Journal of Clinical Medicine of Kazakhstan

J Clin Med Kaz 2018;4(50):21-25 doi:10.23950/1812-2892-JCMK-00592

Authors: Rizaldy Taslim Pinzon, Niyata Hananta Karunawan

Ischemic heart disease and stroke are the leading cause of morbidity and mortality worldwide. Ischemic stroke and ischemic heart disease have similar pathophysiological mechanisms and risk factors. Ischemic heart disease patients are associated with increased morbidity and mortality, but the studies describing outcomes of ischemic heart disease in ischemic stroke patients are a lack. This is the first study to correlate ischemic heart disease in ischemic stroke with length of stay and functional outcome by using modified Rankin Scale (mRS). This study aims to compare the clinical outcome of ischemic stroke patients with ischemic heart disease and without ischemic heart disease. Methods: This retrospective cohort study of 200 patients were first incident acute ischemic stroke recorded in the Bethesda Hospital Yogyakarta Stroke Registry (2012-2017). These patients were divided into ischemic stroke patients with ischemic heart disease and ischemic stroke patients without ischemic heart disease. The primary outcomes of the study was in-hospital mortality, disability measured by modified Rankin Scale (mRS), and length of stay. The data were analyzed bivariate followed by the Chi-square test and Mann-Whitney. Results: Data of 200 patients with 100 stroke patients with ischemic heart disease consist of fifty-eight male (58.0%) and eighty-six (86.0%) were more than 50 years old. Compare to 100 stroke patients without ischemic heart disease consist of fifty-eight male (58.0%) and eighty-nine (89.0%) were more than 50 years old. The mortality of stroke patients with ischemic heart disease group is eighteen patients (18.0%), sixty patients (60%) have poor functional outcome (mRS >2) and have length of stay 7.50 (0-40) days. Bivariate analysis showed stroke patients with ischemic heart disease group is significantly associated with higher in-hospital mortality (RR:2.9, 95%CI:1.1–7.3, p<0.019), worse disability (RR:2.6, 95%CI:1.3 –5.1, p<0.005) and prolonged hospital stay (7.50 (0-40) vs 4 (0-14), p<0.001) than in stroke patients without ischemic heart disease group. Conclusion: Ischemic stroke patients with ischemic heart disease is statistically significantly associated with higher in-hospital mortality, worse disability, prolonged hospitalization than in ischemic stroke patients without ischemic heart disease

J Clin Med Kaz 2018;4(50):34-39 doi:10.23950/1812-2892-JCMK-00600

Authors: Alima Almadiyeva, Zhanay Akanov, Venera Almatova, Karlygash Absattarova

Aim: A study was conducted to assess the clinical and economic effectiveness of vildagliptin in adults with type 2 diabetes mellitus (T2DM) with poor glycemic control against the metformin monotherapy. Materials and methods: 280 sources were identified in accordance with the search strategy; 40 sources were subjected to critical analysis, of which 22 full-text publications were included in the present study. Results and discussion: Significant advantages of the use of vildagliptin in combination with metformin in improving glycemic control, regardless of the initial level of glycosylated hemoglobin (HbA1c), age or body mass index (BMI) compared with other dipeptidyl peptidase-4 inhibitors, were found; Combination therapy using 50 mg of vildagliptin and metformin twice daily significantly reduced the mean baseline HbA1c (-0.7 to -0.9%) and fasting blood glucose levels (-1.4 to 0.1 mmol/l) compared with placebo, as well as with other dipeptidyl peptidase-4 inhibitors; this combination also led to the greatest increase in QALYs (0.18 over the life span) among dipeptidyl peptidase-4 inhibitors compared to treatment with a combination of metformin and glimepiride. Thus, the combination of metformin and vildagliptin gives advantages in efficiency and additional mechanisms of action, since it does not increase the risk of hypoglycemia and does not contribute to weight gain. Conclusion: Combination therapy using metmorfin and vildagliptin is more cost-effective, since it does not increase the risk of hypoglycemia and does not lead to increasing weight.