The Clinician最新文献

{"title":"Early signs of myocardial dysfunction in patients with rheumatoid arthritis and ankylosing spondylitis","authors":"L. Feiskhanova, D. Abdulganieva","doi":"10.17650/1818-8338-2020-14-3-4-k632","DOIUrl":"https://doi.org/10.17650/1818-8338-2020-14-3-4-k632","url":null,"abstract":"The objective of the study – identify early preclinical signs of myocardial dysfunction in patients with rheumatoid arthritis and ankylosing spondylitis.Material and methods. We examined 142 people with verified rheumatic diseases. All patients were divided into 2 groups. The first group consisted of patients with rheumatoid arthritis – 95 people. The second group – patients with ankylosing spondylitis – 47 people. The control group included 70 practically healthy individuals. In addition to standard diagnostic tests, all patients underwent tissue dopplerography of the heart using the GE Vivid E9 ultrasound device using the two-dimensional deformation technique (speckle tracking) to assess the deformation and rate of myocardial deformation, as well as determining the level of matrix metalloproteinase-9 in the blood serum.Results. Among patients with rheumatoid arthritis, diastolic dysfunction of both the left ventricle and both ventricles was more common than in the control group. The same pattern was observed in the group with ankylosing spondylitis. The calculation of the relative risk showed that the presence of rheumatoid arthritis in 4,42 times increases the risk of diastolic dysfunction of the left ventricle in comparison with practically healthy people (CI 1,6–12,2). In individuals with rheumatoid arthritis also results in a deterioration of systolic function of both ventricles. The level of matrix metalloproteinase metalloproteinase-9 was highest and most often increased in patients with ankylosing spondylitis. Among patients with rheumatoid arthritis, the average level of metalloproteinase-9 was low, but the incidence was higher than in the control group. The obtained results indicate that in these rheumatic diseases there is a marked degradation of the extracellular matrix components.Conclusion. Patients with rheumatoid arthritis and ankylosing spondylitis are characterized by a deterioration in the diastolic function of the left ventricle or both ventricles simultaneously, which is accompanied by an increase in the level of metalloproteinase-9.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67773422","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":"Heart myxoma under the mask of interstitial lung lesion: a difficult case from practice","authors":"A. V. Novikova, N. Pravdyuk, N. Shostak, N. V. Galimova, D. P. Kotova, D. V. Abeldyaev, G. G. Aleksanyan","doi":"10.17650/1818-8338-2020-14-3-4-k635","DOIUrl":"https://doi.org/10.17650/1818-8338-2020-14-3-4-k635","url":null,"abstract":"The aim of the investigation was to describe a clinical case of the development of interstitial lung lesions in a 57-year-old man with a large left atrial myxoma, which had a reverse development after myxomectomy.Materials and methods. Patient V., 57 years old, was hospitalized in the therapeutic department of the City Clinical Hospital No. 1 named after N. I. Pirogov in connection with bilateral polysegmental pneumonia. A month before hospitalization, he underwent an outpatient examination for progressive dyspnea. Myxoma of the heart was diagnosed. Due to the progression of respiratory failure and the appearance of fever, he was hospitalized. Amidst the multistage antibiotic therapy, there was a torpid course of lung pathology with syndromes of bilateral dissemination and “ground glass”, bilateral lymphadenopathy of the mediastinum, high pulmonary hypertension, and systemic inflammatory reaction syndrome. Thromboembolism of the branches of the pulmonary artery, tuberculosis, sepsis, infective endocarditis, neoplastic processes of pulmonary and other localization were excluded.Results. The clinical picture corresponded to interstitial lung lesions within the framework of paraneoplastic syndrome in heart myxoma. It was decided to urgently carry out myxomectomy.Conclusion. The clinical case demonstrates the development of a rare variant of paraneoplastic syndrome in left atrial myxoma, which was suspected during the patient’s treatment for bilateral polysegmental pneumonia. The progression of the pulmonary lesion was explained by active interstitial inflammation and was supported by the immunological activity of the heart tumor.The performed myxomectomy, despite the persisting syndrome of systemic inflammatory reaction and infiltration of the lung tissue, led in 2 weeks to complete resolution of interstitial lung lesions and pulmonary hypertension, which confirmed the causal relationship between myxoma of the heart and involvement in the pathological process of the lungs.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67773022","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":"Клинико­-эпидемиологический анализ случаев энтеровирусной инфекции в Орловской области у взрослых","authors":"С. А. Архипина, Э. А. Гринишина","doi":"10.17650/1818-8338-2020-14-3-4-K616","DOIUrl":"https://doi.org/10.17650/1818-8338-2020-14-3-4-K616","url":null,"abstract":"Objectives – to identify the clinical and epidemiological features of enterovirus infection in the adult population in the Oryol region, to track the seasonality of the disease, distribution in different age groups, and to assess the main clinical forms, symptoms, and complications. Objects and methods of research . The object of investigation was 24 medical histories of patients who gave informed consent, with a confirmed diagnosis of “enterovirus infection”, the 2 nd infectious diseases Department of Department of Oryol region “City hospital. S.P. Botkin”. Results . For the period from 2009 to 2019 was gospitalizirovany 24 patients with laboratory-confirmed diagnosis “enterovirus infection”. The most patients with this diagnosis were in 2017 – 33,5 %, the least – in 2012 – 4,1 %. In 2013 and 2019, there were no patients. Women were sick more often than men – 55 % of the total number of subjects. After analyzing statistical data, it was found that young people (aged 20–29 years) were sick more often – 58,3 %. There is a summer-autumn seasonality: 45,8 % and 54,2 %, respectively. 37,5 % of the subjects were in contact with infectious SARS patients. 37,5 % also left the Oryol region the day before. Most often, enterovirus exanthema was observed in patients – 58,3 %.. The onset of the disease in 100 % of cases was acute. All patients had fever, most often subfebrile – 54,2 %. The studied patients complained of body aches – 100 %, headaches of various localization and intensity – 96 %, sore throat – 12,5 %, vesicular-papular rash on the skin of the trunk, limbs, and head – 58,3 %, and enanthema on the oropharyngeal mucosa – 12,5 %. In 100 % of cases, the diagnosis was confirmed by a positive polymerase chain reaction response to the presence of enterovirus RNA. Conclusion . The study revealed that over the past 10 years, enterovirus infection in the Oryol region has a consistently low level. It is more common in young people. The disease is characterized by summer and autumn seasonality. In this area, the more common form is enterovirus exanthema.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"14 1","pages":"52-56"},"PeriodicalIF":0.0,"publicationDate":"2021-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45680353","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":"Efficacy and safety of two “Carmolis” forms for combined local therapy of knee osteoarthritis: results of a multicenter clinical trial","authors":"L. Denisov, V. Sorotskaya, É. A. Leonova, L. V. Меn’shykova, M. Sukhareva, S. Glukhova, A. Lila","doi":"10.17650/1818-8338-2020-14-1-2-100-106","DOIUrl":"https://doi.org/10.17650/1818-8338-2020-14-1-2-100-106","url":null,"abstract":"Objective – to evaluate efficacy and safety of “Carmolis” fluid and gel in patients with knee osteoarthritis, as well as the gel efficacy combined with ultraphonophoresis.Materials and methods. The study included 200 patients, who were divided into 2 groups depending on the way of application of “Carmolis” forms. Group 1 included 165 patients with knee osteoarthritis (the main group included 90 patients, the control group – 75 patients), who underwent complex local treatment with 2 “Carmolis” forms. Group 2 included 35 patients (20 people in the main group and 15 in the control one). The main group received phonophoresis with “Carmolis” gel, and the control group received “Carmolis” gel locally on the affected knee joint. Patients’ average age in group 1 was 62,7 ± 8,5 years, the average age in the control group was 61.4 ± 8.7 years, the disease duration was 10.1 ± 4.7 and 9.2 ± 6, 0 years, respectively. In group 2 the average age and disease duration were 60.1 ± 12.8 and 5.7 ± 5.4 years, respectively.At the initial stage 90 patients of the main group 1 were rubbed “Carmolis” fluid locally in the joint followed by massage. After the fluid absorbed completely, “Carmolis” gel was applied, followed by massage. In the comparison group (75 patients), standard therapy was combined only with “Carmolis” fluid applied on the II knee joint.Twenty patients of the main group 2 were treated with phonophoresis combined with “Carmolis” gel. Clinical efficacy was assessed by pain dynamics.Results. Treatment with two “Carmolis” local forms significantly decreased average on moving from 61.8 ± 14.2 to 30.7 ± 14.2 (р <0,001), at rest – from 49 ± 19, 9 to 20.4 ± 8.5 (р <0,001), on palpation – from 38.7 ± 10.4 to 18.4 ± 5.7 (р <0,001). A similar dynamics was also revealed during WOMAC assessment (Western Ontario McMaster Universities OA Index). Before the treatment start the average WOMAC pain level in the main group was 240.5 ± 39.8, after the treatment – 114.8 ± 30.4 (р <0,001). The control group also showed pain decrease, but to a much lesser extent than in the main one. At the end of the treatment course, patients of both groups demonstrated a pronounced decrease of synovitis sings, but there were no differences between the groups. The dose of non-steroidal anti-inflammatory drugs in the main group was reduced in 70 (77.8 %) patients, in the control group – in 50 (66.7 %). The tolerability of both forms was very good and good. No adverse events were registered. Data on the effectiveness and safety of “Carmolis” gel combined with ultraphonophoresis are presented in the article.Conclusion. According to the results, combined therapy using “Carmolis” liquid and gel significantly reduces joint pain and synovitis severity, increases joints» functional ability and improves patients» general condition, which allows reducing the dose of non-steroidal anti-inflammatory drugs. Both “Carmolis” forms had excellent and good tolerability.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"9 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141205988","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":"Возможности терапии бета‑адреноблокаторами у пациентов в периоперационном периоде при кардиохирургических и внесердечных хирургических вмешательствах","authors":"Д. П. Котова, В. С. Шеменкова, Валерия Александровна Демина","doi":"10.17650/1818-8338-2020-14-1-2-73-81","DOIUrl":"https://doi.org/10.17650/1818-8338-2020-14-1-2-73-81","url":null,"abstract":"Сardiac complications are the most frequent non-surgical complications after surgical interventions, increasing the length of the patient’s stay in the hospital, the economic costs and the percentage of deaths. The frequency of patients with cardiovascular diseases who require surgery is also high. Optimization of drug therapy in the perioperative period is one of the factors of successful outcome of the surgical intervention. The pathophysiological basis for the development of many cardiac events in the postoperative period is an increase in the activity of the sympathetic nervous system, which leads to an increase in heart rate (HR) and myocardial oxygen demand. These changes may increase the risk of myocardial ischemia, arrhythmias, and other cardiovascular events in the early postoperative period. For example, the development of myocardial infarction (MI) in the perioperative period leads to an increase in hospital mortality by 15–25 %, and increase in the risk of developing cardiac death in the next few months. The main group of drugs for relieving these effects is beta-blockers (BB). This drug class has a wide range of applications: treatment of angina, arrhythmias, hypertension, MI, heart failure. Currently, there is a large evidence for the possibility and feasibility of using BB in patients undergoing surgery. In this article, the authors highlights the issues of prescribing BB in patients with comorbid pathology in the perioperative period. The analysis and comparison of studies on various aspects of BB use in the perioperative period performed. Currently, there is a mixed opinion about the benefits and risks of perioperative therapy of BB, which causes the high relevance of this issue for discussion.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"16 2","pages":"73-81"},"PeriodicalIF":0.0,"publicationDate":"2020-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141206116","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":"Infective endocarditis: diagnostic difficulties","authors":"N. Chipigina, N. Karpova, M. V. Belova, N. P. Savilov","doi":"10.17650/1818-8338-2020-14-1-2-82-90","DOIUrl":"https://doi.org/10.17650/1818-8338-2020-14-1-2-82-90","url":null,"abstract":"In recent decades, against the background of incidence rate increasing, infectious endocarditis (IE) remains in the category of diseases with a high mortality and a “difficult diagnosis”. According to different studies, 5.2–14.8 % of IE cases were detected only at autopsy or heart surgery, and 27–42.8 % of IE cases with fatal outcome were not diagnosed before death. In 25–66 % patients infectious endocarditis was diagnosed later than 1 month from the onset of symptoms (including later than 3 months in almost a quarter of patients). Late diagnosis, considered as one of the independent risk factors for an unfavorable prognosis of IE (relative risk 2.1), is most frequent with IE in elderly patients. The generally accepted diagnostic criteria of IE, providing a standardized approach to the diagnosis of IE, rely on laboratory and instrumental evidence of bacteremia and visualization of vegetations and signs of valve destruction, as major clinical diagnostic criteria. However, a diagnosis of IE is not suspected at an outpatient stage in 54–79 % of patients, so the necessary transthoracic echocardiographic examination and bacteriological blood tests are not performed. In 84 % cases of right heart valves IE and 27 % of left heart valves IE extracardiac manifestations of the disease due to cardiogenic emboli, immunocomplex mechanisms, or systemic inflammation were initially regarded as an independent disease and patients were hospitalized with incorrect diagnosis. Most often, such masks are associated with involvement of lungs, nervous system, and kidneys, less often rheumatological, vascular, hematological guise and the onset with myocardial infarction or acute abdominal pain are noted. The lecture analyzes the causes of IE diagnosis errors and describes clinical situations that allow suspecting IE, as well as situations in which IE must be considered with a differential diagnosis. Authors emphasize that timely clinical suspicion, with availability of modern effective heart imaging and bacteriological studies remains essential basis for early IE diagnosis.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141205935","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":"Infective endocarditis: diagnostic difficulties","authors":"N. Chipigina, N. Karpova, M. V. Belova, N. P. Savilov","doi":"10.17650/1818-8338-2020-14-1-2-82-90","DOIUrl":"https://doi.org/10.17650/1818-8338-2020-14-1-2-82-90","url":null,"abstract":"In recent decades, against the background of incidence rate increasing, infectious endocarditis (IE) remains in the category of diseases with a high mortality and a “difficult diagnosis”. According to different studies, 5.2–14.8 % of IE cases were detected only at autopsy or heart surgery, and 27–42.8 % of IE cases with fatal outcome were not diagnosed before death. In 25–66 % patients infectious endocarditis was diagnosed later than 1 month from the onset of symptoms (including later than 3 months in almost a quarter of patients). Late diagnosis, considered as one of the independent risk factors for an unfavorable prognosis of IE (relative risk 2.1), is most frequent with IE in elderly patients. The generally accepted diagnostic criteria of IE, providing a standardized approach to the diagnosis of IE, rely on laboratory and instrumental evidence of bacteremia and visualization of vegetations and signs of valve destruction, as major clinical diagnostic criteria. However, a diagnosis of IE is not suspected at an outpatient stage in 54–79 % of patients, so the necessary transthoracic echocardiographic examination and bacteriological blood tests are not performed. In 84 % cases of right heart valves IE and 27 % of left heart valves IE extracardiac manifestations of the disease due to cardiogenic emboli, immunocomplex mechanisms, or systemic inflammation were initially regarded as an independent disease and patients were hospitalized with incorrect diagnosis. Most often, such masks are associated with involvement of lungs, nervous system, and kidneys, less often rheumatological, vascular, hematological guise and the onset with myocardial infarction or acute abdominal pain are noted. The lecture analyzes the causes of IE diagnosis errors and describes clinical situations that allow suspecting IE, as well as situations in which IE must be considered with a differential diagnosis. Authors emphasize that timely clinical suspicion, with availability of modern effective heart imaging and bacteriological studies remains essential basis for early IE diagnosis.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"8 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141205942","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":"Efficacy and safety of two “Carmolis” forms for combined local therapy of knee osteoarthritis: results of a multicenter clinical trial","authors":"L. Denisov, V. Sorotskaya, É. A. Leonova, L. V. Меn’shykova, M. Sukhareva, S. Glukhova, A. Lila","doi":"10.17650/1818-8338-2020-14-1-2-100-106","DOIUrl":"https://doi.org/10.17650/1818-8338-2020-14-1-2-100-106","url":null,"abstract":"Objective – to evaluate efficacy and safety of “Carmolis” fluid and gel in patients with knee osteoarthritis, as well as the gel efficacy combined with ultraphonophoresis.Materials and methods. The study included 200 patients, who were divided into 2 groups depending on the way of application of “Carmolis” forms. Group 1 included 165 patients with knee osteoarthritis (the main group included 90 patients, the control group – 75 patients), who underwent complex local treatment with 2 “Carmolis” forms. Group 2 included 35 patients (20 people in the main group and 15 in the control one). The main group received phonophoresis with “Carmolis” gel, and the control group received “Carmolis” gel locally on the affected knee joint. Patients’ average age in group 1 was 62,7 ± 8,5 years, the average age in the control group was 61.4 ± 8.7 years, the disease duration was 10.1 ± 4.7 and 9.2 ± 6, 0 years, respectively. In group 2 the average age and disease duration were 60.1 ± 12.8 and 5.7 ± 5.4 years, respectively.At the initial stage 90 patients of the main group 1 were rubbed “Carmolis” fluid locally in the joint followed by massage. After the fluid absorbed completely, “Carmolis” gel was applied, followed by massage. In the comparison group (75 patients), standard therapy was combined only with “Carmolis” fluid applied on the II knee joint.Twenty patients of the main group 2 were treated with phonophoresis combined with “Carmolis” gel. Clinical efficacy was assessed by pain dynamics.Results. Treatment with two “Carmolis” local forms significantly decreased average on moving from 61.8 ± 14.2 to 30.7 ± 14.2 (р <0,001), at rest – from 49 ± 19, 9 to 20.4 ± 8.5 (р <0,001), on palpation – from 38.7 ± 10.4 to 18.4 ± 5.7 (р <0,001). A similar dynamics was also revealed during WOMAC assessment (Western Ontario McMaster Universities OA Index). Before the treatment start the average WOMAC pain level in the main group was 240.5 ± 39.8, after the treatment – 114.8 ± 30.4 (р <0,001). The control group also showed pain decrease, but to a much lesser extent than in the main one. At the end of the treatment course, patients of both groups demonstrated a pronounced decrease of synovitis sings, but there were no differences between the groups. The dose of non-steroidal anti-inflammatory drugs in the main group was reduced in 70 (77.8 %) patients, in the control group – in 50 (66.7 %). The tolerability of both forms was very good and good. No adverse events were registered. Data on the effectiveness and safety of “Carmolis” gel combined with ultraphonophoresis are presented in the article.Conclusion. According to the results, combined therapy using “Carmolis” liquid and gel significantly reduces joint pain and synovitis severity, increases joints» functional ability and improves patients» general condition, which allows reducing the dose of non-steroidal anti-inflammatory drugs. Both “Carmolis” forms had excellent and good tolerability.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"18 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141205925","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":"Safety of selective non-steroidal anti-inflammatory drugs: analysis of the last years data","authors":"N. Shostak, A. Klimenko, N. Demidova, D. A. Anichkov","doi":"10.17650/1818-8338-2020-14-1-2-91-99","DOIUrl":"https://doi.org/10.17650/1818-8338-2020-14-1-2-91-99","url":null,"abstract":"Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used pain relievers. However, their use often threatens with serious undesirable effects, associated mainly with damage to cardiovascular system (CVS), gastrointestinal tract, kidneys and liver. Contraindications to NSAIDs prescription are clearly regulated, algorithms for their personalized appointment are determined taking into account risk factors for cardiovascular and gastrointestinal adverse events. The severity of NSAIDs side effects is mainly due to the selectivity to cyclooxygenase-2 (COX-2), as well as the physicochemical properties of various drugs. Cardiovascular adverse events differ among various NSAIDs both within commonly used drugs and among COX-2 inhibitors. It is well known that NSAIDs selective for COX-2 are safer in terms of the effect on the gastrointestinal tract than non-selective drugs. A meta-analysis showed that relatively selective COX-2 inhibitors (meloxicam, etodolac) were associated with a comparable risk of developing symptomatic ulcers and ulcers identified by endoscopy, and safety and tolerability profiles of the drugs were similar.All NSAIDs are associated with cardiovascular toxicity, however, different drugs have significant risk differences. The mechanism of NSAIDs cardiovascular adverse effects is associated with an increase of blood pressure, sodium retention, vasoconstriction, platelet activation, and prothrombotic state. It has been shown that the risk of cardiovascular adverse events when taking COX-2 inhibitors (celecoxib, etoricoxib) significantly increases. According to a study of more than 8 million people, it was found that the risk of myocardial infarction was increased in patients taking ketorolac. Further, highest to lowest risk authors list indomethacin, etoricoxib, rofecoxib (not currently used), diclofenac, a fixed combination of diclofenac with misoprostol, piroxicam, ibuprofen, naproxen, celecoxib, meloxicam, nimesulide and ketoprofen. When taking NSAIDs, the risk of heart failure decompensation increases, and it turned out to be the greatest for ketorolac, etoricoxib, and indomethacin. Meloxicam, aceclofenac, ketoprofen almost did not increase heart failure risk. It should be noted that when using the drugs (except for indomethacin and meloxicam), there is a tendency to increase the total cardiovascular and renal risks with increasing doses. Thus, it is obvious that a very careful approach is required when choosing NSAIDs. If there is an increased risk of gastrointestinal complications associated with NSAIDs, selective NSAIDs are preferred, with both coxibs and traditional selective NSAIDs showing the best safety profile in the studies. To minimize cardiovascular side effects specialists should consider the risk level of cardiovascular complications, as well as results of large clinical studies where particular NSAIDs are compared.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"7 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141205999","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":"Возможности терапии бета‑адреноблокаторами у пациентов в периоперационном периоде при кардиохирургических и внесердечных хирургических вмешательствах","authors":"Д. П. Котова, В. С. Шеменкова, Валерия Александровна Демина","doi":"10.17650/1818-8338-2020-14-1-2-73-81","DOIUrl":"https://doi.org/10.17650/1818-8338-2020-14-1-2-73-81","url":null,"abstract":"Сardiac complications are the most frequent non-surgical complications after surgical interventions, increasing the length of the patient’s stay in the hospital, the economic costs and the percentage of deaths. The frequency of patients with cardiovascular diseases who require surgery is also high. Optimization of drug therapy in the perioperative period is one of the factors of successful outcome of the surgical intervention. The pathophysiological basis for the development of many cardiac events in the postoperative period is an increase in the activity of the sympathetic nervous system, which leads to an increase in heart rate (HR) and myocardial oxygen demand. These changes may increase the risk of myocardial ischemia, arrhythmias, and other cardiovascular events in the early postoperative period. For example, the development of myocardial infarction (MI) in the perioperative period leads to an increase in hospital mortality by 15–25 %, and increase in the risk of developing cardiac death in the next few months. The main group of drugs for relieving these effects is beta-blockers (BB). This drug class has a wide range of applications: treatment of angina, arrhythmias, hypertension, MI, heart failure. Currently, there is a large evidence for the possibility and feasibility of using BB in patients undergoing surgery. In this article, the authors highlights the issues of prescribing BB in patients with comorbid pathology in the perioperative period. The analysis and comparison of studies on various aspects of BB use in the perioperative period performed. Currently, there is a mixed opinion about the benefits and risks of perioperative therapy of BB, which causes the high relevance of this issue for discussion.","PeriodicalId":82998,"journal":{"name":"The Clinician","volume":"13 5","pages":"73-81"},"PeriodicalIF":0.0,"publicationDate":"2020-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141206132","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}