Vol 8, No 8 (2022)

Type 2 diabetes mellitus (DM 2) is one of the significant risk factors for the development of cardiorenal pathology. Objective: to study the prevalence of atherosclerotic CVD (ASCVD), CKD, CHF in patients with different duration of DM 2 hospitalized for inpatient treatment, and to identify predictors of their early development and progression. Material and methods. The study included 1150 patients with DM 2 (483 males and 667 females) hospitalized in V.P. Demikhov City Clinical Hospital in the period 2020-2021. All patients underwent standard clinical, laboratory and instrumental examinations, as well as therapy correction. To assess the role of DM in the development of cardiorenal pathology, all patients were stratified into two groups according to the duration of the disease: group 1 included patients with DM 2 <5 years, group 2 included patients with DM 2 >10 years. Results. The mean age of the patients was 65 [57; 74] years, median BMI was 31,2 [26,3; 35,8] kg/m2. The mean HbA1c was 9,6 [7,9; 10,9] %, 88,6% of patients had HbA1c >7%. The median fasting blood glucose was 7,6 [6,4; 9,2] mmol/l, postprandial glucose 11,4 [9,7; 14] mmol/l. Dyslipidemia was recorded in 69,8% of study participants. Of the total number of patients with DM 2 87,6% had hypertension, 56% CHF (43,91% CHF with preserved EF, 12,09% CHF with moderately or reduced EF), 49,9% ASCVD (MI 24,7%, stroke 18,9%, diseases of the arteries of the lower extremities -17%, angina pectoris 6%). The most significant predictors of ASCVD, CKD, and CHF were age >60 years, duration of DM, hypertension and CKD. The male gender was associated with an increased chance of developing ASCVD, while the female gender was associated with CHF and CKD. Conclusion. Among the studied patients, there was a high incidence of ASCVD, CHF and CKD, regardless of the duration of DM. There was a high prevalence of the main risk factors for CVD: high levels of HbA1c, hypertension, obesity and dyslipidemia. Based on the analysis, risk factors associated with complications from the cardiovascular and renal systems in this cohort of patients were established.

Currently, indicators of central aortic pressure (CAP) in patients with a combination of arterial hypertension (AH) and atherosclerosis of the arteries of the lower extremities (AALE) of varying severity remain insufficiently studied. Objective: estimation of the main parameters of CAP in patients with AH and AALE. Material and methods. 120 patients with AH were divided into 3 groups: group 1 46 patients with clinically manifested AALE; group 2 39 patients with asymptomatic AALE; group 3 35 patients with AH without AALE. All patients underwent general clinical laboratory and instrumental research methods, including 24-hour blood pressure monitoring (24h-BPM) with the determination of CAP indicators, USTS of the arteries of the lower extremities. Results. Higher average daily values of central systolic blood pressure (cSBP) were found in patients of the 2nd group compared to the 3rd (p=0,04). Patients of the 1st group showed lower average daily and daily values of central diastolic blood pressure (cDBP) compared with the 2nd group (p<0,05), as well as higher values of the average daily and daily cDBP in patients of the 2nd group in compared with the 3rd group (p=0,02). Higher values of central pulse BP (cPBP) were established in patients of the 1st group compared with the 2nd and 3rd groups (p <0,05). The indicators of the central augmentation index (AIXao) in patients of the 1st group (38 [29; 45] %) were significantly higher than in patients of the 2nd (30 [23; 38] %) and 3rd (30 [21; 32] %) groups (p <0,05). Higher AIXao values were found in patients with critical lower limb ischemia (39 [29; 46] %) compared to patients with asymptomatic AALE (30 [23; 38] %, p=0,014). The dependence of AIXao on the degree of stenosis (%) of the arteries of the lower extremities in patients with AH and AALE of varying severity was found (r=0,319, p=0,003). Conclusion. Statistically significantly higher values of cPBD, AIXao and lower values of cDBP in patients with AH and manifested AALE indicate a more pronounced violation of the elastic properties of the main arteries. The data obtained make it possible to judge a greater LV afterload and a decrease in coronary perfusion against the background of a decrease in LV diastolic filling in patients of this group. The dependence of aortic stiffness on the degree of stenosis of the arteries of the lower extremities was revealed.

Malignant tumor is regarded to be an independent high risk factor for venous thromboembolic complications (VTEC) development. Currently, there is no consensus on VTEC predictors in patients with malignant neoplasms (MN), which makes it difficult to determine the timing of preventive measures starting. In this regard, it seems valuable to be able to identify the most significant risk factors for VTEC in oncologic patients. The aim of the study is to examine high-risk factors of VTEC development among malignant neoplasms patients using modern biomarkers. Material and methods. A comparative analysis of the level of the cell adhesion marker P-selectin was carried out in 122 patients with pulmonary embolism (PE) having also malignant neoplasms who were hospitalized at Republican Cardiological Dispensary of the Ministry of Healthcare of the Chuvash Republic, and 89 outpatients with malignant neoplasms without PE at the basis of Republican Clinical Oncological Dispensary of the Ministry of Healthcare of Chuvash Republic. Results. The leading risk factors for VTEC in patients with malignant neoplasms were: age over 57 years, a history of thromboembolic events, concomitant cardiac arrhythmias, localization of the oncological process (colorectal cancer, pancreatic cancer, combined cancers), size of the tumor 55 process, the presence of regional and distant metastases, early onset of the disease (the first 3 months from the diagnosis of malignant neoplasm), fibrinogen levels >2,6 g/l, CRP >16,9 mg/l, hemoglobin <110 g/l, D-dimer >2,0 pg/ml, P-selectin >375,0 ng/ml. Conclusion. Early detection of established risk factors for VTEC in malignant neoplasms patients will allow initiating primary VTEC prevention at the outpatient stage (prescription of oral anticoagulants). In patients with an intermediate risk of VTEC, when deciding on the appointment of anticoagulant therapy, as a clarifying laboratory method for detecting thrombotic readiness, in addition to determining the concentration of D-dimer in the blood serum, it is advisable to evaluate a new biomarker of cell adhesion P-selectin.

In the last 10 years, the interest to age-related changes in male reproductive system, in particular, androgen deficiency, has been growing. The purpose of this review is to analyze the similarities and differences between the currently available guideline documents on age-related androgen deficiency diagnosis and treatment. The article considers guidelines of the American Urological Association (AUA) from 2018, the British Society for Sexual Medicine (BSSM) 2017, the Canadian Medical Association (CAM) 2015, the Endocrine Society 2018, the Endocrine Society of Australia (ESA) 2016, European Academy of Andrology (EAA) 2020, European Association of Urology (EAU) 2020, International Consensus on Sexual Medicine (ICSM) 2019, International Society for the Study of Male Aging (ISSAM) 2021, American College of Physicians (aCp) 2020, Russian Association of Endocrinologists (RAE) 2021.

During the pandemic, the number of cases of pseudomembranous colitis in patients infected with SARS-CoV-2 increased significantly. The article presents a clinical case of pseudomembranous colitis in a 68-year-old female patient during hospitalization for COVID-19. The peculiarity of this case is the dominance of encephalopathy manifestations in common clinical picture, in connection with which the patient was urgently hospitalized in the neurological department with acute cerebrovascular accident referral diagnosis. The development of severe encephalopathy in patients with pseudomembranous colitis is taking place due to a direct toxic effect at the central nervous system of enterotoxin TcdB Clostridium difficile. Pleural effusion and ascites were other main clinical manifestations of pseudomembranous colitis in current clinical observation.

Currently, more and more research works are devoted to dietary fiber (DF) and its effect on the body of healthy people and patients with various diseases. The effectiveness of DF has been shown not only in terms of correcting existing disorders, but also in preventing such diseases as, for example, type 2 diabetes mellitus, one of the pathogenetic factors of which is an intestinal microbiota imbalance. DFs are known to serve as an energy substrate for the intestinal microbiota and as a factor regulating its metabolism. However, due to the poor tolerability of DFs by many patients, recommendations for their use are not adequately implemented as it should be. In addition, some sources of DF are difficult to access or do not meet the financial capabilities of the population. Performing studies on the influence of this group of substances at carbohydrate metabolism can help create more accurate recommendations concerning amount and type of Df used in a given situation, as well as increase the patients' interest in their use.

Despite the fact that the number of new cases of SARS-CoV-2 infection has significantly decreased recently, the clinical manifestations of the consequences of the infection and, above all, the pain syndrome, remain an urgent problem for practitioners. The purpose of an open observational study was to analyze the efficacy and tolerability of Alflutop in the treatment of dorsopathies of the lumbosacral localization (DLL) in patients with post-COVID syndrome (PCS). Material and methods. The study included 75 patients with DLL and PCS who received Alflutop 2 ml every other day 10 injections. The values of VAS pain, LANSS, digital pressor algometry, Post-COVID-19 Functional Status (PCFS) questionnaire were analyzed. The total duration of follow-up was 3 months and 20 days. Results. The severity of the pain syndrome changed significantly after 1 month and 20 days (42,3±8,4 vs 33,1±7,0 mm, p <0,05), and following the end of observation it decreased to the level of «insignificant» (15,1 ±8,8 mm, p <0,05). LANSS questionnaire: significant decrease after 3 months and 20 days (14,6±2,3 vs 9,4± 1,8 points). We registered a significant increase in the local pain threshold after 1 month and 20 days (4,56±1,3 kg/cm2), the maximum after the study completion 5,46±1,8 kg/cm2. The suprasegmental pain threshold changed significantly in relation to the initial value only at the finцэl visit 6,08±1,9 kg/cm2. At the end of therapy, there was a significant improvement in the functional status of the examined category of patients (PCFS: 3,0±0,4 vs 1,9±0,8 points). Conclusions. The use of Alflutop in patients with DLL and PCS can reduce the severity of pain and improve the functional status of patients in a short time from the start of therapy.

Quality medical care performing for COVID-19 patients is possible only on the basis of a multidisciplinary approach. Estimation of the nutritional status, and, if necessary, its correction is an important component of comprehensive treatment and rehabilitation programs for such type of patients. Older age, polymorbidity, sarcopenia, and malnutrition are risk factors for the adverse course of COVID-19 infection. Correction of nutritional status disorders in COVID-19 patients should be carried out at all stages of treatment. The importance of the problem of nutritional support is reflected in many publications concerning the treatment of COVID-19 patients. Use of specialized dietary therapeutic food products in most cases makes it possible to meet the needs of patients in necessary nutrients, reduce the severity of sarcopenia and increase the effectiveness of rehabilitation measures.