The study was aimed at investigation of the effect of the "low triiodothyronin syndrome" (LT3S) on the course of heart failure (HF) developed on the background of post-infarction cardiosclerosis. The biennial study included 157 patients with HF (with a myocardial infarction on the background of coronary heart disease). During hospitalization, a standardized assessment was carried out, hemodynamic parameters, clinical and biochemical blood tests, levels of thyroid hormones (thyroid stimulating hormone (TSH), free T3f and T4f, reverse T3r) were determined. Statistical analysis has shown that for the diagnosis of LT3S in patients with HF on the background of post-infarction cardiosclerosis, it is advisable to use serum T3f level, ≤2.07 pmol/l. The frequency of LT3S in patients with HF during hospitalization is 17.8%. Patients with LT3S are younger, have larger left ventricular size, lower ejection fraction, a high relative risk of re-hospitalization within 2 years due to decompensation of HF (2.224 [1.363-3.630]). A regression model of the re-hospitalization of patients with HF has been described, which included: weight, thyroxine and triiodothyronine concentrations, non-toxic goiter, growth, total cholesterol levels and LDL cholesterol, blood granulocyte content. It is shown that the risk of re-hospitalization of patients with HF due to decompensation of the disease increases when the equation of this model exceeds ≥1,321 (sensitivity - 93.78% and specificity - 40.45%, p=0.0001).
Aim - optimization of the treatment of obesity and chronic heart failure (CHF) patients by identifying key factors for the progression of cardiac decompensation and the principles of using metoprolol succinate, taking into account pharmacogenetic aspects in the complex treatment of this comorbidity. 127 patients with CHF 2nd-3rd stages, 1st-4th functional class by New York Heart Association at the age of 32-87 (61 [57; 65]) years were examined, including 93 men and 34 women. A comparative analysis of certain clinical criteria using the sequential analysis of Wald A.A. The results were statistically plausible with p<0.05. Conducting factor analysis allowed to separate groups of indicators and estimate the specific weight of individual factors in the pathogenesis of combined pathology - obesity and heart failure. The first two factors determine 76.8% of the variability of the indicators, given the indicators that load them, they were given descriptive titles "clinical-hemodynamic factor", "clinical and anthropometric factor". The proposed prognostic protocol provides new possibilities for predicting the efficacy of metoprolol succinate in patients with obesity and chronic heart failure. The developed discriminatory models allow to objectify the criteria for determining the doses of metoprolol succinate in patients with obesity and chronic heart failure - the maximum initial, maximal endpoint, and also to evaluate the expediency of a subsequent stepwise increase in dose. Perspective of further studies - development and clinical approbation of the protocol of the use of metoprolol succinate in patients with CHF in the context of obesity, taking into account the results of the conducted factor analysis and developed prognostic means.
According to literature, the presence of concomitant diabetes mellitus type 2 (DM) is associated with a high frequency of complications in patients with acute myocardial infarction (MI) due to the development of repeated episodes of myocardial ischemia, left ventricular dysfunction, life threatening rhythm disorders, and thromboembolic events Aim: to analyze the state of immuno-inflammation based on the study of calprotectin, as well as to assess the presence and nature of links with carbohydrate metabolism parameters based on the study of blood glucose, insulin and insulin resistance. Patients with AMI in combination with DM 2 were found to have a significant increase in the level of calprotectin by 25.9% (p<0.001) compared to patients with AMI without DM 2. Assessment of carbohydrate metabolism rates revealed changes in the form of statistically significant increase in the concentration of fasting glucose in patients with AMI in combination with DM 2 by 41.8% (p<0.001) when compared to patients with isolated AMI. As for serum insulin, the level of this parameter when combined with the course of AMI and DM 2 significantly exceeded those in patients with AMI without DM 2. The level of HOMA index in patients with AMI with concomitant DM 2 when compared to patients with isolated AMI was also higher (differences are statistically significant, p<0.01). The study showed a correlation between serum calprotectin and insulinemia (R=0.57; p<0.05), HOMA index (R=0.52; p<0.05), fasting glycemia (R=0.59; p<0.05) and troponin I level (R=0,64; p<0,05). The obtained results indicate that the growth of immune inflammatory activity due to the proinflammatory parameter of calprotectin is accompanied by an increase in changes in carbohydrate homeostasis in the form of an increase in the degree of insulin resistance in patients with AMI and DM 2, and severity of cardiac ischemia.
The aim of research was to investigate the plasma microRNA (miR-133а) level in patients with essential arterial hypertension (EAH). A total of 45 patients with EAH 2-3 degrees aged 52.14 ± 8.25 years and 21 healthy individuals (control group) with comparable age and sex distributions. The following frequency of risk factors was revealed among the examined patients: overweight (53%), dyslipidaemia (73%), pre-diabetes (13%), asymptomatic hyperuricemia (29%); hypertension-mediated organ damage: increased arterial stiffness (27%), left ventricular hypertrophy (55%), atherosclerotic plaque in the carotid artery (40%), microalbuminuria (15%), moderate stage of chronic kidney disease (22%) and cardiovascular diseases: stable ischemic heart disease (11%) and heart failure with preserved ejection fraction of NYHA functional class I (18%). The plasma miR-133a level was determined by polymerase chain reaction using "CFX96 Touch" detection system (BioRad) and "TaqMan microRNA Assay" and "TaqMan® Universal PCR Master Mix" reagents (Thermo Fisher Scientific, USA). It has been established that in patients with EAH the plasma level of miR-133a was significantly lower than in practically healthy individuals (0,182 [0,102; 0,301] ), vs (0,382 [0,198; 0,474]), p <0.05). It has also been revealed a significant decrease in the level of miR-133a in the blood plasma in patients with such organs damage as LVH (0,133 [0,099;0,184]) in comparison with patients without LVH (0,238 [0,155; 0,410]), p <0.05) and also significantly lower than in healthy subjects in the control group (0,382 [0,198; 0,474]), p<0.05). There were no statistically significant differences in the plasma levels of miR-133a in the group of patients with EAH, depending on the presence of risk factors, other organ damage and cardiovascular diseases. The findings suggest the significant role of reducing of plasma levels of miR-133a in the pathogenesis of hypertension itself and in pathological remodeling of the heart.
In review provides data on pathophysiological relationships of intestinal microbiota with body weight regulation in patients with abdominal obesity. In manuscript discusses the leading mechanisms by which the gut microbiota can contribute to obesity and metabolic diseases, analyzes its components, including gastrointestinal peptides, short-chain fatty acids, bile acids, farnesoid receptors, etc. Western diet high in salt, dysbiosis and endotoxemia can be powerful pro-inflammatory factors responsible for the development of insulin resistance and weight gain. It is promising to prescribe agonists of gastrointestinal peptides, probiotics and prebiotics, which in abdominal obesity are able to inhibit dysbiosis, regulate immune functions, and protect the organism from low-intensity chronic inflammation.
The work was aimed at studying the relationship between the efficiency of bisoprolol and the polymorphism of β1- and β2-adrenergic receptors (β-AR) genes in patients with heart failure. The two-year study included 251 patients with heart failure (with myocardial infarction on the background of coronary heart disease). During hospitalization, a standardized examination and prescription of therapy was carried out, including β-adrenergic blocking agent (β1-AB) - bisoprolol. Afterward, 61 (24.4%) patients stopped taking β1-AB (bisoprolol) as a result of intolerance or violation of compliance; 190 patients took bisoprolol for 2 years. The frequency of rehospitalization (RH) due to decompensation of heart failure (HF) (or intravenous injection of loop diuretics), mortality, and the development of a composite endpoint (CE) for 2 years was taken into account. The control group consisted of 55 healthy individuals. Genotyping was performed using 3 polymorphisms (Gly389Arg of the β1-АR gene, Ser49Gly of the β1-АR gene, Gln27Glu of the β2-АR gene) using the polymerase chain reaction. Genetic and epidemiological analysis was carried out using the SNPStats program. The use of bisoprolol with HF reduces the risk of re-hospitalization (odds ratio (OR)=0.519 (0.278-0.967); p=0.037) and CE (OR=0.494 (0.271-0.900); p=0.030) for 2 years of treatment. Treatment of patients with bisoprolol in a dose of >5 mg leads to a decrease in the risk of CE with G/A polymorphism Ser49Gly (c.145A> G) of the β1-AR gene (OR=0.18 (0.04-0.84), with p=0.014). The use of this drug at this dose also leads to a decrease in the frequency of RH and CE with the homozygous genotype C (C/C) of the Gln27Glu polymorphism (c.79C>G) of the β2-AR gene (OR=0.09 (0.02-0.46), at p=0.018 and OR=0.14 (0.04-0.58), at p=0.006, respectively).
The purpose of research - to study the features of circadian profile of blood pressure (BP), the data of echocardiography, pH-monitoring, lipid spectrum, level of apelin and the state of the system "lipid peroxidation-antioxidant protection" in patients with a combination of arterial hypertension (AH) and gastroesophageal reflux disease (GERD) depending on the level of AH. It was examined 126 patients with combination of AH II stage, 2-3 degrees, and GERD, 70 (55.56%) men and 56 (44.44%) women, mean age 56.84 ± 1.17. The anthropometric indicators, a condition of "lipid peroxidation- antioxidant protection", the level of apelin, ambulatory blood pressure monitoring (ABPM), echocardiography, esophageal pH-monitoring were evaluated. Analysis of the results was performed using a computer program IBM SPSS Statistics 21.0 for Windows XP. According to the daily averages ABPM systolic BP/diastolic BP in the I group were 141.2 ± 0.8/90.4 ± 0.4 mm Hg., in II group - 163.3 ± 0.9/101.0 ± 0.5 mm Hg., in III group - 185.6 ± 0.8/112.1 ± 0.5 mm Hg., p = 0.001. There are only 25.39% of patients had normal indicators of the variability of BP among individuals with comorbidity. Transformation from mild AH to moderate was accompanied by a significant increase in the severity of left ventricular remodeling by type of concentric hypertrophy. The data of esophageal pH-monitoring allow us to classify the disorders as severe gastroesophageal reflux in patients with a combination of AH and GERD (DeMeester, 1993). In the group with first degree of AH the average rate of circulating apelin was 930.58 ± 56.27 pg/mL, for the patients with 2nd degree of AH - 880.56 ± 17.97 pg/ml, p>0.05, in patients with third degree of AH - 650.91 ± 12.87 pg/ml (p = 0.001). Assessment of lipid profile has allowed to establish the worse dyslipidemia in patients with 3rd degree of AH combined with GERD (atherogenic ratio - 3.11 ± 0.09). The deterioration of degree of AH combined with GERD accompanied by an increase of oxidative stress with increase of nitrites plasma and malondialdehyde concentration, and decrease of glutathione peroxidase and of SH-groups concentration. Increased degree of AH in patients with severe GERD accompanied by worsening of left ventricular remodeling, reduction of apelin levels, progression of dyslipidemia, and imbalances in the system of "lipid peroxidation-antioxidant protection."
In most cases RCC with venous extension is an indication for radical nephrectomy. However, in patients with imperative indications for nephron-sparing surgery a kidney resection with thrombectomy in rare situations is possible. We present a surgical technique for nephron-sparing surgery in patients with tumor spreading into the main renal vein. From 2007 to 2019 seven partial nephrectomies with removal of the tumor thrombus from the main renal vein were performed. Absolute imperative indications were recorded in 6 (85.7%) patients (4 with solitary kidney, 2 with bilateral tumors). Dimensions of renal tumor averaged 6.5±2.3 cm. Intravenous part of the tumor penetrated the initial portion of the renal vein in 3 cases, main trunk of the renal vein in 3 cases, and cavarenal portion of the IVC in 1 case. The average length of the tumor thrombus was 24.0±6.9 mm, and the width was 9.3±4.8 mm. Tumor thrombi were classified as intrarenal and extrarenal. In accordance with this principle surgical procedures were divided into partial nephrectomy with intrarenal (3/42.9%) and extrarenal thrombectomy (4/57.1%). Intrarenal thrombectomy was characterized by thrombus removal out of the vein lumen from the side of the kidney resection area, while extrarenal thrombectomy included additional opening the lumen of the main renal vein or inferior vena cava (IVC). In one patient hypothermic perfusion of the kidney in situ was used. In two cases the extracorporeal partial nephrectomy with kidney autotransplantation was performed. Warm ischemia time averaged 14.0 minutes. The time of ischemia during hypothermic perfusion in situ reached 76 minutes, the time of cold ischemia during extracorporeal surgery averaged 68.0 minutes. The volume of blood loss did not exceed an average of 621.4±146.8 ml. Early postoperative complications occurred in 4 (57.1%) cases (bleeding -1, ischemic stroke -1, deterioration of renal failure -2). Postoperative mortality was registered in 1 patient due to bleeding and heart failure. The follow-up period averaged 28.7±18.9 months. Distant metastases occurred in 1 (14.3%) patient after 16 months. Local tumor recurrence in the remnant kidney after nephron-sparing surgery was not detected in any case. Nephron-sparing surgery may be used to treat patients with kidney tumors and neoplastic venous thrombosis. However, this complex surgical approach requires further technical improvement.
Over the past decades, there has been an active scientific search for drugs that can increase myocardial contractility and improve the course of heart failure. Omecamtiv Mecarbil, a drug from the group of cardiac myosin activators, heads the list of applicants for clinical use. The article presents the results of several randomized clinical trials which studied the efficacy and safety of Omecamtiv Mecarbil in heart failure: ATOMIC-AHF, COSMIC-HF and GALACTIC-HF. ATOMIC-AHF showed a tendency to reduce the risk of developing supraventricular and ventricular arrhythmias in heart failure. COSMIC-HF has proven the ability of Omecamtiv Mecarbil to improve the quality of life of patients with heart failure. GALACTIC-HF may be a turning point in the medical treatment of heart failure. For the first time, clinical evidence of the ability of the selective cardiac myosin activator Omecamtiv Mecarbil to improve myocardial contractile function, reduce the severity of symptoms of heart failure and reduce the risk of cardiovascular death was obtained.
Patients in pain have different levels of satisfaction. The experience of patients regarding medication is based on their past treatment. The mental satisfaction of the patients for laboratory medication is necessary for their health recovery. The satisfaction of patients is a challenge for healthcare institutes to provide better facilities to patients. The goal of this research is to investigate the impact of taking patch pain medication, taking oral pain medication, and taking intravenous medication on patients' satisfaction with laboratory pain medication. The model of this research is based on the gap in the literature. 645 responses were considered for data analysis with Smart PLS 3.0 for study findings. The findings disclosed the impact of taking patch pain medication, taking an oral medication, and taking intravenous medication is significant on patients' satisfaction with laboratory pain medication. The study has theoretically enriched the literature with a unique contribution to the study model. Practically, the study has discovered the ways the healthcare sector can improve the satisfaction of patients for their better health and satisfaction. The future directions highlighted by this study are useful for future studies to contribute to patients' satisfaction with laboratory medication.
Hepatitis C virus infection (HCV) considered one of the main reasons in Iraq to cause chronic liver disease, which may progress to life-threatening outcomes. Nurses' knowledge about the HCV will impact their practice of standard precaution when managing HCV patients. The present study aimed to assess the nurses' knowledge about HCV in Baghdad teaching hospitals. A cross-sectional descriptive study was performed via distribution of HCV info questionnaires to 150 nurses in three Baghdad teaching hospitals (Al-Kindi, Al-Elwyia pediatric and Sheikh Zayed hospitals). The questionnaire format consists of nurses' demographic data (age, gender, educational level, marital status, years of experience in hospital, workplace in hospital, attending training courses and information sources) and nurses' knowledge of hepatitis C virus (nature of the disease, transmission, prevention, and treatment). The mean score of the knowledge showed fair grade with 66.66±12.9%. As the highest correct percentage displayed in nature of the disease (73%) and treatment (72%). Whereas the lowest correct percentage presented in transmission (69%) and prevention (48.3%). The results exhibited significant difference between the nurses' knowledge about treatment with the information sources (P<0.05), about transmission and prevention with the hospital workplace (P<0.05), and about prevention with the educational level (P<0.005). Continuing educational programs are essential to increase awareness of HCV among the nurses.
In this study, we assessed the impact of COVID-19 on the course of HFmrEF by determining the biomarkers furin and NT-proBNP, questionnaires (EQ-5D-5L), and cardiac ultrasound. A comprehensive examination of 72 patients with HFmrEF (main group) and 18 apparently healthy individuals (control group). The main group was divided into two subgroups depending on the history of coronavirus disease. All patients gave their consent to participate in the study. In the group of patients with a history of coronavirus infection compared to the patients without a COVID-19 history were established: significantly higher concentrations of NT-proBNP (1002.79±215.94 pg/ml and 405.37±99.06 pg/ml, respectively, p-value 0.01), uric acid (429.08±27.01 mmol/l vs. 354.44±28.75 mmol/l, p-value 0.04) and a lower furin to NT-proBNP ratio (0.87± 0.26 and 1.38 ± 1.16, p-value 0.045) in blood serum; using the EQ-5D-5L questionnaire, a significant deterioration of quality of life indicators (64.21±3.04 points vs. 72.81±1.82 points by VAS, p-value 0.02); higher indicators of LVMMi (157.39±6.14 g/m2 and 138.68±6.02 g/m2, p-value 0.03), LA dimensions (43.74±0.95 mm and 41.12±0.85 mm, p-value 0.04) and RA dimensions (40.76±1.23 mm and 37.75±0.85 mm, p-value 0.04). Coronavirus infection in patients with HFmrEF leads to disorders of intracardiac hemodynamics and persistent negative structural changes of the heart. The ratio of furin to NT-proBNP serum levels can be used to determine the impact of the HF syndrome itself on the patients' subjective assessment of their quality of life.