Long-term outcome of infective endocarditis: the impact of early surgical intervention

To determine the impact of early surgical intervention on long-term survival in patients with infective endocarditis (IE), charts of all patients who had IE from January 1987 through December 1996 were reviewed. A total of 252 patients with definite or possible IE were included. Forty-four patients (17.5%) had early surgery on median hospital day 2 (range, 0-30 days), and 208 patients (82.5%) received medical treatment alone. On multivariate analysis, several variables, including early surgical intervention, improved long-term survival rates (hazard ratio, 1.5; P=.03), mainly in patients with Staphylococcus aureus etiology (P=.04). When patients with prosthetic devices were excluded, the median duration of survival for patients who had early surgery was >150 months, compared with 61.5 months for patients in the medical group (P=.1). Early surgical intervention compared with medical therapy alone is associated with increased short- and long-term survival rates in patients with IE, primarily when IE is caused by S. aureus.

Should psychosocial factors be taken into account when developing and implementing population-level preventive programmes?

Aim. To assess social status and selected psychological characteristics in organised urban populations from 5 Russian regions; to compare the results with the prevalence of traditional risk factors (RFs) and chronic disease. Material and methods. In 2009-2010, representative samples of organised populations from 5 Russian cities were examined (total n=2227, 1336 women and 891 men). The questionnaires assessed socioeconomic status (SES), as well as somatic and psychological health. The assessed psychological parameters included Lifestyle Index (LI), psychological resilience mechanisms (PRM), social adaptation, sanogenic reflection, Eysenck phychoticism scale, personal moral potential, emotional burnout syndrome, Hospital Anxiety and Depression Scale (HADS), and Perceived Stress Scale (PSS). The examination included the measurement of blood pressure, heart rate, waist circumference, and hips circumference. Results. The proportion of higher-educated people ranged from 82% in Nalchik to 29,3% in Omsk. Low self-rated wealth levels were highly prevalent (from 10,4-13% to 40,4%). Arterial hypertension was registered in 1,29% and 1,64% of men and women aged 25-34 years. In people aged 65-74 years, the respective figures were 60% and 75,8%. Obesity (body mass index ≥30 kg/m2) was registered in over 50% of the participants from all social groups. Negative (pathological) levels of LI significantly correlated with the majority of somatic diseases (р<0,001) and psychological disorders (р<0,007). In women, negative PRM were significantly more prevalent than in men (р<0,007). In those aged under 50 years, the prevalence of negative PRM was lower (up to 28%) than in those aged 50-60 years (37,8%), or 60-75 years (57,7%) (р<0,001). Conclusion. The development and implementation of population-level preventive programmes should take into account not only morbidity levels and traditional RFs, but also psychosocial features of the respective population groups.

Association of polymorphic gene variants of xenobiotic biotransformation enzymes with susceptibility to pulmonary tuberculosis

The objective: to investigate the relationship of polymorphic variants of genes of xenobiotic biotransformation metabolism enzymes (NAT2 (590G>A (rs1799930)), CYP2E1 (9896C>G (rs2070676)), ABCB1 (3435T>C (rs1045642)), GSTM1 (E/D), GSTT1 (E/D) with the risk of pulmonary tuberculosis.

Subjects and Methods. Within the framework of this study, a population sample of unrelated 1081 individuals of Slavic nationalities (mainly Russians) living in the territory of Kursk Oblast was used.

Results. The del/del (D/D) GSTM1 genotype was associated with an increased risk of developing tuberculosis, while carrying the del/del (D/D) GSTT1 genotype was associated with a lower risk of developing the disease. Polymorphism 3435T>C ABCB1 (TC genotype) was associated with increased susceptibility to pulmonary tuberculosis in the codominization model, while TT+TC genotypes had the same association in the dominance model.

[The methodology of therapeutic hypothermia in children born in a state of asphyxia]

This guideline provides the diagnostic and treatment algorithm for newborns with gestational age over 35 weeks and weighing more than 1800g who has severe asphyxia in birth with the threat of severe or medium-severe hypoxic-ischemic encephalopathy.

Urinary soluble VCAM-1 in systemic lupus erythematosus: a clinical marker for monitoring disease activity and damage

OBJECTIVE

To determine the urinary levels of soluble vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) in patients with systemic lupus erythematosus (SLE) and to assess their relationship with clinical and laboratory features and the degree of activity and damage associated with the disease.

METHODS

The study sample included 24 consecutive patients with SLE. 24-hour urine samples were collected for the determination of soluble VCAM-1 and ICAM-1 levels by ELISA. Disease activity was defined by the SLE Disease Active Index (SLEDAI) and disease outcome by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ ACR) damage index.

RESULTS

The urinary soluble VCAM-1 level was significantly higher in patients with SLE compared to normal controls (32.35+/-34.27 vs. 4.66+/-3.8 ng/mg creatinine, p = 0.0005) and statistically significantly correlated with disease activity (SLEDAI), a low serum C3 level, decreased creatinine clearance and albuminuria, as well as with disease damage (SLICC/ACR damage index). In contrast, the urinary soluble ICAM-1 level was not significantly higher in the patients' group compared with the controls (4.5+/-5.19 vs. 2.72+/-2.31 ng/mg creatinine, p=0.2), but was statistically significantly correlated with hematuria and albuminuria.

CONCLUSION

Our data suggest that the urinary level of soluble VCAM-1 significantly correlates with overall disease activity and damage scores, but not with nephritis in SLE.

[The influence of psychological factors on the integral health characteristic (data from a prospective population study)]

AIM

To develop integral assessment of the health status based on the examination of representative samples from different regions of Russia (Veliky Novgorod, Nizhni-Novgorod, Vologda, Omsk and Nalchik) with the use of special questionnaires and simple anthropometric and functional methods in the framework of a prospective 3-year population study of organized groups.

METHODS

The above questionnaires allowed to elucidate the socio-economic status of the patients, their somatic and psychological conditions (lifestyle index or psychological protection mechanisms (PPM), social adaptation, sanogenic reflexia; also used were Eysenck's psychotism scale, hospital anxiety and depression scale, the perceived stress scale (PSS), and moral potential of personality development scale.

RESULTS

It was shown that the profile of psychological protection mechanisms is dominated by primitive reactions, such as projection, protection, and negation. Most subjects from the sample formed the pathogenic type of reflexia (inability to resolve a problem situation based on the cognitive components of the patient's mental state). Mathematical treatment of the so-called "simple cross-tabulation" with unification of all negative PPM revealed the highly significant relationship of LSI (not norm) with most previous somatic diseases (p<0.001), i.e. the history of myocardial infarction, angina of effort, cardiovascular syndromes, diabetes, hypertension, chronic broncho-pulmonary, hepatic, gastrointestinal, urogynecological, oncological, and psychic diseases. (p<0.007).

CONCLUSION

Pyschological changes have greater influence than somatic ones on physiological parameters determining the population health status which suggests the necessity of taking them into account when planning health promotion measures.