[Clinical features and prognosis in heart failure patients with chronic obstructive pulmonary diseases].

BACKGROUND: Multimorbidity is a specific characteristic of the modern patient with chronic heart failure (CHF) which significantly changes clinical course, prognosis of the syndrome, leads to socio­economic losses and makes significant adjustments to treatment tactics. The goal is to study the clinical features and prognosis of patients with CHF in combination with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: We studied 183 HF patients, including with stable CHF, including 105 with CHF combined with COPD. The clinical phenotype was assessed by its belonging to the functional class and the severity of COPD. A 6­minute walk test (6­MWT), spirometry, echocardioscopy, testing on a scale assessing the clinical condition, quality of life were studied. The end points during the year were: all­cause mortality and cardiovascular mortality, myocardial infarction, stroke, pulmonary embolism, and hospitalization rates due to acute decompensation of CHF. RESULTS: The clinical phenotype of CHF combined with COPD was characterized by a high frequency of smoking, low quality of life and exercise tolerance. Respiratory dysfunction in CHF in combination with COPD was characterized by mixed disorders (68.4%), in CHF without lung disease, restrictive (25.6%). Cardiovascular mortality in comorbid pathology was 4.0%, in CHF without COPD - 4.6%; myocardial infarction was observed 1.7 times more often with lung disease than in patients with CHF only (16.8% and 10.8%); stroke was observed exclusively in comorbid pathology (8.9%). The combined endpoint (all cardiovascular events) with CHF in combination with COPD was achieved 2.3 times more often in comparison with patients with COPD only (29.7% and 15.4%). Hospitalization due to acute decompensation of CHF occurred 2 times more often with CHF in combination with COPD than without it (32.7% and 15.4%) with a tendency to increase as the left ventricular ejection fraction decreased. CONCLUSION: The results of the study demonstrate that COPD contributes to the formation of the clinical phenotype of CHF from the standpoint of the mutual influence of the characteristics of the cardiovascular and respiratory systems, and also aggravates the prognosis that requires an integrated approach to the differential diagnosis and individualization of pharmacotherapy.

[Efficacy of adepress (paroxetine) in the treatment of depression in patients with chronic cerebral ischemia in the late recovery phase of ischemic stroke with the estimation of the velocity of passive transmembrane ion transport].

We studied the correlation between the efficacy of adepress (paroxerine) and the state of cell membranes assessed by the velocity of passive transmembrane ion transport in 39 patients (20 patients with chronic brain ischemia and 19 patients with ischemic stroke). Velocity of passive transmembrane ion transport estimated by the level of Na+-Li+ counter-transport (NLC) in the erythrocyte membrane was a criterion of the cell membrane functional activity. The higher the NLC velocity, the more severe was the course of depression with the development of cognitive dysfunction and pain syndromes in patients with chronic brain ischemia and stroke. At the same time, the higher clinical efficacy of adepress (paroxerine) was seen in patients with higher NLC velocities. Estimation of NLC velocity in the erythrocyte membrane may be used for identification of risk groups for the development of affective disorders in patients with stroke and chronic brain ischemia as well as for prediction of treatment efficacy.

[The functional features of cell membranes in children with bronchitis and pneumonias].

To develop new differential and diagnostic markers of different types of bronchopulmonary diseases, sodium-lithium countertransport through the red blood cell membrane was studied in 119 children, including 30 patients with bronchitis, 21 with pneumonia, and 68 apparently healthy children (a control group). The majority of patients with pneumonia were found to have the maximum high sodium-lithium countertransport rate as compared with patients with bronchitis, although high sodium-lithium countertransport rates are generally typical of children with bronchopulmonary diseases, as shown by absolute values. These indices may be attributable to the influence of a genetic determinant and environmental factors. For final verification of this suggestion, a follow-up of the study group of patients is scheduled, by taking into account a change in the phenotype of red blood cell populations.

[Membrane permeability in combined arterial hypertension and pathology of the digestive organs (based on epidemiological study data)]. / Sostoianie membrannoi pronitsaemosti pri sochetanii arterial'noi gipertonii s patologiei organov pishchevareniia (po dannym épidemiologicheskogo issledovaniia).

An epidemiological study of arterial hypertension and digestive diseases revealed 27% patients with concurrent abnormalities. It was shown that determination of membranous lesions by the rate of red blood cell Na-Li contratransport may be useful in the diagnosis of syntropy.

[The epidemiological aspects of combined arterial hypertension and peptic ulcer]. / Epidemiologicheskie aspekty sochetaniia arterial'noi gipertonii i iazvennoi bolezni.

Altogether 598 workers and employees of an industrial enterprise underwent epidemiological examination. The age of the examined ranged within 30 to 49 years. Arterial hypertension was revealed in 14.2% and ulcer disease in 9% of the population. 1.5% of the population presented with associated pathology. Among risk factors of paramount importance was unbalanced nutrition and hypotensive treatment. Impairment of cell membranes also played a certain role in the occurrence of associated pathology.

[Cytoplasmic membrane damage and thromboplastinemia in hypercholesterolemia]. / Povrezhdenie tsitoplazmaticheskikh membran i tromboplastinemiia pri giperkholesterinemii.

Experiments on 67 rabbits were performed to examine the injured external cell membranes of the vascular wall, appearing in the blood flow in the course of the development of alimentary hypercholesterolemia. The time of the appearance in the blood plasma of the external cell membranes was judged from the activity of their specific marker, 5'-nucleotidase. An abrupt increase in 5'-nucleotidase activity was disclosed in the blood plasma at the height of hypercholesterolemia. The latter circumstance served as an objective criterion for injury to ther external cell membranes and might be regarded as a risk factor in thrombus formation.

[Changes in the glucocorticoid function of the adrenal cortex in patients with myocardial infarct treated with trioxazine and aminazine]. / Izmeneniia gliukokortikoidnoi funktsii kory nadpochechnikov u bol'nykh infarktom miokarda, lechennykh trioksazinom i aminazinom

A protracted observation over the glucocorticoid function of the adrenal gland in patients with myocardial infarction educed a biphasic nature of changes in the concentration of the plasma and urine corticosteroids in this affection. Most informative are shown to be the evidences of activation of the hypothalamo-hypophysial-adrenal system furnished by the biologically active 11-oxycorticosteroids in the peripheral blood plasma. Psychopharmacological drugs produced a less intensive activation of the glucocorticoid function of the adrenal cortex in the acute period of myocardial infarction and they smooth down a renewed rise in the level of steroid during the subacute period of the disease. Chlorpromazine displays a stronger antistress action than does trioxazine, but the available data justify recommending both these drugs for the treatment of patients with myocardial infarction.