Особенности гиперандрогении у мужчин

ОБОСНОВАНИЕ. Сегодня проблема гиперандрогении изучается преимущественно по отношению к женщинам, у мужчин этот вопрос практически не затрагивается, в то же время гиперандрогения у них может быть ассоциирована с развитием ряда заболеваний.ЦЕЛЬ. Охарактеризовать варианты физиологической гиперандрогении у мужчин.МАТЕРИАЛЫ И МЕТОДЫ. Сплошное одномоментное исследование 100 мужчин с гиперандрогенией. При проведении исследования оценивались объем и структура простаты, объем яичек; определялись уровни лютеинизирующего гормона (ЛГ), общего тестостерона, глобулина, связывающего половые гормоны (ГСПГ), с дальнейшим расчетом уровня свободного тестостерона по Vermeullen, и дигидротестостерона (ДГТ). По результатам анализа гормонального статуса пациентов с гиперандрогенией были сформированы 4 группы пациентов: 1-я — пациенты с повышенным уровнем общего тестостерона и ГСПГ; 2-я — пациенты с повышенным уровнем общего тестостерона и нормальным уровнем ГСПГ; 3-я — пациенты с повышенным уровнем общего тестостерона, ДГТ при нормальном уровне ГСПГ; 4-я — пациенты с повышенным уровнем ДГТ при нормальном уровне общего тестостерона и ГСПГ. Статистически значимыми считали различия между группами при p<0,05.РЕЗУЛЬТАТЫ. Возраст и объем простаты пациентов 1-й группы были статистически значимо выше, чем в остальных группах. Для этой группы, несмотря на высокий уровень общего тестостерона, не было характерно наличие жалоб на акне. Пациенты 2-й группы чаще жаловались на акне, но распространенность этого симптома даже в этой группе являлась статистически значимо более низкой, чем у пациентов 3-й группы. При этом частота встречаемости алопеции была статистически значимо ниже во 2-й группе, чем у пациентов как 3-й, так и 4-й групп. Пациенты 3-й группы имели самые яркие клинические проявления гиперандрогении. Для 4-й группы была характерна алопеция.ЗАКЛЮЧЕНИЕ. Повышение уровня андрогенов может выявляться в любом возрасте. При этом у мужчин старшей возрастной группы повышение уровня общего тестостерона может быть обусловлено увеличением секреции ГСПГ и не сопровождаться повышением уровня свободного тестостерона. У молодых пациентов клинические проявления гиперандрогении могут отличаться: для пациентов с повышенным уровнем ДГТ характерна андрогенная алопеция; акне характерно для мужчин с повышенным уровнем общего и свободного тестостерона, а повышение ДГТ усугубляет эту проблему.     

Segurança da Ablação por Cateter de Fibrilação Atrial sob Uso Ininterrupto de Rivaroxabana

Background:Atrial fibrillation (AF) ablation under uninterrupted warfarin use is safe and recommended by experts. However, there is some controversy regarding direct-acting oral anticoagulants for the same purpose.Objective:To evaluate the safety of AF ablation under uninterrupted anticoagulation with rivaroxaban.Methods:A series of 130 patients underwent AF radiofrequency ablation under uninterrupted rivaroxaban use (RIV group) and was compared to a control group of 110 patients under uninterrupted warfarin use (WFR group) and therapeutic International Normalized Ratio (INR). We analyzed death, rates of thromboembolic events, major and minor bleedings, activated clotting time (ACT) levels, and heparin dose in the procedure. The ablation protocol basically consisted of circumferential isolation of the pulmonary veins guided by electroanatomic mapping. It was adopted a statistical significance of 5%.Results:The clinical characteristics of the groups were similar, and the paroxysmal AF was the most frequent type (63% and 59%, RIV and WFR groups). A thromboembolic event occurred in the RIV group. There were 3 patients with major bleeding (RIV = 1 and WFR = 2; p = 0.5); no deaths. Basal INR was higher in the WFR group (2.5 vs. 1.2 ± 0.02; p < 0.0001), with similar basal ACT levels (123.7 ± 3 vs. 118 ± 4; p= 0, 34). A higher dose of venous heparin was used in the RIV group (9,414 ± 199 vs. 6,019 ± 185 IU; p < 0.0001) to maintain similar mean ACT levels during the procedure (350 ± 3 vs. 348.9 ± 4; p = 0.79).Conclusion:In the study population, AF ablation under uninterrupted rivaroxaban showed a safety profile that was equivalent to uninterrupted warfarin use with therapeutic INR.     

Patient flow analysis and referrals — how 1,137 ESRD patients started dialysis during 1998–1999

The study consisted in collecting and analysing data from 15 dialysis centres on referral modalities of 1,137 patients with end‐stage renal failure starting renal replacement therapy. All the centres in question had implemented PFA Patient Flow Analysis®, a management programme for pre‐dialysis care from Baxter designed to help improve the collection of data on dialysis patients, from the first visit to a centre through to the start of renal replacement therapy. The aims of the study were threefold:

• a) describe patient referral modalities and the eligibility of patients for renal replacement treatment;
• b) determine how many early referrals (ERs)* and late referrals (LRs)* have a permanent PD (Peritoneal Dialysis) or HD (Haemodialysis) access at the first treatment;
• c) for the main outcomes (permanent access at the first treatment and permanent dialysis treatment), compare the performance of centres that offer enhanced education with those that do not.

The main characteristics (sex and age) of ERs (54%) are comparable to those of LRs. However, ERs generally have greater access to PD or the opportunity to choose the dialysis treatment. The vast majority (86%) have permanent access at the first dialysis treatment and a large number (44%) have PD as permanent dialysis treatment. Centres with structured pre‐dialysis educational programmes experience a larger number of ERs, therefore ensuring better outcomes. For example, 66.3% of patients at centres with structured pre‐dialysis educational programmes (compared to 48.2% at centres without enhanced education) start the dialysis treatment with permanent access; and more patients (40% vs. 22%) receive permanent PD.     

Неповторимый В.И.Кандрор

Не бывает незаменимых, но есть неповторимые… Это про Вилена Иосифовича Кандрора,  человека, ученого, профессионала, нашего дорогого  коллегу, с которым мы простились в этом году.     

Alterações da Rigidez Arterial em Pacientes com Estenose Aórtica Grave Submetidos à Cirurgia de Troca Valvar

Background:Little is known about the impact of severe aortic stenosis (AS) in aortic stiffness and if there is any change after removing AS barrier with aortic valve replacement (AVR) surgery.Objective:To estimate carotid-femoral pulse wave velocity (PWV) changes after AVR surgery and to define PWV predictors in severe AS patients.Methods:Single-center retrospective cohort, including patients with severe AS who underwent AVR surgery with bioprostheses, between February 2017 and January 2019 and performed PWV measurements (Complior®) before and after the procedure (2±1 months). Before and after AVR, PWV values were compared through paired tests. The associations of PWV with clinical data were studied and linear regression models were applied to estimate pre and postoperative PWV independent predictors. The significance level was set at 5%.Results:We included 150 patients in the sample, with mean age of 72±8 years, and 51% being males. We found a statistically significant increase in PWV values after surgery (9.0±2.1 m/s vs. 9.9±2.2, p<0.001, before and after AVR, respectively) and an inverse association with AS severity variables. In the linear regression model, age and systolic blood pressure (SBP) were established as independent predictors of higher pre- and postoperative PWV, while higher mean valvular gradient emerged as a determinant of lower pre-AVR PWV.Conclusion:We documented an inverse correlation of arterial stiffness with the severity of AS in patients with AS, and a significant increase in PWV values after AVR surgery. Advanced age and higher SBP were associated with higher PWV values, although arterial function measurements were within the normal range. (Arq Bras Cardiol. 2021; 116(3):475-482)     

Fibrilação Atrial (Parte 2) – Ablação por Cateter

More than 20 years since its initial use, catheter ablation has become a routinely performed procedure for the treatment of patients with atrial fibrillation (AF). Initially based on the electrical isolation of pulmonary veins in patients with paroxysmal AF, subsequent advances in the understanding of pathophysiology led to additional techniques not only to achieve better results, but also to treat patients with persistent forms of arrhythmia, as well as patients with structural heart disease and heart failure.     

Fragilidade entre Pacientes não Idosos Submetidos à Cirurgia Cardíaca

Background:Usually viewed as a characteristic of old age, frailty may also occur in non-elderly people, primarily in those suffering from chronic disease. Frailty may increase operative risk.Objectives:To determine the prevalence of frailty patients undergoing coronary artery bypass (CABG) and/or heart valve replacement or reconstruction and/or heart valve surgery, as well as the influence of frailty on postoperative outcomes.Methods:Our study comprised 100 adults who underwent consecutive elective cardiac operations. Frailty was assessed using the Fried scale. Patients also performed a 6-minute walk test, and we measured maximal inspiratory and expiratory pressures. A p value <0.05 was considered significant.Results:Of a cohort of 100 patients, based on the Fried frailty criteria, 17 patients (17%) were considered frail, 70 (70%) pre-frail and only 13 (13%) were non-frail. Among patients with valvular heart disease, 11 (18.6%) were considered frail and 43 (73%) pre-frail. Fifty three percent of the patients considered frail were less than 60 years old (median=48 years old). The differences in frailty phenotype between patients with valvular heart disease and coronary artery disease were not statistically significant (p=0.305). A comparison between non-frail, pre-frail, and frail patients showed no significant difference in the distribution of comorbidities and cardiac functional status, regardless of their cardiac disease. However, hospital mortality was significantly higher in frail patients (29.4%, p=0.026) than in pre-frail patients (8.6%) and non-frail patients (0%).Conclusions:Frailty is prevalent even among non-elderly patients undergoing CABG or valvular heart surgery and is associated with higher postoperative hospital mortality.     

Antioxidant potential of zinc–flavonol complex studied in streptozotocin‐diabetic rats (锌黄酮醇复合物在链脲霉素‐糖尿病大鼠中的抗氧化作用)

Background: Diabetic oxidative stress coexists with a reduction in the antioxidant status, which can further increase the deleterious effects of free radicals. Zinc is an essential trace element with significant antidiabetic activity. However, the acceptance of zinc compounds as promising therapeutic antidiabetic agents has been slowed due to concerns regarding chronic toxicity. Recently, we have designed, synthesized and characterized a novel zinc–flavonol complex and evaluated its antidiabetic efficacy in streptozotocin (STZ)‐diabetic rats. The aim of the present study was to evaluate the role of the zinc–flavonol complex in the antioxidant status of diabetic rats. Methods: Diabetes was induced in rats by i.p. injection of STZ. Diabetic rats were then treated with the zinc–flavonol complex (5 mg/kg, p.o.) for 30 days. The extent of oxidative stress was assessed by determining lipid peroxide levels, pancreatic tissue antioxidant enzyme activities and plasma concentrations of non‐enzymatic antioxidants. In addition, nuclear levels of nuclear factor (NF)‐κB p65, pancreatic nitric oxide (NO), and plasma levels of tumor necrosis factor (TNF)‐α, interleukin (IL)‐1β and IL‐6 were determined. Pancreatic tissues were examined histologically. Results: Oral treatment with the zinc–flavonol complex significantly improved antioxidant levels and alleviated levels of oxidative stress markers. Furthermore, significant increases were seen in NF‐κB p65, NO, TNF‐α, IL‐1β and IL‐6 levels. Histological observations revealed that the zinc–flavonol complex effectively protects pancreatic β‐cells against oxidative damage. Conclusion: The results of the present study indicate that the zinc–flavonol complex has an antioxidative and anti‐inflammatory role in the diabetic milieu.