Vol 5, No 2 (2011)

Due to the increasing number of HIV-infected patients and duration of their survival value for cardiovascular disease complications in the structure of HIV is increasing. The article describes the most common complication, developing in this group of patients. Focuses on the tactics of dilated cardiomyopathy and pericardial effusion in HIV-infected patients. Coronary heart disease and its relation to use of antiretroviral drugs and HIV infection are also described.

Aim – to study the frequency of occurrence and characteristics of arterial hypertension (AH) in patients with bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD).

Materials and methods. The study included 390 asthmatic patients (130 men and 260 women) and 230 patients with COPD (226 men and 4 women).

Results. Hypertension was detected in 158 (40.5 %) asthmatic patients and in 142 (61.7 %) patients with COPD. Analysis results give evidence of higher detection rate of hypertension, as well as higher average systolic and diastolic blood pressure in different age groups in patients with chronic obstructive pulmonary disease, compared with data in the population. This suggests that presence of chronic obstructive pulmonary disease is a risk factor for hypertension in the population.

Conclusion. Unlike in patients with essential hypertension, patients with chronic obstructive pulmonary disease and arterial hypertension family history is not typical. Risk factors for hypertension in patients with asthma were: female sex, severity of disease, overweight. In men 
with COPD risk factors of hypertension included overweight, reduced forced expiratory volume in first second < 50 % of predicted.

Aim – evaluation of ambulatory blood pressure monitoring (ABPM) in pregnant women with metabolic syndrome (MS) in the II trimester, revealing their relationship with specifics of endothelial function, and determinationof possible predictor values of some indicators of ABPM in the development of preeclampsia and placental insufficiency.

Materials and methods. Evaluation ABPM results performed in 82 pregnant patients with MS and 20 healthy pregnant women at 16–22
weeks of gestation.\

Results. More than in 50 % of surveyed patients common nature of MC hypertension was confirmed, which was manifested in a moderate increase in their blood pressure with a abnormality of its circadian rhythm. The presence of these symptoms correlated with hypertension in patients with new-onset abnormality of endotheliumependent vasodilatation in reactive hyperemia of brachial artery.

Conclusion. Negative predictor role of the daily blood pressure index concerning development of preeclampsia and placental insufficiency in
the future was established.

Aim – to estimate the contribution of traditional risk factors in the development of cardiovascular complications (CVC) in patients with chronic heart failure (CHF) of ischemic genesis, the creation of predictive models of adverse outcome.

Materials and methods. The study included 167 patients (144 men and 23 women) aged 40 to 72 years after myocardial infarction with manifestations of CHF and written informed consent signed. All patients underwent general clinical examination, a test with a 6-minute walk test, echocardiography, determination of levels of high sensitivity C-reactive protein (hsCRP), NT-proBNP (N-terminal fragment pro-brain
natriuretic peptide). Monitoring of patients lasted for 12 months with fixing the following end points: worsening of CHF, the development of
unstable angina and myocardial infarction, death, the total number of CVAE.

Results. The development of the MTR during the year in patients with ischemic CHF is associated with age older than 60 years, body weight > 90 kg, heart rate (HR) > 70 beats/min, a distance of 6-minute test < 250 m, greater dilatation and faction ejection < 37 %, uric acid level > 250 umol/L, NT-proBNP > 250 pg/ml, hsCRP > 5.8 g/l. In the model predicting the development of the MTR in patients with ischemic CHF included age, body mass index, heart rate, uric acid levels, NT-proBNP, hsCRP, which are independent significant predictors of adverse outcome.

Conclusion. The created model allows us to calculate individual risk for the MTR in patients with ischemic CHF during the year and make the correction of risk factors for improving prognosis. The sensitivity of this model is 81 % and specificity – 85 %.

Aim – assessment of quality of life (QoL) in patients with rheumatoid arthritis (RA) with the presence and severity of bronchopulmonary lesions.

Materials and methods. The study included 104 patients with RA and 100 patients not suffering from RA and verified chronic respiratory diseases. The analysis of the QOL of patients using questionnaires EQ-5D (EuroQoL Group, 1990) and SGRQ (St. George's Hospital questionnaire to assess respiratory function), performed spirometry, bodyplethysmography , pulse oximetry, the definition of lung diffusion
capacity, multispiral computed tomography of the lungs.

Results. Performance of all scales and the resulting indices of questionnaires EQ-5D and SGRQ showed a significant decrease in QoL of
RA patients compared with those in control group and the general population. A correlation index of EQ-5D with vital capacity (r = 0.47;
p < 0.001) and diffusion capacity (r = 0.67; p < 0.01) of the lungs is revealed. The main reason for the reduction of indices of the questionnaire SGRQ in patients with RA was the presence of shortness of breath. The multi-factorial origin of dyspnea in patients with RA with the
essential role of bronchopulmonary lesions was established.

Conclusion. Bronchopulmonary lesions in the underlying disease have an adverse impact on the QOL of patients with RA. Promising directions for improving the QOL of RA patients with bronchial lesions can be considered for activities for the conservation of respiratory lung function, exercise control RA activity, elimination of anemia correction of psycho-emotional disturbances of anxiety-depressive character.

The main causes of chronic pelvic pain syndrome (CPPS), and its pathogenetic mechanisms are described. The criteria of evaluation of
chronic pelvic stress pain are described .It is proposed to use ultidisciplinary approach for therapy CPPS with compulsory neurologists, chiropractic physicians, psychiatrists and therapists, urologists, gynecologists and proctologists involvement to improve diagnostic and quality of therapeutic measures.

Presented clinical case is a classical version of «amiodarone lung» in patient taking inadequate doses of the drug, probably, according to the scenario of acute clinical course

Degenerative spine disease is one of the causes of back pain. Clinical types of pain and severity of inflammatory changes in the vertebral bodies depend on the activity of pro-inflammatory cytokines. Rate of development and progression of degenerative changes in the spine structures is genetically determined. Therapy of pain syndrome associated with a degenerative disc disease may include use of methods to restore damaged intervertebral disc structures, and also use of different combinations of anti-inflammatory and analgesics therapy.

Evidence based medicine data on ability of antiplatelet, including dual antiplatelet, therapy to improve the life expectancy of patients with high risk of thrombotic complications, especially patients with acute myocardial infarction is presented in brief. The problem of choosing a drug and resistance was overcoming. Modern clinical guidelines on safe antiplatelet therapy are presented.

The article discusses many common clinical and laboratory features of calcific aortic stenosis (CAS) and osteoporosis in patients of advanced age. After evaluation of bone mineral density, risk factors of fractures and falls, in conjunction with bone turnover markers, 2 distinct types of osteoporosis in CAS patients were described. The active character of bone’s turnover and aortic valve calcification can not regard CAS as degenerative, but regenerative process. The article is illustrated by case history, and elucidates the possibilities of pharmacological intervention, including new bisphosphonate drug – xydiphone.