ABSTRACT
AIM: To analyze therapy in patients with arterial hypertension (AH) in 20102020. MATERIALS AND METHODS: Data of hypertensive patients observed in primary health care, entered into the base of hypertension registry for 20102020 years in the whole group (n=44 653) and in a separate subgroup of hypertensive patients in the absence of: ischemic heart disease, a history of myocardial infarction, chronic heart failure (n=20 569). RESULTS: About 80% of hypertensive patients are patients of high and very high risks (from 2010 to 2020, the proportion of very high cardiovascular risk (CVR) increased from 18.1 to 57.3%). The number of hypertensive patients with a history of myocardial infarction increased in 5 times, in 3 times with ischemic heart disease and with chronic heart failure. The number of prescribed drugs increased: mineralocorticoid receptor antagonist (in 5.8 times), loop diuretics (in 7.2) angiotensin receptor blockers (in 3 times), b-adrenoblockers, calcium channel blockers of the dihydropyridine series, thiazide-like diuretics in 2 times. Patients at high and very high risk are more likely reached target blood pressure values. Angiotensin-converting enzyme inhibitors were prescribed in more than 70% of patients with hypertension and the absence of coronary heart disease, chronic heart failure, history of myocardial infarction; the prescription of b-adrenoblockers, angiotension receptor blockers, thiazide-like and loop diuretics increased. CONCLUSION: The proportion of more severe and comorbid patients has increased in observed in primary health care patients with AH over a 10-year period (20102020). This was probably the main factor of increasing antihypertensive therapy and prescribing drugs with additional indications and improving the achievement of target blood pressure in patients with high and very high cardiovascular risk.
Subject(s)
Coronary Disease , Dihydropyridines , Heart Failure , Hypertension , Myocardial Infarction , Humans , Antihypertensive Agents/therapeutic use , Calcium Channel Blockers/therapeutic use , Sodium Potassium Chloride Symporter Inhibitors , Mineralocorticoid Receptor Antagonists/therapeutic use , Hypertension/drug therapy , Hypertension/epidemiology , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Angiotensin Receptor Antagonists/therapeutic use , Diuretics , Heart Failure/drug therapy , Heart Failure/epidemiology , Myocardial Infarction/drug therapy , Thiazides/therapeutic use , Dihydropyridines/therapeutic useABSTRACT
Ðim. To investigate the clinical characteristics and quality of treatment (according to the national guidelines) of patients with arterial hypertension (AH) and chronic kidney disease observed in primary health care. MATERIALS AND METHODS: The study was carried out on the basis of the AH registry data (n=43 133; 20052019 years). Glomerular filtration rate (eGFR) was calculated using the CKD-EPI formula; renal structure and albuminuria were not evaluated. The analysis was performed using the SPSS software (version 22; SPSS Inc). RESULTS: The creatinine level was assessed in 60% of patients, 23.6% of them had decreased eGFR60 ml/ min/1.73 m2. The incidence of co-morbid CVD and type 2 diabetes in patients with hypertension increased markedly with a decrease in eGFR (14 groups): the incidence of coronary artery disease increased 1.8 times (up to 72.5%), myocardial infarction 1.7 times (up to 20.6%), chronic heart failure 2 times (up to 84.0%), atrial fibrillation 10 times (up to 18.3%), history of stroke 3.7 times (up to 15.3%) and type 2 diabetes 2.4 times (up to 32.8%). Achievement of target goals of CV risk factors was not enough: systolic BP less than 50% of patients, triglycerides less than 7%, LDL-C in high and very high CVD risk patients less than 13%. CONCLUSION: Conducting timely assessment of renal function, drug therapy and lifestyle changes in patients with AH and decreased renal functional could prevent severe kidney damage, the development of CV complications, chronic renal failure and reduce mortality.
Subject(s)
Diabetes Mellitus, Type 2 , Hypertension , Renal Insufficiency, Chronic , Humans , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/epidemiology , Creatinine , Outpatients , Cholesterol, LDL , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/epidemiology , Renal Insufficiency, Chronic/therapy , Hypertension/diagnosis , Hypertension/drug therapy , Hypertension/epidemiology , Glomerular Filtration Rate , Treatment Outcome , Registries , TriglyceridesABSTRACT
The diagnosis of resistant arterial hypertension allows us to single out a separate group of patients in whom it is necessary to use special diagnostic methods and approaches to treatment. Elimination of reversible factors leading to the development of resistant arterial hypertension, such as non-adherence to therapy, inappropriate therapy, secondary forms of arterial hypertension, leads to an improvement in the patient's prognosis. Most patients with resistant hypertension should be evaluated to rule out primary aldosteronism, renal artery stenosis, chronic kidney disease, and obstructive sleep apnea. The algorithm for examining patients, recommendations for lifestyle changes and a step-by-step therapy plan can improve blood pressure control. It is optative to use the most simplified treatment regimen and long-acting combined drugs. For a separate category of patients, it is advisable to perform radiofrequency denervation of the renal arteries.
Subject(s)
Antihypertensive Agents , Hypertension , Humans , Antihypertensive Agents/therapeutic use , Consensus , Hypertension/diagnosis , Hypertension/drug therapy , Renal Artery , Societies, Medical , Kidney , Sympathectomy/methodsABSTRACT
AIM: The purpose of this study is to study the effect of sex on the features of therapy of arterial hypertension and the development of cardiovascular complications. MATERIALS AND METHODS: Data from the register of AH from outpatient hospital and cardiology departments of hospitals of 22 regions of the Russian Federation were analyzed. Data of medical documents of 33 564 patients with AH [(36.2%) men and 21 423 (63.8%) women] were entered into the on-line computer program and were analyzed using the statistical software package STATISTICA 10. RESULTS: Cardiovascular and cerebrovascular diseases are more often diagnosed in men: peripheral artery disease, coronary heart disease, acute coronary syndrome, congestive heart failure, ischemic stroke, dissecting aortic aneurysm. The beginning of development cardiovascular disease in men with elevated blood pressure is already observed at age of 25-44 years, which indicates the need for preventive measures already in adolescence and closer monitoring of treatment at a young age. CONCLUSION: The study confirmed the role of the male sex as a risk factor for the development of cardiovascular disease in hypertensive men and women with comparable figures of blood pressure in. Identified gender features must be considered when diagnosing patients with AH.
Subject(s)
Hypertension , Adult , Blood Pressure , Female , Humans , Hypertension/diagnosis , Male , Registries , Risk Factors , Russia , Sex FactorsABSTRACT
Hypertension is one of the most important risk factors for cardiovascular diseases (CVD) in the world, including Russia. Current Guidelines for the management of arterial hypertension do not include different theatment strategies for men and women. Gender and age analysis of antihypertensive treatmen in men and women could reveal unreasonable and non - optimal treatment in each group. The purpose of this study was to identify the gender features of antihypertensive therapy used by primary care physicians in patients with hypertension. Materials and methods. The study is based on the Arterial Hypertension Registry established in 2012. The methodology of it has been described previously [1]. Medical data from outpatient cards were entered by doctors of 53 city primary care medical centers and 5 cardiology clinics from 22 regions of the Russian Federation. The study included the data of 33 564 patients from 18 years and older with diagnosis of arterial hypertension. Gender, age, height, body weight, smoking status, office blood pressure (BP), laboratory and instrumental examination methods, diagnosed cardiovascular and cerebrovascular diseases and comorbidities in accordance with the International Classification of Diseases of the 10th revision [ICD-10], as well as the treatment (antihypertensive and lipid - lowering therapy) were listed. Results and conclusion. Gender differences in the prescription antihypertensive therapy (AHT) in men and women with hypertension were revealed. Apparently, one of the reasons for these differences is the earlier and more frequent development of cardiovascular and cerebrovascular complications of hypertension in men than in women. Beta - blockers (BB) and angiotensin - converting enzyme inhibitors (ACEi) are more often prescribed to men with hypertension and with coronary artery disease (CAD), myocardial infarction (MI) and chronic heart failure (CHF). Women with hypertension are more often prescribed angiotensin receptor blockers (ARB), thiazide and thiazide - like diuretics. The study also showed non - optimal treatment of patients with hypertension. Insufficient prescription of medication which could improve the prognosis of the disease (ACE inhibitors /ARB, BB, mineralocorticoid receptor antagonist) have been identified in patients with hypertension and CAD, MI, CHF. It is noteworthy that in the some outpatient cards of patients with AH there is no record of AHT prescription: at a young age - in 9.6%, at old age in 15.1% of cards. Despite the fact of high and very high cardiovascular risk of the majority of patients, lipid - lowering therapy (statins) was prescribed insufficiently. The most statin administration was observed in hypertensive patients with coronary artery disease (50.1%) and myocardial infarction (62.7%).
Subject(s)
Antihypertensive Agents/therapeutic use , Hypertension/drug therapy , Angiotensin-Converting Enzyme Inhibitors , Diuretics , Female , Humans , Male , RussiaABSTRACT
The paper describes a clinical case of a female patient with severe obstructive sleep apnea syndrome in the presence of congenital hemangioma of the face, soft palate, and tongue concurrent with paroxysmal atrial fibrillation and atrial flutter, paroxysmal supraventricular tachycardia, and sinoatrial block (maximally up to 3.9 sec). Continuous positive airway pressure therapy could reduce the number of paroxysms of atrial fibrillation and atrial flutter, supraventricular tachycardia and eliminate sinoatrial block.
Subject(s)
Arrhythmias, Cardiac , Continuous Positive Airway Pressure/methods , Head and Neck Neoplasms , Hemangioma , Mouth Neoplasms , Skin Neoplasms , Sleep Apnea, Obstructive , Arrhythmias, Cardiac/complications , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/prevention & control , Electrocardiography, Ambulatory/methods , Female , Head and Neck Neoplasms/complications , Head and Neck Neoplasms/pathology , Hemangioma/complications , Hemangioma/pathology , Humans , Magnetic Resonance Imaging/methods , Middle Aged , Mouth Neoplasms/complications , Mouth Neoplasms/pathology , Patient Care Management , Skin Neoplasms/complications , Skin Neoplasms/pathology , Sleep Apnea, Obstructive/complications , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/physiopathology , Sleep Apnea, Obstructive/therapy , Treatment OutcomeABSTRACT
The performance of professional strength and power athletes is influenced, at least partly, by genetic components. The main aim of this study was to investigate individually and in combination the association of ACE (I/D), ACTN3 (R577X) and PPARGC1A (Gly482Ser) gene polymorphisms with strength/power-oriented athletes' status in two cohorts of European athletes. A cohort of European Caucasians from Russia and Lithuania (161 athletes: by groups - weightlifters (87), powerlifters (60), throwers (14); by elite status - 'elite' (104), 'sub-elite' (57); and 1,202 controls) were genotyped for ACE, ACTN3 and PPARGC1A polymorphisms. Genotyping was performed by polymerase chain reaction and/or restriction fragment length polymorphism analysis. Statistically significant differences in ACTN3 (R577X) allele/genotype distribution were not observed in the whole cohort of athletes or between analysed groups separately when compared with controls. The odds ratio for athletes compared to controls of the ACE I/I genotype was 1.71 (95% CI 1.01-2.92) in the Russian cohort and for the ACE I/D genotype it was 2.35 (95% CI 1.10-5.06) in the Lithuanian cohort. The odds ratio of being a powerlifter in PPARGC1A Ser/Ser genotype carriers was 2.11 (95% CI: 1.09-4.09, P = 0.026). The ACTN3 (R577X) polymorphism is not associated with strength/power athletic status in two cohorts of European athletes. The ACE I/I genotype is probably the 'preferable genotype' for Russian athletes and the ACE I/D genotype for Lithuanian strength/power athletes. We found that the PPARGC1A (Gly482Ser) polymorphism is associated with strength/power athlete status. Specifically, the PPARGC1A Ser/Ser genotype is more favourable for powerlifters compared to controls.
ABSTRACT
The authors describe various clinical forms of streptococcal infections, the pathogenetic mechanisms underlying these conditions, and peculiarities of their clinical picture. Also considered are the modern methods employed for laboratory diagnostics of streptococcal infections. The probability of the risk of development of post-streptococcal diseases in the children is evaluated. Measures for the prevention of these conditions are proposed.
Subject(s)
Otorhinolaryngologic Diseases , Streptococcal Infections , Streptococcus pyogenes , Child , Disease Management , Early Diagnosis , Humans , Otorhinolaryngologic Diseases/diagnosis , Otorhinolaryngologic Diseases/microbiology , Otorhinolaryngologic Diseases/physiopathology , Otorhinolaryngologic Diseases/therapy , Risk Factors , Streptococcal Infections/diagnosis , Streptococcal Infections/immunology , Streptococcal Infections/physiopathology , Streptococcal Infections/therapy , Streptococcus pyogenes/isolation & purification , Streptococcus pyogenes/physiologyABSTRACT
The objective of the present study was to elucidate the objective diagnostic criteria for the differentiation between various forms of chronic tonsillitis (CT) based on the results of clinical, bacteriological, and serological investigations. A total of 13 patients presenting with various forms of CT were available for the examination. The mathematical analysis of the data thus obtained made it possible to identify the most clinically significant diagnostic criteria allowing to verify the form of CT. It is concluded that their application in the combination with the classification of chronic tonsillitis proposed earlier by B.S. Preobrazhensky and V.T. Pal'chun can be recommended for the choice of the most adequate strategy for the treatment of the patients chronic tonsillitis on an individual basis.
Subject(s)
Severity of Illness Index , Tonsillitis/diagnosis , Adult , Chronic Disease , Diagnosis, Differential , Female , Humans , Male , Young AdultABSTRACT
The objective of he present works was to analyse epidemiological parameters characterizing the prevalence of chronic tonsillitis morbidity and specific features of its local and systemic complications (the former included paratonsillar abscess, PA, while the latter acute rheumatic fever, ARF, and acute post-streptococcal glomerulonephritis, APSGN). The data subjected to the analysis comprised information collected by the Statistical Department of the Clinical Infectious Hospital No 1 for the past 10 years about the number of hospitalized patients having the diagnosis of tonsillitis in combination with PA and the data on the number of peritonsillar abscess drainage procedures performed between 2008 and 2010 (Statistical Department of S.P. Botkin City Clinical Hospital), the number of tonsillectomies, the prevalence of ARF and APSGN during the last 10 years (Medical Statistics Bureau of the Moscow Health Department), and the results of monitoring regular medical check-ups of the patients presenting with the above pathologies. The number of the patients hospitalized at the Clinical Infectious Hospital No 1 for the diagnosis of tonsillitis in combination with PA was shown to increase as well as the number of autopsies of the patients with PA performed at S.P. Botkin City Clinical Hospital. Simultaneously, the number of tonsillectomies in the clinics of Moscow Health Department decreased whereas the prevalence of ARF and APSGN and the number of the patients with chronic tonsillitis under dispensary observation for over 2 years increased. It is concluded that otorhinolaryngologists working in outpatient facilities must promptly identify indications for radical surgical sanitation of the pockets of chronic infection by means of bilateral tonsillectomy.
Subject(s)
Abscess , Drainage , Hospitals , Tonsillectomy , Tonsillitis , Abscess/epidemiology , Abscess/pathology , Abscess/surgery , Chronic Disease/epidemiology , Drainage/statistics & numerical data , Hospitals/statistics & numerical data , Humans , Moscow/epidemiology , Registries , Tonsillectomy/statistics & numerical data , Tonsillitis/complications , Tonsillitis/epidemiology , Tonsillitis/surgeryABSTRACT
The objective of the present study was to characterize peculiar clinical and laboratory features of trivial tonsillitis for the substantiation of the necessity of prescription of antibacterial therapy. A total of 386 patients presenting with various forms of trivial tonsillitis were available for the determination of anti-streptococcal antibody (ASLO, anti-DN-ase B, ASPH) levels. The results of the measurement were compared based on the Centor scale generally used to estimate the necessity of prescribing antibacterial therapy for the treatment of sore throat. It is concluded that laboratory studies of characteristics of S. Ð yogenes activity are needed in all the patients presenting with tonsillitis in order to elucidate the etiological factors responsible for pharyngalgia and the necessity of prescription of antibacterial therapy for the prevention of pyogenic systemic complications of streptococcal infection.
Subject(s)
Streptococcal Infections/microbiology , Streptococcus pyogenes/pathogenicity , Tonsillitis/microbiology , Adult , Anti-Bacterial Agents/therapeutic use , Diagnosis, Differential , Female , Humans , Male , Severity of Illness Index , Streptococcal Infections/diagnosis , Streptococcal Infections/drug therapy , Streptococcus pyogenes/drug effects , Tonsillitis/diagnosis , Tonsillitis/drug therapy , Treatment Outcome , Young AdultABSTRACT
The objective of the present study was to analyse risk factors and the clinical course of general diseases and disorders associated with chronic tonsillitis. We overviewed domestic and foreign periodicals and present the data thus obtained together with the results of our original investigations. The study permitted to elucidate the risk factors of the complicated clinical picture of chronic tonsillar pathology and substantiate the necessity of the active surgical treatment for the prevention of the development of toxico-allergic forms of this disease. The importance of thorough diagnostics of the diseases concomitant with chronic tonsillitis both for the purpose of identification of its form and for the prevention of the development of serious life-threatening complications is emphasized.
Subject(s)
Cardiovascular Diseases/diagnosis , Kidney Diseases/diagnosis , Musculoskeletal Diseases/diagnosis , Tonsillitis/epidemiology , Cardiovascular Diseases/epidemiology , Chronic Disease , Comorbidity , Humans , Kidney Diseases/epidemiology , Musculoskeletal Diseases/epidemiology , Tonsillitis/complications , Tonsillitis/surgeryABSTRACT
BACKGROUND: The aim of this study was to assess the effects of continuous positive airway pressure (CPAP) on arterial stiffness, central blood pressure, and reflected pulse wave characteristics in patients with severe obstructive sleep apnea (OSA) and stage 2-3 arterial hypertension. METHODS: Forty-four patients with hypertension and severe OSA (apnea/hypopnea index > 30) received stepped dose titration of antihypertensive treatment, consisting of valsartan 160 mg + amlodipine 5-10 mg + hydrochlorothiazide 25 mg. CPAP therapy was added after 3 weeks of continuous antihypertensive treatment with BP < 140/90 mmHg or after adjusting triple treatment in patients with resistant arterial hypertension. The patients were randomized to effective CPAP (4-15 mm H2O) or placebo CPAP (pressure 4 mm H2O) for three weeks, then crossed over to the alternative treatment in a single-blind manner. Office blood pressure (BP), ambulatory BP monitoring, ambulatory arterial stiffness index (AASI), aortic BP, carotid-femoral pulse wave velocity (cfPWV), and systolic wave augmentation index were measured using a Sphygmocor® device at baseline, after antihypertensive treatment, placebo CPAP, and effective CPAP. RESULTS: Baseline cfPWV was above the normal range in 94% of patients. After reaching target BP, the cfPWV decreased by 1.9 ± 1.0 msec (P = 0.007). Effective CPAP achieved a further cfPWV reduction of 0.7 msec (P = 0.03). Increased arterial stiffness (pulse wave velocity > 12 msec) persisted in 35% of patients on antihypertensive treatment and effective CPAP, in 56% of patients on antihypertensive treatment alone, and in 53% of patients on placebo CPAP. Only the combination of antihypertensive treatment with effective CPAP achieved a significant reduction in augmentation index and AASI, along with a further reduction in aortic and brachial BP. CONCLUSION: Effective CPAP for 3 weeks resulted in a significant additional decrease in office BP, ambulatory BP monitoring, central BP, and augmentation index, together with an improvement in arterial stiffness parameters, ie, cfPWV and AASI, in a group of hypertensive patients with OSA.
Subject(s)
Antihypertensive Agents/therapeutic use , Arterial Pressure/drug effects , Continuous Positive Airway Pressure , Hypertension/drug therapy , Sleep Apnea, Obstructive/therapy , Amlodipine/therapeutic use , Angiotensin II Type 1 Receptor Blockers/therapeutic use , Blood Pressure Monitoring, Ambulatory , Calcium Channel Blockers/therapeutic use , Diuretics/therapeutic use , Drug Combinations , Female , Humans , Hydrochlorothiazide/therapeutic use , Hypertension/diagnosis , Hypertension/epidemiology , Hypertension/physiopathology , Male , Manometry , Middle Aged , Polysomnography , Predictive Value of Tests , Pulse Wave Analysis , Risk Factors , Russia/epidemiology , Severity of Illness Index , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/epidemiology , Sleep Apnea, Obstructive/physiopathology , Tetrazoles/therapeutic use , Treatment Outcome , Valine/analogs & derivatives , Valine/therapeutic use , Valsartan , Vascular Stiffness/drug effectsABSTRACT
Pulmonary hypertension is a complex multidisciplinary problem in modern medicine. This review discusses its clinical and pathophysiological type associated with rheumatic heart disease. Current approaches to the pathogenesis and diagnosis of the disease are reflected; basic approaches to its treatment are discussed in terms of current clinical guidelines and new scientific achievements.
Subject(s)
Hypertension, Pulmonary/etiology , Practice Guidelines as Topic , Rheumatic Heart Disease/complications , Endothelium, Vascular/pathology , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/therapyABSTRACT
The objective of the present study was to analyse etiological and pathogenetic mechanisms underlying the development of toxico-allergic manifestations in the patients presenting with chronic tonsillitis. The overview of the publications in the Russian and foreign literature provided materials for substantiating the expediency of the treatment of various forms of chronic tonsillitis on an individual basis. The necessity of further studies of toxico-allergic manifestations of chronic tonsillitis and the use of the active surgical strategies for the management of toxico-allergic forms of the disease is emphasized.
Subject(s)
Hypersensitivity/etiology , Tonsillitis/complications , Chronic Disease , Humans , Palatine TonsilABSTRACT
OBJECTIVE: To study an independent role of the obstructive sleep apnea syndrome (OSAS) in patients with arterial hypertension (AH) according to the data of a retrospective observation. SUBJECTS AND METHODS: all patients underwent polysomnographic test (EMBLA Flaga, Iceland) and the frequency of unfavorable events (stroke, myocardial infarction, chronic heart failure, atrial fibrillation, intermittent claudication, or death) was determined during the case-control observational longitudinal retrospective study. The diagnosis of OSAS was made when the apnea-hypopnea index (AHI) of more than 15 events per hour of sleep; the patients with an AHI of less than 15 formed a control group. RESULTS: Among 120 enrolled patients, 64 (53%) had OSAS. In the patients with OSAS, the baseline AHI was 50.9 +/- 23 events per hour whereas in the control group it was 8.9 +/- 5.2 per hours. Both groups were comparable in age, height, weight, body mass index, snore duration, drowsiness, and respiratory standstill during sleep, blood pressure, total cholesterol, and creatine. While analyzing OSAS, there was no change in the risk for a combined end point (all-cause death, stroke, myocardial infarction, chronic heart failure, atrial fibrillation, or intermittent claudication). Our study was retrospective, the patients were few and AH is itself an important cardiovascular risk factor which should be borne in interpreting the results of our study. We consider that the study of the independent role of OSAS should be continued within a well-designed prospective observation.
Subject(s)
Cardiovascular Diseases/mortality , Hypertension/epidemiology , Sleep Apnea, Obstructive/epidemiology , Female , Humans , Male , Middle Aged , Retrospective Studies , Russia/epidemiologyABSTRACT
AIM: To specify the course and outcomes of arthritides associated with streptococcal infection (AASI). MATERIAL AND METHODS: The trial comprised 60 patients with arthritis (mean age 26.8 +/- 14.0). The patients met the following criteria: arthritis, elevated (< 500 U) titers of antistreptolisin-0 in the absence of heart disorders detected at Doppler-echocardiography (2D-echoCG), urogenital infection, Yersinia infection, psoriasis. In addition to routine clinical tests, the following investigations were made: tests for alloantigen of B-lymphocytes D8/17 and antigen HLA-B27, antibodies to polysaccharide of streptococcus of group A, bacteriological test of laryngeal smears for streptococcal infection, prospective follow-up (mean 31.2 +/- 19.6 mon) with 2D-echoCG. RESULTS: Rheumatic arthritis was rejected in 33.3% patients. Other diseases were diagnosed: early rheumatoid arthritis (10%), seronegative spondylarthritis, juvenile rheumatoid arthritis, systemic lupus erythematosus, Still's disease, Konig's disease, sarcoidosis, gout, arthritis on the background of streptococcal nodular erythema. Acute rheumatoid fever (ARF) was diagnosed in 56.7% patients, poststreptococcal arthritis (PSA) in 10%. PSA differed from ARF by onset at the age of 36.0 +/- 10.2 years, short latent period (11.2 +/- 1.3 days), a significantly longer course of arthritis (95.0 +/- 3.9 days), recurrences. Alloantigen of B-lymphocytes was detected in 52.8% AASI patients (the difference from the control is highly significant (p < 0.001). Arthritis development was not associated with carriage of HLA-B27 carriage. CONCLUSION: In examination of AASI patients for diagnosis of ARV and PSA it is necessary to reject other diseases among which early RA (10%) is most frequent. It is recommended to make diagnosis of ARF in AASI patients with definition of risk factors (age 7-15 years, family history of rheumatic fever, carriage of alloantigen d8/17), 2.5-year and longer follow-up with 2D-echoCG. Diagnosis of PSA is made in rejection of ARF and in the presence of the following characteristics: development of the disease at the age 30-40 years, a short latent period of the infection, long-term persistent course of arthritis, insufficient effect of nonsteroid anti-inflammatory drugs, frequent affection of sacroiliac joints, recurrence, entezopathy.
Subject(s)
Arthritis/diagnosis , Rheumatic Fever/diagnosis , Streptococcal Infections/diagnosis , Streptococcus pyogenes/isolation & purification , Adult , Arthritis/drug therapy , Arthritis/microbiology , Diagnosis, Differential , Humans , Prospective Studies , Streptococcal Infections/microbiologyABSTRACT
AIM: To assess the response to chondroitin sulfate (structum) in low back pain (LBP) due to spinal osteochondrosis. MATERIAL AND METHODS: 30 patients (mean age 51.4 years) with a definite primary LBP took structum in a dose 1 g/day for 24 weeks. The diagnosis was made according to WHO recommendations (2000). The response was assessed with uniform international questionnaires and visual analogue scale. RESULTS: The treatment reduced pain syndrome and improved spinal function in 73.3% patients with LBP studied. CONCLUSION: It would be valid to include long-acting chondroprotective drugs in the program of LBP in spinal osteochondrosis.
Subject(s)
Chondroitin Sulfates/therapeutic use , Osteochondritis/physiopathology , Pain/physiopathology , Spinal Diseases/physiopathology , Adult , Aged , Female , Humans , Male , Middle Aged , Osteochondritis/drug therapy , Pain/drug therapy , Spinal Diseases/drug therapy , Surveys and Questionnaires , Treatment OutcomeSubject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Gastrointestinal Hemorrhage/chemically induced , Stomach Diseases/chemically induced , Adolescent , Adult , Aged , Aged, 80 and over , Diagnosis, Differential , Endoscopy, Digestive System , Female , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/epidemiology , Humans , Incidence , Male , Middle Aged , Retrospective Studies , Russia/epidemiology , Stomach Diseases/diagnosis , Stomach Diseases/epidemiologyABSTRACT
AIM: To assess the response to nonsteroid antiinflammatory drug movalis in LBP syndrome. MATERIALS AND METHODS: Movalis was given in daily dose 15 mg for 7 days, then 7.5 mg daily for 14 days to 22 patients with LBS aged 34-56 years. All the patients had lumbosacral intervertebral osteochondrosis complicated with secondary radiculitis or myofascial syndrome. RESULTS: Movalis noticeably relieved pain syndrome. At the end of the treatment two-thirds of the patients were able to move. Tolerance of the drug was good, satisfactory and bad in 10, 7 and 1 patients, respectively. CONCLUSION: Movalis is effective in LBP syndrome.