scholarly journals Current state of treatment for lower extremity acute deep venous thrombosis (a literature review)

2021 ◽  
Vol 23 (6) ◽  
pp. 851-864
Author(s):  
A. O. Nykonenko ◽  
Y. M. Vailo ◽  
A. M. Materukhin
Keyword(s):  
Quality Of Life ◽  
Pulmonary Embolism ◽  
Anticoagulant Therapy ◽  
Lower Extremities ◽  
Research Topic ◽  
Diagnosis And Treatment ◽  
Blood Clots ◽  
Modern Methods ◽  
Life Threatening

Despite the use of modern methods of diagnosis and treatment, deep vein thrombosis (DVT) of the lower extremities remains a fairly common disease. In half of all cases, DVT may be asymptomatic and manifest itself in subsequent symptoms of pulmonary embolism (PE) or postthrombotic syndrome (PTS). An important role in the pathogenesis of this disease is played by a variety of factors and conditions that contribute to thrombosis in the venous vessels of the lower extremities, as well as impaired venous outflow from the lower extremity due to blockage of the venous lumen by such a thrombus. The action of various treatments is aimed at certain links in the pathogenesis, namely: anticoagulant therapy prevents further thrombosis, thrombolysis dissolves blood clots, surgical and mechanical thrombectomy remove blood clots from the lumen of the vein, lysis or removal of thrombotic masses restores thrombosis in the small circle of blood circulation. There is no single, universal method for combating DVT. In addition, there are new methods, such as the use of devices for pharmaco-mechanical thrombolysis, stent-retrievers which need to be tested for effectiveness and safety, as well as for a comparative analysis with existing treatments. Given the severe consequences of DVT that include early mortality, recurrence and complications of the disease, and can be associated with death, rehospitalization, deterioration in patient quality of life and disability, the choice and application of certain treatments or combinations thereof becomes important. Equally important are the issues of primary and secondary prevention of DVT, which reduce the above-mentioned risks and should be pursued in each patient. The aim. To study the world experience in the treatment of DVT, to summarize modern approaches to the treatment of patients with DVT based on the principles of evidence-based medicine by reviewing and analyzing modern scientific literary sources in scientometric bases. Materials and methods. We searched for publications in scientometric databases including Pub Med, Google Scholar, Web of Sciense, Scopus by keywords, as well as for the latest recommendations and guidelines that cover modern methods of diagnosis and treatment of DVT of the lower extremities. Articles, systematic reviews and literature relevant to the research topic were reviewed and analyzed. The inclusion criteria were: articles and studies describing to the pathophysiology, diagnosis and treatment of DVT, studies with the longest observation, recommendations and guidelines of professional associations regarding DVT. The exclusion criteria were: articles not related to the research topic, a small number of patients included in the study (less than 15 people). Conclusions. DVT and its complications can lead to fatal conditions, such as pulmonary embolism, and often adversely affect patients’ quality of life. DVT is potentially life-threatening and should be considered by a physician and patient as a life-threatening disease. Anticoagulant therapy is the main option for both DVT treatment and secondary prevention of venous thromboembolism and PTS recurrence. Some patients may receive drug therapy on an outpatient basis. Other patients with severe disease and complications need inpatient management. An open surgery, percutaneous endovascular procedures and various combinations thereof with the addition of anticoagulant therapy could be applied to this group. The lack of clear criteria for selecting patients and indications for endovascular interventions and surgical thrombectomy requires further research in this area.

scholarly journals Anticoagulant Therapy of Acute Pulmonary Embolism with Right Heart Thrombi

2021 ◽  
Vol 18 (3) ◽  
pp. 87-92
Author(s):  
N. N. Аvdeeva ◽  
S. А. Sumin ◽  
S. V. Tyapina ◽  
N. А. Volkova ◽  
S. N. Zhabin
Keyword(s):  
Pulmonary Embolism ◽  
Vascular Disease ◽  
Anticoagulant Therapy ◽  
Acute Pulmonary Embolism ◽  
Clinical Situation ◽  
Conservative Approach ◽  
Management Options ◽  
Right Heart ◽  
Blood Clots ◽  
Life Threatening

Acute pulmonary embolism (PE) is a relatively common vascular disease with potentially life-threatening complications. Right heart thrombi deteriorate the prognosis. Due to the known high lethality, such a clinical situation requires immediate diagnosis and treatment. With the existing different management options for intracardiac blood clots, the optimal one is still uncertain. The article describes the experience of therapeutic and diagnostic tactics in a patient with PE and thrombosis of two right chambers of the heart with a favorable outcome while the conservative approach was used.

Outcome and quality of life after central pulmonary embolism: surgical embolectomy versus medical treatment

2008 ◽  
Vol 56 (S 1) ◽  
Author(s):  
A Kadner ◽  
F Recher ◽  
FF Immer ◽  
J Schmidli ◽  
H Tevaearai ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pulmonary Embolism ◽  
Medical Treatment ◽  
Surgical Embolectomy

Clinical case of a comorbid patient with arterial hypertension

2020 ◽  
pp. 31-39
Author(s):  
Ella Polozova ◽  
Vsevolod Skvortsov ◽  
Olga Radaykina ◽  
Mariya Narvatkina ◽  
Anastasiya Seskina ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Arterial Hypertension ◽  
Clinical Picture ◽  
Clinical Case ◽  
Diagnosis And Treatment ◽  
The Moment

The widespread prevalence of comorbid pathology determines the relevance of this problem. Comorbid pathology due to the interaction of diseases, drug pathomorphism, age characteristics of the patient, significantly changes clinical picture and course of the main nosology, affects severity of complications and their nature, significantly affects quality of life and prognosis of patients. Diagnosis and treatment of many diseases is complicated in the conditions of comorbidity. The article presents a clinical case of a comorbid patient with arterial hypertension from the moment of exposure to risk factors and ending with the formation of many concomitant diseases, as an example of trans-nosological comorbidity.

Resveratrol: A new potential therapeutic agent for melanoma?

2019 ◽  
Vol 26 ◽  
Author(s):  
Mohamad Hossein Pourhanifeh ◽  
Kazem Abbaszadeh-Goudarzi ◽  
Mohammad Goodarzi ◽  
Sara G.M. Piccirillo ◽  
Alimohammad Shafiee ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Therapeutic Agent ◽  
Current Knowledge ◽  
Treatment Resistance ◽  
Anti Cancer ◽  
Apoptosis Inducer ◽  
Life Threatening ◽  
First Time

: Melanoma is the most life-threatening and aggressive class of skin malignancies. The incidence of melanoma has steadily increased. Metastatic melanoma is greatly resistant to standard anti-melanomatreatments such as chemotherapy, and 5-year survival rate of cases with melanoma who have metastatic form of disease is less than 10%. The contributing role of apoptosis, angiogenesis and autophagy in the pathophysiology of melanoma has been previously demonstrated. Thus, it is extremely urgent to search for complementary therapeutic approachesthat couldenhance the quality of life of subjects and reduce treatment resistance and adverse effects. Resveratrol, known as a polyphenol component present in grapes and some plants, has anti-cancer properties due to its function as an apoptosis inducer in tumor cells, and anti-angiogenic agent to prevent metastasis. However, more clinical trials should be conducted to prove resveratrol efficacy. : Herein, for first time, we summarize current knowledge of anti-cancerous activities of resveratrol in melanoma.

scholarly journals More comprehensively measuring quality of life in life-threatening illness: the McGill Quality of Life Questionnaire – Expanded

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
S. Robin Cohen ◽  
Lara B. Russell ◽  
Anne Leis ◽  
Javad Shahidi ◽  
Pat Porterfield ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Second Order ◽  
Model Fit ◽  
Life Questionnaire ◽  
Quality Of Life Questionnaire ◽  
Healthcare Environment ◽  
Life Threatening Illness ◽  
Life Threatening ◽  
Order Factor

Abstract Background Domains other than those commonly measured (physical, psychological, social, and sometimes existential/spiritual) are important to the quality of life of people with life-threatening illness. The McGill Quality of Life Questionnaire (MQOL) – Revised measures the four common domains. The aim of this study was to create a psychometrically sound instrument, MQOL – Expanded, to comprehensively measure quality of life by adding to MQOL-Revised the domains of cognition, healthcare, environment, (feeling like a) burden, and possibly, finance. Methods Confirmatory factor analyses were conducted on three datasets to ascertain whether seven new items belonged with existing MQOL-Revised domains, whether good model fit was obtained with their addition as five separate domains to MQOL-Revised, and whether a second-order factor representing overall quality of life was present. People with life-threatening illnesses (mainly cancer) or aged > 80 were recruited from 15 healthcare sites in seven Canadian provinces. Settings included: palliative home care and inpatient units; acute care units; oncology outpatient clinics. Results Good model fit was obtained when adding each of the five domains separately to MQOL-Revised and for the nine correlated domains. Fit was acceptable for a second-order factor model. The financial domain was removed because of low importance. The resulting MQOL-Expanded is a 21-item instrument with eight domains (fit of eight correlated domains: Comparative Fit Index = .96; Root Mean Square Error of Approximation = .033). Conclusions MQOL-Expanded builds on MQOL-Revised to more comprehensively measure the quality of life of people with life-threatening illness. Our analyses provide validity evidence for the MQOL-Expanded domain and summary scores; the need for further validation research is discussed. Use of MQOL-Expanded will enable a more holistic understanding of the quality of life of people with a life-threatening illness and the impact of treatments and interventions upon it. It will allow for a better understanding of less commonly assessed but important life domains (cognition, healthcare, environment, feeling like a burden) and their relationship to the more commonly assessed domains (physical, psychological, social, existential/spiritual).

Proton Pump Inhibitors in 2021: Pros, Cons, and Everything in Between

2021 ◽  
pp. 263451612110217
Author(s):  
Joshua A. Sloan ◽  
Philip O. Katz
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Adverse Events ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Drug Class ◽  
Life Threatening

The medical and lay literature has exploded with reports of adverse events associated with proton pump inhibitors over the last 10 to 15 years. The dissemination of these reports to patients and clinicians have created substantial concerns regarding what has been an exceptionally valuable drug class, dramatically improving patient quality of life, and in many cases preventing life threatening side effects of other medication. Patients are more frequently seeking to avoid these medications, and practitioners are reducing or discontinuing them to the patient’s detriment due to a misunderstanding of the data. This review will discuss the data regarding the most commonly publicized adverse events and attempt to put them in perspective.

scholarly journals Molecular Mechanisms Associated with ROS-Dependent Angiogenesis in Lower Extremity Artery Disease

Antioxidants ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 735
Author(s):  
Greg Hutchings ◽  
Łukasz Kruszyna ◽  
Mariusz J. Nawrocki ◽  
Ewa Strauss ◽  
Rut Bryl ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Blood Vessel ◽  
Lower Extremity ◽  
Molecular Mechanisms ◽  
Lower Extremities ◽  
Tissue Response ◽  
Peripheral Arteries ◽  
Artery Disease ◽  
Lower Extremity Artery Disease

Currently, atherosclerosis, which affects the vascular bed of all vital organs and tissues, is considered as a leading cause of death. Most commonly, atherosclerosis involves coronary and peripheral arteries, which results in acute (e.g., myocardial infarction, lower extremities ischemia) or chronic (persistent ischemia leading to severe heart failure) consequences. All of them have a marked unfavorable impact on the quality of life and are associated with increased mortality and morbidity in human populations. Lower extremity artery disease (LEAD, also defined as peripheral artery disease, PAD) refers to atherosclerotic occlusive disease of the lower extremities, where partial or complete obstruction of peripheral arteries is observed. Decreased perfusion can result in ischemic pain, non-healing wounds, and ischemic ulcers, and significantly reduce the quality of life. However, the progressive atherosclerotic changes cause stimulation of tissue response processes, like vessel wall remodeling and neovascularization. These mechanisms of adapting the vascular network to pathological conditions seem to play a key role in reducing the impact of the changes limiting the flow of blood. Neovascularization as a response to ischemia induces sprouting and expansion of the endothelium to repair and grow the vessels of the circulatory system. Neovascularization consists of three different biological processes: vasculogenesis, angiogenesis, and arteriogenesis. Both molecular and environmental factors that may affect the process of development and growth of blood vessels were analyzed. Particular attention was paid to the changes taking place during LEAD. It is important to consider the molecular mechanisms underpinning vessel growth. These mechanisms will also be examined in the context of diseases commonly affecting blood vessel function, or those treatable in part by manipulation of angiogenesis. Furthermore, it may be possible to induce the process of blood vessel development and growth to treat peripheral vascular disease and wound healing. Reactive oxygen species (ROS) play an important role in regulation of essential cellular signaling pathways such as cell differentiation, proliferation, migration and apoptosis. With regard to the repair processes taking place during diseases such as LEAD, prospective therapeutic methods have been described that could significantly improve the treatment of vessel diseases in the future. Summarizing, regenerative medicine holds the potential to transform the therapeutic methods in heart and vessel diseases treatment.

Functional outcomes and quality of life during long-term follow-up after acute pulmonary embolism: analysis of the prospective multicentre FOCUS study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Barco ◽  
L Valerio ◽  
M Jankowski ◽  
M.M Hoeper ◽  
F.A Klok ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Medical Center ◽  
Combination Group ◽  
Funding Source ◽  
Median Score ◽  
Persistent Symptoms

Abstract Background It is unclear to which extent persistence of symptoms and/or residual haemodynamic impairment clinical course of pulmonary embolism are associated with worse quality of life (QoL). Aims To study the correlation between symptoms and haemodynamic impairment with QoL during the first year after acute pulmonary embolism (PE). Methods The Follow-Up after acute pulmonary embolism (FOCUS) study prospectively enrolled and followed consecutive adult patients diagnosed with acute symptomatic objectively diagnosed PE. In the present analysis, we considered patients who completed the Pulmonary Embolism QoL (PEmb-QoL) Questionnaire at predefined visits 3 and 12 months after acute PE. The PEmb-QoL score ranges from 0% (best QoL) to 100% (worst QoL). We evaluated at these two time points the correlation between persisting symptoms (group: symptoms), elevation of natriuretic peptides or residual right ventricular dysfunction (group: RVD), or their combination (group: symptoms + RVD) and QoL. Results A total of 617 patients were included; their median age was 62 years, 44% were women; 8% had active cancer, and 21% previous venous thromboembolism. At 3 months, patients with neither symptoms nor RVD (n=302) had the highest quality of life (median score 18%, 25th–75th percentile: 8%–34%), followed by those without symptoms but with RVD (n=255; median score 19%, 25th–75th percentile: 7%–34%), and by those with symptoms only (n=131; median PEmb-QoL 31%, 25th–75th percentile: 18%–49%). Patients with both symptoms and RVD (n=170) had the worst quality of life (median score 38%, 25th–75th percentile: 19%–53%); Figure 1A. At 12 months, we found an overall improvement of PEmb-QoL score. The degree of this QoL improvement varied across groups, being largest for patients who recovered from having symptoms + RVD at 3 months to normalization of at least one at 12 months. The change in QoL from 3 to 12 months was smaller both in patients who had neither symptoms nor RVD and in patients who had no recovery in either symptoms or RVD; Figure 1B. Conclusions Persistent symptoms after PE, especially in patients with elevated biomarkers or residual echocardiographic dysfunction, were the main drivers of QoL at 3 months as well as of the course of QoL over time. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): University Medical Center of the Johannes Gutenberg University, Mainz, Germany; German Federal Ministry of Education and Research

scholarly journals Therapy for myeloproliferative neoplasms: when, which agent, and how?

Hematology ◽  
2014 ◽  
Vol 2014 (1) ◽  
pp. 277-286 ◽  
Author(s):  
Holly L. Geyer ◽  
Ruben A. Mesa
Keyword(s):  
Quality Of Life ◽  
Disease Burden ◽  
Myeloproliferative Neoplasms ◽  
Jak Inhibitors ◽  
Symptom Profiles ◽  
Risk Of Progression ◽  
Life Threatening ◽  
Jak2 Inhibition

Abstract Myeloproliferative neoplasms, including polycythemia vera (PV), essential thrombocythemia, and myelofibrosis (MF) (both primary and secondary), are recognized for their burdensome symptom profiles, life-threatening complications, and risk of progression to acute leukemia. Recent advancements in our ability to diagnose and prognosticate these clonal malignancies have paralleled the development of MPN-targeted therapies that have had a significant impact on disease burden and quality of life. Ruxolitinib has shown success in alleviating the symptomatic burden, reducing splenomegaly and improving quality of life in patients with MF. The role and clinical expectations of JAK2 inhibition continues to expand to a variety of investigational arenas. Clinical trials for patients with MF focus on new JAK inhibitors with potentially less myelosuppression (pacritinib) or even activity for anemia (momelotinib). Further efforts focus on combination trials (including a JAK inhibitor base) or targeting new pathways (ie, telomerase). Similarly, therapy for PV continues to evolve with phase 3 trials investigating optimal frontline therapy (hydroxyurea or IFN) and second-line therapy for hydroxyurea-refractory or intolerant PV with JAK inhibitors. In this chapter, we review the evolving data and role of JAK inhibition (alone or in combination) in the management of patients with MPNs.

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