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Objective : to study the importance of cytokines, hepcidin, a soluble transferrin receptor, iron metabolism in the development of anemia of chronic diseases in patients with malignant neoplasms and rheumatic pathology, to identify the leading factors in the development of anemia for each of the studied groups and to develop a working classification...
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We sought to investigate the effects of resistance training (RT) combined with erythropoietin (EPO) and iron sulfate on the hemoglobin, hepcidin, ferritin, iron status, and inflammatory profile in older individuals with end-stage renal disease (ESRD). ESRD patients (n: 157; age: 66.8 ± 3.6; body mass: 73 ± 15; body mass index: 27 ± 3), were assigne...
Background:
The monthly continuous erythropoietin receptor activator (CERA) utilization maintains stable hemoglobin (Hb) after conversion from weekly epoetin-β (EB); however, how the different pharmacologic properties affect the red blood cell (RBC) size determined by RBC distribution width (RDW) has not been evaluated yet. We assess the potential...
Hereditary haemochromatosis (HH) is an inherited disorder of iron metabolism characterized by excessive iron overload and end organ damage. It is a genetically heterogenous hereditary disease caused by mutations that are broadly categorized into HFE and non HFE hereditary haemochromatosis (including Hemojuvelin, hepcidin (HAMP), Transferrin recepto...
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Relevance. Cardiogenic shock remains one of the most common causes of death in myocardial infarction. Aim. To evaluate the features of cardiac rhythm and conduction disturbances in myocardial infarction complicated by cardiogenic shock, as well as their significance for the development of this complication in males under 50 years old to improve prevention and outcomes. Material and methods. The study included males aged 19-49 years old with type I myocardial infarction. The patients were divided into age- comparable groups. The study group consisted of seven patients with cardiogenic shock, the control group - without cardiogenic shock - 223 patients. A comparative analysis of arrhythmias among the variants of the clinical course, complications, as well as their structure in selected groups were performed. The influence of the studied parameters on the risk of cardiogenic shock development in the examined patients was assessed by the method of risk analysis using the Pearson Chi-square test. Results. In the study group, a higher incidence of arrhythmias in the structure of MI complications (85.7%) was revealed than in the control group (24.2%; p=0.003). They were observed in combination with complications of the group of contractile myocardial insufficiency and its mechanical failure (57.1% and 6.3%, respectively; р˂0.0001) and only contractile insufficiency (28.6% and 11.2%; р˂0,0001). In the structure of arrhythmias in the study group, the frequency of observation of atrial fibrillation and flutter (66.7%) prevailed over the control group (4.9%; р˂0.0001), ventricular fibrillation (50.0 and 2.4%, respectively; р˂ 0.0001), supraventricular tachycardias (33.3% and 1.5%; р˂0.0001), supraventricular (33.3% and 8.3%; р=0.03) and polytopic extrasystoles (33.3% and 3 .9%; p=0.0003), ventricular tachycardias (16.7% and 2.0%; p=0.02), complete atrioventricular blockades (16.7% and 2.0%; p=0.02) and asystole (16.7% and 1.5%; p=0.007). The risk of cardiogenic shock development increased with these arrhythmias. Conclusions. The listed types of arrhythmias should be used in the formation of high-risk groups for the cardiogenic shock development in myocardial infarction for monitoring and timely implementation of the necessary treatment. It is also expedient to take them in the prognostic modeling of this complication.
Relevance. Cardiogenic shock remains the most common cause of death in myocardial infarction. Aim. To evaluate the myocardial infarction complicated by cardiogenic shock clinical course features in males under 50 years old (y.o.) to clarify their significance for the development of this complication to improve prevention and outcomes. Material and methods. The study included males aged 19-49 y.o. with type I myocardial infarction. The patients were divided into age-matched groups. The study group consisted of seven patients with cardiogenic shock, the control group - without cardiogenic shock - 223 patients. Comparative analysis of the clinical course variants, complications in selected groups was performed. The influence of the studied parameters on the probability of cardiogenic shock development in the examined patients was assessed by the method of risk analysis using the Pearson Chi-square test. Results. In the study group, there was a predominance of kidney dysfunction (100 in the study group and 10.3% in the control group; p=0.004), chronic heart failure in history less than one year old (50.0 and 15.3%, respectively; p=0, 04), non-anginal variants (abdominal (16.7 and 1.5%; p = 0.0497), arrhythmic (16.7 and 2.5% p = 0.0497) and according to the type of increase in heart failure (16.7 and 1.5%; p=0.0497)) of the clinical course of myocardial infarction, the presence of two or more complications (100 and 38.1%; p=0.005) and combinations of all groups of myocardial lesions (57.1 and 6.3% ; р˂0.0001). The risk of developing cardiogenic shock increased in addition to the above situations with diastolic blood pressure ˂70 mm Hg (Absolute risk: 18.8%; relative: 13.3; p˂0.0001), systolic˂110 mmHg (14.3%; 9.9, respectively; p=0.0004), total peripheral resistance (37.5%; 35.8; p˂0.0001). Conclusions. These factors should be used in the formation of high-risk groups for the cardiogenic shock in myocardial infarction development for monitoring and timely implementation of the necessary treatment. It is also expedient to take them into account in the prognostic modeling of this complication.
Aim. To compare the secretion of interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-1-beta, tumor necrosis factor-alpha (TNF-α), interferon-gamma (INF-γ) in patients with HIV infection with anemia of chronic disease (ACD), iron deficiency anemia (IDA), as well as their combination. To assess the effect of the studied cytokines on erythropoiesis in each of the studied types of anemia in this category of patients. Material and methods. 125 patients with HIV infection were examined: 101 with anemia (55 men, 46 women, 39.4±9.6 years), 24 patients with HIV infection without anemia (13 men, 11 women, mean age 37.6± 7.37 years). In accordance with the Van Santen and Worwood criteria, by determining the transferrin saturation index (TSI), ferritin concentrations, C-reactive protein (CRP), patients with anemia were divided into 3 groups: group 1 – 36 patients with ACD (19 men, 17 women, mean age 41.7±11.8 years), group 2 – 30 patients with a combination of ACD/IDA (18 men, 12 women, mean age 41.2±10 years), group 3 – 35 patients with IDA (18 men, 17 women, mean age 35.4±7.1 years). In all patients, the number of erythrocytes, the concentration of hemoglobin, ferritin, CRP, CNT, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10), interleukin-1beta (IL-1β), interferon-gamma (INF-γ). For quantitative indicators, the arithmetic mean, standard error of the mean, and interquartile range (IQR) were calculated. Significance of differences between several unrelated groups was determined using the Kruskal-Wallis’s test. To assess the relationship between variables, the Spearman correlation coefficient I was calculated. Results. In the ACD group, the maximum concentration of IL-6 (36.6 [IQR, 11.5-51.1]) and IL-10 (21.6 [IQR, 11.4-28.8]) compared with the ACD/IDA group (IL-6 (9.1 [IQR, 5.1-11.4]), IL-10 (15.5 [IQR, (7.1-21.6)]), and IDA (IL- 6 (6.2 [IQR, 1.6–7.2]), IL-10 (8.6 [IQR, 3.9–9.3]) (p<0.05). In the groups of patients with ACD and ACD/IDA, the maximum and almost equal concentrations of TNF-α (15.2 [IQR,6.1-24.1] in the ACD group and 17.3[IQR,7.9-17.3] in the ACD/IDA group), IL-1β (16.7[IQR,4.7-28.9] in the ACD group and 19.2 [IQR,3.9-28.8] in the ACD/IDA group), INF-γ ( 62.6[IQR,4.6-85.3] in the ACD group and 58.3[IQR,8.5-37.5] in the ACD/IDA group), which were statistically significantly higher than the concentrations of these cytokines in patients with IDA and the control group. There were no significant differences in the concentrations of TNF-α, IL-1β, IL-10 and IFN-γ between patients with IDA and the control group. Significant moderate and strong negative correlations were found in the groups of patients with ACD and ACD/IDA between all studied cytokines, erythrocytes and hemoglobin. In the IDA group, the correlation coefficients between cytokines, erythrocytes, and hemoglobin are low or absent. Conclusions. In patients with HIV infection, a wide prevalence of ACD has been shown, especially in patients with immunodeficiency and in the late stages of the disease. ACD, unlike IDA, has a complex multicomponent pathogenesis. This study shows the importance of pro-inflammatory and inflammatory cytokines in the development of ACD in HIV patients, including due to their negative effect on erythropoiesis and hemoglobin synthesis. A working version of the classification of ACD (with a predominant iron deficiency, with impaired regulatory mechanisms of erythropoiesis, with insufficient production of erythropoietin) has been proposed. It is necessary to further study the pathogenesis of ACD in this category of patients to improve treatment.
Relevance. The lipid metabolism changes during myocardial infarction (MI) in men with metabolic syndrome (MS) may be important for the MI complications development. Aim. To evaluate the lipid metabolism changes in acute and subacute MI periods and their role in the MI complications development in men under 60 years old with MS to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with MI and MS. The patients were divided into two age-comparable groups: I - study group, with MS - 95 patients; II - control, without it - 571 patients. A comparative analysis of the lipid metabolism parameters and their dynamics in acute and subacute MI periods in selected groups, analysis of their influence on the risk of MI complications were performed. Results. It was found that in the first hours of MI in the study group, higher levels of triglycerides (3.19 ± 2.34 mmol/l) were noted compared to the control group (2.44 ± 1.75 mmol/l; p=0.02). The dynamics of lipid metabolism at the end of the third week of MI, significant multidirectional changes in all parameters with more pronounced atherogenic changes in the study group were revealed. The risk of MI complications was associated with levels of triglycerides (TG) ˂5.2 (p=0.02), high density (HDL) ≥0.9 (p=0.04) and very low-density lipoproteins (VLDL) ˂0.9 (p=0.04) (mmol/l) of the first hours of MI. Conclusions. The presence of MS impairs lipid metabolism in both acute and the subacute MI periods. In the study group, there is an increase in the levels of atherogenic lipids and their indices during the observation period. MI complications are associated with levels TG ˂5.2; HDL ≥0.9 and VLDL ˂0.9 (mmol/l) during the first hours of MI. It is expedient to use them in predictive modeling.
Anemia is believed to be a medico-social problem affecting a great part of population. Anemia of chronic diseases represents a considerable number of these disorders, which is particularly challenging for long-standing inflammatory processes, systemic diseases and neoplasms. Pathogenesis of this type of anemia is characterized by complex and miltifactorial nature. Pathogenesis is based on disturbance of erythropoietin synthesis and erythropoiesis precursor cells sensitivity, hyperproduction of factors inhibiting erythropoiesis (tumor necrosis factor, interleukins), disturbance of iron metabolism and other hemopoiesis co-factors. Anemia aggravates associated underlying disease course. Quality of life and overall survival deteriorate. Treatment efficacy for anemia influences the time of patient recovery, as well as success of treatment of other diseases. Iron deficiency and erythropoiesis disturbance, similar to hypoferric anemia, are of great importance. However, iron therapy may aggravate patients condition, hence differential diagnosis of this anemia type and true iron deficiency anemia has a great practical value. In the treatment of anemia in the presence of chronic diseases and anemia in the presence of hematologic diseases, the goal of the treatment is generally limited by the improvement of patients quality of life, target value of hemoglobin for transfusion or erythropoiesis stimulating therapy remaining the subject for discussion. Hemoglobin target determination in individuals with cardiac and pulmonary insufficiency who are on chemotherapy, is critically important, because it is this category of patients that does not demonstrate generally accepted target values of hemoglobin, the level of which is not always indicative of hypoxia absence. The review presents current data on diagnosis, treatment of chronic disease anemia (1 figure, 2 tables, bibliography: 12 refs).
Relevance. The quality-of-life assessment in patients with myocardial infarction and acute kidney injury in differs significantly among different researchers. Aim. To evaluate the changes in the quality-of-life indicator associated with heart failure in men under 60 years old with myocardial infarction and acute kidney injury to search for opportunities to improve prevention. Material and methods. The study included men aged 19-60 years old with type I of myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with acute kidney injury - 25 patients; II - control, without it - 167 patients. A comparative analysis of the quality-of-life indicator associated with heart failure (V. Ironosov) was performed in the selected groups in the first 48 hours (I) and at the end of the third week (II) of myocardial infarction. The changes and correlations (C. Spearmen) of quality-of-life indicator with various clinical features were studied. Results. The quality-of-life in patients in the study group did not differ from the control in both phases of the study (1: 58.8 ± 15.8 and 63.7 ± 20.0; 2: 19.1 ± 8.6 and 20.4 ± 13, 5, respectively; p ˂ 0.05) with positive (68%) dynamics in both groups of patients. Significant correlations of the quality-of-life indicator with age, heart rate, blood pressure, lipid metabolism, left ventricular systolic function, total calcium, GRACE index was revealed. Conclusions. The quality of life associated with heart failure indicator dynamics in the study group did not differ from the control group. Tachycardia, arterial hypertension, dyslipidemia, and hypocalcemia were found to be early markers of deterioration in the quality of life. They can be used in the early diagnosis of chronic heart failure for the timely implementation of preventive measures.
