Introduction. COVID-19 induces a procoagulant state, which can lead to various thrombotic and thromboembolic complications, however, there are just a few studies and papers devoted to COVID-19 long-term thrombotic complications.
Purpose. To assess COVID-19, that was experienced more than 12 weeks ago, as a risk factor for developing arterial and venous thrombotic events in the setting of Vascular Surgery Department of N. V. Sklifosovsky Research Institute for Emergency Medicine.
Materials and Methods. The study included 145 patients, 83 (57.2 %) were male, 62 (42.8 %) were female. Mean age of men was 65.0 [57.0; 72.0] years, mean age of women – 73.5 [62.3; 82.0] years (p = 0.003); 84 patients (57.9 %) were older than 65 years. 19 patients (13.1 %) were diagnosed with pulmonary embolism, 79 (54.5 %) with arterial thrombosis of mixed genesis, 46 (31.7 %) with venous thrombosis, 18 (12.4 %) were diagnosed with thrombophlebitis. In the group of patients with history of COVID-19 12 or more weeks ago 45 (58.44 %) were taking antithrombotic medications.
The most common comorbidities were arterial hypertension (83.44 %), chronic kidney disease (82.06 %) and coronary artery disease (62.06 %).
Results. A statistically significant mean correlation was found between anti-SARS-CoV-2 IgG and hemoglobin (r = –0,326; p = 0,006) and between anti-SARS-CoV-2 IgG and glomerular filtration rate (r = –0,300; p = 0,010). COVID-19, that was experienced 12 and more weeks ago, is not a statistically significant predictor of arterial (OR = 1.01; 95 % CI: 0.552–1.940; p = 0.987) and venous (OR = 0.733; 95 % CI: 0.364–1.479, p = 0.386) thrombotic events. Main risk factors for developing thrombotic events in those patients were comorbidities and predisposing factors: arterial hypertension (OR = 6.923; 95 % CI: 1.3842–34.630; p = 0.018), coronary artery disease (OR = 9.867; 95 % CI: 3.1272–31.1310; p < 0.001), atrial fibrillation (OR = 3.875; 95 % CI: 1.141–13.170; p = 0.030), and smoking (OR = 5.855; 95 % CI: 1.201–28.550; p = 0.029).
Conclusion. Alone, COVID-19, that was experienced more than 12 weeks ago, as not a strong predictor of developing arterial and venous thrombotic events. However, in patients with comorbidities, such as arterial hypertension, coronary artery disease and atrial fibrillation, and in presence of predisposing modifying lifestyle factors, such as smoking, there is a statistically significant risk of various thrombotic events.
This article analyzes studies that are significant for clinicians aimed at understanding the etiopathogenetic mechanisms that contribute to the development of ischemic, non-ischemic and viral/bacterial-induced heart failure. A systematic search of literature for 2019–2021 was conducted in PubMed, EuropePMC, SCOPUS, the Cochrane Central Database and medRxiv using the search queries ‘Heart Failure’ and ‘COVID-19’; then we focused on publications that contain data on variants of the course of chronic heart failure in patients with cardiovascular pathology after a coronavirus infection and analyzed them with subsequent theoretical modeling. The prevalence of chronic heart failure among the population susceptible to COVID-19 is significant, as is the prevalence of predisposing conditions that expose infected patients to the risk of developing heart failure during illness and in the long-term period after recovery. For this reason, the dissemination of in-depth knowledge about the clinical consequences and prognostic impact of COVID-19 on this vulnerable category is a priority.
The aim of the study. To study the structure of lethal and non-lethal complications with an analysis of survival and the likelihood of non-lethal complications after mitral valve (MV) replacement with bicuspid mechanical prostheses over a five-year period.
Materials and methods. The data of 260 patients who were treated in the period of 2012–2014 were analyzed a surgical intervention was performed – isolated MV prosthetics with mechanical bivalve prostheses. Among the patients, there were 84 (32.3 %) men and 176 (67.7 %) women. The median age was 51.0 [44.0–55.5] years. Statistical analysis was carried out using IBM SPSS Statistics 26.0 (USA).
Results of the study and conclusions. According to the results of the five-year survival after MV prosthetics with mechanical prostheses, it was 86.6 %. At the same time, acute cardiovascular diseases (myocardial infarction, cardiac arrhythmias) were the leading cause of death. Among non-lethal thromboembolic complications, acute cerebrovascular accident prevailed, it developed in 65.3 %. Among nonlethal hypocoagulation complications, nosebleeds were most often recorded – in 40.5 % of patients. The probability of developing non-lethal thromboembolic complications by the fifth year is 20.0 % vs 18.5 % in the first six months after prosthetics with mechanical prostheses. And the probability of developing non-lethal hypocoagulation complications by the fifth year is 26.8 % vs 6.1 % in the first six months after prosthetics with mechanical prostheses.
Currently, it is promising to study the effect of cardiorehabilitation on the risk of cardiovascular events, re-hospitalization and mortality in patients with cardiovascular diseases, namely in adult patients with myocardial infarction, angina pectoris, who underwent coronary artery bypass grafting and percutaneous coronary interventions. It was found that the number of attendances at cardiorehabilitation sessions affects mortality from cardiovascular diseases. In different countries, there is a problem of low patient adherence to outpatient clinics and cardiorehabilitation courses, which depends on many factors. This article discusses the participation of patients with cardiovascular diseases in cardiorehabilitation programs and the search for new approaches to activate the attendance of cardiorehabilitation courses. One of the relatively new methods is the use of a mobile phone with an appropriate application to increase motivation for physical training, which, in addition to clinical significance, can also become cost-effective for patients. In general, cardiorehabilitation programs should not be episodic events, because phasing and continuity are important conditions for the success and effectiveness of such programs. The main goal of any preventive intervention is to develop stable stereotypes of desirable behavior (useful habits) that will remain with the patient for life.
Arterial hypertension is one of the most common comorbidities in patients with cancer. Moreover, the treatment with anticancer agents can lead to the development of drug-induced arterial hypertension.
The aim of this work is to systematize and analyze data about anticancer agents, the use of which can cause the development of drug-induced hypertension, about epidemiology, pathophysiological mechanisms, risk factors, clinical signs, diagnosis and differential diagnosis, treatment and prevention of hypertension associated with the use of anticancer drugs.
It was found that anti-cancer drugs often contribute to the development of drug-induced hypertension. The mechanisms that determine the development of hypertension are diverse and may include the development of endothelial dysfunction, an increased arterial stiffness, capillary rarefaction, fluid and electrolyte imbalance, and genetic factors. It is important to remember about drugs that can cause drug-induced hypertension to reduce the risk of developing adverse reactions, and prevent cardiovascular disease. Treatment of drug-induced hypertension, caused by anticancer drugs, often requires immediate discontinuation of drugs, due to adverse reactions that are often life-threatening. In some situations, it is possible to reduce the dose of the drugs and / or prescribe antihypertensive drugs. Arterial hypertension is an important risk factor in the development of cardiovascular events, including stroke, coronary heart disease, heart failure.
The purpose of this article is to discuss an algorithm for bedside ultrasound examination in patients with heart failure, which consisting of three blocks: assessment of morphofunctional cardiac pathology, detection of hypertension in the heart chambers, and the presence of congestion. This protocol is based on the point-of-care ultrasound methodology and is designed for use by doctors of clinical non-ultrasound specialties. The protocol is presented in two variations: extended (for expert cardiological assessment) and short for emergency examination. The article provides brief information about the diagnosis, terminology, and classification of heart failure according to modern clinical guidelines.
Asynchronies (desynchronies, dyssynchrony) is a disturbance of the harmonious interaction between the patient’s respiratory system and а ventilator. Asynchronies occur as a result of various reasons and with any form of respiratory support (non-invasive, assisted or fully controlled mechanical ventilation). Asynchrony is a significant cause of biomechanics and gas exchange disorders in the development of both self-injury and ventilator-induced lung injury, an increase of the respiratory support duration and mortality in patients with respiratory failure. Understanding the mechanisms of the asynchrony pathogenesis and assessment of the patient’s respiratory system condition make it possible to timely identify and resolve disturbance of the patient-ventilator interactions. The article presents a classification, the main causes of development, diagnostic and correction methods of different variants of desynchronies in patients with respiratory disorders during of respiratory support.
Electrical injuries are a serious problem around the world. Patients with extensive, high-voltage electric burns belong to the group of severely burned. Timely and adequate treatment, which includes intensive anti-shock measures in the first days after injury, with simultaneous active surgical tactics, is decisive for saving life for such victims. The provision of specialized, high-tech medical care for these complex patients is optimal in conditions of a burn department / center of a multidisciplinary medical organization. However, knowledge of the basic principles of providing emergency and urgent medical care to victims with electrical trauma even before admission to the burn hospital is the key to their further successful treatment.
ISSN 2949-2807 (Online)