CC BY
330. Savilov P. N. Blood flow and oxygen tension in the liver in various ways of its damage and hy-peroxia. Patologicheskaya fiziologiya i eksperi-mental'naya terapiya 2020;64(2):54-62[in Rus] DOI: 10.25557/0031-2991.2020.02.54-62
31. Serov V. I., Barsukov V. A. Dynamics of redox potential, oxygen tension and blood flow in the brain in hemorrhagic shock and hyperbaric oxygenation in: Metabolic mechanisms of hyperbaric oxygenation (ed. A.N. Leonov) Voronezh: VSMI,1980:42-45. [in Rus]
32. Kuznetsov V. A. Dynamics of redox potential and indicators of coupling of oxidation and phosphorylation in muscle tissue in acute blood loss and hyperbaric oxygenation in: Metabolic mechanisms of hyperbaric oxygenation (ed. A.N. Leonov) Voronezh: VSMI,1980:158-160.[in Rus]
33. Savilov P. N. Hyperoxic dilatation of pulmonary vessels Directory in hyperbaric biology and medicine Voronezh 2004;12(1-4):45-85. [in Rus]
34. Savilov P. N. Effect of hyperbaric oxygenation on glutamine metabolism in damaged and intact liver lobes Biomedicinskaya Khimiya 2004;50(2):164-171.[inRus]
35. Savilov P. N. Correction of hyperbaric oxygen disorders of glutamine metabolism in the liver operated on the background of chronic hepatitis Biomedicinskaya Khimiya. 2009;55(4):500-509.[in Rus]
36. Savilov P. N. Effect of hyperbaric oxygenation on glutamine metabolism in the liver Biomedicinskaya Khimiya 2014;60(3):364-367.[in Rus]
37. Shepeleva Ya. V. Influence of hyperbaric oxygenation in clinical regimens on lipid peroxidation and antioxidant protection of the brain of a healthy body
38. Yakovlev N. V. Effect of hyperbaric oxygenation in clinically applied regimens on lipid peroxidation and antioxidant activity of the lungs of a healthy body Diss. Cand of Med. Sci. VSMA, Voronezh,2004 [in Russ]
39. https://rn.gazeta.ru/amp/sci-ence/2020/11/20_a_13367851.shtml
40. Olovnikov AM. A theory of marginotomy. The incomplete copying of template margin in enzymic synthesis of polynucleotides and biological significance of the phenomenon. J Theor Biol. 1973 Sep 14;41(1):181-190.
41. Cohen S., Graham M., Lovrecz G., Bache N., Robinson P., Reddel R. Protein composition of catalyt-ically active human telomerase from immortal cells Science Journal.2007;315(5820):1850—1853.PMID 17395830.
42. Egorov E. E. The role of telomeres and telomerase in the processes of cellular aging and carcinogenesis: Diss Dokt. of Biol.. Sci,. M, 2003.
43. https://ru.widia.org/wiki/%D0%A2%D0%B5 %D0%BB%D0%BE%D0%BC%D0%B5%D1%80% D0%B0%D0%B7%D0%B0
POSSIBILITIES OF MULTISPIRAL COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF CORONARY CALCIFICATION IN PATIENTS WITH DYSPLASTIC HEART
Pimenov L.
Doctor of medical sciences, professor, head of the Department of General Practice and Internal Medicine with the Course of Emergency Medicine, Izhevsk State Medical Academy, Izhevsk, Russia
Remnyakov V.
Candidate of medical sciences, radiologist, head of the Department of Computed Tomography, Republican
Clinic and Diagnostics Center, Izhevsk, Russian Federation
Smetanin M.
Candidate of medical sciences, sonographer, radiologist, Republican Clinic and Diagnostics Center,
Izhevsk, Russian Federation
Avdeev AE.
Radiologist, Republican Clinic and Diagnostics Center, Izhevsk, Russian Federation
Chernyshova T.
Doctor of medical sciences, professor of the Department of General Practice and Internal Medicine with the Course of Emergency Medicine, Izhevsk State Medical Academy, Izhevsk, Russia
Abstract
The problem of heart connective tissue dysplasia syndrome is extremely relevant due to the increased risk of rhythm and conduction disorders, infectious endocarditis, thromboembolism and sudden cardiac death (SCD). Structural heart diseases (SHD) are manifestations of small anomalies of development on the part of the cardiovascular system. Dysplastic heart refers to the combination of constitutional, topographical, anatomical, and functional features of the heart in a patient with connective tissue dysplasia (CTD). The standard for the diagnosis of coronary calcification (CC), one of the known predictors of coronary heart disease (CHD) and complications of cardiovascular diseases (CVD), is multispiral computed tomographic scanner (MSCT).
Keywords: women, connective tissue dysplasia, structural heart diseases, coronary calcification, multispiral computed tomography, ECG synchronization.
Background: The cardiological aspects of hereditary connective tissue disorders (HCTD) are represented by intracardiac and vascular abnormalities. The Russian national recommendations issued over the past 10 years and devoted to the principles of diagnosis, treatment and rehabilitation of patients with CTD emphasize the relevance of this field of domestic clinical medicine [1; 2; 3].
It should be noted that the clinical manifestations of CTD are extremely diverse and complex, different organs and systems are involved in the pathological process, but it is the severity of dysplastic stigmatiza-tion of cardiovascular system (CVS) that determines the life and work prognosis in each individual patient [4; 5]. Coronary calcium (CC) is known to be a characteristic biomarker of atherosclerotic lesions of the coronary arteries and is a frequent finding during MSCT of the chest [6].
According to domestic and foreign authors, the determination of the Agatston calcium index using MSCT is an important tool for predicting the risk of developing CHD and can be used as a predictor of acute coronary events [7; 8; 9; 10].
Methods: The criteria presented in the clinical recommendations of the Russian Scientific Medical Society of Therapists on the diagnosis, treatment and rehabilitation of patients with connective tissue dysplasia (first revision) were used to identify undifferentiated connective tissue dysplasia (UCTD) in the examined patients [2].
We examined 35 patients aged 19 to 37 years (the average age was 25.0±6.5 years) with structural heart diseases (SHD - anatomical changes in the architectonics of the heart and major vessels that do not lead to gross violations of the functions of the cardiovascular system), cardialgia of varying severity, with a history of cardiac arrhythmias, shortness of breath with moderate physical exertion. To determine the presence of CC and assess its severity, multi-spiral computed tomography (MSCT) with ECG synchronization was performed on a Somatom Sensation computed tomography (Siemens, Germany).
The blood lipid profile and the presence of coronary calcification (CC) were evaluated in all patients. To analyze the severity of coronary calcinosis, MSCT with ECG synchronization was performed on a Somatom Sensation computed tomography system (Siemens, Germany).
Currently, computed tomography (CT) with ECG synchronization (assessment of plaques of the first type) and CT-coronarography (assessment of all types of plaques) are used in everyday clinical practice to study the coronary arteries for calcified, mixed, solid plaques.
According to Nikolaev A. E. and co-authors, the detection of calcification of the coronary arteries should be carried out in the form of an additional examination within the framework of screening programs, using visual assessment, or, if the quality of images allows, quantitative assessment [8].
To quantify the degree of coronary calcification, we used a standardized method for determining the calcium index, proposed in 1990 by Agatston A. S. et al
[7]. The degree of calcification of the trunk of the left coronary artery (LM), the anterior descending artery (LAD), the circumflex artery (CX), and the right coronary artery (RCA) was assessed as follows: no calcification (0 Agatston units), minimal calcification (1-10 Agatston units), moderate calcification (11-100 Agatston units), medium calcification (101-400 Agatston units), and severe (massive) calcification - more than 400 Agatston units [9].
The comprehensive clinical and functional examination was conducted in accordance with the international ethical requirements of WHO (GCP - Good Clinical Practice) and the Helsinki Declaration of the World Medical Association on Biometric Research in Humans.
Statistical processing of the obtained results was carried out by the methods of variation statistics using the software Microsoft Excel 2016 and Statistica 10.0 (Statsoft Russia). The Kolmogorov-Smirnov test was used to test the hypothesis of the distribution law. The level of statistical significance in the study was taken as p<0.05.
Results. SHD was clinically manifested by prolapse of atrioventricular valve leaflets in 29 (82.9%) women. In one case (2.9%), an atrial septal aneurysm was registered, in 21 (60%) cases - abnormally located chords. All patients complained of cardialgia of varying severity and almost constantly rapid heartbeat. In 28 (80%) women with Holter ECG monitoring, ventricular extrasystoles were registered, and in 18 (51.4%) - atrial and ventricular extrasystoles. Every second patient (16 out of 35 - 47.5%) complained of shortness of breath with moderate physical activity and 8 patients (22.9%) - of shortness of breath with minor physical activity. 9 respondents (25.7%) noted episodes of shortness of breath at rest, which they associated with stressful situations.
When assessing the blood lipid spectrum, the women were divided into 3 groups (by age): Group 1 (under 20 years old), group 2 (21-30 years old), group 3 (over 31 years old). It should be noted that the parameters of the blood lipid spectrum in all 3 groups of the examined patients were within the reference values.
A clinical case. Patient E., female, 33 years old, engineer, married with 1 child. Height -179 cm, body weight - 57 kg, body mass index (BMI) -19.35 kg / m2 (BMI in a 33-year-old woman normally ranges from 17 to 19.9 kg/m2).
From 14 to 18, she was a member of the Udmurtia youth national basketball team. She stopped playing sports due to the appearance of tachycardia and cardiac arrhythmias and mitral and aortic valve prolapses, diagnosed by using echocardiography. So, she has a structural heart disease (SHD) with manifestations of the syndrome of CTD of the heart (dysplastic heart). The parameters of the blood lipid spectrum corresponded to the norm: total cholesterol - 3.84 mmol/L, HDL cholesterol-2.6 mmol/L, LDL cholesterol - 1.24 mmol/L, triglycerides - 0.93 mmol / l.
Figure 1 shows the results of the MSCT examination of the coronary arteries with ECG synchronization in patient E.
Figure 1. MSCT of the coronary arteries with ECG synchronization in patient E.
The results of the MSCT of patient E. showed a value of the Agatston calcium index (score) equal to zero, which indicated the complete absence of coronary calcification.
According to the MSCT data, the average value of the Agatston calcium index in young women with small heart abnormalities was 0.14 (0.06) (p<0.05), which, in fact, excluded the contribution of coronary sclerosis to the pathogenesis of cardiargia in young women with SHD. The parameters of the blood lipid spectrum in all patients corresponded to the age values of the norm.
Thus, we did not detect any signs of calcification of the coronary arteries and dyslipidemia in our patients. The results obtained may indicate a minimal risk of early development of atherosclerosis in young women with cardiac manifestations of UCTD. Meanwhile, the high incidence of acute coronary events in patients with multiple heart abnormalities in UCTD requires further investigation to identify their predictors [11; 12].
Conclusions. Determining the degree of coronary calcification using MSCT with ECG synchronization is a simple and reliable method for predicting the risk of acute coronary events in patients with undifferentiated connective tissue dysplasia syndrome. Its use as a screening for atherosclerosis is promising. The data obtained in the study exclude the contribution of atherosclerosis to the pathogenesis of cardiac symptoms in women of reproductive age with small heart abnormalities. It is necessary to expand the research program to assess, first of all, the contribution of cardiac autonomic neuropathy, which can be the leading cause of arrhythmic syndrome and determine clinical cardiac manifestations, to the development of acute coronary events.
REFERENCES:
1. UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA (clinical guidelines). Therapy. 2019; 7(33): 9-42.
2. Clinical recommendations of the Russian Scientific Medical Society of Therapists on the diagnosis, treatment and rehabilitation of patients with connective tissue dysplasia (first revision) / / Medical Bulletin of the North Caucasus. 2018. T13. NO. 1-2. PP. 137-209.
3. SUPRANATIONAL (INTERNATIONAL) RECOMMENDATIONS FOR STRUCTURAL ABNORMALITIES OF THE HEART. Medical Bulletin of the North Caucasus. 2018; 13(1-2): 272-324.
4. Nechaeva G. I., Drokina O. V., Druk I. V., Vershinina M. V., Lyalyukova E. A., Kolmenkova I. V. Main directions in the treatment of patients with connective tissue dysplasia. Attending physician. 2014; 8: 70-73.
5. Gnusaev S. F. Syndrome of connective tissue dysplasia of the heart in children. The attending physician. 2010; 8: 40-44.
6. Zhuravlev K. N., Vasilyeva E. Yu., Sinitsyn V. E., Shpektor A.V. Calcium index as a screening method for the diagnosis of cardiovascular diseases. Russian Journal of Cardiology. 2019; 24(12): 153-161.
7. Agatston AS, Janowitz WR, Hildner FJ et al. Quantification of coronary artery calcium using ultra-fast computed tomography. J Am Coll Cardiol. 1990; 15(4): 827-32.
8. Nikolaev A. E., Shapiev A. N., Blokhin I. A., Ramazanova D. M., Shapieva A. N., Gombolevsky V. A., Nizovtsova L. A. New approaches to the assessment of changes in coronary arteries in multispiral computed tomography. Russian Journal of Cardiology. 2019; 24(12): 124-130.
9. Kachurina E. N., Kokov A. N., Kareeva A. I., Barbarash O. L. Assessment of the prevalence of coronary calcification in persons living in the territory of Western Siberia (according to the ESSE-RF study). Complex problems of cardiovascular diseases. 2018; 7(4) 33-40.
10. Greenland P, Blaha MJ, Budoff MJ et al. Coronary calcium score and Cardiovascular Risk. J Am Coll Cardiol. 2018; 72(4): 434-47.
11. Smetanin, M. Yu. Small anomalies of the heart as a manifestation of connective tissue dysplasia: modern diagnostic methods / M. Yu. Smetanin, S. Yu. Nurgalieva, N. Yu. Kononova, L. T. Pimenov, T. E. Chernyshova / / Practical medicine. - 2019. - T. 17, No. 2. - S. 28-31.
12. Smetanin, M. Yu. Vegetative dysfunction as a manifestation of connective tissue dysplasia in women / M. Yu. Smetanin, T. E. Chernyshova, L. T. Pimenov, N. Yu. Kononova // Medical Bulletin of the North Caucasus. - 2018. - Vol. 14. - No. 4. - pp. 594-596.
CLINICAL AND HORMONAL CHARACTERISTICS OF THE HEALTH STATE OF PREMENOPAUSAL WOMEN WITH HYPOTHYROIDISM
Chukur O.
Assistant, Department of Internal Medicine № 1, I. Horbachevsky Ternopil National Medical University
Pasyechko N.
Professor, Head of the Department of Internal Medicine № 1, I. Horbachevsky Ternopil National Medical
University
Bob A.
Associate Professor, Department of Internal Medicine № 1, I. Horbachevsky Ternopil National Medical
University
КЛШШО-ГОРМОНАЛЬНА ХАРАКТЕРИСТИКА СТАНУ ЗДОРОВ'Я Ж1НОК ПРЕМЕНОПАУЗАЛЬНОГО В1КУ З Г1ПОТИРЕОЗОМ
Чукур О.О.
Асистент кафедри внутргшньог медицини, Тернопшьський нацгональний медичний утверситет
¡мет 1.Я.Горбачевського Пасечко Н.В.
Д.мед.н., професор, завгдувач кафедри внутргшньог медицини № 1, Тернопшьський нацгональний
медичний унгверситет гменг 1.Я.Горбачевського
Боб А.О.
К.мед.н., доцент кафедри внутргшньог медицини № 1, Тернопшьський нацгональний медичний унгвер-
ситет гменг1.Я.Горбачевського
Abstract
Aim: to assess the relationship between the severity of menopausal syndrome and the level of thyroid-stimulating hormone in premenopausal women with hypothyroidism.
Materials and methods: 146 premenopausal women with autoimmune hypothyroidism were examined. The diagnosis was made with an increase in thyroid-stimulating hormone, free thyroxine, free triiodothyronine, antibodies to thyroglobulin and / or antibodies to thyroperoxidase and ultrasonographic changes of the thyroid gland. Women were divided into three groups: Group I (25 patients) with low-interval of thyroid-stimulating hormone (TSH) (0.4-2.0 mlU/ml), Group II (63 patients) TSH level was in the high normal interval (2,0-4,0 mlU/ml) and group III (58 patients) with subcompensated hypothyroidism, the average level of TSH was 6.40 ± 0.2 mlU/ml. Assessment of the severity of menopausal syndrome was performed by questionnaire based on the results of the modified menopausal Kupperman index.
Results. According to the questionnaire, menopausal syndrome was detected in 71.2% of surveyed women, in 28.8% of patients it was not observed. Complaints of metabolic and endocrine origin came to the fore. Assessing the state of health of women according to the Kupperman index: in group I there was a mild menopausal syndrome in 16.4% (n=24), the median value of the total modified menopausal index was 22 (7; 34) points, complaints of metabolic 4 (2; 7) and neurovegetative character of 12 (9; 18) points came to the fore, (p<0,05). In group II, menopausal syndrome was detected in 26.7% of patients: mild in 21.2% (n = 31) and moderate in 5.5% (n = 8), the total value of the menopausal index was 36 (11; 55) points, (p <0,05). This group was dominated by metabolic 5 (3; 7) and neurovegetative syndromes 23 (12; 29) points, (p <0.05). In group III, menopausal syndrome was observed in 28.1% of women, it was manifested by subscales of vasomotor 27 (18; 32), metabolic 9 (4; 15) and psychoemotional symptoms 9 (5; 14), that were statistically significantly different from the indicators of group I (p <0,01). Mild menopausal syndrome was detected in 10.3% (n = 15), moderate menopause in 17.8% (n = 26), the median value of the total menopausal index was 49 (15; 56) points, (p <0,05).
