Characteristics of heart rate variability in patients with acute coronary syndrome without ST segment elevation in comparison with clinical and biochemical parameters

BACKGROUND: The search for rational methods of primary, secondary, and tertiary prevention of coronary heart disease. To date, there are several publications on heart rate variability in ischemic heart disease. AIM: To study the state of the regulatory systems in the organism of patients with acute coronary syndrome without ST segment elevation based on the heart rhythm, and their relationship with the clinical, biochemical and instrumental parameters of the disease. MATERIALS AND METHODS: The open comparative study included 76 patients (62 men, 14 women) of mean age, 61.0 0.9 years, who were admitted to the Emergency Cardiology Department diagnosed of acute coronary syndrome without ST segment elevation. On admission, cardiointervalometry was performed using Varicard 2.51 apparatus, and a number of clinical and biochemical parameters were evaluated RESULTS: Multiple correlations of parameters of heart rate variability and clinical, biochemical and instrumental parameters were observed. From this, a cluster analysis of cardiointervalometry was performed, thereby stratifying patients into five clusters. Two extreme variants of dysregulation of the heart rhythm correlated with instrumental and laboratory parameters. A marked increase in the activity of the subcortical nerve centers (maximal increase of the spectral power in the very low frequency range with the underlying reduction of SDNN) in cluster 1 was associated with reduction of the left ventricular ejection fraction: cluster 147.0 [40.0; 49.0], cluster 260.0 [58.0; 64.0], cluster 360.0 [52.5; 64.5] % (the data are presented in the form of median and interquartile range; Me [Q25; Q75], p 0,05). Cluster 5 showed significant reduction in SDNN (monotonous rhythm), combined with increased level of creatine phosphokinase (CPC): cluster 5446,0 [186.0; 782.0], cluster 4141.0 [98.0; 204.0] IU/l; Me [Q25; Q75], p 0.05) and MВ-fraction of creatine phosphokinase; cluster 532.0 [15.0; 45.0], 4 cluster 412.0 [9.0; 18.0] IU/l; Me [Q25; Q75], p 0.05). CONCLUSIONS: In patients with acute coronary syndrome without ST segment elevation, cluster analysis of parameters of heart rate variability identified different peculiarities of regulation of the heart rhythm. Pronounced strain of the regulatory systems of the body was found to be associated with signs of severe pathology: the predominance of VLF (spectral power of the curve enveloping a dynamic range of cardiointervals in the very low frequency range) in spectral analysis with an underlying reduced SDNN is characteristic of patients with a reduced ejection fraction, and a monotonous rhythm is characteristic of patients with an increased level of creatine phosphokinase and MB-fraction of creatine phosphokinase.

The interactions between attention deficit hyperactivity syndrome and addictions

In the article, a group of early career psychiatrists presents the results of a discussion about the relationship between attention deficit and hyperactivity disorder (ADHD) and addictions. Modern views on the commonality of the occurrence of these conditions at the genetic, morphological and functional levels are considered. Possible clinical manifestations and the frequency of comorbidity are described. Modern pharmacological and non-pharmacological approaches to the treatment of these comorbid conditions are discussed in detail separately. The features of therapy in the combination of ADHD with various addictions are highlighted.

Experience of using intra-aortic balloon counterpulsation during coronary bypass surgery and coronary stenting in patients with reduced left ventricular ejection fraction and mitral regurgitation of ischemic genesis

AIM: To analyze the changes in the degree of mitral regurgitation (MR) of ischemic origin and of clinical outcomes in patients with reduced left ventricular ejection fraction (LVEF) and multi-vascular coronary artery disease during use of intra-aortic balloon counterpulsation (IABC). MATERIALS AND METHODS: The results of the treatment of 186 patients with ischemic mitral insufficiency who underwent intra-aortic balloon counterpulsation as a preoperative preparation in connection with a low LVEF were outlined in this manuscript. The patients were divided into 2 groups. Group 1 included 132 patients who underwent coronary bypass surgery while Group 2 included 54 patients who underwent coronary artery stenting. The dynamics of MR and LVEF before and after left ventricular revascularization were studied on the basis of echocardiographic data. RESULTS: In group 1, there was a decrease in the degree of mitral regurgitation by 58% using IABC (p 0.05) in the early postoperative period (based on the measurement of vena contracta, v.c., the width of the regurgitation jet on the valve), and by 54% (p 0.05) in more than 6 months following surgical treatment. In group 2, there was a significant decrease in the degree of MR (based on v.c.) by 42% (p 0.05) in the early postoperative period and by 41% (p 0.05) in more than 6 months following surgical treatment. CONCLUSION: The use of intra-aortic balloon counterpulsation in patients with low LVEF, moderate and severe MI, and with significant coronary artery pathology, led to the reduction in the duration of surgical treatment and the time of using artificial blood circulation through by excluding the need for the correction of MI, both directly during surgical revascularization and in the long-term period (more than 6 months).

Experience of using scleroobliteration in venous angiodysplasia (results of 12-month follow-up)

AIM: To evaluate the results of using the minimally-invasive technique of scleroobliteration in patients with venous malformations. MATERIALS AND METHODS: From 2006 to 2020, 41 interventions were performed for venous-cavernous angiomatosis of various localization through scleroobliteration. Nineteen patients (46.3%) underwent complex treatment, which included a combination of this minimally-invasive technique with other surgical interventions (resection of angiomatous tissues, laser coagulation, and radiofrequency obliteration). RESULTS: Clinical improvement was achieved in 38 (92.7%) patients. According to the data of ultrasound control, 25 patients (61%) experienced no blood flow in the obliteration zone, and there was regression of the initial symptoms within 1 year of observation following intervention. The results of treatment were better due to the local spread of the angiomatous process. With diffuse forms, it was not possible to achieve a positive effect in 3 patients (11.1%). CONCLUSION: Scleroobliteration can provide a positive result in the treatment of patients with venous-cavernous angiodysplasia, both as an independent method and in combination with other minimally-invasive techniques.

Effect of early and late pharmacological correction with GABA derivatives on cognitive disorders in offspring of rats with experimental preeclampsia

BACKGROUND: Preeclampsia is a serious complication of pregnancy which augments the risk of cognitive disorders in the offspring at different stages of life. Presently, there are no methods with proven effectiveness for correction of post-hypoxic disorders in children of mothers with preeclampsia. AIM: To assess the cognitive functions of the offspring of rats with experimental preeclampsia (EP) through early (40th to 70th day of life) and late (24th to 25th month of life) pharmacological correction with gamma aminobutyric acid (GABA) derivatives: Succicard, Salifen, Phenibut, and the drug of comparisonPantogam. MATERIALS AND METHODS: EP was modeled by replacing drinking water with 1.8% sodium chloride solution in rats from the first day of pregnancy to delivery. In the offspring, short-term and long-term memory was studied at the age of 34, 1819, and 2526 months in the Novel object recognition test and Barnes Maze test. The functioning of the GABAergic and dopaminergic systems (which play an essential role in the development of memory) was evaluated by cases of convulsions after administering corazol at a dose of 20 mg/kg intraperitoneally (model of corazol kindling) and by haloperidol-induced catalepsy (haloperidol at a dose of 0.3 mg/kg intraperitoneally), respectively. RESULTS: Early and late pharmacological correction with GABA derivativessuccicard, Salifen, Phenibut, and comparison drug, Pantogamneutralized the negative effect of EP on the function of GABAergic and dopaminergic systems in the offspring of the experimental groups. Therapy with Succicard in puberty and long-term periods of life contributed to the improvement of short-term and long-term memory in the offspring of rats with EP. Thus, it could be reasonable enough to develop a drug against cognitive disorders in children of mothers with preeclampsia. CONCLUSION: In the offspring of rats with EP, short-term and long-term disorders of memory in the functioning of the GABAergic and dopaminergic systems were noted in the early and late stages of the individual development. Pharmacological correction with GABA derivatives improves cognitive processes and the functioning of neurotransmitter systems in the offspring of rats with complicated pregnancy. The highest effectiveness was demonstrated by succicard, and was comparable with or superior to the Pantogam (standard drug).

Qualitative assessment of the impact of some anthropogenic factors on natural foci of tularemia in the Rostov agglomeration

AIM: To qualitatively assess the impact of some anthropogenic factors (construction of industrial facilities, transport networks, intensification of agriculture) on natural foci of tularemia in the Rostov agglomeration. MATERIALS AND METHODS: The official data and reports of the Federal State Budgetary Institution Rosselkhoznadzor, the data of the Department of Rospotrebnadzor for the Rostov region, the Federal State Budgetary Institution Center of Hygiene and Epidemiology in the Rostov Region of Rospotrebnadzor were analyzed. Zoological and parasitological studies were carried out in accordance with modern regulatory documents in force. The detection of F. tularensis markers in field samples was carried out using serological and molecular genetic methods. RESULTS: It was found that the existing territories under natural protection of the Russian agglomeration restrict degradation processes, while maintaining the simultaneous coexistence of native species and synanthropic animals that make up the parasitic circulation system of the tularemia pathogen. CONCLUSION: The qualitative assessment of anthropogenic pressure/action can probably be interpreted as conditionally neutral. This could lead to potential risks of infection of the unvaccinated population of the Rostov agglomeration in natural foci of tularemia. The dynamism of the processes of anthropogenic action requires constant monitoring of the changes in the species diversity of carriers and vectors, their abundance, and infection in the natural foci of tularemia in the Rostov agglomeration.

Milk consumption and gastrointestinal symptoms in preschool girls with different lactase genotypes

AIM: To analyze the frequency of milk consumption and subjective symptoms of intolerance to dairy products in the population of three- to six-year-old girls (born and resident in Samara) based on the genotype of the lactase gene. MATERIALS AND METHODS: We included 103 preschool girls ranging three to six years of age. Parents were questioned about the frequency of milk consumption by the child (per week), as well as the presence of gastrointestinal symptoms in their children (abdominal pain, bloating, flatulence and diarrhea) and the suspected association of symptoms with milk consumption (according to the parents). Buccal samples were taken from all girls to determine the polymorphism of the lactase genes (determination of C/T-13910 variant of the MCM6 gene). RESULTS: A significant relationship between the frequency of milk consumption and the variant of the polymorphic locus of the lactase gene, MCM6 [C 13910T; which affects the expression of the lactase gene (LCT)] has not been established. There is no correlation in the enlarged gradation of frequent milk consumption (47 times a week) and rare milk consumption (23 times a week or less): of 53 girls with the CC genotype 27 (51%) often drink milk, 26 (49%) rarely drink milk; of 39 girls with CT genotype 23 (59%) often consume milk, 16 (41%) rarely consume milk; of 11 girls with the TT genotype, 8 (73%) often consume milk, 3 (27%) rarely consume milk (c2 1.94, p = 0.379). There was no significant relationship between the frequency of milk consumption, subjective symptoms of lactose intolerance (abdominal pain, bloating, flatulence and diarrhea) and the genotype; these symptoms were found only in four girls carrying the C allele (CC and CT genotypes) though not detected in girls with TT genotype. CONCLUSION: In girls of 36 years old, there is no relationship between the frequency of milk consumption, subjective symptoms of lactose intolerance and genotype of lactase gene.

Analysis of the main epidemiological parameters of morbidity with tuberculosis of children and adolescents of the Ryazan region in 2010–2019

AIM: This study aimed to identify the main trends of the epidemiology of tuberculosis in children and adolescents in the Ryazan Region (RR) by analyzing the main epidemiological parameters of morbidity in 20102019. MATERIALS AND METHODS: The morbidity of children and adolescents with tuberculosis in the RR was subjected to retrospective epidemiological analysis. The data of the official and reporting documentation of the Ryazan Regional Clinical Antituberculosis Dispensary and the materials of the state reports of Territorial Administration of Rospotrebnadzor (On the Condition of SanitaryEpidemiological WellBeing of Population) in 20102019 were used. The main epidemiological parameters of morbidity due to tuberculosis were calculated using mathematical methods. RESULTS: The proportion of children and adolescents in the structure of morbidity due to tuberculosis in the RR in 20102019 decreased by 3.9 times and reached 6.09% in 2019. The morbidity caused by the active form of tuberculosis in children (014 years) and adolescents (1517 years) evidently declined by -20.7% and -11.5%, respectively. In children, respiratory tuberculosis predominated (55%100%), and the leading clinical form was tuberculosis in intrathoracic lymph nodes (77%). In adolescents, only pulmonary tuberculosis was identified, and focal tuberculosis was the predominating clinical form (43%). In the study period, the highest morbidity in children was recorded at the age of 714 years. No cases of mortality among children and adolescents with tuberculosis were recorded in 20102019. In 20182019, the primary infection and the risk of infection among children under 14 years of age increased from 1.3% (2018) to 1.8% (2019) and from 2.6% (2018) to 3.3% (2019), respectively. This result might indicate that morbidity due to tuberculosis increased. The majority of ill children and adolescents were identified among vaccinated ones, suggesting that the protective properties of the vaccine were insufficient (80%). CONCLUSION: The morbidity of children and adolescents with tuberculosis decreased, and this decrease directly associated with the general improvement in the status of tuberculosis in the country; in particular, tuberculosis foci in the RF decreased by 2.2 times [4]. In the study period, the morbidity of children (014 years) decreased by 3.5 and 2.1 times in the RR and RF, respectively. The morbidity of adolescents (1517 years) decreased by 3.1 and 2.2 times in the RR and RF, respectively. The mortality of children and adolescents in the RP was 0.0 per 100,000 population of the given age groups. In the RF, their mortalities reduced by 6.5 and 1.6 times, respectively [4].

Multicenter study: outcomes of carotid endarterectomy depending on configuration of circle of Willis

BACKGROUND: The circle of Willis (CW) is an important network of collaterals that provide compensatory redistribution of hemodynamic load. Several studies showed that the CW is open in approximately 50%90% of cases, and the number of missing segments correlates with low brain tolerance to ischemia in internal carotid artery (ICA) compression. Currently, studies dedicated to the relationship of different configurations of CW with the risk of ischemic brain damage. AIM: The analyze the immediate results of eversion carotid endarterectomy (CEA) in patients with different configurations of the structure of the CW. MATERIALS AND METHODS: We included 641 patients with hemodynamically significant stenosis of the internal carotid arteries (ICA) in a study period from 2010 to 2020. All patients underwent multispiral computed tomography with angiography of the extracranial and CW arteries. Based on the structural variants of the CW, six groups of patients were studied: group 1 (64.9%, n = 416) closed posterior part (CPP) with the existence of posterior communicative artery (PCA) and P1 segment of the posterior cerebral artery (PCerA); group 2 (27%, n = 173) an intermediate structure of the posterior part (IPP) with hypoplasia of the PCA or PCerA; group 3 (8.1%, n = 52) open posterior part (OPP) with the absence of PCA or PCerA; group 4 (85.95%, n = 551) closed anterior part (CAP) with the presence of the anterior communicating artery (ACA) and A1 segment of the anterior cerebral artery (ACerA); group 5 (7.95%, n = 51) an intermediate structure of the anterior part (IAP) with hypoplasia of ACA or ACerA; group 6 (6.1%, n = 39) open anterior part (OAP) with the absence of ACA or ACerA. To assess the compensatory potentials of the brain, all patients underwent measurement of the retrograde pressure in the ICA and intraoperative cerebral oximetry. RESULTS: In the postoperative period, 1 death was recorded in group 4 (CAP) due to a hemorrhagic transformation in the zone of ischemic stroke, on the background development of hyperperfusion syndrome. The largest number of ischemic strokes of the cardioembolic subtype was diagnosed in the ACerA territory in the presence of an unstable atherosclerotic plaque: group 1 (CPP) 0%; group 2 (IPP) 0%; group 3 (OPP) 0.24%, n = 1; group 4 (CAP) 0.18%, n = 1; group 5 (IAP) 1.96%, n = 1; group 6 (OAP) 5.1%, n = 2; p 0.9999. The probable cause was embolization against the background increase in the arterial pressure before ICA clamping. In turn, the majority of ischemic strokes of the hemodynamic subtype developed in the territory of PCerA: group 1 (CPP) 0%; group 2 (IPP) 1.73%, n = 3; group 3 (OPP) 3.8%, n = 2; group 4 (CAP) 0.18%, n = 1; group 5 (IAP) 0%; group 6 (OAP) 2.56%, n = 1; p 0.9999. This pattern coincided with the largest number of patients with CW of the IPP and OPP types among all open variants of the structure. CONCLUSION: Parameters of retrograde pressure in the ICA and intraoperative cerebral oximetry do not always demonstrate the need for a temporary shunt (TS). Due to the opened structure of CW, the redistribution of blood flow occurs with the formation of zones of hypo- and hyperperfusion, causing ischemic alterations in the brain matter. Thus, in order to maintain adequate cerebral hemodynamics, to mitigate the effect of hypo- and hyperperfusion, and reduce the risk of ischemic stroke, the open variant of the CW structure should be considered as an indication for a TS.

Advantages and disadvantages of lockdown (self-isolation regime) introduced during the first wave of coronaviral infection for patients with polymorbid pathology

AIM: To study the structure of mortality not caused by coronavirus infection, in patients with polymorbid pathology during the period of self-isolation (lockdown). MATERIALS AND METHODS: Outpatient records of 2 423 patients with polymorbid pathology (841 males and 1 582 females, aged from 18 to 99 years) were examined. The mortality and its causes during three years including a period of lockdown were investigated. RESULTS: The overall mortality rate among patients with polymorbid pathology was 10.2% without differences in gender. The structure of the causes of death in patients with polymorbidity: cardiovascular diseases accounted for 50.8%, oncological diseases 21%, nervous system diseases 7.3%. During the lockdown, an increase in overall mortality by 34.3% was recorded (p 0.05), with an increase in the number of deaths of patients with cardiovascular diseases by 19.5% (p 0.05) (mostly patients with ischemic heart disease). CONCLUSION: An increase in the number of deceased patients with polymorbidity during the lockdown may be due to the limitation of physical activity, of the possibility of examination and consultation by profile specialists. Taking into account the vulnerability of this group of patients, there is an urgent need to develop preventive measures when the situation recurs.