Vol 48, No 5 (2020)
ARTICLES
Database of patients with sarcoidosis of the Republic of Tatarstan: a retrospective analysis for 50 years
Abstract
Background: Sarcoidosis is a granulomatous disease with no established etiology. The prevalence of sarcoidosis is growing, there are changes in the clinic of the disease depending on geolocation and the environment.
Aim: To analyze the database (register) of sarcoidosis patients registered with this disease in the Republic of Tatarstan.
Materials and methods: In Tatarstan, an electronic database of 2715 patients with sarcoidosis has been created, collected over the past 50 years. The frequencies of the phenomena were estimated, and the ChI-square Pearson criterion was calculated to assess the relationship of events and their reliability.
Results: There were 69.2% of women and 30.8% of men. The average age was 44.2 years (15 to 87 years, median 44 years). Men were younger (median 36 years old) than women (median 48 years old). Most often, there was stage II (47.8%) and stage I (40.8%). Lofgren's syndrome was in 13% of patients. 42% had biopsy data, over three decades its frequency increased -21.9%, 34.8% and 49.0%, respectively. After 2010, there was an increase in stage II sarcoidosis, over the past 20 years, the proportion of women has decreased and the proportion of men has grown. Adverse factors of the profession orthe environment were in every third patient. The frequency of prescribing prednisone decreased from 2013 to 2019 from 23.1% to 9.1%, and pentoxifylline increased from 14.9% in 2011 to 58% in 2019. Every third patient received vitamin E.
Conclusion: About 100 new patients were identified annually. An increase in the II radiation stage of sarcoidosis was noted. A biopsy was performed only on every second patient. The treatment was consistent with the international approach - to use prednisone and cytostatics only with the progression of the process.
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The potential for correction of depressive disorders in patients with chronic obstructive pulmonary disease
Abstract
Background: The use of vitamin D in the treatment of depressive disorders in patients with chronic obstructive pulmonary disease (COPD) is justified by its pathophysiology, but it is not always feasible in clinical practice. This may be related to the lack of guidelines for implementation for this patient group, as well as to the inadequate sample of patients with baseline high vitamin D levels or mild psychoemotional distress.
Objective: To assess the changes of psychoemotional status over time in COPD patients against the maintenance of vitamin D levels at>34.3 ng/ml for one year.
Materials and methods: The study included 264 COPD patients randomized into the treatment and control groups (135 and 129 patients, respectively). The patients in both groups were divided into 4 subgroups according to their forced expiratory volume in 1 second (FEV1) values and vitamin D levels. All the patients were administered an inactive vitamin D (colecalciferol): in the main group, according to the scheme ensuring maintenance of the micronutrient value above the goal for 12 months, and in the control group according to the standard scheme of correction of vitamin D deficiency. Depression symptoms were assessed in Geriatric Depression Scale (GDS-15) at the beginning of the study and at its end.
Results: After 12 months of vitamin D treatment, the main group showed a statistically significant decrease in the rate of severe depression (14.8% vs 6.7%, χ2=4.67, p=0.04) and an increase in the proportion of patients with normal psychoemotional status (28.2% vs 49.6%, χ2=13.11, p=0.03). In addition, there was a significant difference between the rates of severe depression in the main and control groups after 12 months of treatment: 6.7% vs 14.7% (χ2=4.52, p=0.02).
Conclusion: Maintenance of vitamin D levels above 34.3 ng/ml in COPD patients for 12 months reduces the proportion of patients with severe depression.
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Diagnosis of small airway dysfunction in patients with chronic obstructive pulmonary disease
Abstract
Background: Small airway dysfunction (SAD) is a functional hallmark of chronic obstructive pulmonary disease (COPD). However, SAD prevalence and its role in COPD pathophysiology are not yet sufficiently studied.
Background: Small airway dysfunction (SAD) is a functional hallmark of chronic obstructive pulmonary disease (COPD). However, SAD prevalence and its role in COPD pathophysiology are not yet sufficiently studied.
Aim: To assess the prevalence of SAD in COPD patients by various functional diagnostic methods, such as spirometry, body plethysmography, and impulse oscillometry (IOS).
Materials and methods: This was an cross-sectional study. Spirometry, body plethysmography and IOS were used in 132 COPD patients in remission under standard anti-COPD treatments. The presence of SAD was confirmed by at least one of the following criteria or their combination: 1) by spirometry: the difference between vital capacity (VC) and forced vital capacity (FVC) > 10%; 2) the presence of air trapping by body plethysmography; 3) identification of the frequency dependence of the resistive resistance at 5 to 20 Hz (R5 - R20 > 0.07 kPa x s/l), as assessed by IOS.
Results: Mean forced expiratory volume in 1 s (FEV1) was 42.9% of predicted. Depending on the severity of the obstruction, the patients were divided into 4 groups: 7 patients (group 1) had the obstruction corresponding to GOLD 1 stage, 37 (group 2) to GOLD 2, 49 (group 3) to GOLD 3, and 39 (group 4) to GOLD 4. SAD was found in 96% of COPD patients, whereas in those with severe obstruction (GOLD 3-4), it was present in 100% of the cases. By spirometry, SAD was identified only in 67% of COPD patients, by body plethysmography in 75% of COPD patients (in those with severe obstruction (GOLD 3 and 4) in 88 and 97%, respectively). With IOS, it was possible to identify SAD in 94% of patients and in 100% of those with severe obstruction (GOLD 3-4).
Conclusion: With deterioration of obstructive pulmonary ventilation abnormalities in COPD patients, there is a progressive increase in small airway dysfunction. Impulse oscillometry seems to be the most effective method for diagnosis of small airway dysfunction, as it helped to identify SAD in 94% of COPD patients and in 100% of those with severe and very severe obstruction.
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Hyperaldosteronemia as a risk factor of renal dysfunction in patients with heart failure with preserved ejection fraction
Abstract
Objective: To assess the relationship between plasma aldosterone levels and renal function in patients with heart failure with preserved ejection fraction (HFpEF).
Materials and methods: A cross-sectional study included 158 patients with confirmed HFpEF. Patients with primary hyperaldosteronism, edema syndrome, end stage renal disease and taking mineralocorticoid receptor antagonists were excluded. Renal function was assessed by determining daily urinary albumin excretion (UAE) and calculating the glomerular filtration rate (GFR). Plasma aldosterone was measured by enzyme immunoassay.
Results: The patients were divided into two groups: 99 patients had normal (40-160 pg/ml) aldosterone plasma level (nAld) and 59 patients had high (> 160 pg/ml) aldosterone level (hAld). hAld patients had significantly higher UAE (median 342 mg/day [interquartile value 253; 453] versus 116 mg/day [32; 255], p < 0.001), and lower GFR (52 ml/min/1.73 m2 [46; 67.5] versus 66 ml/min/1.73 m2 [53; 79]) compared to nAld. The prevalence of impaired renal filtration function and severe albuminuria was higher in hAld group then in nAld (p < 0.001). In binomial logistic regression models adjusted for age, severity of HFpEF and comorbidities high aldosterone plasma level were independent risk factors of significant (< 60 ml/min/1.73 m2) decrease in GFR (odds ratio 4.25, 95% confidence interval 2.01-16.6) and very high (> 300 mg/day) albuminuria (odds ratio 2.23, 95% confidence interval 1.24-9.63).
Conclusion: In HFpEF plasma aldosterone levels are closely related to renal function. Secondary hyperaldosteronism is associated with an increased risk of impaired renal filtration and severe albuminuria.
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Т1 mapping in the evaluation of the risk factors for diffuse myocardial fibrosis in essential arterial hypertension
Abstract
Background: The assessment of diffuse myocardial fibrosis is necessary to plan the management of patients with various cardiovascular disorders, including hypertensive heart disease. The development of imaging techniques has enabled a non-invasive detection of left ventricular myocardial fibrosis by magnetic resonance imaging (MRI) with T1 mapping.
Aim: By cardiac MRI, to identify risk factors for diffuse left ventricular myocardial fibrosis in patients with hypertensive heart disease.
Materials and methods: This was a cross-sectional observational study in 50 outpatients with hypertensive heart disease, aged 46 to 82 years (median, 68 [64; 72] years) and bodyweight of 52 to 120 kg (median, 91 [80; 98] kg). Standard cardiac MRI with delayed contrast enhancement was performed with Optima MR450w GEM 1.5T (General Electric, USA). For assessment of diffuse myocardial fibrosis MRI mapping by 2D MOLLI (3-3-5) technique was used. The results were analyzed with Cvi42 software (Circle Cardiovascular Imaging Inc., USA). The potential risk factors included patients’ age, gender, bodyweight, and diastolic heart failure.
Results: The mean time of T1 relaxation without contrast enhancement was 1122.64 ±63.67 ms, indicating the presence of myocardial fibrosis in 100% of the patients. Female patients had more advanced diffuse myocardial abnormalities (p < 0.001). In the elderly patients, there was a direct correlation between their age and degree of fibrosis (p = 0.006). There was an inverse correlation between higher bodyweight and increased extracellular volume. Heart rhythm disorders and diastolic heart failure had no impact on the changes in the mapping parameters of the left ventricular myocardium and MRI-assessed cardiac output values. No correlation between the myocardial fibrosis and dyslipidemia/hyperlipidemia was found. There was a direct correlation between the native T1 mapping values and extracellular volume fraction (p = 0.004) and an inverse correlation between low values of post-contrast T1 mapping and increased extracellular volume fraction (p = 0.05).
Conclusion: Т1 mapping in patients with essential arterial hypertension allows for detection of diffuse myocardial fibrosis of the left ventricle, which is recognised as a major indicator of myocardial remodeling. Female gender, older age, and bodyweight were the factors associated with more advanced myocardial fibrosis.
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Evaluation of microRNA profile in cervical epithelium for predicting cervical cancer recurrence
Abstract
Background: To predict the development and recurrence of cervical cancer (CC), we selected three oncoassociated miRNAs: miRNA-20a, -21, whose overexpression leads to the development of tumors, and -23b, which acts as an oncosuppressor. Aim: To evaluate the microRNA profile in the cervical epithelium for predicting CC recurrence in patients who underwent early treatment.
Materials and methods: In the study of the informativeness of expression included 145 patients with T1a1-T2a1N0M0 CC who were followed up for 2 years after treatment. Expression of microR-NA-20a, -21 and -23b was analyzed in tumor tissue samples.
Results: The risk of recurrence decreased from 1.0 to 0.92 after 1 year of the follow-up, and to 0.84 after 2 years. The initial expression of microRNA-20a and -21 in the cervical epithelium in patients with recurrent CC was 44% and 47% higher, respectively, than in patients without recurrence, while microRNA-23b expression was 46% lower. When initial levels of microRNA-20a and -21 expressions were 1.08 and 1.18, respectively, the risk of CC recurrence during the first two years after the surgery increased by 10.15 and 7.62 times, respectively. MicroRNA-20a expression in cervical epithelium equal to 1.08 was associated with 23% risk, and equal to 1.4 - with 79.7% risk. MicroRNA-21 expression equal to 1.18 was associated with 15% risk of CC recurrence; equal to 1.4 - with 55.5% risk; equal to 1.7 - 94.6%. Logistic regression showed that recurrence risks increased sharply when microRNA-23b expression declined.
Conclusion: We registered higher levels of mi-croRNA-20a and -21 expressions and lower mi-croRNA-23b expression in patients with recurrent CC, compared to favorable course of the disease. An analysis of the expression profiles of micro-RNA-20a, -21 and -23b after CC diagnosis allow prognosis of recurrence risks within 2 years after the tumor removal surgery.
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CLINICAL CASES
Clinical cases of myocardial infarction in pregnant women: the role of hereditary thrombophilia
Abstract
Acute myocardial infarction during pregnancy is a threatening complication with high maternal and perinatal mortality. According to the literature, hereditary thrombophilia is commonly associated with obstetric disorders and susceptibility to venous thrombosis, whereas arterial part of the vasculature, including coronary, is rarely involved. The article describes two clinical cases of pregnant women with acute myocardial infarction and post-infarction cardiosclerosis, in whom hereditary thrombophilia, associated with the gene PAI-1-675 polymorphism, was diagnosed. Mothers of both patients had suffered myocardial infarction at a young age, while past history of only one pregnant woman was remarkable for multiple perinatal losses. Myocardial infarction may manifest with intense headache mirroring systemic angiospasm.
Based on the clinical observations of acute myocardial infarction in pregnancy, one could conclude that measurements of troponin levels that might be false negative should be done repeatedly, while the signs of transmural myocardial injury at ECG can evolve into those of an intramural myocardial infarction. Miscarriage and fetoplacental insufficiency have been found in the patients with combination of hereditary thrombophilia and myocardial injury. Coronary artery damage in pregnant women can be the result of hereditary thrombophilia, most often associated with the PAI-1-675 gene polymorphism, as well as its combination with the heterozygous state of other genes.
The absence of past perinatal losses and venous thromboembolism in pregnant women with myocardial infarction does not exclude hereditary thrombophilia, and additional work-up of the patient and the proband family is mandatory to exclude the underlying pathology. The course of myocardial infarction may not require an intracoronary intervention, and treatment may consist of non-fractionated or low molecular weight heparin and calcium antagonists.
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