Treatment Of Comorbid Pathology Research Articles

Development of a comorbidity phenotype of acid-dependent diseases and arterial hypertension syndrome for a personalized approach to diagnosis and treatment

Purpose of the study. The prevalence of diseases of the gastroduodenal zone and cardiovascular pathology among the working population is alarming. In order to develop phenotypes of comorbidity of acid-dependent diseases of the gastroduodenal zone and the syndrome of arterial hypertension in hazardous workers, a study of the state of health was carried out. Materials and methods. 4 observation groups were formed, aged 40 to 60 years, with work experience of more than 10 years. The first group consisted of 51 patients with arterial hypertension, the second - 26 patients with acid-dependent diseases, the third - 25 workers with comorbid pathology. The fourth group consisted of 24 workers without this pathology. The clinical examination was carried out as part of clinical examinations in the conditions of the departmental clinical hospital of Russian Railways. To clarify the psycho-emotional status, psychometric testing was carried out using the Stilberger-Khanin anxiety scale and the SANT test. A biochemical blood test included the determination of the level of alanine aminotransferase, aspartate aminotransferase, glucose, creatinine, lipid spectrum, antibody titer to Helycobacter pylori, the amount of endothelin-1, monocytic chemoattractant protein-1. Instrumental studies: fibrogastroduodenoscopy, daily monitoring of blood pressure. Results and conclusions. Indicators of general morbidity among employees of locomotive crews are higher than those of the industry. In the structure of chronic diseases, the prevalence of isolated arterial hypertension and erosive and ulcerative lesions of the gastroduodenal zone exceeds 60%, and the calculated probability coefficient of the combination is 6 times higher than the population one. The development of comorbidity of arterial hypertension and erosive and ulcerative lesions of the gastroduodenal zone under conditions of long-term exposure to a complex of production factors in trained workers was accompanied by the prevalence of personal and situational anxiety as a reflection of the maladjustment syndrome. The main pathophysiological determining modules in each group of patients were identified: the dyscirculatory-inflammatory module was identified as a phenotype of the comorbidity of the studied pathologies. The data obtained allow us to form a personalized approach to the prevention and treatment of comorbid pathology.

Prevention of the development of adverse reactions in the treatment of tuberculosis in combination with diabetes mellitus

Background. In recent decades, tuberculosis (TB) and its resistant forms have become an increasing problem in lowincome countries, especially in countries with epidemics of HIV infection and insulin-dependent diabetes mellitus (DM). DМ has been shown to adversely affect TB treatment outcomes. Low treatment outcomes for TB/DM comorbidity are associated with age, weight gain, or poor glycemic control, and it is the increased duration of DM treatment that may be the best strategy for improving outcomes in TB/DM patients. In the formation of the development of polyneuropathy, one of the components is increasing ischemia and intracellular hypoxia, which is characteristic of TB/DM. Decreased blood flow contributes to the destabilization of cell membranes and neuronal death. The interconnected components of the immune and other systems, namely pro-inflammatory cytokines, play an important role in the formation and progression of these processes.
 Results and discussion. Our clinical assessment of the general condition of patients with TB/DM (23 patients) showed that 91.5 % of the examined patients complained of persistent cough with sputum production, 78 % had shortness of breath, weight loss of more than 5 kg – 89.8 %, thirst – 80 %, 75 % – tingling and numbness of the lower extremities, pain in the legs at night – 85.5 % of people. Sub-febrile temperature (37.4-37.9 °C) was registered in 52.2 % of the examined patients. The general condition of moderate severity prevailed in 49.5 % of patients. Intoxication syndrome (IS) in TB/DM patients by clinical and paraclinical signs was observed in all patients, respectively, pronounced (manifest) IS was recorded in 79.5 %. Body mass index is on average 15.6 kg/m2 (p<0.001). To prevent the development of polyneuropathy, patients with TB/DM was prescribed anti-TB drugs, insulin and additionally pathogenetic therapy according to the scheme: Neuromax, 2 ml intravenously, intramuscular once a day for 7 days, followed by the administration of the drug 2 times a week for 3 weeks, and with the subsequent transition to the tablet form – 1 tablet per day (until the end of the intensive phase of treatment), then Dialipon 3 % solution of 20 ml was prescribed intravenously drip for 7 days (the contents of the ampoule are diluted in 250 ml of 0.9 % sodium chloride solution), with the subsequent transition to a tablet form of 300 mg – 2 tablets once a day for a month.
 Conclusions. The proposed method makes it possible to effectively prevent adverse reactions in the treatment of TB in combination with DM, reduce the manifestations of peripheral polyneuropathy, provide better tolerance to anti-TB drugs, normalize clinical blood parameters, accelerate the rate of normalization of the content of some pro (IL-6, IL-18) and anti-inflammatory (IL-10) cytokines in the blood plasma of patients, which, in turn, reduces the percentage of refusals from the treatment of comorbid pathology.

Оценка комплексного подхода к лечению коморбидной патологии с применением метода энтеросорбции

Оценка комплексного подхода к лечению коморбидной патологии с применением метода энтеросорбции

Фибрилляция предсердий: обзор руководства Европейского общества кардиологов и национальных рекомендаций 2020 года

The review presents the key provisions of the recommendations of the Russian society of cardiology and the guidelines of the European society of cardiology for the diagnosis and treatment of atrial fibrillation (AF), updated in 2020. The recommendations clearly state the requirements for atrial fibrillation diagnosis verification, and propose an approach to the formation of a complex characteristic of the disease in four positions, which is designated as 4S-AF (Stroke risk, Symptom severity, Severity of AF burden, Substrate severity). The authors analyzed the strategy "CC To ABC" (Confirm AF, Characterize AF, Treat AF: the ABC pathway) proposed by European experts, the issues of modern terminology and requirements for verifying the diagnosis of AF, complex characteristics of the disease and stratification of the risk of stroke and bleeding, a new ABC approach in the treatment of AF, where A is anticoagulant prevention of thromboembolic complications, B is the control of symptoms of the disease and C is the detection and treatment of comorbid pathology. The General principles that have changed in comparison with the previous versions of guidelines of 2016 on the initiation and tactics of anticoagulant therapy, pharmacological and non-drug cardioversion, catheter ablation in patients with AF, affecting the prognosis and outcomes in patients with AF, are outlined. It is emphasized that the pattern of atrial fibrillation (first diagnosed, paroxysmal, persistent, long-term persistent, permanent) should not determine the indications for anticoagulant prevention. The solution to this issue is determined by the level of risk according to the CHA2DS2-VASc scale. The introduction of the considered methods of diagnosis and treatment of AF into clinical practice will optimize the burden on the health care system and reduce the costs associated with the burden of AF.

Cerebral Amyloid Angiopathy in Combination with Paroxysmal Atrial Fibrillation

The present article addresses the definition of cerebral amyloid angiopathy (CAA) and its symptoms based on the analysis of the medical case; the issues of diagnosis and treatment of this pathology are discussed. The Boston criteria, which became the basis for diagnosis, study of clinical manifestations and progression of CAA and approaches to its therapy, are presented. Methods and modes of neuroimaging, including magnetic resonance imaging (MRI), which verify micro cerebral haemorrhage, are described. At the same time, the role and significance of cardiac arrhythmias in the genesis of ischemic stroke are discussed, and scales for assessing the risk of its occurrence are presented. The observation of the neurological, somatic, neuroimaging, neuropsychological status of a 62-year-old patient confirms quite rare combination of probable CAA, paroxysmal atrial fibrillation and repeated hemorrhagic functional apoplexy (FA). The relevance of the case described, is a complex clinical dilemma based on mutually exclusive recommendations for the pharmacological correction of such conditions. It is emphasized that in many multicenter clinical studies on the effectiveness of antithrombotic medication (antiaggregants, anticoagulants) in the treatment and prevention of ischaemic functional apoplexy , an important exclusion criterion is a hemorrhagic stroke in past history (including the multiple changes in haemostasis indicators). Taking into account the obtained clinical and laboratory data in the dynamics, the tactics of treating the described patient were determined. The results of studies related to the treatment of comorbid pathology that should become the subject of the development of a personalized algorithm for managing patients in each specific case, are discussed.

CARDIOVASCULAR AND GASTROINTESTINAL COMMUNICATION: PREDICTIVE VALUE FOR COMORBID PATIENT

The article provides the description of the clinical importance of comorbidity, its epidemiology, the attention is focused on the highest prevalence and prognostic significance of cardiovascular and gastrointestinal pathogenetic relations complicating the course of the cardiovascular pathology by development of erosive-ulcerative lesions of stomach and duodenum, the first manifestation of which are often life-threatening gastrointestinal bleeding. Symptomatic gastroduodenal ulcer lesions (SGUL) are described in detail including their modern definition, classification, epidemiology, clinical manifestations and diagnosis with a detailed analysis of features of pathogenesis and course of patients with cardiovascular diseases. SGUL induced by nonsteroidal anti-inflammatory drugs are analyzed including those induced by low-dose acetylsalicylic acid (NDA), risk factors for their occurrence and prevention in groups at high and moderate gastrointestinal risk are considered. The need for further scientific research of topical issues of «comorbidity» to improve diagnosis and treatment of comorbid pathology in public health practice are stressed.

CARDIOVASCULAR AND GASTROINTESTINAL COMMUNICATION: PREDICTIVE VALUE FOR COMORBID PATIENT

The article provides the description of the clinical importance of comorbidity, its epidemiology, the attention is focused on the highest prevalence and prognostic significance of cardiovascular and gastrointestinal pathogenetic relations complicating the course of the cardiovascular pathology by development of erosive-ulcerative lesions of stomach and duodenum, the first manifestation of which are often life-threatening gastrointestinal bleeding. Symptomatic gastroduodenal ulcer lesions (SGUL) are described in detail including their modern definition, classification, epidemiology, clinical manifestations and diagnosis with a detailed analysis of features of pathogenesis and course of patients with cardiovascular diseases. SGUL induced by nonsteroidal anti-inflammatory drugs are analyzed including those induced by low-dose acetylsalicylic acid (NDA), risk factors for their occurrence and prevention in groups at high and moderate gastrointestinal risk are considered. The need for further scientific research of topical issues of «comorbidity» to improve diagnosis and treatment of comorbid pathology in public health practice are stressed.

Use of L- arginine in the treatment of comorbid pathology in neurological patients

Amino acids are the structural chemical units that make up proteins. The special importance of amino acids is that some of them - precursors of neurotransmitters which are necessary for normal functioning of the brain. The absence one of essential amino acid suspend the formation of protein. Correction of deficiency of essential amino acids and replacement carried out by different drugs. Recently, interest in preparations that contain arginine significantly increased. This interest caused by the importance of L- arginine in the body functioning, as L- Arginine is a precursor of nitric oxide (NO). Arginine (Valagyn) is a common post-translational modification of proteins tsytoplazmatycheskyh that has a unique transcriptional regulatory pathways. L-arginine showed a protective effect in ischemia / reperfusion injury, which can be widely used in various diseases of the cardio-sudinnoyi system and metabolic disorders

Antioxidant and Immunotropic Properties of some Lithium Salts

Antioxidant potentials in sprouts vs. seeds of Vigna radiata and Macrotyloma uniflorumC. K., Abdul Rehman, Prabhakar B. T., Vijay Avin B. R., Aditya Rao S. J.

Features of patients with comorbid pathology treatment in internal medicine

Aim. Nowadays more attention is paid to the comorbid pathologies in the internal medicine as they have important social and medical value. Different combinations of the arterial hypertension, chronic kidney disease, osteoartrosis and anemia influences are now studied. The article underlines the main features of the therapeutic tactics in these patients. Methods and results. The paper presents a case of a patient with mentioned pathology, sets out the main guidelines for the management of patients with such comorbid conditions. Conclusion. Treatment tactics should include: minimum interoperability path of excretion, metabolic neutrality, good tolerability and a positive impact on the affected organ, all of which may contribute not only to improve health and improve the quality of life of patients, but also its extension.