Therapy

Due to advances in science and medicine, life expectancy is increasing in many countries, and accordingly, the need for elective non-cardiac surgery in elderly and senile patients is growing too. Chronologic age still remains to be a determining factor in perioperative risk and a reason for elective surgery refuse. There are numerous anesthesia scales and calculators for predicting perioperative risks, widely used by clinicians and anesthesiologists worldwide. However, these scales do not take into account all possible risk factors and can be subjective, making the prognosis generalized. Currently, to accurately calculate perioperative risks in elderly and senile patients, a comprehensive estimation of their functional status in the preoperative period is required. The most promising method for such an assessment is determining peak oxygen consumption, which reflects the body’s functional reserves.

Approximately 90% of hospitalizations for heart failure (HF) are due to manifestations of venous congestion, but the pathophysiological mechanisms underlying it remain incompletely understood and are insufficiently taken into account in clinical practice.

The aim: to study the role of spleen stiffness (SS) in the assessment of systemic venous congestion in patients with acute decompensation of chronic HF (ADCHF).

Material and methods. The study included 77 patients (44 women and 33 men) with ADCHF aged 73.5 ± 7.7 years. All patients underwent standard physical, laboratory, and instrumental examinations, including NT-proBNP, lung ultrasound, bioimpedance vector analysis, indirect transient elastography of the spleen and liver using the FibroScan device, echocardiography, and assessment of congestion severity according to the VExUS protocol on the Philips Epiq7 device. Depending on SS values, patients were divided into two groups: those with SS below and above the median value (< 36.1 kPa and ≥ 36.1 kPa, respectively).

Results. When comparing groups depending on the median value, in the group of patients with SS ≥ 36.1 kPa, dyspnea at rest and paroxysmal nocturnal dyspnea were more frequently detected (p < 0.05), and there was a tendency for an increased frequency of lung rales and hepatojugular reflux. In this same group, more pronounced signs of hypervolemia were noted: a larger amount of extracellular fluid according to BIVA data, a higher frequency of IVC dilation, and increased diameters of the portal, hepatic veins, and IVC, as well as a predominance of severe degrees of venous congestion according to the GRADE scale (p < 0.05). A statistically significant direct association between SS and liver stiffness was revealed (r = 0.46, p < 0.001), as well as a connection with variants of cardiorenal syndrome. In the assessment of echocardiographic parameters, larger right atrial sizes were recorded and severe tricuspid regurgitation was significantly more often diagnosed (p < 0.05).

Conclusion. Increased SS ≥ 36.1 kPa is associated with a more severe heart failure phenotype, predominantly with congestion in the systemic circulation, which allows this indicator to be considered a new marker of venous congestion in patients with ADCHF.

The role of prediabetes in the context of acute decompensated heart failure (ADHF) has not been found yet.

The aim: to identify predictors of ADHF development in patients with prediabetes and to evaluate the diagnostic value of proadrenomedullin N-terminal peptide (20 amino acids) (PAMP) and cancer antigen 125 (CA-125) biomarkers in the blood, including at low levels of N-terminal brain natriuretic peptide (NT-proBNP).

Material and methods. 123 patients with ADHF were consecutively enrolled in the study over a 36-month period. Participants were divided into two groups: the first group included 66 (53.7%) patients with ADHF without prediabetes, and the second included 57 (46.3%) patients with ADHF and prediabetes. During the first 48 hours, patients underwent echocardiography, NT-proBNP, CA-125, PAMP, cystatin C levels, and volumetric sphygmoplethysmography.

Results. In the group of patients with prediabetes, body mass index > 30 kg/m² and triglyceride-glucose index >9 increased the relative risk (RR) of ADHF developing by 2.4 and 2.6 times, respectively. Moderately reduced ejection fraction, diastolic dysfunction and left ventricular hypertrophy, increased indexed left atrial volume, estimated glomerular filtration rate < 60 ml/min/1.73m² and aortic pulse wave velocity >6 increased the OR of ADHF developing in patients with prediabetes by 1.7, 1.8, 1.5, 1.7, 1.8 and 1.5 times, respectively. NT-proBNP values < 300 pg/ml were detected in 21.1% of patients with ADHF. ROC analysis showed that CA-125 levels > 12.037 KEU/mL and PAMP > 31.6 pg/mL can be considered as diagnostic criteria for ADHF in patients with prediabetes. Using these criteria comparatively to NT-proBNP > 300 pg/mL increased the OR for ADHF verification, regardless of glycemic status.

Conclusion. Metabolic risk factors for carbohydrate metabolism disorders, cardiac remodeling, renal dysfunction, and increased arterial stiffness were perceived as predictors of ADHF development in patients with prediabetes. Determination of CA-125 and PAMP biomarkers in the blood of patients with suspected ADHF has a higher diagnostic value than NT-proBNP, including at low values of NT-proBNP.

Chronic heart failure (CHF) remains a pressing public health problem due to its associated high morbidity and mortality. Current data highlight the influence of intestinal microbiota (IM) on CHF via “intestine – heart” axis; however, most relevant studies are based on relative new-generation sequencing data, which does not allow for the estimation of absolute changes in microbial abundance.

The aim: to evaluate absolute changes in the microbial abundance in IM of patients with CHF comparatively to healthy individuals using gas chromatography-mass spectrometry (GC-MS).

Material and methods. The study included 25 patients with CHF (18 male and 7 female individuals, mean age 75 ± 9.4 years) hospitalized in a multidisciplinary hospital. Of these, 60.0% (n = 15) had a low left ventricular ejection fraction (LVEF), 16.0% (n = 4) had a moderately reduced LVEF, and 24.0% (n = 6) had a preserved LVEF. The control group consisted of 23 healthy volunteers. IM composition was determined using GC-MS methodic. Patients with CHF underwent LVEF testing, bioimpedance vector analysis, liver fibroscanning, blood biochemistry, also nutritional status assessment (MNA), and sarcopenia screening (SARC-F, MSRA-7).

Results. In patients with CHF, comparatively to healthy controls, changes in the absolute numbers of a number of microorganisms were detected: an increase in the number of opportunistic proinflammatory microorganisms (in particular, Campylobacter mucosalis, Candida spp., Alcaligenes spp. / Klebsiella spp., Clostridium difficile; in all cases, p < 0.05), Cytomegalovirus HHV-5 viruses, as well as a decrease in the number of bacteria producing short-chain fatty acids (SCFAs), in particular, Clostridium ramosum, Propionibacterium jensenii, Blautia coccoides, Bacteroides fragilis, Eubacterium spp. (in all cases, p < 0.05). Associations between the number of microorganisms and clinical and functional parameters of CHF were also identified.

Conclusion. Signs of intestine microbiota disturbances with an increase in the absolute number of opportunistic proinflammatory microorganisms and a decrease in SCFAs producers in case of CHF were identified. These changes are also associated with the clinical and functional parameters of CHF. Taken together, the obtained results confirm the pathogenetic role of intestine microbiota in CHF and expand our understanding of the “intestine – heart” axis with new data that can be used to identify microbial markers to assess the severity of dysbiosis and develop microbiotherapy for this disease.

Metabolically associated fatty liver disease (MAFLD) is closely associated with cardiometabolic polymorbidity, which determines an unfavorable prognosis and high risk of cardiovascular events in patients.

The aim: to compare clinical, demographic, and comorbid conditions in patients with MAFLD and control individuals without this disease who sought medical help in a tertiary medical center.

Material and methods. Current retrospective “case – control” study included 850 participants: 432 patients diagnosed with MAFLD and 418 controls, matched for gender and age. Anthropometric, laboratory, and instrumental data, as well as comorbidity patterns, were assessed.

Results. Patients with MAFLD were characterized by significantly higher body mass index (p < 0.001) and transaminase levels (p < 0.001). In the MAFLD group, type 2 diabetes mellitus (49.3 vs. 35.9%; odds ratio 1.74; p < 0.001) and dyslipidemia (69.0 vs. 42.3%; odds ratio 3.03; p < 0.001) were significantly more common. A direct correlation was established between the degree of liver steatosis and the number of metabolic comorbidities (from 0.82 at grade 0 to 3.82 at grade 3 steatosis; p < 0.001). The level of liver stiffness positively correlated with the body mass index, fasting glucose and triglyceride levels (p < 0.001). The revealed clustering of MAFLD with type 2 diabetes mellitus and dyslipidemia confirms the role of insulin resistance in the pathogenesis of the disease and reflects its systemic nature. Direct correlation between the severity of steatosis and multimorbidity and cytolysis syndrome determines the advisability of routine screening and multidisciplinary management of such kind of patients.

Conclusion. MAFLD is associated with a significant cumulative metabolic burden. Increasing steatosis and liver stiffness are associated with a progressive deterioration of the carbohydrate and lipid profile, necessitating comprehensive control of cardiometabolic risk factors to prevent disease progression.

Vascular cognitive impairments remains a significant medical and social problem due to its high prevalence and associated severe consequences. Cardiovascular diseases and mental disorders can interact with each other, worsening both mental health and the prognosis of cardiovascular diseases. Much attention is currently being paid to the concept of cerebrometabolic health, which reflects the stages of disorders leading to cerebral dysfunction and determines the importance and targeted type of intervention at all stages of patient care. Recognizing the importance of early detection of cognitive decline is necessary for the timely initiation of measures aimed at slowing the progression of cognitive impairments and preventing the progression of moderate impairments to dementia. Ethylmethylhydroxypyridine succinate (original drug – Mexidol), with its multimodal mechanism of action, in addition to proven antioxidant and antihypoxant activity, has a beneficial influence on life quality, cognitive and functional status, and echocardiographic parameters, as was demonstrated in clinical trials with patients having acute and chronic cerebrovascular pathology and heart failure.

Thrombotic microangiopathy (TMA) is one of the manifestations of malignant arterial hypertension (MAH), requiring differential diagnosis from primary forms of the disease. This article describes a clinical case of TMA associated with MAH in a 38-year-old patient with prolonged exposure to high temperatures. The disease manifested with an increase in blood pressure (BP) to 212/120 mmHg and acute visual impairment. The patient had severe azotemia (creatinine level up to 350 μmol/L), proteinuria up to 1.75 g/day, and stage 3 hypertensive retinopathy. A kidney biopsy revealed signs of acute and chronic TMA, while complement-mediated forms of the disease were excluded. Combination antihypertensive therapy and heat stress management resulted in stabilization of blood pressure and renal function (creatinine 218–228 μmol/L, eGFR ≈ 31 mL/min/1.73 m²). Current observation demonstrates that TMA in young patients can remain to be asymptomatic for a long time. If TMA is detected, a thorough differential diagnosis is necessary. Renin-angiotensin-aldosterone system (RAAS) blockers may be prescribed even in cases of reduced eGFR, in case of its monitoring. Chronic heat stress can be considered to be a potential trigger for the disease.

Iron deficiency (ID) is a significant modern healthcare problem that, despite ongoing programs by the World Health Organization, remains unresolved. Iron deficiency (ID), and iron deficiency anemia as its most severe manifestation, reduces quality of life, worsens comorbid conditions, and increases the risk of hospitalization and death. The most successful strategy for combating ID is timely preventive measures, including informational and educational activities, balanced nutrition, implementation of national iron fortification programs, screening for ID, regular follow-up, and iron supplementation in individuals from the risk groups. Among modern supplementation methods (prevention and correction of ID), iron bisglycinate (VitaFerr) deserves special attention: this form of iron, characterized by good absorption rates, has proven its efficacy and safety in a number of studies and in real-world clinical practice, as is illustrated by the clinical observations presented in the current article.

Knee osteoarthritis (KOA) is a major cause of chronic pain and disability. Many patients with indications for total knee arthroplasty (TKA) must wait on waiting lists.

The aim: to describe the clinical profile of KOA patients awaiting TKA and evaluate efficacy and safety of a single intra-articular cross-linked bionic hyaluronate injection (Flexotron^® Cross).

Material and methods. A retrospective and prospective study was conducted at the «DEMA-Sever Medical Center» (Severodvinsk, 2025). At the retrospective stage, based on the medical records of 86 patients with KOA included in the waiting list for TKA, a clinical portrait of this category of patients was formed. At the prospective stage, patients were divided into two groups: the main group (n = 37) received a single intra-articular injection of cross-linked bionic sodium hyaluronate (Flexotron^® Cross, 60 mg/3 ml) in combination with basic therapy (SYSADOA, aceclofenac 100 mg on demand), the comparison group (n = 40) received only basic therapy. Assessment of patients’ condition using VAS, WOMAC index, SF-36 questionnaire, measuring pain-free walking distance and NSAID consumption were carried out at 7 control points (weeks 0, 4, 8, 12, 16, 20 and 24).

Results. In the main group, by the 24th week of observation, the median pain according to VAS decreased by 53.7% from 67.0 [59.5; 76.0] to 30.0 [24.5; 39.0] mm (p < 0.001), with a significant superiority over the comparison group starting from the 8th week (p < 0.001). The total WOMAC index decreased by 47.4% from 73.0 [63.5; 84.0] to 38.0 [31.0; 47.5] points (p < 0.001). NSAID consumption (aceclofenac) significantly decreased already from the 4th week of observation (p < 0.05): from 6.0 [5.0; 7.0] to 2.0 [1.0; 2.0] doses per week. In the comparison group, changes in VAS and WOMAC scores were minimal (-12.6 and -10.9%, respectively). Adverse events in the main group were reported in 8.1% of patients, all of which were mild and transient.

Conclusion. In the presented study, a single intra-articular injection of cross-linked bionic sodium hyaluronate (Flexotron^® Cross) provided a clinically and statistically significant reduction in pain, improved functional status in patients with KOA over 24 weeks of observation, significantly reduced NSAID consumption, and was characterized by a favorable safety profile. It gives grounds to consider viscosupplementation with a bionic cross-link hyaluronic acid as a justified component of patient management during the period of awaiting TKA.

Relevance of the problem of acute rhinosinusitis (ARS) requires constant introduction of new diagnostic technologies and medications into everyday clinical practice. Thus, in diagnostics of such kind of pathology the olfactometry methodic is advisable, and herbal remedies should be used more widely in its treatment. Among the medications in this group, ORVIS Rhino and Sinupret, which contain identical active phytocomponents, are introduced at the Russian pharmaceutical market. However, a comparative evaluation of these drugs has not previously been performed.

The aim: to compare the efficacy of ORVIS Rhino and Sinupret medicines in the treatment of patients with ARS.

Material and methods. 70 patients with ARS (36 female and 34 male individuals) aged 18 to 60 years were treated. They were randomized into two equal groups: the first group received ORVIS Rhino in addition to standard ARS therapy, while the other group received Sinupret. Treatment outcomes were assessed using visual analog scale scores, endoscopic examination of the nasal cavity and olfactory cleft, Olfactory Threshold Test and olfactory index values.

Results. After 7 days of treatment, no statistically significant differences were found between the groups for any of the five assessed parameters. Significance levels for all statistical tests ranged from 0.277 to 1.000, significantly exceeding the generally accepted significance level of 0.05. Effect sizes were extremely small (close to zero), indicating the clinical insignificance of any observed differences in means or ranks. Interpretation of effect sizes using probability estimates revealed that the obtained P values were very close to 0.5 (range, 0.485 to 0.570), indicating that any observed differences between the two study groups had a random character.

Conclusion. Herbal remedies ORVIS Rino and Sinupret demonstrated statistically indistinguishable efficacy when added to standard ARS therapy. Obtained results confirm the therapeutic equivalence of the studied medicines, which is reflected in the List of Interchangeable Medicinal Products for Medical Use of the Ministry of Healthcare of Russia, allowing ORVIS Rino to be recommended for ARS treatment.