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OBJECTIVE: To assess the outcomes of long-term treatment in multiple sclerosis (MS) patients with Infibeta (interferon beta-1b). MATERIAL AND METHODS: The article presents the results a real-world, multicenter, retrospective, observational study of treatment with interferon beta-1b. We enrolled 332 patients with MS who had been receiving Infibeta for at least 8 years. 60.2% of them had a relapsing-remitting MS (RRMS). 73.2% patients received only interferon beta-1b that was initial DMT. RESULTS: During the first year of the treatment, 66% of the patients reported no relapses regardless of the MS type. No relapses in the 8th year of treatment were observed in 86.9% of patients with RRMS and 77.7% with secondary progressive MS (SPMS). The median number of relapses during the whole follow-up period in RRMS patients was 1. The time to first relapse in the subgroup of patients who received interferon beta as the first treatment was longer compared to other treatment (median 4 and 2, respectively, p=0.0017). 42% of patients with RRMS remained progression-free during 8 years of follow-up. The flu-like syndrome was observed in 61.7% for the first year of treatment; in 36.3% it was periodically and was mild in 71.3%. CONCLUSION: The study outcomes confirm a high clinical response to the long-term treatment with Infibeta in patients with RRMS and SPMS and demonstrate that interferon beta-1b is one an optimal option for the initial treatment of patients with moderate disease activity.
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Esclerosis Múltiple Recurrente-Remitente , Esclerosis Múltiple , Humanos , Interferón beta-1a/uso terapéutico , Interferon beta-1b/uso terapéutico , Interferón beta/uso terapéutico , Esclerosis Múltiple/tratamiento farmacológico , Esclerosis Múltiple Recurrente-Remitente/tratamiento farmacológico , Estudios RetrospectivosRESUMEN
OBJECTIVE: To compare incidence of thromboembolic and hemorrhagic complications in patients with atrial fibrillation (AF) undergoing elective surgery on different schemes of perioperative anticoagulant therapy (ACT). MATERIAL AND METHODS: There were 86 patients (56 (65.1%) men and 30 (34.9%) women, mean age was 69 (64; 78) years) with non-valvular AF who underwent elective interventions. Forty (46.5%) patients underwent abdominal surgery, 34 (39.5%) - cardiovascular procedures, 12 (14.0%) patients underwent surgery for malignant diseases. We have analyzed incidence of thromboembolic and hemorrhagic events and compliance of perioperative ACT modes with current international guidelines. RESULTS: Thromboembolic and hemorrhagic events developed in 14 (16.3%) patients. Thromboembolic complications were noted in 6 (7.0%) patients, hemorrhagic events - in 8 (9.3%) cases. Maximum complication rate was observed in case of bridge-therapy (n=12, 20.0%). Cancellation of ACT was followed by 2 (9.5%) complications, bridge-therapy - by 4 (6.7%) thromboembolic complications. Hemorrhagic events were 2 times more common in case of this therapy (n=8, 13.3%). It was found that ESC guidelines for perioperative ACT were applied in less than half of patients (41, 47.7% patients with AF undergoing elective surgery). Half of complications (8 out of 16) occurred if unapproved modes of ACT were used (including 7 cases of bridge-therapy was not necessary). The causes of these complications were inadequate assessment of perioperative risk of thromboembolic and hemorrhagic events; unreasonable administration of bridge therapy. CONCLUSION: An unambiguous clinical effect of bridge therapy has not been confirmed in patients with high risk of thromboembolic complications. Cancer patients have higher risk of complications compared with others. These events occur mainly due to non-compliance with clinical guidelines and insufficient prevention of thromboembolic events.
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Anticoagulantes/efectos adversos , Fibrilación Atrial/tratamiento farmacológico , Procedimientos Quirúrgicos Electivos/efectos adversos , Hemorragia/prevención & control , Tromboembolia/prevención & control , Anciano , Anticoagulantes/uso terapéutico , Fibrilación Atrial/complicaciones , Femenino , Adhesión a Directriz , Hemorragia/etiología , Humanos , Masculino , Persona de Mediana Edad , Tromboembolia/etiologíaRESUMEN
Data on possibilities of personalized approach for direct oral anticoagulants (DOAC) choice in patients with atrial fibrillation are presented in the article. We also review clinical and fundamental studies and future perspectives on pharmacogenetic and pharmacokinetic tests to predict the efficacy and safety of DOAC.
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Anticoagulantes/administración & dosificación , Fibrilación Atrial/prevención & control , Administración Oral , Dabigatrán , Humanos , Medicina de Precisión , Pirazoles , Piridonas , Rivaroxabán , Accidente Cerebrovascular/prevención & control , Resultado del TratamientoRESUMEN
Atrial fibrillation (AF) is one of the most common heart rhythm disorders in the population. Researchers revealed a direct relationship between their incidence and a patient's age long ago. One of the most challenging issues of clinical practice in patients with AF is anticoagulant therapy used in the so-called very elderly patients aged 75 years and older when age itself is a risk factor for developing both thromboembolic and hemorrhagic events due to anticoagulants, regardless of the mechanism of action of the latter. However, scientific data regarding the treatment and prevention of thromboembolic events in elderly and senile patients with AF are very scarce and often uninformative. The data from the EURObservational Research Programme-Atrial Fibrillation Registry Pilot Phase (EORP-AF Pilot) and the randomized clinical studies RELY, ROCKET AF, ARISTOTLE, and AVERROES were analyzed to identify the most safe and most effective anticoagulant for elderly patients (over 75 years). Relying on the analyses of literature data, the authors propose an algorithm based on clinical characteristics for choosing the anticoagulant for patients older than 75 years.
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Anticoagulantes , Fibrilación Atrial , Accidente Cerebrovascular , Tromboembolia , Administración Oral , Anciano , Anticoagulantes/administración & dosificación , Fibrilación Atrial/tratamiento farmacológico , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Sistema de RegistrosRESUMEN
The paper gives an overview of the European Society of Cardiology (ESC) guidelines updated in 2017. The revised and amended guidelines for areas, such as dual antiplatelet therapy (DAT), treatment of patients with ST-segment elevation myocardial infarction (STEMI), and management of patients with valvular heart disease and peripheral artery disease, were presented in late summer of this year. The authors of this paper present an independent analysis and discussion of new data on the key issues of diagnosis and treatment in patients in the above areas. The recommendations on DAT pay special attention to the timing of the therapy and to the choice of its drugs. The updated data on the treatment of patients with STEMI accurately determine the time to percutaneous coronary interventions, approaches to revascularization; the updates touch upon fibrinolytic therapy and new approaches to lipid-lowering therapy too. Recommendations for the management of patients with peripheral artery atherosclerosis propose for the first time a section devoted to the choice of antiplatelet therapy (an antiaggregant and/or an anticoagulant) depending on the clinical situation.
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Cardiología/métodos , Enfermedades Cardiovasculares/terapia , Manejo de Atención al Paciente/métodos , Europa (Continente) , Humanos , Guías de Práctica Clínica como Asunto , Federación de Rusia , Sociedades MédicasRESUMEN
AIM: To evaluate the efficacy and safety of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) and stages I-III chronic kidney disease (CKD). SUBJECTS AND METHODS: The cohort parallel-group study included 92 patients with AF and stages I-III diabetic and non-diabetic CKD, who were treated with DOACs (dabigatran, rivaroxaban, or apixaban) and vitamin K antagonists (warfarin). The follow-up duration was 12 months. RESULTS: Thromboembolic events and bleeding, which required patient hospitalization or blood transfusions, were not recorded during 1-year follow-up. There was no clinically significant progression of CKD in the groups of therapy with vitamin K antagonists or DOACs. Just the same, a more intense decrease in glomerular filtration rate and a high rate of hemorrhagic complications were revealed in the subgroup of patients with diabetes mellitus (DM) versus those with non-diabetic CKD. CONCLUSION: In patients with non-valvular AF and diabetic and non-diabetic CKD, the use of DOACs effectively and safely prevents thromboembolic events, irrespective of the stage of CKD. At the same time, in patients taking anticoagulants, CKD progresses more rapidly in the presence of DM than in its absence, regardless of a specific anticoagulant. Hemorrhagic complications are more common in patients with AF, DM, and CKD, which requires more frequent monitoring of their kidney function.
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Antitrombinas , Fibrilación Atrial , Dabigatrán , Pirazoles , Piridonas , Insuficiencia Renal , Rivaroxabán , Tromboembolia , Warfarina , Anciano , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Anticoagulantes/clasificación , Antitrombinas/administración & dosificación , Antitrombinas/efectos adversos , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/tratamiento farmacológico , Estudios de Cohortes , Dabigatrán/administración & dosificación , Dabigatrán/efectos adversos , Complicaciones de la Diabetes/diagnóstico , Monitoreo de Drogas/métodos , Femenino , Hemorragia/inducido químicamente , Hemorragia/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Pirazoles/administración & dosificación , Pirazoles/efectos adversos , Piridonas/administración & dosificación , Piridonas/efectos adversos , Insuficiencia Renal/diagnóstico , Insuficiencia Renal/etiología , Rivaroxabán/administración & dosificación , Rivaroxabán/efectos adversos , Federación de Rusia , Tromboembolia/etiología , Tromboembolia/prevención & control , Warfarina/administración & dosificación , Warfarina/efectos adversosRESUMEN
The behavior of the state vector of human cardio-vascular system in different age groups according to methods of theory of chaos-self-organization and methods of classical statistics was investigated. Observations were made on the indigenous people of North of the Russian Federation. Using methods of the theory of chaos-self-organization the differences in the parameters of quasi-attractors of the human state vector of cardio-vascular system of the people of Russian Federation North were shown. Comparison with the results obtained by classical statistics was made.
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Enfermedades Cardiovasculares , Clima Frío/efectos adversos , Exposición a Riesgos Ambientales , Esperanza de Vida , Adulto , Anciano , Enfermedades Cardiovasculares/etnología , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/fisiopatología , Sistema Cardiovascular/fisiopatología , Interpretación Estadística de Datos , Indicadores de Salud , Frecuencia Cardíaca , Humanos , Persona de Mediana Edad , Dinámicas no Lineales , Grupos de Población/estadística & datos numéricos , Proyectos de Investigación , Federación de Rusia/epidemiologíaRESUMEN
A study of registry data revealed that morbidity, mortality, early lethality and frequency of secondary cases of stroke were significantly lower compared to those in the Russian Federation that could be explained by the younger mean age of the population in the Khanty-Mansi autonomous okrug (KMAO). Annual frequency of new cases of stroke among men was higher than among women though the prevalence of risk factors was lower in men. The levels of morbidity in men and women differed significantly than in the country as a whole. Changes in the clinical course of stroke were noted over the period of the study that was supported by the data on the significant reduction of the morbidity with the absence of the dynamics in the mortality and early lethality. The structure of stroke forms was similar to that in the Russian Federation but significant differences were found between men and women. The ratio between the number of cases of stroke of the carotid artery territory and that of stroke of the vertebral-basilar system was similar to the ratio recorded in the Russian Federation.
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Sistema de Registros , Medición de Riesgo/métodos , Accidente Cerebrovascular/epidemiología , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Federación de Rusia/epidemiología , Distribución por Sexo , Tasa de Supervivencia/tendencias , Adulto JovenRESUMEN
The parameters of blood lipid spectrum have been analyzed in 421 patients who survived cerebral stroke and transitory ischemic attacks in 2004-2008. The study included people of Khanty-Mansiysk and Khanty-Mansi autonomous okrug and watchmen. The statistical analysis did not reveal differences between mean concentrations of total cholesterol, high and low density lipoproteins and triglycerides in the settled population and in watchmen. Mean values of all parameters, with the exception of high-density lipoprotein, were higher compared to normative values. The highest frequency of deviations was found for low-density lipoproteins (63.5% of cases). The highest concentrations of total cholesterol and low-density proteins were seen in patients after transitory ischemic attacks regardless of their sex. The comparison of blood lipid spectrum parameters in different age groups revealed significant differences only for total cholesterol.
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Trastornos Cerebrovasculares/sangre , Lípidos/sangre , Enfermedad Aguda , Trastornos Cerebrovasculares/epidemiología , Colesterol/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Federación de Rusia/epidemiologíaRESUMEN
Pulsed optical excitation of the negatively charged trion has been used to generate electron spin coherence in an n-doped (In,Ga)As/GaAs quantum well. The coherence is monitored by resonant spin amplification detected at times exceeding the trion lifetime by 2 orders of magnitude. Still, even then signatures of the hole spin dynamics in the trion complex are imprinted in the signal leading to an unusual batlike shape of the magnetic field dispersion of spin amplification. From this shape information about the spin relaxation of both electrons and holes can be derived.
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Registration of evoked brain potentials was used as a non-invasive and an objective method of diagnosis of the CNS diseases. Somatosensory evoked potentials (SSEP) in response to stimulation of the tibial nerve were studied in patients with hyperactive urinary bladder (HUB) to clarify SSEP role in prognosis of tibial neuromodulation (TNM) efficacy. Urodynamic parameters and SSEP were examined in 13 patients with symptoms of urinary accumulation disorders. Neurogenic HUB was diagnosed in 6 patients, idiopathic one--in 7 patients. TNM was delivered in 30-min weekly sessions (n = 12). Six of seven patients with a cortical potential responded to TNM. Of six cortical nonresponders a positive result was achieved only in two. Thus, patients with the cortical potential demonstrate better effect of TNM than those without the potential. It is suggested that TNM influences both sacral and supraspinal center of urination.
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Potenciales Evocados Somatosensoriales , Nervio Tibial/fisiología , Estimulación Eléctrica Transcutánea del Nervio , Incontinencia Urinaria/diagnóstico , Incontinencia Urinaria/terapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Resultado del Tratamiento , Vejiga Urinaria/fisiopatologíaRESUMEN
It was determined whether high-frequency ultra sound can change the permeability of gray toad Bufo bufo and grass frog Rana temporaria under the action of high-frequency ultrasound. The changes in the permeability of embryonic envelope were assessed by using slowly penetrating fluorochromes ANS, FDA, and fluorescein. It was found that the ultrasound of 0.88 MHz and 0.4 - 0.7 W/cm2 intensity increased the permeability of amphibian embryonic envelope for ANS and FDA, whereas the ultrasound of 2.64 MHz and the same intensity increased that for fluorescein with the retention of low permeability for FDA. Embryos continued the normal development after treatment with ultrasound under these conditions.
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Fase de Segmentación del Huevo/fisiología , Fluoresceína/farmacocinética , Colorantes Fluorescentes/farmacocinética , Ultrasonido , Animales , Bufo bufo , Fase de Segmentación del Huevo/citología , Embrión no Mamífero , Permeabilidad , Rana temporariaRESUMEN
The purpose of the study was to record somatosensory evoked potentials (SSEP) to objectify the results omentomyelopexy in late spinal cord injury. SSEP were recorded in 25 patients in leads of three levels of the somatosensory tract (from the popliteal fossa, from the lumbar enlargement of the spinal cord, and from the surface of the skull in the region of projection of leg presentation in cerebral hemispherical cortex) before and after surgery. The study indicated that there were no pre- or postoperative records of cortical evoked potentials. At the same time there was improvement in the magnitude of SSEP at the level of the lumbar enlargement (36%). In 4 (16%) and 5 (20%) cases of them SSEP changes were clear and unclear, respectively. The assessment of SSEP changes requires consideration of cases with unclear SSEP. Comparison of the results with clinical findings shows a correlation mainly with urological and urodynamic evidence. Thus, there are minor positive changes in the magnitude of SSEP after omentomyelopexy in the lumbar enlargement lead with unclearly pronounced evoked potentials.
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Potenciales Evocados Somatosensoriales/fisiología , Epiplón/trasplante , Traumatismos de la Médula Espinal/fisiopatología , Médula Espinal/cirugía , Traumatismos Vertebrales/fisiopatología , Femenino , Humanos , Masculino , Paraplejía/etiología , Paraplejía/fisiopatología , Periodo Posoperatorio , Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/cirugía , Traumatismos Vertebrales/complicaciones , Traumatismos Vertebrales/cirugía , Factores de Tiempo , UrodinámicaRESUMEN
The results of omental transplantation to the site of spinal cord lesion in 40 patients in late injury are given. Neurological deficit was alleviated in 17.5% of patients. Improvement of segmentary functions was observed in most cases and was recorded within 1 week to 3 months postoperatively. There was no neurological improvement after 6 months postoperatively. Patients with mild spinal cord injuries (D10-L1) had the best outcomes. Comparative analysis of the outcomes of omentomyelopexy with those of treatment in 115 patients undergone meningomyeloradicolysis did not demonstrate any significant difference. Thus, it is not justifiable to use omental transposition in late spinal cord injury.
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Epiplón/trasplante , Traumatismos de la Médula Espinal/cirugía , Médula Espinal/cirugía , Adolescente , Adulto , Descompresión Quirúrgica/métodos , Femenino , Humanos , Masculino , Examen Neurológico , Reoperación , Traumatismos de la Médula Espinal/clasificación , Traumatismos de la Médula Espinal/diagnóstico , Factores de TiempoRESUMEN
Sport-latent somatosensory evoked potentials (SLSEP) were used to objectivize the time course of clinical changes after surgery for meningomyeloradiculosis in the late period of spinal traumatic injury. New evidence was obtained for the correlation between the changes in SLSEP with displacement from the lower thoracic and lumbar regions of the spine and these in the clinical picture of the disease (both neurological and urological) following spinal injury.
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Potenciales Evocados Somatosensoriales/fisiología , Meninges/cirugía , Traumatismos de la Médula Espinal/fisiopatología , Médula Espinal/cirugía , Traumatismos Vertebrales/fisiopatología , Raíces Nerviosas Espinales/cirugía , Enfermedad Crónica , Femenino , Humanos , Masculino , Periodo Posoperatorio , Traumatismos de la Médula Espinal/cirugía , Traumatismos Vertebrales/cirugíaAsunto(s)
Potenciales Evocados Somatosensoriales , Neoplasias de la Médula Espinal/fisiopatología , Adulto , Femenino , Humanos , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/fisiopatología , Neoplasias Meníngeas/cirugía , Meningioma/diagnóstico , Meningioma/fisiopatología , Meningioma/cirugía , Examen Neurológico , Médula Espinal/fisiopatología , Neoplasias de la Médula Espinal/diagnóstico , Neoplasias de la Médula Espinal/cirugíaRESUMEN
Study of somatosensory induced potentials (SSIP) occurring in response to stimulation of the median nerve in a group of patients with damage (traumatic) to the cervical segment of the spine and spinal cord (34) showed a dependence of the degree of changes of the SSIP on the type of injury to the spinal cord. It was found that the changes of SSIP were more marked in transverse damage to the spinal cord than in ventral damage, and in a higher (C5-6) than in a lower (C7-8) level of the trauma. Under conditions of traumatic damage to the nervous system the produced IP will be more clear in changes of the stimulation parameters: reduction of the frequency of the stimulus and the number of summations in averaging.
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Potenciales Evocados Somatosensoriales/fisiología , Traumatismos de la Médula Espinal/fisiopatología , Estimulación Eléctrica , Humanos , Nervio Mediano/fisiología , Pronóstico , Tiempo de Reacción/fisiologíaRESUMEN
In spinal trauma patients SSEPs were studied under median carpal nerve stimulation. In cases with pain syndrome, late SSEP waves (180-280 ms) were more pronounced as related to control group of patients without pain and to normal subjects. Psychoemotional personality scaling (MMPI) revealed the increased levels in the first three scales (s.c. "neurotic triad") in the pain group. A correlation was found between the late (P227) SSEP waves and the "neurotic triad" in MMPI.
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Potenciales Evocados Somatosensoriales , Dolor/fisiopatología , Traumatismos de la Médula Espinal/fisiopatología , Adolescente , Adulto , Anciano , Femenino , Humanos , MMPI , Masculino , Persona de Mediana Edad , Dolor/psicología , Personalidad , Psicofisiología , Traumatismos de la Médula Espinal/psicología , Traumatismos Vertebrales/fisiopatología , Traumatismos Vertebrales/psicología , Factores de TiempoRESUMEN
Short-latent cortical potentials and induced potentials (IP) recorded from the cervical spine in response to electrical stimulation of the median nerve on the wrist were studied in patients with injury to the cervical parts of the spine and spinal cord. The changes in the pronounced character of the somatosensory induced potentials (SSIP) proved to be more marked than those in the controls. A group of patients with considerable increase of peak N1 and corresponding increase of the time of conduction along the central nervous system (up to 20 msec) was distinguished. The latent period (LP) of IP recorded in the region of the cervical parts of the spinal cord was also prolonged in these patients. The pronounced character of the SSIP changes corresponded to that of the neurological disorders in these patients and the course of the subsequent restorative period.