Concomitant Cardiac Pathology Research Articles

THE CHOICE OF ANESTHESIA METHOD FOR HYBRID ANGIOPLASTY. CLINICAL OBSERVATION

Many patients presenting for surgical revascularization of the lower extremities have progressive systemic atherosclerotic disease affecting not only the peripheral extremities, but also the coronary, cerebral, and renal vessels. Vascular patients are therefore considered high perioperative risk patients, making them a real challenge even for experienced anesthesiologists. This article analyzes a clinical case of hybrid angioplasty of lower extremity vessels in a patient with generalized atherosclerotic lesions under regional anesthesia with ultrasound navigation. Analysis of the clinical case and its analysis shows that regional anesthesia provides reliable protection against surgical stress with minimal impact on the body and should be used in patients with concomitant cardiac and pulmonary pathologies.

Failure of Surgical Aortic Valve Prostheses: An Analysis of Heart Team Decisions and Postoperative Outcomes.

Objectives: To analyze Heart Team decisions and outcomes following failure of surgical aortic valve replacement (SAVR) prostheses. Methods: Patients undergoing re-operations following index SAVR (Redo-SAVR) and those undergoing valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) following SAVR were included in this study. Patients who underwent index SAVR and/or Redo-SAVR for endocarditis were excluded. Data are presented as medians and 25th-75th percentiles, or absolute numbers and percentages. Outcomes were analyzed in accordance to the VARC-3 criteria. Results: Between 01/2015 and 03/2021, 53 patients underwent Redo-SAVR, 103 patients ViV-TAVR. Mean EuroSCORE II was 5.7% (3.5-8.5) in the Redo-SAVR group and 9.2% (5.4-13.6) in the ViV group. In the Redo-SAVR group, 12 patients received aortic root enlargement (22.6%). Length of hospital and ICU stay was longer in the Redo-SAVR group (p < 0.001; p < 0.001), PGmax and PGmean were lower in the Redo-SAVR group as compared to the ViV-TAVR group (18 mmHg (10-30) vs. 26 mmHg (19-38), p < 0.001) (9 mmHg (6-15) vs. 15 mmHg (9-21), p < 0.001). A higher rate of paravalvular leakage was seen in the ViV-TAVR group (p = 0.013). VARC-3 Early Safety were comparable between the two populations (p = 0.343). Survival at 1 year and 5 years was 82% and 36% in the ViV-TAVR cohort and 84% and 77% in the Redo-SAVR cohort. The variables were patient age (OR 1.061; [95% CI 1.020-1.104], p = 0.004), coronary heart disease (OR 2.648; [95% CI 1.160-6.048], p = 0.021), and chronic renal insufficiency (OR 2.711; [95% CI 1.160-6.048], p = 0.021) showed a significant correlation to ViV-TAVR. Conclusions: Heart Team decisions are crucial in the treatment of patients with degenerated aortic bioprostheses and lead to a low mortality in both treatment paths thanks to patient-specific therapy planning. ViV-TAVR offers a treatment for elderly or intermediate-risk profile patients with comparable short-term mortality. However, this therapy is associated with increased pressure gradients and a high prevalence of paravalvular leakage. Redo-SAVR enables the surgical treatment of concomitant cardiac pathologies and allows anticipation for later VIV-TAVR by implanting the largest possible valve prostheses.

Differential Diagnosis of Chest Pain Syndrome: Thoracalgia and Cardialgia

Summary. The objective of the study was to conduct a differential diagnosis of chest pain and to identify the percentage of patients with a cardiac component. Material and Methods. 147 patients were examined; mean age was 43.2±1.9 years. Patients' complaints and risk factors were carefully analyzed. MRI examination, radiography of the thoracic spine, electrocardiography, echocardiography, and bicycle ergometry were performed. Exclusion criteria were as follows: acute isolated pathology of the cardiovascular system (myocardial infarction, angina pectoris), deforming and traumatic changes in the spine (grade 3-4 scoliosis, compression fractures of the vertebral bodies, chest deformities). Results. The patients were divided into 3 groups: patients with spinal degenerative disc disease, patients with cardiac symptoms and spinal variables, and a group that mainly suffered from cardiovascular disease. Electrocardiography, echocardiography, and bicycle ergometry were performed to objectively confirm the obtained data. Electrocardiography changes were observed in 29.2% of patients. Among patients with degenerative disc disease, electrocardiography changes occurred in 4%, while they were noted in 21.4% of cases in the group with mixed pathology and 100% in the group of patients with signs of cardiovascular disease. According to echocardiography, 28.6% had cardiac changes. The most common cause was atherosclerosis (50%) and hypertension (21.4%). By observation groups, the level of changes and their severity significantly increased from group 1 to group 3. Bicycle ergometry gave a “positive” test in 20% of cases. Diagnostic procedures revealed a tendency to establish the causes of pain. MRI and electrocardiography play the most important role. The data obtained allow us to conclude that the cause of pain syndrome in group 3 of patients is based on heart and vascular disease. This group is transferred to the supervision of a cardiologist, so in the further study, we paid attention to the groups with spinal osteochondrosis (75) and the mixed group (42). The degree of severity of changes, both quantitatively and in terms of the severity of concomitant pathology, is noteworthy. Thus, in patients with spinal degenerative disc disease, the level of comorbidities reached 18.7%; in patients with cardiac symptoms and changes in the spine, it was 50%, which significantly aggravates their course. The high level of anxiety in the group as a whole is noteworthy, which creates a negative background for treatment and requires mandatory correction. A program of appropriate treatment in the group with combined pathology should be created taking into account its cardiological component. Conclusions. A careful analysis of the results indicates the presence of a group of patients with concomitant cardiac pathology that requires additional correction in the complex of generally accepted therapeutic measures.

COVID-19 in patients with acute leukemia: 3 years' experience of pandemic

Patients with acute leukemia are one of the most vulnerable risk groups for infection with SARS-CoV-2 and severe course of coronavirus infection. During the first 2 years of the pandemic, the mortality rate of patients with acute leukemia was 11-48 %, depending on leukemia type, and only reached population levels in 2022. Risk factors for severe COVID-19 in patients with acute leukemia are old age, concomitant cardiac pathology, metabolic syndrome, and the absence of acute leukemia remission. Chemotherapy administered one month before hospitalization with COVID-19 diagnosis showed statistical significance in influencing hospital mortality only in the group of patients with acute myeloid leukemia. Despite this, the international medical community has recommended delaying the start of chemotherapy until clinical symptoms of coronavirus infection have completely resolved and a negative test result for SARS-CoV-2 has been obtained for all types of leukemia. Currently, the most optimal tactic is to prevent SARS-CoV-2 infection by vaccinating patients with acute leukemia receiving antitumor treatment. If the immunological response to vaccination is insufficient, it is possible to use virus-neutralizing monoclonal antibodies as a safe and effective method of primary prevention of COVID-19.

АСТЕНИЧЕСКИЙ ПОСТКОВИДНЫЙ СИНДРОМ: КЛИНИЧЕСКАЯ ЭФФЕКТИВНОСТЬ ЦИТОПРОТЕКТОРОВ

The study aims to assess the mechanism and efficacy of cytoprotectors as a supplementary therapy for asthenia based on a literature review. The study discusses the cardioprotective effect of exogenous phosphocreatine and meldonium efficacy, their possible role following the COVID-19 infection, especially in concomitant cardiac pathology, post-COVID-19 syndrome and its manifestation in the form of asthenia, and the need to use these energetics in comprehensive therapy for patients with such diseases.

PERFORMING POSTERIOR SURGICAL ACCESS DURING TOTAL HIP REPLACEMENT IN PATIENTS WITH OSTEOARTHRITIS AND CONCOMITANT CARDIAC PATHOLOGY

PERFORMING POSTERIOR SURGICAL ACCESS DURING TOTAL HIP REPLACEMENT IN PATIENTS WITH OSTEOARTHRITIS AND CONCOMITANT CARDIAC PATHOLOGY

DIFFERENTIATED HYPEROSMOLARY THERAPY IN CEREBRAL EDEMA IN PATIENTS WITH CRANIOCEREBRAL INJURY

to study the pathophysiological aspects of cerebral edema and compare the effectiveness of using 15% mannitol solution and hypertonic 3.5%, 7%, 10% sodium chloride solution in the complex treatment of patients with head injury. Material and methods:90 patients from 18 years old to 68 years old with various traumatic brain injuries and inhibition of consciousness level from 4 to 13 points on the Glasgow coma scale were examined. Results:infusion of mannitol at the indicated dosage reduced ICP after 30 minutes by 42, 3%, and after 120 minutes it remained below the initial data by 23.9%. Infusion of a 3.5% NaCl solution already by the 30th minute led to a decrease of ICP by 48.6%, and by the end of 120 minutes the ICP remained below the initial data by 35.9%. Infusion of a 7% NaCl solution already by the 30th minute led to a decrease in ICP by 55.4%, and by the end of 120 minutes the ICP remained below the initial data by 39.9%. Infusion of a 10% NaCl solution already by the 30th minute led to a decrease in ICP by 58.4%, and by the end of 120 minutes the ICP remained below the initial data by 45.9%. Conclusions:the decrease in ICP within 30 and 120 minutes after the introduction of hyperosmolar solutions is more pronounced with iv administration of 3.5%, 7%, 10% NaCl solution relative to 15% Mannitol in calculated dosages, which should be borne in mind in patients with concomitant cardiac and renal pathology.

COVID-19-induced cardiovascular complexities

This study aimed to investigate the features of the clinical course of COVID-19 in combination with the pathology of the cardiovascular system (CVS). A prospective study was carried out. The main group (n=150) consisted of patients with changes in the cardiovascular system associated with COVID-19, i.e. newly diagnosed CV pathology, and patients with exacerbation of cardiac pathology against the background of COVID-19. The comparison group (n=154) included patients with COVID-19, but without any significant concomitant cardiac pathology. The average age of patients in the main group was 67.7 years (from 47 to 86 years), in the comparison group of 66.1 years (from 48 to 88 years). The study groups were representative and did not differ statistically in the nature of COVID-19 symptoms and the degree of lung involvement. Among the cardiac pathology, progressing or first occurring against the background of infection with COVID-19, in most cases, arterial hypertension of II-III degree (60.0%), coronary heart disease (48.7%), arrhythmias (23.3%) were diagnosed. Echocardiographic abnormalities included right ventricular dysfunction (22.7%), left ventricular contractility disorders (18.7%), with decreased ejection fraction (17.3%), diastolic dysfunction (14.0%), and toxic myocarditis (7.3%). The most significant risk factors were the presence of a burdened medical history (RR=10.39), elevated body mass index over 30 (RR=2.63) and diabetes mellitus (RR=1.55). In patients with COVID-19 in combination with CVS pathology, a relatively high incidence of acute onset (64.0% vs. 44.2%; p&lt;0.001), respiratory failure (83.7% vs. 62.0%; p&lt;0.001), admission to the intensive care unit (25.3% vs. 11.7%; p=0.004), development of acute respiratory distress syndrome (20.0% vs. 9.1%; p=0.012), hospital mortality (10.7% vs. 2.7%; p=0.006). Cardiac manifestations of COVID-19 included focal or global myocardial inflammation, ventricular dysfunction, heart failure, and arrhythmias. A high frequency of acute onset of the disease, respiratory failure and hospital mortality is determined.

COVID-19-induced cardiovascular complexities

This study aimed to investigate the features of the clinical course of COVID-19 in combination with the pathology of the cardiovascular system (CVS). A prospective study was carried out. The main group (n=150) consisted of patients with changes in the cardiovascular system associated with COVID-19, i.e. newly diagnosed CV pathology, and patients with exacerbation of cardiac pathology against the background of COVID-19. The comparison group (n=154) included patients with COVID-19, but without any significant concomitant cardiac pathology. The average age of patients in the main group was 67.7 years (from 47 to 86 years), in the comparison group of 66.1 years (from 48 to 88 years). The study groups were representative and did not differ statistically in the nature of COVID-19 symptoms and the degree of lung involvement. Among the cardiac pathology, progressing or first occurring against the background of infection with COVID-19, in most cases, arterial hypertension of II-III degree (60.0%), coronary heart disease (48.7%), arrhythmias (23.3%) were diagnosed. Echocardiographic abnormalities included right ventricular dysfunction (22.7%), left ventricular contractility disorders (18.7%), with decreased ejection fraction (17.3%), diastolic dysfunction (14.0%), and toxic myocarditis (7.3%). The most significant risk factors were the presence of a burdened medical history (RR=10.39), elevated body mass index over 30 (RR=2.63) and diabetes mellitus (RR=1.55). In patients with COVID-19 in combination with CVS pathology, a relatively high incidence of acute onset (64.0% vs. 44.2%; p&lt;0.001), respiratory failure (83.7% vs. 62.0%; p&lt;0.001), admission to the intensive care unit (25.3% vs. 11.7%; p=0.004), development of acute respiratory distress syndrome (20.0% vs. 9.1%; p=0.012), hospital mortality (10.7% vs. 2.7%; p=0.006). Cardiac manifestations of COVID-19 included focal or global myocardial inflammation, ventricular dysfunction, heart failure, and arrhythmias. A high frequency of acute onset of the disease, respiratory failure and hospital mortality is determined.

Features of the Influence of Chronic Obstructive Pulmonary Disease on the Structural and Functional Parameters of the Heart and Vessels: Possibilities for Correction

The presence of concomitant cardiac pathology exacerbates the course of chronic obstructive pulmonary disease (COPD) and worsens the prognosis for both conditions. Objective — to improving the efficiency of diagnostics and treatment in patients with arterial hypertension and COPD, adding L-arginine to the complex therapy. Materials and methods. A clinical examination was performed on a total of 140 patients, consisting of 82 individuals with arterial hypertension complicated by chronic obstructive pulmonary disease (COPD), and 58 patients with isolated hypertension. Each group was further subdivided into subgroups based on their treatment regimen, which included basic therapy alone, basic therapy along with co-existing pulmonary disease management, and a subgroup receiving basic therapy combined with L-arginine supplementation. Results and discussion. The course of the diseases was more severe in patients with combined pathology. An acute drug test with arginine showed a decrease in blood pressure in both the small and large circles of circulation along with changes in endothelial function. Three months after the complex treatment with L-arginine resulted in the decrease of pressure in the small circle of circulation, had an effect on the structural and functional changes of both ventricles, diminished manifestations of diastolic dysfunction of the heart, increasing the physical activity and endothelium-dependent vasodilation, reduced the activity of anti-inflammatory cytokines in patients with hypertension and COPD. The inclusion of L-arginine as a functional corrector of endothelial function to the basic therapy of patients with arterial hypertension and COPD contributes to the improve­ment of the clinical condition of patients, normalizes blood pressure and its daily profile patients after 3 months of treatment, thereby enhancing their quality of life. Conclusions. L-arginine, as a pathogenically selected donator of nitric oxide, along with basic therapy of essential hypertension and COPD improved the state of the heart and vessels and should be used for treat­ment both diseases.

Clinical and Laboratory Characteristics of Patients with COVID-19 on the Background of Cardiovascular Diseases

The research studied the clinical and laboratory characteristics of COVID-19 patients against the background of cardiovascular diseases. A high prevalence of cardiovascular diseases (CVD) was revealed among COVID-19 patients: arterial hypertension (93.4%), chronic heart failure (60.9%), cardiac arrhythmias (40.1%), coronary heart disease (21.9%). A reliable correlation was established between the timing of hospitalization from the onset of the disease and the severity of the infection, mortality was higher in persons hospitalized on the 5–7 day of the disease (59.8%). Patients with CVD are significantly more likely to develop complications, as well as higher deaths (11.53% vs. 4.30%). Pulmonary embolism (44%), acute respiratory distress syndrome (22%), acute kidney injury (20.6%) prevailed in the structure of causes of death. Gender differences in the course and outcomes of COVID-19 were found: the severity of the course and mortality rates were higher among males. According to clinical and laboratory indicators, patients with diseases of the cardiovascular system had a more severe course and a high degree of immuno-inflammatory reactions compared with the group of patients without a premorbid background. Upon admission to the hospital, patients with COVID-19 and CVD were significantly more likely to have a lesion of the pulmonary parenchyma of CT 3 and CT 4 (P&lt;0.05), whereas in the group without concomitant cardiac pathology, lung lesion corresponded to CT 1 (P&lt;0.05); CT of the lungs in dynamics showed differences in the study groups: in patients with COVID-19 and CVD, CT 3 was recorded significantly more often, and in the comparison group — CT 1 (45% vs. 10%, (P&lt;0.05)).

The relationship between cardiovascular pathology and impaired glucose metabolism with vitamin D deficiency (literature review and own data)

Background. Vitamin D plays a significant role in many processes in the human body, which diversifies the symptoms of its insufficiency, so it is not always possible to diagnose its deficiency in a timely manner. At the same time, according to a number of clinical studies, an inverse relationship has been proven between a reduced level of vitamin D and mortality from all causes and cardiovascular diseases, the course of diabetes mellitus (DM), hypertension, chronic kidney disease, atherosclerosis, coronary heart disease; and the mechanisms of the influence of vitamin D deficiency on various metabolic processes have been revealed. The development and progression of cardiovascular diseases and vascular complications of DM are currently the main causes of disability and mortality of patients. All this substantiates the need to control and monitor the vitamin D supply in patients with this comorbid pathology. Aim of the study is to investigate the presence and severity of vitamin D deficiency in patients with type 2 DM and the presence of concomitant cardiac pathology. Materials and methods. Main group included 31 patients (17 men and 14 women aged 51.51 ± 1.73 years, with duration of DM of 8.59 ± 1.70 years) who were treated in the endocrinology clinic from October 2022 to May 2023. The comparison group consisted of 27 patients with type 2 DM who stayed in this clinic in 2020–2021. Serum level of 25-hydroxycholecalciferol (25(OH)D) was studied using the enzyme-linked immunosorbent assay. The level of vitamin D less than 20–30 ng/ml was considered as its insufficiency, and the level below 20 ng/ml as deficiency. Statistical processing was carried out using Microsoft Excel and Statistica 6.0. Results. In the main group, cardiac pathology manifested itself by the presence of hypertension detected in all patients (stage I — 6 cases; stage II — 21 and stage IІI — 4); coronary heart disease and cardiosclerosis — in 7 patients; heart failure of the first or second degree — in all individuals. All patients in the main group were vitamin D deficient or insufficient: 15 had a deficiency (12.96 ± 1.06 ng/ml), and 16 had an insufficiency (23.68 ± 0.72 ng/ml). In contrast to the comparison group, patients from the main group had a significantly lower average level of vitamin D (18.49 ± 1.16 ng/ml vs 28.98 ± 1.02 ng/ml, p &lt; 0.001). Taking into account a decrease in the level of vitamin D supply of patients, including those with comorbid pathology examined in 2022–2023, which is obviously associated with a long stay in shelters and a stressful situation caused by the state of war, and its impact on the course of cardiovascular diseases and diabetes, it is necessary to pay more attention to the detection and timely appropriate correction of vitamin D deficiency. Conclusions. In patients with type 2 diabetes and comorbid cardiovascular pathology, there is a decrease in the level of vitamin D supply. During the war in Ukraine, there is a probable deepening of vitamin D deficiency. The negative impact of vitamin D deficiency on the course of diabetes and cardiovascular pathology justifies the need to monitor vitamin D supply in such patients.

Appendiceal perforation: A rare case of massive neonatal pneumoperitoneum

A pre-term newborn male was admitted to the pediatric cardiac intensive care unit with severe left ventricular and aortic hypoplasia. On day-of-life-13, massive pneumoperitoneum was incidentally identified on a chest radiograph after central line placement. Emergent exploration with thorough examination revealed only a focal perforation at the appendiceal tip. Standard appendectomy was performed; pathology showed appendiceal perforation with focal mucosal ulceration without inflammation . Literature review demonstrated neonates with appendiceal perforation have nonspecific symptoms at presentation (emesis, poor feeding, abdominal erythema) which may be difficult to distinguish from other etiologies of perforation. Infants with concomitant cardiac pathology are at increased risk for spontaneous intestinal perforation due to malperfusion. However, appendiceal perforation does not lead the differential for neonatal massive pneumoperitoneum; rather, large volume pneumoperitoneum typically results from gastric perforation. The true incidence is unknown with fewer than 10 reported cases; importantly, the literature often lacks distinction between spontaneous-perforation versus appendicitis-with-perforation. Given its rarity, discrete examination of the appendix and appendiceal pathology may be overlooked when evaluating neonates with pneumoperitoneum during a standard of care operative exploration. Particularly in patients with high-risk comorbidities where gastric or ileal pathology is not appreciated after thorough exploration, appendiceal perforation should be considered.

Algorithm for the diagnosis and pharmacotherapy of arterial hypertension, chronic heart failure in patients with newly diagnosed tuberculosis and chronic obstructive pulmonary disease in the the intensive phase of tuberculosis chemotherapy

Chronic heart failure (CHF), arterial hypertension (AH), chronic obstructive pulmonary disease (COPD) worsen the prognosis for the cure of newly diagnosed pulmonary tuberculosis (TB), including due to an increase in negative symptoms and a deterioration in the quality of life of patients in the intensive phase of TB treatment. This requires the algorithmic diagnostic actions of a doctor for the subsequent appointment of rational pharmacotherapy with a proven best outcome in the treatment of TB.Objective. To develop an algorithm for the diagnosis and pharmacotherapy of patients with hypertension, CHF and COPD in the intensive phase of chemotherapy for newly diagnosed TB in terms of the best outcome of TB cure.Design and methods. An open, prospective, randomized comparative study included 135 patients who were admitted to a tuberculosis dispensary for the treatment of newly diagnosed TB. Depending on concomitant cardiac pathology, patients were divided into 2 groups: 76 patients with TB, COPD and AH; 59 patients with TB, COPD and CHF. In patients on the background of intensive chemotherapy for newly diagnosed TB, symptoms such as shortness of breath, tachycardia, and increased blood pressure (BP) were first detected or intensified. The selection of treatment regimens was carried out with an assessment of the best tolerability and effectiveness. Duration of follow-up was 6 months with an assessment of the outcomes of TB treatment in comparison with retrospective control (a similar group according to the inclusion and exclusion criteria treated in 2018).Results. During intensive chemotherapy of newly diagnosed TB, increasing symptoms were assessed and analyzed, indicating the appearance or exacerbation of comorbid pathology: AH, CHF and COPD. Based on the results of the study, an algorithm of doctor’s actions was developed for the differential diagnosis of cardiovascular (AH and CHF) and bronchopulmonary (COPD) pathologies with recommendations for prescribing a rational combination of drugs. In patients with TB, hypertension and COPD, the best effect was obtained in reducing the average daily systolic and diastolic BP during therapy with an angiotensin II receptor antagonist and a dihydropyridine calcium antagonist with satisfactory tolerability. For patients with TB, COPD and CHF, an angiotensin-converting enzyme inhibitor (if intolerant, an angiotensin II receptor antagonist) in combination with a mineralocorticoid receptor antagonist and titration of a beta-blocker with the addition of a myocardial cytoprotector to the above therapy showed an optimal effect on the severity of CHF symptoms. These treatment regimens for 3 months led to the achievement of target indicators for BP, heart rate, exercise tolerance in the test with a 6-minute walk, and improvement in echocardiography. Continuation of treatment up to 6 months showed a significant improvement in the outcomes of TB chemotherapy, expressed in an increase in the number of people who achieved cessation of bacterial excretion and closure of decay cavities, without increasing antibiotic therapy.Conclusions. Algorithm of doctor’s diagnostic actions and prescription of rational pharmacotherapy of AH, CHF and COPD in patients with newly diagnosed pulmonary TB leads not only to improved tolerability of TB therapy, but also to the outcomes of curing newly diagnosed TB without intensifying antibiotic therapy.

Сlinical portrait of the ambulatory patient with diabetes 2 types

Objective: estimate the clinical status, a metabolic profile and carried-out cardiotropic, hypoglycemic therapy at outpatients with diabetes 2 types in real clinical practice.Material and metods: the outpatient records of 81 patients of both sexes (average age 63.7 + 1.3 years, men 33 (40.7%) with type 2 diabetes mellitus, who are under dispensary observation in one of the polyclinics of Krasnodar, were analyzed. All patients had some clinical (“experience” of diabetes, body mass index) parameters, blood pressure level, laboratory indicators (fasting glycemia, glycated hemoglobin, total cholesterol, high and low density lipoproteins, triglycerides and medication (antihypertensive, lipid-corrective, antithrombotic, hypoglycemic) therapy evaluated.Results: among patients with type 2 diabetes mellitus, women predominated, most of the patients had obesity of the 1st degree. In 27.2% there was no documented concomitant cardiac pathology, the rest had arterial hypertension and coronary artery disease. Antihypertensive therapy included from 2 to 5 drugs, including all patients receiving ACE inhibitors or sartans, which in 2/3 of cases were combined with amlodipine and in equal quantities with diuretics and beta-blockers. Only 8.5% of patients reached the target level of blood pressure. Lipid-lowering therapy in more than 90% of patients included statins in inadequately low doses, which led to the failure to achieve the target level of low-density lipoproteins in 95% of patients. Antithrombotic therapy was taken by more than 90% of patients, but in a quarter of them without documented indications. One in four outpatients with type 2 diabetes mellitus is diagnosed with nonvalvular atrial fibrillation. Only 71.4% of patients received direct oral anticoagulants. Among the means of hypoglycemic therapy, oral drugs (metformin, sulfonylurea derivatives) or their combination with insulin prevailed.Conclusion: in most of the patients examined with type 2 diabetes, the main goals of cardiotropic and hypoglycemic therapy were not achieved. To improve the prognosis and quality of life of such patients, it is necessary to conduct comprehensive adequate treatment based on modern recommendations.

Retrospective Analysis of the Treatment of Patients with Pain in Osteochondrosis of the Thoracic Spine

Summary. The purpose of this study was to identify signs of cardiac component in the development of chronic pain in osteochondrosis of the thoracic spine.&#x0D; Materials and Methods. Case histories of 434 patients with osteochondrosis of the thoracic spine who underwent examination and treatment in the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine” were retrospectively studied. Among them were 207 males and 227 females. The materials of inpatient and outpatient medical histories and consultative conclusions were processed. The place of residence, lifestyle of patients, the presence of concomitant pathology, duration of the disease, and the frequency of exacerbations per year were analyzed. Risk factors and complaints of patients with a careful emphasis on the nature of the pain syndrome were studied. The results of treatment were evaluated.&#x0D; Results. Males (47.7±2.4%) and females (52.3±2.3%) of working age (89.0%) suffered from thoracic osteochondrosis almost equally. The vast majority lived in cities (88.2%). Isolated thoracic osteochondrosis (43.3±0.3%) with the duration of the disease up to 1 year (72.3%) and the frequency of exacerbations once a year (54.4%) was the most common according to localization. The pain was mainly aching in nature with irradiation to the right half of the chest and right upper extremity (88.5%). The dependence of the pain syndrome on changes in body position and duration over time from one hour to several days was observed (92.1%). Risk factors for the development of the disease include hypodynamia (10.4%), obesity (5.5%), other comorbidities (4.6%), as well as genetic predisposition and bad habits (4.1% and 3%, respectively). In 90.0% of cases, the patients received drug treatment – nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics. 10.0% were treated with physiotherapy (52.7%), massage (97.2%), and therapeutic gymnastics (91.7%). 63.2% of patients were treated using a combination of medical and non-medical methods. According to the outcomes of treatment, a positive effect was noted in 87.5% of patients.&#x0D; Conclusions. Careful analysis of the negative outcomes indicates the presence in this category of patients probable concomitant cardiac pathology, which requires further study and examination.

Adding complexity to complexity: The role of concomitant cardiac surgery in lung transplantation.

Outcomes of lung transplantation have greatly improved over recent years. While patients with concomitant cardiac pathology used to be excluded from lung transplant, today, most of these cardiac conditions can be addressed safely and effectively. Interventional techniques should be preferred. Lung transplant performed by cardiac surgeons allows for concomitant interventions.

Thyroid Pathology in High-Risk Cardiac Surgery Patients with Coronary Artery Disease

The aim. To analyze the features of the perioperative period in high-risk cardiac surgery patients with coronary artery disease (CAD) and thyroid disease.&#x0D; Materials and methods. Retrospective analysis of data of 354 high-risk patients with CAD who were operated and discharged from the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine from 2009 to 2019. All the patients underwent standard clinical and laboratory tests, ECG, echocardiography, coronary angiography and surgical myocardial revascularization with correction of concomitant cardiac pathology. Ultrasound screening of thyroid disease and thyroid hormone levels was not performed in all patients, however, patients with severe symptoms were referred for follow-up.&#x0D; Results. Thyroid disease was diagnosed in 37 (10.4%) patients, of whom 11 (3.1%) had hypothyroidism and were receiving hormone replacement therapy, and 1 (0.28%) had hyperthyroidism on tyrosol therapy. Ultrasound signs of thyroiditis were detected in 7 (1.9%) patients, nodular goiter in 29 (8.1%), and retrosternal goiter in 1 (0.28%) patient. Dependingonthecardiacsurgicalpathology,theprevalenceofhypothyroidismdidnotdifferinpatientswithuncomplicated and complicated forms of CAD (7 [3.6%] and 4 [2.5%] patients, respectively, p = 0.5498). Patients with hypothyroidism received hormone replacement therapy with levothyroxine in a dosage prescribed by an endocrinologist. The day before the surgery, thyroid-stimulating hormone control was performed to confirm the achievement of compensation. When comparing the course of the operative period in compensated hypothyroidism and clinical euthyroidism, no significant differences were found, and the postoperative period didn’t differ in the occurrence of atrial fibrillation (p = 0.0801), hydrothorax (p = 0.5280), but a decrease in the estimated glomerular filtration rate at discharge was found in patients with hypothyroidism (59.5 ± 16.8 vs. 71.3 ± 19.6 ml/min/1.73 m2, p = 0.0493).&#x0D; Conclusions. Timely detection of thyroid dysfunction allows to compensate the condition and avoid postoperative complications. Analysis of the perioperative period in patients with hypothyroidism showed no effect of compensated hypothyroidism on the operative and postoperative periods in high-risk patients with CAD. Decreased glomerular filtration rate after surgery in patients with hypothyroidism requires further study and adherence to the strategy of nephroprotection in polymorbid patients.

ПОИСК ПРЕДИКТОРОВ РАДИОЧУВСТВИТЕЛЬНОСТИ АДЕНОКАРЦИНОМЫ ПРЯМОЙ КИШКИ

Purpose: To analyze a number of immunohistochemical markers as predictors of the radiosensitivity of rectal adenocarcinoma.&#x0D; Material and methods: The study included 122 patients with histologically verified rectal adenocarcinoma, varying degrees of differentiation, and the stage of the tumor process I-IIIC, T2-T4b /N0-N2b/ M0, with the localization of the tumor in the lower-middle-ampullary parts of the rectum. Predictors included in the research: Ki67, p53, EGFR, Bcl2, COX2, P21, E-cadherin. Preoperative chemoradiotherapy was performed up to 48–50 Gy with the use of medications (5-FU, Cisplatin) as a radio modifiers. The analysis was carried out according to the degree of severity of therapeutic pathomorphosis (according to Mandard), a decrease in the stage before surgery.&#x0D; Results: A full course of preoperative chemoradiotherapy followed by surgery was performed at 121 patients, one patient died of concomitant cardiac pathology during the break. The first degree of Mandard pathomorphosis (complete resorption) registered at 12 patients. The second degree (preservation of a few tumor cells against the background of fibrotic changes) – at 27 patients. The third degree (a large number of preserved tumor cells against the background of the predominance of fibrosis) – at 38 patients. The fourth degree (tumor cells predominate over fibrotic changes) – at 27 patients. The fifth degree (complete absence of signs of tumor regression, absence of fibrosis) – at 2 patients. A decrease in the stage of the tumor process according to the preoperative comprehensive examination registered in 114 (94.2%) patients, in 9 (7.4%) patients – there was no dynamics. During the observation period from 2006 until nowadays, 10 people are known to have died. Years in remission range from 3 months to 22 years. According to the results of multivariate and multiple regression analyses, it is possible to successfully predict the effectiveness of chemoradiotherapy, both with the use of biomarkers (Ki67, p53, EGFR, Bcl2, COX2, P21, E-cadherin), and traditional indicators (histological type, stage of the disease, gender, degree of differentiation). It turned out, that both traditional indicators and immunohistochemical indicators work equally well, regardless of each other.&#x0D; Conclusion: Studied immunohistochemical predictors of radiosensitivity of rectal adenocarcinoma, allow to assess the degree of radiosensitivity or radioresistance of the tumor in each patient before the start of preoperative chemoradiotherapy by doing so, it warns us about the effectiveness or ineffectiveness of chemoradiotherapy in a specific clinical situation, which allows us to individualize the approach to treatment, choosing a more suitable treatment method for the patient: neoadjuvant chemotherapy or surgery.

Feautures of perioperative period of high-risk patients with coronary artery disease and type 2 Diabetes Mellitus.

The aim –to analyze perioperative period for patients with CAD and Diabetes mellitus (DM). Materials and methodsRetrospective analysis of 354 high-risk patients who were operated on and discharged from our Institute in the period from 2009 to 2019. All patients underwent ECG, ECHO, coronary angiography and CABG with correction of concomitant cardiac pathology. Results90 (25.4 %) patients had type 2 DM, 161 (45.45 %) – impaired glucose tolerance (IGT). Among patients with DM, 43 (47.7%) had I-III degree obesity (p = 0.017) and 17 (18.8%) - gout (p = 0.0008). In patients with normal glucose metabolism, the comorbidity index was significantly lower than in DM (4.88 ± 1.38, vs. 6.6 ± 2.03, p < 0.0001) and IGT 5.8 ± 1.5 (p <0.0001). Patients with DM were more severe on ES II scale - ES II 9.5 ± 6.6% vs. 8.09 ± 5.8% (p = 0.115). The number of grafts in patients with DM averaged 3.2 ± 1.19 vs. 2.9 ± 1.3 in normoglycemia (p = 0.097). Calcified coronary arteries were detected in patients with normoglycemia in 6 (5.8%) cases, in IGT - in 10 (6.2%), and in DM - in 11 (12.2%). In the postoperative period, AF occurred in 83 (23.4 %) patients, of whom 70 (84.3 %) had type 2 DM and IGT. Deep sternal infection occurred in 4 (4.4 %) patients with type 2 DM. Stroke and TIA had 10 (2.8 %) patients among which 9 (90 %) had glucose metabolism disturbance. Acute kidney injury occurred in 10 (2.8 %) patients, of whom 8 (80 %) had type 2 DM and IGT. ConclusionsPatients with DM were more severe and had more complications. Timely compensation of comorbidity helps to avoid negative results.