Vol 9, No 6 (2023)

Incidence of primary premature ovarian insufficiency (POI) is 1% among females under the age of 40 years and 0,1% – up to 30 years, while the incidence of secondary POI in these age groups varies greatly. Cardiovascular disease (CVD) is the leading cause of death in patients with POI.

The aim was to estimate the 10-year risk of CVD calculated using the FRS and SCORE2 scales and the risk of death using the SCORE scale in patients with POI compared with a control group of healthy women.

Material and methods. The study included 399 women: 133 with primary POI, 133 with secondary POI and 133 without POI (control). The 10-year risk of CVD was assessed using the FRS and SCORE2 rating scales, and the risk of fatal complications was assessed using the SCORE scale. In determining the risk using the SCORE2 and SCORE scale, patients with CHD and diabetes mellitus were excluded from the calculation as high risk. All groups were comparable in terms of sex, age and BMI.

Results. The 10-year risk of developing CVD, both on the FRS scale and SCORE2, was statistically significantly increased in POI females comparatively with the control group. In female patients with primary POI, it was 15,1% (95% CI: 4–25,5%) on FRS and 9,4% (95% CI: 6–14%) on SCORE2 (p <0,05). In patients with secondary POI, the similar rates were 13,3% (95% CI: 3,5–25,5%) and 7,6% (95% CI:4–14%) (p <0,05). In the control group, the corresponding values were 7,2% (95% CI: 3–22,4%; p <0,05) for FRS and 5,1% (95% CI:3–14%) for SCORE2. The risk of death calculated using the SCORE scale did not differ statistically significantly in the study groups.

Conclusion. Females with POI, regardless of its etiology, had a higher burden of CVD (45 and 20% in groups with primary and secondary POI) and 10-year cardiovascular risk calculated using the FRS and SCORE2 scales. The risk of developing fatal cardiovascular events over the next 10 years, as determined by SCORE, did not statistically significantly differ between patients with various forms of POI and healthy females.

The concept of studying the quality of life (QoL) in medicine makes a significant contribution to ensuring the implementation of the principles and approaches of patient-centered medicine.

The aim: to study the possibilities of a patient-oriented approach in determining a treatment strategy, taking into account the QoL of the patient.

Material and methods. The population sample included 1648 persons living in the Ulyanovsk region, aged 16 to 93: 708 male (43,0%) and 940 female patients (57,0%). Urban population of the region consisted 56,2% in the sample, rural population – 43,7%. Average age of all surveyed was 42,5±18,2 years. The study used a standardized SF-36 questionnaire in accordance with the requirements of the International assessment of life quality (IQOLA) project. Data collection was carried out by direct questioning of surveyed persons.

Results. Representative sample of the SF-36 questionnaire is represented by QoL norms in the range from 54,4 (according to the scale of vital activity) to 73,0 (according to the scale of physical functioning) points. When comparing QoL indexes among the surveyed from urban and rural areas, statistically significant differences were obtained for 5 from 8 scales of the questionnaire (p <0,05). Thus, the parameters of the quality of life of urban population significantly exceeded those for the rural population, namely, the indexes that characterize physical component of health and the parameters of the scale of role functioning due to the emotional state. Particularly low among rural residents were the parameters of role activity, which is represented by role functioning due to the emotional state (51,7 points), role functioning due to the physical state (48,4 points), as well as indicators of general health (51,3 points).

Conclusion. Applying a patient-oriented approach in medical care-providing practice, it is necessary to be focused at QoL and take into account the peculiarities of patients’ residence place.

Sarcoidosis is a multi-organ granulomatosis of unknown origin. Diagnosis and treatment of this disease have not been unified for a long time. In 2022, many authors from three scientific medical communities presented federal clinical guidelines on sarcoidosis, which were approved by the Ministry of Healthcare of Russia in the same year. Current article contains the most important practical aspects of this disease, which include the absence of specific markers, need to compare radiation, clinical, morphological and functional data, the presence of variants of clinical course of sarcoidosis without respiratory damage. It is extremely important for physicians to know and understand when and how to start treatment of sarcoidosis, how to manage patients, avoiding early prescription of hormones and cytostatics and responding in a timely manner to the progression of the disease and the development of life-threatening conditions.

Benign metastatic leiomyoma (BML) of lungs is an extremely rare disease characterized by the growth of histologically benign uterine leiomyoma in lung tissue. Most often, this disease does not manifest itself clinically, which makes it difficult for its timely diagnosis and treatment. Usually pulmonary BML is detected incidentally during computer tomography of chest organs (CT of the chest) and, due to the lack of specific morphology, requires differential diagnosis with other pulmonary diseases, which also appear on chest CT with focal rounded formations (lyfangioleiomyomatosis, thoracic endometriosis, metastatic lung disease, etc.). Benign metastases of uterine leiomyoma in the lungs are usually found in female patients of reproductive age and, according to some studies, are estrogen-dependent, which in turn determines the tactics of their treatment. The diagnosis of pulmonary BML is confirmed by immunohistological analysis.

The article presents a description of idiopathic pulmonary arterial hypertension (IPAH) autopsy observation. The diagnosis was made in a 51-year-old patient four years ago and based on the results of an invasive measurement of mean pulmonary artery pressure during right heart catheterization, the index of which was 36 mmHg. During dynamic observation, according to echocardiography, the values of systolic pressure in the pulmonary artery ranged from 66 to 107 mm Hg. Observed patient received treatment with macitentan and spironolactone for 4 years, died with symptoms of pulmonary heart disease. At autopsy, idiopathic plexiform arteriopathy was diagnosed in combination with Heth–Edwards class 4–5 thrombotic arteriopathy with right ventricular failure development.

Hypocalcemia and associated symptoms are common manifestations of postoperative hypoparathyroidism clinical picture. Meanwhile, there are not so many patients with hypocalcemia occurring due to primary hypoparathyroidism, manifested by heart failure (HF). Current article describes a clinical case of a 45-year-old female patient with primary hypoparathyroidism and uncontrolled hypocalcemia, in whom acute HF was developed, and was accompanied by a significant decrease in the left ventricular ejection fraction and heart cavities dilatation. After normalization of the calcium level in the blood serum, the clinical symptoms of HF regressed, cardiac function normalized. That rare case has shown the key role of calcium in maintaining cardiac function in such kind of patients, as well as the critical importance of abolition the reversible causes of HF.

The article examines a clinical case of hereditary gout in a young woman with intolerance to allopurinol and the development of joint deformities, which caused a severe course with disability. A feature of this case is the atypical clinical picture of polyarthritis in the onset with the involvement of large and small joints in a young woman. The dynamics of the development of the patient’s pathological condition is presented, demonstrating the complexity of the treatment of this disease. The administration of febuxostat made it possible to reduce the level of hyperuricemia; however, by this time the patient was disabled due to the formation of multiple deformities of large and small joints of the upper and lower extremities.

Aging biology is currently experiencing a crisis, connected with the fact that modern theories of aging absolutize only some of its manifestations, ignoring its multifactorial character, and try to describe the consequences of aging, rather than its causes. These approaches do not bring researchers any closer to systemic understanding of the problem.

Purpose: to give a theoretical analysis of the underlying mechanisms of aging and show the links between the processes of aging at micro- and macrolevels in the evolutionary development of man and living matter as a whole.

Material and methods. The study of the causes of aging was carried out by analyzing our own long-term observations and literature data.

Results. It was shown that aging is based on the mechanisms of system analysis of information gathered by the organism from external sources, archiving of the most essential information blocks in the structure of proteins and other organic molecules with the following transfer of these blocks to the biosphere as the elements of qualitative transformation of living matter. The biosphere is a «melting pot» in which obsolete structures of living matter are continually decomposed and new structures with higher functional capacities are reconstructed from their fragments. At present the evolutionary development of living matter is focused on the intellectual sphere. By improving the structure of human brain, evolution solves its main task - the development of the intellectual component of living matter.

Conclusion. Aging is one of the most important systemic factors in the evolutionary development of living matter.

Pulmonary hypertension (PH) is a hemodynamic and pathophysiological condition characterized by an increase in mean pulmonary artery pressure of ≥20 mmHg. at rest, measured during right heart compartment catheterization. All over the world, 5 main groups of PH are fundamentally distinguished. The most studied in terms of selecting the optimal pathogenetic therapy is idiopathic pulmonary arterial hypertension (IPAH), which belongs to the 1st group according to the 2018 PH classification. The key point in the pathogenesis of PH is the imbalance of the main vasodilating (for example, nitric oxide, prostacyclin) and vasoconstrictor substances (endothelin-1, thromboxane A2, serotonin) with predominance of the latter. Taking into account the complexity of pathogenesis, patients with pulmonary arterial hypertension require a multifaceted, holistic, and interdisciplinary approach. Current article is devoted to the review of medicamentous remedies for the treatment of PH, as well as the strategy for their prescription.

The aim of the study was to research the efficacy, safety and tolerability of the specialized food product for dietary therapeutic and dietary preventive nutrition «Drink for detoxification LEOVIT» in the complex therapy of patients with diseases of the bronchopulmonary system, as well as to optimize ways to correct micronutrient deficiency. To assess clinical efficacy, safety and tolerability, the product was administered to patients with bronchopulmonary diseases (occupational bronchial asthma, COPD) in a 15-day course, 1 time per day during or after meals. To conduct research, two randomized groups of patients with diseases of the bronchopulmonary system were formed. The study have established that a specialized medical product improves the quality of life, which is manifested in a decrease in the frequency of asthma attacks, sneezing and coughing, as well as in improving mood and increasing vitality, reducing fatigue, normalizing sleep. The therapeutic product has pronounced anti-inflammatory properties, reduces the concentration of CRP by more than 22% and leukocyte markers of intoxication, in particular the Kalfa–Kalif index by 36,3%, the Ostrovsky index by 38,23%, the Krebs index by 41,6%, the PLR index by 30,7%. A 15-day intake of a dietary product reduces lipid and glucose toxicity, reducing cholesterol by 10,8%, low-density lipoprotein by 5,2%, triglycerides by 10% and glucose by 9,5%, reduces the level of total and indirect bilirubin. The authors recommend a specialized therapeutic product for inclusion in the complex therapy of patients with bronchopulmonary diseases to reduce body intoxication and increase the effectiveness of the therapy used.