Saratov JOURNAL of Medical and Scientific Research

Internal Diseases

Irritable bowel syndrome: epidemiological and pathogenetic aspects

Year: 2018, volume 14 Issue: №1 Pages: 53-60
Heading: Internal Diseases Article type: Review
Authors: Tikhonova Т.А., Kozlova I.V.
Organization: Saratov State Medical University
Summary:

The literature review focuses on some epidemiological aspects, molecular-genetic predictors of irritable bowel syndrome formation, the role of psychosocial and infectious factors, low-grade inflammation, imbalance between neu-rotransmitters and cytokines, as well as changes in the intestinal microbiome in the development of irritable bowel syndrome.

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Prediction of heart remodeling in patients with bronchial asthma

Year: 2018, volume 14 Issue: №1 Pages: 49-52
Heading: Internal Diseases Article type: Original article
Authors: Ryabova A.Yu., Shapovalova T.G., Shashina M.M., Lekareva L.I., Kudishina M.M.
Organization: Saratov State Medical University
Summary:

The aim of the study was to identify cardiac remodeling in bronchial asthma (BA), to construct a mathematical model for its prediction to optimize diagnosis. Material and Methods. Atotal of 283 patients with asthma who underwent a comprehensive examination including general clinical, immuno-enzymatic (determination of the N-terminal fraction of the brain natriuretic propeptide, activity of the angiotensin-converting enzyme) and instrumental methods: ECG, ECHO, daily Holter monitoring of ECG, FVD. Results. The analysis of the obtained results showed that in patients with asthma, structural, geometric changes of the myocardium of the right and left ventricles were noted, increasing as the disease became more severe. The activation of local neurohormonal systems, primarily myocardial is no less important. An analysis of the relationship between the concentration of natriuretic peptide and the end-diastolic size of the right ventricle in BA patients revealed a moderate correlation relationship. There was a weak correlation between the right ventricular end-diastolic size, the right ventricular frontal wall thickness and the ACE level. The analysis of the relationship between the above dimensions of the right ventricle and the index of the balance of the autonomic nervous system was reliable. Conclusion. Thus, the development of cardiac remodeling in AD patients occurs against the background of the hyperactivation of neurohumoral systems, including sympathoadrenal, renin-angiotensin-aldosterone and the system of natriuretic peptides.

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Comparative evaluation of autonomic regulation of circulation in patients undergone coronary artery bypass grafting or correction of acquired valvular heart disease

Year: 2018, volume 14 Issue: №1 Pages: 45-49
Heading: Internal Diseases Article type: Short message
Authors: Kiselev A.R., Vulf K.A., Shvartz V.A., Karavaev A.S., Borovkova E.l., Bockeria O.L.
Organization: Bakulev Center of Cardiovascular Surgery, Saratov State Medical University n.a. V.I. Razumovsky Research Institute of Cardiology, Saratov state university
Summary:

The aim of the research was to study the peculiarities of vegetative regulation of blood circulation in cardiac surgery patients who underwent coronary artery bypass grafting (CABG) or correction of acquired valvular heart disease (CAVHD). Material and Methods. In this study we included 42 patients (12 women; 63 (57; 67) years), who underwent CABG, and 36 patients (16 women; 58 (47; 65) years) who underwent CAVHD. The synchronous 15 minutes records of electrocardiogram and photoplethysmogram (PPG) were performed in all patients before and after surgery. Time domain and frequency domain measures of heart rate variability (HRV) and index of synchronization between low-frequency (LF) oscillations in HRV and PPG (index S) were analyzed. Results. Most studied autonomic indices did not have statistically significant differences between patients with CABG and CAVHD in the study stages, except for heart rate, which was higher in patients before CAVHD (p=0,013). Conclusion. The values of HRV and index S do not depend on the difference in the clinical status and the features of performed cardiac surgical interventions between patients with CABG and CAVHD.

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Features of the clinical course of gastroesophageal reflux disease associated with obesity

Year: 2018, volume 14 Issue: №1 Pages: 42-45
Heading: Internal Diseases Article type: Original article
Authors: Andreeva E.l.
Organization: Stavropol State Medical University
Summary:

The research goal is to reveal the features of clinical manifestations of gastroesophageal reflux disease (GERD) in obesity. Material and Methods. A survey and anthropometric study of 51 patients suffering from GERD and obesity aged 30 to 60 years were conducted. The average age of the patients was 42.3±2.11 years. Patients were divided into groups according to the BMI score. The control group consisted of patients suffering from GERD without obesity. Results. The main complaint of the patients of the control group was heartburn, while the patients of the main group had complaints of dyspeptic nature. With an increase in BMI, there was an increase in the incidence of complaints, in addition, complaints of an extra-esophageal nature associated with the direct effect of acidic gastric contents on the pharyngeal mucosa were detected. This regularity is explained in the article by pathogenetic mechanisms of GERD development. In patients suffering from GERD without obesity, the development of the disease is caused by a change in the motor activity of the esophagus due to a decrease in the tone of the lower esophageal sphincter, and in patients with co-pathology the main role is given to increased intragastric pressure, which leads to disruption of the sphincter. Conclusion. Thus, the clinical picture of combination of GERD and obesity differs atypical for GERD current, the main features of which are the predominance of dyspeptic complaints, motor-evacuation disorders, and the presence of extraesophageal complaints.

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Pulmonary lymphangioleiomyomatosis (case report)

Year: 2017, volume 13 Issue: №4 Pages: 828-833
Heading: Internal Diseases Article type: Case report
Authors: Shashina M.M., Shapovalova T.G., Kazimirova N.E., Ryabova A.Y., Arkhangelskaya Е.Е., Lifanova D.V., Chernyshkova M.A.
Organization: Saratov State Medical University, Saratov Clinical Hospital № 8
Summary:

This article presents a clinical observation of a patient with a proven diffuse-nodular form of lymphangioleiomyomatosis of the lungs. Features of the course of the process against the background of pathogenetic therapy which included sirolimus and progesterone have been considered. It is necessary to raise awareness of doctors about the disease that facilitates timely diagnosis and treatment.

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A rare case of Loeffler endocarditis associated with eosinophilic granuloma-tosis with polyangiitis

Year: 2017, volume 13 Issue: №4 Pages: 823-828
Heading: Internal Diseases Article type: Case report
Authors: Skryabina E.N., Safonova V.N., Agareva Т.А.
Organization: Saratov State Medical University
Summary:

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare disease that affects small and medium-sized blood vessels of different organs, characterized by asthma, prominent peripheral blood eosinophilia. Cardiac involvement was reported in 20-50% and it is the major cause of mortality. A case of EGPA in a 43-year-old female, who had endocarditis, associated with thrombus formation in left ventricle, thromboembolic syndrome and recurrent stroke has been reported. The described case has showed that it is of crucial importance to perform the full cardiac imaging even in asymptomatic patients with suspected EGPA. The early identification of cardiac involvement may lead to better prognosis.

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A clinical case of fast progression of amyloidosis of kidneys in rheumatoid arthritis

Year: 2017, volume 13 Issue: №4 Pages: 821-823
Heading: Internal Diseases Article type: Case report
Authors: Romanova I.A., Magdeeva N.A., Nikitina N.M.
Organization: Saratov State Medical University
Summary:

The article presents clinical case of unfavorable outcome of amyloidosis of kidneys in a patient with rheumatoid arthritis. The absence of basic treatment and persistent activity of disease leads to fast progression of nephrotic stage of secondary amyloidosis in a young woman.

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Platelet indices as markers of platelet turnover and aggregation: pathophysiological interpretation, clinical impact, perspectives in research

Year: 2017, volume 13 Issue: №4 Pages: 813-820
Heading: Internal Diseases Article type: Review
Authors: Malinova L.I., Furman N.V., Dolotovskaya P.V., Puchinyan N.F., Kiselev A.R.
Organization: Saratov State Medical University n.a. V.I. Razumovsky Research Institute of Cardiology
Summary:

The purpose of the review is to characterize existing in open access bibliographical databases such as eLibrary and PubMed evidence on clinical impact of morphometric platelet indices as markers of platelet aggregation ability and turnover as a methodology and theoretical framework of further investigation. Studies results were pooled from open access bibliographic databases (eLibrary, and PubMed) according to modified PRISMA algorithm. Relevant studies were identified by systematic searches of the original studies published during the last 10 years in the Russian and English languages. Results of 96 original studies in accordance with inclusion criteria were published during the last 10 years in scientific journals indexed in eLibrary, and PubMed. The majority of publications (64.58%) consist of evidence pro diagnostic and prognostic significance of platelet indices. Studies demonstrating the significance of platelet indices as possible risk markers of thrombotic events in cardiovascular patients were predominating among "pro" publications. In 15.63% published results contradict concept of platelet indices usefulness as diagnostic and prognostic markers in clinical practice. Morphometric platelet indices can be considered as useful diagnostic and prognostic markers of thrombotic events in cardiovascular patients. Existing gaps in evidence suggest the need of further investigations.

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Peculiarities of clinical course of gastroesophageal reflux disease in patients with type 2 diabetes and obesity

Year: 2017, volume 13 Issue: №4 Pages: 809-812
Heading: Internal Diseases Article type: Original article
Authors: Andreeva E.l.
Organization: Stavropol State Medical University
Summary:

Aim: to study the clinical course of gastroesophageal reflux disease (GERD) in patients with type 2 diabetes and evaluation of the parameters of the esophagus 24-hour pH-metry. Material and Methods. In the examination of patients with GERD, three groups of patients were selected for 50 people each. The first group includes patients with GERD with combined course of obesity and type 2 diabetes (mean age 54.6±2.73 year; 32 females and 18 males). The second group included patients with GERD against obesity (mean age 42.3±2.11 year; 30 females and 20 males). The control group consisted of patients with GERD without excess body weight and concomitant pathology (average age43.6±2.11 year; 29 females and 21 males). In addition to collecting complaints and anamnesis, the patients and the control group underwent a 24-hour pH-metric study of the esophagus according to a conventional method. Results. Patients suffering from GERD in the background of type 2 diabetes have a clinically asymptomatic or asymptomatic course; there is a significant increase in the daily pH-metry, indicating a more pronounced nature of the changes. Conclusion. Patients suffering from GERD in the background of type 2 diabetes require a comprehensive examination of the upper digestive tract to identify GERD, even if there are no complaints characteristic of the disease.

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Optimization of chronic kidney disease stages in patients with type 2 diabetes mellitus with the program "ChronicKidneyDiseaseDiagnostics"

Year: 2017, volume 13 Issue: №3 Pages: 484-488
Heading: Internal Diseases Article type: Original article
Authors: Yarkova N.A., Borovkov А.А., Soloviyanova E.N.
Organization: N. Novgorod State Medical Academy
Summary:

Objective: to evaluate the practical possibility of automated calculation of glomerular filtration rate (GFR) in patients with type 2 diabetes mellitus (DM) on the basis of the developed computer program «Chronic_Kidney_Disease_Di-agnostics». Material and Methods. The study included 233 patients (78 men and 155 women) with type 2 diabetes who were hospitalized in the Neuroendocrinological Department of Nizhny Novgorod Regional Clinical Hospital n.a. O. N. Semashko during the period from 2013 to 2016. The average age of patients was 57.75 years [52; 64]. According to the history the mean duration of type 2 diabetes was of 5.3 years [0.3; 8.0]. The average level of glycosylated hemoglobin (HbA1c) was 9.53% [7.0; 10.2]. All patients underwent clinical and laboratory an3 instrumental studies. The data obtained were entered into the program «Chronic_Kidney_Disease_Diagnostics» (authors: N.A. Yarkova, N.N. Borovkov, D.A. Terekhova). Statistical analysis of the results of research carried out by Statistica 7.0. Results. According to the study in patients with type 2 diabetes, chronic kidney disease has been identified in the pre-clinical stages C2 and C1 (56.2 and 25.8%, respectively). Conclusion. The program «Chronic_Kidney_Disease_Diagnostics» is intended for nephrologists, endocrinologists and therapists. It allows specialists to diagnose kidney CKD in patients in the therapeutic profile of the early preclinical stage. It is designed for quick calculation of glomerular filtration rate.

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