Aim. To compare of the quality of life (QoL) dynamics of elderly and senile patients after primary implantation of two-chamber pacemakers during remote monitoring and in-person control in the clinic. Material and methods. This prospective study included 95 patients (50.5 % women) with mean age of 72.5 ± 7.9 years who underwent pacemaker implantation. The treatment group (n = 40) was monitored remotely using the CareLink Network (Medtronic, USA) system with data transmitted monthly for one year. The control group (n = 55) underwent in-person follow-ups. Condition and QoL of each group were assessed prior to surgery, on day 5 at discharge from the hospital, one month and one year after the surgery. The comparison groups are statistically comparable in terms of inclusion criteria, which allowed to perform accurate comparative statistical analysis. QoL was assessed using the Aquarel (Assessment of QoL and related events) questionnaire. Results. In the treatment group, QoL significantly improved at all study stages compared to baseline in the domains of “General”, “Arrhythmia”, “Chest Discomfort” and “Shortness of Breath and Fatigue”, while “Cognitive Functions” improved only after one month and one year. The treatment group showed more pronounced QoL increase (%) at all stages compared to the control group. Analysis of total QoL in relation to detected arrhythmias revealed no statistically significant differences at any stage, either overall (p = 0.776; 0.380; 0.481; 0.067) or in the treatment group alone (p = 0.456; 0.264; 0.128; 0.214). Patients in the remote monitoring group with diabetes mellitus and postinfarction cardiosclerosis showed statistically significant improvement in QoL only after 1 year (p = 0.005 and 0.012, respectively), in contrast to the face-to-face control group. No such differences were observed in patients with acute cerebrovascular accidents. QoL in both groups was not negatively affected by pacemaker-registered paroxysmal tachycardia (episodes of high atrial rhythm, atrial fibrillation, atrial flutter, ventricular tachycardia) identified and verified by a doctor during routine clinical analysis. However, in the patients of the treatment group with episodes of high atrial rhythm, QoL decreased a month later while in the comparison group these changes were reported 5 days after the surgery in cases of atrial flutter. Conclusion. The study showed an improvement in the QoL of elderly and senile patients after implantation of two-chamber pacemakers. A particularly noticeable increase in the QoL (in %) was observed in the treatment group, where changes were recorded at all stages of observation, for the indicators “Overall”, “Arrhythmia”, “Chest discomfort”, and “Shortness of breath / fatigue”. In the control group, improvements were observed only 5 days and 1 month after surgery. It was found that in patients of the main group with concomitant diseases (diabetes mellitus and postinfarction cardiosclerosis), a statistically significant improvement in the QoL was observed one year later (p 0.05), which was not observed in the control group.
Immune checkpoint inhibitors are relatively new and effective agents for treatment of malignant tumors, widely used to combat neoplasms of various locations. Nevertheless, these drugs can cause unwanted immune-mediated phenomena, one of which is capillary leak syndrome. Capillary leak syndrome is characterized by leakage of the liquid part of the plasma from the vascular lumen and is complicated by development of generalized edematous syndrome and hypovolemic shock. Although this complication is rare, it is associated with high risk of fatal outcome, and currently there are no established diagnostic and therapeutic approaches. The aim of our review was to present modern data on capillary leak syndrome caused by immune checkpoint inhibitors. We performed a search and comparative analysis of articles describing this complication. In the PubMed / Medline, Scopus, Web of Science, Google Scholar, and eLibrary databases, 30 clinical case descriptions from 2019 to 2025 were found, 25 of which were included in the review. Development of this complication was most often associated with the use of pembrolizumab (44 %). The median time to development was 12.7 weeks. In one patient, the complication developed against the background of tumor progression. Peripheral edema was described in 96 % of patients. Pleural effusion was the 2nd most common clinical manifestation (68 %). For the management of the complication, 1st-line systemic glucocorticoids were used in 80 % of patients, and they were effective in approximately one third of cases. 13 patients received 2nd-line immunosuppressants, mostly intravenous immunoglobulin. The mortality rate during follow-up was 28 %. With accumulating clinical experience of immune checkpoint inhibitor use, the spectrum and frequency of associated adverse events, including capillary leak syndrome, are expected to grow. This underscores the need to develop diagnostic and therapeutic strategies for this adverse reaction.
Aim. To demonstrate a multidisciplinary approach in management of a patient with generalized sarcoidosis, heart disease and a life-threatening complication in the form of cerebral infarction which required selection of treatment tactics. Material and methods. Patient A., 41, presented with sarcoidosis and Löfgren’s syndrome onset at the age of 23 and developed clinically manifested cardiac disease over the next three years. Cardiac sarcoidosis was characterized by complex life-threatening arrhythmias, progression of chronic heart failure, and infarction-like changes in electrocardiograms and echocardiograms necessitating differential diagnosis. Results. Uncontrolled intermittent use of prednisolone, lack of regular standard therapy for sarcoidosis, and lack of antiarrhythmic therapy largely predetermined the unfavorable course of events, including development of an ischemic stroke at a young age. The development of the cerebral infarction was due to a combination of factors: arrhythmia, newly diagnosed congenital heart defect (patent foramen ovale), hyperhomocysteinemia, and the presence of polymorphisms in the folate cycle genes (MTHFR, MTR). Conclusion. The diversity of clinical manifestations often leads to diagnostic difficulties and errors. In the absence of adequate therapy, the disease progresses and has an unfavorable prognosis. This article presents a clinical observation of a young patient with generalized sarcoidosis with progressive heart disease, hereditary thrombophilia, patent foramen ovale complicated by the development of a stroke.
Vestibular migraine (VM) is a common but underdiagnosed form of migraine. The incidence of VM according to various population studies is about 3 %. Like other forms of migraines, VM is more common in women, especially of periand postmenopausal age. Apart from headaches and dizziness being the most frequent complaints to neurologists, according to the latest statistical data VM is also the most common cause of episodic vertigo. Currently, there aren’t any instrumental diagnostic methods that could confirm presence or absence of vestibular migraine. Diagnosis of this disease is based on results of clinical examination and anamnesis of the patient. Diagnostic criteria, jointly developed by the International Headache Society and the Barany Society, make it possible to diagnose probable or definitive vestibular migraine based exclusively on clinical and anamnestic data. Therapy of VM is based on the same principles as other migraines: relief of attacks and preventive therapy aimed at reducing the severity and frequency of the attacks. However, there are not enough studies on the effectiveness of classical antimigraine therapy in vestibular migraine, and currently in the medical community there are no generally accepted guidelines on treatment of this disease. Despite this, due to the accumulated experience of previous years, possibilities of vestibular migraine therapy are quite extensive and can be effectively applied in routine clinical practice of a neurologist.
Chronic heart failure is common among the population. In addition to the necessary drug treatment of this disease, non-drug approaches to management and rehabilitation of patients are also of great importance. One of the main approaches is physical training which can be divided into several types: high-intensity interval training, moderateintensity aerobic training, and resistance training. A search for literature reviews, systematic reviews and meta-analyses from 2023–2024 was performed in the eLibrary, Google Scholar and PubMed databases using relevant keywords. An analysis of the identified sources was performed, the results of which were also compared with the studies published in 2010–2014. All types of physical training had positive effect on the health of the patients. The advantage of high-intensity interval training and resistance training over moderate-intensity aerobic training in the short and intermediate term was shown, which was later smoothed out, probably due to a decrease in patient adherence to non-pharmacological treatment and kinesiophobia. At the same time, the greatest efficacy of the rehabilitation process and positive impact were achieved by combining different types of training, taking into account cognitive, mental and physiological characteristics of the patient, as well as their social, household, and economic capabilities. Telemedicine technologies and personalized selection of treatment tactics taking into account the stages of treatment and rehabilitation the patient was at, as well as a number of measures such as raising awareness and training the patient, improving their communication and interactions with medical personnel, psychological support and treatment of anxiety and depressive disorders helped to improve compliance.
