Diabetes and coronary artery disease (CAD) are the leading causes of death worldwide. Clinical trials have shown that patients with diabetes and CAD have worse cardiovascular outcomes than patients without these conditions. At the same time, the use of coronary revascularization has significantly improved patient prognosis. Large prospective studies have significantly influenced the choice of revascularization methods in patients with diabetes and multivessel coronary artery disease. International clinical guidelines recommend coronary artery bypass grafting (CABG) for patients with diabetes and multivessel CAD. This review analyzes the long-term effects of CABG and percutaneous coronary intervention using new-generation stents in combination with modern medical therapy to optimize treatment strategies for patients with diabetes and CAD. Continuous improvements in stents, improved quality of care, personalized approaches to medical therapy, and patient characteristics, including comorbidities and anatomical features, can influence treatment decisions and may not always reflect the classic concepts outlined in guidelines. Therefore, clinical trials are needed that take into account the clinical characteristics of specific patient groups and novel technological advances in percutaneous coronary intervention, more potent antiplatelet and anti-inflammatory drugs, and aggressive lipid-lowering therapy. As these data accumulate, the choice of coronary revascularization strategies in patients with diabetes and multivessel CAD may be reconsidered.
Marfan syndrome is an autosomal dominant hereditary disorder of connective tissue characterized by pronounced phenotypic variability. The presented case describes a family with clinical manifestations ranging from isolated ectopia lentis to severe aortic disease without a characteristic phenotype. Furthermore, the age of onset and rate of progression of cardiovascular disease in the relatives also varied significantly. Genetic testing identified a missense variant in exon 10 of the FBN1 gene, resulting in a substitution of a cysteine residue in the TB1 domain of fibrillin-1, which was considered likely pathogenic. Verification of the diagnosis of Marfan syndrome allowed for timely referral of the proband to a cardiovascular surgeon to determine further treatment and adjust therapy. This case also demonstrates that a causative variant does not allow for a definitive prognosis of the disease course. Therefore, all carriers of the identified variant require regular multidisciplinary monitoring, regardless of the severity of clinical manifestations at the time of diagnosis.
Aim . To analyze the profile of cardiac arrhythmias and conduction disorders in patients with familial hypertrophic cardiomyopathy (HCM) based on data from the registry of the National Medical Research Center for Therapy and Preventive Medicine and the Lomonosov Moscow State University (2021-2026). Material and methods . The analysis included 136 patients (48 men, 88 women; aged 19-78 years) — probands and relatives with a verified diagnosis or pathogenic variants in genes associated with HCM. All patients underwent additional examination, including electrocardiography (ECG) and Holter ECG monitoring. Based on this examination, 81 patients with arrhythmias and conduction disorders were identified. Genetic testing identified variants in the MYH7 , MYBPC3 , MYL2 , DSG2 , JPH2 , FLNC , ALPK3 , CACNA1C , ACTC1 , LDB3 , and TNNI3 genes in 60 patients. Results . Atrial fibrillation was recorded in 13,9% of cases (permanent in 3,7%, paroxysmal in 9,6%), ventricular premature beats in 59,6%, and ventricular fibrillation in 2,2%. Ventricular tachycardia (VT) was detected in 24,3% of all registry patients and in 34% of patients with gene variants (n=60). Degree I atrioventricular (AV) block was detected in 11% of cases, and degree II-III AV block — in 4,4%, left bundle branch block — in 5,9%. In genetic analysis, VT (80 vs 20%, p=0,001) and first degree AV block (45 vs 8%, padj=0,027) were more common in carriers of variants in the MYBPC3 gene (n=20) compared with MYH7 (n=25). The groups did not differ in interventricular septal thickness and left ventricular mass index after adjustment for sex, age and body mass index (BMI), whereas LV posterior wall thickness was higher in the MYBPC3 group (padj=0,028). The median risk of sudden cardiac death, calculated according to the Hypertrophic Cardiomyopathy. Risk-Sudden Cardiac Death (HCM Risk-SCD) score was 4,9% [3,4; 7,2] over 5 years n carriers in the MYBPC3 gene variants, compared to 3,1% [2,2; 6,8] (p=0,916) in carriers of MYH7 variants. However, no significant differences were found between the groups. Conclusion . The incidence of VT in familial HCM varies significantly depending on the genotype, reaching 80% in carriers of MYBPC3 variants. Patients with familial HCM, especially those carrying MYBPC3 variants, are recommended to undergo follow-up monitoring with Holter ECG every 6-12 months for the early detection of VT. Detection of VT allows for stratification of sudden cardiac death risk according to the HCM Risk-SCD score and determines indications for implantable cardioverter-defibrillator (ICD).
Aim . To evaluate the efficacy of proprotein convertase subtilisin/ kexin type 9 (PCSK9) inhibitor therapy in patients with extremely high lipoprotein(a) (Lp(a)) levels >180 mg/dL. Material and methods . This retrospective analysis of electronic health records of patients with documented Lp(a) levels >180 mg/dL. Patients were recruited from a large sample of 101 078 individuals who had undergone Lp(a) assessment. Absolute and relative changes in Lp(a) and low-density lipoprotein (LDL) cholesterol (C) levels compared to baseline were assessed during PCSK9 inhibitor therapy. Results . A total of 1105 patients were included. The mean age was 52,7±14,6 years. The median was 53 years. Median baseline Lp(a) was 198 mg/dl, and LDL-C was 4,31±1,18 mmol/l; 12,9% received PCSK9 inhibitors. With PCSK9 therapy, the decrease in Lp(a) level was -29,03 vs -10,28% without PCSK9 inhibitor therapy (p<0,001), the decrease in LDL-C level was -44,83% (p<0,001). The most pronounced effect was noted with the triple combination (statin + ezetimibe + PCSK9 inhibitor) as follows: Lp(a) by -30,31%, LDL-C by -46,79% (p<0,001). A decrease in Lp(a) level was associated with higher baseline Lp(a) (β=0,195; p<0,001) and age (β=0,176; p=0,021). The addition of any PCSK9 inhibitor was associated with a reduction in Lp(a) levels (β=7,764; p=0,002). Conclusion . In patients with Lp(a) levels >180 mg/dL, PCSK9 inhibitors not only lower LDL-C but also reduce Lp(a) in real-world settings. These results highlight the potential of PCSK9 inhibitors as a key component of therapy for patients with extremely high Lp(a) levels prior to the widespread adoption of Lp(a)-targeted agents.
Atherosclerotic cardiovascular diseases (ASCVD) and osteoporosis have a high degree of comorbidity, which mutually exacerbates their severity and increases the risk of complications. Common pathogenetic mechanisms and risk factors for these diseases have been identified. This review summarizes and summarizes data from domestic and international studies confirming the comorbidity of ASCVD and osteoporosis based on identified associations between preclinical parameters, such as bone mineral density (BMD), vascular stiffness parameters (pulse wave velocity, augmentation index), and preclinical atherosclerosis (atherosclerotic plaques and coronary artery calcification). Furthermore, associations between the diseases at the risk level and the often asymptomatic course of the diseases at onset prompted the authors to seek novel preclinical methods for diagnosing and predicting the comorbidity to implement timely treatment and preventive measures. Based on a cross-sectional study demonstrating the independent contribution of carotid plaques and elevated calcium levels to decreased BMD in postmenopausal patients, a diagnostic algorithm has been developed to assess the preclinical risk of ASCVD and osteoporosis and their complications. The results of a prospective study, which confirmed the maintenance of a stable negative association between vascular stiffness parameters, preclinical atherosclerosis, and BMD over 10 years, have led to the development of a method for osteopenia prediction using preclinical markers of atherosclerosis. The proposed methods enable timely risk prediction, diagnosis of comorbidities, and initiation of treatment and preventive measures at various levels of healthcare delivery (outpatient and inpatient), particularly in primary care.
Mitochondrial dysfunction is a complex of subcellular and molecular disturbances in the structure and function of mitochondria that play a key role in the pathogenesis of a wide range of diseases, from hereditary mitochondrial syndromes to age-related non-communicable diseases. The study of circulating biomarkers for non-invasive assessment of mitochondrial health is a promising research area in medical biochemistry, preventive medicine, and cardiology. The aim of this review is to systematize the results of current research on circulating non-invasive biomarkers of mitochondrial dysfunction and assess the potential for their clinical application. The review characterizes specific proteins associated with the structure and function of mitochondria, as well as enzymes and metabolites involved in catabolic pathways. Its analysis is carried out using immunochemistry, enzyme kinetics, and more complex laboratory technologies, including chromatography mass spectrometry. Analysis of serum biomarkers associated with mitochondrial dysfunction and associated metabolic pathways, such as fibroblast growth factor-21 (FGF-21), growth differentiation factor 15 (GDF-15), peroxisome proliferator-activated receptor-γ coactivator 1-α (PGC1α), neopterin, lactate, pyruvate, and ammonia, may serve as potential diagnostic or prognostic tools for obesity and related diseases, heart failure, atherosclerosis, hypertension, chronic respiratory failure, and neurodegenerative diseases.
Aim . To evaluate the prognostic value of type 2 diabetes (T2D) and to study the relationship between T2D and the risk of mortality at different stages of long-term outpatient follow-up in patients with cerebrovascular accidents (CVA). Material and methods . Within the registry of patients who suffered a stroke in 2012-2017, medical records and discharge summaries after the reference stroke (n=900), as well as outpatient records of patients (n=684), were analyzed. During the outpatient phase of follow-up completed in 2025 within the prospective part of the REGION-M registry, the long-term prognosis of patients after stroke was assessed and the role of type 2 diabetes as a possible prognostic factor was determined at various follow-up stages (2017-2025). The primary endpoint was all-cause death. Results . The entire outpatient phase of observation was divided into four following stages: Stage 1 (median (Me) 22 [13; 38] months) — from the reference stroke to hospital discharge (2017); Stage 2 (Me 57 [45; 71] months) — outpatient follow-up (2017-2020); Stage 3 (Me 79 [68; 95] months) — outpatient follow-up (2020-2022); Stage 4 (Me 114 [103; 128] months) — outpatient follow-up (2022-2025). The median total follow-up time was 9,5 years, during this period. In general, no significant differences in survival were found in patients depending on T2D: hazard ratio (HR) =1,24; 95% confidence interval (CI): 0,985-1,567 (p=0,067), however, Piecewise Cox Regression confirmed a significant association between T2D and the death risk in patients with a history of stroke at stages 1 and 3 of outpatient follow-up as follows: direct association at stage 1 and inverse association at stage 3 (HR=0,67, 95% CI: 0,45-0,99, p=0,044 and HR=1,70 95% CI: 1,07-2,71, p=0,026). Conclusion . In the prospective REGION-M registry part, the long-term prognosis of patients with a history of stroke was assessed at various time points. T2D has an independent negative prognostic value at certain stages of long-term follow-up of such patients.
Aim . To study 5-year outcomes in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in a prospective registry. Material and methods . The Registry of Acute Coronary Syndrome without ST-segment Elevation in the Regional Vascular Center (CONTRAST) included 136 patients admitted to the Sergiyev Posad Vascular Center from October 2018 to March 2019 with a diagnosis of NSTE-ACS. At discharge, the patients were diagnosed with unstable angina (UA) (n=112) or non-ST-segment elevation MI (NSTEMI) (n=24). Five-year outcomes were analyzed. Results . The primary composite endpoint (CEP), including all-cause death, nonfatal myocardial infarction (MI), cerebrovascular accident, and emergency hospitalizations for cardiovascular causes, was recorded in 60 patients. Patients with CEP did not differ in age, sex, or risk factors compared to patients without CEP, but they were more likely to have a history of MI, hypokinesis on echocardiography, and a mildly reduced left ventricular ejection fraction. There were no significant differences in the incidence of CEP between patients with NSTEMI and UA. Multivariate Cox regression analysis showed that independent CEP predictors included hypokinesia area on echocardiography, a moderately reduced left ventricular ejection fraction, pleural effusion in the acute phase, and atrial fibrillation. Patients with NSTEMI and UA did not differ in the likelihood of CEP. PCI during and after the reference hospitalization also did not affect the likelihood of CEP. Conclusion . In a 5-year prospective follow-up study of patients with NSTE-ACS, the likelihood of adverse outcomes was determined primarily by clinical and imaging risk factors identified in the acute phase and was independent of the formal discharge diagnosis (UA or NSTEMI).
Aim . To analyze the use of biological age calculators reflecting cardiac and vascular aging in young and middle-aged patients with hypertension (HTN). Material and methods . A total of 205 young and middle-aged male patients (30-55 years) with office systolic blood pressure of 140-179 mm Hg and/or diastolic blood pressure of 90-109 mm Hg were examined. Anthropometric, laboratory, and imaging parameters were assessed. Patients were divided into three groups: Group 1 — body mass index (BMI) <25 kg/m 2 , Group 2 — 25≤ BMI <30 kg/m 2 , and Group 3 — BMI ≥30 kg/m 2 . Biological age was estimated using the Framingham risk score calculator and the QRISK3 calculator. Results . When calculating cardiovascular age using the Framingham risk score calculator, patients with HTN were significantly older compared to those with isolated office hypertension (IOH) (p<0,001). Cardiovascular age calculated using the QRISK3 calculator was significantly (p<0,001) higher in patients with hypertension compared to those with IOH. Patients with HTN were characterized by significantly higher BMI (p<0,001), waist circumference (p<0,001) and hip circumference (p=0,008), common carotid artery intima-media thickness (p=0,013), estimated augmentation index in %, adjusted for heart rate of 75 bpm (Alp75) (p<0,001), vascular age (VA) (p=0,023), reflection index (RI) (p<0,001), cholesterol (p=0,72), low-density lipoprotein (LDL) (p=0,56), very low-density lipoprotein (VLDL) (p<0,001), triglycerides (p<0,001), high-sensitivity C-reactive protein (p=0,021), and a lower high-density lipoprotein (p=0,002) compared to individuals with IOH. A comparative analysis of biological age revealed significant differences in patients with HTN, which was significantly (p=0,006) higher in those with a BMI ≥30 kg/m 2 compared to those with a BMI <25 kg/m 2 . Conclusion . The obtained results confirm the contribution of HTN and obesity to the early vascular aging and, consequently, the entire body.
Aim . To study the structural and functional state of various components of the upper limb skin microcirculation in healthy normotensive working-age individuals depending on body mass index (BMI) and metabolic status. Material and methods . The study included 227 healthy normotensive volunteers (43±6 years old, 120/107 men/women). They underwent a comprehensive examination of various cardiovascular system sections using non-invasive methods. Left upper limb skin microcirculation was assessed using videocapillaroscopy, 2-channel laser Doppler flowmetry (LDF), and transmission photoplethysmography (PPG). Results . When dividing subjects into groups based on BMI (normal weight (18,5 kg/m 2 ≤ BMI <25 kg/m 2 , n=114) and overweight (25 kg/m 2 ≤ BMI <35 kg/m 2 , n=113) based on videocapillaroscopy, LDF, and PPG revealed no differences between the groups for any of the analyzed parameters. When dividing the subjects (n=227) into groups by metabolic status, the group with a metabolically healthy obesity (MHO) phenotype consisted of 53 (23%) subjects, and the group with a metabolically unhealthy obesity (MUO) phenotype included 174 (77%) individuals. In the MHO group, 29 (55%) overweight individuals relative to individuals with normal BMI values (n=24, 45%) had a decrease in the perfusion contribution of endothelial (7,15 and 4,53%), neurogenic (6,12 and 4,12%) and myogenic (5 and 2,97%) mechanisms of precapillary arteriole regulation, respectively. In the MUO group, the opposite situation was noted — subjects with normal weight (n=90, 52%) relative to individuals with overweight and class 1 obesity (n=84, 48%) had higher values of the contribution of regulatory mechanisms to the total precapillary arteriole tone from the endothelial (3,04 and 2,73), neurogenic (2,9 and 2,51), and myogenic (3,33 and 3,08) tone-forming regulatory mechanisms, respectively. Conclusion . BMI, as a microcirculation disorder biomarker in obesity, demonstrates logical/expected patterns only in individuals with MHO. In healthy normotensive individuals with MUO, the opposite state of resistive skin microvessels is observed, which requires further research in this area.
Aim . To analyze the associations of circulating biomarkers of chronic inflammation, programmed cell death, myocardial remodeling, and cellular stress with clinical and paraclinical characteristics of patients with acute decompensated heart failure with preserved ejection fraction (ADHFpEF). Material and methods . The study included 240 patients aged 47 to 96 years admitted to hospital with a diagnosis of ADHFrEF. Blood was collected before the study began, and processed plasma and serum were stored at -80 о C. Serum biomarker levels were determined using enzyme-linked immunosorbent assay (ELISA), chemiluminescence immunoassay (CLIA), and spectrophotometric methods using Multiscan FC (Thermo, USA), Maglumi 2000 (Snibe, China), Lifotronic eCL8000 (Lifotronic, China), and Shimadzu 1800 UV (Shimadzu, Japan) analyzers. Results . A significant association was found between levels of leptin (odds ratio, OR=1,015), interleukin-6 (OR=1,006), ischemia-modified albumin (OR=1,026-1,028 depending on the model), and cystatin C (OR=1,769) with epicardial obesity. Multivariate analysis adjusted for sex, age, and acute kidney injury revealed significant associations between moderate and severe venous congestion (VExUS Grade 2-3) and serum concentrations of monocyte chemoattractant protein-1 (OR=1,004) and cystatin C (OR=3,188). Conclusion . Hypersecretion of biomarkers of chronic inflammation, myocardial ischemia, and renal dysfunction is associated with epicardial obesity and/or systemic venous congestion in patients with ADHFpEF.
Aim . To assess cost-effectiveness for vaccinating people ≥60 years against pneumococcal infection. Material and methods . Markov modeling was conducted using epidemiological data for the Russian Federation for people aged ≥60 years. The cost-effectiveness of monovaccination with a 23-valent polysaccharide vaccine (PPV23), sequential immunization with a 13-valent conjugate vaccine (PCV13) followed by PPV23 one year later, and vaccination with a 20-valent conjugate vaccine (PCV20) were assessed. The analysis was conducted from the perspective of society as a whole and from the healthcare system. The study time horizon was 10 years. Vaccine costs were analyzed based on registered prices, including VAT. Costs and quality-adjusted life expectancy were discounted by 3% per year. A sensitivity analysis assessed the cost-effectiveness of changing the price of PCV20 by 15% and reducing the time horizon to 5 years. Results . PCV20 vaccination reduces the incidence of pneumococcal infection compared to monovaccination with PPV23 and sequential PCV13/PPV23 immunization. When vaccinating individuals ≥60 years, the incremental cost per additional quality-adjusted life year (QALY) from a societal perspective would be RUB3,684,400, RUB2,087,300, and RUB1,385,600 for PPV23, PCV13/PPV23, and PCV20 vaccination, respectively. When analyzed from a healthcare system perspective, the cost-effectiveness ratios are RUB3,908,100/QALY, RUB2,288,700/ QALY, and RUB1,585,300/QALY for vaccination with PPV23, PCV13/ PPV23, and PCV20, respectively. A sensitivity analysis demonstrated the reliability of the obtained data. Conclusion . Vaccination of Russian people aged ≥60 years with PCV20 provides the greatest reduction in pneumococcal infection incidence and is highly cost-effective compared to PPV23 vaccination and is cost-effective compared to sequential PCV13/PPV23 vaccination. All vaccination options are cost-effective compared to no vaccination.
Aim . To describe the design of the Efficacy and Safety of Pitavastatin and PCSK9 Inhibitors in Liver Transplant Patients (PINTL) study and the baseline clinical and laboratory characteristics of liver transplant recipients with dyslipidemia randomized to receive pitavastatin or a PCSK9 inhibitor (proprotein convertase subtilisin/kexin type 9). Material and methods . This open-label, randomized, prospective, single-center study (PINTL, NCT05537948) enrolled 59 liver transplant recipients randomized 1:1 to pitavastatin (n=30) or a PCSK9 inhibitor (alirocumab/evolocumab, n=29). The study included two following 6-month phases: monotherapy and add-on combination therapy in patients who had not achieved target low-density lipoprotein (LDL) cholesterol (C). Efficacy endpoints included absolute and percentage reductions in LDL-C, the proportion of target level achievement, and the timeframe for achieving and maintaining it. Safety endpoints included the incidence of adverse events, changes in liver enzymes, creatine phosphokinase, and immunosuppressant levels. Results . All patients in the pitavastatin group and 89,7% in the PCSK9 inhibitor group received tacrolimus; 60,0% and 55,2%, respectively, received tacrolimus in combination with everolimus. All patients had high or very high cardiovascular risk; the proportion of patients at very high risk was 33,3% and 20,7%, respectively (p=0,382). Before study inclusion, 20,0% and 13,8% of patients received lipid-lowering therapy, and 13,3% and 0% received statins, respectively. The groups did not differ in most baseline clinical and laboratory parameters. The γ-glutamyl transferase level was higher in the group receiving the PCSK9 inhibitor as follows: 46 (31-103) vs 30 (23-59) U/L (p=0,033). Conclusion . The study cohort had a high cardiovascular risk burden and a low frequency of lipid-lowering therapy prescription. Baseline comparability between the groups will make it possible to evaluate the efficacy and safety of the lipid-lowering strategies studied. The baseline difference in γ-glutamyl transferase levels will be taken into account in further analysis.
Objective. To assess the prevalence of prehypertension and hypertension (HTN) among medical students at the University of Basrah. The prevalence of HTN among younger populations has increased over the past few decades. However, data on the specific prevalence of HTN in younger age groups in Iraq remain limited.Material and methods. A cross-sectional study was conducted involving 762 medical students (414 males and 348 females) selected using a multistage stratified random sampling technique. The study was conducted over a three-month period from January to March 2024. Data on sociodemographic characteristics and risk factors were collected using a self-administered questionnaire adapted from the World Health Organization’s STEP-wise approach. Trained personnel measured blood pressure (BP) and body mass index (BMI) following standardized protocols.Results. The mean age of participants was 21.15 years. The overall prevalence of HTN was 13.4%, and 42.5% of students were classified as prehypertensive. Both HTN and prehypertension were significantly more prevalent among male students (16.7% and 55.1%, respectively) than female students (9.5% and 27.6%, respectively). Only 29.4% of the participants with HTN reported prior awareness and treatment.Conclusion. This study revealed a notably high prevalence of HTN and prehypertension among medical students, most of whom were previously undiagnosed. These findings highlight the urgent need for early detection strategies, including implementation of national screening programs and enhanced community education on HTN prevention and management.
Apoptosis is a programmed cell death, the final stage of which (deoxyribonucleic acid (DNA) fragmentation) is keyly catalyzed by the complex of caspase-activated DNase (CAD/DFF40) and its inhibitor (ICAD/DFF45). Normally, ICAD performs a dual function as follows: it facilitates the CAD enzyme folding and blocks its activity. When apoptosis is triggered, caspase-3 cleaves the ICAD/CAD complex, releasing activated CAD, which catalyzes DNA fragmentation. In atherosclerosis, due to impaired cell recycling, CAD activation transforms silent apoptosis into inflammatory necrosis, destabilizing the plaque. In oncology, by contrast, decreased CAD activity, for example, by strengtheв relationship with an ICAD inhibitor, can cause tumor resistance to chemotherapy and radiation therapy. Thus, the ICAD/CAD complex is an important molecular target. Its excessive activation is dangerous in atherosclerosis, and its insufficient activation is dangerous in cancer treatment.
Aim. To evaluate the changes of renal function during treatment with sodium-glucose cotransporter-2 (SGLT-2) inhibitors in patients with atrial fibrillation (AF) and chronic kidney disease (CKD).Material and methods. A total of 100 patients with AF and stage 3-4 CKD were included. Serum creatinine levels, creatinine clearance (CrCl) according to the Cockcroft-Gault equation, and glomerular filtration rate (GFR) using the CKD-EPI equation were assessed. A decrease in GFR ≥20%, a doubling of creatinine levels, and the development of acute kidney injury (AKI) were analyzed.Results. After 18 months, the GFR in the study group averaged 10,1 (95% confidence interval: 3,6; 16,7) ml/min/1,73 m2 higher than in the control group. In patients with stage C3B CKD, the GFR level increased by 4,3±10,5 ml/min/1,73 m2 from baseline. Patients taking SGLT-2 inhibitors had an increased risk of progression from stage C3B CKD to stage C3A: odds ratio (OR) =0,53; 95% confidence interval: 0,42; 0,67. Differences in kidney function were observed only with renin-angiotensin system inhibitors. No doubling of creatinine levels or development of acute kidney injury was observed. There were no differences between groups in the incidence of a decrease in GFR ≥20%.Conclusion. The renoprotective effect of SGLT-2 inhibitors is maintained in patients with combined AF and CKD, especially in patients with CKD stage C3B.
The emerging problem of cardiovascular toxicity associated with antitumor therapy raises the question of timely diagnosis of its early manifestations. To address this issue, a literature review was conducted on an integrated approach to diagnosing early manifestations of cardiovascular toxicity induced by anthracycline antibiotics, including genetic marker testing, coronary computed tomography angiography (CCTA), and cardiac magnetic resonance imaging.
Aim. To study hemodynamic characteristics and exercise tolerance during mechanotherapy in patients after ischemic stroke (IS).Material and methods. The study included 80 patients after IS. Mean age was 61,0±10,5 years, while the duration of ischemic stroke — 13,1±8,5 months. Rehabilitation routing score was 4. Fifty patients have sinus rhythm, while 10 — paroxysmal atrial fibrillation (AF), and 20 — permanent AF. According to Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, there were 21 patients with atherothrombotic stroke, 30 patients with cardioembolic stroke, 29 patients with stroke of unknown etiology. The following examinations were performed: echocardiography with assessment of left ventricular (LV) global longitudinal strain (GLS), blood test with assessment of N-terminal probrain natriuretic peptide (NT-proBNP). Mechanotherapy was performed daily on a Reck MOTOmed muvi simulator (Germany), with hemodynamic assessment during training on days 1 and 12.Results. Patients with AF, compared with patients in sinus rhythm, were significantly older (65,7±7,2 vs, 58,0±11,2 years; p=0,002) and had higher NTproBNP levels (192,1 [30,3; 282,2] vs, 15,7 [0; 16,2] pg/ml; p<0,001). In patients with sinus rhythm, compared with patients with permanent AF, the LV ejection fraction was higher — 59,4±4,8 vs 52,7±6,6% (p<0,001), the left atrial volume index was lower — 20,2±7,9 vs 45,0±15,6 ml/min (p<0,001), the LV GLS in absolute values was higher — -16,4±2,0 vs -11,7±2,5% (p<0,001). On the 1st day of mechanotherapy, patients with sinus rhythm demonstrate a greater exercise distance and a higher value of maximum oxygen consumption compared with patients with permanent AF. By the 12th day of rehabilitation, a significant increase in exercise distance was observed in both groups as follows: in sinus rhythm, 1,9±0,9 km vs 2,4±0,9 km (p<0,001), and in persistent AF, 1,3±0,5 km vs 1,8±0,9 km (p=0,005). No clinically significant hemodynamic disturbances were observed during mechanotherapy in any patient, regardless of AF.Conclusion. During mechanotherapy, patients with AF demonstrated significantly lower exercise tolerance compared to patients with sinus rhythm. Persistent AF partially limited the effectiveness of mechanotherapy: by the 12th day of training, patients achieved an increase in distance, but no increase in power was achieved. Hemodynamic parameters during exercise did not limit training in either patients with sinus rhythm or AF. Mechanotherapy as part of an individualized rehabilitation program after IS did not provoke arrhythmia attacks in patients with paroxysmal AF.
Aim. To implement effective strategies for developing professional written communication in medical students to improve their readiness for future health practice.Material and methods. This study surveyed students at the Privolzhsky Research Medical University, taking into account their interest in testing a set of effective strategies for developing professional writing skills in foreign language classes. A total of 225 students participated in the study. This study analyzes the impact of written communication proficiency on communication effectiveness, identifies specific skills required in professional activities, and optimizes training for further development of reading and translation skills in medical terminology, enabling medical students to quickly navigate complex terms and understand their word-building structures. Particular attention is paid to the implementation of specialized strategies to increase student effectiveness and engagement in foreign language learning.Results. The use of one or more strategies in teaching written communication to medical students significantly improves the quality of professional training and develops the necessary competencies for successful work in the international medical environment.Conclusion. The study revealed that effective mastery of written communication by medical students is a preparatory stage for the development of well-bred speech. Analysis of the presented strategies demonstrated the need for their integration into professionally oriented training, which promotes the development of not only linguistic but also specialized professional skills. Written communication helps medical students memorize, analyze, think, and communicate.
