[The analysis of concomitant pathology in ophthalmologic practice based on electronic medical records data].

The study substantiates possibility of using data retrieved from electronic medical records (EMR) for analyzing comorbidity under diseases of the eye and its adnexa. The purpose of the study is to analyze prevalence and evaluate risk of development of comorbidity in patients with ophthalmologic pathology, based on the data presented in EMR. The total number of patients included into comprised 12 120 individuals. The 653 diagnoses were established and 122 703 requests for medical care were registered. The calculation was applied concerning prevalence, comorbidity index, relative risk of comorbidity. The study established prevalence and level of relative risk of development of opportunistic diseases characteristic for senile cataract and glaucoma. The obtained data on comorbidity may testify in-depth mechanisms of interaction of diseases at cellular, protein or genetic levels. The understanding of mechanisms of interaction of main and concomitant diseases can result in development of new methods of diagnostic, treatment and prevention of diseases. Thus, establishment of glaucoma diagnosis can induce physician to look for possible presence or high probability of development of prostate neoplasm that implies periodic control of prostate-specific antigen. The presented results demonstrate how EMR data can be used to identify, estimate prevalence and risk of comorbidity and also reveals pathogenic mechanisms of interaction between primary and recurrent diseases that can be applied in clinical practice.

[Effect of Bisoprolol on Heart Rate Variability in Patients With Coronary Atherosclerosis: Dependence on Polymorphisms of -1 Adrenergic Receptor Gene].

PURPOSE: To assess effectiveness of a -blocker bisoprolol basing on a study of variability of cardiac rhythm and polymorphism of -1 adrenergic receptor gene (ADRB1). MATERIAL AND METHODS: We examined 99 patients with coronary atherosclerosis either with stable angina without history of vascular events or more than 6 month after myocardial infarction and/or coronary intervention. RESULTS AND CONCLUSION: Patients with coronary atherosclerosis including those after myocardial infarction had signs of autonomic dysfunction regardless of the presence of genetic polymorphism Gly389Arg ADRB1. Sympathetic influences at orthostatic test performed during taking bisoprolol were more pronounced in patients with Gly389Gly ADRB1 genotype than in patients with Gly389Arg ADRB1 genotype. Basing on this observation we conclude that the control by bisoprolol of heart rate regulation in patients with Gly389Gly ADRB1 genotype should be considered inadequate.

[Effect of a vascular event on drug regimen compliance in patients with coronary atherosclerosis].

In order to assess the effect of a vascular event on adherence to treatment we examined a total of 68 patients presenting with coronary atherosclerosis. The patients' age varied from 31 to 84 years (mean 57.1±8.7). There were 55 (81.1%) men and 13 (18.9%) women. Drug regimen compliance was evaluated by means of the Morisky-Green Medication Adherence Questionnaire before and after the vascular event. Of the 68 examined patients, 15 (22.1%) had not taken any therapeutic agents before the vascular event occurred, despite existing arterial hypertension. Drug regimen compliance prior to the vascular event was low in 82.4% of cases. The number of patients with coronary atherosclerosis and low compliance to treatment before the vascular event decreased significantly thereafter (p=0.0012). After the vascular event, the number of patients adhering to the doctor's recommendations on medicamentous therapy increases considerably. At the same time, a sufficiently great number of patients [about 30% of patients after endured myocardial infarction (MI) and 18% after transcutaneous coronary intervention (TCI)] still remain in the category of those "having low drug regimen compliance" and, accordingly, have high risk for the development of recurrent vascular events. Endured TCI increases patient compliance more significantly than MI, which requires additional study of a psychological component of the given fact.

[Disorders of psychoneurohumoral interrelations in patients suffering from arterial hypertension].

To elucidate disorders of psychoneurohumoral relationships in patients with grade I-II arterial hypertension at low, moderate and high overall cardiovascular risk, we measured body mass index, activity of sympathetic nervous system, serum leptin level and performed psychological tests aimed to elucidate situational and personal anxiety, aggressiveness and hostility. The data obtained allow a patient to be referred to one of the three possible types of disturbed psychoneurohumoral interrelations, viz. anxiety-metabolic, anxiety-adrenergic, and aggressive-metabolic, each having its own specific gender-related and clinical features. Discrimination between these types permits to substantiate pathogenetic therapy of arterial hypertension on an individual basis.

Vitamin D Deficiency as an Independent Predictor of Myocardial Infarction in the Elderly.

Cardiovascular diseases are among the most common causes of disability and death in the world, and the number of patients with this category of diseases is increasing every year. This study aimed to investigate the role of vitamin D and the problems caused by its deficiency on the cardiovascular system. Level of D-(25(OH]D) in blood was studied by enzyme immunoassay in 95 elderly patients with myocardial infarction (MI) (the main group) and 92 elderly patients with no history of MI. The level of lipid metabolism as an indicator was determined using a KoneLab 300 auto-analyzer. Based on the results of this study, it was found that the elderly group without MI had the highest amount of D-(25(OH]D)(24.5±1.2), compared to the elderly group with MI (14.8±1.3). The rates of expressed deficiency, deficiency, and insufficiency in the group of elderly with MI were 53.6±5.1, 23.2±4.4, and 12.6±3.4%, respectively. This experiment has shown that D-(25(OH]D) is involved in lipid metabolism and reduces the accumulation of cholesterol by macrophages. The content of vitamin D in blood plasma was a prognostic predictor of MI, which improved MI in the elderly. Regardless of pathological changes, the deficit level of D-(25(OH]D) should be considered a laboratory predictor of MI in the elderly.

[Contribution of neurohumoral dysfunction and overweight to the course of essential hypertension].

AIM: To determine the role of neurohumoral dysfunction and overweight in a clinical course of arterial hypertension (AH). MATERIAL AND METHODS: 200 participants of the study aged 30-60 years with AH degree I-II with low, moderate and high overall cardiovascular risk and mean disease duration 11.1 +/- 9.5 years were examined for body mass index, levels of leptin, soluble leptin receptor, insulin, serotonin and adrenoreactivity. RESULTS: Neurohumoral dysfunction correlated with body mass index. It manifested with elevation of insulin and leptin levels, sympathetic hyperactivity and a decrease of serotonin. CONCLUSION: One of the mechanisms forming and sustaining AH in patients with overweight is leptin-dependent sympathetic hyperactivity while serotonin system activation is more important for patients with normal body weight. Hypertensive patients with obesity demonstrate insulin-dependent hyperleptinemia.