ABSTRACT
The information base of empirical research in the field of inequality of opportunity is discussed. It is shown that the information base is incomplete since many circumstances and efforts remain unobserved, creating an underestimation. The role of family background is studied, including such factors as the integrity of the parental family, the number of siblings, and the psychological atmosphere in the parental family. It is found that the factor of family integrity has a significant impact on estimates for inequality of opportunity.
ABSTRACT
The authors describe two clinical cases of paradoxical embolism of greater-circulation vessels in patients with thrombosis of deep veins of the lower extremities and patent foramen ovale, also discussing different variants of clinical course of paradoxical embolism, as well as approaches to treatment and prevention.
Subject(s)
Embolism, Paradoxical/etiology , Foramen Ovale, Patent/complications , Pulmonary Embolism/etiology , Thrombectomy/methods , Venous Thrombosis/complications , Adult , Cardiac Surgical Procedures/methods , Echocardiography, Transesophageal , Embolism, Paradoxical/diagnostic imaging , Embolism, Paradoxical/surgery , Female , Follow-Up Studies , Foramen Ovale, Patent/diagnostic imaging , Foramen Ovale, Patent/surgery , Humans , Middle Aged , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/surgery , Venous Thrombosis/surgeryABSTRACT
AIM: To evaluate effects of 6-month therapy with losartan in combination with indapamide on a clinical course, immunological, metabolic parameters, left ventricular function, exercise tolerance and quality of life in patients with coronary heart disease (CHD) associated with metabolic syndrome (MS). MATERIAL AND METHODS: Forty six CHD patients with postinfarction cardiac dysfunction in MS were randomized into two groups. Group 1 consisted of 22 patients with impaired glucose tolerance, group 2--of 24 type 2 diabetics. Treatment included combination of losartan (50 mg/day) with indapamide (1.5 mg/day), on demand nitrates, nebivolol. Basic therapy in diabetes included sugar-reducing drugs. Clinical condition, findings of echocardiography, parameters of lipid and carbohydrate metabolisms, immunoglobulins, circulating immune complexes, autoantibodies to cardiolipin (AB to CL), spectrum of proinflammatory cytokines were studied before and 3 months after course treatment. RESULTS: Overactivation of cytokines (primarily IL-2, IL-1, TNF alpha) with high expression of IgA, IgG, CIC, AB to CL was found in CHD patients with type 2 diabetes mellitus and less evident in impaired glucose tolerance. Losartan in both groups had an antihypertensive effect, stabilized LV hypertrophy, improved clinical symptoms leading to cytokines expression decline: TNF alpha by 9.8%, IL-1--by 6.1%, IL-6--by 6.7%. Losartan was well tolerated, caused no negative metabolic effects. CONCLUSION: New original facts of cytokine overactivation and humoral immunity disturbances were discovered which play an essential role in pathogenesis of postinfarction dysfunction and LV remodeling developing in type 2 diabetes mellitus. Losartan 6-month treatment in the fixed combination has a positive effect on clinicohemodynamic and immunometabolic indices. This gives grounds for wider use of losartan in CHD combined with type 2 diabetes mellitus.
