[Modified method for determining the normal values of the aortic root diameter in the focus of aortic pathology in individuals with congenital connective tissue disorders].

INTRODUCTION: Enlargement of the aortic root of occurs in many cases with cardiovascular disease, including congenital connective tissue disorders (CCTD), especially its differentiated and undifferentiated forms (UCCTD). A common deficiency of the generally accepted methods for diagnosing an aortic root dilation may be that persons with CCTD and cardiovascular diseases of potentially having a broader aortic root diameter could be included in the reference groups. The purpose of our study was to develop a modified method for determining the normal aortic root diameter in group of individuals without CCTD and cardiovascular diseases. MATERIALS AND METHODS: The study included 464 apparently healthy people, men and women aged 15 to 65 years. All patients underwent general clinical examination, echocardiography. On the basis of external and internal signs of CCTD, patients with UCCTD were identified - the UCCTD group (n = 208) and without this pathology - the main group (n = 256). The calculation of the normal aortic root diameter (NARD) was made in accordance with the methods of Roman M. J. et al. (1989) and Devereux R. B. et al. (2012). The upper limit values of NARD (UL NARD) were calculated according to the algorithms of Roman M. J. et al. (1989), Devereux R. B. et al. (2012), Campens L. et al. (2014). RESULTS: The data obtained in the main group was used to develop a modified method for the determination of NARD. The mean values by echocardiography and calculated values of the aortic root by modified method of this study were practically the same in the main group, whereas the mean value of NARD calculated by the methods of Roman M. J. et al. and Devereux R. B. et al. in this sample were significantly higher in relation to the listed values. As the NARD values, the UL NARD were significantly higher for all evaluated algorithms in comparison with the modified method. In the group of patients with UCCTD, 13 cases of aortic root dilation were found according to the method of Roman M. J., compared to 19 cases by the modified method. At the same time, 3 patients with aortic root enlargement by the mew method had 7 points of systemic involvement, thus corresponding to the Ghent criteria of Marfan syndrome. The methods of Campens L. and Devereux R. B. were less sensitive, revealing only 5 and 1 patients with aortic root dilatation, respectively. CONCLUSIONS: The results of the study demonstrate that, in order to obtain more reliable information on the condition of the root of the aorta and its proper values, the modified method obtained in the course of the study can be used. This method is more sensitive in detecting the enlargement of the aortic root in CCTD and in diagnosing syndromic CCTD.

[Controlled diuretic monotherapy in hypertensive patients: Efficiency and metabolic safety]. / Kontroliruemaya monoterapiya diuretikami u bol'nykh arterial'noi gipertoniei: effektivnost' i metabolicheskaya bezopasnost'.

AIM: To evaluate the antihypertensive efficiency and metabolic effects of controlled monotherapy with hydrochlorothiazide (HCT) and indapamide retard (IR) in hypertensive patients. SUBJECTS AND METHODS: The study included 50 patients with Stage II essential hypertension, grades 1-3 blood pressure (BP) elevation, who received 3-month monotherapy with IR (n=25) or HCT (n=25). Changes were determined in BP, blood lipid, glucose, and potassium levels. The efficiency of antihypertensive therapy was evaluated in the entire group and subgroups of patients identified in accordance with the used diuretic and the presence (n=27) or absence (n=23) of therapy at previous stages. RESULTS: A total of 54% of the patients included in the study achieved target BP after 3 months of therapy. The proportion of individuals with normalized BP was comparable in the HCT and IR groups (52 and 56%, respectively) and in previously treated patients and those who used for the first time antihypertensive drugs (51.8 and 56.5%, respectively). Normalization of systolic and diastolic BPs was achieved in 78 and 58% of the patients, respectively. Target BP was achieved in 94,1%, 42,9% and 16,7% of patients with grades 1,2 and 3 hypertension, respectively. IR proved to be metabolically neutral whereas HCT was found to significantly increase the blood levels of triglycerides and glucose by 15.3% (p<0.05) and 12.2% (p<0.05), respectively. CONCLUSION: Controlled diuretic monotherapy allows BP normalization in more than 50% of the hypertensive patients. HCT and IR have similar antihypertensive efficiency. Because of the negative changes observed in lipid and carbohydrate metabolism with the use of relatively small doses of HCT, IR is a preferential alternative in the long-term treatment of hypertensive patients.

ACID-FORMING AND MOTOR FUNCTIONS OF THE STOMACH THE SYNDROME OF MALNUTRITION.

AIM: Ref fling pathogenesis factors and the role of disorders of gastric secretion in the formation of the syndrome of malnutrition in patients with connective tissue dysplasia patients. MATERIALS AND METHODS: In a cross-sectional comparative cohort study 83 patients were included: 59 patients with signs of connective tissue dysplasia (study group) and 24 patients with no signs of connective tissue-dysplasia (control group). In all patients the gastrointestinal symptoms were evaluated using a questionnaire GSRS, esophagogastroduodenoscopy, 24-hours pH monitoring, diagnostics H.pylori infection. RESULTS: in patients with connective tissue dysplasia the higher scores were recorded at body pH 1.2 (1.0; 2.8) and antral stomach 8.9 (6.6; 10.0). According to the morphological study the mucosal damage prevalents as pangastritis (20%), fundic gastritis (4%). Changes of intranagastric pH were associated with high rates of duodeno-gastric reflux in 74.5% patients. The severity of symptoms of dyspepsia (postprandial distress syndrome) and the degree of malnutrition correlated with indicators of intragastric pH in the body and antrum. CONCLUSION: The changes revealed intragastric pH may signifcantly alter the digestive conditions in all parts digestive tract contributing desynchronization receipt chyme and enzymes disrupting the normal regulation of pancreatic secretion, promoting the development of maldigestion syndromes, malabsorprion and, consequently aggravate genetically determined disorders trophological status.

[Personalized Risk Assessment of Adverse Cardiovascular Events in Young Patients With Connective Tissue Dysplasia].

Adverse cardiovascular manifestations (ACVM) were registered during 7-year follow-up of young patients with undifferentiated connective tissue dysplasia (CTD). ACVM developed in 28.42% of patients. Most frequent ACVMs were extension/aneurysm of the thoracic aorta (10.75%), cerebral vascular syndrome (10.56%), and arrhythmias (9.11%). Most significant risk factors for extension/aneurysm of the aorta were pathology of vertebral arteries, common risk factors (arterial hypertension, alcohol/drugs, smoking, heavy physical work, sports activities), bicuspid aortic valve); for pathology of cerebral vessels--completely open Willis' Circle, pathology of vertebral arteries, CTD related changes of skin and spine, diagnostic CTD coefficient > 23, chronic diseases of veins; clinically significant cardiac rhythm disturbances--combined valve manifestations of CTD, myxomatous degeneration of heart valves, pathology of the aorta, male sex, metabolic changes of the myocardium, deviations of circadian index, predominance of sympathetic tone, and diastolic dysfunction. Analysis of clinical characteristics (age, symptoms and severity of CTD, QTc dispersion ≥ 50 ms) and presence of unfavorable genetic polymorphisms in ß1-adrenergic receptor gene (Ser49Gly, rs1801252), transcription factor Sp4 gene (A80807T, rs1011168), genes of matrix metalloproteinases type 3 (5A/6A) and type 9 (8202 A/G) allowed to evaluate overall risk of ACVM.

[The influence of psychological factors on the integral health characteristic (data from a prospective population study)].

AIM: To develop integral assessment of the health status based on the examination of representative samples from different regions of Russia (Veliky Novgorod, Nizhni-Novgorod, Vologda, Omsk and Nalchik) with the use of special questionnaires and simple anthropometric and functional methods in the framework of a prospective 3-year population study of organized groups. METHODS: The above questionnaires allowed to elucidate the socio-economic status of the patients, their somatic and psychological conditions (lifestyle index or psychological protection mechanisms (PPM), social adaptation, sanogenic reflexia; also used were Eysenck's psychotism scale, hospital anxiety and depression scale, the perceived stress scale (PSS), and moral potential of personality development scale. RESULTS: It was shown that the profile of psychological protection mechanisms is dominated by primitive reactions, such as projection, protection, and negation. Most subjects from the sample formed the pathogenic type of reflexia (inability to resolve a problem situation based on the cognitive components of the patient's mental state). Mathematical treatment of the so-called "simple cross-tabulation" with unification of all negative PPM revealed the highly significant relationship of LSI (not norm) with most previous somatic diseases (p<0.001), i.e. the history of myocardial infarction, angina of effort, cardiovascular syndromes, diabetes, hypertension, chronic broncho-pulmonary, hepatic, gastrointestinal, urogynecological, oncological, and psychic diseases. (p<0.007). CONCLUSION: Pyschological changes have greater influence than somatic ones on physiological parameters determining the population health status which suggests the necessity of taking them into account when planning health promotion measures.

[Personalized Risk Assessment of Adverse Cardiovascular Events in Young Patients With Connective Tissue Dysplasia].

Adverse cardiovascular manifestations (ACVM) were registered during 7-year follow-up of young patients with undifferentiated connective tissue dysplasia (CTD). ACVM developed in 28.42% of patients. Most frequent ACVMs were extension/aneurysm of the thoracic aorta (10.75%), cerebral vascular syndrome (10.56%), and arrhythmias (9.11%). Most significant risk factors for extension/aneurysm of the aorta were pathology of vertebral arteries, common risk factors (arterial hypertension, alcohol/drugs, smoking, heavy physical work, sports activities), bicuspid aortic valve); for pathology of cerebral vessels -completely open Willis Circle, pathology of vertebral arteries, CTD related changes of skin and spine, diagnostic CTD coefficient >23, chronic diseases of veins; clinically significant cardiac rhythm disturbances - combined valve manifestations of CTD, myxomatous degeneration of heart valves, pathology of the aorta, male sex, metabolic changes of the myocardium, deviations of circadian index, predominance of sympathetic tone, and diastolic dysfunction. Analysis of clinical characteristics (age, symptoms and severity of CTD, QTc dispersion more or equal 50 ms) and presence of unfavorable genetic polymorphisms in 1-adrenergic receptor gene (Ser49Gly, rs1801252), transcription factor Sp4 gene (A80807T, rs1011168), genes of matrix metalloproteinases type 3 (5A/6A) and type 9 (8202 A/G) allowed to evaluate overall risk of ACVM.

[Effects of Meldonia in Early Postmyocardial Infarction Period].

The aim of PMICS (Postmyocardial Infarction Cardiosclerosis) patients therapy within the dispensary supervision is CCI (Chronic Cardio Insufficiency) progression prevention, life quality improvement, hospitalization number decrease and life prognosis improvement. Despite the developed approaches to the given patients treatment, CCI progression prevention, the main disease treatment ensuring and prognosis assessment are not always as much as possible effective. The search of methods improving the given patients prognosis is highly actual. THE AIM: To evaluate the meldonium clinical effectiveness in the early postmyocardial infarction period. MATERIALS AND METHODS: 67 patients were included in investigation, their age ranged from 40 to 70. They survived myocardial infarction (MI) and were discharged for further ambulatory supervision. The patients were randomized into two groups: the first one consisting of 32 patients got basic therapy for ischemic heart disease (IHD). The second group consisting of 35 patients besides basic therapy got mildronate during 12 weeks. RESULTS: meldonium included in standard ischemic heart disease therapy in early postmyocardial infarction cardiosclerosis reduces the rate of angina pectoris attacks (p=0,001), decreased the number of epiventricular extrasystoles (p=0,002) and the number of paroxysmal rhythm disturbances (p=0,001), decreased arterial blood pressure (middle SAP and DAP) p=0,001, improves life quality and lowered the level of anxiety (p=0,001). CONCLUSION: The results received are likely to depend on the use of energetically advantageous pyruvate in glycolytic cycle due to restoration of equilibrium in processes of oxygen supply and its consumption, prevention of ATA (adenozine tryphosphoric acid) transport disturbances, elimination of toxic metabolic products accumulation. No side effects were registered during the course of mildronate treatment.

[Effects of Meldonium in Early Postmyocardial Infarction Period].

UNLABELLED: The aim of PMICS (Postmyocardial Infarction Cardiosclerosis) patients therapy within the dispensary supervision is CCI (Chronic Cardio Insufficiency) progression prevention, life quality improvement, hospitalization number decrease and life prognosis improvement. Despite the developed approaches to the given patients treatment, CCI progression prevention, the main disease treatment ensuring and prognosis assessment are not always as much as possible effective. The search of methods improving the given patients prognosis is highly actual. THE AIM: To evaluate the meldonium clinical effectiveness in the early postmyocardial infarction period. MATERIALS AND METHODS: 67 patients were included in investigation, their age ranged from 40 to 70. They survived myocardial infarction (MI) and were discharged for further ambulatory supervision. The patients were randomized into two groups: the first one consisting of 32 patients got basic therapy for ischemic heart disease (IHD). The second group consisting of 35 patients besides basic therapy got mildronate during 12 weeks. RESULTS: meldonium included in standard ischemic heart disease therapy in early postmyocardial infarction cardiosclerosis reduces the rate of angina pectoris attacks (p = 0.001), decreased the number of epiventricular extrasystoles (p = 0.002) and the number of paroxysmal rhythm disturbances (p = 0.001), decreased arterial blood pressure (middle SAP and DAP) p = 0.001, improves life quality and lowered the level of anxiety (p = 0.001). CONCLUSION: The results received are likely to depend on the use of energetically advantageous pyruvate in glycolytic cycle due to restoration of equilibrium in processes of oxygen supply and its consumption, prevention of ATA (adenozine tryphosphoric acid) transport disturbances, elimination of toxic metabolic products accumulation. No side effects were registered during the course of mildronate treatment.

[Clinical experience of application mildronate at recovery treatment of patients with displazia connecting fabric].

In order to evaluate the effectiveness mildronate in rehabilitative treatment in connective tissue dysplasia examined 240 patients (24,41 ± 7,62 years, 130 men). All patients were treated with 5 ml of mildronate 10% intravenously for 10 days, then 1 capsule (250 mg), 2 times per day for 4 months. The therapy showed a significant decrease in asthenic complaints, reducing the incidence of violations repolarization I (p<0.05) and II infarction (p<0.05), a significant increase in end-diastolic volume (p<0.05), stroke volume (p<0.05), left ventricular ejection fraction (p<0.05) by echocardiography, increased exercise tolerance with the normalization of reaction to physical stress on a dystonic normotonichesky, improved quality of life. During the treatment was not recorded adverse events in patients receiving the drug. Portability mildronate majority of patients described as good to very good (average 8.67 points).

[Endothelial and metabolic effects of perindopril in patients with essential hypertension].

OBJECTIVE: To elucidate endothelial and metabolic effects of perindopril and their interaction in patients with uncomplicated essential hypertension. METHODS: The study involved 30 patients treated with perindopril (5-10 mg/day) for 3 months. The following parameters were registered at baseline and at the end of the study: body mass index, waist circumference, blood lipids and glucose, flow-mediated vasodilation (FMVD) of brachial artery assessed by ultrasound. RESULTS: Treatment with perindopril was associated with significant improvement of FMVD (6.7 ± 4.1% versus 8.7 ± 5.4% at the end of the study, p<0.05) as well as decrease of blood triglycerides (-18%, p<0.05) and glucose (-9%, p<0.01) with no significant changes of other metabolic parameters. Correlation analysis showed no relationship between changes of FMVD and blood pressure during the study (r= -0.14, p=0.42 r= -0.13, p=0.46 for systolic and diastolic blood pressure, respectively) whereas inverse association was observed with changes of blood glucose (r= -0.50, p<0.01). CONCLUSIONS: Thus our data confirm the ability of perindopril to restore impaired endothelial function in patients with essential hypertension independently of blood pressure reduction and make possible to propose its positive metabolic effect relative to changes associated with insulin resistance. It seems that endothelial effect of perindopril may in part be related to diminished adverse influence of metabolic changes on vascular wall.

[Possible applications bisoprolol for heart rate control in young patients with connective tissue dysplasia].

To assess the efficacy and safety of bisoprolol to monitor heart rate (HR) in young patients with connective tissue dysplasia (CTD) examined 58 patients (22,3 + 3,47 years, 38 men). Bisoprolol drug was administered at an initial dose of 1.25 mg/day, with a further increase to 2.5 mg/day in 2 weeks, etc. to achieve the level of heart rate 59-69 beats/min. Average effective dose was 7.27 ± 2.08 mg/day. Target heart rate,improvement of health and the pumping function of the heart, reducing the activation of the sympathetic nervous system and of anxiety achieved the absolute majority of patients. During treatment unit observed transient manifestations of general weakness, headache, episodes of vertigo in the selection of the dose, cases of bradycardia and hypotension pathological registered for the time of ingestion. Thus, the use of mandatory bisoprolol gradual careful titration, starting with 1.25 mg/day as a means to control the heart rate in young patients with CTD with sinus tachycardia, the manifestations of autonomic nervous system dysfunction, safely and effectively in relation to adverse orthostatic reactions.

[[Meldonium in treatment of patients with myocardial infarction].

Therapy with meldonium belongs to "metabolic direction" which is developing in cardiovascular medicine. Its purpose is restoration of impaired cellular metabolism.

[Direct comparison of endothelial and metabolic effects of perindopril combination with indapamide retard or hydrochlorothiazide].

OBJECTIVE: Our aim was to compare changes of vascular and metabolic parameters in patients with essential hypertension on treatment with combination of perindopril with either indapamide retard or hydrochlorothiazide. METHODS: The study involved 40 patients who were randomly assigned to perindopril 5-10 mg/day in combination with indapamide retard (P+I) 1.5 mg/day (n = 20) or with hydrochlorothiazide (P+HT) 25 mg/day (n=20). Waist circumference, body mass index, blood lipids and glucose, endothelial function (EF) determined as the change of resistance index after inhalation of salbutamol, arterial stiffness measured as mean pulse wave velocity after sublingual trinitroglycerin (PWVtng) were evaluated at baseline and 6 months thereafter. Vascular responses were calculated from digital pulse waves registered using photoplethysmography. RESULTS: Dynamics of BP after 6 months did not differ significantly between groups. Treatment with combination of P+HT resulted in significant decrease of EF (-24,3%, p<0,05) accompanied by negative changes of triglycerides (+13,4%, p<0,05) and glucose levels (+9,8%, p<0,05), whereas combination of P+I did not affect endothelial function and was metabolically neutral. PWVtng significantly decreases on both regiments of treatment with the trend in favor of P+I combination (-13,4%, p<0,001 versus -9,8%, p<0,01 for P+I and P+HT combinations, respectively). CONCLUSION: Thus, despite the similar BP reduction the combination of ACE-inhibitor--perindopril with indapamide retard possesses more favorable vascular and metabolic effects compared to combination with hydrochlorothiazide that potentially may account for different prognosis of patients with arterial hypertension on long-term treatment.

[Adrenoreactivity in patients with arrhythmic syndrome associated with connective tissue dysplasia at the background of intake of the magnezium orotate].

Elevated level of -adrenoreception of membranes is observed in patients with disturbances of heart rhythm at the background of connective tissue dysplasia. It is not related to characteristics of the arrhythmic syndrome. At the background of 4-months intake of preparation magnezium orotate significant decrease of degree of desensitization of of erythrocytes has been noted.

[Cardiotoxic effects of breast cancer chemotherapy and their possible correction].

Clinical data are reported upon the examination of a group of 160 women aged 18-55, suffering of a breast cancer and subjected to polychemotherapy using various cytostatic schemes: (I) standard CAF scheme, course repetition each 4 weeks; (II) alternating CAF and AVCFM schemes (intermittent introductions), a total of 4 courses. For the reduction of the cardiotoxic effects of anthracyclines, one part of patients was given an antioxidant preparation of amber acid--Reamberin--whose administration substantially decreased both the frequency of cardial complaints and the expression of clinical manifestations of the astheno-neurotic syndrome and prevented the occurrence of systolic and diastolic dysfunction of myocardium and the heart rhythm and conductivity disturbances.

[Connective tissue dysplasia: the main gastrointestinal manifestations].

Gastrointestinal tract as one of the collagen organ systems, will inevitably become involved in the pathological process in connective tissue dysplasia. In order to optimize diagnosis and treatment tactics of practitioner choice needs to know the major gastrointestinal manifestations of connective tissue dysplasia and to distinguish between concepts: visceral manifestations of connective tissue dysplasia (syndromes of digestive diseases associated with connective tissue dysplasia), maldevelopments and diseases of the digestive system associated with connective tissue dysplasia. The authors have developed and presented a classification of major gastrointestinal syndromes in connective tissue dysplasia.

[Methodological approaches to the expert appraisal of therapeutic care quality in chronic cholecystitis].

AIM: to develop a technology for assessing the quality and consequences of medical care in chronic noncalculous cholecystitis by an expert--a therapist, a gastroenterologist. MATERIALS AND METHODS: One hundred and ninety-three cases of expert appraisal of medical care quality in chronic noncalculous cholecystitis were analysed. The expert appraisal of the quality of medical care was carried out by comparing with that of the reference - the standard for the diagnosis and treatment of chronic noncalculous cholecystitis. To detect the defects correlated with the negative consequences of medical care, the authors calculated statistical criteria for assessing an association between the indices of accumulated informative value and the consequences of rendered medical care. RESULTS: According to the assessed quality of medical care, the patients were divided into two groups: (1) 163 patients with negative consequences of delivered medical care; (2) 30 patients with its positive consequences (a control group). The identifed drawbacks that significantly determined negative outcomes had a certain distribution in the groups by their frequency. The analysis provided calculations of the accumulated informative value index for each case individually for the processes of diagnosis and treatment, by drawing up the boundaries of proper and improper medical care delivered to patients with chronic noncalculous cholecystitis. CONCLUSION: The formulated criteria of positive consequences of medical care are oriented to the differential diagnosis of biliary tract pathology, to differentiated approaches to treatment analysis, and to the likely outcomes of exposure to medical and diagnostic actions on the pathological process, which allows an expert to predict its further dynamics and consequences of rendered medical care. The algorithmized expert appraisal of cases of medical care delivery makes it possible to objectivize the opinion and conclusions of an expert.

[Examination of health care quality in chronic viral hepatitis].

On a basis of consultant's investigation of medical aid for patients with chronic viral hepatitis were proposed the criteria for determine of medical aid quality and algorithm for consultant's investigation.

[Social issues of medical outpatient care for elderly patients with chronic cardiac failure].

AIM: To assess efficacy of therapeutic medical education in the field of chronic cardiac failure (CCF) of social workers taking care of old persons on home nursing. MATERIAL AND METHODS: 87 social workers filled in a special questionnaire before and after training in management of old persons with CCF. RESULTS: Initial knowledge of the social workers about CCF was insufficient, especially their education was poor in CCF symptoms, medication, diet, regime, hospital and outpatient treatment, possible assistance from social personnel. Therapeutic training improved medical knowledge of the social workers. CONCLUSION: Therapeutic education of social workers improves their knowledge about outpatient treatment of old patients with CCF and understanding of a social worker behavior with old CCF outpatients.

[On medical and social work in the complex treatment of senile age patients with chronic heart insufficiency].

The section of medical-social work was entered for the first time into National Recommendations VNOC and OSSN on diagnostics and treatment of chronic heart failure, the second revision. The social help is especially important for persons of senile age and long-livers. It is expedient to study to what extent the employees of social service are ready to participate in the complex observation and treatment of these patients. Interrogation of 274 workers of the complex centers for in-home social service has been worked out. The level of knowledge on matters of conducting persons of senile age with chronic heart failure proved to be low. Majority respondents have not shown any readiness to join medical-social programs carried out by public health institutions.