Vol 25, No 1 (2023): Cardiovascular diseases
Articles
Effectiveness and safety of the herbal preparation Soveren® in patients with hyperuricemia
Abstract
Background. Despite advances in the field of synthetic pharmaceuticals, interest in the use of natural raw materials from representatives of the flora persists throughout the world. Currently, herbal medicine is successfully used in the treatment of both hyperuricemia (HU) and gout.
Aim. To evaluate the effectiveness and safety of the herbal preparation Soveren® in the prevention and treatment of HU.
Materials and methods. The study included 80 patients who were divided into 2 groups: group 1 consisted of patients diagnosed with arthritis with HU (n=40), group 2 – patients with gout (n=40). The natural complex of natural origin Soveren® was prescribed according to the standard scheme against the background of dietary recommendations. Patients with gout also received urate-lowering therapy. Clinical efficacy and safety of treatment were assessed after 6 and 12 weeks according to the dynamics of laboratory parameters of blood and urine, the EuroQol-5D quality of life questionnaire, assessment of the health status of patients, assessment of patient satisfaction with treatment.
Results. The use of the plant complex Soveren® in patients with HU does not have a negative effect on the functional state of the liver and kidneys. The drug has a significant positive effect on blood levels, reducing uric acid by 1.5 times, creatinine by 1.11 times, and urea by 1.3 times. In group 2, the addition of the Soveren® complex made it possible to achieve the target value of uric acid. In addition, in patients of both groups, within 3 months, the level of total protein in the urine decreased by 3 times, a decrease in the degree of leukocyturia was noted. Against the background of taking the drug in both groups, the relative density of urine increases within the normal range, and a slight acidification of urine was revealed, as well as an increase in urinary excretion of ketones. Most patients positively assessed the result of treatment.
Conclusion. Our data confirm the good therapeutic effect and safety of the herbal complex Soveren® in patients with HU. With the introduction of the Soveren® drug into practice, doctors will have a new effective tool for monitoring the course of HU.
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The role of stress and sleep disorders in the development of cardiovascular complications in patients with arterial hypertension: what is important for an internist to know? A review
Abstract
This publication discusses the mechanisms underlying the development of arterial hypertension on the background of stress, discusses the current problems of blood pressure control in patients with stress-induced sleep disorders, the clinical features of patients with hypersympathicotonia as the main mechanism for the development of arterial hypertension and blood pressure variability in patients with comorbid pathology, a diagnostic algorithm, as well as presenting current recommendations in the strategy for choosing the optimal antihypertensive therapy with the possibility of personalized choice in various clinical situations.
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Endocan is a key player in cardiovascular disease: A review
Abstract
In recent years, the attention of scientists has been actively focused on studying the role of endocan as a biological marker of endothelial dysfunction in cardiovascular diseases. Until recent years, endocan has been studied in acute kidney injury, chronic kidney disease, and renal replacement therapy. Endocan, formerly known as endothelial cell-specific molecule-1, is a soluble dermatan sulfate proteoglycan expressed and secreted into the circulation from endothelial cells. Currently available studies demonstrate the diagnostic and prognostic value of endocan evaluation in cardiovascular pathology. It is expected that further scientific and clinical studies will demonstrate the possibilities of using endocan as an additional laboratory tool for diagnosing and assessing the prognosis in patients with a cardiac profile. Drug regulation of endocan concentration and expression may be a promising target for the treatment of cardiac and vascular pathology.
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The role of artificial intelligence in cardio-oncology: present and future: A review
Abstract
Cardiooncology has been developed as a relatively new branch of medicine that focuses on the prevention and treatment of adverse cardiovascular events associated with cancer therapy. Newer, more efficient data acquisition methods, such as the use of artificial intelligence, are desirable to help assess CVR in cancer patients. By extracting hidden patterns and evidence from large volumes of medical data, artificial intelligence can create new predictors and parameters to predict risks in patients with cardio-oncological diseases.
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Cardiovascular therapy in patients hospitalized for elective large joint arthroplasty: real-world practice review
Abstract
Background. The patients who require major lower limb joint replacement have a high prevalence of comorbidities, particularly hypertension. Also, they are mostly elderly, with concomitant obesity, chronic kidney disease, poor glycemic control, etc. These factors individually and collectively increase the risk of complications in the perioperative period.
Aim. To study the features of preoperative drug therapy for cardiovascular diseases considering the indications in patients hospitalized for elective major lower limb joint replacement.
Materials and methods. The study included an unselected sample of patients, 41 males and 77 females (n=118). The mean age was 64.7±11.1 years, and the mean body mass index was 30.7±4.9 kg/m2. All patients had a detailed history, an examination with blood pressure measurement, and their therapy for cardiovascular diseases was analyzed. Of 118 patients, 88 (74.6%) had hypertension, 68 (77.2%) received angiotensin-converting enzyme inhibitors, 20 (22.8%) angiotensin receptor blockers, 17 (19.3%) calcium channel blockers combined with other antihypertensive drugs, 11 (12.5%) had no antihypertensive therapy before hospitalization, despite a recorded high blood pressure for several years.
Results. The routine preoperative outpatient examination included lipid profile in 77 (65.3%) patients, most of whom had total cholesterol only (66 had levels above normal); low-density lipoprotein levels were measured in only 14 (11.9%) patients, and 9 had levels above target for the relevant risk group. Statins were previously prescribed to only 18 (15.3%) patients. Twenty-two (18.6%) patients reported taking acetylsalicylic acid, with only 7 according to indications; 5 (4.2%) received clopidogrel, of which 1 patient had no indications.
Conclusion. Most of the study patients had hypertension of varying severity. Some patients received suboptimal antihypertensive therapy and, in some cases, previously prescribed antihypertensive drug combinations not complying with relevant guidelines. Most patients with hypercholesterolemia did not receive statins with no rationale for not prescribing this class of drugs. Some patients received antiplatelet agents with no appropriate indications.
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Anticoagulant therapy in a hemodialysis patient at high risk of thrombotic and hemorrhagic complications. Case report
Abstract
An attempt to preserve the knee joint in a patient on hemodialysis with stage IV lower limb ischemia with a high risk of thrombotic and hemorrhagic complications is presented. Multifocal atherosclerosis and extensive occlusion of the arteries of the lower leg ruled out the technical possibility of revascularization. The patient refused the proposed hip amputation. An attempt was made to perform amputation at the level of the lower leg. Required therapy aimed at the treatment and prevention of thrombotic complications, and optimization of microcirculation in the ischemic limb. For this purpose, a prolonged blockade of the sciatic and femoral nerves, combined anticoagulant therapy, and treatment with alprostadil were performed. Therapy with antithrombotic and vasoactive drugs was not effective and was complicated by the state of persistent hypocoagulation with an episode of bleeding. Amputation of the limb at the level of the thigh was performed according to vital indications after correction of hypocoagulation. The lack of clinical recommendations on anticoagulant therapy for critical lower limb ischemia in patients with stage 5 chronic kidney disease requires an individual approach to the choice of antithrombotic drugs and their doses, monitoring the state of blood coagulation using an integral method for assessing the hemostasis system – thromboelastography.
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Exogenous ketone therapy for heart failure: A review
Abstract
Heart failure is of major clinical and economic importance and remains a major public health problem worldwide. Despite existing treatment approaches, morbidity and mortality in these patients remains high. The progression of heart failure is accompanied by an increase in the metabolism of ketone bodies. The use of exogenous ketones may become a new therapeutic approach to increase cardiac efficiency, reduce energy deficit and improve cardiac function in patients with heart failure. The review presents the available data on ketone body metabolism in patients with heart failure, preclinical and clinical studies demonstrating the beneficial effects of exogenous ketone therapy in animal models and human studies with heart failure, and describes the potential pros and cons of using this therapeutic approach.
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The state of systolic and diastolic myocardial functions in patients with severe obstructive sleep apnea and their dynamics during CPAP therapy
Abstract
Aim. To evaluate the change in the parameters of systolic and diastolic myocardial functions in patients with severe obstructive sleep apnea (OSA) syndrome before and after CPAP therapy.
Materials and methods. Forty eight patients with severe OSA aged 45–74 years were examined. All patients underwent questionnaires, echocardiography with tissue Dopplerography, speckle-tracking echocardiography. At the end of the three-month course of CPAP therapy, the patients were re-examined, followed by a comparative analysis of the data obtained.
Results. In patients with severe OSA after CPAP therapy, the ejection fraction of the left ventricle and the amplitude of systolic displacement of the fibrous ring of the tricuspid valve significantly increased, which indicated an increase in the relative capacity of the ventricular myocardium. The performed CPAP therapy had a positive effect on the diastolic function of the myocardium of both ventricles, which was manifested in an increase in the ratio of peak rates of early and late transmitral and transtricuspidal diastolic flows. The rate of transtricuspidal regurgitation and systolic pressure in the pulmonary artery decreased in dynamics.
Conclusion. The use of CPAP therapy improves systolic and diastolic heart function, leads to a decrease in systolic pressure in the pulmonary artery in patients with severe OSA. The results obtained substantiate the importance of early initiation of CPAP therapy in the complex treatment of patients with OSA.
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Coagulopathy in cardiac surgery in the context of the COVID-19 pandemic: A review
Abstract
Patients with concomitant cardiovascular diseases and traditional cardiovascular risk factors (age, male gender, arterial hypertension, diabetes mellitus and obesity) belong to a particularly vulnerable cohort characterized by progressive severe COVID-19 and high hospital mortality. Thorough screening strategies, standardized guidelines, and center-level protocols are needed to identify patients who are at greater risk of postoperative complications and mortality. Therefore, in this review, we consider the possible impact of COVID-19 on the patency of bypass vessels in the coronary arteries, mainly in relation to venous shunts. However, this hypothesis needs to be confirmed and further studied in the framework of clinical randomized trials.
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The effect of sex on the normal functioning of the prostate gland: A review
Abstract
This article analyzed the relationship between sexual activity and the structural and functional state of the prostate gland. The biomechanism of hormonal effects during sexual activity was evaluated. The influence of hormones on the functioning of the prostate gland was analyzed. It has been established that constant sexual activity in moderate amounts reduces the risk of developing prostate diseases and is an important method of prevention. To correct copulative function disorders in diseases of the prostate gland, it is advisable to use prostatic peptides that have an organotropic effect.
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A clinical case of hereditary transthyretin amyloidosis. Case report
Abstract
For several years, there has been a significant increase in the number of patients diagnosed with cardiac amyloidosis. However, there are still difficulties associated with the diagnosis, identifying its type and further treatment of the disease. The diversity of the clinical symptoms, the absence of pathognomonic symptoms make it difficult to diagnose, which leads to the progression of the disease. Heart involvement is the main cause of morbidity and mortality in systemic amyloidosis, regardless of the underlying pathogenesis of amyloid production, and in most cases amyloid cardiomyopathy is clinically manifested by rapidly progressive symptoms of heart failure. The article presents a clinical case of a patient with a hereditary type of systemic transthyretin amyloidosis with the involvement of heart, kidneys, liver, nervous system, and the identified mutation in the TTR gene (p.Y89F) has not been previously described in the Russian Federation.
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