All articles - Cardiovascular System and Cardiology
Number of articles: 482
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SELECTION OF THE OPTIMAL DRUG FOR EMPIRICAL ANTIBACTERIAL THERAPY FOR TREATMENT OF COMMUNITY-ACQUIRED PNEUMONIAToday pneumonia remains one of the most pressing diseases of humanity and ranks 4th in terms of mortality. The incidence of pneumonia depends on age, gender and comorbidities. The most common form of pneumonia is hospital-acquired pneumonia, and bacteria are one of the main causes of this pneumonia. For this reason, antibacterial drugs play an important role in the treatment of pneumonia. One of the main problems in carrying out antibiotic therapy is the choice of an antibacterial drug for empirical therapy during the period of increasing resistance of microbes to antibiotics. The results of scientific research, metanalysis, pharmacoepidemiological studies, as well as protocols and guidelines developed on their basis, will help to solve this problem.
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STUDY OF PATHOLOGICAL CHANGES OF THE CARDIOVASCULAR SYSTEM IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASEChronic obstructive pulmonary disease (COPD) is an independent nosological form characterized by limited airflow rate associated with the pathological inflammatory process in the lungs. COPD is an irreversible process that is constantly evolving and causes serious complications from the cardiovascular system. Currently, special attention is paid to the study of risk factors for COPD, including urban air pollution, increased industrial dust, age, smoking, respiratory infections, their frequency, and obstructive pulmonary disease, aggravating the disease. Thus, smoking is associated not only with the emergence of pathological processes in the lungs, but also with the development of systemic inflammatory reactions, oxidative stress, dysfunction of vascular endothelium, increased activity of procoagulant factors, increased oncogenes and other systemic effects.
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LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN PATIENTS WITH MYOCARDIAL INFARCTIONAlthough the existence of diastole became known at the beginning of the last century, for a long time it was perceived as a simple interval during which the chambers of the heart are passively filled for the subsequent injection cycle. The prognostic value of LV systolic function has been comprehensively studied, and relatively little is known about the effect of diastolic dysfunction on the prognosis of patients with LV. To date, only a few publications contain information about the optimal time frame in which LV DF indicators acquire the greatest prognostic value. The contribution of diastolic dysfunction to the development of CHF after MI in patients with preserved systolic function remains poorly understood. After MI, LV diastolic dysfunction is considered to be the earliest marker preceding the expanded picture of CHF. At the same time, according to many researchers, the type of LV diastolic dysfunction corresponds to the severity of CHF manifestations. The development of pathology occurs before the development of the appearance of the clinic and symptoms, as well as therapeutic effects on the mechanisms, which makes it difficult to study, due to insufficient information. Numerous studies state that the following risk factors prevail for the development of diastolic heart failure against the background of IHD, such as female gender, the presence of concomitant pathology in the form of diabetes mellitus, obesity, arterial hypertension, metabolic syndrome and others.
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EFFECTS OF ANTI- TUBERCULOSIS TREATMENT ON THE FUNCTIONAL STATUS OF THE THYROID GLANDData on the functional state of the thyroid gland in patients with tuberculosis, as well as on the effect of anti-tuberculosis measures on the function of the thyroid gland, are poorly studied and contradictory. The state of the thyroid gland has not been studied in connection with long- term treatment, especially in patients with premorbid thyroid dysfunction. The aim of the study was to study the functional status of the thyroid gland in patients diagnosed with degenerative forms of respiratory tuberculosis before and after the intensive treatment phase of anti- tuberculosis chemotherapy. Patients treated at the Samarkand Regional Center for Tuberculosis and Pulmonology, who were diagnosed for the first time with degenerative forms of pulmonary tuberculosis, were examined. The results suggest that synthetic analogues of thyroid hormones may serve as a basis for concomitant use with anti-tuberculosis chemotherapy. This allows patients to achieve successful results in TB treatment interventions.
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STRATIFICATION OF CHRONIC ISCHEMIC HEART DISEASE DEPENDING ON DIAGNOSTIC METHODS AND WAYS OF THEIR TREATMENTChronic stable angina in about 50% of all patients is usually caused by blockage of at least one large epicardial coronary artery by an atheromatous plaque. Angina pectoris occurs due to a mismatch in myocardial oxygen demand, which leads to myocardial ischemia. The indications for coronary revascularization continue to evolve as scientific and technological advances improve both the results obtained with optimal drug therapy and the methods of revascularization. The critical issue is the extent to which all forms of therapy are used appropriately based on guidelines and appropriateness criteria, especially with regard to the cost and availability of care. If symptoms and quality of life do not improve with medication alone, an initial trial of medication with the option of moving to revascularization is appropriate. In general, these results confirm the recommendations and raise questions about the advisability of using coronary revascularization, in particular percutaneous coronary intervention.
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ASSOCIATED RISK FACTORS FOR CARDIOVASCULAR EVENTS IN POSTMENOPAUSAL WOMENAccording to the literature review, it was found that after the onset of menopause, 70% of women develop cardiovascular diseases, and 30% develop osteoporosis. Women with menopausal symptoms show adverse changes with an increased risk of CVD. However, it remains unclear whether the presence of menopausal symptoms can actually predict clinical CVD events or whether it is primarily due to associated risk factors for cardiovascular events. To date, no consensus has been reached on this issue. There are many proposed mechanisms that explain the role of endogenous estrogen as a protector of cardiovascular disease (CVD). Consequently, cardiovascular diseases remain the main cause of morbidity and mortality in women in many countries, among people in the postmenopausal period, and it is quite possible that with an increase in the number of older people, they will remain the main risk factor for the development of cardiovascular diseases and mortality.
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RELATIONSHIP OF ANXIETY-DEPRESSIVE STATE WITH CARDIOVASCULAR DISEASESPatients with cardiovascular diseases usually experience negative psychological conditions. To date, depression has received the most attention among patients with cardiovascular events, especially in patients who had a serious cardiac event such as acute coronary syndrome (ACS). Recently, however, anxiety has become another important psychological construct that is widespread, often co-occurs with depression and interferes with the response to depression treatment, and may ultimately affect the course of cardiovascular disease independent of depression. In this article, we aim to review the latest literature on anxiety and related disorders in cardiovascular disease.
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CLINICAL FEATURES OF CHRONIC HEART FAILURE IN PATIENTS WITH IHD COURSE ON THE BACKGROUND OF ATRIAL FIBRILLATIONAtrial fibrillation (AF) is the most widespread rhythm disturbance among the population of all countries of the world. Moreover, in recent years, there has been a further increase in the prevalence of AF. The adverse effect of AF on life prognosis in patients of this profile is primarily due to a significant increase in the incidence of cardioembolic stroke and systemic thromboembolic complications. The clinical significance of atrial fibrillation (AF) is associated with a five-fold increase in the risk of stroke and a 1.5-2-fold increase in mortality in the population of patients suffering from this type of arrhythmia. Therefore, there is no doubt that the use of effective strategies for the prevention of cardiovascular complications and the development of chronic heart failure is the most important component in the management of a patient with AF. The prognosis in patients with AF with the development of heart failure (HF) significantly increases the risk of lethal cardiothromboembolism (CTHE), therefore, the diagnosis of CHF in early functional classes allows for timely enhancement of preventive antithrombotic therapy in accordance with the increased risk of CTHE. The study of the prevalence of AF among patients with coronary artery disease in the center, taking into account the clinical manifestations and characteristics of AF episodes in order to predict complications and CHF remains an urgent problem.
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STATE OF THE CARDIORESPIRATORY SYSTEM IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY (REVIEW)Hypertrophic cardiomyopathy is the most common hereditary heart disease, the prevalence of which is estimated at 1 in 500 in the general population. This autosomal dominant disease is characterized by thickening of the wall of the left and occasionally right ventricle. The use of cardiorespiratory stress testing helps in assessing the severity of chronic heart failure and the functional capabilities of patients with hypertrophic cardiomyopathy, to predict the risks of cardiorespiratory complications of the disease and identify mechanisms of functional limitations. This article describes in detail the functional ability and stress tests of the cardiorespiratory system in hypertrophic cardiomyopathy. Cardiorespiratory stress testing provides a non-invasive and safe approach for assessing the functional state of the cardiorespiratory system in patients with hypertrophic cardiomyopathy, helping to understand the main pathophysiological mechanisms of the course of the disease. This non-invasive assessment method allows you to stratify a patient with hypertrophic cardiomyopathy in relation to the risks of cardiovascular mortality and morbidity, as well as timely refer to specific treatment methods.
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EFFICIENCY OF ASPIRIN IN PATIENTS WITH RHEUMATOID ARTHRITIS AND CORONARY HEART DISEASEObjective: To study coagulation and intravenous platelet hemostasis when using aspirin in patients with rheumatoid arthritis (RA) in combination with coronary heart disease (CHD). In our study, 82 patients (68 women and 14 men) were examined who were treated with RA in CHD. Studies show that decreased fibrinogen and plasma fibrinolytic activity are associated with the development of atherosclerosis and an increased risk of heart attack and stroke. Our studies also reported similar changes in blood clotting despite the use of non-steroidal anti-inflammatory drugs (NSAID) and aspirin. In our study, resistance to NSAID, in particular to meloxicam, was 8.5%, to nimesulide 7.3% and to diclofenac 6%. Patients who did not show the antiplatelet effect of aspirin in combination with RA with coronary artery disease were prescribed another antiplatelet drug.
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This review summarizes the current evidence on the role of cytokines in the pathogenesis of ischemic myocardial damage. It described the important role of inflammation in the development of coronary heart disease. The role of individual cytokines in the pathogenesis of coronary artery disease and the most frequent forms of it - angina. It is shown that in patients with coronary heart disease progression of the disease is due to an imbalance in cytokine system, elevated pro-inflammatory cytokines (TNF, IL-1β, IL-6). Anti-inflammatory cytokines (IL-4, IL-10) inhibit the secretion of proinflammatory cytokines by limiting excessive intensity of the immune response. Revealed increasing levels of TGF-β1 as a key cytokine that promotes the development of fibrosis in the wall of the heart and blood vessels. The interrelation between improving markers of inflammation and the development of coronary heart disease, the predictive value of these markers of inflammation in patients with stable coronary heart disease: angina of effort of different functional classes. -
POSSIBILITIES OF MAGNETIC RESONANCE AND CT DIAGNOSTICS IN EARLY DETECTION OF CHANGES IN THE JOINT AND LUNGS IN PATIENTS WITH RHEUMATOID ARTHRITISPurpose of the study: Early detection of joint damage by MRI and CT methods of respiratory system damage in patients with rheumatoid arthritis. Materials and methods. The SamMI clinic examined 104 patients with RA and 54 patients with RA-associated respiratory pathology. All patients were divided into early and late stages relative to the course. The mean age of patients in the early stages was 49.4 ± 14.1 years. Among the patients, 87 were women (83.65%) and 17 were men (16.3%). The duration of the disease ranged from 1 month to 30 years (8.8 ± 1.3) years. In the early stages of the disease: changes in the joint sac pannus in 29 patients (85.3%), synovitis in 34 patients (94.1%), thinning of the joint, focal tumors in the paws in 23 patients (67.6%), erosions in 49 patients (47.1%); In the late stage: erosions in 59 patients (47.1%), spherical plaques in the joints in 44 patients (42.3%), sclerotic changes in 17 patients (16.3%). Conclusion: MRI examination can clearly distinguish pannus and synovitis in the early stages of RA. Compared to radiography, computed tomography gives high-quality results in 35% of cases. The use of complex screening methods in RA disease is effective in early and effective diagnosis and choice of treatment.
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COMPREHENSIVE TREATMENT OF BRONCHIAL ASTHMA IN CHILDREN USING RESISTOLWe examined 78 children with varying degrees of severity of bronchial asthma at the age of 6-14 years. The first group of patients who received standard basic therapy and a placebo pill (n = 35); the second group of patients (n = 43), who received along with a similar spectrum of basic therapy, was prescribed the drug "Resistol" according to the scheme. The combined use of anti-inflammatory drugs and Resistol gives a pronounced effect in terms of improving the clinical condition of children, normalizing immunological and lymphocytic parameters in patients with bronchial asthma.
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CLINICAL CHARACTERISTICS OF CARDIOVASCULAR SYSTEM DISEASES AGAINST THE BACKGROUND OF DIABETES MELLITUSPurpose: To study the clinical features of cardiovascular disease (CVD) in the context of diabetes mellitus (DB). Examination materials and methods: In the 1st therapy department of the Samarkand State Medical Institute Clinic, 80 patients with DB type II visceral diseases underwent clinical, laboratory and instrumental examinations. The current classification of etiological and vascular complications of DB was introduced, and it was studied whether this classification was confirmed on the basis of diagnostic criteria. Our tests show that DB is more common after the age of 50. Men over the age of 50 scored 46 (92.0%) among women and 26 (87.0%) among men. Cardiovascular diseases were detected in 49 (61.25%) of the patients examined. Of these, 34 (69.4%) patients had hypertension, 13 (26.5%) patients - ischemic heart disease, 2 (4.1%) patients - rheumatism, heart defects. Conclusion: Against the background of type II DB, mainly diseases of the internal organs lead to the rapid development of various complications in patients and the severity of DB. The correct dose of antidiabetic drugs is important in the complex treatment of comorbidities of DB and CVD.
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MEDICAL AND PSYCHOLOGICAL REHABILITATION: CRITERIA AND METHODS OF ORGANIZATION, FACTORS THAT ARE INFLUENCING ON THE PROCESS OF RECOVERY OF PATIENTS WITH CORONAVIRUS INFECTION. (REVIEW)Psychological rehabilitation is an integral component of a holistic system of medical rehabilitation, but in practice, as a rule, only individual rehabilitation methods are used. During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate, and about one third reported moderate anxiety. Rapid transmission of coronavirus and high mortality rates can increase the risk of mental health problems and aggravate existing psychiatric symptoms, which will further impair daily functioning and cognitive function. This article describes the psychological rehabilitation of patients with suspicion and confirmation of COVID-19, which will allow you to prematurely identify psychological problems (depression, anxiety, lack of motivation, etc.) that can serve as an obstacle to performing physical exercises, including breathing, necessary for secondary prevention of formidable pulmonary complications.
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RESULTS OF OBSERVATIONS OF PERSONS WITH CORONAVIRUS ON THE PRIMARY LINE OF HEALTHCAREThe number of people infected with the SARS-CoV-2 coronavirus, which causes COVID-19, is growing worldwide. The emergence of a severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, against the background of coronavirus 2, causing Coronavirus disease 2019, or COVID-19, quickly increased into a pandemic. Given the fact that the disease is new, it is necessary to study the characteristics of the distribution and the clinical picture in persons who have had this disease. Based on the results of the practical work of the medical organization of primary health care in the context of a pandemic, analyze the distribution and clinical picture of the pathological process of COVID-19 in adult patients. The course of the disease was analyzed in the first 100 patients with confirmed COVID-19: 58 (58%) men and 42 (42%) women. In 11 (11%) patients examined by contact with a sick relative, the disease was asymptomatic; 89% had a mild course of COVID-19 with minor catarrhal symptoms. The largest group of patients who underwent COVID-19 were persons aged 30-55 years (65%): in 20% of cases, the patients were older than 65 years. During the COVID-19 pandemic, a large burden falls on outpatient doctors, because 80% of patients are asymptomatic or mild. Analysis of the clinical picture, data of laboratory parameters allows to diagnose and assess the severity of the disease as early as possible.
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POSSIBILITIES OF ELECTRIC MYOCARDIAL INSTABILITY CORRECTION USING ADEQUATE HYPOGLYCEMIC THERAPYIn this article, we have highlighted our own results on the use of basal insulin Degludec in combination with other antihyperglycemic drugs in patients with type 2 diabetes using long-term ECG monitoring and FreeStyle Libre glycemia. In our patient, with a favorable glycated hemoglobin level, according to the CGM, frequent episodes of hypoglycemia were observed, which were associated with paroxysms of atrial fibrillation. This situation testified in favor of resolving the issue of revising the therapy. Thus, we have replaced the basal insulin Glargin with the newer generation insulin Degludek, which has a more pronounced effect on glycemic variability, therefore, its effect is more predictable. Currently, there is convincing evidence of the effect of hypoglycemia on the development of electrical instability of the myocardium with the occurrence of fatal arrhythmias. The use of systems for synchronous long-term monitoring of glycemia and heart rate will allow more accurate recording of episodes of hypoglycemia and correction of insulin therapy, thereby reducing the risk of arrhythmias.
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FEATURES OF IMMUNOLOGICAL INDICATORS IN PATIENTS WITH CHRONIC OBSTRUCTIVE LUNG DISEASE AND BRONCHIAL ASTHMAThe study was conducted in the Samarkand city hospital in the department of pulmonology. The study included 103 patients. Patients, depending on the presence of pathologies, were divided into three groups. The first group consisted of 37 patients with chronic obstructive lung disease, the average age of which was 48.3 ± 1.7, the second group consisted of patients with a diagnosis of bronchial asthma, there were 36 patients (average 44.7 ± 1.5) and 30 healthy people that made up the control group. The results of the study showed that, with chronic obstructive lung disease and bronchial asthma, changes in the immune system occur, which differs significantly from each other, primarily due to a significant increase in the content of cytotoxic lymphocytes in the blood of patients with chronic obstructive lung disease. It can be assumed that it is the high cytotoxic potential of the immune system of patients with chronic obstructive lung disease that causes damage to the lung tissue, causing the development of pneumosclerosis and pulmonary emphysema.
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THE STATE OF DIASTOLIC DYSFUNCTION OF TNE LEFT VENTRICLE IN PATIENTS WITH MYOCARDIAL INFARCTIONIt has now been proven that severe diastolic dysfunction is a factor influencing the prognosis in patients with acute myocardial infarction. In this article, the state of diastolic dysfuntion of the left ventricle in patients with myocardial infarction was studied. We examined 44 male patients with myocardial infarction aged 40 to 69 years (51.9 ± 9.13 years). All patients underwent clinical examination, including examination, collection of anamnesis, ECG, EchoCG with Doppler sonography. The progression of left ventricular diastolic dysfunction in patients with myocardial infarction is associated with a longer course of coronary heart disease and arterial hypertension. With the aggravation of diastolic dysfunction, there is a pronounced inhibition of the systolic function of the left ventricle. Severe diastolic dysfunction in patients with myocardial infarction is closely associated with electrical instability of the myocardium.
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THE USE OF THE DRUG BRONCHO-MUNAL IN THE TREATMENT OF ACUTE BRONCHIOLITIS IN CHILDRENAcute bronchiolitis is the most common cause of hospitalization of children in the first two years of life, which is characterized by manifestations of bronchial obstructive syndrome and respiratory failure. The causative agent of acute bronchiolitis is a virus. Since the main pathogenetic link is the formation of inflammation in the epithelium of the bronchioles by various agents, we conducted treatment using an immunostimulating drug-Broncho-munal. We treated 50 patients aged 6 to 36 months, who were divided into 2 groups. The patients were hospitalized in the Samarkand Branch of the Republican Scientific Center of Emergency Medical Care, in the departments of pediatrics. 25 patients were prescribed Bronxo-munal in an age-related dosage for 10 days. Clinical manifestations of group I, who received the drug Bronxo- munal, were stopped faster by almost 2 times, compared with patients from group II. The use of the drug Bronxo-munal in acute bronchiolitis has shown that it is an effective anti-inflammatory and anti-bronchoconstrictor drug that prevents and reduces the severity of acute bronchiolitis
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GENETIC RISK FACTORS FOR THE DEVELOPMENT OF UNSTABLE ANGINA PECTORIS IN YOUNG MEN. (REVIEW).Currently, in a number of developed countries, thanks to the implementation of programs aimed at identifying risk factors for cardiovascular diseases and eliminating them, it has been possible to achieve some reduction in the incidence and mortality from coronary heart disease. However, attempts to reduce the incidence of the cardiovascular system only by correcting environmental risk factors are not always effective. In this connection, in order to solve the problem of preventing cardiovascular diseases at the population and individual levels, the study of the molecular genetic basis of diseases of the cardiovascular system and the search for genetic risk markers of IHD and its clinical forms is relevant. This article describes the normal structure and mutation of the interleukin 1 C (+3953) T and interleukin 10 A-1082G genes in unstable angina pectoris in young men. A better understanding of the causes and mechanisms of the development of NVS in young patients is a serious medical and social task. Early diagnosis, followed by a timely and personalized approach to therapy, improves the prognosis of cardiovascular diseases at a young age.
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THE MODERN CONCEPT OF PROPHYLAXIS AND SURGICAL TREATMENT OF STERNOMEDIASTINITIS AFTER CARDIAC SURGERYComplete longitudinal median sternotomy (CLMS) is standard access not only to the mediastinum during cardiovascular surgery on the heart and main vessels, but also on thoracic surgery - 2 sided operations on the lungs, large airways. Despite the long history of the use of PPSS, it is not without drawbacks: inconsistency of the sternum sutures, diastasis of the sternum, complete instability of the bone skeleton of the chest, fragmentation of the sternum. All this can take place to develop both in isolation and against the background of the development of infection. One of the costly, from all sides, complex and formidable complications after cardiac surgery is sternal infection. This article deals in detail with sternal infection, describes in detail the diagnosis, treatment and prevention of sternal infection. Undoubtedly, in the clinical conditions of interaction in the system “organism-pathogenic microflora”, an equally important component joins - a medical institution and medical personnel, which often greatly change the natural course of events. In this regard, the issue of preventing the development of sternal infection in cardiac surgical patients after heart surgery remains relevant.
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ANTAGONISTS OF ENDOTHELIN RECEPTORS IN THE PATHOGENETIC TREATMENT OF PULMONARY ARTERIAL HYPERTENSION (REVIEW)Theoretical aspects of the using of endothelin receptor antagonists in the pathogenetic treatment of pulmonary hypertension are investigated. A comparative analysis of selective and non-selective endothelin receptor antagonists in the treatment of pulmonary arterial hypertension is performed. Special attention is paid to the role of endothelin in the pathogenesis of pulmonary hypertension. The pharmacodynamic and pharmacokinetic features of individual representatives of endothelin receptor antagonists, such as bosentan, ambrisentan and macitentan, the effect of these drugs on clinical symptoms, hemodynamic parameters, and load tolerance were studied.
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CARDIOMETABOLIC RISK REDUCTION AFTER LAPAROSCOPIC SLEEVE GASTRECTOMYAccording to statistical data, published in New England Journal of Medicine, Republic of Uzbekistan is leading among the countries of the Central Asia by number of people with excessive weight – they are 44,5 %, and 20,4 % of them are with superobesity. Surgical bariatric treatment of obesity is the unique method which has proved stable efficiency in reduction of excessive weight at patients with morbid obesity for a long time. The purpose of this study was evaluation of cardiometabolic risk regression after laparoscopic sleeve gasterectomy (LSG). There were observed 35 women with morbid obesity. It was established that cardiometabolic risk reduced after LSG because number of women with average risk by CMDS is reduced in 2 times, with low risk is increased in 1,6 times 12 month after surgery. Level of proinflammatory cytokine IL-6 and CRP start declining at earlier period after LSG. Volumetric - linear parameters of heart change synchronously with reduction of excessive weight and is proportional to changes of a surface of a body.
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MODERN APPROACHES TO TREATMENT OF PATIENTS AFTER EMERGENCY CORONARY INTERVENTIONSIn the article modern questions of treatment after percutaneous coronary intervention at ischemic heart disease and conducting these patients from the point of view of modern requirements and clinical recommendations are considered. Efficiency of antiaggregant and hypolipidemic therapy in patients with stable CHD who underwent planned DES-stenting of coronary arteries is estimated. Patients with stable angina pectoris (SS) of III-IV functional classes (FC) of the Uzbek population (average age 57.3±6.5 years, duration of the disease on the average 5.4±1.2 years) were under observation. According to the indications, a planned coronaroangiography was performed with subsequent implantation of DES-stents on GE OPTIMA angiography unit (USA). As the results of the study showed, the timely use of modern means to control platelet aggregation, lipid metabolism in the use of basic drugs, which include aspirin, clopidogger, statins, individualized approach, taking into account pharmacogenetic studies to treat patients with CHD undergoing stenting, increases the safety and efficiency of treatment.
Journal of Cardiorespiratory Research
