embolism depends not only on the likelihood of recurrent pulmonary embolism, the formation of chronic pulmonary hypertension, but is also associated with an increased risk of ischemic stroke through the mechanism of paradoxical embolism due to the presence of a patent foramen ovale. A venous thrombus migrates through the patent foramen ovale as a result of the operation of an intracardiac right-left shunt. The purpose of the scientific review is to raise awareness of the problem of ischemic stroke in patients with pulmonary embolism. The results of studies and registries are presented, which reflect that the presence of patent foramen ovale increases the risk of developing ischemic stroke in patients with pulmonary embolism. Ischemic stroke can occur within 2–22 days after the onset of a pulmonary embolism clinic, and the risk of ischemic stroke remains within a year. Non-invasive transcranial dopplerography is recommended for diagnosis at the first stage of identification of the right-to-left shunt and is highly sensitive method (95–98%). Transesophageal echocardiography should be considered for the second stage of diagnosis. Thrombolytic therapy or surgical thrombectomy improves the prognosis for this category of patients. Тhrombolytic therapy may be given for up to 14 days in patients with pulmonary embolism. The use of thrombolytic therapy in the development of ischemic stroke becomes a possible option to improve the prognosis patients. The choice strategy for secondary prevention is important because patients have an increased risk of relapse.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"33 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141118787","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}
V. V. Efimenko, M. Khachaturov, A. M. Gasanova, N. Martirosian, I. A. Kuzina, E. V. Goncharova, M. E. Telnova, N. Petunina
Polycystic ovary syndrome (PCOS) is a polygenic endocrine disorder caused by both genetic and epigenetic factors. The relevance is associated with a high degree of prevalence and social significance this disease. The сombination of menstrual dysfunction, anovulatory infertility, metabolic disorders, biochemical and clinical hyperandrogenism cause the importance of this problem. In this regard, Adequate therapy and its timely intensification are the most important aspects. This article highlights basic information about diagnosis and treatment of polycystic ovary syndrome, analyzes in detail the changes in patient management tactic according to the clinical recommendations of ESHRE 2018 and 2023 the issues of the quality of life of women with PCOS. In this review, special attention will be paid to the role of metformin. According to new clinical guidelines, it can be used not only for patients with an increased body mass index (BMI), but also with a normal BMI in order to reduce insulin resistance. A new place of inositol in PCOS therapy is also considered, as an alternative way which increases the sensitivity of receptors to insulin. The treatment with aromatase inhibitors are given to solve such a problem as infertility. The article also highlights the development of treatment methods based on advances in genetics and epigenetics.
{"title":"New aspects in the diagnosis and treatment of polycystic ovary syndrome","authors":"V. V. Efimenko, M. Khachaturov, A. M. Gasanova, N. Martirosian, I. A. Kuzina, E. V. Goncharova, M. E. Telnova, N. Petunina","doi":"10.21518/ms2024-205","DOIUrl":"https://doi.org/10.21518/ms2024-205","url":null,"abstract":"Polycystic ovary syndrome (PCOS) is a polygenic endocrine disorder caused by both genetic and epigenetic factors. The relevance is associated with a high degree of prevalence and social significance this disease. The сombination of menstrual dysfunction, anovulatory infertility, metabolic disorders, biochemical and clinical hyperandrogenism cause the importance of this problem. In this regard, Adequate therapy and its timely intensification are the most important aspects. This article highlights basic information about diagnosis and treatment of polycystic ovary syndrome, analyzes in detail the changes in patient management tactic according to the clinical recommendations of ESHRE 2018 and 2023 the issues of the quality of life of women with PCOS. In this review, special attention will be paid to the role of metformin. According to new clinical guidelines, it can be used not only for patients with an increased body mass index (BMI), but also with a normal BMI in order to reduce insulin resistance. A new place of inositol in PCOS therapy is also considered, as an alternative way which increases the sensitivity of receptors to insulin. The treatment with aromatase inhibitors are given to solve such a problem as infertility. The article also highlights the development of treatment methods based on advances in genetics and epigenetics.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"7 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141123773","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}
The main cause of death among people with DM2 is atherosclerotic cardiovascular diseases (ARDS), the risk of which in this cohort increases 2–4 times. The features of the metabolic background in comorbid patients with type 2 diabetes mellitus are characterized by an aggressive course of dyslipidemia with a predominance of its atherogenic forms. Despite the achievement of lipid targets on the background of statin therapy, the residual risk of cardiovascular diseases in this group of patients remains quite high. The results of a number of major research papers indicate that hypertriglyceridemia may play an important role in this. In this regard, triglycerides (TG) are no less important for the prevention and control of cardiovascular risk in carbohydrate metabolism disorders, in addition to LDL. According to the consensus statement of the European Atherosclerosis Society, the risk of ASD becomes clinically significant at an empty stomach TG level >1.7 mmol/l. The main tool for controlling hypertriglyceridemia today is fibrate therapy. According to available data, the combination of statins and fenofibrate is more effective in reducing total cholesterol, LDL, TG and increasing HDL. To date, fenofibrate is the only molecule that has shown an optimal safety profile and reduced risk of cardiovascular diseases. In the Russian clinical guidelines on lipid metabolism disorders from 2023, it was proposed to divide patients into 3 main categories according to the severity of the increase in TG, on which the management tactics depend: 1.7–2.3 mmol/l; 2.3–5 mmol/l; ≥5 mmol/l. In individuals with TG levels >2.3 mmol/l on the background of moderate or high intensity statin therapy, the use of fenofibrate is recommended, preferably in combination with statins.
{"title":"Metabolic background as the basis for comorbidity in patients with type 2 diabetes mellitus","authors":"T. Demidova, F. Ushanova","doi":"10.21518/ms2024-137","DOIUrl":"https://doi.org/10.21518/ms2024-137","url":null,"abstract":"The main cause of death among people with DM2 is atherosclerotic cardiovascular diseases (ARDS), the risk of which in this cohort increases 2–4 times. The features of the metabolic background in comorbid patients with type 2 diabetes mellitus are characterized by an aggressive course of dyslipidemia with a predominance of its atherogenic forms. Despite the achievement of lipid targets on the background of statin therapy, the residual risk of cardiovascular diseases in this group of patients remains quite high. The results of a number of major research papers indicate that hypertriglyceridemia may play an important role in this. In this regard, triglycerides (TG) are no less important for the prevention and control of cardiovascular risk in carbohydrate metabolism disorders, in addition to LDL. According to the consensus statement of the European Atherosclerosis Society, the risk of ASD becomes clinically significant at an empty stomach TG level >1.7 mmol/l. The main tool for controlling hypertriglyceridemia today is fibrate therapy. According to available data, the combination of statins and fenofibrate is more effective in reducing total cholesterol, LDL, TG and increasing HDL. To date, fenofibrate is the only molecule that has shown an optimal safety profile and reduced risk of cardiovascular diseases. In the Russian clinical guidelines on lipid metabolism disorders from 2023, it was proposed to divide patients into 3 main categories according to the severity of the increase in TG, on which the management tactics depend: 1.7–2.3 mmol/l; 2.3–5 mmol/l; ≥5 mmol/l. In individuals with TG levels >2.3 mmol/l on the background of moderate or high intensity statin therapy, the use of fenofibrate is recommended, preferably in combination with statins.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"110 37","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141124770","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}
Rational pharmacotherapy for chronic heart failure (HF) remains a relevant issue due to the unfavorable prognosis. Several major studies have confirmed the beneficial effect on reducing hospitalization rates and mortality of modern disease-modifying therapy, including sodium-glucose cotransporter type 2 inhibitors (SGLT-2 inhibitors or gliflozins), considered first-line therapy regardless of the left ventricular ejection fraction (LVEF) and diabetes mellitus in HF patients. The review presents the studied mechanisms of action of this group of drugs in HF, including metabolic, hemodynamic, and other pleiotropic effects, through which SGLT-2 inhibitors prevent the development and progression of HF with different LVEF. The possibilities of the influence of SGLT-2 inhibitors on clinical symptoms and quality of life of HF patients are discussed, as well as the change in the level of N-terminal pro-B-type natriuretic peptide as a target for rational clinical use justification. The concept of quadruple therapy, depending on the clinical situation, is presented, the basis of which is the rapid and simultaneous initiation of a combina-Rational pharmacotherapy for chronic heart failure (HF) remains a relevant issue due to the unfavorable prognosis. Several major studies have confirmed the beneficial effect on reducing hospitalization rates and mortality of modern disease-modifying therapy, including sodium-glucose cotransporter type 2 inhibitors (SGLT-2 inhibitors or gliflozins), considered first-line therapy regardless of the left ventricular ejection fraction (LVEF) and diabetes mellitus in HF patients. The review presents the studied mechanisms of action of this group of drugs in HF, including metabolic, hemodynamic, and other pleiotropic effects, through which SGLT-2 inhibitors prevent the development and progression of HF with different LVEF. The possibilities of the influence of SGLT-2 inhibitors on clinical symptoms and quality of life of HF patients are discussed, as well as the change in the level of N-terminal pro-B-type natriuretic peptide as a target for rational clinical use justification. The concept of quadruple therapy, depending on the clinical situation, is presented, the basis of which is the rapid and simultaneous initiation of a combination of major life-saving drug groups (angiotensin-converting enzyme inhibitors / sacubitril + valsartan, SGLT-2 inhibitors, beta-blockers, and mineralocorticoid receptor antagonists), aimed at improving the clinical condition and prognosis. Thus, a modern, effective approach to managing patients with HF and different LVEF necessarily includes the use of SGLT-2 inhibitors, which have sufficient evidence for their use in this category of patients.
由于慢性心力衰竭（HF）预后不良，合理的药物治疗仍然是一个相关问题。多项重要研究证实，现代疾病调节疗法（包括钠-葡萄糖共转运体 2 型抑制剂（SGLT-2 抑制剂或格列奈类））对降低住院率和死亡率有积极作用，无论心力衰竭患者的左心室射血分数（LVEF）和糖尿病情况如何，均被视为一线疗法。综述介绍了这类药物在心房颤动中的作用机制研究，包括代谢、血流动力学和其他多效应，SGLT-2 抑制剂可通过这些效应阻止不同 LVEF 的心房颤动的发生和发展。此外，还讨论了 SGLT-2 抑制剂对 HF 患者临床症状和生活质量影响的可能性，以及 N 端前 B 型钠尿肽水平的变化作为临床合理用药靶点的合理性。由于预后不良，慢性心力衰竭（HF）的合理药物治疗仍是一个相关问题。多项重要研究证实，现代疾病修饰疗法（包括钠-葡萄糖共转运体 2 型抑制剂（SGLT-2 抑制剂或格列奈类））对降低住院率和死亡率有积极作用，无论心力衰竭患者的左心室射血分数（LVEF）和糖尿病情况如何，均被视为一线疗法。综述介绍了这类药物在心房颤动中的作用机制研究，包括代谢、血流动力学和其他多效应，SGLT-2 抑制剂可通过这些效应阻止不同 LVEF 的心房颤动的发生和发展。此外，还讨论了 SGLT-2 抑制剂对 HF 患者临床症状和生活质量影响的可能性，以及 N 端前 B 型钠尿肽水平的变化作为临床合理用药靶点的合理性。根据临床情况提出了四联疗法的概念，其基础是快速、同时启动主要救命药物组（血管紧张素转换酶抑制剂/沙库比特利+缬沙坦、SGLT-2 抑制剂、β-受体阻滞剂和矿物质皮质激素受体拮抗剂）的组合，旨在改善临床状况和预后。因此，治疗心房颤动和不同 LVEF 患者的现代有效方法必然包括使用 SGLT-2 抑制剂，因为有足够的证据表明它们适用于这类患者。
{"title":"Sodium-glucose cotransporter type 2 inhibitors in the treatment of chronic heart failure: new evidence","authors":"V. N. Larina, M. V. Leonova","doi":"10.21518/ms2024-129","DOIUrl":"https://doi.org/10.21518/ms2024-129","url":null,"abstract":"Rational pharmacotherapy for chronic heart failure (HF) remains a relevant issue due to the unfavorable prognosis. Several major studies have confirmed the beneficial effect on reducing hospitalization rates and mortality of modern disease-modifying therapy, including sodium-glucose cotransporter type 2 inhibitors (SGLT-2 inhibitors or gliflozins), considered first-line therapy regardless of the left ventricular ejection fraction (LVEF) and diabetes mellitus in HF patients. The review presents the studied mechanisms of action of this group of drugs in HF, including metabolic, hemodynamic, and other pleiotropic effects, through which SGLT-2 inhibitors prevent the development and progression of HF with different LVEF. The possibilities of the influence of SGLT-2 inhibitors on clinical symptoms and quality of life of HF patients are discussed, as well as the change in the level of N-terminal pro-B-type natriuretic peptide as a target for rational clinical use justification. The concept of quadruple therapy, depending on the clinical situation, is presented, the basis of which is the rapid and simultaneous initiation of a combina-Rational pharmacotherapy for chronic heart failure (HF) remains a relevant issue due to the unfavorable prognosis. Several major studies have confirmed the beneficial effect on reducing hospitalization rates and mortality of modern disease-modifying therapy, including sodium-glucose cotransporter type 2 inhibitors (SGLT-2 inhibitors or gliflozins), considered first-line therapy regardless of the left ventricular ejection fraction (LVEF) and diabetes mellitus in HF patients. The review presents the studied mechanisms of action of this group of drugs in HF, including metabolic, hemodynamic, and other pleiotropic effects, through which SGLT-2 inhibitors prevent the development and progression of HF with different LVEF. The possibilities of the influence of SGLT-2 inhibitors on clinical symptoms and quality of life of HF patients are discussed, as well as the change in the level of N-terminal pro-B-type natriuretic peptide as a target for rational clinical use justification. The concept of quadruple therapy, depending on the clinical situation, is presented, the basis of which is the rapid and simultaneous initiation of a combination of major life-saving drug groups (angiotensin-converting enzyme inhibitors / sacubitril + valsartan, SGLT-2 inhibitors, beta-blockers, and mineralocorticoid receptor antagonists), aimed at improving the clinical condition and prognosis. Thus, a modern, effective approach to managing patients with HF and different LVEF necessarily includes the use of SGLT-2 inhibitors, which have sufficient evidence for their use in this category of patients.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"123 31","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141124031","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}
Metabolic syndrome (MS), including hyperlipidemia and obesity, is a proven risk factor not only for cerebrovascular diseases. Obesity is a dangerous comorbid condition in patients, complicating cerebrovascular pathology, asthenic conditions, diabetes mellitus, liver disease, alcoholism and other diseases accompanied by dysmetabolic disorders. Fundamental and clinical studies of the nootropic fonturacetam (Actitropil) have shown that the drug can be used not only for a wide range of cerebrovascular diseases, asthenia, etc., but also for obesity. The mechanisms of action of fonturacetam in producing pharmacological effects that reduce excess appetite and prevent the accumulation of excess body weight were studied in chemoreactomic analysis. Regulation of the metabolic effectiveness of Phenylpiracetam is based on multi-level correction of target transmitters and receptors that control the metabolism of fats and carbohydrates (influence on leptin, cannabinoid receptors, adrenoreceptors, peroxisome receptors). Phenylpiracetam activates the adrenaline, adenosine, glucagon-like peptide, sphingosine phosphate and peroxisome proliferators (PPARG) receptors and inhibits the cannabinoid, opioid, histamine, glutamate, nociceptin, orexin, neuropeptide Y receptors. The resulting pharmacological properties indicate important pathophysiological effects of phenylpiracetam for the treatment of obesity. A decrease in the rate of fat mass gain when taking Phenylpiracetam is noted due to an improvement in the quality of night sleep. Chemoreactomic analysis of Actitropil indicated new molecular mechanisms of the pharmacological action of the molecule, which reduces excess appetite and prevents the accumulation of excess body weight. Phenylpiracetam (Actitropil) is distinguished by a balance of effectiveness, a high safety profile with no addiction to the drug and safety. Thus, Phenylpiracetam is a racetam that exhibits nootropic, antiasthenic and lipotropic effects.
代谢综合征（MS），包括高脂血症和肥胖症，已被证实不仅是脑血管疾病的危险因素。肥胖是一种危险的并发症，会并发脑血管病变、虚弱、糖尿病、肝病、酗酒和其他伴有代谢紊乱的疾病。对促智药 fonturacetam（Actitropil）的基础和临床研究表明，该药物不仅可用于治疗各种脑血管疾病、气喘等，还可用于治疗肥胖症。通过化学反应组学分析，研究了囟素在产生降低过剩食欲和防止体重过重积累的药理作用方面的作用机制。苯基吡拉西坦对新陈代谢效果的调节是基于对控制脂肪和碳水化合物新陈代谢的目标递质和受体的多层次校正（对瘦素、大麻素受体、肾上腺素受体、过氧化物酶受体的影响）。苯吡拉西坦能激活肾上腺素、腺苷、胰高血糖素样肽、磷酸鞘磷脂和过氧物酶体（PPARG）受体，抑制大麻素、阿片、组胺、谷氨酸、神经肽 Y 受体。由此产生的药理特性表明，苯基吡拉西坦对治疗肥胖症具有重要的病理生理作用。服用苯基吡拉西坦后，由于夜间睡眠质量的改善，脂肪量增加的速度有所下降。对 Actitropil 进行的化学反应组学分析表明，该分子的药理作用具有新的分子机制，可以降低过剩的食欲，防止体重超标。苯吡拉西坦（Actitropil）的显著特点是兼顾有效性、高安全性、无药物成瘾性和安全性。因此，苯基吡拉西坦是一种赛坦类药物，具有促智、抗疲劳和促脂作用。
{"title":"Phenylpiracetam: molecular mechanisms of effects in obesity","authors":"O. Gromova, I. Torshin, L. B. Lazebnik","doi":"10.21518/ms2024-204","DOIUrl":"https://doi.org/10.21518/ms2024-204","url":null,"abstract":"Metabolic syndrome (MS), including hyperlipidemia and obesity, is a proven risk factor not only for cerebrovascular diseases. Obesity is a dangerous comorbid condition in patients, complicating cerebrovascular pathology, asthenic conditions, diabetes mellitus, liver disease, alcoholism and other diseases accompanied by dysmetabolic disorders. Fundamental and clinical studies of the nootropic fonturacetam (Actitropil) have shown that the drug can be used not only for a wide range of cerebrovascular diseases, asthenia, etc., but also for obesity. The mechanisms of action of fonturacetam in producing pharmacological effects that reduce excess appetite and prevent the accumulation of excess body weight were studied in chemoreactomic analysis. Regulation of the metabolic effectiveness of Phenylpiracetam is based on multi-level correction of target transmitters and receptors that control the metabolism of fats and carbohydrates (influence on leptin, cannabinoid receptors, adrenoreceptors, peroxisome receptors). Phenylpiracetam activates the adrenaline, adenosine, glucagon-like peptide, sphingosine phosphate and peroxisome proliferators (PPARG) receptors and inhibits the cannabinoid, opioid, histamine, glutamate, nociceptin, orexin, neuropeptide Y receptors. The resulting pharmacological properties indicate important pathophysiological effects of phenylpiracetam for the treatment of obesity. A decrease in the rate of fat mass gain when taking Phenylpiracetam is noted due to an improvement in the quality of night sleep. Chemoreactomic analysis of Actitropil indicated new molecular mechanisms of the pharmacological action of the molecule, which reduces excess appetite and prevents the accumulation of excess body weight. Phenylpiracetam (Actitropil) is distinguished by a balance of effectiveness, a high safety profile with no addiction to the drug and safety. Thus, Phenylpiracetam is a racetam that exhibits nootropic, antiasthenic and lipotropic effects.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"122 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141123831","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}
Introduction. Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21OHD) is one of the most common autosomal recessive disorders, affecting 1:9000-1:15000 live births. During the last twenty years in most countries prenatal DEXtreatment has been used to prevent genital virilisation and androgen excess outcome on sex brain differentiation of XX-foetus with 21-hydroxylase deficiency. Fetal DEX-treatment for the prevention of prenatal virilization of genitalia in girls affected by classic congenital adrenal hyperplasia (CAH) has been used in many medical centers worldwide since the mid-1980s. The treatment is effective in reducing virilization, but the potential long-term outcome has only been investigated in a minority of treated cases.Aim. To study possible long-term effects of prenatal glucocorticoid treatment on children cognition and physical development.Materials and methods. The prospective research of intellectual development patterns of 288 children from mothers prenatally treated with dexamethasone, and of 107 children (the observational group) from mothers, not treated with dexamethasone, with high biochemical markers of adrenal hyperandrogenism.Results. Significant differences of frequency of overweight and obesity (p = 0.04); of intellectual quotients (p = 0.0004) in schoolaged children have been revealed in the treatment group vs observational group. The level of general intelligence of school-aged children whose mothers have been treated with dexamethasone in I and II trimesters of pregnancy is considerably lower than that of children from the observational group (p = 0.004; p = 0.0005, respectively). The tendency of correlation between IQ quotients of school-aged children and the initiation date of prenatal dexamethasone treatment has been established (r = 0.27; p = 0.004).Сonclusion. Prenatal DEX-treatment at an early gestation can result in significant adverse effects on intellectual abilities and physical development of children furtheron.
导言。21-羟化酶缺乏症（21OHD）导致的先天性肾上腺皮质增生症（CAH）是最常见的常染色体隐性遗传病之一，其发病率为1:9000-1:15000。在过去的二十年里，大多数国家都采用产前二甲羟色胺治疗来预防生殖器男性化和雄激素过多对 21- 羟化酶缺乏症的 XX 胎儿性脑分化的影响。自 20 世纪 80 年代中期以来，世界各地的许多医疗中心一直在使用胎儿 DEX 治疗来预防受典型先天性肾上腺皮质增生症（CAH）影响的女孩产前生殖器男性化。这种治疗方法能有效减少男性化现象，但只对少数治疗病例的潜在长期结果进行了调查。研究产前糖皮质激素治疗对儿童认知和身体发育可能产生的长期影响。对母亲产前使用地塞米松治疗的288名儿童和母亲未使用地塞米松治疗但肾上腺高雄激素生化指标较高的107名儿童（观察组）的智力发育模式进行前瞻性研究。结果显示，治疗组与观察组的学龄儿童在超重和肥胖频率（p = 0.04）、智商（p = 0.0004）方面存在显著差异。母亲在妊娠 I 和 II 期接受地塞米松治疗的学龄儿童的一般智力水平大大低于观察组儿童（分别为 p = 0.004 和 p = 0.0005）。学龄儿童的智商商数与产前地塞米松治疗的开始日期之间存在相关性（r = 0.27; p = 0.004）。在妊娠早期进行产前地塞米松治疗会对今后儿童的智力和身体发育产生重大不利影响。
{"title":"Antenatal dexamethasone treatment and long-term programming","authors":"A. V. Shaitarova, L. A. Suplotova","doi":"10.21518/ms2024-035","DOIUrl":"https://doi.org/10.21518/ms2024-035","url":null,"abstract":"Introduction. Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21OHD) is one of the most common autosomal recessive disorders, affecting 1:9000-1:15000 live births. During the last twenty years in most countries prenatal DEXtreatment has been used to prevent genital virilisation and androgen excess outcome on sex brain differentiation of XX-foetus with 21-hydroxylase deficiency. Fetal DEX-treatment for the prevention of prenatal virilization of genitalia in girls affected by classic congenital adrenal hyperplasia (CAH) has been used in many medical centers worldwide since the mid-1980s. The treatment is effective in reducing virilization, but the potential long-term outcome has only been investigated in a minority of treated cases.Aim. To study possible long-term effects of prenatal glucocorticoid treatment on children cognition and physical development.Materials and methods. The prospective research of intellectual development patterns of 288 children from mothers prenatally treated with dexamethasone, and of 107 children (the observational group) from mothers, not treated with dexamethasone, with high biochemical markers of adrenal hyperandrogenism.Results. Significant differences of frequency of overweight and obesity (p = 0.04); of intellectual quotients (p = 0.0004) in schoolaged children have been revealed in the treatment group vs observational group. The level of general intelligence of school-aged children whose mothers have been treated with dexamethasone in I and II trimesters of pregnancy is considerably lower than that of children from the observational group (p = 0.004; p = 0.0005, respectively). The tendency of correlation between IQ quotients of school-aged children and the initiation date of prenatal dexamethasone treatment has been established (r = 0.27; p = 0.004).Сonclusion. Prenatal DEX-treatment at an early gestation can result in significant adverse effects on intellectual abilities and physical development of children furtheron. ","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"110 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141124662","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}
F. Kh. Orakova, I. K. Tkhabisimova, A. B. Khadzugov, R. A. Ligidova, K. Z. Kodzokova, Z. A. Mizieva, R. M. Alborova, M. R. Khazhkasimov, M. V. Makhmaeva, A. I. Vadaeva
Introduction. Postural orthostatic tachycardia syndrome (SPOT) is a heterogeneous clinical syndrome characterized by an excessive increase in heart rate (HR) in the standing position in the absence of orthostatic hypotension.Aim. To study the change in hemodynamic parameters, heart rate variability (HRV) during the tilt test, as well as to evaluate the indicators of Holter monitoring in patients with SPOT and patients without.Materials and methods. From the patients examined for the presence of disorders of the autonomic nervous system (ANS) associated with orthostasis intolerance, fainting in the anamnesis, persons aged 18 to 40 years were selected. According to the results of the tilt test, the following groups were formed: 1 group – patients with episodes of syncopal states and a negative tilt test, 2 group – patients with a pattern of postural tachycardia (PPT), 3 group – control. All patients underwent standard electrocardiography, Holter monitoring, 24-hour blood pressure monitoring and a long-term passive orthostatic test in accordance with the Westminster Protocol.Results. No deviations were found in all groups based on ECG results, daily ECG monitoring data and blood pressure. Sinus normosystole and normative values of the duration of intervals and ECG waves were observed, the subjects demonstrated normal HRV and SAD and DAD indicators throughout the day. In the first group, an increase in heart rate was observed without a decrease in blood pressure. When assessing HRV during the tilt test, a decrease in the tone of the parasympathetic system was observed in the second group. HRV indicators were analyzed during the day to assess the state of the ANS in the groups. When studying the dynamics of RR intervals, an increase in all HRV indicators at night was recorded.Conclusions. The results indicate a violation of the vegetative response to vertical position in patients with PT, which correlates with orthostatic intolerance and indicates violations of heart rate regulation and an imbalance between sympathetic and parasympathetic activity.
{"title":"Рostural orthostatic tachycardia syndrome","authors":"F. Kh. Orakova, I. K. Tkhabisimova, A. B. Khadzugov, R. A. Ligidova, K. Z. Kodzokova, Z. A. Mizieva, R. M. Alborova, M. R. Khazhkasimov, M. V. Makhmaeva, A. I. Vadaeva","doi":"10.21518/ms2024-153","DOIUrl":"https://doi.org/10.21518/ms2024-153","url":null,"abstract":"Introduction. Postural orthostatic tachycardia syndrome (SPOT) is a heterogeneous clinical syndrome characterized by an excessive increase in heart rate (HR) in the standing position in the absence of orthostatic hypotension.Aim. To study the change in hemodynamic parameters, heart rate variability (HRV) during the tilt test, as well as to evaluate the indicators of Holter monitoring in patients with SPOT and patients without.Materials and methods. From the patients examined for the presence of disorders of the autonomic nervous system (ANS) associated with orthostasis intolerance, fainting in the anamnesis, persons aged 18 to 40 years were selected. According to the results of the tilt test, the following groups were formed: 1 group – patients with episodes of syncopal states and a negative tilt test, 2 group – patients with a pattern of postural tachycardia (PPT), 3 group – control. All patients underwent standard electrocardiography, Holter monitoring, 24-hour blood pressure monitoring and a long-term passive orthostatic test in accordance with the Westminster Protocol.Results. No deviations were found in all groups based on ECG results, daily ECG monitoring data and blood pressure. Sinus normosystole and normative values of the duration of intervals and ECG waves were observed, the subjects demonstrated normal HRV and SAD and DAD indicators throughout the day. In the first group, an increase in heart rate was observed without a decrease in blood pressure. When assessing HRV during the tilt test, a decrease in the tone of the parasympathetic system was observed in the second group. HRV indicators were analyzed during the day to assess the state of the ANS in the groups. When studying the dynamics of RR intervals, an increase in all HRV indicators at night was recorded.Conclusions. The results indicate a violation of the vegetative response to vertical position in patients with PT, which correlates with orthostatic intolerance and indicates violations of heart rate regulation and an imbalance between sympathetic and parasympathetic activity.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"114 41","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141124138","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}
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