AIM:To evaluate the prevalence of risk factors in patients undergoing large joint arthroplasty in real-world practice. MATERIALS AND METHODS:Medical history, information about concomitant diseases and previously prescribed drug therapy was recorded in all participants. In addition, essential laboratory and instrumental examination was performed. RESULTS:The study population included 617 (35.6%) males and 1116 (64.4%) females. The mean age was 64.7±10.4 years, and in 90.5% of patients the mean body mass index exceeded 25 kg/m2. The majority (77.6%) of patients had hypertension and other cardiovascular diseases. Glycemic disorders had 371 (21.4%) patients, with glycemic control being inadequate in 14 (3,8%) of these patients. Chronic kidney disease stages II-V was found in 1,330 (76.7%) patients and all of them also had obesity and hypertension. At study entry, 262 (15.1%) patients were taking different anticoagulants, and 534 (30.9%) patients were taking antiplatelet agents. CONCLUSION:The primary patient population undergoing large-joint arthroplasty of the lower extremities consists of elderly individuals with a high burden of comorbidities (obesity, hypertension, chronic kidney disease, and diabetes), which increases the risk of perioperative complications. The published literature contains limited information regarding the necessary scope of preoperative assessment in these patient subpopulations with various concomitant diseases, as well as potential adjustments to postoperative management strategies. It may be necessary to conduct large-scale prospective studies specifically focusing on various patient cohorts, accompanied by pharmacoeconomic analyses, to determine the necessity and scope of expanded diagnostic workups in this population at high risk for perioperative complications.
The article describes the history of the development and implementation of stress tests in cardiology for the diagnosis of coronary heart disease, with a particular attention to the creation, implementation and development of the treadmill test.
AIM:Testing of therapeutic drug monitoring in the treatment of drug-resistant tuberculosis. MATERIALS AND METHODS:We conducted a pilot prospective study including 15 patients with drug-resistant tuberculosis. Serum concentrations of bedaquiline, linezolid, fluoroquinolone, cycloserine, delamanid (C2h) were determined by high-performance liquid chromatography and mass spectrometry. The influence of clinical and pharmacogenetic factors were evaluated. RESULTS:In most patients, C2h of the drugs were subtherapeutic (57.1% for bedaquiline, 73.3% for linezolid). C2h of bedaquiline were higher in patients with homozygous rs776746 in the CYP3A5 gene (p=0.04), in case of simultaneous omeprazole (p=0.015), high drug load (p=0.005); linezolid - in patients with rs776746 in the CYP3A5 gene (p=0.038) and rs34351236 in the P-glycoprotein gene (p=0.014). The course of chemotherapy was effective in 14 of 15 patients. A factor for cavity closure was a C2h/critical concentration ratio above 1.0 for fluoroquinolone (odds ratio 3.5, 95% confidence interval 1.08-11.24). CONCLUSION:Therapeutic drug monitoring is a perspective tool for personalized approach to improve treatment outcomes in high-risk drug-resistant tuberculosis patients.
The article is devoted to an overview of the current stage of development of the movement of doctors, which received the Nobel Peace Prize in 1985 and was founded by Evgeny Ivanovich Chazov and Bernard Lown. In the year of the fortieth anniversary of the Chernobyl disaster, it is extremely important for the entire medical community to remember the stages of the organization's development, as well as to understand the current state of medical and scientific diplomacy, the development of which is the key to the continued existence of mankind and the protection of the health of the population as a whole.
In recent years, studies have been carried out that have expanded the understanding of the role of pathophysiological mechanisms underlying impaired regulation of aldosterone and activation of mineralocorticoid receptors in arterial hypertension. The aim of this consensus is to consider the association between aldosterone dysregulation and the development of cardiovascular complications, as well as to assess the effectivity and safety of novel nonsteroidal mineralocorticoid receptor antagonists, to expand the understanding of their potential in ensuring the prevention of target organ damage and cardiovascular complications in the treatment of patients with hypertension, to analyze the potential of a new class of drugs - aldosterone synthase inhibitors - in ensuring the suppression of genomic and non-genomic effects of aldosterone and their adverse effects in patients with hypertension, to assess the efficacy of drug therapy including nonsteroidal mineralocorticoid receptor antagonists and aldosterone synthase inhibitors in the category of patients at high cardiovascular risk - in hypertension due to primary hyperaldosteronism.
Aim. To evaluate the prevalence and identify risk factors for Helicobacter pylori infection in patients with acute myocardial infarction (AMI) and stable coronary artery disease (CAD). Materials and methods. A total of 110 patients were enrolled in a single-center study. The patients were divided into two groups according to the form of CAD. The first group (n=54) consisted of patients with AMI after primary percutaneous coronary intervention, with a mean age of 62.00 years; 53 patients (94.64%) were on dual antiplatelet therapy. The second group (n=56) included patients with stable CAD who had undergone coronary artery stenting within the previous year, with a mean age of 67.5 years, of whom 42 patients (77.78%) were on dual antiplatelet therapy. The standard examination included analysis of complaints, laboratory tests (complete blood count, biochemical blood test, coagulogram), as well as testing for H. pylori. The 13C-urea breath test was used for patients with AMI, while for patients with stable CAD, testing was performed via biopsy during esophagogastroduodenoscopy. Results. The frequency of H. pylori infection differed between the patient groups. Among patients with stable CAD, a positive result was found in 17 (31.5%) individuals, while a negative result was found in 37 (68.5%). In the group of patients who had experienced AMI, the proportion of infected individuals was higher, at 26 (46.4%), whereas non-infected patients numbered 30 (53.6%). According to univariate analysis, H. pylori-positive status was statistically significantly associated with smoking and the presence of dyspeptic complaints. These results persisted after adjusting for sex and age. In patients with AMI, the infection was also associated with higher systolic blood pressure, a decrease in total protein level, and a prolonged prothrombin time. The comparison groups were comparable in terms of received drug therapy, except for the more frequent prescription of proton pump inhibitors to H. pylori-positive patients. Conclusion. The findings demonstrate a widespread prevalence of active H. pylori infection among patients with acute AMI and stable CAD. The risk factors identified point to this infection as a potentially modifiable contributor to an elevated risk of gastroduodenal ulcers and hemorrhage in this patient population.
Background. The combination of arterial hypertension (AH) and bronchial asthma (BA) presents a complex clinical challenge that notably elevates cardiovascular risk. Real-world data are scarce regarding the phenotype and incidence of cardiovascular complications within this patient population. Aim. To investigate the prevalence of cardiovascular risk factors and comorbidities in patients with AH, taking into account the presence of BA, as recorded in the national hypertension registry. Materials and methods. Retrospective analysis of a hypertension registry: 56,784 AH patients without BA and 612 with AH+BA. Demographic and anthropometric parameters and comorbidity prevalence were compared. Odds ratios (OR) were adjusted for sex and age. Results. BA prevalence was 1.1%. The AH+BA phenotype was characterized by female predominance (71.4% vs 59.4%; p0.001), older age (65.0 years vs 62.7 years; p0.001), higher BMI (29.4 kg/m2 vs 28.5 kg/m2; p=0.002), and abdominal obesity (53.7% vs 39.0%; p=0.003). BA was associated with higher rates of coronary artery disease – CAD (56.2% vs 41.2%), chronic heart failure – CHF (68.8% vs 48.6%), and atrial fibrillation – AF (10.1% vs 4.3%; all p0.001). After adjustment, BA remained an independent predictor of CAD (OR 2.02, 95% confidence interval – CI 1.71–2.40), CHF (OR 2.47, 95% CI 2.07–2.96), and AF (OR 2.49, 95% CI 1.88–3.23). No association with stroke was found. Conclusion. The comorbidity of BA and AH is associated with a distinct phenotype (older woman with abdominal obesity). BA is an independent predictor of CAD, CHF, and AF, mandating active cardiovascular screening.
Invasive lobular breast carcinoma is characterized by infiltrative growth and a tendency toward atypical metastasis, including to the gastrointestinal tract, where metastases are often diffusely infiltrative, complicating their visualization and potentially leading to diagnostic errors. This paper presents a clinical case of a 55-year-old female patient with long-standing (approximately 20 years) abdominal pain syndrome. Based on imaging studies and elevated fecal calprotectin levels, this pain syndrome was interpreted as Crohn's disease, despite the lack of response to standard therapy. One year after confirmation of invasive lobular breast cancer (luminal A subtype, T1N1M0), the patient continued to experience abdominal symptoms until the development of dynamic intestinal obstruction, which required surgical intervention. Histological and immunohistochemical examination of the resected intestinal segment confirmed metastatic involvement of the small and large intestines. This case demonstrates a rare variant of lobular breast cancer metastasis to the intestine, which had been masquerading as Crohn's disease for a long time. It highlights the need for oncological vigilance in patients with abdominal symptoms and a history of cancer, as well as the crucial role of immunohistochemistry in verifying the diagnosis.
Exosomes are extracellular membrane vesicles with a diameter of 30–150 nm secreted by various cell types into the extracellular environment and regulating many vital physiological processes, including signaling, immune activation, proliferation, differentiation, and apoptosis. Numerous studies conducted in recent years have demonstrated the key role of exosomes in the development of various gastrointestinal diseases, including cancer, allowing them to be considered as potentially promising diagnostic biomarkers. Furthermore, due to their inherent biocompatibility, ability to overcome biological barriers, low toxicity, and immunogenicity, exosomes can be used for targeted drug delivery in the treatment of patients with gastrointestinal diseases. This review article systematizes and presents information on exosomes, their functions, extraction and detection methods, and examines the main exosomal markers, which demonstrate significant potential for the diagnosis and treatment of various gastrointestinal diseases.
Aim. To evaluate the efficacy, safety and impact on gastrointestinal symptoms of Helicobacter pylori eradication therapy with a ready-to-use set of tablets and capsules [omeprazole 20 mg × 2, clarithromycin 500 mg × 2, amoxicillin 500 mg × 4] (Pylobact® AM) in duodenal ulcer patients within the framework of an observational program. Materials and methods. 912 H. pylori-positive patients were included (404 men and 508 women, average age – 43.8 years (43.82±11.39; 18–64 years). Symptoms were assessed using the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire; patients assessed treatment satisfaction, and physicians assessed treatment efficacy and tolerability using a five-point Likert scale. The efficacy of H. pylori eradication was assessed using the results of the 13C-urea breath test, H. pylori antigen stool test, or a rapid urea test with biopsies of the gastric body and antrum obtained during upper endoscopy. A total of 870 patients completed the observational program: 538 patients in the standard triple therapy group (PAM group) and 332 patients in the group enhanced with a bismuth preparation, rebamipide, and/or a probiotic (PAMplus group). A subgroup of patients received triple therapy with bismuth and the synbiotic complex of Floriose with probiotic strains Lactobacillus acidophilus La-14, Lactobacillus rhamnosus Lr-32, Bifidobacterium lactis Bl-04, inulin and B vitamins. Results. H. pylori eradication rates in the PAM, PAMplus, and PAM+Bi+F (ITT) groups were 90.6, 97.03, and 96.82%, respectively. Treatment significantly reduced GSRS abdominal pain scores. Physicians rated the treatment efficacy and tolerability as "very good" or "good" at the end of the program in 93.3% of patients. Patients rated 93.68% as completely or mostly satisfied with the treatment. Conclusion. The effectiveness of H. pylori eradication with a ready-to-use set of capsules and tablets for standard triple therapy is ensured by high patient compliance. The combination of standard triple therapy with bismuth, probiotics, and/or rebamipide increases treatment efficacy.
Aim. To evaluate the structure of cardiovascular pharmacotherapy prescribed during the preoperative period including antihypertensive, antiarrhythmic, antianginal, lipid-lowering, and antiplatelet drugs and to analyze its compliance with clinical indications in patients scheduled for elective orthopedic interventions on the major joints of the lower extremities. Materials and methods. This prospective, single-center cohort study included 1,733 patients. In all patients, a detailed medical history was obtained, an additional physical examination including blood pressure measurement was performed, and previously prescribed cardiovascular therapy was analyzed. Results. The study population included 617 (35.6%) males and 1116 (64.4%) females with mean age 64.7±10.4 years. The majority (90.5%) patients were overweight, and 77.6% of patients had hypertension and other cardiovascular diseases; in 142 (10.5%) patients, no antihypertensive therapy had been prescribed prior to hospitalization, while in 295 (21.9%) patients, target blood pressure levels were not achieved despite previously prescribed therapy. Furthermore, 262 (15.1%) individuals were regularly taking various anticoagulants, and 534 (30.9%) were taking antiplatelet agents; of the latter group, 342 (19.7%) patients had no indications for such treatment. Conclusion. The patient population undergoing total hip arthroplasty and total knee arthroplasty is characterized by a high prevalence of cardiovascular diseases; however, in a subset of these patients, antihypertensive therapy is suboptimal, and many patients with hypercholesterolemia do not receive statins despite clear indications. On the other hand, many patients take antiplatelet agents without appropriate indications – a situation that underscores the need to raise awareness among both patients and healthcare professionals.
This article analyzes materials on the history of Russian medical societies, identifying four periods in their history. The first few voluntary associations dedicated to the development of medical science and the advanced training of physicians emerged in 1804, following the establishment of imperial universities empowered to establish societies. The second period begins in the 1860s, following the simplification of the procedure for approving the charters of public organizations. It is characterized by an explosive growth in the number of medical societies, some of which (the Russian Society for the Protection of Public Health, the Pirogov Society) played a significant role in the development of Russian medicine, reaching the national level in their activities. The third period begins after the Bolsheviks came to power; highly specialized societies focused exclusively on developing the science and practice of their disciplines. The fourth period begins in the 1990s, following the collapse of the USSR and the introduction of evidence-based medicine principles into all areas of healthcare. The number of medical societies grows, and they acquire new functions, such as the development of medical care standards and clinical guidelines.
Aim. To compare surgical and conservative treatment outcomes in patients with severe and fulminant ulcerative colitis (UC), pseudomembranous colitis (PMC), and ischemic colitis (IC) and to identify predictors of surgical intervention. Materials and methods. A retrospective cohort study was conducted between 2015 and 2024 and included 308 patients with severe and fulminant UC, PMC, and IC. Surgical treatment was performed in 108 patients, while 200 received conservative therapy. Clinical and demographic data, endoscopic and imaging findings, complications, and outcomes were analyzed. Predictors of surgical intervention were identified using binary logistic regression with calculation of odds ratios (ORs) and 95% confidence intervals (CIs). Model discrimination was assessed using ROC analysis. Results. Surgically treated patients were younger (p=0.025) and more frequently had a rapidly progressive disease course (OR 2.85, 95% CI 1.65–4.92; p0.001). Endoscopic predictors of surgery included mucosal contact bleeding (OR 1.99, p=0.020) and ulcerative defects (OR 1.97; p=0.012). Among complications, colonic bleeding (OR 6.33; p0.001) and colonic dilation (OR 3.67; p=0.013) were significantly associated with surgical intervention. The predictive model demonstrated satisfactory discrimination (AUC 0.700; p0.001) with high sensitivity (92.9%) and moderate specificity (33.7%). Conclusion. Key predictors of surgical intervention in patients with severe UC, PMC, and IC include rapidly progressive disease course, mucosal contact bleeding, ulcerative defects, colonic bleeding, and colonic dilation.
Aim. To assess the cumulative frequency and patterns of diagnostic reclassification in inflammatory bowel disease (IBD). Materials and methods. A single-center retrospective longitudinal cohort study was conducted at the Department of Gastroenterology, Peter the Great Clinic, Mechnikov North-Western State Medical University. The study included 800 patients with an established diagnosis of IBD. Grounds for diagnostic reclassification were analyzed. The primary endpoint was the cumulative frequency of diagnostic reclassification. Secondary endpoints included patterns of reclassification in patients initially diagnosed with unclassified IBD and ulcerative colitis (UC), median time to diagnostic revision, the clinical and morphological grounds for reclassification. Results. During follow-up, diagnostic reclassification occurred in 17.6% of cases (n=141). Among reclassified patients, the initial diagnosis was IBDU in 16.3% (n=23) and UC in 83.7% (n=118). In 93.6% of cases (n=132), reclassification resulted in Crohn’s disease (CD) (95% CI 88.2–97.0); in 9 patients, the final diagnosis was unknown due to missing data. The median time from the initial diagnosis to reclassification was 42.0 months [16.0; 99.0]. The most common reason for diagnostic revision was the identification of segmental involvement: 50.0% (7/14) among patients initially classified as IBDU and 63.6% (75/118) among those initially diagnosed with UC (p=0.386). In the presence of a stricture, the median time to reclassification was 96 months [37.0; 186.0]. Conclusion. Diagnostic reclassification in patients with IBD is a prolonged and clinically meaningful process. The findings support the possibility of diagnostic reassessment in patients initially diagnosed with UC or IBDU. In clinical practice, when establishing an IBD diagnosis – particularly UC – it is important to consider the potential for reclassification, and when indications for revision are present, to document the fact of reclassification.
Background. Identifying the character, frequency, and intensity of cough is crucial in clinical practice, aiding in differential diagnosis, influencing treatment choices. «CoughScan» is a software with an embedded neural network model designed to assess cough frequency in real-time for diagnostic and monitoring purposes. Aim. To obtain additional data on the efficacy and safety of Rengalin® in the treatment of cough in adults with acute respiratory viral infections (ARVI) using both traditional and new intelligent technologies. Materials and methods. An observational study was conducted involving 60 patients with ARVI, receiving Rengalin® for cough management. Outpatient patients were divided into 2 groups: the main group (n=40) received Rengalin® for 7 days, while the control group (n=20) received no cough medication. The severity of symptoms of ARVI and cough was assessed with Cough severity scale (CSS), «CoughScan», Bronchitis Severity Scale (BSS). Results. The cough severity score on CSS decreased by 2.9 points in the Rengalin® group and by 1.5 points in the control group (p=0.0004). The average BSS score reduced by 1.3 units with Rengalin® and by 0.2 units in controls (p=0.0001). The mean duration of cough during treatment was 5.7±0.2 days versus 7.2±0.4 days without treatment (p=0.0178). Monitoring of daily cough intensity with «CoughScan» also showed a statistically significant advantage in the Rengalin® group (p0.0001). A non-inferiority test based on the area under the curve (AUC) over 7 days indicated comparable results between «CoughScan» and the CSS, with differences within 10%. Conclusion. «CoughScan» is a convenient and reliable tool for assessing cough dynamics in outpatient settings. Its data are comparable to the Cough severity scale regarding treatment efficacy, with antitussive activity of Rengalin® evident from the early days of therapy.
To date, the role of various types of programmed cell death in the occurrence and progression of infectious diseases has been established. One such type, ferroptosis, which was recently discovered, is characterized by iron-dependent lipid peroxidation and is under investigation in relation to the development of disorders of various organ systems, including infections. Recent researches have revealed previously unknown mechanisms of bacterial damage associated with ferroptotic cell death. For instance, the involvement of ferroptosis in infections caused by multidrug-resistant pathogens such as Pseudomonas aeruginosa, Mycobacterium tuberculosis, Klebsiella pneumonia, and Escherichia coli has been demonstrated. The studied pathogenic mechanisms of these pathogens highlight ferroptosis as a potential therapeutic target for infectious diseases and suggest new possibilities for addressing the challenging problem of antibiotic resistance. In this review, we have summarized the main mechanisms of ferroptosis and highlighted new data on the pathogenic aspects of bacterial damage associated with this process. This information may be useful for developing new therapeutic strategies to combat this condition.
Chronic heart failure is a leading cause of increased mortality rates globally, including in the Russian Federation. Guideline-directed medical therapy plays a key role in the management of this patient cohort, particularly among individuals with reduced left ventricular ejection fraction. Of special interest is the subgroup with improved left ventricular ejection fraction, for which data remain limited and the issue of further medical treatment remains unresolved. This review aims to categorize this patient population and address the feasibility of discontinuing or reducing medical therapy.
Aim. To investigate the relationship between vitamin D levels, metabolic-associated fatty liver disease (MAFLD), and arterial stiffness. Materials and methods. This study included 303 patients with a median age of 55 [40; 65] years. All participants underwent duplex ultrasonography with assessment of carotid extra-media thickness (EMT), and liver transient elastography with evaluation of the attenuation coefficient (AC) transthoracic echocardiography for measurement of epicardial adipose tissue thickness (EAT). MAFLD was diagnosed based on hepatic steatosis combined with overweight/obesity and at least two metabolic risk factors. Arterial stiffness was evaluated using the cardio-ankle vascular index (CAVI), measured by sphygmomanometry with the VaSera-1000 system FUCUDA DENSHI (Japan). Serum 25-hydroxyvitamin D levels were measured in all participants. Statistical analysis was performed using Statistica 12.0 software. Results. Patients were divided into 4 groups depending on their vitamin D levels. High arterial stiffness was significantly more frequent in patients with severe vitamin D deficiency compared with those with insufficiency and optimal levels (40% vs 19.5%; p=0.006; 40% vs 0%; p0.0001 respectively). The cardio-ankle vascular index (CAVI) was significantly higher in the severe deficiency group compared with the optimal vitamin D group (7.5 [6.5; 8.8] vs 6.6 [5.8; 7.5]; p=0.03). Significant correlations were observed between CAVI and EMT, EAT, AC, and the presence of MAFLD. Vitamin D levels were negatively correlated with AC and MAFLD. ROC analysis demonstrated the highest diagnostic accuracy for detecting increased arterial stiffness using a combined model (AUC vit D + AC + EMT =0.823; p0.0001). Conclusion. Vitamin D is associated with arterial stiffness and ectopic fat deposition, while its combination with AC and EMT provides high diagnostic accuracy for identifying patients at increased cardiometabolic risk.
Aim. To study the role of type 2 diabetes mellitus (DM 2) as an independent factor in the severe course of COVID-19 in obese patients. Materials and methods. The data of 1414 obese people hospitalized with COVID-19 at University Clinical Hospital №4 of Sechenov First Moscow State Medical University (Sechenov University), were analyzed. Two groups were formed: group 1 – 256 obese people with DM 2, group 2 – 1158 obese people without DM 2. The severity of COVID-19 was assessed using standard laboratory and instrumental parameters. Death and intensive care unit admission (ICU) were selected as the primary endpoints. Results. Patients with DM 2 had higher markers of inflammation and coagulation. The volume of lung damage according to computed tomography in group 1 exceeded the indicators of group 2 – 40 (27,5; 61,25%) vs 37,5 (25; 45%); p0.05. The frequency of ICU admission and deaths in patients with DM 2 was higher (25 and 16.4%) compared with the indicators of group 2 (6.8 and 4.1%); p0.05. According to multivariate regression analysis, DM 2 was an independent factor associated with ICU admission (odds ratio 1.87, CI 1.14–3.06) and death (odds ratio 2.45, CI 1.35–4.45); p0.05. In patients with obesity and DM 2, CRP values of more than 107.8 and 125.7 mg/l have high prognostic value in relation to the risk of ICU admission and death. Conclusion. DM 2 is an independent factor in the severe course of COVID-19.
Background. Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired, life-threatening disease of the blood characterized by intravascular hemolysis by the complement system, thrombotic events and bone marrow failure. The introduction of the C5 complement inhibitor eculizumab into clinical practice has presented new opportunities for the treatment of PNH and its complications, increasing patient survival and quality of life. However, clinically significant variability in treatment response is observed. One of the reasons is patients’ poor treatment adherence (TA), which is associated with a number of factors, including insufficient doctor attention to this problem and inconsistent eculizumab availability in some regions. Aim. To evaluate the impact of eculizumab TA on the attainment of favorable clinical outcomes in patients with PNH in actual clinical practice. Materials and methods. A review of published literature and our own data regarding the use of eculizumab for the treatment of PNH has been conducted. Results. Long-term management of chronic conditions requires adequate adherence to treatment plans in order to achieve effective results. One of the key factors that can influence adherence is the doctor's lack of activity. To achieve PNH treatment goals, it is essential to consider predictors of appropriate / inappropriate adherence. An analysis of the outcomes of eculizumab treatment for PNH patients in Moscow City Hematology Center of Botkin Moscow Multidisciplinary Scientific and Clinical Center revealed that monitoring the frequency of infusions led to a 21% improvement in the optimal response rate to eculizumab therapy, compared to the outcomes of previous pathogenic treatment administered in regional centers. Conclusion. Eculizumab has proven its efficacy and good tolerability and is widely used as a pathogenetic therapy for PNH. It is essential to strictly adhere to the eculizumab treatment regimen in order to achieve optimal results. It is essential for healthcare professionals to closely monitor patient motivation to adhere to their treatment plan. Effective communication between the healthcare provider and the patient is essential for the successful use of eculizumab. It is essential for specialists to make every effort possible to improve patient AT.
