No abstract

Аортальный стеноз является самым частым проявлением клапанной болезни сердца, который требует хирургического или эндоваскулярного вмешательства. Распространенность дегенеративного аортального стеноза увеличивается из-за старения населения. Клиническое течение аортального стеноза характеризуется длительно существующим бессимптомным периодом. Прогрессирующая кальцификация створок клапана приводит к формированию градиента давления в аорте, гемодинамической перегрузке левого желудочка, развитию гипертрофии миокарда, способствующей нарушению диастолической функции левого желудочка. После появления симптомов аортального стеноза двухгодичная выживаемость у пациентов, которым не проводится хирургическая коррекция, не превышает 50 %. В Рекомендациях Европейской ассоциации кардиологов и Европейской ассоциации кардиоторакальных хирургов по лечению пациентов с клапанной болезнью сердца 2017 г. обсуждаются аспекты диагностики аортального стеноза и принципов выбора тактики ведения пациентов с использованием хирургического или катетерного методов лечения. Могут быть рекомендованы хирургическое протезирование аортального клапана или его транскатетерная имплантация. Применение медикаментозной терапии аортального стеноза не показало возможности улучшения прогноза. Ключевые слова: клапанная болезнь сердца, аортальный стеноз, диагностика, лечение.

Objective: improving the effectiveness of hypertension control in patients after COVID-19 with manifestations of depression. Materials and methods: the study included 48 patients with hypertension who had suffered a coronavirus infection. The criterion for inclusion in the study was effective control of blood pressure when using two-component antihypertensive therapy before the development of coronavirus disease and its absence when using the same therapy at the time of inclusion in the study. To identify the symptoms of depression, a study was conducted using the Beck Depression questionnaire. Group A consisted of patients with arterial hypertension with manifestations of depression and group B-patients with arterial hypertension without symptoms of depression. In both groups, a combination of a renin-angiotensin-aldosterone system blocker, a diuretic and a calcium channel blocker were used. The observation was carried out for 4 weeks, the dynamics of blood pressure and its daily parameters, manifestations of depression were evaluated. Results: the presence of symptoms of depression was detected in 39.5% of patients. At the time of inclusion in the study, office blood pressure exceeded the target level in all patients, there was an insufficient decrease in systolic and diastolic blood pressure during the day and at night, an increase in most indicators of blood pressure variability. The use of three-component therapy made it possible to achieve the target blood pressure level in 93.1% of patients without symptoms of depression. In the group of patients with depression, only 21.0% of patients reached the target blood pressure level. The analysis of daily blood pressure indicators showed a decrease in the effectiveness of antihypertensive therapy in the group of patients with depression. All daily blood pressure indicators were statistically significantly higher than in group B. Conclusion: in patients who have suffered a coronavirus infection, it is necessary to identify depression as a possible factor of ineffective control of arterial hypertension and a decrease in adherence to the recommended therapy.

Cerebeolysin (EBEWEAusuia)has a neurotrophic and antioxidant effect an is used for treating protractedextrapyramidal complications resulting fromneuroleptic therapy(tardivedyskinesia, parkinsonism). 30 patients withendogenouspsychoses(schizophrenia, shizoaffective and affective ps)d1osis)werestudied who developedtardivedyskinesia (10 patients). parkinsonism (II patients)and a combination of tardivedyskinesia and parkinsonism (9 subjects). During registration of neuroleptic complications. standard scales were used • ESRS. AIMS. SARS. Cerebrolysin was presecribedi,v. drop infusions everyother day for 28 days. The dosage was made up 5.Q.IO.0. It was found to be equally effective in treating both tardive dyskinesia (responders 60%. partial responders 20%) and parkinsonism (responders 54% and partial responders 18%). Therapeutic efficacydecreasedin combination tardive dyskinesia and parkinsonism (responders 22.2%. partial responders 44.4%). Treatment withcerebrolysin reduced extrapyramidal symptoms and reduced the severity of other adverse effects of the use of psychotropicdrugs.