The Clinician最新文献

{"title":"Medical treatment of obesity: peculiarities of medical treatments, information, responsibility and relation to medical treatment of obesity of patients","authors":"O. Lerman, Yy. V. Lukina, N. Kutishenko, S. Martsevich","doi":"10.17650/1818-8338-2019-13-1-2-27-33","DOIUrl":"https://doi.org/10.17650/1818-8338-2019-13-1-2-27-33","url":null,"abstract":"The aim to evaluate medical appointments, as well as awareness, adherence and attitude of patients to medical treatment of obesity based on the results of a survey of patients with a prospective outpatient registry.Materials and methods. Total 305 patients with obesity in the outpatient “PROFILE” register were surveyed, including self-assessment questions regarding their own body weight, prescription of obesity treatment by doctors, patients’ adherence to the implementation of these recommendations, propensity to self-medication and information about personal financial costs for the treatment of this disease. 42 (12 %) patients refused to participate in the survey. 213 people (69.8 %) who answered the questionnaire were diagnosed with obesity of the 1st degree, 63 (20.7 %) – obesity of the 2nd degree; obesity grade 3 was detected in 29 people (9.5 %). Waist circumference in women averaged 104.7 ± 12.9 cm, in men – 116.7 ± 9.6 cm – all patients had abdominal obesity. 263 (86.2 %) people had arterial hypertension, 117 (38.4 %) patients had coronary heart disease; type 2 diabetes mellitus was diagnosed in every fourth patient (85 (27.2 %) people); atrial fibrillation was diagnosed in 55 (18 %) patients; 48 (15.7 %) people had a history of myocardial infarction, 23 (7.5 %) patients had a stroke.Results. According to the survey results, only one in four patients – 77 (25.2 %) – out of 305 patients who participated in the survey knew about the possibility of drug treatment of obesity. Mostly, patients received recommendations for non-drug treatment of obesity: 242 patients (79.3 %) were recommended to reduce caloric intake, 194 (63.6 %) – increased physical activity. Only 37 (12.1 %) patients with obesity were recommended for weight correction, significantly more often they were recommended and taken by patients with 2 and 3 degrees of obesity compared to patients with obesity of 1 degree (p <0.0001). At the time of the survey, none of the patients were taking drugs to treat obesity. Previous experience of drug weight loss had 42 (13.8 %) participants of the survey. Most patients (more than 70 %), in principle, are not ready to spend money on the fight against overweight, and drugs are considered an extra item of expenditure almost 90 % of obese patients. There is a significant relationship (p = 0.008) between the severity of the disease and patients’ spending on obesity treatment in the range of 1–5 thousand rubles per month: the higher the degree of obesity, the more patients agree to spend this amount on the treatment of the disease.Conclusion. According to the results of the survey, medical treatment of obesity is prescribed by doctors rarely. Apparently, this is due to the extremely low awareness of patients about the possibilities of drug therapy in the treatment of overweight and obesity, the popularity of biologically active additives independently used by patients to reduce weight.","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":"67771630","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}

{"title":"Community-acquired pneumonia. Diagnosis, treatment approaches","authors":"A. Anderzhanova, Yu. A. Meleshkina","doi":"10.17650/1818-8338-2019-13-1-2-55-64","DOIUrl":"https://doi.org/10.17650/1818-8338-2019-13-1-2-55-64","url":null,"abstract":"The article presents current data on the prevalence and etiology of community-acquired pneumonia, shows the contribution of each of the possible pathogens to the structure of the disease. The diagnostic criteria for pneumonia are given. The main algorithms for assessing the severity of pneumonia and the prognosis of the disease using different scales: CURB-65 / CRB-65, PORT (PSI), are described. The purpose of the test is to determine the place of treatment: outpatient or in the in-patient department, in the general department or in the intensive care unit. The criteria for IDSA / ATS (American Thoracic Society / American Society of Infectious Diseases), as well as the SMART-COP / SMRCO scale to determine the need for hospitalized patients in the intensive care unit, are reviewed. The Aliberti and PES scales are given, assessing the risk of the presence of resistant pathogens in community-acquired pneumonia. Modern recommendations on the empirical choice of antibacterial drugs depending on individual patient factors are presented: anamnestic indications for treatment with antimicrobials during the preceding three months, hospitalization within six months before the onset of pneumonia, the presence of comorbidities, the severity of the disease, the risk of resistant pathogens. The average therapeutic doses of antibacterial drugs for the treatment of community-acquired pneumonia in patients with normal renal function are indicated. The questions of the optimal duration of treatment of pneumonia depending on the etiology are considered, the criteria of sufficiency of antibacterial therapy are presented. The reasons for the possible ineffectiveness of the empirical antibiotic therapy of community-acquired pneumonia are described. The importance of identifying a particular form of community-acquired pneumonia – severe community-acquired pneumonia is emphasized. Described drugs for the treatment of severe community-acquired pneumonia. The issues of prevention of pneumonia were discussed, its importance in the strategy of reducing mortality according to the World Health Organization was emphasized.","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":"67771880","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}

{"title":"Analysis of the effectiveness of selection of women for coronarography in real clinical practice","authors":"N. Izmozherova, A. Popov, V. E. Sherstobitov","doi":"10.17650/1818-8338-2019-13-1-2-34-40","DOIUrl":"https://doi.org/10.17650/1818-8338-2019-13-1-2-34-40","url":null,"abstract":"Objective: evaluation of the effectiveness of selection for coronary angiography of women who have applied to a cardiologist for thoracalgia and dorsalgia and regarded primarily as having a clinic of stable angina.Materials and methods. 108 women (median age 59.5) applying to cardiologist due to chest pain were included in a cross-sectional study and underwent coronary angiography. Subjects with identified clinically significant atherosclerotic coronary lesions were compared to persons with intact coronary arteries.Results. One-, two- and three-vessel lesions were diagnosed in accordingly 16; 21 and 26 % of patients. Intact coronary arteries were detected in 37 % subjects. In 17 of 40 persons with intact structure of the coronary arteries spasm of the coronary arteries was diagnosed. Odds ratio for atherosclerotic coronary arteries lesions in type 2 diabetic persons were 7.91 (1.74–36.00), for hypertension odds ratio 4.79 (1.52–15.01). Severe angina (3 and 4 functional class) was significantly more often diagnosed in women with identified coronary atherosclerosis. Severe coronary atherosclerosis was associated with absence of negative or doubtful results, whereas intact coronary vessels, negative and questionable results revealed more than half of the women. The obtained data reflect the relevance of the development of more effective algorithms for diagnosis of coronary artery disease in women, since the gender peculiarities of the formation of coronary atherosclerosis have been clearly confirmed in a number of large studies.Conclusion. Medical history, physical load tests results, and subject’s emotional status should be evaluated to assess the feasibility of coronary angiography.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42961696","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}

{"title":"A clinical case of systemic amyloidosis in a cardiologists’s practice","authors":"V. G. Okorokov, O. V. Evsina, V. A. Fomina, G. Ivanova, E. S. Soldatov, D. V. Dianov, K. A. Tkachenko, A. V. Ganyuta","doi":"10.17650/1818-8338-2019-13-1-2-72-79","DOIUrl":"https://doi.org/10.17650/1818-8338-2019-13-1-2-72-79","url":null,"abstract":"The aim of the work was to study the clinical case of systemic amyloidosis.Materials and methods. Patient Ch., 63 уears old, have admitted to the regional cardiological dispensary with complaints of short stabbing pains in the heart, without reaction to nitroglycerin, interruptions in the work of the heart, mainly at night, shortness of breath with little exertion, weakness, swelling of the legs and feet in September 2018. Sick from April 2016, when was dyspnea on exertion. The high level of creatinine, normochromic anemia have detected. In June 2016 chronic pyelonephritis was diagnosed. In August 2018, a right-sided hydrothorax was diagnosed, a pleural puncture was performed.Results. Laboratory and instrumental research methods were performed. Based on anamnesis data (normochromic anemia, proteinuria, increased creatinine in the blood), clinical picture, data of instrumental studies (restrictive cardiomyopathy, bilateral hydrothorax) clinical diagnosis was made: systemic amyloidosis the kidneys and heart with chronic kidney disease C5 and chronic heart failure. Histological evidence of amyloid and determination of the variant of amyloidosis by immunohistochemical method was recommended. But the patient died before the study. The histological verification of the diagnosis was carried out at the autopsy.Conclusion. This clinical observation is an example of late diagnosis of systemic amyloidosis and postmortal verification of the diagnosis, which is associated with the nonspecific symptoms and the rapidly progressing course of the disease. This case is interesting because amyloidosis proceeded under the guise of other diseases, quickly led to the development of severe heart and renal failure and to the death of the patient before verifying the disease.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43560239","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}

{"title":"Primary infective endocarditis with isolated involvement of the pulmonary valve not associated with drug addiction","authors":"N. Chipigina, N. Karpova, M. M. Tulinov, E. V. Golovko, L. M. Goloukhova, V. S. Kornienko, A. Kostin, V. Barsegyan","doi":"10.17650/1818-8338-2019-13-1-2-65-71","DOIUrl":"https://doi.org/10.17650/1818-8338-2019-13-1-2-65-71","url":null,"abstract":"Objective: to describe a rare case of infective endocarditis (IE) with isolated localization in the pulmonary valve (PV).Materials and methods. We observed primary IE with isolated localization in the PV in a 27-year-old female patient without risk factors of right-side IE.Results. The disease was caused by Streptococcus gordonii and proceeded acutely with typical signs of right-side IE: fever above 38 °С, chills, clinical picture of bilateral septic embolic abscess pneumonia, as well as secondary anemia, secondary thrombocytopenia, and glomerulonephritis. Echocardiography showed large vegetations in the PV prolapsing in the right ventricle and pulmonary artery.Conclusion. IE with localization in the PV should be suspected in patients with fever and clinical picture of septic embolic pneumonia in absence of other embolic situations.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41489320","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}

{"title":"Age and gender characteristics of dyslipidemia prevalence among the Bishkek city residents","authors":"T. Murataliev, V. K. Zventsovа, Z. T. Radzhapova, I. V. Kalinicheva, N. Z. Zhanyshbekova, U. E. Sultan, S. Mukhtarenko","doi":"10.17650/1818-8338-2019-12-3-4-37-44","DOIUrl":"https://doi.org/10.17650/1818-8338-2019-12-3-4-37-44","url":null,"abstract":"Т. М. Мураталиев1, 2, В. К. Звенцова1, З. Т. Раджапова2, И. В. Калиничева3, Н. Ж. Жанышбекова1, Султан у.Э.1, С. Ю. Мухтаренко1 Национальный центр кардиологии и терапии им. акад. Мирсаида Миррахимова; Кыргызская Республика, 720 040 Бишкек, ул. Тоголок Молдо, 3; Кыргызско-российский славянский университет им. первого Президента России Б. Н. Ельцина; Кыргызская Республика, 720 000 Бишкек, ул. Киевская, 44; ОсОО «Интелмед» – «Лаборатория Бонецкого»; Кыргызская Республика, 720 082 Бишкек, ул. Шабдан Баатыра, 6","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67771134","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}

{"title":"Analysis of adverse reactions of antihypertensive drugs registered in the Republic of Crimea for the period 2011-2016","authors":"A. V. Matveev, A. E. Krasheninnikov, E. Egorova, A. G. Dormidor","doi":"10.17650/1818-8338-2019-12-3-4-21-29","DOIUrl":"https://doi.org/10.17650/1818-8338-2019-12-3-4-21-29","url":null,"abstract":"The aim of study was to analyze and investigate the severity of adverse reactions (AR) on drugs used for arterial hypertension treatment in patients living in the Republic of Crimea for the period 2011—2016. Materials and methods . We studied notification cards about AR registered in the regional database of spontaneous messages ARCADe. We analyzed 211 notification cards about AR in patients with proven arterial hypertension diagnosis (ICD code П0—П5). Results. Drugs from the groups of angiotensin-converting enzyme inhibitors and slow calcium channel blockers most often cause AR, among them enalapril and amlodipine are the absolute leaders. AR occurred less frequently in application of drugs from the groups of в-blockers and angiotensin IIreceptor blockers. The study of the clinical manifestations of AR showed that most of them were allergic reactions of varying severity (skin itch, urticaria, swelling of lips, eyelids, tongue). The number of such cases was 70 (33.2 %) from all registered cases of AR on antihypertensive drugs. Examination of the outcomes of AR in patients taking antihypertensive drugs showed that the development of temporary disability was observed in 19 (9 %) cases, the hospitalization of outpatients as a result of AR development on drugs was required in 7 (3.3 %) cases, and in 2 cases patients had to prolong hospitalization. Life-threatening conditions in the form of Quincke’s edema were reported in 13patients. In the remaining 170 (80.6 %) cases AR were not serious and did not cause the above consequences. Assessment of AR severity revealed that mild AR were most common, much less often antihypertensive drugs caused severe AR (the incidence ranged from 5 to 13 %, depending on the method for severity assessment). Conclusion . The obtained results confirm our previously published data that in the structure of AR on antihypertensive drugs, bulk of the reports associated with angiotensin-converting enzyme inhibitors. Most often antihypertensive drugs caused mild AR.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41317576","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}

{"title":"Факторы риска респираторных осложнений у пациентов в периоперационном периоде","authors":"Д. П. Котова, В. С. Шеменкова","doi":"10.17650/1818-8338-2019-12-3-4-15-20","DOIUrl":"https://doi.org/10.17650/1818-8338-2019-12-3-4-15-20","url":null,"abstract":"Diseases of the respiratory system (both acute and exacerbations of chronic ones) remain the most frequent non-surgical complications after surgical interventions of various sizes, increasing the duration of the patient»s hospital stay, increasing economic costs and the percentage of deaths. It was shown that respiratory complications developed after abdominal operations increased the risk of 30-day mortality by 10 times. The most common complications include: reintubation, acute respiratory failure, pulmonary edema, atelectasis and pneumonia. The development of respiratory complications is due to the pathology of the respiratory system and respiratory muscles. It is proved that the use of drugs that inhibit neuromuscular conduction in 75 % of cases provokes the development of atelectasis, respiratory muscle dysfunction and reduces respiratory volumes. Respiratory complications are most often caused by hypoxia or hypercapnia. Hypoxia is characterized by a decrease in the partial pressure of oxygen and is well corrected by additional oxygenation. In the first hours after surgery hypoxemia occurs in 50—55 % of cases with a decrease in saturation up to 80 %. Complete normalization of respiratory dysfunction usually occurs 4—6 hours after extubation. Hypercapnia, on the contrary, is characterized by an increase in the partial pressure of oxygen, the phenomena of hyperkalemia and respiratory acidosis. Correction of electrolyte and buffer disturbances is necessary. It is important for the Clinician to remember the need to identify possible risk factors for respiratory complications (modifiable and unmodified) and ways to correct them. Examination of the patient by a therapist before the planned operation, including possible preoperative preparation in the therapeutic departments of a multidisciplinary hospital helps to reduce the frequency of postoperative complications. In this article the authors describe recommendations for evaluation, prevention and diagnosis of respiratory complications in the perioperative period in patients with comorbid pathology.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"12 1","pages":"15-20"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67771003","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}

{"title":"PULMONARY-RENAL SYNDROME: DIFFICULTIES OF DIFFERENTIAL DIAGNOSIS","authors":"D. Y. Andriyashkina, N. Demidova, N. Shostak, N. A. Tutaev, A. D. Ershov, D. K. Dudin","doi":"10.17650/1818-8338-2018-2-43-50","DOIUrl":"https://doi.org/10.17650/1818-8338-2018-2-43-50","url":null,"abstract":"The study objective is to demonstrate the difficulty of differential diagnosis in pulmonary-renal syndrome using a clinical case as an example.Materials and methods. Male patient A., 68 years old, retired, was hospitalized at the N.I. Pirogov City Clinical Hospital № 1 in December of 2017 with complaints of inefficient cough, fever of 39 °С, weakness, apnea, weight loss up 10 kg in 3 months. Examination revealed skin and mucosa paleness, calf edema, heart beat of 102 bpm, normal rhythm, arterial pressure 130/80 mm Hg, respiratory rate 22 breaths per min. Auscultation revealed harsh respiration in the lungs, weakened in the lower parts, fine moist rales. Anemia (hemoglobin – 53 g/l, erythrocytes – 1.85 × 1012/l, serum iron – 3.1 µmol/l), elevated urea up to 41.4 mmol/l, creatinine up to 843.1 µmol/l (glomerular filtration rate – 6 ml/min/1.73 m2), leukocytes up to 12.5 × 109/l, С-reactive protein up to 124.96 mg/l were diagnosed. Clinical urine analysis showed proteinuria 0.47 g/l. Computed tomography of the chest revealed pronounced infiltrative changes in tissues of both lungs, more on the right, alveolitis, bronchiolitis in the middle lobe on the right, 5th segment on the left. Lymphadenopathy mediastinal was diagnosed. After examination (multiple bacteriological blood, sputum tests, interferon-gamma release assay, echocardiography, bronchoalveolar lavage, sterna puncture, esophagogastroduodenoscopy, colonoscopy, etc.), oncological pathology, tuberculosis of the lungs, sepsis, infections endocarditis and other infectious pathologies were excluded. Antibacterial courses prescribed earlier were ineffective. Immunological blood test revealed high titers (1:1280) of antineutrophil cytoplasmic antibodies (ANCA) with perinuclear fluorescence type (myeloperoxidase specificity), negative antibodies to glomerular basal membrane which allowed to diagnose ANCA-associated vasculitis.Results. Considering the data of clinical, lab, and instrumental examination, the patient was diagnosed with microscopic polyangiitis, ANCA-associated, affecting the lungs (disseminated interstitial lung disease with bronchiolitis) and kidneys (rapidly progressive glomerulonephritis), intrathoracic lymphadenopathy, activity grade III (BVAS index – 23 points). Grade II respiratory failure. Chronic kidney disease 5D (glomerular filtration rate – 6 ml/min/1.73 m2). Grade II arterial hypertension, risk 4. Grade II pulmonary hypertension. Chronic heart failure 2А, functional class IV. Mixed anemia (iron-deficient, chronic disease), severe. Disseminated polyposis of the colon (hyperplastic type). At the hospital, antibacterial drugs (cefoperazone sulbactam), antifungal (fluticasone) were administered, anemia was corrected (iron-containing drugs and erythropoietin, hemotransfusion), hemodialysis. Cyclophosphane 400 mg was administered intravenously, a week later – 800 mg. Methylprednisolone (60 mg/day), co-trimoxazole (480 mg 3 times a week) were prescribed. A pronounced improvement w","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48478237","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}

{"title":"PREVALENCE AND DYNAMICS OF ENDOTHELIAL DYSFUNCTION, CAROTID AND CORONARY ATHEROSCLEROSIS IN PATIENTS WITH CHRONIC RHEUMATIC HEART DISEASE","authors":"V. S. Petrov","doi":"10.17650/1818-8338-2018-12-2-22-27","DOIUrl":"https://doi.org/10.17650/1818-8338-2018-12-2-22-27","url":null,"abstract":"The aim of study was to assess the prevalence and 5-year dynamics of atherosclerosis and endothelial dysfunction in patients with chronic rheumatic heart disease (CRHD). Materials and methods. 205 patients with CRHD were examined. Endothelial function was assessed by “AngioScan-01”, ultrasound examination of carotid arteries was performed, and some patients underwent coronaronagiography. The comparison group consisted from 57 patients with aortic stenosis (AS). Results. In both groups endothelial dysfunction was observed in large (–6.77 ± 0.89 ms – in CRHD group, –6.68 ± 0.04 ms – in AS group) and small (1.73 ± 0.05 – in CRHD group, 1.51 ± 0.04 – in AS group) arteries. Within 5 years of observation in patients with CRHD statistically significant decrease was observed in occlusion index in amplitude (1.5 ± 0.037) and in phase shift between the channels before and after occlusion (–3.13 ± 0.94). It is important that during this period there was no significant deterioration in parameters of echocardiography and 6-minute walk test. Atherosclerosis of coronary arteries was revealed in 33.3 % patients with CRHD and in 52.5 % patients with AS. According to the ultrasound of the neck vessels in 188 patients with CRHD, the average thickness of intima/media complex was 0.84 ± 0.01 on the left and 0.84 ± 0.01 on the right; frequency of atherosclerotic plaques in the carotid arteries was 72.3 % on the left and 68.08 % on the right. The thickness of intima/media complex was statistically significantly higher in patients with AS on the left (1.02 ± 0.02) and on the right (1.15 ± 0.07); frequency of atherosclerotic plaques in the carotid arteries was 93.2 % on the left and 90.9 % on the right. Assessment of ultrasound data dynamics of carotid arteries in patients with CRHD revealed statistically significant increasing of intima/media thickness on the left (0.88 ± 0.01) and on the right (0.9 ± 0.01). There were no statistically significant differences for speed parameters. Conclusions. Endothelial dysfunction takes place in the presence of mitral stenosis or AS, it is more expressed in AS. Also, atherosclerosis of carotid arteries in patients with CRHD and AS is more prevalent than in the population. And the frequency of coronary atherosclerosis in patients with CRHD is insignificant in comparison with patients with AS. Within 5 years of observation both endothelial dysfunction and atherosclerosis of carotid arteries progress in patients with CRHD.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67770823","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}