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Pharmacological and epidemiologic features of myocardial infarction in stationary condition and in the remote monitoring phase
Talipov Rustam Mirkabilovich, Tulaboyeva Gavkhar Mirakbarovna, Tashkent Institute of Physician Improvement, Uzbekistan Republic E-mail: rcardio@mail.ru
Pharmacological and epidemiologic features of myocardial infarction in stationary condition and in the remote monitoring phase
Abstract: Results were demonstrated insufficient efficiency of medicamentous therapy as secondary prophylactic in patients with myocardial infarction in stationary condition, as well in the remote monitoring phase. It is established, that remedy preparations in the remote monitoring phase administrated in relatively low-level doses. It is found the low-level adherence of patient's treatment with myocardial infarction in the remote monitoring phase.
Keywords: myocardial infarction, arterial hypertension, diabetes.
Relevance
It is estimated by WHO, that 17 mln. people are died from cardiovascular diseases (CVD) annually in the world. It is expected, that mortality from CVD will reach - 25 mln. people all over the world in 2020 year. IHD, as reason of death among CVD, takes the leading position 26.7 % in Russia Federation (RF) [1]. Most threatening complication of IHD is myocardial infarction (MI). In particular, 1.1 mln. of Americans suffered from MI, 650 thousands from them suffered first time, for more then 45 % of people it became fatal in 2002 year. With the introduction into practice the modern methods ofMI treatment, including endovascular and surgical, hospital mortality from this disease decreased from 25-30 % to 17-18 %, and in uncomplicated course ofMI to 7-10 % (Ford Earl S., et al., 2007).
Actuality of favors treatment of MI is one of the discussable positions in the modern literature [2]. Observance of the principles of evidence-based medicine decreases mortality and repeated risk of MI at using of a large number of preparations with high evidence base, because efficacy from combination of two preparation is reliable (p < 0.001) comparing to absence of these preparations [3], and model of construction of adgirens principles at MI remains too complicate [4].
Aim of work: Estimation of preparation administration to patients who suffered from MI in stationary condition and in the remote monitoring phase.
Materials and methods of investigation
Work was a retrospective investigation of patients, who admitted to city clinical hospital No 7 of Tashkent with MI. It was included
patients of both sexes. In result of screening of patients according to criterions was included 631 patients. 516 patients went till the end of investigation. In the remote monitoring phase 30 % (n = 155) of patients refused from investigation, 5 % (n = 26) patient's destiny is unknown.
Diagnosis MI on stationary stage was established according to existed criterions of national recommendations in diagnostic and treatment of patients with MI with ST segment elevation, 2007 y. All patients, who included, were invited to the interview (remote monitoring phase). In case of patient absence it was indicated a reason: death, aggravation of state, changing ofliving place, unwilling etc. In case of patient death indicated a date and a reason -coronary death, uncoronary death. In the study, doctor filled individual card of the patient of one example, which consisted of questions of retrospective estimation of features, quality of stationary stage of treatment and remote monitoring phase.
Methods of statistical analysis of investigation results were made using application package statistic programs MEDIOSTAT. It was used standard methods ofvariation statistics: calculation of average, standard deviation (M ± m), criterions of Styudent (p < 0.05).
Results of investigation
After coming of patients into clinic was administrated standard therapy of MI; which included: antiaggregants 94 % (n = 593), anticoagulants 98 % (n = 616), inhibitors of angiotensin transforming enzyme (IATE) 60 % (n = 378), antagonists of angiotensin2 receptor (AA-2R) 14 % (n = 85), statins 90 % (n = 565), trombolytics 42.4 % (n = 122) (fig.1).
Fig.1 Characteristics of the therapy to MI patients in stationary condition and in the remote monitoring phase ( %)
Section 5. Medical science
Double antiaggregant therapy was done in 591 patients (93.7 %) (aspirin in dose 150 mg. and clopidogrel in dose 300 mg). In the remote monitoring phase double antiaggregant therapy (aspirin 75 mg. and clopidogrel 75 mg.) were taken just in 18 % (n = 60) of cases. In 82 % (n = 275) cases patients independently took antiaggregants as a monotherapy (aspirin 82 % (n = 225) and clopidogrel 18 % (n = 50).
High frequency of antiaggregant therapy administration in patients with MI as in moment of hospitalization so in the remote monitoring phase is positive factor.
In stationary condition to 98 % (n = 616) patients were done anticoagulant therapy, 19 % (n = 114) from them heparin, 81 % (n = 502) enoxiparin, 46 % (n = 288) patients came with ST segment elevation, from them to 42.4 % (n = 122) patients was done trombolytic therapy using streptokinase in dose 1.5 ml IU.
p-adrenoblocks in stationary condition took 84.8 % (n = 535) patients. Most frequent administrated preparations for patients with MI among p-adrenoblocks in stationary condition was bi-soprolol in 92 % (n = 491) cases; in the remote monitoring phase took 21.1 % (n = 71) patients.
In stationary condition carvidelol 4.5 % (n = 29) and atenalol 3.7 % (n = 20) was administrated rarely. Atenalol was not used in controlled investigations in secondary prophylactic of MI; hence, it was not proved its positive influence to remote indexes survival and mortality.
IATE in stationary condition was recommended to 59.9 % (n = 378) patients, frequency of administration in the remote monitoring phase was 30 % (n = 101). Most frequent administrated ramipril in 28.8 % (n = 182), rarely enalapril 15.5 % (n = 98), lysinopril 6.3 % (n = 40) and perindopril 9.03 % (n = 57) cases.
Inspite of sufficient good tolerance and safety of AA2R in stationary condition was administrated patients with MI just in 13.5 % (n = 85), azilsartan 0.63 % (n = 4), valsartan 0.95 % (n = 6), irbisartan 1.4 % (n = 9), losaratan 10.5 % (n = 66). In the remote monitoring phase frequency of taking of preparations of this group was just 2 % (n = 85) cases.
Statins were administrated in 89.5 % (n = 565) cases. Among them more frequent administrated atorvastatin 76.1 % (n = 480), rarely simvastatin 5.4 % (n = 34), rozuvastatin 4.8 % (n = 30). Preparations of other groups as lipid decreased therapy: preparations of a nicotinic acid, fibrates, and ezetemib's group were not recommended for taking. It was noticed a positive fact of more wide using of statins in the remote monitoring phase as secondary prophylactic CVD. In our investigation according to worlds of patients statins were taken only by 29.6 % (n = 99) cases.
In stationary condition to 86 % (n = 543) patients with MI were administrated nitrates. In the remote monitoring phase nitrates took 64.74 % % (n = 217) patients. More frequently administrated mononitrates 45 % (n = 151), rarely dinitrates 6.41 % (n = 21).Relatively high using of nitrates by patients with MI in the remote phase from one hand one may explain by existence in most number of cases effort angina of different functional classes. From other hand, just little group of patients with MI in the remote monitoring phase underwent to intervention on coronary vessels of heart.
During indicated period intervention cause of revascularization of myocardium made to 5 % (n = 17) patients, ACB 3 % (n = 10), TLBA 2 % (n = 7).
In fig. 2 represented average daily doses of remedy preparations, which were administrated to patients in stationary condition and in the remote monitoring phase.
Fig. 2. Characteristics of average daily doses of drug preparations, which were administrated to MI patients in stationary condition and in the remote monitoring phase (mg.)
As we can see from received results, average daily doses of indicated preparations relatively not high and in stationary condition and in the remote monitoring phase, and it does not appropriate to international and national recommendations by treating of MI with ST segment elevation to preparations of secondary prophylactic of CVD at patients with MI after discharging from stationary.
At the moment of hospitalization in 86.5 % (n = 546) patients MI developed on the background of AG, duration of disease was 7.3 ± 4.5 year. At the moment of hospitalization average index of SAP was 156 ± 45, DAP 90 ± 12 mm. Hg. Number of patients who reached target level of SAP and DAP in stationary condition was
69 % (n = 356). In the remote monitoring phase did not reach target level of BP17.2 % (n = 356) patients.
On the background diabetes at 140 (22.2 %) patients was registered MI, when average index of blood sugar was presented 6.14 ± 2.5 mmol/l. From data of patients 121 (86.4 %) had got hypoglycemic preparations and 19 (13.6 %) had got insulin therapy.
At admission in stationary in patients was found hypercholesterolemia, which characterized by increasing of general cholesterol (GCh), triglycerides (TG), lipoproteins of low density (LPLD) and decreasing the level of lipoproteins of high density (LPHD) (figure 3).
Improved results of treatment of purulent wounds with complex use of photodynamic therapy and CO2 laser in the experiment
I II II
GCh TG LPLD LPHD
I at the moment of discharge in the remote phase
Fig. 3. Indexes of blood lipid profile in MI patients in stationary condition and in the remote monitoring phase (mg/dl)
In the remote monitoring phase the most negative tendency related to absence of reaching a target level oflipids among majority of patients, although it was observed veracious decreasing of GCh (22 %), TG (16 %), LPLD (21 %).
How can we explain insufficient efficacy of ongoing drug therapy in patients with MI in the remote phase?
Results of investigation showed that in 11.7 %cases (n = 39) patients had forgotten to take drug preparations and violated the multiplicity of their taking. In 47.9 % cases (n = 161) violations was not administrated treatment in scheme. But we have to emphasize,
that in 40.4 % cases (n = 135) patients independently changed doses of drug preparations and even multiplicity of their taking.
Conclusions:
1. Results had demonstrated insufficient efficacy of drug therapy in scheme of secondary prophylactic in patients, who suffered from MI as in stationary condition, so in the remote monitoring phase.
2. It was established, that drug preparations is administrated in remote phase in relatively low doses at the remaining nontarget levels of SAP, DAP, HR, GCh, LPLD, LPHD, and TG.
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3.
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References:
Кардиология. Национальное руководство. Под редакцией Беленкова Ю. Н., Оганова Р. Г. - М.: ГЕОТАР-Медиа, 2007. - 1232 с. Adherence to evidence-based therapies after acute coronary syndrome: a retrospective 1. population-based cohort study linking hospital, outpatient and pharmacy health information systems in Valencia, Spain/G. Sanfelix-Gimeno et al.//J. Manag. Care Pharm. - 2013. -Vol. 19, № 3. - P. 247-257.
Effect of evidence-based drug therapy on long- term outcomes in patients discharged after 2. myocardial infarction: a nested case-control study in Italy/U. Kirchmayer et al.//Pharmacoepidemiol. Drug Saf. - 2013//[Electronic resource]. - Available from: http://www. ncbi.nlm.nih.gov/pubmed/23529919
Kumbhani D. J. Predictors of adherence to performance measures in patients with acute 3. myocardial infarction/D. J. Kumb-hani//Am. J. Med. -2013. - Vol. 126, № 1. - P. 741-749.
Teshaev Oktyabr Ruhullaevich, Murodov Alijon Salimovich, Sadykov Rasul Rustamovich, Hamdamov Bakhtiyor Zaripovich, Tashkent Medical Academy E-mail: saodat.us@mail.ru
Improved results of treatment of purulent wounds with complex use of photodynamic therapy and CO2 laser in the experiment
Abstract: The aim of research was the evaluation of the effectiveness of photodynamic therapy and CO2 laser destructive purulent wounds of soft tissues in the experiment. Photodynamic therapy is a very effective non-invasive and gentle treatment of purulent wounds and serve as justification for the use of the method of photodynamic therapy in clinical practice for the treatment of acute local inflammatory processes combined with CO2 laser and traditional treatments. These laboratory, thermometry, morphological, microbiological and planimetric data suggest that photodynamic therapy and CO2 laser is very effective non-invasive treatment of purulent wounds and serve as justification for the use of the method in clinical practice for the treatment of local acute purulent-destructive diseases of soft tissues.
Keywords: Photodynamic therapy, photosensitizer, experiment, methylene blue, purulent wound, microbe, CO2 laser, laser surgery.
Despite the advances made by medical science, questions of of the wound supports inflammation and slows down the course treatment of patients with suppurative-septic pathology of the skin of reparative processes. According to the literature information, and soft tissues do not lose their actuality. Bacterial contamination the number of patients with acute purulent soft tissue diseases are
