The Clinician最新文献

{"title":"Rheumatoid factor and antibodies against cyclic citrullinated peptide in patients without rheumatoid arthritis","authors":"N. V. Bunchuk","doi":"10.17650/1818-8338-2022-16-3-k669","DOIUrl":"https://doi.org/10.17650/1818-8338-2022-16-3-k669","url":null,"abstract":"A review of data on the possible causes of an increase rheumatoid factor (RF), antibodies against cyclic citrullinated peptide (ACCP) and antibodies to modified citrullinated vimentin (AMCV) in patients without rheumatoid arthritis (RA) is presented. The possibility of hyperproduction of these autoantibodies before the development of the clinical picture of RA was indicated. It is indicated that ACCP and IgA RF have the greatest prognostic value in terms of the subsequent development of RA. These antibodies are recommended to be additionally determined in diagnostically difficult cases. Data on the sensitivity and specificity of detection of RF, ACCP and AMCV in the diagnosis of RA are summarized. The results of detection of the discussed antibodies in various rheumatic (other than RA) and non-rheumatic diseases are presented in detail. Particular attention is paid to diseases in which increased synthesis of RF, ACCP and AMCV may not be accompanied by clear clinical symptoms (Sjögren’s disease, autoimmune thyroiditis, some chronic infections, silicosis, monoclonal gammopathy, etc.). Recommendations are given for examining patients with “accidentally” identified increase in RF or ACCP.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43095782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of myeloperoxidase in atrial fibrillation and ischemic heart disease","authors":"G. F. Bunenkova, S. Salikova, V. Grinevich, E. S. Ivanyuk","doi":"10.17650/1818-8338-2022-16-3-k664","DOIUrl":"https://doi.org/10.17650/1818-8338-2022-16-3-k664","url":null,"abstract":"Atrial fibrillation and ischemic heart disease are the key problems in cardiology. Despite of numerous clinical trials and researches underlying molecular biology remains uncertain. Atrial fibrillation and ischemic heart disease are often combined. During ischemic heart disease progression myocardial tissue structure are changing which lead to structural and electrophysiological remodeling and promote atrial fibrillation. It has been shown a crucial role of oxidative stress and chronic systemic inflammation in ischemic heart disease and atrial fibrillation. Myeloperoxidase (MPO) is one of marker of oxidative stress and inflammation that located in azurophilic granules of neutrophils and monocytes. There are a numerous articles showed a relation between MPO level and cardiovascular disease. MPO is a peroxidase enzyme that is important part of immune system. During disease MPO could facilitate chronic inflammation and local tissue damage through active oxygen forms. MPO releases after lysosome conjunction with phagosome. Oxygen reductase activity of MPO lead synthesis of hypochlorous acid that play role not only in organism protection from infection agents but in matrix transformation and fibrosis. It has been shown MPO can destabilize atherosclerotic plaque and modifies low- and high-density lipoproteins that promote atherosclerosis and ischemic heart diseaseу progression. This review summarizes current data about role of MPO in atrial fibrillation and ischemic heart disease pathogenesis.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46629428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of patients with transcatheter implantable aortic valve","authors":"E. Luneva, E. Malev","doi":"10.17650/1818-8338-2022-16-3-k663","DOIUrl":"https://doi.org/10.17650/1818-8338-2022-16-3-k663","url":null,"abstract":"Valvular heart disease remains one of the causes of cardiovascular morbidity and mortality worldwide. Aortic stenosis is the most common valvular pathology requiring cardiac surgery. For elderly and senile patients with high risks of volumetric cardiac surgery, a new type of biological prosthesis, a transcatheter implantable aortic valve, has become a solution to the problem. Over the past decade catheter interventions for severe valvular heart disease have evolved from balloon dilatation of native stenotic valves to replacement and reconstructive intervention of diseased valves. Transcatheter aortic valve implantation, which is widespread in the USA and Europe, has also begun to be performed in our country, primarily in comorbid groups of patients. Rapid technological advances in device design are likely to improve immediate and long-term outcomes of surgery and expand the current indications for transcatheter aortic valve implantation. The article analyzes the indications for the procedure in accordance with the latest recommendations of 2021, possible complications of the transcatheter aortic valve implantation, as well as the principles of patient management after the procedure, including the principles of drug therapy in this group of patients. Separately, the topic of aortic regurgitation and the possibility of transcatheter aortic valve implantation are touched upon, since this pathology is a new indication that has appeared only in the latest recommendations of the European Society of Cardiology. In this review, we want to acquaint physicians with the indications for transcatheter aortic valve implantation, the main complications, and the principles of managing patients in the perioperative period. The complication rate after transcatheter aortic valve implantation is decreasing due to technical advances and experience of interventional surgeons. In-depth knowledge of potential complications and their prevention plays a key role in improving the immediate and long-term results of surgery.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48599949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperuricemia, gout and comorbidity","authors":"N. Shostak, N. Pravdyuk, T. K. Loginova, G. N. Lazarenko","doi":"10.17650/1818-8338-2022-16-3-k648","DOIUrl":"https://doi.org/10.17650/1818-8338-2022-16-3-k648","url":null,"abstract":"Hyperuricemia is most often combined with lipid metabolism disorders, modifiable risk factors for coronary heart disease, stroke, abdominal obesity, type 2 diabetes mellitus, arterial hypertension, urolithiasis, chronic kidney disease. Current data indicate the presence of pro-inflammatory, pro-oxidant and vasoconstrictive effects of uric acid, which may contribute to the development of cardiometabolic disorders. Normal serum uric acid levels are <6 mg / dl (<360 mmol / l) for women and <7 mg / dl (<420 mmol / l) for men. Currently, the role of hyperuricemia as an independent biomarker of the risk of cardiovascular events is emphasized. Both gout and subclinical hyperuricemia are associated with unfavorable cardiovascular outcomes. Patients should be informed about the risk factors of hyperuricemia; the need for lifestyle modification, diet compliance, and correction of drug therapy for comorbid conditions. According to international and domestic recommendations, urate-lowering therapy is indicated for asymptomatic hyperuricemia (>360 mmol / l) and high cardiovascular risk. The data available today allow us to consider the target serum uric acid level <5 mg / dl (<300 mmol / l) for patients with high cardiovascular risk, including at least 2 of the following risk factors: hypertension, diabetes mellitus, dyslipidemia, stroke, heart attack, chronic disease kidneys, and <6 mg / dl for patients who do not have these risk factors. The urate-lowering drug is selected taking into account the concomitant pathology and the presence or absence of liver or kidney dysfunction. Xanthine oxidase inhibitors are still the first-line drugs for the correction of hyperuricemia. The superiority of xanthine oxidase inhibitors is due to the potential inhibition of the production of reactive oxygen species and their antioxidant effect. Treatment of gout is aimed at achieving clinical improvement in acute and chronic arthritis, preventing recurrence of arthritis and damage to internal organs, as well as reducing the risks of negative effects on comorbid pathology. Clinicians are faced with the task of controlling cardiovascular diseases in patients with asymptomatic hyperuricemia and gout. Further studies are needed to investigate the relationship between gout, hyperuricemia and increased risk of cardiovascular diseases, as well as to establish a more complete picture of the prevalence of a wide range of comorbid conditions.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49570653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socio-economic modeling of the effect of smokers’ transition to smokeless technologies","authors":"N. Koryagina, A. Zhigulev, A. N. Zabotina, R. Dreval, K. Y. Muravyeva","doi":"10.17650/1818-8338-2022-16-3-k672","DOIUrl":"https://doi.org/10.17650/1818-8338-2022-16-3-k672","url":null,"abstract":"Research objective: Quantitative estimation of social-demographic and social-economic impact of the switch of traditional cigarettes smoking to modified risk tobacco products consumption, based on effect upon smoking-related mortality and diseases rates.Methods. Target group – consumers of smoking tobacco: conventional cigarettes (CC) and modified risk tobacco products (MRTP). Base of calculations – analysis of available time series for: CC and MRTP consumption, life expectancy and healthy life expectancy coefficients, statistics on smoking-related mortality and diseases rates, including data on key nosologies (malignant neoplasms of respiratory system, digestive organs, urinary tract; chronic obstructive pulmonary disease; circulatory diseases; cerebrovascular diseases.Results. We implemented prognoses for all the above mentioned parameters to year 2035, calculated direct medical and indirect costs for demographic and economic loss with attention to budget impact analysis, developed five scenarios based on different CC and MRTP consumption.The model of switching from CC to MRTP consumption proves a significant decline of demographic and economic burden even with rather modest MRTP replacement for CC. With current practices of switching from CC to MRTP remaining, during 2021–2035 summary impact would result in 3.6 mln of years saved, 7.7 mln of healthy years saved, 120 thous. of mortal cases and 345 thous. diseases cases prevented. The economic burden would be 3.3 trillion rubles lower.Conclusion. Smoking cessation is the optimal method to reduce health risks, and state policy for stimulation of smoking quitting is necessary. Along with that, transition from CC to MRTP may be an alternative way to reduce health risks for those smokers with long smoking history and either psychological or physiological causes who cannot quit smoking.Even small in the terms of percent transition from CC to MRTP may result in significant decrease of demographic and economic burden on the national scale.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48579881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive conservative treatment as a possible alternative to surgery in difficult orthopedic situations","authors":"V. G. Samoday, D. I. Varfolomeev, V. P. Kuznetsova, M. I. Rylkov","doi":"10.17650/1818-8338-2022-16-2-k662","DOIUrl":"https://doi.org/10.17650/1818-8338-2022-16-2-k662","url":null,"abstract":"Osteoarthritis, both idiopathic and post-traumatic, is currently the most significant problem in orthopedics. It is particularly difficult to treat patient with comorbidities, when it is necessary to decide on surgery for a late-stage joint disease. An operation is associated with a great risk in such patients. Even if the patient does not have serious somatic disorders, the main task of doctors (and this is a multidisciplinary problem) is to prolong joint functioning and maintain the patient’s quality of life.In this article, we report difficult cases, when a complex of non-pharmacological (therapeutic exercise, physiotherapy, orthobiology – PRP therapy) and pharmacological (nonsteroidal anti-inflammatory drugs, chondroprotectors, vitamins, calcium, tissue repair stimulants) treatments ensured a good effect, thereby maintaining the joint function and adequate quality of life without surgery. We also found that the use of Ambene® Bio (a chondroprotector) increased treatment efficacy.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41314303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequency and risk factors of sarcopenia in the elderly people","authors":"Y. Safonova, N. Toroptsova","doi":"10.17650/1818-8338-2022-16-2-k661","DOIUrl":"https://doi.org/10.17650/1818-8338-2022-16-2-k661","url":null,"abstract":"Aim. To determine the frequency and assess the risk factors of sarcopenia (SP) in elderly people living at home.Materials and methods. The study included 230 people aged 65 years and older who lived at home and were observed in outpatient clinic. To detect SP, grip strength was measured and muscle mass was determined using dual-energy absorptiometry (DXA). Severe SP was diagnosed based on the results of Short physical performance battery (SPPB) and the “Up and Go” test. The diagnosis of SP was made according to the criteria of EWGSOP2 (2018). The laboratory examination included clinical and biochemical blood analysis, determination of the level of 25 (OH) D.Results. Probable SP was found in 64.8 %, confirmed SP – in 28.7 %, and severe SP – in 21.3 % of older people. The frequency of SP increased with age from 19.6 % in 65–74 years to 52.9 % in 85 years and older (p <0.05). The results of multivariate analysis showed that the probability of SP increased with a BMI of less than 25 kg / m2 (OR 5,459; 95 % CI: 1,939–15,369; p = 0.0013), severe comorbidity calculated by the Charlson index (OR 5,178; 95 % CI: 1,597–14,128; p = 0.0030) and the presence of such laboratory indicators like level 25 (OH) D less than 20 ng / ml (OR 4,989; 95 % CI: 1,321–12,626; p = 0.0420), total protein less than 64 g / l (OR 8,567; 95 % CI: 2,658–27,617; p = 0.00032), CRP more than 5 mg / l (OR 14,279; 95 % CI: 3,511–58,071; p = 0.00020) and moderately reduced renal function (GFR <60 ml / min / 1.73 m (OR 12,108; 95 % CI: 3,944–37,170; p = 0.00001).Conclusions. Among elderly people, a high frequency (28.7 %) of SP was detected, which increased with age. A BMI of less than 25 kg / m2, a deficiency of 25(OH)D, total protein level of less than 64 g / l and CRP of more than 5 mg / l, a decrease in GFR of less than 60 ml / min were associated with the presence of SP.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43349052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of SGLT2 inhibitors on the course of chronic heart failure in patients with type 2 diabetes mellitus","authors":"A. N. Payudis, O. A. Efremova, L. A. Kamyshnikova, Iu. S. Pavlova, O. V. Dudchenko, I. Khamnagadaev, T. Golivets","doi":"10.17650/1818-8338-2022-16-2-k656","DOIUrl":"https://doi.org/10.17650/1818-8338-2022-16-2-k656","url":null,"abstract":"Diabetes mellitus (DM) is a group of metabolic diseases characterized by chronic hyperglycemia, which is the result of impaired insulin secretion, insulin action, or both. Chronic hyperglycemia in diabetes is accompanied by damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels. Diabetes mellitus plays a significant role in the formation and is one of the significant risk factors for the development of chronic heart failure (CHF) through its glucose toxic effect, the effect on hyperlipidemia and blood coagulation, impaired autonomic regulation of the heart and a number of other mechanisms. Sodium-glucose cotransporter type 2 (SGLT2) inhibitors are a recently emerging class of antidiabetic drugs that act by inhibiting the reabsorption of glucose in the kidneys. Existing studies of the efficacy and safety of these drugs have shown that they have not only antidiabetic, but also a pronounced organoprotective, especially cardioprotective effect. Today it is believed that the main reason leading to this lies in a decrease in sodium reabsorption in the kidneys, a decrease in the content of intracellular calcium and sodium, and an increase in the concentration of calcium in mitochondria. The role of the ketogenic action of these drugs, their effect on oxidative stress and the processes of inflammation and fibrosis in the myocardium is also considered. The most common side effects of SGLT2 inhibitors include urinary tract and genital infections, euglycemic ketoacidosis. Other possible side effects include an increased risk of lower limb amputations, Fournier gangrene, breast cancer in women, bladder cancer in men, orthostatic hypotension and acute kidney injury, and an increased tendency to fracture. Most side effects can be avoided through adequate patient education and assessment of risk factors and contraindications before starting the use of drugs. Despite the clear need for more research on SGLT2 inhibitors, their widespread use will positively affect the health of the diabetic patient population.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48080752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interleukin 17A inhibitor secukinumab in the treatment of patients with psoriatic arthritis","authors":"N. Shostak, D. Y. Andriyashkina, A. Dvornikov, N.  M. Babadaev, D. V. Somov","doi":"10.17650/1818-8338-2022-16-2-k665","DOIUrl":"https://doi.org/10.17650/1818-8338-2022-16-2-k665","url":null,"abstract":"Psoriatic arthritis (PsA) is a chronic inflammatory joint disease associated with psoriasis and characterized by various presentation, course, and response to treatment. A better understanding of the pathogenesis has led to the development of targeted therapeutic agents and innovative treatment strategies for PsA. The article is dedicated to a drug targeting interleukin-17A. Secukinumab is a fully human monoclonal antibody that selectively targets interleukin (IL) 17A, a pro-inflammatory cytokine involved in the pathogenesis of PsA. Secukinumab is the first antibody against IL 17 approved in many countries for PsA treatment in adult patients. In the Phase III FUTURE trial, secukinumab 150 and 300 mg subcutaneously showed high efficacy on disease activity in patients previously treated with non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and / or tumor necrosis factor (TNF) inhibitors and maintaining the effect for a long time of treatment (more than 5 years). In addition, in studies FUTURE 1 and 5 secukinumab suppressed structural joint damage and was associated with consistently low rates of radiological progression after 1–3 years of treatment. Treatment with secukinumab improved physical function and quality of life and was generally well tolerated in both short and long term. Secukinumab is effective in all key PsA domains and therefore represents a treatment option that may be an alternative to TNF inhibitors and other DMARDs in adult patients with PsA.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46400085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding the possibilities of treatment and prevention of venous thromboembolic complications in cancer patients. The role of oral anticoagulants","authors":"R. Bredikhin, R. V. Akhmetzyanov, R. Khayrullin","doi":"10.17650/1818-8338-2022-16-2-k667","DOIUrl":"https://doi.org/10.17650/1818-8338-2022-16-2-k667","url":null,"abstract":"Improving the quality of care for patients with oncological diseases due to the improvement of methods of chemoradiotherapy and surgical interventions, accessibility and modernization of diagnostic potential, is accompanied by a steady increase in the frequency of venous thromboembolic complications, which occupy one of the leading places among the causes of death.Patients with oncological diseases are subject to various risk factors for thromboembolic complications, which are caused by the presence of a malignant neoplasm, due to the development of many coagulation abnormalities, initiating not only an increased tendency to thrombosis, but also a tendency to bleeding. Cancer-associated venous thrombosis, growing out of the framework of certain medical specialties, act as comorbid pathological conditions that require an interdisciplinary approach in developing rational methods of prevention and treatment. Improving the understanding of the pathophysiological mechanisms of venous thrombosis in cancer patients contributes to the development of modern methods of prevention and treatment, among which anticoagulant therapy plays a dominant role. The appearance of oral anticoagulants on the pharmaceutical market, the effectiveness and safety of which is confirmed by a series of randomized clinical trials, opens up new prospects for improving the quality of life and long-term survival in patients with malignant neoplasms.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41431664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}