Vol 34, No 3 (2023)

Diseases of the circulatory system are the main cause of death in the working-age population. The study of the incidence of diseases of the circulatory system of the population of working age in the Russian Federation at the regional level is an urgent task, which is hampered by the lack of statistical information on the incidence of this age group of the population.

Objective. To study regional features and dynamics of incidence rates of diseases of the circulatory system in the working-age population of the Central Federal District in 2014–2020.

Materials and methods. We conducted a continuous retrospective study based on statistics on disease incidence in the population of the Russian Federation published by the Russian Ministry of Health and the Central Research Institute of Health Care Organization and Informatization. We estimated incidence and prevalence rates of diseases of the circulatory system, including ischemic heart diseases, in the working-age population in 2014–2020 and calculated their long-term averages, standard deviations (σ) and the coefficient of variation (Сv). The Shapiro-Wilk test was used to check if the continuous variables followed a normal distribution, and the Mann-Whitney test was used to assess the differences between the rates observed in the constituent entities of Russia.

Results. For the first time, incidence and prevalence rates of diseases of the circulatory system, including ischemic heart diseases, were analyzed in the adult population of working age in the subjects of the Central Federal District. In most parts of the District, we observed an increase in the incidence rates and their statistically significant differences from similar all-Russian indicators for 2014–2019. Changes in the incidence during the spread of the novel coronavirus disease (COVID-19) within the District were multidirectional. Yet, in most regions of the District, we established a statistical difference between the analyzed indicators for the years 2014–2019 and 2020.

Conclusion. Incidence and prevalence rates of diseases of the circulatory system, including the ischemic heart disease, in the adult population of working age in the subjects of the Central Federal District are characterized by pronounced regional features, thus prioritizing further epidemiological studies aimed at establishing their causes and risk factors.

The paper presents the evolution of a surgical collapse approach to treating advanced pulmonary tuberculosis in circumstances where the causative agent shows a higher drug resistance and where the possibility of performing resection operations and pneumonectomies is limited. The authors show the historical aspects of development from thoracoplastic surgery to extrapleural pneumolysis, by filling the extrapleural space. They also depict stages in searchiing for effective biocompatible filling materials that provide a stable collapse of the lung tissue containing cavities and bullous deformity.

The paper shows the experience with extrapleural pneumolysis via silicone implant filling, which demonstrates reliability, high efficiency and cosmetic advantage over thoracoplasty. The beneficial effect of extrapleural pneumolysis with silicone filling with silicone on respiratory function and pulmonary microcirculation was studied.

Today, experience continues to accumulate in the use of extrapleural pneumolysis with silicone filling in the staged surgical treatment of advanced tuberculosis in combination with lung resections of various sizes and pneumonectomy, which considerably expands the boundaries of operability in patients with a decrease in functional indicators that have been previously considered hopeless.

The prospects of the described method to treat this complex patient category necessitates further development of a wide range of issues, including the clarification of indications depending on the localization of the process and the degree of a respiratory function decrease, the improvement of equipment, the features of hospital management of the patients who have undergone surgery and their postoperative rehabilitation.

Endothelial dysfunction (ED) is a pathological condition that is impairment in the synthesis of endothelial factors and is a major component in the pathogenesis of many diseases, including those of a therapeutic profile. Many specialists now consider ED as a universal component in the development of cardiovascular and respiratory diseases. The paper contains information about the main functions of the endothelium and their impact on the organs and systems of the body, the state of microhemocirculation, and the entire internal environment. It also considers ED that affects vasomotor, hemostatic, adhesive, and angiogenic functions and the main markers of endothelial damage. The possibilities of preventive measures and pharmacological correction of ED are discussed.

Objective. To investigate the impact of therapy with Mildronate^® on the state of cerebral hemodynamics, on vascular wall remodeling and endothelial dysfunction in women with hypertension and estradiol deficiency.

Subjects and methods. The investigation enrolled 37 patients (mean age, 43.0±3.5 years) with Stage I–II hypertension, reduced estradiol and elevated follicle-stimulating hormone (FSH) levels, who formed a study group. The patients in this group received Mildronate^® in addition to standard therapy. A control group consisted of 38 healthy women (mean age 43.5±3.4 years) without chronic diseases affecting intracardiac and cerebral hemodynamics. Complete medical histories were taken from all the patients who underwent a mandatory laboratory test (including estradiol and FSH levels), ECG, and duplex scanning of the great cerebral arteries.

Results. The features of vascular bed remodeling, the state of cerebral hemodynamics, and endothelial dysfunction in the examinees can assume that hypoestrogenemia may be a factor contributing to the progression of hypertension and the development of complications, such as cerebrovascular accidents.

Conclusion. The study results have shown that Mildronate^® is well tolerated by patients and is an effective treatment, showing a positive therapeutic effect on endothelium-dependent vascular relaxation, vascular remodeling, and whole-brain hemodynamics.

Objective. To estimate the frequency of risk factors and the features of the psychosocial status in patients with atherosclerosis of the lower extremity arteries.

Subjects and methods. The investigation prospectively included 198 patients with atherosclerosis of the lower extremity arteries. The patients’ mean age was 67.9±8.0 years. Data copying, questioning, instrumental and analytical methods were used to study the patients’ clinical and anamnestic indicators. The survey was conducted using the SF-36 questionnaire and the SpielbergerKhanin test, Mini-Mental State Examination (MMSE), and Morisky-Green scales. Depending on the stage of ischemia, according to the Pokrovsky-Fontaine classification, the investigators formed two investigation groups: 1) 127 patients with Stage 0–IIA ischemia; 2) 71 patients with Stage IIB-IV ischemia.

Results. There was a male preponderance in both groups: 106 men in Group 1 (p=0.03) and 52 in Group 2 (p=0.026). The number of smokers was statistically significantly higher in Group 2 than in Group 1 (37.0 and 49.0%, respectively; p=0.05). No statistically significant differences in diabetes were found between the groups. Systolic blood pressure was also higher in Group 2 than in Group 1 (136.3±15.3 and 130.7±12.9 mm Hg, respectively; p=0.0015). Analysis of physical (p = 0.00019) and psychosocial (p=0.0415) states revealed lower rates in Group 2.

Conclusion. The findings suggest that Group 2 patients had more severe clinical, physical, and psychosocial conditions, which indicates the need to attract a psychologist for patients with more severe ischemia, as well as that to more carefully monitor hemodynamic parameters and to correct modifiable risk factors in both groups.

Objective. To evaluate the effect of hyperbaric exposure on tooth microcirculation.

Subjects and methods. The investigation enrolled 14 divers who had undergone a dental examination, followed by a study of the microcirculation of intact and carious teeth, by using laser Doppler flowmetry during simulated (pressure chamber) diving at a depth of 30 m (0.4 MPa) and 70 m (0.8 MPa).

Results. In the 30- and 70-m diving groups, the baseline microcirculation of carious teeth were higher than that of intact teeth by 43.5 and 45.2%, respectively (p<0.05). After pressure chamber diving, there was an insignificant decrease in the microcirculation of intact teeth compared to the baseline values. The carious teeth exhibited a significant (p<0.05) reduction in the microcirculation parameters compared to the baseline values: when diving at a depth of 30 m by 0.7 perfusion units (by 21.2%) and at a depth of 70 m by 1.2 perfusion units (by 41.4%).

Conclusion. The results of the study have indicated that the higher gas medium pressure caused a decrease in the microcirculation of carious teeth. The magnitude of the change in microcirculation parameters depends on the depth of the dive. Further study of the microcirculation of the teeth will be able to create informative evaluation criteria to search for effective pharmacological agents for the prevention of barodontalgia in divers.

Obesity is a risk factor for cognitive impairment (CI) that has a significant impact on quality of life in patients.

Objective. To study the frequency and nature of CI in obese patients.

Subjects and methods. The study involved 51 obese patients and 28 healthy normal-weighted volunteers matched for age, gender, and level of education. Cognitive functions were assessed using the MoCa test and the Frontal Assessment Battery (FAB) scale.

Results. The median MoCA scores were 28 (27; 29) in the normal weight group and 25 (25; 27) in obese patients; the differences between the groups were statistically significant (p < 0.05). The median total FAB score in both groups was 18 (17; 18) and had no significant differences (p > 0.05).

Conclusion. The findings may suggest that the carbohydrate metabolism is associated with the risk of CI in obese patients, since obesity is related to a number of metabolic and hemodynamic disorders. The MoCa test proved to be a more sensitive cognitive screening test for mild CI in obese patients. Phytopreparations "Femo-Klim" and "Nervo-Vit" can be recommended for women with estrogen deficiency and obesity, as they contribute to the normalization of estrogen levels and weight loss, as well as contribute to the improvement of cognitive functions and psychological state. The drug "Eromax" is recommended for the correction of obesity and cognitive disorders in men associated with low testosterone levels.

The paper analyzes the data available in the scientific literature on the frequency and manifestations of the neurotoxic effect of amiodarone and statins on the peripheral nervous system. It shows the need for a differential diagnosis with immune-mediated polyneuropathies. The authors provide a rationale for the early identification of the neurotoxicity of the drugs to minimize neurological complications. The paper describes a clinical case of a 72-year-old male patient who received amiodarone and statins and developed demyelinating polyneuropathy. Amiodarone discontinuation led to a significant regression of neurological complaints.