According to statistics provided by the World Health Organization, in 2020 there will be about 2 billion adults, 41 million children under the age of 5 and 340 million children and adolescents aged 5 to 19 who are obese. It is proved that quite often obesity is a predictor of the formation of diseases of the musculoskeletal system. The purpose of the study was to determine the state of lipid and carbohydrate metabolism in patients with different stages of obesity and to establish their influence on the course of osteoarthritis. Materials and methods. The study involved 75 patients with osteoarthritis, which proceed on the background of obesity (main group). 50 patients had manifestations of osteoarthritis without changes in body mass index and 37 almost healthy individuals were included in the control group. Anthropometric data and body mass index were calculated. The state of lipid metabolism was determined by indicators of total cholesterol, triglycerides, high, low and very low density lipoproteins, atherogenic factor. The rate of carbohydrate metabolism was assessed by the presence of insulin resistance by calculating the Homeostasis Model Assessment of Insulin Resistance index. Body mass index was calculated by the Kettle formula. Other anthropometric parameters were determined by measuring the volume of the thigh, waist volume and calculated the ratio of volume of the thigh to waist volume. As markers of lipid metabolism we studied the content of total cholesterol, triglycerides, high-density lipoproteins, low-density lipoproteins and very low-density lipoproteins in the blood system with peroxide. The atherogenicity index was determined by the formula of Klimov A. M. Statistical analysis was performed using the software package "Statistica 10.0" and Excel 2010. To quantify the results, the results were presented as the median with a quarterly interval [Q25%; Q75%] taking into account the lack of normal distribution. Quantitative and ordinal changes were compared using the Mann-Whitney test. The correlation was calculated using Spearman's rank correlations. In all procedures of statistical analysis, the significance level p was assumed to be equal to or less than 0.05 (p <0.05). Results and discussion. We divided the patients of the main group into subgroups depending on the body mass index: overweight patients with I and II obesity degree. The comparative analysis of indicators of lipid metabolism allowed to establish increase of indicators of all atherogenic classes in comparison with control. A statistically significant difference in the rate of total cholesterol was determined only in the case of its comparison between the group with elevated body weight and I degree of obesity. Conclusion. In patients with osteoarthritis, occurring on the background of overweight or obesity, there are shifts in lipid and carbohydrate metabolism, which contribute to metabolic disorders in the body and, in particular, cartilage as a type of connective tissue. Patients with isolated osteoarthritis also have hyperlipidemia and in some cases insulin resistance, which is a negative basis for the progression of the pathological process. One of the factors in the progression of osteoarthritis in obese patients can be considered the activation of free radical oxidation of lipids, which occurs both as a result of osteoarthritis and the presence of concomitant pathology
Based on the literature data, we present current literature information about frequency, main spectrum, and prognostic value of cardiovascular complications of the SARS-CoV-2 infection. We have highlighted in detail the variants of cardiovascular disorders in the case of patients with SARS-CoV-2 infection caused by concomitant diseases of hypertension, acute coronary syndrome, myocardial infarction, arrhythmias, virus-associated myocarditis, and heart failure. We have described the adverse cardiovascular effects of medicines of different groups used to treat COVID-19 disease and possible medical interactions. We have summarized some current recommendations on cardiotonic and cardioprotective therapy in the case of patients with cardiovascular complications.
Left ventricular remodeling is one of the earliest complications of hypertension that has been proven to be an independent predictor of cardiovascular morbidity and mortality. In this article, the development of approaches to understanding its mechanics and prognostic value are briefly reviewed, with additional focus on patients with obesity and type 2 diabetes mellitus as frequent comorbid pathologies that significantly modify the typical morphological changes of the heart in hypertension. The main intacardiac mechanisms of decrease of left ventricular function constituing the direct pathophysiological and pathomorphological base for development of chronic heart failure are presented.KeyWords: hypertension, left ventricle, remodeling, dysfunction, chronic heart failure. РЕМОДЕЛЮВАННЯ ЛІВОГО ШЛУНОЧКА У ХВОРИХ НА ГІПЕРТОНІЧНУ ХВОРОБУ: ЕВОЛЮЦІЯ УЯВЛЕНЬАщеулова Т.В., Гончарь О.В., Смирнова В.І., Герасимчук Н.М., Іванченко С.В.Ремоделювання лівого шлуночка є одним із найранніших ускладнень гіпертонічної хвороби та має доведену незалежну цінність в якості предиктора серцево-судинної захворюваності та смертності. У статті наведено короткий історичний огляд розвитку уявлень про механізми та прогностичну цінність різних варіантів ремоделювання лівого шлуночка з додатковим фокусом на пацієнтах із супутнім ожирінням та цукровим діабетом 2 типу як частими коморбідним станами, що у значній мірі модифікують типові морфологічні зміни серця при артеріальній гіпертензії. Висвітлено основні інтракардіальні механізми порушення функціональної спроможності лівого шлуночка, що становлять безпосереднє патофізіологічне та патоморфологічне підгрунтя розвитку синдрому хронічної серцевої недостатності при гіпертонічній хворобі.Ключові слова: артеріальна гіпертензія, лівий шлуночок, ремоделювання, дисфункція, хронічна серцева недостатність. РЕМОДЕЛИРОВАНИЕ ЛЕВОГО ЖЕЛУДОЧКА У БОЛЬНЫХ ГИПЕРТОНИЧЕСКОЙ БОЛЕЗНЬЮ: ЭВОЛЮЦИЯ ПРЕДСТАВЛЕНИЙАщеулова Т.В., Гончарь А.В., Смирнова В.И., Герасимчук Н.Н., Иванченко С.В.Ремоделирование левого желудочка является одним из наиболее ранних осложнений гипертонической болезни и имеет доказанную независимую ценность в качестве предиктора сердечно-сосудистой заболеваемости и смертности. В статье приведен краткий исторический обзор развития представлений о механизмах и прогностической ценности разных вариантов ремоделирования левого желудочка с дополнительным фокусом на пациентах с сопутствующим ожирением и сахарным диабетом 2 типа как частыми коморбидным состояниями, в значительной степени модифицирующими типичные морфологические изменения сердца при артериальной гипертензии. Освещены основные интракардиальные механизмы нарушения функциональной состоятельности левого желудочка, что представляющие собой непосредственное патофизиологическое и патоморфологическое основание развития синдрома хронической сердечной недостаточности при гипертонической болезни.Ключевые слова: артериальная гипертензия, левый желудочек, ремоделирования, дисфункция, хроническая сердечная недостаточность.
The purpose of the study was to analyze the features of the Holter monitoring parameters and their significance in the evaluation of cardiovascular risk in patients with hypertension and obesity. The Holter's was performed by 82 patients with hypertension aged 38 to 76 years (34 men and 48 women). The investigation was carried out on the diagnostic complex SDM 23 "X-TECHNO" in 24-hour. There were 4 groups of patients depending on the body mass index (BMI): 1st with normal body weight, 2nd-with overweight, 3rd-with obesity I degree, 4th-with obesity II-III degree. Based on the results obtained, a combination of hypertension and overweight or obesity is characterized by changes in heart rate variability. This indicates a vegetative imbalance with a weakened activity of the parasympathetic part of the autonomic nervous system. These changes are manifested by a decrease in SDNN 24 and rMSSD, total spectrum power (TF) due to the HF component, an increase in the mean daily heart rate, and statistically significantly higher values of the vagosympathetic interaction index (LF/HF). Smoothing of the circadian rhythm of the heart in patients with hypertension depends on the presence and degree of obesity. The prolongation of the QT interval corrected for heart rate and the presence of ventricular rhythm disturbances of high grades recorded a statistically significantly larger number of individuals in the group of patients with obesity. These rhythm disturbances can be regarded as potentially malignant or malignant according to the risk stratification of J.T. Bigger.
PARAMETERS OF DAILY BLOOD PRESSURE MONITORING AND SERUM LEVELS OF CHEMERIN AND NESFATIN-1 IN HYPERTENSIVE PATIENTS WITH OBESITY
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