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The population of Russia consists of more than 150 local ethnicities. The ethnic diversity and geographic origins, which extend from eastern Europe to Asia, make the population uniquely positioned to investigate the shared properties of inherited disease risks between European and Asian ancestries. We present the analysis of genetic and phenotypic data from a cohort of 4,145 individuals collected in three metro areas in western Russia. We show the presence of multiple admixed genetic ancestry clusters spanning from primarily European to Asian and high identity-by-descent sharing with the Finnish population. As a result, there was notable enrichment of Finnish-specific variants in Russia. We illustrate the utility of Russian-descent cohorts for discovery of novel population-specific genetic associations, as well as replication of previously identified associations that were thought to be population-specific in other cohorts. Finally, we provide access to a database of allele frequencies and GWAS results for 464 phenotypes.
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Frecuencia de los Genes , Estudio de Asociación del Genoma Completo , Humanos , Federación de Rusia/epidemiología , Masculino , Polimorfismo de Nucleótido Simple , Femenino , Predisposición Genética a la Enfermedad , Genética de Población , Fenotipo , Población Blanca/genética , Finlandia , Pueblo Asiatico/genética , Variación Genética , Estudios de Cohortes , Herencia Multifactorial/genética , Etnicidad/genética , Pueblos de Europa OrientalRESUMEN
OBJECTIVES: In hemodialysis patients, central hemodynamics, stiffness, and wave reflections assessed through ambulatory blood pressure monitoring (ABPM) showed superior prognostic value for cardiovascular (CV) events than peripheral blood pressures (BPs). No such evidence is available for lower-risk hypertensive patients. METHODS: In 591 hypertensive patients (mean age 58â±â14âyears, 49% males), ambulatory brachial and central BP, pulse wave velocity (PWV), and augmentation index (AIx) were obtained with a validated upper arm cuff-based pulse wave analysis technology. Information on treatment for hypertension (73% of patients), dyslipidemia (27%), diabetes (8%), CV disease history (25%), was collected. Patients were censored for CV events or all-cause death over 4.2âyears. RESULTS: One hundred and four events (24 fatal) were recorded. Advanced age [hazard ratio and 95% confidence interval: 1.03 (1.01, 1.05), P â=â0.0001], female sex [1.57 (1.05, 2.33), P â=â0.027], CV disease [2.22 (1.50, 3.29), P â=â0.0001], increased 24-h central pulse pressure (PP) [1.56 (1.05, 2.31), P â=â0.027], PWV [1.59 (1.07, 2.36), P â=â0.022], or AIx [1.59 (1.08, 2.36), P â=â0.020] were significantly associated with a worse prognosis (univariate Cox regression analysis). The prognostic power of peripheral and central BPs was lower. However, PWV [1.02 (0.64, 1.63), P â=â0.924], AIx [1.06 (0.66, 1.69), P â=â0.823], and central PP [1.18 (0.76, 1.82), P â=â0.471], were not significant predictors in multivariate analyses. CONCLUSIONS: In hypertensive patients, ambulatory central PP, PWV, and AIx are associated with an increased risk of CV morbidity and all-cause mortality. However, this association is not independent of other patient characteristics.
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Enfermedades Cardiovasculares , Hemodinámica , Rigidez Vascular , Humanos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/fisiopatología , Rigidez Vascular/fisiología , Sistema de Registros , Análisis de la Onda del Pulso , Monitoreo Ambulatorio de la Presión Arterial , Hipertensión/fisiopatología , Hipertensión/mortalidad , Hipertensión/complicaciones , Adulto , Presión Sanguínea/fisiologíaRESUMEN
BACKGROUND: The cardio-ankle vascular index (CAVI) measure of arterial stiffness is associated with prevalent cardiovascular risk factors, while its predictive value for cardiovascular events remains to be established. The aim was to determine associations of CAVI with cardiovascular morbimortality (primary outcome) and all-cause mortality (secondary outcome), and to establish the determinants of CAVI progression. METHODS: TRIPLE-A-Stiffness, an international multicentre prospective longitudinal study, enrolled >2000 subjects ≥40 years old at 32 centres from 18 European countries. Of these, 1250 subjects (55% women) were followed for a median of 3.82 (2.81-4.69) years. FINDINGS: Unadjusted cumulative incidence rates of outcomes according to CAVI stratification were higher in highest stratum (CAVI > 9). Cox regression with adjustment for age, sex, and cardiovascular risk factors revealed that CAVI was associated with increased cardiovascular morbimortality (HR 1.25 per 1 increase; 95% confidence interval, CI: 1.03-1.51) and all-cause mortality (HR 1.37 per 1 increase; 95% CI: 1.10-1.70) risk in subjects ≥60 years. In ROC analyses, CAVI optimal threshold was 9.25 (c-index 0.598; 0.542-0.654) and 8.30 (c-index 0.565; 0.512-0.618) in subjects ≥ or <60 years, respectively, to predict increased CV morbimortality. Finally, age, mean arterial blood pressure, anti-diabetic and lipid-lowering treatment were independent predictors of yearly CAVI progression adjusted for baseline CAVI. INTERPRETATION: The present study identified additional value for CAVI to predict outcomes after adjustment for CV risk factors, in particular for subjects ≥60 years. CAVI progression may represent a modifiable risk factor by treatments. FUNDING: International Society of Vascular Health (ISVH) and Fukuda Denshi, Japan.
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Índice Vascular Cardio-Tobillo , Enfermedades Cardiovasculares , Rigidez Vascular , Humanos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/etiología , Estudios Prospectivos , Progresión de la Enfermedad , Factores de Riesgo , Curva ROC , Adulto , Estudios Longitudinales , Pronóstico , Factores de Riesgo de Enfermedad CardiacaRESUMEN
OBJECTIVES: This analysis compared adherence, cardiovascular (CV) events and all-cause mortality incidence, and healthcare costs among hypertensive patients treated with perindopril (PER)/indapamide (IND)/amlodipine (AML) in single-pill combination (SPC) vs. multiple-pill combination, in a real-world setting in Italy. METHODS: In this observational retrospective analysis of Italian administrative databases, adult patients treated with PER/IND/AML between 2010 and 2020 were divided into two cohorts: single-pill vs. multiple-pill. Patient data were available for at least one year before and after index date. Propensity score matching (PSM) was applied to reduce selection bias. Adherence was defined as proportion of days covered: non-adherence, <40%; partial adherence, 40-79%, and adherence ≥80%. Mortality incidence and CV events as single, or composite, endpoints were evaluated after first year of follow-up. Healthcare cost analyses were performed from the perspective of the Italian National Health Service. RESULTS: Following PSM, the single-pill cohort included 12 150 patients, and the multiple-pill cohort, 6105. The SPC cohort had a significantly higher percentage of adherent patients vs. the multiple-pill cohort (59.9% vs. 26.9%, P â<â0.001). Following the first year of follow-up, incidence of all-cause mortality, and combined endpoint of all-cause mortality and CV events were lower in the SPC cohort compared with multiple-pill cohort. Average annual direct healthcare costs were lower in the single-pill cohort (2970) vs. multiple-pill cohort (3642); cost of all drugs and all-cause hospitalizations were major contributors. CONCLUSION: The SPC of PER/IND/AML, compared with multiple-pill combination, is associated with higher adherence to medication, lower incidence of CV events and mortality, and reduced healthcare costs.
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Hipertensión , Indapamida , Leucemia Mieloide Aguda , Adulto , Humanos , Perindopril/uso terapéutico , Indapamida/uso terapéutico , Antihipertensivos/uso terapéutico , Estudios Retrospectivos , Medicina Estatal , Cumplimiento de la Medicación , Amlodipino/uso terapéutico , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Combinación de Medicamentos , Costos de la Atención en Salud , Leucemia Mieloide Aguda/tratamiento farmacológicoRESUMEN
Famine exposure during early life development can affect disease risk in late-life period, yet, transmission of phenotypic features from famine-exposed individuals to the next generations has not been well characterized. The purpose of our case-control study was to investigate the association of parental starvation in the perinatal period and the period of early childhood with the phenotypic features observed in two generations of descendants of Leningrad siege survivors. We examined 54 children and 30 grandchildren of 58 besieged Leningrad residents who suffered from starvation in early childhood and prenatal age during the Second World War. Controls from the population-based national epidemiological ESSE-RF study (n = 175) were matched on sex, age and body mass index (BMI). Phenotypes of controls and descendants (both generations, children and grandchildren separately) were compared, taking into account multiple testing. Comparison of two generations descendants with corresponding control groups revealed significantly higher creatinine and lower glomerular filtration rate (GFR), both in meta-analysis and in independent analyses. The mean values of GFR for all groups were within the normal range (GFR less than 60 mL/min/1.73 m2 was recorded in 2 controls and no one in DLSS). Additionally, independent of the creatinine level, differences in the eating pattern were detected: insufficient fish and excessive red meat consumption were significantly more frequent in the children of the Leningrad siege survivors compared with controls. Blood pressure, blood lipids and glucose did not differ between the groups. Parental famine exposure in early childhood may contribute to a decrease in kidney filtration capacity and altered eating pattern in the offspring of famine-exposed individuals.
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Hambruna , Inanición , Preescolar , Humanos , Animales , Femenino , Embarazo , Estudios de Casos y Controles , Creatinina , Presión SanguíneaRESUMEN
The availability of patient-reported experience measures (PREM) is an unmet need in Russian healthcare. Objective: To translate, adapt culturally, and validate PREM for outpatients. Methods: A core set of questions from the Patient Experience Questionnaire (PEQ, in Norwegian, available in English) was translated to Russian (forward-backward translation). Acceptability, construct validity, and reliability were assessed. Patients aged ≥18 y.o. were invited to complete the questionnaire via QR-code within 24 h after a medical encounter. Results: A questionnaire with adequate conceptual and linguistic equivalence was obtained. For four questions, a rating scale was replaced by Likert-type. A total of 308 responses were received (median age 55 y.o., 52% females). The correlation matrix was factorable. Four factors were extracted using varimax rotation: 1) outcome of this specific visit; 2) communication experiences; 3) communication competency; 4) emotions after this visit. These explained 65.4% of the total variance. Three items were excluded. The model was confirmed to be adequate. The Cronbach alpha was >0.9. Item-total correlation confirmed discriminative validity. Conclusion: These preliminary results show that the Russian version of PEQ, adapted to national features, shows good psychometric properties. External validation is needed for the broad implementation of this PREM. Innovation: This research is first attempt to use PREM in the Russian Federation. The use of quick response codes is feasible and eases survey conduction. The more PREMs are used the higher the quality of healthcare.
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BACKGROUND: Few studies have compared COVID-19 patients from different waves. This study aims to conduct a clinical and morphological analysis of patients who died from COVID-19 during four waves. METHODS: The study involved 276 patients who died from COVID-19 during four waves, including 77 patients in the first wave, 119 patients in the second wave, and 78 patients in the third wave. We performed a histological examination of myocardium samples from autopsies and additionally analyzed the samples by PCR. We conducted immunohistochemistry of the myocardium for 21 samples using antibodies against CD3, CD45, CD8, CD68, CD34, Ang1, VWF, VEGF, HLA-DR, MHC1, C1q, enteroviral VP1, and SARS-CoV-2 spike protein. We also did immunofluorescent staining of three myocardial specimens using VP1/SARS-CoV-2 antibody cocktails. Further, we ran RT-ddPCR analysis for 14 RNA samples extracted from paraffin-embedded myocardium. Electron microscopic studies of the myocardium were also performed for two samples from the fourth wave. RESULTS: Among the 276 cases, active myocarditis was diagnosed in 5% (15/276). Of these cases, 86% of samples expressed VP1, and individual cells contained SARS-CoV-2 spike protein in 22%. Immunofluorescence confirmed the co-localization of VP1 and SARS-CoV-2 spike proteins. ddPCR did not confidently detect SARS-CoV-2 RNA in the myocardium in any myocarditis cases. However, the myocardium sample from wave IV detected a sub-threshold signal of SARS-CoV-2 by qPCR, but myocarditis in this patient was not confirmed. Electron microscopy showed several single particles similar to SARS-CoV-2 virions on the surface of the endothelium of myocardial vessels. A comparison of the cardiovascular complication incidence between three waves revealed that the incidence of hemorrhage (48 vs. 24 vs. 17%), myocardial necrosis (18 vs. 11 vs. 4%), blood clots in the intramural arteries (12 vs. 7 vs. 0%), and myocarditis (19 vs. 1 vs. 6%) decreased over time, and CD8-T-killers appeared. Immunohistochemistry confirmed the presence of endotheliitis in all 21 studied cases. CONCLUSIONS: This study compared myocardial damage in patients who died during three COVID-19 waves and showed a decrease in the incidence of endotheliitis complications (thrombosis, hemorrhage, necrosis) and myocarditis over time. However, the connection between myocarditis and SARS-CoV-2 infection remains unproven.
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INTRODUCTION: Single-pill combination therapy for hypertension is recognized to improve adherence to treatment. However, less is known about the benefits of triple single-pill combinations. This retrospective observational analysis aimed to assess changes in adherence when treatment was switched from perindopril (PER)/indapamide (IND) + amlodipine (AML) to PER/IND/AML single-pill combination, in Italian clinical practice. METHODS: This analysis used data extracted from administrative databases of Italian healthcare entities. Adult patients receiving PER/IND/AML were selected, and the prescription date was considered as the index date. Among them, those who had a prescription for PER/IND + AML during the 12 months before the index date and a prescription of PER/IND/AML during 6 months of follow-up were included. Adherence was calculated as the proportion of days covered (PDC: PDC < 40%, non-adherent; PDC = 40-79%, partially adherent; PDC ≥ 80%, adherent). RESULTS: Among the identified patients, 158 were exposed users and were included in the analysis. When patients were compared before and after switch to triple single-pill combination, the proportion of adherent patients was significantly higher with PER/IND/AML single-pill combination (75.3%) than with PER/IND + AML combination (44.3%) (P < 0.05). Conversely, the proportion of non-adherent patients was lower with the PER/IND/AML single-pill combination (14.6%) vs PER/IND + AML (17.7%) (P < 0.001). CONCLUSION: This real-world analysis showed that switching to a triple single-pill combination could offer an opportunity to improve adherence to antihypertensive treatment in real-life clinical practice.
Medication adherence is defined by the World Health Organization as the "extent to which a person's behavior (in taking medication) corresponds with agreed recommendations from a healthcare provider". Low levels of medication adherence in hypertension have been linked with increased disease burden and with higher costs for patients. Patients with hypertension whose blood pressure is poorly controlled often need to receive more than one pill. Nevertheless, having to take many pills may result in poor adherence, i.e., patients not taking their treatment as prescribed. Combining multiple drugs into a single pill for the management of hypertension is known to improve adherence; however, limited evidence exists about the benefits of triple single-pill combinations compared with equivalent free combinations in real clinical practice. This analysis evaluated changes in adherence before and after patients switched from a three-drug therapy of perindopril/indapamide single-pill + amlodipine (PER/IND + AML) to perindopril/indapamide/amlodipine (PER/IND/AML) taken as a single pill. In this analysis, real-world data from Italian administrative databases covering around 11% of the Italian population were used. Overall, 158 patients were included. More patients were found to be adherent after switch to PER/IND/AML single pill (75.3% vs 44.3% of PER/IND + AML combination). Partially adherent and poorly adherent patients were fewer with PER/IND/AML single-pill combination (10.1% and 14.6%, respectively) compared to PER/IND + AML combination (38.0% and 17.7%, respectively). These findings indicate that switching to a simplified therapy in which all three drugs are taken in one pill may offer an opportunity for increasing the number of patients that are adherent to their medication.
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Hipertensión , Indapamida , Leucemia Mieloide Aguda , Adulto , Humanos , Amlodipino/uso terapéutico , Perindopril/uso terapéutico , Indapamida/uso terapéutico , Estudios Retrospectivos , Presión Sanguínea , Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Combinación de Medicamentos , Cumplimiento de la Medicación , Leucemia Mieloide Aguda/tratamiento farmacológicoRESUMEN
[This corrects the article DOI: 10.5334/gh.1128.].
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Background and aims: Limited data exist on the cardiovascular manifestations and risk factors in people hospitalized with COVID-19 from low- and middle-income countries. This study aims to describe cardiovascular risk factors, clinical manifestations, and outcomes among patients hospitalized with COVID-19 in low, lower-middle, upper-middle- and high-income countries (LIC, LMIC, UMIC, HIC). Methods: Through a prospective cohort study, data on demographics and pre-existing conditions at hospital admission, clinical outcomes at hospital discharge (death, major adverse cardiovascular events (MACE), renal failure, neurological events, and pulmonary outcomes), 30-day vital status, and re-hospitalization were collected. Descriptive analyses and multivariable log-binomial regression models, adjusted for age, sex, ethnicity/income groups, and clinical characteristics, were performed. Results: Forty hospitals from 23 countries recruited 5,313 patients with COVID-19 (LIC = 7.1%, LMIC = 47.5%, UMIC = 19.6%, HIC = 25.7%). Mean age was 57.0 (±16.1) years, male 59.4%, pre-existing conditions included: hypertension 47.3%, diabetes 32.0%, coronary heart disease 10.9%, and heart failure 5.5%. The most frequently reported cardiovascular discharge diagnoses were cardiac arrest (5.5%), acute heart failure (3.8%), and myocardial infarction (1.6%). The rate of in-hospital deaths was 12.9% (N = 683), and post-discharge 30 days deaths was 2.6% (N = 118) (overall death rate 15.1%). The most common causes of death were respiratory failure (39.3%) and sudden cardiac death (20.0%). The predictors of overall mortality included older age (≥60 years), male sex, pre-existing coronary heart disease, renal disease, diabetes, ICU admission, oxygen therapy, and higher respiratory rates (p < 0.001 for each). Compared to Caucasians, Asians, Blacks, and Hispanics had almost 2-4 times higher risk of death. Further, patients from LIC, LMIC, UMIC versus. HIC had 2-3 times increased risk of death. Conclusions: The LIC, LMIC, and UMIC's have sparse data on COVID-19. We provide robust evidence on COVID-19 outcomes in these countries. This study can help guide future health care planning for the pandemic globally.
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COVID-19 , Enfermedades Cardiovasculares , Diabetes Mellitus , Insuficiencia Cardíaca , Cuidados Posteriores , COVID-19/epidemiología , Enfermedades Cardiovasculares/epidemiología , Factores de Riesgo de Enfermedad Cardiaca , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Alta del Paciente , Estudios Prospectivos , Factores de RiesgoRESUMEN
Age-related changes in the vascular system play an important role in the biological age and lifespan of a person and maybe affected from an early age onward. One of the indicators of changes in the vascular system is arterial wall stiffness and its main measure, i.e., carotid-femoral pulse wave velocity (cfPWV). We examined arterial wall stiffness in a sample of 305 Leningrad Siege survivors to assess how hunger and stressful conditions during fetal development and early childhood affected the state of the cardiovascular system at a later age and what factors may neutralize the negative impact sustained in early childhood. Here, we presented an evaluation of two unique patients with supernormal vascular aging (SUPERNOVA) phenotype from this cohort and described the details of congruence between hereditary resistance and practiced lifestyle yielding slower biological aging rate.
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Numerous studies demonstrated the lack of transferability of polygenic score (PGS) models across populations and the problem arising from unequal presentation of ancestries across genetic studies. However, even within European ancestry there are ethnic groups that are rarely presented in genetic studies. For instance, Russians, being one of the largest, diverse, and yet understudied group in Europe. In this study, we evaluated the reliability of genotype imputation for the Russian cohort by testing several commonly used imputation reference panels (e.g. HRC, 1000G, HGDP). HRC, in comparison with two other panels, showed the most accurate results based on both imputation accuracy and allele frequency concordance between masked and imputed genotypes. We built polygenic score models based on GWAS results from the UK biobank, measured the explained phenotypic variance in the Russian cohort attributed to polygenic scores for 11 phenotypes, collected in the clinic for each participant, and finally explored the role of allele frequency discordance between the UK biobank and the study cohort in the resulting PGS performance.
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Herencia Multifactorial , Polimorfismo de Nucleótido Simple , Frecuencia de los Genes , Genotipo , Humanos , Herencia Multifactorial/genética , Reproducibilidad de los ResultadosRESUMEN
Cardiac fibrosis is the basis of structural and functional disorders in patients with diabetes mellitus (T2DM). A wide range of laboratory and instrumental methods is used for its prediction. The study aimed to identify simple predictors of cardiac fibrosis in patients with T2DM based on the analysis of circulating fibrosis biomarkers and arterial stiffness. The study included patients with T2DM (n = 37) and cardiovascular risk factors (RF, n = 27) who underwent ECHO, cardiac magnetic resonance imaging (MRI), pulse wave analysis (PWV), reactive hyperemia (RH), peripheral arterial tonometry, carotid ultrasonography, and assessment of serum fibrosis biomarkers. As a control group, 15 healthy subjects were examined. Left ventricular concentric hypertrophy was accompanied by an increased serum galectin-3 level in T2DM patients. There was a relationship between the PICP and HbA1c levels in both main groups (R2 = 0.309; p = 0.014). A negative correlation between PICP level and the global longitudinal strain (GLS) was found (r = −0.467; p = 0.004). The RH index had a negative correlation with the duration of diabetes (r = −0.356; p = 0.03), the carotid-femoral PWV (r = −0.371; p = 0.024), and the carotid intima-media thickness (r = −0.622; p < 0.001). The late gadolinium-enhanced (LGE) cardiac MRI was detected in 22 (59.5%) T2DM and in 4 (14.85%) RF patients. Diabetes, its baseline treatment with metformin, HbA1c and serum TIMP-1 levels, and left ventricle hypertrophy had moderate positive correlations with LGE findings (p < 0.05). Using the multivariate regression analysis, increased TIMP-1 level was identified as an independent factor associated with cardiac fibrosis.
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During the COVID-19 pandemic, telemedicine has emerged worldwide as an indispensable resource to improve the surveillance of patients, curb the spread of disease, facilitate timely identification and management of ill people, but, most importantly, guarantee the continuity of care of frail patients with multiple chronic diseases. Although during COVID-19 telemedicine has thrived, and its adoption has moved forward in many countries, important gaps still remain. Major issues to be addressed to enable large scale implementation of telemedicine include: (1) establishing adequate policies to legislate telemedicine, license healthcare operators, protect patients' privacy, and implement reimbursement plans; (2) creating and disseminating practical guidelines for the routine clinical use of telemedicine in different contexts; (3) increasing in the level of integration of telemedicine with traditional healthcare services; (4) improving healthcare professionals' and patients' awareness of and willingness to use telemedicine; and (5) overcoming inequalities among countries and population subgroups due to technological, infrastructural, and economic barriers. If all these requirements are met in the near future, remote management of patients will become an indispensable resource for the healthcare systems worldwide and will ultimately improve the management of patients and the quality of care.
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BACKGROUND: Bromhexine hydrochloride has been suggested as a TMPRSS2 protease blocker that precludes the penetration of SARS-CoV-2 into cells. We aimed to assess the preventive potential of regular bromhexine hydrochloride intake for COVID-19 risk reduction in medical staff actively involved in the evaluation and treatment of patients with confirmed or suspected SARS-CoV-2 infection. METHODS: In a single-centre randomized open-label study, medical staff managing patients with suspected and confirmed COVID-19 were enrolled and followed up for 8 weeks. The study began at the initiation of COVID-19 management in the clinic. The study was prematurely terminated after the enrollment of 50 participants without a history of SARS-CoV-2 infection: 25 were assigned to bromhexine hydrochloride treatment (8 mg 3 times per day), and 25 were controls. The composite primary endpoint was a positive nasopharyngeal swab polymerase chain reaction (PCR) test for SARS-CoV-2 or signs of clinical infection within 28 days and at week 8. Secondary endpoints included time from the first contact with a person with COVID-19 to the appearance of respiratory infection symptoms; the number of days before a first positive SARS-CoV-2 test; the number of asymptomatic participants with a positive nasopharyngeal swab test; the number of symptomatic COVID-19 cases; and adverse events. RESULTS: The rate of the combined primary endpoint did not differ significantly between the active treatment group (2/25 [8%]) and control group (7/25 [28%]); P=0.07. A fewer number of participants developed symptomatic COVID-19 in the treatment group compared to controls (0/25 vs. 5/25; P=0.02). CONCLUSION: Although the study was underpowered, it showed that Bromhexine hydrochloride prophylaxis was associated with a reduced rate of symptomatic COVID-19. The prophylactic treatment was not associated with a lower combined primary endpoint rate, a positive swab PCR test, or COVID-19 (ClinicalTrials.gov number, NCT04405999).
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OBJECTIVES: Adult-onset Still's disease (AOSD) is increasingly viewed as autoinflammatory disease associated with the so-called inflammasomopathy. Proinflammatory cytokines, such as IL-18 and IL-1ß, processed through the inflammasome machinery, play an important role in the pathogenesis of AOSD. AOSD is heterogenous, therefore there are two subtypes of the disease, systemic and articular, which probably imply different approaches for the treatment. Over 20% of patients with systemic AOSD have serositis. Recently, colchicine in combination with non-steroidal anti-inflammatory drugs (NSAIDs) has become the "gold standard" for recurrent pericarditis treatment. However, data on this combination therapy in AOSD are scarce. METHODS: In this retrospective case series study, we assessed the medical history of 20 patients with a systemic form of AOSD. All patients had pericarditis and received а combination of NSAIDs (in most cases ibuprofen 600-800 mg x3 daily) and colchicine (1 mg daily) for treatment. RESULTS: 13/20 (65%) of patients responded to this combination of anti-inflammatory drugs. Of note, not only pericarditis, but also other manifestations were improved such as arthritis, rash, hepatomegaly, acute phase reactants, and abnormal liver tests. CONCLUSIONS: The low cost, safety and wide availability of such therapy make this option relevant and determine the need for further study.
Asunto(s)
Pericarditis , Serositis , Enfermedad de Still del Adulto , Adulto , Antiinflamatorios/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Colchicina/efectos adversos , Humanos , Pericarditis/complicaciones , Pericarditis/tratamiento farmacológico , Estudios Retrospectivos , Enfermedad de Still del Adulto/complicaciones , Enfermedad de Still del Adulto/diagnóstico , Enfermedad de Still del Adulto/tratamiento farmacológicoRESUMEN
ЦелÑ: ÐзÑÑение оÑобенноÑÑей клиниÑеÑкого ÑеÑÐµÐ½Ð¸Ñ Ð½Ð¾Ð²Ð¾Ð¹ коÑонавиÑÑÑной инÑекÑии и влиÑÐ½Ð¸Ñ ÑопÑÑÑÑвÑÑÑÐ¸Ñ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ð¹ на иÑÑ Ð¾Ð´ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ñ Ñ Ð³Ð¾ÑпиÑализиÑованнÑÑ Ð±Ð¾Ð»ÑнÑÑ Ñ Ð¸Ð½ÑекÑией SARS-CoV-2 в пеÑвÑÑ Ð¸ вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸.ÐеÑÐ¾Ð´Ñ Ð¸ ÑезÑлÑÑаÑÑ. ÐÐ»Ñ Ð¾Ñенки оÑобенноÑÑей ÑеÑÐµÐ½Ð¸Ñ COVID-19 в ÐвÑазийÑком Ñегионе бÑли ÑÐ¾Ð·Ð´Ð°Ð½Ñ Ð¼ÐµÐ¶Ð´ÑнаÑоднÑе ÑегиÑÑÑÑ ÐÐТÐÐ 1 и во вÑÐµÐ¼Ñ Ð²ÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ ÐÐТÐÐ 2. ÐÐ°Ð±Ð¾Ñ Ð±Ð¾Ð»ÑнÑÑ Ð² ÑегиÑÑÑ ÐÐТÐÐ 1 пÑоводили Ñ 29.06.20 по 29.10.20, набÑано 5 397 паÑиенÑов. ÐÑием паÑиенÑов на ÑÑÐµÑ Ð² ÐÐТÐÐ 2 пÑоводили Ñ 01.11.20 до 30.03.21, набÑано 2 665 болÑнÑÑ .РезÑлÑÑаÑÑ. ÐоÑпиÑалÑÐ½Ð°Ñ Ð»ÐµÑалÑноÑÑÑ ÑнизилаÑÑ Ð² пеÑиод вÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ и ÑоÑÑавила 4,8 % пÑоÑив 7,6 % в пеÑиод пеÑвой волнÑ. РпеÑиод вÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°ÑиенÑÑ Ð±Ñли ÑÑаÑÑе, имели болÑÑе ÑопÑÑÑÑвÑÑÑÐ¸Ñ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ð¹ и поÑÑÑпали в ÑÑаÑÐ¸Ð¾Ð½Ð°Ñ Ð² более ÑÑжелом ÑоÑÑоÑнии, паÑиенÑÑ Ð¸Ð¼ÐµÐ»Ð¸ более вÑÑокий ÑÑÐ¾Ð²ÐµÐ½Ñ Ð¿Ð¾Ð»Ð¸Ð¼Ð¾ÑбидноÑÑи. РпеÑиод вÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ ÑвелиÑилаÑÑ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°ÐµÐ¼Ð¾ÑÑÑ Ð±Ð°ÐºÑеÑиалÑной пневмонией и ÑепÑиÑом, но Ñеже вÑÑÑеÑалиÑÑ ÑÑÐ¾Ð¼Ð±Ð¾Ð·Ñ Ð³Ð»ÑÐ±Ð¾ÐºÐ¸Ñ Ð²ÐµÐ½ и «ÑиÑокиновÑй ÑÑоÑм¼. Ðаиболее неблагопÑиÑÑнÑми Ð´Ð»Ñ Ð¿Ñогноза ÑмеÑÑноÑÑи, как в пеÑвÑÑ, Ñак и во вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ñпидемии бÑли ÑоÑеÑÐ°Ð½Ð¸Ñ ÑопÑÑÑÑвÑÑÑÐ¸Ñ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ð¹: аÑÑеÑиалÑÐ½Ð°Ñ Ð³Ð¸Ð¿ÐµÑÑÐµÐ½Ð·Ð¸Ñ (ÐÐ) + Ñ ÑониÑеÑÐºÐ°Ñ ÑеÑдеÑÐ½Ð°Ñ Ð½ÐµÐ´Ð¾ÑÑаÑоÑноÑÑÑ (ХСÐ) + ÑÐ°Ñ Ð°ÑнÑй Ð´Ð¸Ð°Ð±ÐµÑ (СÐ) + ожиÑение, ÐÐ + иÑемиÑеÑÐºÐ°Ñ Ð±Ð¾Ð»ÐµÐ·Ð½Ñ ÑеÑдÑа (ÐÐС) + ХСР+ СÐ, ÐÐ + ÐÐС + ХСР+ ожиÑение.ÐаклÑÑение. У паÑиенÑов во вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ наблÑдалоÑÑ Ð±Ð¾Ð»ÐµÐµ обÑиÑное поÑажение Ñкани Ð»ÐµÐ³ÐºÐ¸Ñ , ÑаÑе возникала ÑебÑилÑÐ½Ð°Ñ Ð»Ð¸Ñ Ð¾Ñадка, бÑли вÑÑе ÑÑовни С-ÑеакÑивного белка и ÑÑопонина, ниже ÑÑовни гемоглобина и лимÑоÑиÑов. ÐÑо, веÑоÑÑно, ÑвÑзано Ñ ÑазлиÑной ÑакÑикой гоÑпиÑализаÑии паÑиенÑов в пеÑвÑÑ Ð¸ вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ в ÑÑÑÐ°Ð½Ð°Ñ , пÑинÑвÑÐ¸Ñ ÑÑаÑÑие в ÑоÑмиÑовании ÑегиÑÑÑов ÐÐТÐÐ 1 и ÐÐТÐÐ 2.
Asunto(s)
COVID-19 , Síndrome del Colon Irritable , Humanos , SARS-CoV-2RESUMEN
ЦелÑ: ÐзÑÑение оÑобенноÑÑей клиниÑеÑкого ÑеÑÐµÐ½Ð¸Ñ Ð½Ð¾Ð²Ð¾Ð¹ коÑонавиÑÑÑной инÑекÑии и влиÑÐ½Ð¸Ñ ÑопÑÑÑÑвÑÑÑÐ¸Ñ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ð¹ на иÑÑ Ð¾Ð´ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ñ Ñ Ð³Ð¾ÑпиÑализиÑованнÑÑ Ð±Ð¾Ð»ÑнÑÑ Ñ Ð¸Ð½ÑекÑией SARS-CoV-2 в пеÑвÑÑ Ð¸ вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸.ÐеÑÐ¾Ð´Ñ Ð¸ ÑезÑлÑÑаÑÑ. ÐÐ»Ñ Ð¾Ñенки оÑобенноÑÑей ÑеÑÐµÐ½Ð¸Ñ COVID-19 в ÐвÑазийÑком Ñегионе бÑли ÑÐ¾Ð·Ð´Ð°Ð½Ñ Ð¼ÐµÐ¶Ð´ÑнаÑоднÑе ÑегиÑÑÑÑ ÐÐТÐÐ 1 и во вÑÐµÐ¼Ñ Ð²ÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ ÐÐТÐÐ 2. ÐÐ°Ð±Ð¾Ñ Ð±Ð¾Ð»ÑнÑÑ Ð² ÑегиÑÑÑ ÐÐТÐÐ 1 пÑоводили Ñ 29.06.20 по 29.10.20, набÑано 5 397 паÑиенÑов. ÐÑием паÑиенÑов на ÑÑÐµÑ Ð² ÐÐТÐÐ 2 пÑоводили Ñ 01.11.20 до 30.03.21, набÑано 2 665 болÑнÑÑ .РезÑлÑÑаÑÑ. ÐоÑпиÑалÑÐ½Ð°Ñ Ð»ÐµÑалÑноÑÑÑ ÑнизилаÑÑ Ð² пеÑиод вÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ и ÑоÑÑавила 4,8 % пÑоÑив 7,6 % в пеÑиод пеÑвой волнÑ. РпеÑиод вÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°ÑиенÑÑ Ð±Ñли ÑÑаÑÑе, имели болÑÑе ÑопÑÑÑÑвÑÑÑÐ¸Ñ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ð¹ и поÑÑÑпали в ÑÑаÑÐ¸Ð¾Ð½Ð°Ñ Ð² более ÑÑжелом ÑоÑÑоÑнии, паÑиенÑÑ Ð¸Ð¼ÐµÐ»Ð¸ более вÑÑокий ÑÑÐ¾Ð²ÐµÐ½Ñ Ð¿Ð¾Ð»Ð¸Ð¼Ð¾ÑбидноÑÑи. РпеÑиод вÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ ÑвелиÑилаÑÑ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°ÐµÐ¼Ð¾ÑÑÑ Ð±Ð°ÐºÑеÑиалÑной пневмонией и ÑепÑиÑом, но Ñеже вÑÑÑеÑалиÑÑ ÑÑÐ¾Ð¼Ð±Ð¾Ð·Ñ Ð³Ð»ÑÐ±Ð¾ÐºÐ¸Ñ Ð²ÐµÐ½ и «ÑиÑокиновÑй ÑÑоÑм¼. Ðаиболее неблагопÑиÑÑнÑми Ð´Ð»Ñ Ð¿Ñогноза ÑмеÑÑноÑÑи, как в пеÑвÑÑ, Ñак и во вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ñпидемии бÑли ÑоÑеÑÐ°Ð½Ð¸Ñ ÑопÑÑÑÑвÑÑÑÐ¸Ñ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ð¹: аÑÑеÑиалÑÐ½Ð°Ñ Ð³Ð¸Ð¿ÐµÑÑÐµÐ½Ð·Ð¸Ñ (ÐÐ) + Ñ ÑониÑеÑÐºÐ°Ñ ÑеÑдеÑÐ½Ð°Ñ Ð½ÐµÐ´Ð¾ÑÑаÑоÑноÑÑÑ (ХСÐ) + ÑÐ°Ñ Ð°ÑнÑй Ð´Ð¸Ð°Ð±ÐµÑ (СÐ) + ожиÑение, ÐÐ + иÑемиÑеÑÐºÐ°Ñ Ð±Ð¾Ð»ÐµÐ·Ð½Ñ ÑеÑдÑа (ÐÐС) + ХСР+ СÐ, ÐÐ + ÐÐС + ХСР+ ожиÑение.ÐаклÑÑение. У паÑиенÑов во вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ наблÑдалоÑÑ Ð±Ð¾Ð»ÐµÐµ обÑиÑное поÑажение Ñкани Ð»ÐµÐ³ÐºÐ¸Ñ , ÑаÑе возникала ÑебÑилÑÐ½Ð°Ñ Ð»Ð¸Ñ Ð¾Ñадка, бÑли вÑÑе ÑÑовни С-ÑеакÑивного белка и ÑÑопонина, ниже ÑÑовни гемоглобина и лимÑоÑиÑов. ÐÑо, веÑоÑÑно, ÑвÑзано Ñ ÑазлиÑной ÑакÑикой гоÑпиÑализаÑии паÑиенÑов в пеÑвÑÑ Ð¸ вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ в ÑÑÑÐ°Ð½Ð°Ñ , пÑинÑвÑÐ¸Ñ ÑÑаÑÑие в ÑоÑмиÑовании ÑегиÑÑÑов ÐÐТÐÐ 1 и ÐÐТÐÐ 2.
Asunto(s)
COVID-19 , Síndrome del Colon Irritable , Humanos , Pandemias , SARS-CoV-2RESUMEN
Genetics and environmental and lifestyle factors deeply affect cardiovascular diseases, with atherosclerosis as the etiopathological factor (ACVD) and their early recognition can significantly contribute to an efficient prevention and treatment of the disease. Due to the vast number of these factors, only the novel "omic" approaches are surmised. In addition to genomics, which extended the effective therapeutic potential for complex and rarer diseases, the use of "omics" presents a step-forward that can be harnessed for more accurate ACVD prediction and risk assessment in larger populations. The analysis of these data by artificial intelligence (AI)/machine learning (ML) strategies makes is possible to decipher the large amount of data that derives from such techniques, in order to provide an unbiased assessment of pathophysiological correlations and to develop a better understanding of the molecular background of ACVD. The predictive models implementing data from these "omics", are based on consolidated AI best practices for classical ML and deep learning paradigms that employ methods (e.g., Integrative Network Fusion method, using an AI/ML supervised strategy and cross-validation) to validate the reproducibility of the results. Here, we highlight the proposed integrated approach for the prediction and diagnosis of ACVD with the presentation of the key elements of a joint scientific project of the University of Milan and the Almazov National Medical Research Centre.
Asunto(s)
Inteligencia Artificial , Enfermedades Cardiovasculares , Factores de RiesgoRESUMEN
PURPOSE: Blood pressure telemonitoring and remote counselling (BPTM) improves blood pressure (BP) control in patients with hypertension (HTN). Studies assessing the efficacy of BPTM from a value-based perspective are lacking. We investigated whether BPTM fits all principles of the value-based approach (clinical and economic effectiveness, improvement in patient-reported outcome/experience measures (PROM/PREM)). MATERIALS AND METHODS: Two hundred and forty ambulatory patients with uncontrolled HTN were randomised in a 2: 1 manner to BPTM (n = 160, mean age 47 y.o.) and usual care (UC, n = 80; 49 y.o.) with baseline and 3-month follow-up clinic visits. BPTM employed a mobile application (for patients) and a desktop version (for clinician), which allowed communication and exchange of medical data. The main outcomes were changes in office and ambulatory systolic (S) BPs, rate of BP control. The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were evaluated in economic analysis. The MOS SF-36 score was taken as a PROM, and the PEQ score was used as a PREM. RESULTS: Larger decreases in office and ambulatory SBPs (-16.8 and -8.9 mm Hg, respectively; p < .05) was achieved in BPTM group while the treatment intensity was equal (2.4 drugs). The ICER 11.1 EUR/-1 mm Hg 24-hour SBP/1 year was 75% effective as per willingness-to-pay threshold. BPTM improved PROM (+2.1 in mean MOS SF-36; p = .04), reduced long-term mortality (+0.11 life years gained), leading to +0.49 quality-adjusted life years (QALYs) gained as compared with UC. The ICUR was 4 169.4 EUR/QALY gained. Patient-reported experience was higher in the BPTM (+10 PEQ, p = .01). The UC group showed minor changes in MOS SF-36 and PEQ (+1.3; +6, respectively; p n.s.). CONCLUSIONS: Being cost-effective, BPTM incorporates both clinical benefits and patient-perceived value. Larger randomised studies are needed to confirm our findings.