Purpose Of Secondary Prevention Research Articles

Epidemiology And Biological Mechanisms Of Cardiovascular Disease And Diabetes

The risk of CVDs in T2DM patients in LMICs is higher than in developed nations. It is essential to make an evaluation of the current situation of CVDs among people with T2DM. These CVDs are easily preventable through intervention especially in T2DM patients and this should be done in a comprehensive manner. The following targets and principles should be considered: individual targets of HbA1c for patients, a rigorous control of cardiovascular risk factors such as blood pressure and lipids, and incorporation of newer anti-diabetic, lipid-lowering and anti-hypertensive agents. It is, therefore, crucial to design a stepped-wedge approach that bundles a patient-level intervention, lifestyle, and pharmacological interventions to reduce the risk of CVD in LMIC T2DM populations. When selecting medications for T2DM patients with cardiovascular conditions, several key considerations must be made: When selecting medications for T2DM patients with cardiovascular conditions, several key considerations must be made: It should be noted that the choice of anti-diabetic drugs should take into consideration cardiovascular safety. SGLT2 inhibitors and GLP-1 agonists are newer agents for managing diabetes and have been found to have cardiorenal benefits. The choice of lipid-lowering should be targeted to lower LDL cholesterol and triglycerides as effectively as possible. If the intensity of statin is high; it is considered first-line therapy, and other optional medication includes ezetimibe and PCSK9 inhibitors. To maintain the best pressure level that is suitable for an individual, and as a result control hypertension, the use of antihypertensive drugs is necessary. This makes ACE inhibitors or ARBs the preferred first-line antihypertensive agents because of their cardiovascular benefits. For the purpose of secondary prevention in individuals who have experienced a cardiovascular event, the antiplatelet drug aspirin in a dosage of between 75 to 150 milligrams per day should be administered. This is to minimize the probability of such difficulties re-emerging by influencing platelet activity. In general, adequate blood pressure management and antiplatelet aggregation therapy are key interventions with specific antiplatelet medication needs in this setting.

Evaluation of Statin Indication and Dose Intensification Among Type 2 Diabetic Patients at a Tertiary Hospital.

Diabetes mellitus (DM) increases cardiovascular disease (CVD) incidence and mortality. While guidelines endorse statin use in type 2 DM (T2DM) to mitigate cardiovascular risks and mortality, challenges like statin initiation and prompt treatment adjustments affect patient outcomes. This study aimed to assess the appropriateness of indications for and dose intensification of statin therapy among T2DM patients at Tikur Anbessa Specialized Hospital (TASH). A hospital-based cross-sectional study was conducted from April 1 to June 30 2020. In total, 405 T2DM patients were selected using a systematic random sampling technique. The data were analyzed using SPSS version 26.0. An adjusted odds ratio (OR) was used and a 95% confidence interval (CI) and p-values of <0.05 were utilized to determine statistical significance. Of the total 405 participants, 346 (85.4%) started taking statins for primary or secondary prevention purposes. Indication for statin use was appropriate in 96.2% patients, while for 216 (62.4%) patients their doses were appropriately intensified. Predictors of the inappropriateness of statin use were an atherosclerotic cardiovascular disease (ASCVD) score of ≥7.5% (AOR=0.28; 95% CI: 0.102-0.738, p=0.01), the presence of dyslipidemia (AOR=4.48; 95% CI: 1.85-10.84; p=0.001), initiation of aspirin therapy (AOR=3.7; 95% CI: 1.522-9.144; p=0.004), and an LDL-cholesterol level of 70-189 mg/dL (AOR=0.124; 95% CI: 0.042-0.365; p=0.001). DM duration of ≥10 years (AOR=2.51; 95% CI: 1.35-4.66, p=0.004), male gender (AOR=2.04; 95% CI: 1.16-3.58, p=0.013), age ≥65 years (AOR=2.15; 95% CI: 1.23-3.75, p=0.007) and uncontrolled blood pressure (AOR=2.09; 95% CI: 1.07-4.08, p=0.031) were associated with inappropriate statin intensification. The study found that indication of statins was optimal and about two-thirds of patients had their doses appropriately intensified. Monitoring is needed to avoid inappropriate intensification of statin therapy, particularly in patients with longer diabetes duration, those of male gender and advanced age, and those with uncontrolled blood pressure.

Differential Diagnosis of Cardiac Amyloidosis and Hypertrophic Cardiomyopathy

Diagnosis and differential diagnosis of cardiac amyloidosis and hypertrophic cardiomyopathy is difficult in some cases, which is confirmed by the presented clinical observation. The patient A., 67 years old, from the age of 59 for 7 years suffered from arterial hypertension with a maximum blood pressure of 170/100 mmHg, received hypotensive therapy. Myocardial infarction, a history of stroke denies. Since January 2018, at the age of 65, against the background of spontaneous stabilization of blood pressure figures, shortness of breath when climbing to the 2nd floor, lifting weights, suffocation at night, swelling of the shins, feet, in connection with which I turned to a doctor. When examined on an electrocardiogram, a low voltage of QRS complexes in the leads from the extremities was noted, there was no increase in the amplitude of the r wave in V1–3. Echocardiography revealed a thickening of the interventricular septum and the posterior wall of the left ventricle up to 1.9 cm without obstruction of the outlet of the left ventricle, restrictive type of diastolic dysfunction, dilation of the left and right atria, moderate pulmonary hypertension, moderate amount of fluid in the pericardial cavity. Magnetic resonance imaging of the heart revealed a pattern typical of cardiac amyloidosis: diffuse subendocardial contrast of the myocardium of both ventricles in the absence of local contractility disorders, increased myocardial thickness in all segments, hydropericardium. Biopsy of the skin and subcutaneous fat with Congo red staining and polarization microscopy revealed no amyloid deposits. No mutations in the transthyretin gene responsible for transthyretin amyloidosis (ATTR–amyloidosis) were detected during the genetic study. Sequencing of 10 genes encoding myocardial sarcomeric proteins in the MYBPC3 gene revealed a mutation c.3197C &gt;G (p.Pro1066Arg) in a heterozygous state, previously described in patients with hypertrophic cardiomyopathy of Slavic origin. Cascade family screening for the mutation was not carried out due to the fact that the patient did not know the father, the mother died at the age of 75 from heart failure, the only son died from an accident six months before the patient’s treatment. On 15.02.2019, the patient suffered a circulatory arrest with successful resuscitation measures. For the purpose of secondary prevention of sudden cardiac death, a single–chamber cardioverter-defibrillator was implanted on 22.02.2019. Despite the ongoing therapy, the patient died in March 2019. from progressive heart failure. Thus, a clinical case is presented where magnetic resonance imaging suspected amyloid cardiomyopathy, which did not receive morphological confirmation in biopsies of extra–cardiac localization. Hypertrophic cardiomyopathy caused by mutation c.3197C &gt;G (p.Pro1066Arg) in the MYBPC3 gene was confirmed on the basis of clinical and instrumental and molecular genetic methods. The pattern characteristic of cardiac amyloidosis described in this patient with instrumental examination methods may be due to a violation of autophagy processes previously described with a number of mutations in the MYBPC3 gene, which may lead to the accumulation of amyloid-like inclusions in cardiomyocytes. For differential diagnosis of cardiomyopathies in complex cases, endomyocardial biopsy may be required. The possibility of coexistence of genetically determined hypertrophic cardiomyopathy and amyloid heart disease is not excluded.

Changing perceptions about the role of combination therapy with statin and fibrate in patients with hypertriglyceridemia

The article discusses the modern therapeutic approach to lowering blood triglyceride levels. The need to consider indications for the use of lipid-lowering therapy in patients with hypertriglyceridemia is caused by the emergence of new evidence-based information. The article describes how elevated blood TG levels are associated with the risk of developing cardiovascular (CV) complications, as well as pancreatitis. The mechanisms of TG metabolism that may regulate the relationship between elevated blood TG levels and the risk of developing CV complications are considered. The findings of large randomized clinical trials, including recent ones, which laid the foundation for the current clinical guidelines for the use of drugs to lower triglycerides levels, are discussed. Indications for fibrate therapy in patients with elevated blood TG levels in various clinical situations are considered. The article emphasizes that the icosapent ethyl ester drug is not currently available in the Russian Federation. According to the latest versions of international guidelines, it is considered a first-line drug to reduce the risk of developing CV complications in patients with an established diagnosis of CVD (i.e. for the purpose of secondary prevention). In this context, the significance of fenofibrate as a drug to lower blood triglyceride levels, specifically in secondary prevention of CV complications, can remain quite high in our country. The appearance of a rosuvastatin and fenofibrate combination drug on the pharmaceutical market of the Russian Federation will increase adherence to the therapy, if a fibrate is required to be added to statin therapy.

Telemedicine technologies in patients undergoing percutaneous coronary interventions for acute myocardial infarction: a review of current trends

Cardiology is one of the fields in which telemedicine technologies were first developed and introduced into everyday clinical practice. One of the main advantages of telemedicine is the possibility of remote monitoring of patients for the purpose of secondary prevention of cardiovascular diseases. This review presents the current trends of telemedicine technologies in the observation of patients undergoing percutaneous coronary interventions for acute myocardial infarction, an analysis of current clinical studies on this issue.Key points: 1. The article shows the important role of telemedicine technologies in working with cardiological patients.2. The use of telemedicine consultations improves survival, quality of life, functional status and reduces the profile of cardiovascular risk, as well as reduces repeated hospitalizations and mental disorders.3. The review of scientific research sets up to review the current clinical recommendations of scientific communities on the management of patients with cardiovascular diseases and raises the question of the need for widespread introduction of telemedicine technologies.

Experience of the use of dipyridamole for secondary prevention of ischemic stroke

Acute cerebrovascular accident (ACV) is an important medical and social problem, which is associated with high morbidity, mortality and frequent disability. The current system for providing specialized medical care to patients with stroke has shown its effectiveness, as evidenced by a decrease in hospital mortality and an increase in the number of patients returning to work. However, the incidence of stroke remains high, which is also associated with the COVID-19 pandemic. Every third patient with COVID-19 had neurological symptoms, and a pathomorphological study of the brain of the deceased showed signs of hypoxic encephalopathy in every fifth. Due to the fact that with COVID-19 there is a high probability of developing ischemic stroke (IS), it is necessary to promptly identify and correct the following factors that contribute to the occurrence of stroke with COVID-19: cardiovascular diseases, diabetes mellitus, arterial hypertension, atherosclerosis. Direct exposure to the virus results in systemic inflammatory hyperactivity with a prothrombotic state secondary to protein C and S deficiency. An important problem is both the prevention of the first and recurrent stroke, regardless of the etiology. The basis of secondary prevention is the correction of risk factors, as well as the development of an individual program with antihypertensive, lipid-lowering therapy. The leading line of secondary prevention of IS is antiplatelet therapy, which reduces the risk of developing acute vascular episodes by 25%. For the purpose of secondary prevention of ischemic stroke, acetylsalicylic acid, dipyridamole, clopidogrel are used. In the discussed clinical observation, a patient developed repeated episodes of transient ischemic attack against the background of a stenosing process in the common carotid artery, hypertension, and a previous coronavirus infection. Given that the greatest risk of recurrent stroke is associated with atherosclerosis, which can be complicated by thrombus formation, chimes and acetylsalicylic acid were chosen for secondary prevention. Follow-up observation showed the correctness of the chosen tactics.

Use and perceptions of digital technology for daily life, physical activity and health information among former cardiac rehabilitation patients in Austria: A cross-sectional survey

Objective Digital health technologies offer great potential to improve access and adherence to cardiovascular disease secondary prevention measures such as regular physical activity (PA). However, the use and perceptions of digital technology (DT) among cardiac rehabilitation (CR) patients are not well understood. The aim of this study was therefore to explore the use of DT in former CR patients’ daily lives, for PA and for health information; and to gain insight into patient perceptions of DT for PA, including barriers, facilitators and requested features. Methods A cross-sectional postal survey was conducted between May 2022 and January 2023. Five Austrian CR centres contacted 500 former patients who had completed a phase 2 CR programme from January 2019 onwards. One-hundred seventeen patients (mean [SD] age, 69 ± 10 years, 22% female) responded. Descriptive and thematic analyses were conducted for closed and open-ended questions, respectively. Results Results indicated high DT usage for communication and informational aspects, and to a large extent also for PA and health information seeking. Main facilitators of DT use for PA were attributed to health and behavioural monitoring. Main barriers were lack of perceived need, lack of interest and poor usability. Most frequently requested features included pulse and blood pressure measurement, step count and compatibility to other devices. Conclusions Patients generally used and perceived DT as beneficial in daily life and for secondary prevention purposes such as PA. The survey identified facilitators, barriers and feature requests, which may inform the design and implementation of digital health interventions for CR patients.

Issues of improving the management of patients with ischemic stroke on the background of atrial fibrillation

The article discusses the clinical features of cardioembolic stroke (CES). Approaches to the examination of a patient with clinical suspicion of CES are discussed within the framework of the concept of atrial cardiopathy and its main markers. The principles for choosing the timing of oral anticoagulant administration for the purpose of secondary prevention are presented. The article discusses the special aspects of direct oral anticoagulants prescription in difficult clinical situations, in particular, in elderly and senile patients, after reperfusion therapy, with the development of hemorrhagic transformation, in the presence of combined atherosclerosis, cerebral microangiopathy, anamnesis of intracerebral hemorrhage, as well as severe cognitive impairment. Approaches to the choice of oral anticoagulant in terms of purely clinical benefit are presented.

Evaluation of the natural medical-table hydrocarbonate mineral water application effectiveness in rehabilitation therapy of patients with urolithiasis

Background. Urolithiasis can be considered as a socially significant disease not only because it affects mostly people of working age, but also because it often turns into a chronic form, leading to an increase in the level of disability. This dictates the need to search for effective methods of treatment and prevention of disease recurrence, among which an important role is given to the use of non-pharmacological treatment methods balneological therapeutic factors.&#x0D; Aim. Evaluation of the effectiveness of the natural low-mineralized mineral water Tarkhanskaya-3 use in the rehabilitation therapy of urolithiasis in working-age patients.&#x0D; Material and methods. The study program involved 33 patients with urolithiasis. The patients of the main group (22 people), who did not have concomitant somatic acute or chronic pathology, took mineral water for 28 days 6 times a day, at home under the supervision of a polyclinic doctor and a nurse , at the rate of 4 ml/kg, degassed, heated to 2226 C. The control group (11 people) did not receive mineral water as a non-pharmacological therapy. The history of the disease, changes in the general analysis of urine and well-being (quality of life according to the Wisconsin questionnaire) were studied. The significance of differences was considered according to the generally accepted values of the Student's criterion and 2.&#x0D; Results. Comparative assessment of complaints and quality of life showed an improvement in the condition of patients who took mineral water: discomfort during urination disappeared, the number of patients with a positive costovertebral angle tenderness decreased, while no changes were recorded in the control group. In patients of the main group, a tendency towards a decrease in the level of uric acid from 326 to 256 mol/L (t=0.96; p 0.05) was revealed. Reliable data were obtained on the effect of mineral water intake on inorganic urinary sediment a decrease in the level of crystalluria (oxalaturia) in 70% of cases (2=3.9, p=0.048). Spontaneous discharge of salt crystals was registered in 2/3 of patients, an increase in daily urine output in all patients who took mineral water. The assessment of the quality of life of the main group patients showed a significant improvement in the state of health according to the scale impact on health (t=2.13; p 0.05). Evaluation of clinical and laboratory parameters did not reveal a significant effect on the electrolyte metabolism and concentration function of the kidneys.&#x0D; Conclusion. The intake of Tarkhanskaya-3 mineral water for the purpose of secondary prevention in the rehabilitation therapy of urolithiasis has a positive effect on the course of the disease.

A large-area organic transistor with 3D-printed sensing gate for noninvasive single-molecule detection of pancreatic mucinous cyst markers

Early diagnosis in a premalignant (or pre-invasive) state represents the only chance for cure in neoplastic diseases such as pancreatic-biliary cancer, which are otherwise detected at later stages and can only be treated using palliative approaches, with no hope for a cure. Screening methods for the purpose of secondary prevention are not yet available for these cancers. Current diagnostic methods mostly rely on imaging techniques and conventional cytopathology, but they do not display adequate sensitivity to allow valid early diagnosis. Next-generation sequencing can be used to detect DNA markers down to the physical limit; however, this assay requires labeling and is time-consuming. The additional determination of a protein marker that is a predictor of aggressive behavior is a promising innovative approach, which holds the potential to improve diagnostic accuracy. Moreover, the possibility to detect biomarkers in blood serum offers the advantage of a noninvasive diagnosis. In this study, both the DNA and protein markers of pancreatic mucinous cysts were analyzed in human blood serum down to the single-molecule limit using the SiMoT (single-molecule assay with a large transistor) platform. The SiMoT device proposed herein, which exploits an inkjet-printed organic semiconductor on plastic foil, comprises an innovative 3D-printed sensing gate module, consisting of a truncated cone that protrudes from a plastic substrate and is compatible with standard ELISA wells. This 3D gate concept adds tremendous control over the biosensing system stability, along with minimal consumption of the capturing molecules and body fluid samples. The 3D sensing gate modules were extensively characterized from both a material and electrical perspective, successfully proving their suitability as detection interfaces for biosensing applications. KRAS and MUC1 target molecules were successfully analyzed in diluted human blood serum with the 3D sensing gate functionalized with b-KRAS and anti-MUC1, achieving a limit of detection of 10 zM and 40 zM, respectively. These limits of detection correspond to (1 ± 1) KRAS and (2 ± 1) MUC1 molecules in the 100 μL serum sample volume. This study provides a promising application of the 3D SiMoT platform, potentially facilitating the timely, noninvasive, and reliable identification of pancreatic cancer precursor cysts.Graphical abstract

Aggressive lipid-lowering therapy after percutaneous coronary intervention - for whom and how?: Aggressive lipid-lowering therapy after PCI.

Percutaneous coronary intervention (PCI) has been established as a definitive method to treat obstructive coronary artery disease. The procedure on its own, however, is insufficient to ensure optimal long-term patient outcomes as it is also necessary to achieve good control of relevant risk factors. The process of atherosclerosis as a result of dyslipidaemia is a risk continuum and secondary preventive measures for patients who have undergone PCI are of paramount importance to mitigate the risk of procedural failure and further cardiovascular events. This review aims to provide an overview of the landscape of lipid-lowering therapy for the purpose of secondary prevention by summarising recommendations derived from contemporary guidelines and highlighting the rationale and evidence behind the three main lipid-lowering therapies, namely statins, ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. It also provides insights into real-world challenges and issues surrounding secondary prevention of dyslipidaemia such as suboptimal lipid goal attainment and nonadherence, and assesses the possible methods to overcome them.

Primary hyperparathyroidism associated with acquired long QT interval and ventricular tachycardia.

SummaryWe present a 54-year-old patient admitted to the emergency department due to loss of consciousness. The initial ECG registered monomorphic ventricular extrasystoles and prolonged QT interval (QT corrected (QTc) >500 ms). Sustained ventricular tachycardia (VT) was registered on 24-h Holter ECG monitoring, which clinically was presented as a crisis of consciousness. Coronary angiography and other visualization methods were normal. Implantable cardioverter-defibrillator (ICD) implantation was planned for the purpose of secondary prevention of sudden cardiac death (SCD). Laboratory and hormonal analyzes revealed primary hyperparathyroidism (PHPT), chronic kidney disease, and hypokalemia. Neck ultrasound showed a 25 mm, sharply outlined homogenous tumor mass which was separated from thyroid gland (TG) and exerted a mild impression on lower parts of the left lobe. Dual wash technetium-99m sestamibi parathyroid scintigraphy with single-photon emission CT (SPECT)/CT also showed the uptake of tracer behind the lower half of the left lobe of the TG. Surgical treatment, lower left parathyroidectomy, was performed, and pathohistological analysis verified parathyroid adenoma. The patient was rhythmically and hemodynamically stable for 7 days after surgery, without additional complaints, and was discharged from the hospital. Timely diagnosis of PHPT, correct assessment and surgical treatment, did not lead our patient to unnecessary ICD implantation. Our case suggests an additional intertwining of electrolyte disorders and ventricular arrhythmias in PHPT and more importantly emphasizes the need for caution when indicating ICD, even in patients with the most serious life-threatening arrhythmias.Learning pointsElectrolyte abnormalities in PHPT can have highly malignant consequences, and the occurrence of hypokalemia in the presence of hypercalcemia is underestimated in PHPT, and the consequences can be life-threatening.Although hypercalcemia causes shortened QT interval, concomitant severe hypokalemia may overcome hypercalcemia and prolong QT interval, even in the absence of structural heart disease or LQTS.Timely diagnosis of PHPT, correct assessment and surgical treatment, do not lead to unnecessary ICD implantation.

Change in Life's Simple 7 Measure of Cardiovascular Health After Incident Stroke: The REGARDS Study.

Life's Simple 7 (LS7) is a metric for cardiovascular health based on the 7 domains of smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting glucose. Because they may be targeted for secondary prevention purposes, we hypothesized that stroke survivors would experience improvement in LS7 score over time compared with people who did not experience a stroke. We addressed this hypothesis in the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) cohort of Black and White adults enrolled between 2003 and 2007. Participants who had LS7 data at baseline, were stroke-free at baseline, had a 10-year follow-up visit, and either did not have a stroke or had an ischemic stroke >1 year before follow-up were included (N=7569). Among these participants, 149 (2.0%) had an adjudicated ischemic stroke between the LS7 assessments. LS7 scores were classified as 0 to 2 points for each domain for a maximum score of 14, with higher scores representing better health. Multivariable linear regression was used to test the association of ischemic stroke with change in LS7 score. Covariates included baseline LS7 score, age, race, sex, education, and geographic region. The 149 stroke survivors had an average of 4.9 years (SD=2.5) of follow-up from the stroke event to the second LS7 assessment. After adjusting for covariates, participants who experienced an ischemic stroke showed 0.28 points more decline in total LS7 score (P=0.03) than those who did not experience a stroke. Stroke survivors did not experience improvements in cardiovascular health due to secondary prevention after ischemic stroke. On the contrary, they experienced significantly greater decline, indicating the need for greater efforts in secondary prevention after a stroke.

Acetylsalicylic acid resistance in patients with acute ischemic stroke

This paper investigates the sensitivity to aspirin in patients with ischemic stroke in the early recovery period by optical aggregometry. The obtained results revealed individuals insensitive to aspirin. The aim is to detect the incidence of biochemical aspirin resistance among patients with history of ischemic stroke on the background of aspirin. Material and methods. Clinical and laboratory analysis of 80 patients with acute ischemic stroke who received 75 mg of acetylsalicylic acid (ASA) before bedtime as a preventive measure. Sensitivity to aspirin was determined by optical aggregatometry with adrenaline inducer. With an increase in optical permeability above 60%, aspirin resistance was ascertained. Results. It was found that among the surveyed patients, 20 (25%) were aspirin resistant, that is, the use of ASA for the purpose of secondary prevention in them will not prevent the recurrence of a vascular catastrophe. Conclusions. Monitoring the state of platelet link using optical aggregatometry allows timely to detect the lack of response to ASA and necessitates correction of the applied antiplatelet therapy.

Application of cream formula in treatment of severe heart failure

Cream formula has been mostly used to treat deficiency syndrome. Currently,it has been used to recuperate the body,promote health against aging,and prevent and treat chronic disease. In modern medicine,there are only treatment concepts and methods of diseases,but lack of concepts of " deficiency syndrome" and " restoring deficiency". The concepts of " deficiency syndrome" and " restoring deficiency" could effectively supplement and improve the diagnosis and treatment scheme of some modern diseases. Refractory heart failure,dilated cardiomyopathy,ischemic cardiomyopathy,and valvular heart disease belong to the traditional category of " consumptive disease". The cream formula with the efficacy of restoring deficiency can not only alleviate symptoms and improve the quality of life,but also improve the structure and function of the heart,reduce the dosage of diuretics and the number of hospitalizations,and achieve the purpose of secondary prevention in the treatment of severe heart failure,dilated cardiomyopathy,ischemic cardiomyopathy and valvular heart disease. The cream formula for treating chronic heart failure include Shenqi Pills,Zhenwu Decoction,Yougui Pills,Wuling Powder,Linggui Zhugan Decoction,Danggui Shaoyao Powder,Lizhong Decoction,Buzhong Yiqi Decoction,Guipi Decoction,Yupingfeng Powder,Guizhi Decoction. Long-term administration of cream formula could not only resist aging,but also play an irreplaceable role in the secondary prevention of acute and critical diseases.

Prevention of upper aerodigestive tract cancer through active search strategies and use of equipped propaedeutics

IntroductionUpper aerodigestive tract cancer is among the most frequent malignancies and has epidemiological importance worldwide. Most cases are already advanced at the diagnosis, with a strong negative impact on survival and high cost to the government. Campaigns directed against these cancers have often failed in Brazil. ObjectiveTo evaluate the effectiveness of screening for upper aerodigestive tract cancers, using active search strategies and the use of equipped propaedeutics. MethodsA cross-sectional, prospective, descriptive, analytical and exploratory study, since its objectives are based on the visualization of cancerous lesions in a sample consisting of individuals with risk factors, aiming to expand the necessary knowledge for cancer detection, aiming at secondary prevention of the oral cavity, oropharynx, larynx and hypopharynx cancer. ResultsA total of 16.7% of precancerous lesions and 0.5% of cancer lesions located in the upper aerodigestive tract were clinically visualized. ConclusionThe method was effective in the identification of precancerous lesions for the purpose of secondary prevention, but equally important against upper aerodigestive tract cancer, since in the present study the chance of finding the latter was increased by 22.7, showing it is an alternative for future campaigns against the disease.

The use of herbal drug Canephron® N in ambulatory meta-prevention of uratolysis

The objective: was to assess the efficacy and safety of Canephron® N in the metaphysics of urate urolithiasis.Materials and methods. In this single-center, prospective, openlabel, non-randomized, controlled, parallel study, 60 patients with urethra-urethritis urolithiasis (39 men and 21 women) who underwent disintegration/dislocation of concrements, were divided into two groups. In the main group, patients complied with the general preventive measures for liquids and nutrition recommended by the EAU, and Canephron® N was used in standard dosages for 6 months.Results. The daily diuresis, uric acid levels of blood and urine, the level of magnesium in urine, and the rate of recurrence of urolithiasis in both groups were evaluated.Conclusion. It was found that the use of Canephron® N with the purpose of secondary prevention of uratogenic urolithiasis causes a significant decrease in the factors of urine lithogenicity: a decrease in the concentration of uric acid in urine, an increase in daily diuresis and a change in urine pH to physiologically optimal amounts, contributes to a significant increase in the concentration of Mg + ions in urine, reduces the rate of relapse of urethane lithiasis in stone formation compared with standard secondary prevention of IBD in 3.8 times.

The Effectiveness of Statin Therapy in Women

The article presents the analysis of numerous international studies on the effectiveness of statin therapy in women of different age groups. Effectiveness of statin administration in women with the purpose of secondary prevention of cardiovascular events was shown, whereas many unresolved issues remain on primary prevention.

Do implantable cardioverter defibrillators improve survival in patients with chronic kidney disease at high risk of sudden cardiac death? A meta-analysis of observational studies

Prospective randomized clinical trials show that implantable cardioverter defibrillators (ICDs) can reduce the risk of total mortality in select populations. However, data regarding patients with chronic kidney disease (CKD) are inconclusive. The aim of this study was to evaluate if ICDs affect total mortality in CKD patients at high risk of sudden cardiac death. Two separate meta-analyses were performed to (i) assess the effect of ICD on all-cause mortality in CKD patients at high risk of sudden cardiac death and (ii) assess the effect of CKD on all-cause mortality in patients who already had an ICD for primary or secondary prevention purposes. Medline and EMBASE were searched from 1966 to 2013. A manual search by cross-referencing was performed. Five observational studies with 17 460 CKD patients considered at high risk of sudden cardiac death were included to evaluate the effect of ICDs on patients with severe CKD. Patients with ICD implants had a reduction in all-cause mortality (adjusted hazard ratio (HR) = 0.65, 95% confidence interval (CI) = 0.47-0.91, P < 0.05) compared with a matched control group. Based on 15 observational studies with 5233 patients as part of our second comparison that evaluated the effect of CKD on patients who received an ICD, CKD was associated with higher mortality risk (HR = 2.86, 95% CI = 1.91-4.27, P < 0.05) despite an ICD. The meta-analysis indicates that for patients undergoing ICD implant, CKD is associated with greater risk of dying. However, ICD placement reduces mortality in CKD patients at high risk of sudden cardiac death.

Cardiorespiratory fitness in aging men and women: the DR's EXTRA study

The aim of the study was to describe the levels and to create reference values of cardiorespiratory fitness, expressed as maximal oxygen consumption (VO(2max) ), maximal metabolic equivalents (METs) and maximal workload in aging men and women. We measured VO(2max) directly by a breath-by-breath method during a maximal exercise stress test on a bicycle ergometer with a linear workload increase of 20 W/min in a representative population sample of 672 men and 677 women aged 57-78 years. We presented the age and sex-specific categories of cardiorespiratory fitness (very low, low, medium, high and very high) based on variable distribution and non-linear regression models of VO(2max) , maximal METs and maximal workload. The linear age-related decrement of VO(2max) was -0.047 L/min/year (-2.3%) and -0.404 mL/kg/min/year (-1.6%) in men and -0.027 L/min/year (-1.9%) and -0.328 mL/kg/min/year (-1.6%) in women. After exclusion of diseased individuals, the rate of VO(2max) decrement remained similar. The number of chronic diseases (0, 1, 2 or ≥3) was inversely associated with VO(2max) in men (P<0.001) and women (P<0.001). The present study provides clinically useful reference values of cardiorespiratory fitness for primary and secondary prevention purposes in aging people.