Vol 7, No 6 (2021)

The aim of the study was to assess the correlation between the levels of FGF-23, Klotho, and serum troponin I (a classic biomarker of cardiac muscle damage) and clinical signs of cardiac and vascular remodeling. Material and methods. 130 patients with chronic kidney disease (CKD) stages 2-5D without cardiovascular disease (CVD) clinical manifestations were icluded in the study. In all participants were measured serum levels of FGF-23, Klotho and troponin I (sTr-I), also echocardiography and sphygmography were performed. Results. FGF-23 level correlated with sTr-I (r=0,512; p <0,01), presence of eccentric left ventricular hypertrophy (LVH; r=0,545; p <0,01), LV diastolic dysfunction (r=0,448; p <0,05), indicators of subendocardial blood flow (r=-0,469; p <0,05). At the same time, there was fixed no difference in the level of FGF-23 in patients with normal and high central (aortic) arterial pressure (CAP). Klotho's protein level correlated with concentric LVH (r=-0,463; p <0,01), LV diastolic dysfunction (r=-0,612; p <0,05), pulse wave velocity (PWV; r=-0,667; p <0,001 ), with indexes for estimation the cardiac structures calcification (ECSS; r =-0,581; p <0,01). Multivariate analysis revealed a positive independent association of FGF-23 with eccentric LVH (OR=1,056; 95% C1: 1,006-1,109; p=0,027). Protein Klotho acted as a negative determinant for concentric LVH (OR=0,988; 95% CI: 0,984-0,992; p=0,001), PWV (OR=0,984; 95% CI: 0,977-0,991; p <0,001) and ECSC (OR=0,991; 95% CI: 0,988-0,995; p <0,001). In addition, multivariate analysis showed a correlation between the Klotho protein level (OR=0,980; 95% CI: 0,964-0,996; p=0,016), FGF-23 (OR=3,145; 95% CI: 1,020-9,695; p=0,046) and sTr-I in blood serum. Conclusion. In patients with CKD stages 2-5D without clinical CVD manifestations, an increased serum FGF-23 level and a decreased level of serum Klotho protein are associated with a high risk of cardiovascular diseases development: FGF-23 level - with eccentric LVH (regardless of CAP), Klotho protein level - with concentric LVH, increased PWV and ECSC. Moderately elevated sTr-I level may be the first manifestation of FGF-23/Klotho protein factors imbalance in CKD.

The aim of the study was to estimate the dynamics of liver fibrosis in chronic hepatitis B (CHB) patients during nucleos(t)ides analogues (AN) therapy. Material and methods. The study included 101 patient with CHB (males - 80%, median age 39 years) who received AN therapy for s3 years (maximum 9 years) from 2008 to 2017. Liver density was estimated by transient fibroelastometry use before and during therapy. The severity of fibrosis was assessed using the METAVIR scale. In the course of treatment, the frequency of the virological response (DNA of the hepatitis B virus <150 lU/ml), normalization of ALT and AST activity, the degree of decrease of liver tissue density (according to the data of transient liver elastometry) were determined. The patients were divided into 2 groups: with a significant liver density decrease (s20%) and without a significant decrease of that index (<20%). Independent factors associated with the absence of a significant liver density decrease were identified by means of binary logistic regression. Results. In 98% of patients, a decrease in liver density was observed in average from 8,2 (7,4-10,1) to 6,7 (6,0-7,8) kPa (p <0,0001). The median of liver density decrease consisted 1,4 (1,1-2,2) kPa, or 17.5% (12,3-24,3). In more than half of the cases (57%), there was fixed a decrease in the severity of fibrosis by 1 or more points according to METAVIR scale. Liver density decrease was observed in all patients with initial liver cirrhosis (in 3 patients - a decrease of fibrosis stage according to METAVIR scale). During the study, the proportion of patients with fibrosis sF2 according to METAVIR decreased from 48% to 14% (p <0,0001). Patients who achieved a virologic response showed a greater decrease in liver density than patients who did not achieve this response (median: -1,4 and 1,0, respectively; p=0,023). Patients with a significant decrease in liver density (s20%) initially had higher ALT activity and liver tissue density, and less often there was a development of resistance to therapy and virological breakthrough. A high initial index of liver tissue density (RR=1,96; 95% CI: 1,38-2,78; p <0,0001) came to be an independent predictor of a pronounced decrease in liver density during AN therapy. Conclusion. Long-term treatment with AN leads to a decrease in liver fibrosis in most CHB patients, including those with liver cirrhosis.

The aim of the study is to validate the cytokine storm scale (CSS) in a cohort of patients with COVID-19-associated pneumonia to confirm its diagnostic and informative value. Material and methods. The study included 48 patients with COVID-19-associated pneumonia who were admitted to hospital for treatment, and 73 intensive care unit (ICU) patients. The levels of interleukin 6 (IL-6), interleukin 8 (IL-8), interleukin 18 (IL-18), interleukin 10 (IL-10) and procalcitonin (PCT) were measured using enzyme immunoassay, and CSS was calculated. For each biomarker, grade marks were calculated in the range from 1 to 3: at the border concentration of the studied index, 1 grade mark was awarded, with an average - 2, with a high - 3 (normal values were corresponded to 0 marks). A CSS score of more than 6 was associated with a high risk of adverse COVID-19 outcome. Results. When assessing the informativeness of CSS indexes concerning mortality prediction, it was found that it had high sensitivity (78,79%; 95% CI: 0,61-0,91) and specificity (81,12%; 95% CI: 71,2488,80). Also CSS positively and statistically significantly correlated with the NEWS2 scale (0,58; 95% CI: 0,35-0,75), degree of pulmonary damage according to computer tomography data (0,46; 95% CI: 0,20-0,67 ) and the percentage of pulmonary tissue damage (0,38; 95% CI: 0,01-0,61). Conclusion. The developed CSS has a sufficiently high predictive information value in relation to the risk of an unfavorable prognosis of COVID-19 clinical course. The combined prognostic capabilities of the cytokines IL-6, IL-18, IL-10 and PCT, integrated into a single index, make it more likely to identify patients of high risk of death in case of COVID-19-associated pneumonia.

Objective: to identify the features of apoptosis in patients with chronic obstructive pulmonary disease complicated by acute myocardial infarction, depending on the duration of ischemia. Material and methods. 65 patients with myocardial infarction were examined: 37 patients with chronic obstructive pulmonary disease and 28 patients without pulmonary pathology. Levels of annexin V, heat shock protein 70 (HSP70), and neopterin were determined. Results and conclusion. It was found that the duration of ischemia is directly proportional to the level of apoptosis of circulating lymphocytes with the appearance of necrotic cells. Various intercellular interactions are involved in apoptotic cell death in myocardial infarction, which significantly contribute to myocardial damage. It can affect the subsequent processes of left ventricular remodeling.

ANCA-associated vasculites (AAV) refer to systemic autoimmune diseases that are characterized by necrotizing, low-immune inflammation of the walls of predominantly small vessels and the circulation of antibodies to the cytoplasm of neutrophils aimed against myeloperoxidase or proteinase-3. The most common target organs that determine the severity of the disease and the patient's prognosis are lungs and kidneys. Published in recent years research works allow us to revise the traditional ideas about the optimal AAV treatment approaches. Among the main tendencies one can mark a decrease in the volume and duration of induction therapy with glucocorticosteroids and cytostatics, as well as the possibility of adjusting therapy schemes based on the severity of the course of the disease and the serological profile of the patient. The article presents the modern principles of AAV therapy based on the clinical guidelines of the European Society of Rheumatology and the European Association of Nephrology.

Effective treatment of chronic heart failure (CHF), with a focus on reducing mortality and improving the quality of life of patients is an urgent public health problem. Sodium-glucose cotransporter-2 inhibitors are currently one of the most interesting and studied classes of drugs that demonstrate an improved prognosis in patients with cardiovascular diseases in diabetic and nondiabetic populations. The article describes in detail the known mechanisms of cardioprotective and nephroprotective effects of this class of drugs. A detailed review of studies published in recent years on the study of dapagliflozin on cardiovascular and renal outcomes in patients with diabetes mellitus is presented. Particular attention is paid to the analysis of the DAPA-HF study, which proved the effectiveness of using dapagliflozin in addition to standard therapy in patients with CHF with reduced ejection fraction.

Non-compact right ventricular myocardium is a rare type of cardiomyopathy, it usually results from arrested myocardial development during embryogenesis. This diseasecan be characterized by excessive prominent trabeculations and deep inter-trabecular recesses in the ventricular wall. It might be a component of biventricular non-compact cardiomyopathy or an isolated form. Here we report on a case of 40-year-old male patient with isolated NMRv with a cardioembolic events.

Polymyositis is a multifactorial chronic autoimmune disease with characteristic skin changes and damage to various organs and systems, including muscles, blood vessels, joints, esophagus and lungs. Most often, the disease is in the age group over 40 years old. The clinical picture of polymyositis is characterized by progressive muscle weakness, dysphagia, voice changes, paraorbital edema, and the formation of flexor tendon-muscle contractures. Pharmacotherapy is based on the use of high doses of glucocorticosteroids in combination with immunosuppressive drugs. This article provides detailed description of a clinical case of newly diagnosed polymyositis in a 58-year-old man.

Primary hyperparathyroidism (PHPT) is the third most common endocrine disorder. The manifest form still prevails in Russia; its classic clinical presentation involves bone, kidney, and gastrointestinal disturbance. Calcific pancreatitis associated with diabetes is a rare PHPT presentation. The case demonstrates the late diagnosis of PHPT, against the background of long-term unrecognized classic manifestations of PHPT, that included fibrocystic osteitis, as well as a nonclassical manifestation - calcific pancreatitis, that led to diabetes mellitus. Being undiagnosed and untreated for a long time, the disease developed severe complications both in a patient (fibrocystic osteitis, preterm labor, calcific pancreatitis, diabetes mellitus) and in a newborn (hypocalcemic seizures). After a parathyroidectomy was performed, the partial regression of bone changes was observed. Despite chronic calcific pancreatitis associated with diabetes being a rare manifestation of primary hyperparathyroidism, clinical symptoms of PHPT, and a history of chronic pancreatitis with repeated episodes of acute pancreatitis, should keep a high index of suspicion for hypercalcemia as a cause of pancreas damage.

Heart failure provokes the progression of many diseases, and in recent years its contribution to the global «burden» of diseases associated with a poor prognosis has been confirmed, which requires the search for effective, from the point of view of evidence-based medicine, drug therapy. In 2015, the FDA approved for use a combination drug containing an antagonist of neprilisin and angiotensin II type 1 receptors - sacubitril/valsartan for the treatment of patients with chronic heart failure II-IV functional class and low left ventricular ejection fraction. This decision was based on the results of the PARADIGM-HF study, which confirmed the higher efficacy of sacubitril/valsartan in reducing mortality when compared with enalapril. Currently, a number of major studies are being carried out evaluating the effects of sacubitril / valsartan in patients with different heart failure phenotypes, which is reflected in this article. The advantages and disadvantages of this drug are discussed, as well as the priority group of patients with heart failure who are sensitive to the effects of sacubitril/valsartan.