Pub Date : 2020-05-08DOI: 10.17650/1818-8338-2020-14-1-2-91-99
N. Shostak, A. Klimenko, N. Demidova, D. A. Anichkov
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used pain relievers. However, their use often threatens with serious undesirable effects, associated mainly with damage to cardiovascular system (CVS), gastrointestinal tract, kidneys and liver. Contraindications to NSAIDs prescription are clearly regulated, algorithms for their personalized appointment are determined taking into account risk factors for cardiovascular and gastrointestinal adverse events. The severity of NSAIDs side effects is mainly due to the selectivity to cyclooxygenase-2 (COX-2), as well as the physicochemical properties of various drugs. Cardiovascular adverse events differ among various NSAIDs both within commonly used drugs and among COX-2 inhibitors. It is well known that NSAIDs selective for COX-2 are safer in terms of the effect on the gastrointestinal tract than non-selective drugs. A meta-analysis showed that relatively selective COX-2 inhibitors (meloxicam, etodolac) were associated with a comparable risk of developing symptomatic ulcers and ulcers identified by endoscopy, and safety and tolerability profiles of the drugs were similar.All NSAIDs are associated with cardiovascular toxicity, however, different drugs have significant risk differences. The mechanism of NSAIDs cardiovascular adverse effects is associated with an increase of blood pressure, sodium retention, vasoconstriction, platelet activation, and prothrombotic state. It has been shown that the risk of cardiovascular adverse events when taking COX-2 inhibitors (celecoxib, etoricoxib) significantly increases. According to a study of more than 8 million people, it was found that the risk of myocardial infarction was increased in patients taking ketorolac. Further, highest to lowest risk authors list indomethacin, etoricoxib, rofecoxib (not currently used), diclofenac, a fixed combination of diclofenac with misoprostol, piroxicam, ibuprofen, naproxen, celecoxib, meloxicam, nimesulide and ketoprofen. When taking NSAIDs, the risk of heart failure decompensation increases, and it turned out to be the greatest for ketorolac, etoricoxib, and indomethacin. Meloxicam, aceclofenac, ketoprofen almost did not increase heart failure risk. It should be noted that when using the drugs (except for indomethacin and meloxicam), there is a tendency to increase the total cardiovascular and renal risks with increasing doses. Thus, it is obvious that a very careful approach is required when choosing NSAIDs. If there is an increased risk of gastrointestinal complications associated with NSAIDs, selective NSAIDs are preferred, with both coxibs and traditional selective NSAIDs showing the best safety profile in the studies. To minimize cardiovascular side effects specialists should consider the risk level of cardiovascular complications, as well as results of large clinical studies where particular NSAIDs are compared.
{"title":"Safety of selective non-steroidal anti-inflammatory drugs: analysis of the last years data","authors":"N. Shostak, A. Klimenko, N. Demidova, D. A. Anichkov","doi":"10.17650/1818-8338-2020-14-1-2-91-99","DOIUrl":"https://doi.org/10.17650/1818-8338-2020-14-1-2-91-99","url":null,"abstract":"Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used pain relievers. However, their use often threatens with serious undesirable effects, associated mainly with damage to cardiovascular system (CVS), gastrointestinal tract, kidneys and liver. Contraindications to NSAIDs prescription are clearly regulated, algorithms for their personalized appointment are determined taking into account risk factors for cardiovascular and gastrointestinal adverse events. The severity of NSAIDs side effects is mainly due to the selectivity to cyclooxygenase-2 (COX-2), as well as the physicochemical properties of various drugs. Cardiovascular adverse events differ among various NSAIDs both within commonly used drugs and among COX-2 inhibitors. It is well known that NSAIDs selective for COX-2 are safer in terms of the effect on the gastrointestinal tract than non-selective drugs. A meta-analysis showed that relatively selective COX-2 inhibitors (meloxicam, etodolac) were associated with a comparable risk of developing symptomatic ulcers and ulcers identified by endoscopy, and safety and tolerability profiles of the drugs were similar.All NSAIDs are associated with cardiovascular toxicity, however, different drugs have significant risk differences. The mechanism of NSAIDs cardiovascular adverse effects is associated with an increase of blood pressure, sodium retention, vasoconstriction, platelet activation, and prothrombotic state. It has been shown that the risk of cardiovascular adverse events when taking COX-2 inhibitors (celecoxib, etoricoxib) significantly increases. According to a study of more than 8 million people, it was found that the risk of myocardial infarction was increased in patients taking ketorolac. Further, highest to lowest risk authors list indomethacin, etoricoxib, rofecoxib (not currently used), diclofenac, a fixed combination of diclofenac with misoprostol, piroxicam, ibuprofen, naproxen, celecoxib, meloxicam, nimesulide and ketoprofen. When taking NSAIDs, the risk of heart failure decompensation increases, and it turned out to be the greatest for ketorolac, etoricoxib, and indomethacin. Meloxicam, aceclofenac, ketoprofen almost did not increase heart failure risk. It should be noted that when using the drugs (except for indomethacin and meloxicam), there is a tendency to increase the total cardiovascular and renal risks with increasing doses. Thus, it is obvious that a very careful approach is required when choosing NSAIDs. If there is an increased risk of gastrointestinal complications associated with NSAIDs, selective NSAIDs are preferred, with both coxibs and traditional selective NSAIDs showing the best safety profile in the studies. To minimize cardiovascular side effects specialists should consider the risk level of cardiovascular complications, as well as results of large clinical studies where particular NSAIDs are compared.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"32 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141206176","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 : 2020-05-07DOI: 10.17650/1818-8338-2020-14-1-2-24-33
С. Н. Толпыгина, С. Ю. Марцевич
Despite a gradually decreased mortality from cardiovascular diseases, including coronary artery disease (CAD), they remain the main cause of death in the world. In the coming decades, an increased prevalence of CAD is expected. While methods that are more sensitive are used to diagnose CAD and mortality of the acute forms decreases due to high-tech treatment methods, the prevalence of CAD chronic forms is gradually increasing. According to the modern clinical guidelines, examination and treatment of a particular patient with stable CAD depends on its prognosis, since only in high-risk patients myocardial revascularization can improve life prognosis, however, most patients receive unified therapy. Despite the fact that there are many prognostically significant factors, models and indices developed to assess the risk of death and cardiovascular complications in CAD, a unified approach to risk stratification does not currently exist. The article provides a literary review of how historically the main prognostically significant signs were identified (including clinical anamnestic and psychosocial characteristics, comorbidity, data of non-invasive instrumental studies such as electrocardiography, echocardiography, tests with dosed physical activity, invasive coronary angiography and some of the existing prognostic models and indices that can help a practitioner in stratifying the risk of cardiovascular complications in a patient with stable CAD.
{"title":"Стратификация риска сердечно‑сосудистых осложнений при стабильной ишемической болезни сердца","authors":"С. Н. Толпыгина, С. Ю. Марцевич","doi":"10.17650/1818-8338-2020-14-1-2-24-33","DOIUrl":"https://doi.org/10.17650/1818-8338-2020-14-1-2-24-33","url":null,"abstract":"Despite a gradually decreased mortality from cardiovascular diseases, including coronary artery disease (CAD), they remain the main cause of death in the world. In the coming decades, an increased prevalence of CAD is expected. While methods that are more sensitive are used to diagnose CAD and mortality of the acute forms decreases due to high-tech treatment methods, the prevalence of CAD chronic forms is gradually increasing. According to the modern clinical guidelines, examination and treatment of a particular patient with stable CAD depends on its prognosis, since only in high-risk patients myocardial revascularization can improve life prognosis, however, most patients receive unified therapy. Despite the fact that there are many prognostically significant factors, models and indices developed to assess the risk of death and cardiovascular complications in CAD, a unified approach to risk stratification does not currently exist. The article provides a literary review of how historically the main prognostically significant signs were identified (including clinical anamnestic and psychosocial characteristics, comorbidity, data of non-invasive instrumental studies such as electrocardiography, echocardiography, tests with dosed physical activity, invasive coronary angiography and some of the existing prognostic models and indices that can help a practitioner in stratifying the risk of cardiovascular complications in a patient with stable CAD.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"26 8","pages":"24-33"},"PeriodicalIF":0.0,"publicationDate":"2020-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141206050","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 : 2020-05-07DOI: 10.17650/1818-8338-2020-14-1-2-24-33
С. Н. Толпыгина, С. Ю. Марцевич
Despite a gradually decreased mortality from cardiovascular diseases, including coronary artery disease (CAD), they remain the main cause of death in the world. In the coming decades, an increased prevalence of CAD is expected. While methods that are more sensitive are used to diagnose CAD and mortality of the acute forms decreases due to high-tech treatment methods, the prevalence of CAD chronic forms is gradually increasing. According to the modern clinical guidelines, examination and treatment of a particular patient with stable CAD depends on its prognosis, since only in high-risk patients myocardial revascularization can improve life prognosis, however, most patients receive unified therapy. Despite the fact that there are many prognostically significant factors, models and indices developed to assess the risk of death and cardiovascular complications in CAD, a unified approach to risk stratification does not currently exist. The article provides a literary review of how historically the main prognostically significant signs were identified (including clinical anamnestic and psychosocial characteristics, comorbidity, data of non-invasive instrumental studies such as electrocardiography, echocardiography, tests with dosed physical activity, invasive coronary angiography and some of the existing prognostic models and indices that can help a practitioner in stratifying the risk of cardiovascular complications in a patient with stable CAD.
{"title":"Стратификация риска сердечно‑сосудистых осложнений при стабильной ишемической болезни сердца","authors":"С. Н. Толпыгина, С. Ю. Марцевич","doi":"10.17650/1818-8338-2020-14-1-2-24-33","DOIUrl":"https://doi.org/10.17650/1818-8338-2020-14-1-2-24-33","url":null,"abstract":"Despite a gradually decreased mortality from cardiovascular diseases, including coronary artery disease (CAD), they remain the main cause of death in the world. In the coming decades, an increased prevalence of CAD is expected. While methods that are more sensitive are used to diagnose CAD and mortality of the acute forms decreases due to high-tech treatment methods, the prevalence of CAD chronic forms is gradually increasing. According to the modern clinical guidelines, examination and treatment of a particular patient with stable CAD depends on its prognosis, since only in high-risk patients myocardial revascularization can improve life prognosis, however, most patients receive unified therapy. Despite the fact that there are many prognostically significant factors, models and indices developed to assess the risk of death and cardiovascular complications in CAD, a unified approach to risk stratification does not currently exist. The article provides a literary review of how historically the main prognostically significant signs were identified (including clinical anamnestic and psychosocial characteristics, comorbidity, data of non-invasive instrumental studies such as electrocardiography, echocardiography, tests with dosed physical activity, invasive coronary angiography and some of the existing prognostic models and indices that can help a practitioner in stratifying the risk of cardiovascular complications in a patient with stable CAD.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"8 10","pages":"24-33"},"PeriodicalIF":0.0,"publicationDate":"2020-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141205944","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 : 2020-05-07DOI: 10.17650/1818-8338-2020-14-1-2-34-41
N. Karpova, M. A. Rashid, T. Kazakova, N. Chipigina, A. E. Zudilina
Calcific aortic stenosis is a common heart disease and the most common cause of surgical interventions on heart valves in old age. Eliminated course, nonspecific clinical symptoms, and late patients seeking surgical help, lead to high mortality, reaching 50 % over the next 5 years. Despite the frequent occurrence, our knowledge of this type of aortic defect remains incomplete. About 300 years ago A. Bonnet first described defect as a random isolated pathological finding in the corpse of a Parisian tailor. Later, R. Virchow designated ectopic calcification / ossification as the main cause of the development of the disease and put forward the theory of hematogenous drift. In 1904, J. G. Monckeberg considered calcific aortic stenosis a manifestation of “senile degeneration” of valves and blood vessels. W. S. Roberts retrospectively correlated the classic triad of symptoms with the time of death of patients with aortic stenosis. The progress of cardiac surgery in the middle of the 20 th century made it possible to describe in detail ectopic calcification as an active, progressive, recurrent and potentially modifiable process. In the works of the staff of the Nesterov’s department of facultative therapy demonstrated a high incidence of the disease in the population of the Russia. The main reason for the development of symptoms is a progressive obstruction of the exit tract of the left ventricle of the heart, its uneven hypertrophy, rhythm and conduction disturbances in combination with concomitant arterial hypertension and other comorbidities. A change in the nature of systolic murmur, underestimation of symptoms by doctors and patients themselves, the ambiguity of echocardiography data lead to late diagnosis of the disease and untimely surgical treatment. Disturbances of calcium and bone metabolism significantly reduce the functional status of patients, including due to an adverse effect on cardiac hemodynamics. Modern molecular genetic studies are aimed at finding possible ways to control a systemic inflammatory reaction, suppress lipid peroxidation, inhibit calcification and modify the osteogenic potential of interstitial cells of heart valves.
钙化性主动脉瓣狭窄是一种常见的心脏疾病，也是老年心脏瓣膜手术的最常见原因。消除病程，非特异性临床症状和晚期患者寻求手术帮助，导致高死亡率，在未来5年内达到50%。尽管经常发生，但我们对这种类型的主动脉缺损的了解仍然不完整。大约300年前，a . Bonnet首次将缺陷描述为一个巴黎裁缝尸体上随机孤立的病理发现。后来，R. Virchow认为异位钙化/骨化是疾病发展的主要原因，并提出了血液漂移理论。1904年，j.g. Monckeberg认为钙化性主动脉狭窄是瓣膜和血管“老年性变性”的表现。W. S. Roberts回顾性地将典型的三联征症状与主动脉狭窄患者的死亡时间联系起来。20世纪中叶心脏外科的进步使得将异位钙化详细描述为一种主动的、进行性的、复发性的和潜在的可改变的过程成为可能。在工作人员的涅斯捷罗夫的部门兼性治疗证明了高发病率的疾病在俄罗斯的人口。症状发展的主要原因是左心室出口道进行性梗阻，其不均匀肥厚，心律和传导障碍合并伴有动脉高压等合并症。收缩期杂音性质的改变，医生和患者自身对症状的低估，超声心动图数据的模糊性导致疾病诊断晚，手术治疗不及时。钙和骨代谢紊乱显著降低患者的功能状态，包括由于对心脏血流动力学的不良影响。现代分子遗传学研究旨在寻找可能的方法来控制全身炎症反应，抑制脂质过氧化，抑制钙化和改变心脏瓣膜间质细胞的成骨潜能。
{"title":"Calcific aortic stenosis: known facts and promising studies","authors":"N. Karpova, M. A. Rashid, T. Kazakova, N. Chipigina, A. E. Zudilina","doi":"10.17650/1818-8338-2020-14-1-2-34-41","DOIUrl":"https://doi.org/10.17650/1818-8338-2020-14-1-2-34-41","url":null,"abstract":"Calcific aortic stenosis is a common heart disease and the most common cause of surgical interventions on heart valves in old age. Eliminated course, nonspecific clinical symptoms, and late patients seeking surgical help, lead to high mortality, reaching 50 % over the next 5 years. Despite the frequent occurrence, our knowledge of this type of aortic defect remains incomplete. About 300 years ago A. Bonnet first described defect as a random isolated pathological finding in the corpse of a Parisian tailor. Later, R. Virchow designated ectopic calcification / ossification as the main cause of the development of the disease and put forward the theory of hematogenous drift. In 1904, J. G. Monckeberg considered calcific aortic stenosis a manifestation of “senile degeneration” of valves and blood vessels. W. S. Roberts retrospectively correlated the classic triad of symptoms with the time of death of patients with aortic stenosis. The progress of cardiac surgery in the middle of the 20 th century made it possible to describe in detail ectopic calcification as an active, progressive, recurrent and potentially modifiable process. In the works of the staff of the Nesterov’s department of facultative therapy demonstrated a high incidence of the disease in the population of the Russia. The main reason for the development of symptoms is a progressive obstruction of the exit tract of the left ventricle of the heart, its uneven hypertrophy, rhythm and conduction disturbances in combination with concomitant arterial hypertension and other comorbidities. A change in the nature of systolic murmur, underestimation of symptoms by doctors and patients themselves, the ambiguity of echocardiography data lead to late diagnosis of the disease and untimely surgical treatment. Disturbances of calcium and bone metabolism significantly reduce the functional status of patients, including due to an adverse effect on cardiac hemodynamics. Modern molecular genetic studies are aimed at finding possible ways to control a systemic inflammatory reaction, suppress lipid peroxidation, inhibit calcification and modify the osteogenic potential of interstitial cells of heart valves.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48090669","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 : 2020-05-07DOI: 10.17650/1818-8338-2020-14-1-2-55-61
N. Shostak, A. Klimenko, N. Demidova, D. Y. Andriyashkina
Patients with systemic scleroderma, or systemic sclerosis (SS), have an increased risk of developing malignant neoplasms. Cancer can be diagnosed immediately prior to SS symptoms, at the stage of diagnosis and years after SS diagnosis. The first two cases may indicate scleroderma-like paraneoplastic syndrome. In this case, the main mechanism of paraneoplastic syndrome development is associated with immune system activation by antigens, expressed by tumor cells, which leads to the development of antibodies that cross-react with body tissues, causing damage and secondary regeneration. Thus, cancer induces autoimmunity – mutation-specific T-cell immune response, and pathogenetic mechanisms can be the same for fibrogenesis and oncogenesis.SS clinical and laboratory characteristics that indicate paraneoplastic etiology include minimum time difference between diagnosing scleroderma and cancer, as well as oncopathology in a patient’s or family cancer history, late disease onset (after 50 years), SS symptoms in a man, sudden onset and rapid progression of clinical symptoms, expressed or atypical SS symptoms (malaise, fever, significant weight loss), asymmetric or absent Raynaud syndrome, antibodies against RNA polymerase III, absence of anticentromeric antibodies and anti-Scl70, deviations in laboratory tests indicating possible oncopathology (anemia, hypercalcemia, hypergammaglobulinemia), no response to SS treatment, disappearance of SS symptoms after anticancer treatment and their appearance when cancer reactivation. On the other hand, patients with scleroderma have an increased risk of all types of cancer, with men at higher risk than women. Continuous autoimmune stimulation, B-cell activation, chronic inflammatory process and fibrosis in SS patients can lead to malignant transformation in certain organ systems, especially in lungs.The most important risk factor for lung cancer in SS patients is interstitial lung disease, requiring special attention from a physician. In addition to lung cancer, SS patients more likely than the general population suffer from malignant hematologic diseases, esophageal cancer, hepatocellular carcinoma and bladder cancer. Scleroderma-like skin changes are also possible when cytotoxic drugs are used to treat cancer (docetaxel, paclitaxel, bleomycin, etc.), as well as during radiation therapy.
{"title":"Scleroderma as a paraneoplastic syndrome and tumors associated with scleroderma","authors":"N. Shostak, A. Klimenko, N. Demidova, D. Y. Andriyashkina","doi":"10.17650/1818-8338-2020-14-1-2-55-61","DOIUrl":"https://doi.org/10.17650/1818-8338-2020-14-1-2-55-61","url":null,"abstract":"Patients with systemic scleroderma, or systemic sclerosis (SS), have an increased risk of developing malignant neoplasms. Cancer can be diagnosed immediately prior to SS symptoms, at the stage of diagnosis and years after SS diagnosis. The first two cases may indicate scleroderma-like paraneoplastic syndrome. In this case, the main mechanism of paraneoplastic syndrome development is associated with immune system activation by antigens, expressed by tumor cells, which leads to the development of antibodies that cross-react with body tissues, causing damage and secondary regeneration. Thus, cancer induces autoimmunity – mutation-specific T-cell immune response, and pathogenetic mechanisms can be the same for fibrogenesis and oncogenesis.SS clinical and laboratory characteristics that indicate paraneoplastic etiology include minimum time difference between diagnosing scleroderma and cancer, as well as oncopathology in a patient’s or family cancer history, late disease onset (after 50 years), SS symptoms in a man, sudden onset and rapid progression of clinical symptoms, expressed or atypical SS symptoms (malaise, fever, significant weight loss), asymmetric or absent Raynaud syndrome, antibodies against RNA polymerase III, absence of anticentromeric antibodies and anti-Scl70, deviations in laboratory tests indicating possible oncopathology (anemia, hypercalcemia, hypergammaglobulinemia), no response to SS treatment, disappearance of SS symptoms after anticancer treatment and their appearance when cancer reactivation. On the other hand, patients with scleroderma have an increased risk of all types of cancer, with men at higher risk than women. Continuous autoimmune stimulation, B-cell activation, chronic inflammatory process and fibrosis in SS patients can lead to malignant transformation in certain organ systems, especially in lungs.The most important risk factor for lung cancer in SS patients is interstitial lung disease, requiring special attention from a physician. In addition to lung cancer, SS patients more likely than the general population suffer from malignant hematologic diseases, esophageal cancer, hepatocellular carcinoma and bladder cancer. Scleroderma-like skin changes are also possible when cytotoxic drugs are used to treat cancer (docetaxel, paclitaxel, bleomycin, etc.), as well as during radiation therapy.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67773299","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 : 2020-01-30DOI: 10.17650/1818-8338-2019-13-3-4-36-42
O. V. Arsenicheva, N. N. Shchapovа
Objective: to study the risk factors for acute renal injury, the dynamics of renal function and prognosis in patients with acute coronary syndrome with ST-segment elevation (STEACS) with contrast-induced nephropathy (CIN) after primary percutaneous coronary intervention (PCI).Materials and methods. We studied 20 patients with STEACS, who developed СIN after PCI (follow-up group), and 98 patients with STEACS without СIN (comparison group). All patients were measured plasma creatinine level and glomerular filtration rate by the formula CKD-EPI before and 48 hours after PCI. CIN was detected with an increase in creatinine levels in the blood by more than 26.5 µmol / l from the baseline 48 hours after administration of radiopaque drug (RCP). Endpoints were evaluated at the hospital stage and within 12 months after PCI.Results. CIN after PCI occurred in 16.9 % of patients with STEACS. Among patients with СIN, persons aged over 75 years (60 %), with diabetes mellitus (45 %), chronic kidney disease (75 %), postinfarction cardiosclerosis (50 %), chronic heart failure of functional class III–IV (80 %), developed acute heart failure T. Killip III–IV (90 %) were significantly more often observed. The left ventricular ejection fraction was lower in patients with СIN (p <0.05). The average increase in plasma creatinine 48 hours after PCI was higher in the follow-up group (p <0.05). In patients with СIN more often, than without СIN, three-vascular lesions of the coronary bed were detected (65 and 25.5 % respectively, p <0.001). The same trend was observed, when assessing the average number of coronary artery stenoses, the number of implanted stents and the volume of RCP used. Patients with СIN, than without СIN, were longer in hospital (12.1 ± 0.96 and 10.2 ± 1.11 days respectively, p <0.05) and more often needed re-hospitalization within 12 months after PCI (34 and 4.1 % respectively, p <0.05).Summary. CIN in patients with STEACS after primary PCI was more likely to develop, if the following symptoms were present: age over 75 years, diabetes mellitus, chronic heart failure, post-infarction cardiosclerosis, chronic kidney disease, low ejection fraction of the left ventricle, initially high creatinine level, development of acute heart failure, trisovascular coronary lesion and multiple coronary stenting. The duration of hospital stay and the frequency of re-hospitalizations within a year after PCI significantly increased in patients in the CIN group.
{"title":"Contrast-induced nephropathy in patients with acute coronary syndrome with ST-segment elevation: risk factors and prognosis","authors":"O. V. Arsenicheva, N. N. Shchapovа","doi":"10.17650/1818-8338-2019-13-3-4-36-42","DOIUrl":"https://doi.org/10.17650/1818-8338-2019-13-3-4-36-42","url":null,"abstract":"Objective: to study the risk factors for acute renal injury, the dynamics of renal function and prognosis in patients with acute coronary syndrome with ST-segment elevation (STEACS) with contrast-induced nephropathy (CIN) after primary percutaneous coronary intervention (PCI).Materials and methods. We studied 20 patients with STEACS, who developed СIN after PCI (follow-up group), and 98 patients with STEACS without СIN (comparison group). All patients were measured plasma creatinine level and glomerular filtration rate by the formula CKD-EPI before and 48 hours after PCI. CIN was detected with an increase in creatinine levels in the blood by more than 26.5 µmol / l from the baseline 48 hours after administration of radiopaque drug (RCP). Endpoints were evaluated at the hospital stage and within 12 months after PCI.Results. CIN after PCI occurred in 16.9 % of patients with STEACS. Among patients with СIN, persons aged over 75 years (60 %), with diabetes mellitus (45 %), chronic kidney disease (75 %), postinfarction cardiosclerosis (50 %), chronic heart failure of functional class III–IV (80 %), developed acute heart failure T. Killip III–IV (90 %) were significantly more often observed. The left ventricular ejection fraction was lower in patients with СIN (p <0.05). The average increase in plasma creatinine 48 hours after PCI was higher in the follow-up group (p <0.05). In patients with СIN more often, than without СIN, three-vascular lesions of the coronary bed were detected (65 and 25.5 % respectively, p <0.001). The same trend was observed, when assessing the average number of coronary artery stenoses, the number of implanted stents and the volume of RCP used. Patients with СIN, than without СIN, were longer in hospital (12.1 ± 0.96 and 10.2 ± 1.11 days respectively, p <0.05) and more often needed re-hospitalization within 12 months after PCI (34 and 4.1 % respectively, p <0.05).Summary. CIN in patients with STEACS after primary PCI was more likely to develop, if the following symptoms were present: age over 75 years, diabetes mellitus, chronic heart failure, post-infarction cardiosclerosis, chronic kidney disease, low ejection fraction of the left ventricle, initially high creatinine level, development of acute heart failure, trisovascular coronary lesion and multiple coronary stenting. The duration of hospital stay and the frequency of re-hospitalizations within a year after PCI significantly increased in patients in the CIN group.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67771664","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 : 2020-01-30DOI: 10.17650/1818-8338-2019-13-3-4-74-77
P. Barlamov, E. R. Vasilyeva, M. E. Golubeva, V. G. Zhelobov, A. A. Shutylev, T. Kravtsova
The aimof the work is to describe the clinical case of formation, diagnosis and treatment of the acquired form of blood clotting factor VIII deficiency – of acquired hemophilia A.Material and methods. Patient R., 71 years, from April 2018, was found an acute hemorrhagic syndrome in the hematomic type of large hematomas manifested submandibular region, neck, chest, right breast, pubic and inguinal regions on the right, the anterior-medial surface of the left femur, anterior surface of left tibia. Standard laboratory tests, computed tomography of soft tissues of the neck, lungs, abdomen; coagulogram; blood clotting factors; inhibitor of factor VIII were evaluated in dynamics during the patient’s stay in the hospital; platelet aggregation function.Results. Typical gematomny type of bleeding, prolongation of coagulation indicators, the presence of the inhibitor factor VIII (7,0 BAA), the decrease in factor VIII (2 %) allowed diagnosis of acquired hemophilia A. Anti-inhibitory coagulant complex, fresh frozen plasma was successfully used for treatment. The patient is under observation in the regional Hematology center. The hematomas were not renewed.Conclusion. Our clinical observation demonstrates the features of the course, the algorithm of diagnosis and management of patients with of acquired hemophilia A.
{"title":"Clinical case of an acquired hemophilia","authors":"P. Barlamov, E. R. Vasilyeva, M. E. Golubeva, V. G. Zhelobov, A. A. Shutylev, T. Kravtsova","doi":"10.17650/1818-8338-2019-13-3-4-74-77","DOIUrl":"https://doi.org/10.17650/1818-8338-2019-13-3-4-74-77","url":null,"abstract":"The aimof the work is to describe the clinical case of formation, diagnosis and treatment of the acquired form of blood clotting factor VIII deficiency – of acquired hemophilia A.Material and methods. Patient R., 71 years, from April 2018, was found an acute hemorrhagic syndrome in the hematomic type of large hematomas manifested submandibular region, neck, chest, right breast, pubic and inguinal regions on the right, the anterior-medial surface of the left femur, anterior surface of left tibia. Standard laboratory tests, computed tomography of soft tissues of the neck, lungs, abdomen; coagulogram; blood clotting factors; inhibitor of factor VIII were evaluated in dynamics during the patient’s stay in the hospital; platelet aggregation function.Results. Typical gematomny type of bleeding, prolongation of coagulation indicators, the presence of the inhibitor factor VIII (7,0 BAA), the decrease in factor VIII (2 %) allowed diagnosis of acquired hemophilia A. Anti-inhibitory coagulant complex, fresh frozen plasma was successfully used for treatment. The patient is under observation in the regional Hematology center. The hematomas were not renewed.Conclusion. Our clinical observation demonstrates the features of the course, the algorithm of diagnosis and management of patients with of acquired hemophilia A.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67772159","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 : 2020-01-30DOI: 10.17650/1818-8338-2019-13-3-4-53-58
М. А. Kolchina, O. Kosmatova, V. Novikov, I. Skripnikova
The aim to demonstrate that subclinical atherosclerosis and vascular rigidity in a postmenopausal patient without clinical sings of cardiovascular disease and osteoporosis are connected with a decreased bone mass.Materials and methods. Patient O., 64 years old, was examined at the National Medical Research Center for Preventive Medicine within the program “Comprehensive assessment of total risks and early preclinical markers of osteoporosis and atherosclerosis complications”. No complaints during the examination were revealed. Laboratory tests were performed to evaluate blood lipids level, calcium-phosphorus metabolism, determine marker of bone resorption – CTX (β-crosslaps), measure levels of vitamin D and parathyroid hormone. Instrumental examinations included dual-energy x-ray absorptiometry of the spine and femoral neck, carotid ultrasound, applanation tonometry, multispiral computed tomography of coronary arteries with calcium score determination.Results. During outpatient examination, densitometry revealed decreased bone mineral density in the lumbar spine and in the femoral neck, corresponding to osteoporosis, carotid ultrasound identified atherosclerotic plaques, multispiral computed tomography of coronary arteries – coronary calcification, applanation tonometry – increased aortic stiffness.Conclusion. The clinical case is an example of early-detected preclinical signs of atherosclerosis and osteoporosis, as well as an increased risk of cardiovascular complications. Due to the high frequency of subclinical atherosclerosis, vessel wall state should be examined in women at the beginning of postmenopause. Signs of vascular stiffness and subclinical atherosclerosis give occasion to assess risk of fractures using the FRAX ® calculator and, if necessary, to diagnose bone mass loss using X-ray densitometry. Proposed algorithm can contribute to the early detection of cardiovascular diseases and at the same time improve fracture risk assessment.
{"title":"Early markers of athrosclerotic cardiovascular diseases and osteoporotic fractures in a postmenopausal woman (сlinical case)","authors":"М. А. Kolchina, O. Kosmatova, V. Novikov, I. Skripnikova","doi":"10.17650/1818-8338-2019-13-3-4-53-58","DOIUrl":"https://doi.org/10.17650/1818-8338-2019-13-3-4-53-58","url":null,"abstract":"The aim to demonstrate that subclinical atherosclerosis and vascular rigidity in a postmenopausal patient without clinical sings of cardiovascular disease and osteoporosis are connected with a decreased bone mass.Materials and methods. Patient O., 64 years old, was examined at the National Medical Research Center for Preventive Medicine within the program “Comprehensive assessment of total risks and early preclinical markers of osteoporosis and atherosclerosis complications”. No complaints during the examination were revealed. Laboratory tests were performed to evaluate blood lipids level, calcium-phosphorus metabolism, determine marker of bone resorption – CTX (β-crosslaps), measure levels of vitamin D and parathyroid hormone. Instrumental examinations included dual-energy x-ray absorptiometry of the spine and femoral neck, carotid ultrasound, applanation tonometry, multispiral computed tomography of coronary arteries with calcium score determination.Results. During outpatient examination, densitometry revealed decreased bone mineral density in the lumbar spine and in the femoral neck, corresponding to osteoporosis, carotid ultrasound identified atherosclerotic plaques, multispiral computed tomography of coronary arteries – coronary calcification, applanation tonometry – increased aortic stiffness.Conclusion. The clinical case is an example of early-detected preclinical signs of atherosclerosis and osteoporosis, as well as an increased risk of cardiovascular complications. Due to the high frequency of subclinical atherosclerosis, vessel wall state should be examined in women at the beginning of postmenopause. Signs of vascular stiffness and subclinical atherosclerosis give occasion to assess risk of fractures using the FRAX ® calculator and, if necessary, to diagnose bone mass loss using X-ray densitometry. Proposed algorithm can contribute to the early detection of cardiovascular diseases and at the same time improve fracture risk assessment.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67772251","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 : 2020-01-30DOI: 10.17650/1818-8338-2019-13-3-4-67-73
Р. Р. Ахунова, Г. Р. Ахунова
Objective : to describe the clinical case of a patient with ankylosing spondylitis (AS) with an assessment of the functioning of his body taking into account the clinical situation, environmental factors and personal factors from the standpoint of the international classification of functioning, life and health limitations. Materials and methods . The patient, 26 years old, was hospitalized in the Department of therapy with complaints of periodic aching pain in the lumbar and cervical spine at rest; aching pain in the ankle and knee joints when moving; heel pain when walking; morning stiffness in the spine lasting 30 minutes; weight loss to 11 kg. over the past year. The patient was evaluated laboratory parameters, electrocardiography, echocardiographic examination, ultrasound examination of hepatobiliary zone and kidneys, radiography of pelvic bones, lumbar spine, ankle, knee, foot joints, magnetic resonance imaging of sacroiliac joints. Results . During the examination, a clinical diagnosis was established: as. Formed rehabilitation diagnosis: b280.3, b710.2, b780.1, b130.1, b134.0, b455.3, s760.1, s740.0, s750.1, d230.2, d410.3, d450.3, d850.1, d760.1, d920.2, d475.2, which fixed the patient has intense pain, moderate violations of mobility in the spine, a short morning stiffness, mild depression, severe fatigue; minor violations in the structure of the lumbar spine, knee and ankle joints and joints of the foot; moderate difficulties in maintaining activity during the day, expressed functional disorders, expressed difficulties in walking, minor difficulties in performing paid work, minor difficulties in spending time with family and friends, moderate difficulties in recreation and leisure, moderate difficulties in driving. Conclusion . This clinical case demonstrates the possibility of using ICF in clinical practice on the model of a patient with as, which allows a comprehensive look at the patient and quantify the condition of the patient, to form a common language for the work of a multidisciplinary team to determine the further stage of rehabilitation of patients.
{"title":"АНКИЛОЗИРУЮЩИЙ СПОНДИЛИТ: ОПИСАНИЕ КЛИНИЧЕСКОГО СЛУЧАЯ С ПОЗИЦИИ МЕЖДУНАРОДНОЙ КЛАССИФИКАЦИИ ФУНКЦИОНИРОВАНИЯ, ОГРАНИЧЕНИЙ ЖИЗНЕДЕЯТЕЛЬНОСТИ И ЗДОРОВЬЯ","authors":"Р. Р. Ахунова, Г. Р. Ахунова","doi":"10.17650/1818-8338-2019-13-3-4-67-73","DOIUrl":"https://doi.org/10.17650/1818-8338-2019-13-3-4-67-73","url":null,"abstract":"Objective : to describe the clinical case of a patient with ankylosing spondylitis (AS) with an assessment of the functioning of his body taking into account the clinical situation, environmental factors and personal factors from the standpoint of the international classification of functioning, life and health limitations. Materials and methods . The patient, 26 years old, was hospitalized in the Department of therapy with complaints of periodic aching pain in the lumbar and cervical spine at rest; aching pain in the ankle and knee joints when moving; heel pain when walking; morning stiffness in the spine lasting 30 minutes; weight loss to 11 kg. over the past year. The patient was evaluated laboratory parameters, electrocardiography, echocardiographic examination, ultrasound examination of hepatobiliary zone and kidneys, radiography of pelvic bones, lumbar spine, ankle, knee, foot joints, magnetic resonance imaging of sacroiliac joints. Results . During the examination, a clinical diagnosis was established: as. Formed rehabilitation diagnosis: b280.3, b710.2, b780.1, b130.1, b134.0, b455.3, s760.1, s740.0, s750.1, d230.2, d410.3, d450.3, d850.1, d760.1, d920.2, d475.2, which fixed the patient has intense pain, moderate violations of mobility in the spine, a short morning stiffness, mild depression, severe fatigue; minor violations in the structure of the lumbar spine, knee and ankle joints and joints of the foot; moderate difficulties in maintaining activity during the day, expressed functional disorders, expressed difficulties in walking, minor difficulties in performing paid work, minor difficulties in spending time with family and friends, moderate difficulties in recreation and leisure, moderate difficulties in driving. Conclusion . This clinical case demonstrates the possibility of using ICF in clinical practice on the model of a patient with as, which allows a comprehensive look at the patient and quantify the condition of the patient, to form a common language for the work of a multidisciplinary team to determine the further stage of rehabilitation of patients.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"13 1","pages":"67-73"},"PeriodicalIF":0.0,"publicationDate":"2020-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67772307","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 : 2019-08-25DOI: 10.17650/1818-8338-2019-13-1-2-80-85
E. F. Makhnyr’, N. Shostak, N. Inasaridze, E. V. Chernaya
Objective.To describe the difficulties of diagnosis of Waldenström macroglobulinemia in a patient with atypical clinical picture.Materials and methods.Patient K., 57 years old, came in outpatient department with complaints of unilateral increase in submandibular lymph nodes on the right, discomfort in the nasopharynx, cough without sputum, increased fatigue. During the examination she was consulted by: an infectious disease specialist, otolaryngologist, surgeon, dentist, phthisiologist, hematologist and oncologist consulted her. To confirm the diagnosis conducted diagnostic activities: dynamic assessment of laboratory parameters, examination program cancer search (including multislice computed tomography and magnetic resonance imaging of various areas), with the exception of tuberculosis, monogenically study proteins in the blood and urine tests, biopsy of the ileum, immunohistochemistry trepanobiopsy.Results.During the 4‑year examination in the patient’s blood, an M-gradient in the gamma zone was detected, monoclonal immunoglobulin М-κ 19.3 g / l, Bens-Jones-κ protein in urine (daily proteinuria 0.45 g) was detected during immunofixation. In the myelogram at the light-optical level, the number of cell elements was significantly reduced with a pronounced lymphoid proliferation of 40 %, the granulocytic series and erythropoiesis were relatively narrowed, and plasma cells 6 %. Immunomorphological picture trepanobiopsy our patient based on the data of laboratory methods of research corresponds to the defeat of the bone marrow in Waldenström’s disease-κ, secretion of M-paraprotein. An important feature that allowed to go on the right path of diagnosis was almost pathognomonic for tumor lymphoproliferation, detection of Bens-Jones protein in the urine, which was absent in the onset of the disease.Conclusion.This clinical case is interesting not only by the complexity of the diagnosis of macroglobulinemia of Waldenström in General, but also by the atypical, erased clinical disease in our patient.
目标。描述诊断的困难Waldenström巨球蛋白血症患者的非典型临床表现。材料和方法。患者K, 57岁，因右侧单侧下颌下淋巴结增多，鼻咽不适，咳嗽无痰，疲劳加重而就诊。在检查期间，向她咨询的有:传染病专家、耳鼻喉科医生、外科医生、牙医、眼科医生、血液科医生和肿瘤科医生。为确认诊断进行了诊断活动:实验室参数动态评估，检查方案癌症搜索(包括多层计算机断层扫描和各区域磁共振成像)，除结核病外，单基因研究血液和尿液中的蛋白质检查，回肠活检，免疫组织化学trepanobbiopsy。结果:在患者4年的血液检查中，检测到γ区m梯度，单克隆免疫球蛋白М-κ 19.3 g / l，免疫固定期间检测尿中ben - jones -κ蛋白(每日蛋白尿0.45 g)。在光光学水平的骨髓图中，细胞成分的数量明显减少，淋巴细胞增生明显40%，粒细胞系列和红细胞相对狭窄，浆细胞6%。我们根据病人的免疫形态学图片，根据实验室的数据研究方法，对应于Waldenström病中骨髓中-κ的失败，分泌m -副蛋白。本-琼斯蛋白在尿液中的检测是本-琼斯蛋白在发病时是不存在的，但在肿瘤淋巴细胞增生方面却几乎是典型的。结论本病例的有趣之处不仅在于Waldenström巨球蛋白血症的诊断的复杂性，而且在于本例患者的不典型、隐匿性临床疾病。
{"title":"Atypical clinical picture of waldenström’s macroglobulinemia: a difficult path to diagnosis","authors":"E. F. Makhnyr’, N. Shostak, N. Inasaridze, E. V. Chernaya","doi":"10.17650/1818-8338-2019-13-1-2-80-85","DOIUrl":"https://doi.org/10.17650/1818-8338-2019-13-1-2-80-85","url":null,"abstract":"Objective.To describe the difficulties of diagnosis of Waldenström macroglobulinemia in a patient with atypical clinical picture.Materials and methods.Patient K., 57 years old, came in outpatient department with complaints of unilateral increase in submandibular lymph nodes on the right, discomfort in the nasopharynx, cough without sputum, increased fatigue. During the examination she was consulted by: an infectious disease specialist, otolaryngologist, surgeon, dentist, phthisiologist, hematologist and oncologist consulted her. To confirm the diagnosis conducted diagnostic activities: dynamic assessment of laboratory parameters, examination program cancer search (including multislice computed tomography and magnetic resonance imaging of various areas), with the exception of tuberculosis, monogenically study proteins in the blood and urine tests, biopsy of the ileum, immunohistochemistry trepanobiopsy.Results.During the 4‑year examination in the patient’s blood, an M-gradient in the gamma zone was detected, monoclonal immunoglobulin М-κ 19.3 g / l, Bens-Jones-κ protein in urine (daily proteinuria 0.45 g) was detected during immunofixation. In the myelogram at the light-optical level, the number of cell elements was significantly reduced with a pronounced lymphoid proliferation of 40 %, the granulocytic series and erythropoiesis were relatively narrowed, and plasma cells 6 %. Immunomorphological picture trepanobiopsy our patient based on the data of laboratory methods of research corresponds to the defeat of the bone marrow in Waldenström’s disease-κ, secretion of M-paraprotein. An important feature that allowed to go on the right path of diagnosis was almost pathognomonic for tumor lymphoproliferation, detection of Bens-Jones protein in the urine, which was absent in the onset of the disease.Conclusion.This clinical case is interesting not only by the complexity of the diagnosis of macroglobulinemia of Waldenström in General, but also by the atypical, erased clinical disease in our patient.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67771567","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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