THE ELABORATION OF A THERAPEUTIC COMPLEX FOR UNSTABLE STENOCARDIA WITH THE TYPE II DIABETES MELLITUS BACKGROUND WITH ACCOMPANYING HYPERVENTILATIVE SYNDROME: ANALYSIS OF CLINIC-CARDIOLOGY AND RESPIRATORY-METABOLICPARAMETERS

В статье представлены данные оригинального исследования по созданию терапевтического комплекса, направленного на улучшение интенсивного лечения нозологической ассоциации «нестабильная стенокардия (в качестве основного заболевания) + сахарный диабет второго типа (в качестве фоновой патологии) + гипервентиляционный синдром (в качестве сопутствующего состояния)». Разработанный комплекс основан на контролируемом изменении вспомогательной респираторной оксигенации «в сторону уменьшения» при условии обязательного дополнения базисной фармакотерапии сбалансированной комбинацией препаратов антигипоксического действия и дезагрегантом нового поколения. Проведено сравнительное исследование двух групп тематических пациентов - с применением разработанного комплекса и с использованием «традиционного подхода». Изучены ключевые параметры клинического кардиологического и респираторно-метаболического статуса пациентов. При использовании разработанного терапевтического комплекса по сравнению с «традиционным подходом» установлено принципиальное улучшение параметров клинико-кардиологического статуса при сохранении параметров респираторно-метаболического статуса в пределах адаптивных и безопасных значений. Полученные результаты имеют высокий уровень статистической значимости. Это доказало достаточную обоснованность авторской научно-практической разработки. Представленные в статье данные отличает новизна и практическая применимость, что позволяет рекомендовать их к дальнейшему использованию в практике специалистов клиники внутренних болезней The article presents the data of the original research on the creation of a therapeutic complex aimed at improving the intensive treatment of the nosological association «unstable angina pectoris (as the main disease) + type 2 diabetes mellitus (as a background pathology) + hyperventilation syndrome (as a concomitant condition)». The developed complex is based on a controlled change in auxiliary respiratory oxygenation «downward», provided that basic pharmacotherapy must be supplemented with a balanced combination of antihypoxic drugs and a new generation of antiaggregants. A comparative study of two groups of thematic patients was carried out - using the developed complex and using the «traditional approach». The key parameters of the clinical cardiological and respiratorymetabolic status of patients were studied. When using the developed therapeutic complex in comparison with the «traditional approach», a fundamental improvement in the parameters of the clinical and cardiological status was established while maintaining the parameters of the respiratory and metabolic status within the adaptive and safe values. The results obtained have a high level of statistical significance. This proved the sufficient validity of the author's scientific and practical development. The data presented in the article are distinguished by novelty and practical applicability, which makes it possible to recommend them for further use in the practice of specialists in the clinic of internal diseases

Perforated Jejunal Adenocarcinoma in a COVID-19-Positive Patient

Jejunal adenocarcinoma is a rare type of primary small bowel malignancy. It is generally diagnosed at late stages and as a surgical finding, with abdominal pain or discomfort being the main associated symptom. Cases presenting with perforation are even rarer, especially without disseminated disease. The relationship between cancer and coronavirus disease 2019 (COVID-19) is still being studied, as well as the postsurgical evolution of COVID-19 patients and its possible causality of intestinal perforation. We present the case of a perforated jejunal adenocarcinoma in a COVID-19-positive patient, in whom the symptomatology secondary to the perforation led to an early diagnosis, treatment and adequate postsurgical evolution, despite the concomitant condition.

Chronic kidney disease in patients with diabetes mellitus

Chronic kidney disease is a common complication and concomitant condition of diabetes mellitus. The treatment of patients with diabetes and chronic kidney disease, including intensive control of blood sugar and blood pressure, has been very similar for type 1 and type 2 diabetes patients. New therapeutic targets have shown promising results and may lead to more specific treatment options for patients with type 1 and type 2 diabetes.

Suicide attempt in alcohol use disorder and Wernicke encephalopathy: A case report

BackgroundThe relation between alcohol dependence and suicidal behavior is well known and alcohol consumption is a risk factor to take in consideration in order to prevent suicidal attempts. Wernicke encephalopathy (WE) is a common acute neurological disorder caused by thiamine deficiency frequently associated with alcohol use disorder and often infra-diagnosed. Just few cases are reported about the possible correlation between suicidal behaviour and Wernicke encephalopathy.ObjectiveTo describe the possible association between suicidal attempts and Wernicke encephalopathy.MethodsWe report the case of a 57 year old man, with past diagnosis of disthymia and amphetamine abuse disorder, and a history of bariatric surgery, who was hospitalized in the intensive care unit (ICU) of hospital clinic for a suicidal attempt by mean of metro railway precipitation. He presented two episodes of psychomotor agitation in the context of an abstinence syndrome that reverted with midazolam continuous perfusion and clonazepam 8 mg per day. Consequently to medical improvement, he was moved to Psychiatry Unit of Addictive Behavior and finally diagnosed with alcohol use disorder.ResultsIn the physical exam, bilateral nystagmus and cerebellar ataxia were observed. Signs of malnutrition were detected in the blood analysis. In a brain magnetic resonance image, volume deficits in the mammillary bodies, thalamus, cortex and corpus callosum, as well as peri-aqueductal altered signal were observed, all signs compatible with Wernicke encephalopathy diagnoses.ConclusionsWernicke encephalopathy is a frequent concomitant condition in patients with alcohol use disorder. The consequent cognitive decline could represent an independent added risk factor for suicidal behavior.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Analysis of mortality in patients with stroke according to data of Republican hospital №1 (Tyva Republic)

Aim. To study the change in overall mortality in in-patients with stroke admitted to the department of neurology from 2010 to 2012. Methods. The analysis of the overall mortality in in-patients with stroke admitted to the department of neurology of Republican Hospital №1 was performed using the statistical data from 2010 to 2012. Results. In 2012 overall mortality from stroke has increased by 4.59% compared to 2011. Among the patients who died of stroke in 2012, patients with cerebral hemorrhage dominated over the patient with ischemic stroke. 14% of patients succumbed within first 24 hours, which can be explained by a severe condition of admitted patients. Arterial hypertension, alone and in combination with cerebral atherosclerosis and diabetes mellitus, was the most often concomitant condition in patients who died of stroke at the department of neurology. The reasons for death in patients with cerebral hemorrhage were cerebral edema associated with brain herniation, progression to intraventricular hemorrhage and brainstem hemorrhage. The reason for death in patients with ischemic stroke was recurrent cerebral infarction. There was 1 case of concomitant myocardial infarction in a patient with cerebral hemorrhage. Conclusion. The number of patients who has died of stroke - 200, an autopsy was performed in 81%; the highest mortality was observed in patients aged 51-60 years, the lowest - in patients aged 18 to 30 years (1.5%). Discrepancy between clinical and postmortem diagnosis was observed in 2 cases.

Successful Treatment of Anorexia Nervosa through Isolation

A severe case of anorexia nervosa was treated with behavioral techniques using a seclusion procedure following meals. The treatment succeeded in restoring the weight of the patient from 32 kg to a normal value of above 50 kg. A concomitant condition of excessive drinking disappeared inexplicably following treatment.