Method for clinical prediction of probability of suffered silent stroke in patients with arterial hypertension

FIELD: medicine.

SUBSTANCE: patient is tested to determine clinical characteristics, each of which is scored to calculate a diagnostic index. The following clinical characteristics are determined: arterial hypertension taking into account its stage and length; diabetes mellitus, its length taking into account the patient's age and complications; ischemic heart disease and its length, cardiac angina, myocardial infarction and its length; the patient's age; compliance; smoking. The absence of any of the above characteristics is scored as 0 points. That is followed by calculating the total score; depending on the derived value, a high, moderate or low probability of the suffered silent stroke is predicted.

EFFECT: method enables establishing the presence of the suffered silent stroke reliably.

3 dwg, 4 tbl, 3 ex

 

The invention relates to medicine, namely to internal medicine, and can be used for clinical determination of the probability of the presence of "silent" strokes in patients with hypertension on the background of diabetes mellitus type 2 or without it.

Epidemiological studies have shown the role and significance in the development of vascular pathology of the brain, the so-called risk factors, i.e., such features of the environment or the organism itself, which increase the risk of disease [1]. The main risk factors are: age over 40 years, concomitant pathology of the cardiovascular system; hereditary-familial predisposition; obesity (often accompanied by hypercholesterolemia); lack of physical activity and emotional stress; Smoking and regular alcohol consumption; nutritional factors (excessive consumption of animal fat, salt) [3].

Definite risk factor is diabetes mellitus, forcing the development of atherosclerosis. It is important that even a slight rise in blood sugar contributes to increased strokes.

The presence of diabetes of the 2nd type significantly increases the risk of stroke 2-6 times, while the mortality rate from cardiovascular disease in General and of stroke in particular more than 2-4 times higher in patie the tov with diabetes of the 2nd type [4]. For disorders of cerebral circulation in these patients with severe, because more gross violation of carbohydrate metabolism associated with higher levels of mortality and disability [5].

Often in patients with type 2 diabetes stroke not diagnosed, because it goes without clinical manifestations, respectively, remains without adequate treatment, which leads in turn to re-stroke and increases the level of mortality [6]. The computed tomography (CT) with the aim of screening is to detect the presence of stroke is not possible, because this examination is not only expensive, but also has a frequent limitation of its use to patients associated with x-ray irradiation. We offer a simpler and less costly method of determining the probability migrated outpatient stroke in patients with diabetes mellitus type 2, which is already on the outpatient phase can determine the degree of probability of presence of outpatient stroke and time to send the patient to the necessary examination, prescribe an adequate treatment that may prolong the patient's life.

According to the results of the study under the guidance of the doctor of medical Sciences Rohit Das (Rohit Das) from the Boston University school of medicine, USA, 11% of people who consider themselves anti-lock brakes the lute healthy, corruption was detected in the tissues of the brain in the "silent" stroke. "Silent" stroke is a full-fledged stroke, brain flowing, however, without significant clinical manifestations. People who have had this type of stroke are at increased risk for subsequent development of acute disorders of cerebral circulation and relatively progressive memory disorders [2].

A study of the sources of patent and scientific and medical information sources not identified methods for determining the clinical probability of having migrated "silent" stroke.

A new technical task is to develop accurate and informative method for determining the clinical probability of having migrated silent stroke in patients with arterial hypertension on the background of diabetes mellitus type 2 or without it.

To solve the problem in the method for determining the clinical probability of having migrated silent stroke in patients with arterial hypertension conduct testing of the patient to determine the clinical characteristics and rating of each of the points and calculate the diagnostic value of this define and scored the following clinical signs: arterial hypertension (AH): there is 1 point no 0 points; stage AG: I stage - 1 grade II or 2 grade III - 3 b is the llah; duration of hypertension: up to 5 years - 1 point, 5-10 years - 2 points, 10 years or more - 3 points; diabetes mellitus: there is 1 point no 0 points; the target level of hemoglobin: diabetes without severe complications and/or risk of severe hypoglycemia, the young age of 1 point, diabetes without severe complications and/or risk of severe hypoglycemia, the average age of 2 points), diabetes without severe complications and/or risk of severe hypoglycemia, advanced age 3 points, diabetes mellitus with severe complications and/or risk of severe hypoglycemia, the young age of 2 points, diabetes mellitus with severe complications and/or risk of severe hypoglycemia, the average age of 3 points, diabetes mellitus with severe complications and/or risk of severe hypoglycemia, advanced age 3 points; duration of diabetes: up to 5 years - 1 point, 5-10 years - 2 points, 10 years or more - 3 points; coronary heart disease (CHD): there is 1 point no 0 points; CHD angina functional class: I - 1 grade II or 2 grade III 2.5 IV - 3 points; duration of disease: up to 5 years - 1 point, 5-10 years - 2 points, 10 years or more - 3 points; myocardial infarction in anamnesis: there is 1 point no 0 points; limitation of myocardial infarction: more than 5 years - 2 points, less than 5 years - 3 points, patient age: 55 years - 1 point, from 55 to 65 - 2 points, over 65 - 3 points; adherence to treatment: continuous medication - 1 point, nepo is a constant taking drugs - 2 points, no drugs - 3 points; Smoking: smoke - 1 point no - 0 points; duration area: up to 10 years - 1 point, 10-20 years - 2 points, 30 years or more - 3 points, the absence of any of these signs is estimated at 0 points, followed by counting the total score and a score of more than 22 predict correspondingly high, with a score of 15 to 21 - moderate and a score of less than 14 - low probability of having migrated "silent" stroke.

The method is as follows: patients with arterial hypertension on the background of diabetes mellitus or without it, with coronary artery disease with or without clarifying the patient's medical history and complaints, measure blood pressure and blood glucose level, conduct a CT scan, neurological examination. Define and scored the following clinical signs: arterial hypertension (AH): there is 1 point no 0 points; stage AG: I stage - 1 grade II or 2 grade III - 3 points; duration of hypertension: up to 5 years - 1 point, 5-10 years - 2 points, 10 years or more - 3 points; diabetes mellitus: there is 1 point no 0 points; the target level of hemoglobin: diabetes without severe complications and/or risk of severe hypoglycemia, the young age of 1 point, diabetes mellitus without severe complications and/or risk of severe hypoglycemia, the average age of 2 points), diabetes without severe complications and/or the risk of severe hypoglycemia, old age 3 points, diabetes mellitus with severe complications and/or risk of severe hypoglycemia, the young age of 2 points, diabetes mellitus with severe complications and/or risk of severe hypoglycemia, the average age of 3 points, diabetes mellitus with severe complications and/or risk of severe hypoglycemia, advanced age 3 points; duration of diabetes: up to 5 years - 1 point, 5-10 years - 2 points, 10 years or more - 3 points; coronary heart disease (CHD): there is 1 point no 0 points; Ischemic heart disease angina functional class: I - 1 grade II or 2 grade III 2.5 IV - 3 points; duration of disease: up to 5 years - 1 point, 5-10 years - 2 points, 10 years or more - 3 points; myocardial infarction in anamnesis: there is 1 point no 0 points; limitation of myocardial infarction: more than 5 years - 2 points, less than 5 years - 3 points, patient age: 55 years - 1 point, from 55 to 65 - 2 points, over 65 - 3 points; adherence to treatment: continuous medication - 1 point, unstable medication - 2 points, no drugs - 3 points; Smoking: smoke - 1 point no - 0 points; duration area: up to 10 years - 1 point, 10-20 years - 2 points, 30 years or more - 3 points, the absence of any of these signs is estimated at 0 points, followed by counting the total score and a score of more than 22 predict correspondingly high, a score of 15 to 21 - moderate and if the total score is the Eney 14 - low probability of having migrated "silent" stroke.

The proposed method is based on the analysis of clinical trial data. The study included 20 patients, men and women aged 55 to 75 years. Patients were enrolled in OHAUS "Tomsk regional clinical hospital, neurology Department with suspected acute ischemic stroke. The study included patients with hypertensive disease (HD) is associated with diabetes mellitus type 2 or without it, with coronary heart disease (CHD) or without it. Patients were divided into 2 groups: the first group of patients with GB had second or third degree of increase in HELL. In the second group of patients with GB had second or third degree of increase in HELL on the background of type 2 diabetes mild, moderate or severe severity in the stage of compensation, subcompensation or decompensation. 75% of them GB was associated with CHD, patients had a high frequency of comorbidities and risk factors, complicating the course AG. The clinical characteristics of patients are presented in table 1. (Table 1 Clinical characteristics of the patients).

All patients at admission were conducted clinical studies. Taken into account the following parameters: blood pressure, blood glucose level (studied the nutrient plasma, on an empty stomach), data computed tomography, neurological examination.

Computed tomography was performed to identify acute disorders of cerebral circulation, as well as to identify foci stroke (the presence of post-stroke characteristic cysts). To determine the etiology of the cyst (post-traumatic or post-stroke) technique was used morphometric parameters and the intensity of the Mr signal [5].

For the clinical determination of the probability and frequency of availability of outpatient "silent" strokes in patients with essential hypertension on the background of diabetes mellitus or without it conducted an assessment of each of the signs in points 1 to 3 points with subsequent determination of the frequency of "silent" strokes on their sum. Define and scored the following clinical signs: arterial hypertension (AH): there is 1 point no 0 points; stage AG: I stage - 1 grade II or 2 grade III - 3 points; duration of hypertension: up to 5 years - 1 point, 5-10 years - 2 points, 10 years or more - 3 points; diabetes mellitus: there is 1 point no 0 points; the target level of hemoglobin: diabetes without severe complications and/or risk of severe hypoglycemia, the young age of 1 point, diabetes mellitus without severe complications and/or risk of severe hypoglycemia, the average age of 2 points), diabetes without severe complications and/or risk t is geloy hypoglycemia, old age 3 points, diabetes mellitus with severe complications and/or risk of severe hypoglycemia, the young age of 2 points, diabetes mellitus with severe complications and/or risk of severe hypoglycemia, the average age of 3 points, diabetes mellitus with severe complications and/or risk of severe hypoglycemia, advanced age 3 points; duration of diabetes: up to 5 years - 1 point, 5-10 years - 2 points, 10 years or more - 3 points; coronary heart disease (CHD): there is 1 point no 0 points; Ischemic heart disease angina functional class: I - 1 grade II or 2 grade III 2.5 IV - 3 points; duration of disease: up to 5 years - 1 point, 5-10 years - 2 points, 10 years or more - 3 points; myocardial infarction in anamnesis: there is 1 point no 0 points; limitation of myocardial infarction: more than 5 years - 2 points, less than 5 years - 3 points, patient age: 55 years - 1 point, from 55 to 65 - 2 points, over 65 - 3 points; adherence to treatment: continuous medication - 1 point, unstable medication - 2 points, no drugs - 3 points; Smoking: smoke - 1 point no - 0 points; duration area: up to 10 years - 1 point, 10-20 years - 2 points, 30 years or more - 3 points, the absence of any of these signs is estimated at 0 points, then, shall count the total score and a score of more than 22 predict correspondingly high, a score of 15 to 21 - moderate and if the amount balloonie 14 - low probability of having migrated "silent" stroke. The exclusion criteria were patients symptomatic arterial hypertension, diabetes mellitus type 1, patients previously endured acute violation of cerebral circulation.

Statistical data processing was performed using the program STATISTICA for Windows on a personal computer. Comparison of frequencies was performed using the standard four-course contingency tables. When comparing the frequencies used criteria Chi-square test when the expected frequency of at least 5 and Fisher's exact test otherwise. Normality of distribution was tested by the method of Kolmogorov-Smirnov. Quantitative data in the case of the normal distribution are presented as mean values and their standard deviations - M±SD otherwise median and 25-75% percentiles. The statistical significance of intergroup differences was assessed using student's t-test or non-parametric criterion of Mann-Whitney; the statistical significance of differences between paired measurements by using a matching criterion t or nonparametric criterion of Wilcoxon signed. To identify dependencies between the variables used correlation analysis using the criterion of Spearman. Comparisons of the dependent variables in order to avoid the effect of multiple the comparison criterion was used Friedman and in the absence of intra-group homogeneity for further pairwise comparisons criterion was used Wilcoxon signed.

Differences between values were assessed as statistically significant at the level p<0.05 using two-sided type of analysis.

After computerized tomography and data the following results are obtained: in the first group (patients with hypertension) two people (20%) had post-stroke characteristic cysts, therefore, suffered a "silent" stroke. In the second group (patients with hypertension on the background of diabetes mellitus) all patients (100%) had post-stroke characteristic of the cyst (Fig.1).

The results of the clinical evaluation to determine the probability and frequency of "silent" strokes were following.

In the first group is a high probability of having migrated "silent" stroke had 1 person (10%), moderate 4 (40%), low probability 5 (50%) (Fig.2).

The second group is a high probability of having migrated "silent" stroke had 6 people (60%), moderate 3 (30%), low probability of 1 people (10%) (Fig.3).

Thus, on the basis of data obtained during the study, we can conclude that the presence of such symptoms as hypertension, diabetes, ischemic heart disease, myocardial infarction, Smoking, and the degree and duration contribute to acute violation of cerebral circulation. It is also necessary to say that "silent" strokes in patients with arterial hypertension on the background Saharna the diabetes happen 8 times more often than in patients with arterial hypertension without diabetes.

In 100% of cases, the results of the proposed method coincides with the imaging data as the "gold standard". The sensitivity, accuracy, information content of this method is 100%.

Determining the clinical probability of having migrated "silent" strokes in patients with arterial hypertension on the background of diabetes mellitus or without it will allow to determine the probability of outpatient stroke before the next acute disorders of cerebral circulation and the need for routine computerized tomography. With a low clinical probability of having migrated "silent" stroke there is no need for computed tomography, with moderate or high clinical probability assessment is required computed tomography to identify outpatient stroke.

Example 1.

Patient N., man, 1951, suffers from ischemic heart disease and hypertensive disease for 6 years, diabetes mellitus type 2 for 5 years. It is registered in the clinic, is subject to examination and treatment in the hospital (cardiology). He had a heart attack in 2005. Takes antihypertensive (ACE inhibitors, casinomodule diuretics), lipid-lowering agents (statins). The level is ü glucose and blood pressure monitors constantly, diet keeps not always. History of head injury and CNS no. Smokes for 15 years.

Diagnosis: Ischemic heart disease. Angina. FC II. Hypertension Art. III, AG reached 1 degree, the risk 4. Diabetes mellitus type 2, moderate severity, subcompensated.

Admitted to the hospital with complaints of weakness in his left hand, difficulty swallowing. Blood glucose: 5,8.

The glycemic profile: 8.00-8,7, 13.00-6,9. 18.00-9,0, 22.00-8,1.

Examination by a neurologist: a State of moderate severity. A bit laggy. Inspection of lying. The pupils are equal, the expression is saved. Ophthalmoparesis no. The tongue in the midline. Severe dysarthria. The soft palate fonyuy. Pharyngeal reflex is reduced. Somewhat reduced tone in the left extremities. Miropomazanie left limbs. According to preliminary forecast of the possible presence of acute ischemic stroke.

The study according to the proposed method, the data presented in table.2. The total score was 25, when it defined a high clinical probability of having migrated "silent" stroke.

Was held computed tomography. Conclusion: cerebral vascular accident at the time of the study were not identified. A cyst of the right hemisphere of the brain. The presence of post-stroke characteristic cysts in the brain speaks about previous stroke, while the COO is responsible anamnestic data and the patient card patient clinically stroke not endured. CT brain after 5 days of observation, conclusion: cerebral vascular accident by ischemic type in the left hemisphere of the cerebellum. A cyst of the right hemisphere of the brain.

Example 2.

Patient I., female, 1936 birth, suffers from ischemic heart disease and hypertension for 20 years, diabetes mellitus type 2 in the last 9 years.

It is registered in the clinic, is subject to examination and treatment in the hospital (cardiology, endocrinology). Suffered a myocardial infarction in 2009.

Takes antihypertensive, lipid-lowering means. Glucose and blood pressure monitors constantly, diet observes. History of head injury and CNS no. Does not smoke.

Diagnosis: Ischemic heart disease. Angina. FC II. Hypertension Art. III, AG reached 2 degrees, the risk of 4. Diabetes mellitus type 2, moderate severity, subcompensated.

Admitted to the hospital with complaints of numbness and weakness in his left hand, foot.

Blood glucose: 8,6.

The glycemic profile: 8.00-9,6, 13.00-12,8, 18.00-13,8, 22.0-12,3.

Examination by a neurologist: clear Consciousness, pupils equal. The expression is saved. Strabismus. Nystagmus no. Eye movements in full. Nasolabial folds D>s Tongue in the midline. The soft palate fonyuy. Swallowing saved. It correct. Tendon reflexes with hand D>S, feet > S. m Babinski on the left. The power in the left extremities 4 points, right 5 points. Sensitivity intact. Miropomazanie left limbs when performing EOR the control panel.

According to preliminary forecast of the possible presence of acute disorders of cerebral circulation.

The study according to the proposed method, table.3.

The total score was 23, when it defined a high clinical probability of having migrated "silent" stroke.

Performed computed tomography of the brain, conclusion: Focal changes in brain substance, onmk at the time of the study were not identified. A cyst of the left hemisphere of the brain. HIMG. The presence of post-stroke characteristic cysts in the brain speaks about previous stroke, although respectively anamnestic data and the patient card patient clinically stroke can not stand. CT brain after 4 days, the conclusion: Ischemic stroke in the middle cerebral artery on the right. A cyst of the left hemisphere of the brain.

Example 3.

Patient P., female, born 1949. Hypertension suffers for 5 years. It is registered in the clinic. Takes an antihypertensive constantly. Blood pressure monitors constantly. History of head injury and CNS no. Does not smoke.

Diagnosis: Hypertension Art. III, AG reached 2 degrees, the risk 3.

Admitted to the hospital, complaints have not been actively charged (dysarthria).

Blood glucose: 4.3 mmol/L.

Examination by a neurologist: Consciousness is preserved. GCS 15, NIHSS 18. Examined lying on a gurney. Movement of the eyeballs in full. Nystagmus no. Eye slits are equal. The pupils are equal, the expression is saved. Nasolabial folds are symmetrical. The tongue in the midline. The soft palate fonyuy. Turned it understands, motor aphasia. Movement is limited in the right extremities. The reflexes of the limbs D<S. Pathological signs. The power in his right hand, 3 points, right leg 3 points. Hemihypesthesia in the right extremities. M Babinski on the right.

Clinically, respectively anamnestic data and the patient card patient previously stroke can not stand.

According to preliminary forecast of the possible presence of acute ischemic stroke.

The study according to the proposed method, the data presented in table.4. The total score was 8, when it defined a low clinical probability of having migrated "silent" stroke.

Performed computed tomography of the brain, the conclusion of stroke at the time of the study were not identified. Typical post-stroke cysts no.

Computer tomography of the head is about the brain through the five days of observation, conclusion: Ischemic stroke in the left hemisphere, subcortical departments, the MCA region.

Determining the clinical probability of having migrated "silent" strokes in patients with arterial hypertension on the background of diabetes mellitus or without it will allow to determine the probability of outpatient stroke before the next acute disorders of cerebral circulation and the need for routine computerized tomography. With a low clinical probability of having migrated "silent" stroke there is no need for computed tomography, with moderate or high clinical probability assessment is required computed tomography to identify outpatient stroke.

Thus, the proposed method allows to determine with sufficient accuracy the clinical probability of having migrated "silent" strokes in patients with arterial hypertension before the onset of the next acute disorders of cerebral circulation. With a low clinical probability of having migrated "silent" stroke there is no need for computed tomography, and in the presence of moderate or high clinical probability computed tomography (CT) to identify outpatient stroke required. The proposed method improves the quality is in and the duration of life and spend most adequate and timely diagnostic and therapeutic activities.

Table 1
SignThe number of patients with this symptom in the first groupThe number of patients with the characteristic in the second groupThe number of patients with this symptom in both groups
Age63±1,569±1,566±1,5
Men549
Women5611
AH I degree000
AG II degree022
AG III degree10818
AG<5 years112
AG 5-10 years257
AG>10 years7411
Diabetes mellitus without severe complications and/or risk of severe hypoglycemia, young age (the target level of HbAlc<6,5%)000
Diabetes mellitus without severe complications and/or risk of severe hypoglycemia, the average age (the target level of HbAlc<7,0%)009
Diabetes mellitus without severe complications and/or risk of severe hypoglycemia,
old age (the target level of HbAlc<7,5)
099
Diabetes mellitus and severe complications and/or risk of severe hypoglycemia, young age (the target level of HbAlc<7,0%)000
Diabetes mellitus and severe complications and/or risk of severe hypoglycemia, the average in the Rast (target level of HbAlc< 7,5%)000
Diabetes mellitus and severe complications and/or risk of severe hypoglycemia, advanced age (the target level of HbAlc<8,0%)011
CHD: SN FC I000
CHD: SN FC II348
CHD: SN FC III000
CHD: SN FC IV000
CHD<5 years202
CHD 5-10 years011
CHD>10 years134
THEM<5 years0 11
THEY>5 years101
Smoking <10 years000
Smoking 10-20 years022
Smoking >20 years538

Table 2
IndexPoints
The presence of arterial hypertension1
Stage of hypertension3
The duration of hypertension2
The presence of diabetes mellitus1
The target level of hemoglobin3
The duration of diabetes mellitus1
Cash is Chiyo CHD 1
Functional class SN2
The duration of disease2
The presence of myocardial infarction1
Limitation of myocardial infarction2
Patient age2
Smoking1
Duration of Smoking2
Adherence to the treatment1
TOTAL: Diagnosis: high clinical probability of an outpatient stroke25

Table 3
IndexPoints
The presence of arterial hypertension1
Stage of hypertension3
The duration of hypertension3
The presence of sugar is about diabetes 1
The target level of hemoglobin3
The duration of diabetes mellitus2
The presence of CHD1
Functional class SN2
The duration of disease3
The presence of myocardial infarction0
Limitation of myocardial infarction0
Patient age3
Smoking0
Duration of Smoking0
Adherence to the treatment1
TOTAL: Diagnosis: high clinical probability of an outpatient stroke23

Table 4
IndexPoints
The presence of arterial hypertension 1
Stage of hypertension3
The duration of hypertension1
The presence of diabetes mellitus0
The level of glycosylated hemoglobin0
The duration of diabetes mellitus0
The presence of CHD0
Functional class SN0
The duration of disease0
The presence of myocardial infarction0
Limitation of myocardial infarction0
Patient age2
Smoking0
Duration of Smoking0
Adherence to the treatment1
TOTAL:8
Diagnosis: low clinical veroyatnostnoe outpatient stroke

Sources of information

1. Hacke, W., Kaste, M., Olsen, T. S., Orgogozo J. - M. et al. European Stroke Initiative recommendations for stroke management. Organization of stroke care // J. Neurol. - 2000. - P. 732-748.

2. Hart R., Halperin J. L. Atrial fibrillation and Stroke. Concepts and controversies // Stroke.-2001. - vol.32. - P. 803-808.

3. Leonardi-Bee j, Bath p, Phillips S. J., Sandercock P. Blood pressure and clinical outcomes in the International Stroke Trial // Stroke. - 2002. - Vol.33. - P. 1315-1320.

4. Volchenko S. N. Morphometric evaluation of levorotary brain structures with intracerebral cysts of various origins according to Mr-tomography / S. N. Volchenko, C. I. Laptev, J. B. Lishmanov // Siberian journal of medicine. - Tomsk, 2008. No. 4 (issue 2) - N-107-110.

5. Gusev, E. I., Skvortsova Century. And. cerebral Ischemia. - M.: Medicine, 2001. - 328 S.

6. Reducing morbidity, mortality and disability from stroke in the Russian Federation / Under the editorship Skvortsova. - M.: Littera, 2008. - 192 S.

The method for determining the clinical probability of having migrated silent stroke in patients with arterial hypertension, characterized in that conduct testing of the patient to determine the clinical characteristics and rating of each of the points and calculate the diagnostic value of this define and scored the following clinical signs: arterial hypertension (AH): there is 1 point no 0 points; stage AG: I stage - 1 grade II or 2 grade III - 3 points; duration And is: under 5 years 1 point, 5-10 years - 2 points, 10 years or more - 3 points; diabetes mellitus: there is 1 point no 0 points; the target level of hemoglobin: diabetes without severe complications and/or risk of severe hypoglycemia, the young age of 1 point, diabetes without severe complications and/or risk of severe hypoglycemia, the average age of 2 points), diabetes without severe complications and/or risk of severe hypoglycemia, advanced age 3 points, diabetes mellitus with severe complications and/or risk of severe hypoglycemia, the young age of 2 points, diabetes mellitus with severe complications and/or risk of severe hypoglycemia, the average age of 3 points, diabetes mellitus with severe complications and/or risk of severe hypoglycemia, advanced age 3 points; duration of diabetes: up to 5 years - 1 point, 5-10 years - 2 points, 10 years or more - 3 points; coronary heart disease (CHD): there is 1 point no 0 points; CHD angina functional class: I - 1 grade II or 2 grade III - 2.5 IV - 3 points; duration of disease: up to 5 years - 1 point, 5-10 years - 2 points, 10 years or more - 3 points; myocardial infarction in anamnesis: there is 1 point no 0 points; limitation of myocardial infarction: more than 5 years - 2 points, less than 5 years - 3 points, patient age: 55 years - 1 point, from 55 to 65 - 2 points, over 65 - 3 points; adherence to treatment: continuous medication - 1 point, unstable medication - 2 BA the La, no drugs - 3 points; Smoking: smoke - 1 point no - 0 points; duration area: up to 10 years - 1 point, 10-20 years - 2 points, 30 years or more - 3 points, the absence of any of these signs is estimated at 0 points, followed by counting the total score and a score of more than 22 predict correspondingly high, with a score of 15 to 21 - moderate and a score of less than 14 - low probability of having migrated "silent" stroke.



 

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2 ex

FIELD: medicine.

SUBSTANCE: stage of the clinical course of multiple sclerosis is determined with using a regression equation: The course of the clinical course PC=0.161681 - 0.209483*sex+0.0158676*age+0.0477443* lymphocytes+0.578018* CD3 - 0.259435* CD19 - 2.29788* CD4+1.37512* CD8+0.680127* CD16 - 1.50333* CD11b+0.244827*"ФЧ" - 0.124693*"НСТсп"+1.19125* "РСТак" - 0.0408168*IgG - 0.0501667*IgA+0.379248*IgM, wherein females are marked with one, and males are marked with two; age is completed years at the moment of examination. If the coefficient does not exceed 1.52, then the patient is considered to be apparently healthy. If the coefficient falls within the range of 1.53 - 2.8 standard units, the stage of remittance is predicted. If the coefficient is 2.9 or more, the patient suffers the stage of the active clinical course of multiple sclerosis.

EFFECT: using the given method enables predicting the clinical course of multiple sclerosis taking into account the values of the patient's immunological status with the following correction of the therapeutic approach.

1 ex

FIELD: medicine.

SUBSTANCE: coefficient is calculated with the use of a regression equation: PC=3.12773 - 0.570815*sex - 0.00053521*age+0,0701398*glucose+0.0126693*aspartate aminotransferase - 0.00444583*alanine aminotransferase - 0.0713107*bilirubin+0.104748*thymol test+0.324302*urea+0.00109034*cholesterol - 0.266549*amylase - 0.0371365*total protein+0.166586*lymphocytes - 0.263371*CD3 - 1.90439*CD19 - 0.171236*CD4+0.296383*CD8 - 1.04997*CD16+0.346955*CD11b+0.0512544*"ФЧ"+0.608005*"НСТсп"+0,52123*"НСТак"+0.0105846*IgG - 0.0839649*IgA+0.136765*IgM, wherein females are marked with one, and males are marked with two; age is completed years at the moment of examination. If the coefficient does not exceed 2.36, then the patient is considered to be apparently healthy. If the coefficient falls within the range of 2.37 - 3.10 standard units, the stage of remittance is predicted. If the coefficient is 3.11 or more, the patient suffers the stage of the active clinical course of multiple sclerosis.

EFFECT: using the given method enables predicting the clinical course of multiple sclerosis taking into account the values of the patient's immunological status with the following correction of the therapeutic approach.

1 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to physiology and dermatovenerology, to diagnostic technique for a risk of developing pitted keratolysis accompanied by stress as an uncurable element of the professional environment for the purpose of the goal-oriented prevention of the above disease in the individuals having hazardous occupations. A heart rate variability is examined twice - before and 15 minutes after a hot test on a plantar surface. If observing no decrease of the LF/HF value as compared to the reference, a risk of developing stress-induced pitted keratolysis is diagnosed.

EFFECT: technique provides more accurate diagnosis of a risk of developing stress-induced pitted keratolysis by examining the heart rate variability and using the hot test.

1 dwg, 2 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment. A device for suppressing a power-frequency noise effect on an electric cardiosignal comprises a TR-segment time domain selection unit (2), a key element (8), a filter (14), an amplifier (15), a delay unit (16) and a subtract unit (17). An input of the device is connected to the first input of the key element and an input of the delay unit; an output of the device is an output of the subtract unit. The device comprises an electric cardiosignal second derivative forming unit (1), a comparator (3), an RS-trigger (4), an AND circuit (5), a binary counter (6), a decoder (7), second (9), third (10), fourth (11) and fifth (12) key elements and a scaling amplifier (13).

EFFECT: using the invention enables the higher noise resistance of the analysed electric cardiosignal without misrepresenting information components.

8 dwg

FIELD: medicine.

SUBSTANCE: diagnostic technique for the ischemic heart disease is implemented by stating risk factors, symptoms and ECG findings, diagnostic characters (DC) of which are distributed into groups and assigned with certain numerical scores. Conditional probabilities of the presence or absence of IHD in a specific patient are calculated. The findings are used to establish the diagnosis of IHD or not.

EFFECT: technique enables providing establishing the more accurate diagnosis of IHD by taking into account a complex of various DCs, the records of which are processed by a mathematical model.

2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to diagnostics and physiology. The RR intervals are recorded, and the derived sequence is processed. The RR sequence length is specified not less than 300 sec. That is followed by dividing the RR sequence into data windows A1…An of the length of 75 sec≤A≤300 sec at a window shift pitch B of 1 sec≤B≤10 sec. Further, for each data window: the frequency Fourier transform is used to derive power distribution of the initial window; the derived power distributions are integrated at all frequencies within not less than 0.015-0.6 Hz to produce total power TP of the heart rate variability; low frequency power PLF is calculated by not less than 0.04-0.15 Hz; high frequency power PHF is calculated by not less than 0,15-0.6 Hz; the relation PLF/PHF is calculated; the derived TP sets and PLF/PHF relations are normalised to produce standard values X1…n of the derived TP sets and standard values Y1…n of the PLF/PHF set. That is followed by calculating a synchronism analysis function of each data window f1…n=(sinX1…n-sinY1…n)/|sinX1…n-sinY1…n|. The presence or absence of the stress condition is stated by analysing the derived values f1…n.

EFFECT: method enables providing more reliable diagnosis of the beginning individual's stress condition by analysing the RR interval.

2 ex, 1 dwg

FIELD: oil and gas industry.

SUBSTANCE: treating bronchial asthma (BA) in a child suffering from a mild, moderate or severe episode involves measuring a peak expiratory flow rate (PEFR). The child's age, height and sex are stated. The derived data are used to determine the adequate peak expiratory flow rate. That is followed by calculating the peak expiratory flow rate coefficient by specific formula. The following data of the past medical history are taken into account: the child's duration of the disease, the length of basic therapy, completed months, for one year preceding the acute period of the disease, as well as the presence of allergic diseases in immediate maternal and paternal relatives. A severity of the BA episodes is assessed. Each value derived from the past medical history is assigned with numerical values reflecting their prognostic significance. Heart rates are measured. Cardiointervalography is performed, and a vagosympathetic balance coefficient is determined. That is followed by calculating a risk of cardiohaemodynamic disorders (CHD) taking into account the above criteria by specific formula. If CHD<0.34, Fenoterol selective β2-adrenoceptor agonist is selected as a bronchial spasmolytic in the acute period of the disease. If 0.34≤CHD≤0.46, ipratropium bromide m-cholinoblocker is selected as the bronchial spasmolytic. If CHD>0.46, combined ipratropium bromide + Fenoterol is used as the bronchial spasmolytic.

EFFECT: reduced number of cardiovascular complications in the above category of children.

3 part-s

FIELD: medicine.

SUBSTANCE: invention relates to methods and devices of identifying reasons of cardiac rhythm disturbance. Method consists in perception of signals of heart excitation in multitude of locations with application of multitude of sensors, collection of data from multitude of sensors. Collected data include sensor location for each sensor and time of heart excitation origination in each sensor location, so multitude of times of excitation origination in multitude of locations of sensors are collected, and then their sequence is formed. Obtained data are then analysed and approximate central areas, connected with excitation pathway, pointing to reasons of said cardiac rhythm disturbance, are determined.

EFFECT: application of invention makes it possible to determine location of reasons of cardiac rhythm disturbance for the following treatment with minimally invasive, surgical and other methods.

37 cl, 16 dwg

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine and can be applied as a method of predicting an unfavourable outcome of cerebral circulation impairment. A level of stab neutrophils and erythrocyte sedimentation rate are determined in blood tests. The presence of displacement of midline brain structures is identified on a computer tomography scan. A number of ventricular and supraventricular extrasystoles is determined on an electrocardiogram. If the value of stab neutrophils is 3.5-4.5%, erythrocyte sedimentation rate is 12-20 mm/h, displacement of midline structures is 7 mm and more, an average day value of ventricular and supraventricular extrasystoles is respectively 490-670 and 1530-1880, and in case of blood presence in liquor, an unfavourable outcome of cerebral circulation impairment is predicted.

EFFECT: method makes it possible to increase the prediction reliability.

2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, labour safety, vocational selection of rescue workers. The invention can be used for vocational selection in the sectors of industry using personal protective equipment, as well as for the workers labour safety in the sectors of industry with harmful working conditions. The method involves vocational selection and duty control on the basis of electroencephalogram (EEG) values and cardiological findings. The examination is performed prior to and when using the personal protective equipment. The cardiological examination involves assessing the heart rate variability with using the amplitude-frequency spectrum Fourier analysis VLF at a vibration frequency within the range of 0.0033-0.04 Hz, LF - at a frequency of 0.05-0.15 Hz and HF - at a frequency of 0.16-0.80 Hz, and is five-staged: initial resting state, mental work load, recovery of mental work load, hyperventilation load, recovery of hyperventilation load. At the beginning, the heart rate variations and EEG are examined prior to using the personal protective equipment. If any of the five stages of the heart rate variation examination shows the pulse more than 90 beats per minute, as well as changes from the normal values of: approximating entropy - less than 180, LF - less than 6 point, an alpha wave amplitude - to 12 vibrations per second and the presence of the paroxysmal activity by EEG, the prevailing sympathetic nervous system is stated, or if any stage of the heart rate variation examination shows the pulse less than 60 beats per minute, as well as changes from the normal values of: blood pressure - more than 140/90 mmHg, VLF - more than 130 points, HF - more than 16 points, an alpha wave amplitude - less than 25 mcV, the prevailing parasympathetic nervous system is stated; a low level of adaptation to the personal protective equipment is predicted, and a rescue work is not recommended during the vocational selection; the examination is terminated. If the heart rate variation and EEG prior to using the personal protective equipment fall within the normal values, the heart rate variation when using the personal protective equipment is started with the patient examined when using the personal protective equipment and performing a cycle ergometer test, and recording the hyperadaptotic changes of the assessed values: VLF - more than 130 points in relation to the normal value when using the personal protective equipment and LF and HF vibrations; an incomplete or unfinished adaptation to the personal protective equipment, and the rescue worker is suspended from work for several hours; if VLF is more than 130 points recorded 10-15 min after activating the personal protective equipment, a good adaptation level to the personal protective equipment is predicted.

EFFECT: method enables assessing the vegetative nervous function and predicting the rescue workers' adaptation level to the personal protective equipment.

11 tbl, 5 ex

FIELD: medicine.

SUBSTANCE: invention can be used to identify a high risk of developing impaired glucose tolerance in patients with stable effort angina with underlying administering beta-adrenergic blocking agents with no additional vasodilating properties. Therapy is preceded by conducting 2 exercise tests on the same day to achieve a threshold load power according to the same protocol, initially and 2 hours after administering a single dose of the beta-adrenergic blocking agents. If observing an interval gain of 120 seconds and more from the beginning of the load to the angina attack and/or reduction of an ischemic ST segment on the electrocardiogram not less than 1 mm at the 2nd load as compared to the 1st load, a risk of impaired glucose tolerance is considered to be high. A glucose tolerance test is carried out in these patients 4-5 weeks after the scheduled administration of the beta-adrenergic blocking agents. If impaired glucose tolerance is detected, administering the beta-adrenergic blocking agents is withdrawn. If the 2nd load as compared to the 1st load shows an interval to the angina attack and/or reduction of the ischemic ST segment on the electrocardiogram at a depth not less than 1 mm increasing less than by 120 seconds, a risk of developing impaired glucose tolerance is considered to be negligible. Treatment of these patients with the beta-adrenergic blocking agents is continued without the glucose tolerance test required.

EFFECT: method provides preventing carbohydrate metabolic disorders by the early identification of the high risk of developing impaired glucose tolerance in the given patients by detecting a compensatory increase of the glucose consumption with insulin resistance and a lower availability of free fatty acids to provide myocardial energy needs.

6 ex

FIELD: medicine.

SUBSTANCE: according to one version, the method involves studying the heart rate variability and a motion state, dietary nutrition, baths with mineral water, mineral water intake, physiotherapeutic procedures. The dietary regimen is specified taking into account the measured immunoglobulin IgG values to detect food intolerance and elimination thereof from the nutrition. Low-salt sulphate calcium-magnesium-sodium mineral water is taken. The baths are taken with mineral water from a water-bearing formation of Middle Devonian at a depth of 1100-1278 m by using mineral water representing a salt brine of Devonian Sea M 240-260 g/dm3 of sodium-chloride composition Cl>95, Na++K+>80 mg-eq.%, with an acid reaction of the medium, at pH 4.7-5.5. According to the other version, the method additionally contains massage sessions and acupuncture taking into account the patient's heart rate variability.

EFFECT: group of inventions provides more effective health improvement by taking into account individual food intolerance and the patient's autonomic nervous system features.

2 cl, 3 ex

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment. A blood pressure measuring device under motion activity conditions comprises a pulse wave measurement sensor under a pneumatic cuff in the way of the brachial artery, and a force-balance pulse wave sensor on a diametric side of the hand. Outputs of the measurement and force-balance sensors are attached to respective amplifiers, which are attached to a subtractor, an output of which is connected to a band-pass filter, which is an output of the pressure measuring device. The device is additionally provided with the second band-pass filter, the first and second comparators, the first and second negative threshold voltage source, the first and second gate multivibrators, a logical element 2AND, a shaper for a signal informing on the sensor displacement prohibition.

EFFECT: using the invention enables eliminating false responses and blood pressure measurement errors in case of the prohibited sensor displacement by the real-time information acquisition thereon.

4 dwg

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