A psychometric evaluation of the Chinese version of the Hospital Anxiety and Depression Scale in patients with coronary heart disease

Aim. To evaluate further the psychometric properties of the Chinese version of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for anxiety and depression in Chinese patients with coronary heart disease (CHD) in Xian, China. Background. There is considerable evidence that anxiety and depression are common in patients with CHD and are associated with increased morbidity and mortality. A valid, reliable and sensitive screening tool that can be used readily on this group of patients would be useful for assessment, intervention and outcome evaluation. Design. A single group, cross‐sectional study. Method. Measurement performance was tested on 314 Chinese patients with CHD and repeated on 173 of them two weeks later. Results. The Chinese version of HADS (C‐HADS) had acceptable internal consistency and test‐retest reliability, with a Cronbach's alpha of 0·85 and intraclass correlation coefficient of 0·90, respectively. There was acceptable concurrent validity with significant (p < 0·05) correlations between the anxiety and depression subscales of the C‐HADS and CHD patients’ perceived health status as measured by the Chinese‐Mandarin version of the Short Form‐36 health survey (CM:SF‐36). Principal components analysis revealed a three‐factor solution accounting for 53% of the total variance. The three underlying sub‐scale dimensions are depression, psychic anxiety and psychomotor anxiety. The responsiveness of the C‐HADS was also satisfactory with significant correlation between the changes in the C‐HADS score and the changes in the mental health domain of the CM:SF‐36 (p < 0·01). Finally, over one‐third of the patients demonstrated psychological distress. Conclusion. Empirical data support the C‐HADS as a reliable and valid screening instrument for the assessment of anxiety and depression in Chinese‐speaking patients with CHD. A tri‐dimensional scoring approach should be considered as potentially clinically useful for this group of patients. Relevance to clinical practice. The C‐HADS can guide and evaluate the delivery of psychological care for Chinese patients with CHD.     

THIS ARTICLE HAS BEEN RETRACTEDA psychometric evaluation of the Chinese version of the Hospital Anxiety and Depression Scale in patients with coronary heart disease

Aim. To evaluate further the psychometric properties of the Chinese version of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for anxiety and depression in Chinese patients with coronary heart disease in Xian, China. Background. There is considerable evidence that anxiety and depression are common in patients with coronary heart disease (CHD) and are associated with increased morbidity and mortality. A valid, reliable and sensitive screening tool that can be used readily on this group of patients would be useful for assessment, intervention and outcome evaluation. Design. A single group, cross‐sectional study. Method. Measurement performance was tested on 314 Chinese patients with coronary heart disease and repeated on 173 of them two weeks later. Results. The Chinese version of HADS (C‐HADS) had acceptable internal consistency and test‐retest reliability, with a Cronbach alpha of 0·85 and intraclass correlation coefficient of 0·90, respectively. There was acceptable concurrent validity with significant (p < 0·05) correlations between the anxiety and depression subscales of the C‐HADS and CHD patients’ perceived health status as measured by the Chinese Mandarin version of the Short Form‐36 health survey (CM:SF‐36). Principal components analysis revealed a three‐factor solution accounting for 53% of the total variance. The three underlying sub‐scale dimensions are depression, psychic anxiety and psychomotor anxiety. The responsiveness of the C‐HADS was also satisfactory with significant correlation between the changes in the C‐HADS score and the changes in the Mental Health domain of the CM:SF‐36 (p < 0·01). Finally, over one‐third of the patients demonstrated psychological distress. Conclusion. Empirical data support the C‐HADS as a reliable and valid screening instrument for the assessment of anxiety and depression in Chinese‐speaking patients with CHD. A tri‐dimensional scoring approach should be considered as potentially clinically useful for this group of patients. Relevance to clinical practice. The C‐HADS can guide and evaluate the delivery of psychological care for Chinese patients with CHD.     

Effect of endogenous estrogen on endothelial function in women with coronary heart disease and its mechanism

BACKGROUND: Estrogen promotes and modulates vascular endothelial function, which may be protective against development of atherosclerosis. Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, has been reported to be associated with the impairment of vascular endothelial function. Recent studies suggested estrogen replacement therapy lowers plasma concentrations of ADMA in healthy postmenopausal women. However, the relation between endogenous estrogen and ADMA and their effect on endothelial function in patients with coronary heart disease (CHD) remains unclear. METHODS: Flow-mediated dilatation (FMD) and nitroglycerin-induced dilatation (NID) of the brachial arteries were detected by using high-resolution ultrasound in 33 women with CHD and 17 healthy controls. Plasma estradiol, ADMA, and lipid concentrations were also measured in all subjects. RESULTS: In comparison with control group, FMD and NID were significantly decreased in the CHD group (1.73 +/- 1.26% vs. 5.37 +/- 3.20%, p < 0.001 and 12.38 +/- 6.70% vs. 20.79 +/- 7.57%, p < 0.01, respectively). Plasma estradiol concentrations in the CHD group were lower than in controls (27.80 +/- 12.28 vs. 43.83 +/- 14.30 pg/ml, p < 0.01), whereas ADMA concentrations in the CHD group were higher than in controls (3.39 +/- 1.07 vs. 1.31 +/- 0.69 micromol/l, p < 0.001). Pearson correlation analysis determined that plasma estradiol concentrations were associated with FMD, NID, age, systolic pressure, diastolic pressure and ADMA (r = 0.610, p < 0.01; r = 0.392, p < 0.01; r = -0.589, p < 0.01; r= -0.364, p < 0.01; r = -0.350, p < 0.05; r = -0.553, p < 0.01; respectively). Multiple linear stepwise regression analysis revealed that plasma estradiol concentrations was independently positively correlated with FMD (p < 0.005) and negatively correlated with ADMA (p < 0.05). CONCLUSIONS: Both FMD and NID are impaired in women with CHD. The decrease of endogenous estrogen concentrations and the increase of ADMA concentrations may involve the endothelial dysfunction in women with CHD.     

Metabolic effects of berlipril-5 in patients with non-insulin dependent diabetes mellitus and arterial hypertension

AIM: To study metabolic effects of berlipril-5 (enalapril) in patients with non-insulin-dependent diabetes mellitus (NIDDM) and arterial hypertension (AH). MATERIALS AND METHODS: 24 patients with NIDDM and AH were divided into three groups by the level of basal C-peptide: > 2 ng/ml (group 1), 2-4 ng/ml (group 2) and < 4 ng/ml (group 3). RESULTS: A correlation was found between the level of basal C-peptide and duration of AH (r = 0.7) and NIDDM (r = -0.47), between the level of triglycerides (TG) and glycolized hemoglobin Hb A1c (r = 0.48). Berlipril treatment reduced basal C-peptide level in groups 2 and 3 by 20.65 +/- 1.95% and elevated it in group 1 by 16.4 +/- 1.5%. Fasting glucose levels lowered by 9.2 +/- 1.95% indicating better sensitivity of the liver to insulin. Blood glucose levels 2 hours after meal fell by 8.3 +/- 0.95% (p < 0.05) and Hb A1c by 8.14 +/- 1.25% showing indirectly diminishing insulin-resistance at the level of peripheral tissues. TG and VLDLP significantly declined. CONCLUSION: Inhibitors of angiotensin converting enzyme (enalapril, in particular) produce a positive effect on carbohydrate and lipid metabolism in patients with NIDDM and AH.     

Sevelamer hydrochloride versus aluminum hydroxide: effect on serum phosphorus and lipids in CAPD patients.

BACKGROUND: Dietary phosphorus restriction, oral administration of phosphorus binders, and dialysis are the main strategies to control hyperphosphatemia in patients with stage 5 chronic kidney disease. Aluminum hydroxide (AH) and calcium carbonate, the most commonly used phosphorus binders, have serious disadvantages, such as aluminum toxicity and hypercalcemia. Sevelamer hydrochloride (SH) is a relatively new nonabsorbed calcium- and aluminum-free phosphorus binder. The present study was designed to evaluate the efficacy of SH in the control of hyperphosphatemia and its effect, compared to AH, on serum lipid parameters in patients on continuous ambulatory peritoneal dialysis (CAPD). METHODS: 30 stable patients on CAPD were included in an open-label, randomized crossover study. After a 2-week phosphorus binder washout period, 15 patients (group I) were administered SH for 8 weeks and in the remaining patients (group II), AH was introduced (phase A). After a new 2-week washout period, patients crossed over to the alternate agent for another 8 weeks (phase B). RESULTS: There were similar reductions in serum phosphorus levels over the course of the study with both agents: by 1.18 +/- 0.07 mg/dL (0.38 +/- 0.03 mmol/L) with SH and by 1.25 +/- 0.15 mg/dL (0.40 +/- 0.05 mmol/L) with AH in phase A (p = NS), and by 1.35 +/- 0.25 mg/dL (0.43 +/- 0.08 mmol/L) with AH and by 1.23 +/- 0.80 mg/dL (0.39 +/- 0.25 mmol/L) with SH in phase B (p = NS). Moreover, SH administration was associated with a 10.5% +/- 9.4% and a 20.1% +/- 6.8% fall in total cholesterol (p < 0.05) and low-density Lipoprotein cholesterol (p < 0.001) in phase A, and 11.9% +/- 7.2% (p < 0.05) and 21.5% +/- 2.4% (p < 0.001), respectively, in phase B. In both phases of the study, AH administration was not followed by a significant change in serum lipid parameters. CONCLUSION: Sevelamer hydrochloride is a well-tolerated alternative to calcium- or aluminum-containing phosphorus binder in the control of serum phosphorus in CAPD patients. Furthermore, SH improves the lipid profile in these patients.     

Role of renin-angiotensin-aldosterone system in pathogenesis of arterial hypertension in chronic renal failure]

AIM: To characterize status of renin-angiotensin-aldosterone system (RAAS) in patients with chronic and terminal renal failure (CRF, TRF) and its role in pathogenesis of arterial hypertension (AH). MATERIALS AND METHODS: RAAS was studied in 90 patients with TRF on chronic hemodialysis (CHD) and 17 CRF patients with AH on conservative therapy. Plasma renin activity (PRA) and the level of plasma aldosterone (PA) were measured with radioimmunoassay. RESULTS: PRA with moderate CHD-controlled hypertension (1.16 ng/ml/h) was not higher than in control group (1.33 ng/ml/h), while in severe hypertension PRA was increased 4.6-fold (6.09, p < 0.05). In CRF with severe AH PRA was higher 3.6 times (4.8 ng/ml/h, p < 0.05). PA was in CRF and TRF patients 4-5 times higher than in healthy controls. A positive correlation was found between PRA and mean dynamic AP (r = 0.448, p < 0.01) and PRA with PA (r = 0.31, p < 0.05). CONCLUSION: A leading role of RAAS is shown in pathogenesis of AH in patients with hemodialysis uncontrolled hypertension and, partially, in patients with CRF and severe AH.     

Treatment for dyslipidemias in patients with arterial hypertension

AIM: To evaluate a combination of the effects of non-drug measures and rozuvastatin on the lipid spectrum and blood pressure (BP) in patients with treated arterial hypertension (AH) concurrent with dyslipidemia. MATERIALS AND METHODS: The multicenter open-labeled prospective program included 299 patients from 19 cities and towns of Russia. Two hundred and eighty-eight patients completed phase 1 of the program; out of them 279 patients (149 males and 130 females) aged 58-80 years (56.7 +/- 8.7 years) with a mean AH history of 10.3 +/- 8.4 years. Phase 1 of the program involved 3 visits and it was over 12 weeks after rozuvastatin therapy. Phase 2 (including a visit 12 weeks following the termination of Phase 1) is being continued. RESULTS: Rozuvastatin therapy resulted in a reduction in the levels of total cholesterol (TC) by 2.5 +/- 0.8 mmol/l (p < 0.001), low-density lipoprotein (LDL) cholesterol by 2.2 +/- 0.8 mmol/l (p < 0.001), triglycerides (TG) by 0.8 +/- 0.9 mmol/l (p < 0.001), and atherogenicity index (AI) by 2.8 +/- 1.4 (p < 0.001) and an increase in the content of high-density lipoprotein (HDL) cholesterol by 0.2 +/- 0.2 mmol/l (p < 0.001), which produced the target levels of LDL cholesterol in 61% of the patients, HDL cholesterol in 70%, and TG in 73%. During unaltered antihypertensive therapy there were also decreases in body mass by 1.5 +/- 2.8 mmol/l (p < 0.001), body mass index by 0.5 +/- 1.0 kg/ m2 (p < 0.001), waist circumference by 1.0 +/- 3.2 cm (p < 0.001), and BP by 72 +/- 14.2/4.1 +/- 8.6 mm Hg (p < 0.001). There was an increase in the activity of aspartate aminotransferase and alanine aminotransferase, and creatine phosphokinase; however, this was clinically significant in none patients. CONCLUSION: Rozuvastatin significantly lowers the levels of TC, LDL cholesterol, TG, and AI and elevates the concentration of HDL cholesterol. In the majority (83%) of the patients, rozuvastatin used in a dose of 10 mg/day was sufficient to normalize the lipid profile, which makes it possible to recommend that rozuvastatin therapy should be started from this dose.     

Effect of music therapy among hospitalized patients with chronic low back pain: a controlled, randomized trial]

OBJECTIVE: To evaluate the influence of music therapy in hospitalized patients with chronic low back pain. METHODS: A controlled, randomized study (N = 65). During a stationary rehabilitation stay of 12 days, 65 patients with low back pain were randomized to receive on alternate months standardized physical therapy plus 4 music therapy sessions between day 1 and day 5 (intervention group; N = 33) or standardized physical therapy alone (control group; N =32). Scores for pain (as measured on a visual analogue scale [VAS]), disability (Oswestry index) and anxiety and depression (as measured on the hospital anxiety and depression scale [HAD]) were collected on day 1, 5 and 12. Pain intensity was also evaluated on a VAS just before and after music therapy sessions. RESULTS: Introduced music therapy sessions during a stationary rehabilitation stay in patients with chronic low back pain reduce pain (-2.0+/-2.7 vs -1.8+/-2.6) but not significantly. However, music therapy significantly (p < 0.01) reduced disability as measured on the Owestry index between day 1 and day 5 (-11.8+/-17.8 vs -2.5+/-9.4), anxiety (-3.5+/-3.7 vs -0.9+/-2.7) and depression (-2.1+/-3.0 vs 0.6+/-2.4). The immediate effect on pain intensity (VAS score) was confirmed (p < 0.001). CONCLUSION: Our results confirmed the effectiveness of music therapy for hospitalized patients with chronic low back pain. Music therapy can be a useful complementary treatment in chronic pain and associated anxiety-depression and behavioural consequences.     

Efficacy of a cardioselective beta1-adrenoblocker bisoprolol in patients with chronic obstructive pulmonary disease in combination with ischemic heart disease

AIM: To study effects of a selective beta1-adrenoblocker (B1AB) bisoprolol fumarate (conkor, Nikomed, Germany) on severity of pulmonary hypertension (PH), bronchial obstruction and bioelectric activity of the myocardium in patients with chronic obstructive pulmonary disease (COPD) associated with ischemic heart disease (IHD). MATERIAL AND METHODS: Effects of an 8-week course of bisoprolol therapy on pulmonary hypertension, its efficacy and safety were studied in 30 IHD patients with COPD of stage III-IV on broncholytic therapy. The comparison group consisted of 45 IHD patients with COPD untreated with basic bisoprolol therapy. The following parameters were assessed: chest x-ray data, mean pulmonary artery pressure (MPAP) by echocardiography findings, frequency of anginal attacks by ECG monitoring, bronchial permeability by investigation of external respiration function, partial pressure and carbonic gas in blood, oxygen blood saturation (pO2, pCO2 and SaO2). RESULTS: Bisoprolol has decreased MPAP from 23.8 +/- 0.8 mmHg to 21.9 +/- 1.0 mmHg, by 8%, p < 0.05; frequency of anginal attacks, heart rate from 82.2 +/- 1.4 to 73.2 +/- 1.5 b/min; number of episodes of ST segment depression from 2.35 +/- 0.43 to 0.95 +/- 0.22, p < 0.01; total duration of ST segment depression from 10.1 +/- 2.54 to 2.89 +/- 0.76 min, p < 0.01; number of supraventricular and ventricular extrasystoles for 24 hours from 194.5 +/- 74.4 to 96.2 +/- 27.4 and from 239.1 +/- 124.9 to 111.3 +/- 44.1, respectively. Parameters of a 6 min walk test improved from 326.7 to 442 m, p < 0.01. Bisoprolol had no negative effect on bronchial obstruction. CONCLUSION: Bisoprolol is well tolerated, effective and safe in COPD patients with IHD.     

Spirapril - a new long-acting ACE inhibitor: efficacy and safety in patients with arterial hypertension in combination with diabetes mellitus and impaired kidney function

AIM: To examine effectiveness and safety of quadropril. MATERIAL AND METHODS: Changes in blood pressure (BP), heart rate (HR), levels of glucose, potassium and creatinine, creatinine clearance were studied in 120 patients (48 males and 72 females, mean age 60.6 +/- 0.7 years) with mild to moderate arterial hypertension (AH) with average duration 13.8 +/- 0.7 years. The patients were divided into 3 groups: with AH (n = 40), AH + noninsulindependent diabetes mellitus (DM) (n = 43), AH and nephropathy (n = 37). 8-week treatment was performed with a standard dose of 6 mg/day (1 tablet of quadropril). Control examinations were made 2, 4 and 8 weeks after the treatment. RESULTS: After 8 weeks of treatment a decrease in systolic blood pressure in AH group was 24.0 +/- 3.0 mm Hg and in diastolic blood pressure 16.3 +/- 1.3 mm Hg (P < 0.001). In the group with DM this decrease was 22.4 +/- 2.8 mm Hg and 15.7 +/- 1.4 mm Hg (p < 0.001), respectively. In the group with nephropathy this decrease was 26.4 +/- 2.4 and 16.5 +/- 1.3 mm Hg (p < 0.001), respectively. Heart rate changed significantly only in diabetics: from 75.1 +/- 1.7 to 72.9 +/- 1.3 beats/min. Biochemical parameters in the hypertensive and diabetic patients did not change significantly. In the nephropathy group there was a significant decrease in creatinine and increase in creatinine clearance. Their level of glucose and potassium changed insignificantly. CONCLUSION: The treatment with quadropril results in a significant decrease in blood pressure, does not influence parameters of carbohydrate metabolism, improves nitrogen eliminating function of the kidneys.     

The role of tissue myocardial dopplerechocardiography in early detection of structural-functional changes in the myocardium of patients with mild and moderate arterial hypertension

AIM: To study structural and functional changes in left ventricular myocardium (LVM) of patients with mild and moderate arterial hypertension (AH) with application of tissue myocardial dopplerechocardiography (TMD), correlation between these changes and parameters of electrophysiological remodeling and circadian profile of blood pressure. MATERIAL AND METHODS: Forty-give hypertensive patients were divided into two groups: the study group 2A consisted of 28 patients with mild AH (144.2 +/- 5.8/89.4 +/- 6.6 mm Hg), group 2B - of 17 patients with moderate AH (160.5 +/- 9.1/101.3 +/- 10.2 mm Hg). The control group consisted of 10 normotensive subjects. All the patients were examined using standard echocardiography with assessment of transmitral blood flow, tissue doppler investigation, circadian monitoring of blood pressure, electro-, vector- and decartocardiography. RESULTS: No significant differences in standard doppler, electro- and vectorcardiographic parameters between the patients with mild and moderate hypertension were found. LVM mass index and LV wall relative thickness significantly increased both in 2A and 2B groups vs controls (p < 0.05). Most patients of group 2A and 50% patients of group 2B had no alterations in LV geometry. Lower blood pressure was associated with LV concentric remodeling, higher - with concentric and excentric hypertrophy. In the presence of LV remodeling hypertensive patients developed more pronounced disorders of diastolic function according to TMD compared to hypertensive patients with normal LV geometry (p < 0.05). TMD detected LV diastolic disorders in 82% patients of group 2A and in 94% - of group 2B, while transmitral doppler study detected diastolic dysfunction only in 14 and 29% patients, respectively. A significant difference by Em/Am was registered between patients with mild and moderate AH only in the area of the mitral ring at the side of LV posterior wall (p < 0.05). CONCLUSION: TMD is able to detect earleast structural-functional myocardial changes in hypertensive patients and to determine significant differences in LV diastolic disorders in patients with mild and moderate AH. No significant differences in LVM mass, standard doppler, electro- and vector-cardiographic parameters were found between AH patients' groups.     

冠心病患者合并焦虑抑郁对冠状动脉斑块成分及性质的影响

目的探讨冠心病患者合并焦虑抑郁对冠状动脉斑块成分及性质的影响。方法选择2021年1月-2022年1月在华北理工大学附属医院心内一科接受冠状动脉造影术及虚拟组织学血管内超声(VH-IVUS)检查的冠心病患者共76例。通过医院焦虑抑郁量表(HADS)得分评估患者焦虑抑郁情况,包括焦虑抑郁总量表(HADS-t)、焦虑亚量表(HADS-a)及抑郁亚量表(HADS-d)。通过VH-IVUS技术测量斑块中各个成分占比:包括坏死核心(NC)占比、钙化组织(DC)占比、纤维组织(FI)占比及纤维脂肪组织(FF)占比,并评价斑块是否为炎性薄纤维帽粥样硬化斑块(TCFA)。依据患者HADS量表评分,将患者分为对照组、单纯焦虑组、单纯抑郁组及焦虑抑郁组。比较4组间斑块成分占比的差异;采用Pearson相关性分析,分析HADS评分与斑块中各种成分的相关性。结果焦虑抑郁组坏死组织占比明显高于对照组、单纯焦虑组与单纯抑郁组,差异具有统计学意义(P<0.01)。单纯焦虑组、单纯抑郁组及焦虑抑郁组TCFA占比均高于对照组,差异有统计学意义(P<0.01)。Pearson相关分析显示:HADS评分与坏死组织占比呈正相关(HADS-a:r=0.259,P=0.025;HADS-d:r=0.299,P=0.009;HADS-t:r=0.302,P=0.008)。结论冠心病患者合并焦虑抑郁后其冠状动脉斑块中坏死含量更多、易损性更强。     

Relapse of health related quality of life and psychological health in patients with chronic obstructive pulmonary disease 6 months after rehabilitation

Scand J Caring Sci; 2012; 26; 219–227 Relapse of health related quality of life and psychological health in patients with chronic obstructive pulmonary disease 6 months after rehabilitation Aims: This study aimed to evaluate the short‐ and long‐term effects of 4‐week inpatient rehabilitation on health‐related quality of life (HRQL), anxiety and depression in patients with chronic obstructive pulmonary disease (COPD) and investigate the influence of clinical and socio‐demographical factors on unaltered or improved HRQL after discharge. Methods: A total of 111 consecutive cases with mild‐to‐very severe COPD were recruited from three rehabilitation centres and measured at baseline (t1), 4 weeks (t2) and 6‐month follow‐up (t3). Disease severity was assessed by spirometric tests, HRQL by The St. George’s Respiratory Questionnaire (SGRQ) and anxiety and depression by The Hospital Anxiety and Depression Scale (HADS). Socio‐demography and co‐morbidity was also reported. Changes in SGRQ and HADS scores from baseline to follow‐up were analysed by paired‐sample t‐test, and logistic regression was used to investigate the influence of different factors on HRQL after discharge. Results: Health‐related quality of life and depression improved between t1 and t2: a change of ?3.6 for the SGRQ impact score (p= 0.009), ?2.8 for the SGRQ total score (p = 0.012), a clinical relevant change of ?4.0 for the SGRQ symptom score (p = 0.012) and a reduction of ?0.7 for the HADS depression score (p = 0.011). Between t2 and t3, all SGRQ and HADS scores deteriorated with enhancement of SGRQ impact score (+3.5, p = 0.016), SGRQ total score (+2.5, p = 0.029), HADS anxiety score (+1.1, p = 0.000), HADS depression score (+0.6, p = 0.022) and HADS total score (+1.7, p = 0.000). No significant differences between t1 and t3 were found, except for HADS anxiety score (+0.9, p = 0.003). Patients living alone were 2.9 times more likely to maintain or improve HRQL 6 months after rehabilitation than patients living with someone (95% CI 1.1–7.8, p = 0.039). Conclusion: Short‐term benefits on HRQL and depression after rehabilitation relapsed at 6‐month follow‐up, but without any further deterioration from baseline. Living alone may be beneficial to maintain or improve HRQL after discharge.     

Immunological and pathogenetic aspects of imunofan administration in aged patients with duodenal ulcer

AIM: To specify immunological and pathogenetic aspects of imunophan use in aged patients with duodenal ulcer (DU). MATERIAL AND METHODS: Imunophan was given to 24 DU patients (mean age 62.0 +/- 1.5 years), in whom the size of ulcer varied from 0.6 to 2.1 cm. RESULTS: The patients on anti-ulcer therapy plus imunophan had a pain relief median 6.2 +/- 0.2 days (p < 0.001), control ones--11.8 +/- 0.1 days. The median of scarring duration in the test group was 16.2 +/- 0.2 days (p < 0.001), in the controls--23.8 +/- 0.3 days. In 3 (30.0%) cases the scars were rough. The count of T-lymphocytes in the study group increased from 53.1 +/- 0.6 to 65.1 +/- 0.2% (p < 0.001), of T-helpers/inductors--from 27.8 +/- 0.2 to 38.5 +/- 0.3% (p < 0.001), of cytotoxic T-lymphocytes--from 18.5 +/- 0.5 to 27.3 +/- 0.3 (p < 0.001), of B-lymphocytes--from 12.3 +/- 0.2 to 19.1 +/- 0.1% (p < 0.001). The therapy including imunophan reduced concentration of malonic dialdehide by 23.5%, trienic conjugates by 61.6%; raised the level of superoxide dismutase 1.6-fold, catalase 1.4-fold, glutathione reductase by 41.9% (p < 0.001). Neither immune status nor LPO-AOD changed significantly in patients on the basic therapy alone. CONCLUSION: The results obtained evidence for a positive action of imunophan on inflammation, immune status and antioxidant defense. Therefore, imunophan can be recommended as an adjuvant of basic anti-ulcer therapy in elderly and senile patients.     

Psychosocial conditions do not affect short-term outcome of multidisciplinary rehabilitation in chronic obstructive pulmonary disease

OBJECTIVES: To characterize patients referred for pulmonary rehabilitation on a large number of psychologic and sociodemographic variables and to determine the contribution of these variables on the response to rehabilitation. DESIGN: Cross-sectional, explorative. SETTING: University hospital and outpatient clinic. PARTICIPANTS: Eighty-one consecutive patients with chronic obstructive pulmonary disease (forced expiratory volume in 1 second, 40%+/-16% of predicted) were included in outpatient pulmonary rehabilitation. INTERVENTION: Multidisciplinary rehabilitation program. MAIN OUTCOME MEASURES: Pulmonary function, exercise capacity (Wmax, 6-minute walk test [6MWT]), Chronic Respiratory Disease Questionnaire (CRDQ), Modified Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ-M), anxiety and depression (Hospital Anxiety and Depression Scale [HADS]) were assessed before and after 3 months rehabilitation. In addition, psychosocial adjustment, social support, marital status, mode of transportation, education, employment, and smoking status were assessed at the start of the rehabilitation. RESULTS: Rehabilitation improved exercise performance (Wmax, 6+/-12W; P<.01; 6MWT, 41+/-72 m; P<.001), quality of life (CRDQ score, 12+/-13 points; P<.001), functional status (PFSDQ-M activity score, -8+/-11 points; PFSDQ-M dyspnea score, -6+/-12 points; PFSDQ-M fatigue score, -4+/-8 points; all P<.01), HADS anxiety score (-2+/-3 points, P<.01), and HADS depression score (-3+/-3 points, P<.001). In single regression analysis, only baseline depression was weakly negatively correlated with the change in maximal workload. No other relations of initial psychologic or sociodemographic variables with outcome were observed. CONCLUSIONS: The effects of rehabilitation are not affected by baseline psychosocial factors. Patients with less favorable psychologic or sociodemographic conditions can also benefit from pulmonary rehabilitation. The multidisciplinary approach of the rehabilitation program might have contributed to this improvement.     

Clinicopathogenetic features of coronary heart disease combined with chronic obstructive pulmonary diseases and efficiency of therapy with trimetazidin

Based on retrospective analysis of 2446 in-patient cards, autopsy protocols, outpatient medical documentation, prevalence and features of clinical manifestation of cardiorespiratory pathology (CRP): coronary heart disease (CHD) combined with chronic obstructive pulmonary disease (COPD)--1 stage of study, and also (after randomization and forming of main and control groups), efficiency of myocardial cytoprotector trimetazidin (TMZ) at its long-term use (1 year) in combined therapy (2 stage of study): 135 CHD patients (stable exertional angina functional class II-III: 92 and 43 persons respectively) with COPD of medium severe (111 persons) and severe course (24 persons), were studied. It is shown that CRP is prevailed in elder age groups (after 45 years) and noticed in 56.7% CHD patients. More sevenre course with great risk of myocardial infarction with Q wave (twice, p < 0.001), prolongation of painless ischemia (62.4+/-11.5 min/day vs. 22.8+/-11.1 min/day), inclination to complicated rhythm disturbances (38 vs. 21.9, p < 0.05) and earlier clinical manifestations of heart failure (4.3+/-0.6 years earlier, p < 0.001) is typical for CHD with COPD vs. patients without pulmonary pathology. In one year after beginning of treatment with TMZ (35 mg) number of weekly pain attacks was decreased in patients of 1st group vs. 2nd group (at the average -50.8% -29.3% vs. +12.5% +16.6% respectively); significant (p < 0.05) decrease in duration of painless myocardial ischemia was registered. Decrease in number of supraventricular and ventricular extrasystoles (42.7+/-1.48 vs. 20.5+/-1.07 cases in a day, a < 0.0001), significant (p < 0.05) increase in ejection fraction and decrease in left ventricle end-diastolic volume (12.2+/-0.4% E 12.2+/-0.3% respectively), in dimensions of left (10.9+/-0.03%) and right (8.8+/-0.9%) atrium, in risk of development of acute coronary syndrome were noticed in the patients of main group received TMZ. Thus, long-term (not less then 1 year) use of TMZ (35 mg) in combined treatment assists to normalization of cardiovascular indices, decreases cardiovascular complication occurrence, improves disease prognosis and do not has negative side-effects.     

Characterization of elderly patients in rehabilitation: stroke versus hip fracture

PURPOSE: To compare the characteristics of elderly patients hospitalized for rehabilitation following stroke with those following hip fracture (HF). METHODS: A prospective study in a geriatrics department of a general university hospital in southern Israel. Five hundred and sixteen hospitalized elderly patients were included in the study, 221 following stroke and 295 following HF. The characteristics were compared by univariate and logistic regression analyses. RESULTS: The mean age (+/-SD) of the stroke patients was 71.7+/-7.8 years compared to 77.4+/-7.9 for HF (p < 0.000001). Fifty-three per cent of the stroke patients were women compared to 76% of the HF patients (p < 0.000001). Stroke patients had significantly lower levels of folic acid (p = 0.00002). HF patients had more hearing and visual impairments (p = 0.008 and p = 0.017, respectively), but these were related to age differences between the groups. The Folstein Minimental test result was significantly higher in the HF group (p = 0.002). There were no differences in the symptoms of depression score as measured by geriatric depression screening scale. The Functional Independent Measure scale showed a higher pre-event functional capacity among the stroke patients (p < 0.000001), but there was no difference in this scale on admission to rehabilitation or upon discharge. CONCLUSIONS: There is a difference in the nature of the stroke and HF events. When either event involves an elderly patient with a broad range of limitations and diseases, a new medical condition develops. In this condition the symptoms of depression and the functional state at admission and upon discharge are not significantly different between these groups of patients.     

Long term results of endovascular treatment of ischemic heart disease in arterial hypertension patients

AIM: To ascertain long-term prognosis after endovascular treatment of ischemic heart disease (IHD) in patients with arterial hypertension (AH). MATERIAL AND METHODS: The trial enrolled 87 IHD patients (mean age 54 +/- 8 years) who have undergone successful transluminal balloon coronary angioplasty (TBCA) or stenting. The patients were divided into two groups. Group 1 consisted of IHD patients with mild or moderate AH, group 2--of IHD patients without AH. The repeat examination was made 1-72 months (34 +/- 12) after TBCA, control coronarography was performed in 42 (48%) patients. RESULTS: The groups did not differ much by clinical and angiographic characteristics. Within 72 months the number of unfavourable clinical outcomes (UCO) in group 1 was significantly higher (68 and 19%, respectively; p = 0.02) as well as frequency of repeated TBCA (43 and 19%, respectively, p = 0.03). In both groups TBCA were repeated more frequently because of restenosis than of fresh lesions (91 and 33%, p < 0.0001; 70 and 20%, p = 0.04, respectively). The probability of no need in repeated TBCA was significantly less in group 1 than group 2 (41 and 72%, respectively; p = 0.007), the probability regressing more actively within 8 months after the intervention. CONCLUSION: Total incidence of UCO seventy two months after the endovascular treatment was higher in AH patients primarily due to repeated TBCA. Most of TBCAs were conducted within 8 months after the intervention for restenosis.     

Coronary calcium and statins therapy

AIM: Assessment of the dynamics of coronary calcium score (CCS) evaluated with electron-beam tomography (EBT) under the influence of statin therapy in patients with coronary heart disease (CHD) and hyperlipidemia. MATERIAL AND METHODS: A total of 119 hyperlipidemic CHD patients (mean age 62.1 +/- 9.3 years, 75% males) were included in the study. 69 patients were treated with statins (the study group), 50 patients rejected statins (the control group). CCS was calculated according to Agatson. Initial study parameters in the groups were similar. Mean follow-up was 25.3 +/- 10.6 months. RESULTS: A mean increase of CCS in the study group was 62 +/- 84 units (27.1%) and 122 +/- 180 units (65.2%) in the control group (p = 0.044). Total plasma cholesterol (TC) in the study group decreased by 25.1% from 6.99 +/- 0.92 to 5.24 +/- 0.54 mmol/l), in the control group--by 0.5% (from 6.67 +/- 1.01 to 6.63 +/- 1.0 mmol/l). A weak but significant negative correlation was found between a fall in total cholesterol and CCS increment (r = -0.243, p = 0.008). CONCLUSION: Calcium scoring with EBT or multispiral computed tomography can be used both for pre-clinical diagnosis of coronary atherosclerosis and for monitoring of coronary atherosclerosis progression under influence of hyperlipidemic therapy.     

Histological improvements after a three-year lamivudine therapy in patients with chronic hepatitis B in whom YMDD mutants did not or did develop

OBJECTIVE: The long-term effects of lamivudine and the influence of YMDD mutants on the histology of chronic hepatitis B are not known. METHODS: 3-year lamivudine therapy was given to 16 patients with chronic hepatitis B. YMDD mutants did not develop in 9 patients (group A), while they appeared in the remaining 7 patients (group B). RESULTS: Biochemical and virological responses were invariably achieved in the 9 patients without YMDD mutants, while virological breakthroughs with or without biochemical relapses occurred in all 7 patients with such mutants. All 16 patients accomplished histological improvement, with the total histology activity index (HAI) score decreasing from 11.3 +/- 3.0 to 4.1 +/- 1.7 (p < 0.001). The total HAI score decreased from 11.6 +/- 3.8 to 3.4 +/- 1.3 in the 9 patients in group A (p < 0.001). Although to a significantly lesser extent (p < 0.02), the total HAI score also decreased in the 7 patients in group B from 10.9 +/- 1.0 to 5.0 +/- 1.7 (p < 0.001). CONCLUSION: The results obtained indicate that 3-year lamivudine therapy can induce histological improvements, regardless of the appearance of YMDD mutants accompanied by virological breakthroughs and biochemical relapses.